It is estimated that up to one in five women can expect a diagnosis of Hashimoto's thyroiditis or another thyroid disorder in their lifetime.
Hashimoto's is the fastest growing autoimmune disorder in the US and it's becoming clear that a functional medicine approach has much more to offer patients than standard medical care alone.
For Dr Izabella Wentz, also known as The Thyroid Pharmacist, a diagnosis of Hashimoto's thyroiditis at age 27 set her on a path of research and discovery.
Throughout her quest for answers she has chronicled her successes and failures, which has culminated in two best-selling books, making her a key authority on the subject. Her most recent book "The Hashimoto's Protocol" has just been released and offers a 90 day plan to reverse thyroid symptoms and put people on a path of healing.
Dr Wentz joins us today to share her expertise on recognising, managing and living with Hashimoto's thyroiditis.
Covered in this episode
[00:55] Introducing Dr Izabella Wentz
[02:05] Dr Wentz's background
[06:24] Why there is resistance to integrative approaches
[08:38] Getting to know the thyroid
[11:50] Hashimoto's thyroiditis in 5 stages
[16:19] Hashimoto's thyroiditis: known triggers
[17:20] Women are affected more than men
[22:10] Toxic load and endocrine disruptors
[24:10] Seasonal foods and lifestyle changes
[26:34] Genetic and epigenetic factors
[30:00] The contentious issue of adequate testing
[37:25] Grieving the diagnosis
[40:02] Stages of treatment
[45:37] Gauging the effectiveness of treatment
[47:00] What about iodine?
[51:25] Dr Wentz's resources
[53:15] Final thanks to Dr Wentz
Andrew: This is FX Medicine. I'm Andrew Whitfield-Cook. Izabella Wentz is an internationally acclaimed thyroid specialist and a licensed pharmacist who's dedicated her career to addressing the root causes of autoimmune thyroid disease after being diagnosed with Hashimoto's thyroiditis in 2009. Dr. Wentz is the author of The New York Times best-selling patient guide, "Hashimoto's Thyroiditis: Lifestyle Interventions for Finding and Treating the Root Cause," and the recently-released protocol-based book, "Hashimoto's Protocol: A 90-day Plan for Reversing Thyroid Symptoms and Getting Your Life Back." As a patient advocate, researcher, clinician, and educator, Dr. Wentz is committed to raising awareness on how to overcome autoimmune thyroid disease through the thyroid secret documentary series, the Hashimoto's Institute practitioner training and her international consulting and speaking services offered to both the patients and healthcare professionals. Warmly welcome you, Izabella, to FX Medicine. How are you?
Izabella: I'm just...Thank you so much for having me.
Andrew: Oh, it's my absolute pleasure. Now, I think we're gonna jump straight into it because you've got a lot to cover. This is such an in-depth topic and it's broad. You don't just talk about the thyroid which I love. So, you've got a bit of an incredible insight into Hashimoto's having navigated it yourself, but let's first go back to your pharmacy training and your background. What first happened in pharmacy to alert you to the real issues of Hashimoto's?
Izabella: You know, and truth be told I was never interested in the thyroid or Hashimoto's when I was going through my pharmacy training. So, I learned during pharmacy school that thyroid disease is something that just sort of happened and that you were to just take thyroid medications if you had an underactive thyroid and suppress your thyroid function or take away your active iodine if you had an overactive thyroid, and that was pretty much all I learned, I had one lecture on thyroid disorders in four years.
Izabella: It wasn't until I was diagnosed myself in 2009 is when I really started to become a thyroid expert/human guinea pig, and that was really to take back my own health. I really didn't understand the complexity of thyroid disease during my training. It was, you have this condition there's a pill for it and that's pretty much it.
Andrew: You've spoken about the wounded healer and I think this is a really important concept, those practitioners that have an issue themselves and have overcome it or managed it successfully. They seem to be the ones that have the true passion to help others, to do so themselves as well. So, from your diagnosis, you began to take that keen interest from a functional medicine approach though. So, why functional medicine? What twigged you that standard pharmaceuticals weren't working?
Izabella: Well, it was...I learned about lifestyle changes during pharmacy school, of course, and even though they weren't quite to the degree of functional medicine changes at least we were doing some sort of lip service where if somebody was having high blood pressure or diabetes we were saying, “well, you should lose weight.” And when I was diagnosed with Hashimoto's this was after almost a decade of some pretty debilitating fatigue, acid reflux, irritable bowel syndrome, carpal tunnel, hair loss, panic attacks, you name it, I had it. I thought I was doing everything right. I was like, "I'm not overeating. I'm eating whole-wheat. I'm eating low-fat dairy. I'm exercising, I'm not smoking, I'm not drinking…what is going on? I'm trying to be the healthiest person that I know to be, right? I don't smoke, and why am I developing this condition that older women were supposed to develop, and why is my body attacking itself?”
It didn't really make sense to me that I had this autoimmune imbalance within my body and that all I was doing was taking more hormones for it. Sure, the hormones can help but I was like, "Well, my body is under attack. Don't we wanna stop the attack rather than just take hormones, or in addition to?" And so, that started my journey and at the time I was working as a consultant's pharmacist for people who had a lot of complicated health issues. So they were usually people with disabilities, with multiple chronic health conditions, and the team that I was working on was charged with advocating for them. And so I was always looking outside the box for my clients to try to figure out why they were not feeling their best and if there was anything that could be done for them, and I started utilising that same methodology for myself.
A lot of my clients had conditions that were not traditional conditions. So we had clients with Down's Syndrome and there was not, you know, the standard of care for that condition, and so I was always looking at PubMed and I was always looking at patient forms to try to find out if we could research or find out any of the latest and innovative therapies that could help them, as well as anything that the parents or caregivers were reporting to be helpful. So I started utilising that for Hashimoto's as well, and I was really like interested in what caused the condition and if I can figure out the cause then maybe I could reverse it or at least feel better, right?
Andrew: This is the thing that really interests me is given that the standard of care either isn't there or it doesn't reach the acceptability of what patients are wanting, for control of their disease. Isn't evidence-based medicine supposed to direct a healthcare practitioner to going down the levels of evidence? If you've wasted the top echelon, you go down to the next level. If you've wasted that you go down to the next level. At the end of the day what you want is for Mrs. Jones to feel better. So this is what really stuns me about many clinicians that don't look further. Like what's their paradigm, what is it? Are they just stuck in a box or? Like, what do you feel when you're talking to colleagues that don't believe in integrative medicine?
Izabella: It's a little bit challenging for me to speak to people who don't believe that because they have this air of skepticism and a lot of times the reason I'm talking to them is because they're having some sort of health challenges themselves, right?
Izabella: And so, they're coming to me and they're curious but at the same time to them, it's just...it's almost like, "Well, if food made a difference why didn't I learn about it?
Andrew: Yeah, yeah. Yeah.
Izabella: And if supplements or vitamins actually worked, why did I not learn about this in my four years of medical school, four years of pharmacy school, residency, nursing school," so on and so forth and it's, you know, natural, I feel, for them to be skeptical because they've never been trained in it. And they're often disregarding it but it's going back to, you know, you can only manage what you measure and they're not really measuring these things.
So a lot of times we'll say...I'll also have clients that'll say, or readers that say, "I went to my endocrinologist and he said I don't need to change my diet." And then my question is always, "Well, have the endocrinologists monitored people that went gluten-free with thyroid disease and see the results?" And my encouragement is always for people just to give it a try. They can always go back to how they were before.
Andrew: Yeah. Yeah, I think that's the great thing about integrative medicine is that you've gotta be really, really silly to be unsafe with it, yeah. So let's go delve into the thyroid itself. What happens in Hashimoto's and, you know, tell us a little bit about the thyroid itself. What makes it such an efficient pump for metabolism?
Izabella: So, our thyroid gland is this tiny little gland at the base of our neck and it is in charge of our metabolism. It's in charge of producing thyroid hormones that impact every single cell in the body, and when the thyroid is out of balance we can feel it pretty much on every cell. So you might see a person who has Hashimoto's or an underactive thyroid, they might have anything from hair loss on the top of their head to tingling at the bottom of their feet, and it's one of those conditions that can be very non-specific.
In thyroid disease, when we have an underactive thyroid, essentially the thyroid gland is not able to produce enough thyroid hormones to supply the body with enough hormones, and this is when a hypothyroid state develops.
Izabella: Hashimoto’s is the most common cause of thyroid disease in countries that add iodine to the salt supply. So in developed countries, and we find that what's essentially happening in Hashimoto's is the immune system begins to recognise the thyroid gland as a foreign invader and begins to launch an attack against the thyroid gland…
Izabella: …eventually destroying it.
Andrew: And I said the word pump before because the thyroid is quite an efficient manufacturer of thyroid hormone. Is it true that not like 90% of the thyroid can be damaged and you still can produce enough thyroid hormone but then there's that tipping point? Is that what happens, or does it tend to vacillate while it's being damaged?
Izabella: It can definitely vacillate as it's being damaged. What we see generally is probably for the first 10 years that a person has Hashimoto's they may still be able to "compensate" and produce enough thyroid hormones but at the same time, they're gonna be symptomatic. So, the tests will say that they're euthyroid but their body will not reveal the same thing, right?
So when we talk to these clients or patients we find that they're feeling anxious, we find that they're feeling depressed, they're feeling more tired, they may be having trouble with weight gain, and some cold intolerance. So there's gonna be some degree of symptoms even when the thyroid gland is not fully destroyed, just in the stages where it's being attacked by the immune system, we can still be very symptomatic.
Andrew: So is that evidence of, you know, interleukins that the cytokines that are produced that are causing this issue, that they have systemic effects, or is there some other mechanism there?
Izabella: Definitely that could be a part of the mechanism. Some of the research suggests that it is when the thyroid gland is under attack, when we have breakdown of thyroid cells, t he thyroid hormone gets rushed into the bloodstream and that may produce anxiety symptoms. So there's various mechanisms from inflammation, interleukins to actually physical destruction of the thyroid gland that leads to some dumping of thyroid hormone to the bloodstream.
Izabella: Of course. The very first stage of Hashimoto's is just having the genetic predisposition for the condition. So if somebody has a relative, a mother or a father, who then a grandmother with Hashimoto's, they're going to be potentially in stage one because they have the genes where given the right circumstances their body may start to attack their thyroid gland. For all intents and purposes, stage one there's no symptoms, there's no attack on the thyroid gland. Thyroid hormones are normal. At this stage, we're thinking about prevention, right?
Izabella: The Stage 2 of Hashimoto's is when the autoimmune attack begins on the thyroid gland. So, this begins with white blood cell infiltration into the thyroid gland and this is actually the stage where we start seeing thyroid antibodies, so, thyroid peroxidase, thyroid globulin antibodies are the most common ones, and then we also start seeing symptoms. The most common symptoms at this stage are actually gonna be anxiety related. So, oftentimes patience will be misdiagnosed with an anxiety disorder or maybe depression or some other kind of mood related disorder. At this stage we now also see other symptoms, miscarriages are actually a potential symptom of the stage as well. The stage...the TSH will still be normal, T3 and T4 levels will still be normal.
Stage 3 is the progression of the condition where we start seeing that more and more the thyroid gland is damaged. This is known as subclinical hypothyroidism. At this stage we'll still have thyroid antibodies, T3 and T4 will still be normal, people will generally be more symptomatic, and a telltale sign will be that the TSH will be elevated. Generally up to 10 is considered above, you know, above 3 up to 10 may be considered subclinical hypothyroidism.
Izabella: Stage 4 is when we have progression into overt hypothyroidism. So at this stage, the thyroid gland has been damaged to the point, you know, maybe it's 80%, 90%, depends on the person where the thyroid gland can no longer compensate and can no longer produce enough thyroid hormones. So we'll see a rise in THS again and then 3T3, 3T4 will be low and we'll also see the thyroid antibodies again, and we'll also see a person with more and more symptoms.
Izabella: This is generally the stage when most patients are diagnosed and generally when they're prescribed thyroid hormones.
Izabella: Stage 5. Now this is when it gets scary because Stage 5 is actually progression into other types of autoimmune conditions. And so generally by the time a person gets to Stage 5 they will be treated with thyroid hormone, but if they're not, again, their TSH will be elevated, their T3, T4 would be low, and then we would also see the thyroid antibodies, and then we would also see thyroid symptoms as well as symptoms of additional autoimmune condition and perhaps some lab markers of an additional autoimmune condition. One thing I should mention though is that there is something known as Seronegative Hashimoto’s…
Izabella: …where we don't have thyroid antibodies at all…
Izabella: …and this is thought to be slower, less progressive. On average with the thyroid antibodies we see, it takes about 10 years to get from Stage 2 to Stage 4.
Andrew: And so, to me, this is the normal standard model of care that if you just gave thyroid hormones, that you're looking down the barrel of a progression to autoimmune in a large number of cases. So, is that right or like what percentage of patients progress to overt autoimmune to other conditions?
Izabella: I don't have the statistics on how many progress or actually how long it takes. It can vary per patient. What we do know is the higher the thyroid antibody numbers, the more aggressive the attack on the thyroid and the more progressive the condition is thought to be.
Izabella: And so, those are some potential things to consider that if you have a client or a patient with really high thyroid antibodies that will be somebody that I would be concerned with progressing to other types of autoimmunity.
Andrew: Right. And just, I guess, going a little bit further back looking at triggers, infections and things like that, and certainly stress, seems to be one of the biggest triggers to me. What's your research and experience show?
Izabella: What's interesting is Grave's Disease has long been connected with stress, and there was a case of a woman who was pushed in her wheelchair down a flight of stairs or perhaps she fell and that was when she initially developed Grave's Disease symptoms.
Izabella: Because Hashimoto's takes such a long time to develop, clinicians have had a difficult time creating a correlation or a timeline…
Izabella: …in their research, but generally speaking when I talk to my clients about 70% of them report that they were under significant stress before their autoimmune thyroid condition developed.
Izabella: So, for every man that's diagnosed we're looking at five to eight women.
Andrew: Wow. So obviously there's other things involved. You know, one would immediately point the finger to hormones but there's a lot of...I think there's a lot of cultural things in there as well. Like for instance how women carry the load of stress. They carry the...not just very often these days the work, but also the home work as well, and the family upbringing and...I'm being a little bit sexist I think a little bit stereotypical, but women really are the nurturers and they take so much on. Do you think this is to their detriment? Is like, do men really have to man up and say, "Hey, listen, I'll take the load off of you." And does that play a big role in treatment? Like does it help?
Izabella: You know, I really, really love this question. It's such an important question. I actually have a theory known as the Safety Theory of why more women develop autoimmune thyroid disease.
Izabella: And it really goes back to adaptive physiology. When you think about what the role of our body is. Our body is always trying to get us to survive, right? And so, whenever we're having a significant amount of stress, wherever we're having something going on that stresses us out in the modern world, I like to think about how would a cavewoman respond to that, right?
Izabella: And so, we know that the thyroid gland is an environmental sensing gland. The thyroid gland research shows, can actually detect damage and danger within its environment and then send out signals to the rest of the body when it's sensing danger. And so, in a period where a cavewoman would be stressed this would usually be because of something serious, right? It wouldn't be because of a tax deadline or because of traffic on the road. It would usually be because she was being chased by a bear, because she was under a situation where she didn't have enough food, or perhaps there was some trouble within her village or where she was living where it was a hostile situation.
And so, what's interesting is...actually, there's some studies that have pointed to survivors of prisoners of war, survivors of sexual assaults, survivors of physical abuse, and even survivors of famine, generally they're gonna have higher rates of hypothyroidism.
Izabella: And what's interesting is that hypothyroidism can play a protective role where if our metabolism is fuller, right, and we're in a famine, we don't need to eat as much, so that helps us survive the famine.
Izabella: If we are in a situation where we're perhaps being physically abused, having a hypothyroid condition may actually slow down our metabolism to the point where we're more likely to withdraw and hide, versus being out and about, hence be at risk. What's really interesting is that hibernating bears actually have lower amounts of thyroid hormones that are circulating at the time that they're hibernating. And so, so all this to say is essentially stress can be very, very important in developing thyroid disease. Yes, hormones can play a role, personal care products can certainly play a role because women put twice as many on as men do and they often have hormone-disrupting chemicals in them.
Izabella: But I also think, you know, being a woman in our modern world is more stressful or more, I guess, danger-provoking where we don't feel safe compared to being a man. Just to give you an example, and I could quote a lot of research studies and whatnot, but there's a dating app called Tinder that's popular among young people, and what the app’s founders...they did a survey with their users and they asked the females, "What was their biggest fear in using the dating app?" And the women replied that their biggest fear was that the man that they met was going to be a psychopath and hurt them.
Andrew: Yep, yep.
Izabella: Do you know what the biggest fear the men had?
Izabella: That the women that they met in real life were not gonna be as pretty as they were in their pictures
Andrew: Mm, yeah. Doesn't that speak volumes?
Izabella: Yeah. That's just how our culture is where it's just not as safe to be a woman as it is a man. I know if I was to ever walk alone at night, I would be looking around and making sure I was safe versus my husband would not have that same kind of fear response and going back to, you know, "manning up," I do find that a lot of my female clients who have supportive husbands are usually the ones that get better and that have the best type of outcomes for recovering their health, versus the women that are fighting against their husbands and families to get better, right?
Izabella: You know, absolutely and there's so many examples, but two of them that really come to mind are gonna be fluoride in the water supply. So a lot of communities are placing fluoride in the water supply and this is very prevalent in the United States and in parts of the UK, and in the UK they actually found that their communities that had higher levels of fluoride in the water supply had higher levels of thyroid disease…
Izabella: …and hypothyroidism specifically. So fluoride can actually be used as a thyroid suppressing chemical and the doses of that are gonna be, you know, comparable to drinking six to eight cups of water on a daily basis. It's also added to our toothpaste. Triclosan is another chemical that's added to soaps as well as toothpaste and this is also something that's recently been told in America by the FDA because of its thyroid destructing properties, and there's BPA which is found in plastics and then BPS which is another chemical that's similar to BPA that's found in plastics may also have thyroid destructing properties. And then we have all of the hormones that act on oestrogen whenever we have more oestrogen in the body that means we're binding more thyroid hormone and that means for me to produce more thyroid hormone, if we don't have enough nutrients on board and enough anti-inflammatory compounds, producing thyroid hormones can be inflammatory and can actually initiate the autoimmune attack on the thyroid gland as well. So it's a really whole...a bit of a mess that we've gotten ourselves into with all the fragrance products and all the potions and lotions that we put on our skin, day in and day out.
Andrew: Yeah. One of the things that tweaked my interest then, before when you were talking about bears going into hibernation and having a lot of thyroid hormones. Is one of the issues with modern day society that we don't have any cyclical or seasonal behaviour changes? We don't do less and do, you know, let's say more chores that would keep us warm in winter and, you know, get out and play in summer, that sort of thing, you know? Do you find that that non-cyclical pace of modern day life is one of the biggest issues?
Izabella: I do feel like it's very much contributing where we find, you know, we have these expectations to perform, and if we're tired instead of resting we reach for, you know, a coffee…
Izabella: …or a soda, or something caffeinated to keep ourselves going, where we have this lack of communication with our bodies, right? And so, instead of listening to our body when it says, "Hey, I'm tired I need more rest."
Izabella: Perhaps this is a season where I should be resting more and regenerating more, we kind of push against it.
Andrew: Yeah. And, you know, foods I guess are also in there because we want to have an apple in winter these days. So, you know, it seems to me this huge issue that we just don't eat seasonally anymore. We don't have the sort of, you know, fruits and leafy vegetables that are available in summer, in summer. We have them all year round.
Izabella: Certainly, and I feel like the variety within our diet. So we find that with Hashimoto's if you have a lot of food sensitivities that the triggers are gonna be toxins, nutrient deficiencies, impaired stress response, chronic infections, intestinal permeability, as well as food sensitivities, and when you're constantly eating the same food over and over and over again, you can develop a food sensitivity to it that just that, you know, the more you eat it. So, actually, one of the things that I recommend for people with advanced thyroid disease, I may even recommend a rotation diet when they will rotate through foods even within a 24-hour period…
Izabella: Because they've been eating... Chicken is not a common sensitivity but if all you've been eating is chicken the last two years you may even be sensitive to chicken.
Andrew: And just one other thing that's going back to the correlation with activity, with seasonality and when you were talking about bears going into hibernation and having low thyroid, and in my mind I'm just wondering about, is there any correlation with low thyroid hormones and greater weight and even greater weight signalling hormones? Like for instance, you know, alpha-Melanocyte-stimulating hormone or, you know, the (ob) gene or the DB gene, this sort of things that have...that sway people to a propensity for weight gain. Is there any correlation between the thyroid hormones and the weight controlling hormones or genes?
Izabella: I haven't seen any specific research to the various genes that are correlated with thyroid hormones and quite honestly I think I have a little bit of a radical thought on this based on the research that was done with people who were exposed to Chernobyl within a certain age range, if they were living within a certain proximity to Chernobyl, 80% of children developed thyroid antibodies.
Izabella: So, for me, I don't necessarily believe that only a certain amount of people have these genes I actually believe that the majority of us, given the right environmental trigger, will develop Hashimoto's as a protective mechanism. So it's, you know, my personal theory on that…
Izabella: and I don't know necessarily subscribe to the various genes because I feel like we're constantly finding new genes that are associated with Hashimoto's and I actually believe it's an underlying protective mechanism that the body expresses.
Izabella: And for some people they might have an easier propensity to express that where others might need a stronger trigger.
Andrew: Okay, but you mentioned Chernobyl radioactivity, there's a big issue there. What about somewhere where there isn't a radioactive, you know, stress or call it a stressor? A radioactive isotope being released that damages the thyroid, is there any other examples like for instance...I don't know whether anybody would go in there to actually assay it, but let's say, you know, a war-torn area like Syria or Syrian refugees. Do they have a greater propensity for thyroid disease as well as a stress-related response?
Izabella: I haven't seen any research connecting that. What I have seen is we're looking at people who were in industrial settings. So people who lived closer to factories that were producing halogenated chemicals, they're gonna have higher rates of thyroid disease. People who were in busier cities exposed to more toxins…
Izabella: …have higher rates of thyroid disease. So we're seeing that, and interestingly people with sleep apnea…
Izabella: …which I consider an environmental stressor, they're gonna have much higher rates of autoimmune thyroid disease as well.
Andrew: Ah, okay.
Izabella: I haven't seen specifically anything in war-torn areas but we have seen some studies with prisoners of war who actually end up having hypothyroidism…
Izabella: …and that is thought to be a protective mechanism.
Andrew: Right. Moving on to testing now, because this is such an area of contention you know? An endocrinologist will only do a certain amount of testing and that's it. "They're normal, see you later, goodbye." And there's a lot of practitioners in Australia that have gotten in trouble, particularly medical practitioners for doing tests outside the black box of what is "appropriate." Can you take our listeners in particular medicos, who are still focused on the TSH and, you know, maybe T3, T4. Why these other tests like looking for antibodies and maybe doing an ultrasound, looking at cytology, why they're so important? I mean, I know this is a whole seminar in itself but what are the main, say, five factors that we need to really change?
Izabella: Well, you know, and it kind of...I get riled up when people talk about testing the TSH and then if only the TSH is elevated will they test antibodies. But if you know enough about Hashimoto's you know that the antibodies come first…
Izabella: …and then the change in TSH might come 1 year later…
Andrew: Way later, yeah.
Izabella: …5 years later, 10 years, 20 years later! So, it just...to me, it's so backwards and I feel like people...every clinician should start with the thyroid antibodies because we have a better opportunity to help the patient prevent 10 years of symptoms and 10 years of being told that they're crazy, and we can potentially even reverse the condition and prevent the need for thyroid hormones if we can prevent the damage to the thyroid gland.
So, thyroid antibodies I feel like that should be a standard of care for men, women, children. And they're not expensive tests and they can help predict so many different fertility issues, mental health issues, and if we address the antibodies and lower them, the condition isn't as progressive, right? And the symptoms oftentimes resolve, and sometimes we can go into complete remission. Now, the ultrasound... Here's the thing though, not everybody will have Hashimoto's antibodies…
Andrew: Yep, yep.
Izabella: …but they'll have Hashimoto's. And so, there's Seronegative Hashimoto's where we see that the thyroid gland is under attack so we're not testing positive for antibodies. There may be other types of antibodies that clinically we're not testing for that they may not have had...researchers have discovered different types of antibodies but we're not testing for them, and some of them may be positive. And there are some antibodies that we may not even know about that are stressed, but thyroid ultrasounds are a great way to figure out if there are changes consistent with Hashimoto's on the thyroid gland. So we will see, you know, more damage and scar tissue and more of a rubbery texture when a person has Hashimoto's.
Izabella: And so, thyroid ultrasounds can discover another set of Hashimoto's and of course they can discover thyroid nodules, thyroid cysts, and any kind of other issues that need to be closely monitored or investigated. And then with cytology, we're looking at discovering additional cases of thyroid disease in Hashimoto's. So, based on various antibody tests, studies, you know, we're looking at 13% of the population having Hashimoto's or so in the U.S. But looking at cytology, we're seeing 27%…
Izabella: …of people within the U.S. with Hashimoto's. And oftentimes, it might be an earlier stage or it may be a case of misdiagnosis where the person is not treated appropriately because they don't know that they have a thyroid condition, right?
Andrew: When would it be appropriate to do like an extra test for instance cytology or ultrasound, when would it be appropriate to be suspicious enough to say, "I would recommend this." Do you merely go on symptoms, or do you look at other tests that might give you a clue as to what's going on first?
Izabella: In my opinion, I would recommend that anybody that presents to a clinician's office that they should be screened for thyroid antibody tests and at least once every five years if all things are normal, to have a thyroid ultrasound just to even have a baseline thyroid ultrasound to see…
Izabella: …what’s changing within the thyroid gland. And of course I would recommend... We'll talk about preventive medicine at this point. With cytology, because it is more invasive, this is something that would be recommended generally when you have nodules that are suspicious looking. So I wouldn't say that everybody with a thyroid gland should have a needle stuck in it to see if Hashimoto's is in there, right? But it's definitely something that if you're already doing an assessment of the nodules then it may be wise to see if there are, you know, white blood cells consistent with Hashimoto's in the cells as well.
Andrew: Yeah. What about the simplest of tests like taking temperature for instance, because this is my understanding and please correct me if I'm wrong, is that the thyroid hormones are produced by the thyroid but they don't really give you a sensitive indication of how well they're working at the tissue level. And that even the simplest of tasks like temperature is actually looking for your Basal Metabolic Rate, granted that there's more sensitive and complicated tests that you can do but what about just taking a regular temperature for those people that you suspect?
Izabella: I think definitely taking temperature is an important part of the signs and symptoms that should be evaluated. The only hesitation I have as far as thyroid hormone treatment, you know, like everything that I recommend and Hashimoto's protocol can be done based on a temperature test, however with starting thyroid hormones, you know, I would wanna have more advanced testing done.
Izabella: The reason I hesitate is because the temperature test, this can also reveal adrenal issues, right?
Andrew: Aha, right.
Izabella: So a person with underactive adrenals can also have low temperature and if we just treat their thyroid hormone and they have low cortisol and we give them thyroid hormones, then they start excreting cortisol at a greater rate and we can make the adrenal issue worse. Of course, Addisons being the most problematic example here, but also people with just cortisolism, we can run into that. That would be my only hesitation, is…
Izabella: …you know, is you could use it for doing all the protocols but if you're gonna prescribe thyroid hormones let's get some more evidence on paper…
Izabella: …and perhaps let's also test adrenals which would be...my ideal is just adrenals and the thyroid gland were tested and figuring out starting perhaps support on both ends.
Andrew: Yeah. So, in my mind, I'm trying to form a treatment picture here. So, low temperature really would be a guide for you to be suspicious and therefore do further testing, not as a guide to treat?
Izabella: Right, absolutely. So it's what's causing the low temperature, that could be thyroid, that could be adrenals. You know, perhaps there are other conditions that could be associated with it, but definitely, that's an important sign to look out for.
Andrew: Yeah. One of the topics that piqued my interest in your book was grieving your diagnosis and it really hit me. I think it's quite profound, you know, and a bit of a wake-up call for me personally when dealing with any patient's new diagnosis. Any patients, if it's alien to them, particularly; obviously, if it's very serious, we get that, but what if it's something that we as a clinician deal with day in day out, but to them it could be quite devastating. How do you lead people through grieving versus the logical, "Oh, yes, I have a condition now," you know? What do you find people go through?
Izabella: You know, people go through... It's such a struggle because generally the clinician...I think a lot of clinicians are very proud of themselves when they get a diagnosis right, and they're excited and they're sharing this diagnosis with the patient, and for the patient that may be overwhelming and devastating. They don't know what Hashimoto's is, you know, they think they're gonna die in five days when you say the word Hashimoto's and a lot of times because it's not household name, and then, you know, their immune system is attacking themselves and then they read on the internet about all the potential complications and there's all these forums of patients who just never get better, right?
Izabella: And so it can be quite scary and, you know, for me, what I do is I just encourage everybody to give themselves that permission to grieve their diagnosis and just think of how they would react if this was like a dear friend or loved one, or, you know, a daughter or even as like a pet, right? Just show yourself some compassion and it's okay. It's okay to be upset. You don't have to toughen up and ignore it, you know, like just show yourself some humanity and some compassion.
Andrew: Yeah. I think this is one of the big wake-up calls is when, you know, we are so used to dealing with these terms, with these conditions, with names of drugs, with names of herbs and nutrients, and they can be quite alien to some. I constantly get reined in by my family when I go off on a rant of explaining this. They say, "You've gone into your mind again, come back," you know?
And I think it's really important for us as clinicians to realise that people, lay people don't have the understanding that we do, and that we need to bring it down to the common denominator about what it means for them. Be constantly on the lookout for that and how it affects them.
So, the four fundamental stages of treatment in your book, obviously, the pervading theme here is stress. But one of the interesting things I picked up in your book as well was, to look at the simplest things as well like iron. Don't forget these really simple underlying things that, not necessarily govern metabolism, but help you cope with metabolism with the metabolic processes. So, how do you regain resilience or indeed how does one attain resilience if they've not got it? And I guess the big question there is, how resilient is resilience? What about long-term effects of treatment or long-term successes?
Izabella: So when I first started working with clients and working on my own health, it was kind of addressing individual triggers and addressing...going after various infections and individual root causes, and that can be helpful. And so, you know, you have a stressful event and something else happens and, you know, I've had a lot of clients and some of them have been very successful, and then I've had some that have taught me a lot because, you know, we would keep going back and, you know, we'd get into remission and then the person would get sick again and we'd treat one infection and they'd get another infection, right? And so, that goes back to resilience and how you build your body up, so it's, you know, you're not going to be necessarily Superman and Clark Kent, but you can be less susceptible to getting a gut infection every time you go out on a vacation, and how do you do those things? And you're not gonna be as stressed out by your environment.
And the best way to do that is to support our own body's natural defences for resilience. So, how does our body stay resilient? So, the first way is by getting rid of toxins and having a way to process them out so that we're sort of filtering out what's supposed to be in the body and what's not. The liver is a key organ in this but also the skin is a key elimination organ…
Izabella: …as is the gut. Now, with Hashimoto's we oftentimes have a person with a toxic backlog in their liver, and so they're not sweating enough because hypothyroidism causes low sweating. Their gut is always impaired so they're not clearing toxins out that way. They have circulating immune complexes and that form from the thyroid antibodies, and everything sort of gets stuck on the poor old liver, and so the way to support that is to sweat more and to try to clear out some of that toxic burden. This will make a person less sensitive to their day-to-day stressors. But the way I think of it is sort of, you know, like an overflowing bucket. When you've got so much toxicity within your body, even the smallest stressors will stress you out.
Izabella: So that's the first part of it. The second big part is the adrenal hormones and so I always tell my clients that the way to make other people less annoying and more tolerable is to support your adrenals. And you know like...
Andrew: Adrenal treatment for all women.
Izabella: Yes, yes. Your boss could stress you out, and your kids could stress you out, you know, various things could be stressful in your environment and when you really support your adrenals and a lot of it goes back to just good old self-care, getting enough sleep, being kind to yourself, saying nice things to yourself, and I love adrenal adaptogens, of course, and targeted nutrients but you find that the world becomes an easier place to tolerate and you don't get as stressed out and maybe, you know, maybe you don't get into that fight with your husband, or maybe you don't get angry, and that doesn't lower your own immune defences. Because we know when we're upset that puts our body in that fight or flight…
Izabella: …and takes us out of the rest and digest, right?
Izabella: And then the third most important pathway is the gut, and so we know that the gut plays a really important role in every piece of autoimmune disease, and thyroid is no different, in fact thyroid cells and gut cells have the same foetal origin, but when we support the gut properly and we make it more resilient we find that we see improvements in thyroid function and definitely thyroid symptoms. One of my favourite things for clearing out gut infections which can cause the intestinal permeability and preventing new ones is utilising probiotics such as Saccharomyces Boulardii.
Izabella: This can help eradicate some pathogenic infections and it can prevent new ones. So, you know, definitely for clients whenever I have clients that are traveling I'll tell them to double up on that so that more secretory IgA is produced to protect their gut from oncoming pathogens, and digestive enzymes can help us break down our food into smaller pieces so that it's not as antigenic for us and perhaps kill off some of the potential pathogens that may be on our foods.
Andrew: Yeah. I'm so glad that you talk...I was gonna say highly, but let's say deeply around the gut being an important treatment area, because I remember years ago reading something about glucomannan reducing thyroid antibodies. And I...you know, we always think about, "Oh, they're the thyroid antibodies so they're in the thyroid and the blood." We don't think about how our body gets rid of things.
What about over versus under treatment. How do you gauge treatment-related symptoms, you know, as being a warning sign for over treatment say versus the normal vacillation of the disease progress, i.e., your treatment isn't doing anything and the disease is just vacillating as it would. How do you say, "Aha, I'm on the right track," versus, "what am I doing here?"
Izabella: You know, this is a question I commonly get and, you know, people will say, "Oh, well, do the thyroid antibodies go away when the thyroid gland is fully damaged, right, when the thyroid gland is gone?" but I actually do like thyroid antibodies as a potential measure, a marker for seeing improvement.
Izabella: So, how do we know there are changes and improvement? And we're looking at thyroid antibodies in symptoms and we're trying to draw a correlation with that. Of course, everybody is different but there are certain things that are fundamental for most people with Hashimoto’s: 88% of people feel significantly better on a gluten-free diet, 80% feel better on a dairy-free diet, and we'll see reductions in antibodies as well. Selenium is a very helpful nutrient. So, there's some fundamentals that we can always do to determine if, to help a person improve, and again I'm looking at symptoms and then tracking antibodies and tracking lab markers as well.
Andrew: Yeah. I've gotta cover the issue of iodine, you know, particularly in Australia where we've got a marginal to mild deficiency, at least in the eastern states, to the point where all pregnant women in Australia are recommended to have a supplement even though we've got fortified foods now, bread is fortified with iodine. All pregnant women I'd say the word mandated, but there's guidelines to give all pregnant women a supplement as well as the fortified foods of 150 micrograms of iodine during pregnancy. What about the issue of iodine, how high can you go? How… What sort of silly doses do you see used by some practitioners? I've got some concerns with some but...and what are the risks with iodine with regards to Hashimoto's?
Izabella: Well, iodine is such a controversial topic when it comes to Hashimoto's and, you know, the kind of the origin of iodine used as a treatment, is, it makes a lot of sense because iodine is a part of thyroid hormone and that, you know, back before we had iodine fortification. The primary reason...and it's actually the primary reason worldwide for hypothyroidism was iodine deficiency. And so, very much so if you have iodine deficiency, hypothyroidism, taking iodine will help, right? It's pretty simple.
Where it gets a little bit more complicated is that researchers have found that in countries that started adding iodine to the salt supplies, we see less iodine deficiencies but we see more autoimmune thyroid disease. And so now iodine excess has been determined to be a potential environmental trigger for Hashimoto's. Generally looking, combing through all the research and trying to come up with an answer for my clients, generally you don't wanna be more than 300 micrograms of iodine if you have Hashimoto's and TPO antibodies.
Izabella: Now, there are some people that have taken iodine with Hashimoto's and taken really high doses and it actually helped them. However, what unfortunately I've seen is that there's a certain amount of people where they're given milligrams like 5 milligrams, 50 milligrams and a note that they're recommended daily dose is in micrograms, right? And I've seen their TSH go up to the 100 level when it was maybe, you know, 8 to 10.
Izabella: I’ve seen their thyroid antibodies go up to the 1000 level.
Izabella: One woman had a T4 that was nearly zero and she was bedridden, where before it was like she was subclinical hypothyroid. And, you know, certainly for some people iodine could be a part of the story where they do need to take an iodine supplement to recover their health, and taking an iodine supplement in the form of a multivitamin or a prenatal vitamin, that's generally been found to be safe…
Izabella: …for most people with Hashimoto’s…
Izabella: …and that can actually improve outcomes. So, you know, to kind of make a long story short, I would say the amount that's in a multivitamin, the amount that's in a prenatal vitamin in micrograms, up to 300 micrograms is gonna be generally very safe and very well tolerated by most. On the other hand, when we get into the milligram dosages, that's when we can get ourselves into trouble with accelerating actually thyroid tissue damage, and my colleague and good friend Dr. Datis Kharrazian has correlated some brain related symptoms along with utilising iodine…
Izabella: …where perhaps some Hashimoto's antibodies can be cross-reactive with brain tissue and cause more brain inflammation when the high dose iodine is utilized.
Andrew: Ah, okay. I've gotta say I've always been quite cautious on the high iodine doses that I've seen touted around some where it really concerns me. There’s a…I often refer to a very interesting, tete-a-tete, it's an argument basically between Dr. Guy Abrahams and Alan Gaby in the Townsend letter for Doctors regarding the doses of iodine that were in seaweed. And it's a really interesting thing for anybody to look up.
But I've gotta say for anybody, any clinicians out there looking…who want to learn more about the research that you delved into, they need to read your first book, is that right? And then the second book is really the how to do stuff, how to treat people. Is that correct?
Izabella: That's correct. The first book is very heavily research-based and then the second book is protocol based, so I've got protocols and how to find triggers. So if you have a person with these symptoms you should test them for each priority, these are the best labs to do and these are the best treatment options that I found to be helpful and effective. So I snuck in a little bit of research in the second book.
Andrew: I saw.
Izabella: I just couldn't part with it.
Andrew: But I think it's much needed but it's needed. Yeah, you know, people...praccies need to get the confidence to be able to say, "Aha, I get it now." And, you know...
Andrew: Yeah. I mean, to me it should be a seminal book. It is a seminal book. And I've gotta say along with Dr. Datis Kharrazian. I think those two...you two authors having your personal interest and Dr. Datis Kharrazian having this overwhelming curiosity for when things go wrong and he just wants to help his patients. I think those two combined just get the best for practitioners. So, I've gotta congratulate you on those your two books but also him on his, and I really implore practitioners to get your book. This is the, "Hashimoto's Protocol: A 90-day Plan for Reversing Thyroid Symptoms and Getting Your Life Back" by Dr. Izabella, that's, I-Z-A-B-E-L-L-A, Wentz, W-E-N-T-Z.
Dr. Izabella Wentz, I thank you so much for taking us through some of the crucial aspects and I say some because you really need to read the book. We could be sitting here talking for hours and still not get through it. So thank you so much for taking us through some of these aspects today on FX Medicine.
Izabella: Thank you so much, I really enjoyed this. It was a pleasure.
Andrew: This is FX Medicine and I'm Andrew Whitfield-Cook.
|Dr Izabella Wentz - The Thyroid Pharmacist
|Dr Izabella Wentz - Gifts
|The Hashimoto's Protocol
|Dr Datis Kharrazian
|Dr Alan Gaby: Townsend Letter Editorial on Iodine