The Hidden Epidemic of Low Thyroid Function | Know Your Numbers

Mark Hyman, MD

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Dr. Mark Hyman: Coming up on this week's episode of the Doctor's Pharmacy from 2009 to 2019, the percent of our population with low thyroid function went from 4.6% to 11.7%. So what is going on with the more than doubling of the prevalence of thyroid problems? Welcome to Doctor's Pharmacy. I'm Dr. Mark Hyman, and that's pharmacy with an alpha place for conversations that matter. Welcome to my new podcast series called Know Your Numbers. It's designed to help you understand how your body works, what your own lab and biological data means. The lens of functional medicine, which is a science of creating health. Now for too long, healthcare has required you to go through your doctor to access your own blood tests and biology and rely solely on your doctor to guide you. But we are now entering an era where each of us can access and understand our own biological data and become the CEO of our own health. Know your numbers will help you understand key lab tests that you need to track for your health, including critical tests that traditional medicine often ignores. You're going to learn how to interpret your own lab tests, the true optimal ranges, and understand how all your biomarkers relate to one another. And most importantly, you're going to learn how to optimize your health based on your own personal medical history and biological data. You're also going to learn when it's important to go see your doctor for further testing or treatment. Now, in a perfect world, I'd have the chance to see millions of patients, but the truth is, I'm just one doctor. After over 30 years of seeing millions of biomarkers in tens of thousands of patients, I've come to understand that much is being missed by conventional healthcare. We often wait until we have symptoms or diseases and then get tested, but the transition from wellness to illness can often be detected decades before any symptom or diagnosis. I want people to have access to their own health data and the ability to engage in self-care and lifestyle practices that can optimize health. And that is why I recently co-founded a company called Function Health, where I'm the Chief Medical Officer. Function is a revolutionary new way to understand and manage your health through lab testing that you are not often getting through our healthcare system. All the results are delivered into an easy U2 use dashboard that tracks your numbers over time and gives you actionable insights for every biomarker. We're able to function to democratize much of what I do and give you the keys to your health and put control of your health firmly back in your hands. And now let's get started with this week's episode of Know Your Numbers. Now, do you feel fatigued, lethargic, sluggish, especially when you wake up in the morning? Do you have poor quality cracked nails? Are you cold all the time? Do you have dry skin, coarse hair or hair loss? Maybe you're a little depressed or constipated. Do you have muscle pains and joint pains? Have you lost your outer 30 of your eyebrow? Maybe you have trouble losing weight no matter what you do. Well, if your answer is yes to any of these questions, you may be suffering from a condition that is super common, underdiagnosed and potential life-threatening called hypothyroidism. This occurs when the production, conversion or action of your thyroid hormones in your body is not working or inhibited, resulting in too little active of thyroid hormone in your blood. Now, while the symptoms above might not sound like a major problem on the surface, a problem with your thyroid can actually have catastrophic impact on your health and also on your weight. It's often a hidden factor in many diseases including depression, heart disease, chronic fatigue, fibromyalgia, PMS or premenstrual syndrome, worse menopausal symptoms, muscle and joint pains, irritable bowel syndrome, constipation, autoimmune diseases, and obesity. Now, when I see anybody with a chronic illness, I always think that thyroid may play a role. Now, is this a big problem? Well, heck yeah, it's a big problem. One in five women and one in 10 men have low thyroid function. 38 million Americans are suffering from this. Now, from 2009, this is interesting, from 2009 to 2019, the percent of our population with low thyroid function went from 4.6% in 2009 to 11.7%. So what is going on with the more than doubling of the prevalence of thyroid problems? Now, the other issue here is that 60% don't even know they have a problem. It's like, oh, I'm a little tired, or I'm a little, my hair's a little thin or I'm constipated, or my mood's a little low, my sex drive is down, or my cholesterol's a little high, and they don't connect the dots between what's going on and their thyroid. And a retrospective analysis In 2022 from the Journal of the Endocrine Society, they found that untreated hypothyroidism went up from 12 to 14.5%, and if it is untreated, it increases your risk of heart disease, heart attacks, cognitive decline, and even early death. Now, what are the common symptoms of a poorly functioning or low thyroid condition? While you're fatigued, you're lethargic or sluggish, especially in the morning. You may have brittle or cracked nails. You might be cold a lot when other people are fine. You're cold. You might have dry skin, mouth eyes, coarse hair. You might have hoarseness of your voice, hair loss, which is not uncommon, especially the outer third of your eyebrows. You might have depression, constipation, joint and muscle pain, hard time losing weight. Cholesterol might be high, your blood pressure might be low. You might have irregular periods, weird menstrual cycle, severe PMS, menopausal symptoms, low libido and sex drive, maybe trouble with memory, focus concentration. Now, any of these can just seem kind of like normal things that happen as you get older, but they're not. They're often untreated thyroid issues. The other issue is that there's a lot of autoimmune thyroid condition going on and 90% of the low thyroid conditions, not just low thyroid, it's an autoimmune disease and it's the most prevalent autoimmune disease we have in America. It's called Hashimoto's thyroiditis, and essentially it's your immune system making antibodies that attack your thyroid as if it was a foreign body. And it's much more common in women. Like I said, one in five women and one in 10 men have thyroid issues, but this is 10 times more common in women. There may be some genetic or hormonal factors, and it affects men as well though. So it's can cause erectile dysfunction, low sperm count, infertility, low libido, hair loss. So it also affects men. High thyroid function or hyperthyroidism. It's not as common, but when your thyroid makes too much thyroid hormone, it's overactive and it's basically the opposite. You're on speed, your blood pressure's high, you lose weight, you're hungry all the time, you can't sleep, you're anxious, irritable, you have diarrhea. It's sort of the opposite. And the common cause of this is Graves disease. Four out of five cases of high thyroid in America is Graves disease, another autoimmune disease, and this affects about one in hundred Americans, and it can cause quite severe problems and in cause goiter and could be causing eye issues and quite issues, quite a problem. Now, what is your thyroid? Where is it located? Well, it's an endocrine organ, produce hormones. It's a butterfly shape. It's right in front of your neck here, below the atoms, apple and above the collarbone, and it basically functions as a regulator, the control center of your body. It's like the master regulator of your metabolism. Think of it like the governor on your car. If you got those golf carts or those electric bikes only go to a certain speed, but because it's got a limiter on it, that's kind of what it's, it's kind of the governor. And the slower it is, the slower everything is. It slows your metabolism. It's really important. So what does your thyroid gland do? It regulates metabolism. If your thyroid's working properly, increases energy production, fat burning, mitochondrial function makes your body temperature and the proper regulation, it can affect growth and development. It's really important for fetal brain development, nervous system development. In fact, the whole term, cretinism is a horrible term by the way, but that was used to describe low thyroid in babies. When mothers were hypothyroid and they gave birth to babies, they would be cretin because of the effect of low thyroid during pregnancy on the fetus and the development, it also regulates your heart function. So heart rate, cardiac output, very important, muscle function, bone health, brain function, mood, cognition, the making of new brain cells. It regulates your body of calcium and phosphate levels, and it promotes the storage of calcium in your bones. If you're hyperthyroid, you can actually lose bones pretty quickly. Also, as I mentioned, really important in reproductive health, fertility hormone balance, all the symptoms of PMS. Weird periods all common in people with low thyroid function. And it also is involved in sort of a crosstalk with your stress hormones, your sex hormones, your adrenal hormones. So it's really important. It's not just isolated. You've got this hormonal soup of sex hormones, thyroid hormones, adrenal hormones, insulin, they're all connected. Now, when a healthy thyroid works properly, what happens is that the brain, the pituitary, which is the commanding control center, gets a message from the hypothalamus that says, okay, it's to release a little more thyroid. You need a little more. So the hypothalamus releases something called thyroid tropin releasing hormone or TRH, and that tells the pituitary to make thyroid stimulating hormone or TSH, which is the test that is usually done by most physicians. Now, this is inadequate in and of itself to properly diagnose thyroid problems, you need to look at the full spectrum of thyroid tests. You don't get that. You get instead of one test by your doctor, you get five, you get T, s, h, the free T three, free T four, and thyroid antibodies, two different ones, we'll go through those in a minute. But your TSH is really important because it stimulates your thyroid to produce a little more than thyroid hormone. So you produce mostly T four and a little bit of T three. Now, T four is the inactive thyroid hormone. 90% of the thyroid hormone produced in the thyroid gland is T four, and then the T four gets converted to T three and the thyroid, the liver of the kidneys, Avaya and enzyme called five prime diad. You probably need to know that, but it's important because this enzyme can get screwed up by a lot of things. If you're low in selenium, which is the main enzyme that activates it. If you have heavy metals, if you have yeast, if you have neurotoxins, various factors will cause this enzyme to not work properly, which causes low T three. Now, most doctors even don't properly check these. They check total T three or total T four. You want to check the free form, which is the active form. That's what we do in functional health. The next thyroid hormones is T three or tri IO tine. Thyroxine is T four, and this is the active form of the hormone is 10% is produced in the thyroid gland, but then the rest is converted in your peripherally in your tissues from T four to T three, and T three is the actual actor in your body. It binds to the thyroid receptors on the nucleus of your cell. So it really is a transcription factor for gene expression. So important. That's why it regulates everything. And it forms a complex with this thyroid response element on your DNA and at leads to protein synthesis. And really important because the binding of this requires vitamin D and vitamin A. And so if you have low levels of these nutrients, which is common, your thyroid won't work properly. T three basically ensures every system in your body is working at the right speed, your metabolism, fat burning energy production, your cholesterol memory, your hair growth, bowel speed, your weight, everything. When it's too high, then the feedback loop comes to your brain and says, okay, lower TSH, and then it hals to TSH production. So it's not telling your thyroid to make more. So it's kind of a constant feedback loop of hormones. Now, what's happening when your thyroid's too low, when you have hypothyroidism, we have too little T three or maybe not a conversion of T four to T three, or you have low TT four two, T four also, I mean not T four two, although there is a T two. And so what happens then? Well, your metabolism goes down, you gain weight, you have trouble losing weight, you get cold, you can't warm up your cholesterol's high, your mood's low, your libido's low, you don't want to have sex. All the symptoms we talked about. And when you have this, it's usually often caused, like I said, nine times out of 10 by an autoimmune disease called Hashimoto. So we got to check those thyroid antibodies, and it's amazing how many people have elevated antibodies. We compounded 12% of our people that we tested in over 20,000 people had elevated thyroid antibodies, meaning they had an autoimmune thyroid condition that mostly was undiagnosed. And this was shocking because it does affect everything and it affects people's wellbeing. And these are people who are doing function or typically are health forward people and generally healthy. So it was very disturbing for me to see the prevalence of this autoimmunity in the population and what measures thyroid peroxidase antibody their TPO, and it basically adds an iodine to the thyroid globulin to make thyroid hormone. And when you have antibodies against this hormone, this enzyme, it basically inhibits the process of making thyroid. Your immune system is basically making these other antibodies too called thyroid globulin antibodies and thyroid globulin is the precursor of thyroid hormone. So it's like the building block and then the thyroid globulin antibody attacks the thyroid globulin protein, and you can't make thyroid hormone. So you end up with these two different antibodies through different mechanisms causing a slowdown of your thyroid. And what happens is you get into all these troubles that we mentioned and it's really fixable and we have to get to the root cause. Now we're going to talk about what that is and how to deal with this. Just a little note on high thyroid, if you have too much T three or T four because of another autoimmune condition called graves disease, it causes the opposite phenomenon. You get increased metabolism, weight loss, sweating, nervousness, heart racing, palpitations, trouble sleeping, your eyes bulge out, your heat intolerant instead of cold intolerant, your irritable, you have diarrhea, hair loss sometimes too, and maybe you lose your period, you be shaky and tremors and you might have a goiter. So these are the common things you get with high thyroid. Now, again, that's very rare compared to Hashimoto's is one in a hundred versus one in 10, although it seems like it's maybe more than one in 10 based on our data. So who's most at risk? Obviously women, as I mentioned, and it's really common in pregnancy, you see this a lot. You get postpartum thyroiditis and in pregnancy increase the demand for thyroid hormone. It can mess things up. Menopause, you'll see this often. Estrogen affects thyroid globulin and also, so if it estrogen is too high, you get all sorts of things like PCOS, fibroids, endometriosis, basically you get less T four. And sometimes you'll see also lower globulin and menopause where you'll have decreased thyroid hormones. So there's various ways in which your sex hormones interact with thyroid hormone that kind of mess things up. But we also know that we see the autoimmune thyroid condition associated with other autoimmune conditions like celiac disease. And one of the biggest things, and I've seen this, I would say probably about 35% of the patients that I have have high level of gluten antibodies or anti glidden antibodies, meaning they have some degree of gluten sensitivity or celiac that's causing the Hashimoto. So often getting off gluten will really help. Getting selenium will help and a lot of things we'll talk about in terms of treatment. Also, you might have lupus or rheumatoid arthritis or Sjogren's, which is where you get dry eye mouth and other things. Type one diabetes, Addison's disease, which is an adrenal autoimmune disease, pernicious anemia, which is inability absorbed b12. So you get all these different problems that are a result of some trigger or some factor that's causing the autoimmunity. So the key in functional medicine is to get to the root cause, and we're going to talk about that. Now, there's some genetics involved. There may be a family history of thyroid issues. It's common as we get older over 60. But the issues, why are we seeing this increased prevalence? I mean it's in the population, it's always been, but it seems to be increasing. So why is that? One of the reasons I think is because of the type of gluten we have. We basically changed the gluten in our environment from being these heirloom wheats and grains to a dwarf wheat, which has much higher numbers of glide and proteins, more inflammatory proteins, more starch and sugar, more likely to cause injury to the gut and leaky gut. And this whole cascade about immunity. And we see this link very clearly in the literature of scientific literature. And by the way, all of the things that I'm saying are referenced and we're going to include all these scientific reference, the show notes if you want to go ahead and have a look at those as well. So celiac prevalence is four times higher in those with autoimmune thyroiditis. So it's a well established fact. Now, if you have non celiac gluten sensitivity, not full blown celiac, it can cause again, a lot of thyroid issues. There's something called molecular mimicry where gluten resembles something called transglutaminase, which is in the thyroid gland and it's also present in the gut, and then it attacks the thyroid gland at the same time as attacks gluten. So you get this kind of cross activity. So you basically, the gluten creates this autoimmunity is essentially what I'm saying. The other big factor is thyroid is like the canary in the coal mine in various sensitive to environmental toxins. They used to put a canary in the coal mine and when the air was bad, the canary would die and the coal miners knew to get the heck out of the coal mine because they were going to die too if they stayed there. So our thyroid is kind of like our canary, and I've written an article about this. I'll post it as well as in the show notes. It's Arnold. I wrote a medical journal about thyroid, but endocrine disrupting chemicals are common. They're everywhere. It's basically the petrochemical plastics in a 2021 review. And nutrients use endocrine disrupting chemicals are found in food and food packaging and our water and our personal care products, things like BP, a, phthalates, flame retardants, PCBs, and they basically interfere with our thyroid gland and they interfere with thyroid hormone transportation in the body. Also, heavy metals are another big one. Mercury lead arsenic, another big factor if you see higher levels of mercury, so you lower levels of T three hormone. So I think it's really important for people to make sure that they attest these things. Also, air pollution, not something we can do a lot about except have an air filter. But a 2020 review found that there was higher levels of autoimmune thyroid disease in people who lived in polluted areas, near petrochemical plants where there was maybe cement plants where they were contaminated with pesticides in the environment or PCBs. Also, mold which is ubiquitous can definitely cause thyroid issues. Also, the thyroid gland and function depends on a lot of nutrients and there's so much nutritional deficiency in this country across the board. This is based on national surveys and testing of the American populations and not my opinion, there's 90 plus percent of Americans are deficient in at least one nutrient at the minimum level. The RDA probably 80% are deficient in vitamin D, which is important for thyroid function. 45% are deficient in magnesium. Omega threes probably plus 90 plus percent. So the thyroid needs all a lot of co-factors and helpers. For example, selenium helps convert T four to T three, and that comes from Brazil notes, for example, iodine, which is from fish and seaweed actually is needed to make the thyroid hormone. The very hormone, thyroid hormone is built from iodine molecules also needs zinc, which helps make thyroid releasing hormone. TSH, thyroid hormone needs vitamin A and D to synthesize thyroid hormone to activate the receptor. And gene expression also needs B12. So these are really common problems. We see a lot of zinc deficiency, vitamin D deficiency and so forth. Also stress, we know there's a huge interaction between stress response, your adrenals and your thyroid gland. You really work in tandem. So too much cortisol can interfere with your thyroid hormone production. And we see this, people who have chronic stress will get hypothyroid symptoms and they will sort of down-regulate this. And we see this in chronic disease, it's kind of hypothyroidism of chronic illness. Also even any kind of stress inflammation, anything kind of inflammation. And by the way, we are all inflamed. Our bodies are inflamed for eating ultra processed foods, sugar starch, and that messes up thyroid hormone production through interfering with TSH secretion. Also, a lot of people legalize sugar and starch should get imbalances in your gut microbiome. You get used to overgrowth that can really drive it as well and certain medications will interfere with it. So conventional medicine is not terrible at this, but it's not great either. And I could say this is one of the most satisfying areas of functional medicine for me because we can diagnose what's going on. We are aggressive in diagnosing it based on any symptoms we screen for these questions. And many of these things we call subclinical hypothyroidism. So it may not be overt, but it may be or not be fully expressed, but it may be a partial problem with your thyroid gland that's causing thyroid function and you might not know and it can often go undetected. And in fact, 50% of the time it's undiagnosed. Now, conventional medicine doctors do not run a full thyroid panel. Really important. They only usually do TSH. And also it's important to know that doctors are kind of habits of creature. We have these order forms or these basically sheets that we check off with thyroid hormone testing and there's panels on there that are decades old. Before we had newer assays that could measure free T three, measure free T four. They do things like total T four or free thyroxin index or T three uptake. I mean just stuff that's, it's just so out of date and it's just checked on the panel. I'm like, why are they doing this? It's like using basically a magnifying glass to look at the stars instead of a giant telescope. So it's really important to do the right test. When they do test, they usually only test TSH and they often will not test anything else. Sometimes they'll test free T four, but they don't test the most important hormone, which is free T three. This is the one that does the work. And they also don't test thyroid antibodies like thyroid peroxidase antibodies or antithyroid globulin antibodies. These are the autoimmune antibodies that we're talking about. So the reference range is also important to understand. The reference range goes from 0.5 to five. That's a tenfold range. Now what's the optimal range? Probably like one to two. And when you look at the American College of Endocrinology, they said the optimal range might be now not five, but maybe under three and a half. The National Academy of Clinical Biochemistry says anything over two and a half is abnormal. So the optimal range is probably like 0.5 to two at the most. And often their tests will come back normal, the TSH, but it'll miss the fact that the T three is low, that they're thyroid to antibodies. It may be in the upper range of normal. So you have to look at the whole issue, and this is why they go undiagnosed and untreated and they kind of wait until TSH is way out of range and then it's often too late or often you've already suffered for years. So the other problem is when doctors will prescribe thyroid hormone, they'll often prescribe the wrong one. They give you the inactive hormone, which is called levothyroxine or Synthroid. And the problem is a lot of people can't convert T three to T four fully. There's a lot of reasons for it. The environmental toxins I mentioned nutritional deficiencies, gut dysbiosis, stress, many things, cortisol, all these things interfere with this process. So the patient may get a little better but doesn't feel fully well. And so it's important to make sure you treat them the right way. And I'll talk about that in a minute. Now, from a functional medicine perspective, how do we look at the problem? The first is comprehensive lab testing. We have to look at the full thyroid panel, TSH, free T three, free T four, the thyroid antibodies, really, really important. We also need to look at the root cause because there may be other things we want to look at. Gluten, for example, if the thyroid's off, we look at cortisol, we look at other things that may matter, like CRP and white cell count. We look at the sex hormones to see what's going on there. We look at liver enzymes to see if there's toxicity. For example, you have elevated liver enzymes in 75% of Graves disease. We look at the metabolic health, blood sugar, insulin, and heavy metals like mercury and lead and arsenic. We can test as well. Iodine selenium. These are the things that you can add onto your test is function health if you're concerned. We also do the celiac panel, which looks at the full range of tissue transaminase, anti glidden antibodies. Really important to do the right test. Maybe it can also be some infections. Sometimes like Lyme disease is a big trigger of autoimmune disease. We might look at celiac genetics. So we do a lot of different things. We look at food sensitivities because that can play a role sort of gluten and many other food sensitivities. We might look at the stool test, look at the microbiome and leaky gut. So we go for the root cause and then we treat with the personalized treatment of lifestyle diet and supplements and medications if needed. So we really look at the whole problem. Now, what are the root causes of some of these abnormal biomarkers, right? You mentioned gluten, which can cause these abnormal thyroid antibodies. And you can even see abnormal antibodies, but normal TSH or normal free T three and four, and people are still having issues. It still affects how they feel. And if you're symptomatic, I treat them. This is my personal view. Now, this is what I've seen after treating thousands of patients with this. Sometimes your biomarkers will be off in pregnancy, they'll be off with chronic stress. You'll have high cortisol CRP, sometimes you're over exercising and your high level athlete that can affect you. Psychological stress, nutritional deficiency we mentioned mainly selenium, iodine, vitamin D, vitamin A, food sensitivities, particularly dairy soy. We'll talk about gluten and soy and dairy. Environmental toxins as we mentioned, endocrine disruptors, heavy metals, imbalances in the gut and leaky gut, various allergens, mold, various infections, yeast overgrowth. Medications sometimes can affect it. Birth control use can definitely cause thyroid issues. And it seems that based on large data from the NHANES trials, which was published in BMJ Open with British Medical Journal, if you were having a history of birth control for over 10 years, you had four times the risk of having a low thyroid function. Sometimes iodine absorption can be affected by estrogen, progesterone issues. So estrogen excess can also cause thyroid cell destruction. And why I'm saying this is because we often have a culture of high estrogen. We have lots of sugar and lots of starch that causes our body to put on more fat. Fat produces estrogen, not just your ovaries. Men can get high estrogen levels, so it's really common. Also sometimes if you're on lithium for psychiatric disorders, that can cause thyroid dysfunction. It's important to check that chronic use of anti-inflammatories like Advil ale, they interfere with the binding of T three and four. So I think there's some issues there. If you're on chronic steroids like cortisol, like drugs like prednisone, that can cause suppression, TSH, and various other drugs. So it's important to understand that there may be conditions related to some of these biomarkers we talked about and how to kind of look at all those together and be paying attention to sort of the whole picture, not just one test. So how do you address fourth thyroid function using functional medicine approach, using diet, lifestyle, getting the root cause? Well, the first is remove the bad stuff. Get rid of the inflammatory foods, ultra processed foods, things in a box package can artificial sweeteners, trans fats, sugar sweetened beverages, alcohol, gluten would be the first thing to go. Also, wheat, barley, rice, spell canot, oats, not oats are not healthy food. Trust me, I've written about this, but they're not a healthy food. A 2023 systematic review in meta-analysis published in frontier of endocrinology. And like I said, all these references are going to be in the show notes. They showed that a gluten-free diet for six months reduces the thyroid antibodies and reduces TSH, which is a good thing and increase T four. So this is just a simple gluten-free diet having a profound impact on autoimmune thyroid disease. So the impact of this gluten-free diet on a thyroid function, inflammation, patients with hypothyroidism is really important. Also, reduce your exposure to food sources of environmental toxins like mercury containing fish, tuna, swordfish, shark, king, mackerel, tilefish, Jillian, sea bass, all the big fish and there's lots of guides. We'll put a show note guide on how to use a, for example, lean NRDC guide on low mercury fish, also PFAS, which is plastic packaging, produce, packaging, packaged foods, pesticides, which are on our food use the environmental working group guides for reducing your exposures. You can go to ewg.org and it'll link to skin deep for healthy skincare products and healthy household cleaning products, what foods you should eat, what you shouldn't eat, for example, certain vegetables or foods are worse. Sometimes you might need to deal with food sensitivities like gluten and dairy and even soy and try and eliminating those. Coffee and caffeine may be an issue. Certain foods are called goitrogens. They can interfere with thyroid function, but it's usually raw foods. So raw soybeans or raw peanuts or raw spinach, raw turnips, rutabaga, cabbage, broccoli, collards, mustard greens, kale. People have kale juice like crazy. I don't think that's a good idea because you're getting highly concentrated amount. So cook your kale, cook your vegetables, and cooking really reduces that. So I think I highly encourage people to eat these cruciferous vegetables like broccoli, collard kale, but cook them okay and keep your serving of soy low, like less than half a cup per day. People are drinking like gallons of soy milk and so forth. Soy lattes, I don't recommend that. Also, eat real whole food. Get an anti-inflammatory diet. Get rid of the processed food, the ultra processed food. Get lots of good protein, fruits, vegetables, nuts, seeds. Whole grains can be fine if they're gluten-free. Sometimes paleo can be good for autoimmune disease with no grains or beans or dairy, but you can have fish, eggs, meat, fruits and vegetables, root vegetables. The autoimmune paleo is a little more aggressive. That takes out nightshades like eggplant, tomatoes, peppers, takes out nuts and seeds as well as grains and beans and dairy and coffee and alcohol. I don't recommend that that often. Only if someone's really stuck sometimes other things can be helpful. And increasing the conversion of T four to T three. If you are doing keto, that actually might not be good for your thyroid. It might be good for blood sugar, but you need a little bit of insulin to convert T three to four. It's all the right balance. So focus on balancing your blood sugar and also you need to add in the right nutrients, right? You need iodine when that comes from where fish, seaweed like wakame, nori, kombu, iodide, salt, selenium, which can be gotten from Brazil nuts about two a day. Some of the fish, the small fish, herring, mackerel, sardines, scallops are good at selenium. Omega fats also really important. I call it the smash fish. Small wild salmon, macro anchovies, sardines and herring on my favorite, but I dunno if you like them, tough for you. But I like them. Oysters, scallops, walnuts, flax seed, pumpkin seed, all are a great source of Omega-3. Vitamin D. Hard. You need a lot of herring or a lot of portini mushrooms, but basically sunlight's great. But taking vitamin DI think is really important considering how we live. Also, B12 important for liver function. Vitamin A for the binding, I mentioned that comes from animal foods primarily. You're not going to get it from plant foods, you'll get betacarotene, which has to be converted, but liver is the best source. Poultry also chicken, Turkey, lots of fiber for your gut. Nuts, seeds, all that's really helpful. Now, supplements, should you take supplements, yeah, I think sometimes it's important. Now if you have heavy metals or you have something like that, you need to be treated with proper metal detoxification and I, we'll cover that in this podcast, but we will do a session on heavy metals. You can just take a basic multivitamin and mineral Omega-3, magnesium, vitamin D. So it's really important to know what your numbers are and do your testing to see you're on the right dose. Sometimes if you're having chronic stress, sometimes the adaptogens can help like rhodiola ashwagandha, which are basically to help reduce stress and improve thyroid function. Lifestyle practices are also really important. So meditation, yoga, journaling, walking nature, breath work, whatever works for you. I like steams and hot cold lunges. Also help me relax and de-stress. Making sure you prioritize sleep. Seven, eight hours a night exercise. Make sure you do proper strength training and muscle building that helps glucose control and makes sure hormones are proper balanced and get rid of the toxins. As I mentioned, buy foods that are low in toxins. You can use the Dirty Dozen guide to avoid the most contaminated foods that you should not buy if they're not organic. And then you can look at the clean 15, which are maybe okay to buy if they're not organic. As I mentioned, the skincare product guide, the skin deep guide from the EWG is important. I always filter water. Some of these chlorinated things and chlorinated water, fluoride and water, they can really interfere with thyroid function. They're kind of like in the iodine family, so it can kind of screw up your thyroid function. So also reduce your indoor air pollution, which is a big issue is with an air filter. I encourage people to use a lot of saunas, hot yoga, hot bath, serum toxins. It was actually a study on red light therapy, believe it or not, that regenerated thyroid follicular cells. There were 43 patients, randomized controlled trial who had autoimmune thyroid issues. And when they had 10 sessions of red light therapy, they were able to reduce their, eliminate their thyroid replacement over 30 days. After nine months, they need to launch lower dose and they lower thyroid antibodies and their thyroid look better on ultrasound. So pretty impressive with red light therapy. And then if you need medication, and often you do, sometimes you do all these things, it can normalize, but you have to know what you're doing. Maybe work with a functional medicine doctor. But most doctors, as I mentioned can mention just use the T four, which is Synthroid, oxil, levi, thyroxine. And it really only leads to a partial improvement. For most people. They don't check T three and you need to take a T three as well. So there are versions of T three like tml that are short acting. They're sustained release ones that are compounded. I particularly like the desiccated porcine thyroid. It's called Armor Thyroid or Naturethroid. There's a whole bunch of them out there. Traditional doctors don't like them. They have this belief that they're not safe, that they're unregulated, that they don't, the doses are variable, that they cause all these problems, but they really don't. The one thing you have to know is if you're taking one of these compounds that is a natural thyroid, basically it's like mimicking our own thyroid like bioidentical thyroid. It does suppress TTSH. So you have, because T three feeds back to the brain to suppress TSH. So if you're taking T three, you'll get a low TSH and your doctor will think you're taking too much thyroid hormone. So you have to go by the levels of free T three and free T four, and you have to make sure you check in with your symptoms. How do you feel if your heart's racing and you're anxious and you can't sleep well? You're taking too much. If you have, you also want to check your bone density because taking thyroid can sometimes cause if it's too much, it can cause low bone density. So you want to make sure your bone density checked at baseline. And then over time, by the way, men and women both can have thyroid problems. So if you with hyperthyroidism, there's some other things that can be used. This is mostly just for low thyroid. For hyperthyroidism, it's a little bit different. They'll use beta blockers to slow your heart rate. They have antithyroid medication to slow the thyroid down. They use sometimes radio iodine therapy to basically nuclear thyroid or it's kind of a little riskier, but then you need to be on thyroid your whole life after that, which isn't the worst thing because I think of this as a natural molecule that our bodies make. So it's important to recheck regularly, your levels, make sure you're balanced to do all the other biomarkers we need to do. That's really why it's so important. And the function health panel, as part of your membership, you get the full panel of tests that helps you identify everything from heavy metals. And as I said, I was really shocked to see in the 20,000 people that have gone through so far that the prevalence of antibodies was 12%, which is a little bit high and means there's a lot of people walking around who don't even know they have this issue. It can be really hard to detect. So, and regular medicine kind of sucks at actually do proper screening and testing. And functional medicine is much better at looking at the root cause with comprehensive lab testing, a thyroid panel, hormone panels, toxin panels, sex hormones and inflammatory markers, cortisol and getting to the root cause. So once you do that, you can treat it all with basic lifestyle things. We talked about supplements, and often you'll see improvement. We talked about red light therapy. Selenium can lower it. Getting rid of gluten can lower it. So a lot of things will have an impact independent of taking medication. So as I said, if I could, I'd see millions of patients. But with function health, we're aiming to democratize much of what I do, offering you the keys to your own health. Now we're in a new era of medicine, a democratized data-driven healthcare system, giving each of us access to our own health data that's informed by the latest science and functional medicine. There's nothing more important I believe, than taking ownership of your health and function. Fills a lot of gaps in our strained healthcare system. Now, many of these essential tests are not measured in your typical annual blood panel. There's no more navigating burdensome insurance. No more having to wait for a doctor's appointment. No more need to consult doctor Google to figure out what they mean. Function offers clear actionable results tracked over time, empowering you to be the CEO of your own health. Now the wait list for function is now open and function is live across the United States and soon globally. We're inviting new members to join our wait list every day. If you're interested in taking control of your health, secure your spot on the wait list by visiting function health.com right away. All of this is available for just $499 a year and includes the cost of over a hundred lab tests and a repeat test at six months. So transform your health. Visit function health.com to secure your spot on the wait list. I would love you to leave comments or questions and share this with your friends and family. Subscribe wherever you get your podcasts. Leave a comment. We'd love to know how, for example, you've dealt with your own thyroid issues of what you've learned. And of course, follow me on all social channels at Dr. Mark Hyman. And thanks for tuning in to know your numbers. This podcast is separate from my clinical practice at the Ultra Wellness Center, my work at Cleveland Clinic and Function Health, where I'm the Chief medical Officer. This podcast represents my opinions and my guest opinions. Neither myself nor the podcast endorses the views or statements of my guests. This podcast is for educational purposes only. It's not a substitute for professional care by a doctor or other qualified medical professional. This podcast is provided on the understanding that it does not constitute medical or other professional advice or services. If you're looking for help in your journey, seek out a qualified medical practitioner. Now, if you're looking for a functional medicine practitioner, you can visit ifm.org and search their find a practitioner database. It's important that you have someone in your corner who is trained, who's a licensed healthcare practitioner, and can help you make changes, especially when it comes to your health. Keeping this podcast free is part of my mission to bring practical ways of improving health to the general public. And in keeping with that theme, I'd like to express gratitude to those sponsors that made today's podcast possible.