Interview with Robert Rountree, M.D. Part 1

Stephanie Raffelock’s interview with Robert Rountree,M.D.on Postpartum Chronic Fatigue, Mood Swings,Thyroid problems,liver detoxification and other postpartum symptoms and treatments.     

MRS. RAFFELOCK: Dr. Rountree, what has been your experience seeing postpartum women,what symptoms are most common and what do postpartum women need to do to help themselves.

DR. ROUNTREE: What I can say from my experience as a Family Practitioner very much parallels the one that Dr. Raffelock has had which is that over the years, I’ve had the occasion to see many, many patients with chronic fatigue syndrome.  And, frankly, it didn’t occur to me at the time what they were saying exactly, but later when I put Dr. Raffelock’s lens on, when I put this particular filter on, I began to realize that a significant percentage of them were saying their symptoms started after the birth of their baby.And sometimes I was seeing them 10 years later and they still had the same symptoms that started postpartum.         

MRS. RAFFELOCK:  It was 10 years later that the symptoms started?         

DR. ROUNTREE:  No, that they realized what had happened, they realized that their life had really changed with the delivery of that baby which made it confusing for them. So a typical scenario is that a woman comes in and says, “I’m really tired, you know, I’m really feeling run down.”  And I say, “Tell me a little bit about the history of this.’ And she says, “You know, I’m not really sure when this started.”And then I start asking some questions.  Well, was it last year, was it the year before?  And they start looking back and doing a personal history and at some point they say,“You know, this really changed for me after I had my second child.  And something shifted, and I don’t know what it was but something was different and I never quite made it back from that. I was particularly tired in the first six months, I went to see my doctor repeatedly.  My doctor did a lot of tests on me, they were all normal.  He told me it was in my head, that it was normal to be tired and depressed after you have a baby, so he patted me on the back and I pretty much got into a groove and got used to it and start thinking this is just the way it’s going to be from now on.”         

MRS. RAFFELOCK:  Tell me about where that idea comes from of it being normal to be depressed after giving birth. We have this whole accepted thing in our culture that postpartum “baby blues” is normal. Where did that model come from?         

DR. ROUNTREE:  Well, I think it just came from the observation that something like 80 percent of women complain of some degree of depression especially within the first couple of weeks right after having the baby up to about six months. I think this is where you see those extremely high numbers. And so the assumption was that this is the way it is as opposed to saying, you know, is there something we can do to prevent this from happening or is there an underlying dysfunction? Now, I have to give doctors credit, there’s been a lot of research done on things like thyroid hormone, measurement of antibodies to thyroid so —         

MRS. RAFFELOCK:  What can happen to your thyroid after having a baby?         

DR. ROUNTREE:  Well, postpartum thyroiditis which is inflammation of the thyroid, is probably the most common endocrine disorder. It’s extremely common. I’ve got some statistics here which I can supply to you later but postpartum thyroiditis is a condition that’s similar to other autoimmune diseases where your immune system makes antibodies that attack tissue.And specifically in this case they attack the tissue of the thyroid. The interesting thing about thyroiditis is that it goes through different phases.  In the initial phase it actually can speed up the thyroid, it makes it hot and inflamed so it’s putting out more hormone and it can make the woman anxious, nervous, and that can also lead to insomnia which is part of this whole problem. If a woman’s anxious and she’s nervous and she doesn’t sleep and as a result of not sleeping, she starts to get depressed, so she has what we call an agitated depression.But eventually the gland burns out and then the woman goes into a fatigue scenario.  Now, this is something I saw in residency. I remember diagnosing a woman with this problem who came to see me about three months after having had her baby and she was having all these strange symptoms that she couldn’t pin down. She was feeling nervous and anxious and couldn’t sleep, all these things that I’ve mentioned.And she had gone to see her OB/GYN doctor who said, “Honey, this sort of thing just happens.”


MRS. RAFFELOCK: So from a functional point of view, if you looked at someone with this thyroid condition, would you say that they were possibly nutritionally depleted, that this was something that could be handled nutritionally? 

DR. ROUNTREE:  Well, specifically when you’re talking about thyroiditis, it’s — from my understanding it’s not so much a depleted state as it is that your body’s in this heightened state of immune function. And we don’t really understand all the different aspects of that.Other immune disorders like rheumatoid arthritis and lupus are interesting examples. Often rheumatoid arthritis goes away during pregnancy and then can come back after the pregnancy is over. Lupus can get worse during pregnancy and subside when it’s over. So there’s some very complex things that are happening with the immune system in the course of pregnancy. There’s proteins that are being made called cytokines that regulate lymphocyte functions, specifically the TH-1 and TH-2 lymphocyte balance appears to shift during pregnancy. My understanding is that there’s an up regulation of the TH-1 lymphocytes during pregnancy and that has implications for autoimmune disease. So it may well be that that shift then goes in the other direction right after the baby is delivered. From a functional standpoint, to answer your question, this all gets back to what’s going on in the gut, what’s happening in the gut.  Is there an increase in permeability in the gut called leaky gut syndrome ?  Is there a change in the bacterial flora?  Do you have more yeast growing in the gut as a result of all the hormonal shifts, all the extra estrogen that’s been around? Nobody’s really studied this phenomenon in enough detail to know what’s happening. But what we know from other cases is that when you develop autoimmune disease, it’s often the result of this whole series of events. It isn’t just a phenomenon that occurs over night. If you ask a rheumatologist about this, they’ll say one day you don’t have it and the next day you do. From a functional perspective, it isn’t that you’re walking down the sidewalk and one day thyroiditis drops out of the sky. Instead, what they would say is there’s a sequence of events that might start with some kind of genetic predisposition and then that genetic predisposition is acted upon by a number of different triggers. And those triggers can be dietary in nature, or it can be stress, it can be hormonal.So all these things are influencing your genes to turn them on or turn them off in really specific ways.So let’s say during the pregnancy, a woman has eaten the most optimal dietand she gets an overgrowth of yeast in her gut, or perhaps, she gets an overgrowth of fermenting bacteria because she was craving sugar a lot during her pregnancy, so she was eating too much sugar. Now, this isn’t to say that it’s leading to a nutritional deficiency so much as it’s saying eating all that sugar allows for the overgrowth of bacteria in your intestine that are fermenting bacteria.And those fermenting bacteria then release toxins and those toxins then affect the gut lining. And if you’re affecting the gut lining in that particular way, what do you do?  You open it up, you make it more permeable.  When you make it more permeable, you’re more susceptible to allergic reactions.  Not the classic allergic reactions we think of like allergies to strawberries that give you hives or peanuts or something of that nature, but these very subtle allergic reactions that can cause inflammation.What happens in those kind of reactions is particles of the foods like gluten or corn are seeping through the intestinal wall and getting recognized by antibodies, IGG antibodies usually.  IGG antibodies bond to this antigen, they float around the body until they find a landing spot which might be the thyroid in this case and then that sets off a whole inflammatory reaction from the immune system.           So you can see how there’s this sequence of events that’s pretty complex and if you try to identify any one step and say, Well, it’s this, you know, it’s — yes, eating too much sugar causes thyroiditis, it’s not that direct.  It’s a very zig-zaggy thing that happens.But nevertheless, it’s the result of a combination of genes, lifestyle habits, diet, and then this big trigger that, in this particular case, is called pregnancy.  You know something like this must be going on because it can’t be normal to get thyroiditis.It’s common but it’s not normal, so there must be something, there must be some sequence of events that’s leading to this occurrence.         

MRS. RAFFELOCK:  So now, what could a woman do though to help herself if she had thyroiditis after her pregnancy?  What would be the medical model for treating her and then what would be the functional medicine model for treating her? Or are they the same.         

DR. ROUNTREE:  They’re not the same.  There would be overlap. Certainly, if a woman is having a lot of symptoms from a hyperthyroid phase of thyroiditis, then you might want to treat her with beta-blockers if you’re a conventional doctor.  Because what are you experiencing?  Rapid heart rate, insomnia, etc. So simply capping those symptoms can make the woman a lot more comfortable. And that’s not necessarily a bad thing. Unfortunately, I don’t know a lot of alternative treatments that can get that pulse down and make the person feel as calm. Dr. Raffelock says he can often do this with acupuncture and says that bio-identical progesterone can be helpful along with increasing T-helper 2 function, but there isn’t a standard medical treatment. So if the thyroid is really gone, you know, if your heart’s beating like crazy, if you have a pulse of 110 as a result of this, I don’t know too many other medical options for getting that down. So typically what you would do as a conventional doctor is treat those symptoms and then see what happens.  And if what happens is that the thyroid gland then burns out and the woman becomes hypothyroid, you typically would treat with thyroid hormone replacement and hope that the gland will come back on its own.And I say hope because we really have no way in conventional medicine to encourage the gland to do that one way or another.All we can do is diagnose whether it’s high or low and then treat it accordingly. Now, in functional medicine, we assume that these diseases aren’t just a single phenomenon. As I said, it’s not just something that appeared one day or dropped out of the sky, it’s the result of this sequence of events, it’s a complex phenomenon and potentially it’s reversible.Well, what is it that’s going on that we’d want to reverse?  The body is attacking itself.  The immune system has made a mistake and it’s overreacting.  So there is inflammation going on.  In functional medicine what we’d want to do is treat the inflammation in as gentle a manner as possible, and there’s certain herbs and supplements that we could use to treat that inflammation.Probably the number one supplement would be essential fatty acids, the Omega 3 fish oils, for a number of reasons.  One, is that they’re so safe, we don’t have to worry about harming the infant, in this case they’re very beneficial for the infant’s brain growth.  So these Omega 3 fish oils are a good thing to take anyway.  Everyone can benefit by taking a little bit of fish oil. But there’s also reams of evidence that essential fatty acids can help cool off the inflammatory process no matter where in the body it is occurring. So it’s going to be treating the leaky gut syndrome, it will decrease inflammation in the gut, and it’s going to reduce the number of inflammatory chemicals called mediators that are being released in the bloodstream, prostaglandins, in particular.  Leukotrienes are another group of those.All of these things are involved in keeping that inflammatory process going. So Omega 3 essential fatty acids would be the first place to start and using a good antioxidants would be another place to start and that would include things like a carotene complex, but not synthetic beta-carotene.         

MRS. RAFFELOCK: So there are nutritional supplements that can help?           

DR. ROUNTREE: Yes. Fish oils, a carotene complex that has the whole range of carotenes in it.  Tocopherol complex is the same concept, not just Vitamin E, but all the other things that go with Vitamin E, a little bit of extra zinc, some selenium, some Vitamin C, all of those things seem to go together to cool off the immune cells so that they’re not overreacting.So we might go with essential fatty acids, antioxidants, and then add some kind of anti-inflammatory herb like curcumin which is an extract of the common spice tumeric.         

MRS. RAFFELOCK:  And all of this would be safe if the mother was nursing the baby?         

DR. ROUNTREE:  Yes, the — the good thing about this approach is these are all foods, curcumin is extract of tumeric which has been used in curry.  And pregnant women and women who have had babies have been eating curry in India for a thousand years and to my knowledge there has been no reports of any harm done to the fetus or nursing child. These are all food-based supplements.  And the kind of doses we’d be talking about are not massive.  They’re higher than a lot of people would be getting in a typical diet, but I’m not saying that the higher the dose, the better the effect you’re going to get.  So we’re going to use reasonable doses of all these things.         

MRS. RAFFELOCK:  So now the thyroid thing is one end of the spectrum, you know, a woman gets this thyroid disease or whatever after pregnancy, what about a woman that has taken pretty good care of herself during her pregnancy, she’s taken prenatal vitamins, she’s now on her, maybe her second or her third baby and she is experiencing this phenomena still of feeling exhausted, feeling kind of depressed, they don’t know what the matter is.  Why?

DR. ROUNTREE:  So what we do in conventional medicine is we look for a disease to isolate.

MRS. RAFFELOCK:  Label it?         

DR. ROUNTREE:   Yes. We put a name on it. So we would look for the thyroid problem. If you’re good and you’ve read the literature and you know about this, then you would check a TSH, a thyroid simulating hormone to see if it’s elevated.  And if it’s not elevated, then you’d probably feel pretty confident in saying to that woman, your thyroid is fine.  Okay? I’m saying this a little bit tongue-in-cheek, because those of us in functional medicine know that it’s quite possible to have abnormalities of the thyroid even if all the blood tests look fine.  And for years the conventional endocrinologists have poo-pooed this, have said, that’s absolute nonsense, if the blood tests are normal then you are normal and it’s all psychosomatic.          Well, you could take that same concept and apply it to just about any gland. You could talk about the adrenal gland, for example.  You could say, well, we measured the cortisol levels and the cortisol levels are fine, so you don’t have adrenal insufficiency.  Okay?          But the — the notion — the concept of functional medicine that’s so important is that you can have dysfunction that’s unique to you as a person that doesn’t necessarily manifest as a full-blown disease.  And unless you do the proper testing and use your intuition as a doctor who knows how to look for these kinds of things, you could very easily miss what the problem is.            And this is what I think is going on with a lot of these women is they have subtle biochemical and hormone abnormalities that don’t necessarily fit into one of these boxes like hyper or hypothyroidism or even the box of postnatal depression which is another really big box.You know, maybe the woman’s mood isn’t low enough for us to call her depressed but she feels exhausted and is having trouble coping.It’s so tempting if you’re a conventional doctor to say, “Well, you have a Prozac deficiency.”  To say, you know, “We’ve got just the drug for you and we can treat it and it make you feel better.”  But I just read, for example, that right after delivery, tryptophan levels drop —         

MRS. RAFFELOCK:  And tryptophan does what?        

DR. ROUNTREE:  Tryptophan is an amino acid that’s found in proteins that’s converted in your brain into serotonin. If we start looking at it from that perspective, that’s how we begin to understand the nature of dysfunction.  So instead of looking at the end result which is to say, this woman appears to be showing signs of a quote serotonin deficiency, even though we don’t know for sure that this is the case, still it fits the little box so we put you on the drugs Prozac, Paxil, Zoloft, Celexa, etc.But what if we start back from the beginning and say, Well, we have evidence that tryptophan levels tend to drop in women in this situation.  Well, how can we replenish that tryptophan, what can we do about that? Well — and there’s a lot of different ways to deal with that.  It’s not that easy to get L-tryptophan as a supplement anymore, but you can get something even better called 5-hydroxy-tryptophan or 5-HTP which is one metabolic step closer to making serotonin in the brain.           So basically it’s a way of providing the nutritional precursors.  Or you can get very sophisticated and you can measure amino acids either in the blood or in the urine in combination with measuring what’s called organic acids. So we have these probes. And these probes allow us to start uncovering some of the dysfunction that may be unique to that person.And what I would point out is that we’re not looking for just one thing.  We’re not saying, Okay, our theory is that all these women are deficient in tryptophan.  Instead, I would say, we start with this observation that tryptophan levels tend to drop and then we might say, “Well, what about you, Sally ?”  You know you ate this way during your pregnancy it seemed to be pretty healthy, you exercised, you took care of yourself and then you crashed after you had the baby.  Well, how about if we base our diagnosis on what’s normal for Sally as opposed to whether Sally fits this category of thyroiditis or depression or adrenal or an Addison’s disease or something along those lines. Instead, we’re going to say, “How about we compare Sally to herself?”  And that’s a little hard to do if you haven’t been measuring these amino acids or organic acids throughout a person’s life.  But you can get a sense from looking at those kind of tests whether they’re out of balance or not.And the good news is, there’s things you can do to bring them back into balance.  So I might work on a very simple level with a patient where I’m saying, Okay, let’s just start with something like 5-HTP or maybe let’s use an herb like, say, St. John’s Wort.  And let’s see what happens. Now, how is that different than the drug approach?  Well, the drug approach is basically trying to suppress the symptoms, trying to control the symptom.  If I’m giving a person 5-HTP, I’m basically saying, I’m gonna provide the nutritional building blocks and I’m gonna let her body do what it will with those building blocks. So I’m starting on the front end, I’m doing front-end loading here, starting on the front end and then I’m letting the body go through its own natural processes but I’m helping it along.  St. John’s Wort does the same thing.  Some people think of St. John’s Wort as being the herbal alternative to Prozac.  Well, it’s not really true.  What St. John’s Wort appears to do is not just raise serotonin levels, it appears to modulate all the neurotransmitters in the brain.            Yes, it has some effect on serotonin, but it seems to be working by much more complex mechanism that may actually be working through the immune system as opposed to just blocking the re-uptake of serotonin so that you get more serotonin in the neurosynapses.  Are — are you with me on that?         

MRS. RAFFELOCK:  I’m with you.         

DR. ROUNTREE:  So it’s an entirely different way of looking at things and saying, Okay, there’s dysfunction here.  How can we bring it back into balance as opposed to how do we correct these symptoms as quickly as possible?  And what kind of probes can we use to start investigating this dysfunction?         

MRS. RAFFELOCK:  Now, there might be some doctors that read this book or look into it and say, pregnancy recovery, what’s this recovery about?  Women have been having babies for thousands of years.  What’s this recovery thing about?  And yet there seems to be a myth prevalent in this society that you’re supposed to be birth a baby, go out and plow the fields the next day.  And really the emphasis shifts to the child. Not how are you doing. But, how’s your baby doing?            Can I give you one more example? Their was a mandate of Congress in 1999 that said you have to leave a mother and child in the hospital for 48 hours after a normal vaginal birth.  That was not for the mother however, it was doctors saying “We really can’t tell if there’s anything wrong with the baby unless we observe it for at least 48 hours.” So once again, back to the mother.  Is there a recovery time for most women?  And I know we have to treat everybody individually but is there some kind of recovery period that should be happening that isn’t happening for women?  Are women more on Prozac now than our mothers who birthed us in the 50s and 60s?         

DR. ROUNTREE:  Well, certainly, we treat women very differently now than we used to 50 to 100 years ago after having a baby.         

MRS. RAFFELOCK:  How so?         

DR. ROUNTREE:  Where you would stay in bed for a couple of weeks, you know, and even today the traditional midwives, the women that deliver babies at home, they tell the mom, don’t get out of bed for two weeks except to go to the bathroom and to eat.  But you are confined to bed.  I command you to stay in bed.Now, we have a society whose values are not focused on that kind of self-care. And that’s really an understatement. So I think that part of the problem comes out of our society and what the norms are, where society values productivity, very masculine kind of values. And what has happened in health care with the advent of health management organizations which are really not health management organizations, they’re money management organizations.  They’re organizations that were put together to figure out how to deliver medicine as cheaply as possible. And so if there’s no, quote, proof, that a phenomena exists, then that phenomena and it’s a phenomena that potentially could cost money to the insurance company, they don’t have any proof that it exists, then they’re going to sweep it under the carpet.So for a while there when it looked like they were going to be able to get away with telling women, you ought to be able to deliver that baby and go home in two hours, and I remember having to tell mothers that when I would see their baby in the hospital.  I would get called in as the Family Practitioner to evaluate the child and make sure everything’s okay and then I was supposed to do the discharge, and I was supposed to tell the mom, “Okay, you can leave now.” And, sure, some moms wanted to get out of the hospital as soon as possible and maybe that’s not a bad idea except that if they go home and they’ve got three other kids to take care of, and the husband expects the woman to be making meals and cleaning up the house and all of that, and yes, that does happen.I think there are still some men out there that don’t realize that women need a lot more attention, rest, and support than that.  So if you’re sending a woman home to that, it’s certainly not a healthy thing, but you can’t expect an insurance company to keep the woman in the hospital just so that she won’t be thrown into all those chores. Because that’s not their concern. Their concern is money. The only thing they want to know is are there studies that prove that she’s going to be healthier if she stays here or not?  We don’t really have any studies like that.  As you said, most of the studies have to do with the child.However, there is a doctor who I believe is at the University of Minnesota and I pulled some of his references. He’s been studying women for as long as a year after the delivery and trying to find out whether there’s correlations in long-term health with the amount of maternity leave that the woman had. And what he appears to be showing in his literature is that the woman who have very short maternity leaves have long-term health problems as a result.  Their research is still fairly preliminary, I think, but there’s a couple of good studies that he’s done that went on between six months and a year and that’s what he’s found is that women with short maternity leaves ended up having a lot more infections, and fatigue, and quite a few other symptoms.         

MRS. RAFFELOCK:  And have doctors been trained to ask that question of a woman who complains of fatigue that began after the birth of a child? How long did you take off for maternity leave after the birth of your child?

DR. ROUNTREE:  I wouldn’t say that’s a routine question at all. I don’t even know if that question ever gets asked. I do know that Dr. Raffelock has been testing blood levels of all the major nutrients (fatty acids, amino acids, intracellular minerals), testing bio-identical hormones,neurotransmitters and their nutritional precursors, etc. for many years and has found that the average time for a woman to completely recover her nutrient reserves postpartum is 18-24 months. This makes sense to me because she still might be breast feeding, sleep deprived, taking care of other family members and even go back to work. All these further drain nutrients from the mother so that while she is trying to replenish her nutrients lots of them are being drained off too.So there is the question of how much rest and also the question of these nutritional and hormonal factors as well.

MRS RAFFELOCK: What are some of your other thoughts about postpartum health? 

DR. ROUNTREE: The question really has to do with what is health?  Really and specifically when a woman is pregnant and after she’s had the baby, what does it mean to be healthy?  And I think all of us have some sense of what that means which is that your skin has a certain glow to it, it has a certain vibrance, a certain color. That may be one of the biggest tipoffs we have, I think, is the person’s skin, you know, how does it look? What other symptoms are present and does someone actually feel good? An absence of symptoms doesn’t necessarily mean that a mother is in good health.I think a concept that’s maybe less well understood is the ability to bounce back from stresses.  An unhealthy person doesn’t bounce back very well.  Let me be more specific.  It’s not so much that it’s abnormal to get sick.  Everybody gets bad colds, everybody gets the stomach flu from time to time, you know, if you get a cut and it’s not cared for properly, it can get infected. Healthy immune systems are able to fight off infections. All these things can happen in a healthy person.  But a truly healthy person recovers very quickly from this.So if you’re pregnant and you get a bad cold, it shouldn’t last more than two weeks. If you get a bad cold and it lasts for a month and certainly if it lasts for two months, something is wrong.  So that’s one of the first questions that I ask a mother either while she’s pregnant or afterwards is, “Well, tell me about infections, how do you do with infections?”  Have you gotten more than usual, are you getting one every month?  Are you getting one every two months? One of the studies that I mentioned earlier on women who got more or less maternity leave showed that the women who got less maternity leave had more infections.  So it’s a very indirect indicator that says, They’re not healthy. And they’re not healthy because their immune system isn’t bouncing back.          Certainly, fatigue is another one of those indicators.  It’s a red flag of unhealth.  If a person comes to me and says, I’m fatigued, the first question I ask is, Do you get enough sleep?  How much do you exercise and what do you eat?  Okay?  If you appear to be getting enough sleep and you seem to be eating the right kind of food and you seem to be getting enough exercise and you’re still fatigued, that tells me that you’ve got the beginnings of dysfunction.  That something is out of whack.Now, I’ve had women come in that say, Oh, I’m not fatigued and you can look at them and tell that that’s not true.  And part of the problem that I think we have in our society is we push ourselves so much because we are so focused on task and goals and getting things done that we’ve dissociated somewhat from our bodies.  So there is fatigue as a symptom that a person would describe to me and there’s the kind of fatigue that they would get in their body that I could see as a general lethargy, a slowness, a tired look that the person has where they slump down.  They don’t sit up in their chair, they, you know, they don’t have the physiology of someone who says — who’s telling you my energy’s good and you know that their energy’s good. So it’s a tip off to me if a person says I’m not tired or, you know, maybe I’m just a little bit tired but they’re slumped down in the chair and their body doesn’t look good, it’s somewhat intuitive but it’s extremely important information.So, again, I would look at the vibrancy of the skin, and I would include in that the tongue, you know, I think you can tell a lot by how robust a person’s tongue is, whether it’s coated or not, whether it’s got scalloping in it, or deep fissures or grooves, all of those are tipoffs that something is wrong.            How do the membranes look in the eyes and in the nose?  Are the membranes moist and clean or they dried and cracked and irritated looking?  So that’s something you can tell from a quick glance just by pulling down the lower eyelid or — or using a speculum to look into the nose.  So how are the membranes?  How is the skin?  What’s the color of the skin?  And then what’s the person’s posture, what’s their physiology, how do they hold themselves? And then there’s the whole other issue of how fast do they recover from injuries, from infections, how frequently do they get infections?  I think those are probably the three biggest areas that are tipoffs to me about robust health.I might throw in the other thing about intestinal health, because a lot of people don’t really think that much about intestinal symptoms until they become problematic.  In other words, if they get severely constipated, which is a very common thing in pregnancy and even after pregnancy, if they get severely constipated, then they know something’s wrong or perhaps if they got bloody diarrhea they know something is wrong, and say, Yeah, I’ve got an intestinal problem.But what about gas and bloating and heartburn and cramping and all these things that a lot of us tend to think are just part of living?  And I certainly have seen many patients over the years would tell me if I asked them point blank, “Do you have any intestinal problems?”  And they say, “No, not really.”  Then I would say, “Do you have any gas or bloating?”  And they say, “Oh, yes, all the time.  But I think that’s normal because I’ve always had that.” Well, that’s a tipoff to a functional medicine trained doctor that there could be all kinds of imbalances, there could be overgrowth of yeast as I mentioned earlier, there could be fermenting bacteria, there could be food allergies.  There could be poor digestion and food absorption.  So these subtle symptoms that a person might discount that I would be digging for and will tell me a lot about overall state of health, after all, if you don’t have a healthy gut, then it’s impossible for the rest of your body to be healthy.Something that the old time naturopaths like Bernard Jensen D.C, ND told us this years and years ago that you have to have a healthy gut.  And I thought they were obsessed with their bowels. I didn’t really take it seriously back then, but now with all the new research that’s coming out about bowel health and the things that go on and imbalances and bacteria and yeast, I think we’re beginning to realize that its a very important area to focus on in people.         

MRS RAFFELOCK: What about the body’s ability to process environmental toxins and toxins made within the body?         

DR. ROUNTREE:  So we’ve been talking about the basic issue of overall nutrients that the mother and the child need just for normal development, nutrients to build the bone marrow, nutrients to build other tissues like muscle and skin, nutrients for the mom to make breast milk.  So I think we all understand that these things are essential from that perspective.But I think what’s less well known is the amount of nutrients that go into the process of detoxification which is an extremely important issue that I think comes to bear on this problem of postpartum fatigue.         

MRS. RAFFELOCK:  And what do you mean by detoxification?         

DR. ROUNTREE:  Okay. All our bodies have very specific mechanisms in place for getting rid of toxins. We basically have two different types of toxins that we have to get rid of.  We have toxins from the external environment called exotoxins (from outside sources) and then toxins that we make in our intestines and we make in our cells called endotoxins (from inside sources). So one of those endotoxins would be free radicals.  The simple process of breathing is producing free radicals.  Free radicals are basically molecules that don’t have paired electrons on the outer surface and if you don’t have a paired electron, then you have a very highly reactive molecule that starts tearing up tissue like DNA and cell membranes, etc. But you’re also making a number of chemicals in your gut. Or if you have fermenting bacteria, they’re making huge quantities of chemicals with very strange names like cadaverine and putrescine, etc.  You’re making secondary bile acids in your gut that are recirculating into the blood stream.            Combine that with all the toxins that we’re hit on a daily basis, literally an onslaught of pesticides, the PCBs and the PVBs, the organochlorines, in particular, seem to be a big problem.  These are persistent, organic pollutants.  POPs is the term that’s being used to describe them.  And the reason they’re called that is because they stay around for a long, long time. Some of these things were banned 20, 30 years ago and you can still find them in people’s body fat if you do a fat biopsy.  So our environment is full of these things, it’s in the water, it’s in the food.  If you eat animal products like eggs or chickens or red meat then you’re ingesting them that way.  And your body has do something with it.So everyday your body has to go through this detoxification process where it’s taking these chemicals that could cause harm if they’re not processed and it’s also taking the hormones that are circulating in your body like the estrogens and cortisol and it’s dumping those out.  If it didn’t, you would just be one big pool of estrogen after a while because your glands are making estrogen.  They’re cranking estrogen out all the time.And that stuff has to get dumped out.In order to get dumped out, it has to be processed.  And this processing is taking place in the gut wall, and it’s taking place in the cells of the liver, and to some extent it’s taking place throughout the body but particularly in those areas.  There’s a little bit of it that goes on in the lungs as well.  But it’s a very elaborate process. It usually involves enzymes and these enzymes require a huge amount of energy, a significant percentage of your body’s energy needs in the course of a day go into manufacturing these enzymes. So you have to take these raw materials, you have to take the nutrients and you have to put them together to form these complex proteins called enzymes.  And then the enzymes work for a while and then they degenerate, they fall apart, and you have make new enzymes. So if you have an enzyme that’s trying to get rid of some of these environmental chemicals, right, and  let’s say you had a particularly big exposure to those environmental chemicals in the course of a day, you’re going to run through that enzyme more quickly which means you need to make more enzymes which means you need all the raw nutritional materials to create the energy for the enzyme-making process, and then all the raw materials that you’re going to construct the enzyme out of, all the different amino acids, and then you also need cofactors for these enzymes.  You need magnesium, you need Vitamin B-6 for example.  In fact, that’s what a lot of vitamins and minerals are, they’re cofactors, they are cofactors for enzymatic activity.  They make the enzymes run basically.  So you have two different sets of enzymes in the liver and in the intestines involved in this process. One is the Phase I enzymes also called the cytochrome P450 or microsomal enzyme system.  And then you have what’s called a Phase II enzyme system or the conjugating enzyme system.  Phase I enzymes basically take the raw material, the hormone like estrogen and turn it into something that is a little bit more reactive, something that the body can work with.And that’s called an intermediate.  And that intermediate is actually a highly reactive molecule. It may, in fact, be a free radical. It has to go through that process because it has to be sticky in a way is one way to think about it.  It’s a sticky molecule now that it’s reactive so you can stick an amino acid onto it or you can stick glutathione onto it.  When you stick those things onto it, it allows the body to excrete it through the body or to squirt it back out into the blood where it’s now inert so it can be filtered out into the kidneys and dumped in the urine.  So if you’re  thinking about nutrition from the perspective of these enzymes and the requirements of these enzymes, then first of all, you’re going to need a lot of those agents that are used in the Phase II system to conjugate those enzymes. And the agents would be things like sulphur and glutathione is something that I mentioned.Glutathione is a type of protein.  It’s a tri-peptide, meaning it’s got three amino acids in it.  It’s glutamic acid, glycine, and cysteine.  So you need all of those raw materials to make glutathione which is one of the main detoxifiers.  You need glycine by itself which is a detoxifier.  As I said you need sulphur to help in the detoxification process.  There’s a substance called glucuronic acid that’s used specifically to get rid of estrogen. That’s the one that gets tacked on estrogen so it can get dumped out.  All these things are being made from raw materials. You also need a fair amount of antioxidants. The reason for this is if that Phase II enzyme system isn’t working properly, then you get a build up of those intermediates.  And those intermediates are toxic.  And if those intermediates start getting spewed out into the bloodstream now in the process of detoxification, they’ve created something that’s an even bigger problem. So if you don’t have adequate storage of your antioxidants to detoxify those intermediates, then you run into a problem where you start to actually poison your body.  When you poison your body, the immune system doesn’t work very well, the mitochondria which are the little batteries or powerhouses in the cells that generate energy, they aren’t working very well, they start to get poisoned so your body cannot make adequate energy.    

MRS RAFFELOCK: Do you think postpartum women are particularly vulnerable to these problems?    

DR. ROUNTREE: Yes, because the baby is using a lot of the nutrients especially if you’re breast-feeding, you know, your body’s basically being parasitized so that all the nutrients are going out to help the baby and making immune cells for the baby, you know, your minerals and proteins, and Omega 3 oils are getting poured out in the breast milk, all those things that you need for detoxification. But also because your body has gone through this tremendous shift.  Right?  You — one day you had a baby inside of you, the next day you didn’t. Now, this tissue is going through what we call involution.  Involution is when that enlarged uterus is starting to shrink back down again.  Well, where’s all that tissue going?  It’s being reabsorbed by the body.  Well, what are the mechanisms in place to handle that?           Suddenly those enzymes in your liver and in your gut are having to deal with all that extra material that’s being sloughed off.  Okay?  So you might say, Well, what does this have to do with a woman who’s tired six months later?  It has everything to do with that because when you set these processes into motion, it can take years to recover. So this is pretty revolutionary stuff, I think and it’s straight out of the research papers. There’s really no question that this is going on. Maybe 10 years ago, you’d seen one or two papers about these enzymes and now there’s papers being published on this every single day in journals all over the world. So this is very much state of the art in terms of dysfunction in the body. What is optimal function?  Optimal function’s when you got all these nutrients, you got all these precursors and the thing is running smoothly and efficiently. But it doesn’t take much to throw it off.  Especially, in today’s toxic environment when we’re already having to deal with this onslaught of what are called xenobiotics, foreign materials that our bodies have never dealt with before and our bodies really struggle to deal with that.            So if you’ve got that going on already and then you have a baby, and your body has to deal with detoxifying all the stuff that’s left over from that, you can imagine how that can throw you out of whack.  And how if you don’t do something specifically to address that issue, then that imbalance can basically last for years. And I’ve certainly seen women who like I said earlier five years later, ten years later are saying, I was pretty healthy and then I had this baby and my health went downhill.  Well, I think this is what’s going on. A lot of this can be corrected by taking nutrients the nutrients that replenish the body’s ability to correct these imbalances and heal itself.

MRS RAFFELOCK: Thank you Dr.Rountree.

DR. ROUNTREE:You are very welcome.



2 Responses to “Interview with Robert Rountree, M.D. Part 1”

  1. 1 pregnancyrecovery November 25, 2006 at 9:11 pm

    Hi Dr. Raffelock,

    I was diagnosed with severe Hypothyroidism after my first pregnancy and as you correctly pointed out Dr. Raffelock, the symptoms really seemed to kick in after I got a nasty cold about 8 months after my daughter was born. Things got so bad I went immediately on to Synthroid (150mcg daily) to find relief and have been on it ever since. I am now pregnant with Number 2 and am interested in coming off medication and finding a natural way to deal with my thyroid after my next daughter is born. When do you think is a good time to start exploring a natural option?

  2. 2 pregnancyrecovery November 25, 2006 at 9:31 pm

    Hi Tanya,

    I’m guessing that when you say that I “correctly pointed out” something, that this is something you read in my book. I cannot give you personal health advice on the internet but I can share some generalities about the thyroid gland that may assist you to have a productive conversation with your doctor who prescribed the Synthroid for you. You and your physician will have to decide what’s best for you.

    There are many reasons for thyroid glands to malfunction. Infections like viruses are one possibility as you mentioned. Heavy metals like mercury, cadmium, and lead can bind to the amino acid L-tyrosine (instead of iodine binding to it) and prevent the adequate formation of T-4 and T-3. An autoimmune problem like Hashimoto’s Disease is another cause of first hyper-thyroid and later hypothyroidism. This was discussed in the interview with Dr. Rountree.

    Synthroid is synthetic T-4 which needs to be converted into free T-3 to have the proper effect on the cells of the body. Checking blood levels of TSH, free T4, and free T-3 to make sure that the T-4 in Synthoid is adequately converting into T-3 can be useful. The body requires adequate progesterone, DHEA, selenium, and other co-factors to convert T-4 into T-3 in the cells. Synthroid can lower TSH but still not convert into T-3 so while the blood level of TSH looks good… one may not be receiving the benefits that T-3 provides. An important key is if it helps you to feel better. Sometimes physicians prescribe thyroid medications that contain both T-4 and T-3. Thyrolar and Armor thyroid are examples of these kinds of throid preparations.

    When a physician prescribes a fairly robust dosage of Synthroid, they usually have a very good reason for this. Often the need for thyroid hormone is there because of one of the above mentioned reasons and going a natural route is not always in one’s best interest.

    My suggestion is to discuss your concerns thoroughly with your physician and decide upon a treatment plan that makes sense to both of you. Medications certainly have their place and there is no shame at all in taking thyroid hormone when it is needed.

    Wishing you good health,

    Dr. Dean Raffelock

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