Hashimoto’s Triggers – Autoimmune Thyroid – Podcast #143

Hashimoto’s Disease - Autoimmune Thyroid

Dr. Justin Marchegiani and Evan Brand talk about the different causes and triggers of Hashimoto’s disease. Find out how it is connected to one’s immune system, diet and gut health and learn why women are more susceptible to having it.

The thyroid, adrenals and gut health are important factors to consider in addressing Hashimoto’s disease. Listen to this podcast and learn about the natural solutions and beneficial supplements to support them.

In this episode, we will cover:

01:29   Hashimoto’s Disease

09:24   Socialized Medicine

13:40   Use of Secretory IGA in Measuring the Immune System

15:39   Women and Stress-sensitivity

18:24   Ketogenic Diet, Insulin Resistance and Hashimoto’s







Dr. Justin Marchegiani: And we’re back! Evan, it’s Dr. J. How are we doing, man?

Evan Brand: Pretty good. How are you doing?

Dr. Justin Marchegiani: Good. I’m loving the ambience. My new plantation shutters in the background; just loving that there. Just nice. Ready for an excellent day. Got a little lunch break here. I’m seeing patients all morning. Ready to drop some knowledge bombs, and then get back to patients in the afternoon. How are you doing, on your afternoon?

Evan Brand: Yes. Likewise, same story. I had a female client this morning, who I was telling you over air. We had run her blood work before…

Dr. Justin Marchegiani: Uhhmm–

Evan Brand: …previously. And it was basically just a checkup. I said, “Hey, why don’t we check your thyroids?” She didn’t really have hyper or hypo symptoms, and she showed up with thyroglobulin antibodies, which is one of the type of antibodies you and I test our clients for on blood. And she showed up with a level of 50. And we should see that, as minimal as possible. I mean, hopefully less than 1, but she’s had a 50. And she said, “What’s triggering this?” And, we can go into that today, but I was hoping you and I could really outline a lot of different causes and triggers of Hashimoto’s because it’s so common in our females, we see it every single week. It’s like – well, there different triggers for different people. So, hopefully, we can try to go into a couple of different arenas here, and talk about the big puzzle pieces.

Dr. Justin Marchegiani: I like that. And then people on Facebook, we also got Evan’s audio on the background, too. So, if you’re listening on Facebook, go over, jump on YouTube, justinhealth.– or youtube.com/justinhealth and vice versa with YouTube. Get on the Facebook page so you can get this live feed. We’d like to them and do our Q&A’s too. So this is great. So, a hundred percent. Hashimoto’s the big issue, vex about 30– or thyroid issues, about 30 million people in this country, uh – I’d say, at least, hmmn– I’d say a quarter of probably undiagnosed, or at least undertreated or undersupported because they’re given synthetic thyroid medication. That’s– is T4, right? T4 in origin. And then you have these various enzymes called D2 and D3, that help convert and activate thyroid hormone. And the problem is those enzymes, if you have Hashimoto’s, there’s a good chance that D2, D3 and even D1 enzymes are not working optimally, so then that conversion of T4 to T3 – that inactive thyroid hormone to active T3, about 400 percent increase in the metabolic activity of T3 versus T4, those enzymes aren’t there for the conversion. So that’s a big issue, right? [crosstalk] And not to mention, when you take a thyroid hormone, you’re getting a T4, right? But you’re also getting T3, right? Triiodothyronine, which is your active thyroid hormone, you’re getting T2, which isn’t even tested, right? T2, uh– Diiodothyronine, is a metabolically active hormone, only measure in the research settings, and not even really talked about in conventional medicine, T1, T0, Calciton, which is very helpful for Calcium metabolism. So, again, we’re not getting that in our conventional thyroid medication. The big thing is those D2, D3 enzymes that you’re missing, that T4 to T3 conversion with. So lots of people are being medicated with thyroid hormone, right? Synthroid, Levoxyl, Levothyroxine. Though TSH comes back in the normal range, so they look good on their conventional doctors uh– thyroid test, but they still have all these thyroid symptoms, right there. The thinning hair, the outer third of the eyebrows, swelling of the hands and feet, anxiety, mood issues, constipation, depression, and they’re not getting better.

Evan Brand: So, why? What’s up with these enzymes? What’s happening to them?

Dr. Justin Marchegiani: Well, I mean, there’s the underlying physiology, typically, inflammation, right? Inflammation is what drives people into that disease, or pathological state, right? And that pathological state means more symptoms, right. All the things I just mentioned, the moods, the digestive stuff, uhhmm– the hair loss stuff, the energy, the weight gain, all those things are gonna be affected. Now, a big component we talked about it, ‘cause a lot of these issues, right, thyroid-based things are gonna be autoimmune in nature, so autoimmune means your immune system is actually attacking your thyroid gland, so you have these antibodies, like TPO or Thyroperoxidase, you have antithyroglobulin antibodies, and these are primarily with Hashimoto’s, for instance, and they come and they attack your thyroid gland. And that’s about 90 percent– let’s say 50 to 90 percent are autoimmune in nature, so you and your conventional medical doctor or your endocrinologist says, “Oh, here’s – here’s the conventional thyroid pill.” They’re not actually getting to the underlying immune– immune imbalance, right? They’re not fixing the underlying things, like gluten, right. Grains and gluten, and that molecular mimicry that happens where your immune system can be exacerbated ‘cause of Gluten. That’s the one, one really big component. Couple of others will be gut – the gut issues. So, small intestinal bacterial overgrowth, gut bacterial imbalances, infections, H.pylori, Blastocystis hominis, uh– Lyme or Borrelia burgdorferi, uhm – Yersinia enterocolitica. So those are just a lot of gut infections that can significantly affect your GI. And again, that sulphatase enzyme in the gut made by healthy bacteria, really helps to activate, that thyroid hormone really helps to upregulate those D2, D3 enzymes to get your T4 to T3. So, all that technical jargon, what the heck does it mean? We’re trying to get your– your active thyroid hormone up higher; that’s the goal. Your T3 levels, get them up higher because, just doing it on the conventional side, and say, “Hey, let’s give you uh– a synthetic thyroid hormone.” That may not be enough to actually get the end stage thyroid hormones better. It may make the upstage TSH look better but not the downstream T4 and T3.

Evan Brand: Conventional, like the National Institute of Health, though, say that the Hashimoto’s affects one to two percent of people in the United States. Do you agree? One to two percent or do you think it’s much greater?

Dr. Justin Marchegiani: So you’re saying– repeat that question, one more time for me.

Evan Brand: National Institute of Health– is it – do you heard– are you hearing echoes? Is that messing you up?

Dr. Justin Marchegiani: No. No problem. I just got a comment here. Someone’s saying they’re not hearing the audio on the YouTube site. [crosstalk] You guys are hearing the audio, give me a thumbs-up here, but I think we’re looking good.

Evan Brand: Okay. So, National Institute of Health, they say, “Hashimoto’s affects one to two percent of people in the United States.” I think it’s much, much higher. Izabella Wentz, I think she gave a number that was much, much higher too. What’s your take on this percentage here?

Dr. Justin Marchegiani: Yeah, I think it could be much higher, for sure. I think it could be much higher, and the big issue is that most doctors they aren’t testing for thyroid antibodies. That’s the major issue. Uh– we talked about a patient this morning over in Canada, whose doctors aren’t uhm– they aren’t even testing for thyroid antibodies. And the big reason why is because, think about it, right? If the solution is a synthetic thyroid hormone, like Levoxyl, or Synthroid, or Levothyroid, right, if that’s the ultimate end game, and that doesn’t change whether there’s autoimmunity or gluten issues, or infections, then it stays the same. Why change that, right? Why change that variable up because they’re not gonna do anything different if something else comes back, right? Does that makes sense?

Evan Brand:  Yes, it does.

Dr. Justin Marchegiani:  Even though 90 percent are autoimmune in nature, right? Even though 90 percent of thyroid issue’s autoimmune, they’re not gonna do anything different anyway, so why even look for it? Because then, it just creates more questions the doctors have to answer, and they don’t like to answer questions they’re not prepared to uhm– to answer. Most people…

Evan Brand: And they’re not trained, because if antibodies do come back, they’ve got nothing. They’ve got no way to talk about Klebsiella and Citrobacter bacteria that need to be treated. Uh– yeah, and so uh – just to give a little bit more back story on the Canada, so– you know, Justin and I both have clients in Canada.

Dr. Justin Marchegiani: Yeah.

Evan Brand: And they’ll say, “Hey, we’ve got health insurance over here. It’s free.” But there’s a catch to that. It’s not that good. All they’re gonna do is they’re gonna run, like, a one-marker, like maybe TSH, and then based on that they may give you a prescription drug. But if you don’t have your free T3, the reverse T3, the TPO, the TG antibodies we talked about, may not always using Algin, maybe you tell me there’s a better analogy, but mine is: if you just have TSH and you’re trying to treat thyroid, it’s like touching the sidewalk and estimating the forecast.

Dr. Justin Marchegiani: Yeah. That analogy sounds really, really familiar. I don’t know why.

Evan Brand: There’s no way you came up with that. I’m pretty sure…

Dr. Justin Marchegiani: I came up – I came up with that one. That’s been around for, like, six or seven years, ‘cause that’s how I teach my patients about TSH– TSH. The receptor sites in the pituitary are hypersensitive. The thyroid hormone, therefore, uhm – TSH will drop– will drop more precipitously because the brain is sensing thyroid hormone being a lot higher then what it is. So, peripherally, the thyroid hormones never get high enough and the periphery in the actual tissues but it’s– it’s high enough in the brain ‘cause the brain’s more sensitive to thyroid hormones. So, TSH will always drop faster than what the peripheral tissues need uh– in the periphery there for thyroid hormone. That’s why you don’t want to base your dosing or your support of the TSH 100 percent, ‘cause the TSH is so sensitive. Touch the sidewalk outside when it’s a hundred degrees out, it’s gonna be able to fry an egg on it, right. But again, the air temperature will always be a lot cooler. The peripheral tissues will always be less saturated with thyroid hormone uh– than the latter. Make sense?

Evan Brand: I’ll give it– I’ll give you a credit. It must have rubbed off of me then, if you had that one before. [laughs]

Dr. Justin Marchegiani: It did. I do– that’s mine. That’s uh– that’s a Dr. J-ism. But I’m– getting back on your thing, man, yeah. Socialized medicine for the most parts thinks– Okay, I’ve seen patients from all over the world. All over the world, Europe, Canada– Socialized Medicine’s great if you only need it for acute traumatic issues, right? You sprain your ankle, right? You have to go to the ER, ‘cause of some reason. But outside of that, if you getting stuck on that chronic conventional model, all you have for options are conventional drugs, right? And then number two the waits are like, three to six months to get in. Again, this is what happens. I have hundreds of patients where I’ve had this story, literally had this story they literally told me over and over again. And then because everything is socialized, the government says we’re not gonna reimburse. Reimburse then guess what happens. There’s not a market place for it, right? There’s less people going underground. Now, I do have people over in Canada that are functional medicine doctors and they’re doing– they’re thriving even in a socio uh– even in a uhm– sociological medicine society there, right? Even with a socialized medicine society because, people aren’t getting better even though the medicine’s free they’re still going in paying a lot of functional medicine doctors. And again, we start today. Why am I hampering on this is because, that doctor wasn’t running TPO or any of the thyroid antibodies. So, the socialized medicine said, “Nope. We are not gonna test your thyroid antibodies. We deemed that not appropriate, and this person needs to know they have Hashimoto’s so they can make changes with their immune system, with their gluten, with the gut, with a lot of the converting nutrients to help T$ and T3.

Evan Brand: So let’s– let’s go through a list. I know, we could kind of jump around but, maybe we could do like a top five [crosstalk] or maybe even like a top ten.

Dr. Justin Marchegiani: Yeah. Let’s do it.

Evan Brand: So, number one– in no particular order, but number one, you already mentioned gluten. So, this would include any grains, right? ‘Cause even like our Amaranths, our Buckwheat, our Kiwa. That Kiwa could still be cross-reactive and trigger the antibodies, right?

Dr. Justin Marchegiani: Correct. I would still stay away from all grains. Grains probably being number one trigger becau– partly because of the amino acid sequence in the grains, I very similar to the surface proteins of the thyroid. That’s number one. So [inaudible]…

Evan Brand: What about now? Are you seeing issues with him?

Dr. Justin Marchegiani: Well, I mean, that’s a cross-reactive thing so, if gluten is like, you know – if gluten is like the brother and sister, you know, Hamp’s kind of like, maybe the cousin, right?

Evan Brand: Yeah.

Dr. Justin Marchegiani: The second cousin once removed, so to speak. S, again uhm– it may be something that needs to be pulled out with someone on an autoimmune kind of elimination provocation diet for at least a month or two. So, the grains component’s really important. Got to get that out. But not just the molecular mimicry thing. There’s uh– some research looking at Non-Celiac Gluten sensitivity, where they talked about gluten. Even in people that aren’t really Celiac or aren’t even a gluten, like, sensitive person, so to speak. Where just taking that gluten in, they still get gastrointestinal permeability. The guts gets a little bit leaky even with uhm – the fact that they aren’t really gluten-sensitive, so to speak. They aren’t gluten-sensitive but that’s the gut permeability that’s driven by the gluten. And prior, what’s happening is, we’re getting this protein called Zonulin increased. And Zonulin basically unzips, so it’s like an unbuttoning my shirt. That’s Zonulin, right? Unbuttoned zip, right? Opens that gut lining up, and then all these digestive proteins you get right through there.

Evan Brand: So, Zonulin goes up in the presence of grains. We had a question in the live chat about Brown rice. Absolutely, Brown rice would still be in a category of grains that you would want to remove.

Dr. Justin Marchegiani: Yeah.

Evan Brand: If you want to avoid Hashimoto’s. I tried to justify with you for a long time, “Oh, I love my white rice.” You know like, man, it’s just not worth it. And now uh– saw this stew– sweet potato now, and…

Dr. Justin Marchegiani: Yeah.

Evan Brand: …my skin. My skin’s actually gotten better, too. You know, Even though I’ve pulled out – I’ve pulled out the rice.

Dr. Justin Marchegiani: Yeah, man. You go back to your old uh– YouTube videos, you had some– some stuff going on there, [crosstalk] and you like’s porcelain skin.

Evan Brand: I tried gut bugs, too.

Dr. Justin Marchegiani: Yeah. Use some gut bugs, man. You’re almost up to a runway model status, Evan.

Evan Brand: I don’t know about that but I appreciate it.

Dr. Justin Marchegiani: You’re getting there. Good.

Evan Brand: Oh, so gluten, [crosstalk] so gluten grain…

Dr. Justin Marchegiani: Gluten and the Zonulin – gluten, the Zonulin stuff and then also other grains still may have some gut irritating compounds, right? The Lectins, some of the Phytates, some of the Oxalates, some of those things, which can be irritating on the gut. So, really, it comes down to like, getting the immune system in the molecular mimicry going. But then it also has some impact on the Zonulin and the leaky gut.

Evan Brand: Okay, so you already said the immune system. Let’s hit on that piece. Let’s make that like our number two or number three. Uhm – we can measure the immune system with the secretory IGA on the Stool Test that we’re running on people.

Dr. Justin Marchegiani: Yeah.

Evan Brand: Uhm – can we go on that number and just use secretory IGA as our immune system, kind of our first line of defense?

Dr. Justin Marchegiani: Yeah.

Evan Brand: And if we see IGA’s low, can we say, “Okay, you’re more susceptible or…”

Dr. Justin Marchegiani: A hundred percent.

Evan Brand: …this will trigger?

Dr. Justin Marchegiani: Yeah. We’ll see low IGA levels. IGA is that mucosal membrane barrier. It’s that first line of defense that lines the gastrointestinal tract, all your mucus membranes, your mouth, you know, our anal cavities, flatulent tract, urinary canal, everything. Every little surface there, even your eyes have IGA in the surface there. Your first line of immune defense. So, when that gets weakened, typically, it will go up and there’s an acute infection. You’ll see it there. We run Stool Test while measuring the stool, and then we’ll actually see it drop down for Chronic Stress. So IGA’s really important, ‘cause that’s a good measurement that your immune system is under stress.

Evan Brand: Right. So, a lot of times, more often than not, you and I are gonna see chronically low IGA, indicating that someone’s been dealing with these issues for a long time. So, Chronic Stress, overwork, maybe they’re not sleeping as well as…

Dr. Justin Marchegiani: Yeah.

Evan Brand: Maybe they have gut infections that are damaging that IGA because people may say, “Well, if I’ve got Hashimoto’s, how did I get a low immune system in the first place?” Well, chicken or egg, all of it– I mean, you could have had adrenal stress, which then weaken the gut. Then you picked up gut bugs, or vice versa.

Dr. Justin Marchegiani: Yeah, absolutely.

Evan Brand: Okay, what’s– what’s next?

Dr. Justin Marchegiani: Yeah, typically it’s a combination of emotional stress that tends to set people up. That tends to be it. So, there’s, you know, you choose with whatever’s happening with your life: work stress, financial stress, family stress, kid’s stress. Whatever’s happening there, that tends to set things up, and that will weaken the immune system.

Evan Brand: I had a female client did uh– that I talked with earlier. She’s a teacher, so she’s on summer break, right now. She’s feeling much, much better. But when she’s back in school, she’s done. She wants to get out of the field of teaching. Everything kind of gets worst, symptom-wise.

Dr. Justin Marchegiani: Yeah.

Evan Brand: So that’s a good example of work stress…

Dr. Justin Marchegiani: Yeah.

Evan Brand: …right there.

Dr. Justin Marchegiani: Yeah, absolutely. And then, women are a little bit more prone to it, because there’s actually a research on this, where their immune system can go out of balance. Like, one emotional, like, you have an emotional argument with the woman, their IO6, their Intergluten-6 can go out of balance for up to two days after a fight. For some of the men, they can go out of balance for like a few hours, but then it’s back in. So I always– this is part of the mechanism why women are more prone to autoimmune conditions. Their immune system probably just a little bit more, I should say, a little more sensitive. And there’s also the Estrogen issue, right, because, Estrogen can affect the CD4 to CD8 balance. And they can skew that balance. So, the more women are Estrogen dominant. That can throw off their immune system. Their CD8, CD4, their natural killer cell, to help her cell ratio. CDH’s your natural killer. Your CD4’s your helper cell. And they could skew that ratio uh – up.

Evan Brand: So, I’m guessing the– like the ancestral view of why woman’s immune system would be more sensitive. Would you say just because of uh– uh– having children, where the immune’s got to be able to modulate itself not to attack and kill the fetus, for example. So, their immune system’s a little bit more variable than a man. Or what do you think is the ancestral lenses?

Dr. Justin Marchegiani: Yeah. I think, it probably has to do with uhm– I think it probably has to do with just raising children in that extra level of empathy, being able to take on other people’s feelings, and kind of be able to uuuh– what’s your need, right? You got, like, you know, you’re raising a child. You have to be to really sense what’s going on. I think that may play into it. I’ve zero evidence outside. That’s just my opinion; just observation. But there’s research and studies on that. Also, blood sugar can throw people’s immune system off to. So like skipping meals, and not giving enough nutrition, and just going long periods of time. So, that’s a big thing, right. That’s a big thing, so, I just, you know, I tell people just make sure you get your communication and your relationships kind of dialed-in. If you’re having issues with the spouse, get the communication down. Try to get, like, try to create a really good environment, where you can communicate, and you’re not gonna get flooded and drive people’s immune systems off.

Evan Brand: Right.

Dr. Justin Marchegiani: You know, that’s kind of, that’s number one. Number two, so let’s get meals, right. Now, when you’re healthier, you can play around with intermittent fasting, okay. That’s a good tool, but you got to get it dialed-in with your hormones good first, and you feeling good first. I may get that dialed-in later on.

Evan Brand: Oh, how about Ketosis too. Like, I tried it with Dr. Mercola, and he’s like– he’s like concerned that a lot of people are going into a ketogenic diet but they’re doing it for too long. So, he’s kind of a proponent of, like, five days on and then two days off. Or hold his go and eat potatoes, and things like that. And really kind of carb-griefy. So, how much of this thyroid epidemic, Hashimoto’s even kid of in the Health Space where you and I are working. These women come into us. They have triggered Hashimoto’s, do you think Ketogenic diet could be a trigger, potentially?

Dr. Justin Marchegiani: Well, I think, Ketogenic diet has actually helped a lot of people with Hashimoto’s, especially ones that are insulin-resistant, because insulin-resistance can actually block thyroid conversion. So, that’s my issue– is if your insulin-resistant, you may do really well with the Ketogenic diet for a while, but then you may hit the wall.

Evan Brand: Yeah.

Dr. Justin Marchegiani: So, then the question. When you hit the wall, that’s where you may start gradually increasing your carbs up. Maybe 10 grams a week, and maybe do a couple of low carb days, like Keto days, and then come out for one or two days in the higher carb side. But, I think, if you’re coming into this, being overweight, with uh– hips circum– you know, waist circumference greater than 35 for a female, 40 for a male. There’s probably some level of insulin-resistance that a Ketogenic diet will help reverse. But then you may have to refine or retune your carbohydrate thresholds afterwards.

Evan Brand: Okay, and that will always be based on adrenal health, and that would be based on, maybe, Vitamin D status or gut infections, depressants, of those. There’s always more, more things, so when people find, “Oh! Ketogenic diet,” It’s like there’s so many different variables out there and these other pieces of the puzzle.

Dr. Justin Marchegiani: Yeah, yeah. I mean, Atkins was sniffing around the right area when he started talking about Ketogenic diets in the 70’s. the problem with Atkins is, he didn’t put enough qualifiers on it. I mean, okay, great. So I eat a whole bunch of meat now, is that gonna be hormone antibiotic, free, you know, laden meat, or is it gonna be organic grass-fed. Oh, Atkins says soy protein’s okay. Eeh! Aspartame’s splendid, okay. Eeh! Right, not good. So, protein quality’s really important. So, if you’re gonna do protein powders, you know, Collagen peptides, you know, P protein, like maybe– maybe some really good grass-fed wheat protein, right. Choose really good protein sources if it’s powder. Or choose really healthy meat souces, or really fat sources. Lots of toxins are stored in the fat, so if you’re eating diseased animals, you’re not gonna get high quality of uh– of a meat product passed down to you from a nutrient perspective.

Evan Brand: Yep, well said. Okay, so we hit the secretory IGA, we hit the Zonulin, we hit the gluten.

Dr. Justin Marchegiani: Also, we talked about thyroid nodules too, right. Someone on uhm– Facebook here, had commented here. So, thyroid nodules are just like these little abnormal tissue spots in the thyroid, but typically gonna be driven by autoimmunity, right. So, Hashimoto’s gonna be the major thing. Hashimoto’s, typically, is an autoimmunity that is involving TPO antibodies, and antithyroglobulin antibodies. Now, again, all autoimmunity, for the most part, will end in low thyroid. The difference is grave disease has a couple of antibodies that can jack up thyroid functioning. Keep it up to the point where you may stroke or you may have an issue if left untreated. So, we that with TSI or Thyroid Stimulating Immunoglobulin and also TSH Receptor antibodies, so, which you want to make sure under control. Why? It helped saved many thyroid uhm – from going into uh – graves or a thyroid storm state by using specific nutrients to help it. and also…

Evan Brand: What happened with uh– with thyroid nodules? Let’s say, someone…

Dr. Justin Marchegiani: Yeah.

Evan Brand: …has antibodies at that point. Maybe we suggest they go get a thyroid ultrasound. They say– Okay, hey. Can you palpate? Like, would you suggest an ultrasound, or can you palpate and figure out whether you have nodules?

Dr. Justin Marchegiani: Oh, great. Let’s go into that. So, try to palpate the thyroid is – Find the Adam’s apple, so like, mine’s right here.

Evan Brand: Get a little closer to the mic, so people can hear good.

Dr. Justin Marchegiani: Yeah. This is your Adam’s apple right here. Right. So, I feel here. I go down, about one centimeter, and then out a centimeter. And, you know, I would do it by standing behind myself, who I can step out of my body. About be here. I touched each side and I press it into the other. And I would have myself swallow water. And I would feel, just for any irregularities in the surface. It will be almost impossible to do it to yourself just as I demonstrated with the angle. But you would stand from behind someone, and you have just nice flat palms, and you just go through the surface, and you touched, you pushed, and you want to feel it come out in the other side. And basically, you want to just feel a smooth surface, and you want to not feel it as an inflamed puffy. You have to feel a couple normal ones to know but, that will give you a pretty good idea.

Evan Brand: The ultrasound sounds easier though. I mean, let’s just say, that you come back with nodules, what happens? Do you just – do you just play the waiting game? You just watch him or how do you approach it?

Dr. Justin Marchegiani: Yeah, I mean, it depends where you’re at, right? There’s always that increase chance of potential thyroid cancer, right. So, it’s good to get that screened, ‘cause of the increased risk. But it’s not the first thing I worry about. Because if you just do all the things that we tell you, I can’t tell you how many patients whose nodules have just significantly reduced. Significantly reduced.

Evan Brand: Yep.

Dr. Justin Marchegiani: Though, I’ve seen that happen so many times, so, hey, you know, just run it by your endo. See what they say. And then just let them know that you’re gonna do some things on the functional medicine side. And, come back and monitor it. you just want to make sure it’s moving in the right direction. Now, some nodules can be caused by low Iodine, too. Again, w tend to get enough Iodine, a couple hundred MIC’s really odd. You need like 200 MIC’s is like they already– hey, you may need a little bit more, but you got to be careful with supplementing Iodine because the Iodination process that happens, so– Iodination is nothing more than the Iodine bonding to the Thyroxine molecules to make your thyroid hormone, right? Like T4 is your Thyroxine, your 4 molecules, your Thyroxine bound to four molecules of Iodine. That process of binding it and pulling out the sticking glue getting stuck there. That’s called Iodination. That process spits of a lot of Hydrogen peroxide which can be inflammatory. And that can drive a lot of B cell infiltration. Your immune cells into your thyroid and exacerbate that autoimmune attack. So you got to be careful off the bat when giving any Iodine. So I always like to get in the Selenium in there first, get the diet dialed-in, get the lifestyle stuffed-out then, and then really lower the information first before I go after it. And if we go after it, we’ll titrate that slowly. We won’t go at it hard. There’s a lot of docs out there that go really high in the Iodine I don’t recommend going high of the bat. I think it’s better off going slower, and work on the foundational stuff first.

Evan Brand: Yeah. Love it. Uh – I was gonna ask you a question about Iodine. I forgot what it was. Tsk. Darn. I lost my point. Alright. Let’s keep moving on. What else comes to mind for triggers.

Dr. Justin Marchegiani: Yeah. So we talked about the food stuff. We talked about blood sugar, we talked about emotional stress. That’s still a big one, okay. Because, emotional stress taps in to your sympathetic nervous system and your sympathetic nervous system wires right down to the adrenals. And that’s umping out Cortisol. Pumping out Adrenaline. And your body will always sacrifice sex hormones for stress hormones. It’s just the hardwired adaptation. Right? If you don’t survive today, you’re not gonna have to worry about reproducing tomorrow, right?

Evan Brand: Yep.

Dr. Justin Marchegiani: So, gut component– the gut component’s very important. We talked about gut bacteria, and how the healthy bacteria’s really helpful with the Sulphatase. Also, that’s where we absorb nutrients, right/ that’s where we absorb a lot of our B Vitamins, a lot of our minerals, a lot of our amino acids, right. Thyroxines and amino acids, that’s part of making thyroid hormone. Also, 70 to 80 percent of your immune system is located in your gut, right? So, you want to jack up your immune system, you know, just get your gut in bad shape by not digesting food, putting a lot of inflammatory things in there. [crosstalk] And uh – throwing off your gut bacteria and uh – whole bunch of steroids from the foods, antibiotics from the foods, anantibiotics in your uh – medicines for maybe, reasons that, maybe be unwanted, so to speak.

Evan Brand: Right. Yeah, the gut’s huge. I mean…

Dr. Justin Marchegiani: Yeah.

Evan Brand: I don’t really like the term SIBO because it’s so generic, but you and I, we see so many different species of bacteria. We can assume that most of them are going to be growing up from the colon to the small intestine.

Dr. Justin Marchegiani: Yeah.

Evan Brand: So if you’ve never been diagnosed to SIBO, or any type of bacterial overgrowth, like specifically, Justin and I are gonna  be looking for, like, a Citrobacter or Klebsiella, or there’s two species of Proteus. Those are all autoimmune trigger bacteria. That’s in the literature too. So, if you’ve got bacterial overgrowth, bacterial infections, parasites, Yeast, or like we see many times a combination. So it could be a Citrobacter, plus Blastocystis hominis, a parasite, plus Candida. That’s uh – that a – that’s a triple whammy there.

Dr. Justin Marchegiani: Yeah.

Evan Brand: That could definitely cause the antibodies to go up. The good thing is this is reversible, right. Now, would you say– I know for us, you know, we’re not medical doctors so we can’t use the term uh– cure. Uh– but is it possible for a cure for Hashimoto’s or when you get your antibodies down, let’s say, you were at a 50 on your TG antibodies, and we do all the good work with you. We get the antibodies back down, let’s say, below a five. Are you cured or can you always just rebound quicker than the average person back up to that bad state of Hashimoto’s again?

Dr. Justin Marchegiani: Yeah. I mean, you can always ramp back up, but it’s all about adaptation, right? The healthier you are, the greater ability you have  to adapt to stress. So, when you have the susceptibility for a certain disease. So, someone posted on Facebook, I have anti-NaN antibodies, that’s kind of a very broad sense, but your predisposed to certain conditions, certain diseases. Maybe Rheumatoid arthritis, maybe Lupus, maybe Scleroderma, maybe CREST, right. So a lot of autoimmune conditions you may now predispose for. But that just means you have the genetic triggers, those genetic switches, are kind of right in the middle, and if those stressors flick it down, right, that stress could flip that gene on and they could activate. So we managed all the things that we talked about, right? Blood sugar, nutrient density, stress, grains, gut health, uhm – being infection-free, ideally, healthy probiotics, healthy gut bacteria, and then making sure that if there’s thyroid damage already, we support that, making sure we support thyroid activation, right. Zinc, Magnesium, CoQ10, Selenium, maybe the right Iodine, use your functional doctors resource, making all those nutrients and things are dialed-in. That’s gonna significantly help improve your resiliency, so if you do have a disease, you may be able to– your body may be able to keep it in check enough, were the symptoms aren’t even visible. But some they say you’re cured, but legally we can’t say you’re cured.

Evan Brand: Right, exactly. What about the liver? What’s the role of the liver?

Dr. Justin Marchegiani: Yeah. Yeah. So the liver’s really important ‘cause a lot of those deionized enzymes. They come from the liver, right. So, the liver’s really stressed and taxed dealing with the whole bunch of fructose coming in there, ‘cause your Insulin-resistant or toxins, and round-up and pesticides, and a whole bunch of junk. It may not be able to do its job, activating and converting thyroid hormones, so we want to make sure, number one, that we are uhm – keeping the stress off it. ‘Cause a lot of liver stuff is more about to stop adding crap to the system, right?

Evan Brand: Exactly.

Dr. Justin Marchegiani: And then number two, I know, Izabella Wentz talks about it in her book, the Hashimoto Protocol. She starts a lot of her patients on a liver cleanse that first month, which can be helpful. So, Liver Support Phase 1, Phase 2, detox support. In my line, it’s uh– Phase 1 is either uhm– Antioxidant Supreme or Liver Supreme, and then Phase 2 is gonna be Detox Aminos. That supports all the Phase 1 and Phase 2 pathways that run your liver. The fat-soluble, the water-soluble, and the water-soluble to excretion in Phase 2. That’s really important.

Evan Brand: So, list of some ingredients. So this is like your Methionines, your Taurines, your milk fissles, [crosstalk] your Vitamins A, you Beet powder, your Artichoke extract.

Dr. Justin Marchegiani: Artichoke, yeah. And then your Phase 2 is gonna be  more of your amino acids. That’s like an acetylation, methylation, uh– glutathione conjugation. All that stuff. So cysteine, glutamine, glycine, uh – taurine’s in there, methionine, uh– We throw Calcium-D-Glucarate in there. Those are really good compounds.

Evan Brand: Cool, cool. Uhm–

Dr. Justin Marchegiani: So I think we hit some good triggers. We talked about some things to help about things to help with thyroid conversion too. We talked about the liver, we talked about the infections and the leaky gut, and then yeah. The whole thing about gluten– oh by the way.– uh– I’ll tell you off the air.

Evan Brand: Alright. Alright.

Dr. Justin Marchegiani: But I’m–

Evan Brand: Hey. Let me tell you something that– before you – I want to –  I want to mention two things. I believe we hit it already, but the adrenal piece, uh– with Cortisol stress, with adrenal problems. You can also pack the conversion of T4 to T3 hormone there. So you got to get your adrenals checklist.

Dr. Justin Marchegiani: Yes. Oh yeah. We got to hit that, man.

Evan Brand: Yeah. So…

Dr. Justin Marchegiani: Yeah.

Evan Brand: So, if you’re working on your thyroid, but you’re not working on your gut, and your adrenals, your results are likely going to not be very good, because adrenal stress is gonna reduce the conversion rate. And then, you can go back to it. But let me say one other thing. I had a client this morning. She was trying to justify uh– eating gluten, and grains, and crackers and stuf like that, because of her food-sensitivity test.

Dr. Justin Marchegiani: Exactly where I was going, man. You’ve read my mind.

Evan Brand: Alright. Her food-sensitivity test said, “I’m not sensitive to gluten.”

Dr. Justin Marchegiani: Yeah.

Evan Brand: And so, she’s still doing gluten. I said, throw your food-sensitivity test away.

Dr. Justin Marchegiani: yeah. I mean the big issue, right. Some of the non-celiac gluten sensitivity research. People that weren’t even gluten-sensitive, they have increased gut permeability.

Evan Brand: Say that again. Just to make sure that it’s like super clear for people.

Dr. Justin Marchegiani: Yeah. People that weren’t gluten-sensitive, right, they weren’t like celiac, they weren’t like having any gluten issues, based on conventional standards, when they got exposed to gluten, they noticed some level of leaky gut, some level of permeability in the gut. Based on the study’s objective criteria diagnosis for it. So that means, more leaky gut, means more immunogenic compounds, undigested foods, LPS, Casein, right – all these things. Dysbiotic bacteria may get into that bloodstream, may start to cause some immune system kind of pissed off, right? Then it may go out looking for that thyroid tissue, or maybe even uhm– the pancreas, or other tissues, or other autoimmune tissues.

Evan Brand: Or even if it doesn’t go straight to that, the gluten could still cause a leaky gut situation, which then sets you up. So, when you go to Sushi Night, you could go pick up Blasto, or some other parasite, which then causes even more damage…

Dr. Justin Marchegiani: Yeah

Evan Brand: …which then leads to the antibodies. SO, one way or another, you’re setting yourself up. There’s really just no justification for gluten in the diet.

Dr. Justin Marchegiani: Yeah, exactly. I won’t give any press to the book. It’s out there right now. We’ve talked about it before.

Evan Brand: [inaudible]

Dr. Justin Marchegiani: Yeah. People say, “Oh. Gluten this and that, maybe okay.” Not necessarily okay. I don’t think it’s uhm– something that people should be consuming. Some people may be able to handle it. Again, if you’re gonna consume gluten, you better off doing it and uhm– sourdough form, if you’re gonna do it. Or, you know, if  you are healthier, right, and you’re on the right track. Every now and then you wanna do a little bit of white rice, as a treat. As long as you’re doing good, as long as you’re on point, right, then I think that’s okay.

Evan Brand: Yep. Yeah, for sure. Alright now, uhm– there was something else. I interrupted you. I hit the Adrenal piece, and I had to talk about the food-sensitivity testing and the lady trying to justify gluten.

Dr. Justin Marchegiani: Yeah, that was it. I think we hit it, and I think just the– the adrenal imbalance, whether high Cortisol or low. So, Chronic stress, low cortisol, with the reverse Cortisol rhythm, or acute stress, really high Cortisol, both can affect your thyroid conversion and activation.

Evan Brand: Yep, yep. Got it. So, I mean, yes. You can take adaptogenic herbs. We love, we promote those, but that’s still not addressing the root cause. So if you hate your job, we can give you all the Ashwagandha, Rhodiola, uh– Siberian Ginseng in the world, and we’re gonna help you adapt to the stress, but you still got to remove the stress. It’s like I know you see the analogy of the engine life, putting the tape over the uh – the check engine light in the car. I like the analogy of like a doorbell too. Like if you keep pushing the doorbell. Uh– your still gonna have issues. You can try to like disable a doorbell, but it’s still being pressed. Like, you hate your job, or you’ve got a turbo relationship. I had a woman, who she told me. She said straight up, “Evan, until I divorce my husband, I will not get better.” And I said, “Well, I fully support you in that decision.” And now, she’s going through the divorce. She’s already starting to lose weight, just based on the reduction of the emotional stress. So I think that’s just amazing, and unfortunately, that happens. But, if you wanna be healthy, you got to make some tough decisions, sometimes.

Dr. Justin Marchegiani: I agree. I appreciate you’d actually given me credit for that analogy. I thought you were gonna pawn that one off of yourself.

Evan Brand: [laughs] No, definitely not.

Dr. Justin Marchegiani: Good, ‘cause I wasn’t gonna give you, like, two Paleo demerits for that, but I’ll hold those back.

Evan Brand: Appreciate it. 

Dr. Justin Marchegiani: Good. You got a credit in a bank of Dr. J here. Excellent. So, I think we hit everything: the Cortisol stuff, we hit the gut stuff. Someone over here, I’ll try him in. So, someone talked about this is functional medicine on demand, can Candida hang around in the thyroid? Candida can create things known as acetaldehyde. Acetaldehyde can be inflammatory, right. Like, it’s one of the products of alcohol. So that can be inflammatory and really affect things. Candida can also get the immune system wrap up. Uhm –  Candida or acetaldehyde in the gut can convert in the Salsolinol. Salsolinol’s known to increase uhm– antibodies to uhm– receptors for dopamine in the substantia nigra midbrain. So, that can create other issues with autoimmunity, so yeah. Candida is not a good thing either. And that’s, you know, that’s according to conventional medicine, not really to exist at all. But we see it all the time.

Evan Brand: Oh, yeah. I mean, Honestly, and I think I may have mentioned this. I told you this or I told people on the air already, uh– sorry if I’ve repeated myself. I’m sure we do that all the time.

Dr. Justin Marchegiani: Yeah.

Evan Brand: But, when I first started learning about Candida and yeast, I thought, “Oh, candida, Yeast.” You know, I kind of put it on like the bottom of the totem pole, below bacteria and below parasites, in terms of the effect on the body. But I’ve seen all kinds of crazy stuff with Candida alone, where it’s like, whether it’s brain fog, depression, fatigue, cravings, I mean, something that sounds so benign. “Oh, Candida,” “I’m gonna do a Candida Cleanse.” It’s like, a lot of people promote it, kind of like– almost like it doesn’t exist, or almost like, it’s a trendy topic, and you can just do some type of, like, “Candida Cleanse smoothie”, “go buy my online candida program and you’re gonna get better”. It doesn’t work that way. But, candida can affect almost everybody’s system, whether it’s adrenals, whether it’s gut, whether it’s Lewd…

Dr. Justin Marchegiani: Totally.

Evan Brand: …depression, anxiety, etc., It can all stem just from a Yeast overgrowth. And I would say, you tell me if your stats are different on your side of clients, but for me, I’ve seen about, nine out of every ten people, shows up with Yeast.

Dr. Justin Marchegiani: Yeah, and the big issue with Candida and Yeast is that, some people have it but, it’s just the tip of the Iceberg. The other infections that may trumpet, so to speak in the hierarchy. So, Candida may be an issue in some people, it can be a main issue. Right? Like, we’ll run a Stool Test, and we’ll see it like, “Oh. We have some Candida there.” And then we’ll look at another test. Nothing else comes back. And then on uh– Organic Acids. We’ll see the Arabinose, or the Arabinitol, really high, so we’ll, “Okay. This really maybe a Candida issue.” And then we’d see some clinical symptoms, like uhm– Seborrheic dermatitis or Cradle cap, or just you know, dandruff. You may see some yellow-discolored fingernails, maybe some white coating in the mouth, maybe some tinea versicolor rash. Right? We may see some of those things that may say, “Hey. This may be a primary Candida issue and we hit it hard.”

Evan Brand: You said that a bit quick. The tinea– what’s that? Yeah. It’s like little blotches on the skin.

Dr. Justin Marchegiani: Okay. They just look like little blotches, and it’s uhm– it’s pretty smooth to the skin. It’s not really itchy. It doesn’t really spread but you want to kind of gross yourself out. Just put it in the Google images, and you’ll see the umpteenth degree of it. But it’s just gentle blotches on the skin. They tend to be a little [inaudible]and scarred.

Evan Brand: I know sometimes people may think it’s that but it could be like Keratosis pilaris instead.

Dr. Justin Marchegiani: Keratosis pilaris tends to be a little bit more flaky, and uhm– that tends to hit the back of the arms. [inaudible]…

Evan Brand: Yeah. Such like on your triceps he’s pointing to.

Dr. Justin Marchegiani: …like little back here. Right? That tends to be essential fatty acid stuff. So again, if you’re having issues digesting fats, someone in our live chat, so they don’t break down fat well. Hope you get the gut work done, ‘cause that’s a big, big component. ’Cause if you’re not breaking down fat well, you’re probably not breaking down protein well, either.

Evan Brand: So that would mean, if you’re spinning your heart and money on a good quality fish oil, then you could be potentially wasting your money even if it’s triglyceride form, if digestion’s compromised.

Dr. Justin Marchegiani: Yeah. I mean, most underrated supplements out there, if you were to start on two things: enzymes and HCl. That’s it. Enzymes and HCl get the diet. [clears throat] Excuse me; frog at me. Get the diet a hundred percent dialed-in so, you can actually break down that food. Put the money on the food quality. Get the food quality up.

Evan Brand: Yep. I had a lady tell me, she’s like, “I feel so much better by doing Apple cider vinegar. I don’t notice taking enzymes and HCl.” And I was like, “Okay. You can try it. But I– I’ve still think HCl and enzymes do better than just …

Dr. Justin Marchegiani: Oh.

Evan Brand: …apple cider vinegar but– so…

Dr. Justin Marchegiani: Yeah. Apple cider vinegar’s a great starting point if someone’s like, “Ooh. I don’t know. I’d had some bad reactions to HCl.” Okay. Great let’s just start with the teaspoon of apple cider, but, we’re gonna go with food in your belly first. And then they’ll do good, alright, let’s go to a tablespoon. [crosstalk] Okay, let’s go to–

Evan Brand: You know what I’d do? I make a little tonic. I’ll do like uh– apple cider vinegar. I recently got uh–

Dr. Justin Marchegiani: Yeah.

Evan Brand: …a lime, or like a citrus, squeezer. So, I’ll do like uh– a lime or lemon and uh– apple cider vinegar in there. And then, sometimes, I’ll add like some Vitamin C, or I’ll add that adrenal tincture I told you about. I’ll add that tincture to it. And it’s like a great little tonic.

Dr. Justin Marchegiani: Yeah. I think that’s great, and then, typically, then we do a little graduation ceremony when we go from that apple cider vinegar to the HCl. That’s the next step.

Evan Brand: Yep.

Dr. Justin Marchegiani: Any of the comments said? What do you think, man?

Evan Brand: I think we should wrap it up. I think we’d hit a lot of different triggers here. And if people want to learn more, you’ve done plenty of videos on Hashimoto’s. We’ve done more podcasts on this, so there’s hours of more content, I’m sure, that we’ve created on this. So, just go on justinhealth.com. You can search Hashimoto’s or search thyroid. You could check out my site too, Evan Brand, and make sure you’re subscribed. So, if you want to join in on the conversation, we can answer your questions on the fly. And, of course, if you want to work with Justin, visit his site too, jusyinhealth.com. You can schedule. If you want to schedule with me, same thing, evanbrand.com. And, we’re available. We deal with this stuff all the time, and don’t take no for an answer. Somebody says, “No, I’m not gonna run these antibodies, then you leave.” You fire them because, if you want to get on the root cause of your issue. You have to have the biomarkers. If you’re guessing and checking, you’re building up your supplement graveyard, you’re not gonna get better that way. You really got to get these number on a piece of paper first, because you got to be able to track them and we have to be able to see. “Okay, look. Once we did this, we fix your gut. We got the adrenal support.” And look at the antibodies, drop, drop, drop, drop. And then eventually, “Hey. Maybe you don’t have a thyroid problem anymore.” And it’s totally possible we do it all the time.

Dr. Justin Marchegiani: Awesome. So, here’s the sequence. Ready? Instead of buying crap food, you increase the food quality, and you choose the right kinds of food. That’s number one. That will start to get– that will start to lower inflammation, and give you more energy. As you start having more energy, you can start cutting the emotional stress out of your life. Get used to it with your spouse. Work on it with your spouse. Get a book on communication. Get it– things fixed with your kids. Do your best to fix things at work. Whatever other stressors, all dealing with emotional stress takes energy. So most people that have a lot of emotional stress, typically they don’t have the energy to deal with it. So, get the energy up by just getting the food right. Then you can start to deal with the emotional stress. And then, once that’s kind of dialed-in, you can start adding in some supplements to fast-track it. first set iss gonna be digestive support, and after that, you really want to work with the functional medicine doc to get everything else dialed-in. But work on the foundational stuff first, and then make sure while you’re doing all that, you’re not causing yourself to spin around in a rabbit wheel. While you’re doing excessive exercise, too much CrossFit, just so you’re getting drained with that. And then if you can combine in the good sleep and the good hydration, now you’re set. So, now, when you go see a functional medicine doc, it’s like, “Boom!” You hit the ground running.

Evan Brand: Oh, man. We could– we could have done a whole podcast just on CrossFit and thyroid issues, so maybe for a future day. But yeah, over exercise – I have a lady last week. She said, she exercises CrossFit six or seven times a week. She’s doing CrossFit, and like, “Gosh!” way too much.

Dr. Justin Marchegiani: Yeah. And a CrossFit may be great if you’re – if you’re already healthy, if you’re diet’s spot on, if  you’re resting hard, if you’re doing some good things, post-workouts and pre-workouts to recover. But if you’re not there, it’s not gonna be the best thing for you to start off. Unless, you’re a gym’s got a really good On-Ramp Program, and they get the Arm Wrap style in, where they’re not doing some, you know– they have some great timing with their Arm Wraps, then it’s probably okay. But you got to go somewhere where there’s a good Arm Wrap Program.

Evan Brand: But even then, even if you were optimally healthy like you were talking about, would you still tell somebody, “Go do seven days a week in CrossFit?”

Dr. Justin Marchegiani: No. No,– the only– I mean, professional athletes do that if they want, but they’re taking naps, and that’s their job during the day. But, the average person, typically, I would say, maxes four times a week.

Evan Brand: Working, living a life, being a parent or uh– spouse, I mean, it’s tough.

Dr. Justin Marchegiani: And, ideally, spread it out. Right? Monday, Tuesday– Monday, Wednesday, Friday gig, you know. During the week, trying to keep a day off in between.

Evan Brand: Yep, yep. Well said. You said something else in your, in your small rant. I forgot what it was. I was gonna– I was gonna ping off of it. But I guess we should wrap this thing up.

Dr. Justin Marchegiani: Yeah, I mean, it’s funny, like, you ping me at lunch time, “Let’s do a podcast, alright.” And then we’re like “Only fifteen minutes. Only. That’s it.” Then, it’s all like, an hour later, “Damn it!”

Evan Brand: I know. 

Dr. Justin Marchegiani: “What happened?”

Evan Brand: I know.

Dr. Justin Marchegiani: We tried to be disciplined. 

Evan Brand: I know.

Dr. Justin Marchegiani: Alright. Well, I think we hit all the good stuff on the foundatinal side. Is there anything you wanted to add to the foundational piece?

Evan Brand: That’s exactly what it was. Blood sugar balance, make sure that that’s keep.

Dr. Justin Marchegiani: Yeah.

Evan Brand: That was exactly a blood sugar balance, hydration, you’re getting your good minerals, using your good salts, uh – using trace minerals if you have to, trace mineral supplements if needed.

Dr. Justin Marchegiani: Yeah.

Evan Brand: Uh– we talked about the fatty acids with the fish oil. Optimizing HCl and enzymes, supporting the liver, gull bladder, supporting detox pathways, supporting methylation if you have to, uh– and looking for the root cause, getting the testing. Without the [crosstalk] testing, you’re guessing.

Dr. Justin Marchegiani: Love it. [crosstalk] Love it. Excellent. Alright. Evan, I’m gonna go hang up here on YouTube. I’ll go say goodbye on my Facebook peeps, and we’ll talk real soon, my man.

Evan Brand: Take care.

Dr. Justin Marchegiani: Take care.

Evan Brand: Bye.

Evan Brand: Bye.



“Hashimoto’s Protocol” by Izabella Wentz






Hashimoto’s and Hypothyroidism – Foundational Info to Heal Your Thyroid – Podcast #54

Dr. Justin Marchegiani and Evan Brand talk all about thyroid issues in this podcast.  Listen as they share their recommendations on the first steps that patients with thyroid issues need to take in order to be successful along with helping them to push their thyroid to heal in the right direction. 

Find out what the potential signs and symptoms of a thyroid issue are and distinguish between adrenal and thyroid issues as well as the difference in dealing with thyroid issues from a conventional medicine approach versus from a functional medicine perspective. They also differentiate adrenal failure versus adrenal fatigue. Have you ever wondered what role does progesterone have that affects the thyroid function? Discover more about it and the other hormones affecting thyroid issues in this interview.

In this episode, topics include:

1:18   Thyroid 101

2:35   Thyroid physiology

6:20   Adrenal physiology

11:29   Conventional medicine approach versus functional medicine perspective

21.30   Adrenal failure versus adrenal fatigue








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Dr. Justin Marchegiani:  Hey, it’s Dr. J here with Evan Brand and today we’re gonna be talking about thyroid issues.  We got lots of patients coming in to our offices and they’re like, “Hey, doc, I got a thyroid issues, what do I do?”  And we haven’t even talked about what we’re gonna say yet, but we’re just gonna have a dynamic conversation about what we recommend any of our patients that are coming in that think they have a thyroid issue, what the first steps they need to take are to be successful and to start helping to push their thyroid to heal in the right direction?  Evan, what’s up today, man?

Evan Brand:  Hey!  Not much.  I’m fired up.  Let’s do this thing.

Dr. Justin Marchegiani:  Dude, I’m–I’m ready to go, man.  My thyroid’s feeling great today, so let’s do this.

Evan Brand:  Sounds good.

Dr. Justin Marchegiani:  Before you go in, what did you have for breakfast?

Evan Brand:  What did I have?  I can’t even remember.  I woke up.  Did I eat anything yet?  I may even be fasted honestly, what did I eat?  I have no clue.  If I re–if I remember, I’ll let you know.

Dr. Justin Marchegiani:  Nice.  So you didn’t eat any leprechauns or gnomes today?

Evan Brand:  No.

Dr. Justin Marchegiani:  Nothing like that?

Evan Brand:  No.

Dr. Justin Marchegiani:  Gotta love those grass-fed leprechauns, man.  They’re awesome.

Evan Brand:  Yup, yup.

Dr. Justin Marchegiani:  Especially if you get some Kerrygold butter, you know, it’s like perfect.

Evan Brand:  A little pinch of Himalayan salt.

Dr. Justin Marchegiani:  That’s it, that’s it.  Alright, so thyroid issues.  Thyroid 101.  So first off, anyone’s that potentially having hair loss, energy issues, fatigue, the outer third of those eyebrows that are thinning, potential constipation, vertical ridging on those fingers, low temperature, you know, tingling, numbness in the fingers and toes, these are all potential signs and symptoms of a thyroid issue.  But the problem with the thyroid is that a lot of the symptoms–it’s like a Venn diagram where there’s a massive overlap between thyroid issues and adrenal issues.  So all of my patients no matter if they have a diagnosed thyroid issue or not, we wanna look at the thyroid and the adrenals side by side.

Evan Brand:  Yeah, I remember what I had for breakfast.  It was organic pork sausage that my wife made for me.  That’s why I didn’t remember because I didn’t prepare it.

Dr. Justin Marchegiani:  Nice, awesome.

Evan Brand:  Yes, so you’ve already alluded to–to–we were gonna talk about, you know, what is the first step to do when it comes to thyroid issues, and for me, my answer which I didn’t know your answer–my answer was gonna be to look at the adrenals because if the adrenals are taxed, then it’s gonna be pretty hard to us to keep the thyroid in a good, healthy, functioning manner if the adrenals are taxed.

Dr. Justin Marchegiani:  Yeah, so let’s just break down thyroid physiology for the listeners.  So your thyroid gland is this little bow–bowtie type of gland that sits just below the Adam’s apple.  So if you just kinda run your hand or down your chin here where your chin and your platysma, that skin underneath your chin hits your throat, that your little bump there that’s your Adam’s apple, if you go about a couple–about a centimeter down and a centimeter out, that’s your thyroid gland and that gland secretes a hormone called T4 that is–that gets converted into an active thyroid hormone, T3.  So that gland right there, bowtie-shaped, that thyroid hormone is needed for all cells of the body to be metabolically active, right?  To control metabolism and that T4 about 20% of it happens at the thyroid gland.  So the conversion of T4 to T3, right?  T4 inactive, T3 active, 20% of that conversion happens at the thyroid gland.  The other 80% happens peripherally.  So now out of that 80% that happens peripherally, 60% is the liver, 20% is in the healthy gut bacteria and the other 20% is via healthy adrenal function and stress regulation.  So there’s a lot of like percentages in there, I go back to the anchorman quote, 60% of the time, it works every time, a 100% of the time.  So it’s a little confusing, so just quick little recap on it.  20% of the thyroid conversion at the thyroid, T4, T3 done, right here.  The other 80% happens peripherally, 60 liver, 20 gut–healthy gut bacteria and gut function, 20% by healthy stress and adrenal management.

Evan Brand:  That’s cool, yeah, and so you mentioned the liver, that is a place where I actually would have not started with the–with the thyroid but I didn’t realize the–the huge percentage there.  I always look at the adrenal stress pictures so maybe I’m looking at the smaller piece of the pie when I should be looking at the bigger one.

Dr. Justin Marchegiani:  Yeah, I mean, the enzyme. 5-deiodinase enzyme–so deiodinase what it means is it’s de-i–it’s deiodinating meaning it’s pulling off an iodine molecule.  So when you see like T4, with the T4, the T stands for tyrosine which is an amino acid and the 4 stands for 4 molecules of iodine.  So when you’re deiodinating something you’re pulling off 1 iodine molecule.   So you’re pulling off 1 molecule off the T4, which then makes it the T3, and the enzyme that does that, that 5-deiodinase enzyme is selenium-based.  And a lot of that conversion happens in the liver.  That’s where that enzyme is most metabolically active.

Evan Brand:  And a lot of people are deficient in selenium.

Dr. Justin Marchegiani:  Absolutely, I mean, 2 to 400 mcg a day is gonna be a pretty good amount, and if you’re sitting there thinking well, I just gotta have 3 Brazil nuts, *beep*, the selenium content in Brazil nuts can range between ten-fold.  So you could have 3 Brazil nuts hoping to get 200 micrograms of selenium or maybe you’re getting 20 micrograms of selenium depending upon the soil it’s grown in.  So there’s quite a lot of variations, so really important that you’re on a good multivitamin that’s got 200 mcg of selenium in it just off the gecko.  And all of my patients are on a high quality, highly absorbable multi with 200 mcg of selenomethionine as our thyroid insurance policy.

Evan Brand:  That’s great, yeah.  I should probably switch mine.  I’ve been using just a standalone, because I’m not using a multi right now personally.  I’ve just been using a 200 mcg of selenium by itself.

Dr. Justin Marchegiani:  Nothing wrong with that, too.  So we talked about the thyroid, right?  Let’s talk about adrenal physiology, just so everyone kinda can wrap their head around it.  I wanna take these complicated concepts, break it down, and have people walk away with an action point.  So the adrenals, they sit right on top of our kidneys and they help manage stress.  And again, stress isn’t just emotional stress, it’s physical stress.  It’s also chemical which could be blood sugar, it could be infections, it could be inflammation.  And our adrenal physiology is we’re pumping out cortisol and that cortisol fluctuates throughout the day in a diurnal rhythm, meaning higher in the morning, lower at night, and that cortisol is there to help give us energy.  It’s there to help put out the fire of inflammation but our adrenals also put out significant amount of sex hormone, too, called DHEA sulfate.  And that sulfate is really important for healing, it’s really important for sex hormone output for female so a lot of PMS symptoms are gonna be caused by adrenal fatigue and we need healthy levels of cortisol to be able to help assist in thyroid conversion.  So that cortisol, if it’s too high, that cortisol will actually block thyroid conversion and increase TSH which is this brain hormone called thyroid-stimulating hormone.  So too much cortisol, we block that T4 to T3 conversion, and we have TSH go up.  And if we don’t have enough cortisol, then we’re tired already because cortisol gives us energy and it regulates blood sugar, if we don’t have enough cortisol for thyroid conversion.  And then typically in those patients, TSH will even look normal on a lab test but T3 will be low.  And you’ll go to your doctor every time, you go to your endo, and then they’ll tell you your thyroid’s fine when it’s not.

Evan Brand:  Yeah, actually, I just got a lab result back from a female patient yesterday.  She’s in her mid-30s.  She loves high intensity interval training.  She’s got everything pointing at adrenal issues, so we finally get the–the salivary results back.  Her cortisol is so low, man.  She’s in the 0-5 range in the morning and she’s just like 2-3 units per day.  The only thing that was in range was her nighttime level because she–just completely tanked at that point.

Dr. Justin Marchegiani:  Yeah, absolutely, I see that all the time.  So things that we’re trying to get across to anyone listening is so you get some thyroid symptoms.  Take a step back.  We gotta look at the thyroid, right?  Individually.  We gotta look at the adrenals individually.  So the test you want for the adrenals is gonna be a #201 by BioHealth, that’s a cortisol rhythm test.  And if people are having a hard time getting access to this test, they can reach out to you, they can reach out to me, and we can get access to these tests for them and evaluate it.  That’s step one.  The next test is a full thyroid panel.  That’s gonna be your TSH.  That’s gonna be your T4 free, your T4 total, your T3 free, your T3 total.   Ideally, a T3 uptake and reverse T3.  And thyroid antibodies because a significant percent of these patients, they’re autoimmune.

Evan Brand:  I think that’s awesome that you mentioned that and you’re never gonna get told to run that by your conventional doctor.  So once again we’re looking at this from a functional perspective, not the “Oh, your TSH is low or whatever, here’s some Synthroid.”

Dr. Justin Marchegiani:  That’s it.  That’s it and most patients because they’re autoimmune–what autoimmune is it means self attacking self, that your immune system is ramped up to the degree where it’s attacking the thyroid tissue and breaking it down and the problem with that is is people that have this autoimmune type of sequelae of symptoms, they’re in the middle of hyper to hypo because as the glands being attacked or stabbed if you will, the–the thyroid hormone is dripping out, creating hypersecretion because there’s a lot more dripping out if you will.  It’s kinda like to use the gruesome of like let’s say you–you stab someone, right?  A whole bunch of blood comes out in the beginning, but in the end the person’s empty and there’s no more blood left.  Think of thyroid as like that.  I know it’s kind of a gruesome analogy, but honestly you will never forget it and you’ll be able to wrap your head around, “Oh, I’m having a hyper-like symptom, oh, wait, now I’m hypo,” and you kinda go back and forth, you’re gonna think of those thyroid as like you’re basically your immune system is putting little knives into it and it’s dripping the hormone out, and you only got about 3-4 months of thyroid hormone stored in those follicles.  So once those follicles has been bursted for a long enough time, they’re eventually gonna run dry and you’re gonna start having more hypo-like symptoms.

Evan Brand:  Yeah, and if people had access to the video feed here, they would be laughing out loud at your–your–your hand demonstrations, it’s just an–a great–great analogy.

Dr. Justin Marchegiani:  I know, I’m like pretending I have a knife in my hand and like trying to s–and like motioning like I’m stabbing my thyroid gland, oh man, and just so everyone knows I do have Hashimoto’s so I can speak from experience.  I’ve had to make myself an expert on thyroid health because of necessity because conventional medicine typically offers nothing for it.  So–

Evan Brand:  Yup, you’re a wounded warrior, man.  Those are the best ones to see.

Dr. Justin Marchegiani:  Absolutely and I can tell–I can say with confidence that anyone watching this or listening to the show is gonna walk out of it knowing more than their conventional trained endocrinologist on–on thyroid issues from a functional perspective.  They’re gonna know more of the disease stuff of course, like you know, thyroid nodules and–and Graves’ and things like that, but the thing is, conventional medicine’s approach is pretty much 3 options, okay?  If it’s Hashimoto’s or hypo, it’s Synthroid.  Most people that are given Synthroid, that’s synthetic T4, they don’t convert it to T3, so they still have tons of thyroid symptoms.  Number two, if they’re Graves’, they’re typically gonna just want a thyroidectomy, pull the darn thyroid out, done, right?  Number 3, radioactive iodine, shut the thyroid gland down.  I mean, those are the 3 major options, or they’ll give like methimazole or propylthiouracil to help knock down the thyroid hormone levels, you know,  they’ll–they’ll get PT or something like that.  So those are like the 3-4 options that are in the cookbook of your conventional endocrinologist for thyroid.  There may be a rare thing left out there, you know, thyroid cancer, thyroidectomy as well, but that’s your general kind of gist, and the majority of people, 90% of people are gonna be in the hypo-Hashimoto camp and there’s gonna be underlying issues that are affecting the thyroid conversion outside of their control.  It’s not gonna be pathological, it’s gonna be functional and that’s where we come in to really get to the bottom of it.

Evan Brand:  Yup, so we alluded to the adrenal distress picture but I mean, what’s the other important picture, I mean would you look at something like adding in some liver support, I mean some milk thistle, if you’re gonna be helping take some of the load off of the toxin filtration process that the liver’s doing, is that gonna free up more energy so to speak, more fuel for the liver to do its job in thyroid conversion?  Am I–Am I thinking right there?

Dr. Justin Marchegiani:  Absolutely.  So a lot of times we’ll start out and we’ll run an organic acid test and we’ll be able to run various organic acid markers that will look at liver function like hippurate, glucarate, there’s about 6 or 7 of them, sulfate for instance, pyroglutamate for B12. so we’ll be able to run these different markers that look at methylation, that look at an–acetylation, that look at our detoxification pathways from a phase 1 to phase 2 perspective, so we can really get a window on how it’s functioning.  But typically off the bat because I don’t wanna get into supplement overload with patients, the first thing we’re doing is just clearing out all the liver stress from a diet and lifestyle perspective, alright, aspartame, all the junkie food additive, gluten, all of the crap that’s just in your diet, that has to go first, right?  Because our liver is always detoxifying, you know, giving detoxification support, you’re not, you know, turning on detoxification systems, you–your buffering it, you’re taking the stress off which can be helpful, but we always wanna make sure we’re stopping the stress from going in first, and then–then it’s probably better supplementing later.  So for me, I have a 3 body system approach where it’s hormones first and then part of that foundational layer, below that is diet, lifestyle and nutrition.  So that’s the first step that we’re looking at before we go deeper and there’s exceptions to every rule but that’s in general, the first step.

Evan Brand:  Yeah, I always like to geek out and go beyond because sometimes I assume that people have the diet and lifestyle picture figured out but a lot of people are still struggling with that.

Dr. Justin Marchegiani:  Yeah, I mean, I see so many of my thyroid patients, they’re just–their adrenals are shot and they are just so myopically focused on the thyroid gland that the forget about the adrenals and they forget about their female hormones, right?  We can’t forget progesterone, a female hormone is responsible or highly involved in TPO production, okay?  So TPO is thyroid peroxidase.  That’s an enzyme that actually helps build or make thyroid hormone.  It binds the iodine and the–and the tyrosine together and if we have super low progesterone, that’s gonna lower thyroid peroxidase activity.  So we’re gonna be making less thyroid hormone just by having lower progesterone.  And again, why do we have lower progesterone?  Well, because progesterone goes downstream to make cortisol if we’re under a lot of progesterone and that low progesterone in the second half of the cycle, right before during that week before you bleed, that’s your PMS time, well, that’s where PMS happens typically due to that progesterone falling out early.

Evan Brand:  And the reason that happens you’re saying is because you have elevated cortisol from excess stress, is that what you’re saying?

Dr. Justin Marchegiani:  Yeah, elevated cortisol in the acute phase and then chronically low in the–you know, lower in the chronic phase.

Evan Brand:  Uh-hmm.  So–

Dr. Justin Marchegiani:  Meaning the longer that stress has been going on, that cortisol bottoms out.

Evan Brand:  So when that cortisol bottoms out, what happens to progesterone then compared to when cortisol’s high.

Dr. Justin Marchegiani:  Well, progesterone’s a building block for cortisol.  So if we look at the adrenal hormone cascade, we see cholesterol as the first domino, like all hormones are made from cholesterol.  So don’t go on a low fat diet, vegan diet.  You will destroy your hormones.  I’ve seen it hundreds of times.  Again, some people do better on it than others and a lot of people feel better on a vegan diet because they’re coming from it–with a crappy standard American diet, so they see improvement and they think well, it’s the vegan diet, but no, it’s all the other crap they cut out.  That’s another podcast for another time.  But cholesterol first, conversion to pregnenolone.  Pregnenolone then gets converted to progesterone on the other side of the cascade and then progesterone gets converted to cortisol.  So you can see what happens is if we’re under more stress, this progesterone escape, this cortisol escape where that progesterone leaks down because it’s needing to deal with the cortisol stress.  The cortisol needs to be there to manage the stress and inflammation.  So I always tell patients, your body is hardwired to deal with the stress of today versus the healing of tomorrow, right?  Progesterone’s there for healing, it’s there for healthy brain and–and brain function and relaxation.  It’s also there for pregnancy, right?   Progestation, progesterone.  So all those are really important but if our bod–body is so stuck in the stress in the moment, tomorrow never happens because you’re always in this stressed out state.

Evan Brand:  And that’s a miserable place to be by the way.

Dr. Justin Marchegiani:  Oh, my gosh, absolutely.  So almost all my female patients, they come in with some degree of thyroid issue, some degree of adrenal fatigue, and then because all of these are connected, right?  These hormones function and dysfunction together, there’s a level of PMS and/or female hormone dysfunction along with it.

Evan Brand:  Uh-hmm.  Yeah, and then you were kinda alluding to the pregnenolone steal, if people wanna geek out and read about that, it’s an amazing–just to look at the chart of the hormones getting stolen and sex hormones are messed up and now your libido’s gone, and I mean, it’s just–everything goes haywire.

Dr. Justin Marchegiani:  Oh, my gosh, absolutely.  Did you wanna comment on that a little more?

Evan Brand:  Well, I was just a–I just think you’re doing a really good job of taking a pretty complex topic and breaking it down.  I mean, this is intimidating for some people to try to take this knowledge into their lives and apply it and you know, if they try to go back to their doctor with this information, you know, they’ll probably be just laughed at or maybe even, they’ll get their eyes rolled at.  “Oh, I heard this functional medicine doctor and this functional nutrition guy talking about this and just silly.”

Dr. Justin Marchegiani:  Exactly and just remember, right?  If you’re going to your doctor and you’re trying to get functional medicine help in the conventional medical model, you’re like banging your head against the wall.

Evan Brand:  Uh-hmm.

Dr. Justin Marchegiani:  Alright?  It’s–it’s gonna be very, very difficult, right?  It’s trying to get your surgeon to not operate.  I mean, your surgeons are typically there to operate.  That’s what they’re there for.  That’s what they’re trained for.  And same thing with conventional physicians.  Conventional physicians are there to–most of the time just prescribe drugs unless they’ve been taking training outside the conventional medical paradigm.

Evan Brand:  Uh-hmm.

Dr. Justin Marchegiani:  So if you go there, you’re gonna find yourself having to educate your doctor more about this and again, why do you wanna sit there and educate your doctor about this when you can find people that are already educated?

Evan Brand:  I agree.

Dr. Justin Marchegiani:  I have patients all the time and they’re like, “Well, can you call my conventional doctor and–and talk to them about that?”  I’m like, “That is an act of futility.”  I mean, they can listen to this podcast but you’re much better off just finding people that are already in sync because then you don’t have to waste time.  So with that, the typical downfalls I see–most patients go to their doctor, they about adrenal issues.  Let’s say the topic of adrenal issues are brought out, right?  Conventional doctor, the first thing they go to is Addison’s or Cushing’s disease.  So Addison’s is an adrenal failure state, cortisol is almost non-existent.  And then Cushing’s is a hyper, hyper cortisol state, right?  Where you typically have elevations of blood sugar, you have the moon shape face, you have the buffalo hump in the back, you know lots of adiposity and that’s it.  So we have the two extremes, right?  So basically, you go to your doctor, it’s the one extreme on the high and the one extreme on the low, and the idea that everything in between is normal, that’s the idea.  That’s what it is and in the functional realm we realize that there are two extremes and there’s a functional spectrum in between there.  And the farther away you reach the high or low end, the more symptoms you have.  But the problem with that philosophy is that you may never each, you know, the high or the low end.  And what that means is that you’re stuck.  You’re never gonna get help.  You’re gonna be told it’s all in your head and there’s gonna be no solutions for you.

Evan Brand:  Right.

Dr. Justin Marchegiani:  That’s the problem.

Evan Brand:  Yeah, or here’s an anti-depressant, it’s just–that’s–that’s what we’re gonna do.  Yeah, so–

Dr. Justin Marchegiani:  And they’re just gonna just say, it doesn’t exist, so we wanna just differentiate adrenal failure versus adrenal fatigue, right?  Adrenal fatigue is more of the functional imbalance that may or may not progress into a disease state.  90% of people that have adrenal fatigue are never gonna progress into an Addison’s or Cushing’s state, it’s just not gonna happen.

Evan Brand:  I was gonna say–

Dr. Justin Marchegiani:  Those conditions are rare.

Evan Brand:  I was gonna say, I–I’ve personally never seen adrenal failure.  I’ve only dealt with the fatigue side of things luckily.  I mean, I don’t even know if–I don’t know.  I’m sure there’s people out there that are–that are in that, but I haven’t–I haven’t dealt with any.

Dr. Justin Marchegiani:  Yeah, so if you’re going to your conventional doctor and you’re having this conversation, just know that there’s gonna be a massive amount of backlash and there’s why, right?  Because of the–the differences in fatigue versus failure, right?  Adrenal fatigue is more of an HPA, right?  Brain talking to adrenal issue and also a stress feedback loop issue, right?  That’s number one and then on the thyroid side, well, most doctors are gonna run a TSH, which is a thyroid-stimulating hormone test which is nothing more than a brain test.  It’s looking at your pituitary.  So for instance, if we wanted to test something, it makes sense to actually test the hormone that the gland produces.  So for instance, if we wanna test your hormone function for your, let’s say your testosterone, right?  We would test testosterone, right?  We wouldn’t test LH per se, we would test testosterone.  That makes the most sense because testosterone is the actual hormone we’re looking at.  But LH, that’s the pituitary hormone that tells the gonads to make testosterone.  So why would we just look at LH when we can go look at the actual hormones being made.  Same thing, take that analogy now and throw it into the thyroid.  Why are we using brain hormones to look–to look at and assess the thyroid when we can actually test the T4 and T3 hormones individually?  Well, it’s just because it’s an antiquated way.  It’s what we were able to test first and it’s kind of the whole model of drug-prescribing is based off of that.  So it’s a very end-stage approach.  We’re look at the disease pathology, the high and low versus the functional imbalances that happen in between.  So we wanna live on the in between side, you know, all of the functional imbalances in between not on the high and low side.  Most patients that come to see us, they’ve–if they’re on the high or low, they already know it and they’ve been prescribed and typically many of them still don’t feel better and they still need answers.

Evan Brand:  Yup, and we do.  We do get them back into that functional range and it’s amazing how much you can feel better.  Even something like optimizing vitamin D levels has been huge for–

Dr. Justin Marchegiani:  Yeah.

Evan Brand:  Like my grandpa.  He was having a lot of chronic low back pain issues.  I found a couple of studies linking the two and we upped his vitamin D, re-tested and now, you know, he’s better.  He’s got some other inflammatory issues going on, but I mean, just getting back in the functional range of everything one at a time is just–it’s the way to health and healthy people do exist and it is possible for you to get better out there.

Dr. Justin Marchegiani:  Yeah, and a lot of people for instance aren’t getting the help they need from a functional perspective in the thyroid community, in the conventional community, because most thyroid issues are autoimmune in nature.

Evan Brand:  Uh-hmm.

Dr. Justin Marchegiani:  So because they’re autoimmune, giving a thyroid hormone does not fix the immune system destroying the thyroid tissue and then the inflammation that’s then created by that then affects conversion of T4 to T3, it then affects receptor site uptake, so it affects the hormone from binding into the receptor site so a hormone has to go into this receptor site to have a metabolic effect, kinda like your key is useless it goes into the lock and turns.  It’s kinda the same thing and autoimmunity is affected by things like gluten and potentially dairy and infections and selenium levels and nutrient levels and leaky gut, and all of these things that are functional medicine issues and they will never ever be touched upon in the conventional medicine community.

Evan Brand:  Yup.  So just a quick question, I know we gotta wrap things up here–people that are listening, they may just feel like, “Wow!  This Synthroid is killing me.”  Going cold turkey on Synthroid, what are the–what are the complications or issues there?

Dr. Justin Marchegiani:  Well, again, if you’re prescribed a thyroid hormone by your conventional medical doctor, most of the time, 99% of the time you need it because they’re using TSH as a established range to dose thyroid hormone.  The problem with that is is that TSH takes about 5-10 years to go high.  So most of the time, your thyroid issues have been going on for almost a decade.  So you don’t ever wanna come off thyroid hormone if you were prescribed it but you wanna find in someone like us.  Now typically what I do off the bat is I don’t ever take them off their thyroid hormone but we may change and put them on a full spectrum thyroid hormone, where they’re getting T4.  The same T4 levels, not that touching that at all, but also adding in some T3 as well, and then also looking at the adrenal side of the fence.  And most people that are dose thyroid hormone based on TSH, they aren’t given enough thyroid hormone.  So if the gland has been destroyed for a couple decades or a decade or so, they may need thyroid hormone because the B cells, alright, the immune cells have infiltrated that thyroid, they’ve destroyed, they–now the tissue has gone fibrotic, it’s now scar tissue, and it’s no longer functional.  Again, we may be able to get recovery back, but if we don’t have recovery, we gotta make sure we’re getting enough thyroid hormone for healthy function.  So we always wanna make sure we’re getting enough thyroid hormone but we don’t wanna base it off a TSH per se, we actually wanna use our T3 free and T3 total to look at how much active hormone we’re actually making.  That’s gonna be the best way to do it.  Don’t look at TSH.  Your brain is much more sensitive to thyroid hormone than the peripheral tissue.  So what happens is, the thyroid hormone, the TSH will actually go lower in response to the thyroid hormone.  So your thyroid hormone may not be quite where it needs to be for optimal function in that T3 reference range, but your TSH may go low because your TSH and your thyroid or inverse, right?  TSH goes high when thyroid’s low.  TSH goes low when thyroid’s high.  So if we see the TSH drop, most doctors go, “Oh no!  We’re giving you too much thyroid hormone.  You’re overdosing.  You have Graves’.”  But just look at the T3.  Most of the time we’ll see the T3 in the top half to the top 25% of the range.  It’s not even high but most docs will just jump to that conclusion, you’re given too much without actually looking at the hormones individually, which drives me nuts because it’s like they’ve–if we can look at the direct temperatu–if we can look at the direct measurement of the hormone, let’s do it.  And the analogy I give my patients is, using a TSH as a gauge for thyroid hormone levels is like going outside and feeling the sidewalk to detect what the temperature is, right?  So the sidewalk’s always gonna be way hotter than what it is, right?  So we have this extra sensitivity thing going on.  And why the hell touch the sidewalk when you–when you can just look at the thermometer or pull up your weather app on your phone, right?  We have much more sensitive ways.  So don’t go outside touching the sidewalk, go and look at your app for the temperature.  Same thing with your thyroid.

Evan Brand:  That’s awesome.  I was waiting for the analogy, man, and I’m pumped.  That’s a great way to wrap this thing up.

Dr. Justin Marchegiani:  That analogy like hit me 2 weeks ago and I was like, “Eureka!”

Evan Brand:  That was incredible.  I was thinking the whole time we were going through this I was listening but I was trying to visualize an analogy and I was drawing a blank.  So you really killed it with that one.

Dr. Justin Marchegiani:  Yeah, ex–yeah, thank you.  And I just want everyone that’s in the conventional model and trying to get help, I know how it feels.  It’s ridiculously frustrating.  I have so much empathy.  Don’t bang your head against the wall.  I want you to have compassion for your medical doctor and to understand where they’re coming from.  They’re just coming from a different place, okay?  So if you need the functional medicine support to heal which the majority of people do, then we need a different and your MD may not be the best person to get that approach.  Get all the pathology stuff ruled out first.  We wanna make sure nothing’s being missed from a global pathological standpoint, like a cancer or something, maybe an over, you know, hypothyroid issue like TSH through the roof or something.  But once that’s been addressed, they gotta reach out to people like you and people like me to get this stuff under wraps.

Evan Brand:  Definitely.

Dr. Justin Marchegiani:  So I know, I–you know, went into like professor mode today.  We’re gonna have this stuff all transcribed, so go back, take a look at it.  Read it a few times.  We’ll do more podcasts on it.  People who have more questions, let us know.  We’re gonna be happy to break this down.  I want everyone to walk away with an action item.  So action item is get a full thyroid test, get a full adrenal test if you’re on the fence.  That’s your first two things to do and then from there, we can talk about options about what the next steps are.  But those are your first 2 options and if they need it, they can get it from me or from you.

Evan Brand:  Yup, sounds great.

Dr. Justin Marchegiani:  Evan, do you want to add some stuff?  I feel like I was just an absolutely ball hog today.  I’m so sorry.

Evan Brand:  Oh, no.  No, perfectly fine.  I’m sitting here loving it, man.  It’s been great.  No, I just want to say that, you know, the main thing is that you’re–you’re taking baby steps in the right direction.  So maybe you’re on the fence about this, you’re looking into the testing, that doesn’t mean that you should wait until you get testing and you actually get a piece of paper that says you need help.  It’s okay to go ahead and start helping yourself right now.  Removing the gluten if you’re still eating that.  Removing the excess stimulants if you’re doing that.  If you’re speeding 30 miles over the speed limit today on the highway, reducing that, you know, all of these lifestyle things that we’re going to recommend you anyway, go ahead and get started on some of those now.  If you’re speedometer or your RPM in your car is red lining right now, you have the power to turn that down and get yourself out of the red line.  Take a hot Epsom salt bath or something this evening, you know.  Get that red line down, start calming yourself down and getting yourself ready for the therapy that we’re gonna put you on anyway and you’re really gonna help accelerate your results.  You’re gonna get better faster and at the end of the day, that’s what we want.  We wanna help you get well as fast as possible, but in an ethical and you know, an intelligent way.  We don’t just wanna come in with huge jackhammer.  So just slowly work yourself there and–and start–start swimming now and we’ll meet you at the other side.

Dr. Justin Marchegiani:  Absolutely.  And you forgot to mention how important consuming the grass-fed leprechauns are.

Evan Brand:  Grass-fed leprechauns, yup.

Dr. Justin Marchegiani:  Alright, everyone, hope you enjoyed the show.  Check out the transcription, beyondwellnessradio.com, notjustpaleo.com.  Thanks everyone and have a great day!




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