Recently I interviewed Dr. Westin Childs, as he discussed some of the different supplements that can benefit those with hyperthyroidism/Graves’ disease and hypothyroidism/Hashimotos’, and below is the written transcript. If you would prefer to listen the interview you can access it by Clicking Here [1]:
With me, I have a very special guest, Dr. Westin Childs. Dr. Childs is a former osteopathic physician that focuses on helping people with thyroid problems, weight gain, and hormone imbalances. He takes a functional medicine approach to these systems and believes that everyone, regardless of their hormone status, can get back to feeling 100% using a combination of medical and natural therapies. Welcome, Dr. Childs.
Dr. Westin Childs:
Thanks, Eric. I’m glad to be here. For those who maybe don’t know, we had Eric on my podcast previously, so this is our second time chatting. The first time was awesome, so I’m really happy to be here.
Dr. Eric:
Happy to have you, Westin. Why don’t you start out by discussing how you started helping people with thyroid conditions?
Dr. Westin:
Sure. Full disclosure: I’m not practicing now. I originally went to an osteopathic medical school. When I came out, I started in radiology and moved to functional medicine. I knew I was going to do something related to hormones and weight loss. Weight loss was the thing I was most interested in at the time. I also wanted to focus on menopausal type stuff and hormone replacement therapy in that setting.
I was working with a couple of chiropractors. They just kept sending me patients that they couldn’t get all the way better. They would do what they could. They would use supplements, diet, lifestyle, and so on. Some of these patients needed thyroid medication, so they would send these patients to me. I learned a lot in practicing and helping these people get better. I started to use things. I found out certain things didn’t work. I would start out with levothyroxine, which is what I was taught. I’d add natural desiccated thyroid extract. That would help some people but not others. Then I wanted to combine T3. I added more and more therapies. We were able to really help these people who otherwise weren’t able to get help from either their conventional doctors, their endocrinologists or family practice doctors. As a result, it grew from there.
Once you help a couple people, you attract people like crazy. There were so many thyroid patients who would come. In a way, I joke and say that I was attracted to that field out of necessity. There was such a void that needed to be filled in that area with thyroid management. Nobody was doing it. That is really what happened. I got interested in that. Because the thyroid is so integral to the systems and body including your metabolism and other hormone systems, it allowed me to do the things I wanted to do anyway. I was able to help a lot of patients who had low thyroid function and Hashimoto’s because weight gain is one of the main symptoms of that. I learned a lot about weight loss doing that. These people still had issues with estrogen and progesterone, so they needed bioidentical hormone replacement and therapy. That is how I got into it.
From there, I started doing my blog. I did my podcast and videos. Here we are.
Dr. Eric:
How long ago was that?
Dr. Westin:
I look pretty old, but it was just in 2015. I have only been doing this about five, six years.
Dr. Eric:
Wonderful. We are going to chat about supplements. It’s probably a good idea to start off by letting everybody know that supplements are important. They can play a big role in helping someone regain their health and feel better. But of course, we always want to start with diet and lifestyle, and I’m sure you would agree with that.
Dr. Westin:
For sure. When we talk about supplements, which is really what we’re going to talk about today, I want to zoom out a little and say: When I was looking at thyroid patients, you have a lot of different therapy options available to you. Really, supplements are just one bucket. Now having said that, I think supplements provide a lot of benefit because they are something you have control over. What I mean by that is they are not gated by a prescription path. You don’t need to go to your doctor and say, if you want to switch from a synthroid or levothyroxine to something else, you can’t do that on your own. Your doctor needs to prescribe that for you. But when it comes to supplements, you have the option to mix and match things. You can play around with them. You do have a lot of autonomy using over-the-counter supplements, which is why I am attracted to that field.
As Eric was saying, these are supplements. They are not meant to be used in isolation. They are supplements to whatever else you are doing. As we are talking about supplements, we will be going deep into those supplements themselves. But remember they are part of a complete therapy system. You are going to have diet, supplements, medications, hormones, lifestyle, stress reduction, improved sleep. This is just one element of many different buckets that you need to look at in terms of treatment.
I’ll also add one other thing here: When possible, you want to get as many nutrients (which is what supplements are providing) as you can from the foods you are consuming. A lot of times, that may not be possible, especially if we are talking about the soil depletion of certain nutrients. The foods that we’re consuming don’t have as much nutrients as they once did. In that case, it makes sense to supplement.
In other cases, it makes sense to supplement because some foods that are really rich in certain nutrients and vitamins may not be palatable to you. You may not like to eat those. You may not like to consume seaweed if you are looking for iodine. You may not like to consume oysters every day because you want to get your zinc elsewhere. You have to play around with all these things together. But I do think supplements have a really important role in the treatment of a lot of thyroid patients and can provide benefit. But they should not be looked at in isolation. They should be looked at as one part of a whole treatment plan.
Dr. Eric:
Let’s dive into the supplements what are some of the more common supplements that you recommend?
Dr. Westin:
Are we talking about Hashimoto’s patients? Graves’ Disease? What were you thinking? Or just general?
Dr. Eric:
I was thinking we could do it either way. We could focus on hypothyroid patients and then hyperthyroid. Some supplements are better suited for those with Hashimoto’s, and some are better suited for Graves’, and some could benefit both. I’m open to however you want to start.
Dr. Westin:
One of the main benefits of supplementation is you have the ability to manipulate and fine tune what nutrients you’re using to try to obtain some specific purpose. There are a lot of ways to look at supplements and how to use them, but that is how I think about it.
When I am looking at thyroid patients, I am really thinking about what sort of thyroid problem do you have? It’s not always obvious. You might think to yourself, I have Graves’ Disease, therefore I have hyperthyroidism; therefore, my thyroid is actively hyperthyroid. This isn’t always the case. For instance, you could be taking an excessive dose of methimazole, which is blocking your thyroid beyond that which would be normal. You could go from hyperthyroid to hypothyroid in which case there is maybe some room for improvement there.
Likewise, imagine you are somebody who has hyperthyroidism. Let’s imagine you had your thyroid ablated or surgically removed via thyroidectomy. Even though you were previously diagnosed as hyperthyroid, once your thyroid is removed, you are more in the hypothyroid camp. You have to think about what is your current thyroid status? Then you can determine what kind of supplements you want to use at that point. That is really how I am thinking about it.
We will talk about supplements that boost thyroid function, supplements that improve the immune system. We can talk about supplements that will be beneficial for Hashimoto’s and Graves’. There are some supplements that can make those conditions worse. On the flip side, there is also a lot of supplements important for general health. We can talk about those more broadly and then dive into these other areas more specifically as we need to.
For general health, zinc would be a really good one. I would look at magnesium as that tends to be depleted in a lot of people, especially related to stress. All the B vitamins, B12 especially. These tend to be depleted in stressful situations, and they tend to be impacted by those with thyroid function due to how the thyroid impacts the metabolism and how these are excreted or retained inside the kidney or intestinal tract. I would include Vitamin D although I think that has relevance when it comes to autoimmune diseases as well. I could put that in both Graves’ and Hashimoto’s. Those are the basics.
These are more related to vitamins and nutrients and not necessarily botanicals. I want to separate those two. Botanicals are when you are extracting a specific element of a plant. Ashwagandha is an adaptogen. We talked about berberine, which is a plant alkaloid. You can take these specific elements of plants, crush them up, put them in a capsule form, and take them to obtain some sort of benefit as well. You really have vitamins, nutrients, minerals, botanicals, and herbs. Which one you use, and when you need them, depends on your situation and thyroid status. In fact, I would also include probiotics and omega-3 fatty acids. These are the more general supplements you’d want to consider taking on a daily basis if you have any thyroid problem.
If you have a specific thyroid problem, we can go down that route as well depending on which one you’re thinking.
Dr. Eric:
Keeping in mind of course that Graves’ and Hashimoto’s are autoimmune conditions. With both of those conditions, they can take any of those supplements you just mentioned.
Dr. Westin:
That’s how I view it, yes. I would say that these are supplements for generalized health. They are to improve your health. When you look at patients, these are patients that if you took any random sampling of someone from the United States, they are someone who would benefit from taking those supplements, in my opinion, which is why they are included in a lot of multivitamins. When you look at statistics, something like 68% of adults in the United States are taking supplements in some form. They must believe that supplements provide some form of benefit; otherwise, 68% of people would not be buying them and using them on a frequent basis.
Where you get into some contradictions are how conventional doctors view supplements versus how integrative and functional medicine practitioners view supplements. You can talk about those from two different angles, so that gets more complicated.
The gist is most conventionally trained doctors who are treating thyroid conditions tend to be against supplements. We can talk about which ones and why. Especially iodine. That is a controversial topic. Whereas the integrative and holistic and more functional medicine practitioners tend to be pro-supplements. This is probably because they have seen how beneficial and effective they can be, and probably because they have used them personally.
I would say in my own situation, dealing with my own personal health problems, I found supplements to be incredibly effective, more so than prescription medications. It’s hard to argue with somebody that supplements don’t have enough scientific data to support them when it is clear that a lot of people experience benefits when using them. I want to put that in the background there in terms of context.
Dr. Eric:
I agree. As you know, I was diagnosed with Graves’ Disease. Of course, diet and lifestyle played a huge role, but I took supplements, and I think they also played an important role in my recovery. Same when I work with patients.
Without question, if I had to choose one thing, it would be diet and lifestyle over supplements, but ideally, I would recommend both. I would recommend they do everything they can from a diet and lifestyle perspective, like eating well, managing your stress, getting sufficient sleep. But supplements also play an important role. We are on the same page with that.
Why don’t we start with low thyroid function? What are some of the supplements if someone has an overt low thyroid hormone levels or sub-clinical hypothyroidism?
Dr. Westin:
When it comes to someone who has low thyroid function, I want to distinguish that we are talking about someone who has an insufficient amount of thyroid hormone in their body, meaning they are experiencing low thyroid function. The reason I am harping on that is because you can have people with hyperthyroidism experience these symptoms. It’s not specific to people who have been diagnosed with Hashimoto’s or hypothyroidism. We are talking specifically what is happening at the cellular level. Are your cells being impacted by thyroid hormone sufficiently to improve or cause the effects that you want thyroid hormone to do? If that is not the case, there are supplements you can take potentially to augment how well that thyroid function is working.
I think of that in three broad categories. We can help with thyroid hormone production. We can help the thyroid gland produce more thyroid hormone by providing the necessary building blocks the thyroid needs to produce those hormones. We are providing it what it needs so it allows it to occur.
Then we can talk about thyroid conversion. You can take supplements to support the conversion of T4 to T3, which is essentially saying, even if you have your thyroid hormone produced from the thyroid gland, it’s not going to work unless it is converted from the inactive form, T4, to the more biologically active form, T3. T4 does have some biological activity.
Lastly, you can talk about supplements that help thyroid cellular hormone sensitivity. We are saying that not only does the thyroid hormone have to be produced from the thyroid gland, it must also be converted from T4 to T3, and your cells must then be sensitized to it so it can actually function. Each of these categories, we have different supplements that work. If you want to talk about any of them in more detail, let me know.
When it comes to thyroid hormone production from the thyroid gland, we are really looking at 1) tyrosine, 2) iron, which is important for thyroid peroxidase; and 3) iodine. These three nutrients, not really vitamins per se, are absolutely required for thyroid hormone production inside of the thyroid gland. When you take these things, you are saying, “Look, I am providing the body with necessary building blocks that it can take to produce more thyroid hormone.”
Not so much in the case of tyrosine, as tyrosine is an amino acid. Most people are not tyrosine deficient. However, I will say that people who are supplementing with tyrosine do tend to see improvement in thyroid hormone production. I believe there is probably some competition between the use of tyrosine between the adrenal gland and the thyroid gland, which both use it for the production of building blocks of hormones. So I do see the benefit of using tyrosine even though people are not grossly deficient in it. That is not something you see very often.
You do frequently see iodine deficiency. You also see sub-optimal iron levels. Iron is required for the activation of a certain enzyme, which is involved in the production of thyroid hormone. You need iron for that enzyme to function. I find that thyroid, especially low thyroid, impacts the absorption of iron in the intestinal tract. There are a ton of patients who are iron-deficient or at least have sub-optimal iron levels such that these enzymes are not functioning 100%. It’s not like they are turned off. Instead, think of it as them running about 80-85% of normal instead of 100%. You have a slight drag on the efficiency of that system because there is a sub-optimal level. That is why I have to say I am a big proponent of checking on your standard lab tests for iron. That is one of my recommended lab panels for thyroid patients. You have to. If you don’t, it doesn’t matter what you do because you won’t see the success there.
Dr. Eric:
I agree.
Dr. Westin:
Ferritin, very important. If you have not had your ferritin checked and your iron, make sure you do, if you’re suffering from low thyroid function.
Iodine is the one I left for last because it’s another topic by itself. Before we do that, iodine is of course required for thyroid hormone production. I say it forms the arms and legs of the thyroid hormone molecule. Essentially, when we describe thyroid hormones, we describe them as T4 or T3. That annotation of 4 or 3 describes how many iodine molecules is on that compound. That hormone is either biologically active or inactive, or it turns into reverse T3 based on the configurations of that iodine. If you don’t have enough iodine, which a lot of people don’t, then you will have a problem producing enough thyroid hormone.
From a thyroid hormone production perspective, those are the three nutrients I would recommend that are most important. We can talk about conversion and cellular sensitivity here in just a minute as well. I don’t know if you wanted to dive into iodine in a little more detail.
Dr. Eric:
Sure,we could talk more about iodine. With iron, I agree with you once again. Ferritin, I like to see iron saturation, TIBC. With iodine though, do you recommend testing, like a urinary test or a blood test?
Dr. Westin:
Great question. Generally, no. I’ll explain why. There are a number of ways to test iodine. We won’t get into those testing methods. One of the more accurate ones is the 24-hour urine testing or the iodine loading tests. That is probably the most accurate of the available testing methods.
However, the controversy surrounding iodine is whether or not iodine is potentially harmful to those people who have thyroid problems. Part of that loading test requires taking high doses of iodine. If you are in the camp that says iodine is potentially dangerous, and yet you are giving someone a high dose to get tested, you put yourself in a little bit of a pickle. A one-time dose is probably not going to cause a problem for you there. But you have to think about these things as well. Not only that, but that particular test is also potentially difficult to do. It requires a lot of patient compliance. It is a bit of a nuisance. It’s annoying. It’s a little expensive. What do I do with the results afterward? I don’t recommend it for those reasons.
However, I also recommend starting with physiological doses of iodine as supplementations. If you are going to say, “I am a proponent of higher doses of iodine,” (I don’t know how deep you want to get into the iodine rabbit hole here) but the way I think about is because iodine is physiologically necessary for humans, they cannot produce it, meaning you must be getting it from your diet or supplement, that is how the physiology works. You need it. Therefore, if I am supplementing with a dose that is within the RDA, then I feel comfortable recommending that dose to somebody, whether or not I know what their actual testing is.
But I would say if you are somebody who is recommending higher doses of iodine in the range of 6-12.5 mg or higher, then I think it’s probably incumbent upon you to check and make sure that that person can actually handle that. Try a lower dose to make sure you are not potentially making that problem worse.
That is why I am not a super huge fan of iodine testing. I think it does make sense in certain situations, but I do feel comfortable recommending the physiologic dose range of about 100-250 mcg per day in supplement form or via foods. I don’t think you will see an issue with that. I will support that by saying there are tons of foods that have iodine in them that most people have no idea have iodine in them. Eggs, deli meats, strawberries, oat milk, tuna, etc. You are consuming a lot of these things on a daily basis. If you haven’t had a negative experience, chances are you are probably doing okay with iodine, at least in that dose range.
Furthermore, I have last I looked 80,000 bottles of supplements sold with iodine in them. I have a huge database of patients who have used iodine now. Very few people who actually have problems with iodine, especially at that dose. I can’t think of more than a couple off the top of my head. I think that when we are talking about these lower doses, especially the food situation, I think it’s safe. I brushed over a lot of areas because I think we could talk about iodine all day if we really wanted to. That’s why I don’t recommend routine iodine testing.
Dr. Eric:
Thanks for sharing. I agree. I know there are some practitioners who tell people both with Hashimoto’s and Graves’ strictly to avoid iodine. I agree that most people just taking normal doses of iodine and not getting into the mg doses are usually not going to have a problem.
To be fair, there are some people who take higher doses of iodine and rave about it. I’ll admit I was one of those people years ago. I took higher doses of iodine, following Dr. David Brownstein. I had a positive experience. I was recommending iodine to most of my patients, the higher doses, doing the iodine loading test, which I can’t say I do routinely now. If I will do testing, I’ll do more iodine spot tests for the reason you mentioned because the iodine loading test involves a 15mg tablet of the potassium iodide. You just never know how someone is going to handle it. I agree that lower doses of iodine in people who feel comfortable talking iodine as part of a multivitamin, which would be anywhere from 75-200mcg. There is always going to be exceptions with anything that someone takes. I agree. Iodine is important.
There is a different perspective when it comes to hyperthyroidism and Graves’. With Hashimoto’s arguably the low thyroid hormone is caused by the immune system damaging the thyroid gland. Maybe iodine isn’t as important in that situation. If someone does have a deficiency, then of course you want to address it. Even with Graves’, I am not afraid of giving a multivitamin with iodine in there.
Dr. Westin:
Nor am I.
Dr. Eric:
If someone does happen to have a reaction, it’s usually not severe with such a low dose. They can just stop taking it. With higher doses, it’s a different story.
Dr. Westin:
Previously, one of the treatments for Graves’ and hyperthyroidism was high doses of iodine to block the uptake of the production of thyroid hormone. This used to be a therapy back in the day. Clearly, there was something about iodine that is therapeutic in the setting of hyperthyroidism and hypothyroidism as we discussed. It’s really hard to come up with any definitive statement.
From the perspective of the patients, it gets a little confusing because you have people who are adamantly against it, adamantly for it, and people who are adamantly for really high doses of it. You have this wide variety of opinions. Patients are swimming through it and not knowing what the actual answer is. I think you hit the nail on the head when you said it is really an individualized thing. That’s how I look at it. If you’re really not sure what to do, and you’re afraid to cause a problem, get that help that a lot of people provide, like you do, Eric, if you need it. They can help sort through a lot of these things.
But my opinion is that most people taking that physiologic dose range will be fine. That’s my experience. I don’t think that’s a problem. If you want to start using it for therapeutic purposes, meaning you want to start potentially blocking thyroid hormone production from the thyroid gland because you are trying to stay off of the more prescriptive medications such as methimazole or PTU, you probably want a practitioner to help guide you through the process.
Likewise, if you want to use higher doses for hypothyroidism, because you are trying for detoxification of elements, I would probably get some help with that.
But the general physiologic doses, my personal opinion is that it’s probably okay to use. You really should not see significant harm, especially if it’s combined or taken with selenium, and you don’t have any issues there.
Dr. Eric:
I do want you to discuss conversion. One other thing I’ll mention is if someone doesn’t want to take methimazole, or if they are unable to take it, if they have taken it and experienced some side effect which is common with antithyroid medication, then I will typically recommend not the high-dose iodine but bugleweed, an herb with antithyroid properties. That’s what I took. I have another episode that focuses on bugleweed and motherwort. There are other options besides taking high-dose iodine, even if someone is unable to take antithyroid medication.
Dr. Westin:
For sure. I agree. My greater point is definitely don’t do that on your own. You want to be guided by someone like you if you are going to take that approach. If you are trying to take yourself off methimazole in favor of more alternative medications, I would definitely not recommend you do that on your own. Whichever one you and your practitioner decide on. I think we’re on the same page there.
Dr. Eric:
Yep. Let’s dive into conversion problems.
Dr. Westin:
Conversion is really important for low thyroid function. Understanding the conversion process is still important for people with hyperthyroidism. This conversion process is a process by which your body essentially takes a slightly biologically active form of thyroid hormone, usually in the form of T4, and converts it either to a very biologically active form, T3, or a blockading hormone, RT3. This conversion process is important for all types of thyroid hormone. From a physiologic perspective, a thyroid patient should understand the process.
Now when it comes to low thyroid function, a lot of thyroid patients have a problem with that converting, taking T4 to T3. When it comes to hyperthyroidism, most people are taking that T4 to RT3. It’s a completely different pathway; it goes down the fork. We are trying to accelerate down this path, if you have low thyroid function. There are a number of nutrients you can do that with, including zinc, selenium, and guggul extract, as well as pretty much anything that reduces inflammation. We know that inflammation as a process, infections, anything that stimulates the immune system and goes down that pro-inflammatory pathway will reduce the conversion of T4 to T3.
You can take these supplements, and it just so happens that a lot of hypothyroid patients need more zinc and selenium generally. That has just been my experience for most people; that is not universally true. It is not always the case, especially with selenium. But most people can benefit from supplementing with zinc and selenium.
When we get into guggulsterone, that is different. That is more of a botanical. That is an extract or ingredient we talked about previously. It also has other benefits, like anti-inflammatory. Pretty much anything that has an anti-inflammatory effect, like Omega-3 fatty acids or antioxidants or Vitamin C. Anything in that area. I will use rosemary extract. You can take plant or herbal extracts that are known to have anti-inflammatory effects and combine them together to enhance that pathway. That’s what I’m thinking about.
We can talk about dosing or keep it broad. Those are the four broad categories of supplements you can take to improve thyroid conversion.
Dr. Eric:
Before we get into dosing, how about talking about the conversion? A lot of it takes place in the liver and gut. Do you recommend things to support liver and gut?
Dr. Westin:
That’s another way to look at it. I am trying to keep it more simple. If you go to a practitioner, they will look at the system in your body and see the whole picture. We are speaking more generally here. Let’s say you went to see Eric, and he was trying to figure out why you aren’t converting. As Eric said, a lot of that conversion occurs predominantly in the liver, some in the intestinal tract, and some occurs at the cellular level. The nutrients required at the cellular level are different than those required in the liver or gut. When you go in and are being evaluated, you can try to pinpoint what issue is in your body. It will be different for every person. Some people might have more liver problems because they have insulin resistance. Some people may have issues with detoxification or their bile ducts because they had their gallbladder removed. Other people may be suffering from gut infections or inflammatory conditions or leaky gut or intestinal overgrowth or fungal overgrowth. Those are highly individualized. You have to go into that area and determine what needs to be treated.
That being said, there are certain basic things that you can do. If we want to be basic about it, with liver health, that includes things like consuming foods that are high in sulfur like cruciferous vegetables or using milk thistle. If you want to take a generalized approach there, you can use glutathione.
When it comes to gut health, we can talk about probiotics, prebiotics, herbal antifungals, antibacterial agents. it depends on which area you’re looking at. But you’re right to point out that the majority of the conversion does occur in the liver and the gut. Some occurs peripherally inside cellular tissues as well.
Dr. Eric:
Thanks for that. With dosing, especially selenium and zinc, because you don’t want to take too much of either one, what would be a general dosage that would be recommended?
Dr. Westin:
Good point. You can get highly individualized here as well. When it comes to zinc, I’m a fan of the lowest possible dose of zinc you can take, somewhere between 8-10 mg. Assuming you can take it without food and assuming you can take it by itself and are getting the maximum absorption. You will find the majority of zinc comes in higher dosages. You have a lot of people who experience nausea and indigestion when using zinc, which is why I recommend lower dosages. That maximizes absorption and minimizes side effects. It’s repleting the base level you need.
When it comes to selenium, that’s different. Most people need zinc more than selenium because you don’t want to go overboard on selenium. I haven’t found too many issues taking 30-60mg of zinc if you don’t know what your level is and are blindly supplementing.
With selenium, that’s another story. You can run into problems with selenium toxicity. I tend to lean backwards a little bit there. In the past, I used to recommend higher doses, 300-400 mcg, especially with patients with autoimmune diseases. I have since reined that back in, so I will recommend somewhere in the range of 100-200mcg range of selenium. That should be taken in context with what you are consuming.
People are consuming a lot of Brazil nuts because they are known to be a high source of selenium. The problem is there are a lot of issues related to the content of selenium inside Brazil nuts, which depends on where it was harvested, the size of the nut, and so on. Also, because of the keto diet, these nuts have been brought to prominence, so you have a lot more people consuming more Brazil nuts. If you accidentally take 5-6 Brazil nuts in one day, you can get up to the 500-600mcg dose of selenium, combined with whatever supplements you are taking. You could pretty easily get up to 900-1,000mcg of selenium per day, which is clearly more than you want to be taking.
So I recommend you proceed cautiously with selenium. If you stay in that low dose range and eliminate sources of selenium like Brazil nuts, you should be okay. I recommend using selenium in supplement form because you titrate that dose. There is a lot of variability between your Brazil nuts (one might have 40 mcg and one might have 90, it’s hard to know). If you are using a supplement form, you can fine tune and titrate it. I took 100 mcg last month, and I am monitoring my progress. I am looking at my symptoms and lab tests. How do I feel? It’s easier to monitor in that way. Did your question get answered?
Dr. Eric:
You just mentioned the doses for zinc and selenium. If you want to mention the other two-
Dr. Westin:
Those are variable. Guggulsterone and anti-inflammatory dosages can vary. I won’t go into those in detail. More important for thyroid patients are zinc and selenium, and not overdoing on those two areas.
Dr. Eric:
One thing to add with the selenium is if you are also taking a multivitamin, that probably has selenium as well. Besides the Brazil nut consumption, if you are taking a multivitamin, some will have up to 200mcg of selenium, too. If you are taking a separate 200mcg of selenium and eating Brazil nuts on top of that, you might be in trouble.
Dr. Westin:
That’s how I think about it. Like you said, just take stock of what you’re taking. Look on the back. Make sure you’re not overdoing selenium. I take this into context when formulating supplements and adding them together. But I will say if you go back 5-6 years, a lot of practitioners were recommending a 400mcg dose range. That was pretty popular back in the day. There was at least one study that I know of that said, “You can take up to 400-500mcg of selenium and not go into toxicity issues.” But that assumes selenium from all sources. Make sure you look on the back of every one of your bottles. Make sure there is no hidden selenium in there. Also take stock of what you’re eating that might contain high doses of selenium, which is mostly Brazil nuts, when talking about meaningful sources.
Dr. Eric:
If someone is taking magnesium, which dose would you recommend for that?
Dr. Westin:
I’m a big fan of magnesium. It can be impacted for thyroid production predominantly in the kidneys. I personally recommend in the 150-300mg dose range. Which type of magnesium you use really depends on the problem and what you’re trying to treat. You can use much higher doses of magnesium if you wanted to, especially if you are using in the form of magnesium citrate, and you are using it for gut health or constipation. You can use it predominantly for depression if you have someone suffering from brain fog or depression. That’s another form. If you are just trying to get it in the body, that’s another form. It depends on how you are trying to get it in the body and for what purpose.
I will say more generally I have included that more broadly for people who take it. You have Graves’. I don’t have a thyroid problem. But I will still recommend it for someone like me and for someone like you. It gets depleted a lot in stress. Since we’re all under a lot of stress, we all tend to benefit from using magnesium. It helps lubricate the bowels. It’s an overall good supplement to take.
If you don’t know where to start, somewhere in that 150-300mg dose range. You can always exercise dosing based on bowel tolerance. If you take it and notice you are getting indigestion or loose stool, you can back up on your dose. You can manipulate it that way. What dosing do you tend to recommend for magnesium? Or do you?
Dr. Eric:
I do recommend magnesium. I agree the form varies. Sometimes I will recommend magnesium citrate. Sometimes I will recommend magnesium malate or magnesium glycinate. It really does depend in the situation. Typically, the average dose would be anywhere between 150-400mg. There are some cases where you could justify taking higher doses. If we are talking about average, most people don’t need to take more than 400mg.
Dr. Westin:
I would recommend if you are trying to figure out what to take, some of these things we’re talking about are incredibly safe to take. You don’t need to worry about side effects. Selenium, you can go toxic. Iodine can potentially cause problems. But I have never seen anybody take magnesium and have a significant problem. If you are wondering about taking magnesium, as far as safety goes, it’s a pretty safe supplement to take.
Dr. Eric:
I agree. If someone does take too much, you might get some loose stools. Other than that, that’s it. Selenium, iodine, and iron, you don’t want to do too much. You want to test for that.
Dr. Westin:
I should have mentioned this: Some of these nutrients absolutely require testing prior to taking. Iron is one of those. You can go toxic on iron and have iron overload syndromes. Hemochromatosis is the genetic form of that that people can suffer from. It’s quite common. Iron, iodine, and potentially selenium. Some of those, you don’t need to.
Even the magnesium testing is not super accurate to begin with. That is variable as well. Some people might be using it for a completely separate purpose. Maybe you are more interested in its effects on the bowel than its intracellular effects. You could be using it for some physiologic purpose as well. In which case the numbers don’t matter as much. I take a lot of liberties in terms of how I use these and what I test for and the purpose of using the supplement. That is just how I think about it. That may not jibe with other practitioners. I have found good success in using supplements in these ways.
Dr. Eric:
You mentioned earlier the B complex. You think most people benefit from using that?
Dr. Westin:
I will tell you a little story. When I was practicing four or five years ago, one thing I would universally do, and it was just phenomenal, is I would give pretty much every thyroid patient a B12 shot. I would give it to them in a methylcobal form, 5,000mcg, so high dose. Relatively to the RDA. You wouldn’t believe the improvement that these people would see using B12 shots over other forms of B12. I really learned from that lesson that thyroid patients do really well on supraphysiologic dosages of B12 and other B vitamins. That was something I saw clinically.
There is no data or science to prove that this is the case. If you look at the data, people will say that supplemental forms such as oral or sublingual forms are not superior to B12 shots. That doesn’t jibe with what I saw clinically. People would come back and beg for more shots. They would want more and more. I don’t know if it has to do with how it gets into the cells, if it goes directly into the muscle cells and is providing mitochondrial energy in that way. I am just spit balling as to why it works or why it may work differently than oral. But I do believe the low thyroid patient population, and I can’t imagine this is untrue for hyperthyroid patients, that they respond fantastically well to shots. They can use sublingual or oral capsules as well.
If you are low in one of the B vitamins, the same triggers would cause the other B vitamins to be lower as well. They tend to be water-soluble as a family, with the exception of one, so they tend to go together. If you are low in one, you will probably be low in the others, which is why multivitamins can be beneficial. Whatever habits you are doing, stress or poor diet or eating food that is processed or refined, these things will deplete your nutrients.
Also, the thing about thyroid function is it has specific impacts on your intestinal tract as well. It causes decreased absorption of things like B12 or iron specifically. People need more of these nutrients compared to the average population.
Lastly, another thing is you can actually have autoimmune diseases of the intestinal tract, which result in further impairment of B12 absorption. Graves’ Disease is the most common cause of hyperthyroidism, and Hashimoto’s is the most common cause of hypothyroidism. We know these autoimmune diseases tend to go together. You are more likely to have it from thyroid function from the autoimmune perspective.
In my own clinical experience, I have seen the benefit there. I highly recommend B12 shots if possible. If you can’t go for that, get the sublingual form or the oral capsule. I see slightly better clinical improvement with sublingual, but I think capsules are still great. It’s harder to get the other B complexes inside of the sublingual versions, so you are usually getting B12. That is something to consider.
Honestly, I don’t have a thyroid problem, but I use B12 shots periodically as well. Maybe it’s placebo, but I feel amazing after I get them. I haven’t had one in a while. But this conversation reminded me to get one when I go home. Have you ever tried B12 shots, Eric?
Dr. Eric:
No, I have not. I will run out and get one.
Dr. Westin:
You can go to a weight loss clinic usually. But it has to be in the methylcobalamin form. We can talk about methylated versions of B complexes. As a thyroid patient, you want a methylated version of it. Don’t get cyanocobalamin for many reasons. This form can be metabolized as cyanide and cause thyroid problems. Get the methylcobalamin version. 1,000mcg-5,000mcg once per week is the range I recommend. Go get one, Eric. I think you’ll like it.
Dr. Eric:
I will need to give that a try. How about any supplements specifically that you recommend for people with hyperthyroidism or Graves’?
Dr. Westin:
I tend to take a more broad approach in the sense that I look at immune function and general systems that I see people mostly have problems with. I have a hyperthyroid bundle that I will sometimes recommend for these patients. If you want to get more fine tuned, you will need to see someone like Eric, who will recommend this probiotic or this antifungal or this antibacterial. There are some general things.
Multivitamins for sure. I am not afraid of using iodine, so I include that in there as a low dose. I am also a big fan of supporting adrenal health because I think regardless of thyroid status, you still have taxing that occurs at the adrenal function level and can result in fatigue, even though you are feeling that wired sensation that can occur with hyperfunction. Gut health is also definitely important.
That is how I would look at hyperthyroidism. From there, we can go down into these other things we mentioned previously, like focusing on systems like liver health and gut health. Those are the general supplements for hyperthyroidism. Oh, I forgot to mention you want to focus on the immune system, which would include things like Vitamin D, zinc, and even Omega-3 fatty acids.
Dr. Eric:
I agree. I give pretty much every one of my patients, whether they have Hashimoto’s or Graves’, Omega-3 fatty acids. Vitamin D, I will test first. Most people are deficient in Vitamin D.
Dr. Westin:
Do we have time to talk about Vitamin D?
Dr. Eric:
Sure.
Dr. Westin:
I will say this: Absolutely test. I don’t know about you, but in my history of testing, I find only a handful of people come up normal. Is this your experience, too?
Dr. Eric:
Every now and then. It’s rare for people who aren’t taking it. I can’t say I haven’t seen anybody who is normal who is not taking Vitamin D.
Dr. Westin:
That has been my experience as well. A lot of people know Vitamin D is important, but they don’t understand how important it is. A lot of people tend not to want to supplement with it so much because it’s hard to experience some sort of clinical benefit when you take it. Your numbers went up, but how did you feel? Did it really help you? When you are taking an adrenal supplement like Ashwagandha or rhodiola or ginseng or maca root, a lot of people notice some benefit fairly rapidly. They can tell this thing is helping them with their libido or energy or sleep. It’s easier to take something if you notice the improvement. But that Vitamin D level is so important.
Having said that, I am with Eric on this as well, I don’t think I have seen maybe one person who is not supplementing with Vitamin D already. I live in Arizona. Where do you live?
Dr. Eric:
North Carolina.
Dr. Westin:
We are probably fairly similar. You should have a lot of sunny days there. It should be enough to get sufficient Vitamin D through the sun, latitude-wise. It is so common that it’s deficient. I will say it is pretty easy to take a Vitamin D supplement, in the D3 form, to get the right dosing. But you will want to test. I still recommend if possible that you get it through the natural route. That is far more beneficial from a Circadian rhythm point of view, the skin. Depending upon where you live, if you are far too north, or what time of year it is, or how much cloud cover you have, or if you use sunscreen, it may not be possible. If that is the case, you want to supplement. But if you do want to get it the natural way, you can.
The rules of thumb is you want to have 40% of your skin exposed. You don’t want to have any sort of suntan blocking lotion on. You want to be out where your shadow is shorter than you are. If you walk outside and your shadow casts a shadow that is 10 feet long and you are six feet tall, that is the wrong time of day for sun exposure. It needs to be between the hours of noon and 2pm typically. 40% of skin exposed, no suntan lotion, and clear skies. No cloud cover. If you can go out and spend about 20 minutes out there, you can get a significant amount of Vitamin D through the sun. That light that comes into your eyes, this is all beneficial for your Circadian rhythm. It can help you with sleep. This is the best method to get Vitamin D.
If you can’t, or if you want to rapidly get it up for some reason, you can use the Vitamin D3 formulation. You can take it that way. The micellized version is best. 1,000mcg all the way up to 5,000mcg. Some people need as high as 10,000mcg, depending. But you have to play around with it with your practitioner.
Dr. Eric:
I agree. Thank you. Not that you can’t get some benefits from the sun, but try to get as much naturally, just like from a nutrient standpoint. You want to get as much from food as possible. One other question with Vitamin D: When someone supplements, do you recommend Vitamin K2 to go along with it?
Dr. Westin:
I used to, universally. I don’t really see a lot of clinical benefit or utility in doing that, so I have since stopped recommending it. I only recommend K2 if they have a specific issue with osteoporosis or bone health or cardiovascular issues. Most of the people who would come to me did not have those issues. I thought it brought up the price of the Vitamin D3, and I saw little benefit, so I didn’t. I don’t frequently recommend it. I used to do it a lot. Every single person, you’d get D3 and K2, that combo. I don’t see a lot of benefit, so I stopped doing it personally. But if you want to do it, go for it. I don’t think there is anything wrong with it. K2 is an incredibly beneficial nutrient for general health. What is your opinion on that situation?
Dr. Eric:
I have been recommending it for a number of years because I was taught that it helps get the calcium into the bone. Whether everybody needs the K2, I don’t know, as there is not a good way to test for it. What I have also learned is that it is fairly safe. You can’t overdose with K2. It is really a play it safe mechanism if someone is taking D3 to take a K2 supplement combo just to make sure that they are getting the calcium guided into the bone. Whether they need it or not, I don’t know if any practitioner really knows. That is the approach I take.
Dr. Westin:
I try to use the fewest amount of supplements to get the biggest bang for the buck. When it comes to that, you do see diminishing returns once people start taking 8-12 supplements. I have seen people taking 20+. What is the expense of this? How feasible is it to get all of these inside your body? What benefit are you getting? Are you having interactions between the two? Are you preventing absorption of certain nutrients? We get into complex situations when you start taking a bunch. If I don’t see the clinical utility of it over time, I am more hesitant to recommend it because I think to myself, what if we took that out and added something else instead? Would you get more benefit if for instance we used rhodiola in place of K2? Or something like that. That is the philosophy I would take when looking at everything.
As you mentioned, there is nothing wrong with taking K2. A lot of people prefer to take it, especially with some of those studies, which are convincing. I haven’t seen clinical benefit personally.
It also depends on the age range of the population in which you are helping. Predominantly, the age range and gender I would see that need the most help are women, ages 30-45. These women tend to not experience any sort of issues with cardiovascular problems or bone density issues until postmenopausal. They are 15-20 years away from that issue. I don’t know who you’re seeing. That does play a role.
Dr. Eric:
It varies. I would say the average is a wide range, anywhere from 30-60. Mostly women. I see men, too. 80-90% of my patient base is women. I see women in their 30s, some in their 20s, some teens. On average, I would say 30-60, which is a pretty broad range. Can I ask you one more question?
Dr. Westin:
Absolutely.
Dr. Eric:
Do you think that a multivitamin is necessary? Would you recommend a multivitamin in most people with Graves’ and Hashimoto’s?
Dr. Westin:
Good question. Complicated answer. I would say this is how I would look at it. When I was treating people and practicing, I would rarely ever recommend multivitamins. That is because I was able to fine tune what that person needed. If you are not seeing a general practitioner, and most people are probably seeing subpar practitioners, no offense to anyone out there, but they are not going to have that knowledge to give them the direction that they need.
Generally speaking, most thyroid patients would benefit from a multivitamin, and I would recommend that. With the exception of people who are seeing someone like you who understand the nuances and could directly concoct a special set of nutrients, supplements, vitamins, botanicals, and herbs for that specific person. In the absence of that, then it’s better to use that than not at all. That is how I would look at it.
But you can do a lot on your own. I would say if you are a thyroid patient, spend some time reading and researching. If you pay attention to your body, if you try these things and experiment a bit, stay away from things we talked about previously that can potentially cause harm. You can do a lot on your own. I don’t think you should be too scared to do that. You can get a lot of improvement.
A lot of that will come down to the severity of your illness. There is always a spectrum. You might have someone on this side who is fairly easily treatable, and some things like a probiotic, Omega-3s, changing your lifestyle, eating whole foods, removing fast food may be sufficient for you to see significant improvement. If you tried these things and don’t see improvement, see someone like Eric because you will have to progress into more complicated diets, infections in the gut, liver health and insulin resistance, etc. Generally speaking, most people could benefit from a multivitamin regardless of thyroid status.
Dr. Eric:
Thanks for sharing. Any other last words as far as supplementation goes for those with thyroid conditions?
Dr. Westin:
I don’t think so. The thing I would leave everybody with is that I want to get a point across that to empower thyroid patients, do a lot of the research and learning on their own. It can be very frustrating when they are unable to get certain treatments and medications. Realize there is a wide array of supplements and so on that you can use and are available over the counter. They are not equally as good. They won’t necessarily be the key to helping you by themselves. But they can be used in conjunction with medications. That is my preferred method. Use this with diet and lifestyle. Doing it that way, a lot of people could benefit from the use of supplements.
Dr. Eric:
Thanks again for sharing everything. Thanks for your time. Where can people learn more about you?
Dr. Westin:
If this information is interesting, check out my website. Search “Dr. Westin Childs.” If you type in “Dr. Westin Childs, start here,” I have a list of eight resources you can download. Downloading them will put you on my email list. We have a set of lab tests, foods to avoid, clinical studies you can take to your doctor to promote getting the right type of treatment. Tons of downloads to check out.
Dr. Eric:
Same thing with YouTube?
Dr. Westin:
I will pop up if you type in my name. YouTube, website, podcast, etc. Whatever your fancy is, there is something there for you.
Dr. Eric:
Thanks, Westin. Appreciate everything that you have shared with the listeners. I hope to have you back again in the future. I would love to do that.
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