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Today we're talking about all things Hashimoto. What is it? How do you know if you have it? What are the symptoms? What can we do about it? Let's dig in.
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Hashimoto is different than hypothyroidism. I want you guys to separate these things out in your mind as two completely different entities. Okay, so Hashimoto is an autoimmune condition. It's an autoimmune disease where your body actually mounts an immune response against itself and begins attacking your thyroid gland. With that attack, over time, slowly you lose thyroid gland tissue, hormone-secreting tissue, to that inflammatory attack. That hormone-secreting tissue is then left as kind of scar-y, inflammatory tissue that doesn't secrete hormones as well. And therefore, over time, Hashimoto is a common cause of hypothyroidism or low-functioning thyroid. However, you can have Hashimoto without hypothyroidism, and you can also have hypothyroidism without Hashimoto.
Some research shows about 80 or so percent of people with hypothyroidism have Hashimoto's antibodies. Those are the statistics we see in studies. I actually find at Modern Thyroid Clinic that the incidence of Hashimoto with hypothyroid patients is actually lower in my experience. And I honestly attribute that to just environmental load, environmental toxins slowly breaking down our thyroid function over time, separate than an autoimmune component or Hashimoto. But needless to say, research says about 80% of people with hypothyroidism have Hashimoto.
What does that mean? It means really, if you have hypothyroidism, if you're being treated for a thyroid condition, your clinician really needs to be checking for Hashimoto's antibodies. You should know if you, in fact, have this because the treatment for this is very different than treatment for plain old hypothyroidism.
So, what do we need to actually know if you have Hashimoto? Well, you need what's called thyroid peroxidase antibodies, as well as thyroglobulin antibodies checked. Okay, my ranges for differentiating Hashimoto for TPO antibodies, and of course, I'll put all of this in the show notes, is if you have antibodies less than 34, you're not in a Hashimoto state. You do have antibodies, and we need to keep track of them. We need to monitor them so that we can intervene if they ever are to increase to a degree that you truly do have Hashimoto. Thyroglobulin antibodies on the other end, ideally, are less than one. Okay, so I'll include that in the show notes for you.
Symptoms associated with Hashimoto. Like, well, how would I know if I need to be screened for this? What would make me think I should look into this? So truthfully, most symptoms of thyroid conditions come from the hypothyroidism component of a thyroid condition, not necessarily the autoimmune thyroid component. Meaning, what's truly creating symptoms in the mass majority of people and truly debilitating their lives is low-functioning thyroid or hypothyroidism or low thyroid hormone output or poorly managed medication. However, if we want to think generally about symptoms of thyroid conditions encompassing both Hashimoto and hypothyroidism, they are the following: they are fatigue, brain fog, weight gain, cold intolerance, dry skin, brittle nails, brittle hair, hair loss, hair shedding, right? The loss of the outer portion of your eyebrows, cracking on the bottom of your feet, elevations in your blood sugar or cholesterol on labs, depression, low libido or low sex drive. Trying to think if I left anything out. Dizziness. Someone brought that up in a question on social media. One of my first symptoms that I actually experience if I forget my thyroid medication or, um, I'm sensing that I'm getting to too low is dizziness, kind of feeling the swimming head feeling. Um, so those are the big ones for sure.
What differentiates Hashimoto's symptoms from hypothyroid symptoms is honestly very commonly people with Hashimoto's or autoimmune thyroiditis, a form of autoimmune disease involving your thyroid, is a goiter. And what a goiter is is like this fat pad almost on your lower neck. It looks like a little fat roll below what we refer to as your Adam's apple. Um, swelling there, tightness, kind of difficulty swallowing at times. And what that is is the specific localized inflammatory reaction of your thyroid gland is creating this expansion of it, and you can, it's visible in many cases, or you can feel it internally with that difficulty swallowing. So Hashimoto people still often experience hypothyroid symptoms, but those symptoms are honestly fixed if we can properly manage your medication, if we can properly manage your thyroid hormones. The swelling of that thyroid gland is often fixed if we can address the Hashimoto's.
Okay, I'm a perfect example of someone who used to have a massive goiter. I've posted pictures on my social media, on TikTok and Instagram, showing you guys, hey, look, this is how bad my Hashimoto's used to be. I also look like a completely different person because I was so inflamed. It was horrible. Um, but you can visibly see now I don't have a goiter anymore. I don't have any swelling in my thyroid gland at all. In fact, and I, in fact, don't have Hashimoto anymore. My Hashimoto has been in remission for over 10 years. Regular medicine would tell you that's not possible.
So that's kind of our next topic that I want to bridge. There is a vastly different approach between regular, run-of-the-mill primary care or endocrinology approach to Hashimoto versus a functional or integrative or holistic approach to Hashimoto's. And it's kind of jarring in the differences. So, you know, traditional approach says, hey, look, we checked your antibodies, you have Hashimoto. You basically won the reverse lottery. This is totally random. There's actually nothing you can do about it. We never even need to worry about checking these antibodies again because we know you have it. We only need to worry about checking your thyroid function labs and seeing if we can intervene with balancing your hormones. But your Hashimoto, never even need to worry about that again.
Functional and integrative medicine views autoimmune diseases as modifiable. And a lot of the ways that we work to modify them are working on inflammatory pathways, reducing inflammation in your body and in your exposures, or improving detoxification from inflammation, etc. And that can directly correlate to a reduction in your antibodies.
Why does it matter if you have an antibody reduction? You know, what's the purpose? Well, the higher your antibodies are, the more of an immune response your body is having on your thyroid gland. The higher that attack, the more thyroid gland you're actually losing in real time. So if we can reduce those antibodies, that translates to number one, preservation of more of your thyroid gland as you age. Number two, when you have one autoimmune disease, you're actually at an increased risk of developing another of over 30% compared to the regular population that doesn't have an autoimmune disease. Okay, so if we can reduce those antibodies measurably, then we can infer that that is a risk reduction in your risk of developing another or more serious autoimmune disease. Now, later, 10 years down the road, which is obviously hugely important. And then the last great, great thing about reducing these antibodies is that shows an objective marker of a reduction in your body's inflammation. And you know what, guys? Inflammation makes you feel crappy. Like it makes you feel foggy, it makes you feel worn down, it makes you feel heavy, you can't think clearly, you're a little depressed. Like it makes you feel like crap. So if we can measurably reduce your body's inflammatory level, so in fact, you don't even actually have to get your antibodies completely into remission to get a ton of benefits of, you know, inflammatory reduction. Um, ideally, we would get you into remission and get those antibodies below those thresholds we talked about. My threshold for remission for TPO or thyroid peroxidase antibodies is 34. My threshold for thyroglobulin antibodies is less than four, ideally less than one. But if someone hits less than four for thyroglobulin and less than 34, they're in remission. Even if you don't accomplish remission, but your antibodies drop 30, 40, 70%, that is huge for again, thyroid preservation, risk reduction in autoimmune disease, feeling better on a day-to-day basis. So don't buy into the idea that there is nothing you can do for your Hashimoto, that you don't need to even check these antibodies anymore. We actually check antibodies at Modern Thyroid Clinic every three months, and we see measure, basically, our progress. We'll intervene, we'll make an intervention, decide what we want to do, measure antibodies before that intervention, and three months later to see how well it's actually working. You can harness the power of this information in an extremely powerful way.
So let's talk about my favorite ways to reduce antibodies. My favorite ways to work to get people into remission. So let's lay a little bit of foundation here. Number one, I am not an extremist. I know a lot of people in functional medicine are. I know a lot of people in the wellness sector expect you to do unrealistic things that they do not do or can't sustain doing or no one can sustain doing over time. And that is not how I roll. So you can find those people easily. You can find extremists. You can consult with them, and they'll take away everything all at once in your life. And if that's the route that you want to pursue, you can. That is not the route that I choose to pursue as a clinician. It's not a route I choose to pursue personally or to escort my patients through. Um, I think it can be very damaging. And in all honesty, there are very, the things that we do at Modern Thyroid Clinic that make the most difference in people's quality of life to get them back their lives are very low intervention on their part. They don't need to do a lot of work to accomplish that. So essentially, I want people's effort putting into reducing their antibodies to be worthwhile. And I also generally do not start to work on antibody reduction or change anyone's lifestyle ever until I give them the energy, the capacity, the motivation to do it by balancing their hormones and creating that energy in their lives. So wanted to just put that all out there. But after, you know, after they work with us at Modern Thyroid Clinic for a treatment cycle or two, people feel well enough to take on a little bit.
So some of my favorite things, especially, um, you know, in the beginning, are nutrients. So glutathione. Glutathione is our body's most potent antioxidant and anti-inflammatory agent that we actually make ourselves. Um, it combats inflammation, it combats autoimmune diseases, and it very often correlates as being at a low level when people have an active autoimmune condition. Meaning, a lot of what protects you from autoimmunity is having enough glutathione naturally available to your body. And a lot of people don't produce it well enough. A lot of people's genetics are poor for glutathione production. Those people, you'll commonly see this family history, this genetic kind of pass-on gene of autoimmunity. And those people often have poor glutathione. So glutathione, I use it orally. Um, I often have my patients take 500 milligrams before bed. Or I use it transdermally. And I love transdermal glutathione specifically for autoimmune thyroid issues like Hashimoto or Graves. I have my patients place the glutathione cream directly on their neck so that it absorbs transdermally and is most potent at the site of application. Um, I'll put some of my favorites in the show notes. I have my patients do topical glutathione ideally twice a day as opposed to once a day like oral. I do not utilize liposomal glutathione. It's amazing, it's wonderful, it tastes and smells like rotten eggs, y'all. Let's, let's be real. If I am not willing to do it, I am not asking my patients to do it. And I am not consuming rotten eggs twice a day or once a day. Like, it's just not happening. So again, that's a line that I have as a clinician. Don't hesitate at all to utilize liposomal glutathione if it's worked for you and it's what your clinician utilizes and you don't mind it. But again, I just, I don't ask people to do things I'm unwilling to do myself. So that's one.
Another one is selenium. 200 micrograms of selenium in research has shown to reduce antibodies over the course of, I believe it was six months with that study. Um, it's another one. I, I find it either works or it doesn't. So, you know, test and retest.
Some other things that I like to do are gut testing. Looking at your microbiome. Single-handedly, if I had to pick like one area of your body to influence, um, and change to create a healing mechanism for Hashimoto, it is very much your gut. So your gut is the center of inflammation in your body, hands down, in a lot of different mechanisms. But one way is looking at the microbiome. Do you have an imbalance of good and bad bacteria? Do you have a proliferation of yeast? Do you have potentially leaky gut, which I find to be a lot more common than the functional medicine world kind of purports. Um, but we test this at Modern Thyroid Clinic to try to clean up any significant gut imbalance. We use a company called Doctor's Data, which uses PCR testing, the most kind of valid form of testing. And then we work to heal that. Candida, especially, I find to be reasonably frequent in my patients, and it really can disrupt their lives and create weight gain. Um, candida often causes intense, intense carb and sugar cravings, especially in the evenings. So, um, it just really wreaks havoc from an inflammatory standpoint, from a metabolic standpoint. So it's a big one.
Um, you know, iodine is another nutrient that's kind of controversial. And I, again, don't usually think about things as black and white. So there are very pro-iodine people in the thyroid community that think you need to utilize a ton of it. And then there are people that are the anti-iodine people, or that say, listen, if you can actually restrict iodine, you can reduce your Hashimoto's antibodies. I specifically, in my patients with Hashimoto's, am careful about iodine. So iodine can certainly create a situation where your autoimmune thyroid issue worsens. It can directly increase antibodies. It can increase antibody activity. And, you know, Dr. Alan Christensen, which you all know I love and adore that man, and he is extremely well-researched and respected in the thyroid community and has been a longtime mentor to me, released a book a few years ago. I actually have it here. I think it's called The Thyroid Reset Diet, but I can't quite see the name of it. Um, and it works to actually reduce and restrict iodine in your natural diet. And several of my patients went on this protocol, and y'all, we had stalled at antibody reduction for a couple of years, specifically in one of my patients. She went on his diet, her thyroglobulin, which are actually historically pretty hard to influence as compared to TPO, consistently reduced every single appointment in a way that we hadn't seen since the beginning of our work together. So it took that last little bit of residual antibody activity and shut it down, and that was with restriction of iodine completely. So at that point, I was like, wow, you know, this is really, really fascinating. I'm actually seeing this work in front of my eyes. So feel free to check out his book, Dr. Alan Christensen. I will also include that in the show notes.
Let's talk about diet. I know you're scared. Don't be scared. Everything's okay. All right. So I swear, some people literally do not come to Modern Thyroid Clinic because they're afraid we're going to meet them on day one and be like, listen, you're going to go on an autoimmune protocol forever. You're going to be gluten-free forever. You need to be paleo forever. And that's not how we roll. So, does food impact your antibody levels? Yes. Is it an extremely powerful way to reduce antibodies by changing your diet? Absolutely, 100%. But again, this goes back to, I do not ask people to do things that I have not done, am not willing to do again, and maintain myself. So for this reason, I am not a proponent of the autoimmune protocol or the AIP diet. In my opinion, it is overly restrictive and it is unnecessarily restrictive. So could it possibly reduce your antibodies? Absolutely. Could you possibly reduce those antibodies with a less restrictive diet? Yeah, most people can.
So my way of pursuing diet changes with my patients at Modern Thyroid Clinic is by doing inflammatory food testing. IGG testing. This is not testing that you get when you go to your allergist where they prick your skin and they measure your IG antibodies. Those are like, oh my gosh, I ate crab, I got hives, my tongue swelled, I used an EpiPen. That's really easy to determine if you have a response like that. When you eat crabs, you have a physical manifestation of that allergy, and it's pretty easy to pin down. Chronic, insidious inflammatory responses to foods do not respond that quickly. And in fact, measurably have a half-life of about 26 days, meaning that immune reaction lasts close to 50 days in your body. So it is not noticeable often immediately after you eat. It's this cumulative inflammatory issue that happens over time, and then you feel tired, fatigued, brain fogged, swollen, puffy, all of those types of things. I forgot that symptom earlier too when talking about symptoms of Hashimoto: puffy face. That's a big one. That was one of the biggest ones I remember early on was like telling my mom, I don't even look like myself. Like, what's going on? Like, I look in the mirror and I'm unrecognizable to myself. So anyway, sidetrack.
But so with inflammatory food testing at Modern Thyroid Clinic, we use a company that measures about 200 foods. Unfortunately, it's not available direct to consumer, meaning you can't order it yourself. It has to be ordered through a clinician. But there is one called Everly Well that is direct to consumer. It's not as good in that it doesn't check enough foods, in my opinion, to determine patterns. But still, it's something, right? Which something is better than nothing. And so, you know, I measure foods, food inflammatory responses, and then we specifically take out foods that are driving inflammation in each unique patient. Okay, we measure antibodies before we change their diet for three months because again, the half-life of that inflammation is about 26 days. We remeasure their antibodies, and then we see how those dietary changes have impacted their levels measurably over time. We continue that until we're able to get antibodies low enough where we can start to incorporate foods back into the diet.
Okay, there are patterns for people with Hashimoto of what foods create a reaction. And some of the things that you hear online have truth behind them. Like gluten. Gluten is a common issue that we see create inflammation in our patients with Hashimoto. It's not number one, though, guys. And had you asked me 12 years ago, I would have been like, it's got to be gluten. It's for sure, like, it's gluten, right? And until I tested and retested and tested and retested, I figured out it's actually gluten is not number one. Dairy is number one. Which, you know, pros and cons there. It's, it's harder to take out dairy and replace it with something tasty, whereas gluten, you know, if you wanted to track down a gluten-free pizza, you probably could. That's reasonably tasty, or I think so. A gluten-free or a dairy-free pizza is a lot harder, in my opinion, to be honest.
But so if I share these with you, of course, they're not one-size-fits-all, but at least it empowers you with some information of what perhaps you could try to do to reduce your own Hashimoto's antibodies. So number one is dairy. Right? Number two is gluten. Number three is grains. Number four is eggs. Number five is legumes. And number six is nuts and seeds. Okay, by the time you get down to nuts and seeds, it only accounts for like 5% of people. So most people don't need to be on like an autoimmune protocol, an AIP diet. Like, if 5% of people need that strict of a diet, then we're over-restricting so many people by putting them on that diet. And again, it's hard to sustain. It's difficult. It's a struggle. And that's not what we're going for.
So my recommendation is, if you would like to try to change your diet and see if it influences your antibodies, what do we do first? We measure our antibodies. You check your TPO, you check your thyroglobulin. And then pick one food group, y'all. Just one. I recommend gluten or dairy to start. Either or. Don't do both. Don't set your up, don't set yourself up for having to be overly restrictive for the next six months. So pick gluten or dairy. For example, dairy. Go dairy-free for three months. Recheck your antibodies. If they've dropped, continue. Then six months in, say, okay, now I want to try to take out gluten. Measure antibodies before, take out gluten, measure them three months later, see how they've changed. If they're not reducing, right? If you go dairy-free and you're strict for three months and your antibodies haven't changed, guess what? I would say you get to incorporate dairy back in. Then try gluten, right? So that way you end up only taking out the foods that are absolutely necessary for you. Okay, I hope that's helpful for y'all. But measure and remeasure. Test and retest. That is the key.
You know, another easy way that I've seen antibodies reduce, one of my patients posted about this online last week, is intermittent fasting. So I've seen antibodies reduced time and time again with no dietary changes, with only intermittent fasting. So they eat all types of foods, they just eat them in a shorter window. And I want to do a whole episode on intermittent fasting. I'm going to see if I can bring on my friend Cynthia Thurlo, who's brilliant. Um, we've been talking about intermittent fasting together for years now, and it really is a powerful, powerful tool to reduce inflammation, even increase energy, increase cognition, um, heal the metabolic damage that hypothyroidism creates. But briefly, if I wanted to give you my quick synopsis about intermittent fasting that I utilize with my patients, because again, I'm all about giving you guys tools that you can use right now today to help get your life back. Okay, I recommend women intermittent fast four to five days a week. No more. So take off the weekends, take off days that you have plans. I recommend eating with my patients in an eight-hour window. Outside of that window, you don't do anything that raises your blood sugar or insulin. So no food, obviously. You can have coffee and tea, but you need to be extraordinarily careful about what you put in that tea and that coffee. It can't have sugar, it can't have carbs, it can't have protein. It needs to be less than 50 calories. So find your workarounds. I have posts on Instagram and TikTok about how I make my coffee to work around intermittent fasting because I will not fast if my coffee tastes like crap and I can't have it. So eight-hour window. That window does not need to be the same every day. Some days it can be 10 to 6, some days it can be 9 to 5, 12 to 8. Let it be flexible according to what you have going on that day. Let it be flexible according to if you're hungry in the morning versus the evening that day. The beauty of intermittent fasting that I think is missed in the world of wellness is that it's flexible, y'all. It doesn't need to be so darn rigid and dogmatic. Harness that. Don't buy into the extremism. And it is an extremely powerful way to reduce antibodies.
My favorite way, or one of my two other favorite ways of reducing antibodies, and the thing that I've used for the last 10 years, especially in cases of severe Hashimoto, 100% of my Graves patients are on this, I'm on this, people that struggle with inflammation, like they're just constantly managing their inflammation. My favorite way is LDN, or low-dose naltrexone. This is a medication. It's a microscopic dose of a medication, but it is a med. It actually triggers and works by your body changing its physiology to modulate your immune system in such a way to reduce inflammation of any kind. So it actually doesn't matter where it's coming from. It just turns down your body's inflammatory and immune response to the offending agent, which is really powerful. It does this in a way that is not immunosuppressive. So it's not like steroids that lower inflammation. It actually turns down your inflammatory response while improving your immune function, which is extremely unique. I have seen LDN reduce TPO antibodies 500 points in three months, y'all, with no other lifestyle changes. It's pretty incredible. It also has anti-aging benefits. It can help protect your body against cancer because it modulates your immune system in a way that can upregulate and prune off weak cancer cells. I've seen a study against its benefit for preventing more serious cases of COVID and long COVID. Downsides are honestly really darn minimal. You pay for it out of pocket. It's usually $100, $120 bucks every three months. Vivid dreams, definitely the most common side effect. And occasionally, about 8 to 10% of my patients will wake up a little groggy in the morning because you take it at night. That almost always goes away. For whatever it's worth, I've probably put, I don't know, two to 3,000 people on LDN over the course of my career, and I've probably had five people stop it from side effects. So exceedingly well tolerated.
My last way that I'm not going to go deep on in this for reducing antibodies, but I will do a complete separate multiple episodes about this, is GLP-1 agonists. The new class of weight loss medication. These drugs, in my opinion, are widely grossly misunderstood. And they have benefits for long-term health outcomes that are not being talked about enough. And those benefits are completely outside of weight loss. But one of them in the thyroid community and the thyroid sector that I've personally witnessed over and over and over again is a reduction in antibodies. So I am seeing these meds reduce people's Hashimoto's antibodies significantly and quickly. So we'll talk more about that in another episode.
Okay, I think that is a lot of the information. I will post a Q&A session on social, so tune in there, and we can follow this conversation up with some questions. And I so appreciate you guys tuning in today. I'm excited to play a part or some role in your ability to get your life back, even if not my patient. So thanks for tuning in. Thanks for being here. And remember, there is no reason to still have thyroid symptoms.
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