An Interview with Dr. Adrienne Clamp

Thoughts From a Hypothyroid Physician Practicing Integrative Medicine

Adrienne Clamp, MD is an integrative physician practicing in McLean, Virginia. Photo © Adrienne Clamp

Dr. Adrienne Clamp is a traditionally trained physician, hypothyroid herself, who has gradually shifted her focus toward a more holistic, integrative approach to medicine, including thyroid and hormone balancing. Dr. Clamp is in private practice with my physician, Dr. Kate Lemmerman. In her practice, Dr. Clamp is shifting away from general practice, which is allowing her time to focus on in-depth problem-solving for thyroid, adrenal and hormonal imbalance patients, as well as holistic health and acupuncture. I had an opportunity to interview Dr. Clamp about her philosophy about thyroid and hormonal care, her own health, and relationships with patients.

Mary Shomon: You were trained as a traditional MD, but you now practice medicine along with acupuncture, and other nontraditional approaches from a Western standpoint. What caused you to become interested in acupuncture, reiki, herbal medicine and holistic health?

Adrienne Clamp, MD: I went into medicine, at least in part, because of my fascination with people and how they work. At the time I was trained, the disciplines of traditional medicine and alternative medicine rarely, if ever, crossed paths. It was not long after I entered practice as a young physician that I came to realize that allopathic medicine, while a fabulous tool, did not have answers for many of the ills that plague people.

I think that since those early years, my antenna has always been up for what else is out there that might be of help in those situations where what I had learned was not helping. I read about many world cultures and their approaches to health.

In 1999, I was fortunate enough to be able to study acupuncture and the Chinese system of understanding health and disease in a detailed way. It literally transformed the way in which I understood health and disease and people. Here, at last, was a sophisticated system that did not divide people into their component parts but spoke of the interrelationship of all parts, spiritual, emotional, psychological and physical and their interactions that result in health or disease.

I was hooked and have not stopped studying since. My husband despairs of me ever deciding that I have taken enough courses or read enough books!

My real passion has always been with understanding the human organism in all of its complexity. I am fascinated by the many ways that has been accomplished by different cultures throughout history and by contemporary practitioners, with different ways of understanding. I think that honoring all those ways of understanding and dealing with people, even if they are not my primary way of thinking, is a valuable tool in helping people to heal and reach their full potential.

Mary Shomon: What is your favorite part about being a doctor?

Adrienne Clamp, MD: That answer probably differs with what period of my career we are talking about. In my youth, I delivered tons of babies and took care of lots of kids and young Moms and Dads. I loved every minute of it. After doing that for several years, I moved to the Washington area and worked for the Healthcare for the Homeless Project. I worked with homeless families and individuals and helped to establish care for homeless pregnant women. And I loved every minute of it.

Later on, I taught in the Family Medicine Residency Program at Georgetown University, helping to prepare newly graduated physicians for careers in Family Practice.

I loved every minute of it. I have worked in the field of Addiction Medicine delivering medical care to this poorly understood and often poorly treated segment of our population. And I loved every minute of it.

For awhile I did only medical acupuncture (and still do a lot of it) and loved every minute of it.

My practice now is largely integrative medicine. I especially enjoy working with people when the standard answer or the "quick fix" has not worked very well. With many patients, I'm taking an "alternative look" to help them meet their health goals on their own terms, not on mine. I particularly enjoy working with people who want to take charge for themselves and change their lives.

So, I guess the answer is: "I love it all!" Or perhaps, I love the vocation of accompanying people on their journey, in the best and the worst of times and of giving help and comfort when I can. After all these years -- and I graduated from medical school back in 1979 -- I can honestly say that I have the best job on the planet, the job of "being with" other people in a way that helps them to heal and realize their potential. It is a profound privilege that I am grateful for every day.

Mary Shomon: A while back, there was an article in Time magazine, by columnist Dr. Scott Haig, called When the Patient is a Googler. Dr. Haig doesn't take kindly to patients who do their own research -- he called them "Googlers" and "brainsuckers." I took major issue with it, however. The reality is, however, that many of us -- and in particular, thyroid patients trying to get answers -- are forced to do our own research. What are your thoughts about "Googlers" and patients who do their own research? And why do you think some doctors don't like them?

Adrienne Clamp, MD: Ah Googlers, I am one myself! I have to say that I have learned a lot from Googlers over the course of my career. One cannot know everything, and I really appreciate the patients who care enough to spend time educating themselves. I regard my job as helping people to make sense out of what they have read. There is a lot of good information out there and a lot that is not so good, and there is little way of knowing what it what. That is my job, helping to sort it out.

I tell people that they are the captain of their own ship, I am just the first mate. The job of the first mate is to assist the captain and keep the captain out of trouble. Setting the agenda is the role of the captain. Of course, the first mate should alert the captain if they are heading for disaster (like setting a course which will take them over a waterfall), but the ultimate decisions lie with the captain.

I think that many doctors do not like Googlers for a variety of reasons. Some have no tolerance for anyone who challenges their authority, others do not want to consider options other than the standard. In my experience, most physicians truly want to help their patients, but have a limited amount of time to consider anything but the most essential, tried and true options. Taking an alternative look and considering other options take a lot of time.

It also takes having an open mind and willingness to look at things in ways one may not be familiar with.

Sometimes, however, Googlers are not able to see anything but what they want. It is the job of the physician to protect patients from unwise decisions and actions. I have found it necessary sometimes to agree to disagree with a patient about what is in their own best interest.

I try to always respect the opinion and wishes of a patient, but wish them to also respect me as well. When there cannot be mutual respect, there is little chance for a mutually beneficial relationship. I think it all comes down to working together for a common goal and not getting caught up in what is not helpful, such as posturing and power struggles.

Mary Shomon: Do you feel a patient doing his or her own research can go too far? How?

Adrienne Clamp, MD:I think that doing too much research can be harmful if it makes someone unable to make a decision because there is too much information. People can really scare themselves as well. Doing research is fine as long as a patient is willing to let his or her physician help make wise and safe decisions.

Mary Shomon: Can you talk a bit about the focus of your current practice?

Adrienne Clamp, MD: My current practice is set in a small healing center with practitioners from other disciplines including physical therapy, naturopathy, homeopathy, craniosacral therapy and holistic psychotherapy. This mix assures a lot of cross-fertilization between disciplines, which I really enjoy.

Because of my interest in integrative care and the fact that I am the only MD in my practice, I do not serve as a primary care physician for my patients.

My medical practice is primarily consultative, so my patients tend to have a primary care physician whom they are comfortable with that I can work collegially with.

My medical patients tend to be those who prefer an open-minded approach, one that takes into consideration both traditional allopathic methods and alternatives. I enjoy working with patients whose problems have not been solved in a traditional setting with traditional methods.

I work with patients with all kinds of problems but have a special interest in patients who have "normal numbers" and still do not feel "well." Much of my work in recent years has been with fatigue, thyroid issues, bioidentical hormone replacement and other issues of wellness.

My other great love is my acupuncture practice. Acupuncture is helpful for many kinds of problems and can really benefit those who are lacking in energy, experiencing a great deal of stress, pain problems and many other issues as well. It can be very helpful in achieving a better state of balance and overall wellness. I do implement herbal and homeopathic remedies as well when they would be useful.

Mary Shomon: You focus quite a bit on patients with thyroid/adrenal/reproductive hormone imbalances. Is this due to your own thyroid condition?

Adrienne Clamp, MD: I truly find this area fascinating. The hormonal system is one that is at the very center of regulation of all of our functions. It is often overlooked unless it has gone totally awry. Just optimizing hormonal function can make really dramatic differences in the way that people feel.

Also, this seems to be an area that people have a hard time getting their doctor to address. As I mentioned, I truly enjoy working with people for whom the ordinary measures have not yielded good results.

I myself suffer from hypothyroidism and it was difficult for me to get help with it because my numbers were "normal," even though I did not feel well. There is nothing like personal experience to teach one about an issue in a whole new way. I feel like I understand both hypothyroidism and hyperthyroidism with my insides as well as my intellect. I also really enjoy seeing people blossom and prosper when something so simple is addressed. I love hearing things like, "I didn't know how bad I felt until I started to feel well again."

Mary Shomon:What is your approach to treating thyroid/adrenal/reproductive hormone imbalances?

Adrienne Clamp, MD: I often consider the adrenal status to begin. The role of suboptimal adrenal function is not very well addressed or recognized. It can wreak havoc and undermine health and wellness if not addressed. When thyroid function appears to be normal and still someone suffers with all the symptoms of hypothyroidism, often adrenal hypofunction is to blame.

Diagnosis can be suggested by the history of recent or prolonged stress, or recurrent bouts of serious illness. It is best confirmed by measurement of cortisol levels throughout the day and evening.

The adrenal gland may be overreacting or underfunctioning and testing of the pattern of cortisol secretion helps to sort this out. I moat often do this by having the patient collect salivary cortisol levels at several times during a typical day. Measurement of the other hormones made by the adrenal gland such as DHEA sulfate and aldosterone is also helpful.

Treatment of the adrenal gland dysfunction depends on the pattern. I usually turn to herbal adaptogens first, as well as recommending work on stress reduction by means such as meditation, relaxation, learning different coping mechanisms and psychological counseling, among others. Sometimes hormone replacement is needed and in extreme cases of hypofunction, even low doses of cortisol, though this is typically only after trying the other approaches.

In the case of sex hormone status, I use blood, urine and salivary testing, depending upon the presentation of the patient and whether I am trying to diagnose deficiency, excess or imbalance. I prescribe compounded bioidentical hormone replacement. Using nonbioidentical hormones is like forcing a key that does not fit a lock into it and expecting smooth operation of the lock.

I do not think it works well.

There are a variety of ways to address hormonal imbalances. You can pick the most glaring imbalance and work at that first, or you can try to address all imbalances at once. Most commonly, I assess thyroid and adrenal function first -- and often together -- unless a sex hormone imbalance is obvious. For instance, correcting thyroid imbalance will often relieve symptoms of PMS and menstrual irregularity without needing to use progesterone. However, if PMS is present in isolation, without evidence of thyroid dysfunction, then going right to progesterone is often the preferred approach. All that being said, I think I really try to address each person as an individual and not use a "shotgun" or "cookbook" approach.

Mary Shomon:Can you give a quick overview of some of the ways you believe in treating adrenals?

Adrienne Clamp, MD: In cases of excess, I use herbal adrenal adaptogens and lifestyle modifications, as well as phosphatidyl serine, to calm an overactive adrenal response. In the case of hypofunction, I first attempt treatment with adaptogens and if there is positional hypotension (low blood pressure), licorice root. If this doesn't yield good results, I use low dose natural cortisol (hydrocortisone) which may take the pressure off of the adrenal gland and give it some time to recover its function.

Cortisol, however is not a benign drug and can have side effects. I usually reserve it for more resistant cases. I also use unrefined Celtic Sea Salt in some cases, especially those with hypotension. Adrenal glandular preparations can also be helpful, though I use them less often -- more from a lack of experience in using them than from a belief that they are not helpful.

Mary Shomon: Can you give a quick overview of some of the ways you believe in treating thyroid conditions?

Adrienne Clamp, MD: I think it is important to use the preparation that the patient feels best on. That being said, I usually begin with natural desiccated thyroid because it most closely mimics the normal thyroid gland.

If this is not what the patient feels best on or has objections (for example, those who keep Kosher, or who are vegetarians -- since natural desiccated thyroid is a pork derived product) I use synthetic T4 and T3 alone or in combination. Often compounded T3 is a useful adjunct to T4 when quick-release (manufactured) T3 is not well tolerated or needs to be dosed multiple times a day.

I myself feel best on a combination of natural desiccated thyroid and compounded slow release T3. I do have some patients on T3 alone, but that is more unusual. Again, everyone is different and it often takes some experimentation to find the agent or combination of agents that gives the best result.

Mary Shomon: As a physician with a thyroid condition yourself, what do you think is especially misunderstood about what thyroid patients go through?

Adrienne Clamp, MD: I think that often patients are not taken seriously when they express how poorly they feel. One of the most common things I see is treatment of fatigue and weight gain as laziness and dietary overindulgence on the part of the patient. This is insensitive and not helpful. Patients would not come to a physician if it were that simple.

In my experience, most thyroid patients have a very difficult time being taken seriously if their "numbers" are normal. They are often offered antidepressants and psychotherapy when what they need is optimization of their thyroid hormone levels. When people feel better, they are able to exercise. When they are fatigued, exercise if a difficult task and often makes their fatigue worse.

I have seen many patients who have been told that how they feel is just part of getting older and they should just accept it. I do not think that aging has to be equivalent to feeling poorly. Depression is often a result of just not feeling well, not a neurotransmitter defect. These are a few of the many things I think that hypothyroid patients hear all the time that are simply the result of suboptimal thyroid function.

Mary Shomon: Can you give a quick overview of some of the ways you believe in treating reproductive hormone imbalances?

Adrienne Clamp, MD: I most often use compounded bioidentical hormones, though sometimes I use herbal remedies or Chinese herbal formulae. It really depends on the imbalance. I think that progesterone deficiency is a greatly underdiagnosed problem, much more so than estrogen deficiency in my experience.

Also testosterone is often overlooked as well. There are many herbals that have been used and are useful, but I tend to use the hormones themselves when I have made a diagnosis of deficiency. I do not believe it is optimal to use nonbioidentical hormones.

Mary Shomon: How has your own experience getting your thyroid condition diagnosed and treated changed the way you are practicing medicine with your own patients?

Adrienne Clamp, MD: Hopefully, I can help as well to repair the feelings of mistrust and anger that some patients have towards the medical community over this issue. I think I have always listened to people in a caring and compassionate way, but I hope that my own condition has made me more sensitive and dedicated to taking patients seriously and working to get them well. Thyroid disease is something that has taken its toll on my health, and so I can understand with an expanded awareness what patients who struggle with this are going through.

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About Adrienne Clamp, MD: Adrienne Clamp, MD, is board certified in Family Medicine and Medical Acupuncture. She graduated from the University of Kansas School of Medicine in 1979, followed by a residency in Family Medicine at the St.

Francis Medical Center in Wichita, Kansas. She has served on the faculty at the Georgetown University School of Medicine as an Assistant Professor of Family Medicine. Dr. Clamp -- along with Kate Lemmerman, MD -- is in private practice in McLean, Virginia. Dr. Clamp is also a certified Usui Reiki Master and Teacher, and is an accomplished musician and artist. Dr. Clamp's website is located at

Source: Mary Shomon interview with Adrienne Clamp, MD. July 22, 2008

Photo © Adrienne Clamp

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