Doctor Detective with Bryan Walsh |

Every year, the Centers for Disease Control and Prevention (CDC) conducts a study called the National Health and Nutrition Examination Survey. This survey, which is the largest of its kind, tests for over 200 different chronic diseases, including diabetes and obesity. The data collected from the survey could help doctors to improve diagnoses and treatments, but it’s rarely looked at in depth. That’s why I decided to do an in-depth look myself.

We all have that friend who hates to cook. We know they are always busy, but you can never include them in your dinners. The solution to this problem is to turn your friend into a Doctor Detective, and then have them cook for you. These Doctor Detectives report back to you with simple recipes that are easy to follow and will help your friend lose weight without them even knowing.

Doctor Detective is a podcast hosted by Bryan Walsh, a physician and medical reporter. The show combines a reporter’s curiosity, investigative skills, and medical expertise with the show’s featured co-host’s background in forensic pathology and forensic science. Together, they examine the dark side of medicine and investigate the unsavory aspects of medicine.

Doctor Detective meets a lady with adult acne in this week’s case study. But, as he soon learns, acne is the least of her issues. Can Doctor Detective help her get back on track with sex hormone, cortisol, and blood sugar imbalances? Find out in the next paragraphs.

Eat less calories and exercise more. It’s a fantastic prescription for boosting health and body composition in general. It does not, however, always work.

Even with a great workout routine and a well-balanced diet, some individuals have strange symptoms and complaints, especially considering how much effort they put into their fitness and health.

We know there are just a few specialists on the world to turn to when we encounter customers who have issues that exercise and diet — not to mention their own physicians — can’t seem to cure. Bryan Walsh is one of them.

Dr. Walsh has a keen intellect, a fitness background, a naturopathic medical degree, and a long list of extra training and certifications. His wife, too, is a naturopath. (We’re willing to wager that his children are the healthiest on the world.)

Dr. Walsh transforms from mild-mannered parent and husband to forensic physiologist when clients have nowhere else to turn. He takes out his microscope and examines blood, saliva, urine, lifestyle, and everything else he can think of. He also breaks the physiological impasse.

That’s why we leapt at the opportunity to collaborate with Dr. Walsh on a monthly case study segment. You’ll learn how to enhance your own health and discover how a skilled practitioner thinks by following along with these interesting instances.

In today’s case, we’ll meet a client who just had one issue for Dr. Walsh: adult acne. However, Dr. Walsh found that she had issues with her sex hormones, blood sugar, and stress hormones after additional examination.

Learn how “Doctor Detective” Walsh solved the puzzle and assisted this customer in achieving unexpected outcomes.

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The customer

It’s not every day that a healthy young lady with a positive outlook comes into my office with health problems. There are a lot of them. That immediately drew my attention.

Jill was 34 years old and in good health. She did, however, suffer from adult acne. Acne, you know, the thing you’re meant to grow out of about the time you stop stealing from your parents’ booze cupboard and lose your infatuation on Justin Bieber? Jill’s acne, on the other hand, never received the message that it was time to move on.

Jill was a lady with a purpose. She’d seen a number of traditional physicians who had only prescribed antibiotics (minocycline, tetracycline, clindamycin), as well as Differin®, Retin A, and azelaic acid as topical and oral medicines. When that didn’t work, she turned to natural acne washes, zinc and chromium supplements, and honey masks for relief.

Nothing seemed to help. Doctors informed her there was nothing wrong with her and that she would have to put up with the outbreaks.

Not only had her acne not improved after two years of trying everything, but she was also getting regular urinary tract infections (likely from the antibiotics). Her frustration was palpable. She sensed something wasn’t quite right.

But what exactly is it? She seemed to be in good shape. Her organic diet allowed her to eat healthily. She was a frequent exerciser. Her weight was normal at 5’9″ and 130 lbs. She was even cheerful and enthusiastic.

However, acne was just one of her problems.

Jill was certain that she, too, was suffering from hormonal abnormalities. She’d been trying to conceive for ten years with no success. Her and her husband had all but given up on her desire to have a child.

Symptoms and indications of the client

When Jill entered my office, I inspected her. She had a lot of acne and a lot of facial hair. All other physical exam results were normal, with the exception of a low blood pressure (100/70).

I delved further, taking notes along the way. The following is what Jill described:

Symptoms / Signs	My views on the subject – possible problems
If she misses meals, she becomes lightheaded.	Sugar levels in the blood
In the afternoon, he feels weary.	Thyroid, adrenal hormones, sex hormones, and anemia are all factors to consider.
During her menses, she has breast discomfort, swelling, cramps, pelvic pain, and irritation.	Unbalanced sex hormones
In the mornings, he relies on coffee to get moving.	Anemia, low thyroid, and adrenal hormones
Has sugar and salt cravings throughout the day	Adrenal hormones, blood sugar
Bloating and gas are a problem for her.	Dysbiosis, illness, and poor digestion are all symptoms of dysbiosis.
Depression, anxiety, and “emotional instability” are all issues that people face.	Unbalanced neurotransmitters, sex hormones, and blood sugar

Aha, I realized. Jill is most likely suffering from blood sugar problems (i.e. reactive hypoglycemia), sex hormone imbalances, digestive dysfunction, and possibly adrenal hormone imbalances, based on her medical history, indicators, and symptoms so far.

After many years as “Doctor Detective,” I like to believe my instincts are quite excellent. Still, I’m a cautious person. I’m not one for jumping to conclusions. As a result, I relied on diagnostic testing for confirmation.

The exams and evaluations

Taking a thorough medical history and analyzing symptoms attentively may frequently reveal all you need to know about a situation. However, there are certain topics that you just cannot learn by asking questions.

I can’t look inside my customers’ blood vessels or cells, and I can’t predict their urine chemistry. I receive information through lab tests that I wouldn’t obtain from a discussion. In fact, one of the most helpful weapons in my arsenal is labwork.

I prefer to begin with some simple tests. These are sometimes all I need. A good blood chemistry test and a salivary hormone panel are always my first steps. Jill is a candidate for a digestive function panel as well, but we decided against it for the time being.

The results of the tests

Panel of blood chemistry

A good blood chemistry panel, when analyzed properly, may reveal a lot about a patient’s internal physiological processes. The following are some of Jill’s key results from her blood chemistry panel:

Marker	Result	Reference Range in the Laboratory	Thoughts
BUN	7 mg/dL	5-26	Low – potential liver problems or problems with protein metabolism (i.e. digestion)
Globulin	2.4 g/dL	1.5-4.0	Protein metabolism problems linked to digestion may be borderline low.
LDH	133 IU/L	100-250	Hypoglycemia with a low threshold – reactive hypoglycemia (blood sugar fluctuations)
WBC	4.7 x 103 per uL	4.0-10.5	Immune suppression is a possibility since the level is borderline low.
MCV	94 lF	80-98	B12/folic acid insufficiency is borderline high (common with digestive issues)
Phosphatase Alkaline	35 IU/L	25-150	Low – Zinc and/or vitamin C insufficiency may be present.
Uric acid	2.5 mg/dL	2.4-8.2	B12, folic acid, and/or molybdenum deficiency may be present.
TSH	3.087 micrograms per milliliter (uIU/mL)	0.450-4.500	Thyroid problems were suspected due to borderline high TSH and borderline low thyroxine, but these will be examined later.
Thyroxine	0.5 mg/dL	0.3-1	Normal.

Even though none of these numbers were beyond the lab reference range, I nevertheless highlighted a few of them as potentially worrisome. Why?

Most people are unaware that, with the exception of lipids (cholesterol, HDL, LDL, and so on), the laboratory’s range is generated from blood samples collected from individuals seeing their doctor. To put it another way, ill individuals. People who are well see the doctor much less often than those who are ill.

When your doctor says your blood test is “normal,” what he or she is actually saying is, “You are as healthy as 90% of individuals visiting the doctor today,” and “Congratulations!” You don’t have a strange, unique disease!”

That is insufficient for me. I don’t simply want to hear that people are surviving; I want to know how they are surviving. I’m curious as to how I may help them flourish.

As a result, we look at blood panels in a new light: as a tool to assess health and function.

In addition to the symptoms listed above, the blood chemistry revealed signs of potential dehydration (slightly increased albumin, hemoglobin, and hematocrit), which may be concealing an anemic tendency on her blood work. Dehydration makes anemia more difficult, if not impossible, to detect on a blood chemical test.

Is it possible that there are many dehydrated anemic people going about today being told they have nothing wrong with them? Yes, absolutely. There’s a lot more than most people know.

Panel of hormones

Jill was dealing with a variety of hormonal issues.

To monitor her hormones over the course of a month, we performed a month-long female hormone panel. The end results are shown in the graph below. Normal estrogen for a female cycle is shown in blue, whereas normal progesterone is represented in red. Jill’s results are shown in a dashed green color.

Results of the hormone panel – click to expand

Jill’s progesterone levels and timing are pretty typical, but estrogen levels start and finish high throughout the month, as seen in this graph. This indicates that estrogen is the dominating hormone. Many of her menstrual symptoms may be explained by her elevated estrogen levels and their impact on her tissues.

But it was what we discovered while measuring her testosterone that was probably the most important discovery in terms of her acne.

Marker	Result	Reference Range in the Laboratory
Testosterone in saliva	67 pg/mL	5 to 20 pg/mL

Despite popular belief that testosterone is a “male” hormone and estrogen is a “female” hormone, both men and women generate both hormones. It’s simply a question of relative quantities.

Women with high testosterone levels are more frequent than most people think. Infertility, poor libido, mood problems, trouble reducing weight, and more visible indications like acne and facial hair development are all symptoms of high testosterone.

We thought this was the smoking gun we were searching for when it came to Jill’s acne.

Panel of cortisol

To add insult to injury, Jill’s cortisol levels were consistently low throughout the day (as seen below — her findings are plotted on the blue line), indicating reactive hypoglycemia.

Cortisol, also known as a glucocorticoid, has a big role to play in keeping blood sugar levels in check. When individuals with low cortisol miss meals, their blood sugar falls too low, and epinephrine is produced as a last resort to raise glucose levels. Between meals, adrenaline is responsible for shakiness, lightheadedness, and irritability.

Results of the cortisol panel – click to expand

The treatment plan

We may be “hired health gunslingers,” but we’re not supplement addicts. We also have little regard for doctors who send their patients away with shopping bags full of vitamins. It’s just not required. Some individuals need more than others, but you should not take a supplement unless you have evidence that you require it.

We also don’t believe in particular condition procedures. We don’t have an acne regimen or even an acne supplement, for example. Instead, we examine which physiological pathways are malfunctioning and use tailored dietary methods to restore those pathways.

Having stated that, let’s see what we did for Jill.

The first problem is blood sugar abnormalities.

Reactive hypoglycemia, also known as high blood sugar swings, was suspected based on her symptoms and laboratory work (low LDH). Reactive hypoglycemia in women frequently increases testosterone production, thus this is an important issue to address.

Whether or whether they are hungry, it is critical for women with this disease to consume modest, frequent meals. Jill has delayed too long between meals and has caused hormone chaos in her body whenever she feels lightheaded or unsteady. Her blood sugar swings will be helped by addressing her low cortisol.

Vitamin deficiency is the second problem.

Based on her blood tests, Jill seemed to be lacking in a number of minerals (vitamin B12, folic acid, vitamin C, and zinc), so we prescribed a high-potency multivitamin-mineral called Complete Multi by Designs for Health (2 caps, three times a day).

We also gave her extra sublingual vitamin B12 (1mg three times a day) since vitamin B12 absorption may be hampered by stomach problems. This was intended to assist with what seemed to be a mild case of macrocytic anemia.

Digestive dysfunction is the third issue.

Jill was put on a three-week exclusion diet to help decrease the inflammation in her stomach caused by potential food allergies. We also added digestive enzymes to the mix (Digestzyme by Designs for Health, 2-3 capsule per meal). We also placed her on Designs for Health Probiotics Supreme (2 caps per day) later in her regimen to assist fight the presumed dysbiosis she developed from antibiotic usage.

Hormone abnormalities are the fourth issue.

Her excess hormones, particularly estrogen and testosterone, had to be removed. Because steroid hormones are cleaned out of the body mostly via the liver and gall bladder detoxification pathways, this is the easiest method to do this. We utilized Designs for Health Amino-D-Tox (2 capsules, three times a day), LV/GB (one capsule, three times a day), and Apex Energetics Clearvite (one scoop three times a day, which also addresses gastrointestinal health).

Adrenal imbalances (Issue #5)

Adrenal imbalances aren’t usually addressed straight away. Rather, we support alternative systems for a period of time, then re-evaluate and see what has changed. Given the elevated testosterone, we needed to treat the low cortisol to break the vicious hormonal cycle that occurred whenever her blood sugar dropped too low. We recommended Apex Energetics’ Adaptocrine (2 caps, three times a day) as an adaptogenic supplement to boost the body’s stress response.

Obviously, there were other issues to address and other paths we might take, but this would suffice for the next 12 weeks, during which time we’d repeat lab tests and assess her symptoms.

This may seem to be a lot, but it’s all for a good cause. If her testosterone levels are excessive, for example, we must halt its overproduction (due to blood sugar swings) and eliminate the surplus levels (i.e. liver support).

The outcome

Jill completed a follow-up blood chemistry panel and salivary hormone testing a few weeks after completing the program. While we were delighted with her symptom improvement, the test findings first perplexed us.

Jill’s acne has completely cleared up in terms of symptoms. She also felt “happier and more alive” than she had in a long time, with “abundance of energy,” no more gas and bloating, emotional equilibrium for the first time in ten years, and “abundance of energy.”

Isn’t it true that the mission was completed? Not at all.

Her testosterone level has dropped significantly, from 67 to 15 pg/ml, which is a positive thing. Her estrogen and progesterone levels, on the other hand, remained very high. She also showed elevated glucose, alkaline phosphatase, white blood cells, and fat levels (cholesterol and triglycerides).

We weren’t going in the direction we wanted to go. We scratched our heads, unsure of where we’d gone wrong and where we’d go next.

But then we received our response.

We received our response a week later. Jill was finally expecting a child! In an ecstatic email, she wrote:

“Yet the greatest, most joyful, and most unexpected outcome was… I discovered I was pregnant!” My husband and I never imagined we’d be able to become pregnant with my hormones in this condition, much alone so soon after treating my health concerns.”

The strange lab results that came back after testing were explained by her pregnancy. So, goal achieved, it seems.

Summary

So, what can we learn from Jill’s experience?

1. Low cortisol is frequently linked to symptoms of reactive hypoglycemia, such as shakiness, lightheadedness, and irritability between meals.
2. Hormone abnormalities, particularly increased testosterone, are nearly usually the result of blood sugar variations in women.
3. High testosterone in women may cause depression, infertility, weight gain, poor libido, and acne, as well as outward symptoms such facial hair growth and acne.
4. To get rid of excess testosterone, you’ll need to balance your blood sugar to slow down its synthesis and boost liver detoxification pathways to get rid of any that are currently there.

In the following article…

Jill contacted us a year later, overjoyed with her new baby boy but experiencing a new set of symptoms: severe tiredness, sadness, and difficulty losing weight.

A blood test revealed an extremely high TSH (Thyroid Stimulating Hormone) level, as well as low thyroxine and T3 levels (Thyroid hormones). Her main problem, however, was not a lack of thyroid hormone. Her issues were caused by something that is extremely prevalent nowadays, which we will discuss next month.

Detectives, stay tuned.

Find out more.

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Bryan is the Health Coach for The Bachelor. He’s the guy who follows the contestants around the world while they’re on the show. He’s there to make sure the girls are eating right, drinking the right amount of water, not getting injured, not getting sick, and not feeling uncomfortable. He’s there to make sure the girls are feeling healthy and confident about their bodies. Bryan has been an integral part of The Bachelor franchise for more than a decade, and he was also the ‘health coach’ for the 2012 Bachelorette season.. Read more about the good detective and let us know what you think.

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