Hashimoto’s Thyroiditis with Dr. Angela Lucterland: Rational Wellness Podcast 246
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Dr. Angela Lucterland discusses Hashimoto’s Thyroiditis with Dr. Ben Weitz.
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4:15 Hashimoto’s thyroiditis is the most common autoimmune disease and in the US it accounts for about 95% of cases of hypothyroid. [Hakuru Hashimoto was a Japanese MD and researcher who discovered Hashimoto’s Disease and published a paper on it in 1912.] In general, the conventional medical profession diagnoses hypothyroid via an elevated TSH and prescribes thyroid medication, typically synthetic T4. If you don’t test the antibodies, then you will miss the diagnosis of Hashimoto’s and taking thyroid medication will not fix the autoimmune component. Antibodies are often present 10 years or longer prior to enough tissue damage for someone to feel it, which gives us a huge opportunity to treat it with a Functional Medicine approach. A full thyroid panel should include TSH, Free T3, Free T4, reverse T3, and TPO and TGB antibodies.
6:03 It is important to run both of the thyroid antibodies–both the TPO and the TGB antibodies, even though high TPO antibodies are more common. Ideally we would like to see their labs improve, their symptoms improve, and also see their antibodies go down, then we know that they are improving.
7:05 Dr. Lucterland considers a TSH above 2 or 2.5 to be significant, though it may be useful to measure the TSH several times, since there can be some fluctuation of TSH levels. Also if you take vitamins with biotin, it can affect the measurement of TSH levels, so you should probably avoid taking multivitamins or other vitamins with biotin for a week prior to testing.
11:31 For patients that require thyroid medication, Dr. Lucterland feels that most patients do better with natural thyroid, like Armour vs synthetic T4 like Synthroid, since these natural products have not only T4, but they also include a little T3, which usually makes patients feel better.
13:37 Besides giving thyroid medication, since Hashimoto’s is an autoimmune disease, we need to restore barrier function and restore self tolerance. We need to remove environmental toxins and pathogens.
14:45 To get an idea of barrier function, Dr. Lucterland likes running a comprehensive stool analysis and she includes zonulin, which is a marker for leaky gut, though it is marker that tends to fluctuate quite a bit.
19:15 Before she runs the stool test, Dr. Lucterland will do a month of Lifestyle Intervention, so she will often start with the paleo diet
Dr. Angela Lucterland is a Doctor of Chiropractic and a Functional Medicine practitioner with a specialty in treating patients with autoimmune diseases like Hashimoto’s thyroiditis. Her website is AngelaLucterland.com.
Dr. Ben Weitz is available for Functional Nutrition consultations specializing in Functional Gastrointestinal Disorders like IBS/SIBO and Reflux and also specializing in Cardiometabolic Risk Factors like elevated lipids, high blood sugar, and high blood pressure and also weight loss and also athletic performance, as well as sports chiropractic work by calling his Santa Monica office 310-395-3111. Dr. Weitz is also available for video or phone consultations.
Dr. Weitz: Hey, this is Dr. Ben Weitz, host of the Rational Wellness Podcast. I talk to the leading health and nutrition experts and researchers in the field to bring you the latest in cutting edge health information. Subscribe to the Rational Wellness Podcast for weekly updates, and to learn more, check out my website drweitz.com. Thanks for joining me. And let’s jump into the podcast. Hello, Rational Wellness podcasters. Today, I’m excited to have an interview with Dr. Angela Lucterland on Hashimoto’s thyroiditis. Dr. Angela Lucterland is a doctor of chiropractic and a functional medicine practitioner with a specialty of treating patients with autoimmune conditions. Dr. Lucterland, thank you so much for joining us today.
Dr. Lucterland: Thanks for having me.
Dr. Weitz: Great. So before we get into the topic of this discussion, perhaps you can tell us a bit about your journey and how you came from being a chiropractor to getting into functional medicine.
Dr. Lucterland: Yeah, so everyone has a unique journey and mine just happened to be on the way to medical school like a lot of people that wanted to be in healthcare and help individuals. And there was this moment of truly applying to school and deciding to leave where I was like, I don’t want to prescribe meds every day. I don’t know what I’m going to do. I actually thought public health may be an avenue for me. So I joined the Peace Corps. I went to West Africa and did public health initiatives over there. And when I was over there, I had a dear friend of mine that went to college with me that got cancer for the second time. And it’s one of those things where you get that message and then you look around and you’re like, nobody here has an autoimmune disease. Nobody here has cancer. They may die of an infectious disease and lack of antibiotics or trauma or something like that, but it’s a very different world, right? And it started me thinking. And when I went back to the United States, I obviously had a very big road ahead of me to say, “How am I going to influence the health of individuals moving forward?” I’m not in Africa, it’s not an infectious disease problem. It’s a chronic disease problem, basically ruining our quality of life. And I was introduced to a chiropractor and gave he me a book on the philosophy of root cause medicine. And that was the rest of the story.
Dr. Weitz: Great. So that’s before you became a chiropractor or are you-
Dr. Lucterland: Yeah.
Dr. Weitz: Okay.
Dr. Lucterland: Yep. That was between undergrad and then going to my doctorate, I spent some time in Africa and as a chiropractic student, I did clinical rounds in Vietnam for a while. So same thing. We’re going to talk about some thyroid conditions, but you see goiters and stuff when you go to these types of developing countries and what is the intervention over there versus what is the intervention over here? And a lot of it has to do with, what does the lifestyle look like for these people? What are you actually dealing with? And it’s just different in a developed country, for sure.
Dr. Weitz: So you went into chiropractic because you wanted to get into Functional Medicine?
Dr. Lucterland: Always. Yes. And at that time, I mean, now there’s tons of programs and things you can do to get certified, but at that time, chiropractic was probably the most recognized alternative healthcare profession that I was aware of at that time.
Dr. Weitz: Right. Great. So you actually never practiced musculoskeletal-
Dr. Lucterland: I did.
Dr. Weitz: Oh you did. Okay.
Dr. Lucterland: I did. I did for about seven years, I did them both, which that’s tricky. If you can figure out how to do them both, great. But I’ll tell you, when I moved from doing both to just doing functional medicine, I was having some of my old chiropractic patients show up and need functional medicine for things. And I’m like, “Why don’t you tell me about this three years ago?” And they see you as a musculoskeletal doctor many times.
Dr. Weitz: Right.
Dr. Lucterland: Yeah.
Dr. Weitz: Yeah. I’m doing both. I treated 20 chiropractic patients before we did this interview today. So let’s talk about Hashimoto’s thyroiditis.
Dr. Lucterland: Okay.
Dr. Weitz: Who’s Hashimoto?
Dr. Lucterland: I don’t know. I don’t know. It sounds like a-
Dr. Weitz: I think it’s some Japanese scientist, or maybe it’s a town in Japan or something like that. Anyway, it’s the most common autoimmune disease. How do we determine if someone has Hashimoto’s?
Dr. Lucterland: Yeah. So this is a huge deal and I’m sure your audience knows this, but it’s worth repeating. Most, most hypothyroid conditions are actually Hashimoto’s undiagnosed.
Dr. Weitz: Most conditions in the United States. Yes.
Dr. Lucterland: Yeah, yeah.
Dr. Weitz: Maybe like 95%, right?
Dr. Lucterland: Correct. So many people. And I mean, if all I had to do was niche down and do one thing every day for the rest of my life, and I had all the tools available to me, it would be hypothyroidism because this is such a big area with such a big impact for so many people, especially women, especially women who have children, and what happens is conventional medicine is testing TSH. They’re using an abnormal range for what is normal for that. And they’re just saying, “You either are hypothyroid or you’re not,” and prescribing some type of thyroid medication. And when you start to dig further, you realize many times that’s not solving the problem. TSH isn’t thyroid in general. And if you’re not testing the antibodies to the thyroid, you’re completely missing the diagnosis of Hashimoto’s and thyroid medication will not fix Hashimoto’s. So when you think about antibodies being readily identifiable for 10 years prior to enough tissue damage for someone to feel it, we’re missing a huge opportunity to really intervene for these people.
Dr. Weitz: So what do you consider a full thyroid panel?
Dr. Lucterland: So obviously TSH gives you some indication, but then your free T3, free T4, reverse T3, I don’t always run it, but it is a good marker to figure out whether or not someone has inflammation and oxidative stress playing a part in it, TPO antibodies and thyroglobulin antibodies.
Dr. Weitz: Okay, great. So between the TGB and the TPO antibodies, which one of those do you think are more significant and what levels are you looking at that really spark your interest?
Dr. Lucterland: I think just like any lab, I don’t know what is perfect for one person. So I’ve seen people be out of range, but actually be very stable and fine above what would be considered abnormal for both of those antibodies. And I’ve also seen the opposite. So I tend to run the test, identify whether or not they’re in range, couple it with their symptoms, and then I look for patterns in progress. So if they’re feeling better and their antibodies are going down, we know we’re moving the needle, right? So I wouldn’t say that I am super specific to which one matters more than others, I would say most people would probably say TPO in the case of Hashimoto’s, but I’ll tell you, sometimes those are completely normal and the thyroglobulin antibodies are the problem. And if I didn’t run both, I missed it. Right.
Dr. Weitz: Right. So once we find out that somebody has Hashimoto’s what’s the typical form of treatment?
Dr. Lucterland: So-
Dr. Weitz: And let’s start with a patient who has some of the symptoms of hypothyroid and what, by the way, when it comes to TSH, what do you consider the optimal range? Or what do you consider to be out of range that would warrant potentially taking thyroid medication? Because there’s a lot of controversy over what the TSH range should be like 2.5, I mean, 0.5 to 3.5 to 2.5 to 4 to 4.5, it’s all this controversy over what’s considered the normal range.
Dr. Lucterland: Right. And again, the person in front of you is going to give view an idea of how they feel, which you can never discount that. I will say sometimes I have people that their TSH is higher than I would like to see it. And they’re telling me that they feel normal. Now, TSH fluctuates constantly. So just like a lipid panel, you got to take that into consideration. If you do have an abnormal reading, which I would consider anything above 2.5 to be abnormal, however, people usually feel their best 2 or less, obviously not too low, but for Hashimoto’s, I would say anything above 2, 2.5 would be my upper limit. And if they’re not telling you that they feel bad and they’re actually above that, if you ran it again, you may find that it’s a fluctuation. So sometimes if that’s not correlating with one another, I will rerun the test.
Dr. Weitz: Right.
Dr. Lucterland: And I have to say this, because I think sometimes educated people, especially now that you can do lab testing on your own in many regards or doctors that are unaware, if we’re giving our patients supplements with biotin or B vitamins, so your prenatal, your multis, your B complex, because they’re tired, all of this stuff, something for their hair because it’s been falling out, it impacts not the actual thyroid function, but it impacts the testing assay. So it will give you abnormal readings if they’re on biotin. So I usually tell people don’t take any supplements for like a week before you run your labs, just to make sure that the labs that we’re getting are accurate to your physiology and there’s not any interventions with the assay.
Dr. Weitz: Yeah. I’m aware of that, but it’s not clear to me, do we know exactly which tasks are impacted by biotin and which labs, is it any lab that’s running thyroid? Or is it just a certain methodologies that…
Dr. Lucterland: That’d be a great question for the labs to answer, but my understanding is it’s TSH pretty much across the board.
Dr. Weitz: Okay. And do we know if they’re taking biotin, would the TSH go up or down?
Dr. Lucterland: I think it goes up. It goes up.
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Dr. Weitz: When it comes to patients who need thyroid medication, do you have an opinion about what’s the best type of medication that typically works?
Dr. Lucterland: I do. It’s a little bit biased just from my own clinical experience, but I feel like a marriage between T3, T4, like an Armor or Nature-Throid is usually what people feel-
Dr. Weitz: A natural thyroid. Right.
Dr. Lucterland: Yes. However, if somebody doesn’t have conversion issues like in their liver, if that’s all working great and they don’t have high levels of inflammation and they have nutrients, sufficiency of vitamin A and iron and all of that stuff, they may do okay with something like synthroid or levothyroxine. I just find that most people feel the best if they have a little bit of T3 in there. Now if it sends them into palpitations and sweating and whatever, then you know, okay. Maybe you’re a different one.
Dr. Weitz: And by the way, these natural formulations like Armour or the other formulations Westhroid, et cetera, they not only have T4 with some T3, there’s some T2, some T1, there’s some other nutrients in there that may be beneficial as well.
Dr. Lucterland: Yeah. I think as natural as possible, right? And I heard someone say this and I wish I could remember who it was so I could give them credit, but I did think it was a good analogy for people to think about. Like when we think about taking medication for cholesterol or something like that, we’re really taking a medication that’s blunting something or changing the physiological process of creation or something like that. But with thyroid, it’s sort of like taking vitamin D in the sense that you are supplementing something you don’t have enough of, but you’re not really interfering with physiology. So they can be a good adjunctive intervention, while you’re are trying to clear up immune system dysfunction. I mean, with Hashimoto’s, you’re really trying to address the immune system, but it’s sort of like giving them a natural thyroid medication in the meantime, until we can get theirs fixed and the immune system quit attacking it and all of that kind of stuff, it’s really not doing any harm long-term.
Dr. Weitz: Right. Okay. So besides giving them thyroid medication, what are the other important things we want to do to help effectively manage patients with Hashimoto’s thyroiditis?
Dr. Lucterland: I would say it’s not specific to Hashimoto’s, it’s just pretty much any autoimmune disease that you have. You need to restore barrier function and restore self tolerance. There’s two things you need to think about when you’re doing that. One is the removal of any toxicity, which could be something like environmental toxins, pathogens, something we call PAMPs, pattern recognition receptors will go crazy over those molecular patterns, but then also creating sufficiency. So this is where diet becomes such a big deal. If you don’t even have the building blocks to create the hormones or to be the co-factors for the enzymes to convert them and all of that, then you’re really never going to get anywhere. So sufficiency, removal of toxicity in order to restore barrier function and self tolerance in my opinion have been the two biggest things. I have a couple other opinions too, but those are big.
Dr. Weitz: Okay. So why don’t we start with barrier function? What are you talking about?
Dr. Lucterland: So I love comprehensive stool analyses for this. However, I would say that comprehensive stool analyses are really just about a 20% snapshot of accuracy of that actual microbiome of what’s going on, but it does give me markers that always change. And I’m big on like trying to predict, oh, I think this person has this or that. Wrong. And I’ll tell you every single time I run one, I do something a little bit different than if I hadn’t run it. So for me, it gives me information, whether it be a pathogen or an imbalance in the microbiome or digestive issues, eosinophil protein X, or secretory IGA or something like that gives me some type of information. Even beta glucuronidase is a big deal, right? You can run zonulin on a comprehensive stool analysis. So I do it, I will say though, I don’t love it. It’s another marker that fluctuates constantly, and I feel like it doesn’t always correlate to what I already know.
Dr. Weitz: By the way, for those who don’t know, zonulin is a marker for leaky gut. And so, barrier function, you’re referring to leaky gut, you’re referring to hyper permeability of the intestinal tract.
Dr. Lucterland: Exactly. So your cell lining in your gut is one cells thick and they touch each other. And for them to open up and let appropriate nutrients through and whatnot, zonulin regulates that opening. Now, I will tell you, some leaky gut or permeability is completely independent of zonulin. So you can have things just go straight through an enterocyte as well. So there are pitfalls to running zonulin, and I would say the gold standard, if you’re really looking at barrier function or tight junction structures, you would run something like antibodies, maybe to LPS. So LPS is lipopolysaccharides, which is a portion of a gram negative bacteria wall. Now, the reason that’s important is because it happens to be probably, I hate to say definitives, but one of the most immune stimulating compounds that exists, sometimes they add it to vaccines and whatnot as an adjuvant, we give it to rats to study autoimmune disease in them. So it is a potent immune stimulator and it’s very big. So when you-
Dr. Weitz: Is that a test that you run?
Dr. Lucterland: I don’t do a ton of it. This is why I’m saying, if I make the assumption that anybody that I have identified as an autoimmune patient has lost barrier function. If someone-
Dr. Weitz: Meaning, i.e., they have leaky gut.
Dr. Lucterland: Yes. If somebody wants to have more definitive markers around that, I would say run something with antibodies against actin, myosin, all of the tight junction structures and potentially antibodies to LPS. That will tell you. LPS should never be in the bloodstream. So if you’re seeing antibodies to LPS, you know a huge molecule has gotten through these tight junctions, even in a leaky scenario. I mean, it’s huge. So that’s very definitive, but for me, I’m making that assumption with autoimmune patients that that’s the case, because that’s how the inappropriate immune response of self tolerance has happened.
Dr. Weitz: Who offers antibodies to LPS?
Dr. Lucterland: I believe Vibrant does, Cyrex does. And for Cyrex, it’s array 2. I think it’s the Wheat Zoomer, Gut Zoomer with Vibrant.
Dr. Weitz: Okay.
Dr. Lucterland: Yeah. So I think gut testing is my favorite. If all I did though-
Dr. Weitz: And what’s your favorite gut test or stool test?
Dr. Lucterland: I like the comprehensive stool analysis, the GI Effects from Genova. And like I said, it’s because it gives me a good picture of tons of things that I can intervene on. Everything from digestion to inflammation to potential pathogens, not just confirming leaky gut.
Dr. Weitz: Right. I tend to use the GI Map.
Dr. Lucterland: Okay. Yeah. People really like that too.
Dr. Weitz: Similar. Okay. So-
Dr. Lucterland: Although does that one have beta glucuronidase?
Dr. Weitz: Yes.
Dr. Lucterland: Okay. Did they add that?
Dr. Weitz: It’s been available for at least several years.
Dr. Lucterland: Okay. Okay.
Dr. Weitz: Yeah.
Dr. Lucterland: Yeah.
Dr. Weitz: So we’re looking at leaky gut. We’re going to do a stool test, try to improve the health in a microbiome, try to shore up the leaky gut. So we’re going to use some protocols there. What else do we want to do to try to intervene to the underlying potential root causes of this autoimmune condition?
Dr. Lucterland: I would say before I even run a stool test, I do a good month of lifestyle intervention. And the reason I do that is because it’s sort of like in the musculo-skeletal world, if you hurt your back from deadlifting or something like that, you can’t just go back the next hour and do more deadlifts to an injured back. You have to remove the offender or the trigger. And for many people, a chronic source of immune trigger is dietary proteins or inflammatory compounds or toxins in their food. So there’s got to be, in my opinion, an overhaul that gets me at least to a foundational set point where when I run a stool test now, which changes in the matter of 24 hours, when you eat something different, right? I want it to tell me what’s happening in you when you’re already eating appropriate things. I don’t want to know what your microbiome is when you’re eating crap. I already know it’s crap. You know what I’m saying?
Dr. Lucterland: I want you to take away some of the triggers and start to eat some nutritious and healthy food. And then we’ll take a picture of what your microbiome’s doing, because literally within 24 hours, you can change your microbiome just by changing what you eat.
Dr. Weitz: So how do you decide for each person what’s the best diet?
Dr. Lucterland: I always start with a paleo diet. I’m partial to that simply because the removal of gluten and dairy and just processed foods in general, many people have heard of the Whole30. That’s another really great one with tons of resources if you’re looking for just like a programatized thing to do and it’s doable, right? When I first started doing this, it wasn’t common for there to be gluten free foods in the aisles and all these cookbooks and things like that, but it was doable to say, just eat meat, vegetables and fruits, nuts and seeds. That’s it. Like, that’s all you got to eat. When you get more intricate into the AIP or the autoimmune protocol, it’s a more strict version of that. I will say in Hashimoto’s I don’t like people to go super low carb because thyroid function does somewhat rely on carb thresholds, the conversion of T4 to T3 does.
So I find that when people go super low carbs, so that’s one adjustment I sometimes make, but that’s a good standard one. Now, if we were talking about Crohn’s today or ulcerative colitis, I would choose a different one just because the nature of where it’s occurring. But for Hashimoto’s and most thyroid or most autoimmune disease, I would say paleo is a good start.
Dr. Weitz: Some people recommend avoiding certain foods that are called goiterogens.
Dr. Lucterland: Yeah. I don’t subscribe to that. So I’ve been doing it a long time and I know it was something that was thrown around in the media for a while and then people got really scared about eating broccoli and cauliflower or broccoli sprouts. And quite frankly, I think it’s been disproven quite a few times, but I just never saw it clinically being an issue either. And if it was, I mean, you would have to just eat so much. It’s ridiculous. And there’s too much benefit to having sulfur compounds and raising glutathione status and things like that that I just, sulforaphane, I just wouldn’t have people stop eating those.
Dr. Weitz: What do you find are the most common food sensitivities that trigger Hashimoto’s?
Dr. Lucterland: I don’t love food sensitivity testing, simply because if you have a leaky gut, you’re going to come back with 50, 100 foods. So that maybe that’s the poor man’s version of a leaky gut test, right? If that’s what you run. And you’re like, “Oh my gosh, I got to avoid all these things.” It’s really not that you’re sensitive or allergic to all these things. It’s more of an indicator that tons of food proteins have actually gotten into the bloodstream where they should have never been in the first place and your body responds appropriately and says, “Hey, you shouldn’t be here. Let’s make an antibody.”
Dr. Weitz: So fix the leaky gut.
Dr. Lucterland: Fix the leaky gut and you fix the food sensitivities. The ones that never really go away though often, which this is where people have the question, is this a lifelong diet for me or whatnot? I would say, if you have an autoimmune disease, you should probably avoid gluten and dairy forever. And I’m just saying that because if you don’t, then you could have a relapse or a flare. I mean, you already have susceptibility to that in your genetics, and once you’ve started the roller coaster, sometimes you’re on it. And while it can be managed, it’s just one thing that why would you introduce a trigger?
Dr. Weitz: You mentioned, when we were talking off air before we got started, that you often find certain chronic infections to be triggers for Hashimoto’s. Can you talk about that?
Dr. Lucterland: Yeah. I love the idea of molecular mimicry, which is just really an amino acid sequence, where there’s only, like what? 20 amino acids to choose from. When you think about molecular mimicry and amino acid sequences, they can overlap between food, our own tissues, infectious agents, like bacteria, viruses, et cetera. And so I know that there’s known overlap with some specific organisms, but I don’t think we’re there yet to be saying that these infections mean this is a likelihood. I know H. Pylori is a common one that people talk about, but I would say any infection in general is a driver of immune response and addressing any infection is going to be good practice just for inflammation levels and everything.
Dr. Weitz: Do you do any testing when you suspect there might be an underlying infection, either test for infections or test for antibodies to infections?
Dr. Lucterland: I do run testing. Sometimes I find potential pathogens within the GI tract. So that’s on a comprehensive stool analysis. Sometimes I run antibodies or titers for things like Epstein–Barr, obviously H. Pylori is something a little bit different too, but you can do that a million different ways. Sometimes antibodies are tough because it means you have immune memory of something doesn’t mean activity currently.
Dr. Weitz: Right.
Dr. Lucterland: Right? So.
Dr. Weitz: If you find some evidence of some chronic infections that you think might be playing a role as triggers for their autoimmune condition, how will you typically address these?
Dr. Lucterland: So if it’s bacteria or virus or potentially a parasite or a fungus, you use a little bit different compounds. In the world of natural medicine, a lot of antimicrobial compounds are antimicrobial to all of those things. So it can be an easy choice to use things like, goldenseal and uva ursi and berberine and that sort of thing.
Dr. Weitz: Okay.
Dr. Lucterland: But if you’re using a pharmaceutical, then obviously you’ve got to make a decision based on the type of pathogen, right? I’ve even used phages. I don’t know how much you’ve used phages in practice.
Dr. Weitz: I did a few years ago, but I kind of fell out of it. You like those phages?
Dr. Lucterland: I do sometimes, when you find gut pathogens. It was the original antibiotic, right? You have to have a specific phage for a specific infection. So it doesn’t have quite broad [spoff 00:26:34] like an antimicrobial agent, like thyme, oregano or something would, but they can be helpful.
Dr. Weitz: So which particular products are you using?
Dr. Lucterland: Oh, wow. So I love Candicid Forte as an antimicrobial in general. Obviously the name suggests that it would be antifungal, but I do really like that nutrient profile as an antimicrobial. Ortho Molecular has another one called Paracid Forte. So that’s a really a mixture of antiparasitics. And they have a product called Intestin-ol too, which is a combo of thyme, oregano and one other essential oil, which if someone has recurring or chronic infections, sometimes there’s a biofilm component to that. And if you don’t sort of get through the biofilm when you’re treating, then they can have these quiescent cells there at the bottom, but then just kind of reinfect in its new cycle. So I do like those products. I use one actually from Body Ecology called EcoPhage for the phages personally, but those are some I like.
Dr. Weitz: Does that-
Dr. Lucterland: Biocidin is always a good one.
Dr. Weitz: … Does that have more than one phase or?
Dr. Lucterland: Yes. Has four, I think.
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Dr. Weitz: What about environmental chemicals, like BPA or heavy metals? Do you find that these are sometimes triggers for Hashimoto’s?
Dr. Lucterland: So I care about all kinds of toxins for various reasons, but I would say I’m a super stickler for things that compete for binding with iodine and things of that nature. So things like fluoride is a big one, and you can find fluoride in tons of things, not just toothpaste or at the dentist, it could be in your water, it could be in black tea, it could be in medications. I mean, there’s a laundry list of medications that actually have fluoride on them, which is crazy, but that type of thing is important to address.
Dr. Weitz: Yes. Certain antibiotics and et cetera.
Dr. Lucterland: Yeah.
Dr. Weitz: So the reason why you’re concerned about fluoride is because it’s in a category of substances known as halogens, which also includes bromine and chlorine. And all these substances compete with iodine, which is a necessary ingredient for thyroid hormone.
Dr. Lucterland: Exactly. And so this is where it starts to become a large topic. And when people hear it all and they’re unfamiliar, they go, “Oh my God. Well, what do I focus on the most? Like, what’s the most important.” And I always say, “The one that’s causing you the problem.” And it’s impossible to know until you try to get yourself at a reset. Now, if you tell me you never use fluoride, you have your water filtered and you don’t go in chlorinated pools and whatever, well, then we can rule maybe that being a huge deal for you. But the one that matters the most is the one that’s causing you your problem. So you’ve got to kind of go down the laundry list with them. What are your hormones like? What’s your stress like? What’s your diet like? Do you have infections? What’s your [nuity 00:31:14] product regimen? What’s your environment? And you have to kind of then hone in on the areas that they are telling you have a bunch of red flags.
Dr. Weitz: Right. So what do you think about iodine for patients with Hashimoto’s?
Dr. Lucterland: Way to be controversial. I go both ways. Sometimes I find that it doesn’t matter at all really in the presence of selenium. And I don’t notice that it causes any abnormal or deleterious impact in my patient. And sometimes it does. And if it does, then we avoid it. Although I’m not shy about using it in the beginning, I guess.
Dr. Weitz: You’re talking about typical dosages, like 100, 200-
Dr. Lucterland: Yes. I wouldn’t mega dose. I would not mega dose. Yes. But just typical, like 200 micrograms in the presence of adequate selenium. Lots of times, I see people okay with that.
Dr. Weitz: Right, yeah. I actually have some Hashimoto’s and never had any thyroid symptoms. And I tried to high dose iodine and it’s… For several years, my TSH was like seven or eight and then one year it went up to nine. So I decided to try to high dose iodine. It went up to 25, so.
Dr. Lucterland: Wow.
Dr. Weitz: So I stopped the high dose iodine, bumped up my selenium, my vitamin D, my zinc and did some gut work. And I got it down to 4.5, but I tried the 12.5 milligram iodine, because some people claim that might be beneficial. I never recommended it to patients and I never will.
Dr. Lucterland: Right. Yeah. No, that is probably a no for me, but-
Dr. Weitz: I always like to try everything on myself first.
Dr. Lucterland: Me too. And I get a bunch of flack for that because it’s like, “Well, you don’t fit the patient demographic.” I said, “I know,” but what I wouldn’t do for myself, I wouldn’t do for anyone else. And N equals one means N could equal many, for many people. So something’s really great, and this is where the art of medicine comes in. You’re not going to have the perfect protocol, you’re not going to have the perfect person telling you the exact thing that works for everyone. It just doesn’t work like that. So people have to be willing to work with their doctor and the doctor has to be willing to experiment, when something isn’t working, with options.
Dr. Weitz: What other nutritional supplements have you found to be helpful for Hashimoto’s patients?
Dr. Lucterland: Well, they mostly focus on either restoring gut barrier function. So that’s a lot of the things you hear about probiotics, glutamine, immunoglobulin. So as I mentioned, LPS is one of the most potent immune stimulator. And If you’ve got leaky gut to the point where LPS is turning it on, just binding LPS in the gut lumen with something called serum-derived bovine immunoglobulins can have a profound effect on allowing that patient’s immune system at the barrier to just settle down enough to heal.
Dr. Weitz: So SBI Protect?
Dr. Lucterland: I like SBI Protect. Yep. And so that’s sort of like a borrowed immune system in the same way colostrum is, but there’s no dairy to it. So if these people are trying to avoid dairy for the immunogenic effects we spoke about, then using a serum-derived version of that. And the binding capacity studies show that it binds to way more than LPS, right? If toxins, H. Pylori, tons of different components. So it can be a safety net for people. So that type of intervention with gut healing. And then the one that I find that many people overlook, at least when I’m working with clinicians is mitochondrial support. So mitochondria are integral in immune function and even T-cell differentiation or how you see a pathogen and respond to it. And then whatever you tell your T-cells to turn into, are they turning into TH1 or TH17 or whatever. All that to happen appropriately requires mitochondrial function. T-cell surveillance requires mitochondrial function. So if you’re not supporting the mitochondria and filling up metabolic reserves for them to do their job, then I feel like you kind of maybe miss some of the modulating impact that they-
Dr. Weitz: So what are some of the key nutrients for mitochondrial support? Obviously we have CoQ10.
Dr. Lucterland: CoQ10. I would say ALA, acetyl-l-carnitine, because that shuttles the free fatty acids in for use, and acetylcysteine, which we all know more about that now that we ever imagined we needed to, but those are important. I was going to-
Dr. Weitz: Actually NAC seems to be… I think if we have a nutrient of the year, maybe zinc is the nutrient of the year, but other than that, NAC, it’s amazing how many benefits NAC has.
Dr. Lucterland: Yes.
Dr. Weitz: And yet apparently the FDA is considering taking it off the market.
Dr. Lucterland: They’ve been saying that stuff forever. I don’t buy it. I mean, I know some people have taken it off of their selling platforms out of fear, but until there’s a letter, I don’t, a real letter, I don’t see it, but. Well, yes-
Dr. Weitz: Well actually, if we could figure out how that happened, we should do that with all the nutrients. I’d be happy if Amazon stop selling everything.
Dr. Lucterland: Right? That happened because, do you want to know how it happened? So somebody was selling it for hangovers. Well, in the supplement world, you can’t use a structure function claim that says it’s a drug that treats something. So they got in trouble for saying that it treated something. And that caused them to send a letter. And the letter then trickled into anyone selling it for drug related purposes will be shut down and whatever. And obviously the platforms have a lot invested in people purchasing through them. And so they was like, “No one sells NAC now.” But really it came from somebody saying it treats hangovers.
Dr. Weitz: But apparently the information I’m getting now is that the FDA has reviewed NAC and they’re saying that it was approved as a drug. The supplement industry need to prove that it was in common usage prior to that approval use as a drug. Otherwise, it’s going to be taken off the market and only used under prescription.
Dr. Lucterland: Yeah. And that’s the game, right? How much has something been used before you altered it a little bit or used it as a drug? Are you going to say the same thing about fish oil, now that SLSs can be sold as a prescription?
Dr. Weitz: Well, there are certain vested interests that would be very happy to have all those nutritional supplements taken off the market and only sold as prescription drugs.
Dr. Lucterland: Right. And until then, they can tell everyone that they don’t work.
Dr. Weitz: Yes.
Dr. Lucterland: So yeah. I think-
Dr. Weitz: When’s the next JAMA article that’s going to tell us how vitamin D, fish oil and magnesium are all bad for you?
Dr. Lucterland: Yeah. But so from mitochondrial perspective, I do think NAC, ALA and acetyl-l-carnitine as high dose as a trio. I don’t know if you’re familiar with Dr. Kaiser’s work. He used to work with HIV patients and he was trying to figure out how to restore CD4, CD8 counts in them. And he used a dosing of those big nutrients. There was another set of nutrients that were just foundationally-
Dr. Weitz: Right. Did hear about this. Yeah.
Dr. Lucterland: Yes. And within 12 weeks, he was able to restore immune markers through this mitochondrial cocktail, if you will. I actually think it was covered by insurance in some states because it was so successful.
Dr. Weitz: Wow.
Dr. Lucterland: Yeah. So-
Dr. Weitz: And what do you think about selenium for hypothyroid, specifically Hashimoto’s?
Dr. Lucterland: I think that’s a no brainer. And I think people should start asking like, I can always supplement with something, but where do I find these things in nature? Because when you find them in nature, you get added benefits, right? So if I tell you to take a selenium supplement, that’s fine. But I don’t then get the added benefit of certain fatty acids within Brazil nuts, I don’t get the additional nutrients that are in there. And if you get calories in your body that also come along with these nutrients you need, then it’s cheaper. And I have never claimed to be smarter than nature. Like, I’m sure there’s a ton of things that we don’t know yet that works synergistically together. And I bet you, we find out they’re packaged in foods together. So I always encourage patients that if we’re going to talk about you getting iron or selenium or whatever, we’re going to talk about, where can you get these in your diet? And we’ll supplement as needed. But think about that first always.
Dr. Weitz: Yeah. My approach is to try to do both. And the reason I want to do both is I want to cover my bases, I want to get all those other nutrients we don’t know about that are say found in Brazil nuts, go along with the selenium, and I’m definitely a big believer that food is the best way to go. But the problem with Brazil nuts is any given Brazil nut could have this much or this much or more or less, or you have a handful and now maybe you’ve got a really high dosage or maybe you’ve got a low dosage in this particular sample because of where they were grown. So I’m going to typically recommend a modest dosage by supplementation, because that way I know we’re getting a specific form and a specific dosage that’s going to guarantee that person’s at least getting a minimal amount and then also recommend food sources, like say, for selenium, Brazil nuts.
Dr. Lucterland: Exactly. And I think that’s a good approach. It’s a good approach with anything, especially if you’re trying to replete something, you’re not going to get enough in food to replete something in any type of fast rate at all, but it is good for the patient to remember where do these things come from and what can I do? What do I have control over that can help support that?
Dr. Weitz: Absolutely. Are you familiar with the group out of Brazil that has shown that using infrared laser over the thyroid causes positive changes in thyroid tissue for patients with Hashimoto’s?
Dr. Lucterland: I’m not. But it wouldn’t surprise me. Do you use laser in your clinic?
Dr. Weitz: We do.
Dr. Lucterland: Okay. So, chiropractors and body work people have been using lasers to improve cellular function in tissues for a really long time. So it doesn’t surprise me. Same thing with infrared saunas and just the ability to have red light or whatever, all of the things that the biohackers do these days have some cellular impact that… But even yoga in inversions. So bathing the thyroid with blood when you’re upside down is oxygenating. Is it going to cure your Hashimoto’s? No, but there’s a ton of things built into healthy practices that are beneficial.
Dr. Weitz: That’s great. So any final thoughts you want to leave the listeners with about Hashimoto’s or your approach to treating thyroid conditions?
Dr. Lucterland: I would just say that if you are not feeling right, listen to yourself and get a full thyroid panel, first and foremost. From there, find a functional medicine doctor, because a functional medicine doctor is going to help you navigate which areas to focus on and help you fix your lifestyle factors in conjunction with some of the ancillary things that you can do to make yourself feel better in the meantime, like potentially a medication or a supplement that could boost thyroid function, et cetera, but functional medicine is where it’s at with autoimmunity, in my opinion, because you’re not going to find someone that’s looking at all of those things and actually uncovering and peeling back the onion, unless you are working with someone who takes that approach.
Dr. Weitz: Absolutely. And this is not a knock on conventional medical doctors, but since you’re not essentially dealing with lifestyle and diet and the things that we deal with in the functional medicine world, they don’t really have the tools to deal with these underlying triggers for autoimmune disease. So if you see a conventional doctor, they’re going to most likely supplement you with thyroid medication, which may make you feel better. And however, at the same time, it’s important to have, in my opinion, a functional medicine practitioner who can help you deal with the underlying triggers for this autoimmune condition. Because if all you do is add thyroid medication, you’re not dealing with this underlying autoimmune condition that is leading to your immune system attacking your own tissues. And over time, the likelihood is that more of the thyroid gland in this case will end up being damaged, destroyed, and you may need more thyroid medication, you may end up with another autoimmune condition. Statistically, if you have one autoimmune condition, you’re much more likely to have another. So I think most patients would be well suited to have a conventional doctor and also have a functional medicine practitioner who can help them deal with the underlying causes. And they think that way everybody will get the best of both.
Dr. Lucterland: Absolutely. And I tell everybody the same thing, don’t give up your conventional doctor, because I’ve had so many patients that once they’re autoimmune disease, whether it be their gastroenterologist for Crohn’s or the rheumatologist for RA or whatever, see what’s possible, then they start going, “Wow, what did you do?” And they start learning. And then all of their patients in the future benefit from the journey that you were on. So I love having both parties.
Dr. Weitz: And patients know that most of the time you’re going to do better doing both, just because you see a functional medicine practitioner who takes you off of gluten and dairy and does some of these other natural things, that doesn’t mean you want to stop your thyroid medication.
Dr. Lucterland: Right. Yep.
Dr. Weitz: So great. So how can listeners, viewers find out more about you and your program?
Dr. Lucterland: So you can find me on Instagram or Facebook, Dr. Angela Lucterland is the handle in both of those. I do have a blog which has articles and sort of functions like a website and whatnot. But I might say those are probably the easiest ways to get ahold of me. So if you Google Dr. Angela Lucterland, it’ll pop up. There’s probably years and years worth of posts. I don’t even want to Google myself.
Dr. Weitz: Thank you, Angela. And when I post this in about three weeks, I’ll send you links that you can share with your followers.
Dr. Lucterland: Okay. Perfect.
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