#337 Hypothyroidism and Hashimoto's: How to Know if You Have It and What to Do Next with Dr. Nicole Fujiyama

The information provided in this podcast is educational and not intended to diagnose or treat medical conditions.

Dr. Doni Wilson struggled for decades to solve her numerous health issues and heal her body. But with focused determination, she healed herself. And in doing so, she discovered the Dr. Doni Stress Recovery Protocol. On this show, you're gonna hear from doctors, nutritionists, and experts along with Dr. Doni who will give practical advice and wisdom to help heal your body. This is How Humans Heal. Hi and welcome to How Humans Heal. I'm Dr. Donnie Wilson, and in this episode we're going to be talking about hypothyroidism, meaning low thyroid function, and especially low thyroid function that is caused by Hashimoto's disease, which is an autoimmune condition. So many of you ask me questions about low thyroid function and Hashimoto's, and so I am really excited to have— to be bringing this expert to this episode, and I'm going to introduce you to Dr. Nicole Fujiyama. She is a naturopathic doctor like me. She graduated from Bastyr University. She also has a master's in acupuncture. She's an author of the book called Autoimmune Strategies, and she actually has an online program for Hashimoto's. It's a Hashimoto's program, so she's actively helping people with hypothyroidism and Hashimoto's. And so she's here to help you all understand, is that possibly something that's going on for you. And maybe you already know it's something going on for you, but you've had questions and wondering if you're doing everything that you could be doing to address it and even potentially reverse it, right, Dr. Nicole? This is something that is actually possible to address and reverse.

Yes, 100%.

Ah, and this is it. You don't often hear this from the endocrinology office or your GP's office. Oftentimes people may be You know, first of all, have a hard time being diagnosed with low thyroid function. And then even if they are diagnosed with low thyroid or Hashimoto's, they might not be— they might just be given a prescription and not actually being helped to prevent it from getting worse or actually get it to turn off altogether, the autoimmunity. And so that's why I'm so glad to have you here because I know this is your expertise. You help people day in and day out. In this situation. So thank you so much for being here with us today.

Yeah, thank you for inviting me. I'm glad to be here. I'm excited.

So when— let's start with, say someone is just not feeling their best and they're kind of wondering, might thyroid be involved in the way they're feeling? What are some of the most common symptoms, and even maybe some symptoms that are not so common that you find are like That kind of say to you, is it sort of a red flag? Hey, I better go look and see if this person may have hypothyroidism or Hashimoto's. How would someone know that might be going on for them?

Yeah, I think that's what makes this complicated in the beginning, is that the signs initially are very general. So there are things like low energy, or maybe you're having some constipation or some bloating, or you're having Maybe your thoughts aren't as clear as they used to be. You know, so a lot of people assign it to just old age or getting older, or I'm just stressed, when these are really the beginning signs of something is not right. And what makes it even more—I don't want to say frustrating—but a little bit more difficult for people to recognize is that not everyone has very obvious symptoms of hypothyroidism. I think it's very low in one of the studies was like 10% of people have very obvious what we consider hypothyroid symptoms, and a majority. The majority of people just kind of have these very general symptoms that just keep getting worse, gradually getting worse. Things like gaining weight is also included until they keep mentioning it to their doctors and then finally their doctors start testing.

And when the doctor tests for thyroid function, oftentimes what I see in the results I'm looking at is oftentimes doctors might just check the TSH, which is thyroid stimulating hormone, right? So they might just be looking at that. And that might not catch a low thyroid function just by looking at the TSH is what I find. What do you think about that?

Yes, exactly. And so, I mean, the TSH, just labs in general, just a snapshot in time. So if you just catch it at the right time and your TSH is looking good, like an hour later, it could be sky high, you know, and you just wouldn't even know because it just didn't catch it at that time. And especially with Hashimoto's, TSH is not the first thing to change. You'll usually see thyroid antibodies start increasing first, and that is something that most doctors just don't screen. And so again, it just really goes unnoticed for many, many years until they start having these very obvious hypothyroid-type symptoms, and then they get tested for TSH, right? And then maybe they'll get tested for antibodies, but sometimes not even that. From just talking to a lot of people, they really have to push their doctors to actually test it, or a lot of times they just get it tested on their own and then bring it I really want to emphasize how much more common that is, that because you don't—

if, say, you ask the doctor, and we can tell you here, I'm going to ask Nicole exactly which tests to ask your doctor to run. But say you ask the doctor to run these tests, and even if the doctor is hesitant, because sometimes some doctors are open to that, and they'll run exactly what you ask.

Mm-hmm.

And some doctors might be like, oh no, it's not going to get approved, and they are hesitant about ordering it. I want you to know that there are ways to order yourself and pay out of pocket for certain tests. And sometimes that's worth it if you're not feeling good. If you're feeling tired, gaining weight, constipation, dry skin, also headaches and menstrual symptoms like PMS, menstrual cramps.

Right.

All of these can be associated with low thyroid function. So if you're like, hey, wait a minute, my doctor says my labs are all normal, but I don't feel good. It's— it could be worth it to— if you need, even if you have to pay out of pocket a couple hundred dollars to get the right test done to find out. So, so Nicole, what, what tests— like if someone's— you say, okay, go to your doctor and at least ask for these tests to get done.

Um, well, from my experience, I, I definitely tell people to get these tests done. Whether or not your doctor will do it is, you know, up to them, but, um, definitely a full thyroid panel. And then specifically for Hashimoto's, you're gonna wanna get the TPO and the TG antibodies. So those are the thyroid peroxidase and the thyroid globulin antibodies, and that will actually diagnose Hashimoto's.

So then you can see, are there actually thyroid antibodies present? And when we talk about, like you were saying, when we're talking about Hashimoto's, it's really looking at 2 different antibodies. The letters I think of is the ATA and TPO, right? The ATA and TPO is usually what it says, but you can also You can also on the lab just say thyroid antibodies. Even if you don't remember the specific names of them, you can just say, I want to get tested for thyroid antibodies, and they should check for 2 of them, not just one.

Yeah, yeah. If you're ordering them, it'll just bundle them together. It'll just say thyroid antibodies.

Yes. And then I also find that I really like to ask patients to get the TSH, and you said full thyroid panel, but I like to really say get a free T3 and free T4. I'm saying free like F-R-E-E, right? Because we want to see those free hormone levels. Do you find those are helpful as well?

Yes. Yeah, all of it. Like, I, I honestly think all of it is helpful, but yeah, definitely those in particular, just to see like what is going on with the thyroid. Like, how is it functioning?

Because some doctors will just run the T4 Yeah, not the T3. Yeah, maybe you can help us— help everyone understand the difference between T4 and T3 and why it's so important to know the T3.

Yeah, well, your T3 is your active form, and so that is really the one that you want to pay attention to, especially if you're having a lot of those symptoms. And like, I, for whatever reason I don't understand, a lot of doctors just kind of don't pay attention to it, but it's, it's actually very important. And it's also important to recognize the conversion too, like whether you're having conversion problems. Like maybe you're getting enough T4 but you're just not converting it into T3, which is what your body wants to use. And so those numbers are important to help, you know, determine treatment and figure out what is actually going on. And I just want to make a note too that with symptoms for Hashimoto's, especially hypothyroid symptoms, those are not beginning stages of Hashimoto's. Like, those are usually more advanced stages, meaning that you've had these thyroid antibodies most likely for months or years, most likely years, and then now you're experiencing the result of those immune responses and the antibodies flagging your thyroid, your immune response responding and damaging your thyroid, and then now you're having the symptoms of that. So I just really want to make that clear because I think a lot of people think when they're diagnosed with Hashimoto's that this is the beginning Like, it— this is when it starts. And it's like, no, actually, if we go back and look at your health history, we find that this has probably started many years. And for some people I've looked at, even in their childhood is when all this started.

Yeah, it's, it's such a good point that it's kind of like been hiding in the background, and, and most times it wasn't tested, so you wouldn't know. And then eventually it's damaging the thyroid enough so that then the The thyroid hormone levels start dropping. And I also want to point out that the reference ranges on the lab results are not necessarily the optimal ranges, because that's a source of confusion too, right? The doctor might be like, it's all normal because it's in the reference range, but that doesn't mean your thyroid function is optimal.

Yes, yes. Yeah, the reference ranges that they use for a lot of times are so big, you know, and most people, at least like what I've seen, especially with the thyroid numbers, Even within normal range, they're still feeling very sick. And I've like, I, I don't use those ranges and I know you don't use those ranges either, but, um, you know, a lot, they're made for basically disease. Like they're diagnosing disease is what those ranges are for. They're not looking at, um, preventing disease or telling you, hey, you're creeping up to like hypothyroid. No, they're not for that. They're just to tell you like, hey, now you're hypothyroid. Okay, now we can do something about it, which is not. It's just reactive medicine, right? Which is not what we do. And so we definitely want to prevent that.

Yeah, that's such a good point. It's about catch— we want to catch it earlier so that we can prevent it from getting worse versus letting it go until it's really bad and then dealing with it at that point. And I see that a lot of times in conventional medicine, that that's that reactive medicine that you talked about versus preventive medicine. And even when, like, even when a A practitioner, even if this is an endocrinologist who's finally identifying oh now there really is a thyroid issue. Even then, the the prescription they often will give will be a T four medication, right? A Synthroid or levothyroxine, some form of T four as a replacement. And those are those formulas are whether you get the brand version or the generic version, they're they're basically thyroid hormone that. Produced by a pharmaceutical company and it's replacing the thyroid function that your thyroid's not producing, but it's— if it's only replacing T4, then you— it might not really totally solve the issue. Maybe you can talk to us that through, Dr. Nicole. Why is that— that why is it that that's what they're recommending and why isn't it totally fixing the problem?

Yeah, I mean, it makes sense why they're recommending it because you are hypothyroid, so you're just not making enough thyroid hormone for your body to function properly. And just being low thyroid hormone causes so many different issues just because you have thyroid hormone receptors everywhere in your body. And so basically that thyroid medication is replacing a thyroid hormone deficiency. Kind of like, I kind of think of it as like type 1 diabetes, you know, they're using insulin, like shots to replace the insulin that they can no longer make, right? But that's not really addressing like the reason why you developed that in the first place. You know, so it's not addressing the actual immune system because Hashimoto's is an autoimmune disease. So that we know is for a fact. And then we also know that if it's an autoimmune disease, that you have some sort of immune dysfunction and immune imbalance. And so how do you expect then to like reverse your symptoms, start losing weight and doing all those things, start healing your thyroid if you don't actually address that immune dysfunction? You know, and so the thyroid is a super important part for people who actually need it, that thyroid hormone replacement. But it's just not the whole picture. And so that's why you could be taking that thyroid hormone medication and still have symptoms, is because you're just dealing with just one small part. It's an important part, but it's just one small part of this whole big picture that is just not being addressed.

Thank you. Yeah, that, that makes much more sense. So then we can say, okay, yes, we need to get some thyroid hormone in, because sometimes, you know, I talk to patients who are Hesitant even to take, you know, Synthroid or levothyroxine or any kind of thyroid support. I think it's important to know, hey, it's going to help because we know your thyroid is not doing 100% of the job right now.

Yeah.

So we need to replace it because that's the only way for your body to start getting the right signaling. We don't want to underdo it and we don't want to overdo it. We want to get it just right. We don't want to We're not trying to suppress your thyroid function. We're just trying to fill in the gap of whatever it's not producing. And there's no perfect test for that either, right? We have to, based on what your levels are, and everybody's body responds uniquely, so we have to kind of say, okay, based on your results, we're gonna start at a low dose and then retest and see how your body's responding to determine what's the right dose for you. Mm-hmm, yeah. But it's not, 'cause a lot of times I think people wish that, you know, it's not like I don't know, like a blood test that could say to us, oh, you need exactly this much thyroid hormone. The blood test doesn't tell us that, right? We have to see that the function's low, and then we have to figure out what's your best dose.

Yeah, and I think that's why just kind of general recommendations just don't work, because everyone's body responds differently and everyone has like a different, uh, ability to adapt to certain medications and things in a different way that their body receives it and responds. And we have no idea what your body's gonna do until we actually go through it. And then, yeah, we can adjust. But to like, we can kind of maybe predict what will happen, but like, we won't know for sure until, you know, you actually start taking it and then we can start adjusting. And yeah, I've had that too where— People will talk to me and say they're very hesitant to take medication, and I usually ask them, you know, like, well, why? And I think there's just a lot of fear about, like, pharmaceutical companies, like, things that are in the medication. You know, I think there's also that fear of just being on it for the rest of their life. And, you know, I really have to talk to them and kind of let them know about what the thyroid hormone does to their body, like how important it is and how important it is for their healing. And why it's necessary. You know, like, just with naturopathic medicine, it's not like the first thing that we do. Of course, it's not the only thing we do, but there's times like this where it is super important for healing. And I just try to explain that to them. And usually once they start understanding a little bit more, then they're a little bit more open to trying it. And then, you know, once they start feeling better, they start noticing the changes and they're like, okay, this is what my body needs as part of that healing process. But yeah. I, I get that a lot. They're, you know, people just don't want to take medication. Um, they're afraid of what's in it. Um, and especially with levothyroxine, there's been so many recalls on that, just the generic. Yeah, so I get it.

Yeah, and it's— and to the way I think about it is that natural hormones are natural too, you know, and that as naturopathic doctors, part of what we do is help to Also balance natural hormones using, using natural hormones. And to that end, that brings me into thinking about, you know, just opening the conversation about all the options. Because while your endocrinologist might only be talking about Synthroid or levothyroxine, or, you know, something, one of those common prescriptions for thyroid, Yeah. I like for people to know that there's actually many more options available. We can You might hear about, you know, what I would think of as like a synthetic thyroid hormone, which means made in a lab, versus thyroid hormone that's coming from an animal source, or what's often referred to as a desiccated thyroid, meaning it's from an animal's thyroid gland.

Mm-hmm.

And so that's considered more of a natural form because it's from an animal source. And the other thing that happens when we get it from an animal source is that it has both T3 and T4 combined, right? So it's not just the T4, it could be T3 and T4 combined. But, you know, again, like you're saying, we have to really try that and see how that person responds. Some people don't do well with animal-derived thyroid hormone, and then we may need to go back to synthetic. But even then, we can work with a compounding pharmacy to compound—

Yeah.

And get still the T4, T3 combination in a form that matches what we would get from our own thyroid gland or from an animal's thyroid gland. So just maybe, yeah, how do you talk to people about these different options? You know, how do you choose between synthetic, compounded, desiccated? How do we— how can someone think through those different options and figure out what's best for them?

Yeah, I think my approach is pretty simple. I just tell them, I'm like, whatever works for your body is what we're gonna go with. Uh, just because I've seen, like you said, uh, you know, patients who have been on like, say, Synthroid, for example, and, you know, not me prescribing it, but before they've come to see me, and they've just upped their dose like more and more and more and more, and the TSH is just like not budging. It's just going up and up and up, and they just feel horrible, you know? And then They'll come to me and they're like, help me. I'm like, okay, well, you know, come to find out in their health history they used to take Armour, and they said, you know, when I was on Armour I felt so much better. I was like, okay, well let's just switch you to Armour then, you know. And now their TSH is normal, you know, it's going up from like 40 to now it's in like a good, uh, range that I like. And so I think it just depends on the person, uh, what they're able to respond to, and then also like their labs. Like, do you need T3? You know, maybe you don't. Maybe you just need some T4. Maybe you need a little bit of T3. Maybe we need to do like a combo of things. And so I think it just depends on the person, their symptoms, how they're responding, their labs and their lab trends. And then that's usually how I determine that. And then also what's— what do they want to take? You know, I was like, okay, well, if that fits with what I'm okay giving you, let's try that first.

Yeah, yeah, I completely agree. And it just— you— so it's important, any of you listening, it's important to be working with a practitioner who can talk this through with you and say, okay, here's all the options, what do you feel like you want to start with? And then what I recommend, and I'm curious about what you recommend, Dr. Nicole, is, is I recommend once you start on a thyroid hormone, whatever type you're taking, to retest your levels in about 6 weeks. You know, you want to give your body some time, but you don't need to wait 6 months. Like, sometimes I find that—

Yeah.

offices will tell people come back in 6 months, but to me that's— it's unnecessarily long that the person might not be feeling good. Yeah. What do you recommend for your patients?

Yeah, yeah, I, I do the same thing. And I think it's, it's just in the like AMA standards that if you change the dose of thyroid medication, like you retest in like 6 to 8 weeks. So, you know, I, I think I agree with you. And just even in general, like even if you're not changing the dose or anything like that, I think 6 months is just way too long. I've had people in my program where I've seen their labs and they're on thyroid medication, but they actually get their labs done and they're hypothyroid, you know, and that's changed since the last time they got their tests done, like 6 months or a year ago. So it's like we have no idea how long you've been hypothyroid. You could have been for 6 months, you could have been for a year, like no idea. And so that whole time you're thinking that you're getting the thyroid hormone that you need, but actually you're not. And Again, thyroid hormones affect every part of your body, so you've just been deficient in that hormone for now a year, you know, and then there's effects that come with that too.

Absolutely. So definitely, if you— like, like we're saying, definitely, like, if you haven't had your, your thyroid labs done in the last 6 to 8 weeks, it's time. Go get them rechecked. If we can inspire you now to be like, okay, go get them checked. And then, and then track it. I love when patients have like almost create their own Excel sheet, you know, and, and kind of track, okay, this date, this is what they were, and this was the dose I was on. And then we made this change. And then on this date, okay, this is what they were, so that you can track it over time. And you can— we start to look for, okay, what's— what did— how did your body respond? And some people, we make tiny dosage changes, right? Sometimes you only make like a—

Mm-hmm.

5— if it's a, let's say it's a desiccated thyroid like Armour that you mentioned, maybe we make a 5 milligram change. In another person, we might be able to make a 15 milligram change. So we— you really have to know your body and how much can you— how much of a dosage change should you make, and then how much of a difference does that make in your numbers?

Yeah, I, I think that's one of the things that I recommend to everyone. And I, even on social media, and I feel like people maybe get mad at me for saying this, but I just tell them, I'm like, if you want to know one of the best things you can do is just track all your information, like track all your symptoms, track your labs. And because it's just so much easier as a visual to see the changes, and it is just so helpful, like for me as well too, when patients bring them in and they are— they're tracking and they give it to me, it's just so much easier for me to see what's been going on. And then I can look for those patterns and trends that maybe they're not seeing. And, you know, as opposed to someone just recalling, because a lot of people can't remember what they ate for breakfast, you know? So there's no way you're gonna remember like a month ago what, you know, your dosage or what you were taking or your symptoms. So if you just have it on a piece of paper or even a spreadsheet, a Google spreadsheet, something, it, you'll look back and you'll even, I have a lot of patients be like, oh my gosh, like I didn't even realize how bad I was back then. You know, so it, it's also really good.

Yeah.

It's simple and it's very helpful.

And just, just know that your doctors, your endocrinologist is likely not doing that. So you kind of have to take it into your own hands. And it's, it really is one of those scenarios where when you can take this into your own hands and start to get organized and, and get ahead of it, you're going to feel so much better. You're going to actually find your dose. And sometimes you can get to a dose and a product that your body does really well with. And then even then you're going to want to check in on it every so often because sometimes it changes. you're under a lot of stress or you go through menopause, or what are some of the things you find that all of a sudden the person's thyroid goes off track even if it's been stable for years?

Yeah, I would say, um, kind of anything that would just basically flare, like a Hashimoto's, for example. So any sort of like really stressful events, uh, if you're getting— not getting— like you used to get a lot of good sleep and now you're not getting good sleep for a period of time. If you change your diet in any drastic way, because that can be a stressor. And so I— if you're sick, if you got really sick, I find that will throw it off. So there's— your thyroid is very sensitive to these things, and it's not just Hashimoto's that'll affect your thyroid. It's like inflammation, it's stressors. And so, you know, those things you just may want to check in because just maybe you might need a little bit more support during that time, and then you can always adjust it again later. So. Your body's, you know, I think a lot of people forget that the body's very dynamic, so that it's constantly changing and adjusting and trying to keep that balance. But sometimes it's just not able to do that on its own anymore, and then we have to step in and try to help it.

And that's exactly how I see our role as naturopathic doctors, right? We're saying, hey, we want to help the body back to its balance and when— and identify when it got out of balance and then how to help it back to balance. And to the point of tracking your symptoms as well, like tracking your doses and tracking exactly which thyroid product and brand and dose and your lab levels. A patient recently, I was helping her through this process and she had been struggling for years seeing all different doctors in New York City even, 'cause people think, oh, I'll just go to New York City and there's gonna be a doctor who solves this. But she'd been to so many doctors And finally, she and I were just really tracking it so carefully. And she realized that even with like sometimes products that theoretically shouldn't be causing side effects, in her case, were causing digestive effects. Like she had a history of, let's say, something like IBS, but certain thyroid formulas would aggravate the bloating.

Mm-hmm.

And she, so she, it was only through her precise tracking that she and I were able to go, oh, It's when you take— even if she got it, let's say compounded through a compounding pharmacy or a desiccated thyroid, she would get flares of this bloating. And so finally she switched to Tirosint, which is a synthetic form. But finally, when she switched to Tirosint, she no longer had the bloating.

Wow.

So it was like— but it took that carefulness of tracking to figure that out. And so I just want to encourage all of you, if you if you're still not feeling great on whatever you're taking, get— work with a practitioner who can, like Dr. Nicole and I, who can help you get there, you know? Because it— don't give up. Don't just assume, oh, I'm just gonna feel a little bit off. No, let's, let's, let's get it to where it could be. And, and even then, like we're saying, like, that's just one part of the— one piece of the puzzle. Um, but at least we want to get the right dose because then you've got the right signaling through your body Then we can go into— let's go into that now. Some of the bigger— you know, this is the tip of the iceberg. Let's look at this iceberg of factors that influence the thyroid because you mentioned conversion earlier. That alone I'm thinking of because from T4, thyroid hormone T4 converting to T3 doesn't even happen in the thyroid gland. It happens in the body. So let's talk through what are some of the things that could affect What affects thyroid conversion to T3? That's a whole list of things too. Like, we're talking about stress, but more, even more.

Yeah, well, I think stress is a huge one. Like, I feel like that's the main one that I see that affects that. And then that brings in another lab, right, which is called reverse T3, um, because then that's what your active T3 is converting to, which is a form of T3 that your body cannot use. And there's like There's different reasons why your body will do that, but I find the people that are very stressed— and it can be an internal stress too, so not just, you know, external stress like a job or moving or all these things going on all at once, but an internal stress can occur as well too— but I find that, yeah, people who are just very stressed do not have that resilience or the ability to adapt to that stress and that flexibility. Then Yeah, I see. I see that a lot that can affect that conversion. And so no matter how much T4 you take, you know that's not going to change anything. You have to change what is actually affecting that conversion, and in this case it would be the stress. So if you're for some people they're not able to change their environment, then you have to change your body's ability to then adapt right to that stress. And so then that's what Then I would help patients really work on. And so then there's different, different things that you can do, of course, to support it. There's herbs and, you know, there's all kinds of things. But, you know, I think really focusing on what those root causes really are and that baseline, because, you know, I just always think of our therapeutic order that we have and that pyramid. And I think a lot of people really skip over the basics and establishing a baseline. But I feel like it's the most important thing that I— the more I keep working with people, the more I feel like people are missing. Because I think people think they're doing it, but when you really deep dive into, you know, how's your nutrition, how's your sleep, how's your stress, how are your relationships, like, are you breathing? Like, are you getting in the sun?

The basics, right? Yeah, back to Basics.

Yeah, like super basic. And most people are not— they can't check that list off. And, you know, if we're not starting on a good foundation, then when we start adding all these things, when people start taking a whole bunch of supplements, it just doesn't do— it just doesn't work as well, you know. And then your body can't use it effectively like it's supposed to. So I, I feel like that baseline and those basics are super important. And of course, like, your ability to adapt and manage your stress is of those things that are really important. And I see, I see it right behind you too.

That's why I talk so much about stress and write about stress, because it ultimately, it comes back to that, right? Like, not that we're trying to eliminate all of our stress, but we're trying to see, okay, I'm human, I'm gonna have some stress. How can I help myself recover from it each and every day in the moment so that the So that we're constantly— again, back to this balancing. How do we— if we know stress is there, how do we balance it with enough anti-stress so that the stress isn't having a negative impact? Because as you've been saying, the stress can impact our ability to convert T4 to T3, and the stress also makes it more likely that our immune system's gonna go into an autoimmune mode and trigger the Hashimoto's. So for both of those reasons—

Yeah.

It's important to not just try to avoid stress, which is— you can do, you can reduce your stress sometimes, but more importantly, let's, let's see how the stress is impacting. Like, I would say, like, check cortisol levels. You probably do that too.

Mm-hmm.

And help the cortisol levels, because cortisol, if it's too high or too low, is gonna impact thyroid function and thyroid conversion and auto— and the immune system. So we might as well optimize Optimize the cortisol, and also come back to these basic foundational what I call self-care, right? Like the diet, the sleep, the recovery activities, the exercise—the things that help us constantly recover from the stress we're exposed to.

Yeah, no, I agree with everything you just said.

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Yeah, like if you're not sleeping, that's a problem, you know? Like, I don't care what you're eating, if you're not sleeping, it's like the first thing we have to fix, you know? So that, that's kind of what I'm talking about with like the basics. And no supplement is going to fix that, right? We have to figure out why are you not sleeping, what's going on, you know? And, um, especially when it comes to stress too, like Not sleeping will make you more stressed, 100%. And I tell people that their adrenals and their thyroid are BFFs. So if one is struggling, the other's gonna step in and help support it. But if both of them are struggling, then, you know, not very—

You're gonna— who's gonna help who? Yeah.

Yeah. Now you're both like trying to hold each other up, but both of you are struggling. So it's like you're just on the struggle bus altogether. And so you have to really just kind of take a step back. I feel like a lot of people are doing way too much than what they really need to be doing. Take a step back and really start going back to the basics and really make sure you have those foundations rock solid, and then you can build upon it. And it takes time. Like, a lot of people that I worked with who were chronically stressed had, you know, just a lot of stress in their life. Their adrenals were kind of kaput, and, you know, now they're dealing with Hashimoto's. I find that that's one of the things that can take time to heal. So, you know, when people have the expectation of this needs to be done like by next month, it's like, whoa, whoa, whoa, whoa, whoa, whoa. You know, you've been dealing with this for like 20 years, you know? And so I think part of that too is understanding how long your body may need to actually heal and repair because, you know, we're helping you with the stress resilience and, you know, adapting to the stress, but then we also have to deal with the repair too at the same time. And you're— if you're constantly being exposed to these things that are causing inflammation, causing immune dysfunction, you know, that repair and that recovery is just going to take a lot longer, you know. And maybe not a lot longer, like, not like you're not going to feel better, you will, but, you know, the repair is still going to be ongoing. And so I think having that expectation is also very helpful because some people just stress themselves out with their own thoughts, and, you know, that's like a whole other thing.

Yeah, so just kind of preparing yourself like, okay, this is, this is, you know, ultimately like, this is our human experience. Is kind of seeing, hey, what does my body need and how can I support it? And you're gonna continue then supporting your body over time. It's— there's no point where we're not gonna need to support our bodies is the way I look at it. That's just the human journey. And, and Yeah. To the extent that we're trying to just sort of like exist in our minds and in our to-do list and expect that our bodies are gonna keep going, It's only that's only going to last for so long. At a certain point, your body is going to be like, "Hey, I need some attention over here." So Hashimoto's can be one of the ways your body is asking for attention.

Yeah, yeah, and the symptoms are just signs, right? They're just like telling you, like, "Hey," or just kind of warning, being like, "Hey, we need to pay attention here. You need to pay attention to this now." You know, and I tell people, look, if you don't stop and slow down and really, you know, take a step back because a lot of the women I work with are very high achieving. They're very like go, go, go. You know, they're very. They just are achievers. And so, you know, I really have to tell them like, hey, we need to take a step back and really slow down because if we don't, then your body will do it for you. And you just don't want to be at that point of when your body does it for you.

Exactly, exactly. Better to prioritize it now and pace yourself and go little by little. And, and, and I love this, you know, taking better care of yourself. And I wanted to ask you about Diet and gluten in particular, because I think it is something that when people start reading about Hashimoto's, they likely might start hearing about the connection with gluten. You know, obviously there is some research that's connecting how gluten can trigger Hashimoto's autoimmunity, but it's not like it's the sole trigger. Of course, we were just talking about how stress is a trigger also. What is your perspective on gluten and what do you recommend around that?

Yeah, so I think again, based on the research like you mentioned, uh, removing gluten is a really good idea because, uh, well, one of the reasons— there's, there's a few— but one of the reasons is because it can create inflammation in your gut, and then that inflammation can then break down the gut barrier. And one of the key components to pretty much all autoimmune diseases is that leaky gut or that intestinal permeability that just gets out of control. And so if we can reduce that then that's just going to be helpful in healing that gut barrier and then reducing the symptoms and reversing those symptoms. So I think going gluten-free is super important. And if you're already creating antibodies to gluten, then that is very important because now your immune system is already reacting to it. You already have antibodies to it. So every time you eat it, it's exposing— it's getting exposed to your immune system, and your immune system is then making antibodies to it, which then— and this is another reason why removing gluten is so important— Those gluten proteins can look similar to those thyroid proteins. And so then it's not only making proteins to the gluten, but also to your thyroid and potentially your brain, because it— again, they're similar in a protein structure. And so I think those are a couple reasons why going gluten-free is important and why it's emphasized. But again, it's not— like you said, it's not the only thing that causes immune dysfunction and immune imbalance like we were talking about. So I—

Right.

With the thyroid hormone replacement, again, that's important. You know, removing gluten is also important. And those are just 2 parts of that big picture of reestablishing your immune system and immune balance, but it's, it's not the only thing. And what I find is that people will do, like, just focus on the diets and nothing else, but, you know, and then still have symptoms.

But again, like we talked about, there's just other things that can cause that immune dysfunction and imbalance and inflammation that I love how you're using the terminology immune imbalance because I think there's still a lot of confusion about what is autoimmunity and, and, and is it even possible to reverse autoimmunity? And, and so maybe if you— maybe let's talk about that a little bit too. Like, what's— why actually is— what is autoimmunity and why is it happening and how can it be reversed so people can have a better understanding of that?

Yeah, yeah. And I just want to make a note too that when I say reverse symptoms, I'm not talking about cure. I think those are 2 different things. So right now with Hashimoto's, there is no cure, but, you know, we can get into remission, which is like what we're aiming for, our goal. And that is what I'm talking about when I say reverse symptoms. So I just wanted to clarify that. It's good to clarify. Yeah, yeah, in case anyone had questions. Um, but yeah, so with autoimmunity, it's when your body, your immune system, starts making Antibodies to your own tissue, which it shouldn't do, and it's a form of a loss of what we call tolerance. So tolerance is when your body basically ignores your own tissue, things that are not harmful. It doesn't create antibodies to it; it doesn't react to it. But with autoimmune diseases, what happens is somehow that immune response gets or that tolerance gets lost in a way, and your immune system gets confused. So your immune system still functioning the way it should. It's just now it's targeting your own tissue, which it shouldn't. And because your immune system has access to every part of your body, it can potentially create antibodies and damage any part of your body, which is why we have so many autoimmune diseases and they keep finding new ones is because the antibodies that they're finding. So yeah, it's really a loss of what we call tolerance, immune tolerance.

And it, and there can be some genetic susceptibility to, or tendency toward developing an autoimmune condition, and that it's also possible to shift that back off again. We can shift the immune system out of— I think about it as it gets shifted into autoimmune mode and we can shift it out of autoimmune mode.

Yeah, yeah. I, I tell people, just to keep it super simple, there's like 3 factors that really lead to autoimmune diseases like Hashimoto's. So is that genetic predisposition? Uh, not everyone has a genetic issue though. That has an autoimmune disease, but it's just like one of them, you know, makes you more susceptible to them. Uh, the leaky gut that we talked about, the intestinal permeability, and then it's like these lifestyle and environmental factors. So usually it's like a combination of those 3, uh, that then increases your risk for autoimmune diseases. But as we're seeing now that things are becoming more toxic, you know, we just had COVID and these, uh, infections and all these things start compiling in our body. These environmental factors start becoming more of a concern damaging the gut. And so you don't even need a genetic disposition anymore. Now you can just have those 2, and people are developing autoimmune diseases more and more. So those are— yeah, those are the kind of things that I see that— so we can do something about 2 of those things.

Yes, absolutely. And, and it— and to know that it's not likely something that's going to get mentioned in your endocrinology appointment or even even if you went to an immunologist or even you went to the, the GP or internist there, it's not something that's usually taught in a standard medical school to, to aim to shift to, you know, to reverse this, right? To help you detoxify or to recover from stress or to shift your immune system back to balance. And so just knowing that that's why you're probably not hearing about that there, but you are hearing about it from us because we're naturopathic doctors and this is our training, is look at how has the body been impacted by our environment, whether that's stress, whether that's lack of sleep, whether that's toxins, whether that's, you know, something else in your life that shifted your body, your immune system into this pattern. And now we can go, okay, let's understand that. Let's give your body what it needs to, to shift back or at least prevent it from getting worse.

Mm-hmm. Yeah, 100%. Like, your body's just doing what your body is meant to do. And it's just trying to keep the balance. It's just trying to keep everything going good and functioning, you know. But yeah, there's times again when it just gets out of balance and out of control and it just can't do it anymore. And so we have to step in and help. And yeah, when you go to the endocrinologist, that's just not their lane, you know. I feel like we all have our own lanes of genius and expertise, and that's just not theirs, you know. Theirs is more pharmaceutical. Theirs is making sure, you know, You don't die with these thyroid issues, you know, like what's going on? You know, like kind of very like severe cases in a way is kind of like what I see, and their go-to is pharmaceuticals. And for us, like with naturopathic medicine, of course, obviously we don't want you to die either, but, you know, we just have more in our scope of practice that we can, that we can use, and we just have a different perspective of what causes diseases and how to heal those diseases. And so our treatment and what we're looking for and the patterns we're looking looking for and just how we approach it is just like night and day, you know. So it— you can't expect to go to an endocrinologist and expect the same kind of treatments that we're doing. It's just their mode of medicine is just so different. So it, you know, I think understanding that and just understanding like why you're going to endocrinologists and just know that and just have that expectation again that, okay, I'm going to them, they're just going to be looking at these things. They may just be managing my thyroid and that's it, like thyroid medication. And that's what, that's what they're going to do. And then for everything else, like, you come see us.

Yeah, because then we can help with like, okay, what's underneath this? What's, what's really going underneath? And we might be looking for things like mold toxicity or other environmental exposures, and, you know, glyphosate, for example. We might be looking for, like we talked about, gluten sensitivity, leaky gut, or even microbiome imbalance. Are these some of the things you see in your, in your patients as well?

Yeah, 100%. And I try to tell people, it's, you know, kind of like what we talked about, is that your body just wants to heal. Like, our job is just to find what's blocking that healing and then just repair the healing that's done. So that could be so many different things, right? And everyone is unique. So I've never had anyone with Hashimoto's have the same reasons and, you know, triggers that cause their disease. They're just all different. And maybe some of the treatment are the same, but it's just never this, you know, it's never the same treatment for everyone just because everyone's so unique. And so, you know, I think that's what makes us so different too, is that we're not just prescribing like the same 5 things for everyone, you know. And maybe we are because they work, but you know, our The way we look at things, though, too, is also very different, and we take each person as a very unique person. So yeah, maybe for a lot of people the same five things work, but maybe for this one person, like we have to create a whole different thing, a whole different treatment plan, even though they all have the same like Hashimoto's, you know. So I think those things are also really important, and that's why sometimes these generic plans just don't work for everyone, and why you still have symptoms is because you're just unique. And you have your own things going on. And so maybe there's something that's missing that's a huge trigger for you that nobody's actually talked to you about or explored. And, you know, I think that's why coming to see people like us, like naturopathic doctors, are so important, because just our scope and the way we see things are just so different, um, which is super awesome.

Well, and too, I'm thinking That by the time then we help you solve like the thyroid and the Hashimoto's, likely we will have solved other health issues at the same time. Because if we, we, we then maybe would have helped you heal your gut and rebalance your microbiome and address nutrient deficiencies, um, like, you know, iron deficiency is another common one that comes up with low thyroid function.

Yeah.

So we're fixing— not— we're, we're starting with the thyroid, but it ends up solving many things. And so you end up Yeah. Other health issues going away. And not only that, but you then are preventing other health issues. Because I always remember the research that shows that the low thyroid function actually increases the risk of heart disease. So if we're wanting to prevent heart disease, which is the, the leading cause of death for men and women, if we want to prevent heart disease, the first thing we need to do is look at your thyroid. function, because low thyroid function also can raise cholesterol levels. And so sometimes people might be treating their cholesterol, but it actually is low thyroid function.

Yeah, I see that a lot actually, where people have like lipid issues and their doctors are like, we're gonna put you on a statin. I was like, okay, well, first of all, your lipids are not that bad that you need a statin. And second of all, it's from your Hashimoto's. It is not— it is the Hashimoto's that is affecting your thyroid, and the thyroid isn't affecting that. And so we need to fix those things if we We want to correct the lipids. Yeah, 100%. Yeah. And that's what's amazing, right, with your body. It's— you, you just start, just start someplace, someplace, because it's all connected, you know. Start at the place that it's causing the most issues, and it's just gonna affect everywhere in your body because it's all connected. So yeah, I think it's just— that's why you just don't need like 50 jillion things.

It's like, then we say, yeah, like, we get to very efficient because if we really get to the source of the issue, we can solve many issues at once. And then we're, we're helping you prevent major health issues at the same time without— instead of using a prescription that either is just masking the situation or potentially causing other side effects or risk factors. You know, to me, it's like, why would we do that if we can actually solve it? it with things that help you prevent other issues, you know? So it's a—

Yeah.

It really comes back to this broader philosophy of how we address human health and healing. And, and this also makes me think of, you know, because sometimes people will say, well, I, I went to the health food store or I was online and I saw this thyroid product and I started taking it, right? Because I think I have low thyroid, so I'm just gonna take this thyroid supplement. And while sometimes those supplements might be okay, but they might not be enough because they're not individualized to you. Do you see that too? Do people come to you saying, can I just take this product?

Yeah, yeah. And I would like to do a PSA out there for everyone. Like, just because it is natural does not mean it is safe. Okay.

Yeah. So have us look at it with you and actually look at your labs and And look at your situation and say, is— does this product contain the ingredients your body needs? Or if not, let's find one that does, but not— let's not just guess.

Yeah, I, um, I was listening to a, a talk from Dr., uh, Dick Tom, and I— if you guys don't know, he's like this elder in our naturopathic profession. And, uh, I heard him say— I'm probably just totally going to butcher what he said, he said it so much better— but But he said that all these natural therapies work, right? Like, they all work, but it just depends on does it work for you and the timing of it and the dosage, you know? So, and to me that makes sense. It's like, yeah, all of this stuff works, but like, does— is it gonna— is it the right time for you to use this? Like, is it gonna work for you like right now with what you need? And are we doing the right dosage with which, you know, for you? And exactly what you said too, like the combination of things as well also have a synergetic effect that I think people don't realize. And so is that synergetic effect helpful for you, or is it becoming another block in your healing that now we have to address?

Exactly. And so that's why, you know, we're warning against trying to do it yourself, because as it's tempting, because you maybe you realize, okay, my endocrinologist isn't helping me enough with my thyroid, and, and I really don't wanna— I wanna be able to— I don't wanna just let the high Hashimoto's cause more damage to my thyroid. I actually want to get this going in a different direction. And so I think it's good you're learning and listening and you're trying things. It's just that beware, because there's a lot more that as naturopathic doctors, Dr. Nicole and I, we're looking at so much more than that. We could help you actually achieve your goal more efficiently and safely and effectively. So that's where reaching out to us could really help you on, on this journey. So I want to make sure I'll put down in the notes, of course, how to reach Dr. Nicole So you all can learn more from her, follow her on Instagram and other social media, and you can check out her Hashimoto's program where she can guide you to do all of this. Is the, is the Hashimoto's program a group type program, Dr. Nicole, or how do you do it?

Yeah, so it's a group mentorship program, and it's really for people in the beginner/intermediate phases of Hashimoto's. So it's definitely not for people who are like more advanced or, you know, have done a lot of sort of treatments and things like that. This is definitely more for someone who's just starting out or kind of in that intermediate stage.

Perfect. So if you're just like starting to learn about this and you're wanting help with like, okay, how do I figure out what are the different options and what should I be thinking about, then Nicole has an online group program where you can also be— it's nice to be in a group of other people who are in the same situation because you learn from each other. I find I find in my group program, people really love having a community of people who are right. You can ask questions, you can learn from each other, and this way you're not trying to navigate this all on your own.

Yeah, and I found, um, within my program that people move just so much faster, and it's because they just have more access to the information, other people, and then also myself. So So we're just able to move through things so much quicker. And so that's why they just get results so much faster.

And then once you've figured this out, then you also know what to do to maintain it, right? Once you learn how to take better care of yourself and which nutrients your body needs and what diet works best for you, then you can, you can just maintain that going forward. It's not like you have to keep on recreating the wheel. You just now know what to do to maintain. Do you find that's the case?

Yeah, with my patients and also especially in my program, I find that people, because they're tracking their symptoms and because they're making the connections, that they just understand their body so much better and how they respond and how Hashimoto's shows up for them so that they're just not blindsided anymore when something comes up or they get like a little flare. They, they know why it's happened, and so then they know what to do to correct it. And I think that's super empowering. So now they can go forward. You know, in life and know how to manage it. And then say if something comes up and they're like, oh my gosh, I like— something new happens, you know, and they don't know how to, how to deal with it, then, you know, they just come back and we help readjust and find their new baseline and see what's going on and then move forward from there. But they establish that again, that foundation and that baseline. They know where they're at, and then they can always go back to that baseline in order to heal and to repair. And so they have that knowledge now then for life.

It's so good. I would— what came to mind as I was listening to you was even like, say, with pregnancy, because sometimes, first of all, when you're trying to get pregnant, but also once you are pregnant and then postpartum, thyroid— that's another time the thyroid levels can shift and the immune system can shift. So this is another important time, right? To like— I, if I'm helping someone to get pregnant, that's the one of the first things I check is their thyroid, and especially if they're— if it's taking longer for them to conceive. And then also, if you know you're taking thyroid hormone and then you get pregnant, it's important to retest the levels. And the obstetrician usually isn't gonna pay attention to your thyroid, so you need someone else to help you with that. Do you find that too?

Yeah, I tend to work more with women who are either trying to get pregnant or like postpartum, um, not as much like during pregnancy. But yeah, for if you have Hashimoto's, you have high thyroid antibodies, you definitely want to best if you have the time to reduce those thyroid antibodies and get things under control as much as possible if you're trying to conceive. And then afterwards as well too, uh, I find that women need a lot of support, uh, especially to kind of rebuild everything because their immune system was, yeah, you know, suppressed for a long time. Most people actually feel really good during pregnancy, probably. Maybe that's why I don't see them. Um, but then afterwards, you know, everything kind of bounces back again. And so, uh, now they're like, oh no, What is going on? Is this just having— I just had a baby, or is this from my Hashimoto's? I'm not sure. Right.

Yeah, it could be some of the same symptoms like hair falling out, fatigue, depression, which are common with postpartum, but it could be thyroid related. So if you're postpartum and experiencing some of this, even if you didn't have a thyroid issue before, let's get some blood work and find out. Could your thyroid have been been impacted with the pregnancy and now we need to help your thyroid.

Yes, that's definitely a common scenario I've seen too, where they were tested for their thyroid, even thyroid antibodies, and then they were positive and they're like, okay, maybe it's just transient because we just had a baby. So they recheck it again though, and the numbers are still steady or they're increasing and they're like, uh-oh, okay, this is not going away.

And one more question before we go is I'm thinking of a case where a woman came to me and She— there's thyroid antibodies showing, but her TSH and her free T3 and free T4, even when I look at them, they look good. And she has— she's not having symptoms. So she's like, you know, should I really invest in doing something about this now, or should I recheck it in a year and kind of live my life?

Yeah.

You know, and sort of like, how do you know when to start working on it? And it may be really a personal decision, but I'm curious of What do you, what do you suggest for people?

Yeah, I mean, well, technically we shouldn't be having any sort of thyroid antibody, right, um, in our bodies. And so that's already kind of a red flag for me. But, you know, there are cases where you could have transient thyroid antibodies where you have them because, like, say maybe you were sick or something, you know, was happening, and then they go away and they just don't come back, you know. Then I think that's different. But if you have these thyroid antibodies, they're not going away, in fact they're increasing, but you don't have symptoms, um, I still think that's a really good time that you want to start being again proactive and preventative. Because again, like autoimmune diseases, they, they call them a silent— they call them silent killers because of that, because you have these thyroid antibodies and you just don't feel anything yet, you know. And that's because again, these things, the damage, the things that occur don't happen right away. They take usually years, you know, before you start feeling it. And so you don't want to to wait until you have the symptoms. You want to start doing something about this now. And what a blessing that you had the labs and you could catch it at this time, at this early stage. You know, it's just like if you have like early cardiovascular disease, right? You wouldn't wait until like, ah, I'm just gonna wait until a couple arteries are blocked, you know, and I start feeling it, then, then I think I'll do something about it. Like, no, right? You'd be like, oh my goodness gracious, I'm gonna do something about this now. I don't, I don't want You know, so it's kind of like the same thing. I agree. I agree.

Might as well like take the sign from your body and be like, okay, let me at least start making some changes. Yeah. And then recheck and see how your body responds. And then, then if your body needs more help, give it more help. So yeah.

And that's like the easiest time to change everything. Like if you were to just do diet, like you could probably just wipe that out. Like that's when like just diet alone is probably the most effective for, for people in that situation. Um, maybe not everyone, But, you know, just changing your diet, like, that could just take care of that right there.

Yeah, do it when it's easy to shift versus if it gets worse, then we may— there may be more factors we have to address to get it to shift. I love it. Thank you so much for talking this all through with us today, Dr. Nicole. It's so helpful. And thank you all for listening in. I hope this— thank you. I hope you've all been taking lots of notes, or you can look at the notes down below if you missed anything, or reach out to us if you have more questions. I'll definitely have contact information for Dr. Nicole down below. Thanks again for being here and talking this through. I can't wait to talk again soon, Dr. Nicole. Thank you.

And thank you so much. Bye, everyone.

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