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Hello, everyone. Welcome to another fabulous podcast, women to women series, where we talk about hormones, adrenals, weight and Trauma. And today I'm thrilled to have somebody I've known for a long, long time. And we actually started doing online stuff together many years ago. We want to talk about how long. This is Dr. Alan Christensen. Let me tell you a little bit about him. He's a board certified who focuses on thyroid care and is a New York Times bestselling author, and I knew him when, whose recent titles include the Thyroid Reset Diet and the Metabolism Reset Diet. So we'll dig into a little bit of that information because it's new information. Dr. Christianson has been featured on countless media appearances, including Dr. Oz, the Doctors, and the Today Show. He's a founding president behind the Endocrine Association of Naturopathic Physicians, and the American College of Thyroidology. So thank you so much for being here today. And now you're going to keep us abreast of what's new in the thyroid world.

Yeah, Marcelle, happy to be here with you. Dear friend. And yeah, let's get a good update for everybody.

Yes, let's talk about iodine. I was talking about thyroid last time on one of the programs. And everybody's so curious because I don't know if I should have it or should I not have it or how do I get it or what's too much? And what about selenium? I heard that a Brazil nut or two Brazil nuts a day is way too much? What should I do? So let's dig in and find out.

Well, that last one I can answer in a moment. The Brazil nuts are awesome. They have a lot of selenium. The amount can fluctuate. However, the kind of selenium they have is a kind that we cannot overdose. There's been some big studies done on that in preschool kids in Brazil, actually. So you're not going to overdose. You won't get too much, but two to four today can be a great.

Way to keep your selenium on tap. Perfect, perfect. So let's dig into iodine.

That was the simple one.

Now we can go to the more complicated one. I remember years ago that the new thing to do on the block, and we actually have somebody come to IFM and present, and he was adamant that we should do 12 milligrams of iodine a day.

Yeah.

I saw some disasters after that myself. So let's dig into kind of that whole piece about iodine, why it's so important.

I did too, you know, and the thing is people are different. They're different in how much iodine they tolerate. We're not really different in how much iodine we require, but we are different in how much we tolerate. And basically those who are prone to thyroid disease are the ones who don't tolerate a little bit of extra iodine. It's really that simple. And yeah, funny paradox, the thyroid needs iodine and it can't work without it, but it needs it so badly. and the amounts are so small that a little bit too much iodine actually slows the thyroid like too little can. And for those who are sensitive to it, that might not be much and it can be the biggest known driver of thyroid disease.

So how do you decide for yourself how much iodine you need or do we need to have iodine testing to find out kind of what our status is and how much to add?

Well, I wish testing was useful and I wish it were accurate. You know, it really would make a lot of sense, but it's neither actually. The studies show that the testing makes sense at a population level, but not at an individual level. The issue is that iodine is in three main compartments. It's in your thyroid, your blood, and your urine. The blood and the urine don't really reflect what's in the thyroid in most circumstances. They fluctuate so much, they don't even reflect what's happening at an individual. They only reflect useful things at a group level. Deciding how much we need If someone is plugging along, their thyroid is normal, it's not a big thing they have to think about. They can have some, they can probably do okay with amounts that reasonably fluctuate. High amounts can be catastrophic for anyone, but if someone does have existing thyroid disease, there's two big windows to think about. There's how much iodine you'd want to keep your thyroid from worsening, and then we'll talk about an opportunity by which, if you're at a narrower window, it may improve your thyroid function.

And what is that, you know, how help the audience understand where do I fit into this? Let's use me. I don't have a thyroid problem. How much iodine should I have every day?

So we've got a lot of great population studies and what we see is that the sweet spot for the lowest rate of onset of thyroid disease is about 50 to 200 micrograms of iodine per day. And that's an easy bar to hit. So, almost any food you could think of, you know, all foods have some iodine. Some foods have a lot. So, staying in that range is really just eating a healthy diet with a lot of variety, but not doing high amounts of things that contain a lot, like iodine supplements, massive amounts of sea vegetables, a few other processed foods here and there. But that's really all you need to think about in a case like that.

So, let's, I'm going to put you on the spot here.

That'S true.

Thyroid testing.

Yeah.

You know, in the conventional world, what we do is we do a TSH and a free T4, and that's it. And then we make a decision. If you push somebody, they might do a free T3, and that's all they really do. How my experience has been that that really does not give me enough information about what the thyroid is doing. Where are you with all of that?

Yeah, you know, totally true. So we think about diagnosing someone who's prone to thyroid disease, seeing someone who has health risks from their thyroid function, and then seeing someone that might have an opportunity to improve symptoms by changing their thyroid functions. And a lot of data suggests that the broad range of normal is not the same as the range of scores we find in people free of thyroid disease. So I'm not one really to feel a need for like 100 tests, but I think more about reading the tests that are there with more nuance. So I think about how these tests would compare to what's optimal, and that does vary for someone's age, their gender, their health status, But as a generalization, the further they are towards the hypo side of normal, the more they're looking like even low thyroid function within the normal range, the more likely that thyroid could be affecting their health.

And what about thyroid antibodies? There's a lot of controversy now about thyroid antibodies.

Sure. Yeah. So most thyroid disease is autoimmune. Nearly all of it is. And if you define someone based upon confirmed autoimmunity via biopsy, if we look at that population and then go backwards, we see that about half of those people have measurable thyroid antibodies. So yeah, if someone does have measurable thyroid antibodies, they have existing autoimmune processes that may or may not lead to thyroid disease. Now, if someone lacks those thyroid antibodies, that doesn't mean they don't have thyroid autoimmunity. So they confirm there's thyroid autoimmunity when they're there, but they don't rule it out when they're absent because yeah, about half of people with biopsy confirmed autoimmunity don't have positive antibodies. So they're worth checking, but it's also worth knowing that even if they're negative.

Autoimmunity is the most likely culprit. And if one is suspicious of autoimmune issues, what are your recommendations in terms of that?

Well, so the question is really what drives thyroid disease. And the biggest single one is the extra iodine that I mentioned. One recent analysis showed that there's three irrefutable factors behind thyroid disease. One is age and one is female gender. and those are things we can't readily change. But the third factor, so basically, iodine, it's an antiseptic. It's like bleach, it's like hydrogen peroxide. It's a really great thing at killing little bugs, and it does that because it generates massive amounts of free radicals when it can. And so within the thyroid, that makes it helpful for forming thyroid hormone, but when there's a tiny bit extra, those extra free radicals hurt the thyroid cells, and they make the normal thyroid proteins look foreign. They make the proteins of the thyroid look like they're part of an infection. So your body attacks these proteins like they're foreign, and that's how autoimmunity starts.

So in order to change that then, if we kind of look at that as a possibility, then changing one's diet and decreasing the amount of iodine you have in your diet, doing clean foods, doing, you know, artificial colors, sweeteners, dyes, exercising on a regular basis, missing anything?

No, a lot of it is processed foods and we look at the overall amount of dietary iodine, how it's changed. In the last several decades, it has gone up a lot. And globally, that's been good. Globally, we've eradicated severe iodine deficiency. In '92, 112 countries were in that category. By 2014, that number was brought down to zero, which was a big win. But We brought 52 countries up to a state of at risk for thyroid disease due to iodine excess. And the biggest categories of food that changed was the iodine content in processed grain products and also dairy foods. So those kind of added on top of it. And the basal amount is from salt, seafood, egg yolks, those have been pretty steady. So someone who's trying to keep stable thyroid function, they're better off avoiding those high sources When someone wants to improve their thyroid, they want to temporarily avoid all those big sources to get in that reparative window. The cool thing is that as researchers thought about this as being a possibility, first as a driver for thyroid disease and then possibly a way to reverse it, there were some large studies that were done. In one representative study, they took people who had had thyroid disease for a little more than four years on average. As a clinician, their TSH scores were over 14 on average. To everyone else, they were very hypothyroid. There was nothing subtle about this. They were overtly sick and they had been untreated for several years, which is unusual, but nonetheless, there they were. They did one thing only, and that was they reduced their iodine. They targeted under 100 micrograms. Now, not everyone complied, not everyone reached the target, so we'll come back to that. But over the course of two months, that average TSH score of 14 for 78% of people, they regained perfectly normal thyroid function. And they had watched these people for about six months before the study. They weren't bouncing up and down. They were just stuck hypothyroid. And for the first time in years, 78% had perfectly normal thyroid function just by doing that. They were not given medication. They were not told to sleep better at night. They were not told to do anything besides just get their iodine down. So that was 78%. So let me come back to this quickly. So the remaining people, one big chunk of them was in the group that didn't get to the target. So you got to play to win. They didn't play, right? So we'll ignore that for a moment. The other group, they did improve, but their scores were off by larger factors going into it. their TSH scores were in the 50-5-0 to 200 range. They improved by 50% or greater, but they were not yet normalized. So the final group of those who did play, they did get to that target, but they failed to improve at all. They comprised about 3% of participants. So of those who did follow the guidelines, 97% saw big improvements or a complete normalization of thyroid function, within a couple months.

Amazing.

Yeah.

Then, you know, for people that are listening to this, because thyroid is a huge issue for so many people, many people come in and say to me, I've been on thyroid replacement now for seven years. You know, can I ever get off one? And two, if one has a, you know, a tsh of 14, you know, how long does it take to normalize? And what are the things that you recommend that they do? immediately to get that thyroid normalized so they don't have to be on medication.

For the rest of their lives. Yeah, second one, quick answer to that. I recommend they follow those guidelines. I wrote the thyroid reset diet as a simple way to implement what was done with clinical trials and also, you know, healthier way overall because the clinical trials just had them change at one variable. I also talked in the reset diet about just being on a good diet, you know, and other reasons why a healthy diet is relevant to your health in other ways and also to be nutritionally complete. The studies were looking at just one thing, so they didn't worry if the participants might have gone too low in calcium or they might have cut out something else. So I wrote the Thyroid Reset Diet as just a healthy way to get in that reset window. Now, for those who are on medication, so what we talk about, the term now used is de-prescribing. When can and how can someone withdraw from thyroid medication? And one of the bigger recent studies It gave people just very cursory guidelines to avoid extra iodine. Basically said, don't take supplements that list iodine as an ingredient. It took people who had been on third medication for between four to 10 years and they went through a de-prescribing protocol. Their dose was reduced, they were monitored for their blood levels, monitored for their symptoms. What they saw is that with those most basic recommendations, 44% of people could completely come off of medication with stable levels and no symptoms. They also saw that of those who, that 80% overall, 84% precise, were able to lower their dose by some degree. And within that 84% was that 44% that needed none. So another 40% was able to reduce greatly. And they saw that those who were on medicine for five years or less, it was more likely, you know, those who were not needing as high of a dose was more likely But yeah, there are many people and that, but again, that was with the most basic, basic recommendations of iodine regulation. So I do believe that with more thorough control, those numbers could get better in terms of how many can improve and yeah.

And if somebody was going to be compliant in other ways besides decreasing iodine, what else are they going to be doing to really accomplish that feat?

You know, all the things you tell people to do, they're going to be exercising. Less stress, better social relationships, fixing your adrenals, all those things that you talk about, they all matter. They're all relevant. So if they do those things as well, they're only going to have better odds.

So I'm going to kind of explain that a little bit more for those people that may be new to us and haven't heard this before. So, you know, the adrenals in my world trump thyroid. So if we get the adrenals stabilized, it really makes a difference with regards to of thyroid function, not so much the autoimmune components to it, but even that it will do that because adrenal issues cause more autoimmune issues as well. Getting enough sleep, having right relationships. You know, I talk a lot about toxic relationships, you know, people that you're just kind of feeling comfortable around, having less of those in your life and having more joy, getting outside, exercising, putting your planting your feet on the floor, and having a spiritual connection as well. All of those are things that both Alan and I talk about all the time with our patients. And we talk about in the writings that we do as well. I just kind of wanna reiterate that in addition to no processed foods, staying away from artificial colors, sweeteners, dyes, being careful what you put on your skin, being careful what you do, including makeup for women and all those kinds of things. 'Cause there are things now available for women in particular that don't have toxins in them, including nail polishes. They don't have toxins either. So you can definitely change the way that you address your day-to-day life. So let's talk about if we ever test for iodine, do you ever test anybody's iodine status or you just are kind of saying to them all, let's reduce your iodine, make sure you get enough to have a healthy thyroid, but that's it.

Yeah, so thoughts on that. So the clinical trials, some of the ones I mentioned, they would look at iodine levels pre and post. And what they saw was that the iodine levels did not predict a clinical response. So yeah, so whether urine or blood, it doesn't correlate necessarily with iodine in the thyroid. And it would be, it seems intuitive that you could test people and those who are high in iodine, this could help. And those who weren't high, they could do something else. But that just wasn't how it played out in the clinical trials. So yeah, what I do encourage is that if someone has followed the guidelines, and they've gone two months into that and they've seen no change in thyroid function, there is one test called the urinary iodine to creatinine ratio, not the same as urinary iodine in general, but it's calibrated via creatinine. And after someone has already reduced iodine, that test may help to see if they just need more time or more reduction. So if their urinary iodine to creatinine ratios are still above a target after two months, then they may have larger stores that they've not completed the elimination of, which can happen, or there are some hidden sources they're not aware of. So that's one window of time in which it can be useful. Blood iodine, it has no relationship really with nutritional iodine status. It's useful for iodine toxicology. So if someone's on a medication like amiodarone and they're having complications six months down the road, and you're wondering if they're still circulating iodine, yes, serum iodine can show that. But everywhere short of extreme toxicology levels, it has no linear relationship with nutritional status. And urinary iodine, the difficulty with it, even including urinary iodine to creatinine ratio, is that it requires multiple samples to know the status for one person. If you're looking at hundreds of people, that's a wash because you only want to know the group levels and you see that. A recent published article showed that you need to require, you need at least 20 tests to be within 80% accuracy for any one person because your levels vary so much from time to time. So there are no good tests to show the nutritional status of iodine for one individual. There's many other iodine tests. There's skin tests, there's hair tests. They're not useful, they're not accurate, but it's just not accurate and it's not clinically relevant. except for those who have already tried and may not have seen progress.

So what you're saying, Alan, is completely antithetical to everything out in the world. You are pretty much, which is, you know, we can change our iodine status by decreasing it, not increasing it, that the whole notion of our need for iodine is no longer, you know, holding true. That we also have the ability for some people to be able to wean them off thyroid if they are monitoring their iodine status and being really mindful of that. So how long does that take for someone if they're wanting to do it? And, you know, I appreciate the fact that much of what you're talking about is also based in science as well that we, you know, we science takes a long time to catch on to things. And you're just ahead of the curve, you know, helping people understand that we've got a thyroid, you know, hypothyroid crisis, in my opinion, everybody and their sisters on thyroid medication. And it would it would be lovely to change that.

Well, the crisis is twofold. In one sense, the disease is on the increase, and on the other fold, it's often over prescribed when not needed. And so there's many people on it, you're totally right. And you asked about the duration, how long does that take? And of course, how long someone's been on treatment. A big thing is how much their dose compares to what their body would make by itself. Are they taking as much as they would ever make if their third was gone or a tiny fraction of that? But throwing some of those things aside, average person who's not taking some ridiculously high dose hasn't been on it forever. Typical duration somewhere between 3 to 3 to 12 months for someone who can get by unless or not need it. And yeah, biggest single factor is regulating the iodine. The selenium you mentioned at the beginning is also important. And then all the things you talked about with adrenal health and stress are big toward that goal as well. And I ask people too, I hear many that say, how can I get off this medication? And my pushback is always, what is the biggest health goal? is it dropping your pill count by one pill? Because there's probably a way to do that. You probably some pill that's not necessary. And, and it's often the case that they have some symptoms, that they're not feeling well in certain ways that they ascribe to their thyroid. And in a lot of cases, they can be from other factors altogether. So I really want to get someone have a global perspective on, you know, where is your health now? Where do you want it to be? And if this happens to be, you need one less pill along the way, that's awesome. But I want to make sure the.

Win is really a win, make sure they really address the most important things for them. Absolutely. So let's get into, you know, if one has to supplement. As you know, there's tremendous controversy about, no, you need T4 and you never need T3. It's not been my experience. I have a lot of people in my practice on thyroid medication. And your thoughts about Armour Thyroid as well as compounded T3 and T4.

Yeah, yeah. So for sure. You know, the American Thyroid Association did a pretty massive survey in 2018 and they had about 12,000 people who were following their site. So really can be a conventionally biased group of anything. And they were surveyed about, you know, how well are you doing on treatment? And the results were pretty abysmal. And one thing that surprised me is that about 40% of those people surveyed were not only on T4, like you mentioned, they were on natural thyroid or compound, like you talked about. They were on some other mixture. And people that were on other mixtures, they did a little better in terms of their general survey responses. So, there has been this long, since about 1972, there has been this dam about like T4 only and that's it. The dam's got a lot of cracks in it. In the thyroid world, that idea is moving past, but clinically it takes some time to unfold. So, yeah, types of medications. So, as a category, natural desiccated thyroid has T4 and T3, it also has T2, and there's a lot of other biologically active thyroamines that are out there. It's about a dozen or so. And this is kind of like a, you know, whole grain versus refined sugar argument. In the body, there's a lot of proteins that work together. And just one of those things certainly can help, but it's not quite the same balance of all factors the body would do by itself. And so natural thyroid is a better approximation of that. Now, there have been issues with recalls and brand availability. You know, Armour's been one of the brands that in the recent past has been less affected by that and has remained on the market, so that's been available. Now, compounded thyroid, the cool thing about that is as a practitioner we could dial up any potency we wish, we can adjust raw materials. My consideration is just quality control. So there are some pharmacies that do go above and beyond, but they don't have to. And the difficulty is if you can control which pharmacy a patient uses in your we're aware of some procedures, that may be one thing, but we can't always control that. And if we can't, there's a lot of case reports of compounded thyroid that came out badly. Now, and I wouldn't talk about compounding in general, but thyroid hormones are different. So most things that are compounded are things to where the dosages are milligrams, meaning grains of salt. And thyroid meds, the potencies are micrograms, so it's thousandth of a grain of salt. And even when they're made by our world's best standard manufacturing processes and it's automated, recalls are common because you can't perfectly make things at the microgram level. So when they're handmade, we know that the problems are common, but there's not recalls because there's not oversight. So that's my concern about compounded synthetic thyroid.

Yeah, got it. And if you are going to give your opinion about T4 versus T3, T4, T2, what would you say?

You know, the funny thing is that you and I share the bias in that there's a lot of people who are on T4 medicine and they do fine. They didn't go out of their way to come to see you or me.

That's right. That is exactly right.

So I acknowledge that. And many people have already been on T4. And so because of that, by default, I'll often use natural desiccated thyroid. Again, I like the fact that there's all those three active hormones plus the other active biological molecules. I personally over the years didn't use pure T3 as much. Mostly I would use natural thyroid. Some people do not tolerate any T3 and they do better on consistent T4. There's some pure brands out there and some do well on T4 plus natural thyroid to change things a little bit. So I often would do that, but those are most typical approaches I would take. Then there are some that would do well on T4 by itself as well. dosed better for them.

So it's an interesting kind of concept though also, Alan, which is that I think a lot of people don't know how badly they feel until they feel well.

Sure.

And it's unfortunate that, you know, in medicine we talk a lot about conditions and diseases. We don't talk about prevention. We don't talk about the fact that you can be, you know, 85, 95 and still hiking and still biking and energy. I mean, seriously, we don't. we see those people on multiple medications and just not feeling well. So it's, you know, it's in my goal now is to really help women, because that's my audience and my avatar, understand that you can be incredibly healthy and feel vivacious and full into your 70s and 80s and maybe older. So I think a lot of times people need to really question when they wake up in the morning, do you have energy? Do you have joy? Do you have gratitude? Do you have the energy at the end of the day? I'm a ballroom dancer to go dancing and kind of do that into the evening? If the answer is no, then something's probably off and you might want to talk with your practitioner about it. Is it your thyroid? Not necessarily, but it could be one.

Of the things that's associated. Well, just a couple follow-up points to cheerlead along what you're saying. I think that so often we live lives in ways that are not optimal. Like you said, we're not aware of that because we don't have we haven't experienced the contrast. And those things, they affect us in the moment, but they're also cumulative. So the cumulative effect of a lifestyle that's not serving us, it often gets perceived as aging. Like, oh, I'm getting older. No, you're not. The things that are working against you have just gone on for a long time. That's not the same as aging. And they can look very similar. So that's a common point of confusion for people. And there's often much more possibility they have to do better than they could imagine.

Absolutely. Now, do you have a recommendation for many of the multis have iodine in them? And that's fine if that's all they're getting every day, but oftentimes they're getting that plus the food that they're eating or whatever.

Yeah, that's a great point. Not only that, there was a big study done in which multis were analyzed and some scientists grabbed 120 popular brands, analyzed them, and the question was, did the labeled iodine match the assayed iodine? and even within five percent, never once did it come with even five percent of the target. And scores of products, it was three or four times more than what was on the label. So yeah, if someone has or is prone to thyroid disease, they're better off avoiding iodine and multis. That can be a big contributor to their total intake.

Absolutely. So finding one of those might be a little tricky for them, but there's pharmaceutical grade supplements that certainly from many of the brands that we have in our offices for sure, and some of the ones that we don't have in our offices as well. So what did I forget? What do you think is really important for people to understand that I forgot to say?

I think the biggest thing you did say, but I always just love to iterate is the fact that this is something that can get better. And even me focusing this for 25 years, my views have changed a lot about how much someone can get better on their own. and how much improvement is possible. But yeah, if it's been off and you're not feeling well, please don't assume that your thyroid can't get better. And please don't assume that you can't get better because those things are both entirely possible. So yeah, don't give up hope and keep listening to Marcel and following her advice, but know that in me. But these things can make a difference. Thyroid function is much more reversible than I even thought in the past.

And, you know, many things are, you know, when you come from the perspective that we do, which is functional medicine, we're always looking at, well, what's the cause of that issue? And in medicine, we tend to treat it and we are not doing that. We're saying, wait a minute, what's off? And the nuances that you're bringing up today are fabulous, which is, yes, it is possible that you could get off your medication. There's not a guarantee, but it's worth a try to see what happens with your numbers, how have you improved your health and what's going on with your diet. And also in Chinese medicine, thyroid is kind of the voice that we have within us. So we've got that component as well. Are you able to really speak your truth? And that's very much true for women in menopause, is being able to have a voice for themselves because sometimes they've been very quiet because everybody around them needed their support and they didn't take care of their own needs.

That's great.

So how can they find out more about all the amazing work that you're doing and your incredible website and all the amazing things that you do?

You know our hub is the site so yeah drdrchristianson.com and we put out new blogs all the time and you know new content and new books every so often so yeah that that's the place.

Awesome, awesome. Well thank you so very much. I appreciate everything that you do and I always have and it was delightful to have you on as a as always.

Always good to see you, Marcel. Are you gonna connect in person again at some point?

Yeah, I hope so.