93. Dr. Izabella Wentz: 90% of Thyroid Problems Are Autoimmune - Here's What Doctors Miss

Most people think thyroid issues are just about taking a pill, but over 90% of hypothyroid cases are actually Hashimoto's—an autoimmune condition attacking your thyroid gland. In this episode of Extend, I'm joined by Dr. Izabella Wentz to dive deep into why standard TSH tests fail for years, how artificial sweeteners trigger thyroid dysfunction, and the gut infections that could be destroying your thyroid. We also discuss the lifestyle interventions that can reverse Hashimoto's, the thyroid antibody tests your doctor isn't running, and why an Epsom salt bath might be more powerful than you think. Dr. Izabella Wentz, PharmD, is a clinical pharmacist who has dedicated her career to addressing the root causes of autoimmune thyroid disease after being diagnosed with Hashimoto's thyroiditis in 2009. She's the author of three books and founder of ThyroidPharmacist.com. We Also Discuss: Why Standard TSH Tests Miss Thyroid Disease for 5-10 Years The Complete Thyroid Panel Every Person Should Demand: TSH, T3, T4, Reverse T3, TPO, TG Antibodies How Artificial Sweeteners Trigger Autoimmune Thyroid Disease The Gluten-Thyroid Connection That Can Reverse Hashimoto's Gut Infections Behind Thyroid Dysfunction: H. Pylori, SIBO, and Blastocystis Hominis Why Thyroid Antibodies Attack Your Brain, Fertility, and Mental Health—Even Without Thyroid Hormone Problems The Selenium + Myo-Inositol Protocol That Reverses Early Hashimoto's Why Iron Deficiency Makes Thyroid Medication Useless Synthroid vs. Armour vs. T3: Which Thyroid Medication Actually Works The Hashimoto's Personality: Stress, Trauma, and Autoimmune Disease Red Light Therapy and Cold Laser for Thyroid Regeneration Why Your Thyroid Symptoms Might Actually Be Low Cortisol Thank You for Our Sponsors: Pendulum: Use code DARSHAN or use the link https://pendulumlife.com/discount/DARSHAN to get 20% off Pendulum membership first orders. Learn more about Dr. Shah: Website: https://www.drshah.com/ Clinic: https://www.next-health.com/ Instagram: https://www.instagram.com/darshanshahmd/ Learn more about Dr. Izabella Wentz Instagram: https://www.instagram.com/izabellawentzpharmd/ Website: www.thyroidpharmacist.com https://thyroidpharmacist.com/gift/?fbclid=PAZXh0bgNhZW0CMTEAAac_H_XNWbn75Z35APxSm_kbhOBwyDhshNpsXIjeg5Lk7FUFFnLxm5EZhSuNlA_aem_3QJVRmzPlKNRpy-xBMA3yQ

Speaker names marked ? are inferred from speaking time and the show’s known hosts — they are not voice-verified.

• 0:03Dr. Darshan Shah?

  Welcome to Extend with me, Dr. Darshan Shah, a podcast dedicated to cutting-edge science, research, tools, and protocols designed to help you extend your health span. Having become one of the youngest doctors in the country at the age of 21, and trained and board-certified at the Mayo Clinic, I've accumulated three decades of practice as a board-certified surgeon and longevity expert. Over that time, I've discovered that a mere 20% of health knowledge yields 80% of the results when it comes to your health span. We're living in a new era where we are creating a new healthcare system, no longer focused on disease management, but achieving optimal health and vitality. Join me as I interview world-renowned experts, offering you a step-by-step guide to proactively avoid disease, and most importantly, extend your health span.

• 0:49Dr. Darshan Shah?

  Today on the show, we're going to be joined by one of the most influential voices in integrative and functional medicine. Her name is Dr. Isabella Wentz. She's a clinical pharmacist, a researcher, and the bestselling author of the book known as The Thyroid Pharmacist. Dr. Wentz holds a doctor of pharmacy degree and is a fellow of the American Society of Consulting Pharmacists. But it was her own diagnosis of Hashimoto's thyroiditis in 2009 that set her on her mission to uncover the root causes of autoimmunity and chronic fatigue. Since then, she's helped millions through her evidence-based protocols that have addressed the guts, the adrenals, mitochondria, and the immune system, not just in the thyroid, but throughout the entire body. Her books include Hashimoto's Protocol,

• 1:33Dr. Darshan Shah?

  The Adrenal Transformation Protocol, and Hashimoto's Food Pharmacology. They've become essential reading for anyone seeking to reverse the chronic symptoms of thyroid disease. Her latest work centers on how to reset the body's stress response, and she has research published in multiple publications around the world. Dr. Wentz is here today to talk about what's really driving thyroid dysfunction and burnout, and what we can do as patients and clinicians to restore balance. Let's welcome Dr. Wentz to the show.

• 2:06Dr. Darshan Shah?

  Dr. Isabella Wentz, so good to see you here at the Extend Podcast. Thanks so much for joining me today.

• 2:13Speaker 01

  Thank you so much for having me. It's such an honor and a pleasure to be here with you, Dr. Shaw.

• 2:17Dr. Darshan Shah?

  Yeah, this is a subject that we haven't talked about yet in the podcast, so I'm super excited. You know, I think a lot of people think of hormones as their testosterone levels, or maybe they're going through perimenopause and they're worried about their estrogen. And I think that, you know, I come from surgery and I did a lot of surgeries on the thyroid gland. And whether it be for thyroid cancer, thyroid cysts, or even sometimes Hashimoto's disease. And it's a really important organ. But what I see from a big picture view is no one really even thinks about the thyroid until it's too late, until all of a sudden you're seeing an endocrinologist and a surgeon, and now there's a major problem. But from

• 2:59Dr. Darshan Shah?

  what I learned from listening to you is that these problems actually start sometimes years or decades before maybe your thyroid values become abnormal, even you get symptoms, right? And I'm so excited to dive into that with you today.

• 3:14Speaker 01

  I'm excited to be here and to dive into that. It's crazy because for a lot of people, they start having thyroid symptoms, but by the time they're diagnosed, it'll be 10 years of symptoms and an attack against their thyroid gland. And a lot of times, they need severe interventions at that point. When if we were able to uncover thyroid disorders in the earlier stages, we can do a few lifestyle tweaks to help the person feel their best and prevent the progression of the conditions.

• 3:41Dr. Darshan Shah?

  Right, right. And you have personal knowledge of this, right? You suffered from Hashimoto's.

• 3:45Speaker 01

  Yeah, in full disclosure, I was never interested in the thyroid gland during pharmacy school. I just thought it was this like really boring gland. And you took drugs to suppress it if it was overactive, and you took some hormones if it was underactive. And it wasn't really until I was diagnosed myself with Hashimoto's after almost 10 years of debilitating symptoms ranging from acid reflux to irritable bowel syndrome to chronic fatigue, hair loss, panic attacks. Just, you know, I had a laundry list of symptoms. Achieved in my twenties, but most people do in their seventies, right? Like with all of the symptoms that I had. And that's when I realized that the conventional medical approach just wasn't really cutting it because essentially a person will be offered thyroid hormone.

• 4:29Speaker 01

  But that's going to be at the very late stage of thyroid dysfunction. And the thyroid hormone, as much as being a pharmacist, I was hoping it would be a cure all. It didn't really do much for me. So it helped me from sleeping 12 hours a night to 11 hours. That was an improvement, right? I no longer had to wear two jackets in Southern California. I only had to wear one jacket in the middle of the summer. Improvement, right? But I was still suffering with pain, fatigue, carpal tunnel, panic attacks, all sorts of digestive symptoms. And I see this is actually the case for many women with thyroid dysfunction. The thyroid meds only can do a little bit, and a lot of times they're not even indicated.

• 5:08Dr. Darshan Shah?

  Yeah. Wow. Okay. I can't wait to dive into all the science behind that. Before we start though, I have a few quick questions for you that I think kind of set the stage for the rest of the conversation. And then I'd love to dive into the science and the treatments and what people should watch out for. But question number one, what are some of the things that people are doing to affect their thyroid health? And they don't know that they're doing this?

• 5:31Speaker 01

  Artificial sweeteners. So Splenda, things of that nature. These can actually be problematic and cause autoimmune thyroid disease. Some individuals can go into remission simply by removing artificial sweeteners from their diet.

• 5:46Dr. Darshan Shah?

  Wow, that's incredible. And when you say artificial sweeteners, you're talking about Splenda, sucralose, like all of the artificial sweeteners.

• 5:53Speaker 01

  Exactly.

• 5:54Dr. Darshan Shah?

  Got it. Okay. Well, we're going to talk more about that. Number two, what's the most underrated lifestyle change that people can do to support their thyroid function?

• 6:02Speaker 01

  One of the most helpful things that people can do to support their thyroid function is actually take an Epsom salt bath. This can really help regulate our nervous system, replenish our magnesium stores. Most people with thyroid dysfunction are going to be magnesium deficient. And Epsom salts are a great way to get magnesium into our system.

• 6:22Dr. Darshan Shah?

  Oh my God, did not know that. All these years I had no idea that the Epsom salts would help with thyroid health, but it makes total sense. You're right. We can get more magnesium. Magnesium is one of the elements that a thyroid gland needs to make thyroid hormone, right? So, yeah. And lastly, what do you wish more people knew about the connection between stress and thyroid health?

• 6:44Speaker 01

  I wish more people would know that the thyroid gland and our stress hormones are a two-way system and a feedback loop. And so anytime that we're going to be under significant stress, that can actually trigger and worsen our thyroid conditions. And having a thyroid condition is going to make life more stressful for us. So, stress management is going to be a key component to feeling your best when you have a thyroid condition.

• 7:09Dr. Darshan Shah?

  Yeah, makes complete sense. Well, fantastic. So, your history with the thyroid gland, you suffered from Hashimoto's yourself, you were taking medications, it wasn't really helping. How did you end up solving your personal thyroid issues?

• 7:22Speaker 01

  I was working in public health at the time, and I was working with individuals who had disabilities and multiple chronic health conditions. And for a lot of them, there wasn't necessarily like a standard of care. So, I spent a lot of time going in PubMed, talking to specialists, talking to their families, and looking at patient forums to help them figure out what interventions they could make. And I thought, okay, well, what if I could do the same for Hashimoto's? And sure enough, I started looking information on PubMed, and I found a lot of research on lifestyle changes, various nutrients that people could take. One of the big pieces of research that I initially found was the

• 8:05Speaker 01

  connection between celiac disease and gluten sensitivity, along with thyroid disorders. Some individuals with autoimmune thyroid disease, who also had celiac disease, were able to get their thyroid conditions into remission and normalize their thyroid function simply by cutting gluten out of their diet. And to me, this was a big aha moment. What if there's a trigger that is causing my immune system to get out of balance and causing me to have this autoimmune condition? Most people don't know, but when they have a sluggish thyroid, underactive thyroid, hypothyroid, they actually have an autoimmune condition more than 90% of the time.

• 8:42Dr. Darshan Shah?

  Yeah, that's such a great point, because, you know, at Nex Health, my clinical practice, we test lots of biomarkers on people. And one of the core biomarkers that we started testing Many of our patients is anti-thyroglobulin antibody. And the reason we do that on all patients now is because we know that people get that antibody way before their thyroid gets dysfunctional. And a lot of times it is tied very closely with other inflammatory markers, other markers of gluten sensitivity, for example. And the way I look at it is like when your body is attacking its own tissue, it's not just picking one tissue, right? Is the thyroid is maybe one of them.

• 9:23Dr. Darshan Shah?

  And some people pick the thyroid, some people's immune system picks the thyroid over other tissues. But usually it's a flare up of the entire immune system, right? And so these things are so interrelated and gluten, leaky gut gluten, any type of food sensitivity, something going on in your gut affects your entire body. And the thyroid is one symptom of that problem. But at the same time, you're probably also attacking your brain, your cardiac muscle, your liver. It's all happening at the same time.

• 9:53Speaker 01

  Yeah, and your gut and the challenge is that a lot of times people will go to their conventional doctors with symptoms. So they'll say, I'm feeling anxious, I'm having panic attacks, I'm more fatigued. I'm having this weird dizziness or brain fog or digestive issues. And most doctors will not run thyroid antibodies. They might run the thyroid stimulating hormone test, which is the screening test for thyroid dysfunction. But that test can be normal for the first five, 10 years of having thyroid antibodies. And those antibodies can actually be symptomatic. They've been associated with multiple miscarriages, brain dysfunction, cardiac issues, a general feeling of being unwell, feeling anxious. And my big concern for a lot of young women,

• 10:38Speaker 01

  when they're in their childbearing age, when they're teenagers, moody teenagers, they might actually have thyroid dysfunction. When they are diagnosed with IBS, that could actually be thyroid dysfunction. But a lot of times they're given the runaround because nobody's looking at their thyroid antibodies. And so they're being told like your symptoms are in your head. You have fork to mouth disease, everybody's tired, right? Everybody's got digestive issues where really it's that thyroid dysfunction that could be leading them to have so many different symptoms.

• 11:08Dr. Darshan Shah?

  Yeah, it's so true and it's so important. And I hope that every listener of this podcast, if they're feeling some of these symptoms that you're discussing, and I'd love to go through like a laundry list of symptoms, because I think, you know, it's, it's super important that we do that because a lot of people don't realize what the symptoms of Hashimoto's or just thyroid dysfunction are, because you're right, they get dismissed, you know, a lot. So we should run through some of these symptoms so people can maybe trigger like, ah, maybe I do want to get checked. And getting checked doesn't mean just checking your typical TSH level, which is what every doctor checks, because that's the one they know is a thyroid issue. It goes way beyond that. I'd love to talk about the biomarkers of thyroid dysfunction next. So let's run through some symptoms. You already mentioned

• 11:53Dr. Darshan Shah?

  a few of them, maybe starting from the top now, let's do it.

• 11:56Speaker 01

  Yeah, let's do it. So the thyroid hormones impact every cell in the body. So the symptoms can be very nonspecific.

• 12:02Dr. Darshan Shah?

  Right.

• 12:02Speaker 01

  And oftentimes, patients and doctors might miss this. But here are some symptoms. So one of them might be hair loss.

• 12:09Dr. Darshan Shah?

  Yeah.

• 12:10Speaker 01

  Starting at the top of your head, if you have diffuse hair loss, which means hair loss from every part of your head, you're brushing your hair, you're just losing more hair, your hair becomes more tangled, that would be a red flag for me that you might have some thyroid dysfunction.

• 12:21Dr. Darshan Shah?

  Okay.

• 12:22Speaker 01

  Brain fog is going to be another common symptom. So you're walking into the room, you forgot why, right? You can't find your keys. You are having trouble with word finding. Some people think they have like early onset Alzheimer's, right? They're like, what is going on with my brain? I'm not as sharp as I used to be. That's another big red flag for me that you might have thyroid dysfunction. Another big red flag symptom is the loss of your eyebrow hair, especially the upper third of your eyebrow. That's a really big red flag. We can have eye puffiness. In some cases of thyroid dysfunction, we can also have eyeball protrusion. This is generally with an overactive thyroid. People might experience puffiness in their faces. They might experience dullness in their skin. They'll

• 13:06Speaker 01

  just say, I used to have beautiful skin. Now it's like lackluster. I don't know what's happening. Another red flag symptom is cold intolerance. So if you're the lady in your office and everybody is wearing Wearing a T-shirt or a tank top and you've got a scarf and a jacket and you're like, I'm just like chilly all the time. That's going to be a big red flag that your thyroid might be a culprit. We can have palpitations, we can have anxiety, panic attacks, we can have actually depression. I've seen some people misdiagnosed with bipolar disorder even when they have thyroid dysfunction. Sometimes this could manifest as postpartum thyroid issues. In women, it might manifest as multiple miscarriages or trouble conceiving, having children with developmental concerns.

• 13:51Speaker 01

  This can also be a big symptom. We can have weight gain. Of course, weight gain can be caused by a variety of different things, but we definitely want to consider thyroid dysfunction. Sluggishness overall, so you're just fatigued and you're having trouble getting out of bed. And maybe your bowels are sluggish, so you might have some constipation, although some might have diarrhea. Swollen tenderness in your body, any kind of joints and pains. These would be some of the most common symptoms that people present with. But I think there's over like 200 symptoms that I've seen reported that were tied to thyroid antibodies and thyroid dysfunction.

• 14:31Dr. Darshan Shah?

  Yeah, so if your overall health is changing or you just feel crappy and not yourself and not your normal level of energy, your bowels are changing, this might be all indicators of thyroid dysfunction. So, you know, a lot of people, they go to the doctor, they have all these multitude of symptoms and they can refer to different people. And then you go see the psychologist for your depression, here's a gastroenterology referral for your constipation. And your hair, you're losing hair loss, here's a dermatologist. And it's crazy to me, like you go to all three of these different specialties and they'll do a million exams before they detect a thyroid antibody level.

• 15:07Speaker 01

  And this was happening to me in my twenties. I was like, I'm like, I've got allergies and reflux. And this was like the allergist and then the dermatologist was looking at my hair loss. I had a cardiologist for my palpitations and gastroenterologist for, you know, for my digestive issues. And treating the thyroid dysfunction and the inflammation helped me resolve all the Those symptoms very, very quickly. And it's really quite remarkable. Another common thing that people don't realize is it may affect men differently than women.

• 15:37Dr. Darshan Shah?

  Hmm, let's talk about that.

• 15:38Speaker 01

  So for men, the gentleman that I've worked with, a lot of times they'll say they have trouble growing a beard. And their libido might be affected. So generally, men are less likely to come see their doctors. But once their libido is affected, that's, that's when they're going to come in and see them, right? And definitely thyroid dysfunction can impact testosterone levels. And so some of them are put on testosterone before their thyroid is corrected. And really their testosterone levels might actually normalize if you just correct their thyroid function. And then some of them might report they have trouble building muscle. So they're like working out, going to the gym, but they're just not building muscle like they used to.

• 16:16Dr. Darshan Shah?

  Got it. Okay, those are all such important symptoms for people to recognize. And I think, you know, when you look at functional medicine, which is looking at root causes. One of the root causes of disease that presents itself in multiple systems throughout your body are hormone deficiencies and dysregulation of your hormones. And your thyroid is at the center of that. So if you're getting referred to a lot of different specialties in medicine, go back to the root causes, right? And so what we're talking about today, Hashimoto's, is inflammation, which is a root cause. Thyroid dysfunction, which is a hormone disturbance, which is also a root cause. And so these are kind of coming together to create all these symptoms.

• 16:54Speaker 01

  Yeah, absolutely. And we had talked about the testing, right? So let's get into those biomarkers. A lot of times people will say, okay, I looked up my symptoms online. Or I have a family history of this. Doctor, can you test me for thyroid dysfunction? And most doctors will. However, not all of them will run the right tests. So generally speaking, the thyroid stimulating hormone test is going to be the screening test. The challenge with that test is that it can be normal for five to 10 years before we see a fluctuation or elevation in that. And we might still have an autoimmune attack against our thyroid gland. So I'm a big advocate of testing thyroid antibody levels, thyroglobulin antibodies.

• 17:38Speaker 01

  And thyroid peroxidase antibodies, and I just tell people to write down TG and TPO. And your doctor will know what we're talking about. Getting those done can be a really important indicator that your thyroid gland is under attack. There's some inflammation going in your body and that there's something you can do about that. And then I also advocate for testing for thyroid hormone levels. So when we think about TSH, it's actually a pituitary hormone that responds to or is supposed to respond to how much circulating thyroid hormone we have. Now, there's sometimes a communication breakdown and your TSH can be normal or even low, even when you don't have enough thyroid hormones on board.

• 18:22Speaker 01

  So you do want to test the thyroid hormones directly and that could be the T3 test and the T4 test. And then in some cases, people can have something that is, there's a few different names for it. One of them is like non-thyroidal thyroid illness, which, which sounds kind of odd. But essentially what that means is there's something else driving your thyroid dysfunction. So your thyroid gland might be normal and not under attack for all intents and purposes. But because of a stress pathway, or perhaps you have low iron or low ferritin stores, you might be producing something called reverse T3. And that basically means instead of making active thyroid hormone, your body makes dummy thyroid hormone that binds your thyroid receptors.

• 19:07Speaker 01

  But instead of turning them on, it just blocks them. And so a lot of times people will have the classical thyroid symptoms, but it's not actually coming from their thyroid. And getting that test can tell you if that's what's going on.

• 19:20Dr. Darshan Shah?

  The reverse D3 test, right?

• 19:21Speaker 01

  Exactly.

• 19:22Dr. Darshan Shah?

  Because isn't reverse D3 converted to active thyroid hormone as well?

• 19:27Speaker 01

  So.

• 19:27Dr. Darshan Shah?

  Or is it the other way around?

• 19:29Speaker 01

  Yeah, so the thyroid hormones, T4 is one of the main thyroid hormones. And typically when people get medications, that's what they're going to get. They're going to get levothyroxine, which is T4.

• 19:40Dr. Darshan Shah?

  Right.

• 19:40Speaker 01

  And our body internally converts that, however much of it it needs, to the more active thyroid hormone, T3. So T3 Is the one that makes our hair grow, gives us a lot of energy. It's much more active than the T4.

• 19:54Dr. Darshan Shah?

  Right.

• 19:55Speaker 01

  And this conversion happens in the gut and the liver, different peripheral tissues in the body. It doesn't always happen correctly. So part of, part of the whole managing of thyroid dysfunction is making sure the person has enough of both T4 and T3 in many cases. But what can happen and sometimes is people get on thyroid medications and instead of their body making the active thyroid hormone, which is T3, the, the body will convert to reverse T3, which is the not active thyroid hormone.

• 20:26Dr. Darshan Shah?

  I see. So a full thyroid panel then in your mind includes a TSH, a T3, a reverse T3, a T4, and also anti-thyroglobulin and thyroxidase.

• 20:37Speaker 01

  Exactly.

• 20:38Dr. Darshan Shah?

  And that's, that's the Cadillac, if you will, of evaluating a thyroid. And keeping in mind that the thyroid antibodies will change way before the TSH does. And sometimes the TSH won't change, but you'll still have low thyroid hormones. And then there's other reasons that thyroid hormone might not be working. That has not anything to do with your thyroid gland. And that's why we're checking a reverse 33, a reverse T3 to make sure that you're not having any of those problems.

• 21:03Speaker 01

  Exactly.

• 21:03Dr. Darshan Shah?

  Okay, great, good. Fantastic primer on thyroid hormone levels. And how often should people be checking these? Or is this something that people should check whether or not they have symptoms? You know, we, just to be complete here, we check them on all of our patients once a year. What are your thoughts around that?

• 21:19Speaker 01

  I think that's a fabulous idea. I would advocate for at least once a year, especially for young women. Women are really impacted by thyroid conditions. One in five women will have this disorder at some point in their lives. And early detection can prevent mental health issues. It could prevent irritable bowel syndrome, fertility issues, you know, weight challenges. So getting a good baseline can be very, very helpful. And I would advocate for everybody to get them at least once a year. If you're symptomatic and if you're actively trying to manage your condition, I would advocate for testing every three months or so to make sure those markers were improving. So if we're doing lifestyle intervention. We want to see those thyroid antibodies reduced. If we're doing medications, we want to see those hormones normalize,

• 22:04Speaker 01

  and that would be more frequent testing.

• 22:06Dr. Darshan Shah?

  Yeah, and then you mentioned fertility. I think so many people now are going through fertility treatments.

• 22:11Speaker 01

  Yeah.

• 22:11Dr. Darshan Shah?

  And I wonder, do you think all of them are getting their thyroid markers done prior to fertility?

• 22:16Speaker 01

  I wish. I wish I could stand on a soapbox and say, like, every woman of childbearing age should have her thyroid function tested because thyroid, like, very, very minimal changes in thyroid function can make it harder for a woman to conceive. Even if the TSH is a teensy, teensy bit elevated. So using super tiny low doses of thyroid hormone can improve conception rates. The baby, once you are pregnant, the thyroid hormone requirements increase. And if you don't have enough T4, this is what your baby is dependent on, they can end up with developmental disabilities. They can end up with some delays, some health challenges. You might end up with a miscarriage.

• 22:59Speaker 01

  And even thyroid antibodies have been shown to impact fertility rates. So even with in vitro fertilization, having elevated thyroid antibodies, they can, they can actually impact fertility rates. So interventions that can help lower those thyroid antibodies can improve fertility rates.

• 23:16Dr. Darshan Shah?

  So the thyroid antibodies directly, you mentioned a lot of associations with high thyroid antibodies, whether or not you have thyroid dysfunction. Are the thyroid antibodies directly affecting, like, your brain, your fertility, separate from the thyroid glandular issues, separate from the thyroid hormone issues?

• 23:33Speaker 01

  Correct. Yeah, not many people know this, but there's a lot of research that supports how thyroid antibodies can perhaps cross react with cerebellar antibodies. And so you might have some brain dysfunction. They can impact synovial fluid, so making it harder for women to conceive, just their presence being there. So it's very, very fascinating light of work. A lot of research in psychiatric conditions. There was one case report of a woman with borderline personality disorder who was hospitalized. And the staff were able to track her symptoms and correlate them with her thyroid antibodies. The days when she was More symptomatic, she would have higher thyroid antibodies. The days when she was asymptomatic, her thyroid antibodies would be much lower.

• 24:15Speaker 01

  And there's so many different case reports, so many interesting studies with a whole host of different mental health conditions. And the sad thing is, a lot of times, patients are essentially told that it's in their heads and the thyroid antibodies don't matter. And once you have them, there's nothing you can do and there's nothing you need to do. They're always going to be there. Now, my, my passion and my line of work focuses on, actually, there's a lot we can do to lower them and sometimes get them to completely go away.

• 24:42Dr. Darshan Shah?

  Yeah.

• 24:43Speaker 01

  And the person's symptoms oftentimes correlate where we see the antibodies going down and they feel significantly better.

• 24:50Dr. Darshan Shah?

  Yeah, yeah, it's so true. I think, I see that a lot because I think that whether or not it's causal, like the thyroid antibodies directly causing their symptoms, there's definitely, they're associated. And so when, when the antibodies go down, the symptoms go down almost universally, you know? If not, there's usually something else going on, on top of it. But yeah, that's, that's really interesting that, it's another reason why we should be checking thyroid antibodies on people is the, they themselves can be causing these symptoms.

• 25:21Speaker 01

  They can be causing symptoms, they, they can be cross reacting with different types of other antibodies, inner ear antibodies with vertigo, cerebellar antibodies, there's a whole host of different cross reactivity that can occur. And also, they're a flag or they're, they're a sign from your body that something is out of balance. They just don't happen out of nowhere. There's something driving them, some kind of inflammatory response. It could be an infection, it could be a nutrient deficiency, it could be stress. But they're an important marker to keep track of. And I feel like people oftentimes, nine out of 10 times, their antibodies are lower, they're going to feel better.

• 25:59Dr. Darshan Shah?

  Yeah. So these thyroid antibodies are produced by our immune cells. And why do our immune cells produce these? What is leading to a rise in thyroid antibodies?

• 26:09Speaker 01

  In the healthy, normal person, it can be part of natural cell turnover, right? They kind of work on cleanup duty. But generally speaking, those levels could be like zero, one, or two, if you were to measure them. Anything above like a nine with the thyroid antibodies indicates that there's some kind of an inflammatory process. There's a few different theories to this. One of them could be because of molecular mimicry or the bystander effect. So perhaps you have an infection in your thyroid gland and your immune system is trying to clear that infection. So it attacks the thyroid gland. Maybe you have a infection somewhere else in your body. And when the immune system takes pictures, you know, it kind of recognizes that infection.

• 26:52Speaker 01

  It might take snippets of the protein codes, of the protein sequences on that infection. And some of them might have cross reactivity with the thyroid gland. So infections like Borrelia, H. pylori, various different ones look similar to the thyroid gland, to the immune system. There could be gluten sensitivity. So parts of the gluten protein might look similar to the thyroid gland. Once the immune system has recognized that as a foreign invader, then it might recognize the thyroid gland as a foreign invader. There's different cytokines that may be implicated with thyroid dysfunction. Sometimes they're driven by gut infections where the gut infection may really tweak the immune system to turn on more and produce more thyroid antibodies.

• 27:34Speaker 01

  These are some of the more common patterns that I typically see and we try to uncover when a person has those antibodies.

• 27:41Dr. Darshan Shah?

  Yeah, and most of the immune system, we know, there's a large percentage of our immune system that lives in and around our gut, right? And so when we, when we have gut sensitivities, whether it be through gluten or dairy, or even leaky gut from lots of different reasons, people get leaky gut, this can just react with the immune system in our gut, creating an overall inflammatory situation in your body that can also lead to thyroid antibody production.

• 28:07Speaker 01

  Yeah, it's been very, very fascinating. And this was actually kind of my big aha moment was I had irritable bowel syndrome before my Hashimoto's diagnosis. And then I came across the work of Dr. Cassio Fasano, who talked about the three-legged stool of autoimmunity. He's very famous in functional medicine circles. And he mentioned that every case of autoimmune disease has intestinal permeability as part of its presentation. So you could have the genetic predisposition, which is one part of the stool. You have some kind of a trigger. And I mentioned a bunch of different infections or nutrient deficiencies. Food sensitivities connect as triggers. And then there's always that intestinal permeability piece. And you need all three of those for the autoimmune condition to manifest.

• 28:52Speaker 01

  And so it's been interesting to see, you know, sometimes you can address the triggers directly. You can say, okay, we know this person has X, Y, and Z infection. We can treat it, or we know they have this nutrient deficiency. We can treat that or toxin. We can't really change genes this day and age. Maybe in the future we'll be able to. But we can always work on that gut health piece. So even if we don't know what triggered somebody's infection, or even if it's like a virus that we can't necessarily get rid of, we can always work on that gut piece. And that oftentimes improves thyroid function, thyroid antibodies, and almost always helps with a ton of different symptoms.

• 29:29Dr. Darshan Shah?

  Yeah, yeah, it's so true. I mean, the gut is so connected. We're finding out more and more to every system in the body. And the hormone system is definitely not excluded from that.

• 29:39Speaker 01

  Yeah, yeah, there was a meme, and I think it said, I had 99 problems and healing my gut helped like 97 of them.

• 29:47Dr. Darshan Shah?

  So true, I know, right? Okay, so, you know, I think people hearing this now have some hope if they're suffering from these symptoms. They can get some blood work done. They can see if they're having antibodies to their thyroid. And kind of what's your order of, I guess, treatment or advice that you give to people that come to you of where do we start first? I mean, because there's so many different ways you can address this.

• 30:09Speaker 01

  Yeah, I have a process that I take people through and generally speaking, it's going to start with a bit of an elimination diet. So we know that gluten, dairy and soy are the three most common reactive foods. Eighty-eight percent of people, in my experience, are going to be sensitive to gluten and about eighty percent are going to be sensitive to dairy and soy. And what that means is essentially they're going to be very symptomatic when they eat these foods. And when they eliminate them, their brain fog might improve, their weight might start to normalize without changing anything else, just the overall inflammation in their body is going to start improving. I've had people go into complete remission from Hashimoto's just by getting off of those three foods for ninety days, right?

• 30:51Speaker 01

  So this is a great place to start. It's not easy. You know, I'm, I'm from Poland and my pierogi are like gluten and dairy. For my Italian friends, you know, that love their pasta. But there are ways to do this and find alternatives. And this day and age, I mean, you can get anything gluten-free and dairy-free. There's so many wonderful alternatives. The second important thing that I really advocate for is testing your nutrient levels with your doctor and also considering some nutrients that are going to be generally safe and well tolerated. The nutrients that we're going to be recommending for testing would be B12, ferritin and vitamin D. All three of these are going to be commonly deficient

• 31:32Speaker 01

  in people with thyroid dysfunction. B12 can lead to neurological issues. With ferritin, that is the iron storage protein, and typically people don't utilize their thyroid hormone correctly when they don't have enough of this ferritin. And so these individuals, even if they're on thyroid hormone, they'll continue to have thyroid symptoms. They'll say, I'm on levithyroxine and I have brain fog. I feel like my head is floating away from my body. I have hair loss. I'm always cold. I'm still having thyroid symptoms. And the research shows that once you get their ferritin levels up to like ninety to one-ten, their

• 32:13Speaker 01

  thyroid function improves. The other way to work around this is to give them T- Free hormone directly because one of the things we need for proper thyroid hormone conversion is enough iron. And so some people will say like, I just didn't feel good on levothyroxine. And so I needed a medication like natural desiccated thyroid or Cytomel to feel better. And oftentimes that the root cause behind that could be because they have low ferritin. So oftentimes, that's a really big thing that people ignore and are not aware of how important that is for thyroid function. And then vitamin D is critical for so many different processes in the body and for immune function.

• 32:54Dr. Darshan Shah?

  Right.

• 32:55Speaker 01

  Generally speaking, my ladies in remission with Hashimoto's, they keep their vitamin D levels between 60 and 80. I know this is like a controversial number. Not everybody recommends.

• 33:05Dr. Darshan Shah?

  I recommend between 60 and 80. Yeah, that's exactly what we recommend. Yeah.

• 33:09Speaker 01

  Yeah. And it just works really, really well. Once you get the levels up to that that level of the vitamin D, they tend to get into remission. They have more energy, depression lifts, and their thyroid antibodies just really start reducing. So this is a really great place to start for a lot of people with regard to things they can try on their own, you know, Epsom salt baths or magnesium, great for thyroid function. A lot of times anxiety, insomnia, irritability, cramps, pain, all of these things are signs that you're magnesium deficient. Even if you're sensitive to loud noises, that can be a big red flag.

• 33:47Dr. Darshan Shah?

  Oh, interesting.

• 33:48Speaker 01

  Yeah, I know. One of my friends used to have this bumper sticker back in the day, and it said, if it's not too loud, you're just too old, right? And I like to say like, no, it's not too loud. You're just magnesium deficient.

• 34:00Dr. Darshan Shah?

  Magnesium deficient.

• 34:02Speaker 01

  The other important nutrients that have been associated with thyroid dysfunction, selenium deficiency, has been found very commonly in people with thyroid dysfunction and autoimmune thyroid disease. Getting on a selenium supplement anywhere from like 83 micrograms to 200 micrograms per day can help reduce thyroid antibodies by about 40 to 50% in three months. Can reduce thyroid eye disease, can improve fertility, reduce the rates of Really a big change in thyroid antibodies, anxiety and hair loss is what I typically see in my clients. Recent research has come out on myoinositol,

• 34:41Speaker 01

  which is a natural sugar, around 600 milligrams of that can help with balancing blood sugar and can get thyroid disease into remission, especially when used synergistically with selenium.

• 34:54Dr. Darshan Shah?

  Wow.

• 34:54Speaker 01

  So in the subclinical thyroid state, which is like you have a little bit of thyroid dysfunction, your thyroid antibodies are a bit elevated, but we're not quite ready to get you on thyroid hormone. Sometimes utilizing selenium with myoinositol can get people completely into remission, where their thyroid antibodies go away essentially and their thyroid function normalizes.

• 35:15Dr. Darshan Shah?

  That's amazing. And that even works for people that are like have clinical Hashimoto's?

• 35:20Speaker 01

  Clinical Hashimoto's and the research is basically with subclinical Hashimoto's. So a TSH up to 10, where it can normalize the TSH. I've had some ladies go on the myoinositol selenium combination who have had Hashimoto's for many years and they've actually needed to reduce their thyroid meds. So and some of them have been able to wean off of thyroid meds. Not, not every single person, but this is a really powerful combo. And a reminder for everybody listening, if you're doing supplements and lifestyle changes and if you're on thyroid hormone, you want to keep testing that just to make sure you're not overmedicated. It can be a good thing to need less thyroid hormone, but it can feel quite awful, like to have palpitations. And, you know, you don't want too much, too much thyroid hormone. You want just the right amounts.

• 36:05Dr. Darshan Shah?

  Yeah, especially if you're working on treating it, you want to keep testing so you make sure that your TSH is coming down. You can come off of your thyroid hormone eventually, hopefully.

• 36:13Speaker 01

  Yeah.

• 36:14Dr. Darshan Shah?

  That's such an important point. You're right. So, I mean, why doesn't everyone know this? Myoinositol and selenium, it seems like so easy. Neither one of them are prescription. And you can really start working on reversing this thyroid dysfunction.

• 36:28Speaker 01

  Yeah, it's really quite incredible. The research wasn't there when I was first diagnosed, but in the last few years it's come out. Initially myoinositol was used for PCOS and it's also used for diabetes. Diabetes and even gestational diabetes. So it's got a long term profile of being a generally well tolerated and safe supplement. Some people might get some dizziness from it if they're, you know, if they're already have low blood sugar because it can really work on balancing our blood sugar levels. But it can be a beautiful supplement that can help a lot of people.

• 37:01Dr. Darshan Shah?

  Oh, such great advice. And then what is getting a thyroid ultrasound fit into this entire workup of this picture?

• 37:08Speaker 01

  This is such an important part of your diagnostic workup. And I would advocate for people to at least have one in their journey and their healing journey. If they have thyroid nodules or any kind of sign or symptom of thyroid dysfunction, they would want to repeat those. But every five years or so is if somebody has Hashimoto's, for example, or Graves' disease, I would advocate for doing one of those. If you have thyroid nodules, depending, depending on the kind, you might want to repeat that every year. On accident, I've somehow initially, I wasn't working with people on their thyroid nodules. But I realized after some time and some of my clients,

• 37:49Speaker 01

  that a lot of the things that help Hashimoto's can actually shrink thyroid nodules and help them go away. So that's been really fascinating for me to see over the last decade. It's like, oh yeah, I wasn't intending to help with that. I wasn't, I didn't even know, like, we can shrink thyroid nodules. But a lot of the things like selenium and treating the different infections, they can absolutely shrink those nodules and get them to go away too.

• 38:10Dr. Darshan Shah?

  Oh, so, okay, so you recommend getting a thyroid ultrasound. If you're going through any sort of thyroid dysfunction treatment, at least one time to get a baseline, which I agree with as well. I think it's really important as being part of the workup. You know, one of the things that I used to do when I was a surgeon was we removed a lot of thyroid nodules, right? Because they could be cancerous, sometimes you don't know. But if you do find a thyroid nodule, it's incredibly important to see an endocrinologist or a surgeon, because a lot of times it does need to be biopsy to rule out cancer.

• 38:39Speaker 01

  Yeah, absolutely. So there are different nodules and some of them are benign. And some of them can be cancerous. And so it's important to do a biopsy to figure out if, if that can be a potential issue. And, you know, I've had a lot of clients that will say their doctors refuse to do an ultrasound. And I just don't understand why. I'm like, this is so important. And I I'm a big advocate of of being like, OK, well, can you put it in my chart? That you're refusing to do this, or I have a family history, or just really advocating for yourself that this is something that you need.

• 39:14Dr. Darshan Shah?

  Yeah, yeah, I mean, and there's no radiation to an ultrasound. It's a pretty benign test. And you get so much good information from it. At least it gives you peace of mind, right? That there's nothing there that we need to worry about as far as biopsies got concerned.

• 39:27Speaker 01

  Yeah, absolutely. And there is a slider increase when you do have thyroid antibodies. There's also going to be a bit of a higher risk of thyroid cancer. It's not like a tremendous risk, but I I mean, I some people will go to their primary doctors and will say like, oh, I got diagnosed via this way. And they don't think I need an ultrasound. And I'm always like, no, let's make sure you get an ultrasound. See if there's any nodules, see if any of them need to be biopsied, right?

• 39:53Dr. Darshan Shah?

  Yeah. So say someone comes in to you as a pharmacist and, you know, they are having thyroid dysfunction. Their thyroid hormone levels are low. The doctor recommends them to go on thyroid hormone. I think that needs to be a trigger to figure out, number one, why there's an issue. And also checking thyroid antibodies, right? Because a lot of them won't have thyroid antibodies. So you can start reversing the course of this disease. Being on thyroid hormone doesn't necessarily mean to be a lifelong sentence, right?

• 40:21Speaker 01

  It depends on the person. So if you've had your thyroid surgically removed, you definitely need to be on thyroid hormone, like no amount of celery juice is going to replace your thyroid gland, right? If you've had thyroid disease for quite some time, too, you know, it's a progressive condition. So every year that you have it, more of your thyroid gland gets destroyed, right?

• 40:41Dr. Darshan Shah?

  Your thyroid gets burnt out.

• 40:42Speaker 01

  It gets burnt out.

• 40:43Dr. Darshan Shah?

  Make it, right?

• 40:43Speaker 01

  Yeah, it can it can atrophy with time. And so at that point, you might need to be on thyroid hormones long term, right? In the early stages, or in a lot of times in children or women with postpartum thyroid issues, there's actually a pretty good chance that you can get back your thyroid function if you do the lifestyle changes. So if you figure out what's driving that inflammation and driving that autoimmune attack and you lower. The thyroid antibodies, they're generally a marker of how aggressive the attack is against your thyroid gland. And the research shows, you know, the higher the antibodies, the quicker you're going to go from normal thyroid function to hypothyroid, right? And so when you can get that under control, your body can regenerate, right? It doesn't do it as fast as we would hope.

• 41:28Dr. Darshan Shah?

  Yeah.

• 41:28Speaker 01

  But it can. Some random things that can help with that regeneration process would be cold laser therapy over the thyroid gland.

• 41:35Dr. Darshan Shah?

  Really?

• 41:36Speaker 01

  There's a clinic in South America in Brazil that was doing this and it would be guided by ultrasound. And they would use like a dental cold laser. And they would find thyroid function would come back and thyroid antibodies would reduce. Some people do utilize like red light therapy devices over the thyroid gland and they do find this can help as well. The selenium and myonosatellin early stages, randomly aloe vera juice in some cases.

• 42:04Dr. Darshan Shah?

  Really? Huh.

• 42:05Speaker 01

  Yes. A researcher who had thyroid dysfunction was taking it for her skin. And then she noticed her thyroid function normalized. So she conducted like a a clinical trial on this. Thank goodness for researchers like that. And then in some cases, a low iodine approach. So for many people, like excess iodine can be a trigger for thyroid dysfunction. People are like, wait, I thought you needed iodine to make thyroid hormone. Yes, but it's like a Goldilocks nutrient. So when you get too much.

• 42:37Dr. Darshan Shah?

  Right.

• 42:37Speaker 01

  You know, it's kind of like running on a broken leg. Yes, running is good for you, but not if your leg is broken.

• 42:42Dr. Darshan Shah?

  Right.

• 42:42Speaker 01

  So that can kind of flare up the autoimmune process. But there are some case studies and some of my clients where I've seen like they were eating seaweed snacks and they were like taking really high dose iodine. Where we've been like, huh, I wonder if this caused your Hashimoto's. And then we would put them on a temporary iodine restriction. They would be able to get their thyroid function back. So there's a few different things we can do if we know what's driving the dysfunction, right?

• 43:09Dr. Darshan Shah?

  Yeah, absolutely.

• 43:15Dr. Darshan Shah?

  Dr. Shah here, and I want to take a quick moment to talk to you about metabolism. So you've probably already heard, unfortunately, 88% of Americans are metabolically unhealthy. And it's not because of what they're eating. It's actually a lot about what's living in your gut. I'm talking about your microbiome. This is the community of bacteria that controls everything from how you process sugar, to your energy levels, to your mood. There's actually one specific strain in your microbiome called Akkermansia muciniphila that's absolutely critical for metabolic health. This is a bacteria that strengthens your gut lining. It helps you metabolize carbs more efficiently, and it increases GLP-1 production naturally.

• 43:58Dr. Darshan Shah?

  The problem is, almost everybody is completely deficient in it. And until recently, there was no way to get this. But that's why I'm really excited about joining Pendulum. They're the first company in the US to bring live Akkermansia to the market. The company was founded by PhD scientists and doctors with the Mayo Clinic as their first investor. The metabolic daily formula that I take every single day doesn't just contain Akkermansia, it's formulated with multiple next-generation strains. And these all work together to optimize your metabolism from the inside and out. So you can track every macron calorie if you want, but if your gut microbiome is out of balance, you're going to be fighting an uphill battle.

• 44:39Dr. Darshan Shah?

  Pendulum is going to give you the tools that you need to fix your gut at its source. Try Pendulum today. Head to my link below and use a discount code. You're going to feel the difference a healthy gut microbiome can make. So let's go back to the medications for thyroid treatment. There's Armour Thyroid, there's Synthroid. Can you talk about the different medications that are available? And what people should ask their doctor about when they get put on thyroid medication?

• 45:07Speaker 01

  Yeah, definitely. So there are thyroid hormones on the market. The most common ones are going to be Levothyroxine is the generic name, and you might see brands like Synthroid, or Levaxel, or Tyrecent. And these generally contain T4 Thyroid hormone. So this is a less metabolically active hormone. That's very important, but it still needs to be converted to the more active thyroid hormone known as T3.

• 45:32Dr. Darshan Shah?

  Why do pharmaceutical companies make the less active version? I mean, I know they've made them for decades, but why is that made instead of just giving everyone T3?

• 45:39Speaker 01

  It's a very interesting history.

• 45:42Dr. Darshan Shah?

  Okay.

• 45:42Speaker 01

  So when we first started treating thyroid dysfunction, we were using the thyroid glands of animals. So desiccated thyroid glands of animals were used to replace thyroid hormones in humans. And as you can imagine, back in the olden days, the quality controls weren't quite there. So you can have a person stabilized on one batch of of this, right? And after some time, they would become unstable once they got a refill in their medication. Because they didn't really have a good way of measuring how much active thyroid hormone was, you know, in that thyroid tissue. These days, we have better assays, so we can actually measure that a little bit better. But the pharmaceutical companies came out with synthetic T4.

• 46:26Speaker 01

  And the synthetic T4 seemed to stabilize TSH much better. And so this was offered as a safer alternative and a more reliable alternative. I know when I was in pharmacy school, it was like, no, nobody should be on natural desiccated thyroid hormones like Armour. These are like old school medications. They don't really work as well. You can have unstable levels. And you just need to put everybody on levothyroxine. Now, the tricky part about that is levothyroxine is known as a pro-drug, which means it needs to be activated in the body to the more active version. Pro-drugs work beautifully well on paper. Every single, you know, time on paper, they can convert it. But in the human body, it doesn't always happen. And so we might have nutrient deficiencies.

• 47:11Speaker 01

  We might have genetic variations. We might be under a lot of stress. Iron deficiencies, toxins, whole host of things can prevent that proper conversion. Now, pharmaceutical companies also had T3 medications, which are just direct T3. And that has a very, very short half-life. And it was also used as part of a weight loss regimen. For people along with like phenteramine and fen-phen and whatnot, for people who were overweight, but not thyroid hormone deficient. And that was a really like touch and go situation where people would get hospitalized with cardiac issues. You don't want to make a person hyperthyroid,

• 47:53Speaker 01

  right? And so I feel like T3 in particular got a bad rap because of that. Now, I will say, there are practitioners that know how to use those hormones correctly. We don't want to overdose them. We don't want to underdose them, but we want to figure out what that individual person needs, right? Do they need more T3? Do they need more T4? What's the right balance for them? Are they absorbing their thyroid medications properly? In some cases, people might have gastric issues and they don't absorb the tablets, but they might need something like Tyrosin, which is in gel cap. And so my question for people is always, when you talk to your doctor's office, ask them if they know how to work with the different thyroid medications. Do they know

• 48:36Speaker 01

  how to work with natural desiccated thyroid-like armor? Do they know how to work with T3 like Cytox? Do they know about there's different formulations, not just Synthroid, there might be Tyrosin? Because one of the challenges I have with with some of my readers and people on social media, they'll say, "My doctor didn't want to prescribe this medication. How do I force my doctor to prescribe that?" I'm like, "You don't. Like, you don't want to be their first patient on something they don't know how to use." You want to work with somebody that's really well-versed in these medications because hormones, especially thyroid hormones, they're Goldilocks hormones, and having too much of them can be a bad thing and dangerous. And not having enough can mean that you're going to have a lot of symptoms.

• 49:18Dr. Darshan Shah?

  Right, right. And so what's kind of the optimal protocol for working with a patient that's on thyroid hormone? Are you checking levels and symptoms frequently? How can patients know that they're being appropriately monitored?

• 49:30Speaker 01

  Definitely making sure every six weeks, every six to eight weeks, if you're just getting on thyroid hormones, that you're testing your blood levels and you're checking with your doctor about your symptoms. It does take a while to stabilize, right? So it's not going to be like, um, I start today and I feel better tomorrow thing. Because the medications do take a while to get built into our system. They have, um, T4 in particular has a pretty long half life. So that means it's going to take a while before you get balanced with it. But definitely don't be somebody that is happy with somebody putting you on a medication. And then telling you to come back a year later, right?

• 50:05Dr. Darshan Shah?

  Exactly, especially with any hormone.

• 50:07Speaker 01

  Yeah.

• 50:08Dr. Darshan Shah?

  I think most hormones, you need quarterly monitoring. And if not quarterly, at least every six months, but we try to monitor our patients every quarter.

• 50:16Speaker 01

  And I think that's really great advice. I would say that's a minimal for when you're starting off. Once you're stable on them, you might be able to say every year is fine. Of course, if you're symptomatic and it's hasn't been even three months, then you would want to check in. Cause sometimes things can change very quickly. You might become over medicated or under medicated. Sometimes there might be drug interactions. If you're put on other drugs, that can impair your absorption of thyroid hormones too. So anytime you're symptomatic, I would say like, let's, let's get a blood test and see what's going on.

• 50:50Dr. Darshan Shah?

  Right. And if you're actively trying to reverse.

• 50:52Speaker 01

  Yeah.

• 50:52Dr. Darshan Shah?

  The Hashimoto's as well. So, okay, going back to Hashimoto's, let's talk about this, um, uh, more in depth now, if you don't mind. Can you tell us a little bit about what is Hashimoto's? Where did the name come from and how do you diagnose Hashimoto's?

• 51:06Speaker 01

  So it sounds like an exotic Japanese sword fighter, right? But it's actually a very common condition affecting one in five women. This is the primary cause of an underactive thyroid. And what it is, it's inflammation of the thyroid gland that's mediated by the immune system. And eventually this inflammation leads through the breakdown of thyroid tissue. So a person starts off with Hashimoto's. Their thyroid gland is under attack. And with time, their thyroid gland is going to get destroyed to the point where it can no longer compensate. And it can no longer make its own thyroid hormones. And at that time, the person might get the label of hypothyroid.

• 51:41Dr. Darshan Shah?

  And do they get like glandular swelling? Can they see it in their neck?

• 51:45Speaker 01

  Sometimes, but not always. So you can't necessarily like depend on that glandular swelling. In some cases, people's thyroid glands might actually shrink.

• 51:54Dr. Darshan Shah?

  Yeah, right, exactly. And is there a blood level where you actually get diagnosed with Hashimoto's? Where now the, you know, your doctor says, oh, you have Hashimoto's based on your blood test? Or is it that not the case?

• 52:05Speaker 01

  The thyroid antibody tests are going to be helpful for figuring out if you have Hashimoto's. Depending on the lab, it might be above a nine or it might be above a 35. And I generally will say like a healthy person without thyroid dysfunction should have maybe like one to three thyroid antibodies circling around or zero. So if you have thyroid antibodies, that can be an indication that you have Hashimoto's. Now, but it's a little bit tricky because there's also something known as seronegative Hashimoto's, in which case you don't actually have thyroid antibodies. But you might be able to find your thyroid is infiltrated by white blood cells when you do a thyroid ultrasound. So you might see some of the consistent markers of Hashimoto's on an ultrasound.

• 52:48Speaker 01

  And obviously, the normal person wouldn't be able to see that. So it would have to be a doctor that knows how to read the ultrasounds. And then also, some people, their thyroid gland might look normal on an ultrasound. But when they get a fine needle biopsy for like a nodule, they might actually find inflammation and white blood cells, which are an indication of Hashimoto's. So there is, most people are going to have thyroid antibodies, TPO and TG antibodies. Those are very common. But some people might not have antibodies, but they might still have Hashimoto's. I think that's very mind blowing for a lot of people.

• 53:21Dr. Darshan Shah?

  Yeah, and so those you wouldn't necessarily know unless you get an ultrasound or a biopsy.

• 53:25Speaker 01

  Yeah.

• 53:26Dr. Darshan Shah?

  And usually those aren't done unless someone feels a nodule or you're having, you know, your TSH is low and you're having issues. Or your TSH is off, your thyroid hormones are off, and you're having issues.

• 53:37Speaker 01

  Yeah, or if you have like a goiter or swollen thyroid gland, then typically you would get an ultrasound. But a lot of times people are walking around and they don't even know, right? That they have this condition.

• 53:48Dr. Darshan Shah?

  Right, right, right. And so, okay, now that we've kind of Like define this and people know it's a problem and we have the symptoms kind of delineated and where the blood test to look for, what can we do about it? We've alluded to the gut as being one place that we can start working. Let's go through some of the other things that you could. Well, let's talk about the gut first. How can we heal our gut to where it's not causing this inflammatory reaction?

• 54:10Speaker 01

  So generally speaking, we're trying to figure out what is going on with the gut. Why is it leaky, right? And could be food sensitivities. So celiac disease, big driver of leaky gut. When we heal that, in some cases, when we get off of gluten, we can get celiac disease into remission and that can also get Hashimoto's into remission. Not in every case, but in a lot of cases that can happen. SIBO, small intestinal bacterial overgrowth can be a powerful driver of intestinal permeability or leaky gut. About 50% of people with hypothyroidism might have this. There could be nutrient deficiencies. Zinc and L-glutamine are two common ones. Stress can increase intestinal permeability.

• 54:53Speaker 01

  Having dysbiosis, so not enough of like the good bacteria and some pathogenic bacteria. They can essentially interfere with our gut lining. And then there's something that I feel like is very underappreciated, but protozoa infections.

• 55:05Dr. Darshan Shah?

  Oh yeah, talk about that.

• 55:06Speaker 01

  So these are tiny, tiny microscopic parasites that can infect our gut. They have been correlated with irritable bowel syndrome. They've been correlated with hives, whole host of different conditions. And most recently implicated in Hashimoto's, specifically a protozoa called Blastocystis hominis. And this has been found to be potentially a trigger for Hashimoto's. And it's interesting, when I started working with clients, about 30% of them had it. And when we treated that, a lot of times their antibodies would go away or lower. Their food sensitivities, symptoms would improve. Some of them were able to normalize their thyroid function.

• 55:48Speaker 01

  And there are research now, so they had a few case reports and they also did a small study. And for whatever reason, this protozoa seems to impact our immune cells and has been very Related. Yeah, they've had people published now in the medical journals where their people normalize thyroid function when they treat this. Or when they can go into remission. Now, I won't say like every single person has just one trigger. Some people might have multiple triggers. So they might have like H. pylori and SIBO and a protozoa and a gluten sensitivity. But it's always interesting for me to be like, oh, this person, we just did this one thing and things got better. Sometimes it's like a whole host of different.

• 56:29Dr. Darshan Shah?

  How would you diagnose that protozoan infection? Or how would you know if you had that?

• 56:33Speaker 01

  I really love doing comprehensive stool tests. They give us a lot of information. Patients are usually terrified of them because they have to like poop in a little jar. And you know, that you don't have to necessarily poop in the jar. You can just get a bigger, bigger little plate and scoop it in. But it does, they do provide a lot of information. I really love the gut sumer test. That can be very helpful and the GI map test can be very helpful as well. Lately, gut sumer has been finding a lot more infections in my experience. But I know next month, when this publishes, the case could be different. There's a lot of wonderful functional medicine tests out there that can test for these infections.

• 57:13Dr. Darshan Shah?

  Yeah, I think, you know, stool testing, especially if you're suffering from any autoimmune condition and specifically thyroid and Hashimoto's, I think it's really important to be complete and just check those. I think you get a lot of good information. We use a gut sumer here as well. I also love GI map. I think they also do a good job and just, you know, it's so counterintuitive though, you know, being trained in medicine. Thyroid dysfunction, do a stool test. You know, that's not what you're taught, but they're absolutely interrelated and you can find things. For the protozoan infection, how do you treat that?

• 57:43Speaker 01

  There's a few different ways you can treat it. One of, one fabulous research article came out about using sarcomiasis boulardii. And they utilize that in children. And so that's a very gentle way of doing that because that's a probiotic yeast. And that can essentially boost our own body's immunity. And that can help to treat a lot of protozoan infections and just stabilize a lot of gut imbalances. So I like utilizing that. For some people, they might need more intervention. They might need something like berberine or oil of oregano. And typically, that's like a 60 day protocol. So not, not many people are very happy to, to wait that long. And then I love the medication Alinia.

• 58:26Speaker 01

  It's a anti-protozoa, anti-viral. It's got all kinds of benefits.

• 58:31Dr. Darshan Shah?

  That's a prescription, right?

• 58:32Speaker 01

  It's a prescription medication. So you would absolutely need to get a prescription for that. But that seems to have pretty good activity against most strains. There's a lot of research on using metronidazole, which is a similar medication, a little bit older with some, with some more side effects. But there is evidence that this protozoa and other infections are becoming resistant because it's an old school drug. Nice thing about metronidazole is it's like very inexpensive. Where the Alinia, if somebody's insurance doesn't cover it, it could be like thousands of dollars.

• 59:02Dr. Darshan Shah?

  Yeah, it's really expensive. Beyond the gut, where else would you want to start working as far as life cell interventions go?

• 59:08Speaker 01

  Well, I think a big elephant in the room is like stress.

• 59:12Dr. Darshan Shah?

  Yeah.

• 59:12Speaker 01

  For people with Hashimoto's. And there are some amazing professionals in the space that have identified like a Hashimoto's and an autoimmune personality. And these are people that might be taking care of everybody other than themselves and not speaking out for themselves and burning the candle at both ends. And I won't say all of my clients have been like that, but definitely I do recognize that many of them, their condition does start after a stressful event. So maybe they go to grad school or maybe they have a child, which we think of these as good stressors, right? But they're still going to be stressors for, for us, right?

• 59:50Dr. Darshan Shah?

  Still a stress, yeah.

• 59:51Speaker 01

  Yeah. Or a death in the family or something to that effect. And so really taking the time for ourselves to grieve, to take care of ourselves is going to be a really, really big, important part of getting Hashimoto's into remission and feeling better. I, you know, I recommend like supplements. You can do adrenal adaptogens. You can do B vitamins, vitamin C and magnesium. And these are some of the, you know, nutrients that get depleted under. You're under a lot of stress and that could put you more at ease, right? And make you feel better. I say that adaptogens make everybody around you less annoying. So you know, they're helping you tolerate like daily stressors.

• 1:00:35Speaker 01

  And those are great things that people can do. But there's also sometimes it's like deeper work that nobody really, you know, it's not easy, right? But past history of trauma, childhood trauma, ACEs. All of these have been connected to developing autoimmune diseases later in life. So for many people, healing is both physical. So looking at what nutrients, food sensitivities, infections, toxins you might have present in your body. But it might also be emotional and spiritual and psychological.

• 1:01:05Dr. Darshan Shah?

  Absolutely.

• 1:01:06Speaker 01

  And not for everybody. I'm not saying everybody needs to go to, you know, therapy or EMDR when they have Hashimoto's. But for some people, that's very much a relevant trigger that kind of keeps them stuck. And they're perhaps the messages that they're saying to themselves are very unkind. And they're always hard on themselves and they're pushing themselves. That can be past their limits. That can be something that puts our body in this fight or flight state and takes it out of the rest, digest, heal state. And for many of my clients, like that's actually the most powerful way to get rid of their fatigue and to get rid of their brain fog is really focus on like self-care. One of my prescriptions is like pleasurable activities. So do something that you really love doing.

• 1:01:51Speaker 01

  Give yourself permission to play bridge, window shop, whatever it is that like lights you up. You know, art, a lot of people have different hobbies or passions, but no time for those passions because of all the things they should be doing.

• 1:02:06Dr. Darshan Shah?

  Yeah, yeah, it makes total sense. I love that. If you want to play bridge or window shop, is this enjoyable? Just go do it. Don't, don't shame yourself for those kinds of things, right?

• 1:02:16Speaker 01

  Yeah, and I think in this day and age, especially like high performers or when we have elderly parents to care for, children and careers, we can withhold a lot of these beautiful things for ourselves. And we don't take the time to stop and smell the roses and rest and really do the things that nourish us. It's not just food that nourishes us, right?

• 1:02:37Dr. Darshan Shah?

  Your last book, I think, was on stress, right? And adrenals and how, do you talk a lot about how the adrenal gland and thyroid gland are interrelated?

• 1:02:45Speaker 01

  It's really fascinating. I have found that a lot of my clients, they will get put on thyroid medications and they'll be very fatigued before the medications and they'll say, I have more energy now. This is great. But within a few weeks, they'll crash. And in most cases, it's because of a cortisol issue and adrenal dysfunction where they don't actually have enough cortisol. It's not the same as Addison's disease, but it's, it's basically a communication breakdown.

• 1:03:14Dr. Darshan Shah?

  Got it.

• 1:03:14Speaker 01

  When we are low in thyroid hormone, our cortisol clearance slows down. What that means is the body keeps more cortisol around. Cortisol kind of tries to make up for the thyroid energy, but cortisol energy is like I had eight cups of coffee and cocaine, whereas, you know, thyroid energy is like I'm calm and collected and steady. And so I feel like it's like this beautiful, brilliant design that we have.

• 1:03:39Dr. Darshan Shah?

  Yeah.

• 1:03:39Speaker 01

  But what happens when a person starts taking thyroid hormone, their cortisol clearance normalizes. And sometimes that might unmask a low cortisol state and that can be problematic.

• 1:03:51Dr. Darshan Shah?

  Cortisol just unable to be broken down and they're now all of a sudden they are metabolizing it and that cortisol just kind of goes away.

• 1:03:59Speaker 01

  Right.

• 1:03:59Dr. Darshan Shah?

  And it unmask that state.

• 1:04:01Speaker 01

  And they're not at cortisol. People think like cortisol is bad, right? We hear that word in the news and it's like, it's cortisol. Everybody has chia cortisol. It's bad. And that, you know, news tends to sensationalize everything. So we actually need cortisol to live. If we didn't have cortisol, we would not be alive.

• 1:04:19Dr. Darshan Shah?

  Right.

• 1:04:19Speaker 01

  And we need just the right amounts of it to produce energy, to manage inflammation in our bodies, right? And when people have autoimmune disease, they oftentimes an inflammation like Hashimoto's thyroiditis, rheumatoid arthritis, all the itises, that's unmanaged inflammation. And a lot of times they have these low cortisol states. They will be the people that have trouble waking up in the morning. They have trouble with their energy levels all night. They'll say, I sleep for 10, 12, 14 hours. I have unrefreshed sleep. And many of my autoimmune clients were in that state. Chronic fatigue syndrome, fibromyalgia, Hashimoto's. And I figured out a way to get them back into feeling energized

• 1:05:04Speaker 01

  within about four to six weeks through utilizing a lot of like heavy lifestyle changes, like circadian rhythm, getting in tune with that, getting really good sleep. It's been really fascinating because when I first started, I was like, okay, you have to take hormones to get your cortisol levels back up. Hydrocortisone or Pregnant Alone or DHEA. And we would work on it through like more of a supplement intervention and cutting out caffeine, which many people wanted to kill me for.

• 1:05:34Dr. Darshan Shah?

  But I found a much more.

• 1:05:35Speaker 01

  Yes, yes, they were like, this is the worst plan I've ever been on.

• 1:05:40Speaker 01

  But we found a way to do that with utilizing lifestyle changes. And a lot of them are like pleasurable activities. So most of the people, they actually enjoy doing them. And they were able to get their energy levels back up and normalize their cortisol patterns with with those interventions.

• 1:05:56Dr. Darshan Shah?

  That's amazing. Yeah, I think, you know, that's a whole other topic that I want to have you back on the podcast for to talk about cortisol and adrenal glands and how we can diagnose and work on our cortisol state as well. But we could talk about that for another hour for sure. But it's important to know that they're interrelated. All your hormones are working together to try to keep you at a at a state of health and energy. And sometimes they just need some help and they need your help with lifestyle interventions, with supplementation sometimes, with modifying your diet and sleeping according to your circadian biology. All of these things work together to treat your your hormone symptoms and your hormone levels. While maybe you're on hormone medication, maybe you need to be,

• 1:06:41Dr. Darshan Shah?

  maybe you'll be on it forever. But most of the times you can put into place a program that you reverse the disease. So there is a future where you might not need those exogenous hormones. And I think that's really, really an important message that you're putting out there. I love your books. This book here, Hashimoto's Food Pharmacology. Tell us a little bit about it.

• 1:07:03Speaker 01

  This book was in response. To a lot of my clients who really wanted some easy protocols. So things they could do at home to change their nutrition. Supplements they could take at home, including digestive enzymes and replenishing their nutrient status and delicious recipes that were gluten free, dairy free and soy free. So this book has over a hundred recipes and it's got the guidance. So you can be your own nutritionist. I always recommend that you work with a physician or nutritionist or practitioner. But this will give you the information that you need to take charge of your health when you have Hashimoto's.

• 1:07:38Dr. Darshan Shah?

  Yeah. Yeah, I think a lot of the advice you've given there is probably even good for people that don't have Hashimoto's and just good dietary advice.

• 1:07:45Speaker 01

  Yes, it's been very fascinating. I've had people reach out to me and say, I don't have Hashimoto's, but your book taught me how to properly nourish myself and how to cook. And this is something that anybody I think can benefit from, just knowing how to properly nourish and feed your body, right?

• 1:08:02Dr. Darshan Shah?

  Yeah, I love that. Is there any other advice you have for people out there that might have gotten a diagnosis of Hashimoto's or suffering from thyroid dysfunction that they could benefit from?

• 1:08:12Speaker 01

  I would say definitely don't think that you've tried everything and don't think that it's hopeless. A lot of times we have the resources and the technology and innovation. Sometimes it's like very simple things that can turn your health around very quickly. I've had people who were on thyroid meds and they were on disability because they were feeling so exhausted and fatigued. And something as simple as a nutrient deficiency like thiamine helped them turn their health around, sometimes in like less than a week where they would feel more energized. So there are resources and tools out there. You, you know, definitely educate yourself and don't take no for an answer if you have a practitioner that's like, you have thyroid disease, you know, you're just going to be

• 1:08:57Speaker 01

  destined to be tired and overweight your entire life. Don't take that for an answer.

• 1:09:02Dr. Darshan Shah?

  Yeah, that's such great advice. Thank you so much, Alba, for coming on the show. And I can't wait to have you on again to talk about other hormone topics. Where can people find out more about you and learn more about what the work you're doing?

• 1:09:16Speaker 01

  Thank you so much for having me. It's been such an honor and a pleasure, and I so appreciate the work that you're doing for the world. My website is thyroidpharmacist.com. People can find me there. I'm on Instagram, Facebook, and TikTok. And I also have a podcast called Thyroid Pharmacist Healing Conversations, where we talk about how to reduce thyroid antibodies, we talk about how to make your own T3, and I would, of course, love to have you as a guest on that.

• 1:09:43Dr. Darshan Shah?

  I can't wait to do that. Thank you so much. Well, great. And I've listened to your podcast on YouTube and also on Apple Podcasts, right? And it's really, really helpful. I learned so much from you. So thank you for doing this with me. And I can't wait to see you again soon.

• 1:09:58Speaker 01

  Thank you so much.

• 1:09:59Dr. Darshan Shah?

  Yeah.

• 1:10:02Dr. Darshan Shah?

  Thank you so much for listening to the podcast today. Please remember to subscribe if you liked this episode, and give us a good review, and share a link with your friends. It really helps us support all of our efforts. I also want to remind you that the information shared on this podcast is for educational purposes only and is not intended to replace professional medical advice, diagnosis, or treatment. Please consult with your healthcare provider or physician before making any decisions or taking any action based on what you hear today, especially if you have any underlying health conditions or on any medications. Your doctor knows your personal health situation the best, and it's always important to seek their guidance.