Bite Back with Abbey Sharp - Is It Really Your Thyroid? The Truth About Weight Gain, Fatigue and “Normal” Labs with Dietitian Priscilla Swahn

Starting point is 00:00:00 It's like we have demanded that women find this pathological origin story for their weight gain because our culture treats ordinary body diversity and the fact that bodies change as we age as some kind of personal failure. Welcome to another episode of Bite Back with Abby Sharp, where I dismantle diaculture rules, call out the charlatans spinning the pseudoscience, and help you achieve food freedom for good. Today we're diving into what has become a bit of an enigma in a lot of online spaces. And that is thyroid, nutrition, and health. To many, the thyroid is this mysterious organ that is seemingly at fault for all that ails us.

Starting point is 00:00:48 The fatigue, the brain fog, the hair loss, constipation, depression, and the difficulty losing weight. And because many of these symptoms are overwhelmingly common and non-specific, especially for women also navigating paramenopause or other life changes, the thyroid health community online has become a magnet for wellness culture BS. From grifty root cause protocols to hyper-restrictive diet hacks to sketchy supplement stacks promising to fix a broken metabolism, it has become increasingly difficult to tell where legitimate thyroid care ends and fear-based misinformation begins. So to help us sort through the noise, today I'm joined by registered dietitian and thyroid health specialist Priscilla Swan. We're going to be unpacking how the thyroid actually affects your metabolism and weight.

Starting point is 00:01:43 Why your labs may be normal, but you feel anything but. What the research actually says about all of those miracle thyroid supplements and superfoods and what you should be focusing on if you are struggling with thyroid dysfunction. A quick reminder here that the information in this episode is for entertainment purposes only, and I always recommend working with an RD and medical team for one-on-one care. Also, if you have not already subscribed to Bight Back, I really would appreciate if you would. It really does help me spread the word. So please do your little shares, leave me your love notes on the episodes,

Starting point is 00:02:20 and thank you in advance for all of your support. All right, friends, let's dive in. All right, thank you so much, Priscilla. I'm very excited to chat with you. so thanks for joining us on ByBack. Absolutely. Thank you for having me. I'm so excited.

Starting point is 00:02:33 Okay, so, you know, to set up these conversations, like I often like to kind of start with some basic definitions because we know a lot of the time, you know, people hear a word on social media, in this case, thyroid or hypothyroid. And we may be like, no, it's related to weight or metabolism or energy levels, but we don't necessarily understand fully what it does. So can you help set the stage and tell us what even a thyroid is and what a normal healthy thyroid is designed to do? 100%. Yes. And you are so correct. I feel like it's gaining a lot of traction on social media. And then women naturally are just saying, hey, it must be my thyroid. And that's what's going on. And they might not be wrong. And so, yeah, so the thyroid, it's that little butterfly gland right in the front of your throat. And it's the.

Starting point is 00:03:27 powerhouse of a lot going on as far as hormones and your metabolism. And so that is the primary issue that we're seeing is when it's not working appropriately even becomes suboptimal, then your metabolism becomes a little more sluggish, the metabolic rate, as we call it. Yes, yes. It's really in charge of, you know, it's the metabolic regulator, you know, your resting metabolic rate, body temp, heat, heart. heart function, blood circulation, metabolism of different macronutrients, fluid, salt balance,

Starting point is 00:04:02 nervous system, like muscle, digestive motility, like it really plays a role in so many different things. It's kind of the jill of all trades, so to speak, and it's, it influences every system in the body to some capacity. But can you just kind of tell us what, what kind of symptoms does that translate into if we're looking at hypothyroidism or low thyroid hormone versus hyperthyroidism, okay high levels. Yeah. So hypothyroidism, the most common one that we hear a lot about is the weight gain. And then also it can affect our temperature. So feeling more cold all the time, even when it's hot outside, hair loss, low energy. Those are prominent hypothyroid symptoms. And then hyperthyroid is the exact opposite. You're losing weight. You're a little more jittery like you had too much coffee, a little more heart.

Starting point is 00:04:55 palpitations going on anxiety on edge and a little more restless and hard to sleep at night. I would bet all my savings that every woman listening to this episode right now is probably, you know, hearing this long list of symptoms, whether we're talking about the hypothyroidism, and thinking, oh my God, that's me. That's me. Like I have fatigue. I struggle with, I struggle to lose weight. I feel puffy or bloated. So these are pretty. like non-specific symptoms that could be related to thyroid dysfunction, but it could also have, you know, a multitude of other explanations. So, you know, obviously the next critical step here is for your doctor to run some tests. And so, you know, for folks listening, usually the first test

Starting point is 00:05:44 is T-S-H, my goodness, thyroid-stimulating hormone. But then, you know, sometimes doctors will also want to look for T-4, T-3, possibly antibodies, essentially. But let's just say you do all that. And your labs come back within range. And your doctors are like, yep, you're good. Is that it? Or are we sure we're good? Yeah.

Starting point is 00:06:07 And I love that you threw out there the antibodies because I was going to throw that out there because you're right. Doctors most of the time just draw the T-SH. And then it's like, no, no, no. Let's go back. Get the T-3, T-4 as well. We want to make sure things are converting well in the gut and the liver. And then lastly, the antibodies.

Starting point is 00:06:24 But if you've done all the things and you're just like, oh, it's still normal, then that's when we want to discover, is it more of a metabolic issue? Are there allergens out there as far as celiac disease going on? Just checking the boxes for these things. But a lot of women are still left feeling crazy. Like, oh, that's wrong with me. And I have still found that research has shown that it can take up to 10 years for. a thyroid condition to fully develop where it shows on the paperwork that you're getting back

Starting point is 00:06:59 from your doctor on the labs. And so you can be developing all those symptoms during the course of these 10 years. So, okay, a little less, you know, you can't eat carbs like you used to or drink that soda or have as many glasses of wine. You're starting to see it. And so that's where it's maybe where I say normal isn't your optimal thyroid level as well. Some people operate at a level for their thyroid. Yeah, I think what's really important for folks to know, and this is not just when it comes to thyroid number, lab values, but a single lab value can really only tell us so much because a reference range of what is quote unquote normal, these aren't magical borders where symptoms

Starting point is 00:07:42 suddenly switch on and off, like you've said here. And, you know, reference ranges typically describe just 95% of a healthy population, not necessarily any one individual's ideal thyroid set point. So as you mentioned when it comes to like the progression of these things, patterns are really important. And so, you know, what are our thyroid levels before versus after when symptoms started? So for example, if you think about a free T4 reference range being from 10 to 20 picomoles per liter, which is a pretty big range of what is quote, quote, normal. One person's usual value might always be at 11. while another person always sits at 19,

Starting point is 00:08:27 but the change from 19 to 12 would still remain technically, quote, quote, normal, but it's a significant departure from that person's kind of historic pattern or what their normal is. Absolutely. So I think that, you know, don't just think that you check something once and then, okay, then you don't need to worry about it again. These things, we're looking for patterns, stay with blood sugars and things like that. And so, you know, when you look at Twitter,

Starting point is 00:08:54 studies and family studies, they suggest that about two-thirds of person-to-person variation in thyroid levels in the concentrations are genetically influenced. So this is really like we all have our individually genetically regulated set points and we need to be paying attention to our own numbers as opposed to just what that range says. One thousand percent. bad yeah now one of the most common complaints obviously amongst folks with hypothyroidism is this experience of having the sluggage metabolism difficulty losing weight as you mentioned how much exactly of an impact does the thyroid or hypothyroidism play in your metabolism and body weight yeah so it it does

Starting point is 00:09:42 have a big impact as it is correlated to your metabolic rate dropping. So that's the amount of energy your body is burning. So for other people's eating 2,000 calories, their body's going to burn that right off, whereas you might not do it as fast and it's going to conserve some of that as fat to store for later. But at the same time, women can make this so much harder on themselves, by eating less and less, working out harder and harder. And that's just telling that metabolic rate, like, oh, at first we'll lose a little weight, but we're starving ourselves. I have to protect you.

Starting point is 00:10:24 We're going to keep decreasing that amount of energy that we're burning so we can save that as fat because we don't know if we're going to eat again. And that's compounding the issue even further. Right. Yes. And I mean, I want to just kind of take a moment to be mindful that, that, you know, talking about this, you know, how much of your of your weight gain, for example, is due to your hypothyroidism, it can be a very sensitive topic to unpack because, you know, if we are to suggest

Starting point is 00:10:51 that the thyroid, the pathology only accounts for modest metabolic variations, it feels like we're shifting that blame back onto the individual, despite their lived experience of weight loss feeling very, very hard. But then of course, if we are just kind of saying, oh, well, every difficult weight loss experience is just a thyroid problem, and that's it. it and it mean ignoring those other factors, as you've mentioned, of over-restriction or over-exercising. And, you know, also kind of falsely implies that bodies should be predictably controllable as long as, you know, lab values are within range. But as we just talked about, that's not necessarily, you know, that's not necessarily what's going on. And so what I found really interesting

Starting point is 00:11:34 when I was doing research here was that, you know, the American Thyroid Association estimates that, that hypothyroidism accounts for about five to 10 pounds of excess body weight or difficulty losing five to 10 pounds. And then, you know, weight gained beyond that is due to a variety of different factors over restriction, you know, you know, over exercising, genetic, environmental, medication, reproductive, behavioral factors that, you know, affect weight in everybody. So I think that, you know, it's definitely important to recognize, you know, where the initial challenge was. But then as you said, sometimes the things that

Starting point is 00:12:16 die culture has taught us to do to fix that or to reverse that may actually be doing more harm than good. 1,000% yes. And maybe you can speak to that a bit, like over restriction, you know, under fueling, under eating, chronic dieting, disordered eating. What is the impact of that on our thyroid? levels. Oh, yeah. So it definitely compounds the issue. Like you said, there's already an issue,

Starting point is 00:12:46 but I love that you brought up the research, like five to ten pounds extra. Like, okay, maybe I can live with a five to ten pound extra difference. But I think what happens in the mindset is so powerful. As women, we feel like we're losing control the moment we see the scale go up, we freak out, and we're like, I'm going to control this. And so instead of just gaining the five to ten pounds, as they're eating less and less working out harder and harder, over-restricting, that scale is going up more and more as that metabolic rate is dropping further. And so it takes a toll on your metabolism, the mindset, and nutrient deficiencies, the absorption of that, inflammation, and we just see all these hormonal imbalances start to snowball, so to

Starting point is 00:13:31 say. And it just gets worse and worse. All the symptoms that were hypothyroidism become mega. thyroid issues. Right, right. And so, you know, I want to come back to that piece when it comes to, you know, what do we do here? But I also want to note that, you know, in your experience, for example, knowing that a lot of women are struggling with their weight and whether they've been, you know, hyper-restricting because this started as just like, you know, a minor hypothyroidism and then it's, of course, snowballed or not. In your experience, when the thyroid is treated,

Starting point is 00:14:07 via, you know, medication. And let's say labs fall back within, quote, quote, normal range. Does it automatically just reverse all the symptoms and poof, the weight just falls off? Or is it more of just like a leveling of the playing field to an average person's weight loss trajectory? Yeah. So what I commonly see with women that come to me with a thyroid condition, they're put on a thyroid medication like levothoroxin. And maybe at first, they start to feel a little rome.

Starting point is 00:14:37 regulated a little better, but then it just goes back to feeling crummy and seeing the scale go up, inflamed, exhausted, and they go back to the doctor. And that's where this frustration comes from is their labs are in the normal range because the thyroid stimulating hormones are doing exactly what they're supposed to do, bringing it into balance. But there is a lot of underlying issues that that medication can't address, such as the metabolic health, the stress, the inflammation that's in that body. So even clients that even go on something like a GLP1, OZMPIC, they'll see the scale even going down. It might help with that,

Starting point is 00:15:17 but they're still feeling very blah. And they're still like, why am I not feeling better? And that's when I say, because you haven't addressed the underlying issues of all these years of the stress, inflammation that you've put on your body. Yeah, I think that's really, really important to note because, you know, often a lot of folks, you know, including those who are abusing medications like levothyroxine, see this as kind of like weight loss medication. Oh, I'll just go on this medication. I'll drop all the all the weight. And, you know, when I dug into the data, there was one review that found that only 52% of patients lost weight within two years of starting these medications. And the average low, you know, when I dug into the data, there was one review that found that only 52% of patients lost weight within two years of starting these medications. And the average, loss among that the full group was only 0.1 kilograms. So, you know, if you are banking on this being kind of like, oh, this is the panacea, this is going to change my life, this is all that needs to happen, and then everything's going to fall into place. And you're not addressing some of those kind of other issues that I'm hoping to get into now. You know, you may not see the full

Starting point is 00:16:31 recovery that you're, that you're after. One thousand percent. Yeah. And can you now like tell us a little bit about like what is your approach when you are working with a client or patient who they've started the medication? Maybe it hasn't yielded the results that they were hoping that it would. What are some of the kind of, you know, underlying issues that we need to tackle at this point? Yeah. So when patients come to me, they always say they just want to feel better. But overall, the data shows they all want to lose the weight. And then the cherry on top is feeling better and improving the lab work along the way. And so I, as a dietitian, I want to honor the aspect, okay, if you need a lose late, let's lose weight. But I also want to address it in a very gentle

Starting point is 00:17:17 way because they've gone years dieting. And I do not want them to go into a restrictive mindset. But at the same time, what I see is some of the three overarching root issues with thyroid conditions is insulin resistance, inflammation in the gut, and then stress in the body. adrenaline fatigue is what we're seeing going on. And it's starting to peel back those layers in a mindful, gentle, anti-inflammatory way that we start to see improvement across the board. And so what are some of the kind of best practices, so to speak, when it comes to nutrition for folks with hypothyroidism? Yeah. So the biggest one is I take a mindful, gentle approach. And so I start telling my clients, let's start having a breakfast, lunch and dinner, snacks as eat as needed, and eating till

Starting point is 00:18:12 full. And trust me, that freaks out 99% of my clients because they're like, I'm going to gain weight. Don't you know? And I'm like, you've been under eating, like probably under 1,200 calories for years every day. And so that's just one of things because we want to start getting the metabolism to trust us again. It's a relationship. And so starting to wake that up. And then we do take an anti-inflammatory approach at first. So we do go gluten-free, dairy-free at first while going low carb. So to be gentle, heal that inflammation, the insulin resistance. But I always tell my clients, that's not the end goal. You're not going to do this forever. As long as you don't have an allergy, we can, it's like a muscle. We have to start out gentle with our weights, but we can make

Starting point is 00:18:59 it stronger and more resilient. And that's how it is with food as the body is healing. Okay, this is really, really great. I thought we would play a little quick fire myth busting. I love doing this with my kind of healthcare professional guests. And so I want to ask you about a number of different online hypothyroid kind of cure lore that we hear about online. You tell me if it's more of a hype or hack or, you know, in what circumstance it makes sense. Okay. Sound good? Yes. bladder whack, bladder rack. I read it and I was like, what the egg is that? That does not sound yummy. Oh gosh, I'm always having to be up to date on these and I even had to look that one up. I was like, what the hell is this? And I've had individuals come to me and so it's eating seaweed, a certain type of raw seaweed apparently. And I've had individuals ask me about this, I guess. And it's all not great. It's not a hack. And even with that, it's a high. It's a high. highly absorbable type of plant, seaweed is. So it can actually absorb a lot of the metals

Starting point is 00:20:06 apparently around it and it can affect the absorption of your thyroid medication. So no. No, we don't like that. Okay. Now you kind of alluded to this one, but gluten-free, dairy-free diet for life. No, I do not recommend that unless they have celiac disease. Yes. Okay, fair. That makes sense, that's excellent. And what is the, and it is the idea of removing it at the beginning to help to essentially gently reintroduce foods as the gut is. Exactly. Because the gut is just like, hey, we're angry right now. We're reacting to everything we eat. So if we can just take out a couple foods and provide a nice, less inflamed gut, and then it's more gentle to reintroduce. Got it. So lower FodMap to exactly. Yeah. Okay, cool, cool. Brazil nuts every single day.

Starting point is 00:20:55 So Brazil nuts is a tricky one. So selenium is amazing for the thyroid. However, there's a caveat. We do not want to go crazy with the Brazil nuts because there is such a thing as selenium toxicity. So don't take the bag of Brazil nuts. Just have like one to three max a day. But don't take that with a selenium suppolent. It's one or the other. Right. Okay. Love that. Okay. Fluoride-free water, fluoride-free toothpaste, no fluoride at all. I don't recommend that. I think fluoride's great for the body. There's lots of research out there, and I have yet to find anything that says don't do it. And the main thing is, if you have an iodine deficiency, that can affect the fluoride that you're consuming. So let's address the deficiency, and that won't be as much of a problem anymore. Okay. I love that.

Starting point is 00:21:44 I love that. Tyrosine supplements. I'm not a fan of supplements in general. I'm one of the weird dietitians because you're, you're not a fan of supplements. because your body is so inflamed the gut. And so you're hardly absorbing anything you're giving it supplement-wise. So let's take that out of the equation and just heal it with food. And then your lap start to improve.

Starting point is 00:22:04 And if you have a true deficiency after several months, then we can look at that. But I don't think that's necessary. And what is the, why tyrosine? Like, why is that the amino acid people talk about? Because there's a lot of things. I mean, I'm going to be honest, I'm not the expert when it comes to all these supplements. because I'm just like, why do we even need these? But there's a lot of people saying, like, it has a lot of benefit to the thyroid.

Starting point is 00:22:28 We need tyrosine. And so it just gains a lot of traction in that. Yes, that makes sense. As do all these trends, don't they? No, we all think more and more is better. Absolutely. Okay, here's another one that I hear probably a lot, is avoiding all cruciferous vegetables. No.

Starting point is 00:22:47 So that's the biggest thing. So when someone is very inflamed, they come to me and they're like, I can't eat anything. And I'm like, okay, that's when we go back to it. It's just several foods and we can get there. But there's a lot of research. So you might hear cruciferous or goyrogenic foods. You should avoid that with a thyroid condition. And I found research that said you'd have to eat an insane amounts of those foods to actually affect your thyroid.

Starting point is 00:23:13 Like, insane. Like it's not attainable. And then with the cruciferous veggies, I have found, you know, we think, oh, it's 20 foods. If you still have gut issues after a month of targeting some of those main inflammatory foods, then it might just be one or two of those foods like broccoli or cauliflower. It's not all of them. Right.

Starting point is 00:23:32 And that, I guess, also kind of plays into the Fodmaps, the gas production, going kind of easier, vegetables that are easier to digest perhaps than the cauliflower and the kale and all that stuff. Okay, that's really helpful because obviously, these are really nutritious foods and we don't want to encourage people to cut these things out if they don't have to. So I think that's great. Okay. Then my last one is vitamin D megadoses. So I'm not a fan of anything. Megadosis. So it's kind of like the idea of vitamin C powders that we take during the winter. And honestly, the body can only absorb so much of that vitamin C. We get rid of the rest. So the vitamin D, you can also get toxicity. You can be overdosed in vitamin D. If we're

Starting point is 00:24:18 taking too much. So just take a standard like 2,500 micrograms or talk with your doctor. Don't go crazy with it. We don't want to hurt a good thing. Yes, absolutely. I love that. Yeah. And I mean, really with any of these supplements, the benefits in the data and the research are really only there when we're correcting a deficiency. So more is not necessarily more. And so again, it really speaks to the importance of kind of getting blood work and, you know, working with a registered dietitian because hypothyroidism is not just like, you know, people with hypothyroidism is not a homogenous group. Like everyone is going to react to different foods differently and their journeys are going to look very different depending on

Starting point is 00:25:03 where they started and where they're going. So I think this just reinforces that we don't want to kind of go in there with a blanket supplement stack or diet for everyone. And so, you know, it really pays to be working with a registered dietitian like yourself. who can kind of help walk you through what works best for you and your body. So that's so helpful. And if you, you know, for folks who are struggling with hypothyroidism or symptoms of hypothyroidism and they're not able to get a diagnosis because their lab work looks great. Do you have any kind of words of encouragement or support for those who are feeling like

Starting point is 00:25:42 frustrated by the lack of answers and the lack of solutions of what to do in this situation? Yeah, absolutely. So even if the labs are coming back normal or you're just like, what do I do? All the overwhelming information is contradictory itself. And so I usually just say, be gentle and less is more when it comes to women and our hormones and our thyroid. So if all you can start doing is just having your breakfast, lunch and dinner and start being mindful at those meals, maybe within 30 minutes to two hours and think, hmm, is there a trend in this food? that I'm eating where I'm feeling really exhausted or bloated and take just note of that food and you might surprise yourself and it might just be two or three foods that are affecting

Starting point is 00:26:28 your mood, your exhaustion or the weight and then test it out. You know, at the end of the day, just test in a healthy way. Yes, yes. And I think it's really important because often, you know, as women, we have become accustomed to, you know, tracking things for the sake of macros or calories or for restricting or cutting things. And there is a gentler way when we're basically using this as data, collecting data to better understand how different foods and meals and combinations make us feel how they keep us satiated, how our energy levels are, how our digestion is after a particular meal.

Starting point is 00:27:08 And to use that data non-judgmentally to inform, you know, future meals and snacks and choices that we make from a place of self-care rather than, a place of self-denial. So I mean, I really appreciate what you do in, in this world. You know, the thyroid world, I'm sure you know, is full a lot of grifters online. And there's no shortage of miss and disinformation. So where can friends find you if they're looking for, you know, more information and more support? Absolutely. So I'm on Instagram at priscilla swan. or on my website priscilla swan.com and so definitely reach out we have so many resources available. Amazing. Well, thank you so much, Priscilla. Yeah, thank you so much, Abby. Okay, such an interesting

Starting point is 00:27:58 conversation and one that I think likely resonates with a lot of women, even if they do not have a confirmed thyroid dysfunction. You know, for so many women who have struggled with their weight all their lives, getting a confirmed diagnosis of something like hypothyroidism may in some ways become like a thin layer of armor against a diet culture that otherwise assumes that gaining weight or not being able to easily lose it is simply a marker of laziness or lack of discipline. It's like we have demanded that women find this pathological origin story for their weight gain because our culture treats ordinary body diversity and the fact that bodies change as we age as some kind of personal failure. But when you really interrogate that expectation, you really can't unsee the damage of weight stigma.

Starting point is 00:28:53 Even the language we often use in thyroid health communities of having a quote-unquote broken metabolism reinforces the idea that a body is only functioning properly if it is easy to make smaller. So when thyroid treatment may improve labs but does not produce dramatic weight loss as discussed is not uncommon, people may feel betrayed or believe that they have failed yet again. But I just want to remind all of you listening that you do not need abnormal bloodwork to be worthy of compassion. Your body size does not become more acceptable because a lab test explains it. and it does not become less acceptable when the tests come back normal. We can take symptoms seriously, investigate them thoroughly, and provide evidence-based care

Starting point is 00:29:48 without turning weight into the ultimate measure of whether a treatment worked or not. So if you are feeling frustrated by your body, exhausted by the search for an explanation, or convinced that you just have not found the right diagnosis or supplement or protocol yet, please know that your experience is still valid. You deserve care that is curious, thorough, and respectful. Not care that makes your worth contingent on the number on the scale or a flag on your blood test. But on that note, friends, I'm going to wrap it up here. I really hope that you enjoy this episode of Biteback. And if you did, I would love if you would subscribe to the podcast and leave me a five-star review and a little love note on the episode because it really does help me out. Also, you can check out my YouTube, Instagram,

Starting point is 00:30:41 and TikTok. I've got links to all of that in the show notes. But signing off with Science and Sass, I'm Abby Sharp. Thanks for listening.

Bite Back with Abbey Sharp - Is It Really Your Thyroid? The Truth About Weight Gain, Fatigue and “Normal” Labs with Dietitian Priscilla Swahn

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