Thyroid Hacks Part 2 with Dr. Ruben Valdes: Rational Wellness Podcast 158

Dr. Ruben Valdes talks about Improving Thyroid Health in Thyroid Hacks Part 2 with Dr. Ben Weitz.

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Podcast Highlights

6:17   Hashimoto’s thyroiditis is an autoimmune condition and it is the main cause of hyothyroidism in the US today.  We do not know if Hashimoto’s patients fare any worse or better than other people if they contract COVID-19.  But patients with diabetes tend to fare less well since many of them are in an immunosuppressed state, since blood sugar spikes tend to cause glycation of white blood cells.  Gycation is when the sugar in the bloodstream sticks to proteins in the retina, to nerves, in the brain, to hemoglobin in red blood cells (HemoglobinA1C), and to white blood cells.  Diabetic patients have more trouble fighting off an infection and diabetes is associated with a worse outcome with COVID-19 infection. 

13:00  At this point we don’t really have much data as to whether patients with Hashimoto’s thyroiditis will fare better or worse with COVID-19 infection, but it’s interesting that some of the key nutrients for thyroid health–zinc, selenium, vitamin D, and iodine if they are low will increase your risk of a worse outcome with COVID-19.  Patients with autoimmune disease will likely fare worse with COVID-19 and viruses like the SARS-COV-2 virus tend to trigger the formation of autoimmune diseases. Viruses can lead to autoimmunity through 3 mechanisms: 1. Molecular mimicry, 2. Bystander activation, and 3. Epitope activation.  1. What molecular mimicry means is that viruses can hide from the immune system by expressing a protein that is very similar to self. It could be similar to thyroid, the brain, the lungs, depending upon the area that the virus is going to infect. This allows the virus to hide from the immune system. Then, when the immune system goes after the virus, it can inadvertently attack yourself.  2. With bystander activation the virus begins to break down the cells it’s infecting, and those cells die and break open, there’s going to be self-antigens that are released as that cell dies, and that’s going to now create a self-attack. The immune system’s going to identify these intracellular antibodies and begin to go after those tissues because they contain that antigen.  3. With epitope activation, which is very similar just to a much larger scale to bystander activation when there’s very diffused tissue breakdown, and when we see things like what happens with coronavirus, this cytokine storm, this huge wave of inflammation to a specific tissue.  So it would not be surprising if one of the sequelae of this COVID-19 is an increase in autoimmune diseases.

19:17  There are various triggers for Hashimoto’s thyroiditis, including viruses. Hormonal surges, such as of insulin or cortisol, can be activating to the immune system.  Cortisol is secreted by the adrenal glands when we are stressed, when we’re in the fight-or-flight, and we know that cortisol initially has an immuno activating effect.  Longer term, cortisol ends up becoming immunosuppressive, which is why cortisone is sometimes used to treat autoimmune diseases.  Stress and cortisol can  shut down some of the areas of our innate immunity and start overactivating our acquired or antibody-based immunity, thus serving as a trigger for the development of autoimmune disease and for the relapse of autoimmune disease.

25:32  If you have an autoimmune patient, such as one with Hashimoto’s, the first thing you should do is metabolic clearing. This involves using an elimination food plan where the foods that are inflammatory for most people, like gluten, dairy, soy, grains, sugar, are removed, combined with a liver detoxification program, which is essentially the 4R program taught to many of us years ago by the father of Functional Medicine, Dr. Jeffrey Bland.  We increase hydration and support the liver detoxification process with the right nutritional supplements. Then if we are dealing with excess cortisol, we will use adaptogenic herbs to support adrenal balance.  Having a diet high in carbohydrate and sugar and eating to excess can lead to recurrent insulin surges and this can also be a trigger for autoimmune disease.  Surges in estrogen, as occurs during the menstrual cycle, in women with PCOS, and each day when women take the birth control pill, increases the risk for Hashimoto’s. Dr. Valdes suggests that a copper IUD might be a better birth control device than the pill.  Even women during perimenopause and the transition to menopause will experience periods of estrogen surges.  This fact that estrogen surges can serve as a trigger for autoimmune disease is one reason why at least 75% of those with autoimmune diseases are women.  And then we also have toxic forms of estrogen (xenoestrogens) from the environment like pesticides, bisphenol A and phthalates, etc. This is also why we are seeing girls in the US beginning to develop adult female characteristics, breast tissue, pubic hair at or around the age of eight or nine, which is unheard of, as compared to our European counterparts, where most of their girls begin to develop their adult female characteristics around 12, 13, 14, even 15, which is normal.  The estrogenic load on both men and women in our society is very high.

34:49  One of the other triggers for autoimmune diseases like Hashimoto’s is heavy metal toxicity, like mercury.  Other common metal toxicities are cadmium, aluminum, and lead. For mercury, we have two forms, methyl mercury and inorganic mercury.  Inorganic mercury we get from primarily amalgams in our mouth, whereas organic, methyl mercury, which we get primarily from fish.  Cadmium comes mainly from cigarette and other tobacco smoke.  Aluminum is everywhere in our society. And even copper, which is an essential nutrient, if levels are too high is dangerous, comes often from copper piping leaching into the water. This is similar to the situation with lead.  Dr. Valdes likes to use heavy metal testing from Quicksilver Scientific, including the Tri-Mercury test, which measures hair, urine, and blood for both organic and inorganic mercury.  He likes the protocols developed by Dr. Christopher Shade, who is the founder of Quicksilver.  To detoxify heavy metals, Dr. Valdes recommends using EDTA for the metals other than mercury and using tons of glutathione and NAC because glutathione has this wrapping effect when the metal is pulled from the tissue, it’ll wrap it, and it’ll make it less damaging for cellular tissue as you detoxify it.   You also want vitamin C, which is going to be immunomodulating. As you clear it, you want to have a lot of zinc. You also probably want to do remineralization because as you’re pulling metals, you’re also pulling minerals, which you want to replenish. What else is pretty important? You want to increase liver detoxification. So, you want to increase your intake of cofactors and milk thistle and all of the things that help the liver push stuff out. So, yeah, you really need a good comprehensive toolkit.  For binders, Dr. Vlades tends to recommend activated charcoal and chitosan and he likes IMD from Quicksilver, which is a proprietary, highly purified silica with covalently attached thiolic (sulfur) metal-binding groups, allowing it to bind metals in the intestines. Dr. Valdes also like to use a liposomal form of EDTA, which helps to chelate our metals and it is also a really good emulsifier and helps to break down biofilms. 

43:53  The next possible trigger for Hashimoto’s could be leaky gut and/or gut dysbiosis. If patients have leaky gut or increased intestinal permeability, undigested food particles and lipopolysaccharides will get absorbed into the blood stream. We need to rebalance the gut by clearing out pathogenic bacteria and rebuilding the microbiome. Antimicrobials and probiotics can be helpful. Fasting for 3, 5, 7, or 11 days and taking bone broth can be a very helpful tool. 

50:13  Biotoxins, like mold toxins and Lyme Disease, can also be a triggers for Hashimoto’s.  22% of the population are carriers of a susceptibility in a gene called HLA-DR/DQ, and for people that are susceptible, what that means is that their immune system cannot identify or create antibodies or transport and present the biotoxin itself. This tends to drive autoimmune disease. The more people are staying inside their homes, often without good air circulation, they are more likely to get exposed to mold and mycotoxins.  When it comes to mycotoxins, the first thing is mold removal from the home, which includes vacuuming, cleaning, and using an Air Oasis air purifier can all help. Formula 409 kills mold and also viruses.  The best binders for mycotoxins are the prescription ones: cholestyramine and Welchol. Dr. Valdes recommends the Richie Shoemaker protocol that focuses on normalizing various immune markers, including the C4A, the TGFB-1, the MMP-9. There’s different steps for each one of those, and ultimately, there’s an intranasal spray called VIP, vasoactive intestinal peptide. That will repair the tissues of the sinuses and of the gut to finalize the whole process.


Dr. Ruben Valdes is a Doctor of Chiropractic and an expert in Functional Medicine. He is the Chief Content and Marketing Officer of Novis Health Systems, a Functional Medicine franchise. He wrote 3 books, including The Chiropractic Entrepeneur, From Diabetic to Non-Diabetic, and The Thyroid Hack. Dr. Valdes can be contacted through Novis-Health.com.

Dr. Ben Weitz is available for nutrition consultations, including remote consults via video or phone, specializing in Functional Gastrointestinal Disorders like IBS/SIBO and Reflux and also specializing in Cardiometabolic Risk Factors like elevated lipids, high blood sugar, and high blood pressure and also weight loss, as well as sports chiropractic work by calling his Santa Monica office 310-395-3111 or go to www.drweitz.com. Phone or video consulting with Dr. Weitz is available.


Podcast Transcript

Dr. Weitz:            Hey. This is Dr. Ben Weitz, host of the Rational Wellness Podcast. I talk to the leading health and nutrition experts and researchers in the field to bring you the latest in cutting-edge health information. Subscribe to the Rational Wellness Podcast for weekly updates, and to learn more, check out my website, drweitz.com. Thanks for joining me and let’s jump into the podcast. Hello Rational Wellness Podcasters. Thank you so much for joining me again today. Please give us some readings and review on Apple Podcasts. If you’d like to see a video version, you can go to my YouTube page, Weitz Chiro, and if you go to my website, drweitz.com, you can find detailed show notes and a complete transcript.

                                Today, our topic is a functional medicine approach to thyroid health with Dr. Ruben Valdes, and this is part two of our interview. In part one in the interview, Dr. Valdes and I spoke about thyroid health, what makes a thyroid misfunction, how to a test for it.  A lot of focus was on diagnostics, but we really didn’t have much time to get into the particular triggers and how to treat them, and with the overwhelming majority of patients in the U.S. having autoimmune hypothyroid, nor did we get to talk about secondary hypothyroidism or how to treat it.

Dr. Valdes:          That’s a mouthful, yep.

Dr. Weitz:            Yes, yes, yes, and I’d also like to remark that at the time of this recording, we’re in the midst of the coronavirus, COVID-19 pandemic. So, that’s providing a background into what’s going on, so I’d also like to ask Dr. Valdes a few questions about that particular topic.  Dr. Ruben Valdes is a doctor of chiropractic and an expert in functional medicine.  He’s the Chief Content and Marketing Officer of Novus Health Systems, a Functional Medicine franchise. He’s written three books including The Chiropractic Entrepreneur, From Diabetic to Non-diabetic, and The Thyroid Hack. Dr. Valdes, thank you so much for joining me again today.

Dr. Valdes:          Thank you for having me, Dr. Weitz. It’s always a pleasure.

Dr. Weitz:            So, how is this coronavirus pandemic affecting you and your practice and how have you been able to pivot?

Dr. Valdes:          Well, I mean, just like everybody, we’re being profoundly affected. Almost overnight, our entire practice has been flipped upside down. Initially, we got a communication from the board saying, “You guys are an essential service. You’re working with high-risk patients, diabetics.” Then the state said, “All non-essential medical services meaning immediate response to COVID-19 needs to shut down.” Then we got another communication from the Department of Homeland Security saying, “Yes, you guys need to stay open.” So, what we’ve done, we were fortunate enough to be partially set up for virtual consultations, virtual appointments, and we just bulked up that side of our practice. So, all of our current patients are being taken care of virtually just like we are doing right now.  This type of Zoom call, we’re providing support. We’re being able to drop-ship their test kits, their supplementation, and that’s really been quite the blessing. I think I’ve been busier the last four or five days than I have been in the last three or four months. So, I feel really fortunate right now that we are in a position where we can help a lot of these patients.

Dr. Weitz:            So, currently, your practice is pretty much focused on the functional nutrition component, correct?

Dr. Valdes:          That’s correct, yes. Yeah, we’re 100% functional medicine right now.

Dr. Weitz:            So, you find Zoom. Is that a good HIPAA-compliant platform? Is that working for you?

Dr. Valdes:          It’s not perfect, but we’re very fortunate that HIPAA laws have become very flexible right now for this very reason, and there was a declaration on this really at the beginning of COVID-19 arriving stateside. There was really a lot of stimulus for doctors to go virtual to be able to take care of their patients this way. So, right now, Zoom’s not a perfect tool. There’s some better, like Spruce is a lot more HIPAA compliant, but the laws around this stuff are pretty flexible right now in order for us doctors to be able to deliver care to our patients.

Dr. Weitz:            Okay. I know a number of other people in the functional medicine space who’ve tried to find ways to make sure that they were compliant with all the rules related to, “Is it okay to treat somebody in another state where you’re not licensed and how does all that work?”

Dr. Valdes:          Yeah, I mean, there’s definitely a lot of laws that go deep into that. Our franchise has worked with probably the best legal firm in the country. They’re out in California, and normally, these things are very, very strict. If it’s somebody from another state, you have to have a physical examination to establish a doctor-patient relationship, and sometimes you have to have a local there, perform the exam, send it to you. Right now, I can’t really speak into that very much because I don’t have anybody at the time that would be outside of my state. So, I do have a few patients from Florida, from the Charlotte practice, and we’ve already had the establishment of a doctor-patient relationship in the past. So, right now, now we believe that we’re pretty much in compliance within our state laws.

Dr. Weitz:            Cool. So, with respect to Hashimoto’s thyroiditis, Hashimoto’s being a cause of overwhelming majority of patients with hypothyroid in the United States is an autoimmune condition, and how does this impact the potential if they contract coronavirus? Are they more or less likely to have a worse response or is it not related at all? We know that patients who have a compromised immune system are more likely to have a worse response. What about somebody with an autoimmune condition like Hashimoto’s?

Dr. Valdes:          Yeah, that’s a great question, and I appreciate you throwing me into the hot water of controversy right out the gate.

Dr. Weitz:            That’s what we’re here for-

Dr. Valdes:          Good. I love it.

Dr. Weitz:            … to solve some of these controversies or at least bring a little bit of light where there is otherwise darkness.

Dr. Valdes:          Yeah, so here’s my position in what I’ve read. I really can’t say… On the side of susceptibility to the viral infection, I don’t feel comfortable enough to have a well-formed opinion yet because number one, this is a completely new virus. It means that none of us have preformed antibodies. So, at the end of the day, that really leaves all of us in a place where we can contract the virus.

Dr. Weitz:            Yeah, I would assume that we’re all probably, if we get the right exposure to the virus, are probably equally likely to become infected. Let’s just assume that. The question is, “Who’s going to have relatively mild symptoms and who’s going to need hospitalization?” Then you hear some patients just have a horrible response and within a day or two, it just overwhelms your body and takes over.

Dr. Valdes:          Yeah, so first, I’m going to talk to you about what I’ve seen, and then I’ll talk about the research around this topic. So, I haven’t seen any of my Hashimoto’s patients contract the coronavirus yet. I have seen some of my diabetic patients already having contracted the coronavirus and for them, it’s very, very ugly. Like every diabetic, we know and we consider them to be immunosuppressed because with spikes in blood sugar, there’s glycation of white blood. So, most of them walk around in a deep or relatively deep immunosuppressed state.

Dr. Weitz:            Okay, okay. I want to stop you there for a second because I don’t think that’s a point that is generally talked about or even considered is we generally think a type one diabetes as an autoimmune condition. Type two diabetes, we generally think of it as a condition related to diet and lifestyle, and we don’t think of it as having an autoimmune component, but can you explain that again? How is type two diabetes impact the immune system?

Dr. Valdes:          Yeah, so it has a huge impact. High blood sugar, when there’s excess sugar in blood, there’s a process called advanced glycation. So, the sugar molecules begin to stick to proteins, to cells, and it really decreases their function. So, whenever a diabetic goes into the emergency room, immediately right off the bat, the attending emergency room physician is going to check them off as immunosuppressed.  They’re going to be treated as an immunosuppressed patient because this advanced glycation affects the function of white blood cells by sugar sticking to the proteins in the white blood cell.  So, for many of them, when their blood sugar is high, we’re talking above 120 and maybe even lower than that. They have a lot of difficulty fighting off infection. Now, the problem-

Dr. Weitz:            So, let me just clarify a little bit for patients or for anybody who’s listening, doctors, et cetera, who aren’t familiar with advanced glycation end products. These are AGEs, and these are components of the sugar molecules that combine with proteins in the body, and when you measure the hemoglobin A1C, you’re measuring one of these advanced glycation end products, which is where the sugar molecules combine with the hemoglobin.

Dr. Valdes:          Yeah, 100%, and think about it like-

Dr. Weitz:            So, that’s a red blood cell, but now you’re seeing the same process also occurs in white blood cells.

Dr. Valdes:          Yeah, it occurs everywhere. When there’s high blood sugar, think about the blood becoming syrupy, full of sugar. So, that’ll stick to the proteins in the retina. In the nerve endings of the retina, there’s proteins there. In the brain, in the peripheral nerves, it’ll stick in joint tissue and in renal tissue. That’s why diabetes is so diffused in its complications because these proteins are being damaged everywhere. So, the immune system is no exception to that process of advanced glycation. So, I’ve seen it already in them. The infection lasts a long time for them. It doesn’t go away. It progresses very rapidly.  In addition to that, we know that people that have diabetes or high blood sugar, when they contract an infection, their blood sugar shoots up and it goes higher because now, there’s inflammation. There’s more insulin resistance. If they’re in a hospital setting, and they were just a controlled metformin-based diabetic, a lot of times in the hospital, the standard is to start injecting them with insulin to bring their blood sugar down. Once they go on insulin, then they’re put on insulin forever. So, it just becomes a very rapidly progressing scenario for them.   So, I can speak on that side with a lot of confidence on Hashimoto’s.  I still don’t have first-hand experience of my patients contracting the illness, but I do have very, very strong suspicions as to what it’s going to look and how they’re going to evolve if they contract the infection.

Dr. Weitz:            It’s interesting just thinking about it. It just so happens that some of the key nutrients necessary for thyroid health, zinc and selenium and vitamin D, which are talked about a lot are also if any of these are low or less than optimal, increase your susceptibility to viral infection.

Dr. Valdes:          That’s right, and to complications from viral infections, and I know that zero patients that have ever walked in through my door coming from a conventional model of care where all that’s done for them is taking Synthroid or levothyroxine, right? None of them come in with high levels of selenium or high levels of zinc. So, the majority of these patients are straight out of the gate just because of nutritional status in a situation where they are at risk for complications or progression of the virus if they were to become infected.  So, in addition to that, if we go into the topic of autoimmunity, then that really opens up the conversation because I think that it’s not about the prevention of the infection, but what’s going to happen to so many of these patients that already having a pre-existing autoimmunity whether Hashimoto’s or lupus, sclerodermis, psoriasis, MS, whichever one of these conditions. We know that viral infections are huge, huge triggers of autoimmunity, hands down, rarely any exception to that rule.

Dr. Weitz:            Interesting because I think that there’s perhaps somewhat misconception that autoimmunity is simply an immune system that’s overactive, which would mean that would be a good thing if you had a viral infection, right?

Dr. Valdes:          You would wish but not really. So, there’s really three main mechanisms to autoimmunity in connection with viruses. One of them is called molecular mimicry. What that means is viruses are very, very sneaky, very sophisticated types of infections, and the way that they hide from the immune system is by expressing a protein, an antigen that is very, very similar to self. It could be similar to the thyroid. It can be similar to the brain. It can be similar to the lungs depending on the area that the virus is going to infect, or it has a preference for infecting.  So, many times when the immune system creates a response to that virus, if the response is very aggressive, like you were saying, very overactive. Then it’s going to go after the tissue. Also, it’s going to go after self because they look very, very similar to the immune system. There’s also something called bystander activation where the immune system whereas the virus begins to break down the cells that it’s infecting, and those cells die and break open, there’s going to be self-antigens that are released as that cell dies, and that’s going to now create a self-attack. The immune systems going to identify these intracellular antibodies and begin to go after those tissues because they contain that antigen. Then there’s another one called epitope activation, which is very similar just to a much larger scale to bystander activation when there’s very diffused tissue breakdown, and when we see things like what happens with coronavirus, this cytokine storm, this huge wave of inflammation to a specific tissue.

                                So, we know that viruses especially when they take hold, they are very immuno activating, and there can be a lot of overlap between virus antigens and self-antigens, and that’s why I’m really, really worried for autoimmune patients, Hashimoto’s patients because we know that if they were to contract the virus, viruses, especially very pathogenic viruses are a huge source of immune activation, and that can mean on the least a relapse of the condition, a reactivation, but on the worst, development of now new autoimmune diseases moving forward, and I think some of the people that are out there talking about this are maybe trying to bring down the tone and create less worry, less concern, less stress but in reality when you really look at the mechanisms of autoimmunity, this becomes very alarming for the population moving forward, not just for what’s going on right now.

Dr. Weitz:            Now, the things you’re talking about, how speculative are they? I could just see the editors from New England Journal of Medicine saying, “Well, there’s really no human scientific randomized trials to show that any of this is truthful.”

Dr. Valdes:          Yeah, well, they’re really not very speculative, and they’re not too far-fetched. They are speculative for this virus in particular because it’s a novel virus. We don’t have enough data. We don’t have enough knowledge, but when you look, and I’ve looked at a lot of reviews of the literature linking viral disease and the development for autoimmunity, and we have class one data. We have the best available studies that have shown over and over that viral infections can be very strong triggers for autoimmunity. So, we know that enteric viruses and children are deeply linked to the development of type one diabetes. We know that viruses like Epstein-Barr and cytomegalovirus are deeply linked to auto immunities of the thyroid and of the brain. Those are well, well documented facts.  It wouldn’t be a surprise to me that with the type of infectivity and pathogenicity that COVID-19 has to the respiratory tract. I would be surprised that we don’t see long-term autoimmune consequences from this infection.

Dr. Weitz:            Okay, cool. Good way to start. Let’s pivot to where we left off in the last discussion, and that’s talking about the triggers of Hashimoto’s and what to do about these.

Dr. Valdes:          Yeah, so Hashimoto’s really like any other autoimmune disease has a pretty extensive number of triggers. We can talk about hormonal surges. If hormones like insulin or cortisol or estrogen are surging, that means spiking day after day. These high levels of hormonal surge can be immuno activating. They can signal the immune system and say, “Hey, there’s too much hormone. What’s going on? Is there a tumor in a tissue? Do we need to go clear it?” So, hormonal surges are big activators.

Dr. Weitz:            So, let’s go into that a little bit. Let’s talk about some of those hormonal surges. So, why don’t we start with cortisol, say?

Dr. Valdes:          Yeah, so one of the biggest known autoimmune activators. Cortisol is secreted by the adrenal glands when we are stressed, when we’re in the fight-or-flight, and we know that cortisol has initially an immuno activating effect, but long-term, unimpressive effect. When cortisol is detoxified or in the liver, it becomes cortisone, and which has a very immunosuppressive effect. When this stuff starts compounding, it can begin to shut down some of the areas of our innate immunity and start overactivating or driving domains of acquired or antibody-based immunity. So, we know that stress is one of the biggest triggers for the development of autoimmune disease and for the relapse of autoimmune disease.

Dr. Weitz:            Now, what about cortisol having lower levels because a lot of us who do like the salivary cortisol testing find that a lot of patients especially with long-term stress just have lower cortisol levels.

Dr. Valdes:          Yeah, and for me personally, clinically, that’s just an indicator that at some point, they had very, very high cortisol levels. Now, I’m not very clear on the mechanisms between the immune system and having low cortisol as clear as I am when cortisol is surging, but yeah, to me, that’s usually an indicator that at some point, this person had very high levels of cortisol and now, they’re shutting down their production or slowing down their production.

Dr. Weitz:            Now, I can’t help but make another comment about coronavirus, because unfortunately, it seems to be on everybody’s mind including my mind, like 23 out of 24 hours a day as much as I try not to, but some of the data seems to indicate that nonsteroidal anti-inflammatory is actually worse than your response, and corticosteroids seem to be potentially somewhat beneficial, and there are some articles showing that glycyrrhizic acid, which is contained in licorice, which helps your adrenal glands to produce more cortisol may actually be beneficial.

Dr. Valdes:          Yeah, very interesting and super confusing too because we know that a chronic stress response reduces your… Sorry about that. Reduces your ability to fight off infection. That’s common knowledge, and right now, the thing that I worry about is people stuck in their house, stressed out of their minds, eating all this crap. If they were to contract the infection, in my mind, it really creates a negative scenario. So, it is confusing to see that there would be benefit from-

Dr. Weitz:            Well, it’s probably about the timing. In other words, if you were to have a surge in cortisol before or at the beginning, that might make it… I’m only speculating here based on some of the stuff I’ve read. But perhaps once you’ve got the virus that’s starting to create this inflammatory situation in the lungs, that can lead to that big cytokine storm that’s creating all this damage to the lung, scarring, et cetera, that sometimes can be fatal. Maybe at that point, using cortisone can help to lower that inflammatory response. So, it’s not always about the exact substance but the timing as well.

Dr. Valdes:          Yeah, that makes a lot of sense. Well put. Well put. Yeah, I mean, that makes sense, absolutely, and in the hospital, right now, I know that what they’re doing for most people, I know a lot of the doctors are not very comfortable yet with the hydroxychloroquine and the Z-pack. Apparently, it’s a pretty aggressive combo, especially for heart. So, I know that for the most part what they’re doing is albuterol to the lung, which is just an anti-inflammatory cortical steroid. So, it makes sense. If at that point, probably the main thing is driving down inflammation in the respiratory tract.

Dr. Weitz:            Yeah, so anyway, so cortisol surges that will… How does that affect Hashimoto’s now?

Dr. Valdes:          Yeah, so we know that-

Dr. Weitz:            Sorry to get you off track, doc.

Dr. Valdes:          No, all good. So, we know that when cortisol is surging, it’s activating, it’s spiking, it can be immunoactivating. It seems that whenever there’s a preponderance of hormone over time or repeatedly over time, it can signal the immune system to activate. We suspect it’s probably part of just innate immunity, the way that the immune system would clear tumors. Probably when there’s continuous urgings of specific hormones, there seems to be signaling to the immune system that there’s a problem with this tissue.

Dr. Weitz:            So, if you have a patient with high cortisol levels that seems to be triggering their Hashimoto’s, how would you treat that?

Dr. Valdes:          Great question. So, it’ll depend a little bit. Really, we like to go three pronged with it. Classically, we’ll use adaptogens. Whenever we have someone that’s autoimmune after we’ve done metabolic clearing, which we like to do with almost every autoimmune patient-

Dr. Weitz:            What is metabolic clearing?

Dr. Valdes:          So, metabolic clearing is a combination of an elimination food plan where we remove most of the foods that we know are problematic for the immune system in most people.

Dr. Weitz:            Which would be what?

Dr. Valdes:          So, it would be things like gluten, dairy, soy, grains, sugar obviously, some of the key things we know to be very inflammatory and immunoactive.

Dr. Weitz:            Okay.

Dr. Valdes:          We combine that with liver detoxification. We improve nutritional status. We clean out the gut a little bit, and that’s what we mean by metabolic clearing. We increase hydration significantly to be able to eliminate metabolites, xenobiotics, all of the things that-

Dr. Weitz:            So, essentially, you’re talking about one of the pillars of functional medicine approach as originally taught to us by the father of functional medicine, Dr. Jeffrey Bland, using a 4R or the 5R program.

Dr. Valdes:          That’s correct, yeah. So, we really liken and find a lot of value in initiating every autoimmune or almost every… There’s some patients that won’t tolerate it, and we can talk about that, but almost every patient that we take on, we to start them on there because it’s such a broad… It covers so many pieces, and one of the things that it does, it helps people eliminate excess hormones during that period of time. So, if one of the things is they’re having surges of insulin or of cortisol or estradiol, their overall hormonal levels are going to decrease by detoxification. So, that’s one thing. Another thing is we want to induce things that can have a direct effect.

Dr. Weitz:            Well, I’ll tell you what. Let me stop you there because we went into the cortisol. Why don’t we talk about the surges of insulin and what we can do about that?

Dr. Valdes:          Yeah, so those are probably the easiest to talk about because most of the time, those are 100%… I don’t know why this keeps going off.

Dr. Weitz:            What happened?

Dr. Valdes:          Can you hear those notifications or am I the only one hearing them?

Dr. Weitz:            Yeah, I don’t think I’m hearing them, doc.

Dr. Valdes:          Okay, sorry about that. So, insulin is 100% connected to dietary intake for the most part. So, people that have a diet that’s very high in carbohydrates, people that have a diet that’s high in starches and sugar, people that just eat in excess and eat way more than they should be eating are going to be experiencing recurrent insulin surges. Now, if on top of that the patient has mechanisms of insulin resistance, if they’re secreting excess glucagon, if they’re having high cortisol, which will also drive high blood sugar, then those things can worsen the insulin spikes. So, initially, we want to also in the elimination diet make sure that we’re keeping their carbohydrate levels and their sugar intake as low as possible, and then in other stages of the treatment, we’re going to go into some of the mechanisms for the insulin surges themselves. Is that clear?

Dr. Weitz:            Yeah, sounds good, and then estrogen surges. Why would somebody have estrogen surges?

Dr. Valdes:          Yeah, so two specific times of life. One of them is women that are on the pill for-

Dr. Weitz:            Birth control.

Dr. Valdes:          … birth control. Whenever they consume their birth control pill, they’re going to have an estrogen surge, and they’re going to detoxify it, eliminate… Their estrogen level’s going to drop. The next day, what do they do? They take it again. So, it resurges, and it’s interesting because we tend to see… When you see younger adult females in their 20s or 30s, almost always there seems to be a connection too with birth control. So, that’s a common place where you’ll see estrogen surges. Also in-

Dr. Weitz:            Hold on a second. So, are you saying there’s a connection between birth control and Hashimoto’s?

Dr. Valdes:          Yeah, yeah, and there’s a lot of research on that. Just a search in PubMed will show you that it’s been linked historically with birth control therapy.

Dr. Weitz:            So, if you have a patient with Hashimoto’s, what is your advice if they’re on birth control and you detect it. They’re having an estrogen surge.

Dr. Valdes:          Well, that’s going to depend. I mean, if they are wanting to-

Dr. Weitz:            In consultation with their gynecologist.

Dr. Valdes:          In consultation with their gynecologist. Most of the time, like an IUD might be a better. An IUD, copper primarily now-

Dr. Weitz:            Because there’s been a lot of problems with some of these IUDs.

Dr. Valdes:          Correct. There are, and there’s really problems with most forms of birth control then. Some women might be having really big issues with their menstrual cycle. They might have PCOS. They might have all these issues, and they have a lot of bleeding and sometimes, there’s a consideration for an IUD with estradiol to offset that. So, in conjunction with their OBGYN provider, I would probably recommend a copper IUD as a preferred method, but I know that’s… I mean, you’re putting me super in the hot water today. It’s an extremely controversial topic, but that would probably be a preferred route. Now, do understand that a lot of people go on birth control, and not everybody develops autoimmunity. So, there’s other factors.

Dr. Weitz:            Of course.

Dr. Valdes:          There has to be other potential immune triggers. Sometimes, there’s genetics that are predisposing. So, it’s not a general rule of thumb, but if we were to speak generally, we know that this causes estrogen surges, and estrogen surges are known to be potentiators of autoimmunity and then to add to that, perimenopause and menopausal females also experience estrogen surges during that period. So, there also can be, and there is a surge in the demographic information of people that develop autoimmunities later in life. There seems to be a prevalence, and really, one of the reasons why I think that this is also so much more common in females than it is in males.

Dr. Weitz:            Right, and this is often referred to as estrogen dominance.

Dr. Valdes:          Correct.

Dr. Weitz:            Then of course we have the toxic forms of estrogen from the environment like pesticides and bisphenol A and phthalates and on and on and on.

Dr. Valdes:          Oh, yeah. I mean, we can spend an entire day there, and it’s really crazy. From even the stuff that’s put in food, like estrogen is directly and purposely placed on food. We are seeing here in the U.S., girls that are beginning to develop adult female characteristics, breast tissue, pubic hair at or around the age of eight or nine, which is unheard of, and we look at our European counterparts. Most of their girls begin to develop their adult female characteristics around 12, 13, 14, even 15, which is actually normal. So, the estrogenic load on our population both female and male is incredible. It’s incredible.   So, yeah, from toxic forms from nutritional forms, and the worst part about it is our body could potentially get rid of some of this stuff, but when you throw in all the other chemicals over 700,000 toxic chemicals every day to each and every one of us, the toxic burden is so high that if we’re not doing things very purposely, very actively for our detoxification pathways, most of us are vulnerable to this estrogenic bombardment.

Dr. Weitz:            Okay, good. So, let’s move on to some of other triggers for Hashimoto’s.

Dr. Valdes:          Yeah, so I mean, there’s so many I can mention off, and then we can go into whichever ones, but there’s toxins like mercury, one of the biggest ones, permeability issues in the gut, food sensitivities, viral infections, which we spoke about.

Dr. Weitz:            Okay, so why don’t we start with toxins?

Dr. Valdes:          Okay.

Dr. Weitz:            So, we’ve got heavy metals, mercury. Are there other heavy metals or is mercury the main one that you-

Dr. Valdes:          No. There’s definitely more. Cadmium, aluminum, lead really tend to be the biggest ones. I’m sure there’s more, but those are the ones that I tend to see more frequently. Mercury, two forms, methyl mercury and inorganic mercury. One, we get from primarily amalgams in our mouth unless you were a kid playing with the stuff that was inside of your thermometer, which I unfortunately did, and-

Dr. Weitz:            Same here unfortunately.

Dr. Valdes:          And then methyl mercury, which we are getting primarily from fish. Then cadmium, the main source in humans is cigarette smoke and tobacco smoke, and aluminum… I mean, it’s everywhere from cans-

Dr. Weitz:            Ubiquitous.

Dr. Valdes:          It’s ubiquitous. There’s also a form that’s rarely talked about, which is copper, and copper is an essential nutrient but at the degree and amount that we’re being exposed to it, it’s actually very toxic to both us and our environment.

Dr. Weitz:            Especially since we’ve switched over to copper piping for a lot of our plumbing.

Dr. Valdes:          Correct, yeah.

Dr. Weitz:            We went from lead, which obviously is problematic to copper.

Dr. Valdes:          Which is slightly less problematic but still problematic, and when we look at the world of cognitive disorders, it’s a big, big player in that, and then aluminum, cadmium, lead, mercury. Yeah, I think those are the main ones that we tend to really pay a lot of attention to.

Dr. Weitz:            So, the preferred testing, you use serum. Is it provoked urine? Is it hair?

Dr. Valdes:          We like to use just for practicality and for accuracy as far as what we’ve seen, we like to use Quicksilver Tri-Mercury with blood metal. So, we run blood metals, but then mercury because of its… It really behaves in a way that it’s very unique in its differences between methyl and organic or inorganic mercury. We like to have the Tri test, which will check hair, urine and blood for mercury.

Dr. Weitz:            Now, is the Quicksilver metals test, is it simply a serum test? Is there some reason why doing the Quicksilver metals test is better than just running serum metals through LabCorp or doing it NutrEval, which includes serum metals?

Dr. Valdes:          Well, I mean, one of the things that we like is that it’s very comprehensive, so it includes a lot of different metals together with essential minerals, which are also metals. Things like zinc and copper and all those will also be. So, we do it primarily because of convenience. I don’t know. In that side, in the blood metal side, I can speak in to the mercury side, and there’s definitely huge benefits to run-

Dr. Weitz:            No, I can see the benefit of doing that Tri metals test.

Dr. Valdes:          Right, yeah, but as far as the blood metals, nothing really that would stand for me. As a preference, it’s just the convenience of having all of those metals tested together.

Dr. Weitz:            Sure, good, and then when you find the metals, what do you do? Let’s say you have an elevation of whatever, mercury or cadmium or specific protocols for each one. Is there a general metals detox program you do?

Dr. Valdes:          Yeah, I mean, again, we do like the protocols that have been created by Dr. Shade who is the founder of Quicksilver, and there’s differences. A lot of the metals that are non-mercury metals are going to require on top of everything else, they require EDTA to be able to emulsify them and bring them out. Now, if you do EDTA with mercury, you actually push it further into the tissue. So, you make the patient worse. There’s definitely a lot of different specific things. You always want to have a binder that will catch the metal in the gut. You always want to have tons of glutathione and NAC because glutathione has this wrapping effect when the metal is pulled from the tissue, it’ll wrap it, and it’ll make it less damaging for cellular tissue as you detoxify it.   You also want vitamin C, which is going to be immunomodulating. As you clear it, you want to have a lot of zinc. You also probably want to do remineralization because as you’re pulling metals, you’re also pulling minerals, which you want to replenish. What else is pretty important? You want to increase liver detoxification. So, you want to increase your intake of cofactors and milk thistle and all of the things that help the liver push stuff out. So, yeah, you really need a good comprehensive toolkit.

Dr. Weitz:            So, for binders, do you do a combination binder? There’s a number of things that are on the market or do you use specific binders for specific metals?

Dr. Valdes:          Yeah, I mean, most of the time, I activated charcoal, and I like chitosan. Those are my two really big ones. There are some combination ones out there. If they’re in stock, hey, it’s convenient. I’ll use them. Also, IMD, which is a very specific gut binder can also be beneficial especially when dealing with mercury.

Dr. Weitz:            What is IMD?

Dr. Valdes:          I’m not sure what the letter stands for, but it’s just a binder. That’s why it’s called IMD, and it’s just a little bit more specific for toxins that bind to the lining of the gut.

Dr. Weitz:            And then sodium EDTA, what form is that in? Are you talking about a nutritional supplement or intravenous or-

Dr. Valdes:          Yeah, well, we use nutritional supplements. We use it in an oral liposomal liquid, but intravenous can be very, very beneficial, and actually, I found a tremendous amount of benefits for EDTA, and we can talk about breaking down biofilms in infections, breaking down and emulsifying viruses in the respiratory tract, which is an interesting application to talk about right now, but EDTA is a really good emulsifier. So, when things are sticking, it works like a soap to release things. A liposomal form is very absorbable, so we tend to like it.

Dr. Weitz:            Okay, interesting. Yeah, I think what you’re referring to is that some infections, bacteria, viruses that get into your system may form a biofilm, a protective coating that protects them, and it’s more difficult for your body to get rid of it, but viruses… I know bacteria do this, but viruses do this as well?

Dr. Valdes:          No. Viruses don’t form biofilms, but viruses can be… This comes from some of the studies around Monolaurin and laurisidin. EDTA has no research that I’ve seen on application, but things that have an emulsifying effect have the potential of removing viral load or lessening viral load. So, that’s why I think it’s very interesting. It could be an interesting application to play around, and don’t take this as a medical recommendation. This is just a curious mind because seeing we do use it clinically for a lot of sinus infections, we’ll put it up there with it as a nasal spray with things like MARCoNS or very aggressive bacterial infections, and it works at emulsifying the biofilm. So, my suspicion, my clinical interest is that EDTA could have a very similar effect with viral infections also.

Dr. Weitz:            Okay, so let’s move on to the next trigger for Hashimoto’s. So, we already covered to some extent food sensitivities, insulin, cortisol, estrogen surges, dysregulation, and we talked a little bit about heavy metals. What would be another common one?

Dr. Valdes:          Yeah, so a huge one, and this is the thing that everyone talks about obviously is the gut and increased membrane permeability issues in the gut.

Dr. Weitz:            By the way, sorry to keep interjecting, but non-stop, I have this coronavirus thing on my mind, but I just recently read an article that it turns out that more than a reasonable percentage of patients… I forgot exactly the number that the infection will actually start with gut symptoms. So, it seems to actually get into the gut to begin with, and then obviously somebody who has a leaky gut would potentially be an easier route into the rest of the system.

Dr. Valdes:          Absolutely, yeah, absolutely, and out of the COVID-19 prevention and treatment manual, they showed that for some of the patients that were presenting gut symptoms, they showed the value of a high-caliber probiotics, something like VSL#3 and high levels of acidophilus specifically is what they talked about in the publication. So, absolutely, absolutely.

Dr. Weitz:            Would you mind sending me a copy of that that I put in the show notes?

Dr. Valdes:          Yeah, absolutely. I posted the whole manual on my LinkedIn page. So, if you just go to Dr. Ruben… I’m happy to send it anyways, but that’s a quick way of getting it.

Dr. Weitz:            Okay, sounds good.

Dr. Valdes:          So, yeah, absolutely. There’s a mechanism there. For those that are not familiar with leaky gut, in 2020, you should, but leaky gut, medically, that’s not a medical term. When we talk to a gastroenterologist or whatever, they call it increased membrane permeability, and it is a thing. It is a diagnosis. Our gut is the only tissue in our body that is one-cell layer thick. So, it’s very thin. It’s designed for absorption and filtration, and those cells are held together by proteins that gates, have a gating mechanism for specific things that are larger that can be absorbed to be, let’s say, decided upon like the Panama Canal, and things can go up to a certain stage and then permeate through, or they can be rejected and go back into stool, into the bolus.   So, people that have increased gut permeability will absorb things that shouldn’t be absorbed. It can be undigested food particles, which are a problem because just like viruses, some of the surface antigens in food can create molecular mimicry. It can create confusion for the immune system. Lipopolysaccharides, which are these proteins that are produced by bacterias, which are very, very inflammatory, they can absorb viruses. They can absorb a lot of things that are not supposed to go into the bloodstream creating this chronic activation of the immune system, driving some of the autoimmune pathways.

Dr. Weitz:            Okay, cool. So, what do we do about problems with… How do we identify problems with gut health and then what do we do about them?

Dr. Valdes:          Yeah, so there’s a lot of things that drive gut permeability. One of them, and I rarely hear people talking about this, but it’s just the amount of food that we eat and the frequency with what we eat. It’s crazy. In America, we eat a lot, a lot, and all the time, and what happens is every time there’s food going through this one-cell layer of tissue, it’s damaging. It’s creating some abrasion. So, something that’s incredibly effective for leaky gut is fasting. Stopping eating. We preach this stuff all the time. The body has the ability to heal, to repair itself. So, going on a fast 3, 5, 7 days, or 11 days, and something that makes that easier is having something that’s densely nutritious, something that has a lot of collagen. Something like bone broth can be a very, very useful tool for a fast in repairing the gut. So, that’s one of my preferred.  There’s also people that need specialty stuff. So, if we test, and we find that there’s a nasty infection like Klebsiella, Clostridium, an overgrowth, an imbalance. We need to go in there and begin rebalancing that microbiome, get rid of the stuff that might be driving inflammation, that might be driving some of the breakdown of the cell tissue.

Dr. Weitz:            So, how would you handle that? Are you talking about using anti-microbials?

Dr. Valdes:          Yep. We would use anti-microbials that would be specific to the sensitivity of the pathogen or the dysbiotic fungus or bacteria that we would find. If there is a suspicion of an enterovirus, which most of the time we don’t really have a test for, for viruses in the gut, but a lot of people have viruses in the gut. Here’s a place where your lurasidone and potentially your oral EDTA would also have a great benefit in helping get rid or decreasing the viral load in the gut. So, just another little tool.

Dr. Weitz:            I know some of the PCR stool tests now include some viruses, a limited number.

Dr. Valdes:          Yeah, some do. I’m still interested in seeing a little bit more data on PCR, but I think there’s a ton of promise there for sure.

Dr. Weitz:            Oh, yeah, we pretty much switched over to using the GI-MAP from Diagnostic Solutions-

Dr. Valdes:          Nice. Very cool. Very cool.

Dr. Weitz:            … which is a PCR-based stool test. So, next trigger for Hashimoto’s, what would be the next thing? So, we did heavy metals. We did food sensitivities. We did insulin, cortisol, estrogen. What would be the next one?

Dr. Valdes:          Yeah, so we can talk briefly about one that’s very common, but rarely spoken about, and we got into this a little bit the last time, but biotoxin illness. We know that 22% of the people, the population are carriers of a susceptibility in a gene called HLA-DR/DQ, and for people that are susceptible, what that means is that their immune system cannot identify or create antibodies or transport and present the biotoxin itself. So, a domain of their immune system becomes chronically active.  Now, if you ask the developer of all of this stuff, Dr. Ritchie Shoemaker, he will tell you there’s not enough data yet to confirm that this is a driver of autoimmune disease. Possibly, I don’t know. I haven’t spoken to him in a long time, so I don’t know where he’s standing right now on this, but clinically, we see an immense amount of people that have these susceptibilities that move on to develop autoimmunity, and when they are autoimmune, these tend to be big triggers.

Dr. Weitz:            So, by biotoxins, the main one you’re talking about is mold mycotoxins?

Dr. Valdes:          Yeah, mold mycotoxins is the most prevalent one, but there’s also Lyme disease, which is becoming more and more prevalent.

Dr. Weitz:            Most people put that in the infection category.

Dr. Valdes:          Well, it is both infectious and biotoxin because initially, when you’re bitten by a tick, you get a Borrelia infection, but the Borrelia is a biotoxin-producing organism just like mold or just like specific types of blooms or just like MARCoNS. Microorganism, some of them can produce these nasty biotoxins. So, some people that are non-susceptible do a great job at getting rid of the infection and getting rid of the biotoxin. Some people that are susceptible can get the infection, and they might be treated for the infection, but the biotoxin illness will linger on and stay around. So, it falls into both categories and right now, actually, this is a pretty interesting and controversial subject.

                                I interviewed somebody yesterday about this because all of us are being forced to stay indoors and for a lot of people, they’re now indoors with their other enemy, which is mold, and they don’t know about it, and for a lot of people, potentially about 20% of our population, they’re going to begin to become sicker and sicker from being indoors. Buildings, structures are not built the way that they once were in the past. There was a lot of focus on air circulation on being able to move the air from the outside-in, and that’s one of the things that really can get rid of these biotoxins.  Sunlight gets rid of molds, and now, people are living in homes being in building structures that have poor air circulation. So, the longer that we are indoors, the sicker a lot of our population and the people that you and I see are going to be coming back outdoors.

Dr. Weitz:            Which is interesting because actually part of it has to do with the construction, trying to make your home more waterproof ends up reducing the air circulation.

Dr. Valdes:          Correct.

Dr. Weitz:            Then you end up with moisture that builds up within the walls that can contribute to the mold.

Dr. Valdes:          Absolutely, yeah. Yeah, I mean, there’s so many little things to that, from the way that your windows are flashed to the angle of the roofing. If one little nail goes in the wrong place, it’s like crawl spaces are a problem. Basements are a problem. Sump pumps are a problem. There’s so many things that can really contribute. Even in the best-built home, this is a problem that can really affect any and all of us.

Dr. Weitz:            So, I think this is going to have to be our last point.

Dr. Valdes:          No problem.

Dr. Weitz:            Once again, we’re running up against the time clock because I do have a patient coming up. So, your preferred method of getting rid of mycotoxins and Lyme?

Dr. Valdes:          Yeah, so mycotoxins or first thing is removal. So, remove the person from the environment that is making them sick or change the environment. Remediate the environment.

Dr. Weitz:            Which right now is really hard when you’re supposed to stay in your house.

Dr. Valdes:          Right, absolutely. It’s incredibly hard. So, for when that can’t be the case, there is a protocol. I’ll send it to you. There’s two things that have been shown effective in killing mold. Formula 409 is fantastic. Nothing else can kill the stuff. So, using that stuff on your house, which is toxic, so I don’t know. Go to the backyard for a little bit. Vacuuming, cleaning, all that becomes important. There’s also something called Air Oasis, which can actually kill the biotoxins. It’s also effective for killing viruses in the environment too.

Dr. Weitz:            I just had somebody show me an air filtration system that also puts out hydrogen peroxide and then claim that that helps get rid of mycotoxins.

Dr. Valdes:          Absolutely, yeah, absolutely. I mean, they’re not hard to kill. So, for the time being, that would be the best strategy for Lyme, which you mentioned the only way of removing the exposure really is if you have the active infection is doxycycline or an antibiotic that will get rid of the infection. I’m not very familiar with natural methods that can get rid of Borrelia. For the toxin, unfortunately, the only binders that we have documented success with are cholestyramine and Welchol, which are both prescription binders.

Dr. Weitz:            These are for the mold?

Dr. Valdes:          Yeah. This is once the toxin is in the body.

Dr. Weitz:            Okay, the mycotoxins.

Dr. Valdes:          Then you bind it. You bind it with a binder in the gut to get rid of those.

Dr. Weitz:            Those are both prescription meds?

Dr. Valdes:          Those are both prescription. There is some promise around okra seed and chitosan has the shape where it would bind the toxin, but unfortunately, most of the chitosan out there is not enterically coated, so by the time it reaches the gut, it denatures, and it doesn’t make it to the bile where is where we would bind the toxin. So, for the time being, cholestyramine and Welchol are really the only thing, and I research this all the time. There’s some people out there saying that they have a binder that would do this or that but in reality, they are ineffective. So, that would be the main thing and from there, it’s a very streamlined protocol where you begin to normalize each one of the immune markers, the C4A, the TGFB-1, the MMP-9. There’s different steps for each one of those, and ultimately, there’s an intranasal spray called VIP, vasoactive intestinal peptide. That will repair the tissues of the sinuses and of the gut to finalize the whole process.

Dr. Weitz:            Those are basically part of the Ritchie Shoemaker protocol?

Dr. Valdes:          Yes, correct.

Dr. Weitz:            Okay. Excellent, Dr. Valdes. Tons of interesting information. Once again, we could have gone on for another hour, but I think this’ll give everybody a lot of things to think about. So, for the listeners and viewers, how can they contact you and find out about seeing you or visiting one of your offices, real or virtual?

Dr. Valdes:          Yeah, so the best way right now is www.novis, which is N-O-V-I-S.health. So, no .com, just .health. Novis.health. That’s our main site. We’ve actually have bulked it up. We’re releasing a new site on Wednesday. So, we’re very excited about that. People will be able to book their virtual consultations right on the site.

Dr. Weitz:            Awesome. Thank you so much.

Dr. Valdes:          Thanks, doc. Have a great day, and thanks for all your awesome work.

Dr. Weitz:            Thank you.


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