Transcription
What's one belief about thyroid disease you wish you could erase forever? >> The belief that you're stuck with it, that you have to always not feel well. The thyroid is amazingly resilient. My current record is 45 years of being on medicine and not needing it. And and the big Wow. >> Yeah. And the biggest thing is really symptom management. So, if you're not feeling well and struggling with that, you can feel better.
Welcome to the medical disruptor, a place where well-versed humans can ask the hard questions and get evidence-based answers you won't find anywhere else. Our community is always informed, empowered, and science-backed. Every guest on the show must be clinically trained MDs, NPs, PAs, and researchers who want more and expand beyond their conventional education to find deeper answers for complex health challenges. And me, I'm Dr. E, the NP with a PhD, and I help smart, well-versed humans go from medically gaslit to medically empowered. My guest today is Dr. Alan Christensen, a board-certified naturopathic endocrinologist and a New York Times bestselling author of the Thyroid Reset Diet. I'm going to tell you right now, whatever you think you know about thyroid, throw it out the window because you're about to learn the opposite. This was a really enlightening episode and I cannot wait to share it with you. Dr. Alan Christensen, Dr. C, I'm so excited to have you here. >> Well, thanks Dr. E. I'm happy to be with you as well. [laughter]
Amazing. So, let's just jump right in um and let people know how you're disrupting medicine. You're a board-certified naturopathic endocrinologist. You're a best-selling author on the topic of thyroids, which we'll talk about. Um, you've trained thousands of doctors around the world. Yet, you said your approach to thyroid care is different from both conventional and functional. So, we're going to get to the functional piece later because I think that's really interesting, but we first want to talk about that disruption of conventional medicine. I think you're a double disruptor. What was the moment that you realized that mainstream appro approach to thyroid was just not it? Well, that would have been probably about 1992 during one of my uh three during one of my residency times. And I saw people that had severe symptoms of classic thyroid disease that did better when they went on treatment, yet their conventional doctors told them this wasn't their problem. They shouldn't have been on treatment. So, I saw that happen countless times. >> So, you saw people who were taking the meds and feeling better. >> Mhm. But so initially they were told you don't need the meds but then a different provider went and gave them the meds and they felt better and you're like how is this possible? How is one person telling you you don't need it? >> So that's a headscratcher. >> So what did you discover there? What was the issue? Why are some people getting better on meds? >> Well the highle trend had been always just looking at seeing what was affecting people in the real world and also looking deep at medical literature and kind of comparing the two of those. And what I learned was that there was just a big disconnect between what was known and what was done. You know, best best data and common practices. And there were those to whom they were hypothyroid enough to be symptomatic and deserved to be on treatment but but weren't or were undertreated or weren't really given treatment options. So that was one big disconnect that I became aware of. And back back then, so normal TSH scores were considered normal up to 10 to 15 based on the laboratory. >> Oh, okay. That's the piece I was missing. What? That's crazy. >> Yeah, that's evolved a lot both directions. >> Wait a minute. So, okay, just for reference point for our audience in since I've been practicing um the the normal TSH, just go let's just do a refresher for our audience. The higher your TSH, the less functioning your thyroid is. And I know you're going to go deeper than that, but let's just start here. And so, um you know, at what point, what you're talking about, Dr. see is like at what point do we start this medication. So we have it where kind of around the like just rounding around the TSH of four is where conventional medicine you will usually treat and we know that that's not enough. You're saying that when you were practicing they didn't start medicating until a TSH of 10 or 15, >> right? Yeah. >> So the patient with a TSH of 10 or 15 is dragging. They're exhausted. like I can't even imagine functioning with a TSH of 10 or 15. So they were going to their doctors being told, "Oh, your TSH is fine." >> Well, some are. It's so surprising. There's so many things that are counterintuitive. So, one big study looked at those that were looking at thyroid levels in just random populations, not in those who are symptomatic. The difficulty is that as clinicians, most people we see, we see them because they're symptomatic >> and we assume that their experience is typical of others. But in truth, if you take random populations of people, most even with overt hypothyroidism and severely elevated TSH scores, most are asymptomatic, believe it or not. >> I do believe it because you know what, you're right. Sometimes I'll see patients who'll come in with a TSH of like 43. And I'm like, how are you not sleeping right now while you're talking to me? And they're like, "No, I feel fine." One of the biggest studies looking at how thyroid levels correlate with symptoms in general populations, not the medical population, showed that uh 83% of those with overt hypothyroidism is are asymptomatic. >> Wow, that's fascinating. So, if they're asymptomatic, so so walk me back here before I even go on to my next question because this is this is really interesting. [laughter] We didn't even start yet and we're already walking back. Um, so is your what is your stance then? Is your stance that you're treating this number or will you only treat it if symptomatic? >> Well, so I really don't go so much by my stance per se. There's really good guidelines that we have in place. So hypothyroidism occurs on a continuum and there's versions of that where the gland really has quit functioning and a subset of those people are symptomatic from it. Many aren't and sometimes they can reverse that without medication. actually 60% of the time they can with diet but some cannot and in those cases med medications provide health benefits regardless of symptom control. >> So still coming back to my question um are the guidelines currently to treat that number regardless of symptoms. >> Well current guidelines differentiate hypothyroidism into normal, subclinical and overt. So there's ideas about normal versus optimal and we can set that aside. subclinicals where TSH is mildly elevated. These guidelines differ per age and per other status. This could be anywhere from above normal range of 4.5 up to 10, maybe up to 20 for some populations, but still some secretion of T4 present. So T4 is still being made to a reasonable degree. So that's subclinical. Then we've got overt. That's where the TSH is marketkedly elevated. Most consider over 20. Some there's some gray ranges of 10 and 20 per groups. and T4 is well below range, not low normal, but really suppressed. So that's truly hypothyroidism. Subclinical is actually not hypothyroidism. It's a risk for it. >> And yeah, overt hypo benefits from medication. Subclinical in nearly all cases does not. >> It does not benefit or the guidelines say not to treat. >> Guidelines say not to treat because it does not benefit. It does not reduce symptoms for most people. It doesn't lower the risk of progression of thyroid disease and it doesn't improve health outcomes. So when I say doesn't benefit, guidelines show that treating those with subclinical hypothyroidism, there's some gray gray zones, but in nearly all cases, it doesn't make people feel better as far as group outcomes compared to placebo effects. It doesn't improve health outcomes like disease risks like heart disease, and it doesn't cut their risk of progression to more severe thyroid disease. >> Okay. So, you know what I think we should do here for a moment is maybe give everyone a quick refresher of of TSH, T4, T3, so that they know what we're talking about because I think we've already you like jumped five steps ahead. >> So, you got a little thing about where a bow tie would be. That's your thyroid. It's not that big and it's not blue and fuzzy, [laughter] but yeah, that's somewhere around here. And it controls how your body makes energy, repairs tissues, and allows for nerve conduction. You know, the big big high level. Your brain regulates it. Thyroid stimulating hormone. Your thyroid gland is lazy. It only works when it's stimulated. So when it needs to get a kick in the seat of the pants, that number goes higher. The thyroid makes two primary hormones, T4 and T3. The body actually makes dozens of thyronomines out of those, all many of which have some importance, but those are the big two stars. And so we can measure these things. We can measure how much the brain is yelling at the thyroid. That's the earliest indicator when there's a change in function. And then we can also measure the hormones coming out of it. >> Love that. And so let's talk real quickly about labs because I think one of the outcries among our uh our colleagues is that why are we only testing TSH, right? So what would you recommend should be the most basic labs to really understand what's going on with someone's thyroid? >> Well, to back up one more step. So thyroid disease, most common version is hypothyroidism. Most common cause is autoimmune hypothyroidism. There's not good data there. A lot of folks who have autoimmune hypothyroidism don't have evidence of that on blood tests. In fact, half of them don't. So there's not easy rule outs, but the the prevalence of autoimmune thyroid disease in adult women is somewhere around 20 25% per age, gender, ethnicity, about a quarter or so. And the pres. It's a lot. Yeah. And the presence of the gland really shutting down is somewhere around 1%. And the autoimmune side can cause all the classic thyroid symptoms, the fatigue, the hair loss, the weight gain, the infertility, you name it, regardless of thyroid function. So if a woman is struggling in some way and she's symptomatic, she's somewhere around 20 times more likely to have thyroid autoimmunity than she is to have hypothyroidism. So for me, it's not a matter of digging deep for hypothyroidism. That's the big missing piece. It's screening for autoimmunity. Okay, that's really interesting. So, uh you're saying that some of the symptoms that we've attributed to hypothyroidism is really it should be attributed to the autoimmune piece. >> They can occur regardless of thyroid output in someone who has thyroid autoimmunity. >> Okay. So, like you could be feeling and that's and we're talking about testing for antibodies. Is that correct? Or you're saying that sometimes they don't even have antibodies? >> Well, the easiest first meth method is screening for thyroid antibodies. This is about Hashimoto's thyroiditis and yeah somewhere around half of those with it will have measurable thyroid antibodies in the bloodstream. >> So what we're saying is that so we can have antibodies for a really long time meanwhile the thyroid is functioning fine and you can have all the symptoms because you're currently in the fight of your life. If you're automatic, you can also have health risks, greater cardiovascular disease, risk for certain cancers, risks for infertility, uh risk for babies with autism for moms who have the antibodies. These are all with perfectly normal thyroid function. >> And and so if you just do a TSH or T4, any of these function labs, we're missing the bigger picture of the autoimmunity. >> 20 times more likely to see autoimmunity than overt hypothyroidism. >> Okay, that's really important. So, if we had to, and I'll ask you this again later, if we really want to know, especially if we have a family history, mom has it, my aunt has it, my grandma has it, and I'm feeling the symptoms, and I keep getting this TSH is normal, even they did a deep dive into my T4 is normal. What you're saying is, we really need to check antibodies because you could be cooking for a while and not feeling well during this cooking phase. So on the one hand we have these people who have antibodies but their thyroid is normal which would make sense that if people are getting these thyroid medications for whatever reason this is why they're not feeling better because their thyroid is functioning >> right >> is that correct? >> That's totally that's totally right. And so we have millions of people who are being put on medication maybe because like oh my god you're so fatigued and you have all these things and maybe they're maybe their clinician like sees the antibbody maybe the TSH like kind of creeping up like let's give you some thyroid medication and they take and they're like you know what I really I just don't feel well and it's because we really have not addressed what's happening. Is that accurate? >> Totally accurate. And many many experts are saying now that thyroid medicines these are among the top three prescribed medicines globally and they have been for decades. So, and many are saying that 85% or more on them have no business being on them. That their real problem is autoimmunity or their thyroid is functioning fine, but they have some abnormal level of a marker that's not truly hypothyroid. And these are things that medicines don't tend to help with. And the medicines cause risks. Sure. Every medicine has a potential side effect. What about before we continue on to Hashimoto's, what about hypothyroid that kind of just happens with age, just like a slow decline, nothing extreme? Does that require medication? >> Okay, here's a commercial break that's not really a commercial break because I'm not selling anything. I made you a free guide that will show you exactly how to track patterns, document symptoms, and get taken seriously. I called it build a case. The skills you already use everywhere else, but now you're going to use them here. Click the link in the description to get your copy. Now, back to the show.
Um, I want to back up one step. The medications and risks super briefly. So, people on medication, if they're overdosed, there's many risks for hyperthyroidism. If they're not overdosed, we have good evidence to show that those on thyroid medications, not overdosed, have higher risks for hip fracture, for uh about twice the rate of unexpected mortality and higher risks for 15 different types of cancers. So, it's not a not a harm, it's not just let's try this and see if it works. This is a very loaded decision. So being on this medication even if you're stayed in normal range y or is it just no >> what is it about the medication if it's just supposedly the hormone that your body's making? >> Well the fascinating thing about being an endocrinologist is that we're we're trying to understand the ocean and we can look at the first first foot or so on the surface by our blood tests. There's a whole lot going on behind the scenes. Some of which we know that we we have some we have some guesses about what's going on and a lot of it we're totally clueless. So taking hormones is not the same as making hormones. Even if we're giving the exact same thing the body would make, even if we're achieving blood levels that look normal, it's not the same as when the body's doing it by itself. >> And so we're not exactly sure why, but the studies have shown that if you're if you're >> there's a lot of theories and mechanisms, but basically you're disrupting the body's internal control of a tight regulatory pathway. Thyroid hormones regulate cell turnover. They're implicated with many types of encogenesis genes. They're connected in these ways. And when we're taking away the body's regulation of that, it's all taking place in tissue specific ways that we now lose some control over. >> Fascinating. This is very different than what many of our colleagues are saying, right? So many of our colleagues or maybe the pendulum is swinging and maybe I'm just catching up. So forgive me if that's the case, but I know that it was it was the pendulum was on one side where we weren't medicating. So we we we felt that we were not medicating people early enough that we were waiting for their TSH to climb and they were walking around in a place that's unmedicated. So now we had a lot of functional medicine providers who are like the TSH has to be tight. It shouldn't even be at three or four. It should be between two and three. And like this idea that like we should get people on it as quick as possible to help improve things. and the idea that the the labs and conventional medicine, the range of labs and conventional medicine was not taking into account people who need this. Um, and you're saying you're kind of turning this on its head. You're saying don't that's we should not be rushing to put people on medication. >> There's quite a bit of Yeah. The idea about normal and optimal, it's it's well intended, but it's honestly misguided. There's strong evidence that those who are athyrotic, their thyroid is taken out, they need medications long term. There's clearly a subset of them that will do better with a lower normal TSH rather than a higher normal TSH. There's good evidence for that. Now, many have taken that to mean that everyone with a high normal TSH needs medication and the one just doesn't follow from the other. >> Understood. Is that is that where it came from? >> That's where it came from and that's as far as the evidence goes. There's no evidence saying that un that people are unhealthy when their TSH is higher. You were asking before about how it changes with age, hypothyroidism. Our best evidence now suggests that those who are 65 and older have greater longevity when their TSH is higher, even slightly above range. >> Why is that? >> Uh there's probably ways by which the body is deliberately slowing down basal metabolism and slowing down the rate of certain cell turnover pathways that shouldn't be as active. So, it's part of the body's own homeostatic mechanisms. This is a big deal because I don't know if my audience really appreciates how doubly disruptive this is. [laughter] And honestly, I have to say that when I I saw the topic of thyroid, I was kind of like, okay, I feel like I've talked about thyroid so many times and what you're presenting here is really the opposite of what has been presented by other clinicians. I'm sure you're aware of this. >> I know. This is what keeps me up at night, and this is why I'm doing my best to get the news out there. Yeah, >> this is really this is really revolutionary because I have to say it again just because I don't know if my audience is like truly grasping how revolutionary it is. Like we thought like there I've had people on my show and I know there are still people who are saying this like we need to medicate and get patients into that two to three range as quickly as possible closer to two. um whether they have antibodies or not, like as you get to a certain age, you should be on this and really keeping a tight tight tight look at the TSH and the T4 and and keeping as optimized as possible. Almost using it in the same way as our post-menopausal women when we give them estrogen and progesterone and just really just using that as part of the hormonal arsenal as it was. And you're saying that not only is this not correct, but it's actually dangerous. >> There's risk not risk free. Yeah, >> that's that's amazing. So, who is the segment of the population that you absolutely think needs to be medicated? >> Those that lack a thyroid and those who have overt hypothyroidism that doesn't respond to diet and lifestyle changes. >> Okay. So, so people without thyroid, okay, that's clear. I think that's non-arguable. And then overt is, as you said, is over 20. TSH of over 20. >> The TSH is marketkedly elevated and the T4 is well below range. The thyroid. So the thing is what we a higher TSH does not correlate is not really hypothyroidism. And there's been talk about changing this nomenclature because subclinical hypothyroidism is not hypothyroidism. It's it's kind of like saying you're attempting to speed but you're not speeding right now. [laughter] >> It's it's fascinating. >> That's fair. >> So we should really be focusing on the T4 then. >> Excuse me. >> Should we we should be focusing on the T4? >> Uh it's context. It's both of those things together. So yeah, either in isolation can be meaning different things, but if we're seeing the body begging the thyroid to work, this is Captain Kirk yelling at Mr. Scott to get us into warp. Mr. Scott says the engines can't take it. We're stuck on impulse power. So the brain's begging the thyroid to work. And we can see that there's not much coming out of the thyroid. That's that's hypothyroidism. >> Sure. >> The TSH being high normal, that's not hypothyroidism. The T3 being low normal, that's not hypothyroidism. That's the body's set point. >> Wow, okay, I love this so much. So, >> and you can and there are times in which thyroid hormones can be non-specific stimulants. There's a subset of people who are tired that they can take stimulants and not be tired for a while, but doesn't mean you're really addressing the cause of the problem or doing a good thing for them. You could swap out cocaine for thyroid meds and a lot of folks wouldn't feel [laughter] tired, but they wouldn't be healthier from that. >> They wouldn't be healthier. >> Yeah, that's true. That's that's a good point. Um, so this is this is really honestly so mind-blowing. I'm so so glad you're bringing it. And you said something else that was interesting. You said if they are overtly hypothyroid and they didn't respond to lifestyle. So you're saying don't run there. Let's first do lifestyle. Let's talk about that lifestyle. What should we do maybe before or concurrent with our medication? Well, so for clinicians, uh, for subclinical and even some cases of overt hypothyroidism, but we have good data that 40% of overt hypothyroidism, the most effective strategy you can do as a clinician is to sit on your hands and do absolutely nothing. 30 to 40% of the time, these findings are not recurrent. If you simply retest the person in a few months, they're normal again. >> Wow, okay. But what about the lifestyle? What are lifestyle changes do we want them to do? >> Sure. So, there's there's causes of thyroid disease and contributors, and I really want to pull those apart. You know, you have a you have a ham and an egg breakfast. Well, the the pig made a commitment, you know, and the chicken made a contribution. So, they're not the same. [laughter] >> That's fair. Oh, I like that so much. Okay. >> So, the a cause of a disease, that's a commitment that can make a disease happen regardless of what else is going on. Now, a contributor means if you're going to get the disease, this might make it a little worse, a little earlier in some way, but it wouldn't make it happen if it's all that there was. So, there's endless things that are contributors to like any chronic disease, any way that you've got a chronic disease, if your body is out of homeostasis, it'll be worse. So, that list goes on forever for all chronic diseases. A lot of these things in the natural medicine world are called causes of thyroid disease. They're not. Mold is not a cause of thyroid disease, nor is mercury or lead. These things can be pushing the body out of homeostasis, no doubt about that. But they're not causal onto themselves. There's irrefutably four causes of thyroid disease. There's age, gender, genetics, and iodine status. Those are the only four things known to be totally causal. >> Okay, tell us about those four. >> Well, so of those four, there's one we can move like a lever, and the other three we can't. You know, age, gender, and genetics. and gender and genetics are kind of interwoven. And what we see is that the genes correlating with thyroid disease are predominantly X chromosome genes. And identical twins, if one has thyroid disease, the other's odds are more than 70%. So this is a genetic disease. And the question is, what do these genes do? What are these genes responsible for? And most that show up show up in all versions of thyroid disease, whether that's Hashimoto's or Graves or thyroid cancer. It's the same the same suspects. And what they do is they change the activity of deiotinase enzymes. So in practicalities, what that means is they give someone a different iodine tolerance than someone else would have. Fascinating. Okay. So let's talk about iodine because let's every you know there's this uh iodine kind of paradox where we're like oh take as much iodine as you can we've iodized our salt but it's much more nuanced than that tell us about the iodine >> you know iodizing the salt started in 1924 the reason for that was because a high percent of young men who were recruited for world war I were ineligible because of goiters so around areas with a lot of fresh water like around the great lakes there was this is the goiter belt and it was a public health success. The goer rate went down by about 10fold in those areas. But the rate of autoimmune thyroid disease in adult women went up 26fold, not percent, 26fold in the following decade. And we've seen this now in a hundred other countries that have done iodine fortification. >> Okay. So why what happened? >> It's a really narrow window for some people. for everyone, everyone, for every nutrient. There's a point at where you can get too little and a point where you can get too much. With iodine, it's a narrower window in for everyone. And for some people, it's even tighter. And that's that genetic difference. So, if you've got the genes making you prone to thyroid disease and your chronic intake is somewhere above 200 micrograms per day, your risks become much higher. So, we realized that there was a population of men that we needed to go out to war and they had goiters. And goiters, um, can you give us an oversimplified explanation of what a goer is? >> Just a big thyroid, you know, not not quite this big, but bigger than it should be. >> And it's generally because it's working harder. >> It's trying harder to work. And historically, there have been many parts of the world that have been very low in iodine. We've still got a few pockets. they're mostly gone but in those areas we see higher rates of pediatric goer and also congenital hypothyroidism. So we differentiate pediatric and neonatal thyroid disease that's structural from adult thyroid disease that's functional. >> Okay. And so we had this idea back then that said oh well we must you know this population needs more iodine and if we give them more iodine we can reduce this goer. um which we did. >> Mhm. >> But we never saw and and so then this connection of well there is obviously a connection between iodine and thyroid but then this like in in the psychology of the masses iodine thyroid you need more iodine thyroid. Um, but what we didn't see is for those who are not necessarily who are not iodine deficient, for those who are predisposed to a genetic issue, too much iodine actually throws them over and starts their flare up. Did I get that right? >> Yep. Exactly. >> So the So in in helping one population, we've harmed the other population, which is women with a genetic predisposition for thyroid issues. >> Yep. And it's not something that we've ever really we we haven't discussed as a population. We haven't reversed it. We haven't had this conversation of like because we still could buy iodiz salt. It's still very popular. We're not talking about what that's doing affecting women. Is that you know that's what I am gathering. >> Yeah, there have been a lot of efforts to start to curtail that and they've gone a little further in the EU than they have in the United States. We've been trying to curtail it in iodized dough conditioners. We've pulled it out of uh antiseptics and hand sanitizers that was banned in 2018 when it was found that healthcare workers were exposed to excessive amounts. So it's being curtailed but but yeah it was a success for pediatric goer but a problem for adult female autoimmune thyroid disease. >> Amazing coincidence that Hashimoto's was discovered by a Japanese doctor. You know populations that have higher intakes of iodine have higher rates of thyroid disease. The Japanese lead the world in that. >> Wow. Okay. Makes sense. So we have this, you know, you said age, gender, and genetics, but then we do know that some things can turn genes on or off, right? So you could have the genetics and some people get the disease like like diabetes. >> Sure. >> So what are the things that could turn that on and off and those are contributors, I imagine. >> Not so much. So these are genes that are primarily iodine regulators and they're the thing that's affecting them is just chronic excess exposure. So the story is that there's two main phenotypes, two main ways that human metabolism is expressed for iodine metabolism. One of which is adapted to coastal environments. They can tolerate chronic high amounts and usually detoxify that well. The other genotype is more adapted to inland environments. They can do better on smaller amounts, but they can't detoxify quite as effectively. So iodine is a powerful source of free radicals. That's how thyroid hormones help to spark energy production. But the drawback is when they're unchecked, they trigger the immune response and they damage thyroid cells. >> So, are you saying that in terms of turning this gene on or off, iodine is the main culprit? >> These the body changes expression based upon iodine exposure. So, you you've already got a tendency that's there or not. If it's there and you're chronically overexposed, then it's not a matter of the genes turning on. It's more a matter of the chronic irritation triggering the immune system. >> Fascinating. Okay, this is this is this is a big deal. This is a really big deal if we're saying that you know we carry this gene and iodine is the single thing that can agitate it and bring it on faster or not like that. It's very rare that we can point to a single >> this was the first nutrient found to be correlated with a disease process and the first nutrient identified as essential. We have more data on it than on any other nutrient by far. That's amazing. Um just this idea that you can for a population can be over iodized. Um and >> the most recent one was Denmark. They started fortification in the year 2000. You know, very technological society, very well doumented society. They've got a centralized medical system and they showed they did their fortification flawlessly. They were able to get the average intake up by 50 micrograms per day per person, which was the goal. They did a really good job at it. And for the 18 years they tracked it closely, they saw average of 50% year-over-year increases of thyroid prescriptions, thyroid diagnosis, and use of thyroid medications. >> Wow, that really turns everything on its head. That's amazing. So, now let's talk about So, we talked about the causes, let's talk about the contributors. Let's talk about those eggs. >> They're not that interesting. There's there's a lot of we can talk about. They really don't have big effect sizes or big outcomes. There are things that if your health is off in some way, you should address it. You should sleep at night, not eat junk food. The studies about reversing thyroid disease by controlling iodine. Didn't address any of those sorts of factors. They didn't have people heal leaky gut or add nut build up nutrient deficiency. They did nothing but lower iodine. And the vast majority could reverse adult thyroid disease with that one step. >> But what about this concept? I mean, I could say when I used to treat patients anecdotally as we cleaned up their diet, without question, um, things got better. And are you are you saying that's less about the thyroid and more about just their overall autoimmune status? >> Well, yes. And also the the other factor is that many ways cleaning up the diet can inadvertently change iodine intake. So case in point, iodine comes from many different dietary sources, but the two categories that have changed the most in the last several decades in terms of how much iodine these food categories have are processed grains and dairy products. So a lot of people change or they go gluten-free. They've cut out dairy and they also radically change their iodine intake. So in many cases, they change that even if they didn't realize that's what was going on. So you're saying the cleaning up of the diet, the only factor that is changing is the iodine. >> Well, so one one look at this was the most recent study on the autoimmune paleo diet and its effects upon Hashimoto's thyroiditis. And in the study, they tracked many micronutrients and they had people follow protocols that pretty extremely, you know, cleaned up the diet as they would call that. They cut out wide ranges of food groups, processed foods. And what they saw was that the overall populations that followed this had higher levels of thyroid antibodies and a decreased thyroid volume on ultrasound. Their thyroid autoimmunity got worse and their thyroids became less healthy structurally. Now, what they showed was that the the group average ended up inadvertently raising iodine because of some recommendations for uh pink salt or for sea vegetables. And they argued that despite all the other dietary changes, the fact that their iodine intake went up caused this net worsening effect of their thyroid function. >> So, your book, The Thyroid Reset Diet, it's not about stimulating or boosting the thyroid. It's about allowing it to heal. Can you say more about that? >> Sure. Yeah. So, the studies on low iodine diets that had dramatic benefits were using protocols that were really just meant to be done for most low iodine diets were written for someone who's getting prepped for a procedure and they just have to cut out a lot of food categories for a few weeks. >> And there's really not a lot of concern about the the overall health of the diet or the suitability of the diet or its completeness or whatnot. So I wanted to make a diet that did all the things we know that are relevant for thyroid health and kept at a healthy iodine window. We do know that being at the extremes at macronutrients can be of detriment to peripheral thyroid hormone metabolism. We also know that many phytonutrients have useful effects upon the body's regulation of peripheral thyroid production. So I wanted to do all the things that were good and make a diet that was sustainable for those who are doing it longer term. >> What do you mean by peripheral thyroid production? Tell us what that means. Sure. So, there's how your thyroid is working and what your body does with thyroid hormones. And so far, we've been talking about how the thyroid is working. We also know that if your body is in an extreme state, you may shut down its response to thyroid hormones or convert them into inactive ways. Those aren't really thyroid disease, but there are ways in which it shifts the whole axis of thyroid hormone utilization. >> Example, ketogenic diets. You know, kids don't get a lot of uh thyroid disease. uh adolescence get about one case per every 1250 children. But if these adolescence are on a ketogenic diet because they have seizures, the rate of hypothyroidism becomes more like 27%. So yes, so what we do can change how the body regulates thyroid hormones. >> So a ketogenic diet can make it worse. >> Yeah. Not so much causing thyroid disease, but inhibiting thyroid output and and blunting the body's response to thyroid hormones, inactivating the hormones in the periphery. What about the ketogenic does that? >> Uh the basic body thinks it's in a starvation mode and so it downregulates metabolism. >> Understood. >> Even if you're at a chloric excess and gaining weight, there can be this starvation response to to hormone metabolism. >> Interesting. Because so many people go on keto thinking it will help their thyroid, but this the idea that the thyroid is going to be like, whoa, we need to conserve could actually make things worse. That seems so reasonable. It's been well studied in kids and adults and yeah. >> Wow. So, where's like functional medicine's blind spot here in your opinion regarding thyroid? >> Well, the overuse of medications, uh, relying very heavily on trying to hit optimal levels of T3, not understanding iodine, using iodine tests incorrectly and and then overdosing on it and putting a lot of energy into things that are that at group levels have been studied and not are not consistently effective. And where do you think conventional medicine's blind spot is on this topic? >> Uh not giving credence to the relevance of autoimmunity and not not screening and addressing that in ways >> not seeing it early enough like with the antibodies. >> Not really giving it much relevance at all. It in in many cases they will screen antibodies as a confirmation of a cause of hypothyroidism but almost never are their treatments given. And to the defense, the treatments on offer in most conventional circles are mostly just thyroidctomy or imunosuppressants which have significant side effects, but there's strong evidence that the antibodies cause symptoms and morbidity complications and that lifestyle changes can improve them. So that that's the big blind spot there. >> So in conventional medicine, you would want them to to see it earlier and suggest lifestyle interventions like that would be the ultimate. And with functional medicine, you want them the same, >> but not to run to medications. >> There is still a huge problem of overuse of medications. Then that's not aligned with the guidelines. So yeah, they should just follow their own guidelines better in that regard. >> So there's two there's two parts and whether it's functional and conventional and they kind of share it interestingly. >> Different medicines. They both overuse medicines but they use different medicines. [laughter] >> Interesting. Okay. So they both should look at things earlier which I think functional medicine has really been like loud. >> They've done a better job at that in terms of getting out the idea of testing earlier, more thoroughly, testing for antibodies. They do a better job in that way. >> And then really when we talk about lifestyle interventions besides global health, like really figuring out what's happening with iodine. >> The global health is important. They do a good job at that. That's all great. But the biggest single factor for thyroid health is getting iodine status right. So then and then and not relying on medication or supplements too much. >> Correct. >> We we didn't talk too much about the this idea that's very popular in function medicine about the non-converters from T4 to T3 and these supplements that could help converters. Tell us a little bit about that. >> Yeah, so the idea it's a true thing that there are differences. This is back to peripheral metabolism. So there's T4, T3, T2, reverse T3. Those are among thyronomines. There's actually a dozens of thyronomines that are biologically active and these are regulated primarily by deiotinase enzymes and in many cases the body can intentionally downregulate T3 for example. We need reverse T3. It's actually a good thing in some context. It's not a bad thing. So there's this balance the body strives to maintain. And there are times to where lack of certain nutrients can make that conversion not occur as well as it would. There's also times to where health problems the body will convert deliberately due to health problems but the the issue is the health problem. So the extreme example is a thing called non-thyroidal illness syndrome where someone's in intensive care for congestive heart failure. They will greatly suppress their formation of T3 at the cost of forming more reverse T3. That's not a defect. That's really an adaptation. So the question there in those cases is not so much how do we manipulate that conversion but how do we identify the problems there and take care of them. >> Amazing. I love that so much. Now something that we've really never talked about before is thyroid nodules. Can you tell us what they are? >> Yeah. Common things. So thyroid cells grow rather rapidly on the order of a couple months and you know higher turnover rate and many don't follow the signals right. Many grow at their own pace and they're extremely common. So someone's age and year, is there approximate risk of having a thyroid nodule in a percentage? You know, when you're in your 50s, it's about a coin toss as to whether or not you've got thyroid nodules. >> Thyroid cancer is the fastest increasing type of cancer in women in the modern world. So it's not the most prevalent, but it's by far the most rapidly increasing. And somewhere around 3 to 7% of thyroid nodules contain thyroid cancer. So that's the relevance of nodules. If someone has them, they should be aware of them and they should be tracking them. >> But are they coming just from the inflammation of the hardworking thyroid? Is that where they're coming from? >> No, they're more common with thyroid inflammation, but not exclusively. So, you know, same thing with goiters. They can occur independent of thyroid function or thyroid inflammation. They can be just clearly aberant cells with wrong growth signals. Um, can is it common to see thyroid nodules on people who don't have thyroid issues? >> It happens. Yes, it's not not uncommon at all. >> It's not uncommon. It's just we're not as >> it's more common with thyroid disease, but it's not the least bit unusual without thyroid disease. >> What it what about the thyroid disease makes it more common >> localized changes in cell turnover rates and more more genetic variations? I saw on one of your Instagram posts that there are things that people can do if they have nodules. Tell us about that. >> Yeah, there's really good evidence that a couple things make a big difference. So, one of which is just being in a healthy iodine window. There's that one again. Other one, if someone has uncontrolled TSH levels, like marketkedly elevated, that can stimulate the nodules growth. Uh we also know that being in a state of weight gain and high insulin can worsen nodules. So growing all over can also mean growing localized in bad ways. And then neutrauticals, there have been some pretty decent studies. We could see more, but placebo studies showing that certain neutrauticals have raised raised the risk raised the likelihood of nodules shrinking rather than growing. >> Like which ones? >> Good data on uh nigella which is a seed extract. also good evidence on uh bosellia which is a plant resin >> uh spirulina specifically freshwater versions of that >> and prunella which is a Chinese herb. So all things shown either in combination or independently to decrease the size of nodules at a group average >> and so this would be a supplement you could definitely get behind. I imagine um I know that you also have created some supplements. Is this one of the supplements you've created? It is one is called nodule control and it's just the exact things used in human clinical trials showing that on average there's about a 75% reduction for typical people with nodules. Many don't see reduction. Some see more than that. So the basic idea is if someone has nodules and they're told that we can watch, we can monitor for that then doing things like neutrauticals or lifestyle changes is totally reasonable to help just hedge your bets. >> Sure. is the idea and what is the reason we want to shrink the nodules like you know >> to cut the risk why the cancer risk >> to prevent the risk from becoming cancerous. So having nodules just having the nodules increases your risk that they will >> of nodules become cancerous and the more they grow the greater that likelihood is. >> And so if we're monitoring why not take these supplements to help shrink it and reduce that risk. If you're at a state to where your doctors want to do procedures, you should do the procedures. But if you're at a state to where watching is acceptable, that's totally reasonable to help your odds. >> Yes, my audience would definitely not forego a recommended procedure just to take a supplement. So >> glad to hear that. >> Of course, [laughter] >> not true for all audiences, but I'm glad to hear that. >> Yes, if there someone's recommending a biopsy, my audience, if you're not doing that, then I don't know, you might be in the wrong place. Remember, this is the medical middle where we take all the things that from all sides and make the best choices. For the listener who suspects that their thyroid is off or maybe they're on medication but they still feel awful, what's the very first step you want them to take tomorrow morning to start restoring their thyroid balance? >> Different situations. Um, so the one that feels off and isn't sure, you know, screen for autoimmunity. That's the big thing. Medication not going well. both cases and actions that they can do on their own is is regulate iodine. You know, be aware of what their intake life is. Uh the best way is by doing an inventory. There's a lot of tests that aren't all that useful. There's a website I made. It's iodineventory.com.
You can get a free check to see just by tracking what your typical food categories and amounts and thyroid meds and supplements are. You can get a good sense of your iodine intake and it'll it'll tell you if it's way out of range or not. So, that's the easiest thing to do. For starters, getting adequate selenium is helpful as well. That can make your body more able to buffer iodine than it would be otherwise. Have a couple Brazil nuts most days. That that's a useful way to get some easy insurance for that. So, those are some simple action steps.
I love that the I hidden iodine in your diet and the fact that you have this um tracker is amazing. I love that so much because I don't think we know. It's not it's not something that any of us focus on. Maybe you do, but I think most of my listeners have never tracked their iodine before.
It's not easy to track. The amounts vary so much, but yeah, you can get a good gauge in that by knowing about your food categories and typical frequencies.
That's that is that is a great first thing to do tomorrow morning. Anyone who has questions, go do that immediately. Now, if there was, you know, if there was one belief, one myth that you want every listener to re-examine about thyroid disease that maybe is keeping them stuck, what would it be?
That you're stuck and that the things you do don't matter and if you're on medications, you got to be on them for life. So, if you've got a thyroid, you need medicines. These same things will help the medicines work better for you as well. But barring that, the thyroid is amazingly resilient. And there's evidence now that people I've seen people current my current record is 45 years of being on medicine and not needing it. And and the big Wow.
Yeah. And the biggest thing is really symptom management. So, if you're not feeling well and struggling with that, you can feel better. That's the thing to hold on to is don't think that you're stuck not feeling well. You know, maybe the the last steps or the last few steps haven't been the ones to really bring it home, but something still should be. So, yeah, don't give up on that.
Oh, I love that so much. I'm going to have some rapid fire questions. Some of them we've covered, but it's nice to have them in blurbs if that's okay with you. One supplement that's doing more harm than good.
Iodine. Easy one.
Easy one. Okay. What's one food that's wrecking thyroid balance but most people think is healthy?
That's easy. That would be seaweed. A recent study showed that it also raises the risk of thyroid cancer and also others have shown that it raises the risk of breast cancer.
What's one belief about thyroid disease you wish you could erase forever?
The belief that you're stuck with it or that you have to always not feel well.
I love that so much. Is there anything else you want to tell our shared audience?
Just that just know that your body is amazingly resilient and that it's good to think about how to support it and not how to take over. You know, do things to help your body work better, but try not to do things that take away your body's abilities, like replacing the things it would make by itself.
Dr. C, it has been just like completely amazing to have you on the show. You have undone a lot of what we know about thyroid, and I'm so glad that you were part of our show today.
Well, I'm happy we got to connect and yeah, thank you for what you're doing and and thanks for sharing good information.
Of course, that brings us to the end of another episode of the medical disruptor. This is what medical disruption looks like. Not blaming, but exposing the limits of the training and pushing the conversation forward. You're part of a community that doesn't exist anywhere else. A safe space for people who want real scientific information, but also want to ask questions without being made to feel crazy. Our community is informed, empowered, and sciencebacked. Ready to go deeper? Dr. fatlam.com has my book, PDFs, newsletter, and a link for consults. Until then, keep asking questions, keep asking for more, and keep disrupting.