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

Dr. Eric Osansky: 

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

Katy: 

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

Dr. Eric: 

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

Katy: 

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

Dr. Eric: 

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

Katy: 

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

Dr. Eric: 

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

Katy: 

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

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

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

Dr. Eric: 

You had some concerns with the medication. 

Katy: 

Yes. 

Dr. Eric: 

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

Katy: 

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

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

Dr. Eric: 

How did you do on the antithyroid medication? 

Katy: 

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

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

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

Dr. Eric: 

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

Katy: 

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

Dr. Eric: 

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

Katy: 

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

Dr. Eric: 

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

Katy: 

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

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

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

Dr. Eric: 

You still for the most part- 

Katy: 

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

Dr. Eric: 

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

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

Katy: 

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

Dr. Eric: 

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

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

Katy: 

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

Dr. Eric: 

Selenium, I assume you are getting from the multi. 

Katy: 

Yeah. I believe that’s in the prenatal. 

Dr. Eric: 

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

Katy: 

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

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

Dr. Eric:

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

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

Katy: 

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

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

Dr. Eric: 

Okay. Any roadblocks you anticipate in achieving that goal?  

Katy: 

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

Dr. Eric: 

Your baby is 14 months old, right? 

Katy: 

Yes, my baby girl is 14 months old. 

Dr. Eric: 

How is sleep? 

Katy: 

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

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

Dr. Eric: 

You haven’t done any adrenal testing?  

Katy: 

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

Dr. Eric: 

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

Katy: 

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

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

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

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

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

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

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

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

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

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

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

Dr. Eric: 

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

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

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

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

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

Katy: 

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

Dr. Eric: 

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

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

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

Katy: 

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

Dr. Eric: 

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

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

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

Katy: 

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

Dr. Eric: 

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

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

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

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

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

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

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

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

Katy: 

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

Dr. Eric: 

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

I agree with everything you said. Coffee enemas. 

Katy: 

Debatable.

Dr. Eric: 

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

Katy: 

There are a lot of steps. 

Dr. Eric: 

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

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

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

Katy: 

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

Dr. Eric: 

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

Katy: 

.73. 

Dr. Eric: 

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

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

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

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

Katy: 

Great, thank you. 

Dr. Eric: 

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

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

Take care, Katy. Thank you. 

Katy: 

Bye, thank you.

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

Dr. Eric Osansky: 

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

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

Annika Carroll: 

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

Dr. Eric: 

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

Annika: 

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

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

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

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

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

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

Dr. Eric: 

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

Annika: 

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

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

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

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

Dr. Eric: 

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

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

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

Annika: 

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

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

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

Dr. Eric: 

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

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

Annika: 

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

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

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

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

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

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

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

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

Dr. Eric: 

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

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

Annika: 

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

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

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

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

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

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

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

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

Dr. Eric: 

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

Annika:

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

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

Dr. Eric: 

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

Annika: 

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

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

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

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

Dr. Eric: 

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

Annika: 

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

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

Dr. Eric: 

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

Annika: 

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

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

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

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

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

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

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

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

Dr. Eric: 

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

Annika: 

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

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

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

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

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

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

Dr. Eric: 

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

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

Annika: 

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

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

Dr. Eric: 

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

Annika: 

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

Dr. Eric: 

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

Annika: 

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

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

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

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

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

Dr. Eric: 

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

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

Annika: 

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

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

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

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

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

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

Dr. Eric: 

No, I have not heard of it.

Annika: 

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

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

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

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

Dr. Eric: 

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

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

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

Annika: 

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

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

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

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

Dr. Eric: 

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

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

Annika: 

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

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

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

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

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

Dr. Eric: 

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

Annika: 

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

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

Dr. Eric: 

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

Annika: 

Thank you so much. 

Recently, I interviewed Dr. Alan Christianson, and we discussed iodine’s role in thyroid health, the complexities of iodine uptake, genetic influences, potential risks of excessive iodine intake, the significance of thyroid antibodies, the risks and benefits of thyroid medication, and more. If you would prefer to listen to the interview you can access it by Clicking Here.

Dr. Eric Osansky: 

I am so excited to chat with Dr. Alan Christianson. This is going to be an amazing conversation. We are going to be talking about his book The Thyroid Reset Diet, iodine, thyroid antibodies. Let me go ahead and dive into Dr. Alan’s bio here. 

Dr. Alan Christianson is a board-certified naturopathic endocrinologist focusing on thyroid care. He is a New York Times best-selling author whose recent title is The Thyroid Reset Diet. He is the product formulator for thyroid-specific coformulation supplements. Dr. Christianson has been featured in countless media appearances, including Dr. Oz, The Doctors, and The Today Show. He is the founding president of the Endocrine Association of Naturopathic Physicians. Dr. C, it’s great to have you on the show. 

Dr. Alan Christianson: 

Hey, Eric. Happy to be with you. Thanks for having me. 

Dr. Eric: 

I enjoyed reading your book. I forgot if I also listened to it on Audible. Usually, that’s how I read books these days. I definitely have the hard copy as well.

Let’s start off by talking about the book and what motivated you to write The Thyroid Reset Diet. It’s not your first thyroid-related book; you have a few other ones. Why did you decide to take the time to write this book? 

Dr. Alan: 

There have been a lot of thyroid diets proposed and talked about. I really hadn’t been that engaged in many of them because there hadn’t been a large amount of clinical evidence. There have been some recent clinical trials, saying that diet could make a difference. It wasn’t the kind of dietary approach that was commonly used, so that was really it. This is actually pretty helpful. It’s not what everyone’s doing, so let’s take advantage of a good opportunity here.

Dr. Eric: 

Makes sense. Just to make it clear, I know this, but for those who are listening, this is based on research and also your experience with working with patients as well. This isn’t just a bias where you are anti-iodine, correct? 

Dr. Alan: 

We can talk a lot about iodine, the whole culmination of that. It’s been about 20 years of medical practice focusing on thyroid care with a real big bias, if anything, toward safe, effective outcomes. I don’t care what does what, where it comes from or how it works. If it will work and is shown to be effective, I’m all for it. A safe option is important to me.

Dr. Eric: 

I don’t know how to word this. Were you ever on the iodine bandwagon? You’re familiar with Dr. David Brownstein’s work. Before you did your research, were you at any time recommending separate iodine supplements? Were you always on the cautious side when it comes to iodine? 

Dr. Alan: 

The arc of that as a physician learning in medical school or in nutrition, I was always aware of iodine being relevant for thyroid disease but never thought much more about it than that. A thing I learned as a historical anecdote, so to speak.

Somewhere around the late ‘90s, I started seeing more and more patients who were developing thyroid disease after megadose iodine supplementation. This was the late ‘90s/early 2000s. I was curious about that. 

The origin for all of this was a dear man who passed away. Guy Abrams was his name. He wrote a group of books called The Iodine Project. They were published in magazines. He was called the Original Internist. He compiled all that and called that The Iodine Project. That is where all of this came from. Really nice guy. I talked to him in depth. Read all of his work. All of his citations. I found it really intriguing. 

It’d be a really cool thing if this massive problem affecting a lot of people could be solved by just giving them nutrients. It was an easy thing to think. There are many examples in natural medicine where people are getting too little of an essential nutrient. RDA amounts may not be enough. Foods may be low in that. It was an easy story for me to get into. It made a lot of sense in a lot of ways.

The tough thing was it was asking to suspend the last century of research on iodine. This is the most studied nutrient on the planet probably. It was the first nutrient known to be correlated with this specific disease. We have tons of data epidemiologically, interventionally, mechanistically. The more I studied about the ideas behind all of this, it was plausible, but it didn’t sync with what we already knew.

To answer the question, I was aware of that approach but not really into it for a while until I did the research on it. Then I saw the megadoses were not safe. The more recent iteration was the idea that taking below a threshold could also be therapeutic. For quite a while, I knew it was relevant. I knew people could have a problem by getting way too much. The more recent thing that inspired The Thyroid Reset Diet was that deliberately going to a lower range short-term could help fix problems as well. 

Dr. Eric: 

One of the main concerns is it could be a trigger of autoimmunity, Graves’ and Hashimoto’s. 

Dr. Alan: 

Yeah. Fascinating thing. Iodine is unlike any other nutrient. Most other nutrients, the amount that’s in the bloodstream is the amount the tissues get exposed to. It’s the same concentration. If you were swimming in soup, what the soup has, that’s what you get. That’s how the tissues and glands work in most cases.

Not with iodine. It’s gated. The parts of the body that use iodine, they selectively uptake it. It’s by a mechanism called the sodium iodide symporter, or NIS for short. The basic idea is if there is sparse amounts, you pull more in. If there is way too much, you block it from coming in. That creates what’s called the iodine paradox. 

If you get way too much iodine, you block the uptake of it, and you can create something that seems like an iodine deficiency. Too much is just like too little. If someone goes above the requirements, they can have the same problems as if they were deficient. It’s like if you blew a fuse. There’s plenty of power there, but there’s none getting in because your body shut off the safety mechanism. It’s the exact same thing for iodine in your thyroid. A little more variation. 

There are two main human genotypes. There are those who are well adapted to being in coastal environments, where you pretty much never have no iodine or very little. Sometimes, you would get a lot. There are adaptations for people who can dump out iodine or block it when they need it. 

Then there are those who are adapted to being inland, so they weren’t coastal. They were adapted to be in a lower iodine environment. They were good at operating on small amounts. You don’t get both superpowers. The coastal people couldn’t do great if they were really deficient, and the inland people couldn’t do great if they got a lot of excess.

The problem is that thyroid disease is primarily genetic. We look at the genes involved in that. They are all the genes involved in regulating iodine. Those who are better adapted to being in lower iodine environments, if they are exposed to amounts that are not always harmful for all people, that can be problematic for them.

Dr. Eric: 

You answered one question I had, which is why some people can tolerate higher amounts of iodine, whether that’s ioderal or another type of supplement. It is dependent on the genotype, according to what you just mentioned. 

Dr. Alan: 

That’s one part. The tolerance varies a lot per genotype. There has been so much data on this epidemiologically. If populations stay between 50-200mcg per day for adults, that’s received the lowest rates of adult thyroid disease. When you get above 200mcg per day, that’s when those with the lower tolerance start to have problems. Those who don’t really have problems, who are not intolerant, they’re probably safe to occasionally get to about 1,100mcg per day. They can tolerate a bit more. That’s the tolerance side.

There is also toxicology, which is not genetically variable. 

Then there are requirements. The requirements are pretty much based upon body size. There is not a lot of genetic variation with that and not a lot of differences in absorption or assimilation of it. We absorb it really well. It’s quite different from iron or B12. The tolerance is quite variable based upon one’s genetics. 

Dr. Eric: 

Does it matter the source of iodine? Meaning if someone has the inland genotype, so they can’t tolerate high amounts of iodine, does it make a difference if they are getting that iodine from supplementation versus sea vegetables, such as kelp for example? 

Dr. Alan: 

That’s a really good question. I have heard you say iodide. We could differentiate a lot of subtypes, to be really precise. Most forms we are exposed to are iodide. They are chemically already reacted with something. Iodine is formed when it’s now in a highly reactive state. That’s what happens within the thyroid. We’ll talk more about thyroid peroxidase (TPO). That’s what oxidizes it. 

In terms of what it does, there are many compounds that can form with iodides. That can be relevant in terms of when they are in supplements or sea vegetables. Ultimately, the biological properties are of the actual element. Once it’s in a concentration, where it’s freed from the bond, and it becomes an active iodine, that’s when it does what it does. 

It’s a chemical element. As such, it’s irreducible. Unless you have a particle accelerator, you can’t change an element. It does what it does, whether it’s from one supplement or another, or in a nanoparticle or a raw state. It’s labeled a lot of different ways. But it’s a chemical element. That’s where its properties come from. It doesn’t differ if it’s in a food source or supplement or different compound. 

Dr. Eric: 

Thanks for explaining that. You’re familiar with Dr. Brownstein’s work. He and others will say that the problem is the oxidative stress is caused by iodine, so if you take antioxidants such as selenium, Vitamin C, others, that will minimize the potential risk associated with iodine. What are your thoughts on that? 

Dr. Alan: 

There is total truth to that, but this is a matter of degree. There are a couple of people who have taken Guy Abrams’ work. They were collaborators of his. They were transparent about sharing his work. They have not innovated it. Those are the same things Guy Abrams said many years ago. 

The short version of the story was that Guy Abrams was a gynecologist. He saw clinical trials showing that iodine could lower the pain from fibrocystic breast disease. Not having a nutrition background, nutrients can act like drugs or like nutrients. They can do a drug-like effect, or they can fill the role of a nutrient. For example, if I got a cut or scratch from working on a yard recently, if you put iodine on your skin, you can kill bacteria. They’re separate things. 

The same is true with viruses. It’s not an iodine deficiency. It’s more a matter of an excess uptake of it. Not seeing that distinction, he thought, oh wow, that high dose helped. That must mean they required that much. That spawned all this same work from these same people.

It’s not a matter of a deficiency. Biologically, it has many properties. Someone’s tolerance is largely set by their genotype, but it’s also influenced by other factors, like their nutritional status. If someone is lacking in selenium, that will further narrow their iodine tolerance. That doesn’t mean one can megadose on selenium and suddenly now can take thousands the amount of iodine that is recommended.

It’s a real problem. Anyone can go on PubMed, and there are sad stories about many people who have been hospitalized from a thyroid storm caused by higher doses of iodine. There are many babies who are born with congenital hypothyroidism because their mothers were taking high doses of iodine. These were amounts and products that are recommended verbatim by these sources you mentioned.

These things are not safe. They cause big, dramatic harm in some cases. Most people with thyroid disease, getting too much can slow the thyroid and also trigger the whole autoimmune response. 

The slowing effect, that’s the whole tripping the fuse that I mentioned, called the Wolff-Chaikoff effect. The autoimmune response, when you’re forming thyroid hormones, you’re first off oxidizing iodide. That’s TPO. Then you’re attaching it onto the protein thyroglobulin (Tg). That’s where iodine is stored. 

Iodine itself is a big source of free radicals. That’s why we can use it as an antiseptic. If you think of bleach or peroxide, those are things that kill stuff by making free radicals. Iodine is no different. It happens to be useful but in very controlled amounts. In the thyroid, when there are amounts there that are not well regulated by the body, that extra free radical damage triggers an immune response, an inflammatory response. Now the lymphocytes treat this enzyme TPO, or this protein Tg, as if they are foreign. That’s the cycle of autoimmunity.

There are so many things that can give rise to thyroid disease. It has been argued that there are only about four factors that are truly causal, that can do it by themselves. That’s age, gender, genetics, and iodine exposure. 

A recent researcher argued that of the controllable factors, that’s really just iodine exposure. Age, gender, and genetics are not controllable. Of the many other controllable factors that give rise to thyroid disease, it was argued that all of those together are less relevant than one’s iodine exposure.

Dr. Eric: 

How about Graves’? You mentioned TPO, Tg. Any impact on the actual TSH receptor? Can it cause an increase in Graves’ antibodies? 

Dr. Alan: 

There is less epidemiologic data about iodine exposure triggering Graves’. Once it has started, then it certainly is a big driver of the disease process. All the medications targeting Graves’, all they’re doing is delaying iodine uptake. They are simply slowing that sodium iodide symporter and making less into the thyroid. That’s why they take about 4-6 weeks to do anything. There is already a certain reservoir within the thyroid. The less coming in, the easier that can go. 

The iodine paradox comes back here again. If someone is in the emergency room from thyroid storm, the blockers like methimazole or propylthiouracil (PTU), taking 4-6 weeks to work, they can’t help in the acute portions of a thyroid storm. The only thing that can block it that dramatically is megadose iodine. You’re blowing the fuse. When you give a high dose of it, that’s the most powerful way to shut it down. 

There have been some clinical trials on using iodine as a longer-term manager for Graves’. The trials look effective. The drawback is none of them were large enough where we could say confidently that it wouldn’t have raised the risk of acute thyroid storm. Theoretically, if there is more substrate there to make hormone, there is more of a chance that the gland could go out of control. It’s possible a subset of people could have more tendencies toward thyroid storm. 

You can shut it down in the case of Graves’ with high dose iodine. At the same time, if one is watching their iodine intake, that will make whatever else they do for Graves’ treatment take much less time and require much less medication.

Dr. Eric: 

It could potentially be effective, but it’s unpredictable. If they are experiencing a thyroid storm, taking high amounts of iodine might help. But using preventatively, that might backfire in some cases and actually cause a thyroid storm? 

Dr. Alan: 

Correct. That is the unknown. We know that during an acute storm is when the most effective single treatments are. If someone were doing it chronically, they might be more apt to have a storm form. When an acute storm happens, no treatments are perfect, and it can be life-threatening. It’s something that you wouldn’t want to risk triggering. 

Dr. Eric: 

Definitely agree. When someone is focused on eating whole, healthy foods- You go into detail in your book, and you list foods like the micrograms of iodine. Would you say it’s easy to exceed the 200-250mcg if you are just relying on food alone and not taking any supplemental sources of iodine? Is it something people still have to monitor on average? 

Dr. Alan: 

A recent study by the American Heart Association impressed that question: What percent of the population is likely above that 200mcg threshold? This is the thing. You’ll have people argue, “Oh no, Americans are low or high.” Averages are deceiving. 

There is a story about a statistician who had his feet in an ice bucket and his head in the oven. He was at an average of 72 degrees. He should have been comfortable. Not all parts of a big thing like America are at a set number. 

In this analysis, they broke people down by age, gender, ethnicity. The range of those that were above that safe iodine window varied. About a few of the cohorts were as low as high 20s, and some were as high as low 40s. Ballpark, about a third of the population has been known to be above that threshold by dietary intake. It can happen. One can get there pretty easily by dietary intake. If there is some in supplements, that will go on top of that.

Dr. Eric: 

It’s been a while since I read your book. My skincare products could have iodine. Could that be a concern, too? 

Dr. Alan: 

There used to be quite a bit in hand sanitizers. Pre-pandemic, that was changed, or else it would have been worse. 2018, it was identified healthcare workers were at risk of iodine-induced thyroid disease. They were using hand sanitizers that were iodine-based. That was a common problem. Many were excreting unusually high levels of iodine.

Both thyroid hormones and iodine are not always intuitive. It’s really about micrograms. It’s about microscopic amounts of things. Iodine is a really useful ingredient in personal care products. It makes them not rancid. It makes them stay smooth and not separate out the different constituents. It’s been in a lot of things. It doesn’t take huge amounts. 

The most common individual compound used is called polyvinylpyrrolidone or PVP. A lot of natural products can use that and call it a kelp extract or sea vegetable extract. Same thing. It’s a useful stabilizer. It doesn’t take a lot. 

It might be a few percent of the product that contains PVP. PVP is about 12% iodine. It sounds like we’re not talking about very much. Again, it’s mcg. If you take a conditioner for example, and you do a couple pumps of that, you have about 20g, or 20 million mcg. Now you take that 1%, and 12% of that. You figured that intact skin might absorb 4% with a couple minutes of exposure. What you’re left with is still about 1,200-2,000mcg that could be entering the bloodstream. That could be another source for people.

Dr. Eric: 

Very interesting. I want to talk more about thyroid antibodies. Before we move on, anything else you’d like to chat about related to iodine? 

Dr. Alan: 

Well, one thing that creates a lot of confusion is iodine testing. Many will hear different views. A super logical approach is let me test my patients or get myself tested to see where I fit in this.

The drawback is iodine is really volatile. It’s the amount in the thyroid and how your immune system responds to it that matters the most. It’s not just how much is in your blood or urine. 

The urine does reflect your overall intake but not on a 24-hour cycle. If you’re studying populations, urine tests are fine from a nutritional status, according to groups of 500 or more people. When you’re looking at individuals, they have done a lot of math on this. You have to test someone over 200 times to be within even 80% confidence of their status. One test tells you pretty much zero. There is so much variability. That’s even for a 24-hour urine or a spot urine or a challenge urine. It’s simply not a meaningful thing.

Serum tests are used quite a bit, too. What they exist for is evaluating the effects of iodine in toxicology ranges. Almost the main reason for this, there is a medication for this called amiodarone, which contains a lot of iodine, like 250mg. Now we are talking thousands of mcg per tablet. This medicine can have side effects anywhere in your body, and they might come on six months after usage. 

The useful thing about a serum test is someone who has had amiodarone, and they are having kidney failure. You are still wondering if they still have too much iodine, so you test their serum. Th serum levels only elevate when the kidneys can’t clear it anymore. Before then, they might be higher or lower, but there is no correlation with nutritional status of iodine. 

Many people get urine tests or blood tests. From there, they think, “I was low or high.” It really means nothing.

The most meaningless is the skin test. You can smear it on your skin, and it will disappear after a while. The story is that it disappears faster if your body wants it. The kernel of truth is that there are some nutrients that our intestinal tracts absorb more quickly if we are lower in them, like iron, for example. The other kernel of truth is a lot of things get in our bloodstream from our skin. Our skin can’t pick and choose. Our skin has no way of preferentially absorbing based on our requirements.

The other big disconnect is iodine disappearing doesn’t correlate with it absorbing. It correlates with it oxidizing after interacting with oxygen. Iodides are dark; iodine is invisible. That one doesn’t mean anything either.

Dr. Eric: 

Good to know. No great test for iodine, whether it’s urine, serum… 

Dr. Alan: 

You can get a good sense of your status by knowing your cellular intake. Do an iodine inventory. Know what’s in your medications, your supplements. What are the main food categories you consume? Because iodine is pretty consistently absorbed, you can know your status based upon what your intake is. 

Dr. Eric: 

For more information, highly recommend Dr. Alan’s book, The Thyroid Reset Diet. Check that out. 

Let’s talk about thyroid antibodies. There is a lot of controversy with thyroid antibodies. If they’re too high, does that at all relate to the severity of the condition? Is it possible to have false negative antibodies? I know the answer to that, but some people don’t. If you could talk a little bit about what people should look for with thyroid antibodies. Are there concerns if their thyroid antibodies are crazy high compared to mildly high? 

Dr. Alan: 

Great question. This is a fascinating thing. You have done a lot of good work on Graves’. The funny thing is there is discussions now in the medical literature about Graves’ and Hashimoto’s being one disease with a continuum of how it manifests. There is a lot of overlap between the autoimmunity in both of those diseases. 

As a generalization, this is something that makes me nuts. So many conventional doctors do not wish to test or entertain the relevance of thyroid antibodies. To their point, the antibodies aren’t big predictors of thyroid disease actually. They really don’t have that strong an effect upon predicting who will develop versions of thyroid disease. That’s why they dismiss it.

The drawback is the antibodies have big effects upon health and symptoms and disease risks independent of thyroid function. No matter how perfect your thyroid is working, if you have marked autoimmunity going on, that by itself can cause a great deal of problems. That’s where they should be taken into account and screened and looked for.

To credit the conventional side again, they don’t have a lot of treatment options for them that they consider useful. You can give high dose steroids like prednisone. You can surgically remove the thyroid. You can do immunosuppressants. That’s all killing flies with a shotgun. The harmful effects would outweigh the benefits. But there is good evidence that diet, lifestyle, and nutraceuticals can be helpful for the antibodies. 

Dr. Eric: 

You said that just because someone has let’s say TPO and/or Tg antibodies, that doesn’t necessarily mean that they will develop thyroid disease or hypothyroidism. 

Dr. Alan: 

Let’s put some numbers on that. Our language really lacks the nuance of predictive value. Is there a risk? It is a risk. Here’s the numbers. 

One of the recent studies looked at people’s nine-year risks of developing overt hypothyroidism, having their thyroid shut down. It is broken down into people who had no measurable antibodies, moderate elevations, and high elevations. 

This cohort had about a 1% annualized risk for developing thyroid disease. We see that in most populations. That is when they had negative thyroid antibodies.

With the highest level, where both antibodies were what is considered the highest elevation per this study, the risk was higher. If you annualize the risk, it went from 1% to about 1.7%. It was higher. In the big scheme of things, you could say it was almost twice as likely. It was, but it was 1.7%. 

For someone to be told, or for a doctor to think, “Well, your antibodies are high. Your thyroid is about to shut down,” there is a 98.3% chance it won’t. 

Dr. Eric: 

That’s really high. You’re talking about long term, not even over the next 6-12 months. 

Dr. Alan: 

You take that over nine years, and you are talking about an 11-13% risk. 10% over nine years roughly. 

Dr. Eric: 

The challenge is they don’t test- Maybe not considered a challenge, but they don’t test antibodies typically unless the TSH is out of range. Maybe the thyroid hormones. Some will just look at TSH. 

Dr. Alan: 

It doesn’t change treatment regardless. There are a few cases of what’s categorized as subclinical hypothyroidism, where some guidelines will take into account marked antibody elevations. In most cases, it doesn’t really inform or influence conventional treatment.

Dr. Eric: 

Yeah. My point is that in most cases, you wouldn’t know if you had thyroid antibodies in the absence of thyroid disease because you are usually not testing the thyroid antibodies unless you have thyroid disease. If you were to do the opposite, and do predictive antibody testing, and test the TPO and/or Tg antibodies, maybe even TSI, in the absence of thyroid disease, is there any purpose of doing that, if most people aren’t going to develop thyroid disease to begin with? 

Dr. Alan: 

The question is irrelevant if they are relevant in every other way. There is so much evidence on this. Normal thyroid function, elevated antibodies has been clearly shown to be correlated with poor quality of life symptoms: hair loss, anxiety, fatigue symptoms. We look at health risks. There is clear data on cardiovascular disease, infertility, certain types of cancers, autism. These are with all perfect thyroid function.

Yes, high antibodies, even in the absence of thyroid abnormalities, they are very clinically relevant. For many people, they are a source of ongoing symptoms. 

Dr. Eric: 

Okay. You also mentioned genetics are in there, too. If there is a family history, a mother has Hashimoto’s, maybe it’s also not a bad idea to eventually test her children for antibodies, even if the thyroid is seemingly normal, just because there’s a greater likelihood of developing those antibodies. 

Dr. Alan: 

Certainly if they have any thyroid suspicious symptoms. Knowing a family history, that can justify one taking steps to minimize their risk of developing thyroid disease. Keeping iodine reasonable, making sure that selenium and iron statuses are healthy. 

There is this new paper that came out today from the NIH, showing a pretty strong inverse correlation in many populations between serum iron and Hashimoto’s onset. Nutrients are important. The more one can do to cut the risk of things that go wrong that trigger thyroid disease, it’s worth doing, especially when there is a family history.

Dr. Eric: 

Agreed. Getting back to negative antibodies. If someone has Hashimoto’s in the presence of negative antibodies, or Graves’ in the presence of negative antibodies, is there a way to determine that they still have Hashimoto’s or Graves’ via an ultrasound or other types of imaging? 

Dr. Alan: 

Yes. You’re talking about seronegative Hashimoto’s or seronegative Graves’. Hashimoto’s, first off, we know about the numbers mostly from studies that looked at people after they had thyroid biopsies. They had a biopsy done for some other reason. The most definitive way to confirm or rule out Hashimoto’s is the biopsy.

They would take those who were known to have Hashimoto’s on biopsy and look backward and see if they had measurable thyroid antibodies. Biopsy-proven Hashimoto’s roughly half the time, the antibodies are negative. That’s even those who had it for a larger length of time. 

Seronegative Hashimoto’s is a well-known phenomenon. If it’s suspected, a biopsy is not a practical step for that. Ultrasounds can be. That is one way you can often see the tell-tale signs of autoimmunity by the specific changes that occur on ultrasound. 

The same thing happens for Graves’. A little more rare. It’s also more time-dependent. The first year someone is manifesting hyperthyroidism that is suspected of being Graves’, there is about a 5% or 10% risk of being seronegative. In most cases, the receptor antibodies or stimulating immunoglobulins are going to be positive when Graves’ is there.

If you go out after that first year, it’s probably 5% or fewer that are seronegative. It does happen that there is false seronegativity with Graves’. It’s more rare than with Hashimoto’s. In those cases, ultrasound or iodine uptake are the main ways you would know about that in a seronegative case.

Dr. Eric: 

Do you know the reason why those cases are seronegative? I know they are IgG based. I don’t know if it makes sense to test IgG and see if that’s depressed. Are there other mechanisms involved? 

Dr. Alan: 

We are going to get pretty weird here. The answer to that in clinical research is that the antibodies we’re aware of are probably not the actual causes of thyroid disease. There is smoke that is often present with a fire but not always. You can have really hot coals that can burn you.

I remember my grandpa, we had a barbecue. He buried the coals in the sand somewhere. I was walking around barefoot and burned myself. There was no smoke, but they were pretty darn hot.

That’s the same way with a lot of autoimmune processes. We know about a dozen immune mediators that are probably relevant for that occurring. Most of us can’t test for it clinically. Your antibodies are like smoke. Generally, you have a hot fire with smoke. Not 100% of the time though. It’s not the smoke doing the damage. 

Dr. Eric: 

It’s more of a consequence of the autoimmunity, not necessarily the cause of the autoimmunity, those antibodies. 

Dr. Alan: 

They’re often present when it’s going on, but not always. 

Dr. Eric: 

How about with Graves’? I agree, it seems that TPO and Tg antibodies are not actually doing any damage whereas the TSIs are not necessarily doing damage, but it seems like, at least according to the research, that they are binding or stimulating the TSH receptor. 

Dr. Alan: 

For sure. The mechanism and action of hyperthyroidism, it’s probably a big driver. Not necessarily triggering tissue damage.

My favorite analogy there is like a short circuit on a doorbell. When it works right, the doorbell goes off. Somebody opens the door. In the case of Graves’, you’re triggering that response, but there is nobody there. The thyroid thinks it’s being told to work, but it’s not. 

That’s a funny quirk of language and acronyms. We have the TSH, and then TSI, that are almost the same thing. Your thyroid can’t tell those apart either. Your thyroid is listening for TSH, waiting when it should be told to work. But it can’t differentiate that from TSI. The errant immune cells can set off a doorbell even though there is no one there.

Dr. Eric: 

Okay. I find this conversation fascinating. Seronegative antibodies for someone with Hashimoto’s or Graves’, how would they be able to tell if they are in remission since the antibodies are negative? Are there other ways? 

I don’t know your approach. Do you consider someone ever to be in remission? You practice functional medicine, so you’re not just giving thyroid hormone replacement or antithyroid meds. What other factors do you look at before you determine someone might be in a state of remission? 

Dr. Alan: 

It’s a funny thing. In a lot of the pop health space, so to speak, you put a lot of weight in the idea of being in remission. It’s not a defined term. People can mean they no longer need medication. Some say that means your antibodies are negative. There is no strict definition for that in medical literature.

Many people who are given medications, we could talk about this a lot. That is a big soapbox of mine. Most of them were prescribed medication unnecessarily and never needed them. Many can withdraw and taper and come off very successfully. That is remission of hypothyroidism.

The other paradox about thyroid antibodies is they are also natural mechanisms. Back to primarily TPO and Tg. They are natural mechanisms of killing old cells. Some people have them positive to a low amount, and they are not negative. They are not always causing a problem. Some are concerned about antibodies and levels that are not clinically relevant, and they consider remission when they’re negative.

Another paradox to throw into account is if your immune system is suppressed or weakened, almost all things that are measured that are antibody-based become negative. You could ruin your health in a lot of ways when your antibodies become negative.

Same thing with allergy testing. You could take immunosuppressant medications, and now all your allergy tests are negative. You’re not healthier. 

Negative antibodies, as a generalization, when they are extremely high, that’s usually a problem. Lower is better. There are many who will fixate on those things being zero or super bad if they are even up to a high amount, which is not always true. 

Dr. Eric: 

Thanks for explaining. You said there is no definition of remission. That being said, at least your definition, can someone with Hashimoto’s still be considered to be in remission if they’re on thyroid hormone replacement? If they’re feeling good, let’s say their antibodies are negative, but the damage is severe where they, at least at the time being, can’t get off the thyroid hormone replacement.

Dr. Alan: 

The antibodies have very little correlation to the requirement for thyroid medications. The only thing that correlates with that is overt hypothyroidism, when the gland is really shut down, or being athyreotic, not having a thyroid. There is not a strong correlation between antibody levels and thyroid hormone output. There is some rare variants of Hashimoto’s that are different. The most common types, there is not a strong relationship there.

Being in remission. Take the word out if people have different meanings about it. Let’s talk about getting better. Can someone decrease their antibodies and correlate that to symptoms and problems by a safe natural method? Most can. There is good evidence about that. 

One of the clinical trials that inspired The Thyroid Reset Diet took people who had marked elevations of antibodies and overt hypothyroidism, so TSH scores averaging 14-200, quite high. Three months of one simple dietary intervention, 78% had normal thyroid function with no medication. Those who are not on medication, a good chunk can get better.

There has been a lot of focus now on people who have been unnecessarily prescribed thyroid medication. Most of the recent studies have also encouraged iodine reduction as part of the process to help them come off. 

Thyroid meds contain a lot of iodine. If you’re consuming an adequate amount already between diet and supplements, and the meds are on top of that, that makes one more barrier for your thyroid to function normally again.

If someone is more deliberate about being lower on iodine to allow room for what’s in the medication, they get better odds of no longer needing the medication. Studies have shown that about 84% of people can decrease their medication and be stable. About half can come off. There is a lot of different cohorts that go into those numbers. Most medications were prescribed unnecessarily, and most can reduce or come off. 

Dr. Eric: 

That’s great news. Just by reducing their iodine intake? 

Dr. Alan: 

Well, there is a process of tapering. Some people, if they do that alone, their medicines will suddenly become outgrown. They will move to a hyperthyroid state if they stay on the same dose, but their TSH goes below range. That is a clear sign that your thyroid is getting back online again. 

For many, that doesn’t happen, but if they were to taper with a safe, prescribed process and be supervised for that, they could be tracked over time and stay stable. Some just see that they need to reduce. Others now have the potential to reduce.

Dr. Eric: 

Could this be true even if someone has been on thyroid hormone replacement for a long time, like 10-15 years? 

Dr. Alan: 

The stats change. The odds are highest for those who have been on it for four years or fewer. I have seen people who have been on medication for 45 years who are now on none and are doing fine. For someone who has a thyroid, it is not impossible. It doesn’t work for everyone. For many people, it can. 

Dr. Eric: 

That’s great. You mentioned thyroid hormone replacement is high in iodine. Is that both levothyroxine as well as desiccated thyroid? 

Dr. Alan: 

A little more so for desiccated thyroid actually. The active hormone, T4 and T3, the 3 and 4 refer to atoms of iodine. Levothyroxine, if you look at the dosage per active ingredient, it’s about a 100mcg dosage of levothyroxine, about 65% iodine. It’s about 65mcg. 

The dose equivalency of desiccated thyroid, it’s hard to make dose equivalencies. The best comparison is about 60mg. 

The difference here is a lot of the iodine in desiccated thyroid is not in the active hormone. It’s in other iodinated proteins. Per 60mg dose of desiccated thyroid, it’s about .2% iodine. You run the math and get 130mcg of iodine per tablet. 

In the big scheme of things, if someone needs thyroid meds, I would not encourage them to choose their medicines based on the iodine content. There are a lot of folks who need meds who can do better on desiccated thyroid. When someone is tapering or deprescribing, it is one more thing to take into account. 

Dr. Eric:

Very cool. Do you have a preference when it comes to levothyroxine or desiccated thyroid? Does it depend on the person? 

Dr. Alan: 

There are populations where desiccated is not a great option: pregnancy, lactating. Elderly, there is a deficit of data; we are not clear on that as much. But in populations where it is an option, there are many who find it preferential and many who feel better on it, even at the same levels. There are also many who do fine on T4. 

Most people who I see on thyroid meds who are not doing well, it’s often not a matter of which medicine. It’s about if they need it in the first place. If you don’t, what happens is when you take it, your body loses a whole lot of homeostasis. 

We can measure the tiniest bit of thyroid homeostasis between the things we have access to in our blood tests. There is another dozen levels behind the scenes we know of that we can’t measure. There are unknown unknowns as well. We lose a lot of homeostasis when we take over a big, important job by our bodies. Many people are symptomatic even with optimal perfect blood levels. Those same people do fine when they are now taking care of it on their own again and are not taking external therapy that wasn’t necessary. 

Dr. Eric: 

For someone who, let’s say they were just getting a random physical, TSH was elevated, and the medical doctor, because they were just getting a physical, puts the person on thyroid hormone replacement because the TSH was elevated. Especially if that person wasn’t experiencing hypothyroid symptoms, they just had the TSH elevated. It sounds like there is a good chance. We can’t give specific recommendations here. But just saying if maybe they read The Thyroid Reset Diet, minimize their iodine intake, incorporate diet and lifestyle factors, that they might very well be able to reduce or even get off the thyroid hormone replacement. 

Dr. Alan: 

What you described is what we call subclinical hypothyroidism. There have been massive articles in the last year in the Journal of the American Medical Association and in the British Medical Journal asking the question that you asked: Is someone like that better off taking medication for their TSH being elevated? 

There is a movement now afoot to relabel that as a laboratory artifact and not with a name that sounds like a disease. Subclinical hypothyroidism is not hypothyroidism. A thyroid is still functioning just fine. There is this TSH elevation. Some people are certainly possessing thyroid symptoms, but not that many more than are present in the population with normal thyroid function. 

The data is totally clear that at a population level when the only variable is thyroid medication, there is no net benefit to symptoms, and there is no net benefit to health. There are a lot of risks created. There are about 15 types of cancers that people are put at risk for when they are unnecessarily put on thyroid medication. That is based upon five pretty big global studies now in the last few years. It’s a huge decision. There is no net benefit.

The difficulty is that when someone is seeing a person in natural or functional medicine, the only variable is not medication. There are a lot of other things. If they are doing better, it’s probably more credit to those other things than just the medication. 

Dr. Eric: 

Just backtracking. You said that taking hormone replacement can increase the person’s risk of developing five different types of cancer? 

Dr. Alan: 

Dr. Eric: 

15. Even worse. 

Dr. Alan: 

We just counted a couple days ago. I was saying 12, and someone asked which 12. I made a post, and it was 15. I had to recount. 

Dr. Eric: 

I don’t know if research shows that correlation doesn’t always mean causation. They are pretty sure it’s due to the actual levothyroxine, for example? 

Dr. Alan: 

Thyroid hormones have a lot of effects that induce tissue turnover and cell activity. That is not different from any other hormone implicated with cancer risks. In fact, even more so than many others. This is true for T4 and T3. There is mechanistic evidence supporting this possible correlation.

You’re right. Correlations do not prove causations. This is how we learned about tobacco, that those populations have higher risks. The studies looked at cohort populations that are not on thyroid meds. They did a pretty maniacally accurate job of lining up the other risks that were present. Same number of smokers, same number of obese, etc. Here is a cohort just like that but on thyroid meds. It’s pretty compelling.

There are five different studies, and each study was done in a different part of the world. They were independent. They saw the exact same cancers at pretty much the exact same degrees of risk. It’s a compelling concern. 

The thing about a risk is that it’s not definite. No one is saying this definitely will happen, or it’s definitely a problem. But it’s a risk. People should be informed of risks when they are present. 

Dr. Eric: 

I agree. It just makes me wonder. Most people who are on thyroid hormone replacement are on levothyroxine. Many are on Synthroid, which also has other ingredients, fillers and other things. It makes me wonder if it is the actual thyroid hormone replacement, or if it is the fillers in the levothyroxine. We don’t have an answer to that right now.

Dr. Alan: 

There are not good mechanistic arguments for the fillers in the doses used. There are pretty clear mechanistic arguments to why T4 and T3, even more so T3, could be drivers for those cancers. They are known to do that in cell studies in vitro. We know we take away a certain amount of internal homeostasis when they are given exogenously. It’s a compelling concern. 

Dr. Eric: 

Very interesting. Before we wrap things up, is there anything else that I should have asked you that I didn’t ask you? Anything else you want to chat about related to iodine, thyroid antibodies, or anything else? 

Dr. Alan: 

You asked great questions. You’re super knowledgeable about this stuff. I’m happy to have a chance to speak with you about this.

The big thing I’d love people to hear is I’d encourage them to keep listening to what you’re sharing with them and not to give up on their hope. Realize that in my experience from doing this now for about 30 years, more than ever before, I’m hopeful about the capacity for the body to work by itself, for the thyroid to heal, and for the power of simple changes in diet, lifestyle, nutraceuticals. These things are big.

If you learned what Dr. Eric says and apply those and work with good doctors, don’t give up on feeling your best. Don’t give up on your body working well again.

Dr. Eric: 

Well said. Thank you so much, Dr. C. Where can people buy your book? Where else can they find out more about you? 

Dr. Alan: 

Wherever you buy books, your local bookstore or Amazon. 

DrChristianson.com. That is my main hub for blogs and articles. 

Dr. Eric: 

Wonderful. This was an amazing conversation. Thank you so much, Dr. Alan. It was great chatting with you. 

Dr. Alan: 

Good to be with you, Dr. Eric.

 

Recently, I interviewed Laurie Villarreal, and we discussed her thyroid journey, the role of stress in blood sugar regulation, the benefits of using continuous glucose monitors (CGMs) to track blood sugar levels, how to use heart rate variability (HRV) as a tool for assessing stress, tips for managing blood sugar, and more. If you would prefer to listen to the interview you can access it by Clicking Here.

Dr. Eric Osansky: 

I am excited to chat with Laurie Villareal, as we are going to talk about blood sugar imbalances. I’m really looking forward to this conversation. I’m going to dive right into Laurie’s impressive bio here. 

Laurie Villareal helps high-achieving, mission-driven women regain control of their weight, health, and hormones in midlife, so they can have more energy to pursue their bold goals and active lifestyles without restrictive diets, stacks of supplements, or overhauling their lives. 

Her unique method artfully blends the science of real-time biofeedback with innate body wisdom to help zoom in on the unique triggers and tweaks that support your body in turning down physiological stress to turn up restoration and healing. 

With a client list spanning the globe and over 20 years of experience in the health and wellness space, you may have seen her in publications such as Self Magazine or Thrive Global or sharing the stage with known persons such as Dr. Joe Dispenza or JJ Virgin. 

She is also a national board-certified health coach, functional nutrition provider, and long-time endurance athlete and movement educator turned hormone specialist after being challenged with her own hard-to-solve hormone health issues. Laurie not only understands her clients’ journeys and challenges, but she has been there, too. Welcome, Laurie.  

Laurie Villareal: 

I’m so happy to be here. Thanks for inviting me. Looking forward to this. 

Dr. Eric: 

Same here. This is going to be a great conversation, talking about blood sugar imbalances, continuous glucose monitors (CGMs). I want to talk about your background because you have your own thyroid journey, which led to you focusing on what you help people with now, correct? 

Laurie: 

Yes, that’s exactly right. 

Dr. Eric: 

Let’s go ahead. If you could give a little bit of that story. 

Laurie: 

Sure. It’s probably similar to a lot of people you’ve worked with, maybe even yourself. I struggled for a number of years actually, where I didn’t exactly know what was going on with my health. I was an athlete, an endurance coach, and trainer. At the time, I understood a lot about health, balancing stress, recovery, eating well. I paid attention to all of those things for decades. That was a really important piece of being an endurance athlete.

For two years, I was noticing small, insignificant symptoms at first that eventually became debilitating. It went from me having regular periods for decades to suddenly having uncontrollable periods that I didn’t know what was going on. As an athlete, sometimes I would run for several hours, and I wasn’t able to manage that, that I was bleeding so uncontrollably. 

I wasn’t recovering well from even my easiest workouts. I say I wasn’t recovering well, but I was not recovering. It would take me what felt like weeks sometimes to recover from easy workouts. I needed naps all the time. I was exhausted when I woke up. 

I began having memory issues, where I couldn’t remember an appointment I saw in my calendar only an hour before. I was having debilitating anxiety that I had never experienced before. 

Same story, like a lot of women or men. My doctors said I was fine. There was nothing wrong. Even though previously I was functioning at a very high level, they thought, Oh well, you’re not doing too bad. But I was nowhere near where I was before.

I definitely took this journey of trying to figure things out on my own. That eventually led me to studying functional nutrition. From there, I ended up learning a lot about balancing blood sugar and stress and all the things that you learn in functional nutrition. I had already studied nutrition, so I knew a lot about it. 

Because I had a family history of diabetes, both my dad and my mom had diabetes, I had been very interested in blood sugar since I was a kid. I didn’t want to get diabetes, and I also wanted to help them take better care of themselves and their diabetes, which they were not that interested in doing. Now I know they have got to want it themselves as well. 

I went down this journey of learning a lot about blood sugar. I got really curious for myself the connections that that could have to some of what I was experiencing. Eventually, I figured out it took some time, but I had made some connections that led me to think it was my thyroid. I ended up working with a practitioner who had said yes, it is, but it wasn’t showing up when the doctors were just measuring TSH. They were looking at it more deeply than that.

In addition, because I was so curious about blood sugar, and I had been using blood sugar devices since I was young, I started paying a lot more attention to that, trying to get curious about what was going on with my blood sugar health. 

I started treating my thyroid and figured out I had hypothyroidism. I realized that some of what had been going on with me was related to stress. I should say a lot of what had been going on, that perhaps had led me to that thyroid journey. Certainly, some of these discoveries were the things that helped me unravel my thyroid healing and get better. 

At the time, when I discovered that I did have something going on with my thyroid, I didn’t want to go straight to medication initially. I wanted to figure out what was actually at the root of this. 

Also, I wanted to take care of my body from a more holistic approach, which definitely studying functional nutrition had helped with that. Getting extra curious about the relationship to stress and what was going on with my blood sugar and inflammation and all of those pieces. I took a deep dive in that area. 

Like I said, I had that family history. I really wanted to better understand that piece. That is a big part of what brought me to what I’m doing now.

Dr. Eric: 

When talking about blood sugar, a lot of people are aware of the impact of diet. I don’t think people think enough about the stress, especially with blood sugar. Let’s say if someone is eating a wonderful diet, whole, healthy foods, minimizing refined foods and sugars, or even completely avoiding them, but they’re stressed out all the time, not getting sufficient sleep, can they still have blood sugar dysregulation? Even if they are eating a really good diet? 

Laurie: 

Absolutely. I have experienced it for myself. Not getting quality or the quantity of sleep your body needs to recover can have an impact on your glucose levels. At the same time, stress has a pretty big impact on your blood sugar levels separate from food. 

Also, when you’re eating while you’re stressed, those foods are going to react very differently from when you have a meal when you’re not stressed. Stress definitely is a huge factor when it comes to blood sugar regulation. It’s one of the biggest ones that the women I work with, maybe it’s not the food; maybe it’s something else I have been ignoring for a while or are just not aware of. Sometimes, we are not aware of the stress we have going on in our body.

For me, some of the stress I had in my particular situation, I wasn’t aware of it. 

Dr. Eric: 

It could go beyond emotional stressors. If someone is overtraining or other physical stressors as well. 

Laurie: 

Absolutely. I like to say there are a lot of different stressors, but they all go into the same bucket. Your stress bucket at the end of the day can have stress from all sorts of things, like physical stress, mental stress, emotional stress, and physiological stress, which we often don’t consider, like infections. There could be a lot of things going on that are creating stress in our bodies. We add a little bit more, and it overflows our bucket.

Dr. Eric: 

When I dealt with Graves’, I was underestimating the impact stress had on my health. That, and also overestimating how I handled stress, too. Double whammy there. 

Laurie: 

It’s very common.

Dr. Eric: 

Exactly. Definitely want to talk about measuring blood sugar, blood testing, CGMs. Do you also recommend measuring adrenals? Do you just take the perspective of most people have adrenal issues, so rather than testing, making the assumption that someone has an adrenal problem? 

Laurie: 

I wouldn’t say I make the assumption, but because- I usually just start straight off with the bio sensors and see what those say. We can right away start making tweaks with them. Later on, down the road, sometimes, we look more specifically into the adrenals, say with cortisol testing is what you’re probably talking about.

Usually, with things like a CGM or HRV, we can see already where their stress is at. At least enough to start making some changes. 

I don’t think I’ve ever had anybody who I’ve worked with who was like, “Your stress is fine.” But of course, there can sometimes be things going on that need a closer look, such as through the data with the bio sensors that I like to use. 

We can sometimes see something going on where maybe they have high cortisol in the evenings when it should be low, or they have low cortisol in the morning when it should be high. In this case, I would probably look sooner than later. 

It’s not that I don’t think it’s important to look at the adrenals right away. It’s more that I think it can be just as effective to start working on stress via the bio sensors and then help women start feeling better and get the results versus going to that testing, waiting for the result to come back, and doing it in that path. I just do it the other way around. 

Dr. Eric: 

Okay. We’ll talk about the bio sensors. What are the consequences of having blood sugar imbalances, whether it’s insulin resistance, hypoglycemia, etc.? 

Laurie: 

It can be different for everyone. They show up differently in different bodies. It could look like feeling like you’re on an energy rollercoaster. It could look like being moody and irritable, having brain fog, having cravings, especially for carbs and caffeine. It can look like waking up feeling sluggish, increased stress, feeling less resilient. 

It could show up feeling like you have other things going on with your hormones. In my case, I had really heavy periods. You can notice changes in your menstrual cycles. Maybe you don’t cycle at all. 

It can show up as skin issues. Strangely, that is actually one of the things that women tend to see the most when they work with me on having a blood sugar imbalance. “My skin issues have cleared up after years of struggling with this.” They had just thought this was their new norm. 

Dr. Eric: 

Is it more common for people with blood sugar imbalances to have problems staying asleep than falling asleep? 

Laurie: 

I certainly see the quality of sleep. The more dysregulated the blood sugar, the lower the quality of sleep usually because blood sugar would tend to be less stable at night if it’s less stable during the day. That instability at night creates poor quality sleep. I see that a lot. 

Whether or not the person is getting the right quantity or going to bed easily or waking up easily, that seems to vary. Certainly, I would say if your blood sugar is dysregulated, your sleep quality is not as good as it could be. You’re likely waking up feeling sluggish. 

What I also notice quite often is in the middle of the night, if you have blood sugar instability, blood sugar can tend to dip down low and wake people up. Either dip down low or increase, depending on what they had for dinner or how the rest of their day went. I can also see highs and lows happening that wake people up and disrupt sleep. There could be a lot going on with sleep and blood sugar. You probably see that, too. 

Dr. Eric: 

Yeah, definitely. I see a lot of disrupted sleep or poor sleep quality. 

Let’s talk about diet. You probably would agree that there is no diet that fits everyone perfectly. There probably are some do’s and don’ts that you recommend when it comes to foods that you would eat. Obviously, refined foods and sugars probably would be a no-no. 

Can you talk more about that? Certain foods that you recommend eating and certain foods that you recommend avoiding in general to have healthy blood sugar? 

Laurie: 

It will look different for every person. And a few things we know that are very supportive are whole foods. Whole foods versus processed foods versus highly refined foods, especially when it comes to carbohydrates. Anything that will go in the blood sugar quickly. The more refined, the more processed it is, that is usually the case. It’s going to raise your blood sugar more quickly, which usually leads to a blood sugar crash afterward.

However, we do notice that when you pair your foods in a certain way, when you order your meals in a certain way, you can actually change that up a little bit. Sometimes, it’s not always about the food, but it’s about how you eat the food. 

As I said earlier, even the state of your stress at the moment you’re eating your meal. 

Absolutely, nutrition is important. Also, having fat, fiber, and protein with whatever you’re eating can help quite a bit to stabilize your glucose levels. That would mean, say you’re having an apple. It might be helpful also to have some nuts with that apple. It might even be more helpful to have some nuts before you have that apple. Once the apple is broken down, that can help the glucose release slower in your bloodstream. That can be more supportive.

In addition, usually people discover that there is this carbohydrate tolerance. Fats and proteins are having less of an impact on blood sugar most of the time than, say, carbohydrates. Especially refined ones. They’re all going to react differently in your body depending on how they are prepared, whether they’re raw or baked or blended. All of these things do matter.

In general, if you’re eating a whole food diet, and you’re paying attention to eating fat, fiber, and protein at the same time, you’re eating the rainbow, you’re getting lots of different nutrients that can be supportive for blood sugar health, I notice that to be- In terms of what works for most people, I would say that can be quite helpful in helping stabilize blood sugar.

Dr. Eric: 

You use the CGMs as well? 

Laurie: 

Yes. 

Dr. Eric: 

Can you talk about that? How do you use CGMs to determine what foods people could get away with, not get away with eating- How their body reacts from a blood sugar perspective. Also, tie that into the HRV that you use as well. 

Laurie: 

Just as an example, before I started using these with clients, I was using the prick monitor for years. I was also using CGMs for myself before I started using them with clients about 10 years ago.

 I would also use it on my husband. It was interesting to see. I have diabetes in my family, so I have the genetics for more likely to have blood sugar issues. We can be so different between him and me in how our body reacts to things. We have worn them together for a few months at a time. Dang, you can eat that, and your blood sugar is fine? I don’t get it. 

We really are so different when it comes to how our body responds to foods. It’s not just our body. It can be the environment. There are a lot of things that play in. Inflammation in our body. What we’re exposed to. How we pair and order our foods. 

When we’re able to wear a CGM, we can not only see how those things are influencing our glucose. We’re seeing in real time that you eat an apple, and you see what is happening on the CGM when you eat it. You’re not just seeing it, but you’re also feeling what your body feels like when your blood sugar does this. 

Sometimes, a woman will eat an apple. It will go up to 200. I have seen this recently. They don’t feel so well. Then the next time, they eat an apple with some nuts, and it bumps up to 140 instead. They don’t have that same aftereffect that they had when they ate it on its own. By using a CGM, you can also begin to see what tweaks and tricks can work for you. Do they actually work for you? 

Also, I could say to eat some nuts with your apple. Maybe your blood sugar is still going to spike, and it will still have an impact and create symptoms for you. I like to use it in a way not to say so it’s good and bad to have your blood sugar at certain levels. Yes, certain levels can be more inflammatory. I like to have a specific range that women are in. 

Also, we pay a lot of attention to how that makes you feel when your blood sugar does X. For some, they can have symptoms right away. They feel tired. For some, they feel cravings 30 minutes later. For some, all day long, they have been tired and hungry. For some, it interrupts their sleep. I really get to pay attention to not only what the CGM is saying with your meal, but also how you feel afterwards, how you feel before. 

We also get to learn what your baseline levels are. If your baseline levels are in the healthier zone, or maybe they are in the prediabetes zone, we know more about if you need more adjustments to help you get into that healthier zone. In that case, there might be some more healing protocols that help to heal your body, so it is responding better to your foods, and your baseline levels are coming down to a healthier range. 

It really depends on where the person is at when they start using the CGM. There is so much information that it can give you, such as how well it’s going while you’re sleeping. How are the foods you’re eating throughout the day, especially at night, influencing your blood sugar throughout the night? How is that affecting your sleep? 

Are you waking up feeling recharged? If you’re not, are there some adjustments you can make and notice at the same time how that impacts your glucose levels? Does that help you have better sleep? It’s just about making connections. Does this help you or not? 

I find that I love data. A lot of people I work with love data. It can be really helpful to see it versus just feeling it. 

Dr. Eric: 

That makes sense. For those who are not familiar with CGMs, how do you know what your blood sugar is in the middle of the night? You’re tying it into an app, correct? Then you can look at the app and see the data. Some people say, “I know if I look at it during the day, I can tell. How do I know throughout the day when I’m not looking at it? In the middle of the night?” If you could talk more about the app you use. 

Laurie: 

We used to have the prick monitor. Now there is a CGM that monitors your glucose pretty much 24/7, especially the newest ones that have just come out. Used to be that you’d have eight hours of data, and it would have to connect with an app on your phone or a little reader. Now via Bluetooth, most of them will send the data straight to an app on your phone. From there, you can see continuously over 24 hours what is going on with your glucose levels. You can see it in the middle of the night and in the day. 

For a lot of people, I often recommend at first just to collect the data without thinking too much about it. Let it collect in the background, and you can look at it later. 

When you are looking at it, you are also in this self-editing state. You are seeing it, but you’re also wanting to fix it. When you’re sleeping at night, it can be nice to see the data and see what’s going on.

Dr. Eric: 

I use the CGM for a couple weeks. I didn’t realize when I used it that you have to have it on Bluetooth all the time. If someone is crazy about that, how about the EMFs? Is there a way around that or not really? 

Laurie: 

Yes. I use the Abbott one. Abbott used to have a 2 where you need Bluetooth. Sometimes, you can find the 2; you don’t need the Bluetooth. In that case, you have to scan it every eight hours. You might miss data if you don’t do that. You can do the same thing with the one that has the Bluetooth. I do recommend turning that off at night. 

It does have an alarm. You don’t want the alarm waking you up at night if your glucose is going low. Chances are, if you’re not a diabetic, it won’t be life-threatening. 

You can turn that Bluetooth off. Then you have to turn it back on in the morning, so it can connect and send the data.

If you’re someone who doesn’t like having Bluetooth on, because I don’t, I just turn it on occasionally and let it connect and sync the data and then turn it back off. You don’t have to have the Bluetooth on continuously. It is on the censor. 

Now that you have asked that question, I don’t know a lot about what it’s doing when you have your phone off, but it’s on your arm. I will look into that.  

Dr. Eric: 

Definitely let me know. I’m curious about that. How about HRV? What do you use to mention heart rate variability? I have had other guests talk about it, but in a minute or two, if you could explain what HRV is. 

Laurie: 

HRV is a measurement of your heart. It’s the space in between the beats of your heart and how far apart they are. We want more variability. The more variability there is, the more resilient the body is. The less variability, the more rigid. 

The HRV is a measurement of your nervous system. When we look at HRV, and we see HRV going up or going down, it depends on how you would use the measurement. You can use the measurement in a number of different ways. For example, if every day you are taking a baseline measurement at the same time. 

Usually, if you use a device, it will give you your daily HRV score. You can use that score from day to day to see how well you’re recovering. Are you restored? Is that number going up or down or staying the same? That says a little bit about your stress levels in terms of how well recovered you are. That’s how I use HRV. 

Before I used HRV, I used heart rate. It was also a measurement you can use to see when you wake up the next day, is your heart rate going up, down, or staying the same? If it’s gone up, it’s a sign that your body isn’t as well recovered. If it’s gone down, you’ve recovered a little bit. Of course, it could mean other things. 

If you are just using the measurement for how well recovered you are and what your stress levels are like, HRV can work just as well as heart rate. And it can also show us other things. Everybody will be different in terms of HRV. 

There is the Oura ring. I like it. It’s my personal favorite. There is also Woop. I have that as well. It measures HRV. Even the Apple Watch measures it. They all measure it a little bit differently. 

A device like the Oura ring will show you daytime HRV. You can also see when your HRV is going high. It’s typically a sign that your body is more restored and in a more relaxed state. When it goes low, you tend to be more in the parasympathetic, upregulated, more of a stressed state. We can use HRV if you have access to it throughout the day to see your daytime stress.

I do like it in a similar way that I like the glucose levels throughout the day because it gives us information. Maybe you didn’t recognize when you had that meeting, your HRV was way low. At the same time, your glucose went way high. There was a stress piece involved maybe. That can be interesting.

If nothing else than just telling us about how we’re recovering from day to day, HRV can be quite helpful for that. 

Dr. Eric: 

Did you say Woop? 

Laurie: 

Yes. 

Dr. Eric: 

What is that? I know what the Oura ring is. Is Woop an app? 

Laurie: 

Woop is similar to Oura, except you wear it on your wrist. It doesn’t have a clock or face that you look at. It’s designed for athletes, so you can do heart training with it on and not get it damaged. At least not as easily as your more delicate Apple Watch. 

It does have Bluetooth on the Woop as well. I’m pretty sure you can turn it off. That’s why I like Oura the best because it has airplane mode. 

There is the Woop. There is also Garmin, which has a pretty nice feature with HRV called the Body Battery. For someone who is just starting, it can be easy because it takes the data like HRV and heart rate and sleep and give you an estimate on how well recovered you are the next day. That can be a fun place to start for some people. But I do love the Oura ring the best.

Dr. Eric:

Are those the main two bio sensors you use? 

Laurie: 

I use those two. The other one I love is Heart Math Inner Balance sensor. Have you tried that? 

Dr. Eric: 

Yes, I do use it. I love it as well.  

Laurie: 

You get that real-time data when you’re doing the training to see the impact it’s having. Also, the improvement you’re getting when you continue to do it. 

Dr. Eric: 

All right. Do you rely on the CGM, or do you also look at blood sugar markers, like hemoglobin A1C, fasting insulin? 

Laurie: 

I typically recommend doing a fasting insulin. You could also do a hemoglobin A1C. Why not a fasting glucose. We can pretty much see that in no time using a CGM. The hemoglobin A1C is nice to have if you are going to go down the route of using CGMs. You can see where you start, so it’s a good baseline. After you have been wearing CGMs for a while, it also gives you an estimated HBA1C, which is similar to what you would get if you had the bloodwork done.

I do like fasting insulin levels as well as a baseline. I like to use these to test before and then use the CGM and make adjustments personalized to you as you try to do the work to balance your blood sugar levels and get your baseline levels down if you need to. As you do that, it’s nice to have that to check in on later. How is my insulin now after I have been doing this work? How is my HBA1C now? That can be quite helpful. 

Dr. Eric: 

What would you say the optimal ranges would be for hemoglobin A1C and fasting insulin? 

Laurie: 

As I’m saying this, I always have different numbers in my head. EU and US. I think that’s the same, under 5.1 for hemoglobin A1C. 

Dr. Eric: 

Yes. 

Laurie: 

You’re saying yes, so I must have that correct. 

Dr. Eric: 

Yep. I think 5.6 is the upper limit. If it’s over that, 5.7, you’d consider prediabetic. 

Laurie:

It’s the same EU and US. With fasting insulin, under 7. How about you? 

Dr. Eric:

I would agree. Dr. Mark Hyman says less than 5 for insulin. I’m with you. If someone is a 6 or 6.5, and if hemoglobin A1C is looking good, I think it’s okay. 

I don’t know if you ever see this. Insulin looks good, like insulin might be a 5 or even a 4, and hemoglobin A1C is in the upper end, so it contradicts each other. If hemoglobin A1C is 5.5, 5.6, but their fasting insulin is looking good, I don’t know if you’ve seen that. If so, do you rely more on one or the other in that scenario? 

Laurie: 

Yeah. It’s interesting with fasting insulin because I have also tested insulin throughout the day, and it can vary a lot. This is similar to glucose. 

I get curious when I see that number. Is that really telling me what’s going on in their body throughout the day? HBA1C is an average, so it’s more reliable, I think. That’s why I like to go look at what’s going on on the CGM with glucose levels.

If someone is able to achieve pretty regulated glucose levels, they’re in a healthy range, their baseline is in a healthy range, their insulin is 7, and they have been able to improve tons of symptoms and feel great, I would say that they’re doing all right. If they don’t have anything else going on. I look at that first.

Because of the rise in cortisol in the morning, and probably some other things going on in the morning, women’s blood sugar can be moving up a little bit. The rest of their glucose levels are stable and nice and beautiful and not creating symptoms for the rest of the day. 

I have also experienced where I have ridden my bike to go get my bloodwork done. Different factors will affect it differently. If you’re riding your bike, and maybe you’re a little bit stressed out. You’re quickly riding there through traffic. Your insulin level might look different versus if you were just sitting at home when you woke up that morning. 

I don’t really pay attention to it as much as I do with the CGM. This can give me a lot more information. 

Dr. Eric: 

I’m sure you get a lot of questions about fasting, intermittent fasting. How helpful can intermittent fasting be for someone who has a condition such as insulin resistance, type 2 diabetes? 

Laurie: 

Well, I think fasting can be helpful. And I have also seen it not be helpful. I have experienced that for myself when I was going through that thyroid journey, trying to figure things out. I had gained a bit of weight. I decided I wanted to try fasting. I tried keto. I tried several things. When I noticed that my blood sugar was very dysregulated, it made it even more dysregulated. There was a stress factor going on that I hadn’t quite yet recognized. Those things were creating more stress in my body.

Usually, I recommend it to people when I feel that they have gotten a little bit of a better control over their glucose levels and their stress, so we are not adding more stress. I usually like to use a CGM while they’re doing it, so I can see the impact that it’s having. Is it positive or negative? Fasting too long for women in particular, especially when they’re menstruating, we can see a lot of negative effects on the CGM. 

It’s very personal. The ones that tend to have more success in my experience tend to be the ones who are already on the healthier side in terms of metabolic health.

Maybe because we are on a thyroid podcast here, I’d love to know what you think. Also, I would say for those people who do have a history of thyroid health issues, I would find it much less supportive. How have you experienced that? 

Dr. Eric: 

Like you, I think it depends on the person. I will say I do work with people with Hashimoto’s, but I also work with a lot of people with hyperthyroidism and Graves’. 

When I dealt with Graves’, I lost 42 pounds. I definitely would not have wanted to incorporate intermittent fasting at that time. My adrenals were taxed. There were a number of reasons why I don’t think I would have been a good candidate for intermittent fasting back then.

Yeah, I would say it depends on the person. I do agree that some people do it extremely. I have had people do it on their own, where they are fasting for 20 hours, and they only have a four-hour eating window. The question is first of all, the stress that is putting on their body on a daily basis. Potentially on their thyroid as well. Also, are they getting enough protein? Nutrients overall? 

As far as a 16-8 fast, which is pretty popular, I think it depends on the person. I can’t say that I recommend for most of my patients to fast. If someone is in a good state of health, and they want to do it on a wellness routine, that’s one thing. 

If someone is healing, I can’t say it can’t help with healing. I’ve had Cynthia Thurlow and other fasting experts on the podcast. I’m sure many would say it will help with healing and autoimmunity. There is a time and place for that. 

I think it’s really individualized. It does depend on the person. You bring up a good point with the CGM. Just another way to see from a blood sugar perspective how their body is handling it. 

Laurie: 

HRV can be helpful, too. Is it increasing stress? Is it helping you recover? If it’s not getting better, if HRV is going down, then that’s a sign that healing is not going up. I do look at that as well. 

To your point about nutrition, absolutely. When women are fasting and trying to heal, and they are not getting enough nutrition, they are not getting the nutrients they need for that healing, fasting is not typically working very well. 

Dr. Eric: 

Yes, agreed. Before we wrap this up, one more question that you probably won’t be able to answer. I know you use HRV, but when are they going to come out with a continuous cortisol monitor? 

Laurie: 

I am looking forward to that. I think a continuous insulin monitor would be amazing. I heard recently that’s probably not happening for some reason, which I don’t remember. 

I do not know. That would be amazing. And at the same time, I think we’re getting into a period where these are going to become more available to us. I think it’s very cool actually. 

And I think it’s even better when you can work with a practitioner who really knows how to use these tools. A lot of us have access to HRV and other metrics on their watch, but they don’t know what to do with them or how supportive it can be. It is nice to go down the avenue of learning about it for yourself. 

Wouldn’t that be great if we had a continuous cortisol monitor? 

Dr. Eric: 

Maybe in the near future. It wouldn’t be a shocker with all the technology they have coming out. Stay tuned, I guess. 

For those who are looking to learn even more about balancing blood sugar, how to use CGMs, HRV, where can they find out more about you, Laurie? 

Laurie: 

My recommendation would be to take one of my quizzes. You can easily get to my site by typing in YourHormoneQuiz.com. Even better, YourBloodSugarQuiz.com. This conversation is about blood sugar. You might want to check out how your blood sugar is doing. Take the quiz, and you will get on my mailing list. You will get all of the details on how you can stay in touch.

You could also visit me at YourBetterBalancedBlueprint.com. You can find me there as well. 

Dr. Eric: 

Thank you so much. I’ve had other people talk about blood sugar, but this is the most we’ve gone in depth with regards to the CGM. It was great tying it into the HRV as well. This was a wonderful conversation. Appreciate you being on the show. 

Laurie: 

Thank you so much. Lovely being here. Wishing you and your audience all the best.

Dr. Eric: 

Thanks! Same to you, Laurie. 

 

Recently, I interviewed Stacy, and we discussed her diagnosis, the symptoms she continues to deal with, why she opted for a natural treatment approach, her dietary and stress management practices, the need for comprehensive functional testing, 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 with Stacy from Ohio. Thank you so much for joining us, Stacy. 

Stacy: 

Thank you for having me.

Dr. Eric: 

I’m looking forward to the conversation. Stacy has been dealing with Graves’ Disease. How long have you been dealing with Graves’? 

Stacy: 

I was diagnosed in March 2022. 

Dr. Eric: 

Have you taken any antithyroid medication since then? 

Stacy: 

I went the natural route, so I have done everything naturally. Just some herbal medicines. 

Dr. Eric: 

Similar to what I did. 

Stacy: 

Yeah. 

Dr. Eric: 

How did you find me? I think you’ve read both of my books? 

Stacy: 

Yes. When I was diagnosed, I did a search for Graves’ and found your book. That is actually what inspired me to treat my Graves’ naturally. I started researching what can I do, and that’s what inspired my journey to go this route. 

Dr. Eric: 

Wonderful. Any family history of Graves’ or any other autoimmune conditions? 

Stacy: 

Graves’, no. My mom does have the opposite as me. She has low thyroid. It does run in the family for thyroid. 

Dr. Eric: 

Okay. What are some of the common symptoms that you’re currently experiencing? 

Stacy: 

A lot of the symptoms in the beginning, those have subsided. I am still experiencing a little bit of heart rate. It will drop down into the 50s, and it will spike anywhere up to 150. That’s just from walking. The heart palpitations go along with that. Tired all the time. Insomnia. I can get out of breath just from walking every now and then. 

I feel a lot better, but with that, I started getting some bloating issues. I don’t know if it’s all related. Some symptoms have gotten better, and I have gotten some new symptoms. 

Dr. Eric: 

Some symptoms have improved; some other symptoms have come on. When was the last time you had a thyroid panel? 

Stacy: 

June. I had TSH, T3, and T4 tested. 

Dr. Eric: 

Did it show you were still hyper? 

Stacy: 

No. What is considered normal but not optimal. My TSH dropped; it is going back down. My T3 and T4 are going up. It wasn’t enough to cause alarm basically. 

Dr. Eric: 

This was a few months ago in June. 

Stacy: 

Yes. 

Dr. Eric: 

It sounds like the herbs are helping. Still not optimal in experiencing some of those symptoms you mentioned, like increased heart rate, fatigue, insomnia, out of breath, some bloating. Not all those necessarily relate to elevation in thyroid hormone. 

You’re taking specifically bugleweed and motherwort? 

Stacy: 

It’s been quite a while since I came off of that. Once my thyroid levels got back into the normal range, I came off of that. One of the ingredients was melissa. There is a whole bunch of other ingredients that I can’t read the names of. 

Dr. Eric: 

Lemon balm, it sounds like. Did it seem like it was helping? 

Stacy: 

Pretty quickly, from the initial, the TSH, which I guess is always the last to improve. My T3 and T4 almost immediately started to go down. 

Dr. Eric: 

How about antibodies? It sounds like you didn’t test them last time. But have you tested them in the past? 

Stacy: 

No. In the beginning, it was odd because my antibodies- I was only tested for TPO antibodies. Initially, I was diagnosed with Hashimoto’s. Then it was determined that I actually had Graves’. I was misdiagnosed, I guess. They were 321. I wasn’t tested again until almost a year later. They actually increased to 631. I’m not sure why the jump. It doesn’t seem to be as much of a concern. It is for me. 

Dr. Eric: 

The doctors usually don’t pay much attention to that. It sounds like you didn’t have the Graves’ antibodies tested. They diagnosed you with Graves’ based on the hyperthyroidism and having the TPO antibodies. Assuming if you had one auto antibody that you probably had the other one, but they didn’t test the other one. 

Any eye symptoms? Any symptoms of thyroid eye disease?  

Stacy: 

No eye symptoms. I actually asked my eye doctor because I visit every year. He said everything is great. My vision is actually improving. I’ll have an eye twitch every now and then, but I think that’s more along the lines of cortisol related. That is the only thing with the eye that I notice. 

Dr. Eric: 

Okay. How would you like your health to be 6-12 months from now, if you could paint a perfect picture? 

Stacy: 

Well, I guess I’ve never really paid much attention to my heart rate before until I was diagnosed. I could tell a difference when it varies, when it jumps. I guess it’s stable, my heart rate.

One thing I didn’t mention, in the beginning, I had gained over 30 pounds before I was diagnosed. I was one of the ones that didn’t lose weight during the Graves’ diagnosis. Having difficulty losing weight. I would like to be able to get that weight off, get my heart rate under control, and finally be able to sleep through the night and not be tired all the time. 

Dr. Eric: 

Those are of course really good goals to have. 

Stacy: 

Yes. 

Dr. Eric: 

In your opinion, what is the #1 thing preventing you from restoring your health? Is there a potential roadblock? 

Stacy: 

Not that I’m aware of. I do clean eating. I exercise. I’m at a loss as to what’s causing the symptoms. 

Dr. Eric: 

Let’s talk a bit about eating. Have you followed an AIP diet in the past? 

Stacy: 

Initially, when I first was diagnosed, I immediately went gluten-free and dairy-free. Then once I met with my doctor, he had me follow the blood type diet. Kind of similar to AIP, but I would call it more restrictive in the sense that there is a lot more things that you have to eliminate based on your blood type. 

Dr. Eric:

Are you still following that diet? 

Stacy: 

Yes. 

Dr. Eric: 

Diet isn’t everything. Obviously, it’s important, or else I wouldn’t have written an entire book on it, The Hyperthyroid Healing Diet. But that being said, there are some differences between the blood type diet. It depends on your blood type. There are different variations. There are some foods that are allowed on a blood type diet that might not be allowed on an AIP diet, and vice versa. We are going to talk about some testing and see what you might have done. 

If your diet hasn’t been working for you, not to say that it’s not offering any benefits, but there is still some work to do. It might be worth at least attempting for a month or two an AIP diet.

I wouldn’t combine the two; it would be too restrictive to combine an AIP diet with a blood type diet. You could try to do that, but I would probably recommend not doing that. Maybe just take a break from the blood type diet, follow an AIP diet for a few months ideally and see. 

You very well might need to go beyond that. Even in The Hyperthyroid Healing Diet, I focus a lot on diet, but there is a lot more than just diet that I talk about. 

This leads us to the next topic: stress. How has stress been over the last couple years? 

Stacy: 

Stress was actually probably one of my main triggers that brought the Graves’ on. I’ve done really well as far as management of my stress. I was in a pretty toxic work environment. I have since gotten a new job. Much less stress on day-to-day things. I don’t notice myself being stressed, but I very well could be, and it’s just not compared to what it used to be.

Dr. Eric: 

It sounds like it’s definitely better than it has been. Maybe there are some stressors you’re not aware of. Without question, it sounds like it’s improved. 

How about sleep? You’re experiencing insomnia. How long has that been going on? 

Stacy:

I noticed it come on after the diagnosis. It would get better. I’ll wake up at maybe 2am or 3am, sometimes 4am. It takes me a long time to get to sleep. It’s not as bad as it used to be. There were times I couldn’t sleep at all. It has improved, but I still wake up and feel exhausted. Definitely an improvement from where I was two years ago, but still not where I’d like to be.

Dr. Eric: 

Getting back to the blood type diet. Was that recommended by a natural health care practitioner? 

Stacy: 

Yes. 

Dr. Eric: 

You have been working with a functional medicine practitioner. Have you done comprehensive blood testing or just the thyroid panel? 

Stacy: 

Yes. I do get comprehensive blood testing done every year. 

Dr. Eric: 

You’ve done Vitamin D? Iron panel? Blood sugar markers, like hemoglobin A1C? I don’t know if you’ve done fasting insulin. Has everything looked good, or has anything been out of balance that’s significant? 

Stacy: 

Yes, I’ve done all of those. Nothing I can think of. Several years ago, my Vitamin D was very low. I’m thinking it was 17. I got it up. I think it was 80 this past time. I just had it done in March. I brought that up significantly. That’s the only thing I can think of that stood out.

Dr. Eric: 

You’re in northern Ohio, so you probably need some Vitamin D supplementation, especially in the fall and winter months. 

Stacy: 

Yes. 

Dr. Eric: 

Vitamin D recently looked good, and the other markers looked okay. Hopefully, they paid attention to optimal ranges. For example, iron saturation, if that’s on the lower side but within range, some doctors won’t really pay attention unless it’s out of range. Hemoglobin A1C, if it’s on the upper end, some won’t say anything unless it’s above the range, and someone is in the prediabetic- Hopefully, being a functional medicine practitioner, they will focus on the optimal ranges.

Has the practitioner done any other types of testing? Any functional medicine testing, like adrenal testing or gut microbiome or anything like that? 

Stacy: 

I’m supposed to be getting the DUTCH test, but we were waiting. I’m just coming off of birth control from being on it well over 20 years. He wanted to wait until I was off of it for a good four months, just to get a better reading. I think that includes the adrenals. 

Dr. Eric: 

Wonderful. Yeah. Diet-wise, we spoke about maybe giving AIP a try. 

Stress management, even if you feel stress isn’t a factor, if you’re not doing so, I would always block out time for stress management. 

Sleep is important, but the question is why are you having the sleep issue? Obviously, it’s not that you don’t want to get more sleep. It is better than it was a couple years ago, but still not where it used to be. 

The DUTCH test might show some things like having high cortisol. Low cortisol in the morning could also be a factor with adrenals. That looks at the sex hormones. It gives a lot of good information. Looks at melatonin, the DUTCH complete. If your melatonin is low, maybe you need that. A lot of people just take melatonin. If you don’t have a melatonin deficiency, typically melatonin won’t help with sleep. That’s a good test to do. 

It will also look at the B vitamins. Birth control can deplete those vitamins. It looks at the metabolite for B12 and the metabolites related to B6. That’s great you’re doing that test. 

You also said you experienced some bloating. Is it when eating certain foods or just randomly? 

Stacy: 

After my cycle, for an entire two weeks. Two weeks out of the month, I am bloated every day. After that, I’m fine. This started probably about three or four months ago. This was prior to coming off of the pill. I’m not sure what’s related to this, if it’s thyroid, gut, or something else. It’s definitely becoming an issue. 

Dr. Eric: 

Probably not directly the thyroid. Maybe the hormones. We’ll see what the DUTCH test looks like. Gut might be worth looking into. Another thing to consider, when I dealt with Graves’, I had the opposite problem of losing a lot of weight. Some people don’t lose a lot of weight, like you gained weight and didn’t take any antithyroid medication. Obviously, it wasn’t due to that. 

We need to look into other factors. Adrenals could be a factor. The sex hormones. The DUTCH test looks at the metabolism of estrogen, which could also relate to weight gain. inflammation overall. 

I can’t say I do gut testing on every single person. With a lot of your symptoms, it’s fair to do the DUTCH test first, but maybe if you’re not getting all the answers you need with that test and switching to an AIP diet, that might be another good test to look into, doing a comprehensive stool test, like a GI Map or GI Effects or something similar to see if you have imbalances. You need to have a healthy gut to have a healthy immune system. 

Also, if your doctor isn’t going to do it, at least on your own, I would test the TSI, just to get a number on that and see what that is looking like. When we have Graves’, that should be elevated. TPO antibodies sometimes will fluctuate. It has a greater tendency to rollercoaster back and forth. You said yours increased to 631, which is a pretty big jump going from the 300s. Definitely keep an eye. 

The TSIs sometimes will do that. Usually, you will see a more consistent decrease when things are heading in the right direction. If things are not heading in the right direction with either of the antibodies, or ideally both because long-term you want both of them to be normal, that tells us that something is missing. 

I do have an episode on the podcast, Episode #150, on lowering thyroid antibodies. I have a series of episodes that I’ll be coming out with. By the time this interview is live, it might already be out. I will have more episodes on antibodies because it is a hot topic. You read my book, so I talk about them in the book. A lot of what I mention in both books will help with antibodies. 

There’s diet. I always will recommend stress management. Get the TSIs tested. If you’re doing everything from a diet and lifestyle perspective, it can be helpful. You’re already doing the DUTCH test. Maybe a comprehensive stool test, based on the results of the DUTCH test. 

I’m sure you will be given recommendations from the ordering doctor. If things head in the right direction, great. If you’re losing weight, sleeping better, awesome. If not, then that’s when you might- That’s a challenge. If you do testing, and if things don’t go in the right direction, the question is to do more testing, or are there imbalances that were found then corrected? 

If you did a DUTCH test, and there were a lot of findings, you focus on those findings for a few months, and things don’t move in the right direction. We could say let’s do a comprehensive stool test. But I guess you could also say maybe to do a DUTCH retest, depending on what it shows. That’s what the functional medicine doctor you’re working with should guide you on. 

If you have problems with estrogen metabolism, a lot of times, that’s coming from the gut. It’s one of those things where maybe doing a stool test is a good idea. Maybe you don’t have to do it. Maybe you get the answers with the DUTCH test. 

I’m sure you knew what I was going to say because you have read my books and have been following me for a while. Still, I read the book on the blood type diet a long time ago. I say this in the book, too. I will be biased with the diets I recommend. I even say in the book that there is no one diet that fits everyone, which is why there are multiple diets in the book. If any diet is not working, in your case, the blood type diet, makes sense to switch to another diet and give that a try. I think there is a good chance you will have to go beyond the diet.

I’m glad to hear you are doing the DUTCH test. I hope that gives good information. It’s one of those catch 22s. You are spending the money because you want answers. You don’t want it to look really bad, but you want to have findings that you could correct. Hopefully, you do the test and get some good answers that the doctor will give advice based on that will hopefully help with your insomnia, weight gain, and energy levels. If not, you might need to dig deeper than that. 

Stacy: 

Yeah. All right. 

Dr. Eric: 

Well, thank you so much for agreeing to do this audit. It was great having this conversation. Thank you for reading my books. I really appreciate that. I hope everybody listening to this found this to be valuable. Look forward to catching everyone in the next episode. Take care, Stacy. 

Stacy: 

Thank you. You, too.