Hashimotos Root Cause Solutions With Inna Topiler | Podcast #237
Hashimotos is an autoimmune disorder in which antibodies directed against the thyroid lead to chronic inflammation. Also known as chronic lymphocytic thyroiditis, Hashimotos is the most common cause of Hypothyroidism in the United States.
Get a wider picture on Hashimotos’ root causes, symptoms, and solutions, and how can other issues with thyroid or gut affect your overall body health. Find out what Dr. Justin and Inna Toppiler talked about here.
Inna Topiler – MS, CNS
In this episode, we cover:
0:50 Eczema patient, oxalate issues
05:31 Moderate or high oxalate foods
10:19 Inflammation bucket
14:57 Hashimotos Symptoms
Dr. Justin Marchegiani: Hey guys, it’s Dr. Justin Marchegiani, welcome back to beyond wellness radio. I have clinical nutritionist, Inna Topiler in the house, you know, as part of my thyroid reset summit, which was excellent. Make sure you get access to that, but you know, welcome to the podcast. How are you doing?
Inna Topiler: I’m good. Thank you so much for having me. I’m excited to be here.
Dr. Justin Marchegiani: Well thank you. It’s great. We’re doing it via video. So if you guys are listening to the podcast, make sure you subscribe to the Youtube Channel justinhealth.com/youtube hit the bell, hit the subscribe button so you can get access to these awesome podcasts and video as well. So what’s going on with you, and I know you’re a clinical nutritionist, you’re kind of in the trenches every week with patients. Just is there a memorable patient or case that kind of comes to mind the last week or two we can kind of break down for the listeners?
Inna Topiler: Absolutely. So I am typically, I’m seeing, you know, probably about 1520 people a week. And then I do research and I do my podcasts. And working on the summit the other days. And so people usually come to me after it, probably similar to you after seeing two, three, four, sometimes even 10 different practitioners. So I’m kind of their health detective and I’m solving a lot of mysteries. So, um, lots of cases come to mind, but actually I’d like to tell you about one. Uh, she, um, is 30 years old and she was having a lot of Eczema and a lot of rashes and she’s been to numerous dermatologists and have taken, I can’t even tell you how many rounds of steroids and um, antibiotics, topical creams, you name it. And you know, it’s a very frustrating thing when your skin’s always itchy and red and uncomfortable. And a lot of it was on her face too, which I mean, that’s how you present to the world. So it’s, um, you know, it was great in a lot of issues for her and she’s tried everything and she, but essentially came to see me, she’s already gluten free. She was dairy free, you know, she was doing a Paleo type diet. So she was doing in her mind everything she was taking probiotics. She was paying, you know, $50 for this like very special probiotic yogurt. I mean she was doing it but yet unfortunately her symptoms were not any better. Um, and so we did some testing, we did an organic acid test, we looked at foods and what was very interesting for her, the issue actually wasn’t that she was sensitive to a food. She was actually sensitive to compounds in food. So as she was trying to be healthier, she was eating a lot of leafy greens. As you know, we all hear Kale, it’s good for us. And um, cauliflower and spinach. Um, and she was eating because she’s changed to more of a Paleo template. She was eating things made of almond flour and she was having a lot of sweet potatoes cause she wasn’t eating starches. And when we looked at it, we said, okay, well she actually had high sulfate on her organic acid tests and she was living a lot of sulfur, but she was also consuming a lot of foods that had, um, oxalates in them. Um, and oxalates are, they’re almost like these crystal x structures and they can really affect our body negatively. She also had elevated Billy Rubin. And what’s interesting is Billy Rubin has to go through this one specific pathway in the liver to get metabolized. And that same pathway is also what conjugates the oxalates and also a lot of carcinogens and estrogens, estrogens from the environment.
Inna Topiler: So not to make it too complex, but basically, if you guys can think of a, uh, you know, let’s say a drain, right? And we have the faucet that’s on. So if the drain is open, the water goes through where everything goes down. But if the drain is clogged, you have the faucet on, it backs up, and eventually the sink overflows. And that’s what was happening with her. So, even though she was doing all this sort of right things and you know, she did the Paleo, she was taking probiotics, she looked at all that and it really wasn’t her issue. So once we actually changed her diet and um, believe it or not, I had her removed green juices even though I know we hear that it is so beneficial for us, but it was too much Solfa for her. She was using tons of Kale and spinach is for sharing. It was too much sulfur. She was also eating spinach almost every day in a salad. And while spinach has a lot of benefits, it is very high in oxides. A Cup of spinach has 300 milligrams of oxalates, which is a really high amount. And so, and just so you guys know, if someone has issues with oxalates and if you have that sort of club drain and things aren’t going through, it’s recommended that you eat less than a hundred milligrams of oxalates per day.
Dr. Justin Marchegiani: Oh three times. That would just the spinach exposure alone. Right?
Inna Topiler: Exactly.
Dr. Justin Marchegiani: I’m just con– So, it’s a couple of questions here is off the bat it was the issue with the sulfur, was it more the oxide? It sounds like it was more of an oxalate issue.
Inna Topiler: It was more of an oxalate issue, but the sulfur kind of tends to go hand in hand. It seems like she was dumping sulfur in the urine and she didn’t actually have enough in her body. So we had to make sure that she wasn’t overdoing it. But sulfur is found in so many different foods and we can’t remove all sulfur. So, you know, they were kind of intertwined, so we had to make sure that she wasn’t overdoing it, but still getting some and then making sure that we’re working on the liver pathways to process that.
Dr. Justin Marchegiani: Totally now, a lot of the organic acid tests sometimes correlate a lot of the oxalates with yeast or fungal overgrowth. Did you see a yeast or fungal overgrowth with this patient’s [inaudible]?
Inna Topiler: Such a great question. Yes we did. It wasn’t that bad, but it was there. Um, and actually, um, to let you know, but that when we started to address her diet, we didn’t even get to the yeast yet. We just started changing the Diet. We took out almond, we replaced it with other nuts. We took out the spinach, her rashes disappeared.
Dr. Justin Marchegiani: So basically you kind of pulled out maybe like a list here of all your moderate and higher oxalate foods and you used, did you just focus on cutting the high ones or even the moderate ones?
Inna Topiler: I just focused on the high. Um, so many foods have oxalates and she was already so restricted. I didn’t want to overwhelm her too much. So we kind of spinach, we cut out almonds and we lowered potatoes —
Dr. Justin Marchegiani: and almonds and what are good replacements for those?
Inna Topiler: Um, so, um, you can do, um, I mean all of the — See, the problem is that with leafy Greens, uh, some of them are not gonna have as many oxides, but they’re going to have a lot of sulfur. So then we don’t overdo that. So I had her do more things like Romaine lettuce and then we ate other vegetables, asparagus, green beans, Zucchini. It’s okay not to always have leafy greens. I think that her body just needed a break from those. So we really focused on other vegetables.
Dr. Justin Marchegiani: What about Kale, does Kale works? Kale. I mean I think it’s obviously higher sulfur, but it’s a lower oxalate one, right?
Inna Topiler: It is.
Dr. Justin Marchegiani: Just cut the nuts out. And you were kind of not alternative–
Inna Topiler: We did coconut. Um, we also looked at other nuts like walnuts that are not as high in Oxalates. And then she wasn’t actually necessarily sensitive to the grains, at least not from what we figured out. So she was doing Paleo because she thought that it was healthier, but it wasn’t really helping. So we actually put in a little bit of a millet. Millet is really low in lectins. So a lot of people that don’t do well with grades can tolerate that. And then we put in a little bit of rice and she was okay with that. Of course, obviously everyone is different. So it doesn’t mean that everyone can do that. But in her case, it was better to have a little bit of the grain, um, and lower the amount of potatoes that she was doing because otherwise it was all potato or almond flour based stuff. Another thing we did was cassava flour. I’m a big fan of cassava and again, I mean you want to do it in moderation because if you have a lot of it that can be higher glycemic. But we did use it in some baking and she was doing cassava flour tortillas and that worked well too. And that’s grain-free.
Dr. Justin Marchegiani: Awesome. I know the oxalates can kind of get in the joints too and kind of crystallize and um, and create pain and inflammation. Was this patient presented with any of those symptoms at all?
Inna Topiler: No. So for her it was more the skin issue and I think that, yeah, I do have another person who was having that issue with their joints. Um, she was in her mid forties and she was feeling very arthritic and she said to me, I’m not that old. What’s happening here? And she went to see a rheumatologists and they tested for rheumatoid arthritis. He did all the testing that came out negative and she also was eating spinach, pretty much every day we cut that with for her. All we did was cut spinach and her [inaudible] went away. Another thing I want to mention is related to that is people sometimes don’t realize, and again I’m not trying to bang up on Kale or spinach. I mean obviously there’s benefits. I’m not saying it’s bad for everyone, but sometimes people also don’t realize that a lot of leafy greens, even though they do a fiber, they can back us up a little bit. So if you’re eating a lot of Greens and a lot of cruciferous vegetables and you’ve, if you have constipation, just be mindful of that. Especially if you have thyroid issues because you know there’s a correlation with that. Um, you may want to lower that and that can help.
Dr. Justin Marchegiani: Can cooking foods also help one, break down some of that fiber, but also help lower the oxalates a little bit. You look at strategies and trying to take some of those raw oxalates and maybe cook them down a little bit to help decrease the amount.
Inna Topiler: Yeah, that definitely helps. But I think initially it does help to try to cut more of it out. Um, plus you know, it helps with the rotation because people get into a rut, as you probably know. And you know, they have spinach and okay, this is good for you. I’m gonna eat it every day. Okay. They’re still, yeah, let’s get from an eat it everyday. So it’s nice to rotate. So I think, yeah, if you’re eating a lot of something, it’s good to give your body a break and then we’ll add back slowly. And the cooked versions are definitely going to be better.
Dr. Justin Marchegiani: Yeah. If you love it, rotate it. That’s a good edge. I like that. And what happened to her skin? So how did that progress? Did you have to go deeper and, and do, you know, work through the digestive system and you find the gut infections? How did her skin progress over the, you know, a bit of time here.
Inna Topiler: So what’s really great is that all of the rashes went away as soon as we changed the foods. And I mean, as you can imagine, she was just ecstatic because she’s been dealing with it for so long.
Dr. Justin Marchegiani: When you say rashes, you mean the Eczema, right?
Inna Topiler: Well, it was Eczema and rashes, so it was kind of a combination. So it was like rashy itchy bumps and then the dry scaly spots that —
Dr. Justin Marchegiani: Did you see any connection at all with histamine with her.
Inna Topiler: Yes. Um, and I think, I don’t know if you agree, but I feel that the histamine is just a temporary reaction because everything else is flared up. I don’t think that she would have that problem longterm, but a lot of the foods that have oxalates like the spinach is going to have histamine as well. Um, and we did lower some Kombucha and some yogurts that she was doing.
Dr. Justin Marchegiani: Yeah. I find the same thing. Like you have your stress bucket or your inflammation bucket. I did a podcast, they on allergies and we talked about, you know, here’s your bucket and we have all these different antigens in there. And when you’re already topped off and off, sometimes just those simple histamines could be an issue, but if your bucket was lowered, it wouldn’t be a problem. And a lot of those foods are still really nutrient dense and who doesn’t like Bacon and Kombucha. Right. So I totally get where you’re coming from on that.
Inna Topiler: Yeah, exactly. Exactly. Um, I think also, um, when you look at the histamine reaction, a lot of what goes on in the gut is going to affect that. So if you’re got some mass and if there’s dysbiosis and overgrowth and Sibo and everything else, you’re going to be more likely to react to them. So it’s kind of like same analogy as you’re get in with the bucket, but in addition to the food intolerances, there is all this infection that’s in there too.
Dr. Justin Marchegiani: 100%. And how much better is her skin now? She half is you almost a hundred percent gone.
Inna Topiler: It’s 100%.
Dr. Justin Marchegiani: Oh Wow. That’s awesome. Anything else you have to do with the skin stuff?
Inna Topiler: Um, well we are starting to address, um, there some SIBO, the yeast, we’re working on that, but the skin cleared up just from the food and it’s not always the case. I mean obviously everyone is different so sometimes you have to look at everything until you see improvement. But in her case, um, she was lucky and it was really nice that just the food alone clear it up. Now that doesn’t mean we’re done. There’s obviously still stuff going on and she was experiencing some bloating and some discomfort that’s still there, which made sense. She was a little bit upset about that at first cause she said, okay, my skin’s better, but why is this still there? So I had to tell her, well, we just started, we still have a lot more work to do. So one thing at a time.
Dr. Justin Marchegiani: Yeah. It’s always interesting when you work with patients because as a clinician, I mean, you know, there’s a bunch of levers you’re going to be pulling, right? Diet, stress, hydration, exercise, looking at the gut, looking at the hormones, right? And you may not know one of those levers make may get you 90% of the way there while the other couple don’t move the .. lot. And it’s hard to know which one it is because you have so many experiences where summits evenly spread out some, it’s just that one lever and everything is right. You notice that too.
Inna Topiler: Mhmm. Definitely, definitely.
Dr. Justin Marchegiani: And its always a surprise.
Inna Topiler: It is. And sometimes when I talk to someone I could Kinda tell like, all right, I don’t know if it’s my intuition or just looking at the test could be my logical brain, but I’m like, ah, I think it’s going to be over here. Sometimes I’m right, sometimes not. But yeah.
Dr. Justin Marchegiani: And what is your Mr average patient look like as she is? Is it female 35 40? What’s the Avatar right in there? What other, what other major issues are you seeing the patient’s coming in outside of just the skin issues? Is there another type of pattern that just, it’s constantly knocking on your office door.
Inna Topiler: A lot of fatigue. I see a ton of autoimmunity and you know what they say, you attract what you yourself have or had or I’ve dealt with. And so I’ve, uh, I have Hashimoto’s, which I’ve been able to successfully reverse. I still have some antibodies, but they’re a lot better than where they were —
Dr. Justin Marchegiani: Saying you’re a man. I’m in the same booth as you. What was your most recent thyroid test? You remember your personal results?
Inna Topiler: I do. I test mine every, you know, probably two months or so. Um, so just to give everyone a little bit of a history, my antibodies, when I first tested them, and this was back when I’d probably go in 20 years, when I was in my early twenties, they were in the seven hundreds, which is very high. And that’s when I was like, okay. And then over the years just with doing detox and working on my gut, working on metals, they’ve shut up to as high as 6,000. So that was my ultimate high. I’ve gotten them. Yeah. So I’ve gotten them, uh, to the 200 mark now. That’s the lowest they’ve ever been. Um, and interestingly enough, and I want to touch on this because I think this is an important piece. I’ve done everything. Literally like all the cleanses, um, took, took out all the metals that all the nutrients, um, worked on my gut and basically I was as perfectly as I could be and my antibodies were around 450 and they stayed there for awhile. They flared up postpartum after I had my son and then they went back to the 450 mark and I kinda thought, okay, this is just my baseline and you know, it’s better than 6,000. But then I started meditating and I got a lot more into the mind, body aspect and just seeing the importance of all of that. And without changing anything else, I was still doing the same diet, the same nutrients. My antibodies dropped under the 200 points. So that’s what got me to the 250 mark.
Dr. Justin Marchegiani: Wow. How about your thyroglobulin? Where are those coming back positive at all?
Inna Topiler: Mildly. So were added, vary anywhere between like 30 and 80. They never really got above a hundred.
Dr. Justin Marchegiani: Okay. Got It. I’ll go over mine with everyone. Just to be transparent. Are you, do you need thyroid hormone? You know?
Inna Topiler: I do. So I take a very small amount. And that’s another thing I wanted to mention really quick. As a nutritionist, I always try to do things naturally. And for the longest time I was very against taking thyroid medication. My TSH was always borderline. It was always in like the waterline normal lab, you know, optimal range. It was not borderline, it was out. I was in like the 4.5 um, range and by T4 was a little bit on the lower end. MIT three was always low, was in the 70s but I always said, you know what, this is my job. I need to do things naturally and I’m going to do that for myself. And finally, I mean years later I talked to someone and you know, cause every practitioner needs their own practitioner, right? We can’t take care of ourselves. We need someone to help us as well. And I decided to do a little bit of supplementation and it was so life changing. I can’t even tell you my hair started growing, my energy improved that I wasn’t feeling bad, but I just felt so much better. And I take, I do a compound it two 43 and I have 52 T4 and 13 micrograms of t three so really like not a very large dose, but what an amazing effect that has.
Dr. Justin Marchegiani: That’s great. That’s awesome. Yeah. I ran my blood tests here two weeks ago. My TSH, I don’t, I do not need thyroid support because of my labs. We’ll go over it. TSH was 1.81 so it was below two below two and a half. T 4 free was 1.4 which is good. A T4 total was 8.7 which is good. We want between six and 10 ish. If you, you know, Well if you don’t agree and let me know too, she had three total was 103 and T3 free was 3.5.
Inna Topiler: Those are great numbers!
Dr. Justin Marchegiani: Yeah, they’re pretty good. TPO antibodies. I’m, I’m keeping them below 16, 15 ish. So those were in the sixties or seventies. A couple of years back. Thyroglobulin has popped up to 74 though. So that’s a little bit on the higher side for me. When these labs were done, um, I ate a little bit of a gluten free dessert the night before, so my glucose was a little bit high in the morning, 105 and my insulin was a little bit high at 11. So right now I’m tightening up the gluten free dessert stuff and, or any dairy in my diet and I’m trying to go a little bit lower carb. I’m going to be testing my insulin and all my antibodies next month. So, you know, as clinicians we like to monitor our own stuff and kind of benchmark our own stuff too. So that’s just for transparency’s sake. That’s where I’m at.
Inna Topiler: Thanks for sharing.
Dr. Justin Marchegiani: Yeah. Cool. But it’s good though. I think it’s great as a clinician that you have your own challenges because it causes you to really look deep. It causes your patients, I think to know that you’re trying to practice what you preach as well. And I think it’s tough too because like I’m in a place where I’m like, I don’t want to take thyroid hormone, but I also understand, you know there’s probably a delineation of when you do, obviously you crossed that. Can you walk us through, what’s that threshold? Is it, are you looking at TSH? Are you looking at a T3 threshold? What are you looking at the say, hey, I need thyroid hormone.
Inna Topiler: So for me I looked at both of those. So while TSH of course is important, if you know with Hashimoto’s that can sometimes fluctuate and if my T4 and T3 was normal, I wouldn’t have done it. But I had the very textbook pattern. My TSH was elevated slightly, my T4 was slightly low a, my TSH was 4.5 so it was out of the optimal range. My total T4 was five point. I mean that, we’re going back years now, but it was under six, it was like 5.8 and my T3 was 70.
Dr. Justin Marchegiani: All is your T3 free.
Inna Topiler: Uh, like 2.7. I mean it wasn’t terrible but–
Dr. Justin Marchegiani: It was under this lower side for sure. Yeah.
Inna Topiler: Yeah. Um, you know, and because of the pattern that if it was just one of the numbers, then I would think, okay, maybe I’ll just wait and see. And I’ve tried a lot of natural stuff and I’ve tested it in the numbers were always showing up that way. So it wasn’t just, you know, cause the TSH will fluctuate. Things can happen from day to day. This was consistent month after month. And knowing that we need thyroid hormone for every cell in our body. And this is something that people may sometimes not realize because we think, okay, thyroid is important for our metabolism. It’s important for temperature control. But there’s just so much more than that. We need it for our brain, we need it for our feet. I mean we need it for our gut, for everything. And I actually realized, wait a minute, I’m being so hardheaded here, like I’m going to do things naturally. I’m not going to go on this. Meanwhile, I’m actually harming my body. If I don’t have enough thyroid hormone, then my guts not going to heal the way that it’s supposed to and other things are not going to work. And I’ve tried a lot of natural stuff. Now here’s the thing, I’m not saying anything against natural stuff. That’s always my first resort with everyone. Um, it’s just that because of fresh tomatoes for awhile and my thyroid was damaged due to it, I need it. Not everyone does, but you know, it’s just looking at everything and weighing it out. And I think it’s important because sometimes people can, you know, go too much one way and then kind of forget about everything else on the other side.
Dr. Justin Marchegiani: Yeah. A lot of people come into this thyroid game and they’ve kind of caught their thyroid or their immune system beating up their thyroid like 10 years into this relationship. And it’s like, okay, you’ve been beaten me up for like 10 years and there may be some functional tissue that’s not quite producing that hormone like it was, you know, a decade ago. So that’s where you kind of have to replace things. But a lot of times, you know, you may be able to replace some of that functional tissue by doing all the things that we’ve talked about. We’d be all in the thyroid summit that we talked about, but gluten and the leaky gut and supporting some of these nutrients, but sometimes there’s just kind of the gap, right? And that’s kind of where you have to really be real. Look at the TSH, the look, how much is the brain talking, and then look at the actual hormones and say, Hey, are we at least getting to mid range or so? And if we’re not, then we got to look at a bumping that up, especially if we have low thyroid symptoms, like your cold hands or cold feet, maybe thinning eyebrows, mood issues, motility. What kind of, what were your low thyroid stuff?
Inna Topiler: Uh, cold hands and feet. Yup. Um, hair loss but not so much loss where like, you know, it was falling out. It was just really thin and brittle. Yeah. And you know, it was interesting too, it never grew past my shoulders. It was just like the end when I was younger. It did and then it just stopped like it would get here and that’s it. And since then, you know, my hair swell, I’ve cut it recently but it’s way past my shoulders now. So that was kind of an interesting thing. I did have a little bit of the eyebrow thinning fatigue, irregular cycles, issues with motility. I mean, not terrible, but just, you know, things are just, we’re not 100% and when I optimize that, it all just completely aligned.
Dr. Justin Marchegiani: And was there like as you went through kind of like adding various things in and dressing various systems? Where’s there a couple of things that was like, oh, this really accelerated this or this really accelerated that?
Inna Topiler: Um, how many before doing thermos and I did a lot of stuff to really balance my body, still cleansing out the yeast. I had a lot of Candida, a lot of mercury in a lot of copper. Yeah. Clearing the Candida was huge. I mean I had a lot of IBS symptoms which got so much better than motility stuff was still a little bit off, which the thyroid helped with. But overall the dissension against the bloating in that, that way better with the candida. I had to tell a cop on a ton of mercury and that was not an easy road. I mean it was probably a year or two year and a half process, probably even more two years of detoxing that and I did a combination of some culation um, along with some other methods. Um, so that really helped a lot too.
Dr. Justin Marchegiani: That’s great. Excellent. And what made you want to go compounded with your thyroid versus like an armor or Nature-Throid or WP?
Inna Topiler: So that’s a really good question. And um, what happened to me was interesting. I actually went on West steroid. That was the first one I went on and I, uh, I still like kinesiologist back in the day and he muscle tested me and he’s like, oh, this is great cause I was back then I was like, okay, I’ll just do armor because that’s what everyone was doing. And he said, no, no, the WPS can be better for you. So I’m like, okay. I did that. And um, and I felt really good. That’s when my hair started to grow back and my energy was good, I felt great. But then I tested my antibodies and you know, before starting that there were in the four or five hundreds they went up to 3000.
Dr. Justin Marchegiani: Woah! Holy smokes.
Inna Topiler: And I thought, hmm, okay, that’s kind of weird. And I thought maybe it’s a fluke. I waited another six to eight weeks, retested 3,500. I’m like, okay. Did another couple of months where he tested above 5,000 the lab didn’t quantify when it was above 5,000 so I’m like, okay, well obviously something changed here. And I’ve talked to a bunch of different practitioners and colleagues and I knew that there was something in the WP that was affecting in, even though there’s not a ton of research and even though people say you can take it, it’s fine, you know, there are um, you know, studies that show and I think, you know, anecdotally like in my case as well, they, because it is a natural substance. If your body attacks your on fire and he can then attack the armor of the WP. And of course it doesn’t happen to every person. Not saying everyone Hashimoto’s can’t take it, but I was the one or 2% that it happened to.
Dr. Justin Marchegiani: Yeah, it’s rare. I have not seen the patient like that, that bumped that high because of it. I’ve heard from other colleagues though, I always retest because I’m always looking for it. You know, it’s like a, it’s like the, the, the, the metaphorical Unicorn you hear of it and I’m always looking, but it’s great that, you know, you actually went through that and you saw it and did you go right to compound or did you notice you had the same effect with armor and P or nature throid too.
Inna Topiler: Um, so what I did, and interestingly enough also I talked to a few colleagues and what they were saying is, well, if you feel good then don’t worry about it. And I just did not really agree with that and I guess I feel good, but there’s inflammation going on. So I wanted to, once I realized that it must be that I wanted to get off right away. I–
Dr. Justin Marchegiani: How did you feel though? I’m just curious. What happened to your thyroid symptoms?
Inna Topiler: Gone. I felt great. Hmm. Yeah, I felt great. No issues at all, but I just knew that these numbers don’t look right and if the inflammation is silent, but it’s there. So I, if I had more time, I was also trying to get pregnant at the time and I just didn’t want to kind of mess around with stuff. If I had more time I probably would have tried Armour just to see if it was different, you know, if there was something in the WP versus the armor. But I said, you know what, let me not waste time here. Let me just go to a synthetic. And I didn’t want to do Synthroid and Cytomel just because there’s some other additives in there. And my doctor that I was working with worked with a pharmacy that was nearby the [inaudible] Compound and it was very easy. I know sometimes it could be difficult if your doctor’s not open to it, but I had someone that already had a great pharmacy, um, that they worked with. And so I did the compounded synthetic T4 T3 and I have to tell you, and this is, I know it sounds weird because you’re like, how can this happen this fast? My antibodies dropped from above 5,000 to a thousand and then they went to 400 within two months.
Dr. Justin Marchegiani: Wow. Did you try the, the tyrosint for the synthetic T4 that’s clean?
Inna Topiler: I didn’t, I just went right to the compounds. Okay. Because with the tire scene I’d still need the T3 and —
Dr. Justin Marchegiani: Then you would really want to put it together.
Inna Topiler: Yeah, exactly. And it’s all in one pill so it’s easier.
Dr. Justin Marchegiani: Are you open or are you curious to try adding it back in and see what happens?
Inna Topiler: Not really. Only because you know, I mean, and I, I definitely play Guinea pig a lot and I try stuff, but I got my antibodies down. I really don’t want to take any chances, have them going back, ever–
Dr. Justin Marchegiani: Do it. That’d be an amazing blog post to, to do it. Cause this is really good because you mean as a clinician you hear about these patients but sometimes you don’t really see them or sometimes you know, a lot of doctors don’t retest. I always retest after someone’s given a thyroid hormone support and that’s amazing because that’s a huge jump. I’m blown away right now. It’s amazing learning experience for everyone though. Awesome. Yeah.
Inna Topiler: It really is. And again, I mean I, for everyone watching, I don’t want you guys to think that that’s going to happen to you. I mean there’s a small percentage of people. It’s not everyone who has Hashimoto’s, but it’s worth looking at because it is possible and it’s amazing how quickly that happens too.
Dr. Justin Marchegiani: What other strategies can the listeners kind of utilize or apply regarding reducing their antibodies outside of just changing thyroid support? Cause most people we’ve kind of recognized that may not be helpful. There’s a lot of data actually showing that things like WP or thyroid glandular can lower antibodies. In your case it was the opposite. But what other strategies have you done or you’ve seen work with patients?
Inna Topiler: Well, I think that when we look at antibodies, we want to look at the immune system, right? Because that’s the immune system being confused. Um, you know, it’s not your thyroid’s fault. It’s the immune system that’s producing those antibodies. So we really want to look at the triggers and everyone’s going to have different triggers. But we all want to look at different infections. So whether it’s Epstein borrows, recommend that people test that and see to make sure it’s not reactivated or that you don’t have a lot of past antibodies and you can test for that by doing VCA, igm, VCA, Igg, um, and the EBNA. And, um, so look at that cause that’s just such a common infection. Yeah.
Dr. Justin Marchegiani: You’re saying run the viral capsid antigen, the nuclear antigen. Would you also run the early Antigen for the EBV Epstein?
Inna Topiler: Well, the early one, I guess if you’re feeling sick, um, if you’re not yeah, to activate, if you’re not feeling sick, you could just run the other ones to see. And um, you know, there are things that you can do, um, specific antioxidant, zinc, selenium and Acetyl cystine lysine to help your body to fight that. Um, you know, also look at toxins and I’m sure you guys probably talk a lot about this on the podcast, but you know, things we’re putting into our body everyday. So, of course our food, but also what we’re putting on our skin, what we’re drinking, our water from, the type of water that we’re drinking. That’s all really important. Um, and um, you know, with food, obviously making sure that you’re not eating anything that you’re sensitive to and that can change. You might be sensitive to certain things at certain times of your life and others at others. So doing food sensitivity testing, looking at things like food compounds, like oxalates are so far. And then the other big thing is stress, um, and the adrenal glands. And I think that we all talk about stress and we all know, okay, we need to stress less, but a lot of us aren’t really doing anything about it. And we kind of just blame it and say, okay, well let’s just stress. But you know what? Yes, it’s just stress, but we still have to support it. And so I think there’s so many techniques. Meditation has been really, really life changing for me. And, um, I learned it from Emily Fletcher with this Eva. Um, really, really liked that technique because she talks about that you actually don’t have to quiet your mind. And that was so interesting for me because I’m a perfectionist, and so every time I try to meditate, I’ve tried not to think, and by trying not to think, I would think more. Yeah. Right. So then I felt like I was failing and I’m like, why can’t do this? Why would I do something that I fail at every day? I mean, any intelligent person is going to have that thought. Right. And so she teaches that the job of meditation isn’t to quiet your mind. Um, it’s kind of like she says, you know, you tell, you can’t tell your heart not to beat, so you can’t tell your brain not to think. Um, the, you know, so she kind of does it with a mantra and she has this technique of doing it that I found to be way easier than anything else I’ve tried, which is why it’s been so successful for me. And that’s changed so much for me in my health.
Dr. Justin Marchegiani: Can you walk me through what that looks like? So, okay. You sit down. Can you just kinda just walk me through your flow?
Inna Topiler: Sure. So, um, you know, and again, it’s not a meditation teacher, so there’s, there’s more to it than that–
Dr. Justin Marchegiani: But people I think value it coming from just an everyday person that’s done it but also gotten great results. I’m really intrigued with the antibody immune response you had by doing it. That’s amazing.
Inna Topiler: Yeah. And I think with that, and I’ll walk you through the technique in just a second. I just want to tell you what the antibodies, I think what was happening to me is whenever I would see my antibodies high or I don’t feel well, sometimes I feel achy or just off, I would call it my sort of quote unquote autoimmune symptoms. I would right away start to obviously get nervous and then think, okay, what do I do? Which supplement do I take? What food do I cut out? I need to do this, this, and this. So it was a lot of doing and while doing is good, I didn’t want to say anything negative about that. I was almost like getting in my own way, if you will. So I would be doing so much that I actually wouldn’t allow my body to rest. And I really needed to remember that the body does know how to heal. We just have to get out of our way and give it a chance. And because I was always doing and so active, I was actually elevating my cortisol by freaking out, so to speak about all of the stuff that was happening. So what meditation did, and what I do now is if I start to not feel well, and Emily actually talks about this in her course. So if you feel like you’re getting sick, the first thing you do is go get your buns in the chair. So then you could take that 15 minutes and actually get out of your own way, not thinking about every supplement to take. And again, you still have to do that, but allow your body that 15 minutes so that it could do what it needs to do and then go take the supplements and the other things that you need to do. So it’s a combination. And so with the technique, she walks people through a little bit of mindfulness for the first, um, minute or so where you just tune into your body so you listen to what you’re hearing. You can see what you’re seeing with your eyes closed. You can smell your surroundings, you can taste to see what the taste in your mouth is. That just brings you more into your body. Um, and then the way that she teaches is to do with a mantra and everyone actually gets a personal mantra, um, through her course. Um, but if we just take a word, let’s say, um, like we could use ohm for example. And so what people would do is it would close their eyes and then in their mind they would just say the word ohm and they would just repeat that with their eyes closed over and over again. Um, and it’s something that shouldn’t be super loud. It could just be like maybe slight whisper or just, you know, you can hear yourself saying it or, um, you can just kind of repeat it like very, very softly in your mind. And what’s nice about that is it gives you something to concentrate on. Um, and then if you go into some type of a daydream and you don’t realize, that’s okay. But if you realize that you’re not saying your mantra, then you want to go back to it. And that’s kind of the difference between if you don’t realize you’re still meditating, if you realize and you choose to stay off, then you’re off and you want to bring yourself back. I mean, obviously there’s more to it. Like I said, I’m not a meditation teacher. This is just her technique that I’m using. There’s more to which is a book and a course that people can learn from. And I don’t get paid for this. I just like her work. So I mentioned it again. Um, but it’s really, really helpful. Um, another thing that I also found very helpful in the mind body front is, um, uh, one mentor of mine, his name is Dr Mario Martinez. He has a book called the Mind Body Code, and he also has a workbook that’s an audio called the mind body code. I highly, highly recommend that. Um, what he talks about is that oftentimes a lot of our emotions can be stored physically in the body. And we all have different wounds that we can be wounded by, you know, our parents or society when we’re younger. And, um, some of the wounds that are really common are shame, abandonment and betrayal. And most of us are gonna have at least one, but probably all three at some point in our life. And you know, with portrayal doesn’t have to be something really, really major, but even minor betrayal can count. And then shame is something that, you know, we’re exposed to since childhood. I mean, even as toddlers, you know, if our parents says, don’t do that, um, you’ve been a bad girl or you’ve been a bad boy, that shaming. But of course it could happen to a higher degree as we get older. And shame can really affect the thyroid and autoimmunity because, um, you know, our thyroid is in our throat. That’s our fifth shocker. That’s our expression. And so when you feel shamed, um, that can really suppress that voice. And so there’s a big correlation there. So I did some of that work, um, with him. And you know, people can also, if they’re interested in that they can get the audio book and the workbook. Um, it’s very inexpensive and there’s a lot of great information with that.
Dr. Justin Marchegiani: I think we really touched upon some really excellent concepts. He really connected the dots here. Great clinical experience or feedback with the antibody increase with the glandular support. Is there anything else you know, that you want to highlight here for the listeners that you think is extra valuable you want to add?
Inna Topiler: You know, I think what I would want to add is, you know, for people that are watching, listening to this, that have health issues, you really want to make sure that you have the right mindset. Um, because when we look at people that get better, those that have a positive outlook and a mindset that they can figure out the answers and then they can heal, do better than people that are unsure. And of course for a lot of people it has been a long road and you guys may have dealt with a lot of stuff and may have gone to many doctors that perhaps were not helpful. And sometimes it is hard to keep the face if you’ve hit a lot of roadblocks and walls along the way. But if there is a way to just really believe that you can, um, because the answers are out there and there is hope, um, you know, we just have to have that notion that it is possible because it is, you know, usually if you’re experiencing a health issue, there is some type of a reason behind it. Like, things don’t just happen out of nowhere. Sometimes we don’t know what it is and we have to test and dig. Um, but if you can have that knowing that the answers are out there because they are, it’s gonna help you in healing.
Dr. Justin Marchegiani: I 100% agree when you’re in pain, right? Pay attention inside. Now that’s the acronym. So it’s always, instead of looking out, look in. So that’s really good feedback, you know, where can the listeners find more about you and what you do and the information that you produce and provide?
Inna Topiler: Absolutely. So I actually just recently launched a podcast. It’s Health Mystery Solves, and we had a great interview that went live a couple of weeks ago. So that’s a, you can subscribe on iTunes or it’s healthmysterysolve.com. Um, I also have a virtual practice, complete nutritional wellness.com. I have lots of blogs, but I think probably the main thing is going to be the podcast because there’s new content every week.
Dr. Justin Marchegiani: That’s awesome. Yeah, I’m on the podcast, so everyone go over and listen to our interview was really great and thanks for this awesome information. Look forward to connecting with you again. So, you know, thanks so much.
Inna Topiler: Absolutely. You’re welcome. Bye Bye. Have a great day. Bye.
Dr. Will Cole Video: Hypothyroidism, Hashimoto’s and Fatigue – Podcast #36
Hypothyroidism – The most common cause of hypothyroidism is Hashimoto’s thyroiditis. “Thyroiditis” is an inflammation of the thyroid gland.
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.
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
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.
You can also click on the Write A Review button. If you really enjoy this show, write us a review. Let us know on iTunes. Let the world know. Think of one person that would benefit from listening to this show and share it with them. Sharing is caring.
Also, check out JustInHealth.com, which is my personal site. And I have some complimentary functional medicine consults available. You can also sign up for the Free Thyroid Series and Female Hormones Series as well.
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 o
Iodine and Hashimotos… Friend or Foe?
By Dr. Justin Marchegiani
Iodine and Hashimotos thyroiditis are two very controversial yet very popular areas of discussion in regards to the treatment of hypothyroidism. Most people who hear of someone suffering from low thyroid symptoms will think of iodine as the first magical solution. Iodine is an essential nutrient needed for thyroid-hormone synthesis, so it’s understandable that these inferences would be drawn. There are people in the United States that suffer from iodine deficiency because of poor nutrition, and some might live in certain parts of the world (like the goiter belt in the United States) where iodine is deficient in the soil. Most people aren’t aware that the majority of thyroid issues are an an autoimmune disease called Hashimotos thyroiditis.
Iodine and Selenium
There’s one problem: when iodine is given in high amounts in the presence of inadequate amounts of selenium, inflammation can occur. Selenium is also needed to activate thyroid hormone from T4 (inactive) to T3 (active). Most patients I see, even when given Synthroid, the standard-of-care treatment, have a difficult time converting it into T3. The scientific literature also supports that the majority of thyroid conditions are autoimmune in nature, making the necessity of selenium even more important.
Too much Iodine
Too much iodine can cause a condition known as the Wolff–Chaikoff effect, which, in effect, causes short-term hypothyroidism. This is a process where too much iodine is given and the thyroid gland responds by shutting down thyroid hormone production for up to 10 days. During this time, the thyroid gland uses an escape mechanism in which more iodine accumulates in the blood by blocking its transport into the thyroid tissue via the sodium-iodide symporter (NIS). By blocking the thyroid gland’s uptake of iodine, the body has time to urinate out the extra iodine.
On the other side of the fence, we see another effect known as the Jod-Basedow phenomenon in which patients with a goiter (low iodine causes an enlarged thyroid gland) who are given too much iodine will go into a hyperthyroid state.
Iodine and the Double-Edged Sword
So you can see that it gets a little confusing regarding iodine and its effects on the average person. On one side of the coin, you may get a hyperthyroid effect; on the other, you may get a hypothyroid effect.
I strongly recommend you see your functional-medicine doctor before taking large amounts of iodine. If you want to get your thyroid assessed, please click here!
When iodine is used, it should always be used in smaller amounts, tapering up to a higher dose. There are doctors who are famous for using higher amounts of iodine to treat thyroid disorders. Dr. Brownstein for instance. Even when treating Hashimoto’s, he has made comments referencing that using iodine early on is akin to throwing gasoline on the fire. I am also aware that he typically uses selenium, magnesium, zinc, vitamin C, and sea salt in conjunction with iodine. As you can see, iodine is never used alone.
What Types of Iodine Are Best?
Using a combination of iodine and iodide is always best. There are solutions on the market, such as Lugols or Iosol, that contain the proper balance of iodine to iodide. When iodine is given in supplement form, it’s primarily taken up by the breast tissues, prostate, uterus, and ovarian tissues. I always give a solution that contains both iodine and iodide.
Below is some technical scientific jargon, but as long as you understand the three key steps I share below, you will have a good grasp of what’s going on in your thyroid gland.
The Key Steps to Making Thyroid Hormone
- NIS (sodium-iodide symporter): The NIS brings iodide from the blood into the thyroid tissue. Iodide is then converted to iodine via an oxidation reaction. This is just a fancy term that means it loses some electrons.
- Iodine is bound to thyroid-binding globulin in a process known as organification.
- Iodine plus thyroid-binding globulin is bound to a molecule of tyrosine. Three other molecules of iodine are also present, making it four iodine molecules total. This is our storage, or inactive, thyroid hormone T4.
The By-products of Thyroid Metabolism
The key thing to focus on in the picture above is that when thyroid hormone is made, hydrogen peroxide (H2O2) is pumped out as a by-product of the reaction. Hydrogen peroxide can be very inflammatory and can even call some B-cell lymphocytes to the scene. The B cells are there to help clean the inflammation yet can cause more inflammation as the hydrogen peroxide accumulates.
You can think of selenium, the main ingredient to glutathione peroxidase, as the water that is needed to put out the fire in the thyroid tissue. Without selenium, thyroid will continue to burn and the immune system will continue to call more antibodies to the scene, including thyroid peroxidase antibodies (TPOAb) and TBG ab, to fight the good fight. Over time, through collateral damage, the thyroid will burn a slow death. Typically, in about 8–10 years, you will start seeing thyroid symptoms during autoimmunity.
For most patients, as they’ve probably already experienced, their doctor won’t have too many answers outside of a Synthroid prescription. You have already read this above, but in the video as well, you will see that Synthroid does nothing to address the underlying inflammation and autoimmunity that is occurring. It also doesn’t address any of the key nutrients that would be necessary to help put the fire out.
Selenomethionine (selenium) has been shown to reduce thyroid antibodies in as little as three months! Selenium is an essential nutrient that every thyroid patient needs to be supplemented with. Not all patients may need iodine initially; you may be accidentally waking a sleeping dragon if iodine is given.
Chapter 48, “SYNTHESIS OF THYROID HORMONES” in: Walter F., PhD. Boron (2003). Medical Physiology: A Cellular And Molecular Approach. Elsevier/Saunders. p. 1300.