Hashimoto’s Thyroiditis with Dr. Marc Ryan: Rational Wellness Podcast 426

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Dr. Marc Ryan discusses Hashimoto’s Thyroiditis with Dr. Ben Weitz.

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Podcast Highlights

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Dr. Marc Ryan is a licensed acupuncturist, herbalist, and Functional Medicine practitioner.  He’s written two books about Hashimoto’s thyroiditis, How to Heal Hashimoto’s and The Hashimoto’s Healing Diet. He teaches at YoSan Acupuncture College, and his practice is devoted to treating patients with Hashimoto’s.  His website is HashimotosHealing.com.

Dr. Ben Weitz is available for Functional Nutrition consultations specializing in Functional Gastrointestinal Disorders like IBS/SIBO and Reflux and also Cardiometabolic Risk Factors like elevated lipids, high blood sugar, and high blood pressure.  Dr. Weitz has also successfully helped many patients with managing their weight and improving their athletic performance, as well as sports chiropractic work by calling his Santa Monica office 310-395-3111.

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Podcast Transcript

Dr. Weitz: Hey, this is Dr. Ben Weitz, host of the Rational Wellness Podcast. I talk to the leading health and nutrition experts and researchers in the field to bring you the latest in cutting edge health information. Subscribe to the Rational Wellness Podcast for weekly updates and to learn more, check out my website, drweitz.com.  Thanks for joining me, and let’s jump into the podcast.

Hello, rational Wellness podcasters. Today we’ll be having a discussion with Dr. Mark Ryan about Hashimoto’s Thyroiditis. Dr. Mark Ryan is a licensed acupuncturist, herbalist, and functional medicine practitioner. And we’ll be discussing Hashimoto’s thyroiditis, which is the most common autoimmune condition in the us and I’m just going to talk for a few minutes about Hashimoto’s to give us a little background about this condition.  So, while the prevalence of Hashimoto’s thyroiditis occurs in about one to 2% of the population, up to 20% of the population have positive thyroid antibodies. Women are affected five to eight times more frequently than men. Over 90% of those in the US with hypothyroidism have Hashimoto’s, meaning that their low thyroid is autoimmune in origin rather than a rising from an iodine deficiency called goiter.  Prior to 1924 in the United States, the main cause of hypothyroid was iodine deficiency. Especially across the northern part of this country and in Appalachia where the soil was iodine deficient, and this area was known as the goer belt. Iodine deficiency leads to enlargement of the thyroid knowns, goer, and in extreme cases can lead to [00:02:00] impaired neurological, stunted growth, physical deformities.  But starting in 1924, we instituted iodized salt. When this happened, rates of goiter dropped to very low levels, but rates of Hashimoto’s soared. A similar pattern has occurred in other countries around the world that have instituted iodine supplementation.

So, as I mentioned, Dr. Mark Ryan is a licensed acupuncturist, herbalist, and functional medicine practitioner.  He’s written two books about Hashimoto’s thyroiditis, how to Heal Hashimoto’s. The Hashimoto’s Healing Diet. He teaches at Yoan Acupuncture College, and his practice is devoted to treating patients with Hashimoto’s. Dr. Ryan, thank you so much for joining us today.

Dr. Ryan: Oh, thank you for having me.

Dr. Weitz: Great. Let’s start by talking about your story with Hashimoto’s.

Dr. Ryan: Yeah, so I, you know, I think like many [00:03:00] acupuncturists, I started out as a generalist and you know, worked for many years in, in a number of different other people’s practices. And then opened my own practice in San Pedro. Had a big multidisciplinary practice there for several years and I kind of, it was a big thing.  I kind of crashed and burned and got burned out and, you know, I was working like. You know, I’m sure you know, 12, 15 hour days doing long hours. And I just like burned the candle at both ends. And through that process, I ended up closing that practice and decided I wanted to, like, reimagine myself and what I was going to do with my career.  And I went and got some business training and one of the things that they said was you have to choose a niche. Like if you wanna be successful, you need a niche. So I was like, well, and I was thinking about my patient population. I thought maybe I’ll do thyroid stuff. You know, I always, I seem to have a lot of thyroid patients, even at that time for some reason.

And so I chose, [00:04:00] originally hypo, just hypothyroidism as the niche. And then six months later I was diagnosed with Hashimoto’s. Huh. And then, so that pro, you know, obviously it became not just a professional choice, it became a personal you know, mission. Because my experience with it, and this is experience I’ve had with lots of patients over the years, is I went, I had a good friend who was an MD.  He did all the testing. We did ultrasound, you know, found nodules. We found that my TPO was quite elevated. It was really high. I was at 1200. But all my other numbers were normal. And so it was basically, it was like, well, yep, you have Hashimoto’s, but there’s nothing we can do about it right now.  We’re just gonna keep an eye on it. And once it gets bad enough, which means, you know, that translates to once your thyroid’s sufficiently destroyed, we’ll put you on Synthroid and then you know, it’ll be fine. So it was at that point I realized like. Holy crap. Like they have nothing to offer in the Western medical model.  There’s really nothing for people who don’t have advanced [00:05:00] destruction of their thyroid with Hashimoto’s. So that really be kind of started my whole journey of learning and research and studying and working with people to try to find solutions for things that. You know, we have

Dr. Weitz: before it gets that bad.

And by the way, this is also the reason why most medical doctors, even endocrinologists, rarely test for thyroid antibodies. And if they do test, they’ll never test again because there’s nothing they can do about it.

Dr. Ryan: Correct. They don’t, it doesn’t change their treatment strategy. One iota. If they find the person has, you know, antibodies if the antibodies are a hundred or if they’re 3000, you know, it does, they do not do anything differently.  Yeah.

Dr. Weitz: So, what are some of the most common symptoms that somebody with Hashimoto’s can have? Which, what symptoms did you have?

Dr. Ryan: Yeah, I mean, it’s, three of the most common are fatigue brain fog and weight issues, [00:06:00] usually trouble losing weight, although there’s a whole. You know, sort of subpopulation that has trouble gaining weight.  Those are the common, most, three common symptoms. Hair loss is another one, which is particularly troubling for women sometimes. Dry skin, usually some sort of gut. Dysbiosis or leaky gut or some gut prop. Food sensitivities are also very common. Joint pain is quite common. But the top three are brain fog fatigue and, weight gain. I didn’t have any weight issues really, about my top symptoms were brain fog and fatigue. I had pretty severe brain fog. I remember one day I, a patient came out I had for 12 years and I could not remember their name, and I was like, oh, so’s in my brain right now.

Dr. Weitz: Yeah. I, by the way I also have Hashimoto’s and have never Oh, really?  I didn’t know that. Yeah. I’ve never taken thyroid medication and I’ve been dealing with it using a functional medicine approach as well.

Dr. Ryan: Yeah.

Dr. Weitz: I’ve actually to my knowledge, never [00:07:00] had any symptoms. My TPO antibodies are, you know, around a hundred, 150, so it seems to be a lower level, but I’ve certainly been working on managing it.  So, what a patient sees a conventional medical doctor with Hashimoto’s, how did they get treated?

Dr. Ryan: Yeah. If you go to see a conventional medical doctor, usually the first line of treatment, if they see. Some imbalance in your numbers. If they see elevated TSH or some Usually they just test TSH and maybe Right.  TSH is really the one number they really focus on. Right. So they find that the TSH is elevated out of range. They will usually prescribe Synthroid.

Dr. Weitz: Right. Which is essentially synthetic T4.

Dr. Ryan:  Correct.

Dr. Weitz:  Can you explain what T4 and T3 are and what TSH is?

Dr. Ryan: So, TSH is produced by the pituitary–Thyroid Stimulating Hormone, and basically it’s, your brain gets signals from the body, [00:08:00] and then there the, through the HPT axis, the hypothyroid, pituitary, and thyroid axis, it signals the thyroid.  And tells the thyroid to either produce more thyroid hormone or less. And in the body produces naturally about 12 parts, T4 to one part T3, and that T4 has to be converted into T3 for it to be biologically functional and most of that happens in the liver. About 60% in the liver.  Another 20% of that conversion happens in the gut with good bacteria, and then the final 20% happens in the peripheral tissue. So the body has to go through that process of conversion and then also it has to then absorb the thyroid hormone properly. All, you know, all the cells in the body have thyroid hormone receptors.  But there can be problems, and I think this is where we come in as natural functional medicine practitioners. There can be problems with conversion, there can be problems with absorption you know, all along the way there. So [00:09:00] just taking medication doesn’t always guarantee that it’s gonna function properly in the body because of that whole process.  Right.

Dr. Weitz: And can you explain what T4 and T3 are?

Dr. Ryan: Yeah, so T4, as I said, body produces mostly T4. It’s not the biologically active form, although it does do some things within the body, but by and large it has to be converted to T3, which is the biologically potent form of T3, that works on the cells and causes the metabolic changes that it does.  And T3 is so active. That your body actually has mechanisms for turning it off. There’s something called reverse T3, which also happens in the liver, where if you’re under times of stress if your adrenals are too taxed or if you’re iron deficient. Then the body will take that T3 and make it inactive just because it, it’s so metabolically potent [00:10:00] and, you know, can cause stress and other things.

Dr. Weitz: And if in case there’s some lay persons listening to this who might not understand how important thyroid hormone is, can you explain why thyroid hormone is such an important hormone?

Dr. Ryan: Yeah, I mean, in Chinese medicine we sort of view it as a v. The personification, if you will, of kidney yong, which is your body’s metabolic fuel in a sense.  Every cell in the body has thyroid hormone receptors. It is what powers the, you know, it’s like the engine that powers the function in your body. So whenever you are hypothyroid, whenever you are, if you aren’t absorbing it probably, or your body’s not utilizing it properly, it can affect every system of the body.

One example is the liver. Like when someone’s hypothyroid it’s everything. All the processes in the liver slow down. So often you’ll get elevated cholesterol and other problems as a result, just because that [00:11:00] metabolic energy that fuel. It is not being processed and utilized properly and everything slows down.

Dr. Weitz: Essentially, the thyroid is the master regulator for every cell in the body.

Dr. Ryan:  That’s exactly right.

Dr. Weitz:  Every tissue in organ. So let’s go into proper testing. Yep. When you wanna assess the thyroid besides looking at the whole person and their symptoms, et cetera, what lab tests should ideally be run?

Dr. Ryan: Yeah. So I mean, for me it’s always important to do as complete a thyroid panel as possible, particularly if it’s the first time that person’s being tested or if it’s someone who has not been tested for some time. So that would be the TSH I would. Order the total T three and the total T four.  That’s the amount of T four and T three that are, is both free in the body and it’s bound to proteins. And then I would also order the free T four and the free T three. These are the free fractions. What is bioavailable? I like to also look at the [00:12:00] reverse T three. Most MDs will not. Order that test. But I like to look at that test ’cause that can tell us something about conversion.  If you look at the ratio between free T three and the reverse T three and then the two antibodies which tell us I, is there an autoimmune process going on that’s TPO or thyroid peroxidase and TGAB, which is a thyroid globulin antibody. So a complete thyroid panel would include all of that so that we can really assess how the thyroid is functioning.  And whether or not the autoimmunity is part of the equation. 

Dr. Weitz:  So, autoimmunity in the conventional medical world is either ignored as in cases of thyroid autoimmunity, or in other forms of autoimmunity. There are medications that suppress some or all of the immune system. In the functional medicine and traditional Chinese medicine world, how do we address autoimmunity?

Dr. Ryan: Yeah. So what, [00:13:00] first of all, what is autoimmunity? Autoimmunity is like the body has lost the ability to recognize itself in a sense, right? It’s, you, your immune system has flagged your own tissue as an invader and is attacking it. So. What we wanna try to assess is how is that imbalance occurring within your body?  Are there different parts to the immune system? What we call t th one, TH two, TH three, TH 17. These are all th stands for T helper cell. One of the things we do in functional medicine is we assess, well, what is this relative balance of these different parts of the immune system and where it may it be overzealous.

You know, at first there were theories about Hashimoto’s being a th one dominant condition. I think OO over time research has shown this, that maybe it was an oversimplification, but there’s usually some kind of imbalance there in, in the th one or th two aspect of the immune [00:14:00] system. And then th three is, so see, let’s explain what those are.

Th one is kinda like the frontline of attack the immune cells that, that do the actual tacking of pathogens. TH two is the antibody system. I think of that sort of as like military intelligence, if you were to use it thing that your immune system is flagging certain parts of that certain parts of the, of your own body with autoimmunity, but other.

Pathogens when it’s, you know, fighting a virus or bacteria. And then th three is sort of the command and control structure. This is the part of the immune system that is overall balancing this process. And so we wanna try to assess that and calm down the attackers, you know, quiet that portion of the immune system and strengthen that.

Command and control structure, which is what Vitamin D and glutathione are both very helpful for. Right.

Dr. Weitz: So what are, what how do we understand how our body gets dysregulated? You know what, [00:15:00] why would our immune system start attacking our own cells?

Dr. Ryan: That’s a great question. There are a number of different theories for that.

You know, some, there’s a theory called molecular mimicry. Correct. Where the, you know, immune system sees you know, your own cells as similar to a pathogen, I think sometimes. And I

Dr. Weitz: think that’s one of the most,

Dr. Ryan: Dominant thoughts in this

Dr. Weitz: world, right?

Dr. Ryan: Right. Yeah. It’s one of the top theories on it.

You know, I think autoimmunity itself is a perfect storm. There’s a, there’s usually a genetic component. There’s usually exposure of some kind of pathogen, like Epstein Barr for example. You know, in that case, you know, Epstein Barr can attach to thyroid tissue, and then you kinda get this hybrid of your own tissue and Epstein Barr and all combined and the immune system just flags that.

And you know, your own cells are kind of, you know, the. The residual victims of that. There’s [00:16:00] also usually, you know, stresses is definitely a big component to the onset pregnancy for women is sometimes an onset. And usually some kind of gut dysbiosis or, you know, problem in the gut too.

So it’s usually it’s definitely a, not a single cause I don’t think. I think it’s really a perfect storm of all these things. So,

Dr. Weitz: let’s see. We talked a little bit about testing, so, let’s go into how we handle patients with Hashimoto’s and what’s the first thing you like to look at?

Dr. Ryan: Well, I’ll definitely do a thyroid panel, but I like to do also a more, much more complete panel just to see what other systems are being impacted and how, so we want to, you know, do a lipid panel. We want to look at the liver, do a lip, a liver panel, look at the kidneys, how they’re functioning to a renal panel, you know, comprehensive metabolic panel.

We wanna look at red and white blood cell counts, you know, how’s that being impacted? We wanna check [00:17:00] to see are they anemic? So we do an iron panel as well. And look at ferritin. It’s very important since this is not just a thyroid problem, it’s really a systemic problem because of the influence of thyroid hormone.

We really need to assess the entire body and see what’s going on. So we’ll look at all those things. Look at blood sugar metabolism, how that’s you know. In the person. I also, you know, I like to think in terms of this, the endocrine triangle, that’s the thyroid, the adrenals, the blood sugar, the pancreas all is one system really.

So we, we want to check and see how that is all being impacted. And then, you know, we have to treat, we have to prioritize what we find in that process and you know, treat the patient holistically in their entire body. Do you look at food sensitivities when you do your testing? I do, sometimes I do.

Yeah. I mean, it depends, you know, that’s part of the intake process we wanna see, you know, are they having [00:18:00] food reactions generally, you know, even if I don’t do testing, I generally advise people to get off of gluten and dairy just because it can have such immune stimulating effects that can make your auto autoimmunity worse.

And people often do have food sensitivities, but it’s not usually the first thing that I will test. I generally do just the blood tests first to. To assess how the system is right,

Dr. Weitz: so when you book, you address how you explain how adrenal stress has an effect and reduces the conversion of T four to T three.

So that, that’s why talk about the adrenals and how that affects the thyroid.

Dr. Ryan: Yeah. So that’s why it’s important that we assess that, that triangle that I was just alluding to. The and that’s the stress piece, I think too. Right? That’s the there’s, has a huge the adrenals it’s interesting.

In Western medical model, the adrenals are not really

Dr. Weitz: Yeah. Unless there is Cushing syndrome. Exactly. Unless it’s super advanced, really extreme. They don’t recognize any other [00:19:00] adrenal problems. And I think part of that’s because of the way they test for it.

Dr. Ryan: Oh, right, exactly. Because they’re.

What is testing for the adrenals in West Medical in A CTH, which is the equivalent of TSH in the adrenals. Yeah, so it, and it’s serum cortisol, right? And right and cortisol in the bloodstream. What I do like to test is do to do a saliva test the four point cortisol saliva test, which we take samples of saliva four times throughout the day and actually look at the circadian rhythm and how the body is processing.

Cortisol and how that’s impacting everything. But yeah, I think the point that you brought up is very important and that is that stress and too much cortisol being produced and adrenal dysfunction has a huge impact on the thyroid. And I think one of the main reasons is there’s that communication system between the brain, between the hypothalamus pituitary.

And these glands is so much the same, right? There’s the [00:20:00] HPA axis, there’s the HPT axis, it’s the same communication pathways. And once they’re disruptive in the adrenals, they’re gonna be disrupted in the thyroid as well. So that it’s super important that we evaluate that.

Dr. Weitz: When you see a dysfunction with the adrenals, how do you address that?

Dr. Ryan: Depends what it is, but generally we wanna, we want to you know, really look at their circadian rhythm, what’s going on, how are they, what’s their sleep hygiene like, you know, how is their sleep? What is their blood sugar, you know, balance. Like are they hypoglycemic, are they insulin resistant? Like where are they in that?  ’cause those two things are also very much intertwined. So, you know, part of the first thing to assess is, okay, how. How are, how is your sleep? How is your circadian rhythm? Are you know, taking care of that piece? And then often we’ll do things to try and reestablish that communication between the hypothalamus and pituitary by using app adaptogenic herbs perhaps.  [00:21:00] Or you know, in Chinese medicine we’ll do an approach where we’ll work on that kidney yang and kidney in balance. There. But I think, yeah it’s all, again, the holistic approach is it looks at blood sugar stability, get that communication from the brain and trying to establish and rebalance those.

Dr. Weitz:  So, why is blood sugar such a common problem and how do we properly assess blood sugar?

Dr. Ryan: Yeah, so blood sugar issues are maybe the most, and when I say

Dr. Weitz: blood sugar we really mean insulin resistance is probably right, the main problem.

Dr. Ryan: But even, I mean, we see both things.

We see both types of dysfunction, like hypoglycemia is also a major problem. For people with Hashimoto’s. Yeah. It’s just the other end of the spectrum. It’s just the, that bloodstream mouth, but Right. So let’s explain what those two are. So hypoglycemia means you have too little sugar in the blood.

That, those are the type of people who you know, they can’t skip meals. They get really like lightheaded or [00:22:00] hangry. Often we’ll also see, you know, low triglycerides, which are sugar stored as fat, like they have no sugar reserves. So, you know, these type of people are really vulnerable to their blood sugar crashing.

And that has an entire impact on the thyroid in the system. And those people usually on

Dr. Weitz: their way to high blood sugar.

Dr. Ryan: Correct. Right. That’s usually earlier on in the progression that, that imbalance. And then the other side of that is insulin resistance, which is also called metabolic syndrome, which is you know, pre-diabetes that, that pathway towards becoming a type two diabetic, which is, you know, an incredibly common problem we have in our culture because I think a lot of processed foods have so much sugar and.

Whatnot. And so that’s the opposite problem, where you have too much sugar in the blood and then that can lead like to things like, you know, elevated ferritin where you can’t access iron either until you get this like double. You know, [00:23:00] fatigue problem because of that imbalance. So, w with that, we really wanna assess, we wanna look at their fasting glucose, look at their hemoglobin A1C, look at their lipid panel, look to see how they’re processing sugar and how it’s being utilized in their body.

And try to, you know, get people to be conscious about. Stopping these huge spikes and crashes of sugar in their daily life and create more balance throughout the day. How do they do that? Well, generally, again, we have to figure out where they are on the spectrum, but we, you know, that first starts of the, you know, it’s not really an old wives tale, but having a good breakfast is actually a critically important thing where you have you know, ellos, frosted flakes, starting the day with sugar is a recipe for disaster because you, that’s exactly what happened to you.

Like you’re sure. Hits this roof and then you crash a couple hours later and then the rest of your day is trying to make up that. So yeah, we wanna start the day with a good protein, a good fat [00:24:00] balance making sure then from there on making sure we’re, you know, wherever you are on that spectrum, you’re eating frequently enough throughout the day so your sugar doesn’t crash and you’re not, you know, binging too much on carbs and sugar along the way there.

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So go to Apollo Neuro and use the promo code Whites today. And now back to our discussion. In your book you talk about how hypothyroidism can lead to decreased blood flow to the kidneys, increased uric acid, even high blood pressure. Can you talk about [00:26:00] that?

Dr. Ryan: Yeah, so. Again because of thyroid hormone is so influential on so many different systems.

Whenever you’re hypothyroid or something, I call functionally hypothyroid. If you, sometimes we’ll have enough thyroid hormone in our system, but because of thyroid receptors being blocked or just systemic inflammation or this blood sugar stuff that we’re talking about that can lead to.

Other systems being impacted and not functioning properly. So we can see that with the with blood pressure and the kidneys usually it it starts as low blood pressure, but over time it, it can kinda snowball into a problem where you actually end up with high blood pressure.

Dr. Weitz: Yeah. And we, you know, I see a lot of patients who do a lot of labs.

Who are trending towards having kidney problems. And I think it’s often unrecognized when we look at kidney function tests that a lot of times we’ll use [00:27:00] aerial filtration rate EGFR. Yeah. And on the labs it says anything over 60 is fine. Right. The reality is. When you get below 60, you’re actually at grade three.

Kidney failure, right. Precise. One and two are much higher than that. So 60 really should not be the cutoff for assessing thi kidney function.

Dr. Ryan: Right. Exactly. I mean, funny brings up, I had a couple patients last week, like two opposite issues resulting in, in kidney damage in the decline of the EGFR and that’s explain that.

CGFR is blood flow in the kidneys. It’s actually how your kidneys are processing blood and therefore how everything is working through them. And you’re right. What. In the Western medical model, there are five stages of chronic kidney disease and after stage three a, it’s a really big problem.[00:28:00]

Like the, you know, that’s where you’re

Dr. Weitz: and stage three starts at below 60. Right. So, so somebody comes in with 65, they’re already at stage two kidney failure.

Dr. Ryan: Correct. So like that’s why it’s so, but the labs say normal. That’s why it’s so important for us to check and evaluate this. So over the last week, I had a couple different patients.

These weren’t Hashimoto’s patients, but it was very interesting to see. One of them was this elderly man who’s, you know, this is in vogue right now where people are being put on, you know, large amounts of thyroid hormone replace, not thyroid of hormone replacement. This elderly man who’s 81 years old, was put on like huge doses of testosterone.

How are a dosage. His testosterone was over a thousand. Okay. On the blood test. Okay. I don’t remember what the exact dosage was, but anyway, they brought me in like four years worth of lab work, and you could see this steady decline of EGFR. So it went from, you know, like [00:29:00] in the eighties to the forties.

Right and through, as it was charting it, you could see when he was aggressively dosed testosterone, just like the absolute immediate decline of kidney function. And basically what was happening was he was, they were, you know, causing intrinsic kidney damage with this aggressive supplementing, you know, so this is one of those things where, yeah, thank God they.

Hey, thank God that came to me, and we could figure out what the problem was and stop it so that it doesn’t have further kidney decline. And b, that, you know, like there’s consequences to doing things.

Dr. Weitz: Like, hey, everything should be in some sense of balance. Some sense of balance, yes. Yeah. Not that hormone replacement is bad, but.

Dr. Ryan: No, it’s, it could be appropriate. Yeah. But you gotta be paying attention to how it’s impacting the rest of the system. And then the other case was interesting, got sort of opposite problem. The person who had pretty [00:30:00] significant B12 deficiency and that ended up causing like high elevations of homocysteine, which is inflammatory mark and causes inflammation in the arteries.

And that was, you know, impacting blood flow to the kidney. And he was also experiencing decline. In kidney function, EGFR as a result. So,

Dr. Weitz: Can point now, hypothyroidism increases risk of heart disease. You mentioned in your book it can increase cholesterol, which you just mentioned. I think a lot of people are somewhat aware of that, but it can also increase homocysteine levels, right?

C-reactive

Dr. Ryan: protein. Right. So, so again, because of the influence of thyroid hormone on all the systems. We see, like I said it’s very, when you’re hypothyroid, it’s very common to see elevations in cholesterol and the other lipids. Also, one thing that there’s definitely been an established link to is the M-T-H-F-R gene mutation and Hashimoto’s.

And that can lead in and of [00:31:00] itself to elevated homocysteine. In fact, like, you know, I teach my students one of the poor man’s tests for elevated homocysteine or sorry, EZ test for M-T-H-F-R mutation is elevated, cysteine over 15. So that basically what you have is this combination of risk factors that increase the possibility and the probability of some kind of heart disease and heart problem.

You get those elevated lipids, you get the high homocysteine, which is impacts blood flow and causes inflammation in the arteries. You get just general inflammation, which we see with the C-reactive protein. You get this, again, another sort of like vicious cycle or perfect storm. Of risk factors that can lead to more problems.

Dr. Weitz: So let’s talk about the potential benefits of nutritional supplementation for patients with Hashimoto’s. And let’s first start with the most controversial nutrient, which is iodine.

Dr. Ryan: Yeah. So Ida this is like one of those areas

Dr. Weitz: where there’s by the way, let me throw an anecdote in there.[00:32:00]

So I have Hashimoto’s and my TSH has been for a lot of years between around seven and eight. Then one year it went up to nine. I decided I would try the high dose iodine. I took 12 and a half milligrams and my TSH went up to 25. So stop that. Exactly. So eating anything that had iodine in it, like seaweed.

Figured out what else I needed. I was really low on zinc. I have a gene that can’t absorb zinc, really ramped up the zinc supplementation as well as the vitamin D, as well as selenium. And then I got my TSH to between four and five.

Dr. Ryan: So perfect antidote because that is exactly what happens with Hashimoto’s patients, who, in my experience, who do high dose iodine.

I I think that’s really the problem, is it’s just excessive amounts. Like we, the reality, we, our body does not need that much iodine for [00:33:00] thyroid function. It’s very important. But the amount we actually need is relatively small, right? So, so if you’re gonna, you know, having seaweed occasionally is actually sufficient.

And I take a multi that

Dr. Weitz: has 150 MCG, and that’s fine.

Dr. Ryan: Right, right. So I think the controversy and the problem really is with excessive iodine, right? Supplementing and that can cause, you know, the, your autoimmunity to flare too. So, particularly I iodine salt is also problematic for autoimmunity.

And when you combine those two in relatively high doses, that’s a real recipe for disaster for the someone with thyroid autoimmunity.

Dr. Weitz: Now, why is iodine salt worse than, say, supplements iodine or eating seaweed?

Dr. Ryan: It’s because salt. It can also you know, amplify the autoimmune process.

Just the sodium itself? Yes.

Dr. Weitz: Yeah. Okay. So what other supplements can be helpful [00:34:00] depending upon the patient? Well, yeah, of course.

Dr. Ryan: And do you test for nutrients? There’s a wide variety. I mean, I do test for some nutrients. You know, all common minerals. We wanna look at the things that are most important for thyroid function, like selenium and zinc like iron you know, so those are the most common ones I’ll look at.

Sometimes I’ll look at B12 and folate as well. Right. But, the, I think we were talking earlier about the different parts of the immune system. We wanna test vitamin D levels too as well to see, ’cause that’s gonna give us a sense of, you know, how do they have enough vitamin D to, to help strengthen that regulatory part of the immune system.

I think glutathione is a very helpful, supplement as well. It’s a Mastro antioxidant. I think in general, you know, we were talking about how a lot of thyroid hormone conversion happens in the liver. You know, so one of the things I see often too is with patients is that the, there will be [00:35:00] some reason that their thyroid hormone is not functioning as well, whether there’s thyroid hormone resistance or the systemic inflammation or what have you.

And then the doctors are just gonna keep increasing the dose and increasing the dose and increasing the dose, whereas and that in and of itself can cause other problems. So what I look at first is, okay, what. Where can we just improve this process by improving these other areas? So let’s maximize liver function.

Let’s make sure that we’re getting, you know, the liver’s detoxing properly, that it’s being supported properly. Let’s look at the gut and see is there any kind of dysbiosis there? Can we support the good bacteria and the microbiome and the gut? Let’s look at the systemic the rest of the body where we’re.

This inflammation, the systemic you know, in this peripheral tissue can cause problems. So, so let’s look at things that are anti-inflammatory, like, like turmeric or resveratrol or things like that. So, you know, I think we get a lot more, we have a lot more success clinically when we think that way.

Dr. Weitz: And I do [00:36:00] think that there is a relatively small sig, but. Significant percentage of practitioners who have adopted a philosophy that when it comes to thyroid. You supplement with thyroid hormone, if the patient doesn’t feel really well, you just keep increasing that dosage. And I’ve had a number of patients come in my office and they’re actually in hyperthyroid from pushing that dosage up so high and granted there may be a few cases, maybe with a history of thyroid cancer where you.

It may be justified, but just for the sake of managing symptoms, pushing that TSH so low with such an aggressive level of thyroid hormone potentially, I think is damaging to the body. And you’re suggesting other ways to try to bring the BA body into balance and address those other symptoms besides simply pushing the thyroid hormone higher and higher in the [00:37:00] body.

Dr. Ryan: And yeah, I think the danger of overmedicating, like we know. That it can lead, particularly in women that can lead to osteoporosis. If you’re too aggressive with thyroid hormone supplementation. The heart itself is very sensitive to T three and to thyroid hormone, so you can do damage to your heart by overmedicating.  There are, again, there are, you know, we were talking about the testosterone supplementation. There are consequences to overall supplementing, right? So we always wanna be looking at balance. Right.

Dr. Weitz: What about thyroid medication? Do you have an opinion about that?

Dr. Ryan: Well, I mean, I. I don’t really like have, people always ask me what’s the best medication?  Like, I, right. You know, so

Dr. Weitz: people say, oh, you should take Tyrosint. It’s better absorbed. You should use, right. You should use armor, you know, it’s natural. It has some T three you should use exactly. Synthetic T four with synthetic T three.

Dr. Ryan: Exactly the problem with that is I’ve seen basically every permutation of it and that it doesn’t always [00:38:00] work for people in the same way.

Like some people actually really do better with synthetic T four. Right? And then other people do need that additional T three that you get with armor or nature. Thyroid, and then, yeah, tyrosine. It can be a great choice because it comes in gel. There’s no filler, so we can eliminate that variable.

But, you know, I think there’s no like magic bullet way of figuring it out. You have to like experiment and you have to pay attention to what’s going on there. And you know, I’ve seen people on the flip side who have reacted to natural thyroid as though it was their own thyroid hormone and actually flared up their autoimmunity.

So, you know, that’s a very complicated, difficult question and often it’s just trial and error to we find the right mix for that person.

Dr. Weitz: So what type of diet is best for patients with Hashimoto’s hypothyroid, and should they stop eating [00:39:00] broccoli? Great question. I mentioned broccoli ’cause broccoli’s in a category of foods known as goergen.

Dr. Ryan: As goergen. Yeah. I’ll start with that. So I think. I liked your little history at the beginning talking about the, you know, the history of Appalachian, the goiter belt, and the fact that we didn’t have, you know, at that point in our history iodized salt and that’s impact that, that is ancient history for us, so, right.

The whole goitrogen. I think, you know, myth is part of that ancient history. It’s no longer an issue and I think the health benefits of broccoli and other, you know, those cruciferous vegetables far outweigh any problem that, that they may have caused. So I think that’s a complete non even.

Dr. Weitz: Just explain what this concept of greater gens is.

Dr. Ryan: Yeah. So the. These vegetables like broccoli, cauliflower, kale, the things of that family I. Can [00:40:00] potentially lead to more increase in, in goiter and nodules in the thyroid, which by the way are very common. The vast majority are benign, but you know, almost everyone will develop some sort of thyroid.  Growth, you know, before they die. So in, in large quantities in the absence of sufficient eye, by the way, how

Dr. Weitz: are they alleged to do that?

Dr. Ryan: The pro I, that’s a good question. Okay. Sorry. I don’t remember

Dr. Weitz: how they okay. Sorry, I didn’t mean to put you on the spot. So, but we have these gor units that are known to I, I think they’re supposed to block the conversion of T 40 T three.

Dr. Ryan: Right, right, right, right. Yes.

Dr. Weitz: And so they,

Dr. Ryan: right. They’re involved in that, but it’s usually, again, in the absence of sufficient amount of iodine. Right. That, that, that happens.

Dr. Weitz: Oh, so it’s a myth that e eating foods like [00:41:00] broccoli aren’t gonna make your thyroid function worse?

Dr. Ryan: I believe so. I believe so.

Again I think it’s the benefit far outweighs the negative of those because they’re very productive against cancer and thyroid cancer in particular. So just diet in general. I think this is a really interesting topic because I went through process for a while. You know, it was, there was a diet that was.

Super pop. It’s not so popular anymore, but it was called the Autoimmune Paleo Diet. Correct? Yeah. It’s I mean, generally I still am in favor of it but I learned something the hard way. Basically it’s a diet where it’s essentially the paleo diet where you’re, you know, minimizing carbs.

It’s just taken to the next level where you’re cutting out every, anything that’s potentially inflammatory. So you’re cutting out carbs, you’re cutting out dairy, you’re cutting out nuts and seeds. You’re cutting out legumes. So it’s a pretty restrictive diet, mostly you know, protein and vegetables.

But one of the things I discovered the hard way was that you can’t stay on that [00:42:00] restrictive a diet for too long because you end up degrading is known in the body as oral tolerance and oral tolerance is our capacity to adapt to different foods. And the only way we can do that is to be exposed to them.

So again, back to balance. You know, I often advocate people go on some sort of, you know, restrictive diet initially to just to calm the immune system. And so we can work on the gut, but it’s critically important that they don’t stay on that super restricted diet for too long because that in and of itself can cause problems.

Dr. Weitz: So, which is the best super restrictive diet to start on? Is it the autoimmune paleo?

Dr. Ryan: I like the autoimmune paleo. Yeah, I think that’s a, I think that’s a good approach. Yeah. So for, but like for 30, 30 to 60 days only, don’t go more than that.

Dr. Weitz: Right? Okay. So you can look that up. Basically, you avoid dairy, you avoid gluten, you avoid all grains, you avoid legumes.

You also avoid nuts and seeds, correct?

Dr. Ryan: Correct. All those different things and nightshades too. [00:43:00] For Right. For people. So it’s anything that’s potentially inflammatory. Right. And it works wonders in terms of calming down the immune system. Just again, you. We can’t stand it for too long,

Dr. Weitz: right?

Because it’s gonna lead to nutritional deficiencies and those foods you’re eliminating that can cause a little bit of inflammation. Also have many benefits that outweigh that. And having a little bit of inflammation means that you have a properly functioning immune system. Anyway.

Dr. Ryan: Right. Exactly.

Yeah. Our immune system is not meant to be completely shut off. It does good

Dr. Weitz: work for us. Absolutely. Which is one of the problems with medicating to suppress your immune system, right. Helps you fight you off infections, cancer pathogens, et cetera. Yeah, exactly. Yeah. Alright, great. Any, anything we haven’t covered that you wanna explain?

Dr. Ryan: Not really. This has been a great discussion. We, I think we’ve touched on a lot of [00:44:00] important things. I just think overall for people, you know, if you’re new to this, you’ve just been recently diagnosed with Hashimoto’s and you’re feeling lost or you’re struggling, just know that there’s a lot that we have to offer.

In the functional medicine, Chinese medical world for you if you’re feeling abandoned or you know, not that supported by your md. There, there’s a lot that we can do. And it’s generally pretty well and easily managed if it’s done properly,

Dr. Weitz: right? So simply taking Synthroid should not be the end of the story, and if you’re not feeling great after that.

You should really seek out a functional medicine practitioner like myself, like Dr. Ryan. How can listeners and viewers get in touch with you?

Dr. Ryan: Yeah, I’m, I have a couple social media accounts. I’m on Facebook and Instagram. I currently teach what’s your tag on Instagram?

Instagram is at Hashimoto’s Healer. Okay. And I currently am a professor and clinical [00:45:00] supervisor at Yoan University where I’m teaching students how to practice you know, functional medicine as we discussed and I do see patients there as well. And

Dr. Weitz: if they want to get ahold of you directly, what’s your website?  Phone number, contact? Yeah, my website’s,

Dr. Ryan: ha hashimoto’s healing.com. You can reach out to me through there or message me, you know, via social media.

Dr. Weitz: Great. And your books are available on Barnes and Noble, Amazon,

Dr. Ryan: et cetera,

Dr. Weitz: correct?

Dr. Ryan: Well, there, but books are published by Hay House. Actually just approached me, they’re gonna do an audio version of my first book, how To Heal Hashimoto’s.  We’re in the process of doing that right now. They were gonna clone my voice and have ai

Dr. Weitz: and you said, no way. Let’s bring on the real thing.

Dr. Ryan: Yeah, it was like, yeah, I dunno. We’re in discussions with that right now, so I will read the book happily. They wanna replace me with a robot, but yeah,

Dr. Weitz: that’s the world we live in.  That’s the world we live in. Does the [00:46:00] robot have Hashimoto’s?  Okay, thank you, mark.

Dr. Ryan:  My pleasure.

Dr. Weitz:  Great talking with you.

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Thank you for making it all the way through this episode of the Rational Wellness Podcast. For those of you who enjoy listening to the Rational Wellness Podcast, I would very much appreciate it if you could go to Apple Podcast or Spotify and give us a five star ratings and review.  As you may know, I continue to accept a limited number of new patients per month for functional medicine. If you would like help overcoming a gut or other chronic health condition and want to prevent chronic problems and wanna promote longevity, please call my Santa Monica White Sports Chiropractic and Nutrition office at 3 1 0 3 9 5 3 1 1 1 and we can set you up for a [00:47:00] consultation for functional medicine and I will talk to everybody next week.