In this episode, Dr. Eric Osansky tackles a challenge many people with hyperthyroidism face: helping friends and family truly understand their condition and treatment choices. Whether you’re dealing with Graves’ disease or another form of hyperthyroidism, explaining what’s happening in your body—and why you’re taking a natural approach—can feel overwhelming.

You’ll learn how to navigate tough conversations about treatment choices, including medication, diet changes, and natural healing approaches. Dr. Eric shares practical ways to set boundaries, communicate your needs, and handle skepticism—while staying focused on your healing journey. If you want a clearer, more balanced understanding of how to advocate for yourself and explain hyperthyroidism with confidence, you’ll get a lot out of this episode.

Click Here to listen to it on the Save My Thyroid podcast

Dr. Eric Osansky:

Hyperthyroidism isn’t something that most people are familiar with. Think back before your diagnosis. Chances are, you probably didn’t know anything about hyperthyroidism. If someone was in your shoes, you probably wouldn’t understand what they were going through.

When someone chooses to take a natural approach, it’s not uncommon for friends and family members to question the person’s decision. After all, shouldn’t your endocrinologist know what’s best for you? Of course, it’s easy for them to have this perspective when they are not the ones being pressured to receive radioactive iodine or thyroid surgery.

The goal of this episode is to help you communicate your hyperthyroid condition clearly and confidently and help your family and friends better understand why you are choosing to save your thyroid.

Let’s start off by discussing what hyperthyroidism actually is. This is what you would convey to your family and friends. You could explain to them that the thyroid gland regulates metabolism and energy. In hyperthyroidism, the thyroid becomes overactive.

If you want to, you could even compare hyper versus hypothyroidism. Hypothyroidism is a lot more common. There is a chance maybe one of your family members or friends has hypothyroidism. With hypothyroidism, the thyroid hormone levels are low. Typically, that will lower metabolism. In hyperthyroidism, it speeds everything up. Everything is overactive. Essentially, the body runs too fast. It’s like your body’s engine is stuck in overdrive.

You could go on to explain some of the common symptoms associated with hyperthyroidism. You might not have all of these, so feel free to be specific to your symptoms. Some of the more common symptoms: rapid heart rate, which I definitely dealt with when I had Graves’ heart palpitations; anxiety; fatigue.

Fatigue, wired versus tired. You might not want to explain this part. Hyperthyroidism puts a lot of stresson the mitochondria, which are the energy powerhouses of the cells. Or you can. It’s up to you. Fatigue is also common. Some people, especially in this day and age, where they might look things up on Google or ChatGPT and say, “With hyperthyroidism, fatigue is not really a classic symptom.” As I mentioned, it does put a lot of stress on the body, the mitochondria, so it’s not uncommon to experience fatigue.

Quite frankly, when I dealt with Graves’, I felt more wired than tired. Everyone is different.

Weight changes. This is different. When I dealt with Graves’, I lost 42 pounds. I lost a lot of weight. Many of my patients lose weight. It’s not uncommon for people to gain weight, too. This is where it might become confusing. If they look up hyperthyroidism, and you’re not losing weight, they might not understand. I do have some episodes on the podcast that you could show them.

Sleep problems are very common. Just because of the elevation in thyroid hormone.Sometimes, it causes heat intolerance, which can also cause sleep problems.

Increased bowel movements. Hair loss. There are a number of symptoms. Feel free to explain them. Even though they can look it up, chances are they won’t take the initiative to do so.

If you have Graves’, then you probably want to tell them that Graves’ is the most common cause of hyperthyroidism. It’s more of an immune system condition. It’s actually an autoimmune condition. A lot of people are familiar with autoimmunity these days. You could mention that it’s where the immune system attacks the thyroid, specifically the TSH receptors of the thyroid gland, which results in too much thyroid hormone.

If you have a different hyperthyroid condition, try your best to explain this. If you have toxic multinodular goiter, that involves swelling of the thyroid, which is a goiter. You could also let them know that it involves multiple thyroid nodules. I don’t think you have to get into detail about thyroid nodules. You could tell them they are little bumps on the thyroid, little growths, in an easy-to-understand way. Essentially, it’s an enlargement of the thyroid gland, or thyroid swelling, and multiple bumps on the thyroid.

With toxic multinodular goiter, you have too much thyroid hormone. I would focus more on the hyperthyroidism part than the goiter and the nodules.

There are others, like subclinical hyperthyroidism. Most of the concern will be with Graves’ and toxic multinodular goiter. Subacute thyroiditis is very prominent, but it’s temporary. Usually, the person will eventually become hypothyroid.

Let’s talk about focusing more on Graves’. Most people listening to this have Graves’. Not everybody. With Graves’, you want to talk about that immune system. You don’t get into cytokines and all these other things, which you might not even be familiar with either. I don’t expect everybody listening to this to know the nuts and bolts when it comes to the immune system. It involves immune system dysregulation.

You could talk about some of the triggers briefly. I mention the four main categories of triggers are food, stress, toxins/toxicants, and infections. The goal is to find and remove those triggers. The symptoms could fluctuate, and they vary. You could look up hyperthyroidism online, and your symptoms may not match all the symptoms online. Everybody is different.

The point is, by talking to them about the triggers, they will understand it takes time. Healing takes time. Your goal is not just to put a band-aid on this; your goal is not just to take the medication. Maybe you’re choosing to take antithyroid medication or beta blockers, but you want to do more than that. You want to heal.

When it comes to symptoms, as I mentioned, symptoms can differ, and they can be confusing. Feeling exhausted, with that wired but tired feeling. Voracious appetite, they might be seeing you eat all the time, but you might also be losing weight. Not everyone does. If you are losing weight, yet you are eating all the time, again, it’s the increased metabolism. Anxiety that is more than psychological, that is also important.

Letting them know that many of your symptoms are physical, not just emotional. There aredefinitely psychological aspects with Graves’, but there are also the physiological aspects. Even things like Graves’ rage, there is a physical component. It’s not all emotional or psychological.

It’s important to convey this to your friends and family, so they understand it’s not just stress. That is of course a factor. You may be feeling chronically stressed. Stress can be a factor in causing hyperthyroidism. When you’re dealing with these conditions, you may be even more stressed out. This is going beyond just stress. There is that physiological component.

Healing, as I just mentioned, takes time. If someone takes antithyroid medication, that could work quickly. Within a few days or weeks, they might feel a lot better. There are side effects that are common, which not everybody experiences. If someone is taking antithyroid medication, you might expect in many cases to get quick results.

If you are taking a more natural symptom management approach, like taking bugleweed, motherwort, or L-carnitine, it could take more time. You might have to explain to them that the medications are harsh on the body.

If you’re listening to this and taking medication, I work with a lot of people who take the meds. I even though I personally didn’t take the meds, I have nothing against the meds. I am giving both sides of the story.

If you are taking medication, and it’s helping, let them know. This might offer them some comfort. Yes, you are not doing everything naturally; you’re trying some things conventionally.

If you’re like me, where you are not taking any medication, then explain to them that the reason you decided not to take the medication is because first of all, side effects are very common with antithyroid medication, and you could describe some of those. It could put stress on the liver, lower white blood cell counts, affect the gut microbiome. They could search online as well. You’re not making this up.

Also, you have known people like yourself and others who have successfully managed their symptoms naturally through herbal medicine. L-carnitine is not an herb. You could say natural agents (bugleweed, lemon balm, motherwort). They might not understand if it’s a few weeks into the treatment, and you’re still showing many of the signs and symptoms. You need to let them know, especially if you’re taking a full natural approach and not taking medication, that it could take some time.

You could let them know that, assuming you have Graves’, it involves the immune system. Even if you don’t have Graves’, you have to focus on improving adrenals. You need to improve gut health and nutrient deficiencies. You need to find and remove triggers.

Like I said, if you’re taking medication such as methimazole or PTU or beta blockers, let them know that. They might feel more comfortable that you’re taking medication. It depends. I work with people whose family members might be on the first consultation call with them, and they’re all supportive. It’s not like family are never supportive. If you have a spouse or other family who aren’t supportive, and you are taking medication, they probably will be happy that you’re doing so.

If they are more naturally mindset, they might not be supportive. But it is your body. It is your decision. You could cut to the chase and say, “It’s my body. It’s my decision.” But I think it’s important to help them understand, to try to decrease tension.

Let them know that whatever approach you’re taking from a symptom management perspective, whether it’s medication or natural agents, you’re doing things to help control the thyroid hormone levels, reduce cardiovascular symptoms. Managing the symptoms is different from addressing the cause of the problem.

Then there is diet. For a lot of people, this is a big factor. For example, if someone is working with me, and their spouse is not fully on board, they might question why you need to follow a restrictive diet. Nobody likes restrictive diets. I don’t even like that term. It’s an elimination diet. We’re eliminating certain things or restricting certain things, but the foods you are allowed to eat, you can eat a good amount of these foods. I don’t like that term, “restrictive diet,” but it can be restrictive.

Like I said, diet can be more difficult to communicate to some people. When you’re avoiding foods that are healthy, eggs are not part of an AIP diet. If you’ve read my book The Hyperthyroid Healing Diet, the level 3 diet, which is a modified AIP diet. Eggs are excluded, not because they’re unhealthy. You might need to mention that eggs are healthy. Tomatoes have some health benefits. But eggs are a common allergen, and tomatoes have compounds that could in some people be inflammatory, especially with autoimmune conditions.

Especially if you have Graves’, you might want to point this out. Most people do fine with both eggs and tomatoes. With certain autoimmune conditions, these foods sometimes can increase inflammation. You can say they negatively affect the gut. Whatever is easy for you to communicate.

Like I said, it’s challenging. In some cases, when a significant other isn’t supportive, the person I am working with may end up making two meals, which can be stressful. I’ll talk more about that.

Feel free to let them know about my book The Hyperthyroid Healing Diet. If they’re not on board, they probably won’t want to read it, but it might offer them some reassurance that there is a book on it. If you have a physical copy, it’s pretty thick. It’s not like it’s short; it’s close to 500 pages. It’s quite comprehensive.

When it comes to limitations, everybody is different. When I dealt with Graves’, I felt like I, for the most part, could do what I had to do. I didn’t feel like I couldn’t do my daily tasks. For some people, energy levels are dramatically affected. They might not be able to go to work and do whatever job you’re doing. You could let them know some days you have energy, other days you don’t. Stress associated with your job really flares things up, worsens your symptoms. You need more sleep, which is important for recovery.

You want to communicate all these things. You might think it’s common sense, but they might not understand. They might not understand even when you communicate this. You need to make the effort. You need to explain that healing often requires lifestyle changes. Obviously, diet changes; stress management; getting proper sleep.

Ideally, you want to get support from your family members and friends, especially family members. Anyone who lives in the household, you could let them know that they need to be patient with your recovery. Understand fatigue. Help reduce your stress, not increase it. Respecting any dietary changes you make.

You could tell them it’s not helpful if they minimize the symptoms you have, saying, “You look fine. It doesn’t look like anything’s wrong with you.” That’s the case with many autoimmune conditions or other health conditions. At least, initially, many people do look fine.

In my case, when I lost 42 pounds, I didn’t look fine, but it did take time for me to reach that point. Not everybody will lose weight to begin with, let alone that much weight. Some people look normal.

Obviously, if someone has thyroid eye disease with Graves’, and it’s moderate to severe, then you know something’s wrong, and it’s not just a psychological thing.

You could obviously show people your lab results if you want to. If it’s a significant other, they may see them anyway. They may go to the doctor’s appointment with you, which might not be a good thing.

Most endocrinologists aren’t going to be supportive of natural treatment options. You will need to explain that is the training they have in medical school. There are functional medicine practitioners and natural health care practitioners who open their minds and realize that there is a cause of the problem.

Getting back to what’s not helpful, mocking dietary choices, making the spouse or significant other cook two separate meals every single night for dinner.

Set boundaries when necessary. You need to do what’s necessary to heal. Protect your energy. Avoid unnecessary debates with your family and friends. Ultimately, it does come down to it’s your body, so it’s your decision.

You might not want to start with that. You might not want to be confrontational, but if you do everything you can to communicate this to them, and they still don’t understand, then you might just need to draw the line still and do what’s necessary to focus on your healing.

Let them know, “I appreciate your concern. This is something I truly believe in. We have a thyroid gland for a reason. I’m going to do everything I can to save my thyroid, and I am working with this other practitioner.”

If you go to an endocrinologist initially, and your significant other is with you, and your endocrinologist says, “It’s Graves’. There is no cure for it other than removing your thyroid or getting radioactive iodine. If you don’t do that, you’re at risk of thyroid storm, going to the ER.” They will use these scare tactics.

Not to say there is not risk. We know there is risk. They won’t bring up the risks of radioactive iodine or thyroid surgery though. Not that they don’t know, but they may not know if they don’t look it up. The endocrinologist won’t bring it up. Youcould bring it up to the endocrinologist.

The truth is the endocrinologist will be defensive. “The risks are low. It’s definitely more risky to deal with the hyperthyroidism.” Again, they are an authority figure to most people. If your family or friends are more medically oriented,they will buy into what the endocrinologist says.

You have to stand up for yourself if that’s the case and let them know, “I understand you care about me. I could always get the radioactive iodine or the surgery. Once I make that decision, there is no turning back.” The thyroid gland is very important. “Sure, I could get my thyroid removed and be on thyroid hormone permanently,” but the research clearly shows that if someone has one autoimmune condition, there is a greater likelihood of developing other autoimmune conditions in the future.

If you have a non-autoimmune thyroid condition, you could still say, “This is not addressing the cause of the problem. Yes, I could get my thyroid removed, but I’m still at risk of having other health issues. If I develop toxic multinodular goiter, and I am not doing anything to improve my health. If I do things to improve my health, by following a natural treatment protocol, and things don’t get better, I could always get radioactive iodine or surgery. I will do things to manage my symptoms in the meantime. Again, I want to be able to live with my decision if I go that route.”

Hopefully, you’re listening to this because you want to save your thyroid. Explain to them that you’re not completely opposed, maybe even if you are. When I dealt with Graves’, I didn’t even think about surgery or radioactive iodine. I was open to taking medication. I’m not saying under no circumstances I wouldn’t have received thyroid surgery, but I was trying to do everything to avoid surgery and radioactive iodine.

I will start wrapping this up by reminding you that there are resources that are not only for you but for others. There is this podcast. You could have themlisten to this episode if you want to. You could talk to them, but if you’re still arguing, maybe have them listen to this. Maybe have them listen to some other episodes about healing. That is what the podcast is about.

There are also books out there, including mine, about addressing hyperthyroidism naturally. They know it is possible. You could visit my website and show them some testimonials I have on there. If they’d rather read than listen, but they don’t want to read the book, I also have my new Healing Graves’ Naturally newsletter on Substack. You can refer them to that. A lot of the articles will help those with other thyroid conditions besides Graves’.

Remember, you’re not alone. I understand it can be challenging to explain hyperthyroidism and why you chose to take a natural approach to others, which is why I decided to put together this episode.

Some people don’t want to hear it. They were brought up with that medical mindset. No matter what you say, they will take the side of the endocrinologist. In that case, all you can do is stand up for yourself. Education and communication are important and can improve understanding. Some people will sway them, or at least make them understand and respect your decision. If not, you need to do what you need to do to save your thyroid.

In the case of family, this might be difficult. In the case of friends, if it comes down to it, and you have one or two close friends who are not on board and really making you feel bad about your decision, you might need to take a break. I am not saying to end the friendship; that’s up to you. But maybe you need a break. Even family, if it’s not someone in the household, maybe you distance yourself a little bit while healing.

You want to have that positive mindset. You don’t want to have the negativity every single day. You don’t want someone telling you you need to do radioactive iodine or surgery every day. If you’re managing your symptoms naturally, you need to take the medication. You don’t want to have someone telling you this day in, day out, or even a few days a week, if you are trying to take a natural approach.

Hopefully, you found this episode to be valuable. Appreciate you listening as usual. Of course, I look forward to catching you in the next episode.

***

Explaining Graves’ and other types of hyperthyroidism, you don’t have to get into great detail. Especially with Graves’, you need to let them know that it is an autoimmune condition, which more and more people are becoming familiar with, just because they are so common.

If you have a different type of hyperthyroid condition, you can get into the basics. Tell them that you have an enlarged thyroid gland with multiple nodules.

It’s about addressing the cause of the problem. The issue with conventional medicine is that with Graves’, when you go to an endocrinologist, they don’t do anything for the immune system component. You want to make sure you communicate this to your friends and family.

Explaining common triggers. Talking about how there are underlying causes for this. Let’s say your significant other needs some convincing, and you bring them to the endocrinologist. The endocrinologist is going to say that there is no underlying cause that we know of. It might be a challenge to convince your significant other, family, or friend that there is an underlying cause.

Maybe it’s by having them listen to my podcast or read my book. There are other sources out there, too. I’m not the only one talking about hyperthyroidism. Admittedly, there are not as many practitioners talking about hyperthyroidism as there are with hypothyroidism.

Explaining side effects of other treatments. Antithyroid medication has a time and place, but side effects are common. A lot of people who work with me take antithyroid medication, so I’m not against it. If you do take it, that’s fine. Tell them that you’re taking the medication to be safe while addressing the cause of the problem.

If you’re taking a natural symptom management approach like bugleweed or higher amounts of L-carnitine, show them the research. I have podcast episodes that talk about bugleweed and L-carnitine.

Radioactive iodine and thyroid surgery are extreme procedures. They know this, but you might need toremind them that you could always get the surgery or the radioactive iodine. There are side effects associated with these, so you want to try your best to avoid these.

If it’s Graves’ and autoimmune, you could tell them that if you have one autoimmune condition, you’re at greater risk of developing other autoimmune conditions in the future, according to the research. Radioactive iodine and thyroid surgery do nothing for that autoimmune component.

Explaining the diet you choose to follow. This could be very challenging. I discussed this in the episode. They probably won’t read my book, which by the way, I checked, it’s actually closer to 400 pages, not 500. You could have them listen to the podcast.

To us, it makes sense. Diet is important. For some people, it doesn’t make sense. Ultimately, it’s up to you to follow the diet, to block out time for stress management, to get sufficient sleep, regardless of whether your friends and family are supportive. That being said, I would try your best to explain the importance. Maybe show them some of the resources.

Finally, letting them know that even though you plan on doing everything you can to save your thyroid, conventional treatment is always an option. Once again, maybe you’re already taking antithyroid medication. If your endocrinologist is pressuring you to get radioactive iodine or thyroid surgery, and your friends and family are also thinking about that for you as the main options, tell them, once you get these procedures, there is no turning back. You want to be comfortable with your decision.

This is your body. It’s easy for them to say to get the radioactive iodine or surgery when it’s not them who’s getting it. Tell them, “I am considering it.” When I dealt with Graves’, I was not considering it. But if it eases some tension, you could say you are considering it. Right now, you are going to do everything you can to save your thyroid.

I really hope you found this episode to be valuable, especially if you are having difficulties explaining hyperthyroidism to your friends and family. Explaining you are choosing to save your thyroid, to take that natural treatment approach to address the underlying cause of the problem.

As usual, I look forward to catching you in the next episode.

In this Q&A episode, Dr. Eric dives into the powerful connection between gut health and thyroid function. Recorded during a Substack livestream for his Healing Graves’ Naturally newsletter, he begins by explaining why the gut is such a central player in thyroid autoimmunity. With most immune system cells residing in the gut and about 20% of thyroid hormone conversion occurring in the gut microbiome, maintaining gut health is critical for those dealing with Graves’ disease, Hashimoto’s, or other thyroid conditions.

Throughout the episode, Dr. Eric answers listener questions about gut testing, including when to use comprehensive stool tests, SIBO breath tests, or organic acids testing. He also discusses leaky gut testing, parasites, H. pylori treatment options, histamine intolerance, and how gut imbalances can contribute to symptoms like bloating, gas, and constipation. He explains how diet, stress management, and proper digestive support can play a role in restoring gut balance.

Listeners will also learn about natural approaches to supporting stomach acid levels, the role of fiber in producing beneficial compounds like butyrate, and whether sweeteners like stevia or monk fruit affect the gut microbiome. If you want a clearer, more balanced understanding of the gut-thyroid connection and practical answers to common gut health questions, you’ll get a lot out of this episode.

Click Here to listen to it on the Save My Thyroid podcast

Dr. Eric Osansky:

Welcome, everyone. Thanks for joining me. We are going to chat about the gut and the thyroid. This will be a great live call. Obviously, this is live now, but this is going to be a future podcast episode. I am recording this on February 11, so sometime in March, this will be uploaded to the podcast and YouTube.

For those in the future who are listening to this on my podcast, this livestream is on Substack. I have a new Healing Graves’ newsletter, which is why I have been doing some livestreams in the month of February.

What I am going to do first is talk a little bit about the gut and the thyroid. Then I will go ahead and answer some questions that were emailed to me. Then we’ll go ahead and address the live questions. Thanks for joining me.

Let’s talk about the gut and the thyroid. How does the gut relate to the thyroid? First, most of the immune system cells are located in the gut. Most thyroid conditions are autoimmune in nature. Not all of them, but approximately 90% of people with hyperthyroidism have Graves’, and approximately 90% of people with hypothyroidism have Hashimoto’s. Since most of the immune system cells are located in the gut, you need a healthy gut to have a healthy immune system.

In the very first newsletter, I spoke about the triad of autoimmunity, also known as the three-legged stool of autoimmunity. There are three factors necessary for autoimmunity to develop. One is a genetic predisposition. Two is exposure to one or more environmental triggers. Three is an increase in intestinal permeability, which is the medical term for a leaky gut. That leaky gut component is another way that the gut relates to the thyroid health.

Also, T4 is produced by the thyroid gland. The thyroid gland does produce some T3. Those are the main thyroid hormones, T4 and T3. There is also T1 and T2, but we’re still learning about those, and we can’t test for those at a lab. We can only test for T4 and T3.

Most of T3 is actively produced by the conversion of T4 into T3. Approximately 60% of the conversion takes place in the liver, and approximately 20% of this conversion takes place in the gut microbiome. If you don’t have a healthy gut microbiome, that can negatively affect the conversion of T4 to T3.

We also have to consider that a healthy gut is necessary for optimaldigestion and absorption of nutrients, some of which are important for thyroid health.

Those are four different ways in which the gut plays an important role in thyroid health. Before getting to the questions, of course the focus this month has been on my new newsletter, which is Healing Graves’ Naturally on Substack.

I do have another newsletter that has been out for over a year now, Healthy Gut, Healthy Thyroid. If you are interested in learning more about the gut, I don’t want to overwhelm people with too many newsletters, but at SaveMyThyroid.com/Newsletter, you can check that one out, too.

I was releasing one newsletter every week. Now, it’s more like once every other week. I have a difficult time keeping up with everything and wanted to come out with this Substack focusing on Graves’. Healing Graves’ Naturally right now will be every single week, Friday at 10:45am. Healthy Gut, Healthy Thyroid is released on Sunday morning.

Let’s dive into the first question: What are the top tests you recommend to evaluate someone’s gut health?

Great question, Daphne. I would say it does depend on the person. I can’t say I recommend the same gut test to everybody. The most common gut related test I recommend is a comprehensive stool panel. I have been using mainly the GI Map for a number of years. I’ve used other companies. GI Effects is a really good one. There are a few others.

The GI Map is the one I’ve used the most. That’s a comprehensive stool test that focuses on the large intestine. It looks at things like H-pylori, parasites, opportunistic bacteria, markers related to gut inflammation.

There is also SIBO testing. That’s a breath test. If someone is having a lot of gas and bloating, especially when eating certain foods, it doesn’t guarantee it’s SIBO. It could be something else. I very well might recommend a SIBO test over a comprehensive stool test in that situation.

There is also organic acids testing, which is not specific for the gut, but the first page of the organic acids test from Mosaic Diagnostics looks at fungi, yeast, bacteria. It looks at the classic candida marker, which is arabinose. It looks at Clostridia. Some stool tests look at Clostridia, too, but it doesn’t differentiate between commensal or harmful, good or harmful strains of Clostridia. Great Plains, or Mosaic, it used to be called Great Plains for a number of years, but now it’s Mosaic. They test for the more harmful or pathogenic strains of Clostridia.

Those would be three of the top tests. Not to say I recommend all of those if someone is having a gut issue. Usually, I’ll start with one. Sometimes, I’ll do a stool test and a SIBO test. Sometimes, I’ll do a stool test and an organic acids test. Many times, I’ll just start with the GI Map, for example.

If you had to choose one test to determine whether someone has a leaky gut, which one would it be?

I don’t do a lot of leaky gut testing these days. I used to do a lot of leaky gut testing. My go-to test at the time was the Array #2 from Cyrex Labs. That’s their intestinal permeability test. It’s a blood test.

These days, I know a lot of practitioners recommend zonulin, which you can add to a GI Map, for example.

There is the classic test for evaluating whether someone has a leakygut test, which is the lactulose mannitol test, a urine test. If someone has higher lactulose levels, that typically indicates a leaky gut.

I don’t do a lot of leaky gut testing these days for a few reasons. One is it’s not telling us what’s causing the leaky gut.

Also, I found when I did the testing, most people had a leaky gut. Most people had positive findings. Additionally, if someone has a negative finding, I still would question is it really negative, or do they actually have a leaky gut? According to the triad of autoimmunity, if someone has Graves’ or Hashimoto’s, they should have that leaky gut component.

Now, unless someone really wants to do a leaky gut test, ultimately, it’s up to the person I’m working with. Most of the time, I’ll say let’s spend the money elsewhere. The test from Cyrex Labs is a couple of hundred dollars. If you add zonulin to a GI Map, it’s not as expensive, but it’s still an extra expense.

If zonulin is elevated, then the person probably has a leaky gut. If it’s negative, it doesn’t rule out a leaky gut. I do see a lot of negatives when people do zonulin, whether it’s through me or another practitioner.

If I had to choose one, it would still be the Array #2 from Cyrex Labs.

I have been experiencing a lot of bloating and gas recently. I did a GI Map, which didn’t show any parasites or anything significant. I have heard you say that stool testing is imperfect for parasites. In my situation, would you assume that there are parasites and treat them?

You’re experiencing bloating and gas. You did a GI Map. Parasites were negative. Nothing else showed up, or at least nothing significant. Stool testing is definitely not perfect for parasites.Similar to what I just mentioned for leaky gut testing. They’re not exactly the same.

If you test positive for parasites, you probably have parasites. If it’s negative, it could be a false negative. If someone tests negative for parasites, and they have bloating and gas, I am not automatically going to treat them for parasites. It depends.

Bloating and gas could be related to other conditions, like SIBO. Maybe we would do a SIBO test. Maybe we would have started with the SIBO test if they were having bloating and gas when eating foods higher in FODMAPs, like fermented foods, higher fiber foods.

I am not opposed to treating parasites. If we have done testing, and the person has eliminated certain foods, and they are still having gut issues, there is the possibility of parasites. It could also be something else as well.

In your situation, I wouldn’t necessarily jump to the parasite treatment. I would say maybe do a SIBO breath test. I understand it can get costly. I am more conservative with testing. I do like to test and try to find the answer rather than to guess. Every now and then, we do need to guess, if everything looks negative, and diet and lifestyle is not changing the gut symptoms. The tests aren’t perfect.

It is said that Crohn’s and thyroid disease are related. How do you start curing them? What would be the first step you would take?

I am assuming that this person was already diagnosed with Crohn’s, so you know you have Crohn’s.

The first step would be diet, having someone eat a healthy, clean diet. For those who have read my book The Hyperthyroid Healing Diet, I have three diets in there. Level 3 is a modified AIP diet. Level2 is a modified paleo diet, and level 1 is a modified Plant Paradox diet, which is by Dr. Steven Gundry.

In this situation, if it was Crohn’s or ulcerative colitis, which is another type of IBD, I would recommend, especially if someone had Crohn’s and Graves’, a level 3 diet, a type of AIP diet. Even a paleo-type diet is good and could greatly help.

I would start with diet and lifestyle. Diet is number one. Stress management and sleep, too. In this case, I would probably do some gut testing, maybe a comprehensive stool panel, unless the person was experiencing other symptoms that led me to believe they had SIBO or something else going on.

I commonly recommend prebiotics, probiotics for some conditions. Prebiotics can make things worse for SIBO sometimes. For Crohn’s, usually not, but everybody is different.

The first step would be to clean up the diet and focus on diet and lifestyle.

At what point do you stop usingbutane HCL with pepsin? How do you know if you need it any longer or not? My numbers are optimal, except for my TSI, which is now down to 187. I was and still am very strict with my diet. Making changes as you suggested in your thyroid diet book. When I stopped using it, there were nights where I felt like I had heartburn, according to people who have described it. Very uncomfortable when I bent over to pick things up. I went back on it, and all that stopped. Is it trial and error for going offof it? Is it something you stay on? Any issues with long-term use?

Ideally, you don’t want to be on it permanently. If someone had to be on it long-term, it’s fine. But you want to try to address the cause of the stomach acid. Chronic stress is a big factor when it comes to low stomach acid. Low thyroid, which is not the case with you, could also affect stomach acid. Sometimes, there are autoimmune conditions affecting stomach acid.

Ideally, you want to try to address the cause, so you can rely less and less on butane HCl with pepsin. It’s great that it’s helping with those digestive symptoms, but if you stop it, and those symptoms come back, that is suggesting that they still haven’t been resolved.

It is kind of trial and error over time, getting to the point where you need less and less. I don’t know how many you’re taking. If someone is taking more than one capsule per meal—you always want to take this with meals high in protein—then you reduce it gradually. Going from three capsules to two capsules and see how you feel. Gradually decrease until the point where you don’t need it. If you’re still experiencing symptoms, like you can’t get off it, it would still seem like there is something underlying that needs to be addressed.

I guess you could say it is kind of trial and error. There is not a great test to determine if you have low stomach acid. There is a butane HCl challenge, which means that when you have adequate stomach acid, you probably don’t need butane HCl. You might actually get heartburn by taking it.

That’s another sign, too. If someone is taking one capsule 2-3 times a day with meals high in protein, and they are feeling great, and then all of a sudden, they start feeling some heartburn when taking butane HCl, that’s a good sign. That means your body is starting to produce stomach acid on its own. That would be an indication you don’t need to take butane HCl.

What approach do you take when someone is dealing with a histamine intolerance?

I won’t go into great detail here for those who are not familiar with histamine intolerance. I do have some episodes on my podcast about this.

Histamine intolerance, the gut definitely plays a big role. Potentially do some gut testing. Maybe a GI Map or a SIBO breath test.

There is also some genetics behind it. There are certain enzymes associated with problems with histamine. The most well-known enzyme is DAO, diamine oxidase. Some people have genetic variations that might make it more challenging for them to break down histamine. Certain supplements like quercetin or a DAO supplement can sometimes help. Sometimes, I’ll do that in combination with a lower histamine diet.

If there is a lot of gut dysbiosis, which essentially are gut imbalances, we want to address the gut and do things to heal the gut. That can play a role in histamine intolerance.

Like I said, for more information, check out my podcast. I have at least one if not a couple of solo episodes on it. I also have some guest experts talking about histamine intolerance.

We have another parasite question. I kind of answered it, but it’s asked in a different way. I have heard we all have parasites. If this is true, does it make sense to do a parasite cleanse once or twice per year?

I am not a big fanof randomly treating parasites. I do like to test and see if someone has parasites. I have had people on the podcast just treat everybody for parasites, and I have had others who don’t treat everybody for parasites, which is the approach I take. I can’t say I treat every single person for parasites.

I don’t do a parasite cleanse once or twice a year. When I dealt with Graves’, I didn’t need to do a parasite cleanse in order to get into remission. Parasites in my opinion aren’t the trigger in all people. In some people, they definitely can be.

Even though testing is not perfect, I do like to test. If we do a test, and it’s positive for parasites, then we got that baseline. After a few months, ideally, we want to test.

Maybe we don’t have to test. If the person has Graves’, and their antibodies normalize, gradually decreasing and normalize, maybe we don’t need to retest. Let’s say the person has some GI symptoms, and they don’t resolve, maybe we want to retest, just to make sure the parasite is still there. Maybe the parasite is still there, and we need to treat it further. Or maybe it’s not there, and we need to do additional testing.

It could be a challenge. You might retest, and it might be gone. Is it gone because it’s really gone? Is it gone because it’s a false negative? We could go back and forth and say because of that, we should randomly treat. My approach is to test and see what we find.

The GI Map is looking at more than just parasites. There are companies like Parawellnessthat are specific for parasites. They don’t look at anything else.

I usually don’t recommend Parawellness right off the bat because I like a test that looks at other things, not just parasites. There have been times where we have done a GI Map and a SIBO test and other tests, and nothing is showing up.

I mention Parawellness, which I found out about from one of my podcast guests, Dr. Ami Kapadia, who spoke about different things related to the gut, including Parawellness. The company has been around for a while. I have used it on a few patients, and I think it does a better job of detecting parasites than many other stool tests. Again, that’s all it’s looking at.

Do you have any solutions for constipation? I move my bowels most days, not every day. I don’t feel like I’m fully evacuating.

I think I might have an episode on the podcast about constipation, but I’m not sure. If so, it’s probably a solo episode. I don’t know if I’ve interviewed anybody specifically to talk about constipation. On my other website, NaturalEndocrineSolutions.com, if you do a search for constipation, I have an article on chronic constipation.

You of course want to make sure of the basics. You’re eating healthy, staying well hydrated. Regular movement is important.

I have always been more sluggish in my bowel movements. I used to be constipated when I was in my 20s (I’m now 55). I was having two bowel movements per week, sometimes just one. Diet definitely has helped. Eating better. Staying hydrated.

But regular movement, doing a lot of walking also helps with gut motility. If someone is sitting all the time, and I do my fair share of sitting, but I also have the luxury of working remotely most of the time. I do have an office, but I usually work from my home office. I have a treadmill with the desk on it, so on my breaks, I will often be walking and working at the same time. I do get a lot of steps per day.

Also, SIBO, depending on the type, could cause diarrhea or constipation. If someone has methane dominant SIBO, that could lead to constipation. In some cases, we might want to do a SIBO test and see what that shows.

Those are some potential causes. Not to say with someone with hyperthyroidism can’t experience constipation, but if someone with hyperthyroidism is taking antithyroid medication, and that is slowing down their thyroid, that could cause constipation.

Ideally, you want to try to figure out the cause of the problem. There is a time and place for supplements. Magnesium is something a lot of people take. Magnesium citrate in this case before going to bed. Triphala is an herb that some people take that could be beneficial.

There is a time and place for supplementation, but you want to make some of the changes I mentioned. Make sure you’re eating well, staying well hydrated, regularly moving. If you have something underlying, such as SIBO, you want to address that.

I know that artificial sweeteners can disrupt the gut microbiome, but how about natural sweeteners, such as monk fruit and stevia?

Monk fruit, I don’t know of any studies showing that could disrupt the gut microbiome. I think monk fruit is okay.

Stevia, there is one older study showing that it can have a negative effect on Lactobacillus. I don’t consume stevia like I used to. I used to add stevia to my green tea and herbal teas. I can’t say I do that anymore. If there is stevia in a protein powder, I’m not nervous about it. There is not a lot of evidence of stevia having a negative impact on the gut microbiome.

It is a contraceptive. If someone is trying to get pregnant, they might not want to take anything that has stevia, especially adding stevia to anything. That’s something to keep in mind.

There is not a lot of strong evidence that it affects the gut microbiome. That being said, it’s not something that I regularly add. I don’t add at all these days; in the past, I did.

If it’s an ingredient in something, even that, I can’t say I regularly have powders and other things. These days, there is plenty of powders that are unflavored. If you’re a smoothie person like me, you can add berries to make it a little bit sweeter. You could also add monkfruit separately.

Again, there is definitely more evidence with artificial sweeteners having negative effects on the gut microbiome.

I know you prefer a natural approach for H-pylori. When do you think that taking antibiotics is a good idea? I know antibiotics also kill the good bacteria, but I have been working with a naturopath and still have H-pylori after treating it for three months.

It’s a catch-22. You’re right. The antibiotics can disrupt the gut microbiome, but it could take a lot longer to get rid of H-pylori treating it naturally through herbs or triple probiotic therapy. I had Dr. Nikolas Hedberg, who was one of my first guests on my podcast four years ago, who spoke about triple probiotic therapy for H-pylori.

It can be challenging to treat H-pylori naturally. That is what I still recommend. In this situation, you’re not asking about starting off with natural versus antibiotics. If someone has been following a protocol like you for a few months, and H-pylori is still present, is it time to make the switch to antibiotics? Should you continue with the natural approach?

Ultimately, it’s up to the person. Usually, what I do is recommend a two-month protocol for H-pylori and then retest. If it’s still there, it’s up to the person. But if the person is treating it for another two months, which I know is a long time, and it could be pricey with the supplements.

Again, Ireally would try to avoid antibiotics if at all possible. They don’t just use one antibiotic with H-pylori; they use two. It’s a quadruple therapy. Two antibiotics, a proton pump inhibitor, which is a triple therapy. Sometimes, I’ll add bismuth.

Ultimately, it’s your decision. I have had patients who took antibiotics. I have had patients who took antibiotics initially. They did not follow a natural protocol. They looked to eradicate it and rebuilt the gut microbiome.

The thing is, the antibiotics are more effective than the herbs, but they are not 100% effective. I have had people over the years take two antibiotics, and H-pylori is still there. That’s another dilemma. Do theydo another round of antibiotics, or do they switch to the natural method?

I will say the GI Map, one advantage there, if someone tests positive for H-pylori, they will tell you what antibiotics you’re resistant to. This way, you could show it to the prescribing doctor if you take antibiotics and make sure you’re not taking antibiotics you’re resistant to.

Does healing the gut help with TED?

Absolutely. Thyroid eye disease (TED), like Graves’, is an autoimmune condition. It’s where the immune system attacks the tissues of the eyes. Remember, a healthy gut is a healthy immune system. You still have to find and remove triggers. I’m not saying if all you do is heal the gut, it will resolve TED. If you have an unhealthy gut, and you have TED, you really do need to optimize the health of your gut.

I know that gluten can cause a leaky gut, but why are gluten-free grains excluded from your level 2 and level 3 diets? It would be nice to have some gluten-free bread once in a while.

A lot of people love their bread. When healing, I would try to avoid grains, just because even gluten-free grains can be harsh on the gut. Ultimately, it’s up to the person.

My level 1 diet, I do allow a small amount of grains. Even then, I ideally say avoid grains. Certain grains, like white basmati rice, is one of the few grains that are allowed on that diet. It’s a modified Plant Paradox diet.

There is a bread called paca, which I have only seen at Whole Foods. Other places might have it. They have a bread that is organic, gluten-free sourdough. The two ingredients are buckwheat and sea salt. If someone is going to insists on eating bread, I’d say probably to eat that. Again, ideally, I would say avoid bread while healing.

The reason is they still also are harsh on the gut. That’s why they’re excluded, not just from level 2 or level 3, but regular AIP and paleo diets. The level 2 and 3 diets aren’t completely made up by me. They’re modifications of AIP and paleo, which already exclude all grains, including gluten-free grains.

When should someone choose to see a gastroenterologist for their gut instead of a functional medicine doctor? Are there any conventional GI doctors that also recommend functional medicine testing?

I’m sure there are conventional gastroenterologists who recommend functional medicine testing. I don’t know if they would be able to say they are conventional if they recommend functional medicine testing. They are medical doctors, and maybe they also went through Institute for Functional Medicine certification, so they combine conventional and alternative treatments.

I mean, as far as when should you see a gastroenterologist instead of a functional medicine doctor, usually, I’m going to recommend starting with diet and lifestyle changes. If those aren’t improving the gut, and a lot of people, when they work with me, they have already done things with diet already.

Usually, when you go to a GI doctor, you will get an endoscopy and a colonoscopy. There are times and places for those, but they are invasive. I’d rather someone do a comprehensive stool test or an organic acids test if they need a SIBO breath test, do that. Unfortunately, most GIs don’t do those tests. Some GIs will do SIBO breath testing, but not all of them.

Try to do things naturally. Ultimately, it’s up to the person. In my Healthy Gut, Healthy Thyroid newsletter, I have an article where I focus on colonoscopies. I talk a little bit about endoscopies, too. There is a time and place for them, but usually, I would recommend a more conservative approach first. Ultimately, it’s up to the person.

The final emailed question, and then I will look for any live questions related to the gut and thyroid: Can mold have a negative effect on the gut?

Yes. You can have mold colonize the gut. Remember, mold is a fungus, just like yeast. There is not a great test for this, but organic acids testing looks at some mold markers. That would be the test that I would look at.

If it’s negative, it doesn’t necessarily rule out mold colonization of the gut. If certain markers are positive on an organic acids test, especially the one from Mosaic. There are other ones, like Genovva has an Organics test, which is their organic acids test. Nutroval has some organic acid markers. In this case, if we’re looking at mold colonizing the gut, I would rely on the organic acids test from Mosaic Diagnostics.

Beyond butter, are there any other ways or foods to consume to help with butyrate or produce it?

Fiber-rich foods are going to help you produce butyrate. If you’re following a level 3 diet, then fiber-rich vegetables, cruciferous vegetables for example, asparagus. There are butyrate supplements as well. I would say try to do as much as you can through food sources.

What would be driving almost zero zinc in my system?

I’m answering this because she says she has ulcerative colitis, which of course relates to the gut, for 26 years and Graves’ for four months.

The ulcerative colitis definitely could affect digestion and absorption. You need healthy stomach acid levels for the breakdown of minerals. Maybe it’s related to the ulcerative colitis. Maybe it’s related to minerals. I’m not sure if you also tested for H-pylori, which suppresses stomach acid. Not just zinc, but it could cause deficiencies in other minerals.

You mentioned almost zero zinc. You might also want to do other tests. I don’t know if you just did a serum zinc. There is also RBC zinc, red blood cell zinc, which is more intracellular. That is another option, to do a different type of zinc test.

Can you make a stream devoted to heart palpitations?

Maybe. I don’t know how much interest there will be. How many questions there would be just on heart palpitations. The reason why I came up with a separate Q&A on bugleweed is there are so many questions I receive all the time about bugleweed. What should I take? How much should I take? How long should I take it? What if it doesn’t work?

With antibodies and the gut, there are also so many questions. With heart palpitations, I don’t know if I could have a whole Q&A session.

This is all to celebrate the release of my Healing Graves’ newsletter. Last week, I did a general Q&A to kick things off. Then I decided to have a couple of themed Q&As, which I could also use as future podcast episodes. I can’t say I will do these regularly on Substack, but there may be an opportunity for one more general Q&A, where people could ask about copper and heart palpitations, etc. Then I will probably take a break from these for a little bit.

How do you increase stomach acid?

It depends on the cause of the stomach acid. Someone said they are taking butane HCl. You could take bitter herbs. Those are options.

Do you have chronic stress? Chronic stress is a big factor when it comes to low stomach acid. H-pylori can cause low stomach acid. If someone has Hashimoto’s, or someone with hyperthyroidism taking antithyroid medication, because low thyroid can cause low stomach acid. Autoimmune conditions can affect parietal cells; that is a completely different issue.

If it’s due to chronic stress or H-pylori, we want to address the stress. We won’t completely eliminate the stress, but try to minimize stressors by improving our perception of stress and blocking out time on a daily basis for stress management.

Improving health of the parasympathetic nervous system, maybe doing some Vagus nerve exercises such as vigorous gargling, humming, singing out loud, taking cold showers or doing cold plunges.

If someone has H-pylori, you want to test for that first to see if you have it. If you do, follow a natural protocol, or like I said earlier when someone asked a question about this, there is a time and place for antibiotics.

Could dandelion tea or extract help with gut health?

Maybe. It’s more for liver support. There is a connection between liver and gut. I really like herbal teas. I can’t say dandelion is my favorite herbal tea tastewise, but from a health perspective, it’s really good. It won’t hurt for gut health.

I would choose ginger tea over dandelion tea to benefit gut health.

We can kind of relate this to the gut: Are there any nuts and seeds you recommend for hyperthyroid healing?

I don’t know if you know my story, but when I dealt with Graves’, I was eating more of a paleo diet. Back in 2008, there wasn’t an AIP-type diet. I hit a roadblock in my recovery. There is a marker, secretory IgA, which lines the mucosal surfaces of the body, including the GI tract. That was on the saliva test I did.

My adrenals were low, my cortisol was low, my DHEA was low, and my secretory IgA was low. I was working on improving my adrenal health, and I did a retest. My cortisol, DHEA, and adrenal levels were better, but my secretory IgA was still depressed.

I was eating mainly nuts. I forget, it’s been so long, but I don’t know if I was eating seeds. I was eating almonds and cashews, etc. I took a break from nuts for a few months and retested secretory IgA, and it was normal. They are excluded from AIP because nuts and seeds can be harsh on the gut.

In the book The Plant Paradox, Dr. Steven Gundry talks about certain nuts and seeds that are more gut friendly. Of course, properly preparing them, like soaking, sprouting them will help.

Almonds and cashews are two of the harsher nuts. Those are two of the main ones I was eating, especially cashews, because I love them. Walnuts, pecans, pistachios, macadamia nuts seem to be more friendly and less harsh on the gut. I don’t know if they will assist with hyperthyroid healing directly.

If I were to go back in time to 2008, maybe if I ate those nuts, everything would have been okay. I can’t say 100% that was what caused the secretory IgA to increase, but that is the only change I made. It could have been a coincidence.

If you haven’t read my book The Hyperthyroid Healing Diet, it’s really comprehensive.

I think that’s it with questions. Thank you so much for your support. For those listening to the podcast in the future, thanks as usual for subscribing to the podcast.

In this episode, Dr. Eric Osansky talks with returning guest Dr. Izabella Wentz about her new book, IBS: Finding and Treating the Root Cause of Irritable Bowel Syndrome. Drawing from both personal experience and clinical insight, Dr. Wentz explains why IBS is often more than just a stress-related diagnosis and how it can serve as an early warning sign of deeper imbalances, including thyroid autoimmunity.

The conversation explores the difference between IBS and inflammatory bowel disease, why some people diagnosed with IBS may actually have celiac disease or IBD, and the many possible root causes behind chronic digestive symptoms. Dr. Wentz discusses food reactions, SIBO, parasites, H. pylori, medications, nutrient deficiencies, thyroid hormone imbalances, stress, and lifestyle factors that can all play a role in gut dysfunction. She also shares why testing matters, why symptom relief is not the same as true resolution, and why approaches like the low FODMAP diet may only be a short-term tool.

This episode gives listeners a broader, more practical understanding of how gut issues connect with immune dysregulation and thyroid health. If you want a clearer, more balanced understanding of IBS, IBD, and what these digestive symptoms may really be telling you, you’ll get a lot out of this episode.

Click Here to listen to this on the Save My Thyroid podcast

Dr. Eric Osansky:

I am super excited to chat with return guest, Dr. Izabella Wentz. This time, we are going to be talking about irritable bowel syndrome (IBS). She has a new book IBS: Finding and Treating the Root Cause of Irritable Bowel Syndrome. Really excited to chat about this.

Let’s first dive into Dr. Izabella’s bio here: Dr. Izabella Wentz is a compassionate, innovative, solution-focused, integrative pharmacist dedicated to finding the root causes of chronic health conditions. Her passion stems from her own diagnosis of IBS as well as Hashimoto’s thyroiditis.

Beyond her beautiful children, her most proud accomplishment is creating a road map that has helped thousands of people get into remission via her New York Times’ bestselling books Hashimoto’s Root Cause and Hashimoto’s Protocol.

She is hoping now to help broaden the understanding of getting IBS as well as IBD (inflammatory bowel disease) into remission with her newest book IBS: Finding and Treating the Root Cause of Irritable Bowel Syndrome.

Thank you for joining us, Dr Izabella.

Dr. IzabellaWentz:

Hi, Dr. Eric. It’s so great to be here with you again. I always love collaborating with you.

Dr. Eric:

Same here. This is going to be exciting, talking to you about IBS. As I mentioned in the bio, you’re really well-known for your books on Hashimoto’s. You also wrote a book talking about your adrenals. Why did you decide to write a book specifically on IBS?

Dr. Izabella:

It sounds kind of odd. My branding has been the Thyroid Pharmacist for so long. Thyroid, IBS, what is the connection there?

I’ll start with saying there is a personal connection for me. When I was in pharmacy school, one day, I was studying for an exam. I had two exams every week and was up really late at night, eating ramen noodles with god knows what, studying.

I woke up in the middle of the night with really awful digestive symptoms, to the point where I couldn’t even go to school that day, and I had to miss my exam. My lovely teacher said I needed to get a doctor’s note, so I went into my physician’s office, my primary care doctor, and he said, “You have IBS. This happens when you’re stressed out. You’re in pharmacy school. This is a really high curriculum.”

I had 40 hours of classes every week, and I had two exams every week. It was a pretty intensive process the first three years of pharmacy school. The last year was more clinical.

I had constant issues with having to run out of my classroom and into the bathroom. I had to carry an extra set of pants with me. It was a rough time.

That was really a big turning point in my health. With time, I ended up with additional symptoms. What started off as IBS ended up turning into anxiety. Then I had hair loss and so on and so forth.

What’s really been interesting to me is when I went through functional medicine training, IBS oftentimes precedes an autoimmune diagnosis. This was certainly the case in me. This IBS condition can actually lead us to have a dysregulated immune system. People end up with so many different conditions, where the gut is going to be at the root.

I decided to write this new book because my hope is to reach people before they get that autoimmune diagnosis. Maybe in the early stages of their autoimmune diagnosis. Many of my clients in the early stages of their autoimmune diagnosis had IBS, and we focused on getting the IBS into remission. Lo and behold, a lot of their other conditions went away.

It’s a really deep dive on gut health and all of the drivers, food sensitivities and beyond. SIBO and stress. This all can lead a person to have IBS.

Dr. Eric:

You were diagnosed with IBS prior to Hashimoto’s. How long after your IBS diagnosis were you diagnosed with Hashimoto’s?

Dr. Izabella:

Let’s see. My IBS diagnosis was in 2002-2003. The Hashimoto’s was around 2009.

Dr. Eric:

You probably had it underlying for a while before the diagnosis, I would imagine.

Dr. Izabella:

Right. When I first started working on getting Hashimoto’s into remission, I went gluten-free and dairy-free, which was part of my root cause presentation, not the only issues that were going on, but certainly getting off of those foods helped. I remember thinking, wow, it’s not supposed to hurt when you eat food? This whole time, every time I would eat food, I would be in pain. I thought that was just the normal digestive process, where you eat something and are in pain.

I also didn’t realize that I had abs. I had been going to work out. I was a big gym person, where I would go to work out. I always wanted to get a six pack, but I couldn’t. All of a sudden, I got off of those foods. Wow, where did my abs come from? I was constantly bloated. I didn’t realize that wasn’t normal.

Dr. Eric:

How common is IBS? I don’t know if you know any statistics.

Dr. Izabella:

Yes, actually. IBS accounts for 12% of visits to primary care physicians. It’s one of the most common functional digestive disorders affecting 25-45 million people just in the United States.

Dr. Eric:

Wow. 25-45 million?

Dr. Izabella:

25-45 million. That’s a lot of people.

Dr. Eric:

Yeah. How is it typically diagnosed? You probably start out with your primary care doctor. Maybe you go to a gastroenterologist. What do they use to diagnose IBS?

Dr. Izabella:

A lot of times, people think of it as a diagnosis of exclusion, which means we would do a bunch of different tests. You would test negative for everything. But that’s not what happens.

It’s a clinical diagnosis, where essentially, the physician takes a person’s medical history, self-reported clinical symptoms, and potentially, they might look at their current medications to provide that diagnosis.

When I look at the statistics of how many people get the diagnosis of IBS when they actually have Celiac or IBD, that is just wrong. Anywhere from 10-25% of people who have the IBS label might actually have one of these other conditions. There are conventionally available lab tests and diagnostics that can be done with a gastroenterologist. Most people do get their diagnosis from a primary care doc, not necessarily a gastroenterologist.

Dr. Eric:

Are you saying that it does happen where someone might be diagnosed with IBS, but they really have Celiac or IBD?

Dr. Izabella:

Yeah. In one study, 25% of people diagnosed with IBS actually had Celiac.

Dr. Eric:

Oh wow.

Dr. Izabella:

10% of people with IBD are misdiagnosed with IBS. I met people who thought they had IBS.

I remember I had this lovely woman who I met who was a professional surrogate. I was pregnant with my first child at the time. I was like, “Man, I would not do this professionally. Bless you for doing that,” giving people this wonderful gift. At the same time, I feel so terrible when I’m pregnant. “You must be one of those women who feels better when she’s pregnant.” “Absolutely, I have this horrific IBS normally, but when I get pregnant, it goes into remission.” I was like, “Oh, you know, actually that might be IBD.”

We do know that certain autoimmune conditions, IBD being one of them, can go into remission. Sure enough, she found out later she had IBD. For 10-15 years, she was told it was just IBS. Just IBS, right? Getting that proper diagnosis allowed her to get proper care.

Dr. Eric:

We were chatting before this, and you mention this in the book, too. Your husband has a history of IBD? Ulcerative colitis. Was he diagnosed relatively quickly, based on your experience with IBS? Did he get his ulcerative colitis diagnosed quick, or was it a drawn-out process?

Dr. Izabella:

Thanks for asking. It was during the time I was pregnant with our son. He just started to have some really odd symptoms. A lot of them were pain and some irritability, insomnia, some bloating. When I started going into labor, he was having some bleeding. I thought it was probably sympathy pain. “I’m busy. I can’t help you.” That didn’t resolve. We thought maybe he had hemorrhoids or something, but within two weeks of our son being born, we were like, something’s going on. Our primary care doctor said it was a red flag.

We were very fortunate to have a functional medicine doctor. This was after I had already had my healing journey and had functional medicine training. We weren’t going to see a regular primary care doctor who is too busy to talk to us. This wonderful doctor recommended my husband get a colonoscopy right away, and that revealed an ulcerative colitis diagnosis.

We were fortunate to catch it quickly, and we were also fortunate to be living in Boulder, where three of my dear friends were IBD and gut health experts. Having gone to an IFM training during my pregnancy on gut health, we developed a plan for him, and we got him into remission from IBD rather quickly, within a couple of months.

He did have a couple of flareups throughout that first year. We were able to dial everything in to really figure out what his triggers were.

The title of my book is “Finding and Removing the Root Cause of IBS.” There is an entire chapter on IBD and exactly what you need to do to get that into remission. Crohn’s, ulcerative colitis, microscopic colitis, those are all examples of IBD.

Chances are, if you’ve been told you have IBS, you actually have IBD. I want to make sure you have the proper road map for how to heal that. That will be different from treating IBS, whether you’re considering a conventional lens or a functional lens.

Dr. Eric:

With IBD, we’ll talk more about IBS, but wrapping up with IBD. Ulcerative colitis, Crohn’s, those are considered to be autoimmune conditions?

Dr. Izabella:

They are considered to be autoimmune conditions, but there is some controversy about that. To the best of my knowledge, I would consider them autoimmune conditions.

Dr. Eric:

Okay. I’ve seen both. Some say they are, and some say they aren’t. I wanted to get your opinion.

Dr. Izabella:

I’ve seen arguments for both sides, but I’m maybe going to say it’s autoimmune until I have other evidence. It is classified as an autoimmune condition as far as I know.

Dr. Eric:

How about IBS? Is there any relationship between IBS- You said earlier. There is that gut relationship. You could go anywhere you want with this question, but can you expand on what you mentioned earlier? There is the leaky gut component, that increase in intestinal permeability, the relationship between that and autoimmunity. I assume a lot of people with both IBS and IBD have that increased intestinal permeability.

We know with IBD, if you have one autoimmune condition, you’re at greater risk of developing another. With IBS, it seemed like it was. You developed IBS, and six years later, you had a Hashimoto’s diagnosis. Withclients, have you seen that also? With clients with IBS, or maybe not your clients, because you address the root cause.

Overall, the point is, if someone has IBS, it seems like they’re more susceptible to developing Hashimoto’s, Graves’, or a different autoimmune condition, correct?

Dr. Izabella:

Absolutely. They’re more likely to develop IBD or anxiety as well. There is a school of thought that believes certain cases of IBS are autoimmune. There is an inflammatory component.

In my client experience, looking at people’s histories, I do see that. They were diagnosed with IBS, and they were diagnosed with an autoimmune condition five, 10, 15 years down the road. There is this clear connection in many cases. Other times, there isn’t.

In my experience, every case of autoimmunity has three things that need to manifest in order for it to happen. That’s going to be the genetic predisposition, some kind of a trigger, as well as that intestinal permeability/leaky gut component.

What are the symptoms of intestinal permeability/leaky gut? We do know that some people might be asymptomatic. They might not have any symptoms.

For others, the symptoms might be IBS symptoms, diarrhea, constipation, bloating, pain with defecation, so on and so forth. There is going to be a large percentage of people with IBS, specifically diarrhea-predominant IBS, who also will have intestinal permeability when they are tested for it.

I’m not going to say that every case of IBS is going to turn into autoimmunity. That certainly would not be the truth. I wouldn’t be able to prove that. But there is a large percentage of people with IBS where I feel like the IBS is the message that lets us know that they have intestinal permeability, and that can lead to those holes in our gut that can lead to autoimmunity.

Dr. Eric:

You had IBS-D, it sounded like. Do you find it more difficult to treat IBS with constipation, IBS-C, compared to IBS-D?

Dr. Izabella:

I feel like there needs to be a different approach sometimes. In people with hypothyroidism, we really do need to focus on their thyroid hormone because just a little bit of hypothyroidism can cause that constipation, right? A lot of times, we are modifying things and thinking about slightly different approaches when we are treating-

My approach to health and healing is always there is this root cause approach underlying things you need to fix. There are also some symptom management tools that we need to consider for people.

For example, one of my big go-tos for constipation is going to be magnesium citrate. It is awonderful form of magnesium for constipation, not so good for diarrhea, because it does act as a gentle laxative. This might be a good starting point for a person.

If they have constipation, I might also be thinking of carnitine or thymine as potential muscle tone stimulants to help with peristalsis.

You can’t necessarily use the same bag of tricks for every kind of person with IBS. Certainly not with every symptom presentation of IBS.

My book is divided into different root causes and also symptom solutions. I actually cover acid reflux, diarrhea, and constipation, as well as bloating. Those are just so common in people with IBS.

Dr. Eric:

What are some of the IBS root causes? You mentioned food sensitivities. I’d love to have you talk about SIBO. I’ll let you take over. What are some of the things you mentioned in your book when it comes to the root causes of IBS?

Dr. Izabella:

One thing I’ll mention is there was a study done in 2011 with 303 people with. The doctor found that 98% of the time, they had treatable causes for their IBS. Some of the more common causes he found were Celiac and bile acid malabsorption. These were very common drivers.

In my experience, and from some of the research out there and the things I’ve seen personally, I could categorize it as essentially an umbrella term, where you have a label, and then you have various root causes that could be driving to those same symptoms.

Things like medications. Being a pharmacist. If somebody is on opiates, there’s a good chance they will be constipated. Imodium is an opiate derivative, and we know that is used for diarrhea and slows things down.

Birth control pills containing drospirenone as a progestin. Some of the common brand names were Yas or Yasmin. These have been found to induce IBS.

When I was in pharmacy school, if there was an exam question about what kind of side effect this medication causes, the correct answer was always digestive issues. If I didn’t know the answer, and I see digestive issues, that’s the one I’m going to pick. When in doubt, medications can really harm your gut.

Alterations instress hormone. Alterations in thyroid hormone. Digestive enzyme deficiencies, such as pancreatic enzyme deficiency. These can really lead to issues with fat digestion.

We talked about SIBO. There is also SIFO, small intestinal fungal overgrowth. Sometimes, mold can be a trigger for IBD. Toxins and chemical triggers.

Western lifestyle. Stress, alcohol use, dehydration, poor bowel habits. Not getting enough walking into your daily rhythm. I used to have this wonderful little dog. Whenever he was constipated, we would take him on a walk, and he always pooped. Same goes for humans. We have to move our hustles.

Nutrient depletions. Zinc and glutamine are two big ones when it comes to diarrhea. I mentioned carnitine, thymine, magnesium as some of the ones relevant to constipation.

Celiac is a biggie. That always needs to be considered. There are a ton of other food reactions, whether that includes high nickel foods, lactose intolerance, fructose intolerance, sucrose intolerance, alcohol, caffeine, carbonated beverages. For some people, artificial sweeteners can be really triggering for them. Some of them actually, when you eat them in high enough doses, they become osmotic laxatives, where they can cause gut irritation.

One thing that not a lot of people talk about, which I love talking about, is parasitic infections, bacterial infections, viral infections. Any kind of infection that can impact our gut wall can be potent producers of IBS and autoimmunity as well.

Dr. Eric:

A lot of potential causes, you’re right. As you know, I focus more on hyperthyroidism and Graves’. Just doing the research on antithyroid medications such as methimazole and PTU, seeing the impact that those have on the gut microbiome and the barrier. There are a lot of things. Antibiotics and PPIs, many people are aware of those. There are so many other medications that have a negative impact on the gut that we wouldn’t think of.

Dr. Izabella:

Yeah, absolutely. I advocate for anybody who is having digestive issues to do a medication review with their pharmacist to see if they have a medication that might be contributing. NSAIDs, aspirin. Metformin can be a really big driver of bile acid malabsorption and diarrhea. Various antibiotics. Sometimes, if people are overdoing it on magnesium, they can have some diarrhea. It’s a lot. We want to make sure we consider these things.

For the elderly population, that struggle with constipation, there are some medications like anticholinergics, antihypertensives, calcium channel blockers. These are all medications that I would really want to evaluate if somebody is struggling with constipation.

Dr. Eric:

Makes sense. Do you in your book talk more about not just the root causes but how people can further identify them? You mentioned that you might have to put together a medication list and run it by your doctor. When it comes to some of these other causes, there are so many that you mentioned. Does the book give some guidance on how to find and eventually eliminate some of those triggers?

Dr. Izabella:

I go through essentially the different potential triggers that a person can have. I give people a bit of a plan on what to do.

A great place to start would be eliminating foods. There are a lot of different food drivers for IBS. An elimination diet can be really helpful for determining that.

Really focusing in on your digestion next. What I mean by that is utilizing your parasympathetic rest and digest state. Potentially, not running around and eating at the same time. You want to get into that relaxation mode. Take some deep breaths. Saysome gratitude for your food. Chew your food properly to get those digestive juices going. You might want to consider some herbal bitters or digestive enzymes. That is probably the place I would start for most people.

If you don’t have symptom resolution, or if you have an autoimmune condition, or you really want to do your due diligence, we do talk about different lab tests people can do and things to ask their gastro doctor to do. We do come at it from an integrative approach. Me and the mouse in my pocket. I don’t know why I keep saying “we.” I do come at it from an integrative approach, where I talk about what things to discuss with your gastroenterologist and the testing to do as well as what are some functional medicine approaches.

I’m a proponent of test rather than guess, especially if you’ve been sick for a while. I know there are wonderful parasite cleanses on the market. You have to consider that I’m going to give you a symptom list with a high likelihood that you will have parasites or SIBO, but you still want to test for that. You don’t want to assume.

With parasites, there are different ones out there that could be causing digestive issues. Some of the herbs might only work for one. Medications might only work for one. If you have a different one, then you’ve taken a bunch of herbs and medications, and that guy is still alive and well and causing issues in your digestive tract if you don’t know what you got.

Dr. Eric:

Agreed. I am a big proponent of testing. Iadmit that tests aren’t perfect. I’ve had different people on the podcast who treat people for parasites without testing. There are others who do the testing.

I’m definitely in that category where even though the tests aren’t perfect, I like to test to see if we can find the problem. If you do a comprehensive stool test, you find the parasites, now you know how to treat them. You also have a baseline finding, so you can do a retest in the future to make sure it’s gone. You could also try to go by symptoms. Sometimes, you can’t go by symptoms.

Same thing with SIBO. It’s great to test. If it’s positive, maybe the person’s 80% better. Maybe you just keep on going with the treatment for a little while longer. Eventually, you want to do a retest and see if it’s negative.

The person I learned this from Allison Seebecker, who focuses on SIBO. She mentioned that even if someone is having symptoms, let’s say a couple of months of following a SIBO protocol, and they’re experiencing symptoms. If they’re 80% better, you don’t want to assume that the SIBO is still there, causing the remaining 20% of the symptoms. Maybe there is something else.

You might do a follow-up SIBO test. Maybe it’s still present, so you want to continue with the treatment or make some tweaks to the treatment. If the SIBO is not an issue, maybe someone has SIBO and a parasite. The SIBO has been resolved but not the parasite.

We’re on the same page as far as testing. If you do a bunch of testing, and you’re not getting answers, but you’re strongly suspecting there might be a parasite, I am not completely opposed to treating. I definitely prefer testing whenever possible.

Dr. Izabella:

I’m in agreement with that. The thing about SIBO is people sometimes think they take the herbs or the medications or the Elemental Diet, and it will be gone. The thing about SIBO is it islike a relative overgrowth. You want zero things growing.

You want to have a bald head. If you have long hair, and you took some herbs, you got a haircut. It’s still there. Maybe you took another set of herbs or medications. Now your hair is shorter. But you want to make sure that you fully shave down that SIBO. Testing will help us determine that, versus just assuming if it’s gone, even if you’re asymptomatic. That’s my two cents on that.

I have a chapter on SIBO in here. I do talk about, just like you mentioned, you want to make sure you rule out what’s upstream or downstream. If you have parasites, that could be opening up your valve, which could be causing bacteria from your intestines to come into your small intestine. We don’t want that. If you have H-pylori in your stomach, that can lead to an overgrowth of SIBO as well. The bacteria are not getting neutralized when they’re going down.

They often talk about SIBO treatment failures or SIBO as a root cause. It can be a secondary issue because someone might have another issue. Hypothyroidism is one example. If you have an underactive thyroid, your motility will be slow. Then you will be more likely to grow your hair, grow your SIBO. Not your real hair, but more likely to grow bacteria in that small intestine.

Dr. Eric:

How does that differ from a conventional approach? The conventional approach, they are not going to do testing for parasites. Some will test for SIBO. I don’t find it to be common. Elimination diets, usually not. What have you seen as far as the conventional standpoint when someone first goes to their medical doctor or GI doctor?

Dr. Izabella:

Only about 13% of IBS patients ever see a gastroenterologist. The history of how the IBS diagnosis came to be is back in the day, they were actually using lab tests to figure out if someone had IBS. All the labs came back normal. I think all of us in the thyroid space have heard that before. “My labs were normal.”

Here’s the thing. If you’re using the wrong labs, of course they will be normal. When you actually are using the correct, more advanced diagnostics, you can find these things. In this day and age, we have really advanced stool testing that we can utilize. We have advanced SIBO testing that we can utilize. These things weren’t around 30, 40, 50 years ago. Now, we can utilize this testing to figure out what a driving factor is.

Then we also have a lot more research about some of the lifestyle factors. We can really tailor that to a person.

As far as diagnostic tests, there are some red flag symptoms that would suggest more diagnostic workups. If someone, let’s say, has bright red blood in their stool or dark blood intheir stool, if they had weight loss, if their onset of IBS symptoms was after the age of 50, any kind of fever, so on and so forth, it’s recommended that the person get screened for IBD, bacterial infections, parasitic infections, etc.

Interestingly, one particular study found that 0% of IBS patients received those tests to rule things out. I don’t know everybody’s experience with IBS. I know my experience was a long time ago, and it was not super helpful. The doctor I saw was very compassionate and a lovely man, but he just gave me some medications. Those medications gave me blurry vision and constipation, which I was happy to have constipation for a change. At the same time, that didn’t really treat what was the underlying issue for me.

Dr. Eric:

Would you say now that your IBS is completely resolved, you’re not having any of those, hopefully not the urgent diarrhea, but no bloating, no gas, nothing that indicates that you have IBS?

Dr. Izabella:

I actually was able to get that into remission before I got Hashimoto’s into remission. It was much easier to get that into remission. I’m not bloated anymore. I don’t have abnormal GI. I have normal digestion. It feels amazing to eat food and not get a stomachache from it and not be bloated from most foods and not have to run to the bathroom and not have to plan my life around bathroom trips.

Dr. Eric:

For someone who is listening to this, and they’re thinking, “Maybe I have IBS. I’m not sure. Maybe I have IBD,” you mentioned approximately 13% of people with IBS end up going to a gastroenterologist. What is the next step?

If they are having symptoms that make them think they might have IBS or something different like IBD, should they go see a functional medicine practitioner? Obviously, read your books. That is probably the #1 thing. But in addition to reading the book, should they be thinking about functional medicine? Should they start with the book and see how they feel before actually scheduling an appointment with a functional medicine doctor? Go through the book, follow the elimination diet, make some of these other changes, and see if that causes change before seeing someone and doing some of the testing that we recommended? Would you say a combination of both?

Dr. Izabella:

I’m a big proponent of education, but education doesn’t replace medical guidance and supervision of course. This book is meant to be a guide for patients and for practitioners on the different causes and triggers and healing protocols for all the causes of IBS. I think this is a really great starting point for people to educate themselves.

I don’t know about you, but typically, the people who I personally work with or have worked with already have an IBS diagnosis or IBD diagnosis. They have gone down the rabbit hole of going to a gastroenterologist and primary care doctor. You definitely want to do that.

If you haven’t gone to a primary care doctor with your symptoms, you need to. If you haven’t gone to a gastroenterologist with your symptoms, you should. There is a list of labs that you can do to rule out things like cancer. You can have diarrhea from colon cancer. This is a very serious condition. Obviously, the approach will be way different than eliminating a few foods and not drinking coffee. This is always a good first step for everybody if they haven’t had that.

If you already have gotten the clearance from a gastroenterologist, and they don’t know what to do next, and you’re still not better, I would say- In one study actually, less than 25% of people with an IBS diagnosis got better with the conventional approach. Most of them continue to have symptoms.

If you’re someone who continues to have symptoms, working with a functional medicine practitioner is going to be really helpful. I hate to say this, but not all of them are created equally.I feel like in my line of work, some of the people I have worked with want to be healed, and they want to just surrender and have somebody heal them. It does take you being your own advocate and you speaking up for yourself.

Some of your practitioners might not even know about some of the root causes I have shared in this book. When you have this book and a wonderful practitioner working in synergy, and a patient advocating for themselves with a really educated practitioner, that is where I see the magic happening.

Dr. Eric:

Maybe in some cases, it makes sense to get your practitioner one of these books, too. They will be up to speed with some of the triggers. You’re right. There are some functional medicine practitioners who aren’t as familiar with IBS.

Anything else that I should have asked you that I didn’t ask you? Anything else you wanted to chat about, whether it’s something else in your book that we didn’t cover yet or anything else?

Dr. Izabella:

Hmm. Maybe some surprising foods that can cause IBS symptoms?

Dr. Eric:

Yeah, let’s go for it.

Dr. Izabella:

Gluten and dairy are some of the more common foods that can cause IBS symptoms. Also, raw lettuce and blueberries are very common triggers of IBS. Sometimes, high fiber foods can be a trigger. For some people, it’s fatty foods if they have a pancreatic enzyme deficiency.

In my literature review, and working with some clients, I have been really concerned about the widespread use of food additives and artificial sweeteners. So many of them can actually cause IBS symptoms.

Dr. Eric:

Blueberries? Lettuce, too. Especially the blueberries. That potentially could be a surprising food that causes some IBS symptoms.

Dr. Izabella:

A lot of raw foods, yeah.

Dr. Eric:

Do you talk in the book about some of the different- A low FODMAP diet is pretty popular when it comes to SIBO. I don’t know if you cover that in your book.

Dr. Izabella:

I do. To be honest, I am not a fan of the low FODMAP diet. I think it can be a helpful band-aid in the short term, but I have seen people on this diet forever. When you have SIBO, you have bacteria in the small intestine that feed off of certain foods, like FODMAP foods. You’re not giving them the food that they feed off of that causes you symptoms, but it doesn’t eradicate the bacteria. You’re basically just keeping them quiet at that point. Then it can lower your gut diversity, too.

I’m not a big proponent of it. Of course, if it helps your symptoms, then you could utilize that diet.

Also, the elephant in the room and the root cause is all those bacteria in your small intestine, you need to get rid of them, some kind of antimicrobial. The one diet that does actually starve them is the Elemental Diet. You could consider doing something like that if you are passionate about a dietary approach. The low FODMAP diet won’t do anything to get rid of your problem.

Dr. Eric:

Like you said, you don’t want to follow it long-term because there are concerns about the negative impact that it will have on the gut microbiome.

The Elemental Diet actually is treating it. With the Elemental Diet, it’s 2-3 weeks that you follow it. In some cases, maybe a little longer. But it’s not like they’re following it for three months. But low FODMAP is not a treatment. It might just make you feel better, if that.

Dr. Izabella:

Some people don’t feel that much better with it. It’s so popular, but there are other things that work better.

Dr. Eric:

This has been an excellent conversation. I’m sure my listeners have learned a lot about IBS and IBD. I didn’t expect to talk as much as we did about IBD. That is really common as well. Like you said, some people get misdiagnosed, so it’s good to understand the differences between them.

I agree with you. If you’re in the beginning of this, as far as seeing a gastroenterologist just to rule out some things if you’re not sure. Sometimes, it could be something bad. Most of the time, it won’t be colon cancer, but it could be. If it is something like that, you would want to get that diagnosed.

Where can people find out more about you? I assume they can get the book on Amazon. For those who are not familiar with you, your website, your podcast, anything else you’d like to share.

Dr. Izabella:

My website is ThyroidPharmacist.com. I am on Instagram, @IzabellaWentzPharmD. On Facebook. I have a YouTube channel I just started. People can watch my podcast and listen to it. It’s called Thyroid Pharmacist Healing Conversations. We had Dr. Eric on there recently. You can check out our interview.

The book can be found on Amazon, Barnes & Noble, wherever books are sold. I do have some preorder bonuses. If you go to ThyroidPharmacist.com/IBS, you will be able to get linked up to that.

Dr. Eric:

This was a great conversation. Excited about the book. I know it will help so many people, just like your other books. Thank you so much for doing this. We will have you back in the future. It seems like every year, you’re writing a new one. I have a feeling this won’t be your last one. We’ll have to have you back again.

Dr. Izabella:

Thank you so much. I really appreciate you having me. I am not sure if this will be my last book or not. I just had a baby, too, so I don’t know what my future holds. A very exciting time in the Wentz household. I really appreciate you having me and the work that you’re doing to save so many thyroids.

Dr. Eric:

You as well. Thanks again, Dr. Izabella.

Dr. Izabella:

Thank you.

***

Dr. Eric:

That was anawesome conversation with Dr. Izabella Wentz. That is her fifth book. Wow. I have three books. I have to catch up. I’m two books behind her. She has three books on Hashimoto’s, one on adrenal health, and then this one on IBS.

IBS versus IBD, for those who maybe are confused. Two different conditions. Irritable Bowel Syndrome versus Inflammatory Bowel Disease. Crohn’s and ulcerative colitis are types of IBD.

Stil questionable whether they are autoimmune. We had that conversation. She feels like they are. I’m not sure. I go back and forth. I thought at one point they were autoimmune, but some sources say they’re not. Either way, they can be a factor when it comes to autoimmune conditions.

Speaking of which, the IBS-autoimmune relationship. This can increase intestinal permeability, which is part of the triad of autoimmunity that I discussed elsewhere, and we chatted about it as well. That can make someone more susceptible to an autoimmune condition such as Graves’ or Hashimoto’s.

Celiac versus IBD. Dr. Izabella mentioned how the studies show that 25% of people diagnosed with IBS actually have Celiac. 10% of people with IBD also were misdiagnosed. There is some overlap. You figure it wouldn’t be that difficult to diagnose Celiac. IBS can be more challenging to diagnose. Celiac shouldn’t be that difficult. Crohn’s, ulcerative colitis, those can be more challenging.

H-pylori and IBS. She spoke about different gut infections like parasites and bacteria, specifically H-pylori. It’s interesting because she is right. H-pylori affects stomach acid. Low stomach acid can lead to overgrowth of bacteria, SIBO. SIBO is a factor in IBS. Approximately 70% of people with IBS have SIBO. Not all cases of IBS are caused by SIBO.

We also spoke about concerns with the low FODMAP diet. First of all, the low FODMAP diet is not a treatment for IBS or SIBO. The Elemental Diet is a treatment for SIBO. Many people don’t want to do this diet, but a low FODMAP diet is one concern.

I mentioned some concerns about long-term negative effects it could have on the gut microbiome. I am not saying people should never follow it. It’s just not a good long-term solution. You probably don’t want to follow a low FODMAPdiet for six months.

Something we didn’t discuss during the conversation, but I wanted to mention here. If someone had Graves’ or Hashimoto’s, and let’s say they have SIBO, I usually would recommend an AIP diet. If someone has SIBO, they might want to follow a low FODMAP diet. I don’t usually recommend doing both, following AIP and low FODMAP at the same time. One of those diets is pretty restrictive, let alone combining both of those.

Usually, I would recommend holding off on AIP, if you are going to start with the low FODMAP. It’s not a long-term diet. Address the SIBO first, that’s fine. It won’t hurt if someone wants to follow AIP while eradicating SIBO. Combining the different diets could be challenging.

Seeing a gastroenterologist. Toward the end of the podcast, Dr. Izabella was talking about how with certain GI symptoms, you want to see a GI doctor. I agreed. But I don’t want to give people the impression that everyone with bloating, gas, even diarrhea should see a gastroenterologist.

Keep in mind, if you go to a gastroenterologist, they will probably recommend an endoscopy, a colonoscopy. There is a time and place for those. I can’t say I’m a huge fan of those, but like I said, there is definitely a time and place. I won’t get into doing them preventatively, especially colonoscopies, here.

It depends on the person, the GI symptoms. Most of the time, when I am working withsomeone, if they have certain digestive symptoms, I won’t recommend to go see a gastroenterologist. If someone is having rectal bleeding, I would look into that. It could be hemorrhoids. There is a chance it could be cancer.

If someone is having some digestive discomfort and diarrhea, in that case, I’m not opposed if someone wants to go to a gastroenterologist, but I don’t think everybody needs to do that. Making some dietary changes initially is a good idea.

That being said, keep in mind it could take a few months to see a gastroenterologist. I suppose if someone wants to, they can always schedule an appointment to see one a few months out. It might take that long. And then make diet changes. If the diet changes don’t work, maybe do some functional medicine testing, like a comprehensive stool panel. Maybe a SIBO breath test.

Just wanted to clarify that I wasn’t suggesting foreveryone with GI issues to see a gastroenterologist.

That is pretty much it. Really enjoyed the conversation with Dr. Izabella. She wasn’t sure if there would be a sixth book in the future. I think there will be. If there is, we’ll definitely have her back. If not, maybe we’ll still have her back in the future. She is always welcome to be on the podcast. I really enjoyed being on her podcast as well.

Hope you found this episode to be valuable. Thank you so much for tuning in. Of course, I look forward to catching you in the next episode.

In this Q&A episode, Dr. Eric answers listener-submitted questions all about thyroid antibodies—what they are, why they matter, and how they impact both Graves’ disease and Hashimoto’s thyroiditis. He begins by clarifying the three main thyroid antibodies—TPO, TSI/TRAB, and thyroglobulin antibodies—and explains why understanding these markers is critical when assessing true remission.

Throughout the episode, Dr. Eric addresses common concerns such as: Can you be in remission if antibodies are still positive? How often should antibodies be tested? Can diet alone normalize them? He also explores the role of environmental triggers, gut health, gluten, iodine, and even supplements like selenium, black seed oil, and low-dose naltrexone (LDN). You’ll hear practical guidance on why antibodies fluctuate, what “optimal” really means (not just “within range”), and why many conventional endocrinologists don’t routinely monitor these markers.

If you’re confused about your antibody results—or wondering why you relapsed after being told you were “in remission”—this episode will help you connect the dots. If you want a clearer, more balanced understanding of thyroid antibodies and what they really mean for your recovery, you’ll get a lot out of this episode.

If you prefer to listen to the podcast episode Click Here

Dr. Eric Osansky:

This is an opportunity to get questions answered related to thyroid antibodies. For those who are not familiar with me, I am Dr. Eric Osansky. I am a chiropractor, clinical nutritionist, and functional medicine practitioner. I have been helping people with thyroid and autoimmune thyroid conditions since 2009.

I was personally diagnosed with Graves’ and restored my health by taking a natural approach. This will be on the podcast. This is the first time. For those who are in the future listening to this on the podcast, this was recorded on Substack. If you aren’t subscribed to my Substack, Healing Graves’ Naturally, you can do so by visiting SaveMyThyroid.com/GravesNewsletter.

My podcast, even though it does focus a little bit more on hyperthyroidism and Graves’, I do get some people who listen who have Hashimoto’s. Most of the questions today will relate to hyperthyroidism and Graves’, but some of them will relate to Hashimoto’s. A lot of people with Graves’ also have antibodies to Hashimoto’s as well. Even some of the questions that relate to Hashimoto’s will be relevant to those with Graves’. There is also overlap when it comes to finding and removing triggers with different types of auto antibodies.

I might not get to all questions. Again, I’m just sticking to questions that relate to thyroid antibodies. If people have questions that are not related to the topic, again, I won’t be answering that here. I might be having another live stream later this month. This is going to just focus on thyroid antibodies.

Let’s start by talking about the different types of thyroid antibodies. There are three main types of thyroid antibodies. The most common are thyroid peroxidase (TPO) antibodies. Those are more common in those with Hashimoto’s but also very common in those with Graves’. According to the literature, approximately 60-80% of people with Graves’ have TPO antibodies. I do see that a lot in my patients. With Hashimoto’s, around 90% of people have those antibodies.

I am not going to go into great detail here. If you want to learn more about the antibodies, I have individual podcast episodes. If you’re not familiar with my podcast, for those who are listening to this live, my podcast is Save My Thyroid. I have individual episodes that focus on each of these antibodies. TPO is one type of antibody, the most common type.

The second type is thyroid stimulating immunoglobulins (TSI), which are specific to Graves’. TSI is a type of TSH receptor antibody (TRAB). You can test either one or both on a blood test.

The third main type of thyroid antibody is thyroid globulin (TG), which is more specific for those with Hashimoto’s.

There are other antibodies. There are thyroid inhibitory immunoglobulins (TII), which I have a podcast episode on, too. But those first three are the main three you can test for at just about any lab.

A lot of people have 2-3 antibodies. When I dealt with Graves’, I only had TSI. I didn’t have TPO or TG. Very common for people to have TSI and TPO. Not as common but not rare for people to have TSI, TPO, and TG,all three of the main antibodies. If TSI is positive, usually TRAB will be positive, too, and vice versa. There are exceptions.

As far as normalizing antibodies, because I don’t think anybody specifically asked that question when it comes to antibodies, at least not directly. I figured I would say in order to lower antibodies, you want to find and remove triggers and heal the gut. I have spoken about the triad of autoimmunity. I wrote about that in my first Substack article. I have discussed it on the podcast numerous times.

The triad of autoimmunity has three components necessary for autoimmunity to develop. One is a genetic predisposition. Two is exposure to one or more environmental triggers. Three is increased intestinal permeability, or a leaky gut. You can’t change the genes, but fortunately, by finding and removing triggers and healing the gut, you can reverse the autoimmune component in those with Graves’ as well as those with Hashimoto’s and any other autoimmune condition.

I have spoken about forming categories of triggers, which include food, stress, chemicals, and infections. That being said, let’s go ahead and dive into the questions.

I’m going to start with the questions that were emailed to me. I sent out a few emails. I said there were a few ways to respond. One was to email, and another way is to ask on the live call. With the live call, it might be challenging because there might be questions that don’t relate to antibodies. We’ll see. I’ll try to get to as many questions as I can. I can’t guarantee I’ll get to all questions because it depends on how many questions we have.

The first question, I kind of already answered: Which antibodies are specific to Graves’?

Those are the TSIs or TRABs.

I kind of also answered this next question: Is it possible to have both antibodies for Graves’ and Hashimoto’s?

Not only is it possible, but it’s actually quite common to have antibodies for both.

Can someone be in a state of remission if they have positive thyroid antibodies?

In order for someone to be in remission, you want those antibodies to be negative. The goal is to go to an endocrinologist’s office and not be diagnosed with Graves’ or Hashimoto’s in the first place. To be fair, they won’t start with the antibodies usually. They will look at the thyroid panel. If they look good, they won’t look at the antibodies. If they were to look at the whole picture, you would want not only the thyroid panel to be within the optimal reference range, but you would want those antibodies to be negative. If the thyroid antibodies are still positive, I don’t consider the person to be in remission.

That’s the problem when going to a regular endocrinologist. Many of them don’t even look at antibodies. They might do an initial test for thyroid antibodies, and that’s it. Some of them do regularly test for antibodies. Again, many of them don’t.

When they put someone on thyroid medication in the United States, commonly methimazole, that person is on the medication for 18 months to two years. If the person’s numbers look good, and they’re at the point where they’re ready to get off the medication-

Maybe they start off with a higher dose. It depends on the person. Some people only start with 5-10mg. Some people, 20-40mg. Let’s say they start off with 20mg. A year and a half later, they reach a point where they’re on 2.5mg, like half a tablet per day. The numbers are looking really good, maybe a little bit more on the hypo side, so the endocrinologist says, “You might be in remission. We are just going to take you off of the methimazole.”

Many times, they won’t look at the antibodies. I can’t say they never do, but they will just go by the thyroid. The antibodies in the background are still positive. As long as you still have thyroid antibodies, there is still a chance. In the case of Graves’, if you have positive TRI or TRAB, there is potential to become hyper again. That’s why a lot of people will relapse when they’re told they’re in remission because they weren’t really in remission.

The simple answer would have been no, I don’t consider someone to be in a state of remission. That’s my definition. Others might have a different definition. Wanted to give the reasoning behind that.

Does eating foods that give me a reaction contribute to thyroid antibodies?

It could. It depends on the food. Just because someone has a sensitivity to food doesn’t necessarily mean it will cause thyroid antibodies. Not always. It could contribute or cause the development of thyroid antibodies. Gluten is probably the most well-known food allergen that can be a trigger. Not necessarily all foods are triggers, but they could be. Certain foods could be.

This question relates to the last question. It’s another diet question. Is it possible to normalize thyroid antibodies through diet alone?

It’s possible, but usually, most people need to go beyond diet and lifestyle. I talk about this in my book The Hyperthyroid Healing Diet. A lot of people who work with me already are following a healthy diet. They’re following an AIP diet, or for those who’ve read my book, a level three diet. The reason they’re working with me is because the diet maybe helped to some extent, but it didn’t successfully put them in remission. Maybe it didn’t even improve their numbers.

I’m not going to say it’s impossible. There are some people who all they do is make dietary changes, and they seem to go into remission. That being said, it’s great to start with diet. That’s something everybody can do on their own: make dietary changes. I find most people do need to go beyond diet and lifestyle. In my book The Hyperthyroid Healing Diet, I have an entire section that talks about going beyond diet and lifestyle.

For those who are just hearing about this book, it is available on Amazon in print as well as on Audible if you prefer listening to books.

I have some questions related to Graves’ and antibodies. I have been told Hashimoto’s can also predispose to or cause Graves’. Is this true?

That’s the first part of the question. Having one autoimmune condition will make you more likely to develop other autoimmune conditions in the future. I can’t say that if someone has Hashimoto’s, that will predispose them to having Graves’. Just the fact that they have had one autoimmune condition will increase the likelihood of having other autoimmune conditions in the future.

Are there specific autoimmune antibodies with Graves’ that impact eye health specifically that can be tested for?

In the case of TED (thyroid eye disease), it’s typically the same TSIs that affect the eyes. They not only attack the TSH receptors of the thyroid gland, but they can also attack the tissues of the eyes, resulting in TED.

Is Graves’ always an autoimmune condition with the presence of antibodies that can be tested for?

It’s an autoimmune condition. There are times where someone can have negative antibodies, like false negative antibodies, which can make it challenging. I wouldn’t say that’s common. That’s why you don’t want to just rely on one test. Sometimes, it can be challenging.

It is always an autoimmune condition, but you don’t always get the presence of antibodies. Most of the time, you will.

My thyroid antibodies were gradually decreasing for six months. All of a sudden, one of my tests showed they increased. Does this mean the trigger hasn’t been found?

Maybe. It’s possible. I would say you can’t just rely on a single test. It’s not uncommon for people to hit roadblocks. I will say that. But you don’t want to overreact with one test. If someone’s antibodies have been decreasing, and all of a sudden, a single test shows they’re increasing, that doesn’t mean that you’re starting to go backwards. It could mean that.

Sometimes, it’s a rollercoaster ride. I have this conversation frequently with people. Sometimes, you will see a person take 2-3 steps forward, and then it seems like they’re taking a step backward. As long as you’re taking more steps forward, that’s okay.

In a perfect world, we want everybody’s thyroid antibodies to gradually decrease without any setbacks. It’s very common for that not to happen and for the antibodies to fluctuate.

In this situation, it could mean that the trigger hasn’t been found. I wouldn’t make that conclusion with just a single test. I would see what the next thyroid antibodies test looks like. If you see a pattern where the antibodies are continuously increasing, that is a sign that more detective work might need to be done.

Even though a few of these questions relate to Hashimoto’s, a lot of people with Graves’ have Hashimoto’s antibodies, but there is some overlap when it comes to addressing Hashimoto’s antibodies.The next question asker was diagnosed with Hashimoto’s last April with a thyroid antibody of 599. She didn’t specify which one. It might have been TPO or TG. She has added many new supplements to her diet, optimized her diet. She avoids seed oils and gluten. Focuses on whole foods. Good quality probiotics. Digestive enzymes. She has healed many of her gut symptoms and contained her GERD symptomsthrough the use of herbal licorice and heartburn relief supplements. She gets her steps in. 7+ hours of sleep. She is doing a lot of good things.

Her question is: I continue to see no movement on the scale, and my weight is about 15-20 pounds higher than my ideal. My overall cholesterol numbers are good, but my LDL markers are still in the high range. After a six month recheck of labs, my thyroid antibodies were still 450. While my overall thyroid numbers look normal, and my thyroid is still functioning, what else can I possibly do to improve my situation? It’s a bit disheartening to feel like I’m doing everything right, and nothing really is changing about my condition.

It sounds like you’re doing a lot right from a diet and lifestyle standpoint. The diet, you’re taking some basic supplements, the multivitamin, Vitamin D, selenium, fish oil. You’re taking a few others as well. Things for the gut.

As I mentioned earlier, most people need to go beyond diet and lifestyle. Usually, if someone comes and sees me, and they have done what you’ve done, because it is common for people when they see me, a lot of people follow a strict diet and supplements, and they aren’t seeing changes still.

That’s where doing a comprehensive health history is part of the evaluation process. Almost always, doing some type of functional medicine testing. Doing comprehensive blood testing, too. Doing adrenal testing, whether it’s a saliva test or dried urine test. I like hair mineral analysis testing. I know it’s not perfect, but I like to do it. Sometimes, I will do a comprehensive stool test like a GI Map or GI Effects. There is mold testing, organic acid testing, stealth infection testing.

I’m not saying everybody should do all these tests, but the point is that usually, we can’t just rely on diet, stress management, and sleep.

If you don’t incorporate a healthy diet, if you’re eating inflammatory foods, stressed out all the time without management, and not getting sufficient sleep, it will be difficult to heal.

If someone is doing all those things right, and their antibodies still aren’t budging, then typically you need to go beyond diet and lifestyle. That’s where doing some testing, ideally working with a practitioner, is what you would want to do.

It’s not an uncommon story. I realize it’s frustrating. The good news is there are other things you can do. If you can’t do anything else from a diet and lifestyle standpoint, then maybe there are other things you can do, like the testing.

Is there any supplement that will make my thyroid antibodies decrease quickly?

There is not a single supplement to lower and normalize antibodies. There is a lot of research with selenium and antibodies. Having healthy Vitamin D levels is important. Having healthy omega-3 fatty acid levels is important.

It comes down to finding and removing triggers. It’s not just about taking supplements. Supplements can to some extent help with antibodies. I’m not suggesting that anybody take specific supplements, but these are ones I commonly recommend to patients. Selenium, Vitamin D, fish oils. There are people who take those and don’t see any change in their antibodies. We dig deeper and do some testing for triggers and work on eliminating them.

On the other hand, some people will take those supplements and notice some improvements. Very rarely are they taking those supplements and seeing a normalization of their antibodies.

Why are endocrinologists so resistant to testing for antibodies?

I brought that up earlier. I mentioned how many endocrinologists will do it one time, and that’s it.

They’re not doing anything to improve the health of the immune system. When you goto an endocrinologist for any type of hyperthyroid condition, they’re focusing more on the thyroid. They’re looking to suppress the thyroid through antithyroid medication or recommending radioactive iodine or thyroid surgery. They’re not looking to improve the health of the person’s immune system. That’s the main reason why many are resistant, and many don’t test thyroid antibodies regularly.

How often should one check thyroid antibodies if they were initially elevated?

I usually recommend a thyroid panel every 6-8 weeks. You could do it every month. Every month is fine if insurance covers it. At the very least, 6-8 weeks. If you could test antibodies every 6-8 weeks, great. If not, every other month. If you’re paying out of pocket because your endocrinologist won’t test for it, maybe you could do every six weeks a thyroid panel, and every three months, do the antibodies.

If you could do them every single time, that’s great. If not, then I would say every other time you do a thyroid panel.

How long does it take to lower thyroid antibodies? Is it still possible to lower thyroid antibodies if they have been elevated for many years?

In my case, it was nine months before everything looked good, including thyroid antibodies. Some people, it’s a year. Some people, it’s over a year.

It definitely is possible to lower and normalize antibodies, even if someone has had elevated antibodies for many years. You could address the autoimmune component, even if someone has been dealing with Graves’ or Hashimoto’s for a long time. The answer is yes, it’s possible.

Should all the thyroid antibodies be normal in order for someone to be considered in remission?

Someone asked something similar. If you want Graves’ to be in remission, you want TSI and TRAB to be within the optimal range. Doesn’t mean they need to be zero. That’s a common question.

When you say “normal,” there is normal and optimal. You don’t want the antibodies to be on the higher end of the range, even if they’re within the range. For example, with Graves’, maybe not the best example because there are different reference ranges. For those in the United States, LabCorps’ range for TSI is 0.55. If someone’s TSIs are 0.53, kind of on the higher side. I’d like to see it at .3 or below.

Let’s say someone’s antibodies are .27, and it’s been below .3 for a while. I wouldn’t say they’re not in remission. It’s not uncommon to have some auto antibodies. Youwant them to be normal, within the optimal range. Doesn’t mean they need to be zero.

I have been on 75mcg of levothyroxine for 30 years for hypothyroidism. Two years ago, in 2024, my TSH was .01, T4 17, T3 5.5. I am not 100% sure, but it looks like those values are outside the United States. In the United States, if someone had a free T4 of 17, it would be really high. Free T3 of 5.5 would also be high. The TG antibodies were 657, and the TPO antibodies were 25. Those are within range according to the lab she used. My levothyroxine was reduced at that time to 25 and 50mcg, alternating levels every other day. My TSH was 3.65. A little bit on the higher side. T4 12. TG 295. Still elevated. TPO went down to 9 in the summer of 2025. I am going for labwork in the summer of this year.

I have healed my gut within the last three years. I generally feel healthy with diet and lifestyle. I am wondering about the significance of TG antibodies.

As I mentioned a few times, I wouldn’t be comfortable with those antibodies being elevated. It’s challenging. I am not saying it’s easy to normalize thyroid antibodies. The purpose of this call is to talk about things that can help with thyroid antibodies.

It’s possible to lower and normalize antibodies. It is not easy. Yes, it will take some detective work to find and remove triggers. It sounds like your gut may have already been healed based on what you said. There could be other triggers. According to the triad of autoimmunity, it’s not just a leaky gut but other environmental triggers could also be a factor.

What is the drawback of taking LDN to lower thyroid antibodies?

The drawback is LDN is a medication that modulates the immune system. The drawback by lowering antibodies is that if you’re also following a natural approach, you don’t know if the natural approach is working. The LDN is masking.

It’s a little similar with methimazole. If someone is taking antithyroid medication for Graves’, you still can monitor the antibodies. The immune system is more important than the thyroid with antibodies. If someone is taking LDN for modulating the immune system, if you’re also trying to find and remove triggers, you don’t know if you’re successful in finding and removing those triggers if the LDN is already normalizing those antibodies.

I was diagnosed with hyperthyroidism due to Graves’ about 2.5 years ago. I was put on 10mg of methimazole, and I have been slowly tapering down to 5mg three times a week. My TSH, T4, and T3 have been normal for about 18 months now. My TSI is just slightly above the .55 that my lab deems undetectable. I am getting another blood test next week, so hopefully I will be under that threshold. My doctor says at this point I can discontinue the methimazole completely with the recheck in 4-6 weeks.

Myquestion is is it safe to stop the medication? Should there be more tapering off? I want to be off of it but don’t want to end up back on it because we dropped off too quickly.

It’s great that that doctor is looking at the antibodies and waiting for the antibodies to be negative. If they are on the higher side, like if it was .52 or .53, I would be nervous. Let’s say it was .25. You’re at 5mg three days a week, which is a low dose. Is it safe to stop the medication?

Keep in mind, I can’t give advice about stopping medication. You’re not asking me that, but in a way, you are. If I say it’s not safe, then you would be continuing with the medication.

I will say, it depends on the person. If the antibodies are well within the range, there is a good chance the person won’t become hyper. Every endocrinologist is different. Some endocrinologists would maybe put the person on 2.5mg three days a week. Some would say let’s do 5mg twice a week rather than completely stopping.

There is not a risk risk, meaning like with beta blockers. I have never seen this happen with beta blockers because I’ve had people on their own abruptly stop beta blockers, but you’re not supposed to do that. You could have a rebound heart attack in the literature. I haven’t seen anything similar with antithyroid medication such as methimazole.

I’m not reallyconcerned about that. The main concern is will someone become hyper again? That is the risk of stopping too soon.

You’re on a low dose three times a week, so you might be fine. I noticed in the chat, which I try not to look at. Someone just said, “My endocrinologist said there is no smaller dosage than 5mg.” That’s true. But a lot of them will just use a pill cutter to cut in half to 2.5mg.

I think we have two or three more questions. Then we will get to the live questions.

I was diagnosed with Hashimoto’s about three years ago. Various symptoms. High TPO. Periodic diarrhea issues, libido issues, tingling in the hands. I have seen a number of practitioners. Not sure if their prescribed plans are working for me. Information indicates that gut issues may be a leading trigger. Trying to find out how to fix it. What test do you recommend to get to the true cause? How to address it?

It depends. People might get tired of that answer. But it does depend. That’s what the health history is for. If someone is having a lot of bloating and gas with certain foods, then maybe they’re better off doing a SIBO breath test, whereas if they are having other symptoms, like heartburn, reflux, maybe looking at H-pylori. You can’t always go by symptoms with H-pylori. More times than not, I will do a comprehensive stool panel, like a GI Map.

It does depend on the symptoms. If someone seems like they might have SIBO, a stool test will look at the large intestine, not the small intestine. I would recommend a SIBO breath test if I’m suspecting SIBO. If we are thinking someone has yeast overgrowth, a stool test will test for it, but it may not always pick it up. You might want to do an organic acids test instead.

Again, I would say the #1 test I recommend is the comprehensive stool test, like GI Map or GI Effects. It does really depend on the case presentation.

If you’re not sure, I would say maybe start with a comprehensive stool test. Like I said, if someone has a lot of gas or bloating, with certain foods, like higher FODMAP foods, like fermented foods, higher fiber foods, then I might start out with a SIBO breath test.

Last question: I tested negative for TSI antibodies in November. TRAB was tested in January and also negative. However, in January, my radioactive iodine uptake scan was 51% over 24 hours. Because I had a high uptake, I met with an endocrinologist, who said it was likely Graves’. My T4 has been going down from 2.3 to 1.9. Still a little high but getting there. TSH is staying between .16-.13 since November. I have been taking a multivitamin with iodine from May-November but stopped in early November after I found out my TSH was low. My T3 has been in the normal range the whole time but has decreased from November to January. Could this still be seronegative Graves’? Could there be another cause of the hyperthyroidism, possibly caused by too much iodine?

I follow a vegan diet and wonder if I’ve been deficient in iodine before taking a multivitamin. Would it be worth testing for antibodies again in the future? Is the Graves’ the only reason the radioactive iodine uptake scan would have been so high?

I recently cut out gluten. Is that necessary for someone without antibodies?

A lot of questions here. It is possible that the iodine can cause hyperthyroidism. I have nothing against iodine. I have had good experiences with iodine. It definitely affects thyroid. Iodine can be beneficial in some cases, but in some cases, it can definitely cause hyperthyroidism. That’s possible.

Elevated uptake usually is related to Graves’. There could be other causes. If someone has toxic multinodular goiter, it might be elevated. Doesn’t sound like that’s the case with you.

If someone follows a vegan diet, and they are not getting any sources of iodine, they could be deficient in iodine. Understand looking to take an iodine supplement. No, you weren’t taking an iodine supplement; you were taking a multivitamin with iodine. I misunderstood. The iodine in a multi, not to say it can’t cause hyperthyroidism, but I commonly give a multivitamin with iodine. I am cautious with iodine, and I talk about this in my books. I’m not anti-iodine, where I recommend 100% avoiding iodine.

In most cases, people run into trouble if they are taking separate iodine supplementation or eating too many high food sources of iodine, like kelp. Some people have subacute thyroiditis, but the uptake test usually wouldn’t be high with that.

You mentioned it could be seronegative Graves’, which is where you have false negative antibodies. As I mentioned earlier, that is a possibility. It’s not too common, but that would make sense.

I do think it would be worth testing for antibodies again in the future. There are different immunoglobulins, which are antibodies. There is IgG, IgA, and IgM, which you can test at a regular lab. If IgG is depressed, that could give false negative antibody results. You might want to look at that and make sure that’s not depressed. It is very possible that you have false negative antibodies for Graves’.

Finally, you asked is cutting out gluten necessary for those without antibodies? In my opinion, I would say it’s a good idea not to eat gluten regularly, even if you don’t have an autoimmune component. If I work with someone who has toxic multinodular goiter, which is hyperthyroidism but not autoimmune, I still recommend avoiding gluten. They may not have an autoimmune component, but gluten could increase permeability of the gut, which is still a factor for a lot of conditions.

You need a healthy gut to metabolize estrogen. Estrogen metabolism could be an issue in some cases of toxic multinodular goiter.

I think it’s a good idea regardless, even if someone doesn’t have Graves’ or Hashimoto’s.

That’s it for the email questions. We had a lot of email questions. Thanks for those questions. Let’s see what questions were put in the chat here. This is not very user-friendly here on the phone. If I miss a question, I apologize. I can see one line at a time and have to scroll very carefully here.

What are your thoughts on blackseed oil for lowering antibodies?

There is some evidence with blackseed/black cumin helping with TPO antibodies. Hashimoto’s, not Graves’. I like it. Definitely has a lot of different properties, some anti-inflammatory properties, some antiviral properties. You still want to do things to find and remove triggers. You can’t have a blackseed deficiency, but you can have a selenium deficiency. Supplementing with selenium isn’t going to normalize your antibodies. Same thing with blackseed. It could help, but I can’t say it’s something I commonly recommend to people I work with.

I need to prioritize supplements. Even though I do like it, it’s not typically something I recommend. I can’t say I have seen any dramatic changes in thyroid antibodies.

If you are allergic to dairy and sensitive to gluten, if you ate these, would it show up as raised antibodies?

It could. Gluten could potentially increase antibodies. Dairy as well. It’s a more common allergen. Gluten, dairy, and corn are foods that could raise antibodies. Not all foods, even if you’re sensitive to them, like if someone has a food sensitivity to broccoli, that is probably not going to increase antibodies. Doesn’t mean you don’t want to address the food sensitivities. But those two can.

Do TRAB and TSI both need to be in the negative range to be considered in remission?

I answered a similar question. Yes, they need to be well within the range. Not necessarily zero, but within the optimal range. Well below the lab reference range to be considered in remission.

My most recent TRAB is less than 1.0. Is this negative? TSI was less than 89%.

Most labs, TRAB is- First of all, less than 1. Most labs, 1.75 is the threshold for TRAB. If it just said 1.0, not less than, it would still be considered normal. Less than 1 is undetectable, which is great.

What if I have elevated TSI and TPO? Does this mean Graves’ and Hashimoto’s? What does remission look like from the perspective of a traditional endocrinologist, taking methimazole and these antibodies disappearing?

An endocrinologist will sometimes look at antibodies, but they often won’t. TSI is more specific for Graves’. TPO is an enzyme that is important for the production of thyroid hormone, so if you have TPO antibodies, you’re more likely to become hypo over time. If you have TSI, that is stimulating the TSH receptor. TPO is more closely associated with Hashimoto’s.

Essentially, you do have antibodies for both Graves’ and Hashimoto’s. Ideally, you want both of those to be in remission.

Most endocrinologists probably won’t even look at TPO with Graves’. They might not even look at TSI. If they look at anything, it would be TSI or TRAB. They would focus on normalizing that.

Have you heard about reishi and butyrate to lower TRAB antibodies? Are they helpful in your opinion?

I have a supplement, Hepatommune Supreme, that offers liver support but has some mushrooms, reishi and cordyceps. You need to find and remove triggers still. There is no evidence in the literature about these decreasing thyroid antibodies. Reishi can modulate the immune system, offer some immune support. Like I said, I wouldn’t necessarily rely on that for lowering thyroid antibodies.

Butyrate is a short chain fatty acid. You can get butyrate through eating fiber-rich foods. It’s definitely important for a healthy gut. A healthy gut is important for a healthy immune system. Butyrate can play a role. I wouldn’t say people have to necessarily supplement with it. I don’t think there is any evidence in the literature showing that it normalizes thyroid antibodies.

There are a lot of things that can be helpful. I don’t want someone taking 30 supplements. I am not shy about recommending supplements. I am not shy about taking supplements or recommending them. There are a lot of good supplements out there. Doesn’t mean you should take all of them. That’s what a lot of people are doing. Let’s look for the one or two supplements that will be gamechangers. Usually, it’s just a combination of diet and lifestyle factors, finding triggers, using targeted supplements. You definitely don’t want to overdo it. But a good question.

Around four years ago, my TRAB was around 10.4. Two years ago, they were around 7, and now 3.34. Can I be faithful that I am n the remission path?

Maybe. It’s great it’s heading in the right direction. It’s taken a while. I am not sure what you’ve done, if you’ve done anything besides cleaning up your diet, managing stress, getting sufficient sleep, finding and removing triggers. If not, I will be biased and recommend doing that.

It does look good. Like I mentioned earlier, someone asked a question about things improving for six months, and then their antibodies increased. Even if it increased, that doesn’t necessarily mean you’re no longer on the right path. If it continues to decrease, or if it decreases with an occasional increase, that’s very common.

I think I got to all the questions. Thank you so much for subscribing to the Substack. For those in the future who are listening to this on the podcast, if you’re not subscribed to the Healing Graves’ Naturally Substack, you can visit SaveMyThyroid.com/GravesNewsletter to do so.

This was great. We had a lot of people showing up on the livestream, which I’m happy about. A lot of emailed questions. Everyone, thank you so much. Thanks for your questions. Hope you have a great rest of your day. Take care, everyone.

 

In this episode, Dr. Eric Osansky talks with certified nutritionist and menopause specialist Leah Vachani about blood sugar imbalances, insulin resistance, and how these issues often show up long before a diagnosis of prediabetes or type 2 diabetes. Leah shares how her work with women in perimenopause and menopause led her to see blood sugar as a major missing piece in hormone health, energy, sleep, and weight regulation.

Together, they explore why stress, poor sleep, processed foods, and hormone shifts can all contribute to unstable blood sugar. Leah also explains how continuous glucose monitors can help people see their individual patterns more clearly, from food triggers to stress spikes, while also discussing the limits of CGMs, fasting insulin, A1C, protein intake, apple cider vinegar, intermittent fasting, and exercise.

This conversation gives listeners a practical, realistic look at how to support better metabolic health without chasing perfection. If you want a clearer, more balanced understanding of blood sugar imbalances and insulin resistance, you’ll get a lot out of this episode.

Click Here to listen on the podcast

Dr. Eric Osansky:

I am going to read Leah Vachani’s impressive bio here. Sometimes, I do it in the conversation, but I’m going to do it here instead: As a passionate advocate for holistic health and wellness, Leah helps women over 40 transform their lives through sustainable nutrition and lifestyle changes. As a certified nutritionist and menopause specialist, her expertise combines practical health coaching with science-backed strategies that deliver real results.

She specializes in hormone balancing, energy optimization, and sleep improvement, helping women get off their mood rollercoaster, sustain energy throughout the day, and fall asleep faster while staying asleep at night, through her website, LeahVachani.com; her podcast, Women Aging Powerfully, which I was a guest on; and as host of the Women Aging Powerfully Summit, where I have guested in the past.

She also shares evidence-based health strategies, nutritional guidance, and wellness tips. She offers personalized coaching through her group and 1:1 programs. Her mission is to empower you to take control of your health journey one small but powerful change at a time. Whether you’re struggling with low energy, poor sleep, or mood swings, or simply want to optimize your wellbeing, Leah provides the tools, support, and accountability you need to feel like yourself again.

***

I am super excited to chat with today’s guest, Leah Vachani. We are going to be talking about blood sugar imbalances. It’s going to be a great conversation.

I want to start out, Leah, by- First of all, how are you doing today, Leah?

LeahVachani:

Good. I’m happy to be here. Thanks for having me on.

Dr. Eric:

It’s great to have you here. You do a lot with hormones and menopause and blood sugar. A lot of people have blood sugar imbalances. Is that the reason you decided to focus on helping people with blood sugar imbalances, because it’s so prevalent?

Leah:

That’s a really good question. When I went into nutrition, working with clients, I had zero desire to talk about blood sugar. As I progressed in my practice and my age, I hit perimenopause, and everything I thought I knew kind of went out the window. Everything that was working for me in the past in my 20s and 30s didn’t work anymore.

As I dove into perimenopause, menopause, hormone issues, and my problems, because when you solve your problems, you tend to solve your clients’ problems, I realized that we say it’s a hormone issue for perimenopause and menopause, which it is 100%. But what I didn’t realize is a big part of that puzzle is blood sugar and insulin. Insulin is acting like a hormone in the body.

When I started to dive into that, I realized that it was such a big player in how we feel as women going in our 40s, 50s, 60s, and beyond, and how everything is changing. That is intricately involved in that.

At that point, I was like, I can’t ignore this. I need to do a deep dive into blood sugar, insulin, how that plays a role. That’s how I got here, working with clients.

Dr. Eric:

Thanks for that brief background. Why do so many people have blood sugar imbalances, insulin resistance, type two diabetes?

Leah:

It’s growing. The prevalence of type two or prediabetes is growing exponentially, which is concerning. I think it’s a very complex issue, butit can come down to some of the same factors.

In general, we just aren’t eating a great diet anymore. A lot of people are eating more packaged foods, more processed foods. Part of that is a time issue. We lead very stressful, busy lives. We don’t take the time to cook anymore.

Stress and sleep are a huge part of what my clients are dealing with, what many women are dealing with. Not addressing stress and sleep are huge components of blood sugar issues.

Of course, we talked about hormone shifts. That is out of our control in a way as we go through this shift. That plays a huge role in insulin resistance, which I’m sure we’ll talk about, and blood sugar imbalances.

Dr. Eric:

A lot of people don’t think about stress and sleep when it comes to blood sugar. Definitely could have dramatic impact. The importance of sleep, getting that 7-8 hours of sleep.

Leah:

I can expand on those if you want. We could do 10 episodes just on stress and sleep. That’s how complex it is.

Dr. Eric:

Yeah. When it comes to sleep, what is your approach? Is it the typical 7-8 hours, or does it depend on the person? Do you find some people can get away with six hours and still have healthy blood sugar levels and mitochondria?

Leah:

Everyone is biologically unique. What works for one woman, maybe that six hours of quality sleep is fine for her. Another woman might need eight hours of quality sleep. The key is quality. It’s not your time in bed. I actually use devices in my practice to help women. The first question is, how are you feeling? Are you waking up feeling rested and restored?

Beyond that, we use things like continuous glucose monitors (CGM). If a client has an Oura ring, I love using data to steer where we’re going with this because as you said, sleep is a huge issue for so many women, especially in that perimenopause/menopause phase of their life.

For me personally, I actually don’t address sleep first. I find if I tell a woman, “You just need to work on your sleep,” there are so many factors happening during the day that are affecting her sleep. We first start with trying to manage her blood sugar levels and stabilizing that. That ironically helps a lot of her sleep issues. That’s where we start.

Dr. Eric:

Great point. If someone has blood sugar issues, that could affect sleep. Stress also can affect sleep. If you say, “Work on going to bed an hour earlier,” which is not a bad idea.If someone is going to bed at 11pm, midnight, not a bad idea to go to bed a little bit earlier.

If they are having issues falling asleep and/or staying asleep in the first place, you want to address that rather than just telling them to go to bed earlier and just laying in bed and not falling asleep, or having those issues waking up in the middle of the night and not falling back asleep.

You’re right. It is important to address blood sugar imbalances.

How do stress and adrenals play into that? Do you instruct the person to block out time for stress management?

Leah:

Funny enough, if I can get a client to wear a CGM, then I don’t really need to harp on them about addressing stress because they actually see what stress is doing to their body.

I’ll use an example. I had a client who had rising blood sugar issues, but it wasn’t showing up on labs, which is very common. You’ll go to get your fasting glucose, and the doctor will say, “Everything’s normal.”

What was happening behind the scenes is her blood sugar was doing this rollercoaster ride, lots of highs. Her insulin in her body, she was doing overtime, pumping that insulin out to get that blood sugar down. She had all the classic signs of insulin resistance, which we can dive into later.

Once I got her to wear a CGM, she actually saw that while diet was playing a role in her blood sugar issues, what she didn’t realize was those moments of stress, the email from her boss, the fight with her spouse, the kids. I love my kids, but it’s a lot of extra things that we are dealing with that we might not be realizing are elevating our stress levels. She would see that on the CGM. Her blood sugars were just spiking on these moments of stress, and it was happening way more frequently than she realized.

When I connected that, and she realized that “When I’m stressed, my blood sugars are rising,” she then had the motivation to address that. For everyone, it is different. She was able to connect that and then address those moments.

What was the question again? I think I got off on a sidetrack here.

Dr. Eric:

I was asking, do you have people block out time for stress management while also doing things to balance blood sugar since there is that link between stress and blood sugar?

Leah:

With everyone, it’s different. Some people are so stressed out that they just need to address a few things at a time. We’ll pick and choose what are the easy obstacles first? I have a bunch of tricks up my sleeve about how I can help people with sleep and stress. They are so intertwined that it’s hard to pull it apart.

Things like magnesium for example. I’ll have a lot of my clients start magnesium. That takes the edge off their stress levels. It helps them relax, especially if they have muscular tension. It helps them sleep better.

We’ll do things like a five-minute breathing exercise. It’s amazing what you can do with your body and the way that it relieves stress if you just do five minutes of breathing. We’ll do small techniques like that.

If I say, “You need to address stress,” most people are lost. They have no idea how to do that. We take baby steps and use the toolkit of things I can throw at them.

Dr. Eric:

That’s great. When it comes to stress management, I recommend starting slow. Start with a few minutes per day. In my opinion, it’s about getting into that routine of stress management. Block out time for stress management, especially if you have to do 15-20 minutes per day, which for some people, they are doing a lot more than that. For others, they can’t even imagine 5-10 minutes per day, let alone 15-20 minutes a day.

What exactly do I do? There are different types of stress management techniques. I think we’re on the same page.

I want to talk more about the CGMs. Getting back to insulin resistance. It’s so common that we assume that most people listening to this know what insulin resistance is. Let’s backtrack a little bit. If you could briefly explain what insulin resistance is and how you differentiate insulin resistance from type two diabetes, for example.

Leah:

Most people do have insulin resistance who are listening, and many of us don’t even realize it as we are going through our day.

If you were to think of a lock and a key, and every cell has this doorway that is going to allow glucose into the cell to use for energy, there is a receptor, which is like the lock on a door. The insulin is the key that goes in and opens that lock and allows the glucose to come in. In a perfect world, that sounds great.

Except insulin resistance is when that insulin isn’t functioning as well. Your cell receptor isn’t listening as well. If you were sitting in a room, let’s say, and someone was playing some music, and they slowly turned up the volume more and more and more but slow enough where you didn’t realize all of a sudden you are sitting in this room with music blasting at you. It is so loud that you barely even hear the music anymore.

That’s what insulin resistance is. Your cells are bombarded so much that they stop listening and realizing that the insulin is there to help. It’s a rudimentary analogy.

What the signs are that a lot of people don’t see is their blood glucose is rising over time. What you might see on a lab is your fasting glucose will start to rise over the years. You also might see your A1C start to rise, which is the snapshot of the last three months of what your blood glucose has been doing.

Some people will start getting skin tags or some dark skin in certain areas, like their elbows, neck line. Some crepey skin.

Another sign is weight gain that is coming on in the midsection especially. You’re doing the same things. You’re eating the same. You haven’t changed a lot, but you start to gain that visceral fat and the weight around the waist.

Another sign would be energy levels. Not having the energy levels you used to have, which I know could be due to a lot of things, but that’s one of the things.

Sleep issues. Waking up at night to pee more is a common issue. I could go on and on. Those are some of the common ones.

Dr. Eric:

When it comes to lab markers, you mentioned hemoglobin A1C. It’s an average of the blood glucose over a number of months, approximately three months. You mentioned earlier fasting glucose. We’ll talk more about CGMs. Do you like to see fasting insulin as well?

Leah:

I do. Doctors won’t usually run that test, so I will ask all my clients to get it. It’s a question of whether the doctor will actually run it or not.

Dr. Eric:

Agreed. A lot of them don’t.

Leah:

It’s a huge piece of the puzzle. If I could wave a magic wand and have every doctor test fasting glucose and fasting insulin at the same time, it would make my job a lot easier.

Dr. Eric:

Agreed. What do you like to see the numbers at? You could mention fasting glucose. What do you like to see fasting insulin at as well as hemoglobin A1C? What are your optimal levels?

Leah:

Fasting glucose, most people have seen that number. They know if they’re under 100, it’s usually considered normal. The prediabetes range would be 100-125mg/dl. If you’ve had a number over 125, it’s probably leading to adiagnosis of diabetes, especially if you have more than one of those numbers.

Hemoglobin A1C is the measurement of the last three months on average of what your blood glucose levels are doing. The normal range is considered less than 5.7%. I like to see it a little bit lower than that. I like more of an optimal range. Prediabetes would be 5.7-6.4%. if you have a number of 6.5% or higher, you’re probably in that range of getting diagnosed with type two diabetes.

Fasting insulin, if you’re getting it, can be confusing because what your doctor will consider normal is a very wide range. I think it’s 2.6-24.9 or something like that. It’s a wide range. The optimal range for me personally is 2-5 although if you’re in the 5-10 range, I consider that pretty good. If you’re over 10, let’s address some blood sugar issues.

I don’t know if that outlines some optimalversus normal ranges. That’s where I’m at with my clients.

Dr. Eric:

Makes sense. Ideally, between 2.5-5 for fasting insulin, but if it’s less than 10, you’re not too concerned.

Leah:

Yeah. I work a lot with optimal ranges versus “normal” ranges. That’s another topic of discussion, right?

Dr. Eric:

Yeah. Getting to that, have you seen cases where either insulin looks good, but hemoglobin A1C is maybe within the range but kind of on the upper end, 5.5, 5.6? Or vice versa?

I guess what I’m asking is have you seen scenarios where they don’t agree with one another, the labs? Maybe it’s the opposite, where hemoglobin A1C looks good, and insulin is high? I guess I’ll see more frequently where hemoglobin A1C is on the higher side, 5.5, 5.6, yet their fasting insulin lookspretty good. It’s definitely below 10, even around the 5 mark. Their fasting insulin looks good, and maybe their glucose also looks good, but the hemoglobin A1C is on the higher end. What do you do in that situation?

Leah:

That’s a really good point. Generally, a prediabetes or diabetes type two situation is happening for sometimes a decade or two behind the scenes before you’re actually getting that diagnosis. The journey there is happening for 10-20 years sometimes.

To your point, what I will see sometimes is a “normal” fasting glucose and a pretty good hemoglobin A1C number, like an okay, normal, slightly elevated maybe, but their fasting insulin is much higher.

What is often happening is their body is pumping out so much more insulin. It’s working so much harder because behind the scenes, their glucose levels are rising, but their body is still capable of punching so much insulin out to keep those glucose numbers down. That’s not a good state to be in.

That’s why the fasting insulin number is so important. You can usually catch these metabolic issues earlier if you’re doing all three of those tests versus just the glucose and the hemoglobin A1C. Is that what you’re seeing sometimes?

Dr. Eric:

Yeah. Also, I can’t say I have everybody use CGMs. I don’t know if you do, but that of course will give some additional information as well. The blood sugar markers are kind of a snapshot. The hemoglobin A1C is looking at an average, but it is still a single test. No single test is perfect. If you suspect they have blood sugar imbalances, or if you suspect there is conflicting information, doing the CGM can provide some additional information that could be helpful.

Leah:

It’s fascinating to see people wear a CGM because they have their flaws, too. There are pros and cons. One of the flaws, I’ll put it out there because I think people should know this. There is a margin of error. It’s up to 12% or something, which can show you a number that-

Let’s say the CGM that you’re wearing on your arm has a fasting blood glucose number of 105, which is getting into that prediabetic range. In actuality, the margin of error is such that your actual number, if you went into a lab that morning at that specific time, would show you at 95. People really don’t understand that there is a margin of error.

What I like CGMs for is it can show you- For example, if your choice of breakfast is steel cut oats with some berries and maybe some sprinkling of nuts on it. You think that’s a really healthybreakfast, right? That’s what we’ve been taught. It is decent for some people. For other people, it can completely throw their blood sugar on this rollercoaster ride all morning or all day.

What the CGM will show you is what foods are working for you in your system and what foods are spiking your blood glucose, what are not spiking it. It’s like wearing a little coach on your arm, telling you what foods are good for your body and what foods are maybe not so great.

Dr. Eric:

Great point. You’re right. Some people will do fine with a banana, but other people, it will really spike up their blood sugar. That could be with so many other foods as well.

You mentioned a margin of error. I used a CGM on myself for two different cycles. I don’t know if it was the instructions, but I got the higher reading. My blood sugar usually isn’t whatever it was, around 102 or something. I learned in some cases, you have to calibrate it, so that could also help, too. A little bit of a pain, I guess you could just assume there’s that margin of error. That’s probably the easier way.

With me, I got the glucometer, where you prick your finger, and that was lower. That was the normal amount. Then you enter it into, it’s been a while since I did this, the app, three consecutive days. Then it calibrates it, and that number will actually come down based on that. At least the one that I used.

If you know there’s that margin of error, and especially if you’ve done a fasting glucose recently, and you know your number was 95. The CGM said 105. You know it was artificially spiked up. There is that option.

Leah:

Well, there’s only the option for certain CGMs.

Dr. Eric:

Yeah, I was going to say that, depending on the CGM.

Leah:

Yeah, we teach that in my course because the world opened up to people that don’t necessarily have diabetes or even prediabetes last fall, I think it was. No, maybe it’s over a year now. It’s been a little over a year that they opened up the over-the-counter options. You can get the Stolo or the Lingo.

Before that, you could only do prescription. Those prescription CGMs, you can actually calibrate like you were saying. But the over-the-counter ones, unfortunately, I don’t know why they made this decision, but you can’t calibrate it officially in the app.

What you can do, and what I teach my clients to do, is get a very inexpensive glucometer and know in your head, “I did the finger prick, and it said it was 90. My CGM said it was 100. It’s about 10% off.”

What I really love is it shows you trends. That’s really what we’re getting down to. We’re not trying to change one number; we’re trying to change our lifestyle over weeks and months. Those small choices you make for breakfast or dinner or even shutting down the kitchen three hours before you go to bed, that can completely change your glucose patterns overnight.

I mentioned the stress connection. It’s really fascinating. These little changes can make a big change in your blood glucose.

Dr. Eric:

I agree. How long do you usually have your clients wear them? Is it usually two weeks? Do you have them go longer? It might also depend on the situation.

Leah:

For my group programs, we do four weeks. The first two weeks, we just collect data. How is that oatmeal affecting you? How is that glass of wine affecting you? People need to see how what they have been doing in the past has been creating this internal story of why their A1C is a certain way, why their blood glucose is a certain way. They need to see it first.

Then the next two weeks, it’s like beinga data scientist and experimenting. You experiment on yourself. “What if I change my oatmeal in the morningto eggs and avocado? How does that change my blood sugar levels? What if I don’t eat three hours before bedtime? How does that change my blood sugar? What if I add more protein to my daily diet? Instead of getting 55g a day, what if I up it to 75g a day?” All of these things, we experiment with.

Most of my clients love this experiment so much. They end up graduating from the program and getting another CGM and doing their own experiments ongoing, which is cool. I love that. I love that they have that empowerment of knowledge and what they can do with it.

Dr. Eric:

Awesome. I was going to ask you about the diet. Part of the diet depends on the CGM. I also assume that you have certain guidelines. You’re not going to say eat anything. Go eat refined foods and pizza. If your CGM looks fine, which it probably won’t, but if for any reason it does, it’s fine to eat those foods.

I assume you recommend whole, healthy foods. I don’t know if you’re more plant-based or carnivore. Can you talk a little bit about the diet that you recommend to your clients overall? Based on the CGM readings, make whatever modifications they need to make.

Leah:

I have yet to see someone go ahead and eat all processed foods and not have their CGM show them that is not going to be healthy for them. But you never know, it might happen.

I believe that there is not one diet that is perfect for everyone. I think everyone is biologically unique. I use some therapeutic diets with clients. I will use therapeutic ketogenic diets or more of a carnivore for a period of time. It depends on the client and what their needs are.

In general, I think I could probably say a blanket statement of most of us are eating too many carbs. We could lower that number. Most of us could eat more whole foods. Most women, especially in their 40s, 50s, and beyond, could eat more protein. Those are blanket statements, but I find 99% of people fit that mold.

Dr. Eric:

I’ll ask you the protein question. Everyone has their own opinion. How much protein do you typically recommend?

Leah:

I find if I tell my clients- Again, I work with women in perimenopause, menopause, and beyond, 40s, 50s, and beyond. If I tell them their goal is 100g per day, that’s actually difficult for a lot of women, just getting to 100g.

Would I like to see that number higher for some people? Absolutely, especially for my clients on GLP-1s, I want that number of protein to be much higher. If anyone is dealing with for sure muscle loss, as we age, that’s a big factor. A lot of women are dealing with that. They’ll have more protein. Even getting them to 100g, which is about 33g per meal if they’re eating three meals a day, that is a feat in itself. We start there.

Then we assess. How are you feeling? Most of them feel amazing after getting 100g. They actually want to increase their protein. Then we increase from there.

There is a formula that you could use if you wanted. There is a lot of opinions out there. What I find works for most people is if you take your ideal body weight and multiply it by .7, that’s the minimum grams you should be trying to get.

Dr. Eric:

Ideal body weight-

Leah:

Ideal body weight in pounds. Multiply it by .7. That gets you your goal in grams for protein.

Dr. Eric:

Okay. Your ideal body weight x.7 would be the grams in protein you should be eating, correct?

Leah:

Minimum, yeah. I think it works out. A 150-pound person is going for 105 grams per day, minimum.

Dr. Eric:

Okay. How about supplements? Do you recommend any supplements to support blood sugar? There are things like berberine, alphalipoic acid, others.

Leah:

With my clients, we keep it really simple. I find if I throw a bunch of supplements at people, they miss the main part of this whole journey, which is food. For me, the biggest piece of the puzzle is what you’re actually eating in terms of food. I will give them things.

I mentioned magnesium, which isn’t necessarily specific for blood sugar, but I find it helps amazingly with stress and sleep, which then helps with blood sugar.

One of my most favorite tools is apple cider vinegar. We’ll do a tablespoon or two of that in a small amount of water before meals. That actually is incredible. It does incredible work with lowering their blood sugar.

Cinnamon as well.

Some people use berberine, but again, it’s usually that extra layer where women just can’t think about adding another pill to their already large, long list of supplements they’re doing. We keep it very simple. Cinnamon and apple cider vinegar are the go-tos.

Dr. Eric:

Makes sense. You mentioned GLP-1s. If your clients are on GLP-1s, they might need more protein. What percentage of your clients are on GLP-1s? What are your thoughts on that? I assume they’re on it prior to seeing you. They’re already taking it before seeing you.

Leah:

It varies quite a bit. I tend to be the last resort. They will try it before they go on GLP-1s. A large percentage of my client base is like, “Okay, let’s try this CGM. Let’s try managing blood sugar and get this stubborn weight off.” It’s usually a weight thing. That’s why people are coming. It helps a lot more than just weight, I’ll say, but that’s usually why people come in the door.

A lot of my clients actually, after they have done this process of discovering how a CGM is outlining what foods are good and bad, how their diet needs to change, they end up not doing the GLP-1.

I’m not against it. I’m actually in this neutral boat right now with GLP-1s. I have my reservations. I also have seen it have amazing outcomes for people. Let’s talk about it on an individual basis.

If youare going to go on it, here’s what you need to do. The protein is a big one obviously. Weight lifting. Retaining that muscle is a huge component of it.

But you asked what percentage of clients are on it. I would say not that many. 10-15% possibly. I’m usually the last resort. Let’s try this first before I go on GLP-1s.

Dr. Eric:

I was just curious. It makes sense. Try to do everything you can from a diet perspective. Not to say there is not a time and place for the GLP-1s. With this, we’re also on the same page. If they decide to take it, that’s fine. If you could avoid taking it, that’s great.

A couple of things before we start wrapping it up. Intermittent fasting. I wanted to get your thoughts on that. You also mentioned that protein can be challenging. If eating three times a day, it could be 33g per meal. Depending on how long you’re fasting, that can sometimes even be more challenging. Is intermittent fasting something you recommend? 16-8 fasts for example? Or is that not usually something that you-

In my case, I’m not against intermittent fasting, but it’s not something I tell my patients, “Let’s go ahead and do 16-8 fasting.” Some people I work with, I wouldn’t want them to do 16-8 fasting. If someone has hyperthyroidism, and they’re losing a lot of weight, or other reasons why I may be cautious in some cases. I’d love to get your perspective on it.

Leah:

I love that you brought this up. I’m going to be honest. I made the mistake when I first started working with clients of recommending it to almost everyone. What I learned as I went is that it’s an incredible tool. I love intermittent fasting. It’s an amazing tool, when used at the right time for the right person.

The mistake that I made, including on myself, was when you throw someone into intermittent fasting, and they’re not physically ready for it, it can have counter effects. It can backfire. They won’t feel good doing it. They won’t get the outcomes they’re looking for, and they will probably hate you as a nutritionist. They’ll be out the door.

If you are someone who is considering intermittent fasting, you need to ask yourself first, “Am I metabolically flexible?” What I mean by that is: Is my body only capable of burning glucose, mostly from carbs, or can I flex and burn ketones as well? Can I utilize ketones in the body? If they cannot, if they’re not there yet, then it’s not a great option for fasting yet.

But you can change the metabolic flexibility of your body. You can teach it to be more flexible and burn ketones. When you do that, fasting can be an amazing tool for these people.

I don’t know if that made sense. Yes, I do use fasting. 18-6, fasting for 18 hours, keeping that window of eating to six hours is the first step. No, it’s not. Getting people to fast overnight, 12-14 hours, that is the first step. I’m shocked athow many people don’t do that. That should be a baseline for everyone. We were meant to fast overnight. That’s what break-fast is: you’re breaking the fast.

If you are considering going into some 18-6 or other intermittent fasting diets, you need to look at your schedule and figure out when you close down that kitchen and when your first bite is in the morning. If that is not a minimum of 12-14 hours, start there. Then go to 18-6.

See how your body feels. You might have to take a step back. You might have to increase protein and healthy fats. Building that foundation of hormones in the body, getting that body to be metabolically flexible.

I do have clients who go into OMAD, one meala day, or TMAD, two meals a day. I do find that the trickiest part for that is they love how they feel so much that they want to keep fasting. Then you have to pull them back and say, “We need to make sure you’re getting enough protein.”

Having one meal a day for once a week is perfectly fine. You could make up your protein needs on the other six days. When people start doing it seven days a week, we need to look carefully. Are you actually getting the nutrients you need?

I wouldn’t just jump into it without someone overseeing your diet, is what I’m trying to say.

Dr. Eric:

I agree. That is a concern. Getting one meal a day, you’re probably not getting enough protein. You might not even be getting enough nutrients. If you are doing that continuously. Short-term is a different story.

The final question I want to ask you is exercise. You did mention resistance exercise, which is pretty common for building muscle mass. A lot of practitioners recommend that these days. Do you recommend any cardio? What typically do you recommend from an exercise standpoint?

Leah:

Good question. I’m not an exercise physiologist or trainer, so I’ll put that out there. What I have seen with my clients is many of these women are coming in stressed out and exhausted. I am not telling that woman to go lift heavy things in the gym every other day.

For that woman, that is starting with walking, or any movement that feels good where they are focusing on their diet first and dialing that in. As they start to feel better, they’re sleeping better, their stress level is going down, they’re feeling more energetic, then we’ll talk about, “Can you lift heavy weights?”

Maybe that’s body weight first. There’s no shame in that.I have a lot of women who are just doing body weight exercises, and they’re feeling great. They’re retaining their muscle, and they love it. Other women are moving on past that and lifting heavier things. That’s great. You and I both know that as we age, we lose muscle faster.

You have to just take a step back and think, “What does my body need right now?” We live in this culture, “You must lift heavy things. You must go to the gym 3-4 days a week.” Maybe not right now. Maybe start with treating your body a little bit kinder. Start with diet. Are you hydrated? How is your stress level? If you’re not sleeping well, why would you go to the gym four days a week and tear down your muscles? When will they repair?

It’s a very specific individual choice for each woman. Each woman needs to take a look inside and see where they’re at right now. If you don’t have your diet, sleep, and stress dialed in, I don’t think you should go do resistance training four days a week.

Dr. Eric:

Okay. Thanks. You’re right. Ifsomeone doesn’t have their diet dialed in, if they’re still eating refined foods, fast food, not to say they won’t get any benefit from resistance exercise, but I would agree. You want to start withdiet and lifestyle. Exercise is part of lifestyle, but the diet and even stress management- All of these things are important.

It’s great that you take that step-by-step approach. This is the order that you should do it in, not just telling them, “Go to the gym. Go do some resistance exercise. Go block out 30 minutes a day for stress management.”

Leah:

I read this study. I can’t remember what the name of it was. They looked at the health of people who did a 30-minute block of exercise versus 2-3-minute blocks 10 times spread throughout the day. The people who had the better metabolic shift intheir body were the people who had the small increments spread throughout the day, versus the people who did the 30-minute increment one time per day.

It goes to show that sometimes, what we think is the best for us might not be. If you are sitting all day at an office or desk, getting up once an hour for two minutes is going to be better than if you struggle to fit that 30-minute training session in, and you sit the rest of the day. I thought that was fascinating. Any movement is better than nothing.

Dr. Eric:

Agreed. Thanks for this conversation. Obviously, we could easily talk for another hour. This is a conversation that it’s hard to fit in everything in a short period of time. Overall, I think you shared a lot of great information.

For those who are interested in learning more about you, including the program you mentioned, where can people find out more about you, Leah? How can they join the program?

Leah:

Thanks! The easiest way is to go to my website, LeahVachani.com. From there, I havelinks to everything, to Instagram, YouTube, the course signup. It is a group program that we do periodically throughout the year. It’s not a DIY. It’s pretty cool. There is community that we build. You get Zoom coaching calls. That’s nice to feel part of something. They can join there.Get on my mailing list. That is the best way. You will get discounts, too.

Dr. Eric:

Awesome. This was great. Appreciate having this conversation.

Leah:

It was my honor. Thanks for inviting me.

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Dr. Eric:

That was a great conversation with Leah. Spoke about blood sugar and sleep. She mentioned how she focuses on blood sugar first if someone is having sleep issues, simply because this could impact sleep. It makes sense that if you are having sleep issues, what is the cause of the sleep issues, and focusing on diet and lifestyle. Directly helping with blood sugar can greatly help someone get better sleep.

Blood sugar and stress. She discussed how stress can affect the CGM readings. A lot of people don’t think about the impact of stress on blood sugar. Obviously, we realize the impact of diet on blood sugar. If we are eating a lot of carbohydrates and refined sugars, stress can have an impact. Diet and stress management can help with blood sugar, which in turn can help with getting a better night sleep.

She recommends magnesium to help with sleep. It could also help to some extent with blood sugar. I didn’t ask her what type of magnesium. I like magnesium glycinate. Magnesium malate if someone has constipation. Maybe magnesium citrate.

Magnesium in some cases can help with sleep. It’s usually low-risk. Usually, it won’t cause side effects other than- Everybody is different. I can’t say 100% it can’t cause side effects. Anything can. But minimal risk.

If someone has enough magnesium in their system, and they take more, it could cause loose stools, sometimes diarrhea. If that happens, you know that you don’t need to take magnesium.If you take a few capsules, and you get loose stools, then you might want to back down to one capsule per day.

We spoke about optimalranges for blood sugar markers. I have had a number of other natural health care practitioners on the podcast, a few who spoke about blood sugar. It seems like 5 or less is ideal for insulin. I agree. That would be ideal. If someone is a little bit higher, like 6, 7, 8, I usually don’t get too concerned.

Leah agreed. She didn’t know that’s what I think about insulin. Less than 5 is great. She said as long as it doesn’t exceed 10. If it’s 9 or 10, I’m not crazy about that, but it depends. If someone is an 8, and everything else looks good, and the hemoglobin A1C looks okay, maybe it’s all right.

Speaking of hemoglobin A1C, 5.7 typically is when someone is in that prediabetic range. She likes to see it below that. She didn’t give a number. I have had other experts say even with hemoglobin A1C, they want to see it at 5 or less. If I see it at 5.2, 5.3, I don’t get too concerned. You might want to keep an eye on that. Maybe incorporate a CGM.

I was giving her examples where you might have one marker looking good and the other marker not looking as good. Which one do you trust? Maybe just retest them. If you see that pattern, where insulin looks good and hemoglobin A1C doesn’t look good or vice versa, maybe you get a CGM.

Speaking of CGMs, the margin of error we discussed. It’s important because when I was using a CGM- I don’t use one regularly. I tried one for two weeks. I forget if the company sent me two or if I ordered two. I got two CGMs. I used one of them for two weeks. Then I took a break. At a later date, I used the other one. You integrate it with an app.

At first, I was seeing the numbers were in triple digits. That’s not what my blood sugar usually is. Then I learned about calibration and got a glucometer. I pricked my finger for three days in a row. As she mentioned, the over-the-counter ones, which were not the ones I used, I didn’t know that you can’t calibrate them. You can still do the glucometer; you just can’t calibrate it.

You could prick your finger, and if you see 2-3 days in a row your morning fasting glucose is, let’s say, 95, and the CGM says 105, you know there is a 10-point difference.

Apple cider vinegar. She recommends one or two tablespoons of raw apple cider vinegar for blood sugar. She also recommends cinnamon. You could easily integrate them. Get some organic apple cider vinegar and maybe some cinnamon. Everybody is different, but there are some studies showing that apple cider vinegar and definitely cinnamon to some extent could help with blood sugar.

I can’t say I recommend for everybody to take supplements, but I do like berberine, alpha lipoic acid. To me, those aren’t long-term solutions. Sometimes, they could speed up the process. If someone takes them temporarily for a few months, obviously, and incorporate diet, stress management. She tries to minimize supplements, which is fine. I don’t overload people with blood sugar supplements. It’s something that is in my toolkit.

Intermittent fasting. This is where we differ a little bit. Well, with supplements, but I don’t give a ton for blood sugar. For intermittent fasting, she starts with having people do an overnight fasting, 12-14 hours. That part, I agree with.

Then it sounds like she recommends an 18-6 fast to some of her clients. It sounds like if they tolerate a 14-hour overnight fast, then she will jump into an 18-6 fast. Maybe it’s not across the board, and it was my mistake for not asking her. We both had a time crunch when we met.

Sometimes, when I do an interview, the person has a little bit more time if we go over the hour. Even if the interview is not exactly an hour, it’s not like we meet and press record right away. Usually, we talk for a few minutes. If someone has to go at the top of the hour, then I make sure that we’re done a few minutes before. She had something going on. I knew she had something going on, so I scheduled something as well. We had less than an hour for this conversation. Still covered a lot, but I didn’t have time to ask her a few questions, and that was one.

I am not a huge fan of regular 18-hour fasts. I have spoken about this on the podcast. Even for some people, 16 hours is too much. The concern with 18 hours, and we spoke about this a little bit, but getting enough protein. If someone is eating one meal per day, it’s hard to get enough protein. If someone is eating two meals a day, and they only have a six-hour eating window, every two hours, they could get some protein in. I still find it’s really narrow. I am not saying every now and then, but on a daily basis, that’s extreme.

I don’t know how long she recommends it. Maybe she only recommends it for a few weeks, which for some people, might still be a long time. If it’s a few weeks or throughout her program, which I think is four weeks, then that’s not too bad. I think really long-term, you want to be careful about doing too long of a fast. An 18-6 fast continuously is not a good fit for everyone.

Everybody is different. Some people will do fine with longer fasts. Like I said, the concern is not getting enough protein or nutrients in general.

That is it. Really enjoyed talking with Leah. Hope you enjoyed the conversation on blood sugar imbalances and CGMs.