Resetting Your Thyroid: The Surprising Truth About Iodine and Health - Dr. Alan Christianson

85% of the people coming to me seems like the thyroid is not optimal.

So we know, for example, that iodine may be a factor in developing risk for thyroid cancer, but there's no data saying that changing iodine changes existing thyroid cancer, for example. But we do have pretty good data saying that in the case of known autoimmune hypothyroidism, overt hypothyroidism, subclinical hypothyroidism, and autoimmune hypothyroidism, that roughly 60 to 80% of adults per the study stand to fully reverse the disease by iodine regulation.

Hello, everybody. Thank you so much for joining me again. And I'm delighted today to have on our podcast Dr. Alan Christensen, who I'm so excited to have a conversation with. I know he's a wealth of knowledge. I met Dr. Christensen at a biohacking conference where he was sharing his knowledge so generously and just such a genuine and kind person. And then I read his book and I was very impressed that I made some changes to my own diet, hoping to improve my thyroid function. So I'm excited to invite him onto my podcast. Hi, Dr. Christensen, thank you so much for being here.

And Dr. Joy, thank you for having me.

Yeah, yeah, you're so welcome. So I'm excited for you to share your knowledge and I'll just introduce you a little bit so the audience know a little bit more about you. So Dr. Alan Christensen is a board certified naturopathic endocrinologist who focuses on thyroid care. He's a New York Times best selling author whose recent title include the Hormone Healing Cookbook and the Metabolism Reset Diet. Of course. His newest book is the thyroid Reset Diet. Dr. Christensen has been featured on countless media appearances, including Dr. Oz, the Doctors show, the Today Show. He is the founding president behind the Undercurrent association of Naturopathic Physicians and the American College of thyroidology. So welcome, Dr. Christensen.

Thank you.

Yeah, so I really, you know, I want to find out a little bit more, you know, about your journey in, you know, thyroid, you know, particularly your specialization in thyroid care. And, and what, what got you into it and what got you interested in what iodine is doing to the thyroid. So maybe you can share a little bit about your journey.

Sure, sure. So, yeah. So getting into thyroid care, you know, I was a naturopathic physician finishing up training and this would have been early to mid-1990s. At the time, there was a lot of just diverse ideas about thyroid function between natural medicine and conventional. So there was Ideas like body temperature was all you needed for diagnosis, or any amount of medication was fine. And it was kind of odd because before then there were certainly many examples of natural treatments or alternative medicine, but it was more so herbs instead of drugs. There weren't so much challenges to the whole diagnostic criteria or when a condition was present or when treatments were warranted. That really started with thyroid disease. And so there's these very different views. And in my clinical exposure early along, I saw that these views sometimes were helpful, but there's also like harm or side effects from that. And I saw the shortcoming to the conventional approaches as well. But it was a real puzzle. And I don't know, I connected with those who were struggling with thyroid disease because I had been through a lot of similar symptoms early in life from related to cerebral palsy, fatigue, and weight issues, and it was getting more prevalent. You know, it's something that the frequency of most versions of it roughly tripled in the first couple decades of my practice. So it was just a real rising concern at the time.

When was that?

The first couple decades, between about 1990 and 2014. Thyroid cancer, thyroid prescribing, thyroid diagnosis. Most of these things roughly tripled.

So you said you had your own health challenges?

Yeah, I was a pretty unhealthy kid. I had seizures, grand mal seizures, they thought to be secondary to cerebral palsy. And I was just really, really obese when I was like 12 and always couldn't do sports. Super uncoordinated and, you know, self conscious about that. So, yeah, health books changed my life and made me kind of want to do the same thing.

That's amazing. You need to. You made a transformation I would have never imagined. So. So thyroid was a big part of your transformation?

It was something that I really resonated with my training because it something that was similar to what I was going through. So for me, lifestyle helped, you know, and what I saw in those with thyroid disease is that they had similar issues, but lifestyle alone wasn't enough. There was something else holding them back. So it made me really want to understand it better.

Okay, so I know one of the focuses you have is iodine. So how did that come to the forefront?

Yeah, funny thing. So for probably the first decade of my practice, it really was not. I was aware of the fact that historically, iodine deficiency was a big driver of thyroid disease. Didn't really appear to be on the map anymore. Then somewhere around the end of the 90s, there was this emergent idea about people needing mega doses of iodine. Actually, a patient of mine, he's someone that I practiced in Arizona. A lot of folks were seasonal. They would go to other places when it was hot and he was like that. So I'd see him off and on half the year. He came back down one year, and this was this man in his 70s, just flawless health, and suddenly he had toxic nodular goiter. And that was really unusual for his demographic. And so I poked around some more and he goes, oh, yeah, I found out that I was iodine deficient and soon after started taking iodine, though, I got this. This nodule. Like, well, how. Why were you tested? How are you. So there's this whole idea about people needing mega doses. It was just emerging then and early along I saw that, yeah, megadoses could be harmful, like they were in his case. And so then the next. So the first stage was that I thought little about it at all. Second stage was, oh, wow, a lot of folks are taking too much. This is a problem. And the third stage was that, yeah, many people, even if they're not taking massive amounts, a little extra can be an issue. And if they get to a low range, that can reverse the disease.

Okay, I know it's still a prevailing theme that a lot of providers or biohacking people are pushing more and more iodine, you know, taking a lot of iodine. So. And some say, you know, there are different forms of iodine. Maybe some forms are bad for you, some are not. So maybe you can shed some light on, you know, just the iodine controversy.

Yeah, for sure. And that's what it is, the different forms of it. That's a quick thing to dispatch with. So iodine's activity comes from its role as a chemical element, you know, and elements by definition are irreducible, you know, barring like a particle accelerator or something. So whether it's bound with one compound or another or whether the molecules are bigger or smaller, no relevance whatsoever. You know, iodine is. Iodine is iodine, whether it's aqueous or nanoparticles or potassium iodide or whatever. It's. The effects correlate with the iodine content. You know, that's a simple one. And as far as the prevalence of the views. Yeah, I don't have a sense about whether they're on the rise or not. They're still around, for sure. I do hear about that. And this. It's a really intuitive idea. You know, it's a really. A superficial understanding of how the body works. Makes it sound really logical. I think about it like keys for a car. You know, if you've got, if your key's missing, your car does not budge. And now here's the key. Well, your car works like magic and it's like, oh, that's so cool. And we know better than to think that a hundred keys will make your car go 100 times as fast, right? But when it comes to nutrients and hormones, we often think in a linear way. We often think that, oh, if there are circumstances in which too little iodine could cause disease, then everyone with a disease must be a problem of iodine. Well, every car problem is not a problem of keys. And there's a point at where extra keys just get in the way. So what we now know is that nutrients, hormones, things that exist in the body, they always have these, these parameters. There's always a certain amount the body needs and too little and too much are both problematic. In some cases those two are closer together than others. And in some cases they look a lot alike. The other, they can cause the same problems. And iodine is one of the biggest examples of that. Most nutrients, you've got a fair amount of leeway, you know, vitamin C. If you're getting enough, you're not likely to harm yourself from that. That doesn't happen that much. There's like a thousand fold range. But iodine, there's, there's three considerations. There's nutritional requirements, there's toxicology, and there's intolerance. Three different things. So nutritional requirements are pretty much given based upon body size. There's not a lot of genetic variation on that. It's really just body, body mass that dictates it. Toxicology is similar. Pretty much anyone above some threshold, given their kidney function, they can't excrete any extra and it starts to simply damage their organs. You know, iodine was a common means of suicide back in the 1800s, which is why the bottles had skull and crossbones on them. So, yeah, that's toxicology, but then intolerance. So what we now know is that there is a lot of genetic diversity for iodine tolerance and some people cannot process even slight excesses. And those are the people who are genetically prone towards thyroid disease.

Oh, that's so interesting. So you think it's the excess that tends to cause the disease or.

So a lack could, but a lack really doesn't happen in the modern world. We've had six documented cases of iodine deficiency in the United States since 1980. And those are people that had minimal gastrointestinal structure left. Most was removed surgically, and they were often on diets that were comprised of only raw produce, like no other foods. So you can get deficient, but it's not easy. So different for kids and adults. But adults, intakes of even like 20 micrograms per day often offset deficiencies. So. So, yes, and we know that the window of disease onset increases above about 200 micrograms per day. That's the threshold where some people can become harmed by it. Not everyone, but. But some can. And we have pretty strong data saying that the average intake in the US is somewhere around 180 or so micrograms. So the average is safe, but averages are deceiving. We have subpopulations based upon age, ethnicity, gender, of which between 30 or 40% of people are exposed to amounts that are unsafe for some. So, yes, and we've seen this whenever a country has fortified iodine in their salt. The US started to do that electively in 1924. In the following decades, the rates of autoimmune thyroid disease increased 26 fold, not percent fold. Afterward, Denmark did the same experiment in the year 2000. They tracked the rates of thyroid disease, thyroid diagnoses, third medication requirements, and for 17 years running, that was tracked, the rates went up by about 50% per year. So it's been a pretty classic correlation, drastic.

So what about. Okay, so you've seen people with goiters, right? And I remember seeing, when I was in China, you know, I remember seeing a neighbor with the big goiter. Do you think that was much more prevalent prior to the supplementation That? I don't know. I don't even know. When they implemented in China, fortification in.

The US Lowered the rate of goiter. For sure. You can get goiter from way too little iodine, from too much iodine, and for factors that have nothing to do with iodine, in areas that had endemic iodine deficiency, it often is prevalent. However, in 1994, there was actually 112 countries on the earth that had endemic severe iodine deficiency. By the time we went from 94 to 2004. I'm sorry, 1992 to 2014, the number of countries that severe deficiency was reduced to zero. We now have none. But we have 53 countries categorized as at risk for thyroid disease due to iodine excess. So, yes, deficiency has been a problem historically, not even that far back, but it's largely been eradicated. And in the modern world, the bigger risk for those who are prone to it is the excess.

So do you think the eradication was because of iodine? Supplementation.

Oh, for sure. Fortification. No debates about that. Yeah.

So you think that it still plays a role? It may. May be helpful.

Iodine's not a bad thing, but we don't need to supplement with it in the modern world. We find it in pretty much all of our food sources.

Okay, but what about before we fortified iodine in the salt? You said there was more prevalence of iodine deficiency. So if we don't eat iodinized salt, do you think we're risking deficiency?

Well, so the times historically in which that was true, like in the US Were times in which local food was all that was on the table. And the problem there is that the iodine content in soils varies greatly regionally. So some areas, like around the Great Lakes, they were called goiter belts. So before iodine deficiency, goiters were not pervasive everywhere. There were certain pockets where they were prevalent, and most parts they were not prevalent at all. And so now our food supply is so diverse, and also we have so many more food categories available that barring in. Barring rare cultures that are on mono diets that have no access to food outside of their own region, it's not. Not an issue. So the average intakes now are just simply above those thresholds.

Okay. Yeah. So I think you laid out in your book very nicely the correlation between iodonizing our salt and. And the prevalence of thyroid diseases. So it happened in. Did it happen in almost every country that has done that to their salt?

So it's a funny thing. It has. And the problem can be too little, too much, or a change. So the body has some level of adaptation. We can't perfectly adapt to any amount of iodine, but we try. And so when that changes abruptly, that by itself can also unmask disease. So even countries that had less than they needed when they moved to amounts that were thought to be appropriate, that still would raise the rates of disease for periods of time. So it's a very, very tenuous relationship.

So how can we make sure that we're actually eating adequate amount and not.

Again, we've had six deficiencies since 1980. So to assure that you're consuming an adequate amount, you need to do nothing whatsoever other than eat a range of foods. Okay.

All right. Which means that nobody needs to supplement iodine.

You know, one of the most extreme populations would be pregnant women, as far as to make that statement for the Cochrane Review Group. You know about this? But they look at large medical questions and do pretty thorough reviews, available literature, and try to draw conclusions from that they did a recent review on the effects of iodine supplementation on pregnancy, and they showed that doing so does not improve mother's health, does not improve baby's health, but it does raise the risk of mom having thyroid autoimmunity, and it does raise the risk of mom having marked morning sickness and other complications. So. So, yeah, the idea of supplementing with it even in pregnant populations has gone by the wayside.

Hmm. I wonder, is that in the prenatal vitamins?

It often is. And that's a fascinating story by itself. Many papers have been written about that being a problem and all, and about the quality control as well. They do have it. They don't have the labeled amount ever. They often have many fooled the labeled amount.

Well, that's a little scary. Yeah. Thyroid disease, I don't even know what the prevalence is, but almost nobody. Well, I would say, well, 85% of the people coming to me. Seems like the thyroid is not optimal.

Yep. It's very prevalent. It's very common.

Yeah. So how. How do you propose then, if you think iodine has been the. One of the driving forces for thyroid disease? And. And you're talking about a diverse range of thyroid diseases, right?

Well, we know in terms of. So there's two ways to think about that. There's relationship in causing disease and then its relevance and then reversing existing disease as far as adjusting it. And those don't always overlap. So we know, for example, that iodine may be a factor in developing the risk for thyroid cancer. But there's no data saying that changing iodine changes existing thyroid cancer, for example. But we do have pretty good data saying that in the case of known autoimmune hypothyroidism, overt hypothyroidism, subclinical hypothyroidism, and autoimmune hypothyroidism, that roughly 60 to 80% of adults per the study stand to fully reverse the disease by iodine regulation. Multiple clinical trials showing this. We also see that those on thyroid medication, there have been a couple trials looking at how well they can deprescribe or lower their dosages if they avoid extra iodine. And papers have shown that when that's taken into account, about 84% of people, even if you leave in those who are overtly hypothyroid, can substantially lower their dose with no adverse effects. And around half of that same group can eliminate their medication with no adverse effects.

Hmm. Okay. I know there's a huge rise in autoimmune Hypothyroidism. Is there a huge rise in thyroid cancer as well?

Yes, they've both gone roughly in parallel, as I think roughly tripling over the last two to three decades.

And do you think the thyroid cancer could be related to the high level of iodine?

There's a lot of factors that can be one, that can be one risk factor basically, to take a good mechanism in place. Iodine is an oxidant. It think about, like bleach, think about hydrogen peroxide. We put all in iodine. We put all those things on the skin to kill infections because they're pro oxidants. They create a free unpaired oxygen that causes free radical damage. And if you've got a bacteria trying to get its way into your body, that's awesome. You want to damage its cell wall. You know, that's a good thing. But the problem is that when you get a little extra within your thyroid, that free radical damage recruits your immune system and you start to damage the proteins, the enzymes of your thyroid, thyroglobulin, thyroid peroxidase, and the lymphocytes become activated and they start to attack those same structures. So that's the main known mechanism of action for developing autoimmune thyroid disease.

Wow. Okay. And I guess the good news is that it's very reversible.

That's the exciting news. You know, one study that I've mentioned before took people who had had some of your audience. Their, their TSH scores were averaging 14. What that means is that they were overtly hypothyroid, well outside of range, not subtle. And they had been there for about 6 to 12, 12 months on average. They were pretty stably there. They weren't given medications. The only intervention was they were trying. They were tried to get their iodine below about 100 micrograms per day. They all had marked signs of autoimmunity. Within three months, 78% had completely normal thyroid function, again with no other changes. And of the people that didn't get better of that 22 odd, some percent that didn't improve, There was a couple of categories. So one big category, they, they weren't compliant. They didn't get to the low iodine target. So, yeah, but another category, they did comply and they did improve, but they didn't completely normalize. So many of them had scores that were, you know, 50 or 200. They were way, way, way outside of normal and they improved markedly. But in that time frame, they didn't yet get back to normal. So they didn't fall in the 78%. So if you change the definition and say, okay, of those who did it, how many either were reversed or got a whole lot better, then that was actually 97%. So, yeah, it's been just staggering how helpful it can be.

That's incredible. Why is this information not available yet? I mean, seems like to most people.

Even healthcare, that's a question I ask myself rather frequently. Are you the. I appreciate being on your podcast to help make it more available.

Right. Are you the only voice talking about this?

You know, others have joined in, but. But I. Ego aside, I did really start this discussion.

Yeah, I see, I see. Wow. I mean, these are powerful data. So complete reversal. And in so many women, I mean, mostly women, I guess, suffering from thyroid issues. And that could be questioned why?

Yeah, well, definitely we know that the genes that I talked about, as far as those that affect iodine metabolism, they're primari X linked genes. So women get two sets of those. And if there are any things on the X linked genes that are problematic, they're just twice as apt to have them manifest as men are. So that's one big factor.

Okay. And so since we know that there could be profound changes after restricting iodine intake. And you think three months should be enough to reset the iodine function? Correct.

In most cases. And so the best analogy I've thought of is this is like the straw that broke the camel's back. You know, it's not that the straw was bad per se. There was just one. There was just a little bit too much of it. And also, to use this analogy, imagine that you wanted to let the camel heal. You know, you couldn't take one straw off and expect the camel's back to heal. Right. You've got to like unload it for a while. So that's. That's the same thing. If you can get below a certain threshold, this free radical damage is low enough, the thyroid gland can often heal itself.

So what are the strategies to get people to reduce the toxic load?

You know, simple thing, it's identifying the big sources and just cutting out the main ones. Again, everything has some, so you can't get to zero and you don't want to. But if you get the big outliers away, then you do a lot better. There's some things that have a lot, but not many people consume them. And there's other things that have not quite as much, but everyone eats too much of. And so. And there's also then further that there's some foods to where their Content has changed over the same time frame over these last several decades. So the biggest culprits that fit all three of those criteria would be processed grains and dairy products. These are things that a lot of folks consume. They consume more of those, especially more processed grains over the last few decades, and the amount of iodine in those foods has increased. So those are two big relative categories.

How did iodine get into the grains?

Yeah, so not in grains directly, but in commercial processing. And it's. Honestly, it's a bit of a mystery. So on one hand, you can see labeled products that will say containing iodized dough conditioners, but that's not a perfect exclusionary criteria. You know, some studies would assay commercial breads and differentiate them based on whether they had any listed iodine ingredients or not that didn't predict their iodine status. So there are things that end up in processed foods that do not become part of the ingredient list. That's a, that's a known fact. And there are ways iodine can be used in processing grain products.

Interesting. Yeah, that's a strange idea. So. So the dairy, I assume, is. I, I think I. It. It may be related to using iodine to clean the, the udder of the cow.

Exactly. That's one big source. Another one is there are some feeds that are fortified with iodine. And the third one is a lot of cows are given fish meal as a cheap protein source, and that ends up. And they concentrate that iodine pretty badly. So, yeah, those three things can cause the iodine content in milk to be really pronounced. Actually, funny thing, but I mentioned how thyroid disease picked up in the US around the time of iodine fortification. In the UK it picked up nearly as much. They didn't fortify with iodine, but they did fortify their, their cow feed with iodine around that same time.

Wow. Okay, so. So people would not have imagined that processed grains and dairy would be in a good, big source of iodine. So, so these are things you consider as food. Low amount of iodine. But people consume a lot of. Correct.

Well, not a low amount. They're a moderate amount. Sometimes they're actually a high amount. So the highest sources would be things like sea vegetables. Many don't consume them. Some do, but they have just massive amounts. But yeah, overall, dairy and grains of the food categories in which the amount of intake of those categories has increased and the iodine in those foods has increased.

I see. So sea vegetables. But. But would you suspect that the Japanese populations is. They're the best known for Eating probably the most amount of seaweed in the world. Right. Are they high in their thyroid issues?

So what do we call autoimmune thyroiditis? What's the name for that? Chronic lymphocytic thyroiditis.

Hashimoto's.

It's not Omalley's disease. It's not. It's not Ortega's disease.

There's a problem.

The Japanese have the highest rates of all versions of thyroid disease, and they've got a lot of good health in many ways. But it's not a coincidence that it was a brilliant Japanese doctor that first worked out how this whole thing happened.

But he didn't know it had to do with seaweed.

Not yet. But soon after that has been back pretty well. And many areas that have the highest intake have the highest rates of thyroid disease.

Wow.

And even one. One more wrinkle, many then say, well, what about the Japanese? Iodine? Breast cancer and all that? Breast health. So within Japanese, those with the highest iodine excretion are the ones most prone to develop breast cancer. So. So, yeah, they do consume a lot. They have a lot of good things going for their health, but the iodine is not helping them.

Okay, Amazing. So do you feel like these are the biggest sources of iodine in our diet or.

Well, so it's. It's. It's all. It's cumulative. Right. Those are the ones that have changed a lot. So. So those two. Not. Not everyone eats seaweed. Those who do. There's a lot of iodine there. Iodized salt is another big source. And there's iodine added to salt. But a lot of popular salts have massive amounts of naturally occurring iodine. So pink Himalayan salt. Some assays have shown that per serving it has twice. The iodine is iodized salt and often surprises people.

Oh, the Himalayan salt has twice amount. Okay. Wow.

Yeah. Assays have been inconsistent, but some have shown that it has twice the amount of iodized in fortified salt.

Wow.

So that can be a big source. Egg yolks can have a fair amount seafood. That's the one that bothers me the most because there's so much data about the benefit of seafood. Thankfully, there are versions that are lower in iodine. And then also we think about cosmetic products. So, yeah, things we put on the skin. Iodine's a useful chemical, just like bleach and peroxide are, you know, so it makes. In making a. Like a conditioner, for example. It makes it stay smooth and not separate out and not get rancid quickly. But we Absorb some of that. It was in hand sanitizers that was taken out in 2018 by the FDA when it was found that so many hospital workers were being exposed to unsafe amounts of iodine from frequent use. But we still have it in quite a few personal care products. Conditioners, face creams, body lotions. You know, conventional products primarily call it PVP or related names, polyvinylpyridone. Natural products call it sea vegetable extract or kelp extract or things along those lines. But it's iodine and we absorb a bunch of it.

I see. Okay, so reading the labels, that's, that's concerning sea vegetable extract. I mean, that sounds so healthy and lovely, but if you're trying to flush out the iodine, that's something.

Well, so I've run the math on this, and the typical amount of, of PVP used in a conditioner, same thing as a C extract, it's about 1 to 2%. So it's not like the whole bottle, but that compound is about 14 iodine by weight. And healthy skin will absorb about 4% of iodine when it's held in contact. So the things we put on us and we leave on, we can absorb some of that. So when you run all the math on that, I, I worked this out one time and I grabbed my wife's conditioner bottle and I, you know, he took the recommended amount and I weighed that and it was like, it was 20 grams. So like 20 million micrograms. Right. So you, you do all those percentages and we're talking about micrograms being relevant. And what you walk away with is about 10 days, 10 times one day's safe, upper limit exposure to iodine.

Wow, okay. No wonder it's so prevalent. So, okay, so it sounds like a person has to be highly vigilant in order to flush out the iodine in a system, you know, at first, but.

It'S not a hard thing. And thankfully, dietary. Well, in terms of just briefly, personal products, when I wrote the book, I spent a lot of time looking at just popular products and scouring ingredient labels. I would say that about, I don't know, a third or a quarter of products are problematic. Most aren't. It's very easy to work around that one. And then in terms of dietary sources, all the food categories have safe options. So whatever. You don't have to be, you know, restrictive or carnivore or something that you got a lot of food options. Once you figure out how to work around some of those big pitfalls, it's.

Not hard so what are the alternatives for the, the grains and dairy?

Well, so for grains, yeah. Again, just distinction. It's not the grains per se, it's commercial products. So anything you're not buying pre baked, even if it's like flour product, you can just flour itself. You can bake anything at home. You can cook up rice, you can, you know, it's not grains per se, it's just the commercial processing.

It's the baked grain products.

Well, and, and yeah, commercially baked, yes. You bake them at home. It's not a factor.

Yeah. And a dairy, for example. I love raw dairy. You know, from raw farm, I assume that there's not going to be excessive amount of iodine in. I mean, it depends on how they were processing or how they were cleaning the cows.

Yeah, I've seen limited assays on non commercial products. I've seen a handful of assays and organic products. Organic dairy is often a bit lower, like 30% lower. But in terms of the goals and the targets, I think about two stages to that. In the book I talked about like a reset stage and a maintenance stage. So the reset stage is where you want to fix things and you want to get below that a hundred microgram level. So that's something that's not forever. But for that period of time, you would want to avoid foods that can contain even moderate amounts of iodine and that would include organic dairy. I haven't seen assays on raw. I don't know why it would be different per se. One could assay it. I just haven't seen that available.

All right. Yeah, I guess for, for more tips then they should read your book. Right?

Yeah. This is the one prior. This was the thyroid reset diet. And, and the story that I'm sharing with you was one that like you said, hasn't really come out is important. It compelled me to write the book. You know, I spent about a year and a half just pouring through medical literature to, to pull this together. And it's a real strong story that this is what drives it and this is also a way to help it.

Mm. Yeah. Maybe you can share some of the stories that you've seen in patients when they are getting on this reset diet, what happened to them?

You know, funny thing is that most people that I've seen clinically were on thyroid medication. So it's always good when they're working with someone who's tracking them closely. The main pitfall is that many who aren't being tracked well suddenly do not need their medication. And it's Suddenly too much for them because their thyroid starts working again rather promptly. So that's a, that's a common, common issue. But, but yeah, a large percent of people can come off of medication. And even funny thing I've seen is that even those who lack a thyroid and do need medication long term. There's ways by which extra iodine makes their body resist thyroid hormone. So peripherally they don't absorb the hormone as well. So a lot of folks who will always need medication find that they need less and they do better on what they need.

Oh, that's fascinating. So the iodine not only affecting the thyroid gland, but also affecting how other cells are, are responding to, to thyroid hormones.

We call this a peripheral metabolism. Yeah, there's a big group of diodinase enzymes, a big group of phase 2 conjugating compounds by the liver, a big range in cellular receptor activity, cell membrane permeability, you know, gut metabolism. There's tons of things that the body adjusts to make it all right. And too much iodine, it engages basically a fuse. You know, too much of it blows the fuse and your body fights it. Your body resists thyroid hormone.

What about Hashimoto's? So have you seen really good results? What about the antibodies? Were they able to come back to normal?

Yeah. So like, like the study I mentioned, most all people can reverse autoimmune thyroid disease. The study showed, you know, 78%. I see similar results clinically. Hashimoto's funny thing, most thyroid, most hyp. Thyroidism is Hashimoto's. About half of people with Hashimoto's do not have measurable antibodies. So a common thing doctors will say is, oh, their antibodies are negative, they don't have Hashimoto's. It doesn't work that way. Negative antibodies doesn't rule out Hashimoto's. And the funny thing is that thyroid antibodies can affect a lot of symptoms directly and they can be strongly tied to iodine levels. In the case the two antibodies we measure, there's four measurable antibodies, two that we talk about the most anti thyroid globulin and antithyroid peroxidase. So thyroid peroxidase, that's the enzyme that oxidizes iodide into iodine. It makes iodine, basically. And thyroglobulin is a template on which iodine attaches. So it's directly linked to each of those. The odd thing about the antibodies is they have the least effect they have is upon the risk of thyroid disease. They have a very, very small correlation with Someone's risk of developing overt thyroid disease.

Wow. Okay. But that's the marker we use. And so do you think they're faulty markers?

No, it's a marker that's relevant for symptoms. Precise numbers. So those that have antibodies greater than 500, both of them up greater than 500, their nine year risk of overt thyroid disease is about 3%. If someone has negative antibodies, their nine year risk of overt hypothyroidism is about 1%. So. So yeah, over the course of many years, you see a difference, but it's. It's not, it's not what people think. It's not as big of a driver as you would expect, but it is. But what people don't think is that it does cause other problems. So the antibodies do directly cause a lot of symptoms that are blamed for being thyroid symptoms.

Hmm. Just the elevated antibody themselves is causing.

They cause infertility, they cause heart disease, they raise the risk for autism in pregnant women. They cause weight gain, they cause low quality of life, they cause marked edema in the body. So they do a lot. And then those are all things I mentioned with normal thyroid function. So before any changes to the thyroid, they alone can do all of that?

Yeah. So just curious, somebody with normal free T3, because that's, I guess, one of the best tests to see how much thyroid hormones you have in the body. No. And. But if somebody has elevated thyroid antibodies, it doesn't matter what your free T3 is.

Correct. Doesn't matter. Any of it is.

Can you explain that a little bit? And you know why? With adequate amount of free T3, we're still not getting good function.

It isn't not getting good function. It's having symptoms and having problems. It's not a deficit of thyroid hormone. So the autoimmunity is not taking away the third hormone. It's causing these problems via a range of other mechanisms. And most, most thyroid disease is not a lack of thyroid hormone. You know, that's. That's only overt hypothyroidism, which is very rare.

But the treatment tends to be more thyroid hormone.

That's a common treatment. That's. That's really gone. Yeah. There's a big disconnect between the medical literature and medical practice. So overt hypothyroidism is where the T4 is tanked way below range and the TSH is like greater than 20. In that case, thyroid medications can improve health. They're not the only option, but they can be helpful. Short of that, what we call it is subclinical hypothyroidism or suboptimal hypothyroidism. And one large study in the British Medical Journal a couple years ago showed that of over a million patient years that people with subclinical hypothyroidism so elevated tsh, you know, market abnormalities, that thyroid medication did not as a class improve quality of life symptoms, did not lower disease risks, did not benefit things such as weight or fatigue, and did not, it actually worsened mortality risk overall. So yeah, so most of it is not a lack of thyroid hormone.

Well, that's very discouraging since a lot of anti aging doctors, so I'm in an anti aging field and optimizing the, the numbers if that's what early in.

My practice I was in the, the first, the A4M. I was in their, their, their second ever meeting I guess in 95. And I kind of came away with this idea that we could read blood levels and we could make the body, we could restore hormonal optimization and that was all and that you'd be the same as a healthy person. So one big paper from Korea looked at people on thyroid medication and looked at large cohorts that were pretty much identical in terms of thyroid levels and identical just very well matched in terms of overall risk symptoms. And what they showed was that the total mortality risk was more than doubled in those on medication. So we've got all these data sets. So making hormones is not the same as taking hormones and the blood levels don't always show the difference. So a lot of it goes on behind the scenes. But people who endogenously can make thyroid hormone are not the same as those who exogenously take thyroid hormone. Even, even natural hormone, even the right amounts. It's not the same as what the body does at the end of the day.

So if a patient comes to me, let's say the, the free T3, you know, it's, it's 2.3. And so an anti aging medicine, you know, a 4M by the way, is American Academy Anti Aging Medicine. So they recommend a level of above 3.5 for free T3. And then the, they recommend the, the TSH to be below 1.2 right somewhere there. So if a person's TSH, let's say is you know, 1.5 or 1.8 and their T3 is 2.3. It, you know, an anti aging doctor would tend to supplement a little bit, you know, add a little bit of, you know, armor thyroid, which is combination of T3 and T4.

So the difference is going to do more harm. There's two different questions that. It took me a lot of time to see the difference here, but there's two different questions. So one question is, could these levels, if they're not optimal, could they correlate with some health problems? Right. And the second question, which seems like it's the same as the first question, it seems like if the answer is yes, that these levels could be a problem, that therefore treating these levels is a solution. But that's a different question. It's not the same question. You can't say, if someone has a higher tsh, they don't feel well. That doesn't infer necessarily that pushing the TSH down by exogenous medication will reverse that problem. That's what we thought for so long. And the scenarios that I described you from the British Medical Journal study, those are all way more advanced disease than you're talking about. That's like so much further along. And those people don't improve their health outcomes. And this is why people are always trying to adjust the dose and track this and track that. It's a fool's errand to begin with in most cases. Briefly, this is a topic I get passionate about, is all these data sets. So the whole thing about needing high T3. So there's. There's a valid argument that healthy people generally have a lower tsh. A lot of good data points support that. Now, a lot of folks who didn't have a thorough understanding of thyroid physiology assumed that therefore healthy people should have a high T3. The truth is, yes, there is an inverse relationship to TSH and T3. However, only at the extremes, only at the extremes of hyper or hypo will you see a reverse relationship. T3 is not how much hormone landed in the body. T3 is highly regulated. Think about serum calcium. You don't drink a glass of milk, and if your serum calcium go through the roof for an hour, your body buffers the heck out of that. And T3 is the exact same way. It's where you want it to be based on what you've got to work with. So the idea that healthy people should always be high, There have been a lot of studies. People can look this up easily. There's a lot of studies saying, what are populations like that have high levels of T3? They get more breast cancer, they get more diabetes, it's more common in the obese populations. It's not reflective of healthy people. And just the idea that the TSH and T3 are stuck on the string and they do this, they don't do that. And doctors see that when they try to push the T3 up just a little bit and the TSH plummets. You know, that happens all the time. It's because these things are not regulated by the same mechanisms.

Do you think there's a detriment for TSH to plummet? I remember I've tried taking thyroid supplementation, right. My TSH was less than 0.01, so.

So you're honestly asking me if there's a risk to smoking? That's what this question is like the seriously medical data behind that. It's no, there's no controversy about this. There's a lot of doctors who, because they try to have high T3, they want to ignore low TSH. But you've got to bury your head deep in the sand. You know, there's a person I spoke to two days ago and she reached out and said, you saved my life. She was, I was seeing a doctor who tried to push my T3 up and she was narrowing my TSH. I was in the emergency room twice and I almost d of congestive heart failure. And I stumbled across what you've talked about about this. This is a big mistake that's being done in anti aging medicine and it's harming people. The TSH is not just telling your thyroid to work. It's telling your blood vessels to repair themselves. It's telling your brain to repair new cells, it's telling your bones to fix themselves. We need some TSH for a lot of reasons. Long before there's high levels of T3 or T4. A low TSH is a risk factor. We've got big data sets of those who naturally have a low tsh. This is called subclinical hyperthyroidism. And we have big data sets from people who are treated for thyroid cancer that, that intentionally had suppressed TSH levels. They're not good. We know this.

So I mean the gold standard, I mean in a lot of fields is to only check tsh. But then in anti aging medicine, I think the, the T3 and T4 had come to the forefront and they really want to optimize that. So you think that's misguided and I.

Think that nothing should be ignored. I don't think it's only about this thing or that thing or the other thing. But we also can't ignore any of the blood markers. We can't say that someone can have completely abnormal blood markers. And we're not going to worry about that. So T3, T4 are important. They don't. The idea of having them have to be high normal, I can't find good evidence to support that. But the idea that you can ignore one of the blood markers and say, yeah, we're going to pretend that one's fine even though it's not. No, I can't do that. Okay.

Okay. So would you. So you would just leave it alone if somebody has a little bit higher TSH and then kind of low normal of the, the T3, T4.

So if someone has early thyroid disease or suboptimal levels, again, there's two separate questions. There's, can that make them not feel well? And does that benefit from medications? And a third question is, are there other options? So you don't have to let someone not feel well. You've got other options. You can simply start by modeling their iodine intake.

So if they're feeling well, then you won't really touch the thyroid hormones unless they're grossly abnormal.

Yeah. There's an argument about at what point does overt disease or subclinical disease become an independent risk factor in the context of someone who's asymptomatic? And that's highly based upon age, health status, pregnancy, other things along those lines. But yeah, someone who's asymptomatic, that's. That's not the populations I really see or work with. I see the opposite, those who are symptomatic in various ways. But.

Yeah, right. Yeah, but I'm in the anti aging field and you know, I treat a lot of, you know, serious diseases too. But, but optimization has been such a mantra that you need the hormone to be at certain levels. But, but it doesn't sound. Yeah, intuitively, again, you got to pull.

Apart, doesn't abnormal hormone causes symptom. You got to pull that apart from does exogenous use of that hormone correct that problem? They're separate questions and you can only answer. And you can't, you can't assume that the second question is answered by the first question. You can only say that someone is improving their health by taking this thing. If you can look at large data sets of people who've been closely tracked who have taken that thing, and we've done that now in the thyroid world, we've seen that barring more overt disease, it just doesn't help. People just don't do better as a group and they don't have better health outcomes.

Okay. All right. So if somebody has subclinical, maybe Thyroid not quite optimal. Maybe they have, you know, the energy level could be improved and the numbers, you know, not too impressive. With TSH and T3, T4. Would you then embark on this thyroid reset diet?

That's the simplest thing. There's good data about nutraceuticals being helpful as well. But yeah, those steps plus the thyroid diet are strong evidence behind them being useful.

Okay. And I remember meeting you and then you weren't, you weren't that enthusiastic about supplementing thyroid hormone itself.

Well, I shouldn't say that. It's got a place and there's a lot of folks where it's been positively life changing and many people need it. I'm, I've been a prescriber for a long, long time, but I think it's overused. I think that, that, but in more cases than not, like the study that I mentioned, the BMJ study, it argued that conventional patients, 85% of them never needed thyroid medication that were put on it. And those are conventional patients. I would argue that in our worlds of natural medicine, it's a higher number than that and it's not beneficial. And there are risks to it as well. There's a lot of cancer risks that are associated with use of thyroid medication. There's greater mortality risks. It's a significant intervention that one needs to think through.

Okay. Wow. I hope more doctors are listening to this and maybe rethink of their approaches. But you know, if what they're doing is causing harm to their patients, that's.

Problems that we don't always see that in the short term. A lot of the things I'm talking about, you wouldn't notice by watching your patients. You only see by large data sets of people over large periods of time.

Yeah, yeah, yeah. Thank you so, so much for bringing this to attention to the public and everybody. I'm sure you are trying to educate the, a lot of providers as well. Yeah. So really appreciate you sharing your knowledge and it's a lot of work to put all this together and to speak out. So thank you so much. I hope patients are finding this really helpful. I hope they go get your book. You know, it's very informative. The thyroid reset diet and, and maybe, you know, it's only three months of the trial.

Right.

Maybe they can get everything to come back to a much better place. I mean, wouldn't that be beautiful? Just change your a little bit and then you avoid all the problems, you know, of, of trying to, you know, go to the doctors and, and get all, get on the medications. It just. It's a much more sensible way of approaching things. Yeah. So where else can people find more about your work and learn more from you?

I'm, you know, easy doctor, Dr. Christiansen.com. that's our main hub, and all things come from that. Yeah. Lots of blogs and videos all the time and tons of stuff that comes out.

Okay. Any parting words of wisdom before we end?

You know, after 26 years of practice, I've just come to see that lifestyle approaches are even more powerful than I ever thought, which is what I went into medicine wanting to do anyway. And also that the body is more resilient than I ever thought. So, yeah, don't ever think you're stuck with symptoms. You know, work with people like Dr. Joy, and work to really get to the root cause. Work to do things naturally, and you can do much better than you might ever imagine.

Beautiful. Thank you so much, Dr. Christensen. It's been a pleasure talking with you. It's great information. Yeah. I really enjoyed speaking with you.