The Best Tests To Figure Out Your Fatigue Root Causes with Dr. Rajka Galbraith

Content By: Ari Whitten & Dr. Rajka Galbraith

In this episode, I am speaking Rajka Galbraith, MD – who is an expert in helping women achieve optimal health and educating people on disease prevention and overcoming many diseases of lifestyle. We will talk about how to use testing to identify your fatigue root causes.

Table of Contents

In this podcast, Dr. Rajka and I discuss:

  • Is detoxing just a hoax?
  • The most common nutrient deficiencies present in people with fatigue (and the most optimal levels)
  • How mold and mycotoxins affect health and energy levels
  • Do your genes really cause fatigue?
  • The best lab tests to get to identify your fatigue

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Ari: Hey there, everyone Welcome back to the Energy Blueprint podcast. I’m your host, Ari Whitten, and today I have with me Dr. Rajka Galbraith, who has been practicing medicine for over 22 years. She’s certified by the Institute of Functional Medicine, in functional medicine. She’s also certified by the American Board of Family Medicine and the American Board of Integrative and Holistic Medicine.

She’s passionate about empowering women to achieve optimal health, and in turn having them become ambassadors to empower their families and others. It’s her personal mission to spread the word that disease prevention and cure are possible. She has particular interest in nutrigenetics. Although she puts the focus on epigenetics first, which I’m sure we are going to talk about in depth.

She herself has battled many avoidable symptoms and diseases, and would like to put an end to this for our future generations. She’s an international speaker, wife, mother of two and avid yogi who loves the arts and travel. Her private practice, Simply Health Institute is located outside of Chicago. Welcome to the show Dr. Galbraith. It’s such a pleasure to have you.

Dr. Galbraith: Thank you so much Ari for having me on the show. It’s always a pleasure to share the word and spread the knowledge so that we can impart on as many others as we can the knowledge that we both have. Thank you so much.

Ari: Yes, my pleasure. I know we’re going to be talking a lot about labs in this episode, we’re going to get really in depth on the best lab tests to get if you’re dealing with fatigue, how to identify the causes of that, but tell me about your personal journey of how you got here first.

Dr. Galbraith: Yes, I’d be happy to share. Just like many of us in our space, we all usually have battled something [inaudible] here but even before I had issues, as a young child, I had all these dreams like any other child has a dream and one was to be a doctor, one was to heal and cure everyone and one was to have my own children. It was really sad as through the course of my life, almost none of these dreams were actually actualized and when I first came into private practice, it became very clear that I wasn’t healing anyone and their fatigue is probably one of the biggest symptoms that comes across my doors.

We were inappropriately taught to, you do your exam and do the blood work and 99% of the time the blood work that I was taught to do then came back normal, and then you would wrongly suggest that this person was perhaps depressed or maybe it was in their head and shouldn’t– Would they be interested in trying maybe some Prozac.

I’m mortified now to think about my goodness, like how many people did I offer this to that were wrongly being treated. I dealt with the patients I had in front of me with all the tools that I had. That’s what brought me around and just going from multiple symptoms, and that first symptom being fatigue, that even though we got to the bottom of that lead to more and more and more, and it was with each subsequent learning that knowledge base that I kept expanding on through developing my skills in functional medicine, that I was able to heal myself and now thousands of others.

Ari: Beautiful. There’s something that you said there that I think is really important to dig into a little further, which is the fact that in your original training, you said 99% of the time the results would come back normal. I don’t know if you know, but there is– I’d be excited to learn if you’ve seen this. There’s actually, I think it was from 2015-2016, somewhere around there, there was some evidence-based guidelines that were published in the journal American Family Physician.

The title of this paper is called Fatigue and Overview and it was these evidence-based guidelines for physicians on how to treat their patients who come into their office complaining of fatigue. They found some remarkable things. I’ll mention some of the biggest things that they found. One is, there’s four what they considered the standard best, most evidence-based treatments for people with fatigue. They are, get ready for it, doing a walk and stretch for 30 minutes a day, cognitive behavioral therapy, antidepressants and stimulants as needed.

Those were literally the four things that they have in far as– That’s the best of modern conventional science-based medicine. “Science-based,” “evidence-based,” of what they have to deal with people complaining of fatigue. They also said, there’s some guidelines for testing and basically, they said, unless symptoms weren’t specific testing for a specific condition like if somebody has symptoms that weren’t testing for tuberculosis, obviously, you’d run a tuberculosis test and so on.

Otherwise, standard testing is the normal standard lab tests, and they said explicitly 95% of the time, there are no findings on those blood tests that change their standard recommendations. There’s nothing in those tests that they find that gives them any unique insight into treating and helping those people, 95% of the time.

Dr. Galbraith: Wow, wow. I guess they–

Ari: Which lines up very well with what you were saying there that most of the time these people with fatigue are going to their doctors and basically say they’re being told, “Hey, these results look normal, I guess you’re just depressed. Here’s some antidepressants.”

Dr. Galbraith: Yes. Well, shockingly, they’ve expanded the treatment protocol from Prozac to three other options there, but- and it fits. It fits with exactly what I was told. As a physician, I actually didn’t see a doctor to diagnose my Hashimoto’s and live with it for over a decade because I was afraid they would say the same thing even though my numbers indicated otherwise. I just happened upon a woman that had similar numbers. She was a patient of mine.

She’s actually my colleagues wife. We looked out and I sent her to an endocrinologist who really thought outside of the box, and he was able to identify she had Hashimoto’s thyroiditis that needed treatment. Then I let go of that fear of being labeled as “depressed” [unintelligible 00:07:00] saw myself and back then we no longer do this test but he did a TRH stim test which stimulates the thyroid, it’s supposed to behave accordingly. I flunked and my antibody levels were up at 250.

He says, “You’ve been living with this for a decade.” He also gave me combination therapy, which is something that the traditional medical community does not adhere to, and they only give free T4 or legal thyroxine, which is free T4 and they typically do not add in some T3. I promptly moved from the west coast to the east coast and lo and behold, an endocrinologist here and I didn’t know functional medicine, promptly took me off of the T3, of course, because it was poo-pooed and still is. Yes. Thank you for sharing that study.

I had to laugh. 2015 all my focus was on functional medicine. I did not read that study, but it goes along with everything I was taught except for expanding upon now instead of saying Prozac, there’s three other options you have here.

Dr. Rajka’s approach to helping people with fatigue

Ari: Yes. Well, you didn’t miss out on much, you arrived at all the same conclusions even without seeing it. Having said that, the conventional medical model doesn’t– In my opinion, I will just state very bluntly, I think they’re ignoring massive amounts of good science on things that we know are linked with fatigue.

Just to name a couple of very obvious examples. One is the whole science of circadian rhythm and sleep, which we know is intimately tied with fatigue and I would even go so far as to say it’s probably the single most common cause of fatigue. Within the 10,000 plus people who have gone through my Energy Blueprint program, I’ve actually pulled them to see what they feel have been the biggest needle movers for them, and by far in a landslide, circadian rhythm optimization has been the single biggest factor for the most people.

Nutrition, obviously huge factor. Notice that nutrition is not one of the things addressed for people with fatigue. You can have somebody who’s eating the standard American diet goes complaining of fatigue to their doctor and who receives no nutritional advice. It is just insane that this is considered the best science has to offer.

Having said that, that model is, I would argue extremely flawed and very limited. What is your approach to helping patients with fatigue?

Dr. Galbraith: It goes without saying, our intake forms are- mine is almost 25 pages long. It’s really looking at a thorough close look at their everything that led to where they are now. Timeline of events, how are they born, what was their mom and dad’s predisposition to illness and disease? What happened in their childhood? Were they sick repeatedly? And what other triggers that came along.

How many courses of antibiotics, of course, that’s we’re looking at what went on with the microbiome, how that child was delivered. Again, for the microbiome, which is so important for our mental wellbeing as well as our immune health, and going on down the list. I even look– I insert the adverse childhood event questionnaire, which looks at stressful events as when people are children because it definitely correlates with the incidence of having a chronic disease and prolonged like stress responses.

These children grow up, and then they’re more prone to developing diseases and also having these prolonged stress responses. Imagine as we’re an adult, if you’re not taught how to modulate that, you’re constantly bombarded by things that can stress you out, so to speak. Looking at– I always teach in the very first appointment, the eight triggers for inflammation.

I remember that by the word, STAINS, in the first S is sleep and stress. You hit the nail right on the head. The next one is toxins. The A stands for adverse food reactions or inflammatory foods, and the I is any infectious processes and getting back to toxins, it could be biotoxins like mold and Lyme. N is for nutrient deficiencies and you said that very well, no one talks about nutrition.

I feel a lot of these, if someone goes through an elimination type diet, like say the whole 30, the first thing they say is they’re sleeping better. Well, guess what? I’ve studied these biochemical pathways extensively to know that they don’t function with the right co-factors, which are vitamins and minerals. When you start finally supplying your body with that, well guess what, you can make melatonin, lo and behold, you’re not having spikes in your blood sugar at night, which might wake you up and just regulate your sleep-wake cycle as well.

Then that last S is being sedentary or being solitary. Unfortunately, there are times, like currently, where we’re being forced into social isolation, so we’re going to have to find creative and ingenious ways to stay socially connected.

Ari: Beautifully said. I really liked that model. It’s a nice quick summary of a lot of the biggest factors that cause fatigue for most people. From here in assessing that, aside from handing out the 25-page intake report to all the listeners, can you talk about like what some typical scenarios of labs might look like? What would you be looking at as far as the first tier of labs to maybe sort of biggest bang for the buck, and then we’ll get into maybe some of the more specific labs from there.

Dr. Galbraith: I have a comprehensive lab panel that can be done in most of your local labs. Think Quest, LabCorp, here in the Midwest, I’m using a lab called [unintelligible 00:12:48], and they’re all blood markers except for- I look at iodine levels in the urine. I start with the metabolic panel and is it okay, I was going to point out just the things that get missed in the allopathic society. On your metabolic panel, it’s your electrolytes, liver and kidney functions. Some of the subtle things I see that get missed all the time is that patients have liver enzymes for adults.

We should be in our teens and twenties and what I’m referring to is something called the AST and ALT, with the ALT being a little more specific for the liver. If you’re not in the teens and twenties, it says a couple of things. It says that potentially the toxic burden on the liver is higher and/or your carbohydrate intake is higher. I’ve seen fatty liver now down as young as 10 and 12, and so that’s the sounding when their liver values are at 30 or 35, a couple points out of range. That’s something that I think gets missed.

If you come in and say the upper limits are normal for your lab are 40 and your level is at 38, well guess what, that’s too high. It says there’s something wrong. We should pay attention. Fatty liver from too many carbs says, “Hey, if you eat less carbs, you may not feel as fatigued and of course you’ll reverse that.” Unfortunately, 20% of that in liver or a portion goes on to cirrhosis and on cirrhosis, 20% die. That’s why it’s really important to pick that up.

The other thing that gets missed a lot is the alkaline phosphatase, which if low, suggest zinc deficiency and we say no zinc, no think. So it’s one of the key nutrients and also fuels a lot of our metabolic pathways. So, look at that. It should high in children who are growing for bone turnover, fine pregnancy from placental sources and then it may be high in escalated liver disease, but that’s with metabolic panel what I’d be looking at closely. Then I also look at with a fine-tooth comb, what is the blood sugar level? Normal is up to a 100, what if you’re 99?

That’s not optimal at all and I’d like my patients 75 or lower, even maybe up to 80 is what we’re looking at. Then we move on to the complete white blood count, and two of the things, and that’s a measure of white blood cells and whether you’re anemic, so hemoglobin, hematocrit and your platelets are the big four. I’m looking at- those white cells are chronically suppressed. You’ve got to think about, and it’s not an acute viral infection, you got to think about prolonged toxic exposure.

By that, I mean everything that’s in your environment, the water, the air, the products you put on your face and clean your home with. As far as the– and then I look at one other thing that most docs don’t, is the MCV and that’s the size of the red blood cells. We were trained in traditional medicine. If someone was anemic, you’d call it microcytic anemia. If the number was under 80, you call it macrocytic if it’s over 90. I use a value of about 90 to say, “Hey, you probably have a higher need for B12 and folate.” Then there are some innuendos on how to replace the B12 and folate.

Same with platelets, if they’re low, I’m looking at, is that toxic exposure. I had a patient who had ITP, which is idiopathic thrombocytopenia and that’s almost always some toxic trigger. We worked nicely to reduce that. Then for a thyroid panel, most doctors will just do a TSH and that tells you that’s the chemical, just to put it in lay people’s terms so I can catch everyone listening. It’s the communication from the brain down your thyroid. So thyroid-stimulating hormone to release thyroid hormone itself. The first thing that is released is free T4. I tell people, that’s like me giving you a check.

You’re my employee, I give you a check, it’s of no use until you go to the bank and you convert that check into cash, and the cash is where the money is. Then if a stress response comes in, so say times of famine where there’s no food to eat or in today’s society, you say you’re [unintelligible], or you are completely just stressed out, the body will try to preserve itself at all costs and it will convert that free T3 to something called reverse T3 and I call that the voided check. You really can’t utilize [unintelligible] to that.

Ari: That’s a really good analogy by the way. I haven’t heard anybody speak about T3, T4, RT3 in those terms. It works, I like it.

Dr. Galbraith: You like it, good. I did borrow the first, the cash and the check from someone else, but the voided check is my own. I said, [unintelligible] analogy it’s why it’s not functional. Then I’ll look at the two most common antibodies, thyroid peroxidase antibodies and thyroglobulin antibodies. Now if you think they’re hyper, maybe they had a history of hyperthyroidism or they’re losing weight or anxious, then I go in later and maybe get in the thyroid-stimulating immunoglobulin and that tends to be associated with [unintelligible].

Then total T3 and reverse T3. That’s just looking at the total amount and how much of that is the stress response and we set that as- so that’s just the core and we haven’t even expanded on the other stuff. I wanted to just take a break and allow you to make any commentary [unintelligible].

Ari: Thank you for doing that. I’m reeling with questions here of all avenues we could go down. Let me ask first, maybe a short answer question, which is, of those all those different factors you mentioned, and you mentioned a lot from macrocytic anemia to insulin resistance to thyroid issues, liver issues, fatty liver, and a few others in there. Would you say that any particular issue or any couple of those issues are put on quote the most common of what you see in your fatigue patients? Or does it just vary widely?

Dr. Galbraith: It does vary. I would say a combination. It’s never– people have asked me, is it one thing, what if we just peel away one layer of the [unintelligible] that you say trigger it. [unintelligible] it’s usually combo. If you’re going to see the blood sugar dysregulation is really rampant and common and you don’t have to be overweight at all. I’ve had some of the leanest patients in my population come back with blood sugar issues where their glucose is up over 90.

That usually with alk [unintelligible] is again almost in say 60 to 80% of patients low suggesting zinc is low, and a high proportion of patients have that mean corpuscular volume that’s up over 90 suggesting a need for B12 and folate that’s not being supplied to the bodies, to the cells. Those would be the most common, probably followed by the liver. You asked a great question and I don’t know the absolute, so I’m giving you like a clinical picture of what I’ve observed over running labs on thousands of people.

Detoxing – yes or no?

Ari: Got it. I’m curious, have you seen- as you were talking about liver health and how common of a problem it is, you’re seeing it in younger and younger patients now and there is an epidemic of fatty livers now as you’re talking about. There is kind of a meme I would say within some of the ‘evidence-based communities’ that scoff at any talk of liver support and detoxification and say, “You don’t need any of this liver support and detoxification garbage because our bodies detoxify just fine. That’s what we’ve got to liver and kidneys for.”

I’m just curious if you’ve seen it. I personally find that attitude laughable because it’s like the equivalent of saying, you don’t need to exercise because you’ve got muscles. You don’t need to do anything to support your cells in functioning optimally because you just have those cells and they should just function optimally on their own. But it’s like, no, obviously they’re not functioning optimally because we have an epidemic of fatty livers and elevated liver enzymes and people’s livers are not functioning optimally despite the environment and lifestyles that we have.

Dr. Galbraith: That’s a super great question. A couple of things, it depends on who my audience is. If I’m addressing clearly what you’re asking, if it’s an allopathic colleague or– I’m in a lot of groups and when I feel like I noted the data, I see it as an opportunity to educate and it’s really funny. I’ll educate and even if I get bombarded with some negative comments, at least 30 people message me privately, “Oh my goodness, my levels are elevated. What do you think I should do?” So they are open and I think we should continue to educate even though they have a different lens.

For the lay public when they say, “But, my doctor says that detoxes are stupid or crazy or just like a bunch of mumbo jumbo.” I break it down to the basic level and explain that we detoxify day in and day out from everything we’re exposed to. Now, we’re calling that there’s three steps bringing it in, breaking it down to a chemical that’s actually more harmful to us and then packaging it up so it’s water-loving so we can pee, poop or sweat it out. So packaging it and then actually transporting out being the third step. So we’re constantly bombarded.

When you have a five-year-old child versus an 85-year-old man, you’re going to have a lifetime of exposure to different things and that ranges from car exhaust fumes and in the home, it’s your cleaning products. The cleaning products, I said, you don’t want your home to smell clean from toxic products because that’ll be in your bloodstream in 26 seconds and you better hope we detoxify it, but we’re all given a bucket of how quickly we can do that. Clearly [unintelligible] all of these issues, I know my bucket’s small and we’ll get to talk into the genetics, but I know what I need to do to protect myself.

I say if you want to just be mindful, the only thing we can do is avoid and then enhance the way we excrete by the foods we eat and just the supplementation when it’s needed. It just depends on what’s going on. So does everyone need a liver support? Maybe not. I had a gentleman come in and I have a nice campaign behind him, with his permission, I can use it. I tell people, “Be like Frank.” Frank was an 89-year-old man. He came to me and he didn’t have any illnesses till he hit 88 and three quarters and he developed bladder cancer. I have my reasons to believe why he had this.

He, nice Italian man who grew his own vegetable garden with no pesticides, all organic, predominantly vegetables, but of course, was deficient in just zinc because he wasn’t eating the [unintelligible]. He had the cleanest nutrient profile I’ve ever seen. He took a major hit when he had anesthesia for the bladder cancer surgery and we were able to provide him with the proper liver support and he was able to detoxify and he felt so much better. Of course his daughter was already my patient and they were all grateful. I said, “You know, I’m going to use that, be like Frank.”

So be like Frank, [unintelligible] fruits and vegetables and it took him 89 years to get this. One of the things we identified in his history was he was filtering his water with a Brita filter, and that does not remove any of the toxic environmental chemicals. I’ve started to actually measure selectively in some patients when they’re not getting better, environmental toxins.

There’s one called MTBE, it’s found in contaminated groundwater that’s contaminated by gasoline. All of us should be considering reverse osmosis and until you can get there, perhaps the Berkey filter, they claim they filter some of the chemicals out, but in the interim, you may have to resort to plastic bottle water just for a short period of time to get rid of those toxins. Of course, don’t leave it in your car and let it heat up because then you’re going to be trading one evil for another.

Ari: Yes. I get spring water delivered to my house on a regular basis from a very pristine source at altitude. I live in San Diego where it’s possible to get that, not everybody in every location around the world or around the country has that. Yes, a high-quality filter that filters out these contaminants is just critical. Having said, this topic of fatty liver, I’m curious what some practical recommendations would look like to help people dealing with that situation?

Dr. Galbraith: I start with diet first and foremost. It depends on how bad it is. If they’re sky-high, being an allopathic doctor, I have to ensure there’s not two clauses going on. Sometimes you see two different things going on. I had someone who was over ingesting alcohol or had been lifelong and had just quit, but then had that and then was firmly of the belief that he should be ingesting carbohydrates to workout, and clearly for his body was too much. So we had to reeducate them.

The first thing I talk about is diet. Within a minute or two in the office, I can teach people this is the glycemic load and that’s the sugar load per serving. I say there’s three levels, there’s low, medium and high. I’m like, if you have fatty liver, you can eat low load foods all the time. I want to give you some examples. Medium-low foods a couple of times a week. The high foods should be considered as a feast, in times of celebration, once in a while you don’t ever want to deny yourself, but certainly want to limit it while we’re trying to revert your liver enzymes back to normal.

The low load foods for fruits would be berries and melons, that’s what I quickly teach patients. For vegetables, any of your leafy greens, your cruciferous, so broccoli, cauliflower, and Brussels sprouts. For grains, if you’re going to eat grains, avoiding white potatoes which are high, sweet potatoes fall in the middle category, [unintelligible 00:26:56] low and of medium. So the grains are going to want to be eliminated.

Certainly if they’re eating bread day in, day out, you’re going to take that away. With children, you’re looking at the brown diet, which is, unfortunately, chicken nuggets, mac and cheese, bread and cereals. You have to almost eliminate almost all of that and maybe save it as an unhealthy treat, I guess.

The role of zinc and copper in fatigue

Ari: Got it. I’m tempted to ask about practical recommendations on things like macrocytic anemia or insulin resistance or some of the other things you mentioned, but I don’t want to take too much time delving into that. Maybe we should move into other lab tests, identifying some of the other factors that might be at play in someone’s fatigue.

Dr. Galbraith: I look at zinc and copper ratios in everyone. It’s been pretty well studied. William Walsh’s happens to ironically live here in the town that I’m practicing in Naperville, Illinois, who’s studied this for over 40 years and he looks at that imbalance, and it’s also being utilized as one of those inflammatory triggers for dementia that Dr. Dale Bredesen has studied. We want zinc and copper to be in a ratio of 1:1, approximately, it can be slightly higher and both in the range of 90 to 100 in the blood.

Then you can measure how much of that copper is free-floating by looking at how much of something called ceruloplasmin [unintelligible] copper is present. For copper, you want to take the value of copper, say it’s a 100 minus 3 times the ceruloplasmin and you want that to be less than 30. I have a calculator. I actually like it a little bit lower than that.

Bringing someone into balance, maybe not specific to fatigue, but people will wear out if they’re constantly anxious or panicked and they’re not sleeping and that’s keeping them up, and you said sleep was crucial, is that if someone has this imbalance, for some people, it’s a very quick fix. You’re looking at complete improvement of anxiety or panic in about 10 to 14 days. It’s so super fast and important not to miss.

Then I’m looking at other nutrients that are important. Of course, because the thyroid, we’ve already mentioned, I’m going to be looking at not only zinc, which is important for thyroid, but selenium and iodine, there’s almost, I don’t know– Probably not 100% of my patients are deficient, but the iodine can be quite low and I just do a random spot check. There are other more sophisticated ways [unintelligible] you want them at least in the middle of the range, even higher, maybe 75th percentile iron levels as well. Those are—

How inflammation may affect your health

Ari: I got a question on iodine really quick. This is somewhat of a controversial area. I have some friends, for example, Dr. Alan Christianson who he’s about to publish a book on iodine in the context of thyroid disorders. From what he’s told me, after doing all this research to write a book on this subject, his take is that there is a very, very narrow range of optimal for iodine and it’s really easy to have too little and it’s also easy to have too much.

It’s something to be really cautious with because if you have too much iodine, it can do just as much harm as being deficient. It seems to be quite easy to get too much especially when you are using supplemental iodine. There seems to be quite a bit of thyroid supplement formulas on the market that have iodine in them, which in his view, are very dangerous. I’m just curious if you have any thoughts on that whole area?

Dr. Galbraith: I do, and it relates to early clinical experience. I had a mentor who really liked to supercharge patients. I love what he did say, he said, “I’m going to tell you stuff, but then you need to investigate on your own and see what works for you and patients.” In the beginning, you’re following what your mentor is saying as you’re consuming such large volumes of information. It only takes throwing one person into hyperthyroidism to stop doing that and stop supplementing with such high levels. Thank goodness this woman was easily remedied back down by removing it.

I tend to stick to physiologic doses and by that I mean about 150 micrograms, and so you have some of the cowboys out there saying, “You need 15 milligrams,” which is infinitely higher. I agree with Dr. Christianson 100%. You can be too low or too high. You just have to be really careful with it. On that matter, if you have a family member that has [unintelligible].

I had a child come in six years old, mum has mushy, she brought him in for evaluation. He had bad cough. His cough was all food intolerances, or what we call sensitivities, but his thyroid looked like he was hypothyroid almost, and for him it was all zinc. We removed the inflammatory triggers, gave him enough zinc and it all reverted back to normal. That’s really crucial to be able to normalize that at the age of six, it just doesn’t keep going and going and then the body–

He actually had a low-level of antibodies that regress back to normal that then the thyroid burns out. It’s been attached for so long and then you can’t do anything but give them replacement. It takes 5 to 10 years for them to really look floridly hypothyroid. If they don’t get into the hands of a practitioner, that’s a long time to suffer.

Ari: Absolutely. I interrupted your flow a little there with the digression on iodine but fell free to carry on.

Dr. Galbraith: Yes. Then not only those nutrients, I do look at an inflammatory marker called hs-CRP. In patients optimal is under one and it goes– Sometimes people can have inflammatory triggers and that number is normal. It’s not end all reveal and you’ll see it decrease once the levels of inflammation, so when you fix their diet and you treat any gastrointestinal dysbiosis which is an imbalance of good or bad bacteria. It’ll normalize and it’s also a good tip-off if it’s not normalizing that there’s something still arise and sometimes it’s dental infections that have remained hidden for a long time.

A variety of things. Optimal values again are another one and anything over three. We know even the allopathic community is associated with increased risk of clotting, so cardiovascular disease, heart attack and stroke. So they’re very familiar with this as well. The other one is homocysteine. Homocysteine is a marker of methylation, and it’s a snapshot view and to see how the methionine pathway, that’s a pathway that involves homocysteine. I tell patients it’s needed in order for our body to ultimately go on and make our DNA and RNA and turn it on and off.

That’s why it’s crucial. Optimal value in my mind is four to six, in that range. Same thing, it can be too high or too low. As the level goes high, we know it is associated with clotting, so much over 10, maybe 12. Where this comes into play is if someone’s at risk for heart attack or stroke, that puts them at a higher risk, or if they’re trying to get pregnant, it puts them at higher risk of having miscarriages, so we want to control that very carefully. You can use the B12, trimethylglycine, zinc, B6, even some folate.

Probably we would have to save that whole topic of what type of folate and how much for another conversation, but some patients cannot tolerate a lot of folates. I’d say even if you didn’t know someone’s history or didn’t measure a blood marker called full blood histamine, and that was another marker that was studied extensively by William Walsh and found that these people that had serious mental health issues, someone with a whole blood histamine over 75, he called an under methylator and did not require folate.

I know that sounds contradictory. If they’re 40 or under, they were an over methylator and could tolerate it. If you give someone that’s an under methylator a ton of folate, you’ll eventually deplete their serotonin and make them tank. It became quite clear as we have gone through cases with him and very interesting, but I’d say a sweet spot for folate is not even taking it’s depending how sick someone really chronically ill, it’s not going to tolerate very much at all.

Someone who’s normally healthy about 500 micrograms if you’re going to do active folate. People can tolerate, you don’t have to measure. I teach practitioners and I’m like, “If you don’t know, either don’t give it or give 500 micrograms or less then you’re not going to get into trouble because you can make them suicidal.”

Ari: I’m curious. Let’s say you’ve run all the labs you mentioned. Let’s say a few things come up, nothing really notable, and let’s say you put them on a regimen of maybe a few different supplements, change their diet a little bit to try and deal with those things that came up, but they’re not displaying any signs of getting better. Where would you look next?

Dr. Galbraith: I’m going to look at– We always do the foundational pieces and then I would offer– I have two levels of treatments. We have to assume if they have a history for dysbiosis, so treat the gut. That is doing a gut healing program, or we would measure and do a stool test. It’s not wrong to do either and if you’re going to– Because sometimes money is a concern and these stool tests range anywhere from $300 to $400 and so it’s not cheap. Of course, my preference is test, don’t guess, but you can do a trial period.

Say we optimize that and they weren’t better, then I’m going to be looking at toxic burden and toxins. Several ways to look at that one thing that has gone missed and I’ve just probably for the last couple years have been looking at is mold toxins. That has come back as a source of fatigue, thyroid dysfunction, and weight loss resistance. Those are the three common things. I know it can cause much more. Any of these symptoms can represent that. All of us are exposed to mold. 25 to 30% of the population is susceptible to becoming very sick from mold exposures.

There’s urine testing that can measure the excretion of mold toxins into the urine, and then that needs to be addressed. People’s fatigue gets better, it depends how sick they are. If it’s just fatigue, it can get better quite readily. If it’s fatigue and if they’re already demented, it takes a little bit longer. There was a woman who came in and we measure on a mental status a test called a MoCA. She was down at a level of 17.

We found the mold toxicity. Of course, I was treating a wide variety of abnormalities seen from nutritional deficiencies and so on and even hormonal loss at the age of 78. When we started treating them all, we got her MoCA score normals up to 30, up to 24 in just about three months. That was pretty quick. My preference–

Ari: In the 40s or 50s or something?

Dr. Galbraith: No, the max is 30 on that test. It’s called the MoCA.

Ari: Under 30 is considered good?

The role of mold in fatigue

Dr. Galbraith: No, no. The test is 0 to 30, and so 26 to 30 is considered normal. Actually, I would anticipate– She was down to 17, so we got her back into the range of where she was more mild. We call it mild cognitive impairment, it makes her safer to drive. I look at mold toxins and then it may even reach and look for is this an underlying chronic Lyme disease or a Lyme infection that’s been persistent in brewing. The interesting thing is if you treat the mold, typically the rest will also get better. So you have to start there or you can make someone much worse.

Ari: How common do you think the mold issue is?

Dr. Galbraith: I think it’s really common. I think it’s really common and unfortunately, until someone’s starting to manifest signs, it might not be explored. Anyone who has dysfunction, anyone who has a known exposure to a water-damaged home, you’re going to be looking, anyone who has chronic disease, we should probably be looking as the second layer because you still have to foundationally make them put everything into place, so you’re just throwing a Band-Aid on the problem if they’re not eating right overall.

I had a woman come in with- I call it smoldering lupus and that means the medical community ignored the labs for almost a decade and she would get intermittent symptoms and she had a colonoscopy in December, and went to full-blown lupus after the colonoscopy. As you know, for colonoscopy, they clean up your bowels, so you remove all your good bacteria. That’s my speculation anyway, is a trigger and probably the anesthesia, they gave her a conscious sedation so maybe [unintelligible] that.

That’s all speculative, but she worsened and her son was on [unintelligible] and he had already told me that they were away on vacation and their hot water tank burst. They didn’t know and they were home for two days and they saw a black mold growing up the walls. Fortunately, their insurance company took it very seriously and it made them leave the home, evacuate.

It took two years to remedy the home, but they were back and forth getting items. At least we know their current home was tested as of a couple years ago and they wouldn’t allow them back into it. It was completely remediated top to bottom and they treated– they threw out almost all their furniture but their clothing was all treated accordingly. That’s huge, so that is going to be her biggest trigger.

Even though if you can catch someone early in the disease process, this is another thing with labs we didn’t even talk about if someone has a history of autoimmune disease, I’m running an autoimmune panel because those markers and myself included, can be present for a decade before you have symptoms, like it was for this woman.

You want to do something about it before it’s– you don’t wait. I mean, unfortunately, that’s what we’re trying to do and how profound. She got 90% better in six weeks without even remediating the mold but we know to keep her there, we’re going to have to address it.

Ari: This is an issue that hits close to home for me, literally, because we just discovered mold in my bedroom closet three months ago and it was growing. I mean, literally growing 8 feet away from my bed where I sleep, covering the wall in there behind all of our clothes so we couldn’t see it until we moved all these clothes out of the way. Then it became apparent and it was a huge amount of mold.

I was sleeping in this room for- I don’t know how many weeks while this mold was growing there, but I started to have some symptoms as a result of it and started being abnormally susceptible to getting colds and things like that and couldn’t figure out why my immune system was struggling so much. Then we discovered the mold.

We had it remediated, but I’m actually still curious to what extent that those mold mycotoxins might still be affecting my body. I’ve heard mixed opinions on how long the mycotoxins seemed to sort of stick around in the body. Some people are like, it stays there forever and you can’t really get rid of it. I’m curious what your take on that is.

Dr. Galbraith: Well, I’ve become more passionate about it because my patients have it and they’re our best educators when they come in with these symptoms. Then when you hit a roadblock, you research and study some more and then you collaborate with others. The mycotoxins take anywhere from one to three years to eliminate. It’s not a quick process. The belief in the community of those of us that treat is that it is really important to remedy those or they will continue or can be an issue, so they’re never good to harbor in the body.

I would also probably couple with other symptoms as a person susceptible, so those are the two other things. It’s kind of like two people exposed to arsenic, I heard that there was a husband and wife team and the wife was on her deathbed, went to the ER multiple times. They finally figured it out and they’re practically ready to arrest the husband because he thought he was poisoning her and it turns out he had higher levels.

You want to look at the whole big picture, someone susceptible, do they have symptoms? What are the levels? There are levels that are probably not an issue and interestingly enough, there’s a study that’s going to be released, it hasn’t yet. Probably because my strength is that I have large networks of physicians and practitioners I collaborate with and they actually fed people moldy foods at high levels and measure mycotoxins and it didn’t increase the levels.

Usually, with the current companies were using, so it’s Great Plains Labs and RealTime Labs, both have merit and value. If you had the money, you would do both. Most patients don’t have the money, I’m just doing Great Plains and if they’re not getting better, I make them get the other one too, to see what we’re missing.

Ari: Great Plains and what was the other one you mentioned?

Dr. Galbraith: It’s called RealTime Labs.

Ari: Okay. They measure for different mycotoxins or you’re validating the same mycotoxins that the finding is accurate.

Dr. Galbraith: They’re measuring for different ones. One is better at picking up some and one better picking up others. I have someone who we’ve gotten– we’ve done pulled out all the stops and it’s really unusual to have someone’s memory. It’s a subtle measurement, so we do an online test, kind of like a neuropsychological eval that you do in people who are worried about ADHD. It’s an online test patients can do themselves at home and her motor processing speed and a lot of cognitive function.

It’s all subtle, so she’s not feeling it but we’re measuring it and it’s gone down a bit, so we’re going to be exploring what did we miss. In her case, unfortunately, I think she was told her home was clear. It’s not clear. I mean, we need to really go back and look and if you talk to some of the mold experts they’ll say have several companies, if you’re told no, keep looking because it’s there, you just haven’t found it.

Ari: Interesting. I think I might have missed what the conclusion was from this study. You’re saying they fed them foods with mold and they didn’t find that it was reflected in t, so that’s why you’re saying get two different tests?

Dr. Galbraith: No, it’s not reflected in the test, so some people– I’m sorry, I should have kind of– Let’s back up. People will say–

Ari: I thought it was maybe the mycotoxins affecting my brain.

Dr. Galbraith: [laughs] No, I don’t think so. I think I’ve been pretty clear on this and I really like people all the time for a cognitive function, but no. One of the questions that comes up, well, won’t my mycotoxins go high if I eat moldy foods? The answer is no, not to the level of what we would see if you’re truly going to have an issue with it.

Ari: Got it. Do you have any tips on helping people clear mycotoxins that would normally stick around? With metals, there’s obviously substances that can help chelate these metals, is there anything analogous to that when it comes to mycotoxins?

Dr. Galbraith: Yes. The big five, it depends on the mycotoxin present. If it’s ochratoxin it’s cholestyramine. That was a drug used to lower cholesterol. It’s commercially available. I don’t recommend it commercially though, because it’s got aspartame and yellow dye number 7 in it.

Ari: I think the main side effect from that, isn’t that olestra with the famous anal leakage side effect?

Dr. Galbraith: No, actually, cholestyramine is biding, so most people are pretty constipated with it. I think it’s triglycerides, I thought it was, but, yes, olestra you’re right to do that. Then several others are activated. Charcoal, Kalorama, bentonite clay, and if you have gliotoxin, [unintelligible]. You’re almost always going to be– I have them on the four and then I’ll add in [unintelligible] if they’ve got gliotoxins. You going to [unintelligible] depending on what’s present.

The role of genetics in health and energy levels

Ari: Got it. I know we maybe don’t have enough time to delve into this in great depth but I’m curious about your thoughts on the role of genetics and genetic testing in all of this. It’s needless to say, given that you haven’t mentioned it thus far, it’s not necessarily the foundation of the most important tests that one should do in the first place, that one should look if they’re dealing with fatigue. But it’s there to some extent and maybe if somebody is not getting better through some of those earlier interventions, you might look to genetics, I presume.

Dr. Galbraith: Yes. I have passionately studied this for years now and I can work it both ways. I can reverse engineer it based on what people are telling me and I’ll present in just a couple minutes. In a case, a woman came to me, same thing, she thought she wanted a genetics review and she developed– there was a lag of a month between her being able to get to see me and my schedule. She came in and in-between time was diagnosed with acute rheumatoid arthritis, so very unfortunate, but fortunate for her she was able to tap into her community and she started working with the dietician, went on the AIP diet.

I took her through my usual steps. She actually flew in to see me from out of the country and then I gave her– normally I’ll give people multiple steps, but for her, we did multiple steps, tested her stool, we cleaned up her diet, supported her immune system with the appropriate nutrients, addressed any abnormalities on lab, removed any other triggers and sent her off to do this healing protocol followed by a detox.

I never heard from her and then 18 months later she resurfaced and I thought, “Gosh, she really must not have gotten better. She goes, “What are you talking about?” She was like, “I feel like I’ve never had rheumatoid arthritis.” Then, the reason why she was seeing me for genetics was because she was trying to get pregnant, she was an infertility case. We knew that she was homozygous [unintelligible], we knew her homocysteine level without treatment was at the higher concerning level. It was very clear to me why the things work that made her better.

I’ll just mention two quick genes. One is that– and we’re all– we produce free radicals in our body even when we produced energy so that something ATP, so it make us feel energetic and a norm– there’s a small amount that’s acceptable. Then these free radicals also necessary to counteract bugs or infections, but as it gets too high and we don’t suppress it, you can actually start getting tissue destruction. She ended up having a mutation and something called superoxide dismutase, SOD.

I didn’t know at the time, but I was listening to a lecturer who said, “Hey, I gave it to my wife and it made her rheumatoid arthritis pain get better.” That was why when we introduce that as needed modality, why her pain got a level lower and a level better and she got better and better. Then we did a detox on her and she was living in a country where she couldn’t get a whole lot of organic vegetables and it was polluted. She had a PON1 mutation in that PON1 detoxifiers from pesticides and herbicides. It really made sense to me. Without having it, we cured her, but boy, I would’ve have been able to target it better.

There’s value in doing it both ways. I know you and I will get to talk in the future, but glutathione is a big one. I can’t wait to explore that with you. That was my whole issue because you could be absent and not even have the full gene and I’m absent and missing twofold genes that regulate an antioxidant that is considered a super, are the major most antioxidant in our body and it explains why I kept progressively getting sicker and sicker and sicker.

Ari: Wow, you can be missing the whole gene for glutathione? Wow.

Dr. Galbraith: Yes. There’s three main genes. There’s probably more than just three, but three main ones. Two of the three I have, you can have zero, one or two copies, and I have zero copies of two of the three. The third one is mutated. For me, as you can imagine, glutathione is in my regimen every single day.

Ari: Wow. Interesting. I didn’t know that you could have no copies of it. Very, very interesting. This has been absolutely fascinating. I think this is an hour-long grand tour of lab testing and how it relates to fatigue. This is something that I haven’t yet done on the podcast. I’m really thankful for your knowledge on this topic. You are a breadth of knowledge on this. I can really tell when I interview someone when they have maybe a very superficial understanding.

There’s a lot of practitioners out there who hide behind their lab tests and they hide behind their standardized protocols of this abnormal biomarker means I prescribed this supplement or this regimen. Having done 200-plus interviews, having studied this for 20-plus years, I can tell the people who have a more superficial knowledge and hide behind their lab tests and the people who really know their stuff.

I can tell you really know your stuff. You know the details, the ins and outs of the science and all these topics. It was very, very impressive. Thank you much for sharing your wisdom and sharing your knowledge with my audience. I really appreciate it.

Dr. Galbraith: You’re very welcome. My goal is really, I hope if it can even help one person, and it’s funny how we’re told maybe a year later, “I listened to that interview and it tipped me off as to what I should be working at and I’m much better forward.” That’s [unintelligible]

Ari: Absolutely. If somebody wants to follow your work or get in touch with you to work with you as one of your patients, how do they do that?

Dr. Galbraith: My website’s really easy to find. I’ll just spell it out. It That’s probably the best starting point. On Facebook and Instagram with that same Dr. Rajka spelled out that way. People want to follow me there. I also do lots of Facebook lives. I have lots of goodies in store as far as lots of innovative things coming up, lots of interviews, et cetera, and of course, it is in the pipeline.

Ari: Beautiful. Dr. Rajka, thank you much. We really appreciate you coming on. I know we have another interview lined up in a couple of weeks here to have you on the Superhuman Energy Summit, which is going to be coming out in July. Really excited to have another conversation with you. This was a pleasure and it was great to get to know you and have you share your wisdom. Thank you so much.

Dr. Galbraith: You’re welcome Ari.

Show Notes

Dr. Rajka’s approach to helping people with fatigue (13:00)
Detoxing – yes or no? (24:35)
The role of zinc and copper in fatigue (32:15)
How inflammation may affect your health (34:31)
The role of mold in fatigue (43:19)
The role of genetics in health and energy levels (52:34)


Learn more about Dr. Rajka’s work here

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