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

Dr. Eric Osansky: 

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

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

Dr. Alan Christianson: 

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

Dr. Eric: 

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

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

Dr. Alan: 

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

Dr. Eric: 

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

Dr. Alan: 

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

Dr. Eric: 

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

Dr. Alan: 

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

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

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

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

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

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

Dr. Eric: 

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

Dr. Alan: 

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

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

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

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

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

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

Dr. Eric: 

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

Dr. Alan: 

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

There is also toxicology, which is not genetically variable. 

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

Dr. Eric: 

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

Dr. Alan: 

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

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

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

Dr. Eric: 

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

Dr. Alan: 

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

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

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

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

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

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

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

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

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

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

Dr. Eric: 

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

Dr. Alan: 

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

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

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

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

Dr. Eric: 

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

Dr. Alan: 

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

Dr. Eric: 

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

Dr. Alan: 

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

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

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

Dr. Eric: 

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

Dr. Alan: 

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

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

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

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

Dr. Eric: 

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

Dr. Alan: 

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

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

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

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

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

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

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

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

Dr. Eric: 

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

Dr. Alan: 

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

Dr. Eric: 

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

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

Dr. Alan: 

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

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

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

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

Dr. Eric: 

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

Dr. Alan: 

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

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

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

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

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

Dr. Eric: 

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

Dr. Alan: 

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

Dr. Eric: 

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

Dr. Alan: 

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

Dr. Eric: 

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

Dr. Alan: 

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

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

Dr. Eric: 

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

Dr. Alan: 

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

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

Dr. Eric: 

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

Dr. Alan: 

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

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

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

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

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

Dr. Eric: 

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

Dr. Alan: 

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

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

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

Dr. Eric: 

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

Dr. Alan: 

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

Dr. Eric: 

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

Dr. Alan: 

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

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

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

Dr. Eric: 

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

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

Dr. Alan: 

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

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

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

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

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

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

Dr. Eric: 

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

Dr. Alan: 

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

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

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

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

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

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

Dr. Eric: 

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

Dr. Alan: 

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

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

Dr. Eric: 

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

Dr. Alan: 

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

Dr. Eric: 

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

Dr. Alan: 

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

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

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

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

Dr. Eric:

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

Dr. Alan: 

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

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

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

Dr. Eric: 

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

Dr. Alan: 

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

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

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

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

Dr. Eric: 

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

Dr. Alan: 

Dr. Eric: 

15. Even worse. 

Dr. Alan: 

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

Dr. Eric: 

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

Dr. Alan: 

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

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

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

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

Dr. Eric: 

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

Dr. Alan: 

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

Dr. Eric: 

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

Dr. Alan: 

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

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

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

Dr. Eric: 

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

Dr. Alan: 

Wherever you buy books, your local bookstore or Amazon. 

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

Dr. Eric: 

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

Dr. Alan: 

Good to be with you, Dr. Eric.

 

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

Dr. Eric Osansky: 

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

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

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

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

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

Laurie Villareal: 

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

Dr. Eric: 

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

Laurie: 

Yes, that’s exactly right. 

Dr. Eric: 

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

Laurie: 

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

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

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

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

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

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

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

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

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

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

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

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

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

Dr. Eric: 

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

Laurie: 

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

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

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

Dr. Eric: 

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

Laurie: 

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

Dr. Eric: 

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

Laurie: 

It’s very common.

Dr. Eric: 

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

Laurie: 

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

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

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

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

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

Dr. Eric: 

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

Laurie: 

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

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

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

Dr. Eric: 

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

Laurie: 

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

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

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

Dr. Eric: 

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

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

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

Laurie: 

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

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

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

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

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

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

Dr. Eric: 

You use the CGMs as well? 

Laurie: 

Yes. 

Dr. Eric: 

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

Laurie: 

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

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

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

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

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

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

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

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

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

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

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

Dr. Eric: 

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

Laurie: 

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

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

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

Dr. Eric: 

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

Laurie: 

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

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

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

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

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

Dr. Eric: 

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

Laurie: 

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

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

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

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

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

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

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

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

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

Dr. Eric: 

Did you say Woop? 

Laurie: 

Yes. 

Dr. Eric: 

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

Laurie: 

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

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

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

Dr. Eric:

Are those the main two bio sensors you use? 

Laurie: 

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

Dr. Eric: 

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

Laurie: 

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

Dr. Eric: 

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

Laurie: 

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

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

Dr. Eric: 

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

Laurie: 

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

Dr. Eric: 

Yes. 

Laurie: 

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

Dr. Eric: 

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

Laurie:

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

Dr. Eric:

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

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

Laurie: 

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

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

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

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

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

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

Dr. Eric: 

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

Laurie: 

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

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

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

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

Dr. Eric: 

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

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

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

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

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

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

Laurie: 

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

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

Dr. Eric: 

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

Laurie: 

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

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

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

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

Dr. Eric: 

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

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

Laurie: 

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

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

Dr. Eric: 

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

Laurie: 

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

Dr. Eric: 

Thanks! Same to you, Laurie. 

 

Recently, I interviewed Stacy, and we discussed her diagnosis, the symptoms she continues to deal with, why she opted for a natural treatment approach, her dietary and stress management practices, the need for comprehensive functional testing, and more. If you would prefer to listen to the interview you can access it by Clicking Here.

Dr. Eric Osansky: 

Welcome to another Save My Thyroid audit. I am chatting with Stacy from Ohio. Thank you so much for joining us, Stacy. 

Stacy: 

Thank you for having me.

Dr. Eric: 

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

Stacy: 

I was diagnosed in March 2022. 

Dr. Eric: 

Have you taken any antithyroid medication since then? 

Stacy: 

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

Dr. Eric: 

Similar to what I did. 

Stacy: 

Yeah. 

Dr. Eric: 

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

Stacy: 

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

Dr. Eric: 

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

Stacy: 

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

Dr. Eric: 

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

Stacy: 

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

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

Dr. Eric: 

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

Stacy: 

June. I had TSH, T3, and T4 tested. 

Dr. Eric: 

Did it show you were still hyper? 

Stacy: 

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

Dr. Eric: 

This was a few months ago in June. 

Stacy: 

Yes. 

Dr. Eric: 

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

You’re taking specifically bugleweed and motherwort? 

Stacy: 

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

Dr. Eric: 

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

Stacy: 

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

Dr. Eric: 

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

Stacy: 

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

Dr. Eric: 

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

Any eye symptoms? Any symptoms of thyroid eye disease?  

Stacy: 

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

Dr. Eric: 

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

Stacy: 

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

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

Dr. Eric: 

Those are of course really good goals to have. 

Stacy: 

Yes. 

Dr. Eric: 

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

Stacy: 

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

Dr. Eric: 

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

Stacy: 

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

Dr. Eric:

Are you still following that diet? 

Stacy: 

Yes. 

Dr. Eric: 

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

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

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

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

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

Stacy: 

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

Dr. Eric: 

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

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

Stacy:

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

Dr. Eric: 

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

Stacy: 

Yes. 

Dr. Eric: 

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

Stacy: 

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

Dr. Eric: 

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

Stacy: 

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

Dr. Eric: 

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

Stacy: 

Yes. 

Dr. Eric: 

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

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

Stacy: 

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

Dr. Eric: 

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

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

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

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

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

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

Stacy: 

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

Dr. Eric: 

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

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

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

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

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

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

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

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

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

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

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

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

Stacy: 

Yeah. All right. 

Dr. Eric: 

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

Stacy: 

Thank you. You, too.

Recently, I interviewed Agnieszka, and we discussed the her journey with Hashimoto’s, symptom development, the various tests she has done, the changes she has made since her diagnosis, the main symptoms she’s continuing to experience, her experience with thyroid hormone replacement, my recommendations for dietary adjustments and testing, alternative thyroid treatment options, and more. If you would prefer to listen to the interview you can access it by Clicking Here.

Dr. Eric Osansky: 

Welcome to another Save My Thyroid audit. I am very excited to chat with Agnieszka here. She is joining us from Poland. Her health journey is with Hashimoto’s. Thank you so much for joining us. 

Agnieszka: 

Thank you so much. I’m really happy to be here.

Dr. Eric: 

I’m happy you’re here, too. You’ve been dealing with Hashimoto’s for a little over four years. Is that correct? 

Agnieszka: 

Yes, that’s right. I was diagnosed around four years ago. I don’t know how long before that I had it. When I was diagnosed, I didn’t really have any significant symptoms. I was just running a regular hormonal check-up. My sister also has Hashimoto’s, so I decided to check antibodies. That’s when I found out. 

Dr. Eric: 

I was going to ask you if there is a family history, and you just answered that question. Your sister has Hashimoto’s as well. Any other family members? 

Agnieszka: 

Not that I know of. My mother doesn’t have thyroid issues or autoimmunity. It’s just my sister that I know about.

Dr. Eric: 

You are taking thyroid hormone replacement, correct? 

Agnieszka: 

Yes, that’s right. I started in May this year, so around five months ago. I tried natural methods. I tried cleaning my diet and doing different things that I thought would support me, but symptoms started to appear and became stronger. In the end, my doctor decided to check if thyroid hormones could be helpful. So far, I haven’t noticed a big difference actually.  

Dr. Eric: 

You haven’t really noticed it helping much, being on thyroid hormone. 

Agnieszka: 

Unfortunately not. I also looked at the test results and confirmed one of the ones I had before. Apart from TSH, which lowered, my thyroid results of free T3 and free T4 are more or less the same. Hasn’t improved. 

Dr. Eric: 

You’re on synthetic T4, right? Levothyroxine? 

Agnieszka: 

Yes. 

Dr. Eric: 

You said it’s been about six months. That’s all you’ve taken. You haven’t tried anything else like desiccated thyroid. 

Agnieszka: 

No. It’s not available in my country. Only T4 is prescribed by doctors. 

Dr. Eric: 

For prescription, you can only get T4. In the United States and some other countries, they have glandulars that are not prescription. 

Agnieszka: 

I am trying to contact an Italian doctor, and hopefully I will be able to experiment with some other treatments as well. 

Dr. Eric: 

Hopefully that works out. Obviously, you want to try to address the cause of the problem and focus on the immune system since Hashimoto’s is more of an immune system problem. Some people do need to take thyroid hormone replacement as well. 

Before we have this conversation, I have everybody fill out a brief application and ask about some of the major health challenges. You put fatigue, brain fog, and hair loss. Wasn’t too long ago that you filled out the application, so I assume you’re still having these symptoms. 

Agnieszka: 

Yes. The most challenging is the fatigue and brain fog. It makes my life difficult and working difficult. It has a huge impact on the way I live and everything I do. 

Dr. Eric: 

I can imagine. One question I have been asking most people in this audit: How would you like your health to be six months from now, 12 months from now? Obviously, you want to be filled with more energy, you want the brain fog to be gone, and you want the hair loss to stop. Anything else that if you had to paint a perfect picture? Are those the main things? 

Agnieszka: 

What you said is the best summary of what I would want for myself. I would like to get my energy levels back and to be able to have a normal life and to enjoy it. I have always been an energetic person and doing a lot of things. Now, I find it sometimes difficult to get through the day when I just do my job. I work and don’t have much more energy for other things. I also struggle at work; I work as a teacher, teaching language. It requires mental clarity.

Dr. Eric: 

The fatigue is all the time then? It’s not worse at certain times throughout the day? 

Agnieszka: 

I have noticed that it gets worse around half an hour after meals. I try to eliminate the foods. Since the diagnosis, I have been gluten-free. I also try to limit dairy. I tried other products. I don’t eat red meat generally since I was 14. But I eat fish. I’ve tried to eliminate different products and see how I would feel. I haven’t noticed big differences. 

Basically, after a majority of my meals, I feel weakness and brain fog. That lasts around 2-3 hours after a meal, starting half an hour after. Then it gets better again. In the evenings, I also feel more fatigue as well. 

Dr. Eric: 

After any meal, whether it’s breakfast, lunch, or dinner, you feel fatigue about 30-45 minutes after. 

Agnieszka: 

That’s right.

Dr. Eric: 

Have you had your blood sugar checked? Not just glucose, but hemoglobin A1C and fasting insulin. 

Agnieszka: 

Yes. I had my glucose tested. I had my insulin tested. I haven’t had that test done. I’m not sure about its professional name, when you drink a lot of glucose- 

Dr. Eric: 

The glucose tolerance test. 

Agnieszka: 

Right. One of the doctors suggested that to me. I haven’t done it yet. Although he said that if it was connected with glucose, I would probably feel lower energy later, not so quickly after eating or having a meal. I haven’t explored that possibility yet.

Dr. Eric: 

How about weight? Is it pretty stable? Are you gaining weight, losing weight? 

Agnieszka: 

My weight is pretty stable. Let me think. I’m rather a slim person. I’m in Europe, so it’s other measurements. I guess it would be around 116 pounds. My height is 5’7”, I would say. I’m rather slim and have always been like that. I don’t see any fluctuations in my weight. 

Dr. Eric: 

That’s good. Any digestive symptoms: bloating, gas, constipation, loose stools? 

Agnieszka: 

Absolutely. Bloating after most meals. Maybe now it’s gotten a little better. I would not say I’m constipated because I’m quite regular, but the stool is hard. That’s something I’ve experienced for more than a year. It doesn’t come easily. 

Dr. Eric: 

How has stress been over the last four years since you’ve been diagnosed? Who knows how long prior to being diagnosed you’ve been dealing with Hashimoto’s. How is your stress handling? 

Agnieszka: 

For the past 2-3 years, I must say that it’s been really great. I feel balanced and peaceful. I meditate every day. 

Prior to my diagnosis, I had a very stressful period. I had a challenging long-distance relationship, so I suspect it might have been one of the triggers, if not the main trigger. I was trying to do my best using my tools, but I definitely was much more stressed back then.  

Dr. Eric: 

Sounds like stress might have been a trigger, or at least one trigger. More recently, over the last few years, hasn’t been as bad. You’re doing things to help with stress management, such as meditation. 

Agnieszka: 

Yes, that’s right. 

Dr. Eric: 

Have you done any type of adrenal testing, like saliva testing or DUTCH testing? 

Agnieszka: 

No, I haven’t. My cortisol was checked, but it was a single test, like one time. Of course it didn’t show the curve. 

Dr. Eric: 

The Circadian rhythm, yes. You just did a morning cortisol in the blood? 

Agnieszka: 

Yes, that’s right. 

Dr. Eric: 

How is your sleep? 

Agnieszka: 

I don’t sleep long. It’s around 6-7 hours. Now, I believe I sleep much better than I used to. Earlier, I had problems, and I would wake up at night around 4am, and I couldn’t fall asleep again. That was one of the first symptoms I started experiencing. After introducing some treatment and sleep hygiene, and I got rid of a parasite because I also received a diagnosis, I noticed changes, and it improved. 

Dr. Eric: 

Since addressing parasites, you noticed that your sleep has improved. 

Agnieszka: 

Yes, that’s right. 

Dr. Eric: 

You did stool testing. You put down GI Map. You did a mycotoxin test for molds and an organic acids test. Correct? 

Agnieszka: 

Yes. 

Dr. Eric: 

It was the GI Map that showed the parasites? 

Agnieszka: 

No, the GI Map was done afterwards. It didn’t show any parasites. It was early at the beginning of my diagnosis that I had a stool test. It was roundworm and ringworm that were discovered. I followed the treatment prescribed by my doctor. I did natural treatment and medicine. I retested. There were parasites again, so I continued the treatment. Then it was negative. 

I’m not sure if it is gone because I know these tests are not super reliable, and they often can be false negative. That’s what I did, and I think it took me quite a lot of time, almost one year, the whole treatment. 

Dr. Eric: 

You did not do the GI Map initially. That was maybe the last stool test you did. You did another stool test that showed that you had parasites. You underwent treatment and did a retest, and it sounds like it still showed parasites. You continued treating and did another one, not the GI Map. The GI Map was negative, but you did another test also, which was negative for parasites. Correct? 

Agnieszka: 

Yes, that’s right.  

Dr. Eric: 

With the symptoms, we’re not sure of the digestive symptoms as related to parasites. Did they improve at all after treating for parasites? Were they worse before you had the treatment? 

Agnieszka: 

The main symptom that changed was the improved sleep. It got better. Since then, I have been sleeping better.

As for fatigue and brain fog, I think they came a little bit later on, which might be connected with my age. I’m in perimenopause; I’m 45. I could see the symptoms start to get worse with time. 

Dr. Eric: 

What did the mold test, the mycotoxin test, and the organic acids test show? Anything significant? 

Agnieszka: 

The mold test showed stool strength of mold. I had the consultation with a functional medicine practitioner in the U.S. I didn’t retest after taking supplements. What was said was the numbers weren’t extremely high, but there were two strains of mold. 

Dr. Eric: 

Did you have your house tested for mold, too? 

Agnieszka: 

Unfortunately not. I’m renting an apartment. I don’t see any signs of mold outside, but I realize that things might be hidden somewhere. 

Dr. Eric: 

That is a possibility. Anything significant on the organic acids test? 

Agnieszka: 

No. Most of it looked okay. We were correcting these things with the other practitioner in terms of nutrients. There were no pathogens or anything like that. 

Dr. Eric: 

Getting back to diet, because you put this on the application, you’d like to try an elimination diet but are concerned about protein intake because you don’t eat meat, only fish sometimes. That’s why you didn’t do AIP. You made some changes like eliminating gluten, as you mentioned, and some other changes, like avoiding eggs. But you haven’t followed a strict AIP diet because you’re more of a pescatarian, not a vegetarian. 

When it comes to diet, there is no diet that fits everyone perfectly. Typically, with Hashimoto’s and Graves’, I will recommend AIP. It is more challenging if someone isn’t eating a decent amount of meat for protein. It’s not like it can’t be done. Regular paleo diet is a little bit easier because it allows you to eat eggs. You avoided eggs, but you currently eat eggs. 

Agnieszka: 

Yes, I currently eat eggs. I didn’t notice any particular changes when I stopped eating them. 

Dr. Eric: 

I know you said you went gluten-free. Have you tried avoiding grains altogether as well as nightshades?  

Agnieszka: 

No. I don’t eat a lot of grains because I’m on a low carb, high fat diet currently. Still, of course, there is some buckwheat or millet. From time to time, I eat rice. I haven’t tried avoiding them totally. 

Dr. Eric:

How about dairy? Have you gone dairy-free? 

Agnieszka: 

I can see dairy doesn’t serve me very well, especially things like cream or milk. I feel bloated after. There is some reaction. I try to avoid it in general. 

Dr. Eric: 

I would listen to your body. I would continue avoiding gluten and listen to your body with dairy. 

I mean, I think it’s worth taking a break from grains. I’m not saying that’s the magic bullet in your case, but there is a good book No Grain, No Pain. For some people, grains could be holding someone back from recovery. It could be harsher on the gut and sometimes cause inflammation, even gluten-free grains. That might be something to consider. 

And nightshades, too. If you haven’t taken a break from tomatoes, eggplant, peppers, and white potatoes, just to try. Not everyone has a problem with nightshades. 

There are reasons why those foods are excluded from an AIP diet. Even a paleo diet, grains are not allowed for the reason I mentioned, that they could be harsher on the gut. Grains aren’t a great source of protein. Same thing with nightshades. Those two, from a protein perspective. 

If you’re eating things like legumes, make sure they’re well prepared, pressure cooked, so they are easily digestible.

I agree with the mold. Maybe look into it. I know you’re renting. That’s challenging because you don’t want to spend a lot of money when it’s not your place. Even when it’s your place, you don’t want to spend a lot of money testing for mold. Like you said, you can’t always go by seeing mold. It doesn’t sound like it was too bad as far as the levels on the mycotox test. Something to keep in mind. 

When someone has mold, or even if someone doesn’t have mold, thinking about fatigue. A lot of things can cause fatigue. You mentioned brain fog. Those are your two main symptoms. The hair loss, which some of that could be thyroid hormone-related. Your thyroid levels are still not optimal. There could be other things like nutrients.

Maybe something to look into, adrenals. Doing adrenal saliva testing or a dried urine test that looks not only at adrenals but other hormones and metabolism of hormones. That could play a role sometimes in energy levels and cause other symptoms like hair loss.

Nutrients. I assume you probably had a full iron panel, looking at iron and iron saturation. 

Agnieszka: 

Yes, I had my iron checked. I had lipids checked. I had B12 checked. Some other ones. 

Dr. Eric: 

Were they looking good? Were they not the lab range but optimal range? 

Agnieszka: 

They look good. I supplement as well. I also supplement B vitamins. Not all the time but every couple of months. 

Dr. Eric: 

Iron, a lot of people are lower. The iron saturation should be between 30-40%. A lot of people are in the low or mid-20s, which for some people is enough to cause low energy. If that’s looking good, and B vitamins are looking good, like B12, that’s great.

Even though your nutrients look good, your gut seems to be an issue because you’re having bloating. Maybe it’s food-related. It may be worth eliminating more foods before diving even deeper. But going on an elimination diet, eliminating grains, nightshades, continuing to eat, whole, healthy foods. If those aren’t helping, you might need to dig deeper.

That is the challenge with parasite testing, like you said. The GI Map, I love it, but it only looks at 12 different parasites and worms combined because it uses PCR DNA testing, which is great, but there are limitations as to how many parasites it can look at.

The other test you did that showed you were positive was negative. Maybe that was a true negative. Maybe not. May be worth redoing that test again. If not, then there could be something else. 

It could be SIBO, when someone has bloating and/or gas. Maybe it could be too much bacteria in the small intestine. That’s something to look at. That could cause a lot of different symptoms, including fatigue, brain fog, and others. 

I’m not saying to do all of this. These are things to keep in mind. 

I don’t know if you looked into stealth infections like Lyme or bartonella. There are limitations with the test, too, if you just go to a regular lab. Lyme is often negative, even if you have Lyme. Not to say that you have it, but to keep in mind. I dealt personally with chronic Lyme, so I am more aware of the impact of these tick-borne infections. It can come from other places, too, like fleas potentially. You definitely need to dig deeper.

It sounds like stress is good. Sleep could still be better. You said 6-7 hours. Trying to get 7-7.5 hours at least because that will affect energy. Continuing to get more sleep. Sometimes, with sleep, you have to look at adrenals, too. That’s all you’re able to get on your own maybe, so you may need to look into adrenals and sex hormones and see if there are issues there. 

It sounds like you might need to dig a little bit deeper. You have done a lot, which is great. I know it costs money for the GI Map and organic acids test and mycotox tests. These are not cheap tests. That’s why I’m saying to make some of these dietary changes and see how you feel. 

If things are not heading in the right direction, maybe the adrenal saliva test or the DUTCH test. Maybe another parasite retest. Not necessarily the GI Map, but the one that was initially positive for parasites to see what it looks like. If that is looking good, maybe look into something like SIBO testing. If you absolutely have to, stealth infections. 

When I dealt with Lyme, there was no evidence of a tick bite, no rash. Everybody is different. I didn’t have fatigue; mine was more neurological symptoms. With Lyme, you often have other symptoms like migrating muscle and joint pain. If you don’t have that, it doesn’t mean you don’t have Lyme. I would look more into Lyme if you have pain that moves around. The fatigue and brain fog, a lot of different things can cause that. I’m just saying that’s something I wouldn’t overlook.

Those are some things to consider. I know it’s a lot that I threw at you. 

One more thing: optimizing thyroid hormone. When we want to address the cause of the problem. Your most recent TSH was 2.99, which is within the lab range, but not optimal, so you are working on that. The synthetic T4 is not a good fit for everyone. I know you can’t get desiccated thyroid, but you are working on getting the glandular. 

Everything else could play a role in the autoimmune response. There is a time and place for thyroid hormone, but if the synthetic T4 is not working for you, hopefully you can get something else in its place. 

Agnieszka: 

Yes, great. Thank you so much. You have given me a lot of tips and next steps. Honestly, I felt a little bit lost. I knew there could be a lot of root causes. Now I feel like I have a clear path and step-by-step things I can explore and look into. Thank you very much for that. 

Dr. Eric: 

You’re very welcome, Agnieszka. Have you read my book Hashimoto’s Triggers? 

Agnieszka: 

Yes. 

Dr. Eric: 

That goes into a lot of detail with different triggers. Thank you for reading that. Thank you so much for doing this audit. I really appreciate it. Hope you found it helpful. It sounds like you did. Hope everyone listening found it to be helpful. Thanks, everyone for tuning in, and catch you in the next episode. Bye, Agnieszka. Take care. 

Agnieszka: 

Goodbye.

Recently, I interviewed Nanette, and we discussed the  long-term medication use, her treatment with propylthiouracil (PTU), dietary changes, the importance of stress management, why we need to address underlying causes like insulin resistance and inflammation, my approach to testing and lifestyle modifications, and more. If you would prefer to listen to the interview you can access it by Clicking Here.

Dr. Eric Osansky: 

Welcome, everyone. I am very excited to do a Save My Thyroid audit. We are going to be talking to Nanette here on her experience and personal journey with toxic multinodular goiter. How are you doing today, Nanette? 

Nanette: 

I’m doing really well, thank you. Thanks for having me. 

Dr. Eric: 

It’s a pleasure. Looking forward to this. If you could give a little bit of your background. How long ago were you diagnosed with toxic multinodular goiter? 

Nanette: 

I’m 63. When I was 16, I had a nodule on my thyroid. My dad noticed it. This is 1978, and I had that removed surgically. I went 10+ years with no thyroid treatment at all. Then I hit 30, and I got another nodule. I had that one removed. I had most of my thyroid, but I had two surgeries with two nodules removed. At 30, they put me on some Synthroid. I had been back and forth for a little while taking the Synthroid. I was euthyroid. Then I was off all thyroid medication. 

Almost 20 years ago now, I had a change. I felt bruised, like I had been in a fight or something. I couldn’t figure that out. Then I went to the doctor, and they said, “Oh, I think you’re hyperthyroid.” I was moving at the time. It turns out for the last 20 years, I’d had toxic multinodular goiter. Really, only the last 10 years, I had been treated for that. 

I tried methimazole, which made me crazy, not crazy but really got my heart rate up and going. My local doctor didn’t want to try PTU, so I went down to Phoenix and found a doctor there who wanted to try PTU. I have been on that for five years now almost. 

I listened to one of your podcasts, which made me real nervous, that that’s not good. Just yesterday, I saw the doctor, and she said I’m really on a pediatric dose. Just enough to calm my thyroid enough. I’m actually feeling pretty good. 

Nicely, she said yesterday, “I really don’t want surgery on you.” A lot of doctors are resisting it because I’ve had two surgeries with scar tissue. That inadvertently saved my thyroid. I had more than one doctor say, “Too bad they didn’t remove your whole thyroid.” I still have it. It does work a bit. If I don’t take the PTU, my TSH goes really low, like .002. I get heart palpitations, which is really my biggest and only symptom. 

I’ve had sonograms every year. Yesterday, I had one. My nodules are stable. I will follow up in a year. I asked about the radio ablation. She said, “Well, you have at least three nodules we’d have to do that to, and that’s a little invasive. You’re doing well.” My liver enzymes have been well, so so far, I’m sticking with what I have. I’m hoping to learn from you.

Dr. Eric: 

Wonderful. Thank you for sharing your background. We were chatting a little bit before I pressed Record about the radiofrequency ablation, how they didn’t have that years ago, and that’s why you got the individual nodules removed. 

I also mentioned how they usually don’t do that, so you got lucky that they didn’t remove your entire thyroid gland. At least these days, I don’t hear much about doing even partial thyroidectomy, where they remove half the thyroid gland, let alone the single nodule. That’s not great that you had the nodules, but it’s great that they didn’t remove the entire thyroid gland.

As far as PTU, I mean, everything is risk versus benefit. When I talk about medication on the podcast, I try not to talk too negatively. Sometimes, I do get into the research about some of the negative consequences. Obviously, with both methimazole and PTU, it can put stress on the liver. Everybody’s different. That’s why there’s liver panels available to monitor that. I know you’ve been given the liver panels. 

You mentioned you’re on a pediatric dose. If you’re tolerating it well, you don’t want to be on that forever, but for now, if it means preserving the health of your thyroid gland while trying to figure out what you can do, which is why we’re chatting here. Some endocrinologists will recommend surgery or radioactive iodine right away if someone is unable to tolerate methimazole. It sounds like you had to go to Phoenix to get that prescription. They were resistant in your area to switch you to PTU. 

Long story short, I’m glad that you were able to get the PTU, so at least, it buys you time, and everything seems to be stable. Hopefully, I will give you some helpful advice to put you on that road to recovery.

As far as you know, you have been dealing with it for a long time. Maybe not toxic multinodular goiter specifically, but having nodules. That all started when you were 16. Do you know of any other family members with a thyroid condition? 

Nanette: 

Definitely. My grandmother, my dad’s mother, had the same thing. Multinodular goiter. Her daughter, my aunt Linda, she had thyroid cancer and had her thyroid removed. Then her daughter, my first cousin, she had free thyroid cancer and had her whole thyroid removed. She is a little younger than me. Family history there definitely. 

Dr. Eric: 

Okay. Has the PTU pretty much controlled all your symptoms, or are you experiencing any currently? 

Nanette: 

It has helped my symptoms very much. I have tried to wean myself off of it before with the doctor. My symptoms just came roaring back, or I feel my heart palpitations lying in bed, thinking, “Oh no.” I can’t hold a glass of water because it shakes. It definitely helps. That’s been my only symptom, the heart palpitations. I’m just thumping. 

Dr. Eric: 

Is it occasional or pretty much all the time? 

Nanette: 

Now I’m good. Occasionally, I feel my heart fluttering in my chest.

Dr. Eric: 

Before being on the PTU, that was the main symptom. 

Nanette: 

Yes. Tremors in my hands as well. 

Dr. Eric: 

Okay. I’m glad the PTU is helping with that. 

My next question, looking into the future, if you had a crystal ball, ideally, what would you like your health to be like six months from now? 

Nanette: 

I would like to be off the PTU totally. That would be nice. I have been trying your Level 3 diet. I am about five weeks into that. The doctor was familiar with that. My endocrinologist yesterday mentioned some people try that. She didn’t elaborate too much. 

I’d love for my nodules to go away and me to get off the PTU. That would be wonderful. 

Dr. Eric: 

Okay. The doctor was a little bit supportive of the diet, it sounds like. Many are not supportive and just say it’s a waste of people’s time. That was the endocrinologist that you’re seeing? 

Nanette: 

Yeah, down in Phoenix.  

Dr. Eric: 

That’s great that the endocrinologist wasn’t just dismissive of diet because many of them are. Obviously, it’s great that you’re following a Level 3, which is like an AIP, modified autoimmune protocol. You don’t have history of autoimmunity. On the application, you did say something about in the past Hashimoto’s, but all of your current antibodies seem to be negative, correct? 

Nanette: 

Right. I was told when I was first diagnosed at age 16, it was an autoimmune thing. Then I heard the word “Hashimoto’s” somewhere in the next 20 years. I really never paid attention to thyroid antibodies until you mentioned them. I guess I don’t have Hashimoto’s. If I did, it’s gone.  

Dr. Eric: 

It is possible. It’s also possible that they misdiagnosed you. The only way to know is by looking at the blood test years ago. If you had elevated thyroid antibodies back then, those are the antibodies for Hashimoto’s. It is possible that at least from what we see, you no longer have them. There is always the possibility of false negative antibodies, so the blood test is not perfect. That’s something to think about. 

Also, one question I almost forgot to ask you until now: How did you find out about me, Nanette? 

Nanette: 

I think I had signed up for a health summit, and I found Dr. Amie Hornaman. I looked at her website and sent her a note. She said, “I work with hypothyroid. You need to talk to Dr. Eric. He works with hyperthyroid people,” which is rare. Most people are hypo/Hashimoto’s. To find someone who concentrates on hyperthyroidism. That’s how I found you. I signed up for your Thyroid Boot Camp. I bought your book. Here I am. 

Dr. Eric: 

I’m glad Dr. Amie referred you to me, and you signed up for the live event that I had not too long ago, the Thyroid Healing Diet Boot Camp, and got my book. Wonderful.

My next question: Do you feel like there is anything preventing you from reaching your goals, from getting off the PTU, from restoring your health? Any roadblocks? 

Nanette: 

I don’t think so. The diet is a little tough. I miss potatoes and rice and bread. That’s harder than I thought. 

I don’t think so. It’s really hard to believe how much I have learned in the past month and a half. I’ve paid attention to my lab results. I’ve had thyroid problems for 46 years. I don’t think there’s anything stopping me from reaching my goals. 

Dr. Eric: 

Okay. Awesome. Have you done comprehensive testing at all besides getting thyroid panels? I’m sure you’ve gotten CBCs, metabolic panels, maybe lipid panels. I don’t know if you’ve had Vitamin D, iron panels, other types of blood tests. 

Nanette: 

Yes. Those are all good. I had follicular lymphoma 10 years ago. I was diagnosed with that. I don’t know where that came from; it just showed up. My bloodwork is followed closely, especially my liver, because the lymphoma was in my spleen and bone marrow. I was a bit nervous about taking some PTU because that can affect your liver. Everything has been very good. My panels are great.

My immune system is a little squished because of the chemo, which I had because my spleen was so enlarged. My bone marrow was affected greatly from the non-Hodgkins lymphoma. Besides having a low IgG level, my panels have been good on everything. 

I take Vitamin D. I’m out in the sunshine. I live in Arizona. I’m outside every day. I go for walks every day. I try to do all the good stuff. 

Dr. Eric: 

I’m sure they have done fasting glucose as part of a metabolic panel. Have you looked at hemoglobin A1C and fasting insulin in the past? 

Nanette: 

I don’t think I’ve ever had that done. My glucose has always been good. Did I get that done? 

Dr. Eric: 

Well, if you read some of the materials on my website as well as the podcast, when I speak about goiter and nodules, whether it’s multinodular goiter or just goiter without the nodules or just nodules without the goiter- In your case, it’s toxic multinodular goiter. There is a few different factors. 

One could be blood sugar imbalances, such as insulin resistance. Fasting glucose of course is usually tested as part of a metabolic panel. That is far from a perfect test. Hemoglobin A1C is the average blood sugar over 2-4 months. A lot of doctors do test for hemoglobin A1C, but most don’t test for insulin, which could also be helpful. 

If someone has maybe a hemoglobin A1C that doesn’t look too bad—it might be on the higher side but within range—then we want to see insulin ideally less than 5 in a fasting state. If we see that in double digits, or even an 8 or 9, and the hemoglobin A1C is creeping up, like 5.5, 5.6, which is still within range, but on the higher side, it’s not officially an insulin resistance or type 2 diabetes or prediabetes diagnosis until someone’s A1C is 5.7. 

Most endocrinologists, if someone has a hemoglobin A1C of 5.5 and a fasting insulin of 9, which they usually don’t test, they usually won’t say anything. That usually is not optimal when it comes to blood sugar. That could at least be a factor. Doesn’t mean it’s the only factor. That is something to look into.

Yeah, I would at the very least test those two markers and see what those show. Hemoglobin A1C ideally, you want that less than 5. Even if it’s 5.1, 5.2, that’s still really good. If insulin is less than 5 or even honestly 5 or 6, it’s still not too bad. If you see those numbers on the upper end, or at least hemoglobin A1C on the upper end of the range, 5.5, 5.6, and insulin above a 7, that’s when you might suspect blood sugar imbalances.  

Nanette: 

Okay, I’ll follow up on that, thank you. I never thought about it. 

Dr. Eric: 

You’re welcome. Another potential factor when it comes to nodules and goiter, problems with estrogen metabolism. I think you said you’re 63. It’s been a long time since you cycled probably. As we get older, both men and women’s hormones are going to decrease. 

You still have some estrogen. Even if you have a smaller amount of estrogen, which you do compared to 20/30 years ago, you still have to detoxify that estrogen. You still have to metabolize it. Some people have problems metabolizing the estrogens. 

Do you have any history of uterine fibroids, ovarian cysts, endometriosis, any breast cancer? I know you mentioned follicular lymphoma, but not breast cancer history or fibroids or cysts? 

Nanette: 

Not in me, no. I had some endometriosis toward the end. Didn’t bother me. I should check for estrogen metabolism? 

Dr. Eric: 

Something to consider. The problem with testing for it is you can’t do it through the blood. There is a dried urine test called the DUTCH test. There are a few dried urine tests; the DUTCH is the most well-known test that looks at adrenals, hormones, but the big thing is looking at how you metabolize your estrogen. With your history and background, you might want to consider doing that type of test. 

Nanette: 

Will do, thank you. 

Dr. Eric: 

There is more information. Even if you just do a random search, you’ll see a lot of practitioners who do that test. There is a lot of information out there. Those are two areas. Inflammation in general could be a factor.

There is the controversial iodine. Too much iodine isn’t good, but too little iodine can cause problems. This can lead to nodules and/or goiter. With toxic multinodular goiter, you want to be careful. Have you tinkered at all with iodine on your own? 

Nanette: 

No. It’s in a multivitamin I take. 

Dr. Eric: 

Sometimes, the iodine can worsen, like exacerbate the toxic multinodular goiter. That’s where you might want to consider working with someone if you look into that. Even doing something like DUTCH testing, maybe consider working with a functional medicine practitioner. 

With iodine, there is urinary testing if you were interested in doing that. Blood testing is not too accurate. Even urinary testing is not perfect. There is a lab, Hakala Labs. They have different types of urinary iodine tests. Iodine spot test is what a lot of people choose.

There is also the loading test, but that involves taking a 50mg tablet of potassium iodide, which many people do fine with, but some people might not. 

Usually, with patients, I start with blood sugar, problems with estrogen metabolism. Most of the people I’m working with have some type of inflammation. The iodine, it depends. Some people are gung-ho and hear a lot about iodine and want to look into it. Others, based on what I say, they might be a little bit nervous. 

I personally had a good experience with iodine, so I am not anti-iodine. I have worked with a lot of patients over the years, and I have seen both good and bad. You just never know how someone is going to respond. I can’t say it’s something I test for in everybody but wanted to make you aware of it. 

Nanette: 

Okay. 

Dr. Eric: 

Diet and lifestyle. You are following a Level 3 diet, which is more autoimmune-focused. It won’t hurt for you to do that. You said you have been following it for five weeks? 

Nanette: 

Yes. 

Dr. Eric: 

You can keep that up. A lot of times, for non-autoimmune thyroid conditions like yours, I might recommend AIP, if you’re having gut issues. Otherwise, a Level 2, which is a modified paleo diet. You have already followed it for five weeks, so if you want to continue for 2-3 months, like another 3 weeks, or make it a full 90 days, that’s fine. It won’t cause harm to do that. But if you’re finding it really difficult and challenging, and you wanted to transition to a regular paleo diet, a Level 2 diet, as I talk about in my book, you definitely could do that. 

Nanette: 

I get to move up then! Yay! 

Dr. Eric: 

There you go. You got my book and attended the Thyroid Healing Diet Boot Camp. If you do that, you might still want to do the reintroductions, which I talk about in the book, rather than just make the transition. Since you have already done it for five weeks, it’s up to you. 

Nanette: 

I’ll go back to the book. 

Dr. Eric: 

Diet and lifestyle for any thyroid/autoimmune thyroid condition is important. You’re already doing everything you can from a dietary standpoint, it sounds like.

Are stress and sleep okay on your end? 

Nanette: 

Yeah, I’m good there. My husband and I are retired. We do a lot of volunteer work. We do a lot of church work. I’m at a stress-free side of life. My kid is all grown up; he’s good. 

Dr. Eric: 

I can’t advise you to get off the PTU, but first of all, what we mentioned here, hopefully by addressing the cause of the problem, over time, you will see changes. 

It can be tough with nodules. I can’t say everybody who has toxic multinodular goiter, moreso the nodule part, all the nodules shrink and go back to normal on an ultrasound. But everybody is different. We do sometimes see some really good changes. Other times, we’ll see changes, but it depends on the person. 

We do get people with both Graves’ and toxic multinodular goiter to the point where they don’t need it. The only way to know is by incorporating these changes. If you don’t need the PTU, eventually the numbers on the thyroid panel should be hypo. Then the doctor should gradually wean you off. 

You might have heard me talk about natural agents like bugleweed and L-carnitine. Have you tried those at all? 

Nanette: 

I have not. 

Dr. Eric: 

That’s something to consider. It depends on the person. If someone is taking methimazole or PTU, and they’re tolerating it well, and they’re okay with taking it, there will be people who will continue taking it. 

Your situation is a little bit different because you have been on it for five years and are tolerating it well. If you have to take it for good, you will, but if there is an alternative, then you’d rather do that. 

The thing about bugleweed and L-carnitine. A couple things actually. They’re also not doing anything to address the cause of the condition. You would just be managing your symptoms naturally while still trying to address the cause of the problem.

Also, they don’t work for everyone. If someone is taking a medication, I can’t tell them to stop it. Even if I could, I wouldn’t tell them to do that because I don’t know if the bugleweed or L-carnitine would help. 

Commonly, what I tell people to do is if they are taking antithyroid medication and are looking to get off of it as soon as possible, I can’t tell them to do that, but I could say to continue doing what you’re doing. Let’s add some bugleweed to that, like half a teaspoon, twice per day, for example. The dose depends on the person and the levels. Some people might be a full teaspoon twice a day. According to the literature, 2,000-4,000mg per day of divided doses of L-carnitine tartrate. 

If it’s working, and you’re on PTU and bugleweed, then a few months from now, you do another thyroid panel, and it tends to be on the hypo side, then the goal is for the endocrinologist to say- If you don’t tell them what you’re doing, he/she might not know, but if you’re more hypo, let’s cut the PTU further. Eventually, if you continue that pattern, get to the point where you’re just relying on the bugleweed and/or L-carnitine.

As you’re addressing the cause of the problem, hopefully get to the point where you don’t have to rely on anything. That’s the ultimate goal.

If someone had to rely on a choice, where they were taking long-term bugleweed or long-term PTU, I’d rather them take bugleweed. Everybody is different. Some people would prefer the medication since it’s covered by insurance, whereas bugleweed is not. They are paying the money for that. 

Like I said, the ultimate goal with all these conditions, whether it’s Graves’ or toxic multinodular goiter or Hashimoto’s, is to address the cause of the problem. It’s different with Graves’ because Graves’ is autoimmune, and we’re doing things to address the autoimmune component. Even with toxic multinodular goiter, there is an underlying cause behind that. 

I gave the more common causes according to the literature and my experience working with patients. The insulin resistance, problems with estrogen metabolism, inflammation, sometimes iodine deficiency. Those are some of the things to look into.

I’ll wrap up by saying obviously, I will be biased because I am a natural health care practitioner. Some things you could do on your own, like the Level 3 diet. Testing the hemoglobin A1C, fasting insulin. You could get that through your doctor. 

As far as doing some of these other tests, one thing I didn’t mention is the dried urine test will look at estrogen metabolites, but also the gut plays a role in metabolizing estrogen. Some people could benefit from doing a comprehensive stool panel to see what’s going on. If they have a lot of imbalances in the gut, then they might need to do things to improve their gut health, even if they are not experiencing gut symptoms.

The point is, it can get complex. You try to do as much as you can on your own. Take advantage of my book and the information you gained from the boot camp. But if you feel the need, there is me and other functional medicine practitioners; consider working with them. 

Any questions on your end? 

Nanette: 

That was interesting about how I might have gotten this in the beginning. I grew up on a farm, inland, West Virginia. Maybe iodine deficiency, I’m not sure.

Dr. Eric: 

Could be pesticides. If you grew up on farmland, I don’t know your farm, but other surrounding farms, being exposed to the toxins that could also act as endocrine disruptors and could affect the metabolism of estrogen as well. There is a lot of possibilities. Maybe you don’t do this now, but drinking water out of plastic bottles for a period of time. Could get exposed to the xenoestrogens that way. 

This happened when you were really young, as far as the start of it, the nodules. It does seem like something happened prior to turning 16. 

Nanette: 

Right. Maybe some trauma, too. When I was about eight, I was pushing a chair into the table, and I slipped. I hit myself right here with the table. Maybe that was a little trauma. Certainly was trauma. Maybe that contributed over time. 

Dr. Eric: 

Yeah. That definitely could have caused inflammation. You formed the nodules when you were 16. Chances are the doctors that you looked at didn’t think about the cause. They just said, “You have a nodule. We need to remove it.” Then you got another nodule and needed to remove it. 

That’s the problem with most medical doctors, including most endocrinologists. They never ask what the cause is. That just comes down to the training in medical school. There are some who go on to focus a little bit on functional medicine and open up their minds. Unfortunately, that’s not the case with most doctors. 

Nanette: 

Things have improved. Of course, I want to know why I got this and where it came from. I will check for insulin resistance. 

Oh, you mentioned gut tests. I actually did do a gut test. For the most part, that was good. I had some high H-pylori. I took some mastic gum to get rid of that. I don’t know if it’s gone, but I did the mastic gum. I have been taking a lot of supplements to build up my gut. I am still doing that along with your diet.  

Dr. Eric: 

Wonderful. 

Nanette: 

I’ve been working really hard to get better. I would love to get rid of my nodules and the PTU. You don’t think that being on PTU at a low dose for five years is alarming? I seem to be tolerating that well. You’re not telling me to run away. 

Dr. Eric: 

I have an episode on my podcast on low dose antithyroid medication for a long time, talking about this. Most of the research out there is on taking lower doses of methimazole. There are people who have been on methimazole for 10-15 years, even longer, without a problem. It’s been a little bit since I put together the episode. 

There wasn’t a lot on long-term PTU. It really comes down to monitoring the blood tests. It’s not ideal. Even being on methimazole, if someone works with me, and the end result is them on methimazole, that’s disappointing to me because I want to get them to the point where they’re not on medication. That’s why they’re coming to see me, not for me to tell them to get off, but to get them to the point where their thyroid is working properly, and their immune system is working properly. Their endocrinologist, based on the results, will wean them off. 

It’s not ideal to be on PTU for five years or longer, but risk versus benefits. If you’re monitoring the liver enzymes, and if the white blood cell count is remaining okay, because sometimes the antithyroid medication will affect the white blood cell count. If your liver, white blood cell count, kidneys all look okay, and you’re on a lower dose, then let’s put it this way. 

If I was in your situation, and if I had to choose between low dose PTU and getting radioactive iodine or thyroid surgery, I am pretty confident I would be doing what you’re doing and staying on the PTU, as long as my bloodwork continued to look okay. I wouldn’t be happy that I’m on the PTU, but that’s why we’re having this conversation, too. If you were happy, you wouldn’t be doing this audit. 

From a risk versus benefit standpoint, yeah, if I had a choice, if the option was being on low dose antithyroid medication or getting surgery or radioactive iodine, I am pretty sure I would choose low dose antithyroid medication. 

Nanette: 

It’s nice to keep your thyroid. 

Dr. Eric: 

Exactly. That’s obviously the goal: try to help people save their thyroid. 

Thank you so much, Nanette, for doing this. I really appreciate this. Hope you found the feedback to be valuable. 

Nanette: 

I did. Thank you, Dr. Eric. 

Dr. Eric: 

Thank you. Take care. 

Nanette: 

Okay, bye.