hashimoto's

#283 Elle Russ on the Heavy Metals & Hashimoto's Connection

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Elle Russ is a writer, health/life coach, and host of the Primal Blueprint Podcast. She is becoming the leading voice of thyroid health in the burgeoning Evolutionary Health Movement (also referred to as Paleo, Primal, or Ancestral Health). Elle is a certified Primal Health Coach and serves on the advisory board of The Primal Health Coach Program created by Mark Sisson.  Originally from downtown Chicago, Elle lives and plays in Malibu, CA. You can learn more about her at http://www.elleruss.com

Elle wrote The Paleo Thyroid Solution after consulting with over two dozen endocrinologists, internal medicine specialists, and general practice MDs...but her thyroid condition was only getting worse - and nothing from doctors resembled a solution or even hope. 

Exasperated and desperate, Elle took control of her own health and resolved two severe bouts of hypothyroidism on her own – including an acute Reverse T3 problem. Through a devoted paleo/primal lifestyle, intensive personal experimentation, and a radically modified approach to thyroid hormone replacement therapy…Elle went from fat, foggy, and fatigued – to fit, focused, and full of life!

Today We Discuss

  • Infections and the Reverse T3 connection
  • Thyroid hormone conversion issues
  • And much more!

#227 Dr. Izabella Wentz on Hashimoto's Protocol

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Today's Guest

Izabella Wentz, Pharm.D., FASCP is a passionate, innovative and solution focused clinical pharmacist. She has had a passion for health care from a very early age, inspired by her mother, Dr. Marta Nowosadzka, MD.

Fascinated by science and the impact of substances on the human body, Izabella decided to pursue a degree in pharmacy with a dream of one day finding a cure for a disease. An avid learner and goal-oriented student, she received the PharmD. Degree (Doctor of Pharmacy) from the Midwestern University Chicago College of Pharmacy at the age of 23.

After graduation, she excelled at numerous roles including working as a community pharmacist, a clinical consulting pharmacist and later a medication safety pharmacist. She is a Fellow of the American Society of Consultant Pharmacists, and holds certifications in Medication Therapy Management as well as Advanced Diabetes Care.

During her time as a consultant pharmacist, Dr. Wentz worked as part of an interdisciplinary team consulting on thousands of complicated patient cases, often caused by rare disorders. She was regarded as an expert in clinical pharmacology and would be called to investigate cause and effect by performing comprehensive medication therapy reviews to help identify and resolve adverse drug events. She quickly became well versed in finding and evaluating emerging research to help address her clients’ unique challenges. Although trained as a pharmacist, she was an ardent champion for lifestyle interventions, which often helped patients much more than any medications.

After moving to a new city, she was given the opportunity to lead a statewide medication safety initiative, transitioning to a career in medication safety and healthcare quality improvement. There, she developed an expertise about the whole systems approach, rapid tests of small change; outcomes tracking and root cause analysis.

After being diagnosed with Hashimoto’s Thyroiditis in 2009, Dr. Wentz was surprised at the lack of knowledge about lifestyle interventions for Hashimoto’s, hypothyroidism, and autoimmune conditions. She decided to take on lifestyle interventions as a personal mission in an effort to help herself and others with Hashimoto's.

After two years of researching Hashimoto's and Hypothyroidism, she decided to combine emerging knowledge with her quality improvement expertise to run rapid tests of change on herself that led her to discover the root cause of her condition. She has summarized three years of research and two years of testing in her NEW book: Hashimotos Protocol.

Today we discuss

  • How common is Hashimotos in men and women?
  • What is the biggest root cause?
  • The parasite and bacterial link to thyroid illness
  • The Hashimotos Protocols

Transcript

lEvan Brand: Dr. Izabella Wentz, welcome back to the podcast!

Dr. Izabella Wentz: Evan, thank you so much for having me. I love chatting with you. I’m so excited!

Evan Brand: Yes! I do too. Let’s talk about your new book. So, is it called the “Hashimoto’s Protocol”? Is that the official title?

Dr. Izabella Wentz: Yeah! That’s the official title and it’s focused on helping people restore their health in a relatively short amount of time. My first book focused on helping people figure out what their root causes were and what their triggers were – it was Hashimoto’s, the root cause. I was focused on helping people figure out and dig for their health. It wasn’t until I met one of my readers in Chicago where she had asked: “Can you give us specific protocols? Can you just give me some templates? Exactly what do I need to eat? Exactly what supplements do I need to take? What do I do first? What do I do second? What do I do third?”, and I was like, “okay, let me think about that a little bit more.” I didn’t really quite get the idea for a protocol book until I took a pilates class with this really, really intense instructor. She was giving me a lot of pilates homework. She was telling me exactly which muscles I was using for each movement and then she was quizzing me and then she was having me make up my own pilates movements and I was like, “wait a minute. I don’t want to be a pilates expert. I just want to look fit in my swim suit, that’s really all I want.” And then, it kind of dawned on me that not everybody wants to be a Hashimoto’s expert, that some people just want a done-for-them protocol that can help them feel better right away. And so, this is what Hashimoto’s Protocol is. It’s three fundamental protocols that start off by supporting the liver, adrenals, and gut. This can really help to transform a person’s health in as little as one to two weeks. And then, we move in to some more of the advanced protocols where we start going after some of the more advanced root causes, some of the more rare and intense of root causes like infections and toxins that require additional interventions.

Evan Brand: Excellent! Well, I’m sold. Sign me up! I think I have a copy in the mail. So, I’m excited to get it. That’s great. Now, how common is Hashimoto’s? This is something that, in our little bubble, you would say 99.9% of women have it, almost. I mean, the amount of women that I talk with and work with that have Hashimoto’s is so huge that maybe my number is skewed from the general population; but maybe not.

Dr. Izabella Wentz: Right. Well, a 100% of people I work with have Hashimoto’s, right? That’s my area of specialty. But, in the general population, we’re actually looking at 27% of people that have Hashimoto’s when you do advanced diagnostic testing like thyroid antibodies, thyroid ultrasound, or fine needle aspiration or biopsy of the thyroid glands. Now, backing into this, when we start looking at women – for every man that’s diagnosed, we have 5 to 8 women that are diagnosed. And then, when we start looking at people who are reaching out to practitioners for help, then we’re looking at a higher percentage rate. So, really thinking about that, if there’s a woman that’s coming to a healthcare practitioner with complaints about fatigue, weight gain, anxiety, any kind of mood issues, or impaired brain function, there’s a pretty good chance that she has Hashimoto’s. I highly recommend investigating that as a potential cause of the imbalances in her body.

Evan Brand: So, what’s the percentage difference? Maybe you stated it quickly and it went over my head, but compared to men versus women with Hashimoto’s.

Dr. Izabella Wentz: Wow. So, for every man diagnosed, we’re looking at 5 to 8 women.

Evan Brand: Okay. Wow, that’s massive. Now, have you come up with a solid answer on why is it so much more common for women? Is it due to the fluctuations of *…hormones(5:19) that can influence thyroid? What’s the biggest piece of the pie of why women are so much more susceptible?

Dr. Izabella Wentz: Yeah. I’ve actually thought about it quite a bit and I’ve come up with my own theory on that and it’s the safety theory of thyroid disease. Now, we can talk about hormonal fluctuations being a root cause because we know that pregnancy, puberty, and perimenopause are gonna be times when we see higher rates of Hashimoto’s and that’s also when we see whenever we have fluctuations in estrogen that impacts how much thyroid hormone we need, how much thyroid hormone is binding, how much is not binding. And then, we’re also looking at personal care products. So, we know that women use, on average, twice as many personal care products than men do, and the personal care products have higher levels of toxins within them. But, that’s really just a small piece of the pie of the triggers and the root causes. When we really, really back into this, I start thinking about what the role of the thyroid gland is from an adaptive physiology standpoint. Now, research has shown that the thyroid gland can actually sense danger and then send out danger signals to the rest of our body. When you think about it, it actually makes sense that a hypothyroid person would be more likely to survive a dangerous situation. When we think about what’s happening in Hashimoto’s, the very first thing that happens is the thyroid gland becomes under attack by the immune system and this sends a rush of thyroid hormones into the blood stream. Usually, this makes a person more anxious, more irritable, and more hypervigilant, which could be something that’s beneficial in times where we’re under a lot of – let’s say we’re under threat, to be hypervigilant, to be more anxious would actually be protective. Now, as the stress continues, it becomes chronic, we keep having the thyroid gland attacked and attacked and attacked until it can no longer produce thyroid hormone and then a person becomes more withdrawn, more lethargic, more tired, carries more weight on them. And, going deeper into this, we find that prisoners of war have higher rates of thyroid disorders so they’re more likely to be hypothyroid. Now, we know that with your prisoner of war, stonewalling could be a way to actually survive. So, if you’re not acting up, if you’re not getting in the captor’s face, then you’re more likely to survive the situation. We know that women who’ve been sexually assaulted have higher rates of thyroid disorders. It kind of goes back to adaptive physiology in cave man and woman times. We know that women carry the primary responsibility of bringing new life to the world as you know from having your baby, right? And so, it’s really, really important for women to be tuned in to our environment. And so, the thyroid gland is essentially an environment-sensing gland and, back in the day, there were various things that happen that sent us a message that we weren’t safe. So, in the case of cave women times, if there wasn’t enough food, a lot of time this would be sensed as nutrient deficiencies or reduced calorie intake or eating stuff that is not food, right? That would send a signal to the body that it wasn’t the best time to reproduce. And, for survival of the person in the species, it was probably best to go back in a cave and get some rest, and maybe hold on to some of that extra weight. We know that thyroid conditions cause fatigue, they cause weight gain, and they cause fertility issues, as well as the withdrawal and apathy. And so, we go through all these scenarios of how toxins, infections, how the food supply – these could all be potential root causes and all of them can be traced back to the safety theory. When you go through and think about how if there was a lot of toxicity around and there was toxicity within the body, that would be a good signal for us not to reproduce and to shut down thyroid function. If there was a famine going on, that would be a good time to actually slow down our metabolism because that would help us survive. Now, we know that people that survived the Irish potato famine were more likely to be hypothyroid. There’s just so many example of these in the world of how when our body feels unsafe that our body tries to protect us and slow things down for us, and the easiest way to slow down our body is through attacking the thyroid gland. Now, being a woman, I could tell you that it’s simply being a woman in this world is not as safe as being a man, even the perceived safety that women have. Just to give you an example, I could go into the science and all of this and [say] how women are more likely to be victims of physical abuse or sexual abuse, but one really easy example is to use the stats from a Tinder study where Tinder asked its users – they asked the women – what was the biggest fear they had about meeting a potential mate on Tinder. The women replied that their biggest fear was that the man that they met was gonna be a psychopath and murder them, right? The men’s biggest fear was that the woman was not gonna be as hot in real life as she was in her Tinder profile. And so, really, backing into this, it’s like the thyroid gland becomes under attack, slows us down, puts us in a semi-hibernation mode to help conserve our energy, conserve our metabolism and protect us from whatever it perceives as stress. Now, for women that I work with and my readers and my clients, I always say, “okay, what are you doing in your life that’s sending you and your thyroid messages that you’re not safe?” So, are you eating processed foods that are resulting in you becoming nutrient deficient and so, then, your body thinks you’re not eating enough and you don’t have access to enough food. Are you eating foods that cave women would not consider food, like processed grains and wheat, right? Humans didn’t evolve to eat grasses, that could be sending your body a signal. Are you doing a lot of exercising? So, people who run marathons – a lot of times, they end up with thyroid challenges because the body thinks that you’re under stress and the body thinks that – our ancient bodies – think that we’re being chased by bears when we’re running so much, rather than understanding that we’re competing in a marathon. There’s a lot of these different ways we can send these signals, sometimes it’s through the way that we perceive stress, sometimes it’s because we’ve had trauma in our lives, sometimes it’s because of the food we’re eating, sometimes it’s toxins, and sometimes it could be infections within our bodies that are sending the stress signal that something’s not right and that we’re in danger.

Evan Brand: You did a great job. I love you so much more for putting the ancestral lens on this whole thing because it makes sense that the hypothyroidism – this could be hundreds of thousands of year old condition that was designed to protect and save us but, now, the cellphone notification or the email notification, or twenty social media networks to check are now replicating the threats that would have been outside of the cave and, instead, we have a more toxic environment plus the influence of, say, social media and all these places that were pooled – we’ve basically created the same thing but it’s just a completely – the same situation that the nervous system perceives but it’s completely different as opposed to the saber tooth cat…

Dr. Izabella Wentz: A bear.

Evan Brand: …or a bear, yeah, right outside the cave.

Dr. Izabella Wentz: Right. The interesting thing, too, is that social rejection and social isolation can actually produce thyroid hormone abnormalities. So, they’ve done studies in sheep that were separated from their flocks and they have altered thyroid hormone abnormalities. They’ve done studies in rats where they drop an intruder rat into a cage, a mama and papa cage of rats, and then the intruder rat gets attacked by the resident rat and that’s how rats experience social rejection. The rat that was socially rejected had an altered thyroid hormone profile. When you think about – we’re connecting, now, through social media but we’re very much isolated from the flock and that, certainly, can bring on thyroid disorders, as can mean girl experiences in high school or somewhere earlier in life because these patterns, they actually stay with us. So, it’s not just that it happens and then we have thyroid hormone alterations for a couple of days and things balance out on their own, no. It’s left to their own devices. These patterns can stay with us for a really long time, unless we do something to reprocess them and rebalance them.

Evan Brand: Wow. So, let me clarify there. So, you’re saying if someone had – say , a woman had a mean girls experience, she was treated very poorly in high school, she was rejected, she never felt like she fit in – that pattern could be programmed into her nervous system to basically have this – we’ll just call it the rejection switch – turned on which could then set her up 10, 20, 30 years later down the road for more thyroid issues. Is that what you mean?

Dr. Izabella Wentz: Yeah, absolutely. So, social rejection is an example, having trauma as a child, having physical abuse, having sexual abuse – all of these things have been connected to long-term changes in how we perceive stress and in long term changes of, basically, our self recognizing itself or attacking itself. And so, we need to essentially reset and reprocess these patterns, otherwise, we can make ourselves – we’re sending these signals to the thyroid gland that we’re under attack and you think about when a person has had some negative trauma or experiences in their life, they’re led to believe certain things about the world and about themselves and it’s usually [that] the world is not a safe place: I’m not safe here. I’m not good enough. I have to fight. There’s something wrong with me. And, when you send these messages over and over and you’re thinking them within your body, it’s not far-stretched to suggest that, perhaps, the body might follow and start rejecting a part of yourself as well.

Evan Brand: Wow. That’s a trip. Let’s talk about some of the numbers just for a couple of minutes about testing. I want to ask about antibodies because you’ll have people that will send over bloodwork maybe that they’ve had run from a different practitioner or they’ve got it several years ago and you’ll look at some of these reference ranges. Now, I know there’s a functional medicine range and you got the conventional range, but what numbers should people look at? If we’re looking at TPO or the TG antibodies, what number becomes a concern? I mean, if it’s a 3, you’re still below. Let’s just say if they say less than 6 is where you want to be and you’re at a 3, does that still mean for you [that] the thyroid is under attack even though it’s registering anything or is there a threshold where that number has to hit and then you say, “okay, this is a concern”.

Dr. Izabella Wentz: So, this is kind of – a little bit of a complicated question because a person without thyroid disease may have some circulating thyroid antibodies and they may play kind of like a clean-up role, and so 0 to 1 might be what we see, anything above that might be an issue but then we’re also getting into the element of – there’s something known as “seronegative Hashimoto’s” where a person might have Hashimoto’s but they might have zero antibodies. This is thought to be a less aggressive version of Hashimoto’s but it still can cause a lot of symptoms and the same damage and destruction of thethyroid gland. We used to think that this was rare but, now, studies looking at using ultrasounds and looking at using fine needle aspiration of the thyroid gland were now finding that there are a large number of people that are seronegative Hashimoto’s; anywhere from 30 to 50% may not have thyroid antibodies but have Hashimoto’s. So, it’s like, yeah, I’d like to see them as zero but even if they are at zero you may still have Hashimoto’s.

Evan Brand: Wow. So, let me just give you a reference range here. So, looking at a *LabCorp (18:25) right here. So, if we see like a 0 to 34, I use per milliliter for the thyroid *[peroxidase] (18:31), the TPO antibodies, 0 to 34 is the range and you see a 6, is that something that you would be concerned about or would it be based on symptoms and all that? I mean, if everything else is checked out okay, there were no symptoms of Hashimoto’s but, yeah, you still had the 6 on radar, what would you do?

Dr. Izabella Wentz: I would recommend doing a thyroid ultrasound for that person to try to see if there is an autoimmune attack on the thyroid gland.

Evan Brand: Wow. What would the ultrasound show? How does that work?

Dr. Izabella Wentz: So, the ultrasound is gonna be done over the thyroid gland and a few different things it will look for. So, it will look for whether the thyroid gland might have been – if it’s enlarged or if it’s been shrunken. So, either one can happen in Hashimoto’s. It will look for whether or not there are nodules on the thyroid gland. Nodules are gonna be present [in] about 50% of people in the United States and they seem to be more common in people with Hashimoto’s, and sometimes the nodules might be a way that you find out you have Hashimoto’s; sometimes they’re cancerous, sometimes they’re “benign”. But, if they’re there, that tells us that there’s an imbalance within the thyroid gland anda lot of them – actually, all of the same recommendations I recommend for Hashimoto’s can be used to effectively get rid of nodules. And then, we’re gonna be looking at the texture of the thyroid gland. So, whether it is healthy thyroid tissue or whether there is infiltration of white blood cells, which can be basically seen as kind of like damaged within the thyroid gland, and then if the texture appears more rubbery on the ultrasound, that can be an indication that it’s Hashimoto’s. So, it’s something that I wouldn’t necessarily say a person should look at their own thyroid ultrasound and learn how to read it because it’s gonna be a bit more complicated but, definitely, I recommend every person have a thyroid ultrasound done at least once and then have a pathologist [or] radiologist interpret that for you and give you a full report so that you know exactly what’s going on. They’ll let you know if you have changes consistent with Hashimoto’s. They’ll let you know if you have nodules. They’ll let you know if your thyroid gland is enlarged or if it’s the right size. And so, this is something – (sighs) yeah, at least once a year and for people – I’m sorry, at least once in a lifetime, and then if you have nodules then you have that done once a year to try to determine if they’re shrinking based on the interventions that you’re making.

Evan Brand: Got it! Okay, well said. Now, the next natural question becomes: Well, what’s the conventional approach to this? If you go to your standard doc or even someone who claims that they’re integrative and you ask for a thyroid ultrasound, is that pathologist or radiologist – are they gonna be able to accurately identify and diagnose some type of Hashimoto’s issue present with the thyroid?

Dr. Izabella Wentz: Yeah. Actually, what I’ve seen is that they can. So, that usually is, I would say, from a conventional medicine standpoint, they usually do get that right. What they don’t necessarily get right is the treatment after that point, right?

Evan Brand: Yeah.

Dr. Izabella Wentz: So, then they’re like, “oh, well, your thyroid is showing signs of Hashimoto’s”, or, “you have nodules”. And then, the recommendations that come from the conventional doctor, not the person that interprets the report, are gonna be, “well, we can give you meds, we can wait and watch, or we could cut out your thyroid” or…

Evan Brand: My goodness.

Dr. Izabella Wentz: …  – which are never – cutting out the thyroids, to me, that should be a last resort.

Evan Brand: Wow. So, you feel like that Hashimoto’s is well-established, at least, into the these conventional communities that if someone went down the street to their standard MD and got the referral and got the ultrasound done, you think that they have a good chance of getting a proper diagnosis if something was going wrong on the ultrasound.

Dr. Izabella Wentz: Yeah, absolutely. The only challenge is, of course, if the ultrasound is normal or, in some cases, a person might have nodules but the ultrasound might not have the right kind of changes – it might not give them enough information to diagnose Hashimoto’s. So, in some cases, they would do a fine needle aspiration of the nodule and when they do that and they test the nodule to make sure it’s not cancerous, they can also test it for Hashimoto’s. So, they could take that little bit of thyroid tissue and they can analyze it and let you know if it’s showing the white blood cells that are infiltrating the thyroid glands. That’s another more advanced method. Obviously, I wouldn’t recommend everybody to stick a needle in their thyroid glands and look at it under a microscope. It’s usually reserved for people who have nodules because, obviously, this is a much more invasive procedure than doing a blood test or an ultrasound. But, when you do the fine needle aspiration, you can find additional cases of Hashimoto’s that the ultrasound and the antibodies would have missed.

Evan Brand: Okay, that’s well said. So, you may not have to recommend someone go for all three of those at once, would you say, if you had to do an order of operations, would it be blood testing, ultrasound, and then the fine needle aspiration – 1, 2, 3?

Dr. Izabella Wentz: Exactly. And, the fine needle aspiration would only be if you had nodules.

Evan Brand: Okay. Got it, got it. Okay, so, you mentioned the liver – why does the liver come into play and when does it come into play? For example, if you’re working with a client, are you gonna bring adrenal support on board first? Are you gonna bring liver support on board first? Is it kind if case by case dependent or is there kind of a set staging of things that you arrange these to?

Dr. Izabella Wentz: I used to bring adrenal support first, and that was sort of the functional medicine training, as you do – the adrenal, gut, and then the liver, right? Adrenal, gut, and detox. I was having some clients where I was putting them on adrenal supplements or I was putting them on various – even vitamins like B-vitamins, and they would have adverse reactions to them. What I figured out is that, a lot of times, they have toxic backlogs where a lot of them had multiple chemical sensitivities, they were just uber sensitive to everything, even supplements that were very, very benign and not likely to cause an adverse reaction; they were reacting to their thyroid hormones, they were reacting to every single filler. And so, what I started doing with this group of people is I started putting them on liver support first where I would say, “okay, we need to clear out some of that backlog before we actually can put you on supplements”. I wasn’t really expecting to see big changes in how they felt but what ended up happening was, within two weeks, I ended up seeing tremendous health breakthroughs in people that I didn’t see before when I was doing the adrenal support, the gut support, it would take me many months to see big changes in symptoms. And so, with the liver support, I was seeing people having better mental clarity, losing weight, their headache’s going away, their allergy’s reducing, their pain reducing within just two weeks. I ended up starting this with my clients and then when I created a group program I just decided off that bat, “let’s just start everybody on liver support because that’s gonna bring people on the same playing field.” So, [it’ll] level the playing field for everybody if we just do liver support to start with, and then 65% of my people who were started with liver support actually felt significantly better within the first one to two weeks. So, I used to work on outcomes research when I was working in public health as a consulting pharmacist there so I’m a little bit OCD about that, trying to figure out what interventions are actually an improvement, what changes am I making for my clients that are an improvement. And, I always do this with my clients or anybody that’s in my programs where I harass them and I try to get really good outcomes to try to figure out: Okay, is this working? Is this working for one person only or is this working on a population health level? And so, this was really, really great because I did this outcome survey and 65% of people felt significantly better. And, just to give you some examples of the things that improved, one woman – this was around Christmas time, about two years ago – she sent me a message and said, “oh, my goodness. I used to have multiple chemical sensitivities…”, she had headaches, she had elevated thyroid antibodies, pain in her body, and mood alterations, and I think I might have mentioned migraines. But, within the first week of doing the liver support, she got in touch with me, she left me a message and said that she was at the mall shopping with her kids for Christmas for the first time in many, many years. At the shopping malls, a lot of the stores like the Yankee Candles and the Abercrombie’s, they spray perfumes and all these things that are supposed to attract customers into their stores or give the brand experience, right? But, what ends up happening is, for people that have multiple chemical sensitivity, this is hugely reactive for them and some of them can’t even step into a shopping mall. This woman was saying she was going into Abercrombie, she was going into Yankee Candle store with her kids, and it was a non-issue for her – that her pain went away, her headaches were gone, her mood got better. I don’t if it was because she was more free to do things in the world or if it was as a result of the liver support; next time we tested her antibodies, those reduced as well. We still had to do additional interventions but it was like, “wow, that’s beautiful. You can really kick start a person’s healing with just a two-week liver support protocol.” And so, this is something that I do across the board with everybody now and this is what my book, “Hashimoto’s Protocol” – this is the very first fundamental protocol that I have people follow for two weeks.

Evan Brand: That is awesome! I mean, what a great story! I’ve been affected by fragrances myself. Sometimes I’ll go into a bathroom and I’ll just put my shirt over my nose because you’ll walk in and you’ll (imitates spraying sound) hear the spray of the freshener right on to you. Now, and this is a little bit of a tangential question but, if someone were sensitive before, like this woman, you gave her the liver support then she was not sensitive anymore, would you still say, “hey, look, you really don’t want to be hanging out in Yankee Candle stores”, or do you feel like, with the adequate liver support and all of these other foundations in place, that she could still be in those stores without having big trouble?

Dr. Izabella Wentz: It’s kind of like – the way I think about the liver, it’s sort of like this government worker and when the government worker has way too many papers to process, then the government worker gets really cranky and sluggish and doesn’t process anything for you. So, you’ll be like, “hey, can you do this one thing for me? This paperwork will only take you a minute,” and they’ll say, “okay, I have a 6-month waiting list to process that one minute application.” And so, this is sort of what’s happening with the liver. We get so many toxins from everywhere in our environment, right? And, when you have an autoimmune condition, this actually makes the situation even worse. The longer you’ve had it, the more toxicity you’re gonna build up. So, we talked about sweating, how great that is for detoxifying, right? We know that people who are hypothyroid or have Hashimoto’s are less likely to sweat. No, it’s never one of the big things that people come to me and complain about, “oh, I just wish I could sweat”, no, most people don’t mind but, really, hypothyroidism makes a person less likely to sweat. And so, then, they’re not excreting toxins through their skin. Then we have the antibodies and circulating immune complexes when we have Hashimoto’s and those are *formed to foods, those are formed to the thyroid gland, those are formed to our body tissues (31:10) when we have autoimmune disease, and those get kind of stuck to the liver. And then, we have, potentially, medications that people are taking; those get shunted to the liver. Then we have a person who has a leaky gut which is present in every case of every autoimmune condition. So, then, that detox pathway is not working as well, so then the liver gets the extra burden. And, of course, when we’re using personal care products, when we have gene mutations – all of this is like the perfect storm of just having way too much stuff for the liver to handle. And so, my process is to support liver pathways and to also reduce the kind of bombarding of yourself with all these chemicals. So, during the two-week process I actually have people remove things from their environment like the low-hanging fruit that are causing a backlog. So, we’re removing inflammatory foods that are gonna cause those circulating immune complexes. We’re having women and men go on a personal product cleanse where they get rid of those personal products. So, yeah, definitely, I recommend staying away from the Yankee Candle stores and those kinds of – the Uber cars with all of the air fresheners. So, you want to kind of not give your body, not give that office worker, all these extra things to process. You want to take that two-week period and really give your body, your liver, an opportunityto catch up on all that backlog paper work. And then, at that point, you adjust your lifestyle and you kind of maintain it where – I don’t recommend that you go and spend every single day at the mall but you should be able to go shopping with your kids and that it’ll be fine without you getting really sick.

Evan Brand: Got it, got it. Well said. So, you mentioned Uber and air fresheners. Do you know how much hate mail I got when I sent my email list and email about my petition. So, I’ll make a long story short, when my wife and I were in Florida, we took an Uber. The guy used an air freshener bomb in the car and we had miserable headaches by the time we got out. I think any person would have had a headache. I created a petition to the CEO of Uber and it’s got like 11,000 signatures. I got so much hate mail saying, “oh, you’re gonna nerf the world. Let’s just ban everything,” but you’ve just outlaid this. This is not something to laugh or poke fun at, this is a real issue that can definitely affect even thyroid function in this case.

Dr. Izabella Wentz: Oh, my goodness. There’s so many chemicals in our environment that are potentially thyroid-disrupting chemicals. When you think about the whole canary and the coal mine – the whole story is, back in the day, in order to sense toxins, the coal miners – before they made the coal miners sick, they would put canaries in the coal mines and once the canaries started getting sick and dying that’s when you knew that there were toxic levels within the coal mines and they needed to be evacuated. Now, I think the thyroid gland should actually be a canary (chuckles) gland, right? It’s called the butterfly-shaped gland but it’s actually kind of like that canary in the coal mine because it concentrates things around us. It’s meant to concentrate iodine but, in many cases, it concentrates whatever’s in our environment.  And so, the thyroid gland is, oftentimes, gonna be the first thing affected when we have these levels of toxins around us. Now, fluoride, triclosan that’s found in antibacterial soaps and in toothpaste – it’s been banned from soaps but not from toothpaste – these are toxins everyday that we’re exposed to. It’s constantly building up in the thyroid gland. All of the different smells and perfumes – think about the message that’s sending to your body. If you spend 20 minutes [or] an hour in an Uber and you’re in this ultra-concentrated smell of toxins, that’s gonna send a message to your body that the world is a toxic place because cave women didn’t have Ubers, right? And so, we’re basically – our ancient body is sensing this intense, intense toxic load around us. And so, it’s a way of understanding that our body’s trying to protect us and how do we send those messages of safety to the body and, definitely, avoiding things that could be sending you those negative messages is key.

Evan Brand: Well, maybe a smaller goal for this year, then, is you and I can chat about a way to get my petition to hit like a 100,000 signatures or something so maybe the CEO of Uber will pay attention to it and, maybe, at least have like a fragrance free option on the app where that way you can check that if you prefer to avoid fragrance and then fragrance-free drivers will come pick you up.

Dr. Izabella Wentz: Oh, my goodness, I love the fragrance-free option because there’s – I mean, if you’re not chemically sensitive then you probably might become chemically sensitive if you’re riding around in an Uber, right?

Evan Brand: Agreed, agreed.

Dr. Izabella Wentz: And the drivers as well!

Evan Brand: I know, I know. So, anyway, I just wanted to let you know. I thought that was crazy. I got so much hate mail [with] people saying, “wow, this is ridiculous. I can’t believe you created a petition for that.” But, I think it’s totally valid.

Dr. Izabella Wentz: I think some people may not be sensing the effect that it has on their body. They may not be connecting that Uber ride or that time they were exposed as something that’s toxic to them. For me, one of the things – and this is kind of another layer that I cover in my book but it’s a matter of toxins is – there’s two ways that you can become reactive to a toxin, one is obviously if you just have a lot of the toxin in your body and so that’s just like huge amounts of toxin; but then there’s people that might be sensitized to specific toxins. For example, mercury, for some people, may be highly sensitizing even in tiny amounts, nickel is another example. If you know, some women, they can’t wear any kind of earrings that are not real silver, real gold, because they’re nickel-sensitive. So, they’re not able to wear that cheap jewelry, right? And so, this is a sign that the person is chemically reactive to something, even in small amounts. For me, I’m actually very chemically reactive to formaldehyde.

Evan Brand: How’d you find that out?

Dr. Izabella Wentz: How [did] I find out? Probably in my undergrad, during anatomy class where I fainted. (chuckles)

Evan Brand: Wow. Seriously? Like, doing dissections of animals?

Dr. Izabella Wentz: Yeah. At first I thought it was because I was grossed out by it, which was a part of it, but then this happened in animal biology, animal anatomy, and then it happened in human anatomy as well, and then later on it happened at IKEA where I was just walking around the MDF and the particle board furniture – that actually is very chemically reactive for me.

Evan Brand: Oh gosh.

Dr. Izabella Wentz: Now, my reaction has lessened since that time since I’ve done all of the detox. But, I definitely try to avoid things like having MDF around me because I’m chemically reactive to formaldehyde. There’s a lot of different toxins that people may be reactive to: mercury, formaldehyde, nickel, and just even small amounts of that can set a person off. So, there may be some people who build up the toxins and then maybe there are other people that are just immediately reactive.

Evan Brand: That is incredible. So, you’re saying even though you’ve done the detox and you’ve cleaned up your life, you could still be sensitive to it. Like for me, I may not have to assume that I’m still toxic, I may just forever be sensitive to certain fragrances, for example?

Dr. Izabella Wentz: Yeah, right. So, it’s one of those things where you can decrease your toxicity. So, now, I won’t faint if I go to IKEA. (laughs)

Evan Brand: Right!

Dr. Izabella Wentz: But, my eyes will start itching and I’ll start coughing and I’ll start having a stuffy nose and then I’m like, alright, I need to get out of this situation. But, it’s not as severe but your body is still sending you the messages that: this is not working for me.

Evan Brand: Okay, got it. Well said. Oh, my gosh. That is amazing. Well, thank you for sharing that. Let’s talk a little bit about leaky gut. I know we don’t have too much time left but how does leaky gut play into this whole picture with the thyroid, with liver toxicity, and these undigested food particles getting into the blood stream? How big – I don’t know, maybe this is my obsession with breaking down things into pieces, but how big of a piece of the puzzle is the leaky gut situation that’s so common in the clients that we work with?

Dr. Izabella Wentz: It’s huge. So, this is a factor in just about every single person with Hashimoto’s. They’re gonna have impaired permeability of their intestines and the leaky gut. One of the things that, I think you and I are both passionate about is trying to find out what the root cause is of the leaky gut. Now, in some cases it might be a nutrient deficiency, right? And so, you might do some bone broth and you might do some L-glutamine and that calms things down. And then, we’re starting to look at – okay, are there digestive enzymes that are missing? And so, we might replace digestive enzymes when we see an improvement there in the leaky gut, but then there’s also issues when people can have infections that can be causing their leaky gut. Now, one of the challenges that I’ve seen with people kind of doing things on their own is that they think that food is the only way. Food can be extremely helpful for healing the leaky gut but if you’re seeing that your health plateaus after three months of being on a clean diet or that you’re losing more foods, this is actually an indication that there’s something going on with your gut; there’s something deeper. When I did some testing with my clients in 2015, I found that 80% of people who didn’t get better or didn’t get into remission with nutrition and diet alone ended up having some sort of a gut infection and the gut infection is gonna be something that’s gonna be causing you to be reactive no matter what you’re eating. You could be eating the cleanest diet and all of a sudden you’ll start reacting to the foods there if you don’t fix that leaky gut.

Evan Brand: That’s incredible. Now, what were you seeing infection-wise? Was it more parasites? Was it more bacterial overgrowth? Was it more candida? Was there any one thing that stands out?

Dr. Izabella Wentz: The biggest thing that I would say that I found in my clients was the parasite blastocystis hominis.

Evan Brand: Yup.

Dr. Izabella Wentz: That was gonna be the most common one. I didn’t know if that just happened to be more common in the general population or what not so I wasn’t quite sure at first. And the, there was some interesting studies that – I just started studying blasto and I found out that it was connected to hives, and so people with hives are more likely to have it and then when you eradicate it, the hives go away. There’s also studies connecting hives with Hashimoto’s and there was studies connecting blasto with irritable bowel syndrome; when you treat it, irritable bowel syndrome goes away. And, Hashimoto’s and irritable bowel syndrome oftentimes go hand in hand. So, I was like, huh, that’s really, really interesting. Finally, a study came out in 2016, maybe? 2015? that actually showed that people – there was one person, a case study of the person with Hashimoto’s where they had blasto and their blasto was treated and their Hashimoto’s went into remission, which is what I’ve been seeing for the last few years with many of clients where we start seeing their thyroid antibodies go down, their multiple food sensitivities go away, hives go away, irritable bowel syndrome goes away and, in some cases, they get into remission; [with] other people we might have to dig deeper and find other root causes but that’s sort of what I have been seeing over the course is when you get rid that one parasite, things sort of get better when you have Hashimoto’s

Evan Brand: That is so magical. That makes me feel so good. Your episode in the 220’s, I believe, of the podcast, you’re the first person that gets their hands as dirty as me with looking and finding and successfully eradicating gut bugs, because I found the same thing – blasto’s huge. I’ve been seeing a lot of dientamoeba fragilis this year, which I can’t really attribute why. It seems like they’re – it’s almost like a season. This is blasto season, and then you got crypto season, and then dientamoeba. It’s kind of weird to see where I’ll hit a period of three months where everyone I test, half or more, shows up with parasite x and then it’s all bacteria, it’s all C-difficile that I see for a couple of months. It’s strange how things seem to go in a cyclical pattern like that.

Dr. Izabella Wentz: It is interesting, too, I’ll have – and H. pylori is another common one, both for Hashimoto’s and Graves’ but I’ll see that where I’ll see three clients in one day and then all of them will have something similar. It’ll be odd. It won’t even be necessarily like a test that we did but, for example, I learned from my clients that a potential root cause may be breast implants. And then, within a day I had three different clients that – we looked at their health timelines and all of them started getting sick around the time that they had breast implants put in. A couple of them actually had them explanted and went into remission.

Evan Brand: What? How – what’s the mechanism of that?

Dr. Izabella Wentz: Toxicity and it’s basically – when you think about – it’s kind of like host versus not graft but, essentially, when you’re implanting a foreign item, foreign thing, into your body, your body might recognize it as a foreign invader, as it should because that’s its job. And so, in some cases, women with breast implants, and it doesn’t matter if they’re saline, it doesn’t matter what [their] composition are, if they’re leaking, if they’re not leaking – they may recognize the breast implants a foreign invader like they would an infection and then this launches an autoimmune attack on the body. I’ve been seeing this for a few years now and, finally, I just got an article about it. Dr. Tom O’Bryan just forwarded me this article within the last month that this has finally been published – the connection between Hashimoto’s and breast implants.

Evan Brand: Oh my goodness. That is incredible. Well, now, women are getting butt implants, too. So, I guess the same thing would apply there.

Dr. Izabella Wentz: I don’t have any clients who have had butt implants that I know of that have had that as a root cause but any kind of implant could be a potential root cause, whether they’re dental implants, whether they’re – even some people get dental composites and if those dental composites, let’s say they have nickel in them or another kind of substance that you’re reactive to, then that can be a triggering event for you.

Evan Brand: Interesting. I wonder about Botox, if that would be anything – considered an invader or if that’s not invasive enough, or what about tattoos, even?

Dr. Izabella Wentz: Botox – so, there are actually studies that show Botox has some cross-reactive proteins to the thyroid gland. I don’t have a lot of experience with Botox. I’ve tried to ask some of my friends that specialize in it or have had experience with it and I haven’t been able to clinically hunt that down to see that Botox induce a thyroid condition but it definitely has the potential because there are parts on the botulism toxin that looks similar to the thyroid gland. So, there’s some potential there.

Evan Brand: Interesting. Wow. So, infections and attacks in general – this is a huge piece in Hashimoto’s, then. I’m so looking forward to reading your book. This is gonna be probably one of my favorite books, maybe of all time but definitely of this period of my life, for sure. It’s just the fact that there’s so many things out there that can throw you off. You don’t have to get stressed or overwhelmed by it. If you really just zoom out and get the 30,00-foot view, you can zoom in and then you go into parasite treatments and all of that but you got to find this stuff first, you got to figure out what is before you can fix it. I tell people all the time, “you got to remove the guesswork from it”, because there are so many people out there that are listening and they’re self-diagnosing themselves, they’re self-treating themselves and I think that’s great, I think the whole do-it-yourself attitude that our health community has done has gotten us a lot of good benefits but, at the same time, if you’ve not done this yourself before, if you’ve not done it a thousand plus times like you have, a thousand plus times like I have looking at people, then you’re gonna end up spending more money in the long run because you’re gonna buy supplements that maybe are not good for you or maybe you’re buying the wrong brand of supplements because it’s not professional grade so it’s got fillers that could contribute to Hashimoto’s which, I believe, you and I have talked about before. So, there’s just – I guess, maybe, what my takeaway here is you really want to look for a guide like this, both a book but a practitioner as well, having them on board [who’s] educated and trained in this stuff because there are so many puzzle pieces that if you go to someone who – they’re a “food is medicine” guru and that’s all they do, if you don’t get good results then they may just say, “oh, you’re an outlier,” or, “you don’t have enough willpower,” or, “you need to try to lift more at your crossfit box”, and that’s why you’re failing. But, a lot of that is ridiculous when you really have more clinical background because you can look and you can say, “no, you’re not an outlier. This is not your fault. This is what’s going on and this is what we have to do to fix it.”

Dr. Izabella Wentz: Mhmm. Yeah, exactly. It’s really – I think that [it’s] the responsibility of the patient to also become educated because people who are educated, they have the best outcomes. So, you can’t necessarily just give all of your power away to a clinician. Like you said, you may not be working with the right kind of person, and it really takes a collaborative effort where you’re a part of your healing journey, you’re not just giving that away. And, you also want to have somebody that if you’ve already done the clean diet thing for 90 days and you’re still struggling, you want to dig deeper and you want somebody that’s in your corner that’s been there.

Evan Brand: Just a quick question: Out of all the clients that you’ve worked with, what percent of them were or are already doing some type of clean diet, maybe even as far as an autoimmune protocol with their diet, before they start working with you?

Dr. Izabella Wentz: In the last few years, I would say, probably 95%. When I first started it was – none of them were right. And so, now, it’s because I have so much education online where I provide information on nutrition, and how people can get started, and I have my books. All of my clients are gonna be “people that didn’t get better with diet”. We end up finding that 97% of them have a toxic backlog. 80% of them, when we did the test in 2015, had a gut infection when we did just one test with them. And then, the other thing was 95% of them had low cortisol levels. And so, this was something that you can’t necessarily diet your way out of. You do have to take some nutrients and take some support for that and really adjust your lifestyle.

Evan Brand: That’s incredible. Well, I’m so glad you mentioned that. My numbers are pretty similar. I’d say 90 [to] 95% of people are doing some type of – whether it’s paleo template, they’ve taken out the grains, or they’ve gone even full autoimmune paleo and they’re still not getting results. I’m just glad for you to mention this as not only an expert and a researcher and a clinician, but just as someone that’s in the trenches with me because it gets frustrating when you see these books come out and it’s a book that’s trying to convince people that all they have to do is just follow this diet plan and everything’s gonna magically fall into place. And then, these people end up so frustrated because they’ve done the diet, they’ve removed everything, they’re so isolated now, they feel like they can’t go anywhere, they can’t do anything, and then they beat themselves up, right? So, then you get in this toxic, negative thought spiral where these women, specifically, are beating themselves up because they think that they’re doing the diet part wrong; maybe in 1% of the cases it’s that but most of the time, it’s these deeper root causes we’ve chatted about today that they’ve just never been investigated. If they simply get the investigative work done, they’re probably gonna find something that’s gonna give them a lot more room to work with so they can start seeing improvements.

Dr. Izabella Wentz: Mhmm. Yeah, exactly, and that’s why the way that I set up my book is that we have the fundamental protocol so these are the things that everybody will benefit from and these will help 80% of the people feel significantly better. And then, I also have a series of assessments for people where we think about, okay, now, what are – “here are some questions about what you’re currently struggling with, what your history is, and let’s think about some of these potentially advanced root causes.” And then I have – the second part of the book is basically protocols for the advanced root causes. So, maybe you’ve already done the liver support, you’ve supported your adrenals and your gut, you’ve changed your diet around, but now let’s look at if you have blasto, how do you figure out that you have it, what kind of tests do you have your practitioner order, and then what are some of the protocols that I’ve seen to be successful. And so, I’ve listed those out for people and it gives them another kind of eye opener because, like you said, with the whole “food is medicine movement”, I love it but at the same time it can be very dangerous because people can get into a point where they listen more to this theory than they listen to their own bodies. For me, really, an integrative approach is best for most people where they kind of take and pull different pieces of what’s working for them and for their unique bodies; not necessarily a cookie cutter approach, right?

Evan Brand: Yup! Agreed. Awesome. Well, we’ll send people to your website where they can check out the book. It’s called “Hashimoto’s Protocol: A 90 Day Plan for Reversing Thyroid Symptoms and Getting Your Life Back”. To me, this is essential reading for anyone and everyone, even if you, personally listening, have not had a diagnosis of Hashimoto’s. First, you likely need to get tested just to double check and triple check; and, secondly, I guarantee there’s somebody in your life that has Hashimoto’s, maybe they’ve not got diagnosed yet. So, to me, this is one on my bookshelf. I’ve taken a minimalist approach to books. I’ve gotten rid of like 90% of them but this is one that I cannot wait to get and it’s gonna be on my bookshelf for a long time. So, Izabella, thank you so much. You’re my hero.

Dr. Izabella Wentz: Oh, my gosh. Thank you! I really appreciate that.

Evan Brand: Well, tell people where else they can get more information on your work. Should they go to ThyroidPharmacist.com, is that the best hub?

Dr. Izabella Wentz: Yeah! Exactly. So, that’s my website where I have – I put out new articles every week about Hashimoto’s and, basically, what you can do to recover your health in bite-size pieces. If you got to ThyroidPharmacist.com/gift I’m gonna have some awesome resources for you to get you started right away including nutrition guides, some recipes, as well as how to address some of those nutrient deficiencies. We didn’t talk about this in great detail today but nutrient deficiencies are very common root causes and then they’re really easy to resolve because you start taking some nutrients and then you start feeling better right away.

Evan Brand: Wow. Well, if you have 30 seconds, let me ask you about that real quick. So, in the order of operations here – so, let’s say, the liver support, now you’re bringing that in to the front, are you gonna bring nutrient support in…

Dr. Izabella Wentz: Yup!

Evan Brand: …at the front of the protocol as well?

Dr. Izabella Wentz: Yeah, exactly. So, the liver support protocol is four pieces where we’re removing foods, removing toxins, adding foods, and adding nutrients, and adding ways to support the liver; and some of that does involve various nutrients that can be really, really helpful.

Evan Brand: Love it. So, before you even get in to taking care of infections, you’re gonna go ahead and bring the nutrients on board first.

Dr. Izabella Wentz: We’re gonna be building up that resilience first.

Evan Brand: Yup.

Dr. Izabella Wentz: So, we’re gonna make the person stronger and stronger and, in some cases, they can overcome infections on their own. In other cases, they’re gonna have a much better body that will help them fight infections and along with the herbs and the protocols that we’re using. So, it’s like you lessen the chance for reinfection and you help the body overcome, right?

Evan Brand: Yeah. Love it. Okay, last rapid fire question: I’ve had so many MDs where I’ll work with a client, we’ll get some lab test run, they’ll go to their doctor and show them, “oh, look what’s going on,” and the doctors laugh at an herbal protocol. I’ve successfully eradicated hundreds, if not over a thousand, infections now in my clients with herbs. So, I’ve personally proven the success side by side but I wanted to hear your thoughts on herbs for eradicating infections as well.

Dr. Izabella Wentz: Oh, yeah! Absolutely. For example, blasto – I know there’s Facebook groups and people that sort of believe that you can’t eradicate it. Now, I have a protocol that I use and involves *[saccharomyces] boulardii (57:24) as well as a few other herbs and I’ve done like three follow up tests with my people and all of them are symptom-free and they don’t test positive for blasto anymore. So, yeah, protocols absolutely do work. It helps when you prepare the body, too.

Evan Brand: Love it, love it. Awesome! Oh, man. You pump me up Izabella. This is great.

Dr. Izabella Wentz: Oh, my goodness. I’m so excited to chat with you. I’m so excited to have a kindred spirit and get this information out into the world.

Evan Brand: Well, we got to bring some energy into this thing. Sometimes these topics get heavy; these get deep, they get heavy, they get – I don’t want to say debilitating but sometimes these conversations can be overwhelming for people. It’s like, oh, my gosh, and the way that you’ve outlined all of this – it pumps me up. It’s like, “look, here you go.” I mean, I’ve not heard of any other in-your-face-here-it-is-it’s-possible approach. Sometimes the message is: “Here’s my unique little niche. I’m this guy. I’m gonna focus on this little tiny piece of the puzzle just so I can be that guy,” and you’re like, “nope, I’ll pull myself out of that. Here’s this and this and this,” and you lay it all out on the table. So, once again, that is just so impressive. We’ll send people back to the website and I can’t wait to chat with you again. I’m sure we could do a whole other hour about so many pieces of this puzzle that we didn’t get to talk about today.

Dr. Izabella Wentz: Mhmm. Absolutely, likewise. It’s been such a pleasure.

Evan Brand: Take care!

Dr. Izabella Wentz: Thank you so much! You too.

Podcast #179 Dr. Justin and Evan Discuss Calorie Counting, Ketogenic Diets and Food Obsessions

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Today Dr. Justin and I discuss Calorie counting. This is something that many of our patients do before they come work with us. It's generally not needed but so many people do it because this is the conventional model of thinking when it comes to getting healthy and/or losing weight. If you are using a whole-foods approach to your nutrition, a lot of things will fall into place, which can include the amount of calories that you are consuming. Many times, obsessing, counting and even weighing your food can be a mistake, since it will stress you out and cause you to lose enjoyment for food.

When food becomes something that is a threat to your health or your weight, we need to change course on the mode of thinking you are in.

Many times, ketogenic diets are something that our patients have experimented with. Whether it is cyclic ketogenic diets where you may go low-carb for a few days, followed by a period of adding more carbs back in, or if it is something that you stick with long term, this dietary approach can be a miracle, but for the right person at the right time.

We discuss that if you have adrenal fatigue, you may not be a good candidate for a ketogenic approach for the time being. After you heal the adrenal dysfunction, it can be something to incorporate later for weight loss, cognitive function and more.

Lastly, we discuss a story about a new patient that paid a large sum of money to a naturopathic doctor that told her to eat peppers for the nutrients in them, even though she has Hashimotos Thyroiditis, an autoimmune thyroid condition.

Since we know that nightshades can be a problem for autoimmune disease, I don't ever advise this for my patients, and I told her that it may be a good idea to reevaluate this relationship with the practitioner. The last thing I want is for someone to keep working with someone if they are not comfortable with the advice that their practitioner is giving them.

If you would like to discuss your health goals and symptoms, you are welcome to schedule a 15 minute free consult via phone or Skype right here.

Podcast #144 Dr. Justin and Evan on How to Heal Your Thyroid

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Today's Guest

Dr. Justin Marchegiani and Evan Brand talk all about thyroid issues in this podcast.  Listen as they share their recommendations on the first steps that patients with thyroid issues need to take in order to be successful along with helping them to push their thyroid to heal in the right direction. 

Find out what the potential signs and symptoms of a thyroid issue are and distinguish between adrenal and thyroid issues as well as the difference in dealing with thyroid issues from a conventional medicine approach versus from a functional medicine perspective. They also differentiate adrenal failure versus adrenal fatigue. Have you ever wondered what role does progesterone have that affects the thyroid function? Discover more about it and the other hormones affecting thyroid issues in this interview.

In this episode, topics include:

1:18 Thyroid 101

2:35 Thyroid physiology

6:20 Adrenal physiology

11:29 Conventional medicine approach versus functional medicine perspective

21.30 Adrenal failure versus adrenal fatigue

The show

Click here to listen to the show on iTunes where you can listen, download and subscribe to the show.

Click here to listen to the show on Stitcher streaming radio where you can listen and subscribe to the show.

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Submit your question for the show here.

If you would take two minutes when you get to iTunes or Stitcher to subscribe to the podcast, write a star and written review for the show. This helps other people find this information. Thank you!

Transcription

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Dr. Justin Marchegiani:  Hey, it’s Dr. J here with Evan Brand and today we’re gonna be talking about thyroid issues.  We got lots of patients coming in to our offices and they’re like, “Hey, doc, I got a thyroid issues, what do I do?”  And we haven’t even talked about what we’re gonna say yet, but we’re just gonna have a dynamic conversation about what we recommend any of our patients that are coming in that think they have a thyroid issue, what the first steps they need to take are to be successful and to start helping to push their thyroid to heal in the right direction?  Evan, what’s up today, man?

Evan Brand:  Hey!  Not much.  I’m fired up.  Let’s do this thing.

Dr. Justin Marchegiani:  Dude, I’m–I’m ready to go, man.  My thyroid’s feeling great today, so let’s do this.

Evan Brand:  Sounds good.

Dr. Justin Marchegiani:  Before you go in, what did you have for breakfast?

Evan Brand:  What did I have?  I can’t even remember.  I woke up.  Did I eat anything yet?  I may even be fasted honestly, what did I eat?  I have no clue.  If I re–if I remember, I’ll let you know.

Dr. Justin Marchegiani:  Nice.  So you didn’t eat any leprechauns or gnomes today?

Evan Brand:  No.

Dr. Justin Marchegiani:  Nothing like that?

Evan Brand:  No.

Dr. Justin Marchegiani:  Gotta love those grass-fed leprechauns, man.  They’re awesome.

Evan Brand:  Yup, yup.

Dr. Justin Marchegiani:  Especially if you get some Kerrygold butter, you know, it’s like perfect.

Evan Brand:  A little pinch of Himalayan salt.

Dr. Justin Marchegiani:  That’s it, that’s it.  Alright, so thyroid issues.  Thyroid 101.  So first off, anyone’s that potentially having hair loss, energy issues, fatigue, the outer third of those eyebrows that are thinning, potential constipation, vertical ridging on those fingers, low temperature, you know, tingling, numbness in the fingers and toes, these are all potential signs and symptoms of a thyroid issue.  But the problem with the thyroid is that a lot of the symptoms–it’s like a Venn diagram where there’s a massive overlap between thyroid issues and adrenal issues.  So all of my patients no matter if they have a diagnosed thyroid issue or not, we wanna look at the thyroid and the adrenals side by side.

Evan Brand:  Yeah, I remember what I had for breakfast.  It was organic pork sausage that my wife made for me.  That’s why I didn’t remember because I didn’t prepare it.

Dr. Justin Marchegiani:  Nice, awesome.

Evan Brand:  Yes, so you’ve already alluded to–to–we were gonna talk about, you know, what is the first step to do when it comes to thyroid issues, and for me, my answer which I didn’t know your answer–my answer was gonna be to look at the adrenals because if the adrenals are taxed, then it’s gonna be pretty hard to us to keep the thyroid in a good, healthy, functioning manner if the adrenals are taxed.

Dr. Justin Marchegiani:  Yeah, so let’s just break down thyroid physiology for the listeners.  So your thyroid gland is this little bow–bowtie type of gland that sits just below the Adam’s apple.  So if you just kinda run your hand or down your chin here where your chin and your platysma, that skin underneath your chin hits your throat, that your little bump there that’s your Adam’s apple, if you go about a couple–about a centimeter down and a centimeter out, that’s your thyroid gland and that gland secretes a hormone called T4 that is–that gets converted into an active thyroid hormone, T3.  So that gland right there, bowtie-shaped, that thyroid hormone is needed for all cells of the body to be metabolically active, right?  To control metabolism and that T4 about 20% of it happens at the thyroid gland.  So the conversion of T4 to T3, right?  T4 inactive, T3 active, 20% of that conversion happens at the thyroid gland.  The other 80% happens peripherally.  So now out of that 80% that happens peripherally, 60% is the liver, 20% is in the healthy gut bacteria and the other 20% is via healthy adrenal function and stress regulation.  So there’s a lot of like percentages in there, I go back to the anchorman quote, 60% of the time, it works every time, a 100% of the time.  So it’s a little confusing, so just quick little recap on it.  20% of the thyroid conversion at the thyroid, T4, T3 done, right here.  The other 80% happens peripherally, 60 liver, 20 gut–healthy gut bacteria and gut function, 20% by healthy stress and adrenal management.

Evan Brand:  That’s cool, yeah, and so you mentioned the liver, that is a place where I actually would have not started with the–with the thyroid but I didn’t realize the–the huge percentage there.  I always look at the adrenal stress pictures so maybe I’m looking at the smaller piece of the pie when I should be looking at the bigger one.

Dr. Justin Marchegiani:  Yeah, I mean, the enzyme. 5-deiodinase enzyme–so deiodinase what it means is it’s de-i–it’s deiodinating meaning it’s pulling off an iodine molecule.  So when you see like T4, with the T4, the T stands for tyrosine which is an amino acid and the 4 stands for 4 molecules of iodine.  So when you’re deiodinating something you’re pulling off 1 iodine molecule.   So you’re pulling off 1 molecule off the T4, which then makes it the T3, and the enzyme that does that, that 5-deiodinase enzyme is selenium-based.  And a lot of that conversion happens in the liver.  That’s where that enzyme is most metabolically active.

Evan Brand:  And a lot of people are deficient in selenium.

Dr. Justin Marchegiani:  Absolutely, I mean, 2 to 400 mcg a day is gonna be a pretty good amount, and if you’re sitting there thinking well, I just gotta have 3 Brazil nuts, *beep*, the selenium content in Brazil nuts can range between ten-fold.  So you could have 3 Brazil nuts hoping to get 200 micrograms of selenium or maybe you’re getting 20 micrograms of selenium depending upon the soil it’s grown in.  So there’s quite a lot of variations, so really important that you’re on a good multivitamin that’s got 200 mcg of selenium in it just off the gecko.  And all of my patients are on a high quality, highly absorbable multi with 200 mcg of selenomethionine as our thyroid insurance policy.

Evan Brand:  That’s great, yeah.  I should probably switch mine.  I’ve been using just a standalone, because I’m not using a multi right now personally.  I’ve just been using a 200 mcg of selenium by itself.

Dr. Justin Marchegiani:  Nothing wrong with that, too.  So we talked about the thyroid, right?  Let’s talk about adrenal physiology, just so everyone kinda can wrap their head around it.  I wanna take these complicated concepts, break it down, and have people walk away with an action point.  So the adrenals, they sit right on top of our kidneys and they help manage stress.  And again, stress isn’t just emotional stress, it’s physical stress.  It’s also chemical which could be blood sugar, it could be infections, it could be inflammation.  And our adrenal physiology is we’re pumping out cortisol and that cortisol fluctuates throughout the day in a diurnal rhythm, meaning higher in the morning, lower at night, and that cortisol is there to help give us energy.  It’s there to help put out the fire of inflammation but our adrenals also put out significant amount of sex hormone, too, called DHEA sulfate.  And that sulfate is really important for healing, it’s really important for sex hormone output for female so a lot of PMS symptoms are gonna be caused by adrenal fatigue and we need healthy levels of cortisol to be able to help assist in thyroid conversion.  So that cortisol, if it’s too high, that cortisol will actually block thyroid conversion and increase TSH which is this brain hormone called thyroid-stimulating hormone.  So too much cortisol, we block that T4 to T3 conversion, and we have TSH go up.  And if we don’t have enough cortisol, then we’re tired already because cortisol gives us energy and it regulates blood sugar, if we don’t have enough cortisol for thyroid conversion.  And then typically in those patients, TSH will even look normal on a lab test but T3 will be low.  And you’ll go to your doctor every time, you go to your endo, and then they’ll tell you your thyroid’s fine when it’s not.

Evan Brand:  Yeah, actually, I just got a lab result back from a female patient yesterday.  She’s in her mid-30s.  She loves high intensity interval training.  She’s got everything pointing at adrenal issues, so we finally get the–the salivary results back.  Her cortisol is so low, man.  She’s in the 0-5 range in the morning and she’s just like 2-3 units per day.  The only thing that was in range was her nighttime level because she–just completely tanked at that point.

Dr. Justin Marchegiani:  Yeah, absolutely, I see that all the time.  So things that we’re trying to get across to anyone listening is so you get some thyroid symptoms.  Take a step back.  We gotta look at the thyroid, right?  Individually.  We gotta look at the adrenals individually.  So the test you want for the adrenals is gonna be a #201 by BioHealth, that’s a cortisol rhythm test.  And if people are having a hard time getting access to this test, they can reach out to you, they can reach out to me, and we can get access to these tests for them and evaluate it.  That’s step one.  The next test is a full thyroid panel.  That’s gonna be your TSH.  That’s gonna be your T4 free, your T4 total, your T3 free, your T3 total.   Ideally, a T3 uptake and reverse T3.  And thyroid antibodies because a significant percent of these patients, they’re autoimmune.

Evan Brand:  I think that’s awesome that you mentioned that and you’re never gonna get told to run that by your conventional doctor.  So once again we’re looking at this from a functional perspective, not the “Oh, your TSH is low or whatever, here’s some Synthroid.”

Dr. Justin Marchegiani:  That’s it.  That’s it and most patients because they’re autoimmune–what autoimmune is it means self attacking self, that your immune system is ramped up to the degree where it’s attacking the thyroid tissue and breaking it down and the problem with that is is people that have this autoimmune type of sequelae of symptoms, they’re in the middle of hyper to hypo because as the glands being attacked or stabbed if you will, the–the thyroid hormone is dripping out, creating hypersecretion because there’s a lot more dripping out if you will.  It’s kinda like to use the gruesome of like let’s say you–you stab someone, right?  A whole bunch of blood comes out in the beginning, but in the end the person’s empty and there’s no more blood left.  Think of thyroid as like that.  I know it’s kind of a gruesome analogy, but honestly you will never forget it and you’ll be able to wrap your head around, “Oh, I’m having a hyper-like symptom, oh, wait, now I’m hypo,” and you kinda go back and forth, you’re gonna think of those thyroid as like you’re basically your immune system is putting little knives into it and it’s dripping the hormone out, and you only got about 3-4 months of thyroid hormone stored in those follicles.  So once those follicles has been bursted for a long enough time, they’re eventually gonna run dry and you’re gonna start having more hypo-like symptoms.

Evan Brand:  Yeah, and if people had access to the video feed here, they would be laughing out loud at your–your–your hand demonstrations, it’s just an–a great–great analogy.

Dr. Justin Marchegiani:  I know, I’m like pretending I have a knife in my hand and like trying to s–and like motioning like I’m stabbing my thyroid gland, oh man, and just so everyone knows I do have Hashimoto’s so I can speak from experience.  I’ve had to make myself an expert on thyroid health because of necessity because conventional medicine typically offers nothing for it.  So–

Evan Brand:  Yup, you’re a wounded warrior, man.  Those are the best ones to see.

Dr. Justin Marchegiani:  Absolutely and I can tell–I can say with confidence that anyone watching this or listening to the show is gonna walk out of it knowing more than their conventional trained endocrinologist on–on thyroid issues from a functional perspective.  They’re gonna know more of the disease stuff of course, like you know, thyroid nodules and–and Graves’ and things like that, but the thing is, conventional medicine’s approach is pretty much 3 options, okay?  If it’s Hashimoto’s or hypo, it’s Synthroid.  Most people that are given Synthroid, that’s synthetic T4, they don’t convert it to T3, so they still have tons of thyroid symptoms.  Number two, if they’re Graves’, they’re typically gonna just want a thyroidectomy, pull the darn thyroid out, done, right?  Number 3, radioactive iodine, shut the thyroid gland down.  I mean, those are the 3 major options, or they’ll give like methimazole or propylthiouracil to help knock down the thyroid hormone levels, you know,  they’ll–they’ll get PT or something like that.  So those are like the 3-4 options that are in the cookbook of your conventional endocrinologist for thyroid.  There may be a rare thing left out there, you know, thyroid cancer, thyroidectomy as well, but that’s your general kind of gist, and the majority of people, 90% of people are gonna be in the hypo-Hashimoto camp and there’s gonna be underlying issues that are affecting the thyroid conversion outside of their control.  It’s not gonna be pathological, it’s gonna be functional and that’s where we come in to really get to the bottom of it.

Evan Brand:  Yup, so we alluded to the adrenal distress picture but I mean, what’s the other important picture, I mean would you look at something like adding in some liver support, I mean some milk thistle, if you’re gonna be helping take some of the load off of the toxin filtration process that the liver’s doing, is that gonna free up more energy so to speak, more fuel for the liver to do its job in thyroid conversion?  Am I–Am I thinking right there?

Dr. Justin Marchegiani:  Absolutely.  So a lot of times we’ll start out and we’ll run an organic acid test and we’ll be able to run various organic acid markers that will look at liver function like hippurate, glucarate, there’s about 6 or 7 of them, sulfate for instance, pyroglutamate for B12. so we’ll be able to run these different markers that look at methylation, that look at an–acetylation, that look at our detoxification pathways from a phase 1 to phase 2 perspective, so we can really get a window on how it’s functioning.  But typically off the bat because I don’t wanna get into supplement overload with patients, the first thing we’re doing is just clearing out all the liver stress from a diet and lifestyle perspective, alright, aspartame, all the junkie food additive, gluten, all of the crap that’s just in your diet, that has to go first, right?  Because our liver is always detoxifying, you know, giving detoxification support, you’re not, you know, turning on detoxification systems, you–your buffering it, you’re taking the stress off which can be helpful, but we always wanna make sure we’re stopping the stress from going in first, and then–then it’s probably better supplementing later.  So for me, I have a 3 body system approach where it’s hormones first and then part of that foundational layer, below that is diet, lifestyle and nutrition.  So that’s the first step that we’re looking at before we go deeper and there’s exceptions to every rule but that’s in general, the first step.

Evan Brand:  Yeah, I always like to geek out and go beyond because sometimes I assume that people have the diet and lifestyle picture figured out but a lot of people are still struggling with that.

Dr. Justin Marchegiani:  Yeah, I mean, I see so many of my thyroid patients, they’re just–their adrenals are shot and they are just so myopically focused on the thyroid gland that the forget about the adrenals and they forget about their female hormones, right?  We can’t forget progesterone, a female hormone is responsible or highly involved in TPO production, okay?  So TPO is thyroid peroxidase.  That’s an enzyme that actually helps build or make thyroid hormone.  It binds the iodine and the–and the tyrosine together and if we have super low progesterone, that’s gonna lower thyroid peroxidase activity.  So we’re gonna be making less thyroid hormone just by having lower progesterone.  And again, why do we have lower progesterone?  Well, because progesterone goes downstream to make cortisol if we’re under a lot of progesterone and that low progesterone in the second half of the cycle, right before during that week before you bleed, that’s your PMS time, well, that’s where PMS happens typically due to that progesterone falling out early.

Evan Brand:  And the reason that happens you’re saying is because you have elevated cortisol from excess stress, is that what you’re saying?

Dr. Justin Marchegiani:  Yeah, elevated cortisol in the acute phase and then chronically low in the–you know, lower in the chronic phase.

Evan Brand:  Uh-hmm.  So–

Dr. Justin Marchegiani:  Meaning the longer that stress has been going on, that cortisol bottoms out.

Evan Brand:  So when that cortisol bottoms out, what happens to progesterone then compared to when cortisol’s high.

Dr. Justin Marchegiani:  Well, progesterone’s a building block for cortisol.  So if we look at the adrenal hormone cascade, we see cholesterol as the first domino, like all hormones are made from cholesterol.  So don’t go on a low fat diet, vegan diet.  You will destroy your hormones.  I’ve seen it hundreds of times.  Again, some people do better on it than others and a lot of people feel better on a vegan diet because they’re coming from it–with a crappy standard American diet, so they see improvement and they think well, it’s the vegan diet, but no, it’s all the other crap they cut out.  That’s another podcast for another time.  But cholesterol first, conversion to pregnenolone.  Pregnenolone then gets converted to progesterone on the other side of the cascade and then progesterone gets converted to cortisol.  So you can see what happens is if we’re under more stress, this progesterone escape, this cortisol escape where that progesterone leaks down because it’s needing to deal with the cortisol stress.  The cortisol needs to be there to manage the stress and inflammation.  So I always tell patients, your body is hardwired to deal with the stress of today versus the healing of tomorrow, right?  Progesterone’s there for healing, it’s there for healthy brain and–and brain function and relaxation.  It’s also there for pregnancy, right?   Progestation, progesterone.  So all those are really important but if our bod–body is so stuck in the stress in the moment, tomorrow never happens because you’re always in this stressed out state.

Evan Brand:  And that’s a miserable place to be by the way.

Dr. Justin Marchegiani:  Oh, my gosh, absolutely.  So almost all my female patients, they come in with some degree of thyroid issue, some degree of adrenal fatigue, and then because all of these are connected, right?  These hormones function and dysfunction together, there’s a level of PMS and/or female hormone dysfunction along with it.

Evan Brand:  Uh-hmm.  Yeah, and then you were kinda alluding to the pregnenolone steal, if people wanna geek out and read about that, it’s an amazing–just to look at the chart of the hormones getting stolen and sex hormones are messed up and now your libido’s gone, and I mean, it’s just–everything goes haywire.

Dr. Justin Marchegiani:  Oh, my gosh, absolutely.  Did you wanna comment on that a little more?

Evan Brand:  Well, I was just a–I just think you’re doing a really good job of taking a pretty complex topic and breaking it down.  I mean, this is intimidating for some people to try to take this knowledge into their lives and apply it and you know, if they try to go back to their doctor with this information, you know, they’ll probably be just laughed at or maybe even, they’ll get their eyes rolled at.  “Oh, I heard this functional medicine doctor and this functional nutrition guy talking about this and just silly.”

Dr. Justin Marchegiani:  Exactly and just remember, right?  If you’re going to your doctor and you’re trying to get functional medicine help in the conventional medical model, you’re like banging your head against the wall.

Evan Brand:  Uh-hmm.

Dr. Justin Marchegiani:  Alright?  It’s–it’s gonna be very, very difficult, right?  It’s trying to get your surgeon to not operate.  I mean, your surgeons are typically there to operate.  That’s what they’re there for.  That’s what they’re trained for.  And same thing with conventional physicians.  Conventional physicians are there to–most of the time just prescribe drugs unless they’ve been taking training outside the conventional medical paradigm.

Evan Brand:  Uh-hmm.

Dr. Justin Marchegiani:  So if you go there, you’re gonna find yourself having to educate your doctor more about this and again, why do you wanna sit there and educate your doctor about this when you can find people that are already educated?

Evan Brand:  I agree.

Dr. Justin Marchegiani:  I have patients all the time and they’re like, “Well, can you call my conventional doctor and–and talk to them about that?”  I’m like, “That is an act of futility.”  I mean, they can listen to this podcast but you’re much better off just finding people that are already in sync because then you don’t have to waste time.  So with that, the typical downfalls I see–most patients go to their doctor, they about adrenal issues.  Let’s say the topic of adrenal issues are brought out, right?  Conventional doctor, the first thing they go to is Addison’s or Cushing’s disease.  So Addison’s is an adrenal failure state, cortisol is almost non-existent.  And then Cushing’s is a hyper, hyper cortisol state, right?  Where you typically have elevations of blood sugar, you have the moon shape face, you have the buffalo hump in the back, you know lots of adiposity and that’s it.  So we have the two extremes, right?  So basically, you go to your doctor, it’s the one extreme on the high and the one extreme on the low, and the idea that everything in between is normal, that’s the idea.  That’s what it is and in the functional realm we realize that there are two extremes and there’s a functional spectrum in between there.  And the farther away you reach the high or low end, the more symptoms you have.  But the problem with that philosophy is that you may never each, you know, the high or the low end.  And what that means is that you’re stuck.  You’re never gonna get help.  You’re gonna be told it’s all in your head and there’s gonna be no solutions for you.

Evan Brand:  Right.

Dr. Justin Marchegiani:  That’s the problem.

Evan Brand:  Yeah, or here’s an anti-depressant, it’s just–that’s–that’s what we’re gonna do.  Yeah, so–

Dr. Justin Marchegiani:  And they’re just gonna just say, it doesn’t exist, so we wanna just differentiate adrenal failure versus adrenal fatigue, right?  Adrenal fatigue is more of the functional imbalance that may or may not progress into a disease state.  90% of people that have adrenal fatigue are never gonna progress into an Addison’s or Cushing’s state, it’s just not gonna happen.

Evan Brand:  I was gonna say–

Dr. Justin Marchegiani:  Those conditions are rare.

Evan Brand:  I was gonna say, I–I’ve personally never seen adrenal failure.  I’ve only dealt with the fatigue side of things luckily.  I mean, I don’t even know if–I don’t know.  I’m sure there’s people out there that are–that are in that, but I haven’t–I haven’t dealt with any.

Dr. Justin Marchegiani:  Yeah, so if you’re going to your conventional doctor and you’re having this conversation, just know that there’s gonna be a massive amount of backlash and there’s why, right?  Because of the–the differences in fatigue versus failure, right?  Adrenal fatigue is more of an HPA, right?  Brain talking to adrenal issue and also a stress feedback loop issue, right?  That’s number one and then on the thyroid side, well, most doctors are gonna run a TSH, which is a thyroid-stimulating hormone test which is nothing more than a brain test.  It’s looking at your pituitary.  So for instance, if we wanted to test something, it makes sense to actually test the hormone that the gland produces.  So for instance, if we wanna test your hormone function for your, let’s say your testosterone, right?  We would test testosterone, right?  We wouldn’t test LH per se, we would test testosterone.  That makes the most sense because testosterone is the actual hormone we’re looking at.  But LH, that’s the pituitary hormone that tells the gonads to make testosterone.  So why would we just look at LH when we can go look at the actual hormones being made.  Same thing, take that analogy now and throw it into the thyroid.  Why are we using brain hormones to look–to look at and assess the thyroid when we can actually test the T4 and T3 hormones individually?  Well, it’s just because it’s an antiquated way.  It’s what we were able to test first and it’s kind of the whole model of drug-prescribing is based off of that.  So it’s a very end-stage approach.  We’re look at the disease pathology, the high and low versus the functional imbalances that happen in between.  So we wanna live on the in between side, you know, all of the functional imbalances in between not on the high and low side.  Most patients that come to see us, they’ve–if they’re on the high or low, they already know it and they’ve been prescribed and typically many of them still don’t feel better and they still need answers.

Evan Brand:  Yup, and we do.  We do get them back into that functional range and it’s amazing how much you can feel better.  Even something like optimizing vitamin D levels has been huge for–

Dr. Justin Marchegiani:  Yeah.

Evan Brand:  Like my grandpa.  He was having a lot of chronic low back pain issues.  I found a couple of studies linking the two and we upped his vitamin D, re-tested and now, you know, he’s better.  He’s got some other inflammatory issues going on, but I mean, just getting back in the functional range of everything one at a time is just–it’s the way to health and healthy people do exist and it is possible for you to get better out there.

Dr. Justin Marchegiani:  Yeah, and a lot of people for instance aren’t getting the help they need from a functional perspective in the thyroid community, in the conventional community, because most thyroid issues are autoimmune in nature.

Evan Brand:  Uh-hmm.

Dr. Justin Marchegiani:  So because they’re autoimmune, giving a thyroid hormone does not fix the immune system destroying the thyroid tissue and then the inflammation that’s then created by that then affects conversion of T4 to T3, it then affects receptor site uptake, so it affects the hormone from binding into the receptor site so a hormone has to go into this receptor site to have a metabolic effect, kinda like your key is useless it goes into the lock and turns.  It’s kinda the same thing and autoimmunity is affected by things like gluten and potentially dairy and infections and selenium levels and nutrient levels and leaky gut, and all of these things that are functional medicine issues and they will never ever be touched upon in the conventional medicine community.

Evan Brand:  Yup.  So just a quick question, I know we gotta wrap things up here–people that are listening, they may just feel like, “Wow!  This Synthroid is killing me.”  Going cold turkey on Synthroid, what are the–what are the complications or issues there?

Dr. Justin Marchegiani:  Well, again, if you’re prescribed a thyroid hormone by your conventional medical doctor, most of the time, 99% of the time you need it because they’re using TSH as a established range to dose thyroid hormone.  The problem with that is is that TSH takes about 5-10 years to go high.  So most of the time, your thyroid issues have been going on for almost a decade.  So you don’t ever wanna come off thyroid hormone if you were prescribed it but you wanna find in someone like us.  Now typically what I do off the bat is I don’t ever take them off their thyroid hormone but we may change and put them on a full spectrum thyroid hormone, where they’re getting T4.  The same T4 levels, not that touching that at all, but also adding in some T3 as well, and then also looking at the adrenal side of the fence.  And most people that are dose thyroid hormone based on TSH, they aren’t given enough thyroid hormone.  So if the gland has been destroyed for a couple decades or a decade or so, they may need thyroid hormone because the B cells, alright, the immune cells have infiltrated that thyroid, they’ve destroyed, they–now the tissue has gone fibrotic, it’s now scar tissue, and it’s no longer functional.  Again, we may be able to get recovery back, but if we don’t have recovery, we gotta make sure we’re getting enough thyroid hormone for healthy function.  So we always wanna make sure we’re getting enough thyroid hormone but we don’t wanna base it off a TSH per se, we actually wanna use our T3 free and T3 total to look at how much active hormone we’re actually making.  That’s gonna be the best way to do it.  Don’t look at TSH.  Your brain is much more sensitive to thyroid hormone than the peripheral tissue.  So what happens is, the thyroid hormone, the TSH will actually go lower in response to the thyroid hormone.  So your thyroid hormone may not be quite where it needs to be for optimal function in that T3 reference range, but your TSH may go low because your TSH and your thyroid or inverse, right?  TSH goes high when thyroid’s low.  TSH goes low when thyroid’s high.  So if we see the TSH drop, most doctors go, “Oh no!  We’re giving you too much thyroid hormone.  You’re overdosing.  You have Graves’.”  But just look at the T3.  Most of the time we’ll see the T3 in the top half to the top 25% of the range.  It’s not even high but most docs will just jump to that conclusion, you’re given too much without actually looking at the hormones individually, which drives me nuts because it’s like they’ve–if we can look at the direct temperatu–if we can look at the direct measurement of the hormone, let’s do it.  And the analogy I give my patients is, using a TSH as a gauge for thyroid hormone levels is like going outside and feeling the sidewalk to detect what the temperature is, right?  So the sidewalk’s always gonna be way hotter than what it is, right?  So we have this extra sensitivity thing going on.  And why the hell touch the sidewalk when you–when you can just look at the thermometer or pull up your weather app on your phone, right?  We have much more sensitive ways.  So don’t go outside touching the sidewalk, go and look at your app for the temperature.  Same thing with your thyroid.

Evan Brand:  That’s awesome.  I was waiting for the analogy, man, and I’m pumped.  That’s a great way to wrap this thing up.

Dr. Justin Marchegiani:  That analogy like hit me 2 weeks ago and I was like, “Eureka!”

Evan Brand:  That was incredible.  I was thinking the whole time we were going through this I was listening but I was trying to visualize an analogy and I was drawing a blank.  So you really killed it with that one.

Dr. Justin Marchegiani:  Yeah, ex–yeah, thank you.  And I just want everyone that’s in the conventional model and trying to get help, I know how it feels.  It’s ridiculously frustrating.  I have so much empathy.  Don’t bang your head against the wall.  I want you to have compassion for your medical doctor and to understand where they’re coming from.  They’re just coming from a different place, okay?  So if you need the functional medicine support to heal which the majority of people do, then we need a different and your MD may not be the best person to get that approach.  Get all the pathology stuff ruled out first.  We wanna make sure nothing’s being missed from a global pathological standpoint, like a cancer or something, maybe an over, you know, hypothyroid issue like TSH through the roof or something.  But once that’s been addressed, they gotta reach out to people like you and people like me to get this stuff under wraps.

Evan Brand:  Definitely.

Dr. Justin Marchegiani:  So I know, I–you know, went into like professor mode today.  We’re gonna have this stuff all transcribed, so go back, take a look at it.  Read it a few times.  We’ll do more podcasts on it.  People who have more questions, let us know.  We’re gonna be happy to break this down.  I want everyone to walk away with an action item.  So action item is get a full thyroid test, get a full adrenal test if you’re on the fence.  That’s your first two things to do and then from there, we can talk about options about what the next steps are.  But those are your first 2 options and if they need it, they can get it from me or from you.

Evan Brand:  Yup, sounds great.

Dr. Justin Marchegiani:  Evan, do you want to add some stuff?  I feel like I was just an absolutely ball hog today.  I’m so sorry.

Evan Brand:  Oh, no.  No, perfectly fine.  I’m sitting here loving it, man.  It’s been great.  No, I just want to say that, you know, the main thing is that you’re–you’re taking baby steps in the right direction.  So maybe you’re on the fence about this, you’re looking into the testing, that doesn’t mean that you should wait until you get testing and you actually get a piece of paper that says you need help.  It’s okay to go ahead and start helping yourself right now.  Removing the gluten if you’re still eating that.  Removing the excess stimulants if you’re doing that.  If you’re speeding 30 miles over the speed limit today on the highway, reducing that, you know, all of these lifestyle things that we’re going to recommend you anyway, go ahead and get started on some of those now.  If you’re speedometer or your RPM in your car is red lining right now, you have the power to turn that down and get yourself out of the red line.  Take a hot Epsom salt bath or something this evening, you know.  Get that red line down, start calming yourself down and getting yourself ready for the therapy that we’re gonna put you on anyway and you’re really gonna help accelerate your results.  You’re gonna get better faster and at the end of the day, that’s what we want.  We wanna help you get well as fast as possible, but in an ethical and you know, an intelligent way.  We don’t just wanna come in with huge jackhammer.  So just slowly work yourself there and–and start–start swimming now and we’ll meet you at the other side.

Dr. Justin Marchegiani:  Absolutely.  And you forgot to mention how important consuming the grass-fed leprechauns are.

Evan Brand:  Grass-fed leprechauns, yup.

Dr. Justin Marchegiani:  Alright, everyone, hope you enjoyed the show.  Check out the transcription, beyondwellnessradio.com, notjustpaleo.com.  Thanks everyone and have a great day!

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