Rational Wellness Podcast 028: Thyroid Health with Dr. Holly Lucille
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Dr. Holly Lucille talks about Thyroid Health with Dr. Ben Weitz.
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1:05 I introduced the topic by explaining that thyroid enlargement, known as goiter, from a lack of iodine was the main cause of hypothyroidism for many years until we started the nationwide iodine supplement program where we added iodine to salt. We saw goiter go away but rates of Hashimoto’s autoimmune hypothyroid skyrocketed. And restricting iodine intake is often helpful for autoimmune hypothyroid.
4:25 I asked Dr. Lucille what alerts her when she sees a patient in her office that they might have thyroid problems? Dr. Lucille explained that active thyroid hormone, T3, getting into our cells is responsible for our metabolism and any signs of hypometabolism, such as weight gain, fatigue, constipation, hair thinning, and depression, alert you to the possibility of a thyroid problem.
5:35 I asked if hypothyroidism is suspected, what lab tests should be ordered? Dr. Lucille explained that the reason we run lab tests in the first place is to confirm what we already suspect clinically. She prefers to be comprehensive in her lab testing for thyroid, rather than just running the TSH, which is what many doctors run. Dr. Lucille used an analogy of a runner running a 440. Leg one is the higher brain center of the hypothalamus and the pituitary that are getting signals from the rest of the body as to the need for thyroid hormone. Leg two is the communication down to the thyroid itself. Leg three is the making of thyroid hormone directly at the level of the thyroid, mostly T4. Leg four is the conversion of T4 to active T3. She likes to run a total T4, a free T4, A free T3, TPO and TGB antibodies, reverse T3, and Thyroid Binding Globulin.
9:02 I asked, just to play Devil’s advocate, if I am an insurance company or a conventional MD, since T3 and T4 correlate with TSH, why do you have to run all these other tests? Dr. Lucille said that in some of the problematic cases she sees, these don’t necessarily correlate. These tests allow us to figure out where the problem of an under-functioning thyroid is and how to fix it. Also TSH is unpredictable with age, infection, stress, calorie restriction, inflammation. Also, there is a big controversy as to what the healthy range for TSH is. Normal at one time was up to 4, then 3.5, and now many consider up to 2.5 as normal. Dr. Lucille mentioned that the National Academy for Clinical Biochemistry has said since 2002 that the TSH should be between .5 and 2.0. Many studies show that TSH above 2.5 is associated with metabolic syndrome, elevated fasting triglycerides, increased blood pressure and an increase in body mass index. TSH is not enough to properly assess thyroid disorders, other than thyroid tumors.
10:55 I told Dr. Lucille that I would play Devil’s Advocate one more time and asked, why do we need to do these tests for autoimmune thyroid (TPO and TGB antibodies) if there is nothing that we can do about autoimmune conditions? Dr. Lucille related a conversation she had with a prominent endocrinologist that since we know that most cases of under-functioning thyroid is related to autoimmune destruction why doesn’t he regularly run these antibody tests and he said that because his treatment would not change. Dr. Lucille said that she is concerned that if all you do is place the patient on Synthroid and you don’t do anything about the underlying autoimmune condition, then the autoimmune condition will progress into attacking another organ of the body. Even though their TSH is within normal limits, such patients will continue to suffer.
13:22 This is why it would be beneficial for most patients to not only see their conventional MD for diagnosis and treatment, but they should see a Functional Medicine practitioner like you, Dr. Lucille, or me to discover the underlying causes and triggers for their autoimmune condition and to use some strategies to reverse it. I asked Dr. Lucille to talk about what some of the underlying causes and triggers for Hashimoto’s autoimmune thyroiditis. Dr. Lucille explained that dietary factors, stress, and environmental toxins, like heavy metals, can all stimulate an autoimmune condition. The immune system is mostly around our gut, so healing our gut is important in treating autoimmune diseases like Hashimoto’s.
15:35 I asked Dr. Lucille what are some of the things she will look at with respect to the gut that might relate to thyroid problems? Dr. Lucille said that she will look at dietary factors and the number one recommendation she will make once she has confirmed that there is an autoimmune thyroid condition is going 100% gluten free. She explained that back in the 60s they started using dwarf wheat and this is much higher in gluten and it can lead to hyper-permeability or leaky gut. The lining of the digestive tract is only one cell thick and there are very tight junctions and when the gut is leaky, and larger protein molecules like gluten get into the blood stream and the immune system mounts a response to them. This is when the immune system gets confused and starts to attack our own tissues.
17:41 I clarified that when the immune system attacks the wheat it can get confused because the gluten is very similar in appearance to the thyroid tissue proteins and then the immune system attacks the thyroid gland itself. Dr. Lucille explained that this is why it is so important to heal the gut in such patients. If the thyroid patient was born by c-section then they will not have been innoculated by the bacteria in the vagina during the birth process and will not have as healthy a microbiome and the immune system will not develop like it should. Also, if patients were not breast fed, they will not have as healthy a microbiome.
20:07 I asked if such thyroid patients should avoid foods termed goiterogens, like broccoli? Dr. Lucille answered that patients would have to eat such a large quantity of such foods like broccoli that they would have social problems before it affected their thyroid. She also pointed out that if you steam such cruciferous vegetables, it will deactivate some of their goiterogenic affect. We don’t want our patients not eating such healthy foods like broccoli. We not only want the patients to feel better, their TSH get to a healthy level, but we also want to see the antibodies come down, which shows that we are getting the autoimmune component under control.
21:58 I asked what she thinks about a couple of other goiterogenic foods–soy and canola oil? Dr. Lucille says that she doesn’t like soy, esp. since 99% of it is genetically modified, or canola oil for her thyroid patients.
22:38 I asked Dr. Lucille about whether patients with Hashimoto’s should be taking additional iodine, esp. since iodine is often included in thyroid supplements and in multivitamins? Dr. Lucille responded that T3 stand for Tyrosine with 3 iodine molecules, so iodine is necessary for making thyroid hormone. On the other hand, iodine can spur on a Hashimoto’s attack. She noted that she will sometimes test for iodine deficiency using an iodine urine spot test. Dr. Lucille said that if she can eliminate food sensitivities and heal the gut and supply enough antioxidant support like high dose absorbable curcumin and vitamin C, then she can iodine and there does not seem to be a problem. She has been able to recover from an iodine deficiency and not have that autoimmune component be spurred on.
25:20 I asked what she thinks about the halides: flouride, chloride, and bromide that are in the same row of the periodic table and can compete with iodine? Most of our water has chlorine and flouride added and bromide is added to many common foods, including in some almond milk products. Dr. Lucille responded that these elements absolutely need to be avoided since they can attach to our thyroid and block iodine. She believes that this is one reason the rates of thyroid cancer have been increasing the last six years. It’s true that we once were over iodized, but Dr. Lucille feels that iodine deficiency is on the rise again with so many people avoiding iodized salt and consuming sea salt and other natural forms of salt.
27:08 I asked about importance of the antioxidant, selenium, for thyroid health? Dr. Lucille expounded on the importance of selenium for thyroid health and the need for it to convert T4 to T3. She noted that she will sometimes start patients out on 800 mcg of selenium if there is active Hashimoto’s to get those antibodies down and then taper off.
28:13 I said that I was re-reading Isabella Wentz’s Hashimoto’s Thyroiditis, which I think is the best book I have ever read about thyroid. Isabella was talking about how you end up with hydrogen peroxide being produced as a result of the conversion of Iodide to Iodine, the usable form, and this hydrogen peroxide will damage the thyroid cells unless you have enough selenium to help neutralize that.
28:54 I then asked what are some other nutrients that are important for thyroid health? Dr. Lucille explained that she always tests vitamin D, since vitamin D is important for optimal thyroid function and she prefers a range of between 60 and 90. She also makes sure ferritin (a stored form of iron) levels are at least at the 90 to 110 level. She will use a bis-ferritin source of iron along with vitamin C for absorption. Dr. Lucile said that both zinc and magnesium are very important for thyroid function. The thyroid is one of the most nutrient dependent organs. Also, essential fatty acids are important.
29:55 I asked for those patients who require thyroid hormone, what does she find is the most effective form of thyroid medication? Dr. Lucille said that she gets some patient who come to see her who are already on Synthroid, which is straight T4, and if there is a T4 to T3 conversion problem, then this may not be the best form to use. Nutrient deficiencies, heavy metals, alcohol use, sleep disturbances can all affect conversion. She prefers a porcine derivative of thyroid like Armour, where you are getting some T3 along with T4, which doesn’t have to be converted. Some folks do better on Synthroid and there is some speculation that a porcine derivative can aggravate an autoimmune condition. We also don’t want to do high dosages of thyroid hormone. High dosages of thyroid suppress endogenous thyroid hormone production, it can suppress the binding glonbulin and receptior sites can become less sensitive to thyroid hormone.
33:09 I asked which natural brand of thyroid medication that she prefers to use? Dr. Lucille said that for patients who are very sensitive tend to do well with the WP Throid. I mentioned that I had heard that the maker of Armour thyroid, Forest Labs recently got purchased by a bigger pharmaceutical company and they had changed the formulation. Dr. Lucille pointed out that they also increased the price. Sometimes patients can react to the additional ingredients that are added to some of these formulations. For example, Synthroid has corn starch and lactose and some sensitive patients could have a reaction to either of these.
35:27 I asked about sub-clinical hypothyroidism and whether it is something that should be treated at all? Dr. Lucille said that what is referred to as sub-clinical hypothyroidism is when the patient has symptoms of hypothyroid but normal TSH and she thinks this would better be termed sub-laboratory hypothyroidism. We should treat people and not treat lab tests. We should ask, Could this be an autoimmune problem? Could there be a binding problem? Are we not absorbing the T3 into the cells? Sometimes dysbiosis can create end products that compete with T3. There can be thyroid receptor resistance, similar to insulin resistance. Dr. Lucille said that by taking a Functional Medicine approach to thyroid, by allowing the body to heal itself by removing food sensitivities, by restoring nutrients to optimal status, and improving lifestyle can allow the thyroid to heal. Your thyroid is your metabolism–it’s your get up and go and when your get up and go gets up and went, it doesn’t feel very good.
Dr. Holly Lucille can be reached through her web site, http://drhollylucille.com/ and she is available to see patients at her office in The Body Well at 7235 Santa Monica Blvd., West Hollywood, CA 90046 by calling 323-658-9151.
Dr. Ben Weitz is also available for nutrition consultations and chiropractic care at 310-395-3111.
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