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
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.
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.
Terrible heart burn !!What helps? Has anybody had any issues with Omeprazole or any acid reducer.
OMEPRAZOLE: aka Losec, Prilosec, Prilosec OTC and Zegerid
classified therapeutically as antiulcer agent and pharmacologically as a proton-pump inhibitor
Used for maintenance of healing in erosive esophagitis, duodenal ulcers with or without H.Pylori. Short term treatment of active benign gastric ulcer. The OTC or over the counter is for heart burn occurring more than or equal to 2x a week.Read More
Today we are going to be talking about the adrenal glands. I had a question from someone asking me what the adrenal glands were so here you go!
Adrenal fatigue symptoms:
Being a night person, hard time falling asleep, slow starter in the morning:
All signs that your cortisol rhythm is out of balance causing cortisol to be high at night and low in the morning. It should be the opposite.
Do you tend to be keyed up and have trouble calming down?
This is a sign of increased adrenal output or hyperadrenalism. Having high cortisol with low DHEA can cause this. In the beginning stages of adrenal breakdown, the body’s response to stress is to increase the cortisol output from the adrenal glands. If the stress never stops, this process doesn’t stop and you will eventually have adrenal fatigue.
Do you get a headache after exercising?
This means your adrenalsRead More
Autoimmune disease comes in all different forms. I have been on the autoimmune protocol for about 11 months. I spent a whole year before going on it contemplating whether or not I should do it.
It is daunting. Overwhelming. A. Lot. Of. Work. All that cooking. I got used to it.
I had questions. What will I be able to eat? Will I be able to go out to eat? Will I be able to have any fun? What will a social situation look like? I adapted.
I have had such a love for food my whole life. It was my friend when there was no one else. It was love. It was comfort. It was my everything. It was the way I showed love or that I cared about someone. I cooked for them. I baked. I loved to bake. Bread, cake, cookies, brownies, muffins, more bread, more cake. What my kids didn’t eat I did. I love sweet things. I love chocolate. I loved sugar. None of this is allowed on the autoimmune protocol. So, you bet, I took a long damn time to decide to do this knowing what I would have to further cut from my diet. We can be positive and say, “Look at all the good stuff you CAN have.” Well. You can have a lot of stuff. Lots of vegetables. Veggies up the wazoo. You can have beef heart! And Liver! Yum! Do you hear the sarcasm? When 39 years of your life is consuming the Standard American Diet (SAD), this feels like kind of a big deal. Especially if you have emotional ties to food.
I know I am supposed to be eating those nutrient dense offal things. I am not because I can’t get past the idea of what it is. The texture even. Gah! No thanks.
When I did this. I was all in with what needed to be restricted. But I was not adding in any offal. So I didn’t and you know what? I still felt really good. My thyroid numbers got better. Then, as I started to feel better I added some foods back in. Not in the “proper” way but in a way that worked for me which was like this: You put pepper on that meat? Okay. Let’s see if I have a reaction to it…. No reaction. Okay. Pepper seems to work.
One day in August I made plantain brownies with carob. The recipe called for 2 eggs. I ate half the pan in about 12 hours and had a major reaction but it wasn’t how I expected. Not even 12 hours in to eating those brownies did I become so irritable that I could not even stand myself. I couldn’t believe it. I was raging. My poor kids. So, no eggs for me. I reinforced that idea when I mistakenly ate some gluten free crackers that had egg yolks (no wonder they were so good) as a snack before bed and the next day became increasingly irritable. That really bums me out. I liked eggs. I know that I dot’ want to live life in a state of constant rage though so I am willing to cut them out. I am not happy about it. Don’t get me wrong. I am actually a little pissed. I have a pity party every so often and do the whole “why me?” thing but then I let it go. The more I do that the worse it gets.
Now it is 11 months in and I have let some things slip. I have a vegan gluten free bread every so often and some Mary’s Gone Crackers crackers on occasion. They don’t seem to wreck my digestion and if I don’t eat them every day it seems to be fine.
I have decided that if I am so restrictive with my diet, I am unhappy. I do my very best most of the time and on occasion I do enjoy something off the protocol and I don’t feel bad for it. I still always eat gluten free but occasionally have some dairy. Dairy and I don’t get along so if I have it, it is usually just a tiny bit. Like a lick of ice cream or a dab of butter. I definitely feel better when I stick closer to the protocol. I have not reintroduced peppers or eggplant but have done well with some of the nightshade spices like chili powder. I am not so sure on tomatoes though. I have to do a "real" reintro to know for sure. That would mean just eating tomato instead of adding tomato in to a recipe and wondering if that is what has caused the issue. I'm not very diligent about doing a proper reintro of a food. I let life get in the way.
The real killer for me is sugar. I am addicted and I have intense cravings which are related to a yeast overgrowth which I am working on killing off. Too much sugar has resulted in me having to deal with psoriasis and this last go round with it gave me two new patches to deal with. Needless to say I got really mad when these popped up. I first got mad at myself for eating stuff I know is bad for me and then I got mad that I just can’t be normal. That is the most frustrating part for me. I just want to be like every one else sometimes and I can’t. When I look back on my life though it seems like I never have been able to be like every one else. When I try to be I find Idon’t feel like myself. So I have come to realize that my path is to take the road less traveled and see what I find. For me that is this new life of stress management, sleeping when I need to and eating so that I don’t continue to stay sick. Being well means different things for different people and my mission is to help you figure out what well means for you.
What do you do that makes you feel good?
Locally I teach a class called RESTART®. It is a five week long nutrition program with a three week sugar detox built in to it. I am a sugar addict and have been toying with the idea of giving up sugar for at least the last nine years. I used to work at a fitness center and one of the instructors there didn’t eat any sugar at all except for what was naturally occurring in fruit. None. At. All. I just could not get over how happy she was about it. It was a mystery to me at the time because sugar and sweet treats were my life. I baked almost every week and ate whatever my family didn’t finish. Muffins, cookies, cakes, bars. You name it and I baked it. Except croissants. My neighbor and friend made those and I never got around to making them before I gave up gluten. I always wanted to try to make them though. That and marshmallow’s from scratch. My husband thinks I am crazy but I find it almost meditative to bake. I loved it. Sugar became such a problem for me that I could not make any treats because I would end up eating the whole pan of whatever it was I made.
So, this idea of giving up sugar sat with me and marinated in my head for nine years. It nagged at me occasionally especially when I started to look at how diet can affect well being. When I started to see a Naturopathic Doctor for my Hashimoto’s, she told me I needed to cut sugar out of my diet. I always said I would try or that I was trying but as Yoda says, “Do or Do Not, There is No Try.”. He was right. I did not give up sugar and didn’t even really try to do it until I was put on a specific diet to heal my gut. No sugar allowed. It wasn’t even that hard to do it when I was told specifically to stay away from it. That lasted for 3 weeks and the chiropractor that put me on it said I didn’t have to be on it anymore. That was all I needed to give myself permission to indulge in something sweet. I don’t remember what it was but I know I went off the deep end and ate too much sweet because my psoriasis came back with a vengeance. When that happened I got so mad and frustrated with myself for “screwing up” that I caused a flare.
Fast forward a year and I became a RESTART® instructor leading a group of people to detox from sugar and learn about nutrition. I questioned how I could walk through a sugar detox if I didn’t give it up too.
I gave it up with my first class. I went through the whole detox with them and for me, it wasn’t so bad. I had already given up most refined sugar but was getting my fix through potatoes and a lot of fruit. Yes, you read that right. Potatoes. I replaced my need for a sugar high from sweet treats to potatoes and other starches like sweet potatoes and plantains. Sugar is sugar and your body treats all sugar the same really. It converts the sugars in potatoes and fruits in to energy just like it would a piece of candy. Of course there are nutrients in the foods I was eating so it wasn’t all bad but my body still needed a break and RESTART® gave it just the break it was looking for.
It allowed me to regain control of that demon I had been dealing with my whole entire life.
If you are wondering if the program is right for you, then keep reading. On the RESTART® program, you will be cutting out all forms of sugar including most fruits. Preparation will be key to your success. You will be prepping all of your meals for the 3 weeks you are cutting out sugar. There is no way to do this while eating processed junk foods or convenience foods with some exceptions that we discuss in class. You will be given a list of what is allowed and what is not allowed on the plan. We will also share ideas of how to plan our meals so we aren’t left in a jam where we are starving and there is nothing to eat.
A great tip to remain successful is to tell your friends and family about what you are doing so you can have lots of support. Better yet, enlist a friend to do it with you so you can support each other and be accountable to one another. You will also have the support of the other class participants each week as well as my private Facebook group that is just for RESTARTers.
The RESTART® program is about adding lots of real whole foods to your diet and replacing all the processed foods in your life. We all have our go to’s and we can all give them up for 3 weeks.
I am an emotional eater. When I am feeling down or stressed I want to sooth myself with a treat. It might even be a coping mechanism for me. This program forced me to take a look at the reasons I turned to certain foods like sweets. The RESTART® program has helped me learn and to develop a new relationship to food and my reasons for turning to sugar. It is an uncomfortable place to be at times but I came out okay on the other side.
I have regained control of my sugar addiction.
Treat yourself in ways that don’t involve food. Hikes or walks, relaxing baths, massages or a yoga class. All of these things can make you feel just as good as a pint of ice cream (better in the long run) without the guilt that usually follows.
When you cut sugar out of your diet, you will likely experience the “sugar flu” or detox symptoms. It usually happens within the first two weeks and lasts for a couple of days. Mood swings, depression, issues with digestion, skin rashes, muscle or joint aches, less energy. This is the result of toxins leaving your body. You will feel so much better in the end.
You will also find that things that didn’t seem so sweet before will taste sweet enough to you after the three weeks are up. I had a private client recently who I put on this diet and she did not like green apples. She refused to eat them while on the program because they were too sour. I encouraged her at the end to just try one before she had a naturally sweeter apple. She found that the green apple was significantly less sour to her after the three weeks and she actually enjoyed it. Most of us consume things that are extremely sweet and when we give those things up, our taste buds have a chance to reset and we are able to really taste our food. This reset allows our brain to reset too. It won’t crave the crazy sweet stuff like it used to.
Real whole foods will be enough.
We all slip up. It’s okay. There is no guilt in RESTART® about slipping up. Just move on. it doesn’t mean you have to start over. Be kind to yourself. Nobody is perfect. Our motto is “Whatever I eat, I choose it consciously, I enjoy it thoroughly and then I let it go.”
You will see positive changes. Everyone is different but you may experience weight loss, more energy, improved digestion, clearer skin and a clear mind. You just won’t believe how negatively sugar was impacting your whole body. By the end you will feel so great about how you have impacted your health for the good. All in only five weeks.
Are you feeling ready to give your health a RESTART®? Classes do run regularly but sign up for my newsletter here to stay on top of when the next class is. You can even host one in your home or we can do one via the web. Contact me for more information.