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An Interview With Dr. Izabella Wentz on Finding and Treating The Root Cause of Hashimoto’s Thyroiditis

Note: This is the transcript from an interview I conducted with Dr. Izabella Wentz.  Dr. Wentz is the author of the book Hashimoto’s Thyroiditis: Lifestyle Interventions for Finding and Treating the Root Cause.

Dr. Eric: Hello everyone. I’d like to introduce you to our special guest, Dr. Izabella Wentz. She is a pharmacist who has dedicated herself to addressing root causes of autoimmune thyroid disease after being diagnosed with Hashimoto’s in 2009. She’s the author of the New York Times bestseller patient guide, Hashimoto’s Thyroiditis: Lifestyle Interventions for Finding and Treating the Root Cause. And she is an ardent champion of incorporating lifestyle change and functional medicine into the treatment of autoimmune disease.

How are you doing today Dr. Izabella?

Dr. Izabella: I’m doing great Dr. Eric and thank you so much for having me.

Dr. Eric: You’re welcome, and it’s great to have you. I really do look forward to interviewing you, and before asking you some specific questions I’d like to start by having you take a few minutes and explain your thyroid story and what motivated you to write your bestselling book.

Dr. Izabella: It’s kind of a funny story because people will ask me if I always had this big interest in the thyroid and I didn’t. When I was going through pharmacy school we learned about the thyroid gland and thyroid medications but it was just something that we learned in one day.

It was basically if you have a thyroid condition you take thyroid medications and that was it. I think there was some mention about it being autoimmune but nothing else besides that. And I was commonly dispensing thyroid medications when I worked in the community pharmacy and never realized the amount of suffering and pain people went through when they actually had thyroid disorders.

So I was diagnosed myself in 2009 and at that point I was fatigued, losing my hair, having joint pains, I had irritable bowel syndrome and all of these really strange symptoms that made me feel like my life was slowly falling apart. I went from being a relatively healthy person to where slowly my health was deteriorating and I was still in my 20’s. I went to my doctor who basically told me that I was getting older and losing my memory and hair, and gaining weight, and all these other things were part of getting older. Of course, I was only 26 at the time.

I eventually kept pushing and asking questions and going to different doctors, doctor shopping and trying to get some answers for all the symptoms I was experiencing. Then I was diagnosed with Hashimoto’s. At first I was relieved because I thought “okay, I have an answer to my problem and I can start on medication and I won’t be so tired anymore, and maybe I won’t be losing my hair”. But at the same time, the medication only helped a little bit and I was also interested in figuring out what I had done to develop this condition at such a young age because I thought I was leading a really healthy life. I was eating whole grains, low fat dairy, I was exercising and not smoking or drinking and I was just shocked. I wanted to know if there were any lifestyle factors that brought this condition on and if I could do anything to reverse or slow its progression.

And that’s how I got on this journey, I wanted to figure out if there was anything I could do on my own and I started digging for some answers and some lifestyle changes. One of the first things I discovered was the gluten free diet, which can make a drastic change in people in how they feel and look, and some people can actually put their condition into remission with a gluten free diet.

We went from there and my mom saw some improvements in my health. She’s a medical doctor trained in Poland and she told me that I needed to start writing things down so we can get this information over to my cousins and family members in Poland who had also been diagnosed. That’s kind of how the Hashimoto’s Patient Guide came to be. I was writing down things, I was researching and working on this to get myself better and I’m just really glad it’s been able to help other people as well along the way.

Dr. Eric: That’s a great story, and so from what I understand you were writing the book not necessarily to write a book, but to just write your own experience to benefit others and then turned it into a book?

Dr. Izabella: That’s kind of what was happening. When I was first diagnosed I had this brain fog like a lot of people do and I would research things on the internet, I’d go to the medical journals and get all of this great information and then I would forget it the next day. So it was really important for me to keep all of these things in a central place.

So the guide was kind of my own healing guide as well, and now it’s turned into that for other people.

Dr. Eric: Fantastic! Let’s get rolling with some questions. One of the questions I wanted to ask you is if you think it’s possible for the thyroid gland to regenerate if someone is able to suppress the autoimmune component of the condition?

Dr. Izabella: Absolutely, and I’ve seen it over and over again. So in some cases when people remove the triggers and they remove the root causes, or whatever is causing their immune system to attack their thyroid gland, thyroid tissue can regenerate. The challenging thing is that in different people it happens at a different rate. So one person may go gluten free and within 3 months they may need to start reducing their thyroid medications and get completely off their thyroid medications.

I collect a lot of remission stories from people on my website and we have a few people like that who basically changed their lifestyle and were able to get off thyroid medications because their thyroid function returned. Then we have other people who will do all of the right things and will see a reduction or even a remission in their thyroid antibodies but still may require the use of thyroid medications.

I wish there was a magic formula, and I used to think that it was younger people who had the condition for a shorter amount of time that were more likely to regenerate their thyroid tissue, but I’ve also had some people in their 50’s who have had the condition for 20 years who treated an infection they had and were able to get off thyroid medication. I don’t think there are any hard and fast rules, but definitely eliminating your triggers and supporting your body will help.

Dr. Eric: I agree. You first have to find and remove the trigger. And like you mentioned, I also haven’t noticed a set pattern. It can be someone who had the condition for a couple of years and someone else who had it for 20 years. Like you said, the person on thyroid medication for 20 years might able to get off the medication, whereas the person taking it for only a couple of years might be unable to.

And the challenge too, as you know, is if even if someone thinks they only had their condition for two years, chances are they’ve had it for quite some time. It takes time for the autoantibodies to be present and most of the time, as you know, they don’t test for the autoantibodies and usually they just do a thyroid panel. And so the autoantibodies might have been present five years prior to the TSH being affected and the person went through that time unaware of the condition.

Dr. Izabella: Yes absolutely! Some things that I found to be helpful is making sure you have your ferritin levels optimized, and have your adrenals optimized so that you’re not in a fight or flight mode, and you’re in a rest and digest mode, and just making sure you’re nourishing yourself properly.

Those are the things that are going to be helpful no matter if they help you get off thyroid medication or not. But like you said, it’s hard to prove, and some people will have thyroid antibodies for 10 or maybe 20 years before they actually start seeing a change in the TSH.

Dr. Eric: Exactly. Since you’re a pharmacist I want to ask you a few pharmaceutical questions. First, do you have a preference when it comes to patients with Hashimoto’s taking Armour vs. a compounded T4 or T3 product?

Dr. Izabella: I found that most people do very well with a combination of T4 and T3, and with Armour in a very, very small percentage of people. Some people might see an increase in thyroid antibodies with Armour, and so in that case I’d recommend doing the T4 and T3 compounded medication. Then we also might have potential problems with some of the fillers used in Armour. Some of the Armour products used to be corn-based, and some people who are very corn sensitive weren’t able to tolerate it. So in that case doing a compounded T4 and T3 medication may be beneficial.

The problem with compounded T4 and T3 medications is that they have to be made by specially trained compounded pharmacists. And you want to make sure the compounding pharmacist uses something called PCCA as a starter because thyroid medications are dosed in micrograms and so that’s like 1/1000th of a milligram. Most pills out there if you take Ibuprofen or Advil that’s 200 milligrams. So thyroid medications are dosed in 1/1000th of that and so it’s really easy to get the dosage wrong if you’re not using these specific starters that have the starting material very, very diluted. So that makes it very difficult to make the dose inaccurate.

If you go to your chain drugstore, even if they offer compounding medications they may not be doing them as accurately. So I’d always recommend working with a pharmacy that uses PCCA starters. Then making sure you ask for the medication to be prepared filler-free. A lot of times they can do that for you and make it gluten, dairy and soy free. There’s also 2 different types of fillers that can be used, Avicel and Methocel. And so the Methocel is extended release and some people with gut issues, which is mostly everyone with Hashimoto’s, may have trouble absorbing that medication.

I have seen people who were put on a compounded that was a suspend or release medication and they were not absorbing any of it. I would want to make sure you talk to your pharmacist about not including any kind of fillers that might impair the absorption of the medication.

Dr. Eric: What is the best way, in your opinion, to find a doctor who is willing to prescribe either Armour or compounded T4 and T3? Because most of them will just write a prescription for synthetic thyroid hormone medication such as Synthroid. What advice can you give with regards to finding a doctor who is more open minded to prescribe either natural thyroid hormone or the compounded thyroid hormone?

Dr. Izabella: Synthroid is the direct choice when you look at all the guidelines that most endocrinologists and physicians get. They’ll say that most people will do well on Synthroid and it’s the first drug you need to prescribe. There are some concerns, and back in the day Armour wasn’t standardized correctly. This hasn’t been an issue for many years now and the Armour and all of these other medications are going to be just as safe and potentially more effective for most people with Hashimoto’s.

I actually have a kind of pharmacist trick for this. In order to find a doctor in your area who prescribes this kind of medication then I suggest people work backwards and call their local compounding pharmacy, or call their local pharmacy, and I usually recommend working with independent pharmacies because the staff and people there actually want to take the time to get to know their customers, clients and patients vs. people who work in a community pharmacy, as they’re usually much more short staffed. If you’re working with the big chain boxes like CVS and Walgreens unfortunately people there don’t have enough time to interact with their patients.

So you call and ask them for a list of doctors in the area that prescribe these kinds of medications that you’re interested in getting. That will shorten your homework and research because when you just go through your insurance you’ll get a list of doctors and then you’d have to call each one and ask them if this doctor is open to prescribing these kinds of medications. Whereas, if you go through your pharmacy you’ll get a list of doctors that the pharmacists will know are good with exploring alternative thyroid medications and not just Synthroid.

For most doctors, if they haven’t prescribed something before then they’re not going to feel very comfortable with it because it’s a liability for them. And you probably don’t want to be the first patient they try on something either. So it’s good to go to a doctor who has a lot of experience with those kinds of medications.

Dr. Eric: You make an excellent point, because most people choose a doctor based on their insurance plan, and even if they don’t have health insurance they’ll just go to a doctor who is convenient. But starting with the pharmacist is probably a good idea. Even if you called some of the offices of the doctors, the doctor won’t actually speak with you. The receptionist will probably know what the doctor prescribes, but sometimes they won’t know.

So you might have to actually make an appointment to find out that the doctor’s only going to recommend Synthroid or another type of synthetic thyroid hormone. But that’s a good point to actually contact the pharmacist first and ask them for their list of doctors who will be willing to send you back to the pharmacist, and so that’s great advice.

Dr. Izabella: Just a little trick, right?

Dr. Eric: Yes, and thanks for that. I know you mentioned Armour with the fillers, but how about comparing Armour with Nature-Throid. Isn’t Nature-Throid a little more hypoallergenic than Armor?

Dr. Izabella: Yes, and so Nature-Throid is going to be a little bit cleaner and have fewer fillers compared to Armour. Then WP Thyroid which is made by the same company as Nature-Throid is going to be even cleaner and so that will have even fewer fillers.

So some people may react poorly to one of these medications, and I always want to make sure they’re reacting to the medication and not the fillers. So if they don‘t do well on Armour then they may want to consider doing something like Nature-Throid or the WP Thyroid medication, and that may absorb better for them. But if you’re someone who has a reaction to a filler in a medication, that may prevent you from properly absorbing the medication.

Dr. Eric: Okay that makes sense. WP Thyroid…is that the same as Westhroid?

Dr. Izabella: Yes, they kind of did this weird thing where they rebranded and what not, but yes, it’s through RLC Lab and that’s the new name they’ve had for the last 2 years or so. One thing about pharmacists is we always like our old names and so it’s taken awhile for me to call it that. But that’s a medication you can get that has fewer fillers and they call it WP Thyroid. They used to call it Westhroid Pure but there was some confusion with the other Westhroid and so it’s just WP Thyroid now.

Dr. Eric: Okay. For some reason I thought the ingredients were pretty much identical with Nature-Throid and Westhroid or WP Thyroid but it’s a little cleaner according to what you’re saying. So the WP Thyroid is cleaner than the Nature-Throid?

Dr. Izabella: Yes, and so it’s got even fewer fillers, and the fewer the better is my opinion on medications.

Dr. Eric: Great, and thanks for that as well. I commonly recommend the product Thytrophin PMG to my patients with Hashimoto’s and have done so for many years. I found it interesting that you mention it in your book. I wondered if this is also something you commonly use in your practice to help neutralize the effects of the thyroid antibodies?

Dr. Izabella: Yes, I found it very helpful. I’ve seen people reduce their thyroid antibodies by taking that supplement. It’s interesting because the science behind it is kind of weird. You try to look at the description from the company and basically what it says is that it neutralizes the antibodies and it helps to regenerate thyroid tissue and then it gives basically a blueprint for what a healthy thyroid gland is supposed to look like.

I kind of thought it was a very interesting mechanism of action but that’s all I was able to find on it. I tried it myself and have had clients who have tried it and most people have reported very positive results from reducing thyroid antibodies and feeling better. What has been your experience with it?

Dr. Eric: As I said, I’ve used it for a number of years and it does a pretty good job of neutralizing the effects of the antibodies. Of course it’s not removing the trigger, which is important to mention too. And just taking the Thytrophin PMG, if that’s all you do then it might minimize the effects of the immune system attacking the thyroid gland, but you still need to change your lifestyle and diet and try to find the trigger and remove it. But I’m still using it in my practice and recommend it to many of my patients.

Dr. Izabella: Good. I like to think of it as a decoy, right?

Dr. Eric: Yes.

Dr. Izabella: To distract the immune system from your actual thyroid gland while you work on all these other things. But it’s not something, like you said, that should be used on its own. Unfortunately, if there was a magic pill that’s not necessarily it.

Dr. Eric: I agree, and it’s good that you describe it as a decoy because from what I understand that’s what it does. The immune system actually attacks the Thytrophin PMG and so it’s just taking a lot of burden off the actual thyroid gland, thus allowing the thyroid tissue to regenerate as you were talking about. Once again, we do need to focus on removing the trigger, and so thanks for mentioning that as far as a decoy goes.

Obviously Hashimoto’s thyroiditis is an immune system condition even though some people perceive it as being a thyroid condition. In your experience, on average, and I know it varies from person to person, but how long on average does it usually take to rebalance the immune system once the cause of the condition has been addressed?

Dr. Izabella: It depends on the root cause. So for example, if someone had Celiac disease and that was their root cause, sometimes they get off gluten and dairy and within 3 months they don’t have any thyroid antibodies anymore and they start feeling amazing within a few days. I think that’s one of the best case scenarios where we identify the trigger and remove it right away.

With other things it can be progressive, and so let’s say if you have an H. Pylori infection that you treat. You might see a trend in reducing thyroid antibodies over the course of a few months but might not see the full effects for a year. But I’d say for every intervention, and I even recommend people to test their thyroid antibodies on a monthly basis when they’re actively doing different interventions trying to reduce them, you should see a trend of them going down in that first month.

Dr. Eric: I agree and ideally you want to see them consistently go down. Now sometimes I do see them fluctuate, but ultimately the goal is to get them where they’re going down and, of course, are eventually normal. Every now and then there will be someone who tests negative for antibodies the first time and then when you test them again they’re positive…so that’s another thing to bring up which you’ve probably have seen as well.

My point is that you can’t just go by one single antibody test if someone has an elevated TSH they get the thyroglobulin and thyroid peroxidase antibodies and both are negative. I’m sure you’ve seen where these might present as negative but then later on are positive. Have you seen that with some patients?

Dr. Izabella: Yes, absolutely and the thought is basically the autoimmune destruction of the thyroid may still be happening without any thyroid antibodies, and so that’s kind of one part of it. Then if your immune cells are out of balance and let’s say you don’t have enough white blood cells on board because overall your immune system is suppressed then you won’t be showing as many thyroid antibodies. As you get healthier and get a healthier level of white blood cells you might actually see a higher level of the thyroid antibodies as well, which some people might think is a negative but at the same time…you want to look at the whole picture.

How is the person feeling? If a person comes to me and they don’t have any thyroid antibodies and are feeling horrible, then of course we want to look at getting them to feel better and so we’re not going to say “well, your numbers look fine so I can’t do anything else for you”. And the reverse is also true, as if they’re feeling amazing and even if we see an increase in thyroid antibodies, of course we want to monitor that but we want to make sure that overall the first goal is to get the person to feel good, to get rid of their symptoms and then working on correcting all of the imbalances.

Dr. Eric: That’s an excellent point, as you have to look at the whole picture and not just the antibodies. As you said, if someone has antibodies that are decreasing but they’re still not feeling good, or for any reason they’re feeling worse, then obviously you want to address that. You’re not just treating the blood test results but you’re helping the person, and so that’s an excellent point there.

Let’s talk a little bit about selenium now. Can you talk about selenium and how it can potentially decrease thyroid autoantibodies in some cases? Perhaps you can discuss whether the average person can get enough selenium through food, or whether they need to take selenium supplements.

Dr. Izabella: Selenium is one of those things that I recommend for just about everybody with thyroid disorders. There are multiple studies that have shown that selenium can reduce thyroid antibodies in people with Hashimoto’s, and studies have also shown a positive effect on Grave’s Disease. Additionally, selenium has shown a positive effect on pregnancy and in preventing post-partum thyroiditis after pregnancy.

The different studies seem to show there’s a magic dose of it and so that’s going to be around 200 micrograms per day. A dose of 100 micrograms doesn’t work as well, and selenium is also one of those Goldilocks supplements that if you get too much of it, it can be toxic. So I will generally recommend anywhere between 200 and 400 micrograms per day of the selenium as a selenomethionine supplement.

The studies have shown that you’ll see a reduction of thyroid antibodies by about half at the 3 month mark. So if someone had 1,000 TPO antibodies, by taking the selenium they should see the antibodies drop to about 500. Selenium deficiency has been deemed as an environmental trigger for Hashimoto’s. What’s interesting is people with Celiac disease, people with Crohn’s Disease, people with any kind of irritable bowel issues are going to have a harder time absorbing selenium from their foods. As we know, the gut and thyroid are very much connected and this is a big thing that I always recommend for just about everybody in making sure they take a selenium supplement if they develop a thyroid condition.

Most multi-vitamins are not going to contain enough selenium in them and different things can impair its absorption. I can probably talk about multi-vitamins another time, but basically you put everything in one pill and all these different nutrients interact with each other for absorption and then you don’t end up absorbing anything when you take a multi-vitamin in a lot of cases. Some things do get absorbed but selenium absorption may not happen appropriately from the multi-vitamin.

I usually recommend taking the selenium supplement on an empty stomach in the morning. You do want to space your thyroid medications by about 30 minutes if you take those. What I’ve seen with clients is a lot of times they’ll say they feel a lot less anxious and their mood is going to be improved once they start taking a selenium supplement. If they’re monitoring their thyroid antibodies they’re going to see a reduction in their thyroid antibodies with that.

Another interesting thing to note that I just learned a couple of years ago is that gluten free diets, which are of course another big recommendation for people with Hashimoto’s, may make a person deficient in selenium as well. Some of the richest sources of selenium may include grains, as well as Brazil nuts. I know a lot of people have said they’ll take Brazil nuts to get their daily selenium dosage, but the only issue with that is that the content of the selenium in the Brazil nut is going to depend on where the Brazil nut was grown. If it was grown in a selenium rich soil it’s going to have more selenium, and if it’s grown in a soil that doesn’t have enough selenium then it’s not going to have an adequate dose of selenium. So people can actually under or over dose themselves with Brazil nuts given that we really don’t know how much selenium is in them.

A lot of times I’ll say to try to get most of your nutrients from food, but with selenium, because it’s such an important nutrient for thyroid function and because it has a neuro therapeutic index I’ll say skip the Brazil nuts and take a selenium supplement.

Dr. Eric: To summarize you said the average dosage would be between 200 and 400 micrograms. Is that correct? And then selenomethionine is typically what you recommend?

Dr. Izabella: Yes, that’s usually going to be my recommendation. Most people will do very well with that and the only exception is if someone is both iodine and selenium deficient, which is not very common, but selenium deficiency might exacerbate an iodine deficiency and so that would be the only thing.

So if you’re someone who reacted poorly to a selenium supplement and probably out of 1,000 people I’ve seen maybe one person like that, then there is a potential you may be iodine deficient.

Dr. Eric: I also found it interesting that you recommend taking it on an empty stomach because usually I recommend taking it with food. So I need to test it on an empty stomach with my patients and see if there’s a difference with the effectiveness. So you said to take it in the morning without food, such as a half hour after thyroid medication if they’re taking thyroid medication?

Dr. Izabella: Yes. I used to recommend it with thyroid medication and I had a couple of people, and I don’t know if their selenium had some calcium in it, the supplement they were taking had calcium and then that person reported that their TSH numbers got a little off balance. Now I recommend spacing it out about 30 minutes from the thyroid medications just to be sure. Thyroid medications are very finicky with absorption.

Dr. Eric: I agree with spacing it out and not taking with the thyroid medication. I haven’t given it to my patients on an empty stomach and so it’s something I’m going to test and see.

Dr. Izabella: Okay.

Dr. Eric: So just to clarify, if someone is on thyroid hormone medication you have them wait a half hour, they take selenium and then do you have them wait another half hour until they have breakfast?

Dr. Izabella: Basically, first thing when you wake up you’d take your thyroid medication and then you’d wait about 30 minutes to take your selenium and then wait another 30 minutes. I used to also recommend just waiting 30 minutes for thyroid medication but I found that not most people, but a lot of people actually need that hour before starting to eat because, like we said, thyroid medication can be finicky with their absorption.

Dr. Eric: Let’s talk about goitrogenic foods. Do you believe that people with Hashimoto’s should completely avoid goitrogens such as soy, and other goitrogens such as cruciferous vegetables?

Dr. Izabella: That’s such a great question and it’s one of those myths I like to bust. The word goitrogen is an old kind of word and it’s used to describe basically things that can enlarge the thyroid gland, but it can be done by a lot of different mechanisms.

Unfortunately, they’ve put these wonderful Brassica vegetables into this category like broccoli and cauliflower. A lot of people with thyroid disease think they can absolutely not have any broccoli which isn’t true. Basically, there’s a compound in these vegetables that could potentially interfere with iodine absorption into the thyroid gland. Well, if people are already taking thyroid medications or they have Hashimoto’s, iodine deficiency is sometimes the root cause, but in most cases it’s not. So usually eating these vegetables is not going to be an issue for most people.

I’ve just done a survey of about 2000 people with the kinds of foods they react to and what kind of reactions they were having with their foods. There was a huge percentage of people who reacted to gluten and dairy and soy and those kinds of foods, but as far as broccoli and cauliflower and foods like that, very few people reported that they actually reacted to those foods.

What I would suggest is that if someone isn’t on thyroid medication and is subclinical hypothyroid and maybe has an iodine deficiency, they may find that these vegetables slow things down for them a little bit more. So in that case you would just have to see them to break down the goitrogenic compound. But other than that, most people with Hashimoto’s can eat plenty of veggies. And so eat plenty of broccoli and cauliflower, raw or steamed or whatnot, it will be helpful with detoxification.

The only exception, of course, is soy. Soy works as a goitrogen because of a different mechanism, and so it interacts with thyroid peroxidase. They did studies in children who were fed a soy formula instead of breast milk and found these children were more likely to develop thyroid antibodies later on in life. So soy has been connected to Hashimoto’s and potentially inducing Hashimoto’s. So that’s one thing I definitely recommend avoiding.

In contrast, things like dairy or gluten, where people will often feel it in their stomach or gut when they eat this food. You may not have that kind of reaction to soy, but a day or two later after you eat it you might feel a little edgy or feel really tired. That’s because of its way of acting on the thyroid gland. So for most people with Hashimoto’s I recommend staying away from soy.

Dr. Eric: Yes, I agree. A few years ago I actually wrote some articles talking about goitrogens and I was telling people to minimize their consumption of goitrogenic foods. But that was not due to any research I did, but was based on information I learned from nutritional conferences I attended, and people who I perceived as being experts in thyroid health telling their patients not to eat goitrogens.

But then the more research I did and have done over the years I just realized that pretty much all of the studies have been on animals with regards to cruciferous vegetables, and usually involve large doses. Every now and then you’ll get a person who says when eating broccoli their thyroid swells. And like you said, if someone notices a difference they might want to ease up, but these are very healthy foods. So to deprive people of broccoli, kale and cauliflower… I think most people can definitely eat these foods without a problem.

And with soy, besides the goitrogenic properties, most soy is genetically modified. But even if you’re consuming non GMO fermented soy you still have to deal with the goitrogenic properties, and it also has some anti nutrients which also is a factor. So I agree with you about trying to not eat, or to limit the consumption of soy. Thanks for sharing that.

You’ve mentioned iodine a few times briefly so I want to talk a little more about iodine as far as some of the risks and potential benefits of iodine intake, and whether you think people with Hashimoto’s should completely avoid iodine, or if taking a small amount of iodine is okay.

Dr. Izabella: Wow we’re covering all the myths and controversies today. With iodine I know there are a lot of advocates out there who will say that high dose iodine can be very, very helpful for every thyroid disorder. I’m not going to disagree with that. I think everybody has to do what’s right for them, and iodine can help people with thyroid disorders.

The issue with Hashimoto’s, however, is that your thyroid gland, which is supposed to process iodine, is actually impaired. So when you give a person with Hashimoto’s who has an inflamed thyroid gland more work to do by giving it more iodine that can cause further inflammation.

In surveying my clients and readers about this…I’ll give you an example. About 80% of people said that going gluten free made them feel better and nobody said it made them feel worse. With high dose iodine I had about 25% of people saying it made them feel better and then 25% of people said it made them feel worse. So it’s kind of dangerous, I think, to be recommending it when you don’t really know and are just playing a guessing game, because for some people it may help them feel better and it may help especially if they’re iodine deficient and so you give them a high dose and it may actually make them feel better.

But then you have the other half of the people, which happen to be a lot of clients I’ve seen and I always try to recommend something safe first and safety is always my big thing. Let’s make sure everything is safe. And I’ve had clients who on their own or working with other practitioners they took very high doses of iodine and some had their thyroid antibodies skyrocket, going from a 200 or 300 range to the multiple thousand range. One woman’s TSH jumped to 98 and her T4 was at like zero, believe it or not, and she was bedridden because of the high dose of iodine.

I get super nervous about it, about these high doses of iodine, and studies have shown that it can accelerate thyroid tissue damage. On the other hand, the dosages you would get in a multi-vitamin is something like 150 micrograms. These dosages will actually be safe for most people with Hashimoto’s and will be helpful and they haven‘t shown any increase in thyroid antibodies when you just take a very tiny low dose of 150 micrograms per day, which is the recommended daily allowance.

Other studies have shown that people who actually go on an iodine restriction with Hashimoto’s may be able to improve their thyroid function as well. Where I am with that is for most people I’ll recommend working on these. I usually try to work on the things I know are very safe and very effective like the gluten free diet. Then if we’re still working with some of these issues then we may recommend a multi-vitamin. If someone has been on this super high dose iodine then I may recommend that person to just try to repair the damage and get off iodine for a short term period.

I wish I had a straightforward answer to say this is what we do every single time, but it’s not always so easy, and as you’re well aware there are a lot of different nutrients that act in synergy with one another. I always want to make sure everyone has their selenium on board, they’ve got their B vitamins and vitamin C on board and all these other things before we move on to the iodine. And iodine wouldn’t be a first level recommendation, it would be something like…okay we’re still struggling and we did this gluten free diet and we tried to address any infections and we’re still struggling…what else can we do?

But that is my stance in a nutshell for Hashimoto’s.

Dr. Eric: That’s great. I’m probably more pro iodine than you, but I’m also cautious with iodine, and I agree with you that some healthcare professionals will recommend high doses of iodine to all of their patients, or some people will take on their own a 50 milligram tablet of Iodoral daily without any testing. Some people will do fine, but some people don’t do well, and there’s really no way to predict who will do well and who won’t, and so I am cautious. And when I do recommend iodine I recommend testing, and even if someone is deficient I’ll recommend smaller doses and not have someone start out with very high doses. I usually don’t ever have people reach that high of a dose as I just mentioned such as 50 milligrams. So thanks for sharing that with us.

Alright, the last question I wanted to ask has to do with some of the common infections you see with your patients.

Dr. Izabella: For me, when I think about Hashimoto’s in general it’s in two parts, and one part is that your body is in a weakened state because maybe you’re nutrient deficient and/or maybe you’re eating foods you’re reacting to. Or maybe you’re under a lot of stress, or maybe you’ve been exposed to toxins, and that’s one thing that a lot of the lifestyle factors can address by getting you the right nutrients, getting you on the right diet, by taking supplements or doing some detoxifying.

The other part is the chronic infections. There’s a theory of autoimmunity called Molecular Mimicry where basically what is happening in very simple terms is that the immune system begins to recognize our thyroid glands as a foreign invader because there’s something else in our body that has invaded our body that looks similar to the thyroid gland. So different bacteria, viruses, potentially parasites might have protein structures that are similar to the thyroid gland, and so as the immune system… I like to think of it as walking around with a little IPhone and it takes a little picture of the protein sequence and then when it sees a similar protein sequence it will start attacking.

So there are a few different infections that have been identified as having a similar sequence to Hashimoto’s. H. Pylori and Yersinia are similar to the thyroid gland and have been identified. The most common infections that I’ll see are going to be H. Pylori, Epstein Barr Virus, and then parasitic infections in the gut. And so blastocystis hominis is a very common one too.

What we’ll find a lot of times is when you identify and treat that infection the person will feel better and in some cases they will see a reduction in thyroid antibodies and in some cases you’ll see the person going into remission. Those are the most common infections and I recommend doing stool testing. There is a company called BioHealth Labs that does the H. Pylori test and they also test for blastocystis hominis and you can have your doctor run a Epstein Barr virus panel. Most people have had Epstein Barr virus infections but they can become reactivated in people with Hashimoto’s and sometimes can keep the autoimmune response happening when they’re infected with that.

But research has connected so many different infections, and many are looking for that one infection, but it’s not always that one infection. I think it’s a combination of genes and maybe not having the right kind of natural flora, and the infection will determine what kind of disease you get.

Dr. Eric: With the stool testing, especially for parasites, do you typically have patients collect a stool sample on multiple days, such as collecting 3 or 4 different stool samples to increase the accuracy?

Dr. Izabella: Yes, that’s a really important question because a lot of times people will say I had a stool test and it was negative and they may have just had one stool test. The important thing to note is that the parasites may not shed in every stool or in every bowel movement, so the more stool samples you do the better your chances are at catching the parasites. So I actually recommend doing at least 4 stool samples on 4 consecutive days. You can also half that by doing it over 8 days where you put a little bit of a stool sample into each vial where you put 2 days worth of stool into one vial and that way you have a higher likelihood of potentially picking up the gut parasite.

I know this sounds nasty and gross and I didn’t want to believe it myself because we think we live in the Western world and we don’t have these kinds of things but it’s very common in people to have gut parasites and gut infections. They can then lead to all kinds of problems such as irritable bowel syndrome and having multiple food sensitivities, which then increases the antigenic load in Hashimoto’s.

Dr. Eric: Okay. One last question relating to the infections: do you take more of a natural approach, or do you prefer antibiotics, or does it depend on what type of infection?

Dr. Izabella: I’d say it depends on the person and it depends on the infection too. So whenever I write about it or I talk to clients about it I always want them to work with their own physicians and healthcare practitioners and I’ll give them a list of recommended therapies. So you may take a medication and then follow it with herbs, or you may take just the medication or just the herbs. I just give people some information on what some of the more effective ones that I know of and let them take this information to their doctor and make the decision on their own, because some people feel much more comfortable with antibiotics and others don’t feel comfortable with them at all. And there are certain infections that may not be susceptible to herbs, or it may take a really long time to eradicate them the herbal way of 2 to 3 months vs. 2 to 3 days on a medication.

So it’s different drugs for different bugs as I like to think of it.

Dr. Eric: I like that. Different drugs for different bugs. Thanks Dr. Izabella for answering these questions and I’m sure everyone found this information to be useful.

What I’d like you to do now is take a few minutes and talk about your excellent book, Root Cause. I’m sure many people reading this blog post have already read it, but I’m sure there are some who haven’t read it. So if you can talk a little bit about your book.

Dr. Izabella: Sure, and I think it has the longest title ever. It’s called Hashimoto’s Thyroiditis: Lifestyle Interventions for Finding and Treating the Root Cause. It’s available on Amazon. If you look for Hashimoto’s Root Cause or Izabella Wentz you’ll find it.

Basically it’s a patient guide to help people find out what the root causes and triggers may be and it gives people information on lifestyle changes they can start implementing on their own. So supplements they can take and different nutritional things they can do on their own, as well as more information so they can take it to working with doctors like yourself.

I think it’s really important for people to be empowered and be their own health advocates and be on board with what’s happening within their own bodies. And working with a physician is excellent but you don’t want the change to come from you because you can tell a person what to do and you have all this wonderful knowledge and experience with patients over so many years, but it’s really up to the patient to do it right in many cases.

Dr. Eric: Yes.

Dr. Izabella: To change their diets, to take that supplement and take that test. So the Patient Guide is all about how to figure out what’s going on with your body and the things you can do on your own to get yourself better.

I have a website too and its www.ThyroidPharmacist.com [1] and I have lots of great information on there. I try to write a new blog post every week. I’m a big research nerd and so I’m always researching different types of infections and different root causes. As we both know, it’s not always the same thing for every person that triggers their Hashimoto’s but at the same time there are a lot of universal things that we can recommend that will help most people feel much better.

Dr. Eric: Great, and for anyone listening who hasn’t read her book I would definitely get it. I’m not saying that just because I’m interviewing you, but it is one of the best books I’ve ever read on Hashimoto’s. It’s one of those must reads for anyone with this condition.

Dr. Izabella: Thank you so much for that. I forgot to mention I also have a free book chapter if people go to www.ThyroidPharmacist.com/gift [2] they can get the Nutrient Depletions and Digestions chapter and get a gluten free quick start diet as well as some recipes. When I first tried to go gluten free I did it all wrong. I was eating all this junk food and setting my blood sugar on fire.

Thank you so much for having me and I hope everybody found this information helpful.

Dr. Eric: Great and thank you again Dr. Izabella for sharing this information. Again, visit ThyroidPharmacist.com/gift for the free chapter in her book and ThyroidPharmacist.com for the weekly blog post. Then go to Amazon if you want to read the book which I highly recommend.

Again, thanks again for doing this interview. I thought it was great and I’m sure everyone has benefited from this information.

Dr. Izabella: Thanks so much Dr. Eric.

Dr. Eric: Thank you.