Dr. Will Cole Video: Hypothyroidism, hashimotos and fatigue – Podcast #36

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In this interview with Dr. Will Cole, we talk about thyroid dysfunction and how to fix it! Over 30 million Americans are suffering from hypothyroidism or low thyroid function. Our thyroid gland produce hormone that helps keep our metabolism working optimally. With less thyroid hormone, our metabolism gets slower while at the same time many symptoms occur. Many people have Hashimoto’s thyroiditis which is an autoimmune thyroid condition. Conventional medicine does nothing to address the root cause of autoimmune thyroid conditions.

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Listen to this podcast as they discuss about nutrients to maximize thyroid conversion as well as nutrient testing. Dr. Cole also shares how he deals with his thyroid patients and tests he orders for them. After you listen to this interview, you’ll be able to learn a lot of information on hypothyroidism and Hashimoto’s.

In this episode, we cover:

7:22 Main differences between functional medicine and mainstream medicine

12:06 About medications and the focus on TSH

21:50 Different kinds of tests being run for thyroid

31:30 On iodine

36:30 Importance of selenium

38:30 About gluten and Hashimoto’s patients

 

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Dr. William Cole D.C, graduated from Southern California University of Health Sciences in Los Angeles, California. He has his post doctorate education and training in Functional Medicine and Clinical Nutrition. Dr. Cole consults in the Pittsburgh area and phone or webcam consultations for people around the world. He specializes in clinically investigating  underlying factors and customizing health programs for chronic conditions such as thyroid issues, autoimmune, hormonal dysfunctions, digestive disorders, diabetes, heart disease and fibromyalgia.

Dr. Justin Marchegiani: Hey, there! This is Dr. Justin Marchegiani and welcome to another awesome episode of Beyond Wellness Radio. Again, we have a great show in store for you. Before, go to BeyondWellnessRadio.com, click on the Newsletter Sign Up button and you can sign up for our newsletter and get show updates right in your inbox before anyone else. You can also click on the Questions button and even speak questions live, and we’ll be able to answer it on the air for you.

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You can also go to ReallyHealthyNow.com. That’s Baris Harvey’s website where has some great articles and blogs and videos for you there as well and even some consultations. Again, we have an awesome show in store. Stay tuned.

Hey there! It’s Dr. Justin, welcome back to Beyond Wellness Radio. Again, we have an excellent guest on today’s show, Dr. Will Cole. Dr. Cole’s practice is over in Pittsburgh, Pennsylvania. He also has a virtual clinic worldwide. Dr. Cole’s a functional medicine doctor. He specializes in thyroid conditions and–and much more. Again, as functional medicine doctors, we really have to specialize in the whole body, but again Dr. Cole, welcome, tell us about yourself a little bit.

Dr. Will Cole: Hey! Thanks for having me, first of all. My–like as you said, we have a clinic here in Pittsburgh, Pennsylvania. We have a virtual functional medicine practice where we do webcam and phone consultations for people in the United States and around the world. Clinically, this–my education background, my doctorate is from Southern California University Health Sciences in Southern California and my post doctorate as you’ve mentioned is in functional medicine and clinical nutrition. So, I also write for the mindbodygreen, one of the largest health websites in the world, one of their health experts for the last couple of years, and I have a passion for education people about chronic and autoimmune conditions and it’s–I’m really excited to talk with you about the thyroid today.

Dr. Justin Marchegiani: Well, really good! So, tell me about your health story, every functional medicine doctor has their own story of how they got into this field. So, how did you get into this field?

Dr. Will Cole: For me, it was just kinda growing up around it. I, my–my father was in the healthcare field and just kind of seeing some great minds, people like Dr. Mercola, that has kinda change the–the landscape of–of the healthcare in the United States and really everywhere and they just inspired me and saw people that are really struggling with chronic issues, getting more and more medications and seeing that all be reversed and get healthy and the doctors are able to take them off that medication, that’s hugely inspiring as–as a young kid growing up and I kinda knew in high school, “Hey, I wanna be a part of this, too. I wanna–I wanna make–make some changes in people’s lives for the better, too.” So, that’s kinda with–with me. I know a lot of clinicians have kinda gone through some–some major health issues that kind have been–that was the catalyst to make them where they’re at today. For me, I’ve been blessed and lucky to not have to go through that, so, that’s my story.

Dr. Justin Marchegiani: That’s great, awesome! And again, we are really fortunate because Paleo f(x) is coming up here the end of April. So, anyone that’s gonna be in the Austin area, Dr. Cole and I will be on a panel with another naturopathic physician. We’ll be talking all about thyroid, so we’re–the goal of today’s talk is to kinda give everyone a sneak preview of some of the things that we’re going to be talking about in the thyroid realm. And again, thyroid is one of these conditions, it’s so common in the U.S about 30 million people have this condition. About 1 in 5 are autoimmune and functional medicine really is the only field that’s equipped to addressing the autoimmunity because that’s kind of a one-size-fits-all in conventional medicine. Can you talk more about how you addressed, just your typical thyroid patients? So, they–they come to you. They have maybe hair falling out, fatigue, depression, weight gain, the whole nine yards. How do you work them up?

Dr. Will Cole: Yeah! I think that–you’re right. This is a huge problem in the United States and I think research says like 20 million Americans have low thyroid issues. One in 8 women will develop a thyroid issue in her lifetime and worldwide, it’s insane, that’s like upwards of 250 million people around the world have some sort of low thyroid issue. Huge! And the–the inadequacy of standard model of care is like glaringly obvious because they’re just running these basic labs, TSH, maybe T4, and based on just, “Hey, here’s Synthroid. See you in 3 months.” And that works for some people and for a lot of people it work for a little bit, but then, plateaus and they’re kind of left where they began.

Dr. Justin Marchegiani: Right.

Dr. Will Cole: And the reality as–as you know, I know, that you’re kind of seeing this on a daily basis in your clinic is that we have to look beyond those sort of basic labs and that’s where it kinda starts with for myself. I’m assuming you as well. We need to run a full functional thyroid panel to kind of see the–the intricacies, these underlying pathway dysfunctions that are at play that will not be effectively addressed with Synthroid alone or at all.

Dr. Justin Marchegiani: Right, right, right.

Dr. Will Cole: So start with–starts with diagnostics, so full thyroid panel which you probably talked about in your show in the past kind of the–the extended panel and then we look at all the–the implications hormonally that–that are interplayed with the thyroid as well. So we look at adrenal function. We look at hormonal function as far as estrogen and progesterone imbalances and then obviously the gut is a huge component–component of that as well.

Dr. Justin Marchegiani: Yeah.

Dr. Will Cole: So the conversion pathways as well as the total immunological standpoint because a large–a large part of these people are having autoimmune component to their case. So until you deal with the root issue what’s causing the low thyroid problem in the first place, which in–I would say the majority of them are autoimmune in nature. They may not be full blown Hashimoto’s disease but they are in some degree, they’re immune system’s attacking their thyroid. So we have to have a comprehensive view of it and then you kind of know definitively, “Okay, this is why you feel the way you feel and let’s start these addressing these–these issues one by one.”

Dr. Justin Marchegiani: That’s great. Now you talked about a full thyroid panel. Can we just for all the listeners, just kind of contrast maybe what a conventional thyroid panel would–would entail and how a complete thyroid functional medicine panel would be different and what extra information are we getting from that?

Dr. Will Cole: Great. So I–I think it would be good for us to go back up a little bit and look at the main differences between functional medicine and mainstream medicine.

Dr. Justin Marchegiani: Mmm.

Dr. Will Cole: The first thing that you and I are gonna be different than their standard endocrinologist or PCP is that we’re gonna interpret the labs that are run currently, the ones they typically ran–we’re gonna interpret those labs differently because, you know, on that reference range, they have, you know, from X to Y, this is what your numbers should be, anything outside of that range is high or low; if they’re both fine, and you know, there’s a problem there. When we get that–that­ average through a statistical bell curve average of the people–the population of that lab–

Dr. Justin Marchegiani: Exactly.

Dr. Will Cole:   People that typically go to labs are not the healthiest population so if your doctor is saying, “Hey, your labs are normal,” and then you’re still going through these laundry list of symptoms, what they’re really saying is you’re a lot like a lot of other sick people because that’s just looking at this general huge reference range. So we as functional medicine practitioners are looking at a much thinner range of where your body is functioning the best, where your health is great, you’re off of medications, you’re not having symptoms, you have all that energy back, you’re at the weight that you wanna be. That’s the optimal range and that’s gonna be a lot thinner range than that huge reference range. So we’re interpreting the labs that are run currently, the ones that you guys have from your PCP or endo differently using a much thinner guideline and then I would say, number two, we’re running more extensive labs that aren’t run. And the reason why they’re not run is not because your doctor is some mysterious, you know, keeping you–keeping you in the dark. What–it just doesn’t change the treatment. You’re gonna get Synthroid of levothyroxine whether you have true primary hypothyroidism or an autoimmune disease attacking the thyroid or whatever other conversion issue or metabolic issue you’re–you’re dealing with. The end result is gonna be the same, so why would they run more labs if ultimately the only option they have to give you is that Synthroid or levothyroxine. So the full thyroid panel in–in regards to your–your question is that we are running beyond just the TSH and T4. We’re looking at free T4, free T3, so those are the free forms of that thyroid hormone. What’s biologically, metabolically active to the body, what’s getting in the cells that’s–that’s usable by the body, and then we’re looking at T3 uptake which looks in our–our realm, the functional medicine realm looking at estrogen and testosterone imbalances and we’re looking at again all the other implications beyond that, too. So the free fraction hormones we’re looking at–the T3 uptake and of course, we’re looking at the antibodies, thyroid peroxidase and thyroglobulin antibodies, to rule in other autoimmune components to the patient’s case. So the most common being Hashimoto’s disease and so I’m assuming many of your listeners are–are the well, you know, learned. They do know what they’re talking about and are aware of the–the rise of autoimmunity in their–in the world and–and how we need to address it.

Dr. Justin Marchegiani: Yeah. And is TSH a thyroid hormone, Will?

Dr. Will Cole:   Well, it’s secreted by the brain.

Dr. Justin Marchegiani: Yeah.

Dr. Will Cole: Secreted by the pituitary gland so it’s not a thyroid hormone. It’s kind of like the analogy that I use and maybe it’s not the best. But I always say it’s the communication with the brain and the thyroid. So if your TSH is high, this is like inversely proportional. A lot of people get confused. A lot of my patients do, they’re–they’re looking at this high TSH and they think, “Well, maybe why shouldn’t I be hyperthyroid? Why am I not losing weight? Why am I not feeling like hyperactive?” Well, this is an inversely proportional number to your–from your brain to your thyroid. So it’s–it’s basically your brain screaming at your thyroid if you have a high TSH saying, “Work more, work more,” because it’s not secreting hormones for whatever reason. But again, there’s a lot of people with normal TSHs that have low thyroid issues. One of them being a pituitary hypofunction. If your pituitary gland is not working well because of stress or inflammation or chronic infection, your brain is not communicating with your thyroid. So you can have a normal-looking, pretty looking piece of paper wrapped TSH, but you’re having low thyroid symptoms and that’s why we have to look at these communication lines with the brain. So that’s why a large part of my clinical approach is having a brain-based component to it of addressing these–these neurotransmitters issues and these hormonal communication lines with your endocrine system.

Dr. Justin Marchegiani: Yeah and a lot of patients I see, again their TSH may be normal but then their T4 and T3 conversion is off, or let’s say a patient had thyroid issues. Let’s say, you know, they had elevated TSH, they were put on some Synthroid. Now their TSH is back to normal, so the doctor thinks they’re fine but we run a full panel, you see T3 free and total is–is totally low. And one the big things I think a lot of medical doctors don’t realize is that the cells of the anterior pituitary are very sensitive to thyroid hormones. So once someone’s on a thyroid medication or supplement that may have endogenous thyroid in it, TSH will be the first thing that drops, and you may not get that conversion across. Can you talk about medications and how doctors are so just focused on TSH and not the–the other downstream hormones?

Dr. Will Cole: Yeah, I–I think that they’re really is–is part of the bigger picture that we see across the board with all chronic disease is the training and the standard model of care that has its place but their training is diagnose the disease and match it with the corresponding drug. It’s really the only option they have as far as the PCP setting. So if you have high cholesterol, you’re gonna get high cholesterol drug. If you have diabetes, you’re getting diabetes drugs. If you’re depressed, you get the anti-depressants. It’s just the–

Dr. Justin Marchegiani: Right.

Dr. Will Cole: There’s a medicinal matching game. But when it regards to–to the thyroid is that, it’s just a very incomplete view and kind of hanging your head on this one number–we’re all more complex than just one number on a piece of paper and you kinda have to look at the downstream, like you said, conversion issues that–that the thyroid has to go through to actually be used by the body, so as you mentioned, low T3 syndrome is a huge problem around the country because the conversion happens in the liver and a large, smaller part in the gut, this is where the conversion of T4 to T3 occurs and if your gut’s not working well and if your liver is not well, you can have low T3–T3 syndrome or that just under-conversion issue, and yeah, you have to deal with the conversion at that point. It’s really not a thyroid problem, it’s a conversion of the thyroid problem.

Dr. Justin Marchegiani: Yeah, that makes sense. Now regarding, you know, thyroid issues, we know T4 is this inactive thyroid hormone, are you aware of any-any physiological uses in the body for T4 or is it primarily T3?

Dr. Will Cole: Yeah, it’s primarily T3, I think to a lot–a smaller degree, it’s usable to some degree, but no, the more metabolically active is gonna be T3.

Dr. Justin Marchegiani: That’s right and most people or most doctors aren’t looking at this conversion. What factors are you seeing that are affecting T4 to T3 conversion? You mentioned gut bacteria with the–with the acetic acid and the sulfatase enzymes. You mentioned liver with the whole deiodinasation process, that’s your body cleaving iodines off–it’s a selenium-based process. We need selenium to do it. What other processes are really important for that T4 to T3 conversion?

Dr. Will Cole: Yeah, I would look at, again, a full mapping of the hypothalamic-pituitary-adrenal axis–

Dr. Justin Marchegiani: Uh-hmm.

Dr. Will Cole: The HPA axis because if someone has sustained high cortisol levels or if anyone has sort of andrenal fatigue–

Dr. Justin Marchegiani: Yeah.

Dr. Will Cole: As we call it, spectrum, even just chronic stress levels–chronic systemic inflammatory issues will decrease the conversion ability of T4 to T3. So you kinda have to look at the complete history and I don’t think a–I think a lot of clinicians aren’t even taking the time to really look at it. You have to look at these underlying issues that give rise to chronic thyroid symptoms.

Dr. Justin Marchegiani: Exactly. And you mentioned cortisol there and we know that high cortisol will actually block T4 to T3 conversion, and we know if it’s too low if we’re on a full out adrenal fatigue stage 3, not enough cortisol will prevent conversion as well, because we need some cortisol for this conversion and I see a lot of patients, we’ll kinda look at their full thyroid panel on one side and then we’ll look at their adrenal panel on the other and some people, their–their adrenal will be in worse shape than their thyroid. How many people or just on general, how many patients are you seeing on average that are coming in where their adrenals are actually in worse shape than their thyroid even though they thought maybe they had a thyroid problem pri–primarily?

Dr. Will Cole: A huge percentage of people. I mean, because if we’re talking these all compassing typi–classical low thyroid symptoms and then then they think that’s what they’re going through, that gets the most buzz, it’s the most popular, that’s the most people are aware of in their–their consciousness but when you run the labs, you’re seeing, “Okay, actually you have a lot of other hormonal things going on but it’s actually not thyroid.” I see that on a daily basis. So you cannot sort of pigeonhole these issues and just assume they’re all thyroid issues because thyroid may be a part of it but it’s–

Dr. Justin Marchegiani: Yeah, yeah.

Dr. Will Cole: Basically victim of these other hormonal problems.

Dr. Justin Marchegiani: Yeah, that’s really true and what nutrients are you also looking at to assess or what nutrients are you making sure that patients have enough of to maximize thyroid conversion?

Dr. Will Cole: Yeah, I would definitely look at selenium, zinc issues which help with the conversion issues and just help with thyroid physiology as whole, and that’s something that you can measure on a–on a simple blood test to kinda see what’s going on as far as the micronutrients are concerned and many people are deficient in these–these nutrients. So those are two main, main–main nutrients that we will work on.

Dr. Justin Marchegiani: And what objective tests are you doing to assess these nutrient levels?

Dr. Will Cole: We’re running a blood panel. Full blood panel to–to kind of see the micronutrient aspects of it and as far as the nutrients, it’s mainly through blood.

Dr. Justin Marchegiani: Are you doing like a SpectraCell? Are you doing like a NutrEval? Are you doing–

Dr. Will Cole: SpectraCell is typically what we use.

Dr. Justin Marchegiani: Okay, got it. Do you have any experience doing like a NutraEval by Genova or–

Dr. Will Cole: I’ve seen them before from other clinicians–

Dr. Justin Marchegiani: Organic acid test?

Dr. Will Cole: Yeah, I’ve seen them before. We don’t run them on a regular basis. Do you run them?

Dr. Justin Marchegiani: I do the organic acids a lot. I mean, you know, there are some markers on your conventional blood panel where you can kind of infer some nutrient deficiency, you know, alkaline phosphatase and zinc and RDW and–and selenium–

Dr. Will Cole: Uh-hmm.

Dr. Justin Marchegiani: But they’re indirect markers, but yeah, that SpectraCell is a good one, too.

Dr. Will Cole: Right, that’s my favorite one to looking at the nutrients.

Dr. Justin Marchegiani: Yeah, and what are you doing to look at liver function? Because you–we know liver is so important for thyroid hormone conversion.

Dr. Will Cole: Yeah, what I’m doing is I’m running a comprehensive metabolic panel and looking at the AST, ALT, and the GGT and looking at the functional range, not just the–the huge reference range. But looking at the liver enzymes in the optimal range on the blood test that a lot of these people have already. So I always tell patients like, “Look, we can start with the labs you have already and just the functional medicine interpretation of those labs to kind of see,” and you know what, so many people don’t even know what all these biomarkers mean and just explaining to them, “Hey, look, this is what’s been going on. Your doctor hasn’t talked to you about it mainly because there’s no medication for it. But it’s actually a problem and your doctors ran these labs but there hasn’t been a conversation about it.”

Dr. Justin Marchegiani: Yeah, that makes a lot of sense. That really does. Now on that note, I have a blog up here in front of you that you wrote a little while back on autoimmunity and some–

Dr. Will Cole: Yeah.

Dr. Justin Marchegiani: Of the triggers. Can you talk about, just comparing contrasting, you know, your run-of-the-mill, your primary or secondary hypothyroid patient, whether it’s a pituitary or conversion issue, and then compare that to just, you know, an autoimmune thyroid. What’s the difference and how would–

Dr. Will Cole: Yeah.

Dr. Justin Marchegiani: You treat them?

Dr. Will Cole: And I would–they–there can be separate cases but my finding is that a lot of these patients are–have more than one thyroid category where we put them in. They are autoimmune, the majority of them.

Dr. Justin Marchegiani: Yeah.

Dr. Will Cole: Even if the antibodies are below the level where we can classify them as Hashimoto’s, there’s some sort of autoimmune response going on there, and then they have conversion issues. And they have pituitary hypofunction, so–and they have thyroid resistance which is similar to–to the insulin resistance because of the chronic inflammation they’re going through. So they have this multi-tiered faceted aspects that–that are pieces of the puzzle to them healing when they overcome them. So, but again, most of the patients that I see are autoimmune patients and a large majority have been diagnosed or will be diagnosed with Hashimoto’s disease or autoimmune thyroiditis and a large part of autoimmune patients is finding out their food triggers, because autoimmune patients as you know they’re given very little options in the standard model of care. They’re really given steroid therapy and that’s basically it. And they–they’re kinda left to fend for themselves, so and then they don’t realize and they’re told by their doctor that what you eat doesn’t really matter at all. You can kinda eat whatever you want. It’s not gonna play a part in your autoimmune disease and that’s just not what research is showing as the foods you eat have direct implications to the rise of your inflammation and autoimmune response in your body. And I’ve seen every food under the sun, even healthy foods, I’ve seen autoimmune patients flare up against these seemingly innocuous healthy benign foods. So you have to kind of cut through the confusion so people that have cleaned up their diet, people that have–that are eating a Paleo diet or–or kind of conscious eaters and clean eaters that are still having symptoms, we need to kind of cut to the confusion what is their immune system flaring up against.

Dr. Justin Marchegiani: Got it. Alright, so you mentioned some of these triggers. You mentioned some foods and now with these foods just kind of be all the foods that would be, you know, cut out of an–kind of your basic autoimmune diet, your nuts, your seeds, your nightshades, your gluten–

Dr. Will Cole: Yeah, those are the–

Dr. Justin Marchegiani: Sweet potatoes, eggplants, peppers. Go ahead.

Dr. Will Cole: Yeah, I know. That’s the–the big guns for sure. We would–

Dr. Justin Marchegiani: Yeah.

Dr. Will Cole: Clean those guys up right out of the gate and then we typically I run the Cyrex multiple–multiple autoimmune food panel, the–the newer one they have that kind of–

Dr. Justin Marchegiani: Array 4? The Array 4?

Dr. Will Cole: I believe so–I don’t know for sure. I think it might be autoimmune because that’s like molecular–that’s the cross-reactive foods–

Dr. Justin Marchegiani: Yes.

Dr. Will Cole: I believe. So it’s not the cross-reactive foods which we would run that as well, but they have, I think it’s Array 10. It’s higher up in the–in the arrays, that kinda looks at just food intolerances as a whole and obviously I–no one really has like a spinach intolerance but if their body is reacting against this, it’s really due to the gut. So what I have them do is while they’re healing the gut, avoid those foods, so they do not have this inflammatory response against these healthy foods.

Dr. Justin Marchegiani: Got it. So patients come in to you, what are the average tests that you’re running off the bat? I know it’s gonna be different for each patient depending on what their goals are but just on average, how many tests are you typically running off the bat and what are they in general?

Dr. Will Cole: Yeah, the first–my first tier test is gonna be a functional blood testing, just through their–

Dr. Justin Marchegiani: Mmm.

Dr. Will Cole: Labs, typically. Their Quest or LabCorp we typically use. So it’s gonna be a comprehensive metabolic–metabolic panel. We run a nuclear magnetic resonance to look at the subfractionation of the lipids. We’re looking at the micronutrients. We’re looking at a full thyroid panel obviously.

Dr. Justin Marchegiani: Mmm.

Dr. Will Cole:   We’re looking at homocysteine, C-reactive protein–

Dr. Justin Marchegiani: Uh-hmm.

Dr. Will Cole: We’re looking at MTHFR, gene mutations. That’s kind of basic testing for us.

Dr. Justin Marchegiani: Yeah.

Dr. Will Cole: And then the secondary testing is gonna be a full saliva adrenal stress index through diagnostics, looking at cortisol rhythm; looking at estrogen, progesterone, LH, and FSH; some basic food intolerances, and then we run a 2-day collection stool test from Doctor’s Data to look at the microbiome, so predominant bacteria; any yeast, fungal, parasitic issues; bacterial overgrowth, leaky gut syndrome, and digestion and absorption abilities because we see impairments of that a lot because of the population of the autoimmune patients that we’re seeing. So that’s basic testing that we run and then we go a little bit deeper for patients that have cleaned a lot of their lives, that are eating healthily, but they’re just at a plateau and we run sort of these–these deeper tests for those people.

Dr. Justin Marchegiani: That’s great, doc. And I know in your article here on 6 Triggers for Autoimmune Thyroid Disorders and How to Avoid Them, you mentioned infections and you talked about your 2-day sample from Doctor’s Data. Is there a reason why you do the 2 versus the 3?

Dr. Will Cole: I just think it uncovers things that may be missed on the 1-day and they have a 3-day collection, too, where we use that often as well.

Dr. Justin Marchegiani: Okay.

Dr. Will Cole: So I think that you’re just gonna uncover things that maybe fall through the cracks, no test is perfect, and I just find that maybe things negative on day 1, and day 2 and day 3, they’ll be positive. And a lot of people can get these false negatives and they go on for years of their lives not knowing why they’re sick, and it’s just if we just took the extra day to run these labs, we can give them insight into these underlying things that are lurking but aren’t easily detected.

Dr. Justin Marchegiani: Yeah, a lot of times I’ll run 2 different stool tests from 2 different companies, you know, minimum of 3 days each, sometimes we’ll even throw in one of the genetic stool tests, too, and almost all the time, one will pick up an infection where the other one didn’t quite pick it up.

Dr. Will Cole: Yeah, that’s brilliant. That’s even better. So I think the more you can kind of give people answers and say, “Hey, this is why you’re struggling,” and it’s just that’s the beginning of healing and I’m just getting that relief off their shoulders that “Hey, I’m actually feeling this lousy for a reason. It’s not just all in my head.” I’ve told many people as you know are told this for years–

Dr. Justin Marchegiani: Yeah.

Dr. Will Cole: “You’re just crazy or you’re just depressed. Here’s an anti-depressant.” And then they start second guessing themselves and thinking, “Well, maybe this is just in my head.” It’s not in just in your head. It’s–this is a real physiological issue that’s really just, you’re not getting the answers because of the inadequacy of–of the standard model of care.

Dr. Justin Marchegiani: Yeah, I had a patient just the other day come in and she’s a young high school student and she has a bowel movement on average once a week if she’s lucky. And she goes into her primary care and, you know, obviously they just throw her the prokinetics, you know, your–your laxative medications, your enemas. But then while leaving the doctor’s office, the doctor tried prescribing her with anxiety. And it’s like, “Wait, wait a minute!” Like I think anyone would just naturally feel anxious if they couldn’t poop.

Dr. Will Cole: Right.

Dr. Justin Marchegiani: You know, less than one time a week. It’s like, “Come on.” So that’s the kind of standard of care where even when we have blatant imbalances in physiology, we’re still gonna try to make you feel like it’s all on your head and we’re gonna give you some medication that’s gonna probably cost more side effects than help.

Dr. Will Cole: Yeah, exactly. I think it’s very well said and it’s just this very symptom-based model which we’ve seen for–for–for decades here and it’s just where–as far as crisis care, I think emergency care in this country we have some of the best emergency care systems in the world, but when you’re talking about chronic care, daily chronic disease that are–it’s really what’s killing the United States, chronic disease and autoimmune conditions, we’re a dismal failure. We’re really very, very inadequate as far as the options that people are given.

Dr. Justin Marchegiani: I totally agree. And are you seeing a lot patients of yours that are having these issues and are being scapegoated with anti-psychotic medications?

Dr. Will Cole: Oh, absolutely. They just–that’s the easy drug to give. That’s the easy solution. You have anxiety, you have depression and–or you have these unexplained health issue, and they basically are saying it’s a mental issue. They’re basically making it up. It’s part of a mental disorder and they’re given these anti-psychotic drugs and it’s just–it’s not dealing with the root issue of why they’re going through what they’re going through. And we know just through the cytokine model of cognitive function, basically how inflammation impacts brain function, depression and anxiety and these type autistic symptoms, all of these things have implications to the gut, to the microbiome, and to inflammation. Until you deal with those issues, these real measurable physiological issues, you’re gonna have these symptoms and you can be dealt up from medications but ultimately you’re not dealing with the reason why you have the problem in the first place.

Dr. Justin Marchegiani: Yeah, I totally agree. That makes a lot of sense for me and I know that you being a functional medicine doctor, you have a system-based, a systems-based approach, where when someone’s talking about their symptoms, right? They may take about fatigue or brittle hair or my fingernails are this, you’re in your–in your mind like going back, “Oh, maybe they’re adrenals are off, maybe they’re not absorbing fatty acids and protein,” where maybe the average doctor is like, “Ooh, let’s see depression, SSRI, stomach pain, mmm, proton pump inhibitor.” So your mindset is totally different. You’re working in a different way mentally when you’re listening to these histories versus the conventional MD, is that correct?

Dr. Will Cole: Yeah, absolutely. In other words, functional medicine is systems medicine or, you know, mechanism medicine. So we’re looking at these underlying mechanism dysfunctions that give rise to chronic and autoimmune conditions. So yeah, the symptoms are a–a–are a–are just the tip of the iceberg. Symptoms are a result of something going on underneath the surface that we need to kinda backtrack and come up with a hypothesis of what’s not working well and then implementing tools, natural tools, to fix these underlying dysfunctions.

Dr. Justin Marchegiani: Yeah, I love that. That’s why functional medicine just makes so much sense.

Dr. Will Cole: Yeah, it’s logical. I mean, people that have a logical mind or they just wanna find out why–who doesn’t wanna find out why they feel the way they feel? I think ultimately most people do not want to just mask symptoms. They may want it for the meantime, in the short term if they’re suffering, I understand that. But then long term, we have to ask the question, “Why do I have this problem in the first place? It’s not a medication deficiency. So let’s find out how we can get better so eventually as I’m getting healthier, I can get myself off these medications with my doctor’s help.”

Dr. Justin Marchegiani: That makes sense. Now in your blog article which I recommend everyone to read here. The 6 Triggers For Autoimmune Thyroid Disorders at drwillcole.com, click on the blog link there. But you talked about infections, we touched upon, you know, how you assess that with, you know, certain stool tests–

Dr. Will Cole: Uh-hmm.

Dr. Justin Marchegiani: 2-3-day ones, et cetera. What infections are you seeing on average with your patients?

Dr. Will Cole: Yeah, we’re seeing bacterial pathogenic infections–

Dr. Justin Marchegiani: H. pylori?

Dr. Will Cole: Yeah, H. pylori–

Dr. Justin Marchegiani: SIBO kinda stuff?

Dr. Will Cole: Yeah, and strep infections, too. Overgrowths of those–those coliform units of bacteria, and we’re seeing candida, not just the Albicans. There are different kinds of species of candida, yeasts, fungal issues, and occasionally we’re seeing parasitic infections as well. So these types of things are constant, cyclic inflammatory triggers to people that are struggling with these unexplained health issues that may be thyroid-related, may have a thyroid component and they’re–

Dr. Justin Marchegiani: Uh-hmm.

Dr. Will Cole: Just think it’s entirely thyroid, but as we talked before the–the call started, the body’s all interconnected.

Dr. Justin Marchegiani: Yeah.

Dr. Will Cole: And the idea that one of these separate boxes where we’re just gonna have a pill for each of our problems, the reality is that we need to look at the body as a whole entire system and–and start fixing these issues one by one.

Dr. Justin Marchegiani: Yeah, that makes a lot of sense. Now, what kind of parasites are you seeing in your clinic with patients?

Dr. Will Cole: We’re–we’re seeing really everything as far as the parasitic infections, but it’s not–to pinpoint one, I don’t really. Yeah.

Dr. Justin Marchegiani: Yeah, I know how science–

Dr. Will Cole: The scientific–

Dr. Justin Marchegiani: Yeah, I know the scientific literature is really keen on for instance H. pylori is a big one, Yersinia enterocolitica, those are big ones that are connected with the autoimmunity for sure.

Dr. Will Cole: Yes.

Dr. Justin Marchegiani: What’s your experience with Lyme’s–Lyme’s disease or Lyme disease and Hashimoto’s or Graves’ for instance?

Dr. Will Cole: Yeah, we don’t see very many in my practice model. We don’t see a lot of Lyme’s patients, it’s not really my focus but the autoimmune component of Hashimoto’s and Graves’, that’s the majority of our patients, and yeah, we–we have many patients that have Hashimoto’s and many patients that have gone years of their lives thinking they have a thyroid problem but again, their TSH is normal, but then when you run the antibodies, the thyroid peroxidase and thyroglobulin antibodies, it’s through the roof. To be officially diagnosed with Hashimoto’s, you need to have a high TSH and both positive antibodies but they’re again, they’re somewhere on that autoimmune spectrum.

Dr. Justin Marchegiani: Yeah, now we can’t have a–a talk on thyroid without touching upon iodine.

Dr. Will Cole: Yes.

Dr. Justin Marchegiani: So there’s a couple different schools of thought of iodine. There’s the Kharrazian approach which is iodine for anyone is totally bad that has autoimmunity and then we have, you know, the Brownstein approach which is, you know, maybe some iodine may be really helpful and we’re gonna give very high doses, you know, up to 12.5 mg, maybe 50 mg, the–the Abraham approach kinda, where do you fall in on that spectrum with giving iodine and can you compare and contrast it with someone with Hashi’s or autoimmune markers or not? Can you–

Dr. Will Cole: Yeah. Yeah and I’ve kinda been on both sides of this and I’m more from the disease Kharrazian point of view as definitely it’s from an autoimmune standpoint so we definitely avoid it. I consider it a contraindication for autoimmune patients only because of what I’ve seen personally. The research, I’ve–I’ve included the hyperlinks in–in the article on drwillcole.com for that as well. But just on a practical level, what am I seeing clinically? I–when I see patients on iodine when they’re coming in here, I’ve seen people flare up because of that so that paired with the research going on there, I–I think that we knew it to at least err on the side of caution when you’re talking about iodine supplementation for autoimmune thyroid patients. With that said, if someone’s clearly an autoimmune patient and they’re having low thyroid issues, iodine can be a great part of–in low dose, it’s a great part of them healing. So I think this is a–the bigger picture of what we both agree upon is that there’s no one size fits all, and even natural things, what works for one person may not work for the next person. So to make blanket statement and say that iodine is not used for anybody and then the other person’s iodine is this magic pill for everything, I think that it’s a little bit more nuisance and there may be some generalities that are–that are true but we kinda have to look on it on a case by case basis.

Dr. Justin Marchegiani: And when you have an autoimmune patient, you know, let’s say you’re fixing their adrenals, you’re maximizing vitamin D, you’re cleaning their diet, blood sugar stability, sleep. Let’s say they’re 6, maybe 9 months, and they’re starting to do better, you know, when–at what point would you start potentially maybe adding in a couple hundred micrograms of iodine? Would there be a point you may try adding in just a little bit once they’re–

Dr. Will Cole: Yeah.

Dr. Justin Marchegiani: Once things are stabilized?

Dr. Will Cole: Yeah, I definitely feel like that. And if you run the antibodies and they’re negative and we’re talking about, I would say probably 6-8 months, maybe it’s a little bit more conservative of me, but that’s where I would go. I would wait at least 6-8 months, let everything sort of heal down–dampen, put into remission and then we have really low dose just to kind of test it that way because at point, it can be the tool to push us past any plateaus that we find ourselves at at 6-8 months into care.

Dr. Justin Marchegiani: Are there are any markers on lab outside of like, you know, a SpectraCell or an iodine loading? Is there any general marker that you would look at on a thyroid panel to say, “Hey, maybe you could use some iodine supplementation?

Dr. Will Cole: I do the urine iodine test just through Quest or LabCorp. We do the urine–the random urine test.

Dr. Justin Marchegiani: How does that work? Can you walk that through our listeners?

Dr. Will Cole: Yeah, it’s just a urinalysis from the lab. So typically the patients are going–we have–we’re sending them to–to LabCorp or Quest and they’re getting this and we’re just looking at the iodine levels and seeing where their levels are at and if they are low–again, if it’s an autoimmune case, I’m going to wait until we kind of calm everything down and then test it in low amounts. I rather them get a little bit iron–iodine-deficient than have an autoimmune flare-up and a thyroid storm. And that’s just my personal opinion.

Dr. Justin Marchegiani: Yup.

Dr. Will Cole: I think that other clinicians have–have valid points as well, and then as they’re calmed down and things are healed up, then we can kind of talk about very small amounts of iodine at a–at a time.

Dr. Justin Marchegiani: So regarding that iodine loading, is there a loading dose that you would take before that test? Is that like a 50 mg kind of Lugol’s or Iodoral capsule you take?

Dr. Will Cole: Yes, 50 mg and we use that same, yeah.

Dr. Justin Marchegiani: So they give that to the patient and they go to the lab, they collect their blood that next morn–or their urine that next morning, is that how it works?

Dr. Will Cole: Yes.

Dr. Justin Marchegiani: And then you’re essentially looking for less, like the–

Dr. Will Cole: Exactly.

Dr. Justin Marchegiani: Less iodine in there means you’re body is taking it up. The more that come back in the urine means you’re more, I would say, sufficient.

Dr. Will Cole: Right, more, yeah–

Dr. Justin Marchegiani: Okay.

Dr. Will Cole: Sufficient. Exactly.

Dr. Justin Marchegiani: Okay, great. Any other comments on iodine? I know the whole io–de-iodina–deiodination–deiodination, that’s a funny word. That’s basically–

Dr. Will Cole: Yeah.

Dr. Justin Marchegiani: How your body takes iodine and binds it to tyrosine and makes thyroid hormone T4.

Dr. Will Cole: Yeah.

Dr. Justin Marchegiani: That process I know when there’s deficiency in selenium, we spit out a whole bunch of hydrogen peroxide and that’s one–one of the big cascades of–

Dr. Will Cole: Yeah.

Dr. Justin Marchegiani: The whole autoimmunity. Can you talk about how important selenium is to autoimmunity?

Dr. Will Cole: Yeah, it’s a huge stabilizer to the immune system. So it’s one thing that we test and typically we’re just testing that from the SpectraCell lab and when we–it’s one of the nutrients we need to reinoculate the body with. We need to nourish the body with this nutrient to stabilize the immune system so when there’s a–a lack of it. It’s–it’s a piece of the puzzle. Again, I don’t wanna make it as the magic bullet for everything but it is a factor that I see clinically in people who are gaining their health.

Dr. Justin Marchegiani: That’s great. Do you see patients with Epstein-Barr reactivated viruses like Epstein-Barr for instance that’s may be driving their autoimmunity?

Dr. Will Cole: Absolutely, yeah. I think that researches show this as well as the majority of people that have autoimmune disease have had some sort of viral infection, bacterial infection in the year prior to their diagnosis. So yeah, it’s a factor to them feeling the way that they feel and you have to deal with these–these viral issues and bacterial issues and balancing the immune system as much as you can to regain that plasticity of–of their health so they can regain function back.

Dr. Justin Marchegiani: That’s great and do you have an approach on how you address viral issues?

Dr. Will Cole: Yeah, we–typically I use for viral issues, I use GI-Synergy from Apex, sort of–it’s like a microbiome bomb, gut immune bomb. Do you use that as well?

Dr. Justin Marchegiani: I–I used to use that. I use a couple of other things for viruses, main–mainly like very high dose monolaurin from what I understand is very good and high dose Reishi mushrooms is very good as well.

Dr. Will Cole: Yeah, I feel like the Reishi mushroom is actually in GI-Synergy as well.

Dr. Justin Marchegiani: Oh, okay, that’s cool. Very cool. So on your 6 Triggers blog here, you also mentioned gluten and I think a lot of our listeners are probably very aware that gluten and the thyroid, there’s this cross-reactivity and molecular mimicry with gluten in the thyroid tissue. Can you just touch upon gluten and how important that is with Hashimoto’s patients?

Dr. Will Cole: Yeah, I think it’s a–a huge factor and I think a lot of people when they have a thyroid issue or they’re even then diagnosed with Hashimoto’s and they know that, they kind of beg for these labs from their doctor and they know they have Hashimoto’s and so they’re given no option beyond that, and from my perspective looking at the research and again, you can look at drwillcole.com and I’ll have the hyperlinks going to the–the different studies and I know you’ve written about it as well, is that this is kind of a no-brainer. You just cannot be eating gluten if you have an autoimmune condition and I would say statistically, since the majority of low thyroid patients have some sort of autoimmune issue. That you should off of gluten entirely if you have any thyroid issues just to err on the side of caution and because of the–the cross breeding of the grain supply in the United States throughout the years, it’s a molecularly a different beast than we have–we have known through our history. So there’s a mismatch between out genetics, our biochemistry and the things we’re eating, this biochemistry so that molecular mimicry that’s going on the body’s causing an attack against the gluten protein as well as your thyroid tissue and Lord knows what else, I mean poly-autoimmunity is a very common thing that we see in–in our clinic. People with 3 or 4 different autoimmune diseases and this is being fueled in part by the foods that they are eating. And–and then people will give it like 3 weeks of this or 4 weeks of that, and they’ll say, “I didn’t notice a difference after 4 weeks of being off of gluten,” and the research shows it takes up to 6 months to–to downregulate some of the inflammatory cascade that are going on because of gluten. So yeah, it’s a big factor that people have to kind of stay true to it and you can’t just be a little gluten-free. It’s like saying you’re a little bit pregnant.

Dr. Justin Marchegiani: Yeah.

Dr. Will Cole: You’re either pregnant or you’re not, and you kinda have to stick through it and is–it is a big piece of the puzzle. It’s not the entire puzzle but it’s a factor into people regaining their quality of life back.

Dr. Justin Marchegiani: That’s great. We’ve gone over a lot of stuff today. I think everyone is gonna have to listen to this show twice, even myself, so I’d like to–I’m starting to ask my–my interviewees here a couple of questions to end the show. So first question I’m gonna ask you, if you had to be on a desert island and this is a–I took this from Mike Mutzel’s podcast, but if you were on a desert island and you could only bring one herb with you, one herbal product, what would it be?

Dr. Will Cole: It has to be an herb?

Dr. Justin Marchegiani: Yeah.

Dr. Will Cole: Herb–

Dr. Justin Marchegiani: Favorite herb.

Dr. Will Cole: Milk thistle.

Dr. Justin Marchegiani: Milk thistle. Good. So you plan on doing a lot of drinking on the island, right? And then what are like your favorite that you would say the best 3 things you could do to optimize your health?

Dr. Will Cole: Mmkay. 3 things to optimize health. I would say, eat good fats, avoid sugar, and eat lots of plant foods.

Dr. Justin Marchegiani: And then with fats, do you mean like olive oil or like coconut oil or fish oil? What do you got?

Dr. Will Cole: I’m talking about good, good saturated fats like good grass-fed beef and ghee and clarified butter, and yes, and mono and saturated fats like olive oil, avocado oil, yeah.

Dr. Justin Marchegiani: Great, awesome. Well, everyone listening you can find more of Dr. Cole at drwillcole.com. Doc, where else can the patients or all the listeners find you here.

Dr. Will Cole: You can find me at–on Twitter @drwillcole, says D-R-W-I-L-L-C-O-L-E and yeah, drwillcole.com has all the links to me on social media so you can follow me on Facebook, like me on Facebook, follow me on Twitter, all that good stuff, and you’ll see us both at Paleo f(x) in Austin at–at the end of April.

Dr. Justin Marchegiani: End of April, it will be a really good thyroid panel. We’re gonna be on 10 AM that Thursday opening up Paleo f(x). So we’re really stoked. Anyone that really wants to get more hands-on information about your thyroid and reach out to Dr. Cole, and also come to Paleo f(x). And again, Dr. Cole also has his 14 Life-Altering Health Tips mini eBook on his site, so feel free, get that. That’s a–a freebie and Dr. Cole, it was great chatting with you.

 

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