The Functional Medicine Approach to Graves' Disease and Thyroid Disorders with Dr. Eric Osansky

Welcome to The Perfect Stool: Understanding and Healing the Gut Microbiome. This is your host, Lindsey Parsons, and today I'll be speaking with Dr. Eric Osansky, published author of Natural Treatment Solutions for Hyperthyroidism and Graves' Disease, Hashimoto's Triggers, and The Hyperthyroid Healing Diet, and host of the podcast Save My Thyroid. Dr. Osansky is a doctor of chiropractic practic, has a master's degree in human nutrition and functional medicine, certifications as a clinical nutritionist and certified nutrition specialist, and training in herbal therapy. After achieving remission from Graves' hyperthyroidism in 2009, he's dedicated his career to empowering others to address thyroid and autoimmune conditions naturally. But before our conversation, if you haven't yet followed or subscribed to the show, be sure to do so. And if you want to get transcripts of the podcast, pop over to my website, HighDesertHealthCoaching.com, and sign up for my newsletter. You'll also get my recently updated free ebooklet, Finding Your root cause through stool and organic acids testing when you sign up. And if you haven't yet done my quiz on which stool or functional medicine test would help you get to your root cause, you can find a link in the show notes and take that. Now on to the show. Welcome to the podcast, Dr. Osansky.

Thanks so much for having me, Lindsey Parsons. Very excited to have this conversation.

Me too.

So can you tell me about your own health story and how it's shaped your practice?

Yeah, so I was diagnosed with hyperthyroidism and eventually Graves' disease, and it's usually a shocker to everyone and to me as well. Just, I was, uh, in the process trying to lose weight. I was a little bit overweight, maybe like 10, 12 pounds. Normally like 180— I mean, I'm 170 and I was like 182. And so I was dieting, detoxifying, exercising intensely, too intensely, but was losing weight. And little did I know that the weight— some of the weight loss I'm sure was due to what I was trying to lose as far as the exercising and the dieting, but some of it was as well related to the hyperthyroidism. And I didn't catch on until I was walking in a retail store and I took my blood pressure at one of those automated blood pressure machines, and my blood pressure was normal, but my resting heart rate was a little bit high. And I figured because I wasn't fully resting, I was walking around, so I took my heart rate manually the next few days, and it was anywhere between 90 and 110 beats per minute. And so I figured something was up, went to a regular doctor got a few blood tests, was diagnosed with hyperthyroidism, and then eventually saw an endocrinologist, got the Graves' disease diagnosis. And at the time, I really didn't know much about Graves'. My background's a chiropractor. I didn't know about Graves', but as part of my continuing education credits, I would always attend nutrition and functional medicine seminars. And I did coincidentally attend a few functional endocrinology seminars where they focus more on hypothyroidism and Hashimoto's just because that's a lot more common. But they spoke a little bit about hyperthyroidism and how there are natural symptom management options. And, and there are— with anything, there's a cost behind it. So I decided that when I was diagnosed, I, I was going to at least attempt a natural approach. Had no idea if it would work. I mean, I tried to be optimistic, but when you don't know anybody else who dealt with the same condition that you're dealing with, you know, you are a little bit skeptical. But thankfully, what I did work worked over time. I was able to normalize my thyroid hormones, my antibodies, the thyroid stimulating immunoglobulins, which are specific for Graves', and then just realized that there are so many others with thyroid and autoimmune thyroid conditions. And so I started— this was back in 2009 when I started working with others with these conditions. And just over the years, I've been known more for hyperthyroidism and Graves' just because of my experience. And then also, there's just not a lot of practitioners that focus on hyperthyroidism and Graves'. Most focus more on, again, hypothyroidism and Hashimoto's just because it's the much more common condition.

Yeah, yeah.

So yeah, why don't you elaborate as to the difference between those two conditions? Sure.

So I guess maybe start off— I could start by talking about the difference between hypo and hyper and then talk about like Hashimoto's and Graves'. So you have thyroid hormones. So the main thyroid hormone that's produced by the thyroid gland, which is the butterfly-shaped glands, um, in the middle of the neck, and T4— it produces mostly T4, a little bit of T3, but T4 converts into T3, which is the active form of thyroid hormone, and that binds to the receptors. And there's also T1, T2— we're still learning about those, and you still can't test for those at a regular lab. But with hypothyroidism, you have those thyroid hormones on the lower side, and then with hyperthyroidism, it's the opposite— you have too much thyroid hormone., and then there's a pituitary hormone called thyroid stimulating hormone, or TSH. And so TSH communicates with the thyroid gland. And so when you have low amounts of thyroid hormone, there's more TSH just telling the thyroid gland we need more thyroid hormone. So as a result, with hypothyroidism, with low thyroid hormone, usually have higher TSH. And again, that's in response to the lower thyroid hormone. With hyperthyroidism, since you have too much thyroid hormone, The pituitary gland is trying to communicate to the thyroid gland, let's slow things down, there's too much thyroid hormone. So there's low TSH, oftentimes depressed TSH. So with hyperthyroidism, you have elevated T4, T3, low or depressed TSH. And then hypothyroidism, you have low T3, T4, and many times it's subclinically low, which means it might be within the lab range but kind of like on the lower side. So it's not overtly low. It's not outside of the range. Unfortunately, many doctors will ignore it because it's within the lab range even though it's not optimal. But again, so hypo— low thyroid hormones, elevated TSH. And then most thyroid conditions are autoimmune. So most hypothyroid conditions are related to Hashimoto's, and Hashimoto's is when the immune system attacks the thyroid gland, and that's over time what causes the low thyroid hormone. Whereas with Graves', Graves' involves the immune system attacking binding to TSH receptors of the thyroid, which stimulates the thyroid to produce more thyroid hormone. And there's different antibodies. I mentioned the antibodies that came back positive for me were thyroid stimulating immunoglobulins, which are specific for Graves', and then there's thyroid peroxidase antibodies or TPO antibodies, which are more common in Hashimoto's, but actually a lot of people with Graves' have them as well. I was negative for those, but I do see them a lot in patients with Graves' and Hashimoto's. And then thyroid globulin antibodies, those are more specific to Hashimoto's. Those are the 3 main types of antibodies. And so yeah, essentially that's the difference between the 2 conditions. And the problem with conventional medicine is that they do absolutely nothing for the immune system. As you know, they focus on the thyroid. So if you have low thyroid, if you have Hashimoto's, usually they'll recommend thyroid hormone replacement like levothyroxine. And then what hyperthyroidism, they'll recommend either medication such as methimazole or PTU or radioactive iodine, thyroid surgery in some cases. And again, there's time and place for conventional medicine, there's time and place for thyroid hormone, time and place for anti-thyroid medication, even time and place for thyroid surgery. But that's all they do. Like, when it comes to medication, again, they, they do absolutely nothing for the underlying cause of the problem, which, um, again, that's why people are listening to this and watching this, because they want to know what to do. They don't want to just take the medication. Again, maybe you have to take it along with addressing the cause of the problem, but if that's the only thing you're doing, then you're setting the stage potentially for developing other autoimmune conditions in the future.

Yeah, um, I've also seen on blood tests sometimes just a measurement of thyroglobulin, period. What's that about?

Yeah, so thyroglobulin, so that's a protein of the thyroid gland. So when you have thyroglobulin antibodies That means the immune system is actually attacking and damaging thyroglobulin. And you could test thyroglobulin separately. I can't say I do on a regular basis. I mean, if thyroglobulin— like, if someone gets— someone has thyroid cancer and then they get the thyroid gland removed, then they'll look and they'll test thyroglobulin just because that should be like low or pretty much non-existent because there's no thyroid gland. On the other hand, if someone has the thyroid gland. And if they test for thyroid globulin and if it's elevated, I mean, it could mean a few things. Sometimes it's just elevated because you have those thyroid globulin antibodies. There is some evidence that it could be related to an iodine deficiency. I don't know if I would rely on that for that. There are some published journal articles showing that. And then also, when it's really high, it could be an indication of cancer. Most of the time it's not. I mean, I've seen some high readings, all— at least when I look at it, when I— again, it's usually not cancer, but there's always that risk. Usually, again, if you have those thyroglobulin antibodies, it's not uncommon to also have that thyroglobulin marker elevated as well.

Yeah, that's why I've seen it, because my sister had thyroid cancer and had her thyroid removed, and I look at her blood tests, so I—

that's why her doctor orders those. Yeah. Do you have a standard reference range or a, an optimal reference range for TSH that you like to follow?

I like to see between 1 and 1.5. I mean, everybody's different. So if it's like between 1 and 2, that's fine. If it's a little bit below 1, you know, I get a little bit nervous when it gets below 1 just because I see a lot of people with hyperthyroidism. But you know, if it's— if someone has like 0.8s, if they're 0.8s, I don't panic. Yeah, I would say like a sweet spot is 1, between 1 and 1.5. But again, if someone has a TSH of 1.8 and everything else looks good, like their T3, T4 within the optimal ranges, I mean, obviously symptoms alone, you can't just rely on symptoms alone, but if they're feeling good, other, the other tests are within optimal ranges. I wouldn't recommend intervention necessarily just because the TSH is a little bit above what I consider the optimal range. I mean, some functional medicine practitioners consider like an optimal range between 1 and 3. So if someone's like a 2.5, they would consider that to be fine. Most natural healthcare practitioners, usually when it gets above 3, there's the consensus it's an issue.. And the problem is that most labs, their reference range goes up to like 4.5 or 5. So someone could have a TSH of like 4.3, and that usually is indicating a problem. But because the lab says that it's not a problem, they usually just say, look, maybe say keep an eye on it. They might not. If it's just part of a physical, they might not say to keep an eye on it, just do the next physical. And so, but yeah, that would be what I consider the optimal range of TSH.

Yeah. So what symptoms are common with Graves' disease and how do they differ from Hashimoto's?

Yeah, so I mean, I could share again some of my symptoms. So when I dealt with Graves', I experienced again that increased resting heart rate, so the tachycardia, which is a pretty common, a pretty classic symptom. I also had heart palpitations. I didn't have anxiety, but anxiety is, is pretty common. Insomnia is common. I did experience a lot of weight loss. I, I mentioned how I was trying to lose weight and I was at 182 and I ended up at 140, which is, uh, definitely a lot lower than I was, partially I'm sure due to my weight loss efforts. But again, a good amount of the weight loss I'm sure was also due to the hyperthyroidism as well. So weight loss is common. Again, think of it, it speeds up everything. So again, the increased heart rate, increased, again, the palpitations, the anxiety increases bowel movements. So frequency of bowel movement, sometimes loose stools, diarrhea, heat intolerance, where it's, uh, what hypothyroidism, you get things slowing down. So you get fatigue, you get brain fog, you get constipation commonly. Instead of heat intolerance, you get coldness. Hair loss is common with both hyper and hypo depression. More, probably more common with hypothyroidism. Not that people can't be anxious with high— and that's the thing, sometimes you get conflicting symptoms. Like, there are people with hyperthyroidism who don't lose weight, who they, they have the opposite problem for numerous reasons. And so they might have issues losing weight or actually be gaining weight, and that's even more frustrating because Most of people, I wouldn't— I guess it doesn't matter if it's women or men, but because, you know, men, a lot of men like myself was trying to lose weight. But either way, it gets frustrating. Some people, when they lose weight with hyperthyroidism, that's like the silver lining. It's like, oh, it's, it's a bummer to have Graves' and hyperthyroidism, but at least I lost 15 to 20 pounds. Whereas someone who was looking to lose weight and then they're gaining weight, or they can't lose weight, and they see that one of the classic symptoms is weight loss But yeah, those are some of the— so again, with hyperthyroidism, everything is in the classic situation sped up, and then with hypothyroidism, again, everything is slowed down. But like I said, sometimes you do get that overlap of symptoms. One other thing I should mention that's common with Graves' specifically, not necessarily hyperthyroidism, but there's a condition called thyroid eye disease, and that's when the immune system attacks the tissues of the eyes. And so in some cases of Graves', approximately like 50%, even though most cases are very mild. But some cases it's noticeable where you see the eye bulging, um, the person could experience double vision, swelling of the eyes. So, and that's in severe cases, it could compress the optic nerve. Again, most cases are more on the mild side, but that also— they're— every now and then I'll work with someone and that was their first symptom, like they had actually eye symptoms and didn't know what was going on, and they went to an ophthalmologist, maybe first an optometrist and then eventually an ophthalmologist, and got diagnosed with Graves' that way and not through an endocrinologist, which is how most people are diagnosed with Graves'.

Yeah, okay.

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So what causes Graves' disease and how does it relate to gut health?

Yeah, great question. So with Graves', as well as with other autoimmune conditions, you have what's called the triad of autoimmunity, also known as the three-legged stool of autoimmunity. So there is a genetic component. That's one of the components. And of course, you can't change the genes. You could change expression of genes.. But the good news, you could change the other two factors, which is being exposed to one or more environmental triggers. And the third component is that increase in intestinal permeability, which is also known as the, the leaky gut. And so if you're exposed to triggers, it could be certain foods such as gluten. Stress could be a trigger, both emotional, physical stressors. I was also— I mentioned I was exercising intensely, so the over— I was overtraining, so it was in my case, stress was definitely a factor, but it wasn't just emotional stress. There was too much exercise, infections like viruses. Speaking of the gut bacteria like H. pylori, there's a correlation between H. pylori and Graves' as well as with Hashimoto's. Toxins and toxicants— we, of course, we live in a toxic world. And then again, you have that leaky gut component as well. So that— so the gut plays a role in a few different ways. You get that leaky gut that can make someone more susceptible. And then most of the immune system cells are located in the gut. So just by that alone, you need a healthy gut to have a healthy immune system. And then I mentioned certain infections, uh, things like H. pylori, parasites can set the stage, or at least be contributing factors when it comes to a development of Graves'.

So is there a specific diet you recommend to people with Graves' disease?

Yeah. Yes and no. I mean, I wrote— so one of my books, The Hyperthyroid Healing Diet, a little bit misleading because when you hear that, you might think that there's a single diet, but I actually talk about 3 different diets. And even with those diets, there are variations, but there's what I refer to as a level 3, level 2, and level 1 diet. The level 3 is the most restrictive. It's an autoimmune type diet, kind of like a modified AIP diet. And that's usually where I recommend for people to start with and then follow that kind of— it's like an elimination diet is the way I look at it. It's not a permanent diet, it's a starting point, an elimination type diet, and eventually they'll reintroduce foods. But then a Level 2 is kind of like a modified paleo. So if someone just is not ready to follow a Level 3, then they could follow Level 2, again modified paleo. And then Level 1 is the least strictest of the diet. If you're familiar with Dr. Steven Gundry's, like, Plant Paradox diet, it's like a modification of that, though it does allow some properly cooked legumes, beans, lentils, minimal grains. So there's more flexibility. So if someone's like a vegan, they might choose to follow the Level 1 diet. But I mean, really, we both know it— there's no single diet that fits everyone. I mean, what we all have in common as practitioners is at least more on the natural side, maybe not conventionals, but even conventional, you would hope that they recommend whole healthy foods, avoiding the refined foods and sugars. And then, of course, common allergens like gluten, dairy, at least while healing, especially gluten. Essentially, it's an autoimmune type diet is what I recommend, but it really depends on the person.

Yeah, that's one of the things that I sort of object to in the Gundry stuff about the excluding the beans and lentils, because as somebody who looks at gut health reports all the time, low fiber and low butyrate producers, that's one of the things I see most common on people's gut reports, stool tests, you know. And so if you take out beans and lentils, which are like the powerhouses of providing fiber, then it's really hard to get enough fiber. Well, especially if you're— I mean, if you're hard to get enough protein if you're a vegan or a vegetarian other than—

yeah, I agree. I mean, even with AIP, you know, more recently I've questioned just because the benefits that legumes have to the gut microbiome. And it's like, you know, I know they're not part of AIP and they're not part of paleo for the same reason, just because of the lectins and the compounds. But then if you're properly preparing them or pressure cooking them, at the very least greatly reduces those. And so I've also thought about, you know, is it really— is it absolutely necessary for people to— I mean, people do heal on AIP and paleo. But it's, it is more challenging to get in the fiber-rich foods that way. And, but it's also, I mean, legumes also are a good source of protein.

Yeah. I used to eat very few until I got report with high beta-glucuronidase and I knew I needed to cut down on my meat and my fat and eat some more plant-based protein. So I just went out and I bought several bags of hard beans and started soaking 'em overnight and putting 'em in my Instapot. And like all of a sudden it became easy, like what seemed like this big obstacle to eating them, it was like, oh no, if I just soak 'em at night, then the next day I've got a solution. Like I've got something for dinner. And for me personally, they, they definitely help.

Quick question with that. Do you still need to soak 'em if you put 'em in a pressure cooker though, or?

I soak and rinse them too. I think that gets rid of some of the lectins.

Have you found that mycotoxins play a role with Graves?

In some cases, yeah. Definitely becoming more and more aware of the impact of mold and mycotoxins and you know, whereas like 10 years ago, yeah, I didn't recommend urinary mycotoxins testing. Now of course it's a lot more common. There are more labs that offer that, which makes it easier. But yeah, that falls in the environmental toxin category. And unfortunately, as you're aware of, I'm sure it's a problem that is overlooked because if someone just doesn't see a leak or, you know, any signs of water damage, they assume that mold's not an issue, even though it could hide behind walls underneath the floor. And then, yeah, it could colonize the gut as well. Yeah, that could definitely be a potential trigger and/or impact gut healing as well if it is colonizing the gut.

Yeah, I've been testing it more and more and unfortunately finding so many people with mycotoxins. And even people are like, oh, we just—

it's a new house, it's only 6 years old and we just moved in.

It's like, well, yeah, but it's in Florida. And did it rain while they were making your house? And then suddenly, all of a sudden, the mold spores are already in there. Like, new house is no guarantee. And I hate to deliver that news because it's like a super huge expense. So all I can say is to people, before you buy a house, before you rent a house, just pay for a mold test because you'll save yourself such a nightmare.

It's important you mention this too, because a lot of people might say, oh, I just had the inspector, like, check. The inspector said that it's mold free, but they're not mold experts. So when you say do a mold test, like you, you need to go outside of what the home inspector is doing because a lot of times they'll miss the mold. Yeah. So yeah, thanks for bringing that up.

Yeah. And stuff.

And yeah. You talked a little bit about some of the conventional treatments for Graves'.

What are the risks of doing those treatments?

Yeah, so I mentioned that there are 3 treatments, typically 3 treatment options. So the first is antithyroid medication. Methimazole is the most commonly recommended medication, at least in the United States. And then there's also propylthiouracil or PTU, which sometimes is given especially like first trimester of pregnancy, or if someone can't tolerate methimazole, they might put the person on PTU. I mean, side effects are common. I mean, it's all risk versus benefits. I mean, you do want to be safe while addressing the cause of the problem, and there are natural options to help with that. But like I said, there is a time and place for the meds. But the meds, I mean, they affect the liver. A lot of people have elevated liver enzymes, sometimes could suppress the white blood cell count. I mean, there's evidence that it affects the gut microbiota, so it affects the composition, affects the permeability of the gut potentially. So yeah, it's one of those things. If someone absolutely needs to take the medication, and a lot of people I work with do take the meds, and if they're tolerating it well, they're on— especially if they're on lower doses, I can't tell them. I'm not going to tell someone to stop taking the meds because there's also no guarantee that natural agents like bugleweed, which is what I took, will work. I mean, it worked wonderfully for me. Bugleweed's an herb that has antithyroid properties. Yeah, the medication, like I said, side effects are common, sometimes causes rashes. But like I said, it's risk versus benefits. So if someone's listening to this and if they're taking antithyroid medication and they're tolerating it well, Again, it does— doesn't mean that you should switch to a natural agent. Again, when people work with me, some people do ask, well, if I'm on the methimazole, I'm tolerating it well, but can I switch to something like bugleweed? And I'll tell them, I can't tell you to stop taking the methimazole. You could add the bugleweed at the same time, and then when you do your updated thyroid panels, if things are looking better, then you can ask the prescribing doctor to reduce the dose of methimazole and gradually wean off that way. I mean, radioactive iodine is another treatment, and that is pretty much destroying the cells of the thyroid gland. So goes without saying, you don't want to do that. So that's a pretty big risk, is that you most likely will become hypo. But it's beyond that. It's not doing anything for the immune system. None of these things, as I mentioned earlier, you know, whether it's thyroid surgery or whether it's radioactive iodine, they're just focusing on the thyroid gland. So what radioactive iodine they also— I don't think they do this. I don't know why they do it in other countries and not here, but they'll quarantine people for like a few days and they'll— again, I mean, it's radiation. You're not supposed to get pregnant 6 months after getting radioactive iodine, yet they'll say, oh, it's fine, it's not a problem, it's completely safe. So that again, and I have some information on my podcast on radioactive iodine. Like, oh, another reason too is it could increase the risk of developing thyroid eye disease. And this is also in the research. So most endocrinologists is if someone has thyroid eye disease, they won't recommend radioactive iodine. But the problem is sometimes people have like a very mild case of thyroid eye disease and they don't know it. So there's been cases where someone took the radioactive iodine or received radioactive iodine and then they develop thyroid eye disease, like the eye flared up. So they probably already had it, but it was kind of underlying, and it's a bummer when that happens. And surgery, again, there's a time and place for surgery. Again, if someone has thyroid cancer, then they very well might need to get thyroid surgery. But with Graves', again, I'm not saying there's never a time and place, but the problem is it's again an immune system condition. So if you get your thyroid removed, you're not doing anything to address the autoimmune component of Graves'. And then obviously there are risks with thyroid surgery. So if you— someone listening to this chooses thyroid surgery, you want to choose a surgeon who has done a lot of them, like ideally hundreds of them, just because it's not uncommon to have damage to the parathyroids, for example. And so again, you could say it's rare, but it's, it's not that rare. It's not like 1 in a million, maybe it's like 2%, and that's to me is a high enough percentage where, like, again, it's maybe in some cases something to consider, but it should be usually a last resort.

Yeah, yeah.

I have a client who had surgery. I, I don't know if it was thyroid surgery or different surgery, but the parathyroid was damaged and she has real trouble. I mean, it's an important gland for regulating the mineral wants in your body. She has real trouble regulating her minerals and keeping right.

So especially calcium.

Yeah, yeah.

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Tell me about the natural treatments for Graves', and I want to hear more about this bugleweed. I've never heard of that. Like, how is that used?

Yeah, bugleweed is an herb, so it's not as common as other herbs like milk thistle or ashwagandha, for example. It's an herb that the main properties is that it lowers, helps to lower the thyroid hormones. And when I took it again, that was my first experience with it. I didn't know if it would work, but I started taking it. I took a teaspoon twice per day. And pretty quickly noticed my heart rate was decreasing, but I was having palpitations. So I took another herb that's common with hyperthyroidism, one called motherwort. I don't know if you heard of motherwort. That helps to support cardiovascular system, has some other benefits too. But I took the motherwort and that helped greatly. And so a lot of people I work with take bugleweed and motherwort. There's also L-carnitine, which I'm sure you're familiar with, but L-carnitine, commonly used for like fatty acid oxidation and supporting mitochondria. But research shows that larger amounts could block the entry of thyroid hormone into the cell. So like taking like between 2,000 and 4,000 milligrams per day. So that's another option for some people. There's also lemon balm, is a common herb used in the hyperthyroid world and has some mild antithyroid properties. When I dealt with Graves', I didn't take lemon balm or L-carnitine just because I wasn't as familiar with them back then. So from a natural standpoint, there are those options. I mean, they're like, selenium is very important just overall for the immune system. A lot of research with not just Graves', but also Hashimoto's and selenium, vitamin D, we know modulates the immune system, omega-3 fatty acids. There's a lot of natural agents. One thing though, I do want to bring up that you mentioned mold and for mold, people use binders. Like, for mold, a lot of— like, like, as most natural healthcare practitioners use natural binders. But then there's also what's called cholestyramine, which medical doctors use. And cholestyramine actually has been shown in the research to help with hyperthyroidism as well. Now, it's not my number one go-to, but if someone can't tolerate the anti-thyroid medication like the methimazole. And maybe if the natural agents aren't working, cholestyramine is something to consider as well, if you could get a prescription. And again, the way I've had people get a prescription is just show the endocrinologist the research. I mean, if they say that I told them to get cholestyramine, they usually won't be able to get it because they don't want to hear that from a chiropractor. But if they actually show them the published research— and the published research shows that it's for mild hyperthyroidism, but I've had some people where their thyroid hormones are pretty high and the cholestyramine has worked. Again, it's not doing anything for the cause of the problem, but neither is bugleweed and motherwort. Those are just natural symptom management options. And then I probably should— this is not natural either, but low-dose naltrexone. Some people take that as well to modulate the immune system with not only Graves', but Hashimoto's. You know, I find with Graves', it's more hit or miss that it doesn't always work. And of course it's also not addressing the cause of the problem.. So usually I try to focus more on the natural agents, correct the nutrient deficiencies. Someone needs adrenal support, of course, do as much you can from a diet and stress management standpoint, but sometimes give supplementation, sometimes probiotics, prebiotics to support the gut microbiome. And of course, trying to do as much as you can through diet as well. I like doing testing as well. Some practitioners aren't big into testing and I don't go crazy with the functional medicine testing, but I do like to do some testing, you know, some adrenal testing, some, you know, gut testing at times. But like I said, it does depend on the person. I don't like to just recommend the same supplements for everybody. I like to see what patterns they have with the adrenals and what's going on with the gut. And of course, I do blood testing as well. And if someone's deficient in vitamin D or other nutrients like Iron is a common one too. You probably see this too. A lot of people are deficient in iron. But yeah, sorry, I went, went off a little bit as far as some of the natural approaches, but if you have any other questions regarding that, definitely let me know.

Yeah, no, I was curious if you've thought about what the mechanism of action of cholestyramine working might be.

Well, from what I understand, I, I maybe I'm wrong, but I thought it actually binds to, just like it is a binder, so it's actually binding to the thyroid hormone and kind of then the body kind of clears it out, is from what I understand it doing now. And if that's true, of course, if someone has hypothyroidism, they would want to be careful, especially if they're taking— and we know this too, like, if they're taking any type of med, not medication, not just thyroid hormone replacement, you would want to take the cholesteramine away from any meds, away from any foods, because it could bind to those as well.

Right, right.

Yeah.

I hadn't thought about that because certainly there's gonna be people that I'm working with who are hypothyroid and getting mycotoxin treatment, although I don't normally, since I'm not a doctor, there's no cholestyramine involved.

Yeah.

But sometimes they do bring in a doctor who does prescribe it.

And I was curious, do you see then that adrenal issues are often upstream of the hyperthyroidism?

Yeah, I mean, adrenals definitely. Whether you have hypo or hyper. Yeah, you do wanna focus on that adrenal and that's why I test. I mean, you could also say, well, if everybody has adrenal issues, why not just address adrenals? But I like to see the adrenals because in my experience too, I'm a little bit biased because my adrenals were shot. I had low cortisol, low DHEA. The saliva test I use also looks at secretory IgA, which was also in the tank. So everything was low.. And it took that to convince me, cuz at that, up until that point I'm like, yeah, you know, I think stress is a factor, but I'm doing a good job in managing stress. Not also really thinking about the overtraining that was impacting my body. So I think some people do need that convincing then to see the adrenals. And then also it was nice because I was able to do a retest like 3 months later and see things improve, head in the right direction. But yeah, I think without question, adrenals are a priority. I mean, not just with thyroid, but with sex hormones. You know, I'm not against HRT, but, you know, I think a lot of people have low sex hormones because their adrenals are compromised. And, you know, again, there's a time and place for hormone replacement therapy, but why not optimize adrenals either initially, or even if you're going to do at the same time, eventually you might not need as much of the HRT if you're improving adrenal health with hyper and hypothyroidism. And I definitely think that's a big priority.

Yeah.

So I'm currently using a continuous glucose monitor. I got a free sensor for a couple of weeks. And now, like, I mean, of course, I know that I have stress. But now I can see it in, like, super clear terms because I can see that as soon as, you know, I have some stressful event, you know, my body's shooting out cortisol. My blood sugar is jumping up. So I can see it, like, in real stark terms. I can also see that when my blood sugar drops at night to way too low, my body releases cortisol. Out, my blood sugar shoots up. And, you know, and you don't really realize, like, the constant state of stress we're under. But just working, just the hours in which I'm working versus watching television, the difference in my blood glucose is stark. So yeah, so I mean, to get back to the whole adrenals, can you just adjust the adrenals, or do you really need to address the root cause, which is the stress?

Yeah, no. Oh, absolutely. I mean, it's— yeah, just, it's not just about taking supplements. I mean, if all you do is take some adrenal supplements, that's probably not going to fix the problem. So to me, that's like extra support. Like, the number one thing you need to do is improve stress handling. In many cases, you're not going to be able to do anything about the stressor, especially if someone's like a caretaker or something. Like, there's situations where it's impossible to eliminate the stressor. So it's all about improving stress handling. And, and that's great, the example you gave. And someone brought up to me like, yeah, will they ever come out with continuous cortisol monitors? And again, like you said, there is that relationship between blood sugar. So you could certainly use like a CGM for that. But it would be also cool if they do eventually look at the actual cortisol levels too. And you could see that like throughout the day, that would be even even more convincing because still a lot of people when they look at CGM, they're not making that relationship between stress. They're just thinking about food and, and what they're eating. But you're right, I mean, again, there is that relationship between blood glucose, insulin, cortisol. And yeah, so I, I think that was the big— that's the big game changer because these days I don't take adrenal support. I did take adrenal support back then just for extra support, But it's been years since I did that. Now what's keeping my adrenals in a healthier state is, I mean, the two main things is just blocking, like, stress management techniques, or blocking out time for stress management, and just again, try not to take life so seriously, realizing that, you know, things could always be worse. And, and then the other thing is sleep. Just try. And, and honestly, I could even that, I could do a better job I was just telling someone, a patient, like early today that last night I was proud of myself because I got to bed at 9:58, like before 10:00, which for some people might sound impressive, but my wife wakes up early. So I got up today at a little after 5:00. So that's in bed for like 7 hours. I probably got like 6.5. And again, I try to get like aim for 7, 7.5 hours sleep. But I don't always accomplish that. So again, I could even improve that. But the two things, stress management, sleep, are really critical when it comes to optimizing your adrenal health.

Yeah, no, so I'm kind of questioning, like, do these saliva adrenal tests really capture what's going on? Because I did a Vibrant Hormones Zoomer, and so you're getting both the urine and the saliva at the same time. And the first time I did the test, I was super stressed out because I woke up at 5:30 in the morning and I normally get up at 7:00. So I'm just like totally annoyed that I have to spit for the next 15 minutes at 5:30 in the morning and then half an hour later and then like half an hour after that or an hour after that and take urine samples. And I'm doing all this stuff and I'm like, whatever cortisol reading I get, I can tell you it is not reflective of how I normally feel because I am completely stressed out. And I did it again and I was not stressed out. So I'm curious to see whether there'll be a big difference. But the urinary cortisol wasn't elevated. It was just the saliva. Which I assume is a more direct measure of what's going on right then and there. So I do wonder if we had this continuous cortisol monitor, if we did it day after day after day. I always tell people if I'm doing adrenal testing, try and make it be like a non-stressful day, like just a regular day.

Same here. Yeah. And we also do some dried urine testing as well. So not on everybody, but either way, if we see like an extremely elevated cortisol in the morning, the first thing we'll do is Was it a normal morning? Was it— were you like extremely stressed out that morning? Because you're right, it doesn't make a difference if that's one of the flaws of going to a lab and doing a blood test is a lot of people get stressed out with the blood draw and that could artificially spike up cortisol. But you bring up a good point. If someone is just stressed out for whatever reason, and again, like, yeah, the collection procedure, sometimes that does stress people out. Some people have issues like that or difficulty generating enough saliva, and that could be stressful as well. And then they see, like, abnormally high cortisol levels. And so you're right, there's no perfect test. And, and you're absolutely— yeah, what we discussed, like, it would be awesome to have that continuous cortisol monitor so you don't have to collect any samples, and you just— it's constantly just monitoring your cortisol throughout the day. And I'm sure it's, it's got to be coming.

I mean, you would figure I mean, they're already developing toilets that are like analyzing your microbiome, so I can't imagine it's too far off for the cortisol.

That can't be hard. If not, me and you, we could team up and create it.

So there we go. Yeah, no, I mean, speaking of going to labs, so every time I test my fasting glucose, it comes in around 99, 100, 102, something like that. So I thought, do I ever have low glucose? Well, sure enough, I do. It's just that the cortisol then shoots up and it pushes it back up. So it's not— so I realized just seeing that fasting glucose at that, I mean, of course you can look at A1C and you look at insulin and all these other things. So I, I knew that there was probably not a blood sugar problem, but now it confirms it because I have the CGM data. So interesting. So in terms of nutrients, you mentioned some things like selenium and vitamin D and omega-3s.

Any other nutrients that are really important for thyroid function, either way, for Graves', for Hashimoto's, Yeah, I mean, iron I mentioned is important for more so for hypo as far as if you're deficient in iron, that could be a factor with hypothyroidism. But I mean, if you're deficient in iron, even if you have hyper, of course, regardless, even if you don't have any thyroid condition, you want to correct iron deficiency because its importance is for supporting mitochondria. But magnesium is important overall. I mean, really all the nutrients are important, but Probably the most controversial nutrient when it comes to thyroid health is iodine. And iodine, you need it for thyroid hormone production, but too little could result in hypothyroidism. But then there's concerns over too much iodine, and it's confusing because you have different practitioners giving different recommendations. There's Dr. David Brownstein has a great book, Iodine: Why You You Need It, Why You Can't Live Without It. And very interesting book. And he's been doing this for a long time, but he does recommend high-dose iodine, like 50mg of, like, Iodoral. And again, he's had success for it, I'm sure, or he wouldn't be recommending it. But not everybody does well with massive amounts of iodine. And then you have others who recommend the opposite, like 200mcg or less of iodine, and that's see that. And there is some evidence in the literature that iodine could maybe play a role in developing autoimmune conditions. And I mean, I have at least every few people per year I see who it seems like the problem that they had, like usually in hyperthyroidism, developed when they started messing around with iodine, like taking iodine. And I should say I actually, in the past, when I dealt with Graves, 2008 is when I was diagnosed. Back then, the higher dose, like Dr. Brownstein and all that, that was more in favor. So I actually, at that time, I was taking high-dose iodine, and I had a good experience with it. Like, I can't say anything bad personally, but so because I had a good experience for a few— the first few years, I was having everybody do, like, an iodine loading test, which also involves taking high-dose iodine, like a 50 milligram tablet of iodine and doing the urine test. And I would say, I mean, a lot of people did okay, but then I did see people who didn't do well, and sometimes it would increase the hyperthyroidism. And so others like Dr. Fipponi with Dr. Datis Kharrazian started talking about the concerns with iodine, and then others followed his lead. I realized that iodine's important, but you want to be careful especially when taking separate iodine supplements. I'm not anti-iodine. If someone's taking a multi with iodine or eating some food sources of iodine, I think usually it's okay. And even in those situations, there'll be this controversy that like some, like Dr. Alan Christianson, will say even with the food sources, keep it like 200 micrograms or less. And those are Hashimoto's. But, you know, the thing is everybody is different. But because you don't know who's going to respond negatively, to iodine supplementation, I'm definitely more on the cautious side. And I don't recommend for people to just take, you know, Iodoral or, you know, other iodine supplements. And if someone was going to do that, then yeah, they probably should do like a urinary test. Even that, there's no perfect test for iodine too. So that's the thing. But iodine, I felt the need to bring it up just because, you know, a lot of people have questions about iodine and there is so much conflicting information. And I wish I had all the answers when it comes to iodine. But all I could tell you is that can be helpful in some cases, and you definitely don't want to be deficient in it. But at the same time, you don't want to necessarily just randomly take like 25, 50 milligrams per day because that could potentially cause more problems.

Yeah, I thought that the whole thing was Hashimoto's was named after a Japanese doctor or patient. I don't know. Because in Japan they're eating tons of iodine because of all the seaweed. Yeah, yeah.

And there, yeah, again, the evidence, there is some evidence in the, the research showing that, that, yeah, makes them potentially more susceptible. Like I said, I'm more even, even with the food sources, like, you know, someone's eating, it depends, like sea vegetables, definitely, like kelp could have a whole lot of iodine. So that I usually, and I talk about this in my book, The Hyperthyroid Healing Diet, again, I'm more cautious not only with the iodine supplements, but like really high amounts of iodine-rich foods. I would say in those with thyroid conditions, maybe not to do that, just to be on the safe side.

Yeah. Just a quick request. If you're someone who's used my product Tributrin Max and you've enjoyed it, I was wondering if you would be so kind as to go on to Amazon and leave me a review. You can go to tinyurl.com/reviewtmax. That's tinyurl.com/reviewtmax. Review TMAXX, or you can look on the show notes and there'll be a link to do that. Thank you so much. What about zinc?

Yep, zinc is very important. Vitamin A, very important. Both of those— zinc, vitamin A— also helpful for the receptor, the thyroid receptor, as well as omega-3 fatty acids. All, again, all the nutrients are, are important. Some of them more important, specific, like manganese is important, but I don't know really specifically for thyroid health, like manganese and chromium. We know chromium for blood sugar, but from a thyroid health perspective, we could say, well, if your blood sugar is out of balance, that could affect your adrenals and your thyroid. So indirectly we could make connections to all these as well. But yeah, zinc is definitely important for immune system health.

Okay, so to summarize, could you just go over the basic steps of trying to reverse autoimmune thyroid disease, whether it's Graves' or Hashimoto's? Sure.

I mean, so number one thing I talk about is being safe, more so with hyper, but even with hypo. Like, if someone has really low thyroid hormone levels, maybe they do need thyroid hormone replacement. If someone has elevated thyroid hormones, again, they could try— the bugleweed is an option, L-carnitine in higher doses are an option. But again, some people do need the anti-thyroid medication. But either way, you want to be safe while addressing the cause of the problem. And then I would say the foundations of just incorporating the diet as well as stress management, sleep, not over-exercising. You don't want to be couch potato, but you don't want to overtrain. So the foundations are important. And then I do like to do testing because I find that many times we need to go beyond diet and lifestyle to see if we have adrenal imbalances, if we have— which most people do. And you mentioned the mold and other toxins and toxicants and gut issues.. And so I try not to go overboard with the testing. I mean, and ultimately it's up to the person. If I recommend more comprehensive testing and the person's on a budget, then of course we'll try to prioritize the test and vice versa. If I'm recommending more conservative and someone's like, hey, I just want to do all these tests, I might tell them, well, you know, you don't have to. We could start out with these tests, but if like insistent on doing more testing, that's fine. But so, yeah, so number one, safe symptom management. Two, the foundations. Three, let's do some testing to try to find some of the triggers and underlying imbalances. And then based on those, I usually give, like, general recommendations initially. Like, I'll— I have almost everybody on an omega-3 fatty acid just because most people aren't eating fish or not enough fish. And so you could do a test if you want to confirm, but if they're not eating fish and not taking a fish oil, I don't think I've ever seen anybody who has a healthy omega-3 index who's not, um, taking omegas and not eating fish. But so I do recommend some basic supplements, but based on the test results, that's when I'll give more specific recommendations. But I will— one thing I'll say though is everyone could start with diet and lifestyle. I mean, again, you want to be safe too, that safe symptom management, so make sure that's in play. But you could do things on your own to change your diet, you could do things on your own to improve stress handling. And I mean, sometimes you need help when it comes to sleep, depending on what the cause of the sleep issue is. But definitely work on diet and lifestyle on your own if you can't afford to work with a practitioner. Of course, I'll be biased, you're probably biased. We think, you know, like, it's good to have that support system and someone who's knowledgeable and guiding you through, you know, like, what to eat, what not to eat, what supplements to take and not to take. And some of that's in, I mean, in my book books. And of course, there's a lot of, like, our podcasts as well. But there's no replacement for that one-on-one support, which is why, um, you know, Lindsey does what she does, I do what I do, and other practitioners do what we do. But if you're not in the position to work with someone, definitely I would say start with diet and lifestyle.

So where can people find you?

Yeah, thank you. So, uh, so my podcast, which you of course appeared on, so check out Lindsey's interview, um, my interview with Lindsey, savemythyroid.com., and you can just click on podcast. Uh, you could also check out my YouTube channel, savemythara.com/youtube. Let's see, I have a great— a Healing Graves Naturally newsletter, savemythara.com/graves-newsletter. Then my books, so I have Hashimoto's Triggers, Natural Treatment Solutions for Hyperthyroidism and Graves' Disease, which is in its third edition, and The Hyperthyroid Healing Diet. You could find all those on Amazon. And those, um, those are probably the best places I would say to start.

Okay, great. I'll link all those in the show notes.

Well, thank you, thank you. This has been a wonderful conversation.

Yeah, thank you so much. Any final thoughts before we go?

There's hope. And I say that just because unfortunately most medical doctors won't— if you ask any— not any medical doctor, but I find most endocrinologists are not the most open-minded Doctors, again, I've had some on my podcast who are, but if you ask them about diet, lifestyle, they'll pretty much shoot it down. You're not really going to get much hope working with your doctor if you ask if there's anything else you could do except to take the levothyroxine that they prescribe or the anti-thyroid medication that they prescribe. They'll just say no. Well, in the case of hyperthyroidism, they say, yeah, you could take your thyroid out or get radioactive iodine, but they won't do anything for the cause of the problem. But, you know, I've been— besides my own personal success story, I've been working with people for now over 16 years, and it's definitely possible. It's not easy. I'm not going to say it's easy to do it, but it's definitely worth it, not just to restore your current health or your— so, like, reverse your current health condition that you're dealing with, but then also to prevent other health conditions from developing in the future. So definitely well worth it.

Yeah, indeed.

Okay, well, thank you so much.

It was great having you.

Uh, thank you. Thank you so much, Lindsey Parsons.

Well, that was the first conversation I've ever had about Graves' disease on the podcast, so it was long overdue, and I hope you got a lot of valuable information from it. You can support the podcast by buying supplements at a discount from my FullScript dispensary, ordering tests at a discount from my Rupa Health Labs store, or using my affiliate links to iHerb, which is available worldwide, or Amazon. And just a note that you can use my Amazon link to buy anything, so I'd appreciate it if you'd bookmark my link and use it not just for supplements but for gifts and everyday items to support the podcast. If you'd like to connect with me online, you can follow my High Desert Health Facebook page, join my gut healing Facebook group, or join my newsletter list at highdeserthealthcoaching.com, as well as follow me on Instagram, TikTok, Pinterest, Mastodon, and X. Links for those are in the show notes. Thanks for joining me today, and here's wishing you all the perfect stool.