Recently I interviewed Jodi Cohen, as we chatted about essential oils, and below is the written transcript. If you would prefer to listen the interview you can access it by Clicking Here:

Dr. Eric Osansky:                                                                         

With me here, I have Jodi Sternoff Cohen, who is a best-selling author, award-winning journalist, functional practitioner, and founder of Vibrant Blue Oils, where she has combined her training in nutritional therapy and aromatherapy to create unique proprietary blends of organic and well-crafted essential oils. She has helped over 50,000 clients heal from brain-related challenges, including anxiety, insomnia, and autoimmunity. For the past 10 years, she has lectured at wellness centers, conferences, and corporations on brain health, essential oils, stress, and detoxification. She has been seen in The New York Times, Wellness Mama, Elephant Journal, and numerous publications. Her website is VibrantBlueOils.com. This is visited by over 300,000 natural health seekers every year. She has rapidly become a top resource for essential oil education on the internet today.

Wow. Very impressive credentials, Jodi. Thanks for joining me.

Jodi Cohen:

Oh my gosh. Always a pleasure. It’s fun to talk to you.

Dr. Eric:

Why don’t we start out by talking about your backstory? How and why did you start Vibrant Blue Oils?

Jodi:

Necessity is the mother of invention. My nutrition story really started with my second child. My first child was really easy, and I just assumed I was this great mom. I had another one 22 months later. My second one was more challenging. He had very little impulse control. We used to try to cue him by touching our nose, saying, “Look at my nose.” He was all over the place. I was taking every parenting class I could find, reading every parenting book. Nothing really helped.

One day, we were at a birthday party, and a friend of mine noticed that he was behaving really well and complimented me. The next thing we knew, another mom handed out a snack, like a Ritz cracker or something. My son literally ate the cracker and Jekyll/Hyded and took off running in the opposite direction. After I sprinted after him, grabbed him, and brought him back, my friend said, “Gosh, I’ve never seen him shift like that after eating something. My brother was on Ritalin his whole life, and it turns out he was just allergic to weird foods. You should take him to a nutritionist.” I thought, that’s easy. I’ve done everything else.

Took him to a nutritionist. The nutritionist basically said he was super sensitive to excitotoxins and of course corn, soy, and dairy, pretty much everything in that Ritz cracker. When we changed his diet, the next day he could look at our nose. He was an entirely different child. I was so blown away by the difference food could make that I went back and got a degree in nutrition and was trying to help other moms with the kids. I lived in Seattle, Washington near Bastyr University, so I had access to all these great Bastyr practitioners. I learned this technique called muscle testing that I found super helpful for assessing wiggly children.

It later turned out to be very helpful when my own rock bottom hit. My then-husband was so depressed that we had to move him into a residential treatment facility. Once I knew he was safe, and it wasn’t my job to keep him safe, it was like I could finally tap out of the marathon. I had no energy. My adrenals were kaput. I could barely get out of bed. The kids were five and seven. I would get up with them, make them breakfast, pack their lunch, take them to school, come home, climb back in bed, and set the alarm for pickup. I knew enough to know it was my adrenals, that I should be taking glandulars, that I was taking adaptogenic herbs. Basically, everything I was ingesting did nothing.

A friend of mine who I had helped with a fundraiser had been planning to give me a box of essential oils as a thank-you gift. She showed up and said, “You know, you have been so high stress,” which means high cortisol, “that I bet you’re systemically inflamed. I bet everything you’re ingesting isn’t getting assimilated and absorbed. Oils are a nice roundabout way to get things in your system because you can smell them and get them in through the olfactory channel. You can topically apply them and get them through the skin. This might help.”

For anyone who has felt like nothing they’re trying really works, and they have that moment of hopelessness and despair, like, “Nothing will help me, this might be my new forever,” and then someone says, “Maybe this will work,” you’re like, “Throw me any rope. I’ll try it.” I muscle tested the box to see if anything in there would help my adrenals. I was really encouraged because I got a very strong yes.

What I typically do is dig further to see what kind of remedy is going to be supportive. I kept getting the same five oils, which threw me initially because I normally get one or two. Then it occurred to me that they are fluid, liquid. I can combine them. I decided to test each one, five drops of this, seven drops of that. Pulled a shot glass out of my kitchen. Mixed them. Put them over my adrenals on my lower back. Felt like myself. It was like a reset button had been pushed. I could go running. I could go to the supermarket. I could do laundry. All those things that felt like too much for the past month, I was finally able to tackle.

I just kept making up other remedies. When I felt better, my friends in the health community were like, “What did you do? We want to try it.” It was testing for their clients, testing for everyone. They kept saying, “You should do something with this.” I originally thought, Gosh, it’s so obvious. Someone must be doing this.

I finally felt like I had enough of my wherewithal to go online and research what was out there. I was very surprised by two things. The first being that no one was really looking at blends to support different organ systems and regions of the brain.

The second was that they made it seem really complicated. If I had had my wits about me and started with research, I never would have blended essential oils because I would have felt completely unqualified. That was kind of the impetus. I tripped into something that helped me personally and seemed to help other people. Once I knew that, it felt helpful just to put it out there.

Dr. Eric:

Wonderful. Thank you for sharing that. Can you talk about some of the different applications of essential oils, like topical versus aromatherapy? Are there different indications for each one? Do you have a preference?

Jodi:

I definitely have a preference. The easiest way to use an oil is to unscrew the top of a bottle and smell it right under your nose. It goes directly into your system. It’s really accessible. I know a lot of people talk about diffusing, and that’s because you literally burn through it a lot faster. But it’s also wasteful because you only need that little bit below your nose for maybe 10 seconds. To fill a whole room with it, a lot of it is going to waste.

There is also topical application. What I do is use specific acupuncture points, like reflex points, to apply it. One of the things that people talk about is there is a localized effect. You hurt your wrist, and you put an inflammatory cream on it, and it helps your wrist. That’s localized. It doesn’t necessarily help your back, but it doesn’t matter. People assume a topical application of essential oils, if you hurt your wrist and are putting an anti-inflammatory oil on your wrist, yes, it will help your wrist. If you are putting it on an acupuncture point or a reflex point, it can help systemically. People dismiss topical application. They assume it needs to get through the skin into the bloodstream and get carried to the liver, and then get pumped from the heart through the body. That takes too long. So it’s faster to drink it or inhale it. But when you’re using acupuncture points, it actually sends a signal immediately. That’s what I try to do and how I’m different than other essential oil companies or practitioners.

Dr. Eric:

Hmm, that’s pretty interesting. My followers are those with thyroid and autoimmune thyroid conditions. I know that some essential oil experts talk about myrrh and frankincense and rubbing the essential oils on the thyroid gland after diluting it with carrier oil.

Jodi:

You can do that. That won’t hurt you. But the way I look at it is there is always things that are going astray under the surface. The way I look at it with thyroid is it’s a combination of stress, gut issues, and detoxification challenges because that then throws off the endocrine system, which throws off your thyroid. What I am trying to do is return those systems to balance through the application of topical remedy often in combination with diet, lifestyle, supplements, and other things. We are trying to make sure the garbage leaves your body, so it doesn’t get recirculated and cause stress on the liver and then throw off thyroid functions.

We are trying to ensure that your hypothalamus adrenal pituitary access is not overfunctioning and throwing off your hypothalamus so then the signals to the thyroid are getting confused. We are also trying to ensure that you’re able to digest, absorb, and assimilate all of your nutrients that are the precursors and building blocks to your thyroid signaling mechanisms.

Dr. Eric:

If I understand you correctly, the priority wouldn’t be reducing inflammation, but more addressing underlying causes and imbalances, using essential oils to support the gut, support the liver, reduce your toxic load, support adrenals.

Jodi:

Yes. I mean, it won’t hurt you to put frankincense and myrrh on your thyroid. To me, that’s teaching someone to tread water as opposed to helping them swim ashore.

Dr. Eric:

Makes sense. You have a history of Hashimoto’s as well, correct?

Jodi:

Yes, it’s pretty much in remission. it’s been going steadily down over time. I love Izabella Wentz and her stuff. Basically, oils are great. It’s like if someone wants to lose weight, I think of exercising or dieting. Do both. The more you can throw at whatever is out of balance, the easier it is to return to balance. Definitely they should be working with you. They should be changing their lifestyle, their diet, add in some supplements, and you can also use oils to hit it from a different angle.

Dr. Eric:

It’s great to hear you say that. You’re encouraging people to use essential oils but not in isolation. In combination with eating well, stress management, other supplements may also be necessary. Of course, I would expect that answer. But one question that I did have is if you use essential oils as a substitute for other supplements. It sounds like the answer is no, that you use them in combination.

Jodi:

I’ll give you an example. We have an oil that I call Parasympathetic. We put it behind the earlobe on the mastoid bone. It stimulates the parasympathetic nervous system, which is the nervous system that controls your whole digestive cascade. If you’re eating in a parasympathetic state of the nervous system, you’re better able to digest, absorb, and assimilate your nutrients and supplements. If you’re taking a gram of nature throid, and you’re stressed out all the time, what actually gets assimilated might be less. You might need a higher dose. If you are able to digest, absorb, and assimilate all of your nutrients and supplements, it’s possible that you can over time work down in dosage, just because you’re getting more from what you’re ingesting. I always tell people to work with a doctor. This is not a do it yourself guessing game.

Dr. Eric:

Definitely makes sense. You mentioned the parasympathetic nervous system. Can you talk more about the role of the vagus nerve, not only when it comes to digestion, but anxiety, and what essential oils you would recommend in those cases? Obviously, it depends upon the person probably, but some general ones you commonly recommend.

Jodi:

Backing up. Your autonomic nervous system controls your autonomic functions: your breathing, heart rate, digestion, detoxification. All of the things that the body does automatically that you don’t need to think about. It’s really designed to keep you alive. It has different gears, different speeds, kind of like in your car, you can accelerate, or you can slow down. If there is any kind of danger, we use the example of the lion chasing us down the street. I don’t see that many lions on my street in Seattle, but I do see a lot of people who watch the news and get nervous. Or maybe see something on social media, and they feel fearful.

When we’re feeling like our survival is at stake, our nervous system prioritizes resources differently. It activates what’s known as the sympathetic branch of the nervous system, or the fight or flight branch. Blood flow for example is routed away from your core, your organs of digestion and detoxification to your arms and limbs, so you can fight or flee.

Your eyesight changes. You can look at people’s pupils, the black part of their eyes. If they’re in sympathetic fight or flight, that black part is much bigger, like a saucer. That allows you to take in more light. It’s called selective attention. If you are trying to escape danger or fight danger, you do not need to contemplate the history of the universe. That might paralyze you because you are overwhelmed with options. You just need to focus in on those immediate choices, so your pupils get really big.

If you have anyone in your life who tends to be anxious, and you are trying to have an important conversation, check their pupil size. If they’re big, they’re not going to hear you because they can’t take that information in. When my kids were little, one of the preschool teachers said, “Connect before you correct,” meaning that if you are at the playground, and he throws something in the sandbox, don’t yell at him in the sandbox. Scoop him up, move him to a different part of the playground, let him calm down, make sure the pupils are small, and then say, “Hey, this is a friendly place. If we can’t be friendly, we can’t be here.” Then they can hear you.

Anyway, when you are in sympathetic fight or flight, you are not able to heal. That is not helpful to your thyroid. What you want to do is gearshift into parasympathetic, where you can rest, repair, and regenerate. The gearshift between these two branches of your nervous system is the vagus nerve. It is the longest nerve in the body that most people have never heard of. Cranial nerve #10 starts in the very back of the head. It connects the brain to the body, body to the brain. It splits and is most accessible right behind the earlobe on both sides. It winds around both sides. It then winds through the throat, the heart, the lungs. Any point the vagus nerve touches can be used to stimulate or shift gears and turn on parasympathetic. This is why deep breathing is so helpful. This is why yoga is great. You’re stimulating the vagus nerve.

Early in my oil journey, I had read some research that bergamot is great for calming the nervous system. People think of lavender. I was playing with how to activate my parasympathetic nervous system. I was getting mediocre results. When you go on a diet and you lose one pound, you didn’t gain weight, but it’s not great. I started digging into the research and coming upon a vagus nerve stimulation strategy. There was one practitioner, a neuroscientist out of New York, called Kevin Tracey, who was actually surgically implanting pacemaker-like devices behind the ear lobe on the mastoid bone. It was two surgeries, one behind the earlobe and one in the neck for the battery. He was having amazing success stimulating the vagus nerve, turning on parasympathetic. The FDA actually approved this for epilepsy, depression, and migraines.

When I heard stimulate, it was almost like a light bulb went on, like Oh, I don’t sedate, I stimulate. It’s not that you need to calm the vagus nerve with lavender or chamomile. You need to stimulate it. Listeners may know there are several oils that are stimulatory or hot, like peppermint, oregano, rosemary, thyme, cinnamon, clove. Things that if you were to put a little bit on your skin, your skin might feel warm. It might look a little red. If this happens, you do not want to put water on it. Oil and water don’t mix. You would take another oil, anything in your house. It could be vegetable oil, coconut oil, and dilute with that other oil on top, and it will make it less red, less burning.

When I started thinking, Oh, I’m stimulating the vagus nerve, then I started playing with different stimulatory oils. Clove tested the best. But there is a little bit of chemistry that goes into oil combining. Clove has medium-sized molecules. From the time when you apply it to when it actually gets through the skin, 10-15 minutes. Lime or other citrus oils have super small molecules, so they get in much quicker. When you combine clove and lime, it’s kind of like combining a really good athlete and a really smart person, and you get an athletic, smart person. You’re getting this stimulatory, fast-acting blend that you can then apply behind the earlobe on the mastoid bone, and it works like an acupuncture needle. It helps you stimulate the vagus nerve to activate the parasympathetic nervous system.

Dr. Eric:

Thanks for that explanation. How frequently would someone apply it? If they are feeling anxious, that would be an ideal time to apply it. Let’s say they apply it in the morning, and then it returns. Would they do it again later that day? Or is it once a day?

Jodi:

When people start with me, I am trying to make it as easy as possible. If you can link a new habit to an old one, it’s easier to remember. How many of us have piles of supplements that we just never remember to take? For people who are starting out, leave it by your toothbrush. Put it on when you brush your teeth. Then they will remember. They will notice, when I use this, I feel better. Honestly, when you can perceive the benefit, you do it. For anyone who is on thyroid medication, when I forget to take it, I am sleepy during the day. All of you who are on thyroid medication remember to take it because you see the benefit.

To answer your question, I know people who carry it in their purse. They keep one in the car. I had one woman who said it’s what gets her through election night. She was putting it on literally every four minutes. Better that than maybe drinking an entire bottle of wine. It’s adding salt to your food. Use as needed. But if you’re starting out, give yourself a break. Make it as easy as possible so you can set yourself up for success.

Dr. Eric:

Also, as far as the points of application, you mentioned the acupressure points. For example, with the vagus nerve, they would rub it behind the ear. When other people say rubbing essential oils on the feet, are they using acupressure points then?

Jodi:

Yeah. The feet are wonderful points of application for a number of reasons. Some people either are sensitive to smell, or they’re married to someone who is. When you put things on your feet, you can cover them with socks. It’s not as smelly for the other people in your life. There are tons of acupressure points on the feet. Also, the skin on the feet is a little bit thicker, so those hot oils that I mentioned, some of them are good for anti-microbial, anti-bacterial things, like thyme and oregano. Putting it on the bottom of the feet, it doesn’t feel warm. It’s a great application point for younger children who might be squirmy. You can put things on their feet while they’re sleeping. I have a whole list on my website of where they are. It’s wonderful for a variety of reasons.

Dr. Eric:

Can you also give a few essential oils for liver health? You were talking about the importance of liver and detox.

Jodi:

We have two liver blends. Emotions can play a role in your health because- What oils are particularly good at are moving stagnation. When things sit stagnant for too long, that’s when problems occur. Think of the pond where all the water is stagnant, and things start to grow. In terms of actual physical liver health, like grapefruit is good, helichrysum is good. We have a liver blend that combines things in interesting ways.

For emotional health, blue tansy is really good. The liver is where we stuff our anger. For so many of us, we’re good girls, we’re pleasers, we want to make everyone happy. Sometimes that means we do all of this, and it’s either unappreciated, or someone changes the plan. What do we do with our anger? We don’t get mad at people; we stuff it, and we don’t necessarily know how to release it. Blue tansy is a great way to let things go so that we don’t carry them anymore.

When you think of the trail that the garbage follows from the cell to the toilet, it goes from the cell to the lymph to the blood to the liver to the gallbladder to the gut to the toilet. At any point along that process, it can get stuck and stagnant. Oils really help move fluids. Like in the plants. The water is down in the ground in the root. The leaves can be hundreds of feet in the air. They help keep things moving.

Lymph congestion is common around the thyroid, around the neck. There is a lot going on in the neck. A lot can be bottlenecked and stagnant. Castor oil is fabulous. The mint oils. Spearmint tests better than peppermint. We have a lymph blend. Anything you can do to help things move along the neck. Even just using your fingers to press downward. Lymph drains 75% more on the left side. The clavicle is a bottleneck. Just gently massaging that area. All of these things help to make sure that the garbage leaves your body and doesn’t hang out by the thyroid and cause problems.

Dr. Eric:

Are there any other essential oils that are your favorites that you haven’t mentioned?

Jodi:

Rose is a really good one, especially when you are feeling like you need a little bit more hope or joy. Or if you are experiencing any kind of grief or loss. I had a major loss, and I would wake up in the middle of the night and almost feel like I was having a heart attack because the emotional pain in my heart was so intense. Applying rose oil over the heart really helped. It’s like when you have a charley horse, and you get up and step down, and all of a sudden, the spasming stops. Rose can really help with intense pain and grief and loss.

Dr. Eric:

When talking about the application, you’re usually using one or two drops per essential oil.

Jodi:

Yes. Less is more. You don’t need a ton. When you’re cooking and putting Tabasco sauce in, you’re not going to dump the whole bottle. More is not better. A little bit goes a long way.

Dr. Eric:

How about for candida overgrowth? Oregano? Which oils would you recommend?

Jodi:

Candida serves a purpose. It helps to absorb heavy metals. I encourage people to work with a practitioner because if you’re just getting rid of the candida, and you’re mobilizing the metals, you will have another problem. You want to make sure you’re taking some kind of binder.

Yeah, oregano can be good. Thyme can be good. Lemongrass is good. We have an article that details the good candida. Most people don’t realize that it’s not just a problem. It’s usually growing to protect you from other things. Be careful just eradicating it without making sure you’re mopping up the metals in the process.

Dr. Eric:

All right. Let’s talk about choosing quality essential oils. There are a lot of different companies out there. Like anything else, herbs and supplements, not all essential oils are created equally, correct?

Jodi:

That’s kind of what the marketing speak is. I think that there is a lot of fear-based marketing that I don’t like to play into. Anyone who has ever grown an herb garden, it’s hard to kill mint and lavender. What I would say is when you can, buy organic because they are the concentrated essences of plants. If you are concentrating pesticides, or even things that are grown in metallic soil, that’s not ideal. But I don’t want to terrify people from stepping into it.

If you are new to this and you have never played with oils, honestly go to your health food stores and smell, and see which ones you like. Pick one. Orange is a very affordable oil that smells really good to a lot of people. It’s good for focus and mood. Just try it.

You can add it to your bath. I love Epsom salt baths, which are also good for the liver. I use Mark Hyman’s recipe of two cups of Epsom salt, one cup of baking soda. Since the pandemic started, I have been putting in a lot of borax since that seems to help the immune system. I use the bathtub like a mixing bowl. I use one or two drops of lavender and stir it into the salt before I add the hot water. Make it as warm as you can tolerate. Stay in as long as you can tolerate. It helps to use your skin as a detox pathway so that it lessens the burden on the liver.

Dr. Eric:

How about oral health? Would you recommend oil pulling? I do oil pulling; I don’t add essential oils admittedly. I just swish it with coconut oil, but I have heard where some would say to add some essential oils.

Jodi:

Yeah, I do that. Katie Spears of Wellness Mama has a really good oil pulling recipe. I think she uses a cup of coconut oil, 30 drops of peppermint oil, and she puts them in those candy trays in the fridge and lets them cool so they become almost candy-like. It makes it really easy. I have tried different oils. Sesame oil is recommended. Some of them taste not great. You don’t necessarily want to keep it in your mouth for that long. Adding a little bit of peppermint. You can also use cinnamon or clove. It makes it more pleasant. When it’s more pleasant, you’re open to swishing it around for 15 minutes, and it’s not as disturbing. I definitely like that.

Dr. Eric:

For people listening to this who are brand new, you gave some really helpful tips. If they’re still thinking, I don’t know where to start, I know you said just go to the local health food store and get a couple essential oils. If someone has Hashimoto’s and they are experiencing fatigue and brain fog, the typical symptoms, or again Graves’, and they’re experiencing anxiety, would you just get the essential oils based on their symptoms? Or are there some general essential oils you’d say to start with?

Jodi:

I wrote a book on this called Essential Oils to Boost the Brain and Heal the Body. I’m friends with a lot of practitioners who treat super chronically ill patients. They were saying these people show up at their door with file folders full of their test results. They have Lyme, this, and that. They think they are unbelievably complicated and difficult. What we realized is those are all data points. They can change.

Most people have five imbalances that throw them into ill health. One is what we already talked about, that their nervous system is in the wrong gear. They are operating in the high-stress gear of sympathetic when we should move them into parasympathetic so you can turn on the body’s ability to heal.

They are not sleeping. They are not falling asleep. They are not staying asleep. That throws off everything else.

They are not draining. They are mobilizing toxins. Maybe they are drinking their green juice, so all the toxins are mobilizing. Think of yelling “Fire!” in the movie theater without opening the emergency doors. All you’re doing is getting everyone running around in circles and bumping into each other. You need to make sure the garbage leaves the body. Those are the main three things.

That’s what I really get into in the book: How do you use oils? There are certain challenges as a practitioner. You’re low on B vitamins. That’s an easy one. You supplement with B vitamins. You’re unable to activate your parasympathetic nervous system. This one person says to gag yourself with a tongue depressor. Splash your face with freezing water. Terrify yourself. Guess what? Compliance is zero. That’s hard to do. No one wants to do that. No one wants to evoke something that is unpleasant.

But if I say to someone, “Take the parasympathetic essential oil. Flip the bottle. Put it here,” that takes less than two seconds, it smells good, it makes you feel better, and you will remember that. It’s those kinds of things that I am trying to do.

I recognize there are oil companies that have deep loyalties. In the book, I share the recipes. If you have a house full of oils and don’t want to buy more, I get it. Here is the recipe. Make your own. If you’re worried, “Oh gosh, I don’t want to do it wrong. I’m not sure exactly,” I have ready-made solutions. I am trying to meet people where they’re at and empower them with strategies to help their body return to health.

Dr. Eric:

That makes sense. The name of the book is Essential Oils to Boost the Brain and Heal the Body.

Jodi:

Exactly.

Dr. Eric:

They can also learn more about you by visiting your website, VibrantBlueOils.com.

Jodi:

Yes.

Dr. Eric:

Thank you so much for sharing this information, Jodi. I appreciate it. I’m sure that they found it to be extremely valuable. I learned some things, too. Appreciate you taking the time to spread your wealth of knowledge with essential oils. Definitely check out Jodi’s book. Visit her website. Thanks again.

Jodi:

Thank you so much for having me.

Recently I interviewed Dr. Westin Childs, as he discussed some of the different supplements that can benefit those with hyperthyroidism/Graves’ disease and hypothyroidism/Hashimotos’, and below is the written transcript. If you would prefer to listen the interview you can access it by Clicking Here:

With me, I have a very special guest, Dr. Westin Childs. Dr. Childs is a former osteopathic physician that focuses on helping people with thyroid problems, weight gain, and hormone imbalances. He takes a functional medicine approach to these systems and believes that everyone, regardless of their hormone status, can get back to feeling 100% using a combination of medical and natural therapies. Welcome, Dr. Childs.

Dr. Westin Childs:

Thanks, Eric. I’m glad to be here. For those who maybe don’t know, we had Eric on my podcast previously, so this is our second time chatting. The first time was awesome, so I’m really happy to be here.

Dr. Eric:

Happy to have you, Westin. Why don’t you start out by discussing how you started helping people with thyroid conditions?

Dr. Westin:

Sure. Full disclosure: I’m not practicing now. I originally went to an osteopathic medical school. When I came out, I started in radiology and moved to functional medicine. I knew I was going to do something related to hormones and weight loss. Weight loss was the thing I was most interested in at the time. I also wanted to focus on menopausal type stuff and hormone replacement therapy in that setting.

I was working with a couple of chiropractors. They just kept sending me patients that they couldn’t get all the way better. They would do what they could. They would use supplements, diet, lifestyle, and so on. Some of these patients needed thyroid medication, so they would send these patients to me. I learned a lot in practicing and helping these people get better. I started to use things. I found out certain things didn’t work. I would start out with levothyroxine, which is what I was taught. I’d add natural desiccated thyroid extract. That would help some people but not others. Then I wanted to combine T3. I added more and more therapies. We were able to really help these people who otherwise weren’t able to get help from either their conventional doctors, their endocrinologists or family practice doctors. As a result, it grew from there.

Once you help a couple people, you attract people like crazy. There were so many thyroid patients who would come. In a way, I joke and say that I was attracted to that field out of necessity. There was such a void that needed to be filled in that area with thyroid management. Nobody was doing it. That is really what happened. I got interested in that. Because the thyroid is so integral to the systems and body including your metabolism and other hormone systems, it allowed me to do the things I wanted to do anyway. I was able to help a lot of patients who had low thyroid function and Hashimoto’s because weight gain is one of the main symptoms of that. I learned a lot about weight loss doing that. These people still had issues with estrogen and progesterone, so they needed bioidentical hormone replacement and therapy. That is how I got into it.

From there, I started doing my blog. I did my podcast and videos. Here we are.

Dr. Eric:

How long ago was that?

Dr. Westin:

I look pretty old, but it was just in 2015. I have only been doing this about five, six years.

Dr. Eric:

Wonderful. We are going to chat about supplements. It’s probably a good idea to start off by letting everybody know that supplements are important. They can play a big role in helping someone regain their health and feel better. But of course, we always want to start with diet and lifestyle, and I’m sure you would agree with that.

Dr. Westin:

For sure. When we talk about supplements, which is really what we’re going to talk about today, I want to zoom out a little and say: When I was looking at thyroid patients, you have a lot of different therapy options available to you. Really, supplements are just one bucket. Now having said that, I think supplements provide a lot of benefit because they are something you have control over. What I mean by that is they are not gated by a prescription path. You don’t need to go to your doctor and say, if you want to switch from a synthroid or levothyroxine to something else, you can’t do that on your own. Your doctor needs to prescribe that for you. But when it comes to supplements, you have the option to mix and match things. You can play around with them. You do have a lot of autonomy using over-the-counter supplements, which is why I am attracted to that field.

As Eric was saying, these are supplements. They are not meant to be used in isolation. They are supplements to whatever else you are doing. As we are talking about supplements, we will be going deep into those supplements themselves. But remember they are part of a complete therapy system. You are going to have diet, supplements, medications, hormones, lifestyle, stress reduction, improved sleep. This is just one element of many different buckets that you need to look at in terms of treatment.

I’ll also add one other thing here: When possible, you want to get as many nutrients (which is what supplements are providing) as you can from the foods you are consuming. A lot of times, that may not be possible, especially if we are talking about the soil depletion of certain nutrients. The foods that we’re consuming don’t have as much nutrients as they once did. In that case, it makes sense to supplement.

In other cases, it makes sense to supplement because some foods that are really rich in certain nutrients and vitamins may not be palatable to you. You may not like to eat those. You may not like to consume seaweed if you are looking for iodine. You may not like to consume oysters every day because you want to get your zinc elsewhere. You have to play around with all these things together. But I do think supplements have a really important role in the treatment of a lot of thyroid patients and can provide benefit. But they should not be looked at in isolation. They should be looked at as one part of a whole treatment plan.

Dr. Eric:

Let’s dive into the supplements what are some of the more common supplements that you recommend?

Dr. Westin:

Are we talking about Hashimoto’s patients? Graves’ Disease? What were you thinking? Or just general?

Dr. Eric:

I was thinking we could do it either way. We could focus on hypothyroid patients and then hyperthyroid. Some supplements are better suited for those with Hashimoto’s, and some are better suited for Graves’, and some could benefit both. I’m open to however you want to start.

Dr. Westin:

One of the main benefits of supplementation is you have the ability to manipulate and fine tune what nutrients you’re using to try to obtain some specific purpose. There are a lot of ways to look at supplements and how to use them, but that is how I think about it.

When I am looking at thyroid patients, I am really thinking about what sort of thyroid problem do you have? It’s not always obvious. You might think to yourself, I have Graves’ Disease, therefore I have hyperthyroidism; therefore, my thyroid is actively hyperthyroid. This isn’t always the case. For instance, you could be taking an excessive dose of methimazole, which is blocking your thyroid beyond that which would be normal. You could go from hyperthyroid to hypothyroid in which case there is maybe some room for improvement there.

Likewise, imagine you are somebody who has hyperthyroidism. Let’s imagine you had your thyroid ablated or surgically removed via thyroidectomy. Even though you were previously diagnosed as hyperthyroid, once your thyroid is removed, you are more in the hypothyroid camp. You have to think about what is your current thyroid status? Then you can determine what kind of supplements you want to use at that point. That is really how I am thinking about it.

We will talk about supplements that boost thyroid function, supplements that improve the immune system. We can talk about supplements that will be beneficial for Hashimoto’s and Graves’. There are some supplements that can make those conditions worse. On the flip side, there is also a lot of supplements important for general health. We can talk about those more broadly and then dive into these other areas more specifically as we need to.

For general health, zinc would be a really good one. I would look at magnesium as that tends to be depleted in a lot of people, especially related to stress. All the B vitamins, B12 especially. These tend to be depleted in stressful situations, and they tend to be impacted by those with thyroid function due to how the thyroid impacts the metabolism and how these are excreted or retained inside the kidney or intestinal tract. I would include Vitamin D although I think that has relevance when it comes to autoimmune diseases as well. I could put that in both Graves’ and Hashimoto’s. Those are the basics.

These are more related to vitamins and nutrients and not necessarily botanicals. I want to separate those two. Botanicals are when you are extracting a specific element of a plant. Ashwagandha is an adaptogen. We talked about berberine, which is a plant alkaloid. You can take these specific elements of plants, crush them up, put them in a capsule form, and take them to obtain some sort of benefit as well. You really have vitamins, nutrients, minerals, botanicals, and herbs. Which one you use, and when you need them, depends on your situation and thyroid status. In fact, I would also include probiotics and omega-3 fatty acids. These are the more general supplements you’d want to consider taking on a daily basis if you have any thyroid problem.

If you have a specific thyroid problem, we can go down that route as well depending on which one you’re thinking.

Dr. Eric:

Keeping in mind of course that Graves’ and Hashimoto’s are autoimmune conditions. With both of those conditions, they can take any of those supplements you just mentioned.

Dr. Westin:

That’s how I view it, yes. I would say that these are supplements for generalized health. They are to improve your health. When you look at patients, these are patients that if you took any random sampling of someone from the United States, they are someone who would benefit from taking those supplements, in my opinion, which is why they are included in a lot of multivitamins. When you look at statistics, something like 68% of adults in the United States are taking supplements in some form. They must believe that supplements provide some form of benefit; otherwise, 68% of people would not be buying them and using them on a frequent basis.

Where you get into some contradictions are how conventional doctors view supplements versus how integrative and functional medicine practitioners view supplements. You can talk about those from two different angles, so that gets more complicated.

The gist is most conventionally trained doctors who are treating thyroid conditions tend to be against supplements. We can talk about which ones and why. Especially iodine. That is a controversial topic. Whereas the integrative and holistic and more functional medicine practitioners tend to be pro-supplements. This is probably because they have seen how beneficial and effective they can be, and probably because they have used them personally.

I would say in my own situation, dealing with my own personal health problems, I found supplements to be incredibly effective, more so than prescription medications. It’s hard to argue with somebody that supplements don’t have enough scientific data to support them when it is clear that a lot of people experience benefits when using them. I want to put that in the background there in terms of context.

Dr. Eric:

I agree. As you know, I was diagnosed with Graves’ Disease. Of course, diet and lifestyle played a huge role, but I took supplements, and I think they also played an important role in my recovery. Same when I work with patients.

Without question, if I had to choose one thing, it would be diet and lifestyle over supplements, but ideally, I would recommend both. I would recommend they do everything they can from a diet and lifestyle perspective, like eating well, managing your stress, getting sufficient sleep. But supplements also play an important role. We are on the same page with that.

Why don’t we start with low thyroid function? What are some of the supplements if someone has an overt low thyroid hormone levels or sub-clinical hypothyroidism?

Dr. Westin:

When it comes to someone who has low thyroid function, I want to distinguish that we are talking about someone who has an insufficient amount of thyroid hormone in their body, meaning they are experiencing low thyroid function. The reason I am harping on that is because you can have people with hyperthyroidism experience these symptoms. It’s not specific to people who have been diagnosed with Hashimoto’s or hypothyroidism. We are talking specifically what is happening at the cellular level. Are your cells being impacted by thyroid hormone sufficiently to improve or cause the effects that you want thyroid hormone to do? If that is not the case, there are supplements you can take potentially to augment how well that thyroid function is working.

I think of that in three broad categories. We can help with thyroid hormone production. We can help the thyroid gland produce more thyroid hormone by providing the necessary building blocks the thyroid needs to produce those hormones. We are providing it what it needs so it allows it to occur.

Then we can talk about thyroid conversion. You can take supplements to support the conversion of T4 to T3, which is essentially saying, even if you have your thyroid hormone produced from the thyroid gland, it’s not going to work unless it is converted from the inactive form, T4, to the more biologically active form, T3. T4 does have some biological activity.

Lastly, you can talk about supplements that help thyroid cellular hormone sensitivity. We are saying that not only does the thyroid hormone have to be produced from the thyroid gland, it must also be converted from T4 to T3, and your cells must then be sensitized to it so it can actually function. Each of these categories, we have different supplements that work. If you want to talk about any of them in more detail, let me know.

When it comes to thyroid hormone production from the thyroid gland, we are really looking at 1) tyrosine, 2) iron, which is important for thyroid peroxidase; and 3) iodine. These three nutrients, not really vitamins per se, are absolutely required for thyroid hormone production inside of the thyroid gland. When you take these things, you are saying, “Look, I am providing the body with necessary building blocks that it can take to produce more thyroid hormone.”

Not so much in the case of tyrosine, as tyrosine is an amino acid. Most people are not tyrosine deficient. However, I will say that people who are supplementing with tyrosine do tend to see improvement in thyroid hormone production. I believe there is probably some competition between the use of tyrosine between the adrenal gland and the thyroid gland, which both use it for the production of building blocks of hormones. So I do see the benefit of using tyrosine even though people are not grossly deficient in it. That is not something you see very often.

You do frequently see iodine deficiency. You also see sub-optimal iron levels. Iron is required for the activation of a certain enzyme, which is involved in the production of thyroid hormone. You need iron for that enzyme to function. I find that thyroid, especially low thyroid, impacts the absorption of iron in the intestinal tract. There are a ton of patients who are iron-deficient or at least have sub-optimal iron levels such that these enzymes are not functioning 100%. It’s not like they are turned off. Instead, think of it as them running about 80-85% of normal instead of 100%. You have a slight drag on the efficiency of that system because there is a sub-optimal level. That is why I have to say I am a big proponent of checking on your standard lab tests for iron. That is one of my recommended lab panels for thyroid patients. You have to. If you don’t, it doesn’t matter what you do because you won’t see the success there.

Dr. Eric:

I agree.

Dr. Westin:

Ferritin, very important. If you have not had your ferritin checked and your iron, make sure you do, if you’re suffering from low thyroid function.

Iodine is the one I left for last because it’s another topic by itself. Before we do that, iodine is of course required for thyroid hormone production. I say it forms the arms and legs of the thyroid hormone molecule. Essentially, when we describe thyroid hormones, we describe them as T4 or T3. That annotation of 4 or 3 describes how many iodine molecules is on that compound. That hormone is either biologically active or inactive, or it turns into reverse T3 based on the configurations of that iodine. If you don’t have enough iodine, which a lot of people don’t, then you will have a problem producing enough thyroid hormone.

From a thyroid hormone production perspective, those are the three nutrients I would recommend that are most important. We can talk about conversion and cellular sensitivity here in just a minute as well. I don’t know if you wanted to dive into iodine in a little more detail.

Dr. Eric:

Sure,we could talk more about iodine. With iron, I agree with you once again. Ferritin, I like to see iron saturation, TIBC. With iodine though, do you recommend testing, like a urinary test or a blood test?

Dr. Westin:

Great question. Generally, no. I’ll explain why. There are a number of ways to test iodine. We won’t get into those testing methods. One of the more accurate ones is the 24-hour urine testing or the iodine loading tests. That is probably the most accurate of the available testing methods.

However, the controversy surrounding iodine is whether or not iodine is potentially harmful to those people who have thyroid problems. Part of that loading test requires taking high doses of iodine. If you are in the camp that says iodine is potentially dangerous, and yet you are giving someone a high dose to get tested, you put yourself in a little bit of a pickle. A one-time dose is probably not going to cause a problem for you there. But you have to think about these things as well. Not only that, but that particular test is also potentially difficult to do. It requires a lot of patient compliance. It is a bit of a nuisance. It’s annoying. It’s a little expensive. What do I do with the results afterward? I don’t recommend it for those reasons.

However, I also recommend starting with physiological doses of iodine as supplementations. If you are going to say, “I am a proponent of higher doses of iodine,” (I don’t know how deep you want to get into the iodine rabbit hole here) but the way I think about is because iodine is physiologically necessary for humans, they cannot produce it, meaning you must be getting it from your diet or supplement, that is how the physiology works. You need it. Therefore, if I am supplementing with a dose that is within the RDA, then I feel comfortable recommending that dose to somebody, whether or not I know what their actual testing is.

But I would say if you are somebody who is recommending higher doses of iodine in the range of 6-12.5 mg or higher, then I think it’s probably incumbent upon you to check and make sure that that person can actually handle that. Try a lower dose to make sure you are not potentially making that problem worse.

That is why I am not a super huge fan of iodine testing. I think it does make sense in certain situations, but I do feel comfortable recommending the physiologic dose range of about 100-250 mcg per day in supplement form or via foods. I don’t think you will see an issue with that. I will support that by saying there are tons of foods that have iodine in them that most people have no idea have iodine in them. Eggs, deli meats, strawberries, oat milk, tuna, etc. You are consuming a lot of these things on a daily basis. If you haven’t had a negative experience, chances are you are probably doing okay with iodine, at least in that dose range.

Furthermore, I have last I looked 80,000 bottles of supplements sold with iodine in them. I have a huge database of patients who have used iodine now. Very few people who actually have problems with iodine, especially at that dose. I can’t think of more than a couple off the top of my head. I think that when we are talking about these lower doses, especially the food situation, I think it’s safe. I brushed over a lot of areas because I think we could talk about iodine all day if we really wanted to. That’s why I don’t recommend routine iodine testing.

Dr. Eric:

Thanks for sharing. I agree. I know there are some practitioners who tell people both with Hashimoto’s and Graves’ strictly to avoid iodine. I agree that most people just taking normal doses of iodine and not getting into the mg doses are usually not going to have a problem.

To be fair, there are some people who take higher doses of iodine and rave about it. I’ll admit I was one of those people years ago. I took higher doses of iodine, following Dr. David Brownstein. I had a positive experience. I was recommending iodine to most of my patients, the higher doses, doing the iodine loading test, which I can’t say I do routinely now. If I will do testing, I’ll do more iodine spot tests for the reason you mentioned because the iodine loading test involves a 15mg tablet of the potassium iodide. You just never know how someone is going to handle it. I agree that lower doses of iodine in people who feel comfortable talking iodine as part of a multivitamin, which would be anywhere from 75-200mcg. There is always going to be exceptions with anything that someone takes. I agree. Iodine is important.

There is a different perspective when it comes to hyperthyroidism and Graves’. With Hashimoto’s arguably the low thyroid hormone is caused by the immune system damaging the thyroid gland. Maybe iodine isn’t as important in that situation. If someone does have a deficiency, then of course you want to address it. Even with Graves’, I am not afraid of giving a multivitamin with iodine in there.

Dr. Westin:

Nor am I.

Dr. Eric:

If someone does happen to have a reaction, it’s usually not severe with such a low dose. They can just stop taking it. With higher doses, it’s a different story.

Dr. Westin:

Previously, one of the treatments for Graves’ and hyperthyroidism was high doses of iodine to block the uptake of the production of thyroid hormone. This used to be a therapy back in the day. Clearly, there was something about iodine that is therapeutic in the setting of hyperthyroidism and hypothyroidism as we discussed. It’s really hard to come up with any definitive statement.

From the perspective of the patients, it gets a little confusing because you have people who are adamantly against it, adamantly for it, and people who are adamantly for really high doses of it. You have this wide variety of opinions. Patients are swimming through it and not knowing what the actual answer is. I think you hit the nail on the head when you said it is really an individualized thing. That’s how I look at it. If you’re really not sure what to do, and you’re afraid to cause a problem, get that help that a lot of people provide, like you do, Eric, if you need it. They can help sort through a lot of these things.

But my opinion is that most people taking that physiologic dose range will be fine. That’s my experience. I don’t think that’s a problem. If you want to start using it for therapeutic purposes, meaning you want to start potentially blocking thyroid hormone production from the thyroid gland because you are trying to stay off of the more prescriptive medications such as methimazole or PTU, you probably want a practitioner to help guide you through the process.

Likewise, if you want to use higher doses for hypothyroidism, because you are trying for detoxification of elements, I would probably get some help with that.

But the general physiologic doses, my personal opinion is that it’s probably okay to use. You really should not see significant harm, especially if it’s combined or taken with selenium, and you don’t have any issues there.

Dr. Eric:

I do want you to discuss conversion. One other thing I’ll mention is if someone doesn’t want to take methimazole, or if they are unable to take it, if they have taken it and experienced some side effect which is common with antithyroid medication, then I will typically recommend not the high-dose iodine but bugleweed, an herb with antithyroid properties. That’s what I took. I have another episode that focuses on bugleweed and motherwort. There are other options besides taking high-dose iodine, even if someone is unable to take antithyroid medication.

Dr. Westin:

For sure. I agree. My greater point is definitely don’t do that on your own. You want to be guided by someone like you if you are going to take that approach. If you are trying to take yourself off methimazole in favor of more alternative medications, I would definitely not recommend you do that on your own. Whichever one you and your practitioner decide on. I think we’re on the same page there.

Dr. Eric:

Yep. Let’s dive into conversion problems.

Dr. Westin:

Conversion is really important for low thyroid function. Understanding the conversion process is still important for people with hyperthyroidism. This conversion process is a process by which your body essentially takes a slightly biologically active form of thyroid hormone, usually in the form of T4, and converts it either to a very biologically active form, T3, or a blockading hormone, RT3. This conversion process is important for all types of thyroid hormone. From a physiologic perspective, a thyroid patient should understand the process.

Now when it comes to low thyroid function, a lot of thyroid patients have a problem with that converting, taking T4 to T3. When it comes to hyperthyroidism, most people are taking that T4 to RT3. It’s a completely different pathway; it goes down the fork. We are trying to accelerate down this path, if you have low thyroid function. There are a number of nutrients you can do that with, including zinc, selenium, and guggul extract, as well as pretty much anything that reduces inflammation. We know that inflammation as a process, infections, anything that stimulates the immune system and goes down that pro-inflammatory pathway will reduce the conversion of T4 to T3.

You can take these supplements, and it just so happens that a lot of hypothyroid patients need more zinc and selenium generally. That has just been my experience for most people; that is not universally true. It is not always the case, especially with selenium. But most people can benefit from supplementing with zinc and selenium.

When we get into guggulsterone, that is different. That is more of a botanical. That is an extract or ingredient we talked about previously. It also has other benefits, like anti-inflammatory. Pretty much anything that has an anti-inflammatory effect, like Omega-3 fatty acids or antioxidants or Vitamin C. Anything in that area. I will use rosemary extract. You can take plant or herbal extracts that are known to have anti-inflammatory effects and combine them together to enhance that pathway. That’s what I’m thinking about.

We can talk about dosing or keep it broad. Those are the four broad categories of supplements you can take to improve thyroid conversion.

Dr. Eric:

Before we get into dosing, how about talking about the conversion? A lot of it takes place in the liver and gut. Do you recommend things to support liver and gut?

Dr. Westin:

That’s another way to look at it. I am trying to keep it more simple. If you go to a practitioner, they will look at the system in your body and see the whole picture. We are speaking more generally here. Let’s say you went to see Eric, and he was trying to figure out why you aren’t converting. As Eric said, a lot of that conversion occurs predominantly in the liver, some in the intestinal tract, and some occurs at the cellular level. The nutrients required at the cellular level are different than those required in the liver or gut. When you go in and are being evaluated, you can try to pinpoint what issue is in your body. It will be different for every person. Some people might have more liver problems because they have insulin resistance. Some people may have issues with detoxification or their bile ducts because they had their gallbladder removed. Other people may be suffering from gut infections or inflammatory conditions or leaky gut or intestinal overgrowth or fungal overgrowth. Those are highly individualized. You have to go into that area and determine what needs to be treated.

That being said, there are certain basic things that you can do. If we want to be basic about it, with liver health, that includes things like consuming foods that are high in sulfur like cruciferous vegetables or using milk thistle. If you want to take a generalized approach there, you can use glutathione.

When it comes to gut health, we can talk about probiotics, prebiotics, herbal antifungals, antibacterial agents. it depends on which area you’re looking at. But you’re right to point out that the majority of the conversion does occur in the liver and the gut. Some occurs peripherally inside cellular tissues as well.

Dr. Eric:

Thanks for that. With dosing, especially selenium and zinc, because you don’t want to take too much of either one, what would be a general dosage that would be recommended?

Dr. Westin:

Good point. You can get highly individualized here as well. When it comes to zinc, I’m a fan of the lowest possible dose of zinc you can take, somewhere between 8-10 mg. Assuming you can take it without food and assuming you can take it by itself and are getting the maximum absorption. You will find the majority of zinc comes in higher dosages. You have a lot of people who experience nausea and indigestion when using zinc, which is why I recommend lower dosages. That maximizes absorption and minimizes side effects. It’s repleting the base level you need.

When it comes to selenium, that’s different. Most people need zinc more than selenium because you don’t want to go overboard on selenium. I haven’t found too many issues taking 30-60mg of zinc if you don’t know what your level is and are blindly supplementing.

With selenium, that’s another story. You can run into problems with selenium toxicity. I tend to lean backwards a little bit there. In the past, I used to recommend higher doses, 300-400 mcg, especially with patients with autoimmune diseases. I have since reined that back in, so I will recommend somewhere in the range of 100-200mcg range of selenium. That should be taken in context with what you are consuming.

People are consuming a lot of Brazil nuts because they are known to be a high source of selenium. The problem is there are a lot of issues related to the content of selenium inside Brazil nuts, which depends on where it was harvested, the size of the nut, and so on. Also, because of the keto diet, these nuts have been brought to prominence, so you have a lot more people consuming more Brazil nuts. If you accidentally take 5-6 Brazil nuts in one day, you can get up to the 500-600mcg dose of selenium, combined with whatever supplements you are taking. You could pretty easily get up to 900-1,000mcg of selenium per day, which is clearly more than you want to be taking.

So I recommend you proceed cautiously with selenium. If you stay in that low dose range and eliminate sources of selenium like Brazil nuts, you should be okay. I recommend using selenium in supplement form because you titrate that dose. There is a lot of variability between your Brazil nuts (one might have 40 mcg and one might have 90, it’s hard to know). If you are using a supplement form, you can fine tune and titrate it. I took 100 mcg last month, and I am monitoring my progress. I am looking at my symptoms and lab tests. How do I feel? It’s easier to monitor in that way. Did your question get answered?

Dr. Eric:

You just mentioned the doses for zinc and selenium. If you want to mention the other two-

Dr. Westin:

Those are variable. Guggulsterone and anti-inflammatory dosages can vary. I won’t go into those in detail. More important for thyroid patients are zinc and selenium, and not overdoing on those two areas.

Dr. Eric:

One thing to add with the selenium is if you are also taking a multivitamin, that probably has selenium as well. Besides the Brazil nut consumption, if you are taking a multivitamin, some will have up to 200mcg of selenium, too. If you are taking a separate 200mcg of selenium and eating Brazil nuts on top of that, you might be in trouble.

Dr. Westin:

That’s how I think about it. Like you said, just take stock of what you’re taking. Look on the back. Make sure you’re not overdoing selenium. I take this into context when formulating supplements and adding them together. But I will say if you go back 5-6 years, a lot of practitioners were recommending a 400mcg dose range. That was pretty popular back in the day. There was at least one study that I know of that said, “You can take up to 400-500mcg of selenium and not go into toxicity issues.” But that assumes selenium from all sources. Make sure you look on the back of every one of your bottles. Make sure there is no hidden selenium in there. Also take stock of what you’re eating that might contain high doses of selenium, which is mostly Brazil nuts, when talking about meaningful sources.

Dr. Eric:

If someone is taking magnesium, which dose would you recommend for that?

Dr. Westin:

I’m a big fan of magnesium. It can be impacted for thyroid production predominantly in the kidneys. I personally recommend in the 150-300mg dose range. Which type of magnesium you use really depends on the problem and what you’re trying to treat. You can use much higher doses of magnesium if you wanted to, especially if you are using in the form of magnesium citrate, and you are using it for gut health or constipation. You can use it predominantly for depression if you have someone suffering from brain fog or depression. That’s another form. If you are just trying to get it in the body, that’s another form. It depends on how you are trying to get it in the body and for what purpose.

I will say more generally I have included that more broadly for people who take it. You have Graves’. I don’t have a thyroid problem. But I will still recommend it for someone like me and for someone like you. It gets depleted a lot in stress. Since we’re all under a lot of stress, we all tend to benefit from using magnesium. It helps lubricate the bowels. It’s an overall good supplement to take.

If you don’t know where to start, somewhere in that 150-300mg dose range. You can always exercise dosing based on bowel tolerance. If you take it and notice you are getting indigestion or loose stool, you can back up on your dose. You can manipulate it that way. What dosing do you tend to recommend for magnesium? Or do you?

Dr. Eric:

I do recommend magnesium. I agree the form varies. Sometimes I will recommend magnesium citrate. Sometimes I will recommend magnesium malate or magnesium glycinate. It really does depend in the situation. Typically, the average dose would be anywhere between 150-400mg. There are some cases where you could justify taking higher doses. If we are talking about average, most people don’t need to take more than 400mg.

Dr. Westin:

I would recommend if you are trying to figure out what to take, some of these things we’re talking about are incredibly safe to take. You don’t need to worry about side effects. Selenium, you can go toxic. Iodine can potentially cause problems. But I have never seen anybody take magnesium and have a significant problem. If you are wondering about taking magnesium, as far as safety goes, it’s a pretty safe supplement to take.

Dr. Eric:

I agree. If someone does take too much, you might get some loose stools. Other than that, that’s it. Selenium, iodine, and iron, you don’t want to do too much. You want to test for that.

Dr. Westin:

I should have mentioned this: Some of these nutrients absolutely require testing prior to taking. Iron is one of those. You can go toxic on iron and have iron overload syndromes. Hemochromatosis is the genetic form of that that people can suffer from. It’s quite common. Iron, iodine, and potentially selenium. Some of those, you don’t need to.

Even the magnesium testing is not super accurate to begin with. That is variable as well. Some people might be using it for a completely separate purpose. Maybe you are more interested in its effects on the bowel than its intracellular effects. You could be using it for some physiologic purpose as well. In which case the numbers don’t matter as much. I take a lot of liberties in terms of how I use these and what I test for and the purpose of using the supplement. That is just how I think about it. That may not jibe with other practitioners. I have found good success in using supplements in these ways.

Dr. Eric:

You mentioned earlier the B complex. You think most people benefit from using that?

Dr. Westin:

I will tell you a little story. When I was practicing four or five years ago, one thing I would universally do, and it was just phenomenal, is I would give pretty much every thyroid patient a B12 shot. I would give it to them in a methylcobal form, 5,000mcg, so high dose. Relatively to the RDA. You wouldn’t believe the improvement that these people would see using B12 shots over other forms of B12. I really learned from that lesson that thyroid patients do really well on supraphysiologic dosages of B12 and other B vitamins. That was something I saw clinically.

There is no data or science to prove that this is the case. If you look at the data, people will say that supplemental forms such as oral or sublingual forms are not superior to B12 shots. That doesn’t jibe with what I saw clinically. People would come back and beg for more shots. They would want more and more. I don’t know if it has to do with how it gets into the cells, if it goes directly into the muscle cells and is providing mitochondrial energy in that way. I am just spit balling as to why it works or why it may work differently than oral. But I do believe the low thyroid patient population, and I can’t imagine this is untrue for hyperthyroid patients, that they respond fantastically well to shots. They can use sublingual or oral capsules as well.

If you are low in one of the B vitamins, the same triggers would cause the other B vitamins to be lower as well. They tend to be water-soluble as a family, with the exception of one, so they tend to go together. If you are low in one, you will probably be low in the others, which is why multivitamins can be beneficial. Whatever habits you are doing, stress or poor diet or eating food that is processed or refined, these things will deplete your nutrients.

Also, the thing about thyroid function is it has specific impacts on your intestinal tract as well. It causes decreased absorption of things like B12 or iron specifically. People need more of these nutrients compared to the average population.

Lastly, another thing is you can actually have autoimmune diseases of the intestinal tract, which result in further impairment of B12 absorption. Graves’ Disease is the most common cause of hyperthyroidism, and Hashimoto’s is the most common cause of hypothyroidism. We know these autoimmune diseases tend to go together. You are more likely to have it from thyroid function from the autoimmune perspective.

In my own clinical experience, I have seen the benefit there. I highly recommend B12 shots if possible. If you can’t go for that, get the sublingual form or the oral capsule. I see slightly better clinical improvement with sublingual, but I think capsules are still great. It’s harder to get the other B complexes inside of the sublingual versions, so you are usually getting B12. That is something to consider.

Honestly, I don’t have a thyroid problem, but I use B12 shots periodically as well. Maybe it’s placebo, but I feel amazing after I get them. I haven’t had one in a while. But this conversation reminded me to get one when I go home. Have you ever tried B12 shots, Eric?

Dr. Eric:

No, I have not. I will run out and get one.

Dr. Westin:

You can go to a weight loss clinic usually. But it has to be in the methylcobalamin form. We can talk about methylated versions of B complexes. As a thyroid patient, you want a methylated version of it. Don’t get cyanocobalamin for many reasons. This form can be metabolized as cyanide and cause thyroid problems. Get the methylcobalamin version. 1,000mcg-5,000mcg once per week is the range I recommend. Go get one, Eric. I think you’ll like it.

Dr. Eric:

I will need to give that a try. How about any supplements specifically that you recommend for people with hyperthyroidism or Graves’?

Dr. Westin:

I tend to take a more broad approach in the sense that I look at immune function and general systems that I see people mostly have problems with. I have a hyperthyroid bundle that I will sometimes recommend for these patients. If you want to get more fine tuned, you will need to see someone like Eric, who will recommend this probiotic or this antifungal or this antibacterial. There are some general things.

Multivitamins for sure. I am not afraid of using iodine, so I include that in there as a low dose. I am also a big fan of supporting adrenal health because I think regardless of thyroid status, you still have taxing that occurs at the adrenal function level and can result in fatigue, even though you are feeling that wired sensation that can occur with hyperfunction. Gut health is also definitely important.

That is how I would look at hyperthyroidism. From there, we can go down into these other things we mentioned previously, like focusing on systems like liver health and gut health. Those are the general supplements for hyperthyroidism. Oh, I forgot to mention you want to focus on the immune system, which would include things like Vitamin D, zinc, and even Omega-3 fatty acids.

Dr. Eric:

I agree. I give pretty much every one of my patients, whether they have Hashimoto’s or Graves’, Omega-3 fatty acids. Vitamin D, I will test first. Most people are deficient in Vitamin D.

Dr. Westin:

Do we have time to talk about Vitamin D?

Dr. Eric:

Sure.

Dr. Westin:

I will say this: Absolutely test. I don’t know about you, but in my history of testing, I find only a handful of people come up normal. Is this your experience, too?

Dr. Eric:

Every now and then. It’s rare for people who aren’t taking it. I can’t say I haven’t seen anybody who is normal who is not taking Vitamin D.

Dr. Westin:

That has been my experience as well. A lot of people know Vitamin D is important, but they don’t understand how important it is. A lot of people tend not to want to supplement with it so much because it’s hard to experience some sort of clinical benefit when you take it. Your numbers went up, but how did you feel? Did it really help you? When you are taking an adrenal supplement like Ashwagandha or rhodiola or ginseng or maca root, a lot of people notice some benefit fairly rapidly. They can tell this thing is helping them with their libido or energy or sleep. It’s easier to take something if you notice the improvement. But that Vitamin D level is so important.

Having said that, I am with Eric on this as well, I don’t think I have seen maybe one person who is not supplementing with Vitamin D already. I live in Arizona. Where do you live?

Dr. Eric:

North Carolina.

Dr. Westin:

We are probably fairly similar. You should have a lot of sunny days there. It should be enough to get sufficient Vitamin D through the sun, latitude-wise. It is so common that it’s deficient. I will say it is pretty easy to take a Vitamin D supplement, in the D3 form, to get the right dosing. But you will want to test. I still recommend if possible that you get it through the natural route. That is far more beneficial from a Circadian rhythm point of view, the skin. Depending upon where you live, if you are far too north, or what time of year it is, or how much cloud cover you have, or if you use sunscreen, it may not be possible. If that is the case, you want to supplement. But if you do want to get it the natural way, you can.

The rules of thumb is you want to have 40% of your skin exposed. You don’t want to have any sort of suntan blocking lotion on. You want to be out where your shadow is shorter than you are. If you walk outside and your shadow casts a shadow that is 10 feet long and you are six feet tall, that is the wrong time of day for sun exposure. It needs to be between the hours of noon and 2pm typically. 40% of skin exposed, no suntan lotion, and clear skies. No cloud cover. If you can go out and spend about 20 minutes out there, you can get a significant amount of Vitamin D through the sun. That light that comes into your eyes, this is all beneficial for your Circadian rhythm. It can help you with sleep. This is the best method to get Vitamin D.

If you can’t, or if you want to rapidly get it up for some reason, you can use the Vitamin D3 formulation. You can take it that way. The micellized version is best. 1,000mcg all the way up to 5,000mcg. Some people need as high as 10,000mcg, depending. But you have to play around with it with your practitioner.

Dr. Eric:

I agree. Thank you. Not that you can’t get some benefits from the sun, but try to get as much naturally, just like from a nutrient standpoint. You want to get as much from food as possible. One other question with Vitamin D: When someone supplements, do you recommend Vitamin K2 to go along with it?

Dr. Westin:

I used to, universally. I don’t really see a lot of clinical benefit or utility in doing that, so I have since stopped recommending it. I only recommend K2 if they have a specific issue with osteoporosis or bone health or cardiovascular issues. Most of the people who would come to me did not have those issues. I thought it brought up the price of the Vitamin D3, and I saw little benefit, so I didn’t. I don’t frequently recommend it. I used to do it a lot. Every single person, you’d get D3 and K2, that combo. I don’t see a lot of benefit, so I stopped doing it personally. But if you want to do it, go for it. I don’t think there is anything wrong with it. K2 is an incredibly beneficial nutrient for general health. What is your opinion on that situation?

Dr. Eric:

I have been recommending it for a number of years because I was taught that it helps get the calcium into the bone. Whether everybody needs the K2, I don’t know, as there is not a good way to test for it. What I have also learned is that it is fairly safe. You can’t overdose with K2. It is really a play it safe mechanism if someone is taking D3 to take a K2 supplement combo just to make sure that they are getting the calcium guided into the bone. Whether they need it or not, I don’t know if any practitioner really knows. That is the approach I take.

Dr. Westin:

I try to use the fewest amount of supplements to get the biggest bang for the buck. When it comes to that, you do see diminishing returns once people start taking 8-12 supplements. I have seen people taking 20+. What is the expense of this? How feasible is it to get all of these inside your body? What benefit are you getting? Are you having interactions between the two? Are you preventing absorption of certain nutrients? We get into complex situations when you start taking a bunch. If I don’t see the clinical utility of it over time, I am more hesitant to recommend it because I think to myself, what if we took that out and added something else instead? Would you get more benefit if for instance we used rhodiola in place of K2? Or something like that. That is the philosophy I would take when looking at everything.

As you mentioned, there is nothing wrong with taking K2. A lot of people prefer to take it, especially with some of those studies, which are convincing. I haven’t seen clinical benefit personally.

It also depends on the age range of the population in which you are helping. Predominantly, the age range and gender I would see that need the most help are women, ages 30-45. These women tend to not experience any sort of issues with cardiovascular problems or bone density issues until postmenopausal. They are 15-20 years away from that issue. I don’t know who you’re seeing. That does play a role.

Dr. Eric:

It varies. I would say the average is a wide range, anywhere from 30-60. Mostly women. I see men, too. 80-90% of my patient base is women. I see women in their 30s, some in their 20s, some teens. On average, I would say 30-60, which is a pretty broad range. Can I ask you one more question?

Dr. Westin:

Absolutely.

Dr. Eric:

Do you think that a multivitamin is necessary? Would you recommend a multivitamin in most people with Graves’ and Hashimoto’s?

Dr. Westin:

Good question. Complicated answer. I would say this is how I would look at it. When I was treating people and practicing, I would rarely ever recommend multivitamins. That is because I was able to fine tune what that person needed. If you are not seeing a general practitioner, and most people are probably seeing subpar practitioners, no offense to anyone out there, but they are not going to have that knowledge to give them the direction that they need.

Generally speaking, most thyroid patients would benefit from a multivitamin, and I would recommend that. With the exception of people who are seeing someone like you who understand the nuances and could directly concoct a special set of nutrients, supplements, vitamins, botanicals, and herbs for that specific person. In the absence of that, then it’s better to use that than not at all. That is how I would look at it.

But you can do a lot on your own. I would say if you are a thyroid patient, spend some time reading and researching. If you pay attention to your body, if you try these things and experiment a bit, stay away from things we talked about previously that can potentially cause harm. You can do a lot on your own. I don’t think you should be too scared to do that. You can get a lot of improvement.

A lot of that will come down to the severity of your illness. There is always a spectrum. You might have someone on this side who is fairly easily treatable, and some things like a probiotic, Omega-3s, changing your lifestyle, eating whole foods, removing fast food may be sufficient for you to see significant improvement. If you tried these things and don’t see improvement, see someone like Eric because you will have to progress into more complicated diets, infections in the gut, liver health and insulin resistance, etc. Generally speaking, most people could benefit from a multivitamin regardless of thyroid status.

Dr. Eric:

Thanks for sharing. Any other last words as far as supplementation goes for those with thyroid conditions?

Dr. Westin:

I don’t think so. The thing I would leave everybody with is that I want to get a point across that to empower thyroid patients, do a lot of the research and learning on their own. It can be very frustrating when they are unable to get certain treatments and medications. Realize there is a wide array of supplements and so on that you can use and are available over the counter. They are not equally as good. They won’t necessarily be the key to helping you by themselves. But they can be used in conjunction with medications. That is my preferred method. Use this with diet and lifestyle. Doing it that way, a lot of people could benefit from the use of supplements.

Dr. Eric:

Thanks again for sharing everything. Thanks for your time. Where can people learn more about you?

Dr. Westin:

If this information is interesting, check out my website. Search “Dr. Westin Childs.” If you type in “Dr. Westin Childs, start here,” I have a list of eight resources you can download. Downloading them will put you on my email list. We have a set of lab tests, foods to avoid, clinical studies you can take to your doctor to promote getting the right type of treatment. Tons of downloads to check out.

Dr. Eric:

Same thing with YouTube?

Dr. Westin:

I will pop up if you type in my name. YouTube, website, podcast, etc. Whatever your fancy is, there is something there for you.

Dr. Eric:

Thanks, Westin. Appreciate everything that you have shared with the listeners. I hope to have you back again in the future. I would love to do that.

Click Here to visit Dr. Child’s website

Click Here to visit Dr. Child’s YouTube channel

 

Recently I interviewed Dr. Nikolas Hedberg, as we chatted about infections in Graves’ disease and Hashimoto’s, and below is the written transcript. If you would prefer to watch the interview you can access it by Clicking Here:

With me, I have Dr. Nikolas Hedberg. Dr. Hedberg, we are going to discuss infections and thyroid health. How are you doing today, Dr. Hedberg?

Dr. Nikolas Hedberg: Great. Thanks for having me on.

Dr. Eric: You are welcome. Thank you for being on. Before we start, I am going to dive into Dr. Hedberg’s bio. He is a chiropractic physician, a board-certified chiropractic internist, board certified in nutrition by the American Clinical Board of Nutrition, and an herbal medicine fellow. Dr. Hedberg is also the founder of the Immune Restoration Center in Asheville, North Carolina, where he consults with patients worldwide. He is the founder of the Hedberg Institute, an online functional medicine education platform for practitioners of all types who want to build a highly effective and successful functional medicine practice. He has also been a speaker for many years in the functional medicine arena, presenting on autoimmune disease and the connection between infections and chronic illness, which is what we’ll be discussing here. He is also the author of the book The Complete Thyroid Health and Diet Guide, a comprehensive guide to understanding thyroid disorders from a functional medicine perspective.

Doc, if you don’t mind, I’d like you to start out by discussing your background, how you started working with people who have autoimmune thyroid conditions with more of a focus- Currently, you focus a lot on infections. Of course, with Hashimoto’s or Graves’, if they have infections, that’s a potential trigger. Why don’t you tell everyone how you got started?

Dr. Nikolas: I first started practicing 18 years ago. I was building my practice and giving lectures around Asheville. I realized that the thyroid lectures always drew standing room only crowds compared to all of the other illnesses I was talking about. I knew there was something there that I really had to look into. Patients started coming in who were taking Synthroid, and it really wasn’t working, not feeling much better. The combination of those two factors drove me into the direction of focusing on thyroid.

Once you start to focus on thyroid, you realize the vast majority of people with hypothyroidism have Hashimoto’s Disease. There really is no medical treatment for Hashimoto’s. Those patients are really left without many answers from the conventional side of medicine. As you dig deeper into Hashimoto’s, you find out that a lot of practitioners are overlooking chronic stealth infections as the driver of autoimmunity. A lot of practitioners are focusing on important things like gut health and Vitamin D, but the infectious aspect, I found over the years, is usually overlooked. That has just always been a main interest of mine, the immune system, chronic infections, especially viruses. I am most interested in chronic viruses.

Dr. Eric: The same applies with Graves’. Most patients with hyperthyroidism have Graves’ Disease. People with Graves’ Disease tend to have viruses. This is not just my clinical experience, but in the literature, too, there is a correlation with both Graves’ and Hashimoto’s for different infections. Of course, we’ll talk about some of the different infections here.

Why don’t we start out by discussing how an infection can trigger an autoimmune thyroid condition such as Graves’ or Hashimoto’s?

Dr. Nikolas: The immunological description is very complex. There are six potential different mechanisms. I will break it down so that people can understand it and not go into tremendous technical detail.

Basically, your immune system recognizes viruses, bacteria, parasites, fungi, things like that. Those immune cells attack those particular microbes. In autoimmunity, the immune system is unfortunately making antibodies against your own tissue. For the thyroid, it’s thyroid tissue. There are particular types of infections that can look similar to thyroid tissue. The immune system is looking at amino acids. What those look like on the surfaces of particular infections and on the thyroid. It makes antibodies against whatever has those same amino acid sequences. That is basically how it happens.

There are other ways it can happen, such as there can be a pretty strong infection in a particular organ like the thyroid. There is a lot of debris in that area due to inflammation. In that soup, the mix of debris and infection and self tissue, the immune system gets confused, and it starts to tag the self tissue and the microbe that is in that particular organ as foreign. Both get attacked. That is called molecular mimicry. We have known about that for quite some time. Actually in about 1972, it was discovered that cytomegalovirus was connected to lupus. That was the first discovery. It’s not something new. That’s almost 50 years we have known about it. That’s basically how it works.

Dr. Eric: Besides potentially causing autoimmunity directly through that molecular mimicry mechanism, some pathogens, such as H-pylori and parasites can increase the intestinal permeability of the gut. Could that also be a mechanism, through the triad of autoimmunity? Maybe it’s not a trigger, but it’s making the person more susceptible.

Dr. Nikolas: Definitely. There are studies on intestinal permeability and leaky gut and direct connection with Hashimoto’s and other autoimmune diseases. You mentioned H-pylori. That is going to have an impact on multiple factors, not just in the gut, but in what micronutrients are being absorbed and utilized. Some of these infections can definitely affect the gut and create dysbiosis and increased permeability, and that can lead to autoimmunity.

Dr. Eric: Why don’t we talk about some of the different infections that you see more commonly in your practice with your patients? Or you could also in addition to that bring up those in the literature. I know yersinia enterocolitica is one associated with both Graves’ and Hashimoto’s. I can’t say I see a lot of patients with yersinia when I do testing. What are some of the more common infections that you see with your patients?

Dr. Nikolas: I’ll start with yersinia because unfortunately it’s missed very often in stool analysis. It hasto be tested in blood as well. IgG, IgM, and IgA antibodies. Often, you will see the stool analysis misses it, but it’s active through blood testing. That’s one connected to Graves’ and Hashimoto’s. The connection there is the surface proteins of yersinia look just like thyroid tissue.

H-pylori is another one that is very common. The connections with H-pylori and Graves’ are stronger than they are with Hashimoto’s, but there is definitely a connection with both. You can pick up H-pylori pretty accurately with a stool test, breath testing, or blood testing. A lot of the studies on H-pylori and autoimmune thyroid disease are usually in stool.

If you get deeper  into the intestine, blastocystis hominis, there used to be just one case study published in the literature on this particular parasite and Hashimoto’s. A paper just came out either last year or the year before. A very good paper with direct connections showing blastocystis hominis is connected directly to Hashimoto’s. They went a little further and actually treated the blastocystis hominis, and the patient’s symptoms got much better. Their immune markers got much better. Their thyroid health got better by eradicating the parasite.

It’s one thing to identify a particular infection connection. The other is, can we actually do something about it? Will the patient get better if we get rid of it? Blastocystis hominis, in that case, it does. With H-pylori, there are some studies that show if you treat H-pylori, the patients can reduce their thyroid medication dose, and some of their thyroid markers can improve. That is another connection there as far as treating the particular microbe.

Outside of the gut, and sometimes inside, the main one is going to be Epstein-Barr virus. This is the most common virus in all types of autoimmune conditions. There is a lot of literature on Epstein-Barr virus and both Graves’ and Hashimoto’s. Those are the most common. There are a lot of other ones like HHV-6, Herpes 6. There are good studies on that with Hashimoto’s. Unfortunately, you can’t accurately test an adult for HHV-6 reactivation. It’s an ambiguous way to know if it’s reactivated or not. Viruses can transactivate each other, meaning if EBV reactivates, it can reactivate another virus like HHV-6 and vice versa. With all the herpes viruses, the functional medicine treatment for them, if you treat one, like Epstein-Barr, that will be effective for all types of herpes viruses. Even if you don’t know for certain if one of them is positive or not, if you treat one, you will be treating the other.

Dr. Eric: Do you usually treat the viruses with an antiviral herbal approach?

Dr. Nikolas: It’s a three-pronged approach. Especially the herpes viruses and Epstein-Barr, they rely on what’s called NF Kappa B, nuclear factor kappa B, which means there is inflammation. EBV relies on that to proliferate.

The first thing to do is to use some kind of anti-inflammatory that works on NF-Kappa B. The most common ones that I’ll use are curcumin, black cumin seed oil, resveratrol, quercetin. Those are all effective here.

The second prong is you want to support natural killer cells, CD8+ T cells, cytotoxic T cells that contribute things like EBV. To support those, you want to use a mushroom. I’ll usually use cordyceps and reishi. That’s the second way.

The third is with monolaurin, also known as lauric acid. This dissolves the fatty acid envelope around the virus, so it exposes it to the immune system, so it’snot as stealth without that.

Those are the three things I’ll do to approach chronic viruses like EBCV.

Dr. Eric: Regardless of whether it’s EBV or cytomegalovirus or another one like Parvo virus, that approach seems to help. With EBV on a blood test, if someone tests positive for EBV, the IgM antibodies, that’s more of an acute infection. Maybe when they first got it years ago, the IgM marker would show up. What’s your take on people who have IgG markers? Most people do have IgG. Do you pay attention to the three different IgG markers? I spoke with Dr. Kasia Kines, who wrote the book The Epstein-Barr Solution. She pays more attention to that early antigen antibody. Others are more focused on how high the antibodies are, like if they are in triple digits or undetectable. How do you interpret the EBV markers?

Dr. Nikolas: Let’s talk about what’s very clear in the literature on EBV diagnosis and interpretation. You’re right. The IgM is elevated during acute infection. On average, IgM is gone in about seven weeks. In the vast majority of people, that will not return for life.

The two IgGs that you’re talking about where people are looking for elevations, the nuclear antigen and the viral capsid antigen, those alone can’t tell you if there is reactivation. The only thing that can tell you there is a high viral load or high immune response. That doesn’t mean there is reactivation. You do have to mainly look at the IgG early antigen. Unfortunately, the major labs like Labcorp and Quest don’t have the early antigen on their standard panel. They just have the other three. You have to request to add the early antigen in. Labcorp used to include the early antigen for the last 16-17 years, and they just took it out a year or two ago. You do have to look at the early antigen.

A few caveats there: There are some individuals genetically who will just have elevated early antigen for life, IgG, even when the virus is no longer active. You do have to take that into account. Then it becomes more of a clinical diagnosis. You also have to look at the complete blood count, looking at the white blood count, neutrophils and lymphocyte ratios. If you see the lymphocyte screeping up toward neutrophils, that can be an indicator of chronic viral activity.

The early antigen, you could run it, and it could be high. But it takes about six months for the early antigen to calm down and become negative once the virus is successfully deactivated. You could also be in the middle of a successful deactivation of the virus, but it is still positive.

Those are all really important things to know, that alot of people aren’t looking at or don’t know. You don’t want to jump to conclusions if the early antigen is high.

Dr. Eric: Do you test for EBV and other viruses with pretty much all of your patients?

Dr. Nikolas: Not all of them. It depends on how ill they are. A lot of them come in and already have had EBV testing. 99.999% of the time, the early antigen is not included. A lot of times, if I am testing, I am just doing the early antigen, not looking at the other markers. I couldn’t give you an exact percentage, but the vast majority, I’m looking for viral activity in patients with autoimmunity. The vast majority come back positive.

Dr. Eric: Going back to the gut infections, you mentioned yersinia being positive more in the blood testing. When H-pylori is positive and you treat it, from what I understand, you don’t want to retest in the blood because those antibodies could take a while to get rid of. Is it the same with yersinia? If you detect that it’s positive in the blood, and you treat someone for it, do you just put them on the protocol for a specific amount of time? How does that work as far as the retesting for yersinia enterocolitica?

Dr. Nikolas: I had to call the lab. If you test yersinia through Labcorp, say, they send it out to a specialty lab called ARUP Lab. I called them and had a long conversation with a pathologist there. If you really want to know about laboratory diagnosis, you want to talk to pathologists. We talked about it for a while.

There is no real definitive way to be certain if the infection is successfully treated if any of the markers are still elevated or not. You run the IgG, the IgA, and IgM. Now you can be pretty confident with the IgM it will only be around for seven weeks. If you see that elevated, you know it’s arecent yersinia infection, so they got it from some contaminated food or water. Most of the time, you’re not going to see the IgM elevated. These people are chronic.

That leaves you with IgG or IgA. IgA can still be high if the yersinia is successfully eradicated. It can take a long time, over a year, for that to become negative.

The IgG is the last thing to look at. Once they have had it, that can actually go away completely. It’s different from a lot of IgG tests, where usually they’re elevated for life once someone has had it. Someone can have a negative IgG test in this case. The main purpose of the blood test is to identify if they have it, and if it’s relatively recent. If you see both the IgG and the IgA are both positive, that’s a really strong indicator that it is an active infection.

Dr. Eric: With H-pylori, how commonly do you see that in your patients?

Dr. Nikolas: It’s very common because of my patient population with Hashimoto’s. Probably anywhere from 60-80%, somewhere in that range, it’s positive. H-pylori is a little bit tricky with the interpretation. Especially if you are doing stool testing. I use the GI map from Diagnostic Solutions. I’ve had long conversations with the lab developers there. It becomes a clinical diagnosis if you see it. You will see a particular number. That does mean there is some H-pylori, there is some activity, which we would expect because such a large portion of the world has it.

The question is if it’s causing a problem. If it’s elevated, in the red, and the clinical picture fits with if they are having symptoms of H-pylori, then that’s the case where you would most likely want to treat it. But if they don’t have any gut symptoms at all and it’s high, I won’t do an extensive treatment for H-pylori just because of the lab tests if it doesn’t fit clinically. That’s how I approach those H-pylori markers.

Dr. Eric: When you do treat it, do you take more of a natural approach, or do you typically recommend the triple therapy consisting of antibiotics and the PPI?

Dr. Nikolas: I do a triple therapy approach with triple probiotics. I use a LactoBif blend, a saccharomyces boulardii, and a spore-based probiotic. I will use all three types. Strengthening stomach acid production, strengthening digestion, along with the probiotics is very effective for most people. If it isn’t, I would go in with a few herbal antibiotics for three or four weeks. That clears it out quite nicely.

Dr. Eric: Talking about symptoms, you mentioned that with H-pylori, you rely on the symptoms. Are there cases, when it comes to infections, where you don’t rely on symptoms, where it could potentially be a trigger, even if the person isn’t experiencing specific symptoms associated with that infection?

Dr. Nikolas: Yeah. Almost all of them, there could not be any symptoms.  So HHV-6 and EBV, they might not really have any strong symptoms related to those viruses, but they are active. Yersinia, you can have yersinia in the gut, and it’s not causing any major symptoms. Again, H-pylori, if they don’t have the symptoms of it, but they have a very strong autoimmune response, and we are doing a lot of the things we would normally do, and they are not moving along the way we would like them to, I might go in there and do a trial and knock it out in three or four weeks. See if there is some improvement. You’re not really going to do any harm treating H-pylori alternatively because we’re not using antibiotics to damage the gut micro flora.

Thinking of other infections that are connected there, like Hepatitis C, there is a really strong connection between Hepatitis C and Hashimoto’s. Hepatitis C actually has a stronger connection with Hashimoto’s than any other infection that we know of. In fact, Hepatitis C can leave the liver and set up in the thyroid. It’s called an extra hepatic reservoir. It can drive autoimmunity there. Some people with Hep C, especially early on, don’t have any symptoms. It’s always a matter of doing some extensive investigation.

Dr. Eric: As far as the research, I don’t think there are any other parasites in the literature associated with either Graves’ or Hashimoto’s, but have you seen from a clinical perspective where, maybe not blastocystis hominis, but maybe another parasite is present, the person’s symptomatic, and that seems like it might be a trigger? You treat the parasite, and there is a positive correlation with their immune markers going down.

Dr. Nikolas: Yeah. Blastocystis hominis really is the only one that I have ever been able to find in the literature connected to thyroiditis of any kind. But hypothetically there would be some similarities with other types of parasites if you look at the blasto mechanism. Blastocystis hominis is going to drive TH17, which drives autoimmunity. People with parasites, not always, but a lot of them tend to have a TH2 polarization. When you successfully eliminate any kind of infection that is driving TH17 or a TH2 polarization, then theoretically, you would help the immune system and help autoimmunity. Again, no strong evidence to support that other than blastocystis hominis. I’m sure you’ve seen it, and I’ve seen it, and other practitioners have seen it, where you treat the parasite, and they do get much better.

Dr. Eric: Definitely. Of course, to be fair, many times, we’re working on other things, too. It’s not just the parasite. Sometimes it’s then difficult to make the connection, but there have been cases where I’m pretty sure it was due to a parasite that is not in the literature. That greatly helped. Thanks for sharing that.

Speaking of parasites, you said you do the GI Map, which I do as well. Would you agree that stool testing, it can be helpful, but also with parasites, it’s not perfect? Even though the GI map again is DNA-based. Arguably, it might be more accurate than other testing. Still, there is always a chance for a false negative, correct?

Dr. Nikolas: Yeah. I mean the way I explain it to patients is you have the villi in the intestine. The stool analysis, it’s mainly going to pick up the stool that is passing over the brush border of the intestine. You can have deeper infections deep in between the villi. You can have parasites in there, all kinds of things. There is no way to pick up everything that is in someone’s gut ona stool analysis. It’s just impossible. We can’t go by that exclusively just because of the depth of the spaces in between the villi.

Dr. Eric: After you treat someone for H-pylori or a parasite, it’s a little bit different with viruses, but specifically with the gut infections, do you usually retest after treatment, or do you rely mostly on the presentation of the person and some other markers like blood markers?

Dr. Nikolas: Early in my career, I would retest. As the years went on, I tested less and less. If the patient is feeling good and their symptoms are gone, I leave it up to the patient if they want to retest or not. I have some patients who really want to see on paper that everything is cleared out and they are going to be okay going forward. Other patients are feeling great. There aren’t any indications that they have any ongoing infections. I say, “You’re fine. You’re good to go. We don’t have to spend the money and retest.”

Dr. Eric: Do you use any biofilm disrupting agents, like N- acetylcysteine (NAC), or proteolytic enzymes when treating infections?

Dr. Nikolas: N-acetylcysteine the main one that I use for biofilms. The herbal medicines that I use pretty much all disrupt biofilms, if I am using something for an intestinal parasite or H-pylori or fungi. The triple probiotic approach plus the herbs, if it seems like a difficult case, then we use NAC, is all more than enough. There are products out there designed for biofilms. I’ve used those in the past. I didn’t really find an amplified successful outcome using those. The fewer the supplements, the better, is how I approach things. The things I do usually work well without using those extra products. They can definitely work, but the question for me is always, do I really need them in this particular patient?

Dr. Eric: Makes sense. Thanks for sharing that. How about stealth infections such as Lyme disease? Viruses could be considered those, too. Or co-infections such as Bartonella, babesia. Can those be potential triggers of autoimmune conditions?

Dr. Nikolas: The literature is weak on all the tick-borne infections. But there are a couple papers on Borrelia, the bacteria that causes Lyme disease and thyroiditis. Those are ambiguous. Any kind of strong infection that drives an immune response can potentially trigger autoimmunity. There are a lot of anecdotal reports of rickettsia, which is also transmitted through ticks, and other biting vectors as being connected to Hashimoto’s.

You do find in the Lyme community a fair number of them have autoimmune thyroid disease. Whether those are particular microbes from the tick, or is it just because their gut is so messed up from all the inflammation? Is it because they have been on so many antibiotics, which has caused dysbiosis and gut problems? Whether it’s all the inflammation, the stress of having Lyme disease. It could be any of those things. I can just say that the literature is pretty weak on the connections there, but you do see it a lot.

Dr. Eric: That is true. I was diagnosed with chronic Lyme three years ago. I have a history of Graves’. I was concerned it might retrigger it. Fortunately, it didn’t. I tested all the thyroid antibodies, not just the thyroid stimulating immunoglobulins.

You mentioned stress. One question is the impact of stress on infections, especially viruses. Do you agree that to some extent they are more opportunistic, if you could talk about the importance of optimizing one’s immune system health, such as improving adrenals and stress handling, how much overall does that help in preventing certain infections? Maybe not the gut infections, or maybe them as well. Especially viruses, stealth infections, Lyme disease.

Dr. Nikolas: Huge factor, not just because of what it does to the gut and the immune system, but lymphocytes have cortisol receptors on them. Chronic stress drives cortisol elevations. That causes down regulation of cortisol receptors on lymphocytes. The immune response becomes weak over time, the longer someone is under stress. That allows these opportunistic infections to grow. Stress is #1 in my practice, figuring out every potential possible stress input to the system and figuring out how to mitigate that. You won’t really get great results unless you’re addressing all those factors.

Also, adrenaline drives histamine. Histamine drives chronic viral activity. Adrenaline and cortisol both drive TH2 polarization, which drives TH17. Unfortunately, TH17 cells are the major drivers of autoimmunity. Whenever it comes to the immune system, there are always multiple factors there. You can draw out all the connections, and it looks like a big web. Stress is one of the most important fundamental aspects of chronic infections and autoimmunity.

Dr. Eric: I definitely agree with that. I had a case of shingles a few years ago, too. I’m pretty sure that was just due to a ton of stress that summer. I agree. Stress management, getting proper sleep, extremely important. Diet, lifestyle factors, very important.

All right, thanks, Dr. Hedberg. I appreciate you sharing all this information. It was great chatting with you about infections. Could you share with the audience where they could find out more about you?

Dr. Nikolas:My website is DrHedberg.com. That is where I have my articles and my podcast. That’s for potential patients. The Hedberg Institute at HedbergInstitute.com is for functional medicine practitioners. I have functional medicine courses there that they can sign up for and learn how toeffectively treat all these conditions that we’ve talked about.

Dr. Eric: Again, thanks, doc. Appreciate you taking the time to talk about infections. Hope everyone learned a lot.

Dr. Nikolas: Great, thanks for having me. Enjoyed it.

Recently I interviewed Dr. Amie Hornaman, as we chatted about thyroid blood chemistry, and below is the written transcript. If you would prefer to watch the interview you can access it by Clicking Here:

Dr. Eric:

With me, I have a very special guest, Dr. Amie Hornaman, who is host of her own podcast The Thyroid Fixer. How are you doing, Amie?

Dr. Amie Hornaman:

I’m great, Eric. Thank you so much for having me on.

Dr. Eric:

Wonderful. Let’s dive into Dr. Amie’s bio here. She again is known as The Thyroid Fixer. She is a woman on a mission to optimize thyroid patients around the world and give them their lives back using her proprietary transformational program, the Fix Method. She is also the founder of the Institute for Thyroid and Hormone Optimization. After her own experience of unsufferable symptoms, misdiagnoses, and improper treatment, Dr. Amie set out to help others who she knew were going through the same set of frustrations and who were on the same medical rollercoaster. With a focus on optimizing thyroid and hormone function, and thus optimizing her patients, Dr. Amie looks at you as a unique individual, not just a lab value. She examines all factors that tie into thyroid dysfunction and thyroid symptoms and fixes you to get your life back, which I assume is why you’re called the Thyroid Fixer.

Dr. Amie:

And that’s the goal.

Dr. Eric:

Why don’t you start off by giving a little bit of your back story? How you started fixing other people’s thyroid glands. Obviously, you do more than just the thyroid. But let’s talk a little bit about your backstory.

Dr. Amie:

So many of us in this health space, it’s that pain to purpose story. It’s going through something ourselves that brings us into helping others. If we rewind to 20-something years ago, I was actually competing in figure competitions, which is like body building, but more softer, more feminine. You still have to get on stage in a bikini. I was doing fitness modeling, too. Listen, I do not come from a family of skinny minis. My family has obesity and Type 2 diabetes in it. I always would have to diet down and really work at it. I knew what to do. I knew how my body would respond. I had done it many times before.

I was getting ready for a show. The diet is chicken, broccoli, asparagus, fish. You’re going to the gym twice a day. This one particular show, I started gaining weight instead of losing weight. I mean 20+ pounds. I stopped weighing myself after I hit 20 pounds because I didn’t want to see the scale go up anymore. I was not myself. I was depressed, fatigued. My hair started falling out. I went from doctor to doctor saying, “Listen, I know my body. I know something’s off. Please do something and tell me what is going on.” They were all saying, “You’re ‘normal.’ You’re fine. Just eat less and exercise more.” Are you kidding me? There is no possible way to actually eat less or exercise more than I already am. They gave me the runaround. A lot of patients get the, “You’re just getting older. You have to live with it. Everything looks fine on your labs.” Back then, I didn’t know anything about labs. I didn’t know what they tested and didn’t test because I was just a patient, just like all of you, trying to figure out what the hell was going on with me.

Seventh doctor finally touches my throat and says, “Swallow.” She says, “You have a goiter. We’re going to ultrasound it. We’re going to run more tests, but you have Hashimoto’s.” I leave there and am like, “Yes! This is awesome! I have an answer and a pill. This will fix all my problems. I will lose weight and feel like myself again.” Five months later, nothing. No change whatsoever.

I always joke. I’m pretty sure, Eric, that we had Gateway computers back then, the big box ones. I went on there and found this thing called T3. I saw all this research that T3 works really well with T4. Of course, I was on Synthroid, like many people are stuck on in the beginning. I bring this information to my doctor and say, “Look at this. This T3 thing looks like it works really well with T4. How about we do that?” She goes, “I’m not going to do that.” I said, “I’m going to find somebody who will.”

I finally went into the functional, integrative medicine space. I kept hearing this guy’s name. When you hear it three times, it’s the universe telling you something. I go to this guy who changes my life. He is now my mentor. He got me on the path that literally gave me my life back: doing the right tests, doing the right treatments, supplements, nutrition, medication, the whole deal. That is when my career changed because I thought, “You know, if I went through that frustration,” I mean, I was crying in my car after the sixth doctor told me I was normal. I just wanted an answer. This is unacceptable. I needed to get out there and help other people who were going through these frustrations that I went through because I am just one little person in Erie, PA. There are plenty of other people out there suffering.

That’s why I’m here. I went to functional medicine training. Got my master’s and my doctorate. Now I am in this space helping others.

Dr. Eric:

Wonderful. Thank you for sharing that. In the bio I gave, one thing I mentioned is that you do more than just look at the labs. You want to treat the whole person. But we are going to focus on thyroid blood chemistry because we do look at labs. Same thing here on my side. I think labs are important; it’s just not the only thing. Unfortunately, medical doctors only look at labs; they may look at more than just TSH sometimes, but a lot of them just look at TSH and just give medication for Hashimoto’s, thyroid hormone replacement. For hyperthyroidism or Graves’, they will give antithyroid medication unless they resort to ablation or thyroid surgery. As far as thyroid labs, what do you do? TSH would be one. Discuss some of the labs.

Dr. Amie:

The must-dos. The must-haves with thyroid labs. If you don’t have these, we really can’t tell what’s going on. You start with the TSH. If you’re lucky, you will get a free T4. We might see those, but quite honestly, that doesn’t give me the whole picture whatsoever. We absolutely need a free T3 because T3 is the active thyroid hormone. I’m sure you talk a lot about that here. We want a free T3 level. We want the reverse T3 level, which is the antithyroid hormone. Of course, we want the TPO and TGA antibodies because I want to know if you have Hashimoto’s, even if you have your thyroid taken out. I have many patients who go, “I don’t have a thyroid anymore.” I go, “I know. I’m still going to check your antibodies because your antibodies can still be present even after thyroid removal or ablation.” Those are all of the thyroid labs that I like.

Of course, like you said, I look at the symptoms. I always say “both and.” Yes, we have to do the thyroid, but we also have to look at your hormones, insulin, nutrients, and all those other factors that come together so beautifully to help your thyroid medication work better, or if you still have it, your thyroid work better. We have to pair all of that up with your symptoms into one big, beautiful picture.

Dr. Eric:

That’s what I do, too. I definitely recommend a full thyroid panel. I will say reverse T3, and we can talk more about it, I don’t do it anymore on my Graves’ patients. With hyperthyroidism/Graves’, and most of my patient base has hyperthyroidism, because of the hyperthyroidism, pretty much everybody has an elevated reverse T3. It’s different in the hypothyroid world. We could talk about that. Pretty much I would say just about everyone who is hyper has that elevated reverse T3. When you correct the hyperthyroidism, often that will resolve.

Talking about TSH, thyroid stimulating hormone, can you explain why you don’t want to rely on TSH alone?

Dr. Amie:

I see so many patients in the hypo space, or they have gone through hyperthyroidism or Graves’, and they either had treatment with medication or removal or radioactive iodine. Now we are replacing with thyroid hormone replacement if they had removal or ablation. If we rely on the TSH, the TSH can basically lie. If we are replacing with medication, that is going to go down. Especially if we are replacing with medication that contains T3, because if you had your thyroid removed, guess what? We still have to replace with T4 and T3. If we are replacing with medication that contains T3, that is naturally going to go down. I have also seen it go down below a 1 with T4-only medication, which is more rare, but it does happen.

Then you are in a situation where you go to your conventional doc. That TSH is .5, .01, let’s say. Your doctor freaks out and thinks you’re hyper. Meanwhile, you’re like, “No, doc, I was hyper last year. Remember, we treated me. Now I’m gaining weight, and my hair is falling out, and I’m tired. I’m sure as hell not hyper.” If you rely on that TSH alone, that person will look hyper and not be. You have to look at the actual thyroid hormones since TSH is a pituitary hormone, not a thyroid hormone. You can’t rely on TSH alone to get the full picture of what is actually going on in a person’s body.

Dr. Eric:

Agreed. Thank you for explaining. That’s what I was looking for. The pituitary hormone, I knew you would get to that. Perfect explanation.

I mentioned that in hyperthyroid patients, I typically don’t test for reverse T3 anymore. Why do you recommend reverse T3 in your hypothyroid patients, which I do, too? I do see some patients with hypothyroidism and Hashimoto’s.

Dr. Amie:

If reverse T3 is high, let’s say we are using thyroid hormone replacement, NTD or T4/T3 combinations—because if they have had their thyroid removed or ablated, or if they have Hashimoto’s, so it’s slowly being destroyed and we are catching them in the later stages, we use that medication—that T4 can convert to reverse T3. If a person is on too much T4 medication, maybe not enough T3, or the other factors that cause reverse to go up like inflammation, high insulin, estrogen dominance, low iron status, anemia, or if you don’t have enough iodine, zinc, or magnesium, all of that can push up reverse T3. Reverse T3 is basically a survival mechanism of your body. But if that’s high, and you’re walking around trying to live life and do a job and raise a family and run a business, you will be in survival mode all the time. It might just mean that we need to adjust your medication or look deeper at what is causing that reverse T3 to be elevated and fix that so that your body is not walking around in a protective survival mode all the time.

When you’re in the ICU or ER, the reverse T3 can be high. If you’re a Graves’ patient, you’re in this autoimmune flare where your reverse T3 is going to go high because it’s saying, “Listen, we don’t need any more thyroid hormone. Stop, there’s too much anyway.” That makes sense. If you’re hypo or on the other side of Graves’, where you have already had the surgery or the RAI, then we don’t want you walking around in survival state anymore. Now we are replacing that thyroid hormone. We want that to work and your body to make you feel good. We no longer want you in that high reverse T3 state. You don’t need to be in survival mode anymore.

Dr. Eric:

Makes sense. Thank you for that explanation. Let’s talk a bit about optimal ranges. We both agree that we don’t want to rely on the lab ranges, which again, most medical doctors do. They will just test the TSH and maybe the free T4. But even if they look at free T3, they will usually say everything is okay if it’s not red flagged by the lab. Can you talk a little bit about lab ranges versus optimal ranges?

Dr. Amie:

This is a big thing for everybody. I heard Mark Hyman once describe that standard lab value ranges are like the side of a barn. If you stand 50 yards back, and I give you a ball and you throw it at the barn, you will hit the side of the barn. But if I put a target on the barn, it will be tougher to get in that target. That target is the functional optimal range. That is where we know as functional practitioners that you will feel better as a person. Your life will be much better if you are optimal.

Let’s take free T3. Free T3 is 2.4. The cut-off for the lab value range is 2.3. She didn’t get flagged. She didn’t get that L; it’s not red. If you don’t get the L or the H next to your lab value, your doctor is probably not paying attention to it and what it means. To me, as a thyroid practitioner, I am going, “This is bad. This is low. We want you at 3.5 or above.” For any listeners who might be out of the country, we want it in the upper quadrant of the range. Now, that being said, some people even do better when that free T3 is above range because most labs will cut it off at 4 or 4.5. Some people do really well at a 6. Some people do really well at a 10. That doesn’t mean they’re hyper because you have to look at the whole picture and how they feel and what we’re actually doing with them medication-wise. You cannot go by that standard lab value range, or you could be left feeling like garbage. You have to go by the optimal ranges. Then take it one step further and find your optimal.

Dr. Eric:

To clarify, for those with hyperthyroidism, you are talking probably more with hypothyroidism, if they are taking thyroid hormone replacement, you are not as concerned if they are hyper. But if someone with hyperthyroidism has a free T3 of 10, chances are their free T4 is elevated, too. Then of course we want to look at the whole picture. If TSH is depressed, and free T3/free T4 are elevated, and the person is hyper, that is a completely different story.

But you’re giving a situation where someone with Hashimoto’s might be on thyroid hormone replacement. I agree, some labs actually go as low as 2.0. Some might have a free T3 of 2.1. Most medical doctors, unless the TSH is elevated because the free T4 and free T3 are low enough to bring that TSH out of range, then they will pay attention to that TSH. If free T4 is .7 and free T3 is 2.1 and TSH is 4.2, which is within most lab ranges, they will usually ignore it. Maybe if the person presents with some symptoms, possibly. Thanks for that explanation as well.

Dr. Amie:

If I could expand a little bit, going off what you said, you really have to look at the whole picture. I’m sure you get this question a lot, too. People will go, “Dr. Eric, what should my free T3 level be?” 3.5 or above is the optimal range for me, but it’s the whole picture. Just like you said, if you’re walking around with a 3.5 or 5, and then your free T4 is a 7, and your TSH is .001, now you’re in a hyper state. You have to look at the whole picture and then ask the person those four important words that we normally don’t hear in conventional medicine, “How do you feel?” I know we are talking about optimal ranges, but it’s not just about one individual lab value. I get that question all the time: Where should my free T3 be? I can give you a general answer, but it’s about looking at how everything is working together.

Dr. Eric:

Getting back to the example of someone with Hashimoto’s, if they are on thyroid hormone replacement, and it’s a little bit on the higher side, but they are feeling great and everything else looks good, then you might be happy. On the other hand, if it’s on the higher side and they’re feeling hyper and not feeling good and experiencing hyper symptoms, then it might be a good idea to adjust the thyroid hormone.

You said you don’t take desiccated? You take actual T3, correct?

Dr. Amie:

Yes, I am a T3-only patient.

Dr. Eric:

You’re only T3?

Dr. Amie:

Ok.

Dr. Eric:

Many medical doctors only give T4. Here is a question. Going off track, if someone needs T3, but their doctor just refuses, I assume you would just say probably go to another doctor, maybe see a functional medicine practitioner. If they do test for free T4 and it looks good, but free T3 is a little bit low, you would say maybe see someone else?

Dr. Amie:

Yeah. You start with testing. My rule of thumb is if you ask your doctor for a full thyroid panel with all the tests that you and I just went over, and they say no, it’s time to get a new doc. That’s the first test. That’s a test for your doctor. If your doctor won’t test you as apatient to get that full picture, and you’re going in and saying, “Here’s my symptoms,” and they won’t even listen to you and see what’s on paper right in front of them and have answers to why you’re feeling the way you’re feeling, time to move on.

Part B is let’s say you do have a low free T3. You do the same thing that I did. “Hey, I was listening to this chick, and she is a thyroid expert. She said this thing about T3 being awesome. I’m on T4 only. Look, my free T3 is only a 2.1. By the way, I’m gaining weight, my hair is falling out, and I’mreally tired.” If your doctor says no, it is time to move on.

That being said, I do have patients who want to go the natural route. That’s fine. If you’re taking T4 and it’s not converting properly, and your T3 is low and your reverse T3 are high, we can do all of the other things to help that conversion happen. If you want to stay on your medication or you really are stuck- I have patients in Australia, the UK, and Canada where I can’t prescribe for them. We have to do it the natural route. We have to push that conversion of T4 to T3 and take out all the blocks that are impairing that conversion from happening. It can be done naturally. If you’re here in the States and you’re on the struggle bus, it’s definitely time to get a new doc.

Go the functional route. Yeah, you gotta pay out of pocket. Chances are insurance isn’t going to cover it. But guess what? You’re going to get more than five minutes with a functional doctor because that’s all you get with insurance at your current doctor at your PCP or endocrinologist. That’s absolutely what I would say.

Dr. Eric:

Let’s talk about thyroid antibodies. You mentioned for Hashimoto’s, there are thyroid peroxidase antibodies, anti-thyroglobulin antibodies. For Graves’, there is thyroid stimulating immunoglobulins, which is a type of TSH receptor antibody. How important are antibodies to you to look at initially and to keep track of? A lot of patients, I don’t want to say obsess over antibodies. Graves’ and Hashimoto’s are immune conditions. I like to look at antibodies, too, but I want to get your opinion when it comes to thyroid antibodies.

Dr. Amie:

We have to test for them because I want to know whether you have an autoimmune condition or not. I want to know whether you have Hashimoto’s or not or Graves’ or not. We have to test initially. We also want that baseline, where you are starting. Here’s the thing. Many times, doctors won’t test, so I will see patients after they have been through 10 years of testing or even 10 years of thyroid treatment, but they never had their antibodies tested. Or they had them tested once. The testing part is important, just to know whether or not there is an autoimmune condition present. With hypothyroidism, 90% of it is Hashimoto’s. It might not get flagged right away. Oftentimes, we see antibodies come up as a false negative. We want to test multiple times to check that.

We want to see if you’re doing big jumps. I don’t care about little jumps. You’re right. Patients will get kind of a little bit obsessed with antibodies. I will get messages like, “Oh my gosh, my antibodies went up by 50.” So? Maybe you were stressed out, or you got glutened at a restaurant. I don’t care about those little changes. If your antibodies go from 100 to 3,800, we need to pause and take alook at that. That’s why I like testing but not obsessing. It’s just knowledge. It’s just ongoing biofeedback for me and the patient. We don’t hang our hat on the antibodies.

It comes back to, “How do you feel?” those four words. If a patient is feeling great, obviously we want to get your antibodies to 0. But if you are feeling amazing, and you’re losing weight and are living life and have energy and your hair is growing, I don’t care if your antibodies are 100 or 200. We are going to keep working at it, but I’m not going to obsess over that number because I want you feeling good. Does that make sense? It was a long answer to a short question, but that ties all those pieces together.

Dr. Eric:

Yeah, it makes sense. It beats the opposite where if someone’s antibodies are looking great, and they are still feeling lousy, there could be other imbalances as well. It definitely makes sense.

When it comes to retesting, I have a couple of questions. One question is how frequently do you retest a thyroid panel? A second question that ties into it is do you test the antibodies every single time you recommend a thyroid panel?

Dr. Amie:

First question is how often. I get asked this a lot by my patients. General rule of thumb if we are doing an overhaul on their medication. Depending on how much we changed, in that beginning stage, we will retest in 4-6 weeks just to see what’s going on. Then after that, and after we get them more optimized, we can space it out. But I always tell them if you feel wonky, if anything is going awry, then we retest sooner. That three-month or four-month or six-month marketer of when we are going to retest you is not set in stone. If you are gaining weight or feeling crappy again, sometimes a patient will say, “I feel like I did before I started medication. What’s going on?” especially with that whole NP recall. I was getting messages left and right, being like, “Why do I feel like garbage? Why do I feel like I did before I started meds? Why do I feel hypo again?” It was the medication. We need to test again obviously. We need to test now. Something is going on in your body. We just retest sooner.

Antibodies, I space them out. Maybe every third test, we take a peek at them. Again, will we put them in a full panel if someone is feeling badly? Yes. If someone reaches out and is like, “What is happening?” then yeah, we test everything.

Dr. Eric:

I take a similar approach. I can’t say I recommend testing antibodies every single time.

Dr. Amie:

No.

Dr. Eric:

Endocrinologists differ. If they do test antibodies, it will just be the very first time, and that’s it. They will never test for them again. I do have some patients who are still working with an endocrinologist. Not that I’m complaining, but some test the antibodies every single time. It really varies. If they are getting testing through me, if they really want to test antibodies every single time, I won’t argue. But typically, it will be like every other time.

With hyperthyroidism, it might be a little bit different. Initially like you said, you might want to test more frequently. But with hyperthyroidism, you definitely want to keep an eye on them. if they are on antithyroid medication, there are other tests we will want to look at like liver enzymes, making sure the white blood cell count isn’t depressed.

Speaking of that, let’s talk about other tests that you do. As far as blood tests, I assume you do the basics like CBCs with differentials, comprehensive metabolic panels. Do you want to talk about that as well?

Dr. Amie:

Definitely. A long list. CBC with diff, CMP, obviously. I love looking at hemoglobin A1C and insulin because most thyroid patients, whether hyper or hypo, will have insulin resistance. Since the thyroid gland is the master, it will start throwing off your other hormones. We want to look at all the hormones. Insulin is a hormone; we want to look at that. We can’t hang our hat on glucose because glucose can lie. So we want to test A1C and insulin.

I like looking at a C-reactive protein for inflammation. Full hormone panel. Ladies, you have more than estrogen. You need a full hormone panel. That includes progesterone, free and total testosterone because testosterone is very important for my ladies. It is often overlooked by conventional medicine as being important. There is an optimal range for that, too, for you to feel good. Then we look at pregnenolone, DHEA. If we can get a four-point salivary cortisol panel to look at adrenals, I like to do that. Obviously all the nutrients: selenium, magnesium, iodine, Vitamin D. Vitamin D is a hormone. We look at that, too because that can get thrown off with hypo. I am probably missing some in there, but those are the ones that come immediately to mind. We will run an Epstein-Barr virus panel, Lyme Disease, tick-borne illness, all those things that could drive up reverse T3 and be co-infection.

Dr. Eric:

As far as Lyme, you will run a Lyme panel on everybody?

Dr. Amie:

No, I don’t. It depends on the symptoms. It’s obvious what’s going on with some people. It’s right here in black and white. As we get a little bit deeper, I had one patient that has long-haulers from C. I won’t say it out loud. She has long-haulers. As we look, what’s driving this? Epstein-Barr, less than 90% of us have that, too. Is it active or in its dormant stage? Is there a Lyme component, too, that is making her feel incredibly fatigued, or is it just her thyroid, or is it just the long-haulers? We want to rule that out when someone has that crushing fatigue.

If you look at their thyroid panel, and everything looks fine, or at least we have you optimized here, what else is going on that you’re so tired? Your Vitamin D is good. Zinc is good. You’re checking all those boxes. Then you think you better run Lyme and tick-borne here because there might be something a little bit deeper. So I don’t automatically run that. If I am working with a patient that is working with their own practitioner, good luck getting the full Lyme panel. It will just be the one marker. We have to do it on the side because this isn’t going to give us the information that we need.

Dr. Eric:

Yeah, I specifically asked you that question because I was diagnosed with chronic Lyme three years ago. I can’t say I run a Lyme panel on everybody. I do more frequently test Epstein-Barr in a lot of my patients. Also, with Lyme, the regular labs, Lab Corp, Quest Diagnostics, I don’t find reliable. You might get lucky, but usually if I’m testing, I’m using a specialty lab to look more at Lyme and co-infections.

I agree with the adrenal saliva testing. I’ve been doing that for years. I don’t know if you do DUTCH testing on patients. The last few years, I started doing dried urine testing on some patients. It depends. When you test for hormones, do you mainly do it through the blood? Or are you familiar with DUTCH?

Dr. Amie:

I’m familiar with DUTCH. I’m still on the fence with that, too. I’ll do it in patients I’ll feel like we need to compare both serum and urine and see the metabolites that we find in the DUTCH test. But I am all about saving patients money, too. If we can get the answers with a blood test that is by your insurance or you can get on the cheap from Ulta Labs, let’s go that route. That test is expensive. If we don’t need it, we’re not going to implement it and make you spend more money out of pocket. We can get a lot from blood. It is so split in our little world here of functional medicine, like the iodine controversy, the DUTCH hormone controversy. Dried urine is the best because we get the metabolites. No, that’s after the urine has already processed it; we have to use blood. You’re hearing both sides, and you know you need to land somewhere here. I go back and forth, too. Like you, I will use the DUTCH if it’s absolutely necessary to get a bigger picture.

Dr. Eric:

Saliva testing, you do use with most patients to look at adrenals?

Dr. Amie:

Yeah, that’s the gold standard. That’s the one where I will say, “We need to use something other than blood.” The four-point salivary cortisol panel, it gives us that look of what your cortisol is doing throughout the day. You can’t just go by blood and have one morning marker. It will give us some feedback, but I like to see what that cortisol half curve is doing. Is it actually in the right curve? Is it flatlined high? Is it flatlined low? That really requires saliva to get an accurate measure.

Dr. Eric:

Same here. I use more saliva testing than a DUTCH test. If I do recommend that, I add adrenals onto that. When I dealt with Graves’, I used the saliva test, and I have been using that for a long time. You definitely want to look at the circadian rhythm of cortisol and not just that single sample, which could again be influenced by like if someone is nervous going to a lab and they get that blood test, the withdrawal itself can cause the cortisol to spike up.

One other question that comes to mind for testing is thyroid ultrasounds. This obviously is straying from the blood or saliva tests. It’s different, but it does relate to thyroid. Do you recommend thyroid ultrasounds to your patients?

Dr. Amie:

I do recommend it. It’s that individual thing. Sometimes we can go off the blood, and we know what’s going on. There’s no palpable goiters, nodules. No one is having trouble swallowing. We don’t have those symptoms. On a case-by-case basis, if someone is having trouble swallowing, if they have a visual or palpable nodule, then we want to get an ultrasound. If they are in the latter stages of Hashimoto’s where that thyroid gland is being destroyed, we want to get an ultrasound.

I’m not sure where you use it with hyperthyroidism. But in those cases, yes. I have a patient right now who just got an ultrasound because she could actually feel that something has grown. Sure enough, one of her nodules has grown in size, so they are going to biopsy it. Okay, ultrasound. Good. In that case, really helpful. But not everyone needs one. I recommend it as a baseline if you can get it, if your insurance covers it. Coming back to the saving money part, if it’s black and white in front of me with the labs, and I know what’s going on, and I know what we’re going to treat and how we’re going to treatit, I won’t always say, “You must get an ultrasound” because they might end up with a $300 bill for that.

Dr. Eric:

I agree. I don’t think everybody needs it. When I was diagnosed with Graves’, I saw an endocrinologist at the time. She actually did not want to do an ultrasound, but I talked her into doing one. I was willing to pay out of pocket; I didn’t have insurance at the time. I wanted to know. I can’t say it’s necessary in every single person with hyperthyroidism or hypothyroidism.

This was a great discussion. I appreciate you sharing this information with my listeners. Any last words when it comes to any type of testing?

Dr. Amie:

The main thing is to get the full picture all at once, I know you probably see this in your patients, too, but I see conventional medicine do this willy nilly thing. We’ll test TSH first. If that’s bad, then we’ll do more testing, free T3 and free T4. If that’s a problem, then we’ll come over here and test your hormones. Why not do everything at once? Why not have everything right in front of you so you can look at it like a puzzle, and you’re putting the pieces of the puzzle together?

If I gave you a puzzle and said, “Hey Eric, do this puzzle, but I’m only going to give you a quarter of it,” you wouldn’t know if this was a corner or a middle piece. You have no idea. You don’t even know what the picture is. We need the whole thing. We need all the information at once.

You have to be your own patient advocate sometimes. Sometimes you have to order your own testing to get the full picture if there are pieces missing in your puzzle. Demand it. Testing gives us answers. We can compare that testing up with how you feel. Things can change. That is where the magic happens. Unless we have everything in front of us, how do we know? We don’t want to throw darts. We don’t want to say, “Maybe you have low testosterone. Maybe you’re estrogen dominant.” Then we start treating that, and it’s wrong. No, let’s get some numbers, some answers.

Dr. Eric:

I agree. When I recommend testing to my patients, I do take into consideration not everybody can afford everything. I will give options, too. Ultimately, it’s up to the patient. Even if I think something is not optional, it really is optional because they might- If we need to further prioritize, of course we will do so. We want to get answers. We don’t want to just rely on basic blood tests. Same thing with adrenals. I like to do saliva testing there. I think we’re on the same page with that.

Again, thank you so much for getting together. You shared some wonderful information. Where can people learn more about you? I know your podcast is one place.

Dr. Amie:

Yep, The Thyroid Fixer podcast on all podcast platforms. They can also find me by going to my website, DrAmieHornaman.com. If they are interested in booking a call, they can book a free discovery call. You can talk to a member of your team about how we can work together if you are in that hypo state. I know a lot of your patients do swing from hyper to hypo, from Graves’ to Hashi. Do you see that a lot?

Dr. Eric:

Over time. People do it quickly because they are on the antithyroid medication. A lot of people with Graves’ also have the thyroid peroxidase antibodies. A lot of them also have anti-thyroglobulin antibodies. Over time, some people do become hypo. That’s also why we want to try to address that immune system component to prevent them from getting to that state.

The Thyroid Fixer is the podcast on all platforms. The website is DrAmieHornaman.com. Thanks again. Appreciate your time, Dr. Amie. We’ll have to have a part two in the future.

Dr. Amie:

Definitely. Thank you, Dr. Eric for having me on.

***

Dr. Eric:

Thanks again for listening. One thing I wanted to mention is that my optimal reference ranges differ slightly from Dr. Amie’s. Part of this is probably because I work more with people who have hyperthyroidism. For the free T4, I like to see the levels between 1 and 1.5. For the free T3 levels, I like to see them between 3 and 3.5. As for the TSH, I like to see it between 1 and 2. 1 and 1.5 would be even better. As Dr. Amie mentioned, everyone is different. If your numbers are slightly higher or lower, and if you’re feeling great, and everything else is looking good, you shouldn’t get too caught up with the numbers.

Recently I wrote a series of blog posts discussing the ketogenic diet, Paleo diet, and carnivore diet (I’ve discussed the AIP diet in the past and so I didn’t include it as part of this series).  When I was dealing with Graves’ disease in 2008/2009 I followed a restrictive diet during Thanksgiving and the rest of the holiday season.  And many of my patients with hyperthyroidism/Graves’ disease and hypothyroidism/Hashimoto’s also avoid certain foods during this time of year (as well as other times).  It’s never fun to restrict foods, especially during the holiday season, although keep in mind that even if you’re following one of the diets mentioned above, you can still enjoy the holidays while eating whole, healthy foods.

The truth is that there will always be reasons you can come up with to stray from whatever diet you’re following.  There are birthdays, anniversaries, other holidays (i.e. Valentine’s day), summer cookouts, etc.  No matter what time of year you’re trying to follow a strict diet it isn’t easy.  And I realize that not everyone reading this will be following a specific diet, but the goal of this blog post is to give some encouragement to those who are following a restrictive diet.

Whether you are following a strict diet or plan on indulging more than you probably should, I want to wish you a Happy Thanksgiving!!!