Adrenals, Thyroid, and Insulin: The Key Hormones Behind Fatigue with Dr. Ritamarie Loscalzo

Adrenals, Thyroid, and Insulin: The Key Hormones Behind Fatigue with Dr. Ritamarie Loscalzo

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Hey everybody, welcome back to the EnergyMD Podcast where we help you resolve your chronic fatigue and related symptoms from especially long COVID and chronic fatigue syndrome so that you can get back to living your best life naturally. So really excited today because we're going to be talking with my friend, Dr. Ritamarie Loscalzo and all things energy related. She's an expert in nutrition and hormones. So I'm going to take this opportunity to ask some of the questions that I've been having in this realm.

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for oh the recent past, I should say. So really excited to chat with her. So let's learn a little bit about Dr. Ritamarie. So she is the founder of the Institute of Nutritional Endocrinology and an internationally recognized leader in functional health. A doctor of chiropractic with certifications in acupuncture, nutrition, herbal medicine, and heart math. She specializes in root cause solutions for insulin.

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thyroid, adrenals, and digestive issues. With 30 plus years of experience, Dr. Ritamarie teaches practitioners to use nature and science to restore health, and she inspires audiences as a bestselling author, speaker, and podcast host. Her show, Reinvent Healthcare, empowers wellness professionals worldwide to transform care and create lasting change. Dr. Ritamarie, thanks so much for joining me today.

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Thank you for having me. It's always such a pleasure to talk to you. Wonderful. So let's start off first with, with energy. And, know, for people who are listening to this right now and they're not sure if they have an energy issue, how does somebody know if they're struggling with an energy issue? Yeah. And, know, it's interesting because a lot of people don't know they have an energy issue. And I was one of them because I was caffeinating myself all day to cover it up. So, um, that was back in the day, but yeah, well,

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First of all, you can't get up in the morning, you're driving yourself around, you don't have the energy to do all the fun stuff. That's the obvious stuff, right? um But the other things that, you know, people that just get up and have their cup of coffee and then their next cup of coffee and then their sugar in the afternoon saying, don't realize that they're depleted and that they're tired. And that was my case. I would just have my black tea, 10 cups a day. I never considered myself a tired person. I was always bouncing around like this. So that's it, but also...

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Low energy is in other parts of the body, so in the brain, right? So you're depressed or your brain is just like feeling like you're going through mud trying to come up with answers, right? Things that used to be easy for you are hard. Digestion, right? Constipation. That's an energy issue, right? Dry skin. People don't think of that as an energy issue, but the skin can't replicate and replenish itself because it's low in energy. Breathing problems. So any system, every system in the body.

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can be experiencing low energy. And so it may not be the overt, I just don't have the energy to get up and get around in the day. Yeah, and I think that's really important. People need to know that you deserve to get better. You deserve to have your best life, right? And if you're dragging around, if you need to nap, if you're surviving on caffeine, then there's something that you can do about it, right? Yeah, yeah, absolutely. That's the one thing I forgot to say.

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This is a common one. You hear it all the time, too. Oh, I get that usual three or four o'clock in the afternoon dip. And people just think that's normal, like we're supposed to have all day energy, right up until, you know, it's time to go to bed. And that four o'clock afternoon dip is part of the low energy picture. Right. So what is your opinion of the siesta? Right. So a lot of the world likes to take an afternoon nap. ah You know, I'm kind of

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I'm kind of torn. Like, is this natural? Is this created by this is obviously created by man? Is it with our natural rhythms? I don't know. What are your thoughts? I know that's a good question because I'm not a napping person. Right. If I go down, I'm going down. That's it. I'm going to be down there for seven or eight hours. But I think that there's a lot of countries that do that. They slow down. We in our kind of modern world, which will go, go, go, go, go. And, you know, it could be a helpful thing to take.

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you know that power nap they talk about that 20 minute power nap. been studies that show that people who nap have better overall function better cognitive function better hormone health and all I don't know that there's been enough studies to prove it one way or the other but I also think that there's so much bio into that visuality that some people are going to do really well with it my son 20 minute power nap middle of the afternoon he's good to go for many hours.

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If I try to go down for a 20 minute power nap, first of all, I won't fall asleep. But if I do fall asleep 20 minutes later, I'm going to wake up groggy. And because I've tried that when I've like done an overnight flight or something like that, I wake up groggy if I don't get the full spectrum of sleep. So I think it varies from person to person. But I always tell people if you're feeling tired, just take a break. Just try it. Try taking that and replenishing yourself as opposed to what we typically see is more coffee, more coke, more sugar.

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to keep us going, why not actually really recharge your body by getting a little bit of sleep, which is what your body needs. Yeah. And I think, you know, people don't really need to nap. You know, the adrenal glands really like it when you are horizontal. And so sometimes just lying down for 15 minutes. Yeah. You know, and maybe that's kind of like part of the idea around the siesta, though it is for a couple of hours. But it's nice to it's nice to have a break. I think there's also the psychological benefits of, you know, where we're

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We're not living to work. We're working to live essentially, you know, it pays our bills sort of thing, which a lot of Europe does and a lot of the rest of the world. Yeah. Excellent. Okay, great. So yeah, so a lot of the time when I'm talking about the causes of chronic fatigue, chronic fatigue syndrome, long COVID, we're talking about deficiencies. We're talking about toxicities in the deficiencies. We're talking about hormones, which I know you're an expert in. Can you talk to us a little bit about some of these hormones that are playing a role when people are tired?

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Oh, absolutely. The first one that comes to my mind and most people's minds is thyroid, right? If you're thyroid, it sets the metabolic rate of every cell in your body. So if the thyroid is deficient, if we have deficient thyroid hormone or we have problems with the receptors on the cells that the thyroid hormone isn't getting in. So I think of it as intracellular deficiency as opposed to blood deficiency, because a lot of people are they're tested and they're, your thyroid numbers look good. And even bifunctional.

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ranges, they may look good, but it's not getting into the cells. So it's a cellular deficiency there. Cortisol, right? A lot of people have too much cortisol, but a lot of people have too little cortisol. And what they don't realize is too much cortisol leads to the sequela of too little cortisol. So cortisol is that stress hormone that helps us to shunt some stored glucose into the bloodstream so we can feed the muscle, so we can run and get away from predators and all the

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the things that it's meant to do. So that can be a deficiency. um Insulin, although I usually see insulin as an excess. So a deficiency of insulin is usually seen in something like type 1 diabetes, some kind of autoimmune condition that's attacking the cells that make insulin or attacking the insulin itself. So we have a deficiency. But most people, again, when we talk about cellular, they are deficient of insulin.

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cellularly, right? Because it doesn't grab on and it's not able to get into the cells. I do this thing, well, it latched on to glucose. There's glucose in there somewhere. Glucose and knocking it into the cell and then we have intracellular low glucose, which means the mitochondria can't make energy. So those are some of those that are the ones that come to mind most. Yeah. And when you talk about intracellular thyroid, is there a measurement?

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to determine whether somebody has good intracellular? No. It's an exclusion. It's a diagnosis of exclusion, as we might say in medicine, right? You basically go, TSH looks good. T4 looks good. T3 looks good. No antibodies. know, reverse T3, everything looks good. Why does this person have symptoms of low thyroid? It's because it's not getting into the cell. Now, there are certain things that would predispose someone to having poor intracellular because

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The cell receptors require vitamin A, for example, their retinol related or dependent receptors. So it can't get in if there's not enough vitamin A in the system. Too much homocysteine can damage those cell receptors and we can't get the thyroid in. Too much cortisol or too little cortisol. So we see that stress response that doesn't allow that to get into the cells. But yeah, there's no like direct tests. Like we can't go into a...

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do a biopsy of your cells and see if they have appropriate levels of thyroid, which is why I think so many cases are misdiagnosed, right? My people are, oh, your TSH looks fine. Here's some antidepressants and here's some laxatives and here's something for your dry skin. But wait a minute, that picture looks like a thyroid. It probably is because it's not getting into the cells. Yeah. So what I do, and I'm curious about your thoughts on this, is that I find that when we

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we work on people's adrenals and then we work on the mitochondria, those things will improve thyroid function. Yeah. Yeah. And then, um, and what's interesting is that sometimes the thyroid will appear worse after I do that. And my supposition is that the thyroid's been trying to compensate for low adrenals. And so it kind of pushed itself up. And then once you've got the adrenals and the mitochondrial on board,

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then all of a sudden the thyroid can kind of relax and then it appears worse. Any thoughts? Have you seen that? Any thoughts on that at all? That's a great point. And I haven't really thought of it that way. But it's a kind of almost like a rebound thing, right? It was over and over and over. It goes, I don't have to do this anymore. But I think it's a good theory. don't have any direct experience with that, but it totally makes sense. Cool. And then the other thing that I do that

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I think that is interesting and I'm curious about your idea is that I do a subjective thyroid ramp up. So I don't prescribe anymore. So I have people take a glandular supplement, a little amount. And when I, when they have either low thyroid numbers or low thyroid symptoms, even if the numbers are fine, I'll have them do, you know, increase by a little bit every two weeks and get them up to a dose. That's too much. So they get hyperthyroid symptoms, and then I take them down a little bit. And it seems like

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that's kind of their optimal dose. And I feel like that saves time because then you're not waiting for the labs to come back every eight weeks or so. What do you think about about that approach? I think you have a really interesting perspective there, right? And and you know, you do have to be careful if you're putting somebody into hyperthyroid, right? Because you don't want to affect the heart. That's a biggie, right? That hype that it can affect the heart. So you have to be super careful and be doing it, you know, with the right monitoring and

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If you're only seeing somebody like in a traditional medical practice, like once a month, you can miss that sign and they may go, Oh, my heart was beating a little fast. And the next thing you know, they're in the ER. Right. So I think that's, that's the downside of that. There's a risk there, but if you're staying in touch with people on a regular basis and really teaching them what to look for, it could be a good way. But I think that there's also, we have to look at what is the cause of that. Yes. Clean up the adrenals, right. But what is the cause here?

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The mitochondria do not like toxicity, right? They're like the cell danger response and they're going to go, I'm not making energy for you to go, you know, jumping in, running and all that. I'm making energy to get rid of these toxins. So it's really important that we don't use a glandular in place of all the other stuff, which I know you do. You do all these other pieces to look for the toxicities and the viruses and all those other things. Yeah. Yeah. That's a good point. And yeah, good recommendation for people who are listening to this.

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Don't go out and do your own subjective thyroid ramp up. You know, some of those side effects can be heart palpitations, diarrhea, agitation, anxiety, you know, so make sure that you're under the care of somebody um who knows what they're doing. So let's talk a little bit more about thyroid and thyroid lab testing. What's your opinion on like what should be run and how accurate are thyroid labs?

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Yeah, it's a good point how accurate are any odds, right? They're point in time, but I like to look at trends and I like to look at interactions. So I think with thyroid, you know, I want to make sure there's a TSH, total T4, because then we know what that thyroid is actually producing, free T4, free T3, that's the active part that goes into the cells and creates the metabolic changes, and then antibodies, TPO and...

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antithyroglobulin are the two main ones, but if somebody comes in with hyperthyroid type symptoms, I'm also going to add an anti, what is it called? The receptor one. Thyroid receptor antibody. T-RAB. I always remember it as T-RAB. Yeah, yeah, yeah. There you go. That one. Right. To rule out Graves' disease. Yeah. And it's interesting because you can have, oftentimes when people have Graves, they have both.

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Oftentimes and oftentimes an early sign of Hashimoto's is actually great. So the presentation is hyper and then it goes to hypo. So yeah, I think it's important a lot of times to do both, you know, unless you're not sure. Yeah. Right. When you have autoimmunity, oftentimes you can have multiple autoimmunities to different parts of the body, right? The immune system is confused, dysfunctional, etc. So and the antibodies, obviously, like you said, they're a snapshot in time.

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Are they going to if the antibodies are negative but somebody has low thyroid, what is your suspicion for Hashimoto's? I mean, it depends, right? If they're 90 percent, according to statistics, is is going to be Hashimoto's. There's a 10 percent that's a primary hypothyroidism. So I'm still watching it. Right. And I'm looking for signs of other autoimmune conditions and I'm still going to. OK, maybe I don't care if they have a diagnosis, quite frankly. Right.

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I just want to know what's at a balance in the body. So we're going to look at the gut. We're going to look at the microbiome. We're going to look at leaky gut. We're going to look for chronic low grade infections. We're going to look for mold and all the things that create and cause an autoimmune condition. We're going to look for that anyway, whether or not the antibodies show up. If the antibodies show up, then we have something we can put our teeth on and be able to say, OK, look at this. It's 600 this month.

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And, look at that, we did all this work and now it's down to 200. We're working in the right direction. But sometimes the antibodies don't show up. You could do an ultrasound and see if there's any nodules and nodules usually indicate that there is uh an autoimmune condition. But when in doubt, I assume there's an autoimmune condition and I'll get everything balanced around that. Right. And in general with complex chronic disease, I mean, at least all the people that I see.

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You know, they have all of what I call the toxic five. They've got the heavy metals, the chemicals, the molds, the infections, the nervous system dysfunction. Right. And all all of them need to be addressed. Oh, yeah. So do you ever find that as people are getting better, sometimes the antibodies go up instead of down? I've seen that occasionally. Usually I don't. um Usually if I see that trend that they're going that they go up and they keep going up, then I'm thinking, well, maybe there's they're releasing something.

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that's causing more stress on the system, right? Maybe their liver is not able to handle releasing, maybe they're losing weight, but we're seeing that the fat contains a lot of toxins, which overrides the... So I'd start to look at the liver and the liver capacity and helping them to support it that way with herbs and nutrients and foods and lifestyle, or everyday detox is what I like to call it. Nice. So you kind of alluded to this a little bit.

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You know, when people's hormones are off, what do you what do you like to do for your approach? Which depends on which hormones, right? Right. My approach to pretty much everything is to look at what are their foundational lifestyle habits, right? I don't care what their vitamin C level is, if they're not sleeping. That's a more important thing for me to look at, or if they're getting stressed and they're living in a toxic environment or whatever.

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So we really got to look at all that and the foods, right? If they're eating the standard American diet and the ultra processed foods, it's looking at that. So my first approach to any hormonal imbalance or any imbalance in the body is to get all of those foundational habits in place, get the food in place, get good nutrition. Obviously, if somebody has clear malabsorption, we're going to work on how do we get the gut handling this better. But a lot of times it's like take away the stress. Don't keep battling it with these

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ultra-processed foods that are causing oxidative stress on the body, let's fix that. And you may have to do some other stuff temporarily to fill in the gaps and fill in the holes. So in today's day and age, people are stressed out. Yeah. And they may be hesitant to change their food plan. um Food now costs more, especially organic food. oh

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Do you have any tips or how do you help people make that transition from, you know, standard American diet to a healthier diet? Yeah, so I haven't worked with anybody on the standard American diet in a long time because people that come to me are usually I've tried this and I'm on a good diet and oh, what next? Right. But it's really important to see that what's your most important asset. So I start with what's your big why at the start?

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Why do you want to get healthy? Why do you want to lose weight? What is important to you? And how do we work with that? And I spoke to somebody just the other day who said that she was, uh she knows she needs to lose weight. She knows she needs to get healthy, but it's really hard. And she didn't have a big enough why. And then she found a why. Like it was, you know, I don't want to go into all the details, but she found some reason like, oh my God, I can help that person over there. I can save that person's life.

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if I get my own health in order and that's flipped the switch for her. Right. So what is it that's going to flip the switch? I love to play the piano, but I so much joint pain. can't play the piano anymore. I really miss it. I want to do that. Or I want to see my kids grow up or I want to see my grandchildren or whatever that might be. So I get people connected and then I kind of ask a question, which do you like more this goal or the chocolate chip cookies? And they go,

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Well, this goal, of course, right? Okay, let's talk about how we're going to wean you off the chocolate chip cookies. I'm going to teach you how to make chocolate chip cookies that are good for you, that are gluten free and dairy free and sugar free, but taste delicious. Would you like to do that? Right? So that's how I do it. And I offer them substitutions, right? I don't tell them unless they obviously have to get off of chocolate. I don't tell them you have to get off of chocolate, right? So or whatever their favorite food is, I'm using that because it's mine, but.

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never had to get off of it. the point is, like, for example, I had somebody and I knew she coffee was not good for her. And it was just stimulating her and all this. And it was just not a good thing for her. But she just loved her coffee. And then we looked at her genes. And we found a gene that there's a gene that processes most of the caffeine, but also processes the toxic estrogens that cause DNA damage. And I said, you know, every time you drink a cup of coffee,

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your body's less attention towards this estrogen process. And I basically said to her, you know, you're have to make a choice, which do you like more, your coffee or your boobs? And she said, oh my God, when you put it that way, I'm done. She hasn't had coffee since. Nice. Yeah, that's great. The psychological reasons for why we're drawn to certain things is really important. Big, yeah.

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Yeah, and people forget that you can still have a very meaningful Christmas and Thanksgiving and whatever your holiday is and you can eat differently. Yeah, and still be enjoying it and loving it. And I do this. I go for Thanksgiving at the in-laws house and I make all these treats and they're like, wow, this is healthy. Holy cow. I could eat like this if somebody made me this food every day. It's like that's what I do. I teach people how to do it and it's easy.

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It's not hard. you have we've got Thanksgiving coming up? What is it next week? Do you have a favorite Thanksgiving food that is maybe different than the standard food? I kind of have gotten into this. Let me try to make things that are similar, so I definitely I make cauliflower mashed potatoes right instead of white mashed potatoes. Um, always some sort of veggie kind of combo with lots of different veggies and maybe throw cranberries in it to make it more traditionally, you know.

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Thanksgiving-ish. I always make dips so that people are standing there, you know, wanting to have something to dip their celery into or encourage them to do celery instead of the chips. So I make a bunch of different dips. you know, mostly I have I have substitutes for the traditional Thanksgiving type recipes like stuffing and gravy and mashed potatoes and all. Yeah, and they taste delicious. It's delicious. We do some similar things. My wife does a whole bunch of different varieties of

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cranberry sauce, with orange zest and vanilla and whatever else, I think. And then she makes a lot of pies, because you can really, if you want to put some stevia in there to sweeten it up a little bit, but it's basically just fruit oftentimes. so, yeah, so you can definitely We made a sweet potato pie one year with, I make the crust out of uh basically,

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things like pecans and hazelnuts and put it together and fill the pan. And then we made sweet potatoes and mixed it with coconut milk. Oh, that's good. It's just delightful. Sounds delicious. Yeah. So you mentioned genetics just a moment ago when you were talking about caffeine. Where's the place for genetics when you're talking about complex chronic disease and figuring out where to go with folks?

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It's really my motivational factor. It's what I use to motivate people to make the changes mostly that I already know. But then beyond that, it's how do we find these specific things that is like, oh, no wonder you can't go pump your own gas. You feel like miserable because you have this particular detox snip that causes you to not be able to detoxify the fumes from that, right?

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No wonder, oh, every time I go to somebody's house and I have charbroiled meat, can't, I don't feel right. have burgers on the grill. Oh, you have this CYP1A1 and it doesn't allow you to break those down or whatever. That's where I really find the help. But it's also helping people, because everybody's a little different, right? You can take a general diet and a generalized style, or you can make it specific for people. Oh, you have a gene that says you probably don't break down lactose well. You have a gene. So it helps me.

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to help them to really customize, but it also helps them to say, oh my God, I'm not going to do that anymore. Or I'm going to do that even though I knew that 20 years ago that I should be doing it. Awesome. So um let's talk a little bit about gut and then we'll adjourn. in terms of where does the gut play a role in this? know, for years I spent trying to heal people's guts and then I

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I found that I really didn't have success until I was getting rid of like heavy metals, chemicals and molds. Cause sometimes those inhibit things. Have you seen that same thing? What are your thoughts on healing the gut? Yeah. So I think that it's important. I like to start with the gut. Well, the habits first getting their habits cleaned up obviously, but the, gut and the blood sugar, right? They they're hand in hand. And when I do the things that should be helping to heal this person's gut and it's not, then I go looking for those.

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those unusual things and you get people that are coming to you who are already tried almost everything, right? And they're ready for that next step. But some people aren't. mean, they just have to stop eating Oreos three times a day and their gut heals, right? So we look at that kind of stuff, you know, get them taking enzymes or get probiotics in them and things like that and we heal it. But it's usually with, for me, it's like, okay, this didn't work. Or they come in and they say, I did this, did this and this. I'm like, oh, okay.

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then we're gonna start looking at those other things. Makes sense. Yeah. So at this point, is there anything that we haven't talked about that you wanna make sure you share with our audience?

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Hmm.

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No, I think the only thing I would say is that when it comes down to it is we get to choose everything we do throughout the day, right? And our choices are what matter and how quickly we're gonna get well, how quickly we're gonna restore energy and how long we're gonna stick with it, how consistent we're gonna be. So it's like every choice matters is really the thing that I would impart with people. Nice.

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And so where's the best place for people to go to learn more about you and the work you're doing? Well, there's a few places on social media, Facebook, Dr. Ritamarie, wherever you go, Dr. Ritamarie on Facebook and on YouTube and on Instagram and whatever. Then www.drritamarie.com is my website. And if you're a health practitioner looking to like really up your skills in functional medicine and nutritional endocrinology, which is my specialty, then it's: www.inemethod.com

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INE for the Institute of Nutritional Endocrinology: www.inemethod.com. Awesome! And we'll drop those links below. I highly recommend Dr. Ritamarie's program. I've definitely heard from practitioners who've gone through it they've been very pleased with it. And they, you you come out having all these skills and you know exactly how to, how to treat patients in front of you. So it's really invaluable. Dr. Ritamarie, thanks so much for joining me today. So appreciate the work you're doing. Thank you so much for having me. Appreciate you and all the work you're doing.