Ep. 98: How To Optimize Your Diet & Lifestyle For Hypothyroidism (Hypothyroidism Part 4)

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In this episode we discuss:

  • How fasting decreases thyroid function
  • Why carbs are essential for thyroid function
  • Specific anti-thyroid foods to avoid 
  • Why interventions like cold thermogenesis, caloric restriction, and fasting are not the answer for hypothyroidism
  • The impact of sleep on our thyroid health

1:06 – how to address and reverse hypothyroidism 

2:36 – the importance of carbs, calories, and fat for improving thyroid function 

16:24 – the importance of eating consistently (and not fasting) for thyroid function

18:00 – saturated fats vs. PUFA and micronutrients for thyroid function

19:45 – basic bioenergetic diet recommendations for hypothyroidism

22:14 – anti-thyroid foods (goitrogens) to avoid 

23:08 – other diet considerations when transitioning to a bioenergetic approach 

25:56 – low iron in women and excess iron from carnivore or keto diets 

27:47 – cruciferous vegetables and thyroid health 

28:43 – how to properly address nutrient deficiencies for thyroid health

35:06 – whether stressors like exercise, cold thermogenesis, caloric restriction, and fasting are supportive of thyroid health

47:54 – optimizing sleep for thyroid function 

Links from this episode

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Jay Feldman 0:05
If you're eating low carb or fasting for your thyroid health, you're definitely going to want to listen to this episode of the energy balance podcast, a podcast where we dig into the physiology behind the bioenergetic view of health and teach you everything you need to know to maximize your cellular energy. Today's episode is part four of our hypothyroidism series, and in today's episode, we'll be discussing how fasting decreases thyroid function, why carbs are essential for thyroid function, as well as the specific antithyroid foods that you want to avoid, why interventions like cold thermogenesis, caloric restriction and fasting are not the answer for hypothyroidism and the impact of sleep on our thyroid health as always to take a look at the studies, articles and any other relevant links from the episode, you can head over to Jay Feldman wellness.com/podcast to take a look at the show notes. And with that, let's get started.

So let's shift gears and talk about what to actually do in the state or situation where we do find that we are dealing with hypothyroidism and there's a lot that we can do here, and a lot of this is going to go back to what we talked about as far as all those factors that affect thyroid activity. So that's a key piece. Here. Is if we know the factors that affect thyroid activity, the things that inhibit the production and conversion, we can then reverse engineer, you know, to determine what sort of things we want to do, to do the opposite, you know, to support thyroid hormone production and conversion and oppose those other things. So we'll talk through dietary things, lifestyle things, supplements, and then also the medication side, in terms of what we do want to do in terms of hypothyroidism and what we don't want to do when it comes to the medications. We'll talk about the issues with using t4 only. You know the t4 monotherapy, which is the typically prescribed and conventionally approved method of, quote, treating hypothyroidism, even though the vast majority of cases, it doesn't do anything of the sort. So we'll talk about that as well, and some good alternatives there.

Mike 2:15
How to mask hypothyroidism in your labs, 101, with t4 monotherapy.

Jay Feldman 2:21
Yes, exactly, yeah, exactly.

Mike 2:24
So I guess Go ahead. Go ahead. I was gonna say on a dietary front.

Jay Feldman 2:30
Yeah, let's start with the diet and break it down. If you want to jump in or start us off, feel free.

Mike 2:36
Yeah. I think I kind of see it in a hierarchy. The easiest way to start is the first thing you want to do is you want to do is you want to be eating enough on a regular basis you want to be getting enough calories in your diet and again. So I guess just a like, brief tangent on the caloric piece here. I think for both of us, we see calories as a tool, right? It's, it's, it's a measure of energy that you're in taking on a regular basis. Because it's hard to compare watermelons and steak, because they're, you know, a little bit different. So basically, calories allow us to say, Are we eating enough energy on a regular basis? And and quantify that to some extent. And so the first piece is, you want to be making sure you're eating enough energy on a regular basis. If thyroid is going to control your energy production, then obviously the your body is going to fine tune the amount of energy that you're producing based on the substrate that's available. So if you start to go and you see this in the literature, when you start to go on low calorie diets, you start to see decrements in thyroid function. And it may not always be elevations in TSH. It could be adjustments in peripheral thyroid metabolism with the deiodinase enzymes and then conversion of t4 to reverse t3 versus t3 so you can see things along those lines. That's problems that you can see specifically when you don't have enough calories on board. So that's kind of the first piece, are you eating enough calories on a regular basis? If so, check the box. Next piece I would say, would be, are you eating enough carbohydrate? This would be another really big one, because you could be eating enough fat and protein in your diet, but if you're on a low carb diet, there's direct negative effects on thyroid function, thyroid function from that perspective as well. So it's really important to make sure that you have enough carbohydrate in your diet on a regular basis. So I would say that's probably step number two. Step number three is you also want to make sure that you have adequate fats in your diet as well is kind of in this goes kind of hand in hand with the actual calorie piece. It's very it can be very hard to get enough calories in on a regular basis, enough energy in on a regular basis if you're on a very low fat diet. So it's important to the other thing is, there's our specific benefits to getting enough fats on a regular basis, for hormonal function, for energetic substrate partitioning, where some tissues may be using fats at rest, like muscles and other tissues, like the central nervous system, will be running primarily on carbohydrate, so you can have a sparing effect there. So again, adequate fats, there's other benefits of that's not going to go through all of them here, because we've gone through them in other podcast, so we can discuss link to some of those but essentially, you want to make sure you're getting enough calories, you have enough fats and carbs. The last piece is adequate protein is important, and especially because some components, like thyroid hormone, is dependent upon tyrosine. But I think overall, the main factors to really prioritize in terms of substrate is fat and carbohydrate and then protein. Again, it's not going to drive calories that much because there's a threshold for protein, and it tends to not add that much caloric intake into the diet. So the number we usually talk about there is point six to point eight grams per pound, and that's the amount to maintain lean mass, stimulate muscle protein synthesis, but not oxidize that protein for energy, which is, and we've discussed this as previously before but that oxidizing of protein for energy is not ideal, because of the production of ammonia and then in higher levels, the simulation of gluconeogenesis, elevated glucagon levels and things along those lines. So again, calories, first, then you get your make sure your macros are right. You want to have enough carbohydrate. You want to have enough fat. The minimum amount of carbohydrate I ever really want to see, or I ever really recommend for people, is about 200 grams on the bottom end, the absolute minimum, I would say, you want to shoot for from like a producing adequate or having adequate exogenous carbohydrate on board for central nervous system function and other carbohydrate dependent functions in the body, would be 150 grams. But obviously I think having a 50 gram buffer would be a lot nicer. So I usually shoot for 200 grams at the minimum, and then fat intake. That one's a little bit less research as far as specific numbers, where you can see specific numbers with carbs and protein. But I would depending on your size and muscle mass, you probably want to trend towards more fat in the diet. Maybe, I'd say, if you're if you're a man who's over six foot, you're over 200 pounds, or you're in that 180 and above Mark, you're probably going to want to shoot for like, 20 to 30 grams per meal, maybe a little bit more. And then for women who are a little bit more on the petite side, maybe you're a little bit smaller, shorter, you don't have as quite as much muscle mass as men, you're probably going to shoot for maybe between the 10 to 2010, to 25 gram mark, depending on on your size and where you're at. Then that's per meal. And then obviously we're not recommending like, long fasts or anything. So I probably shoot for maybe three to four meals a day, depending upon appetite levels and how much you're eating in the meal lifestyle and all those types of things such, you're eating at least consistently throughout the day, and you don't have these massive gaps or massive overnight fast for the like that, like at 1820, hour fast. So that's another thing that can directly impair thyroid function from a dietary perspective. Is if you're having long fasting periods, you can lower thyroid, the thyroid axis, you can increase the glucocorticoid axis, and then you can start to decrease the surge as well. So so that can be, over time, a bit stressful. Um, along with low carb and along with low calorie diet. So those would probably be the, the biggest pieces to start, as far as, like, uh, dietary intervention and Jay, I'll give you the four here, if you wanted to add anything to those elements.

Jay Feldman 8:15
So to you brought up a lot of great points. And kind of the general idea here is that we want to be well fueled in order to support our thyroid activity. And we've talked so we talked through a lot of the research behind these things when we were talking about the factors that affect our thyroid hormone production and conversion. And the basis here, the basic idea is that when we don't have enough fuel on board, it is going to lead to adaptive effects, to lower metabolic rate, to be able to allow us to exist for longer, to get through a period of low fuel, low food for longer, and as a result, one of the main things that happens there is lower thyroid activity. If we're trying to increase thyroid activity, that's not a good idea, really, at any time, it's not a good idea unless we're literally starving as we're literally in a famine, then yeah, you do want to maybe lower your thyroid activity in that point. But if you want to improve your function, improve your thyroid activity, improve the function of all of your systems, you want to be increasing your metabolic rate. You want to be increasing thyroid activity, and as a result, you want to be increasing or at least having adequate amounts of fuel onboard. There's a huge confounding variable here, which is weight and weight loss. So linked episodes where we talked about why you don't want to just be cutting calories and everything for that end but what we're talking about here, and as you mentioned, we want to get enough calories. We want to get enough of the macronutrients, the carbs, fats and proteins. We need to have adequate amounts of each of them to have enough fuel to keep our thyroid activity up, and we also want to eat consistently. We don't want to use any sort of fasting for the same reason for those same signals. Now this is largely the opposite of most of the thyroid you know, pro thyroid type recommendations you'll see out there. If you're trying to improve your thyroid activity, you're normally told one of a few things, cut carbs, maybe do like a high protein, low fat, sort of approach, or high protein, low fat, low carb approach, do some fasting, I don't know, cut calories to lose weight. I mean, it's do an autoimmune paleo thing, which is normally low carb as well. I mean, it's, there is no consideration for what these things are doing on the physiological level in terms of their signaling. There's just an idea of creating an enemy and then trying to avoid an enemy without, again, without the all of the factors that we discussed throughout these last several episodes of how these things affect our thyroid status and what they are signaling biologically. So with that in mind, it's super important, as we talked about, to include enough carbohydrates. That's really paramount, as well as enough calories. When we decided, the research in the earlier episodes talking about the factors affecting thyroid status, as far as you know, the fact that lower carb diets will lower t3 they'll increase reverse t3 relative to higher carb diets. And also they'll tend to lead to increased free fatty acids, which are going to displace the thyroid hormone binding from the binding proteins. And so that's another reason why they're going to affect our thyroid function. So that's huge there. We also talked about the importance of insulin for directly increasing t4 to t3 conversion, and also for opposing the stress hormones. Stress hormones, we know are going to be largely active when we're on a low carb diet or a low calorie diet. Those are going to impair t4 to t3 conversion and increase the t4 to reverse t3 conversion. And Insulin helps to do the opposite of those things and oppose those stress hormones and bring those down. So it's, you know, a few of those reasons and mechanisms through which carbohydrate feeding is incredibly important, or getting enough carbohydrates is incredibly important for thyroid status. And we see this in the literature. And you were mentioning getting at least 200 grams of carbs, which I think is, you know, as you were saying, that should be really a minimum, and that's where you see, by far the largest effect is getting up to that 200 gram mark for thyroid status. After that mark, there are still benefits to increasing t3 production and everything. They're just smaller. They're not as dramatic, because when you're going below that 200 gram Mark, you're really cutting into those, those basic needs for the average person. Now, if you're more active, if you're larger and, you know, an average in terms of body size, muscle mass, any of those things, those needs are going to be notably higher. But just at a very kind of minimum, that 200 gram mark is is, you know, where I put that? And we've talked about, you know, what goes into that value in previous episodes. I'll link to that. But we also see that very clearly in terms of the effects on thyroid activity. So that's part one. On the carb side, on the calorie side, we've seen the fact that low calorie diets will directly do the same thing, they'll decrease t3 increase reverse t3 although, again, this is not as dramatic with a higher carb, low calorie diet, but it will still happen if you're on a lower carb, low calorie diet, it's going to be even worse. You know, we're putting both of those stresses together, and you see it on the opposite side too, if you're getting extra calories or quote over feeding, that also helps to increase t3 so again, that doesn't mean that that's really our goal here, but there's all sorts of issues with even the idea of what's considered calorie, lower, high calorie or overfeeding. So I'll link back to episodes where we discuss that.

Mike 13:13
Before you jump in. I just want to tack on something into the to the macronutrient, calorie piece. I would say pro there's like a spectrum of, like, what's probably the worst from a hormonal function. So I would say, like, a high protein, low fat, low carb, is probably going to be like, one of the worst options. And then you have, like, a moderate protein, higher fat would probably be second worst. And then you have maybe a higher, higher protein, or, like a moderate protein, adequate carb or higher carb and a lower fat, and then the last one after that would be like, actually, and this, I think, speaks to what we generally talk about is sufficiency of all of the macronutrients. So it's we're not villainizing one macronutrient over the other. Here. What we're saying is that there is a requirement for each macronutrient for different functions and purposes in the body, and the goal is to optimize those amounts so that the body can function seamlessly, can function metabolically well, and not have to rely on any type of backup system, whether that's the adrenaline or the catecholamines to release free fatty acids, or that's glucagon to produce more glucose, or cortisol to deal with maybe an excess gluconeogenesis, because you have a really high protein, low fat, low carb diet. So yeah, so the goal is sufficiency, and I think that's a very different, maybe, like philosophical or conceptual shift, than seeing one macronutrient as a problem and then trying to just eliminate that. It's seeing, like a nuanced perspective that the individual will have different requirements for different macronutrients, and finding those specific macronutrients for the individual so that the body can function optimally is the outcome in the context of eating enough so we're not destroying the hormonal profile and then leading to situations where maybe we lose weight initially, but then subsequently we start to like gain in weight, because the hormonal profile takes a huge dip so that very big conceptual shift and I just something important to to keep in mind when you're when you're thinking, when you're thinking about these things, or how you're thinking about these things,

Jay Feldman 15:13
yeah, yeah. Great points. Great points. And you mentioned a few ranges for the macros that I think are helpful, the point six to point eight grams per pound of protein, being a good range with the carbon take 200 grams at a minimum. But after that, the way I would determine carbs versus fats is typically going to be dependent on our fat needs. As we were saying, we're going to have higher need for fat if we have higher muscle mass and if we are more active. From a percentage standpoint, of course, from an absolute number. If we're larger in mass, we'll need more fat as well. Normally, from the percentage standpoint, I would be looking somewhere in the 20 to 40% range.
Again, higher on that range, if you have higher muscle mass, or you're more active in a way that's using more fat and lower of that lower in that range, if those things are not relative to relevant to if you have lower amounts of muscle mass, and you're not as active in using that muscle as much, which is what's going to use that fat at rest, largely to spare, as you said, the glucose, yeah, and then yeah, filling the rest in with some extra carbs, depending on where you fit, where you fit in that the fat range. So I think those are all helpful. You know, indicators there, or parameters there, I should say. And then we you mentioned this as well. Eating consistently is something that's so important when it comes to thyroid status. And again, this is because of what it is signaling to us biologically, if we're going through fasting and feeding cycles, not only is that signaling that in that immediate moment, we're not getting enough fuel, enough food, but also that signaling that over time, we're going to continually be going through these experiences, and we need to conserve to prepare for that. And so as a result, consistent fasting, consistent, and I'm not even saying 12345, day fast. I'm saying even intermittent fasting has been shown to have these negative effects, where it'll reduce the conversion from t4 to t3 and increase the conversion to reverse t3 among lots of other things. So even that typical 16, eight intermittent fasting, which is normally a part of the same recommendations to lower the autoimmune state, and all of that is going to impair our thyroid activity and again, coming back to where a lot of these recommendations are coming from, the autoimmune paleo, the low carb, you know, avoiding sugar and dairy and all those things a lot of that's coming from this misguided molecular mimicry idea, this idea that that is what's going to drive an autoimmune state. And we've talked in detail in that autoimmune series about why that's not the case. And in reality, if you are taking these things out, it's normally going to come at a pretty major cost. And the reality is that these things are most likely not going to be contributing to any thyroid issues if they're used in the right context. So that would be, you know, these first things that we're talking about, I think, are the most important when it comes to kind of the big picture view of what we want to do on the diet side. One of the next most important things would be favoring the saturated fats over the polyunsaturated fats. See this in every area of physiology, that the polyunsaturated fats are disastrous, and thyroid is no exception. Not only is it disastrous for energy production, which, of course, is going to have impacts in inflammatory cytokine production and stress hormone production and all of that, but also there's direct effects of the polyunsaturated fats, where they inhibit the thyroid binding to the thyroid binding globulin. They do impair t4 to t3 conversion. They also actually interfere with the t3 binding to the nucleus. We talked about that as well, and in that earlier portion, talking about the factors that affect thyroid status. So that's another huge one. Is shifting away from the polyunsaturated fats toward the saturated fats, and this is something that's pretty ubiquitous with all organ systems. And there are a couple other things that are worth mentioning when it comes to diet and thyroid status. One is just in general, of course, we want to have a nutrient dense diet, but in particular, we want to make sure that we're getting the nutrients that are important for thyroid activity. We mentioned earlier that this is an important factor. It's rarely the driving factor of our thyroid state. Think for the vast majority of people, a selenium deficiency or zinc deficiency is not going to be the cause of your hypothyroidism, but making sure that you're sufficient there is going to be important for making sure that you've got adequate thyroid status. So things like selenium and zinc, things like Iodine, vitamin E, B vitamins, vitamin A, iron, vitamin C, vitamin D and we want to make sure that we're sufficient in these things from the diet or in vitamin D from the sun. We have talked about also the issues with too much of some of these things like iron and vitamin A, and how that and iodine, how those can have dichotomous effects. So we want to be careful. But in general, we want to be eating energy. Want to be eating a nutrient dense diet. And you know, for somebody who's this is their first foray into a bioenergetic approach, and they want to make some dietary adjustments, and they want to get enough fat and carbs in and protein in, without the polyunsaturated fats and with enough nutrient. Plants in a way that's going to support their thyroid activity, keep their stress hormones down, and that's going to not cause any gut disruption or endotoxin production, which would also inhibit thyroid activity. Just as a basis some real general guidelines, and we talked about, you know, it can link to other places where we've talked about this, but in general, we want to be focusing on carbohydrates from fruits, ripe fruits, and other kind of fruit counterparts, like dried fruit, frozen fruit, fruit juice, and then also cooked roots and tubers. On the fat side, we want to focus on saturated fats from Roman and animals, beef and lamb, bison, as well as dairy. And also, we can go with coconut oil, olive oil, avocado oil, things that are generally low, PUFA macadamia, not oil as well, but largely avoiding most of the seed oils and vegetable oils and all that, other than those, also making sure to avoid polyunsaturated fats that are found in fatty chicken and pork that are not fed perfectly or in a very perfect environment, because those are going to tend to be very high in The polyunsaturated fats. And then on the seafood side, sticking to low fat seafood as well. That's going to make sure that we're also avoiding the polyunsaturated fat content there. And that also informs us, not only of the fats, but of the proteins as well. Our main protein sources coming from, you know, the low PUFA ones, essentially, not the nuts and seeds, not the grains, but rather these, these low PUFA meats, for the most part. One other thing I'll mention on the fat side is cocoa butter, chocolate, those are also good options that are highly saturated and very low and unsaturated fats. All right, just a quick interruption here to mention that if you're dealing with a lot of the really common symptoms of hypothyroidism, low energy and fatigue, chronic pain, weight gain, digestive symptoms, brain fog, poor sleep, hormonal imbalances, or any other low energy symptoms. Then head over to Jay Feldman wellness.com/energy, where you can sign up for a free energy balance mini course, where I'll go over all of the different things that you can do from a diet and lifestyle perspective to maximize your cellular energy improve hypothyroidism and resolve these symptoms and any other chronic health conditions. So again, head over to Jay Feldman wellness.com/energy, to sign up for that free energy balance mini course and now back to the episode. So those are some basic things. And the last kind of specific thing I want to mention on the food side is we particularly want to avoid goitrogenic foods, and so this is going to be largely vegetable and legume based things. So soy is a huge one here, but also the cruciferous vegetables, which is, you know, broccoli, cauliflower, kale, brussel sprouts, that whole family and the this doesn't mean we need to fully avoid these, with the soy, I would probably avoid it as much as possible. When it comes to cruciferous vegetables, if we cook them, that helps a lot to reduce the goitrogens, because certain enzymes get broken down that increase the gorogenic activity. So that is something that's particularly important. But we do just want to be careful if we're dealing with thyroid issues with these families, with these goitrogenic foods, because they will interfere with a few different aspects of thyroid hormone production, and so it's just another factor to consider from the diet side. Yeah,

Mike 23:09
the couple points that I just wanted to jump in on so specifically, so say someone's coming from a background where they're having a hard time implementing carbohydrates, or they maybe they have type two diabetes or something like that, and they're trying to come to the bioenergetic approach, and they're seeing problems with blood sugar regulation or blood glucose readings and things along those lines. Specifically, I would really recommend that if when you start out, you start out with maybe, like whole fruit sources, instead of going straight to juices or very dense carb sources. And it's not that I think that the carbohydrates are problematic, but if you have a rapid influx of carbohydrate and you have an impaired ability to dispose or use of that carbohydrate effectively, then that can start to create some issues. So generally, I start people with whole fruits, maybe some dried fruits, if they tolerate those, because you're getting some of the fiber, you're getting the plant compounds, you're getting the nutrients, and then you're also getting the carbohydrate, and if you're I would also recommend eating that with a meal, so with protein, fat and maybe some cooked vegetable that has some fiber with it as well, because that'll also all of that will alter the blood glucose response. So you won't have such a drastic peak in blood glucose, and you can have like, a more consistent, steady curve, so you're not feeling that roller coaster. Even for people coming off low carb who are in a state of physiologic insulin resistance, they may find that they'll do better with slowly introducing the carbs and then doing it with not jumping to like tons of maple syrup or granulated sugar first, or even like downing 64 ounces of orange juice at first, but maybe slowly adding in some of the whole carbs, the whole fruit carbs, and maybe if they do tolerate some of the starchier carbs, like cooked potatoes or something like that, introducing those with meals, and then increasing juice and things like that as you go along, and making sure that you have a solid tolerance set, because there is a transition. Period in these different states where you start to increase your carboxidation, and in the type two diabetic state, multiple things are going on. So the fruit is adjusting the microbiome, the plant compounds are helping improve function at the liver, and now you you're possibly increasing your carbohydrate oxidation. So there's going to be a transition period, and it's important to keep that in mind, because I there's been a in when people come to this fear, I guess, based on, like, the general ideas that are seen, I guess, in in social media and, like the popular culture area of this, it's like, oh, sugared milk and orange juice and ice cream and things like that. And then people find that they may not do so well initially with that, especially if they're coming from these, these problematic backgrounds or not problematic. But like, like, there's physiologically, like, having some issues for their low carb, type two diabetes, impaired glucose tolerance. They have some weight to lose, etc. So I would just slowly move in from that direction. As far as the next piece I just wanted to touch on in the nutrient section, particularly in women, something that I've seen quite consistently is a low ferritin value, and so that's extremely important to correct your iron status in in order to improve a lot of your thyroid function and your hormonal function overall, if your ferret and if your ferritin values are less than 50, I would really recommend trying to get them over 50 and probably keeping between 50 and to 100 I wouldn't like if you're really low, it's probably not going to be ideal for that hormonal status, particularly thyroid function. As we talked about, iron being important, important in thyroid peroxidase function. So that's something to keep in mind. Again, zinc and copper and selenium are all important as well. But there can also be another thing that I see is people coming off carnivore or keto who had a very meat heavy diet having extremely high iron levels and their ferritin being over the reference range. So in those circumstances, I would recommend correcting that as well. That for women, that can be as simple as just decreasing iron intake, uh, or foods that are very heavy in iron to like, an appropriate level, because a lot of times it's like you're eating multiple pounds of red meat a day and organs and yada yada, like that whole paradigm. And it's not that I have a problem with those foods, but excess iron can be problematic as well. And for men, phlebotomy may be something that may may be needed in those in those circumstances, but also important to always look at your hemoglobin hematocrit if you're going to do phlebotomy, so you don't make yourself anemic in the process. So those are just like a couple areas that I've been seeing very consistently lately that I think is important to address. So iron overload, iron deficiency, and then also impaired carbohydrate tolerance, slowly walking in from that perspective. And then the other thing, the last piece I wanted to touch on, for the cruciferous vegetables, is specifically, if you are running, like I wouldn't do, even if you're cooking, it large volumes of cruciferous vegetables. Because I've had a I had a client actually did a video showing this who was eating large volumes of cruciferous vegetables. They were all boiled. But because he was doing, I think, 12 ounces to a pound per day, he wound up having impaired thyroid function overall. And so basically the correction was just limiting switching his vegetable sources, and in order to minimize, in order to minimize the glucosinolates. So those are the goitrogenic or antithyroid compounds. Boiling for roughly like 20 to 30 minutes is the way to go. But even then, your gut microbiome can still hydrolyze some of the glucosinolates that are left or some of the nitrile compounds. Again, these are the antithyroid compounds and that could have a negative effect on your thyroids ability to uptake iodine. Now, with the iodine piece, that doesn't mean supplementing high dose iodine is a good idea either. And we kind of discussed this with the wolf shakeoff effect and some of the other effects that occur. But get you can get some. You can increase the iodine intake in your diet with eggs, with dairy. You can use a little bit of seaweed. I wouldn't go, like, out of control with it, because very high doses, like even small doses of seaweed, can give you high amounts of iodine. So you want to have sufficiency with with a lot of these things, like iodine, and you really don't want to do an excess, because then there can be problems well, and a lot of times with correcting deficiencies of these things, I prefer, like, a like, a consistent approach, instead of, like, super dosing things and then winding up on the other side with a problem so taking enough so that you can rebuild your stores and be sufficient, instead of massively dosing things, because then a lot of times I've seen people get into problems where they massively dose some mineral compound or Something like that, and then it goes all the way in the other direction, and you have to take it back. So, um, nutrient density being extremely important from diet first, and then you can kind of maybe possibly test and see where you are with some of the mineral mineral components, and then kind of adjust in a more consistent and slower fashion from there. And. And give it, give it time. Give these things time to correct. Because it's, I think it's a it's a much more effective and gentle approach. You don't overcorrect or develop problems on the other

Jay Feldman 30:11
side, yeah, yeah, absolutely. The one thing I wanted to come back to there was just the ferritin side of things, where there's two things I want to kind of throw in. So one is ferritin can be a great indicator of iron status, as we mentioned earlier, as well. It can also be an indicator of thyroid status, where low thyroid can also cause low ferritin. So sometimes it can be hard to parse those things out, and we might want to look to other factors on the symptom side, anemia can be very similar to hypothyroidism, so it's hard to tell which symptom is due to what but we do want to consider that either low thyroid or low iron status could both contribute to low ferritin. So you want to consider other aspects of your context to try to sort that out. And yeah, you can make small changes, as you were saying, and see if that makes a difference. Yeah. And on the ferritin side, sometimes I would say more of like a 40 to 100 talk to the details another time, but you were saying 50 to 100 I'm okay saying it slightly lower, but that might be a longer conversation. Yeah.

Mike 31:11
And with ferritin, too, something I would look at if you do see alterations in there, like say you have drastically elevated ferritin levels. I would also take a look at CRP and ESR, so C reactive protein and erythrotite, erythrocyte sedimentation rate, because those things will be markers of inflammation, and inflammation can drive up ferritin values despite your like your actual iron status, you can see a high value in inflammatory states because of an acute inflammatory response. So that's something too important to keep in mind as well, overall, and that's that's a protective mechanism. So I would just take a look at those simultaneously, with a hemoglobin, hematocrit, a ferritin and like, again, these are all lab things with the thyroid profile, the total, like a lipid panel, that could give you an idea of of what you have going on overall, from an inflammatory perspective, from an iron balance perspective, from a thyroid perspective, there's obviously other markers you can look at we talked about, I think we discussed, like the the associations with TSH and cortisol. And then for some of these values, you can look at, like the zinc and selenium values. You can look at your copper value like a serum copper value, maybe it's through ceruloplasm or plasmin. Now, again, I'm not saying this because I think Jay and I fall into, like the Morley Robbins camp of things. It's more that like there is an importance for copper and there is an importance for iron, and getting them right is, is important if you are struggling with some, with some of these situations, same thing with sink or selenium. Um, but it's not that like one is the again, it's the same. Same thing with the macronutrient stuff. It's not like one mineral is the devil, and then there's this other Savior mineral, like carbs are the problem and fats are the saviors. It's more like, you want to make sure that you have things in sufficient amounts, and you're getting them in sufficient amounts in your diet. So just as, I guess, a little bit of a tangential point, but if you really want to see where you're at nutrient wise, the first step I would do would be log in chronometer and see where your nutrient intake is at and where your gaps are. And then then kind of correct those, either dietary or with some with, like, some appropriate level of supplementation. And then you can also, if you're still having some sticking points, then I would start to consider, hey, maybe we can test, like, some of these things, and see where we're at, and see, is there something that needs to be corrected? Is there something that's too high? Is there something that's too low? So there's like, just like with symptoms, you can look at symptoms of what you have going on, and you can see lab tests, and then for nutrient status, things along those lines, you can look at diet, and then you can also look at lab tests, and then you can also consider symptoms in there as well. So there's multiple steps and ways to kind of assess what you have going on. And there's a lot of tools at our disposal, whether that be expensive lab testing or a relatively inexpensive lab testing, or even looking at chronometer or taking looking at your symptoms or checking your pulse and temp, things along those lines. There's a lot of things at our disposal that we can use to determine is our health moving in the right direction. Are the interventions that we're putting in place moving that needle for us, or do we need to continue to make some adjustments?

Jay Feldman 34:18
Yep, yeah, absolutely. And we want to consider these things in context. So as you were saying, you know, on the iron side, on the ferritin side, those can, you know, ferritin can be elevated due to inflammation. Can be elevated due to infection. You know, if we're looking at anemia markers, things like hemoglobin and hematocrit, should be included, in addition to just looking at ferritin, that might help us identify if it's low ferritin due to low thyroid versus due to low iron, among other things. So yeah, just it's certainly another area that we want to consider here. But I you know, with the caveat that as you were, as we both kind of discussed, it's rare that a deficiency in any one of these vitamins or minerals is the primary driver of a hypothyroid state, and we just. To make sure we're getting enough of them in order to be sufficient for thyroid activity. Yep. So there are a couple other things that are important to consider for more of the lifestyle side, as opposed to diet, although, of course, there's a ton of overlap because it's the same biological system and pathways mechanisms. But when we're when it comes to things like exercise or other kind of stressful interventions, things like cold thermogenesis or caloric restriction or fasting, which, again, kind of dovetails in with what we were talking on the diet side. We want to remember that stress, whether it's we're seeing it through elevated stress hormones or just inhibited mitochondrial function and respiration, or through increased inflammatory cytokines, all those things are going to inhibit the thyroid hormone production and the thyroid hormone conversion to active thyroid hormone, and increase the conversion to the inactive reverse t3 and so as a result, we want to consider a couple things one, we want to consider we are not driving excessive stress with really any intervention. And this is especially something that we want to keep in mind when it comes to movement and exercise, is that we do not want to be doing the thing that creates the most stress. That is not how we get the most benefit. And this is especially the case if we're in a hypothyroid state. We're trying to be very prone to that stress. So in contrast to trying to do some excessive amounts of exercise, lots of endurance training, or just a lot of training in general, which is associated with, you know, reduced thyroid hormone production and conversion, we want to again, instead of that, focus on consistent movement, not being sedentary, and moving and exercising in a way that we can handle and that does not drive excessive stress. We're able to recover from it well, we're still able to have decent energy throughout the day afterward. It doesn't wipe us out the next day or anything like that. Those are important barometers. We had a few episodes talking about the balance with exercise and how we strike that balance, and how much is too much? How we identify that, and the fact that that can vary a lot depending on context. It's very easy to over train on a low amount of exercise, if we're untrained, or if we're already in a stress state, if we're on a low calorie diet, or if we're dealing with hypothyroidism. So we need to consider that overall context, and trying to out exercise your thyroid state is never going to work. It's going to make it worse. And so instead, we just want to make sure that we're moving on a good consistent basis to get the benefits of movement and avoid the negatives of sedentarism, but we want to make sure that we're not exercising excessively and finding that balance. So those episodes would be important ones to kind of refer back to there if you're looking for more details, beyond the general idea of don't exercise to try to cause stress, and don't exercise to a point where it's interfering with energy, sleep, cognitive function, all of that stuff for that day or the next day. The other kind of piece of that that I kind of alluded to is driving stress does not lead to improved function. And this is the kind of combating the idea of hormesis, which is the idea that we want to drive stress to improve function. And if you're taking that approach, you might think that doing something that is stressful is going to lead to an increase in thyroid activity as a defensive, adaptive response as not the case. Even if it did that, it would be short term, and it would be doing it through all these stress mechanisms that long term would come at some major costs and major issues, like we've talked about with caloric restriction and fasting and low carb diets that work through all those pathways. The I would say the evidence and mechanisms are pretty clear here, and if you are in, you know, kind of stuck in that hormesis mindset, I would take a look at the series that we did talking about hormesis, which I'll link to, where we dug into all that in more detail. So I'll let you go ahead Mike on those couple of things. Yeah, for exercise again,

Mike 38:47
I think it's about dose. I think the dose is important, and the dose is adjusted based on what you have going on in your lifestyle. So you want to be auto regulating your exercise with the things that you have going on your lifestyle, so that you're not basically taxing the system too much. Because, again, the outcomes for exercise, the whole point is to, like, have the stimulus and then recover from it. And whether or not it's actually stressful or not may not really be the mechanism by which it's having the benefit. And we kind of went through this. So if you're doing weight training, or if you're doing any type of like zone two stuff, or whatever the deal is, I would really make sure that you're adjusting that appropriately to what your current ability to handle that is. So if you're not, if your work isn't that stressful, you don't really have too much accessory stuff going on, sleep as well. You're eating well, you're probably going to be able to get by with that exercise, be able to do more and be comfortable with that. Then, if you were, like, working 60 hours a week, and your sleep was kind of trash, and you have three kids and all that type of stuff, and then you're trying to, like, you know, wake up at five o'clock in the morning and then run your your 5k before work. I would in those circles. Stances, it may make more sense to get the sleep and then try to organize the lifestyle in another way so that you're sleeping effectively. You're still getting your food in. So another example could be like, you eat breakfast and you eat dinner, but you don't eat anything in the middle of the day, which I see is extremely common and a lot of people I work with because they have because of their work life, right? So they eat breakfast in the morning, they get their kids ready to go, and then in the middle of the day, they're working, working, working. And then they just, they don't take that time to really get a solid meal for themselves. And then they come home and they have dinner, and then they they go to sleep late, and then they, then they try to wake up and do exercise in the morning. And it's like, there's only so long you can run that before you start to develop like longer term problems. And it can, doesn't necessarily always have to manifest in weight. It can manifest in other areas psychologically. It can manifest in gut symptoms. It can manifest in sleep problems, etc. So I would, I kind of would get your foundation right first. So make sure you're sleeping well, make sure you're eating well, make sure you're managing the other stressful factors in your life and then adjust your exercise accordingly. You're not going to I don't think it's feasible to expect that you're going to perform like an elite level bodybuilder with six days a week of lifting when you're not resting and eating and managing the other factors accordingly. The same thing with with running or any type of sport, you're not the professional athletes who are or people who are running at elite level, these things and their lifestyles geared towards it, are actively managing other areas to minimize their stress that they can perform and they can handle the load, and whereas in and then you see a lot of people in everyday life, kind of People who aren't necessarily, like, making money out of their exercise or their sports or whatnot, who are still trying to run the similar schedule with all of these other factors on board. So I really

Jay Feldman 41:50
have to mention, just, just interject real quick, those athletes who are still doing all the recovery and everything normally, it still does come to a major cost of their physiology. That's despite, despite doing all of that,

Mike 42:00
yeah, with massages and and sleep schedules and, like, personal chefs and yada yada. And it's like, you have your mom, or you have a mom or a dad who's like, has all their kids and they're working and they're working out and they're not eating, and their sleep is tailored. And it's like, why am I having all these symptoms? And it's like, if you don't have those baseline components in first, then you can't expect to perform at that high level, because it's, again, it's it's the body requires certain inputs to get certain outputs. You need enough substrate to generate enough energy. You need enough sleep to recover appropriately. And if you have other things pulling on those energy systems like that does create a demand. So it's not this endless that there's there's, it's not this endless, uh, pool of energy that you have that's definitely becomes limited. I remember the first time for myself when I realized that in college at some point, I was like, Oh, the harder I work, the better my outcomes will be. So I can just endlessly work hard. And then I started to realize, well, there's a limit to actually how hard I could work and how long I could do that, and then eventually you will burn out. And that was in the low carb biohacking, intermittent fasting type of phase that I think you go through that mentality, or at least I did, without really understanding the implications, and you come out the other end and you're like, Okay, there's definitely a limit. And I definitely reached that limit and went over it, and now I'm going to suffer the consequences for that, and I'm going to and how do I recover? Is, I think, the question for that, and it may involve not, you know, squatting 400 pounds every, like,

Jay Feldman 43:32
multiple times a week. Yeah, it's you were making an important connection, which is that when we're exercising, if we're like that is directly using the fuel that would otherwise be fueling other functions. We talked about this in our exercise series, but when we're talking about how important getting enough substrate is for adequate thyroid activity, and we're also talking about that when we're in a low thyroid state, we're already limited how much energy we can produce if we're using both the energy and fuel, but especially the energy for exercise, and we're limited in how much we can produce, that is going to further depress our metabolism, further depress our thyroid activity, and further depress all of the things that influences all of those other bodily systems in order to compensate. And this is also something again we talked about in that series, in terms of the that model for energy expenditures, instead of the additive model. It was the, remember this called, I

Mike 44:29
don't remember what it was, but I know what you're talking about, where, essentially, at a certain level of exercise, you found that the it started to take away from the energy from other bodily systems, or affect other bodily functions, instead of just adding to the level of energy that you already you already had on a regular basis,

Jay Feldman 44:47
right? Right? So in contrast to the general kind of additive model of energy expenditures, talking about this constrained model of energy expenditure, which basically meant that if you just exercise by an extra three. 500 calories or something like that. That doesn't mean that then you went from burning 3000 to 3500 that that 500 calories will come at the cost of kind of energy used in other organ systems. So again, we dug into that in more detail and exactly what that all meant in that, in that previous series. Yeah,

Mike 45:18
I think it's an important way to think about is like, it's actually, it can come down to, like a logistics problem, right? There's only so many calories that your body can or there's, there's only so much food that your body can assimilate on a regular basis, and there's only so much energy that your cells can produce from that food substrate on a regular basis. So it's not this endless meter that you can just keep bringing up or down. It's, it's like there is a degree of fixation there, where, like, there is a top limit. And to this type of stuff, where you you can't really produce anymore, you can't assimilate more food. You can't divert more food to substrate, and then you have to start taking from other areas in order to exactly and the other thing is your ability to assimilate that food, and your ability to convert that food into substrate will be altered by other factors, like sleep, like digestive issues, things along those lines, hormonal problems, particularly in hypothyroidism, you're seeing an impaired ability to convert that substrate to energy, to ATP. The other thing is, in hypothyroidism, say you have SIBO, or say you have impaired, slowed gut motility, or you have decreased stomach acid, or anything along those lines, what you also find is your ability to take that food and convert it into substrate can be impaired in the through the digestive process, and then you may have these compounds being generated in the gut that are going to impair your actual ability to convert that substrate into energy because of the different bacterial products. So it's a, it is important to think like, these are actually logistical things. It's not this, like willy nilly type of system, or this, like random system. It's you have a set amount. It's not, it's not set. Like, obviously there's a range, but you have a range of ability to absorb nutrient, and then you have a ability, a certain capacity, to convert that nutrient to to or food to substrate. And then you have a certain capacity to convert that substrate to energy. So if you have any blocks along those systems, and you start to try to overpower it with exercise, it's that it's going to have to come from somewhere, right? And so again, the way I like to describe it as a company, if the accounting if the company has a certain amount of revenue, and the accounting department starts to really ramp up its use of revenue, well, marketing's probably going to suffer a little bit. Maybe there's a couple layoffs here or there. And so it's kind of the same thing that you're going to see in inside the body, whether that's digestion, mood, libido, hormonal, function, sleep, etc, those processes can start to take a hit. So yeah, that's, I think it's important to keep that perspective in mind, particularly with the exercise piece.

Jay Feldman 47:50
Yeah, yeah, absolutely, absolutely. There's one other factor here when it comes to lifestyle that's particularly important when it comes to thyroid activity, or just considering the general energetic balance, and that is sleep. So we know that night has some inherent stress to it, which is part of why, over time, throughout the night, our TSH increases, our cortisol increases, and all of that. Part of that is due to not eating during that time, but part of it also has to do with the inherent stresses of night, which is part of why we sleep, to kind of maintain ourselves during that point. And we also know, and we mentioned this in the factor, in terms of the or in that section talking about the factors affecting thyroid activity, that if we don't get enough sleep, that'll decrease our thyroid hormone production over time, even in the short term, it will cause an immediate stress effect that'll actually increase those things, just like any other kind of stress, and that's why we don't want to rely on those mechanisms. But it's just worth mentioning here that we want to be prioritizing sleep. It makes a huge difference for a thyroid hormone, you know, production and activity and thyroid status, overall metabolism as a whole. It also makes a huge difference for hormones. It makes a huge difference for insulin sensitivity, for weight gain versus weight loss. We did a couple episodes talking about sleep details there, if you are struggling on that front, low thyroid activity can also cause some issues with sleep. It basically puts us in a state where, if we aren't able to produce enough energy, our body can actually properly relax. It keeps it in a stress state, which can make it harder to fall asleep and stay asleep. So that can be huge kind of circular issue here, where you have impaired thyroid activity, causing issues with sleep, further impairing thyroid activity. But if you are struggling there outside of the thyroid side of things, I would check out those episodes where we talk through various strategies to implement to improve your sleep.

Mike 49:38
Yep, yeah. I don't have too much to add there. I think it's pretty I think we kind of covered it above as well. But yeah, that's these are kind of like, again, there's that foundation right, diet, sleep, stress levels, those are going to be, get those things right, and things will start, will start to improve. And obviously there's subcategories within each of those. But those are kind of like the big. Big areas overall, to really optimize from a health perspective, and then you can start to like, you move into the next areas where it's like exercise and things like that. Yeah, exactly.

Jay Feldman 50:11
All right, we're going to end that episode there and pick back up in Part 5, where we'll be discussing the problems with using t4 only medications like Synthroid and levothyroxine for hypothyroidism. We'll also be discussing when it makes sense to use thyroid hormone supplements, how to use t3 t4 and or desiccated thyroid or NDT for hypothyroidism, whether thyroid hormone should be taken away from food due to absorption concerns, and whether we should be concerned about thyroid hormone supplementation suppressing our own thyroid hormone production. If you did enjoy today's episode, please leave a like or comment. If you're watching on YouTube and if you're listening elsewhere, please leave a review or five star rating on iTunes. All of those things really do a lot to help support the podcast, and are very much appreciated as always. To check out the show notes for today's episode, where you can take a look at the studies and articles than anything else that we refer, that we referenced, you can head over to Jay Feldman wellness.com/podcast and if you're looking to reverse your hypothyroidism with clear action steps and strategies, along with personalized guidance from me, head over to Jay Feldman wellness.com/solution, where you can find All of the information for the energy balance Solution Program. This program includes customized health coaching, a video library that includes a video talking specifically about how you can evaluate your thyroid status using blood work and symptoms, as well as when you should supplement with thyroid hormones, how to dose them and how to pick the right product. The program also includes resources like a sample meal plan and supplement guide, as well as access to a private community to find out all the details. Head over to Jay Feldman wellness.com/solution, and with that, I'll see you in the next episode. 

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