The main cause of thyroid disease with Isabella Wentz
Hashimoto is the most common cause of thyroid disease in the country, and it can cause destructive symptoms long before an ordinary doctor makes a diagnosis or offers treatment. And here the functional approach is different. In this episode of Revolution Health Radio, I talk with renowned thyroid specialist Isabella Wentz about how functional medicine can quickly identify the root cause of thyroid disease and help people feel better faster.
In this episode, we discuss:
- Isabella's Experience with Hashimoto
- The relationship between the thyroid and fertility
- The problem with the usual tests of the thyroid gland
- Autoimmunity and Hashimoto
- How to use food as a cure for thyroid disease
Show notes:
Hello everyone, Chris Cresser is here. Welcome to the next episode of Revolution Health Radio. This week I am very pleased to welcome Isabella Wentz as my guest. Isabella is a world-renowned specialist in the thyroid gland and a licensed pharmacist who has devoted her career to eliminating the root causes or causes of autoimmune thyroid disease after she was diagnosed with Hashimoto thyroiditis in 2009. She is the author New York Times patient guide Hashimoto's thyroiditis: life interventions for finding and treating the root cause and the newly released protocol-based book Hashimoto Protocol: a 90-day plan to eliminate thyroid symptoms and return to life,
I have known Isabella for some time. I really respect her approach. I think this is reasonable and balanced. And we look into the eyes on many topics related to the thyroid gland and autoimmunity. I am very happy to talk to her about her latest book, which Food Pharmacology HashimotoHe is considering a nutritional approach to solving autoimmune dysfunction, especially with the help of Hashimoto. I hope you enjoy the interview as much as I do. Let's dive in.
Chris Cresser: Isabella, thank you very much for joining us. Nice to see you on the show.
Isabella Wentz: Thanks so much for accepting me, Chris. I was a longtime listener. So glad to be on.
Chris Cresser: Fine. So let's start with a little about your past and your story. I know a little about it, but some of my listeners may not know about it. So how did you finish this job? How did you come to this?
Isabella's Experience with Hashimoto
Isabella Wentz: So, I became a thyroid pharmacist as a result of my own wellness journey. I, full disclosure, I was never interested in the thyroid gland during the pharmacy school. I thought it was a very boring condition, when you just gave someone a thyroid hormone, if he had an inactive thyroid gland, and you suppressed the production of thyroid hormones, if they have a hyperactive thyroid gland. And little did I know that many of the symptoms that I had at the pharmacy school were related to my thyroid condition.
Only a few years after graduation, these symptoms only accumulated, and every year I had more and more symptoms when I conducted additional testing and found out I had HashimotoAnd I wanted to become the healthiest person I had with Hashimoto, and maybe find ways to slow down the progression of a condition for some of its symptoms. And it was in this way that I became an Hashimoto expert / guinea pig, really trying to recover with the help of some of these lifestyle interventions that simply were not the standard of care at the time I was diagnosed.
And as a result of my own wellness journey and restoration of my own health, I was able to work with other people who had very similar symptoms. It's amazing how many things that helped me, ultimately helped them, and from that point on, just deepened my knowledge. So I have been doing this job since I started 10 years ago with my own diagnosis.
Chris Cresser: Well, let's talk a little more about this diagnosis, because I am always curious how people interact with the conventional system. And this is a little different, because you were a practitioner yourself. But have you seen a doctor? What did they test initially? Have they diagnosed you with Hashimoto? Or did you find out for yourself through your own reading?
Because, as you well know, many people come to the doctor, and the doctor will simply test for TSH, that's all. And if this is “normal,” and I’m making air quotes here, let's say it’s 4.25, which is considered normal in a regular system, this is the end of the story. But, of course, you cannot diagnose Hashimoto only with the help of the TSH test, which most people get. So how did this happen to you?
Isabella Wentz: Wow, yes, I mean, because, I think, the average person, the diagnosis takes about 10 yearsAnd I would say that for me was quite similar. I had symptoms, probably as a child, because I was exposed to Chernobyl, and then I had a pediatrician, and my mom actually tested my thyroid function when I was a teenager, because she thought my thyroid looked puffy .
The traditional approach becomes very wrong when it comes to diseases of the thyroid gland. In this episode of RHR, I talk about how a functional approach can identify and treat the underlying cause of thyroid disease. #wellness # chriskresser #functionalmedicine
Chris Cresser: Right.
Isabella Wentz: And at that moment my TSH was normal, so she took me to an endocrinologist, a children's endocrinologist. Then I started having symptoms again in my first year of study, I was depressed, and all these strange things just happened to me that were not like me. And I finished, I was a good girl, I was a student before medical care, so I always went to the clinic and did everything that you had to do.
And I always came back, and they said: “No, everything was fine. It's okay I was exhausted. At some point, I was diagnosed with the Epstein-Barr virus, when I, I think, was a sophomore in college. They said, “Oh, you are recovering from this. That's why you were tired last year. ” I said, “Oh, great. That would be good to know last year.
Chris Cresser: Which is interesting because it is one of the possible triggers of Hashimoto and autoimmunity.
Isabella Wentz: This is a triggering or aggravating factor for many people, so we just don’t appreciate it. I think we, you and me.
Chris Cresser: It is not widely known, it is true. So, you are studying in college, returning to the clinic, but at the moment they are just looking at TSH or maybe at T4 and T3. Has anyone else tested your antibodies at this stage?
Isabella Wentz: No, definitely not. And then, every year after graduation or after undergraduate, I developed irritable bowel syndrome. And then they said: “Oh, that's because there was such a stress in the pharmacy school,” which, of course, was.
Chris Cresser: Right.
Isabella Wentz: And then it was acid reflux, then allergy, then hair loss, and then brain fog. And I came back, and everything was fine. "No, you have no anemia, your thyroid is fine." At some point, I got the results of my thyroid test, and it looked like your TSH is 4.5, all right.
Chris Cresser: Normal.
Isabella Wentz: Everything is fine. And I was, for example, about 20 years old, and now I know, of course, that I was like a sloth with TSH of such a number, and, as a rule, we want it to be about one for most people over 20 years old. Then it was, I just kept going, because I had all these problems, and I ended up going to an allergist, because I was allergic to everything. And it was she who discovered in me these high antibodies to the thyroid gland. And they were antibodies to TPO, but at that time there were more than 2000 of them.
Chris Cresser: Wow, yes.
Isabella Wentz: Yes, it was a long way.
Chris Cresser: Right. And if someone checked these seven or eight years ago, when these symptoms started, they could get a little worse, and it might be possible to intervene there and slow down or stop or reverse the progression of it. Of which, of course, we talk a lot in functional medicine, right? This idea identify pathology at an early stage before it manifests itself in a diseaseBut your experience is a great example of where it may fall.
Isabella Wentz: Of course, because at that moment, when I was diagnosed, I already needed a thyroid hormone. If I had been diagnosed five, 10 years ago, potentially I could have prevented depression, fatigue, carpal tunnel, all these symptoms. And I could possibly prevent the use of drugs. But we know that it is much easier to prevent damage to an organ than to grow it back.
Chris Cresser: Absolutely, absolutely. And this, I mean, I feel that your experience with Hashimoto as a whole is such a good example of the need for a functional medicine model. Because, as you explained, both the appearance of antibodies and the organism, which affects the production of antibodies and attacking the gland, usually precede the development of actual hypothyroidism or clinical signs and symptoms by year, if not by decades. And therefore, if you are just waiting to see a high level of TSH and a low level of thyroid hormones, you are short of years or, again, decades, when you could intervene and stop the progression of this condition. And still antibody testing is not part of the standard of treatment so far,
Isabella Wentz: And this is so backwards, because antibodies appear earlier than you see changes in thyroid hormones and TSH.
Chris Cresser: Yeah.
Isabella Wentz: And this is so regrettable, because on any day when you are testing TSH, there may be days when you have thyroid disease. But since you still hesitate in the early stages of Hashimoto's development between hypo and hyper with thyroid gland destruction, you will add thyroid hormone to your system with each attack on the thyroid gland. And you can test with normal TSH on some days, with elevated TSH on some days, and with low TSH on some other days. So this is a kind of luck nobody, if you are not in a really far advanced hypothyroidism.
Chris Cresser: Stages of it. Yeah. I constantly remind my patients and readers of this. This is TSH, I remember a couple of studies suggesting that you need to test it about 15 to 20 times to get the true average value, because it is so changeable day after dayAnd there are also some studies that, as I know, you know, suggest that TSH has a circadian rhythm, such as cortisol. So it fluctuates even during the day. Therefore, if you test it at different times during the day, you will get different values.
And so difficult, as you mentioned, for someone who is trying to understand it, if you rely only on TSH because of this recurring-remitting future of the early stages of Hashimoto. I see this all the time in my patients, where we regularly test the thyroid gland. And they can bounce back and forth between hypothyroidism, normal thyroid function and hyperthyroidism, even at that early stage when they flare up. And it is simple, really impossible to understand if you look only at TSH and do not test free T4 and free T3, as well as the antibodies to the thyroid gland themselves.
Isabella Wentz: Yes, I am a big supporter of testing for thyroid antibodies. So, antibodies to TPO and antibodies to TG, if you have suspected thyroid disease and you are a woman. I just had my first child last year.
Chris Cresser: Oh, congratulations.
Thyroid and Fertility Compound
Isabella Wentz: Thank you so much. And I know that many women have a miscarriage, or they can't get pregnant due to thyroid disease or even thyroid antibodies. Therefore, I would say that every woman of childbearing age must pass these tests. Anyone with any suspicion of thyroid disease, anyone with mental health symptoms. Because what I think is crazy is not a pun, but many times people show anxiety and depression as some of their first symptomsAnd these may be the only symptoms they have for years.
Chris Cresser: Sure sure. You may know some of my own backstory with this. It is not me personally, but my wife. When we tried to conceive many years ago, we had problems. It has been about a year, and this is not necessarily unusual, but at some point we started to think that maybe we need to figure it out. This is not as fast and easy as we had hoped. So, being myself, I did this rather deep immersion in research and did some testing. And we found that in the case of my wife, she had antibodies to TSI.
So this was not an assumption about Hashimoto's disease, but about Graves's disease. And sometimes there is some kind of crossover. She also had several antibodies to TG, and there is always the question of whether it is Graves or Hashimoto. And in a sense, it doesn't matter when you look at it from a functional point of view. Because it is an autoimmunity. And so we were going to look at it from this point of view. And for her we made some herbs, and we did, she was already on a really good diet and lifestyle. And then the low doses of naltrexone in her case became a huge shift.
And soon after, she conceived, and then was able to give birth to a healthy child. So this can make a big difference. I mean that it can really make a difference between being able to conceive and carry a child until the end of term and not even be able to conceive in the first place. And it’s just sad that so many women suffer from it and don’t even know about it.
Isabella Wentz: Yes, it is incredibly sad to see people who have a multiple miscarriage, potentially unable to get pregnant from the very beginning. And I like the fact that you used an integrative approach when you used some of the best, integrative medicine with low doses of naltrexone and functional medicine, as well as diet lifestyle medicine. And I firmly believe in using everything that we have, whether it is thyroid hormones, some innovative complex medicines and nutrition, and everything we can to try to make a person feel better.
Chris Cresser: Absolutely. I mean, My motto has always been that it works and does the least harm, and it’s better that there is no harm at all.And often drugs do not fall into this category. But sometimes it is, and it may indeed be the best option, or at least one of many options, in this case. Thus, another thing, of course, with – and this can happen in such a situation – is that a woman can become pregnant, can carry a child to full term, but then the child has problems with the thyroid gland due to the fact that the mother Hashimoto.
Or we know that it may increase the risk of hypothyroidism and thyroid problems in a child. And this is often for the same reasons that we talked about, it is not diagnosed much later. They may have a subclinical problem with a low-level thyroid gland, which can be the cause of many of their strange and mysterious health conditions.
Isabella Wentz: And one more thing, I feel that this is super undervalued, many times women also develop thyroid disease after childbirth. And being a new mom, I kind of like: “Yes, I could see how people develop a thyroid condition in terms of the stress of functional medicine, with very long nights and anxiety about your child when he is awake and whatnot.” So this is another very big total time when women say, “Hey, I felt fine. I had a normal pregnancy. I had this beautiful baby, and here I am, three, six, nine months later, and I just do not feel again. I'm exhausted. I am concerned. I do not lose weight, or maybe I lost weight very quickly. " And often it can be a really thyroid gland, which can fail right after a woman has a child.
Chris Cresser: Yeah. This seems to be the sad consequence of pregnancy and childbirth. I cannot tell you how many patients I have, that their appearance of Hashimoto occurred after the birth of a child. And research suggests, and it makes sense, there is a deep immune shift that occurs during, especially in the second and third trimester. The first trimester shifts in one direction, then it shifts back in another direction. And then after birth, it shifts again in a different direction. So all these shifts back and forth, I think, can, if there are any predisposing factors, can provoke the Hashimoto offensive.
Так что да, я согласен, это действительно, это облом, верно? Не кажется справедливым, что что-то такое удивительное и прекрасное, как рождение ребенка, может вызвать это. Но, к сожалению, это часто случается. Это один из триггеров для многих женщин, которые испытывают это.
Проблема с обычными тестами щитовидной железы
Давайте еще немного углубимся в обсуждение проблем с традиционный подход к тестированию щитовидной железы, Потому что я думаю, что многие в вашей аудитории и в моей аудитории несколько знакомы с этим. Но для новых слушателей, я думаю, что это действительно важно, чтобы объяснить это. Потому что, как мы уже говорили, очень много людей пойдут к врачу и просто получат уровень TSH. И мы немного поговорили о проблемах только с тестированием на TSH. Но давайте углубимся в обычный диапазон для TSH и почему это проблематично. Вы упомянули, что ваш TSH был 4,5, и вам сказали, что это нормально. Но в чем проблема?
Изабелла Венц: Обычная настройка для стиральной машины.
Крис Крессер: Right.
Изабелла Венц: Итак, что интересно, когда я первоначально проводил исследование своего собственного здоровья и исследование для своей первой книги, было очень интересно узнать, как определялись «нормальные диапазоны» ТТГ. И только из-за того, что они использовали кровь разных людей, и у некоторых людей из этого пула крови у них действительно была болезнь щитовидной железы. И поэтому референсный диапазон стал слишком слабым. И у нас был этот огромный диапазон, потому что люди с заболеванием щитовидной железы фактически оказались в группе «здоровых людей». И так, если коротко, есть действительно большой референсный диапазон, где он действительно, если они просто смотрели на уровень в крови здоровых людей без заболеваний щитовидной железы, TSH должен быть где-то между 0,5 и два,
И это не все другие вещи, о которых мы говорили, с изменениями в течение дня, а также с различными колебаниями, когда у вас есть ранние стадии состояния. Так что да, вроде референсные диапазоны слишком слабые, И часто у меня бывают женщины, которые говорят: «О, да, меня проверяли на заболевание щитовидной железы». И я говорю: «Вы носите пальто, и на улице 90 градусов. Дай мне посмотреть твои лаборатории.
Крис Крессер: У вас больше нет бровей, и вы оставили след волос, когда шли через здание. Да, нет, это действительно безумие, потому что это, конечно, не только для TSH. Это верно даже для других маркеров щитовидной железы, но для многих других маркеров на панели крови. И это безумие для меня, что так много лабораторных полигонов строятся на изучении больных людейили, по крайней мере, включая людей, у которых есть заболевание, которое вы пытаетесь найти в выборке. Это просто не имеет никакого смысла вообще.
И все же это то, что мы имеем с TSH. И я знаю, что по-прежнему существуют противоречия по этому поводу, и есть противоречия по поводу того, является ли ТТГ, скажем, 2,5, когда гормоны щитовидной железы в норме, является поводом для беспокойства. И из-за изменчивости TSH, о которой мы упоминали, если ваши антитела щитовидной железы в норме, ваш TSH, ваш свободный T3 и ваш свободный T4 нормальные, и у вас есть одно значение TSH 2,5, лично я не думаю, что это означает: « Ах, у тебя гипотиреоз. Ах, нам нужно что-то сделать прямо сейчас.
Но это определенно то, на что я бы следил и продолжал смотреть. Но если ваш TSH равен 4,5, как у вас, Изабелла, то, на мой взгляд, это значительно выходит за рамки того, что мы видим у здоровых людей.
Изабелла Венц: И другое дело, я тоже был таким симптоматичным.
Крис Крессер: Yes.
Изабелла Венц: И поэтому я терял волосы и забывчив, я был очень ленив в своих повседневных делах. Я спал по 12 часов в ночь, и у меня были действительно высокие антитела. Если бы они были проверены, это было бы найдено, и это было бы ясно … Мне нравится, что в функциональной медицине у нас так много разных вариантов. Когда у кого-то есть TSH, который, возможно, немного повышен, мы можем сделать некоторые из этих вещей образа жизни и подождать несколько месяцев. И может быть, что TSH нормализуется.
В традиционной медицине это в основном: «О, хорошо, у вас есть эти антитела, и у вас есть немного повышенный уровень ТТГ, но он недостаточно высок, чтобы мы могли его лечить. Так почему бы нам просто не подождать, пока ваша щитовидная железа не сгорит. Вернись ко мне, когда … Теперь ты чувствуешь себя ужасно. Возвращайся ко мне, когда чувствуешь себя ужаснее."
Крис Крессер: «Вернись ко мне, когда твоя щитовидная железа была настолько разрушена производством антител, что больше ничего не остается, кроме как дать тебе гормон щитовидной железы», – похоже на это, верно?
Изабелла Венц: Да, и как фармацевт, Я сторонник фактического использования гормона щитовидной железы ранее в игре потому что это одно из того, что было показано одному, облегчить симптомы, что очень важно, но во-вторых, это также может замедлить развитие болезни. Это никоим образом не лекарство, но оно может немного снизить уровень ТТГ, так что, я думаю, мы не будем уделять столько внимания щитовидной железе с точки зрения иммунной системы. И это позволяет щитовидной железе немного раздражаться и снимать воспаление.
Крис Крессер: Да уж. Итак, давайте вернемся к thyroid сейчас. Итак, мы знаем, что диапазон для ТТГ слишком широк и что, когда здоровые люди изучались с нормально функционирующей щитовидной железой, вы видите ТТГ между 0,5 и 2 или 2,2, в зависимости от того, на какие исследования вы смотрите. Иногда я вижу панели от поставщиков первичной медицинской помощи или практикующих врачей, у которых есть ТТГ и общий уровень Т4. Так что это шаг вперед от просто TSH, но тогда это всего лишь T4. Так в чем же проблема?
Изабелла Венц: Я думаю, что, как я уже сказал, это большой шаг в правильном направлении, но в то же время Я люблю использовать свободный T4 и свободный T3, потому что это говорит нам, сколько гормона щитовидной железы на самом деле доступно для взаимодействия с рецепторами гормонов щитовидной железы, Общий Т4 включает гормон щитовидной железы, который может быть связан и недоступен для использования организмом. И это может быть по разным причинам, с различными типами гормональных нарушений, потенциально стрессовой реакцией, недостатком питательных веществ.
Крис Крессер: Right. И тогда у вас есть проблема, которая Т4 должен быть преобразован в Т3, И мы знаем, что 93 или 94 процента гормона, вырабатываемого щитовидной железой, – это Т4, который относительно неактивен. Это должно быть преобразовано в T3, чтобы, как вы говорите, стать биологически активным и завершить миссию гормонов щитовидной железы. И одна из вещей, которая уменьшает преобразование Т4 в Т3, является inflammationЧто, конечно, можно ожидать от человека с аутоиммунным воспалительным заболеванием, верно?
Изабелла Венц: Абсолютно, и это одна из вещей, которая также есть в моем списке любимых мозолей с традиционным подходом. Потому что много раз, только лекарства T4 используются для людей, когда у них есть заболевание щитовидной железы. И люди скажут: «О, я чувствую себя немного лучше. Возможно, мне нужно всего лишь 11 часов сна вместо 12 ». Но они все еще не превращают лекарство в активный гормон. Таким образом, T4 известен как «прогормон», что означает, что он будет, организм должен что-то с ним сделать, чтобы быть более активной версией.
А на бумаге преобразование Т4 в Т3 происходит идеально каждый раз. В организме человека не так уж и много. Но, как вы сказали, есть так много разных вещей, воспаление является одним из них. Недостаток питательных веществ, стресс, который может помешать превращению Т4 в Т3. Одна из важных вещей, которую я вижу, – это нарушение печени. Если у нас нарушена способность детоксикации и просто … это не то, что вы обязательно найдете в обычном лабораторном тесте. Но есть субклинические явления, когда человеку просто не хватит этого гормона Т3.
И часто я буду выступать за использование различных типов гормональных препаратов щитовидной железы, которые содержат не только T4, но также T3, а иногда и T2 и T1, чтобы действительно обеспечить человеку наилучшие результаты, которые он мог получить от медикаментозной терапии.
Крис Крессер: Absolutely. А для тех, кто не знаком, препарат T4 – это левотироксин или Synthroid в США. Это, как сказала Изабелла, это стандарт заботы. Мол, это то, что получит большинство пациентов, если у них диагностируют щитовидную железу, гипотиреоз. И с тех пор По статистике, Хашимото является главной причиной гипотиреоза в США.мы не говорим о редкой вещи здесь. Мы говорим о том, что у большинства людей с диагнозом это будет.
Итак, Synthroid действительно будет, он может работать, без сомнения, для некоторых людей. Но для многих людей, многих людей, возможно, большинства с гипотиреозом, у них будут проблемы с этим преобразованием. И затем происходит то, что происходит, и я уверен, что вы рассматривали это как фармацевт, где люди должны были бы, врач должен назначать более высокие и более высокие дозы левотироксина, потому что конверсия не происходит, и пациент все еще чувствует себя плохо. И тогда их TSH в основном достигает нуля. У них высокий T4, но их T3, особенно их свободный T3, все еще может быть низким, и они могут быть действительно симптоматичными. Так что они попали в тупик, не так ли?
Изабелла Венц: Они становятся однобокими в своих гормонах щитовидной железы, и у них могут быть реакции от высокого T4, такие как различные типы болей в суставах и боли в мышцах. И что прискорбно, так это то, что у них по-прежнему будет выпадение волос, у них будет прибавка в весе, у них будут проблемы с настроением и туман в мозгу. И во многих случаях общепринятый подход говорит: «Хорошо, ну, вы все еще в депрессии, и ваша щитовидная железа в норме. Так что это не может быть вашей щитовидной железой. Вам нужно обратиться к психиатру »или« Вы все еще теряете волосы. Ну, это не твоя щитовидная железа, потому что ТТГ в норме, и у тебя гормон щитовидной железы, поэтому посмотри у дерматолога или еще у кого ».
И тогда, конечно, мудрый психиатр и мудрый дерматолог скажут: «Эй, а как насчет этого гормона Т3?» Интересно то, что лекарства Т3 использовались некоторыми психиатрами для лечения рефрактерной депрессии. И это отчасти расстраивает обычных людей, потому что они получают обходной путь от обычной медицины. Вы почти чувствуете, что сходите с ума, потому что никто не проверяет, через что вы проходите и опыт людей с заболеваниями щитовидной железы. Я разговаривал с тысячами людей с Хасимото, и многие из них переживают одно и то же.
И иногда, если честно, для меня, например, когда я работаю с клиентом, иногда они просто хотят, чтобы их услышали. И иногда я самый первый человек, который говорит: «Да, это имеет большой смысл в том, что вы чувствуете себя таким образом, даже если вы делаете X, Y и Z». И я вижу это время и время снова.
Крис Крессер: Да, да, это, опять же, я упоминал об этом раньше, и я скажу это снова, это такой прекрасный пример необходимости функционального подхода, Поскольку вы упомянули, мы говорили о проблемах с преобразованием T4 в T3, и воспаление является одним из основных факторов. Конечно, функциональная медицина может помочь нам найти причину этого воспаления, которое часто бывает в кишечнике, а не всегда.
Но мы также знаем, что вы упомянули печень, большая часть преобразования T4 в T3 происходит периферически. Смысл не в самой щитовидной железе. Это происходит в кишечнике. Это происходит в печени. Это происходит в клетках вокруг тела. И я думаю, что около 20 процентов преобразования Т4 в Т3 происходит в кишечнике. Так что, если у кого-то кишечник не функционирует нормально, это может вызвать проблемы со щитовидной железой, даже если они вырабатывают достаточно гормона щитовидной железы. Щитовидная железа вырабатывает достаточно T4, но из-за воспаления и проблем с кишечником у них все еще наблюдаются симптомы гипотиреоза и низкий уровень T3 из-за того, что еще происходит в организме. Иногда это называют синдромом низкого T3. Мы много говорили и писали об этом, но это подчеркивает необходимость действительно комплексного подхода.
Конечно, еще одна проблема, о которой вы упоминали ранее, – это дефицит питательных веществ. Итак, мы знаем, что цинк и selenium требуется конвертировать T4 в T3, Итак, здесь так много вещей, которые нужно посмотреть. И это один из недостатков модели, и вы так хорошо это подчеркнули, когда вместо этого более комплексного подхода с одним человеком, который может видеть всю картину, кто-то направляется к психиатру, дерматологу, гастроэнтерологу и всем остальным. эти специалисты, которые на самом деле просто смотрят на это через очень узкую линзу, и никто не собирает все кусочки вместе.
Изабелла Венц: Да, я всегда шучу, что вы идете к врачу левой руки, а затем вы идете к врачу правой руки, и тогда каждый из них просто смотрит на одну часть вас, верно?
Крис Крессер: Ага-ага. Я имею в виду, мы можем продолжать об этом. Я думаю, что большинство слушателей знакомы с проблемами, о которых мы говорим здесь. Но я считаю, что Хасимото, в частности, является таким хорошим примером того, как нам нужно улучшить нашу нынешнюю систему. Потому что традиционный подход действительно, действительно терпит неудачу пациентов.
Аутоиммунитет и Хасимото
Итак, мы поговорили о проблемах с TSH. Мы поговорили о том, почему тестирования на TSH и даже просто тестирования общего T4 и общего T3 недостаточно, и нам нужно протестировать свободный T4 и бесплатный T3. Мы говорили о тестировании на антитела щитовидной железы и почему это так важно. Но давайте еще немного углубимся в аутоиммунную фигуру. Потому что, скажем, кто-то проверяет – вот здесь вопрос с подвохом – антитела к щитовидной железе, и они нормальные. Можем ли мы тогда просто сказать: «Хорошо, они однажды проверили свои антитела к щитовидной железе, они нормальные, у них абсолютно нет хасимото»? Потому что это часто случается. Мы видим это в обычных условиях. Somebody begs their practitioner to test for thyroid antibodies and they do it once, the person doesn’t have positive antibodies, and the practitioner says, “Okay, you don’t have Hashimoto’s.” What’s the problem with that?
Izabella Wentz: You know there’s also something called seronegative Hashimoto’s where, back in the day depending on what study you looked at, they would say that 80 to 90 percent of people with Hashimoto’s had one and/or the other antibody. And so there was 10 to 20 percent of people who could have Hashimoto’s without any of those antibodies.
Chris Kresser: Yep.
Izabella Wentz: But now there were more studies done through fine needle aspiration, which is an invasive procedure and is generally not done to test for Hashimoto’s. It’s generally done to look at thyroid nodules to test them for cancer, any kind of abnormalities. And when you use that procedure, what you can do is you can look at the cells within the thyroid gland under a microscope and you can tell if there were changes consistent with Hashimoto’s in those cells. And unfortunately or fortunately, this method can uncover additional cases of Hashimoto’s when even the thyroid antibodies are “normal.” And, again, normal conventional medicine, some labs will say if they’re under 100, they’re normal. Or if they’re under 35, they’re normal. If they’re under nine, they’re normal.
And you know what’s normal, again? It could be, I would say, under maybe one or two might be “normal,” but you also want to look at the thyroid ultrasound. Because we could see some of the changes consistent with Hashimoto’s on a thyroid ultrasound. And then with, as I mentioned the fine needle aspiration, we can find more cases of Hashimoto’s that way. But that means, or how could I put this? But that in order to find every case of Hashimoto’s we would have to look at every single thyroid cell under a microscope. So you’d have to remove the entire thyroid gland and look at it under a microscope to really rule out Hashimoto’s.
Chris Kresser: Yeah, and this goes back to what we were talking about before with how the lab range for TSH was developed is in the NHS cohort, the Nurses’ Health Study. They did try to eliminate people with known Hashimoto’s by—and also undiagnosed Hashimoto’s—by testing for thyroid antibodies. But as you just explained, that will not eliminate everybody with Hashimoto’s. In fact, quite a few people will be missed. So, and then antibodies fluctuate.
We know that there’s a relapsing and remitting characteristic of Hashimoto’s, Anyone who has Hashimoto’s knows this, that if they test their antibodies serially over time, they’ll see them go up and down, depending on what’s happening. And if you just do one test, you might catch someone on a good day, right? And their antibodies are normal. And then I think I also see this—sometimes practitioners will only test for TPO antibodies and not do thyroglobulin.
You mentioned that before, like, that some people have one antibody, not the other. And it’s not unusual for me to see someone who has normal TPO antibodies but very high thyroglobulin antibodies. And that person would be missed if only TPO is tested for.
Izabella Wentz: And to get even more nerdy, there are additional types.
Chris Kresser: We like nerdy here. So go ahead.
Izabella Wentz: There are additional types of thyroid antibodies that we don’t necessarily even test in the real world. They might be available to scientists.
Chris Kresser: Antibodies to thyroid hormone itself, which are not typically tested for. And then some of the Graves’ antibodies, and yeah.
Izabella Wentz: Iodine transporter antibodies, the list just goes on and on. And I don’t write about it on my blog, but I did, like, a healthcare professional presentation a few years back, and at that time I think there were, like, 16 different ones that were identified. I’d have to go back to my notes, but yeah. So you could have antibodies that haven’t even been described yet that’s a part of your thyroid physiology at this point.
Chris Kresser: Yeah, and so this is where we come back to—
Izabella Wentz: Good old symptoms.
Chris Kresser: Symptoms and also just research. Because it’s important, this is where, when we look, there are different kinds of evidence, right? There’s clinical evidence, there’s evidence that we look at from research. There’s anecdotal evidence. But when we look at the research, we see that, statistically speaking, Hashimoto’s is the most common cause of hypothyroidism in this country. In other parts of the developing world where дефицит йода is still more prevalent, that is the number one cause, But here in the developed world, it’s Hashimoto’s.
And then if you rule out iodine deficiency and nutrient deficiency and other potential causes of hypothyroidism, and if the patient has symptoms that are consistent with autoimmune inflammatory disease, which we’ve talked about throughout the show, and maybe they have higher T4 and lower T3 and certain things which are known to trigger or exacerbate the immune system, make their condition worse, maybe they had a viral, they had mono, and their symptoms started after that, or maybe their symptoms started after they delivered a child, then you put those pieces together and you make a clinical diagnosis. You put all those together, even if you don’t have conclusive evidence through antibodies that it’s Hashimoto’s, it’s there, in the Functional Medicine this is what differentiates it from conventional.
Again, there’s no downside to treating it as an autoimmune condition, like, doing some diet changes and things like that, because we’re not using immunosuppressive drugs, like you might with Crohn’s disease or something like that. So in that case, the standard of proof needs to be higher. But with Hashimoto’s, if you’re going to go on an autoimmune protocol diet, to me that’s a sufficient, if you suspect it, that’s even one way to test the theory.
Izabella Wentz: Right. And it’s, yeah. I feel like we’re still learning so much about Hashimoto’s at this point, and a lot of times we need to trust people on what they think is going on with them. And a lot of times the recommendations we make from a Functional Medicine standpoint are going to be overall helpful to the body. So when we have a person with Hashimoto’s, I’m not necessarily thinking, “Hey, let’s suppress your immune system because it’s overactive.” I’m thinking, “What infections could you have that are setting you off? What foods are setting you off? What nutrient deficiencies do you have that we need to address so that your body will be able to balance itself better?”
And we’re really focusing on treating the person as a whole in their whole body and that might … what’s kind of, I think, wonderful about this is from a conventional medical standpoint when I used to be a regular pharmacist, we would give people medication to treat one condition and then we would bring on symptoms of another condition.
Chris Kresser: Well, there’s another medication for that.
Izabella Wentz: Yeah, like for people who are depressed, we’d give them Effexor. And then they get high blood pressure, which is a side effect of Effexor that most psychiatrists don’t really know about because they don’t test blood pressure in their patients.
Chris Kresser: Да уж.
Izabella Wentz: And so then the person would go back to their primary care doctor and they’d be like, “Oh, you have high blood pressure. Let’s give you a blood pressure medication for that.” And then you get a blood pressure medication for that and some of them cause you to have potentially fainting. I had one client who … I used to be a consultant pharmacist for people with disabilities. And a lot of times they weren’t able to advocate for themselves. So I was the one that was sent in when they were having all these issues.
And I had one client, no joken he started off on an antidepressant, then was given this blood pressure medication that caused him to have fainting because when he would stand up it would drop his blood pressure and heart rate too much. And so then he was put on a seizure medication, because people thought that he was having seizures. And the seizure medication caused some abnormal overgrowth in his gums. So then he was placed on another medication for that. And it was just like one thing after another, and that was traced back to one initial medication.
How to Use Food as Medicine for a Thyroid Disorder
Chris Kresser: Yeah, the medication treadmill, I call that. And it’s a very real thing. It’s why so many people over the age of 65 are taking five or more medications. So let’s talk a little bit about how to avoid that in the case of Hashimoto’s. Because this is, your first book was really focused on, the Hashimoto’s protocol was focused on reversing symptoms, but your new book, which is Hashimoto’s Food Pharmacology, looks more at food as medicine. And to me this makes a lot of sense. I agree with you a hundred percent, actually.
Often my patients are surprised to hear me say this that if you do have already, Hashimoto’s has progressed to the point where there’s been some destruction of the gland, and even at the very early stages, using thyroid hormone is just smart because it’s so crucial for so many cells in the body. And it can prevent or slow the further progression of Hashimoto’s, as you mentioned before. At the same time, in the conventional model, that’s the only thing that is done. So let’s talk about some of the other steps that people can take, particularly with food, to quell the inflammatory response that really is the root cause of the condition.
If we think of this from a Functional Medicine perspective, I’m always telling patients, “You really don’t have a thyroid problem. You have an autoimmune problem that’s affecting your thyroid.” So how do we look at, what are the biggest things for you in terms of food that can help people to kind of put the brakes on this inflammatory reaction?
Izabella Wentz: So, I love using food as medicine, and food pharmacology is just amazing, how the things that we put in our bodies can have such profound effects on us. It seems so easy, but at the same time when I was in pharmacy school, I just didn’t quite see that. I just thought medications had an effect. But we know that everything that we put in our body is going to send messages to it. And so with Hashimoto’s and just about every autoimmune condition, and I would say about every health condition, this is why I love using food so much, is because you’re not going to make one thing, generally you’re not going to make one thing worse by focusing on treating your Hashimoto’s with food.
And so for me, I really look at the patterns that most people with Hashimoto’s have, and I would argue to say that most people with autoimmunity have this too. One of them is going to be, which we talked about, micronutrient deficiencies, And so we want to figure out which nutrients are going to be deficient. And many times we can address this by eating a nutrient-dense diet. Sometimes we may need to add some enzymes to ensure that we’re removing the nutrients from these foods properly. And thyroid hormones can help with that as well, because if we have an underactive thyroid, then we might not be extracting nutrients properly. And then in some cases, we may need to add some supplemental nutrients as well.
Then we’re looking at macronutrient deficiencies, So a lot of times people with Hashimoto’s will have diets that are deficient in protein and fat. Sometimes this is a consequence of long-term deficiency and digestive enzymes where we just kind of, we find that we don’t feel so good after we eat protein or fat. So we just end up gravitating more towards carbohydrates. It also doesn’t help that most of our nutrition education comes from commercials nowadays. So it’s, like, make sure you, I know when I was in pharmacy school, I was shocked that carbohydrates were not, like, a requirement. I thought, like, fat was something that was optional because of all the commercials I watched for a low-fat diet.
Chris Kresser: Yes.
Izabella Wentz: Of course, I’ve already mentioned deficiencies in digestive enzymes. Blood sugar swings. This is something that’s crucial that can be addressed with proper nutrition, food. And then we have a toxic backlog. A lot of times we find that the foods that we’re eating can be contributing to that toxic load and not helping us with it. And this could be some of the processed foods, some of the toxins that are present in our foods, genetically modified foods. And then one really easy thing is fluoride in our water supply. Unfortunately, that can have some adverse effects on the thyroid.
Food sensitivities—this is a biggie. I often times, unfortunately, will find that’s the only thing that people focus on. Food sensitivities are a big deal when you have Hashimoto’s. There are going to be foods that are reactive that can make your thyroid condition and your symptoms worse. We want to make sure that we’re removing those foods, but we don’t want to get obsessive about removing every food forever. Because the key is to restore our body’s ability to tolerate as many foods as possible. And then intestinal permeability.
So we want to always focus on that piece with nutrition, just because that can be contributing to everything else that we may see. So I would say those are kind of like my big goals for people of things they can do with food.
Chris Kresser: Those are great goals. And where do you come down with AIP and the autoimmune protocol?
Izabella Wentz: I think that AIP is a wonderful protocol. I have found in my experience that people typically do best on a Paleo-like diet. I did some outcomes research with my clients, initially, and then with readers. A majority of them do best with either a gluten-free diet—so 88 percent of people find that gluten is not their friend. Being gluten free makes them feel better. And then we’ve got about 80 percent improvement of people with a Paleo diet and close to that with autoimmune Paleo.
I’m not the person that’ll say, like, every single person with Hashimoto’s needs to be 100 percent autoimmune Paleo. I feel like everybody needs to be individualized. These diets are amazing templates. I will say, in my book I have three different dietary templates, and one of them is the introduction where it’s не содержит глютен, без молочных продуктов, soy free, and you can start there. And then if you feel, if you still have more symptoms and issues, then you’ll eliminate more foods until you get to more of a Paleo template.
And then if you don’t do well there or if you plateau there, then you may eliminate more foods to get into the autoimmune Paleo-like template. Or the other option I recommend for people, depending on where they are, is start off with the autoimmune Paleo template, and then you’ll add in more foods back. And there’s different reasons and different seasons, and people may, there might be foods on autoimmune Paleo that they may not do well with. And there may be foods that they’re just fine with.
So it’s a matter of, I feel like you want to have a good template. You want to start off there and pick one that fits best for you right now. And then you’re going to want to modify that based on your individuality. Like, my goal for people is to become their own nutrition gurus and to kind of awaken their intuitive ability to figure out which foods serve them, which ones cause them harm.
Chris Kresser: Yeah, I love that approach. And it’s very similar to how I think about it. AIP can be a game-changer for some people, there’s no doubt about that. I’ve seen that. There’s actually even now some peer-reviewed research supporting its use for Crohn’s and inflammatory bowel disease and found that it achieved similar or better results than standard immunosuppressive drugs, which is pretty incredible.
So we know that that can have a great impact for some people. At the same time, it is an extremely restrictive diet and it’s not necessary for all people. And I think there has been a sort of misconception. I see this in my patients. Patients come in and they tell me they’ve been on AIP, and I ask them if they’ve really had any benefit from it. And they say, “No, not that much compared to, like, a more expanded Paleo diet.” And I ask them why they kept doing it. And they tell me they just thought that that’s what they need to do because they have an autoimmune disease and everyone who has an autoimmune disease should be on AIP.
And my explanation to them is, “No, we don’t have, there’s not enough research to suggest that these foods are universally harmful for people, the foods that are removed in an AIP approach are universally harmful and therefore, anyone with any kind of autoimmune disease should be on it for life.” I think that’s a huge stretch from what the research has told us so far. And it sounds like you and I are on the same page, where people should basically eat as diverse a diet within a template of healthy foods as they can tolerate and feel good on.
Izabella Wentz: Absolutely. And in my experience, it’s not necessarily that the foods are evil. It’s that we have a leaky gut for whatever reason. And whatever foods we’re eating when our gut is leaky are the foods that we’re going to react to. And the autoimmune Paleo diet tends to work in our Western society because it eliminates some of the most common foods that are over-eaten.
And so a person, let’s say they were on an all-coconut diet every day, then they got an H. pylori infection or they got a Blastocystis hominis infection and were not able to digest fat properly. Because of some digestive enzyme deficiency, they may end up becoming sensitive to coconut milk. And so, and I think coconut is an amazing, hypoallergenic food. But we really want to look at the individual and what their sensitivities are. And we also want to do a whole-person approach. We don’t just want to say keep removing more foods and you’ll be healed. We want to say, “Okay, why are you sensitive to these foods? What can we do to reduce that sensitivity?” And some of the things that I talk about in my book are going to be digestive enzymes. We’re going to be addressing nutrient deficiencies.
I recommend actually trying to rotate foods so you’re not eating the same thing for breakfast, lunch, and dinner every day. You’re giving your body an opportunity to sort of recover from eating the same things over and over. And the big piece of course, and I always tell this to everybody, is if you’re not getting better on a diet for three months, there’s a really important thing to consider is looking at other things. Working with the Functional Medicine practitioner. You have a gut infection that’s making you intolerant to everything.
Chris Kresser: So important, so important. And I would say—and we don’t have time to go into detail on this. I’ll be talking about it with another guest in an upcoming podcast, but there’s so much, I think, so many different converging lines of evidence now that suggest that we can heal food intolerances, in many cases, Maybe not in all cases, but by addressing gut permeability, by addressing the gut–brain axis, and looking at the gut as the second brain in the nervous system, taking steps to reduce stress, there’s a lot that we can do.
And as you said, Izabella, in Functional Medicine we’re really concerned with the root cause, Food is often not the root cause. It’s a trigger because there’s an existing root cause of a leaky gut or a disrupted gut microbiome. So we need to always remember that removing the trigger does not necessarily address the cause, It could be one necessary step, at least for some period of time, but it’s often not enough on its own to address that underlying cause.
Izabella Wentz: Yeah, I’ll be really looking forward to that discussion. I personally have seen a lot of success in people getting rid of food sensitivities with some of the strategies I mentioned and also with using systemic enzymes. That’s been a little nice thing that people can add. And that was my goal in Food Pharmacology was to include all these different helpful things so people weren’t just removing more foods and they have this comprehensive guide to become, like I said, their own nutrition guru.
Chris Kresser: Great. Well, thank you so much for joining us, Izabella. I love your most recent book, Hashimoto’s Food Pharmacology, I think it’s such an important contribution because as we’ve discussed all along, the standard of care of just prescribing thyroid hormone, especially Synthroid, or levothyroxine, is just not sufficient for people with hypothyroidism and Hashimoto’s. And looking at things from a more holistic view is really going to make a far bigger impact long term for everybody. So where can they find the book and learn more about it?
Izabella Wentz: The book can be found on Amazon and Barnes & Noble, wherever books are sold. And hopefully it helps keep people on their health journeys. I know it’s hard when you’re first diagnosed and trying to figure it out. And hopefully this gives people a bit of a tool to take charge of their own health. Thank you for having me. It’s such a pleasure to be here with you. I’m a huge fan of your work, and thank you for the work that you’re doing in the world.
Chris Kresser: Well, you’re welcome, and thank you, Izabella. And where can people find more about your work?
Izabella Wentz: Thyroidpharmacist.com is where I usually hang out. It’s my website, and I share all kinds of new research about Hashimoto’s and some of the things that have worked for me, as well as my clients and readers.
Chris Kresser: And I think you have a very active Facebook community.
Izabella Wentz: Absolutely. You can find me on Facebook.com/thyroidlifestyle, or search for Izabella Wentz or Thyroid Pharmacist, you’ll be able to find me. I usually pop in there just to say hello and answer readers’ questions on a daily basis.
Chris Kresser: Great, great. Well, thanks again, and good luck. And we’d love to have you back on the show in the future.
Izabella Wentz: Thank you so much, and you have a wonderful day.
Chris Kresser: You too, take care.
Now, I’d like to hear from you. Have you undergone testing for a thyroid disorder? Or, if you’re a practitioner, have you considered autoimmunity as a root cause for any of your patients? Let me know! And, as always, if you’d like to submit a question, you can record one here,