Recently, I interviewed Pamela, who has the antibodies for Hashimoto’s and is also dealing with extreme fatigue as well as some digestive issues. We discuss her experience with thyroid hormone replacement, struggles with extreme fatigue, anxiety, and digestive issues, the importance of accurate testing for conditions like SIBO and adrenal health, potential treatment options, the need for a comprehensive approach to managing symptoms, 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. I am chatting here with Pamela, joining me from Ohio with her little doggie, Charlie. Nice to talk with you, Pamela. How are you doing today? 

Pamela: 

Thanks, Dr. O. I’m doing well. 

Dr. Eric: 

Awesome. Pamela here is dealing with the antibodies for Hashimoto’s. Some of the symptoms she has been experiencing, some of her main challenges: fatigue, along with anxiety, PTSD. 

You have also worked with a number of different practitioners. It’s been three functional medicine practitioners? Two or three? 

Pamela: 

It’s been two, and one is a doctor/coach, non-prescriber.

Dr. Eric: 

Can I ask how you found me? 

Pamela: 

I think just because I was watching other thyroid videos, you came up in my feed. Then I went on your newsletter list. 

Dr. Eric: 

How long have you been dealing with those Hashimoto’s antibodies? When were you first diagnosed? 

Pamela: 

My diagnosis was in April of last year. Then I was briefly medicated with T3 only. I had just an awful experience. The doctor kept saying I just needed a higher dose. It got to the point where I wasn’t sleeping or eating. I got a second opinion. 

Dr. Eric: 

Are you no longer taking the T3? 

Pamela: 

No. For me, it was a disaster. You just recently sent out a newsletter about thyroid rage. I had that with the T3. It was just terrible. I almost got fired from my part-time retirement job. It was just awful. I am laughing about it, but it was truly the worst of my life as far as medical. I couldn’t eat. I couldn’t sleep. 

Dr. Eric: 

We were chatting a little bit before, and you said not too long ago, you got a thyroid panel, and your free T3 is looking good. It’s 3.3, which is well within the range. Based on that alone, it seems like at least now, you don’t need any T3, so it sounds like it was a good idea you stopped taking it. 

Pamela: 

I was relieved to see that. I guess I am converting. As long as I keep the nutrition up and stress down, I shouldn’t need medication at this point. I seem to be going the right way. 

Dr. Eric: 

That’s great. Not everybody with antibodies for Hashimoto’s needs to take thyroid hormone replacement. A lot of doctors will just put everybody on it. Your body told you that you didn’t need it. Obviously, your recent blood tests show that, too. Your antibodies are still quite high but are heading in the right direction, correct? 

Pamela: 

Right. I’ve looked at myoinositol and black seed oil. I don’t know if one is considered better than the other or if I just have to experiment with them. 

Dr. Eric: 

You haven’t taken either one of those? 

Pamela: 

No, I haven’t. 

Dr. Eric: 

We could talk about different options with myoinositol. There is some research of how that combined with selenium can potentially help. I actually like black cumin. I can’t say I take it every single day, but I am a fan of black cumin. We will talk about both of those. If I forget, remind me. I want to talk about other things, too, but we will get back to that. 

We mentioned some of the symptoms. How long have you been experiencing fatigue for? 

Pamela: 

That is originally why I went to a functional guy in the first place. I had been treated for hepatitis C. About a year went by, and I was feeling tired and draggy. I didn’t nap every single day. Now I’m napping multiple hours every day and sleeping 7-8 hours a night. Just seems like a lot. 

Dr. Eric: 

7-8 hours a night, most people should be doing that. But the napping during the day.  

Pamela: 

Each month, the Fitbit was telling me it was going up, the percentage of days with naps. I’m up to 65% of my days, I need a multiple-hour nap. 

Dr. Eric: 

Oh wow. A few hours, not just a 20-30-minute power nap. 

Pamela: 

No, hours. I lose the whole afternoon. 

Dr. Eric: 

Wow, okay. Definitely need to talk about that. 

Is the anxiety better since you’re not on the T3, or is that still an issue? 

Pamela: 

It’s much better now that I’m not on the T3. Somewhere along the line, phosphatidylserine was suggested for sleep. It had a terrible effect on me. That stuff kept me awake all night. I recently got a Gaba L-theanine product, and it had a little bit of it in there. The same thing started happening, like the first couple hours of my sleep didn’t even register on the Fitbit. 

Dr. Eric: 

It had the phosphatidylserine supplement in there? 

Pamela: 

Yeah. 

Dr. Eric: 

Have you had your adrenals tested? Saliva testing or dried urine testing? 

Pamela: 

No. He did blood testing that first round last April. 

Dr. Eric: 

Okay. The reason I ask is because typically, phosphatidylserine is given when someone has higher cortisol at night. 

Pamela: 

I have very high cortisol. 

Dr. Eric: 

How do you know you have it at night if you haven’t had it tested? 

Pamela: 

I don’t know about night. The morning one. First, it went down. Between September and I had it tested again in February, I think, it went from the teens, where it was sort of high, to 28. 

Dr. Eric: 

Wow. You’re talking about a morning cortisol blood test at a lab?  

Pamela: 

Yes. I just sent off a 24-hour one because I have a doctor’s appointment coming up. 

Dr. Eric: 

A 24-hour, is it the urine one, where you collected the urine? 

Pamela: 

No, the four-point saliva. 

Dr. Eric: 

Great. It would be interesting. Sometimes, someone will have elevated cortisol in the morning, but at night, it won’t be elevated. That wouldn’t be an indication for the phosphatidylserine. Obviously, there are things you potentially need to do to sleep. You said you sleep 7-8 hours at night. Is it uninterrupted sleep, or do you wake up in the middle of the night and have difficulty falling asleep? 

Pamela: 

The Fitbit says I’m awake a lot. It has little slashes throughout the night. I am on a medication that is supposed to be lowering the cortisol. 

Dr. Eric: 

Do you know the name of the medication? 

Pamela: 

It’s called Clonidine. It used to be called Catapres when it was a blood pressure medication in the ‘80s. I know it from then. 

Dr. Eric: 

How long have you been on that for? 

Pamela: 

Since April of this year. 

Dr. Eric: 

April 2024? 

Pamela: 

Yes. 

Dr. Eric: 

About five months or something like that. Have you noticed that helping with your sleep? 

Pamela: 

Yes. It took a long time for it to kick in. The dosage was increased to .02, and that’s when it really kicked in.  

Dr. Eric: 

When we are talking about adrenals and cortisol, we have to talk about stress. How has stress been? What are you doing from a stress management perspective? 

Pamela: 

I don’t really feel stress. That’s the thing. I had a hectic career, and now I’m retired. I’m gardening and playing with my dog and taking art class. It doesn’t seem like I have stress, but my body seems to think otherwise. 

Dr. Eric: 

It could be other stressors. You mentioned PTSD, so it could be past stressors still affecting the physiology. It could be stealth infections. There could be other factors that affect the adrenals and cortisol, even if you don’t feel stressed. 

I will say when I dealt with Graves’, I knew stress was a factor, and it was a different situation. I wasn’t retired and am still not. At the time, I was in denial. I’m not saying you are, but sometimes we don’t know. That’s why it’s good you’re doing the saliva test, just to see what it looks like. 

Obviously, you did cortisol in the blood. The only thing with the blood is sometimes, going to the lab itself or getting the blood draw can spike up the cortisol. That’s why it’s not completely accurate. It will be interesting to see what the saliva test shows. 

Even if you’re not feeling stressed, you’re retired, it sounds like it’s low stress. If you’re not doing anything to block out time for stress management, it won’t hurt to incorporate deep breathing or something like that. 

Pamela: 

The Fitbit has some mindfulness exercises I do probably three times a week. I do a little bit of yoga and stretching. And I walk. 

Dr. Eric: 

Those are all good. 

Pamela: 

They stopped me from walking for a while. They didn’t want me to do anything that would stress my body in any way. I had to gain weight for one doctor to see me. She told me she wouldn’t see me if I didn’t gain weight. 

Dr. Eric: 

You had the opposite problem that a lot of people have. You were underweight? 

Pamela: 

Right. It’s weird because I really don’t feel any Hashi symptoms, except fatigue. 

Dr. Eric: 

No coldness? 

Pamela: 

I got tested for infections and mold and lots of different stuff. I feel like I have been through the testing machine. 

Dr. Eric: 

How did you get tested for mold? 

Pamela: 

There were plates to put around the house that we sent in. Some swabs in my nose. 

Dr. Eric: 

Those came back negative? 

Pamela: 

All that was negative. This was the only house I looked at where the basement didn’t smell musty. We have sprung leaks, but we’re running the dehumidifier and crossing fingers at this point until we can get somebody out to fix the outside wall. 

Dr. Eric: 

Sounds good. Sometimes, depending on the company you use for the plates, there hopefully was an accurate reading. I’m not saying to do this, but there is urinary testing for mycotoxins that looks at mold in the body to see if you have mold in your body. If that comes up positive, then the question is where is it coming from? If it’s not coming from the house, or is it coming from the house, and you had a potential false negative test with the plates? 

Pamela: 

The H-pylori thing, I think I had to breathe into something. 

Dr. Eric: 

The urea breath test? 

Pamela: 

Then I did a lot of stool testing because I had diarrhea starting with the T3 all the way through March of this year. 

Dr. Eric: 

That stopped when you stopped the T3? 

Pamela: 

No, it kept going. I was down to about three foods that I could eat: coconut, pumpkin, and peanut butter of all things. My weight was really dropping. In that year, probably 30 pounds. 

Dr. Eric: 

You lost 30 pounds? 

Pamela: 

Yes. 

Dr. Eric: 

Did they find out why you were losing weight? Are you gaining the weight back now? 

Pamela: 

No. I am gaining it back now. When I was doing the coaching through the fall, I decided to do an elimination diet with meat. Carbs were the problem; I couldn’t digest them. 

Dr. Eric: 

You went on a carnivore-type diet? 

Pamela: 

I went on a carnivore diet. I had to tweak my digestion a little with HCl and enzymes at first, but I gained weight. I feel pretty good, except I can’t get rid of this tiredness. 

Dr. Eric: 

H-pylori breath test was negative. Did you do a comprehensive stool test, or were they just tests through LabCorps or Quest? 

Pamela: 

No, it was through Mosaic. 

Dr. Eric: 

Mosaic Diagnostics. You did their stool test? 

Pamela: 

Yeah. The report was five pages long. 

Dr. Eric: 

It looked okay? 

Pamela: 

It looked okay. Some leaky gut stuff at the time, last fall. I just kept doing those supplements and following the advice on that. My digestion is pretty good. For a while, I could see fat in my stool, undigested fat. That has completely stopped. I think it’s a #4 on the chart, which is normal. What I would call normal poop. That seems to be resolved. Every once in a while, I get diarrhea. Somebody suggested that I take Vitamin A after a fatty meal, and that seems to stop it. 

Dr. Eric: 

Your gut is better. Maybe not optimal, but it’s improved.  

Pamela: 

Much improved. 

Dr. Eric: 

Still experiencing the fatigue. Adrenals, which we spoke about. You’re doing testing on that. Nutrient deficiencies. Have you done an iron panel recently? Not just a CBC. 

Pamela: 

Not recently, no. Back at the beginning, he did iron and ferritin. 

Dr. Eric: 

You actually sent those, too. 

Pamela: 

There was a ferritin in what I sent you. 

Dr. Eric: 

I think there was also iron. Maybe I’m wrong. There was ferritin. Ferritin didn’t look too bad; it was 62. Maybe there wasn’t iron, just ferritin. It did have iron saturation. This was from last year, September 2023. The iron saturation was 18%. Ideally, you want it to be between 30-40%. 18% is still within the lab range, which is 15-55. Definitely on the lower end. A lot of times, the medical doctors will blow it off because it’s within range. Same thing with the iron. It was 66 when you really want it to be 90-100. 

If your iron is low, the questions you want to ask is are you consuming enough iron? If you are eating mostly a meat-based diet, the answer would be yes. You’re not cycling; you’re post-menopause, so you’re not a cycling woman. That is not the issue. Then we’d look at digestion, the gut. Are you digesting everything, absorbing everything? 

The stool test, I will say this. I like Mosaic Diagnostics for some of their testing, like their organic acids test. The urinary mycotoxins test, they have a good one. I can’t say I love their stool test. On a scale of 1-10, it’s not a 1, but it’s definitely not a 10; it’s somewhere in the middle. It sounds like it still showed some things. It wasn’t a perfect test. 

Pamela: 

It had some gram-negative bacteria. 

Dr. Eric: 

I also think about things like SIBO or SIFO. A stool test would not detect that. Just because you mentioned the weight loss. You were taking the T3, but you said even after T3, you were experiencing weight loss and some diarrhea. It wasn’t just related to T3. 

SIBO in some people, not everybody, will cause weight loss, but it could cause diarrhea or constipation, sometimes alternating. A lot of people do have symptoms with SIBO, but not everybody. It’s very common to have bloating and gas. Especially when eating foods that are higher in FODMAPs, like carbohydrates, which you cut out. You’re eating more meat, so it makes me think that it might be something to look into in the future. 

Pamela: 

I did two rounds of antimicrobials in the fall. I started right after this testing, and then I did another round in December. 

Dr. Eric: 

Which one did you take? Do you remember? 

Pamela: 

Designs for Health. 

Dr. Eric: 

Probably their GI Microb-X? 

Pamela: 

Microbial, yeah. 

Dr. Eric: 

I’m not saying that wouldn’t help at all, but SIBO can be challenging. Sometimes, the broad-spectrum antimicrobials don’t work for SIBO but could work for other things in the gut. Like I said, something to consider. 

If things are not improving, and if you already have been through the medical route, going to gastroenterologists, and they do their endoscopies, a colonoscopy in this case, wouldn’t show anything. Again, that is usually what they’ll do. The H-pylori you had done. 

If you are still not getting answers, even though it’s heading in the right direction, and you feel you can’t introduce these other foods, and you are just relying on a meat-based diet, that is at least something to consider. Maybe there is some overgrowth in the small intestine. 

There is a breath test you could do. Mosaic Diagnostics doesn’t offer that, but there are other companies like Genovva and a few others that have the breath test for SIBO. Definitely something to look into. 

Let’s see what the adrenals look like. A lot of things can cause fatigue. The stealth infections like Lyme, bartonella can cause that. EBV. Some of these tests for Lyme and bartonella, the tick-borne infections aren’t too accurate. If you look at Lyme at a LabCorps or Quest, many times it will be negative, even if someone has it. I’m not saying you have it. I’m just saying that some labs are more reliable than others. 

In your situation, I would say since you already did the adrenal saliva test, which is a test I like, you might as well wait and see what that shows. If that isn’t giving all the answers, then it sounds like the gut still has some work to do potentially. If you are still having diarrhea, then I would look maybe at doing a SIBO breath test. You could also look at maybe doing a retest of the stool test, perhaps using another lab, like doing a GI Map or Genovva GI Effects or other labs that I like. 

Like I said, based on what you said, if I had to choose between doing a SIBO test or another comprehensive stool test, I would lean more toward using a SIBO breath test and see what that shows.

Before wrapping it up, you asked me about the myoinositol and the black cumin. I told you I would get back to those. For what you’re experiencing, I don’t think those will be magic solutions to your fatigue. I think you’d have to go beyond those. 

There are some studies that show myoinositol and selenium can be beneficial in those with Hashimoto’s, moreso the immune system. To be honest, even someone with Graves’ could take selenium. Even the myoinositol, it seems like it has immune modulating properties. 

Same with black cumin. Even though there are no studies on black cumin with hyperthyroidism, and there are one or two related to hypothyroidism, it seems like it’s not directly affecting the thyroid, but the immune system, which is good because that is what you are dealing with with the elevated TPO antibodies. It might help. 

I think you will need to go beyond that. The saliva testing that you’re doing, maybe do some initial testing with the gut that we spoke about. It shouldn’t hurt to take those. Just taking those alone is probably not going to be the answer. 

Selenium by itself in the research has been shown to lower TPO antibodies. Do you absolutely need to take the myoinositol with the selenium? It’s something we don’t know unless someone tries it out. Some people might take both in combination and see a dramatic decrease in their antibodies. Others, maybe not so much. 

Same thing with black cumin. Like I said, I like black cumin. It has a number of different health benefits. I have written at least one if not multiple articles on black cumin. It can help with COVID. I’m a fan of black cumin. It’s not that I am not a fan of myoinositol. One might be beneficial to some extent. 

I think you also might need to do additional testing. You already did one of them that I would recommend, the saliva test. 

That is where I would go. Let’s wait for the results of the saliva test and see what that shows. If there are a lot of imbalances in cortisol levels, and you do things to address those, and that helps, that’s great. If not, if you’re still experiencing fatigue, diarrhea, or other symptoms, you might need to dig even deeper. Maybe do the SIBO breath test that I mentioned earlier. 

Pamela: 

Okay. That’s great. Very helpful. 

Dr. Eric: 

Pamela, thank you so much again for applying to do this audit. It was great having this conversation. I hope everyone also benefited from listening to this conversation. Tune into the next episode. 

Pamela: 

Thanks so much. 

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 sixth and final part of my series, I’m discussing the crucial link between gut health and thyroid antibodies. I’m talking about how the gut impacts autoimmune thyroid conditions, the concept of leaky gut, the 5R protocol for gut healing, strategies for supporting gut health, my approach to testing, and more. If you would prefer to listen to this part, you can access it by Clicking Here.

There are a few reasons why healing the gut is essential to lower and eventually normalize the thyroid antibodies associated with Graves’ and Hashimoto’s.

First of all, most of the immune system cells are located in the gut. As a result, you really do need to have a healthy gut in order to have a healthy immune system.

I have also mentioned in other episodes the triad of autoimmunity. Remember, it involves three components necessary for autoimmunity to develop. Component #1 is a genetic predisposition. Second is an exposure to one or more environmental triggers. The third one is an increase in intestinal permeability, also known as leaky gut.

That leaky gut is necessary for autoimmunity to develop. Healing the leaky gut is also necessary to reverse autoimmunity and therefore lower those antibodies, eventually normalizing them.

Let me briefly explain what a leaky gut is. You have these tight junctions, which connect adjacent cells of the small intestine and prevent larger molecules from passing through. What I like to do is use my hand and show my fingers. Think of my fingers as the cells of the small intestine. You have these tight junctions in between the fingers/cells of the small intestine, holding them together. When you have that leaky gut, you have damage to the tight junctions. If you open up those fingers or have the spaces in between the small intestine become larger, this allows proteins and other larger molecules to pass into the bloodstream, which causes an immune system response.

What causes a leaky gut? There are a number of factors. This leads us into a discussion of the 5R protocol. This discusses the different things you need to do to heal the gut.

The first component also relates to some of the causes of the leaky gut. That very first component is Remove. You want to remove those factors that can cause a leaky gut.

Food is one of the factors. I have an episode in this series dedicated to food triggers, such as gluten, corn, others.

Certain infections can also cause a leaky gut. I have an episode in this podcast series on lowering and normalizing thyroid antibodies that talks about infections. Not all infections cause a leaky gut. In that episode, not every infection I discuss will cause a leaky gut. Ones that are specific to the gut can cause a leaky gut.

Not necessarily infections, but SIBO or yeast overgrowth also could be a factor.

Certain environmental toxins. I have an episode on environmental toxins when it comes to lowering and normalizing antibodies. It doesn’t mean every single environmental toxin will cause a leaky gut. One that potentially can is glyphosate.

Glyphosate, to be honest, I don’t know if there is evidence of it directing a leaky gut. It definitely seems to cause dysbiosis, an imbalance in the gut flora. That seems to go hand in hand with the leaky gut. You could have imbalance in the gut flora without having a leaky gut. Many times, when you have that imbalance, you have a leaky gut.

Medications like antibiotics, proton pump inhibitors, even antithyroid medication such as methimazole or PTU. There is a time and place for medications, including antithyroid medication. They can not only cause that dysbiosis, but there is some evidence that shows they can affect the intestinal barrier, those tight junctions.

It is important to understand you can have a leaky gut without experiencing any symptoms. If you are having symptoms such as bloating, gas, stomach pain, you could have other things going on such as parasites, H-pylori. H-pylori will typically cause heartburn and reflux, but you also might not have symptoms. The point is, you can have a leaky gut in the absence of digestive symptoms.

That’s the first R of the 5R protocol. Some of those factors can be a cause of a leaky gut, so you want to remove those factors.

The second R is Replace. You might need to replace things like digestive enzymes. A lot of people have low stomach acid. Maybe taking something like butane HCl or some bitter herbs, those are some examples of things that you might have to replace. Even dietary fiber falls under that replace component.

The third R is is Reinoculate. You want to reinoculate the good flora with probiotics, prebiotics. The question you might have is should I do this through food? Should I do this through supplementation? You definitely want to do as much as you can through food. If you enjoy eating fermented foods for example, and you are able to tolerate fermented foods such as sauerkraut and fermented pickles, then by all means, eat these foods.

Prebiotics, eat plenty of foods that are high in fiber, and that will provide prebiotics. For example, if you are eating green, leafy vegetables, which I do add to my smoothie, they are not the best source of dietary fiber. They are not high in prebiotics. Other types of vegetables like cruciferous vegetables are high in fiber.

Some people might not be able to tolerate cruciferous vegetables, especially if they have something like SIBO. You just have to listen to your body. Same thing with fermented foods. It could also be histamine intolerance.

Definitely try to do as much as you can through diet. That being said, I do like supplements. I have been taking a probiotic supplement for quite some time. I would recommend if you take a probiotic, take one that has a decent potency, at least 25-30 billion CFU, colony forming units.

Also, make sure it lists multiple strains, not just a species. An example of this is Lactobacillus acidophilus, which is a species. Lactobacillus acidophilous LA-14 is a specific strain. You could look at the label, and if you see the species name, usually with the strain, you will see a letter/number combo. It might just be numbers or extra letters. You definitely want to list a strain and not just a species.

When I dealt with Graves’ in 2008/2009, I did not add extra prebiotics. I tried to get what I could through diet. For the last six or seven years, I have been adding prebiotics to my smoothie. The ones I get are inexpensive, especially compared to probiotics. They are providing some extra prebiotics. I try to get as many prebiotics as I can from food as well.

The fourth R is Repair. You want to do things to repair your gut. A lot of people just jump right into repair. They will do things like drink bone broth or take supplements such as L-glutamine or other gut healing supplements. If you’re a vegan/vegetarian, and you are not going to drink bone broth, cabbage juice is an option also to help to heal the gut.

Again, you need to address the first three R’s. Don’t necessarily need to do these in order. You could remove, replace, reinoculate, and at the same time, repair. If you just jump to repair, and are drinking bone broth or taking a gut healing supplement like my SMT GI Restore, which is a great supplement, but if that’s all you’re doing, and you’re not doing things to address the cause of the leaky gut, replace, and reinoculate, you won’t be successful in healing the gut.

Repair is important, but a lot of people jump right into that. They don’t address the other ones. They might take probiotics. I see a lot of people when they work with me who are already taking a probiotic, a digestive enzyme, and maybe drinking bone broth. They haven’t done as much as they could to address that first R, remove.

The fifth R is Rebalance. Rebalance the parasympathetic nervous system. You could do this through mind/body medicine. Vagus nerve exercises. With mind/body medicine, meditation, yoga, even deep breathing. When you talk about Vagus nerve exercises, singing loud, either in the shower or in your car or wherever. Vigorous gargling also stimulates the Vagus nerve. Taking cold showers as well, which is something I do.

Those are the five components of the 5R protocol. This is necessary for optimal gut health. Some people will say you need to go beyond the 5R protocol in some cases. Maybe, but you always need to incorporate the 5R protocol. I’m not saying that in every case, if you just incorporate the 5R protocol, that alone is going to heal the gut. Many times, it will. If you try to do other things and not incorporate the components of the 5R protocol, you won’t be successful in healing the gut.

I also want you to be aware of childhood factors that could impact the gut. For example, C section versus a natural birth.

Being bottle-fed, which was the case with me. I was never breastfed. If you’re breastfed, that has beneficial impact on the gut microbiota.

Antibiotic use when younger. I took a lot of antibiotics when I was younger, which definitely wasn’t beneficial to my gut microbiome.

Proton pump inhibitors. I don’t know the statistics with children, but you’d be surprised how many children take acid blockers. A lot of children aren’t eating well, so a lot of it does come down to diet. If they have symptoms, many times, the practitioner won’t look to make recommendations- I would hope a natural healthcare practitioner would be making dietary recommendations, but going to a conventional medical doctor or nurse practitioner, some of them are open-minded, but not all of them. They might just recommend some medication, which can have a negative impact on the gut.

There is a time and place for antibiotics. When I was growing up, I’m sure some of the antibiotics I took maybe were necessary, but definitely not all of them. That’s a big problem, not just with children, but adults as well, taking too many medications overall, not just antibiotics.

Should you test the gut microbiome? I think it depends on the person. There are natural healthcare practitioners who will test everybody’s gut microbiome. I won’t say that’s a big thing. Doing functional medicine testing isn’t cheap. Everything adds up. To me, it’s a matter of prioritizing. There are practitioners who will recommend leaky gut testing for everyone. There are practitioners who will recommend a comprehensive stool panel for everyone. That’s just their approach. I am not saying anything negative.

With regard to leaky gut testing, at one point, I tested everybody for a leaky gut. I would do usually the Array #2 from Cyrex Labs. That’s their intestinal permeability test, which is a blood test. You could do zonulin in the stool, which is not a perfect marker. Lactulose mannitol test is a more classic test, which is not perfect. Even Array #2 is pretty good, but I’m sure not perfect. No test is perfect.

I will say that most people tested positive for a leaky gut, which made sense. I do work with some people with non-autoimmune thyroid conditions, but most of my patients have Graves’ or Hashimoto’s. According to the triad of autoimmunity, you’d think they would have a leaky gut. Most people did.

What I decided to do is stop doing it. It’s great for the person to see they have a leaky gut, but it’s a couple hundred dollars for the test. Why don’t they spend that money elsewhere, and we will assume they have a leaky gut?

The one upside to doing leaky gut testing upfront is if it’s positive, later on, you can retest and see if it improves, which it hopefully will. Now you could still do a leaky gut test later, even if you don’t do an initial test. You wouldn’t know if it’s positive to begin with.

I will say that most people test positive for a leaky gut. If they were negative for a leaky gut, I would question whether it was a true negative or a false negative. I just make the assumption that people have a leaky gut. A lot of practitioners take this approach as well.

There are other types of tests, like comprehensive stool panels. GI Map by Diagnostic Solutions and GI Effects by Genovva Diagnostics are two of the most well-known tests. There is a newer one from Doctor’s Data.

I like the GI Map and GI Effects. Those are my two favorite tests. I don’t recommend these tests to everybody. There are some practitioners who do. They’re expensive tests. That’s not the reason I won’t recommend it. If I think someone needs a test, I will recommend it.

The challenge is sometimes you don’t know. You can’t always go by symptom. You can use that for justification that everyone should get a comprehensive stool panel for example.

When I dealt with Graves’, I didn’t get a comprehensive stool panel or a leaky gut test or any gut-related tests. I did an adrenal saliva test, which did look at a marker called secretory IGA, which lines the mucosal surfaces of the gut. Mine was depressed, so I did have that test. I didn’t have any specific gut testing like a leaky gut test or a stool panel. I did find I was able to get into remission, and I have taken that approach with a lot of people.

If someone has obvious digestive symptoms, then I will usually recommend some type of gut test, whether it’s a comprehensive stool test or a SIBO breath test. Maybe doing an organic acids test, which is really good for looking at yeast overgrowth.

I will do some testing. Many times, I will give an option. I will list a comprehensive stool panel as an optional test, and someone might choose to do it. If someone doesn’t choose to do it, yes, there is always a chance they might need to do it later on. That’s why I also give it as an option. To force everybody to spend $300+ on a comprehensive stool test for example when many of these people won’t need it, I don’t feel comfortable doing that. If someone absolutely wants to do it, or if I feel like they need to do it, then I will give that recommendation.

You can’t always go by symptom. Sometimes, I won’t recommend it. The person might not be progressing or might hit a roadblock, and we recommend it later on. Would have been great if they did it initially. Like I said, that’s my approach, where I don’t recommend it to every single person.

If you’re listening to this and in the future decide to work with me, keep in mind, it’s up to you. You can do it. I will usually list it as an option when I send my follow-up recommendations.

There are also tests looking at the diversity of the gut microbiome. A GI Map or GI Effects looks at some of the good flora of the body, but its main focus is looking for pathogens and opportunistic bacteria, things like H-pylori. Even with the GI Effects, that’s an add-on. Parasites; certain opportunistic bacteria like Streptococcus, Staphylococcus, Klebsiella, Pseudomonas. It also looks at markers related to digestion like pancreatic elastase; secretory IgA; calprotectin. I do find the test to be valuable, even though I don’t do it on everybody.

The stool tests that look at diversity, they’re focusing on the number of different microorganisms. You want to make sure that they’re in good amounts, that they’re not too high or low. A comprehensive stool panel is called “comprehensive” because it looks at lots of things.

If you are just looking at the diversity, Viome is not my favorite, but that test is looking at the diversity. They are not looking at things like H-pylori or parasites. It’s not that I dislike Viome; it’s just that they give recommendations based on AI. It’s still not perfected. Nothing bad about Viome.

The information on the diversity is accurate, but when they give recommendations on foods you should eat and not eat based on your gut microbiome and some other information, I’m not sure it’s accurate. This is also based on what they have said, listening to some of their webinars, admitting they are still using a lot of AI to come up with those recommendations.

Next question you might have is how do you know if the gut has been healed? This is a very common question that I get asked. There are a few different ways. One is if you did that initial leaky gut test, then you could do a retest and see if it’s been healed.

Even if you didn’t do a leaky gut test, let’s say you made that assumption that someone had a leaky gut. You could still do a leaky gut test later on and see what that shows. If it’s positive, that person’s gut has not been healed. If it’s negative, assuming you believe in the results, false negatives are possible.

When I dealt with Graves’, I did secretory IgA on the saliva test, which was really low, less than detectable. Eventually, I retested. The first time I retested, it still remained undetectable. Then I made some changes to my diet. At the time, I was eating paleo because there was no AIP diet back in 2008-2009. When I retested after avoiding nuts for a few months, my secretory IgA was normal. I am not 100% sure, but I was pretty sure it was due to the nuts because that was the only change I made.

Let’s say you have Graves’ or Hashimoto’s, and your thyroid hormones are in balance. Your antibodies are normal. You’re not experiencing gut symptoms. When you get to this point, maybe you didn’t have gut symptoms to begin with, but you had elevated thyroid antibodies associated with Graves’ or Hashimoto’s or both. Either way, if everything seems to be in balance, and if you were experiencing gut symptoms but no longer are, you could definitely do that.

That’s what I used. I did look at secretory IgA in saliva. It’s not like I absolutely did no testing. As I mentioned earlier, I didn’t do a comprehensive stool test or a specific leaky gut test. When secretory IgA is low, that usually correlates with a leaky gut, but it’s not a specific leaky gut test.

Hopefully, you enjoyed this presentation on lowering thyroid antibodies by healing the gut. I also hope you enjoyed the entire series on how to lower and normalize thyroid antibodies. Just remember that it’s not always easy to lower and normalize thyroid antibodies, but it is very possible.

Thanks again for tuning in. 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 part five of my series, I’m discussing the link between infections and autoimmune thyroid conditions. I talk about the significance of recognizing hidden infections, when to consider testing and retesting, natural treatment approaches for addressing infections, the value of working with a practitioner, and more. If you would prefer to listen to this part, you can access it by Clicking Here.

In this presentation, I will discuss lowering thyroid antibodies by addressing infections. Like environmental toxins, I think that infections are an overlooked factor when it comes to the challenges in reversing the autoimmune component of Graves’ and Hashimoto’s.

Numerous studies suggest that viruses, bacteria, and other microbes can lead to the development of an autoimmune condition. How do certain microbes trigger an autoimmune response? I won’t get into great detail here, but essentially what happens is the immune system responds by producing what’s called type one interferons and pro-inflammatory cytokines. These are directed at the microbe. This in turn results in T cell and B cell activation, which can ultimately result in an autoimmune response.

However, there is also the concept of molecular mimicry. What this essentially means is some bacteria and viruses have amino acid sequences that are similar to those in humans. As a result, when a human is exposed to such a microbe, the immune system not only will attack the bacteria or virus, but since the microorganism has the same amino acid sequence as the human tissues, the immune system will also target the tissues of the human, which causes inflammation and can potentially trigger an autoimmune response.

Let’s talk about some of the different viruses and bacteria and other microbes, starting with Epstein-Barr Virus (EBV). Most people will test positive for EBV. Just because you test positive for this doesn’t mean it’s an autoimmune trigger. That being said, some studies have correlated EBV with both Graves’ and Hashimoto’s. Again, it can be a factor, but just because you test positive for EBV doesn’t mean it is the factor.

How do you test for EBV? It is tested for through the blood. There are other methods, like the GI Map, which is a comprehensive stool panel. Also tests for EBV as well as cytomegalovirus. Most of the time, this will come back negative because you will not find EBV in the stool most of the time. Usually, we test for it in the blood.

There are three what’s called IgG markers that you would want to test for, if you choose to test for EBV. There is an IgM marker. The three IgG markers include viral capsid antigen (VCA) IgG, EBV nuclear antigen IgG, and early antigen IgG. Many practitioners will test for VCA IgM and the nuclear antigen, but they won’t test for the early antigen. If the early antigen is positive, this may indicate a reactivation of the virus.

I will say that most people I test will have elevated VCA IgG and nuclear antigen IgG antibodies, but even when they are very high, this doesn’t always confirm that EBV is causing a problem. If you have those two along with the early antigen, then that also doesn’t 100% confirm a reactivation. Some healthcare practitioners will say it does, but I don’t think it does.

On the other hand, if you have the VCA IgM antibodies elevated, this typically will indicate an active infection.

Cytomegalovirus is another virus. Like EBV, it is a type of herpes virus. One study shows that cytomegalovirus along with some other microbes may be involved in the pathogenesis of Hashimoto’s and Graves’.

COVID-19, a newer virus. When COVID hit in 2020, definitely saw an increase in mostly hyperthyroidism and Graves’ as well as subacute thyroiditis, which initially presents as hyperthyroidism. COVID also could be a factor.

I won’t talk about all the different viruses, but there are others, like herpes simplex and parvovirus. Viruses can potentially be a trigger.

Let’s talk about some bacteria. We have your Yersinia enterocolitica, which is a bacteria that can lead to numerous health problems, including enterocolitis, acute diarrhea, pseudoappendicitis. There is evidence in the research that Yersinia enterocolitica can play a role in the development of Graves’ and possibly Hashimoto’s.

Helicobacter pylori, or H-pylori, is a bacteria located in the stomach. A number of studies link H-pylori with both Graves’ and Hashimoto’s. In addition to potentially being a direct trigger possibly, H-pylori can also interfere with the production of stomach acid, which can cause problems with digestion, lead to yeast overgrowth and bacterial overgrowth, which also can affect permeability of the gut. This is part of the triad of autoimmunity.

There is definitely controversy over H-pylori. Some practitioners will say you don’t want to treat for it unless the person is having overt symptoms like heartburn or acid reflux. But I have had patients even without those symptoms go into remission when addressing H-pylori.

If I have a patient with Graves’ or Hashimoto’s, and H-pylori is clearly positive, even in the absence of symptoms, I will recommend typically an herbal protocol. The person sometimes will choose to take antibiotics. I usually would not. It’s up to the person. If the person is experiencing reflux or other symptoms like heartburn, even then, you might want to consider a natural approach. Then I could understand if someone wants to get more aggressive. Most of the time, I would recommend a natural approach.

I should mention with H-pylori, there are numerous testing options. I will talk more about testing. I just want to mention here, because H-pylori, there are 3-4 ways of testing. You can test through stool; blood, which looks at antibodies; the urea breath test. You usually want to do the breath test or stool. You can test through the saliva as well.

Let’s talk about Lyme next. Lyme is caused by bacteria known as Borrelia burgdorferi. Typically transmitted through a bite from a tick. There is also evidence that fleas might transmit. Maybe even mosquitoes. That’s more controversial. Definitely ticks. Probably fleas. Possibly mosquitoes.

There is some evidence that Borrelia burgdorferi may be involved in the development in autoimmune thyroid conditions. I was diagnosed with chronic Lyme in 2018, 10 years after my Graves’ diagnosis. It didn’t play a role in my Graves’ diagnosis, but in some people, it could be a factor.

I was also diagnosed with bartonella, which is another tick-borne infection that in some cases can be a potential trigger.

Let’s talk about parasites. They also can potentially be a trigger. To be honest, there is not a lot of evidence in the research showing that parasites can trigger autoimmunity. I have seen it in my practice. Someone with Graves’ or Hashimoto’s has a certain parasite. A common one is Blastocystis hominis. Like H-pylori, people will say you don’t want to treat every case of this. Some practitioners will recommend treating it regardless, even if the person is not experiencing any symptoms.

I think they can be a problem at times. I can’t say I treat everybody for parasites. There are some practitioners who won’t even do testing, but they will assume everybody has parasites and will treat everybody for parasites. I have had some of these people on my podcast who take this approach.

I have also had other practitioners who won’t treat every case of parasites, even when it’s detected on a test. They might just look at the symptoms. If the person is not having gastrointestinal symptoms, they might choose not to treat the parasite. Still a good amount of controversy with parasites.

There is candida or other types of yeast. When we think about yeast, we usually talk about candida, but it’s not the only yeast out there. Even though yeast can be pathogenic, it’s not like you can’t have a fungal infection. Most of the time, it’s more of an overgrowth that is opportunistic. It’s normal to have yeast in the gut microbiome. It’s when it gets too out of hand. If you have low stomach acid or if you are eating a lot of refined sugars, for example, that could also be a factor in yeast overgrowth.

SIBO, small intestinal bacterial overgrowth. Most bacteria should be in the large intestine. With SIBO, the bacteria build up in the small intestine for different reasons. It’s not really an infection; it’s too much bacteria in the wrong place.

I wanted to bring it up here along with candida and yeast overgrowth because some people may have that question. They are not infections, but they definitely can affect the gut and also play a role in autoimmunity. Maybe not necessarily direct autoimmunity although there is some evidence that candida might. At the very least, both yeast overgrowth and bacterial overgrowth in the small intestine can affect permeability of the gut, which is part of that triad of autoimmunity.

There is also something called SIFO, small intestinal fungal overgrowth, where there are too many fungi in the small intestine.

Limitations of testing for infections is what I want to talk about next. For example, parasites, the reason why some practitioners will not test their patients for parasites is because the tests aren’t perfect. You might do a comprehensive stool test, and it might look negative for parasites. That doesn’t 100% rule out parasites. A little bit of a catch-22. Sometimes, you have to use your judgment.

I like to do testing. If someone has parasites or SIBO or H-pylori, I like to see it on a test. I don’t want to blindly treat it. You need to keep in mind that sometimes you might have false negatives. Then it’s a judgment call. If you strongly suspect someone might have parasites or another type of gut infection, there is a time and place for treating, even if it comes back negative on a test.

H-pylori, not all tests are created equal. Sometimes, you will see a stool antigen test come back negative, whereas it might be positive on a urea breath test. Or vice versa. The GI Map and a few other tests do PCR testing, specifically quantitative PCR testing. They might detect H-pylori, where other tests aren’t detecting it.

Just because it’s detectable doesn’t mean it’s out of range. Debatable, but it depends on the person. If it’s detectable, and the person is having overt digestive symptoms, especially heartburn or reflux, maybe you would want to treat it. If they are not having any gut symptoms, but it’s detectable and not elevated, then you might not want to treat H-pylori.

Lyme, false negatives are very common. Just going to a conventional lab especially. That’s why there are special labs. When I dealt with Lyme, I wanted to get tested initially at a regular lab. The doctor I went to didn’t think I had Lyme, so I went to a Lyme specialist. I got the test through a company called Medical Diagnostic Laboratories. That ended up detecting Lyme as well as bartonella. There are other companies such as IGeneX, which is the most well-known for testing Lyme and coinfections. Galaxy Diagnostics is another one. There are others. I use MDL.

Even these specialty labs aren’t perfect. Sometimes, you might suspect someone has Lyme or bartonella. It might come back negative.

Speaking of bartonella, a lot of practitioners will test for Lyme but will stop there, and they won’t look at other tick-borne infections like bartonella or babesia.

Let’s talk about some of the potential treatments. Of course, there is a time and place for antibiotics and antiviral agents, the conventional treatments. I want to focus on the natural remedies. I am not going to spend a great amount of time on the different herbs that can help. I am just going to go through these quickly.

Berberine is one that could be very effective. You could take it as part of goldenseal. The most abundant alkaloid of goldenseal is berberine. These days, you see a lot more berberine supplements than goldenseal supplements. You could treat with goldenseal or berberine.

I recommend working with a practitioner, not self-treating, of course. I know a lot of people will self-treat, but still, I will be biased because I am a practitioner. If you self-treat, keep in mind you could have die-off symptoms. You might feel worse before you feel better. You might want to start slow.

Berberine could help with bacteria, yeast, parasites,

Oregano oil is very potent. It could affect some of the good microbes. You don’t want to take it for a really long time if you take it. Another reason to work with someone. Oregano oil can help with bacteria, yeast, parasites as well.

We have garlic. Of course, you can eat garlic, but you can also take it in supplement form. As a supplement, it has other benefits, like supporting cardiovascular health. It also has antimicrobial effects. Bacteria, even viruses, yeast, parasites.

Even if you eat garlic, like if you add it to your food, which is what I do, I also take a garlic supplement, too. We use a lot of garlic when cooking, so that will also be beneficial. It’s not like you have to take it as a supplement. I take it as a supplement more to support cardiovascular benefit. I am not taking it as an antimicrobial on a consistent basis.

Mastic gum is not as well known. I won’t say it’s specific for H-pylori. When practitioners use it, it’s usually for H-pylori in combination with other agents.

Caprylic acid, that could help with not just yeast but bacteria and parasites as well. It’s more well-known for yeast.

Speaking of parasites, some of these other ones I mentioned can help, but there is also wormwood. Wormwood, black walnut, and clove oil are the three herbs that are typically used for parasites.

Olive leaf can help with yeast, but also viruses, as can quercetin. A lot of people take quercetin for allergies or a histamine intolerance. It has antiviral properties.

Monolaurin for yeast and viruses.

Then there are others like colloidal silver. When I was dealing with Lyme and bartonella, I took some herbs. I took homeopathy, too, which I won’t get into here. Homeopathic formulas could also be helpful. I also took some colloidal silver.

Now I hear a lot about methylene blue, which I eventually will have a guest expert to focus on that. I am not the person to focus on that. I can’t say I use a lot of methylene blue in my practice. I would like to have someone who focuses on it.

I should also mention that even taking probiotics and prebiotics can also help. You need to think of it in the gut microbiome especially. A lot of these microbes are in the gut microbiome. Not all of them. Some viruses are outside.

When talking about the gut, like H-pylori and parasites and even candida overgrowth in the gut, taking probiotics, Lactobacillus and Bifidobacterium-based probiotics, Saccharomyces boulardii. Spore-based probiotics can also make a difference. In some cases, maybe only taking probiotics can help. I found that sometimes taking probiotics won’t help with infections. Something to keep in mind.

I mentioned the antibiotics and antiviral drugs. Time and place for these. This is why it’s a good idea to work with a practitioner to get recommendations. If someone works with me, whenever I can, I’ll recommend more natural approaches.

There is a time and place for antibiotics. For example, if someone has SIBO, and they go through an herbal antimicrobial protocol, and if it’s not really helping, they might have to take an antibiotic such as Rifaximin or Xifaxan, which are the same thing pretty much. That is specific for SIBO. If someone has H-pylori, and for whatever reason, they are not responding to the natural protocol- I really hate when people with H-pylori take antibiotics because they are taking multiple antibiotics. I can’t say that there is not a time and place for antibiotics. Sometimes, antibiotics are necessary.

Getting back to the testing. Should you test for infections? I don’t test everybody for infections. It really depends on the person. There are practitioners who will recommend a comprehensive stool panel on every single patient. They will look for things like H-pylori and parasites and opportunistic bacteria.

I think there is value in this. I don’t recommend it to everybody, but I could understand why some would. If someone is having certain digestive symptoms, that’s not improved by changing one’s diet. They might want to look into a comprehensive stool panel or maybe a SIBO breath test, especially if they experience a lot of gas and bloating when eating certain types of foods.

Organic acids test is not specific for infections, but very good for fungi, including yeast. For yeast overgrowth, I like the organic acids test. It also looks at Clostridium, which is a bacteria.

There is also blood testing for viruses, tick-borne infections. When I dealt with chronic Lyme and went to MDL, that was a blood test.

I think the testing for infections should depend on the person. Like I said, there is an argument that everybody should have a comprehensive stool panel or even an organic acids test. Some practitioners will recommend every single one of their patients get these tests.

I don’t do that. If the patient wants to do these tests, even if I don’t think it’s necessary, that’s fine. If I think there is a good chance it will show something, I will recommend it.

That’s the thing about testing. You don’t know until you do the testing. That’s why there is no right or wrong. It’s up to the person. If they want to do comprehensive or conservative testing.

I can’t say I’m always conservative. I tend to be on the more conservative side. Sometimes, I recommend more comprehensive testing, depending on the situation. Ultimately, it is up to the person.

That’s all I wanted to cover with regards to infections. 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 four of my series, I’m discussing the impact of environmental toxins and toxicants on thyroid antibodies and what you can do to reduce your toxic burden. I talk about the differences between toxins and toxicants, mechanisms of thyroid autoimmunity, practical detoxification strategies, the role of supplementation, the need for thyroid antibody testing, and more. If you would prefer to listen to this part, you can access it by Clicking Here.

In this presentation, I am going to discuss how to lower your thyroid antibodies by addressing environmental toxins, which of course are a huge problem in this day and age. 

Let’s start by discussing what is the difference between a toxin and a toxicant. Think of a toxicant as being natural. For example, mycotoxins from mold are natural, whereas xenoestrogens, such as bisphenol-A or BPA, are manmade. I tend to use the word “toxin,” but in some cases, should be using the word “toxicant.” When I say “toxin,” I’m many times referring to a toxicant. Keep that in mind. 

How can environmental toxins or toxicants trigger thyroid autoimmunity? What happens is that the body is very resilient. We are being bombarded on a daily basis with these environmental toxins and toxicants. In most cases, our immune system is able to handle this toxic burden, but over time, many of us lose chemical tolerance. 

There could be a few different reasons. One is simply the toxic burden becomes too high, but there are also some genetic factors behind this. Some people unfortunately, due to their genetics, can’t handle as high of a toxic burden as other people can. 

Let’s briefly discuss some of the mechanisms for how environmental toxicants trigger thyroid autoimmunity and thus lead to the formation of thyroid antibodies. 

One is through an increase in pro-inflammatory cytokines. You get chemical exposure, and that causes oxidative stress. This oxidative stress in turn will activate the T cells of our immune system. This increases pro-inflammatory cytokines. As the name implies, pro-inflammatory cytokines promote inflammation.

As far as how they specifically lead to the formation of antibodies, the chemicals also have the ability to bind to the tissue proteins. You get the activation of B cells. This leads to the formation of these auto antibodies. 

There is another mechanism: increasing intestinal permeability. Remember, we have that triad of autoimmunity. There are three factors necessary for autoimmunity to develop. One is genetics, and we can’t do anything about genetic factors. We can do things to change the expression of our genes, but we can’t change our genes. 

The second component is exposure to one or more environmental triggers. Environmental toxins or toxicants can be a direct trigger. 

Also, we have the third component of the triad, which is the increase in intestinal permeability, or a leaky gut. These toxins and toxicants in some cases can cause a leaky gut, which can also be a factor in autoimmunity and indirectly lead to the formation of thyroid antibodies. 

I’m not going to spend a lot of time in this episode discussing the different types of environmental toxins and toxicants, as I want to focus more on what you can do to reduce your toxic burden, which in turn can greatly help with lowering and eventually normalizing those thyroid antibodies, especially when these toxins and toxicants are a main trigger.

I do want to spend a few minutes discussing some of the more common environmental toxins as well as their sources. 

Xenoestrogens. There are different types of xenoestrogens. The most commonly known is bisphenol-A, also known as BPA. A common source is plastic water bottles. There could be other sources, even thermal paper receipts. 

The problem is that the manufacturers of these products, like plastic water bottles- Now they have BPA-free plastic water bottles. There are other structural analogues such as BPS and BPF that could be just as bad. The research shows possibly even worse than BPA. Just because something is BPA-free does not mean that it is free of other xenoestrogens that can act as endocrine-disrupting chemicals. They could disrupt the thyroid gland. They could disrupt other hormones. They could also potentially be a factor in autoimmunity. You want to do everything you can to minimize exposure to these xenoestrogens. 

I make a big deal about the plastic water bottles because there are people still buying plastic water bottles by the case and drinking it day in, day out. They could make a really big impact on their health just by making this change. I know in some cases, this might not be easy. In many cases, it is. 

Stop buying them and get a filter, or drink water out of a glass bottle, something like Mountain Valley Springs. Definitely more expensive. Getting a case of Mountain Valley Springs is more expensive than getting a case of whatever plastic water bottle (so many different brands these days), but it’s your health you’re talking about. In many cases, not just you, but the health of your family members, including young children while they are still developing. 

Every now and then, not a big deal, but if this is your main source of water, I would definitely look elsewhere. Get another source. Get a filter. Drink out of a glass bottle, Mountain Valley Springs or another source.

Flame retardants found in furniture, even clothing. These are toxic. 

Many times, I’ll talk about your mattress. You should be spending at least a quarter of your life in your bed sleeping. Hopefully, closer to a third of your life. I’m not saying if you have a conventional mattress, discard it and get a more natural mattress. If you are on the market, or you will be on the market for a mattress any time soon, you want to look carefully when it comes to your mattress. We don’t hesitate to spend whatever amount on a car, thousands of dollars sometimes, many times tens of thousands of dollars. Many people will get the cheapest mattress they can buy. Obviously, you want a good mattress also for support and your spine. The toxin profile as well. Something to consider. 

There are companies, like Naturepedic. Avocado is another one. There has been some controversy with Avocado and their certifications, but I think they’re still really good compared to the conventional mattresses out there. There are other companies as well. Just do some research. 

When we were on the market for a new mattress, we went to Asheville, North Carolina, which we’re not too far from. If you’re on the west coast or somewhere international, then you probably won’t want to go to Asheville, but maybe there is some place similar where you can stop and try out the mattresses. In this case, they had Naturepedic. They might have had other ones, but I remember specifically Naturepedic.

Parabens found in cosmetics and natural cleaners. It is a little bit costly, but when you think about it, it’s not like food. I can understand trying to eat organic food is also something that is a good idea just because of the pesticides and herbicides. That can add up because you’re going through food a lot quicker than you are cosmetics and cleaners. 

At least with cosmetics and cleaners, I would say to switch to natural cosmetics and cleaners that you are using on a regular basis. For example, if you use a spray to clean your home on a daily basis, then use a natural spray or make your own using your own ingredients, like apple cider vinegar, regular vinegar, baking soda. You can make your own concoction. You can go online to learn how to make your own. Something like cosmetics that you use on a regular basis and other cleaning products.

I mentioned pesticides and herbicides. When it comes to the food you eat, trying to eat organic. Some will say it doesn’t make a difference. Other studies demonstrate that it does make a difference. I am willing to spend the extra money on organic. I know everything adds up. 

At the very least, try to eat organic produce. If you eat meat, try to eat organic meat. I realize it’s more than just eating organic. For example, if you’re eating beef, arguably even more important or just as important is making sure it’s 100% grass-fed/grass-finished. Just be aware of the food that you’re eating. 

Pesticides are a big problem. Not just in the foods we eat, but the sprays. That’s another thing. If you are having your house regularly sprayed with pesticides, you might want to reconsider or try to look for a company that uses more natural products. I know there is a time and place. Sometimes natural agents don’t work as well as chemicals. 

A lot of businesses use them understandably because you don’t want to walk in a business and see bugs. In that case, if they are doing it on a preventative basis, which many businesses are, they could look into a more natural option because those pesticides will impact your health over time. It could take decades. Something else to consider. 

There are solvents such as benzene, xylene, toluene. Think of all the sources, things like gasoline fumes, cigarette smoke, motor vehicle exhaust, industrial emissions, even things like glues, paints. There’s only so much you can do. 

If you are out and about, you will probably get exposed to some of these. For example, if you go for a walk, you might not want to walk on a busy road, especially during rush hour in the morning or in the evening when there are a lot of cars. You will be getting exposed to even more motor vehicle exhaust. 

If you like to take a walk or a morning run or ride your bike, maybe go to a greenway or a park or even just a neighborhood, like a housing development, and ride around. It saddens me when I see people trying to improve their health by riding their bikes or running in a bad area. I know sometimes you might not have a choice, but if you do have a choice, I would not do it on a busy road. 

Some people live on a busy road, which that’s another thing. If you live right near a highway, I realize you probably won’t move any time soon. Maybe in the future, that is an option. Again, it seems like an extreme measure, but day in day out, being exposed to all the motor vehicle exhaust from those cars definitely can take its toll on you over the years. 

Things like painting your home. You can get low VOC paint, no VOC paint. 

Formaldehyde is another toxin found in building materials, adhesives, binding agents, carpeting. There are other chemicals potentially, too. Even hardwood floors. If you do hardwood floors, like we have in our home, regular hardwood floors also emit toxins such as VOCs. It takes some detective work, trying to find companies where there are natural options. It can make a big difference in your health.

Mycotoxins from mold is a big problem. A lot of people have mold issues. It’s not always visible. You might not have any visible mold in your home, but it could be behind walls, underneath the floor, if you have a crawl space. 

You could test your home for mold. There are different companies. ImmunoLytics is one. Mycometrics is another. Seeing if there is mold in the home.

There are also ways you can test your levels. There is a urine test, Mosaic Diagnostics. Real Time Laboratories are two of the most popular tests that will look at mycotoxins in the body. 

Glyphosate, which is the active ingredient in the herbicide Roundup. Eating organic will help, but it won’t get rid of the glyphosate. It will reduce the amount of glyphosate you are exposed to. There are many more. 

I mentioned estrogens, but I didn’t get into microplastics. I do plan on having another episode, which possibly might even be out by the time this episode is out. If not, it probably won’t be too long after that. I do plan on having at least a Q&A episode and maybe an expert talk about microplastics, nanoplastics.

Before I talk more about how to optimize detoxification, how to eliminate toxins from your body, reduce your toxic burden, you might be wondering if you should test for toxins. I do some testing for toxins. There are a few different options out there. 

The problem is that you can’t possibly test for all toxins out there. For example, it’s very common to test for heavy metals. There is urine testing, hair testing. I like testing for heavy metals, but even if things look good on one of these tests, it doesn’t mean that you’re in the clear. You could have these other toxins that I mentioned. 

Maybe you do a test for heavy metals, and it looks okay, but you have problems with mycotoxins. Pretty much all of us have xenoestrogen exposure, plastic exposure, glyphosate exposure, which you could test for. I am not saying everyone should test for glyphosate or mycotoxins. 

You can do comprehensive testing. I can’t say I do this on most people. I do some basic testing for heavy metals. Regardless of what that shows, I assume everybody has an elevated toxic burden. I am always doing something to support detoxification, which I will talk about shortly.

There is also an interesting test by the company Cyrex Labs called the Array #11, which looks at the immune system response to certain environmental toxins. For example, most tests out there, like urine testing or hair testing, look at the levels. Just because you have high levels doesn’t mean you’re reacting negatively. Also, just because you have low levels doesn’t mean everything is good. You could have a low level of a toxin but still have a loss of that chemical tolerance I mentioned earlier and still have issues with lower levels of toxins. 

The Array #11 looks at the immune system response to environmental toxins such as heavy metals and parabens, formaldehyde, even mold. It’s a really good test. I don’t use it as much as I probably should because it is not a cheap test. I do assume people have an increased toxic burden, so it’s not like I’m not doing anything. 

If someone is in a situation where their thyroid antibodies are struggling to normalize or even decrease, if they are headed in the wrong direction, let’s say you are doing a lot for detoxification. You might want to look into this because there is maybe one or two toxins you are reacting to, and you just need to do a better job of avoiding exposure to these as well as detoxification. Something to consider. 

When it comes to reducing your toxic burden, I do have some other podcast episodes including experts who have spoken about this. I have a two-part article on my website on how to optimize detoxification. 

A few things I’ll mention here. First, detoxification is nutrient-dependent, not just vitamins and minerals although those certainly are important. Making sure you are getting enough vitamins, minerals, and fatty acids. Amino acids are important as well. If you’re nutrient-deficient, that will affect detoxification. Another reason to eat whole, healthy foods. There is a place for supplementation, but it shouldn’t be a substitute for eating a whole, healthy foods diet. 

Also keeping in mind there is three phases of detoxification. I won’t go into great detail because I have discussed these in articles and other episodes. There is phase one, phase two, and phase three. Phase one is you get the development of a reactive intermediate, which if you’re not having a healthy phase two, where you’re clearing out and making these reactive intermediate more water-soluble, that’s not a good thing. Phase three is the actual excretion of the toxins, which happens through urine, feces. If you’re constipated, that is not going to be a good thing. All three phases of detoxification are important. 

It’s also important to understand that there are genetic variations that are very common that can affect detoxification. It doesn’t mean you need to do genetic testing although sometimes that could be helpful. It could give clues as to why maybe you need more detox support than other people. Some could get away with basic detoxification, whereas other people cannot. 

In this day and age, it’s really difficult to do it through diet alone. I will say that. I do a lot through diet, especially eating green, leafy vegetables. As I mentioned, it’s not just vegetables. You need amino acids, which you won’t get from your vegetables. Getting enough protein is important. Eating a wide variety of foods. 

Supplements can also be helpful to support detoxification. Supplements can help at least to aid in correcting nutrient deficiencies, in combination with a healthy diet. 

There is NAC, which is a precursor to glutathione, and can support detoxification. I really like NAC. It can be effective. Pretty cost-effective compared to other supplements.

Alpha lipoic acid can also help to support detoxification and reduce oxidative stress, as can NAC. It’s an antioxidant. 

You can take glutathione, like a liposomal glutathione. Many are familiar with the herb milk thistle, which increases endogenous or internal levels of glutathione. Schisandra is an herb that can support detoxification. There are others as well. Not going to cover them all here. 

Keep in mind it’s not just about the liver. You have lymphatics that play a role in detoxification. Kidneys are important. With the lymphatics, regular movement is important. Not just going to the gym three times a week but moving throughout the day. Rebounding is really good. Dry brushing can help to spread the lymphatics. With the kidneys, making sure you’re well hydrated can go a long way. A lot of people don’t drink enough water.

You can do other things to eliminate toxins and toxicants from your body. Sweating the toxins out either through sauna or exercise. Just make sure especially if you do sauna, you want to replenish electrolytes because you will not only lose toxins and toxicants but also minerals.

Colonics, colon hydrotherapy. I can’t say I do them. Same thing with coffee enemas. Those can also support detoxification. 

I do sauna on a regular basis, three times a week. If someone has unmanaged hyperthyroidism, where their heart rate is really high, like in the 90s or even triple digits, you might want to hold off on doing sauna, just because it will further increase your heart rate.

Of course, you want to do everything you can to minimize your exposure to environmental toxins and toxicants. You want to try to eliminate toxins. Part of reducing your toxic burden is not only eliminating toxins, but also minimizing exposure to these environmental toxins. 

Just a reminder that when retesting your thyroid antibodies, if they’re decreasing, heading in the right direction, awesome. If not, there are other episodes in this series where I discuss different factors. This episode is specifically talking about environmental toxins. We tend to overlook these at times. If you are hitting a roadblock in your recovery, especially with antibodies, don’t rule out the impact of environmental toxins. 

That’s all I wanted to cover. 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 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.