Perimenopause and menopause with thyroid issues. Episode 33.

I'd be interested in hearing you discuss hashimoto’s and thyroid medication during perimenopause and menopause, and/or how those hormones can affect your thyroid and the way your body absorbs thyroid medicine. I'm 51 with Hashimotos, Armour Thyroid (90mcg), with levels considered normal by the endocrinologist. 

I am gluten and dairy free and eating well. But I still struggle with constipation, weight gain, insomnia, facial puffiness etc--hypothyroid symptoms. In November I had the first period that I have had in about 8 months. In the weeks after that, everything seemed to be in good working order...lost the weight, digestion was great, puffiness went away. Now a few months later (with no periods), all those same symptoms are returning.

I had been on Armour from June until I saw the endo in November .  I saw the endo on 11/19 and my TSH was 4.6, Free T4 0.81 (those are the only ones they gave me and there isn't a patient portal where I can peek at others that might have been taken).  

They advised me to go up to 90mcg at that time as he likes the TSH lower.  The period that I had was on 11/13 and so when I saw him everything was going GREAT...had dropped 6 pounds without trying, sleeping well, digestion good.  Have been on 90mcg since November and am creeping steadily upwards, digestion sluggish, insomnia, etc.  Ahhh!

Michelle. 

Thanks for your question Michelle- it is quite likely there are hundreds of thousands of women in your shoes. Before I forget to mention it- work with your doctor to at minimum add in a Free T3 test. TPO and TgAb antibodies tests and Reverse T3 would also be helpful. 

This is a complicated issue and I can give you some good general information but as with everything- we are all bio individual so you will have to experiment to find what works for you. 

Women start to make less estrogen and progesterone as we near our 40’s. This alone can trigger our thyroid to slow down. It sounds like you might be on a hormonal roller coaster here which is totally possible as you approach menopause. 

I like seeing that your endocrinologist likes to see your TSH lower than 4.6. Ideally it should be around 1-2. But upping your medication might not be the solution. That is not to say you shouldn’t take it as prescribed- I’m just saying there might be things you can do that will allow you to take a dose and stay there without having these fluctuations like you are. 

You say you are eating clean and gluten and dairy free. That sounds good, but what does clean eating mean to you? 

How much sugar or starchy foods are you eating? Once we hit a certain age, those starchy carbohydrates can be a problem for some of us when we are looking to maintain or lose weight. 

Those of us with hypothyroidism whether caused by Hashimoto’s disease or not can encounter issues with insulin resistance. Our body cannot process and tolerate sugars like it used to- my body certainly can’t. This means that you will have to be very mindful of what you are putting in to your body and even what time of day you do it. 

Maybe you feel tired an hour after eating lunch- even a paleo style lunch. If it had some starches in it, and you are feeling tired- like a sugar crash- then you likely are not tolerating starchy carbs at that time of day. 

If you struggle with sleeping- falling asleep or staying asleep a bit of starch in the evening meal might help you sleep better. The only way to know is to try it for a couple of days. 

Let’s talk about what perimenopause and menopause are before we dive in to what might be happening with you. 

During perimenopause (the 2-12 years before you reach menopause) 

It can start in your late 30’s but is more commonly occurring in your 40’s. You can have hot flashes, sleep problems, mood swings, and heavier than normal periods (this part is the worst if you ask me) and these symptoms can wax and wane for a good 10 years. 

Your estrogen during perimenopause will be fluctuating significantly to the point that you will have more than you’ve ever had circulating through your body at some times and other times it might be low. It is much like the blood sugar roller coaster but is called the perimenopause roller coaster. 

Symptoms include: 

• heavy flow that is new to you or longer flow (high estrogen)

• cycles that are less than 25 days long

• changes in breast tissue: lumps, sore, swollen (high estrogen)

• waking in the middle of the night and you didn’t before

• worse or more cramping

• start of night sweats, especially before a period (low estrogen)

• migraines that are new to you or are worse

• mood swings before a period (high estrogen)

• gaining weight without changing what you are doing

You may have some or none of these symptoms. About 20% of us will have dramatic changes during perimenopause. The rest of us are lucky to have minor issues. 

Progesterone is gradually lost during this time which is kind of like a cruel joke from mother nature because it is the progesterone that helps counteract the affects of estrogen. 

It also helps us deal with stress and the loss of progesterone makes us feel more anxious, depressed and have poor quality sleep. 

Managing your diet and allowing some self care. 

• Don’t kill yourself in the gym- over exercising or doing too intense of a workout will affect your energy levels for days to come, especially if your adrenal glands are worn out or confused about what to do for you

• Learn to let stuff go- like dishes and cleaning the house. 

• Avoid alcohol- this alone can wreak havoc on your hormones at this stage in the game. It keeps us from getting rid of that excess estrogen AND lowers progesterone.

• Manage your blood sugar. Journal your food so you can see just how much starchy food and sugary foods you might be eating. 

• Take magnesium- it calms our brain, helps us sleep and regulates our brain communication with our body

• Exercise gently, especially if you are dealing with Hashimoto’s. Autoimmune Strong is a great place to start. 

If you are dealing with heavy bleeding, you need to avoid dairy which Michelle already is, avoid alcohol, eat fermented foods and lots of veggies to help keep your gut bacteria healthy. Gut bacteria clear estrogen from your body and so does fiber so eating more veggies than you already are can be really helpful. I also find my energy to be better when I eat more veggies- like 7-8 servings or more a day.  

If your hypothyroidism is not being managed well (meaning your TSH and free T3 are not optimal)  then you may have heavier periods as well. Work to get your TSH around 1-2 and some doctors think it is okay if it is a little below one (.3 to .5)— especially if you are on a natural desiccated thyroid hormone replacement- When T3 is optimal you might find a suppressed TSH. Finding a doctor that will allow your labs to look this way is another story. 

Also keep in mind that you might feel great at a TSH of 2 and someone else might feel good at .3. This is bio individuality. It is so important to know your body and learn how to tell when things are off. 

Your thyroid medication may need to be adjusted seasonally too. If you live in a climate with winter- even all for seasons then your TSH may rise in winter and fall during summer. Another reason to really be in tune with your body and its signals. 

Part of my job as a Nutritional Therapy Practitioner is to help you learn how to do this. 

Menopause starts one year after your last period and symptoms should be better. 

You will have much less estrogen and progesterone at this point. Your adrenal glands will be making estradiol in your cells and this is supposed to be enough to keep you feeling good. BUT- if your adrenals were taxed for years before this happens then you may have some issues. 

Your endocrine system is made up of the pineal and pituitary glands in your brain, the thyroid and parathyroid glands, the Thymus (works with the immune system), Adrenals glands, pancreas and your ovaries. All of these work synergistically together as a system and when one is off, they will all be off. 

You can’t just take a supplement for your adrenals and think that it will fix your issues. It will help in the short term but it is a band-aid and not getting at the root cause of your problem. 

If you have gained weight around your middle, you are more than likely dealing with insulin resistance. This means that your cells are not accepting glucose or sugar from insulin as it travels through your blood stream to bring your cells sugar. Your liver and your muscle cells are not accepting the sugar so it just stays in your blood stream and eventually gets transported to fat tissue for storage. This is why we gain weight.  

The best way to combat this is to quit sugar completely. No dessert, no sweet anything. Every time you eat sweets it makes your insulin resistance worse. Even fruit- so keep your natural sugars to below 25 grams of fructose

High fructose corn syrup in soft drinks is 55% fructose, sugar cane is 50% fructose and honey is 40% fructose. Eight ounces of orange juice has 18 grams of fructose.  So pay attention to what you are eating. If it is sweet tasting, it is likely contributing to your weight at this point. 

Starchy foods like potatoes and rice are mostly glucose and very little fructose but you might find you still have a problem with those as well and will need to test your carb tolerance with a glucose monitor. Start with sugar though. It is more important at this stage to remove sugar from your diet and then look at the starches. 

Hormone fluctuations during perimenopause and menopause can affect how your thyroid functions. 

You might end up with estrogen dominance (the highs on the rollercoaster) which can keep thyroid hormone from attaching or making their way into the receptors on your cells. This means your cells are not getting thyroid hormone creating hypothyroid symptoms. 

Thyroid hormones are similar in chemical make up to estrogen. Too much estrogen or eating too much soy can block the receptor sites as well leaving you with less thyroid hormone in your cells and hypothyroid symptoms. 

As we lose our progesterone, we may see or feel a need for more thyroid hormone. We need progesterone to get T3 which is what our cells use and need. 

Our thyroid naturally slows down as we get older and therefore will not be able to get enough hormone to our cells affecting not only our energy but creating all the other symptoms we have talked about before. 

If you are dealing with chronic stress, and most of us are, this will also affect our ability to make enough thyroid hormone. 

When your thyroid is not working optimally or you are not medicated optimally, all of your hormones will be disrupted. 

It will be important to know if you are in menopause or if you’re having a thyroid problem. If you take estrogen thinking you are in perimenopause or menopause and it is actually your thyroid causing the problems, you might end up feeling worse and the estrogen will affect your thyroid function. Vicious cycle as with so many things in our body. One can’t work well without the other. 

If you have crazy periods during your 30’s and 40’s it is more likely an issue with thyroid than perimenopause. Thyroid problems are often the cause of early perimenopause. I’m a textbook example of this. 

They make the symptoms of perimenopause and menopause worse, affect blood sugar, make you depressed, affect your ability to handle stress. 

You have options: 

• start with journaling your food to pinpoint

  • are you eating enough

  • are you eating too much sugar

  • is your ratio of protein fats and carbohydrates where it should be

  • are you eating a lot of processed foods or a whole foods diet?

• exercise

  • reduces hot flashes

  • better mood

  • lessens depression, less anxiety

  • higher sex drive

  • sleep is better

  • more energy

  • lowers insulin resistance

  • increases bone density

  • helps manage weight

• natural supplements- introduce 1 at a time and wait 2-3 weeks before adding another one

  • maca powder

    • will help your hormones adapt and balance as needed

    • can reduce hot flashes

    • supports the entire endocrine system, including adrenals and thyroid

    • can regulate menstrual cycles

    • can increase energy and stamina

    • don’t take it if you are on estrogen

  • soy- is supposed to be helpful as a phytoestrogen to help with menopausal symptoms. I’m not sure how I feel about this. Don’t supplement but get it in food form. I would go for tempeh and miso and NOT genetically modified. 

  • Black cohosh

    • helps to reduce hot flashes

    • helps insomnia, fatigue, anxiety, depression

    • helps with joint pain/body aches

  • Damiana- tea or tincture (2-3 ml 2 to 3x/day)

    • helpful for hot flashes, low sex drive and general well being

  • Dong Quai

    • hot flashes, insomnia, fatigue, anxiety

  • Vitamin D

    • helps regulate endocrine system

    • supports sleep

  • Chasteberry or Vitex

    • helpful for breast tenderness

    • balances progesterone

    • water retention

    • headaches, irritability, depression, fatigue

    • sleep issues

The Period Repair manual is a must read for every woman

Supplements suggested can be bought through this trusted source (my fullscript store)

How does blood sugar dysregulation affect the thyroid? Episode 31.

Welcome to episode 31 and Happy New Year. 

I spend a lot of time between Christmas and New Years reflecting on my year and always being really hard on myself for not accomplishing more than I did. 

I had a great year, I have good relationships with people in my life that matter and while they are not perfect and not always great, I am working hard to show up better in those relationships. So here is to a new year full of health and great possibilities in all areas of my life and in yours too. 

I am really grateful you are here. 

I teach a class called The RESTART Program as a Nutritional Therapy Practitioner and it falls right in line with the subject matter of today’s podcast. I am discussing managing blood sugar in relation to thyroid health. They go hand in hand and one out of balance puts the other out of balance. 

My class is all about managing blood sugar and about Restarting with a new outlook on food and nutrition. It is a real food sugar detox where you learn how to eat real food to manage your blood sugar, you get nutrition education and you get support from me and from the members of the class. We have a private facebook group and we meet each week for five weeks with the detox starting on the second week.

There are no shakes, no pills- just real food. This class has been life changing for so many people and I really love teaching it. Learn more at www.outofthewoodsnutrition.com/restart 

Susan O.  “RESTART® gave me the tools to reverse pain, lose weight, increase energy, and best of all, the common sense of how we should be living and eating. Thank you for helping me make a difference in my life and my family.”

Tina T.  “I came to the RESTART® class just wanting to learn how sugar affects the body. I left class feeling better and with a ton of knowledge. It’s a lifestyle change I can do. Stick with this class, you won’t regret it.”

Melissa M.  “I now understand what I need to heal myself and my family. This class changed my attitude towards food and health. If you are sick and tired of being sick and tired all the time, I highly recommend taking RESTART®.”

You can register for class now at www.outofthewoodsnutrition.com/restart  Cost is $147 for the entire five weeks and will be taught via zoom which is free for you to download. 

Okay- on to the show. 

Why is maintaining healthy blood sugar levels or keeping your blood sugar balanced so important for your thyroid?

Most if not every organ and tissue in the body needs glucose or sugar. It is what helps us make energy in our cells so if you are lacking in sugar your cells are not getting the materials they need to produce energy so your cells will not have energy, your organs won’t and you definitely won’t have any energy. 

When you have a low level of glucose, your blood sugar is low and your thyroid won’t be getting enough energy or enough sugar to turn into energy to function. It will be sluggish and not able to produce enough hormone for you. 

When you have higher levels of glucose in the blood or high blood sugar on a regular basis, you end up with something called insulin resistance. Say you eat a meal that is pretty carbohydrate heavy of maybe pasta or bread or pizza and that gets broken down into little particles of sugar. It will cause your blood sugar to rise and your body says “I’ve got to get rid of this sugar in my blood. There is too much in here and it can damage my blood vessels. So it releases the hormone insulin which is supposed to lower blood sugar in the blood by bringing the sugar to the cells so it can use it for energy production. 

The problem when we eat all that refined carb garbage is that you are eating too many carbs for your body to handle so you are dealing with this higher blood sugar issue with the quick rise of insulin to help manage the levels of sugar in your body. It’s not good and your body- your cells eventually get tired of receiving the sugar from insulin so they become resistant to it. They are like- “No more. My cell door is closed. Go away!” 

So you have this sugar with no where to go because the cells don’t want it. It is just floating around in your blood stream. But it has to go somewhere so what does your body do?

It stores it in your fat tissue or creates fat tissue to store it. 

Now your thyroid is looking for nutrients but the cells are resistant because of the insulin resistance. The cells are refusing the sugar being transported by insulin.  No fuel for the thyroid means it isn’t going to produce enough hormone for you and you feel sluggish. You might have the TSH of 5 or 7 or 9 that your doctor says is fine when you know it isn’t fine because you feel like crap. 

Now keep in mind this is a very simplified explanation of things because I want you to be able to get the idea. 

When your blood sugar is high either from insulin resistance or because you are constantly eating all day long or because you eat the Standard American Diet then you probably are experiencing some inflammation.  We are all bio individuals- where you experience inflammation may be different than someone else.  If you have inflammation in your thyroid due to autoimmune attacks or because of something else- your thyroid cells are not able to take in the nutrients they need to function well. 

Two important nutrients are iodine and the amino acid tyrosine.  If you have an inflamed thyroid, that doesn’t mean you should supplement with these two nutrients. That is a band-aid. The root cause might be the mismanaged blood sugar and you should be able to get both of those nutrients from your diet.  

Missing these nutrients through mismanaged blood sugar is one way you can get  to an autoimmune diagnosis. 

Here is the kicker. People with high blood sugar levels in their blood and insulin resistance tend to have low thyroid hormone production which will increase your TSH. When TSH goes on the rise it can make insulin resistance worse. 

I think I can attest to this- when I experimentally went off my medication I felt and actually still am pretty puffy. I ate three cheesecake flavored M&M’s last Saturday and a couple hours later had a small patch of psoriasis on my palm and the back or nape of my neck is itchy. It can mess you up. It is a vicious cycle. 

When you have a high TSH because your body can’t make enough on it’s own, as your blood sugar lowers the cells in your thyroid are affected. We need the proper amount of T3 and T4 to maintain healthy blood sugar. The more out of control our blood sugar gets, the more our thyroid can’t function properly. It is sluggish and that contributes to insulin resistance even more. 

The best way to fix this is to fix your blood sugar balance. To keep it balanced and reset things. So obviously diet is a huge factor and that is what the RESTART Program is all about. There are other things you can do as well. 

Sleep is huge. One night of bad sleep, loss of sleep can create insulin resistance in a healthy person so for those of us suffering from insomnia, you are in that vicious cycle again and so having diet dialed in will be really important. We repair our body at night and cortisol is supposed to be low at night- if you are not sleeping both of those things are going to be messed up. No repairing of tissues, and cortisol can be high which means insulin resistance and fat storage/creation. 

Exercise. When your muscles are worked or exercised and trained, if you will, they become insulin sensitive which will lower your insulin resistance. For many of us with autoimmune disease we need to go slow and I can’t recommend enough the Get Autoimmune Strong Program. Please go to the show notes and use my link to check it out so I get credit for sending you. It helps me pay for the podcast. 

A lot of experts will recommend burst training where you do something intense for 30-60 seconds and then rest for a few minutes and do it again. I am not in the place where I can handle that so if you get exhausted from working out- autoimmune strong is for you. 

You can also use a standing desk instead of sitting desk. I got one on Amazon that sits on top of my cheap Craigslist desk for about $80-$90. It was a good investment. 

Manage stress. This along with sleep is sometimes more important than eating well. That’s not to say you shouldn’t eat well but these other two are really really important. When you are experiencing a lot of stress- mental/emotional or physical, your cortisol levels go up. When the cortisol is high, your liver will create sugar to increase your insulin and again we have a cycle we don’t want to be in. 

Cortisol is in our body to give us a burst of energy to escape danger. Our primitive mind doesn’t know the difference between actual physical danger and what goes on in our mind, or even between a close call on the road and running from a bear. It is all the same to our body. So chronic stress- not good for our body fat and our blood sugar. Unfortunately, our body prefers to get its energy or sugar from our muscle rather than our fat so we end up losing muscle and getting fatter in this scenario of unbalanced blood sugar.  

So we have this high blood sugar because of high cortisol and we have resistant cells, they don’t want any more sugar so more and more sugar gets released either through you eating something because your body has told you you need more energy so you crave some kind of sugary carb food or because you are stressed so the blood sugar levels are higher and higher- your body thinks there isn’t enough sugar because the cells are refusing it and so the levels get higher and higher in the blood and that gets shuttled to fat because it needs to get rid of it. 

When you eat matters and what you eat at night matters too. When you eat before bed, if it is a carb heavy food like a cookie or a bowl of cereal, your blood sugar will be high when you go to bed and you will have a crash around 1-3 am when cortisol is released to raise your blood sugar. Ever wake with a start or have heart palpitations at that time and then you can’t get back to sleep? That is a blood sugar issue. Then you pile on lack of sleep because you couldn’t fall asleep and you have more insulin resistance. 

Eating protein at breakfast or your first meal is important to keeping your blood sugar stable all day long. If you aren’t eating protein and you have insulin resistance and issues with cortisol, your body will take what it needs in the form of sugar from your muscles- creating less muscle and more fat. 

You may need to eat every 3 hours for a short time to get your blood sugar balanced, but don’t eat a bunch of carbs every 3 hours. Eat some healthy fats and proteins with veggies to keep your blood sugar stable and then eventually you will be able to make it from meal to meal without needing a snack. Eating all the time, snacking all the time will keep your insulin levels high all day long which means more fat storage, inflammation and stress on the body and on your thyroid. 

All this stress affects your pituitary gland and TSH is secreted from the pituitary gland. When your adrenals and cortisol are working hard to manage stress and blood sugar, there isn’t much room for your thyroid to be helped out so it takes a hit and becomes sluggish or you develop autoimmune disease.  Cortisol inhibits production of T4 and of TSH (will show up as a high TSH on a lab). 

So we have a thyroid that isn’t working. This causes a decrease in the rate the cells take in sugar (glucose). The receptors on your cells don’t know what is going on so they can’t take in the right amount of anything.  Your blood sugar is out of whack and T4 and T3 are not being secreted from the thyroid like they are supposed to either. You are dealing with inflammation because insulin overproduction will also produce inflammation. 

You are dealing with a blood sugar rollercoaster here. Sometimes too high blood sugar due to a meal you ate or stress or whatever and then low blood sugar because of the rise in insulin, too much insulin which causes a crash- when you get really tired after a meal or after a bunch of sugar. Cortisol gets involved to try to fix the problem and it starts all over again. Not good. You crave the sugar to get you out of the crash. 

The solution here- besides taking my class is to heal your gut, remove some of these foods that are causing your blood sugar to be so out of control. Figure out if certain foods are causing you inflammation, get some good nutrients in to your diet. Get some omega 3 fats, fiber and protein in your diet.  You might need chromium, magnesium, cinnamon can be really helpful in lowering your blood sugar and testing your blood sugar. I am working on getting someone on the podcast who is an expert in finding your carb tolerance. It involves pricking your finger- I’m not so good at that. I have to have my daughter do it for me so I don’t mess with it- I really need to do that though. I know there are certain foods that really spike my blood sugar and the thing of that is- it can be different for everyone. You might really react to an apple whereas someone else won’t be affected at all. I’ll work on getting a good guest to help us figure that out. 

Ideally you want your blood sugar levels to stay somewhere in between 80-100. This would be on a blood glucose monitor. You can get a good picture of your blood sugar from a Hemoglobin A1C test. This will measure the sticky proteins of sugar that are attached to your red blood cells. This causes your red blood cells to become brittle and cause damage to your blood vessels. This is how we end up with plaques in our veins. 

In The RESTART Program we don’t use any sweeteners on the sugar detox. Some safe alternatives if you are going to have sugar keeping in mind that sugar is sugar and will affect your blood sugar the same -are honey, maple syrup and maybe coconut sugar. Again- these all will do the same damage if you eat too much of it. You shouldn’t be having any more than 22-24 grams of sugar a day according to the world health organization. That is not a lot when you figure 4 grams of sugar is = to 1 teaspoon of sugar. 

Stay away from aspartame, splenda and other artificial sweeteners. Some people think stevia in green powder form or the liquid drop forms are okay- I don’t care for the taste and I don’t know that my body loves them either. Some people do okay with erythritol or xylitol- they can cause bloating and irritate your gut. Avoid agave as it is pure fructose. It will for sure spike your blood sugar. 

The bottom line here is that you cannot address your thyroid without addressing your blood sugar and your diet. 

Diet changes alone can result in weight loss, more energy, better sleep, lessened cravings, better skin, and a better functioning thyroid. 

I’d love to have you in my class. Learn more or register at www.outofthewoodsnutrition.com/restart

Check out autoimmune strong here. 

Thanks so much for joining me today.  I’m glad you are here. Please leave me a review on iTunes and share this podcast with anyone you know who might be helped by it. 

I’m sending out a recipe for breakfast soup in my newsletter next week so go sign up for the newsletter on my website if you want that. It is really good. You will also get an ebook called 5 things your doctor won’t tell you about hypothyroidism. 

Join the Help For Hashimoto’s facebook group to get ongoing support from other members and from me. 

You can find me on instagram at stephanieewalsntp but all the action will soon be in the newsletter. 

See you next week! 

Study on blood sugar and hypothyroidism

How do you push through the fatigue? Episode 13.

Q.  How do you push through the fatigue? I just want to get my life back on track.

Q.  I’ve got hypothyroidism/Hashimotos. Around noon I start getting tired and it can get to the point of dozing off. I've had every thyroid level possible checked and it's within normal range. We've actually checked it numerous times. I've had my b12 and folic acid checked along with my hormone levels, vitamin levels, and had a CBC done. Everything is good. I'm wondering if maybe we are missing something. Could I have something that we haven't checked for yet. I've also got bipolar2, depression/anxiety and ptsd which I take Topamax for. I also take Levothyroxine for my hypothyroidism.

First let’s talk about Topamax. I want you to know what you are on.  Your doctor should be testing your kidney and liver function and your blood should be tested to be sure you are able to process the drug well. They can become toxic very quickly.  

You should not drink alcohol while on this medication as it interferes with the effectiveness and it can make you sleepy as well as slow your heart rate. 

Antacids will keep you from being able to absorb this medication as well as any nutrients from your food. 

Fiber supplements can reduce the effectiveness of this medication. 

This drug will cause you to be low in folate or deficient in it. 

It has not been approved to treat PTSD but is endorsed by the National Alliance on Mental Illness to treat bipolar disorder and other mood disorders. 

Common side effects: 

Diarrhea, Dizziness, Double vision, Fever, Hair loss, Loss of appetite, Mood changes, Nausea, Reduced perspiration, Sinusitis, Stomach upset, Taste changes, Tingling or prickly skin sensations, Tremors, Uncontrollable eye movements, Urinary tract infection, Weakness, Weight loss.

With that being said, let’s move on and talk about fatigue. 

This is a super common issue for those of us dealing with thyroid issues and there are a number of reasons why fatigue could be your issue. 

Anemia.

You can have anemia from a deficiency of B12, Iron or folic acid. Your doctor may check your iron levels but do they check B12, folic acid and ferritin? Any one of these can contribute to fatigue.  And just because your lab says you are in the normal range doesn’t mean you are in the optimal range. j

Normal ferritin levels are between 12 -150 ng/mL. Mine is currently at 17 and I struggle with energy often. Some thyroid experts would say that optimal ferritin levels should be at 90-110 ng/ml for good thyroid function.  If you are still losing your hair- it could be an iron deficiency. 

And B12 values from your doctors lab may include values from people who were deficient in B12 so you can’t always rely on the lab values. “normal” is between 200-900 pg/mL but under 350 can give you neurological symptoms.  

Food sensitivities, not food allergies which is when your immune system reacts to protect you like when someone’s throat closes off in a nut allergy.  This alerts the IgE part of your immune system and happens as soon as a food is ingested. The IgA and IgG sections of the immune system will react to foods in what I would call a sensitivity or intolerance. These can cause us to be fatigued. 

IgA reactions happen in the intestinal tract which can cause inflammation there each time we consume a particular food. This will damage the intestines and can cause us to be unable to absorb nutrients from our diet. You may have symptoms like diarrhea or looser stools, constipation, reflux or you may not have any symptoms at all. You can end up with conditions like IBS, gas, rashes on your skin, acne, asthma, headaches, irritability and fatigue.  Celiac disease is in this category. 

If your T3 is low and you have high Reverse T3, this will affect your energy. T3 helps our cells make more energy. Reverse T3 makes T3 ineffective so that we are slowed down a bit. If Reverse T3 is high, we will not have any energy and one of the biggest reasons this might be high is due to stress. Another problem could be that you are not converting T4 into T3. This can be due to stress, or even nutrient deficiencies either due to low stomach acid or a compromised gut. You might find you need to be on a medication that has T3 in it. 

If your TSH is high, you will not have energy. Not all lab values are created equal here. You need to make sure that you are in a good range. Lab values for TSH are made up from a population of all kinds of people- those who are seemingly healthy and those who have undiagnosed thyroid problems and even the elderly who often have lower functioning thyroids.  The best reference range for most people is to have a TSH around .5-2 uIU/L. Personally,  mine is lower than .5 and I feel pretty good on that.  If you are taking NDT you can have a TSH that might look hyper and if your T3 is in normal range you probably feel pretty good. This can cause alarm with your doctor but try to have a conversation with them about it. 

How is your blood sugar?

This is a really really big one because it affects our adrenal glands which also have a role in energy. The good old blood sugar roller coaster will cause your adrenals to become weaker or cause the signaling between your brain and your adrenals to not work well leading to what is called adrenal fatigue or HPA axis dysfunction. For people like us with Hashimoto’s we may not tolerate those refined carbohydrates very well at all. Sometimes we get a big release of insulin when we consume sugary or refined “white” foods that others might not. So our blood sugar goes up really fast and we may have too much insulin in our blood which causes us to crash with fatigue and even anxiety or nervousness. This stresses our adrenals and leads to more fatigue.

Adrenal health is important for energy. If you are suffering from Adrenal fatigue you likely don’t have much energy to speak of even if this is the only thing you are dealing with. This is such a big deal and it takes some time to bring your adrenal health back in good standing. You need to avoid caffeine, keep your blood sugar balanced, make sure you are sleeping well and resting when you can, managing stress and probably supplementing. You can listen to Episode 7 of this podcast for more on adrenals. 

Having good digestion is key to energy. 

Many of us will be nutrient deficient and usually deficient in those nutrients that help our thyroids to function well. Just having hypothyroidism makes it harder for us to get our nutrients out of the food we are eating. This means the digestive system has to work a little harder to break down our foods and this can cause a lot of fatigue. We often have lower levels of stomach acid and most of us don’t eat when we are relaxed and we certainly don’t take the time to chew our food well. Right there is three strikes against us in the energy department. 

When we are not relaxed when we eat, we are not in “rest and digest” mode or what is called parasympathetic mode. This means we are in fight or flight mode which is not a good environment for good digestion. We already are not making enough stomach acid because we have symptoms of hypothyroidism, then we are not relaxed so we make even less. Then we are not chewing our food well- like 20 chews per bite to break it down. So, we have all this food in our stomach, not enough stomach acid and it is not being broken down. Our digestive system is working extra hard to try to break this stuff down- using all kinds of extra energy and that makes us tired. Then you have undigested food going through your intestines. You have leaky gut or intestinal permeability and these undigested food particles are then getting in to your blood stream causing your immune system to go on alert and inflammation occurs in the body. Fatigue is going to be a factor here. 

If you have low vitamin D, you can have fatigue. Get some sun. Lay in the sun for 10-15 minutes or go for a walk on a sunny day and expose as much skin as possible. Take a supplement of D3 if needed and make sure to have your levels checked by your doctor. Low D is a factor in autoimmune diseases like Hashimoto’s. 

A good diet will go a long way to helping you with your energy problems. High quality proteins and veggies along with a small amount of fruit. The big foods to eliminate for us are going to be gluten, dairy, eggs, nuts and I would try to eliminate nightshades to see if you feel better. This is basically called an elimination diet and is important for you to start to feel better, have more energy and bring your body back in to balance. 

You can find Hydrozyme at www.getbiotics.com use code DFILC163 to access. 

Natural desiccated thyroid hormone vs. synthetic, dry brittle hair, and having invisible illness. Episode 6.

I have Hashimotos and recently my hair has turned extremely dry and brittle. My doctor increased my medication a month ago, but still no change in my hair. I definitely feel as though it’s caused by something with in me as opposed to any products I may be using on my hair since those have not changed. Any suggestions would be sincerely appreciated!

Jody

Losing your hair and or having dry brittle hair are common symptoms in hypothyroidism. Some things that might be causing this for you are: 

1. is your thyroid medication/treatment optimal?

   1. all the cells in our body need thyroid hormones to function properly. T4 only medications like levothyroxine and synthroid might not be working well for you. Maybe your body doesn’t do well converting t4 to t3 which is what your cells use. You might need a T4/T3 combo medication.

   2. Make sure your doctor is testing TSH, Free T3, Free T4, Reverse T3 and the antibodies- TPO and TgAb. Functional medicine lab ranges according to Datis Kharrazian for TSH are 1.8-3.0 mU/L (milliunits per liter). Personally, I have felt best when mine is a bit below 1.0 which is common for those of us on Natural desiccated thyroid hormone. Free T3 functional range is 1.2-4.9 mg per deciliter, free t4 functional range is 1.0-1.5 ng/dL (nanograms per deciliter. If you lab results are not in these measurements, you can google how to convert them in to these numbers. Don’t worry about taking notes on this either, all of this will be on my website at out of the woods nutrition dot com. The antibodies should be at zero but that doesn’t mean you don’t have the autoimmune thyroid conditions of hashimoto’s or graves disease. Our immune systems fluctuate- when you have your blood test they might be considered within range- so don’t rely on antibodies testing alone to mean you do or do not have the disease.

   3. What are your iron levels like? Ferritin is our storage iron. If that is low it can result in hair loss and probably are related to dry hair too but more so hair that is falling out. Having good ferritin levels encourages hair growth and having low levels means your body will put hair and nail health on the back burner to ensure that the tissues that really need iron get it first. Liver is a great way to get your iron. Personally I can’t stand liver in the form of pate or cooked so I take either an iron supplement occasionally or I take Vital Proteins liver capsules which are not cheap. I have liver in my freezer and have not taken the time to dehydrate it and put it in capsules which would be way more cost effective.

   4. If you are not making enough stomach acid, you will not be breaking down your food, protein in particular, so you will not be getting all the nutrients you need from your diet which will affect how supple your hair is. Are you eating enough protein? Hair and nails are made of protein. If you are deficient either because you are not eating enough or because you are not breaking down your food well enough you will be deficient and your hair will pay the price. I recommend starting out on a low dose of HCl aka Betaine Hydrochloric Acid with Pepsin to help you break down your food. Something like 150mg to start with and go up from there………..

   5. Something your pharmacist won’t tell you- some thyroid medications can cause hair loss. So, the very thing you are depending on to feel well is causing your hair to fall out. The package insert for your medication will also tell you that you should not be taking it if you are suffering with adrenal insufficiency- adrenal fatigue.

   6. If you have hashimoto’s you have an autoimmune disease and that means you are likely susceptible to having more than one autoimmune disease- most commonly 3 AID and the likelihood of having a total of 7 over your lifetime. These things don’t happen overnight either. Your body suffers internally for years before another disease becomes symptomatic. This is why it is soooo important to address diet and lifestyle issues. We don’t just all of a sudden get sick overnight. Our body is like a car- pick your dream car or even the one you are driving now. How you care for that car today and for the time you drive it will determine just how long that car runs well for you. You have to put the right kind of fuel in to it. You have to change the oil and have other fluids checked. Your car wants to run well for you but it will break down if you don’t give it what it needs to run properly. Our bodies are the same. You only get this one chance to be here now. Your body does what it can daily to maintain homeostasis or balance. It works really hard to keep us alive and running well. What we fuel it with really does matter. A calorie is not just a calorie. You will get so much more out of 100 calories of veggies vs. 100 calories of cookies.

   7. Speaking of fuel- how is your blood sugar? According to Izabella Wentz: Blood sugar swings- due to high refined carbohydrates and not enough good quality protein and fats will cause T4 to be converted to Reverse T3 which keeps T3 bound up so the body and the cells can’t use it. This can cause us to lose hair too. Again, I know you were more concerned about dry brittle hair but the two go together.

   8. Are you digesting your fat well? Are you eating a good balance of omega 3 and omega 6 fats? Get a high quality fish oil and eat some healthy fats like olive oil, avocados and coconut oil to get a good mix of omega 3 and omega 6. The ratio of those should be around 1:1 and most of us get about 1:20 with omega 6 being the 20 because it is in a lot of processed foods and restaurant foods in the form of canola oil and soybean oil.

   9. Some people believe that supplementing with collagen can help your hair. We make less of this protein as we get older so you can try it to see if it helps. I would give it about a month.

   10. I would lastly look at your hair products. It doesn’t sound like this is an issue for you as you said you didn’t have a problem before and you had not switched products. My favorite hair products are Intelligent Nutrients- they are good for your hair and for the environment. I do think you are right though, your hair problem is internal. I would encourage you to use a food journal to keep track of what you are eating and how you feel and you may notice that you might need to change some things.

Good luck Jody, and please let me know if any of these suggestions helped you! 

Hi! Your podcasts have been great so far...thank you, thank you, thank you. I have been diagnosed with hashimotos for the past two years. I am 34 years old.

I decided to visit the doctor two years ago when I started having body aches and unusually dry skin. I was extremely tired all the time, however I thought that was natural due to having a newborn. I soon realized it was much more than being a “tired mom”.

I was put on levothyroxin. Seemed to even my levels out until recently. Started having stronger symptoms again and revisited the doctor. Taken off of levothyroxin (synthetic thyroid medication) and placed on nature throid (natural thyroid medication). What do you believe are major differences in a synthetic vs natural thyroid prescription?

Thank you again for all of your honest, transparent, and giving information.

CM

We have a similar story. I was diagnosed after my second child was born. I went in for a literal pain in my behind which turned out to be sciatica and when the doctor asked me if I needed anything else I told him I felt extra tired but thought it was because I had a toddler and an infant. He did a TSH test- standard for conventional medicine and my TSH was at 150- so clearly I had an issue with hypothyroidism. He put me on levothyroxine and I never felt good after that. My periods were heavy, I was cold all the time- like chilled to the bone and my adrenals were shot. 

Your question is about the differences between synthetic medication like levothyroxine and natural desiccated thyroid hormones like Naturethroid. I will get to that but I want to first address why things leveled off for awhile but got worse and your medication had to be adjusted. 

1. You were diagnosed with hashimoto’s which is first an issue with your immune system and second and issue with your thyroid- likely hypothyroid symtoms. When the autoimmune disease is not treated with diet and lifestyle modifications, your immune system can remain on high alert and can continue to attack your thyroid tissue killing it off. This often gives us the feeling of going between hypo and hyper symptoms. Maybe this has happened to you, maybe not. Anyway- one of the reasons for needing your dose to be increased is because more of your thyroid has been killed off. I guess you never said that your dose was increased but just changed to a different medication. Still, this is something to be mindful of.

2. Now, on to the differences between synthetic and natural hormone medications.

   1. NDT was used in the 1800’s to treat patients with hypothyroid symptoms. The medication is made from pig thyroid glands and this is why it is called natural. It also contains all the thyroid hormones present in our own thyroid tissue. Desiccated means that the pigs are bred for the purpose of getting the thyroid. It is removed with a specific protocol, frozen, minced, dried and made into a fine powder. It is defatted and batches are combined to get a uniform mixture of T4 and T3. The benefit of the natural desiccated medications is that you get what your body would have normally provided for you had your own thyroid stopped working properly. This means the right ratios of T4 and T3, and T2, T1 and T0. There is not a lot of research on T2,1 and 0 but they are obviously there for a reason so this might be why some people really feel so much better on NDT. The dosages are often referred to as grains. One grain equals 60 mg of NDT In Armour which is made up of 38mcg of T4 and 9mcg of T3. You can find conversion charts from manufacturers for most of the NDT medications on the market.

      1. Armour, NatureThroid and Westhroid are the most common prescriptions. My favorite was WP thyroid until I couldn’t get it anymore but have found great success using a compounded thyroid medication which is just the thyroid powder and cellulose which I open the capsule and put under my tongue. This is called taking the medication sublingually. It bypasses your stomach, gut and liver and goes right in to the bloodstream. This works for me, but doesn’t mean it will work for you. You can try it and see how you feel after a week on it. I take my meds in divided doses. Half in the morning when I wake up and half in the late afternoon. Western Research Labs or RLC labs is the manufacturer of your medication. You may be able to get all the ingredients of your medication on their site. Also be aware that your pharmacy can switch your medication without telling you if they run out of what is prescribed. You can ask your doctor to write your prescription to be dispensed as subscribed or you can let your pharmacist know that you do not want them to switch your meds. The main reason NDT meds are different is because they contain more than just T4. T3 plays a big role in cognitive abilities in the brain and how the brain functions. Got brain fog? Maybe you are not converting T4 to T3 or maybe you are lacking in T3. NDT might be what is the key to your brain fog, depression and mood problems for us. If you don’t feel any changes in those things, maybe you are not on a high enough dose or your body isn’t using it well. This is where diet changes can help. T3 is supposed to be better absorbed by the gut than T4. Studies show that 95% of T3 is absorbed within the first 4 hours of taking it and will happen even faster on an empty stomach. Back when Armour was first being used, they were making doses of medication based on symptoms and relief of those symptoms. Novel idea huh!?

      2. In 1926 synthetic thyroxine was created. Synthroid was made. To market this great money making drug- the maufacturer sold physicians on the idea that it was better than NDT. Research was funded to prove it was better than NDT. Unfortunately the study didn’t show Synthroid to be better than NDT. The research study was not published and the Dr. performing the research was discredited. A journalist caught on and broke the story and there was a lot of trouble for the manufacturer in the 90’s. The FDA pulled the medication due to irregularities in formulation. It was even marketed and sold in the US without formal FDA approval. In 2013 28,000 bottles of 150 mcg of Synthroid were recalled due to being a lower dose than stated on the bottle. Your doctor likely is just used to prescribing this medication because that is what they are taught. They have been told that NDT causes heart problems which is really a load of crap. Too much can lead to atrial fibrillation, osteoporosis, insomnia, heat intolerance, tremors, and more. My body takes awhile to get used to a NDT Medication change and that is why dosing it twice a day is recommended. Fight for the chance to try this kind of medication if you don’t feel well on synthetic only medications. The synthetic medications are really about money. Synthroid is the 4th most prescribed medication in the US at 70 million prescriptions a year. The profit from Abbott Labs funds endocrinology groups and their meetings as well as clinical research grants. Do you think they are going to publish studies that show their medication doesn’t work as well? Probably not. Pharmaceutical companies have more to gain by you being on a synthetic medication that keeps you sick vs. the Natural medication that makes you feel better.

I want to also talk about how it feels to have a disease that isn’t visible. I was talking with my niece and her husband last weekend about thyroid. Somehow the subject came up and my nieces husband said something about if your thyroid isn’t working right you are basically screwed or something like that. I had to laugh because he is so right. We don’t look sick but some days we just feel terrible. It is hard on us and hard on our families. My parents don’t understand, especially my dietary restrictions. They quit inviting my family over for dinner. My mom never makes an effort to understand how this has affected me. I don’t hold that against her- she is doing the best she can with the tools she has. So she says things like, let’s go out for pizza- you can eat a salad. Oh that sounds like so much fun to eat a salad while everyone else is enjoying pizza. It’s never- “let’s go to a restaurant where you can really enjoy the food”. She has thyroid problems too but all I ever hear is “I am so glad I feel so good”- what is normal for her is to feel tired and have a headache or just say she doesn’t feel good. She lays on the couch most afternoons and she had a headache everyday of my life in the morning. Sometimes we think we feel good because normal is to feel bad. 

Here are what some people are saying about what they want people to know about hashimoto’s. 

BA says:  In my case support... You don't "look" sick... My husband truly truly is trying to understand it all. He sees what it does to me but doesn't understand why. Thinks with diet and exercise I'll be just fine...

LH says:  Digestive issues, fatigue, stress,

GH says:  That everything can be great and you look and feel wonderful then you suddenly crash and feel like death. For weeks.

TF says:  Like one minute I lost 60 pounds, was working out every day at the age of 50 and living my best life and out of nowhere this monster hits me and now it’s horrible. I don’t know from one day to the next what is coming. I don’t even understand most of it. this disease is so extensive and complicated

TC says:  Why food makes us sick? Hurt? Not sleep?

KT says:  Always test your thyroid ANTIBODIES! All my “usual” thyroid labs were in the normal range, but antibodies off the charts... so grateful I finally had a doc test them!

TW says:  The fatigue is real, I’m not lazy. I don’t “want” to take a nap, I have no choice. What is needed? Research. Education of MDs and endocrinologists.

SJ says:  Extreme fatigue, and excessive weight gain ! 100 lbs, which I've been unable to loose for 20 years. Insomnia as well , and digestive issues ( gluten intolerant ). HASHIMOTO'S IS A BEAST !

TB says:  Research to determine which diet is the best for Hashimoto's. Extreme fatigue and brain fog are real!

SD says:  Educating MD's who are still treating all of our symptoms seperately, telling patients they are overweight because they eat too much and don’t exercise enough, and prescribing thyroid replacement that is man made instead of natural desiccated thyroid (NDT). Quit my doctor of 21 years 8 years ago and found a naturopath. Best decision of my life!!!

MH says:  More education, more testing. Doctors to understand test results vs symptoms and please don’t say” well you are  borderline even though you have these symptoms, so we will not treat you.”

TM says: Our tired is not their tired , it’s not even in the same realm . Our weight gain is not our fault . We are not lazy, we’re tired.

CE says:  Our inflammation is unlike others due to the constant aches we endure along with insomnia, depletion of vital nutrients, and gut problems.

AO says:  It may seem invisible but our body is having a nuclear war. New symptoms and concurrent disorders are constantly showing up, that don't seem to be related sometimes, and there hasn't been enough research to do anything but regulate diet and control some symptoms. It IS disabling for a large amount of people. With mine I had to quit work and can only last 2-4 hours of any type of work before I am too exhausted/weak/ill to function.

RS says:  More knowledge/awareness for everyone...So doctors stop running basic labs, so that people are more aware of symptoms and can ask for the correct labs, so loved ones can be more supportive of those with AI diseases, and so everyone realizes how vastly important our diets effect our health. The majority of people who find out I have Hashi’s have no clue what it is. I don’t look sick, so they don’t understand how I can go from 100 to bed ridden for days, or understand why I eat the way I do if I don’t have “food allergies.” People just don’t understand any of it, even my family and closest friends.