My Notes From the Diabetes Summit
An Interview with Izabella Wentz PharmD
We know that thyroid disorders are very common in the general population, anywhere from ten to twenty percent of the population. This risk for thyroid disease increases almost to double with people who have diabetes and about thirty percent with type 1 diabetes also have autoimmune thyroid disease. On the other hand people with Hashimoto’s and thyroid disease are often at risk for either diabetes or dysglycemia, a study in Poland showed that fifty percent either had diabetes or glucose intolerance.
Type 1 diabetes is an autoimmune condition and so is Hashimoto’s, research shows if you have one autoimmune condition your more likely to have another autoimmune condition. Some of the root causes are going to be the same it depends on your genes for what autoimmune conditions your going to develop as well as the triggers in your environment. You need three things for autoimmune to manifest, the first part is the genes, the second part is an environmental trigger. This can be an infection, a toxin, stress, nutrient deficiencies and the third is intestinal permeability. For one reason or another a person may have leaky gut where the gut doesn’t properly hold it’s contents then people are getting these things into the circulation and setting off an immune response. According to recent studies this is present in all autoimmune conditions including type 1 diabetes so I recommend with anybody who has this to focus on. I have found working with patients they usually have a combination of nutrient deficiencies, food sensitivities, they may have infections and also intestinal permeability. We look to see if we can take away some of the triggers to help people get into remission.
You can suspend autoimmune disease, obviously if your thyroid or another organ has been completely destroyed it’s really hard to reverse that damage but you can slow down the progression of it or stop it. A lot of times it’s the same underlying root causes or triggers that are causing the immune system to attack a whole bunch of things not just your thyroid or pancreas. A lot of people with diabetes also have to worry about hypothyroidism and hyperthyroidism. Worldwide we see iodine deficiency as the primary cause of hypothyroidism in just about every country that adds iodine to the salt supply. We find 90-97% of people with hypothyroidism actually have Hashimoto’s you just weren’t told you have it. Often times you’ll be told your thyroid is sluggish or you have hypothyroidism, doctors will often times not tell them why they developed this condition so I encourage everyone to ask and have the test done for Hashimoto’s.
The classic symptoms for hypothyroid is cold intolerance, hair loss especially the upper third part of the eyebrow, fatigue is the biggest complaint, weight gain or inability to lose weight, libido and fertility. If your thyroid is not working properly and you get pregnant you may be at risk for losing your baby or at risk for not getting pregnant so it’s good to have a thyroid test done. Another one is mood disorders, people can feel like their going crazy, you may feel super anxious, depressed, people have even been diagnosed with psychotic disorders, bipolar disorders even schizophrenia because in the initial stages of Hashimoto’s. What’s happening is your thyroid gland, all of these packets of thyroid hormone get rushed into your bloodstream and you have these spikes up. Thyroid hormone makes us more active more awake, once that’s cleared out you get really sluggish this can look like bipolar condition to the average clinician.
All of these symptoms are one hundred percent reversible, the other part is knowing you have this condition so if your experiencing any of these symptoms make sure you have a thyroid test. Don’t have them just do the basic panel, I had chronic fatigue for about nine or ten years where I was sleeping for ten to fourteen hours a night and I went from doctor to doctor and they said ok we tested you for anemia and the thyroid everything is normal try a psychiatrist and get some antidepressants. The problem was that they were only testing my TSH the TSH is the basic test for hypothyroidism, TSH is thyroid stimulating hormone. In most cases this test will not pick up on Hashimoto’s in the early stages and also doctors used to use an old reference range, new research has redefined the reference range to no greater than 2.5 for normal. Most patients feel best with a .5-2, some doctors argue that 1 is where you should be at. For me when I got my TSH down to 1 from 4.5 all of my symptoms went away including my hair growing back and sleeping only eight hours a night.
The other important test is thyroid antibodies TPO and TG antibodies, these are the tests that will be indicative to tell if you have Hashimoto’s. These levels will be elevated for up to five to ten years before you see it in a test in TSH. If you can pick up on Hashimoto’s before you have a change in TSH you can prevent thyroid damage to your thyroid if you do the right things. The other tests are going to be free T3 and free T4 there may be a pituitary component basically that there’s a breakdown in communication between your thyroid gland to your pituitary gland and your TSH may be normal but in fact you don’t have the right amount of thyroid hormone circulating. Free T3 and freeT4 are going to measure that. The last test that everyone should get at least one time in their life is a thyroid ultrasound test. Studies have shown that 80-90% of people with Hashimoto’s will be positive for thyroid antibodies but there are also people that will not have these antibodies show up for what ever reason and the way to see if it’s Hashimoto’s is to do the ultrasound.
Some antibodies are normal when you get about thirty five it’s a concern, there are a few reference ranges but most use greater than thirty five as an indicator of being positive for thyroid antibodies and you will want to reduce this. The higher the antibodies the greater your risk of developing hypothyroidism in the next 1-5 years, it’s a thyroid events Amsterdam score it’s on my web page you can search for THEA it’s basically a risk assessment to get a number to see your chance of getting hypothyroidism.
When I was in pharmacy school we had a very short lecture on thyroid disorders and told what the drug of choice was their super synthrex, easy to treat send them out the door goodbye, that’s the conventional school of thought unfortunately. Working as a pharmacist for many years and being diagnosed myself and now working with a lot of people with Hashimoto’s sure synthrex works for a lot of people, it does help to reduce some of the attack on the thyroid gland because it makes it less visible to the immune system but I may be biased I find the majority of my clients don’t have that experience. Some people are not able to properly convert synthroid the active ingredient that is known as T4 in pharmacology, we call it a pro-drug because it needs to be connected to T3 which is the more biologically active hormone. Not everybody does that correctly or efficiently so we will see a lot of times these people will get on these medications and their hair keeps falling out and they can’t loose weight. For these people we would recommend doing a natural desiccated thyroid medication or a compounded medication that contains T4 and T3. Some of the active hormone is already in that medication pre converted so the person can just take it and start feeling better right away. I’ve seen miracle stories where these people were switched onto this medication that has fallen out of favor because it’s an older medication available as a generic.
A lot of people will be told they have a sluggish thyroid and given medications and get sent off then a few years down the line they develop another autoimmune condition like lupus or rheumatoid arthritis because they didn’t address the root cause of Hashimoto’s. Conventional medicine basically says you’ve got this problem here’s a drug for it goodbye, that should solve all your problems. The medications as important as they are in people who have an underactive thyroid really just mask the symptoms of the underlying attack on the thyroid. I think this is part of the reason a lot of doctors won’t test you for Hashimoto’s once you find out your own body is attacking your thyroid then how do I stop this attack, how do we reverse this condition.
One of the big things that always triggers autoimmune disease and about every disease you could probably think of is stress. Try to reduce the stress in your life whatever is causing you stress that’s not necessary try to cut it out. Start working on yourself think of the positives, start meditating, yoga or running whatever you can do to help manage stress because it’s not helping you with anything. Most people will not reverse one hundred percent of their autoimmune conditions just by letting go of stress but some people have. The power of having a good mindset is powerful and a good place to start.
Another source of stress is food so looking at your diet balancing your blood sugar is very important, a lot of my symptoms of anxiety, hair loss and palpitations I was able to stabilize those symptoms by stabilizing my blood sugar. Blood sugar swings cause an uprise in thyroid antibodies, you could do a green smoothie for breakfast that has plenty of fats and plenty of protein I have a recipe on my website. You want to cut down the starchy foods even the fruit if you drink a lot of fruit juice in the morning that could be causing these swings. Also look at food sensitivities and the foods that are causing your immune system to react. Celiac disease has been known as the great imitator when someone has celiac disease and their eating gluten their body recognizes it as a foreign substance and begins to launch an attack against the gluten, sometimes this results in an attack of anything that looks like the gluten which sometimes is the thyroid gland.
People who had subclinical hypothyroidism and Hashimoto’s were put on a gluten free diet twenty percent of those were able to eliminate their thyroid antibodies and their thyroid function would return to normal. What I found is most people with not just celiac disease it’s most people with Hashimoto’s and autoimmune disease do better on a gluten free diet. Their thyroid antibodies will go down and a lot of their symptoms will go away. Another big food is dairy I’ve seen people with type 1 diabetes have shown that dairy could be a trigger for it, it could also be a trigger for Hashimoto’s. I also had a lot of symptoms go away when I cut dairy out of my diet. Some of the other triggers are going to be eggs, grains, nightshade vegetables, nuts and seeds. Doing something like food sensitivity testing or an elimination diet can be very helpful in figuring out your food triggers. I have seen people completely reverse their condition by trying a gluten free, dairy free, soy free diet, paleo diet or an autoimmune paleo diet. For some people this is all they need to do is take care of their nutrition and that reverses their condition. Soy is a big that’s like really poison to the thyroid gland.
The other thing I look at to see is if you have nutrient deficiencies the bigger deficiencies are going to be selenium, taking selenium has been shown to reduce thyroid antibodies by almost fifty percent over a ninety day course of taking 200 mcg. That can help with the hair loss and anxiety as well as the fatigue. The other big deficiency is stomach acid, I was diagnosed with acid reflux which is common with Hashimoto’s. What’s happening and there’s a lot of studies to back this up, hypothyroidism actually results in having no or low stomach acid which means your not properly breaking down your food. You will have some symptoms that look like stomach acid because you’ll be regurgitating things it also results in your getting more food sensitivities. Taking something to support stomach acid I like something called Betaine with Pepsin can make a dramatic difference. I have information on how to take this on my website just go to thyroidpharmacist.com/gift
There is this autoimmune theory known as molecular mimicry which means our immune system will react to a bacteria or virus that we have and launch an attack on whatever you have. When that pathogen will have a protein sequence that’s similar to part of our body like the thyroid gland then our system will also attack that body part. There are a variety of different infections that have been implicated in triggering Hashimoto’s, Epstein-Barr Virus and H-pylori are two of the most well known. I have seen a lot of people who treat these infections and go into remission from Hashimoto’s, they will work with conventional medical doctors that are a bit more open minded or they will work with their functional medicine doctors and get on antibiotics or herbal antibiotics to clear these infections which results in the body no longer attacking themselves. Another problem is an impaired ability to get rid of toxins, there’s a specific gene mutation that a lot of people have the MTHFR gene, that basically makes us not be able to get rid of toxins as quickly. I recommend methylated B vitamins, methyl folate would be one example and not eating a lot of processed foods that add folic acid in because in those cases a lot of people can’t metabolize that anyway.
I always recommend working with a functional medicine doctor to get to the root cause.
Six steps to health – find the correct diagnosis, manage your medication, food pharmacology, getting your diet right is essential food is medicine, balance your adrenals and thyroid, heal the gut and remove toxins. There is a direct connection of the microbiome to insulin resistance and diabetes, studies have shown how gut health can trigger type 1 diabetes. There are a few different causes for low T3, take a T3 medication can be helpful in the short term, looking at reasons why their not making enough T3 a lot of times it’s stress. Stress cause us to make more reverse T3 your body may be making enough T3 but it’s being converted to the reverse T3. Stress is a really big factor for adrenal function as well as some nutrient deficiencies, zinc is one that can be implicated in not properly converting as well as selenium. We have to look at the whole picture as to what’s causing the T3 to be low. When people have diabetes their also going to have a problem with lipid abnormalities, increased cholesterol, increased triglycerides and thyroid disorders if you have hypothyroid the same thing is going to happen. If you have elevated LDL cholesterol and triglycerides you need to look at your thyroid and make sure it’s properly optimized and managed because you might be able to get those normalized just by going on the right dose and type of thyroid medication or doing some of these functional medicine things. They don’t work overnight their not magic pills but they can make a tremendous difference in the long run.
There is a free gluten free quick start guide on my page and recipes.
Izabella Wentz PharmD web page thyroidpharmacist.com
Disclaimer: The information contained on this site is for educational purposes only and should not be used as a substitute for diagnosis or treatment rendered by a licensed physician. it is essential that you discuss with your doctor any symptoms or medical problems that you may be experiencing.
M.Scherker medical researcher