Hypothyroid with Dr. Mona Morstein: Rational Wellness Podcast 250
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Dr. Mona Morstein discusses Hypothyroidism with Dr. Ben Weitz.
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3:20 Autoimmune diseases like Hashimoto’s thyroiditis, the most common form of hypothyroid in the US, are more common in women. This may be because estrogen tends to stimulate the immune system, which is also why estrogen levels tend to be suppressed during pregnancy, so that the immune system is down regulated during pregnancy so that the mother’s immune system will not attack the baby as a foreign substance. For this reason, some women will have their autoimmune condition go into remission during pregnancy.
5:15 Lab Testing for Thyroid. 1. TSH–this is the signal from the pituitary to the thyroid to make more thyroid hormone. 2. Free T4. 97% of what the thyroid produces is T4, which the cells of the body can convert into T3 as needed. Free T4 is more important to look at than Total T4, since only the free hormones are active in the body. 3. Free T3. 4. TPO antibodies 5. TGB antibodies. For some reason, some doctors are only ordering TPO and not TGB antibodies, but you need to order both. Reverse T3 should not be run most of the time because many things can elevate reverse T3, including too much thyroid hormone, depression, infection, illness, heart failure, eating too few calories, medications, including Metformin, birth control pills, and beta blockers.
13:37 Thyroid binding globulin could be a valuable lab if you look at both total T4 and free T4 and total T3 and free T3 and want to see if the free thyroid hormone is low is it because you need more thyroid or could too much be getting bound?
15:20 You should avoid taking supplemental biotin, such as in a multivitamin or a hair formula or a B complex, for 24 hours before running your thyroid labs, since the machines that run the tests use biotin in the process.
16:35 It is also best to run the thyroid labs fasting and not take thyroid medication till after drawing the blood.
19:25 TSH level controversy. The American Academy of Clinical Endocrinologists has set the normal range of TSH at .4 to 4.5 mlU/L, whereas the National Academy of Clinical Biochemists has set the upper limit of TSH at 2.5, since 95% of people with zero thyroid disease have a TSH of less than 2.5.
23:29 Subclinical hypothyroid. This is when you have an elevated TSH but free T3 and free T4 are within the normal range. Before considering placing such patients on thyroid medication, we should try to heal their thyroid.
26:32 We need to investigate some of the possible causes of Hashimoto’s with detailed history taking and specific labs. There are specific nutrients that affect thyroid regulation. There are heavy metals that affect the thyroid. There can be food sensitivities. There can be microbiome imbalances. Infections can lead to inflammatory reactions and Yersinia is an infection found in the gut that is associated with autoimmunity with the thyroid, so doing a stool panel is a good idea. And ask your patient to fill out a diet diary for a week.
30:26 Iodine. Iodine is very controversial with some doctors claiming that most patients with hypothyroid need much larger dosages of iodine and other research that indicates that patients with Hashimoto’s should not take iodine. If we look back in history we see that in the US and many other countries we used to have a lot of people with enlarged thyroids known as goiters. In fact, an area of the country was known as the goiter belt, which was a region across the midwest of the US where goiter was very common because soil in those states had lower levels of iodine and those people had lower intake of iodine. Then we added iodine to the salt supply and we saw levels of goiter drop precipitously and levels of autoimmune thyroid (Hashimoto’s) rise precipitously. On the other hand, many people have moved away from using iodized salt and have switched to sea salt and Himalayan pink salt and we do know that iodine is crucial for thyroid hormone production. But Dr. Morstein does not find that patients with hypothyroid do well with taking higher dosages of iodine, such as the 12.5 mg Iodoral product on the market. Some Functional Medicine doctors were using an iodine loading test where patients consumed a 50 mg loading dose followed by a urine test and expecting 95% of it to be present, but this is a stupid test because humans are not designed to absorb such a large dose of iodine at one time. Unfortunately, we do not have an accurate way to test iodine status at this time.
39:55 Halogens. There is a row in the periodic table of elements that contains Flourine/flouride, Chlorine/chloride, Bromine/bromide, and Iodine and Flourine, Chlorine, and Bromide can all compete with Iodine and cause an Iodine deficiency. Flouride is often added to drinking water and in many toothpastes, while chlorine is also often added to drinking water, found in bleach, and chloride is in salt as sodium chloride. Bromide is often added to bread and other packaged products such as almond milk as a preservative. We should drink filtered water and use filters on our showers.
42:05 Foods. Rather than take certain foods out of the diet that might negatively interact with thyroid, such as gluten or dairy or soy, Dr. Morstein believes in doing food sensitivity testing and she likes to use Alletess testing and taking all of those foods out that test positive for one to two months or so and build up the gut and then when they start feeling better you start putting these foods back one at a time. No one should be taken off eating gluten without first testing if they have celiac disease, but unfortunately this is done a lot. If they have celiac disease, then they should avoid gluten more intensely. And there is this triangle connection between celiac and Hashimoto’s and type I diabetes. There have been a lot of trials on soy and thyroid and Dr. Morstein does not think that you should live on soy and eat crappy soy like soy turkey and soy hot dogs, etc. But there is nothing wrong with eating some good organic soy tofu a couple of times per week. And there is also nothing wrong with eating vegetables from the brassica family, like cabbage, cauliflower, broccoli, radish, kale, esp. if they are cooked. They don’t seem to be a problem for thyroid, despite them being labeled goiterogens. There is a case of a 88 year old woman who ate two pounds of raw bok choy every day for months and wound up in huge hypothyroid crisis.
Dr. Mona Morstein is a Naturopathic Doctor who practices at Arizona Medical Solutions in Tempe, Arizona. Dr. Morstein: has a practice focus on treating patients with autoimmune diseases, hormonal conditions, diabetes, thyroid, and gastrointestinal disorders like SIBO and IBS. She is the author of the best-selling book Master Your Diabetes: A Comprehensive, Integrative Approach for Both Type I and Type II Diabetes and she lectures frequently at medical conferences. Her website is azimsolutions.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 be discussing Hashimoto’s hypothyroid with Dr. Mona Morstein. Dr. Mona Morstein is a naturopathic doctor in Tempe, Arizona. She’s practicing functional medicine at her clinic, the Arizona Integrative Medical Solutions, with focus on treating patients with autoimmune diseases, hormonal conditions, diabetes, thyroid, and gastrointestinal disorders like SIBO and IBS. She’s the author of the bestselling book, Master Your Diabetes, and she lectures frequently at medical conferences.
Our topic for today is Hashimoto’s thyroiditis, which is an autoimmune disease in which thyroid cells are destroyed via cell and antibody-mediated immune processes. It’s the most common cause of hypothyroidism in the U.S. and other advanced countries that supplement the population with iodized salt, while in developing countries, the most common cause of hypothyroid is the lack of iodine. Hypothyroid or low thyroid is when the thyroid gland is sluggish and not functioning as well as it should. On lab tests we’ll typically see TSH levels go up and T3 and T4 levels go down. And this can result in a number of symptoms, including fatigue, sensitivity to cold, constipation, dry skin, muscle pain, depression, irregular or excessive menstrual bleeding, memory and brain fog problems, high cholesterol, hair loss, brittle nails, weight gain, and a number of others. The conventional medical approach is to simply prescribe thyroid medication. Whereas in the functional medicine world, we want to address the underlying autoimmune condition as well as help to normalize the thyroid function with appropriate medication and nutritional supplements. But there are lots of controversies with respect to Hashimoto’s, including the significance of the level of antibodies, the proper range of TSH, which other test’s the most appropriate to run and monitor, whether to use natural versus synthetic thyroid, whether to use T3 as well as T4, whether to increase our intake of iodine or to restrict it, the role of gut health in regulating thyroid function, whether gluten or dairy or soy negatively affect thyroid function, and whether eating broccoli is bad for your thyroid among other issues that Dr. Morstein: is here to help sort out. Dr. Morstein:, thank you so much for joining us.
Dr. Morstein: Thank you. Thank you, Dr. Weitz. Thank you.
Dr. Weitz: Okay. So Hashimoto’s is an autoimmune disease and we know it’s much more common in women. Do we know why autoimmune diseases are more common in women than men?
Dr. Morstein: Well, many autoimmune diseases are more common in women than men. There are ideas of estrogen leading to them. For example, many women with some of the musculoskeletal autoimmune diseases actually can get into a remission during their pregnancy and then after their pregnancy, their condition can reaffirm itself. So obviously that’s one of the most interesting aspects is the estrogen connection, since men don’t really have that to any substantial extent outside of insulin resistance or something like that.
Dr. Weitz: And we think that that probably has something to do with some level of… Not dysregulation, down regulating over immune system that occurs during pregnancy so that the mother is less likely to reject the baby as a foreign substance, right?
Dr. Morstein: So the main estrogen during pregnancy is estriol, which is a little weaker than the estradiol and estrone that is going to be needed and generally higher during the cycling. And yes, there is also the idea that there is this fetus in the woman and the immune system has to not reject that fetus as something foreign. And then that may trickle over to settling down the immune system in other manners, less inflammation and less attacking itself in other ways it might naturally be doing.
Dr. Weitz: So what are some of the most important lab tests to look at for diagnosing Hashimoto’s hypothyroid?
Dr. Morstein: Well, to start with, basically TSH, thyroid stimulating hormone, which comes from the pituitary and stimulates the thyroid to make its hormones such as T4. Now, around 97% of what the thyroid produces is T4, just because T3 is so strong that the thyroid says, “I’m going to make T4 and then the rest of you cells in the body, the intestine cells, the liver cells, all these cells, you decide how much T3 needs to be converted to run all of your cells.” So there is levels of total T4, but the most important one is free T4. Total means T4 that’s bound and then that’s free. And the only hormones that are active are the free ones. Then that’s going to go into the cell. And then we have total T3, but also free T3. And that’s the active form of T3. So a TSH of free T4, a free T3, will give us good ideas about the hormones that are made from the thyroid and converted into the active T3. For diagnosis of Hashimoto’s, of course, we have to add in too, antibodies. And I want to say too, because there’s this really, really bad idea out there. I see so many patients come to me with labs where just thyroid peroxidase antibodies were a measure and not antithyroglobulin antibodies. And you have to do both. One or the other maybe elevated.
And I don’t know why lately there seems to be a thing where, “Well, let’s just do TPO,” but that’s not complete enough. So it has to be both of those antibodies to see if an autoimmune disease that we diagnose Hashimoto’s is being instituted, where the body’s own white blood cells are now attacking the thyroid in two separate areas, right? TPO is the enzyme attaching iodine to the tyrosine. And the antithyroglobulin antibody is attacking thyroglobulin, which is like the foundational protein upon which we put tyrosine and what we attach iodine to. So there can be autoimmunity in both of those areas.
Dr. Weitz: I think part of it’s because there’s confusion among practitioners about which tests to run, because some out there are saying you have to run like 15, 20 different tests, you got to do free T3, and you got to do total T3 and total T4 and free T4. So let’s try to sort this out so we know exactly for sure which tests we should do. So everybody agrees, you should do TSH. And some practitioners say that’s all you need. And I think that’s where we end up not realizing that the patient has autoimmune hypothyroid. So we definitely have to do these thyroid antibodies. And I totally agree, we need the TPO and the TGB, and there may be some others because 10% of the patients are negative for TPO or TGB that have Hashimoto’s. But what about doing total T4 and total T3 as well as free T3 and free T4, is there any reason to do that?
Dr. Morstein: If people want to just see what’s the total or what’s the conversion to free T3, I suppose they can. You could see how much is bound. For myself, I personally don’t feel it’s necessary to do the total T4, the total T3. And also another thing that’s a very problematic lab that in general should not be done, which is going to make me sound like a [inaudible 00:09:41], it’s reverse T3.
Dr. Weitz: Right. It’s very common in the functional medicine world especially.
Dr. Morstein: Yes, it is. But it’s not really beneficial. Reverse T3 is kind of the way we throw out thyroid, right? It’s the end product, right? So we have T4, which is named T4 because of it containing four iodines. And then T3 is the removal of one of those iodines and in the right now. So you can have T3 made by selenium, enhancing the deiodinases enzymes, or if you don’t have that selenium in that, then we’ll pull it out in the outer ring and make reverse T3. Now, this is a huge problem because rT3 can… So they’re looking to see if it’s elevated, right?
Now, many, many, many things can elevate reverse T3. You could have just too much thyroid hormone. And then the body’s just trying to get rid of it, all kind of life stressors, infection, illness, just having a reaction to something or even medications, like for example, Metformin, birth control pills, beta blockers. Common medications can raise reverse T3, even depression. A posttraumatic stress disorder has been shown to raise reverse T3. Not getting enough calories in, especially carbs and proteins or lab error, right? It can happen, especially if there’s an autoimmune thyroid disease, it raises, for no reason at all, it can be found elevated in literally completely healthy people with completely healthy thyroids and no Hashimoto’s. Chronic heart failure can raise it, right? So you can do it, but you have no way to interpret really what’s going on with it being elevated. So it’s really not a helpful lab value of people really understand reverse T3 and really know what affects it.
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Dr. Weitz: What about thyroid binding globulin, is that a valuable test?
Dr. Morstein: So obviously that’s valuable, especially if you’re looking at the total T4 and then the free T4, and trying to understand how much is bound. There are things that raise that, like birth control pills, for example, can raise that. So if you really want to go to that level, that’s fine, but I will say there is…
Dr. Weitz: In other words, let me just stop you for a second. So what you’re saying is, maybe birth control pills can raise this level of binding globulin. And if too much of your thyroid hormone is bound, not available for the cells, you might be producing enough thyroid hormone, but you don’t have enough free thyroid hormone to actually do the job?
Dr. Morstein: Yes. That is definitely something you can look at in regards to the THG and total T4 and free T4. And then the total T3, which is bound by the same thing and free T3. So you can certainly use those to try to understand, is there something blocking the formation of the free, right? That is certainly an analysis in regards to, do we need to deal with the blocking or do we need to deal with more medication to try to overpower that if something is happening, that we may or may not be able to identify?
Dr. Weitz: Right. So I looked at your PowerPoint from your talk. You mentioned that when getting your labs done, you should avoid taking biotin for eight to 12 hours. The biotin’s a B vitamin, and we’ve learned over the last several years that certain labs use biotin as part of their process in running-
Dr. Morstein: The machines use it.
Dr. Weitz: The machines use it in running the lab, and we don’t really know which labs use it and which labs don’t, is that right?
Dr. Morstein: Yeah, that is true. And I would actually say, avoid biotin for at least a day or one or two days.
Dr. Weitz: Is that enough time? Is one day enough?
Dr. Morstein: I think so. Because our nutrients don’t float around our bloodstream.
Dr. Weitz: Right. And it’s water soluble and-
Dr. Morstein: Right, exactly. So this is going to be used up or excreted as necessary.
Dr. Weitz: So for the average person, this means for one day, don’t take your multivitamin, if you’re taking a B complex or-
Dr. Morstein: Or a hair product will have biotin…
Dr. Weitz: Hair product that often have high biotin. Okay.
Dr. Morstein: Yeah. We want them to search everything and just do that. And then in general-
Dr. Weitz: And you also mentioned that your thyroid labs should be done fasting?
Dr. Morstein: Yeah. So there is a study that showed that people fasting had more accurate labs than people that had eaten before them. And so the idea is many, many people take their thyroid first thing when they wake up and wait at least a half hour before eating. By the way, taking thyroid at bedtime is a great time to also take it. But what we do then is generally have people schedule the earliest lab, wake up, not take their thyroid, do the lab, and then take their thyroid. We know that T3 is very rapidly absorbed, and we can get an artificial elevation of T3 if people have taken their thyroid within say five hours of the lab test. And that can throw off interpretation obviously.
Dr. Weitz: Right. So do you usually recommend if they’re already taking thyroid medication and not take their medication before the labs?
Dr. Morstein: I do. I do. And now just a lot of people, especially getting older, might wake up and have to urinate at night. They can certainly take it then. In fact, the thyroid’s natural biorhythm is coming out around 2:00, 3:00 or so in the morning. So taking it at bedtime actually matches the natural output of thyroid and then leaves you open to get your blood work done anytime the next morning-
Dr. Weitz: Well, that negatively affects sleep?
Dr. Morstein: No. So it doesn’t, right? So that’s because… This is a common question, right? We are putting enough thyroid in just to get you to normal. So at least with my patients, I don’t see anybody saying, “Wow, I took that and now I can’t sleep.” Like for example, that may happen for some people with B vitamins, not a good thing to take before bed for many people, but the thyroid doesn’t really seem to do that. I actually have some patients who say it actually helps them fall asleep. So it’s interesting.
Dr. Weitz: So can you explain what subclinical hypothyroidism is?
Dr. Morstein: Yeah. So subclinical hypothyroidism basically is a term we use when the TSH is elevated beyond what we feel comfortable with. And we can talk about those. [crosstalk 00:19:20].
Dr. Weitz: Why don’t we do that real quick? Because we just finished the lab testing. Let’s just talk about TSH for two minutes here.
Dr. Morstein: So there’s two different organizations that have chimed in about where the TSH level should be. And one was this [inaudible 00:19:40] study, which studied that TSH, they said, had this upper limit of 4.5 mlU/L and this was what they’ve decided, the American Academy of Clinical Endocrinologists, they chose that study to say that the TSH up to 4.5. So generally it’s like 0.4 to 4.5 is within the norm. Now, this other organization called the National Academy Of Clinical Biochemists, they said, “You know what? In our research, like 95% of people who have zero thyroid disease have a TSH of less than 2.5. And so while conventional MDs have gone with that TSH to 4.5 is good, almost every naturopathic functional doc has gone with the NACB and believes that TSH should be less than 2.5 for maximum numbers of truly healthy thyroid. So there is this disconnect and we all know on our lab that on our lab reference, they’re all going to 4.5. So then we have to have-
Dr. Weitz: And in fact, when we think about lab reference ranges, most people don’t realize this, but they really reflect the average American. And in many ways, I certainly don’t want to make my goals to be like the average American or for my patients.
Dr. Morstein: I once called a lab, I called a lab once and said, “Where did you get your postprandial glucose readings?” Because they were not following what the research said that really… I mean, see, the postprandial insulin. So the postprandial insulin should be, in all the research I read, was like 30 or less, but they had it going up to 89. And this lab, which is a famous lab, if I mentioned it, everybody would know this lab. They deal with millions of people probably a day. They said, “Oh, we just took 50 of our healthy employees and measured it.” And that’s the lab value that they use now to measure millions of people. And their postprandial insulin goes to like 89. So when we look at these reference ranges, we have to understand that we have a righteous allowance to not always agree with them.
Dr. Weitz: Absolutely. And that’s the danger of just looking for the things that stand out in red. I had a patient in last week and we were looking at her liver enzymes and her ALT was 65. And I said, “Whoa, your liver enzymes are up.” But it was normal. And I looked, and there was a little star, this was from UCLA. And the reference range is now 70.
Dr. Morstein: Oh my God, that’s terrible.
Dr. Weitz: So I think what that means is as a result of two years of pandemic and everybody staying home, eating junk food and drinking more alcohol, we’ve seen liver enzymes go up. So now we’re just raising the reference range with what people, that’s what they consider good, but it’s not.
Dr. Morstein: It’s not. That’s not good.
Dr. Weitz: So let’s go into subclinical hypothyroid.
Dr. Morstein: Right. So subclinical hypothyroidism, now, again, depending on functional docs would likely say over 2.5, conventional docs would say likely over 4.5. So we have this elevation of the TSH generally with at least the free T3 and the free T4 being still within the normal range, which is where the thyroid is able to make hormones, but the pituitary is starting to have to yell at it to do so. And so the reason is, why are we now starting to have to yell? What is blocking the natural flow and rhythm of the thyroid that the normal just make thyroid isn’t working and the pituitary is now having to start speaking much louder to it? And there’s many reasons that could be happening.
Dr. Weitz: So should patients with subclinical hypothyroid be treated? And if so, how?
Dr. Morstein: Okay. Right. So for me, I don’t necessarily agree that every person on the planet needs to be on thyroid medicine. And to me, I look at that like, okay, so my patient presents with constipation. They have two bowel movements a week. So do I just put them on laxatives or do I try to look at their diet and their exercise? And do they need more… What’s going on with their colon, that they can’t have a daily bowel movement? And with the thyroid with subclinical, I’m going to be looking at the thyroid and saying, “What’s blocking this natural flow?” Let me spend a few months trying to heal the thyroid before just automatically putting them on thyroid medicine.
And the other thing is this, if you automatically put them on thyroid medicine, that underlying imbalance is still there. Nothing was fixed that the body is talking to us and we can just overshadow the body and say, “I don’t want to listen, here’s your thyroid.” Or we can say, “You know what? This is subclinical hypothyroidism. Let’s try to heal your thyroid.” And all my patients are all like, “Great, that’s a great idea. Let’s look into what could be blocking it.” And then we can be retesting your thyroid every five or so weeks. And seeing now, I have been able to heal loads of patients with subclinical hypothyroidism. So that’s why I like to start in that area because you know what? You can always stick them on thyroid, but do we have to every single person, right?
Dr. Weitz: Absolutely. So as functional medicine practitioners, we want to look at the root causes. How do we go about figuring out what are some of the underlying triggers and root causes for Hashimoto’s?
Dr. Morstein: For sure. So for me, that depends on many things, right? So there’s so many-
Dr. Weitz: We look at their history. We want to consider-
Dr. Morstein: Yes. We want to do particularly obviously labs. It is nice to know you can have Hashimoto’s and still have either a completely functional thyroid still, or a subclinical hypothyroidism too. Hashimoto’s does not automatically completely destroy a thyroid and immediately require medication. So obviously it is nice to add in the labs just to make sure is this subclinical hypothyroidism just in and of itself or does it also have among potential other reasons, an autoimmune component? So that is good to know. So there’s a lot of factors that do affect the thyroid. There are many nutrients that affect the thyroid regulation. There are potential heavy metals that affect the thyroid. There can be with food sensitivities, there can be gut microbiome imbalances. So there’s a whole-
Dr. Weitz: Chronic infections.
Dr. Morstein: Yes. And well, infections can affect that depending on what the infection is. But yes, that can certainly lead to a lot of inflammatory reactions in the body [crosstalk 00:28:28].
Dr. Weitz: Including certain well known viral infections. And when it comes to heavy metals, we really got a series of environmental toxins in addition to heavy metals that can also be triggers.
Dr. Morstein: Yes. The liver and kidney can be involved as well. So it is a huge thing just to look at step by step with patients and to take the time to go over what they may be most sensitive to or do full investigation of all of these things.
Dr. Weitz: So what are some of your favorite panels or other ways to investigate some of these issues?
Dr. Morstein: So I am a big, huge… I do a lot of food sensitivity. I’ll do that with every autoimmune disease. I do like to look at the gut microbiome. There are certain bacteria like Yersinia, for example, that has an association with autoimmunity in the thyroid. So a stool test, culture, PCR, we can discuss those, but just looking to see if there is a dysbiosis that has association, or even not enough beneficial bacteria, just not enough healthy microbiome to see. So looking at the gut, because that is so related to the whole entire body, I will always do a diet diary, on every single patient will do a week long diet diary. And there are some labs, labs are… I’m sure we’ll be talking about, for example, the huge problems with iodine labs. There a huge problems with those, but you could do, there are other nutrients-
Dr. Weitz: Why don’t we go into iodine right now? So that’s a good segue because this is a big discussion and there’s many directions we can go in no matter what we do, we’re not going to cover all of it, but let’s go into iodine. Iodine is very controversial.
Dr. Morstein: It’s very controversial.
Dr. Weitz: One of the reasons why is because if we go back in history, the United States, like many other countries, had a lot of people with goiters, these big and large thyroid glands. And the main reason for hypothyroid was a lack of iodine. And we had the Goiter Belt, and we started adding iodine to the diet by adding it to the salt. And we saw levels of goiter drop precipitously and levels of autoimmune thyroid rise precipitously. And we’ve seen the same pattern in country after country around the world. So we know iodine is crucial for thyroid function and yet do we need extra iodine? Especially since maybe people are moving, especially natural health enthusiasts are moving away from iodized salt. And we’re using Himalayan pink salt and sea salt and things like that. And so we have most multivitamins will have a modest dosage of iodine. We’ve seen iodine possibly being beneficial in preventing breast cancer. And then we have actually one really well known functional medicine doctor who advocates very high dosages of iodine.
Dr. Morstein: Yeah. I’m not really a fan of that at all. Look, my view, high dose iodine is not just a bad idea, it’s dangerous. I can’t tell you how many patients. So we have one doc who invented a supplement called Iodoral, which is 12.5 milligrams. I don’t know… And that was a very, very big thing around 10, maybe 15 years ago where there was this test. However, in my opinion, it [inaudible 00:32:45] stupid it was that people would take 50 milligrams of iodine and then had to recover 95% of it in their urine or they were judged deficient.
When studies on cows, when they did the exact same test, showed that 90% of the iodine of course was in the stool. Because when your body is designed to absorb 150 micrograms a day, you cannot put 50 milligrams in the intestine and expect the gut to absorb it. Just like you can’t say, “Well, you should get 300, 400 milligrams of magnesium, why don’t we just put 2000 milligrams of magnesium?” Well, that’s going to cause diarrhea. Too much vitamin C, that will cause diarrhea. And vitamin C is one of our most massively easy things for our body to absorb, and yet you’re going to get diarrhea. So these tests and everything are a problem. Now, [crosstalk 00:33:39].
Dr. Weitz: This was called the iodine loading test.
Dr. Morstein: It’s iodine loading test and it makes no sense. So please never do it. So that’s Dr. Mona Morstein, that’s my opinion.
Dr. Weitz: What about doing serum iodine or other-
Dr. Morstein: No. So no, that’s mainly the one of the problems with iodine is that there are no real good tests for it. Serum iodine pretty clearly is going to reflect your previous meal and how much iodine may have been in it, but it has nothing about stored iodine in your thyroid or on your thyroid hormone. The World Health Organization will do spot urinary testing. This is not designed for an individual’s analysis of their thyroid level. This is designed to do maybe 1000 people in a village, perhaps undeveloped village to see, on average, where do we feel iron levels are in a bigger population in that regard? Now, it’s not designed that one urine that’s going to tell you where your iodine stores are, right? So serum is not listed in studies as a good measurement. There is this 24-hour urine ironary collection, but day-to-day iodine intake is so variable that these… It’s amazing, we can put rover on Mars and take pictures and we can’t figure out really how to measure iodine in any typical patient that’s walking in our door.
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Dr. Weitz: Generally speaking, for patients with Hashimoto’s taking 100 or 200 micrograms of iodine in their multivitamins, probably fine, but any more should definitely be avoided.
Dr. Morstein: I mean, when that was big and people were, if they are still taking these massive doses of iodine, this is actually in the literature that it can cause hyperthyroidism. And I’ve seen almost two dozen patients who develop Graves’ disease solely as a result of taking these enormous doses of iodine. So I feel it’s a very unsafe and unstudied way of working with patients. So yes, we don’t want iodine… Look, I’m a naturopath, you’re functional, we don’t mind that you’re taking higher doses of B12, RDA, six micrograms a day. Do we care that people are taking 200? No. Do you need to take 1000 a day? No, but we don’t mind going over, like RDAs like vitamin C. Of course we want people to take 1000 or so a day. But iodine…
Dr. Weitz: The RDAs are based on what’s going to prevent scurvy and things like that, and that’s not our goal anyway.
Dr. Morstein: Exactly. But the iodine is a narrow range and it really needs to be a narrow range. Now, if you follow someone like Alan Christianson with the Thyroid Reset Diet, who feels that when we look at these studies of iodine deficiency from where it was in the 1990s to where it is now, there’s huge decrease in iodine deficiency. And like you said, but so much more autoimmune disease and the association that where countries had deficiency and low autoimmune disease, and now they’re putting all of this iodine in salt and promoting it and supplements, that what comes with that is more Hashimoto’s thyroiditis. So we have to really understand that minerals in general have tighter okay limits than… I mean, you can say 25 milligrams of zinc is fine, but if you take 100 every day, likely, given a couple few months, you can get copper deficient. Minerals are just different factors, right? And iodine is one of them. I mean, I was chair of nutrition at a naturopathic medical school, and iodine, I think, needs a very tight reign.
Dr. Weitz: So there are certain minerals called halogens. Yes. And these are in the same row in the periodic table. And these are often found in the diet. They’re controversially generally not good for us for a number of reasons. And the reason we find them is that chlorine is often added as an antibacterial in drinking water. Fluoride is often added supposedly to help our teeth, but it’s a great way for chemical companies to dump some of their toxins into our drinking water and have us pay them for it. And bromide is often found as an additive in many food products.
Dr. Morstein: Breads, a lot of breads as an emulsive. And of course bread is not only that, but remember chloride is sodium chloride, right? So you get this combination in bread and I’m not anti-grains, but just saying bread is our highest source of sodium chloride in our diet. And of course has the bromine in it for processing of it.
Dr. Weitz: And so these halides compete with iodine.
Dr. Morstein: Yes.
Dr. Weitz: So is that something we should be concerned about or not?
Dr. Morstein: Well, I think generally of course. I think most of us would want people to have a good filter on their water that they’re using to drink at home. And also shower filters. Like I have a filter in my… I have a water softener and it has a filter, but that filter is pretty old by now. And you can’t really change those. So the shower filters, the water filters, this is a good start in that regard in terms of blocking it. And then obviously just salt is vital, but maybe we don’t need five or six grams a day of it in our diets, right?
Dr. Weitz: Right. So which foods might negatively interact with thyroid? A lot of people talk about gluten. I’ve seen some articles where people recommend avoiding dairy. I’ve seen some articles about soy. Which of these foods potentially are going to be negative or is it just depending on the person?
Dr. Morstein: So for one thing, I don’t think we should ever do kind of lazy medicine. I do a lot of food sensitivity testing. And I do that with every person with autoimmune disease. And let me trust you, not everybody with Hashimoto’s seems to be sensitive to gluten. It could be corn or eggs or dairy or soy. We need to work with each body’s individual needs. Now, gluten [crosstalk 00:42:57].
Dr. Weitz: My guess is like you with me, a lot of patients that come in to see us, we’re not their first doctor. And so they’ve already taken gluten and dairy out. So I don’t know if those tests are actually going to be helpful, because you don’t want to tell them to start eating gluten if it’s going to make them feel bad. Those tests are not going to detect gluten sensitivity if they’re not eating it.
Dr. Morstein: Yeah. But I mean, that’s fine. I mean, obviously if people already know that gluten affects them, why would you… But I would say one thing, before any doctor or any patient stops eating gluten, they must absolutely be tested for celiac disease. You cannot tell patients, “Well, just stop gluten” without first testing them for celiac. This just should never be done. And unfortunately I think it’s done a lot. And so we’ve got to check that first, since we know celiac and Hashimoto’s, type 1 diabetes, have this triangle connection. If someone has celiac disease, their avoidance of gluten has to be so much more intense and exponentially severe. Then you have non-celiac gluten, and neuropathy. But a lot of my patients, they do come to me first, they’ve had or they haven’t had a testing or they’re not avoiding this or that.
So it’s not like every one of my patients coming to me isn’t eating gluten or dairy. I don’t really necessarily think dairy and thyroid… I think that would be its own entity. Now, soy, I mean, there’s been a lot of studies on soy, many, many trials on soy on the thyroid. I lived in Japan for a year as an undergrad. Obviously soy was part of every meal to some extent. And in general, if a person has enough iodine in their body, soy should not really be a problem for them. Now, this doesn’t mean you should live on soy, but you shouldn’t live on bacon either. But to say that you can’t have soy tofu or [inaudible 00:45:23] a couple times a week, that that’s going to harm your thyroid, that’s not true. That really isn’t true, if you’re looking at meta-analyses of really looking at soy.
So don’t just live off of soy, don’t be a vegan and eat soy chicken and soy turkey and all of this crappy soy, but to naturally include good soy, organic soy in your diet a couple times a week or so forth, that isn’t going to hurt your thyroid at all. And neither will the brassica family. So the brassica, your cabbage, cauliflower, broccoli, radish, kale, these really when they’re cooked, they really don’t seem to be a problem for the thyroid at all. And goitrogens in them are going to be inactivated when they’re cooked.
Of course, there is this very, very, very, very famous 88-year-old woman, God bless her, who ate like two pounds of raw bok choy a day for months, and wound up in a huge hypothyroidic crisis. Like even mixed edema, things that we just never really see in America, because we can catch things so early. So that was one woman eating… I don’t know how much two pounds is, but it’s got to be a lot of bok choy every day. So don’t do that. But cooking these, these are not a problem. You don’t have to restrict them. They’re so good for the body in so many different ways.
Dr. Weitz: Unless of course that person happens to be sensitive to them. And if they’re sensitive to them, they could form IgG or other types of antibodies, and those antibodies could cross react with thyroid tissue, right?
Dr. Morstein: I don’t see it too often. And remember, when we do a food sensitivity test, maybe if you’ve got like 20 or 30 foods, they’re not really sensitive to those foods. The best way to do a food sensitivity test is if you do it, you spend a month pulling out, you build up the leaky gut because you’re having leaky gut to have all of those reactions. And leaky gut is totally associated with autoimmune disease. And then in a month or so, they’re feeling a lot better, whatever is going on. And then you can start adding foods back one at a time. It’s a misnomer that if you get this food sensitivity test, like for the rest of your life, you can never eat these foods again. That’s not an appropriate way, at least the way I do it, of working with these food sensitivity results that we see.
Dr. Weitz: So you’re saying do food sensitivity panel, any particular panel that you like?
Dr. Morstein: Yeah, for sure. I have no financial association, but I’m a huge advocate of Alletess, which luckily, they have the website, foodallergy.com. So they must have gotten it right when the internet was invented.
Dr. Weitz: And so you do a food sensitivity panel-
Dr. Morstein: I do.
Dr. Weitz: You pull out the foods that they’re highly sensitive to?
Dr. Morstein: No, that’s another mistake. You pull out all the foods, one, twos and threes. No, you pull out every positive food. You don’t screw with the one, twos and threes because that’s in the lab. Their ones may be their worst foods and their three maybe something they can add in and it’s not a problem at all.
Dr. Weitz: Oh, interesting. Okay.
Dr. Morstein: So clinically, it doesn’t always [crosstalk 00:49:10].
Dr. Weitz: Pull all those out and then work on healing the gut and-
Dr. Morstein: And then within one or two months, there’s usually a substantial improvement and then they can start adding foods back in one at a time, see what re-initiate a symptom, that would be on the no list long term, but all the others can be added in and the patient won’t have a problem with those. We’ve been able to isolate just the one or two that’s the real problem.
Dr. Weitz: What are some of the other important thyroid nutrients? I’m thinking about zinc, you mentioned selenium, vitamin D, iron.
Dr. Morstein: Yes. So obviously zinc is super important. It regulates the hormone from the hypothalamus to the pituitary, the pituitary to the thyroid. It regulates the deiodinases, so their activity, which is taking T4 to T3.
Dr. Weitz: Right. The conversion of T4 to T3, because if that doesn’t happen… Yeah.
Dr. Morstein: That needs selenium as the nutrient co-factor but overall it’s regulated by zinc. And then vitamin A. So the thyroid receptor in the body is what we call an RXR receptor, a retinoid X receptor. And these are honestly very common receptors. For example, vitamin D uses an RXR receptor. And the retinoid means that vitamin A has to be part of that, to have the receptor acknowledge the thyroid and set up the DNA and the mitochondria and everything. So this is why so many pills will have vitamin D with vitamin A, because you need the vitamin A for its receptor and the same with the thyroid, you need vitamin A to activate and keep their receptors working well too.
Dr. Weitz: Cool. So how much vitamin A do you advocate?
Dr. Morstein: 5000 or 10,000.
Dr. Weitz: Okay. Typical.
Dr. Morstein: Just very typical. Yeah.
Dr. Weitz: Right. Vitamin D is also super important, right?
Dr. Morstein: Yes. Vitamin D is important. Vitamin D, we say vitamin, but it’s actually kind of a hormone regulator as a whole, blood sugar, other hormones, it’s amazing.
Dr. Weitz: Cardiovascular, [crosstalk 00:51:49].
Dr. Morstein: Yeah. Cardiovascular. So mood of course, great for the mood. So obviously that’s an easy thing for us to check in the labs and then to dose accordingly. I don’t think anybody needs more than 10,000 IU a day, so anywhere generally, depending on a patient, generally from two to seven or eight is my typical doses for patients, because I live in a very sunny area too.
Dr. Weitz: I’m in Southern California, you’re in Arizona, but we still see quite a large number of patients that are-
Dr. Morstein: [crosstalk 00:52:31]. Yeah, why is that?
Dr. Weitz: [crosstalk 00:52:31] less than optimal levels of vitamin D.
Dr. Morstein: I mean, probably of course it’s hard to get in the diet, but also we live in very sunny areas where people step outside and smother themselves with sunscreen. I don’t use sunscreen for almost 30 years now and it doesn’t seem to be aging me too much, but people will go outside immediately, if your SPF is over eight, you’re going to block vitamin D.
Dr. Weitz: And we’re all trying to get our cholesterol levels as low as possible to prevent heart disease. And [crosstalk 00:53:05].
Dr. Morstein: That’s a controversy [crosstalk 00:53:06].
Dr. Weitz: The conversion of sunlight into vitamin D occurs through cholesterol.
Dr. Morstein: Right. Exactly. True. True. Absolutely. Yes. Although it should be high enough to do that unless it’s maybe less than 100 or over 100, 125, vitamin D should be [crosstalk 00:53:30].
Dr. Weitz: Right. But we’ve got new medications on the market and they’re picking LDL targets of below 40 as the goal.
Dr. Morstein: I know. It’s crazy. It’s crazy.
Dr. Weitz: So in a few minutes left, what are your favorite herbs or botanicals to help with thyroid function?
Dr. Morstein: So that’s good. There’s a lot of like, that’s what I use in products like with subclinical hypothyroidism where just trying to stimulate the thyroid. Now, of course, most people know about, of course, that we used to call them seaweeds, but that’s not cool, so now they’re sea veggies. So sea veggies are good, but again, the problem with sea veggies is that we don’t know how much iodine is in those sea veggies. And so you have to just deal with sea veggies to get… If you’re using that for an iodine source, very judiciously. Like if you’ve got a little Costco iodine sea vegetable little cup, maybe just have four or five slices a day, because little amounts can have quite a bit of iodine. So we can include sea veggies, particularly the brown sea veggies, which are a little more like bladder rack, for example, very well known vegetable used in thyroid medication.
So we’re going to do… So ashwagandha is a really good herb that can be… Well, ashwagandha, I mean, it’s so good for everything, but that’s another good herb to consider with patients where you’re trying to balance them, obviously doing nutrients as well, making sure that they have everything in it. Other ones are blue flag, an herb called [inaudible 00:55:50], so that’s been shown to help increase T3. Other adaptogens, Eleutherococcus, Centella, maybe even of course, thyroid glandulars are used very commonly, probably have a little iodine in them, but definitely are used in many products to stimulate the thyroid. Like we use adrenal glandulars and ovarian glandulars to stimulate these end organs. So those are some other ones to consider if there’s… To settle down antioxidants, like if there’s Hashimoto’s, things like licorice or I love curcumin, I use a particular product, a very anti-inflammatory just to help balance some of the autoimmune damage that could be happening, working with the gut, for sure. So just a comprehensive in those regards.
Dr. Weitz: Great. So I think that’s a wrap there. I’ve got a nine o’clock patient. So this was great information. How can listeners and viewers find out about you and your book and getting in contact with you?
Dr. Morstein: Thank you. My website, drmorstein, M-O-R-S-T-E-I-N.com. And so that they have my clinic contact and everything, my book, Master Your Diabetes, which is I’m super proud of, you can get that, just Google Master Your Diabetes and Morstein on Amazon and that’ll come up. It’s just really good. And so those are best ways to get a hold of me, I think.
Dr. Weitz: Great. Thank you. Thank you for making it all the way through this episode of the Rational Wellness Podcast. And if you enjoyed this podcast, please go to Apple Podcasts and give us a five-star ratings and review, that way more people will be able to find this Rational Wellness Podcast when they’re searching for health podcasts. And I wanted to let everybody know that I do now have a few openings for new nutritional consultations for patients at my Santa Monica Weitz Sports Chiropractic and Nutrition Clinic. So if you’re interested, please call my office, (310) 395-3111 and sign up for one of the few remaining slots for a comprehensive nutritional consultation with Dr. Ben Weitz. Thank you, and see you next week.
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