Interview with dr. Pamela Wartian Smith MD

Our Guest – dr. Pamela Wartian Smith MD

Dr. Pamela Wartian Smith spent her first twenty years of practice as an emergency room physician in a level 1 trauma center with the Detroit Medical Center and then 29-years as a Functional or Personalized Medicine specialist. She is an internationally known speaker and author. She also holds a master’s degree in public health along with a master’s degree in Metabolic and Nutritional Medicine. Dr. Smith is in private practice and is the senior partner for The Center For Precision Medicine with offices in Michigan and Florida. She has been featured on CNN, PBS, and many other television networks, has been interviewed in numerous magazines and has hosted two of her own radio shows. Dr. Smith was one of the featured physicians on the PBS series “The Embrace of Aging” as well as the on-line medical series “Awakening from Alzheimer’s” and “Regain Your Brain”. Dr. Pamela Smith is the co-director of the Personalized Medicine Certification at The Morsani College of Medicine, University of South Florida. She is the author of fourteen best-selling books. Her book: What You Must Know About Women’s Hormones, 2nd edition was released in 2022. Her book, Maximize Your Male Hormones, was released in 2023 and her book What You Must Know About Thyroid Disorders, 2nd edition, was released late last year. Her newest book, How to Prevent Breast Cancer: Before and After, is due out this fall. 

You can learn more about dr. Pamela Smith at:

https://centerforprecisionmedicine.com/ https://personalizedmedicinecertification.com/ https://www.amazon.com/stores/Pamela-Wartian-Smith/author/B001IQWHVA?ref=ap_rdr&isDramIntegrated=true&shoppingPortalEnabled=true

Adina Dabija is a Licensed Acupuncturist nationally certified in Oriental Medicine by the National Commission for Certification of Acupuncture and Oriental Medicine NCCAOM. She holds a Clinical Master’s Degree from Pacific College of Oriental Medicine New York and formal certifications in Medical Qi Gong, and in Korean Physical Manipulation (Kyo Jung) from the Institute of Classical Asian Studies, New York. Since 2021, Adina has been certified with American Board of Anti-Aging Medicine (ABAAHP) to provide the highest standards of care in all aspects of metabolic and longevity holistic health practices.

Key Points

– Functional metabolic personalized medicine looks at the root of a medical problem and connects the dots between different body systems

– Normal hormonal levels have an overall anti-inflammatory effect on the body, so hormonal balance is of crucial importance to prevent disease

– Anyone with an autoimmune disease would benefit from eliminating gluten from diet, fixing the gut and decreasing inflammation

– Low progesterone level, occurring in conditions such as premenstrual syndrome (PMS) and polycystic ovary syndrome (PCOS), increases the risk of developing breast, ovarian, endometrial and uterine cancer; other types of hormonal dysregulation could also cause cancer if untreated

– Women with breast cancer should aim be hormonally balanced after they receive a conventional treatment, in order to prevent recurrence; they should also test themselves for environment toxins. There are new effective ways to eliminate polychlorinated bisphenols (PCBs) and other estrogen-like compounds

– A daily routine of stress regulation through prayer, meditation, qi gong, tai chi, yoga and other mind-body practices is as important as everything else we do for health restoration and maintenance

– ADHD (attention-deficit/ hyperactivity disorder) and other psychoneuroimmunological issues in teenagers are linked to environmental toxins and overuse of electronic devices

– Every future mother should test herself for environmental toxins before conceiving

– A life worth living is a life in service to others

The Video

The Transcript

Adina 0:02 

Welcome to Wise and Wild of America, a series meant to inspire and empower you on your self discovery and self authorship journey. I am Adina Dabija and had the honor to host here last week dr. PS. with whom I had a very interesting conversation on various health topics such as hormonal balance, autoimmune dysfunction, breast health, mood disorders in teenagers and also her personal journey from a ER doctor to a functional personalized medicine doctor, teacher and author.

Adina 0:11 

Dr. Pamela Wartian Smith spent her first twenty years of practice as an emergency room physician in a level 1 trauma center with the Detroit Medical Center and then 29-years as a Functional or Personalized Medicine specialist. She is an internationally known speaker and author. She also holds a master’s degree in public health along with a master’s degree in Metabolic and Nutritional Medicine. Dr. Smith is in private practice and is the senior partner for The Center For Precision Medicine with offices in Michigan and Florida. She has been featured on CNN, PBS, and many other television networks, has been interviewed in numerous magazines and has hosted two of her own radio shows. Dr. Smith was one of the featured physicians on the PBS series “The Embrace of Aging” as well as the on-line medical series “Awakening from Alzheimer’s” and “Regain Your Brain”. Dr. Pamela Smith is the co-director of the Personalized Medicine Certification at The Morsani College of Medicine, University of South Florida. She is the author of fourteen best-selling books. Her book: What You Must Know About Women’s Hormones, 2nd edition was released in 2022. Her book, Maximize Your Male Hormones, was released in 2023 and her book What You Must Know About Thyroid Disorders, 2nd edition, was released late last year. Her newest book, How to Prevent Breast Cancer: Before and After, is due out this fall.

Adina 03:21

As a student of dr. Smith, I found her approach very useful in my personal practice, especially when it comes to immune regulation and hormonal health. Here is the first question I had for dr. Smith last week: what exactly is “functional medicine” and what are some of the roadblocks preventing it from becoming mainstream – in this day and age?

Dr. Pamela Smith 3:31

That’s honestly my goal, to help it become mainstream. I just turned seventy. This is my natural color of hair and I don’t have a lot of wrinkles for my age because I really personally, as I do professionally, participate in functional medicine. And that looks at the cause of the problem instead of just treating symptoms. It doesn’t mean that I throw away the baby with the bath water, of course I believe in conventional medicine. I kind of see this as a current specialty and we hope it will become more of a broad range approach, where all primary care doctors, gynecologists, neurologists, cardiologists will really want to adopt this approach in their particular specialty. Of course I write prescriptions for medicines, but if you look at the cause of the problem, sometimes you can treat the cause and you don’t have to go down the road of medication. Also, every single prescription causes between two and ten nutritional depletions. In the conventional medicine model we don’t look at that. Let’s take myself as an example. I do take bioidentical hormones, which include estrogen that is compounded, progesterone and DHEA, but estrogen depletes the body of B5 and B6. That is true for estrogen of any variety that is prescribed, whether is oral contraceptive, synthetic or natural hormones. But conventionally we really don’t say to the patient to take B vitamins twice a day, however we should, so people don’t have nutritional depletions. And there are a myriad other things. It kind of connects the dots, shall we say.

Adina 05:52

Thank you! That makes a lot of sense. And that’s why I took this clinical mentorship class that I took with you, and also I am the happy owner of some of your books, and I am looking forward to your upcoming book about breast cancer! Before I ask you about the book that is due to come out very soon I want to ask you, what is your main goal when you talk about what should I do as a practitioner “on Monday morning” – because your approach is very hands on, very practical, and that’s why is so helpful to me – especially in difficult cases such as let’s say an autoimmune condition or a hormonal balance issue. What do you think is crucial for me to do on Monday morning in this personalized medicine model, generally speaking?

Dr. Pamela Smith 6:21

I am so glad you asked that! Let’s take autoimmune diseases, since you asked about that. That’s really the body attacking itself, whether you are talking about thyroid with Hashimoto’s or Grave’s or you’re talking about the colon and looking at Chron’s disease. When I was in medical school there were only twenty five autoimmune diseases. There are now 108, with 107th being the long haul covid and long haul lyme being 108th. So chronic diseases are changing because the body is literally attacking itself, which is an inflammatory process. So on Monday morning, if someone has any of the autoimmune diseases, we always start with: one – take the patient off of gluten, because it does seem to be an issue for people with autoimmune diseases. Second – we fix the gut, because the gut is not normal in people with an autoimmune disease and the gastrointestinal tract is 70% of the immune system. So we have to look at the cause of the problem. We do a functional medicine test, we fix it and third we decrease the inflammatory component by starting low dose naltrexone. Naltrexone has always been used for drug overdoses at doses of 150mg, but in low doses (1mg to 3.5mg) it very much helps decrease the inflammatory component that occurs with autoimmune conditions. So we are able to go after some of the causes of the problem. Can we reverse all autoimmune diseases? Of course not. Can we reverse a small number? Yes. I used to have Reynaud’s disease, I don’t anymore, some of my patients who had Hashimoto’s early on – we’ve been able to decrease the titers and actually in some of the cases cure them, but with this approach most people do not progress in their disease process. It does not get worse because we are looking at the cause of the problem.

Adina 8:43

I asked many doctors about this approach and some are still resistant to prescribing something that is used for drug abuse. There are some legal issues involved, I believe. Is there anything natural that you can substitute LDN with?

Dr. Pamela Smith 9:13

Yes. Certainly curcumin or turmeric decreases inflammation, omega 3 fatty acids otherwise known as fish oil and people really should not be as a patient, or as a prescriber to use LDN because it’s been used for ten years for this purpose and it is now well documented in the medical literature. The trouble is we get so busy and we don’t have time to read everything in the medical literature. It’s part of the reason I started a brand new course in personalized medicine, a certification at the Morsani College of Medicine at the University of South Florida to help practitioners get additional training in this area, so they can add on to whatever their specialty is or to their family practice.

Adina 10:06

How can we find this course and is it in person or is it online?

Dr. Pamela Smith 10:11

The first course is currently run in person only. We ran it in April in person in Scottsdale and it sold out and we are running it again in November in St. Petersburg Florida at the beautiful Don CeSar. People can go to personalized medicinecertification.com to find more information about the program and to sign up online. The first course is Endocrinology and we look at prescribing hormones for both men and women, the pros and cons, because it’s not for everyone, we look at thyroid disease extensively, we look at a hormone people don’t know much about called pregnenolone. That’s such an important hormone because it’s the hormone of memory, it also decreases inflammation. In fact estrogen, progesterone, testosterone, DHEA, cortisol, pregnenolone and melatonin are all anti-inflammatory. That’s on site and to complete the certification we also have case studies and webinars and what we do in the clinic on Monday morning is how this course is designed. It’s really very practical. Next year will be course two and three, there will be hybrid courses. People can join us in March in Huston, we will be looking at dermatology, autoimmune diseases, infectious diseases and some other specialty areas, or they can take it online, and in November next year we will be back in Scottsdale for Course 3, which will be hybrid – how to interpret functional medicine labs, and we will be looking at memory, neurology, psychology and toxicology. Toxins are becoming more important in today’s world. There are some very new and exciting techniques to get rid of toxins like polychlorinated biphenyls (PCB) that we will be discussing.

Adina 12:22

This seems very interesting, and I can testify that this training is very useful and although I didn’t take everything above, what I have learned with you so far changed my practice and personally my life. I want to spend some time talking about your upcoming book on breast cancer. I think every woman should own a copy of your book on hormones. I personally use it almost every day as a reference book in my clinic. What triggered this book idea on breast cancer? Is it because it’s the second most common cancer in women in the United States, after lung cancer?

Dr. Pamela Smith 13:21

Really it’s a two fold answer. I was perfectly happy as an ER doctor in a level 1 trauma center until I couldn’t sleep. And I was fortunate enough to go to a conference and found out that perhaps having low progesterone was the cause of the problem. Eleven doctors wanted to give me a sleeping pill, instead I did the first saliva test in the Midwest and I found out that I happened to be very low in progesterone. It was very fortuitous that I did this because if you are low in progesterone and you have a lot of estrogen, called estrogen dominance, which I had, you are at increased risk of getting breast cancer. I also found out that I had a gene causing me not to methylate correctly, creating methyltetrahydrofolate reductase insufficiency. So I’ve been taking methylated vitamin B for thirty five years. That started me down this journey. I really decided to write the book on breast cancer because I have breast cancer on both sides of my family and one side I never even met the grandmother, I have a cousin who had breast cancer and on the other side I have cousins who had breast cancer. Plus, it’s becoming more common. When I was in medical school, one in twenty four women got breast cancer; it is now one in eight. It used to be that we saw breast cancer later on; I am sure you saw the new study that came out this year (2024) that we’re seeing cancers of the breast and of the colon in very young women. So in writing this book, my goal is to help prevent breast cancer and for women who have had the disease to help prevent a recurrence. 

Adina 15:10

What is some practical advice that you could offer to someone who already has breast cancer, let’s say an early stage of breast cancer?

Dr. Pamela Smith 15:22

For the early stage of breast cancer, absolutely have your hormones measured! And depending on your treatment, find out if you have estrogen dominance and if you have enough hormones for balance. We can do a simple methylation test, we can measure homocysteine and we can fix methylation defects in every single patient, so we don’t have to have that as an issue, we just have to be aware that fifty percent of people don’t methylate well and we can fix that by taking methylated vitamins. There are other things that we can do; we really do believe that most people get cancer, at least the cells, seven or eight time in their lifetime. There are three things that feed those cells: stress, sugar – I am still working on chocolate, that’s a hard one for me, personally –  and toxins. We do measure cortisol, the stress hormone, by saliva testing, we certainly can work with people on their diet and decrease inflammation – because sugar causes inflammation and breast cancer is inflammatory – and we do have ways now to remove polychlorinated biphenyls (PCB) and other estrogens – like compounds present in the body, like bisphenol A. Because in conventional medicine the treatments are great and I do recommend people have conventional treatments if they have breast cancer, but then usually the oncologists stop and they don’t go on to look into how to prevent a recurrence. 

Adina 17:12

Is there a significant association, generally speaking, between hormonal dysregulation and occurrence of cancer?

Dr. Pamela Smith 17:21

Yes. In fact in many women it starts when they are very young. Women with premenstrual syndrome and polycystic ovary syndrome (PCOS) have low progesterone; women with PCOS also have high testosterone. We can diagnose PCOS when someone is eighteen. She has already an increased risk in becoming diabetic, in being overweight and we don’t commonly talk about the increased risk of developing breast cancer, ovarian cancer and also endometrial or uterine cancer. We know that when she is 18. So we can start even then in helping prevent it. So great things to do on Monday morning! I don’t know about you but every time I talk about that I get goose bumps, because we can help people even at very young ages. 

Adina 18:12

Could you offer us an example of someone young that you helped?

Dr. Pamela Smith 18:17

Absolutely! I have a patient who happens to be a physician and she has a lot of stress as all practitioners do, so we worked on her stress, we got her hormones balanced, because they were not balanced, but another hormone that was not balanced in her was insulin. That’s the hormone that regulates blood sugar and honestly most patients, unless they see a functional personalized medicine doctor never had the hormone measured. But we measured it, fasting insulin was very very high, which meant she was insulin resistant and she would become diabetic and in helping her eat better, exercise, balancing the hormones, working on the insulin, she lost seventy pounds and she did much better, she felt better, she was able to help her own patients better and she started dancing. And, believe it or not, she went on, in the state and territory she lives in, to win Dancing with the Stars. None of this would have ever happened if she had not gone down the road of looking at hormonal balance. 

Adina 19:35

That’s amazing, fascinating work! I wanted to ask you, when you talk about stress regulation, it sounds simple, but in the routines that we all have it is not so easy to set up that timeframe to relax. How do you approach this with someone who is very busy professionally and maybe has kids to take care of home too?

Dr. Pamela Smith 19:37

Well, first of all, when we look at the idea of exercise, that means that we exercise for memory, but it also means that we do calming exercises – stress reduction techniques like prayer, meditation, tai chi, yoga, qi gong, exercise, massage, breathing techniques. If as a practitioner you start your day with something calming and on the opposite days more aggressive exercise, then the day doesn’t get away with you; you have actually done it before the day gets more stressful as the time goes on. Also, a multivitamin is really important because the adrenal glands that make cortisol use nutrients, adaptogenic herbs like ashwagandha, ginseng, rhodiola; calming herbs are very important as well. Honestly, I do believe that we can improve cortisol in practitioners but probably we don’t normalize it until they retire. Because they really are available to the patients, most practitioners are twenty-four hours, seven days a week every day of the year and because of that it does make the stress a little bit more intense, but we can take it down a notch.

Adina 21:33

Could you please share some of your personal or professional roadblocks, some stressful moments of your career, or your life? You already mentioned one early on, your sleeping problem… How did you handle stress and challenges?

Dr. Pamela Smith 21:54

People have personal stress and professional stress. Unfortunately most practitioners kind of have both. When personal stress comes its way, you have to realize that God doesn’t give you more stress than you can handle. And at some point, whatever that professional stress may be, weather it’s a spouse or a child or taking of a parent – I took care of both of my parents and really I was so thrilled that I had the ability to do that, to help each one of them throughout their life struggles and at the end of their lives – so all of those become challenges for practitioners. So when I took care of my mom and dad I cut down my hours and I used stress reduction techniques. I speak at a lot of medical conferences, I will be going to Huston to speak at a conference in October and I will speak at two different compounding pharmacies. Then I have a day off and then I am speaking at the conference. So I’ll be in Huston for six days, and that day off I will go have a massage and a facial – that’s just as important as everything else to keep you healthy.

Adina 23:17

That’s so true! What general advice would you offer to a young doctor?

Dr. Pamela Smith 23:17

If you are in the medical school right now, please don’t give up, don’t feel like this is never going to end, we all feel that way! Stay on the course, you will end up loving it, it’s the best career in the entire world! When you get done, sit down and seriously ask yourself what specialty area you want to go into, because it really does define the rest of your life, the hours that you work and what kind of patients you will see. If you are like me, you are not good with kids, because if kids die that really affects me, so I tried as an ER doctor not to rotate to children’s, because it was really hard on me – and them! So try to realize what your limitations are and what your own talents are. Explore this field of personalized functional medicine! Whatever you decide to be – whether you will be a dermatologist, or oncologist , or whatever your field is, there is a personalized functional medicine side to that. Please try to incorporate that into the patient care and remember when you see them, to ask one question: “What brings you in to see me today?”. Always make sure you deal with their chief complaint. You may think that something else is more important, but to give comfort to the patient is the most important thing. If you help them with their chief complaint, they are much more compliant with other things that you want them to do. 

Adina 24:54

Thank you! How would you approach – I know you are not seeing kids as much – but what advice would you offer to a mother who deals with a teenager with attention deficit disorder or depression or other psychoneuroimmunological problem?

Dr. Pamela Smith 25:15

Really the health of a child has to do with the health of the mother. So I always start with the health of the mother. If you have a planned pregnancy, make sure that you are healthy. We are doing toxin testing now for people who are planning on pregnancy. If they have PCBs, lead, mercury etc., because they are transferred through the placenta and through the breast milk, we want to get those out before they get pregnant, because we do know that some of those things are related to ADD, ADHD and generally to neuroinflammation. So the health of the mother is what we start with. When we start looking at the teenager, we are looking at getting those toxins out of the body, we look at neurotransmitters testing, measuring GABA, serotonin – the happy neurotransmitter – and trying to get those into alignment. I really do believe for someone to be healthy , they have to be physically healthy, emotionally healthy and spiritually healthy – whatever that may mean for them. So we want them to look at all components of their life. But I do have some concerns about  what happens when people stay on the computer and cell phones etc so much, because it is rewiring the brain, we are getting neuroinflammation, it causes insomnia in some patients; so unless someone calls, honestly I turn off my cell phone and my computer at 7pm, doing so helps people sleep better. People don’t adequately socialize if they stay on the computer all the time and  don’t really talk to people. It is important to hug other people! I very much enjoy doing this podcast with you today, but it would be great if I could give you a hug! Those kinds of things sometimes get forgotten and we need to reinstitute those back into medicine.

Adina 27:15

Well, I’ll make sure I’ll get that hug at the next conference I’ll see you!

Dr. Pamela Smith 27:19

Perfect!

Adina 27:22

So how can we find your books, especially your upcoming book on breast cancer?

Dr. Pamela Smith 27:27

On Amazon. And I do want to mention my male hormones book. We talked about women, but I also wrote a book on male’s hormones, Maximize your Male Hormones – because if we help her be balanced we want to help him be balanced. Prostate cancer is on the rise as well, becoming a common cancer in men, so there is a lot to offer. So Amazon is the easiest and the most cost effective way to get my books.

Adina 27:57

Great! Very exciting! I am looking forward to getting your book on breast cancer. Dr. Smith, you are such an inspiration for all of us in this field and I am just curious: what do you think it’s a good life, a life worth living?

Dr. Pamela Smith 28:17

A life worth living is really one where you can help other people, because it’s really not about you, it really is about what you can do to help other people. When it comes to this functional personalized medicine approach – we all deserve this kind of health care! So people who are practitioners watching this podcast – I hope they will join me in helping this medicine become the standard of care for all, because all people really do deserve this. That honestly would be the best thing that could ever happen in my life – to see this kind of medicine progress forward.

Adina 29:06

Thank you so much, I am so grateful for you taking the time to be here today – and I am looking forward to giving you that hug at the next conference!

Dr. Pamela Smith 29:14

I am looking forward to it as well and thank you so much for the invitation!

Adina 29:19

Thank you!