Your Thyroid Isn't the Problem — Your Gut Is | Dr. Cassie Smith

What if your labs look “normal,” but you still feel exhausted? Dr. Cassie Smith joins Dr. Josh Axe to share how her own experience with Graves’ disease shaped her approach to hormone health. They explore the gut-hormone connection, hypothyroidism, PCOS, insulin resistance, and hormone replacement therapy—and discuss what persistent fatigue, thinning hair, and difficulty losing weight may warrant investigating.

Speaker names marked ? are inferred from speaking time and the show’s known hosts — they are not voice-verified.

• 0:00Josh Axe?

  But around 80% of hypothyroidism is Hashimoto's. They literally almost never address the root cause of what's going on in the thyroid.

• 0:09Speaker 01

  It's estimated there could be almost 50 million people in the United States to have hypothyroidism that haven't been treated.

• 0:14Josh Axe?

  Why would taking birth control increase the risk or cause hypothyroidism?

• 0:19Speaker 01

  So we have to remember that birth control is a synthetic hormone. It shuts our brain's ability down to make our own. So it tricks our body.

• 0:27Josh Axe?

  Let's talk about PCOS. Why is it called type three or type four diabetes?

• 0:32Speaker 01

  You know, we learn in school, you have to be overweight. You have to be insulin resistant and you have to be an ovulatory or you have to have irregular cycles. So it was all tied to a high insulin problem. But as of May 2026, it got reclassified as polyendocrine metabolic syndrome because we now know that there are actually seven types of PCOS.

• 1:05Josh Axe?

  I just wanted to say how incredibly grateful I am for each and every one of you who makes this community so special. And as a thank you, I'm going to be giving away over $5,300 in prizes to many of you. I'm talking about a sunlight and sauna, a red light therapy mask, cellular blood work testing, Manukora Manuka honey, an eco hydrogen water flask, a signed copy of my New York Times bestselling book, and more. To enter, subscribe to the Dr. Josh Axe Show on YouTube for 10 bonus entries. Leave us a review on Apple Podcasts or Spotify. I'm excited for many of you to win free prizes.

• 1:46Josh Axe?

  By the way, the only way you can be signed up in these is if you are subscribed to the podcast. The giveaway ends December 14th and we'll announce the winners on December 22nd. Make sure to subscribe and leave a review so you can be entered to win.

• 2:02Josh Axe?

  Today, there are millions of people struggling with hormone issues. Hypothyroidism, PCOS, perimenopause and menopausal symptoms, low testosterone and so much more. And today I've brought on Dr. Cassie Smith. She's a dual board certified endocrinologist. And today we're going to dive in how to heal the root cause of all hormone issues. We'll talk about the top herbs and supplements. We'll talk about root causes connected to gut health. We'll talk about how most of the time when you're treating things like thyroid, you're actually treating the wrong organ to start and you need to start upstream if you truly want to heal and reverse whatever you're dealing with. Hey, I'm so excited to invite Dr. Cassie Smith to the show. Thanks so much for coming on.

• 2:43Speaker 01

  Thanks for having me, Dr. Josh.

• 2:45Josh Axe?

  Well, I was watching some of your videos. You've done a great job of what I've seen is really talking about what are the root causes of hormone issues? I know, in fact, you wrote an entire book on how the gut is deeply connected to hormone issues. And so what I really like to start off with here is, you know, one of the most surprising stats that people are unaware of when we talk about hypothyroidism, and I know we're going to get into a lot of other hormone issues today, but around 80% of hypothyroidism is Hashimoto's thyroiditis. There's an autoimmune component. So why is it that people go into their doctor today and their doctors tend to run just, hey, TSH, put their patients on levithyroxine, so T4. And they literally almost never address the root cause of what's going on in the thyroid.

• 3:31Speaker 01

  I couldn't agree more. And, you know, to your point, millions of people are hypothyroid, but it's estimated there could be almost 50 million people in the United States to have hypothyroidism that haven't been treated because doctors are running TSH and they're saying, you're fine, but you have every symptom of hypothyroidism and nobody's looking deeper. Nobody's checking your free T3, nobody's checking your reverse T3, nobody's looking at a TPO antibody to see, could you have an autoimmune issue? And I think a lot of it is tied to our lifestyle and our gut, which is what I found after I treated over 10,000 patients and I started realizing, wow, there are all these people that have hypothyroidism and why? That was my, always my question was why? You know, I had a thyroid issue in medical school, which is what drove me into endocrinology fellowship.

• 4:16Speaker 01

  I had Graves and nobody could tell me why. And nobody, you know, they would just say, take a medicine and the medicine didn't make me feel good. And I was like, well, why do I have this? And nobody wanted to look as to why. It was just, well, here's a medication. And I think that's what we're taught, unfortunately, in traditional medicine. And I think we really need to be pulling, you know, pulling back the curtain and figuring out why are so many people getting sicker and sicker and sicker? I saw a post you just did talking about birth control and how birth control makes you 280 times more likely to develop hypothyroidism over your life.

• 4:49Josh Axe?

  Is that something you've found too in practice?

• 4:51Speaker 01

  100%. I wrote about it in my book. There's a whole chapter on medications, birth control, PPIs, statins, all of these things that we're taught to give people that actually a lot of times damage our gut. And when our gut becomes damaged, it increases our risk of having autoimmune issues. And the first thing that typically fails in women, especially when we're stressed and our hormones are fluctuating, our sex hormones is our thyroid.

• 5:15Josh Axe?

  Talk about this for a minute in terms of why, you know, you did mention gut health. So maybe that's part of that. But why would taking birth control increase the risk or cause hypothyroidism?

• 5:28Speaker 01

  It's a great question. So we have to remember that birth control is a synthetic hormone. So it's a synthetic estrogen progestin. But what it does is it shuts our brain's ability down to make our own. So it tricks our body kind of, and so it makes us stop making estrogen and progesterone so that we don't ovulate, so that we don't conceive. So when we shut the pituitary down, the pituitary is our brains, our body's command center. It's kind of like the motor of our car. So we are literally shutting our brain down, saying, don't make any estrogen, don't make any progesterone. Well, the problem is that synthetic hormone that we're taking, our body doesn't accept the same as the natural hormones we make. It starts changing the microbiome in our gut. So there are certain bacteria that live when we have estrogen and there are certain bacteria that live when we have progesterone.

• 6:13Speaker 01

  And when we take that natural hormone away, those bacteria can't live. Then we get an imbalance. So we have bad bacteria instead of good bacteria. And then those bad bacteria release something called lipopolysaccharide, which is something that damages our gut. So women develop leaky gut. And when we develop leaky gut, meaning there are little holes in our gut, our immune system triggers because 70% of our immune system lives outside of our gut. And when our immune system is chronically activated, it drives up our cortisol and our insulin, not to mention a lot of our thyroid hormone is converted in our gut. And so there's this big nasty circle of, wow, now we have insulin resistance, our cortisol is chronically high, we're waking up in the middle of the night stressed, we don't actually

• 6:55Speaker 01

  have estrogen and progesterone to calm us down and to rebalance our cortisol and our insulin. And so we just get into the cycle of we can't convert T4 to T3. We become hypothyroid. And I think the Hashimoto's develops because of the intense gut and immune issue that we have from, you know, leaky gut.

• 7:15Josh Axe?

  Well, I mean, think about how many millions, if not tens of millions of women really are, have Hashimoto's or hypothyroidism because they got put on birth control when they were a teenager. I mean, it is, it is absolutely crazy. You know, one other thing, and I think is another part of what you mentioned, another side effect is, is that when, when somebody would, and people could do an easy search on this on Google, on my website, drax.com, on an AI tool, but look up what nutritional deficiencies birth control is associated with. Well, number one is good bacteria. That's the first one you mentioned. That's the biggest one. But in addition to that, vitamin B1, B2, B9, B12, and selenium. These are all the things you also need for methylation and for a number, for thyroid function, of course, selenium as well.

• 7:59Josh Axe?

  And so when people are reading the side effects on a lot of these bottles of medications, it actually isn't telling you the full side effects, right? And so that's a, that's of course a major issue there. Another thing that I know that isn't happening in a lot of doctors' offices is a lot of the blood panels are so minimal and outdated, you know? And I, and I found this to be incredibly important. I saw an interview where you talked about this and I really appreciated it, getting into the most important lab markers women need if they think they have thyroid issues or hormone issues. What are the most important lab markers, maybe your top five in order or so that your doctors may not be running?

• 8:41Speaker 01

  Well, from a thyroid perspective, definitely you need a free T3 and you need a reverse T3 and you need a TPO. You know, I want you to have a free T4, but free T3 is the active hormone. And so if your free T3 is low, what that tells me is even if your TSH is happy, your TSH is just a signal from your brain. So the blood flowing through your body, maybe it has thyroid hormone, maybe your thyroid's actually making T4. But if the T4 doesn't convert to T3, the active hormone, it doesn't matter. And so if there's T4 in your body, your brain's going to be happy and your TSH is going to say, okay, great. But your cells, your hair, your skin, your brain fog, your constipation, it, it's not going to get better because it needs that active T3.

• 9:25Speaker 01

  And so that conversion from T4 to T3 is inhibited in millions of Americans because of medications. So there's an enzyme called deidnase that converts T4 into T3. That enzyme is downregulated or doesn't work when we take metformin, when we take birth control, when we take statins, when we take PPIs, when we take antibiotics.

• 9:47Josh Axe?

  Basically anything that stresses the gut or liver.

• 9:49Speaker 01

  Yes, when our gut doesn't work, when our insulin's high, 93% of Americans have insulin resistance. So like all these people are walking around and although our brain may be happy and we have T4, we're not making T3. So that would be like saying, okay, we're going to pump oil and we're going to have all this crude oil available to make gas, but we never turn it into gas. And we have all these cars waiting for gas. There's no gas. Same thing in people. And so I think that's one of the big things that women are walking around with every symptom of hypothyroidism and nobody's listening. The other thing is ferritin and there are new guidelines as of Friday, I think.

• 10:22Josh Axe?

  I just saw they just changed the number.

• 10:25Speaker 01

  Your ferritin is, and the other thing, a lot of people have bad guts and their microbiome is shifted because so ferritin is another thing that a lot of people are deficient in. You need ferritin to take T3 into the cell.

• 10:37Josh Axe?

  Yeah.

• 10:37Speaker 01

  So let's say, God willing, you actually have the ability to convert T4 into T3 and it goes to the cell, you know, we go to put the gas in the car in order to actually undo the gas, the gas can, you know, put the gas in, we have to have ferritin. Ferritin is what takes T3 into the cell. Most women are ferritin deficient because our guts and because we have menstrual cycles and nobody checks it. They check your hemoglobin, your outdated hemoglobin lab, of course, I mean, and you're not anemic. So they say, okay, you're fine. The normal level for ferritin is 16 to 150.

• 11:11Josh Axe?

  What a crazy wide range.

• 11:13Speaker 01

  16 to 150. And so if you're, if you're 17, they're like, you're great. But now the guidelines as of Friday said, if you're a menstruating woman, they actually recommend at least 50, thank God.

• 11:22Josh Axe?

  It was 50 or 55. Yeah.

• 11:24Speaker 01

  50. Yeah. And so I say 70 for your thyroid.

• 11:27Josh Axe?

  Yeah. Yeah. Yeah, it's incredibly important and, and, and I mean, ferritin is so important for just oxygenation of your body to your point, your cells working properly. Um, it's a big deal, you know? I've seen this a lot. I talked about this recently where, and this is a little bit of a different topic, but uh, women post birth, when they have kids, the amount of energy it takes and the amount of blood it takes to make a placenta. If a woman has a miscarriage, the amount of blood that's lost there. Um, you know, to make breast milk, there's a lot of those same building blocks it needs. And so there are so many women, especially young moms that are dealing with just major, in Chinese medicine, we just call this, I mean, it's anemia or it's just borderline, but it's blood deficiency, you know?

• 12:11Josh Axe?

  And this is why they're tired, their hair is thinning. Again, it's a lot of the symptoms of hypothyroidism are causing it. And so I, you know, I see this too all the time. When you, when you look at ferritin being too low, what do you think some of the main causes of ferritin being low are?

• 12:26Speaker 01

  Great question. A lot of it is your gut. So if you don't have a good barrier in your gut, a good lining, you can't absorb nutrients. If your good bacteria are not there to help you absorb micronutrients, you're not absorbing them. If the bad bacteria outweigh the good. So I think a lot of it is gut lining integrity. Some of it's medication. There's an infection called H. pylori.

• 12:47Josh Axe?

  Yeah.

• 12:48Speaker 01

  That I think probably millions of Americans have that don't realize it. If you're listening to this podcast right now and you've had heartburn or acid reflux for years and you've just been put on a PPI, you know, a miprazol or renitidine or, and you've been on it for years and nobody's looked at why, you probably have an infection. And oh, by the way, that medication long-term and turning down your stomach acid increases your risk of colon cancer astronomically. And in my opinion, it should be malpractice to just keep refilling a medication instead of figuring out why this person has acid reflux.

• 13:19Josh Axe?

  Yeah, absolutely.

• 13:20Speaker 01

  So I think a lot of people have gut issues. I think a lot of people have gut integrity issues, infections, and then a lot of people, it's their diet. You know, our nutrients are so depleted in soil and we have to eat so much more food now to get the nutrients our grandparents did in the 50s that I think a lot of people just don't get, especially women, menstruating women, women who just had babies, we don't get enough nutrients.

• 13:43Josh Axe?

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• 14:27Josh Axe?

  That's mybloodwork.com so we can help you regain your health. You know, the, the other thing is I, I don't think that most people understand what a healthy diet is.

• 14:40Speaker 01

  Correct.

• 14:41Josh Axe?

  And my entire focus has been personalize that diet because, you know, I, I learned really early on, a patient with hypothyroidism versus a patient with IBS or cancer or a male with low testosterone. So a lot of those diets are just completely and radically different. And I think a lot of women think, oh, I'm eating healthy because I'm eating a lot of salads, maybe chicken, um, smoothies.

• 15:02Speaker 01

  Yeah.

• 15:03Josh Axe?

  You know, diet coke. I mean, there's all kinds of things.

• 15:05Speaker 01

  Green, leafy things that could be making your gut worse.

• 15:07Josh Axe?

  Yeah. But it's like, but you're not getting any heme iron, you know, for, you know, they're, so, so, you know, a therapeutic diet is what, what your body needs, you know? And so, um, you know, when I look at a lot of these ancient forms of medicine, whether it be Ayurveda or Chinese medicine or the way they would just eat in more ancient times, there was a lot more of this soups and stews and warming things and, and it's just we're getting a lot, a lot less of that today. Okay. I want to, I want to ask you about the connection between different hormones and the hormone cascade. Cause when I asked you about, uh, the biggest markers that we're missing, you said T, yeah,

• 15:47Josh Axe?

  T3, reverse T3, those TPO, the, the different sort of antibody markers there with thyroid. Would you have two others on there potentially? Insulin and morning cortisol because those are so connected and anything else you really look at?

• 16:02Speaker 01

  Yeah. So that's a great point. So insulin and cortisol are the other two that I kind of hadn't gotten to, but insulin is so powerful. I think insulin resistance is the reason that we age, we get disease and we ultimately die. Inflammation, right? So inflammation is the root of, of all evil and insulin is the most inflammatory molecule in our body, hormone in our body in excess. We need a certain amount of insulin, obviously. When we eat, we need insulin to take food and direct it or signal to it where to go. But if we have too much, it is so toxic. It starts telling us to put food in the wrong places. We start developing excess adipose tissue. I think what people forget is that adipose tissue is an endocrine organ.

• 16:47Speaker 01

  It's the most dangerous endocrine organ that we have. When you have excess adipose tissue, it releases interleukin-6 and tissue necrosis factor alpha and all these signals that are bad. And it converts estrogen into bad estrogen. There's nothing good that happens in excess fat cells.

• 17:02Josh Axe?

  Right, yeah.

• 17:03Speaker 01

  And insulin is the reason that people have that. And insulin also, when it's elevated affects your gut. It affects when you have all this, you know, elevated cytokines and all these markers that are inflammatory, you know, your immune system's like, oh my gosh, what's going on? We're being attacked. When that happens, then what happens is, okay, now we're not converting our thyroid hormone, we're not, you know, making progesterone and estrogen. So I think insulin is definitely overlooked. I think that's why people a lot of times have issues losing weight, they have issues with their thyroid. And then cortisol, to your point, you know, I don't know very many women in their 40s who haven't experienced, you know, waking up in the middle of the night, like, oh my gosh, at 3:00 AM, like, why, you know, why am I wide awake? It's a cortisol issue.

• 17:44Josh Axe?

  That's right.

• 17:44Speaker 01

  And it's because of our lifestyle. It's because our hormones are shifting. It's because of gut issues. And these things are completely overlooked in traditional medicine. Again, cortisol, normal range, five to 18. What does that mean? So you're either adrenal insufficient and dead or you're cushionoid. Like, that's not all normal.

• 18:02Josh Axe?

  Yeah.

• 18:02Speaker 01

  So.

• 18:03Josh Axe?

  Yeah. Yeah. I mean, I, I tend to find, like, if I, I really feel like most of the time it's a insulin or cortisol issue. Like, those are the two hormones because, you know, if, if, and one is diet and the other is stress. And by the way, I think, I think insulin's way easier to fix, honestly, directly. Cortisol to me is the one in working with patients that's much more challenging because it is so related to somebody's childhood trauma, their daily habits, their relationships. I mean, there are so many factors. I mean, hey, I can change your diet. I can get you on some supplements to equalize, you know, and support your insulin, but cortisol then impacts insulin, right? And so I find like, if I have a really hard case and I'm like, why isn't someone breaking through?

• 18:48Josh Axe?

  There tends to be this cortisol stress component that is the limiting factor.

• 18:52Speaker 01

  Yeah. And let me tell you about that. That's closely tied to your gut and this is how. So there's a whole chapter about this in my book. I agree with you. It's so hard to fix cortisol because of people's childhood traumas. Maybe they're not eating the right diet for themselves. So if they are eating a diet that they think is healthy, but they're not giving themselves the nutrients they need, their body goes, why am I not getting those nutrients? Your body is stressed. It hikes your cortisol.

• 19:16Josh Axe?

  Yeah.

• 19:16Speaker 01

  So your brain, anything that enters your brain, every thought you have, you know, what I have to do today, what did I not get done on my to-do list? I don't like how my body looks. I'm, you know, don't like how this person treats me. Anything that enters your brain, your brain tells your stomach by way of your vagus nerve. So anything that goes into our brain, stress can literally kill you, but it's affecting our gut by way of the vagus nerve. So when we're stressed, our stomach is getting the signal and then our immune system gets the signal and it's like, oh my gosh, we're stressed. And so then if we're eating in stressful situations, millions of Americans are eating while they're on meetings, they're driving cars, they're not, you know, they're not chewing their food. Guess what? When you're eating like that, none of that nutrient is getting absorbed because your gut's like, oh my gosh, what's going on?

• 20:00Speaker 01

  Your insulin goes up and so all that food you're eating while you're driving, you might as well not eat because it's just being stored as fat.

• 20:05Josh Axe?

  Yeah.

• 20:05Speaker 01

  Your body doesn't know what to do with it. And so your cortisol directly affects a lot of your gut. And this is why I also think, you know, it's so difficult to fix because people don't realize that and they don't look at the gut.

• 20:19Josh Axe?

  You know, I went on a mission trip, uh, this is, this is a long, almost 20 years ago, this is to Asia and, um, they would take a two-hour lunch break.

• 20:27Speaker 01

  Yeah.

• 20:28Josh Axe?

  And so they would go out, they would eat for an hour and then they would, I mean, this, one of the cities, everyone in the community came in, did Tai Chi for like 30 minutes and then, and then they went back to work. I mean, these people worked incredibly hard, but they really took hours around their meals. And that's the most important time, right? It's like, hey, you know, you can't go and run a 5K and eat a cheeseburger because all of your blood goes to your, the, you know, the part of your brain for alertness and your extremities versus you get that vagus nerve back on and that parasympathetic, that blood, that energy goes to those organs. You can rest and digest, you can, you know, your hormones go to where they need to go for repair, regeneration. But, you know, that doesn't happen. I think, and I think there's so many people, like I think about my mom growing up. My mom had three kids and my mom worked and my mom, like my mom, and this was after my

• 21:13Josh Axe?

  mom went through chemotherapy and, and radiation and all the trauma she went through when I was younger. And so like, That's a lot. And I think there are, it's busyness. It's just excess things on the schedule. One of the biggest prescriptions I have for patients is start saying no more, right? Let's, let's have some time where you get to do things you love to do. Let's have family dinners. Let's just really say no more and have some margin just to relax and enjoy your life and don't be rushing all the time. But because there's no doubt that high cortisol, to your point, is a major driver of issues. I saw this statistic recently, and it kind of shocked me. I didn't sit there for a minute and say, is that, is it really that high? Eighty-eight percent of people are metabolically unhealthy.

• 21:58Speaker 01

  I think it's ninety-three.

• 22:00Josh Axe?

  Wow.

• 22:01Speaker 01

  I think it's ninety-three. I saw that from Dr. Mark Hyman, because he's talking about anyone who's fasting insulin is above five. Now, it was ninety-three a couple of years ago. Maybe it's down to eighty-eight because of GLP-1s. Who knows? But it's a lot, right? It is a lot. And I see labs, we check labs on every patient. We check fasting insulin on every patient. And I look at them all. And I would say I'm lucky, once a week, to have someone under five.

• 22:28Josh Axe?

  Yeah.

• 22:28Speaker 01

  Lucky.

• 22:29Josh Axe?

  Yeah.

• 22:29Speaker 01

  And I'm like, oh, wow, this person's actually metabolically healthy.

• 22:32Josh Axe?

  Yeah, yeah. I mean, it's, it's, it's probably the single biggest marker. Yeah, I was looking at something recently, and they were talking about, hey, if you only have these nine markers, you could predict somebody's longevity better than anything by far. And the number one

• 22:43Speaker 01

  Insulin?

• 22:44Josh Axe?

  Was insulin.

• 22:44Speaker 01

  Cortisol?

• 22:45Josh Axe?

  CRP.

• 22:46Speaker 01

  CRP, probably free T3.

• 22:48Josh Axe?

  Vitamin D might have been on there.

• 22:49Speaker 01

  Vitamin D, definitely. Testosterone, maybe.

• 22:52Josh Axe?

  Yeah.

• 22:52Speaker 01

  There's a correlation, Framingham, the Framingham score, if you had low testosterone, a low free testosterone and a low vitamin D, increased your risk of overall cardiac mortality by one hundred and forty-four percent, both.

• 23:05Josh Axe?

  Wow.

• 23:06Speaker 01

  Each one individually was about fifty, sixty percent.

• 23:08Josh Axe?

  Wow.

• 23:09Speaker 01

  Vitamin D is, is really important.

• 23:13Josh Axe?

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• 23:57Josh Axe?

  for you to read this content. I hope it's going to change your life.

• 24:02Josh Axe?

  I want to talk about testosterone. I want to talk about PCOS. Before we do that, though, I do want to talk about GLP-1s. You spent time in a research facility, really looking at GLP-1s. What is your position on GLP-1s, how they should be used, how they're being used today, anything else that may support, you know, GLP-1s within the body? I'd love to hear your opinions.

• 24:24Speaker 01

  Such a loaded question. You know, I did research on GLP-1s in diabetic people, type two diabetes, very insulin resistant. And the doses that we use are astronomically high.

• 24:34Josh Axe?

  Yeah.

• 24:35Speaker 01

  They're so high. And so it makes sense that those people lose weight and their blood sugar gets better. I don't know that we really need to push them to those levels in people, to be honest with you. I think that that's kind of an easy way to do it. I think that if we, as traditional medicine doctors, or just in general medicine, talk to people about how they can lower their insulin, how they can lower their stress, it would help a lot of it. I think that in the general population, I use them, especially in people with PCOS or PMOS now.

• 25:02Josh Axe?

  Yeah.

• 25:03Speaker 01

  Because insulin is the driving issue in these people. I mean, actually, now that PMOS has been reclassified, we talk about the gut. But insulin's a huge issue. And so I think in most people who are metabolically unhealthy, but not diabetic, small doses, I mean, very small doses, can be beneficial in addition to lifestyle modification. But it's not a magic crystal ball. It's not a magic wand. And so I think that they're over prescribed in higher doses than needed. And we're going to end up with a bunch of women in ten years with osteoporosis, you know, breaking their bones because they're losing their muscle.

• 25:39Josh Axe?

  I mean, you do see this in people, you know, and there's someone I know in particular, and the face is sunken in, you know, and we see their, their mus, their musculature is lost. And part of it actually has to do with, because they're losing it too fast. You actually don't want to lose weight that fast. And it's a challenge. But I agree with you. And so I, I am probably like you, generally a fan of peptides, because, you know, these are within our own organs. I mean, to me, they are nutrients per se, or can act like that, or more, really, they're more of these messengers in the body. But and there's a lot of, I think a lot of things that are peptides, people don't realize, you know, really, technically, insulin's a peptide, creatine's a peptide, glutathione's a peptide. So I mean, I think peptides are great, but overall, and this is what I see the medical

• 26:24Josh Axe?

  community do constantly. Hey, let's find something somewhat natural. Okay, now let's make it synthetically. Okay, now let's ten or twenty X the dosage. And rather than, you know, the natural medicines, hey, let's nudge the body and support it in going where it should go. No, let's force it to do what it, the body's not, you know,

• 26:43Speaker 01

  Or let's cycle it, instead of just putting people on it and increasing the dose forever. Let's, you know, like our hormones cycle. But I agree with you. I think that it's a very powerful tool in people, assuming we're teaching them how to unwind the root cause of why they ended up there in the first place. Let's talk about your sleep. Let's talk about your movement. Let's talk about your diet. Let's talk about your thought processes. Let's talk about, are you seeing the sun? You know, all of these things. In addition, it's kind of like, you're, you know, your cheerleader, it makes it a little bit easier. But I don't think it should be given without you being medically supervised. And I don't think it should be given with a lot of these people, oh, I got this online, and somebody told me to start it, and they told me to just go up by five units every month, and that

• 27:27Speaker 01

  was it. And it's like, no, that's probably not the best way to do it. And to your point, I mean, I've put people on these GLP-1s, and they've, I had a lady, literally, that I saw last week, she'd been on one for three months, very tiny dose, lost twenty-one pounds of fat, lost point five pounds of muscle. She lost a lot of weight pretty quickly, but she was also very big. But she didn't lose any muscle, because we gave her a very low dose. We gave her a very set diet, like protein regimen. And we said, you have to move your body. And then she said, I want more. And I said, too bad. Like, you don't need anymore. Actually, you need less, because you lost, I don't want you losing more than like a pound a week. But you can take these and not lose muscle if it's, if it's done correctly.

• 28:07Josh Axe?

  Yeah. And I love the way you did that, because I mean, that's the way that it should be done across the board. Part of it has to do with laziness with doctors today. Part of it has to do with not doing, you know, my, my philosophy has always been, I'm going to treat people like my own family members, and I'm going to do everything I can to help them heal naturally, and not think about just them one year from now, but trying to get them somewhere thirty or forty years from now, you know, like, I'm really blessed. I have parents that are in their mid-seventies, that are water skiing, they could run if they want to. I mean, like, very, very good health, because they've been so lifestyle and habit oriented in doing, doing the right things. And I really want that for everybody to be, you know, with their, playing with their grandkids, and feeling great and alive. And, and if you do it the way that you're talking about,

• 28:52Josh Axe?

  people will get there. Let's talk about PCOS. Why is it called oftentimes type three or type four diabetes?

• 29:00Speaker 01

  Well, I think it's because in the past, PCOS was, you know, we learn in school, you have to be overweight, you have to be insulin resistant, and you have to be anovulatory, or you have to have irregular cycles. So it was all tied to a high insulin problem. High insulin, which then drives your body to make more testosterone, and your high testosterone and high insulin get into this circle. But as of May, twenty twenty-six, it got reclassified as polyendocrine metabolic syndrome, because we now know that there are actually seven types of PCOS. There's an adrenal PCOS driven by high cortisol. There's a post-pill PCOS driven by you're on birth control.

• 29:38Josh Axe?

  Yeah.

• 29:38Speaker 01

  There's the, you know, old school PCOS insulin driven type. But there are different types now. And it's polyendocrine, because we now know it's not just an ovary issue. It's not just a hormone issue. It's not just a, I feel like the old PCOS was very stigmatized. Like, we blamed people. It is now, your gut is a huge driver. There's multiple reviews last year, case reviews, showing that PCOS was driven to gut issues and gut microbiome. And so there's all this new research now showing that when our Strobelome, which is the bacteria in our gut, are not metabolizing our hormones correctly, we develop hormone issues, and we develop things like PCOS, and our insulin goes up.

• 30:17Josh Axe?

  Yeah.

• 30:17Speaker 01

  So I think that it's a really good step in the right direction for PCOS or PMOS, because now doctors are going to actually have to check a morning cortisol, check an insulin. Like, now it's going to be, you have a form of PCOS or PMOS, let's figure out what form. And so it's going to make people look further.

• 30:35Josh Axe?

  Yeah, yeah, it's so good. Yeah. And I thought, I thought the update was fantastic. I'm so used to saying PCOS, because I said it for twenty-seven years, that

• 30:42Speaker 01

  PMOS.

• 30:43Josh Axe?

  PMOS is definitely a more accurate way to look at it. And I do love, because it's more personalized, looking at, hey, you know, here's the, you know, four different types that we're looking at, and the different connections. And, and it makes treatment more effective, especially when you're doing it from a more natural standpoint, to, to your, to your point in getting more of the root cause. And so.

• 31:04Josh Axe?

  And of course, PCOS is also such a huge cause of infertility today.

• 31:07Speaker 01

  Yes.

• 31:08Josh Axe?

  Huge cause. I will say this, though. So I feel like, you know, when I think about 20 years ago, when I was looking at some of the statistics around infertility rates, and I would look at things like, how often is it maybe the issue with the women having the trouble conceiving and the male, the health of their sperm and their issue? It used to be a little bit more dominant on the woman's side. Now, now it's very, I mean, I saw recently, it was something like 35% of the time, it tends to be with the woman, 30% with the man in terms of what they're seeing statistically. And so, and this is because, I mean, male testosterone has been, I mean, it's almost mind blowing when you look at the statistics on how far it's dropped over the last 50 years.

• 31:51Speaker 01

  Yeah, I see it all the time. I see somebody almost once a week now in my clinic in their twenties, late twenties, early thirties with low testosterone, and they've gone to the doctor. And when we say low testosterone, let's clarify this for listeners. Your testosterone can be 250 to 1100.

• 32:10Josh Axe?

  Yeah.

• 32:10Speaker 01

  That's considered normal.

• 32:11Josh Axe?

  Yeah.

• 32:12Speaker 01

  Which is crazy.

• 32:12Josh Axe?

  Exactly.

• 32:13Speaker 01

  All comers, all age. And so if you are a 27 year old man and your testosterone is 250, there is a problem.

• 32:20Josh Axe?

  Yeah. Oh, yeah.

• 32:21Speaker 01

  There's a problem. And you feel it. You, you know, you're tired, you're losing muscle mass, you have no ambition, you have no sex drive. And so I think that's part of the issue as well, is we have these 20 and 30 year old people, this is part of the fertility issue. We have low testosterone, and then when you have no desire to, you know, to make babies, then we're going to have issues. But they just don't feel well. And so the question is why? And a lot of times I see in these, these young guys, it's scary, their pituitary gland is not online. So when your testosterone's low, your brain should be like, oh, my gosh, make testosterone, make testosterone, your FSH should be high. It's not.

• 32:57Josh Axe?

  Yeah.

• 32:57Speaker 01

  And the question is why? And a lot of times I find these guys, they have thyroid issues, or they have insulin issues, or they have cortisol issues, or gut.

• 33:05Josh Axe?

  You know what's funny? In Chinese medicine, they would say that when a woman has, it's called qi and yang deficiency, that's hypothyroidism. So the body is missing mitochondria, it's missing energy, and it's missing the ability to regenerate and heal. And so most women with that end up be diagnosed with hypothyroidism. Men, the exact same pattern. In Chinese medicine, they tend to get diagnosed with low testosterone. And so, but there probably are a lot of men also with, because maybe the, the numbers are off today and the way we look at them with these thyroid issues as well, and a very similar thing. I had, I had somebody come in recently to the clinic, and his testosterone levels was, he's about 40, and were like 91. I mean, so low. And we got

• 33:50Josh Axe?

  it up to over 1,000 in six months.

• 33:53Speaker 01

  That's awesome.

• 33:53Josh Axe?

  And we did it without TRT. We did, I mean, honestly, the single biggest thing he did was change his diet and reduce stress. Now, we did other supplements, you know, we did, you know, a couple of herbals, we really focused on vitamin D and zinc, because those were low clinically as well. But I mean, the body can heal very, very quickly if you start doing all the right things.

• 34:12Speaker 01

  Especially when you're young, because you have a lot of mitochondria left.

• 34:15Josh Axe?

  Yes.

• 34:16Speaker 01

  No, I completely agree. But a lot of these guys with low testosterone too, I mean, you look at their gut, a lot of times it's like, did something happen? When people got COVID, killed their guts. When they get, you know, sick, when they get put on antibiotics, kills your gut flora. And then when your gut flora dies, testosterone's important for your gut flora as well. You're going to get higher cortisol, you're going to get higher insulin. Then as that starts to go up, maybe you're not sleeping as well, you're stressed, then guess what? That starts affecting your thyroid hormone production. And then now that your gut is leaky, then you're not going to make testosterone. It's just this big circle. And then, you know, here we are. We have 20 year olds that have testosterone in the 200s, and they go to the doctor, and the doctor says, oh, you're normal, or they say, well, let's just put you on TRT. And it's like, no, we have to figure out why. And we have to start trying to help them fix

• 35:01Speaker 01

  their, their testosterone.

• 35:03Josh Axe?

  Yeah, I totally agree.

• 35:03Speaker 01

  It's crazy. I mean, and I see it, you know, I got out of fellowship in 2017, and I used to see one of these guys maybe once a month, once every couple of months. I see one at least every week. It is definitely a big deal. But to your point, we need to be looking like, if that's you, and you're listening to this, you need to find someone that will help you figure out why. You don't want to be like this forever.

• 35:27Josh Axe?

  Yeah. You know, from a nutritional deficiency standpoint, I don't know how much micronutrient testing you do, or you do or don't do, but I mean, I tend to see a lot of micronutrient deficiencies, a lot. And I feel like, one, one thing I'm always trying to do is go as far upstream as possible of like, where is this starting? And so, you know, we talked about vitamin D, we've talked a little bit about ferritin, of course, critically important. Are there any other nutrients in particular that you think that are really important when it comes to metabolic health and gut health that you see a lot of your patients missing?

• 36:02Speaker 01

  Yeah, that's a great question, Dr. Josh. For sure. I mean, we look at iodine levels too, it's very controversial, but we look at iodine, we look at vitamin D, and I'll tell you why. We look at iodine, we look at vitamin D, we look at B12 and folate. So many Americans have MTHFR and low folic acid levels, and you kind of touched on it. Your ability to methylate and have, you know, not have folic acid is so crucial to hormone metabolism.

• 36:31Josh Axe?

  Yeah.

• 36:32Speaker 01

  And a lot of people are walking around with MTHFR, and they wonder, why do I have brain fog? Why am I doing all these things and I don't feel better? Well, it's, it's so critical. So we look at B12, we look at folate, we look at vitamin D, because there's a cell, every single cell in your body has a vitamin D receptor, super important. We look at iodine, we look at ferritin. Those are minimal. Now, depending on what symptoms people have, sometimes we look at other things as well.

• 36:54Josh Axe?

  Yeah.

• 36:54Speaker 01

  We look at iodine because I just want to know. I want to ballpark. I think most people are iodine deficient in general, because of, most people don't eat a lot of seaweed, you know, raw fish, et cetera, in the US. But also, we have bad guts. And iodine, I think people forget iodine is the backbone of thyroid hormone. So if you go back to biochemistry,

• 37:15Josh Axe?

  Yeah.

• 37:15Speaker 01

  iodine is the backbone of T3 and T4. You need either three or four thyroxine molecules attached to iodine, and that's how you make T4 and T3. So it's crazy to think, oh, you're going to fix someone's hypothyroidism if they're iodine deficient.

• 37:28Josh Axe?

  Yeah.

• 37:29Speaker 01

  I mean, your body needs iodine. Not to mention, I think people also forget that iodine gets rid of toxic halogens, so bromide, chloride, and fluoride.

• 37:38Josh Axe?

  Yeah.

• 37:39Speaker 01

  All on the periodic table under iodine. Iodine is able to displace those things off of cells and out of your body if you have enough.

• 37:46Josh Axe?

  Yeah.

• 37:46Speaker 01

  And chloride, bromide, and fluoride cause our DNA to mutate and cause bad things to happen. So you want iodine. It's very beneficial. There's studies right now going on with breast cancer. So now they're starting to look at breast cancer, and is it iodine deficient, or iodine sufficient? And I think, hopefully, in a few years, whenever you get a breast cancer diagnosis, it will say ER PR positive iodine deficient. So you know, oh, my gosh, let's get on some iodine.

• 38:13Josh Axe?

  Yeah. Yeah. So I think part of the big, and if, I'd love for you to share this, when it came to iodine, you know, the way that I would look at it is, if I had somebody come in and their autoimmune markers were high, I was a lot more careful with, especially the dosage of iodine. If there really wasn't any sort of autoimmune reaction going on, there's TPO, you know, like antibodies were low, we would tend to, sometimes go a little bit higher in the dosage and do, I would do like, you know, liquid calp and that type of thing. But, but what are your thoughts on that? And why, why is it controversial to talk about iodine? Is it related to sort of it, you know, increasing the risk of goiters and that type of thing?

• 38:51Speaker 01

  This is a great question. So if you actually look, and I know people have shown me the articles about why you shouldn't do iodine with high TPO antibodies.

• 39:00Josh Axe?

  Let me say this too. I did have somebody, a family member who had Graves' disease. They took iodine.

• 39:04Speaker 01

  Well, that's not good.

• 39:06Josh Axe?

  They had developed a, a significant goiter.

• 39:09Speaker 01

  Right. So Graves is different than Hashimoto's. So remember, Graves is overproduction of thyroid hormone. So I would never give somebody who's hyperthyroid of any type iodine, because your body is making too much thyroid hormone. I don't want to go give gasoline to the fire.

• 39:24Josh Axe?

  Of course.

• 39:25Speaker 01

  You don't want to give someone iodine, because then they're able to make more thyroid hormone. So never would I give anyone hyperthyroid, whether they have Graves or they're just hyperthyroid. I would never give them iodine. Hashimoto's is the opposite, though. Remember, Hashimoto's is, our body's not making enough thyroid hormone, or our body's being attacked. So here's the interesting thing. If you think about how thyroid hormone is made biochemically in our body, iodine, and then thyroxine attaches to the iodine molecule. And remember, in biochemistry, our body is, is so made perfectly, that when we have a chemical reaction that occurs, we have to neutralize it. So when thyroid hormone is made, the byproduct of thyroid hormone is peroxide. And if you don't neutralize peroxide, then cells lysopen.

• 40:08Josh Axe?

  Yeah.

• 40:08Speaker 01

  So you know what neutralizes it? Making sure that you have enough things like methylated B vitamins, glutathione.

• 40:15Josh Axe?

  Huge.

• 40:15Speaker 01

  Yeah. And so the problem is not an iodine deficiency with Hashimoto's. It's the fact that people have micronutrient deficiencies, and so their cells are lysing. And then when their cells lys, that increases their TPO antibody, then they're also eating things like gluten, and they have a leaky gut, and gluten looks very much like TPO. And so we have multiple reasons our thyroid is being attacked. Iodine is not the reason.

• 40:37Josh Axe?

  Yeah.

• 40:38Speaker 01

  And so I think iodine unfortunately got this bad rap. Yes, you shouldn't take it if you're overactive. But if you're underactive, there's no reason to not take iodine. Now, do you need, again, to your point, massive amounts? Like, some people say, no. I don't think that we need 20 times the, you know, recommended dose. But a little bit of iodine, I think is important, because you want, if your body's healing, you want your body to have the iodine needed to make T4 and T3.

• 41:03Josh Axe?

  Yeah, and it makes total sense. You know, something I've been telling my patients now for quite a while is, you don't need a pill, you need a protocol.

• 41:08Speaker 01

  You need a protocol.

• 41:09Josh Axe?

  And the reason that is, is to your point, there are a lot of different things going on in the body. And the problem is today, and this is true in conventional medicine, it can also be true in functional medicine, is, is that, you know, a lot of times, it's sort of this one size fits all. Hey, here's level of thyroxine, that's the treatment. Or even in conventional, I see this in natural medicine. A doctor had the carnivore diet helped them, or a keto diet, or a vegan. And so they recommend to all of their patients.

• 41:35Speaker 01

  Right.

• 41:36Josh Axe?

  That exact same diet, or you get a doctor and they get on, everybody needs iodine, or every single person needs B12, whatever it is. But the reality is, if you're really doing a good job, you're getting an extensive panel, you're looking at a history, and then you're able to look at, oh, your issue is, whoa, your GGT, your glutathione is totally bottomed out. So, hey, we need iodine, but you also need glutathione, we need to change your diet, we need to do these things. And that's how, like, even when my mom was able to heal cancer, like, that was it. It was a full protocol. And people are gonna get the best results when they're working with a practitioner that is laying out a very detailed personal protocol for them. And that's the thing I love about your approach, is you're really looking at these different pathways in the body going upstream and saying, hey, let's fix the early, like, for thyroid.

• 42:21Josh Axe?

  It's like, you understand, there's cortisol, there's insulin, there's iodine, there's vitamin D, there's, there's stuff going on in the gut microbiome, and we need to find out where this fire is occurring and put it out. Because, you know, there are so many people today taking supplements, or eating foods, or doing things where they're just wasting their money and time, because that's really not the root issue.

• 42:41Speaker 01

  Right. No, I completely agree. Everyone, I love that. Everyone needs an individualized protocol or plan or approach, because medicine is not a one-size-fits-all. That's what traditional medicine tries to teach us, and that's why so many people are so sick.

• 42:56Josh Axe?

  Yeah.

• 42:56Speaker 01

  Because everyone's body is different, to your point. And that's why I think labs are very important, but I also think lifestyle is very important. You know, you can be doing everything right. Like, I get these people sometimes who come to me, and they are, I mean, they're eating well, they're moving their body, they do everything right, except they sleep four hours a night. And they have the biggest, you know, mental load, you know, mental load. I had a lady recently who came in who's a big attorney, and she's like, I only have time to sleep for four hours. That's just, you know, I'm like, well, then I can't help you. Like, there is literally no way, because guess what? The only thing wrong with you is your cortisol and insulin are high. And you eat well and you exercise, but your cortisol and insulin are high because, and your growth hormone is low, because you don't sleep. Like, and your body, that is when your body heals itself. Our body was made to fix itself, but we can't heal ourselves if we're never sleeping.

• 43:41Speaker 01

  And so I think it is really important that you look, and I do think that we miss the gut a lot of times, you know?

• 43:47Josh Axe?

  Yeah, I agree.

• 43:48Speaker 01

  When people, especially, you know, you mentioned postpartum women twice. I, my heart goes out to them, because a lot of times their hormones are shifting so much. And when their hormones shift, it affects their gut. And if they get a little bit of leaky gut and their hormones start shifting, guess what? Now they're not making dopamine and serotonin, or they're not able to absorb it from their gut. And then they get postpartum depression. And then instead of somebody using their brain and saying, oh, my gosh, let's fix your leaky gut, and let's get you a little bit of sleep and a little bit of help, we put them on an SSRI.

• 44:16Josh Axe?

  Oh, yeah.

• 44:17Speaker 01

  And then they go on an SSRI, and that destroys their, and it's just this, it's a mess.

• 44:22Josh Axe?

  And that's why, in these traditional cultures, pretty much for the next 90 days after you give birth, you're eating soups. It's like soups and kanji, and like, what is it, applesauce? It's like, what are the easiest things and best things for your gut?

• 44:34Speaker 01

  To digest.

• 44:35Josh Axe?

  In building blood, that's what you're gonna eat.

• 44:41Josh Axe?

  If you've been told your blood work is normal, but you feel anything but normal, you're not imagining it. A standard blood work panel was never built to show you what's actually going on in your cells. And your standard primary care doctor will likely never connect the dots between all of your symptoms and what's starting in your cells. And the cellular blood work analysis that I created was built just for this. It's an at-home kit that also comes with a full hour review with a senior health advisor who will show you what is going on deep in your cells, and if one of our healing protocols might be right for you. We've got hundreds of five-star reviews on TrustPilot, and most of them started right where you are.

• 45:23Josh Axe?

  If you're ready to finally be heard, then go to mybloodwork.com to book your cellular blood work analysis today.

• 45:32Josh Axe?

  I want to ask you about hormone replacement therapy. You know, so last year, when Robert F. Kennedy Jr. and the HHS removed this black, black box warning, I kind of had this sort of like, internal struggle. It was funny, because all of a sudden, like, all these people, even in the natural health community, were like, this is amazing, this is fantastic, it's like, great for women's almost rights or freedom. And I thought to myself, well, you know, I mean, I want to be accurate in labeling, and maybe it shouldn't have had a black box warning, and that's, that's fine. But I still felt a little bit torn, because I thought, I just don't think our entire perspective around hormone replacement therapy is correct.

• 46:14Josh Axe?

  Like, I really, my, my hope is, and this is across the board with everything, is like, if you're not coupling it with the root cause of why hormones are off in the first place with lifestyle and diet and those types of things, then I still think there's a problem with trying to do this by itself without addressing any underlying issues. But I'd love to hear your thoughts on, on hormone replacement therapy and how you recommend it, or if you do to patients.

• 46:38Speaker 01

  Yep. So you nailed it, Dr. Josh. I think that hormones are amazing when done correctly, but here's the caveat. A hormone is going to act in the environment you put it in. So I think that the problem here is that if you're shoving hormones in a toxic environment, those hormones are gonna metabolize toxically. And then ultimately, this is where people say hormones cause cancer. I don't think that's fair. Hormones don't cause cancer. Hormones can be metabolized in a toxic environment to toxic metabolites that increase your risk of cancer. And so, now, are there some synthetic hormones that have been shown to cause cancer? Yes. At the WHO, there were some, you know, progestin. But bio-identical hormone replacement, you've got to put it in a good environment.

• 47:22Speaker 01

  And this is my problem, too, with some people out there pushing hormones, is like, okay, yes, I think hormones are great. Estrogen, progesterone, testosterone are all great hormones. They do great things for us. They help with blood flow to our brain, they protect our bones, they help with mucus membrane support, they protect our heart, protect our muscle. But if we're shoving them into a toxic environment with high insulin, no micronutrients, no B vitamins to help, you know, metabolize them, no glutathione, our estrobolome is dead, and we can't actually metabolize those hormones correctly, and we're making bad metabolites, are we helping people?

• 47:56Josh Axe?

  Yeah.

• 47:57Speaker 01

  You know, and so, the way we do it is, we're like, okay, we check all your labs, we talk to you about lifestyle, and it's like, okay, this is where you're deficient. Here are the things we need to do from a lifestyle perspective to make sure your gut is healthy, so that we can actually absorb the B vitamins that we're trying to get into our system, we can make glutathione, we can lower our cortisol, we can lower our insulin, our estrobolome comes back on circuit, so we're actually metabolizing our insulin correctly. You have to have a bowel movement every day. You have to, because that's how we get rid of toxins. This is why a lot of people have toxic metabolites of estrogen. And this is why most women on hormones get bad hormonal symptoms, because they're constipated. And when we become constipated, our bad estrogen that we're trying to get rid of recirculates.

• 48:40Josh Axe?

  Can I tell you, so my mom, she had cancer, this would have been back in, I think it was like 94, this was when I was in junior high, and she went, underwent chemotherapy. And afterwards, she went from having, you know, before that, she was having a bowel movement a day, after that, it was like two, two a week, you know? And 10 years later, my mom gets cancer again. And I really believe that a big reason why she got cancer again was just the lack of bowel movements. I mean, honestly, when she was diagnosed the second time, we were able to help her heal naturally without chemo, without radiation. But my single biggest focus was probably.

• 49:14Speaker 01

  Her bowel movements.

• 49:15Josh Axe?

  Her bowel movements. It's, it's huge.

• 49:17Speaker 01

  That and sweating, like, that's how we get rid of toxins.

• 49:19Josh Axe?

  Yes, yeah.

• 49:20Speaker 01

  And so, so to your point, I don't think we should be hammering hormones in someone unless we're helping them make sure that they're metabolizing correctly and we're excreting the bad ones.

• 49:30Josh Axe?

  And also, you know, I, I've seen it too, where, when I, hormone replacement therapy 20 years ago, it used to be, okay, women that are going through menopause, not peri even, but just menopause, we're doing, that's, that's when they're being prescribed. Or a male in their 60s or older. Now, there are men in their 20s.

• 49:49Speaker 01

  Yep.

• 49:49Josh Axe?

  Being prescribed testosterone.

• 49:50Speaker 01

  Yep.

• 49:51Josh Axe?

  I had three women I've worked with over the, just over the last two years, they got prescribed estrogen in their, like, early 30s, and then they developed breast cancer. And I'm not saying there's a, here's, here's the thing. I think if it's prescribed right, for the right person, the right time, the right age, you know, point in menopause, it can make sense. You know, I do think there's a group of people, hormone replacement therapy, when you're doing the right diet and lifestyle with it, I, I don't have a problem with it, but I do have a problem with how it's being prescribed. It seems like it's being prescribed to every, everybody now.

• 50:25Speaker 01

  Yeah, again, I think in that, you know, if you have a 30-year-old that has low estrogen, the question is why? And I don't want people to suffer. And so if you're having really bad side effects.

• 50:34Josh Axe?

  Yeah.

• 50:34Speaker 01

  Then maybe we need to give you a very low dose, but we need to make sure it's metabolizing correctly. We need to, you know, be monitoring those levels. So if I ever give somebody estrogen like that, I'm, I'm following their estrogen level, but I'm also making sure, are we fixing your gut? What does your estrobolome look like? Do you have enough glutathione? Do you have enough B vitamins? Are you pooping every day? Like, very easy questions. I can ask you all of that in one minute.

• 50:58Josh Axe?

  That's right.

• 50:58Speaker 01

  And so if you're not asking those questions, and if you are getting hormone replacement therapy, and somebody's not asking you that, it's kind of malpractice, in my opinion. Because, I mean, we don't want to give you something that can harm you, we want to put it in the right environment.

• 51:11Josh Axe?

  You know, you're one of the few medical doctors that I've ever met who's actually said that.

• 51:16Speaker 01

  I know.

• 51:17Josh Axe?

  Because, and by the way, and I really appreciate, because I, listen.

• 51:19Speaker 01

  I know.

• 51:19Josh Axe?

  Listen, every doctor, myself included, with a DC degree, yours with an MD degree, has taken an oath of, first, do no harm.

• 51:27Speaker 01

  Right.

• 51:28Josh Axe?

  And the reality is, if you are, without ever addressing somebody's diet, or lifestyle, or exercise, or any of those things, if you're just giving them a drug, the reality is, they all have side effects, you are doing harm most of the time without doing the thing that would help them the most.

• 51:45Speaker 01

  To be honest with you, you know, I told you, I did a lot of research, I worked for some pharmaceutical companies for a while, and then I learned better. And so I say I'm a recovering traditional medicine doctor, and I really mean it, because, you know, once you learn better, you have to do better. And I appreciate what you said, like, I treat everyone like my family, too. And I can't imagine or fathom putting people on medications without explaining to them the risks and benefits, and also explaining to them, like, hey, you know, we might not need this if X, Y, and Z. And I do think it's just, it's very unfortunate that in traditional medicine, we give doctors prescription pads, but we don't hold them accountable to talking to people about lifestyle and other things like that.

• 52:25Josh Axe?

  You, you know what I was thinking about? This is, this week, I thought to myself, because I, I just spoke last week at a, at a university, it was Life University in Atlanta, Georgia, and there are a lot of doctors of chiropractic there. And then I also recently had spoke to a group of osteopaths, and then another, and the medical doctors, and, and I was thinking to myself, okay, what are they covering in school right now? And I thought about, well, MDs and DOs are pretty much getting pharmacology.

• 52:51Speaker 01

  Yeah.

• 52:51Josh Axe?

  DCs are getting a lot of different stuff. It's more musculoskeletal. It's a little pharmacology. It's a little nutrition and that's good. But really, for the most part, the way that doctors should be practicing today, the way that you practice, I practice, some of our amazing colleagues we have that practice more functional medicine. We are getting almost zero training in how to practice what I would call true medicine, root cause medicine. I mean, doctors across the board, none of us are getting trained that way. We all have to learn that after school. And it's a little bit crazy because I'm like, how many, how many DCs, DOs, MDs are learning about food?

• 53:35Josh Axe?

  You know, as medicine, how many of them are learning about herbal medicine? How many of them are learning about all the different types and benefits of what type of exercise is better, what type of people? A lot of the advanced therapies today, hyperbaric oxygen therapy, red light, ozone, I mean, so I'm going to love it.

• 53:50Speaker 01

  Gut health.

• 53:51Josh Axe?

  Backs here, gut health.

• 53:52Speaker 01

  No, I, I completely agree. And to your point, I have a degree, the highest degree in the United States in diabetes, metabolism and endocrinology, right? So a medical degree in metabolism. You know how much nutrition I learned in my fellowship in the United States as a medical doctor about metabolism? Zero. You have any board questions I had about metabolism? Maybe one. I just recertified my boards. Maybe one out of 180. So it's like, if I'm not learning it, obviously no one else is learning it. And I agree, like it's your gut should, we should learn about our gut because everything starts in the gut. You know, I mean, it's, it's crazy that we don't learn this.

• 54:34Speaker 01

  But is it because, I don't know, is it because pharmaceutical companies have some role in that and, you know, give money to medical schools? Or is it, I don't know, but it's crazy.

• 54:44Josh Axe?

  Well, yeah, I mean, I do think on the DO, MD side, I do think that's part of the case. Part of it on the DC side, I think it's just being stuck in the past. But I do think, and this is why I think it's going to be interesting to see how schools and all this changes in the future. Because what people need and what's going online now, and even these sort of conversations you and I are having, they're moving so much faster than the schools are, are moving and it's becoming so outdated. Because I mean, I was thinking about this week, I'm like, does there need to be a new degree and type of school out there? Probably.

• 55:15Speaker 01

  Yes, a functional medicine. I've thought about it too. I actually.

• 55:18Josh Axe?

  There's certifications, but it really should be a full.

• 55:20Speaker 01

  I agree. I've had so many people reach out to me after they read the book and they're like, oh my gosh, how can I learn, you know, learn more about this? I tried to write it where anyone could read it, like a patient and help themselves, but also providers, because I'm like, doc, I didn't learn this in school either. You know, I learned it from the school of hard knocks, life, patience, like wanting to make people better. And it took years. And I agree, it's like, you know, I always want to help people. And so if I found a patient I couldn't help, I'm like, why? And then myself too, like I was really sick with Hashimoto's. And so that's how I got down a rabbit hole with gut health. And five years later, I was like, okay, this has helped 10,000 people. I have to tell someone about it. And it's like, we have to make that more accessible to your point in school so that people understand this because it's so needed. And it's just so sad because of the amount of people we could really help

• 56:05Speaker 01

  just by talking to them about, do you have a bowel movement every day? What do you eat and what do you think is healthy? That conversation right there would probably do better than any prescription you could write a patient.

• 56:16Josh Axe?

  I totally agree. I totally agree. It's getting to the root cause. And here's the great thing is, all those things you mentioned, you can fix those things. You can fix most of them free. Absolutely. Well, Dr. Cassie, it's been a pleasure talking to you. You're brilliant. And I want to encourage everybody to check out Dr. Cassie's book. It's called Fix Your Gut, Fix Your Hormones. You can get this book in bookstores, it's on amazon.com. It's a great place to go get it, just on amazon.com. Again, Fix Your Gut, Fix Your Hormones here with Dr. Cassie Smith, MD. I want to encourage you guys on YouTube. Let me know, what is the single biggest takeaway you had from the interview with Dr. Cassie today? Is there something she said or that we talked about that you said, that's me? Or I'm going to go and do this, but we'd love to hear from you.

• 57:00Josh Axe?

  The most insightful thing we talked about on today's podcast. And if you have any other questions, feel free to reference those on YouTube as well. Hey, where can people find out more about you and your amazing work?

• 57:11Speaker 01

  Oh, thanks. So I'm on Instagram, YouTube, all the social handles, at Modern Endocrine underscore.

• 57:18Josh Axe?

  That's right. So, yeah, so it's not Dr. Cassie Smith, it's Modern Endocrine underscore.

• 57:23Speaker 01

  If you, if you look my name up, you'll, I think you'll find it. It's tied. But there, my book, like you said, it's on Amazon. It's on Audible and Spotify now too. I have a podcast, Hormones Metabolism and You. And we have a website, modern-indocrine.com, where we just try to help people just like you be healthier. And again, a lot of it is free. It's just education that's, that's needed that a lot of people, even doctors, don't have unfortunately.

• 57:48Josh Axe?

  Yeah. Well, we're, we're, we're working on getting it there. So, hey, everybody, thanks so much for tuning in here to the Dr. Axe Show. Remember, every week we're diving deep into the science and principles of how you can heal physically, mentally, spiritually, and take your health and your life to the next level. Hey, in the show notes, we'll put links here to the amazing work that Dr. Cassie's doing. Also, we will put a hormone balancing guide in there. You can go and download that as well. And also, hey, do me a big favor. The number one thing you can do to support the show is subscribe. That way you don't miss a thing. And think about, is there one person, maybe if you've got a friend and they've got some hormone issues, share this episode with them. It may change and transform their life. So thanks so much for being on Mission with Us. We can't wait to see you on the next episode. God bless.