Season 4, Episode 1: Encouraging Real Healing and Creating Change in Healthcare with Dr. Tieraona Low Dog

Evelyne: Thank you so much. I could not be more excited to talk to you. I’ve mentioned your course on the show before because I loved it so much. And I’m also a little nervous because I want to do justice to how much you’ve influenced my life and how much you’ve contributed to the world of integrative medicine and herbal medicine. And today we’ll be talking about a few different topics, including using nervines in clinical practice as well as the state of nutrition in America today. Your list of accomplishments is pages and pages long, and then who you are as a person just exceeds all of that. So I will just read your short bio for those who don’t know you yet.

Tieraona Low Dog MD has been deeply drawn to the natural world since childhood. Her journey encompassed various disciplines, including massage therapy, martial arts, midwifery, and herbal medicine before she earned her medical degree from the University of New Mexico School of Medicine. Her career is characterized by her advocacy for healthcare that is compassionate, effective, equitable, and mindful of environmental sustainability. Her leadership extends to her tenure as director of the first interprofessional fellowship in integrative health and medicine, fellowship director for the University of Arizona’s Center for Integrative Medicine, founded by Andrew Weil and co-founder and guiding teacher for the New York Zen Center’s Fellowship and Contemplative Medicine.

She’s the founding director of the Integrative and Functional Medicine Fellowship at the University of California Irvine’s Susan Samueli Integrative Health Institute. Recognized as a foremost authority in integrative medicine, women’s health, dietary supplements, and herbal medicine. Dr. Low Dog’s scholarly work encompasses over 50 peer reviewed scientific articles, 25 chapters in medical textbooks, holding appointments at the National Institutes of Health and the United States Pharmacopeia.

She has written six books on health and medicine, including four with National Geographic, and she has presented at over 600 medical and scientific conferences. Incredible, Tieraona. I just don’t know how you’ve done it all. So I’m curious, you started as an herbalist and midwife and massage therapist and martial artist, and you’ve been practicing and teaching herbal medicine since you were very young, right? I’m curious about the decision to then go to medical school. Why’d you do that?

Dr. Tieraona Low Dog: Well, thank you. Thank you for the invitation to be here with you and it’s always a delight to be with you, Evelyne. I had a very wonderful life and practice. I had an herb shop down in Las Cruces, New Mexico. I’d started an herbal company. I was teaching martial arts at New Mexico State University. I was very busy. I’d done training as a midwife, so my life was very full and very rich. I had a migrant worker who came in to see me who had a very sick child, and I was running. I had to go get my own child from daycare and we were late. The woman who worked with me, we were late.

I told the gentleman that he needed to take the child to a physician and that the child needed to be seen. And a couple of days later, the gentleman came in and my partner who worked with me came and knocked on the door and asked me to come out. He’d brought me some flowers. I was so relieved that the child was better, except when I went out, he had brought me flowers for my “kindness”. But the child had died and he did not take the child to see a physician because he was very scared because they were not legally in the country. And that was a long time ago, the 1980s. It hit me really hard. And what I really understood was that I did not know enough.

I did not know enough. The child had meningitis. I mean, I know now what the child had and probably could have been saved with IV antibiotics. And so I realized that there were limits to what I could do and that I wanted to be able to do more. So I made the decision to go and do my undergraduate work and then be able to go to medical school, which I went to in Albuquerque, New Mexico to the University of New Mexico. And I loved it. It was a wonderful program. I loved being a physician. I loved being a doctor. And I believe that having all of those other experiences before I went to medical school.

So already having been sitting with people, already having attended many births, having a full and rich life, being a mother before I ever went to medical school, made that experience even better for me because I wasn’t just young and out of college. I’d had a lot of life experience by then too. And I think because I was older, that training was particularly meaningful for me.

Evelyne: How old were you when you started medical school?

Dr. Tieraona Low Dog: I must have been 34.

Evelyne: Wow. That’s amazing.

Dr. Tieraona Low Dog: I hear sometimes people are like, “I’m 30, it’s like I’m too old to do whatever.” And I’m like, “Well, I would never hold that. I would never hold at any age that you’re too old to pursue a dream. And if it is your passion and it is your dream, your only regret will probably be not using that opportunity to go and follow it.” But that’s kind of been my own personal life’s mission. Most of my life is to be deeply curious, always be deeply curious, find the best ways I know how to serve, and then go get the instruction, the training, the experience that I need to be able to deliver that.

Evelyne: That’s beautiful. Thank you for sharing. And you didn’t just stop there. You went on to become this leader in integrative medicine with the fellowships that I mentioned, and now this new fellowship in integrative and functional medicine at UC Irvine. Why is it so important for you to train clinicians and expand practitioner’s knowledge of botanical medicine?

Dr. Tieraona Low Dog: Well, I’m a teacher at heart, so I love teaching because it allows you to be a student. So all teachers are students because you’re always one question away from not knowing the answer. Always. Students come in and they ask you something, you’re like, “That’s a great question. I’ve never thought of that. I need to go learn more. I need to understand more.” So education has always been, whether I’m educating a patient one-on-one where we’re talking together and they’re often educating me as well, by the way, it’s usually bidirectional.

But then in medicine, finding that many physicians are hungry for a broader way of thinking about the root cause of the problem, not just the medication that may relieve the symptoms or mask the symptoms, but actually swimming upstream to try to figure out what’s causing this in the first place. And then wrapping that within this whole person care. And as a family doc, that’s obviously a huge underpinning of my own philosophical way of viewing the world. And certainly patient care is how do I come alongside you and understand your story, your values, your goals, and then help you find a way to return to or move forward into a healthier state of being.

So because I’ve seen so much of that amongst physicians, it was very fortuitous that Andy Weil asked me to come and run the fellowship program down at the U of A, which I loved. I started as the director of botanical studies, then the director of education, and then moved up to the director of the fellowship program. And I’m very proud of the work that we did there. And then I retired from the U of A and was invited at the Academy of Integrative Health and Medicine to work on that fellowship, which was the first truly interprofessional program. And then I really had retired. Now I am retired from my branch.

And then my friends, Kohan and Choto, two amazing monks at the New York Zen Center said, “We believe that we need to have a fellowship program in contemplative medicine because so many physicians are burning out.” You need to remember, we launched that during the pandemic and the human toll that the pandemic took on everyday people and patients and nurses and doctors, and everybody’s life was touched by it. But this contemplative medicine really allowed us to help clinicians and healthcare professionals step back and really nurture and nourish themselves and find a new way to dance with their clinical practice.

And now I’m at UCI, UC Irvine, at a brilliant school. And for the first time intentionally being able to weave together integrative and functional medicine, which I’ve long felt was the right approach to bring that whole person-centered, heart-centered care within root cause medicine and merge those together because they’ve been artificially separate, which has been a shame. And in my experience, a lot of my fellows have done one or the other then ended up doing both. So why not just have a program that embraces both, so when people graduate, they actually have skillfulness in both of those.

Evelyne: I love that. That’s amazing. I was actually going to ask this question more towards the end, but you just made me think of it. So many doctors who go into practice, they want to help people, they want to facilitate healing. And yet in our current state, in the US, in healthcare, it just seems impossible between insurance companies and all the administrative burden. And I just wonder what your thoughts are on that. Do you think it’s possible to create change in the system?

Dr. Tieraona Low Dog: I’ve personally never met a healthcare professional that went into it because they thought, “Oh yeah, this is a great way to make a lot of money.” The training’s way too long. It’s too intense. You’d make more money going into just business. So I would say that every nurse I’ve met, every doctor that I’ve met, every chiropractor that I’ve met went in because they wanted to help people on their journey. I think one has to be very careful about separating out the modern business of medicine from the practice of medicine. Because I do believe that many, many clinicians practice in a way that is all their heart they’re giving to the people.

I know this from my own interactions with many physicians, just how genuinely caring they were for me or a family member. The business of medicine, the corporate practice of medicine is a problem. It’s a problem. And algorithms don’t fix the problem, though I think artificial intelligence will help things. It’s certainly going to help with education. And acute care is just like we’ve got acute care down pretty well. It’s like you are in a car accident, you get transported to the hospital, we can take pretty good care of you. The problem is that the management of chronic disease or the prevention of chronic disease and the promotion of health is not given a lot of attention, and that’s going to take a fundamental change.

I do think change is possible. I think change is happening because people are demanding it. The everyday person is demanding a more personalized approach, longer appointments with their provider, not having to wait three months to be seen. And they’re also saying, “Look, I want more precision medicine. I want you to think of me as a person, not just one person that was in a randomized controlled trial. I have my own ideas, my own history, my own values, my own goals. I want you to see and treat me as myself.” I do think with more sophistication, with testing, more emphasis on promotion and prevention, even some of this anti-aging movement, which I have mixed feelings about.

I think that it’s beginning to drive a lot more awareness about personalized medicine. I do think it’s going to change. I think that it will crumble under the weight of its own bureaucracy. But just like people might not have thought in the 1940s and fifties that civil rights would’ve done what it did in the 1960s. That changed. It caused a monumental change in how we look at each other and systemic racism and the women’s movement. I mean, my mother couldn’t open her own checking account. And now women can not only open their own checking account and have their own businesses and run for politics.

So the women’s movement changed things and now we have an environmental movement, but it doesn’t usually happen from within the major structures themselves. It generally happens from the general population. Activists within there saying, “We want something different.” And I think that we’re seeing that with everyday people saying, “I want something different with my healthcare.”

Evelyne: Definitely. And it is interesting how social media even is driving it. So I think that practitioners don’t have a choice but to become more updated on some of these trends and learning more about personalized medicine, integrative medicine, functional medicine. I love how you’ve described what you do as the bridge between the woman growing peppermint in her garden and the researcher isolating menthol in the lab. Why do you think that herbal medicine is still kind of like this alternative? Is it just because the lack of funding of large studies? Even though with many plants we have hundreds or thousands of years of traditional use. Can you speak more on that?

Dr. Tieraona Low Dog: So I actually think many people are fascinated by plant medicine, herbal medicine. I think many physicians and pharmacists are fascinated by it. I think they’re a little scared because of concerns over quality, quality control, not knowing if they’re going to interact with certain drugs. So I think that there’s some hesitation there because they didn’t have enough training to sort of understand how you would merge it within the more broad, modern western medical system. However, I think most people and most clinicians realize that plants are bioactive. They have bioactive compounds. It’s not just we’re telling you to eat more fruits and vegetables, whole grains, nuts, seeds.

I mean, it’s not because we want you just to have more fiber. It’s because within these plants are hundreds if not thousands of compounds that interact with the body in unique ways that have a physiologic effect. So for me, I’m fascinated by plant medicine. I’m fascinated by how people understood that poppy had the effect that it had for pain and analgesia and even for sleep thousands of years ago. And they didn’t need to understand that they bound to receptors, that there were opiate receptors in the body. They just observed how it worked. Digitalis withering was able to isolate that from the foxglove plant more than 200 years ago.

And it revolutionized our ability to manage congestive heart failure at a time when people were dying from just drowning in the fluid when their heart couldn’t pump adequately. So we had many… Reserpine from rauwolfia was the first effective antihypertensive medication that we had came from a plant that had been well known. So for me, I’m constantly intrigued by herbal medicines and how they can be used to improve the health and wellbeing of people in modern times. And that there is a tremendous amount of evidence that we have from history. And now we have a lot of modern evidence, rather that’s basic science, laboratory data, human randomized controlled trials, and often a mixture of all of those things.

That do indicate for many of the common problems that people have with fatigue. “I’m tired, I’m not sleeping well, I’ve got irritable bowel syndrome, I get headaches.” All these kinds of things. There’s so many plants that offer an alternative to pharmaceuticals, which can be for some of these conditions, habit-forming. They can have more side effects, they’re more costly, they have more environmental issues associated with them. So definitely I think there’s a place for medicine. And I think that both the general public and health professionals are interested. They just have legitimate concerns about safety and quality.

Evelyne: And I don’t want to make this into a commercial, but I just have to talk about your course and how we met and how you got me so into herbal medicine. I feel like I’ve always been attracted to plants since I was little, but I’m sharing this in case somebody is like, “I do want to study more herbal medicine.” And so when I first started working in the professional supplement industry, my first conference was the Scripps Natural Supplements Conference here in San Diego in January of 2012. And I saw you speak for the first time, and I was just mesmerized because you were just such an amazing speaker.

And you said that, “Oh, sometimes I have people over to my ranch for hibiscus margaritas back when I used to drink Ka’Chava shakes.” And I just thought, “Oh my gosh, I have to go there.” So I came up to you at the end of your talk and I said, “I’m going to come to your ranch one day.” And you haven’t been able to keep me away since then. So I went to your ranch for the first time in the summer of 2014 with my friend Lisa, and then I signed up for your course Foundations in Herbal Medicine. And then I’ve gone back six more times to Herb Camp in the forest, and it’s just so fun making medicine and going on plant walks and doing case studies.

And I’ve met so many amazing people because of coming to the ranch and of course, including your amazing daughter, Kiara, who’s a dear friend. And I also, because of you, have this deep love for Santa Fe, New Mexico and such a special place, and then where you live in the national forest on sacred land, what a beautiful healing environment. It’s just incredible. So I’m grateful to you and your course, the Foundations in Herbal Medicine course. I’ve mentioned it on the show before because truly, out of all the education I’ve ever taken in this field, it was my favorite. I frequently reach for your materials.

Back then we got the printouts, and so I have them all in binders, and when practitioners ask me questions, I frequently reach for those, whether it’s about a certain herb or certain condition and dosing. And we learned herbal pharmacology and herbal formulation and how to make tinctures and plant identification, and then going through the body system by system. And then the case studies that took hours and hours and back in the day, you used to spend hours going through those and providing feedback.

Those are some of my most cherished possessions, which may sound silly to somebody listening, but it’s so true. I’ve just referenced them over and over. So I’m so grateful to you for your education.

Dr. Tieraona Low Dog: Thank you. Love the Foundations program. I started the original foundations program though in the nineties, and then it’s been updated multiple times. It was on old video cassettes. I love that program. And now for the case studies, we have three and four day intensives where you come here and we work through 20 cases. You have to work through them before you come, and then you have to submit them. But we’re all working through them together as a group, which is a lot of fun. We do some pretty complex cases there too. We have a lot of practitioners that come through.

Whether they’re a nutrition or pharmacy or doctors or acupuncturists, chiropractors, we have a lot of practitioners that come through that are just deeply curious about the plants. And it’s interesting today because it’s like, “More plant-based foods, more plant-based foods, eat more plants.” And of course, there’s a lot of things masquerading as food that are made out of something that looks like plants. I do not support heavily, heavily processed plant foods.

I think plants should be consumed in their more whole kind of forms, but the fact that we’ve moved so far this direction really speaks to the fact that we continue to find that the more plants you consume, the more beneficial effects you have on your health.

Evelyne: And I think so helpful just for practitioners to immerse themselves more into that world and to learn the science and the traditional use and kind of like that herbal archetype, which I want to get into a little bit more. So I’d love to talk about what practitioners see so much of right now, and you mentioned it before, just as a collective, there’s a lot of anxiety in the world right now. There’s a lot going on.

Life is stressful and we have wonderful plants that can support us, and I think that people are more aware of adaptogens. I feel like a couple of years ago that wasn’t in popular culture per se, but now everybody’s talking about ashwagandha and rhodiola and nervines, which I also love and are so supportive. I feel like those aren’t talked about quite as much just yet. So I’d love to talk about nervines. Why do we need them?

Dr. Tieraona Low Dog: Well, I’m not sure you need nervines. I think that depends upon the individual. And I think I would step back to say anxiety particular depends upon how much it interferes with one’s life. But a lot of anxiety today comes from worrying about things which are outside of one’s control. And so having conversations around what actually can you control and what can’t you. So if you’re anxious all night because of some of the traumas that are happening in the world, war, environment, things like these. I understand how that affects you, but it’s affecting you in a physical way now because you actually…

There’s only so much you can do about it. So either find ways to do it, donate, be of service, be involved in environmental movement, anything like that that makes you feel better. But to think that a plant will somehow just alleviate all of that until you change the way that you’re viewing the world is also not realistic. Having said that, there are many things that can help us with the anxiety and tension that we’re feeling, that are not pharmaceutical, that are not benzodiazepines and things like this. There’s a whole array of them, depending upon your own personal temperament.

When we talk about temperament in herbal medicine, we really talk about what’s the temperament of this person and what is an herb that matches that temperament? This is not a novel concept. It’s fundamental to ayurvedic medicine or traditional Chinese medicine or [foreign language 00:26:06] medicine. That constitution is fundamental to creating formulas. We have it in western medicine too, Western herbal medicine. We just typically talk about it more as temperament. So for instance, you have a little child who’s five years old, who’s fussy and can’t settle, and their tummy is upset all the time.

Whenever they get upset, their tummy’s upset. Well, that’s a perfect chamomile kind of. That’s wonderful. You can just give them some manzanita, some chamomile tea, or you can do it as a glyceride that doesn’t have alcohol in it. They’re just drops without alcohol. But that’s a perfect example of how you could match an herb that’s also very safe for a young child. You have somebody who maybe does use benzodiazepines and is trying not to use them, and they have difficulty sleeping and they’re a caregiver and they’re taking care of a parent, or they’re taking care of a sick child, or they’re a professional, a healthcare professional, and they are burning out.

It’s like, “I’m just burning out on what I’m doing.” Passion flower might be the perfect opportunity for them. We can actually use passion flower to help people as they wean off benzodiazepines. And it’s a wonderful, wonderful plant that is underused in my opinion, for that kind of nervous tension, anxiety, and especially for that kind of person that’s constantly giving and doesn’t have a lot of reserves. The nervines are so many. Lemon balm is another classic one that was known a thousand years ago, was referred to as the gladdening herb. The herb of your hearts delight.

It was consumed not only to relieve tension, but to actually enhance mood and to make one happier, feel more joyful. Those are beautiful names for a plant a thousand years ago. And today we realize that lemon balm helps relax the nervous system, good for the tummy, good for upset tummy, good for problems maybe focusing when you get anxious, it’s hard to focus your mind. So lemon balm is one I grow in my garden and I drink almost every day during the summer. It’s a little mint. It’s just a beautiful young plant that’s easy to consume. We’ve studied in six week old babies for colic, so it has a great safety profile for it.

So lemon balm, another one of those for kind of tension and just difficulty with soothing. So there are many, many more nervines that are out there, but these are some of the common ones. Chamomile, lemon balms, passion flowers, valerian, that can all be used to kind of settle and soothe tension.

Evelyne: I love those. And you made me love passion flower, just the way that you talk about it. And I think there’s something inherently helpful too with how you describe the herbs to the patient. Describing to them, you have so much going on and you’re a helper. And passion flower, this is what it’s used for. And I think people resonate with that storytelling as well. And I think that’s something that I’ve learned from you. I remember this case study that we did.

I think it was one of the ranch weekends. And I don’t remember the specifics of the case, but it was a teenage boy who was smoking weed probably for anxiety. And you said something like, “Well, honey, maybe that’s just not your plant.” And I loved that because I think that sometimes… Especially in our field, I see that, “Oh, if you have this, then take this herb. If you have that, then take that herb.” But really more matching it to the person.

Dr. Tieraona Low Dog: I think that you want to be careful not to just reduce the plants to take this for that, take this for that. That’s very much a drug model. But even amongst the drugs, if you have somebody who’s a diabetic, who has some hypertension, a little bit of stuff going on with the kidney, you would use an ace inhibitor over something perhaps like a beta blocker. So even there when you have a multiple choice of different medications that would all lower blood pressure, there are secondary characteristics on those drugs that would help you choose one over the other.

And it’s the same thing with plants understanding a primary action, but then some of their secondary attributes so that you can more align them. We had a woman here just this past weekend, and she’s older, a little bit of mental fogginess. Noticeable for me because I had seen her a few years ago and some cognitive changes. And she just said, “I am done with… I’m tired of taking care of people. I feel like I need to take care of myself, but I just feel tired.” And I said, “Oh girl, you need some Viking. You need a little Viking energy.” And she looked at me and she goes… Because she’s part Scandinavia.

And I said, “You just need to bring some of that Viking energy back into you.” And she goes, “Oh, I like that. What could I do for that?” So we spoke for a few minutes and I said, “How about just a little bit of rhodiola? Let’s just give you a little tiny bit of it and let’s see how you do.” So she was telling my daughter Kiara, because Kiara drove her back to her car to get her car from the ranch. It was the third day, and she said, I’m loving this Viking. I’m just loving this Viking herb that I have. I’m feeling stronger and I’m just feeling, I don’t know.”

She had a hard time describing it, but for her, you could tell she was feeling a little fragile. She was feeling a little depressed, a little mentally foggy, tired. And so rhodiola, I could have just said she’s stimulating adaptogen. It can help with mental fogginess. Both single and repeated doses have been shown to help, may also help with some of your physical fatigue, but actually she wouldn’t have heard any of that. She actually heard what resonated for her about what… And because she’s also Scandinavian, just talking a little bit about how Vikings would use this before they went on long journeys to keep from them getting sick.

It would help them with focus. And I said, “I’m just feeling like you need a little bit of that.” Versus ashwagandha. Ashwagandha was not going to be her herb. I mean, that’s not the right adaptogen for what she was presenting with. Bacopa could have been another one for the mental fogginess, but there was just a sense of being with her that there was something deeper that needed to go on that actually had more stimulating activity to it. And what I love is I see all these products, now they have 15 adaptogens in them. And I’m sort of like, “Is that like the kitchen sink?”

It’s like if we just put 15 different adaptogens, you’ll think that the body will find what it needs. So that’s an interesting one too, that product developers, some do better than others for the masses. Trying to create a formula that really will meet the needs of a specific group of people. But it’s why herbalists typically custom formulate because they can make exactly what you need. Or even if they don’t custom formulate, they may say, “I want you to take this product because it has these three herbs, and those three herbs are the ones I want for you.”

Versus the person who just goes to the health food store and is standing there in front of 500 different herbal products with no idea what to take, just none. Because there’s so many with different blends that I think it can be overwhelming for many people to try to sort that out for themselves.

Evelyne: I love that Viking story, and you’re bringing up something else I want to talk about, which is some of the things practitioners should know. So I want to go back to the examples that you used of passion flower and lemon balm, just for two of them. When you recommend those… Of course it’s going to depend on the person, but some general ideas. What is the dose that we’re taking? How long is somebody taking it? How often are they taking it? Multiple times, during the day? Should they take it forever or just for a couple of weeks or months? Can you speak more on that?

Dr. Tieraona Low Dog: So I think that’s a complicated question only because dosing varies considerably based upon a plant. If we’re just talking about the crude herb or just the herb that’s not been processed really, other than sort of maybe dried. Fresh dosing is different than dried dosing. When you dry it, you typically use less than fresh because fresh has so much water in it. If you’re using a standardized extract or an extract that’s been standardized to a particular marker compound, then you might want to follow what doses were used in the studies, right? Because most of these standardized extracts have been through clinical trials.

So what was the dose used for that? If it’s a tincture, we actually have quite a lot of data from the old pharmacopeia when physicians would prescribe tincture. So that is more commonly known. Then you have to take into consideration is this a 10-year-old, a 50-year-old, an 80-year-old? Is their liver good? Their kidneys good? And then what is the intended purpose? And the reason I’m saying this because I know you’re looking for more of a straightforward answer, is that it’s not that straightforward. And I think this is why sometimes practitioners feel a little overwhelmed because it’s like, “Wow, that was just a lot, she said.

How am I going to know all of that?” So following the directions on a standardized extract for most practitioners is a pretty good way to do it because many of them have been prepared according to clinical trials. How long do you take something? Well, that depends. I drink lemon balm for three months because it grows fresh in my garden every day. So I drink it every day for three months, and then I drink it less in the winter. So some herbs blur the line between food and medicine, and so they can be consumed on a regular… You could drink chamomile every day if you wanted.

I mean, you could have peppermint tea on a regular basis. So many of these can be consumed fairly regularly as just part of the diet, as beverages. When it comes to other things like adaptogens, rhodiola or ashwagandha or things like this, there may be for me more of a eight to 10 week window with a quick check-in, first week or two. How’s it feeling? How are you doing with it? “Oh, I noticed I have a rash.” “Okay, good to know. Ashwagandha’s a nightshade, you may have a nightshade problem.” I mean, so kind of checking in. But then if they seem to be doing well for, usually an eight to 12 week, eight to 10 week period in there, and then you can readjust.

Hopefully you’re doing diet things, you’re doing fitness things, you’re doing other stress management. So when you’re looking at that whole person, what’s changing? And then how do you adjust that accordingly? So I would say that many things people are on probably for eight to 12 week sprints, other things may be longer. You just may have to take them longer than that based upon what the problem is that you’re trying to address.

Evelyne: Thank you. And it is a very nuanced conversation, and I feel like whenever somebody asks me anything, whether it’s diet or herb or what to take, I always say it depends on because there are so many factors involved. One question that I get quite frequently, and this could be a whole other conversation, but I would just love some quick thoughts on it from you. People always ask about herbs that are safe in pregnancy and breastfeeding and anxiety is so common, postpartum anxiety, and sometimes I steer more towards the nutrients, I know there are some herbs. Can you talk a little bit about that?

Dr. Tieraona Low Dog: Sure. I mean, definitely during early pregnancy, you just want to be thoughtful about what you’re taking, right? But ginger’s quite safe to be using for morning sickness and things like that. Chamomile’s quite safe to be consuming during pregnancy. So I mean, there’s a number of teas that you could consume that are just safe. You could certainly have lemon balm as just an afternoon drink if you’re feeling tense. In the postpartum period, I think where you have to be thoughtful about is if you’re breastfeeding, it’s really different breastfeeding a four-week-old baby than breastfeeding a 2-year-old child.

Because the development of their ability to metabolize different compounds is really different at four weeks than it is at 18 and 24 months where they’re eating food. They’re not just relying on breast milk as their sole source of nutrition. So I’m a little bit more cautious in that first 12 to 16 weeks. I certainly use, again, teas like chamomile, lemon balms and lavender essential oil for aromatherapy, things like this. These can all be very beneficial. I think the bigger thing is just when you take your child home or you have your child at home, depending on where you have your baby, especially the first one or two.

I think that it’s overwhelming for many people. Even when you have a partner that is home with you. It’s an overwhelming state of being. You’re tired, you’re up breastfeeding, the baby doesn’t sleep. The baby is nursing every three hours, if you had a C-section, you’re dealing with that now on top. You had a surgery on top of having a baby. And I just feel that there’s not enough sort of the doula, the nursing doula, the eight-week doula that comes for those eight weeks after the baby’s born. It’s like, “How do I help support you, position you, get you rest, get you sleep?” And so yes, there are herbs that can help.

Shatavari is wonderful. I love shatavari as a herb to help with breast milk production and for soothing and for regeneration of you. Shatavari is quite safe. It’s an adaptogen that’s specific in the postpartum period. But I would just say that I think that there’s a lot of unrealistic expectations that are placed on women who come home. Many who only have six weeks to be home with that child before they’re now starting to have to go back to work, and they’re still trying to breastfeed because we’ve told them six months of exclusive breastfeeding is the best thing for your baby.

“And I’m trying to go to work and I’m trying to pump and I’m trying to sleep and I’m exhausted.” So yes, there are herbs for this, but this is also a societal issue, a work issue, a women’s rights issue, a women’s health issue that I think is part of a bigger conversation. But shatavari would be one of my big ones there. I love shatavari. I tell women to take the powder and make it in a milk either a dairy or an almond or an oat milk, chop up some date, put it in there, maybe a little cardamom and then drink it. It’s delicious.

And having a cup or two of that a day can be not only nourishing on a deep level after you’ve given birth, also help with milk supply, but also it’s, “I’m taking time for myself as I drink this cup of shatavari, I’m drinking it, and it’s just my own me time because right now I feel like I have no me time at all. The baby is my life.”

Evelyne: I love shatavari too. I used to send some shatavari powder to my friends when they became moms, and I haven’t been doing that. I don’t know why. I’m going to go back to that.

Dr. Tieraona Low Dog: Great. It’s a great gift.

Evelyne: So I want to switch gears a little bit. You wrote a book a few years ago called Fortify Your Life, and you talk a lot about this at conferences. What is the current nutritional status of people in the US based on the newest data?

Dr. Tieraona Low Dog: Well, that data is now getting older from the CDC, but this is CDC data from the NHANES, the big nutrition health survey that they do. They did their second biochemical monitoring report. So instead of just asking people, what did you eat last week and how many servings of vegetables do you eat in a week? Or what did you eat in the last 24 hours? They actually drew blood and urine for a number of different types of micronutrients, vitamins, minerals, things like that in the body. And it was a little shocking, I think. About 10% of the American population is deficient in vitamin B6. I mean 10%.

It’s a staggering number when you think about the fact that nobody checks B6, nobody’s even thinking about vitamin B6. About 18 million Americans mostly over the age of 50 are deficient in B12, about 15.7 million Americans basically meet the diagnostic criteria for scurvy, which is a severe vitamin C deficiency. It depends upon which lab value you use because there’s different lab values for vitamin D, but if we use the Endocrine Society’s prior cutoff of 20 nanograms per mil as being sufficient, that you had to have more than 20 nanograms per mil, or you would not have enough vitamin D.

If you looked using that cutoff, 90 million Americans over the age of one years of age do not have adequate vitamin D. The list goes on. Low iron remains a significant problem for many women, especially Hispanic and African-American women. And as a group, women 25 to 39 years of age are borderline insufficient for iodine, which has a huge impact if you should become pregnant or are breastfeeding. So this is just shocking when you think about, “Well, we live in the United States, surely everybody gets all the vitamins they need.” And one of my pet peeves is when we keep saying, “Oh, a multivitamin doesn’t prevent cancer.

It’s not reducing heart disease.” And I’m like, “It’s filling in gaps. It’s filling in key gaps that may be occurring and likely may be occurring, especially if you’re over 50, especially if you’re pregnant, especially if you’re obese, or if you have a particular diet that limits in a significant way, macronutrients like you’re a vegan perhaps.” So to me, it’s just shocking. And then it’s like, “Well, multivitamins don’t prevent cancer.” I’m like, “Okay. I never said they did. I don’t think most people take a multivitamin because they think it’s going to keep them from getting breast cancer.”

I think most people are taking a multivitamin because they know they don’t eat well, and they’re trying to fill in any gaps that they may be having because all of these vitamins and minerals, with the exception of like vitamin D, which you could get from the sun, most of these vitamins and minerals are essential, and you must get them in your diet. And if you don’t, your biochemistry doesn’t work very well. And that’s just a fact. And they didn’t do adequate testing for things like zinc because it’s harder to test for magnesium wasn’t one of them. And we know that Americans are quite low in magnesium.

And it was one of the reasons I actually wrote that book. My father almost died from a sudden cardiac death from being on proton pump inhibitors in his late seventies, early eighties, being left on them for years just as an oversight. It was an oversight so he just got left on them. And he began having muscle twitching, muscle cramping, some palpitations and then one morning he woke up and literally felt like he was going to die, that his heart was in such a poor rhythm. When I spoke to the attending physician at the VA hospital, he told me he said, “Well, his magnesium so low.”

So when I asked, “Well, does he have diarrhea? I mean, why is his magnesium so low?” And he’s like, “Well, I don’t know, doc.” And I’m like, “Well, we need to get to the bottom of that.” My dad was hospitalized four days on magnesium by IV. And the long and short of it was he was taking a proton pump inhibitor that he’d been left on for about four and a half years, and his magnesium was just brutally low. When I said to the doc, who was a wonderful doc, by the way, he took good care of my dad. I said, “Well, that’s probably it, was that PPI.” And he goes, “Doc, you think so?” And I’m like, “Yeah, I think so.”

And he said, “Really? Do you know how many of these old guys are on this stuff here?” And I’m like, “Yeah, I do.” And the fact that we had an internal medicine doctor who was completely unaware that there’s a black box warning on PPIs for severe magnesium deficiency if you’re over 50 taking higher doses or have been on it for longer than a year. So problematic. So it’s not only that we may not be eating everything we’re supposed to, but it also may be that we take medications that also make it difficult for us either to absorb it, increase the excretion of certain nutrients, or increase the demand for them.

Magnesium is a classic example. B12 with metformin is another one. How many diabetics are on metformin and nobody’s checking their B12.

Evelyne: It’s so important as clinicians to look at drug nutrient interactions, but also drug nutrient depletions. And I did want to mention that Designs for Health does have a drug nutrient interactions and depletions checker that’s coming to the website, which will be such a great resource. And I think, again, your book, Fortify Your Life is just an excellent resource for that kind of information. I think every clinician should read that. Since you mentioned the PPIs, I’ve always found it so helpful how you help people transition off PPIs. Would you mind sharing a little more about that?

Dr. Tieraona Low Dog: Sure. And actually, we did put together a small book. It’s on Amazon. We just created it because we had so many people just asking. It’s called Healing Heartburn Naturally. There’s three sections on it. There’s one, the problems with PPIs. One, what do you need to do if you don’t want to take a PPI? How do you control the heartburn? Two, if you’re on a proton pump inhibitor, how do you wean off of it? And the third piece is you have a condition that requires you to remain on that proton pump inhibitor.

What do you need to be doing to protect yourself from the adverse effects of that PPI? Because some people may need to be on these lifelong, if not for a considerable amount of time. So there’s a whole series of things that you can do to wean off of them. But the whole thing is that many people must wean off. When you’ve been taking one of these proton pump inhibitors, which are inhibiting acid production, and you suddenly go off, a significant number of people will experience severe rebound reflux. And many people will say, “It’s worse than it was when I started taking the drug.”

And that’s because you’ve shut off all these acid pumps now, and now that you’ve freed them, instead of having a hundred of those pumps, you’ve got a thousand pumps. Because the body doesn’t recognize that it’s on a drug that’s suppressing acid, it just realizes that the pH in the stomach is not what it needs to be. So you’re continuing to try to fight against that. There’s a number of things. So weaning slowly and then eventually weaning onto an H2 blocker from a PPI is important. Then there’s some other things that you can do.

Meanwhile, I think a lot of people do not know that melatonin, you make far more melatonin in your gut than you do in your pineal gland. And a lot of its job really is to ensure that that lower esophageal sphincter is going to get tight and not allow reflux to come back up. And so we’ve got a couple of studies looking at melatonin. One that I think was well done using endoscopy. Showed that at four weeks, essentially melatonin was equivalent to a proton pump inhibitor. And at eight weeks, both were effective at alleviating the heartburn, but only the group that got melatonin actually experienced a tightening of that lower esophageal sphincter.

So I like melatonin as part of the weaning protocol for people when they’re coming off of it. I think also digestive enzymes can be very important for people. You want to be careful about that. With hydrochloric acid and things, I’m talking about more of a broad-based kind of digestive enzyme to help with the digestion of foods because many people just have very poor digestion. Prokinetics can be very helpful. We use alginates. Alginate is amazing at creating a pocket inside the stomach that can physically act as a barrier to prevent reflux back in there.

So alginates are popular. I alginates. I think they’re very good. Amla is an interesting fruit that is used in India, which has good data on it for heartburn. Ginger can be used, it’s a prokinetic. Artichoke leaf is a good prokinetic, also good for heartburn. A lot of people don’t just have heartburn. They have also what we call dyspepsia, meaning they have bloating and gas and reflux. It’s kind of this whole pattern that they have. And so a number of these things like artichoke leaf can be very helpful in that kind of case, both for the dyspepsia and for the heartburn.

But I would encourage you, if you are caring for people who are dealing with heartburn and you’re looking for different protocols, rather they want to avoid the PPI, they want to get off the PPI or there’s somebody you need to keep on the PPI because they’ve got Barrett’s or they’ve got something that requires this. The healing heartburn naturally is quite useful and a lot of patients of mine love it. So again, just a practical guide for people.

Evelyne: Thank you so much for sharing all those tips. And that’s amazing about melatonin. Tieraona, I just want to talk to you forever, but I know we’re starting to run out of time. So I have a few questions that we ask every guest on the show. And the first one is, what is something that you’ve changed your mind about through all of your years in practice?

Dr. Tieraona Low Dog: What have I changed? I’m always changing my mind. No, I mean I do. I think that every day you’re learning something new, so you’re building on whatever you knew before. I think that the one thing I’ve probably changed my mind about the most is thinking that I know as much as I do. So I’ve changed my mind that I know everything. I don’t know everything. And I think that when I was young, I thought I knew a lot more things.

And the older I’ve got, the more I’ve sort of realized that it’s unknowable. There’s so much that’s just unknowable. Everything we know in medicine is doubling every 90 days. There’s just no way to keep up with that. Artificial intelligence will probably help us to a degree, but I probably have changed my mind about that.

Evelyne: It’s amazing hearing that coming from you, because I wish I had the breadth and depth of knowledge that you have. A question about supplements. What are your three favorite supplements just for yourself that you take?

Dr. Tieraona Low Dog: I take magnesium every day religiously. I take vitamin D all winter. I have pretty good vitamin D levels, but I know I don’t get enough in the winter, so I always take a vitamin D and I take a basic multivitamin without iron because of my age and lack of menses. And then I drink a lot of herbal teas, so blends of them. So I take in turmeric fairly frequently and ashwagandha fairly frequently, lemon balm all summer. I drink a lot of chamomile. I drink green tea as well as black tea.

So I’d say that supplements, when we think about supplements, we’re often thinking about what’s in a pill. And I would just say that when I’m thinking about how do I supplement my diet, I’m also thinking about all of the teas that I drink, all the garlic and onions that I’m adding to my dishes. I know what you were looking for, more of the vitamin D and the mag, but I would say that I supplement with many things from the plant world as well.

Evelyne: And something that I’ve learned from you is sometimes it is just easier to start somebody off with an herbal tea, right?

Dr. Tieraona Low Dog: They taste better. For many people. If I want it more medicinal, I tell them, put two tea bags in the cup, not just one, steep it a little bit longer, but for many people it feels more like lifestyle for them. It feels more like I’m adding something to my lifestyle versus I’m just taking a lot of medicines. And just so people remember that Traditional Medicinals and others, I have no relationship to the company, but I do like to tell people because they’re at so many grocery stores that they’re also… When you’re working with somebody that may be socioeconomically disadvantaged, that those herbal teas are covered by SNAP.

And that particular brand is medicinal strength. It’s not like a… I love Celestial Seasonings. Who doesn’t like them? It’s just such a sweet tea when you’re just wanting to have a beverage. But if you’re looking at a medicinal tea, that brand actually makes medicinal strengths teas, and it’s covered by the SNAP program or what people know as food stamps.

Evelyne: That’s great and so helpful. And then the last question that I have for you is, what are your favorite health practices that keep you balanced? You speak so much all over the world, you’re always traveling, always giving. How does Tieraona come back to herself?

Dr. Tieraona Low Dog: I live deep in nature. I live in a log cabin on several hundred acres up in the mountains. I’m very remote. It wouldn’t be for most people, but I live out here with my bears. I know their names. My mountain lion, she’s of age now to mate. Our bobcats, our coyote family. I mean, I know all of my plants here, my trees. So I get to walk every day in the deep green. I’m deeply immersed in nature. And when I’m gone for very long, my husband will say, “Oh, there she is. She got home. She’s got to go for a walk.” And I will literally, I get home and I need to go for a long walk.

It just grounds and orients me. I think nature is my primary healer. I do like to meditate. I’m a deep dog lover. I think my dogs have always been part of my healing. But I love my bed. I love my cup of tea in the morning. I love routine. But I’d say living out here in nature is very healing to me, and it’s my primary healing practice.

Evelyne: Yes, beautiful. And like I said, it’s just such a beautiful special place to be in Pecos. Tieraona, thank you so very much. I couldn’t express my gratitude to you enough. I sometimes have a hard time articulating how I feel because I feel so deeply, but I don’t have the words. But thank you for coming on this podcast and also just for everything that you’ve brought to my life and to the life of so many others. I’m getting tears in my eyes. My life has just changed because of you. And I’m so appreciative.

Dr. Tieraona Low Dog: And I would say the same for you, Evelyne. You changed many people’s lives and you touch many people’s lives with the work that you do. Even these podcasts that you put together, a way that you are reaching people and sharing knowledge and wisdom. You have so much wisdom of your own from being in this field for so many years that you’re a real gift for the people that you interact with and the people that you serve. So I don’t do a lot of these interviews anymore. I’m pretty busy, but when I heard it was you, I said, “Of course, she’s family.” So you’re family.

Evelyne: Thank you. Thank you so much. I really appreciate that. Thank you. Thank you for tuning in to Conversations for Health today. Check out the show notes for resources from our conversation, and please share this podcast with your colleagues. Follow Rach or leave review wherever you listen or watch. And thank you for designing a well world with us.

Voiceover: This is Conversations for Health with Evelyne Lambrecht, dedicated to engaging discussions with industry experts exploring evidence-based, cutting edge research and practical tips.