Ep. 210 – Understanding the Thyroid’s Effect on Your Hormones, Weight Loss Resistance and Metabolic Function with Amie Hornaman

Your trusted source for nutrition, wellness, and mindset for thriving health.

I am delighted to connect with Dr. Amie Hornaman today! Dr. Amie, a.k.a The Thyroid-Fixer, is a woman on a mission to optimize thyroid patients around the world and give them their lives back using her proprietary transformational program: The FIX Method. She is also the founder of the Institute for Thyroid and Hormone Optimization.

When she was in her twenties, Dr. Amie did competitive fitness modeling. She had to work extremely hard to get herself in shape to compete in shows. While preparing for one of the shows, she started gaining weight instead of losing, so she went to the doctor. She ended up seeing many different doctors, all of whom misdiagnosed her. She continued searching until she eventually found a functional integrative practitioner who did the right tests, saved her life, became her mentor, and changed the entire trajectory of her career!

In this episode, Dr. Amie and I dive into thyroid health, the role of specific lab testing, and why checking reverse T3 is so important. We discuss molecular mimicry, weight-loss resistance, and why women need to check testosterone. We also talk about the controversy around iodine and discuss low-dose naltrexone, and the use of berberine, chromium, and inositol.

I hope you gain as much from this episode as I did!


  • How did Dr. Amie become so passionate about the thyroid?
  • Some of the tests that traditional healthcare providers are not doing, that Dr. Amie commonly requires for her patients.
  • It is possible to have an autoimmune thyroid issue and have negative antibodies.
  • Dr. Amie discusses the role of reverse T3.
  • Some common clinical reasons individuals tend to struggle with high reverse T3.
  • Dr. Amie talks about molecular mimicry and explains how gluten can impact the thyroid, exacerbate autoimmune disorders, and cause a leaky gut.
  • Why some people did not feel any better following a gluten-free diet when the gluten-free diet first came out.
  • Eating less processed foods is generally the best way to support your physical health and maintain metabolic flexibility.
  • Some potential causes of weight-loss resistance in women.
  • For many women, testosterone is the missing link.
  • Problems with the Women’s Health Initiative Study.
  • Dr. Amie shares her thoughts on iodine, LDN, and berberine.


Dr. Amie Hornaman, a.k.a The Thyroid-Fixer, is a woman on a mission to optimize thyroid patients around the world and give them their lives back using her proprietary transformational program: The FIX Method. She is also the founder of the Institute for Thyroid and Hormone Optimization.

After her own experience of insufferable symptoms, misdiagnoses, and improper treatment, Dr. Amie set out to help others who she KNEW were going through the same set of frustrations and who were on the same medical roller coaster.

She grabs your hand, gives you answers about your health that no one has told you, and gives you the actual tools and personalized treatment to fix you. What makes her program unique is the extra support and accessibility that you can’t find anywhere else. That’s the transformational journey. With a focus on optimizing thyroid and hormone function, and thus optimizing her patients, Dr. Amie looks at you as a unique individual and not JUST a lab value. She examines all factors that tie into thyroid dysfunction and thyroid symptoms and FIXES you to give you your life back.

Connect with Cynthia Thurlow

Connect with Dr. Amie Hornaman

Books mentioned:

Estrogen Matters: Why Taking Hormones in Menopause Can Improve Women’s Well-Being and Lengthen Their Lives — Without Raising the Risk of Breast Cancer by Avrum Bluming and Carol Tavris

The XX Brain: The Groundbreaking Science Empowering Women to Maximize Cognitive Health and Prevent Alzheimer’s Disease by Lisa Mosconi

“I knew that with the hell I went through, there had to be other women going through the same hell.”

– Dr. Amie Hornaman


Cynthia: Welcome to Everyday Wellness Podcast. I’m your host, Nurse Practitioner Cynthia Thurlow. This podcast is designed to educate, empower, and inspire you to achieve your health and wellness goals. My goal and intent are to provide you with the best content and conversations from leaders in the health and wellness industry each week and impact over a million lives.


Today, I connected with Dr. Amie Hornaman known as The Thyroid Fixer. We dove deep into talking about how she became so passionate about thyroid management, the role of traditional healthcare labs and how they can miss, subtleties to thyroid dysfunction, the role of autoimmunity, molecular mimicry, the role of nutritional choices with thyroid management, several potential causes of weight loss resistance. We also touched on hormonal replacement therapy and how more often than not testosterone can be a missing link if women are really struggling with weight loss resistance, specific problems with Women’s Health Initiative study that we’ve talked about in prior podcasts and I asked her lots of questions about iodine, low-dose naltrexone therapy and berberine as it pertains to thyroid, and blood sugar dysregulation and management. I hope you will enjoy this podcast and find it as invaluable as I did. 


Welcome Dr. Amie. I’m so excited. We are connecting to talk about a shared mutual interest in thyroid and thyroid health.


Amie: Thank you. I’m so happy to be here. I love giving this information to any and all who wants to learn.


Cynthia: What got you so passionate about the thyroid? Was it during your training, or was it a family member, or yourself, or someone who was suffering from thyroid issues?


Amie: Pain to purpose.


Cynthia: [laughs] 


Amie: You know how most of us in this space, we’ve all gone through something that then piques our interest and we say hey, “Wait a minute, if I suffered with this, other people are too,” right? My story started many years ago. I was in my 20s, and I was doing fitness modeling and competing. You have to die it down and get really teeny-tiny to get on stage. By no means, I do not come from a skinny-mini family either, by the way. I have diabetes in my family, we have obesity in my family, and I’m 5’2″. I would always have to work my butt off to get that show ready shape that was necessary to compete. But no worries, I did it multiple times. This one particular show prep, I started gaining weight instead of losing. Now, I’m not a calories in, calories out kind of girl, but let’s face it. Biologically, it didn’t make sense that the scale was going up. Not if you looked at my diet of fish, chicken, broccoli, and asparagus. I was going to the gym twice a day. It just didn’t make sense. I did what we all do. I go to the doctor. I go to the doctor and I say, “Hey, doc, this is what’s going on.” Actually, I started with my sister. I blame her first because she’s a doctor and she’s a DO-


Cynthia: [laughs] 


Amie: -and she doesn’t know the thyroid. I give her a break but I like to blame her. She said, “You’re normal. Everything’s fine.” Then she referred me to another one of her physicians in her practice and they said, I was fine. I went to endocrinologist, they all said, “You are air quote, normal. You’re fine. Just eat less and exercise more.” I was like, “What the–? How is that even going to be possible?” It’s not even possible. I keep going, I keep going, I keep plugging away. Six doctors later, all misdiagnosed me. The seventh doctor touches my throat says, “Swallow.” She goes up, “You have a goiter on your thyroid. We’re going to run some tests, do an ultrasound, but here’s the pill.” I leave the doctor’s office, I’m like, “Yes, there’s a pill. Now, I’m going to lose weight. Now, I’m going to feel better. Yay!” Five months later, nothing. Not one single change. 


Now, looking back, I knew she gave me T4 for only. It was not performing all of the tests that we have to do to get that full picture of the thyroid. I do some research. Yeah, I joke around. I think I had my big old gateway computer at the time. I’m doing the Dr. Google thing that we all do. I find this thing called T3 and this test called reverse T3. I take this information to her and she goes, “Yeah, I don’t do that.” I wanted to find somebody who does. I kept hearing the name of this functional, integrative practitioner. You hear something three, four times, it’s God, the universe, whatever you believe in telling you, just call this person and go.” I call him. He’s now my mentor, changed my life, saved my life. Totally changed the trajectory of my career, which is why I’m here now. And it gave me my life back, did the right tests, the right supplements, the right nutrition, the right medication. And all of that mattered at the time in order to get my thyroid up and running again, in addition to testing everything else that goes along with thyroid dysfunction. So, that’s really how I came into this space. I knew the hell that I went through, there had to be other women, especially going through this same hell.


Cynthia: Well, what’s interesting to me and I say this as a traditionally trained allopathic provider is that I saw women every single day in clinic or the hospital that were counting the same situation. They didn’t understand why they were gaining weight, they were on thyroid replacement, most of them Synthroid, which for anyone that’s listening, that’s a synthetic version of T4. If you can’t convert inactive to active thyroid hormone from T4 to T3, your body can’t use it. This is where I think the traditional allopathic model really misses the opportunity to understand that it’s more than just providing T4. Because there are people who do fine on Synthroid or the generic alternative. But there are most who do not, and we have to really be looking at our patients as individuals, and I really commend you for not embracing or going along with the current status quo of, you are of a certain age and I’m not even sure what age this happened. I know you’re still very young, but whatever age this was occurring that you have very unsympathetic healthcare professionals who are like, “So what? You gain five or 10 pounds. That’s not a big deal. Look at my other patient population. They’re all morbidly obese. Why should you be concerned about this?” 


And yet, I think weight loss resistance to me is a sign of an imbalance somewhere that we need to determine. It may not be abundantly clear right away. You were alluding to the right task. When you’re talking with your patients about baseline labs, what are some of the tests that you commonly want done that the traditional providers are not doing. I think this is a really good way to start our conversation today, because this question comes up so frequently. I always say, “You need a full thyroid panel” and people are like, “What is that?”


Amie: Exactly. Because if you go into your doctor and you say, “Can you give me a full thyroid panel?” And you’re not specific with what you want on that panel, you’ll get TSH and maybe if you’re lucky, you’ll get free T4. That to them is a full “thyroid panel.” But what I like to see, we have to go deeper. So, “Okay, yes, we know TSH, free T4. Fine, fine, fine. T4 is inactive. Yeah, I like to take a look at it. Sure, I want to see what your pituitary is doing by testing that TSH, then we have to go deeper.” T3 is the active thyroid hormone. That we need to know how much free unbound T3 active thyroid hormone is in your body. Because that’s what’s getting into the cell. That’s what’s giving you a metabolism, and growing your hair, and allowing you to go to the bathroom every day, and making you feel good, and giving you energy to get through your day. We need to know what that free T3 level is. That is imperative. 


Then we also want to know what your reverse T3 is. Now, we’ll dive into a little bit more about what reverse T3 is. But in a nutshell, it’s the anti-thyroid hormone. Free T3 is the gas, reverse T3 brakes. We want to know both of those numbers. Then I want to know how many antibodies you have. If you have Hashimoto’s, TPO, thyroid peroxidase, and TG antibody, thyroglobulin antibody, we want both of those two. It’s amazing, Cynthia. How many doctors think you only have one–? We’re just going to test one antibody and call it a– No, let’s test two of them. Let’s test them both because there are two to see if this person has Hashimoto’s or not. To see if it’s an autoimmune condition, to see if we have to pay attention to the destruction of the thyroid gland. And then how much we have to really crack the whip on going gluten free because if there are Hashimoto antibodies, then we have to help that person along to be gluten free because of molecular mimicry, which we can get into as well.


Cynthia: Well, I think it’s really important for everyone to understand that you can have an autoimmune thyroid issue and have negative antibodies. I say this with love because I was one of those people. I’ve been gluten free for over 10 years and I reversed another autoimmune condition. And if you have one, you’re more prone to more than one. And so, I had psoriasis, after being treated for Lyme, very common. Cleared that with going gluten free, developed hypothyroidism in my early 40s and I never will forget my doctor saying to me, “Congratulations, you don’t have Hashimoto’s.” I was like, “Oh.” I’m one of those odd very small percentage of people that has non-autoimmune hypothyroidism. Well, I’ve come to find out that actually isn’t correct.


Amie: Right. 


Cynthia: My antibodies are probably negative, because I don’t eat gluten. If you’re out there and you have hypothyroidism, you can assume you have Hashimoto’s until proven otherwise. That is the bulk of people that have an underactive thyroid. I just wanted to shove that in there, because I, for many years, I was like, “This is awesome. I don’t have Hashimoto’s. Yeah, I do. I actually do. It’s in remission.”


Amie: Yep. 


Cynthia: But nonetheless, super important. When we’re talking about reverse T3, because this is a really poorly understood lab. It’s an easy one to draw, it is covered by your insurance, it is not a weird integrative medicine test. 


Amie: Right.


Cynthia: Let’s talk a little bit about this. Maybe for the benefit of listeners, who maybe are not as familiar as with these terms, T4 and T3, most of our thyroid hormone is in the form of T4, a very small percentage of it is in T3. T3 is the gas tank. That is what actually is the active thyroid hormone. And so, the role of reverse T3 is–


Amie: Yes. Let’s break this down. The role of reverse T3, we want reverse T3 because if you go into the hospital, you’re in a car accident, your appendix just burst, whatever traumatic state that your body is in, and you land in the ER, you land in the ICU, that reverse T3 is going up, because it’s going to protect you. It is built in our bodies to slow down all of those systems that don’t really have to be operating when you need to survive. When your body is in survival mode, you don’t need to burn fat, you don’t need to grow your hair, you don’t need to feel good. That reverse T3 will go up in order to shut those other systems down, so that everything that your body needs to heal and survive is there for you. It’s great. But here’s the thing. We don’t want reverse T3 high when you’re running around all day, taking the kids to school, and going to the grocery store, and running a business, and being a mom, and being a wife, and being an entrepreneur, and going to work. No, that’s the last time we want you with a high reverse T3. So, it absolutely needs to be tested. 


I love using analogy, so your listeners can understand. Here’s another one to think of. Even if you are taking thyroid hormone replacement therapy and hopefully, you are not on T4 only, because Cynthia said earlier on and I 100% agree, T4 to T3 conversion doesn’t always happen on its own without a little bit of T3 in the mix. We have to check all of those things that can come into play and hinder T4 to T3 conversion and raise reverse T3, and the list is long. Most of us don’t convert. We want to make sure that even if you are on thyroid medication, you’re converting that. Even if you are on something that contains T3, we want to make sure it’s getting into the cell. Reverse T3 is like a bouncer at the club, sitting outside your cell door. Now, think about this. Every cell in your body has a receptor site on it for T3, the active thyroid hormone. Every cell, your brain, your heart, every single cell. If reverse T3 is high, it’s like the bouncer with his arms crossed outside the club going, “Yeah, T3, you’re not getting in and you’re not getting in either.” It’s literally blocking T3 from getting to its receptor site that it so desperately wants. 


Even if we’re testing your free T3 to see how much of that active thyroid hormone is in your body, it can look really pretty on paper. If we don’t know your reverse T3, your doctor could easily say, “Well, look, hey, your TSH is good, free T4 is good, free T3 is good, you’re good.” And you’re like, “Wait a minute, no, I’m gaining weight, I’m tired all the time, my hair’s falling out.” If no one tests that reverse T3, you could literally be walking around in survival mode and all of that T3 in your system cannot get into the cell to do its job.


Cynthia: What are the most common reasons that you see clinically for individuals that are struggling with high reverse T3? I have a couple that I’ve seen in clinical practice. I think with our increasingly metabolically inflexible population, insulin resistance plays a huge role. But what are some of the other more common things that you are seeing in clinical practice?


Amie: I totally agree with you in some resistances. Number one, I had one patient I have to tell you about her reverse T3– Young girl, too, young. Reverse T3 was so high. It was actually flag high. Of course, we have functional optimal ranges and then we have that standard lab value range that you see on your labs. Her reverse T3 was actually flag high at a 35 or 37. Her insulin was a 57. I have never seen an insulin level that high. That was absolutely why her reverse T3 was elevated. 100%. Now, we also see estrogen dominance as a reason, low iron, anemia, low ferritin, low magnesium, low iodine, just a low nutrient status. There are genetic snips that can interfere with T4 to T3 conversion. The list is long and that’s why I get so confused and so irritated when patients will come to me, and just like you said earlier, Cynthia, this is not a wackadoodle new age functional test that we’re asking for. This is a standard test that should be part of every thyroid panel and I have so many patients come to me saying, “Well, I asked my doctor and they said, it’s only useful in clinical purposes.” Meaning, if you’re lying trying to survive in the ICU or the ER, yeah, of course, we want to test that. But again, like I said I want to know what is your reverse T3 when you’re walking around.


Cynthia: No, it makes complete sense. On a lot of levels, I’ve seen it high with stress. How many people over the past two years haven’t had more stress than they normally are dealing with. I also see it in that very type A woman, who thinks if a little bit of exercise is good, too much exercise is better, just like fasting. If a little bit of fasting is good, too much fasting is better. And so that particular personality, the people that want to do Orangetheory fitness five days a week with no recovery, and they restrict their carbs, and they measure everything, they’re very controlling in terms of how they look at their lifestyle choices. I always say, I applaud you for being so diligent, however. That amount of stress, and overexercising, and what is creating inflammation, and oxidative stress is not helping your body. If you’re listening to this and you fall into one of those buckets, there’s no judgment. But we have to be kind to ourselves. If the last two years have taught us nothing, we need to be kind to ourselves, we need to get out in nature more, we need to do a little less exercise. I’m all for exercise, but let’s be smart with our time. 


Amie: Right.


Cynthia: Now, I want to make sure that we pivot just a little bit to talk about a term that we’ve already identified, molecular mimicry. The reason why I mention this is, I am asked, I have a monthly group, every month I have someone that asked a question about this. Because they really want to be told that, “It’s okay to eat gluten if they have an autoimmune issue with their thyroid.” And so, I talked around the physiology, and talked about dairy, and talked about gluten. But let’s talk about what these actually do to our thyroid, how they impact leaky gut, how they can exacerbate our autoimmune disorder when we continue to eat these foods, which maybe if you don’t have an autoimmune issue are probably, potentially okay. I just say, potentially, because it’s oftentimes what’s done to gluten, what’s done to grains that creates a lot of these health issues. But I would love for you to get your insights on what this is doing in the body, so that someone else can explain it to my community and do it in a way that makes it a little more tangible.


Amie: Right. Okay. So, another analogy coming at you here. I always talk about any autoimmune condition. But we’ll focus on Hashimoto’s, today. Any autoimmune condition, you have a group of soldiers in your body. Those are the antibodies. Those are the TPO and TG antibody that I want you to have tested. That’s going to tell us how many soldiers you have that are– They’re just confused, they think your thyroid gland is an invader, they think it’s a bad guy. These soldiers go out and they attack your thyroid because they think, “Ooh, bad guy. We need to attack. We need to start a war.” Now, when you go gluten free, those soldiers like– You experience and I experience the same thing. Those soldiers can go down to zero, which is where we want them. We don’t want you to have soldiers in your body. You might always have that genetic predisposition for autoimmune, but we ultimately want to get those soldiers down to zero. So, they’re not going out. When you are gluten free, that is what allows those antibodies to continue dropping down.


Now, gluten. This is fascinating, actually, when you think about it. Gluten has a molecular structure, very similar to your thyroid gland. When you consume gluten and you have Hashimoto’s, your soldiers are prime for attack. They see that gluten coming in, they’re like, “Guys, it’s war. We got to go out, we got to attack this.” They go out and they start destroying that gluten molecule that very much looks like the thyroid gland, and then they move over to your thyroid gland, and destroy it more. Now, if you’re sitting there saying, “Well, wait, I don’t have a thyroid gland. I had a total thyroidectomy, I had radioactive iodine.” Okay, they’re going to go somewhere else. They’re going to move to your joints, and you’re going to get RA, they’re going to move to your gut, you’re going to get Crohn’s, maybe celiac, you don’t want that. You want your soldiers contained in their barracks and you want them to basically go down to zero. 


The other thing that occurs whenever we expose ourselves to gluten, you’re building your army. Now, those 10 soldiers might go to a hundred, might go to a thousand. Now, you have more destruction. More destruction happening to your thyroid. As your thyroid gland is destroyed, it’s not going to work very well. Just like when you’re sick and you have to stay home from work, you’re not doing much work that day. You are laying in your bed, right? A beat-up thyroid gland is not going to produce thyroid hormones that you need to feel good, to lose that, to have your brain function. It’s not going to work very well. We don’t want it beat up on a daily basis. You wouldn’t like that. If somebody came your house and beat you up, we don’t want your thyroid gland beat up on a daily basis. That’s why it’s so, so important. I think if you can picture that analogy and if you can think about it that way, that we have scientific proof that a gluten or gliadin protein molecule looks like the thyroid gland. You think about that every time you eat gluten. Every time you go, “Well, you know what a little bit won’t hurt.” Well, my friend, Susie, next door, she’s gluten all the time. She doesn’t have any problems. If you think about you and your particular autoimmune condition, if you have Hashimoto’s, and you’re eating gluten, you are slowly or you are quickly destroying your thyroid gland every single time. So, that should give you a little motivation to go gluten free.


Cynthia: Why do you think this is so poorly understood? Why do you think there aren’t more of us talking to our patients about this? 


Amie: Ah, that’s a really good question. I want to say because and I’ve said this forever. I think the gluten-free diet, whenever it came out had its heyday. Maybe I don’t know, seven, 10 years ago, maybe even longer. But it got a bad rap because people would implement “gluten free,” but they would go out and buy everything in the grocery store labeled gluten free. “Okay, well, I’m going to replace my cereal with gluten-free cereal, my bread with gluten-free bread, and my pasta gluten-free pasta, my cookies with gluten-free cookies.” And they’re still taking in high amounts of carbs and sugar, and inflammatory ingredients that are still as you mentioned earlier destroying your gut, producing leaky gut. So, going to the gut, let me sidestep there. We used to and I’m sure you’ve had guests on talking about this, but I’ll talk about it as well. We used to think that the gut from your mouth to your bum was a totally enclosed system. Tile and grout, tile and grout, totally enclosed. Now, we know that that grout isn’t so solid. It’s like a little swinging door. When we eat things that like pesticides, gluten, high-inflammatory foods that can open the door and these we call them in the functional world, LPS, lipopolysaccharides, they can get into the bloodstream and cause inflammation. 


Now, that doesn’t mean that they’re going to get in your bloodstream, you’re going to have a sore knee or a tennis elbow. It can create this full body inflammation. Meaning, it can inflame your thyroid. It can shut down production of thyroid hormone, or it can cause a migraine, or it can cause you to gain weight, it can cause a multitude of symptoms. But we know that these particular food groups cause that. When people, years ago went gluten free, they all said, “Well, I don’t feel any better. I didn’t lose weight. My inflammation didn’t go down.” It was because you weren’t replacing it with real whole food. You were replacing it with the gluten-free manufactured version, which still jacked her insulin up, which still created an inflammation, which still cause leaky gut. You didn’t even get the benefits of a true whole food, real food, gluten-free diet. That’s where I think it got almost brushed aside is like, “Oh, that’s another one of those new age fads that are coming out. It’s the next diet thing.” Well, no, it’s not. 


We have scientific proof. If you do it the right way, you can actually experience the benefits that should have been experienced years ago when it first came out. But nobody really told people, “Listen, don’t just go to the grocery store and purchase everything labeled gluten free. That’s not what you want to do.” No one guided anybody back then. But now, we know. So, I think our job as practitioners is to talk about it more, is to educate the population, so that they can understand the why. I think when you understand the why, when you know why you’re doing something, when you know why you’re giving up something that maybe is really hard to do, it sticks more. You have that motivation, you have that reason, you have that carrot dangling like, “Okay, I’m going to feel better, and I’m going to lose weight, and that’s why I’m doing what I’m doing. That’s why I’m eliminating gluten.”


Cynthia: Well, I think it’s a really good point and certainly, a very important one to that as we are transitioning to a more nutrient dense diet that we are conscientious about the food choices we’re making, and I’m always very transparent, and I tell everyone, “I don’t buy gluten-free bread, I don’t buy gluten-free cookies, I don’t buy any of that stuff,” because I am the type of person that if I eat one ant I’ll eat several and I do better having a piece of dark chocolate because then my brain goes, “Okay, we’re satisfied. We move away.” But flour, gluten-free flour, regular flour, etc., it is still like mainstreaming cocaine. Because it gets instantaneously into your bloodstream, it lights up our brains, we get this dopamine surge, we feel good. One of the challenges I always have and I’m sure you probably do as well is that when I encourage people to go lower carb, they’re like, “Oh, I can have the almond flour, this, and the almond flour that.” Well, yes, that’s lower carb. However, we’re still not getting away from these highly processed flours. Part of the challenge in our world where whether it’s keto, whether it’s low carb, whether it’s paleo, primal, etc., it’s all this highly processed hyper palatable food. I don’t care how you label it. 


I was just at a keto event with a bunch of wonderful individuals. One of the sponsors, who will remain nameless, my husband was with me, and he was trying some of their products, and I’m dairy free, so, a lot of what they had was not a good choice for me. I happen to flip over one of the packages of stuff that they had and one of the sweeteners was sucralose. As an example, here we are, artificial sugars. But if someone’s coming from eating like Ho Hos, and Ding Dongs, and Twinkies, this is healthier, but those artificial sugars, we know they disrupt the gut microbiome. You were just talking about that. And so, I think it’s just this building awareness of, “Okay, if you really want bread, you shouldn’t be doing it often and you really should try to find something that’s less processed, or make it from home, or make zoodles instead of pasta.” Just find healthier options, I mean, we’re both realists. But I think it’s the hard truth is you just need to eat less processed food. That’s really the best way to support not just your thyroid, but your physiology in general. 


Most if not all, women that are listening to this podcast are north of 35. All of a sudden, our carbohydrate intake has to change. It doesn’t mean no carbs, it just means you can eat endless amounts of pasta, and rice, and bread, and think that you’re going to maintain metabolic flexibility. This is a great segue to talking about weight loss resistance. A lot of the hormones we’ve touched on like insulin, and leptin, and thyroid hormone, and obviously, as someone that used to do bodybuilding, I can imagine that when you got into this position where all of a sudden you were gaining weight, not losing weight, knowing that you had a methodology that was working effectively when we’re looking at women north of 35, perimenopause, menopause, this is a huge problem and it’s a source of frustration. I’m endlessly supportive and loving in my approach because I know how frustrating it can be. Even more, so, for people who’ve never struggled with their weight, they’re like, “What am I doing wrong?” That’s how I came to intermittent fasting, because I was like, “Something is not working. I need to try a different strategy.” So, when we’re talking about weight loss resistance, when you’re working with your patients, what are some of the things you’re thinking about that they might be doing that are making this harder for them to lose weight?


Amie: If we start at the top with the master gland, thyroid, we have to optimize that first, downstream from that, like you mentioned is insulin. 99% of hypothyroid Hashimoto patients have insulin resistance. That has to be addressed. It has to be. And I always talk about “it’s not fair syndrome,” because we go through this. Even if you aren’t north of 35 or you were just diagnosed with a thyroid condition, you go through this, it’s not fair stage. Like I mentioned, Susie, your neighbor earlier, you look at Susie, and you go, “Wait a minute, why can she eat her gluten-free bread, and her fruit all day long, and throw in some whey protein? Why can she eat that way, but I can’t?” Well, it’s called insulin resistance and a thyroid problem. That’s the double whammy to weight loss resistance. Thyroid problem, insulin resistance. The triple whammy is low testosterone with that. Testosterone, I call it the GSD hormone. Get stuff done hormone. 


Cynthia: [laughs] 


Amie: You need it to get stuff done. Motivation, sex drive, fat burning, muscle building, brain function, and again, that is a test. It’s a lab value that is lost in conventional medicine. Because there definitely is an optimal range. As women, we get stuck into this standard lab value range that is huge, wide, vast. If you fall in the lower part, but you’re still in that range, and you’re not flagged, and that lab value isn’t red, and you don’t have an H or an L next to it, you are forgotten, you’re dismissed, you’re told you’re normal, everything is fine. In conventional medicine, you could have a testosterone of a 3as a woman and still be called normal, because the cutoff is 2. Do you know how you’re going to feel with a testosterone level of a 3? You’re not going to burn fat at all. Weight loss resistance out the wazoo. Low testosterone actually triggers Hashimoto. That is one of many things that can flip that autoimmune switch for Hashimoto’s. Any kind of stressor like pregnancy, perimenopause, hormonal changes, low testosterone will flip on that Hashimoto switch.


Now, you’re entering that triple whammy zone of weight loss resistance with low testosterone as well. Optimal in my book, over 50. Again, and this is total. There’s total and free testosterone that we can check on you. But when you’re looking at the total, I want that number over 50. And again, you could be called normal if you come in at a 3, at a 5, at a 10. That’s not normal. That’s not enough testosterone. Testosterone is also almost villainized with women because you do have the bodybuilding circuit that’s abusing it. When you tell an average soccer mom, 45-year-old woman, “Hey, your testosterone is in the tank.” We need to do some bioidentical hormone replacement. I don’t want to look like a dude. You have no testosterone. That person over there that’s abusing it has male levels of testosterone. Let’s find a happy medium for you. You can get stuff done. So, you can feel like a badass rockstar like you’re meant to feel. Testosterone is that third component, whenever we’re talking about weight loss resistance.


Cynthia: I love that you brought it up because not only is it not talked about a lot and I did a great podcast talking about testosterone replacement therapy with Dr. Kyrin Dunston last year, because for many, many women it is the missing link. And unfortunately, it’s a controlled substance. Obviously, you have to have it prescribed. I find most women do better on creams than they do on injectables. But obviously, it’s different and unique for each woman. My own practitioner was saying, “I don’t like to use injectables, even if it’s subcutaneous all that often because it can be a little less predictable.” And he said, “Sometimes, women will have these overt insane libido drives,” which maybe their partner’s happy, but they get to a point where like, “I understand what it must be to be a younger person, because all I’m doing is thinking about this one activity and I can’t get work done.” But for those of us that have experienced low testosterone, I can tell you, you feel unmotivated, you struggled to put muscle mass on, even muscle definition, your libido goes in the toilet.


I hear from a lot of women and I’ve experienced this myself until it was replaced. I remember thinking, it was a whole different world. It’s not just the superficiality of seeing its muscles, the organ of longevity, it’s obviously critically important. Our libidos are important, our motivation is important, but it’s also understanding that the brain physiology. It is not just testosterone, it’s not just estrogen, it’s not just progesterone that our bodies need the testosterone signaling in our brains, with our bones, with our muscles. We, sometimes, lose sight of this. I think the Women’s Health Initiative that it came out in 2002 has really done us a disservice. Us, as women, obviously your mother’s generation, my mother’s generation really suffered through this and we can see a lot of the side effects that have come out of that. But our generation is demanding better care. I always say, I’m hopeful that my nieces, I have three of them that they are going to get better care because we are advocating for all women. But it is completely unacceptable for women to suffer when what they really need to consider with the right practitioner is replacement, whether it’s with thyroid hormone, whether it’s treating the insulin resistance, whether it’s addressing the thyroid, excuse me, the testosterone needs estrogen, progesterone, etc., all of us, it’s not a stew.


We all have to have different ingredients, because each one of us are bio individuals. But no woman should have to suffer in middle age. That’s something that has become abundantly apparent to me having the opportunity as I’m sure you have and talking to different women. I have women in their early 60s, who are smart, and they have suffered for years with brain fog, and poor sleep, and forget about their libido. I just interviewed Dr. Tabatha yesterday, and we were talking about some of the changes that go on in the vagina, and the vulva, and throughout the body, and she was saying, “Too many women I see, who haven’t had sex in 10 years, maybe their partner passed away, maybe they lost interest, and they’ve gotten to a point where they no longer can have sex comfortably.” I always say we need to be intervening years, and years, and years before this happens, so that women can make the best decisions for them, and they can find the right provider that’s going to be able to support their needs in a way that aligns with their own wants and needs.


Amie: Absolutely. And I’m glad you brought up the Women’s Health Initiative study, because I still have even young women, even our generation and younger are still, and I use this term very lovingly and very loosely, brainwashed from what they’re– Because it comes back to their doctor. Their doctor, who educated them that hormones are bad, because we have this study that shows that it causes cancer. Their doctors are stuck in outdated information. And not even so much outdated, but we have to look at what happened in the Women’s Health Initiative study. They use synthetic hormones. They did not screen and remove sick women or preexisting conditions. They didn’t do any of that. We could dive in for an hour on just the Women’s Health Initiative study on its own, but I’m still finding women that are being told misinformation if I can use that term. Misinformation by their PCP, by their general practitioner, or by their OB-GYN. It’s the doctor’s responsibility to come into 2022 to get educated, to stay educated, to stay updated. It’s very, very similar going back to the thyroid. I will still hear practitioners say, “Well, your TSH is suppressed. So, we need to drop your thyroid medication.” Meanwhile, these women are still suffering. They’re like, “Wait a minute, I don’t feel well still. I still haven’t lost weight, I still have this brain fog, and you’re going to drop my thyroid medication?” Again, it’s these doctors that are focused on TSH alone because that is what they learned. 


I actually gave a talk to a group of integrative wellness practitioners that even though, they’re integrative, even though, they’re functional, even though they have that term, “Ladies, you have to make sure that they specialize in thyroid and hormones,” so, I gave a talk to this group of docs that want to learn more about the thyroid and I said, “Why are we still in the Synthroid box? Why are we still in the low TSH, it’s scary, and it’s going to break your bones, and cause a heart attack box?” We have the studies to show that that’s not true anymore. Let’s move out of that. We have more than Synthroid. If your patient had depression, you would put them on five different antidepressants plus an antipsychotic, and Xanax but you won’t do anything other than Synthroid. Why is that? One doc raises his hand goes, “That’s all we’ve learned.” Well, thanks for being honest. But my God, get out of the box, so you can treat people, so you can actually help people feel better because that’s what our job is. We have to stay updated on the latest research, on the latest information, and not be scared and not have a fear that it’s based in misinformation or outdated information.


Cynthia: Well, I think it’s the know better do better I tell everyone. I graduated from my Nurse Practitioner program in 2001 and the following year, the Women’s Health Initiative came out. I remember saying to my mom, “Oh, my gosh, you need to get off–” I think she was on Premarin. “You need to stop Premarin and progesterone. This is bad.” I’m watching a whole generation in my family that are suffering needlessly. My one aunt, my dad’s sister had her hysterectomy done in her 40s, because she had heavy periods and that’s what they offered her. And she said, “No one ever talked to me about hormone replacement therapy.” And now, she’s small bone like I am, and osteoporotic, and my mom is osteoporotic, and trying to talk to my mom like, “We can’t now reverse everything. You’ve been without estrogen for 20 years.” With the impact on brain, and bone, and heart health is significant, not to mention all the other symptoms. I think it’s important if you’re listening to this podcast and you haven’t listened to my podcast with Dr. Avrum Bluming and Dr. Carol Tavris, I really encourage you to listen to it and their book, why Estrogen Matters. They recommend it almost daily. Another great book is The XX Brain by Dr. Lisa Mosconi. I hope to be interviewing her this year. It’s been tough working around her availability, but I do hope, because I recommend her book quite a bit. But those books really shifted my perspective. And certainly, when we talk about the Women’s Health Initiative, we talk about know better do better. This is why it’s so important for us to be having these conversations and why this is so invaluable. 


Now, there are some things that are controversial about thyroid. When I say controversial, you talk to a variety of different practitioners, whether they’re integrative docs, whether they’re nutritionists, whether they’re NPs, whatever their title is. Iodine appears to be fairly controversial. I have Brownstein’s book, he’s proiodine. I’ve interviewed Dr. Alan Christianson, who is anti-iodine. Let’s talk about iodine. We know it’s a trace mineral, it’s used to create thyroid hormones, T4 and T3. We don’t just have it in our thyroid, which I found fascinating. We find it in our breasts. People have fibrocystic breasts, oftentimes, it’s because they’re low on iodine. Most are found in the eyes, and the gut, and the cervix, and saliva, so, it’s everywhere. But what is your position on iodine? Are you forechecking iodine and replacing, are you conservative? What are your thoughts?


Amie: Let me start by saying, I, too, have read Brownstein’s book. I’m still working on getting him on my podcast. He is impossible to get in touch with. I have interviewed Dr. Alan Christianson as well and read his book. I see both sides of the story. And really in the functional space, you’re right, Cynthia. That is split down the middle. Literally, 50% of functional, integrative, out of the box thinking practitioners will say, “No, no don’t use iodine with Hashimoto’s patients.” The other 50% will say, “Use it.” I fall into the use it, because if you really break it down and look at what iodine is and what it does. We were talking about reverse T3 earlier. One of the causes of elevated reverse T3 is low iodine. The thyroid needs iodine to convert that T4 over into T3, so, it doesn’t convert to reverse T3. We need iodine. We do. We need it for our immune system, we need it for our breast health. You’re absolutely right. Fibrocystic breast patients, they love iodine because it takes that away and they’re much more comfortable. 


Dr. Brownstein has used it in some breast cancer patients as well. You can dive into his work and read up on that. But it’s such an important trace element and it’s in the periodic table. It’s amongst all of the other halides. When we look at the halides that are toxic to our thyroid, we have fluoride, as in your fluoride toothpaste, yeah, you want to cut that out. Chlorine, and bromine-bromide. Iodine will actually bind to those toxic halides, and excrete them, and help to excrete them out of your body. It’s a wonderful protectant to the thyroid as well. Now, I think again why it got a bad rap is because there are some practitioners that were using massively high doses of iodine with our patients, massively high. Those patients went into either a thyroid storm where they went severely hyper or they dropped into a deeper hypo state. But again, if we can just find a happy medium, we don’t have to eliminate it and avoid it. We don’t have to use massively high doses. Let’s just use a nice therapeutic middle of the road dose for support. Everybody is unique and everybody’s individual. So, it does help to be working with a practitioner that can help you titrate up and titrate down. But if we just find that middle ground– 


Now, when you’re talking about testing, I’m still diving into this, because again, you will find a different opinion on how to test iodine for absolutely everyone. I was interviewing Barton Scott on my podcast, and we were talking about the hair mineral analysis, and we’re talking about iodine. It’s funny sometimes when you interview a guest. They say something that clicks and you go, “That’s it. That’s the point I’m standing on.” He says it just nonchalantly, he was like, “Well, every cell in your body needs iodine and there’s no definitive test. So, we don’t even include iodine on our test because how about you just take it, because you need it?” I was like, “Oh, I like that.” You can get into testing deep, provocate with a high dose and then catch urine for 24 hours. Do you go by blood, do you go by hair? There’re so many different testing methods out there for iodine, no one can decide which one is right. So, how about you just find that middle ground and take it, because you need it and it’s going to help you. Don’t take too high, don’t avoid it completely, just find that middle ground.


Cynthia: It’s interesting how much things have changed as it pertains to iodine, because when I started several years ago in the functional space, we’re using the Hakala. Urinary testing appeared to be accessible and reasonable. And then we were all paranoid about repleting with iodine. You would do like lugols, where you would tell people to go eat a bunch of seaweed and then after Fukushima, where you have to source it from a non-irradiated [laughs] type of seaweed. And so, that became a sourcing issue. To me, it makes sense that probably in our modern day lives that we do need some repletion. The question is, how much? That’s always the question that I have. I appreciate that you talked about that so thoughtfully. It’s interesting to me how not just iodine, but also things like low dose naltrexone have become more popular. I’m seeing a lot of patients, not patients that I’m prescribing this for, but people I work with that I share patients with that are going on LDN and finding that this is the thing that is reducing inflammation and reducing it not just systemically, but at the cellular level, and allowing them to have improvement in insulin resistance, and stimulating their pituitary, and their growth hormone, all these amazing things. When I dove down the rabbit hole preparing for this, I was like, “Because I don’t prescribe this medication, I understand fundamentally how it works.” But I wanted to make sure we could have a fruitful discussion. What are your thoughts on LDN?


Amie: I love LDN for most people.


Cynthia: [laughs] 


Amie: Just like you said, low-dose naltrexone, and we’re talking a very low dose. If we’re looking at naltrexone, that’s usually in the milligram range of 50 to 100. It’s used for alcoholism, opioid addiction. That’s high does. That regular to high dose naltrexone. Low-dose naltrexone is in the 1.5 to 4 milligram range. We use very low dose. It’s usually compounded by our compounding pharmacy. We start off very slowly. We’ll start with 1.5, we will titrate up over the course of a few weeks to a month until we hit that 4-milligram dose. It has been shown to lower antibodies in any and all autoimmune conditions. I was actually speaking to a dear friend of mine that has MS and is in a wheelchair, and he was doing research into vitamin C drips. I said, “Talk to your doctor about LDN.” Because MS is autoimmune. It works on all autoimmune conditions to lower that antibody attack. It lowers inflammation of any kind. It definitely improves insulin sensitivity. That’s one big thing that when we use LDN with Hashimoto patients, they get a double bang for their buck, because we’re lowering their antibodies. Like I said earlier, 99% of Hashi patients, hypothyroid patients have insulin resistance. So, now, we’re improving their insulin response or improving that insulin sensitivity. 


In addition, of course, changing diet and using other supplements to help that along. But LDN does work with insulin resistance.  Lot of patients that will start that will report that they lost a couple pounds. Well, yeah, you’re reducing inflammation, systemically, full body and you’re improving your insulin sensitivity. Now, the population wise in most people. There is a small part of the population that will be affected mood wise by LDN and they’ll develop almost a flat effect, like, antidepressants take away your feelings. That’s what LDN does in a small subset of the population. I’m very much an advocate, like I said earlier, of finding a practitioner to work with. If you have a thyroid problem, if you have dysregulated hormones, if you have both, if you’re not sure yet, find one that specializes in thyroid and hormones. Because what I see sometimes is that, because that particular practitioner tried LDN on themselves or one patient and they had that experience of a flat affect, they won’t prescribe it to anybody. It has so much potential. It can help so many people. And guess what, if you have that experience, you stop it. Low to no side effects, low to no side effects whatsoever. It’s one of those kinds of like, “Why don’t we just try it? See how the patient responds. If it helps, awesome. If they get a little bit wonky on it, we stop it.” It’s that easy. And then it’s in and out of your system. So, I love it. I love it for Hashimoto’s, I love it for insulin resistance, I love it for inflammation, high hs-CRP, it just does so many different things that benefits the body.


Cynthia: Well, I feel it’s talked about, but probably not proactively enough because I have seen clients that are concurrently working with someone that prescribes it or friends that have gone on it that it’s been life changing for them. If you’ve got Hashimoto’s, and you’ve got insulin resistance, and you’re really struggling, this is definitely a medication that you want to have a discussion with your healthcare professional about. You probably need to work with someone that’s functionally or integrative medicine focused. Obviously, we’ll put links to IFM. That’s usually my go to, if I don’t know someone personally and if someone’s not in a state where I have friends that practice, and I know are leaning into these things. The only other thing I wanted to talk about and again, it ties into this insulin resistance piece. There’s a lot of good research that berberine is as efficacious as metformin or Glucophage. And so, there’s a lot of women who are insulin resistant, especially as we’re heading into perimenopause, and menopause, and we struggle with carbohydrates, the right types of carbohydrates, how much sleep etc., or using a lot of berberine with your patients. And if so, how much are you starting with? 


Because the interesting thing about berberine is, it’s not just an insulin sensitizer. It also is an antimicrobial. So, sometimes people will say, “I took berberine and I started having diarrhea or loose stools and so a little bit dosage related.” There are many ways we can use berberine with patients and with symptoms, but as an aside, it’s also a potent antimicrobial. I’ve actually had women using berberine for insulin resistance or concerns about that who end up getting night sweats because their blood sugar’s dropping so precipitously. It’s actually waking them up and we’ve been able to capture the data because they’ve got a continuous glucose monitor. But I’m curious, are you using much berberine, do you like it?


Amie: Love. Love, love, love berberine. I love it. I have been using it for many years, many years. The therapeutic dose is 1,200 milligrams per day. Whatever company you’re using, I actually have a berberine supplement coming out where I increase the dose to 600 per capsule, because sometimes, it’s really hard. Most companies have 400 milligrams. A person has to take it three times a day to get to that therapeutic dose where it actually does start impacting the insulin regulation, blood sugar regulation but it’s so much easier, just take it twice a day with your main meal. If you are intermittent fasting, take it with lunch and dinner and that’s it. You don’t want to take it on an empty stomach, because that is where you get a little bit of GI distress. And yes, very similar to metformin, there are so many studies on berberine. So many. All positive, amazing. Similar to metformin, it can produce a little bit of a laxative effect, but that’s also telling us, berberine is used as part of a gut healing protocol. That’s telling us that your GI tract needs a little bit of love. 


While we might back off the dose of berberine until someone gets used to it, and their bowel movements balance out, and they’re not having the loose stool anymore, and then we’ll increase the dose again, even though, that’s happening, it’s not necessarily something to panic about unless it goes on for weeks and weeks on end. And then, okay, we might have– Maybe berberine just isn’t for you but I very rarely see that. Most of my patient population can start it, titrate up, get to that therapeutic dose, and their bowel movements balance out. In the hypothyroid community, Hashimoto community, most of them are constipated. They’re like, “Bring on the berberine because I want to go to the bathroom every single day.” I absolutely love it. Like you said, it’s antimicrobial, it’s antibacterial, it’s a potent antioxidant. I absolutely love it and I actually have a case study out. Now, this is not with the Hashimoto patients. I’m diverting a little bit, but it’s pretty powerful. 


I have a case study that I wrote with a colleague of mine that was published and it was one of my patients that came to me as an insulin-dependent diabetic. He checked himself into the hospital, he knew the signs and symptoms of high blood sugar, his blood sugar was 600, his A1c was 13.9. They put him on insulin, he laughs, he called me, he’s like, “No, I’m not doing insulin the rest of my life. We have to do something about this.” I’m like, “Okay, well, give me time, give me time.” I never thought it would be this quick. I said, “Give me time and we’ll do this.” We changed his diet, started intermittent fasting, he was already on metformin, incorporated berberine. Because there’s a lot of studies that show that metformin and berberine work together very, very well. In six weeks, he was off of his insulin. His A1c dropped to 8.4. Doctors are happy enough to take him off the insulin. His blood sugars went from 600. There was still on 300 hundreds. Six months, reversed his diabetes. A1c down to 5.4. Blood sugars at 80, 90, 120, 130, that’s it. Amazing effect, amazing effect. So, yes, I very much love berberine.


Cynthia: How about chromium GTF?


Amie: I’ll throw that in. There’s not enough hardcore evidence. I want to say enough power behind chromium. For me to say, use this on a regular basis, I would pick berberine all day long. In the interest of maybe saving money, but if it’s already in your berberine supplement, hey, bonus that’s fine. 


Cynthia: How about inositol? 


Amie: Another one that I will stack with berberine for patients that are really moving out of the insulin resistance space and are already stepping their feet into full blown type 2 diabetes. So, then, I’ll stack inositol with berberine, again for that one, two punch on the blood sugar and insulin control.


Cynthia: No, it makes sense. I’ve been using a lot of inositol at night with patients just seeing improvement in overnight blood sugars, because I think one of the blessing/curses of a continuous glucose monitor is that then people are constantly looking at data. Some people are interested in their data and they don’t perseverate over it. Some people are interested in their data and then they become obsessive about it. I think inositol to me has been more efficacious than chromium GTF. I feel chromium GTF is like regular gas. If you want to step it up, there’s the berberine. I think inositol can be a nice accompaniment, but I’m seeing good use of inositol before bed to help a little bit with sleep, help with blood sugars. That’s where I’ve seen it to be most helpful.


Amie: I like that. Yeah, I like that stack.


Cynthia: Yeah. 


Amie: That’s perfect. 


Cynthia: Well, Amie, I want you to let my listeners know how to connect with you, how to connect to your great podcast, which I’ve had the great fortune of being a guest on. How can they hear more about your programs and learn more about you?


Amie: Absolutely. My podcast is The Thyroid Fixer Podcast. It’s on all podcast platforms. Wherever you listen, you can find me there. You can go to my website at dramiehornaman.com. And if you are interested in learning more about working together, you can book a free assessment call, so, we can go over everything with you and see if you are a fit, if we’re the right fit for you to help you out with your thyroid and hormone problems. And then of course on all social media platforms. Instagram, @dramiehornaman, same as YouTube, Facebook. You can find me everywhere. So, I look forward to connecting to your audience.


Cynthia: Awesome. This has been a great conversation. We look forward to having you back.


Amie: Thanks, Cynthia.


Cynthia: If you love this podcast episode, please leave a rating and review, subscribe, and tell a friend.