39: The Thyroid's Crucial Role in Breast Health and Beyond with Dr. Alan Christiansen

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Hi there, it's Dr. Jen, and welcome to another episode of the Keeping Abreast podcast. This week, we are talking about something that is affecting more and more people and is of supreme importance. And I am delighted to have Dr. Alan Christensen here to talk about this very important topic, which is thyroid health. So Dr. Christensen is a naturopathic endocrinologist with a subspecialty in thyroidology. I didn't even know that was a thing, but I know that you know your stuff in this area and that it is your thing. You are founder of Thyroid Specific Specific Formulations, and you have written eight books, including the Thyroid Reset. So, Dr. Christensen, thank you so much for being here, and I am, like, giddy with excitement over what we're going to talk about over the next hour.

Well, you're not giddy alone. I'm with you too. It'll be a lot of fun, Jen.

So why do we need to talk about thyroid disease? How common is thyroid disease?

Yeah, boy. Based upon how you want to define it, it can be about a quarter of women, you know, if they reach a certain age. So very prevalent. Yeah. On the rise. Most top 1 to 3 prescriptions worldwide are for thyroid conditions. So super big. And, yeah, thyroid cancer, underactive, mostly. Most common autoimmune disease of all. So this is a big thing.

Yeah. What made you so interested in thyroid disease? Like what? What lit you up for this area?

Yeah. Curious thing. You know, when I started in my residency, there was such a massive gulf between this conventional view and the alternative view. You know, it still is, but it was even wider then. The alternative view was pretty much any symptom was fair Game for thyroid medication to any dose. And the conventional view was almost the opposite, that, you know, no matter how bad things were, no one got any sort of treatment. And there were some radical views that were emerging at this time, like Broda Barnes and Dennis Wilson. Stuff had just come out. And I saw some people help from this, and I saw some people nearly killed from this. And I thought, shoot, this is. There's. There's got to be some way in which we can figure out how people can be given safe, effective treatment and who needs. Which. Who needs how much? And that was about 30 years ago, and I've been at it since.

Yeah, yeah. And. And as you said, it's a huge dilemma because we're Talking about nearly 25% of women having some level of thyroid dysfunction. So I know that you talk about how to recognize thyroid disease. So what are the signs of thyroid problems, and what should people do when said signs are emerging?

Yeah. So the most common issue and the earliest issue is autoimmunity and inflammation. And signs of that are, you know, a lot. A lot of classic symptoms people hear about being thyroid symptoms. Unexplained weight gain, fatigue, hair loss, menstrual irregularities. Interesting little points, is that it's not common to have a large number of symptoms. It's common to have, like, two to four symptoms that are really pressing. And it's also a little more common if those symptoms are emergent, meaning they changed at some particular point in time, not they've been with you forever. So those are some of the top few. The weight, the hair, the fatigue. Yeah. Menstrual changes, digestive issues, swallowing speaking problems. So if you got a couple of those things that aren't like they used to be, and there was a time frame which a few of them really shifted, those are the biggest red flags.

Yeah. Unfortunately, I think that so many of those things get explained away by other areas of dysfunction, and we're going to get deep into why that happens. But, you know, as far as menstrual irregularities, even if the gynecologists are thinking that the thyroid might be involved, they measure a TSH and maybe a T4, and then they say, oh, not the thyroid. Here's some birth control pills. Right. And I think that this is probably happening more often than it's not. So what should the workup be? What should the evaluation be for thyroid disease to truly rule it out?

Yeah. So back to the point about the most common emergent facet of it being the autoimmunity. Simple thing is just Screening for thyroid autoimmunity, we can talk more about the ins and outs of that, but that's something that's often not done unless there are severe abnormalities elsewhere. 1. One recent study looked at about 20,000 people, and it mapped out the prevalence of thyroid symptoms and how that correlated with actual thyroid dysfunction. And there's different degrees of abnormal thyroid levels, but an actual deficit, like a clear deficit of thyroid hormone, that's present in about 1% of people with thyroid symptoms. But the thyroid autoimmunity, that can be present in about like, 89% of people with thyroid symptoms. And, yeah, you don't see that without measuring for thyroid autoimmun.

Yeah. And I mean, that is part and parcel to how our conventional medical system works, unfortunately, because until you fall off the cliff, no one tells you that you're in danger. Right. We wait for everyone to fall off the cliff. So by the time you have measurable thyroid hormone level abnormalities, you're. You're far down the line.

Well, and here's where it gets weird. So everything you said is totally true. And people with thyroid autoimmunity, they may never have abnormal thyroid levels. You know, many of them never do. You know, the bizarre thing about thyroid autoimmunity is that has many radical effects upon one's health. It has very subtle effects upon thyroid disease, which is weird, but it causes pretty clear symptoms. And many people never progress to overt thyroid dysfunction that they could have autoimmunity going on for decades of their life.

So with that in mind, so many women are on Synthroid. Like, I mean, at least half of my patients are on Synthroid. And we know that many people who are put on Synthroid, which is synthetic hormone, thyroid hormone, are not getting benefit from it. So can you, can you get into that a little bit? Because to me, there's a pattern here.

Yeah, Just to expand on appointment that I made quickly before, like the. Remember Casey Kasem's top 40?

Of course.

Top 40. Yeah. And Dick Clark before that. So they make that same thing for prescriptions every year. They make a top 200 list. And thyroid meds are often top one, never further down than top three. And that's pretty much always Synthroid. So, yeah, globally, this is like the most widely prescribed medication, you know, barring few exceptions. And there's strong evidence that nearly everyone taking it is not benefiting. There have been big surveys showing, like, satisfaction rates from users, and it's. It's abysmal. And then there's data saying that the problem is that most people Given third medication, they don't actually have a deficit in thyroid hormone. There's. There's degrees of. Of risk for a deficit, and there's an actual deficit. And current conventional guidelines suggest that over 87% of those who are currently taking thyroid medication never really warranted it. They never laid a situation in which it would benefit them. And that's why they're still struggling in various ways. They. They didn't really have the things going into it that made them need that.

Yeah. Are there any other concerns with people put. I mean, other than not benefiting from that, are there any other concerns with putting people on Synthroid on synthetic thyroid medications?

Yeah, this is the thing, and it's kind of a weird thing. We talk about synthetic and natural with hormones. And this is one of my little things. We. We've got one way we define that when we refer to hormone replacement, and one way we define that when we talk about thyroidology. And they're not consistent. So with hrt, we say something is natural if it's chemically identical to what the body makes, still synthesized. It didn't get popped from a tree. It was still synthetically produced, but it was made to be a bioidentical molecule. But we don't keep that same nomenclature when we're talking about thyroid meds. So there's no one who's more concerned about excessive use of the meds than me. But none of them are actually synthetic by that definition. You know, they're all bioidentical.

Yeah.

To your point, the drawbacks, you. Yes, we've got strong evidence that the drawbacks are many. We see about a doubling increase in mortality for. And I want to back up a step in. People who are on thyroid medication compared to almost identical group of cohorts with the same sorts of medical risks, the same thyroid levels, and the same age, gender, demographics. So all those things are matched up, but the only difference is one person is making their hormones and one person is taking their hormones. Only difference. So in those cases, we see about double mortality risk, and we see substantial risks for almost any kind of cancer, including breast cancer, roughly 24% higher. Yes, there are serious drawbacks that are almost never communicated to people.

What is happening there that increases the risk of mortality, that increases the risk of chronic disease, and that increases the risk of cancer.

Basically a suppression of homeostasis. The body has so much regulatory work that goes on in ways that we can measure down to like an inch, and we know about maybe a foot below that. But there's another thousand Feet below that. So our body has dozens and dozens of thyronamines, biologically active thyroid like proteins, and they're kept in this very exacting balance between them all. So when we take a hormone from outside the body, there are some cases to where someone just clearly has too much or, or they need it and they clearly have too little. But even when levels are normal, there are changes going on that we know are happening, but we cannot measure. So. Yeah, so taking a hormone in this case is not the same as making a hormone.

And then getting a little deeper. So what is the dysfunction that is being caused by taking the hormone? Because clearly it is directly leading to dysfunction. If it doubles the mortality, is it doubling the mortality by overstimulating the heart? Is that where it's coming from? What are the mechanisms that it's changing things?

Primarily cancers and cardiovascular disease are the biggest two categories.

Yeah. So I'm curious why, Because I have for so long seen a link between people on synthetic hormone and I don't know that it, that it's the same. Well, let me just say levothyroxine, I don't know that it's the same for nature thyroid or armor thyroid or any of the, that, that kind of hormone replacement. But I'm definitely, I definitely see a preponderance of my patients who, you know that you only get to me if you have breast cancer. A preponderance of my patients are on levothyroxine. And when you look at the data, if you try to google it, it says that there is no relationship between hypothyroidism and breast cancer, although I know.

There is also to date, so hypo hyper and then exogenous. So from outside the body. So there's pretty strong data that the mild to moderate degrees of hypothyroidism actually lower risks for breast cancer. There's also strong evidence that hyperthyroidism, whether that's from medication or from unmanaged hyperthyroidism or from early hyperthyroidism, all of those correlate with an increased risk. And now we've got about five pretty large studies that are from different parts of the globe showing that, yeah, those on thyroid medications, even with stable thyroid levels, have a greater risk for many cancers, including breast cancer. It's about a 24% risk increase. And those same data sets have shown up in five big cohorts around the world. And so, yeah, we know that being medicated to any amount raises risk being overmedicated or having unmanaged hyperthyroidism raises the risk and being mildly to moderately hypothyroidism lowers the risk. Now, no one's advised to be or remain hypothyroidism for that reason, but it's just one more line of evidence supporting the conclusion.

It's surprising to me because when you think about the dysfunction that's happening in the body with hypothyroidism, I would think that because you have a slower metabolism, because you have blood sugar issues, because there are a number of things that are going along with hypothyroidism that I would think would. Would be. Would make you more likely to have breast cancer.

There was a period in junior high where I did construction work and there was a guy who was my foreman of sorts. And when he was sober enough to be at least, he gave me some advice that I've never. It's been some of the best advice ever got in my life. And there was one, someone else on our crew who was boasting about his romantic accomplishments. And they seemed quite implausible even to me as a young man. I said, do you think that's true? And he said, well, let me tell you something. He goes when it comes to guys. He was saying specifically about guys talking about girls, but it was a more broad application in my mind. He goes, when you hear stuff like that, you know, believe about half of what you think and, you know, half of what you hear and none or half of what you see and half of what you think and none of what you hear and you'll come out about right? And so I realized that in terms of medicine, we can think and we can imagine all kinds of things on any side of any argument. And so I believe of none of what I think. I only believe things we can see that have documented to have happened. I could totally think that too, that, yeah, hypothyroidism is bad in the body for a lot of ways and not advised. But in terms of actual real world outcomes, there's lower rates. And in terms of mechanisms, we know that, we hear about how certain things like xenobiotics or synthetic plastic compounds can directly influence breast cancer growth or production or proliferation. The same is true with thyroid hormones. You know, they do those same things as well. And when the body is losing some control over regulation, the activity of those hormones is just less regulated.

So let's go back and talk about the antibodies because that is part of the workup that's often missed. And people are not looking for thyroid antibodies. They're not looking for the autoimmune component, and that is the most prevalent issue is autoimmune thyroiditis. So where is that coming from and what should we be doing about it?

Yeah. So to take a step back, there's. There's four relevant antibodies, but two that we can really focus in on that are most commonly discussed clinically. And by understanding their chemistry, their roles, it all becomes pretty clear. So the two that are most relevant are involved with forming hormones within the thyroid. And the thyroid, it pulls in nutrients, makes them into hormones, and secretes the hormones. Now, every nutrient has some role to play, but there's a handful that are, like, just the superstars of this show. Iodine, selenium, iron, zinc, pretty much in that order. So iodine is the active compound that forms the energetic molecule that is thyroid hormones. And we talk about T3 and T4. The 3 and 4 are just numbers of iodine atoms.

Yeah.

So the two elements that are involved in measurable thyroid autoimmunity are thyroid peroxidase and then thyroglobulin. Thyroid peroxidase, it's the enzyme that turns on iodine. So it gets ready to attach, it activates it, it oxidizes it, to be a little precise, it converts iodide into iodine once it's been activated. Where it attaches is a template protein called thyroglobulin. So, yeah, these are carrier sites for transferring and storing iodine. And the risk for thyroid disease is highly, highly genetic. So if you have an identical twin with thyroid disease, your odds are like 79%. So family history is very big, and the genes involved are genes that change how one metabolizes iodine. So those prone to thyroid disease are ones that can't tightly regulate iodine as well as others can. When it's not well regulated, it accumulates in these structures, and they become treated as if they're foreign and the body attacks them.

Interesting. So. So if you find these antibodies, if you're saying that it's a genetic issue. Right. Is this something that we don't have control over, or can we reverse this situation?

Yeah, thankfully, we are getting more data arguing that the one doesn't follow, the other things can be genetic but not determined. You know, they're apt to happen, but not destined to happen and not stuck with it. And that's the exciting thing we've learned in these last several years. There have been many large clinical trials showing that simple dietary regulation of iodine can reverse thyroid disease for the vast majority of people.

And so iodine is one of those goldilocks things though, right? So too little is a problem, too much is a problem. So how do we figure this out and how do we make sure that we have the proper level of iodine?

Yeah, yeah. So the trick there is really just where we're seeing disease emerge and what's, what's the sweet spot and how much is the typical intake and what is the genetic tolerance. And, and what we see right now is that our population in the US is averaging around 180 or so micrograms for intake. Totally fine. Those genetically prone to thyroid disease, they run into issues if their recurrent intake is consistently above 200 micrograms. So not that far away. And about 30 to 40% of the population is at risk for that. They're consuming amounts that are excessive. The weird thing is that as adults there's so many food sources of iodine and so many mechanisms we have on doing well with meager amounts that iodine deficiency is basically non existent in the modern world. In 92 we had 112 countries categorized as severely deficient. By 2014, that number was brought down to zero. There have been six documented cases of iodine deficiency in the United States since 1980. So it happens. And we always want to think about not too little, not too much. But those prone to thyroid disease are more at risk for too much than too little.

And so what, what are these sources? How, how are we getting iodine? Because when I think about iodine rich foods, I'm thinking about sea vegetables, which most Americans are not consuming sea vegetables. So where are they getting this iodine?

Those are crazy high in iodine. And you're right, they're not as common in the diet. The biggest contributors to iodine in the typical American diet are dairy foods and processed grains. Dairy foods. They're present as a contaminant, they're used as a teat sanitizer. A fish meal is often given to cows. And then also they're fortified with cattle feed, processed grains. They're used in a lot of ways to condition does and condition the texture of products.

So if you're not eating dairy and you're on the Jen Simmons plan and you're also not eating grains.

Yeah.

Where is your iodine coming from? And do you have to worry?

Some do, some don't. So those are two big sources. Those are the amounts that have changed the most. Other sources include supplements. You know, a lot of them have it in overt sources, some have it hidden. Personal care products can have whopping amounts. And we absorb enough across our skin to where that can really add up. Salt. Salt can be fortified to iodine, or it can have naturally occurring iodine and a lot of salts that don't say they're fortified, still have a lot that's naturally occurring. And there's some foods that are wonderful foods that I encourage people to have in their diets. But when they're really watching their iodine during that first stage, they may have to be more cautious with. And those would include egg yolks and seafood.

So you just mentioned that first stage. That first stage of what?

Yeah, yeah. So if the body has had an excess in the thyroid and that's the driver of autoimmunity, if you get below a threshold, you've got a good chance of reversing that. So in the thyroid reset diet, I just call that the reset stage. And I basically did a massive amount of legwork because you can't find very thorough iodine assays for foods. You only find a list of a few. But they. They do exist and they do fluctuate, and they do very seasonally. So I made a pretty massive database and broke foods down into ones that have amounts that are generally going to be harmless, moderate amounts that are pretty consistently moderate, and then amounts that are either just always high or pretty variable. So, yeah, red light, yellow light, green light. And the reset stage is green light foods. Once you fix things and you're better, you can add back in some of those moderate foods and you should. You should have more variation in the diet.

So again, you're talking about fixing things. So I want to go back to how do people know that there's an issue? Because we talked a little bit about symptoms. You're saying that measuring the thyroid hormone levels is not a reliable way of knowing if you have thyroid dysfunction.

Good. If that's off, there is a problem. But if that's not off, it doesn't mean there's not a problem.

Not a problem. So how do people know that they have a problem? And what. And what is the intervention?

You know, ultimately, this is a situation of working with a good. A good doctor because it does take measurement, but it also, it takes really knowing someone's clinical situation, knowing their family risk. Some need to dig deeper than others. The simplest action step is measuring thyroid antibodies is getting a blood draw for antithyroid peroxidase and antithyroglobulin. Now, there's wrinkles. There are people with autoimmune thyroid disease in which these things are not positive, they're just not measurable. But they're still active. And that's where a doctor could hear someone with a very pronounced family history and very suspicious symptoms. And they may then go on to do an ultrasound, especially if they've got localized symptoms and they can see evidence of autoimmunity, even if there are negative antibodies. So the simplest first step is screening for antibodies. But if there's still concerns, a doctor may need to dig further.

And so there are physical signs of inflammation on an ultrasound that would. That would confirm autoimmunity?

Yes. Yeah, yeah. There's different versions of Hashimoto's, but most create a bit of a Swiss cheese appearance, extravascularity, you know, some calcification, some changes like that.

And is, does everyone that have. Has autoimmunity, should they be getting an ultrasound of their thyroid?

It's a good thing. They've got higher risks for nodules and higher risks for thyroid cancers. And amongst women, thyroid cancer is the fastest increasing type of so.

And then can this autoimmunity be reversed?

Yeah, so one study took those that had pretty advanced autoimmunity and overt hypothyroidism. The thyroid was really shutting down, and for three months did just one thing, which was dietary regulation of iodine. 78% of the people had fully reversed autoimmunity and fully normalized their thyroid function within three months. Of those who didn't get better, one cohort had levels that were more abnormal than others, and they weren't normalized, but they were improving radically. And another cohort simply wasn't compliant. You could measure their compliance status and they weren't there. So of those who were compliant, those who improved significantly or completely normalized, that was over 95%.

And is there a time limit on that in that if it goes unrecognized for a year, two years, what is the time period at which time you can no longer reverse that process?

Well, in terms of the disease process, there aren't large cohorts who have been untreated for long periods of time. The study that I cited is 4.2 years on average. They were all untreated. Another cohort which has been more studied has been those who've been on thyroid medications unnecessarily. And yeah, there's. There's actually not a cut and dry timeframe. But of course, the longer something goes on, the lower the odds become. I spoke with someone two weeks ago who was medicated for 45 years, who now is not and has better thyroid levels and no symptoms. So, yeah, there's. There's not really a cut and dry timeframe where someone can't get better.

Wow. So there are more and more people steadily put on thyroid medication. So what do you think about that?

Well, the conventional literature argues that people who are seeing regular endocrinologists and regular doctors that somewhere around 87% don't need the meds in the natural health space. I guess I thought it's such a big bias because everyone I treat is because of thyroid disease. But I would argue that it's even more prevalent in the natural health world that we think that everyone needs more and many are put on them. So yeah, somewhere around probably not less than 90% of people on them don't need them. And, and they're, they're not harmless.

Wow. So what, what are the harms?

Yeah, increased risk for almost every kind of cancer you can take a shake, shake a stick at. A rare exception is colorectal. But breast, brain, ovarian, lung, prostate, stomach, esophageal cancers are all on average about 50% higher risk with those on thyroid medications.

Wow, that's really scary considering that I think you told me that thyroid medications are amongst the top three medications received around the world. So this is another example of we're actually creating the diseases that we say that we're trying to prevent or avoid.

In the mindset that the older I get, the more I get pushed into is that our bodies are amazing, you know, and our bodies have such capacity for homeostasis. And I don't like the idea of trying to hack our bodies. We can nurture, you know, we can improve upon our ability to achieve homeostasis, but we can't get in and take over. Sometimes we have to, you know, but that's so we should be so sparing and so cautious about taking over the body's chemical pathways.

For people who are already down that road, they're on that road. They're on thyroid medications. Are there ways to get off? Are there, are, are there things that we need to be mindful of?

Yeah. So the literature onset first was the study saying that the meds are often not needed. Then the next wave of studies was that the meds are harmful. And so the follow up question was just that, what about those who are on them? So the, the concept is called deprescribing and we're used to the idea of prescribing, but no one thinks about de. Prescribing. People end up in all these meds they may have needed at one point, may not need going on. So a lot of studies have been done on this, and most of them take people, many of whom have even overt hypothyroidism. They actually did have a really big lack at one point. And the first few studies did nothing more than give them a schedule of tapering over anywhere from two weeks to two months. And without there being much more thought than that, about 60 to 70% could lower greatly. Now, the next wave of studies understood the correlation between iodine and thyroid disease and then also the high iodine content of thyroid medications. And it had people avoid some of the more obvious sources of iodine. They didn't get as deep as I would have liked, but they at least talked about iodine in supplements and salt and in some of the highest foods. Once that was taken into account, those stats went up to 84% that could successfully come down. By coming down successfully, I mean, their thyroid levels stayed fine or got better and their symptoms stayed fine or got better. So, yeah, 84% could come down and half could come off completely. Now, the kind of things that your listeners are hearing you talk about and the things that people you've helped directly do, all the good things in natural medicine are only going to make those odds higher. So, yeah, not even doing a lot of smart stuff. 84% chance of lowering and 50% chance of being off.

That's. That's really amazing and also a little scary. Right. So there are a lot of things that go into thyroid hormone. We talked about iodine being that. That very important central molecule. But what about the other nutrients that go in? Because if, if thyroid, if. If thyroid health is not dependent on iodine, Although I don't want to say that that's, that's not exactly correct, but that our body is really good at maintaining that in homeostasis. Are there things that are really important that also affect thyroid health that maybe our body doesn't do as well with homeostasis? Like I'm thinking of vitamin D, for instance.

Sure, sure. Yeah. The biggest documented factor is selenium as far as being relevant. And the enzymes that regulate iodine, most of which are selenium dependent. So we know that if someone is lower in their selenium status, whatever their genetic iodine window is will be even narrower. They'll have even less of a tolerance of it. That's a big one. You mentioned vitamin D. Totally relevant, especially for onset of the autoimmune response. Last one of the top three would be iron, so kind of a shocking thing. But of those with autoimmune thyroid disease, 30 to 40% have a thing called atrophic gastritis or autoimmune gastritis, also called thyrogastric syndrome. That makes them not able to assimilate oral iron very well. And many of them have latent iron depletion. And it doesn't even take overt anemia, just minor latent iron depletion. All of the iodine, all of the iodine controlling enzymes are mostly heme dependent. So if someone is below ideal and iron, they're also more prone to severely abnormal thyroid levels and more, more problems, more symptoms from it all.

And selenium is one of those minerals that I think about also being a goldilocks mineral with too little is not good, but too much is not good too.

Yeah, so there's selenosis. There are times where you can get an excess of that. That has happened a few times when selenium was, was excessive in dietary supplements or folks just take too many supplementing forms that get further above 400 micrograms get to be excessive. Thankfully, dietary sources of selenium are not a risk, barring one exotic source called paradise nuts. So Brazil nuts are actually not a risk. They've got a form that can't bioaccumulate and other dietary sources really can't either.

I don't know what paradise nuts are.

They're not really common things that you Once a blue moon they can be found. They're from South America. But there's there different chemical form of selenium than Brazil nuts contain.

All right, well that's good to know. And the last, the, the other thing that I wanted to ask you about because we, we did talk about.

We.

Talked about products, self care products that may contain iodine, forms of iodine and we, we mentioned some names. So I want people to know what to look for in their, in their products. What is it going to be called? Because I know when we look for sugar, when we look for antibiotics, there's a zillion names. You know, it's, it's a, it's a, a wolf in sheep's clothing for so many people. Right. So what is iodine hiding as?

The most common one is PVP polyvinylpuridone. There's a couple dozen other names of that that are close to it. In natural products the main thing is really sea vegetables or sea vegetable extract or kelp extract.

Okay, that's great. And so who do you recommend thyroid medication for?

Yeah, so there's degrees of hypothyroidism, there's in natural medicine, many Talk about normal levels and optimal levels. And that's a valid way to suggest if someone may have relevant symptoms, but it's not a valid way to say who needs medications. So then we have what's called subclinical hypothyroidism. That's where TSH levels are above range, but the thyroid hasn't yet quit. Then we have overt hypothyroidism. That's where the TSH is very elevated and the thyroid's pretty close to quitting. So with overt hypo, medications aren't the only option, but they're totally a reasonable option. And then those who lack a thyroid, they're necessary. But there have been large, large meta analysis on those with suboptimal or subclinical hypothyroidism. There's not a net benefit to medications. There's not a net improvement of symptoms or an improvement of overall health risks or even a lowering of future thyroid disease risks.

So with the people with overt hypothyroidism, you said that medication is not the only option. So what are the options for people who have clinical symptoms and they have thyroid levels that are clinically low? Right. What are some of the solutions for them?

Yeah, the exact same dietary study that I cited, there have been others done at different levels of hypothyroidism. And those with overt disease, roughly 40 to 50%, can reverse that with dietary change. Another big wrinkle is that overt and subclinical hypothyroidism, if you do nothing but retest that person, weeks or months down the road, 30 to 40% of the time, it's not even there. So that's an important point, too. It's not to put a lot of weight on any one reading.

And so what does that dietary change look like?

Well, I mapped out the details in the Thyroid Reset Diet. The studies that I cited, they exclusively lowered iodine. They did nothing else. And it's possible to do a very low iodine diet that's at a good iodine range, but is not really a healthy diet otherwise. So that's what inspired me to write the Thyroid Reset Diet. There's a lot of ways in which we know processed foods are not great things. And there's other ways in which thyroid function can be affected by diet. Not to that as large of a degree, but, you know, macronutrient balance, other micronutrients are relevant, certain phytonutrients are helpful. So, yeah, it's really just a healthy diet. And Doing all the steps along with that big one and not just that big one.

While we're talking about diet, I'm curious. We hear that there are many food groups that can actually exacerbate thyroid disease and worsen thyroid health. So can you talk about soy?

Sure, yeah. In great detail. This has been studied pretty thoroughly. The first inkling of soy being relevant came about in the 50s when certain infant formulas were made with soy as a protein source. And the backstory is that iodine is a mineral, and then soy protein is a protein. Proteins and minerals can interact, and sometimes you only really know that when you see how it plays out in large groups of people. So prior to then, infant formulas were using casein. They're using cow's milk. And the earliest iterations gave enough iron that should have been adequate for an infant that received all the nutrition from that formula. But many were iron deficient, and they learned, oh, wow, casein binds with iron. And so we've got to put in more iron than we would expect to compensate for that. And once they did, everything was fine. The same kind of wrinkle happened with soy and iodine. They didn't really know how soy would bind with iodine. So the first few generations, there were infants that were iodine deficient because of the soy, and they realized, oh, yeah, this is a binding issue, just like we had with iron and casein. So they added iodine to compensate. It all went away, but that's what started the story. Since then, there have been a lot of thoughts and concerns that have persisted since then and massive, massive amounts of clinical research on this topic. The last large meta analysis was 2019, and they pulled together all the known studies, and there's simply not a known correlation. There's simply not a way in which soy foods affect any version of known thyroid disease. I wrote about this, and before doing so, I reached out to lots and lots of my friends in the thyroid space and in the health space and said, hey, you guys, I'm trying to sort this out. I don't really have an agenda here. You've talked about soy being a bad thing. Send me the studies. I just want to make sure I'm not missing anything. And I spent many months gathering data and asking everyone and doing a pretty exhaustive literature review. There's no smoking gun. There's really no relevant risk.

Do you think it has something to do with the prevalence of thyroid disease in Asia and in the Asian cultures where soy is a prevalent part of their diet?

Well, if you take soy as a Dietary variable and look at other parts of the world, it's not a big factor. You, if you look at iodine intake as a factor, it's huge. Japanese have the highest iodine intake by far.

Yeah. So is it true, true and unrelated.

What's that?

Is it true, true and unrelated?

True, true, true, true. They consume more soy and. But yeah, not, not related to thyroid disease.

Yeah, yeah. What about cruciferous? I get people all the time who come into my Facebook group and say, how can you tell people to eat cruciferous vegetables when it interferes with thyroid, Thyroid function.

So the truth about that is if someone only consumed raw crucifers, and by only, I mean only then they could have problems. And I've actually seen that, believe it or not. I've seen people who are consuming almost nothing but blended broccoli and blended carrots and like, no other foods, like no salt, no nothing. And they have developed goiters from that. But in the context of a normal diet, crucifers have so much more net benefit than drawback. If you're looking at areas of endemic goiter, which are now almost largely gone, populations that consume basically mono diets on like, one or two localized foods, iodine, poor soil. If they tag cruciferous vegetables on top of that, the goiter rate will go from like 30% to like 30.4%. So that's the relevance of it. But in the modern world, yes. There's so much more benefit and just really no measurable detriment that way.

Yeah.

And.

I, I, I just want you to reiterate because I've also heard people say, well, it may not be true of cooked cruciferous vegetables, but raw cruciferous vegetables are the issue. You know, everyone wants the smoking gun. They want something to blame.

Yeah, yeah. In terms of things to blame for thyroid disease. So one large study that was done a few years ago was a meta analysis of all causative factors of thyroid disease. And they said there's, there's basically three smoking guns. There's genetics, there's gender, and there's iodine. There's only one of those things we can change. So back to your point, though, about raw versus cooked. You know, same story. No, there's no. Yes, it is true that in the case of someone who's having a problem in those rare circumstances, there is more of an effect from raw. But in the real world scenarios, the, the negative effect from raw is so minimal that the benefits outweigh it greatly. You can have them how you want to have them?

Yeah. Why is gender an issue?

Yeah, there's thoughts about that. So autoimmunity across the board is more common in women. I mentioned how thyroid disease is largely genetic and it kind of. And it's a bit of a misnomer to pull apart genes and gender. Right. Because we're. Our gender is genetic. So most of the genes that are involved are genes that act on D iodinase enzymes and these are enzymes that regulate iodine metabolism. These are primarily X linked traits. So women get two sets of these chromosomes and if they have some less, more recessive versions of these gene variations, they're more apt to manifest from having two X chromosomes, whereas men just have one. And that's probably relevant for a lot of autoimmune differences in general. There's two other theories as well, but that's the leading one as to why women get more thyroid disease.

And so I want to talk about the relationship of thyroid disease to other areas of health. Because we are seeing so much thyroid disease. How does that relate to other areas of chronic illness?

Well, and to pull it apart, I would even talk about thyroid levels, like a deficit of hormone or an excess of hormone, then the autoimmunity. This next answer I'll give because the autoimmunity thing, again is so much more common. And these problems that I'll talk about, they occur in people with perfect thyroid levels. But thyroid autoimmunity. So we now have data saying that can be a driver for infertility, for heart disease, for early cognitive decline. Also there's good evidence for certain types of cancers, such as liver cancer, a big range of many ongoing health symptoms, and then also greater risks for autism amongst children for mothers that have thyroid autoimmunity.

And what about fertility?

Yeah, big factor for fertility, both in terms of conceiving and also retaining through the first trimester. And that's true for those that have problematic thyroid levels, which again, is more rare. But it's also true regardless of thyroid levels, when thyroid autoimmunity is present. Yeah, lots of data around that.

So this, the amount of thyroid disease that we're seeing seems to be getting more and more common. And we're. And we're seeing it. I don't, I don't want to see a younger ages, but it does seem like it's just becoming more and more present and prevalent. What, what's happening there because our genes aren't changing.

So this was looked at most closely in Denmark. They did a really good job tracking rates of diagnosis, different, different procedures related to Thyroid disease and rates of thyroid medication usage. They were the most recent industrialized country to fortify their salt with iodine, and they did that in the year 2000. And year after year, they've had a net 50% increase for each year since then. The United States we fortified in 1924. In the following decade, our rate of thyroid autoimmunity went up by 26 fold. Between 191980 and about 2010, the amount of iodine in 23 of the top 25 dietary sources roughly doubled or tripled. So the population that's being pushed above that safe threshold per their genetics is quite simply increased.

So have we just completely adapted to be able to be healthy with very little iodine? And we're kind of pushing this if someone's good, more is better agenda and causing the actual disease.

So to some extent, yes. Now back to your first point. Have we adapted? So there's kind of. There's two human genotypes. So we don't really adapt as individuals, we adapt as populations. And some genotypes are really well adapted to being in coastal areas. You know, they can survive on a wide range of foods in the ocean, and if they get massive amounts of iodine on occasion, they can generally deal with that. Other genotypes are well adapted to be more inland, and they can do really well on sparse amounts. But you can, you can, you can have a vacuum cleaner that stores everything, or you can have like a big dump that gets rid of the extra, but you can't have both.

So.

So, yeah. So those who are genetically less able to tolerate those occasional excesses, they do great on minuscule amounts, but they can't tolerate the occasional excesses. And those are the genotypes that are more. Getting more at risk now.

So why isn't this generally understood? Why aren't we talking about this all the time? And why aren't we. Is there a test to determine who will and who won't tolerate iodine?

We know about a dozen relevant genes, but the tough thing is that gene status is never the same as gene expression. The biggest thing is really just existing thyroid disease or a family history of thyroid disease. That's the best way to know.

Yeah. So your genotype isn't always your phenotype.

Exactly.

They don't always look like what your genes test.

Yep.

And so what does the average person do with this information?

Well, if they have or are prone to thyroid disease, if they work to get to a range to reverse the problem or prevent it, they've got a whole lot of Good odds of that making a difference. It's an awesome story and it's really cool. I mean, over all the years, I'm more optimistic now than I have ever been about there being safe, natural solutions for people. This is a big deal that affects a lot of people and causes huge problems. And in almost all cases, there are safe lifestyle approaches that can help.

Now, there are a number of people who connect thyroid deficiency with breast cancer.

You meant to say iodine, but yes, go ahead.

Oh, yeah, sorry. Iodine deficiency with breast cancer. Thank you for the correction. And they're literally rubbing iodine on their breast every day. So what's happening there?

Well, so the story. And you asked a question before that I didn't really address adequately about. Why is. Why are there different views about this? So there was a dear man who's passed away who was a gynecologist, and he saw some studies showing that iodine can lower fibrocystic breast disease symptoms. Totally true for about two thirds of women. They can for about a couple months. But he thought that it helped because they were low in iodine and their breasts needed massive amounts for various benefits. And that was plausible, but it didn't really take into account how iodine works. So iodine is a unique nutrient in that there's a special pump that puts it in certain places. So the thyroid has a pump and the breast tissue has a pump. It's called the sodium iodide symporter. Now, when you get an over expression of that pump and you pull too much iodine in breast tissue, you damage proteins like you do in the thyroid, and you can cause fibroadenomatous breast disease. If there's a stronger expression of that active pump, you can also cause the DNA damage that can lead to breast cancer. Not the only thing that causes it, of course, but it's one of the mechanisms. Now, the paradox about iodine is when you're exposed to a lot of it, you shut off the pump, you know, you stop taking it up. So a high amount short term can look just like less. Ken One example of this is in the case of Graves disease, when there's huge amounts of thyroid hormones coming out that can be fatal. The only way to stop that instantly can be a massive dose of iodine because you totally shut down the thyroid. So iodine helps those symptoms, not because the breasts need more, because sometimes you can stop them from taking up any by giving a lot of. This idea was further augmented by looking at Japanese women. Higher iodine intake, lower rate of breast Cancer. And so many thought, oh, there must be a clear correlation there. Well, there have been studies done now in Japan that have been replicated in other parts of the world showing that those that are on the higher side for iodine are on the higher side for breast cancer risk. So we know now it's more of a direct correlation, not an indirect one.

And is that tied to the same thing that we're talking about with hyperthyroidism, Graves disease, and an increased risk of breast cancer?

Well, it's even independent of that. So independent of thyroid disease, being on the higher side of iodine status in a population correlates with being at a higher risk for breast cancer.

So how should people be measuring this? How do they know this is the tough thing?

So there's a lot of iodine tests, and pretty much none of them are worth very much. The amount in the body varies so much from time to time that when you're testing hundreds of people, many tests are adequate for gauging populations, but for individuals, none are perfect to say how much you have. There is one test that can show how much you're getting rid of pretty well. And that's not to say to measure to see if someone's deficient. But that's a good way to see if someone who's trying to avoid it has gotten down to a therapeutic level. That's a urinary iodine to creatinine ratio test. There are serum iodine tests, which all authorities argue have no relationship whatsoever with nutritional iodine status. There's random urine test, 24 hour urine tests. All of these tests are accurate if you repeat them, no exaggeration, hundreds of times. But an individual eating means nothing. There's a skin iodine test, which was debunked in 1932 for having any relevance. So, yeah, so if someone, if someone has or suspects thyroid disease, their best action step is to get to a lower level. There are inventory. So the most meaningful way to know your status is to inventory your intake. You know, URL, I made this. It's free. It's iodine. Inventory.com. someone can just look at their common food types, their supplements, their thyroid medications, which also contain iodine, and they can get a sense of what their typical daily intake is like.

And so if I'm hearing you correctly, no one should be supplementing with iodine. And that iodine deficiency is almost unheard of. And that by just by living, you can get adequate levels of iodine without being intentional about it at all.

Well, and I learned about this stuff by seeing, by being a thyroidologist already and seeing the fallout from those who were supplementing with iodine. This, this fad really first started emerging about in like 99 or 2002. And I saw people that really you would. The first man was a guy in his mid-70s, healthiest guy you can imagine, and he suddenly has severe Hashimoto's, which was weird. And I said, well what? And I talked to him and he said, well yeah, doctor said I was low in iodine, I've been taking it. And he took this massive dose of iodine for a loading test and that's when it all started, like, oh wow. And I saw more and more cases like this. So yeah, it triggers those problems and that's how I learned about it because I saw these things happen to people.

Yeah. So that's really amazing. And actually quite contrary to what I knew and understood before and I know a lot of people in the breast world talk about iodine deficiency being a huge problem.

I know.

Why do you think there's such a misunderstanding about this?

Yeah, I've actually written about a 20,000 word blog about trying to answer that and you know, old habits die hard. One story. Some stories are very plausible, you know, kind of saying before about I don't believe the things I think. I only believe things that we can actually see and measure. So the story is a simple story. It's like, hey, there's this one nutrient that they don't want you to know about that everyone's low in and it's causing this big problem. And if you have more of this one inexpensive nutrient, all these problems go away. It's an appealing story. I wish that were true, you know, and it's an easy thing to go viral. And it's simple to say, oh yeah, you take this thing and we need more of it, we don't get enough, our diets get too little. And there's so many other scenarios where that is true, there's so many examples where that is the case. But so many people have gotten caught up into just that simple narrative and haven't really said, but is that true? But what happens to people at these different intakes? You know, this is the most studied nutrient on our planet. We've got, we know more about this, we know about vitamin C or anything else. This is one of the first nutrient disease correlations ever understood by humans. We've got massive data sets. We know exactly what ranges correlate with the most or the least thyroid disease. There's so much data around this. But this narrative that's gone around just doesn't align with this larger body of data.

It's just so funny how a narrative can be so convincing and so untrue at the same time. But I. I guess I shouldn't be surprised in that I'm surrounded by that narrative every single day with mammograms. Save lives.

Sure.

Right. So that. And people really believe in them. And. And not just. Not just lay people, not just consumers, but the. Almost. The entire conventional medical world will die on that hill.

Perfect example. It seems intuitively true, but yet if any of them took some time to look at the existing literature, they would come to a different conclusion. And that's the same story here.

Yeah, it's really astounding. So I want to leave people with some really practical information. So the first thing that everyone should do, I'm guessing, is check their supplement bottles and make sure they're not supplementing. Right.

Check your personal care products, too. They can contain a lot. It was recently banned in hand sanitizers because so many hospital workers were getting toxic from it. But a lot of what goes on our skin in the terms of iodine goes into our bloodstream, and the microscopic amounts add up. So, yeah, personal care products and supplements are good places to start. Which.

Which personal care products, other than hand sanitizers are. Are the most likely culprits.

The things that are most relevant are the things that we use in significant quantities and that we leave on our skin. So body lotions, face lotions, conditioners, possibly shampoo, but those are the most relevant ones. The main ingredients, the core one is polyvinyl pyridone PVP Papa. Victor Papa, to use the phonetic Alphabet. Now, that one's got about two dozen different names, but that's the most common one. And this is not a natural versus synthetic cosmetics issue. In natural cosmetics, we call that sea vegetable extract or kelp extract. That's got other names too, but those are the most common two names for it.

And there are a lot of people who are putting kelp flakes on their food. Is that an issue?

Totally. Yep. Yeah. The amounts in kelp in the course of like an ounce of kelp is roughly 20,000 times what the World Health Organization calls a safe upper limit for a day.

Yeah. So we're checking our supplements, we're checking our personal care products. Should everyone have thyroid antibodies measured?

If someone has relevant symptoms, for sure, if they've got a family history and symptoms that don't really fit anywhere else, then it's definitely A good thing to.

Look out because I don't know how frequently that's happening even in people that have relevant symptoms. In that I see people all the time who have never had thyroid antibodies measured and they're on thyroid medication.

You know, Dr. Jim, as you were saying about mammograms, I really got your passion right there because your depth of knowledge and the disconnect there. So a thing like that with me is endocrinologists refusing to measure thyroid antibodies. And I could, I could sit and cite studies for the next two hours showing that thyroid antibodies cause harm regardless of where your thyroid levels are. But this is a case to where the policy is we don't measure them. And I guess to their defense in the conventional world there really aren't drugs that treat them. I mean, there's no reason they couldn't give lifestyle recommendations. But there's good data that lifestyle can help with them, you know, diet and supplements. But the data that they cause harm regardless of the rest of it is just irrefutable.

Yeah, I agree with you. And it's, and it's one of my sticking points too is I'm always measuring and, and I ask people and they say, well, why I never had that measured before and why does that matter? And my, my doctor told me that you can't do anything about it anyway, so why test it? Right? And I think that, you know, that's part of the thinking is that if you're only going to use, you know, if you only have two tools in your toolbox, then of course you're not going to order a study that doesn't use those two tools, you know, but.

Somewhere along the way doctors have to be responsible for their patients well being and addressing the data that exists, not just what they're spoon fed. If you go the tiniest bit out of your way and Google diet, thyroid antibodies, there's, there's massive data about things being helpful. Oddly, in the natural world we pursue the methods that have been shown not to work, but there are approaches that make a really big difference.

Yeah, well, because those approaches are easy and there are so many people that, well, first of all they're trusting in their doctors, right? And that's a very easy thing to, to for their doctor to do, prescribe a pill. But it's not so easy to sit down and talk to them about what foods to avoid, what products to avoid, and they may not even know. And I'm not saying that in a denigrating kind of way in that like I didn't know, I didn't know. Right. So I think for us and for our part of it, we see life as the never ending pursuit of knowledge, information and approaching it with curiosity and being as unbiased as we can. Because as you said, like, you can't, you can't go by what you believe. You have to go by what, what, what you can prove. Right. Although it still like doesn't make sense in my head because cancer is a metabolic disease and hypothyroidism is metabolic disturbance.

Sure. And T3 is a cell growth factor. It's a cell, it's a proliferange. It's just like a synthetic estrogen in that sense.

Yeah. So we talked about where to look for supplements, body care products, that kind of thing. Things that sit in your, on your skin for a while are going to get absor into your system. And we talked about soy is not a problem and the crucifers are not a problem. And in fact they are the opposite of the problem. They are actually protective. What are the foods that are a problem that people need to be mindful about?

The biggest things are the iodine outliers. Another big category that's often confusing is salt. Salt. So many salts have naturally occurring iodine, some have it fortified. A lot of the popular salts these days are ones that contain a lot of naturally occurring iodine. I'm looking at you pink Himalayan salt. So it's got twice as much as synthetically added to fortified salt.

So should we be avoiding that entirely? Should we be using it sparingly?

Well, it's not even, it's not even a sodium issue. I mean that's a different discussion. But in terms of the iodine stuff, it's not even a sodium issue. I've, my views have evolved on this a lot over the last, I don't know how long, but coming into the natural health world starting in the 80s, you know, my, the, the idea was that sea salt was kind of like a vitamin. You're getting all these extra nutrients from that. And I don't know, I've run the math. I mean it's available as far as how, which nutrients and how much. And you run the math like oh really, like a tenth of a milligram of potassium. That's not going to change my life, you know, so there's really not enough to help. But now there's data about microplastics. So yeah, 90 plus percent of sea salt and pinkhamalion salt is full of microplastics, like stuff you can See, under just a magnifying glass, you know, and then we look at the other things that are present that all the other minerals that you don't want, the cadmium, the arsenic, the lead, the mercury, you know, this is stuff worth avoiding. And then just the iodine content being high and really variable. So I'm, I'm more and more a fan of just pure salt. Like just kosher. Kosher salt that just has salt, nothing else in it.

Yeah, that's good to hear. And so salt. Are there any other foods that, that you think that people should really be limiting?

Well, yeah, so just. And it's not even per se limiting. It's the cool thing is that this is not a hard swap. Like of all the foods there are, there's iodine safe versions of everything. So it's really not restrictive, it's not difficult. You're just being aware of the categories that have the most and doing easy parallel swaps. And salt is a great example. You're, you're not giving up on anything. You can use it as would be appropriate. And yeah, no big issues that way then.

Yeah, but should we be avoiding sea vegetables? Limiting sea vegetables. I remember there was this awesome food store around me that used to make this kelp pad Thai and there was a big warning on the, on the box that you shouldn't eat it more than once a week. But it was really good.

So this is the thing too, where my views have evolved. You know, way back in the early 80s, I was into macrobiotics. Sea vegetables were a big part of that. And now there's been a lot of data about populations that consume the most sea vegetables. They have higher rates of many cancers and higher rates of thyroid disease as well. So they do have a wide range of nutrients. But whenever you get foods that, that happen to have a whole lot of stuff from dirt or seawater, for every nutrient there's also a toxin. Like no one really chose what went in there per se. And that, that's the issue with them. So they, they taste great. I love sushi, you know, no reason want tasty stuff. But I've seen a lot of folks just go crazy on, on seaweed snacks and wreck their thyroid short term because of that. So it's a food to watch if you're prone to thyroid disease or if you have it.

But is this reversible in that are we the damage that's done in the short term, can we just restrict in the long term and can we reverse that damage?

You know, little modification restrict in the short term and keep an eye on in the long term. And in nearly all cases, the answer is yes. There are those where their thyroid has shrunk to nothing. There's those where it was taken out. They are the minorities. The other big group though is those who are on medications they might not need. And similar story is also optimistic. There's now been big data sets saying that 84% of them can radically reduce their dose and about half can come off entirely. So, yes, the thyroid's more resilient than we thought.

Wow, that, that's such great news. Because I know that, that, that is another narrative that is, that is spoken all the time that, well, you've been on thyroid medication for this long, you know, there's no chance of you recovering thyroid function. And so I'm going to, I'm going to give you the takeaways. You tell me if I'm wrong. Everyone with thyroid symptoms should have antibodies checked. We should all be mindful of our iodine intake. Look in your supplements, look in your personal, personal care products, look where it's coming in in your food. And we don't need to supplement because we don't, most of us don't need much at all. And we have highly adapted and that we are getting what we need from just routine dietary sources. Also, it seems as if, if you eliminate a lot of those high iodine foods, you're also eliminating microplastics and other things that come along with, with those foods. And that even if you have had thyroid dysfunction, your thyroid is a resilient organ, unlike what we have known and understood, and that you can recover thyroid function. And then is, is that true at the other end of the spectrum as well, with an overactive thyroid?

In most cases, yes. Actually, in even more cases, there's good evidence that most common form of that Graves disease, that if someone can get out of the hyperthyroid state, they've got about a 95% chance of the condition going away within 18 to 24 months. So. So yes, it's more dangerous in the short term, but it's more commonly reversible when well managed.

And so in the short term, if you can. What you mean is, if you can get through it without having a heart attack or some other catastrophe, because that's what happens.

Well, yeah, there's a feedback loop called the hyperthyroid autoimmune loop where basically the excess of thyroid hormone creates inflammatory changes that worsen the autoimmunity that releases the excess of thyroid hormone. So the whole thing feeds back upon itself. And the medications that treat that are medications that block iodine uptake. So if someone has less coming in, the medications work better. If they can get out of that hyperthyroid state, then there's a really good chance of it resetting.

But it has to be done along with iodine restriction, I would imagine for sure.

And that's, that's always recommended. Yeah, the medicines are blocking iodine and there's a lot more coming in. They just can't work.

Yeah. So this was amazing. Thank you so much for clearing so much of this up. It's such an important conversation that we need to have clearly as 25% of women are suffering from some degree of thyroid dysfunction. So, you know, it's happening, it's happening all over and we need to know about it and what to do about it. Make sure sure you pick up your copy of Thyroid Reset so that you can reestablish homeostasis in your thyroid because it is such an important gland and it is basically the key to our metabolism and our metabolic health. So it's super important. But it's involved in so many of the systems in our body. It helps our brain to function properly and our heart to function properly and our body hormonal system, our endocrine system to function properly. And it's important for fertility and really so many, so much of our function is reliant on our thyroid. Where can people find you?

Dr. Christiansen.com Main website at Dr. Alan Christiansen Social Media so wherever and yeah, always sharing a lot of this stuff and I just want to give one one quick statement for the listeners. I really encourage you to rewind and listen to Dr. Jen's summary. Again, I couldn't say any that stuff better. It was a great wrap up for Key Steps so please give that one more checkout before you finish.

Well, thanks for the plug. If you liked this episode, please share it with your friends and your sister and your mother and your family and your community because it is an important topic and we one that is very commonly misunderstood. I know I learned a lot today and thank you so much for being here, for supporting me and for joining us today. It's Dr. Jen. Bye for now.

Thank you for joining me on this episode of the Keeping abreast podcast with Dr. Jen. I I hope you found the discussion informative and empowering. Remember, rest, health is health. So by staying informed and taking proactive steps, you have the power to optimize your well being. My team and I encourage you to apply the knowledge gained from today's episode to make positive changes in your life and share what you've learned with others. If you enjoyed this episode, please subscribe to our podcast and leave us a review. Your feedback and support mean the world to us and help us to reach more people who can benefit from these conversations. Stay connected with me on social media where I share additional resources, advice, updates and announcements related to breast health. You can find me on Facebook, Instagram and YouTube. Dr. Jennsimmons and remember, my Jen has two N's, so until next time, remember to stay proactive, informed and confident in your breath. Breast Health Journey the key to your health is you.