I decided to create a series of episodes covering the different factors that can help you lower and eventually normalize your thyroid antibodies. Today, in part three of my series, I’m discussing the role of stress, which is a big factor in many people. I talk about my experiences with stress when I was dealing with Graves’ disease, when to consider adrenal testing, stress management techniques, the role of supplements, the benefits of personalized support, and more. If you would prefer to listen to this part, you can access it by Clicking Here.

In this presentation, I’m going to discuss how to lower your thyroid antibodies by addressing the stress in your life. When I say “stress,” I don’t mean just emotional stressors, but physical stressors as well. I’ll get into more detail about this shortly, but let’s go ahead and answer the following question: How can stress trigger thyroid autoimmunity? 

First of all, stress can increase proinflammatory cytokines, which promote inflammation. There are other factors that can increase inflammation, but stress is one of them, essentially causing dysregulation of the immune system.

Also, stress can decrease something called secretory IgA. It lines the mucosal surfaces of the body, including the gastrointestinal tract. When someone has a lower secretory IgA, typically, they have a leaky gut, that increase in intestinal permeability. 

There is something called the triad of autoimmunity, which has three components necessary for autoimmunity to develop. That includes a leaky gut. Stress can promote inflammation, causing dysregulation of the immune system, and it can also potentially increase permeability of the gut. 

It’s important to understand that not all stress is equal. When it comes to emotional stressors, there is acute and chronic stress. Our body was designed to handle acute stress situations, but it wasn’t designed to handle the chronic stress that most people deal with. That is part of the problem and also part of the solution: trying to change the perception of the stressors. It’s going to be difficult, if not impossible, to completely eliminate stress from your life. I’ll talk more about addressing these stressors. 

How can you tell if stress is a potential trigger? Many people have a good idea that stress is a factor. When I have an initial patient consultation, whether it’s someone who has Graves’ or Hashimoto’s, I have everyone fill out a health history. 

I ask everybody to give me an idea of the stress levels and stress handling. There is a scale on the health history form, 1-10. If someone circles 10 for their stress levels, that means their stress levels are pretty high. If they put a 1 for stress handling, that means stress handling is low. A lot of people will do that. They may not put 10 for stress levels, but if they put stress on the higher side, that gives me a good idea that they are aware that stress is a factor. If they put a 1 or 2, maybe stress isn’t a factor, but many times, they’re underestimating the impact that stress has on their health or overestimating their stress handling ability. 

One thing I recommend with just about everybody is to test adrenals. By testing the adrenals, you can actually see what the cortisol and DHEA levels look like. These are adrenal hormones. 

Prior to my diagnosis with Graves’, I didn’t feel like stress was a factor. Even when I finally got the diagnosis of Graves’ before I did any type of adrenal testing, I thought I did a good job of handling stress. I didn’t deny that stress was a factor, but I did an adrenal saliva test and was surprised that it was as bad as it was. I had very low cortisol levels, low DHEA. I had low secretory IgA, which I tested as well. 

Testing the adrenals can be helpful to see the pattern that you have. Some people have elevated cortisol levels. Not everybody has depressed cortisol levels. Some people have elevated secretory IgA. 

When it comes to the different types of testing, I mentioned saliva testing; that is what I did back in 2008 when I dealt with Graves’. 

There is blood testing, too. There are a few problems with blood testing. First of all, cortisol responds to stress. Some people get stressed out by getting the blood draw, so getting the blood draw can cause a false elevation of cortisol.

Another limitation of testing for cortisol in the blood is you will typically only do a single sample. Maybe you will go in the morning to get that single cortisol test done. You really want to look at the circadian pattern of cortisol. It should be at the highest level in the morning and gradually decrease throughout the day. If you’re just looking at that single cortisol level in the morning, then you’re not sure. If it’s elevated, maybe it’s elevated because you got the blood draw. Maybe if you did it at home, it wouldn’t have shown the same findings. 

Not to mention you could also do it earlier. If you wake up at 6am, ideally you are supposed to collect the first saliva sample right when you wake up. The lab might not open until 8am, so you might have to wait for a couple hours to get that first sample. 

There is also dried urine testing, with the DUTCH test being the most well-known dried urine test. That also looks at the circadian rhythm of cortisol. They also offer saliva testing as well. Either one will look at the circadian rhythm of cortisol and DHEA. 

The DUTCH test does not look at secretory IgA. You could test secretory IgA through a comprehensive stool test. Not all saliva tests will test for secretory IgA. There are a few companies that offer that. 

I do recommend, if you haven’t done so already, to consider some type of adrenal testing. Not through the blood. Typically, a saliva test or a dried urine testing. 

I mentioned my Graves’ story. I underestimated the impact stress had on my health. Emotional stressors were definitely a factor, but there are also physical stressors to consider. That was the case with me as well. I was overtraining. 

There are different ways you can overtrain. I have consulted with people who are running marathons and triathlons. Not to say that that’s always going to cause too much stress and lead to a chronic health condition, but if someone has a condition such as Graves’ or Hashimoto’s, they probably need to give their body a break if they are running marathons or triathlons. You don’t have to do that. 

With my case, I wasn’t running marathons or triathlons. I was just working out at the gym, but I was definitely overdoing it. I was wiped out after working out. I should have known better at the time, but I didn’t. I didn’t listen to my body. I’m sharing this with you to make you understand that different stressors, even fasting- 

More recently, intermittent fasting has become more and more popular. I was really restricting calories back then, really going extreme. I’m sure I wasn’t getting enough protein, and I was overtraining. 

I’m not saying intermittent fasting is bad, but if someone is fasting for 20 hours a day, that’s a stressor on the body, especially if you are doing it every single day. If you are doing a 20-hour fast or a 24-hour fast once a week, many people can handle that. Not everybody. I have worked with patients who are doing 20-hour fasts every day with only a four-hour eating window. I have worked with people who are overdoing it, whether it’s at the gym or running outside in the morning.

There is also stored trauma, trauma from many years ago, even as a child, which can cause dysregulation of the nervous system and the immune system. Not to get into detail here. I do have some interviews on my podcast with Dr. Irene Cop (episode #22) and Dr. Aimie Apigian (episode #69) that you can check out. 

It’s also important to mention that stress can affect the sex hormones. You need healthy adrenals in order to have healthy sex hormones. If someone has low progesterone, low estrogen, low testosterone, as we get older, yes, we do expect these to decrease, but they should be within a certain range. I really don’t like the blood test; the lab ranges I’m not crazy about. 

If you look at a test like the DUTCH test, I do like their ranges. For estrogen and progesterone, the post-menopausal ranges. If you look at a blood test for progesterone in post-menopause, if it’s 0, it’s considered to be within range still. You don’t want 0 for progesterone or any sex hormone. 

Let’s say you do a dried urine test, and your progesterone or estrogen or both are below the post-menopausal range. There is definitely a time and place for bioidentical hormones, but you also want to do things to optimize adrenals. Most conventional medical doctors aren’t doing that. Many aren’t doing anything. Some doctors will give bioidentical hormones, but you also want to optimize adrenals. Maybe then the person doesn’t need bioidentical hormones, or maybe they need a lower dose in that case. 

How can you become a master at handling stress and therefore address this component that can affect antibodies? We can say that stress alone in many cases, just like food alone in many cases, isn’t the reason why someone has elevated antibodies. As a result, just doing things to improve stress handling might by itself not normalize antibodies. 

Let’s put it this way. If someone is stressed out all the time, either emotionally or physically, it really will be difficult to lower and normalize those antibodies. This should be a piece of the puzzle, just like eating well by itself might not normalize your antibodies, but if you eat inflammatory foods, it really will be difficult to lower and normalize antibodies. 

Like I said, you might want to test your adrenals if you think that everything is good. Even if you’re retired, and you think stress is low, maybe stress is low, but everybody has stress. It’s obviously different types of stress if someone is retired. They don’t have the stress associated with work. But there might be other stressors. Every now and then, someone does truly have low stress, so they are doing a good job of managing stress. A lot of people tend to underestimate the stressors and overestimate their stress handling. 

When it comes to becoming a master of handling stress, a reminder: It’s the perception of the stressors. You want to try to do what you can to change the perception. Having a positive mindset alone isn’t going to be the answer, but that does play a role. 

One thing I would recommend is keeping a gratitude journal daily, writing down three things at night before you go to bed and in the morning. Maybe most days, it’s the same three things. Realizing that you do have things to be grateful for because when it comes to chronic stressors, a lot of it is just thinking about the negative impact of our jobs and finances and relationships. These could be serious stressors. There are others that I didn’t mention here. 

Sometimes, there is not a whole lot we can do about these stressors, at least in the short term. Writing a gratitude journal every single day, preferably twice a day, reminds us that we should really be grateful. Everybody does have some things to be grateful about, no matter how difficult life may be. 

I do recommend incorporating one or more stress management techniques, whether it’s deep breathing, meditation, yoga, biofeedback, even hypnotherapy. There are a lot of different options. You want to choose at least one that you are willing to do. 

If you’re not doing anything currently, or if you’re not doing anything daily- Let’s say you’re doing yoga three days a week. I would say go a step further and block out time every single day. Start with five minutes a day, or even three minutes. Let’s say five minutes per day; most people can find five minutes per day to get into the routine of stress handling. 

This is similar to exercise. With many people, you need to get into a routine of exercising. If you go every now and then, a lot of people will eventually stop going. A lot of people will get into a routine and stop, too. But a lot of people will get into a routine and eventually increase the duration. 

Maybe you increase the duration only a few days per week. For example, maybe you start out with five minutes every single day, doing deep breathing. Then after a few weeks, Monday, Wednesday, Friday, you spend 10 minutes doing deep breathing, and then five minutes the other days. Maybe you increase it to 15 minutes per day. If you want to do it every single day, eventually go from five minutes a day to 10 minutes every single day to 15 minutes every single day. Keep in mind you don’t have to. Obviously, the more you do, the better. 

A lot of this is just by getting into the routine of stress handling. Let’s say you’re blocking out time in the morning or evening to do some deep breathing. In the middle of the day, you have a stressful event at work or an argument with a friend or family member. Hopefully, by getting into the routine, you’ll incorporate that at the time, or maybe right after. You have something happen at work. During that time, you’re stressed out. Then you take five minutes right after the incident to do some deep breathing. That can greatly help. Highly recommend this.

I need to talk about the importance of getting quality sleep each night. At least 7-8 hours a night. Sure, there might be some people who can get by with six hours or less. There are some genetics that have shown that some people might not need 7-8 hours. I’d say the majority of people, especially those who are dealing with an autoimmune thyroid condition, probably should get at least seven hours’ sleep. That doesn’t mean seven hours in bed, but seven hours asleep. If you take 15 minutes to fall asleep, you want to be in bed for seven hours and 15 minutes. 

You want to set yourself up for success when it comes to sleeping, meaning you want to have a good sleep environment. Make sure the room is completely dark at night. Minimize the use of electronics before going to bed. Try not to do anything that stresses you out before going to bed, like watching the news, for example. Don’t eat too late. I recommend two hours after eating dinner before going to bed. Three hours is even better.

There are a lot of factors that can affect sleep: Blood sugar issues and adrenal problems are two of the most common ones. Adrenal problems relate to what I’m talking about here. I understand that some people listening to this might have difficulties falling and/or staying asleep. It’s something you need to work on. It may be something you have worked on, but you need some help from functional medicine practitioners. Something to consider.

Nutritional supplements and herbs. I like them, but they aren’t a replacement for blocking out time for stress management. I mentioned a gratitude journal, so that’s important. Supplements aren’t taking the place of that either. Sometimes, they can be helpful. 

When I dealt with Graves’, I saw my adrenals were really low, so I took some nutritional supplements and herbs. I took licorice root for the low cortisol, which extends the life of cortisol. If someone has high blood pressure, licorice root is a contraindication, so it’s not a good fit for everyone. 

Taking B vitamins is something I did. Vitamin C. There are other things, too. Adrenal glandulars, rhodiola, holy basil, eleuthero or Siberian ginseng, ashwagandha.

I love ashwagandha, but it is a member of the nightshade family. It can also support adrenals and the HPA (hypothalamic pituitary adrenal) axis, but it can also affect the HPT (hypothalamic pituitary thyroid) axis. For some people, it can increase the hyperthyroidism. Just something to be aware of. 

I’ve had patients with hyperthyroidism, including Graves’, take ashwagandha. Usually, it’s part of a formulation, not by itself. Even as part of a formula, it won’t have as much ashwagandha as when you take it by itself, but still, sometimes, it can cause hyperthyroidism or increase hyperthyroidism. If that’s the case, when you stop it, it usually resolves.

Phosphatidylserine is something that can help, especially with higher cortisol levels. There are a lot of natural agents that can help with supporting adrenals. There are things that can help with anxiety, like L-theanine, for example. I do recommend working with a practitioner, not just randomly taking supplements. I also did adrenal testing, so I also didn’t randomly take the supplements. I didn’t take all the supplements I just mentioned.

I want to finish up by talking about the Vagus nerve. You have the parasympathetic system, which is the rest and digest system, and then you have the sympathetic nervous system, the fight or flight system. Most of the time, you want the parasympathetic nervous system to predominate. Certainly not all the time. A big way to accomplish this is by doing Vagus nerve exercises. Vigorous gargling is one thing you can do. Singing loud, either in the shower or in your car or somewhere else. Taking cold showers can also help. I have an article on my website about these exercises.

That’s pretty much all I wanted to cover with regard to the impact that stress has on the antibodies. Again, it’s a piece of the puzzle. Just managing your stress alone usually is not going to normalize the thyroid antibodies. It does play a significant role. Optimizing your adrenals is very important. Definitely something you want to pay close attention to. 

I hope you found this information to be valuable. As usual, I look forward to catching you in the next episode.

I decided to create a series of episodes covering the different factors that can help you lower and eventually normalize your thyroid antibodies. Today, in part two of my series, I’m discussing how to lower your thyroid antibodies by addressing food triggers. While all of the episodes in the series will be important, this one might be the most important. I talk about the Triad of Autoimmunity, the role of elimination diets to identify food triggers, testing for food sensitivities, specific food categories and their impact on gut health, common food allergens, the role of iodine, pros and cons of intermittent fasting, and more. If you would prefer to listen to this part, you can access it by Clicking Here.

There could be many factors that can cause elevated thyroid antibodies. In this presentation, I’ll be discussing the impact of food triggers.

Before I begin, I want to mention how eliminating food triggers alone usually won’t normalize thyroid antibodies. They definitely can be an important piece of the puzzle though.

I also want to let you know that the first couple minutes, I might get a little bit technical, but after that, I think it will be pretty easy to understand.

Let me start off by discussing how food can be a trigger of thyroid autoimmunity. Certain foods can cause an increase in pro-inflammatory cytokines. As the name suggests, these promote inflammation. They can also cause a decrease in what’s called regulatory T cells, or T-regs. There is also something called molecular mimicry, and this is when the peptide sequence of certain foods is similar to those of human molecules.

Certain food allergens can result in a decrease of something called oral tolerance, and this triggers an immune system response against various components of food proteins. In other words, eating certain foods can result in the immune system attacking the food proteins and potentially attacking bodily tissues with a similar amino acid sequence.

I mentioned oral tolerance. What is this? Oral tolerance plays a key role in preventing our immune system from attacking dietary proteins.

I also mentioned regulatory T cells, or T regs. These play a big role in preventing our immune system from reacting to food antigens. You want to have an abundance of these regulatory T cells. Having a decrease in these regulatory T cells can cause a loss of oral tolerance. This in turn can set the stage for a leaky gut.

A leaky gut is part of the triad of autoimmunity. I have spoken about the triad of autoimmunity in other podcast episodes, videos, articles, blog posts, and thyroid health-related books. According to the triad of autoimmunity, there are three factors necessary for autoimmune conditions to develop, including Graves’ and Hashimoto’s.

The first component of the triad of autoimmunity is a genetic predisposition. Just because you have a genetic predisposition doesn’t mean you will develop an autoimmune condition.

The second component of the triad of autoimmunity is exposure to one or more environmental triggers.

The third component is an increase in intestinal permeability. The medical term for this is a leaky gut.

You might be wondering whether all foods can potentially be triggers of autoimmunity or cause a leaky gut. The answer is no. Healthy foods sometimes can be problematic in other ways. I’ll talk about that soon.

There are definitely some foods that are more problematic than others. This includes common allergens. When talking about common allergens, the four main ones that are talked about a lot include gluten, dairy, corn, and soy.

Soy is a little bit controversial because without question, there are benefits to eating organic fermented soy. I wouldn’t necessarily categorize soy with these other common allergens. That being said, I usually do recommend for people to take a break from eating soy when healing. I’ll talk more about soy later.

When it comes to healthy categories of foods, sometimes it’s not a matter of them being triggers but either increasing intestinal permeability or maybe not actually causing the leaky gut but being a little bit harsh on the gut and preventing the gut from healing.

Let’s discuss some of these foods. Grains are excluded from both an autoimmune protocol or AIP diet as well as a standard paleo diet. The reason is because grains can be harsh on the gut. Can they actually cause a leaky gut? Certain grains with gluten potentially can. Gluten-free grains aren’t probably going to cause a leaky gut but can potentially prevent the gut from healing.

I do recommend to take a break from grains while healing. It does depend on the person, but we’re talking about autoimmune conditions. There are some people who might be able to get away with eating some rice or other gluten-free foods.

I should mention some of the gluten-free foods. Rice is gluten-free. Keep in mind that if you just buy regular rice at a health food store or a grocery store, just by itself, it’s gluten-free. If you buy pre-packaged rice or go out to eat and get rice as a side, it might not be gluten-free. Sometimes, rice will have wheat in it, if you get a box of not just plain rice, but rice with other ingredients. Similarly, if you go out somewhere, and you just get a side of rice with whatever else you’re eating. You want to make sure that it’s gluten-free.

Oats are commonly cross contaminated with gluten, so if you do eat oats, which I am recommending to take a break from all grains, including oats. But if you were to eat them, you want to make sure they are certified gluten-free.

There are pseudo-grains such as quinoa that are gluten-free. Millet and buckwheat are two others. You want to take a break from all grains, including gluten-free grains, while healing.

These all include different compounds like lectins, phytic acid, glycoalkaloids. Different foods will have different compounds, which can affect permeability of the gut or prevent someone’s gut from healing.

Let’s talk about legumes. Legumes are also excluded from not only an AIP diet but from a standard paleo diet. Soy falls in the legume category. Like I said, there are health benefits from eating organic fermented soy, but I usually recommend taking a break from soy.

Some people would do fine with legumes if properly prepared, if you soak the legumes or put them in a pressure cooker.

If someone is a vegan or vegetarian, it might be difficult to follow an AIP or regular paleo diet. This is a case where I might make an exception and hope the person heals even though they are eating legumes. Typically, legumes are excluded from both an AIP diet and a regular paleo diet.

Nightshades also are excluded from an AIP diet. Nightshades include tomatoes, white potatoes, eggplant, and peppers. They do have some health benefits, but in some people, they can cause inflammation or affect permeability of the gut. Usually, I tell people to take a break from them.

Nuts and seeds. A lot of people can tolerate them, but it also depends on the person and what nut they are eating. Almonds and cashews, as much as I love them, especially cashews, they can be harsher on the gut.

When I was dealing with Graves’, there was no AIP diet back then. This was 2008 when I was diagnosed. I was following just a regular paleo diet. I wasn’t eating eggs because I’m not a big egg person. I’ll talk about eggs next. I was eating nuts and seeds and hit a roadblock in my recovery, so I decided to take a break from them for a couple months. Things got back on track. Was it a coincidence? Could be.

For some people, I wouldn’t consider nuts and seeds a trigger or even causing a leaky gut, but they can sometimes be harsh on the gut.

I mentioned almonds and cashews can be harsher on the gut than other nuts, like pistachios and macadamia nuts, which are less harsh. You can prepare nuts in a certain way. You can soak them or sprout them.

Ultimately, it’s up to you. If you are following a strict AIP diet, you would be avoiding nuts and seeds. If you are following a paleo diet, that will allow you to eat nuts and seeds. Even in that case, you might want to limit the nuts and seeds you eat and not overdo it. Maybe just focus on eating certain nuts and seeds.

Let’s talk about eggs. Eggs are included in a paleo diet but are excluded from an AIP diet. Eggs make a great breakfast food. They’re a good source of protein and nutrients.

The problem with eggs is they are a common allergen. I wouldn’t classify them with gluten, dairy, and corn. They don’t fall in the same category of those foods. They are still considered a common allergen. When someone is following an elimination diet, they are typically told to eliminate eggs. There are compounds in the egg whites, which can affect the permeability of the gut.

It’s really up to the person. If someone is really stressed out about following the AIP diet and are following a regular paleo diet, they might do fine with eggs. If someone is willing to take a break from eggs while healing, I would recommend doing so.

I want to shift gears and talk about iodine, mainly the food sources of iodine because we are talking about food here. Iodine in some people can be problematic. I personally had a good experience with iodine many years ago, so I am not anti-iodine. Eating higher sources of iodine such as sea vegetables or certain types of seafood or shellfish can be a problem for some people with Graves’ and Hashimoto’s.

In my book The Hyperthyroid Healing Diet, I talk about iodine in food. I actually talk about iodine in all three of my books. I get into the greatest detail in this aforementioned book though; there is a separate bonus chapter on food sources of iodine.

It depends on the person. Some people might be able to get away with eating sea vegetables and/or shellfish. I would just be careful not to overdo it because iodine might be problematic in some people.

As far as how much iodine should you consume, some will suggest 200mcg or less of iodine per day when it comes to food and if any is in a supplement you’re taking, like a multivitamin. I find that a lot of people can consume more iodine than that, 300-400-500mcg. It does depend on the person.

The mg doses of iodine, usually you won’t get that from eating food. Maybe if you are eating kelp. Most of the time, if you’re eating other food sources, you probably won’t get really high with iodine. As far as exceeding 500mcg and getting into the mg dose, it’s usually supplementation that causes that.

Just be aware that food sources of iodine can be a problem. I wouldn’t say necessarily that they would be a trigger. Potentially they can be. They may be exacerbating in some people the autoimmune response, but not really one of the main triggers. If someone is taking high dose supplementation, that’s a different story.

Let’s now talk about how to detect food triggers. Two of the main ways are through an elimination diet or food sensitivity testing. There are benefits and limitations of each. Benefits of an elimination diet, which is what I typically recommend to my autoimmune thyroid patients, is there is no cost, whereas when doing food sensitivity testing, it can get expensive. AIP is a type of an elimination diet.

The limitation is that you might react to some healthy foods. Not to say that something like broccoli or avocadoes will be a trigger for Graves’ or Hashimoto’s, but some people might be sensitive to them and as a result might have some inflammation. If you do a food sensitivity test, it might pick it up. That’s a benefit of the food sensitivity test.

One of the limitations is not all of them are reproducible, which is not a good thing if you spend money on a test. Not that most people would do this, but if you took two blood samples at a time and sent them to the same lab for a food sensitivity test, and put two separate names on it, if they came back with different results, that wouldn’t be a good thing. The test was not valid at all. That is a concern with some food sensitivity testing, especially IgG food sensitivity testing.

If someone does a food sensitivity test, and it has a lot of findings, then it’s usually a leaky gut. A few dozen foods, including healthy ones like broccoli, lettuce, avocado, asparagus, all these healthy foods, eliminating the food might not be the problem. It might be a matter of just healing the gut, which is easier said than done.

I have episodes on my podcast where I talk about healing the gut. I talk about it in my three thyroid-related books and blog posts and articles. That’s also something to keep in mind.

Another limitation depends on the food sensitivity test. With IgG food sensitivity testing, you need to be eating the food in order for it to test positive. If you’re avoiding certain foods, you wouldn’t expect those foods to come back positive. In some cases, a person will, which means they are either getting exposed to that food and they don’t know it, or we have to question the accuracy of the test.

I like an elimination diet. I’m not saying there is not a time and place for food sensitivity testing. If someone is hitting a roadblock, that might be a time when you might want to consider food sensitivity testing, to see if it shows if they are reacting to something. Maybe if they only react to three, four, five foods, they could easily eliminate those foods. If they are showing 20 foods, 30 foods that they are reacting to, then the solution might not be eliminating those foods but really focusing on gut healing.

When following an elimination diet, you want to eventually reintroduce foods. If someone is following an AIP diet, I would recommend following it for at least 30 days. Ideally, 90 days. Regardless of whether it’s 30 days, 60 days, 90 days, or even longer, you want to reintroduce foods slowly, one at a time, every 3-4 days. If you reintroduce multiple foods at the same time, and you have any type of reaction, then you wouldn’t know which of those foods is causing a reaction.

Sometimes, it can be challenging to know if you’re getting a symptom because of a specific food. An example I commonly give is let’s say someone has eliminated eggs. After three months, they reintroduce eggs, and then they get headaches. Is it possible the headache is due to a stressful day and not the eggs? It is possible.

In that case, you might want to document that you are getting headaches, take a break from the eggs for another few weeks, and once the headaches subside, reintroduce the eggs. If you get the same symptom, it probably is a sensitivity to the food, and you might want to eliminate that food again for another 3-6 months, or longer than that possibly.

Reintroducing foods, I talk about this in my book. I have podcast episodes. If you want more information, I recommend checking out those resources.

Let’s talk about diet more. You might be wondering is there a certain diet that you should follow? I have spoken about AIP. Should you follow AIP? Is it okay to follow a regular paleo diet? In some cases, I mention maybe even vegans and vegetarians would be a little more flexible and follow what’s called a plant paradox diet, which is by Dr. Steven Gundry.

I do recommend for most people who have Graves’ or Hashimoto’s or the antibodies for both to follow an AIP diet. But there is no perfect diet for everyone. Some people might not be ready to follow AIP. It might be too stressful.

Maybe they are eating fast food on a regular basis and a lot of refined foods and sugars. The goal should be to take a break from gluten and introduce some whole, healthy foods. We want to set them up for success. We don’t want someone to start any diet and then feel like they can’t follow it. A lot of it is mental, but still. Whatever the reason, if someone is unable to follow it, and then they go back to old habits, we don’t want that to happen.

If someone has Graves’ or Hashimoto’s, AIP is great. A lot of people find it restrictive because they are not eating enough protein, not eating enough variety. AIP, not to say it’s easy, but you want to make sure you’re eating enough, especially getting enough protein.

If someone is not willing to follow AIP, I would say paleo would be the next thing. Plant Paradox, if someone is vegan or vegetarian. I talk more about these in other resources.

I want to wrap up this presentation by talking about fasting. Some have asked me over the years whether intermittent fasting can play a role in lowering thyroid antibodies. I do like intermittent fasting. I actually incorporate intermittent fasting on a wellness basis.

When I was dealing with Graves’, I wouldn’t have wanted to incorporate intermittent fasting because I was losing a lot of weight, and my adrenals weren’t in good shape. Those are some of the things we look at. If someone doesn’t have healthy adrenals, if someone has hyperthyroidism and is losing a lot of weight, they might not be a good fit for intermittent fasting. Maybe in the future, they can incorporate it, but intermittent fasting isn’t for everyone.

Most people would be okay doing 12-14 hours. 12 hours, most people should do. There are some exceptions. 16-8 is a common intermittent fasting routine. That depends on the person. Some people will go beyond that, 18-6, or 20 hours per day fasting. I think this can get extreme if you are doing it on a daily basis. The problem is that if you have such a small eating window, you might not get enough nutrients. Also, you might not get enough protein.

I like fasting. I interviewed a few experts on the podcast: Cynthia Thurlow, Dr. David Jockers. You can check out their episodes. I’m definitely not against fasting, but I would be cautious.

That’s pretty much all I wanted to cover. Food can play a big role when it comes to at least lowering thyroid antibodies just by itself. It’s usually not going to completely normalize antibodies, but it is an important piece of the puzzle. I would do things from a dietary standpoint, which is why I decided to put together this presentation as well as other presentations that focus on helping to lower your thyroid antibodies.

I hope you found this information to be valuable. As usual, I look forward to catching you in the next episode.

I decided to create a series of episodes covering the different factors that can help you lower and eventually normalize your thyroid antibodies. In today’s episode, I’m starting with the basics. I discuss the complexities of thyroid antibodies, the importance of proactive testing, why we need to address underlying causes rather than solely focusing on symptom management, the role of supplements, and more. If you would prefer to listen to this part, you can access it by Clicking Here.

This is the first of multiple episodes where I focus on how to lower and normalize thyroid antibodies. While I do have other episodes where I discuss this topic, since many people have questions related to thyroid antibodies, I figured I would create a series where I dedicate individual episodes to different factors that can help you lower and eventually normalize thyroid antibodies. 

I want to start out by mentioning that lowering as well as normalizing thyroid antibodies is not an easy process. It can be challenging to accomplish this. I might make it sound like it’s easy at times, but it definitely is not. It can be challenging to find and remove the triggers, to heal the gut. Just wanted to let you know that up front. 

This is also why I decided to dedicate specific episodes. Having one single episode to talk about thyroid antibodies can be helpful as well, but still, just because it can be challenging, I thought it would be helpful to have a series of episodes where I go into greater detail about this.

Let’s talk about what antibodies are. An antibody is a Y-shaped protein that is part of an immune system response to something called an antigen. An antigen is a foreign substance that causes an immune response. Examples include pathogenic bacteria, food proteins, chemicals. These antibodies are secreted by something called B cells of the immune system. They essentially serve as a form of protection.

Why do some people develop thyroid antibodies? There is something called the triad of autoimmunity. It has three components. Component #1 is a genetic predisposition. #2 is exposure to one or more environmental triggers. #3 is an increase in intestinal permeability, which is the medical term for leaky gut. Those three factors are necessary for autoimmunity to develop and thus thyroid antibodies to develop. 

There are different types of auto antibodies. We will focus on the ones that relate to thyroid autoimmunity here, but there are many other autoimmune conditions, which are all associated with different types of antibodies. 

The most common type of thyroid antibody is called thyroid peroxidase (TPO) antibodies. TPO is an enzyme that is important in the formation of thyroid hormone. 

When you have these antibodies, the actual antibodies aren’t doing anything. Well, they’re not always a consequence. Thyroid stimulating immunoglobulins (TSIs), which I’ll talk about next, do affect the thyroid. Many times, these antibodies are a consequence of the autoimmune component. That’s the case with TPO antibodies. They are not doing damage to the thyroid gland. 

But when you have TPO antibodies, it could indicate that there is damage happening in the background. It doesn’t always mean you have damage to the thyroid gland, but that definitely can be the case. Over time, if you don’t address the autoimmune component, it can lead to hypothyroidism, low thyroid hormone levels. If you have elevated TPO antibodies, I recommend to do things to try to lower and normalize them, which is what this series is about. 

Next, TSIs. These are associated with Graves’. These actually do affect the thyroid directly. These bind to or stimulate the TSH receptor of the thyroid gland, resulting in the excess production of thyroid hormone. 

I should also mention TSIs are a type of TSH receptor antibody (TRAB). You can actually measure TRABs as well. I usually stick with TSI because they are more specific to Graves’. I’ll talk shortly about TRAB more because there is another antibody associated with that, not just TSI.

Let’s next talk about thyroid globulin antibodies. They are associated with Hashimoto’s thyroiditis. Thyroid globulin is a protein of the thyroid. If you have those antibodies, the antibody itself isn’t damaging the thyroid gland, but the presence of these antibodies may indicate that you’re experiencing damage to thyroid globulin.

You can also test for thyroid globulin, too. Don’t get that confused. If you are trying to look at the antibodies, you want to test for thyroid globulin antibodies, not thyroid globulin itself. 

I should also add that it’s not uncommon for people to have all of these antibodies. You could have TPO, TSIs, thyroid globulin antibodies. Some people have a combination of TPO and TSI. In fact, literature shows that 60-80% of people with Graves’ will also have TPO antibodies. 

When I dealt with Graves’, I did not have TPO antibodies; I just had TSIs. A lot of people do have those TPO antibodies.

Then there is another type of antibody I briefly want to mention called thyroid binding immunoglobulin or TSH binding inhibitor immunoglobulins. These are also a type of TRAB. Many labs don’t offer this type of test. Even if you wanted to, you can’t necessarily test for it. It is a type of TRAB. 

I usually just test TSI, but if you tested TSI and TRAB, and TRAB was positive, but TSI was negative, then one can maybe conclude that if you were able to test the TSH binding inhibitor immunoglobulin, that would be positive.

I’m actually going to have another Q&A episode where I focus more on TSH binding inhibitor immunoglobulins, so stay tuned for that. A little bit confusing in the literature. Some associate it with Graves’. Some say it has nothing to do with Graves’. I’ll talk more about that in a future episode.

If you’re not following this, I wouldn’t worry about it. It’s not important when it comes to lowering thyroid antibodies. I’m giving an overview of the different types of antibodies. Like I said, the main ones you are going to test for are TPO, TSI, thyroid globulin antibodies. Those are the three main ones I would focus on. Like I said, it’s really just an overview as far as going over the different types of antibodies. 

When should you test thyroid antibodies? Most medical doctors, including endocrinologists, don’t test the thyroid antibodies at all. The only time they may test thyroid antibodies is if someone is diagnosed with hyperthyroidism or hypothyroidism, high thyroid or low thyroid hormones. 

Let’s say they do a TSH. Unfortunately, a lot of doctors will only do TSH as part of a physical. If TSH is within the lab range—it might not be in the optimal range, but in the lab range–they won’t look at thyroid antibodies. 

If someone has elevated TSH, or on the higher side, like 3.5, which is within most lab reference ranges but is above the optimal range, they very well might have thyroid antibodies, especially TPO and/or thyroid globulin antibodies. Most medical doctors would wait until the TSH is outside of the reference range before testing thyroid antibodies.

The thing is, thyroid antibodies develop before the thyroid gland is affected. The presence of thyroid antibodies doesn’t always mean that the thyroid is being affected. Still, if you have a family history of Graves’ or Hashimoto’s, doing predictive antibody testing, even if it’s every few years, is a good idea, just so you’re aware that you have those antibodies. 

If you have the antibodies, that doesn’t mean you’ll develop hyperthyroidism or hypothyroidism, but you very well might. It’s good to know that, yet most doctors will wait until the thyroid gland is actually affected.

As far as when you should test for thyroid antibodies, I would say it would be a good idea to test them- Arguably, most people listening to this have Graves’ or Hashimoto’s. If you’re listening to this, and you have Graves’ or Hashimoto’s or antibodies for both, and you have children- I’m not saying you should test your three-year-old for thyroid antibodies. In the future, when they get a blood test, I would test for thyroid antibodies. I wouldn’t go out of your way to test for thyroid antibodies in family members. I do think it should be more of a prescreening process, predictive antibody testing.

For those who have already been tested for thyroid antibodies, which probably describes most people listening to this, ideally, if everything was free, I would say test for it every single month. Honestly, I don’t think that’s always necessary. Sometimes, it can cause more stress because especially in the beginning, when you’re trying to restore your health, the antibodies might fluctuate. It might stress you out if you test them every month. 

That being said, I wouldn’t go six months between retesting. I would say at least every 3-4 months. If you could do it every two months, that would be great. I do like to keep an eye on the thyroid antibodies. 

In the beginning, not as important, when someone is starting to make changes to their diet and lifestyle, and maybe doing some functional medicine testing. As their health improves, eventually, we do want to see positive changes in those antibodies. 

Which of these thyroid antibodies should you test? Should you test all of them? A lot of people, when they see me with Graves’, they might just have TSIs, for example. Should they test these other two antibodies? Or if someone has Hashimoto’s, and they have TPO and thyroid globulin antibodies, should they test TSI? 

I don’t think it’s always necessary to do this. In the case of Hashimoto’s, they might have positive TSIs. I know I just said predictive antibody testing, but if someone had a family history of Graves’, and they have Hashimoto’s antibodies, then I would say it’s a good idea. If someone has a family history of Hashimoto’s, but they tested positive for Graves’, maybe they should also test TPOs. It’s not going to hurt to look at all three antibodies. If you are paying out of pocket, might be a little bit pricey. 

I will say the approach isn’t going to be different. At least, my approach and most functional medicine practitioners, if one has a single thyroid antibody, it’s not like we’re going to change our approach if someone has three thyroid antibodies. 

If someone has hyperthyroidism compared to hypothyroidism, the symptom management option is going to be different. As far as the treatment approach, it won’t be different. 

That being said, if someone does have multiple thyroid antibodies, sometimes you’ll see one normalize but the other remain high or fluctuating. If you only test one, and it’s elevated, but eventually normalizes, that doesn’t mean the other antibodies will normalize. That’s also something to keep in mind. 

Another question you probably don’t have, but I’m going to bring up: How common are false negative thyroid antibodies? Can you have Graves’ or Hashimoto’s yet have negative antibodies? Can you have Graves’ and have negative TSIs? Can you have Hashimoto’s and not have either TPO or thyroid globulin antibodies?

The answer is yes. In the case of Graves’, it’s not as common. Most people with Graves’ will have elevated TSIs. It is a little bit more common, it seems like, in those with Hashimoto’s to have false negative antibodies. You could do a thyroid ultrasound, if you have elevated TSH and the antibodies are negative, and see what the ultrasound says.

I do have an upcoming interview with Dr. Alan Christianson. He talks more about this. Definitely would tune into his interview if you’re interested in learning more about the potential of negative thyroid antibodies. I want to say it is possible.

Let’s say someone has hyperthyroidism, and they have negative TSIs, but they have the symptoms of thyroid eye disease, which is commonly associated with Graves’. Chances are they probably have Graves’ even if they don’t have TSIs present on a blood test. Something to keep in mind.

The million-dollar question: How can you lower and then normalize thyroid antibodies? I won’t get into great detail in this episode because that’s why I put together a series of episodes. I am going to talk about food triggers and stress and chemicals and infections and healing the gut. I am not going to cram all of this into a single episode, which I have done in previous episodes. I am going to dedicate individual episodes, talking about the different factors that can play a role in thyroid antibodies. That means you would want to address those factors in order to lower and normalize thyroid antibodies.

I just want to remind you again that it’s not easy to lower and normalize thyroid antibodies. In some cases, some might go gluten-free, and those antibodies lower and in some cases even normalize. I can’t say it’s never easy, but many times, it’s challenging and not that easy, where you can just eliminate gluten, clean up your diet, and the antibodies will normalize. Sometimes, it is; many times, it isn’t. 

That’s pretty much all I wanted to cover here. Of course, I hope you found the information to be valuable. I’m sure you’ll find the future episodes related to lowering and normalizing thyroid antibodies to be valuable as well. As usual, I look forward to catching you in the next episode.

Recently, I interviewed Katy, who was diagnosed with Graves’ disease just two days before discovering she was pregnant, and we discussed her diagnosis, initial fears about taking medication, the importance of consistent monitoring, the health of her baby, the significance of gut health, reducing toxic exposure, maintaining a balanced diet, and more. If you would prefer to listen to the interview you can access it by Clicking Here.

Dr. Eric Osansky: 

Welcome to another Save My Thyroid audit. Very excited to chat with Katy here, joining us from Seattle. How are you doing today, Katy? 

Katy: 

I’m doing great. I’m excited to be here. Thanks for having me, Dr. Eric. 

Dr. Eric: 

You’re welcome. Thanks for agreeing to do this. So far, I haven’t done a lot of these audits, but this is definitely unique compared to some of the audits, as you were dealing with Graves’ while pregnant. Before we have that conversation, can I ask you where you found out about me? How long ago did you find out about me? 

Katy: 

I found out about you around the same time I was receiving my diagnosis. There really wasn’t a lot of material that I could find for helping Graves’. A lot more information on Hashimoto’s. I was furiously searching the internet and stumbled upon you on Google. Then I ordered your book on Amazon and started listening to your podcast.

Dr. Eric: 

Thanks for letting me know. We have everybody who does one of these audits fill out an application. Two days before you found out you were pregnant, you were diagnosed with Graves’, correct? 

Katy: 

I had received my suspected diagnosis. We had done one round of lab work in early August. Then it was late September. My naturopathic doctor I saw didn’t want to diagnose based off one round of labs; she wanted to see over the course of at least a month and getting me on some natural herbal tincture with things like bugleweed and motherwort to address the symptoms I was experiencing.

Dr. Eric: 

When you found out you were pregnant, then you had the conversation with an endocrinologist. I don’t know if you brought up anything natural, but they are not usually open to anything natural. During pregnancy, we don’t know about bugleweed. There are no studies with bugleweed and pregnancy. You had the conversation about the medication. What were your thoughts initially when you were told that you should take PTU in the first trimester? 

Katy: 

It actually was my naturopathic doctor who recommended getting me on the PTU and off of the herbal tincture, even though she was the one who had formulated the tincture, because of the risks you were talking about. It’s not studied enough to know. 

She felt that the risks of a pregnancy not being medicated with the PTU were greater. She gave me all the options. She said we could do nothing. We could keep me on herbs. We could try iodine. We could try a variety of things. 

But we ultimately felt like to sustain the pregnancy, getting on the PTU was the best measure, even though it was personally very scary for me because I had never taken a medication that was a bit more long-term and especially in what I felt is a more high-risk scenario. 

Dr. Eric: 

You had some concerns with the medication. 

Katy: 

Yes. 

Dr. Eric: 

But you decided to take the PTU. You took that the first trimester. After the first trimester, you switched to methimazole. 

Katy: 

Yeah. Like I said, my naturopath got me started with PTU. Emergency requests were sent to get me into an endocrinologist. He agreed with her recommendation of PTU and kept me on that. I was very grateful that he had a philosophy of doing the lowest doses possible and very consistent monitoring every month. I don’t know if that’s common with every endocrinologist, but it worked well for me. 

I was experiencing everyday lip peeling. My lips would peel. I tried to increase my hydration. We weren’t sure if it was connected to the PTU or not. Because we couldn’t resolve that, he switched me over to methimazole after the first trimester. The lip peeling didn’t resolve with that switch anyway. He didn’t want to keep switching me, so we just kept going and gradually got to decrease the dose over the course of the pregnancy. 

Dr. Eric: 

How did you do on the antithyroid medication? 

Katy: 

I was actually shocked to feel better than I had felt prior to pregnancy. I felt almost more back to my normal self. My symptoms prior to pregnancy were I had hand tremors. I had high social anxiety, which is very unlike me. I tend to be an anxious person, but not to the extent that I was trying to avoid social settings. I was having, I called it feeling my heart in my throat, but then later on, I felt these are heart palpitations. I had a slightly enlarged thyroid. I never had nodules or anything like that. 

I was having these various symptoms and was so fatigued I didn’t want to cook or exercise. I was only in my second year of being married, and my husband was like, “I don’t know what’s going on with you.” He could notice some real change of when my condition really plummeted me and how my lifestyle was affected. 

Getting on the thyroid medication, while it was really scary, I noticed a lot of my old self coming back as those symptoms decreased.

Dr. Eric: 

You had some of the classic symptoms associated with hyperthyroidism/Graves’. The antithyroid medication helped. You are currently not taking antithyroid medication. Was it after post-partum when eventually you were able to get off of the methimazole? 

Katy: 

No. Actually, it was a few weeks before- I think it was at 38 weeks of pregnancy, I was able to get off of my thyroid medication. I was being co-managed by midwives and my endocrinologist and the high-risk fetal maternal medicine doctors. They felt that it was appropriate to discontinue because I was almost getting to the hypo range at that point.

Dr. Eric: 

Okay. You got off a few weeks before post-partum, at 38 weeks. You haven’t been on the medication since? 

Katy: 

No, they have continued to monitor me. They checked me at six weeks post-partum and again six months later. When my daughter was around her first birthday, they checked me again. My thyroid is doing well. The only thing we are starting to notice is the TSI creeping up again. 

Dr. Eric: 

We will definitely talk about that. I want to talk about what you did besides taking a medication. You said you got my book. Also, your background is as a registered dietician, so I assume you were eating a clean, healthy diet. I shouldn’t assume, but I’m guessing you probably did. 

Katy: 

I will tell you I was recommended by my naturopath when we were first anticipating a possible Graves’ diagnosis when I was doing the herbal tincture. She had had me go gluten-free, dairy-free, really work on cutting out inflammatory foods. 

However, probably like most moms could relate, in that first trimester, I didn’t want to eat anything. Also, they had suspected my thyroid medication, since I was new to taking it, was increasing the morning sickness/nausea. I was having a double whammy of nausea. I was just eating anything I could stomach at the time. Sometimes, that did include gluten and dairy. As the pregnancy continued, I was able to work on cutting those out again.

Since I have done food sensitivity testing now, I have been working to eliminate some of those higher inflammatory foods for my body. I found out I did not have a gluten sensitivity. I have a yeast sensitivity. I still think cutting out gluten, from what I have read about thyroid, was helpful regardless.  

Dr. Eric: 

You still for the most part- 

Katy: 

I am for the most part gluten-free. I had gotten into a sourdough kick, so I have been a little bit sad about working that out of my diet again. 

Dr. Eric: 

There is a sourdough bread that is also gluten-free. The fermentation of the sourdough obviously reduces the gluten. They did studies with sourdough and Celiac. The earlier studies maybe suggested that people with Celiac could safely eat sourdough, but later studies said that wasn’t the case. 

I actually found a sourdough bread that was gluten-free. It is available at least in North Carolina, but you’re in Seattle. If they have it here, they probably have it there. If you really want sourdough bread. Maybe you could even make your own; I’m sure you could.

Katy: 

Maybe there is some hope for us gluten-free sourdough mamas. 

Dr. Eric: 

There you go. Diet, a little bit varying, especially earlier on, but later on, avoided gluten and dairy. Currently gluten-free for the most part. 

Anything else that you did during pregnancy? You have to be cautious with supplements, but besides taking a pre-natal, is there anything that you took? Exercise also? 

Katy: 

I have MTHFR genetic mutation, so I was taking a prenatal that was relevant to that concern. I was taking omegas as my naturopathic doctor’s recommendation. She had also had me of course continue Vitamin D, continue my probiotic. Currently, I have a custom-made multivitamin that includes things like L-carnitine, some of the B vitamins I was deficient in. But I still take my pre-natals and omegas and all of the things I got started with. We are trying to tailor it a little more to what my body needs now. 

Dr. Eric: 

Selenium, I assume you are getting from the multi. 

Katy: 

Yeah. I believe that’s in the prenatal. 

Dr. Eric: 

On the application, I asked about some of your biggest health challenges. You put fatigue, constant bloating and gut issues, and anxiety. Are all those current health challenges, or are those what you dealt with more in the past? 

Katy: 

Those almost feel chronic for me. I was feeling better during pregnancy with the fatigue in some ways. I think I had normal pregnancy fatigue, but I also had energy that I hadn’t experienced in the depths of the really hard part of my Graves’ diagnosis. 

I think it was hard in pregnancy to tell with bloating because I already had the belly going on. I don’t know if I wasn’t noticing my symptoms in the same way as now being post-partum. I am back to that same level of bloating I was experiencing earlier. I am preparing to work on the results of my GI Map, which indicated having H-pylori. I am believing there is more of a root cause to that that also is probably contributing to my thyroid autoimmune condition. 

Dr. Eric:

Okay. You did put on the application that you got the GI Map and had H-pylori. Also, the food sensitivity testing you mentioned. You did MRT, mediator release testing. That also included a cell nutrient panel as well. 

I kind of know the answer to this next question. We chatted a little bit before pressing Record. One question I have been trying to ask is how would you like your health to be 6-12 months from now? It seems like one of the main goals, besides making sure that TSI doesn’t get higher, which will talk about, setting yourself up for the next pregnancy, so you’re in an even healthier state than you were last time. 

Katy: 

Yeah. I would agree that really is the next goal for me. With this last pregnancy, I was trying to get repaired, get my body in a good place, and then was surprised when I found out I was already pregnant when I didn’t think I could be with the Graves’. 

Now, this next year, I’m currently working on weaning from breast feeding and just renourishing my body, trying to make sure the thyroid is under control, so we can look at being open to conception for a second child in the next year. 

Dr. Eric: 

Okay. Any roadblocks you anticipate in achieving that goal?  

Katy: 

Like most humans, and maybe new moms, there is sometimes a disconnect from head knowledge to implementation. I think I’m aware of a lot of things to do, but sometimes just living it out in the day to day, building new habits can be tough, especially when you’re still learning to care for somebody else. 

Dr. Eric: 

Your baby is 14 months old, right? 

Katy: 

Yes, my baby girl is 14 months old. 

Dr. Eric: 

How is sleep? 

Katy: 

Sleep is going pretty well for her now. She sleeps about 10-11 hours at night. I think my bad habit that maybe some moms can relate to is once I put her down, I want to stay up because I’m like, “This is my time.” I can find myself feeling tired around 9:00 but still staying up to 11pm because I like the quiet. I’m trying to learn how to reverse that to getting up earlier and enjoying time on my own in the morning. 

However, I’ve never done any of the cortisol testing, but I feel like I really get this second wind and get reinvigorated at nighttime, especially when I am by myself. That might be an area I want to pursue testing in in the future, too, to figure out where I’m at.

Dr. Eric: 

You haven’t done any adrenal testing?  

Katy: 

Not currently. The practitioner I was working with really wanted me to focus on the GI Map. Since I was still nursing, she felt like maybe my hormones wouldn’t be in the place to fully look at it yet. I have only had two menstrual cycles post-partum now, too. We are still getting back in the groove of where my hormones are at. 

Dr. Eric: 

Let’s also talk about the health of your baby. That’s a fear when diagnosed with Graves’, not only having a healthy pregnancy, not having a miscarriage, having no complications with the birth process. Your baby girl, 14 months old, and she’s healthy. Everything is great, correct? 

Katy: 

Yeah, she is very healthy. I feel very grateful because I really had some dark days when I first found out that I was pregnant with her. I figured I had high risk of miscarriage, birth defects because of how severe my thyroid labs were looking. I never would want to wish a miscarriage upon myself or experience something like that. 

I almost in the dark parts of my mind was tempted to think, would that be better for this baby compared to all the horrible things people are saying or doctors were saying could happen, or even the risks of the medication. Cancer-causing properties, they claimed for some of these medications, or other things that felt very scary. 

I was very grateful once I made it past that first trimester mark. They had still warned me that sometimes there could be later birth issues or miscarriages that could happen with where my thyroid was at. I did feel a little bit nervous the whole time. 

The one thing that she did have that maybe I haven’t mentioned to you yet is she did have an inner uterine growth restriction. She always was on the small end during pregnancy, bouncing around the 10th percentile, which was the lower cut-off. As we got closer to the end of the pregnancy, she started drifting from 10th to 7th to 4th. The doctors were getting pretty concerned if there was a placenta failure or if there was something going on. I had to receive extra monitoring and began going in every week for them to look at the blood flow from the placenta to baby and check up on her and her growth.

I really felt like I experienced a miracle. We have a really faith-based community that was surrounding us in this time. We spent a lot of time praying over her and our pregnancy. She went in three weeks from that 4th percentile to 22nd, which was more than she had ever been, right there at the end of the pregnancy. 

It really was a special day to find out no more growth restriction. It also was the day I got off my thyroid medication, and they cancelled the planned induction that they had scheduled for her because of the growth restriction. That was that 38th week mark. That was the big scare. 

They cancelled that induction. Week 40 comes. I don’t go into natural labor. 41 comes. They’re trying to get me to come in for an induction. I really wanted to go into natural labor, and I didn’t. On the day of the 42nd week, they were like, “Ma’am, you really need to come in for an induction.” I did. Baby girl was born, a little over 24 hours after the induction started. 

It felt like the moment of truth. Will she come out and we’ll find out something is wrong or isn’t wrong? She was born, and she was perfectly healthy. We had a full beautiful golden hour with her on my chest. 

They did continue to do testing. Even when we followed up with the pediatricians, they tested her thyroid labs three times in those first couple months. We never saw any issues. I just felt very grateful for how the pregnancy started and how we have ended with this really healthy, beautiful girl. 

One of my questions for you is whenever I talk to the pediatricians now, at her being over a year old, they say there is no need to further test her for thyroid conditions, unless she starts showing symptoms. I feel like it might be hard to see symptoms in a little one from my perspective. 

Maybe you have some advice. I know you have a recent podcast that I started listening to with a pediatrician who specializes in this area that maybe would be good for me to reference of what to do and how to know to keep checking up on her as she grows. 

Dr. Eric: 

I don’t know that young if I would say to get regular blood tests. It’s a little bit different with Graves’ and Hashimoto’s. With Graves’, first of all, rare to see Graves’ that young, for me anyway. Not to say it can’t happen, but most of the time, when I see children with Graves’, usually around 7-8, which is still young. Not to say there haven’t been cases where they are younger. 

No child likes to get bloodwork done. If it was absolutely necessary, I would say it’s really important to get it done every single year. 

Honestly, I don’t know. I’m not an expert when it comes to dealing with children that young and hyperthyroidism and Graves’. Some people with Graves’ have antibodies for Hashimoto’s, too. With Hashimoto’s, the antibodies can be there for five, ten, 15 years without symptoms, silent for a long period of time. If someone has TSI, usually it’s a quicker process, as far as them developing thyroid symptoms. 

If someone has a history of Hashimoto’s or antibodies, it may not be a bad idea to test them earlier. It may not be necessary to test them every single year. If you could get the child without much fuss and hassle doing the blood test, then sure. Otherwise, I’d say maybe every few years. 

If you wanted for peace of mind to do a blood test, before she is two or around two, that’s fine. I don’t know if it’s necessary to do it every year on an annual basis. 

Katy: 

I don’t think they tested her antibodies now that I think about it. 

Dr. Eric: 

They usually don’t. They will just look at thyroid and see if the thyroid is out of range. Really, they should be doing the opposite. You develop antibodies before you develop a thyroid condition. Ideally, you should, but that’s just the backwards thinking of medical doctors. They will usually just focus on the thyroid. If the thyroid is out of range, then maybe they will look at antibodies. 

I won’t say not to worry about it. If you want to do one within the next six months, that’s fine. After that, every now and then, every few years. 

If it were my child, there’s genetics. I had Graves’. It’s not like I had my daughters every year testing to see if they developed. Thankfully, so far, they’re older and still no signs or history. Nothing in the bloodwork. 

Katy: 

That’s good to know. I felt like when I found out I was pregnant with her, this child is doomed to this same condition and this horrible experience I had. I’ve heard, even your story, it’s not always the case. As parents who have experienced it, we can be proactive in monitoring them and getting them healthy lifestyles, too. 

Dr. Eric: 

Exactly. That’s all you can do. Take the knowledge that you have now, and pass it on to your daughter and future children. That’s what I’ve done. 

As far as what you can do with future pregnancies. Diet and lifestyle are always going to be #1, but you mentioned the H-pylori and GI Map. You need a healthy gut to have a healthy immune system. TSI, even though it’s not as bad as it was prior to the Graves’ diagnosis, you still want to make sure that you keep it in check. I would do everything diet and lifestyle. 

The gut is important. If H-pylori is a factor, then it could be difficult sometimes to get rid of H-pylori. There is definitely controversy when it comes to H-pylori. Some will say not to worry about it if you’re not having certain symptoms. You’re not having classic symptoms like heartburn or reflux, which are usually associated with H-pylori. You’re having bloating. There’s something going on, whether it’s the H-pylori or not. 

Katy: 

There are a few other opportunistic- I have low good ones, some other higher not great ones. The H-pylori is the standout one for sure. 

Dr. Eric: 

Which is very common with the GI Map. Very common to have things like streptococcus, staphylococcus show up. Sometimes, it can be problematic. Depends. If someone has pseudomonas or klebsiella, those are usually more problematic than some others. Even in that case, not all the time. 

H-pylori could also cause some of those other findings on the GI Map. It’s not perfect when it comes to parasites also. If it was negative for protozoa and worms, you need to keep in mind. 

I recommend GI Maps to patients. The limitation of PCR DNA testing is that they can’t test for all parasites. That’s also a possibility. When I think of bloating, sometimes I think of SIBO. It makes sense that you’re under the guidance of a naturopath. Follow the recommendations for H-pylori if the bloating persists. You also have the MRT test, so you have already worked on eliminating foods that were positive. 

If those changes, along with addressing H-pylori, don’t help, you might need to dig deeper and look into other testing. Hopefully, that’s not the case. 

You definitely want to do everything you can to optimize the gut prior to getting pregnant again. Also, lowering your toxic burden because you can’t really aggressively detox while you’re pregnant. Not to say you have to aggressively detox, but I usually recommend prior to getting pregnant to do things to reduce your toxic load. 

You’re breastfeeding right now, so you mentioned with H-pylori, you want to wait until you’re done breastfeeding. Assuming you don’t get pregnant right away, and you have some time to get rid of the H-pylori, and it wouldn’t be a bad idea to do things to reduce toxic load, which I have episodes on the podcast where I also interviewed other experts on that topic. I spoke about that. 

Healthygut, reduced toxic burden. You are already doing a great job with diet. Stress management, sleep. All that good stuff. 

Those are the two things I’d say. The gut and reducing toxic burden. Once you get pregnant, you are really limited, especially with toxic burden. 

Katy: 

Totally. Part of the gut protocol is to do saunas, to work on lymphatic drainage. I have been introduced by my practitioner to coffee enemas. I am a little nervous, but she is feeling like that could be a good route to go. There are a couple new things we are going to be implementing as well as the castor oil packs, which I’m familiar with. 

Dr. Eric: 

Cool. Lymphatics. I don’t know if you listened to my interview with Kelly Kennedy. You could also do dry brushing and rebounding. She also has this little gizmo; for those listening, she has something called the Flow Vibe. It helps with the lymph nodes, to help stimulate the lymphatic flow. 

I agree with everything you said. Coffee enemas. 

Katy: 

Debatable.

Dr. Eric: 

I’m not against coffee enemas. I just don’t recommend them, not because they’re harmful. I know they’re part of other protocols like Gerson protocol, which is one of the cancer protocols. I think coffee enemas will only help. The more challenging part of a coffee enema is nobody likes to do the enema, but the preparation of the coffee also. 

Katy: 

There are a lot of steps. 

Dr. Eric: 

Exactly. Once you’re in the routine, assuming you do take the step forward and do that, I am sure you’ll be okay. 

Sauna, I do that three times a week, so I am an advocate of sauna. You don’t want to do that while pregnant. Prior to pregnancy, sauna is great to do for whatever few months to reduce your toxic burden. 

It sounds like you’re already doing some great things. I’m sure your next pregnancy, whenever that may be, will also be a healthy one. Hopefully, I know the goal is obviously to try to not be on the medication, even though you had a successful pregnancy this time. You want to do everything you can to avoid the PTU and methimazole and try to keep the hyperthyroidism and Graves’ in check. If you optimize your gut health and do some other things we chatted about, I think you’ll be successful in doing that. 

Katy: 

Thank you. Can I ask you what you’re hoping for? What would be an ideal TSI to stay below? When I first was diagnosed, I got flagged at 2.57. Now, I’m down to 0.73. At my lowest, I was at 0.51. 

Dr. Eric: 

There are different ranges for TSI. Some labs have a percentage, where you are supposed to be below 140%. Ideally, the range you are talking about is .55 or below as normal. You were at .51. The higher number was over 2. More recently, you’re at .73. 

Katy: 

.73. 

Dr. Eric: 

I do like to see it below .55. Honestly, I would say ideal is .3 or below. Well below the range. Even .51 makes me a little bit, not nervous, but it’s on the higher end of the range. As long as you have a positive TSI, there is always the risk of becoming hyper. 

The good news is you still have things to work on with H-pylori and the reduced toxic burden. It sounds like you already have a lot of things planned with coffee enemas, sauna. I have seen TSIs using those values not a lot, but a little bit over 100 on the higher side. Commonly in double digits. 

Your number is still on the lower side, which is good news. I’d feel a lot more comfortable going into your next pregnancy if it was below the reference range rather than being a little bit above. I would definitely work on those things. 

Every now and then, monitor the TSI. I wouldn’t be fanatical about it where you are testing it every week or every other week. I wouldn’t go six months without testing it either. I would keep an eye on it to make sure it’s heading in the right direction. If you’re doing everything you mentioned and we chatted about, I think it will. 

Katy: 

Great, thank you. 

Dr. Eric: 

Thanks, Katy. Appreciate you agreeing to do this. Hope you found it to be valuable. 

Everyone listening, thank you for tuning into this audit. I hope you found this conversation to be helpful, too. Look forward to doing another one of these audits in the future. Look forward to catching everyone in the next episode. 

Take care, Katy. Thank you. 

Katy: 

Bye, thank you.

Recently, I interviewed Annika Carroll, and we discussed her journey with sleep disturbances, psychological and physiological factors affecting sleep, the role of diet and lifestyle, practical strategies for improving your sleep quality, why high-quality sleep is foundational to our overall health and well-being, and more. If you would prefer to listen to the interview you can access it by Clicking Here.

Dr. Eric Osansky: 

I am super excited to chat with Annika Carroll. We will be talking about how to get better quality sleep. Very excited for this conversation. Let me go ahead and dive into Annika’s bio here. 

Annika Carroll is a functional sleep and health coach for high-achieving women and is the owner of Sleep Like a Boss. Annika is committed to helping women in midlife take back control of their sleep, restore their energy, and avoid burnout, so they can thrive both at work and in their personal lives. Her approach gets to the core of sleep struggles, tackling issues like hormone imbalances, gut health, and daily habits because sleep problems are really just in your head. Thank you so much for joining us, Annika. 

Annika Carroll: 

Hi, Eric. Thank you so much for having me. 

Dr. Eric: 

This is going to be an amazing conversation. So many different people have sleep issues. Before we talk about this, let’s get a little bit more of your background. What led you to become a functional sleep and health coach? 

Annika: 

Well, the fact that my sleep went out the window surprisingly and never wanted to return, no matter what I was doing. I literally had no clue what was going on because in my 20s, I used to hit the pillow and be out and be up 30 minutes before the alarm went off in the morning. I would go all day, and I was fine. 

I had my child. I went back to work a year later in my 30s. I got sick; I had food poisoning, which I didn’t recover from for a long time. Doctors couldn’t figure out what was going on with me, and I couldn’t sleep anymore. Every night, I’d be up from 1-4 or so. It was driving me insane. I started developing this fear of going to bed. This is going to happen again; this is another horrible night. 

I completely went into burnout. There was a point where I could not go to work anymore because I was not capable. I was spending time on the couch. Doctors ran test after test after test of the tests they ran. They looked at blood, stool, H-pylori in the gut. They didn’t find anything. They didn’t figure it out. 

They told me to see a therapist, which I did. It helped a little for things that I had to work on, but not with my sleep issues.

Then I found a functional practitioner. I was actually looking for hormonal imbalances, so period problems and anxiety and things like that. My sleep started getting better. Then I put two and two together, and I found somebody who was in the functional space and was doing something with sleep. This is what I really wanted to do, because I was a functional practitioner by then.

Sleep is our superpower, I think. If we don’t have it, we just don’t feel good. We can’t do anything. If we get a good night’s sleep, it’s the foundation for everything. Like you said, too many people are struggling. Some of them don’t even know, and a lot of people don’t talk about it. 

Dr. Eric: 

Yeah, exactly. You said you developed food poisoning. Then it was after that incidence where you started having sleep issues, right after having food poisoning? 

Annika: 

Before that, I had a very traumatic birth with my son that was a very stressful time. There was some trauma there that I hadn’t dealt with. I was fine. I was at work. I was super busy. Then work slowed down, and I was good. 

Then I had this food poisoning. It never really- I couldn’t eat anything anymore. For months after, I was on oatmeal and bananas. Everything else I put into my body was not good. I looked like I was six months’ pregnant every night. 

I started self-experimenting. Let’s do some live probiotics. I didn’t know what was going on. My doctors said they couldn’t find anything. “I have looked at your blood. It’s amazing. I have looked at your stool. I can’t find anything. It’s all in your head.” 

One of the gastroenterologists I saw gave me an IBS diagnosis. I had never heard of IBS because I wasn’t in this space. That was in Germany because I am from Germany. They were very vague. How can you even diagnose this? This isn’t anything, from what they were writing. I didn’t think it was an answer. I started digging more. Doors opened.  

Dr. Eric: 

It’s related to it because it’s related to your story, which is what caused the sleep issues. When I think about food poisoning and gut issues, I think of SIBO because I know that damage can take place in the migrating motor complex when having food poisoning, which can relate to IBS. Most GI docs won’t look into SIBO. They will give you a diagnosis like IBS and not do a breath test to see if you have SIBO. 

You don’t usually relate food poisoning with sleep. So many different factors of course can cause sleep issues. 

You also mentioned this fear of going to bed. How big of a problem is that? When someone develops a sleep issue, initially, it could be so many different things as we mentioned. Maybe it starts out physiological, but then becoming more of that fear or mental aspect, I assume that’s pretty common. 

Annika: 

Yeah, it is. I think it sometimes is even the reverse, that we just have a stressful period. Everybody does in life. We don’t know that there’s anything with our bodies because we don’t understand what stress does to the gut for instance. We just assume we are going through a stressful time, and this will settle down, and sleep will come back, which in a healthy body, would be the case.

For a lot of people, even during that stressful time, they already start panicking. They start having that fear. Then we get into this vicious cycle that our body is in a constant fight or flight. It’s constant stress, about the fact that we try to sleep and think about it too much. Then it becomes a self-fulfilling prophecy, and you self-sabotage with this fear cycle. 

Sleep is passive. We can’t force it. If the body is safe to relax, the body will eventually sleep. If it’s not, for whatever reason, whether there is a physical stressor like your gut and all the other things that we talk about, or something that is in your mind, that might be very real. There might be something you’re going through that is very stressful. Or it might be something that is just a story that we have now created. “I just worry so much. Tomorrow will be an awful day if I don’t sleep again. If I wake up at 2am again, I will lose my mind and can’t perform the work tomorrow, and the kids and everything.” We have to break that cycle.

Dr. Eric: 

What are some approaches? I know we’re jumping ahead. I experienced that as well. I can’t say I’ve had life-long sleep issues, but there was a time in my life where I did start having sleep issues, and it did become more psychological. I know with me, I just trained myself to get out of it, just doing some mind-body medicine, not checking the clock in the middle of the night. 

What are some things for someone who is listening, and if there is that stressful component, where it becomes that emotional cycle? Thinking every night before going to bed, “Am I going to be waking up at 2am? Will I be able to fall asleep to begin with?” 

Annika: 

This is hard to do. The first thing is to accept it. If it starts raining outside, we just don’t worry about that too much. We can grab an umbrella and still go. With sleep, it’s kind of like that. If we can get to the point where we say, “I might be waking up at 2am again. I might not get a lot of sleep. It won’t kill me. I’ve done this before. I will be okay. Will I be tired? Is it annoying? Yes. We can accept that. We don’t have to push that away. We just have to get to a point of saying, “I will figure this out.” 

I often have clients literally do that throughout the day. Whenever this thought comes back in, because it comes back, you’re so tired, “This will be another bad night.” In that moment, start catching yourself and say, “It will be okay. Whatever happens is going to be okay. I will start figuring this out. I’m going to start looking at this.” That’s okay. 

We don’t want to go to, “I will figure this out. I will have awesome sleep.” If you say this to yourself, your body and brain will be like, “No.” 

My safe zone, my brain thinks waking up at night is okay. That’s what keeps it safe right now. We are trying to change that. That poses a threat on the brain. If you are making changes too quickly, that’s often why you can’t sustain them. 

We go very slowly. I’m going to figure this out. Not “I have the solution. It’s going to be great tomorrow. But I’m on a process.” Most people don’t get to disastrous sleep from today until tomorrow. Getting into it took a while. Getting out of it might take a while. Be easy on yourself. 

Start looking at what’s happening during the day. Are there moments where you can just breathe? If you’re tired, can you take five minutes where you just do nothing? Listen to your favorite song. Go outside. Take small breaks. That restores your energy, too. That gives your body a little bit of leeway, so to say, to recover. 

People are going to think she’s crazy: Don’t move your bedtime forward. Do not try to make up for that lost sleep by going to bed at 8pm if your normal bedtime is 10:30pm. Your body works on a rhythm. If you start moving that back and forth because there were bad nights of sleep, so I’m going to bed at 8pm now because I’m so tired that I could fall asleep on the couch, try not to do that. 

You’re messing with your body’s rhythm, and your body gets even more confused. Try to get closer to 9:30/10pm, and then go to sleep. Often, we build enough sleep pressure that we can carry that through better, or at least fall asleep quickly again when we wake up. 

Dr. Eric: 

Thanks for sharing that. I know with a lot of these interviews, let’s go over some points, and then at the end, give how do we overcome the sleep issues? It’s such a big factor, so I wanted to conquer the emotional part, the stress part of sleep. I appreciate you talking about this. 

There are other factors that I want to talk about. Diet, blood sugar is a big factor. If you could talk about the impact of blood sugar imbalances on sleep and insomnia. 

Annika: 

It’s a biggie. I would say probably 80% of my clients who struggle with waking up have blood sugar dysregulation. If you’re someone who has struggled with wakings, and you cannot fall back asleep, let’s have a look at blood sugar. 

Our blood sugar should be reasonably stable throughout the day and night. What happens if we eat? Yes, our blood sugar will go up because we put glucose into the system, and that will get absorbed into the cells with the help of insulin. Then our blood sugar comes down a little again, stays hopefully somewhat stable. If that happens throughout the night, too, then we’re good.

What often happens throughout the night for multiple reasons that we could go into is our blood sugar drops too low. If that happens, our body wakes us up because it’s a stress response. The body thinks you’re basically dying; you need food. Your blood sugar is too low. How does the body generate that in the moment because you’re not up and eating quick enough? It will break down muscle tissue to create energy for glucose. That requires cortisol. 

Cortisol is our awake hormone; it’s often called the stress hormone, but it’s also your awake hormone. It brings you energy because that’s its main job. it provides glucose to the system. If that happens, your cortisol goes up. It might not even shoot up completely, but it goes up a certain amount that might be enough to suppress your melatonin, which should be helping you with sleep at night. 

Cortisol is up, and you’re up. I could clean the house now. I could plan a vacation. I’m totally up. It’s going to take you 60-90 minutes to fall back asleep because that’s how long the body needs to break that cortisol down. Melatonin is strong enough again to help you fall back asleep and then hopefully stay asleep. Often, it’s 4/4:30am. That hour/hour and a half, might get up, start doing emails and work. Then we have shifted so much in our cycle and our biology that it’s a total mess.

Then, if you have had a bad night like that, you might notice that you start gravitating toward crappy foods the next day, like muffins, really starchy things, ultra-processed, quick fixes, energy, chocolate. That is normal. The body needs that energy. The carbs provide that energy very quickly. 

Then we send our blood sugar on a rollercoaster again because we are putting a lot of sugar into the system. What goes up comes down. Then it crashes. Then we need more sugar again. That falls down. Then we do that whole thing the next day. That continues overnight again. With that, we can establish another one of these vicious cycles.

If we can keep our blood sugar in a better space throughout the day, we’re likely setting it up for success at night. 

Dr. Eric: 

Obviously, eating well, eating whole, healthy foods, minimizing refined foods and sugar is important. How about eating at night? When do you typically recommend for people to stop eating? 

Annika:

It depends on the person. If you’re having a big dinner, like a lot of people eat dinner as their largest meal of the day, I would try to finish 2-3 hours before you go to bed. Things like Thanksgiving dinner. The big stuff, three hours before. If it’s your normal dinner, maybe two is okay. For some people, it doesn’t fit in otherwise. 

The earlier you can move it, the better it is generally because your body has digested everything, so it doesn’t need to digest while you’re sleeping, which helps with restorative sleep. Then we sometimes play with snacks.  

Dr. Eric: 

I was just about to ask you, is there a time and place for eating right before going to bed? 

Annika: 

Yes, there might be. However, it is not something we want to do forever. We want to get your blood sugar organized. To help you avoid that ditch at night where you wake up, if you eat within half an hour, or sometimes an hour is okay, so 30-60 minutes before you go to bed. 

You hear different things. Some people say it should be a protein snack. Other people say other things. What I have been successful with is a balanced snack. Some protein, a little bit of fat, and a little bit of starchy carbs. If it’s a dip in blood sugar, we need some glucose in that snack to avoid that dip. The protein and fat just help to slow digestion down and carry that whole response a little better.

If you can do a little bit of Greek yogurt, with some blueberries in it. Or I am on the gluten-free front, so gluten-free crackers, maybe with a little bit of hummus on them. Or some carrot sticks with hummus, or celery sticks. Some olives with crackers. A little bit of cheese, if dairy is your thing, can work. A little piece of chicken, like a small bite, with olives or something. Some people go with fruit. It depends. I wouldn’t eat a whole banana. It’s very high on the glycemic index, so it can mess with your blood sugar. A small piece of it with yogurt could be okay. It’s a bit of a trial for what the person reacts to well. 

If you’re somebody who wakes up in the middle of the night and is actually hungry, that is definitely a sign that you’re waking up because of your blood sugar. You didn’t eat enough throughout the day. 

Dr. Eric: 

Makes sense. You said you don’t recommend for people to do that long-term. You don’t want them forever to be having a snack right before going to bed. How long usually should someone expect to be eating snacks before going to bed, ultimately breaking the cycle? I know it’s different. Are we talking about where someone might be doing this for maybe a week, or a couple of months on average? 

Annika: 

I would say probably 1-2 months is more what I’m seeing, if you’re consciously working on stabilizing your blood sugar throughout the day. If you’re not, this might be a longer thing. 

Is it really harmful to do that if your caloric intake is fine? If we are not overeating because of that. I think if you get restorative sleep with it, that is probably more healing than not having sleep. Overall, metabolic health and blood sugar regulation is so critical for overall health that it would be my preference for someone to work on that, so that is not what is sabotaging their sleep anymore. 

Dr. Eric: 

Okay. How about blue light, electronic pollution? What impact does that have on sleep? More and more people are aware of the impact, but there are still a lot of people who dismiss that. They’re still on their iPhone or on their computer before going to bed. What impact can that have on sleep? 

Annika: 

It can have a big impact in the sense that the blue light that is emitted, especially when you’re on your phone or computer, is very close to your face. It shines right into your eyes. This can suppress melatonin release, so that will hinder you to sleep well. We need a good amount of melatonin to sleep well. 

People ask, “Do I just put on a filter that Apple provides?” Yes, that’s a first step. There are also blue light filters, blue light-blocking glasses that people can wear. If you actually want to make a dent into that, well, the easiest thing is don’t use them at night. Avoid them. Put your phone to bed, like literally put your phone to bed. Buy yourself an alarm clock that is analog. The old school, little squares from Amazon for $10. That is your best bet. 

No push notifications coming in in the middle of the night that light up your phone and vibrate on the nightstand. That’s a big one.

If you go into blue light-blocking glasses at night, if you want that to work, they have to be the orange ones. The clear ones are mainly during the day to filter off the light from the screen, so we don’t get tired eyes. With sleep, they don’t really show in the data that it is a significant increase in melatonin. That is what the red-light bulbs or orange blue light filters do. 

EMFs in general, electromagnetic fields, is another thing. Some people are very sensitive to that. Some more than others. We are all surrounded by EMFs all the time. It’s an epidemic. 

We live with electronic devices, and it doesn’t have to be a phone. Your toaster. Anything you plug in. The power lines you live by. The everyday use of appliances are more low-grade EMFs. Often, it’s the sum of the individual things. We’re not just using a toaster. We are on cell phones and computers at the same time. 

I would keep these things out of the bedroom. The bedroom is for sleep. Keep everything out of there that shouldn’t be in there. It can really make a difference for people. Often, they don’t think that’s their problem. If we do that simple step, they already notice a difference. 

It’s shown to affect your nervous system. It’s shown that EMFs affect your immune system. There are studies that prove that. If you’re someone on the more sensitive side of that spectrum, or your bucket is full, these types of things can tip them over the edge. Even if it’s by itself, it wouldn’t maybe be that big of a story, but it’s a piece of the puzzle.

Dr. Eric: 

Great advice. What are one or two other factors that can affect sleep that are either common or uncommon? Whatever you want to chat about. 

Annika: 

The #1 thing that I see besides stress, because we never take breaks. We just expect to hit the pillow and fall asleep and sleep through, and it doesn’t happen because we never take breaks. We are just on all the time.

We don’t spend enough time outside. It’s really that simple. They go together actually. Our body functions best if it has a lot of natural light because that natural light gives the body information of what time of the day it is. 

Why is that important for the body? It knows, “I need to release digestive hormones. I need to make sex hormones now. I need to release cortisol. Oh, I need to make melatonin because we are soon going to bed.” The body knows that through the hues of the light and the angle at which the sun rays fall onto your retina in your eye. 

We have totally ignored this for decades. With the technology coming on, we have totally forgotten about this. Cubicles, people sitting in boxes all day, working in factories, not seeing daylight.

I was giving a talk a couple weeks ago in a hotel, so one of those big rooms. It’s a conference center actually. We were in there, and I was like, “Can anybody tell me what time it is without checking the time?” “No.” This is exactly what happens. You have no idea. 

If there are no windows, or if you work in a basement, you literally have no clue what time it is. You need to go outside and give that input. If people do that and stay off their phones at night and their devices, really take time and breathe, enjoy life in the moment, and follow every trend we see on social media, you will be a lot better with your sleep. The nervous system calms down, and all of your systems improve over time. Your gut balances out. Your hormones balance out. This is all a problem because all this stress causes all these issues. We have to address fixing the gut, fixing the hormones. Taking that stress component, so the body can get back into homeostasis and maintain that, too. 

Dr. Eric: 

Going outside, something I could also improve on, too. Something I have been working on, as I’m sure you can relate, other people can relate, you just get busy with whatever you’re doing. In my case, not only working with patients or doing these podcast interviews, there are so many different things. It’s a matter of choosing. 

I try to get some sun in the morning, but I also like to get some in the middle of the day. Quite frankly, sometimes I don’t because it’s a matter of choosing: do I need to get this task done, for example, and sacrifice the 10-15 minutes? Maybe I should compromise at times and say, “Even if I go outside for 3-5 minutes, that’s better than not going out at all.” Sometimes, I do that. Sometimes, I don’t. I do need to be more consistent. Thanks for reminding me as well as letting all the listeners know, too. 

Annika: 

One thing I often see with women particularly though, alcohol. We have talked about diet. Alcohol, that red wine at night. Yes, you fall asleep faster, but your sleep is bad quality. It’s a thing. I understand. We’re anxious, we’re busy, we just want a few minutes of Netflix and drinking that wine. If you’re struggling with sleep or don’t have energy, it is not a good idea. It’s been proven. It’s counterproductive. It doesn’t help. 

Finding something you enjoy. Asking that question of “What’s missing? Why do I need that wine? What could I be doing instead to relax? What do I need? Is it a phone call with a friend? Is it connection? Maybe I want to sit there and watch something but drink something else that doesn’t have alcohol in it.” That is a big one often that I see. If I actually ask the question, like I do on my intake form, but if we go into that conversation, can we check that out? It’s going to make a difference.

Dr. Eric: 

Even having a single glass of red wine for example can affect sleep quality? 

Annika: 

Yes. There are studies that show for women, it really helps with falling asleep. It has that sedating, relaxing effect. But it messes with your deep sleep and REM sleep. That’s why often the hangover in the morning isn’t just “My liver couldn’t handle it,” which is part of it. The older we get, the bigger this problem becomes. But it’s often that you didn’t get enough sleep, and there is still too much hormone in the system that should have been cleared out from sleeping. 

Dr. Eric: 

How about caffeine? If someone is having sleep issues, is it okay for them to have a cup of coffee early in the morning or a cup of green tea? Is that something they should also avoid completely if they’re having problems falling and/or staying asleep at night? 

Annika: 

That is a bit of an individual thing. I think for most people, having a coffee or green tea before lunch is okay. For most people, it metabolizes at a point. Coffee can metabolize very slowly, so you can still have caffeine in the system very late at night. If you can’t fall asleep, I would actually consider trying decaf for a little and see how that goes. The falling asleep to me thing, there could still be caffeine in the system. Waking up is not so likely, but falling asleep.

If you struggle with anxiety, leave the coffee, and see what happens. It’s often a thing. For women, I often see that anxiety improves. 

If we are so tired that we can barely function, I may switch clients to a matcha latte, if they are coffee with milk drinkers. That green tea is a slower release caffeine. You get a bit of a boost, but you don’t get the caffeine up and down.

If it’s just brain fog, maybe look into lion’s mane. I find this works really well with brain fog. Sometimes, we might not need caffeine. But it’s an individual thing.

The one thing I would try not to do is not make that the first thing in the morning. Don’t wake up and immediately get to the coffee machine. With nothing else, it hits the system. If you’re not sleeping, and you are likely already super exhausted, that really pushes your body very hard, and it’s going to drop very quickly. Likely at around 10am, you will be reaching for ultra-processed foods for more energy, or another coffee, because you cannot sustain that level that you pushed your body to. We need to work on getting you more energy in the morning, so you can then have coffee, and it carries you a little bit into the afternoon. 

Dr. Eric: 

Supplements. You always want to try to address the cause of the problem. Whether it’s stress, or we spoke about blood sugar, the caffeine, the alcohol, whatever it is, you want to address those imbalances, whatever factor is causing the sleep issues. 

There is a time and place for supplementation. What are your favorite supplements or some of the supplements you commonly recommend, which might also be your favorites? Assuming you recommend supplements at times to your clients, what are some of those supplements? 

Annika: 

I do, but I often don’t go for the full-on sleep supplement because I want to get to the root cause, and I want to get away- If I am already having fear of not sleeping, and I put a pill in there to sleep, then I make myself potentially dependent on only sleeping if you take that pill. Then we take that pill out, and we have to go through that whole behavioral thinking process again of “I can sleep without a pill.” That is why I go on supportive supplements. 

The one thing that I find helps really well is topical magnesium. That can be a lotion or a spray. Lower legs or bottom of your feet every night consistently. We are likely depleted in magnesium anyway. It may take a while. Bottom of the feet for some reason, the skin absorbs very well. It seems to be going into the system very well and works really well for a lot of people. 

Another one that I really like, if we have blood sugar issues is inositol. I like it in a powder. I put it in my matcha because it’s sweet. It’s natural to the body. We are still putting a synthetic hormone in, but it is natural to the body. It helps regulate blood sugar and can really help people get over that night hump, even if you take it during the day. We play with it. Some people take it in the morning with their coffee, and some people take it before bedtime. That really depends. That is something I have seen work really well, even in small doses, until we get that blood sugar stabilized.

If we have someone who is anxious and exhausted, rhodiola is something I often really like. I often recommend taking it in the morning, not at night, just so we get through the day a lot better. 

I am honestly not a huge fan of melatonin because I have not had great success with it. A lot of clients haven’t had great success with it. I use it to shift someone’s circadian rhythm sometimes. If they sleep until 11am or 12pm, and we need to get them to get up at times that allow them to participate in the work force, so we sometimes do it at certain times of the day, a time release one. 

I don’t know if you have heard of this product, but Herbatonin.  

Dr. Eric: 

No, I have not heard of it.

Annika: 

It’s the company that makes Femmenesscence, Symphony Natural Health. They have a plant-based melatonin called Herbatonin. Melatonin is not just a sleepy hormone; it’s a very strong antioxidant. It has more significant antioxidant properties than synthetic melatonin.  

I have had really great success with it in very low doses. They have a .3mg capsule and a 3mg capsule. I have a lot of hard-core not sleeping clients who do okay on .3-.6mg. It often works even better in combination with a little bit of magnesium. It doesn’t give you that hangover effect at all. It could happen that you start dreaming weird things, but that happens on melatonin, too. Once your body gets deep sleep and into REM sleep, it catches up. 

That is something I sometimes like to use for the time that we’re figuring out what’s going on. Often with sleep clients, we have inflammation, like gut issues. That antioxidant is so nice that we can get that oxidative stress and all the fun stuff that comes with the inflammation a little bit better in check, even throughout the night. That’s a product I’m really excited about actually. It just works a bit differently. 

It doesn’t work for everybody, like a lot of these things. There is always a bit of a trial. But it does work for quite a few people. 

Dr. Eric: 

Herbatonin, maybe combining it with some topical magnesium on a temporary basis. A lot of people can take a lower dose, .3-.6mg. Wonderful. 

With melatonin, this person might not see you because they might be sleeping okay. I’ve come across some people who have been taking melatonin for quite some time, years maybe, so sleep is not an issue. Maybe it is related to their taking melatonin, maybe not. How would you approach that person? 

Would your approach be, “They’re taking melatonin. They’re sleeping well. They’ve been on it for a few years. Let’s let them be.” Or would you want to try to get them to the point where they are not relying on melatonin? For someone who has been on it for so long, is that possible? 

Annika: 

We don’t know. If they came off, would they have trouble sleeping? Generally, they should not. Over a short period of time because your body does not lose its ability to make melatonin. The amount of melatonin that the brain releases to get you to sleep is marginal, in comparison to how much we weigh and how big we are. It’s a teeny, tiny amount. The body kicks production back in.

There might be a bit of a rough period, but it should work. It’s hard to say. Am I someone who thinks synthetic melatonin is great? No, I don’t. We don’t have studies that say it’s harmful. Melatonin is such a strong antioxidant, so it’s being looked at in cancer treatments. Will they give certain treatments throughout the night in the future for melatonin? We know melatonin levels are higher, so the body can maybe work with the treatment better and handle the treatment better. 

Personally, I think we can do it without, if the body is healthy. Should we give the body something it doesn’t need? Not necessarily. That’s why I’m such a fan of this plant-based one because it literally just has three ingredients. It has chlorella, rice, and alfalfa sprout, and that’s it. If that’s what it takes versus a synthetically made thing that you buy at the health food store in the UK, prescription only because it’s technically a hormone. I would recommend people at least look into how they can change it. 

The easiest question for me is how do you work with light and darkness? Melatonin is the darkness hormone. Is your bedroom dark? Are you avoiding lights at night? Are you giving your body everything it needs to make melatonin? 

Dr. Eric: 

Before wrapping up, I have two more questions. Is there anything else that I should have asked you that I didn’t ask you? Anything else you’d like to discuss? 

Then the second question is when should someone consider working with someone like you, a sleep specialist? 

Annika: 

We could talk about sleep for weeks. There are so many things. I think the questions that you asked are great. I think they’re the ones people often ask that are important to an audience.

When should someone reach out to somebody like me? I think whenever you’re not satisfied with your sleep. When you wake up, and you didn’t sleep well, or you sleep okay, you get a good amount in, but you’re still exhausted. Something’s not right. 

If you know that you’re someone who has some issues here and there, maybe your periods are wonky, maybe you are getting to the menopausal or post-menopausal stage and your sleep is gone because that happens a lot. There is a bit of digestive issue. Sometimes, people have no symptoms. A lot of people do a deep dive into it. You’re struggling with energy and sleep. Then I think it’s a good idea.

If you’re someone who snores or whose partner says, “I think you stopped breathing sometimes. I touch you, and you keep breathing,” then please go see a sleep specialist in the sense of someone who assesses for sleep apnea. A lot of people are underdiagnosed. That might not fix your overall sleep problem, but it should be looked at. That is something I can ask questions about. I would symptomatically assess you for that, but I would send you somewhere else because that is not my specialty. 

A lot of people don’t know that something like what I do exists, but it is important. You don’t need to struggle. You need to sleep. I have clients who go 30-35 years with horrible sleep. You see it at their age. It wasn’t good. 

Dr. Eric: 

Agreed. Unfortunately, a lot of people experience sleep issues, where they are only getting 4-5 hours per night. Some people, obviously less than that. So glad that there are functional medicine practitioners like you out there helping people to get better sleep, to get more quality sleep. That being said, how can people find out more about you, Annika? 

Annika: 

You can check out SleepLikeABoss.com. You can listen to my podcast, Sleep Like a Boss, where we talk all kinds of functional health and sleep. You’ve been on. 

I’m not as active on social media as I probably should be, but I try to stay off as much as I can. There is Sleep Like a Boss on Facebook, and @_AnnikaCarroll on Instagram. But the easiest is the website. 

Dr. Eric: 

As I mentioned since we started recording, it’s been a while since I had someone focus on sleep on the podcast. You shared some great strategies, important information. Appreciate you taking the time to have this conversation with me. 

Annika: 

Thank you so much.