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A New Study on Hashimoto's Disease, Diet and Lifestyle

In this part, we talk about:

  • Why this research was wanted
  • How the research was funded and designed
  • Results of eating regimen and way of life on treating Hashimoto

Present notes:

Hi, everybody, it's Chris Kresser. Welcome to the second episode of Revolution Well being Radio. This week, I'm excited to welcome my guest Altin towards Angie and Rob Abbott. We’re discussing the very fascinating results of a current research taking a look at autoimmune protocol and other behavioral and way of life measures as a attainable remedy for Hashimoto patients.

And should you've been listening to the program for some time, chances are you’ll keep in mind that I had Angie and Dr. Konijeti discussing the outcomes of their analysis on autoimmune protocol within the remedy of inflammatory bowel illness. It was the primary peer-reviewed AIP research ever to be accomplished, and now this is the second one taking a look at AIP for autoimmune illness intervention, and I feel some more are already underway.

So it's actually thrilling to see this formal research of the protocol we've anecdotally recognized have been efficient for many years. And this specific research was fascinating because it did not simply take a look at the AIP food plan; it checked out other behavioral and way of life measures. So I'm wanting forward to speaking to Rob and Angie about their outcomes. Let's dive in.

Chris Kresser: Thanks a lot for being right here. I'm actually wanting forward to diving in.

Angie Alt: Yeah, thanks so much for having us, Chris.

Chris Kresser: So inform us slightly about what you planned to seek out on this research

Rob Abbott: Angie, do you need to go first?

Angie Alt: Want? I used to be simply going to ask, why don't you start, Dr. Abbott?

Why this research was wanted

Rob Abbott: Okay. Nicely, yeah, so I feel that we really understand what we are looking for in this area, and this physique of people understand how diets can have an effect on persistent illness. And while we may be a bit of an echo chamber in area, it is getting into a bigger medical area. And so, particularly, Angie has been really pioneering work on the autoimmune protocol, or AIP, as a part of a broader eating regimen and weight reduction intervention for autoimmune illnesses, and was a part of the first research to take a look at the AIP and way of life program for inflammatory bowel illness. And it was back in 2017, I feel when it was lastly launched.

Chris Kresser: Sure, we talked about it in the program. It was definitely an exciting remark.

Rob Abbott: I keep in mind once I heard about it, I feel it was by means of Angie and you, Chris. I imply, it just exploded in area. And I acquired out. I used to be like, that is so great to do that. Study, assortment of manuscripts. Dr. Konijeti was fascinated about doing it. I nonetheless keep in mind studying the paper initially and not absolutely understanding that Angie and Mickey had been a part of it and had seen issues in the paper's methods.

In fact I despatched Mick a message. And Mickey is like, “Of course, Rob. Duh. “Here we were. But after the paper came out, I thought it was gorgeous. And so I really wanted to connect and met Angie and Mickey at an ancestral health symposium. And we decided to kind of collaborate because they had realized, through some research done to the public, that they wanted their audience to really want more research, more evidence behind this approach in various autoimmune diseases. And hopefully as a kind of support to the wider medical community. And it was just a natural partnership for me to join a team and bring a medical perspective.

But also the layman's perspective as he grows up in medical school, reading your article, Chris, and seeing how to translate some of the more sophisticated science into a more secular audience description, but without losing its value. And when we started talking about the subject, I said, “Hey, it would be a great idea to do a new research because I don't want to wait another five years for some scholarship agency to finally come around and say let's investigate. "I was like, 'Let's do this myself,' I didn't fully understand what it was going to do to do it, but I just knew that Angie had used her program before. And then we had songs.

And yes, I came to Angie and Mike and I was like, "Hey, what do we want to study and who do we want to study? What population?" And so it was obvious that we wanted to use his frame, SAD to AIP 6 for the health coaching program he used with AIP IBD spent a number of years with great clinical success. And it came into being. And then we kind of said well, including our clinical experience and the fact that a couple of my patients are residing, going through a program with Angie who has autoimmune thyroid disease or Hashimoto and background, I think those people are doing well in the program. please.

Also, considering that Hashimoto and the massive affected population have no other treatments outside of hormone replacement therapy, it just seemed clear that we had to give some evidence, for good or bad reason, that you could do something besides just put people on hormone replacement therapy. And overall, I was looking at some of the literature – and you've probably seen it, Chris – that hormone replacement doesn't change the lives of many people. Yes, it may be helpful, but many people still have symptoms. And so they're just left to dry out with nothing.

Chris Kresser: Yeah.

Rob Abbott: So I'm not rushing too far, but we've basically been like, 'Yes, we want to research this population. We want to use Angie, but we want to add another twist. “And I think the biggest thing I want to bring up in our discussion today is that this study was not a diet study. It was Personal Medicine, Functional Medicine, Functional Nutrition and Health Coaching.

And I think one of the questions I had was probably the single most important question I had in my first AIP IBD study was that the title focused too much on AIP and made it appear on the diet. And it did not give power to the Angie program. It didn't really give, it didn't acknowledge unless you read from the paper and understood his program that it wasn't just about writing people and saying that you should do this. There was commitment, there was community, there were all these other aspects that we know as multidisciplinary, multi-faceted interventions, that they are important.

But I felt that we really had to take advantage of the tools they teach in this therapeutic context and use them instead of just using the power of one tool, AIP.

Chris Kresser: Definitely. Yes, it is so important. Especially the very established link between stress and autoimmune disease, sleep deprivation and physical activity, and the relationship that all these contributions have to autoimmune diseases such as Hashimoto's and IBD. Super, very important.

How was the research funded and planned

Chris Kresser: So how was the research funded and planned because you did not go through the traditional process of doing this?

Angie Alt: So when we did this giant survey of our community with only thousands and thousands of responses, we saw a Rob-type saying that our community really wanted research and they were willing to get behind it. So we decided to start crowdfunding to do research. Then Rob also worked with Genoa and they went behind us and apparently donated a lot for testing. But we went out to our communities and said, "Hey guys, we have a chance to do this and will you support us?" And we raised $ 12,000 in about three weeks.

Yeah, that was great. It was really great to see such support and get Genoa from behind. And with that, and honestly, this research team is willing to spend a lot of hours unpaid –

Chris Kresser: Yeah.

Angie Alt: But it's okay. It is an investment in the future that we were all ready to make. So we got it there. It was, of course, very thin to do it on that budget, but we made it happen. And most of all, I think knowing that our community was willing to be like that was a great feeling.

Chris Kresser: Yes, I love this model. Because such science is, commercial interests do not just ruin someone who has a particular program of action to achieve a particular result. It's not about medication research; it is so valuable and necessary. And yet, there is so little public funding available for it. But now we have this huge and growing group of people who I call civic researchers and passionate advocates of health and well-being, and who are ready to support our understanding of these concepts.

our tax dollars are toward that or at least some of them. But in the world we live in, it doesn't happen as much as needed. So it's great to see you leverage the interest and support of your community to accomplish this.

Angie Alt: Yeah, it was great to get such a unique approach to it and to show that we can eliminate the conflict of interest where the money came from, go there and do some research.

Chris Kresser: Cool. So how did you define the study, given that it was a complex intervention and that you were not just studying the effects of a single monotherapy like medicine? How did you set up the study?

Rob Abbott: Yeah, so we used the structure of the AIP IBD study – then I will go over some of the first study to the AIP IBD study and our study. The AIP HT study – but we wanted to use the original, as much as the original research design from that first pilot, recognizing that it was a really good first rough draft, and it was wise and budget-wise to use one

So we knew we had is a limitation that we have no control group. So there would be no chance. Everyone would intervene. Blinding is not really a realistic way to make a varied lifestyle weight loss intervention. And it's also kind of meaningless. So it's a kind of criticism that wasn't really valid. But we had one arm and wanted to get about 15 to 20 people based on budget size, and with the experience that Angie saw group dynamics, we didn't want a huge group. But we also didn't want too small a group. And between 15 and 20 there was a kind of ideal group size where people felt connected, but no one was too big. But neither, it's like we five are doing this.

And we once again published a poll on social media with strict parameters. It is always challenging to try to balance when you apply the exclusion / inclusion criteria to the subjects to make sure that you do not add too many selection biases, which is one of my pet pipes that people choose very specific criteria for inclusion. So I wanted to make it still broad but relevant. And so we decided to pick up people between the ages of 20 and 45 who had Hashimoto's thyroiditis, which I just needed to see either in the form of a medical history, certified by the doctor's hospital registry, or by evidence of elevated antibodies. And it may be, the antibodies could only have been out of the normal. I did not care. We did not look for people with hundreds, hundreds and thousands of antibodies, TPO antibodies or thyroglobulin antibodies. Because I didn't want to be kind of biased. And we also took precautionary measures and did not want pregnant or breastfeeding women, and we were also restricted to either normal weight or just being overweight. So the BMI is below 30, essentially 29.9. And it was more of a safety mechanism. Because I've seen Angie's program, and I knew it would work.

And so I wanted to minimize the knowledge that human thyroid medication is changing. And I could not provide direct treatment to the participants as I would in my clinic. I wanted to minimize massive, potential massive weight loss during the intervention and the need to monitor thyroid function during the treatment itself. So we wanted to get people who were either of normal weight or overweight, which some said – and I agree – Hashimoto people have weight problems. There are weight problems in America.

So there was a considerable number of people that we couldn't enroll because they didn't fit into the BMI class. But it was more from a security standpoint. And still, well, maybe not completely generalizable, I would like to generalize some of the observations, as we will talk later, to that group. The age rating was also intended to try to minimize the hormonal effects of the menopause of confusion if there were any other considerations in the late 40s or mid 50s. And so we did 20-45, also knowing that there is typically an age group where people are diagnosed or suffer from Hashimoto's disease.

So we identified a population that was special, but I think a good description of who is most disproportionate to Hashimoto. If we had just researched old black men and found results, it would have been rather poorly designed and could not be generalized, as this is a small fraction of people who have suffered compared to middle age. We only had women. We had it open for men and women, but we ended up only getting women. But that population was potentially the best representation of the wider population when you were going to make a pilot. And also by doing it on social media, we can get people around the country to many states. And so I think we had 12 or 13 states.

There were a couple of people from California, Virginia and Texas. But we actually had a good spread between individuals in several states, which, even from a small sample, was pretty great to get even a diverse group with only 17 people reporting. So we had 17 people, and the main questions we wanted to ask in this study were the combination of subjective and objective outcomes. So the main thing I'm interested in, and you're probably also agree, Chris, is that I want to see the patient actually improve either in their symptoms, quality of life, certain parameters, which means something to them. [19659009] And so, our main result was an improvement in quality of life with the SF-36, which is a pretty comprehensive quality of life survey. It is quite well validated and as a secondary result we also included the MSQ or Medical Symptoms Questionnaire developed by Jeffrey Bland through the Institute of Functional Medicine, which I consider and probably many people in this audience find very useful in outpatient clinics, to somehow objectify someone's burden. So they were the two main markers.

Subjective, yes, but we had to find a way to tell the person's experience as objective. But knowing that if we didn't see improvements there and we saw objective improvements, I wouldn't really care that much. Because I really wanted to see people be better. Nonetheless, we apparently measured thyroid antibodies and hormones. So we had a full thyroid panel so we could look at all the hormones as well as TPO antibodies and anti-thyroglobulin antibodies. And I preferred the hypothesis that seeing patients in the past would require less medication and increase in the hormone we can see TSH drop. The fact that we see hormones changing in a way that people do not need so much medicine. And that maybe the antibodies will drop even in a short time even. And the whole study itself was designed to last only 10 weeks. So I mean, it's a really short time, and I'd love to study longer. But we didn't really have the budget to do the labs every six weeks or every 10 weeks.

Chris Kresser: Sure.

Rob Abbott: But for up to 10 weeks we thought we might have antibodies. And the last two entries we had about the statistical structure and the endpoint were, and I didn't really have a primary hypothesis prior to this study because there is no population to study that marker is routinely used. But I wanted to measure inflammation in some way. So we ended up using the high-sensitivity C-reactive protein as a nonspecific sign of inflammation, knowing that if someone is not acutely ill, this sign should not be elevated, it should not be abnormal. Track and see if we could see some immune modulation through this hsCRP, or whether we also used a complete blood cell count with a difference. So we look at white blood cells, lymphocytes, eosinophils, monocytes, that sort of thing. So I had those markings to see if we could see any kind of immune modulation. Interestingly, in the latter case, which I do not want to go too far from the weeds, but I've always been really shocked by studies into the relationship of vitamin D and changes.

There are so many variables out there that can affect vitamin D. Even to say that if you put somebody in the hospital and control everything, to say that the vitamin D changed into your intervention is still a little stretchy, and to me, it is, like, irrelevant anyway because it is in the hospital. But I included it in fact, because I have seen that many patients come to me really high level of vitamin D, because it is like a universal medication.

Chris Kresser: Yep, everyone uses a high dose of it. [19659009] Rob Abbott: And so, for security reasons, I knew the kind of population we could get. So I really included it. But again, there is no reason to change any kind of hypothesis because there are only so many variables. And eventually we found some people who had vitamin D in the 80's, 90's and even had high calcium. And so I was really able to help them alleviate it.

But the quality of life questionnaire, the symptom questionnaire, and the thyroid panel were the most important scorers and things we looked at. And we did the labs at the beginning of the study, and 10-12 weeks later we repeated the labs and wanted to see how they changed.

Chris Kresser: Great. So tell me what you found.

A new study by Angie Alt and Dr. Rob Abbott shows promising results on the Autoimmune Protocol (AIP) diet as a way to treat Hashimoto's disease. In this Revolution Health Radio episode, I talk to Angie and Dr. Abbott about their findings and discuss how behavioral and lifestyle calls influenced their results. The Effects of Diet and Lifestyle Use on the Treatment of Hashimoto

Rob Abbott. : So I'll go a little bit, and then I'll let Angie talk a little bit more about dynamics. So what we ended up with was, initially, the average antibody level – and I put this in context with some of the results – the average antibody level was just, the TPO antibody was only about 200. And maybe I love your thoughts here Chris, but for me , about 200 is a pretty good clinical gain. And I didn't know what it was going to be. We talked about not knowing what people's levels were. They just had to be somewhat abnormal when we were writing people.

So I saw that I was in the beginning and I, like I don't think before the study even started, I don't think there will be how we see it decline in just 10 weeks if we start from 200 versus 1,000. But then again, if we started with 1000 and dropped to 500, was that your intervention? Or was it just after they returned to recession? But the average antibody level at the beginning was only 200 and the average TSH at the beginning was about 2. So we had a pretty good sample, a pretty good average.

Chris Kresser: Could you speculate that it was because of the population that you recruited from a population that is already fairly high in health awareness, given that they are in the community, the Angie community?

Rob Abbott: Yes, I totally agree that we, in the beginning, did the frequency survey of food. Although made for all kinds of hazards, especially the first one that asked them to look at their diet over the past year, quite generally, when I looked at everyone's eating frequency questionnaires, if they represented a diet I call above average, it was definitely not the American standard diet. It wasn't AIP. It wasn't even strictly Paleo. But it was better than average.

And then when you started talking to people – and Angie could probably give more information within the group – we started with people who did a lot of things right. Or had done things right and heard about AIP and believed it worked. It's kind of an income-critical reason for you to let people know they had an expected expectation. Well, you are not going to do that, from the perspective of life change, a person does not think it will help them, so it is foolish to tell people who do not know what it is or do not think it will happen.

Chris Kresser: Well, yes, that the placebo-controlled model comes out of the study of monotherapies and drug treatments.

Rob Abbott: Right.

Chris Kresser: It's really meaningful. or valid in a model such as Functional Medicine where you take a number of different measures. And I think in this case I have more research and a bigger budget compared to the standard of care. And I know that it is the people of Mark Hyman and the Cleveland Clinic who are doing a lot of research. Because the whole placebo controlled thing is an object in drug trials.

Rob Abbott: Right. Yeah, I know, and just like that, if you are going to plan how we hope to design future studies that have a control arm that is either a weightless group or gets a constant standard of care that you are already getting or maybe it has received some different diet treatment. But when you have all these versatile elements, it is just silly to try to figure out what does what.

And people are probably familiar with Dr. Dean Ornish, who was probably a pioneer in this lifestyle, studying lifestyle well. strictly. And if you go and speak with him, and I am sure that you are likely to be quite good friends with him, Chris, you go talk to him and people just give him all kinds of shit, "Oh, low-fat, plant-based vegetarian diet is, tappaat people without giving them fat. "But if you ask him the most important part of his intervention, he says it's love. No other elements. It's a connection. It's this loving compassion of the group, both in and of itself.

And so I say, once again, that this is a complex intervention in functional medicine, it is complicated, so it makes no sense to study it in the way that was used in supplemental or drug trials.

Chris Kresser: Yeah. And to be fair, this research method we're talking about has its drawbacks. is conducting research because he has used some of these studies in v to prove that a low-fat, more carbohydrate-rich herbal diet is responsible for the results of these interventions. And you may not know that it is true or you may not know that it is not true by the way these studies are designed.

What you can say is that the versatile intervention to which XYZ involves was effective compared to whatever was studied. I think you could then design additional studies that just compare the individual components of these interventions. So, for example, you are comparing a low fat diet versus a low carbohydrate diet. And of course these studies have been and are being done. So it's still useful, but I think it's just important to be objective and identify the strengths and weaknesses of the different research plans, as I know you did in this case.

Rob Abbott: Yes. It's about drawing the right conclusions, and I want the community to hear later on the podcast, we want to make sure we draw the right conclusions from our research, and we're positively critical. Do not say that it is something that it is not and look at it as a rough draft for future changes.

But yeah, and going back to the results in the group with everyone, both thyroid hormones and thyroid antibodies, we didn't see any clinically or statistically significant changes. Big Pharma could have come in and said it was really positive because people weren't worse But I didn't say it. We didn't say it.

So we didn't see things as a group, but six of the 13 women, so one woman couldn't stop the study because she actually got pregnant. A pretty awesome reason to kick.

Chris Kresser: Absolutely.

Rob Abbott: And towards the end of the study, so 16 women out of 17 ended up and we didn't see any changes when you looked at group or clinical levels of thyroid hormone or antibodies. We saw that six out of 13 women who started HRT started to lower their medication by the end of the study.

In some cases, the couple i people actually fell in the beginning and even more in the end. . And all of this was based on our tests and the clinical symptoms and follow-up of the local doctor. And yes, that's a huge, high percentage. And there were even other people looking at the individual stats that I was trying to put in the crude paper so people could see what we were doing.

Chris Kresser: Thank you.

Rob Abbott: Because one of my pet cats, there are a few of my pet cats.

Chris Kresser: Definitely your pet pee.

Rob Abbott: I hate trying to figure out in one figure what was studied and interpreted. And so I just, wanted everything to be there so that people could be their own critical citizen scientists. And even the numbers we use, I tried to include raw data. Because we had just enough people, it didn't get too nut to have one character to see, "Oh, yeah, there's a kind of outsider. This is it. "So you could be a better critical judge, instead of artificially doing some weird characters and just doing things that distort the information. so that they didn't really reduce their medication by the end of the study. I think they probably are going to reduce them soon. They saw big bills in TSH. And a couple of people even when you looked, And there was weight loss in the whole group, both clinically and statistically significant, both in the whole group and even in the overweight groups, but a couple of people needed less medication and they did not lose weight.

TSH did not lose or lose weight. there was a big TSH drop and they lost a couple of pounds, and this is a self-report. You have to take it for what it is. But at least on the basis of the self-report, I couldn't explain these changes. Ja yksi nainen jopa käytti T3-lääkitystä tutkimuksen alussa, eikä hänellä ollut T4-lääkettä. Ja sanoin hänelle, että sinun täytyy saada lääkärisi antamaan sinulle T4. Tämä ei ole turvallista. Ja saan hänen laboratorionsa takaisin tutkimuksen lopussa ja pyydän häntä, oi, niin että hänellä on nyt T4.

Ja olen kuin: “Joten mitä aloitit ottamaan?” Ja hän on kuin “Voi , Minä vain otan vähän vähemmän T3: ta. ”Ja olin kuin“ mitä? Etkö ota mitään T4: tä? ”Ja niin hänen hypoteesissani oli, että siellä oli tietysti tukahduttava vaikutus, koska hän otti vähän vähemmän T3: ta. Mutta hänen kilpirauhasensa alkoi tehdä T4: tä uudelleen.

Chris Kresser: Joo.

Rob Abbott: Molemmat interventiot? En osaa sanoa mitä. Interventio plus hieman vähemmän tukahduttamista. Mutta näissä tapauksissa on riittävästi sekoittuneita, että TSH: n lasku oli selvästi tämä, eikä yksilön tarve vähentää lääkitystä ollut vain painonpudotuksen takia. Joillekin ihmisille, joo. Sillä oli vaikutus. Mutta jopa ryhmänä se oli keskimäärin noin kuusi tai seitsemän puntaa. Emme puhu 20 kilosta, joita yritimme välttää olemalla liikalihavia.

Joten kun katsot tätä tasoa – enkä yritä keinotekoisesti luoda jotain, jota ei ole olemassa. Sanon vain, mitä näimme yksilötasolla, se on aika huomattavaa. Ja en tiedä, Chris, sinulla todennäköisesti oli joitain pohdintoja, mutta Angie, sinä annat todennäköisesti vieläkin ymmärryksiä työskennellä ihmisten kanssa päivä päivältä. Ja voimme päästä joihinkin muihin tuloksiin. Mutta se oli melko mahtavaa juttua 10 viikon interventiossa.

Chris Kresser: Kyllä, se on ilmiömäistä, ja se sopii hyvin yhteen kliinisen kokemukseni kanssa, jonka olen tehnyt tätä yli kymmenen vuoden ajan. Tyypillisesti TSH: n parannus on se, mitä odotan näkevämme, kun aloitamme työskentelyn ensimmäisen kerran Hashimoton taudin kanssa, ja panemme heidät AIP: n tai vastaavan ravintoaineiden tiheän anti-inflammatorisen tyyppisen ruokavalion interventioon sekä elämäntavan muuttamiseen.

And truly the speak we’ve to offer, as you probably did, Rob and Angie, is “Hey, whether someone in our clinic is the prescribing physician or someone else, you have to be in touch with them because what often happens here is as you reduce the inflammatory burden, your thyroid function is going to improve. And it’s going to start producing more endogenous thyroid hormone. Therefore the dose that you’re on now of your thyroid medication is going to likely be too high and you might start to experience hyperthyroid symptoms in some cases. Because the dose that was necessary for you before you started this intervention is now too high.”

And we don’t say anything to them about any expecting a change in antibodies within the first few months. And I feel one of the causes for that is that research have proven that antibody manufacturing can typically path what’s occurring clinically by a number of weeks or extra. So the modifications that I make in the present day, like, if I have Hashimoto’s and I make modifications in the present day, that’s not going to point out up in my antibodies tomorrow. It may be three or 4 weeks or much more before my antibodies drop.

Angie Alt:  Yeah, that’s totally true. It was lucky, I feel, for Rob and I because we had partnered prior to now on patients that he was seeing in his clinic. And then he asked them to enroll in my program. And we already had had the experience of one in every of his patients in my program coming to me and saying, “Oh, you know, I feel badly now. I’m starting to have probably hyper symptoms. I don’t think this is working.”

And then I might say, “Oh well, I think it actually is working. That’s why you’re feeling this way. Let’s go back to Dr. Abbott and have an adjustment in your medication.” And positive sufficient, that was the appropriate strategy, that we have been properly prepared for that with the women we have been working with within the research.

Chris Kresser:  Yeah, I think about that helped too because some individuals may’ve dropped out or not made those modifications. And that’s why we’re all the time very careful to alert individuals to that upfront. As a result of it might avoid outcomes that wouldn’t be desirable as a result of they know what to expect.

Angie Alt:  Right, precisely. They’re much less anxious and they’re more ready for a way things may change.

Individual Case Studies

Chris Kresser:  Yeah. So, Angie, I’d love to listen to somewhat bit extra about a number of the particular case studies. I feel that would help convey this to life for individuals. Oftentimes once we’re taking a look at a research, we’re simply taking a look at knowledge and averages. We’re not wanting on the expertise of individual individuals. And I feel it’s, I all the time love to talk to the researchers because I get a lot more colour and life when it comes to what truly happened within the research and how the intervention affected individuals. So can we perhaps share a number of anecdotes from specific individuals in this research?

Angie Alt:  Yeah. Gosh, there was so many sort of special little issues that occurred along the best way. I’m making an attempt to focus on a number of of them. I know one factor that we ran into, because we had additionally Genova’s lab behind us and some more specialized Useful Drugs sort of testing, we acquired to see things that I didn’t get to study once I participated in an IBD research.

And through the natural acids checks, we obtained to see things like heavy metallic issues and things like that come up for ladies. And we had—Rob, you may need to right me if I’m mistaken here—but we had a minimum of one or two ladies who truly got here into the research with some heavy metallic issues. And once we obtained these results back, we met with these ladies. And since this can be a research that’s completely dietary and way of life targeted, we weren’t going to do something outdoors any specialized protocols to attempt to handle that.

However we made recommendations to the women like growing issues like parsley and cilantro of their weight loss plan, sort of adding those herbs in the place they might. I feel I inspired a number of of those ladies to blend those recent herbs into their bone broth. Discover ways to convey it into their food regimen slightly bit more steadily. And at the end of the research once they had these exams repeated, we discovered that they didn’t have that heavy metallic toxicity anymore. And that was simply by including herbs over a 10-week period. I used to be really blown away by that.

Rob Abbott:  Yeah, we didn’t do a proper statistical evaluation from elements of the natural acids, primarily because it was all exploratory, and must be for a second paper anyway.

Chris Kresser:  For research functions only.

Rob Abbott:  Yeah. Because we designed the research with out even having them, and it was a generous donation from Genova that helped us to make use of that in a more specialised Useful Drugs intervention, which we will speak about. However yeah, so I looked at ladies at first, and we used the Genova Diagnostics NutrEval with poisonous factor display.

So it included entire blood, arsenic, lead, mercury, and cadmium. And as I just stated, we weren’t doing, we had no scope to be able to do any type of fancy cleansing intervention, however a number of people got here up at first. And you may take this for what it is. It’s only a entire blood pattern. It’s not a urine provocation. It’s just what’s within the blood at that time based mostly off of Genova’s reference ranges. And a number of other came again with excessive mercury. And some had dental amalgams, some didn’t. And it was seafood. But mercury appeared to be a problem.

And a couple individuals even had lead present up as a problem. So we made word of it, as Angie stated, with people and gave some what could seem perhaps inconsequential small modifications, however perhaps one thing to psychologically help them really feel like they might detoxify. And I figured at greatest like we’d see a 50/50 wash. Like, perhaps some individuals would go up, some individuals would go down, just statistical noise from this. But virtually universally—and I don’t have a statistical calculation on this, and so you possibly can just take my word for what it’s—but virtually universally taking a look at it, anyone who was high came down, either nonetheless staying out of the traditional range or even turning into normal.

There was no one who went from primarily no toxicity to toxicity. And so I don’t know what to make of that absolutely, because it’s simply of a single sort level check. It’s an entire blood check. Nevertheless it was fascinating to me to see that clearly there was one thing going on to get cleansing methods online and points of this intervention. Because the whole blood mercury that was there at first was not. And this was simply 10 weeks, and these individuals didn’t move, they didn’t change something radical. And even simply in the event you had stopped eating tuna as a lot, that also wouldn’t have had an enormous impact, at the very least for my part. And so that was type of simply an interesting sudden discovering from the NutrEval.

Chris Kresser:  Truly not sudden for me. I can’t keep in mind, a while ago, somewhere wrote something, a blog within the Practitioner Coaching Program, I’m unsure. Rob, perhaps you keep in mind from the ADAPT program, but there are actually research that correlate mercury publicity with thyroid antibody manufacturing. One from Ann Haynes, truly, checked out knowledge from 2007 and 2008, I consider, and they found ladies with the very best blood mercury levels showed higher odds for greater thyroglobulin antibody manufacturing.

And I’ve seen comparable findings for lead and arsenic, I consider. And it is sensible. I imply, we all know that these metals cause irritation and oxidative stress and that the thyroid is especially prone to that. So it’s undoubtedly one of many things that I discover in my patients with Hashimoto’s and other autoimmune circumstances.

Angie Alt:  Yeah, I mean, that was, like I stated, I’ve by no means been in a state of affairs where I was capable of see these laboratory modifications myself, and that was really cool to observe that. I feel when it comes to other case studies, despite the fact that she didn’t get to complete with us, obviously our participant who got here into this system dealing with infertility and really having a high personal aim to perhaps restore fertility and turn into pregnant, clearly having—

Chris Kresser:  I used to be going to ask you that when Rob had talked about that she dropped out because she acquired pregnant. What was going via my mind was, was she making an attempt to conceive and then not capable of conceive? And did this intervention help with that? In order that’s really cool.

Angie Alt:  Yeah, undoubtedly. I feel it was about week 9, she came to us and stated, “Hey, you guys, I don’t think I can continue this study because I’m pregnant.”

Chris Kresser:  Yay. That’s one of the best information ever.

Angie Alt:  And so we have been like, nicely, we don’t mind that at all. That’s superb. However not totally sudden for me either. I’ve seen that occur during the last six years a number of occasions in the course of the course of my program. And it even occurred with a younger lady who had very premature ovarian failure. And she or he even received pregnant, which completely floored her docs. And so obviously that was really exciting.

Chris Kresser:  I’d take all of those infertility diagnoses with an enormous grain of salt.

Angie Alt:  Sure.

Chris Kresser:  As a result of I’ve discovered through the years that, and Robb Wolf used to speak about this so much, where when individuals would come to his fitness center and he would begin advising them on weight loss plan, get them on a Paleo weight-reduction plan, get them understanding, in the event that they have been younger ladies, he would ask them about conception and birth control.

As a result of what you found was so many women would just get pregnant and they weren’t necessarily making an attempt to. But that they had not been getting pregnant with not utilizing birth control or paying much attention to it. And then once they clear up their food regimen and tackle their physical exercise and start enhancing their well being, rapidly the physique’s like, “Oh, hey, all right. Things are cooking now. Now we can do this.” And I will typically warn my younger feminine or ladies of child-bearing age of that too, particularly in the event that they’re not planning on doing it to get pregnant, to watch out and pay more attention.

Angie Alt:  Yeah. I’ve undoubtedly adopted the identical strategy through the years, Chris. I say to them at first, “Pay attention, ladies. Those of you who aren’t planning it might have a surprise, and for those of you who are planning it, you might achieve your goal.”

Chris Kresser:  Proper, proper. So I’m just, I’m rewinding a bit bit as a result of I just needed to look something up right here. So yeah, I’m taking a look at a research of, I mentioned the mercury and Ann Haynes. And this one, this is from the Journal of Environmental Pollution. “Lead and Cadmium Exposure, Higher Thyroid Antibodies and Thyroid Dysfunction in Chinese Women.” They discovered correlation between lead and cadmium levels and greater TSH and hypothyroidism and greater antibody production in ladies.

Yeah. After which there’s an entire bunch of different research in the event you look. And in case you pull that one up, you’ll see tons of comparable articles along the same line. So it is, I’m glad you talked about that. Because it’s one of many issues that is typically unexplored, and it’s one of many reasons that the traditional strategy to treating Hashimoto’s is so lacking. As a result of it’s the basic instance of symptom-based illness management the place the dysfunction, the last word impact of Hashimoto’s or hypothyroidism, is low thyroid hormones. So the intervention is then thyroid hormone. Just give thyroid hormone with none attention on why the thyroid hormone is low in the first place and what’s inflicting that.

And Rob, that is in all probability a superb segue. You’re, among many other qualifications, you’re an ADAPT-trained practitioner who has studied Useful Drugs, and this is the strategy that you are bringing to your work and this research particularly. So how did the ADAPT practitioner coaching inform the best way that you simply looked at this, designing the research and the outcomes?

Taking a Useful Drugs Strategy to Hashimoto’s

Rob Abbott:  Yeah, properly, I simply assume, I’ll maintain the story brief, and I don’t need to embarrass you, Chris. But I mean, my story even stepping into this area is nuts. Over six and a half years in the past I was a affected person myself, having stopped medical faculty, not understanding what was going on with my life. And I got here throughout Chris’s podcast, truly, in the hospital and began listening to it and just, like, mild bulbs went off in my head. Like, that is how I’m going to get myself higher and that is what I’m going to do to assist individuals once I come back to high school. And so I went by way of all of faculty understanding, all of conventional medical faculty figuring out that is the strategy I needed to take, and earlier than I even met Angie and Mickey in individual, I used to be handing out a few of your articles to sufferers within the hospital. Handing out books and recipes.

Chris Kresser:  You have been that annoying guy.

Rob Abbott:  I used to be, ultimately, however my attendings just stopped caring as a result of they’re like, “He seems to really care about these people. He’s probably doing something helpful.” However then I acquired the fortunate alternative between my fourth yr of medical faculty and starting residency to be part of the ADAPT program. And it was a good time interval because my fourth yr was, it’s the simplest yr of medical faculty by far. It’s all this elective time, principally doing analysis. Truly had time to actually pour myself into the program and then put it into follow too, and residency to some restricted extent.

And the structure of methods to really, it’s all conceptual framework. I mean there’s some lovely pearls at how you can really apply the medical drugs day in and day trip, which isn’t all the time essentially taught via the Institute for Practical Drugs. However I had some good core protocols, nevertheless it was more the conceptual framework. How do you consider this stuff? What varieties of questions are you asking? It even helped inform how I did my notes and created remedy plans. And I had lovely handouts that I might give to individuals that you simply offered in this system, which was, I mean, speak about a work that you simply don’t need to do on your personal when there’s one thing already there. I didn’t need to reinvent that wheel. So that’s lovely assets. However it actually was a conceptual framework of how you can, what sort of questions to ask individuals and to honor their story.

And so I carried that by means of residency and acknowledged too that that was going to be a priceless piece for our intervention. And so I truly met with the women initially of the research individually, all nearly, and went over their preliminary lab testings, their testing findings, their objectives and informed them we’d be assembly again midway via the research to go over a few of the more nuances of the organic acids check and the stool check, nonetheless just making dietary recommendations. We weren’t going to do something high-level intervention. And then met with them again on the end of the research to go over the final results.

And so had this fixed particular person useful care, and in between there, Angie and I and the opposite well being coach, Andrea Hirsch, we met together to type of undergo everyone and provide you with these objectives for individuals and all be on the same page. So it will be simply this excellent multidisciplinary group dynamic, which now, once I first did the ADAPT coaching, the well being coaching program hadn’t come out but. But people at the moment are in your ADAPT well being teaching training.

And so what this intervention turned was principally simply blending actually personalised Useful Drugs with an integrated—I say that because we have been communicating together, not just integrative—however this built-in strategy where I might communicate with Angie doing and Andrea doing steady well being coaching with the group in a group setting. And there’s just, I begin to get speechless once I understand the implications of what we research. And while I don’t need to go leaping and say everyone used to do this, but we are validating the personalised care movement. We’re validating the rules of Practical Drugs. We’re validating the position of well being coaches. And we’re validating the rationale to do it altogether.

And Chris, I mean, you’re principally, I imply, I’m preaching to the choir right here, but you’re training people to principally embody these roles, to play these roles for individuals in several ways. And it’s received to be the longer term. However this research and hopefully future research that we design with this multidisciplinary construction are beginning to point out the efficacy for a number of persistent immune circumstances, autoimmune circumstances. And we’ve to make use of this. We now have to make use of this structure. So I’ll cease there as a result of like I stated, I’m operating out of phrases. However it’s so superior to me.

Health Coaching and Collaborative Care

Chris Kresser:  Yeah, kudos to you both. I imply, it’s just this research, I was tremendous excited once I heard about it as a result of it truly is a manifestation of the imaginative and prescient that I’ve had for a very long time of this collaborative apply mannequin, where you hyperlink licensed clinicians which are maximizing scope of their follow, ordering exams, deciphering the results, prescribing remedy, with the help of the allied suppliers like well being coaches who are working within the trenches each day with individuals that really help them in making the modifications that must be made. And that’s the only method forward right here.

We’ll never have enough docs to deal with continual illness, and they’re not arguably the individuals who must be working intensively with individuals to make the modifications which are required because they don’t have the time or even the coaching to do the food regimen conduct and way of life help. That’s the job of a health coach. And likewise, well being coaches will not be educated to order and interpret lab exams and prescribe remedy and do procedures and the things that docs do. So putting them collectively on this method and then tying that to a strong and rigorous research that may show the outcomes is simply, it’s superb. I’m so excited about what you guys have accomplished.

And Angie, I’d love to hear a bit of bit more about your perspective because the well being coach in this intervention. We just heard from Rob from a physician’s perspective. And how was it so that you can be concerned on this and working with patients and working with Rob?

Angie Alt:  Yeah, I imply, it’s an superior model. For me, it’s a dream-come-true state of affairs. Because the starting, once I started my well being coach coaching and then ultimately went on to add nutritional therapy training to it and started working with individuals and then realized that one of the simplest ways for me to leverage what I was doing can be in a gaggle setting, and then to culminate in  this chance to get to work aspect by aspect with the physician and actually, actually take the load off of his shoulders in some ways and let one of the best of his expertise and experience really shine and come by means of for these ladies. And then also in turn have his respect that I knew how to do this piece of main them by means of the process. And we might talk in actual time about that and pivot as wanted for the patient’s needs. That’s an superior feeling, and the outcomes converse for themselves. It’s clearly clear that doing this mannequin is greatest for everybody. I feel health coaches can primarily stand in the hole. We’re the bridge between the patient and the physician, and we’re where the real-life stuff occurs. And that’s not the most effective use of the physician’s time, nevertheless it’s an incredible use of our time.

Chris Kresser:  Absolutely, yeah. And as you stated, it permits you to work on a multidisciplinary staff, it recognizes you as a reliable healthcare skilled who has quite a bit to supply and is a vital member of the group. And especially with interventions like this. If the intervention is just a drug, what is a well being coach doing there?

Rob Abbott:  “Did you take your medicine this morning?”

Chris Kresser:  And there are actually well being educators that assist make sure the individuals do this, and I’m not saying that’s not invaluable. But in a medical mannequin where you’ve got these multifaceted interventions which are eating regimen, conduct, and way of life based mostly, well being coaching becomes absolutely important.

Because we know that 6 %, solely 6 % of People at present are following even simply the highest five health behaviors recognized by the CDC, much less a extra rigorous protocol like AIP that additionally includes stress administration and getting enough sleep and physical exercise. So we can’t truly do that without well being coaches, identical to we will’t make as a lot progress as we need to make with well being coaching alone without collaboration with clinicians.

Angie Alt:  Right. Exactly. I assume that’s one other piece of it for me, Chris. You recognize that that’s some extent of frustration that I came up towards many occasions up to now and in all probability will still sooner or later to some extent—understanding that my shoppers in all probability want some next-level stuff, however they’re having hassle accessing that care or I don’t have a partnership with a physician that I can advocate them to, one thing like that.

And so it was awesome on this setting to be … We might proactively tackle things like symptoms beginning to turn into hyper. We might proactively cope with what was coming out on the lab work and what Rob was deciphering there. That’s superior to get to try this in virtually real time.

Chris Kresser:  Completely. And I mean, we might go on and on. Unfortunately, I have to wrap this up in a minute right here. However we’re all on the identical page there and share the identical imaginative and prescient. And that’s in fact, for me, why I’m coaching each practitioners and health coaches. As a result of that, to have health coaches and clinicians which are educated in the identical not simply philosophical framework, however the same sensible framework, the place they have a shared understanding of the analysis to remedy, the weight loss plan and way of life conduct modifications, the framework for taking a look at these circumstances and methods to intervene.

To me, that’s the place it gets very highly effective. Because when you can do that in collaboration and you’re beginning with that shared framework, it will get really exciting, as you’ve got confirmed with this research. So thank you both for doing this work, and I’m excited to see what is coming next and for coming onto the show and sharing the results with us.

Angie Alt:  Thanks for having us, Chris.

Rob Abbott:  Yeah, thanks, Chris. And thank you for giving us the framework to even research in the first place. And I know you’ll proceed to help and create the clinicians and well being coaches that may perform the care and the research that we’re just starting now. So, yeah, thank you.

Chris Kresser:  Yes, yes, we just wrapped up enrollment for the second cohort of the ADAPT Well being Coach Training Program, which could be very thrilling. And the primary cohort simply graduated in early June here and simply phenomenal results. If you want to take a look at a number of the experiences that folks had in this system and the way it modified their life, you possibly can go to We’ve collated quite a lot of movies and written tales from individuals in this system. It’s just been super gratifying and rewarding for me to see that.

And then we now have enrollments for the fall, both the Practitioner Coaching Program and the Well being Coach Coaching Program arising this fall. So you possibly can study more about these at Click on health teaching or Useful Drugs. After which Rob and Angie, where can individuals discover out extra about your work?

Rob Abbott:  Angie, you possibly can go first.

Angie Alt:  Everyone can find me and my associate Mickey Trescott over at You’ll discover hyperlinks to the complete articles for both the AIP IBD and the AIP Hashi research articles. You will discover them there. You will discover our books, yow will discover our podcast, you’ll find our social media. All the issues.

Rob Abbott:  And also you’ll find slightly bit of myself over there too. I do get to write down and have been fortunate to be able to associate with Angie and Mickey. I noticed too, and I’ll simply throw it in there, it’s, like, self-explanatory to me, however the individuals’s symptom burden and quality of life did get radically higher. I feel I didn’t truly say that explicitly as a result of we jumped to thyroid and that podcast. But individuals obtained approach higher in this research.

Chris Kresser:  Yeah, that was one of the foremost constructive findings of this research in some methods.

Rob Abbott: Dramatic enchancment in quality of life and radical lower in symptom burden, which was superb. Yeah, I’ve a collaborative clinic apply, a Practical Drugs vitamin follow, in Charlottesville, Virginia, referred to as Resilient Roots. It’s shaped out of the construction that was within the ADAPT framework. So I work alongside a nutritionist, and we’re utilizing a few of the construction that was within the ADAPT framework.

So I can’t tell individuals sufficient how useful that program could be. And so we’re seeing people regionally in Virginia and truly doing digital care too, Practical Drugs care, not full-scope medical care. However so if you want to be a brand new affected person of our follow and have been aware of Chris Kresser, we utilize those rules in our clinic. And I additionally do some podcast and poetry and other blogs and issues on my private website, referred to as A Medicinal Mind. And even, and I hold forgetting about this too because it was a long time ago, however I do have an eBook, the second version of it too, a free eBook on the website that was my encyclopedia. It’s an abridged model of all of the assets which might be out there so that you can study—integrative health, Practical Drugs, and it’s received podcasts, it has books, it has weblog articles, it has conferences. It’s just, there’s a wealth of issues on there. Even when you’re on this area, you’re going to seek out something on there. Somebody you haven’t heard of. And perhaps you discover a new podcast to take heed to. And I up to date it last yr. I haven’t up to date it this yr.

But undoubtedly, join the email record, download and get that eBook and share it with individuals. Because it was my encyclopedia for what I discovered in all my rabbit gap diets throughout my medical faculty coaching to try to find Useful Drugs. And I used to be like, I needed to have one thing like this to help slender this down. In order that eBook is there for people if they need to obtain it.

Chris Kresser:  That’s an amazing useful resource. Nice resource. I’ve seen that and highly advocate it. What’s the web site, Rob?

Rob Abbott:  Yeah, so it’s It’s sort of a play on A Lovely Mind, however yeah,

Chris Kresser:  Nice. And I highly advocate those of you who need further assist, and if Rob and Angie are a very good fit for what you’re on the lookout for, they’re both phenomenal practitioners in their very own right. And I can’t advocate working with them sufficient.

So thanks, everyone, for listening. Hope this was inspiring to hear. There’s so many phenomenal developments occurring in the subject proper now. It’s really, it’s simply so rewarding for me to be part of all of this, and I know so lots of you’re keen about it, whether you’re contemplating a profession within the well being professions or you’re just, again, a citizen scientist and well being advocate and someone who needs to help this motion going forward, we respect your help and your advocacy.

So thanks for listening. Proceed to send in your questions,, and we’ll speak to you next time.

Do you’ve Hashimoto’s disease? Have you tried an AIP food regimen to deal with the situation? Comment under and share your story.

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