Dr. Erica Zelfand is a licensed family doctor specializing in integrated mental health and functional medicine. In addition to treating patients of all ages in her private practice, Dr. Zelfand is ketamine prescriber, facilitator of therapeutic psychedelic experiences, international speaker, and medical writer. She often presents at medical conferences on the clinical applications of psychedelic healing and advocated for the recent legalization of psilocybin assisted therapy in Oregon. She also trained in MDMA-assisted psychotherapy through MAPS. In this episode of the Third Wave podcast, Erica talks with Paul F. Austin about physical wellness, integrated mental health, and legal psilocybin in Oregon.
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0:00:00.2 Paul Austin: Welcome back to the Third Wave podcast. Today, I'm speaking with Dr. Erica Zelfand, a licensed family doctor and a functional medicine practitioner.
0:00:13.1 Erica Zelfand: In my private practice, the way that I realized I needed to start considering psychedelics was that a lot of my patients were struggling with things that I could slap labels on like fatigue and malaise, depression. I'd realize, "Okay, maybe an antidepressant, maybe not. Maybe methylated B vitamins, maybe not. Maybe magnesium, maybe not. Amino acid support." No, their souls just aren't happy because they're not doing what they came to this planet to do. And there's no vitamin for that, of getting somebody's mind aligned with their soul for accomplishing the things they wanna do in the short time they have on this strange, chaotic, beautiful world, in this outrageous human body.
0:01:02.3 PA: Welcome to the Third Wave podcast. I'm your host, Paul Austin, here to bring you cutting edge interviews with leading scientists, entrepreneurs and medical professionals who are exploring how we can integrate psychedelics in an intentional and responsible way for both healing and transformation. It is my honor and privilege to bring you these episodes as you get deeper and deeper into why these medicines are so critical to the future of humanity. So let's go and let's see what we can explore and learn together in this incredibly important time.
0:01:39.6 PA: Hey listeners, I am so excited to have Dr. Erica Zelfand on the podcast today. We go deep into the topics of microdosing, of autoimmune issues, of testosterone, and estrogen, we talk about Erica's path and story going from McGill University to Naropa and to becoming a psychedelic-licensed family doctor, someone who understands those intersections of psychedelic medicine, functional medicine and care, love and compassion.
0:02:11.7 PA: Dr. Erica Zelfand is a licensed family doctor specializing in integrated mental health and functional medicine. In addition to treating patients of all ages in her private practice, Dr. Zelfand is a ketamine prescriber, a facilitator of therapeutic psychedelic experiences, international speaker and a medical writer. She often presents at medical conferences on the clinical applications of psychedelic healing and advocated for the recent legalization of psilocybin-assisted therapy in Oregon, USA. She also trained in MDMA-assisted psychotherapy through the Multidisciplinary Association for Psychedelic Studies, otherwise known as MAPS, and is a volunteer trip sitter, medical lead and psychedelic harm reduction workshop co-facilitator with the Zendo Project and other organizations.
0:02:53.5 PA: Dr. Erica and I met for the first time many, many moons ago virtually and then when I spoke at the Wonderland conference last year, we were on a panel together and had a chance to have lunch together, prior to that and get to know one another and she's such a heart-centered compassionate facilitator while still very, very, very sharp. So you're gonna love this interview with her today.
0:03:18.2 PA: Before we dive into today's episode, a word from our sponsors.
Hey, listeners. Today's podcast is brought to you by Beckley Retreats. Dubbed the Queen of the Psychedelic Renaissance by Forbes, Amanda Feilding founded the Beckley Foundation in 1998, a think tank and NGO dedicated to furthering psychedelic research and advocating for evidence-based global policy reform. Now, Beckley Retreats is building a bridge between scientific research and ancient wisdom traditions, the result being a richly transformational program based in community for people seeking the next level of well-being, of purpose and creativity. As a trusted partner of Third Wave, we strongly recommend the upcoming retreats for Beckley in Jamaica, as well as many other locations. Head to go.beckleyretreats.com/thirdwave to book your transformational psilocybin program today. That's go.beckleyretreats.com/thirdwave to book a retreat with Beckley Retreats today.
0:04:25.9 PA: Without further ado, here's my conversation with Dr. Erica Zelfand.
Erica, welcome to the podcast.
0:04:35.3 EZ: Thanks for having me. I'm really excited to be here.
0:04:37.6 PA: As am I. We had a chance to spend some quality time together in Miami at the Wonderland conference that was there last year. And you've been working with the team at Microdose a little bit on this Science of Psychedelics course, which I wanna touch on later. But before we get into sort of all the juicy stuff of microdosing and what's going on in the scene in Oregon, legalizing psilocybin-assisted therapy, I'd love if you could just provide a bit of a frame for our audience in terms of how you got here.
0:05:04.8 PA: And when I was doing some initial research, I noticed that you had attended one of the most prestigious universities in Canada, McGill University. You initially did not study medicine, you went back to study medicine afterwards and then attended a very unique medical school in Oregon. So I'd love if you could just tell us a little bit about that journey, why you chose to become a medical doctor, why you chose to attend that university in Oregon and how that eventually led you into the psychedelic space.
0:05:33.7 EZ: Yeah. Sure. Well, there's that saying "We plan, God laughs." There's also that line by John Lennon, "Life is what happens when you're making other plans." And that's very much the story of my career progression and my personal life unfolding for that matter. So as you mentioned, I went, did my undergraduate degree at McGill University in Montreal, Canada. When I went to university, I really had no idea what I was doing there. I really could have used a gap year, but my folks said, "That's nice. If you want a gap year, you can go get a job and pay for it all yourself." And I was like "Ah." [laughter]
0:06:12.1 EZ: "I think I'll go to university and try a few things and see what sticks." So I started out as a political science major because I didn't know what to major in and I guess that's what you major in when you don't know what to major in. And my first class that I went to had literally 300 students in the class. The class was so big that we filled the largest lecture amphitheater in the faculty of arts building and then there was a spillover room where there was another amphitheater where you watched the class on a TV screen. And the first day of class, I was sitting there in, whatever, the 50th row, and I looked to the right and to the left, just to this sea of students and the teacher started talking and it just sounded like.
0:06:55.9 EZ: And I said, "I think I'm in the wrong place. I don't think I'm supposed to be here." So I went to the registrar and I said, "I'd like to change my major." And they said, "Okay, what would you like to change it to?" And I said, "What's the smallest department in the faculty of arts? I want small classes." They said, "Religious Studies." And I said, "That's perfect. I'll do religious studies." And it wasn't just for the numbers reason alone, I was actually very interested in Eastern religions when I was in high school, I created an independent study with some of my friends and we were reading the readings of Zhuangzi and Tao Te Ching and very much interested in Eastern philosophy.
0:07:37.3 EZ: And so, my undergraduate degree was actually in studying religion. I did... I was supposed to go to Southeast Asia. I had these beautiful romantic plans of shaving my head and being a Buddhist nun in a monastery and those plans were canceled by SARS. Do you remember SARS?
0:07:53.4 PA: I remember SARS.
0:07:57.5 EZ: They canceled the whole program. So I was scrambling, figuring out what to do with my study abroad opportunity and a religious studies teacher who, I kid you not, his name is John Milton said, "Hey, there's a great Buddhist university in Boulder, Colorado." And I was like, "Okay, let's check it out." And so I did my study abroad at Naropa University in Boulder, Colorado. And while I was at Naropa University, I took an elective course called Approaches To Healing. And it was a survey course of different types of natural and alternative complementary medicine systems, everything from Ayurveda to osteopathy, acupuncture, etcetera, etcetera. And the course was taught by a naturopathic physician named Janine Malcolm. And when the course was finished, I loved the course, it was super interesting to me and she said, "Hey, if any of you ever wanna come do a job shadow, my door is always open."
0:08:54.5 EZ: I was like, "Yeah, yeah, yeah, that's nice." I went back to McGill, was preparing all my applications, I wanted to go to Oxford University and do a master's in comparative literature 'cause I took on a double major of English literature. And a friend of mine said, this is a direct quote so pardon my language, she said, "When are you gonna pull your head out of your ass and realize you're supposed to be a doctor?" And it was just one of those like butterfly flapping its wings moments in my life where it was like as if someone had slapped me across the face and I was like, "What are you talking about?" But those words really, really rippled and unfolded in my life and I realized like, "Hey, that's what I'm supposed to be doing. That's the path." Oh, but conventional medicine, man, I have all kinds of issues with how the American medical system is operating and treating illness, treating the human body.
0:09:48.3 EZ: Then I remembered Janine had offered this opportunity of a job shadow, so before I knew it, I was back in Boulder, Colorado and observing her treatments with patients and going, "Okay, naturopathic medicine, that's what I wanna be doing." And then I was faced with this question from well-intentioned people who kept saying, "Well, you're smart enough, why don't you become a real doctor?" I was like, "Ooh, I think that is a real doctor." That's what I wanna be doing. That's real healing what she's doing. Actually, identifying the causes of people's illness, educating them, empowering them, and then aligning them with allies, yes, in the pharmaceutical world, but also in the natural world for the body to return to harmony.
0:10:34.9 EZ: And that's how I found myself at the National University of Natural Medicine in Portland, Oregon, which is one of very few still operating naturopathic medical schools that is accredited as a medical school in North America. So that was not the plan [laughter] at all. I thought I was gonna be, I don't know, teaching literature courses in a university somewhere for the rest of my life wearing a blazer with the leather cut-outs over the elbows. I thought that that was gonna be me.
0:11:06.5 PA: With a shaved head maybe even. Yeah, the...
0:11:09.6 EZ: Maybe, yeah. Maybe as a Buddhist nun. English professor, Buddhist nun, I don't know, but...
0:11:14.4 PA: Exactly.
0:11:15.7 EZ: Yeah. I don't know what happened.
0:11:19.0 PA: Where did you go... And so many questions now that I'm curious about because just the fact that you chose to go into religious studies, there's an interesting overlap there with sort of the awareness that psychedelics open up, that you studied and were interested in these Eastern religions that you went to Naropa. So there are sort of like... There's clearly a lot of signs showing up that at some point you would sort of enter the psychedelic space. And so, I'm wondering, A, where did you grow up? What type of family life did you grow up in? What was that environment like? And then, at which point did psychedelics sort of enter the picture, either personally for you or both personally for you but also professionally? I'm curious about that as well.
0:12:08.4 EZ: Sure. It's interesting to hear you say that there were these clues that psychedelics might play out in my life because I never thought of it that way, actually, but now that you mention it, I do see it. I grew up... I was born in Canada to Russian immigrants, so I'm a first-generation Canadian, then we moved to the United States when I was a baby, so I spent most of my childhood in a lovely, just quintessential New England town outside of Boston. And I grew up in a town, I grew up in a... To Russian Jewish immigrants who were really not allowed to practice their religion in Russia. And here we were in the United States sort of figuring out what it meant to be an American Jewish family and I was in a suburb that was predominantly Jewish as well.
0:13:01.0 EZ: So that was the container, that was the context that I knew. And there is something, I hate that it's a trope but it's true, this trope of the Wandering Jew that I just always been very... Even from an early age, very interested in metaphysical things, very curious about how other people pray, how people worship, the many paths to spirit, there's this saying in Buddhism "Many paths, one Dharma" and how that plays out in life. And so, there was this yearning and this curiosity for a connection, a deeper connection, a stronger connection, more paths of connection to spirit, to spirituality, to life essence, that as a university student, declaring a major in religious studies was how I could do that.
0:13:57.8 EZ: And then when I started studying naturopathic medicine, there's this core philosophy in naturopathic medicine called Vitalism. And it essentially means that the organism, not just the human organism, but nature in general wants to be alive, wants to press into healing, wants to shift into alignment with itself, with nature. And when I'm working with my patients, I feel like part of what my job is to assess "How vital is this person? How strong is their vital force?" In Chinese medicine, they call it Chi, right? And to augment that and work with that and flow with that.
0:14:39.8 EZ: So I wasn't expecting my studies in medicine to be so spiritual, but I felt like they really were because I felt like what I was trying to do was align with a person's vitality, with their core oomph, what makes their heart beat, what makes them kick. And in my private practice, the way that I realized I needed to start considering psychedelics was that a lot of my patients were struggling with things that I could slap labels on like fatigue and malaise, depression or, I love this one, adjustment disorder. It's like, you don't know what to write, just write adjustment disorder. Adjustment disorder with depressed mood, adjustment disorder with anxiety, sleep disturbance.
0:15:26.2 EZ: And then as I would talk to these people, I'd realize, "Okay, maybe an antidepressant, maybe not. Maybe methylated B vitamins, maybe not. Maybe magnesium, maybe not. Amino acid support." No, their souls just aren't happy because they're not doing what they came to this planet to do. And there's no vitamin for that, of getting somebody's mind aligned with their soul for accomplishing the things they wanna do in the short time they have on this strange, chaotic, beautiful world, in this outrageous human body. And the closest tool I had for that was homeopathy. And I'm just gonna be honest, I'm not a very good homeopath. I took extra courses in it, it's just... I love that system of medicine, I'm not good at it.
0:16:21.7 EZ: And then I realized as my own personal work with psychedelics was unfolding, it was actually when I was in the medicine space that the medicine was like, "Psst, hey doc, pull your head out of your ass. [laughter] You're supposed to be giving people psychedelics." It was like it was this eureka light bulb moment, it was like, "Wow, yeah." People aren't cars. Medicine isn't car mechanics. And when we talk about mind-body medicine, that's great. What are we missing? The soul. What about mind-spirit medicine? So bringing that home. I love my job. I love my job.
0:17:03.3 PA: Psychedelics, almost as a vitamin of vitality, that's sort of what I'm hearing reflected back. That there isn't a B vitamin or amino acid that's gonna address sort of the malaise of the soul. But when psychedelics are used within a container, they can sometimes, they often act as that vitamin of vitality. And that's what I often talk about even in relation to my own experiences with psychedelics is they've allowed me to become even more vital through their use because they open up this sort of deep, primal, ancient wisdom or capacity that normal everyday life either represses or suppresses or keeps down because it's so wild in that way. And there seems to be this relationship between healing and our capacity to get in touch with that sort of wild human nature.
0:18:00.6 EZ: I like that. Yeah. Yeah, there's a... Sometimes it's wild but it's an authenticity, it's a realness, it's a taking off of the mask. And so often, I'm using that language, because that's what I hear people say so often. So when I say, "Why do you wanna do this work?" They say, "'Cause I know I'm walking around with a mask on and I need help taking it off. I'm terrified. I don't know how to do it. I know I need to do it. I'm scared to do it. I don't wanna do it but I wanna do it." Essentially, people wanna become themselves.
0:18:41.1 PA: That's beautiful. And that gets a little bit to... It really gets into something that you had mentioned on your website, which is that you really see yourself as a detective-teacher rather than a doctor. And so often when we think about this sort of new paradigm that psychedelics introduce, a large part of it is moving away from prescriptions and moving into almost like an allowance or a guiding rather than a direct pointing. And I'd love if you could just expound on that a little bit, where that came from, what was the origin of that framing and how does that play out on your own practice, in particular as it relates to psychedelics.
0:19:38.3 EZ: So I was taught in school in particular by one of my mentors, Dr. Dixon Tom, to always ask why. Why? Okay. This patient is tired. Why? Oh well, she's anemic. Why is she anemic? Oh, her periods are heavy. Why are her periods heavy? Oh, she has a uterine fibroid. Why does she have a uterine fibroid? And as we're answering those questions, sometimes there are biomedical answers. "Oh, because they have this disease." "Oh, because they have this gene or they're not eating enough of this in the diet." "This is happening because there's a growth in the body." "Why is there a growth in the body?" And sometimes there isn't a biomedical answer. "Why does this person get migraines?" "Oh, because they're constipated." "Why are they constipated?" "Oh, because they have slow transit time." "Why do they have slow transit time? Their thyroid looks normal, they're eating healthy, their nerves and their gut are... Like, why?"
0:20:45.6 EZ: And as I talk to the person, I feel like to be a good doctor, I do have to be a detective because I'm listening, I'm listening for clues. And sometimes the clues I get are mental-emotional. Oh, this person's constipated because they hold. Why do they hold? Oh, because they were taught in childhood that any time they spoke, bad things would happen. So they learned to hold the stuff in, right? And then if we come at this from a biomedical standpoint, sorry, we're talking about poop a lot, and give this person, "Okay, just take some MiraLAX then you'll go to the bathroom." Okay, but you've just overridden the nervous system's mechanism for how it thinks it needs to be working. So the nervous system is going, "This holding pattern isn't working enough, I need to hold even more." And then this person is not only constipated, but now they have insomnia because they're holding.
0:21:45.5 EZ: There's no vitamin for that. We can do MiraLAX and then we can do Ambien for the sleep. Okay, now the nervous system needs to hold in a different department. Where is it gonna hold next? So, listening, and you can't do that in a seven-minute visit, which is what the conventional medical model calls for, unless you're psychic, which I'm not. [chuckle] I need to listen to the clues. So that's the detective piece.
0:22:20.6 EZ: And then the other thing I say is that I'm not a doctor, I'm a teacher. I'm not a... There's this beautiful word "healer" and I really would love to consider myself a healer, but it also implies that I have some kind of magical powers, which I don't. I teach people what's happening in their bodies and then I use my knowledge of physiology, of botanical medicine, of the healing systems I know, to then tell that person, "Based on what your body is telling me, I think it is crying out for X, Y, or Z. And here's how to give that to your body. Here's why I think you might need this, here's how to do it." And then it's up to the person to go and do it.
0:23:02.6 EZ: And my hope is that I can educate them enough that they feel like, "Man, I gotta do this." [chuckle] And then go take care of themselves. But whether they do or don't, that's the part I can't control. So I can offer information and support, I don't do the healing. The person's body and nature does the healing. And that comes into my work with psychedelics as well because when I'm teaching students on psychedelic facilitation, I think less is more and I kinda joke that when patients come to me for a psychedelic work, say with ketamine or when I'm working abroad with psilocybin, I joke, "You know, the patients aren't coming to see The Dr. Zelfand Show, they're coming to do their healing."
0:23:49.5 EZ: And I set the stage for that. I help make sure they're safe, I support, I create a container, then I get out of the way. I shut up and I get out of the way. And I literally, depending on the space, leave the room. Just leave the door cracked. Just trust. Trust that the medicine works, trust that the person's inner vitality, that the healing power of nature is within them and without them, the medicine works.
0:24:20.4 PA: And this has really become in the last few years, the psychedelic tool has become, from what I understand, one of the core tools in your toolkit. And I imagine that will only continue to grow and develop as legalization crests in the mainstream. And I do want to touch on that. I know we talked about that prior to the podcast, I wanna talk about your work with InnerTrek and psilocybin facilitation. But before that, just as a transition from that sort of detective teacher framework into specifically psilocybin facilitation, I'd love if you could just talk us through some of your healing systems.
0:24:56.6 PA: On your website you have about—it might be 13-14 healing systems that you have and utilize in your toolkit. And I'd love to just hear a little bit about what... What healing systems do you find yourselves most commonly using, most commonly utilizing? Are there three or four in particular or is it really sort of a balance between all of them? I'd love to start there and then I have some questions about how that relates to some of the biomedical and other psychedelic stuff that we've been talking about so far.
0:25:25.2 EZ: Sure. Sure. Yeah, so in terms of the healing systems, it's tricky. I love having a lot of tools in my toolkit because I don't think medicine is one size fits all. And I think different systems of healing, even different dose ranges, different philosophies of healing are gonna work different for different types of patients. So part of it is assessing patient's vitality, assessing their temperament, assessing their lifestyle, what's their compliance gonna be like with different things, but by far and away, the most common thing that I use in my practice, now keeping in mind, I practice in North America, so North Americans are primarily suffering from and dying from diseases that are largely preventable through diet and lifestyle. So that is really the backbone of how I work with my patients.
0:26:15.7 EZ: We talk a lot about nutrition. What are you eating? We talk a lot about digestion. I kind of joke, I talk about poop all day long. And the interplay between the immune system, the digestive system, the hormones, how all of that interplays in a person's health. So really teaching people about how their bodies work, reinforcing the healthy alliance with food. Our relationship with food has become so fractured in this culture where people don't... They know they need to eat healthier, they don't know what that means. Does that mean keto? Does that mean paleo? Should I be plant-based? Should I be doing intermittent fasting? Is it a calorie in and calorie out, is it calorie a calorie? Should I not eat foods that are purple on Tuesdays? What about this blood type dieting? People are confused about how to eat. We've lost a lot in our culture also in terms of people don't know how to cook. People don't know how to prepare food anymore.
0:27:26.6 EZ: So when I say you need to eat healthy, they say, "Yeah, but I don't know how to cook." I'm like, "Okay, can you buy some carrot sticks and a rotisserie chicken at the grocery store?" Like, "Oh yeah, sure. I could do that." "Okay. Can you have a bunch of hard boiled eggs in your fridge and grab one every morning on your way to work?" "Oh yeah, I can do that." So a lot of work around nutrition and then a lot of work around lifestyle. Work-life balance, sleep hygiene.
0:27:54.5 EZ: Americans have disgusting sleep hygiene. I'm like, "Oh, what do you do before bed?" "Oh, I take my iPhone into bed and I doom-scroll for an hour." Okay. You don't need Ambien, you need to put your phone down and do some diaphragmatic breathing or like fold your laundry or call a friend. My goodness. So, do you exercise? Do you move your body? Do you move your body 'cause you have to? Do you hate every minute of it? Let's talk about that. Why aren't you taking a dance class if that would bring you joy? Why are you forcing yourself to go run around the track, which you hate doing? So creating attainable goals in sustainable ways is the foundation. And sometimes patients say, "Okay, yeah, but what supplement are you gonna give me?" And I'm like, "You need to earn your supplements." [laughter] You need to eat your own food and poop once a day. And then we'll talk about if you even need a supplement anymore.
0:28:51.0 PA: I love that. Attainable goals in sustainable ways. And this is something we touch on in our training program for coaches as well. There's a real focus on the biological in terms of diet and lifestyle, sleep, exercise, movement, sunlight. You could also include meditation, breathwork, yoga, some sort of mindfulness practice.
0:29:09.9 EZ: Absolutely. Yeah. Or even do you do every day, do you do something that you love? Even for five minutes, do you do something you enjoy every day? Do you laugh every day? Do you laugh once a week? Do you laugh once a month? Some people don't.
0:29:30.8 PA: Right.
0:29:32.1 EZ: When's the last time you cried? Questions like that.
0:29:37.9 PA: The expression of emotions, getting back to that point of vitality, 'cause oftentimes, the ability to feel emotions and express emotions is intimately tied to the level of vitality that we're able to bring into our life as well.
0:29:52.7 EZ: Absolutely.
0:29:54.1 PA: Kind of a particular question then that goes into lifestyle and diet and nutrition is the role of the thyroid. You had mentioned that earlier, it's also, I think, a pretty prevalent thing that's on your website and I'd love if you could just kind of—what is the role of the thyroid in functional medicine? How could we identify if there might be issues with the thyroid? Just kinda give us a lay of the land as it relates to thyroid and how it's tied to health.
0:30:19.3 EZ: Absolutely. Great question. Well, I'll say, first and foremost, the biggest mistake that I see other doctors making is that when they're treating patients with depression, they put them on an antidepressant medication before they check their thyroid. Hypothyroidism, meaning under-functioning of the thyroid, is the number one organic cause of depression in the developed world. So before you start spending tons of money on therapy to talk about your mother or before you take that Prozac, get your thyroid checked. Super, super basic important and if you're hypothyroid and you don't address it, your depression's not gonna get better and you're gonna have other health problems as well.
0:31:03.8 EZ: So in terms of what the thyroid is and what it does, the thyroid is a gland shaped like a butterfly and it sits right here on the front of the neck. And unlike other glands in the body, in the hormonal system, those are buried a little deeper in the body. Some are in the brain, some are in the abdomen, in our trunk, this sits right at the front of your neck. It's super vulnerable. It's super exposed. So the thyroid is a bit of the canary in the coal mine in terms of endocrine health, in terms of hormone health for everyone, especially, especially, for women.
0:31:41.1 EZ: So what the thyroid does is it secretes thyroid hormone, and thyroid hormone is like it goes to virtually every cell in the body and steps on the gas pedal. So whatever the function of that cell is, thyroid hormone revs it up and makes it work more. So thyroid is what makes your heartbeat regular. So if you're hyperthyroid, your heartbeat's gonna be... It might be too fast, if you're hypo, it might be slow. It controls oil secretion in the skin. That's why people with hypothyroidism often have a dry skin or they... Wrinkly skin or they look older than they are. Energy levels. People with hypothyroidism are often tired. People with hyperthyroidism might have insomnia, might have trouble sleeping. And mood. Hypothyroidism, more likely to be depressed, hyperthyroidism, more likely to be anxious or revved up, irritable, easily aroused, things like that.
0:32:39.0 EZ: And it controls so much more including cardiovascular health, including how many people in this country have high cholesterol? That's linked to thyroid. How many women have issues with their menstrual, with their monthly menstrual period, right? That's linked to thyroid as well. So many women have issues with fertility in this country. And it's not my specialty, but I do have some patients who are going through IVF and working with infertility, spent tens and thousands of dollars on IVF, nobody checked their thyroid. And that was the problem. Check the thyroid, put them on half a grain of thyroid replacement, they get pregnant two months later.
0:33:24.0 EZ: So a big vulnerability for the thyroid is environmental toxicants and this is where sometimes I think people might think that I'm like the crazy lady with the colander on her head screaming on the corner, we live in a really toxic world. Fluoride in the drinking water, terrible for the thyroid. And not just in the drinking water, but when you take a shower, anything that's in that water, it's gonna get vaporized, you breathe it in, that affects your thyroid. Junk in the food that we eat. Stress hugely affects the thyroid. If you're not exercising, if you're not stimulating your metabolism, if you're not eating regularly stimulating your metabolism, if you're living in this constant low grade level of stress that we do in this culture, you're doing your thyroid huge harm.
0:34:22.1 EZ: So, unfortunately, by the time somebody comes to see me, I have to scrape them off the floor, we're not even playing the preventative game anymore. But it's a growing, growing number of individuals, in particular, women who are having thyroid problems.
0:34:41.2 PA: I'd love to dive a little bit deeper into that because we haven't spoken about it in the podcast before and it's even bringing up ideas and thoughts about some of our own training program, let's say, there's a facilitator or a coach or therapist who's working with psychedelics, they're interested in functional medicine and they're interested in either doing this for themselves or for the clients that they work with, how might they navigate that? Is there sort of a test that you can just take at home to check your thyroid levels, do you need to go [to] a functional medicine doctor to get that checked? And then, how... If someone, let's say, has hypothyroidism, what are usually some of the things that you ask them to do to adjust that? And it could just be the lifestyle changes that we mentioned already but I don't know if there's anything else in particular.
0:35:30.2 EZ: Lifestyle change is huge, huge and minimizing exposure to toxicants. In terms of testing, I do practice functional medicine, I like it. You don't have to... This is what kind of drives me bonkers is you don't have to do a $10,000 functional medicine program to understand this stuff. And so sometimes I'm like banging my head against the wall, I'm like, "What are my colleagues doing?" [laughter] So the most basic test of thyroid function is called the TSH, a thyroid stimulating hormone. When you order a TSH on a patient and you get that reference range back, that reference range is huge and it says anything upto like 4.5 is normal. If someone has a TSH of 4.5, that's not normal. Sorry, not sorry. I like to see it under 2.5.
0:36:24.0 EZ: So what a TSH is, thyroid stimulating hormone, it's actually secreted by the brain and it's the brain's signal to the thyroid, essentially putting it in order like, "Hey thyroid, make me some hormone." And so, if the TSH level goes up, it means that the brain is yelling at the thyroid, "Hey, I need you to work harder for me. What are you doing down there?" So if someone has a TSH of 4, it's technically in the reference range recording to the lab, but I've never seen someone with a TSH of 4 who felt well. So it's understanding the test, but also the reference ranges.
0:37:06.2 EZ: The other tests to look at are to check thyroid antibodies. Thyroid, and I can write these down for you, you can put them in the show notes if that feels relevant but...
0:37:15.0 PA: That would be awesome. Yeah.
0:37:16.0 EZ: Thyroid peroxidase antibody and thyroglobulin antibody. What those antibodies are looking for is to see: is there an autoimmune process? Meaning, does this person's own immune system for some reason think that it needs to be attacking this person's thyroid? We're seeing a growing number of autoimmune diseases in this country, in the United States, one in seven people has an autoimmune disease, that's a lot, that's a lot of people. And so, sometimes what happens is I can order a whole thyroid panel on someone, not just the TSH, but also their free T3, free T4, reverse T3, I'm throwing a lot of medical jargon out there, forgive me. Things might be more or less in range, but then it comes back they have thyroid antibodies that are positive. And what that tells me is your immune system is starting to attack your thyroid. It hasn't killed off so much of your thyroid that these lab tests are abnormal, but if you keep doing what you're doing, your immune system is going to destroy and injure your thyroid. And you're really gonna be up a creek. And yeah, we can treat that but it's a heck of a lot easier to jump in and do the preventive piece at the beginning.
0:38:32.5 EZ: Again, especially important in women, women are the canaries in the coal mine when it comes to endocrine health. Women are a lot more sensitive to environmental toxicants and because of the nature of what we do, how we have periods, we have babies, etcetera, etcetera, we go through menopause, we have these big triggers that can really jolt our systems into autoimmune processes.
0:39:00.6 PA: That was a beautiful description.
0:39:00.9 EZ: Thanks.
0:39:01.2 PA: I feel like that in itself is a $10,000 class that I just took...
0:39:03.9 EZ: Oh, see, there you go. Now you don't have to... [laughter]
0:39:05.8 PA: On the thyroid. And I have so much more context now on some of the endocrine system. So the natural follow-up that I have to that is testosterone.
0:39:13.9 EZ: Yeah.
0:39:15.0 PA: If thyroid health is very... Men and women struggle with it, but it is, like you said, women are much more sensitive to it. I think another epidemic that we're seeing in the male population is very low testosterone. And I'd love if you could just provide sort of a brief on your understanding of that and what's happening, what's responsible for low testosterone levels, basically, a rinse and repeat of what we just covered with the thyroid would be phenomenal.
0:39:44.6 EZ: Sure, you've got it. One more thing I'll say about the thyroid is the thyroid needs nutrition. So if your iron levels are low, you're not gonna make enough thyroid hormone. And when you're a woman and you bleed monthly and now you wanna play around with being a vegan, hmm, it makes me real unhappy [laughter] as a functional medicine doctor.
0:40:09.3 EZ: Okay, so to address your question now about testosterone. Yes, a growing thing that we're seeing, it's a multi-billion dollar industry, also the low T clinics, this is another thing that I see in medicine where people are kind of popping up with these low T clinics and charging a lot of money for membership for... I don't know, a drug that I can just prescribe through a regular pharmacy, I don't get it. But I do get it, business, money, right? I'm a bad capitalist. So, for men, we are starting to see low T. And we're seeing it for a couple of reasons: One, there's a reason that women live longer than men. Men are nuts, they do crazy things, especially in adolescence. And a lot of them have a history of a head injury. So if you played football in college or you got blackout drunk at a party and got punched in the head or fell backwards off of a porch when the railing broke and hit your head, history of a head injury can derail the communication between the hypothalamus and the pituitary. These are two parts of the brain that are intricately connected when it comes to hormonal health.
0:41:28.3 EZ: So the hypothalamus talks to the pituitary, the pituitary then talks to the other organs in the body, one of them being the gonads, the testes. So, sometimes it's a blunt head injury that has caused somebody's problems. Sometimes it's an indirect head injury and I think the way in which we've structured our society and our relationship with stress and our relationship with technology is a head injury. So you've got other guys who never been punched in the head, never been knocked out, never had a concussion, but sleep like five hours a night, stay up late gaming or are addicted to porn or addicted to their screens, eat garbage, so their blood sugar is all over the place, they don't meditate, they don't exercise. And essentially, their immune system is just in this constant state of stress.
0:42:25.5 EZ: After a while, something's gotta give. And reproduction is pretty low on the list of functions. You don't need to reproduce to... The species needs to survive, but you'll survive if you don't reproduce. So a big part of the work that I do with men is actually rehabilitating their nervous systems. And they wanna talk about, "Okay, should I be doing testosterone cypionate or enanthate or should I do Sustanon?" And I'm like, "Dude, you need to sleep eight hours a night and meditate and balance your blood sugar. You might not need any of these drugs."
0:43:05.1 PA: Maybe lift some weights, right? Maybe...
0:43:06.0 EZ: Maybe lift some weights. Yeah, like...
0:43:08.1 PA: Do some kettlebells.
0:43:09.5 EZ: Yeah, maybe like go 60 days without looking at porn, like give yourself a break here. So... It's brain, it's essentially all brain and... Not all, but in parts of the world, you can see men have low T caused by something called primary hypogonadism and that means there's a problem with the testicles. The testicles don't work properly, they can't make enough testosterone. A majority of cases that I see in my practice in North America is secondary hypogonadism, meaning the testicles work just fine, they're just not getting the proper signal to work. The brain isn't talking to them. If the brain talked to them, they'd make enough testosterone.
0:43:54.2 EZ: And so, those guys, if we... When we do kind of go down the line and diet, nutrition, all that jazz is locked in, those guys actually do pretty well with hCG as opposed to straight testosterone because the hCG is like a synthetic... It mimics the way the brain stimulates the testicles. So the hCG stimulates the testicles and the testicles make testosterone as opposed to injecting testosterone straight into the bloodstream, which lets the testicles get lazy. I'm not into making lazy glands. I don't think that's a good practice if we can avoid it, yeah.
0:44:29.4 PA: Not a good practice, no. And my sense is, just like you had mentioned with the thyroid, hypothyroidism, first get that addressed before you start an SSRI or addressing these other things that are related to depression. And my intuitive sense is that's also true for a lot of men. In other words, first address if you have... Get your testosterone checked to see if you have low T. Address that first and do what needs to happen to address the low T and that will probably prevent you from needing to go maybe on an SSRI or other things as well. That's why I picked that as the more male one 'cause I just... I've been hearing more and more that it's I think an epidemic, not a pandemic, but it's an epidemic now with a lot of men.
0:45:16.2 EZ: Yeah. The other thing I'll say about the low T is a lot of guys think they have low T. And if you go to a low T clinic, I don't mean to demonize all of them, they're not all like this, but some of them, no matter what your level is, they'll say, "Yeah, you have low T." And a lot of guys think they have low T because they have erectile dysfunction. And although testosterone does inform erectile health, the other thing that hugely informs erectile health, first of all, is the nervous system. You have to be in your parasympathetic state to get erect, you have to be in your sympathetic state to ejaculate. So you need to have good nervous system tone.
0:45:55.8 EZ: The other thing that hugely affects erectile health is the cardiovascular system because what an erection is, is it's the blood vessels in the penis dilating, blood flowing in, then those vessels constricting, trapping the blood in the area. That's what an erection is. So all the testosterone in the world isn't gonna do anything for you if you have cardiovascular disease. And because the blood vessels in the penis... A joke, even in the most well-endowed man, the blood vessels in the penis are small as compared to the vessels in the rest of the body. So erectile dysfunction can be the first warning sign of a cardiovascular disease. You can have erectile dysfunction for like... I think there was a study showing something like seven years before you'll even have a high blood pressure reading. So looking... So it's back to diet, it's back to lifestyle, it's back to stress management, meditation, moving your body, eating real food, things like that.
0:46:58.8 PA: It's also the canary in the coal mine, which is the same thing that you mentioned for the thyroid, right? And so that, I think for men is usually a good sign that if the core biological mechanism that we're here for, which is really to reproduce in some ways, is not all of a sudden working, then that's probably a good sign that something is off in a pretty significant way.
0:47:19.1 EZ: Yeah. Little side note. I was recently visiting my best friends and we were kind of like wrestling and roughhousing and the little boy impaled himself, not quite in the business, but in the neighborhood and his dad said, "Careful bud, you wanna be able to have babies someday." And his little boy said, "I don't wanna have babies, dad. I wanna live alone and play video games." And we were like, "Yep. That's this next generation, isn't it?"
0:47:51.8 PA: TikTok, gaming.
0:47:53.8 EZ: Yeah. “Wanna live alone and play video games.”
0:47:55.1 PA: Yeah, hopefully that'll change, hopefully that'll change. All right, so we've kinda covered a smorgasbord of...
0:48:02.0 EZ: Yeah, we have.
0:48:03.1 PA: Of things so far and I wanna get this all the land is in sort of the last here 15, 20 minutes of our conversation and talk about a really exciting project that you have been a part of, that you're helping to pioneer, which is a psilocybin facilitator training program with InnerTrek. And correct me if I'm wrong, but I believe that's alongside Tom Eckert, who was one of the core architects along with his...
0:48:26.6 EZ: His late wife.
0:48:28.7 PA: Recently passed wife, Sheri of the proposal 109 for Oregon. So I'd love if you could just kind of a bit of a switch here, but I'd love if you could kinda bring us into how you got involved with InnerTrek, what is it that InnerTrek is doing, what's going on in Oregon with proposal 109 and facilitator training programs, just sort of help us get that lay of the land for our audience.
0:48:52.2 EZ: Sure. Yeah. Well, it's a really exciting time. And it's funny, the other side of the coin of excitement is fear, it's definitely like a, "Whoa, here we go." I feel like coming down on a roller coaster like, "I'm having a good time." It's definitely a bit of that energy right now. Oregon was, as you know, but maybe the listeners don't, Oregon is the first state in the United States to legalize psilocybin services, not just a city, but the whole state, and not decrim but legalize, with some caveats, being that psilocybin needs to be consumed on a licensed premises, the person has to stay on the premises the whole time, and they're accompanied by a licensed facilitator, and the substance they're taking is regulated, a licensed psilocybin preparation.
0:49:46.3 EZ: So that is gonna take into effect next year in 2023, and in the meantime, we gotta train the army 'cause there are a lot of people who wanna take advantage of accessing psilocybin services legally above board, and the Oregon Health Authority has stated that if somebody wants to facilitate that process and have a license, they need to go through a mandatory training program. And so, I'm really, I know people use this word a lot, but I really mean it, I really am honored to be a part of InnerTrek, which is one of what I anticipate will be many programs popping up over the next few years, but to be working alongside Tom, who was one of the masterminds behind this whole ballot measure, who's been working without pay tirelessly over the last seven years to make psilocybin accessible to as many people as possible. Who lost his wife in the process, grieved hard, and then picked himself up and said, "I gotta keep going, I gotta keep doing this for her at this point to honor her."
0:50:58.6 EZ: And so, but it's also this process of, we joke that we're building a plane as it's going down the runway because we're creating the program and then the Oregon Health Authority will give some guidance on like, "You can do this, you can't do that. Never mind, we don't want this many hours in this department, we need... Now you need three times as many hours." And then we go, "Ugh" and then we scramble and change the whole thing. And then the Department of Education came knocking and was like, "Hey, wait a minute, you're doing professional trainings, you need to be licensed by the HECC." And we're like, "Are you kidding me?" [laughter]
0:51:37.0 EZ: So there's a real labor of love that comes with being first to market with something. It means that all of the hard stuff gets thrown at you. All of the expensive stuff, all of the last minute pull your hair out stuff and I'm so grateful that I'm part of a team, that we can do it together as a team. I don't think any one of us could do it alone. And we really are, not just with the InnerTrek team, but with the other programs that are starting, I feel like we're a village and we're like, "Okay, how do we convince the Department of Education that we're legit even though we're teaching how to work with a substance that's still federally a scheduled one? How do we convince the HECC to give all of us licenses to open our programs?"
0:52:32.3 EZ: So, administratively, it's a nightmare, but I think it's gonna be well worth it. I know it's gonna be worth it. And the number of students that have applied, I think we got like over 400 applications for 100 seats just in our first cohort.
0:52:48.7 PA: Wow.
0:52:50.3 EZ: People want this. People are ready for this. And it's coming. It's coming down the pike.
0:52:57.7 PA: It's phenomenal. And give us a little bit more context in terms of the program itself, what are the details, how long is it, what's included as part of it, how much... What are some of the general requirements that the OHA is asking of these programs as well? I would love to... Any context would be awesome.
0:53:17.6 EZ: Sure, yeah. So the OHA has mandated a certain number of hours in various departments, for example, a certain number of hours focused on pharmacology and neuroscience. A certain number of hours on peer support skills, a certain number of hours on cultural considerations, diversity, equity and inclusion and things like that. There are also... So in InnerTrek's program, we are having a didactic portion that's in-person. So once a month, we will be meeting in person at a beautiful, beautiful piece of land with both indoor and outdoor classrooms, just outside of Portland. So we'll be meeting once a month in person and then once a week online. We have amazing instructors. Okay, I'm not just saying this, it's a really good program. [laughter] I've been helping create and curate all of our guest speakers and oversee what we wanna teach these students and why, we keep asking why. Why do the students need to know this? It's gonna be an awesome program.
0:54:30.8 EZ: So then there'll be a portion online and then, the students as mandated by the OHA and as we agree needs to happen, the students need to have some kind of practicum training, some sort of hands-on element, where they're working with alternative states of consciousness, they're actually getting to practice supporting other people through alternative states of consciousness, through difficult experiences.
0:54:53.7 EZ: And what's interesting about the law in Oregon is that to become a facilitator, you don't have to be a licensed therapist or a doctor or a social worker. You need to have a high school diploma or GED equivalent. That's it. So we're not only needing to teach people about how the substance works and how to work with systems of oppression within our culture, but also how to actually facilitate, how to be a peer facilitator, how to offer some counseling support without crossing over into doing psychotherapy. So there's a lot, there's a lot to learn. The program's gonna be six months, about 160 hours total and I'm excited to be teaching it. I'm also excited to take it. As we're designing our lesson plans and our guest lectures, I'm like, "Ooh, yeah, I can't wait for that one. [laughter] Can't wait to get nothing."
0:55:52.0 PA: What are some examp—Can you announce that publicly yet? Who are some of the faculty that you have who will be part of the program process first thing.
0:56:00.3 EZ: I don't know who all is confirmed yet. I do know that... I think I can safely say Robin Carhart-Harris.
0:56:04.3 PA: Gotcha. Okay.
0:56:07.1 EZ: And then...
0:56:07.6 PA: Oh, great.
0:56:08.0 EZ: The other people who I really wanna tell you 'cause I'm so excited, but I'm gonna hold it [laughter] for right now.
0:56:13.9 PA: Okay. That's fair. And when does it start? When does the program start?
0:56:17.9 EZ: Probably this fall, it looks like.
0:56:21.1 PA: This fall? Okay. So the date is still getting and landing as you kinda figure things out with the OHA and HECC?
0:56:26.9 EZ: Exactly, exactly. We're ready, we're...
0:56:30.7 PA: Gotcha.
0:56:30.7 EZ: We're ready to rock. It's just, we need that green light from all of the bureaucratic la-la-las. But it's coming. It's coming.
0:56:42.3 PA: Yeah.
0:56:42.7 EZ: Yeah.
0:56:43.3 PA: Good. Good. And so, for a follow-up question to that, who can legally work with psilocybin? Meaning, is it only Oregon citizens who can take the medicine or can people fly in from other states to work with the medicine? I think that's question one. The second question that I have is who qualifies to become a facilitator? Do they have to be a citizen of Oregon paying taxes in Oregon or could someone from Texas fly in whenever they wanna have retreats and experiences, maybe they're a citizen of Texas, but they still get trained in one of the programs in Oregon, is that possible? What are the details around that?
0:57:28.2 EZ: Sure. Well, in terms of who can receive services. Anyone. So yes, somebody from Iowa who wants to take psilocybin could fly to Oregon and receive psilocybin services in Oregon. Also, what I think is really cool about how the ballot measure was written is people receiving psilocybin services do not have to have a medical diagnosis to qualify. That greatly increases access. So, if we said, "Oh, you have to go see a psychiatrist and have X, Y, and Z diagnosis," that would really limit who could afford and who could feasibly access this. There's no such requirement. You could go into a psilocybin service center and say, "My sole purpose for taking psilocybin is curiosity." That's good enough. And you can be from anywhere. There will be of course, screening questions to make sure that it's medically safe for that person, but they don't need to check any medical diagnostic boxes, so to speak.
0:58:30.3 EZ: In terms of who can oversee the services. There is a delay period of two years. For the first two years, this is only for Oregon residents. Meaning, if you wanna be a psilocybin service center or a licensed psilocybin facilitator, you need to be an Oregon resident. Come 2025, that'll change. But Oregonians get first dibs on this. Now, did other companies get wind of this and relocate some of their employees to Oregon to establish residency? Yes, of course that happened. And I do anticipate that we'll have a curious flood of people who suddenly wanna live in Oregon, who happen to work in the psychedelic world. But for now it's Oregon residents. You don't have to be an Oregon resident necessarily to do one of the programs, the training programs, but when you actually go to apply for licensure, unless you're an Oregon resident, I do believe you will be denied for the first two years.
0:59:34.4 PA: And final question, what's going on with microdosing as it relates to proposal 109 and the OHA?
0:59:40.2 EZ: That's a tricky one because my understanding per the law is that you need to be in a licensed facility to actually take the substance. So if someone wants to microdose every day, that's kinda awkward for them to have to go to a facility to get their micro... You know what I mean? That feels a little bit like a methadone clinic model to me. But another ballot measure also passed at the same time as 109, which was ballot measure 110, which was decrim, which didn't say it's legal per se, but it did say that the legal system in Oregon is not really going to waste time or energy pursuing people who have small amounts of substances. I believe it's upto 12 grams of dried mushrooms.
1:00:32.3 EZ: So if you are for some reason caught with mushrooms, I'm not a lawyer, don't quote, double-check this, but my understanding is you get a little slap on the wrist. You pay a $100 fine or you have to take a course on why drugs are bad. But it doesn't end up on a criminal record, it doesn't stop you from getting a job or working with children someday necessarily. So because the risk is a lot lower now, I think my understanding is if people wanna microdose, they're just doing it on their own. They don't necessarily want to be understandably paying a service center to oversee that process, which is a real, real luxury 'cause I gotta say, I actually have a client who's in another state who right now is looking at 10 years in prison because she had mushrooms or microdosing and she was caught with them.
1:01:28.3 EZ: So the fact that Oregon as a state decriminalized small amounts of drugs, I think is gonna create a lot more equity in our landscape, in our cultural landscape as a state and help people access medicines that they may need.
1:01:48.1 PA: And it feels like an ideal compromise or middle ground at this point in time. Proposal 109 and 110, I think was the decrim proposal to decrim small amounts of drugs on a state-wide basis. One project that we've started working on, which I don't know if I've clued you in on this yet, Erica, but we're starting a non-profit called the Microdosing Collective to help to start regulatory policies specific to microdosing supplements because a lot of these measures that are being passed in Oregon, I think in Oregon, you do need to go into a service center and I saw some law or rule where there needs to be one facilitator for every 10 people who are microdosing, one facilitator for every eight people who are taking higher doses if it's done in a group context.
1:02:33.8 PA: Even in Colorado where there looks like something will be on the ballot at the end of this year, it's only for high doses. A lot of the state legislature right now is passing high dose legislation. And at some point, I think it's not gonna be in the near future, in the next year or two, but the vision with the Microdosing Collective is how do we start to get actual policy passed to support microdosing as a wellness supplement or a vitamin or something that can be utilized not just sort of in a grey market area like decrim but really in a above ground dispensary model where there's education and sort of kinda like what we see in cannabis right now, it's lab-tested, you know what's in it, all those types of things.
1:03:17.3 EZ: I love the "you know what's in it" element because now patients ask me, "Well, where can I get mushrooms?" And I'm like, "I can't aid and abet illegal activity. I can't tell you." And then they say, "Okay, well, I bought these mushrooms, how do I know that they're good? How do I know what's in them? How do I... " I'm, "You don't. I don't know." In some ways, you're almost safer buying like powders, synthetics because you can at least test those, right? You can buy drug testing kits for those. So yeah, some kinda standardization.
1:03:48.9 EZ: The other big thing I'm seeing with microdosing is when people tell me they're microdosing and I'm trying to get a sense of if it's working or not, I say, "Oh, how much are you taking?" And they go, "Oh, one capsule." I'm like, "How many milligrams of psilocybin mushrooms are you taking?" "I don't know." "Okay." People have no idea how much they're taking. So some kind of a standardization, I think would be really helpful to the end user. I do just need to be like the.
1:04:22.6 EZ: You've heard me be the Debbie Downer on panels before. I do need to say microdosing's not for everyone and I have seen it make people manic. So it's not... I'm not a "Everyone should be doing mushrooms all the time" kind of a person. So I will say I feel a little nervous when I hear that people could just go and buy mushrooms directly. But I can work through those feelings. [laughter]
1:04:49.3 PA: And my sense on that is it would be a similar... There would still be a similar screening process as you have for 109 in terms of going in and before someone can receive it. It's not just gonna be like a cannabis dispensary model, where you could go in and anyone basically can get access to it. The caveat is you won't necessarily require supervision as you are doing it.
1:05:08.7 EZ: Sure. Sure.
1:05:11.2 PA: So I think there's... But I... Yeah, 'cause I hear you that there's the other big core concern and I think this is the fear of many in the psychedelic space that... Or even in policy or those who aren't that involved in psychedelics but are watching this happen, is all of a sudden people can go buy microdoses and they could take 10 of them or 20 of them or 30 of them and it's a full dose. What I think prevents that is a price point basically, where if you have a microdosing supplement and you charge $100 for 30 microdoses that are each a 100 milligrams, people are gonna use that as proper medicine and not feel compelled to eat a bunch when they can just, I don't know, grow their own mushrooms or do whatever.
1:05:53.9 PA: So this is new, it's within the last six months that we're doing it. But it does feel like a major gap that's not being addressed and I think my fear is as psychedelics crest into the mainstream, my sense is the vast majority of people who come into this who are new are going to want to microdose. And maybe for that first time or two, they'll wanna do it under supervision, but then after that, they'll realize there's really no need to do it under supervision and there's really no one who's addressing that gap right now in the market. So I think my concern is just someone's gotta do something about that.
1:06:30.2 EZ: If not you, then who? If not now, then when? Yeah, I completely agree. Yeah, I think, yeah, if someone's really nervous, maybe the first one or two times to be with someone, but yeah, it's really... What I have my patients do is when they're new to microdosing, I say, "If you're gonna do this, I wanna have a 15-minute visit with you two weeks after you start and then a month later, just to have another set of eyes on you, just in case you're starting to show signs of hypomania that you think are flow state, just to have like a wall to bounce this off of." But I don't feel that I need to be there monitoring them on a daily basis. Absolutely not. Absolutely not. And that's me being like over-protective, mommy doctor, which what I'm doing might even be overkill, but it's what makes sense to me for my patients.
1:07:33.8 PA: Well, Erica, it's been a pleasure. I know this has been a long time coming, we've been trying to get this on the books and we finally did it. So I appreciate you joining us for this wonderful podcast where we covered all matter of things. As just a sort of final note, people wanna learn more about your work. If they wanna learn more about InnerTrek's training program, where can they go to find out more information?
1:07:58.8 EZ: Sure. There's my website, which is drzelfand.com or if my last name is a doozy for you, simbahealth. Yes, like the Lion King, simbahealth.com, it takes you to the same place. So that's where you can learn about all things Dr. Z. And then innertrek.org is the training program that I will be a lead educator for and then I also have some courses online that people can just take self-paced at home. Those were produced by Microdose Media but you can find links to all of that through my website as well. So if you wanna learn at home, I have a course on microdosing, macrodosing, ketamine, MDMA. We didn't even talk about ketamine or MDMA today but so much to talk about. We'll just have to do this again sometime. [laughter]
1:08:49.7 PA: We'll have to do it again sometime. And the name of that course is The Science of Psychedelics. Is that correct?
1:08:54.4 EZ: Thank you. Yeah, that is the name of the course, Science of Psychedelics.
1:09:00.8 PA: Perfect. Great. Well, Erica, thank you once again for popping on.
1:09:03.0 EZ: Thank you, always a pleasure.
1:09:27.3 PA: This conversation is bigger than you or me, so please leave a review or comment so others can find the podcast. This small action matters more than you know. You can find show notes and transcripts to this podcast on our blog at thethirdwave.co/blog. To get weekly updates from the leading edge of the psychedelic renaissance, you can sign up for our newsletter frequency at thethirdwave.co/newsletter, and you can also find us on Instagram at @ThirdWaveishere or subscribe to our YouTube channel at youtube.com/Thethirdwave.