Speaker 1: 0:00

Hello everyone, welcome to Hashimoto's Nutrition Rx. I'm so excited to introduce today's special guest, dr Alan Christensen. Dr Christensen is a renowned functional medicine endocrinologist, best known for his expertise in thyroid health. He's the author of eight books that have become a New York Times bestsellers. Dr Christensen has helped countless individuals optimize their thyroid health and today he's going to share his insights on how we can go beyond traditional thyroid medication to truly support our bodies. In this conversation, we're going to talk about who can get off thyroid medication, the role of iodine in thyroid health, the connection between gut health and thyroid function, and the most effective supplements and dietary strategies for those dealing with Hashimoto's. If you're looking to improve your thyroid health, manage symptoms more effectively or simply get deeper understanding of the functional medicine approach to Hashimoto's, this is an episode you don't want to miss. Dr Christensen's practical advice and evidence-based strategies will empower you with the tools you need to take control of your thyroid health and overall well-being. So, without further ado, let's dive into this conversation, dr Christensen welcome.

Speaker 2: 1:31

Thank you so much. Appreciate you having me.

Speaker 1: 1:34

We're so lucky to have you and thank you so much for dedicating your time. So we're gonna go through our conversation slash interview and then we'll answer some of the questions from our live audience. So, live audience, you can say hi to us. I'll be monitoring our comments, tell us where you're from, the questions you want to ask or maybe the topic you want us to cover closer to the end of this conversation. So I think, without further ado, are you ready to start? Yeah, yeah, dr Christensen. As a functional medicine endocrinologist, you have taken a unique approach to treating Hashimoto's and hypothyroidism. What led you to pivot from traditional thyroid treatment methods to more holistic functional medicine approach? What changes did you see in patients' outcome that influenced that shift?

Speaker 2: 2:31

Yeah, funny thing, a lot of people went on a traditional medical curriculum and then afterwards went into natural medicine. There's some of us that went into natural medicine from the very get-go. So for me, my natural medicine journey started when I was about 12 years old. I was a fat kid with seizures and cerebral palsy complications, and health books changed my life. It made me want to go into natural medicine, so I learned about ways to do that and my training from the beginning started with a focus on diet, lifestyle, evidence-based therapies, so not so much a pivot something I went to from the very beginning. Yeah, my focus was on thyroid care early along and I saw that there was a big difference between some of the purely natural approaches, the conventional approaches, and then there was also a lot of medical evidence that no one was paying attention to. So that's how that journey worked out.

Speaker 1: 3:22

Amazing. So you've been dedicated to this journey for many years. You didn't switch from one thing to another. I'm glad to hear that you weren't a chiropractor that decided to treat thyroid health. So that's why so many of us including myself as a Hashimoto's patient myself think that you're one of the best resources out there in Hashimoto's world. So we really appreciate all the work that you're doing and the books that you wrote. I think somebody said, if you want to hide information, write a book, meaning that a lot of people don't read the books. But I think all the wealth of knowledge truly is in the book, and you have written incredible resources.

Speaker 2: 4:09

The one person that read it all got a lot out of it.

Speaker 1: 4:11

Yes, Now, before we dive into this non-medication approach for someone with Hashimoto's, let's address the elephant in the room, because many of my clients they come to me with the goal of getting off thyroid medication. While I have had a few instances where clients were able to reduce their thyroid medication doses or even stop taking it entirely, I understand that this goal isn't realistic for everyone. So what's your perspective on stopping thyroid medication, or who do you think is most likely to achieve that outcome?

Speaker 2: 4:50

Yeah, this is a super important topic. I'm happy to have a great detailed conversation with you about it. I think it's one of the most important things really people face right nowadays in this world. This is something to where my focus all along has been natural therapeutics and my views have evolved as evidence has evolved. And the evidence has evolved about when thyroid medications help and especially about the nature of thyroid disease and how symptoms come about from thyroid disease.

Speaker 2: 5:17

We think about hypothyroidism and then Hashimoto's, and for quite a while it was thought that whenever someone is symptomatic, it was because they lacked in thyroid hormone, and there's some cases where this is irrefutable someone's thyroid is taken out.

Speaker 2: 5:31

If they're not on medication, they're overtly hypothyroid. They're symptomatic because their body misses something. And in natural medicine, they really wanted to help more people and realize that many people were symptomatic but weren't put on medication, and so they kept on expanding the guidelines on where someone should start medication and saying, oh, if you're normal but not optimal, if your TSH is a little on the high side, if your T3 is too low, medicine might help you. And at the same time, the conventional world has been questioning its use of medication, and now we've got really strong data showing that barring the most extreme versions of hypothyroidism symptoms don't come from a lack of thyroid hormone. If anything, they're coming from the autoimmune response, and medications don't really help the autoimmune response. That's pretty clear. So, yeah, there's many people who are put on thyroid medications that, from what we now know, aren't likely ever going to benefit, and there's many more risks than we're aware of.

Speaker 1: 6:31

Also, I completely agree with your statement and because I'm only working with people and mostly women with Hashimoto's. They come to me and they have Hashimoto's and they get on medication for hypothyroidism right after pregnancy and we know that hormonal spikes they can cause hypothyroidism right Decrease in thyroid hormone in the blood, so they get on the medication and then when they get off the medication, they announce to the world or they even start an Instagram account saying here's what to do to get off thyroid medication. And I'm like first, that was only caused by short-term hypothyroidism that got resolved postpartum yes, you still have Hashimoto's, but not everyone with Hashimoto's will develop hypothyroidism down the road, depending on what approaches they do. So there are so many aspects of why people get on thyroid medication and why they can get off thyroid medication, but this is not a universal thing. I don't think it should be a goal for somebody to come in and say get me off thyroid medication, do whatever you can.

Speaker 2: 7:39

Shouldn't be a goal, but I think it's a valid concern. The evidence we have now is that about 90% of those on thyroid medication didn't need it to begin with and studies have shown that roughly 84% can successfully take less or come off. And taking it when it's not necessary has been shown to raise the risk for 15 different kinds of cancers and bone loss and heart disease and premature death. And that's with normal blood levels. Now, somewhere between 25 to 30% of those on thyroid medication are overdosed at any given point in time and in those cases the risks are even more clear. I want to be clear. There are those who have had overt hypothyroidism. That's a subset, that's actually true hypothyroidism and we see that by a TSH score generally well above 20. T44 scores way below range. It's not subtle and those are cases to where medicines actually aren't the only option. We can talk a lot more about diet and iodine, but they're a reasonable option in that case and they can be lifesaving. But most people have what's called subclinical hypothyroidism or suboptimal Subclinical. The TSH is high, generally less than 20. T4 is still being made, might be low normal. T3 might be low normal, might be below range, but this is still subclinical.

Speaker 2: 8:56

The body here is not lacking in thyroid hormone. The body is compensating in ways to keep thyroid levels stable. And then we've got what often is called in natural medicine, suboptimal levels. Things are normal, but they're not what someone would call optimal, and there is a case to be made for normal versus optimal in those who require medications or even for those who are having symptoms. But there's not good evidence that people who are normal but unoptimal are going to have a net health benefit by adding in medication. So yeah, there have been many studies now on the process of deprescribing. There's always more to learn, but there's quite a bit mapped out to it and many can take less and be stable and many can come off as well.

Speaker 1: 9:31

So exciting. It's exciting that the new research comes out and this deprescribing the medication. Keep looking at this trend and hopefully it will increase. More people will get off thyroid medication. But again, it's so important to understand that some people will remain on thyroid medication for the rest of their lives. Sure, and they shouldn't believe somebody on Instagram. That's all they're preaching getting off everybody's thyroid medication. So that's the bottom line. Now let's talk about non-medication approaches that someone with Hashimoto's can explore. Do you believe that diet and lifestyle changes alone can make a significant impact?

Speaker 2: 10:11

I'll believe anything in the world if there's good evidence behind it. And there's good evidence behind this and it's a funny thing because I hear many peers argue against the possibility that you can really reverse or change thyroid disease and like, yeah, go to PubMed Co-ethnical studies. They exist and it's funny, the studies that have been the most positive as far as really reversing disease have all been around diet and they've all been around one type of diet. So we've had a fair amount of research looking at the way different diets affect thyroid disease. Actually, ramadan wrapped up recently. We've got data about how Ramadan and intermittent fasting affect thyroid function. Data on keto diets, low-carb diets in general, aip diets. There's actually a curious one from Croatia about different food types looking at how they affected thyroid function. A fair amount on gluten-free diets, mostly with celiac disease, and then we've got about 10,000, 20,000 studies on iodine intake dietarily and thyroid function. So those are the main things that have been looked at so far.

Speaker 1: 11:09

I think, as of right now, is one of the best ways to treat Hashimoto's, because it's inflammation, it's that full body systemic inflammation, autoimmune disease. Of course you can take prescription medication. There is actually an article that's been out for many years and it's titled Metformin as a cure for Hashimoto's, and I saw a huge spike in my clients asking for Metformin to treat Hashimoto's. Because what did it do? It balanced blood sugar. It decreased inflammation. But there are other ways dietary changes, diet supplements that do the same thing.

Speaker 2: 11:49

I think it's worth thinking about causes and contributors, like what really causes something and what contributes to it. Like a chicken, a ham and egg breakfast the ham was like a chief, the pig was a cause, the chicken was a contributor. So things that cause thyroid disease. A recent study, recent meta-analysis, argued there's only four, there's only things. So a cause means that even if nothing else was on the table, this one thing could make someone develop thyroid disease. And a contributor means if someone were prone to thyroid disease, this might make it more likely this week rather than next month, or a little worse rather than a little milder. So a contributor might push the scale, but contributors alone it's impossible for the disease to emerge. Big difference. And I see a common thing in natural medicine People list hundreds of things that they call causes, most of which are actually contributors. They really can't make it happen by themselves. H pylori, mold, lyme, whatever else. If someone has health problems they should take care of them, but these things alone haven't been shown to actually cause thyroid disease.

Speaker 1: 12:51

Somebody just made a comment on one of my posts. She said that her doctor just told her that her low vitamin D level caused Hashimoto's. I was like, wow, that's a little involved. It's definitely a lot. Most people with Hashimoto's have low vitamin D levels and increasing or optimizing low vitamin D level will improve some of the symptoms Hashimoto's but it's definitely will not trigger. This is a contributing factor.

Speaker 2: 13:18

Sure, vitamin D is a kind of interesting case that's a little bit different than many others. So there's a lot of things in the body that can non-specifically elevate with inflammatory levels, like ferritin can be an example. Of course there's direct measurements of inflammation, but there's a lot of things we measure that aren't measuring inflammation but can be skewed by inflammation. Vitamin D is called a reverse phase acute reactant, so it's the opposite. So when someone's in an inflammatory state, vitamin D levels go lower, and we're not totally sure how much of that is an adaptation or a defect.

Speaker 2: 13:50

But for a long time people saw correlations between low vitamin D and tons of health conditions and many thought maybe this was causal, Maybe the low vitamin D caused these problems. So there were many studies done on things like cancer risks or various other factors, certain infectious diseases in which vitamin D was given as an intervention to see if it changed the outcome, and almost exclusively they failed to change the outcomes. So the interpretation now is that, yeah, a lot of ways when you're sick, your vitamin D gets lower, not so much the vitamin D made you sick, it's more so. That's one of the ways the body responds to being sick. So it's not healthy to be vitamin D deficient. But yeah, you're right, that's not really a causative factor anymore.

Speaker 1: 14:30

And you said there are four main things. That kind of trigger Hashimoto's.

Speaker 2: 14:36

Four known causes and three of them are somewhat overlapping Age, gender and genetics. Those three have some overlap. Gender and genetics overlap. Our gender is genetically based and a lot of the genes that correlate with thyroid disease are more apt to be expressed on the X chromosome. That's one of the three reasons why women have a higher rate of thyroid disease. And then age, whenever there are things that can be genetically driven, the more years we're around, the more odds there are of various glitches showing up. So yeah, those three, we call those the existential causes. We can't change those. We can't press a button and change our genetics or our age or our biological gender at birth. We can't change those things readily. But the fourth one that's irrefutably causal is our iodine status. And that also relates to the others, because most of the genetic variations are variations on how we metabolize iodine.

Speaker 1: 15:27

So your book, the Thyroid Reset Diet, presents a compelling approach to managing Hashimoto's and hypothyroidism through dietary iodine regulations and you suggested that we need to reduce iodine intake to 50 to 90 mcg per day. That can lead to improvement in thyroid function and the symptoms. Is there a gold standard for testing iodine levels? And actually somebody asked that in the chat I saw that question, international swim.

Speaker 2: 15:55

Thank you so much. Good question. Thank you for the feedback. There is at a population level and there are good ways to test for individuals. But depends upon the circumstances. I'll explain more about this. So there's testing to see if one could benefit by changing their iodine intake and then there's testing to see if one has successfully changed their iodine intake already. So they're different things.

Speaker 2: 16:18

Now, when you're looking at large groups of people, there's many versions of urinary iodine tests that are pretty reasonable for gauging the status of a population, meaning 500 or more people. You can do spot urine iodine tests just at a random sample or 24-hour urine tests. They're reasonably accurate. But the problem is when we look at individuals there's so much variation from one reading to the next that it's not very useful. At a population it doesn't matter because you're not trying to say Sally, john and Joe, how are they doing. You're saying how is the population at large? And so the variations make no difference. They all kind of level out. But at an individual level they've done so many studies on this you literally have to test yourself. If you're doing a 24-hour urine it's closer, but no exaggeration, you have to test yourself about 270 times, to be within 90% accuracy.

Speaker 1: 17:08

Okay so that's not practical for most people.

Speaker 2: 17:11

We've got serum tests for iodine. They mean nothing for iodine nutritional status. They're only useful when one is crossed a threshold at which their kidneys cannot eliminate iodine. So with iodine there's like a nutritional range and there's a toxicologic range where it's damaging the organs and that's where serum levels can be helpful. But they don't go up or down in relation to our nutritional status. There is a popular skin test. You put it on your skin, you watch it disappear. How fast does that happen? It's an intuitive thing, but there are ways in which our intestinal tract may preferentially take up more nutrients when we're lacking and less than we have enough. And there are many nutrients that do get into our blood from our skin. Those two things are true, but our skin can't pick or choose. That's one problem. The other problem is iodine disappearing is not the correlation with iodine absorbing, that's just it oxidizing with air exposure. So yeah, that was actually studied in the 1930s and found not to be accurate.

Speaker 1: 18:09

Yeah, so many popular things that are not helpful at all.

Speaker 2: 18:14

Yeah, so wondering how it can help. When someone has been trying to control their iodine intake and they've been doing it for a few months, then urinary iodine to creatinine ratio tests can be reasonably accurate to see if they've gotten to a lower iodine target or not. And the amount of iodine per microgram of microgram of iodine per gram of creatinine is roughly correlating with one's daily intake and that's pretty much a one for one ratio. So if you're below 100 micrograms of iodine per gram of creatinine you're generally at that therapeutic window. So this is useful. If someone has been on a low iodine diet and they're not sure if it's helping them or not, they can simply test that and if they're on target, maybe they need to look at some other factors. If they're not on target, either there's still more they're exposed to or they need more time to get to a therapeutic level.

Speaker 1: 19:05

So they would need to have a base iodine base Nope. Just follow a lower iodine intake test to see if you're on target.

Speaker 2: 19:14

Yeah, in the book I talk about iodine inventory. There's some easy tools online like iodineinventorycom. That's the most useful way to see your status early along and if you've been at it for a while and you're just not sure if you're seeing headway after you've already been on lower iodine, then it's useful to test to see if you're low or not. You would think that you could do a baseline test and say Sally's high iodine, this will help her, but Martha is low iodine already. This won't be useful for her. It doesn't work that way. The iodine already in the thyroid and how the body responds to it doesn't directly correlate with the amount in the tests and studies on people who have benefited from lower iodine diets. Some did try that. Some did look at iodine status before, during and after. It didn't predict who responded and who didn't.

Speaker 1: 20:00

And if somebody doesn't have access to testings or doesn't know how to track, I think going on the lower iodine diet and excluding the foods high in iodine and watching your symptoms, I think it on the lower iodine diet and excluding the foods high in iodine and watching your symptoms, I think it's better than testing anything.

Speaker 2: 20:14

Sure, yeah, guidelines in nutrition suggest doing an inventory of one's intake. You can do that for free Iodininventorycom. You can just enter in food categories, medications, supplements. Get a good gauge of your intake. And, yeah, being aware of the sources. The thyroid reset diet. I talk about the big sources, how they're categorized, so there's ways you can map that out for free.

Speaker 1: 20:37

Incredible. In the book you have such a good protocol that is outlined that answer all these confusing questions about iodine. So everybody, go check the book out. Or, if you have it sitting on your shelves and you haven't read it, because a lot of people do that they buy all the book and they just don't know. Just overwhelmed with all that information. So go read the books. Now we're going to continue talking about what are some of the most common dietary mistakes people with Hashimoto's make and how can they optimize their diet to support thyroid function and just overall health.

Speaker 2: 21:08

Sure. So overall health and thyroid function. They certainly overlap the studies that we have on varying things that affect thyroid function. I mentioned a quick overview. That was actually all the studies that there are Intermittent fasting, keto, ramadan gluten. There's been a lot of studies on soy. We could talk about that.

Speaker 2: 21:25

Aip diets these have all been researched so far. No huge effects. No big effects. I could talk about that in a whole lot of detail. And then we've got tens of thousands of studies on iodine. So that's a big one. There are some other effects with changes in macronutrient intake and then also total fuel intake. And then we've got some data on some other micronutrients being relevant. So a big thing is just total fuel, not so much. You won't really cause thyroid disease by starving or just going low on your diet, but your thyroid will slow. Your thyroid will compensate by slowing your metabolic rate and that can correlate with a central decrease, meaning your TSH will go lower, even though your body might be making less hormone. It can also correlate with a peripheral increase, meaning that you'll activate less of your thyroid hormone into the active forms. That happens also if your carbohydrate intake is below a certain threshold.

Speaker 1: 22:18

Yeah, I think a lot of people with Hashimoto's, just because Hashimoto's slows down your metabolism. So a lot of people try to lose weight and the first thing they do they go on a lower calories, low carbohydrate diet and the restricting calories can raise cortisol levels, increasing stress on the body, and high cortisol levels convert more T4 into this reverse T3. Like you said right, it's an inactive form of thyroid hormone that kind of shuts down your metabolism, causing weight resistance. I would say. So low-carb diets, low-calorie diet, is a big no-no, big mistake.

Speaker 1: 22:59

Another, I think, mistake is that people don't address food sensitivities. They just continue to eliminate more foods over the years without looking at the real problem. What causes that food sensitivity? And there are so many studies. There is not a lot, but there are well-designed studies that linked H pylori infection to food sensitivities because it inflames the gut lining, causing this increased intestinal permeability, aka leaky gut, which allows these undigested food particles into your system. That causes this full body systemic inflammation that worsens not only thyroid issues and other symptoms but also leads to more food sensitivities.

Speaker 2: 23:44

Yeah, and many get on diets that are very extreme and cut so many things out. One of the more common ones is the AIP diet. Many have done well with it in various ways and that's totally fine. But there've been two studies so far on its effects on Hashimoto's. The first one showed no differences, no improvements in thyroid function. The second one showed a worsening of thyroid function. It showed that thyroid antibodies got higher, thyroid volume decreased and the authors of the study, they were looking at many facets of the diet and they found that many people inadvertently ended up raising their iodine intake and, to go back a step, we lost over the second I forgot to mention.

Speaker 2: 24:20

But with Hashimoto's it's actually not caused by the measurable thyroid antibodies, but it's correlated with the measurable thyroid antibodies and the main mechanisms are that they're involving thyroid proxidase and thyroglobulin. So thyroid proxidase its job. It's an enzyme that allows iodine within the thyroid to become more active. It goes from an inactive state of iodide to be oxidized into iodine, in which state it has more capacity to undergo reactions, and once it does that it binds onto a protein, thyroglobulin. So those are the elements of the immune attack thyroid proxidase and thyroglobulin, and the immune attack is driven by iodine triggering it. It's been shown that the extra amounts recruit the lymphocytes, the specific immune cells, into the thyroid and activate them and cause them to treat the thyroid tissues as if they're foreign. So that's the main direct mechanism of action behind that.

Speaker 1: 25:14

And I agree with you on the AIP diet Two not very well-designed studies. They were contradicting each other. And a lot of people do feel better on the AIP diet is because they eliminated a lot of processed foods. They're already eating pretty unhealthy. They hit the wall and they're like, oh, let me do this AIP diet. Of course they're going to feel better because they stopped drinking frappuccino from Starbucks and eating donuts and they attribute that to AIP diet. This is just drastic reduction of additives, toxins, sugar and maybe even losing weight. And now AIP diet, I think is okay short term under supervision of medical doctor. But the most important step is not following a diet is the reintroduction phase, which most people miss or don't do, because it's very hard to introduce the foods the right way and then track your symptoms.

Speaker 2: 26:09

I can come off like a broken record sometime, but the medical literature about thyroid function is. There's one thing we can change that affects it, and I love the fact that we have so much research behind this. I think about research studies like product reviews. You want to buy a water bottle on Amazon. There's a whole bunch of things there and it might be the case that this water bottle that has only one one-star review. Maybe you'd really love that one, but you probably won't and you're probably not going to buy that. And that's the cool thing about medical research is that people are different. You may respond to something that other people don't, but the odds are. You want to leverage your time and you want to do what's most likely to work and start with that. You can't do 10 diets, each one for six months and do that for five years and figure somewhere in there. Something's going to work. You want to follow the product reviews. You want to go with what's been shown to be the most effective, with the best odds for the most people.

Speaker 1: 26:59

Exactly Best odds. That's all we have to play with. There's not one really protocol besides the iodine diet, because that's very well researched in a lot of published peer review studies. But everything else is all, like you said, just reviews per bottle. So we don't have that one protocol that all size fits all approach. So it's always for me it's always like a trial and improvement, not trial and error.

Speaker 2: 27:26

We just learn what's working as we go One of the studies that I mentioned in the book. It took people that had average TSH scores of 14. They were pretty markedly hypothyroid. They all had elevated thyroid antibodies. For three months all they did was keep their iodine intake below about 100 micrograms. Now, not everyone succeeded, so that's an important thing. We'll come back to that. And some people going into it had TSH scores much higher, like between 50 and 200. But the average was about 14.

Speaker 2: 27:55

Now, in three months, at a group level, 78% of people had normal thyroid function. They were totally normal. No medication, that's the only thing they did. They weren't eating healthier, they weren't exercising or sleeping, they weren't taking selenium. All they did was regulate their iodine. 78% were better. Now, remember not everyone did it and remember some people were way off going into it. So the people that didn't do it didn't get better. No big surprise. They were part of that 22% and some of the ones that were off by those huge factors. They improved a lot, but they didn't yet normalize. So if we rephrase that to say, of those who achieved the targets and were following the guidelines, how many either totally got better or were very close to it in that timeframe? That was over 95%. So people are different, but really there's a starting place. There's like a logical starting place here.

Speaker 1: 28:44

Yeah, that's a good odds. That's a good odds that you can start with and, as you said, the water bottle review that I have personally with my client. I had a recently client came to me with all kinds of symptoms, inflamed thyroid. She brought her ultrasound with her and she said I felt fine all these years and now I feel like Hashimoto's is flaring up. We did a simple dietary food recall. Of course. I reviewed the supplements and all that stuff and what we found out?

Speaker 1: 29:14

That about two or three months ago she started taking all these new supplements because she reads the blog or sees something on TikTok and everybody's taking all these supplements. All of her supplements, each bottle, contained high level of iodine. There was like 200 mcg per bottle, which is it's not that bad right. All of her supplements, each bottle contained high level of iodine. There was like 200 mcg per bottle, which is it's not that bad right If you have functioning thyroid gland. But she had a four stage Hashimoto's so she was barely making any thyroid hormones. So those four or five bottles supplements that she was taking this mega doses of iodine, supplements that she was taking this mega doses of iodine. And then you add food on it that supplies iodine naturally to that bucket. So she, as soon as we excluded all of the supplements with iodine, within a week she felt like a brand new person. She went back to feeling great, so that was an easy fix, I guess.

Speaker 2: 30:06

That's great. I'd love to expand upon hypothyroidism and Hashimoto's how they relate. So we've got the autoimmune effect, which can show up by measurable thyroid antibodies, mostly thyroid peroxidase, thyroglobulin. There's a few others that are out there too. About half of people with Hashimoto's never have measurable antibodies. We call this seronegative Hashimoto's. That's often surprising for somebody here, but sometimes we only know about Hashimoto's by structural changes on ultrasound. So yeah, that's Hashimoto's. That's independent of TSH, t3, t4. That has nothing to do with TSH, t3, t4. We can have varying degrees of normal function or hypothyroidism, independent of the autoimmune response and regardless of how much hormone the thyroid is making. Someone can be fully symptomatic and at risk in a lot of ways from the autoimmunity. Now the hypothyroidism is categorized into two formal categories the subclinical and overt, the risk thing and the really happening thing and then what we call suboptimal. So the relevance is that people can get these degrees of hypothyroidism independently of Hashimoto's or with Hashimoto's.

Speaker 2: 31:12

I mentioned before the connection with iodine. The big picture with it and the genetics are that humans are well adapted to two different ecosystems, basically coastal or inland. So coastally adapted humans have deiodinase enzymes that allows them to clear large amounts. On occasion they could eat a lot of kelp and shellfish and not get overloaded. Now, on the other hand, inland humans have better adaptations to lower iodine environments, so they're not as good at clearing a lot, but they're really good at holding on to every bit and doing well on small amounts. And the genes work in ways to where you've got one or the other, but not both. So most of the genes now that correlate with thyroid disease are among these more inland genotypes, and what happens is that the more time someone spends above about 200 micrograms per day, the more likely they are to have an immune response take place against their thyroid, and we see this from thousands of population studies worldwide, from iodine being fortified to foods. We started in the US in 1924. In the following decades, the rate of Hashimoto's amongst adult women went up 26 fold, not percent fold. So that's the thing there.

Speaker 2: 32:23

Now with hypothyroidism, there's separate mechanisms. So when the body goes above its iodine window, its own personal iodine tolerance, you're basically blowing a fuse in a circuit, and so rather than there being more current in the circuit, you have less. You have none. So that's the paradox is that when you're above your window signs you might think of as being iodine deficient. So on one side the extra amounts can trigger the immune response. The other side, the extra amounts can shut down the thyroid. So, independent of the immune response, we can shut down the thyroid by high-dose iodine and we actually use that in emergency medicine. When someone's in a life-threatening thyroid storm, in the case of Graves' disease, for example, we give a negative iodine to shut it right down. So a case like your client, the extra iodine can worsen the autoimmunity, but it can also worsen the hypothyroidism by separate overlapping mechanisms.

Speaker 1: 33:14

Absolutely, and thank you so much for explaining all of this in details. I think the foundation is so important for people to understand. To work with somebody who understands the first difference between Hashimoto's and hypothyroidism and the treatment options. We always have options. There's not one thing that we prescribe or advise to all of our clients. So we know that lower iodine diets work. We also know that there are a lot of conversations around the gut and thyroid connection. So what role does the microbiome play in the thyroid health and how can people with Hashimoto's improve their gut health?

Speaker 2: 33:52

Yeah, great, great question. So autoimmune disease as a big general category is one thing and then autoimmune thyroid disease is another thing, and there's been a lot of data about autoimmunity in general correlating with early stages of gut health being a factor, and there have been studies correlating changes in the microbiome with developing thyroid disease. There hasn't been a lot of data just yet that reversing those changes reverses thyroid disease and so far it's like one of those vitamin D puzzles Is this a chicken or an egg? Is this an adaptation or a cause? One thing that I love to talk about, which is under-discussed, is there's a very high rate of autoimmune intestinal disease with Hashimoto's. Most common thing by far is called autoimmune gastritis, also called thyrogastric syndrome. That's an autoimmune disease that affects between 30 to 40% of people with Hashimoto's. Most don't know they have it.

Speaker 1: 34:45

Is there a way to test for them or are there any signs and symptoms that are distinct to that? Signs and symptoms not distinct? A way to test for them, or are there any signs and symptoms that are distinct?

Speaker 2: 34:50

to that Signs and symptoms, not distinct Ways to test. Yes, so not everyone that has. It is symptomatic at early stages. As it progresses it can cause poor absorption of nutrients. Generally the progression is iron is first malabsorbed, then B12, then zinc, and then various proteins and not so much. The others get better but it becomes cumulative. There's more and more things that get malabsorbed as it goes along and then long-term it raises the risk for esophageal and stomach cancers as well. And, correlating with symptoms, about two-thirds of those who have it will start with more upper intestinal symptoms gas, bloating, reflux, heartburn-type symptoms.

Speaker 2: 35:27

Some don't Testing for it there's a marker, the APCA, which is a marker of antiparietal cell antibodies. So the disease itself is attacking parietal cells in the stomach. They make HCL, they make mucin and they're also involved with intrinsic factor production. So the earliest sign of the disease is when those are positive. The other blood marker that's useful is gastrin, which is a protein of the stomach lining. So the second stage of the disease there's a measurable breakdown in the lining and then gastrin elevates. So earliest sign is APCA is up. Next sign gastrin is up also. At that point someone should be working with a gastroenterologist to see if there has been any precancerous change, but very common condition, very underdiagnosed, sadly. Many in functional medicine are aware of malabsorption and they often talk about treating with HCL. These people can often be lacking in HCL, but because they're also lacking in mucin, hcl is dangerous for them Absolutely.

Speaker 1: 36:27

And I would think that calprotectin would be elevated just because it's such a good marker of inflammation. And in my practice I do a lot of stool tests and it's not necessarily testing for specific autoimmune disease. But research shows that almost every person with Hashimoto's has gut dysbiosis or altered gut microbiota, so we know that it starts there. So a lot of my clients have extremely high levels of calprotectin and I know since of course, we're addressing gut dysbiosis, maybe chronic gut infection, maybe increased intestinal permeability, but when I see that number the inflammation number is so high I refer them to endocrinologist, whatever the city they are at, because there is something that needs to be done and I don't know if it is a biopsy. Is it checking for the markers that you just mentioned? So it's something very serious and, like you said, it's underdiagnosed. Nobody ever came to me with that diagnosis, so I hopefully the diagnosis criteria will change for people with Hashimoto's to improve the symptoms?

Speaker 2: 37:34

I don't know. There's comorbidities. So with thyroid disease, symptoms come about because of changes in the immune response, because of levels of thyroid hormone or because of comorbidities. So having thyroid disease means that there's something different about your body because of the disease, but also you're in a certain demographic that has that thing go wrong and because of those two factors. Other things are more common as well. The thyrogastric syndrome I mentioned is one of about 15 very common comorbidities. So, yeah, really managing thyroid disease well, that's part of it, and all too often I'll see where people fixate upon trying to perfect these thyroid levels, giving medicines, changing the medicines and someone's symptomatic because they've got undiagnosed other diseases Parathyroid disease is a common one as well or inflammatory bowel, like we mentioned. We also see apnea, quite common fatty liver disease. So, yeah, many of these things are present and they're often just not given attention and that's why people are still symptomatic.

Speaker 1: 38:29

And that's why and I keep saying all the time it takes a village to treat Hashimoto's. You need to have endocrinologists and gastroenterologists and the dietician and everybody, because we all specialize in our own things. Yes, we know a lot about it, but, like I said, it takes a village. Now we definitely know that there is a connection between gut health and Hashimoto's, but we also know that supplements play a big role in how we support thyroid health. Can you share your thoughts on which supplements are the most beneficial for individuals with thyroid issues and how can we incorporate them into our daily routine?

Speaker 2: 39:07

Yeah, great question. Funny thing when I wrote the Thyroid Reset Diet I spent about a year and a half and I read every published study on diet and thyroid disease quite literally and read all the references and I stumbled across a lot of studies that were high quality ones on interventional trials using different nutraceuticals for facets of thyroid disease. Things like lowering antibodies, decreasing nodules, increasing thyroid volume, reducing hypothyroid symptoms, so on. There's good evidence. Lots of things to talk about there. The big thing is there's many common nutrients that are needed for many different ways within the thyroid and the best thing I encourage people is to start with an appropriate multivitamin, iodine-free. It's a big thing to work around.

Speaker 2: 39:47

There's debates about folic acid and folates and how folic acid might be metabolized. There's a genetic variation, pretty much universal in those with thyroid disease that might change how folic acid is metabolized. That's a consideration in multis too. And then B6, there's a lot of ways in which the body has to activate B6 into something called pyridoxal 5-phosphate. That conversion may not work as well in the populations with thyroid disease. When B6 is not converted, it by itself in excess can cause a lot of symptoms neuropathy, anxiety, mood changes. So the big things I think about with the appropriate multi is avoid iodine, avoid synthetic B6, and consider folates over folic acid.

Speaker 2: 40:30

But that's a good foundation. There's specific things. For example, a lot of good studies on black cumin oil being useful for diminishing antibodies, for diminishing hypervascularity, for lowering thyroid cancer risk so great thing there, prunella. Good studies about that being part of a combination with spirulina boswellia for diminishing nodule size. Pretty good studies on large reductions for a large number of people. So we could talk about many examples. But yeah, there's robust data behind many ways nutraceuticals can help as well.

Speaker 1: 41:04

Absolutely. I think a lot of people rely on supplements too much, but I do believe that they have a place in somebody with Hashimoto's and, like you mentioned a good multivitamin and I'm so glad to see that a lot of companies are now making methylated B vitamins because of MTHFR mutation that is, like you said, pretty universal, I would say. The other one I would add is definitely vitamin D, because we're just chronically deficient in vitamin D. I always say don't supplement blindly, don't listen to those interviews and say, oh, I'm going to add vitamin D. You may not be deficient, but most people are.

Speaker 2: 41:42

Many are. I'd love to make an expanded comment there. So an odd thing happened in the States to where there was many studies coming out about vitamin D, correlating with diseases and talking about specific blood levels. Now, medical research is written in metrics, it's written for an international audience and our blood tests here are in standard units and this is a sad story. But many health experts saw these studies and they started making recommendations and they failed to appreciate the conversion factor between the units in the studies and the units in blood tests in the United States and so many were pushing these blood levels saying, oh, you must be 60 to 80 or 80 to 100 or something. Yeah, that's great for metrics, that's not great for US units. It's just like miles versus kilometers.

Speaker 2: 42:27

I did an interview with a parathyroid surgeon and she's had many cases of people who have been debilitated with parathyroid-like symptoms and seeming parathyroid disease from simple vitamin D excess. And this can happen when nanograms per mil the US units start getting above 60 or 70, like not that crazy high. So there's a really big benefit from vitamin D. Many get low in it, but in the natural medicine world I see tons of people overdosing it on as well. So you're right, it's really testing and being specific. But it's also the mindset for nutrients. Is not that more is better, it's that the best amount is best. Very narrow windows.

Speaker 1: 43:06

Yeah, best amount for you for that specific person.

Speaker 2: 43:10

Yeah, and you don't have to reinvent the wheel, and these are things that we know about. We've got good data on what are healthiest ranges and we can find that. And it's tempting to think that if, for example, if studies suggest low vitamin D correlates with some condition, that if we go on the super high side, we're going to make that thing go away. And the way I think about it, imagine keys for your car. If your car is not moving at all and your key is not there there, you go, put the key back in and you're fine. But guess what? The key is in and you're turning it. You can't go buy a thousand keys and make your car work better if that's not the problem. And that's what nutrients are like. They're not a gas pedal. It's not the more you take, the more they do.

Speaker 1: 43:55

It's that if they're not there it won't work, but once they're there, it's going to work as well. It's going to work based upon all other factors and in most cases, people take too many supplements.

Speaker 2: 44:02

As far as the number of supplements, I could not agree more. There have been large studies showing that 20% of those who end up in emergency rooms due to acute liver failure are taking too high of a number of supplements and, interestingly, they're not even taking supplements known to be liver toxic. It's just the number together that starts to strain the liver. Yeah, I totally agree on that.

Speaker 1: 44:22

Exactly. Somebody needs to come up with an app that scans all of your supplements and tells you what you're overdosing on if you're missing iron, because most supplements don't contain iron. Overdosing on if you're missing iron because most supplements don't contain iron. And just with female menstruating, we tend to be low in iron, so that's another thing you have to test before you supplement.

Speaker 1: 44:41

That's because it's a mineral that can cause liver toxicity really quick because it builds up. And I just had a client two weeks ago. She was doing iron infusions and of course her liver enzyme were all over the charts and she felt terrible and she was lucky that she didn't end up in the hospital. But this is such no, don't do infusions.

Speaker 2: 45:03

Yeah, iron is something that some nutrients have a narrower therapeutic range than others, and also they have a more specific audience need than others, and iron is one of the best examples of that. The infusions can be life-saving helpful I've done those but they can be horribly overused and if someone doesn't need them they're completely toxic. I completely agree with that. It's also one to where there's strong evidence that if someone has thyroid disease, their iron needs are now a little different. So a lot of the ways that we use thyroid hormones depend upon iron deficient enzymes or, I'm sorry, iron requiring enzymes, and so when iron scores can still be normal but below optimal, there's a thing called latent iron depletion and it's still normal levels. But ferritin is dipping on the low end of the range and many with thyroid disease can have more elevated TSH, more symptoms, more hair loss, more issues that show up. So it does take specificity.

Speaker 1: 45:54

For some reason, this conversation reminded me of the post that you did a few weeks ago about optimal amount of water you should take with your thyroid medication. It blew my mind and I'm like, oh, there's one more thing that we need to consider and remember to either tell our patient or even, in my case, to remind myself. Now my question is does that apply to both levothyroxine and like natural desiccated thyroid hormone? Is there a difference?

Speaker 2: 46:27

As a generalization. That question comes up all the time and there are differences in type, but not differences in relevance. Natural thyroid NDT is levothyroxine. It's the same T4 that's in there. There's also T3, there's also other things, but it still requires absorption. And there are other versions of thyroid medication that are easier to absorb. We've got one that's in gel caps, we've got a few that are liquids, but things that are tableted. There's not huge differences in how well they're absorbed and there's many circumstances in which someone is on medication.

Speaker 2: 46:58

Again, first question is are you supposed to be on medication? Because the weird thing is that if you're on it, you're not supposed to be on it, it won't work well, you'll be symptomatic, your levels won't be stable, you'll always be chasing it, and so sometimes it's fighting a losing battle. That's the first question to get through, and if you don't need it, it's not going to work right, no matter what you do If you do need it. There are many people where their scores aren't stable for a lot of generally simple reasons, and I see a lot of doctors chasing doses, chasing medicines, and they might be drinking too much water with it. They might not be timing their tests properly with their menstrual cycle. They might've had biotin the day before their labs. There's often really reasons for that, and the water trick is one of those.

Speaker 1: 47:40

And I love your page. I, as a thyroid patient myself, refer to your page all the time. I'm like, oh, what did you say three weeks ago about menstrual cycles and when to take it? Such a great resource and such a fun one I love. I personally like your videos.

Speaker 2: 47:57

Thank you.

Speaker 1: 47:58

So we covered a lot of information and my Instagram feed is not coming through, so I don't know if I have questions there, but I think we answered all the live questions that came in. Mine are not connecting properly either. Yeah, something did not work. But what I do want to do, I want to do a round of rapid fire questions, so I'm going to ask you a few questions. You can explain a little bit about them or not, or you can just answer and move on. That's why they're a rapid fire, but I think they'll be a little fun for our audience to get to know you a little bit more. Somebody lucky got in before my rapid fire questions. They ask what about electrolytes for Hashimoto's? Is it a yay or nay?

Speaker 2: 48:44

Neither Not good not bad. One thing I would say is that a lot of electrolyte formulas have a lot of iodine. Don't ask me why. It doesn't make any sense that it's there, but it often is. There's not really differences in need for electrolytes because of Hashimoto's. There are comorbidities that can correlate with altered adrenal function that can make that relevant, but direct Hashimoto's by itself. No change in that.

Speaker 1: 49:05

And a lot of supplements don't necessarily list electrolyte powders. They don't have to list iodine on their packet right.

Speaker 2: 49:13

They don't, yeah, nothing does. Yeah, yeah many of them do, but you're right, there also are many hidden sources of it.

Speaker 1: 49:20

Yeah, so we have to read the ingredient list to know which ingredients can be potential source of iodine. So that's a little bit trickier and that's why I review very closely every supplement that my client comes in. Okay, we are going to move to this. Rapid fire questions. Is there a yay or nay for peptide injections for?

Speaker 2: 49:42

Hashimoto's. So the saying is that the early bird catches the worm right In medicine. The saying is the second mouse gets the cheese. It's a little bit dark. It's dark and morbid, but peptides. You might be the first mouse. I don't like to be the first mouse. I like things that are well studied and have a long track record behind them.

Speaker 1: 50:01

Yes, I agree. I agree with you on that. If you were sent to a deserted island and could only bring one supplement, which one would you?

Speaker 2: 50:09

bring Giant capsule with lots of food. I don't know. One supplement Deserted island? Well, I'm probably not going to need vitamin D. As white as I am, I'm not going to need fish oil if I'm not on a deserted island. That's tricky Boy. I don't know. Magnesium Depends on what I'm eating. Yeah, I don't know, that's a tough one.

Speaker 1: 50:33

I don't have a tidy answer, but your answer was perfect. You already named all the important nutrients for Hashimoto's and overall health. So everybody take note.

Speaker 2: 50:38

Vitamin D, if it's porcelainium in the soil that could be a relevant one for the deserted island, especially for me having to get more iodine than I'd want because of the available food. So there we go. That's my best answer. Bring a bag of Brazil nuts.

Speaker 1: 50:51

What's your go-to stress-reducing activities after a long day?

Speaker 2: 50:57

My wife and I play cards a lot After a long day is different than the beginning of the day. Beginning of the day I'm active, I'm exercising, end of the day, go for a little walk based upon the weather, based upon what she's up to, but we play a lot of cards. We're Midwesterners here, we play cribbage, we play card games. That's a favorite, amazing, and it's very good exercise for the brain it is.

Speaker 1: 51:20

We play each other most every day, so we're pretty competitive and we know each other's moves. So, yeah, I love it. I love it Now if you could only work with one lab test for thyroid health which one would that be?

Speaker 2: 51:28

Oh, this will get me in trouble. Only one lab test, that's tricky. So I'm really struggling between TPO and TSH. So TPO, earliest indicator for most people with the disease is active. Anti-tg is earlier than that. T3 and T4 are nice, they're later. They're 50 times less sensitive for changes than TSH is. I know TSH is verboten but it is the earliest indicator of changes in function. So for thyroid function, if I only had one it'd be TSH I want to have more than one and thyroid inflammation. What would catch the most who are symptomatic would be TPO.

Speaker 1: 52:06

Good, Very good. What's the biggest myth about thyroid health that you wish people would stop believing Boy the?

Speaker 2: 52:13

biggest single one, iodine's, got to be up there. More is not better. That it's not a bad thing, it's not the villain, but we need targeted amounts, and people are. I said that before. I won't back in the soapbox, so that's probably it.

Speaker 1: 52:27

What's one lifestyle change you think everyone with Hashimoto's should try?

Speaker 2: 52:35

One that everyone should try. So I see people, that people are so different. I don't want to be a broken record and say that again. That's the best documented.

Speaker 1: 52:42

If you think this is the best approach, say it.

Speaker 2: 52:45

As far as evidence we have for adult chronic thyroid disease in the modern world, regulating iodine is the one thing shown to make a big difference and that's the thing the study that I cited. There's so many good things you can do for your health that are important. You got to sleep, you need a good social community, you need overall diet, your exercise, some meaning in life. These things all matter. But that study that I cited they did none of that. No one did any of those things and pretty much everyone who did it had radically improved thyroid function. So I can't deny that's the one thing that has the biggest effect.

Speaker 1: 53:17

So it's not the number of things we do, it's that the things we do consistently. You can't try something for a week.

Speaker 2: 53:24

They're specific. They actually are relevant to this disease process. You can do 20 or 30 things that are all vaguely good for you, but they may not affect this particular disease process and many of the things have been studied.

Speaker 1: 53:36

Yeah, instead of trying cold plunge, maybe try to do lower iodine diet and see which one is working.

Speaker 2: 53:42

I've heard before, zero plus zero plus zero is still zero. You can do 20 things that each one might not be that big of a deal. It's not that big of a deal. Find the one thing that'll have the biggest effect, what has the best product reviews, so to speak, and focus on that.

Speaker 2: 53:58

Exactly, and this is about thyroid disease. For other conditions this wouldn't apply at all. It's really there about being specific to your needs, your condition and what has the best evidence behind making a big difference. So, diet, lifestyle, natural therapeutics they're wonderful, but they're all specific and you want to figure out what's going to give you the biggest effect.

Speaker 1: 54:16

I agree. What's one thing people would be surprised to know about you?

Speaker 2: 54:21

I'm surprised to know about me. I'm an endurance athlete. I ride unicycle off road quite a bit. It's a weird thing that some don't know, so yeah, yeah, I didn't know that.

Speaker 1: 54:33

I follow you very closely.

Speaker 2: 54:35

I've been a climber for quite a while. I've done an awful lot of vertical rock climbing over the years and been in some pretty cool places. But probably the weirdest thing that many don't know is the off-road unicycling. So pretty much anywhere you could see somebody riding a mountain bike. I've done train like that on one wheel. That's fun though.

Speaker 1: 54:49

Wow, that's fun and dangerous. Sounds very dangerous.

Speaker 2: 54:52

Yes and no. I've raced mountain bike quite a bit. So on a unicycle you're not going as fast and it's easier to bail off a unicycle than it is to unclip and bail off a mountain bike. And learning how to ride a unicycle, you're falling tens of thousands of times. You get really good at it. Good at falling, yeah, good at jumping off quickly.

Speaker 1: 55:12

I fly fighter jets. That's awesome, yeah, so I can do rolls and all that stuff. And some people say that's dangerous. I'm like this is the safest sport.

Speaker 2: 55:22

That's awesome. I was a VFR pilot for a while. We had our own little plane, but never took it anywhere near that far. So yeah, hats off to you.

Speaker 1: 55:29

Yeah, thank you. Thank you. The last question I have is there a book or podcast or documentary you have recently enjoyed that you would recommend to us?

Speaker 2: 55:41

Yes, many Boy shoot. You know what this is really boring and maybe nerdy. I've been very into classic fiction as of late because of my son's interests. He's a literary major these days. Everyone knows the basic story about Moby Dick. It was actually one of the earliest novels ever written Herman Melville. He had quite an amazing life story, a phenomenal book, one of my all-time favorite. I've read it like three times in these last couple years. So yeah, moby Dick, spend some time with that. It's intense. It's a phenomenally good book amazing.

Speaker 1: 56:12

Thank you so much for sharing that and I think we learned a little bit more about you. So thank you for your insight and, dr C, thank you so much Again. I cannot thank you enough for dedicating a whole hour to us sharing your knowledge, sharing your expertise, a little nuances, so I'm sure this conversation was very insightful for a lot of our listeners. I will put all of your information in the show notes. This live podcast will be featured on YouTube, facebook, instagram, everywhere, and it will be easier to find.

Speaker 2: 56:48

So again, thank you so much. It was a fun conversation. Thank you for having me. So again, thank you so much it was a fun conversation.

Speaker 1: 56:53

Thank you for having me. Thank you, I hope we'll have more conversations, maybe doing a deep dive on, I don't know, maybe do a reading of your book. I would love to do that or talk about specific supplements or something. Thank you so much and have a wonderful rest of your day will do.

Speaker 2: 57:09

Thanks again for having me, natalia, bye.