Recently I interviewed Dr. Emily Kiberd, and we talked about mold-gut-thyroid connection. If you would prefer to listen to the interview you can access it by Clicking Here [1].
Dr. Eric Osansky:
Hello, everyone. I am very excited to chat with today’s guest, Dr. Emily Kiberd, as we are going to be talking about keeping fit and muscle mass. This is the first time I am talking to anybody on the podcast in depth about exercise, building muscle mass, what to do and what not to do.
Let me give Dr. Emily’s bio here. Dr. Emily Kiberd is a chiropractor, mama to Elvis and Brooklyn, and the creator of Thyroid Strong, which is the only doctor-designed exercise program for women with Hashimoto’s to learn how to work out with the burnout. She has been featured in Vogue, Women’s Health, Self, as well as Fortune for her expertise in strength training, injury prevention, and ergonomics. She also has a wonderful podcast called Thyroid Strong. Thank you so much for joining us, Dr. Emily.
Dr. Emily Kiberd:
Thanks for having me. Excited to be here.
Dr. Eric:
Let’s talk a little bit about your background. Obviously, I gave a very brief bio right now. How did you make the transition? Were you always helping people with muscle mass and exercise? Over the last few years, did you make that transition?
Dr. Emily:
I have been a chiropractor since 2007. Coming out of school, it’s like adjusting, maybe doing some soft tissue work. It gets very boring in my opinion very quickly when you are doing the same thing every day. A certain number of people get better, and a certain number of people come back, “I still have some pain here.” Obviously, as a practitioner, you want to help as many people as you can.
The journey evolved. A lot of it was doing yoga teacher training and using yoga therapy in the practice. Then it evolved into doing strength training, knowing where there is too much mobility, too much movement, and where there is not enough movement. People assume there is a tight muscle, or something feels stuck, so we should release it. Get a massage or stretch or release. Oftentimes, that can be compensation for something else that’s not stabilizing. You have to work on that other place that is stabilizing that compensation. Sometimes, that tight place will let go. The practice slowly evolved into that.
As with anyone’s practice, it should be an evolution, I think, as you learn more. I am always curious and hungry for knowledge. In 2016, I had my first kiddo, Elvis. For the first year, I was just exhausted. All those symptoms that you think are “normal,” everyone’s like, “You’re a new mom.” This is not good.
18 months post-partum, he’s walking around. I was exhausted. My hair was falling out. The outer third of my eyebrow was missing. Couldn’t lose about 25 pounds of baby weight. Every time I ate, my tongue would swell, and I had a little bit of eczema on my hand. I went through the primary care/endocrinologist.
I went to two functional medicine docs, until I met my current functional medicine doc, Dr. Gabrielle Lyon. “How come no one has tested more than TSH? You have an autoimmune condition. You have the presence of thyroid antibodies. The official diagnosis would be Hashimoto’s, but it’s good that we caught it early. If you catch it early and figure out what the trigger is for that inflammation, you can go into remission.” That is exactly what happened.
When on this journey of changing how I was eating. I let go of gluten. Basically anything I was eating, I was reacting to. I was having histamine intolerance. Kind of like mast cell activation syndrome. I could smell someone’s clothes. I knew they washed them in Tide, from 50 feet away. Especially in NYC, where you can smell everything. There are lots of odors. It was very intense.
Part of the journey was finding out I had mold in my apartment, which can cause a histamine response and cause that overactive immune system. It can trigger Hashimoto’s as well. I had water damage and mold and Aspergillus. I did a lot of developing country travel in my 20s, so I had about three different parasites: hookworm, roundworm, and pinworms. I went on that journey of starting to decrease that inflammatory load.
I was over training, which was the birth of Thyroid Strong. I was trying to lose the baby weight, and I was going to spinning classes. Sometimes, I’d do a double spinning class, so two 45 minutes back-to-back, so 90 minutes of spinning, about four days a week. Or I’d do a spin class and walk across the street and then do a high intensity interval training class, Barry’s Bootcamp. The weight would not come off, and it was very frustrating.
Part of this journey was not only addressing those underlying root causes but changing how I was eating and that lifestyle factor of dialing back my exercise and getting smart about it. Through my own journey, I was then seeing more autoimmune women coming into the clinic. I was co-treating them with different functional medicine docs in the area in NYC. They were addressing functional medicine, internal stuff. All the women had joint pain, muscle aches, and low muscle tone. The docs were like, “Hey, I need you to get them out of pain and put some muscle on them.”
Probably in 2017, that was this evolution of seeing more autoimmune women. From that lens, from the angle of “How are they moving?” Normally, when you see a doctor, you’re sitting down across from them. They’re reading your labs and giving you a game plan or a supplement protocol, and “we’ll see you in X months.” I’m getting them moving, checking what’s moving too much? What’s not moving enough? How can they pick up things in certain ways? Checking their tone of the muscle, checking their deep tendon reflexes, which can change when you are hypothyroid, and looking at them through that lens.
I’m going to guess a lot of women who have an autoimmune condition are not assessed in that way. A lot of doctors don’t do that. I don’t think there are a lot of doctors who are functional medicine or endocrine and do rehab and strength training. That was the birth of Thyroid Strong and seeing more women in person struggling. From the clinical practice, there were certain things that I picked up. Oh, this is a consistent finding, which is interesting that no one is talking about. It was really an evolution, starting in 2015.
Dr. Eric:
Wow, that’s some journey. Obviously, every person’s journey is different. I am also a chiropractor by trade and dealt with Graves’ Disease. I didn’t deal with mold, which it sounded like you had some serious mold issues, or parasites.
One thing we have in common is I was also overtraining. I was overtraining prior to my Graves’ diagnosis and should have known better, both of us being practitioners. It’s not like they teach that in chiropractic school about training. Rehab to some extent. What you’re teaching definitely is not taught in school for chiropractors or medical school. It’s great you’re helping others, and it’s great you’ve been in remission with your Hashimoto’s condition.
I don’t know where you want to start. Do you want to start with what you actually recommend as far as different types of exercise? There’s cardio, resistance training, high intensity interval training (HIIT). Do you recommend one of those, a combination, or maybe something different?
Dr. Emily:
Because fatigue is such a big component of Hashimoto’s, I want my exercise to be efficient and effective. I used to train for triathlons and marathons. Long states of cardio. I find that there is also, as you know, an adrenal component to Hashimoto’s. If I’m thinking I want my exercise to be efficient and effective, and I know being hypothyroid, it is harder to keep muscle on the bone. Muscle is essential to help with the turnover of thyroid hormones from the inactive form, T4, to the active form, T3. It happens in certain places: the gut, the liver, and the muscle tissue.
Knowing that, I know that women want to lose weight. Those are the two biggest struggles: I’m exhausted, but I’m overweight, and I want to lose it. If I want my exercise to check those boxes, I like resistance training. Feeding the muscle tissue.
I like women to be walking. A lot of women are like, this cultural mindset of, “Oh, I need to lose weight. I will put on my running shoes and go for a run.” It’s not the right message to be sending.
When we put more muscle on the bone, the more muscle we have, the more calories we burn at rest. If we want to lose weight, but we don’t want to cause a Hashi flare-up or be bed-ridden for three days because there are definitely women who are so fatigued they can’t get out of bed, I like resistance training. I like it on the heavier side, so you can hit that fatigue. Lower reps and long rest breaks in between sets. I like kettlebells because they’re very forgiving when you are first learning form. They’re portable. You can travel with them. We can talk about why kettlebells are so great. That’s what I prefer.
I would prefer that over HIIT, especially if that adrenal component is there. If women are burning candles at both ends in other aspects of their life. As you start to put on muscle, you’ll have more energy. You’ll be changing your body composition. The number on the scale might be the same, but you’ll notice your clothes are fitting better. The number on the scale might be the same because muscle weighs more than fat.
I think this focus on let’s feed our muscle tissue if we want to lose weight, versus “Oh, I need to lose the fat.” When we talk about losing fat, it comes from this place of deprivation. Put yourself in a caloric deficit. Try to run it out. Versus if you focus on feeding the muscle tissue, your body composition will change. Your clothes will fit better. You’ll be burning more calories at rest. You’ll have more energy.
Muscle is a very expensive organ. It requires more feeding of it. Ideally, protein. It’s almost like changing your body from a place of elevation, feeding your muscle, to this place of deprivation, which is starving yourself to lose fat.
That’s how I like to get women to work out. If they want to run, like if it fills their soul, like if they have been a runner before, you still have to strength train. Even if someone likes to walk, I’ve had women who can walk 30 minutes, and then their back starts to hurt. Maybe it’s more core strength, more glute strength. Maybe it’s strengthening your butts or hamstrings. If you get that woman to resistance train three times a week, for someone who is deconditioned, I will work them up to three to four times a week. Then they can go for a walk for an hour and don’t feel pain.
I don’t feel like there is any downside to having more muscle on the body. The way you will get there is through picking up something heavy, putting it down, and doing it again, as well as making sure you’re getting your optimum protein every day.
Dr. Eric:
We have people with both Hashimoto’s and Graves’ listening to this. I agree for both. Resistance training for those with Hashimoto’s and Graves’, it’s very common to lose muscle mass. With Graves’/hyperthyroidism, a lot of people are losing weight. Some people with hyperthyroidism do gain weight. Sometimes, it is the opposite problem. Either way, I like what you said. You might not see the changes on the scale. Not that they won’t. Some people will.
Dr. Emily:
Yeah, for sure.
Dr. Eric:
But if not, some might get discouraged. It’s important you mentioned that because muscle is denser than fat. Just to set those expectations.
One thing you recommend in between sets is to take longer breaks. Are we taking two minutes or five minutes in between typically?
Dr. Emily:
If you go to a boutique or aerobics class, there is not really a break until the end of class. Maybe there is a 30-second break. I like women to do 60 seconds, 90 seconds. If someone is more seasoned, and they’re lifting really heavy, up to 2-5 minutes. It really depends on where they’re at on their workout journey. 60 seconds minimum.
During that time, I like to have women toning their Vagus nerve. With Hashimoto’s especially, stress is a big piece of the puzzle. Stress can come in the form of emotional stress, physical stress, environmental stress like mold or parasites. There is this cultural message of “Don’t stress. Destress. Avoid stress.” Stress is inevitable. How can you lean into that stress to make you more resilient?
One of the ways to do that is when you’re in a stress state, the quicker you drop into that calm parasympathetic, everything is okay, the quicker you can get out of the stress state and back to the parasympathetic state, usually the more resilient I find people to be, high performing.
If you pick up a weight, it’s elevating your heart rate, breath rate, getting you out of breath. You take your rest break and have this moment to drop back down into the parasympathetic. I have some inside Thyroid Strong sing with their tongue on the roof of their mouth and try to extend their exhale as long as possible, ideally twice as long as their inhale. It’s almost like you’re training your nervous system. A lot of people train their nervous system seated or in a meditative state. You’re doing it after putting a stressor on your body. I like to do that during the rest breaks.
It also makes the time go by faster if you’re not used to taking 60, 90, 2-minute breaks. People are like, doo doo doo. You get them to sing and hum and extend their exhale twice as long as their inhale, and it goes by quicker. That’s also why I like long rest breaks.
When women do that, I find they don’t get into that “Oh my god, I’m so tired after my workout I need a nap.” That’s very common. Women are like, “oh my god, I worked out, and I’m totally tanked out. I can’t function the rest of the day.” Our workouts shouldn’t take away from our day; it should enhance the rest of our day. It shouldn’t take us bedridden for a nap. It should energize us, if we fuel properly afterwards, and enhance our day.
When you take a little bit of a longer rest break, and you’re doing these things that can help you drop back into the parasympathetic state, women feel more energized and not so tanked out the rest of the day.
Dr. Eric:
Very cool. I’m going to try that during my next workout, too. You’re right. Even if people are taking a minute or 90 seconds or a couple minutes, depending on the intensity, most people are not doing anything. They’re just hanging out. Going to the gym-
Dr. Emily:
Checking their phone.
Dr. Eric:
Half the people are on their cell phones. That’s great advice. How about frequency of resistance exercise? Do you recommend four times a week or less or more?
Dr. Emily:
Women with Hashimoto’s are on the spectrum. There is the Crossfitter, burning the candle on both ends, overtraining, six days a week. I’d probably drop that person to four times a week depending on their fatigue and symptoms. Maybe three. If you do three, they are itching for another day. So four days a week.
On the other end of the spectrum is a woman who is more deconditioned. She maybe walks 2,000 steps a day. She has maybe never touched a weight and is scared of them. That person needs to be worked up to three days a week. I do encourage walking as a form of exercise. I know a lot of women love to walk. It’s not resistance training or walking; it’s doing both. If someone is very deconditioned, this can be a lot.
Those are the two ends of the spectrum. A sweet spot would be three days a week. If someone needs more, four days a week. Even my friends who are doing bulking hypertrophy programs, where they’re eating 2,500 calories a day, 250 carbs a day, they work out four times a week. They’re not doing six days a week. It’s too much, especially for the Hashi population, where you have to consider the inflammatory load. You have to consider fatigue and adrenal health when designing a program.
Dr. Eric:
Do you work out four days a week on average?
Dr. Emily:
Yeah. I try to walk every day. Bike my kids to school. Depending on what I’m working on, yeah. I would say 3-4 days a week.
Dr. Eric:
When do you prefer working out? Is there a best time to work out, like first thing in the morning or in the afternoon?
Dr. Emily:
If someone is trying to reset their Circadian rhythm, so maybe they have low cortisol in the morning and are dragging, it would probably be better to try to work out in the morning to spike your cortisol when it should be highest. Maybe out in the sun to get some sun in your eyes would be great.
Just by my nature, I am a mid-day worker-outer. Around lunch time. If I work out after 2pm, when I lived in NYC, I would get done with work at 7pm and go to a spin class at 7:45pm. Then I would be wired until 2am and wonder why. If I work out after 2pm, maybe 3pm, I get a second wind at 10pm when I should be going down. I try to push it earlier in the day, mid-day.
Dr. Eric:
I definitely want to talk to you about the kettlebells. Before we get into that, what do you recommend as far as protein intake?
Dr. Emily:
I think a lot of women are under-eating protein. I think protein should be prioritized. For people who are bedridden, the more muscle they have on their bones, the more likely they are to recover from their injury or sickness.
For protein, I like to shoot for 1g per pound of ideal body weight. If my ideal body weight is 150 pounds, I will have 150g of protein a day. I will dose it equal. Sometimes, culturally, we dose dinner as a higher protein intake. Ideally, you would want it in more even amounts. In this example, like 50g for breakfast, lunch, dinner. I try to eat my protein first, and then I take in fiber, so vegetables.
I have a history of being a grazer. I don’t sit and eat. I try to make myself sit and eat. There is a dose dependency, like a time frame. I try to get my protein within 25 minutes, versus eating a little bit, doing something, and eating a little bit more.
There is a dose dependency to trigger toward, then muscle protein synthesis. We are eating protein for the amino acid profile. Protein is very satiating. It’s almost impossible to overeat protein. You would probably throw up if you did. Especially for the women who want to lose weight, it’s great because it’s very hard to overeat protein. It’s important to get protein in the morning after we’ve been in that fasted state and sleeping. Most women are undereating protein.
Sometimes, I have women just change their protein intake, not even pick up a kettlebell yet, and they’re like, “Oh my god, I have so much energy, I don’t even know what to do with myself.” All they did was try to hit 30g minimum per meal. That triggers muscle protein synthesis. You get your 3-5g there. That’s what I try to shoot for. That’s really from the work of Donald Layman, who is a researcher who is retired now. But he was in that field, especially around boosting.
Dr. Eric:
I’m sure someone who is listening to this is thinking, “There is no way I can get 1g per 1 pound of body weight.”
Dr. Emily:
Ideal body weight.
Dr. Eric:
Animal protein I would imagine is your primary source then of protein.
Dr. Emily:
Yes. Just so there is a complete amino acid profile. When I was first diagnosed with Hashimoto’s, and I was reacting to everything, I had H-pylori, stomach acid. I couldn’t really eat that much. I was doing a pea protein shake as a medical grade food because that was all I could tolerate while I healed my gut and worked through those triggers.
I prefer animal protein. I know for some women who don’t eat a lot of animal protein, “five eggs for breakfast?” They feel like they are choking them down, and they’re full up to their chin. You might have to work up to that. I would say animal protein is my main source.
Dr. Eric:
Would you recommend if someone initially is struggling to get it through food, is it okay if someone wanted to supplement with protein powders or take amino acid supplements or both?
Dr. Emily:
Yeah, I think that’s fine. I have a protein powder that is made out of beef, Equip. The research is mixed. There is some research that shows the amount of protein you actually absorb from plant-based protein is less than what is stated on the package. Animal protein is a more absorbable form as a protein source. The newer research shows they’re equally absorbable.
I wouldn’t be pounding soy protein, I’ll just say that, if you have a thyroid condition. But if you wanted to mix it up- Five eggs is 30g of protein per breakfast. Most women can’t eat five eggs. Why don’t you try two eggs and two sausage links, like chicken sausage? Or maybe you have two eggs and a protein shake. It doesn’t feel like you’re stuffing yourself full of food.
Dr. Eric:
That makes sense. Let’s talk about kettlebells. Why do you like kettlebells? What are some ways you recommend for people to use them? Do you just recommend kettlebells for resistance training? I’m sure you’d be okay with people using weights and bands. Do you just stick with the kettlebells, or do you have other things you incorporate into a routine for resistance training?
Dr. Emily:
As you go heavier in weight, you’re going to need heavier weight. If I deadlift 1.5 times my body weight, picking up 2 100-pound kettlebells is awkward because they are so bulky. Then I would use a hex bar or barbell. You have to learn the form with the barbell; it’s not very forgiving, especially as you are trying to get around your shins as you’re lowering down.
If you take the deadlift, which is basically a hinge movement where you’re sitting your hips back, standing upright, squeezing your butt. If you think about a barbell, you have to navigate the barbell around your shins. It’s awkward as you’re lowering it down.
You could use dumbbells. Where do they go? You have to shave your shins with them. Kettlebells, you can literally get right below your center, right below your crotch basically. You can sit your hips back, pick them up, and put them right below your center. A barbell is a little bit in front of you, so it’s away from your center. Little nuances like that.
If you start someone with barbell deadlifting, it’s a little intimidating and awkward. Kettlebells, they’re much more forgiving when you’re first learning form. Your form ideally would be good and almost perfect, so you don’t injure yourself. But if your hips are too low or too high, you won’t injure yourself. But with a barbell, your form has to be dialed in, 98% perfect, in my opinion.
I also like kettlebells because there is this offset weight. Let’s say you will press overhead. If you have a dumbbell, the weight is on either side of your hand. With a kettlebell, the bell sits on the back of your wrist. When you’re holding the kettlebell in front of your chest, what we call the rapt position, you have to curl your wrist into neutral. You don’t want your wrist to be cocked back. You want it neutral.
If they put their hand up and make a fist, and if you push down on the hand with the other hand, and then you make a straight fist, and you push, you can literally feel the shoulder stabilizing muscles. Your latissimus, your serratus, activate. Because there is this offset weight where the bell is on the back of your wrist, it forces you to create these points of stabilization in your body that doesn’t happen necessarily with a dumbbell.
The other thing I love about kettlebells is you can use them ballistically. In Thyroid Strong, we do seven moves that are essential for people to do for life to be good at life: a hinge, a squat, some sort of push movement, a pull, a lunge, a carry, like you’re carrying your groceries, and some sort of control of rotation of your core. We work up to over the six weeks of kettlebell swings. We do drills, so you’re not just swinging a bell all over the place. Get your heart rate up. It’s a tool to get you breathy, get your heart rate up without going for a run, without doing more of a HIIT, where you’re doing 15-30 seconds of all-out work, and you’re getting your heart rate up to 80-85% of your maximum heart rate, and then doing 15-30 seconds of rest. That is more of a HIIT. You could do 10 kettlebell swings and get your heart rate up.
The other tools that could be used as ballistic moves would be a barbell. Now, you’re getting form. If you cleaned a barbell up to your chest, now you have to get your form dialed in. I like kettlebells because they have that ballistic potential to help you get your heart rate up.
Dr. Eric:
It sounds like those who go through your Thyroid Strong program will become experts in using kettlebells. When it comes to form, I might be wrong, but I think you’re saying it’s not as important with kettlebells or dumbbells, but it may be easier to keep proper form with kettlebells.
Dr. Emily:
It’s more forgiving when you’re first learning. Because the weight can be under your center, versus in front of your center with a barbell, if you do a heavy carry, like if you have two bells and they are down toward your sides, and you are packing your shoulders, if you did that with a dumbbell, they are hitting your legs, and it’s awkward. Kettlebells are not. You can hold them down to your sides, and they glide past your legs. It’s just more forgiving when you’re first learning form. There can be a little more margin of error because that’s what happens when you learn form. You do it not that great the first couple of times.
Part of Thyroid Strong is there are really good cues in working with patients in person to get someone into the perfect deadlift setup. Versus you might work with a trainer. Sit your hips back, grab the bell, stand up. Where do my feet go? Where do my knees go? Are my hips too low or too high? In Thyroid Strong, there are cues. You can get someone in the perfect starting place.
There is just more margin for error when you’re first learning with kettlebells than maybe some of the other tools out there.
Dr. Eric:
That makes sense. I don’t know if you mentioned this earlier. Obviously, you spoke about having longer breaks in between sets and doing the Vagus nerve exercises, stimulating the parasympathetic nervous system. Do you have someone do 12 sets or 10 sets or just until they’re fatigued? Does that depend on the person?
Dr. Emily:
If women are more new, I typically have them do three sets. Someone who is more conditioned, four sets. In terms of reps, which is the number of times you pull a weight, and then a set-
Dr. Eric:
I mean, how many reps and how many sets. I meant to say repetitions specifically first.
Dr. Emily:
For someone who is scared of picking up a weight and is more deconditioned, I might start them at three reps to get them to grease the groove of the movement, create that muscle memory. Once they’re starting to get into a groove of working out, 6-8 reps. I very rarely go over 10 because I am trying to factor in not wanting to fatigue someone, especially if they haven’t dealt with those other inflammatory loads in their body. That’s when I say, “You build muscle when you hit fatigue,” and fatigue, when you’re working out, by the last couple reps, on a scale of 0-10, you’re hitting a 7 or 8 in perceived exertion. That’s one way. That doesn’t resonate with me really well.
The other way to think about it is by the last couple reps, you ask yourself, “How many more could I do?” If you have two more in the tank, that’s a good place to be. If you could do five or 10 more, then you need to pick up a heavier weight.
The third way to talk about it is on the last couple reps, the concentric phase, where you’re shortening the muscle, fatigue is when you can’t get full range of motion on that phase. That would be another way of considering failure. That’s where hypertrophy happens. That’s where muscle maintenance, growth happens.
The fourth way that I talk about that a lot of people don’t talk about is do you lose form in default into this extension compression conversation? This is from learning and studying for the Prague School in the Czech Republic this technique called dynamic neuromuscular stabilization. They basically looked at how babies learn their movement patterns and how they hit their milestones. For example, the first six months of life, maybe three months, is literally trying to bring their knees up to 90 and create rigidity and a brace in their core. 4.5 months, they roll. At six months, they’re sitting. There are these milestones babies hit.
A baby who is not developing properly, which is about 30% of babies, will default into this extension. If people don’t know what an extension is, it’s an arching of their back—to compress their spine to execute a movement. Versus using their intra abdominal pressure. Babies who don’t develop well will do that. They’re flaring their ribs and cranking their back out; you can see their paraspinals activated.
We do that as adults when we hit fatigue. If you have ever seen a Crossfitter do a muscle up where they are holding rings and pushing through and pushing up, when a Crossfitter hits fatigue, they will literally crank into extension in their low back and neck to try and execute the movement. Versus using their core and using good intra-abdominal pressure.
Same thing when you fatigue in any other move. You will basically default into this extension/compression compensation. Basically favoring extension in the low back and neck. You will see this in a deadlift. People stand up and are pulling, pulling, pulling, and will over push through their hips and crank up their back. You will see it in a plank. Someone is simply holding a plank. Once someone starts to fatigue, their back will start to arch, and they will lift their chin to crank on their extensors. That is another way to know that you’re hitting fatigue.
In terms of reps and sets, you want to hit about 8-10 sets per muscle group per week. It’s a good place to be if you want to gain muscle or maintain muscle.
Dr. Eric:
Like you said, if it’s toward the end of each rep, especially if it’s the last set and still kind of easy, that’s an indication to increase the weight.
Another question with that: Do you recommend them for people in general, women and men, to keep on increasing the weight? Do you recommend a wellness weight, where they have reached a weight, and they should stay at that weight? Do they keep increasing the amount they lift?
Dr. Emily:
You want a program that has progressive overload. There is progression of the weight over time. There are other ways to progress without necessarily picking up heavier weight. It’s basically more time under tension.
An example would be you do a squat. You hang out on the bottom of the squat for an extra second or two, or an extra breath, before you stand up. You didn’t increase the weight, but you increased your time under the load, which will then increase the volume.
You could do 1.5 reps, so you go down in a squat, come up halfway, go back down, and then stand up. It’s another way to increase the load without necessarily picking up a heavier weight.
I do that in Thyroid Strong because it’s a home base program. I don’t want women buying 20 kettlebells because they’re expensive. They don’t want to clutter their living room. So you have a 12-kilo, 14-kilo, and 16-kilo. That’s what we have to work with. Instead of you investing in a heavier bell, we’re going to do these techniques to keep more time under tension without necessarily having to pick up a heavier load.
Yes, you want progressive overload. A great way to do it is to slow down the e-centric phase of any move. The e-centric phase, if you’re doing a bicep curl, this is the concentric, and this is the e-centric. Your muscle is lengthening under the load versus concentric, which is shortening. Any move where it has an e-centric phase, you make that 3-4 seconds. You stand up with a dead lift. As you’re lowering back down, you take 3-4 seconds to lower. It’s a great way to not necessarily have to pick up a heavier weight.
Dr. Eric:
Women listening don’t have to keep on purchasing kettlebells. That’s one reason why I was asking that.
One of the things prior to the interview that we were talking about is hypermobility. Talk about hypermobility and autoimmunity.
Dr. Emily:
I haven’t found any research on this. I go to PubMed every week and type something in and try to see if there is any research on it.
What I noticed with women with autoimmune conditions that I was treating in the clinic was I’m looking at them through a lens of movement. What’s moving too much? What’s not moving enough? I will check a Beighton score, which is a physical therapy orthopedic test looking for hypermobility. The places you look are the knees, elbows, thumbs, pushing down and touching the soft part of the forearm, pinky bending back beyond 90. The last point is someone standing straight, bend forward, touch the floor, they can palm the floor. Kind of like a yogi, but they probably created biomechanical hypermobility. If those points come up in a Beighton score, there is a sign of tissue laxity/joint hypermobility.
I was finding this in women with autoimmune conditions. It wasn’t 100% of the time. It was probably like 80-90% of the time. But it was significant enough to be like, Hmm, okay. All these women are coming in with joint pain and muscle aches, and they all want to get adjusted and a massage.
Listen, no amount of massage is going to help create that stability and rein in that joint that is hanging out of the ligaments. We need you to resistance train, get stability and strength in the right places. A lot of women will feel tight in their mid-back. We can do some mobility drills and adjust you there, but you need ultimately strength. No amount of stretching or yoga is going to rein in the integrity of the joints. I noticed this in a lot of women with Hashimoto’s.
Other people I have talked to, like Jessica Drummond, who is on the East Coast and is a physical therapist, she has noticed a lot of women with long haul COVID having this intermittent joint hypermobility or joint hypermobility post-COVID. Some of the trainers that I talk to who also do resistance training or programming for women with Hashimoto’s, they notice a lot of Hashi women have joints that are totally hypermobile. It was a clinical observation, but it was something that really guided how I cued and programmed inside Thyroid Strong.
Dr. Eric:
Very interesting. Do you talk about that more in your program?
Dr. Emily:
Yeah. Let’s say you’re standing up from a dead lift. You’re at the bottom, and you stand up, knees straight. Most trainers would say, “Grab the weight, and stand up.” Someone who is hypermobile, and their knees hyperextend, don’t know where their center is. If you just ask that person to stand up, and they jam into their knees, they will get joint pain, probably on top of their hypothyroid condition causing joint pain anyway.
I teach women to foot dial, which helps bring tension from the feet up the legs. Professional lifters do this. If you stand with your feet, toes turned out ever so slight, and as you’re standing up, you squeeze your heels together, but you don’t move your feet. You will literally draw tension, like your whole leg will activate: your quads, your glutes. You can stand up with straight knees without jamming them into hyperextension. That’s one example.
In the plank, if your elbows are straight, their elbows will hyperextend. You can get them to push through their index knuckle, which comes from how babies crawl. Babies who crawl and develop properly will ground their index knuckle into the ground. Babies who don’t develop properly will actually hang out on the pisiform side of their hand and crawl like this versus actually pushing through. In a plank, you can get someone to push through their index knuckle and turn their elbow crease toward their thumb and get them out of hyperextension. That helps activate your serratus. It helps your shoulder stability.
If you did a plank where you are hanging out on the outside of your hands, and you’re hyperextending your elbows, you won’t fuel your shoulders into protraction, into the shoulder blade wings going down and wide across the ribs. Those are cues that are very specific from my background of studying how babies move as well as working with women and trying to get them into good form. Simply being, “Oh, don’t put a little bend in your elbow.” That’s not enough. If you just put a little bend in your elbow with the elbow hyperextension, you won’t feel your shoulder stabilize, which is important in a plank. Most people think of plank as a core exercise. It is full body tension. It is connecting shoulder stability to core stability.
Dr. Eric:
I’m sure many listening are eager to get started. Where should they get started? I’m thinking Thyroid Strong should be a good starting point. If there is anybody who is maybe not ready to think about doing it on their own, could you give a few tips prior to joining you in Thyroid Strong?
Dr. Emily:
Thyroid Strong is six weeks. I have shorter two-week programs. If someone isn’t sure they want to fully invest, these courses are under $50. They are full recorded videos of workouts.
I do a lot of stuff on my Instagram. My website is DrEmilyKiberd.com. Different workouts, moves, form cues. A lot on social media.
Dr. Eric:
Also, your podcast, which is also called Thyroid Strong. Is there anywhere else where they can find you?
Dr. Emily:
I’m on YouTube and TikTok. And I do have a private Facebook group for women who want to find out more. Sometimes, people don’t necessarily want to email or DM, so there is a Facebook group. Women are like, “Oh my god, I’m not alone. Here is 4,000 other women who also have Hashimoto’s and extreme fatigue or exercise intolerance when they work out.” The group is called Thyroid Strong.
Dr. Eric:
That’s not just for people who join Thyroid Strong. Anybody can join that?
Dr. Emily:
Yep. I have a separate Facebook group for people who join the program. Then we get really nitty gritty. There are videos and form checks and keeping people accountable and creating accountability buddies for their workouts. We talk a lot about protein and weights.
Dr. Eric:
Thank you so much, Dr. Emily. Appreciate your time. I always learn a lot when having these conversations, and today was no exception. I definitely learned a lot. Thanks again.
Dr. Emily:
Awesome, thank you.