Last week I released a blog post entitled “Choosing Your Thyroid Healing Healthcare Team”, and one of the healthcare practitioners I spoke about was an endocrinologist. Many people with thyroid and autoimmune thyroid conditions end up being referred to an endocrinologist. And while I can’t say that I had a horrible experience with my endocrinologist when I was diagnosed with Graves’ disease, over the years I’ve had many patients inform me that they didn’t have a good experience with the one they consulted with.

This is especially true for those people with hyperthyroidism, as many endocrinologists will pressure their hyperthyroid patients to receive radioactive iodine or thyroid surgery. And not surprisingly, most endocrinologists aren’t open to natural treatment methods. Sure, every now and then there will be someone who tells me that their endocrinologist is receptive to them taking a natural treatment approach. But this is rare, as most feel that diet and other lifestyle factors don’t play any role in improving the health of people with these conditions.

I’d love to hear what your experience has been with your endocrinologist. If you had a negative experience please let me know! If you worked with an endocrinologist who was open to you taking a natural treatment approach please let me know! Thank you for sharing your experience with everyone!

It’s not easy dealing with a thyroid or autoimmune thyroid condition, which is why it’s a good idea to work with one or more healthcare practitioners.  Most people with these conditions will at the very least see a medical doctor, but if you’re looking to optimize your health then you also might want to consider working with someone who has an open mind.  Of course you also want to consult with someone who has a good amount of experience dealing with your specific condition.

So let’s go ahead and take a look at some of the different healthcare professionals you might choose to work with:

Primary care physician. Many people will initially get diagnosed with hypothyroidism or hyperthyroidism by their primary care doctor.  In the case of hypothyroidism/Hashimoto’s thyroiditis they might prescribe thyroid hormone replacement, although in some cases they will refer out to an endocrinologist.  In the case of hyperthyroidism the primary care physician will almost always refer the person out to an endocrinologist, although they might write a prescription for antithyroid medication or a beta blocker to manage the symptoms in the meantime.  This is what happened to me when I was diagnosed with hyperthyroidism in 2008, as I saw a primary care doctor, was given a prescription for a beta blocker, and was referred to an endocrinologist.

Endocrinologist. Many people with hypothyroidism and hyperthyroidism will be referred to an endocrinologist.  As mentioned above, this is especially true with most people who have hyperthyroidism, but many with hypothyroidism will also be referred to an endocrinologist.  Frequently it’s an endocrinologist who will diagnose someone with hypothyroidism as having Hashimoto’s, and will diagnose someone with hyperthyroidism with Graves’ disease, toxic multinodular goiter, etc.

For those with hypothyroidism/Hashimoto’s, the person will probably be given a prescription for Levothyroxine.  In the case of those with hyperthyroidism, the three common options are 1) antithyroid medication, 2) radioactive iodine, and thyroid surgery.  Although it’s a shame that endocrinologists don’t do anything to address the cause of the problem, this of course comes down to their training in medical school.  For those with Graves’ disease and Hashimoto’s (or the antibodies for both), keep in mind that endocrinologists aren’t immune system specialists, which is yet another reason why they treat the thyroid gland, while doing absolutely nothing to improve the health of the person’s immune system.

Sometimes I’ll get asked how someone can find an endocrinologist who has an open mind towards natural treatment methods.  The truth is that while over the years I’ve had a few patients who had an open-minded endocrinologist, most of these specialists don’t want anything to do with natural treatments.  If anyone reading this has worked with an endocrinologist who is open to a natural approach I’d love to hear from you in the comments section below.

Functional medicine practitioner.  If you are serious about getting to the underlying cause of the problem then I would strongly suggest working one-on-one with some type of natural healthcare practitioner/functional medicine doctor.  Obviously I’m a tad biased because I fit into this category, but it is very difficult to restore your health on your own.  Don’t get me wrong, as it’s not easy to restore one’s health even when working with an expert, but it is far less challenging when you have the proper guidance and accountability.  I realize that not everyone can afford working with someone, and ideally you want to work with a practitioner who has experience with thyroid and autoimmune thyroid conditions.

Finding someone who has experiencing working with hypothyroidism/Hashimoto’s shouldn’t be too difficult, as there are many natural healthcare practitioners who have a lot of experience with these patients.  It’s a different story with hyperthyroidism, which explains why approximately 80% of my practice consists of people with hyperthyroidism/Graves’ disease.  Even though I have written a book on Hashimoto’s, I’m perceived as being more of a “hyperthyroid specialist” since I personally dealt with Graves’ disease and restored my health.  Plus I also have written a book on hyperthyroidism, not to mention many articles on the topic, and recently I’ve even conducted a couple of hyperthyroid-related challenges!

So how do you find a functional medicine practitioner who has experience dealing with your specific condition?  Well, a lot of people find me through the search engines (i.e. Google, Bing) when conducting a search for certain keywords related to “natural hyperthyroid treatments”.  You can also visit the website for the Institute for Functional Medicine and conduct a search.  There are a lot of practitioners on the site who work with Hashimoto’s patients, although it might be more difficult finding someone who works with a lot of hyperthyroid patients.  In fact, I find that even some endocrinologists don’t have much experience with hyperthyroidism, and one reason is because it’s not as common as hypothyroidism.

Nutritionist /Nutritional health coach.  A few years ago I hired my first nutritional health coach (she actually was already working with me and I sent her to the Institute for Integrative Nutrition), and then in early 2020 I hired another nutritional health coach.  Prior to that I was the sole person talking with patients about diet and nutrition, and I felt comfortable since I received a masters in nutrition degree, along with a few nutrition certifications.  And so you certainly can work with a single practitioner who does it all, as my patients received great results when I took this approach.

That being said, I think patients appreciate having a dedicated person they can speak with who focuses on diet and nutrition.  And quite frankly, both of my nutritional health coaches do a better job than me when it comes to giving recipes, food substitutions, etc.  In fact, for some people it might be best to start consulting with a nutritionist or a nutritional health coach.  While diet alone might not be enough to restore your health, you won’t receive optimal results if you eat an inflammatory diet consisting of refined foods and sugars, fast, food, etc.  And it really is a good idea to cut out common allergens such as gluten and dairy.  I won’t get into detail about this here, as I’ve discussed diet in other posts, as well as in my books.

Acupuncturist.  I’ve had some patients see an acupuncturist while under my care, and while I can’t say that doing this is absolutely necessary, there are benefits of seeing an experienced acupuncturist.  I actually discussed this in a past blog post “Can Acupuncture Benefit People With Thyroid Conditions?”.  And so if you’re considering seeing an acupuncturist you might want to read this.

Other healthcare practitioners.  In addition to the ones listed above, there are other healthcare practitioners to consider working with.  Many wouldn’t think of a biological dentist when it comes to thyroid healing, but problems with oral health can sometimes play a role in thyroid health.  One blog post I wrote that you might want to check out that relates to this topic is entitled “Are Silver Fillings Harmful To Thyroid Health?“.

Although I’m a licensed doctor of chiropractic, I can’t say that everyone with a thyroid/autoimmune thyroid condition needs to see a chiropractor in order to restore their health.  But if you want to read more about this then check out my blog post entitled “Chiropractic and Thyroid Health“.

I understand that while many people will see a primary care doctor and/or endocrinologist to diagnose and manage their condition, many won’t see a natural-oriented healthcare practitioner because they simply can’t afford it.  If this describes you I would check out a blog post I wrote entitled “Following A Natural Treatment Protocol On A Budget“.

Who Is Part of YOUR Thyroid Healing Team?

I’d love to hear what type of healthcare practitioners you’re working with!  Perhaps you’re working with multiple practitioners. You might even be working with a different healthcare practitioner that I didn’t list above, and if this is the case I definitely want to hear from you!

If you’re feeling stuck with your thyroid or autoimmune thyroid condition, then you might be interested in joining our Free 5-Day Accelerated Thyroid Healing Challenge starting on Monday May 17^th!

During this 5-day challenge you will…

• Learn how to overcome both common and overlooked “roadblocks” that are preventing your thyroid/immune system from healing
• ​Discover how to reduce your “toxic thyroid”
• ​Find out why removing the trigger doesn’t always break the chronic inflammatory cycle associated with Graves’ disease and Hashimoto’s, and what you can do to stop this cycle
• ​Create your thyroid/immune healing action plan

The Free 5-day challenge will include the following…

Component #1: Daily Accelerated Thyroid Healing Video Lesson

During this daily 10-20 minute recorded lesson I will focus on a different topic that is essential to speed up the healing of your thyroid gland/immune system. There will be one pre-recorded lesson every day for 5 consecutive days, which means that you can access it at your convenience.

Component #2: Daily Accelerated Thyroid Healing Assignment

I want people to take action, which is the whole point of any challenge.  And so each day there will be a daily assignment designed to help speed up your thyroid/immune system healing.

Component #3: Daily Live Calls

Monday through Thursday I will be going live on Zoom (and will livestream to Facebook), and each day I will be discussing a different topic related to thyroid healing.

Component #4: Two 90 minute live Q & A sessions

There will be two separate live Q & A sessions.  These will be 90 minutes each, and I’m having two in order to accommodate those in different time zones.

Component #5: Access to a private members-only group

We want you to build relationships with one another and enjoy this challenge together. Although you can still watch the daily video lessons and attend the live calls and two Q & A sessions without joining the Facebook group, if you want to connect with others and be eligible for the prizes (discussed below) then you’ll want to join the Facebook group. I plan on having my nutritional health coaches moderate the groups, although I’ll also pop in every now and then.

Component #6: Prizes for Participation!!!

There will be a daily prize for those who answer the daily question, and then at the end of the 5 days there will be a grand prize!!!

You Get All of This For FREE!!!

For more information on the Free 5-day Accelerated Thyroid Healing challenge check out the link below:

www.RapidThyroidHealing.com

On Friday April 30th I interviewed Dr. Rudrani Banik on thyroid eye disease, and below is the written transcript. If you would prefer to watch the interview you can access it by clicking here:

Here is the transcript:

Dr. Eric:

With me I have Dr. Rani Banik, who is a board certified ophthalmologist and fellowship-trained neuro-ophthalmologist with additional training in functional medicine. Dr. Rani focuses on the root cause of eye diseases and uses integrative strategies for conditions such as thyroid eye disease, macular degeneration, cataracts, dry eyes, glaucoma, as well as other diseases of the visual system, and her treatments are based on nutrition, botanicals, lifestyle modification, essential oils, and supplements. Dr. Rani runs a private practice based in New York City.  In Manhattan. Is that correct?

Dr. Rani:

That is correct, yes.

Dr. Eric:

She is also an Associate Professor on Mount Sinai in New York City where she serves an educator and researcher. Dr. Rani also is frequently featured as an expert in the media, and has been interviewed on a lot of different places, Good Morning America, CBS, NBC ABC, New York Times, Washington Post, Fox, and a number of others. Dr. Rani has been voted as Castle Connolly Top Doctor and New York Magazine’s Best Doctor in Ophthalmology every years since 2017.

Well, thanks for joining me, Dr. Rani.

Dr. Rani:

Thank you Dr. Eric for that kind, kind introduction. That was wonderful. Thank you.

Dr. Eric:

You are very welcome, Dr. Rani. Well, I’d like to start out by asking you to explain to those who are unfamiliar the difference between an optometrist and an ophthalmologist, and then also a neuro-ophthalmologist. So, if you could explain the difference between the three.

Dr. Rani:

Sure. So, many people don’t realize that there are very different Os in eye care. So, there’s ophthalmologist, optometrist. There’s also optician. So, what’s the difference? Well, an ophthalmologist is a doctor who has gone through medical school, and then done an internship and residency in ophthalmology, and some of us have done fellowships as well. An ophthalmologist treats eyes diseases both medically and surgically. We also do prescribe glasses and do additional testing as well.

An optometrist has gone to optometry school. So, optometry school is for four years, and then after that, not all optometrists, but some optometrists do a residency as well, a one to two-year residency. Depending on the state, the scope of, I guess, care for optometrists varies. Optometrists typically prescribe contacts, glasses. They do primary eye care, again, depending on the state. Depending on the state, some of them can actually prescribe medications as well, for example, eye drops. They can manage basic diseases like early glaucoma, et cetera.

Then an optician is someone who actually has a license in opticianry, and an optician has an associates degree. I think it’s about two years, and they actually make the glasses, and they help to fit the glasses.

Then a neuro-ophthalmologist, which is what I am, is basically an ophthalmologist who’s done additional training. So, I did a fellowship in neuro-ophthalmology. It was an extra year of training. Neuro-ophthalmology, basically, encompasses all the connections between the brain and the eye. So, all the cranial nerves that have to do with vision, how our brain processes vision. So, I deal with a lot of different neurologic conditions like brain strokes, brain tumors, concussion, autoimmune diseases that affect the eye and the brain, for example, multiple sclerosis, and also thyroid eye disease. So, that’s also within my skillset in a nutshell. I also deal with migraines. So, that’s a big part of what I do as well.

Dr. Eric:

All right. That’s a big problem as well. A lot of people have migraines, and might not relate it to the eyes. So, that’s good that you’ve mentioned that as well. So we’re going to be chatting about thyroid eye disease, we’re going to be talking about an integrative approach to thyroid eye disease. So, why don’t you go ahead and explain what thyroid eye disease is?

Dr. Rani:

Sure. So, many people don’t realize that there is a thyroid-eye connection. The connection is an indirect connection. So, basically, when the thyroid gets involved with autoimmune disease, for example, either Graves’ disease or Hashimoto’s disease, if there are autoimmune antibodies in the body, they can cross-react. Those antibodies that attack the thyroid can cross-react with tissues in the eye socket.

So, in the eye socket, we have the eye muscles. We also have fat in the eye socket and some other soft tissues. So, the receptors on those tissues in the eye socket look very similar to receptors on the thyroid gland. So, these auto-antibodies can attack these tissues in the eye socket and cause inflammation. When there’s inflammation either in the eye socket or even on the lids or the surface of the eye, that’s called thyroid eye disease.

Dr. Eric:

All right. So, you mentioned it could occur in either Graves’ or Hashimoto’s. Even though it seems to be a lot more common on Graves’ disease, a small percentage of Hashimoto’s patients also has thyroid eye disease, correct?

Dr. Rani:

Absolutely. I think a lot of people, like you said, they automatically associate with Graves’ disease hyperthyroidism, but it can be seen with either. Then there’s also a subset of patients who are actually what we call euthyroid, meaning they have normal thyroid function test, they have normal TSH, free T4, T3, but they have antibodies. Even patients who have normal thyroid function can also have thyroid eye disease if they have the antibodies floating around.

Dr. Eric:

When you say antibodies, there are different types of antibodies like thyroid-stimulating immunoglobulins…

Dr. Rani:

Any of them. So, TSI, thyroid-stimulating immunoglobulin, thyroid peroxidase antibody, thyroglobulin antibody, any of them can potentially cross-react with the tissues in the eye socket.

Dr. Eric:

Okay. That’s really interesting. So, what are some of the symptoms that you see with patients that come to your office with thyroid eye disease?

Dr. Rani:

Yes. So, interestingly, a lot of patients don’t even know that they have symptoms of thyroid eye disease when they come in. Many of them have perhaps been misdiagnosed as something else because symptoms can overlap with other eye conditions. So, I would say the most common symptom is probably dry eye. Many people with thyroid eye disease start off with a feeling of scratchiness, irritation of the eyes, like there’s sand in the eye or a grittiness.

Then what can happens is that there can be swelling of the eyelids. So, puffiness, particularly of the outer corners of the upper lid, sometimes even the lower lids can get very puffy, very swollen. Then as the disease progresses, there can be redness of the eyelids, redness of the surface of the eye, and also changes in the eyelid.

So, oftentimes, people develop what we call lid retraction, where the lids basically open up wider and it gives a look of a stare. We call it the thyroid stare because the eye is just wide open. It’s because the tissues in the eye socket have become inflamed and they become very tight. So, when the muscles get very tight, then the lids open up very wide. Then as the disease progresses, more serious types of symptoms can occur.

The next category would be bulging of the eye. So, people can get where one or both eyes may look more prominent, really just very inflamed. Their eye socket is very congested. Then if the muscles in the back of the eyes get affected, that can lead to a feeling of tightness, pressure. It can even lead to double vision because the eyes can get misaligned. So, if the muscles get very thick and swollen and congested, inflamed, the eyes may, for example, one eye may be higher, one eye may be lower or one eye may start to turn in a little bit, and give people double vision.

Then I would say the worst, I shouldn’t say the worst, but the most advanced form of thyroid eye disease is when there’s actually potential loss of vision, and that happens because the nerve, the optic nerve, which is in the eye socket, which is the nerve that connects the eye to the brain, that nerve can get, basically, compressed by all the congestion in the eye socket, so by the muscles, by the tissues that are all inflamed, and then people can actually lose vision. So, that’s at the other end of the spectrum, but there’s just a whole range of symptoms people can have if they have thyroid eye disease.

Dr. Eric:

Okay. As far as blindness, that’s pretty rare?

Dr. Rani:

It’s extremely rare. So, I just want to reassure everybody. Yes, it can happen, but it’s in less than 5% of people with thyroid eye disease that that actually happens. So, fortunately, the majority of people don’t progress that far. Most people with thyroid eye disease do have some lid changes, puffiness, dryness, surface issues, but not necessarily the other issues that I mentioned, but I did want to give people an overview of all the different types of manifestations thyroid eye disease can have.

Unfortunately, because many people come in with puffiness, and especially seasonal puffiness, for example, with allergies like we’re right in the middle of springtime right now, people may have puffiness of their lids, redness, irritation. So, many people with thyroid eye disease get misdiagnosed as eye allergies, which is dry eye. So, they get treated for that for months and months and months, and things just aren’t getting better with drops, et cetera. Ultimately, they end up being diagnosed with thyroid eye disease.

Dr. Eric:

So, you’re saying a lot of people think they just have dryness of the eyes, but they really have maybe a more mild case of thyroid eye disease?

Dr. Rani:

Yeah. So, patients themselves may think that it’s something else like dry eye or allergies and even doctors, even optometrists, ophthalmologists. There are physicians who just don’t necessarily think of it because there’s so much overlap between thyroid eye disease and other surface issues of the eye. There are some really characteristic findings that we look for, some very subtle findings that as a neuro-ophthalmologist I really look for, and that is really the lid retraction.

So, for example, normally, our lids should cover the white part of the eye. So, if you’re looking at someone, you shouldn’t be able to see on the top and bottom of the cornea. You shouldn’t be able to see any white, really. If you can see white, that means that there’s lid retraction, that those muscles are very tight and congested. That’s really one of the earliest hallmarks of thyroid eye disease is that lid retraction.

Dr. Eric:

Okay. That’s good to know because I also don’t want people to panic and think they have it because a lot of people do have dry eyes and we don’t want them to think that if they have dry eyes or they have allergies, and if they have Graves’ disease, it doesn’t…

Dr. Rani:

Yeah. Again, there’s overlap. Just because you have some of the symptoms doesn’t meant it’s from the thyroid because there are plenty of people who had Graves’ disease or Hashimoto’s who never developed thyroid eye disease. So, if you’re concerned about it, definitely just get it checked out by your eye doctor.

Dr. Eric:

Right. Why do some people, I don’t know if you know the answer to this, but why do some people with Graves’ disease develop thyroid eye disease while others don’t?

Dr. Rani:

I wish I knew the answer to that. That is the big mystery. I always try to ask my patients who come in with thyroid eye disease, “Were there any triggers? Did something change in your life, in your dietary habits, in your stress levels, in your exposure or was there anything new that you were exposed to like a new toxin or something in your environment?” The majority of people, there really isn’t a clear-cut trigger, but I will tell you that the cases I’ve seen, which are really very prominent, just cases that come on very quickly, many of those patients do report that they’re under a lot of stress.

So, I definitely think that there is some association between stress and cortisol levels and the onset of thyroid eye disease. I can’t tell you how many patients. For example, I had a patient who came in, a young woman who already had other autoimmune diseases. She had a couple of other autoimmune diseases diagnosed prior, but she just got married, so she’d been through planning a wedding, and then actually having the wedding, and a week later, she just came in and she had fulminant thyroid eye disease, and it was probably related to that stress that she had gone through, just with her life change and her celebration.

Dr. Eric:

One thing, also, just to let people know, again, if you think your Graves’ disease condition was caused by stress, again, that doesn’t guarantee that you’re going to develop thyroid eye disease. I learned this from self-experience because I had Graves’ disease in the past, been in remission for quite a while. Stress, definitely, was a factor in my case. Fortunately, I didn’t have thyroid eye disease, but who knows? Maybe I had a very mild case of thyroid eye disease, but it was never diagnosed.  But stress, I think, is a big factor with many chronic health conditions.

Dr. Rani:

Yeah. I also just want to mention that this is really interesting. The timing of thyroid eye disease doesn’t necessarily correlate with thyroid function at all. So, for example, there are some people who have been diagnosed with hyperthyroidism, Graves’ disease years ago and who were under control, well-managed, really asymptomatic from a thyroid standpoint, who maybe 20 or 30 years later may start to develop eye symptoms.

So, it’s very interesting, and I wish I knew the answer to what really triggers the eye issues, but it can be very discordant in that way. They don’t necessarily run in parallel. Then there are some people who actually develop the thyroid eye symptoms first, and then their thyroid, their TFT, they thyroid function test, their TSH, free T4, T3 seem to be normal, and then years later, but they do have antibodies, years later, then they actually develop thyroid dysfunction. So, doesn’t correlate, and in the majority of cases, there’s really no rhyme or reason to it. It’s really a mystery, unfortunately.

Dr. Eric:

Yeah. One thing I have noticed, again, it’s not across the board with patients, but the higher their antibodies, especially in the case of Graves’ with the thyroid stimulating immunoglobulins, it seems like the more likely they are to have thyroid eye disease. Again, I’m not sure if that’s something you notice, but if someone has a TSI of 300-400, they’re more likely, it seems, to develop thyroid eye disease than a TSI that’s in the lower 200s, for example, or in the upper 100s.

Dr. Rani:

Yeah. I don’t know if the actual numbers have ever been looked at, but I’ve definitely seen it. Just clinically, I’ve seen it where many patients who have very active thyroid eye disease, their numbers are really sky high, and not just TSI, but also thyroglobulin antibodies and anti-TPO as well. Sometimes we can use those numbers to track them, to see how they respond to treatment. So, they are useful to follow longitudinally.

Dr. Eric:

Yeah. One problem is, at least with endocrinologists, is that a lot of endocrinologists won’t test the antibodies. They just will look at the thyroid function test, TSH, free T3, free T4, and it depends on the doctor. Some doctors will do it every single time. Some will just do it initially to diagnose the person with thyroid autoimmunity, but, yeah, I agree. I guess it depends. In some cases, especially it seems like more so with the TSI, I do see when someone’s improving, it seems like it gradually decreases.

Again, there’s always exceptions, but sometimes with TPO antibodies, and the thyroglobulin antibodies, again, in my experience, it seems a little bit more of a fluctuation, where sometimes it will more of a roller coaster pattern, but, again, that does depend on the person. Do you think everybody with Graves’ should get their eye checked or you just think if they start experiencing symptoms and there’s…

Dr. Rani:

Not necessarily, no, because as you mentioned, the vast majority of people who have autoimmune thyroid disease, whether Graves’ or Hashimoto’s do not have eye symptoms related to their thyroid, but what I would say is … So, for most adults, they should have an annual eye checkup. So, just go see a regular eye doctor annually, and if there’s anything on the exam, then your doctor may go look further, but there’s no need to go rushing to get your baseline eye exam immediately after having the diagnosis.

Dr. Eric:

All right. Good deal. So, let’s go ahead and talk about some of the natural treatments, integrative treatments. So, what are some of the things that you recommend from an integrative standpoint for those with thyroid eye disease?

Dr. Rani:

So, I would say, first and foremost, is their diet. Most doctors, endocrinologists and ophthalmologists alike probably are not asking their patients about their diet, what they’re eating, but what I found in many of my thyroid eye disease patients is that they’re extremely sensitive to certain types of foods, and they know that when they eat those foods, their eye symptoms tend to flare up or perhaps they’re in remission and then they have a flareup, which is unfortunate.

The food groups that most people are sensitive to happen to be food groups that many people with autoimmune diseases are sensitive to. So, it’s not just specific to thyroid eye disease, but that includes, for example, gluten. Dairy is huge. I mean, I know some of my patients with thyroid eye disease, even if they have a little bit of hidden dairy in their food by accident, let’s say they go to a restaurant, there’s a little bit of cheese in what they’re eating, automatically the next day they feel it. They know that they’ve had something that caused them to flare up. Those are the two that I usually recommend that my patients avoid. Also, soy products and nightshades. Those are the main food groups that I recommend that my patients avoid.

Then for many of my patients, also, particularly the ones who have a lot of lid puffiness, it’s important to also be careful around histamine foods…like foods that are rich in histamine. It’s actually interesting. One of my colleagues and I did a study, this was a while back, maybe 15 plus years ago, using antihistamines for thyroid eye disease, and we found that people who actually took oral antihistamines tended to do better with their puffiness and their swelling, et cetera, just over-the-counter antihistamines like even Singulair or Claritin, Zyrtec can make a difference.

So, just from a dietary standpoint, it’s important to try to keep a food diary because what you may be sensitive to may be very individual to you, and it may not reflect what everyone else may be sensitive to. So, just try to see if there are certain things that are in your regular diet that you may be sensitive to, and then try to experiment and take them out for a few weeks, at least three weeks, but sometimes I tell people, “If you really want to investigate whether you’re sensitive to a certain food or not, eliminate it for a good three months, and then try to reintroduce it very slowly and see if you have a reaction to it.”

I don’t know what your experience is with foods and Graves’ disease and autoimmune thyroid conditions, but that’s been my approach, typically.

Dr. Eric:

I agree. I mean, I don’t think there’s a perfect diet that fits everyone, but I do have my patient with Graves’ and Hashimoto’s or at least most of them start out with an autoimmune paleo diet, and I always mention it’s a starting point, it doesn’t mean that, again, there are some people that don’t do well with it, and that could be the case with any diet, but autoimmune paleo diet, of course, involves avoiding gluten and dairy and soy and the nightshades, but it goes a step further, like corn and pretty much all grains, you’re avoiding and legumes, and even eggs. So, there’s a lot of people who find it challenging. Again, it doesn’t mean that everybody has a problem with eggs, but some people do. So, it’s just a starting point, and then eventually, we reintroduce foods.

You mentioned that most endocrinologists don’t bring up diet, and not only that, but I’ve had patients bring up diets to their endocrinologists and most of them will dismiss it. They won’t be open at all to diet playing a role in Graves’ disease, thyroid eye disease, and same thing with other autoimmune conditions. Usually, they dismiss diet, but, yeah, definitely, I see a huge difference.

That being said, I will say that diet isn’t everything, but what I tell patients is you could follow a strict autoimmune paleo diet or whatever, even a regular paleo diet, and there is a good chance you’ll notice some great improvements, but sometimes you do need to dig deeper. There could be potentially other triggers. Stress, you mentioned before, blocking out time for stress managements, and sometimes infections, and we live in a toxic world, so chemicals could also play a role.

Actually, one other thing. It ties into the supplement. I was going to ask you about supplements you recommend, but regarding the antihistamine. I don’t know if you’ve experimented with natural antihistamines like quercetin, for example, rather than taking something like Claritin.

Dr. Rani:

Yeah. So, I usually recommend that people get it through their food. If they want, they can take a supplement as well, but I usually recommend quercetin-rich foods like red onions, and apples, etc, as an anti-inflammatory, and also turmeric. So, curcumin is a potent anti-inflammatory. So, I do recommend people add that to their diet. If they do take a supplement, make sure you take one that has black pepper, so it helps with the absorption of the curcumin.

I just wanted to mention you were talking a little bit earlier about toxins. So, we know that one of the biggest triggers for thyroid eye disease is smoke and smoking. So, smoke contains, at least cigarette smoke, probably has over 400 different chemicals in it that get released. So, we don’t know exactly which of those chemicals may be triggering the thyroid eye disease, but we know, for sure, that people who smoke have a much higher, much more aggressive form of the disease, and many of them end up with optic nerve issues and potential vision loss. So, going a little bit beyond just stopping, smoking cessation and avoiding smoke.

I also do recommend that people try to avoid fumes of any kind, even cooking fumes, barbecue fumes. These can be really irritating to the eye. So, if you’re cooking, I usually recommend that, especially for people who actually have active thyroid eye disease, that they wear goggles or some covering for their eyes to protect their eyes from that direct exposure to smoke, et cetera.

So, I don’t know if you’ve ever heard that before, but it’s something that is really important, and I think most ophthalmologists do recommend that to their patients, but, again, I go a little bit further beyond just the smoking part of it.

Dr. Eric:

I’ve not heard about that. I actually did write an article years ago about cigarette smoking in Graves’ because in the literature, there’s also not just in thyroid eye disease, but Graves’ in general, a greater incidence of Graves’ disease in those who smoke, but, yeah, as far as avoiding other fumes I did not know. So, that, again, is good to know. How about other supplements like vitamin D is important for a healthy immune system?

Dr. Rani:

Yeah. Absolutely. So, vitamin D, sure, many people have heard this said, it’s not just a vitamin. It functions more like a hormone in the body. It has many, many different roles in the body. One of them is immune regulation. So, it is important to have a healthy immune system, having enough vitamin D, and most of us are vitamin D deficient, especially during the colder months of the year. So, you want to supplement with vitamin D.

I typically recommend my patients try to keep their vitamin D levels around 60 to 70. Now, of course, just check with your doctor to make sure that that’s okay for you. Some people like to go higher, but if you do go higher, you just have to be concerned about calcium deposition in your coronary arteries and you don’t want to develop heart issues because of high vitamin D levels, but you definitely want to, if you’re low or even on the low side, you want to just boost your vitamin D levels.

The other thing, the other mineral is selenium, which I’m sure many people are familiar with when it comes to the thyroid. So, selenium supplementation has been actually studied in thyroid eye disease by a European group, and it’s been shown to help reduce some of the congestion in the eye socket, and the inflammatory response. So, for selenium, the dose is anywhere from 100 mcg twice a day to 200 mcg twice a day is the typical recommended dose.

Dr. Eric:

All right. Well, what do you say about someone who would prefer to get their selenium through foods like Brazil nuts, for example?

Dr. Rani:

Yes. That’s a great resource as well. So, a handful of Brazil nuts, maybe two or three Brazil nuts are wonderful source.

Dr. Eric:

Yeah. The one thing I will say about that, I brought it up because a lot of people, whenever I bring up selenium, they’ll ask about that, and I agree that Brazil nuts are a good source of selenium, but you never know how much you’re getting in a specific Brazil nut. So, it could be anywhere from 10-20 mcg to 70-80 mcg. So, yeah. I am of the mindset you want to do as much through food as possible, but, honestly, if someone is dealing with active thyroid eye disease, usually I will recommend supplementation.

Dr. Rani:

Yeah. In terms of the nutrient content of foods, I just also wanted to bring up that the foods that we get now they’re not grown in the same type of soil that foods were grown decades ago. So, our soil is actually depleted of so many minerals now just because of changes in agricultural practices. So, even though you may think you’re having a wonderful diet and super healthy, probably the nutritional value of that produce, both fruits and vegetables, is lower than it really should be, especially as you mentioned. If you have active conditions, it’s probably best to take a supplement. Now, if you’re doing well, you probably don’t have to take a supplement, but if you actually have symptoms, it’s probably a good time to start.

Dr. Eric:

I agree. Even if you eat organic, it’s important to mention, because a lot of people will be like, “Well, if I’m eating organic,” but it’s still not the same as 10, 15, 20 years ago. So, active versus inactive thyroid eye disease, how long on average, I know it varies, but what do you see as far as active thyroid eye disease lasting?

Dr. Rani:

So, the active stage of the disease is when people actually have a lot of congestion. So, their eyelids, their eye sockets, that’s when people develop the bulging or it’s what we call proptosis is the medical term for bulging of the eyes. It usually lasts anywhere from two to three years, probably closer to two years in most people. It’s very difficult for patients during this time because they’re uncomfortable. Their vision is affected. They see blurry because of the surface issues, the dryness, etc. They have pressure. They may see double.

What people need to realize is that you have to wait the active phase out. Of course, there are things you can do to try to modulate that, but it does run a course of about two years, and you really have to be patient. Then the disease usually, some people call it like it burns itself out. It doesn’t really burn itself out, but it basically becomes stable, and then a lot of the edema, the swelling starts to go away. So, then the puffiness resolves a little bit. Sometimes the bulging improves as well, and then people may have what we call, again, the stable … Some people call it the fibrosing stage of thyroid eye disease. Fibrosing basically means that it’s scarring, but it doesn’t necessarily have to be scar tissue. It’s just not as active inflamed and edematous as the active phase, otherwise.

I think education is really important and just setting people’s expectations that, “Okay. It’s active right now. Let’s see how things are going to go,” and it may take a few years before things really start to quiet down.

Dr. Eric:

How about conventional treatments? So, you spoke a little bit about diet and supplementation. When is conventional treatment necessary for thyroid eye disease?

Dr. Rani:

Yeah. So when there’s a risk of vision loss is when, as ophthalmologists and neuro-ophthalmologists, we become very concerned. There are a couple of different mechanisms where people can develop vision loss. So, one is optic nerve compression that I was saying. If there’s a lot of congestion in the eye socket, the optic nerve can get compressed. People can have peripheral vision loss, central vision loss, color loss. So, that’s definitely an indication for medical treatment.

Also, if the eyes are very prominent, if they’re really bulging, and the eyelids just can’t close properly, then the cornea can get very dry. It can get so dried out that you can actually develop corneal ulcer because the cornea is just not lubricated properly. People can develop infection, which is an ulcer, and even scarring. So, those are the two real main indications for when medical treatment is really indicated, and usually in an emergency type situation.

I like to tell my patients, “Well, I approach this in an integrative way. So, yes, of course, we’re going to try the nutrients, the nutrition first and the supplements, and the conservative measures like using drops and using cool compresses, and using humidification, and essential oils. We’re going to try all of that, but if it ever gets to the stage where your vision is at risk, we’re not taking any chances.” In that situation, then, yes, it really is so important to be started on an agent that will help to decrease the swelling and protect your vision.

The typical treatment is steroids, and I hate to say that, but that really is. Unfortunately, we don’t have anything. Well, I’ll take that back. So, we do have something, which we can talk about, but prednisone in the acute setting is really what’s necessary to help preserve the optic nerve, and in cases where people have actually lost vision or significant vision, we actually sometimes admit them to the hospital and put them on three days of IV steroids. If it’s not so bad, we may just try oral steroids first just to get the swelling to go down, and then people can be tapered off the steroids over time, but up until now, that really has been the mainstay of treatment.

Then recently, actually last January, the FDA approved a medication. This is really the first FDA medication for thyroid eye disease, specifically for thyroid eye disease. It’s called teprotumumab, which is Tepezza, and it’s a biologic agent. Biologic basically means that it helps to modulate the immune system. What it does is it actually … So, what happens in thyroid eye disease is that a particular receptor gets activated called insulin-like growth factor receptor IGFR. So, Tepezza blocks that receptor. So, it blocks that activation. So, a lot of the changes that happen in the eye socket don’t happen.

So, Tepezza is given as an infusion. It’s usually given over the course of 24 weeks, basically, eight treatment every three weeks. So, 24 weeks of treatment. For patients with really active disease, where they have significant vision issues, maybe double vision, a lot of bulging of the eyes, swelling of the eyelids, it really has been extremely useful, and in many patients, really transformational for their care. Again, I remind patients that, yes, we try to approach things naturally whenever possible, but in some cases, we do have to really rely on our medical treatments and a little bit more aggressive treatment.

So, it is part of the toolbox, and it is just something to consider. Maybe have a discussion with your ophthalmologist or your neuro-ophthalmologist about if you may be a candidate and if you are not responding to natural treatments.

Dr. Eric:

As far as I know, it’s only available in the United States?

Dr. Rani:

I think it’s available in other countries as well. I do want to say it’s available in Europe.

Dr. Eric:

At least Canada, I mean, there might be other biological agents in Canada…

Dr. Rani:

Yeah. So, I’m not sure about that, about other countries, but one interesting thing that happened in the US was the drug got approved in January of 2020, and then the COVID pandemic hit, and then once the vaccines were being manufactured, the factory where they actually made Tepezza had to switch over. So, it was mandated by the government to switch over to making the COVID vaccine. So, that became a shortage of Tepezza in the country for quite some time, actually, and it wasn’t until I think about two weeks ago that it became available again. So, there were quite a few patients who were mid-treatment, who actually had to interrupt treatment.

Dr. Eric:

I have one of those patients. I’ve had a few patients. One of them was able to complete the course, fortunately, but then another one, yeah, had to get it interrupted, which was unfortunate.

Dr. Rani:

Yeah, and we don’t know now. If you’ve had been in that situation where you’ve not been able to get the medication or that you basically have to start again from scratch, I’m not really sure how that would work. The other medicine, it’s also biologic that has been used for thyroid eye disease. It’s something called rituximab or Rituxan. That’s actually a much more widely available drug. It’s also given as an infusion, but it’s given every six months. So, in countries where Tepezza may not yet be available, Rituxan is the next best option.

Dr. Eric:

All right. Now, that’s good to know. Then with Tepezza, again, I haven’t had a lot of patients get it, just a couple so far, but one person who was able to complete the course said that it greatly helped with the bulging, the lid retraction, but really didn’t help with the double vision. I don’t know if you’ve seen that or if, again, just varies depending on the person.

Dr. Rani:

Yeah. So, the clinical trial, actually, looked…the primary endpoint was bulging. So, Tepezza helped improve bulging by I think it was about 3 mm or so, but they found that there were some improvement in the double vision, but not enough to be fully restorative in terms of resolving the double completely. Ultimately, let’s say if you’re a candidate for Tepezza and you do Tepezza for 24 weeks, your doctor will assess how effective it was, and then some people actually need a second course of the drug. So, it’s now actually available as a second course.

Also, initially, with the study, they looked at patients who were only in the acute phase, only within nine months of having had symptoms, but now, I think there is a recent study that was published that showed that it’s also effective for people who have chronic thyroid eye disease. So, in that stable progressive phase, you may still be a candidate for Tepezza with the hopes that with some improved swelling, congestion in the eye socket that maybe the double vision may improve as well, but the double vision can be quite challenging to manage.

Clinically, we always start with the most conservative therapy there, which is prism therapy. I’m not sure if your audience is familiar with prisms, but prisms are basically, they’re optical devices that you can put on to glasses, and they basically realign the image onto your eye. So, it’s not realigning the eye itself, but it’s realigning the image so people don’t see double.

So, that’s very effective for many people to use a prism, but, ultimately, if the prism doesn’t help and also as things stabilize, if people still have double vision, then a surgery may be what’s really necessary to get rid of the double vision, but that’s the last resort. Surgery is really not something that we think of unless people are very refractory, they’re not improving to other standard treatments.

Dr. Eric:

Okay, and surgery, typically, is not done in the active phase, correct.

Dr. Rani:

Absolutely not. No. For double vision, so my typical rule of thumb is, first of all, I work with the patient’s endocrinologist to make sure that their thyroid is stable. So, once their thyroid is stable and if they’re on medication, once that’s stable for at least six months, then the clock starts ticking. Then I wait another six months to make sure that their double vision is stable also. The reason is because if someone has double vision and we operate too soon, and things are still changing, they’re dynamically changing in the eye socket, then that surgery may become ineffective because the double vision may come back or it may go the other way. So, it really is important to make sure that everything is 100% stable before having any kind of surgery for double vision. So, patients, it’s really challenging and it’s really difficult for some people to have to know that they have to wait that long, but, really, it’s in their best interest that they should be waiting.

Dr. Eric:

Okay. That makes sense. So, I think this might be my last question, radioactive iodine. So, radioactive iodine, it seems like in the research there is a little bit of controversy, as  it seems like it can potentially cause or exacerbate thyroid eye disease. So, a lot of endocrinologist won’t recommend radioactive iodine in thyroid eye disease patients. So, where do you stand on whether someone should receive radioactive iodine if they have thyroid eye disease?

Dr. Rani:

Yeah. So, what happens with radioactive iodine is, basically, the thyroid tissue is destroyed. A lot of thyroid hormone is released, and also the antibodies are released. That can actually create a thyroid storm in some patients. Even if they don’t have a thyroid storm, if you have a sudden release of a lot of hormone and antibody, the antibodies can, again, cross-react in the eye socket and trigger active thyroid eye disease. Whether they have it before or not, the patient may suddenly develop eye symptoms.

So, what I do is basically let the patient know that they should really work with their endocrinologist to first decide what treatment is best for them. Should they be on a medical agent like methimazole or PTU or do they really need radioactive ablation? If they do, then what I usually recommend is a short course of steroids starting one week before and two weeks after to prevent any exacerbation or activation of thyroid eye disease.

I dose it based on the patient’s weight. So, basically, what I do is I take the patient’s weight in kilograms. So, let’s say somebody is 70 kilos, you take half of that, so it would be 35, and I give them 35 mg of prednisone starting one week before the radioactive ablation and continuing two weeks after, and then that’s it. Then they don’t need anymore. So, that carries them through or covers them for that time.

I have to say, knock on wood, that with that regimen in all my patients, and I’ve seen thyroid eye disease patients for well over 20 years, none of them, knock on wood, have had activation of their thyroid eye disease after having had RAI. So, it’s just something to consider, and make sure you talk to your doctor about it whether they’re on agreement and they can maybe prescribe it for you if you really need to have that radioactive iodine.

Dr. Eric:

Okay. That’s interesting. Again, I try to encourage people if they can, obviously, I can’t tell them what to do and what not to do, but in my opinion, in most cases, radioactive iodine should be a last resort…radioactive iodine and thyroid surgery. So, my goal is to try to address the cause of the problem, but I think it’s important to talk about both sides because sometimes conventional treatment is necessary. So, I just wanted to get your opinion on that.

Dr. Rani:

Yeah. I agree completely. If you can manage it naturally, that’s the best way to do it, but at some point, if it’s really causing a detriment to your health, and it’s not being well-controlled with other treatments, then yes, an intervention is necessary…either thyroidectomy or partial thyroidectomy or RAI. The same holds true for surgeries. So, I do the same for my surgical patients. I put them on steroids for three weeks before and after. I do the same thing.

Dr. Eric:

Okay. So the same routine whether it’s surgery or radioactive iodine. All right. One more quick question that’s related to this. Can someone have mild thyroid eye disease but not know it? Do you just recommend it if they have overt thyroid eye disease or as far as…

Dr. Rani:

If a patient has been seeing me and I know that they have mild thyroid eye disease, I would absolutely recommend the prednisone, yeah. I guess what you’re asking about is what if they haven’t been formally diagnosed, it’s probably best that if you’re considering getting it done or if your endocrinologist is recommending it, go see your eye doctor. Again, see your ophthalmologist and preferably a neuro-ophthalmologist if you can get in to see one, and just get their idea, their opinion on whether it’s active or not. If there’s any indication it’s active, it’s probably best to be pretreated.

Dr. Eric:

All right. Great advice. Thank you for that. This was awesome. Thank you for all the information. So, before we dive into questions, I want you to briefly mention your masterclass that you’ll be having, and I’ll put up here, just if I could display it here, there we go.

Dr. Rani:

Yeah. Wonderful. So, thank you. I really enjoyed our conversation. There’s just so much to talk about. We could probably keep talking for an hour or so about thyroid eye disease. So, what I’m going to be offering is a masterclass, the thyroid eye disease masterclass an integrative approach, where I talk about specifically what are the signs and symptoms of thyroid eye disease, what are the natural ways you can try to combat thyroid eye disease.

Actually, in my practice, I use something called the thyroid eye disease diet or TEDD. So, I would be sharing that in the masterclass. Also, the specific types of supplements and botanicals that I found to be most effective for people with thyroid eye disease, as well as some of the essential oils that I use for my patients. In terms of dry eye, what are the best natural therapies for dry eye beyond just using drops, lubrication. What else can you do in your home environment to help with thyroid eye disease?

Also, just talking about some of the more medical treatments that we touched upon a little bit today. What are the indications? Also, lifestyle things you can do to decrease your risk of activation or worsening of thyroid eye disease.

So, I’m going to be offering this along with Dr. Eric. We’re going to, hopefully, do this together as a single masterclass. There’s only one module. It’s going to be tentatively on June 23rd, which is a Wednesday at 8:00 PM Eastern. Hopefully, if you’re interested, you can register. If you’re watching and you do decide to register, we are offering a 50% off discount. So, the normal price of the masterclass is $99, so then it would be $49.50. So, if you can go ahead and register, I think we’re going to have that available for the next week or so. Is that right, Dr. Eric?

Dr. Eric:

Yeah. I think we decided on a week from Friday, May 7th or, actually, today is Friday. That’s right. So, a week from today.

Dr. Rani:

A week from today, yeah. If you’re interested, please register early. There is limited capacity. There’s only 100 participants that we can have in the masterclass. So, please consider registering.

Dr. Eric:

All right. Wonderful. Well, you’re ready to answer some questions? Looks like we have a lot of questions.

Dr. Rani:

Absolutely. Okay. Wonderful.

Dr. Eric:

All right. Oh, and one other thing about the class also, if for any reason if someone is unable to make it, it’s hard to pick a time that works for everyone, but this will be recorded. So, if for any reason they can’t make it, they could always watch the recording?

Dr. Rani:

Absolutely. Also, I’ll make available downloadable PDF resources, so not just the thyroid eye disease diet, but my resources on how to manage dry eye, eye allergies with thyroid eye disease, digital eye strain, which is I know a big concern of many people is we spend hours looking at a screen. So, how can we help to manage that with thyroid eye disease. So, there’d still be a lot of resources available.

Dr. Eric:

All right. Good deal. Looking forward to that. So, let’s go and we’ll try to get to as many questions as we can. So, Tammy, it looks like myasthenia gravis. Do you have any experience in your practice?

Dr. Rani:

Absolutely. I’m so glad, Tammy, that you brought this up because … So, for people who are not familiar with myasthenia gravis, it is also an autoimmune disease. Myasthenia gravis and thyroid go hand-in-hand or at least thyroid eye disease and myasthenia gravis go hand-in-hand. What myasthenia does is it can cause double vision, and it can cause droopiness of the lids, so opposite of what thyroid eye disease does. So, thyroid eye disease causes wide open lids. Myasthenia gravis causes drooping.

So, a certain percentage of patients with thyroid eye disease will have coexisting myasthenia gravis, and a larger percentage of patients with myasthenia gravis will also have thyroid eye disease. So, definitely, if you have any of those symptoms that are a little bit unusual for just thyroid eye disease, ask your doctor about whether it could be myasthenia gravis or not, and get tested.

So, myasthenia gravis, there’s a couple of different tests for it. There’s a blood test looking for the antibodies. That’s the easiest way to test for it, but there are many people who have myasthenia where it affects the eyes, where their blood test is negative, and we have to go a little bit further. We have to dig a little bit deeper to figure out if someone has it or not.

The last thing I’m just going to mention about myasthenia gravis is that it causes weakness of the eye muscles, and that’s called ocular myasthenia or OMG, but there’s also a chance that other muscles in the body can get affected by myasthenia gravis as well, so your arms, your legs, breathing, swallowing, voice. So, definitely, if you have any symptoms of weakness, and you have a history of thyroid eye disease, definitely talk to your doctor and consider getting tested for myasthenia gravis.

Dr. Eric:

All right. Great. Thank you for that. Then May here has a question, “Do you have any advice for tearful eyes?”

Dr. Rani:

Yeah. So, there are many reasons why your eyes may be tearing. Actually, the most common reason is because the eyes are dry. It may seem very contradictory, “Why are my eyes tearing if they’re dry? That just doesn’t make sense,” but I’ll explain to you why that is. So, first of all, what happens is the surface of the eye dries out, and then we have a large tear gland up here called the lacrimal gland. In response to that dryness, it overproduces tears. So, people end up tearing when they have dry eye.

So, the way to deal with the tearing is to first treat the dry eye, and if you do that appropriately, then usually the tearing also improves as well. Then, again, with thyroid eye disease, there are many other reasons why people may have tearing. For example, eye allergies can also case tearing. Then just swelling of the surface of the eye can also cause tearing and even mucous discharge. So, a lot of other things can happen with thyroid eye disease that people should be aware of.

Dr. Eric:

All right. Jenny, you might have to clarify. I’m not sure if you mean thyroid hormone levels or sex hormone levels. Anyway, if you can maybe further elaborate, if Jenny could elaborate, but then Kelly here asks, “Can you have thyroid eye disease and not be sure?” which we answered that early on. Someone can have a mild case and it not being diagnosed, correct?

Dr. Rani:

Yes, and the best way to make the diagnosis is to get those thyroid auto antibodies done. Really, I advocate to get them done. So, your endocrinologist may say, “Oh, we don’t need them. We just need these TSH, free T4, T3,” but I would really strongly push to get the rest of the antibodies done because that will confirm the diagnosis.

Dr. Eric:

All right. Great. So, this is a bit of a long one, “Recently been diagnosed with demodex in my eyelids. Do you think this could be a sign of TED? Also, do you know how long it could take for demodex to go away? Can it spread to my scalp, nose, other parts of my body?” So, maybe, I don’t know if you could…

Dr. Rani:

Sure. Yeah. So, demodex is basically an infestation of the eyelids of, really, lice. So, we can get lice around the follicle, the hair follicle of the eyelash. So, it’s independent of thyroid eye disease, but it can certainly case irritation, inflammation. The best way to actually treat it is to really just smother the infestation. So, basically, you just goop up your eyelids at nighttime with an ointment, whether it’s just a regular ointment, eye ointment or an antibiotic ointment, and it basically just gets rid of those organisms.

Dr. Eric:

Okay. All right. Just a comment here, “After miscarriage of my twins, I developed Graves’.” I’m so sorry about that. Then Jenny, “I took an allergy test and histamine showed positive.” You mentioned earlier how sometimes the antihistamines can help with thyroid eye disease.

Dr. Rani:

Yeah. One of the things, as an integrative practitioner, that I also try to do for my patients is I do order food sensitivity testing because sometimes it’s really hard just to do a food diary to try to figure out what you may be sensitive to. So, sometimes it’s actually good to get a whole panel done so that you really know which foods you should try to stay away from. So, this is not IgE testing. This is IgG testing. So, I would again advocate for that. Talk to your practitioner about it. Ask if you can get it done, and it really will give you a lot of insights into the foods that your body may be sensitive to. I don’t know if you do that, Dr. Eric, in your practice, but I found it pretty effective.

Dr. Eric:

Yeah. I mean, I have done it. Sometimes I’ll do it. Every practitioner is different. So, I usually start people off with elimination type diet, and do an elimination and reintroduction. It’s not perfect. I find IgG testing … I don’t think there’s any perfect test or perfect method, but I usually reserve it if someone is not improving and we suspect … because we usually, with the part of an elimination diet, we’re having them eliminate pretty much just all the common allergens and things that could be causing inflammation. Of course, there’s always exceptions. Someone could be still reacting to something that they haven’t eliminated.

Speaking of food, so this person asked, “Why nightshades?” I don’t know if you want to talk about it or if you want me to talk about it.

Dr. Rani:

So, I’m not an expert in why nightshades. I mean, I have my theories, but I would love to get your opinion on it if you have some insights.

Dr. Eric:

If you visit my article, I’m sorry, my website, naturalendocrinesolutions.com. You search for nightshades. Essentially, there’s lectins and other compounds in the nightshades that potentially could be inflammatory. They’re not inflammatory necessarily in everybody. They can also potentially interfere with gut healing when someone is dealing really with any chronic health condition, but especially with autoimmunity. You really want to focus on healing the gut, but, yeah, that’s the main reason why you want to avoid nightshades.

Let’s see. Do you see anything as I scroll down? It looks like a lot of these are just comments and not questions. So, Stacy, “What’s good for the pain? I have terrible back pain from fibromyalgia.”

Yeah. It’s a little bit not necessarily related to the topic, but inflammation is huge. I mean, with fibromyalgia, also nutrients, mitochondria, mitochondrial dysfunction, which are nutrient-driven. So, again, as we discussed before, even though you want to try to eat whole healthy foods, in my experience, when someone has nutrient deficiencies, usually, supplementation is required.

Then Dr. Rani mentioned other things that could help with inflammation like turmeric, curcumin, CBD oil, a lot of people are using these, but with that being said, you also want to address the cause of the problem. So, is it a nutrient deficiency? Do you have a chronic infection? Are you eating an inflammatory food such as gluten or dairy? So, there are things that you could take like the curcumin, like the CBD oil, and there are other things you could take for pain. Also, you want to try to address what’s causing the pain.

All right. “How much vitamin D daily?” This does depend. In my practice, and most practitioners will test vitamin D levels, 25-hydroxy vitamin D, and then based on the results. As Dr. Rani says, I like to see a minimum above 50, but some like to see between 60 and 80. My levels is usually upper 50s, lower 60s. As Dr. Rani said, you don’t want it to be too high. So, probably a good idea to work with a practitioner just to make sure you’re not taking too much vitamin D. Then, of course, try to get as much sun as you can as well.

All right. This person, the salt question. So, I mean, I usually recommend, I think, Celtic sea salt is fine, natural sea salt. I think Himalayan salts, for years, I’ve mentioned that it was fine, but recently, there’s been a book that says that Himalayan salt is higher in iodine, which I … I’m not sure. I’ve had people take Himalayan salts without a problem, but Celtic sea salt seems to be pretty safe to take.

Dr. Rani:

Yeah. I’ll just add a comment about salt intake. I do notice that when my patients do report that they’re on high salt diet that their eyelid swelling is worse. So, I usually do salt restrict my patients if they have active Graves’, just as an aside since we’re talking about salt.

Dr. Eric:

Hmm, interesting. So, even like sea salt?

Dr. Rani:

Yeah, especially, I mean, people will notice it especially after they have been sleeping. They tend to have a lot of because they’re lying flat. So, all that congestion, the fluid accumulates in their lid. So, really, it’s just more puffy, but then when they reduce their salt intake or eliminate it completely as much as possible, then they have less swelling in the morning. So, it’s just something you can experiment with to see how your salt intake may impact your thyroid eye disease.

Dr. Eric:

Besides the sea salt, there’s salts in everything. Anything that’s packaged or processed, I mean, if you’re buying fresh fruits and vegetables, you don’t have to worry, but anything that pretty much comes packaged will have sodium. So, that’s also worth mentioning as well.

By the way, Dr. Rani, how are you on time? Do you have a few minutes?

Dr. Rani:

Oh, yes, I can. Yeah, I’m good.

Dr. Eric:

Okay. All right. So, Emem here says, “I’ve read that selenium supplementation can make iodine deficiency worse. With that in mind, although high dose iodine can aggravate Graves’ disease, do you recommend that Graves’ disease patients who want to try selenium for thyroid eye disease also supplement with a small amount of iodine?

I’d love to get your feedback, but I will say that, there’s definitely a lot of controversy with iodine and thyroid health. So, I was one of those that was on the bandwagon years ago. I took high dose iodine. I did fine. I did really good with iodine. So, I was one of those people that was able to tolerate it well. Early on my practice, I would have everybody do urinary testing for iodine, and for those who were deficient would put people on iodine. A lot of people did okay, but not everybody. Sometimes it does seem to make people worse.

Again, I’ve written about this in articles as well. So, I’m not anti-iodine, but I’m definitely cautious when it comes to iodine. So, even if someone is deficient in iodine, even if they’re deficient, I’d be a little bit cautious about having them supplement with iodine, but, especially, just randomly, take iodine. I can’t say it’s something I recommend to my patients, but, again, I’d like to hear what you have to say.

Dr. Rani:

Yeah. I also typically don’t recommend it. If it’s naturally present in foods, then that’s fine, but I wouldn’t take an extra supplement. Now, in terms of the other question, I think maybe she was getting at whether the iodine could be a competitive inhibitor of selenium. I think maybe that was the other question was. I don’t know. I don’t think that they have the same function in the body. Selenium has many different functions. So, I don’t think that they would be a competitive inhibitor of each other.

Dr. Eric:

I would agree. Yeah. I skipped over that, but I haven’t heard where taking selenium will worsen an iodine deficiency. All right. Someone is using eye pressure drops it looks like.

Dr. Rani:

Yeah. So, I’ll just talk a little bit about eye pressure if we have a few minutes.

Dr. Eric:

Sure.

Dr. Rani:

So, one of the other manifestations of thyroid eye disease is because there’s so much pressure, congestion in the eye socket, the eye pressure can go up. Eye pressure is different than blood pressure. It’s actually the pressure within the eyeball itself. So, many people, it’s something that we worry about because if their eye pressure goes up, then they can have damage to their optic nerve or a type of glaucoma.

So, certainly, if you do have orbital symptoms or eye socket symptoms, get your pressure checked by your eye doctor. If it is elevated or if it’s quite elevated, usually in the 30s or so, we do start patients on drops. Hopefully, once their swelling improves, their congestion improves, patients can come off the drops, but it’s more of a protection that patients need the eye drop for.

Dr. Eric:

Okay. Cool. Thank you for that. How about this question? “Would you recommend Tepezza if the proptosis is only 2 mm difference?”

Dr. Rani:

So, it’s FDA-approved for greater than 3 mm. So, 2 mm is actually, glad you brought this up, it’s actually within the range of normal. Many normal people have a difference in their eyes of 2 mm, but three or more is typically what we attribute to thyroid eye disease. So, right now, there are very strict guidelines on whether insurance carriers will cover Tepezza, and one of those guidelines is the amount of proptosis or the asymmetry in proptosis.

Dr. Eric:

All right. Thank you for that. “Could you talk about the pros and cons of Tepezza versus the second infusion option that was just mentioned?”

Dr. Rani:

Sure. So, the second infusion option is Rituxan. It’s R-I-T-U-X-A-N or rituximab. So, rituximab has been used. It’s a slightly different biologic. It works on B cells. It’s a CD20 inhibitor. Rituxan has been used for many, many years. It’s been out there for many years, for many different inflammatory conditions ranging from a lot of eye conditions that we use it for.

So, it has more data behind it. In terms of its actual benefits for thyroid eye disease, it’s never been formally studied head-to-head with Tepezza, so we don’t know if one is better than the other. They’ve been independently looked at in clinical trials. So, again, we can’t really answer that question whether one is better than the other.

In terms of side effect profile, I think Tepezza has a very low side effect profile. Probably, Rituxan has a couple more side effects, but it is less frequent. So, Tepezza is every three weeks versus Rituxan is every six months. So, there’s a big difference in terms of the frequency of the treatment.

Dr. Eric:

So, a single infusion every six months?

Dr. Rani:

Single infusion every six months. So, there’s a first dose and then two weeks later, there’s a second loading dose, but then after the second dose, it’s every six months.

Dr. Eric:

Okay. Does everybody need that? After six months, a lot can change.

Dr. Rani:

A lot can change, yeah. So, usually, people need maybe one or two cycles of it before they start to respond, but then there are other conditions where people need it really indefinitely every six months. There are other autoimmune conditions that I manage that affect the eyes, where people do need it a lot longer.

Dr. Eric:

All right. Thank you for that. This is just someone thanking you for this.

Dr. Rani:

You’re very welcome. Thank you for tuning in.

Dr. Eric:

Yeah. We appreciate everyone tuning in and asking questions. Then Julie here asks, “I had very mild thyroid eye disease when I had two doses of radioactive iodine five years ago. It has become very active and much more severe. What can I do to help it?”

Dr. Rani:

Yeah. So, it really depends, again, on what your specific symptoms are, whether it’s puffiness, whether it’s bulging, double vision, dryness. So, certainly, talk to your doctor about the stage that you’re at, whether it’s still in the active phase or maybe now hopefully after a couple of years, if this all started five years ago, hopefully it’s becoming a lot more transitioning into that more quiescent chronic stage. Talk to your doctor about the options whether it’s drops, supplements or something perhaps a little bit more involved like either medications or even surgery may be an option for you.

I would also suggest perhaps considering taking the masterclass that we talked about because I will talk about, okay, for this stage, these are the best options, and then if it progresses to this stage, these are the best options, and then so on. So, I will break that down in the masterclass.

Dr. Eric:

Great. I’ll bring that up quickly again. Are you good for maybe another three questions?

Dr. Rani:

Sure. Sure.

Dr. Eric:

Okay. Great. So, Jenny is just saying thank you and thank you, Jenny.

Dr. Rani:

Thank you. You’re very, very welcome.

Dr. Eric:

All right. Let’s see. Another, Debra, “Had radioactive iodine two years after thyroid eye disease, Graves’ diagnosis. PTU, methimazole sadly didn’t work for remission. Liver could be damaged at two years on these meds. Took prednisone before radioactive iodine, and after largest radioactive iodine dose allowed without hospitalization. Helped reduce more bulging, then waited to have six reconstructive surgeries in two years.” Wow. “Still get kenalog injections into orbit when they swell or hurt years later like steroid direct into affected area than oral steroid pill and bounce-”

Dr. Rani:

Oh, I’m so sorry to hear that, Debra. Yeah, you’ve been through so much. Again, I haven’t examined you. I haven’t seen you, but from what you’re telling me, it seems like it’s still active despite having the surgeries and the steroids, etc.

You may be a candidate for Tepezza even though it’s been some time. So, definitely talk to your doctor about that option just to get everything to calm down because there’s still some activity there it sounds like. It’s not great getting kenalog injections into the eye socket because that type of a steroid injected into the eye socket, it can cause problems. It can actually lead to high eye pressure, glaucoma even, thinning of some of the muscles in the eye. So, definitely talk to your doctor about the options.

Dr. Eric:

Yeah. I was just going to ask you about the kenalog injections, but you’ve answered the question, so very cool. All right. We’ll go through two more questions. So, “My anti-thyroid peroxidase, anti-TPO levels are 154, not the best, but I manage to lower them. Before they were 195. Still, my right eye is bulging. I know when my levels are not normal because my right eye lets me know right away.”

Yeah. So, again, I will say, and Dr. Rani could also give her feedback, but of course, I don’t know what you did as far as lowering them, but try to do as much as you can through diet and lifestyle. Again, maybe attend the masterclass as well. Tepezza might be an option as well. Again, I think even with that, I will say with the Tepezza, again, I would say probably more for moderate, severe cases of thyroid eye disease, and then also from what I understand, it’s also very expensive for those who don’t have insurance, too.

Dr. Rani:

It is.

Dr. Eric:

Yeah. So, it’s not an option for everyone, unfortunately.

Dr. Rani:

Yeah. So, just to provide a comment there. It’s wonderful that you’re so in tune with your symptoms. Many people, they may dismiss certain symptoms, but it’s wonderful that you’re in tune and you know that, you feel, you can tell from your eye status what your antibody levels are. So I applaud you for that because it’s important to just be aware that you can convey to your doctor what’s going on better and hopefully get treatment that you need if necessary.

I also just want to say about the Tepezza. So, it is expensive. It’s estimated that one course of treatment costs $200,000. So, that’s eight infusions. So, I don’t know whether the price will be going down at any time in the future, but right now, it is at that level. So, it is sometimes challenging for patients to get the authorization that they need to get the medications, but I do think that the company offers some patient assistance programs, so certainly if you qualify based on the criteria.

I didn’t mention this earlier, but I just wanted to show you all. I don’t know if you can see this here. The CAS score is Clinical Activity Scale. Basically, it’s a guide here. I don’t know if you can see here. I’m not quite centered here, but there is a rating scale that we use to really determine how active a person’s thyroid eye disease is. Really for Tepezza to be approved, people have to meet some of these criteria based on their CAS score or worsening of their CAS score.

So, this is something that, again, you can talk to your eye doctor about assessing that score to see if you may qualify for Tepezza and also whether your insurance will cover it or not.

Dr. Eric:

I could also include that sheet as well when I send out the email with the link to the recording.

Dr. Rani:

Absolutely. Yeah. So, I’ll scan this in and create a PDF of it and then we can include that with the link.

Dr. Eric:

Yeah. Let’s get to one more question. So, Lily here and, again, if we didn’t get to your question, I am so sorry, but we might do another one of these in the future. Again, definitely consider joining the masterclass. So, Lily asks, “Hello, Dr. Banik. Thank you for taking my question. I was diagnosed with Graves’ disease in 2018, and my very first symptom was thyroid eye disease. Before, I had bulging eye in the left. I developed heavy eye bags below my eyes first. My blood test has been normal for T3, T4, and TSH for a year now. So, my bulging eyes has gotten better, but the heavy eye bags are still there. Are the cause for the bulging eyes are the same cause for the eye bags? Will the eye bags improve later or will they not?”

Dr. Rani:

Yeah. Great question. So, many people actually experience this where it’s not just the lids that get puffy and swollen, but they actually develop bags. What the bags are are actually fat pads. We have fat pads in the eye socket to help cushion the eye, the eyeball, etc. So, those fat pads get inflamed with thyroid eye disease. It’s all due to that insulin-like growth factor receptor being activated. So, there’s a lot of tissue that gets laid down in those fat pads and makes them very prominent.

Now, what I’ll tell you is that after the active phase of the disease improves, many times the fat pads do increase in size, but they may not go back 100% to how they used to be, how you used to look. I’ve actually only had a handful of patients where they actually went back to their normal pre-thyroid eye disease state. Sorry. Sometimes the fat pads do persist, and in that case, again, some of the natural treatments that we’ve talked about can be effective.

Ultimately, sometimes there’s a surgery that can be done to actually remove the fat pads or to decrease their volume to help people just have better cosmetic appearance. We didn’t talk about this aspect as much about thyroid eye disease, but the cosmetic changes can really be so, for some people, really, really to difficult to manage and very debilitating and their self-image is just so affected by the cosmetic changes, but there are wonderful treatments out there for the cosmetic treatments.

Now, of course, many of them are surgical options, whether it’s lid surgery or something called blepharoplasty, where sometimes the skin and the fat is removed or strabismus surgery, which is where the eyes are realigned. There are many cosmetic options out there. Even orbital decompression, which we didn’t mention at all, but it’s basically a surgery to remove some of the bone to help the eyes go back into a more natural position.

So, those are all extremely effective treatments. Now, of course, they’re surgeries, so they’re not taken lightly and they have to be timed right, but they are wonderful options to help to restore cosmesis and improve people’s appearance, make them look more similar to how they used to look before they had thyroid eye disease.

Dr. Eric:                All right. Thank you for mentioning that. Again, thank you so much for this interview, for getting together for this Facebook live. Hopefully, everyone found it valuable. Again, consider attending the masterclass if you’re dealing with thyroid eye disease. Again, you could just visit thyroideyediseaseclass.com. Until next Friday, a week from today, Friday, May 7th, you could get a 50% discount by entering the code TED. I assume during that class we’ll also be doing some Q&A.

Dr. Rani:

Absolutely. Yes. So, we’ll do a didactic session, and then we’ll stay on for Q&A as long as people have questions. So, happy to answer all your questions. Thank you for having me. I enjoyed our conversation, and I think we covered a tremendous amount, which is amazing. I loved all the questions people typed in. It’s really wonderful to make this an interactive session. So, thank you for having me.

Dr. Eric:

Yeah, you’re welcome. It was great. Excited for the masterclass. Again, maybe in the future we’ll get together for another Facebook live because we definitely had a lot of interest, a lot of questions. Again, I apologize for the questions that didn’t get answered, but definitely, if you can, show up to the masterclass. As Dr. Rani says, we will have a Q&A session there as well.

Well, anyway, everyone, hope you have a wonderful Friday, a wonderful weekend ahead. Again, thank you so much, Dr. Rani, for getting together.

Dr. Rani:

Thank you, Dr. Eric. It’s my pleasure.

Dr. Eric:

All right. Take care, everyone.

Dr. Rani:

Bye-bye.

On Friday April 9th I interviewed Dr. Beverly Yates on insulin resistance and type 2 diabetes, and below is the written transcript. If you would prefer to watch the interview you can access it by clicking here:

Here is the transcript:

Dr. Eric:                                                                                       

I have a very special guest, Dr. Beverly Yates. Dr. Beverly is a diabetes expert and author who has over 27 years of experience working with those who struggle with blood sugar issues related to Type 2 diabetes and prediabetes. And she is the creator of the Yates Protocol, which is a simple and effective lifestyle-based program for people who have Type 2 diabetes or prediabetes. It helps them to achieve blood sugar control, healthy A1C, and fasting blood sugar levels.

Dr. Eric:

Dr. Yates, she’s on a mission to help 3 million people heal from Type 2 diabetes and prediabetes. She is an internationally recognized speaker and expert in the field of diabetes and heart disease. She is author of Heart Health for Black Women, A Natural Approach to Healing and Preventing Heart Disease, and co-author with Jack Canfield of the Soul of Success, volume two. Dr. Beverly, I really look forward to talking with you about insulin resistance and Type 2 diabetes. Thank you so much for allowing me to interview you.

Dr. Beverly:

Hey, it’s my honor. Thank you so much, Dr. Eric, for reaching out. I’m delighted to have this conversation with you today. I hope we are able to help folks get motivated and to feel inspired and to have maybe some more clarity about how these things can happen, how they interact, and most importantly, what they can actually do that would be helpful for themselves.

Dr. Eric:

Yes, I agree. Why don’t we start out with some basics. For those who might not be familiar with insulin, if you could just describe what insulin is, why insulin is important.

Dr. Beverly:

Sure. Insulin is a hormone that is made in your pancreas, and it’s made in a particular part of the pancreas called the islets of Langerhans. And specifically as that’s secreted, insulin does some amazing things for you. It is what grabs up your blood sugar, also known as glucose, and makes that energy ideally available inside of your cells. Insulin does a lot of things for you. You don’t have to think about it consciously. This all happens in the background if your body still makes insulin. If you don’t make the insulin naturally, if you have no insulin production at all, then that person is a person who is diagnosed as a Type 1 diabetic. That is a distinction and that’s different than people who have Type 2 diabetes or prediabetes where their pancreas does indeed still make insulin and perhaps their body’s just not as sensitive to it anymore or is insulin resistant.

Dr. Eric:

Okay. So is prediabetes then the same as insulin resistance?

Dr. Beverly:

Some would say yes, some would say no. That could be a point of controversy and you could say it’s just wordplay, maybe it’s semantics. I think it like this. Prediabetes is watching this train wreck in slow motion. That’s how I explain it to my patients. And so a lot of people will comment and will say, oh, well, I’ve been watching this with my doctor for years and we haven’t really done anything about it. I’ll come back in six months. Then we test certain blood markers, whether it’s fasting blood sugar, or it is A1C, things like that. And then they’ll say, “Well, come back in six months. We’ll see how you’re doing. We’ll just keep an eye on your sugars.”

That’s a common conversation anywhere in the country, perhaps maybe even around the world, but certainly in the US this is often standard conventional medical treatment. And the person’s blood sugar unfortunately will often start to creep up, creep up, creep up, creep up over time. And then when they finally hit a certain number, then they have Type 2 diabetes. And to me, that’s watching the train wreck in slow motion. If you had an actual physical train on the tracks, Dr. Eric, would you be okay with watching that train wreck in slow motion?

Dr. Eric:

Nope.

Dr. Beverly:

Yeah. We’re on the same page. I know we are.

Dr. Eric:

So obviously diet and lifestyle play a big role with both insulin resistance and Type 2 diabetes. And I guess, because you also mentioned Type 1 diabetes, so how does Type 2 diabetes differ from Type 1? And there’s also…I don’t know if you want to get into Type 3 diabetes, but at least Type 1 and Type 2 and maybe differentiate between those two.

Dr. Beverly:

Yeah. People are more familiar with that. With Type 1, it’s one where there’s usually been an autoimmune attack on the pancreas and it has made it unable to produce insulin naturally. That’s typically what is the way Type 1 can unfold. Historically, it used to be something that happened at childhood, a sort of an illness, childhood onset. I definitely know adults who’ve had onset of Type 1. I think a lot of things are changing in our world, whether it is the chemical soup we’re all in, the amount of stress that we are under that is just relentless, etc. Any number of things I think can provoke that autoimmune attack. And so Type 1 diabetes is not strictly anymore just childhood onset.

Similarly, it used to be that Type 2 diabetes in any medical setting was always taught as being adult onset and usually older adults, people in their 60s, 70s, 80s. Now you can have unfortunately people with Type 2 diabetes in their 20s and even as young as 10 years old, which I think there’s a lot that’s wrong in that situation. And nutrition can play a huge part here, regular consistent exercise, but there’s also two pillars that people usually don’t talk about that are every bit as important. That is consistent, great sleep and being able to alleviate stress so that the person isn’t chronically and severely stressed, huge difference because sleep and stress can just run off with blood sugar.

People often accidentally become diabetic. They certainly aren’t trying to have health problems. And unfortunately, the way the conversation often goes, at least here in the US, and I know this is on the internet so people can see it from all over the world. But at least here in the US, people often talk about Type 2 diabetes and prediabetes with a tone of blame or shame as if people are trying to struggle and to have a hard time. I always want to dispel that myth and call out that nonsense right up, because it’s not fair, it’s not true. And it’s not helpful. No one’s trying to correct their health, but now here they have this situation. We need to be able to embrace people, have empathy and help them to make their situation so much better.

Dr. Eric:

You mentioned stress and sleep can cause blood sugar issues.

Dr. Beverly:

Yes, most definitely.

Dr. Eric:

And I guess it’s a little bit of a catch 22 because if someone has blood sugar issues, they might also have problems sleeping, correct?

Dr. Beverly:

One can be like a chicken and egg, which one came first. Similarly with thyroid. People often present with thyroid problems and they often say they’re fatigued. Well, when they have blood sugar issues, they’re often really fatigued. Fatigue is a tricky thing. There’s at least 80 things that could cause fatigue at least. It’s a big list.

Dr. Eric:

Yeah. A good point. There could be numerous causes of fatigue, numerous causes of sleep problems, not just blood sugar obviously. So when it comes to your patients, it sounds like that you, just like I do, I talk about the importance of stress management, importance of sleep in addition to eating well. So diet wise, and again, I don’t know how deep you want to get into the diet, but what typically do you recommend from a diet perspective? Do you recommend more of a ketogenic diet or more of a Paleo diet or just like a whole foods, low sugar, low carbohydrate diet?

Dr. Beverly:

Yeah. In terms of levels I’m always mindful, right? When I talk to my patients, I’m listening carefully about what their history has been with food. Some people’s history is very simple and uncomplicated. For people who have issues where they have emotional eating, or if they know they’ll eat with a lot of stress, they’re stress eater is how they usually say it, or if they truly have disordered eating and they know it. If they have a history of anorexia, bulimia, things like that. I know I need to tread very carefully on any nutritional recommendations I make, else we trigger and set people up to have a problem and to fail. And that’s not what we’re here for. We want to see our patients succeed and thrive.

So I don’t necessarily recommend exclusively one approach over another. What I do emphasize is that they eat a more whole foods regimen relative to what’s going to be safe for them and that they can be successful with. Sometimes I have people do lab testing for food intolerances because food intolerances or food sensitivities can often set up all kinds of problems, including frankly, blood sugar battles. It can also cause cravings because of that oddball reaction where you get that 15 minutes of dopamine pleasure from eating whatever it is that isn’t a food intolerance and then the crash that comes after it and your blood sugar might do that same thing. Go up and bam, it crashes.

So with food, here’s the things that I tell people to do for whom the main conversation is around blood sugar health which is focused on having them become friends with two kinds of food groups, high fiber along with leafy green vegetables. Leafy green vegetables are so full of hydration and water and nutrients. They’ve got lots of vital nutrients. They’ve got vitamins, minerals, antioxidants, polyphenols. They’ve got it all. And that fiber helps to fill you up so you feel full. A lot of times people forget to drink water if they had to drink anything, and then when they finally do, they tend to go towards maybe sweetened beverages, even if it’s artificially sweetened. So they’ve got these fiber goodies in them, these leafy green vegetables and other sources of fiber, it often helps to mute the damage. It helps to get that blood sugar instead of it being this rollercoaster event, make a much more even blood sugar throughout the day. Something I tell people to do is controversial.

Dr. Eric:

What’s that?

Dr. Beverly:

I have people start their day with leafy green vegetables. We make it a featured element of breakfast. And then we add it into lunch and to dinner. And at first people are like, “Dr. Bev., you got to be kidding me. Who eats vegetables at breakfast?” I’m like, “I do. A lot of people, the people who work with me do.” And then after time people love it because they begin to realize it sets up a whole day for success. That one simple thing.

Dr. Eric:

So you recommend it as part of a salad?

Dr. Beverly:

It could be a salad, it could be its own dish. It could be like for instance some… Well, before the pandemic, some of my patients traveled a lot. And so I would tell them wherever you land, get a bag or a pre-washed box of leafy greens because now salad boxes, things like that, it’s like $3, $5. Anywhere in the country, it’s gotten so much more affordable and convenient and get a handful. If you’re going to eat a buffet at a hotel or something like that, bring it with you. That way you’re not at the mercy of somebody else’s idea of breakfast, which is probably some sort of variation of a white bread and some sort of greasy kind of meat. And that’s it for breakfast, right? Bring your veggies with you. It could be steamed spinach. It could be a salad if you like. It doesn’t need to be as fancy as a salad. Literally a handful of say leafy greens. You could have already cooked some if you’re at home. It could be kale, it could be chard, it could be collard greens, bok choy, broccoli. Anything leafy and green, eat it.

Dr. Eric:

All right. I have to ask you then, because I do eat leafy green vegetables for my first meal, but it’s usually in the form of a smoothie. I personally don’t have any blood sugar issues, but for someone who is pre-diabetic or has Type 2 diabetes, is there an issue with both juicing and smoothies? Smoothies is keeping in the fiber, but still some will say maybe that those with blood sugar imbalances shouldn’t have smoothies and maybe they should have a salad. So I’d love to hear what you have to say about that.

Dr. Beverly:

Sure. That’s a great question. I’m so glad you’re calling that one out specifically. I think smoothies are fine for everyone. However, now that I just said that, to me, a smoothie has probably a base fruit in it like say banana, something like that. Bananas have electrolytes, including potassium. Many people are low in potassium. Apricots, plums, dates, things like that, they’re all good for potassium. Typically when people are taking medications, and many people with diabetes often have blood pressure issues so they might well be on a med that’s causing them to leak potassium. So of course they eat the banana from a blood sugar point of view, it’s high on the glycemic index.

Now, not everybody gets a spike in their blood sugar from eating bananas, but some people do. That’s why I say test, don’t guess. When you eat, check your blood sugar, find out if you are having a big response to a food. And if it’s out of bounds, you either cut that food in half, or maybe you just need to eliminate it depending on how sensitive you are. But for smoothie, though, Dr. Eric, I will have people add protein powders along with the banana. We might add ground flax seeds in there for additional fiber boost. And then we can add in things like fresh spinach. We can add in celery, we can add in ginger, apples with the skin on.

I have people eat their fruit with the skin on unless it’s a banana, that’s a little much. But if it’s like peaches, apricots, apples, please don’t peel them because sometimes you will even get say peaches from a can or a jar with a syrup on it and they’re like, “No, ditch that syrup take that peach and rinse it.” You don’t need the extra syrup. And better if you can get the peach fresh, local and in season. You know what I’m saying? Set yourself up for success. So that base smoothie, you can add avocados. There’s just so many things you can add to a smoothie. So I don’t rule things out based on the name. I say, make sure we make it nutrient packed so that you can be healthy and whole and help that blood sugar to heal. That’s what we’re after.

Dr. Eric:

All right. That sounds good. I typically add berries to my smoothie, usually like half a cup of like blackberries or blueberries.

Dr. Beverly:

Berries are great. Those are usually gentle on blood sugar for most people.

Dr. Eric:

Sticking to the topic of fruit…when I first made smoothies years ago, it was more of a fruit smoothie and over time I made the transition to more and more veggies. Now I have five, six, sometimes seven cups of veggies and only a small amount of fruit. Is there any problem with the opposite, having like three or four cups, maybe not five, six, seven cups of fruit, but three or four cups of fruit, or does it depend on the person?

Dr. Beverly:

I’d say it depends on the person. But as a general guideline, if blood sugar is your primary issue, you really don’t want to run a muck with fruits. That doesn’t mean you have to avoid them entirely. Fruits, just like vegetables, are full of nutrients. They have the polyphenols, the antioxidants, the vitamins, minerals, all kinds of goodness, fiber and water. They have hydration actually just packed in there. The thing about fruit is sometimes if a person has a tendency to have a sweet tooth, that you crave sweets, it might be something that kind of pushes them that way. And some people just don’t know when it’s enough. They don’t really measure and they just pour, pour, pour.

And so instead of say having up to a cup of fruit in a smoothie, they might have three, four, five cups of fruit which their blood sugar tolerance, their situation is probably not going to be very kind about. Not a good idea. So I always tell people to start with a small amount, like say a half cup of something, like say a blackberry or a blueberry or a strawberry, raspberry, because those little Harry Berry fruits, they have plenty of fiber, other nutrients. And again, test. Test, don’t guess. Use your glucometer, check that blood sugar, see how you respond. And if your blood sugar is in a good place, it’s okay. But if you have three, four or five cups and you find your blood sugar has spiked, now you have your answer. It’s too much at one time.

Dr. Eric:

Okay. No, that’s great. Just to clarify, do you recommend a glucometer? I assume pretty much all your patients have either prediabetes or Type 2 diabetes. So would you say just people in general, even those who don’t have blood sugar issues, should use a glucometer or mainly those who are pre-diabetic or have Type 2 diabetes?

Dr. Beverly:

Great question. Those who have already been diagnosed with prediabetes or Type 2 diabetes, absolutely you should have a glucometer and should do testing. Now we have even the continuous glucose monitor options, CGMs. I don’t have one, I don’t have diabetes, but just letting you know. I’ll just pan this because that’s where they go now, which is really an amazing piece of technology which is so helpful, so people aren’t constantly having to stick their fingers to get that proper blood. I would recommend if someone has a family history of diabetes, and I do know people who are vigilant this way, that they too check their blood regularly, get that glucometer, get the glucose strips and test so that you too know.

Don’t wait for the train to wreck because sometimes this stuff comes up pretty silently. It can be rather sneaky and you may not have any idea your blood sugar is in that range for either prediabetes or Type 2 diabetes. And then they’re often shocked when they show up at their doctor’s office. You can do this for yourself at home quite safely. There’s just no mystery around how to do these things these days.

Dr. Eric:

All right. How about blood testing for blood sugar? There’s glucose, of course. Fasting glucose I assume is what you recommend, and then hemoglobin A1C, we have insulin. I assume you use at least some if not all of those markers.

Dr. Beverly:

Yes, yes. I look at people’s fasting blood sugar, their fasting morning glucose levels because that’s an important indication of blood sugar regulation. It really should be under 100 when they awaken and go to the lab because they’ve had an entire nighttime’s worth of sleep. Hopefully they had a good night’s sleep. We want to know if the body has reset. So many things happen in sleep. That’s a different interview. So many things happen in sleep, but that blood sugar should reset. It absolutely should be under 100. Ideally, it’s somewhere, in my opinion, between 80 to 90 for good blood sugar relation. It’s not too low so that they feel hypoglycemic and it’s not over 100 and all where their blood sugar didn’t dip low enough that their metabolism reset. We really need those resets throughout the day. I feel like your soul, your body, your spirit, your mind, everything has to reset with sleep.

Dr. Beverly:

And then for A1C, I always love to see it in the fours. Of course, if somebody has prediabetes or Type 2 diabetes, their A1C is not in the fours. From about 5.6 to 5.7, it’s still not yet technically considered pre-diabetic. When I start to see that upward creek, now I’m getting concerned for that person. Then when they hit 5.8, 5.9, 6.0 and up to 6.3, that’s the range, from about 5.8 to 6.3 for prediabetes. 6.4 and higher is considered Type 2 diabetes. If they’re on medications, their doctor might say, oh, well, as long as your blood sugar is under a 6.4, then you’re well-controlled, and they may not consider you. Technically they still have Type 2 diabetes, but if you go off the meds and your blood sugar is still there, you do have Type 2 diabetes.

The good news is that it can indeed be reversed. But if you go back to anything that was causing it beforehand, it will return. So this is the big, big work. The coaching, the support, the encouragement, the practical information and tips to guide people safely and sanely as something they can sustain to keep that blood sugar in good shape.

Dr. Eric:

All right. I’d like to talk a little bit about the treatment, getting into the diet and lifestyle. We spoke about diet, but maybe dig a little bit deeper. So with the testing, you ideally, like to have a hemoglobin A1C of less than five, but for someone without blood sugar issues, you like to see that hemoglobin A1C in the fours?

Dr. Beverly:

Ideally. If they don’t have blood sugar issues, absolutely. If it’s 5.2, I’m not going to freak out, or 5.4, that’s okay. But if I see that trend over time where, like I said, they start out in the fours maybe and then suddenly it jumps maybe as they approach ages 38 to 42, or as they head to either menopause or andropause where hormonal balance might be shifting as aging starts to be more of the conversation that their body’s having, and they see a jump and it jumps maybe four-tenths. So it goes from like say 5.4 to 5.8, now they’re on the low end of prediabetes. Maybe the next time you see them it’s 5.9, 6, stays at 6, then it goes to 6.2. That’s watching the train wreck in slow motion in my opinion.

So they hit 5.8, 5.9, now we need to put a program in place to get it to go back down. I’m not one who’s going to sit there and in good conscious watch someone climb on board the Type 2 diabetes train unnecessarily. I’ll do all I can to help them and encourage them and help them figure out how to make sure the rest of their life supports getting that blood sugar lower. At worst case, it goes no higher. Best case, it goes back to the healthy range in the fours.

Dr. Eric:

All right. No, it makes sense. Now, I’m sure you’re familiar with Dr. Mark Hyman. He’s written a few books on blood sugar and he talks also about insulin. I don’t know if you look at fasting insulin with your patients as well.

Dr. Beverly:

I have looked at fasting insulin. I’ve found sometimes it’s helpful to figure out with people how sensitive their fasting insulin level is. Again, that whole idea of reset. Given your work with thyroid, I’d love to hear what your interactions have been with your patients about this. Because I found fasting insulin sometimes can help explain when people have really tough problems with weight. When their obesity is just beyond sovereign. That patient comes in and they’re just doing everything. They’re busting their butt and they cannot get their weight to move. And I found that the lab testing for fasting insulin sometimes helps uncover what’s behind this. It doesn’t always correspond, in my opinion. That’s not been my clinical experience. How about you? What have you seen?

Dr. Eric:

Yeah, that’s another topic with the relationship between insulin resistance and weight gain and yeah, if someone has not only higher insulin levels but higher hemoglobin A1C levels. But a lot of times they do go hand in hand. I did recently have a patient where the hemoglobin A1C looked pretty good. It was just 5.0, yet their fasting insulin was around 10. I know the lab reference range is like up to 24, but he talks about ideally you want it below five. If I see someone like six or seven, I don’t really get too concerned, but reaching double digits. But it was just a little bit of an unusual situation because the hemoglobin A1C looked good.

But I know there’s no perfect test either. That’s why you got to also, you mentioned a glucometer as another method, fasting glucose. But yeah, you are correct where if someone does have higher insulin levels, not all the time, everybody is different, but I certainly agree that many times it might cause difficulty losing weight. So it, again, depends on the person. I work with a lot of people with hyperthyroidism and Graves’ disease and there are some people with hyperthyroidism that gain weight, but a lot of people lose weight. And I will say probably even I do see insulin resistance in some hyperthyroid patients, although it probably is more common in those with hypothyroidism Hashimoto’s.

Dr. Beverly:

I would agree with that.

Dr. Eric:

Yeah. Diet and lifestyle, again, that could play a big role, but would you say it’s true that for those with insulin resistance/Type 2 diabetes just cleaning up their diet alone isn’t always enough?  I mean, you did mention that earlier when you said sleep and stress management. But I guess also from my research and what I’ve seen, inflammation is a big driving force in these people too. And diet of course could play a big role as well as getting proper sleep and stress management. But sometimes I find that there could be other factors affecting blood sugar or affecting that inflammatory process, which could be at least a contributing factor for blood sugar issues.

I don’t know if you find that as well where it’s not always as simple as just, because you get people who are like, I’m eating low carb, low sugar, I’m getting proper sleep. They might say they’re managing stress. We don’t know for sure but they say that they’re blocking out time for stress management. Yet they still are gaining weight. And again, there could be other factors. It could be they could have low thyroid hormone levels, they could have problems with adrenals which also could relate to blood sugar. But do you find that there are also other factors too that might make it not easy to lose weight just with diet and lifestyle?

Dr. Beverly:

Okay, let’s have this piece of the conversation. There’s the data. There’s the A1C. There’s their fasting blood sugars. There’s their thyroid numbers. There’s insulin as a measurement, their fasting insulin. There’s all this data. Then there’s our patients and our friends and our neighbors, our colleagues, family members, there’s their lived experience. And sometimes the data and the lived experience don’t match. So you’ll find people back in the day, probably decades ago, you could say to someone, “Eat less and move more.” And that might work. Today’s world is far more complex. I know lots of people and I think at this point it’s got to be tens of millions of people, maybe 100 million people for whom the eating less and moving more is inadequate. That’s simply not a helpful treatment plan.

You run the risk of getting punched right across the desk because they’ve already done that and it’s not working and people are so frustrated, they’re really upset. And often they feel like their body is betraying them, as if they’re broken or something’s not working right, or just whatever. And so then when I think about some of these other factors, whether it is chemical and industrial pollution, environmental toxicity, many people have grown up or currently live around places that are very, very toxic. We know that mammals in general struggle with processing toxins because their bodies weren’t made to process a lot of toxins. They were meant to detoxify things that either we ate that were food poisons, break down hormones, stuff like that, as opposed to a constant bombardment of all these other outside exogenous chemicals.

Now you flash forward to 2021. We live in a very different world than what our ancestors had. So if you look at pictures, if you have them in your family, of your great-grandparents, your grandparents, parents. I certainly have in my family. I could see the difference where taller with these generation was also way a lot more. And in this last 20 years, it’s just been this acceleration. When you look at the explosion of Type 2 diabetes here in the US, it is stunning, and around the world. It’s just amazing to see how many more people are struggling with their blood sugar. We’re going from a number where it’s like more than one in three in the US people struggle with blood sugar and are diagnosed, and who knows how many aren’t diagnosed. But who are diagnosed with Type 2 diabetes and prediabetes, we’re approaching one in two.

So that means if you’re in a room full of nine, 10 people, three out of the 10 people to four out of the 10 people have this problem and we’re approaching, it’s going to be five out of the 10 people. It’s not sustainable. And so if it’s environmental causes, if it’s nutrition, strictly speaking, if it is stress, sleep or exercise, really we got to do something about this. And I’ve had success working with people for whom exercise is actually not an option because they’ve been severely injured, maybe they have a knee and/or a hip that hasn’t been replaced, et cetera, where their ability to really move those big muscles of the body and do that metabolic fire is gone.

So it forced me clinically to rely on that electrical engineering background from MIT, that science side, to really look at this from a systems point of view, along with naturopathic medicine with treating the causes and peeling back the layers of that onion to figure out what is it we’re missing. That’s where I got off the train of eat less and move more because I realized it was inadequate. I wasn’t meeting people where they were at. So from my training and clinical experience in the ’90s to now, I really shifted where my focus is and to help people address the things that they actually can control so they don’t feel so out of control, they don’t feel like their body has betrayed them and they are now active players in their own success. I find that is critical in helping people to get the results in the day one, whether it’s blood sugar, weight control, better cholesterol profile, getting rid of high blood pressure, you name it.

Dr. Eric:

All right. Thank you for that. That was great. How about supplements, because everybody loves supplements so a lot of people will try to shortcut the process. Not to say I never give supplements for blood sugar, but just wanted to get your perspective on things like berberine or gymnema or chromium, which is a mineral, and there’s alpha lipoic acid. Where do you stand when it comes to taking supplements to support blood sugar?

Dr. Beverly:

I think supplements for supportive blood sugar are wonderful and I use them with my patients all the time. I have from the very beginning, it’s really very helpful, I call it a healing partner. It’s really a great help. And sometimes with things like where we’re in, you can get multiple coverage. Some of my patients have both diabetes and heart disease. My focus areas are those two. And sometimes I get people with both, and we can get a lot done. So instead of them having 12 bottles of things, they might have three or four that are their key supplements to take. It’s in those evidence-based clinically research levels of therapeutic dosage and it’s just really, really helpful.

And in today’s world, I had read some studies, I can’t remember if it was on FDA’s website or USDA, one of those government websites had analyzed the soil from this was in 2008, I think 2009, and compared it to soil samples that they had from the ’40s, ’50s, ’60s, ’70s, 80s, so 1940s, 1950s, et cetera. They found that the average amount of nutrients in the soil in the US nutrient density had really declined precipitously, had gone down a lot. As a result, the food that we eat from the soil is not giving us the same nutrient density that our grandparents and great-grandparents enjoyed, which would explain why I could easily observe having been around my great-grandmother and then my grandparents and all that I could see like, oh, wow, no wonder they wanted a small portion of something and they were delighted with it. They felt satiated. They were satisfied.

I think that’s one of the struggles that isn’t talked about a lot. In my opinion, in the popular media, we don’t talk about people’s satisfaction. It’s almost like we are all bottomless buckets. We just cannot seem to feel full. And I don’t know if it’s strictly speaking some of the chemical additives to the food, is it the lack of nutrient density upfront, or all of the above? I’m not sure.

Dr. Eric:

Yeah, you make some good points there. Unfortunately, these days it’s very difficult to get everything from diet. A common supplement in the world of thyroid health is selenium. I have a lot of people ask about Brazil nuts, which are high in selenium. And I agree. They are high in selenium. You just don’t know how much selenium you’re getting. It’s variable. If you’re eating organic Brazil nuts, it will be probably higher in selenium than non-organic, but still you don’t know you might be getting anywhere from like 10-20 micrograms to 70-80 micrograms. I mean, it is preferred over supplementation for maintenance, but even then, it’s still variable.

Dr. Beverly:

I think in today’s world, for best results for patients and clients, supplements need to be a part of what is that they do for their own health and wellness. It’s just too variable. You can’t predict it. I would love if it were just food, but I don’t think that’s true. I think you need to do food along with supplements.

Dr. Eric:

Yeah, I agree. Is there a time and place for medication such as Metformin?

Dr. Beverly:

Yeah. Metformin can be really helpful and some people do super well on it. Some people are really aggravated with it and get the side effects, not necessarily the benefits, especially the GI side effects. So I always tell people, you know what, make your best choice, understand what you’re choosing, let’s see if there’s side effects. If you’re okay with them, then try it and see how you do. I think it’s a fine bridge strategy. For the people who are well motivated and who want to take on the lifestyle side of things, I think it’s fine if they’re already on medications, prescription meds. I’m not someone who says, “Oh, you can’t take that.” That’s silly, that’s ridiculous. You take what you need to take. And legally I cannot nor would I unprescribe something. I didn’t prescribe it, therefore I can’t unprescribe it. I think everyone listening needs to know that. Everybody has to stay in their lane.

But with that in mind, if you’re going to make the lifestyle changes and oh my gosh, I sure hope you would, then recognize that your blood sugar may well start to decrease. And if it gets to sort of healthy range, your need for prescription medications may decrease with it. You must, must, must test. Do not guess. Use your glucometer or your continuous glucose monitor, so you know what your blood sugar is doing and make sure you’re in conversation with whoever prescribed your diabetic medications for you and adjust as appropriate. Don’t go and decide you saw a blog somewhere and you’re going to do it yourself or take advice from your mechanic or the nice lady at the hair salon or whatever it might be. Go to the actual expert who prescribed it for you. This is not a time to go rogue for your own safety. I just feel like I have to put those disclaimers in.

Dr. Eric:

Yeah, I’m glad you did. I face the same thing with people on thyroid medication as well.

Dr. Beverly:

I know you do. I have a lot of patients that are on medication. I know you see people just go and do some strange things, don’t you?

Dr. Eric:

Yeah. For those with hyperthyroidism, Graves’ disease, those side effects could sometimes be pretty bad with the antithyroid medications. So I can understand people not wanting to take it. I actually dealt with hyperthyroidism and took more of an herbal approach, but it’s a little bit different with Hashimoto’s because if someone needs thyroid hormone, then there’s really not an herb or something else that they could take as a substitute for thyroid hormone. But sometimes in people with Hashimoto’s, you balance the immune system, and they might be able to get off of thyroid hormone or reduce the dosage. But again, it’s best to go to the prescribing doctor rather than try doing that on your own.

Dr. Beverly:

Yeah. We have those keys to inflammation. For Hashimoto’s thyroiditis, that inflammatory aspect, the “itis”, you always want to be able to dial in on that inflammation. I know with your work, that’s a powerful part of that healing conversation that really help people get that awareness of what is driving inflammation for the immune attack. There’s something behind it.

Dr. Eric:

Oh definitely. For both Graves’, Hashimoto’s and really all autoimmune conditions, that’s a big goal. Try to find the triggers and underlying imbalances. One thing I also wanted to say just because the topic, again, relating to insulin resistance, there’s evidence that insulin resistance can cause thyroid proliferation, maybe resulting in a goiter, swelling of the thyroid gland. And then also nodules too. There could be other causes of nodules like problems with estrogen metabolism, but blood sugar also potentially plays a direct role in thyroid health. But then there’s that inflammatory process as well associated with many cases of insulin resistance. We were just talking about inflammation in relation to Hashimoto’s and Graves’ disease as well. So blood sugar is definitely important, and having healthy blood sugar levels is important with anybody, but that also includes those with autoimmune conditions such as Graves’ and Hashimoto’s.

Dr. Beverly:

That’s right. In literature, all the different aspects of metabolism are in good harmony. And when you’re not in good harmony, different problems can show up. And so you can see multiple things in parallel. Insulin resistance, you could have thyroid nodules. A person might have fatigue. They might have muscles that seem to be atrophying or they don’t get the same kind of benefits like maybe they used to from exercise if they used to do weight training, things like that are a number of shifts that can be really good clues that the metabolic system is really starting to shift.

Dr. Eric:

Yeah, definitely. How about one other thing before we go into, I do want to make sure we answer some questions. We did talk a little bit about weight gain. I don’t know if you want to expand on that just because it is a big issue, more so probably with Hashimoto’s than with Graves’, even though with some people with Graves’ they also experience weight gain. Hashimoto’s, again, we got to factor in the low thyroid hormone. So perhaps to summarize, if someone is struggling with weight gain, what steps do you have them do? Is the first thing you have them do is to just modify their diet? Do you have them do testing to look at their blood sugar levels and maybe other markers such as thyroid?

Dr. Beverly:

Yeah. The first things we would do is to make sure that they have current lab work. So we have the baseline for the data just to make sure we haven’t overlooked anything because sometimes health problems are blamed on weight when they aren’t necessarily related. We have certainly seen where patients have come in and they’ve lost 80 pounds and they still have their original presenting symptoms. So clearly weight was not the cause, was it? You want to be sure that as a doctor you’re not hiding behind that where weight is a shield for thinking about any other problems.

And then from there, look at how they’re eating and what they’re eating and also what time of day they’re eating. Sometimes what I found is that if people eat from early in the morning to late at night, so they never really have a fasting period throughout their day, that that can be a problem. Particularly people who eat really late at night and then go to bed within a half hour, they almost always have a weight problem of some kind.

Then you look at the quality and quantity of the food. Make sure portions make sense, and that they’re eating in a healthy manner for whatever are the foods that are best in agreement with them. I prefer that if people have high fiber diets with healthy protein, healthy fats, and then slow burning complex carbs. I love things like lentils and chickpeas to try to get them in the mix because they are packed with, it has healthy carbs, slow burning, it has fiber and it has protein, all in one convenient little package. You get a lot done with lentils and chickpeas, and they’re delicious. There’s many different ways that you can prepare them.

From there, I don’t insist on exercise. I love it for mental and spiritual reasons, stress relief, for people to exercise. But I’ve had the opportunity to work with so many people for whom their knees or their hips, their back, they’re in so much pain. They just can’t do it. And so I learned to not make that the centerpiece of the treatment.

So then our next stop is either going to be after we’ve looked at food, which is the target, we’re going to look at either stress issues or we’re going to look at sleep. I talk to people about sleep. Typically if they’ve raised kids or if they remember their own childhood, if they had a good childhood, did you have a regular bedtime? Did you have a regular wake time? And if you didn’t have good childhood, what would you have liked for your younger self? Because what you don’t want is chaos in your sleep world. Have that one to two hours of clear transition to sleep.

Give your body every possible signal that it’s going to be time to go to sleep now, and then get out of bed at the same time. So your day and night make sense. Let your hormonal system settle, because if you get up at really different times and go to bed at really different times, guess which system is going to least be able to handle that is your hormonal systems. Your thyroid will be affected, your pancreas, your ovaries or testicles. All of the various organs are sensitive to that. Your digestive system, it really loves regularity. It wants you to go to bed at the same time and get up at the same time.

And just getting people’s sleep ordered from their stress. Some people have extraordinary levels of stress that they carry now in their adult lives, or maybe as a kid. Childhood was awful and they could have a lot of what are now called ACEs, adverse childhood experiences, where they really, really got pushed and their stress systems were always in high drive. It wasn’t the emergency, it was nonstop constant emergencies. And in that environment, it’s just really hard. So now here they are 20, 30, 40 years later and where their health should be in a pretty good place relative to how their life is lived now, they’re starting to fall apart. The problem started a long time ago, now we’re seeing the results.

Dr. Eric:

All right. Well, thank you for that. Again, I would like to get into some questions, but  is there anything else you’d like to add?

Dr. Beverly:

No, I think we’ve covered this really well. For our first conversation, I’m thrilled to be a part of this. I don’t want people to think it’s complicated because kind of in a way it’s not. But it’s not always obvious. As I tell people, the things I ask you to do, and you might have this conversation too with your patients, Dr. Eric, the things that I ask you to do are simple. I never said they’re easy.

Dr. Eric:

I agree. Well, where can people learn more about you, Dr. Beverly?

Dr. Beverly:

Sure. Welcome to visit my website. Https://dr, the abbreviation for doctor, and then my name Beverly, B-E-V-E-R-L-Y, Yates, Y-A-T-E-S.com. You can find me on Instagram. The handle is the same thing @DrBeverlyYates. On LinkedIn, you can type in my name and find me there. And soon I’ll have a YouTube channel that’s repurposed specifically for blood sugar issues. Those are the primary places. You can also find me on my Facebook business page. Feel free to check in there as well.

Dr. Eric:

All right. Wonderful. Thanks again for getting together. Are you okay with diving into some questions?

Dr. Beverly:

Yeah. Sure.

Dr. Eric:

All right, great. Let’s take a look.

Dr. Beverly:

Someone asked if Type 1 diabetes can be reversed. Let’s clear that up. No. Type 1 diabetes, based on today’s knowledge right now in 2021, April 9th, no. Type 1 diabetes where someone’s pancreas no longer makes insulin unfortunately cannot be reversed. People can benefit from very similar strategies around having a healthy blood sugar in all of the goodness that we were sharing earlier, but unfortunately we don’t have a way to reverse Type 1 diabetes at this point in time. I want to be crystal clear about that.

Dr. Eric:

Those with Type 1 diabetes, do they have to be on insulin?

Dr. Beverly:

Yes, it is mandatory they will need to add it. Otherwise any of the blood sugar that their body is making, their glucose, will not get into their cells successfully. You have to have insulin, it’s a requirement. There’s insulin pumps. There’s all kinds of things that are, again, kinder and gentler than what used to go on back in the day. Treatment has improved, but we’re not at a place yet to reverse Type 1.

Dr. Eric:

One question, Type 2 can be reversed, but is there a point of no return where certain people with Type 2 can’t really… I know you can’t guarantee that anybody can be reversed…

Dr. Beverly:

I tell people that there is always a potential with Type 2 diabetes for healing from the damage from diabetes. For some people that will include reversal of the diabetes diagnosis to where their blood sugar will lower to the point where it’s out of the diabetes diagnosis range. So for Type 2, once they get under 5.8, so let’s say if their blood sugar goes to 5.6, 5.5 and back into the fours, they’ve reversed for sure. Now, that doesn’t mean they are no longer susceptible to having the problem and if they were then to, if it was at all a lifestyle or habit based, if they were to go backwards in time and go back to the situation that got them started in the first place, it’s likely to return.

I mean, I want people to be sure that they understand that if they have figured out what are the most healthy levers to pull, so to speak, for themselves, and they’ve got that dialed in, they need to stay that way. If they then decide, “Oh, hey, I’m better,” and then they start to do things that just don’t make sense like they let their sleep just cycle all around and get out of control, lots and lots of stress, no exercise and eat poorly, it’s very likely that Type 2 will return and probably return quickly.

Now, is there a point at which it’s the point of no return? I always tell people I’m not a psychic and I don’t play one on TV. I’m also not God. I don’t feel like that kind of an answer is in my hands. I do think that there is a place at which there’s so much damage that they may not get the full benefit they would have gotten if they’d done something sooner. That’s like watching that train wreck in slow motion or in some cases wreck in fast motion, real time.

If someone has a severe compromise of their circulation, if they’ve lost one or more body parts, if they’ve lost vision and have gone blind in at least one eye, if they’ve lost or are rapidly losing kidney function, if they have severe pain from peripheral neuropathy or they’re flat out numb, these are all great indications about how much healing potential is left. Whatever they can do, even if it’s at end stage severe is not too late, but it might mean that they might not get all the way back to the status of reversal. Make sense?

Dr. Eric:

Yes, definitely. Thank you for that explanation. We have a question from Vicki. How do you stop the constant sugar craving?

Dr. Beverly:

Yeah, sugar cravings are so very annoying. Let me share with you guys a fun factoid. I discovered this in some of my research several years ago, and other people have since brought this forward to share with me. Did you know that the cells on your tongue turnover every 10 to 21 days? So every week and a half to three weeks, you get a brand new layer of cells on your tongue. That’s where your taste buds are. Now, this is important because if you’ve got a taste for sugar, if you have a sweet craving, if the sugar bug has bitten you, you’re going to need to give yourself some time. This is not something that’s going to go away in 24 hours. But you can make a change over the course of 10 to 21 days, for sure.

I find that the herbs can really help, like gymnema and especially fenugreek, with that craving for sugar. Also those leafy green vegetables, like I said, at the beginning of our interview time here. Those leafy green vegetables. In the Facebook group, we have this hashtag of GreensBabyGreens. Those leafy green vegetables can really help get that desire for certain foods to be shifted gradually, steadily and permanently towards the healthier desires. So if you’re constantly battling that desire, that brain-based urge for sugar, that’s a great way. Either the herbs, the veggies.

Dr. Beverly:

And then another tip is simply to try and eat some things that you don’t normally eat, especially if they tend to be bitter. Get your tongue and your palate used to eating things that are a variety and have different flavor profiles than sweet. So much of US food, especially fast food, is all about sugar and salt.

Dr. Eric:

Yeah, that is true. Someone just made a comment here about the protein. There’s so many different protein powders out there.

Dr. Beverly:

Yeah, there are.

Dr. Eric:

Let’s see. Jenny, I can’t lose weight despite thyroid and insulin in range with menopause and no other conditions.

Dr. Beverly:

That’s interesting. With menopause, as we all know, the reproductive hormones for women shift. And so you’re no longer losing that menstrual lining every month. Now, for some women, that leads to a certain kind of peace and calm that maybe they didn’t have before, particularly if they had difficult menstrual cycle. If you had a pretty easy time, then hopefully the dust will still settle. From menopause, you’ll be okay. If you’re finding you’re struggling with weight, including when you have thyroid problems or don’t have thyroid problems, I found a great way to go is to try intermittent fasting.

Intermittent fasting, which if you think about it, the spiritual traditions of the world, every single one of them has some kind of fasting baked right in there. I can’t think of one that doesn’t. I think humans have been wise for thousands of years and we’re just getting caught up now about this and documenting it and giving it the proper credit. I would really suggest to consider intermittent fasting and try and see what happens for you. It is a great way to reset issues with insulin resistance, that’s for sure. And if that’s at all the issue, hopefully you would get some benefit from that. I think trying that out might be a safe, good way to go.

Dr. Eric:

Yeah. I’ll also add what we were discussing earlier. Remember there’s the lab ranges and there’s the optimal ranges. Like the thyroid hormone levels might be within the lab range, but they might be on the low side. It depends on the lab, but for example a free T3 of 2.1, a lot of labs would consider that to be normal, but that is really on the lower side and the active form of thyroid hormone. Same thing we are talking about insulin. The person who had an insulin of 10, the lab didn’t red flag that as being out of range, but from a functional perspective, from an optimal perspective, it’s definitely higher than we’d like to see. And then there could be other factors as well. I mean, I agree with Dr. Beverly. I personally do intermittent fasting as well.

I do think some people need to be cautious, especially when dealing with hyperthyroidism. When I was dealing with hyperthyroidism, I lost over 40 pounds. So in that case, I probably wouldn’t have wanted to do intermittent fasting. And then maybe if someone has really stressed out adrenals too. But overall, , intermittent fasting can many times do wonders for weight loss. But if there’s something else going on, like an inflammatory process, or again, there could be numerous factors, those do need to be addressed. But yeah, I do agree about the intermittent fasting. And then here, it takes a lot of willpower to eat healthy, especially now in the COVID environment.

Dr. Beverly:

Yes, it does.

Dr. Eric:

Yeah. I think it’s always a challenge. Once you’re in the routine of eating healthy, it’s definitely easier. But I grew up eating everything that you shouldn’t be eating. Eating fast food and refined sugars. It wasn’t easy making that transition, but once you start feeling better and you’re maintaining a healthy weight and you have energy, it’s still not easy. I still get temptations. I’m sure Dr. Beverly gets temptations. I’m not saying I never want to indulge and I can’t say I never indulge, but yeah, you are correct. I mean, over the last year, arguably for many people, it has been more of a challenge.

Dr. Beverly:

Yeah, that’s real.

Dr. Eric:

So LDN, low-dose naltrexone. So I could answer this.

Dr. Beverly:

Yeah, go ahead. I’m curious to hear about LDN.

Dr. Eric:

Low-dose naltrexone, that’s a medication that modifies the immune system. It can potentially calm down the immune system in autoimmune conditions. I’ve written some articles on low-dose naltrexone. Definitely check those out on my website. I like LDN, but it’s more hit or miss and it doesn’t work for everyone. When it works, it could do wonders. And it also, it’s not addressing the cause of the problem. So I guess that’s another thing too. I do have patients that take LDN but just keep those things in mind. One, it’s doesn’t work in everybody. And this also for Graves’ too. You mentioned Hashimoto’s, but it can help with other autoimmune conditions. But again, I find it’s hit or miss. And then also you still want to do things to address the cause of the problem ideally and not just rely on the LDN.

All right. And then we’ve got, Dr. Yates is so very knowledgeable. Yes, definitely. I enjoyed this as well. Thank you for that comments. Okay. This is, yeah, I don’t eat after 7:00 on most days. Yeah, I also agree with that trying not to eat late.

Dr. Beverly:

Yeah. Give three to five hours before you go to bed. From your dinner time to sleeping, three to five hours. Just let your gut really go into CP time so now it can do its renewal because that’s the only time it can do its renewal is when you’re asleep.

Dr. Eric:

Yep. I agree with that. I guess we didn’t talk really about duration of sleep, but most will say like seven to eight hours. I guess I would agree with that, but then also take into account if you don’t fall asleep right away. So if you’re in bed for eight hours, but it takes you a while to fall asleep, then I wouldn’t count that time.

Dr. Beverly:

I’ve started to talk to people about this a little differently after reading, oh boy, he’s a researcher over here at UC Berkeley, Matthews. I can’t remember his full name. He has a book on sleep, wonderful book, to talk about sleep with people around give yourself the opportunity to have eight to nine hours of sleep a night. Therefore, if it takes you time to get to sleep, you’re still good. People just seem to relax a little bit with that idea. So otherwise then that’s part of why they don’t go to sleep. They’re stressing them because they can’t sleep easily.

Dr. Eric:

Yeah, that is true. Once you’re in a pattern of not falling asleep, some of it does become psychological and then, yeah, it is helpful if you try to go to sleep earlier. But again, sometimes I have to practice that too. I mean, I’m pretty good with sleep, but again, I can say every single night I get eight plus hours sleep. But I’m also not a night owl, fortunately. So I’m not one that stays up to midnight or one o’clock. All right. Let’s see. I know we got to wrap things up. And I will be on Facebook next week. So if there’s any questions that are unanswered, next week I’ll be doing a full Q&A, so definitely save your questions. But I’m trying to see if there’s anything related.

Janet, my best meal plan for a Hashimoto’s insulin resistance. I mean, since the topic was insulin resistance, I know Dr. Beverly said she doesn’t really recommend a specific diet. She did say the fiber and the green leafy vegetables is what she recommends across the board. And then of course the basics with not eating refined foods and sugars and just really trying to eat a whole foods diet, plenty of fiber, plenty of green leafy vegetables. Anything you want to add, Dr. Beverly?

Dr. Beverly:

Yeah. Those healthy lean proteins and the healthy fats, the avocados, nuts and seeds. And for your carbs, you want those complex slow burning carbs, especially like lentils and chickpeas, because you just get so much nutrient density from it without any problems. I found that to be really helpful. Some of my patients have Hashimoto’s or they have hypothyroidism without necessarily being Hashimoto’s and combination with insulin resistance. So far we’ve not had any problems with people than if they had a history of disordered eating or eating problems that it hasn’t triggered anything. Because I find sometimes if people have those issues, if you put them strictly on something like Keto, they can get kicked pretty hard. So if they start to introduce carbs later, they sometimes really just go hot wild with it has been what I’ve seen happen. It doesn’t happen to everyone. Most of the time people are fine, but for a few I’m like, Ooh, is there some tuning I could have done to avoid this?

Dr. Eric:

Yep.

Dr. Beverly:

Maybe there’s one here I’d like to address. A lot of my patients are Asian. Shout out to Asian folks, hello. I totally get what you’re saying here. The comment is, I used to not crave sweets, but since Graves’, this person has been craving every day, and vowed to stay away from it. Starting to eat brown rice. I totally get, in Asian culture, white rice is preferred. Brown rice has the fiber jacket on it. I get the deeper issues here. I used to practice it in Hawaii and I’m here in California in San Francisco, Bay Area. Lots of conversations have been had around this very topic. So I would simply encourage you to do this.

If you’re going to have white rice, go ahead and have it, enjoy it and consider maybe if it’s a problem for you, cut that portion in half. I have found that that by itself has really helped people, especially if you’re in family events or special celebrations where white rice is absolutely going to be served and you’re not going to be able to get wild rice, brown rice, etc. There’s no point in struggling and trying to fight that river. Instead, maybe look at your portion and make sure you have lots and lots of fiber with it. And I think that that combo will be practical and helpful. It certainly has helped others of my patients who are Asian and who’ve had a similar concern, whether it was food intolerance or it spiked their blood sugar or they craved it or whatever the case might be with rices, in particular white rice. I hope that’s helpful.

Dr. Eric:

All right. Well, thank you for that. Thank you so much for, again, getting together Dr. Beverly. And again, can you let people know one more time where to find… Someone also did mention about your Instagram. I did see over there.

Dr. Beverly:

Yeah. So Instagram is the same. It’s @ sign, and then my name, DrBeverlyYates.

Dr. Eric:

Okay. And your website one more time.

Dr. Beverly:

So the website, if you go to the Google or however you do your web searches, if you put in drbeverlyyates.com, you’ll go right to my website.

Dr. Eric:

All right. Wonderful. Well, again, thank you again for getting together. I think that this was great. Hopefully everyone found it very helpful. I know I learned a few things as well.

Dr. Beverly:

Thanks so much. Take care.

Dr. Eric:

Bye-bye. Thank you, Beverly. Take care. Have a great rest of the day.

Dr. Beverly:

You too. Bye-Bye.

Dr. Eric:

Bye.

 

Although I can’t say that most of my patients experience muscle weakness, I also can’t say that it’s uncommon.  While I see it more in my patients with hyperthyroidism and Graves’ disease, people with hypothyroidism and Hashimoto’s can also experience muscle weakness. In this post I’ll discuss the relationship between muscle weakness and thyroid health, along with other factors that can cause this.

Just as a refresher, there are two main types of thyroid hormones. Thyroxine (T4) is the hormone most abundantly produced by the thyroid, while triiodothyronine (T3) is the active form of thyroid hormone.  Both of these can influence muscle physiology, although T3 is probably the most studied of the two (1).

Do You Really Have Muscle Weakness?

There are a few different ways of measuring muscle weakness to make sure it’s not just overall fatigue the person is experiencing.  One tool is the Medical Research Council Manual Muscle Testing scale.  The differential diagnosis of true muscle weakness is extensive, including neurologic, rheumatologic, endocrine, genetic, medication- or toxin-related, and infectious etiologies (2). Electromyography is also considered in some cases, as it can confirm the presence of a myopathy, and if a muscle biopsy is necessary it can identify an appropriate biopsy site (3).  Speaking of doing a muscle biopsy, this is usually reserved for people who present with acute or progressive muscle weakness who are suspected of having an underlying neuromuscular disorder (4).

Sarcopenia and Thyroid Health

The age-related loss of muscle mass, strength, and quality is known as sarcopenia. There is evidence that thyroid hormone can play a role in sarcopenia in a few different ways.  First of all, it can cause the transition from a slower fiber type into a faster one, which can play a role in sarcopenia (5).  Skeletal muscle quality also relies on the health of the mitochondria (6), and skeletal muscle mitochondrial function is also modulated by T3 (7).

Hyperthyroidism and Muscle Weakness

It is quite common for my hyperthyroid patients to experience a loss of muscle mass.  In fact, this was also the case with me when I dealt with Graves’ disease back in 2008/2009.  Keep in mind that the loss of muscle mass isn’t synonymous with “muscle weakness”, but some people do experience both problems.  The good news is that once the hyperthyroidism has been corrected, over time the person’s muscle mass should increase and the muscle weakness should subside…unless of course if there is another factor responsible for the reduced muscle mass/muscle weakness.

While many people with hyperthyroidism notice that they have a decrease in muscle mass, one of the markers that correlates with this is serum creatinine.  This is part of a comprehensive metabolic panel, and when someone with hyperthyroidism has decreased muscle mass the serum creatinine is usually low.  Normalizing the thyroid hormone levels may help to normalize the creatinine, but this isn’t always the case, as you might also need to do other things to increase the muscle mass, such as eat enough protein and do weight-bearing exercises.

It’s also worth mentioning that some rare muscle myopathies are associated with hyperthyroidism, including myasthenia gravis.  And studies show that treating the hyperthyroidism can improve the muscle response in myasthenia gravis patients (8).

Speaking of studies, I did come across a study which looked to demonstrate the degree of muscle weakness in newly diagnosed patients with Graves’ disease, as well as assess the response to treatment (9).  This was a small study, involving 10 patients, and results showed that muscle weakness is commonly associated with hyperthyroidism and can be profound.  It also showed that the beta blocker Propranolol can improve muscle weakness in people with hyperthyroidism.  Even though Propranolol can decrease the conversion of T4 to T3 I’m still surprised they didn’t use antithyroid medication in the study, although they might have chose to have the patients take Propranolol because side effects are more common with antithyroid meds such as methimazole.

Hypothyroidism and Muscle Weakness

While an excess of thyroid hormone can be a factor in muscle weakness, low thyroid hormones can also be a factor. Thyroid hormone plays an important role in muscle physiology, and while some people who have subclinical hypothyroidism might not experience muscle weakness, it is actually very common for those with overt hypothyroidism.  In other words, if the thyroid hormones are outside of the lab reference range then there is a pretty good chance that muscle weakness will eventually develop.

In fact, a study I came across showed that hypothyroid myopathy affects almost 80 percent of people with hypothyroidism (10).  Hypothyroid myopathy is a condition that presents with nonspecific symptoms of muscle pain, muscle cramps, fatigue, and muscle weakness, particularly exacerbated with exertion and exercise (10).  The authors mentioned that the degree of muscle weakness doesn’t always correlate with the severity of thyroid hormone deficiency.

As for the underlying mechanisms causing the muscle weakness, according to the same study, “T4 deficiency leads to a reduced mitochondrial oxidative capacity, abnormal glycogenolysis (the breakdown of glycogen into glucose) and an insulin resistant state of the cell. This leads to selective atrophy of type 2 muscle fibers (fast-twitching type) as they are dependent on glycolysis for energy causing the slowing of muscle contraction seen clinically in patients with hypothyroidism. Muscle hypertrophy ensues as a result of this, which is believed to be a compensatory response that happens from the accumulation of glycosaminoglycans in the muscle. Increase in connective tissue and muscle fibers also contributed to this hypertrophy”.

If you experience muscle weakness associated with hypothyroidism, there might also be an increase in the marker creatine kinase in the blood.  However, there can be other factors that can increase this marker. The good news is increasing the thyroid hormone levels (i.e. with thyroid hormone replacement) can resolve many cases of muscle weakness, although it can take a number of months for this to occur, and sometimes even several years.

Other Causes of Muscle Weakness

As I’m sure you can imagine, there can be many other causes of muscle weakness.  Here are some other potential causes:

• Amyotrophic lateral sclerosis
• Cerebral lesion (stroke, hemorrhage, mass)
• Compressive neuropathy of the peripheral nerve
• Guillain-Barré syndrome
• Motor neuropathy
• Multiple sclerosis
• Adrenal insufficiency (Addison disease)
• Endogenous glucocorticoid excess (Cushing syndrome)
• Certain medications
• Certain toxins
• Electrolyte disturbances
• Genetic (i.e. muscular dystrophy)
• Infections

I’m not going to cover all of these causes, but I do want to briefly discuss a few of them, including electrolyte disturbances, medications, and infections.  Regarding electrolyte imbalances, while a comprehensive metabolic panel isn’t a perfect way of evaluating the electrolytes, if someone does have low sodium, potassium, and/or calcium then it’s something to pay attention to.  RBC magnesium can help determine if someone has a potassium deficiency.

Some of the medications that can potentially lead to muscle weakness include statins (11), glucocorticoids (12), and fluoroquinolones (13). It’s worth mentioning that the research shows that for those experiencing muscle weakness caused by taking statins, supplementing with CoQ10 can potentially help with this (14). CoQ10 might also benefit some people with hyperthyroidism in general, and not just those experiencing muscle weakness.

Certain infections can also result in muscle weakness.  This includes West Nile virus infection, HIV infection, Lyme disease, diphtheria, dengue fever, neurocysticercosis, trichinosis, Chagas disease, rabies, botulism, herpes zoster, cytomegalovirus infection, hepatitis C, and herpes simplex virus 1 infection (15).  When I was diagnosed with chronic Lyme disease in 2018 I experienced some muscle weakness initially, although thankfully it resolved pretty quickly.

How To Overcome Muscle Weakness

As for what you can do to overcome muscle weakness, you of course need to address the cause of the problem.  If someone has muscle weakness due to hyperthyroidism or hypothyroidism then of course these thyroid hormone imbalances need to be corrected.  If someone has reduced muscle mass and muscle weakness then not only does the underlying cause need to be addressed, but some weight bearing exercises may also be necessary.  As I mentioned earlier, I commonly see this with my hyperthyroid patients, as many of them suffer from reduced muscle mass, and while correcting the hyperthyroidism is important, doing this alone isn’t always sufficient.

I mentioned other potential causes of muscle weakness, and so if any of these are factors then these would also need to be addressed.  For example, if someone has overt hypothyroidism and also has chronic Lyme disease, and if both are factors in the muscle weakness, then it shouldn’t be surprising that both the hypothyroidism and chronic Lyme disease condition would need to be addressed.

Do You Experience Muscle Weakness?

If you currently experience muscle weakness, or if you experienced it in the past and have overcome it, please feel free to share your experience in the comments below.  Thank you!

 

On Friday March 26th I interviewed Magdalena Wszelaki, author of the book Overcoming Estrogen Dominance, and below is the written transcript. If you would prefer to watch the interview you can access it by clicking here:

Dr. Eric:

Hello everyone. This is Dr. Eric Osansky and I have with me Magdalena Wszelaki and she is the author of the brand new book Overcoming Estrogen Dominance. So why don’t we start by talking about why you decided to write the book Overcoming Estrogen Dominance.

Magdalena:

So with a lot of us, the same way you started doing Graves’ disease, it’s a personal story. And I struggled with estrogen dominance for as far as I can remember, having terrible PMS as a young girl, and struggling with a lot of bloating, but when I talk about PMS, you’re talking about, it was probably borderline PMDD when you’re in a fetal position on the floor, with painkillers on both sides of your bed, and canceling out one or two days out of the month for school or work because you really can’t get up, and then coupled that with a lot of other things started cropping it including for example, developing lumpy breasts, and sometimes it was just one lump, sometimes it was lumps on both sides.

And I think any woman who finds lumps on her breasts, it’s one of the most the scariest moments that you have in your health history. And you remember that for a long time because first, you go and Google it, and you are convinced it’s breast cancer, and then it’s also like how do you get it properly diagnosed, you’ve got this contradictory information about the different diagnostic tools, and then you have to wait for the results.

And so it was always a very scary moment, but also, a tendency to put on weight around my buttocks and my hips, it was an interesting one. Developing thyroid nodules, having a history of Hashimoto’s disease. So all of those put together and then finding out later with my DNA testing that I am highly predisposed towards being a very slow estrogen metabolizer. If I did a DNA testing for another reason, and I wanted that to be interpreted to tell me whether that area is a problem, and I’ll never forget how the person who did the interpretation, the consultants emailed me and she said, “Your problem is estrogen, not the other things.”

So and not surprisingly, on both sides of my family, there are estrogenic cancer deaths. Breast cancer, ovarian cancer, uterine cancer run on both sides of my family. So it was a personal story, but then I also started realizing that estrogen dominance is so prevailing with a lot of other hormonal imbalances, so like Hashimoto’s, women generally with thyroid conditions tend to have it, menopause, perimenopause. It always is coupled up with something else, and yet, no one was really talking about it. There was information that’s a bite away thing or it’s all over the internet, or is informal blog posts, or research that no one has interpreted to layman language.

And let alone turn it into recipes, and so I decided, “You know what? I’m going to do this.” And that was the result of creating a 400-page book. That’s not just a health book, but it’s also a cookbook.

Dr. Eric:

And one of the great things about the book is even though it’s 400 pages, I found that you don’t have to read every single chapter. Probably the first few chapters, but there’s a number of chapters in between. So thyroid nodules, which I’d love to talk to you about, fibrocystic breasts, uterine fibroids. So again, if someone wants to go through the entire book that’s awesome. But if they want to just cover some of the book, I guess you would say maybe the first few chapters and then in the middle they could pick and choose, and then at the end you get into the diet and the recipes and the supplements.

Magdalena:

That’s correct. So you’re absolutely right. The first few chapters is what I call the estrogen reset foundation. So you’re resetting your ability to metabolize estrogen in the first few chapters, and that really takes care of your gut, your liver function and your blood sugar levels, and I’m sure those are all the three areas you talk about a lot as well in your own protocols. And so that’s the foundation and I was talking about that it’s really paramount to get that right and do that first.

It’s very tempting to jump onto the feather chapters like go into the thyroid nodule protocol and tinker around with some essential oils on your thyroid and stuff like that. But if you don’t cover the foundation, and really fix your gut, stabilize your blood sugar levels, detox your liver gently, these nodules, they’re not going to go away just because you’re putting Frankincense on it. So that’s how I wrote the book. But if somebody has done the foundation, and then after that, for example, the thyroid nodules persist, or your breasts are still very painful and fibrocystic, then add on that protocol as you’re going through things. Do you want to talk about the giveaway of the book?

Dr. Eric:

Yeah. For anyone who trickled in late I’m chatting with Magdalena. I have her book as well, Overcoming Estrogen Dominance, and she’s going to be giving away a book during this Facebook Live.

Magdalena:

Yeah. So we decided to do that, based on a question we’re going to pop sometime towards the end of the interview, so we mustn’t forget.

Dr. Eric:

Yeah.

Magdalena:

And the question is gonna be based on something that we’re going to be talking about. So we’re going to quiz you guys here a little bit. And whoever gets it right, we’re going to select one person and contact you for your address and mail the book over to you.

Dr. Eric:

All right, that’s awesome. So that’s exciting. So what are some of the common symptoms associated with estrogen dominance?

Magdalena:

I’m so glad you asked that because that is one of the most underestimated, I think, hormonal imbalances, same as with Hashimoto’s, a lot of women go undiagnosed, misdiagnosed. I think when it comes to estrogen dominance, it’s really not even on the radar of most practitioners. And yet, it’s something that almost every woman experiences to some degree in her life. And so let’s go over the list. So first of all, women who are still menstruating, having irregular periods, heavy periods, absent periods, periods that are incredibly painful, so PMS, PMDD, dysmenorrhea.

All of those can be due to estrogen dominance. Then you also have something almost every woman struggles with and that is fibrocystic breasts, some women can have it throughout their entire cycle. Some women it is regardless of the cycle that just have it, having lumps on your breasts, having really painful breasts, so much so when putting on a bra or trying to exercise especially anything that requires balancing is extremely painful and uncomfortable. Fibroids, 80% of African-American women will develop fibroids at one point in her life. A lot of times, we don’t even realize we have a fibroid, very correlated with women with heavy periods. Uterine polyps, something that a lot of women get diagnosed with and Western medicine’s perspective on it as to remove the uterus.

Speaking of thyroid, thyroid nodules as well as thyroid cancer can also be estrogenic and oftentimes are. In fact, the estrogenic cancer category is estrogen receptor positive breast cancer, uterine cancer, ovarian cancer, thyroid cancer, lung cancer, non-smokers is also a form of estrogenic cancer, and a little bit more benign things, but can be also annoying for a lot of women putting a lot of weight around their hips. So fat and cellulite around the hips and thighs and buttocks. And no matter how much you exercise, it just would not go away. And so this is as I said, at the beginning, I’m highly estrogenic, I can be highly estrogenic if I don’t take care of myself.

So if I do put on weight, it all goes down there and that’s typical. So your pear-shaped women tend to be very estrogenic, women who put weight around their abdomen tend to be more in the metabolic spectrum. So high testosterone, high blood sugar levels, insulin resistance potentially. So I would say those are the main ones. Sometimes, this also can be correlated with other things like having varicose veins on your face, melasma which is also a super annoying thing is a brown spotting for a lot of women will be above your lips, it might be around your forehead around here, in the temples. Some women would even get melasma on their breast and chest.

So I would say those are the main ones. I would also just throw in here that having things like mood swings, terrible mood swings can be also due to estrogen dominance, especially before your period. Women with infertility problems, this is especially due to low progesterone levels. So there are different types of estrogen dominance. Maybe we can mention that in a second, but one type is that when you’re low on progesterone and that infertility or early miscarriages in the first trimester can be correlated with that.

Yeah, I would say those are really the main ones. Actually, there’s more. Oh, let me also not forget. Since you’re a guy, and I’m sure you have some men following, prostate problems in men and prostate cancer can also be due to high estrogen levels. Men have estrogen too, it’s just a lot less than women. But you still depend on the same mechanism as women and that is how do you metabolize it. How do you break down those estrogens is also dependent on your diet, on the health of your liver and your blood sugar levels.

Also man boobs. I was just reading the other day that one of the biggest corrective surgeries for men, for women it would be facelifts and botox and breast implants and stuff. For men, it’s actually breast reduction. And so again, men boobs are due to estrogen because estrogen is what makes women, women. And so X is estrogen. This is super common for men who like to drink a lot of beer. Beer, especially hops-based beer, hops are highly estrogenic. So that’s part of the reason. So one of the questions I get a lot is, “If I do your protocol Magdalena, can my husband and my kids do it?” And the answer is absolutely, yes.

There’s nothing in these protocols that will make your man grow boobs. In fact, it’s the other way around where we have a lot of women telling us that when they implement the protocol for the whole family is that their guys sleep better, they snore less, they have less sleep apnea, less restless legs. They have better mood, they have more energy, they’re just much more pleasant to be around with and they lose weight.

Dr. Eric:

You mentioned the surgery and it’s sad that a lot of men will go ahead and get the surgery, yet it’s not doing anything to address the cause or the problem and the estrogen dominance. And speaking of the cause, as you mentioned, the foundations, healthy gut, healthy liver, blood sugar, but you also did mention genetics. It looks like your dog is in the background.

Magdalena:

I’m so sorry. I forgot to…

Dr. Eric:

…excited about this presentation here too.

Magdalena:

Yeah, woohoo.

Dr. Eric:

No, that’s okay. We have two dogs as well here.

Magdalena:

I’m so sorry. Yeah. Would you just hold on a second? Let me just ask them to come over here and-

Dr. Eric:

Sure, sure. And in the meantime, if you have any questions… Magdalena, will be right back. Just taking care of her doggies. But until then, if you have any questions let us know. She does have another interview right after this for her book. But again, if you popped in late, we’re talking about Magdalena’s book, Overcoming Estrogen Dominance. So if you have any questions, feel free to put it in the chat. And we will try our best to get to your questions. We’ll definitely get to a few questions and hopefully we’ll be able to answer all of them. But yeah, definitely check out her book Overcoming Estrogen Dominance, a really good book… I think she’s back here. So let me add her back.

Magdalena:

Sorry about that, that’s what happens when we have two very lively young terriers.

Dr. Eric:

Yeah, no, no, no worries. I think we’re all used to it. If it was two years ago, maybe it would have been a little bit different. But now, with everything going on-

Magdalena:

It’s just so much more real, right?

Dr. Eric:

Exactly. So what I was going to say as far as the causes. You also mentioned genetics. So it sounded like you had some genetic issues. You talk about COMT, a slow COMT being a big cause of estrogen dominance?

Magdalena:

Yes, that’s the biggest one correct. There are a few other ones and I covered them in the book that make an impact, but it’s more of an indirect one. The direct one is the COMT gene. And just to tell you how bad it was, when I went to see a colleague of ours, Dr. Jill Carnahan, she was my physician here in Boulder, Colorado. When I went to see her for the first time about three years ago, and I brought my whole print out of my labs with me as she was going through it and as she’s flipping through it, she didn’t really know me as a person. We were not really friends back then yet.

She’s flipping through the whole material, and she says, “Have you had breast cancer?” I’m like, “Whoa, no. Why would you say that?” It’s just because with these kind of genes, I see women your age and that time I was 45, women your age, with these kind of genes I would have seen breast cancer by now. So I think I dodged it just because I do this work. Well, I did this work, but I also live this life. And if you ask me what is my biggest fear in life, my biggest fear is that I’ll develop breast cancer and go down the path of my aunts on both sides. And it’s not a good quality of life. And before they even had cancer, they just never really had a happy, healthy life, a vibrant, there’s always stuff going on.  There was all this female stuff as my family will call it, female problems. I don’t want to have female problems. I just want to be a healthy, vibrant, individual. So I’m 48 today, and I always joke about that I feel better than when I was 28. So it’s completely manageable, in spite of what your genes are, you just have to put a little bit more work towards it.

Dr. Eric:

And I don’t think you mentioned in the beginning, maybe you did, but that you also had the antibodies for Graves’ and Hashimoto’s. And then also by reading your book, I didn’t know you also had thyroid nodules. Correct?

Magdalena:

That is correct.

Dr. Eric:

To shrink them I assume by addressing the estrogen dominance, the estrogen metabolism problems?

Magdalena:

Absolutely. And a couple of years ago, I went to get a sonogram on my thyroid and the technician and I were chatting, and she had some sleeping problems. So I started giving her advice. So we became fast friends while I was on that bed. And she said, “I’m not supposed to comment on what I’m seeing. But I will just tell you off record that somebody with a history of Hashimoto’s and Graves’, I’ve never seen such a healthy tissue.” So it was a colored version, the latest kind of scans that you can get. And she says it was beautiful pink. Nice one.

So anyway, it’s completely reversible, it’s completely manageable. I think for a lot of people with thyroid nodules … what happens when you go and see a doc, right? Your typical endocrinologist will tell you just wait and see, come back in six months’ time. And then if they biopsy that, and they consider it inconclusive, they will recommend surgery from which they also make a lot of money from insurance. But to your point, and this is why we do this work, it doesn’t address the root cause of a problem. It’s an autoimmune problem, or it’s an estrogen dominance problem with nodules, with autoimmunity, and so really addressing that, it was something that I’ve always been on a mission to do.

So completely reversible. I don’t have them anymore and I think a lot of a lot of people go like, “Well, let me ask you this, if you had a nodule right in here under your skin, you do something about it.” I feel like when something is inside here, we don’t really see it. Very few people know how to go and look for it. Because we’re not really trying to do it. Then it’s like, “We just let it be.” But it’s not about putting anyone in a state of panic, it’s just your body’s way of saying like, “Hey, I’m really struggling here with metabolizing this estrogen.” And I just happened to be depositing that estrogen into your thyroid, and so do something about it.

So those are your early signs that something needs to be done. The other symptom I forgot to mention is gallbladder. So many women suffer from gall bladder problems. And it’s an interesting one between estrogen dominance and gallbladder because you can have estrogen dominance that causes gallbladder issues, or rather, the thickening of the bile that then builds up the gall stones and in the tracks and that’s what causes the problems of releasing bowel and demount when we need it. But you also have the other way around where the removal of the gallbladder let’s just say you’ve had a poor diet before you join this community. So you had a poor diet, you haven’t been eating all that great.

Dairy sensitivities are a big cause for gallbladder problems. But then you have the gallbladder removed and are told that nothing changes, you don’t really need a gallbladder to function. We have 250,000 surgeries of gallbladder removals in the United States and Mayo Clinic said that apparently, 70% of them are unnecessary, it can be reversible. The problem for women with gallbladder removal, something that your doctor doesn’t tell you, and most women don’t connect the dots is that after gallbladder removal, depending on that person about between six months and what supplements you’re taking, six months to two years later, suddenly the woman starts developing really severe symptoms of estrogen dominance, any of those that I’ve mentioned, and we don’t make the connection that was because of the gallbladder removal.

The reason why that happens is because the bile is not just there to emulsify your fats and help you digest fatty foods. But the bile also binds up your dirty estrogen. So I’m hoping that we can talk a little bit about the different forms of estrogen dominance and why that happens because I don’t want to demonize estrogen.

Dr. Eric:

Yeah, I know you said low progesterone. So that’s an example where you don’t have to necessarily have high estrogen. So why don’t you talk about this? You said there are three different types of estrogen dominance.

Magdalena:

Yeah, I’ll cover the main two ones because I think those are the most adjustable ones. I have all the three in my book, but so the first one is what I call the unbalanced partner since we are on that. This is where your estrogen/progesterone ratio is unfavorable. And the interesting thing is that even when you are in menopause or perimenopause, when all your hormones start slowing down, especially the reproductive organ hormones, estrogen and progesterone. So you could be low on both of them. But even though you’re low on both of them, still the ratio between estrogen and progesterone might be unfavorable.

And then that could be one reason why we are estrogen dominant. Especially, we are talking here about the comparison of progesterone to estradiol, E2, which tends to be the more aggressive form of estrogen. Then you have another form of estrogen, which is also incredibly common, and easily manageable to be perfectly honest. And that is what I call ugly breakup. So ugly breakup is basically … Shows you and you can test for it on their test to show you how you break down estrogens into clean estrogens and dirty estrogen. So if you’re a practitioner, it’s what we call antagonistic metabolites.

Now, I don’t want to demonize estrogen because if you’re a woman listening to this, the only reason why you’re listening to this and comprehending things and absorbing information, you’re sitting straight, and you have some muscle strength and healthy bones is because you have estrogen, that makes us women, that gives us cycles, healthy bones, healthy skin, hair, mental cognitive function. And so estrogen is not bad in itself, we need it to function. The problem is how you break down estrogens into metabolites. Think of it this way. Imagine standing on a side of a river and this river is flowing, and right in front of you is this beautiful, whatever, Rocky Mountains river and you have this bank in the middle of the river, and this bank will separate the water into a clean stream and a dirty stream.

So in the body, the function of that bank is your liver. That’s what happens, that’s where the metabolism of estrogen happens. Not only the liver, the gut also, there is some mechanism there when it comes to gut bacteria that break down estrogens as well. But the liver really plays a huge role in this. And there are a couple of pathways, the methylation pathway, the sulfation pathway and the glucuronidation pathway. They’re responsible for breaking down those estrogens. So how healthy and clean your liver is, this is going to be hugely correlated with how estrogenic you could potentially be. And again, the same thing, even if you’re low on estrogen like women, one of the funny emails that we get on a regular basis, even we try to fix it with a copy somehow doesn’t work is that there was a quiz on my website.

And then women take the quiz and they say, “Your quiz doesn’t make any sense.” It says I’m low in estrogen, and I’m in menopause.  Correct. But it also tells me that I’m estrogen dominant, and that doesn’t make any sense. And we explained it in the copy, but a lot of people don’t read it. And so that’s what I’m trying to explain that even though you’re low in estrogen, the little that you have how you break it down, it can make a big difference. So not surprisingly, my whole cookbook, my whole book, and the recipes are very supportive of using fruits, vegetables, fiber that are specifically targeting liver health.

Dr. Eric:

All right. So we also just want to remind anyone who came in late, we probably should let them know that. First of all, we’re discussing Magdalena’s new book, Overcoming Estrogen Dominance. And then we’re also giving away a book… We’re going to ask a question towards the end. So for one lucky winner who will answer that question, that person will … We’re going to randomly choose, is that how we do it… I’m new to these book giveaways.

Magdalena:

Yeah, my team generally picks someone randomly, unless you have … Sometimes we pick somebody who’s very active, ask a lot of questions.

Dr. Eric:

Okay. Speaking of questions, I just want to get to this question because it does lead to one of the questions I was going to ask you. So one of the Facebook groups asked, “What tests can you take to find this out or is it just based on symptoms?” So I know you have an answer for that and I know the answer, but we’ll let you give the answer.

Magdalena:

Okay. So symptoms are obviously very telling and it depends, if you’re really on a tight budget, then going with symptoms and helping yourself by making changes to your diet and adding a few supplements will definitely help. If you have the funds and especially, I do recommend it for women who have a history of estrogenic cancers, managing and or by identical hormones, I hope you’re not taking any synthetic hormones. Then breaking down, managing that element of how you’re breaking down estrogens is going to be really, really important. So for that, I really like the DUTCH, D-U-T-C-H that shows you your estrogen metabolites. This is going to be really helpful to see and understand that. Do you do interpretation of DUTCH?

Dr. Eric:

I do. If someone just wants the adrenals tested, a lot of times I still will do salivary testing. But for looking at sex hormones, I agree, dried urine testing, and specifically the DUTCH test is something I recommend.

Magdalena:

Yeah. And I will also say that blood testing is completely useless when it comes to certain markers. Some people might say that morning cortisol is helpful. Cortisol is not my gig, but I can tell you right now from an estrogen/progesterone perspective, if your doctor has done blood testing then it’s not going to tell you pretty much anything. I remember when I was in private practice, I’m not anymore, but when I was, I used to have women walk into my office and say, “Look, okay, those are my labs, this is my estrogen, my progesterone. My doc says everything is perfect.” And fair enough, it was all within ranges.

Nobody asked her which part of the cycle she was in. And then yet, this person, when you look at her intake form, has got a history of fibroids, she’s got terrible, heavy periods running for 20 days at a time, history of breast cancer in the family. Screaming estrogen dominance, and her physician is telling her that her labs look great. So blood is completely useless. I agree with you. I like saliva, also, for another reason that I feel like it’s a better marker of progesterone. DUTCH estimates progesterone where the saliva actually shows you more … I think it’s just another really great market to look at with that. So saliva and urine for sure.

Dr. Eric:

Like you said, the big advantage of urine testing is that it looks at the metabolites. Saliva doesn’t do that, blood doesn’t do that. So if you want to look at the two hydroxy, four hydroxy, 16 hydroxy… There are other urine test that look at these. I know DUTCH isn’t the only one, but it’s the most common one, it’s the one I use and it sounds like the one you use. So yes, anybody looking for symptoms to start out with maybe like you said, if they can absolutely afford the DUTCH test, and this test also looks at the adrenals, looks at melatonin and looks at some organic acids.
So it’s really a good test. So I’m just looking, we got those questions, I think you triggered a bunch of questions coming in with that. So all right, “Is there a link between hypothyroidism and estrogen dominance?”

Magdalena:

Perfect question Madeline. And the answer is yes, absolutely. So they often go together and in fact, I said it earlier in our interview that I hardly ever see women having just one hormonal problem and typically comes in sets of two or three. So yes, and the mechanism behind it is that when you have high estradiol or you have high metabolites, dirty estrogen is what I call those metabolites, unfavorable metabolites. What happens with estrogen dominance is that excess estrogen binds up thyroid binding, it binds up your thyroid hormone basically.

And so even though you might be producing a sufficient amount of thyroid hormone, the excess estrogen is going to bind it up and up and hence causing or making you feel like you have hypothyroidism. So yeah, definitely. The other thing that happens is that estrogen dominance also can cause the growth of thyroid nodules. And that’s an interesting one because a lot of women who are really hypo suddenly also have bursts of being hyper during that time.

So for those of you who have been swinging between those two, I used to have that swinging happening. I think there are different theories why that happens, but one of them for sure is the fact that thyroid nodules can also produce additional thyroid hormone making you hyper even though you’re hypo so you’re just swinging between those two. Lastly, estrogen dominance just causes a lot of inflammation. And since most hypothyroidism cases are Hashimoto’s, and if you haven’t been tested, I highly recommend for you to get tested for Hashimoto’s antibodies, and when you have Hashimoto’s, you already tend to be on the inflamed side of things.

And so estrogen dominance is like adding fuel to the fire. So all around, yes, absolutely. That’s why a lot of women who have hypothyroidism also have fibroid issues, lumpy breast issues, painful breasts, terrible PMSs and periods, etc.

Dr. Eric:

All right. Great. Thank you for that explanation, and we have a bunch of questions here. Marina asks, “Can IVF cause Graves’?” I don’t think so Marina as far as I know, I don’t think in vitro fertilization will cause Graves’. I don’t know if you have any opinion on this.

Magdalena:

No, I really don’t know much about that.

Dr. Eric:

Okay.

Magdalena:

There’s a question on birth control. I don’t know if you want to do that one. I think it’s a good question.

Dr. Eric:

This one here?

Magdalena:

Yeah. “Also, my surgeon recommends I go on low dose birth control of estrogen, but I don’t want to as it has synthetic hormones and I’m sure will increase estrogen. Should I really stay away from birth control?” So I’m curious what your take is, but I’ll just tell you mine. First is that one thing that I find really amusing on one hand and really frustrating on the other, is when your doctor tells you that it’s a low dose birth control. Have you ever heard of a high dose birth control? A normal dose birth control?

So it’s marketing … First of all, there’s a marketing spiel that’s been created by the pharmaceutical companies on birth control pills that just make you believe that you’re on the lowest dose possible. They don’t even test your hormones to determine the dose that you need. Okay. Our colleague Jolene Brighten has written a great book called Beyond the Pill, and it’s a really wonderful book about getting women off birth control. So for those of you who have younger kids or younger women who struggle with it, I highly recommend to get that book.

But what I have learned from her, just a short version of this is that first of all, when you go on birth control, birth control pills are nutritional muggers. They mug you of Vitamin Bs, magnesium, zinc and guess what? All these minerals, all these vitamins and minerals are essential. For example, B vitamins are essential for detoxifying your liver, and you’re basically impairing the ability or just you’re basically flushing them out of your body, depleting yourself of B vitamins, impairing your liver’s function, and hence, your estrogen metabolism is not going to be as effective.

Magnesium, how many of you here are craving chocolate? It’s almost like a women’s thing. It’s like, “I love chocolate. I can’t live without chocolate.” And it’s like a cultural, joke kind of a thing. But actually, there is a reason behind it. Cacao is high in magnesium, every time you have chocolate, your body’s like, “Oh, thank goodness, I’ve got some magnesium here. I love you for this. Bring on more chocolate.” Problem is there’s sugar in that. So yeah, so all around and most importantly, a lot of times, doctors put us on birth control pills without addressing the root cause of the issue.

So you ask yourself why is your surgeon putting you on birth control pills? Is it really because of contraception? Because there’s a lot of other things you can do with contraception.  Or is it some other reasons? And is it to regulate your periods? Because that’s not stated here. Is it to regulate your periods? Is it to make the periods less painful? What is the reason? For example, let’s just say your periods are irregular, that’s not the way to fix a problem. Okay. So, and actually, your periods tell you a really great story on your overall health, the same way your hair tells the story of your health, your skin tells the story how healthy are you on the inside.

Your periods tell you how healthy of a woman are you. So I think I just want to congratulate you on your intuition to consider staying away from that. And so I would definitely work with somebody like Dr. Eric Osansky to really uncover what is the root cause of your issue. And yes, it will increase estrogen and I will tell you right now, one of the early symptoms that I already knew that I had problem with estrogen was that I’ve been on birth control pills for six months. It was the worst six months of my life. Worse. I felt so off, my breasts were so painful. I used to play a lot of tennis. I couldn’t play tennis.

I didn’t want to have sex, I had headaches all the time. And so I think it was because I’m such a bad estrogen metabolizer, and I had enough intuition, but though I didn’t know any of this back then was just not to do this. And congratulations on your own intuition and to ask this question, so thank you for that.

Dr. Eric:

Yeah, and this question relates to the birth control too in that Victoria wants us to repeat the correct test for hormones and we’re going to talk about dried urine testing with the DUTCH test, but if you’re taking birth control , you wouldn’t want to do the DUTCH test because it’s going to be throwing off those hormones. So if you’re testing for hormones while on birth control, it’s not going to give an accurate reading.

But yeah, dried urine testing is what both Magdalena and I use and recommend. And I definitely agree with what you said with the birth control and good point with the B vitamins and magnesium. B vitamins are also important for adrenals as well.

Magdalena:

And zinc. Zinc and magnesium are essential for progesterone production, for example. And for your immune system. And most of you guys are here probably because of Graves’ and Hashimoto’s and here you are depleting yourself of zinc. One of your immune system nutrients. So yeah, good question.

Dr. Eric:

All right, Rachel, thanks for bringing up the DUTCH test. And then here we have Diane, “Once one has testing in hand, is jumping to bio-identical hormones usurping the opportunity to address underlying causes naturally with diet?” Yeah, and I think you would agree. I forget if you mentioned this in your book. But in some cases, if someone has a complete hysterectomy, then maybe that’s justification for taking bioidentical hormones. But the problem is if someone goes to a doctor who prescribes bio-identical hormones, almost everyone will get a prescription for bioidentical hormones, even those who probably don’t need bioidentical hormones.

Magdalena:

Yeah, so you have a very good point. And women with a hysterectomy, women who are very stressed out during a certain period of time, let’s address this in a second. But I want to show you this pyramid I have in the book, let me just get this centered and it’s called, I call it the healing pyramid. The bottom of the pyramid is food. What it says is always first, then you have herbs. I’m an herbalist, so I love herbs and in culinary applications, and then the supplements which I call it often. So food is first and always, herbs are often supplements sometimes and medications.

And medication is only when needed and I consider bio-identical hormones in the RX staying on top and it’s not to say that you don’t do it. There are times when you do need your thyroid blocker because you’re just going completely berserk, right? But then you work on getting yourself out of it and the same thing. So the challenge is like what you said about going to a clinic that specializes in bio-identical hormones is they don’t get to ask and ever correct your diet. They’re never going to replenish and correct your nutritional deficiencies. And my challenge with getting DUTCH testing done, it will be like boom, okay, we’re going put you on estradiol, estriol and progesterone or DHEA or testosterone or whatever, you’re getting the whole combo.

And the challenge I find with that is that you are not addressing the biggest question which is why is your body not producing your own hormones properly in the first place? Or why are you not metabolizing these hormones in the first place? And by going on these bio-identical hormones, I think sometimes temporarily it’s really helpful just to get you settled and calm you down and enable you to focus. And so when you read books like mine, you can actually process it and get to the kitchen and have the energy to prepare something. But a lot of times, it’s something that we just take forever while we are magnesium-deficient.

A huge one, one of my absolute favorites when it comes to hormonal balance. So let’s talk about magnesium deficiency. Let’s say they don’t correct the magnesium deficiency, they don’t even test for your magnesium. They don’t look at the other symptoms like for example, the fact that you’re having sleeping problems. You’ve got a lot of cramps, you wake up in the middle of a night with massive pain around your shoulders or you’re cramping around, you’re constipated all the time. But they don’t address the magnesium deficiency.

They’d rather put you on a whole bunch of … Even if it’s by identical hormones, but you see then when you have this magnesium deficiency not addressed, then you go like, “Oh, then we’re going to give you stool softeners and then we give you something for the sleep.” And the next thing you know, you are taking 20 supplements and spending 500 bucks a month. And so this is where I think the challenge is and I will say if I had a complete hysterectomy, I definitely would consider going on certain hormones, although it’s really interesting that the body is so amazing certainly if you had a hysterectomy, you’re going to go into menopause sooner or later, but the adrenals step in, and guess what? The adrenals then when there’s an absence the adrenals step in and you’re in menopause, but you’re still producing your estrogen and progesterone through the adrenals which is really fascinating.

And so some women don’t even need to go on bio-identical hormones. But if you’re feeling like you’re brain dead, you got your bone density testing, it’s not looking great, your mind isn’t working particularly great then consider bio-identical hormones, but always in combination with some supplements and a really good diet.

Dr. Eric:

Right. And you bring up a good point about progesterone and estrogen. If someone has low progesterone causing estrogen dominance, they could take something such as chaste tree (vitex), but instead of bioidentical hormones, that’s sometimes an option I’ll give, but the number one thing I’ll try to do is try to improve the person’s adrenals. Just doing that could do wonders for low sex hormones as well.

Magdalena:

Yes.

Dr. Eric:

So now as far as some of the treatments, I don’t know if you want to talk more about food. Of course, the book goes into greater detail, but if you could give a few tips as far as either diet or supplements, I know there’s diindolylmethane, DIM, I’ll let you take over as far as what types of treatments do you recommend?

Magdalena:

Yeah, so let’s just talk about maybe the liver. Definitely a favorite organ when it comes to balancing your estrogen levels. I’ll give you three pointers on what you can incorporate right away today. It’s a Friday today, hopefully you’re going shopping over the weekend. First thing is that you want to surround yourself with really great cruciferous vegetables. So the brassicaceae family of vegetables will be things like broccoli, cauliflower, kale, collard greens, arugula, radishes, turnips, we are going to spring now, radishes … It’s a really great time to buy young radish especially if you go to shopping in farmers market.

These cruciferous vegetables, so it’s the brassicaceae family, the cabbage family, they contain a number of different substances including DIM, diindolylmethane. They also contain some levels of sulforaphane, broccoli sprouts are amazing. By the way, they’re very high in sulforaphane. Sulforaphane kills your breast cancer stem cells, how amazing is that? So throw away the lettuce. There is nothing in the lettuce that’s going to be nutritionally beneficial for you. Okay? Maybe this summer, consider not growing a zucchini which also nutritionally speaking, the density in a zucchini, there’s nothing wrong with a zucchini, it just make you food you’re eating really nutritionally dense that it’s like a bowl of medicine that you’re feeding yourself.

Note: while iceberg lettuce doesn’t have any nutritional value, some other lettuces do have a good amount of nutrients, including organic romaine and green leaf lettuce.

So instead of doing lettuce, incorporate arugula or mustard greens, instead of doing lettuce or instead of doing zucchini, consider chopping up some broccoli or broccolini into your salad or if you can’t do it raw, then you can steam it lightly too. And so all of those are just absolutely wonderful. Your liver is going to love you for that. They also have slightly better quality to them. And the bitterness is something that the liver loves. So the next thing as I mentioned is bitterness. So the liver loves bitters period. In a lot of cultures, bitters are something that is drunk before or after a meal.

If it’s before, it’s an aperitif, if it’s after, it’s a digestif. The French have it, the Swedish have it, the Italians have it and it’s always there to prepare your digestion for receiving food and extracting the best out of your food. But guess what? The liver also loves anything that’s bitter. So you can do a couple of things. If you like digestive bitters, we just formulated our own. Have I sent you our digestive bitters?

Dr. Eric:

No, you have not.

Magdalena:

Okay, I’m going to do it after this call. We formulate a really good-tasting digestive bitter, something you take before a meal and we have another one that’s after a meal that really helps. But even doing things like burdock root tea or dandelion root tea. Today when you walk into most health food stores, if you can look at a tea section, back in the day like 10 years ago, there was two hippie teas kind of thing. Now you have 20 brands and 100 products out there that are non-caffeinated.

And just look for those ones that deliver support once and look for dandelion roots, artichoke or burdock root and have that after or before a meal. Most people will prefer to do it after a meal. That bitter quality is going to tremendously help your liver. The third thing that helps the liver in a huge way is fiber. And flax seed is really wonderful to incorporate into your daily diet. A couple of tablespoons of flax seeds freshly ground, I want to emphasize the word freshly so you don’t buy flax seeds as being per ground in the flax meal form. You can pre-grind it and put it in a little jar and keep it in the fridge for about a week or so.

Not only is it a great source of fiber for both soluble and insoluble fiber, but you have to remember that fiber not only is going to help you with your digestion as in help you eliminate and just a little pointer here. Anyone who’s constipated, not only are you taxing your liver, but you’re recycling all these estrogens, the dirty estrogens I talked about over and over again through your body. So incorporating some flax seeds can really be super beneficial. One of the questions that I get and I thought I mentioned that here that’s like, “Hey, why are you suggesting flax seed? Since flax seed contains phytoestrogens, naturally occurring estrogens. I’m already estrogen dominant. Why on earth would I be adding more estrogen to my diet?”

And that’s a valid question. But remember, your problem is not having too much estrogen. Your problem is most likely how you’re breaking down those estrogens or your level of progesterone to estrogen. So having some estrogen from foods, there’s nothing wrong with that. In fact, flax seeds in the studies helps you to skew the balance towards the clean estrogens away from the dirty estrogens and actually works on a receptor and it blocks the antagonistic metabolites from coming through. So it really helps you, it’s quite amazing. So those are some of the easy things that we can incorporate right away that your liver is just going to love you for.

Dr. Eric:

I grind my own flax seeds.

Magdalena:

You do?

Dr. Eric:

Yeah, I have a coffee grinder.

Magdalena:

You’re a different level.

Dr. Eric:

Yeah, and I’m pretty sure a few years ago I wrote an article on phytoestrogens and spoke about the studies…and it’s obviously different than xenoestrogens which we won’t get into here. You talk about those in your book, I think. But yeah, I definitely agree about the flax seeds. And I know you’ve got to go soon as you have another interview coming up. Do you have time for a few more questions?

Magdalena:

Yeah, let’s do it.

Dr. Eric:

Okay, great. So Michelle asks, “Graves and estrogen dominance as well?” Yeah. So whether it’s hyperthyroidism, hypothyroidism, Hashimoto’s, Graves, you can have estrogen dominance.

Magdalena:

Shall we pop the question that we talked about so that we can find a winner for the giveaway?

Dr. Eric:

Okay, so yeah, what question?

Magdalena:

Do you have a question in mind or do you want me to do it?

Dr. Eric:

How about naming one of the three types of estrogen dominance or should we make them answer two of them?

Magdalena:

Yeah, I think one is good. So I talked about two different types of estrogen dominance and so give out the answer for … Give us an example of one of them that I covered.

Dr. Eric:

Okay.

Magdalena:

And the winner is going to be … My team is going to approach you guys and then we’re going to send you a copy of this book.

Dr. Eric:

All right, so.

Magdalena:

Wow, a lot of comments are coming in.

Dr. Eric:

Okay. So for the book giveaway. Yeah, go ahead and name one of the three types of estrogen dominance that we discussed, two of them earlier. And one question while those responses are coming in …There was one about the Mirena IUD, “Can Mirena IUD cause estrogen dominance?” I would say yes.

Magdalena:

Mm-hmm (affirmative). It’s supposed to work locally. And that’s what they tell you. But it’s the better of birth control pills if you will. It’s the lesser of the evil, but put it this way. If you are really struggling with estrogen dominance and you implement, let’s say you follow the protocol from overcoming estrogen dominance and you still are showing a lot of symptoms. Let’s just say five days before your period, your boobs are really, really painful, and you can’t even put on a bra or you’re struggling with your periods.

Then consider removing it. Not every person responds the same way to the same thing. So just honor that. But I think it’s worthwhile for you to hold on to it and make all these different changes and teach your body to metabolize estrogen a really healthy way, support your liver, do an anti-inflammatory diet. By the way, the whole book is based on an anti-inflammatory diet, an elimination-based diet. So it’s free of gluten, dairy, soy, corn. We don’t do nightshade vegetables, all that potatoes, tomatoes and stuff like that is out and is very low in sugar. There are still desserts, but it’s generally very low in sugar. And it completely redesigns your breakfast as well. I’m a big fan of savory breakfast and not sweet breakfast. So you’re going to learn a new way of eating your breakfast, it might change your entire day, maybe your life.

Dr. Eric:

That’s awesome. And let’s see. As far as some of the answers here. So yes, Patricia, this gets recorded. It’s automatically being recorded. And I’ll also be posting this on my YouTube channel as well. Did anybody actually get it?

Magdalena:

Yes, there’s a lot of people saying the right type of estrogen and I think they just mean it’s too high. And so that is one of the correct answers. Not many people got the estradiol to progesterone ratio. Correct. And really what we are looking for you guys is the different, not the symptom, but the different type of estrogens. So that one we’ve mentioned is estrogen and progesterone ratio. But there’s another one that we mentioned that I’ve been talking about.

Dr. Eric:

Yeah, and I guess I could see how they could get confused because there are three types of estrogen, there’s estradiol, estriol, estrone, but we’re talking about there’s three different types of estrogen dominance, not the estrogens itself.

Magdalena:

Should we pop another question?

Dr. Eric:

Okay, yeah.

Magdalena:

I’ve got one and that is name one of the three things that I mentioned that you can really do, start off today or tomorrow to support your liver health. Is that fair?

Dr. Eric:

Yes. I think that is fair. So yeah, one thing you could do to support liver health that Magdalena discussed. And this again is for the book giveaway. And so Jenny asked if you can please post your book information? So again, it is on Amazon of course, you could find Overcoming Estrogen Dominance. What’s your website as well?

Magdalena:

We actually have the book on overcomingestrogendominance.com, it’s available there as well. So that’s the website for now.

Dr. Eric:

Okay, all right. We got a lot of good responses here. Okay, so let’s see. I think it was more clear. I think that they were confused by the other question which is understandable.

Magdalena:

Great answers you guys, you’ve been listening so it’s awesome. Make sure that this weekend you go shopping.

Dr. Eric:

Oh wow, yeah. All right. So how do we choose the winner? Is that up to me or is that up to you?

Magdalena:

It’s up to you, it’s up to you and just let us know … I would suggest to reach out to that person and give them or you can pick now somebody and then ask them to email you their mailing address and then we’ll send the book there. Wow, so many of you got it right, so many good answers.

Dr. Eric:

Oh boy, yeah. This is tough. Let me just do it quickly because I know we’re running out of time.

Magdalena:

You want to do it after we hang out? Because you can do that too.

Dr. Eric:

Okay. Michelle Pilon, “Drinking burdock and dandelion teas, even artichoke.” Does that sound good?

Magdalena:

That sounds perfect. Yes. Artichoke leaf. Yeah, because it’s found in often is that it’s a very bitter herb actually, but it’s great. Yeah.

Dr. Eric:

It was hard to make the decision, but I know I had to just pick and choose. So thank you everyone for your answers. Thank you Magdalena for this interview, this discussion on overcoming estrogen dominance. Again, definitely go to Amazon or go to overcomingestrogendominance.com and pick up a copy of her book. And yeah, thanks again for chatting about this and thank you everyone. Thanks everyone for your questions and participation. We appreciate it. Hope everyone has a wonderful day and a wonderful rest of your weekend. And thanks again Magdalena for chatting.

Magdalena:

Thank you so much.

Dr. Eric:

Bye everyone.

Although it’s common for me to work with patients who have had hyperthyroidism/Graves’ disease for years, I also work with many people who have been recently diagnosed.  And while many of these people simply follow the advice of their endocrinologist, others realize that most medical doctors don’t do anything to address the root cause of their condition. For those people who want to do more than receive conventional medical treatment, I’ve decided to put together this blog post where I’ll discuss ten tips for those recently diagnosed with hyperthyroidism.

Not only do I think those who have been recently diagnosed with hyperthyroidism will find these tips to be helpful, but even those who have dealt with hyperthyroidism for many years will find value in these tips.  This especially true for those with Graves’ disease and toxic multinodular goiter who are tired of having their endocrinologist bring up radioactive iodine and/or thyroid surgery.

Here are the ten tips:

Tip #1: Keep an open mind.  Since you’re reading this blog post you most likely have an open mind.  Perhaps your endocrinologist recommended radioactive iodine or thyroid surgery, yet this didn’t sound like the best option.  Or maybe you’ve decided to take antithyroid medication, but realize that this is only a temporary solution.  Either way I commend you for considering a natural treatment approach.

Tip #2: It’s important to stay safe while trying to address the underlying cause.  This arguably should have been the very first tip, as it’s very important to safely manage your hyperthyroid symptoms while trying to restore your health.  Many people will choose to do this through antithyroid medication, while others will choose natural agents such as bugleweed or L-carnitine.  When I dealt with Graves’ disease I took the herbs bugleweed and motherwort, although many of my patients rely on antithyroid medication such as methimazole.  Since I didn’t take antithyroid medication I can understand others also not wanting to do this, but if the bugleweed didn’t work in my situation I’m pretty sure I would have taken the medication.  On the other hand, if you’re currently not taking antithyroid medication then trying to manage your symptoms with natural agents is an option to consider.  Just remember that the quality and potency of the herb can make a big difference.

Tip #3: Don’t let your endocrinologist pressure you into receiving RAI or thyroid surgery.  While many endocrinologists will recommend antithyroid medication to their hyperthyroid patients, it’s also very common for endocrinologists to tell their patients with hyperthyroidism that they need RAI or thyroid surgery.  Some will even pressure their patients, and might even use scare tactics.  I’m not trying to make light of hyperthyroidism, as there definitely are risks involved.  This is especially true with unmanaged hyperthyroidism.

But I think it’s crazy for endocrinologists to immediately recommend RAI or surgery when someone is newly diagnosed with hyperthyroidism.  If someone is unable to tolerate antithyroid medication I can understand them mentioning these other treatments, as they weren’t taught in medical school to use natural agents such as bugleweed, motherwort, lemon balm, and L-carnitine.  And they certainly weren’t taught to address the cause of these and other health conditions.

Tip #4: If you have Graves’ disease, remember that this is primarily an immune system condition.  This makes it even more ludicrous for endocrinologists to recommend radioactive iodine or thyroid surgery as a FIRST OPTION.  Once again, I realize that there’s a time and place for these treatment methods, but just remember that they don’t address the autoimmune component of Graves’.  Neither does antithyroid medication or beta blockers (or bugleweed, motherwort, lemon balm, or L-carnitine), but the goal of these is to keep the symptoms in check while you find your triggers and correct any underlying imbalances.

Tip #5: If you have toxic multinodular goiter, common causes include problems with estrogen metabolism and insulin resistance.  Your endocrinologist probably won’t mention this to you, mainly because they don’t keep up with the research.  Just as is the case with Graves’ disease, they are likely to recommend either antithyroid medication, radioactive iodine, or thyroid surgery.  And while toxic multinodular goiter can be challenging to treat naturally, I still think it’s worth trying to address the cause of the problem.

Tip #6: If taking a natural treatment approach, start with cleaning up your diet.  Although eating a healthy diet alone many times won’t be enough to restore your health, it still is important.  After all, if you eat inflammatory foods on a regular basis you probably won’t heal.  In fact, even occasionally eating inflammatory foods might prevent some people from restoring their health.  This doesn’t mean that perfection is required, and I definitely haven’t been perfect with the diet since I’ve been in remission from Graves’ disease, but while you’re trying to get into remission you want to do everything you can to avoid gluten, refined foods and sugars, fast food, unhealthy oils, etc.

Tip #7: Stress is a big factor in the development of Graves’ disease.  In addition to cleaning up your diet, another thing you want to do is work on improving your stress handling skills.  Of course if you can decrease the actual stressors that would be wonderful, but this isn’t always possible.  I advise my patients to start with blocking out 5 minutes for stress management EVERY DAY.  While more than this would be even better, it’s important to get into the daily routine of improving your stress handling skills.

Once you are in the routine of blocking out 5 minutes per day for stress management you then can gradually increase the duration.  As for what stress management techniques you should utilize, I recommend some type of mind-body-medicine (i.e. meditation, deep breathing, yoga, tai chi).  Keep in mind that you don’t need to practice the same technique every day.  For example, if you like yoga then you can practice this three days per week, and then meditation the other four days.

Tip #8: Take advantage of some of the free resources I offer those with hyperthyroidism.  I have hundreds of free articles related to thyroid health on my website.  Many of these focus on hyperthyroidism.  Here are just a few of them:

https://www.naturalendocrinesolutions.com/5-hyperthyroidism-diet-tips/

https://www.naturalendocrinesolutions.com/5-precautions-to-take-when-reversing-hyperthyroidism-naturally/

https://www.naturalendocrinesolutions.com/is-hyperthyroidism-causing-your-frozen-shoulder/

https://www.naturalendocrinesolutions.com/5-things-to-know-about-thyroid-eye-disease/

https://www.naturalendocrinesolutions.com/toxic-multinodular-goiter-vs-graves-disease/

In addition, since 2020 I’ve been conducting free thyroid-related events, and by being on my email list you will be notified whenever I have these free events (5-day thyroid-related challenges, Facebook live and Zoom Q & A calls, etc.).

If you’re interested in communicating with others who have hyperthyroidism, you might want to join my “Hyperthyroidism and Graves’ Disease Natural Solutions Support Group”, and attend my regular Facebook live chats (I do them a few times each month on Friday afternoon).  Here is the link to join:

https://www.facebook.com/groups/hyperthyroidtribe

Sometimes I will also do random Zoom calls for those who aren’t on Facebook.  This is yet another reason to be on my email list, as when I do these I will send an email to everyone to let them know the day and time, along with the Zoom information necessary to attend.

Tip #9: Read my book “Natural Treatment Solutions for Hyperthyroidism and Graves’ Disease.  You can find this on Amazon.com, as well as on other websites that sell books (i.e. Barnes and Noble).  Make sure you get the revised 2^nd edition.

Tip #10: Be cautious about self-treating your condition.  Obviously I’m going to be biased here since I’m a natural healthcare practitioner, although keep in mind that I personally worked with someone when I dealt with Graves’ disease back in 2008/2009.  Many people don’t need to work with someone in order to clean up their diet, improve stress handling, etc.  But while improving diet and lifestyle is important to anyone looking to restore their health, doing this alone usually isn’t sufficient.

I do work with people remotely, so whether you live in the United States or in a different country, you might want to check out my Natural Hyperthyroid Restoration and Optimal Health program.  I do require anyone interested to 1) watch a free webinar and 2) complete a brief online application, and if you want to watch the webinar you can Click Here.

Bonus Tip: Check out the Save My Thyroid podcast.  This podcast is specifically for people with hyperthyroidism, and as the title of the podcast implies, the main goal is to help people save their thyroid gland…while addressing the underlying cause of their condition.  Click Here to listen to the episodes on my other website, and if you have an iPhone and want to subscribe Click Here.  If you have an android and would like to subscribe Click Here.

I’ll wrap up this blog post by mentioning that whether you have Graves’ disease, toxic multinodular goiter, or a different type of hyperthyroid condition, it is possible to regain your health and avoid radioactive iodine and thyroid surgery.  I’m not saying it’s an easy process, as it will take time and a commitment on your part.  But in my opinion it’s well worth the effort.

Have You Been Recently Diagnosed With Hyperthyroidism?

If you have been recently diagnosed with hyperthyroidism I’d love to hear from you!  Have you seen an endocrinologist?  If so, what was your experience? Did you know you wanted to take a natural treatment approach immediately after being diagnosed with hyperthyroidism?  Or did you have no idea that natural treatment methods were an option until you did some searching?  Thank you for sharing your experience with everyone!

On Friday March 5th I interviewed Dr. Amy Day, founder and CEO of the Women’s Vitality Center, and below is the written transcript. If you would prefer to watch the interview you can access it by clicking here:

Here is the transcript:

Dr. Eric:

Hello, everyone. Hope everyone is having a wonderful Friday so far. With me today is Dr. Amy Day. Dr. Amy has been at the forefront of the natural woman’s health movement since 2004 after receiving the fourth ND license in a State of California. So while she was in naturopathic medical school, struggles with her own women’s health issues fueled by Dr. Amy’s passion. So pretty much in short, Dr. Amy’s a hormone expert, so that’s why we’re going to chat about adrenal health, perimenopause, and we’ll also be answering some of your questions later on. She’s the founder and CEO of the Women’s Vitality Center. She specializes in helping busy professional women struggling with perimenopause to balance their hormones. A big part of that is also balancing their adrenals, which we’ll get into. Welcome, Dr. Amy, thanks for getting together for this interview.

Dr. Amy:

Absolutely. It’s an honor to be here, and it’s really been fun to connect with you and get to know you and all the amazing thyroid work that you do. It’s so important how all these different hormones interconnect with each other, and I’m excited to have a conversation about it today. Thank you for having me.

Dr. Eric:

You are very welcome, I’m excited as well. Why don’t we just jump into the adrenals. We’re going to, again, talk about adrenals and perimenopause, and I think Dr. Amy might’ve froze there. Dr. Amy, are you still with us here?

Dr. Amy:

I’m still here.

Dr. Eric:

Okay, as long as we can hear you, so your screen’s freezing a little bit.

Dr. Amy:

Okay.

Dr. Eric:

But no worries. We’re going to start talking about adrenal health, and then we’ll make our way into perimenopause. Can you tell the viewers why the adrenals are so important for our health?

Dr. Amy:

Yeah, so adrenals, many people have heard of them and many people have not. So just to take a little step back of like what are the adrenals? What are we even talking about? The adrenals are a part of our endocrine or hormone system that they have many functions. But one of their main functions is to help us to respond to stress. They’re little glands that sit on top of your kidneys in the middle of your back, they’re like little hats that sit on top of your kidneys and they produce cortisol, which is your main stress response hormone. They also produce a host of other hormones, but that’s one of the big roles for the adrenals. This all has to do with how do you respond to stress? Stress is going to happen in life, so how is that working for you physiologically to be able to respond to that stress?

Dr. Eric:

Thank you for that explanation. Why do so many people have adrenal problems? At least, I see a lot of adrenal problems in my practice and I assume you do as well?

Dr. Amy:

Yeah, absolutely. It’s interesting what we consider to be an adrenal problem. In conventional medicine, there’s this black and white picture of everything’s completely fine, or you’re in a completely diseased state of the adrenals. What we see in more functional medicine, natural medicine practices is everything in between, where the adrenal glands are just having dysfunction related to the chronic stress that we tend to accumulate in our lives. Whether it’s big, short-term stresses that are going on or all the little things that add up over time and are going on for a longer time, that accumulation of stress can make it so that the adrenal system is just not able to completely respond as adequately.

One other thing to mention about what the adrenals do for us, there’s a stress response in the sense of like, in the moment, there’s a stressful thing going on and you get your blood sugar up and your heart pumping and your eyes dilate and your muscles are stronger. You’re flooding your system with blood sugar to be able to fight or flight, so there’s that acute stress response. Then there’s also a role, a really important role that the adrenals do for us, which is regulating the circadian rhythm or our 24-hour clock. Your adrenals produce cortisol for you first thing in the morning, that’s part of your get up and go.

Then those higher levels taper off over the course of the day and drop at nighttime, so regulating that night/day rhythm is another really important thing that the adrenals do. When we’re in chronic stress situations, when our schedules are irregular, when we have an acute issue of something going on, either emotional or physical, any of those things can contribute to the challenge of the adrenal glands.

Dr. Eric:

Okay, great. It’s important what you just said, as it’s not just emotional stressors, but physical stressors, and lack of sleep also have a huge impact on adrenal health. You also mentioned difference between acute stressors and chronic stressors. When someone is in acute stress, the adrenals do a pretty good job of adapting to acute stress, so you’re more concerned about the chronic stress, correct?

Dr. Amy:

Yeah, either the buildup of the chronic stress or the long-term impact of the acute stresses when they happen. Some people, they’ve never been well since some big thing happened in their life or to their bodies or something, and then it’s the long-term consequences coming from that. Because that resiliency wasn’t there to be able to bounce back. That’s how acute stress can turn into a long-term issue or the chronic stress, that’s the every day grind of all the demands in our lives and the get up and go, and the deadlines, and the world that we live in, and the issues that different people face that are just constant drains on our system.

Dr. Eric:

Yeah, and of course it’s only been increased over the last year for a lot of people with everything going on. But even before last year there’s always been stressors, there’s always going to be stressors, and that’s why we want to try to do everything to improve our stress handling skills. We could talk more about that. But I want to talk about, of course, thyroid and adrenals. As far as stress, stress affects adrenals, so what is impact that chronic stress has on thyroid?

Dr. Amy:

I’ll make a couple comments, but I’d love to hear from you, so there’s connection.

Dr. Eric:

Sure.

Dr. Amy:

So often we see when people are having thyroid problems, that there is an adrenal aspect to that also, or it could be vice versa. I see it a lot in practice and we know that in order for the thyroid to function optimally, that the adrenals need to be functioning optimally as well. But I turn it to you, I would love to hear your perspective actually on how that relationship is between the adrenals and the thyroid.

Dr. Eric:

Sure. There’s a few different ways. Especially, when someone is dealing with a chronic stress and high cortisol. T4, as you know, converts into T3, which is the active form of thyroid hormone. Most of this takes place in the liver, some of it takes place in the gut, I think approximately 60% in the liver, 20% in the gut. Those could have an impact on thyroid health. But also when someone has stressed out adrenals, that could affect conversion of T4 to T3, especially when they have high cortisol levels. So a lot of times we’ll see, or I’ll see normal T4 and low T3.

Again, this might be related to problems with the liver, or it might be related to problems with the gut.  So it’s not only adrenals, but adrenals can play a big role. Then chronic stress, for those with Graves and Hashimoto’s, chronic stress causes dysregulation of the immune system, which is a pro-inflammatory state. That could also be a contributing factor, or potentially, a trigger of thyroid autoimmunity. Then another way is there’s what’s called Secretory IgA, which lines in mucosal surfaces of the body, and chronic stress will typically decrease Secretory IgA. That’s a protective barrier, so when you have a decrease in Secretory IgA, it can make you more susceptible to, let’s say, infections, for example.

So those are three different ways in which problems with adrenals can affect thyroid.  One directly affects thyroid, the other ways affect the immune system. But, yeah, I definitely see a lot of that in my practice as well. How about sex hormones? Because, again, we’re going to talk about perimenopause, so do you want to talk a little bit about the impact of stress and adrenals on sex hormones?

Dr. Amy:

Yeah, definitely. I love the points that you just made too, it just speaks to whether we’re thinking of it as an adrenal problem or thinking of it as a thyroid or thinking of it as a sex hormone imbalance, wherever it’s showing up like that, just recognizing that the stresses are showing up in our bodies in all these ways. I feel like in our society, it’s become so normal to just be experiencing stress all the time, and that idea of really recognizing it’s having a huge impact in the idea of how stress is, basically, is detrimental to our physiology as smoking is which we pretty broadly now know most people don’t want to be doing that to their bodies. And yet, we have a lot of stress in our lives and there’s a lot of reasons for that, so it can be challenging.

But, anyway, thank you for pointing out those different aspects of how the adrenals are impacting the thyroid, for sure. The impact on the sex hormones, so the adrenal glands, I mentioned earlier, they produce cortisol. They also produce a host of other hormones. They are actually capable of producing estrogen and progesterone too. So part of what happens in perimenopause is that your ovarian production of estrogen and progesterone start to change. First, women tend to start producing less progesterone and still have the estrogen on board. But then later through the perimenopausal transition and into menopause, then having low levels of both progesterone and estrogen is a typical course for that.

The adrenals are able to produce some estrogen and progesterone, which can help to fill in the gaps, if you will. Stabilizing during perimenopause when the hormones are just on this roller coaster of crazy ups and downs that can be stabilized out, and then postmenopausally, that the adrenals can contribute to the hormones that are missing at that time.

Dr. Eric:

All right. One thing also I’ll mention is that… I don’t want to get too much into the hormone pathway, but it all starts with cholesterol. You, of course, you need healthy cholesterol. If you’re taking something like a statin then that can also affect sex hormones. Then cholesterol turns into pregnenolone, and then it separates into two different pathways. The body will always prioritize the production of cortisol at the expense of the sex hormones. Which makes sense, if you’re in a stressed out situation, you’re probably not going to want to have sex… Like an example of going back to the caveman years where if a caveman was being chased by a lion, or I guess that could happen today too maybe, being chased by a bear or something, you’re not going to want to have sex while being chased by the bear.

You’re going to think about just the fight or flight reaction, so the body’s going to always prioritize cortisol. But the problem, again, as we’re discussing, everybody’s in a chronic state of stress and so they’ll always be pumping out cortisol. That’s going to sacrifice the sex hormones, DHEA is going to be on the lower side, testosterone, the estrogens. You might not see all the hormones low because it takes time for that to happen. We’ll talk about the testing as well, especially, more so with the adrenals. But, yeah, why don’t we jump into perimenopause and talk about… or why don’t we talk about, maybe, talk about testing a little bit and lead into that? Because you do recommend testing the adrenals, is that correct?

Dr. Amy:

I do. It’s interesting, a lot of women will start experiencing some changes. They’re in their late 30s, going through their 40s. For some women, it’s not until their late 40s that it’s really starting to kick in anyway. But just what perimenopause usually starts with is subtle or sometimes not so subtle. But sometimes we’re like not sure, “Is this perimenopause? What’s going on? I’m a little hotter than usual, or my period came late, or I’m snapping at people more often.” No, it’s just because the people are really annoying now, or maybe my hormones are changing. That’s all the different changes that can happen, and we start putting the pieces together like something’s going on here. A lot of women are coming with the question of like, “I want to get my hormones tested. I want to see what’s going on.”

Something that I think is important to know is that there can absolutely be value in testing the ovarian hormones, the estrogen, progesterone, the testosterone…actually measuring and looking at those. But very often the estrogen and progesterone are shifting and changing day by day, and even from one cycle to the next. Timing that testing and really interpreting it can be a little tricky. You can definitely get useful information from it. But most conventional doctors, when I’ve had patients say they went to their doctor, they asked for testing, and the doctor says, “We don’t do any testing.” I think it’s important to know that there can be useful testing to be done. But the first layer of testing that I always recommend is a general screening blood test and adrenal test.

In the general screening blood tests, and that this is going to be… you mentioned a minute ago the sex hormones and adrenal hormones are made from cholesterol. Are you getting enough good fats in? Do you have cholesterol? We’ve been told for heart health reasons, you don’t want high cholesterol, you want to keep your cholesterol really low. But you actually need enough and you want to be getting in those good fats and having that cholesterol as the precursor to your hormones. Screening things like cholesterol, heart health markers, your blood sugar regulation markers, nutrient levels. Things that might explain if you’re feeling tired, if there are things going on in your body that you want to check in on. Thyroid, of course, really important to do a really thorough screening.

Even if you’ve had thyroid testing done before, this is a time in life where because everything’s up and moving and changing a little bit, this is a time where it can show up, even if you’ve been normal in the past. A really good thorough thyroid screen, which I can leave you to chat about. Then the adrenal testing is in looking at your cortisol over the course of the day to see how your production is doing for the adrenal glands, the cortisol, and the DHEA can be really important to look at. That you’re going to get more useful information out of as a first layer, and usually addressing those, the nutrition and the thyroid and the adrenal and the blood sugar regulation, that will create a foundation of stability that helps to decrease the wildness of the up and down roller coaster that perimenopause can be.

Dr. Eric:

All right, thank you for that. With regards to adrenal testing then, I know we chatted a little bit before this interview, so I know, just like I do, you do saliva testing and you also do some DUTCH testing. We’re not going to get too much into the dried urine testing because it is a pretty in-depth test. I guess I could ask you, we both know the answer to this, but of course we’re testing the viewers. Why would you want to do a saliva test, or dried urine test and not just test morning cortisol in the blood?

Dr. Amy:

Yeah, good question. Let’s see, so because of the fact that the adrenals are regulating your circadian rhythm and that 24-hour clock, your cortisol changes throughout the day. It’s a lot like when we’re testing estrogen and progesterone and a woman having a cycle, it matters what day of the cycle we test on because the levels are changing. A level on one day might look low and other then it might be high, but it’s the same number. You have to know what you’re looking at, and the way that cortisol has its cycle in a day, we produce more cortisol first thing in the morning, and then it tapers off as you go through the day and drops at nighttime to help you wind down and go to sleep.

You need to look at that pattern. By looking at only one data point, you’re really not getting a full picture of how the adrenals are responding over the course of the day. Then a blood level is a very short-term, that’s just the amount that’s circulating right in that instant. For some people getting their blood drawn is a stressful experience.

Dr. Eric:

Yeah, I was going to bring that up. I’m glad you did.

Dr. Amy:

In order to get a blood draw, unless you happen to have a partner or someone in your home who’s a venipuncturist, usually, you have to be up and get ready and get out the door and go somewhere to get your blood drawn. Your cortisol peaks about 15 to 20 minutes after you first wake up. So getting that awakening response and getting a sense of what’s happening right away in the morning is more indicative of your cortisol level. There are several factors that make a home test kit, and there’s pros and cons to saliva or a dried urine testing.

But both of those give you the opportunity to test at home and look at four different points, at least, over the course of a day and map out that pattern that gives you an idea. It’s not just am I high, am I low, it’s what’s the pattern over the day? Is what really is what we’re looking for.

Dr. Eric:

Yep, correct.

Dr. Amy:

Did I get all your points? Did you have anything to add?

Dr. Eric:

I think you hit it all with regards to, especially, cortisol. As you mentioned, there’s no perfect test, and a big potential drawback of the blood test is, like you said, a lot of people… even if they’re not stressed out, going to the lab, just getting the blood draw itself for some people, they might not perceive it as being stressful. I know it does come down to the perception when it comes to stress a lot of times. But that’s also important to mention, even when doing a home test. Like saliva or dried urine, you want to collect it on a regular day, and ideally, a lot of people will do it on a weekend just because it’s hard to do during a work day.

But the point is if you have an abnormally stressful day, so if you’re collecting it and you have an argument with your spouse before the collection, or have a headache. I’ve had a lot of people with different patterns, but I remember one specific situation where someone did their saliva test and I saw that it was elevated around lunchtime and they were mentioning that they were studying for an exam and they were stressed out because of the exam. Again, even though the home tests aren’t perfect, and that’s why if I see some crazy findings, I usually ask the person, “Did anything unusual happen that day?”

But, yeah, it’s the same exact reason I’ve been doing saliva testing all these years, and more recently on some people I’ve done dried urine testing. If you’re just focusing on adrenals, I think saliva testing or dried urine testing is fine to do. Yeah, just for that circadian rhythm, so you could see it throughout the day, first thing in the morning and then last thing at the end of the day. Then a couple of samples in between. Thanks for that explanation.

Dr. Amy:

Yeah, should we talk a little bit about the patterns and what that can mean?

Dr. Eric:

Yeah, I think that’s a good idea because also some people wonder why test the adrenals? We’ll get into the patterns and that’s a big reason why. But, yeah, if everybody’s stressed out, why don’t we just assume people have adrenal problems and not do the testing. It’s because different people have different patterns. I’ll let you take over and talk about some of the different patterns.

Dr. Amy:

Yeah. It’s interesting that you put it that way because you’re right, there is this idea that like I know I’m stressed, I know that’s part of it, so why does it matter? What’s going to change based on the numbers or the patterns? To some extent, it’s a valid point to make. If you’re really watching your budget or really trying to just take the most streamlined approach to what you’re doing for your health, if you’re willing to make some lifestyle changes and you don’t necessarily need that data to prove it to you, it’s a lot of the things that help to restore adrenal function are safe and appropriate to do regardless of exactly what your numbers or your pattern really is.

There’s some truth in there, but you can get more specific if you know exactly what’s going on in your own physiology. You can put your effort more focused on the things that your body particularly needs. If you know better where you’re starting from, and the truth of the matter is that for most people actually seeing it on paper is just so, or on the screen if you’re looking at electronic results, it’s validating for one thing. Your other doctors have probably told you, “Everything’s fine. There’s no reason for you to be so exhausted. It’s all in your head,” or whatever. That validation of like, “Yes, there is a real thing going on with you here.”

It gives you a baseline that you can compare to in the future too. You can see, “Okay, I’ve made it this far in my progress at three months or six months,” and you know how to monitor that too. There’s three basic patterns that I usually tend to find.  Of course, every individual is unique and there can be nuances in this. But there’s the people who just like run high. The normal slope might be like this, and they’re just across the top of the chart like this. This is someone who’s probably experiencing anxiety, wakes up in the morning, early on, ready to go, jumps into everything, like, go, go, go, go, go. Mail them in, and ends the day still just powered through and all that.

So some people just run high. Some people run low. This is so hard to get up and get going in the morning that maybe the alarm goes off and you snooze it six times, and you’re dragging yourself out of bed. And try to pry your eyes open and maybe feeling like you have to have caffeine or sugar to get your engine running and get yourself going as you go through the day dragging, foggy thinking, hard to do your work. You get to the end of the day and just like, “Ugh, it’s so just been bottomed out all day long.” Then the other third pattern that’s probably the most common that I see, because it’s the in between point, is a reverse curve. Where you’re tired in the morning, you’re trying to get going. It takes a little while to get it all going and all of that.

You’re tired through the day, a little foggy, maybe some ups and downs. If you’ve got something exciting you’re working on, and then you get to the end of the night. The classic description of this is wired tired, where you get to the end of the night and you’re wishing you could sleep, but boing, everything turns on. Your eyes are wide open and you’re so productive and you’re getting your stuff done, and you’re doing all these things. You finally have this burst of energy and this time maybe late at night, and then you end up going to bed late, and then the next morning you’re tired and the whole pattern keeps repeating too, so the reverse curve. Usually, the order of things over a person’s lifetime is that we can run high, high, high, and go like that for a while.

Then the system starts dysregulating and flips, and then ultimately burnout is that low, just I can’t even mount that response anymore. That’s what we’re looking for on the test results is where are you in at different times of the day to show where you need to focus the most on to help correct the curve and help support the adrenals.

Dr. Eric:

All right, wonderful. Also, we want to let viewers know that we’ll be answering questions soon, so if you have questions for Dr. Amy or myself, just type in the chat and we will get to them. You made some good points, so when I was dealing with Graves’ disease, at that point, I knew stress was a factor, but I honestly didn’t think my adrenals were too bad. I was one that needed validation to get the testing. But I will say this, you can’t always go by symptoms because someone listening might say, “Well, I’m fatigued all day, so I know my adrenals are low.”

But sometimes that’s not the case, sometimes someone will be fatigued yet they might have an elevated cortisol levels. In my situation, I didn’t feel fatigued yet everything was low. I had low cortisol, low morning cortisol, low DHEA. Pretty much everything was low on the test and I felt fine, and probably a big part of that is because with hyperthyroidism you get the increased metabolism so that was offsetting it to some extent. But, yeah, so if I had to guess before that, I would have guessed that either my adrenals were normal, because again, I was in denial, or I would have said if they were out of balance, I would have guessed they might’ve been on the higher side. I would have never guessed they would have been low. That could, to some extent, dictate the treatments.

Obviously, you could, regardless of whether or not you do adrenal testing, you could eat well, you could do meditation, yoga. It’s not like you can’t do anything, but for certain adrenal patterns, you might want to. In my case, again, my adrenals were low, so I took licorice root to help with lower cortisol. If someone has elevated cortisol, they might take phosphatidylserine. You might have other suggestions, and those are just some general… Well, not general, but general based on the pattern. Licorice I would say, if you have high blood pressure, you would not want to take it. Be careful with certain herbs and supplements. But let’s go ahead now and talk about perimenopause.

Dr. Amy:

I just have one other question on testing before we go ahead.

Dr. Eric:

Oh, yeah, sure.

Dr. Amy:

Can you walk us through what you would recommend screen? Because you’re talking about screening is important, right? You can’t always tell based on your symptoms. Your energy could be high or low for so many different reasons, so the screening and looking at these different pieces and figuring out, “Okay, which of these is the biggest factor for this person?” What do you recommend for thyroid screening?

Dr. Eric:

Yeah, so thyroid definitely, of course, TSH or our friend thyroid stimulating hormone, which probably is one of the least important. I still pay attention to it, but a lot of doctors, that’s all they do, is TSH. TSH, I like looking at the free hormones, free T3, free T4. If someone wants to do a full panel where they’re looking also at the total T4, total T3, that’s fine too. But, usually, I stick with TSH, free T3, free T4, thyroid antibodies. It also depends on the presentation of the person. If someone comes in, what I’m suspecting to be Hashimoto’s usually it’ll be antithyroglobulin antibodies and thyroid peroxidase antibodies. If they have Graves, the antibodies specific for Graves are TSI, thyroid stimulating immunoglobulins, which is a type of TSH receptor antibody.

There’s also reverse T3 that could also play a role in conversion. A lot of times you’ll see reverse T3 high if someone has a problem converting T4, T3. The only thing is in hyperthyroidism, I used to do it on all my patients, but in hyperthyroidism, most people have everything high, including reverse T3. I usually don’t recommend it anymore for my hyperthyroid patients. From a thyroid perspective, that’s what I write. Then, of course, the basics like CBC with differential and all. But you just asked about thyroid, but there’s other blood tests. Are those what you do?

Dr. Amy:

Yeah, that’s what I do. The reverse T3, that’s interesting to make that point that you just did. I usually do like to look at it at least on a first layer screening. Because more often the people that I’m interacting with are tired and fatigued, and I’m worried about that conversion or if the adrenals where they got to the liver are playing into that. But it makes a lot of sense if someone is hyper, they’re just going to be high across the board. You’re not really looking at conversion in that instance, it’s more just like everything’s just high for the T3, T4, reverse T3, all of it.

Dr. Eric:

Exactly. All right, so why don’t you talk about perimenopause? What’s the difference between menopause and perimenopause?

Dr. Amy:

Yeah, good, good, good. The technical definition of menopause is when it has been a full year since your last period. It’s defined that way because in the time leading up to menopause, sometimes women will go a long time in between the periods, but then it’ll still come. It’ll be, instead of a month, it’ll be two or three months or five or six months even. Then it might stretch out to like seven or eight months in between periods. But once you’ve gone a full year, it’s pretty unlikely that you’re going to get another period again after that. That’s long enough to say like, “Yeah, your body is done with having periods.” It’s a defining moment, it’s a single day, it’s been exactly a year since you had a period.

I always like to joke and recommend like throw yourself a menopause party on that day. It’s been a year. Then after that day is technically referred to as postmenopause, and then what we’re talking about, especially today, here today is the whole transitional period leading up to the actual moment of menopause when it’s been a year since that last period. There’s a whole stage of life, of transition, and I like to give the visual of thinking about your menstruating years as a bell curve. When you have puberty, when you’re in puberty, when you’re a young teen, unfortunately, it’s happening earlier these days, but usually a young teen first period to start the menstruating years. There’s an on-ramp and we call that puberty and that’s the whole teenage timeframe of body changes and moodiness and questioning who am I really anyway? Like refiguring your life and feeling awkward and having these changes going on.

Then as we get into the 20s and 30s, there’s more stability, and more like the top of that bell curve. For most women, there’s always exceptions. But just in the normal curve of things is pretty regular cycles, and usually, this is the more fertile years and just more stability and regularity in the menstrual cycle. Then there’s the downside of the bell curve. As we taper down, it’s basically what I like to help people think about perimenopause. It’s like puberty in reverse, so it’s a very similar experience where your body is changing and things are going on and you might be feeling moody and all those kinds of things. But the beauty of perimenopause is that you’re older and wiser and hopefully have more resourced in your life and in your experience and in connections and how you can get help if you need it too.

It’s not a disease, it’s not something that needs to be overly medicalized. But it’s a natural life transition and it can be a little ambiguous to define as puberty can be too. At what age does puberty end? There’s no real exact notion to that. When does perimenopause begin is a little loose like that also. As soon as there’s some shifts or changes or things that just aren’t as stable as they had been before, that’s probably the beginning of perimenopause. It can last five, up to 10 even years. It doesn’t mean that you’re going to be menopausal in any moment here, it’s just it’s a phase, it’s a transitional time. There’s a lot that you can do to help support the journey through it all.

Dr. Eric:

Okay, so there are no specific tests for perimenopause?

Dr. Amy:

There’s not an exact test for saying that perimenopause has begun. We can start to see FSH and LH start to rise, but it’s not a direct trajectory. When you’re in your menstruating years, usually, LH and FSH will be lower when you’re postmenopause will be higher. But there’s not a direct line. In perimenopause, it can be all over the place, so you could be high one month, low another month. It’s not an accurate way to assess, and your estrogen and progesterone levels can be changing. But, again, there’s no like no number of high or low because they’re changing. Yes, there’s no exact tests that defines you as perimenopause.

Dr. Eric:

Okay, so what’s the most important thing for a woman to do to help herself have a smooth transition through perimenopause?

Dr. Amy:

Yeah, so that’s the first half of our conversation really is the answer to that question. Really hoping that stabilizing that foundation, and that’s addressing the stress boosting the adrenal resiliency, so that stress isn’t having such a big impact. Getting your nutrition on board, your blood sugar regulated, your thyroid really functioning well. All of that builds this foundation that makes it a much smoother ride. There may still be some ups and downs, but I like to joke that without any of that support in place, perimenopause can be like the thrill seeker roller coaster that’s like woo, up and down, it’s scary and really intense.

But with that stable foundation, we can put you on the little kiddie roller coaster. It’s just there may still be some ups and downs, but you can ride with it and have a good time with it. That’s building that foundation and really I’ve seen that all of those factors are important and I’ve just seen again and again, that the adrenals and the stress that underlies all of those is so much of what makes the difference.

Dr. Eric:

All right, all right, very good. Well, I definitely want to leave some time for questions, and then we’ll also talk about your quiz. Dr. Amy has a quiz that she’d like to share. But is there anything else you’d like to add?

Dr. Amy:

I think just the point, I feel like when we talk about stress and the fact that stress can lead to all these other issues that I just want to be careful to say that it’s not that you have to completely remove yourself from stress or from your life in order to be healthy. I think that it can be easy to go into the extreme of like, “Oh, well, I have to completely change everything and stop doing all these things and all of that in order to get stress down.” I really see it more as how to build your resiliency and how to help your body and your physiology be able to be healthy in an environment that has stress going on in it.

Because a lot of the women that I work with are leaders, entrepreneurs, business owners, or have projects that they’re working on. They have their families that they’re supporting and everything. I think it’s really important that women can do the things that they want to do and have their impact and make their difference and it’s important to have your health supporting you to be able to do all those things too, and that is possible. I’ve been through it myself, up and down, where I get so into something and then I get sick and adrenal fatigue or whatever and I have to build back up again and then that. I’ve learned in that process of figuring out the things that help to keep that stability in place while being able to continue pursuing your passions and doing the things that you want to do.

And having your health really making it all possible instead of your health suffering because of all the things that you’re doing. Just wanted to make that point. Stress can be a good thing, it’s about the skills you mentioned before, are stress supporting skills and how we help our physiology to be able to roll with the things that go on in life.

Dr. Eric:

Wow. Thank you for adding that. I am going to put the link to the quiz, but I’d like you to talk about the quiz so people when they see, why should people go ahead and take your quiz? I’m going to recommend, definitely take the quiz.

Here is the link to Dr. Amy’s Quiz:

https://replenishyourenergy.com/quiz​

Dr. Amy:

Yeah, so the quiz it’s called the why am I so tired quiz. This is something that I just hear from so many women and just being able to get a better understanding about what factors are at play and why you’re feeling so tired all the time and what could be going on that’s going to help you? That idea that stress is inevitable, but if you’re feeling depleted, you’re feeling rundown, you’re feeling the effects of that chronic stress build up, why is it that that’s happening? After you take the quiz, then we’ll talk more also about how to build your resiliency and how to help to get you to a place where you’re having more energy too for all the things that you’re doing.

When you take the quiz, you’ll get your resiliency score, so you’re going to find out how your adrenals are doing and this is just how much of a factor stress is being for you and your particular case. I’ll give you some tips on getting started boosting your energy. I, also, am going to be teaching a workshop later this month called From Fatigued to Fired Up. I’m going to be teaching some surprising strategies in there about the kinds of things that can make the difference to really help make a shift and help to build your resiliency and boost your energy and help you to be able to make your difference and really enjoy your life and do the things that you want to do. But have your health really supporting you in doing that. Start with the quiz and find out why am I so tired? I hope that will be helpful for you.

Dr. Eric:

Great. Then when they complete the quiz, they’ll get information on that masterclass if they want to sign up. Is that correct?

Dr. Amy:

Yeah.

Dr. Eric:

Okay.

Dr. Amy:

Yeah, when you complete the quiz, you’ll get your number. When you click on that, you’ll get some tips, some information of understanding that. At the bottom of that page, there’s a button right there to sign up for the class. Then go through and actually sign up for the class and we’ll make sure that you get your free access to that. If you miss it on that, we’ll send you a follow-up email to make sure that you know when that class is coming. It’s a few weeks from now, but you can reserve your spot now and we’ll send you reminders as it gets closer too.

Dr. Eric:

All right, wonderful. I have it on the screen here. I put it in the chat. Now, it’s not going to go into the Facebook groups, so I’ll have to do that manually, which I’ll do that just because it’s a private group. I’m thinking it’s just going to the page right now, but I also have been displaying it for the last minute or two here. I’ll make sure that I’ll manually put it in the groups, and all right.

Dr. Amy:

If anyone’s listening and didn’t see that typed, it’s just replenishyourenergy.com/quiz. So replenishyourenergy.com/quiz.

Dr. Eric:

All right, cool. Thanks for verbally letting everyone know. Yeah, definitely, sign up for that quiz and as well as the master class. Which again, the masterclass will be later this month, but the quiz you could do right away, or maybe in a few minutes after we answer questions. But, all right, so let’s get to… Stay in your lane. Hello, Dr. E and Dr. A, happy Friday. Thanks for sharing. You are welcome, thanks for attending.

Dr. Amy:

Happy to be here.

Dr. Eric:

We’ve got someone from Facebook watching. That’s the only downside of StreamYard is if they don’t give permission, then their name doesn’t display. That means they’re in the group if it comes up as Facebook user. “I’ve been the reverse curve for all my adult life, and I was told it was because of my low blood pressure, 120 over 60. I developed Graves five years ago, and it got down to five milligrams after beginning toxics. Are you talking about the medication five milligrams? Because I know a lot of patients take methimazole and five milligrams would be like a low dose. Because I don’t think a blood pressure of like 120 over five, that would be like pretty low.

Dr. Amy:

I think they’re saying that they probably started treatment five years ago. They’ve had improvement, they’ve gotten the medication down.

Dr. Eric:

I’m joking. I’m just cracking an unfunny joke here. What would I do to improve the cortisol? Well, I’ll let you, I could always add, but let’s hear from you, Dr. Amy.

Dr. Amy:

One thing that strikes me is I just want to question and reverse the cause and effect or the chicken and egg part of your first comment of having that reverse curve and saying that was because of low blood pressure. I would actually say that more than likely the imbalanced adrenal function is contributing to your low blood pressure. The adrenals, I mentioned early on, they produce a host of hormones. Cortisol is a big one we talk about that has to do with the stress response, DHEA, another important cortisol hormone. They can produce estrogen and progesterone we talked about. Another hormone that the adrenals are responsible for producing is one called aldosterone, which is more to do with regulating your fluid and electrolytes and regulating the kidneys.

So remember the adrenals are actually located on top of the kidneys and there’s a reason for that. Because they actually do regulate the mechanisms of kidney filtration. When the adrenals are not functioning properly, we tend to lose our electrolytes more easily through the urine. And that can cause us to feel low blood pressure because we don’t have that salt and the electrolytes in the bloodstream to hold the fluid in. Then we can get low blood pressure, and a lot of people with adrenal dysfunction have low blood pressure, feel like you get dizzy. If you stand up too quick, you’re going to get dizzy or faint easily. So really supporting, I’d say, one of the first things if you’re having low blood pressure and you’re needing to support your adrenals would be to make sure you’re getting plenty of electrolytes in.

One thing that I recommend for people to start your day, as long as you don’t have high blood pressure and need to watch your self intake, start your day with a glass of water, with some salt in it. It’s a really nice way to start your day and a little squeeze of lemon if you’re inclined to that. But the salt or the electrolytes, first thing in the morning, help to get the adrenals going and help to make sure that your body has that support for the blood pressure. Electrolytes can make a really big difference, and lots of other things that help to stabilize and flip that curve back to being high in the morning, low at night. There’s a lot to that. But one of the first things when I hear that blood pressure piece would be electrolytes.

Dr. Eric:

Yeah, and you would recommend natural sea salt, for example?

Dr. Amy:

Yeah, so either the natural sea salt, Celtic salt, Himalayan salt, and any of the good quality salts that have some minerals with them too. In terms of the amount, it varies to taste. Usually, when this is going on, people will also actually crave salt too. If you do, the person who wrote this in, if you also notice yourself having cravings for salt through the day, then this would be probably really good for you to do. That you put salt to taste, so it should still taste good. It should be like refreshing. If you feel like you’re drinking ocean water and it’s disgusting, then cut the amount of salt back.

What usually happens over the course of a few months is the same amount of salt that you were craving and wanting suddenly starts tasting too salty, and you can decrease the amount that you’re including in your morning water.

Dr. Eric:

All right, thank you for that, Dr. Amy. We’re going to go another question…

Dr. Amy:

And congrats on the improvement so far with the Graves like just to be able to get down to that really low dose and it’s good progress moving in the right direction. I think addressing the adrenals next could probably be really helpful for you.

Dr. Eric:

Yeah, no, that is true. Five milligrams, low dose. Obviously, once it gets to the point where you don’t need the methimazole, but, yeah, one step at a time.

Dr. Amy:

Are there things that you’ve seen, Dr. Eric, that have made the difference for someone to get off that last little bit? To get them to the place where they really don’t need it?

Dr. Eric:

Yeah, probably too much to discuss here because it’s not just the adrenals. Adrenals do play an important role, and like I said, I had a low cortisol pattern the morning. I didn’t have a reverse curve, meaning my cortisol wasn’t high at night. But I had low morning cortisol, and of course, diet lifestyle factors played a big role. Then other things, I mentioned a licorice root in my case, which again, we can’t give specific recommendations here. Since you have low blood pressure you might be fine with that. But, again, in my case, that helped out, B vitamins, vitamin C. Nutrients overall are obviously important. But there could be other things, of course dragging down the adrenals as well.

It could be stealth infections, and again, not saying that’s the case with the person who just asked a question.  I definitely would follow advice of Dr. Amy, or suggestions that Dr. Amy gave. But try to do everything you can diet lifestyle. But sometimes, actually, a good number of times we do have to dig deeper, especially, if diet and lifestyle isn’t enough. If you’ve been dealing with it for a long time, then you might have to dig deeper. Could be, again, like I said, infections, it could be toxic mold, it could be chemicals, environmental toxins. But, yeah, good job so far getting down to the five milligrams.

Maybe just by improving the adrenal health itself, you might not need to dig deeper, or you might have the answer. As Dr. Amy said, it’s not always just emotional stress. We all deal with stressors, a lot of times we could just do things to improve our perception of stress. Again, blocking out time for stress management, mind, body, medicine. But, as I mentioned, sometimes we do need to dig deeper. All right, we got Claire. Thanks for joining Claire. Claire says, “I love the concept of puberty in reverse.”

Cool, cool. Cool. All right, and then I could answer this. “I have hyperthyroidism, is a good for me to go for surgery?” Again, I can’t give specific recommendations. All I could say is that sometimes surgery is necessary. I can’t say it’s never necessary, but in most cases it should be the last resort. It really depends on the situation.  If someone has thyroid cancer, for example, that might be a situation when surgery is necessary. My goal is to try to work with people to try… just like I did, when I had Graves, I could have opted for radioactive iodine and thyroid surgery. I chose to address the cause of the problem.

Everyone is different and there’s a time and place for surgery, but my goal is to try to minimize people getting the conventional medical treatment. At least, for radioactive iodine and thyroid surgery. A lot of my patients do take the antithyroid medication to be safe, some take an herbal approach, but that’s a completely different topic.

Dr. Amy:

I just wanted to say that I think it’s so awesome, Dr. Eric, that you offer what you do. Because the person who just wrote in probably their endocrinologist has only offered surgery, or very few options. I just think it’s, really, it’s so great that you’re here and that you’re asking this question and looking into this. Because I think it’s really important that in our journey of healthcare and healing, that we have access to options and that you’re presented with like, “Well, you can go this route or you can go this route and here’s these different ways about this.” There’s a time and a place, but Dr. Eric has a lot of really great resources and an amazing approach to giving you another option that you don’t have to go for surgery necessarily. It’s one of the options.

Dr. Eric:

Thanks for that, Dr. Amy. My goal is to try to save people’s thyroid gland. It’s not always possible, but again, too many times the endocrinologist will say, “Someone needs to receive radioactive iodine or thyroid surgery.” Again, sometimes that is the best option, but many times that’s not the case. We have a thank you here, so you are welcome. Thanks for tuning in. Then Melissa here: “Sorry I missed the beginning, what kind of doctor do I need to see to get my adrenals tested? I’ve always had a fight or flight state of reacting situations and battled Graves on and off for the last six years. I know stress is a trigger, but never been tested or tried to cope with stress aside from yoga, meditation, lemon balm, motherwort, and CBD at night. What kind of doctor?” Obviously both Dr. Amy and I, we help people with adrenal problems. But I’ll let you expand on who would be a good option-

Dr. Amy:

Yeah, sure. You’re right to ask the question because not every doctor tends to offer testing for adrenals the way that we’re talking about really looking at that pattern over the day and looking at it more holistically. It’s going to be, I’m a naturopathic doctor, Dr. Eric’s a chiropractor, so an integrative functional medicine. More natural holistic practitioner is who’s going to be able to help you with that. I’ll mention, we do have an online group program that we run where we actually give you access and show you exactly how to order your own adrenal saliva test, and really get into the details of understanding what your results mean and what kinds of things to do to focus on to improve your adrenal function too.

That is something that we teach in our group program, which would be an easier to access lower cost way of getting help, or of course in the private practice of either one of us or a functional integrative naturopathic, holistic alternative, etc., practitioner would be able to help you with that too.

Dr. Eric:

All right. I will also add that probably the person who’s not going to treat your adrenals would be your primary care doctor or your endocrinologist, unfortunately. They might run a morning cortisol, maybe look at DHEA, but they’re usually not going to look at the circadian rhythm of cortisol through the saliva, through dried urine testing. Dr. Amy is right, and again, make sure you not only do the quiz, but her masterclass as well. Because that’s going to also… I don’t know if… It might not talk about testing and all that, but it is going to focus on adrenals, correct?

Dr. Amy:

Yes, it focuses on adrenals and strategies to help. It’s different kinds of strategies, it’s not just eat your protein and go to bed at night. There’s more to it than that. Yes, happy to share more with you.

Dr. Eric:

All right. Well, let’s try to get to a few more questions. We probably won’t be able to get to all of them, but Pili here, “is it recommendable to use the natural clock during perimenopause for those of us who no longer want to take the pill? Will the body temperature readings be too unreliable?” I’ll let you take this one.

Dr. Amy:

I can take that. I’m pretty sure what you’re referring to is for the sake of contraception. So during perimenopause, even though your cycles are irregular, you still can get pregnant. Being careful to prevent pregnancy if you’re not wanting to get pregnant is important to do. Taking temperature readings is one way of natural family planning of like noticing your temperature regulations and using that information to know when you’re ovulating and when you’re fertile, and then when you’re not. But, in perimenopause, you’re right to be concerned about that. It becomes more unreliable because the cycle length can change and it’s a lot harder to be sure of what your pattern is going to be and which days you’re more or less hurdle.

It’s already a less reliable method than some other forms of contraception. If you’re wanting to avoid pregnancy, I would be careful about relying on the temperature reading. But regulating your cycle, doing the things about stabilizing that foundation, whether that’s through adrenal support and then fibroid, blood sugar, getting your nutrition, your sleep patterns, all of that, can help to restore a more normal cycle. Which can be a more dependable pattern also. Hopefully, that helps.

Dr. Eric:

All right, do you have time for a couple of more questions?

Dr. Amy:

I could, yes. I love questions, I’m happy to help.

Dr. Eric:

Okay, because this I know someone asked in the Facebook group, “can perimenopause hormones trigger hyperthyroidism or hypothyroidism?” Do you want to cover it or do you want me to talk about it?

Dr. Amy:

No, you take that one.

Dr. Eric:

Okay, so I mentioned earlier, stress definitely could be a factor, and potentially, a trigger of Graves, Hashimoto’s, and I mentioned how chronic stress could affect the conversion of T4 to T3. So that could lead to low T3, which is the active form of thyroid hormone. As far as perimenopause or imbalances of the sex hormones being a trigger, the short answer I think would be no, in my opinion.  And so they’re not really a trigger. Women have been undergoing perimenopause for quite a long time, and I think we do see a relationship sometimes between hormone fluctuations and thyroid conditions…like postpartum thyroiditis is common. But even in that situation      I don’t look at the birth process as being a trigger, as most women have had the antibodies well before for Hashimoto’s. I haven’t seen it where it directly causes hyperthyroidism or hypothyroidism. But for those with Graves or Hashimoto’s, you might wonder is it a trigger? It might be a factor, but just about everybody will have had the autoantibodies for those conditions develop well before perimenopause. So to me I don’t consider it an actual trigger.

Dr. Amy:

Yeah, I agree. I’d say it’s a time in life where it often shows up and it gets discovered, but it’s not necessarily that the perimenopause is what triggered it. They probably never got screened beforehand or the stress of going through perimenopause is more so the trigger than the perimenopause itself, for example, or other things going on. I would say I see a lot of women, while their hormones are changing, it’s a time where you can have changes in your thyroid or discover those changes too. But with the case of the antibodies, it’s very likely that they’ve actually been around for longer and you just didn’t know it. It’s certainly not every woman who goes through perimenopause gets triggered into a thyroid problem, so it’s not a direct thing, but it can compound and come together.

Dr. Eric:

Yeah, it could be a contributing factor. Again, the stress I think is really big. What we spoke about earlier, not just the hormones, perimenopause, menopause, but let’s see, we got Shirley here, and she says “That would be me”, I guess, something you mentioned earlier. Then here we have Tracy:  “Dr. Amy and Dr. Eric, this is Tracy from New York. My saliva test results on Tuesday, 10:00 AM, 0.34, two…”

Dr. Amy:

This looks like cortisol, I think.

Dr. Eric:

Yeah, it’s the four different cortisol levels. Yeah, her first one she didn’t take until 10:00 AM, and then two third. Again, she might have not woken up until around that time, I’m not sure. I don’t know if this is saliva. Oh, yeah, actually she says saliva test results here. I was going to say the units are different from the testing that I’m used to seeing, and probably the same with you. But everything, other than that first one, obviously the first one is the highest, that’s the good news. It is the highest, the other ones are on the lower side. That third and fourth one are undetectable. I don’t know what the range would be for that first one, it depends on the lab. That also might very well, might be on the low side. But, yeah, definitely the other values are all on the lower side. I’m not sure what lab, but yeah, do you have any feedback?

Dr. Amy:

Pretty similar to what you’re saying, different labs have different reference ranges. I would just say look at your results in the normal range. A lot of labs report with a graphic too. You can see the zone on a graphic of what would normal be and then you look at your line compared to that. But like Dr. Eric was saying, the pattern is correct, your highest and then down and then down, so you’re not doing a reverse. But the later numbers for sure, and maybe even that first one are probably low. It’s more of that depleted, like needing to do a lot of restoration to help build back up again. But it’s good that you’re not getting that burst of second wind backwards thing at the end of the night.

Dr. Eric:

All right, thank you. Can you do two more? If you really have to go, I’ll let you go.

Dr. Amy:

No, no, I can do two more, I think.

Dr. Eric:

Okay.

Dr. Amy:

Yep, I’m up for five more minutes, so let’s go!

Dr. Eric:

Okay. Well, let’s do four minutes because I want to also give a minute to wrap up and also give your… so we’ll do like four.. We’ll definitely get you off by four minutes. “Can your adrenals cause pain in that area?”

Dr. Amy:

That’s an interesting question. Not commonly, but I have had some patients who are just really sensitive and really tuned into their bodies and feel like they have some sensation around that. But it’s not typical at all, usually, it’s not something that you’re feeling in your body right in that area. But it’s possible.

Dr. Eric:

Yeah, I would agree. It’s not something that’s common, but, yeah, it’s possible.

Dr. Amy:

Your body is talking to you in some way. But if you’re hurting in that area, I think it’s important to consider what else could be causing that pain. Is it your kidney or…

Dr. Eric:

Kidney, yeah, exactly.

Dr. Amy:

…muscle strain or just something going on with your back?

Dr. Eric:

All right. This might be the last one because it’s a long question. Let’s see. “I was recently diagnosed with Graves. I’ve been one month on Amy Myers protocol, no gluten, dairy, nightshades, eggs, daily curcumin, fish oil, zinc, vitamin Z, probiotic, along with 10 milligrams of methimazole, propranolol. My T3/T4 are back to normal.”

Dr. Eric:

“Liver function tests had gone up. I want to stop methimazole. Someone recommended herbal control my symptoms. Do you have any recommendations?” Okay, so you’re on 10 milligrams of methimazole and the liver function tests, so like AST, ALT have gone up. Maybe due to the methimazole and someone… Yeah. I could cover this. Again, can’t give specific recommendations, but when I was dealing with Graves, I did take bugleweed. I did not take the antithyroid medication. I mentioned earlier how a lot of my patients do take antithyroid medication, such as methimazole or sometimes PTU, or carbimazole if you live overseas. But, yeah, so I took bugleweed, and so that, again, I can’t tell someone to take bugleweed.

Dr. Eric:

My patients I could talk to them about it, but again, I’d say bugleweed and that did a pretty good job with me. The good news is 10 milligrams is still on the low side of methimazole, so you might be okay with making a transition. I will have some patients take methimazole and the bugleweed at the same time, usually, not exactly at the same time, but maybe like an hour or so apart. Again, I can’t tell them to stop taking methimazole as I mentioned. When I was in with Graves, I took five milliliters twice a day of 1:2 extract of bugleweed. But, again, that was my personal situation and I based it on the thyroid blood test. Then there’s motherwort.

Motherwort is more for the symptoms, not really affecting the thyroid, so like propranolol it’s similar to a beta blocker. I took bugleweed and I took motherwort, I actually started with bugleweed but still had some heart palpitations. Instead of taking a beta blocker, essentially, that’s the motherwort. But you want to be careful about abruptly stopping anything. I say let’s wrap it up just because it’s pretty close and I’ve already kept you longer than I promised. Just there’s so many questions and I hate leaving them unanswered. But anyway, register for the masterclass and let me put up one more time that replenishyourenergy.com/quiz​.

Again, I apologize for those that we didn’t get to your questions, but again, thanks for attending. If any questions specific for hyperthyroidism or Hashimoto’s, again, I do these on a regular basis. Not necessarily every single week, even though I think I will be on next week, so stay tuned. Then, again, Dr. Amy, by visiting her quiz, you’ll be on her list as well and you’ll get access to her masterclass. If you have more questions on adrenals, perimenopause, again, definitely fill out the quiz, attend the masterclass. But, again, Dr. Amy, I’d like to thank you again for, not only the answers you gave, but again, going over to make sure we get to some of the questions. Not all of them, but again, we got to a good number of them and appreciate you sharing your thoughts and feedback on adrenal health and perimenopause.

Dr. Amy:

Thank you so much for having me. It’s really fun and happy to answer questions and we’ll do more Q&A at the end of the masterclass too. Check the quiz and hope to stay in touch. Thank you, Dr. Eric, again, for the important work that you do and offering these options in between the nothing or the dramatic really important work. It’s so great that people have options when it comes to their Graves and their Hashi’s, and thank you for having me here today.

Dr. Eric:

All right, you’re welcome. It was a pleasure and maybe we’ll do it again in the future. Again, everyone have a wonderful day, a wonderful rest of your weekend. And same to you, Dr. Amy, have an awesome rest of your Friday and weekend as well.

Dr. Amy:

Thank you, bye.

Dr. Eric:

All right, bye everyone.

During the interview Dr. Day mentioned her “Why Am I SO Tired?” quiz, which you can check out by visiting the following link:

https://replenishyourenergy.com/quiz

She is also having a “From Fatigued to Fired Up” workshop in late March:

https://replenishyourenergy.com/fromfatiguedtofiredup

 

 

As you know, my practice focuses on helping people with thyroid and autoimmune thyroid conditions.  And while I’d have to say that the majority of patients I work with are solely “hypothyroid” or “hyperthyroid”, there are people who fluctuate back and forth between hyperthyroidism and hypothyroidism.  And so the purpose of this blog post is to discuss some of the reasons for this.

Let’s take a look at four different scenarios that can result in both hypothyroid and hyperthyroid symptoms:

Scenario #1: Having the antibodies for both Graves’ disease and Hashimoto’s thyroiditis.  It’s actually quite common for people to have antibodies for both Graves’ disease and Hashimoto’s.  The antibodies for Graves’ disease are thyroid stimulating immunoglobulins, which is a TSH-receptor antibody.  These cause an overproduction of thyroid hormone by binding to the TSH receptor.  On the other hand, thyroid peroxidase (TPO) and anti-thyroglobulin antibodies indicate that the immune system is causing damage to structures of the thyroid gland.  This can result in symptoms of hypothyroidism, although sometimes they can also result in transient hyperthyroid symptoms, which I’ll discuss next when explaining what Hashitoxicosis is.

So for example, Graves’ disease is characterized by a depressed TSH, elevated thyroid hormones, and elevated thyroid stimulating immunoglobulins.  Most people with this presentation will experience hyperthyroid symptoms.  However, if they also have TPO and/or anti-thyroglobulin antibodies there is the possibility that they might fluctuate back and forth between hyperthyroidism and hypothyroidism.  I can’t say that this fluctuation is common, as usually someone with Graves’ disease is predominantly hyperthyroid, while those with Hashimoto’s usually experience hypothyroid symptoms, although I’ll add that many people with Graves’ disease who also have Hashimoto’s antibodies will eventually become hypothyroid if the autoimmune component isn’t addressed. Keep in mind that it can take years for this to occur.

Scenario #2: Having Hashitoxicosis.  I’ve written a separate article on Hashitoxicosis, but I’ll summarize what it is it here.  Hashimoto’s thyroiditis is typically diagnosed when someone has an elevated TSH along with TPO antibodies and/or  thyroglobulin antibodies.  Many people with Hashimoto’s experience hypothyroid symptoms due to the thyroid hormone levels being either less than optimal or overtly low.  But why do some people experience hyperthyroidism? As I mentioned in the previous article I wrote, the hyperthyroidism experienced in Hashitoxicosis is caused by the release of preformed thyroid hormones caused by the destruction of thyroid follicles.

So these people might feel hypothyroid at times, but then at other times they essentially get a “flood” of thyroid hormone into the bloodstream, resulting in symptoms of hyperthyroidism.  Not only will they feel hyperthyroid, but if they get a blood test during these transient hyperthyroid periods it will reveal hyperthyroidism (low TSH, elevated T3 and T4).  Because of this it’s common for these people to be misdiagnosed with Graves’ disease, but this usually could be confirmed or ruled out by testing the thyroid stimulating immunoglobulins. In other words, if someone has a depressed TSH, elevated thyroid hormones (T3, T4), positive TPO and/or thyroglobulin antibodies, and NEGATIVE thyroid stimulating immunoglobulins, then there’s a good chance that the person has Hashitoxocosis and not Graves’ disease.

Scenario #3: Subacute thyroiditis. I can’t say that most people with subacute thyroiditis experience a fluctuation of hyperthyroid and hypothyroid symptoms, but it is possible.  I’ve also written a separate article on subacute thyroiditis, as this is usually caused by a virus, and the patient initially presents with hyperthyroidism, and over time will become hypothyroid.  So the person starts with hyperthyroidism and then usually becomes hypothyroid within a few months, but unlike Hashitoxicosis, it’s not common for people with subacute thyroiditis to feel hypothyroid one day and then hyperthyroid the next day.  I also should mention the research shows that coronavirus-19 can cause subacute thyroiditis, which I discussed in another article.

Scenario #4: Having Hashimoto’s and another condition that causes tachycardia. Tachycardia is an increased resting heart rate, and while this is a common symptom of hyperthyroidism, there can be other conditions that cause this.  Not too long ago I wrote a blog post entitled “Tachycardia and Thyroid Health“, and here are some of the factors that can cause an elevated heart rate.

• Hyperthyroidism
• Elevated cortisol levels
• Hypoglycemia
• Dehydration
• Hyperkalemia (high potassium levels)
• Hypomagnesemia (low magnesium)
• Hypocalcemia (low calcium)
• Infections
• Anemia
• Caffeine
• Certain medications
• Pregnancy
• Hypoxia
• Postural orthostatic tachycardia syndrome (POTS)
• Histamine intolerance

So for example, if someone has Hashimoto’s and elevated cortisol levels, an infection, or histamine intolerance, they might experience tachycardia at times.  Of course tachycardia isn’t the only symptom of hyperthyroidism, but it’s one of the most common symptoms, and so some people will assume they have hyperthyroidism if they have an elevated resting heart rate.  But if someone experiences tachycardia and every time they get a thyroid panel it looks fine or is more on the hypothyroid side, then the increased resting heart rate probably isn’t caused by hyperthyroidism.

It can sometimes be challenging to figure out what’s causing the increased resting heart rate.  On top of this, the person might have tachycardia and heart palpitations, both of which are common in hyperthyroidism.  But once again, just because someone has tachycardia and heart palpitations doesn’t mean they have hyperthyroidism.  I also wrote an article entitled “Heart Palpitations and Thyroid Health”, and if you read the article you’ll notice that some of the same factors that can cause tachycardia can also result in heart palpitations.

How Do You Treat These Conditions?

In the first two scenarios listed above you would want to focus on improving the health of your immune system.  Regardless of whether someone has the antibodies for Graves’ disease, Hashimoto’s, or both, you want to find and remove triggers, correct underlying imbalances, heal the gut, etc.  Of course this is easier said than done, which is why it’s a good idea to work with a competent healthcare practitioner.

As for the symptom management aspect, this is where it can be tricky.  If someone consistently is hyperthyroid then chances are they will take antithyroid medication or herbs (assuming they don’t receive radioactive iodine or thyroid surgery), whereas if someone is consistently hypothyroid they are likely to take thyroid hormone replacement.  But if they are fluctuating between hyperthyroidism and hypothyroidism then they wouldn’t want to take antithyroid agents or thyroid hormone replacement, and so focusing on the cardiovascular symptoms with a beta blocker or an herb such as motherwort or hawthorn would be an option to consider.

In the case of subacute thyroiditis (Scenario #3), while most people will initially be hyperthyroid for at least a couple of months, many medical doctors are still hesitant to give the person antithyroid medication.  Because of this, many people with subacute thyroiditis will be prescribed a beta blocker.  I don’t have a problem putting my patients with subacute thyroiditis on bugleweed while closely monitoring their symptoms and thyroid hormone levels.  But another option is to refrain from taking any antithyroid agents in this situation and just take something to manage the cardiovascular symptoms.

As for Scenario #4, you of course would want to address the autoimmune component of Hashimoto’s, while trying to figure out the cause of the elevated resting heart rate.  Since there are so many factors that can cause tachycardia it can sometimes seem like you’re searching for a needle in a very large haystack.

To summarize, if you were diagnosed with Graves’ disease and experience both hyper- and hypothyroid symptoms then you most likely fall into “Scenario #1”, although it’s also possible that you actually have Hashitoxicosis and not Graves’ disease.  On the other hand, if you have been diagnosed with Hashimoto’s and experience both hyper- and hypothyroid symptoms then you can fall under “Scenarios 1, 2, or 4”.

Do You Experience Hypothyroidism AND Hyperthyroidism?

If you fluctuate between hypothyroidism and hyperthyroidism I’d love to hear from you!  Do you have the antibodies for both Graves’ disease and Hashimoto’s? Or perhaps you were diagnosed with Hashitoxicosis? Either way I’m sure others who experience the same symptoms would love to hear what your experience has been.