Mind Pump: Raw Fitness Truth - 947: The Hypothyroid Hoax

Episode Date: January 17, 2019

This this episode of Mind Pump, Sal, Adam & Justin speak with Dr. Michael Ruscio about thyroid health, the misdiagnosis of hypothyroidism and how to improve thyroid function. Measuring the success of live events and the value of ones like #PodcastHard. (5:11) The potential for Mind Pump & Friends Tour. (8:11) Getting the best bang for your buck, right dose when it comes to red light therapy and products like Joovv. (9:08) Is he finding that there are more zealots in the space? (14:45) The propensity to make things more complicated than they have to be. Why you should always cross reference with a clinician. (17:35)** The misdiagnosed epidemic of hyperthyroidism. (18:50) Does this group benefit from taking the medication that gets prescribed? (27:30) What does a low FODMAP diet look like? (31:35) Why the majority of hyperthyroidism is diagnosed as thyroid autoimmunity. (32:30) What do thyroid autoimmunity symptoms look like and how to go about treating it? (34:15) What are the connections with thyroid and progesterone? (40:56) Is there a negative feedback loop when you're on thyroid hormones? (43:13) Is there any evidence to show your thyroid may be normal but you have low receptor density? (46:23) Does he have cases where someone has hyperthyroidism and fixing their gut issue solves the problem? (49:12) Are there potential dangers with taking thyroid hormones when you haven’t been properly diagnosed? (50:29) How dangerous can this be for a competitor doing this? (54:20) What has the feedback been from his space on this subject? (57:22) Thyroid antibodies and their importance in the grand scheme of things. (1:03:50) Is hyperthyroidism a death sentence or can you reverse it? (1:09:19) How is Hashimoto's disease diagnosed? (1:11:25) Featured Guest/People Mentioned: Dr. Michael Ruscio (@drruscio)  Instagram Website Mike Matthews (@muscleforlifefitness)  Instagram Dr. Jordan Shallow D.C (@the_muscle_doc)  Instagram Ben Greenfield (@bengreenfieldfitness)  Instagram Ari Whitten | Facebook Dr Paul Turek Jonathan Haidt (@JonHaidt)  Twitter Products Mentioned: January Promotion: MAPS Anabolic ½ off!!   **Code “RED50” at checkout** Joovv   **MAPS Prime w/purchase of $500 or more and free shipping** Healthy Gut, Healthy You - Book Lack of interest in sex successfully treated by exposure to bright light -- ScienceDaily The Ultimate Guide To Red Light Therapy: How to Use Red and Near-Infrared Light Therapy for Anti-Aging, Fat Loss, Muscle Gain, Performance Enhancement, and Brain Optimization – Book by Ari Whitten Thyroid-Stimulating Hormone (TSH) Subclinical Hypothyroidism: An Update for Primary Care Physicians File: Low FODMAP Diet Guide - Dr. Michael Ruscio, DC Take Gut Root Cause Quiz NOW The predominant form of non-toxic goiter in Greece is now autoimmune thyroiditis. Cycling Toward Childlessness? | The Turek Clinics A Successful Patient Case Study Treating Insomnia, Weight Gain, Thyroid, and Arthritis Motivated Reasoning Is Why You Can't Win an Argument Using Facts Anti-Thyroperoxidase Antibody Levels >500 IU/ml Indicate a Moderately Increased Risk for Developing Hypothyroidism in Autoimmune Thyroiditis. What Are Healthy Levels for Thyroid Antibodies - Dr. Michael Ruscio

If you want to pump your body and expand your mind, there's only one place to go. Mite, op, mite, op with your hosts. Salda Stefano, Adam Schaefer, and Justin Andrews. Oh, it was a good time with Dr. Ruscio. This put it almost a year since we've had him on the show. Yeah, almost. I didn't realize how fast time and flu there, man. I thought it was just after he dropped his book, but I guess he dropped his book in February of last year.

So yeah, we're coming up on a year. I must recommend his book, at least a few days a week for people with gut health questions. Healthy gut health you is like, that's like the gut health Bible. That's the one I always recommend. Yeah, it's highly recommended. It's helped my wife tremendously.

Especially the way that Mike presents information, which is one of my, why he's one of my favorite people to talk to is he is not dogmatic about anything at all. And he's very careful about how he presents information. And so I really appreciate that, because it can, especially a topic like gut health, can just become a little bit overwhelming. And this is a part of the reason

why we invited him down. Did something a little bit different in today's episode. We did cover some other topics, but the big bulk of this episode was really centered around thyroid. And it was funny, he reached out to me about a month ago and he says, Hey, Adam, you know, I like to come on the show and I really want to address thyroid and right before that,

like literally two days before that, Cassie had emailed me and asked if we could create some more content around thyroid because she runs the customer service side of the business and One of the number one questions that she gets and concerns are people wanting to learn more about thyroid and so there seems to be A uptick and people being diagnosed with These this condition and he's saying it's misdiagnosis, right? Especially people in his space the the wellness crew, the crowd, I should say. And it's pretty revealing what he talks about, how a lot of these people are getting diagnosed with hypothyroidism when they aren't.

They're being prescribed these medications when they don't need to be taking them. And so that's what we talk about. We also talked about, we did mention red light therapy in this episode, and I wanna do a correction here in the intro. I talked about, or at least I had mentioned how red light therapy's been shown to raise testosterone, and Dr. Ruscio said

there were no human studies, there are. There was a recent one, in fact, I believe it was, I wanna say 2014 or 2016 in Italy, they tested 38 men, and they divided them into groups groups and they treated some of them with red light therapy and the others without and the red light therapy significantly increased testosterone. So there is a human study to show that red light therapy. Not just ram balls. Yeah, not just in the day.

You'll know when you listen to the episode. But it does work on testosterone levels, the red light therapy that you find in the Juve lights, which is Juve is one of our sponsors. In fact, if you go to Juve.com. me that it's kind of a challenge for them to go back through all the purchases that they get and find out who came from MindPump so they can actually send over the prime. And so if you're somebody who goes over there and you buy any of the Juve lights and you're looking for your Maps prime program, the best thing to do is actually email info at MindPump Media and let them know that your maps prime program. The best thing to do is actually to email info

at mymputmedia and let them know that you made that purchase. And then, and then Cassie and Rachel on the back end of our side of the business will go ahead and go do the legwork for you and get it over to you faster. Because we had a little bit of a delay on somebody who was buying Juve Lites. We've had quite a few people buy them

through Juve from us and we're waiting on their prime and they wanted to get that as soon as possible. So if you are somebody who goes from this episode and makes a purchase with Juve and you want your prime, maps prime, make sure you email info at myimpunkmedia. And now that we're talking about programs, I do want to remind everybody, Maps and Abolic is still half off all month long. That's our flagship foundational fitness program.

It's great for building muscle, speeding up your metabolism. It's a great metabolism boosting program. So if you're somebody who's got metabolic damage, maybe through too much dieting, you're somebody who's trying to get leaner, but it's just not working without eating low calories. Great way to speed up your metabolism is to enroll in maps and a ball, because it's so effective

at building muscle and building strength. It's 50% off, go to mapsfitinistproducts.com, use the code red50RED5050, five zero, no space for the discount. And of course, on that site is our other maps, fitness programs. So you can take a look at all of them, see which one works best for you.

And that's pretty much it. So without any further ado, here we are talking to our good friend, Dr. Mike Ruscio. I know this year, so I'll tell you that, and we don't have it on dates, but when it does come around, I'll make sure that you're including conversation. His tailor is going to set up some more live events like we did. We had a lot of success when we went down to San Diego LA and we did like this live event thing. And that was a lot of fun. And I think that podcast hard or different from that.

Different from that. We go, was that an retrospective success? I mean, it depends on how you look at what you define as a success. Financially, no, like we didn't make a bunch of, we lost a ton of money on that. But we knew that going into it. It was an investment for us in just a way that we could build and forge relationships. And I mean, and listen to what, if you got a huge relationship, as I believe you did, you said before we got on here with Mike Matthews, you guys speak on a weekly basis. So, for me, that's a win. That's a win, because you're a good friend of ours. He's a good friend

of ours. We've connected you to. You guys have helped each other out greatly greatly and I think that you will always remember that and so That's very valuable to me in relationship building to be able to be a you oh us. Yeah, that's what I'm saying Yeah, very very I wasn't getting there Yeah, one day we made a favor Yeah, that was not a show up with a body at your door The thing that was not good was pairing me with Jordan Shalows and Ben, because I bumped with those two guys and I've never felt so fucking small. They'd be sitting at the kitchen table just talking and I come out and I'd feel like,

hang on, I saw that. Yeah, that could be the guy. That was a tough one. Well, yeah, those guys are giant. How about the conversation though, that we had around the fire that one night? I mean, that's why I think Mike is going to paleo effects because he's eager as I am for another conversation like that,

which is why I'm still hoping to sway you guys to come up. There's a possibility. We should just get on a sky. Yeah, that was great. You should just get on a sky. I don't think you could really. It's like a mock fire that we're all looking at. Yeah.

What it was and what was really cool was this, it's a collection of a bunch of really intelligent people that share a bunch of different perspectives on a lot of really cool topics and everybody is wise enough to be open-minded enough to listen to everybody, put their, or say their argument, and, man, what a, just a great conversation to be a part of and being. And, and to me, that's worth all the money that we spent was to have moments like that, to connect other like-minded people together that can all support and help each other. And that's really what the mind pump movement has always

been about for us is to elevate these people that may not be out there on, you know, in mainstream where everybody's talking about them because they're all about social media and they take half naked pictures. But because they have really fucking great content that more people need to hear here. And I really think to me that that was the real value in the podcast hard event. The event that I was talking about that I would I think would be fun to do with you is we've discussed doing these kind of like mind pump meetups or basically what we do is we pop into like a sponsor's store or location and invite a bunch of our audience

for free to come down and listen to like a live Q&A. And we've discussed doing that like a mind pump and friends tour where we bring like a buddy like yourself for like a big and green filter or Jordan or somebody. And they're a part of the Q&A talk with us and get to kind of, and then we kind of hang out with our audience. We just riff in person with our audience. And then we'll go party after this. You know what could be cool in my area,

if you're looking to do it, I don't know, this is so close to home, if Walnut Creek is so close to us. No, we want to do a close one. Cause there's a cryotherapy center in Walnut Creek. They do cryotherapy, red light therapy, a few other therapies. That might be a cool spot. I mean, CrossFit are probably always a good location also,

but just something to think about. Now, when you check out a lot of these places that do the red light, what brand do you normally see pop up? Juve, and I like Juve, but I recently interviewed are you waiting, are you familiar with him? He wrote the pre-minute book on red light therapy. Oh, I don't, I don't know that is. Photo by OEMO, modulation.

Yeah, I can say that. Yeah, and I'm just a tongue twister. I know what I'm talking about. This big word. Yeah, but he were a really great evidence-based book. I haven't read the whole thing. I've fun through it, but he feels there's a few other lights that you may get a similar, or maybe even better bang

for your buck. And that's no disparagement to Juve. It's just they're on the higher end, as far as pricing. Yeah, and then maybe more like than you need. Like I was doing three panels, total body, and you know, card to Whitten, you know, it's more than you may need. And for some people that may actually be too much of a harmonic stressor for them. Oh, so in other words, what you're saying, and I was wondering this, this is kind of

a cool topic. I would, because I don't know if you've seen, but Juve has just recently came out with like their small little panel. And that's essentially what Witten was saying, which is the distance away from the light dictates the effect, essentially the farther away you are, the more of a superficial effect you're going to get, the closer you are, the more of a deeper effect you're going to get. So if you're doing skin-slashed anti-aging

with the platinum-maladee device, which is what I've been using, you want to be according to Witten about 10 to 14 inches away. I'm assuming if you want to get something like joint or muscle recovery or pain reduction, you want to be, I'm guessing maybe six inches away. Okay. So, it's cool to have that multi-panel, jive light,

but it's really hard to kind of get everything configured to get the dose that you're looking to get in terms of the tissue application. Well, I would imagine that. Do you think that's splitting hairs, though? Yeah. And I also would imagine, Mike, wouldn't it, if you got more than enough, it's not technically hurting you, is it? I mean, actually, so, according to some of what, again, I'm just referencing Witten because I'm not an expert. No, no, I appreciate the conversation. There may be a biphazic response. And according to him, some researchers think

there's more or less to that. I think I actually overstimulated myself with using too much red light. What happened? What did it feel like? I just got really tired. I had bags under my eyes and I was really fatigued and I was like, what the hell happened?

And I thought I was overtraining or this or that. And I'm so not sure that that was the case because there was a few other variables. So I have to kind of go back and isolate out those variables and run the experiment again and see what happens. But there may be about 10 to 15% of people who are what's known as hyper responders, where they really could run the risk of doing, of overdoing it. And it makes sense if you think about fasting or exercise, doing too much of that for any person and too much of doing, or overdoing it. And it makes sense if you think about fasting or exercise, doing too much of that for any person

and too much of that, that threshold kind of changes from person to person, but doing too much of any stressor could eventually do that. Right, right. Isn't it supposed to be parasympathetic in the first place though, isn't it? Well, it's so as sleep, but if you sleep too much, probably can cause problems.

So is, you know, going in a sauna, sauna is parasympathetic until it's not, and then it becomes sympathetic if you're like pushing for time. Okay. So I think there's always a sweet spot. There's always a right dose. Right.

That's a very good conversation because people, we, especially in Western societies, we tend to think of everything as a, if some is good, more as better. I started, yeah. And then not only that, but we also don't take our own personal context into account. So like an exercise, for example, you know, if I never exercise

at all, the right amount is going to be a lot less than if I have high tolerance for it. This is true for any stressor sunlight and maybe even red light. I would think this is true for anything. So this is not... So along these lines, I had another question that... So to get the benefits of it, do I necessarily need to have it on a certain spot? Now I know when I'm trying to address my psoriasis or some of that, then obviously I would probably

want to shoot on there, but if I'm just wanting to get... The systemic effect. Yeah, the systemic effect of it doesn't necessarily need to be on a certain spot or I could just be taking it? As far as I understand it, it's gonna be site specific for the application, at least semi site specific. Right.

So if you wanna, if you have, let's say, panid inflammation on the posterior side of your body, but you're shining the antire, anterior side of your body, then as far as I understand it, not likely you're gonna see the optimal effect if you're not trying to... Did you see the testosterone studies on them?

That, according to... And when I check some of the references, seems to be the most poorly supported, scientifically. Really? One was in Ram testicles, I think a couple were in mice. I don't think there's any human data. There isn't, okay.

Because there was one study that's on the screen. Fucking retill. Well, we have a butt, I mean, this is not, this is obviously anecdote. We have a buddy who raises testosterone mean, this is not, this is obviously anecdot. We have a buddy who raised his testosterone. He was measuring it, and that's the one variable he included. But there was a someone cited a study that showed that you get a more of a testosterone boost

from shining on your testicles versus shining on your body. Was that the RAM study that you're referring to? Do you know? I'm assuming it was RAM. Okay. I mean, the one you're referring to, because it sounds like you're describing a human study where you're discerning between body and testicles shining. Is that what you're saying?

There was a, and you know, I should pull up the studies. There was a study that showed that there was a testosterone boost. He's probably had a producer. Yeah. Studying it on the, and maybe it was an animal study. I guess there might not be human ones. That's interesting. I don't believe there are any human studies and you have to be careful

We don't count bed greenfield But you know I have no problem with someone isolating variables and trying it I just think we have to be careful not to say you know Are you a guy with low testosterone? Here's you know here's a magic bullet next thing to do Yeah, are you finding learn to ram balls? Yeah, are now that, you know, because you wrote the book, Healthy Gut Health of You, you've talked a lot about the microbiome and gut health. Are you finding it all now that the space is becoming, or they're blaming it on everything or saying this is the root cause of everything or do you think that's more, that is continue

to be accurate? Yeah, I think, well, it depends on who on who you ask right because there's always going to be zealots in any group. So there are definitely likely some zealots in the gut space. But I do think it's a fairly defensible statement to say start with your gut and then reevaluate. The challenge I think is when someone's done a fairly good trial of the available gut therapies, they haven't seen optimal results, and they just keep on doing the same thing over and over or harder and harder, and they don't take a lateral look at, like we'll talk about today, at, for example,

thyroid to see if there may be something a skew there that needs to be addressed. So I do think it's a tenable statement to make, but no one thing is a panacea. But the one area that I do think it's a tenable statement to make, but no one thing is a panacea. But the one area that I do feel people will see the most return on their investment in terms of time, effort, energy would be their gut health. Okay. The reason why I say that is any time in the health and fitness space that I've seen something come out that is supported by some science, the next thing I know, like for example, oh, study shows that ketogenic diets help with this particular condition.

And the study shows that ketogenic diet helps with that. And the next thing you know, there's keto cereal for kids, you know, keto socks. Like, it's like, okay, what's going on here? I see probiotics now and everything. Probiotics, yeah. So, I think you are seeing that with probiotics where now there's kind of this one-up effect

where everyone's trying to one-up everyone else with the latest and greatest claim about the mechanism of probiotic and why it's better than the others. Yes, you are seeing that with probiotics where if there's one novel finding about one strain, then a company tends to take that one finding, package a whole probiotic around it, claim it to be the psoriasis probiotic or the rheumatoid arthritis probiotic. But I saw this, this same evolution

when it came to probiotics for constipation where, and actually same thing with your near-tract infections too, where there was one study initially, because it was the only one that was done looking at a probiotic constipation. And so then everyone was shutting from the rooftops, this is the probiotic for constipation. And I said to myself, well, I'm willing to bet a

fairly large sum that within six months to a year, there will be another study in constipation with probiotics with a different formula also showing benefit. And what do you know? I think today there have been three with different formulas all showing benefits in constipation and about three trials with different types of probiotics, at least three trials showing the ability to reduce your anary tract infection in women. So what led you to believe that and what's your takeaway from that?

What led me to believe that is there's this propendancy to make things more complicated than they have to be, and there's a propendancy to take one preliminary finding and expand upon it. And yeah, and make that look like this is the best product for whatever. And that's fine. I guess that's kind of the company's job because they're trying to bring these products to the market and they're trying to market them fine. But that's why you should always cross reference your recommendations with a clinician so that you get a filtered perspective

not just going right to the probiotic manufacturer, but also looking at a clinician who can say, yeah, I mean, that's a decent claim, but it's really a little bit of, you know, fanfare and you can probably cover your bases for constipation and X and Y and Z with these two broad spectrum probiotics. Is there anything that you see people doing now with all this new energy and around probiotics? Is there anything that you see people doing now that is harmful, like any practices with these types of things? We're like, okay, you're probably better off not

supplementing with this many probiotics or with this type if you have this type of condition. Are you seeing anything like that? Well, to maybe shift gears a little bit, the thing that I'm seeing right now that is most alarming to me is the incorrect overdiagnosis of hypothyroidism. Really?

With people. And there's a little bit of a backstory here. So gut is my primary area focused, as you know. But I also keep an eye on thyroid because it's something that's important to my patients. And there is this fairly important connection between the gut and the thyroid. So the thyroid literature is when I've been watching fairly closely now for several years. And as I started fact checking some of the claims that you see in functional and alternative medicine,

I started saying to myself, geez, you know, a lot of this doesn't seem to be supported. And in fact, a lot of the recommendations that are being made for diagnosing, hypothyroidism, and for treating hypothyroidism are actually in conflict to what the majority of the data says. Give me an example of that. So in terms of how you diagnose hypothyroid, there's this feeling in functional medicine that we should be using these narrow ranges. Conventional ranges are too wide, it's said, and our functional ranges are more narrow, and those are quote unquote better ranges. It turns out that that's not really the case and there's this. Can you tell you about ranges of actual thyroid hormones? Ranges of TSH and T4, or specifically TSH and free T4, which are used to diagnose

hypothyroid. So if you have flagged high according to the lab range, according to the conventional range, high TSH paired with low free T4, that diagnosis is hypothyroidism. Now the functional medicine community thinks that your TSH instead of should not be above 4.5 which is where most of the conventional labs draw the line. Functional medicine says you shouldn't be above 2.5. Now where do they get that from? Well it turns out that when you're giving someone who has hypothyroidism, thyroid hormone medication, and you're trying to track their lab values, you want to see their TSH get to

2.5 or below, ideally. But that doesn't diagnose someone who's not on medication as hypothyroid if they're just naturally above 2.5. Does that make sense? This reminds me of like the cholesterol statin hustle in a sense. Yeah, like that. So, as I started fact checking this, I started realizing, that's not correct.

And what does the data there actually show? So to answer that question, we have to understand what subclinical hypothyroidism is. So we talked about TSH has to be high, and T4 has to be low to diagnose hypothyroid. And just to back up for the audience, TSH is the hormone that your brain sends to your thyroid gland to tell it to produce hormone. To tell it to produce hormone and then T4 is what the gland actually makes. So that's how these two interface.

Now, if your gland is not producing hormone, you get more and more signal from the brain down to the gland. It's like you're yelling down. And so that's a TSH, it was higher and higher and higher. Your thyroid's yelling louder and louder and louder to try to get the appropriate amount of hormone out of the gland.

So there's a condition on a subclinical hypothyroidism where you have elevated TSH, so you might be 5, 6, 7, 9, and you have that paired with normal free T4. So, that's known as subclinical hypothyroid, and there's a lot of literature there. And what the totality of the evidence suggests is that most people do not need to be on thyroid medication, nor do they derive any benefit from being on thyroid medication when they are subclinical hypothyroid. Now, question about that. Could that be, because this makes me think of how people's bodies respond to androgens. Like, they find that in some, in any cases, as men get older, fit men get older, their testosterone levels will decline at a much slower rate than most men, but they'll still start to decline a

little bit, but they also find that their receptor density increases. So although their testosterone may be a little lower, because they have increased amount of receptors, the effect is the same, right? It's like they're utilizing more of their testosterone. Sure. Would that be, could that be something in that case where their TSH is super high because although they're thyroid, their active T4 is normal,

maybe they don't have enough receptor so their body's perceiving it as low. Yes, and also there could be another argument made that your body is pretty good at adapting to what you have available. So you could even make the argument that if you don't have quite the amount of T4 that your body would like to have ideally, your receptors could become more sensitive to get more out of that.

Sure. But how we answer that is, do people who have subclinical hypothyroidism do they benefit? Sure. Might do they have less death, less cardiovascular disease, less depression, less fatigue, less insomnia, less joint pain, and the answer is no. There's an exception there for pregnant, I'm not pregnant, for women who have a history of infertility, then trading that has to be helpful.

And in those who are really young and their teens and maybe early 20s, then they may derive a small amount of benefit. But you also said something super high. Having a TSH that is, so the cutoff for members, you don't want to be about 4.5. Having a TSH of 5 all the way up to 10, that's considered pretty acceptable. So if that subclinical hypothyroidism, that TSH gets to above 10, then someone may derive benefit from going on hormone.

But what happens with a lot of people is they go see a functional provider, I'm tired, I'm depressed, and I'm... So they're combining it with symptoms? Well, I mean, there's usually symptoms that accompany. Sure. So you're not usually getting lapses and don't unless there's a reason for it. And so if someone's presenting with symptoms and the clinician doesn't work up and they say, oh, your TSH is 5.6,

we need to put you on third minute. Even though they're having a... Even though they're T4s. Yeah. And this is happening way too often. And being canny of the shitty thing is, is that these people are one being told that they have a disease, hypothyroidism, which they do not.

Right, that is something that hypothyroidism and hypothyroidism are totally different. And two, they're being put on a medication that they don't really need. And why that sucks is because these people, I'm seeing enough of these people now, come in years later, never having had received any benefit from the medication,

being on a medication for years, and now they're wanting to get off it in which they were never on it to begin with. So, and does a, do you get a negative feedback loop from going on in? No, okay. No, and so one study has looked at that

and we can come back to that in a second and please remind me because I don't want to forget that, but I just want to paint that initial picture where I started seeing this context. And so when people were coming in diagnosed with hypothyroidism from anyone other than a very conventional inside the box kind of cautious endocrinologist, then I would double check. If the provider was integrative alternative, functional, natural, whatever, and I mean, notice peragement to that community, right? But this is just what I was thinking, right?

Because I know that more progressive lab assessment accompanies that paradigm of practice. So I started seeing that patients were being told they were hypothyroid when they actually weren't. Because I would have patients bring in their lab work from before they went on the medication, bringing the labs that diagnosed you as quote unquote hypo thyroid. And when I would look at them, you would clearly see these people in an alarming number of cases were not hypo thyroid. So and this is

coming more so from the functional medicine, not so much from the traditional western medicine side. So recently, there was a study published in Greece looking at 291 patients who had an ambiguous hypothyroid diagnosis. They found that 60% of those patients were not in fact hypothyroid. 60. Yeah, that's massive. That's a large percentage. So not only that, but I have the clinician's newsletter that we published monthly and, you know, now

that we're going on almost two years, the doctors in the group are starting to pick these things out. And I'm getting emails from some of these doctors saying, this is getting out of hand. I am having to undiagnose people with hypothyroidism who don't actually have it. And now all these patients, like you said, they're going in there for a reason, they have symptoms, I'm tired, fatigued, maybe classical symptoms of low thyroid, they go in, normal T.S. You know, normal T4, TSH is, you know, 5.6 or whatever, a little bit elevated, they go on

thyroid, do they subjectively feel better from that? So that's one of the other important aspects of this whole conversation, which is I've known us a lot of these patients. I would argue the majority do not derive any symptomatic benefit from going on. In fact, some of them actually even feel worse. I was going to say maybe more anxiety and loss. And what I was going to say is the anxiety and... And what I was gonna say, yeah, is the anxiety because I know like for my wife,

specifically diagnosed like hypothyroidism, she went in there with like massive anxiety issues and that was something that is either unantididiprasin that was thought to prescribe or, you know, hypothyroidism medication. Right, right, so even, you So even the problems now are compounding because there's another, what I think is a misnomer in integrative

and progressive circles of medicine and healthcare, which is T4 plus T3 combination medications like armythiroid or naturethroid are better than T4 alone like levothyroid. And there's some data to support that, but it's a small number of people. So what happens is a small number of people, maybe 15% of people who don't ideally respond to levothyroxin or sin-throid, T4 alone, felt better when they went on T4 plus T3. So natural medicine conflates that to say everyone should be on T4 plus T3 because it's better

So these same people who aren't actually haplothiroid then go on T4 plus T3 and the addition of the T3 has more of a Pennancy to exacerbate Anxiety insomnia, maybe even fatigue in some cases So this is a serious problem and And so this all tied home for me about a month ago, which is when I reached out to Adam and said, listen, I need to come back down and just get some of this off my chest because I've been talking

about this to my audience, but it's getting so bad now I wanted to announce it to a lateral audience. So this patient came in, she had been working with a quote unquote famous thyroid doctor who literally wrote a book on hypothyroidism is fairly well known and she told me that she was diagnosed hypothyroid by her and then she was on medication under her care for about eight months. All the while she felt terrible. She felt worse on the medication, but this doctor had a hard time, and I want to give the doctor the benefit of the doubt,

but the first medication she goes on, she feels worse. Changes the dose, she feels worse. Tries the different medication, she feels worse. And I believe she ended up trying three different third medications, the whole time she felt worse. When I looked at her lab work, she wasn't even subclinical hypothyroid.

Right? She was normal thyroid by any discernible measure. I think her TSH was like 3.8 and her T4 was normal. And on the lab, she writes next to it, call in for your armor prescription. I mean, this is just getting out of hand. Now, the same case, she's been with me for about three months. We've been working predominantly on her gut and all of her symptoms except for one are either gone or markedly improved in just three months. And she's not on the medication anymore. And she no longer thinks she has hypothyroidism which he does not. It sounds like a case of, you know, I'm a hammer. Everything looks like a nail.

Exactly. Yeah. So what did you do for her to, to start with? What were some of the, obviously, you're focusing It sounds like a case of, I'm a hammer, everything looks like a nail. Exactly. What did you do for her to start with? Obviously, you're focusing on the gut. What were some of the invaders or the culprits that were causing these symptoms? If my memory serves me correctly, she benefited quite a bit from a low-fodemap diet, which for people who have gastrointestinal issues, like I believe she had bloating and maybe diarrhea, a low-fob-map diet can be helpful.

And also it's been shown that people who have those gut symptoms also tend to be more fatigue and more anxious and more depressed. What does a low-fob-map diet look like, just for the audience? Well, a low-fob-map diet is going to reduce certain, mainly vegetables, but also some fruits that are high in prebiotics

and feed gut bacteria. And so this gal, what she thought was hypothyroidism, was actually an offshoot of an inflamed gut, and she likely had too much bacteria in her gut. Now, there is a connection actually, not to get too deep, but there is a connection showing that small intestinal bacteria lower growth, or there's too much bacteria in the gut, and hypothyroidism go hand in hand. One large analysis in over 1800 patients found that number one predictor of small intestinal bacterial overgrowth was hypothyroidism. So there is a connection.

This gal did not have hypothyroidism, but they do tend to go together, and sometimes where someone's lingering symptoms are coming from is not the thyroid, it's actually a problem that they got. Now it's interesting because I've had clients in the past who have gotten diagnosed with thyroid issues, but had normal TSH, normal thyroid, but they got tested for antibodies and other things. And so in their way, they explained it to me was, you know, although my thyroid's normal, thyroid, but they got tested for antibodies and other things. So, in their way, they explained it to me was, although my thyroid's normal, my body's not using it, and that's why I need to go on and take extra thyroid.

Is that incorrect? There's no viability in that. Well, your thyroid antibodies, so thyroid antibodies and hormone levels are on two different tracks. There's some interconnectivity between them, but just because you have high thyroid antibodies, does not mean you're going to have problems with your thyroid hormones. And the way this works is the majority of hypothyroidism is caused by thyroid auto-immunity or high levels of thyroid antibodies? Yes, that is true. But here's the thing that really irritates me.

Okay, so most people who are hypothyroid, the cause is thyroid auto-immunity. But if you look at an entire population and you take all the people who have thyroid auto-immunity, only 9 to 19% of those people, according to one study, will ever become hypothyroid. Does that make sense? So what ends up happening is because all of the people who have hypothyroid or most of people who have hypothyroid that causes thyroid autoimmunity, people are told, if you have thyroid autoimmunity, you will become hypothyroid. And that's not true. You actually have a small probability, a probability that we can intervene against and improve, but they don't directly go together.

So here's a question that begs a question. Let's say you do have thyroid autoimmunity, you're not hypothyroid. What does thyroid autoimmunity symptoms look like? And how do you work with that? You're obviously not gonna give them thyroid unless they're hypothyroid. Right.

So this is where we get into, I think, a promising area where I think alternative medicine does a great job if they handle the conversation with the patient correctly. Right? If you say, you have thyroid antibodies, that means you're going to be hypothyroid unless you never have any gluten and you do X, Y, and Z and take these handfuls of supplements for the rest of your life, that's the wrong way to handle this. Because the actual story is, okay, yes, you have thyroid autoimmunity. That increases the probability that you will become hypothyroid. But the good news is that's about 10% to 20% risk.

It's not a high risk. So I want you to be aware of that. I want us to work together to do whatever we can do to decrease that probability, but I don't want you to become nervous, upset, and stressed out thinking you have this ticking time bomb with a high probability of going off. There are a number of things that you can do. A paleo diet or maybe a paleo-low-fod-map diet, there are just two different iterations of kind of the same diet.

Has loosely, I'm speaking a little bit loosely here, but one study showed a 200-point drop in thyroid auto-meaning using a paleo diet, although the sample I think was a bit biased, and another study showed about a 40 to 44 percent reduction in thyroid antibodies from using a paleo like diet. So diet alone can get you there. There's been a number of studies showing vitamin D can help lower antibodies, a number of studies showing some lanyum can help as can coq10 and magnesium. So just some dietary changes plus a nutrient cocktail can get you pretty darn far with this.

And the final kind of cherry on top, although the data here are much more preliminary, is treating any kind of infection in the gut. There's been one study in Italy showing a market reduction in thyroid antibodies when treating H. Pylori, and those who had H. Pylori in the stomach, and a case study that one of the doctors from our newsletter group is writing up where a patient had non-responsive antibodies and the only thing that got her antibodies to respond was treating a gut infection.

So, you know, that's what we can do preventively to make sure or decrease that 10 to 20% probability down to hopefully closer 5%. But it's important that people understand, it's not a death sentence. And what the unfortunate thing that happens is people are told, well, you can never have any gluten and right, so they have this whole kind of like hard nose line.

And then people walk around thinking, I have a disease, I've got to be really careful and I could picture they're probably, you know, constantly having their mind drift off to this, and they're, you know, doing these intermittent searches on Google, and they're really stressed out about it, and that's not how the conversation should be handled, because it an imbues fear in a someone where it really doesn't need to be there. We want to be proactive and do what we can, but we don't want to do it in this, you know, realm of fear. We can't, and we can't overstate that either.

How big of a role that plays in health. Because people here, oh, you don't want to be fearful just because you don't want to be stressed out. But here's a deal. Here's a great example. I'll use Doug as an example. Recently, he had this sleep app that measured his sleep. What time he fell asleep, the quality of sleep that he had and all that stuff. He turned it on and he was monitoring his sleep. How, what time he fell asleep, the quality of sleep that he had and all that stuff.

He turned it on and he was monitoring his sleep. And because he had it on, he was very conscious about wanting to have better sleep, had terrible sleep for two weeks. He had to turn it off and then he got great sleep. The irony. And it is, and there was another study that was, there was a study that was done

on people who did these genetic tests, these like 23 and me tests done on people who did these genetic tests, these like 23 and meat tests. And people would get these tests and see that it would say you have a higher propensity for this potential and this potential. And that would then cause people to get sick because of the stress associated. So it can't be overstated that if you test somebody with thyroid antibodies, which now you're saying we'll increase the risk of going hypothyroid

by nine to 19% and being like, ah, you got antibodies, you got your hypothyroid. Like that's not cool, that'll totally decrease the quality of life. That happens all the time. Wow. So is this just one of those cases of hard to hard to diagnose symptoms, you know, being given this

easy answer. Because like, think of all the symptoms. What are the symptoms of hypothyroid? Like fatigue? What are some of the classes? One of the challenges is that the symptoms are fairly broad, non-specific. So they're going to, you know, if you, you know, I'll throw them out here in a second, but if you throw out the symptoms of that could potentially be attributed to hypothyroid,

so many people will park up, because almost anyone's gonna have at least one of them. I bet you'll hit us all in the middle of it. So fatigue, commercials. Fatigue depression, constipation, weight gain, thinning hair, dry skin, accelerated aging. I know it's my thyroid. Yeah.

I mean, there's potentially insomnia. So, but that's, you can correlate those to IBS, right? You correlate those to food intolerances. You can correlate those to many things. Oh, lack of sleep. Lack of sleep. Yeah, lack of sleep. Just kidding, fucking old.

Shitty diet. I can't lose weight if I'm a diet aches. No, it's not the donuts that you ever bring. I just want to make one quick note for people. We've been working on putting together kind of a quick start guide for my book. And one of the things that we've added into the quick start guide is a thyroid, kind of like a thyroid protocol. So if you go to drrucho.com slash gut quiz, you can take a quiz and that quiz will help you determine if you should do just a quick start guide for your gut

or if you should do the quick start guide for your gut plus some thyroid support. So it's good. And there's also, actually there's a couple additional questions I added for women only to know if they need a little bit of female hormone support. So that will help people because I understand listening to this, if you're new to the conversation, it's like, whoa, right?

So what I did was I took the questions that most tightly correlate to gut problems, thyroid problems, and female hormone problems, and it's a self-assessment. And then the quiz will grade itself essentially and tell you, do the gut quick start guide or do the gut plus thyroid quick start guide or do the gut plus female hormones quick start. Now what are the connections or correlations between thyroid to just speaking on women now, thyroid and issues with progesterone and estrogen for example. Are there any, do we see any relationships there

where I hear a lot about estrogen dominance, that's a big one, right? Or a lot of women are saying, oh, you know, estrogen dominance on these symptoms, do we also see a correlation with thyroid issues as well? There is a correlation in terms of, we know that female hormones and thyroid hormones both impact one another.

And one of the areas that I also think can cause thyroid symptoms or what looks like thyroid symptoms is actually a female hormone imbalance. Because they get a lot of the same symptoms, right? Fatigue, depression, anxiety. Those can also be attributed to female hormone imbalances. We know that progesterone increases a woman's body temperature, which is why you can use a

body temperature chart to track ovulation. And that's likely because I believe progesterone helps to facilitate the free fraction of thyroid hormone. So progesterone helps to make thyroid hormone more bioavailable. Oh, okay. Does it convert T3 to T4? I don't know if it's the conversion. I can't recall if it's the conversion

or if it just helps decrease thyroid hormone binding, glotobuline, and increases the free fraction, or maybe both. And then from an outcome perspective, we do know that women who have problems with fertility is kind of tangential association and have that subclinical hypothyroidism do see improved fertility when going on thyroid hormone. So there's kind of tangential association, and how that subclinical hypothyroidism do

see improved fertility when going on thyroid hormone. So there's kind of this bi-directional relationship between the two. Okay, so increasing progesterone could help with thyroid type symptoms. That may not be related to thyroid, it may be related to progesterone. Right, and that's one of the challenging things is that, for whatever reason, it seems that thyroid conditions are so marketable. And that's one of the challenging things is that, for whatever reason, it seems that thyroid conditions are so marketable. Well, especially the weight loss, depression,

energy, and so I would like to do this one. Right, right, and so the thing that concerns me is someone has those symptoms, they're looking for help, and they just get stuck in that circle of thyroid treatments, and a lot of these patients, if they take a quick stop at gut, and they take a quick stop at gut and maybe also a quick stop at female hormone support, their symptoms are gone. Now, you did say that there isn't a negative feedback loop

when you take thyroid. So there is a negative feedback. Yeah, thank you for being that up. So in that study increase that we were talking about earlier that found 60% of patients were not hypothyroid. They found a few very encouraging things. So good news, more good news, which is the length of time a subject was on thyroid hormone did not dictate their success in being able to come off it.

Okay. So that's really encouraging. Really? Yes. And how long were the, do you know how long the longest ones were on there? I'm assuming, I mean, probably close seven to 10 years. I don't know how many really. I don't know if that was reported.

I'm just guesstimating there. But that's phenomenal because I know for other hormones that's not the case, like women will go on birth control for years and many times coming off after being on for years, takes longer to get your body to get balanced out. If a band stays on testosterone for long periods of time, the odds that he'll have to stay on testosterone

are much higher, but you're saying the study is showing that with thyroid, people were on it for a long time. They went off, body bounce back. Yeah, and I questioned some of those findings with men and with women, because you have to factor into this, if a woman already has female homeowner in imbalance symptoms, not all women who go on breast control do, but let's say a fair subset do, at 19.

And then they try to come off at 29 and get pregnant. The chances are that they're less healthy, unless they've really been doing some work at 29 than they were at 19. Good point. So there's age and wear and tear that could be associated. And the same thing I think may apply with males. And I've been following some of the work of,

Dr. I believe his first name is Paul, but last name is Turek. He's in San Francisco. He's actually really sharp. If you wanna have a male hormone expert on the podcast, I would say have on Turek, because I've been really impressed to you are EK with his work into testosterone and male health.

And he sites a study in encyclers where even if you go on testosterone, if you go on testosterone after starting HCG, you can maintain your endogenous testosterone production. So he actually encourages, because there's some people that speak against that. So, he encourages HCG alongside with testosterone. No, not necessarily, but, you know, if you start testosterone first and then go on HCG, you won't be able to rescue your endogenous production apparently.

But if you go on HCG first and then start endost into testosterone, you can maintain your endogenous production. Interesting. Interesting. I would look that up. Yes, I'm really interested. It was a study in cyclers. The problem is a lot of the people that I've known and read about who have used testosterone use these just insane super physiological doses.

And so I would assume, and this I don't know is for sure, but I would assume, and I would bet money, that there's also a little bit of a dose dependent effect. Like, you know, if you go on testosterone replacement therapy, what is that? 100 milligrams, oh, we're just gonna... Because the receptor- The receptor-done regulation with any hormone is gonna be an issue after all.

Yeah, and athletes are going on five, 10 times that amount, and then they're staying on for a long period of time. They don't go off, so I would assume. Now, what about receptor-done regulation for thyroid, since we were on that topic, is there any evidence that that could also happen? Because my fear would be, if I was somebody that got misdiagnosed with hypothyroidism, like some of the people you're talking about, and I'm taking thyroid, or maybe I'm not taking

thyroid, maybe I have all the symptoms of it, and I got this guy over here who's progressive functional medicine person who's saying, I think you're hypothyroid, I've got another person like you saying, well, you're probably not, even though your TSH is high. Is there any evidence to show? Well, maybe my thyroid's normal, but maybe my receptors are just for whatever reason,

I just have a low receptor density. There might be, I haven't looked at that, but I think we can draw an inference when we look at I feel like it's a stretch right Well, we can draw an inference when we look at the subclinical hypothyroid literature because that's the best evidence I think went when someone isn't officially diagnosed with hypothyroid But they're being told that they might be right the best model we can look at is subclinical hypothyroidism, meaning that people have high TSH and normal T4, what happens? And there doesn't seem to be any

significant correlation to death, to heart disease. Some evidence showing elevation of blood lipids, so that is something to be aware of. And there could also be some mechanism that we're completely unaware of. Like why is your brain, you know, pushing out more TSH if your thyroid is normal, could be something totally different? Or it could just mean that your thyroid has perhaps accrued a little bit of wear and tear.

And so you need a scotch more signaling to have the same level of hormones as everybody else. Would that be the worst thing? Like this might be- It's actually pretty elegant signaling system if you think about it. Yeah, I mean, you know, if this might be a bad example, but if you had three parents with three kids

and you're all trying your kid to come home for dinner and one says, Timmy come home, the other says Sarah come home, and the third says Johnny come home and Johnny doesn't come home. Then you have to go, all right, Johnny come home. Would that be the worst thing in the world yet to you have to yell a little bit louder to get Johnny to come home?

I mean, that's kind of a shitty analogy I get that, but I mean, that's kind of what we're looking at. It's not the worst thing in the world. If you have a little bit higher of a TSH to get you to the same level of fruity forest everybody else. Hmm. And we can speculate all day, but I think what you're saying is, I think I fully agree with you because we tend to look at symptoms and look up for the simple answer and the simple

answer in that case would be, you need thyroid. Let's give you some thyroid versus the complex answer, which would be, let's look at your diet, let's look at your sleep, let's look at your lifestyle, and it could be all these other things. So you have these symptoms, thyroid is normal, TSH is a little high, rather than going in that direction. Do you have cases where someone is actually does have thyroid issue or condition, right? That's with hyper, hypero, and you actually address gut stuff

and that solves the problem, that solves or fixes it. Yes, we publish, I say yes because I'm trying to think of which one of the many is the best one to showcase. But I think Laura, and we did a video conversation with Laura that's available on her website. She was able to cut her thyroid hormone medication dose in half while sleeping better, having less joint pain, better skin and losing weight.

So you can see significant improvements in a multitude of symptoms, including the thyroid picture and the thyroid medication dose, if you improve someone's gut health. Part of why I think that is, is because the thyroid medication that you're taking, that's absorbed in your small intestines. And so if that's an inflamed mess, you may need more of the hormone than you...

It's pretty straightforward. Actually, appear to. And also, if you're inflamed, ostensibly, you have a harder time converting and successfully using that hormone once it gets into your blood and into the periphery of your body are there any Any potential dangers of taking thyroid when you don't need it. I know we talked about the yes What are they mainly cardiovascular? And this is the one something I forgot earlier remember when I said people go on thyroid if they're at home or and they might be anxious or having some or fatigue. Sure.

Heart palpitations is another. And this connects us to the whole debate about should I take T4 plus T3 or just T4? You know, in the bodybuilding community, if they take the number one thing that they'll try to get their hands on, because bodybuilders use thyroid pre-contest, sometimes get lean.

And they'll always try to get their hands on because bodybuilders you styroid pre-contest sometimes get lean and they'll always try to get their hands on, is it cytomel? Is that the one? That's T4, right? T3. T3, excuse me. Which one's the active one? Is it T4, T3? T3. T3. So they'll try and get that one and if they can't get that one, that's the one that everybody wants, then they'll go for the one that has both. T3 and T4, but the active one is that they always want to get their hands on because that's the one that works or whatever the boast. So go ahead. So there's a debate regarding should you go on T4 alone or T4 plus T3.

And let me just clarify by saying, I don't care. Right, what I care is what the evidence shows. Right, so I don't approach this conversation trying to reason my way into the belief that I want to come away with. What most of the evidence shows is that people will do better on T4 alone. And there's actually been three meta-analyses comparing T4 alone to T4 plus T3, concluding that the majority of people feel better on T4 alone. Here's where things get murky.

There have been some studies showing that people feel better on T4 plus T3. But what this appears to be is a small subset of people, maybe 15% of the population that has a potency, a polymorphism or just inefficiency in their didenase enzymes, which convert, which help with cleaving off iodines from the, so T4 is tetraiodothyronine, right? So there's... Somebody has to convert that to T3.

So you need these didenase, you have to cleave off an iodine to kind of make that conversion. And so some people have poor function of that enzyme, so they're poor converters of T4 into T3. And so these people made you best when you give them T4 plus T3, because they have a hard time taking that T4 and converting it to T3. But, and so there is evidence to support that. There are studies, and you can point to them

and say, look, doctor, you showed this study found that this 50% of people perhaps in one study felt better on T4 plus T3. Yes, but was that, you know, I believe this particular study, it was a population of people who already felt, didn't feel optimal on T4 alone. So they went through that first step? Exactly. And then you have to also look at the studies showing that there's a fairly high adverse events mainly of heart palpitations in people who are just inappropriately or in

a premature fashion put on T4 plus T3. So you want to start someone on T4, see how they do, give your doctor a little bit of time to dial in the dose. Next I would consider optimizing your gut health because that may fix the problem. And then only third and finally, essentially, would I consider a T4 plus a T3. Is this because your body, when you take just T3, you can overdo it easier versus when you take T4, your body will convert kind of what it needs. Your body has more control over the throttle, so to speak, because it's going to convert

you to T3. When you give the T3, you're already giving kind of like the gas, right? And so it's much more difficult for the body to choose what it does with that, because you're already giving the active form. How dangerous can this be for somebody like a competitor who's taking this. Well, it's a good question. I haven't looked at long-term safety outcome data. I don't know if there's a lot of great data comparing because it's really hard to adjudicate who is taking too much C3 compared to who is not and then following those people for years

and years in a study. But ostensibly increased cardiovascular occurrences would be one of the things that you would see because someone would have a heart rate that's elevated higher than it should be. That would be my main concern would be a cardiovascular complication. Yeah, some of them would combine it with like, you know, this is what I like, stimulants. I want to know, are you are you privy to how Climbutarol affects the thyroid?

No, I mean, I'm I'm assuming they're What's a mechanism of Climbutarol? It's a beta. It's a beta agonist. It's a bronchodilator. Okay, so if it's a So I believe it to agonist I believe I'm really reaching back into some of this. I believe it's adrenal hormones actually that turn up the sensitivity of your catacomine receptors. So I'm not sure how thyroid ties in, but I want to say thyroid does also have an effect. I know it ties in. I just don't know how.

That's why I'm asking you. I thought maybe you might have more. It may be through receptor sensitivity, but I'm not sure from confusing that with adrenal hormones. So I'm not exactly sure. Well, I mean, I know that just again through friends and stuff, people who competed naturally did terrible when they would take thyroid pre contest because they'd lose muscle. They'd lose muscle and body fat, but they'd lose muscle. It was the guys that were on shit tons of

gear who could preserve muscle that then would go on thyroid and get rid of. But then these are people they don't give a shit. But I mean, they're not really caring about long term effects. It's like, does it work? Right. You know, type of deal. Well, I'm gonna put that on for your homework because it's a very popular drug that's used in the competitive world.

I mean, if you shoot me an email, I can find you the answer to that. Yeah, I'm just here. I know there is some effect. I've experienced it firsthand myself. It's extremely popular in the men's physique, women's bikini bodybuilding world, as far as part of a protocol,

when it's time to get shredded, is to add in Climbutor all. And I mean, of all the things that I've... Plus T3 are just Climbutor. Just Climbutor, although some are taking T3, Anglin. But I do know that it's widely used. And of all the things that I've messed with, it's one of the ones that holy shit

that I feel it more than anything else, which always raises a flag for me, like if my buddy feels is telling me, you're heart's pounding like crazy. I'm sweating just sitting still in a chair, like, yeah. And yeah, so when I feel physiological things like that, like I said, all the things that I have taken, it makes me ride away, I think like holy shit, what could this potentially be doing?

You wanna have a lot of fun, look into the pharmacology of the shit that these competitors take, you'll have all of this. You'll have a great DNP and all kinds of weird crap. So, what's the feedback been like from your space because you're kind of trading on a lot of golden goose's? Because I follow your space quite closely. And they, for a while there,

I haven't seen it so much maybe recently, but for a while there, it was all about thyroid antibodies and your thyroid hormones normal, but you're still hypothyroid. It was like a big deal for a while. Yeah. And unfortunately, I think that's, it's helped some people. Yes.

I think what's been helpful is bringing awareness to thyroid antibodies in part as a predictive measure, like we talked about to predict hypothyroidism and also therapies like diets and vitamin supplementation that can help the decrease those antibodies. That's been helpful, but the problem is there's been such an overreach in terms of how important those things are, the prognosis that's associated with that.

And as another example, how strictly someone has to be gluten free or how to interpret those lab values. So there's been some good that's come of that, but a lot of that I think has been way over extrapolated. And unfortunately, I think it may have done more harm than good. It depends on the person, right, for someone who was on a T4 only medication and they needed to be on T4 plus T3, that information for them is probably gonna be a homerun.

So that's great. And for someone who was eating like crap and their endocrinologist said, well, the only thing we can do is leave with our oxygen and they went on a gluten-free diet and they happened to be sense of the gluten, that's a homerun, right? But the problem is that those situations

aren't necessarily the majority and that nuance is being left out where everyone has to do this all the time. So, how it's being received, I think, depends on who you ask, right? For some of the doctors in our group, there's most namely two medical doctors, one who just completed his residency

and one's been in practice for a few years, who've been emailing me quite regularly saying You know this this stuff needs to get out there more this I mean I'm seeing this all the time. This is really disappointing I mean one of these guys is you know I got a text from him every once in a while just venting. He's like Jesus Christ Like why is this I'm a pretty mild mannered guy and he's and he's saying he's like, but I get so pissed off when I see this What why is this is there is there a I'm a pretty mild mannered guy and he's saying, but I get so pissed off when I see this. Why is there a money motivation here?

Are the doctors making a kickback on recommending these drugs like wire? Or is it laziness? I mean, what do you think? I think it's people have a hard time being objective. I guess, especially in the medical community. It just, it amazes me how people, two different people can look at evidence

and come away with totally different conclusions. And, do you guys know Jonathan Height, you fall in him at all in the political space? Oh, if you like Jordan Peterson, I think Jonathan Height's the next Jordan Peterson. Really. Really brilliant psychologist, and he discusses something known as motivated reasoning. And he uses a great example of students in a PhD program.

I've heard this. Yeah. Students in a PhD program are supposed to review the methods of a study and assess flaws in the methods of the study. Now, the study conclusion that they're evaluating, yeah, there it is, the study conclusion that he's evaluating or that these students are evaluating is coffee consumption in women increases risk of breast cancer. That's not a thing, just for the audience, but that's what this fictitious study that these students thought they were evaluating for methodology flaws were looking at and

They found that women who were coffee drinkers found far more flaws in the study design than anybody else and height Uses that example of a of motivated reasoning Meaning two different people can look at data and come away with different conclusions based upon what their motivations are right We're all biased in some sense, right And so I think for people who are really motivated by the thyroid camp, they will see perhaps some of the evidence that I was showcasing that counters their point of view, and they'll just sweep it under the rug. For me, I just, I don't care, right?

I don't give a shit. I care about what works or you could argue, you do really care and that's why. Yeah, I guess I should say, I don't care about what I think I know. But when I approach things, I never hear this little voice like, ooh, that's gotta be wrong because I think this,

you know, the voice is more so like, hmm, that's interesting, is there more data like that? Okay, let me look at all that in one pile. Let me look at all the data that contradicts that in another pile. Let me weigh these piles and then let me reevaluate or reestablish what my conclusion is. But so many people, it seems, have a hard time doing that. Well, I think in that space in particular,

you have, I've seen this in the fitness space as well, where you have the wellness side, where if anything that's not natural is bad in their eyes, anything that's not organic is bad. And so it doesn't matter what it is, as long as it's natural, it's fine, even though sometimes natural things can be worse for you than a synthetic thing. This is quite true And so I think in your space with these progressive integrative functional medicine practitioners they're trying really hard to counter

Conventional medicine and they're trying so hard that they're looking for maybe they may be looking for ghosts when they're not there and They're finding them and they're like, okay, you you know I this person is hypothyroid and here's why because this is a little off, even though the data may not work. And I was that way for a little while. And, you know, I should also say Adam, maybe one of the things that contributes to that biasness

is a lot of people may not have the time to do the evidence checking. Right, I'm fortunate in the sense that I've set up my life where a few days a week it's my job to check this stuff. Yeah, I feel like a lot of doctors that I've met, they did all their schooling to get to the level of knowledge that they have and that a lot of them stop and they just go into practicing after that

where it's rare for me, but they exist, but it's rare to meet the ones that are constantly reading the new information, the new studies that could potentially contradict a lot of the information they've been saying for a long time. Exactly. Exactly. And then regarding the thyroid antibodies, we should touch on that also because that is an important aspect of this whole picture. Like we talked about, if you have elevated thyroid antibodies, it does increase your risk of becoming hypothyroid. Now, how much, not a ton, right?

The one study in Turan that was a long-term follow-up showed about a 10 to 20, specifically 9 to 19%. Incidents of people becoming hypothyroid when they had thyroid auto-immunity, but the levels of antibodies are important. So there's really two antibodies that are used to assess hypothyroidism. There's TPO, thyroid peroxidase, and TG, thyroid globulin.

The best data we have, the most well-interested marker, is the TPO. So I'll just refer to that one. And most labs cut off TPO, meaning you should not be above 35. So there's another area of debate where do we look at someone who has 78, the same as someone who has 1,224? In an incorrect paradigm I would say yes, you look at those exactly the same. In the correct paradigm I would say that it's just like blood sugar,

where if your blood sugar is 101 or your blood sugar is 181, there is a big difference in the talk you're going to have with someone with those two different blood sugar readings. So this is another important thing for patients to be aware of because if this conversation is mishandled, you could have a pretty good score on your TPO antibodies and not be aware of it and be made to think that you have a major inflammatory problem that could potentially do you harm in the future. So while all the data here aren't totally definitive,

I think it's fair to say that if you have a TPO antibody below 300 to 500, you're at minimal risk for progression to overt hypothyroidism. Because remember, that's one of the things we're trying to suss out, which is I have these antibodies, how at risk am I, given a certain level of antibodies, for becoming hypothyroid in the future? And there was one study that was very good that looked at this that found if third antibodies were below 500, the risk of progressing to

hypothyroidism was minimal. But if you're above 500, you had a moderate risk. And I would argue that if you're above a thousand, you haven't even higher risk. So that's important. Now, one of the counterarguments that's often made against that point is what about the studies showing that people with thyroid antibodies of 100 or 200 or 300, these like lower level antibodies are associated with depression and the lack of well-being. So that is true when that does exist. So that's why I say,

it could be a chicken or the egg thing going on there too. Exactly. And so that's why I say, and I can leave the door open that we wanna be below 300 to 500 in terms of progression to, you know, overt hypothyroidism, but also to your point, it could be chicken or the egg,

or it could be that even those low level of antibodies cause some sort of inflammation in the brain that doesn't lead to become overtly hypothyroid, but may cause problems with mood. Now, the good news is... Well, depression has been strongly connected to... ...inflammation. Yeah. Now, the good news is that when you look at some of these dietary trials, people tend to have a lot higher scores of subjective well-being and quality of life when they go on a paleo-like diet. There's also some evidence showing that selenium, which

can lower thyroid antibodies, may improve quality of life. So just because there may be an association with these low level of antibodies with mood doesn't mean that we've got to try to force your antibodies down to below 35. Because as I've observed, there are many people who will feel fantastic like like Laura as an example. I don't believe Laura's thyroid antibodies ever got into the quote unquote normal range, but she was in the low hundreds and And she lost weight, halftur thyroid dose medication had less joint pain and better skin and we're sleeping better. So you have to be careful

with that because in this by far and away is the one post on my website that has gotten the most comments. I lay out meticulously in the post. You wanna be below 300 to 500. If you're below 300 to 500, you're in good shape. If you're above it, then you should go through some of these treatments, XYZ listed out to help lower your third antibodies. Yet I get so many comments.

My third antibody is R284. What should I do? Yeah, it is. Like everyone I do? Yeah, yeah. Like everyone just, you know, commenting with their antibody levels and really, again, if you're below 300 to 500 and you're feeling well, you're done. You know, if you're at any level of antibody and you're not feeling well, take some steps and if you're above 300 to 500, then take some additional steps reasonably to lower your antibodies. Do all you can reasonably do, but if you aren't able to get them down

any further, let's say you're stuck at 600 and you're feeling well, don't sweat it. So, if it does like progress to hypothyroidism, there are steps you can take, even when on medication you could actually really get back to addressing that through nutrition, through lifestyle. Yeah, it's the body. Well, if say you're clinically diagnosed with hypothyroidism, is that a death sentence like you said in the beginning, or is there steps that you can take to bring you back to balance?

I think it depends on how hypothyroid you were. So first let me say that being hypothyroid in my opinion is one of the best conditions you can have. It's one of the easily even most easy things to say. It really is. I take that all day compared to some sort of neuro-generated condition. Of course. So it's not the worst thing in the world. Firstly, I would say that's a pretty good deck to have in your hand.

We've been able to treat that for decades. Yeah. Now, I was not to diminish that, but again, that's a pretty good one again if you're going to have something. Now, this is more so my inference, but I think there is some data to support this. It depends if you can become unhypothiroid, normal thyroid, after being diagnosed hypothyroid.

It depends on how skewed your levels. So if your TSH was, let's say, eight in your free T4 was low, I think there's a decent chance. low. I think there's a decent chance if your TSH got up to 88, right, or 125, like it doesn't, in some cases, I think the probability is less, you could still run the experiment of coming off your hormone for six to eight weeks and then retesting and seeing where your levels are. But the, the, the, and actually I'm sorry, there is evidence that has answered this question. The severity of TSH elevation and the severity of the antibody elevation does dictate the prognosis.

So the higher antibodies were at time of diagnosis and the higher TSH and lower your T4 were at the time of diagnosis, either the better or the worse of diagnosis that you'll be able to come off the medication. Now, Ruscio, is Hashimoto's diagnosed through TPL? Well, I think there's actually some debate there also. I think the most firm way to make the diagnosis is to look for antibodies and then confirm

with an ultrasound. Okay. I don't think everyone is doing that way. And there may be some new answer that I'm not aware of in terms of. Am I assuming if I looked, we'd find perhaps general agreement in diagnostic methodology, but maybe one or two endocrinology bodies that have a slightly different methodology. But TPO is the most classic marker.

Can you diagnose Hashimoto's with TPO alone? I think you're pretty safe to be able to do that, but I think some would like to see that confirmed with a thyroid ultrasound. And then the thyroid glibin antibodies can also be used. But the reason the thyroid ultrasound may be... What are they looking for just like goiter? So you're looking typically for what's known as hypodecogenicity, meaning of reduced. So the ultrasound is like a wave pulse. And the density of the tissue will either allow, so if you knocked, the thing you had this

arm wire with no clothes and those empty and you knocked on it, you'd have its hollow echo. But if that was filled with clothes, there wouldn't be that echo because there's all this density in there So there's no open space to reverberate the echo So if you have hypo echoedrenicity you have a low amount of echo Because scar tissue has infiltrated the gland and that scarred gland can't produce as much hormone The reason why I think some bodies man I'm gonna echo be wrong on this point, but may want to see confirmatory ultrasound

to confirm the antibodies is antibodies are not perfect. They can sometimes cross-react or other things can for example certain viruses can cause false positives of antibodies. So you can probably start with the antibodies and then follow up with an ultrasound if you wanted to be super cautious in terms of diagnosis. Okay. And I'm sorry, remember that one study we were talking about that found that your length of time on thyroid hormone did not dictate if you'd be able to come off. Right. One of the findings that did correlate to would you be

able to come off or not was the thyroid finding, the thyroid ultrasound findings. So it's a scar tissue. Those who had scar tissue had a lower probability of being able to come off the medication. Of course, that makes sense. Yeah. Well, good times again, man. Yeah, great.

That was a great one. That was a great one. No, no, no, good conversation. I mean, it was crazy that you reached out when you did because literally like maybe a week or two, I don't know if I told you that or not, before that, but Cassie who handles all of our customer service on the backside was actually asking us to do a video

or an episode strictly on thyroid because she's getting so much. Right now, yeah. So when you said that, I was like, oh, that's crazy that you're getting a bunch of questions out there Yeah, we're that we're also we're seeing an influx right now on our end and she was asking for more content that she could share To our audience that was reaching out to her on helping questions about it. So good

Well, you know, I'm glad to be able to offer this and you know, I don't I don't want to seem like I'm disparaging the field I think the field's done a lot of good, but some of these things now are getting out of hand. I think they're all done and attempts to help people, but it's one of the problems with progressivism, where if you're too progressive, then there's a probability where you're going to believe things that aren't fully true. And if you do that in a health and medical space, you can subject people to diagnosis these treatments that they don't actually need to harm them. So, you know, I think this

is a natural part of the evolution of the field where there's going to be this push and pull. And I think the push to get people to understand about thyroid antibodies and how that can be used predictively to dictate risk and how diet and nutrition can be used to manage improved thyroid function is awesome. But we've gotten a little bit overzealous there and now we have to pull back a little bit and that's what I'm hoping to kind of present to people and give them a little bit more of a responsible nuanced view. Excellent.

First you know harm. Exactly. Excellent. Alright man thanks for coming on bro. Thanks guys. Thank you for listening to Mind Pump. If your goal is to build and shape your body, dramatically improve your health and energy, and maximize your overall performance, check out our discounted RGB Superbumble at MindPumpMedia.com.

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