Daily Steps To Heal The Most Common Autoimmune Disease

Coming up on this episode of the Doctor's Pharmacy.

Hashimoto's is the most common cause of hypothyroidism. It's seen as a thyroid condition.

Yeah.

And it's really an autoimmune condition that affects the thyroid.

And this is the most common autoimmune.

Disease in America, right?

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Week'S episode of the Doctor's Pharmacy. Hi, this is Lauren C. And one of the producers of the Doctor's Pharmacy podcast. Conventional treatment for autoimmune diseases like Hashimoto's gives little hope to those who are suffering. But through the lens of functional medicine, we're able to uncover the underlying factors that contribute to the autoimmune disease and begin to treat them at their root. In today's episode, we feature three conversations from the Doctor's Pharmacy about why it is vital to look at the whole body when treating Hashimoto's for any autoimmune disease. Dr. Hyman speaks with Dr. George Papagniello on the food ingredient that is often behind a Hashimoto's diagnosis, with Dr. Elizabeth Boham on advanced functional medicine testing, and with Drew Prohov on the role of.

Inflammation in autoimmune diseases like Hashimoto's.

Let's jump in.

27 million Americans have thyroid dysfunction and 12% more are likely to get it every year. Hashimoto's is the most common cause of that dysfunction, particularly hypothyroidism. And Hashimoto's is an autoimmune process. What is autoimmunity? It's when your body's immune system starts making antibodies against your own tissue. and in this particular case, it's the thyroid.

And this is the most common autoimmune disease in America.

It is.

Right?

It is.

It is the most common.

And we don't really treat it as an autoimmune disease.

No, we treat it as hypothyroidism.

Right.

So when a, and there are probably many women, and we speak mostly about women because they make up a large number of the patients we see with Hashimoto's.

So.

And a large number of these women do not feel better when they're treated and they get diagnosed with hypothyroidism without ever being tested for Hashimoto's. And the reason being is I think the big disconnect in conventional medicine, and that is that it's seen as a thyroid condition. And it's really an autoimmune condition that affects the thyroid. And in that setting, with that mindset and that paradigm, the thought is, well, it doesn't really matter where the hypothyroidism comes from because the belief is that there's nothing to impact that immune response against the thyroid. In conventional medicine, you just sort of let that immune response continue flaming until the thyroid is burnt out. And then the person is on whatever dose of thyroid medication will get their thyroid number, their TSH, into the normal range. And that's considered good medicine. One problem, one problem. There's a lot of women running around with a normal TSH that still feel like crap.

That's right, that's right. So a lot of people are diagnosed, by the way, half of people with low thyroid are not diagnosed.

Oh yeah.

Okay, so that's a problem in and of itself. And if you're talking about 20% of women, it's a lot of people. And 10% of men, it's a lot of people.

That's one problem.

The second problem is, like you said, we treat it by just giving people thyroid replacement. without actually dealing with the root cause of why their thyroid isn't working in the first place. And it's like the same way we treat all other autoimmune disease, which is we say, oh, there's inflammation. Let's give you an anti-inflammatory drug, right? Whether it's Advil or steroids or chemotherapy drugs or immune suppressants that are super powerful and cause cancer and overwhelming infection and death in many people. Like we don't go, what's the cause of the inflammation? So George, with Hashimoto's, which is again so common, what causes the autoimmune disease in hypothyroidism in this particular kind of autoimmune disease?

There are thought, you know, there's no clear understanding of the exact mechanisms that cause the immune system to go awry. There are some theories and there are some associated conditions. But one of the strong thoughts is that, Again, I should go back. I wanna get this in a more clear model. Autoimmune diseases tend to cluster. If you have one, you're much more likely to have another. The reason why Hashimotos is most prevalent is that there's a strong connection between Hashimoto's and gluten. A large number of patients that have Hashimoto's also have genes that make them more predisposed to gluten sensitivity and celiac disease. Gluten, therefore, is seen as a pretty strong trigger to Hashimoto's. Now, I would say if you're thinking about what's the one thing that you can do if you think you have Hashimoto's, go gluten-free.

Or check your antibodies.

Or check your antibodies.

I've checked antibodies for years on these patients because I think this is a pretty well established phenomenon in the literature. It's not like, No. You can go on PubMed, which is the National Library of Medicine, look it up, Hashimoto's, gluten, you'll come up with plenty of articles. And yet, your traditional endocrinologist don't even look at it. And I checked antibodies on every patient with hypothyroidism, with Hashimoto's, and about 30% of the people have some level of antibodies. They might not have celiac, but they have some level. And so tell us, why is gluten.

So connected to autoimmune disease? Gluten is very similar when... So, what gluten can do is it can trigger something called leaky gut. But in most cases, I would say that a person who develops thyroid disorder, particularly Hashimoto's, probably already has a disordered gut, probably already is experiencing some amount of dysbiosis or imbalance in their gut microbiome. and therefore experiencing some level of inflammation in their gut. And if you have that inflammation, then you're already going to be disturbing the permeable membrane that's responsible. It's the gatekeeping system for nutrients to go in and for toxins and for the bad guys to be kept out. That's probably already disrupted. Gluten, which is very prevalent in our processed foods, does one more thing. It triggers something called zonulin, which is the gatekeeper. Zonulin is the compound that's responsible for opening and closing the gates that allow good nutrients and compounds to enter in and then closes to make sure we keep out bacteria, viruses and toxins.

That's right. And I think when you start to grate leaky gut with the gluten, it creates inflammation throughout the body and it can attack different organs and some people can get rheumatoid arthritis, some people get psoriasis, some people get Hashimoto's thyroiditis.

Because when gluten enters in, there's the leaky gut, now the immune system sees it as a foreigner and it begins making antibodies against it. Unfortunately, those antibodies are also made against the thyroid because the gluten structure is very similar to the thyroid. So you get this sort of molecular mimicry that causes the immune system to become confused, and now it's making antibodies against your thyroid.

And studies have shown that, you know, people with Hashimoto's, when they cut out gluten, their thyroid antibodies come down, their autoimmunity gets less.

Absolutely. And I would also, in regards to the testing and looking, particularly at something called thyroid peroxidase antibody, because that's the antibody that's made. It's made against this enzyme that the thyroid makes, that's responsible for making thyroid hormone. It can also make an antibody against thyroglobulin, which is another compound that the thyroid makes that is also responsible for making thyroid hormone. When you test them, if it's positive, that's great. But it's also possible that you'll get false negatives. And if I really think a person has Hashis, they're displaying all the signs and symptoms, then I will retest them and I might even do it after a gluten challenge. If the patient has been gluten free, I will do that just to make sure we may, we confirm the diagnosis.

Yeah.

So it's really, it's really important to.

Think about all the factors that cause autoimmunity because it could be, it could be gluten. That's the most common. But, you know, functional medicine, we don't just look at one thing. We look at all the triggers. And there's a lot, there are, there's a lot of things that cause inflammation in autoimmunity. So can you take us down the.

Road of what are some of the other big ones? Well, I would say this, this is a more complicated one to, to bring up, but pregnancy. So a lot of the patients that come to me with thyroid dysfunction come after pregnancy, or they come years after pregnancy and they say it was after I delivered my first child. It was eight months later that I developed Hashimoto's thyroiditis. Now, there are different thyroiditis that you can develop, but Hashi's can occur after pregnancy. And it is, the mechanisms that are there are largely immune dysfunction. They're related to immune dysfunction. There's large spikes and drops in estrogen that's been linked to the triggering of the immune dysfunction that leads to Hashi's. And there's also this idea that when a woman has a child in utero, you have to suppress your immune system. And after the baby is born, you get an immune rebound. And this results in a dysfunction or imbalance in an appropriate immune response, and you develop antibodies against the thyroid.

No, I'm gonna say, you know, there's also other things, you know, that we're learning about. And, the thyroid is sort of like the canary in the coal mine.

Right.

It's one of the most sensitive organs. It's a gland that regulates our metabolism and our mood and our sexual function and our, you know, weight and our muscle mass and skin health and hair health. I mean, there's so much. We'll go over some of the symptoms that people can have, but triggered by.

Mercury, you know, toxins, heavy metals.

Yeah.

So we can't ignore those. Exactly. So what's happening is that there's this incredible flood. of environmental chemicals that we've been exposed to, that our toxic load is so high and mercury and heavy metals and many others interfere with thyroid function. And they're known as autogens, like antigens, but they're autogens, they cause autoimmune disease, that these environmental toxins have really been well documented to do this. And yet, most doctors who are endocrinologists will not check for your level of toxic load or a level of mercury and they don't treat that. And that's what we do in functional medicine, we look for some of these underlying causes. Absolutely. So it can be gluten, it can be leaky gut, it can be, the environmental toxins, it could be heavy metals, it can be other- Be viruses.

Viruses. Reactivated viruses, it can be stress related. You know, the stress has a huge impact on all of the endothelial linings, particularly the gut and the brain, and can cause leaking of the gut and brain, which will then trigger an autoimmune condition. Exactly, and so the question is, you.

Know, from a functional medicine perspective, we don't just say, oh, you have low thyroid, take thyroid, we go, what is happening in terms of the causes, and then how do we address those directly, whether it's gluten or heavy metals or whatever, and then how do we help.

The thyroid work better?

And in traditional medicines, once you have thyroid issues, you don't bother trying to think about reversing it or stopping it. Particularly if you get it early, you can actually reverse and get the antibodies down.

Yeah, and I think it's really important and what I said earlier is that the hypothyroidism, particularly Hashimoto's thyroiditis, is a body problem. It's a systemic problem that affects the thyroid. And that's how I approach it when somebody comes to me, because even if I get their antibodies down, that will have an impact. That will actually allow their thyroid to function better, 'cause now it's not under this assault, under this attack. But there are other organ systems that impact the thyroid. And so when you have a woman that comes in and she's got three kids and she has lots of stress when she's having hormonal imbalances, you're now talking about the adrenal gland being involved and cortisol being involved. You're talking about estrogen and progesterone balance. You're talking about high levels of testosterone if that woman tends to have PCOS.

That'S like cystic ovarian syndrome.

Right. And if we don't address those along with the thyroid, then they're never gonna feel better. It's sort of a comprehensive approach.

Absolutely. It's a comprehensive approach. And we don't look at all the factors. We don't look at other hormones like sex hormones, adrenal hormones. I mean, if your adrenals are shot from chronic stress, your thyroid is not gonna work properly. And if you take too much thyroid or the right amount of thyroid, your body might feel like you had too much because your adrenals can't keep up and aren't working. So you have to deal with all of it. You have to deal with the gut, you have to deal with leaky gut, you have to deal with nutrition. I mean, there are some key nutritional.

Deficiencies that are linked to low thyroid function. Can you go through what those are? Well, one of the, you know, so what's, it's interesting, the first thing that people will think of is iodine. But, you know, iodine isn't necessarily the problem. I just wanted to bring that one up right away because iodine can be somewhat controversial. There's actually been studies in in China that showed that people with lower iodine or deficient iodine levels actually have less thyroid disease in Hashimoto's than those that have higher iodine levels. But other ones that would be involved would be vitamin D. Vitamin D plays an important role in thyroid function. Selenium plays a very important role in thyroid function, as does zinc and magnesium.

Absolutely. And selenium is, for example, necessary to convert T4 to T3, which is the active hormone. we need, for example, vitamin D to help bind the thyroid hormone at the nucleus to have the effect on gene transcription. So these are all critical steps. So iodine, zinc, selenium, omega-3 fats, vitamin.

D. And when we test, when we, when I test patients, I will routinely test them for selenium levels and vitamin D levels. And I can tell you that eight out of 10 women are deficient in vitamin D and low in selenium and, and that definitely becomes part of the equation. I would say that for our listeners, that if you're a woman or a man who is being treated for hypothyroidism and has never felt well under thyroid medication, despite getting their TSH level into the normal range. Now, for some doctors that they may still be going by the archaic value of 0.45 to 4.5 and not the functional value of 1.5 to 2.5. so you might not even be looked at in the right range. If you're one of those people, then this is the conversation because there's so much more to be looked at. There's targeted nutrients that you've just mentioned.

I mean, selenium can drop your thyroid antibody levels. Yes, it does. Just like getting off of gluten.

Yeah.

And reduce the autoimmunity. Yeah. So these are all important things. And there are foods that contain these things. So there's like thyroid boosting foods, right? We have selenium, which is in fish and Brazil nuts. You have zinc, which is in pumpkin seeds and oysters. You have omega-3 fats, which are in fatty fish. You have vitamin D, where you can have that in herring and porcini mushrooms, although you probably need to get sun or vitamin D to get enough. Iodine can be from eating fish and seaweed. So, there's a lot of ways to get these nutrients to help regulate our thyroid. And, most of us are insufficient or deficient in these at some level. What are the problems with the traditional way we treat thyroid in America around the world.

Well, I think the first thing that as functional medicine docs we recognize is that we're not asking that question why, right? So we're not looking for that underlying root cause, which so often helps us when we're treating our patient because it helps us figure out for them, for that individual person, what do we need to do to help their thyroid work better? So is it because of a nutritional deficiency? We know that we need iodine and selenium and iron and all sorts of good amino acids Vitamin D, just to.

Get the thyroid to work on your cell, you need vitamin D to help it actually send the message to your DNA to do what it's supposed to do. Right. And 80% of us are deficient in.

Vitamin D. Yes, yes. And so if people aren't eating enough of certain foods, we might see nutritional deficiencies or maybe if their digestive system is a mess, they're not absorbing their nutrients well. So we have to ask that question why? Because sometimes that will just help the thyroid work better when we help support it nutritionally. Or maybe it's an autoimmune condition, like you mentioned, Hashimoto's. And then it gets us thinking of a lot of different things, right? It gets us thinking about, well, why.

Does this person have autoimmunity?

Isn't it the most common autoimmune disease? Yeah, it really is. What causes it? Well, you know, the body, in an autoimmune condition, the body starts to fight itself off, right? So it starts to, it looks at the thyroid gland and says, okay, I'm.

Gonna fight you off.

I'm gonna attack you. And when it attacks the thyroid gland, the thyroid gland doesn't work as well. And so then you get low, well in many cases you get a low thyroid. So what causes the autoimmune disease is the big question. We always ask in functional medicine. That's it, why? Right, and everybody's different, right? For one person it may be gluten. We know gluten is associated with a lot of Hashimoto's thyroiditis. Not all, but some.

My experience, you look at thyroid antibodies and you compare it, with the gluten antibodies in that patient and it's about 30% of the time, it could be related to gluten. What do you think?

Dr. Yeah, I think it could be. It could be. It might even be a little higher. It depends because of the patients we're seeing. So we might be seeing more patients who have a lot of different digestive issues going on and so I might see it even a little more frequently.

We call that selection bias. People who are sick select to come.

See us so they have more stuff for sure. But we always think about the digestive system, right? You've got autoimmunity, you've got to think about what's going on in the digestive system. But then you think about could there be an overgrowth of bacteria? Certain bacteria in either the digestive system or other parts of the body have been shown to trigger autoimmunity in some people. We know that.

We're going to talk about that in another podcast. So stay tuned. We're going to talk about the gut and leaky gut.

Okay, we'll do that. We know that imbalances in iodine, actually, excessive amounts of iodine. It can shut down the thyroid.

Yeah.

So, you know, some Hashimoto's, because it's, you know, it was found first in Japan where they have lots of iodine. So, you know, we know iodine is important for the thyroid, but too little is not good, but too much is also not good. So we pay attention to that. And toxins, of course, right? Toxins can be triggers for autoimmune disease in some people.

Yeah, so I'll say that the thyroid.

Is a yellow canary.

Of our body that the yellow canary was the coal miners used to bring the yellow canary into the mine and if it dropped dead they knew the air was bad they had to get out. So it was an early warning sign and the thyroid is like that and it seems to be extremely sensitive to disruption from heavy metals, from pesticides, the plastics and everything.

Yeah, fluoride.

So, yeah, fluoride in the water, all these things can disrupt our thyroid function and often your doctor never even looks works for them.

Absolutely, right? They say, okay, we're just gonna look at the TSH and if it's in the normal range, you're fine, or we're gonna give you medication to get it in the normal range, but not really look a lot deeper.

Yeah, so what is the difference in the testing that... oh, there's one other thing I wanted to bring up, which I remember reading about in the New England Journal of Medicine, was a lady who thought that Bok Choy was healthy and she ate like two pounds of raw bok choy a day and she went into a hypothyroid coma. And people are having kale juice.

Talking about goitrogens.

Yeah, there's a whole kale craze. It's a great point. And people are juicing it and it's raw and you know, raw cruciferous vegetables.

Can be a problem.

Right. Eating a lot of raw broccoli and cabbage and if you're having raw Brussels.

Sprouts or raw bok choy. Eating it in a level that's beyond just like a normal food portion. But as you mentioned, if you cook it, if you cook it, you get rid of a lot of that goitrogenic potential, that the part that's gonna dam or interfere with thyroid function. So you don't have to be concerned when you have cooked cruciferous vegetables, but.

It'S that, like you said, Should I.

Worry about having a kale juice every day? It's a good question. Depends how much kale you put in it, right? Well, I'd like to drink green juices and most of them have a little bit of kale. I'd be careful about it. and it depends on the person, of course, right?

Right?

You're an expert.

What about soy?

So, you know, that's a good question too. You know, I think that if, because.

A lot of people are like, soy.

Is really bad, it interrupts your thyroid, it's dangerous, you shouldn't eat it.

I think if we're going with, you know, non-GMO organic soy as a whole food, like edamame and tofu, then I'm not concerned. Yeah, tempeh, I'm not concerned.

Traditional soy foods that have been used for centuries, right?

Yes.

Miso, tempeh, tofu, natto.

Fermented soy too, right? Yep.

Soy sauce. I mean, those are fine. When we're drinking a quart of soy milk a day, that's a problem. Or when you're having all these fake soy foods that are processed or soy burgers and you're eating stuff that's sort of weird.

Or like the texturized soy protein that they put in cereals and bars just to get that protein content up. We don't, Yeah, that's the stuff I tell people to stay away from. Okay, so you're someone who comes in.

You feel tired, you're constipated, depressed, your skin's dry, your hair's falling out, you don't have a sex drive anymore, you can't concentrate, and you go to a traditional doctor, they'll just test one thing.

What do they test? Right, so they typically test your TSH. Okay, so what is that? Your TSH is your thyroid-stimulating hormone, and there's a feedback loop in the body. So if your thyroid level is low, then the body will get triggered to make more TSH.

And that comes from your brain, from your pituitary gland.

Yes.

And then that TSH will say, okay, make more thyroid. So if the TSH is high, then the doctor says, okay, your thyroid is underactive and we need to treat it.

That's the only thing they test.

Often.

And I think you have your functional medicine doctor, a very different approach.

So what kind of way are you looking at it? Well, we always We always start with a full thyroid panel where you look at TSH, but you look at free T3 and free T4. So free T4 is one thyroid hormone that's floating around in your body, but then the T3 is the active form that your body needs for all the thyroid functions to occur. So we look at all three of those at least. And we often look at thyroid antibodies and sometimes we'll even do things like reverse T3 and the reverse T3 to total T3 ratio.

What is reverse T3? Reverse T3 tell you?

So the reverse T3 is a thyroid hormone that the body, when the body is, I always think of it almost as the brake that the body puts on itself. So when the body is saying, okay, I've got to slow myself down, it takes some of its T3, which is your active thyroid hormone, and it converts it to reverse T3, almost in a way to slow down our metabolism. It's a protective mechanism, I think of, right?

Yeah.

And it makes makes sense that we have that in our body.

A lot of things will actually trigger that that are not actually good, right?

That's very true. So, like, if there's a, you know, if there was a major stress going on, you'd want to have that mechanism in place so you didn't starve to death. But with a lot of chronic stress, which we see a lot these days, we can sometimes see high reverse T3. And the other thing we see a lot that causes that high reverse T3 is sometimes toxins. Yeah, toxins. So can be a sign that we've got to look deeper and say, okay, is this person under a lot of chronic stress? How is their adrenal gland functioning? How are they working to activate that parasympathetic nervous system, that calming nervous system, which helps the body heal? And then we look for toxins.

Yeah.

In the gluten issues, we look for everything that is imbalancing the thyroid. So look for nutritional deficiencies. Do you have selenium deficiency? Do you have iodine deficiency? Are you low in zinc? Do you have low omega-3? you have yeast in your gut, you have heavy metals, you have pesticide exposure, toxin exposures. So we take a very detailed history that your traditional doctor would not do.

Right.

Really look at the broad spectrum of what's causing it because we can just treat the symptoms of the thyroid, but maybe we may not need to do that. And I've seen many patients where you fix these other things and their thyroid gets better.

Absolutely. And it's so powerful when you see that.

It's like, oh, I don't need to do thyroid. I can actually fix the upstream cause.

Yeah.

And it's pretty impressive when you do that.

And the last thing you were talking about was antibodies.

So tell us about what antibodies are and why we should look at them and why traditional doctors don't look at them.

I'm not sure why they don't look at them enough, but the antibodies are giving us a signal that the body is attacking its own thyroid and it's a sign that there's autoimmune disease going on in the body. And we've got to figure out that question, you know, why is that? Why is that going on? so I had a woman who came in to see me and she was 40 and she had been struggling with all those symptoms we talked about with low thyroid. She was cold all the time, her hands were cold, she was gaining weight, she was tired, she was constipated, she was losing hair, her eyebrows were thinning.

Sound familiar to anybody?

I know, right? So I'm like, okay, but then her primary doctor did her TSH and it was Normal. So we then went deeper.

Can I stop you for a sec? So what I was trained, and I'm sure you were trained the same way, was you only checked TSH. If that's normal, then you don't do anything else. And what's normal is a range of like 0.5 to 5.

Often, yeah.

Which is a massive range that actually doesn't reflect even our current understanding on most reference ranges on the lab tests that Even the American College of Endocrinologists.

Says if it's over three and a half, we should be worried. Right, and many, many studies are saying.

People between one and two feel the best, right? Right, and I remember, you know, because I always do all the tests. I don't do reverse T3, but I do TSH, T3, T4, and the thyroid antibodies. Because what I've learned is that even if all those are normal, TSH, T3, T4, you can have elevated antibodies. Yes. And people who have those feel better when they get on thyroid. Very true. And I went to a conference years ago at Harvard, and I, you know, was a traditional medicine conference and the endocrinologist was talking about thyroid. And he said, look, if your antibodies are elevated, they should be treated because they're probably symptomatic and you treat the patient, not the lab test.

But in traditional medicine now we're more treating the lab test, not the patient. And I think that's really important. And the physician sometimes thinks, well, I'll just wait until these antibodies damage the thyroid enough and then I'll treat.

Right.

That's the way they, you know, it's like once the TSH starts to go up, I'm gonna wait until. But we say, okay, no, there's so.

Much we can do.

100%.

There's so much we can do right away.

Yeah.

I remember this patient came in once with blood sugar, like 115 and 126 is diabetes, 100 is pre-diabetes and I'm like, God, you know, did your doctor say anything about your high blood sugars? Oh, yeah, he checked it out. What did he say? He said, well, when it gets to.

Like, 126, we'll treat it with medication. Yeah. But I'm like, no, this is the perfect time to treat you. So tell us about So, right. So, she came in and she wasn't feeling good at all, but her TSH was normal. So, we did the full panel and we saw that her thyroid antibodies were elevated. And so then we had-: Was her.

TSH and the rest abnormal or not really?

No, her TSH was pretty normal. You know, I can't remember exactly, might have been a little on the high side, but I don't even know if it was. I think everything looked really normal, but she had those thyroid antibodies. And so, I had to ask that question, why, right? why do you have these thyroid antibodies? And then it brought us down this whole pathway of what's going on with her digestive system, what's going on with food sensitivities, was there any signs of increased intestinal permeability? And so we pulled her off of gluten and we measured things like her iodine level and her selenium level just to get the right balance. And we actually, we gave her some thyroid hormone. We gave her some Glandular Thyroid Hormone. I used Armour Thyroid on her, which is a combination of T4 and T3. And she started, she really responded well. She felt better. She noticed her hair starting to come back in, her skin starting to be less dry, her bowel movements improving. And so, you know, I think it's important that we take that step and go a little deeper.

And people don't often realize how bad.

They'Re feeling until they start feeling better on this stuff, right? And I think just to back up a little bit, you did something which was kind of unusual, controversial, and most traditional endocrinologists would scoff at, which is you used a combination of T3 and T4 in a hormone that comes from pig that is the entire thyroid combination of hormones, including T2, which we didn't even talk about, that is actually really important to replace your own because you make a complex array of hormones. and often the T4 can't get converted to the T3 in your body, which is the active hormone. So even if you're taking T4, which is what most doctors recommend like Synthroid or Levoxyl or any of these, and they're not terrible but they're just challenging because you actually may not be giving the person the T3 that they really need because their body's not able to make it as well.

Right, so then we ask that, so some people, as you mentioned earlier, feel fine on T4 thyroid hormone that's like Synthroid or, you know, so they do okay with it, but a large percentage of people don't. And that might be because they have deficiencies in nutrients that help the body go from T4 to T3, right? So they might be deficient in iodine or selenium, as we mentioned, in vitamin A or iron, and zinc. We talked about that earlier that they they can't make that conversion as easily. And so the medicine doesn't work as well for them. Or it may be because they have a variation in a gene. We know there's this gene, it's kind of a really, I mean, you know, really interesting low impact type of gene. So what that means is that it, you know, It's not gonna kill you. Right, thank you. It's not gonna kill you, but it can make you not feel so good. and it helps us know how to treat people. So the gene, this DIO2 gene that encodes for this enzyme, the DIO2 enzyme, which helps the body convert T4 to T3, you know, especially in the brain, but also in all throughout the body and make that active T3 thyroid hormone. And what we're learning is that some people have this gene variation, and so when you give them just T4, thyroid hormone, they don't get the benefit. And studies have shown even when lab work looks normal, so even if their T3 looks normal, even if their TSH looks normal, that they do better when you give them some T3, which could be like a glandular thyroid hormone, like Armour, which is a combination of T4 and T3, or it could be a synthetic T3, we sometimes use like Cytomel and we'll add that to Synthroid, for example, or a T4. And so sometimes we see those people who just start to feel better in terms of especially mentally. Energy-wise, mood-wise, they really start to feel better.

We're all familiar with inflammation. You cut your finger, gets a little infected, it gets red, swollen, hot, painful. Those are the signs of inflammation. and so that red hot, swollen, painful happens not just on your skin, but happens inside, and that's inflammation, and that's what drives autoimmune disease. So it's a final common pathway for so many diseases across the age spectrum, but it's a particular kind of inflammation. So heart disease is inflammatory, diabetes is inflammatory, autism is inflammatory, Alzheimer's is inflammatory, depression is inflammatory. Those are not typically autoimmune diseases. so inflammation can be of many types. The particular type that you get with autoimmune disease is where you create autoantibodies. Literally, you are attacking yourself. It's not something outside of you that's attacking you. You create an antibody response to your own tissues. So your body starts attacking your joints or your nerves in MS or your stomach in inflammatory bowel disease or your thyroid in Hashimoto's, which, by the way, is super common, affects one in five women, one in 10 men. half of them are not diagnosed and probably another three quarters are poorly treated. So that's a huge problem. But the ability for the body to recover from this is really important to understand because most people when they get diagnosed with autoimmune disease, they're told this is a lifelong problem. You will always have this. We will have to manage it with immune suppressing medication and hopefully you'll be all right. It's basically how it's done. And the reality is that we can not only improve the symptoms, not only stop it, but we can literally reverse it and get people to lose the diagnosis of autoimmune disease. And you can say it's in remission, it'll come back. Sure. I mean, if you're eating gluten and you cut out gluten and your autoimmune disease goes away, you eat the gluten, it's going to come back, right? So you have to kind of be aware of what are your triggers and we're all a little bit different and need to pay attention to what our unique differences are about what we need to avoid or what we need to do to manage the autoimmunity. But the truth is that once you heal things, the body is so resilient and robust. And so there's so much that we now understand about how autoimmune disease works, but it's not necessarily incorporated into traditional care yet. And what's really heartening to me is I see rheumatologists start to start to get into this. I was talking to one from UCLA, Cedar Sinai, and I was asked to speak to him because one of my patients also was seeing him. and I thought, oh, well, you know, it's going to be a challenging conversation. He's going to question everything I'm doing. He's gonna blah, blah, blah, blah. I get on the phone, he's like, Dr. Hyman, I'm so glad to talk to you. I've been using your approach. I'm using anti-inflammatory diets with the traditional treatments, and we're getting such better results, way better than we ever got. So I see the crack in the, in the edifice of our modern medical care system around autoimmune disease. It's just not fast enough for me because I see so many people suffer needlessly and we do understand in-depth inflammation. And so by using the model of functional medicine, we can help people to remove the causes of inflammation and then put in the things in the body that help regulate the immune system, whether it's vitamin D or fish oil, probiotics. There's a whole bunch of stuff that's on the positive end that we have to add in just so we have to take out the stuff that's causing problems. We have to add in the things.

That help the immune system work better. Now, you give us a great sense of hope because the landscape is changing, but it's also changing slowly. And there are great functional medicine practitioners out there, but a lot of them, especially in the last year, they're not taking on new patients, they're overloaded, you're not taking on new patients, it's very challenging and people are trying to get help and trying to navigate. So for the person that doesn't have access and is trying to figure out the steps that they can take, can they still have hope that there's progress that they can make and stuff that they can do on their own with of course the support of their doctor that they have currently?

Oh my God, yes. I mean, most of the causes of autoimmunity can be managed without the help of a doctor. So, let's start off with the first.

One, which is diet.

Yeah. So, the reason that I write the books that I write is to give people access to the science of functional medicine without having to see a functional medicine practitioner. And, I can't tell you, Drew, how many times people have come up to me and said, Dr. Hyman, you saved my life. Last night, I was going to dinner in LA and someone stopped me and said, My dad read all your books. He had all these issues and autoimmunity and he's cured everything. Thank you. So it's not that you have to necessarily see a functional medicine practitioner to get better. Sometimes you do, but for the most part, if you start with food, because that's the biggest trigger I would say for autoimmunity, and do what I have written as the 10-Day Detox Diet, or we now call the 10-Day Reset, the book I wrote was designed to help people remove the inflammatory foods from their diet and add in the anti-inflammatory foods and to help fix their gut, help boost detoxification, and help the sort of microbiome get back to normal. That alone can work for so many, many people. So essentially what I would say is, and there's a whole bunch of science looking at these kinds of approaches around diet. One of them is about inflammatory bowel disease. They call it the autoimmune paleo diet, which is very similar to the 10-day detox diet, which essentially gets rid of grains, beans, dairy, sugar, processed food, and it also gets sort of eggs, nightshades, and nuts, which can be triggers for some people. I don't remove eggs, nightshades, and nuts for most people because it's not that common. But if you really want to go extreme, you can do that and then you add things back. And one guy came up to me at a lecture at Cleveland Clinic. He said, Dr. Hyman, I have rheumatoid arthritis and I did your 10-day detox diet and all my symptoms went away. Is that possible? And I'm like, yes, if it was something you're eating. Now, if you have mercury poisoning or if you have a tick infection or you have mold exposure. Mold exposure, you're not going to necessarily get all the way better, but you will improve and you still have to do the gut repair, which is really kind of easy to do on your own. Basically for most people, if you just do the 10-day detox diet for 10 days, you'll see whether or not what you're eating is driving inflammation. And for most people it is. That's the first step. And then there are ways to sort of navigate these other aspects around heavy metals, toxins, gut, and you sometimes may need to see a functional medicine doctor. But what I'm finding is now there are solutions that are coming up online. There's a lot of things that are affordable and accessible. You don't actually necessarily have to kind of go see a physician. Sometimes you will, but for most people it's worth a try to start just with diet and lifestyle, exercise, stress reduction, sleep, some basic supplements are really helpful. So getting people on probiotics, getting them on omega-3 fats, giving them on vitamin D, simple things can make a big difference for people by just resetting their biology.

Now, most physicians, again, well-intentioned and sometimes maybe not well-intentioned, but most physicians well-intentioned, is well-intentioned. They see a lot of those recommendations, interventions as sort of soft recommendations, right? Nothing wrong with it, but it's not gonna do anything for you. Why is that? With all the education, with all the background, with everything that's there, why is it that those are seen as soft when it comes to diet, sleep, and exercise and some of these other things that you just mentioned.

It's astounding to me how much data there is, right? And physicians often hide behind the veil of what we call evidence-based medicine. And that is often a sort of deflection from having to do the hard work of looking at the data. Because if you go on PubMed and the National Library of Medicine and you search for diet and autoimmunity, exercise and immunity, sleep and immunity, stress and immunity, various vitamins, omega-3, vitamin D, you'll see there's plenty of data, but no one's put all the dots together and that's what functional medicine does.

So for people who are skeptical, I.

Would say, look, just do your homework. Go look at the data. We need more obviously, but there's a huge start. And we did a preliminary analysis that was done by the rheumatology department at Cleveland Clinic. We didn't actually look at the data, so it was sort of at arm's length and we had a fellow from the rheumatology department look at our patients at the Center for Functional Medicine and then their patients and Cleveland Clinic is, I think, the number two in the world in rheumatology. So they're not like a third rate rheumatology center. These are the best docs in the world. And our docs at the center did better with those rheumatoid arthritis and psoriatic arthritis patients across a number of metrics that are standardized, validated metrics from the rheumatology. They got better in terms of pain, inflammation, symptoms, and so forth. There's a there there and I think there's a real awareness that there's a need to sort of incorporate some of these things. And I think when I hear these stories of other hematologists starting to come on board and other people thinking about how to actually use diet and lifestyle and how effective it is, it's important. And I think the reason we've sort of had this soft idea about it is because nutrition has been the stepchild of medicine. It's like, well, okay, if you don't use much and you won't maybe get overweight and blah, blah, blah. But there really is in a sense that it's that powerful. And when you look at the science around food is medicine, it works better than a drug. Like, I listen, Drew, I don't care what the therapy is. If I thought a biologic was going to be the best therapy for this patient, I'd recommend it. I'm agnostic. I'm not pro or anti-drug. I'm pro finding out the root cause and addressing that. I'm pro creating health and seeing what happens. and when you do that, these problems just tend to go away and we don't have to go in that rabbit hole of medication. So I think we're kind of in this threshold moment where there's a real understanding that the microbiome is involved in so much autoimmune disease. And yet when you go to the rheumatologist or the neurologist or the GI doctor, they're not actually looking at your diet. And it's just sort of stunning to me that they're not. or they're not looking at your microbiome. When you go have rheumatoid arthritis, you go to the rheumatologist and like, let me look at your poop. Or when you go to the neurologist with the MS, they're like, let me look at your poop. And I remember, God, it probably was 25 years ago, I had an MS patient at Canyon Ranch when I was working there, and she said to me, Dr. Hyman, whenever my stomach and irritable bowel gets worse, my MS gets worse. I'm like, oh, noted. So you begin to go to these rabbit holes of listening to patients and listening to their stories and the problem often with medicine is we come up with preconceived ideas about what's going on instead of actually listening to our patients. And most of what I've learned, I haven't learned in a textbook. I've learned from, you know, being on the street, working with thousands and thousands of patients, doing thousands and thousands, maybe millions of tests, and seeing all the patterns in there. And I remember one guy who had severe ulcerative colitis early on, and I was like, oh, we're doing the 4-Hour Program or the time now. It's a 4-Hour Program to rebuild the gut. put them on elimination diet, all things I thought should work, fish oil and this and that.

He just didn't get better.

He was losing weight. He was having bloody diarrhea. It was just miserable. And I said, well, you know, let me go back and look at what the causes are. So we. Let's look at heavy metals. Let's look at all the potential immunotoxic things that are out there. And we found his mercury was off the chart, and I just detoxed him.

From mercury and his ulcer went away.

Wow.

Powerful. Now, you talked about diet. You mentioned a little bit about testing again, a lot of that testing is gonna have to happen with participation from a doctor, an integrative doctor, functional medicine doctor. Not all these doctors are trained in these tests. What about supplements? Where can supplements be a part of the picture? And in some instances, where may they not be helping when it comes to autoimmune?

So I think they're part of the therapy package, but if the same rule applies, if we're standing on a tech, takes a lot of aspirin to make it feel better. If you're, if you've got Lyme disease and that's causing you autoimmunity, take a lot of vitamin D to make you feel better, right? Or fish oil or whatever. So when I think about immunity, I'm thinking, how do I, how do I one help the body's own immune system do what it's supposed to do? And there are, there are basic fundamental ingredients for regulating inflammation in the body. The biggest is the, the Omega-3 fatty acids that come from mostly wild things, right? Wild fish, wild plants, wild animals. We don't eat that much anymore except wild fish. And that's primarily our source of Omega-3 fats. And yet many people don't eat enough fish or they eat fish and it's got heavy metals in it. So it's problematic. So Omega-3 deficiency probably affects 90 plus percent, maybe 98% of Americans. The second category would be vitamin D, which regulates hundreds of genes that control inflammation. So so having adequate vitamin D is very important and it's been linked to, for example, MS. We know that people who have low vitamin D have more MS and it's more common in northern climates where there's low sunlight. So we know vitamin D plays a role in autoimmunity and inflammation. Probiotics are also extremely helpful because they help to normalize the gut. Now, if you have a bad overgrowth of bacteria, you can get into problems if you take probiotics, but it can be very helpful in normalizing the gut. And there's all sorts of anti-inflammatory probiotics. And, and that's a big rabbit hole. We can go down another conversation, but it's, it's, think about Precision probiotics. It's not just like, oh, take lactobacillus. And that's it. There's really different probiotics that do different things for different conditions. And then, and then there's a class of compounds that are more kind of immune regulatory that are, that are phytochemical. So there's a whole class of polyphenols that are plant compounds that regulate. inflammation, for example, curcumin or turmeric. We've heard a lot about that. So that's probably the most potent one. But there's, there's many, all the proanthocyanidins from colorful fruits and vegetables, all the purple and blues and yellows and oranges and greens, they all have anti-inflammatory effects. And so I make sure I include a lot of those in my diet, and spices are great to use for that. So we start to begin to take those. So I, I, and I also look at ways to sort of regulate my gut health and and keep my inner garden healthy. You know, we're coming out with a product called gut food, which is designed to rebuild your gut. How do we feed our inner garden? How do we take care of that? And that's what the purpose of this new product is. How do we, how do we reestablish a healthy microbiome? And I am excited how people are going to do on that because it's one of those areas that is a little messy and, and there's not a lot of great, simple Solutions. So we really have the potential at any time to rebuild our gut. And that's another part of the supplementation is how do we create a healthy gut? And that includes vitamin A and fischel and vitamin D and various nutrients like quercetin and, and, and even things like, like amino acids like glutamine. So what we sort of put together a cocktail of things to help, help rebuild the gut.

Now, you mentioned sleep earlier, and sleep is one of those things that doesn't get as much attention as it deserves. Now, you've done a whole free sleep masterclass, like completely free. People can sign up. We'll put the link to that in the show notes. It's drhyman.com slash sleep, but give just a couple high level components for sleep and its direct connection with recovering from autoimmune.

So sleep is one of those things.

That, you know, when I was in surgery and medical school rotations, they would say, well, you know, real surgeons don't need sleep, right? And, and I, I've used up all my sleep credits in life, and it's, it definitely drives inflammation. You can feel it if you don't sleep. I remember working in the emergency room all night or delivering babies. and I would be so sore and achy and stiff. And I felt like my whole body was inflamed. And I would have to go manage that by sleeping, or I would go take a hot tub or something. And I think we understand that if you have sleep deprivation, it creates a Cascade of dysregulation in the body, hormonal, cognitive and inflammatory and immune. And so sleep is among the best medicines. Why do you think when you have the flu or when you're have a viral infection, you tend to sleep a lot because your body requires that to repair and heal and to activate your immune response. So getting high quality sleep and enough sleep is super important if you have any kind of autoimmune disease and generally.

For everybody, by the way. Yeah, across the board, beneficial, but especially if you're dealing with any kind of.

Disease like an autoimmune disease. I mean, particularly, you know, even in your brain, you know, you have a, a, a immune system in your brain called the microglia and the lymphatic system, which is like the lymph system of your brain. It only works at night.

So to clear out all the waste.

And the garbage and all the things that affect us, we need sleep.

I hope you enjoyed today's episode. One of the best ways you can support this podcast is by leaving us a rating and review below. Until next time, thanks for tuning in. Hey, everybody, it's Dr. Hyman.

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