Podcasts about T4

Have you been told your Free T3 needs to be above 4.0 for you to feel good, lose weight, or have "optimal" thyroid function? It's a common claim in the thyroid world. But where did that number actually come from, and does the research support it? In this episode of the Thyroid Answers Podcast, Dr. Eric Balcavage takes a closer look at the idea of an "optimal" Free T3 range and why chasing a specific lab value can prevent us from asking the more important question: What does this number actually mean in the context of your physiology? This isn't an argument against T3 medication. Some people do feel better when T3 is added to their thyroid treatment, and there are situations where T3 may be an appropriate part of thyroid hormone replacement. The problem is assuming that everyone needs to achieve the same Free T3 number to have healthy thyroid physiology. In this episode, you'll learn: Where the commonly promoted Free T3 target of 4.0–4.5 comes from and why the evidence for it is lacking The difference between a laboratory reference range, an "optimal" range, and a treatment target What Free T3 levels actually look like in healthy populations Why a higher Free T3 does not automatically mean better metabolic health What research on T3 therapy actually tells us about symptoms and quality of life Why feeling better on T3 medication doesn't prove that everyone needs a Free T3 above 4.0 Why a Free T3 result alone cannot tell you whether you're a "poor converter" What DIO2 genetic variants actually tell us about T4-to-T3 conversion How calorie intake, energy availability, exercise, inflammation, illness, and metabolic state can influence thyroid hormone conversion Why the timing of your blood draw matters if you take T3 medication The difference between measuring a peak and trough Free T3 level Why chasing a higher Free T3 with increasing doses of T3 medication can create a very different thyroid physiology How TSH, T4, reverse T3, medication, symptoms, nutrition, activity, and metabolic markers help provide context for your Free T3 result A Free T3 of 2.7 isn't automatically bad. A Free T3 of 4.4 isn't automatically optimal. The same laboratory value can be appropriate for one person and inappropriate for another because laboratory values don't exist in isolation. They have to be interpreted. That means looking at your complete thyroid panel, medication use and timing, signs and symptoms, nutrition, physical activity, recovery, inflammation, metabolic health, and the overall physiological state that produced those numbers. The goal shouldn't be to manipulate your Free T3 until it matches someone else's definition of "optimal." The goal is to understand why your thyroid physiology looks the way it does and determine whether that physiology is appropriate for your current state. Because changing a laboratory value isn't the same thing as understanding why that value was there in the first place. Resources Want to better understand what your thyroid laboratory results are actually telling you? Get a free copy of Dr. Eric Balcavage's Thyroid Labs Decoded e-book: https://drericbalcavage.com/thyroid-labs-decoded  Need Help Identifying the Root Cause of Your Symptoms? If you've been struggling with thyroid symptoms, fatigue, brain fog, digestive issues, or persistent symptoms despite thyroid medication or supplements, schedule a discovery call at drericbalcavage.com to learn more about Dr. Balcavage's physiology-first approach. Learn More About Dr. Eric Balcavage Dr. Eric Balcavage is the co-author of The Thyroid Debacle, author of Is This The Hill?, and the creator of: • State-Based Medicine™ • The Adaptive Thyroid Model™ • The Strategic Thyroid Solution™ His work focuses on helping patients and practitioners understand thyroid physiology through the lens of metabolic stress, adaptation, and whole-body regulation. Is This The Hill? recently released on Amazon. To learn more, access exclusive bonus content, or to order, visit drericbalcavage.com/hill. Connect with Dr. Eric Balcavage

☎️ Book Your COACHING INQUIRY Call: https://calendly.com/d/386-k9q-4cg/coaching-inquiry-call-zoom☎️ Book Your COMPLEMENTARY CONSULTATION and CALORIE CALCULATION Call: https://calendly.com/d/2p8-mxx-dgf/free-consultation-call-zoom⁠⁠⁠⁠⁠⁠Your mitochondria are tiny engines inside your cells. They burn your fat, run your brain, and make your hormones. When they slow down in menopause, you do not just gain weight. You get tired, brain fog, and your hormones get harder to balance.I walk you through the three stages to boost these fat burning cells:➤ BUILD: how to make more mitochondria, including the minerals your body needs to turn T4 into T3.➤ FIX: the parts your mitochondria need, the foods that clean up their waste, and the one supplement mistake that undoes your training.➤ CLEAR: how to get the broken mitochondria out of the way.Plus all six hormones and what each one does to your engines, real doses, real foods, and the order to do it all in.Links mentioned in the episode: ➤ Thyroid Labs for Fat Loss: Why TSH + T4 Aren't Enough | MMP Ep. 232: https://youtu.be/uGZuyWrUuMY➤ Your Ambition Is Making You Fat | MMP Ep. 329: https://youtu.be/5hva_5m_6do➤ How To Sculpt Your Body Over 40: https://youtu.be/4N2NkisnULI➤ Cardio Zones for Fat Loss After 40 | MMP Ep. 327: https://youtu.be/w4lvtunpbMY

What if your low energy, stubborn weight gain, brain fog, poor recovery, mood changes, and stalled progress aren't simply signs that you need to work harder—but clues that your thyroid isn't functioning optimally? Dr. Amie Hornaman, author of The Thyroid Fix, joins us to explain why she considers the thyroid the body's "master gland" and why standard thyroid testing may not tell the entire story. They break down TSH, free T3, free T4, reverse T3 and thyroid antibodies; the difference between "normal" and optimal lab results; Hashimoto's and hypothyroidism; and when thyroid hormone replacement may be appropriate. Amie also explains how gluten, over-exercising, chronic under-eating, nutrient deficiencies and aggressive GLP-1 use may affect thyroid health and metabolism. Plus, she explains the importance of iodine, selenium, magnesium, protein and dietary fat, detoxification, and so much more! Follow Amie @dramiehornaman Follow Chase @chase_chewning ----- 00:00 – WHOOP: Stop Guessing and Start Measuring 01:38 – Is Your Thyroid the Missing Piece? 03:20 – Why the Thyroid Is Your Body's "Master Gland" 06:12 – The Thyroid Labs You Actually Need 07:18 – Operation Podcast 08:15 – TSH, Free T3, Free T4 & Reverse T3 Explained 10:02 – Testing for Hashimoto's and Thyroid Antibodies 10:54 – "Normal" Labs vs. Optimal Thyroid Function 12:49 – When Thyroid Hormone Replacement Makes Sense 14:27 – Can You Improve Thyroid Function Naturally? 16:27 – Gluten, Hashimoto's & Your Thyroid 19:06 – What Happens If Your Thyroid Is Removed? 21:00 – C15:0 essential fatty acids 22:18 – Wellness Habits That Could Be Hurting Your Thyroid 23:01 – Can Too Much Exercise Damage Thyroid Function? 24:30 – Resistance Training vs. Cardio for Thyroid Health 25:57 – Foods That May Interfere With Thyroid Function 27:13 – Can You Take Too Many Thyroid Supplements? 27:55 – Amie's Foundational Thyroid Supplement Stack 29:38 – The Controversy Around Iodine 31:07 – Fluoride, Chlorine, Bromide & Iodine 33:22 – Thyroid Function, Detox & Sauna 34:58 – Hypothyroidism vs. Hyperthyroidism 37:28 – Hashimoto's and Autoimmune Thyroid Disease 38:08 – The "Silent Thyroid Killer" 38:20 – GLP-1s, Under-Eating & Thyroid Function 40:53 – Why Eating Less Doesn't Always Mean Losing More 42:04 – Calories vs. Macros for Thyroid Health 43:32 – Protein, Fat, Carbs & Insulin Resistance 45:09 – Rapid Fire: Most Underrated Thyroid Fix 45:18 – Is Calories-In, Calories-Out Broken? 46:13 – The ONE Food Amie Says to Eat Every Day 47:09 – Where to Connect With Dr. Amie Hornaman 47:51 – What Does Ever Forward Mean to Amie? ----- Episode resources: FREE WHOOP activity tracker 15% off Fatty15 C15:0 essential fatty acids 20% off Operation Podcast studios with code EVERFORWARD

Thyroid dysfunction is often treated like it is easy to rule out. You ask for labs, your doctor checks TSH, and if that one marker is not flagged, you are told your thyroid is fine.But what if that is the problem?In this episode of Biohacking Beauty, we sit down with Dr. Amie Hornaman to unpack what most thyroid conversations skip: the difference between being “normal” on paper and having enough active thyroid hormone available to your cells. She explains why TSH is not a thyroid hormone, why T4-only medication may not be enough for many people, and why women can keep struggling even after being told their thyroid is not the issue.Dr. Amie is known as The Thyroid Fixer, a functional medicine doctor, host of The Thyroid (and Hormone) Fixer podcast, founder of the Advanced Thyroid and Hormone Clinic, and author of The Thyroid Fix. After being misdiagnosed by six different doctors, she built her practice around helping patients get the answers conventional medicine often misses.What's Discussed:(01:22) Why so many women feel like their body is rebelling against them.(04:32) Why the diagnosed hypothyroidism number may not reflect the real problem.(07:11) The difference between being undiagnosed, undertreated, and mistreated.(10:54) Why skin aging after 40 is not only an estrogen conversation.(14:22) How quickly thyroid and hormone changes can show up in the skin.(20:57) Why skin aging needs an inside-out and outside-in approach.(28:35) What markers belong on a full thyroid panel beyond TSH.(30:55) Why free T3, reverse T3, and thyroid antibodies matter.(38:48) What thyropause is and why it can overlap with perimenopause and menopause.(45:01) A one-morning plan to support thyroid, insulin, protein, sleep, and skin health.Listen to this episode of Biohacking Beauty to understand why your thyroid labs may not be telling the whole story, and why your skin, hair, metabolism, mood, and energy may be showing what one marker missed.Find more from Young Goose:Use code PODCAST10 to get 10% OFF your first purchase, and if you're a returning customer use the code PODCAST5 to get 5% OFF at younggoose.comInstagram: @young_goose_skincareFind more from Dr. Amie Hornaman: Website: dramie.comInstagram: @dramiehornaman Podcast: dramie.com/podcast/

On this episode, Jared welcomes functional nutritional therapy practitioner and blood chemistry specialist Shea Sallee for a fascinating conversation about what routine blood work may reveal beyond the standard lab report. Together, they explore the difference between conventional reference ranges and functional ranges, discuss important markers like fasting insulin, GGT, ALP, ferritin, and thyroid labs, and explain how nutrient imbalances can influence overall health and well-being. They also cover the role of symptoms, blood chemistry, hair analysis, and other functional assessments in building a more complete picture of health. If you've ever been told your labs are "normal" but still haven't felt your best, this episode offers practical insights into understanding your blood work from a broader perspective.Additional Information:Shea's Health & NutritionSheasHealth.com801-492-2723Visit the podcast website here: VitalityRadio.comYou can follow @vitalitynutritionbountiful and @vitalityradio on Instagram, or Vitality Radio and Vitality Nutrition on Facebook. Join us also in the Vitality Radio Podcast Listener Community on Facebook. Shop the products that Jared mentions at vitalitynutrition.com. Let us know your thoughts about this episode using the hashtag #vitalityradio and please rate and review us on Apple Podcasts. Thank you!Just a reminder that this podcast is for educational purposes only. The FDA has not evaluated the podcast. The information is not intended to diagnose, treat, cure, or prevent any disease. The advice given is not intended to replace the advice of your medical professional.This podcast is produced by DrTalks.com⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠https://drtalks.com/podcast-service/

Ready to take a deep dive and learn how to generate personal tax-free cash flow from your corporation? Enroll in our FREE masterclass here and book a call hereAre you a high-income T4 earner who feels financially behind simply because you cannot access the same tax strategies as an incorporated business owner?It is easy to compare your tax bill, investment returns, or wealth-building options with someone playing a completely different financial game. But incorporation does not automatically mean more spendable income, and chasing strategies designed for someone else can distract you from the opportunities already available within your own plan.Through the story of a successful T4 earner with rental properties, registered investments, a DIY portfolio, and substantial home equity, this episode explores why knowing more strategies does not always create greater confidence. The real challenge may be choosing a tax-efficient approach that fits your risk tolerance—and staying consistent long enough for it to work.By listening, you will learn how to:Stop comparing two different financial games. Understand why the corporate small-business tax rate does not tell the full story and why incorporated owners still face personal tax when extracting money from their companies.Evaluate your next wealth-building move more clearly. Explore the trade-offs between seeking higher returns, taking on more investment risk, increasing your income, and improving tax efficiency through strategies such as the Smith Manoeuvre.Build confidence through consistency instead of chasing certainty. Discover why long-term financial confidence rarely comes from finding one perfect strategy—and how a repeatable process aligned with your goals, personality, and comfort with risk can move you closer to financial freedom.Press play now to learn how to focus on the financial game you can actually play—and build a strategy you can confidently follow for years.Discover which phase of wealth creation you are in. Take our quick assessment and you'll receive a custom wealth-building pathway that matches your phase and learn our CRA compliant tax optimized strategies. Take that assessment here.Canadian Wealth Secrets Show Notes Page:Consider reaching out to Kyle if you've been……taking a salary with a goal of stuffing RRSPs;…investing inside your corporation without a passive income tax minimization strategy;…letting a large sum of liquid assets sit in low interest earning savings accounts;…investing corporate dollars into GICs, dividend stocks/funds, or other investments attracting corporate passive income taxes at greater than 50%; or,…wondering whether your current corporate wealth management strategy is optimal for your specific situation.This episode of Canadian Wealth Secrets explores how a high-income T4 earner can improve financial planning, wealth management, and tax efficiency without comparing their situation to an incorporated business owner playing by different tax rules. Using a real listener case involving rental properties, RRSPs, a DIY ETF portfolio, and substantial home equity, Kyle and Jon explain why the small-business corporate tax rate does not equal personally spendable income and why salary versus dividends in Canada must be viewed through both corporate and personal taxation. They examine practical investment strategies, including the Smith Manoeuvre, real estate leverage, RRSP optimization, tax-efficient investing, and using home equity to support long-term wealth building. The conversation also highlights risk management, showing that higher potential returns often require greater concentration, private lending, or other risks that may not fit every investor. Rather than chasing the perfect strategy, listeners are encouraged to create a personalized Canadian wealth plan, define their minimum retirement cash-flow needs, and follow repeatable financial systems that match their investor personality. The core message is that lasting financial freedom in Canada comes from understanding the financial game available to you, choosing a strategy you can confidently maintain, and staying consistent on the path toward financial independence.Ready to connect? Text us your comment including your phone number for a response!PE Gate is now offering accredited investors access to Project Rope: the acquisition of an established, cash-generative Canadian industrial business with more than 45 years of operating history.PE Gate's targets an annualized IRR above 25%, net of carried interest.For the Offering Memorandum and full risk disclosure, visit pe-gate.com or email sarmen@pe-gate.com. If you listen to podcasts like The Rational Reminder with Ben Felix & Cameron Passmore, The Canadian Investor, The Canadian Real Estate Investor, Build Wealth Canada with Kornel Szrejber, ChooseFI with Jonathan Mendonsa & Brad Barrett, Afford Anything with Paula Pant, The Ramsey Show with Dave Ramsey, BiggerPockets Money, The Money Guy Show with Brian Preston & Bo Hanson, Invest Like the Best with Patrick O'Shaughnessy, Masters in Business with Barry Ritholtz, The Wealthy Barber Podcast with David Chilton, Financial Audit with Caleb Hammer, In the Money with Amber Kanwar, The Loonie Hour with Steve Saretsky, or More Money Podcast with Jessica Moorhouse — we're confident you'll enjoy Canadian Wealth Secrets too.Canadian Wealth Secrets is an informative podcast that digs into the intricacies of building a robust portfolio, maximizing dividend returns, the nuances of real estate investment, and the complexities of business finance, while offering expert advice on wealth management, navigating capital gains tax, and understanding the role of financial institutions in personal finance.

¿Sabes realmente qué ocurre en tu cuerpo cuando sientes tu metabolismo "frenado"?En este episodio 100% divulgativo y educacional nos sumergirnos de lleno en la anatomía y fisiología de la glándula tiroides. Te guío a través del funcionamiento de este pequeño órgano con forma de mariposa, considerado el verdadero director de orquesta de nuestro organismo. A lo largo del programa, desgranamos cómo las hormonas tiroideas (T4 y T3) dictan la velocidad a la que latimos, quemamos calorías, hacemos la digestión o regulamos la temperatura corporal.Además, analizamos el peligro de someter al cuerpo a dietas extremadamente restrictivas o ayunos prolongados, los cuales son percibidos como señales de amenaza, provocando que la tiroides reduzca su actividad para ahorrar energía.Para cerrar, detallo la lista de nutrientes indispensables (yodo, selenio, zinc e hierro) y las pautas alimentarias necesarias para mantener una función tiroidea óptima, demostrando que cuidar tu salud intestinal y alimentarte de forma suficiente es el primer paso para reactivar tu vitalidad y tu metabolismo desde la base.Conviértete en un supporter de este podcast: https://www.spreaker.com/podcast/comiendo-con-maria-nutricion--2497272/support.

Labs read "normal" but you're gaining midsection weight, foggy and running at 70%? Your thyroid - not just perimenopause - may be the missing variable. Dr. Amie Hornaman explains why TSH alone misses the picture, how elevated reverse T3 "pools" and blocks T3 at the cell even when free T3 looks optimal, and why roughly 98% of women don't thrive on T4-only. She links falling progesterone, rising thyroid-binding globulin, low ferritin and the "thyropause" hitting 80-90% of women over 40. WHAT YOU'LL LEARN Why a "normal" TSH can completely miss a thyroid problem - and the five markers that actually reveal what's happening What reverse T3 "pooling" is, and how it blocks active thyroid hormone at the cell even when your free T3 looks optimal Why roughly 98% of women stop thriving on T4-only medication once they're past 40 How falling progesterone drives estrogen dominance, raises thyroid binding globulin, and quietly strands thyroid hormone before it reaches the cell What "thyropause" is, why it hits 80-90% of women over 40, and how it overlaps with the perimenopause symptoms you're blaming instead Why testosterone acts as armor against autoimmunity - and what its decline switches on How low ferritin, insulin resistance and cortisol compound thyroid-driven fatigue and stubborn belly fat TIMESTAMPS 00:00 - Intro: Why Midlife Women Go Undiagnosed & the Full Thyroid Panel Doctors Skip (TSH, Free T3/T4, Reverse T3, Antibodies)09:46 - Reverse T3 "Pooling," Why T4-Only Fails Most Women & What Actually Drives High Reverse T317:28 - How HRT, Progesterone Loss & Low Ferritin Hit Your Thyroid - Plus the "Thyropause" Switch22:09 - Core Thyroid Nutrients, Iodine Dosing Do's & Don'ts, and How to Actually Fix Low Iron40:14 - High Antibodies and Still Optimized? Hashimoto's Triggers & Protecting Your Thyroid45:40 - Midlife Belly Fat & Bloating: Root Causes, Smart Testing Order & the Gut-Healing Myth53:12 - Thyropause & Lean Athletes: Why Most Women Over 40 Get Hit - Plus The Thyroid Fix Book VALUABLE RESOURCES The Thyroid Fix (Dr. Amie's book) https://thyroidfixbook.com/ Dr. Amie Hornaman's website / book a call https://dramie.com/ Fixxr Supplements (Dr. Amie's line, incl. iodine) https://dramiehornaman.com/collections/supplements Follow Dr. Amie on Instagram https://www.instagram.com/dramiehornaman/ Thanks to my sponsor, Eight Sleep Sleep cooler, recover faster. The Eight Sleep Pod pre-cools your bed and adjusts all night for deeper sleep - dual-zone, so you and your partner each get your own temp.

Tonio Skits joins The Danza Project for Episode 293 for one of his most personal conversations yet. Long before millions of people knew Tonio as a creator, entertainer and entrepreneur, his life was shaped by loss, survival and moments that could have completely broken him. Tonio opens up about losing his mother at just 15 years old, being forced to grow up fast, and the devastating accident that nearly ended his life. After shattering his T3 and T4 vertebrae, Tonio was airlifted to the hospital, placed on life support and says he flatlined during surgery. He was diagnosed as paraplegic, but against the odds, eventually got back on his feet and walked out of the hospital. But surviving is only part of the story. We get into how heartbreak unexpectedly helped create Tonio Skits, his rise during the Vine era, building an audience of millions, transitioning from viral content into acting and business, navigating Hollywood, fatherhood, relationships, faith, money and what success actually means after you've already been given another chance at life. This isn't just the story of how Tonio survived. It's the story of who he became afterward. TONIO SKITS | EPISODE 293 | THE DANZA PROJECT Subscribe for more conversations with the people behind the success, beyond the headlines and outside the character. #TonioSkits #TheDanzaProject #Podcast #ContentCreator #Vine #Entrepreneurship Learn more about your ad choices. Visit megaphone.fm/adchoices

Du isst sauber, nimmst deine Supplements, trainierst regelmäßig und trotzdem bleibt der Blähbauch, der unruhige Schlaf, die Erschöpfung und der Zyklus, der macht was er will? Dann fehlt dir mit hoher Wahrscheinlichkeit nicht die nächste Maßnahme, sondern ein Zustand.In diesem Video erkläre ich dir als Neurobiologin, warum dein Körper nur unter Sicherheit heilt und was im Alarmmodus wirklich passiert: warum deine Verdauung runterfährt, warum dein Blutzucker schwankt, warum die Umwandlung von T4 in T3 leidet, warum Progesteron als Erstes nachgibt und warum eine stille Entzündung entsteht.Außerdem spreche ich darüber, warum Fasten, harte Intervalle, Eiswanne und permanentes Tracking für ein überlastetes System genau das Gegenteil bewirken können, und was stattdessen wirkt.✨Unverbindliche Sprechstunde

Watch the full episode on YouTube:We first covered Baseten last year when DeepSeek mania was at peak hype. Now they have raised a monster $13B round and become one of the new cohort of AI Infra decacorns that are (with Nvidia, Intel, and the semis complex) chief beneficiaries of the Inference Inflection. We return to Baseten at the peak of the 2026 edition of Open Weights debate. Ali has published a viral breakdown of Kimi K3:And since you last saw him, Philip has spoken at AI Engineer and written the definitive book on Inference Engineering spotted all over SF:Three years ago, inference engineering barely existed as a category.Today, it is one of the most critical disciplines in AI. Inference engineering inherently tackles a different question than standard model training: “How do you turn those weights from training into a product that is fast, reliable, and affordable at scale?” Focusing on these creates an entirely new optimization problem.In one recent GLM-5.2 experiment, quantizing more of the model actually preserved its benchmark quality while increasing throughput by 20%, because the errors introduced in different layers could cancel each other out.Inference is no longer just the final step after training. It is becoming its own engineering discipline, with its own research problems, infrastructure, and increasingly specialized roles.In this episode, Baseten's Philip Kiely and Ali Taha join swyx and Vibhu to explain what actually happens after a new open model is released and what it takes to turn “we generated a token” into a fast, reliable, production-ready API.We go deep on cache-aware routing, disaggregated prefill and decode, quantization, speculative decoding, KV-cache movement, model parallelism, GPU kernels, and the race to make frontier models up to 10× faster. Philip and Ali explain why inference optimizations can still produce gains of 20%, 100%, or even 200%; how quantization errors can cancel one another out; why identical weights can behave differently across clusters; and how Baseten grafted a Kimi vision encoder onto GLM-5.2 without changing the underlying language model.The conversation then expands beyond LLMs into NVIDIA Dynamo, mega kernels, Rubin, AI-specific chips, local inference, video generation, diffusion versus autoregressive models, and the enormous compute barrier to generating coherent long-form video. Finally, we explore the convergence of training and inference, continual learning through persistent KV cache, and the emerging loop where models help optimize the infrastructure that runs them.We discuss:* What happens when a 200,000-token request enters an inference system* Cache-aware routing and reusing previously computed KV cache* Why prefill and decode are increasingly handled by different GPUs* When dedicated deployments become cheaper and more reliable than shared APIs* How speculative decoding uses a smaller model to accelerate a larger one* Tool calling, structured outputs, and what LLMs actually do* What it takes to support a new open model on day zero* Grafting Kimi's vision encoder onto GLM-5.2* Retrofitting inefficient model layers with components from other architectures* Why models sometimes collapse into repeating the same token* How hardware, kernels, and race conditions create nondeterministic failures* Preserving model fidelity while making inference faster* How quantization errors can cancel each other out* Why inference optimizations still deliver gains of 20%, 100%, and 200%* How optimized serving can make a model up to 10× faster* NVIDIA Dynamo, KV-aware routing, and distributed model serving* Speculative decoding the speculative decoder* Why local AI is about making models less dumb while data-center AI is about making them less slow* Tensor, expert, and pipeline parallelism across GPUs* Hardware-aware model design, auto-tuning, and the case against mega kernels* Rubin and why inference is becoming a systems problem* Whether modern GPUs are evolving into programmable AI ASICs* Why enormous models like Kimi K3 require GB300-class hardware* Why open-source video generation still trails Veo, Kling, and other closed models* The quadratic attention bottleneck behind long-form AI video* Autoregressive video, real-time generation, and compounding quality drift* Why future video systems may combine autoregressive and diffusion architectures* Training for inference and inference for training* Continuous post-training, deployment, evaluation, and improvement loops* How GLM-5.2 helped optimize the kernels serving GLM-5.2 itself* Why faster networking could unlock dramatically faster decoding* Continual learning, KV-cache compaction, and persistent model memoryShow Notes* How to build a day-0 API for Kimi K3* 22580: From GPT2 to Kimi3, ExplainedPhilip Kiely* LinkedIn: https://www.linkedin.com/in/philipkiely* X: https://x.com/philipkiely* Inference Engineering: https://www.baseten.co/inference-engineering/Ali Taha* LinkedIn: https://www.linkedin.com/in/aliestaha/* X: https://x.com/waterloointernTimestamps00:00:00 Introduction and the 200K-Token Prompt00:03:18 Dedicated Deployments, Speculative Decoding, and Tool Calling00:11:26 Launching Production-Ready Open Models00:19:06 Model Retrofits, Failure Modes, and Nondeterminism00:28:22 Quantization and Canceling Errors00:32:15 The Race to 10× Faster Inference00:40:48 Dynamo, Speculation, and Local vs. Data-Center AI00:50:18 Model Parallelism, Auto-Tuning, and Mega Kernels01:00:55 Rubin, GPUs vs. ASICs, and Custom AI Chips01:10:03 Giant Models and the Limits of GPU Memory01:12:42 AI Video, Quadratic Attention, and Autoregressive Generation01:21:47 Audio, Images, and Diffusion Models01:27:32 Training, Self-Optimizing Models, and Continual Learning01:40:06 Closing ThoughtsTranscriptIntroduction: Baseten, Waterloo Intern, and Inference EngineeringSwyx [00:00:00]: Okay, we're here in the studio with Philip, old friend from Inference Engineering, the book, as well as Baseten and everything that you've done, you and I have done before, as well as Ali. Welcome.Ali [00:00:15]: Pleasure to meet you.Swyx [00:00:15]: Waterloo intern.Ali [00:00:16]: Waterloo intern, always.Swyx [00:00:17]: When did you get “Waterloo intern” as a handle?Ali [00:00:19]: As a handle? Oh.Ali [00:00:20]: I think the rebranding happened mid-March. When I saw it was open, I was like, “I have to take it. Up for grabs.”Philip [00:00:26]: The problem is that Ali is really good at his job and is not gonna be an intern much longer.Philip [00:00:30]: So we have to figure out who's gonna get the handle.Ali [00:00:33]: Well, I'll pass the torch over to the next intern.Swyx [00:00:34]: Oh, okay. It can be, like, you just pass it to another Waterloo grad.Ali [00:00:37]: To another Waterloo intern. No, bruh.Philip [00:00:39]: Yeah.Ali [00:00:39]: Intern.Swyx [00:00:40]: Intern, yeah.Ali [00:00:40]: And no.Philip [00:00:41]: You gotta get an intern from Waterloo.Ali [00:00:42]: Yeah, I've gotta get an intern from Waterloo.Swyx [00:00:44]: Right.Ali [00:00:44]: But they have to follow the path.Swyx [00:00:45]: Oh, it could, but it could come from Baseten, so it's like whoever Baseten gets from Waterloo.Ali [00:00:48]: Right.Swyx [00:00:49]: Has the title of Waterloo.Ali [00:00:50]: It stays in the ecosystem.Philip [00:00:51]: Exactly.Ali [00:00:52]: Halfway through the internship, you either get it or you're out.Philip [00:00:55]: You should also do, like, a big graduation ceremony where you change the handle.Ali [00:00:59]: Just say it.Philip [00:00:59]: For everybody.Swyx [00:01:00]: You guys are good at ceremonies, clearly. We had a nice launch of the book, very successful. But before we get into all that, I wanna start off with a fun question for you. Okay, you're an expert inference engineer. What happens when I send a long query, say two hundred thousand tokens into Baseten's inference? What's the process of query through GPU model routing, balancing, all that? What is all the stuff that we don't think about?Long Context Requests, KV Cache, and Cache-Aware RoutingPhilip [00:01:26]: With a long query specifically, the first thing that I'm gonna ask is, “Have you sent me this query before, or at least part of it?” and I really hope you have, because it's gonna be a lot easier for me and a lot cheaper for you. So the first thing that we're gonna look at is some cache-aware routing, where we're going to see, we probably have a number of instances, a number of replicas up serving whatever model you're hitting. We want to send this one to something with, number one, available prefill workers, and number two, ideally some cached input already there so that we can skip prefill on at least part of these two hundred thousand tokens. If you're doing two hundred thousand tokens, it's probably coding or a multi-turn agent or something where you would expect to have that cached. If you don't, we're gonna have to send it to a prefill worker. We've at least on certain models disaggregated prefill and decode, so you're going to have one set of GPUs that's solely going to process the input, create the KV cache, and get you your first token, and then that's going to be passed over to a separate set of GPUs, which is going to run decode. We're going to iteratively make those tokens. We're probably going to have some speculator model in front of that. I'm going to assume that you're doing coding, and because of that, our speculator model, which assumes you're doing coding, is gonna have a high draft token acceptance rate. If I'm wrong and you're asking me to summarize every Harry Potter book, it's gonna be slower. And then we stream that output to you and account for it, charge you, a couple of pennies and say, “Hey, would you like to send another one?”Swyx [00:03:04]: Except Baseten doesn't charge by pennies.Philip [00:03:07]: Well, yeah, we charge. I'm assuming that we're talking about the public model APIs. If you are setting up a dedicated deployment, then yeah, it's not pennies.Public APIs vs. Dedicated DeploymentsSwyx [00:03:18]: Yeah, one of the key differentiators when I was talking with Baseten initially was that people who want very high volume just need to rent by the box, ‘cause then it's up to you to figure out how to saturate the box.Ali [00:03:31]: And more often than not, it's, like, way cheaper if you're pushing, like, millions of tokens per hour, if you just pay per hour instead of pay per token.Philip [00:03:37]: Yeah, they do. I think that we've increasingly seen a lot of demand for the pay per token APIs, just because everyone wants to try open models, and then once they find a use case that's really sticky, then they move over to dedicated.Swyx [00:03:51]: Is there a best practice on when it's time to swap over?Philip [00:03:54]: Couple reasons. Yeah, reliability, that's a big one, right?Ali [00:03:57]: Like, if they have a very specific use case, they want you to train something specifically for them, like they want their own spec dec, for instance, for their own traffic.Swyx [00:04:04]: Spec dec is speculative decoding.Speculative Decoding and Custom SpeculatorsAli [00:04:05]: Speculative decoding, yeah.Swyx [00:04:07]: You have to explain.Ali [00:04:07]: Sorry. Like, speculative decoding is like, if you have a huge model, right? And so the model is going to be generating one token at a time every single turn, every single forward pass. So we attach, like, this little, like, parasite, like this layer that goes on top of the model, and this model just has to predict. It does three very fast autoregressive forward passes, and it will predict, like, three certain tokens, and then you do one forward stage over the entire original model in order to see if those predictions were correct or not, and then you accept them or you reject them. Now, this draft model is traffic specific, so if you, like, Philip said, if you're summarizing Harry Potter books, I can train exclusively that draft model on Harry Potter books, and I can guarantee you that I'm gonna accept the three tokens every single time. And so with that case, I increase your decode speed. I wouldn't be able to provide this to you if you're a shared endpointSwyx [00:04:53]: YeahAli [00:04:53]: ‘cause I have no idea if you're doing Harry Potter, if you're doing coding, if you're doing English. We don't know. Also, there was a thing in the book that mentioned that if they really cared about a specific threshold, chapter four, I think. Do you remember that?Philip [00:05:06]: Yeah. The things that you can do is you can set a specific, like, batch sizing, a specific, like, parallelism strategy if you're trying to optimize for, like, throughput versus latency. You can. Maybe a NVFP4 quant doesn't pass your benchmarks and you wanna run a model at higher precision, you could do that. There's just a bunch of reasons why you might wanna have your own endpoint and the biggest one, of course, just being, like, you don't have to deal with someone else doing a hundred million tokens of benchmarking traffic at the endpoint when you happen to be trying to serve your users.Swyx [00:05:40]: Yeah. I think one thing that is. That is a classic journey. Like, it's people is asking the, what happens when you type Google into the browser. Tool calling, is that just, you're generating JSON or is there more complication beyond that?Tool Calling, JSON, and Structured OutputsAli [00:05:58]: Certain customers that we have, they have their own post-trained models, and so they demand a tool calling that's not just, like parse a file or go find the weather. It's something that's very specific and you have to do post-training on this. And if the post-training on the model is not good or if the quantization after the post-training to get the inference to be fast, the model will struggle reading the JSON file and reading the tool calling. But it doesn't require its own like sandbox. It's not like it's going to use that tool calling to like escape a sandbox or like it doesn't have to be contained. It can just be a normal dedicated deployment. The challenge with tool calling more and more seems to be that the companies want certain tool calling which is a very sensitive thing to train. And because you're dealing with all of the JSON outputs, if it doesn't like close the end of the request in a very certain manner, you end up with a model that did the tool calling and like the thinking and so as a result of that, it didn't see the result and just hallucinated the result as it decoded. That seems to be the most challenging thing with tool calling, not really the sandboxes model.Philip [00:06:56]: Yeah, that's a challenge on the training side and then on the inference side, there's work that you can do to scope the possible output. So we published this at this point close to two years ago, the solution to this problem which is you make a state machine and you use that to constrain the output to a specific format. So this is the structured output problem. If you remember backSwyx [00:07:27]: Yeah, the specific grammar is,Philip [00:07:29]: Yeah, exactlySwyx [00:07:30]: GML had this thing.Philip [00:07:31]: Yeah. So it's like the old-school “make sure this is only JSON”, return only JSON orSwyx [00:07:38]: YeahPhilip [00:07:38]: Grandma's gonna die type of prompts.Swyx [00:07:39]: Is it BNF grammar? At some point OpenAI had released a thing that was like, yeah, if you want to constrain your output, write BNF grammar, back as NOR.Philip [00:07:47]: In our inference system, it's just a specified output format. And you get the guarantee that your output's gonna be structured along that format. And so applying that to tool calls can like help cut down on. You can still call the wrong tool or call no tool. It doesn't solve the certainty problem but it at least solves the output structuring problemSwyx [00:08:10]: YeahPhilip [00:08:10]: Within tool calls.Swyx [00:08:12]: And MCP is just another form of tool, right.Philip [00:08:14]: Yeah, exactly.Swyx [00:08:15]: As far as there's no special thing there.Philip [00:08:16]: The thing I'm always like explaining to people is the LLM is not capable of doing anything. It's only capable of making suggestions of what to do and then if those suggestions are formatted in a certain way and applied to a system that knows what to do with them, then an action occurs.Swyx [00:08:32]: Yeah. Part of the fun stuff is, this is solved outside of tool calling too. Like in an agent loop if the output is not correct or you're right, like reasoning, tool calling was done in the reasoning trace, just be like, “Oh, I don't know what to do. Let me just try again.” And it might get there after a few tries. And on your point of training, sometimes this is harder in smaller models, so you don't have the same exact quality outputAli [00:08:56]: Right.Swyx [00:08:57]: When you just swap from a big model, right?Ali [00:08:59]: Yeah. I will say that, before, I think we need to go back to inference engineering proper.Ali [00:09:04]: But, I had expected that something would replace JSON because it's hard to stream JSON ‘cause JSON must be complete and you must have open and close brackets and everything. So it's hard to parse something or validate something while it's being streamed. So people invented all sorts of things that are like, I forget the name of some of these alternatives, but it's something like TOML, something like YAML. But JSON seems to be dominant still.Philip [00:09:30]: The JSON outputs aren't that long, right? Like you could have a long-- ‘cause tool calls also contain the arguments in them and perhaps for a certain tool you might pass like a very long argument. But my impression of the median tool call is that it's a relatively small number of tokens, right? So I would expect that speculators are generally fairly good at something as formatted as JSON. And so you would have like a pretty fast decode step there and that the streaming wouldn't be as valuable, but maybe I'm wrong about that.Ali [00:10:02]: I think you're also bounded by the software or that the model is gonna integrate with if the software is built with JSON for the tool calls or if the company that you'- if your customer says that this is how our software works and our tools are interfaced with JSON, you can ask them to like, change their software and say like, “Yeah, this is gonna be better for the model.” but like with the right training shouldn't be that much of a difference. Also more profitable if it outputs more tokens probably.Swyx [00:10:25]: Depends on your business model.Swyx [00:10:27]: It really depends. But I will say that, as a writer with like experience a lot with generated output, I do try to move from text to JSON text which is very long JSON, right? Like there's paragraphs in every field because I'm trying to structure it, right?Philip [00:10:44]: Right.Swyx [00:10:44]: I want you to first make factual statements, then make opinions then make bullet point summaries, have dates, have entity references have your sources for references, all these things. Anyway, so these are things that like I think people who really experiment with structural output have to really care about. But, let's, let's recurse up the stack a little bit. Before we started recording, you mentioned something really cool, which is that there's a lot of engineering that-- inference engineering that goes on when a new model provider releases a new model, right? So let's call it GLM-5.2, Kimi K3. I had previously assumed, especially if it's like, well, GLM 5 to 5.1 to GLM-5.2, like that you've supported them before. Is it that much work?What It Takes to Support a New Open ModelAli [00:11:26]: It's a lot of work.Swyx [00:11:28]: Yeah. Okay. So like, a lot of people, all you guys, right whenever a new model launch like, people rush to say like, “Oh, Hugging Face supports this, Fireworks supports this, Spacetime supports this,” and I'm like, “Yeah, of course we support it.” But what goes into that? What goes intoPhilip [00:11:40]: I think it's more than just support it too, right? It benefits the consumer a lot. Like I think it was with Kimi K2.5 or GLM-5.2 the latest, there was an inference war, right? X provider is at 90 tokens a second. The next day we're at 150. The nextSwyx [00:11:55]: I kinda kicked that off with the GLM-5.2.Swyx [00:11:58]: I wrote a Twitter article about. It got like half a million views,Ali [00:12:02]: Based on being numberSwyx [00:12:03]: YeahAli [00:12:04]: Or it's for something else.Swyx [00:12:05]: Yeah. Which,Ali [00:12:06]: Oh my GodSwyx [00:12:07]: Which then got everyone really excited about, hey, how can we, bend tracks a little bit further and,Philip [00:12:14]: There's a difference between support the model, as in I can make a token out of this model, and support a model, as in I have a production-ready API from this model.Philip [00:12:26]: Getting to the point of I can make a token out of this model is not that hard because generally the, open source inference engines, vLLM, SGLang of the world oftentimes even receive weights ahead of time, maintainers do, or the people making the model merge PRs to ensure support. So you generally can, just get it working on the standard open source stack without too much pain in most cases. The challenge is, every inference company is gonna have own proprietary stack. Some open source components, some in-house stuff. And for any arbitrary model, there's going to be some new stuff. Sometimes you get lucky, like K, two five to two six was, like, pretty similar.Quantization, Speculators, and Production ReadinessAli [00:13:16]: Yeah. It was pure continued post-trainingPhilip [00:13:18]: YeahAli [00:13:18]: If I remember correctly.Philip [00:13:19]: Even in those cases, there's still stuff you have to do. You have to redo the quantization work. You're taking the model from. Generally, these models are not released in NVFP4, and we want them to be in NVFP4 for maximum Blackwell compatibility. So we have to perform that quantization, and, calibrate the quantization to make sure that we're not causing any regression in the model's intelligence. And then we also have to train the speculator, as we've talked about. Generally, we have. We have ZDR, zero data retention on our model APIs, so we don't know exactly the traffic that people are sending us, but we know what's popular. We know that coding use cases are popular. We know that agents, agentic use cases are popular. So we can get public data sets that are representative of that traffic and train general speculators. Now, with speculators today, you need to train the speculator using the base model itself because you're getting hidden states out of the model from running inference on these specific prompts, and that is the training data you use to create the speculator. So there's that process which you need the real model weights for. And then there's of course just the process of, standing up all the infrastructure behind it, loading all this stuff, testing it. And then when there's a new model with a newer architecture, I think that, like, the DeepSeek models tend to be the most challenging as they have, like, the most novel architectural stuff going on, model after model. But every new model has something. Kimi K2 had. Oh, sorry, GLM-5.2 hadAli [00:14:53]: Sparse attention.Philip [00:14:54]: Yeah,Ali [00:14:54]: YeahPhilip [00:14:54]: the DSA.Ali [00:14:55]: Right. Which is brought from DeepSeek.Philip [00:14:57]: Yeah. AndAli [00:14:59]: So you can copy-paste then?Philip [00:15:01]: It kindAli [00:15:01]: I don't know how this works.Philip [00:15:02]: So, like we had to, like, build support for that into our runtime. And you're right, like it is really interesting the way that all of these open source labs borrow from each other. For example, like GLM-5.2 doesn't have vision. So something that, Haley, a guy on our team, if we could take a look at this, he, like, grafted the Kimi vision encoder onto GLM-5.2.Retrofitting Vision into GLM-5.2Ali [00:15:27]: We'll be training the projector.Philip [00:15:28]: Exactly. So if you think about, like, the encoder, there's the encoder, which is the part that looks at the image and turns it into latent information, and then there's the projector which likeAli [00:15:38]: You can say latent space. It's okay.Philip [00:15:41]: And then there's the projector that maps it onto, the model itself, and then there's the model weights. You don't wanna mess with the model weights because you run a chance of making the model dumber at something else for the purpose of giving it vision. So instead, Haley started with just a projector, which is only a handful of millions of parameters.Ali [00:16:02]: That would be, yeah.Philip [00:16:02]: Yeah.Ali [00:16:03]: Can you show the training one?Ali [00:16:04]: Like the way it groksPhilip [00:16:05]: YeahAli [00:16:06]: Very interesting.Philip [00:16:06]: And maybeAli [00:16:07]: That right therePhilip [00:16:07]: Maybe Ali, you should take it from here. You've got a betterAli [00:16:10]: Ooh, double the sandPhilip [00:16:11]: Understanding of this than I do.Ali [00:16:11]: Yeah. You can see, like, he. The way he trained this is really cool. At the beginning, he was training it using just like, “Here's a picture of a mountain. Can you describe what's in this mountain?” And that caused it just like the first, learning walls. Like here you can see this all we're trying to teach it is to translate the encoded. Like it's already taken the encoder from Kimi K. It's taken the image. It'Philip [00:16:31]: Yeah. FrozenAli [00:16:31]: FrozenPhilip [00:16:32]: With adapter.Ali [00:16:32]: Exactly.Philip [00:16:33]: Yeah.Ali [00:16:33]: So the brain is frozen and the eyes are frozen. It's just we're tryingPhilip [00:16:37]: AlignAli [00:16:38]: Interconnect between the eye and the brain, right? So the projector. And so you take the tokens and then he's like, “Oh, can you describe what's in this image?” And he's like, “Oh, it's a mountain,” or it's a person or it's a human, whatever the case is. But that didn't cause complete understanding. So he changed it such that every image was associated with a data set of questions. Like, does this image have a white male? Does this image have birds in the top corner? Does this image have a scientist in it? All of that stuff. And it would have to answer questions correctly. And using not just training on describing an image, but being able to answer question, another question, answer over time. Like you can see the grokking, which is like genuinely insane, that retrofitting vision into a large LLM can learn to that extent. And even for images that it doesn't perform well on, for instance, if you ask it a picture of like Stephen Hawking, “Who is this?” Maybe it doesn't get it, but it will say something like, “This is Albert Einstein.” Like it still understandsPhilip [00:17:25]: Close enoughAli [00:17:26]: That this is a scientist who is a man who has, some significant achievements, all that stuff. So that's like really cool.Philip [00:17:32]: Yeah. So, we've covered Hao Tian before, who the author of the LLaVA paper that did this, a while ago. And I think that's very foundational work for anyone who hasn't done vision work before.Ali [00:17:41]: Same with the CLIP and MetaCLIP, where you go from just captioning to building out questionsPhilip [00:17:47]: RightAli [00:17:47]: Off the image and how much better you can get performance.Philip [00:17:50]: Right. Right. Right. Yeah. But what's, what's so exciting about this is if you look at a model like this. Now, this is a little bit more of a research project. It's not. It got to 56% on MMLU Pro, I think. So not quite frontier. But if you're running this model, you haven't suffered any loss on your GLM-5.2 quality. If you don't have an image, it'll just behave exactly the way it used to. And ultimatelyAli [00:18:14]: Which in the inference code you literally do not include the other part, right?Philip [00:18:18]: Yeah. You would just skip the encoder if you don't have an image input.Ali [00:18:22]: Okay.Philip [00:18:22]: Just confirming.Philip [00:18:23]: YeahAli [00:18:23]: Does it affect a lot on the overall inference side? Like you're not adding much, you're adding a very small vision encoder. These are typically likePhilip [00:18:30]: They're super fineAli [00:18:31]: Less than a billion parameters, right?Philip [00:18:32]: Yeah. It's, - There's a little bit less standardization among vision encodersSwyx [00:18:37]: YeahPhilip [00:18:37]: So the support matrix can be a little bit, sparser. But overall, yeah, it's a pretty, it's a pretty minor component of the overall system. And ultimately what you get out of the system is all of a sudden you have Kimi Vision, GLM weights, and DeepSeek attention all in one model.Open Source Model Grafting and Franken-MergesPhilip [00:18:56]: And that's, I think, a lot of the power and beauty of open source, is that you can take all of these different components and combine them together into a system that's better than anyoneSwyx [00:19:05]: YeahPhilip [00:19:05]: Can be individually.Swyx [00:19:06]: People used to say that you would also do Franken-merges where you would take likePhilip [00:19:10]: YeahSwyx [00:19:10]: Layers from each model.Swyx [00:19:11]: Does anyone do that anymore?Ali [00:19:13]: Well, to your point previously when you were mentioning like, the work that goes into supporting a model when it first comes out, like GLM-5.2 or MiniMax M3 or whatever the case is. Sometimes you do have to like, you do have to switch out some things. Like, for instance, the MiniMax M3 head uses full attention, and with full attention you end up with this like insane bottleneck in spec dec ‘cause you're doing auto-regressive token generation for three tokens, and you're doing this like N squared over all of the tokens that are in your sequence. Your KV cache is like very large because it's not sparse, it's not top K. So we find it better to like, okay, we're gonna replace this, we're gonna replace this layer with a layer from another model that's using like GQA, for instance. And then just with the right training, you can get it to have the same acceptance rate. So it is very possible to retrofit layers from other models and very much needed. If a layer is like inefficient, the training just becomes the challenge, like how do you ensure that you train it properly? Which again to your earlier point is like the mesh between training and inference. As in like you need very good training in order to do fast inference. That's like, I feel like more and more becoming true.Swyx [00:20:21]: Yeah. Anything else on the support side when you say like get it to fully production ready?Loop Detection, Race Conditions, and Non-DeterminismPhilip [00:20:26]: Yeah. I think that there's also a question of just, we can test a model to a pretty extensive degree, but we're trying to get it out quickly and then you see a bunch of other people test it and you get interesting results. There was an issue with, GLM briefly where we had some like mode collapses where it would just output the same token over and over again for certain prompts on certain temperatures. Like once you expose an endpoint to the real world, there's going to be, so many more varieties of things given to it that you're able to, discover and patch things. So it's not just a, day zero process, it's then like for the first week, for the first month, if a model remains popular, like how do you both fix bugs and then continue to push the envelope on performance?Ali [00:21:21]: What do you mean you don't want your model outputting S?Swyx [00:21:24]: Is there loop detection on that stuff, by the way? It still happens like quite a lot, which is surprising.Ali [00:21:30]: We have like we, in our endpoint, like if a model was to output the same token like four plus times, we just cut the generation. We say like, “Oh, sorry, this-- Like try again,” or like we will reprocess the request. ‘Cause we know then, like if it, like if, yeah, it's four times the same token, it's probably collapsed.Swyx [00:21:45]: Yeah. Is there a way to opt out in case I really want that?Ali [00:21:48]: You want that?Ali [00:21:50]: I think there's a way that we have to handle it. I'm not exactly certain, but I feel like in certain models, like when they output something like you can imagine, like a table for instance, and so they want, they wanna draw like 12 dashes and 12 dashes. Yeah, I think there's a way for that to happen. I think we only do it on certain tokens. Like we exclude certain special characters.Swyx [00:22:07]: Yeah.Ali [00:22:07]: So we only do it on like certain like S is the most common almost. GLM-5.2Swyx [00:22:11]: OhAli [00:22:11]: And I think it was DSV 4 as well. Like you'd just have like looping issues where like you literallySwyx [00:22:17]: ItAli [00:22:17]: Just have like S.Swyx [00:22:18]: Yeah. Is there a special, something special about S? No, just randomlyAli [00:22:21]: It just seems to be the one token involved.Swyx [00:22:23]: Yeah. And it'Philip [00:22:24]: Is thereSwyx [00:22:24]: And it's only temperature 0Ali [00:22:27]: NoSwyx [00:22:27]: Even at other temperaturesAli [00:22:27]: Even at like 0.9 or whatever, it will still, it will still collapse.Swyx [00:22:30]: That's weird, right?Ali [00:22:30]: It's, it is an inference problem to be honest, like a software problem. Like oftentimes, the image you run will-- like NVIDIA will release an image for instance, and if we will upstream the changes from their latest TensorRT-LLM image into our stack, we'll find that it fixes it. Or oftentimes this will only happen in an inference engine that you're using like SGLang. But if you were to switch to vLLM, that isn't the case. So it seems to be like an extremely like deterministic software issue and not really a model issue. It's not like a weights problem. Like I'- we'll say like, “Oh, it's a problem with the quant. We did PTQ wrong,” right? But that isn't, that doesn't make sense because the same weights used with a different inference engine does not repeat the problem. And sometimes it's, the kernels that are being used in the backend have like these very subtle sometimes race conditions, where if you were to use this model hosted on one cluster, you will never get this problem.Swyx [00:23:19]: Oh my God.Ali [00:23:19]: But if you host it on a different cluster, you will. And the reason is the KV cache transfer from a node to node in that one cluster is using a slower interconnect than the node to node in another cluster. So that exposes the race, whereas in another cluster it doesn't. So then you end up just like, okay, this model is not gonna be hosted on this cluster. We're gonna host it on, another cluster because that cluster exposed that problem. But then it ends up with like, okay, is it the software? Is it the model weights or is it the hardware?Swyx [00:23:42]: There is a thing about this with temperature 0 still not being deterministic, right?Ali [00:23:46]: Right.Swyx [00:23:46]: Mostly because of hardware. Even at temperature 0 same model, you won't always get the same output.Swyx [00:23:52]: Even-- But I'm surprised by the race condition one because, I thought PyTorch was a graph that like guarantees that you at least, execute things in the right order.Ali [00:24:02]: Well, yeah, true. Like I'm not, I'm not saying that there is. Like well, you have things like PTL optimizations where like you can start a kernel before the end of the previous kernel, and that's like ‘cause you want to do that because there'sSwyx [00:24:12]: It's like pipeliningAli [00:24:12]: Expense. Exactly.Swyx [00:24:13]: Yeah.Ali [00:24:13]: But it'- But you don't do it cleanly. Like you overlap a little bit of the execution. No, it is very possible that the kernel itself, like that one block that is supposed to be running in this instance of time, that kernel itself has a race condition. For instance, like a missing barrier. Like often if you're designing a kernel and you want it to make it to be very fast, if you don't test it extensively, you'll, you'll have certain threads access data points from registers before they've been written to by other threadsSwyx [00:24:36]: YeahAli [00:24:36]: For example, because like your barrier is wrong or your synchronization was wrong. But yeah, like the testing itself is very difficult in those like, andSwyx [00:24:42]: And there's no like borrow checkerAli [00:24:45]: What does that mean?Swyx [00:24:46]: Like Rust. Like the. If you're trying to have like memory safety It sounds like a comparable problem.Ali [00:24:52]: Well, yes, but you're working in CUDA, right, NVIDIA GPUs. Like- You just need a higher level language like modular Maybe that's what modular is supposed to do. I don't know.Quantization Quality and Vendor FidelityVibhu [00:25:00]: How do you see keeping quality of the model? So you talked about all these steps of, okay, you gotta do quantization, train your own speculative decoderAli [00:25:07]: RightVibhu [00:25:07]: Run on different hardware. Looking at other model providers, okay, you kicked off a inference speed race on the consumer end. What goes into keeping quality the same across them, right? Sure, you can run benchmarksAli [00:25:22]: YeahVibhu [00:25:22]: But, like, how do you determine how much quantization are there standards? What goes intoPhilip [00:25:27]: There's a few things on quality. Most inference optimizations are lossless. KV caching, for example. You are just recomputing or preventing recomputing the same values. Speculation, of course, if a draft token is wrong, it gets rejected. The main lossy optimization is quantization. And that really comes down to, number one, data format, number two, which parts of the model you choose to quantize, which layers, and number three, like doing a lot of calibration on the quantized weights, to ensure that you're preserving all the outliers. There's other tricks that you can do, though. A big one is long context, ‘cause one thing you asked at, right at the beginning is, “Oh, what's gonna happen if I send a 200,000 token request in?” So with a long input sequence, you need to, store a lot more information. You need to process a lot more tokens. And so even if a model has a context of a certain length, you might, as an inference provider, choose to build an API with a shorter context length, and of course a full length one as well. Because if someone doesn't need the full million token context, for example, you can get them better performance. I don't know if that's exactly like quality of the model. The way that I think about quality is to what degree are we faithfully serving the original model? If you think of a golden implementation of a model that performs exactly the way the model is designed to perform, I think of quality as how close are we getting to that, 100% fidelity of the model.Philip [00:27:13]: You can also, of course, think about quality from the training side and how do you push yourself past 100%. But when I think about purely inference optimizations, it's getting faster while staying as close to that 100% fidelity mark as possible. And certainly our standard internally is that, like you should not be able to tell the difference between our API and a, official API. I think Kimi in particular does a good job of vendor benchmarking hereAli [00:27:41]: YesPhilip [00:27:41]: Where they haveAli [00:27:42]: They released an actual vendor benchmark.Philip [00:27:43]: Exactly, yeah.Ali [00:27:44]: ‘Cause they accused, some people, Amazon? There was some provider that was not doing very well on Kimi's benchmark.Philip [00:27:50]: Yeah.Philip [00:27:51]: So, with Reflect we probablyVibhu [00:27:52]: This was a long time ago, right?Philip [00:27:54]: No.Ali [00:27:54]: Yeah, like threeVibhu [00:27:55]: They alsoAli [00:27:55]: Four, five months agoVibhu [00:27:57]: This also happened with, I don't remember which model, but they pulled out quite a few, and then they started a whole chart about this. It might have beenPhilip [00:28:03]: Kimi Vendor Verifier.Ali [00:28:04]: Yeah.Philip [00:28:05]: Yeah.Ali [00:28:05]: Yeah, ‘cause you, ‘cause you'd be pissed, right? Like if you'Philip [00:28:07]: Yeah.Ali [00:28:07]: If like if I'm a consumer and I'm using like Amazon's endpoint for instance, and I've used Kimi and I'm like, “Oh my God, like this is bad,” I'm not gonna say, “Oh, Amazon quantized the model in a bad way.” I'm gonna say, “Oh, Kimi sucks.” Right?Philip [00:28:17]: Yeah.Ali [00:28:17]: So it seems like that makes sense.Philip [00:28:19]: Yeah, they care. They care.Vibhu [00:28:21]: Justifiably.Ali [00:28:21]: Yeah, justifiably.Vibhu [00:28:22]: This is probably a stupid question, but just checking, has anything improved from main quantization?Philip [00:28:28]: Yeah.Vibhu [00:28:28]: Like, is quantization always strictly worse?Ali [00:28:30]: Well technicallyVibhu [00:28:32]: NoAli [00:28:32]: It's a lossy. QuantizationPhilip [00:28:33]: YeahAli [00:28:33]: Is a lossy, it's a lossy implementation.Philip [00:28:36]: Speed improvesVibhu [00:28:36]: Speed improves.Ali [00:28:37]: It the number, likeVibhu [00:28:38]: No, I' always look for inverse scaling laws.Philip [00:28:40]: Yeah.Ali [00:28:40]: Yeah.Vibhu [00:28:40]: This is something I learned from Noam Brown, where like things that normally act in one direction sometimes do.Philip [00:28:45]: Well, technically when you run a benchmark, because these models are deterministic, sometimes your,Ali [00:28:52]: YeahPhilip [00:28:52]: NVFP4 quant is like, two basis points higher than yourAli [00:28:56]: No, it's noise. It's noise.Philip [00:28:57]: Yeah, exactly. I'm like, yeah, it's, it's within. That's why I always say within margin of error.Philip [00:29:01]: And I stopped saying that because everyone assumes that what is, well, within some margin of error, we're barely inside of that to the worst, so we're saying. But yeah, sometimes it's just like, gives you a higher output score. But like Ali said, that's noise. To my knowledge, you're not necessarily making the results better. You're just trying to, again, like keep your fidelity as close to 100% to the original model.Layer Selection, KL Divergence, and Better QuantizationAli [00:29:27]: There is, to your point, research that we did on MP. I don't know if you are able to pullPhilip [00:29:31]: YeahAli [00:29:32]: A tweet we did. One of our research interns, Joshua, I think it's a tweet on how we have 20% better quantized GLM-5.2 than NVIDIA. Essentially what we found throughout like this month research is, okay, quantization is a lossy. It's. You're compressing the data from, occupying 16 bits to occupying, four bits, for instance. And so you're losing some information, and you're trying to minimize that. And so when I say that I'm gonna quantize the model, my job becomes how do I find the layers that I can quantize, and how to find the layers to not. For instance, with image models, I don't quantize modulation layers, and I don't quantize out projections because those two are. Like out projection is what you see as the user. Modulation is what the model sees or understands. Right, exactly. And so to his paper, do you have the. It doesn't have the. Yeah. It's a long paper. I don't know if I can findVibhu [00:30:25]: If there's a part to search or it's probably in the thread.Ali [00:30:28]: It's probably in the thread.Vibhu [00:30:29]: Yeah.Ali [00:30:29]: But the long and the short is it is very possible that quantizing more of the model makes the results. Like if I have a model that I quantize layers one, five, and 10, and another model where I only quantize layers one and It is possible that the model in which I quantized more information is going to perform better because the quantization errors have canceled out. And so what Joshua showed in his mathematical proof where he had like a verifier in, is that you can predict which layers are going to have quantization errors that will cancel out with each other, and you choose to quantize those layers. And so the result of doing this mathematical quantization is you end up with a model that's 20% more quantized than another provider, so you get 20% more throughput of it because there's more layers than running an NVFP4, and your quality is better than that other quant because the layers that you chose to quantize have their errors cancel out, like one layer skewed to the right one layer skewed to the left, one layer skewed to the right. Your final logits distribution is more similar to the original distribution of the model, so you have better fidelity. And so the way we proved this was with KL divergence. So instead of just scoring on the benchmarks, we scored the KL divergence between the logit distribution of the quantized model and the logit distribution of the original full precision model, and we showed that with this technique we get. If your probability distribution on the logits which token it wants to select is more of the same as the original model, you're probably gonna end up staying true to the original model. So yeah, so it seems like previously before this, it seemed like the industry was, well, the more you quantize, the worse it's gonna be, ‘cause the more loss you introduce. That's not exactly, not necessarily true. So yeah, doesn't improve it, but can cancel out.Philip [00:31:57]: I think it might be this, but reminds me a good bit about pruning where you can prune off certain layers.Philip [00:32:03]: But very interesting. Didn't know this was a whole paper you guys put out.Ali [00:32:06]: It's. Fun fact, it was originally 72 pages, this paper, and then we decidedPhilip [00:32:11]: WowAli [00:32:11]: We can't tell. We couldn't release it. So it's now 45.Swyx [00:32:15]: Still 39 pages, so very substantive. We talked about evals and all these things and, like what's possible in terms of speedup? Like it's like probably like the numberInference Speedups and BenchmarkingSwyx [00:32:25]: Thing that people do wanna care about, and it's something that you wrote about in your post. Like official API is 70 tokens per second, and you push it up to 90. Is that like a normal thing?Philip [00:32:36]: So what's cool about working in inference, the reason that I think inference is going to be a useful place to do engineering for a long time, is that if you look at highly optimized domains like, say, finance, if you're in finance, you measure how much better you got in basis points. It's like, “Oh, I got five basis points better, like twentieth of 1% better,” that's huge news because everything is so optimized. When we publish optimizations, it's 20%, it's 100% it's 200%. So there's still probably like a lot further to go, honestly. Like you'll, you'll know that inference is pretty much solved when researchers start publishing about how they got 1% faster at something.Swyx [00:33:19]: Which by the way, because I am from the finance background, in the ‘70s, that was the margin at the time. When you did quantitative finance research, you would findAli [00:33:27]: And like 20%, tens of percent.Swyx [00:33:29]: That's. Yes.Philip [00:33:29]: Yeah.Swyx [00:33:30]: And now it'Philip [00:33:31]: Tiny fractionsSwyx [00:33:32]: For those people interested, look up Andrew Lo's paper. He had a really interesting illustration of quant, stat arb, distribution, narrowing down from like those kinds of 20% differences in the ‘70s, down to nothing today, which is very cool.Philip [00:33:48]: Exactly, and we're at the beginning of the same type of thing. Now benchmarking is hard. I think anyone will tell you that, and benchmarking provider speeds is hard because there's so many variables that go into it. What hardware are you using? How much load do you have on the system? What's the exact nature of the prompts and input and output sequence lengths? All that stuff. But overall, when you start stacking these improvements, you're looking at multiples. You can look at it. The most common form, of course, is TPS, tokens per second, which is bad naming by us in the industry, ‘cause there's two tokens per second. There's tokens per second, the throughput number, and the latency number.Ali [00:34:31]: TTMT, yeah.Philip [00:34:32]: Like total tokens per second out of the, out of the GPU as a throughput number. Most people only care about tokens per second as the latency number, which we should call ITL, intertoken latency, but we don't.Philip [00:34:44]: Anyway, so you can imagine a standard API without many optimizations for a 1 trillion parameter model operating somewhere in the 30 to 50 tokens per second range for reasonable traffic profile. And we generally see the goal of, pushing to 10X that. But, not necessarily day zero, but by stacking enough optimizations, if you have, say like four optimizations, each of which doubles performance. Or sorry, three optimizations, each of which doubles performance, then you stack that up, that's an 8X gain. That's the order of magnitude that we're working with in this space. We're trying to make things substantially faster, not just go from like 70 to 90.Swyx [00:35:38]: Are you saying you've. You have done that?Philip [00:35:40]: So let's say you have as a reasonable baseline, 30 or 40 tokens per second. You can achieve 10X that. So like on GLM-5.2, if you run it unquantized, perhaps on H100s even, and you're just using an off-the-shelf inference engine with no particular optimizations, no speculator, nothing extra around like KV routing, no disaggregation, you're, you're probably, yeah, looking at that like 30 to 40. You think that's like a reasonable baseline?Swyx [00:36:12]: Right. Right.Philip [00:36:12]: To get to something like 10X, there's a lot of trade-offs that you're making. If we're running at more like a 300, 400 tokens per second range, you are using the best hardware possible. You have a optimized speculator. You have done all of your quantization work. You are Seeing a pretty high cache hit rate. You are running with a reasonably small batch size and a parallelism configuration that is tuned for latency versus throughput, but it is possible. So the spreads that you see if you, like, go on artificial analysis or you go on OpenRouter and you look at, the worst provider to the best provider, oftentimes can hit that range. 10X is of course very aggressive. It's oftentimes maybe more of a four to six times improvement. But that's the performance that makes us really excited, is when we can get these huge gains, not just go from 70 to 90 tokens.Stacking Optimizations: NVFP4, Speculation, and DisaggregationAli [00:37:19]: It's also, like, hardware dependent. Like, ifPhilip [00:37:20]: YeahAli [00:37:20]: If you have a thing where you're serving it on just, like, a node of H100s and then you throw, like, you shard the model across, like, four nodes of B200s. Like, you can definitely increase the speed with just throwing more hardware at it. Like, normalizing for the same exact hardware and the same number of GPUs.Philip [00:37:35]: Yeah. Then you're looking at, like, a two to 4X improvementAli [00:37:38]: Right. RightPhilip [00:37:38]: Depending on the inference optimizations. So yeah, it's. Some of it's, what's the call, and some of it's who's the driver.Vibhu [00:37:46]: If you break down the two to 4X, say the example is run GLM-5.2Ali [00:37:51]: YeahVibhu [00:37:51]: On B200sAli [00:37:53]: YeahVibhu [00:37:53]: Single node, right? What's, like, the cost trade-off for effort to get, like, the last bit of juice out versus what should people just think of, right?Ali [00:38:01]: Spectre quantization. Yeah.Vibhu [00:38:03]: Spectre quantization.Ali [00:38:04]: That's, that's, that's like 95%. LikeVibhu [00:38:06]: And how far does that get you? And how easy is that for the average person to do? So say right I wanna throw the weights of GLM-5.2 on a node of B200s, how easy is it to find speculative decoder- decoder model or already quantized model? How much work goes into it?Philip [00:38:23]: If you're doing it up front, it's quite a lot of work. If you're doing it today, there's going to be people who have published things that you can just, you can just grab some NVFP4 weights. You can grab a speculator. Yeah, if we're thinking about, like, what are the 2Xs we're stacking, going from, BF16 to NVFP4 is, it's not quite a 2X, right? It's like. I think it's about, like, 30 to 40%, from 16 to 8, and then another 30 to 40% multiplied from, 8 to 4. So that doesn't quite get you a 2X, but, like, roughly a 2X. Speculator, roughly a 2X. Disagg on top of that if you're able to get enough hardware and put enough traffic through it, another roughly a 2X. And then you add in some, double-digit percent increase from having just a better runtime with, the latest kernels and stuff behind it. And that's how it stacks up.Ali [00:39:21]: YeahPhilip [00:39:21]: So building each of those, like, building the, quantized weights is, for someone who really knows what they're doing, hours to days of work. Building the speculator, again, like, hours to days of work. And the, disagg setup, hours to days. Well okay, but like once you haveAli [00:39:39]: Once set up. Once set up. YeahPhilip [00:39:40]: Yeah, getting disagg working for the first time, I'm saying, of course, is very difficult.Philip [00:39:44]: The marginal implementationAli [00:39:48]: Like, if you're just grabbing, like if you are a person, like just a normal consumer who has access to, like, a node of B200s and you're wondering, “How can I just host it myself?” You don't need to quantize the model yourself. There's always gonna be, like, an open source quantized checkpoint. NVIDIA's gonna push one out if no one else does. You. Usually, the providers will have their own spec dec that they've trained as well. You don't need to train your own spec dec. You can just use that as well.Philip [00:40:09]: Yeah. Like, GLM-5.2 has its own MTP.Ali [00:40:13]: Right. Right.Vibhu [00:40:14]: What's multi token prediction?Philip [00:40:15]: Yes.Ali [00:40:16]: I'm justVibhu [00:40:16]: Can you explain that?Ali [00:40:16]: I'm just an expert.Ali [00:40:18]: I can do it for you in case I get it wrong?Vibhu [00:40:20]: No.Vibhu [00:40:21]: Yeah, you should correct if we're wrong, but their multi-token prediction can be used for self-speculative decoding.Ali [00:40:27]: I'm not sure. I'm not gonna correct that.Vibhu [00:40:28]: Okay. I'm semi-confident in thatAli [00:40:30]: Okay. YeahVibhu [00:40:30]: But someone can check. But it's useful to paint the story of, okay, not just the average person, but say a company wants to switch from serverless inference I wanna throw this up on. I wanna rent some GPUs, throw it up. These are the steps you take to do significantly faster than just put it behind vLLM.Ali [00:40:48]: Right.Vibhu [00:40:49]: I was waiting for a mention of Dynamo.Vibhu [00:40:51]: I feel like, that's supposed to be the baseline that you measure against.Dynamo, KV Routing, and Disaggregation ToolkitsPhilip [00:40:55]: I would think of Dynamo as less of a box system and more of a toolkit for building with. So when we talk about doing aware routing, when we talk about doing KV offloading, when we talk about doing, PD disaggregation, Dynamo fundamentally is. By the way, Dynamo is an open source library from NVIDIA.Ali [00:41:17]: We've done a pod with KylePhilip [00:41:18]: OkayAli [00:41:19]: Kyle Cranin.Philip [00:41:19]: Cool. So then your listeners know then that it supports all the different inference frameworks. And it is multi hardware, which is interesting.Ali [00:41:28]: But it's just a router, it's not like an optimizer layer.Philip [00:41:30]: Yeah. All it does, like, what Dynamo is good at, it is a library for moving information around your cluster, around your hardware. So if you have, KV cache on one place and you need it to be somewhere else, Dynamo coordinates NIXL for you to move that around.Philip [00:41:49]: That doesn't mean that, like, out of the box, you just say, “Pip install Dynamo,” and then you get, like, a massive performance speed up. It's more of a developer toolkit.Ali [00:42:01]: Yeah. I would have said it would. It comes with a set of defaults that you can then swap out.Philip [00:42:06]: It does. If the industry at large, I think, was, like, rolling out all of these deployments, standard, then I think it would be, like, a credible baseline. But, we've got to, we've got to benchmark against, like, what we're seeing in the wild.Speculative Decoding Methods: Medusa, EAGLE, n-Gram, and Spec-SpecVibhu [00:42:23]: I did wanna talk a little bit more about PD disagg, because that is probably, like, number three after quantized and speculative decoding. In your book though, I was just gonna pull out the book.Philip [00:42:31]: Yeah.Vibhu [00:42:32]: Like section 522 on Medusa, 523 on EAGLEPhilip [00:42:35]: YeahVibhu [00:42:36]: 524 on gram.Philip [00:42:37]: It's 55, would be disaggregationAli [00:42:42]: Yeah. Well, no, I just wanted to dwell a little bitPhilip [00:42:44]: YeahAli [00:42:44]: The other. Like, so what do you choose to include? What do you choose to not to include? Because there was all these other techniques.Philip [00:42:51]: Yeah.Ali [00:42:51]: Are these still relevant? Because I think they came out, like, a year and a half ago maybe.Vibhu [00:42:55]: Medusa is quite old.Philip [00:42:56]: Yeah, Medusa's old.Ali [00:42:58]: It was old.Vibhu [00:42:58]: But is it in the book as a good, here'sPhilip [00:43:01]: BaselineVibhu [00:43:01]: Baseline vanilla understand it?Philip [00:43:02]: Like you should know this.Vibhu [00:43:03]: Like I read the paper, I'm like, “ it makes so much sense.”Philip [00:43:05]: Yeah.Philip [00:43:05]: So with the book, I had a couple goals. One was to give people just a working vocabulary for the space as a whole, and the other was to give them some intuition about how each of these techniques works. As I mentioned in my AI Engineer talk, which is the first public addendum to this, the speculation space has moved much faster than everything else. So yeah, even at the time that I wrote the book Medusa, I very much included as a way for people to understand how the space evolved rather than what the most modern technique is. And now of course, there's DFlash, dSpark. There's, there's newer techniques even than EAGLE, although EAGLE is still very commonly used.Ali [00:43:51]: SpecSpecta.Philip [00:43:52]: Yes. Speculative decoding.Vibhu [00:43:54]: What canAli [00:43:56]: Oh, it's a paper by Tri Dao and it's like, it's doing speculative decodingVibhu [00:44:00]: HuhAli [00:44:01]: For the speculative decoder.Philip [00:44:02]: Oh, in spec- oh my God.Ali [00:44:02]: It's literally just an another. It's like, yeah, that's the most simple way to explain it, and it seems like he got trivial speed ups there. But it seems that the complexity with training, it's almost like in our mind at least, it's almost as complex as training GANs. Like it's like a very delicate balance and oftentimes you, it's just but yeah, it's literally speculative decoding on speculative decoding.Vibhu [00:44:21]: Speculative.Ali [00:44:22]: Yeah. We saw this paper.Vibhu [00:44:24]: It's interesting, right?Ali [00:44:24]: Yeah.Vibhu [00:44:24]: I wouldn't even expect it to be very particular to train, I wouldAli [00:44:29]: Right.Vibhu [00:44:29]: The naive part of me is like, okay, train speculative decoder.Ali [00:44:32]: But like, and it makes sense, like the whole idea of speculative decoding is you. It's like, it's like almost like the iPhone auto predict version but for a normal model, right? Like you're just, you're just, generating three tokens and you're like, okay, I'll do prefill on them. And so you save those three turns for your original model. Now your speculative decoder is doing three turns of auto regression, so why not just have an even smaller model?Ali [00:44:53]: The other question there is what are the size of speculators? So say forPhilip [00:44:58]: Right. It's like a billion parameters.Ali [00:45:01]: Like for MiniMax, it's. Yeah. It's like one layer. It's like one 60th of the original model usually.Philip [00:45:06]: Yeah. I think we should do a paper when we get back to the office.Philip [00:45:10]: SpeculativeAli [00:45:11]: SpeculativePhilip [00:45:11]: Decoding.Ali [00:45:13]: No, it's, it does seem like how, when do you stop? But then it also seems like if you're able to train spec-spec decode for instance, right? Like if you're able to have a small model that is accurately predicts what the intermediate speculator is gonna predict, that is able to predict what the original target model's gonna predict, then why not just use that smallest model directly, right?Vibhu [00:45:34]: Yeah. This isAli [00:45:35]: Like it seems likeVibhu [00:45:35]: Adjacent to the routing problem.Ali [00:45:36]: Right.Vibhu [00:45:36]: Yeah.Ali [00:45:36]: Right.Philip [00:45:37]: The thing with speculators is one of the practical constraints on using them is that you do have to run a small model on the same hardware that you're running the big model on. There is a orchestration and resource competition problem inherent in that, and that is one of the constraints on speculation in general, is that draft tokens cost resources to create and cost software complexity to manage. And so if you have like infinitely recursive speculators, you add in quite a bit of that complexity on the actual implementation within the inference engine as well, not just in the training process.Vibhu [00:46:17]: I was gonna say, I would wonder if you could do similar, like distillation and pruning of, it's the same thing, it's just a model. Can we not just distill a lot of the weights, quantize the speculator, out of my domain? The question that also comes up is, this is all for big server workloads, right? How much of this applies to, say I have this MacBook, I wanna run Gemma really efficiently. Similar problems, not the same?Local AI vs. Data Center InferencePhilip [00:46:45]: Pretty different. I talked to Selo, about this on his podcast a couple weeks ago. The difference between inference engineering for the data center and for production workloads versus inference engineering for local AI, is that we start with fundamentally like different constraints and different goals. With local AI, it's how do I fit this model onto my hardware and then make it less dumb? And with data center influence, it's how do I load this model and then make it less slow? And we care about less dumb, and they care about less slow. But the local AI inference engineering ecosystem, I think has a lot for us to learn from in the data center space. They are experts in various forms of quantization, including dynamic quantization that we just don't touch, in the pruning, in the distillation, in the, layer removal. There'Ali [00:47:42]: Layer removal matters less.Philip [00:47:43]: Yeah. There'Ali [00:47:44]: No one loves pruning really.Philip [00:47:45]: Yeah. Well, but the, but they doVibhu [00:47:46]: Which is surprising, right? But that's, that's a whole different thingPhilip [00:47:48]: Just to fit something on the laptop.Ali [00:47:50]: Right.Philip [00:47:50]: So yeah, it's a, it's an interesting, it's an interesting space. Not necessarily that like their techniques make sense for us to do in the data center, because we have different resources and different goals, but more that the process as well as the openness of that field is something to, admire.Ali [00:48:12]: Yeah. Like to your point, like, certain optimizations that would. Like for instance, Turbo Quantum Sharper, like it made such huge hype on that and we did like a whole deep dive on Twitter and like said, what is it? How does it work? Why is it good or not? And it took off and it was implemented on local devices because your memory bandwidth is so slow on like a MacBook, for instance. But try putting the same thing on like an NVIDIA GPU on a B200 Turbo quant would not be. Like, it would not be used. Like, NVIDIA - Like, NVIDIA made it clear that this is not a good optimization, and we've seen it firsthand where the overhead of doing dequantization, quantization of, in the kernel itself with turbo quant kernel, each end is much slower than the time that you save from doing the bandwidth. ‘Cause on the B200s, you have like 3.5 terabytes per second. You don't need decrease the storage that much. You don't need to do, FP4 KV cache. You don't need to use a requant. There's, there's, there's better optimizations to be made. But on Edge devices, it's extremely important, it's extremely useful. So, seems to be, like, different optimizations there, but then they're all uniquely combined with like all you wanna quantize the model, you wanna do speculative decoding, like certain common prefixes with bothPhilip [00:49:18]: Principles.Ali [00:49:19]: Yeah, exactly. Exactly. Exactly.Philip [00:49:20]: They also do a lot of work on, model parallelism, especially over, heterogeneous topology, where you have, some sparks and they are wired together with, Ethernet, DGX sparks.Ali [00:49:35]: Yeah, this is the Exo Labs guys.Philip [00:49:36]: Yeah. You have, a nu

Struggling with unexplained weight loss, racing heartbeats, or anxiety that won't quit? Your thyroid could be the hidden culprit behind it all. This episode uncovers the truth about hyperthyroidism and Graves' disease, from early warning signs to natural healing strategies most doctors never mention.Host Jenn Trepeck sits down with functional medicine expert Dr. Eric Osansky on Salad with a Side of Fries to explore how diet, stress management, and gut health can help restore thyroid balance naturally.What You Will Learn in This Episode:✅ How to spot early symptoms of hyperthyroidism, from a racing heart to sudden weight loss✅ Why Graves' disease is often autoimmune, and how the triad of autoimmunity and 4 triggers fuel the condition✅ Natural options like bugleweed and motherwort that may support a balanced thyroid✅ How healing the gut and managing stress can influence long-term thyroid healthThe Salad With a Side of Fries podcast, hosted by Jenn Trepeck, explores real-life wellness and weight-loss topics, debunking myths, misinformation, and flawed science surrounding nutrition and the food industry. Let's dive into real-life wellness and weight loss, including drinking, eating out, and skipping the grocery store.TIMESTAMPS:00:00 Meet Dr. Eric Osansky, author of Natural Treatment Solutions for Hyperthyroidism and Graves' Disease, Hashimoto's Triggers, and The Hyperthyroid Healing Diet04:59 Dr. Osansky shares how he first noticed symptoms of Graves' disease through an elevated heart rate09:50 A breakdown of key differences between hyperthyroidism and hypothyroidism symptoms13:55 Exploring the autoimmune triad and how genetics, triggers, and leaky gut interact17:28 Environmental toxins, mold, and chemicals that may trigger thyroid imbalances22:03 Conventional treatment options like antithyroid medication and radioactive iodine explained26:30 Natural first steps for safely managing hyperthyroid symptoms and discussion of goitrogens31:22 Why stress management and quality sleep are essential for thyroid healing36:42 The gut thyroid connection and how gut health impacts hormone conversion39:34 Final thoughts on iodine intake and finding the right balance for thyroid supportKEY TAKEAWAYS:

Dr. Balcavage's new book, Is This The Hill?, releases at the end of July. Get on the waitlist to receive updates, exclusive bonus content, and early announcements at drericbalcavage.com/hill. Just because a supplement is designed to support mitochondrial function doesn't mean it's supportive for your body right now. In this final episode of Dr. Eric's mitochondrial series, he explores one of the biggest misconceptions in functional medicine: assuming that low mitochondrial function automatically means you need more mitochondrial support. Many people are told they have "mitochondrial dysfunction" based on lab testing and immediately begin taking supplements like CoQ10, carnitine, B vitamins, NAD precursors, methylene blue, or additional thyroid hormone. While these interventions can absolutely be helpful in the right situation, they aren't always addressing the real problem. Dr. Eric explains why mitochondria often reduce energy production as an adaptive response—not because they're broken, but because the body is responding to stress, inflammation, immune activation, poor oxygen delivery, under-fueling, or other protective signals. You'll learn why temporarily feeling better on a supplement doesn't necessarily mean you've corrected the underlying issue, and why increasing energy production without first restoring your body's capacity can actually create more stress over time. Instead of asking, "What supplement do I need?" Dr. Eric encourages you to ask a much more important question: Why are my mitochondria behaving this way in the first place? In this episode, you'll learn: Why mitochondrial support isn't always supportive The difference between increasing energy production and restoring resilience Why low mitochondrial output doesn't automatically mean deficiency How mitochondrial testing can identify patterns without explaining the underlying cause Why supplements may help temporarily but fail to produce lasting recovery How thyroid hormone, B vitamins, CoQ10, carnitine, and other "energy" supplements can increase demand on the body Why your physiologic state determines whether an intervention will help or create additional stress The importance of restoring capacity before trying to optimize mitochondrial function How State-Based Medicine™ approaches mitochondrial dysfunction differently If you've been told you have mitochondrial dysfunction, poor T4-to-T3 conversion, or low energy despite trying countless supplements, this episode will give you a new framework for understanding what's really happening—and why creating the right conditions for recovery is often more important than forcing more energy production. Need help understanding your symptoms? If you've been struggling with fatigue, thyroid symptoms, or chronic health issues despite trying multiple treatment approaches, schedule a complimentary Discovery Call to learn whether Dr. Eric's State-Based Medicine™ approach may be right for you.

20 million people have a thyroid condition and 60% don't even know it — because the labs your doctor runs are barely scratching the surface of what's actually going on. In today's episode of The Wellness Effect, Kira breaks down how the thyroid actually works — from the brain-driven HPT axis to the T4-to-T3 conversion process — and why "normal" TSH doesn't mean your thyroid is fine. The trio unpacks what really drives thyroid dysfunction (stress, gut health, liver congestion, blood sugar, minerals, toxins, and autoimmunity), plus which labs to actually ask for and what to do if your doctor won't run them. Key Takeaways TSH isn't a thyroid hormone — it's a signal from your brain, and a "normal" TSH can still hide real dysfunction in T3, reverse T3, or antibody levels. Most thyroid hormone conversion happens outside the thyroid — 60-70% in the liver, 20% in the gut — so liver and gut health are often the real root cause. Minerals (iodine, selenium, zinc, iron, magnesium) are required raw materials for thyroid hormone production and conversion, not optional extras. Chapters [00:00] - Intro: Why Thyroid Issues Are So Common [01:24] - What Your Thyroid Actually Does [04:50] - The HPT Axis: How Your Brain Controls Your Thyroid [07:50] - T4 vs T3: How Thyroid Hormone Is Made [13:57] - Reverse T3 Explained [19:19] - The Thyroid Labs You Should Ask For [24:46] - Hypothyroid vs Hyperthyroid Symptoms [30:21] - What's Really Driving Thyroid Dysfunction [35:46] - The Minerals Your Thyroid Needs [44:32] - Toxins, Autoimmunity & Hashimoto's [52:02] - What To Actually Do About It [57:18] - Why Working With a Practitioner Matters Resources & Mentions HTMA (Hair Tissue Mineral Analysis) testing GI Map testing Related episode: previous toxic/low-tox living episode hosted by Lacey (referenced re: environmental toxins) Want to Work With Us? Join us in the Root Cause Reset Program: https://www.lifestyleucoaching.ca/wellness-effect-906145 and use code "Wellness Effect" for a FREE functional lab test when you join the program. Follow us on Instagram: The Podcast: https://www.instagram.com/thewellnesseffectpod/ Lacey Iskra - https://www.instagram.com/laceeiskk/ Jensen - https://www.instagram.com/wellnesswjensen/ Kira Iskra - https://www.instagram.com/wellbykira/ Lifestyle U have helped over 1,000+ women transform their mind and body and become the best version of themselves. Want to be next? Click Here to Apply! - https://www.lifestyleucoaching.ca/apply If you loved this episode and want to hear more, subscribe and leave a review! Share this episode with a friend who's ready to start their own wellness journey. Follow us on Instagram at https://www.instagram.com/thewellnesseffectpod/ to stay up-to-date with the latest episodes and tips.  

Why Your Stroke May Not Be Causing Your Brain Fatigue For a long time after my brain surgery, I assumed my body worked like this: the stroke happened in my head, so whatever went wrong afterward would also happen in my head. Fatigue, brain fog, slow thinking all of it filed under “neurological,” all of it explained by the injury I already knew about. That assumption turned out to be wrong, and the way I found out was almost accidental. About eighteen months after my brain surgery, I had thyroid surgery to remove a nodule so large it had pushed my windpipe and esophagus six centimeters out of place. I had no idea it was there. No lump I could see, no difficulty swallowing or breathing that I’d noticed. It was found only because I had a chest X-ray to rule out an infection, and a doctor spotted something that had nothing to do with why I’d walked in. What followed was a slow, confusing recovery from that second surgery, and a wave of fatigue I automatically blamed on my brain, because that was the injury I already understood. It took time to realize the fatigue might be coming from somewhere else entirely: my thyroid. Hormones and Stroke Recovery: The Connection Nobody Talks About I brought this experience to Dr. Robert Hedaya, a Clinical Professor of Psychiatry at Georgetown University Medical Center and a pioneer of functional medicine psychiatry, to understand what actually happened, and to ask a bigger question: how many other stroke survivors are dealing with fatigue, brain fog, or mood changes that they’ve written off as “just the stroke,” when the real driver is a hormonal system that’s quietly stopped working properly? Hormones and stroke recovery turn out to be far more entangled than most of us are told. As Dr. Hedaya put it plainly: the brain is a hormonal organ. Thyroid hormone, cortisol, testosterone, estrogen every one of them acts directly on brain tissue, and every one of them can be knocked off balance by the stress of a major medical event. Why “Normal” Thyroid Bloodwork Can Still Mean Something’s Wrong One of the most important things Dr. Hedaya explained is that a “normal” TSH result doesn’t rule out a thyroid problem, especially after a stroke. TSH is a signal sent from the pituitary gland, and if a stroke has affected the brain’s signaling pathways, the pituitary itself may not respond the way it should. A survivor can have genuinely low thyroid hormone while their TSH sits comfortably inside the standard reference range, because the system responsible for raising that number in response to a deficiency isn’t functioning correctly. He also raised a striking data point: population studies suggest the average TSH in a healthy population is closer to 1.4, yet most labs still use an upper reference limit of 4.5, a range wide enough, statistically, to miss a real problem. His advice for survivors going into a GP appointment: ask specifically for TSH, free T4, free T3, and reverse T3, not just the standard single-marker test, and come prepared with symptoms written down if a doctor pushes back. A Nodule That Grew in Silence The brain is a hormonal organ. It’s an immune organ. It’s a neurological organ… there’s not one hormonal axis when it’s abnormal that cannot cause neurological or psychiatric problems. -Dr. Robert Hedaya My own nodule is a case study in exactly this kind of silent progression. Dr. Hedaya explained that because it grew inward rather than outward, it never created the visible lump most people associate with a thyroid problem, and because it didn’t press on my vocal cords or laryngeal nerve, I never developed the hoarseness that might have flagged it sooner. My body adapted gradually, and the fatigue that eventually surfaced was easy to misattribute to the injury I already knew I had. Cortisol, Stress, and the Difference Between Pain and Suffering Beyond the thyroid, Dr. Hedaya walked through the role of cortisol, the body’s primary stress hormone, and why survivors often struggle to answer a deceptively simple question: “Are you stressed?” His distinction between pain and suffering is worth sitting with: pain is often unavoidable, but suffering is shaped by the story we tell ourselves about a situation, and a stroke can compromise the very brain systems that regulate that stress response in the first place. Testosterone, Estrogen, and the Brain’s Need for Hormones to Rewire The conversation closed on sex hormones, testosterone and estrogen, relevant to both men and women, and their role in neuroplasticity. Dr. Hedaya drew a direct comparison to adolescence: the teenage brain rewires itself while hormone levels are surging, and the same principle applies after a stroke. A brain trying to rebuild pathways needs adequate hormonal support to do that work. Without it, recovery can stall in ways that have nothing to do with effort or physiotherapy. What You Can Do About It If any of this sounds familiar fatigue that doesn’t track cleanly with other recovery milestones, or symptoms a doctor has waved off as “just stress,” Dr. Hedaya’s PNIE (psycho-neuro-immuno-endocrinology) questionnaire is a useful starting point. PNIE Questionnaire download: https://drive.google.com/file/d/1S7kC5uMFgBfS-gWcUOIHp0kOjGnrzZK5/view?usp=sharing If thyroid function specifically is what you’re navigating, the earlier conversation with Dr. Elena Zinkov, “Stroke Fatigue and Thyroid,” goes deeper into that piece (https://recoveryafterstroke.com/stroke-fatigue-and-thyroid/). And for more from Dr. Hedaya, the first conversation on photobiomodulation and stroke recovery is a good companion listen (https://recoveryafterstroke.com/photobiomodulation-stroke-recovery/). Getting your body back after a stroke is rarely just about the brain. My book, The Unexpected Way That A Stroke Became The Best Thing That Happened, goes further into the mindset shifts that came out of my own recovery (recoveryafterstroke.com/book). And if this podcast has helped you, you can support its continuation at patreon.com/recoveryafterstroke. This blog is for informational purposes only and does not constitute medical advice. Please consult your doctor before making any changes to your health or recovery plan. Hormones, Fatigue, and the Brain: Dr. Robert Hedaya Returns (Interview) A baseball-sized thyroid nodule hid in plain sight after Bill’s stroke. Dr. Hedaya explains the hormone testing every survivor should ask for. Support The Recovery After Stroke Podcast Bill’s Book: The Unexpected Way That a Stroke Became Thethe Best Thing That Happened Highlights: 01:45 Hormones and Stroke Recovery 02:11 Understanding Thyroid Function and Its Impact 17:07 Navigating Thyroid Health with Healthcare Providers 27:09 The Role of Stress and Cortisol 39:09 Nutrition’s Impact on Brain Recovery Transcript: Hormones and Stroke Recovery Bill Gasiamis (00:00) And they noticed a massive lump in my throat and my esophagus and my windpipe were pushed six centimeters. And they said to me, well, can you swallow? Can you breathe? Can you do it? And I was like, yeah, I’m all fine. There’s nothing wrong with my throat. that was the first sign that there was something wrong with my thyroid Bill Gasiamis (00:19) Welcome back to Recovery After Stroke. I’m Bill Garciamas, and today I’m joined again by Dr. Robert Hedeya, clinical professor of psychiatry at Georgetown University Medical Center and a pioneer of functional medicine psychiatry, whose highland approach to brain health first brought him onto the show for our conversation on episode 404, where we discussed, amongst other things, photobiomodulation, a type of transcript. cranial laser therapy helping some stroke survivors recover lost function. He’s back today for a conversation I wanted to have for a while, the hormonal side of stroke recovery. We’re going to talk about thyroid function, cortisol, and stress physiology, and sex hormones like testosterone and estrogen, and why every one of these systems can directly affect how well and how fast your brain recovers. I’ll also share my own story of a thyroid nodule that grew undetected, which was discovered after my brain surgery completely by accident. if this conversation resonates with you, my book, The Unexpected Way That a Stroke Became Thethe Best Thing That Happened goes deeper into the mindset shifts that shaped my own recovery. You can find it at recoveryafterstroke.com/book. And if you’d like to help keep this podcast going, you can support it financially at patreon.com/recoveryafterstroke. Bill Gasiamis (01:46) Robert Hedaya, welcome back to the podcast. Dr Hedaya (01:49) Thank you for having me, Bill. Understanding Thyroid Function and Its Impact Bill Gasiamis (01:51) thank you for being here. The last conversation we had was very well received. And it’s always difficult in a one hour interview to ask all the questions that we could possibly ask about the brain and stroke recovery and all the things that people go through. And… I’ve got a lot of other questions that are related to the brain and the link between other parts of the body and the brain, because we have this sense. Well, I did at least when I was first diagnosed that whatever happens in my head is kind of isolated, that it just impacts my head. But there seemed to be some other impacts and cascading effects. that were occurring, uh, that I didn’t know were linked to the brain injury, Dr Hedaya (02:45) Yeah. Bill Gasiamis (02:46) maybe indirectly, but they were perhaps. But one thing specifically that happened to me about, uh, 18 months after my brain surgery was I had thyroid surgery to remove a nodule on my thyroid. And when I was going through the recovery after that, surgery, I noticed that I had fatigue and I thought it was neurological fatigue related to my brain surgery. But it took a long time to develop an understanding that perhaps that batch of fatigue was related to my thyroid. And then that got me thinking all sorts of things. know, if the thyroid also causes the same neurological fatigue that brain injury causes, what people might be missing this in their healing from a brain injury, they might have a compromised thyroid and not know about it. So the first question is, what is a thyroid? What does it do? And why does it cause neurological fatigue? Dr Hedaya (03:54) Okay. So thyroid gland sits in the neck, right? There’s two lobes, there’s one on the right, one on the left, a little kind of island in the middle called the isthmus, and and it controls many functions, metabolism overall, energy overall, just broadly speaking. now it affects the immune system. It’s affects the nervous system. It affects the gastrointestinal system, it affects the muscles, it affects the heart, right? It affects the skin, it affects the nails, it affects the hair. You know, and I could go on and on and on. Okay? Bill Gasiamis (04:34) Wow. Dr Hedaya (04:35) Now the interesting thing about this is that this be a little technical, but the thyroid puts out a hormone called T4 or thyroxine, and this is a little molecule with four iodines in it on it, and that Gives you about 20% of the activity of your thyroid hormones in your body. But then that T4 goes all over the body to different tissues, and each tissue can has its own system to change that T4 into T3 by removing an iodine. T3 has 80% of the thyroid activity. So that means each tissue in the body can control how much thyroid it. It’s using and needs, right? And and has available to it. Okay. So that means the brain, the heart, the liver, the lungs, every tissue has its own enzyme that allows it to kind of modulate how much thyroid, right? Now, so why does that cause neurological fatigue? Well, thyroid in the brain affects neurotransmitters like adrenaline in the brain, which is called nor norepinephrine, noradrenaline. in order for that to work. The T3 has to be in the right amount for the receptors for the noradrenaline to be structurally correct so they can transmit the signal. It’s necessary for production of energy in all the brain cells. It helps the immune system in the brain. It carries molecules from here to there in the brain. it affects serotonin transmission in the brain, so mood regulation, anxiety, obsessiveness, depression. You know, those are just some of the functions of the brain, but it affects every cell in the bane in the brain. So you’re gonna, if your thyroid is off, most likely you’re gonna have some kind of brain problems, particularly, you know, when your thyroid is off, the tissues in your body that are most compromised or most stressed, that’s probably where it’s gonna show up, right? And in the case of stroke, that’s where it’ll show up. Bill Gasiamis (06:44) So it’s possible then, is it possible to overlook it? Is it very obvious that your thyroid is out of, well, is dysregulated or is not working properly? Dr Hedaya (06:56) Well, in general it’s easy to detect. And if you want, I’ll tell you how. So Bill Gasiamis (07:04) Yeah. Tell me how. Dr Hedaya (07:07) so there’s some blood tests that are simple and then s some symptoms. so for most people this holds. When your thyroid is low, you know, you’re gonna be cold easily, you’re gonna have dry skin, brittle nails, hair will fall out. Muscles will be weak, thinking will be slow, movement will be slow, getting up from a chair will be more difficult, going upstairs will be more difficult, your heart rate will slow down, you’ll be constipated. Those are the most common symptoms. If your thyroid is overactive, then you could be have palpitations, oily skin, acne, oily hair. Diarrhea, you know, kind of the opposite. The thing that’s a little confusing with the thyroid is sometimes overactive thyroid can show up and look like it’s underactive symptomatically, or vice versa. So you really need the labs. And the labs are TSH, which is thyroid stimulating hormone, and that’s tells you what the brain is doing. And then free T4. That’s the amount of T4 that’s kind of floating around free, not bound to protein, so it can actually do its job. The way I think of it is like, you know, a lot of the thyroid home is sitting on a bus. It’s not free, it’s bound to protein. Can’t do its job. But the stuff the thyroid this that’s out of the bus or not on a protein, that can do its job. That’s the free T four. And then the free T three, right, which carries eighty percent of thyroid activity. And then the last one is a reverse T3 because sometimes if your tissues in your body are making too much thyroid or getting too much thyroid, they’ll actually, instead of taking the iodine off the T4 molecule on the right side, they’ll take it off on the left side, or vice versa. So they make a fake T3 that doesn’t work. And this way they short circuited okay, you got all this T3. Well, let’s make it into a fake, fake T3 so it can’t do anything. So reverse T3 is also very important. And then you want to measure body temperature. Usually it’ll be low. And then, you know, a physical exam. Those are the ways to do it. If you wanted to go even deeper, you could do some genetic testing. There are genes that will tell you whether you’re converting the T4 to T3 in the brain. Adequately, or maybe you’re more likely to be slow in that regard. So you can have normal numbers in your blood, but your brain might be hypothyroid, right? And there are actually a lot Bill Gasiamis (10:05) Uh-huh. Dr Hedaya (10:05) of studies showing that hypermetabolic, like high doses of free T3, actually reverse treatment-resistant depression because it’s it’s thought that there’s a local in-brain. hypo-low thyroidism. You can have low thyroidism in your heart, in your muscles, but not in the other tissues, you know, because I told you every tissue can control how much it’s making. So if you have a genetic vulnerability, then you you might more be in general be more likely vulnerable to depression or to ADD or to anxiety, things like that. Bill Gasiamis (10:42) Wow. Are you blowing me away? I didn’t expect to hear any of the things that you just said. X. Um, some of the things that you described, the, uh, some of the symptoms that you described, had those intermittently in and out all the time, other than a thyroid nodule, which is what I had, which was obvious on a scan. Dr Hedaya (11:05) Yeah. Bill Gasiamis (11:06) What other things caused the thyroid to not function? correctly. So is there lifestyle factors that interfere with the thyroid gland and therefore, you know, then have the cascading effect and take off, take all those other things or some of those other things offline. Dr Hedaya (11:28) So there a number of causes, right? So first of all, let’s take someone who has had a stroke or chronic illness, right? So you’re under stress and that affects your stress hormones, your adrenal glands, cortisol, etc. Well, if your adrenals kind of poop out, then maybe your body says, Well, I can’t handle all this thyroid, even though the amount is normal, it’s like too much. I can’t handle it, so it’ll make less thyroids. Now you develop a hypothyroidism. You could develop it just because all the chemicals in the environment, the ha the hormone interrupting chemicals, there are hundreds of those. you could develop it ’cause of nutritional deficiencies like tyrosine is necessary to make thyroid hormone, copper, you know, things like that. I can’t tell you offhand which which nutritional factors, but people can look that up, what nutritional factors are important. To make thyroid hormone. and then infections like, for example, Lyme disease causes Hashimoto’s thyroiditis, which is an autoimmune where your immune system’s actually attacking your thyroid. COVID vaccination, like the Pfizer and the Moderna vaccine, if you are genetically vulnerable, can also cause your immune system to attack your thyroid. So there are many, many causes, plus there are inherited genetic vulnerabilities and it It’s not always low thyroid, sometimes it’s high thyroid, hyperthyroidism, like Graves’ disease, right? You can have antibodies Bill Gasiamis (13:01) Mm-hmm. Dr Hedaya (13:02) that are actually stimulating thyroid activity as well. Bill Gasiamis (13:06) Wow. The environmental toxins. we talking about all day, every day household use kind of environmental toxins? I imagine the external of the house, they’re kind of out of our control, right? We’ll talk about like, you know, like pollution or things that are associated to things that are caused that we don’t necessarily control, but internally inside the house or what we expose ourselves to that we can control. what would some of those environmental toxins Dr Hedaya (13:38) Well Bill Gasiamis (13:39) be? Dr Hedaya (13:40) so for example, you know, in your produce, you know, there are pesticides, or in the man made materials in your car or the man made materials in your home. Let’s say you bought a new home and you have, you know, some kind of synthetic floors or furniture with synthetic materials or materials that are natural that are treated with chemicals for various reasons. Those things all can be not everyone is, but many of them are called homes. hormone interruptors because they actually can change the way your hormones function. You know? So we’re the truth is we’re bathed in these chemicals. They’re everywhere. And very hard to escape them. The best thing you can do is kind of try to detox them using a healthy diet, a lot of crucifer vegetables and lots of vegetables, above ground vegetables that are grown in healthy soil. Without pesticides, organic preferably, right? and then there are supplements you can take, such as metagenics makes something called UltraClear Plus, which helps support the liver, and its detox functions. You know, some people are more vulnerable than others, but you know, these thyroid nodules you like you have, they’re very, very common now. Very common. And that’s you know. In large measure, I think these hormone interrupters that are interfering with how the the thyroid follicles in the thyroid gland are operating. Bill Gasiamis (15:13) Is it possible to have thyroid nodules and not know about it? I, I Dr Hedaya (15:18) Yeah. Bill Gasiamis (15:19) say that because I had nodules that were the size of a baseball, apparently in my throat that were growing inwards, that didn’t make a lump outside of my throat, which Dr Hedaya (15:33) Yeah. Bill Gasiamis (15:34) I was not aware of. And the way they found it was they did a chest X-ray after brain surgery because I wasn’t recovering well. to check my chest to see if there’s an infection. And they noticed a massive lump in my throat and my esophagus and my windpipe were pushed six centimeters. Dr Hedaya (15:52) Wow. Bill Gasiamis (15:53) I’m not sure what that is in inches. And they said to me, well, can you swallow? Can you breathe? Can you do it? And I was like, yeah, I’m all fine. There’s nothing wrong with my throat. But that was the first sign that there was something wrong with my thyroid before that. there was no sign of it. I ask that because either I’m totally oblivious or it is possible to have thyroid nodules and not know it. Dr Hedaya (16:23) Well, most people don’t know it. Now yours is so massive, but I think it’s kind of what you said is how it grew. If it grew towards your vocal cords or your laryngeal nerve or something, you would have had some pretty bad hoarseness or something like that. But it grew I guess backwards so it didn’t interfere that much. And I guess your s your body adapted gradually over time. You know, yes, it’s very possible for sure. Very common. Bill Gasiamis (16:49) And how would somebody interact with a general practitioner, for example, now to go through the process of understanding, A, their thyroid health and whether or not they have any nodules. Navigating Thyroid Health with Healthcare Providers Dr Hedaya (17:02) I mean in other words, given what we’ve talked about, how should they approach their doctor basically? Bill Gasiamis (17:07) Yeah. Dr Hedaya (17:08) I guess I would say go to AI, get a list of the symptoms of low thyroid or high thyroid or all of them, check them off. So then when you go to the doctor you have a list, check your temperature, check your pulse, although the doctor will should check that. And then you could say, look, I have these symptoms, or maybe you don’t have any. But if you do, you have these symptoms, and clearly thyroid hormone levels can affect the brain. And I’d like a TSH, a free T4, a free T3, and a reverse T3. That’s it. And if they Bill Gasiamis (17:45) Okay, perfect. Dr Hedaya (17:46) say, no, no, we don’t need to do that, you know, a lot of times what they do, they’ll just do a TSH. Or they won’t do the reverse T3. They don’t, unfortunately, look at the thyroid gland in a dynamic way. They say, the TSH is fine. If your thyroid was low, your TSH would go high. We don’t need to do the rest. But that’s not true. That’s not true at all. Because especially if you had a stroke, your pituitary function may be compromised. Your TSH may be fine or low and your low thyroid. As matter of fact, in the last interview, the case that I talked about, who referred me to you, she actually had a low TSH, but she had a very low, I think it was a free T4. Or free T3 or both, whatever it was, but she had too little thyroid hormone, and her pituitary couldn’t respond because of the stroke. Bill Gasiamis (18:37) understood. So that’s a great list of Dr Hedaya (18:37) So so be you have to be dogmatic and you say to the doctor, look Even put into even put into AI and say, look, if the doctor comes back to me and argues against these tests, what should I say? You gotta be prepared because the doctor will steamroll you. You know, that they only allow this, they only allow that, I’ll only do the free T4. Well, that doesn’t tell you how much has been converted to T3, free T3, and it doesn’t tell you, even if the free T3 is normal, that doesn’t mean you’re not overproducing thyroid and and dis you know, and neutralizing it with the reverse T three. So, you know I mean I I mean I think it’s s so important that a thorough look is is really important. If you have the symptoms, you know. Bill Gasiamis (19:22) I agree with you. That list of to-dos, I’m gonna put that on the show notes. People can go and get that list if they don’t wanna go into AI themselves or they haven’t got the time or whatever. They can just download it from there. And then they’ll be able to take that and begin a conversation with their general practitioner. What’s interesting is that I’m in Australia, you’re in the United States. My general practitioner is pushed back when a… when a patient will turn up and say, I have these tests? They’ll say, well, no, you don’t have any condition that is obvious that you need these tests. So it’s not covered. So you don’t need to do it. So my next suggestion to them is no problem. Order the tests and I’ll pay for them. Now it’s not ideal, but if you’re not going to do them for me and I need to know, cause it’s my health, I’m going to pay for them. So just tell me how much it is and I’ll find a way and I’ll make it happen and I’ll pay for it. So that’s another option. Dr Hedaya (20:17) Yeah. But if you go in with your symptom list, right, and you say, Well, that’s not true, because these are the symptoms, you know, that I have, here they are, right here. You can take a look, you know. And then the last thing I’ll say, this gets even more tricky, is the reference range, I’m sure in Australia, but certainly in the United States, the reference range basically is of the TSH, the pituitary home. Is 0.5 to 4.5, meaning you anywhere in that range and your TSH is normal. That is a bad reference range. And I know it to be a fact because I I I guess I won’t waste your time with it, but I did a study on a hundred people and with a very sensitive thyroid test called a TRH stimulation test. and I was able I hired a statistician to calculate this. And say, well, I don’t want to keep doing this test on everybody. What TSH predicts an abnormal TRH stimulation test? And he came back and said to me, Well, once the TSH is over 1.4, it starts to increase your odds of having an abnormal TRH stimulation. So I said, okay, so 1.4 TSH is my cutoff, right? That’s in my mind. I said, okay, that’s that’s my cutoff, that’s when I get suspicious. Later, several years later, a paper came out, a large, large study, called the NHANES Study, Nurses Health, and I’m not sure what it stands for. Thousands of people followed over many, many years, over decades, and they found the mean TSH in the US population is 1.4. So, right where I what right where my study found. So that means statistically, it is not. impossible to have the upper limit of the reference range being at four point five because statistically the upper limit is never more than two standard deviations. So even if your standard deviation is 1.4, which it can’t be, you you’re not going to reach 4.5, right? Unless you have a it’s called a bimodal distribution curve. If you have that, then you’d say, well, it it could be. But we don’t have that with thyroid. So that reference range is wrong. The upper limit of the reference range should be 2.5. And about half the endocrinologists in the United States believe that. And half say, no, no, no, don’t change it. So that’s another sticky point because, you know, easily people get a result and they’ll go to the doc and say, no, the reference range is 4.5. You’re normal. Then you could say, well, look, I have these symptoms, and they could do a literature search. What’s the normal reference point? What in in the N A N HANES N-H-A-N-E-S study? It’ll show you 1.4. and you could take be prepared to go to the doctor and say, Well, here’s a study that suggests that the reference range may be incorrect. and I have symptoms by the way. We don’t treat the lab, we treat the person. So could we give a trial? Just a trial, there’s no harm done, you know, trial. Let’s see let’s start at a very low dose. Let’s see how I feel. Maybe I’ll get better. I’ll come back in a month. Bill Gasiamis (23:45) Yeah, I love that. It’s really good advice, especially coming from someone who is a doctor who think is thinking on the same way as me, for example, the patient. Because that’s like a match made in heaven. And that’s so rare to be able to get that. Often, my challenge to my general practitioner was well, the reference range isn’t that average of a sick population, because it’s usually a sick population that comes to see you to get bloods. It’s It’s not the most healthiest people that come to see you to get bloods. And that’s kind of how I try to like start the conversation of convincing a general practitioner to do a test that they’re reluctant to do. And when I say they’re reluctant, I’m not in there every day. I’m not in there every week. And I’m not putting stress on the system to an extent where I’ve been over using the system. I’m not at all. in there once, twice a year, maybe, you so if I’m in once, twice a year, well, then, I’m not mucking around. Like I’ve come there to investigate something that I’m suspecting is wrong with me. It’s my body. I’m feeling something. had a bit of a look online. This is what I suspect. Don’t try and convince me out of my thinking or my instinct more better. Why don’t we just, work together to get to the bottom of it. If it is something it is, if it’s not, it’s not, and that’s okay. Not a big deal. I’m better to know. then not no, I think, you know, it’s better to be safe than sorry in my mind. Dr Hedaya (25:16) Yeah. I would I would only think only correction I would make is the reference ranges generally are made on normal populations. Now now the thing is who’s normal anymore? Number one. Number two, that’s a statistical norm that doesn’t tell you anything about your genetics. your vulnerabilities, it’s not an individualized statistic. I mean it’s it not an individualized thing. What’s your normal range? And are you out of your normal range? Nobody can answer that, right? Unless you had previous data before you were ill. And you say, well look, I’ve been running at a 1.1 for five years or 10 years and now I’m at 3.2. That’s a big change. Well, you know you’re stressed. Well yeah maybe but here are my symptoms. Always come back to your symptoms. Bill Gasiamis (26:11) Got it, got it. Dr Hedaya (26:12) No. Bill Gasiamis (26:13) You use the word stress just now and my general practitioner says, I might go in and some bloods might be out of whack or some things might be not feeling great. And he’ll say, are you stressed? And I’m like, well, I’m not stressed. like, I’m not stressed in any way that I can say is worse than normal. For example, I’m Dr Hedaya (26:35) Mm-hmm. Bill Gasiamis (26:36) just, you know, I’m attending to my clients at work. picking up the kids from school, I’m, you know, making sure the bills are paid. Like I’m just doing the normal things that I always Dr Hedaya (26:48) Right. Bill Gasiamis (26:48) do, which tend to be stressful. And somehow when we talk about stress, cortisol seems to come into the conversation. Dr Hedaya (26:57) Mm-hmm. The Role of Stress and Cortisol Bill Gasiamis (26:58) And I don’t know how to respond to a general practitioner who says to me, am I stressed? Because I’m not experiencing something extreme or dramatic. in the months before I came to see him. So can we have a conversation a little bit about stress, cortisol, what is stress, what is cortisol, are they linked? Tell me about that, give me your thoughts. Dr Hedaya (27:21) Okay. Okay, so this is a multi-layer system. Okay, it starts with your perception and your of a situation and the story you tell about you the story you tell yourself about the the situation and your need for control of a situation and as opposed to saying I’m in the flow of the universe and All right, this is you know, this is the way it is, and I’ll adapt to it. Not so easy by the way, but it’s a much healthier way because most things will not stress you. Now, pain, let’s say you stepped on a nail, you’re gonna have stress, okay? Totally stressful, etc. But there’s a a difference between pain and suffering. Most of our problem is suffering. Suffering is a result of thinking patterns. perspectives of yourself and the world and the future and blah blah blah. I could talk about that for a long time. And that is probably one of the most important places to intervene and to train yourself, etc. Now, once this thing is registered as stress, it goes through back to the hypothalamus and the pituitary where all those hormones are controlled, the hypothalamus and pituitary in the brain, now you’ve God forbid, you’ve had a stroke. Those things may be affected, therefore, those systems may not be working well. In that case, you may not be able to handle stresses that you used to handle. You may not you may not have those shock absorbers. So, how do you measure this? I think the way you measure it again are symptoms, and typically it would be low cortisol and low DHA, d DHEA, and low pregnenolone. And the symptoms would be a lot of fatigue, right? Maybe poor wound healing, muscle aches, body pains, getting sick more easily, cognitive slowing, depression, anxiety, extreme exhaustion, salt cravings, in unstable temperatures, you know, I would say yeah You know, th loss of appetite in severe cases, you know, dizziness on standing. Okay. So those are the low adrenal output things. Now how d how do you measure and again, you think you have a problem, go to an AI thing, make that list, check it off, whatever applies, and you know, work yourself up symptomatically and then ask well, okay, what what are the best tests here? What are the best test. Now the way I test it is I get morning I got a morning like eight to nine a.m fasting ACTH and cortisol. It’s gotta be in the morning around between eight and nine a.m. fasting. I also at the same time get a D, like David, H E A and a D H E A sulfate, and then I also get a pregnenolone. And if I think there’s any kind of sex hormone problem that I want to check, then I will check a free testosterone, FSH, LH, and The testosterone measures the free testosterone is very unreliable. So if it comes out low, you want to do it two more times to double check that. But the other measures are pretty reliable. And then you’ll you’ll know the other thing you can do is you could do something called a Dutch test, which is a urine test that’ll look at your cortisol through the day, or an adrenal saliva test. It’s ASI, alleval adrenal saliva index, the Dutch test. or the ASI, both good tests. and those will tell you what’s going on through the day. Like if you’re not sleeping, it could be because your cortisol high at night, you know. Wake up horrible or in pain. Could be because your cortisol is really low in the morning. Really low. You can’t even get out of bed, you know, can’t get going, right? So these are all all things that you can do to measure and then you can replace these hormones and That’s one thing to do. The other thing to do is to work on how you manage stress. There are millions of ways of doing that, right? From meditation to heart math to Bill Gasiamis (32:05) Mm-hmm. Dr Hedaya (32:06) yoga to you know, there’s just a lot a lot a lot of ways to Bill Gasiamis (32:10) Yeah, let’s go back for a moment and talk about testosterone because when I hear testosterone, I’m hearing you say to a male that I need to have testosterone in my body and at certain levels, et cetera. And sometimes it can fall out of whack and you need to get it tested. I had mine tested recently. It’s all good. But women also need testosterone. Tell me about that. Dr Hedaya (32:35) Yeah, so I was I was thinking of both male and female when I said it, Bill Gasiamis (32:38) Yeah. Dr Hedaya (32:39) because it’s it’s you know, women who are postmenopausal can have it’s much more common to have a low free testosterone loss of libido, you know. testosterone the studies which I’ve reviewed a few times, you know, there’s a debate does it affect the mind, the brain, you know. It seems to have an effect on well being, on vitality muscles, sex drive obviously, libido erectile function, brain cognitive function, some mood effects, etc. So I I think it’s important now i it it has to be managed in women as well as men. You know, in in women testosterone is a step on the way to estrogen as it is in men, right? And in the metabolism, right? So it it should certainly be assessed in everybody. Bill Gasiamis (33:39) Yeah. And estrogen, mentioned estrogen. Now, one of them in my mind, it seems to be more associated again to women, estrogen, especially. And, and then men also have estrogen, need estrogen. Dr Hedaya (33:55) Men also have estrogen. I haven’t studied it so I couldn’t tell you, but I imagine it’s doing something. it probably turns men into better leaders after they’re fifty, is my guess. Let Bill Gasiamis (34:08) more emotionally intelligent. Dr Hedaya (34:10) more emotionally intelligent, less testosterone, you know. You know, I I I Bill Gasiamis (34:15) You know what? That’s a good theory. We’ll run with that for now. I might relate to that, know, who knows. Dr Hedaya (34:22) Yeah. I I think Bill Gasiamis (34:24) Awesome, awesome, so… Dr Hedaya (34:24) Yeah, so w for for women on estrogen, it depends, you know, who are you assessing? Are you that’s a whole complex subject, you know. Is it a young woman who’s menstruating? Does she have premature ovarian failure, endometriosis, ovarian cysts, insulin resistance, they all kind of travel together, methylation problems, they travel together. is it someone who’s perimenopausal where she’s starting to lose progesterone and getting a lot of PMS? That’s pretty easy. You can replace the progesterone. Is it postmenopausal a woman who’s just kinda lost the estrogen, lost the progesterone? You know, if there’s a family history of cognitive decline or dementia or something like that, there’s great evidence that transdermal estrogen and some oral progesterone bio bioidentic, not synthetic, is great and reduces the risk for lots of disorders later in life for women. You know. So there’s a whole you know, there’s a whole way of working all that up, depending on who who you’re looking at. But very important. Now so the let me Bill Gasiamis (35:31) Yeah, I love it. Yeah. Dr Hedaya (35:34) say this. The important thing here, and this is maybe the most important thing. Someone’s had a stroke, they’re obviously tremendously stressed. You have to look at all the hormones. You can’t the brain is a hormonal organ. It’s an immune organ. It’s a neurological organ. I used to teach psycho, neuro, immuno, and the chronology at Georgetown for a number of years. Okay? And the brain and hormones, you can’t separate it. So if the brain is under stress, the hormonal axes are under stress, and there’s not one hormonal axis when it’s abnormal that cannot cause neurological or psychiatric problems. Okay? So you must, as part of the work of anyone who’s had stroke. You must look at the endocrine, the hormonal axis. You know, you must look at it. Why? Because if you’re trying to recover from a stroke and you don’t have adequate hormones, it’s gonna be much, much harder. Much, much harder. Right? But Bill Gasiamis (36:37) Peace. Dr Hedaya (36:38) if you have if you have the the hormones at good levels, okay, now the the brain has that. If it has its nutrients, it has that, you know, okay, now it can do something, you know. What happens, think about it this way. What happens in adolescence? The brain is being rewired, the body’s growing, brain is rew being rewired. Where are the hormones? The hormones are skyrocketing. They’re necessary for the rewiring. You had a stroke, you’re trying to rewire brain, you gotta have adequate hormones. Bill Gasiamis (37:10) I love it. This is the thing that people miss. You know, we talk about the gap in stroke recovery. Acute phase gets handled Dr Hedaya (37:19) That’s Bill Gasiamis (37:19) 99 % of the time really well. People get patched up and they get sent home in some kind of alive state, whether they are fully functional Dr Hedaya (37:27) Yeah. Bill Gasiamis (37:28) or working towards it or whether they are less functional and working towards being more functional, like some kind of stage Dr Hedaya (37:35) Mm-hmm. Bill Gasiamis (37:36) of you’re alive and you’re good enough to go home. And then there’s no information after that. So how do we assess address? How, what do we know? What do we not know that we need to know? And this is kind of what this conversation is, right? It’s like, okay, here’s Dr Hedaya (37:53) Yeah. Bill Gasiamis (37:53) a whole bunch of things we’ve just discussed. There might have been things that you heard for the first time. Don’t let that, get in the way of your curiosity and investigate the thing that pricked your ears up, whether it was a symptom that Dr. Hedaya mentioned and just do a little bit more work in understanding what that is, take that to your general practitioner and begin the conversation of taking responsibility for your recovery. And in my mind, like there’s gotta be like a foundational thing that people can do to intervene that doesn’t cost most of the time anything extra. And that helps encourage and nourish the brain in overcoming these challenges, but then has the a cascade effect of having the same positive outcome on all the other organs and hormones. And that to me is nutrition. So like, if you’re, if you would suggest to somebody how they might start thinking about their nutrition as opposed to what they might have been doing before stroke, how do you begin that conversation? And what are the two or three fundamental things that they need to consider? about nutrition. Nutrition’s Impact on Brain Recovery Dr Hedaya (39:11) Okay, so If it doesn’t grow that way, don’t eat it. I never saw a bread tree. I didn’t see an ice cream tree or a Twinkie tree. Okay. So if it doesn’t grow that way, don’t eat it. Balance your plate. Balance your plate. And actually our coach, Caroline Hade, is putting out an ebook. I don’t know, should be out at a week or two or three weeks. It’s like, I don’t know, four or five dollars or something. and that will tell you exactly how to balance your plate. and then I would say very important to have three meals and maybe, depending on your how insulin resistant you are, maybe additionally two snacks. and per day, but keep your calories you don’t want to be overweight, okay, because if you’re overweight, you know, that’s a That’s its own risk factor for brain problems, right? but you can’t lose weight in a day, you’re stressed, you’re hungry, you’re tired, you eat the carbs, you know, everybody struggles with that. But that that is one of the biggest enemies of eating eating eating these processed carbs that we all love is one of the biggest enemies of your health. One of the biggest enemies of your health for sure. Bill Gasiamis (40:35) Okay, there are some great resources that people can again look into how to eat to heal the brain. And we didn’t have to have a deep conversation about that. But I love Dr Hedaya (40:45) Mm-hmm. Bill Gasiamis (40:45) what you said about balancing the plate. And if it didn’t grow that way, don’t eat it. It’s such a simple thing. If it comes in a packet on a shelf in a supermarket with all fancy pictures Dr Hedaya (40:59) Yeah. Bill Gasiamis (41:00) and stickers and a list of ingredients, like it’s probably not nutritional. of food. It’s probably something that’s going to make inflammation worse. It’s probably something that’s going to give you the type of energy that is not helpful. It’s probably going to have a whole bunch of other things. And that’s kind of my approach to healing and recovering my brain. It’s one of the first things I did was just look at my nutrition, immediately stop smoking and drinking. mean, I know it should go without saying, but sometimes you have to have a stroke for it to actually sink in and make sense. and don’t have any alcohol at all. I’m talking about forever if you can, but I didn’t have alcohol Dr Hedaya (41:46) Yeah. Bill Gasiamis (41:47) for at least the first four or five years. And now in the next five years or so, maybe I had one glass per year, just because I was, in an event where it was, everyone was drinking and it was almost necessary to have sip or half a sip or act as if I was drinking. So with that, I think we’ll wrap up this conversation today. There’s been a lot for people to digest, go back and listen to it a second time. And a third time that we have some resources in the show notes. And Dr. Hedaya, thank you for joining me again. And I look forward to our conversation that’s coming up in a few weeks time where we’re going to talk about toxin load and neuroplasticity. Dr Hedaya (42:29) Beautiful. Thanks so much for the opportunity, Bill. I hope I hope people get something out of this and they pursue what they need to pursue. Bill Gasiamis (42:36) Well, that’s a wrap on this conversation with Dr. Robert Hedeya. If there’s one thing to take from today’s interview, it is this. The brain is a hormonal organ and recovery isn’t just about the brain healing in isolation. Thyroid, cortisol, testosterone, estrogen, all of it is connected, and all of it is worth checking if your recovery has plateaued in ways that don’t quite make sense. Dr. Hadea’s free PNIE questionnaire is linked in the show notes. Download it, work through it, and take it with you to your next GP visit. If you want to go deeper on the thyroid piece specifically, go back and listen to the earlier episode with Dr. Elena Zinkov on stroke fatigue and thyroid. And if you missed it, the first conversation with Dr. Hedeya on photobiomodulation is a great companion to this one. if this episode has helped you, share it with someone who needs to hear it. That’s genuinely the best way to help this show reach more survivors. My book, The Unexpected Way That a Stroke Became the Best Thing That Happened, is available at recoveryafterstroke.com/book. And if you’d like to support the show financially, you can do so at Patreon by going to patreon.com/recoveryafterstroke. Until next time, take care of yourself and don’t assume it’s just a stroke. The post Hormones, Fatigue, and the Brain: Dr. Robert Hedaya Returns appeared first on Recovery After Stroke.

Your thyroid does not make one hormone. It makes five. Your last panel probably only tested one. That gap is exactly why I brought Dr. Amie Hornaman onto the show. In this episode of theMedical Disruptor, she shares her own thyroid story, including the 25 pounds that showed up in a matter of weeks and the seven different doctors she saw before anyone gave her an answer. From there we get into why testing TSH and T4 alone misses so much, what a full thyroid panel should actually include, and why she believes most people need more than T4 only medication like Synthroid to feel like themselves again. We break down reverse T3 and what it means when it is elevated, then go into T2, a thyroid hormone that is not T3 or T4, has decades of research behind it, and may play a real role in metabolism and fat burning. We close with what to actually ask for at your next appointment so a normal result is not the end of the conversation. As always, this is a free conversation with a vetted, board certified clinician, no products and no upsells, just information you can take straight into your next appointment. This is how we address medical gaslighting directly, by giving you the language and the data to advocate for your own thyroid health. You are not fine. You are just not sick enough yet. Want more practical health tips? Join my newsletter! https://freechapter.lpages.co/newsletter-opt-in/ "Fine" isn't the same as well. Stop waiting to collapse before someone listens. Build your case https://freechapter.lpages.co/how-to-build-a-case-for-yourself/ Check us out on social media: https://www.instagram.com/drefratlamandre https://www.facebook.com/drefratlamandre https://www.tiktok.com/@drefratlamandre #functionalmedicine #drefratlamandre #medicaldisruptor #NPwithaPHD #nursepractitioner #medicalgaslighting Chapters 0:00 - Introduction 3:22 - Amie's 25-Pound Mystery & 7 Doctors 7:27 - Why TSH & T4 Alone Aren't Enough 19:55 - T2: The Forgotten Thyroid Hormone 28:08 - How to Stop Getting Dismissed 33:21 - "You're Just a DC, Not an MD" Guest Links: FB: https://www.facebook.com/groups/dramie IG: https://www.instagram.com/dramiehornaman/ YT: https://www.youtube.com/dramiehornaman Website: dramiehornaman.com Learn more about your ad choices. Visit megaphone.fm/adchoices

Mark Saxton, CEO of Baird Medical, highlights their microwave ablation technology, which is being used to address a significant treatment gap for benign thyroid nodules. This minimally invasive approach is an alternative to radiofrequency ablation, accommodates patients with pacemakers or other cardiac devices, and provides faster recovery. Unlike surgery, microwave ablation preserves thyroid function, eliminating the need for ongoing hormone replacement therapy Mark explains, "It's very interesting that we're focused on thyroid tumors because they're an extremely prevalent issue. Most of those tumors are benign, and for many of those patients, active surveillance, or what we call watchful waiting, is appropriate. But a portion of those may need more than that. Their nodules are growing, they're becoming symptomatic either cosmetically or they're compressing on their throat, and that becomes extremely bothersome for them."   "A minimally invasive option, like a microwave, may be more appropriate for those patients than a surgery would be. The bottom line is there's still a huge gap between diagnosis and treatment, and that's an exciting problem for us to want to solve." "So surgery is extremely safe and very appropriate in many patients, but there is a scar, it's a surgery, you're under general anesthetic. The other thing that surgery does is if we do a thyroidectomy, we may be destroying the thyroid's ability, obviously, then to provide the hormones, T3 and T4, that regulate some of our metabolism. So with the microwave, we just destroy the nodule. We don't impact thyroid function in that way, so patients don't need that hormone replacement. So that's another great reason to move forward with something more minimally invasive." #BairdMedical #MicrowaveAblation #ThyroidMWA #MWA #ThyroidCare #ThyroidNodules #MinimallyInvasive #InterventionalEndocrinology #Endocrinology #PatientCare #MedicalDevices BairdMed.com Listen to the podcast here

Mark Saxton, CEO of Baird Medical, highlights their microwave ablation technology, which is being used to address a significant treatment gap for benign thyroid nodules. This minimally invasive approach is an alternative to radiofrequency ablation, accommodates patients with pacemakers or other cardiac devices, and provides faster recovery. Unlike surgery, microwave ablation preserves thyroid function, eliminating the need for ongoing hormone replacement therapy Mark explains, "It's very interesting that we're focused on thyroid tumors because they're an extremely prevalent issue. Most of those tumors are benign, and for many of those patients, active surveillance, or what we call watchful waiting, is appropriate. But a portion of those may need more than that. Their nodules are growing, they're becoming symptomatic either cosmetically or they're compressing on their throat, and that becomes extremely bothersome for them."   "A minimally invasive option, like a microwave, may be more appropriate for those patients than a surgery would be. The bottom line is there's still a huge gap between diagnosis and treatment, and that's an exciting problem for us to want to solve." "So surgery is extremely safe and very appropriate in many patients, but there is a scar, it's a surgery, you're under general anesthetic. The other thing that surgery does is if we do a thyroidectomy, we may be destroying the thyroid's ability, obviously, then to provide the hormones, T3 and T4, that regulate some of our metabolism. So with the microwave, we just destroy the nodule. We don't impact thyroid function in that way, so patients don't need that hormone replacement. So that's another great reason to move forward with something more minimally invasive." #BairdMedical #MicrowaveAblation #ThyroidMWA #MWA #ThyroidCare #ThyroidNodules #MinimallyInvasive #InterventionalEndocrinology #Endocrinology #PatientCare #MedicalDevices BairdMed.com Download the transcript here

Is it safe to stop statins “cold turkey”? Can the supplement ingredient HMB counteract age-related muscle loss? Researchers may have discovered the key to development of a true fat-burning weight loss medication; Can a mammogram yield clues about cardiovascular risk? Their bottom line threatened by GLP-1 weight loss drugs, BIg Food tweaks portion sizes, adds spices and flavorings to pique blunted appetites; Vitamins A & D may improve lung health for asthma sufferers; When it comes to thyroid medication prescribing, treat the numbers or treat the patient? 

What Your TSH Number Isn't Telling You ft. Dr. Brittany Henderson Your TSH can look "perfectly normal" and you can still feel exhausted, foggy, cold, and stuck at a weight that won't budge. In this episode of the Medical Disruptor, I sit down with thyroid specialist Dr. Brittany Henderson to find out why. Dr. Henderson is fellowship-trained at Duke, ran thyroid programs at two major academic centers, and now runs her own thyroid-only practice, the Charleston Thyroid Center. She told me flat out that TSH alone is not enough, and that most doctors don't even know how to read a full thyroid panel. In this conversation we get into why TSH is actually a pituitary hormone, not a thyroid hormone, and why the "normal" TSH reference range was built on flawed population data that included undiagnosed Hashimoto's patients. I ask her what free T4, free T3, and reverse T3 actually reveal that TSH can't, and she walks me through why muscle mass is the missing piece in thyroid hormone conversion, since it's muscle tissue that activates T4 into usable T3. She also explains why up to 95% of people with severe Hashimoto's or a thyroidectomy may need combination T4/T3 therapy instead of T4 alone, and we break down the real differences between levothyroxine, desiccated thyroid extract, and combination treatment. We talk about patients who've been on the wrong thyroid medication for decades and what happens when it's finally corrected, plus the flip side: patients who never needed thyroid medication in the first place and how to tell the difference. Along the way we cover how birth control, inflammation, steroids, and menopause quietly throw off your thyroid labs without anyone telling you. If you've ever been told your thyroid is fine while your body is telling you otherwise, this episode gives you the exact labs to ask for and the language to ask for them. Want more practical health tips? Join my newsletter! https://freechapter.lpages.co/newsletter-opt-in/ Still second guessing yourself in the exam room? Click here! https://freechapter.lpages.co/self-gaslighting-habits-to-watch-for/ Check us out on social media: https://www.instagram.com/drefratlamandre https://www.facebook.com/drefratlamandre https://www.tiktok.com/@drefratlamandre #functionalmedicine #drefratlamandre #medicaldisruptor #NPwithaPHD #nursepractitioner #medicalgaslighting Chapters 0:00 - Introduction 2:10 - From Duke-Trained Endocrinologist to Questioning the Standard of Care 12:38 - Why TSH Alone Is Not Enough 23:16 - Combination Therapy and the Muscle Mass Connection 25:17 - Desiccated Thyroid Extract: History and Misconceptions 35:19 - Pushback, Broken Guidelines, and Where to Find Dr. Henderson Guest Links: FB: https://www.facebook.com/DrHendersonMD/ IG: https://www.instagram.com/mythyroiddoctor/ Website:charlestonthyroidcenter.com | mythyroiddoctor.com | thethyroidfoundation.org Learn more about your ad choices. Visit megaphone.fm/adchoices

In this empowering episode, Dr. Fiona Lovely welcomes nurse practitioner Shelby Sheppard, a trusted hormone and sexual health expert who has been caring for Dr. Lovely's own patients for years. Shelby's journey from labor and delivery RN to founding Pause Health reflects her deep commitment to offering women the time, space, and personalized care they deserve—something that simply cannot happen in the standard medical seven-minute appointment. The conversation opens with the remarkable story of how Shelby helped a patient navigate postpartum depression using supplemental progesterone, challenging conventional medical dogma. They then dive into the blind spots of thyroid care, explaining why TSH alone is an unreliable marker and why T4-only medications often leave women feeling unwell. Shelby shares her philosophy of offering patients a menu of options rather than a one-size-fits-all approach. They explore the newly renamed PMOS (Polyendocrine Metabolic Ovarian Syndrome) from PCOS, the underutilized role of testosterone in women's health, and the profound impact of GLP-1 medications on metabolic health and mental well-being.  The episode also addresses sexual health, pleasure anatomy, and why women deserve to feel plugged back in—not just for sex, but for life. Together, they talk about: Why progesterone can be a game-changer for postpartum mood support as well as perimenopausal sleep disturbances, anxiety and others. The limitations of TSH testing for thyroid and why free T3 and reverse T3 matter. How GLP-1s combined with hormone therapy offer superior metabolic results. Testosterone's role in motivation, confidence, and overall vitality. Practical tips for navigating libido changes and communicating with partners. Tune in to learn why women's health is not a one-size-fits-all prescription—and how to become your own best advocate. Connect with Shelby: Website: www.pausehealth.ca Instagram: https://www.instagram.com/pause_health   Thank you to our sponsors for this episode:

In this episode, I dig into one of the most frustrating things I see women struggle with: being told their thyroid is "fine" based on a single number, while they're still dealing with fatigue, weight gain, hair thinning, brain fog, and feeling cold all the time. Here's what I want you to take away: TSH isn't a full thyroid test. It's just a signal from your brain to your thyroid—not a measurement of what your body is actually producing or whether your cells can use it. The "normal" range is so wide you could drive a Mack truck through it. Normal doesn't mean optimal. The numbers I actually look at: Free T3 – the active hormone your cells actually use. It's the one that matters most and almost never gets tested. You can have plenty of T4 (the storage form) and still feel awful if you're not converting it. Reverse T3 – I think of this as the brake pedal that stress slams on. It's a mirror-image molecule (like your left hand vs. your right) that parks in your receptors and blocks the active hormone from getting in. Chronic stress, low iron, illness, crash dieting, and inflammation all push your body to make more of it. TPO and TG antibodies – these can rise 7 to 10 years before your TSH ever moves. Catching Hashimoto's early gives you a window to address the root drivers. It's never just one thing. Your thyroid gets ambushed—inflammation, stress, nutrient deficiencies, gut issues—all stacked and compounded over time. This is especially true in perimenopause, when rising cortisol, falling ferritin from heavy periods, and lower stomach acid all converge. That's why so many women hit a thyroid crash in their 40s. A real story from my own life: I went in for a checkup and asked to have my antibodies retested (I have a history of Hashimoto's). My doctor physically couldn't add the lab to my file because the system only allows it once—even though my previous result was out of range. This isn't about one bad doctor; the system isn't built to support you. I now have to order my own labs through an outside lab. What your body needs to convert T4 to T3: selenium, zinc, iron, and a calm nervous system. These nutrients are commonly depleted in women, especially with a history of oral birth control. And food is the most bioavailable source—so variety matters. Eating the same meal-prepped chicken and broccoli every week can leave you deficient. A word on supplements: more isn't better. I recently had to remove several supplements from a client's routine because they were overloading her with B vitamins and depleting her minerals. Expensive and fancy doesn't mean right for your body. My bottom line: You have to be the driver of your own health. Look back through your old labs right now and check whether your antibodies and Free T3 have ever been tested. If you've been struggling for six months or more, take action. Your body has an incredible ability to heal when we test properly, look at the whole picture, and give it the right things at the right time. If you need help figuring out your next steps, the link to schedule a strategy call with my team is in the show notes. You're not too far gone—you're closer now than you were before you knew this!

Many people are told their elevated cholesterol and LDL levels are simply the result of diet, lack of exercise, or genetics. But what if rising cholesterol is actually a clue that thyroid physiology is slowing down? In this episode of the Thyroid Answers Podcast, Dr. Eric Balcavage explains the important relationship between thyroid signaling, T4 to T3 conversion, cellular metabolism, liver function, bile production, and cholesterol regulation. He discusses why cholesterol is essential for health, how the body produces and uses it, and why elevated cholesterol may be a sign that the body is struggling to convert food energy into cellular energy efficiently. Dr. Balcavage breaks down several mechanisms by which reduced thyroid signaling may contribute to elevated cholesterol and LDL levels, including decreased T4 to T3 conversion, impaired cholesterol transport, reduced LDL receptor activity, diminished bile production, and impaired bile flow. He also explains why simply lowering cholesterol with medication may not address the underlying physiologic stressors driving these changes. If you've been told your cholesterol is high despite eating well, exercising regularly, and doing all the "right" things, this episode explores why it may be time to look deeper at thyroid physiology, cellular metabolism, inflammation, liver function, and the body's adaptive stress response. In This Episode, You'll Learn: Why cholesterol is essential for hormone production, cell membranes, vitamin D production, brain health, and bile formation How reduced T4 to T3 conversion can contribute to elevated cholesterol and LDL levels The critical role T3 plays in liver function, cholesterol transport, and bile production Why cholesterol may rise even when diet and exercise habits are healthy How impaired bile flow and gallbladder function can affect cholesterol clearance Why elevated cholesterol may be a sign of reduced thyroid signaling rather than simply a dietary problem The lab markers Dr. Balcavage uses to assess thyroid physiology, inflammation, metabolism, and cholesterol regulation Why addressing cellular stress and adaptive physiology is often more important than simply lowering cholesterol numbers Resources Mentioned:

SVP and Stanford Steve are back to recap all the storylines coming from Wyndham Clark's US Open win at Shinnecock. In his second US Open victory, the jeering and groans were louder than the applause. Why was that? Is it fair? And how the crowd's response to Wyndham's play was so rare and unlike anything SVP has seen. Scottie Scheffler was in the mix for a career slam on his birthday and Father's Day, but several putts barely missed the cup leading to a T4 for the top player in the world. Sam Burns was in the mix once again but came up short, as three crucial putts didn't fall as Burns looked to finish a phenomenal final round. Finally, a word on Cashmere Ketih's historic weekend and viral moment. The NBA Draft is coming up. Is AJ Dybantsa the pick? And a conversation on Dusty May taking the Mavs job and the ripple effects it could have. Additionally, plenty of World Cup thoughts including the seemingly ever-changing nature of country names along with skepticism surrounding viral social media accounts. And of course, a Father's Day recap with swim stories, plus the future of SportsCenter. | SVPod Time Codes/Topics (0:00) Intro (5:17) Reaction to Wyndham Clark's US Open victory (22:22) On Sam Burns' 2nd place finish (29:27) Cashmere crushed (34:32) Final US Open thoughts (37:44) Shoutout Golf Channel gang (41:50) Who should the Wizards take? (43:57) NBA Draft storylines + Giannis (45:22) Reaction to Dusty May taking Mavs job (50:52) World Cup thoughts (1:00:06) What's with country names changing? (1:01:23) Swim season accomplishments (1:03:00) Vacation loading + SportsCenter future thoughts (1:09:50) Father's Day recap (1:15:45) Thanks for watching Learn more about your ad choices. Visit podcastchoices.com/adchoices

Have you ever been told your labs are "normal"—but you still feel exhausted, gain weight despite doing everything right, struggle with brain fog, poor sleep, low motivation, or simply don't feel like yourself? In this eye-opening episode of The Girlfriend Doctor Show, Dr. Anna Cabeca sits down with endocrinologist and women's health expert Dr. Shamita Trivedi to uncover why "normal" lab results don't always mean optimal health. With nearly 20 years of experience in endocrinology and hormone health, Dr. Trivedi shares how she blends evidence-based medicine with a personalized, integrative approach to help women navigate thyroid dysfunction, perimenopause, menopause, insulin resistance, metabolic health, and hormone optimization. Together, Dr. Anna and Dr. Trivedi discuss the growing epidemic of weight gain, fatigue, and metabolic dysfunction in midlife women—and why traditional medicine often misses the bigger picture. In this episode, you'll discover: • Why "normal" thyroid labs may still leave you feeling exhausted • The difference between normal ranges and optimal hormone levels • How perimenopause creates a state of neuroendocrine vulnerability • The truth about GLP-1 medications and when they're appropriate • Why hormone replacement should never be one-size-fits-all • The hidden connection between thyroid health, metabolism, and weight gain • How gut health, inflammation, and lifestyle impact every hormone system • What women with premature ovarian insufficiency need to know If you've ever felt dismissed, unheard, or told everything is fine when you know something isn't right, this conversation will empower you to advocate for your health and understand your body on a deeper level. Listen now and discover why optimal health starts beyond "normal."   Key Timestamps 00:00 – Why endocrinology plays a critical role in women's health and hormone optimization. 03:20 – Premature ovarian insufficiency: why early menopause can be devastating and what can be done. 09:15 – Birth control pills versus physiologic hormone replacement in young women. 16:00 – Perimenopause as a period of neuroendocrine and immunologic vulnerability. 22:45 – Why hormone therapy should always be individualized. 28:30 – Weight gain, cardiometabolic changes, and why women "catch up" to men in heart disease risk after menopause. 32:50 – The role of GLP-1 medications: benefits, risks, and common misconceptions. 40:40 – Gut health, inflammation, endocrine disruptors, and the root causes of metabolic dysfunction. 52:10 – Microdosing vs. standard dosing approaches for GLP-1 medications. 58:20 – Can you safely come off GLP-1 medications without regaining weight? 1:08:45 – The thyroid conversation: why so many women are told their labs are normal when they don't feel normal. 1:16:30 – T3, T4, thyroid antibodies, and finding the optimal thyroid range. 1:24:00 – A real patient case study: how hormone and thyroid optimization gave a woman her life back.   Memorable Quotes "I don't look at isolated symptoms. I look for the thread that's tying everything together." — Dr. Shamita Trivedi "This is not your body failing you. This is a normal transition that everybody goes through." — Dr. Shamita Trivedi "Menopause is normal and mandatory. Suffering is optional." — Dr. Anna Cabeca "Your body will tell us what it needs. Our job is to listen." — Dr. Shamita Trivedi "Normal lab values are not always optimal values." — Dr. Shamita Trivedi "We have to treat the woman in front of us—not the lab report." — Dr. Anna Cabeca   Connect With Dr. Shamita Trivedi Website: https://drshamitatrivedi.com Casad Health & Wellness: https://casadhealth.com Instagram: https://www.instagram.com/drtrivedi_hormonedoc   Connect With Dr. Anna Website: https://dranna.com Instagram: https://www.instagram.com/thegirlfrienddoctor/ YouTube: https://www.youtube.com/@thegirlfrienddoctor TikTok: https://www.tiktok.com/@drannacabeca Facebook: https://www.facebook.com/thegirlfrienddoctor

If you've ever been told your thyroid labs are "normal" but you still feel exhausted, cold, constipated, anxious, inflamed, or unable to lose weight, this episode is for you. In this episode of The Thyroid Answers Podcast, Dr. Eric Balcavage explores one of the most misunderstood concepts in thyroid care: the difference between a thyroid lab value being normal and being appropriate for your physiology. He explains why thyroid lab markers such as TSH, Free T4, Free T3, Reverse T3, and thyroid antibodies are often interpreted too simplistically and why normal lab values do not always mean healthy thyroid function. Dr. Balcavage breaks down how stress physiology, inflammation, immune activity, gut dysfunction, sleep disruption, nutrient deficiencies, and overall physiologic state can influence thyroid hormone production and T4-to-T3 conversion. He also explains why many thyroid patterns may actually represent adaptive responses rather than broken physiology. You'll learn how to interpret thyroid labs within the context of symptoms, health history, inflammatory markers, and overall physiologic state, and why focusing solely on optimizing lab values often fails to restore true health and well-being. Whether you're struggling with persistent hypothyroid symptoms despite normal labs or you're trying to better understand your thyroid physiology, this episode provides a deeper framework for understanding what your thyroid labs may really be telling you. In This Episode, You'll Learn: Why normal labs don't always equal healthy thyroid function How to determine if your thyroid labs are actually appropriate for your physiology The role stress, inflammation, and lifestyle factors play in thyroid hormone regulation Why low T3 and poor conversion may be adaptive responses Why thyroid medication doesn't always resolve symptoms What to focus on beyond lab values to support better thyroid health Resources Mentioned:

Why do so many people continue to struggle with thyroid symptoms, hormone imbalances, fatigue, weight gain, digestive issues, and poor health even when their lab work looks "normal"? In this episode of The Thyroid Answers Podcast, Dr. Eric Balcavage sits down with board-certified endocrinologist Dr. Cassie Smith to discuss her new book, Fix Your Gut, Fix Your Hormones, and the critical role gut physiology plays in hormone health. Dr. Smith shares her journey from traditional endocrinology to a more physiology-based approach after recognizing that many of her patients continued to get sicker despite receiving standard medical treatment. Together, they explore how gut health, chronic stress, inflammation, lifestyle factors, and cellular physiology influence hormone production, hormone metabolism, thyroid function, insulin regulation, estrogen balance, and overall health. The conversation highlights why optimizing lab values alone often fails to resolve symptoms and why addressing the underlying physiologic patterns affecting the body may be a more effective path toward lasting health improvements. In This Episode, You'll Learn: Why many patients continue to struggle despite "normal" lab results How gut health influences thyroid hormone conversion and utilization The connection between chronic stress, gut dysfunction, and hormone imbalance Why insulin resistance is often driven by more than just diet The role of the gut microbiome in estrogen metabolism and detoxification How inflammation can affect hormone signaling at the cellular level Why hormone replacement does not always resolve symptoms The importance of addressing lifestyle, sleep, stress, nutrition, and gut function alongside hormone optimization How chronic physiologic strain may contribute to ongoing thyroid and hormone symptoms Why understanding physiology may be more important than chasing lab numbers Key Topics Discussed Gut microbiome and hormone metabolism Thyroid physiology and T4 to T3 conversion Insulin resistance and metabolic dysfunction GLP-1 physiology Estrogen metabolism and the estrobolome Chronic stress and allostatic load Inflammation and cellular hormone signaling Leaky gut and immune activation Functional medicine and root-cause approaches Hormone replacement therapy considerations Lifestyle factors that influence hormone health About Dr. Cassie Smith Dr. Cassie Smith, MD is a dual board-certified endocrinologist, Founder of Modern Endocrine, and Chief Medical Officer of Renthyroid. She also serves on the medical faculty of Evexias Medical, a bioidentical hormone company. Dr. Smith is known for helping patients uncover why they still feel unwell despite "normal" lab results by using a holistic, root-cause approach to gut, metabolic, thyroid, and hormonal health. After completing her fellowship at the Harold Hamm Diabetes Center and being named a Top Doctor by 405 Magazine, Dr. Smith grew frustrated with the limitations of conventional care and built a model focused on treating the whole person—not just symptoms. She is the author of Fix Your Gut, Fix Your Hormones: The Critical Connection Your Doctor Is Missing… and Why You Still Feel Bad Despite Normal Labs, and through her popular podcast, Hormones, Metabolism, and You, she translates complex endocrinology into practical, actionable guidance. Today, Dr. Smith and her team help thousands of patients each year get to the root cause of gut health issues, hormone imbalances, thyroid disease, and weight resistance. She is licensed to provide telehealth and in-clinic care across 47 states, based in Oklahoma. She is the author of Fix Your Gut, Fix Your Hormones and host of the Hormones, Metabolism, and You podcast. Resources & Links

Calum Raistrick, Niall Darwin (onepunchnaz)APR Health Solutions Peptides: www.aprhealthsolutions.com - code nyleOptimize HRT Clinic: https://members.optimize-hp.com - code nyleMerch: https://www.aykons.com/nylePlease share this episode if you liked it. To support the podcast, the best cost-free way is to subscribe and please rate the podcast 5* wherever you find your podcasts. Thanks for watching.To be part of any Q&A, follow trensparentpodcast or nylenayga on instagram and watch for Q&A prompts on the story  https://www.instagram.com/trensparentpodcast/Huge Supplements (Protein, Pre, Defend Cycle Support, Utilize GDA, Vital, Astragalus, Citrus Bergamot): https://www.hugesupplements.com/discount/NYLESupport code 'nyle' 10% off - proceeds go towards upgrading content productionYoungLA Clothes: https://www.youngla.com/discount/nyleCode ‘nyle' to support the podcastLet's chat about the Podcast:Instagram: https://www.instagram.com/trensparentpodcast/TikTok: https://www.tiktok.com/@transparentpodcastPersonalized Bodybuilding Program:  https://www.nylenaygafitness.comRP Hypertrophy Training App: rpstrength.com/nyle (code nyle)0:00:00 - Intro0:02:04 - University Days & Naive PED Use0:05:03 - Gut Health & The 1.5g Protein Limit0:10:05 - Midsection Vacuum & Classic Weight Caps0:16:24 - The Real Cause of Waist Growth0:19:34 - Total Drug Load vs. Visceral Fat0:22:30 - Conditioning Secrets: Classic vs. Open0:28:28 - Niall's 12-Week Pittsburgh Prep Plan0:32:47 - Compound Tapering & Injection Risks0:35:02 - Extreme Prep Protocols: Martin & Boss0:40:57 - Systemic Stress & "Landing the Plane"0:43:12 - Blowing a Load the Night Before Show0:43:34 - John Meadows' "Grainy Skin" Secrets0:45:45 - Linear Peaking vs. Volatile Refeed Gauging0:48:45 - Strategic Atrophy & Leg Volume Slashes0:50:15 - Quad & Glute Volume Tiers0:52:08 - Tyler Smith's Extreme Leg Volume Slash0:53:19 - Peptide Protocols & Organ Protection0:55:21 - The Elite Client Portfolio0:57:11 - Coaching Content Creator Brandon Harding1:00:03 - Influencer Stress & Off-Season Fat Fear1:01:37 - Off-Season Fat Anxiety1:02:06 - What Makes a Coach Most Anxious?1:04:16 - Bodybuilding Page Tags & Lineups1:05:00 - Analyzing Kyron Holden & Ryan Terry1:06:47 - Managing Cortisol, Stimulants & Sleep1:11:46 - Advanced Peptides: SLU-332 & GC-11:12:44 - T3 Abuse vs. T4 & Sobetirome Replacement1:13:33 - GLP-1 Downsides in Contest Prep1:14:25 - Tirzepatide for Post-Show Reverse Phases1:16:05 - Why GLP-1s Ruin Peak Week1:20:36 - Compounding vs. Research Chemicals1:21:21 - Blood Panels & Wellness Specialists1:23:16 - GH & Insulin in Classic Physique1:24:46 - Insulin Dosing as an Off-Season Support1:25:24 - Nighttime GH Bolus vs. Microdosing1:27:00 - Patrick Tuor's Insulin-GH Synergy Theories1:28:55 - Lantus vs. Rapid-Acting Insulin Placement1:30:40 - Working with Niall Darwen1:31:29 - Height Measurements and Weight Caps1:32:44 - Height Manipulation & Spinal Decompression1:35:03 - Niall's Future Back Density Strategy1:36:26 - Pittsburgh Pro Post-Weigh-In Load1:37:37 - Off-Season Fiber & Gut Linings1:39:19 - Oral Steroid Toxicity & Digestion Dampening1:40:41 - Low-Dose Oral Strategies1:42:06 - 100mg Winstrol Motility Shutdown1:46:09 - Post-Show Recovery Phase vs. Rebound1:48:09 - Systemic Muscle Memory & Cell Sensitivity1:49:05 - Scientific Training Philosophy1:50:53 - Zachariah's 34kg Hypertrophy Miracle1:52:24 - Slow Eccentrics & Mind-Muscle Intent1:54:40 - Hyper-Focus During Sets1:56:53 - Comprehensive Blood Work Markers1:57:58 - Cruising Protocol Adjustments2:00:15 - Dietary Fats with Pre-Workout Insulin2:01:32 - Coaching Dynamics of Close Friends2:05:00 - Eric's Open Division Transition2:06:10 - Regional Coaching: UK Intensity vs. US Volume2:06:36 - Laszlo Karoly's Density & US Shows Strategy2:07:29 - Slow-Twitch vs. Fast-Twitch Muscle Genetics2:12:01 - Building Exceptional Muscle Mass2:14:20 - One Final Message: Back Yourself First

Why Your Thyroid Is the "Check Engine Light" Your thyroid is the check engine light, not the engine. With Hashimoto's, the real story is happening in your gut, your immune system, and your stress physiology, often years before your thyroid shows it. If you have Hashimoto's and you're only chasing your thyroid numbers, you're missing the bigger question: why is your immune system attacking your thyroid in the first place? In this episode of the Medical Disruptor, I break down what Hashimoto's actually is, what the standard "replace the hormone" approach misses, and why your low-functioning thyroid is often a check engine light for something deeper, including gut health, gluten, infections, chronic stress, and toxins. I'm Dr. E, the NP with the PhD, and I help humans go from medically gaslit to medically empowered. We'll cover leaky gut and the gluten-to-TPO connection, the gut microbiome's role in converting T4 to T3, infections like EBV and H. pylori, how chronic stress and cortisol affect your thyroid, endocrine-disrupting toxins, and the smartest next steps to take before you reach for supplements. Want more practical health tips? Join my newsletter! https://freechapter.lpages.co/newsletter-opt-in/ Feeling "normal but not okay"? Grab my free guide to track your symptoms, spot your patterns, and get taken seriously https://freechapter.lpages.co/normal-but-not-okay-handout/ Check us out on social media: https://www.instagram.com/drefratlamandrehttps://www.facebook.com/drefratlamandrehttps://www.tiktok.com/@drefratlamandre #functionalmedicine #drefratlamandre #medicaldisruptor #NPwithaPHD #nursepractitioner #medicalgaslighting Chapters: 00:00 - Introduction 02:28 - Where Standard Treatment Falls Short 04:47 - The Gut, Gluten & Leaky Gut Connection 08:31 - Infections, Stress & Toxins 11:37 - What To Do Next: 5 Smart Steps 13:39 - Supplements That Actually Help Learn more about your ad choices. Visit megaphone.fm/adchoices

Many people with hypothyroidism or Hashimoto's are surprised when they begin experiencing symptoms like bloating, constipation, food sensitivities, gallstones, fat intolerance, reflux, or elevated cholesterol. These issues are often treated as separate conditions, but they may all be connected through one important physiological relationship: the connection between thyroid function, bile flow, gallbladder health, and digestion. In this episode, Dr. Eric Balcavage explains why thyroid physiology influences far more than metabolism. Thyroid hormone signaling affects stomach acid production, digestive enzymes, gut motility, bile production, gallbladder contraction, cholesterol metabolism, microbiome balance, nutrient absorption, and even the integrity of the gut barrier. When thyroid physiology is altered, digestive function often changes along with it. Dr. Balcavage explores the critical role bile plays in digestion and overall health, including how bile acids function as powerful signaling molecules that influence metabolism, inflammation, blood sugar regulation, thyroid hormone activation, microbiome health, and immune function. He also explains why reduced T4-to-T3 conversion can impair bile production, gallbladder emptying, and bile delivery into the small intestine, creating a cascade of digestive and metabolic symptoms. You'll learn why digestive symptoms, gallbladder problems, dysbiosis, leaky gut, and elevated cholesterol are often downstream effects of chronic stress physiology and reduced thyroid signaling rather than isolated problems. Dr. Balcavage also discusses common bile-support strategies including ox bile, TUDCA, phosphatidylcholine, taurine, glycine, choline, magnesium, and bitters, explaining when they may be helpful and why they often serve as temporary management tools rather than long-term solutions. Most importantly, this episode highlights why addressing the underlying causes of reduced thyroid signaling and chronic physiologic strain is essential for lasting recovery. In This Episode, You'll Learn: Why people with thyroid problems commonly develop gut, bile, and gallbladder issues The important role bile plays beyond fat digestion How bile acids influence metabolism, inflammation, microbiome balance, and thyroid hormone activation Why reduced T4-to-T3 conversion can impair bile production and bile flow The connection between hypothyroidism, elevated cholesterol, and gallbladder dysfunction How altered bile flow contributes to bloating, constipation, food sensitivities, dysbiosis, and leaky gut Why digestive symptoms are often adaptive responses to physiologic stress The relationship between chronic stress, reduced thyroid signaling, and digestive dysfunction When bile-support supplements like ox bile, TUDCA, taurine, glycine, choline, and phosphatidylcholine may be beneficial Why symptom management alone often fails to create long-term improvement The key factors that may be driving reduced thyroid signaling and digestive dysfunction beneath the surface Resources Mentioned:

You've heard about hot flashes. Maybe you've even had them. But the hormone shift that's quietly dismantling your mood, your metabolism, your sleep, and your sense of self? That started years before menopause and most women have no idea. In this solo episode, Dr. Terri DeNeui maps the full three-decade hormone timeline every woman needs to understand: the testosterone loss that begins in your 30s (and its devastating, and overlooked connection to depression), the progesterone decline that hits like a wall in your 40s, and the estrogen fluctuation that makes the late 40s and early 50s the most miserable stretch for many women. She also makes the case for thyroid as the most underdiagnosed piece of the puzzle and explains why a normal TSH doesn't mean your thyroid is actually working. Along the way, she takes on the antidepressant default, sharing her own doctoral research showing that women who optimized their testosterone resolved their depression entirely and the birth control pill habit that well-meaning gynecologists are still prescribing after 40, despite a very real and elevated stroke risk. This episode is for women in their 30s, 40s, and 50s who've been told their labs are fine but know something is wrong and for anyone who wants to understand what's actually happening before settling for symptoms management. What you'll discover: Why testosterone, not estrogen is the first hormone women lose, and what that means for mood, focus, and body composition [04:50] The doctoral research that changed how Dr. Terri thinks about depression in women and antidepressants [05:17] Progesterone: the calming hormone that disappears in your 40s and why heavy, painful cycles are a deficiency not a life sentence [07:19] Why birth control pills after 40 carry serious stroke risk and what to use instead [08:50] The estrogen fluctuation that makes the late 40s and early 50s the hardest stretch for most women [09:43] Why "normal" lab ranges are based on a sick, unhealthy population and where you actually want your numbers [19:44] Thyroid: the most underdiagnosed condition in older women and why TSH alone doesn't tell the full story [16:33] T4 vs. T3 — and the key enzyme most women are quietly losing as they age [17:26] Why women need hormone optimization across the full lifespan not just to manage symptoms during the transition [14:04] The bottom line: your hormones don't just affect how you feel during menopause they shape every decade of your health. Finding a clinician who understands optimization, not just symptom management, changes everything. The Dr. Terri Show is presented by EVEXIAS Health Solutions. For more, visit: https://www.evexias.com Connect with Dr. Terri:

Discover 7 key signs of a slow thyroid and learn how to distinguish between Hashimoto's and general hypothyroidism. Plus, discover natural ways to support thyroid health and address common thyroid problems naturally.

In this Her Stack series episode, I open up about maternal mental health, postpartum anxiety, and the invisible biological load mothers carry long after the six-week checkup is over. This episode is not just for the newly postpartum mother. It is for the mother whose kids are four, eight, fifteen, and still asking herself why she does not feel like herself. I share why motherhood structurally changes the brain, hormones, and nervous system, and why so many mothers are left feeling anxious, foggy, depleted, or unlike themselves without ever being properly screened or supported. I walk you through the science of the postpartum neurosteroid withdrawal, the gray matter changes that persist for years, and the five-system map underneath maternal brain fog. Then I break down the full four-pillar protocol I use with my one-to-one clients: foundational nutrition, lifestyle and biohacking tools, the supplement layer including some of the most under-discussed compounds for the maternal brain, and the advanced peptide layer including Semax, Selank, NAD+, and bioregulators. This is the episode every mother needs. Send it to one. Join The LongHer Life for women-specific guidance on peptides, hormones, and longevity. I TALK ABOUT:  02:00 - My free peptide masterclass for moms next week 04:10 — Why maternal mental health is not just a six-week postpartum issue 06:30 — The numbers every mother should know (and the screening gap that explains everything) 08:20 — How pregnancy structurally changes the brain (Nature Neuroscience, 2017) 11:40 — The neurosteroid withdrawal nobody warned you about, and the FDA's $34,000 drug that proves it is real 13:50 — Pillar 1: DHA, protein, ferritin, blood sugar stability, and methylated Bs for the maternal brain 22:40 — Pillar 2: Protected sleep cycles, morning sunlight, vagal nerve activation, and red light to the brain 28:00 — Yoga nidra and NSDR as the workaround for mothers who cannot engineer a protected sleep cycle 32:45 — Simplifying routines, meals, outfits, and planning to reduce mental load 35:00 — Co-regulation: Why one hour of real adult conversation is medicine 38:40 — Creatine for maternal mental health, depression support, and cognitive fatigue in sleep-deprived moms 40:50 — Saffron and inositol for postpartum mood, anxiety, racing thoughts, and the "can't shut off the brain" symptoms 42:15 — Magnesium L-threonate, glycine, vitamin D, and low-dose methylene blue for sleep, brain fog, mitochondrial support, and nervous system balance 45:25 — Why peptides are an advanced layer and should come after nutrition, lifestyle, and supplement foundations 46:10 — Semax and Selank for anxiety, cortisol support, BDNF, dopamine, brain fog, memory, and maternal brain support 50:00 — NAD+ and bioregulators (Cortagen, Cerluten, Epithalon) for maternal energy, neuronal support, circadian rhythm, melatonin, sleep, and long-term brain health 58:15 — Why postpartum anxiety and depression need different kinds of support, and why SSRIs work for some mothers and not others 1:00:00 — Why lingering symptoms matter and which labs mothers should check RESOURCES: Labs to ask your provider for: TSH, free T3, free T4, reverse T3, ferritin, vitamin D, DHA panel Join The LongHer Life for women-specific guidance on peptides, hormones, and longevity. Free Peptide Masterclass for Moms: Join the waitlist for the next live class. The Her Stack Planner: The first peptide tracking journal built around female biology. Crisis support: 988 in the US, 988 in Canada PRODUCTS MENTIONED: Supplements DHA (omega-3) Creatine monohydrate Saffron (Crocus sativus extract) Inositol (myo + d-chiro blend) Glycine Magnesium L-threonate (BiOptimizers code: BIOHACKINGBRITTANY) Vitamin D Lion's mane mushroom Bacopa monnieri Methylated B vitamins (methylcobalamin, methylfolate, P5P) Methylene blue (low dose, pharmaceutical USP only) Peptides Semax Selank NAD+ options NOVOS code: BIOHACKINGBRITTANY Nuchido TIME+ code: BIOHACKINGBRITTANY Nasal spray (Synchronicity Health code: BIOHACKINGBRITTANY) Bioregulators Cortagen Cerluten Epithalon LET'S CONNECT: Instagram, TikTok, Facebook Shop my favorite health products Listen on Spotify, Apple Podcasts, YouTube Music

Dr. Corey Schuler, PhD(c), FNP, DC, CNS, and director of medical affairs at Allergy Research Group, details his paper “Energy Allocation Resilience and Endocrine Integration” in the International Journal of Molecular Sciences. He introduces the Energy Allocation System (EAS), which emphasizes how the body allocates energy—not just produces it—and links many symptoms to impaired bioenergetics and resilience. They discuss mitochondria as energy generators and cellular signaling hubs, the integrated stress response and endocrine coordination (HPA axis, thyroid, gonads), and mitohormesis/eustress (exercise, fasting, heat/cold, circadian “zeitgebers”). Schuler explains nuanced testing for fatigue (diurnal cortisol, CGM patterns, thyroid markers including T3/reverse T3) and a case of a perimenopausal woman where oral contraceptives and cortisol dysregulation affected glucose patterns. They cover mitochondrial support (removing obstacles like pollutants/antibiotics, triglycerides, carnitine, dietary fats, micronutrients) and pacing/sequencing lifestyle interventions.

Have you been told your thyroid is normal, but you are still gaining weight, losing hair, exhausted by 3 PM, and living in a fog? If you have done everything right, clean eating, consistent exercise, and supplements, and nothing is working, this episode may finally give you the answer you have been looking for. It is not you. It is your thyroid.In this episode, Dr. Shivani Gupta sits down with Dr. Amie Hornaman, functional medicine thyroid specialist, host of The Thyroid and Hormone Fixer Podcast, and author of the new book The Thyroid Fix. Dr. Hornaman spent years being dismissed by six different conventional doctors before a seventh finally diagnosed her with hypothyroidism. Even then, the standard T4-only prescription left her no better. Backed by decades of clinical experience and the science of T3 conversion, reverse T3, and the thyroid-adrenal-hormone triangle, she breaks down exactly why so many women are undertreated and what to do about it.Dr. Hornaman shares her own story of gaining 40 pounds while competing in figure competitions and eating nothing but chicken, broccoli, and asparagus, and how it led her into functional medicine and eventually to building one of the most trusted thyroid practices in the country. Dr. Shivani also shares her personal journey from subclinical hypothyroidism to Armour Thyroid to discovering that even natural NDT was not fully working for her body. If you are a woman over 35 navigating perimenopause, unexplained weight gain, brain fog, or fatigue, and your doctor keeps telling you that you are fine, this episode is for you.WHAT YOU'LL LEARNWhy a normal TSH does not mean your thyroid is optimized, and the 5 tests every woman actually needs to ask for, including reverse T3 and TPO antibodiesThe T4-to-T3 conversion problem: why Synthroid and levothyroxine fail many women, and why T4-only treatment keeps you stuck in a low-energy, weight-gain cycleWhy natural desiccated thyroid like Armour and NP Thyroid is not automatically the answer, and how 80 percent T4 in NDT can still push you into reverse T3 lockdown modeHow perimenopause hormones trigger thyroid dysfunction, and the adrenal-progesterone-estrogen-TBG cascade that most doctors are not addressingThe Ayurvedic and lifestyle foundation: why calming inflammation, supporting digestion, and reducing cortisol are non-negotiables before thyroid hormone replacement can workDr. Hornaman's FIX Method, including the supplement, nutrition, and hormone replacement framework that has helped thousands of women get their lives backRESOURCES MENTIONED:The Inflammation Code (book)Fusionary Formulas Supplements — use code CODE15 for 15% off your first order https://fusionaryformulas.com/?utm_source=Show+Notes&utm_medium=Show+notes+&utm_campaign=Podcast+promo&utm_id=The+Inflammation+Code+Podcast7-Day Inflammation Detox ChallengeWork with Dr. Shivani — Free Discovery Call

On today's episode, Elle Russ speaks with Karen about her harrowing thyroid journey. Her story is one of the most extreme and inspiring thyroid recoveries. After years of debilitating hypothyroid symptoms, failed T4-only treatment, crushing fatigue, hair loss, depression, migraines, and being repeatedly dismissed by doctors, Karen's health deteriorated so severely that she was told she could die if things didn't change quickly. Desperate for answers, Karen took her health into her own hands and discovered something most doctors never discuss: some thyroid patients simply do not do well on T4-only medication and may require direct T3 therapy - sometimes in much higher doses than conventional medicine is comfortable with. In this episode, Karen shares her brutal journey through sourcing medication internationally out of desperation, and finally finding the treatment that gave her life back. Today, after transitioning to T3-only therapy, Karen has: all-day stamina dramatically improved mental clarity freedom from constant migraines renewed confidence improved hair growth the ability to travel, hike, plan life again, and fully show up for her marriage and future This is a powerful conversation about perseverance, patient advocacy, medical gaslighting, and the life-changing impact of proper thyroid treatment. If you've ever been told your labs are "normal" while feeling anything but normal…this episode is for you. Learn more about how Elle can help you with your thyroid issues HERE.

If you've been told your labs are normal but nothing feels normal - this episode is for you. Dr. Tabatha sits down with Dr. Amie Hornaman, the Thyroid Fixer, to unpack what your labs are missing, why T2 is the forgotten hormone, and what to do about it. Why 'normal' labs do not mean a healthy thyroid.The full thyroid picture: T1, T2, T3, T4 - and why most doctors only test twoT2: the forgotten thyroid hormone and how it supports metabolism without disrupting your natural productionHashimoto's, molecular mimicry, and why gluten removal is not optional for autoimmune thyroid diseaseThe gut-thyroid connection: why healing your gut is required for proper T4-to-T3 conversionThe link between under-optimized thyroid and insulin resistance, heart disease, and Alzheimer'sHow to advocate for yourself and ask for the right labsGet Dr. Amie's book The Thyroid Fix: thyroidfixbook.comSupport your thyroid with Thyro-Lift: shop.fasttofaith.com - use code PODCAST for 20% offScripture: Isaiah 40:29FREE 3-DAY LIVE MASTERCLASS - From Stuck to FreeJoin Dr. Tabatha May 26-28 for three live sessions designed for the woman who has done everything right and still doesn't feel well.Day 1 - Your Body Has Been Waiting Day 2 - Turn Your Healing Into Your Calling Day 3 - Why You're Still Not WellLive at 12PM EST. Same Zoom link all three days. Free to attend. Replay available for registered attendees.Register here: masterclass.fasttofaith.com/fromstucktofree

Hey Rockstars! I have another guest with me on the podcast, Connie Nightingale! Connie is a functional health and performance coach specializing in lab interpretation, hormone balance, and total body optimization. Her approach bridges fitness, nutrition, and root-cause health, helping clients go beyond “normal” labs to truly feel their best.Some topics from today's episode include:⭐️Connie's background as a functional health and performance coach specializing in lab interpretation and hormone balance⭐️How lab ranges are based on population data and may not reflect individual health⭐️The significance of testing timing (female hormones and menstrual cycle phases) for accurate interpretation⭐️The value of monitoring trends over time for better health insights and how to spot hidden health issues using lab trends before symptoms appear⭐️The impact of lifestyle on hormone health, especially during menopause and perimenopause⭐️The dangers of overprescribed hormones and the importance of personalized HRT protocols⭐️Starting with lifestyle modifications before medication adjustments⭐️The importance of taking active participation in health—tracking, questioning providers, and understanding lab data⭐️The potential to reverse or improve health conditions through informed actions and lab insights⭐️Key panels: CBC, CMP, lipid profile, thyroid (including TSH, free T3, free T4, antibodies), sex hormones (estrogen, progesterone, FSH, LH)Join the Kickstart Round 14! Kickstart is a guided group coaching experience designed for busy, high-achieving women over 40 who are done with yo-yo dieting and ready to implement proven, sustainable methods for fat loss and strength—tailored to their individual bodies and lifestyles. https://www.rockthatfitness.com/kickstartIf you have a chance, please rate and review the podcast so more women just like you can learn more about the Rockstar way! I appreciate you for your support and love ❤️Connie's Links:Website: https://www.connienightingale.com/Instagram: https://www.instagram.com/conniebegonnie/YouTube: https://www.youtube.com/channel/UC7duTyr-etc9gaobjJC19TAFacebook: https://www.facebook.com/conniebegonnieRock That Fitness Links:⭐️Link to join Rock That Fitness Membership Today https://www.rockthatfitness.com/rock-that-fitness-membership⭐️Join the Rockstar Fit Chicks Weekly Newsletter  https://rockthatfitness.kit.com/e10d0c66eb⭐️Check Out Our Exclusive Offer for Extensive Lab Work with Marek Health ⁠https://www.rockthatfitness.com/rock-that-fitness-marek-health⭐️Head to the Rock That Fitness Instagram Page https://www.instagram.com/rockthatfitness/ ⭐️Music from Uppbeat (free for Creators!):https://uppbeat.io/t/cruen/we-got-thisLicense code: RBWENWHGXSWXAEUE

If you have ever been told your thyroid is "normal" while you are exhausted, gaining weight, losing hair, constipated, freezing cold, and barely making it through the day, this episode is going to hit a nerve. Because the truth is, thyroid care is still failing women in a big way. Too many doctors are only testing TSH, stopping there, and missing the full picture completely. In this episode, I sit down with my friend Dr. Amie Hornaman to talk about why thyroid treatment is still so broken, especially for women in midlife. We go into one of the most important parts of this whole conversation: advocacy. Because when it comes to thyroid health, no one is coming to save you. You have to know what to ask for, what to test, what patterns to look for, and how to push for better care. If you have been dismissed, under-treated, or told your labs are fine while your body is clearly telling a different story, this episode will give you language, clarity, and a much better understanding of what may actually be going on. In this episode, we cover: Why thyroid care has not improved nearly enough for women Why testing only TSH is not enough The thyroid labs women need to ask for What free T3, free T4, reverse T3, TPO, and Tg antibodies actually tell you Why T4-only thyroid medication often does not work well How reverse T3 can put the brakes on your metabolism Why thyroid dysfunction can affect blood sugar, insulin, fertility, and sex hormones The connection between perimenopause, menopause, and new thyroid issues Why many women are being under-medicated for hypothyroidism How to advocate for yourself and find a practitioner who actually understands thyroid care Who this episode is for This episode is for women who suspect they have a thyroid issue, have already been diagnosed with hypothyroidism or Hashimoto's, or have been told their thyroid is "fine" even though they feel anything but fine. It is especially helpful for women in perimenopause and menopause who are dealing with fatigue, weight gain, brain fog, low mood, constipation, hair loss, or feeling like their body has suddenly stopped working the way it used to.   Dr. Amie Hornaman Grab a copy of Dr. Amies NEW BOOK: The Thyroid Fix: The No-Nonsense Guide to Fix Fatigue, Fogginess, and Fat That Won't Budge on Amazon     Sponsors Try Mito Q Hormone and metabolic control mitoq.com/karenmartel Code: MARTEL10 Get 30% off BATCH Gummies. Go to hellobatch.com/HORMONE and use code HORMONE at checkout. Get 15% off Masszymes By BiOptimzers products at bioptimizers.com/hormone with coupon code HORMONE.     Are you in perimenopause or postmenopause and struggling with symptoms—but not getting the support you deserve? At Midlife Solutions, we specialize in hormone optimization for women in midlife. Our all-female clinical team offers telehealth care across all 50 U.S. states, with the ability to prescribe bioidentical estrogen, progesterone, testosterone, and thyroid medication.   Book your FREE Hormone Discovery Call Find out what's really driving your symptoms and what your next best steps are.   Visit the website: https://karenmartel.com   Shop the Midlife Solutions Store Over-the-counter bioidentical hormone creams and oils — no prescription needed. Including: • Progesterone • Estrogen Face Cream • Vaginal Moisturizer and more!   Take the Hormone Quiz Discover hidden hormone imbalances that could be driving your symptoms. Get personalized results (and yes, they may surprise you).   Women's Peptide Weight Loss Program Clinically guided, hormone-aware weight loss for midlife women.   Midlife RESET HRT Program A complete, supportive approach to hormone replacement therapy in midlife.   Your host: Karen Martel Certified Hormone Specialist, Transformational Nutrition Coach, & Weight Loss Expert   Karen's Facebook Karen's Instagram

Send us Fan Mail If you have ever sat in a doctor's office, exhausted and barely recognizing yourself, only to be told your numbers look fine, this conversation is for you. For millions of women living with Hashimoto's thyroiditis, that moment of dismissal is not just frustrating. It quietly erodes something deeper: the trust in their own body. In this episode, former ER nurse and patient advocate Esther Yunkin pulls back the curtain on why so many women go unheard and under-supported when it comes to thyroid and autoimmune health. She talks about what conventional medicine consistently misses, how stress and chronic self-neglect are often part of the picture, and what it actually looks like to begin healing from the root causes up. If you have ever thought "I just want to feel like myself again," this one is worth your time. About the Guest: Esther Yunkin is a registered nurse, holistic health educator, and patient advocate who has lived experience with Hashimoto's thyroiditis. She is the host of the podcast Health with Hashimoto's and works with women to help them uncover root causes, manage their autoimmune condition holistically, and reclaim their energy and sense of self. Her approach is grounded in science, led by compassion, and shaped by years of watching the healthcare system leave people without real answers. Key Takeaways: Hashimoto's has two distinct parts that both need attention: the immune system attacking the thyroid, and the thyroid's reduced ability to function as a result. Most conventional treatment addresses only one of these, which is why so many women continue to feel unwell even when their labs appear normal. The T4-to-T3 conversion gap is one of the most overlooked reasons women still experience symptoms despite being on thyroid medication. If the body is not converting effectively, symptoms persist, but standard tests may not catch it. Autoimmune conditions like Hashimoto's typically have three contributing layers: a genetic predisposition, gut health disruption, and one or more specific triggers. Addressing all three is essential for real, lasting improvement. Chronic stress is one of the leading triggers of Hashimoto's. Many of the women Esther works with are high-functioning people carrying enormous loads and putting everyone else's needs ahead of their own. Learning to manage stress, even within a busy life, is not optional. It is part of the healing process. Hashimoto's often builds silently for ten to fifteen years before a diagnosis. The earlier a woman learns to listen to her body's early signals, the more damage she can prevent. Healing is not linear. Setbacks will happen. The goal is not perfection. It is becoming an advocate for your own body and knowing how to navigate the seasons, not just the good ones. Connect With Esther Yunkin: Website: healthwithhashimotos.com Podcast: Health with Hashimoto's (search in your podcast player) Instagram: @health.with.hashimotos Facebook RN Community: skool.com/health-with-hashimotos/about Episode Chapters: [00:00] When Conventional Medicine Is Not Enough — The question that opens this conversation [02:00] Welcome to Healthy Mind, Healthy Life — Host introduction and guest welcome [03:30] The ER Moment That Changed Everything — Why one patient quitting smoking says everything about what education can do [06:00] Why Your Labs Look Fine But You Feel Terrible — The two-part problem conventional medicine misses with Hashimoto's [08:00] The Erosion of Self-Trust — What years of being dismissed actually does to a woman's inner knowing [10:00] Root Causes, Stress, and the Women Who Give Everything Away — The hidden pattern beneath most Hashimoto's cases [14:00] Starting the Journey Back to Yourself — Esther's first steps, from root cause discovery to breath-based stress reset   Want to be a guest on Healthy Mind, Healthy Life? DM on PM - Send me a message on PodMatch DM Me Here: https://www.podmatch.com/hostdetailpreview/avik Disclaimer: This episode is produced for educational and informational purposes only. All views expressed by the guest are their personal opinions alone and do not represent the views of the host or Healthy Mind by Avik™. The Network does not verify, endorse, or assume responsibility for any guest statements. Nothing in this episode constitutes medical, legal, financial, or professional advice, please consult a qualified professional before making any decisions. Listeners are encouraged to engage critically and independently with all content do not consume blindly. Use this content as a starting point for your own reflection and research, not as a substitute for professional guidance. Third-party content is referenced under fair use for informational purposes only. Guest speakers are solely responsible for their own statements. If you have concerns about any content, please contact us here. By listening, you acknowledge and accept this disclaimer in full. Read detailed disclaimer here. Healthy Mind By Avik™ is a global platform redefining mental health as a necessity, not a luxury. Born during the pandemic, it's become a sanctuary for healing, growth, and mindful living. Hosted by Avik Chakraborty, storyteller, survivor, and wellness advocate. Support the show Want to Be a Guest on Healthy Mind, Healthy Life?

Diagnosis, workup, and the four-step treatment protocol for thyroid storm. Hosts: Annaliese Elam, MD Brian Gilberti, MD https://media.blubrry.com/coreem/content.blubrry.com/coreem/Thyroid_Storm.mp3 Download Leave a Comment Tags: Critica Care, Endocrine, Thyroid Storm Show Notes I. Pathophysiology & Diagnosis Definition: Life-threatening hypermetabolic state resulting from decompensated thyrotoxicosis. Hormonal Profile: Absolute levels of total T₄/T₃ often mirror uncomplicated thyrotoxicosis; storm is driven by rapid rate of rise, increased catecholamine sensitivity, or increased free T₄/T₃ concentrations. Clinical Presentation: Hyperpyrexia (e.g., 104.2°F) Tachycardia/Arrhythmias (e.g., 155 bpm) Altered Mentation: Agitation, delirium, or psychosis; often the primary differentiator between “storm” and “compensated” hyperthyroidism Warm, moist skin Precipitating Events: Infection, trauma, or surgery Parturition Abrupt cessation of antithyroid medications Burch-Wartofsky Point Scale (BWPS): ≥ 45: Highly suggestive of Thyroid Storm 25–44: Suggestive of impending storm < 25: Storm unlikely Note: High sensitivity but low specificity; can be skewed by unrelated febrile illness. II. Laboratory & Ancillary Findings Thyroid Panel: Characteristically low TSH with elevated free T₄ and T₃. Metabolic Abnormalities: Mild hyperglycemia (catecholamine-induced insulin inhibition) Mild hypercalcemia Elevated LFTs and leukocytosis Cardiovascular: EKG may show sinus tachycardia or atrial fibrillation with rapid ventricular response. III. Management: The Four-Step Blocking Strategy Step 1: Sympathetic Blockade (Beta Blockers) Agent of Choice: Propranolol Mechanism: Non-selective blockade; in high doses, inhibits peripheral conversion of T₄ to T₃. Dosing: PO: 60–80 mg every 4–6 hours IV: 0.5–1 mg over 10 minutes Critical Pitfall: Avoid in patients with acute decompensated heart failure with systolic dysfunction; risk of cardiovascular collapse. Step 2: Inhibition of Hormone Synthesis (Thionamides) Agent of Choice: Propylthiouracil (PTU) preferred over Methimazole in life-threatening storm. Mechanism: Blocks synthesis of new hormone and inhibits peripheral T₄-to-T₃ conversion (decreases T₃ by ~45% in 24 hours). Dosing: 200–250 mg PO every 4 hours Step 3: Inhibition of Hormone Release (Iodine) Agents: Potassium iodide (SSKI) or Lugol’s solution Critical Timing: Must wait at least 60 minutes AFTER thionamide administration. Rationale: Immediate iodine administration provides substrate for new hormone synthesis (Wolff-Chaikoff effect bypass), potentially worsening thyrotoxicosis. Step 4: Inhibition of Peripheral Conversion & Adrenal Support Agent: Glucocorticoids (Hydrocortisone) Mechanism: Inhibits peripheral T₄ to T₃ conversion and treats potential relative adrenal insufficiency. Dosing: 300 mg IV loading dose, followed by 100 mg IV every 8 hours IV. Supportive Care & Avoidance Measures Hyperpyrexia Management: Acetaminophen is the standard of care Avoid Aspirin: Salicylates displace thyroid hormone from thyroid-binding globulin (TBG), increasing free T₄/T₃ levels Volume Resuscitation: Aggressive IV fluids; patients are often profoundly dehydrated May require 3–5 liters of isotonic crystalloid per 24 hours Take Home Points I. Diagnostic Essentials Clinical Diagnosis: Based on hyperpyrexia, cardiovascular dysfunction, and altered mentation. Key Differentiator: Altered mentation (agitation, delirium, psychosis) is often the sole finding distinguishing “storm” from “compensated” thyrotoxicosis. Burch-Wartofsky Point Scale (BWPS): ≥ 45: Highly suggestive of storm. 25–44: Suggests impending storm. < 25: Storm unlikely. Note: High sensitivity, low specificity (e.g., hyperthyroid + flu can score > 45). Triggers: Infection, trauma, parturition, or abrupt cessation of antithyroid drugs. II. The Four-Step Blocking Strategy Beta Blockade (Propranolol): Dose: 60–80 mg PO q4–6h or 0.5–1 mg IV over 10 min. Action: Blocks symptoms and inhibits peripheral T4 to T3 conversion. Caution: Avoid in acute decompensated heart failure with systolic dysfunction. Thionamides (PTU): Dose: 200 to 250 mg every four hours. (note: some resources suggest a loading dose beforehand) Action: Preferred over methimazole; blocks new hormone synthesis and peripheral T4 to T3 conversion. Iodine (SSKI/Lugol’s): Timing: Must wait ≥ 60 minutes AFTER thionamide dose. Action: Blocks hormone release. Pitfall: Early iodine provides substrate for new hormone synthesis, worsening the condition. Glucocorticoids (Hydrocortisone): Dose: 300 mg IV load, then 100 mg IV q8h. Action: Blocks conversion and provides adrenal support. III. Critical Supportive Care Hyperpyrexia: Use Acetaminophen. NEVER Use Aspirin: Displaces thyroid hormone from binding proteins, acutely increasing free T4/T3 levels. Volume: Aggressive fluid resuscitation; patients may require 3–5 L/day due to profound dehydration. Read More

Save your seat in the free Thyroid and Hormone class https://fixyourthyroid.com/natalie  If you are a woman in midlife who has been told everything is fine when you know in your body that something is NOT fine, this episode is going to change everything. I have Dr. Amie Hornaman, The Thyroid Fixer, back on the show, and we are going somewhere we have never gone before. One in eight women will develop a thyroid condition in her lifetime. Eighty-eight percent of us are metabolically unhealthy. And yet most doctors run ONE test, look at one number, tell us we are normal, and send us home with an antidepressant. Meanwhile we are gaining weight, losing our hair, can't sleep, can't think, can't lose a pound to save our lives, and being told it is just stress, just aging, just menopause. Today we are tearing that apart. Dr. Amie saw SEVEN doctors before she was finally diagnosed. She is now licensed to prescribe thyroid and bioidentical hormones in all 50 states and most of Canada. She built the Better Thyroid and Hormone Institute, hosts The Thyroid (and Hormone) Fixer Podcast, and has helped thousands of women globally finally get answers. We go DEEP on: Why the standard TSH-only test misses almost everyone, and the six tests you need to ask for by name THYROPAUSE: Dr. Amie's term for what happens when thyroid dysfunction collides with perimenopause and menopause (and why so many women are being treated for the wrong one) The T4-only medication trap: why Synthroid and levothyroxine fail an estimated 98% of patients Reverse T3, the silent saboteur that blocks your active thyroid hormone from getting into your cells Natural desiccated thyroid, the controversy, FDA scrutiny of animal-derived medications, and where Dr. Amie stands T2: the FORGOTTEN thyroid hormone with 30+ years of research that burns fat at the mitochondrial level, does not suppress your own thyroid, does not jack up your heart rate, does not require a prescription, and is showing up in studies as a potential anti-obesity treatment What Ozempic, Wegovy, and Mounjaro are actually doing to your thyroid (and why some women lose ZERO weight on GLP-1s no matter how high they push the dose) The estrogen, progesterone, testosterone, cortisol, and insulin connection: why you cannot fix the thyroid without addressing the whole hormonal system Antibody-support strategies: gluten elimination, black cumin seed oil, low-dose naltrexone, and thymosin alpha Iodine titration cautions, medical gaslighting, and what to say when your doctor refuses to run the full panel The Monday morning action plan: exactly what to do this week if you suspect your thyroid is the missing piece This is not a thyroid 101 episode. This is the conversation I wish every midlife woman was given the day her labs came back normal. You are not broken. You are not crazy. And you are not alone. Sign up for the free Thyroid and Hormone class https://fixyourthyroid.com/natalie    Connect with Dr. Amie: Podcast: The Thyroid (and Hormone) Fixer Instagram: @dramiehornaman Book: https://thyroidfixbook.com/ Live lab-review class https://fixyourthyroid.com/natalie  Better Thyroid and Hormone Institute: dramiehornaman.com   APPROXIMATE TIMESTAMPS: 00:00 — The medical gaslighting that is keeping midlife women sick 06:00 — The full thyroid panel: the six tests to ask for by name 12:00 — Introducing THYROPAUSE: where thyroid meets menopause 20:00 — How estrogen, progesterone, testosterone, and cortisol all impact your thyroid 28:00 — Why T4-only medication (Synthroid, levothyroxine) fails 98% of patients 34:00 — Natural desiccated thyroid, FDA scrutiny, and individualized dosing 40:00 — T2: the forgotten thyroid hormone that burns fat without touching your gland 48:00 — Who should consider T2 (and why it does not require a prescription) 52:00 — What Ozempic and the GLP-1s are actually doing to your thyroid 58:00 — How to protect your thyroid if you are currently on a GLP-1 62:00 — Lifestyle non-negotiables: morning sun, protein, resistance training, sleep, blood sugar 67:00 — Your Monday morning action plan if you suspect your thyroid is the missing piece   Catch the full episode on YOUTUBE HERE: https://bit.ly/MidlifeConversationsYouTube   Learn More About Dr. Amie Hornaman  Instagram ➜ https://www.instagram.com/dramiehornaman Website ➜ https://fixyourthyroid.com/natalie      Thank you to our show sponsors:  MITOQ: Take control of healthy aging and longevity. Get 10% off using code NATALIEJILL at checkout on https://www.mitoq.com/  BIOPTIMIZERS: Get the digestive enzymes I take with every meal here https://www.bioptimizers.com/nataliejill Free Gifts for being a listener of Midlife Conversations! Mastering the Midlife Midsection Guide: https://theflatbellyguide.com/ Age Optimizing and Supplement Guide: https://ageoptimizer.com   Connect with me on social media! Instagram: www.Instagram.com/Nataliejllfit Facebook: www.Facebook.com/Nataliejillfit   For advertising inquiries: https://www.category3.ca/  Disclaimer: Information provided in the Midlife Conversations podcast is for informational purposes only. This information is NOT intended as a substitute for the advice provided by your physician or other healthcare professional. Do not use the information provided in this podcast for diagnosing or treating a health problem or disease, or prescribing medication or other treatment. Always speak with your physician or other healthcare professional before making any changes to your current regimen.  Information provided in this podcast and the use of any products or services related to this podcast does not create a client-patient relationship between you and the host of Midlife Conversations or you and any doctor or provider interviewed and featured on this show. Information and statements may have not been evaluated by the Food and Drug Administration and are not intended to diagnose, treat, cure, or prevent ANY disease. Advertising Disclosure: Some episodes of Midlife Conversations may be sponsored by products or services discussed during the show. The host may receive compensation for such advertisements or if you purchase products through affiliate links. Opinions expressed about products or services are those of the host and/or guests and do not necessarily reflect the views of any sponsor. Sponsorship does not imply endorsement of any product or service by healthcare professionals featured on this podcast.

Today, I'm joined by the incredible Dr. Amie Hornaman, a leading thyroid expert and author of the brand new book, The Thyroid Fix. In our conversation, Dr. Hornaman opens up about her personal struggle with undiagnosed thyroid disease—a journey marked by frustrating medical gaslighting and the dismissive “you're normal” diagnoses from doctor after doctor. She reveals how that experience led her to become a passionate advocate for women (and men) suffering from thyroid dysfunction and a pioneer in holistic, root-cause approaches to healing. Episode Timestamps: Introduction and show purpose ... 00:00:00 Dr. Hornaman's personal story and medical gaslighting ... 00:05:05 Journey to functional medicine and importance of symptom-based care ... 00:11:00 Recognizing key thyroid-related symptoms ... 00:14:51 Wearables and tracking thyroid-related trends ... 00:17:18 Understanding thyropause and hormone fluctuations after 40 ... 00:19:31 Impact of thyroid function on overall longevity and health ... 00:23:43 T4-only medication debate and need for personalized treatment ... 00:36:19 Why T4-only persists in conventional practice ... 00:40:40 T2, metabolism, mitochondrial health, and iodine ... 00:45:21 GLP-1 medications, thyroid optimization, and weight loss stories ... 00:50:16 Personalization of thyroid numbers and treatment ... 00:53:46 Functional versus conventional thyroid lab ranges ... 00:54:59 Thyroid's connection to mood and mental health ... 00:56:42 When lifestyle alone can't restore thyroid health ... 00:58:39 Biggest myth: TSH and T4-only standard of care ... 01:07:59 Our Amazing Sponsors: O₃RACLE by Wizard Sciences — A daily ozonated oil capsule designed to support immune balance, cellular communication, and antioxidant production without clinics, machines, or complicated routines; learn more at wizardsciences.com and use code NAT15 for 15% off. Quantum Upgrade - Supports nervous system balance without wearables or apps—just effortless, 24/7 quantum energy streaming. With 21+ studies showing measurable improvements in stress and cellular function, it's easy to try for yourself. Visit quantumupgrade.io/NAT and use code NAT15 to start the free 15 day trial. MassZymes by BiOptimizers – A full-spectrum digestive enzyme formula with 4x more protease to help break down protein into usable amino acids so your body actually benefits from what you eat—try it risk-free with a 365-day money-back guarantee and save 15% at bioptimizers.com/bionat with code BIONAT. Nat's Links: YouTube Channel Join My Membership Community Sign up for My Newsletter Instagram Dr. Bill Lawrence Episode

What if your “slow metabolism” isn't about calories at all… but a hidden thyroid problem nobody has caught yet? In this eye-opening episode of the Metabolic Freedom Podcast, Ben Azadi sits down with renowned thyroid expert Dr. Amie Hornaman to uncover the real connection between thyroid health, stubborn belly fat, fatigue, hormone dysfunction, and metabolic resistance. Dr. Amie explains why millions of people are being told their labs are “normal” while still struggling with weight gain, brain fog, constipation, hair loss, anxiety, and exhaustion. She reveals why standard thyroid testing often misses the real issue, how reverse T3 can completely shut down fat burning, and why many people feel worse even while taking thyroid medication. Ben and Dr. Amie also break down the dangerous myth of “eat less and exercise more,” the truth about fasting with hypothyroidism, why insulin resistance and thyroid dysfunction go hand in hand, and how hidden inflammation, stress, toxins, and gluten may be sabotaging your metabolism. If you've been doing everything “right” and still can't lose weight or feel good, this conversation may finally explain why.

Today, I am thrilled to reconnect with my friend and colleague, Dr. Amie Hornaman, also known as the Thyroid Fixer. She is the founder and CEO of the Advanced Thyroid and Hormone Clinic, host of the Thyroid Fixer podcast, and a sought-after speaker and author. In today's conversation, we discuss her brand-new book, The Thyroid Fix, and explore the current thyroid-related silent epidemic. We dive into mitochondrial dysfunction, thyroid optimization, and the significance of reverse T3, also unpacking the symptoms that impact your digestion and hypothyroidism, environmental triggers, oral contraceptive use, and how it increases your susceptibility and risk for developing hypothyroidism. We also examine natural desiccated thyroid, the effects of iodine supplementation, and Dr. Hornaman shares her top three lifestyle strategies for a healthy thyroid. This is a truly insightful and helpful conversation, especially for those in my community who are struggling with an underactive thyroid- myself included. Stay tuned for more. IN THIS EPISODE, YOU WILL LEARN: How women with hypothyroidism are often misdiagnosed or medically gaslit Why Dr. Hornaman believes that the actual number of Americans with hypothyroidism may be far higher than current statistics suggest What reverse T3 is and why it increases when we are stressed How thyroid function impacts the way that cells produce energy How a low-functioning thyroid can slow digestion and cause constipation Why do some women require more personalized thyroid treatment than standard T4 therapy? How environmental toxins can disrupt thyroid health Why long-term oral contraceptive use could increase the risk of hypothyroidism Some simple lifestyle habits and biohacks to improve stress resilience in women with thyroid dysfunction Bio: Dr. Amie Hornaman Dr. Amie Hornaman, known as The Thyroid Fixer, is the founder of the Advanced Thyroid and Hormone Clinic and host of the top-rated podcast The Thyroid Fixer. She is the author of the thyroid bible, The Thyroid Fix, the last thyroid book you'll ever need to understand fatigue, fogginess, and stubborn weight. Driven by her own experience with misdiagnosis, Dr. Amie helps people optimize their thyroid, reclaim their health, and step fully into the badass humans they were meant to be. Connect with Cynthia Thurlow   Follow on X, Instagram & LinkedIn Check out Cynthia's website Submit your questions to support@cynthiathurlow.com Join other like-minded women in a supportive, nurturing community: The Midlife Pause/Cynthia Thurlow  Cynthia's Menopause Gut Book is on presale now! Cynthia's Intermittent Fasting Transformation Book The Midlife Pause Supplement Line Connect with Dr. Amie Hornaman On her website Pre-order a copy of The Thyroid Fix  

This podcast episode gives nurses a practical, easy-to-apply overview of common thyroid disorders, focusing on how to recognize and manage both hypothyroidism and hyperthyroidism in clinical practice. It reviews key differences in presentation—such as fatigue, weight gain, and cold intolerance in hypothyroidism versus weight loss, tachycardia, and heat intolerance in hyperthyroidism—while connecting these symptoms to underlying physiology. Nurses will learn important medication considerations, including proper administration of levothyroxine and monitoring for adverse effects with methimazole. The episode also highlights critical safety topics like recognizing thyroid storm, interpreting lab values (TSH, T3, T4), and providing effective patient education. With real-world clinical pearls, this episode helps nurses build confidence in managing thyroid conditions across care settings. Be sure to check out our free Top 200 study guide – a 31 page PDF that is yours for FREE!

What a day for Rory McIlroy (-12). He jumps out to a six-shot lead over Sam Burns (-6) and P. Reed (-6) while Shane Lowry (-5), Tommy Fleetwood (-5), and Justin Rose (-5) sit at T4. We walk you through all of the day's action: Stories of the Day, Down the Leaderboard, Big's Top 10, on-site observations with Soly & Neil, news & notes, and a whole bunch more! Presented by Titleist. Titleist - #1 Ball in Golf High Noon - Sun's Up! Arccos - NLU15 for 15% off at https://www.arccosgolf.com/ Looking to travel this year, check out East Sands Golf Co.: https://www.eastsandsgolf.co/nlu Join us in our support of the Evans Scholars Foundation: https://nolayingup.com/esf The NLU email newsletter: bi-monthly updates on all things NLU: https://newsletter.nolayingup.com/subscribe Join The No Laying Up Nest: https://nolayingup.com/join Learn more about your ad choices. Visit megaphone.fm/adchoices