8 Week Blood Sugar Bootcamp Expert Q&A Call with Izabella Wentz, PharmD

Dr. Mowll: Okay. Good afternoon, everybody! This is Dr. Brian Mowll, The Diabetes Coach. And I’m back with another Q&A Teleseminar with a very, very good friend of mine, Izabella Wentz, PharmD, the Thyroid Pharmacist. Izabella is just awesome. She brings a tremendous amount of great information. She’s written books on Hashimoto’s, which is autoimmune thyroid disease. And she’s got a great blog. It’s the ThyroidPharmacist.com. She’s done a Hashimoto’s summit event, all about thyroid and autoimmune thyroid. And she just continues to put out tremendous information. I feel really blessed and privileged to have her with us today. So, Izabella, welcome to our Q&A Teleseminar today!

Dr. Wentz: Oh, thank you so much, Brian! It’s so great to be here with you! I love the work you’re doing. And I’m really glad to be a part of it.

Dr. Mowll: Great. So for those of you on the line, we’re going to go through some questions and answers today with Izabella Wentz, the Thyroid Pharmacist. If you were lucky enough to get one of the phone seats today, you got a phone line and you’d like to ask a question live, just press star 2 on your phone and that will raise your hand and let me know you have a question. And you’ll actually be able to talk to me and Izabella today. Otherwise, we’re going to go through a lot of questions that were submitted ahead of time. And I’m going to jump right in to some of those questions.

So this one comes from Steve in Dallas. And Steve asks, “I’ve heard that once you are on thyroid medication, you’re on it for the rest of your life. Is this true? Is it possible to get off medication? And how do you know when it would be safe?” So that’s a good one.

Dr. Wentz: That’s a really good question, Steve. And if you see a conventional medical doctor, most of them will tell you just that, that once you get on thyroid medications, you need to stay on them lifelong. And that your thyroid condition, 97% of the case, is going to be caused by Hashimoto’s, which is an

autoimmune attack on the thyroid gland, that that’s just going to keep getting worse and worse and progress.

But functional medicine providers and integrative doctors, practitioners like myself and Dr. Mowll, what we found is people can actually reverse the process of autoimmunity. You can actually reverse disease.

There have been a few studies that found people, about 20% of people, with spontaneously just be able to get off of thyroid medications at some point. So that’s really, really exciting. One of the things is you’re not always going to know that your thyroid function has regenerated. Thyroid medications can actually slightly suppress the autoimmune attack on the thyroid gland and make the thyroid less visible to the immune system.

And if you figure out your other root causes, so some of the root causes of an autoimmune thyroid, may be gluten sensitivity, different types of food sensitivities, nutrient deficiencies, blood sugar imbalances, adrenal stress, different infections, a leaky gut or toxins, once we figure those things out and get those things under control, we may see a remission of the condition. In some cases, when the person gets into remission, they may be able to come off of thyroid medications.

So in my experience, the first thing you need to do is get your autoimmunity under control. So you need to get your ducks in a row and make sure that your root causes are addressed. Once you do that, if you were tested, I would recommend testing for thyroid antibodies.

So you should see your thyroid antibodies reduced. And you should see them under 35, which would mean that you no longer have a significant autoimmune response to your thyroid gland. At that point, it may be something to work with your doctor to try to reduce the thyroid medication. And I would do maybe like 25 micrograms equivalent of levothyroxine every four to six weeks, and then retest to make sure that your body is able to properly compensate.

Some people will see that they actually become hyperthyroid once all of their ducks are in a row. So once they get rid of their triggers and root causes, they may start becoming hyperthyroid. And that’s just something that’s going to be a necessity. Other people may actually just need to reduce the medications very, very slowly to see if their body will compensate and return back to function.

But, again, this is something that I wouldn’t recommend if you’re just starting

off your thyroid. I would recommend this to be one of the last steps that you take because a lot of the other important work is looking at repairing your immune system and stopping the autoimmune attack on the thyroid.

Dr. Mowll: Hey, doc, just a quick question. I read a book by Ken Blanchard. And he, among others out there, recommends—there’s actually an endocrinology group in my area that does this, also—recommends using thyroid medication to lower that TSH to lull the thyroid to sleep and reduce antibody production that way. Do you have any experience with that? What’s your opinion on using levothyroxine or thyroid medication to suppress thyroid activity and reduce the presence of antibodies and the autoimmune attack?

Dr. Wentz: Yeah, definitely. So a lot of times, we’ll come across people who will say that they want to do things naturally without thyroid medications. But thyroid medications are the same hormones that are produced by our own bodies. And giving our bodies thyroid medications is going to be helpful with helping the thyroid rest a little bit because what’s happening in Hashimoto’s and autoimmune thyroid is basically the thyroid is going to be attacked by the immune system. It’s going to be having a lot of damage to it. And it’s not going to be able to produce enough thyroid hormones.

So you’re going to see a rise in TSH. You’re going to see a rise in thyroid stimulating hormone. And you’re going to see just basically the thyroid trying to work extra hard. And when it’s working that hard, one, you’re going to have a lot of symptoms. You’re going to be tired. And two, that’s going to attract a lot of immune cells. So that can potentially up-regulate the autoimmune attack on the thyroid gland because it becomes more visible to the immune system when it works harder.

So when we give the person medications, that actually calms down the thyroid or the thyroid doesn’t have to work as hard. And it becomes less visible to the immune system. So we will often see a reduction in thyroid antibodies after a person is started on thyroid medication. And this can be one of the helpful measures in lowering the autoimmune attack on the thyroid gland. Another supplement that’s very helpful is selenium. So selenium is a byproduct in thyroid hormone synthesis. It’s necessary to help you basically neutralize hydrogen peroxide, which is produced when we make thyroid hormones. And hydrogen peroxide can cause oxidative damage and oxidative stress in surrounding tissue, and therefore, attract more of the immune cells into the thyroid gland. So taking selenium helps to lower the antibodies, as well. A dosage of 200 micrograms have been found to reduce antibodies by about 50% over the course of three months.

Dr. Mowll: Wow, very cool. Okay. We have another question. This is from Luis from Salt Lake City. And I think it’s a she. I apologize if I’m wrong. “The recommendation to combat Hashimoto’s by both Dr. Wentz and Dr. Kharrazian is to eliminate gluten.” At least that’s one component. “However, as a diabetic who have difficulty controlling blood sugar levels, even with medications, all of the gluten-free products are higher in sugar. Do you have any recommendations for gluten-free products that are not so high in sugar?” And then there’s a follow-up question. “Diabetes medications often have serious side effects. I’ve tried many natural supplements. Any information you can give for that?” We’ll answer that later. But this question about gluten-free products being high in sugar, avoiding gluten for someone with diabetes, what’s your recommendation there?

Dr. Wentz: That’s a really, really good question. And it’s one of the things that when I started my gluten-free journey was one of the mistakes that I made because I ended up getting a lot of the gluten-free foods, as well. And a lot of them are actually going to be much, much worse for blood sugar than gluten itself.

So one of the things I recommend is actually eating a whole-food, a real-food diet. So instead of, for example, eating bread made with rice, rice flour, which can really shoot up the blood sugar, I would recommend working with more like almond flour because almond have a source of good fat and protein in them. And you can make really tasty breads and muffins using that base. And really, I recommend more of like a hunter-gatherer or Paleo-like diet, rather than just a straight up gluten-free diet.

I’ll see people who will go gluten-free. And they’ll get on the gluten-free junk food, which was one of the mistakes that I made at first, and will end up actually seeing some symptoms get better with Hashimoto’s, but then will see other symptoms get worse because of the blood sugar imbalances. So things like rice milk or rice cereal, these are going to be very, very full of those carbohydrates that can really turn into sugar in our bodies and put us on a blood sugar rollercoaster.

So for a breakfast, I would recommend doing something like eggs with an avocado. Or a beef hash is one of my favorites, where you would do maybe some butternut squash or cut up sweet potatoes with some onions and you stir fry that with some grass-fed beef, as well as coconut oil. And that would be a great way to start your day so that you can keep very stable blood sugar levels, rather than relying on the gluten-free foods that are based in corn or rice or potato, which we know are going to be very, very starchy and have a negative effect on our blood sugar and diabetes control, as well as

Hashimoto’s. Would you like to add to that?

Dr. Mowll: Well, I was just going to say that I can’t speak for Dr. Kharrazian. But I would be willing to bet that he’s not a big fan of the gluten-free products, either. I think whole food, real food is where it’s at. And you really don’t need grains in your diet. There seems to be an obsession with wanting to find some grain that’s acceptable.

But grains, to me, are really an inferior food source. I don’t think they’re necessary. They’re not particularly high in any nutrients. They’re not even really particularly high in fiber. So I think there’s other foods—fibrous vegetables, low-glycemic fruits, if you can handle them—nuts and seeds. And like you mentioned, things like almond flour, coconut flour can be good alternatives that are going to be much better for stabilizing blood sugar.

Dr. Wentz: I agree.

Dr. Mowll: All right. This is a pretty good one. We have a question from Lena from L.A. And she’s giving some test results. I think she wants you to diagnose her. But we won’t do that. But we’ll use it as an example. She lists a few. Her TSH came in as 5.78, free T4, 1.16, which is middle-low into the reference range, thyroid peroxidase antibody, TPO antibody at 7. And this is a good question because a lot of people have asked me this also. She wants to know if she has Hashimoto’s.

So let’s put it this way. If someone shows the presence of antibodies, but they’re not out of the antibody reference range, which is 0 to 34 in this case, can they still have Hashimoto’s? And do you think that maybe they do so have Hashimoto’s at that point?

Dr. Wentz: That’s a really, really great question. And Hashimoto’s, the antibodies are one of the ways that to test for Hashimoto’s. And researchers will say that about 90% of people with Hashimoto’s will have thyroid peroxidase antibodies, the TPO antibodies elevated above 35 and that about 80% of people will have thyroglobulin antibodies elevated above 35. And this has been the standard medical thought. But recent research has actually shown that there’s something called seronegative Hashimoto’s, which means that you may not have any antibodies or your antibodies may be below 35, but you still will have Hashimoto’s. And you can tell that by doing an ultrasound of the thyroid gland where you’ll see the same changes consistent with Hashimoto’s on ultrasound. And you could also do that with a tissue biopsy, which is obviously a more invasive way of testing for Hashimoto’s where you would have to stick a very tiny needle into the thyroid gland and

take out the cell and to see if there are changes in the cells that are consistent with Hashimoto’s.

So Hashimoto’s is basically what we think about it as an autoimmune attack on the thyroid gland. And what it is is basically a collection of immune cells in the thyroid gland. And this is not something that’s visible to the naked eye and may not always be visible on the antibody test. So chances are that she may have Hashimoto’s.

A recent study was done in people who were undergoing fine needle aspiration of their thyroid gland who were antibody negative, but half of them who didn’t have antibodies actually had Hashimoto’s when they looked at their thyroid cells under a microscope.

So I would recommend further testing, maybe doing a thyroid ultrasound to help determine whether or not she would have Hashimoto’s. And the TSH of 5 is definitely that’s something that is going to be an elevated. So a healthy person should have a TSH somewhere right around 1, if they’re under age 50 and somewhere between .5 and 2 is where most people will feel the most comfortable.

Dr. Mowll: Yeah, I totally agree with that. And a lot of doctors leave that TSH up too high, in my opinion. Especially, if there’s symptoms and your TSH is even up over 2, I think needs some further investigation, for sure.

Dr. Wentz: Absolutely.

Dr. Mowll: Okay. Good. I’m glad you agree. We have somebody on the line who would like to ask a question live. So we’re going to go to this person in just a minute. For those of you who are on the call and you’re calling in with a phone today, if you’d like to ask a question live, just press star 2. And we’ll be able to actually unmute you and let you ask your question.

So we’re going to go to a caller in Atlanta, Georgia, area code 678. So you are now unmuted and please introduce yourself and ask your question.

Caller: The question that I have is that I went to an integrative doctor. And she thought automatically that I had Hashimoto’s, just by my symptoms and things like that. And we started treating for Wilson’s Temperature Syndrome, as well. And so they put me on T3. And it was like a rollercoaster, like you worked your way up to the top, which was 75. And it was like from 7.5 to 75. And then, you went back down. And during this, I felt just horrible. I have chronic Epstein Barr anyway. But I felt just terrible.

And also after that treatment—I did one more round of that—and I ended up gaining in like a two-month period—it was no time—ended up gaining 30 pounds. And now I’m hypothyroid. And I’m wondering did that treatment harm? Could it possibly have gotten my thyroid just so revved up? Because I was so hyper during that time and my blood pressure would be skyrocketed and just a very, very uncomfortable thing. And another reason for her thinking about the Hashimoto’s was that I would go in and out of hyperthyroid to hypothyroid. And I was extremely thin at that point.

So I guess that’s my question is…Oh, and my body does not process T4. Like I can take it. But my body does not know what to do with it. And so I’m trying to figure out how I’m going to get this hyperthyroidism under control, lose the weight, feel better, if I can’t do the T3 or the T4, if my body just doesn’t know what to do with it.

Dr. Mowll: Well, there’s a lot there in that question.

Caller: Yeah.

Dr. Mowll: So, Dr. Wentz, if you want to give that your best shot and then I can chime in a little bit here, too.

Dr. Wentz: Yeah. Absolutely. And I’m sorry for what you experienced. That doesn’t sound like a very fun thing to go through. And I’m sorry for the weight that you’ve gained and the symptoms you’ve experienced.

What I would suggest is looking at your adrenal function. So one of the things that can happen when you get on thyroid hormones, even T3 thyroid hormones, there’s an intricate feedback system between the adrenals and thyroid gland. And when you have too much of the thyroid hormone, sometimes that can further weaken the adrenals. And that can lead us to put on more weight and have more thyroid-like symptoms.

So I would recommend doing an adrenal saliva test to see if perhaps you can get your adrenals into balance. And I don’t work with the Wilson’s Syndrome and Wilson’s protocol. Usually, I actually, will recommend mostly for people who are working with their physicians to either work with a natural desiccated thyroid medication or a compounded T4/T3 or even like a T4 medication, as long as they’re converting it properly.

And then I also recommend really working on the adrenals and working on nutrition and working on getting nutrients addressed. And that oftentimes

helps the person lose weight and feel better without really needing to put them on high doses of the T3 medication, which as you had experienced, puts you on a rollercoaster.

Dr. Mowll: Yeah. Great answer. That question just brings to mind the difficulties in managing thyroid conditions. It’s such a tough condition, I think, to manage. I think this is one of the reasons doctors get so frustrated and ultimately patients get so frustrated is there’s just no one easy answer. People are all different. Their physiology is different. Some people respond just fine to Synthroid or levothyroxine, T4 therapy. Others don’t seem to convert it well. There are so many things involved.

The gut plays a big role. The liver plays a role in conversion, micronutrient balance. You mentioned selenium earlier. And copper and zinc, I think are involved. And there’s just so many factors, the adrenal involvement, autoimmune disease on top of all that. She mentioned Epstein Barr. And I see —and I’m sure you do, too— lot of autoimmune disease triggered by these chronic stealth viruses like Epstein Barr and Lyme. So there’s just so many things at play here that it’s just a difficult condition to handle.

Dr. Wentz: I agree. Dr. Mowll: Anyway. So we did actually have a question from a Barbara from Bridgeport who asked about Epstein Barr. She said she has chronic Epstein Barr. She thinks that might be one of the triggers for her Hashimoto’s. She’s being treated for that right now. And she said she’s quite sick and wondering what to do about this. She says, “I’m off gluten, going Paleo, and just not sure the next step or how to handle this.” Any suggestions there?

Dr. Wentz: Yeah. Definitely Epstein-Barr virus can trigger Hashimoto’s and different types of autoimmune conditions and can make it worse when it’s reactivated. The things that I recommend for people with Epstein-Barr virus, I usually will recommend for everybody with Hashimoto’s a general strengthening protocol where you try to build up your own defenses and your own immune system. So making sure your vitamin D levels are adequate. So I would recommend anywhere from 60 to 80. That should be your target range that when you’re testing your vitamin D levels. To do that, usually I would recommend anywhere from 1,000 to 5,000 international units of vitamin D3 on a daily basis, getting plenty of sunlight. The cells that fight the Epstein- Barr virus, they’re actually vitamin D dependent. So you want to make sure that you have enough vitamin D to support those cells.

And the other thing is making sure that your adrenals are in check. So

making sure your blood sugar is balanced, making sure you eliminate any food sensitivities. Any other types of infections that can potentially weaken your immune system because your immune system gets distracted by those infections, instead of fighting the Epstein-Barr virus.

One of the infections that I’ve found very commonly in people who have chronic Epstein-Barr virus and Hashimoto’s is known as Blastocystis hominis. And this is a protozoan parasite that can be found on gut testing and, oftentimes, eradicating that parasite will help us overcome Epstein-Barr virus easier.

I do recommend doing a supplement called Pro Boost. It is aseismic protein. So our sinus gland helps us with fighting viruses. And this gland basically shrinks as we get older. And this is a glandular version of another animal’s aseismic protein. And that can help with overcoming the viral infection. There’s also different types of herbal protocols. Or I definitely recommend doing coconut oil. That can help with breaking down the virus, along with working with your physician on either herbal protocols or antiviral protocols that are by prescription.

Dr. Mowll: Dr. Wentz, are there any supplements that people with autoimmune disease need to be careful of? For example, there seems to be this balance of stimulating the immune system to fight off infection. But it seems counterintuitive to want to stimulate the immune system with someone with autoimmune disease. So are there supplements that we need to be a little bit careful of that may actually stimulate an autoimmune attack?

Dr. Wentz: There’s some controversy about that with Echinacea and different types of immune stimulants with respect to Hashimoto’s. And there is basically the theory of different parts of the immune system that you strengthen one and you weaken another. And that can help with balancing autoimmunity. It’s known as immune modulation.

And I actually don’t focus too much on that, unless we’re doing something like doing systemic enzymes or low-dose naltrexone or Moducare to help balance that out in a gentle way and supporting just overall immune balance with vitamin D and sunshine and healthy foods. I haven’t found that to be as significant in worsening people’s symptoms or their autoimmunity when they do take these immune-boosting, like reishi mushrooms or Echinacea. I haven’t found that to be an issue as much.

I would say there is something that I find of concern for people with Hashimoto’s. And that would be high-dose kelp supplements or seaweed or

high-dose iodine, which can sometimes actually increase the inflammation in the thyroid gland and attract more immune cells. And some people have actually come down with some new autoimmune conditions when they did high doses of these types of things—the seaweeds. So I don’t recommend those. But other than that, I haven’t seen too much of it really affecting people as much as we’ve been told that it may.

Dr. Mowll: Okay. Thank you. Here’s another great question. This is another case history, I guess, if you will, from Tasha. She says, “I have Hashimoto’s based on elevated TPO. But my TSH is below 1. And my free T3 and T4 are in the normal range.” She doesn’t give the numbers. So we’ll just have to take her word on that. “I’m not on any medication, but am symptomatic with predominantly neurological symptoms like dizziness, being off-balance, difficult concentrating, headaches, and brain fatigue.”

She says she has an organic diet, pasture-raised, gluten-, soy-, dairy-, egg-, nut-, seed oil-, legume-, and nightshade-free, so basically an autoimmune Paleo-style diet. She says that she’s had a spectra cell test, showed no nutrient deficiencies. She did test positive for Blastocystis hominis, which you just mentioned, interestingly. So any suggestions for Tasha?

Dr. Wentz: So in the early stages of Hashimoto’s, you can have swings from hypo- to hyperthryroidism, which is something that perhaps may be happening with you. Or maybe there’s a miscommunication between your pituitary gland and your thyroid gland. So that’s something to investigate. So you may want to do further testing just to be sure for Graves’ disease, for Graves’ antibodies, as well as some pituitary antibodies to make sure there’s not another type of autoimmune process. And I just want to say I want to commend you for really investing in your diet and really working hard to reverse autoimmunity through the diet. I will say that the Blastocystis is a bug that can actually keep us from basically healing. So it causes leaky gut. And you can keep going on a more restrictive and a more restrictive diet with this when you have this parasite onboard because it basically will make you react to whatever you’re eating. So I would highly recommend going after that infection.

If you work with your doctor, there’s a medication named Alinia that can be helpful for that. Saccharomyces boulardii is the beneficial yeast that can help. And then there’s also different types of herbal protocols with berberine and oil of oregano that can help with eradicating that parasite. Metronidazole used to be the drug of choice. However, it’s not really recommended anymore. So looking into your adrenal function because oftentimes the parasite can

whenever you have a chronic infection that can weaken your adrenals and getting rid of the parasite would be some things that would hopefully help you feel better.

Dr. Mowll: Yeah. When you look at Hashimoto’s, there’s obviously a number of triggers. I’m sure there’s genetic factors. And I’m sure there’s just many things that can trigger autoimmune disease, in general. And if we look at Alessio Fasano’s work with the three requirements for autoimmune disease with the leaky gut and the trigger and the genetic propensity, do you see certain triggers being more common. For example, is it typically some infectious disease or is it typically diet related? Is it a combination? What do you see as some of the most common triggers for Hashimoto’s?

Dr. Wentz: That’s a really great question. And I would say the top triggers where I would put them would be food sensitivities, nutrient depletions, adrenal, poor stress response, a lot of adrenal issues, blood sugar issues, intestinal permeability, different types of chronic infections, as well as toxins. And my recommendation for everybody is to start with diet first. And we will see a percentage of people who just need to get off of gluten. And that’s really all they need to do. And that’s their root cause. Within three months, they’ll get into remission. They’ll start feeling better. All of their symptoms will go away. But that’s a small subset of people.

And then we have another subset that maybe has additional food sensitivities. And that will take another three to six months to really see the full effects of getting off of those foods.

But then, you start getting deeper. Definitely if somebody’s been on a clean diet for more than three to six months and they’re not seeing results, then I would highly recommend testing for infections. So that one of the biggies that I will see is people in our patients and clients that I work with or consult with, we’ll see for other people, who haven’t gotten better or into remission with diet, that about 90% of them will have adrenal issues. They’ll have gut infections. And those are probably the two biggest players that I see contributing to Hashimoto’s, as well.

Dr. Mowll: And do you typically recommend like a gut healing protocol? Like how much do you think the leaky gut or intestinal hyperpermeability is a part of this?

Dr. Wentz: It’s actually a huge part of it. So when you mentioned Dr. Alessio Fasano’s work, so he described that autoimmune disease always has three

things present. So you need to have the genetic predisposition. You need to have a trigger that induces the autoimmune disease. And then you need to have the leaky gut or intestinal permeability, which basically means that our immune system’s not going to be properly trained in determining the difference between that trigger and us.

So most of our immune system matures in the gut and that’s properly trained in the gut. So when we have that intestinal permeability and proper gut function, our immune system just doesn’t work correctly. So I’ve found that every person with Hashimoto’s will have that leaky gut component. And that is a really, really big thing that I recommend for everybody, even if they don’t have any gut symptoms. But some people will have IBS or they’ll have acid reflux or bloating or constipation, any symptom like that is an indication that you have that leaky gut. But again, for some people it may be a silent thing. What are some of the root causes of leaky gut? You’re going to see different food reactions. So especially gluten and dairy are the two biggest foods that can trigger leaky gut, so getting off of those. Nutrient deficiencies, zinc, glutamine, and fish oils, this is a general protocol for supporting the gut wall. Looking at potentially dysbiosis, so an imbalance of good versus bad bacteria in the gut, so making sure that the person is eating fermented foods and taking probiotics is going to be helpful.

And then the other piece that I think a lot of people and the kind that the holistic, natural world don’t really focus on a lot is infections. So any time you have a parasitic infection or if you have a bacterial infection like H. pylori in your gut or even a tooth infection that’s in your mouth or a sinus infection in obviously your sinuses, that can actually lead to a leaky gut. If you have an overgrowth of good bacteria in your small intestine, that can lead to a leaky gut. And these are things that I recommend testing for. And it’s always best to do testing and do protocols specific to that.

But every now and then, I’ll also recommend a general gut protocol, which will consist of herbs like berberine and oil of oregano with Saccharomyces boulardii, which is a beneficial yeast. People can do that for a couple of months and then follow that up with probiotics and all of the gut-healing nutrients. And that can help a lot of people’s symptoms and help reduce the antibodies, as well. But it’s always definitely better to figure out the exact infections that you and do targeted treatments for them because there’s different drugs and herbs for different bugs.

Dr. Mowll: Okay. So let’s take a quick time out. And, Izabella, would you mind just mentioning for people who want to find out more about you and your work, maybe read your blog or get your book, where they can get more

information about you and what you do?

Dr. Wentz: Absolutely. So I’m a pharmacist. And I was diagnosed with Hashimoto’s in 2009. And I didn’t like the conventional medical answer of having to basically be monitored for additional autoimmune conditionsnand that there was nothing I could do, other than take medications to help myself feel better.

And while medications did help a little bit, I wanted to see if there was anything I could do to help stop or prevent the progression of the condition. So I really started to do my own research and became a guinea pig/ Hashimoto’s expert.

And my website is ThyroidPharmacist.com. You could find more information about my work there. I do have a pretty active blog. I have some information to get you started. If you go to ThyroidPharmacist.com/gift, that will give my nutrient depletion’s chapter. That will give you some recipes to start with and a gluten-free quick start page.

And I also have a book called Hashimoto’s: The Root Cause, which is a patient guide about overcoming Hashimoto’s. And this is something that’s been out for about two years. And it’s become a New York Times bestseller. And a lot of people have been able to get into remission and feel much better with the book, which it makes me happier than anything. So you can get more information about that on Amazon or on ThyroidPharmacist.com.

Dr. Mowll: Okay. Great. So for those of you on the phone lines with us, if you’d like to ask a question today, this is your chance. Just press star 2. And we have about 20 more minutes. So press star 2, if you’d like to ask a question. And I’ll see that you’ve raised your and. And we’ll get you on the phone today with me and Dr. Wentz.

Otherwise, we’re going to go back to our submitted questions. We have a couple that just popped up there. But let’s read a couple of these submitted questions. And then I’ll go back to the people on the line.

So this is a question I’m sure you get a lot. This is from Nya in Santa Barbara. And basically she’s asking about these goitrogenic foods. She asks if eating too much kale—we could probably ask the same thing about broccoli and cauliflower and cabbage and Brussel sprouts—are these a problem for people with autoimmune thyroid or I would hypothyroidism, in general. And then she also asks about soy products, which is a little bit of a different category. So what’s your position on these foods?

Dr. Wentz: Yeah, this is such a great question. It’s a very, very common Hashimoto’s and thyroid myth. So the goitrogenic vegetables like broccoli and kale and cauliflower, these are cruciferous vegetables. And they’ve been classified as goitrogens, as has soy. Now, the word goitrogen is the seeding word because it basically means something that interferes with thyroid function. There’s a few different ways that different foods and chemicals can interfere with thyroid function.

With the respect of the Brassica vegetables like the kale and cabbage, that mechanism is that they block iodine entry into the thyroid gland. This used to be an issue for people back in the day when the primary cause of hypothyroidism was iodine deficiency.

So back in the day, if you had hypothyroidism or an underactive thyroid, it was pretty simple. Basically, you’d need iodine and tyrosine to form thyroid hormones. And when you don’t have enough of either of those, you’re not going to be able to produce hormones. And this was the primary reason of an underactive thyroid 50, 100 years ago in most of the world.

What scientists and public health officials noted that not having enough iodine in our food supply led to hypothyroidism. So they wanted to remedy that. And they started adding iodine to our salt supply. And so very quickly, within the course of a few years or a decade, people were no longer iodine deficient. And then unfortunately what happened is that we saw higher rates of Hashimoto’s. And that’s what became the primary reason for hypothyroidism. So adding iodine to our salt supply helped prevent hypothyroidism due to iodine deficiency. But then it led to more cases of hypothyroidism due to Hashimoto’s.

The reason why this happened is because iodine is a very narrow therapeutic index nutrient, which means that it’s really good, but in just the specific dosage. So when you don’t have enough of it, you’re going to have problems with your thyroid. And when you have too much of it, you have problems with your thyroid.

And they’ve done these studies over and over again in countries that just recently started to add iodine to their salt supply in Eastern Europe and some of the Middle East. And they found that sure enough, we no longer had iodine deficiency hypothyroid. But then we started to have Hashimoto’s in those countries and the rates doubled, tripled, quadrupled. The more iodine in the salt supply and the longer the salt had been fortified, the more cases of Hashimoto’s you would see in those communities.

So long story short, if you had iodine deficiency hypothyroidism, then potentially, yes, the vegetables, the Brassica vegetables could prevent you from absorbing additional iodine from the food. That would be an issue. But with Hashimoto’s that’s actually not an issue because most people do not have iodine deficiency. And most studies and research points to actually iodine excess being a factor in Hashimoto’s.

These vegetables are very, very good for us. They’ve got great detoxification potential and properties. So you definitely do want to keep them in your diet. You want to make sure they’re organic. There have been some issues with kale, non-organic kale having certain types of pesticides and toxins. So do keep that in mind that you do purchase kale in the organic form. And for the small population of people who may have iodine deficiency, you can actually still eat them. But you just want to make sure you steam or cook them because that will break down their goitrogenic potential.

On the other hand, soy is also classified as a goitrogen. But it interferes with thyroid hormone production in a different way. So it actually interferes with the thyroid peroxidase enzyme. And it has been found to increase thyroid antibodies. So soy is something that we do want to avoid. So I hope that makes sense that it’s not that you can just say goitrogen. It’s basically looking at each individual vegetable in its own class and properties. And the kales and broccolis are great. Soy, you do want to avoid.

Dr. Mowll: Okay, great advice. Thank you. We have a caller who has a question from Tennessee, area code 931. So I’m going to go ahead and unmute you. Caller, please just say your name, introduce yourself, and ask your question.

Caller: Hi, my name is Joyce. And I have a question. In 2012, I had West Nile. And it’s taken me a long time to recover from that. I don’t have any energy, for one thing. I’ve been doing the Paleo for a couple of years. And actually I cannot lose weight. And I have had thyroid tests in the past. And they always told me I was normal.

But I have a very low temperature. Always. And I have for years. So I also have a lot of stress. And I’m wondering. I don’t have the money really to get a lot of tests done. So I haven’t done anymore tests for quite a while. And I’m just curious if it’s adrenals or if it’s the thyroid that could be possibly a problem for me?

Dr. Wentz: That’s a great question. And you bring the low temperature up. And low temperature could actually either be a symptom of the thyroid or the

adrenals. So I think you’re definitely on the right track. Being stressed out is actually often commonly related to adrenals. And that could also be related to thyroid function.

So some of the symptoms of poor adrenal functions are going to be feeling tired, but wired, having inability to lose weight. When you are outside, you’re going to be more light sensitive. These are some symptoms to keep in mind. And versus the thyroid, where you may differentiate that, with thyroid, you just want to take naps all the time. And you might be less motivated, in general, and you might be cold intolerant, where in adrenals you are going to feel a little bit antsy and more agitated. So those are some things to consider. I definitely, if you could, I would recommend testing for both. For adrenals, you would want to do an adrenal saliva test. From the conventional medical standpoint, it’s like voodoo science. And I didn’t believe in it for a really long time as a pharmacist until finally I gave in and I had my adrenals tested. And sure enough, my adrenals were low and corresponding to the symptoms that I had. And then I took adrenal supplements and the adrenal protocol that I was supposed to. And I felt so much better. It turned my whole health around. So I highly would recommend doing that test, even if you need to pay out of pocket for it, the adrenal saliva test where you basically put your saliva in four little bottles, four times throughout the day. This is something that you either have to get through your functional medicine doctor or chiropractor. Or you can order it on your own through a lab like ZRT Lab or the Canary Club or something like that.

Dr. Mowll: Okay. Great. Thank you. A couple of really good questions are just rolling in. There’s one here from Debra. And Debra says, “Have you seen a connection between the MTHFR gene aberrations and Hashimoto’s? And, if so, do you take any special approach for use in people with these mutations?”

Dr. Wentz: That’s a great question. I have seen that to be a common contributor to people in Hashimoto’s. So what the MTHFR gene means is you might have one copy or two copies of a gene mutation. And that will lead you to impairments in methylation. But basically, what that means is you’re not going to be able to properly activate B vitamins. So B12, B5, B6, as well as folate, which are the important vitamins for basically energy production. And then, you’re not going to be able to properly detoxify heavy metals. And heavy metals can be a trigger for autoimmunity. And you’re going to get the autoimmune condition that you are genetically predisposed to have based on…So you have the genetic predisposition and then you have the trigger. And that will determine what autoimmune condition that you get.

And so one of the things that I always recommend for people with this MTHFR

gene mutation is making sure that you are taking a methylated version of a B vitamin and a methylated version of folate. There’s a product by Pure Encapsulations called Homocysteine Factors and then by Designs for Health called Homocysteine Supreme that basically has the methylfolate version, which is the activated folate. It has methylcobalamin, which is the B12. And it also has the active B5 and B6. What it also provides us with is something known as betaine or trimethylglycine, which offers an alternative pathway for breaking down some of these potential toxins that may build up in people with the MTHFR gene mutation.

So that’s something that a person would want to take lifelong and make sure they’re really supporting their folate levels. They also want to test their homocysteine levels. So homocysteine is something that’s going to be potentially associated with heart problems and blood clotting. So you want to always make sure that’s in control. And the Homocysteine Factor supplement can be helpful with that.

You want to avoid any kind of processed foods and any synthetic versions of folate, which are known as folic acid. And they’re commonly added to breads and multivitamins. So you don’t want to take the cheap multivitamins. You want to invest in a quality multivitamin that has the methylated or the active B vitamins in it.

Those are the main recommendations for the MTHFR gene mutation. And eating plenty of green leafy vegetables, which have a natural source of folate in them and eating beets, which have betaine or trimethylglycine in them can also be very, very helpful.

Dr. Mowll: Okay. That’s great. And for those of you who want more information on MTHFR, I recommend Googling Ben Lynch or go to YouTube and type in Ben Lynch, brilliant guy. He’s going to be on The Diabetes Summit 2016. We don’t have a date yet. But it will be some time in 2016. And he’s going to be one of our confirmed presenters, a brilliant guy when it comes to a lot of things, but in particular, these MTHFR defects. So you can check him out also.

And for those of you who feel like you need a little bit of help with your diabetes or blood sugar, there’s a link on the left hand side of the page that says Private Coaching. You can click on that. We have a couple of spots open in our coaching program right now. I do one-on-one private coaching. I have a team of highly-trained dietitians that I work with. These are not your typical hospital-based dietitians; functional and integrative dietitians who really

know what they’re doing. And we work together with clients. So just click on that link. There is a bit of a qualification process. But you can fill out an application and send that in. And we’ll see if we can work with you as a client. We’ve got another great question coming from a different Barbara. And this is probably what we should have started with. But Barbara says, “I know how you’ll probably address this.” So I’ve got to make sure we answer it. “What example is the connection between hypothyroidism and blood sugar imbalance?”

So that’s probably a topic for a whole interview. But maybe, Dr. Wentz, if you could mention a few things. Some of the connections between how the thyroid affects blood sugar and how blood sugar imbalance affects the thyroid and how this forms a vicious cycle?

Dr. Wentz: Yeah, this is a big deal. So blood sugar swings are actually a really, really big deal in people with Hashimoto’s and hypothyroidism. There was a recent study done in Poland that found about somewhere around 46% to 50% of people with hypothyroid had some degree of glucose intolerance or issues with their blood sugar levels. And essentially blood sugar swings are going to weaken our immune system’s response. And then they’re going to make us more likely to see an increase in…

First of all, though, we’ll see there’s going to be a pathway that sets off where basically our adrenals are not going to be able to properly control the blood sugar swings. And eventually the adrenal hormones will run out. And that leads to basically our adrenals not being able to control any inflammation in our body. And eventually, this leads to a higher upregulation of the autoimmune attack on the thyroid gland.

So this is something that I like to think about. When I think about blood sugar swings, they really are like pouring gasoline on the fire for autoimmune thyroid disease. And you’ll see people who’ll feel much, much better when they first go gluten free. As one of the first questions mentioned, when they start eating the foods that are very, very high in sugar like the simple carbohydrates that are gluten-free and the gluten-free products, they might actually see an uprise in their thyroid antibodies. They might see an increase in anxiety and in hair loss.

So this is something that I very much recommend usually actually as a first measure for people with autoimmune thyroid disease is to really get their blood sugar under control. So things I recommend for that are going to be making sure that you’re eating plenty of good fats and proteins and you’re

eliminating your carbohydrates.

In the beginning, people may be so sensitive that they may need to snack every two to three hours to keep their blood sugar levels stable. One thing I also recommend is putting a little bit of coconut oil in your beverage of choice or your tea, avoiding fruit juice, limiting caffeine, definitely no fasting, eating breakfast within one hour of waking.

And doing these seemingly simple things can really, really help to bring the autoimmune attack under control within a pretty short amount of time. So we’ll see people within a couple of weeks of basically making these interventions, they start feeling a lot, lot better. And their thyroid antibodies will start reducing, as well.

Dr. Mowll: Okay. Great. So we just have a few more minutes with Dr. Izabella Wentz, the Thyroid Pharmacist. But we have a couple more call-in questions. So let’s see. We have one who’s calling in via Skype. So I don’t have a name or number. But you are now unmuted. So if you could just say your name and ask your question, please.

Caller: Okay. I was diagnosed with diabetes about five or six years ago. My A1C was really high. It was over 13. And at the same time, my thyroid was way off. They were going to kill off my thyroid and put me on Synthroid. I changed my diet. And then it went back to normal. Well, they said normal. And I can’t look at the test to see whether it really was or not. But I’m concerned. Is that something that can come back? Does it mean that if I don’t watch what I’m doing that I can get to that same situation again?

Dr. Mowll: Did you have your thyroid irradiated. Or when you said they were going to kill off your thyroid, did you have any type of treatment done?

Caller: They were going to do that. But then I drastically changed my diet. I cut my blood sugar in half. And then they said my thyroid went back to normal. But when I’m listening, it sounds like what regular internists say is normal, may not be actually normal. So I’m not really sure. But they said it’s normal. I’m just worried that my thyroid will go out of whack again.

Dr. Mowll: Are you aware of your lab values? Like when you say you cut your blood sugar in half, what’s your blood sugar now? And do you know your TSH and T3 and T4 levels?

Caller: Well, when I was really watching my diet—I changed it drastically— my blood sugar went from about 13.5 to 5.7.

Dr. Wentz: Congratulations.

Caller: Thank you. But I’ve had a really few stressful years these last three years. I’m taking care of a terminally ill person. So my blood sugar is back up again. So I’m trying to figure out what to do.

Dr. Mowll: And what about the thyroid numbers? Do you have any recent thyroid tests?

Caller: I do. But I don’t have it in front of me. So I can’t tell you. But the internist said it was in…When they look at the lab range, that it was within the range. But from listening to your calls, it sounds like it still might not be normal.

Dr. Wentz: I would say you would want to make sure that your symptoms are well controlled. And most people feel best with it between 0.5 and 2.0. And I just want to commend you on what you’ve been able to do. So you’ve been able to really commit to your diet and really get your blood sugar stabled. And you’ve been able to reverse two conditions, not just one. So I want to make sure that you’re proud of yourself for doing that because that’s quite a feat. And it takes a lot of commitment.

With respect to potentially having this issue again, I would say that it does seem like you would have the genetic predisposition. So you’re going to be somebody that’s going to want to keep things in balance. So you’re going to want to keep an eye on your blood sugar levels and you’re going to want to keep an eye on your thyroid and be really committed to the lifestyle changes So I don’t like to think of these types of recommendations as short-term fixes. These are the lifestyle changes that we need to adopt for lifelong. And this is the way that we really should be eating. And this is going to be preventing disease for your entire life, rather than potentially coming down with other types of conditions.

So I want to commend you for really being able to…You’ve uncovered some of the root cause and triggers for why your thyroid and your blood sugars may go out of balance. So I think you already know what to do. And you just need to stick with it. Does that make sense?

Dr. Mowll: Yeah, so that is such great advice. And I think that’s true for all of us, not just those people dealing with chronic disease. We have to stay consistent. And that’s the challenge. Health is not a destination. It’s a process. And we’re always working towards getting healthier.

I look at it like we’re either on a path towards improving our health or we’re on a path towards disease and damage and early death and dysfunction. So we want to be on that path towards getting healthier every year. And that means eating a good diet, staying consistent with that. We’re not gong to be perfect. But we want to do the best we can, staying physically active and fit, keeping our stress under control, and sleeping well, getting proper rest, making sure our gut’s healthy, and our immune system is balanced, and we have positive relationships in our life and spiritual life.

All these things are part of the health spectrum. And we just want to be constantly working on getting healthy. It’s a process. And that can be daunting and aggravating for some people. But I think when you accept that and you just look at it as a path, then there’s less resistance. And it becomes easier. And eventually, it becomes fun.

So, Dr. Wentz, thank you so much for being on with us today. We are out of time. For those of you who want to find out more about all the wonderful things that Izabella Wentz is doing, go ThyroidPharmacist.com. She’s got a great website, a great blog, great book. She does some amazing programs. So please go check her out.

Izabella, thanks so much for taking the time today.

Dr. Wentz: Thank you so much for having me, Brian. It was a pleasure.

Dr. Mowll: And for all of you, thanks for being on with us today.

Thanks for being on with us, today. Everybody, have a great day. And God bless. We’ll talk to you soon. Bye-bye.