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Paleo Diet And Autoimmune Disease: Training Your Immune System NOT To Overreact With Dr. Guillermo Ruiz

HHS 14 | Paleo Diet

Dr. Guillermo Ruiz joins Dr. Lattanza to discuss how our sterile environment, combined with poor nutrition, has left our immune system overly sensitive and easily confused. Listen in as they cover how autoimmune thyroid conditions can be helped by a highly customizable Paleo diet. Dr. Ruiz is the medical director of GoHealth and currently practices naturopathic endocrinology in Arizona where he specializes in metabolic optimization. If you are curious about losing weight, burning fat, and intermittent fasting, this is the show for you.

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Paleo Diet And Autoimmune Disease: Training Your Immune System NOT To Overreact With Dr. Guillermo Ruiz

We have an excellent show lined up for you talking about all things endocrinology, thyroid health, which all circles back to cardiovascular wellness. We have a great guest for you. We have Dr. Guillermo Ruiz. He is a graduate medical student from the Southwest College of Naturopathic Medicine. His aim is to use research to advance naturopathic medicine as an evidence-based approach and focus on finding evolutionary connections between our modern and traditional healthcare systems.

He practices naturopathic endocrinology in Arizona, where he specializes in metabolic optimization. His hobbies include research, learning, practicing, and teaching the benefits of adhering to an appropriate evolutionary diet. Dr. Ruiz sits on several boards of directors for ancestral and evolutionary diet and lifestyle, as well as the board of multiple supplement companies.

His approach is very focused on an appropriate diet for humanity, supplementing where needed, and medicating as warranted. He believes that lifestyle change is the single best approach that a patient can take in order to see their best wellness outcome. There’s so much to come from you. Welcome, Dr. Guillermo Ruiz.

How is it going? It’s going to be so difficult to keep it professional. I know you as Lauren. You know me as Guillermo. We’ve been friends for a while but now we are Dr. Ruiz and Dr. Lattanza.

If I remember correctly, you said, “Since I knew you before you were a doctor, we get to call each other on a first-name basis.”

It’s such a crazy journey. Ever since I’ve known you, this is the dream. It’s to be able to connect to people at a more personal level, share ideas and in the end, helping people. That’s what we’re here for.

I’ve always learned so much from you as a personal friend and a mentor, all one and the same. I’m so happy to have you on the show so we can talk more than over coffee as standard. We wanted to touch on the thyroid. You are my go-to expert when it comes to thyroid health. I’m happy to have you on the show here. While it’s not, first and foremost, cardiovascular, everything is always connected.

I definitely wanted to bring this in. Even the cardiovascular patients out there who might be thinking, “I don’t think I have any thyroid things going on,” you might. I encourage you all to read what Dr. Guillermo has to say here. It’s something that we see and hear about a lot but maybe patients don’t know a lot about it. Could you provide some insight as to what is autoimmune thyroid disease?

We’ve been highlighting our metabolism and the importance of having a good metabolism. Sometimes our metabolism goes a little bit rogue, and it starts attacking the body. We can see different iterations of this. You can have rheumatoid arthritis, where it attacks your joints, autoimmune diseases where it attacks the liver like lupus. The most common autoimmune disease that we have in the United States is autoimmune thyroid disease.

That’s where your body confuses itself and starts attacking the thyroid and destroying the tissue within the thyroid. We stand on the shoulders of mentors. In reality, I wouldn’t be here if it wasn’t for all the help of all the people that have helped, taught me, and picked pearls of information here and there. I remember talking to Dr. Proefrock, another amazing naturopath.

HHS 14 | Paleo Diet
Paleo Diet: Auto-immune thyroid disease is where your body confuses itself and it starts attacking the thyroid. It destroys the tissue within the thyroid.

There’s a book called Epidemic of Absence. It talks about how we live in such sterile environments and our first interactions with microbes or whenever we see a pathogenic encounter. We clean everything and disinfect everything. We go to a restaurant and have some bad food. The first interaction that we have is with something like salmonella, a virus or pathogenic bacteria.

It’s good to have a well-rounded immune system, one that is not attacking you and also one that is not under protecting you.

Talking to Dr. Proefrock who does a lot of cool things. He was talking about how he helps kids with autism. One of the prescriptions he gives the parents is to go get some organic dirt and allow their kids to play with dirt. It’s so simple in having that interaction with those microbes, and eating some dirt helps train the immune system not to overreact. That’s what we’re talking about right here. It is good to have a well-rounded immune system, one that is not attacking you and one that is also not underprotecting you.

We were talking a little bit about allergies. There are studies where they show kids that grew up on farms have fewer incidents of allergies and asthma than kids that grew up near factories or their parents were in more industrialized cities. It’s because there is no interaction with pollen, fur, and all of these things. Our immune system receives those things and they trigger this immune reaction, thinking, “We’re dying. We’re being attacked environmentally.” We have an overreaction.

What do we do in Naturopathic Medicine for things like this overt immune reaction? We have cool plants. I do a lot of studies with plants. The first study on the modulation of masts cells, meaning something that helps you have less of a reaction against something. Dr. Paul Mittman, another mentor of ours and the President of the school, wrote it for Planta. It was trying to show how freeze-dried stinging nettles can help modulate the action of the immune system.

What happens with the thyroid when we have a little bit of a reaction towards something? There have been some proposed mechanisms for things like EBV and the molecular mimicry that happens with EBV. You have a reaction to EBV. Your immune system reacts to this EBV. It goes rogue. It’s Epstein-Barr Virus for people that are not familiar with that acronym. It starts attacking the thyroid tissue. Eventually, your body settles that virus.

That virus is out of your system, and it’s gone but the tissue on your thyroid stays. It continues attacking it. There are a lot of talks about, “I had EBV and now I have a hyperthyroid disease.” They do an IgG test for EBV. That IgG test turns out to be high. Practitioners start treating the EBV that was never there as a root cause and completely forget the immunology lessons from medical school and disregard the thyroid, and then people suffer.

In a nutshell, autoimmune disease is when your immune system goes rogue, whether it is because you have a food allergy or sensitivity towards wheat. Intestinal permeability and viral infections play a part. We’re not trying to treat that directly. We’re trying to treat the autoimmune response towards the thyroid. As a root cause, we should reverse intestinal permeability. We should try to control our immune system so we don’t have other autoimmune concerns. As a baseline, we need to help save that thyroid tissue.

There are many different contributing factors, be it viral, dietary, what have you, that can stimulate the immune system, then it turns on itself. I love that you said, “The metabolism going rogue.” How could a paleo diet help with this autoimmune thyroid picture?

Even a paleo diet or eating in any way from a fad diet. I know you guys in your practice that you’re in paleo, and I love it. I have been doing paleo diets since 2010. I’ve been in this for a very long time but when it comes to being healthier, anything that deviates from the standard American diet is going to be healthy. There are various limitations to all these different diets. It turns out that a paleo diet is customizable according to any person that it ends up being the perfect diet, and people will roll their eyes.

Eating a standard American diet with trans fats, wheat, and inflammatory things are going to wreck intestinal permeability, open up the gut-brain access, cause a lot of autoimmune concerns. Deviating from that to a vegan diet, you are reducing meat for health reasons but now you’re not going out and eating at fast food places.

You might be consuming a lot of sugar now, a lot of fructose, and tons of problems with oxalates and things like that, but it’s better than the standard American diet. It’s not optimal but it’s better. Let’s say you have someone that says, “I have autoimmune concerns. I want to try a paleo lifestyle but I have diabetes.” Paleo diet is macronutrient agnostic. Meaning that if you have problems with diabetes and you need to have a low carbohydrate paleo diet, go for it.

You follow the same rules, which are anti-inflammatory foods. You switch your fuel intake, and instead of eating 150 to 200 grams of carbohydrates, you increase your protein and decrease your carbohydrates. Let’s say you have a high charging athlete that needs a ton of carbohydrates. You can do that. You can continue doing a paleo diet and modify the carbohydrate to protein content.

Let’s say you have someone with problems with their kidneys, and they need to have a short-term protein-sparing fast or a low protein diet. You can change your micronutrients in a paleo diet and reduce the protein, and then increase fats and carbohydrates with a big caveat. I’ve been doing a lot of research in my own personal education on kidneys and protein. I think we got that story wrong. I don’t think that it’s going to pan out in that way. In the end, eating enough protein to sustain biological functions is going to be the most important thing that we can do for our bodies.

I often will pitch the idea of a paleo diet to a new patient. It’s like, “Where do I begin? I don’t want to eat bacon all the time.” It’s so much more customizable than that. It’s not one size fits all. I appreciate you giving those examples. It can be low carb. It can be low carb, high fat. It can be high protein. It varies depending on patient needs and preferences. It is tailored to whatever you want it to be. I appreciate you breaking that down for us. What are some of your favorite sources of carbohydrates in a paleo diet that isn’t a sweet potato?

There are studies that show that after a certain amount of triglycerides that are produced in your liver. There is some damage to the pancreas. You have an alteration in the production of insulin. You have a little bit of insulin resistance or a little bit of insulin production problems. I’ve always known that I work better on a lower carbohydrate diet. Now I’m only eating around 20 grams of carbs, and all of my carbs come from vegetables. I’m eating like metric tons of cauliflower. One of my favorite recipes now is I take a cabbage and quarter it. I put some Umami mushroom powder and some cayenne, salt and pepper. I put a little bit of water and put it in the oven for 45 minutes. It’s delicious, especially if you put butter over it.

I’ve been doing these cycles with low carbohydrate diets, high protein, and a moderate amount of fats. This is a difficult story. It all started around March of 2020. Something happened around that time. I forget now. The world changed. I never lost my job. I don’t have any kids. I live a chill lifestyle but I think the way of isolation and the way of the world got to me. That was enough for my thyroid to break.

It’s a confluence of things whenever people get diagnosed with hypothyroid disease. Most women are diagnosed of having autoimmune thyroid disease after having their first kid. You can imagine that’s a stressful experience. That’s where your immune system goes crazy rogue. It starts attacking the thyroid, and then you become hypothyroid. You start gaining weight. You feel cold all the time. Your hair starts falling. I don’t have any kids. That was my kid. That was my breaking point.

Around March 2020, I started noticing my weight going up and my hair falling. As medical people, we’re chronic hypochondriacs. We are constantly looking for things. I’ve been monitoring my TSH since before school. My family has a long history of thyroid disease. My TSH always wavered between 0.89 to 1.15. I checked it again and it was 1.89.

HHS 14 | Paleo Diet
Paleo Diet: There are studies that show that kids that grew up on farms have fewer incidents of allergies than kids that grew up near industrialized cities.

It’s very close to that range or within the range but I was full-blown having all of the symptoms. I was like, “Something’s going on.” At one point in 2021, I was running around the parking lot in the middle of the summer because all the gyms were closed and whatever, trying to lose weight. I was eating 800 calories a day. I got to 183 pounds.

What’s your normal?

I was 146. It’s a 40-pound difference. When I started medical school, I was 155. I wanted to graduate at 155. On the day of graduation, I was 155. I’ve been doing this for a very long time. I have surgical precision with my weight. I let go, and my weight goes up, and then I go, “It’s time to go back.” It was like, “I’m going to cook at home and that’s it.” It was such a cool experiment because I was not going to a restaurant. I was cooking every single one of my meals. My weight kept going up. I was like, “There’s something wrong.”

I ran my antibodies, and sure enough, my antibodies were through the roof. I was like, “I need to start taking some thyroid medications.” I started taking thyroid medications, and the weight started falling like nothing. All my symptoms got better. All of a sudden, I was a morning person again. All of the things that people have been telling me, they have all those symptoms. I was experiencing those.

When it comes to being healthy, anything that deviates from the standard American diet is going to be healthy.

There are a lot of suppositions that you cannot do a low-carbohydrate diet if you have hypothyroid disease. On and off, I’ve used low carbohydrate diets to help people. I wanted to see if it was possible to do a low carbohydrate diet while taking thyroid medication. If you plan your diet and do it correctly, you will be able to do a low-carbohydrate diet.

To bring it all back from this long rant, I think the least common denominator being as long as it is an autoimmune safe paleo diet, you will be able to do a low carbohydrate diet. When I’m talking about a low carbohydrate diet, I’m not talking about low-carb pizza and muffins. I’m not talking about paleo pizza and muffins. I’m talking about eating unprocessed food and getting the cleanest sources I can afford.

I regularly say, “You can’t look at it and tell what’s in it.” A paleo pizza, you’re like, “This could be any number of different flowers. I have no idea.” If you can’t tell what you’re looking at, it’s a slew of ingredients that you’re not in control of, so maybe reach for something else.

A paleo pizza is nice to have. I don’t want to live my life counting carbs. I’m going to tell you a secret. I’m going to tell all the people that are reading if they’re not bored out of their minds. The reason I’m doing this and lowering my weight at this point is that we have Thanksgiving, Christmas, and New Year coming up. I do all of this. I measure my carbs and whatever because I love to have fun.

During that time, I want to be able to enjoy a drink, have my paleo stuffing with crap flowers but it’s delicious. I’m trying to set myself up to enter the holidays at a lower weight, so I can go through the holidays without having to care. I’m expecting to gain weight, and then pick up right where I left off on January 1st when everyone and their mom is ready to do a diet.

What’s happening during the holidays in the United States is that we gain around 8 pounds. We make all these efforts to lose it, and they teeter off around March. We end up losing 5 pounds. We’re plus 3 pounds. We come around to next Christmas and gain another 8 and lose 5 pounds. That’s why we keep seeing our weight go up year after year. Most of our weight gain happens around the holidays.

In Israel, that weight gain happens around Easter. It’s the same thing. We’re social creatures. We like to be around other people. When we happen to be around other people, we tend to have nice dinners. I’m preparing myself for that period. I can continue to be being at a certain weight that I like to be and then pile up. If anyone asked me, “What is the one thing that you would do for autoimmune disease, cancer, cardiac health or Alzheimer’s?” It’s losing weight.

It sounds very trivial but not being obese reduces all-cause mortality. However you achieve it, there are better ways of gaining your micronutrients, reducing inflammation or whatever. If you have a family member, a friend, and they are not into all of this stuff, trying to convince them to do anything, as a first step like, “Get the first hit.” You lose a little bit of weight. That is going to improve outcomes for all-cause mortality. After that, once they get to a stable weight, maybe now we can start introducing organic foods. At the very beginning or at the very least, being overweight and eating a paleo diet, you still have some work to do.

It can be radical for these patients that come in, and they are obese or maybe they are on a standard American diet. It seems so radical to shift to this all-organic paleo, low carb. Take it step-wise if you must but doing healthy weight loss to get you in healthy weight is going to reduce all-cause mortality.

We’re victims of social media and survivor bias. You see it on a Sunday night football. It’s like, “So-and-so overcame this and overcame that. You can do it too. If I can do it, you can do it.” In reality, those people are gifted to have good metabolisms. I enjoy doing endocrinology because I’ve seen endocrinology as the nexus between lifestyle and physiology. Some people have excellent physiology, and they start doing the lifestyle stuff. The gears connect and things happen.

In 2020, when I told you around March, I was doing the lifestyle but my physiology was not there. Having hypothyroidism reduces your metabolism in such a dramatic way. I was eating around 900 calories a day and gaining weight. I hate cardio. I look back and I roll my eyes. There are people that love working out. I think you’re one of those people. I work out because I have to. I know it’s necessary for my health but I am 30 minutes in the gym. I go into the gym. I do the heavy lifting, and then I get out. That’s it. I check off my chore list.

There’s a commercial going around with this girl and the voiceover is like, “Why do you run?” She’s in a full outfit and running around the streets. The tagline at the end is like, “I run so I can drink my beer.” That is so insane. Why is it insane? First of all, these devices that we have, the tracker calories, are calibrating in such a weird way that they overestimate the number of calories that you’re intaking in order to make you feel better.

If you put an athlete that is super lean into a machine that they’re not trained on and they start running, every single fiber of their muscles is going to fire and are going to burn way more calories than us mere humans. They calibrate that machine, and then they tell us, “If you go on the elliptical for 20 minutes, you’re going to burn 600 calories.” Now you input it into your device, and then you have 600 calories. If you have a good metabolism, if you’re one of those freaks like Dak Prescott or Kyler Murray, you’re going to burn it and that’s it.

If you’re a mere human like me or worse, your metabolism is not working and you are hypothyroid, you think that you are isocaloric. No, you are going to be so overcaloric and then you get frustrated like, “Why is this not working?” You are going to the gym and doing more exercise, counting calories, and maybe the deficit that you need with the metabolism that you have is 400 calories a day. Who can survive with that? Being able to optimize your metabolism is the best way of optimizing everything downstream including your immune system, weight and health in general.

When you talk about physiology and endocrinology, they work simultaneously. You’ve got to have both, and it has all these downstream effects. It’s not just weight loss. Can we touch on how does your thyroid and thyroid hormones affect your cholesterol levels, which might put a light bulb over a lot of people’s heads like, “That might be me?”

We suffer from confirmation bias. I see patients that come in and they’re like, “My cholesterol is 220. I’ve read a lot of that, and it tells me I shouldn’t be concerned.” I was like, “Okay, cool.” I have patients that come in and they’re like, “My cholesterol is 450 but so-and-so says that.” Once you started getting collaterals above 280, I started scratching my head and thinking, “This is not good.” Having low cholesterol is no good. There is a very cool study that shows that a new graph.

HHS 14 | Paleo Diet
Paleo Diet: A paleo diet is macronutrient agnostic. This means that if you have diabetes and you need to have a low carbohydrate paleo diet, go for it.

The sweet spot is between 220 and 240. That’s when all-cause mortality is lower. If you get below 180, all-cause mortality goes up. If you get above 280, all-cause mortality goes up. This is where you need to start looking into the root cause. If your cholesterol levels start creeping up, that is something that we need to pay attention to. Did you know that the first test for thyroid function was a cholesterol level? Around 100 years ago, when we didn’t know about thyroid-stimulating hormones, they would draw your blood. If they saw cholesterol, they would prescribe you thyroid.

There is a link between HMG-CoA reductase and how thyroid-stimulating hormone helps inhibit the HMG-CoA reductase, which is the same mechanism as a statin. The problem is that statins don’t do anything for your thyroid and your metabolism. In fact, they inhibit mitochondria and cause more problems than they help. If you address the thyroid, then you can help both the cholesterol levels and your metabolism. Even when I do a low carbohydrate diet, I have to be very careful with my lipids. My lipids go up fast.

I modify my low-carbohydrate diet. I only use monounsaturated fatty acids. I try to avoid saturated fatty acids, and that’s to keep my lipids looking phenomenal, to where I can print my labs and show them to any doctor and they’re going to be like, “You’re healthy.” If I eat like coconut oil, a lot of saturated fatty acids, my cholesterol begins to creep up to the 260s to 280s, and I don’t like that. They’re easy. For me, I avoid saturated fatty acids.

The way that I see it is when those particles are intrinsically within the fibers of the muscle, our body knows what to do with them. Imagine a world that was completely backward, and Suzanne Somers was not against fat but against sugar. In the ’70s and ’80s, we demonized sugar and we would be in the same situation talking about sugar. We would be like, “We’ve been demonizing sugar for so long. Don’t eat refined sugars.” We take things and run with them. A lot of products that we consume can increase your cholesterol levels.

My girlfriend doesn’t have that problem. She can eat saturated fats in the form of butter, coconut oil, lard, and it doesn’t affect her lipids. I accumulate and my theory is that I’m Mexican. My ancestry is from the equator. Evolutionarily speaking, we don’t have a lot of access to saturated fats. Maybe avocados and coconuts but not refined. My ancestors, if they were able to get ahold of some saturated fat, their bodies would hold on to them hard because saturated fats are very necessary for the good production of other hormones like testosterone, estrogen, progesterone, cholesterols, all of that.

If I give my body an unlimited amount of saturated fat, my body is like, “Yay.” It holds on to it hard, pushing all of those metabolic pathways. I got to be careful with my fueling of fat. If you have someone from the Poles where they have access to the saturated fats in the forms of blubber, seal fat and even dairy, their metabolism is so used to having a steady stream of saturated fats that they get rid of it like nothing. It knows what to do with that.

It’s sad that I can’t cook everything in butter even if it tastes delicious but it’s such an easy fix for me. I use saturated fats more as a seasoning. For example, you were talking about sweet potato, even a regular potato. You make a regular potato and put some fat on top of it to make it taste better rather than cooking everything in fat.

Set yourself up to enter the holidays at a lower weight, so you can go through the holidays without having to care.

I liked that you touched on the fact that low carb does not mean you’re doing a ketogenic diet, keeping pounds of lard, fat and avocado on top of everything. You can do low carb and still moderate your other macronutrients.

We see this with a lot of people taking exogenous ketones. What is ketosis? Ketosis is the ability of your body to burn fat to create energy. We create these ketone bodies that are present in our breath, urine, and blood, and that helps fuel as an alternative pathway. What is ketosis? It’s burning fat. If you are hypercaloric, eventually, you’re going to burn fat. You can eat 500 calories of rice a day, and you will start creating ketones.

Why? It’s because you’re undercaloric, 500 calories of rice are not enough. Even if it comes from 100% straight carbs, eventually, you’re going to start burning fat. You can be in ketosis by eating nothing but rice. The way that I practice a ketogenic diet is not by adding fat. It’s reducing carbohydrates. The biggest problem that I see with things like exogenous ketones is that when you take exogenous ketones, you’re artificially elevating the number of ketone bodies that are circulating in your bloodstream.

I asked my patients and anyone who’s reading this now, “What would you rather do, burn the fat that you consume or burn the fat that you’re wearing?” In order for us to get to the fat that we’re wearing, which is what everyone wants to burn, you cannot give your body more fat and push to burn that. There is a hierarchy of the way that we burn things in our bodies. The first thing that we get rid of is alcohol. Alcohol is toxic. We take a lot of effort to get it out of the system as fast as possible.

I love bourbon but sadly, we have to be aware that if you want to lose weight, probably the first thing that you should eliminate is alcohol. After that, it’s very easy to burn carbohydrates. Your body starts burning carbohydrates. After that, the body starts burning fat. Finally, contrary to popular belief, we burn protein. The body’s not stupid. The body’s wise and protein is essential for many things including the integrity of the heart, muscles and whatever. As a last resort, we will start burning protein for energy.

If you’re eating a meal and you have a beer, some fries, and a burger with some cheese, in the hierarchy of things, the body’s going to go crazy. It’s going to try to get rid of that alcohol. Those calories are gone, and then the carbohydrates. In the end are all the fat that is included in the fries and meat. The body is like, “We satisfied the caloric intake for the day. Let’s store this.” You begin to start things.

If you want to lose weight, reducing carbohydrates to jump those two steps, the 1st step being alcohol, the 2nd step being carbohydrates, and then concentrating on burning fat can be very beneficial. If you want to expedite that, eating leaner cuts of meat and using fat to round things up and make things taste good, and being able to adhere to a diet can be very useful.

The problem is that we see a lot of people like, “I’m going to have this coffee and put some MCT oil.” That MCT oil is going to help with some cognition. There are reasons why you have to do it if you want to do it for therapeutic ketosis, but if you’re trying to lose weight, those extra calories are getting on the way. Reducing or maintaining an acceptable level of fat and not add fat, a ketogenic diet does not mean adding fat to what you’re eating. It’s not eating eggs covered in lard and bacon. It would be reducing the carbohydrate intake at each one of the steps of your meals, increasing your protein, and using fat as a lever to help you with your energy intake.

HHS 14 | Paleo Diet
Paleo Diet: Optimize your metabolism first and foremost. That is the best way of helping everything downstream, like your immune system, weight, and your health in general.

It’s because fat is so incredibly satiating, you can use it as a condiment. It’s so incredibly satiating because it is a massive amount of fuel. Are you intaking fuel?

It’s funny that satiating myth. The most satiating food on the planet is potatoes. In our charts that show you, what is the most satiating thing? Per gram, eating potatoes is the most satiating. There’s a book called The Potato Diet Plan. It’s for five days. You eat nothing but potatoes and you lose weight. There are many ways to skin a cat. Fat is not that satiating. I’ll prove it to you. What is more satiating, 100 calories of raw spinach or 100 calories of olive oil?

The 100 calories of olive oil I can just take and that’s it. It’s gone. There is some truth to it because being ketosis, producing ketone bodies causes a little bit of nausea, which in itself helps reduce hunger. The densely packed calories from fat cannot override a lot of satiety sense source. There is some truth where if you are in a ketogenic state, you’re going to produce more ketones. That in itself causes a little bit of nausea. That is anorexic in itself. It reduces your hunger.

In reality, I’m a paleo guy, and I’m doing a low carbohydrate diet. I love ketogenic diets and everything. Fiber is more satiating than fat. Protein is more satiating than fiber or fat. Those are little things that we hear here and there. We pick up here and there but if you look at the studies and the tables of satiety, in reality, there are things that you can do to help with your hunger that are less caloric and pensive because, in the end, calories do matter. Believe it or not, in the end, calories do matter.

The idea, especially when it comes to weight loss is what is the diet that is going to be satiating that is going to be enjoyable. That is going to allow you to spontaneously reduce your calorie intake for long periods of time to where it’s going to allow you to lose some weight. For example, a lot of people do a shake and a meal like a protein shake for breakfast, a protein shake for lunch, and then a meal at night. That makes that me ravenous. Drinking protein in the morning, that’s it. For the rest of the day, it’s open for business. I’m hungry.

I’m intermittent faster. I love to intermittent fast. If I don’t need anything, I can go until dinner, OMAD, One Meal A Day, without any problems. The problem is that if you don’t have the meal frequency, then your hormones begin to suffer. I have a quiz for you, around how many calories does it takes for a guy to produce sperm?

I would say at least like 600 a day, 800?

It’s 150 calories per ejaculate. How many calories does it take to create a baby?

For a woman? It’s a lot more than that.

It’s 35,000 calories over the span of nine months. Two things out of this. Number one, most of the people that do great with intermittent fasting are guys. I do phenomenal. As soon as I start noticing cortisol or adrenal problems, the first thing that I reintroduce is breakfast because the peak of health is fertility. Anything that goes against fertility is going to decrease metabolism and hormones, thyroid, testosterone, all of that. It can increase cortisol.

Intermittent fasting is a stressor. As long as you are doing Calorie Restriction With Appropriate Nutrition, CRWAN, meaning you are meeting all of your macronutrients and calories, you can buffer that suppression of hormones. Women, on the other hand, don’t have the luxury of eating an apple and being ready to procreate. A lot of the people that are loudmouths like me talking about intermittent fasting on social media were guys.

There are not a lot of women out there. Of my clientele, my patients, 90% are women. They’re coming to me because they heard what this guy is saying about intermittent fasting, “It’s not working for me. I’m gaining weight. My thyroid is being suppressed. I’m going to do it harder.” You’re giving your body a daily reminder that you’re in starvation mode, which your body notices. It’s like, “Let’s start suppressing calories because she’s not ready to procreate.”

What happens when you are super lean? You go into amenorrhea, no periods. Meal frequency specifically in women can be life-changing, especially in someone that has had problems with intermittent fasting because it suppresses your hormones. You don’t have to eat 500, 600 calories per meal. Just giving your body a signal that, “It’s okay. We’re not starving,” having a little bit of protein, some vegetables with some consistency up until your body is at peak level.

HHS 14 | Paleo Diet
Paleo Diet: Be careful with your fueling of fat. Saturated fats are necessary for the production of other hormones, like testosterone. So if you give your body a lot of saturated fat, your body may really hold onto it.

You can then introduce that stressor to help you with whatever. I call intermittent fasting my superpower. I don’t have to stop and make breakfast. It’s amazing and works through lunch. I’ve been trying to eat lunch every day, a tiny little bit, and then a heavy dinner. I could go all the way until night without eating. The reason I make sure I have lunch is because I don’t want to go into that starvation hormone problem. Meal frequency is probably one of the first things that I reintroduced if I feel like I’m too stressed out.

Not being obese reduces all-cause mortality.

Being able to fast is also a signal of health. You don’t want to be dependent on having to eat every 4 or 6 hours. Using it as a tool like if you’re at an airport, that’s the best example. I’m going to be at the airport all morning long. I’ll eat whenever I get to wherever I’m going. That way, you avoid crappy food. You can use it as a superpower. Being able to go the whole morning without eating and crashing is a signal of metabolic flexibility, which is the goal. The problem is when we abuse it because fasting is a stressor just like exercise is a stressor. If you use stressors correctly, you can gain muscle and get lean. If you abuse them, eventually, you’ll stress and they start becoming bad stressors that can sink you even further into your metabolic disruption.

I wanted to touch on this. I thought this was an interesting topic of conversation. What are some pros and cons of the thyroid? Where does functional medicine tend to get it wrong?

I love our generation. I’m a little bit older than you but the next generation of people that are interested in health are so practical. I tell my patients that during their funeral, “You’re dying before me, so it doesn’t matter.” I’m going to be there and I’m going to be crying, “She never took any Advil.” No one’s going to talk about how many pills you took? No one’s going to talk about that. People are going to be talking about how you treated others. Were you there for them? How many patients have you healed?

For the mommies out there, no one’s going to remember how many prescriptions you picked up at the pharmacy. Your kids are going to remember the times that you stayed up all night, taking care of them. We’re so practical and that’s how I look at it. If I have to think a little bit of thyroid medication, that allows me to be there for my patients if there’s a problem and I have to stay up all night. A funny story, my dog got into something and she woke up at 6:00 in the morning and had diarrhea and vomited twice.

I’m not 100% but I feel 99% and one more good night to sleep, and I’m going to be back to 100%. It would be shitty. If I was trying to get off of thyroid medication and I have to have a perfect diet, perfect circadian rhythm, maybe avoid caffeine, and all of those things. Imagine telling your kid or me telling my dog being like, “Sorry, I got to protect my circadian rhythm. I’m going to open the door, let you outside and do your thing.” These little things that I do like eating organic, eating grass-fed meat, taking my thyroid medication is so I can do two things. It’s to be there for my loved ones and enjoy life.

I enjoy bourbon and I like having a drink every once in a while. What’s the point of living if you want to be 100% clean 100% of the time in order to maybe get off of a tiny little pill that you take in the morning? I tell my patients, “You want to get off of thyroid medication. You’re probably going to have to sell your house. Do you like your husband? Move to Costa Rica. If you don’t like him, divorce him. Give away your kids and then farm coconuts and fish. Go to bed at 9:00, wake up at 5:00 in the morning with the sun, and maybe, 9 months out of 12, you might be able not to take your thyroid medication, or you can continue married, doing what you love, watching stupid Netflix shows every once in a while. The only thing you have to do is take that little pill in the morning.”

We put so much stigma because we have to take a prescription but in the end, no one’s going to care in your funeral. They’re going to remember you. I don’t think that life should be measured by the number of supplements or medications that we take but by the amount of love that we give others. That’s self-love, enjoying things, going to a concert every once in a while, being there for your loved ones, and all of the things that we can do in order to make this world better.

It’s everything in moderation. Ultimately, we are a tribe civilization and we thrive best with others. When we’re isolating and have this orthorexic approach to life, that’s not welcoming others in general.

Do you want to live the rest of your life like that?

Those who have the willpower, the drive, and the tribe that supports all that, I applaud them.

Another problem that I see in functional medicine is when people focus on free T3 and free T4, and then furthermore into reverse T3. For example, free T4 and free T3 are snapshots of what’s going on right there at that point with that needle entering your vein, and they took a sample of your blood. Most people, when they get their free T3 and free T4 tested, go in the morning and don’t take their thyroid medication, which means that free T4 and free T3 levels are going to be low.

You take your labs to your practitioner and they see the L. They’re going, “You need more thyroid.” Meanwhile, their TSH, Thyroid Stimulating Hormone is perfect, which is a more stable predictor of what’s going on with your thyroid over four weeks. Another thing that I see a lot is people trying to dose their thyroid medication according to reverse T3. Are you familiar with sex hormone-binding globulin?

HHS 14 | Paleo Diet
Paleo Diet: Ketosis is the ability of your body to burn fat. Then you create ketone bodies that are present in your breath, urine, and blood. That helps fuel as an alternative pathway.

Yes.

Sex hormone-binding globulin is a protein or a globulin that binds testosterone and estrogens to make them inactive and is produced by the liver. Sometimes if you have a lot of liver problems, you start creating more sex hormone-binding globulin, and now your hormones are going to suffer. That’s a protective mechanism to prevent you from getting pregnant or prevent inflammation, in general.

People in the ICU if they have sepsis, the reverse T3 would skyrocket. Utilizing the thyroid creates a lot of proteins and reactive oxygen species. In someone with sepsis or an infection of their blood, they’re creating a lot of reactive oxygen species. Having thyroid being processed and creating more reactive oxygen species can send you down into that inflammation hole even more. The body starts creating reverse T3 to try to quench some of that inflammation.

If you take too much thyroid medication, you will see your reverse T3 go up. First, your TSH notices that you have too much floating T3 and T4. Second, your reverse T3 starts to go up to try to quench it. In the late stages of hyperthyroidism, we see the free T3 and free T4 levels go up. That’s because all of the buffering mechanisms in the body are tapped out. Now you’re starting to accumulate free T3 and free T4.

I see a lot of patients that are taking elephant doses of thyroid medication. Their hair is falling. They have anxiety or worse, if you keep tapping at that thyroid hormone, what happens? Your body becomes resistant to the hormone. Now you’re going to present with hypothyroid symptoms, even though you have a whole lot of too many thyroids in a similar fashion to what happens with insulin resistance. What’s insulin resistance? You have so much hormone insulin circulating through your body, pushing all that glucose into the cell, creating a lot of reactive oxygen species that your body says, “If we don’t do something about this, we’re going to burn up.”

It cuts down the GLUT4 receptors so that insulin doesn’t go in. The same thing can happen with the thyroid. If you keep taking higher and higher doses of thyroid, eventually, your body becomes thyroid resistant. You go to your doctor and present all the symptoms of hypothyroidism. They look at your labs and ignore the TSH and say, “Your reverse T3 is high.” A little bit of thyroid made you feel better, a whole lot more is going to feel better, you keep increasing and they keep going. They keep increasing. Eventually, you end up with such high levels that you either go into hyperthyroidism or present with thyroid resistance symptoms.

We encourage the problem by encouraging more and more.

That’s where we can talk about the root cause. First, being more practical, let’s change the diet. Let’s support thyroid and reduce your thyroid medication to a level that is within the functional levels for TSH, allow this excess oxidation to get out, and then look at why it is that fixing the thyroid didn’t help you. Once your TSH is where it needs to be, then we can move on. Is it intestinal permeability, adrenal fatigue, circadian rhythm disruption? What’s underneath it? Throwing thyroid medication and adding more thyroid, that’s not the solution.

You’ve provided us with a wealth of knowledge for myself and all of our readers to think about. I have always gained so much from listening to you. Before we wrap it up, I want to ask you one more question. Maybe you’ve answered it already, but how do you live a heart-healthy life?

First and foremost, it’s enjoying what I do. Heartbreak is real. People do die from heartbreak. Life’s too short not to do what you love. Our responsibility as doctors is to encourage people to live a healthy life but also practice it. I’m always biohacking and trying things. I’ve done intermittent fasting, mimicking diets, low carb, low fat. I’ve done it all. Understanding that there are things that work for me that might not work for my patients like intermittent fasting, and then believing in our patients.

You hear in school things like, “If a patient says that they only smoke one pack a day, they actually smoke two. If they tell you that they drank a six-pack a week, it’s more like 24.” I think that in the sanctity of the room where we see our patients, I believe my patients. If I trust that I believe them, then I can help. That helping, in the end, is what helps and fills my heart. In the end, I always knew that I wanted to be a doctor, and having those success stories, emails, and conversations where the patient is like, “I finally got to do X.” They’re proud of their progress. That to me, above organic food, good sleep, that’s what fills my heart.

If you want to lose weight, the first thing that you should eliminate is alcohol.

Instilling hope is far and above the best part of our job.

Hope is a great word. That’s a great antonym for cynicism.

Dr. Guillermo, it’s always such a pleasure. Tell our readers where they can find more of you, what you do, and learn more from you.

HHS 14 | Paleo Diet
Paleo Diet: Most of the people that do great with intermittent fasting are guys. When women do it, they’re giving their bodies a daily reminder that they’re in starvation mode which affects their fertility.

You can follow me at 3030Strong. I’m active on social media. My practice is AtGoHealth. I have all the handles on Insta and Facebook. We do some Facebook Lives every once in a while. I need to get back on my podcast. I haven’t released a podcast since 2020 because of reasons. If you have any questions or anything, shoot me a DM. I’m always around on social media if you have any questions.

As always, thank you so much for your time. It’s always good catching up with you. It’s been too long, so let’s not make that happen again.

We need to have dinner soon.

Thank you for tuning in to another episode of The Healthy Heart Show. I hope you all have a great day.

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About Guillermo Ruiz

HHS 14 | Paleo DietDr. Guillermo Ruiz is a graduate medical student from the Southwest College of Naturopathic Medicine. His aim is to use his research to advance Naturopathic medicine using an evidence-based approach, and focuses on finding evolutionary connections between our modern and traditional health care systems. ‍ He currently practices Naturopathic Endocrinology in Arizona where he specializes in metabolic optimization.

His hobbies include researching, learning, practicing and teaching the benefits of adhering to an appropriate evolutionary diet. Dr. Ruiz sits on several boards of directors for ancestral and evolutionary diet and lifestyle, as well as the board of multiple supplement companies.

His approach is very focused on an appropriate diet for humanity, supplementing where needed, and medicating as warranted. He believes that lifestyle change is the single best approach that a patient can take in order to see their best wellness outcome.

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