I am delighted to have Dr. Alan Christianson joining me as my guest for today’s show! Dr. Christianson is a Board-Certified Naturopathic Endocrinologist who focuses on thyroid care. He is also a New York Times bestselling author whose recent titles include The Thyroid Reset Diet. Dr. Christianson is the founding president behind the Endocrine Association of Naturopathic Physicians and the American College of Thyroidology. He has featured in countless media appearances, including Dr. Oz, The Doctors, and The Today Show.
Although tons of information about thyroid conditions is available out there, it can be confusing because so much of it is conflicting. Recent findings have shown that much of what we believed to be true in the past has changed. Thyroid disease has also changed. Thyroid cancers, the prevalence of thyroid treatment, and diagnoses for chronic disease have all tripled over the last couple of decades. Fortunately, Dr. Christianson is an incredible resource! He is joining us today to dive into some of the recent discoveries about the causes of thyroid disease and share some encouraging findings. Stay tuned to learn more!
“There have been a lot of new initiatives to answer the question of what is going on.”
Dr. Alan Christianson
IN THIS EPISODE YOU WILL LEARN:
- Dr. Christianson talks about the changes that have been happening regarding thyroid disease over the last twenty years.
- Dr. Christianson talks about the most important factor for the increase in thyroid disease over the last couple of decades. Understanding it can offer a solution for many people.
- How the thyroid works, its physiology, and how iodine interacts with it.
- Why there is so much iodine in dairy products.
- Dr. Christianson talks about the shift that took place around the mid-1980s that is relevant to thyroid disease.
- Everything related to iodine in our body gets filtered through the thyroid function.
- What you need to be aware of and understand to make educated decisions about the products you use.
- What almost everyone with thyroid problems can do to normalize their thyroid function in a very short time.
- Dr. Christianson shares some encouraging findings regarding over and underactive thyroid function.
- Dr. Christianson talks about thyroid medicines.
- Things you should take into account when having a thyroid test.
- What you can do to help support your body.
- The various factors that work together to exacerbate thyroid function.
- Lifestyle factors that impact thyroid function.
Connect with Dr. Alan Christianson
On his website
Connect with Cynthia Thurlow
Check out Cynthia’s website
Check Out Dry Farm Wines: www.dryfarmwines.com/cynthiathurlow
About Everyday Wellness Podcast
Welcome to the Everyday Wellness podcast with Cynthia Thurlow! Cynthia is a mom of 2 boys, wife, nurse practitioner, and intermittent fasting and nutrition expert. She has over 20 years experience in emergency medicine and cardiology, but pivoted to focus on food as medicine. She loves to share science-backed practical information to improve your overall well being and is grateful to be interviewing leaders in the health and wellness field. Her goal with Everyday Wellness is to help her listeners make simple changes to their everyday lives that will result in improved overall wellness and long term health.
Presenter: This is Everyday Wellness, a podcast dedicated to helping you achieve your health and wellness goals and provide practical strategies that you can use in your real life. And now, here’s your host, nurse practitioner, Cynthia Thurlow.
Cynthia: Today, I’m delighted to have Dr. Alan Christianson. He’s a board-certified naturopathic endocrinologist who focuses on thyroid care. He’s also a New York Times bestselling author whose recent titles include The Thyroid Reset Diet, and for which I am so excited to have you joining us this afternoon, largely because there’s just so much information out there about thyroid that’s so conflicting, and yet I know you’re just this incredible resource. So, let’s really dive into some of the new findings about the causes of thyroid disease, because even as a clinician myself, I was really surprised that I was explaining to my husband, this makes so much sense when I was really diving into the book and doing research for our interview today.
Dr. Christianson: Yeah. So much of what we’ve learned has changed in the recent past. So much of thyroid disease has changed recently. Thyroid cancers have tripled in the last couple decades. Prevalence of thyroid treatment and diagnosis for chronic disease has also tripled over this timeframe. There’s been a lot of new initiatives trying to answer the question of, why is this happening, what’s going on? One large group of medical reviewers, their conclusion was that many factors are responsible. However, the biggest single one by far is the change in our iodine intake. They argued that it was not only the most important, but it was more important than all the other factors combined. So, yeah. [chuckles]
Cynthia: Well, and it’s interesting, because if we think about how much our health as a nation and most westernized countries has really shifted over the last 20 to 30 years, less people cooking at home, more consumption of processed foods, where I’m assuming there is more exposure to iodine. There’s so much of it in the processed food industry, and interestingly enough, I was always feeling badly, because every time I had a urinary iodine checked by my functional medicine provider, they’re like, “Oh, you’re so low. Eat more sea vegetables.”
I’m grateful that I never actually took an iodine supplement, but I know that there’s so much conflict about this particular micronutrient in particular– I think for so many people, we would not have made those connections that you’ve been able to make when you were piecing together all this research behind the book.
Dr. Christianson: Yeah. Big picture, there’s some ideas that have become prevalent in functional medicine that we could tie, I could talk in great detail, but where it came from, why and why things are plausible with iodine, but it’s not true. Where we think about nutrients in general is that vitamin C, magnesium, calcium, zinc, they’re work with countless parts of our bodies, and they do a myriad of important roles. We may get low in them, but there’s really not a common issue of getting too much, your body can regulate that pretty well. None of those things are true for iodine. [laughs] All the ways we’re used to thinking about nutrients do not apply to iodine. And it’s important, we need it, it’s not the bad guy at the story. Most people, probably a slight majority, they can tolerate the normal occasional excesses of iodine, and with no issue. Just like water off a duck’s back, no big deal. But they’re not the ones prone to thyroid disease.
So yeah, it’s something that the amounts in play are so tiny, the body concentrates it many-fold over requirements. Just because of that variable, the whole relationship changes. There was a lot of times historically, or if we went back to pre-1990, a lot of times globally, in which people were getting just less than they need. But now, it’s much easier to get above a threshold that those who are sensitive can tolerate. The really exciting part of it is that, it’s cool to know why things happen, but an explanation is not always a solution. Humpty-Dumpty might have fallen off the wall because a gust of wind came along, but that wouldn’t fix him necessarily. So, the exciting thing is, this can also offer a solution for many people that even if this were the thing that caused their disease, a really high percent of them can see their disease go away by correcting the problem.
Cynthia: I think this is profoundly encouraging, because when I talk to middle-aged women, women that are in perimenopause and menopause, nearly all of them are either on thyroid replacement, or they’re told they have a lagging thyroid, and people are feeling anxious, because for many of them, maybe this is the first time they’ve needed to go on a prescription medication to understand that there could be a reason for why this has transpired beyond just being “middle aged” and highly encouraging. Now, one of the things that I think is really important to talk about those that are not familiarized with thyroid physiology and how iodine fits into that, I think that it’s important people understand there’s just need very small amounts of iodine, it’s not a proliferative amount that we need, but let’s dive into the physiology of the thyroid, because I think even understanding on a very basic level, the way the thyroid works and how iodine interacts, but that will help people understand why we have to be conscientious about this.
Dr. Christianson: Yeah. Iodine is a really powerful substance. The form that it circulates in the body is generally a more dormant one. But it gets activated within the thyroid. Iodine has been used forever as an antiseptic. So, in a lot of ways you can think about it like you would think about like bleach or hydrogen peroxide solution. It massively generates free radicals. That’s great killing infections. That’s useful in some chemical reactions, but it’s exacting. There’s a protein that the thyroid makes, and this protein is, I don’t know, like a big coat hanger. Then, iodine comes along, and it’s various coats that fit on these hooks at the hanger. Once you get the right number of iodine atoms in place, now you’ve got an active thyroid hormone.
So, it’s essential. You can’t have hormones without the iodine. However, I don’t know you’re in a cool part of the country too. I grew up in northern Minnesota, and we’ve got family over and soon the coat hangers overloaded, [laughs] coats laying on the bed and stuff on the floor around it, and mittens and scarves. So, that’s what happens with a little bit extra iodine, is that there’s places for– to be really precise, each molecule of thyroid globulin has special residues to hold up to 13 iodine atoms. But if we get just a little more than our bodies tolerate, we might have 50 or 60 iodine atoms all jammed around that molecule. It’s like the coats exploding all over the coat rack. That by itself makes the thyroid proteins look weird. Your immune cells come in and say, “What’s going on?” They start to attack them, and now there’s an autoimmune process. So, the thyroid is slowed down, and that’s the main trigger for it. This very thing that you need to work a little bit too much of that, shuts the whole thing down.
Cynthia: I think that balance is really critically important that people understand that iodine is not needed, that it’s not absolutely necessary for appropriate thyroid function, but too much of any one thing is no good. Now, one of the things I found really interesting was that in the book, you talk about how our bodies need anywhere from 50 to 200 micrograms, so we’re talking about a very small amount to make thyroglo– Or to actually make healthy thyroid hormone. It’s the exposure that we go about on a day-to-day basis like, people may be thinking, “Well, I’m not taking iodine supplement. I don’t like sea vegetables.” But there are things in our environment in particular, and what I found really disturbing, and I’m not a dairy drinker, I don’t eat cheese, I don’t do any of that, but you’ve talk about the sanitization properties of iodine, and one of the things that and one of the reasons why there is so much iodine empirically in dairy products is that that’s what the farmers or dairy farmers will use to sanitize the cow’s teats. So actually, when they’re going into actually– I’m not even sure the technical terminology. When someone’s milking a cow, I don’t know the other way to put it. When someone’s milking a cow, the cow’s udders have been sanitized with iodine. So, you’re getting it just from there. There’s so many ways that we’re exposed iodine without even realizing it.
Dr. Christianson: Yeah. We get some, we need some, and what happens is, this is a story that’s really about to change. A change took place around the mid to late 80s. There’s other eras that are relevant to thyroid disease, the rates were lower, but around then it started really picking up, and there’s been a constant amount in certain food types like I’ve always had some in iodized salt, there’s always been some egg yolks, will always have some iodine in seafood. Those things haven’t changed all that much. Sea vegetables are really high sources. Most westerners don’t consume that many of them. Some do. They’re certainly relevant. But yeah, the big shift has been dairy processed foods, and cosmetics is being changed and in supplements. So, dairy food and processed grain products, they comprise the top 25 sources of iodine in the average American diet. 23 of those 25 top sources, the amount they contribute has doubled or tripled in the last several decades. So, yeah, this is a big source, and it’s really picked up.
Cynthia: What do you attribute that to? I always talk about the rise of the processed food industry, but I think it’s also the mentality, a lot of people– maybe take COVID out of it. People are home much more than they were before, but how the processed food industry in many ways has convinced families and individuals that they don’t know how to cook. I’ve got an easier faster way to get food on your table, but the untoward effect, whether it’s exposure to seed oils, processed sugars, all these other micronutrients that we think of as being fairly benign really aren’t cumulatively over time.
Dr. Christianson: Definitely a big factor. We also see micronutrients with high amounts of cosmetics, and somehow really, this combination has been a big shift. Yeah, globally, in 1990, we had 112 nations that were severely deficient. Now, there’s none. But we’ve got 52 nations categorized as at risk for thyroid disease due to iodine excess. We are one of those.
Cynthia: So, when that initiative went through, and I also found this really interesting, the role of iodine and having an appropriately functioning thyroid is so critical for neurocognitive function. I’m presuming that was the impetus for actually creating that initiative to begin with, that it was a concern that there are these at-risk nations that are severely impacted by these deficiencies.
Dr. Christianson: For sure. Yeah, congenital hypothyroidism, cretinism, there’s many ways that– basically, all things iodine, as far as human health, they’re filtered through thyroid function. If there’s ever the wrong amount, that plays out by changing how the thyroid works before almost anything else happens. So, places that were severely deficient, they would have people developing with varying problems. Pediatric goiter, enlargement of the thyroid, probably one of the most benign of the problems. Funny thing is most of those problems are more pronounced in younger populations and children. If someone does make it through adulthood, this is less of an issue. It’s less common. But yeah, pediatric greater congenital hypothyroidism, neurocognitive development impairment as you mentioned, those are big factors. If we were to go back even to the 70s and the early 80s, there was times in which almost 2 billion people on the planet didn’t have proper brain function due to a lack of that. So, it was a big public health problem, and they fixed it. It was successful. It was a good thing. But now, we’ve gone a little too far in some areas. [laughs]
Cynthia: Yeah, the pendulum has really swung me opposite direction. If we’ve addressed the iodine deficiency, and now we have this overabundance in many ways, there’s overabundance in so many levels, what are the things that people need to understand so that they can be proactive or be in a position where they can make more educated decisions about the products they’re exposed to you mentioned the cosmetic industry is a huge contributor to why we’ve got this iodine excess, as well as the nutritional component. But what are the things that people need to be aware of so that they can screen, obviously, you’ve got a lot of great information in your book. I strongly encourage people to go check it out, but what are the things the big thing, the high-level things that people need to be aware of?
Dr. Christianson: Yeah, the most important thing I want listeners to take away from this is just a sense about how much change is possible and how likely that change can be. There was one paper, which didn’t make it in the book, because it hadn’t come out yet. It was completed in May of 2020, and this was a paper looking at the role of deprescribing, which basically means someone who’s– not prescribing but deprescribing, where someone will not need our medications any longer. And in this study, they took people and they did the most cursory level of iodine avoidance. They said, here’s some really obvious sources that have too much iodine, like sea veggies like you mentioned, some supplements. Don’t do these things. And let’s see if you can stop taking your thyroid medication. Just doing that, 40% of people who were on longer-term treatment were successfully able to deprescribe. They could stop their medications, they can maintain normal thyroid function, and they could maintain free– no symptoms. They felt fine. They had normal thyroid function. So that was those on treatment.
Now, those not yet on treatment, one of the studies that I cited in the book took those with Hashimoto’s. They’d had it for about four to five years, they were severely hypothyroid. We could talk about numbers, but they were way outside the normal range by a factor of four. All they did with them was a more thorough avoidance of obvious sources of iodine. In three months, 78.3% had perfectly normal thyroid function again. And of those who didn’t get better, most of them either didn’t really follow all the instructions, there was still a lot of iodine coming out of their bodies, or they were improving, but they started so far off that they just didn’t yet have time to normalize. So, they looked at the numbers and said, “Okay, so who in this study did do things right, but just didn’t respond at all? To whom did this not make any difference for?” That was about 3% of participants. Almost everyone got totally normal, or was heading that way. This is something that doesn’t help some people here and there maybe, and this is something that doesn’t help by a subtle amount that you got to squint to see it. This is a big deal. This is almost all people with thyroid problems can see their function radically improve or normalize in short periods of time.
Cynthia: Really incredibly encouraging. For listeners that aren’t aware of this, the bulk of those have an underactive thyroid, it’s generally– and I’ve seen statistics anywhere from %70 to 85%, so somewhere in between is probably correct, are impacted by the auto immune so body attacking self, Hashimoto’s. Then, there are the gray area maybe of 10% to 15% of us who have non-autoimmune hypothyroidism and then an even smaller percentage of people have hyperthyroidism, the overactive thyroid. In those studies, was there any differentiation between each one of those groups or was it just a normal elevation just overall?
Dr. Christianson: Yeah. Those that clearly have autoimmunity and then those that don’t, hypothyroidism and Hashimoto’s were both studied pretty much the same numbers. They also showed subclinical disease where part of the labs are off, part of them aren’t. Same numbers basically. Funny brief aside, so non-autoimmune hypothyroidism is we think now is really, really rare. Most– not most, but right around half of people that have autoimmune thyroid disease may never have measurable thyroid antibodies. A lot of doctors say, “Oh, you don’t have thyroid antibodies present, you must not have autoimmune thyroid disease. Nope, that’s not a rule out.” [laughs]
Cynthia: That’s really significant, because even for clinicians who’ve been diagnosed with hypothyroidism, I thought I was always safe from Hashimoto’s, because my thyroid antibodies were always negative. They were 0. But that’s suggesting that there are a lot of people who may indeed have autoimmune Hashimoto’s without realizing it.
Dr. Christianson: Honestly, the trend clinically has been to assume unless there’s a clear reason otherwise. A lot of the other reasons for hypothyroidism are more historical than present. If someone had their tonsils irradiated back when for a sore throat, that doesn’t go on anymore, or the couple, a handful of medications that might directly slow the thyroid, or some other surgery or procedure that affected it, that barring that stuff, it’s pretty much all autoimmune. Then, you asked about hyperthyroidism Graves’ disease. There have been trials looking at this approach. Now, with Graves’ disease, there’s a fascinating feedback cycle between too much thyroid hormone and then the autoimmunity that causes one to release too much thyroid hormone. We call this the autoimmune hyperthyroidism loop. Someone really first has to break that loop. If they don’t, if they can’t lower their thyroid output by stopping their thyroid, it’ll keep cranking on and keep escalating all by itself.
However, once that loop is broken, whether that’s by the glands spontaneously slowing as it does for some, or medications to slow it, or other procedures to slow it, once the loop is broken, then there’s a lot of data showing that iodine regulation makes things go a lot quicker. Funny thing about Graves’ is that in the moment, it can be more acute and more dangerous for cardiac effects. However, the rate of full remission, full disease remission is actually a lot higher than it is for Hashimoto’s. So, once someone can get stabilized, they have and this is not based on new data, this is just old data, that they’ve got about a 95% chance of normal thyroid function within 18 months just by stabilizing.
Cynthia: That’s incredible, because my whole background as a nurse practitioner was in cardiology. I saw quite a bit of thyroid storm, which is of course, the worst-case impact of overactive thyroid function and people that would have months and months and months of lots of palpitations, lots of arrhythmias, and then things would settle down. Obviously, I didn’t work in endocrinology, but I think that’s very encouraging for people to understand that if you have Graves’, you’re much more likely to be able to get to a point where you were healed from your thyroid, whereas I think that the vast majority of individuals impacted by a dysfunctional thyroid, they’ve been told convinced that they’ll need to be on medication for the rest of their lives. Probably, this is a good segue, because there were a lot of questions that came in about thyroid medications, and for listeners that are not aware, if you’ve been, if you haven’t, we’re not impacted by this recall some of the desiccated products that many of us more naturally mimicked the way that our thyroid should ideally function were pulled off the market, which is what should happen when they test lots, and maybe you can touch on that process. When people are looking at strategies for how to address looking at the thyroid with medication, there are synthetic variations, there are compound and variations, and there are desiccated variations. So, differentiating what these represent, how they work, and I can tell everyone, and I’ll be happy to answer this. I get asked this a lot. I’ve tried all of them in the past year, just trying to get back to some degree of normal thyroid function.
Dr. Christianson: Yeah. In terms of medications available, you mentioned that and there are many people that can do the most common approaches, which is synthetic T4 and do fine from that, stable blood levels, manage symptoms, and that’s great. There’s none of those options– I’m sorry. I should expand. The ones that are manufactured by factories, none of them are inherently bad options. The question is really what’s going to work best an individual. Of those I’ve been exposed to a biased population for the last 25 years, the people that have done the common approaches and felt great have not come to see me and my doctors. They’ve not needed to.
They exist and if you’re on something and doing well with it, there’s not really a big reason to change. When one does embark upon the thyroid reset diet, however, it’s smart to know that your needs may change and those that fits for you may not fit in the future. Now, thyroid medications and iodine, we’re talking about microscopic stuff. No for analogies. If we go down by orders of a million, let’s start with a cow.
Black and White Holstein full-on adult cow. So, that’s one piece to think about. That’s about 1000 kilograms. Now, if we go down by a million, we come down to a ground, and that’s a paperclip. Factor of a million a cow to a paperclip.
Let’s go down by another factor of a million. Well, that’s a microgram. What a paperclip is to a cow is what a microgram is to a paperclip. [laughs] So, it’s dang tiny to be precise. [laughs] Yeah, that’s the quantities in which we think about thyroid hormones. Now, most medications, most supplements, they really are things that are in the milligram and gram potency range, so there are a whole lot easier to make. Imagine that you’re making muffins at home, and you’re making blueberry muffins. So, you’re going to make a dozen muffins, you put them in the tin and bake them. [unintelligible [00:21:03] stirring up. Now, you can easily get close to a cup of batter per muffin, that’s not too hard to do. And if you really watch closely, you might be able to get six blueberries per muffin. That’s possible.
So, imagine you’ve got poppy seed muffins. [laughs] [unintelligible [00:21:24] 1000 poppy seeds in every muffin, and not 1010, or not 900 poppy seeds. Now, we’re talking about making things thinking about a smaller level. If we go thousand-fold smaller than poppy seeds, you can see why it’s hard to get pills to all have the right number of micrograms. It’s just not easy. With our best technology, with our best machinery and quality control methods, it’s not perfect. There’s a lot of processes that require checks and balances and they should. So, in a period between 2012 to 2017, there was 99 recalls on synthetic thyroid medication throughout many different brands. And they should check. We’ve had four recalls– Four or five, there’s been one mandatory recall on natural thyroid and four or five voluntary recalls in the last two decades. So, when it’s your medicine you’re on and it happens, it’s frustrating. It’s it might not be 100%. But in the big scheme of things, medicine recalls, they do happen. There’s medicines that are made by factories, medicines that are made by compounding pharmacies, and medicines that are just nonprescription. There are thyroid glandulars that come from cows that have active hormones that people can buy without prescription. So, yeah, when the factories make it, they use the best techniques, they test– They don’t always come out perfect, and we know that.
Now, the compounding idea, I love the idea of being able to choose the exact hormone, the exact amount, the ratio, but nobody checks. They never have recalls, not because they’re perfect, but because nobody checks. There have been about a dozen published case studies in the last several years of people who’ve been hospitalized from compounded thyroid medications. So, we know they can go wrong by a big degree, but we have no data on how often they go wrong to smaller degrees because no one checks.
Then, over the counter third medicines, they do exist, but the problems that I’ve mentioned are just amplified hundreds of fold. There have been times in which people have went and just bought those and then assayed them in laboratories. Yeah, they’ve got active hormone, but it’s all over the place from build a pill from bottle to bottle, so, not a viable option. Categories of manufactured medications, we have natural desiccated thyroid, which has T4, T3, T2, some of the thyroid proteins. We have T4 and T3 in isolate. We used to have a T4, T3 combo not in the market anymore. So, most people that goes all the way to see someone like myself or someone else in natural medicine, they’ve probably tried T4 and not done well with that. In those cases, I see many do well on natural desiccated thyroid, there are different brands out there, and the brand differences are not huge.
There are some all things that are medication, changing brands can be difficult, because even if the active ingredients are consistent from brand to brand, the inactive ones may not be. And how your body breaks down these inactive things may not be the same way your body breaks down those other inactive things. So, if you change brands or if you’re on a generic and you can get different manufacturers from batch to batch, in those cases, it’s hard to calibrate because it’s always shifting for you. So, the number one rule is, try to maintain one brand as much as possible. I do see many do better subjectively on natural thyroid. There was a big paper done in California two years ago about whether natural thyroid could give as stable blood levels as synthetic hormones. It does. There’s no big differences that way. So, that’s really not an issue anymore. Then, there are those who do fine on T4 only or some T4 plus some T3, but those the real main approaches that are out there,
Cynthia: I think it really comes down to bio individuality, because if I were to take 10 women that were relatively the same age dealing with hypothyroidism, they might all have very differing experiences with each one of the options that you’ve discussed. I’ve been very open with the listeners that Nature-Throid got recalled, boohoo, in September, and I then went on a six-month journey to figure out what would work best me. I started with compound and thinking naively, even as a clinician that was going to work best, because someone in a pharmacy put it all together. What it made me was hyperthyroid, which for anyone who’s been a little underactive to be overactive, I think is probably worse. Then, I had a washout, and then I was put on Armour, which was one of the very few other natural desiccated products that was still on the market. That didn’t work well. Now, surprisingly, I’ve been doing well on Synthroid and Cytomel, which are synthetic T4 and T3, but I got to a point where my functional medicine provider was indicating to me that it really is a trial-and-error process. So, if you’re on something now that’s not working well for you, maybe changing your healthcare provider is one option, but just acknowledging that it may take quite a bit of time, it may not be instantaneous.
Dr. Christianson: Well, and there’s common pitfalls people often go through. In almost all cases, I see more problems with dosage than I see with medication. Very commonly, if someone’s on the wrong amount, doesn’t matter which medicine they’re on. They’re going to do horribly from that.
Dr. Christianson: But that’s honestly, in my experience, a bigger driver. Yeah, I would argue that that one and then also testing, so, I see countless examples. People are tested in ways that are just setting them up to yield inconsistent results. If your blood tests do not take into account where you are and your period, what time of day the test was done, when you took your last thyroid tablet, when you took your last supplements? On three days after all supplements, you’re going to get goofy results and whether or not you’re fasting. If you don’t take those five things into account when you test your thyroid, you will not have meaningful results on your thyroid tests.
Cynthia: I think this is really important listeners to hear a little bit more about you do talk about this in your book. But so, what are the things or the instructions that you provide to your own patients when they are going to be tested for whether or not they’re on the right dosage of medication?
Dr. Christianson: Yeah, so these are circadian hormones. They do fluctuate throughout the day. You got a test in the morning, and 7 AM to 9 AM is ideal. That’s what everyone’s there to get their fasting blood test. It’s a busy time, but that’s the reality. [laughs] Fasting does matter. Having food in your system does change your levels. The timing of your medication is a big one. So, you want to do your blood tests before you’ve taken your thyroid pill. After you take your thyroid pill, your T3, your T4 to a smaller extent, your TSH, these things are all changed in ways that cannot be well calibrated for supplements. By it, it affects almost any blood test you can imagine. It doesn’t so much affect you, but it affects the blood tests. It’s part of how they register many of them.
Then, probiotics can skew thyroid antibodies. There’s actually a few more connections that are relevant. Simple rule is no supplements for three days before thyroid tests. That’s an easy way to get more clear data. Then, menstrual cycle, so, if a woman is not– if this is a guy or a woman who’s not currently having menstrual cycles, this is not relevant. If you are having periods, you want to have your thyroid tested either the first week of your period or the last week. If your periods are totally erratic and goofy, just gets your test done while you’re on your period. That’s the simplest way because you know when that’s happening. [laughs] But if you’re mid cycle, the increase in proteins that bind thyroid hormones are very high, and they can change your scores significant amounts.
Cynthia: That’s really interesting. I’ve actually never heard that before, but it makes complete sense. I think that we’re now in a position whether it’s the functional realm, but we’re really acknowledging that circadian biology and how critically important it is in order to get an accurate depiction of what’s going on, not only with our thyroid, but with other hormone levels. Now, you’re working with your health care provider, you now have these great instructions in terms of when to get tested and what to do before you get tested. What are the labs that you like to use? If someone is on thyroid replacement right now, or is listening and is concerned about their thyroid, what are the labs that they want to have checked when they go to their healthcare provider? Because there seems to be– I always look at it is, when I think back to when I was working traditional allopathic medicine and cardiology, we were very focused on just a few tests. I now acknowledge that we didn’t look at enough testing to really get an accurate view of what was going on with the thyroid, but what are the things that you like to see when you’re looking at labs for your patients to get a full evaluation?
Dr. Christianson: I guess, even a question back is what is the purpose of testing? There’s a couple different reasons for that. One of which is, to make sure people are safe. Prior to 1970, understood a bit less than we do now. We didn’t have TSH tests available and people with thyroid disease had rampant rates of cardiovascular death. It wasn’t clear why. We thought that was just part of being on the retreatment part of having thyroid disease. Once we learned about TSH testing and the importance of it, that basically stopped. It went to almost nothing. But yeah, one purpose of testing is to make sure you’re safe. To make sure you’re not in some unsafe level of treatment.
Symptoms don’t always show when you’re getting too much. You can feel fine or normal when you’re getting enough that could be unsafe. So, one goal is safety. One Goal can also be making sure that you’re getting all the possible benefit from your treatment. And to answer that question, the thought is, to make sure that your thyroid function mimics how it would look in healthy people. We know that people are free of thyroid disease, and then people with thyroid disease who have the lowest rate of early death, the lowest rate of chronic disease, the lowest rate of complications like obesity, and the lowest rate of symptoms. There’s been data looking at all those populations, and if you crunch them all together, you get something that sometimes is different than what the normal ranges. The biggest difference comes up with TSH scores. So, if you pick those considerations like healthy people, they’re going to have normal but lower normal TSH scores. There are ways that one can personalize that further based upon age, gender, pregnancy status, cardiovascular health, kidney health, other variables, but as a generalization somewhere between the low end of the normal range, 0.4, 0.5, and maybe to a little above 2, somewhere in there, which can be personalized further is about where TSH scores fall in those healthy populations.
Now, a funny thing is that many have looked at this and said, if it’s good to have your TSH low normal, you would think it might be good to have your free T3, free T4. These things high normal. And that sounds logical. But when we look at healthy populations and we map out their levels, it just doesn’t show up that way. We actually see a lot of the opposite, that people that consistently have high T3 levels don’t have good health outcomes. No, oftentimes quite the opposite. So, healthy people have a large range of T3 levels with normal no problems, and they actually have low normal T4 most consistently. Yeah, so, toward the question of, at what levels will you best manage health and best control symptoms? It’s something like that. If someone is in a good state of their symptoms, and no apparent health risks, then the question is just are they safe or not? You know, are they at levels that would be not causing harm for them over time. And as far as which tests, there are long list of tests available. Honestly, they’re not all useful. I never run reverse T3 tests. I could talk for days about why but TSH is helpful. When someone’s first being diagnosed, it’s nice to screen their antibodies. The antibodies, if they’re extremely high, they can be relevant in ways that don’t apply even if everything else is good. But that’s rather limited. There are many times in which the thyroid antibodies are not relevant, which some symptoms they don’t affect. Some of their levels are not significant.
So, they’re good to screen at once. They’re not things I really check all the time, and then the free circulating hormones and then finally, thyroid globulin. If someone has structural issues, and also, we get ultrasounds on them, then thyroid globulin, which is not the same as anti-thyroid globulin can be one more piece of data to track any structural problems with the thyroid. But for many people we see for just safety dose adjustments, a TSH can be quite helpful with a deeper understanding of how that should look for that individual.
Cynthia: That’s really helpful although for the listeners, just broad basics. T4 is the inactive form of thyroid hormone, T3 is active. Curious to know why you are not testing for reverse T3, largely because I was always taught it’s the “brakes.” So, T4 can merge into free T3 or into reverse T3, but curious to know and really just for my own knowledge and selfishness honestly.
Dr. Christianson: Yeah. I’m all for it, [unintelligible [00:33:51] as well. But it is the brakes, but it’s normal brakes. [laughs] We actually drive with the parking brake on. So, we need reverse T3 in our brain. We can’t repair cells without it. It’s an important hormone as well. And most T4 that we secrete is made under reverse T3, 60% to 80%, it’s the normal byproduct. There’s been a story told that reverse T3 makes an out-of-control reaction that blocks the formation of T3. Just simply not true. We know all the chemical pathways around those enzymes and they just don’t work that way. If that were true, we would never make any T3, because we mostly make reverse T3.
So, we do see high reverse T3 in a thing called euthyroid sick syndrome. People that have severe– by severe like hospitalized intensive care levels severe, level of disease, in some cases, their body will suppress their third output, we think in a strategy to just to slow everything down. Like if your car is got the engine light flashing and it’s sputtering, you’re going to drive slowly to the garage. [laughs] You’re not going to drive fast to the garage. When someone’s really, really sick, we think their body intentionally slows things down. It does that by decreasing the stimulation on their thyroid and also decreasing the potency of the thyroid hormones in circulation. In those cases, we see that it seems to be adaptive, and even tested to see if people are better off in those cases, if we override that and add in more thyroid hormone, and they’re not, so we think that’s an adaptive response. But there’s honestly a large range of reverse T3 in healthy people, that’s probably not relevant. A low, normal, high all over the place, there’s no clear consensus on any situations in which when it is higher in healthy person, that it’s a problem.
Clinically, when I see people who have been seeing various doctors that are testing reverse T3, in almost all cases when it’s high, it’s because they’re taking too much thyroid medication. That’s a simple thing that makes it too high, and I’ll hear a lot of convoluted explanations about how they have resistance or all these things, but they’re just on too much. If someone does stop taking everything with T4 and only take T3, then yes, reverse T3 will lower just because there’s nothing that can make it out of it. That doesn’t mean that someone’s healthier for that, just means there’s no substrate for it.
Cynthia: That’s really fascinating. For the listeners, I love to learn. Now, I’m going to dive down that rabbit hole after we’re– [crosstalk]
Dr. Christianson: I’m going to send you a 16,000-word blog I wrote about that out. [laughs]
Cynthia: Awesome. I look forward to it. We’ve talked about medications, we’ve talked about testing, now, let’s turn back to the focus of the book and iodine. What are the things people can do to help support their bodies and to do it proactively, now that we acknowledged that we’re very likely all of us are getting, thank you, getting way too much iodine and our diet and our environment as well?
Dr. Christianson: Well, yeah. One more high-level piece that you brought up in your story is iodine testing. This creates a lot of confusion. It seems logical that if you test for something and you’re low in it, you need more of it. But a lot of things we test for can be tested are accurate at population levels, but not at individual levels. That’s just the case of iodine. So, the test for it, if you were to test your urine about 350 times, you could know within 90% accuracy, what your actual status is. But one test has no relevance at all. We have iodine in our blood, that’s only there after our body has controlled it. The amount that matters is what’s in the thyroid, and there’s no simple tests for that unfortunately.
Yeah, as far as being aware of it, someone with thyroid disease, the recommendation then is that if they wish to improve their function or improve their symptoms, then they can get on the low end of that range, like somewhere below 100 micrograms. This is a point I want to expand on too. So, some see their thyroid physically regrow, they get new cells, they can get larger, it can take over again. There are those that lack a thyroid. It’s been taken out. So, the other side of the equation that iodine affects is how thyroid hormones are used in circulation. Many people who lack a thyroid, they’re on medication, it should theoretically be what all they would need. But many of them still have symptoms. That’s because they’re not using those hormones in ways that are ideal. Iodine can be part of that. So, yes, even those that lack a thyroid, they can stand to benefit in most cases. They’ll still need medicine, but they can get more of that, better control symptoms and possibly need less of it.
Cynthia: I think that’s really encouraging because that was a frequent question that came up either people who have had their thyroid partially removed, there were a couple people who had thyroidectomies related to cancer, a partial thyroidectomy is they wanted to know, “Do I have to be on medication forever?” It also speaks to the fact that and I say, we as clinicians, we, as a large group of individuals, we’re not doing a good job explaining to our patients that in some instances, they may need to be on medication long term, and other instances that might be temporary, because I’m consistently hearing throughout social media, whether it was Instagram, Facebook, by messages and emails, responses to messages we had sent out to our community that there’s so much confusion, and do you think that that has a lot to do with the fact that I think the thyroid is being this very elusive organ. Even though, we’ve all trained and obviously, I’m not a trained endocrinologist, but we obviously all had training, but I don’t think we had enough understanding/respect for this part of our physiology in our bodies, because we fail to recognize or remember that the thyroid impacts everything in our bodies. So, it’s no surprise that when it’s not functioning properly, we don’t feel well, whether it’s underfunctioning, underperforming, which is statistically more likely, or it’s over performing, and we’re feeling the effects of that as well.
Dr. Christianson: It’s a big deal, and you’re right. Hormones act on receptors, and generally hormones have receptors in some parts of the body, yes, and some parts, no. But the only one that has receptors in every cell of the thyroid hormones and yeah, the amounts that’s needed for them– I had an analogy. I think I put in the book about, it’s the concentration in your blood that matters that makes you function well or not. Yeah, an Olympic-sized swimming pool– a teaspoon of vanilla extract in an Olympic sized swimming pool, that’s pretty much the concentration of thyroid hormones in your bloodstream. Now, a tablespoon, that could be fatal. A drop or two might be fatal. So, the concentration is ridiculous how exacting that is. But yeah, it’s just– So, if those slight excesses can be fatal, you can imagine that the tiniest variation could be a good day or a bad day.
Cynthia: Absolutely. I think that it also comes down to the understanding that, this is a journey and not a race, and for many people that are impacted by underactive or overactive thyroid function, you may go on a journey of sorts. It’s taken six months to get my thyroid back to feeling somewhat normal, being able to wake up without an alarm clock. Feeling like I’m back to my normal, my normal body composition. So, let’s pivot a little bit and talk specifically about the bulk of the individuals that listen to this podcast are predominantly women, late 30s, early 40s, and beyond, so perimenopause and menopause. And a lot of the questions that came through were specific to medication, which we’ve already addressed, but many others were specific to what starts happening to our bodies as we’re making this transitional period that, no pun intended, that all of a sudden, we develop underactive thyroid, or all of a sudden we start becoming insulin resistant, or as we have this waxing and waning estrogen and progesterone, so, obviously, the sex hormone piece, how did these all work together, or don’t work together that exacerbates thyroid function?
Dr. Christianson: Yeah. They totally work together. Of the three irrefutable drivers of thyroid disease, two are not things that can be done anything with. They’re called the existential causes. Age and female gender are the two other large causes for that. Age is just that, the more chance something can go wrong, the more time that’s passed, more likely bad things show up. It was just more opportunities, and there’s also some level of wear and tear that can be cumulative. But gender, there’s several factors, pregnancy is one. We know that there are foreign cells that can form and cross the placenta and move into mom’s circulation. This is called fetal isochimerism. Basically, these cells can trigger an autoimmune response, and some of them can be thyroid related. So, that’s one factor.
There are also variations on iodine clearance. Now, iodine requirements don’t really differ per age or gender. They do differ per body size, but pretty predictably. But iodine tolerance can differ greatly from person to person. I allude to that where people can get too much, and it’s not a big deal. But the genes that determine iodine tolerance are primarily X linked. So, women have 2 X chromosomes, men have one, so, if there are things that are X linked that are more latent, they’re not going to show up as much for a guy but they will more so for a woman. So, those are a couple of the big drivers.
The other big thing is just the interplay. This came down to why’ve you got to know where you are in your period where you get your thyroid test on, because estrogen interacts with thyroid hormones. Now, not in ways that are deal breakers, but just in ways that change the balance. So, especially coming into or out of pregnancy, into perimenopause and then into menopause, there’s a big shift in your body’s overall estrogen status. Especially moving through perimenopause, that’s fluctuating so much. What that does is it changes your net thyroid needs at a cellular level. If someone’s thyroid is getting by, but hanging on by a thread, and now you’re telling it, “Okay, speed up, slow down and speed up, speed up a lot, slow down a whole bunch,” that can just push it over. [laughs]
Cynthia: Well, it certainly helps explain a lot of the symptoms that women will experience during this transitional period. I feel until I developed an underactive thyroid, which may or may not be related to latent autoimmunity that I’m unaware of now, I think it’s really speaking to the fact that on so many levels our hormones, and I didn’t have a healthy enough respect for hormones until I went through perimenopause that our hormones impact everything that goes on with our lives. The lifestyle’s piece is undeniable. I know that you speak quite a bit about this, that the sleep quality is important, the food we eat is important, and so, I want to make sure that we wrap up our conversation and being respectful of your time. But let’s talk about the lifestyle piece and how that impacts thyroid functioning in a positive or negative way? Because for everyone that’s listening, all of us can benefit from being kinder to our endocrine system and our brain without question.
Dr. Christianson: For sure. All these things are relevant. Sleep, stress reduction, exercise, community, overall diet quality, they’re all huge, huge factors. The shocking thing is that study that I cited that 78.3%, I honestly didn’t do that stuff. I didn’t do anything other than just iodine regulation. So, I think it all matters for countless reasons, and I think that anything you do to help yourself will only do better if your overall stress response and global adaptation and big picture needs are better matched and better dressed. So, I do encourage all about. In this last book, I didn’t go into those things in as much detail. Keep following Cynthia, listening to her, you’ll get a lot of good advice on these important points. The message I want to to get out is that one small little change has an 80% chance of reversing thyroid disease. So, this is the thing I’m saying. This one thing on top of all the rest can make a big difference.
Cynthia: I think it’s really exciting. I know that probably later this summer, my monthly group and I will be doing the thyroid reset diet, because so many people in that group are struggling with thyroid issues. I actually did a quick little video for them before I jumped on to record with you to say, this is one of those books that I think everyone needs to own, especially for those that are trying to think proactively, but I can’t think of many women I know at this stage of life on that that are not impacted by an underactive thyroid, smaller percentage of which are have had some issues of Graves, but I think it’s really critically important that everyone even if you have had a partial thyroidectomy or you’ve had your thyroid removed, that everyone can benefit from some of the tenets. I think the hardest thing for me to give up for a thyroid reset is going to be egg yolks, because I love eggs. I eat a lot of eggs. But I know I can have egg whites, that was the big takeaway. I was like, “I can have egg whites. So, that’s good.” Is there anything that you would like to leave the listeners with as it pertains to iodine function that we haven’t touched on during our conversation today?
Dr. Christianson: I guess just one to your last point to make sure things aren’t daunting. We think about a reset phase and making things deliberate to where there’s chance to heal. They do, and then you’re good. Once they’ve done so, you could do a mega amount of iodine and screw things up again. That’s always possible. But you’re not as delicate as you were before. So, you can get to where you tolerate some with no big problems. I guide people through a reset into a maintenance phase and then you even do some egg yolks. You can phase these things back in, but for a deliberate time, your body can just amazingly heal and recover when it gets right opportunities.
Cynthia: Well, thank you, Dr. Christianson. It’s been so nice to have you on today. We’ll definitely have to bring you back, because as I’ve told you before thyroid is a hot topic for my listeners.
Dr. Christianson: That’d be a lot of fun I’d love to.
Cynthia: Yeah, please, let the listeners know the easiest way to connect with you, obviously we’re going to have a book giveaway when this goes live, but how can they easiest connect with you on social media or through your website?
Dr. Christianson: Easiest thing, social media at dralanchristianson.com. DrAChristianson, Instagram Facebook. I do an office hours live most Mondays. So, if someone has specific questions, they can often come on and just jump on there and ask that. Usually, those are 3 o’clock Pacific, 6 o’clock eastern. But yeah, just jump on social media with me live, and you can ask particular things, and happy to help out.
Cynthia: Thank you so much. Have a great rest of your day.
Dr. Christianson: You too, Cynthia.
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