What are you making for dinner these days? I share some of what I’ve been eating, talk about batch cooking, and the importance of eating enough fats and proteins to keep your body full longer. Also, did you know there are six types of thyroid dysfunction? Let’s take a look at the characteristics and labs for each to try to make sense of it all.Read More
An ongoing conversation on topics that matter to you — by Stephanie Ewals
Your immune system needs to be regulated in order for your Hashimoto’s disease to be managed. There are different ways immune cells could be affecting you. What are B-cells, Natural Killer cells, and Cytotoxic cells? I talk about all of this and more in this week’s episode.Read More
Why is adrenal health so important? Your ability to be resilient, have energy, and endurance all depends on the adrenal glands ability to do their job. What are the symptoms of adrenal issues? And, what causes adrenal stress? Join me exploring this crucial Hashimoto’s topic.Read More
Are you on a hormonal roller coaster? Let’s talk about what perimenopause and menopause are before we dive into what might be happening to this listener (and possibly you). I’ll also share tips on managing your diet and allowing some self-care.Read More
In today’s episode I am talking with Danna Bowman (Thyroid Nation) and Ginny Mahar (Hypothyroid Chef) who have teamed up to create a really cool interactive program on their Thyroid Refresh® website called Thyroid 30®. We talk about how they found each other to team up and create a positive space for thyroid patients to be supported, what some of the biggest mistakes thyroid patients make, how lifestyle choices make a difference in your recovery and more. Use code TryThy30 for $5 off their program starting January 13, 2019.Read More
Why is maintaining healthy blood sugar levels or keeping your blood sugar balanced so important for your thyroid? In this episode, we’ll explore some whys and how-to’s surrounding this issue. Also, check out my RESTART program for more information and support on getting your blood sugar balanced.Read More
Stephanie, Thank you so much for a wonderful podcast. I love that you keep it real while answering difficult questions for us. You have a very calming and peaceful voice and I am always so encouraged listening to your podcasts. Keep them coming. We are listening and learning.
What do you do if you forget to take your medication?
Half life- a half life in the world of medications means the amount of time it takes for the concentration of the medication in your blood plasma to reduce by half. Said another way- it is how long a drug stays in your system or the amount of time it takes for the effectiveness of a drug to reduce by half.
If you are taking levothyroxine, the half life is 6-7 days and up to 9 or 10 days if you are dealing with hypothyroid conditions. If you have hyperthyroid conditions then it can be as little as three days. Nothing seems to be easy with this disease.
Levothyroixine is a common treatment and most likely what your doctor will prescribe unless you have a doctor open or more knowledgeable in thyroid health.
For practical purposes we will go with a 7 day half life for levothyroxine. When you take this medication, around 80% of it goes through your system over a longer period of time, like several hours.
According to the Williams Textbook of Endocrinology, missing a day shouldn’t have a big effect on you. They also say that T4 is absorbed very well by the body so waiting an hour to take your medication before eating might not necessarily be required. Taking it on an empty stomach will give you a more stable TSH reading though. But since we all know that TSH should not be the gold standard, that maybe shouldn’t matter.
The reason you usually have to wait 6 weeks to have your labs tested is because of this long half life. It takes about 6 weeks before your body has adjusted to a dose.
However, if your digestion is not working well and we are going to talk about that in a minute, then you may have issues with absorption and of creation of T3 from your T4 only medication.
There can be an issue in concentration of medication between manufacturers which can mess with your body. So, be proactive and let your pharmacy know that you do not want them to switch your medication without your knowledge. Remember that getting this dose right is like goldilocks- it needs to be just right.
This same textbook also says that NDT is not a good choice for treatment and that TSH is the gold standard so- take it for what it is worth.
A NDT like Armour has a half life of 2-7 days with the T3 having a half life of 4-6 hours. So if you take your medication with T3 in it at 8am then sometime between 12pm and 2pm you have about half of the original dose of medication in your system. Your cells will have used the rest of it. But it should last you about a day. This means half is gone in 4-6 hours, another half of the half (a quarter more ) will be used in another 4-6 hours and so on.
T3 is used up faster because your body doesn’t have to convert it like it does T4. This is why it is a good idea to take a partial dose in the morning and a partial dose in the afternoon.
Now let’s talk about what happens when our digestion isn’t working well because this is very important for our thyroid to work well.
Thyroid peroxidase is an enzyme. It makes thyroid hormones by cleaving off an iodine molecule and adding it to the amino acid tyrosine on thyroglobulin which then makes T4 and T3. In order for this to happen, we need to have available to us: selenium, copper, magnesium, B vitamins, zinc, vitamin A.
You should not just go and willy nilly supplement with these vitamins and minerals. There are many factors involved here and supplementing with some of these may make things worse in the long run. So it is a good idea to either do a lot of your own research or work with someone who knows how to work with your condition.
Our gut or gastro intestinal tract is an important factor in our thyroid health but even before that, what we eat and how we break it down in our stomach is a key factor.
Before we even talk about what you are eating, let’s talk about how you are eating it. Are you running through the drive through before or after your kids activities? Are you eating in the car or eating while you are doing something else? Are you relaxed or stressed while you are eating?
Any of those scenarios will mean you are going to struggle with breaking down your meal before it even gets to your small intestine where most of the nutrients are absorbed.
Digestion actually starts in the brain. We smell our food cooking and our brain signals the production of saliva so we can break down some of that food in our mouth while chewing. Are you chewing your food well? Like 20-30 chews per bite? Really breaking it down so the enzymes in your saliva can begin digesting the carbohydrates in your meal?
Once you have chewed well, you swallow and that ball of food goes in to your stomach and stomach acid and pepsin get to work digesting or breaking down proteins.
Do you have acid reflux after eating? (there is more about this in the audio)
Once it is broken down in the stomach and reaches the right pH then the valve between your stomach and your small intestine opens and fats are broken down by the release of bile and nutrients are extracted in the small intestine and absorbed in to the blood stream.
Here is where your gut health comes in to play since leaky gut or Intestinal Permeability are what contributes to autoimmunity.
We need a balance of gut bacteria in our intestines to help us convert T4 to T3 there. If we are not eating right or digesting well then we will have an imbalance of bacteria and intestinal permeability.
We can end up with parasites, overgrowth of candida and constipation- all with their own contributions to our failing health.
When we have hypothyroid- we have a sluggish gallbladder which means we might struggle to digest our dietary fats and then we are making thick and viscous bile which further messes up the gallbladder function. When this is not working well, we are not detoxifying as well either. so we can’t break down hormones or toxins from our environment.
How are you pooping? No one wants to talk about it but you must be moving stool through your body and going every 16-24 hours. Your BM should be the size of your forearm from your wrist to your elbow, it should come out with ease and you should feel relieved when you are done and not like you still have to go.
Being constipated further contributes to the “bad guys” overgrowing in your Small Intestine and causing bacterial infections, you may experience chronic pain, inflammation, digestive issues, food intolerances and Hashimoto’s.
With all of this happening, we can also have issues dumping estrogen and so it can accumulate. This can cause hypothyroidism that you won’t see on a blood test according to Datis Kharrazian in Why Do I Still Have Thyroid Symptoms. This excess estrogen will keep the thyroid hormones from getting to the cells- causing hypothyroid symptoms.
So you see, taking supplements without first healing the gut is pointless. It is a band aid at best. The only supplement you may need at this point is some stomach acid- Betaine HCl so you can start to break down your food and get those nutrients to your cells, kill off some of the bad guys and bring things back in balance.
You will see improvement in chronic inflammation from changing what you eat and the way you eat it. Start with your plate. With breakfast. Make some bone broth. That is the next recipe to go out in my newsletter so sign up for that.
So reduce inflammation by cutting out gluten, dairy products, eggs, most other grains, soy products and yeast. Yeast can feed an already out of control candida overgrowth. These are some of the big allergens, in other grains it is best to avoid corn for sure.
This gives your body a chance to calm down so it can properly react to foods.
You need to be on an elimination diet for 3 weeks to 3 months depending on how sick you are, how inflamed, or how long you went untreated for Hashimoto’s. In addition to this, you can do something called a FIT test
What can you eat? There are no notes for this. It’s only on the audio.
I was on this facebook group today for people with Hashimoto’s and autoimmune disease. Someone newly diagnosed was wondering about fatigue and being completely drained after workouts and wanting to nap even after 9 hours of sleep. I responded with take the exercise down a notch by trying to just walk for now and google the Autoimmune Protocol. Someone else responded with how they can eat what they want and exercise and that they get down sometimes and maybe a little tired but doesn’t everyone. She said she chooses to live her life, not her diagnosis.
Article on green med info talking about using selenium and Myo-Inositol being used to put hashimotos in to remission and euthroidism which means your thyroid is working on its own.
Before 1970 it was considered toxic but has since been classified as an essential nutrient needed in small amounts. It functions as an antioxidant.
It is hard to get from foods because soil levels are varying so you never really know what you are getting especially if you are not eating local produce that is harvested in soil that is being managed properly. In the US the western part of the country may have higher levels than the eastern part with South Dakota having the highest levels and Ohio the lowest (According to Staying Healthy with Nutrition by Elson Haas.
We have less than 1mg of this mineral in our body and most of it is stored in the liver, kidneys and pancreas. Men need it more than women due to it being in their testes so it may have a function in sperm production.
We lose selenium through eliminations and we should be able to absorb it through our intestinal tract at a rate of about 60%. This, of course will be dependent on your ability to digest your food well and also whether or not your gut is healed. We absorb it better when it is combined with amino acids- this means you have to be eating protein and breaking it down.
Most selenium in foods is lost when they are processed like in white rice or flour. Food sources are liver, butter, fish and lamb, whole grains (out for most of us dealing with autoimmune disease), nuts- especially brazil nuts, shellfish, salmon, garlic, onions, mushroom, broccoli, tomatoes, radishes and Swiss chard can have good amounts of selenium if the soil is good where they are grown. Many experts believe that Brazil nuts have such a varied content of selenium that we can’t necessarily rely on them. If you supplement, selenomethionine is your best bet at around 100-200 micrograms a day. Some suggest 200 mg for about a month and then a maintenance dose of 100 mg. Learn to listen to your body and if you are interested in knowing your levels, getting the plasma selenium test is ideal. Serum and whole blood will work too so if your doctor is able to test it, have them do it.
Toxicity and deficiency symptoms are similar. Liver damage, hair loss, brittle nails with white spots and streaks. They can even fall out. These would be due to high soil levels. If the supplement you are taking is formulated wrong, you can have muscle cramps, nausea, diarrhea, irritability, fatigue, loss of the hair and nails, pain, numbness or tingling of the hands and feet. Deficiency will make you more vulnerable to infections, toxins, and other nutrient imbalances- again- this is where good digestion is key. If you are taking anything to reduce stomach acid you will be deficient in selenium as well as many other vitamins and minerals. Most birth control pills will also deplete you of it as well.
When you are NOT deficient you may tolerate cigarette smoke better as well as alcohol and poor quality fats.
How does this relate to the thyroid? We need selenium to convert T4 to T3 which is the usable form of thyroid hormone that our cells need. Also, when TSH is produced and released, your body gets a message to make more hydrogen peroxide. This is needed to help make thyroid hormone in a round about way. It is needed to make some things happen in your body so the hormone gets made. We need antioxidants to neutralize the hydrogen peroxide after it does its job. Selenium is part of the process of helping glutathione neutralize the peroxide.
In Isabella Wentz’s first book, Hashimoto’s Thyroiditis, she explains that if you are taking in too much iodine, more hydrogen peroxide needs to be produced which will mean you need more selenium to neutralize it. When you are already deficient in Selenium, you can end up with too much hydrogen peroxide which can cause inflammation around your thyroid tissue which creates an immune response, antibodies are produced and you have autoimmune disease.
She recommends taking a selenium supplement on an empty stomach with vitamin E which helps our body absorb selenium better.
Myo-insoitol is the same thing as inositol and is found in lots of fresh fruits and veggies so supplementing with it may not be necessary. High amounts are found in oranges, grapefruit and limes with blackberries, kiwi, cherries, peaches, apples being up there too. You can get it from brussels sprouts, beans, artichokes, cabbage, asparagus, dark greens, zucchini, bell peppers. As long as your digestion is working well you should have no problem getting enough from your diet as long as you are eating real whole foods.
It was once considered B8 but since our body can make it, that distinction was taken away. Some still consider it to be part of the family of B vitamins though. It actually can help your body break down fats for digestion. It helps keep our cells firm so nutrients can get in and wastes can get out. It also helps brain cells work better.
Caffeine can produce deficiency which can look like constipation, hair loss, high cholesterol and even eczema. Again, you can get enough from your diet so you don’t need to supplement.
Learn more about the nutrients our body needs here.
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.
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.