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Many of you probably don't know Isabella. When she was in this class long time ago, she's since gone on to be really quite remarkable in her career, and I, I respect her on a lot of different levels. You know, she wrote a book, which we should all do, about Hashimoto's thyroiditis back in 2009. And no, no, you were diagnosed in 2009. She wrote a book after that, you know, New York Times bestselling book. And she has created an amazing educational program and systems and online presence that has helped a lot of people. And I hear about her a lot from my patients and how inspirational her work has been. So I think, you know, from a clinical standpoint, she's amazing. From an entrepreneurial standpoint, she's incredible. From getting the word out to help other people standpoint, also quite remarkable as well. So I just want to welcome her. Let's turn everything over and we can all start to learn about thyroid and the C as well. You should get control right now. See if that works. Great. Thank you so much, Dan. Let's see here. Can you share screen? Okay. Can you guys see my screen? Yeah, you're perfect. Thanks. Wonderful. Thank you so much for having me, Dr. Dan. As Dan mentioned, I took his class back in 2013, right after I wrote my first book, Hashimoto's: The Root Cause. I was really looking for a way to to get more organized when I first wrote my book and when I first got myself better from Hashimoto's. It was kind of throwing a lot of things at the wall and seeing which ones would stick. So I really appreciate Dan's approach and all of his experience and the wonderful protocols he's so generous, he's so generously shares with the world. So thank you for that, Dan.
So today, we're gonna go over the top causes of hypothyroidism, the top root causes of Hashimoto's. We're gonna talk a little bit about medications. I am a pharmacist, so I would love to share a little bit of insight with some of the good, the bad, and ugly drugs out there. We're gonna be talking about the most helpful nutritional interventions for people with Hashimoto's, as well as the top functional medicine and complementary treatments for Hashimoto's.
So a little bit about me. As Dan mentioned, I was diagnosed with Hashimoto's in 2009, and I am a pharmacist by training. So I have my PharmD degree that I received just a few years before my diagnosis. And I, full disclosure, I was never interested in the thyroid during pharmacy school. It wasn't until my own diagnosis when I became a Hashimoto's expert/guinea pig. So since I was diagnosed, I wanted to figure out if there was anything that I could do to help to slow down the progression of my condition, to feel better, as well as potentially reverse my condition. Once I got myself well, I released a book called Hashimoto's Thyroiditis: Lifestyle Interventions for Finding and Treating the Root Cause in May of 2013. I try to get all the keywords in there. If you try to look for that book, it's on Amazon as Hashimoto's: The Root Cause. And the book has since become a New York Times bestseller. It has reached a lot of different people with Hashimoto's, and we get a ton of success stories of people who read the book and started implementing some of the strategies and got themselves well. My website is thyroidpharmacist.com. I'm the co-founder of the Hashimoto's Institute Practitioner Training Program, which focuses exclusively on training clinicians on how to work with people with Hashimoto's. I'm a trustee for Thyroid Change and a board member for Hashimoto's Awareness. So those are my two charities that I'm a part of. And then I'm also a paid advisor for Pure Encapsulations and a speaker for Designs for Health. And as you can imagine, I mostly speak about the thyroid.
Going back to what we're taught about the thyroid in school, I know a lot of us probably saw some version of this woman in our textbooks. And essentially, we look at, we were either trained that people were hypothyroid or had hyperthyroidism. And so we look at the different symptoms associated with which, with each part of the body. Where a person who has an underactive thyroid will have a puffy face, they'll be sluggish, they'll have a slowed heartbeat, constipation, perhaps some cold intolerance, depression, dry skin, fatigue. They have the infamous brain fog, fertility issues, as well as heavy menses. On the other hand, when we have a person with hyperthyroidism, they're going to be having a protrusion of the eyes, they're gonna be sweating, irritable, had a rapid heartbeat, have excess weight loss and frequent bowel movements. Of course, infertility is present in both sides of the spectrum.
Now, what I don't think a lot of us were taught during school, and I know I sure wasn't, was that Hashimoto's was the primary reason for hypothyroidism, accounting for 95 to 99 percent of cases of hypothyroidism in the United States and in most Westernized countries that have iodized salt. So worldwide, iodine deficiency is the primary cause of hypothyroidism, but this is definitely not the case in the United States. The other thing to consider is that people with Hashimoto's are oftentimes going to have symptoms of both hypothyroidism and hyperthyroidism. So they're going to be having a lot of cases swinging back and forth between the two within the first 10 to 15 years that they have the condition. So we'll see symptoms like a person may have a lot of fatigue and hypersomnia. They may have hair that's becoming coarse, or they may have hair that's becoming thin and starts to fall out. We see a lot of issues with with mood, so anxiety, palpitations, irritability. I've seen people who were misdiagnosed and hospitalized with bipolar disorder, as well as psychosis, and placed on heavy-duty psychotropic drugs in the early stages of Hashimoto's when their thyroid function swings from hypo to hyper, which clearly, as thyroid hormones impact our emotions, that can surely mimic calm bipolar disorder. We have issues with weight. So people with Hashimoto's can have an inability to lose weight, they can have trouble gaining weight, and and those are, you know, not always, it's not always the same for every person. Cold intolerance can be an issue with with Hashimoto's, as can be heat intolerance. Fertility issues. A lot of times we see women who first actually get diagnosed either after having their first baby or not being able to conceive. So issues with conception, issues with miscarriages, as well as potentially having the birth defects have been implicated with with Hashimoto's. And then the brain fog and lack of, lack of motivation, apathy are also common factors of Hashimoto's.
So Hashimoto's, one of the reasons why I really wanted to find out what I can do to help myself, other than to take thyroid medication or in addition to taking thyroid medications, was because Hashimoto's, just like every other autoimmune condition, is progressive. So we know that there are five stages to Hashimoto's. The first stage is the genetic predisposition, where for all intents and purposes, the person just has the genes that will predispose them to developing Hashimoto's. If they're exposed to the right triggers, they have normal thyroid function and they have a normal immune function at this point. The second stage of Hashimoto's, and what is when immune cells begin to infiltrate into the thyroid gland. At this point, we may see a change in thyroid antibodies. So those thyroid antibodies may rise, and we may start seeing some symptoms. We are likely, if if a doctor was to measure the TSH at this point, the TSH would still be normal, as with the free thyroid hormones. In the third stage, we're looking at subclinical hypothyroidism. And at this stage, we're going to have the antibodies, we're also going to start seeing an increase in TSH. So it might be a gradual increase somewhere above two point five, above three, and then the hormones, the T3 and T4, will still be normal. In the fourth stage, is when we reach overt hypothyroidism. So if the person hasn't been diagnosed to this point, this is going to be when we start seeing a big increase in TSH, and we're gonna see low levels of T4 and T3. So if this is actually the stage where most people get diagnosed with Hashimoto's or hypothyroidism, and at this point is when conventional medicine will recommend thyroid medications. The fifth stage is when we have a progression to other autoimmune disorders. So it's not rare to see a patient with Hashimoto's that starts off with hyper, hypothyroidism, they get placed on thyroid medications, and then they develop lupus, or rheumatoid arthritis, or MS, or something else down the line. And so I'm really looking at Hashimoto's, the optimal time to start treating Hashimoto's is going to be in stage two or stage three, because at that point, we can start preventing damage to the thyroid gland. We know that with some of the innovative therapies like low-level laser therapy, we can regenerate thyroid tissue, but it's much, much easier to prevent damage than it is to regenerate any kind of tissue.
And so looking at the proper diagnosis, and I'm sure I am preaching to the choir here, but we know that TSH is not the best test to do if you really want to be a comprehensive clinician. So we know that the TSH reference range has been overly waxed over the last, you know, 20, 30 years. And so looking at just TSH alone, I would say I like to see that somewhere between 0.5 and 2 for most of my clients. That's where they feel their best, and somewhere around 1 is what a healthy young woman with normal thyroid function will usually test with. The other, the other consideration with TSH is in the first 10 to 15 years of Hashimoto's, that TSH number may be normal. So it may fluctuate between, and it also may fluctuate between being low and being high. So as we have a thyroid tissue breakdown caused by the immune system attack on the thyroid gland, we're gonna see packets of thyroid hormone rushed into the bloodstream, and that can induce a transient hyperthyroidism. So the thyroid tests that I recommend for everybody, so if you have any clients that maybe fit some of the symptoms that we talked about, I would highly recommend to do, obviously, the TSH test, but also looking at thyroid antibodies, so thyroid peroxidase antibodies and thyroglobulin antibodies are the most common antibodies for Hashimoto's. Free T4 and free T3. These are going to be the free levels of thyroid hormones. So sometimes these can be affected by, by Hashimoto's, and other times this may be an adrenal issue. Either way, we do want to test those as well. And then in some cases, doing a thyroid ultrasound can be really, really helpful for the person to see if perhaps they have nodules, if they have changes consistent with Hashimoto's on their thyroid ultrasound, or other kinds of suspicious growths happening within their thyroid gland.
Now, thyroid antibodies and Hashimoto's. So we used to think that 90% of people with Hashimoto's had thyroid peroxidase antibodies, and then 80% of them had thyroglobulin antibodies. And if you look at the literature, if you look at UpToDate or PubMed or any of these things that have review articles on Hashimoto's, you'll see these numbers. But what we've actually found in recent years, so some new data has been published, is that there's something that's called seronegative Hashimoto's or antibody-negative Hashimoto's, where a person doesn't have thyroid antibodies, but they do have Hashimoto's. And so up to 40% of people may not have thyroid antibodies. The way you'd be able to tell is if they had changes consistent with Hashimoto's on their thyroid gland. And then there's also, you know, a much more invasive procedure with fine needle aspiration of the thyroid gland, where you would do a biopsy of the thyroid cells, and you'd be able to see that there are immune cells within the thyroid gland. So there's also TSH receptor antibodies. These I recommend testing for as well. They're going to be most likely present in people with Graves' disease. We sometimes do see that people have antibodies to both Hashimoto's and Graves' disease, and of course, they're a little bit trickier to treat in that case. And then some emerging antibodies can also be sodium-iodine supporting antibodies, as well as TPO antibodies that may be present in autoimmune thyroid disease. So the rates of those were anywhere between 17 to 11% for people with Hashimoto's reported in the last few years.
The traditional approach to Hashimoto's and hypothyroidism. So in the very first stages, so I would say in stage two and three of Hashimoto's, people are told that there's not really much that they can do other than to wait until their thyroid gland burns itself out, at which point they'll be placed on medications. Once a person reaches stage four of Hashimoto's, when they have hypothyroidism that's become overt, most, most conventional docs will place them on Synthroid. So Synthroid is a synthetic thyroid medication. It was the number one prescribed drug in all of the United States in 2013 and 2014. And so unfortunately, Synthroid is a prohormone, it's a prodrug, so it needs to be turned into T3 in the body to really, to really help address hypothyroidism. So we know that T3 is the more active thyroid hormone, and ideally, T4, we should be able to convert our T4 to T3 without any issues. Of course, this never looks, it looks good on paper, but it never happens quite so in the body. And my experience, so most people with Hashimoto's, they actually feel best when they take a T4 and T3 combination medication. Unfortunately, most conventional docs will not recommend a T4 T3 combination medication. They are pretty much sticklers for Synthroid or levothyroxine. And whenever patients complain about having additional symptoms, for example, having depression, or being cold all the time, having brain fog, losing their hair, having excess weight, which are very much thyroid symptoms, most conventional docs will either recommend antidepressant medications or recommend that they go see a psychiatrist. What's really cool is that some of the more innovative and integrative psychiatrists have actually started testing their psychiatric patients for thyroid issues and getting them T3 and giving them thyroid medication. So that way, sometimes it does come full circle, if the person does meet the right psychiatrist.
The old-school natural approach to Hashimoto's and just about every other thyroid condition is to give people super high doses of iodine. And, you know, and I can definitely see where this rationale comes from. So historically, iodine deficiency has been the primary reason for hypothyroidism. If we don't get enough of the building blocks to make thyroid, we're not gonna make thyroid hormone, and that makes perfect sense. And back in the day, if you gave somebody, if somebody got, was hypothyroid, you'd give them iodine, and you'd turn them around. Fortunately, nowadays, this is not the case. So most Westernized countries do add iodine to the salt supply. And we know that iodine is the Goldilocks nutrient. So it has a very narrow therapeutic index, and iodine excess has actually been recognized as a trigger for Hashimoto's. Furthermore, giving people high doses of iodine can exacerbate Hashimoto's, as well as accelerate thyroid tissue damage. So this is a screenshot of somebody from my Facebook community. We have about 240,000 people on Facebook under Thyroid Pharmacist, Dr. Isabella Wentz. And, you know, this, this is just a quick description of something that I've seen time and time again in my clients that have come to me after either getting themselves in trouble just doing stuff that they read on the internet, or when they've worked with other kind of old-school practitioners. And so what can happen when you put a person with Hashimoto's on a really high dose iodine, you can see that their TSH will start climbing up. So you'll have a person with a TSH of seven or eight that will go to 98. And then we'll see that their thyroid antibodies have dramatically risen. So some of my client cases had antibodies in the, you know, four to five hundred, up to six hundred range, and then we would see them climb up to 1,000, 2,000, 3,000 after getting on iodine. And then we also start seeing their T4 levels drop, T3 levels drop, and that they, you know, clients I had was actually bedridden and felt horrible. So definitely, I treat iodine like a drug. It's not something that I hand out willy-nilly to people. And there is really not a good test for iodine testing. The iodine patch test, I feel that's more of an old wives' tale rather than a really great diagnostic test.
So let's talk about the root cause approach to Hashimoto's. And so we know that Hashimoto's, just like every other autoimmune condition, has three components that result in the lack of tolerance. And so the genes, so we have to have the genetic predisposition. It has no permeability, or the gut, as well as exposure to antigens. And so it's remission, mission impossible. I've heard this time and time again, and I've had, when I was first diagnosed, people told me that there was nothing I could do about Hashimoto's, that I would just basically have to wait until the thyroid burned itself out, and then at that point, I would need to be tested for other types of autoimmune conditions. And that, you know, there was, I could take medications, and that most of my symptoms and my antibodies would never go away. So remission is possible. I've been able to reach remission, as have many of my clients and a lot of my readers as well. And so how we get there. So one of the things, the ideal situation is if we can figure out what the triggers are and remove them. So if we can figure out what's causing leaky gut, or what some of those antigens are in a person's life and remove them, that's gonna be one way to get there. And of course, we don't know all of the triggers out there. I'm learning about new ones, you know, every month. I learn about new triggers here and there from from my clients and some of my readers. But we can also work on getting a person modulating the immune system and just really supporting them where they are, helping them reduce oxidative stress. So we'll go through some of that. One important thing to note is, of course, genetic predisposition will remain. So if, let's say, somebody's root cause was gluten, and then they got off of gluten, they can go into remission from Hashimoto's. But if they start eating gluten again, they'll get Hashimoto's again. So I definitely think remission is, is a good goal to shoot for, and definitely the first goal should always be to help the person feel better.
So I had to put all the root causes that I'm aware of in different buckets. I would say they would be classified as toxins, intestinal permeability, chronic infections, nutrient depletion, stress response, and food sensitivities. And so we talked about first making sure that the person feels better. So if somebody is has overt hypothyroidism and they're in that advanced stage, a lot of times we do need to recommend that they get on thyroid medications, because thyroid medications are one of the fastest ways for a person to feel better. We know that thyroid hormones impact every single cell in the body, and hypothyroidism in itself can have an impact on the gut. So we know that people who are hypothyroid are going to be more likely to have SIBO, which can further contribute to intestinal permeability. So definitely, I always am looking at seeing if they are on a synthetic medication like T4 to look at whether they're properly converting T4 to T3. So if their T4 is within the reference range, in the kind of high end of the range, and their T3 is in the low end of the reference range, there's probably a chance they're not converting it properly. And then I'm also asking them for their symptoms a lot. In many cases, and if you ask an endocrinologist, they'll say that 90% of people with Hashimoto's can be treated with T4 just fine. And I just, I'm sure I tend to be biased because most of the people that reach out to me are the ones that don't feel well on T4. But I feel like probably the opposite is true. So 90% of my clients actually feel better on a T4 T3 combination medication. So Nature-Throid, WP Thyroid, Armour Thyroid, or some of the ones I recommend, as well as compounded T4 and T3. So I know there's some controversy about natural desiccated thyroid medications and whether they can increase the thyroid antibodies. And this has been kind of a fun topic for Dr. Alan Christensen and I to explore. Dr. Christensen is my co-founder in the Hashimoto's Institute. And what we've actually found is that in some cases, yes, thyroid antibodies can be increased by these medications, but in the majority of cases, they are not. So I always recommend that we test iron antibodies before starting on Armour, Nature-Throid, and WP Thyroid, and then retesting them after. And if you see a rise in antibodies, then looking at a compounded option may be better. However, I would say in, in probably 90% of cases, 95% of cases, you're not going to see that antibody rise. You'll actually see that the antibodies decrease.
And so going back to T4 and T3, I did a survey of 2,232 people with Hashimoto's in 2015 to ask them about what were some of the most helpful interventions that they've made. And Synthroid, 43% of people felt better on this medication, whereas 58.9% felt better on Armour, which is an old-school thyroid medication that has T4 and T3. My preferred ones are usually going to be WP Thyroid or Nature-Throid, just because they're going to be a little bit cleaner and have fewer fillers.
So of course, we know that stress is at the root cause of most chronic conditions. And so obviously, you guys have taken Dr. Dan's course, you know that adrenals are really, really important in autoimmune disease, and especially in the thyroid, because we know that the adrenals and then the thyroid are great friends, and they're always looking at each other and trying to determine what they're doing. So I do like a BioHealth Lab test, as well as the DUTCH test, to figure out some causes of adrenal dysfunction that may be pituitary.
With food, I always think that food is a really great place to start with people with Hashimoto's. A lot of times, when you get them on the right diet, a lot of the other things will fall off. So, you know, their gut may no longer be leaky if you get them on the right kind of food and remove some of the food sensitivities. And so we know that there was a study done that looked at people with celiac disease and Hashimoto's within the last 20 years, and this was an Italian study that found that those who had both celiac and Hashimoto's, after they went gluten-free, within a period of about a year, we saw that about 19 to 20% of the people with Hashimoto's normalized their thyroid function and were able to get rid of their thyroid antibodies. And so we know that obviously for celiac disease, the gluten-free diet is an excellent choice. However, I would say that anybody with an autoimmune condition, I'm sure I'm pretty preaching to the choir here as well, and definitely everybody with Hashimoto's should be on a gluten-free diet.
So in case you guys need some numbers, these are numbers from my Hashimoto's survey that I did in 2015. And 80% of people felt better on a gluten-free diet with Hashimoto's, whereas only three and a half percent of those had celiac disease, which fall somewhere in there between 1 and 50% of co-occurring Hashimoto's and celiac. Now, when you compare the gluten-free diet, 88% better, comparing to 43% better on Synthroid, and, you know, 58.9% better on the patient-favorite drug, we know that this is one of those top interventions that we need to recommend people to go gluten-free yesterday if they've been diagnosed with a thyroid condition. The top benefits, so the top things that people reported seeing improvement after going gluten-free were energy. We know that fatigue is the top symptom of Hashimoto's. Mood, 60% felt better as far as their mood went, and we know that depression and mood disturbances are actually probably the third most common complaint in Hashimoto's. And then weight, which is the second most common complaint in Hashimoto's, improved on a gluten-free diet. So this is definitely my drug of choice for people with Hashimoto's.
Some of the other foods that can be helpful for people with Hashimoto's, or some of the, I should say, some dietary protocols. Food sensitivity testing, about 62% of people felt better by removing the foods that came up that they were sensitive to on food sensitivity testing, and 43% of them reduced their antibodies. So this is, I recommend the test called a Let's Ala test. Labs does an IgG test. I know there's some controversy about IgG testing. What I will say is that thyroid antibodies are IgG antibody types, and whatever we test a person with Hashimoto's with an IgG test, and then we remove the reactive foods, we also see a reduction in those thyroid antibodies as well. And a lot of times, I do like an elimination diet, of course, and I look, what I like to recommend that first. But in many cases, we can find some unique food sensitivities on testing that an elimination diet may not reveal. So I know I've seen people with pineapple and ginger sensitivities, which I normally would not have suspected. The autoimmune Paleo diet, but this has also been very helpful at reducing antibodies, which of course, are a measure of how aggressive the autoimmune attack is on the thyroid gland. And soy-free diet has also been really helpful. And then gluten-free diet, as well as the grain-free and Paleo diet, are usually what I like to recommend. The low-FODMAP diet, which is something that's recommended for SIBO, 39% of people felt better on that. I think that's particularly interesting since about 50% of people with hypothyroidism have been reported to have SIBO in one study. So perhaps it's the ones that have SIBO that benefit from this protocol.
The other types of diets on there. So I went through and asked about a lot of the friends' diets. And definitely look like SIBO-conducted diet and dairy-free diet is, is what I recommend for pretty much everybody across the board. Dairy is the second biggest sensitivity in addition to gluten. Dairy, egg-free, and nightshade-free, this can sometimes help as well. Probably about 50% of people are going to be sensitive to either eggs or nightshades. I've seen that clinically, as well as in this study. Red meat avoidance. There was a study that was talking about any IgG antibodies, which are essentially red meat antibodies, that had some cross-reactivity perhaps with thyroid antibodies. I didn't see that clinically in this study, that also didn't support that red meat avoidance would help people with Hashimoto's. The vegan diet. So we know that the vegan diet, it has been recommended for some autoimmune conditions, and some people have benefited from this type of approach. It doesn't seem to be a good approach for people with Hashimoto's. For every person that felt better on a vegan diet, we had almost another person feel worse on it. You know, comparing that with a gluten-free diet, for every one person that felt worse, we had 88 people feel like better gluten-free.
Most common nutrient deficiencies in Hashimoto's. So whenever I have a person with Hashimoto's, I always recommend testing for vitamin D, ferritin, which is the iron storage form, and then looking at alkaline phosphatase levels. Those can help determine if they have a zinc deficiency. I also will see that they're oftentimes going to be deficient in B vitamins, so especially I will recommend testing for B12. And something that's a little bit surprising is that many of them who have issues with with cold intolerance, grain intolerance, fatigue, may actually be thiamine deficiency. Oftentimes, I'll recommend a thiamine supplement. So that's just B1, 600 milligrams for somebody who's fatigued, and in many cases, it turns their fatigue around with three to four days. And there were a couple of studies supporting the use of thiamine in Hashimoto's. The one that I really liked us to go over in this presentation and highlight is going to be selenium deficiency. So we know that selenium has been recognized, selenium deficiency has been recognized as an environmental factor, an environmental trigger for developing Hashimoto's. And we know that taking a selenium supplement has been shown to be beneficial in all kinds of thyroid issues. So Hashimoto's, we see a reduction in thyroid antibodies within three months after we give somebody 200 micrograms of selenium, as needed, on a daily basis. Pregnancy, we see improved outcomes as far as postpartum thyroiditis. So women who have thyroid antibodies during pregnancy and get on a selenium supplement are less likely to develop postpartum thyroiditis than women that do not. I was looking at some, some of the data out there, and the reported rates of selenium deficiency are pretty low in the US. However, selenium is absorbed in the gut, and so whenever a person has gut issues, which of course, we know most of our autoimmune clients do, we're gonna see that selenium may become deficient. What's also interesting is that we, we will see selenium deficiency when a person is on a gluten-free or grain-free diet. Therefore, I feel like this is a super important nutrient for people with Hashimoto's, and this is kind of part of my starting orders whenever I have a person with Hashimoto's that we get them on a selenium supplement. So even if they're not deficient in selenium, studies have shown that there is benefit. It does reduce oxidative stress in the thyroid gland, and the impact that I've seen on my clients is a reduction in antibodies, reduction in anxiety, and then they also see improved thyroid conversion from T4 to T3, and overall, they just report feeling better, more calm, and more on it. I also like to recommend glutathione and N-acetylcysteine for clients as well.
Toxins. So in an ideal world, we would figure out what the toxins are and get rid of them. Some of the toxins I've seen in my clients over the years have been mold. So definitely mold toxicity can bring on all kinds of autoimmune conditions. Exposure to halogens such as fluoride or bromine, halogenated that's, you know, bed covers, those are going to be all things that can potentially exacerbate Hashimoto's. We saw, we saw a study done in the UK where people lived in two different communities. One community had added fluoride to the to the water supply, the other one did not. And then they looked at the rates of thyroid disorders in both of those communities, and of course, the rates were higher in those communities that added fluoride to the water supply. So I always recommend a reverse osmosis filter or spring water for my clients, as well as getting on a natural toothpaste without fluoride in it. Radiation. So even low-level radiation has been recognized as a trigger. Chernobyl exposure. I was personally exposed. Showed that about, uh, something between 60 and 80% of children within a certain age that were close to that village had thyroid antibodies after exposure to Chernobyl. Petrochemical plants. If you work in one or live closer to one, you're more likely gonna be to have Hashimoto's. Breast implants. So this is something that's been really interesting. I've seen this in a couple of my clients where really their health began declining after receiving breast implants. And then medications. So some of the medications, and like I said, I treat iodine like a drug, that have been associated with triggering, exacerbating Hashimoto's. So iodine, fluoride, amiodarone, lithium, of course, which is used for bipolar disorder, interferon, some of the monoclonal antibodies, although others have been found to actually reduce the likelihood of Hashimoto's and suppress it. Botox. And I haven't seen this clinically, but there's a lot of research supporting that this can be an issue. And then Accutane. I've actually seen quite a few cases of Hashimoto's induced by Accutane, which is an acne drug that has been associated with a lot of, a lot of side effects. So it has a couple of black box warnings and some advanced screenings for people that want to be on it because of some issues with with birth defects, as well as with psychiatric issues.
Going back to the iodine controversy. So we know that iodine is the Goldilocks nutrient. So somewhere between 100 and 250 micrograms per day is, is where we want to be. People with Hashimoto's may be sensitive to as little as 300 micrograms per day. So I generally tell my clients that something that they get in a multivitamin, which is 150 to 250 micrograms, is going to be fine for them. But going on high doses of iodine can be inflammatory for them. We saw rates of Hashimoto's increase in just about every single country that added iodine to the salt supply. So this particular little graph here is from a study done in Iran before and after a national salt iodization program, and we saw the rates of thyroid peroxidase and thyroglobulin antibodies dramatically increase. So, you know, they, they tripled in TPO and quadrupled in thyroglobulin antibodies. So going back to my survey and iodine, for every person that felt better on iodine, we had more people actually feel worse. Whereas iodine restriction, which is something I might recommend for clients who come to me after being exposed to those high doses of iodine, I might say, let's try to put you on iodine restriction for a couple of months to see if we can reduce some of that inflammation. Some people have actually found that to be more helpful than high-dose iodine. And so of course, we want to keep things, all things in balance, and I don't recommend iodine restriction for a long term. This is just a really short-term intervention for somebody that's been perhaps exposed to really high dosages.
Now, looking at that intervention of the high-dose iodine, we have more people feeling worse than feeling better with Hashimoto's. I think you can understand why I'm hesitant to recommend iodine and I'm more likely to recommend a gluten-free diet as the first intervention.
Infections and autoimmunity. I really like talking about infections and autoimmune disease, and there are a few different mechanisms by which infections can trigger Hashimoto's or exacerbate Hashimoto's. So molecular mimicry theory is when we have a pathogen within our bodies that has proteins on it that are similar to the thyroid gland, and as the immune system begins to attack that pathogen, it starts to attack the thyroid as well because it's a case of mistaken identity. The bystander effect is when there is a pathogen that perhaps infects the thyroid gland, such as a virus, and then our immune system goes after the virus and the virus's home, which unfortunately is the thyroid gland. Intestinal permeability. This is going to be how gut infections, and not just gut infections, but definitely dental infections and nasal infections, can be contributing to Hashimoto's because we know it's that three-legged stool of autoimmunity. Some of the infections that have most research supporting them are going to be H. pylori. So we saw a reduction in antibodies whenever we have a person who had H. pylori and that was treated. I have seen some of my clients, I have seen them in many of my clients when we treat H. pylori, I have also seen them get into remission, be able to reduce their dosage of medication, and perhaps because of better absorption, and in some cases, some have been able to get off of medications altogether. The Epstein-Barr virus has been associated with the onset of Hashimoto's, and reactivation of this virus can be something that really makes a person sick. So getting that virus under control is going to be very important. Yersinia enterocolitica has 19 cross-reactive proteins with the thyroid gland, and there have been cases of remission reported in both and Hashimoto's disease with this particular pathogen. I haven't seen it as frequently as I see some of these other infections, but I definitely have seen a few cases that that got much better once this was was treated. Lyme disease, the Borrelia bacteria has 60 cross-reactive proteins to the thyroid gland, so this can be a potential root cause. I have seen this in in a subset of my clients, a lot of times the ones that are very, very sick. SIBO, or small intestinal bacterial overgrowth, 50% of hypothyroid subjects in one study tested positive for SIBO. So I, this is a potent inducer of leaky gut, as are many of these. So it's really important to treat that accordingly, and I have found this to be a pretty common thing in my clients as well from an anecdotal evidence. Blastocystis hominis is a very, very common infection that I find in people with Hashimoto's. Whenever we treat that infection, we see a big reduction in thyroid antibodies, big reduction in food sensitivities, and in some cases, remission. So I was really excited to see a study in 2015 that was published connecting, it was actually just a case report, but it connected Blasto to Hashimoto's, chronic urticaria, and IBS, and showed that eradicating it helped the person get into remission. Fish, pylori, EBV, SIBO, a whole bunch of other parasites, yeast is what I'll see a lot of times too. I always recommend for my clients to have work with a biological dentist to screen for dental infections, and we also recommend screening for sinus infections because that, you know, those sinuses dripping into the stomach, as well as those dental infections, can contribute to leaky gut. And you can be eating the perfect diet and having a really clean gut, but if you have these, and you're still going to have a leaky gut.
So I want to share with you guys what I do with clients, and my approach is really, I would say, two-pronged. One of the things that I do is I really help to make them stronger. So I address their vulnerabilities, where we really talk about getting them on a great nutrient-dense diet, making sure they have enough protein intake, making sure that they're digesting their foods properly. So getting them on a supplement like betaine with pepsin is oftentimes gonna be helpful. Sometimes a fat digestive enzyme may be very, very helpful to help them digest some fats. Sometimes supporting their gallbladder, really digestion is gonna be oftentimes imperative for people with Hashimoto's, and that's an important part of consideration, important consideration when we're attempting to help them with food nutrients. So selenium is going to be the biggest one that I recommend, but also I'm looking at vitamin D, iron, the B vitamins, and any other kind of nutrients that they need, may be deficient. And so a lot of times magnesium comes up as a deficiency. Fatty acids. I usually will go through with clients and give them assessments that they can do. And in other cases, is a test like SpectraCell, which is, which can be hit or miss, but in some cases, it has shown improvement, and it has shown uncovered some things that I normally would not have suspected. And then we know that stress is also a big issue. So we're always working on stress reduction strategies with people. If they have issues with, you know, trauma, then we really work on trying to address those. I really like EMDR, which is a therapy that can help reduce some of those traumatic events that people have gone through, and really working with them to put them in a healing state instead of a fight-or-flight state.
And then we go after the triggers. So the key is that we want to make sure the person is strong enough to handle some of the protocols. Some of the infection protocols can be, can be a little bit intense. The adrenal protocols are usually not as intense. However, some of the toxic protocols may be more intense. And we don't always need to do all of these for everybody. But generally, I will work on food, nutrients, stress, and then adrenals and infections with just about everybody. And then we find a way to support their liver rather than doing a really big push like chelation, if whenever possible. So most of my clients that come and work with me have usually read my book, Hashimoto's: The Root Cause. And a lot of clinicians will say that they really appreciate my book because they have clients that will come in to their offices with my book, and they'll actually be the ones that will say, "Hey doc, can you recommend this test for me? Can you do this for me?" rather than the doctors having to recommend things to their clients and the clients being skeptical. So the book really puts them, really helps to motivate them and really make them an empowered patient that is really gets involved in taking charge of their own health. And so most of the people that have come to me are already eating a really, really clean diet. And so nutrition is not a lot of what I do. I might tweak some things, and I'll have the occasional patient that is still eating gluten that comes to me. But for the most part, I'm looking at additional root causes. So I do a toxicity assessment, a toxicity scale. And so 95% of those had moderate to high results on the toxicity scale. 93% of my people who have agreed to be tested have come up with adrenal fatigue. And 78% have come up with some sort of infections. If you guys want to get a guide for some of the tests that I, or all the tests that I recommend, and the Hashimoto's Institute recommends, you can go to hashimotosinstitute.com/kalish, and it will give you an e-book that we have on all of the functional lab tests we love and use to help uncover root causes.
My secret weapon with my clients has been the liver cleanse. So I used to see that some people, we would put them on supplements, and then they would have an adverse reaction to the supplement, and of course, they would be hesitant about taking something else, and they'd feel worse. And of course, I would feel bad because my goal is always to make people feel better, or not to feel worse. So I found that starting off with the liver cleanse can be very, very helpful. And with my particular protocol, 65% of people within my group program saw an improvement in their symptoms after this cleanse. And so 30% of them didn't see a difference, where 5% did. And what I, and 5% felt worse, where as for the 5%, a lot of times they had symptoms of magnesium deficiency. So we actually upped their magnesium intake, and that resolved all of the symptoms they were having. So one particular client that I had was Michelle, and she had been suffering with multiple chemical sensitivities for many, many years. She said she could have walked past a Yankee Candle store without holding her breath. She had arthritis, an elevated TSH. She wasn't on medications yet, that was her choice. Heart palpitations, an elevated thyroid peroxidase antibodies. And after doing my cleanse, my liver support, within one week, she sent me an email and said that she had gone Christmas shopping for the first time in many years with her children without having an attack, having not being able to breathe inside at the mall, and she was able to finally walk past that Yankee Candle store. Her arthritis had resolved, her mood had improved, her TSH had dropped by one point, heart palpitations were gone, and then her thyroid antibodies also dropped. So what I recommend for the liver cleanse is basically, you're not already on a clean diet, we get them on that. We do a green smoothie. You guys can look that up on thyroidpharmacist.com. We do salads for lunch, meat and cruciferous for dinners. Though cruciferous vegetables are actually just fine for people with Hashimoto's. That's a myth that they are goitrogens and they are not to be used. Hot lemon water in the morning, green juice throughout the day, as well as a slug produced at night, Helio cleanse from Designs for Health, or the smoothie, homocysteine factors, immuno detox, N-acetylcysteine, and then magnesium citrate at bedtime. And as I mentioned, some people had to go up higher on the magnesium.
For elusive root causes, what I'll recommend is low-dose naltrexone. So this is an FDA-approved medication. It was used for opioid withdrawal at the standard dose. However, it can be made into a low compounded dose. Generally, doses between 1.5 and 4.5 are gonna be helpful for people with Hashimoto's. And I have seen some impressive remission stories with thyroid antibodies going from the thousand-plus range down to the hundreds, allergies going away, a lot of people reporting improved energy, reduced fatigue, just overall really tones down the autoimmune response. I recommend this for people who have multiple autoimmune conditions, so they are in that stage of Hashimoto's, and for people who have been working on their health for a long time and haven't been able to identify some of their triggers. 38% of people felt better in my survey on low-dose naltrexone. Some of the most common side effects are gonna be irritability, vivid dreaming, and dry mouth. And usually, the irritability, the dreaming, and dry mouth goes away within a few days, a few weeks to a few days.
I wanted to leave you guys with some of the common factors of success, and these are some things that I think you should reinforce with your clients. So really, clients that I've seen that do there, that do best and really get better are the ones that have a positive attitude, they have a support network, they actually celebrate successes. So even if they have 25 symptoms to start with and they get rid of just one symptom, they celebrate that. They get excited about all the things that are improving. They have stress relief hobbies. Of course, they're willing to invest in themselves and their root. They really think.
They're worth it. They're willing to ask for help, and they're also willing to rest when they need to rest.
On the other hand, the clients that don't do as well as course are the ones that are going to be attached to a dogma. So I've had some people who said they were not willing to change their diet, change their medication, take any supplements, or do any tests. So it, of course, in that case, all we can really do is listen and try to encourage the person to make some changes when they're ready.
People who are guru shoppers that just really expect somebody else to do the work for them are the people that are usually not going to do their best. People who have unrealistic expectations, so they want to be off of thyroid medications within three weeks when they've been on them for thirty days. Some people may be caught up in being sick, whereas being sick actually provides some sort of value to them. Maybe they get attention, and it sounds kind of sick and twisted, but in in some ways, people can be doing that subconsciously.
People who are socially isolated, and then those that have what I like to call paralysis by analysis. So they know everything about all those different diets out there and all the different supplements, but they can't decide if they want to go paleo or autoimmune paleo. So they've just been eating the standard American diet for six months because they just don't know which way to choose. So in many cases, you can help those patients by guiding them.
If you guys want to connect with me and get more information on labs, you can go to hashimotosinstitute.com/kalish. And that is our Hashimoto's Institute practitioner training, and you'll be able to get access to the labs that we recommend throughout the practitioner training. So that's that. Thank you so much for having me here. I hope that you guys found this presentation helpful in working with your patients with Hashimoto's.
Isabelle, that was wonderful. Thank you. Just a couple of quick follow-up questions. What was the name of the food allergy testing company that you prefer for this particular situation?
All the tests. So it's A-L-L-E-T-E-S-S. And do they have a bunch of different panels, or is your one favorite panel that you like for other autoimmune?
One of the panels that I like is the IgG test, and they either have 96 or 184 foods that you can depend on. Maybe some benefit in doing IgA testing in some cases as well.
Okay, great. And then one other question, which was, what about the seronegative crowd? How do you handle that?
With the seronegative crowd, obviously, we don't really monitor thyroid antibodies because they're negative. So we do everything the same way with them. And so we're still still gonna recommend selenium, glutathione, and all these other things to reduce the oxidative stress. I like to see the antibodies just because they can be a marker, just one of the many markers of improvement, but also looking at symptoms is going to be what you want to do with those with those particular clients.
Okay, great. And then let me open up the mic for Larry. He had a couple of questions.
I married, hang a second. I'm sorry, I didn't get my button hit right. Where is it? Oh, oh, here they are. Sorry, I'm not used to being not in presenter mode. Berea's Larry, they're all low. Is about how can you hear me now?
Yes. Thank you. So a great presentation. Thank you for that. I just got a blood test back on it, and he has a TPO of 143. His SHBG seems to be in range, maybe a little low on the T3. I'm just wondering, is it possible to have, you know, a TPO of 143 and not have Hashimoto's?
So generally, Hashimoto's is a diagnosis of rather, you know, you can't like rule out Hashimoto's. So if you have thyroid antibodies, then you do have Hashimoto's. If you don't have siren antibodies, you can still have Hashimoto's. He may be in the initial stages where his other markers are, where his thyroid numbers are still within normal limits. So this would be a great time to work with him on the lifestyle interventions, do some of the things that Dan recommends, getting his adrenals, getting his gut in great shape, and helping him support the thyroid with some selenium and other types of things.
Okay. Would you do thyroid, you know, or something to support the thyroid depending on if he was symptomatic and what he wanted to do?
So what is what's interesting is that even in people with normal thyroid function or subclinical hypothyroidism, getting them on the thyroid supplement or thyroid medication can slow down the progression of Hashimoto's and definitely help people with symptoms. So it's interesting. I've been the the tests have been coming back kind of piecemeal and not necessarily in the order that I want, but he is definitely have adrenal fatigue, but he was very low on his tyrosine on the organic acids test. Giving him tyrosine, if that would, you know, support that while I'm waiting for the other tests to come back as well.
Tyrosine can be helpful, although it can increase the production of some of the catecholamines, so it can potentially exacerbate adrenal issues. So I would just be really careful about supporting that and making sure you're simultaneously supporting his adrenals. So obviously, it's a it helps with the production of thyroid hormone, and it can help symptomatically, but just making sure you're always keeping his and renals in mind when you're getting somebody on tyrosine.
Like some adaptogens or something you're thinking?
Yeah, I like there's a one adaptogenic blend I like called the Daily Stress Formula from Pure Encapsulations, and that has a little bit of tyrosine in it, as well as additional adaptogens, and I found that to be helpful in a lot of my Hashimoto's clients where they find they have more energy.
All right, all right. Thanks, Larry. And Lisa had a question too. We've got one more minute, then we're gonna wrap up. And you guys, by the way, this is not over. You can, if you have other questions that pop into your head later, just send them over to me, and we'll start it. Definitely stay in touch with Isabella. At least, you had a question there. Can't hear me?
Yeah, I was just wondering if she has a handout that has more details about the two-week liver cleanse, like how much cilantro to juice, the lemon juice, of lemon water in the morning, that sort of thing.
I do. I have to give that to my private clients. If you if you wanted to send Dr. Dan an email, I could send that over to you.
Okay, wonderful. I'd really appreciate it.
All right, thanks, Lisa. And I'd be happy if you send that over as well. I can post it for all the doctors. And then also, just want to encourage you all who are interested in this area, which is really important, to think about doing some more studies with with Isabella at her Institute. And I think this would be something that really helps round out and complement the education that you would have gotten through me, which is why we're doing this presentation because this is a pretty big gap in understanding for a lot of doctors, and we don't cover it in my class.
Isabella, thank you so much. I appreciate everything that you're doing out there, and we'll be in touch. You all. All right, take care, everyone. Catch up with everybody next week. Bye now.