Hashimoto's: What a Normal Thyroid Test Can Miss

[0:00] Exhausted by 2 in the afternoon, maybe your hair is in the drain, weight that won't move no matter what you do. You might be told that it's stress or maybe it's just being a mom. Most women have never learned to connect this to your thyroid. Melissa Bunkers heard that too.

[0:17] She's a nurse practitioner. She spent years in emergency surgery and trauma. Her own labs came back normal, but it was early Hashimoto's. Today she runs Revive Functional Medicine, helping women find the answers a basic panel can miss.

[0:32] In today's episode of Dialed In Health, you're going to learn what Hashimoto's is in plain words, and also what a standard thyroid test leaves out, and then how you ask for more. You'll also learn where food, the gut, and stress fit beside your medication.

[0:47] Health and wellness is confusing. There's a new trend every week. Everyone's got an opinion, and it's hard to tell what's real versus what's good marketing. This is Dialed In Health and I'm your host Melissa Goodwin. Every episode we sit down with real providers doing the work and ask them the questions you would ask if you were sitting in this chair.

[1:05] Let's get dialed in.

[1:11] Melissa, welcome to the show. Thank you. I'm so excited to be here. I'm so excited that you're here for a number of reasons. I know so many women. In fact, last week I was filming. And another woman said to me, "I also had Hashimoto. So, it's crazy how prevalent this is and how little it's talked about.

[1:31] So I'm super excited to have you on. Yes, let's dive in. I'm excited. So you were a nurse practitioner in emergency surgery and in trauma. What was happening to you and what what what made your own body hit the wall?

[1:46] What were you feeling? Yeah, basically the perfect storm when I look back. I had had two babies in two years. It was the year 2020. We all know what was going on then. So I was working full time in a hospital setting during a pandemic in emergency surgery and trauma.

[2:02] It was the perfect setup for Hashimoto's to develop, and I suddenly hit a wall. And I, you know, I had been healthy all of my life, eating healthy, exercising, and suddenly I could barely walk around the block my whole. Body hurt on the weekends.

[2:18] I was needing multiple naps and something was not right. And so I went to my primary care doctor as one does, and they checked a few markers, told me everything looked okay. You know, ferritin, vitamin D, maybe on the low side. Take a multivitamin, get some sleep, try not to stress.

[2:37] And I was like, I can't sleep anymore. There's no more hours in the day to sleep. And so I immediately was like. I'm going to become an expert in this. I don't know what is going on, but I immediately enrolled in the School of Applied Functional Medicine. I wanted to become an expert in whatever was going on, and then be able to help other women in the same situation because I knew I couldn't be alone.

[3:00] So your you said your ferritin was low, your iron was low, seven and vitamin D was 17. Like what is that? Like for those of us that have no, you know, understanding what those numbers are. What does that mean, and what did nobody check for you? Yeah, so basically it meant I had at least a couple of nutrient deficiencies.

[3:19] My body did not have the raw fuel it needed to function appropriately, especially when it comes to the thyroid. Ferritin, iron is very important for thyroid function. Vitamin D is important for the immune system. That's important when we talk about Hashimoto's, which I'm sure we'll get to.

[3:37] But so nobody. Checked beyond a TSH, my TSH was normal. I had this entire cluster of symptoms that is very indicative of some sort of inflammation or immune issue going on.

[3:52] I was newly postpartum, which is a very a higher risk time in a woman's life for autoimmunity and thyroid conditions to pop up. And so, unfortunately, nobody. Dug any deeper and I was just kind of dismissed as oh you're stressed and you're a new mom and kind of sent on my way.

[4:11] So how did you find out that it was Hashimoto's? What did you do to to continue the investigation? Yeah, so as part of my functional medicine education, we were able to run a full panel of blood work on ourselves as just kind of practice. I was my very first patient, right?

[4:28] And so I ran those numbers and of course they're also teaching us what. Optimal looks like, and I was, you know, so I had lower levels of antibody. I mean, they were high, but they were they were not sky high, and so that was indicative of an early autoimmune condition starting to happen, and it needed to be addressed.

[4:48] Hashimoto's is one piece of your work, so what else do you help women with at Revive? Yes, okay, so we we help with gut health, we help optimize thyroid hormones, we help with Nutrient deficiencies and a big part of that is behavior and mindset change.

[5:06] So we're not just handing you a list of supplements and saying, "Here you go, good luck," or an elimination diet and kind of sending you on your way. We really want to work with you to make sustainable, long-term changes so that you can feel good for the rest of your life and not just have to band-aid the situation by taking pills and staying on a strict diet forever.

[5:29] So now, for those of us that maybe have never heard of Hashimoto's, there's still people out there that maybe don't know what that is. Help explain it just in plain terms, the plainest terms, simplest terms that you can. Yeah, so Hashimoto's is an autoimmune condition where your body creates proteins called antibodies that then can attack the thyroid, and over time that does real damage to your thyroid.

[5:55] Where your thyroid can no longer produce enough thyroid hormone. Okay, so what's the difference between Hashimoto's and hypothyroidism? You might you might have heard like hypo or hyperthyroidism. What's the difference? Right, so a thyroid condition like hypo or hyper, so hypothyroidism means your thyroid's not producing enough thyroid hormone.

[6:19] Hyper means it's producing too much thyroid hormone. Hashimoto's is related, but it is completely separate. It's a completely different issue. It's an immune system regulation issue, and so Hashimoto's is the number one cause of hypothyroidism in women.

[6:36] So it's very important to know if that is the cause for you. But when we treat hypothyroidism, for example, with a medication, that is not treating that autoimmune piece of thing. So you kind of have this brewing storm underneath that is continuing to affect the thyroid.

[6:53] And that medication that you're on is not not taking care of that autoimmune piece. So, what are the things that can trigger an autoimmune like Hashimoto's? Like you mentioned, having a baby. You know, I know my own mother got it right when her 50s, right after menopause.

[7:13] What are those triggers and why does it happen? What what is happening in our bodies? Yeah, so you mentioned a couple of really vulnerable times in a in a woman's life. Where there are major hormone shifts, so postpartum, so during pregnancy, our immune system adapts so that we do not, our immune system doesn't attack the growing baby.

[7:32] But then postpartum, there are major shifts in hormones, obviously, which then impact the immune system. So it's kind of this rebound autoimmune effect. So a a woman's a postpartum time is a very vulnerable time. And then again, in perimenopause and menopause, we're also seeing those.

[7:50] Major hormone fluctuations that then influence the immune system. So, menopause, babies, what other kinds of triggers might there be? There are lots of triggers, and so I that's really what I refer to as the perfect storm.

[8:05] So, those things are gut health is major. So, most of the immune system lives along the gut lining, and so when we're talking about immune dysregulation or an autoimmune condition. We cannot leave out the gut as part of that, and nutrient deficiencies.

[8:21] So we all know of, you know, vitamin D and zinc, those immune nutrients that are very important for the immune system to, to have appropriate tolerance. The other things would be stress. Stress is huge when it comes to our body's ability to regulate inflammation and the immune system, sleep and recovery.

[8:42] And nutrition is huge. What you're eating on a daily basis, so there's a lot that goes into it. Yes, genetics is also a part of it, but just because a family member has it does not mean you are doomed to get it. And your perfect storm is not going to look like anyone else's, even if that person is in your family.

[9:02] Okay, so what does it feel like? You'd mentioned you were really tired. You've you're like, I can't sleep anymore, right? So what what might somebody with Hashimoto's experience? Yeah, I've I've seen all kinds of things, but really the common denominators are you're sleeping eight, nine, ten hours a night, and you're waking up groggy and still feeling exhausted.

[9:23] You need caffeine to get yourself going, and then by mid morning, you're already your body hurts. You feel like there's bricks on your feet. Your exercise tolerance has gone down. Your maybe your appetite, you don't even really have an appetite or even the energy to.

[9:41] Feed yourself and then towards the end of the day, mid-afternoon, you're kind of crashing again and begging to lay down. Obviously, a lot of us don't have the ability to just take a nap in the middle of our day, but you're doing everything you can to not to not take a nap.

[9:57] And then the interesting thing is at night, sometimes we can feel wired and tired. That was my experience. It was like I knew my body needed this rest. I couldn't shut off. It was this anxiety, anxiousness. It just felt like felt like my body was revved up and I couldn't relax.

[10:14] And then eventually you'd you would fall asleep, but then you'd wake up and it would start all over again. And you just kind of never know when things are going to, you know, how you're going to really feel on a day-to-day basis. You're, I feel like you're describing my life right now. So, uh-oh.

[10:30] How do you? I know, right? So how do you know if it is? Because I've had thyroid tests and they come back normal, right? What are the tests that most of us are getting that we're that we that maybe we're not and what are the tests that we're not getting?

[10:46] Yeah, and I want to be really clear here that what I'm about to say is not I'm not implying that your conventional doctor has has been negligent or they're not doing their job. I am speaking from a functional medicine approach, right? And so when you go to your doctor, they're looking for a diagnosis.

[11:04] So they are following the clinical guidelines to die to see if you have the diagnosis or the label of hypothyroidism. So that, according to the guidelines, is checking a TSH. And if your TSH falls within that normal range, then you do not have the label of hypothyroidismo.

[11:22] However. When I check things, when a woman comes to me and says, "Okay, I still don't feel well. I've been told everything is normal." I am not looking for a diagnosis any longer. I'm looking for, I'm using optimal ranges, which are meant to catch imbalances earlier, and I'm not looking for that label again.

[11:41] I'm looking for the imbalances. Where's the dysfunction? And looking at all systems of the body and and leaving no stone uncovered to really figure out what what the problem is here. So. In terms of a thyroid panel, I want to get free T4, which sometimes you'll get that in conventional medicine, but not always.

[12:00] I also want a free T3 level, so your body has to convert T4 into the active thyroid hormone, which is T3, and that's the biologically active thyroid hormone that gets into that connects to all of your cells in the body. And so oftentimes I'm finding that yeah, a woman does have a normal TSH.

[12:18] Even a normal T4, but she's having a problem making that conversion into the active T3, and so that's really a a functional medicine approach. So again, I'm not saying that your doctor, you know, should be checking that, but when you really just have to know that if you're wanting a an approach that where you dig deeper, that is that is a true functional medicine approach.

[12:38] Now you also mentioned gut health, and this is something I hear all about it, right? And you can buy a gazillion probiotics on the shelf and just add them into your carb, which I'm guilty of doing that. I'm the person that goes to the health food store and just like, "What's this?" Throws it in.

[12:54] Yeah. So how do we know if your gut health is good or bad? I mean, the diet today, what we eat or what's on the shelf or what's offered is so bad. You really have to work to eat healthy or eat, you know, to get all the nutrients you need.

[13:10] How do you know if you've got like here leaky gut, you hear bad, you know, gut health? Like tell me, how do you know if that's a trigger or that could be an issue that might be causing some of these autoimmune issues? Yeah, so my opinion is always test, don't guess. And like you said, there are so many things in our day-to-day lives that can lead to gut issues, stress.

[13:31] Yes, the food that we're eating, antibiotics, you know, a low fiber diet. So You know, even antidepressants and oral birth control have been shown to contribute to leaky gut. So, lots of things in our daily lives. And so, I use something called the GIMAP stool test.

[13:48] Now, this test is not perfect, but in context of the entire clinical picture, I'm able to see on that GIMAP, it's about a five-page report of your entire microbiome. So, it's looking at the good bacteria, the bad bacteria, candida, parasites, worms.

[14:06] Inflammation, immune, and digestion markers. It can even tell us a little bit about how your body's detoxing estrogen. So it's just a really good look of how the gut is functioning overall. And yes, there are markers on there where I can I can see if leaky gut is a part of that equation as well.

[14:22] If you let let let's say you're in the you you've had the test, you said you test T4 and T3, right? Is that the only two tests that you need for a full thyroid panel to to see if you got Hashimoto's? No, it's not. And so I would also be getting TPO and TG antibodies.

[14:40] Those are the two thyroid antibodies. I also like to get something called reverse T3, and you can think of that as the breaks to your thyroid hormone. So even if your thyroid hormones themselves look optimal, if reverse T3 is high, that is putting on the breaks. It's basically blocking the cells from the active T3 getting in, and so we can still see hypothyroid symptoms if your reverse T3 is high, and that really tells me there's.

[15:04] Likely some inflammation, maybe you're overtraining, overexercising, under recovering. So that's really what that reverse T3 means. So really a full thyroid panel is is those six markers, and I can mention them again. So TSH, free T4, free T3, reverse T3, TPO and TG antibodies.

[15:23] So that's going to give us a really good look at what your thyroid hormones are doing, and then it's also going to answer, do you have Hashimoto's? And I'm just really curious because there's You know functional medicine there it's gaining a lot of popularity there's a lot of functional medicine providers out there do most of them are are you know and maybe they're I don't know how the training is different across you know different functional medicine providers do you think many of them are testing the full panel all six or is it usually free T3 and T4 I will be honest I see a lot of times the reverse T3 is left out of that equation But otherwise, typically, if you're going to a functional provider, they are checking checking the other markers.

[16:07] You know, they're looking for the Hashimoto's, they're looking for free T3. Yeah. So they're looking for all six, or you should, if you haven't had all six tested, that might be, and you're having symptoms like the tiredness, you know, the the wired and tired at night, those kinds of things, might be an opportunity to get all six tested is what I'm hearing.

[16:30] Yes, absolutely. And so symptoms. When I think of sluggish thyroid, I think of sluggish anything from head to toe. That includes your mood, your digestion, the your periods. When we talk about really the hierarchy of women's health, I know a lot of women, especially in the perimenopause years, they're concerned about hormone, you know, sex hormone balance.

[16:49] The thyroid is really one of those crucial foundational pieces, as is the gut health, and really. Hormonal issues can overlap with thyroid issues, and so we really want to be making sure that we we do a full workup on a woman in those perimenopause years.

[17:07] Okay, so if your thyroid is, if you are having some thyroid issues and you take hormones, what might happen? Would it not work or have other issues? Yeah, that's a great question. And you know, so oral estrogen, so hormone replacement therapy.

[17:23] The oral pill of estrogen can actually influence the way your body, it can increase your body's need for thyroid hormone because it increases oral estrogen increases something called thyroid binding globulin or TBG, meaning it's going to bind up your free thyroid hormone so that it's no longer available for the body to use.

[17:44] And so that's something to keep in mind too for women who are considering hormone replacement therapy who may be. Know that they already have a thyroid condition or are suspicious that they have one. Oral estrogen can certainly impact thyroid function. I I just want to be clear that's oral estrogen, not like the patch or the pellet.

[18:03] Those are some other forms of that. What about if you're taking testosterone or progesterone? Is there any any interaction there? So with with progesterone in particular, there's not the same way that there's not a Not as big of a correlation between those two things as with with estrogen, but I will say with progesterone overall, in perimenopause, when progesterone is declining, what tends to happen is women don't sleep as well, and when we don't sleep as well, our body's ability to handle inflammation and regulate our immune function definitely is impacted, and so that is the way that progesterone can indirectly affect.

[18:45] Thyroid function and immune function. So why is the thyroid so important in our body? What is our thyroid doing? Why do we need to pay attention to this? Obviously, like if you're feeling sluggish, that's not good. But tell us tell us like why this is important to know.

[19:02] Yeah, so it all comes back to that what I term the hierarchy of women's health. And so really, it is the you know obviously it's a an organ that sits here in your neck and it is the metabolic powerhouse of every single Process in the body. You can think of it as your engine.

[19:18] So again, if the thyroid is running sluggish, you can have sluggish everything else in the body, including the ability to heal the gut or detox sex hormones or, you know, have a good mood or motivation or lose weight.

[19:33] And so it really is the the metabolic powerhouse. And so, lots of other body systems are affected when the thyroid is not functioning optimally. So let's say I take the test, I do the full six I test all six markers, I find out that I have Hashimoto's.

[19:54] What then? Like do we need to know why? Tell tell me more what what you would do next. Yes, absolutely. So if someone comes to me and they do, I've talked to thousands of women at this point. Obviously, I am if someone tells me they have Hashimoto's, I automatically want to know.

[20:11] What is this woman's perfect storm? And I'm automatically thinking the gut, right? So most, like I said, most of our immune system lives along the gut lining. We cannot leave that piece out. And unfortunately, I hear every single day women are telling me, "I'm doing the supplements, I'm doing the elimination diets, I've you know spent lots of money on other approaches, and I can identify very quickly, you know, have you had a GI map?

[20:33] Have you had gut healing? If the answer is no, that is often the missing piece. So I am never skipping over the gut. In fact, that's The number one test, functional test I would recommend if someone has Hashimoto's, is the GIMAP stool test. You can really just be spinning your wheels if we don't truly know what's going on in with the gut.

[20:51] But I'm also getting nutrient testing. I want to know B vitamins, magnesium, and other minerals, electrolytes. I want to know liver function. We are also looking at a seven-day food log. What are you eating on a daily basis? I don't have a single supplement in the world that can.

[21:07] You know, if you're not fueling your body properly on a daily basis, there's no supplement in the world that can overcome that. So that's really, really important. You know, what does your stress, your sleep, your recovery look like? How hard are you training in the gym? There's lots to consider.

[21:23] And so, and I know women come to me all the time saying, "I'm so overwhelmed." Right? They they search one thing about Hashimoto's and then suddenly they're getting all these ads and all this information sent to them about Hashimoto's and it's just so overwhelming. And it's really it's a whole body issue and so it it is going to be difficult to navigate on your own.

[21:42] Yeah, absolutely. So the standard treatment is a a medication, right? A thyroid hormone. What does that do and what does that not do? Yeah, so to be clear, the thyroid medication does not treat the Hashimoto's.

[21:58] There is actually no conventional treatment or medication for Hashimoto's. So if you're going to your endocrinologist, your PCP. They don't have a treatment for that. They're not lying when they say there's really nothing that can be done. So that's really where a functional medicine approach comes in.

[22:14] The thyroid medication is replacing the thyroid hormone, but it's not taking care of the root cause or the Hashimoto's that is leading to the hypothyroidism. So you do prescribe medication in some situations. What might be some situations where you would still prescribe some medication for someone with Hashimoto's?

[22:35] Sure. So again, I'm getting that full thyroid panel. And so if a woman's only on a T4 medication, so levothyroxine, synthroid, that's the gold standard thyroid medication. However, like I said earlier, many women have a problem taking that T4, and then their body has to convert it into T3.

[22:51] And so with that full thyroid panel I'm getting, I can see is there a conversion issue. Some women feel okay on a T4 only medication, but a lot of women, I'd say most of the women that I work with, are coming to me saying, "I'm already taking the thyroid medication." Medication, my TSH is normal, and then we're digging deeper into that full thyroid panel and come to find out they're just not, their body's not able to utilize that medication appropriately, and so that's where I do prescribe in some situations.

[23:17] I'm that's totally within my scope as a nurse practitioner, and so then we can talk about a combination medication that has some T4 and T3 in it, or sometimes we'll, you know, add a a separate T3 medication to the T4 that they're already taking.

[23:33] But and you know research does show it was a small study and so you know not obviously it's still the gold standard to give the label thyroxine in conventional medicine but some studies do show that women prefer a combination T4 T3 medication over T4 alone.

[23:50] When you think about the gut, let's say you're you're digging in, you do the stool test. What might the stool test show that you would address? Yeah, so and this is really interesting. There is a research-backed association between H.

[24:06] pylori and high thyroid antibodies, and so I would say H. pylori is one of the most common things, most common bacterial overgrowths that I'm seeing on that GI map, and that absolutely needs to be taken care of. But I see a wide variety of things.

[24:21] A lot of times, a woman's good bacteria will be on the low side. That really indicates. Possible leaky gut just a depleted body overall, you know parasites parasites are real, but again I'm always testing. I'm not just you know prescribing random parasite cleanses to anybody and everybody.

[24:39] We're also looking at so the immune function that is tested with the GI map, and we can see is that immune system really angry? Is it depleted and overwhelmed? And so gut healing happens in certain phases. We can't just kind of throw a kitchen sink of supplements at.

[24:55] At it and say, you know, here you go, this should fix it. There's always, it's always patterns of things going on on the GI map. It's never just one thing, and so it's really about unraveling that and going through the proper steps to to take care of it. Have you ever had maybe someone that you did the GI testing and they were able to come off their medications because you'd had some other interventions that were working?

[25:20] Yes, yes, I have. And so, when we replace the nutrients that your body's missing, when we address stress and recovery, and when we heal up the gut and really seal leaky gut, which we could certainly talk about that too, then I have. I have seen women be able to lower their thyroid medication.

[25:38] I've seen them be able to come off of their thyroid medication. I'm seeing women come off of their HRT. Now, I'm not saying anyone should stop their medications. But it is possible, not for everyone, and I can never make a guarantee on that. But yeah, I have seen it.

[25:53] Yeah. So tell me about the the leaky gut thing. I again we we talked about like I I hear it a lot. I don't know what it actually means or what it like what would you experience or how you would treat it. Yeah. So leaky gut or enhanced intestinal permeability is a real physiological phenomenon.

[26:13] So the lining of our gut has tight junctions. That is selectively permeable. There are certain things that are allowed to move through, but with leaky gut, those tight junctions break down due to, you know, whether it's your diet, a low fiber diet, stress, maybe some microbes and overgrowths that are showing up on a GI map.

[26:32] Lots of different reasons. A round of antibiotics, you know, those types of things. Lots of things can lead to leaky gut. Those junctions become inflamed, and then they let. Things through that are not supposed to be there, so then the immune system that is living along the outside of that that GI tract, it comes into contact with things, and the the immune system's job is to keep surveillance.

[26:55] Like, is this is this supposed to be here? Is it not? Should I attack? So then when it senses, hey, this isn't supposed to be here, that's when immune function becomes dysregulated. That's when we can get a lot of inflammation, and that's really that connection between Hashimoto's and leaky gut.

[27:11] What other things do you look for? You'd mentioned your vitamin D was low, stress, obviously, blood sugar. How do those things interact with Hashimoto's? Yeah, so blood sugar is really important, not just in diabetes, but we're, you know, that's important for energy regulation throughout the day.

[27:31] A lot of times, when women are skipping meals or not eating enough to fuel their body, we You know, get them get them working with us, and we look at the whole picture and look at their plate structure. That can certainly lead to a lot of energy crashes and brain fog, and it also affects the gut.

[27:49] So, our gut needs good, stable blood sugar to function optimally for those bacteria, the good bacteria, to thrive. And so, blood sugar is really one of those another one of those foundational pieces when it comes to a woman's overall health.

[28:06] How do you said plate structure? I don't think my plates have a structure. I might need some help there too. Okay. Yes, let's talk about that. So, yeah, nutrition is obviously a very important piece of the puzzle. Like I said, there's just no supplement that no amount of supplements you can take to replace good nutrition, unfortunately, right?

[28:25] So I've used something called my core four plate method, and it's really meant to be quite simple. So if you think of a dinner plate. Half of that plate needs to be your non-starchy vegetables, so your greens, your carrots, your green beans, asparagus, things like that.

[28:42] One quarter of that plate should be protein, and the other quarter should be complex carbohydrates, so brown rice, quinoa, sweet potatoes, things like that. And then one to two tablespoons of healthy fats. So three of those meals every single day will set you up for good blood sugar.

[28:59] Good fuel for your thyroid function. We do not need to be afraid of carbs, and you know we could get into the elimination diet talk. We actually don't take that approach. So, but yes, that is my core four plate method that we use with all of our patients.

[29:15] That's interesting because I do when you think about diet and I I you know I've there's been so many things over the years and I have not dug into it as much as I should but what I would see my mom struggling like Sleep issues, flare-up issues, medication changes after medication changes after medication changes, and you know the diet thing.

[29:35] I had a friend who had Hashimoto's and she was like, "I've I've I've cleaned up my diet." Now very she's an athlete, very strict about her diet, and it was a game changer for her. I've seen things about Hashimoto's diets, and like it it does seem like a lot of people start with elimination.

[29:53] So tell me. What do you change first? How what is your approach to that? Yeah, so first of all, what I'll say is a body with Hashimoto's, it is craving recovery and fuel and safety and regulation. And so often, if we're focused on the foods to remove, I know at least in my clinical experience, the woman sitting in front of me, she's automatically overwhelmed.

[30:16] She's automatically stressed, wondering how am I going to make this work. I also have a family to. Feed and the last thing a person with Hashimoto's and hypothyroidism needs is more stress and more overwhelm. So we're really working against ourselves. And often we we do get a seven-day food log on our women.

[30:32] We like to see the data. We're always very data-driven. When we get that food log, we often find that women are just simply underfueling, not getting enough carbohydrates. A lot of times, women are going low carb, trying to lose weight, and that is.

[30:47] That is not going to set you up for for healing, and so we have just found that taking the approach of okay, what can we add in based on lab testing and who this unique person is? What does their body need more of to be able to heal itself rather than what should we take away?

[31:05] What do you what do you tell them to add first when they when you say like what can we add? What's the first thing you tell them to add? I would say the biggest thing we're finding is women are just under eating protein overall. The other one is fiber. However, I will say because we deal with women with so many gut issues that trying to increase your fiber right away causes a lot of bloating, digestive upset, and so we kind of have to do some of our gut healing first, at least partially, before we can reintroduce fiber and and healthier foods like that that yeah boost the fiber content.

[31:38] So. Typically, we're starting with protein. Sometimes it is carbohydrates. So, anytime I'm seeing a low free T3, that active thyroid hormone, there is an association between a low free T3 and not enough carbohydrates or not enough calories overall.

[31:55] So, really, protein and carbohydrates are the biggest ones that we're kind of zeroing in on and making sure your body has enough of those to to start the healing process. So when the other thing that I hear a lot about is gluten, right?

[32:10] And and that's another one where I'm like, is this a fad? Is it really that bad? Or is it you know tell tell me what your your position is on that and especially as it relates to thyroid health. Yes, and this is where it it gets controversial and I get yelled at on the on the internet sometimes because I say that not every woman with Hashimoto's needs to go gluten free and that is the First thing you'll find when you start to research, right?

[32:35] Oh, well, everyone with Hashimoto's has to go gluten-free, dairy-free, sugar-free, soy-free. Remove all the foods you love. But in terms of gluten, here's the thing: if you remove gluten and you feel a million times better, if you notice all of your inflammation and your brain fog and your gut issues have gone away, that's not a food problem.

[32:54] That's an underlying gut problem. And I'm seeing this in my clinical practice. I've seen it for years. When we get the GIMAP stool testing, figure out where the dysfunction is, lower that all that overall immune or that that inflammation bucket, then once we heal the gut, you can tolerate gluten and all foods in moderation again.

[33:16] So I'm not saying that you don't have a true gluten sensitivity or something like that, but that often means we need to dig deeper into gut health overall and not just remove the food forever. Yeah, so tell me, you know, in terms of the weight piece with Hashimoto's, because that this is another one where I've I've you know my mom is short, she's Italian, she's like 5'1".

[33:39] And so there's always there's that struggle already, right? You don't have a lot of places for the for the food to go, but it it I have just watched her struggle with that so much, and it and there is definitely she's a salad eater, she she loves vegetables, she's always been.

[33:55] You know, looking for healthy options. So I grew up around that. It wasn't like there's it's not like there's like cakes and McDonald's all the time. There's a little bit of that because we have grandkids. She has grandkids, but I'm curious why that weight piece is so hard for people with Hashimoto's and what what helps.

[34:13] Yeah, so it's there's there's a lot here. So a lot of times us women, like you said, we grew up in diet culture. Eating less equals. Being good, eating less means weight loss. Eating less means health, right?

[34:28] And so often, I find that women have been underfueling for so long, and that purposely your body will purposely slow down your metabolism and slow down your thyroid function to accommodate for that. And so, that, and that state is a really hard state to lose weight in because then you have to cut calories even further.

[34:49] Your metabolism has already slowed down. Your hormones are already not optimal. You already have nut nutrition deficiencies and you're often exhausted. So again, a body with hypothyroidism and Hashimoto's, especially when you're really in the thick of it with a lot of symptoms, the last thing your body is going to respond to is the stress of a low calorie diet and more exercise and pushing yourself in the gym.

[35:15] That usually backfires. So maybe eating more protein, eating more complex carbohydrates. Tell me, what do you do in the gym then? Because again, this is another like, think about most of us that are now in menopause or perimenopause or older.

[35:31] You grew up in the like cardio world, right? So what should we be doing from a from a exercise perspective? Yeah. So again, if someone's in the thick of it with a lot of symptoms, a lot of exhaustion, the full-on body aches, kind of like I was back in the day.

[35:47] You really have to listen to your body. I would say getting the testing and figuring out what your perfect storm is is so important to really be able to heal your body to to get your energy back and to build a resilient body again. So in those early days, it's really about listening to your body and then healing it along the way.

[36:05] Your energy is going to start to come back, and so I mean walking is always good, but then when when a woman's energy is starting to come back, she's starting to feel better. We are often introducing weight training, so two to three days a week at least of weight training, building muscle.

[36:21] That's kind of our 401k for for our health in terms of protecting our bones, metabolic health. It's very important for women as we age. So you mentioned there's there's a couple things that you you've talked about things that we can do.

[36:38] Now there is also the flare up like Have you experienced any flare-ups? What do what do you do for those? Yes, and so stress is a big one when it comes to flare-ups. Illness is a big one. So anything that's really going to put a tax on the immune system. So sleep deprivation, again, if you're a mom raising young children, I see a lot of flare-ups during that time.

[37:01] So it's kind of just going back to the basics. You know, it's nothing super fancy. The boring basics are really what it takes. So just Getting rest, listening to your body. Again, that's not the time to lose the the last 10 pounds.

[37:16] You know, it's just really a time to listen to your body, fuel well, stop skipping meals. Yeah, all of those basics that really just are the foundations. Yeah. So if you you know a lot of us you you mentioned that this is an autoimmune disease and there's no necessarily cure.

[37:37] Is the right word if you're searching online for Hashimoto's? What do I do? Is it reverse? Is it cure? I mean, is there any what what's the right? Is it manage? How do how do you how do you approach it? Yeah, so there's really no, you know, technical term, but I would say we're not curing Hashimoto's.

[37:58] We're not completely eliminating it forever, but we can certainly put it into remission. We can certainly reverse your antibodies and help those antibodies to come down. So those those are the terms I use. Okay, and if you had a guess, like I'm not, I mean, obviously we are going to record this, but I'm curious if you had to take like shirt size it for me, small, medium, large, or you know, general percentage wise in buckets, how much of this is caused by gut versus that you know something that you need to treat with medication versus like a parasite.

[38:33] Or something else. So, yeah, I would say the gut is huge, honestly. So I'm getting a GI map on 99% of the women I work with with Hashimoto's. I've never seen one come back normal, and that is not an overstatement. I've been doing this for six years and I've worked with hundreds of women.

[38:51] I've never seen one come back where I'm like, oh geez, that wasn't it. I don't know how to help you. That is where the immune system lives, and so that is where we have to start. And again. I hear it all day, every day. Women popping into my messages on Instagram or Facebook and saying, "I'm doing all the things.

[39:09] I'm eating healthy. I'm exercising. I'm taking the supplements. I've worked with functional medicine, but they're missing the gut piece still. And that is the that's the thing that when we finally get that and we heal it up the right way, that makes all the difference." Okay, so don't reach for that parasite cleanse first.

[39:27] No, and I've seen those things do more harm than good. So, yeah, always try to not guess. I've joined a lot of the natural moms groups and that and they love the parasite cleanse. Yeah, I know. And you know what?

[39:42] I'm sure for some people out there, they're like, yeah, I love it. I do it all the time. And okay, if that works for you, great. But it it can do more harm than good. So, sure. Just be careful. Yeah, that makes sense. Yeah. So you've seen some antibodies come down. You've seen antibodies drop with these programs.

[40:00] So tell me, your program specifically is is it five months? Is that how long it is? Yes. Okay. Yes, it is. What are you doing in that five months? Kind of explain that to us. Yep. So we're getting the testing right away. The GI map, a full blood work panel, the full thyroid panel, nutrient testing, all of it.

[40:16] I want to take a look at all systems of the body, and then of course you're providing all of your intake information. And I am sitting down, and it's I I've termed it my mapping method. It's really what they teach you in functional medicine in my certification. What is connected to what? Because all body systems are connected, so we can really draw a line.

[40:34] And by the time I'm done, my paper just looks like you know there's there's lines all over. Everything is connected. So I'm really just digging through where are the imbalances, what is causing what, and then I'm creating a roadmap for you. So this is what needs to happen over the course of those five months.

[40:49] And I really landed on five months because that's Really, the minimum amount of time it takes to get through a true gut healing protocol. Again, it's not here's the list of supplements and a meal plan and then set it and forget it. We're really walking you through each stage, and there's troubleshooting and temporary supplements along the way and nutrition strategies, things like that.

[41:09] So, five months is really the minimum amount of time, not only for gut healing, but also when it comes to seeing those antibodies come down. Thyroid hormones improve, nutrients improve, things like that. So, I always say it's not, obviously don't guarantee that everything is completely resolved in that five months.

[41:30] But for someone with Hashimoto's, that's the minimum amount of time that I want to see you very closely and work with you very closely to get this thing healed up and figured out. Is there any point that it's too late? My understanding is like and I I don't know a lot about this.

[41:46] The medication. So you you set me straight here, but if you take Synthroid or some of those for too long, now your body can't make its own, you know, eh, thyroid. Is it antibodies? T T T tell me the right words. Hormone. Hormone. Hormone. Yeah. So if if you've if that's true, is there a point where it's too late to treat?

[42:06] No, I would say it's never too late. And in terms of taking thyroid hormone replacement medication, so the levothyroxine, Synthroid, whatever it may be, that does. Override your body's own. It basically replaces that hormone for your body, so it's it is doing the job of your body for it, and so I know there's a concern there when women are like, "Oh, well, I don't want to, you know, suppress what my own body is supposed to do." But whenever we're talking about medication, there's a real risk-benefit analysis that we have to take.

[42:38] What is the risk of leaving your body in a hypothyroid state without the medication? Like I said. Sluggish thyroid, sluggish anything through the body, including cholesterol. I see a lot of younger women with high cholesterol because their thyroid hormones are not optimized. It's always a risk-benefit analysis, right?

[42:54] And so, I'm always, not always pushing, but just having that open and honest discussion with a woman. You know, what are the risks and benefits of of both sides, and then really giving her that that option and and making the choice the best choice she can for herself.

[43:10] So even if you've been on medication for a long time and you might not be making the the hormone yourself, there's still things you might be able to do for your gut and other things that might help put those symptoms more in into remission. Absolutely, it is never too late.

[43:26] Like I said, your body wants to heal. It knows how to heal, and it just we have to figure out what the missing pieces are. Where where are the missing nutrients? How is gut health? All of those things. When you give the body that, I have seen a major turnaround in reversing Hashimoto's and improving thyroid function.

[43:45] Absolutely, it's never too late. Tell me what the most common mistake that you see before they come to see you. Obviously, what are people doing that is maybe either causing more harm or or just you know not not addressing the real issue.

[44:01] Yeah, I would say the supplements, and I know it's it's very easy to think that I can easily. There's so much information out there, especially with like AI nowadays. Like throw that into ChatGPT. I'm gonna figure this out. But when it comes to obviously clinical education and experience, it's not the same thing.

[44:20] And even though these supplements are natural, they can do more harm than good. Things like vitamin D or selenium or iodine, right? We yeah, I mean. Too much of a of a good thing is not better, and I've seen real issues, real negative side effects of women who come to me and they're taking 20 different supplements and you know high high doses of things, and there's ingredients that are over overlapping and and no one's really guiding that whole process, and they they are they're doing more harm than good.

[44:51] Again, a Hashimoto's body does not just need a bunch of Natural things thrown at it. It's really about figuring out what your unique body needs, so that, yeah, we can we can give it what it needs, so that it it can do its its own job. All right, well, I'm going to read a few statements to you, and you can tell me your reaction to these.

[45:12] So we've talked a little bit about this one, but if your TSH is normal, your thyroid is fine. No, we need to be checking actual thyroid hormone levels. Once you're on a thyroid medication, there's nothing else you can do. Absolutely not.

[45:28] Honestly, a thyroid issue is a sign of other imbalances going on. Tell me a little bit about iodine. So most people think that iodine is good for your thyroid. The thyroid needs iodine to produce thyroid hormone, but too much can actually lead to hypothyroidism and it can flare autoimmunity.

[45:49] So being tired is just part of being a mom. You know, lots of parts of being a mom are exhausting, but that does not mean that it's normal to be just feeling completely depleted and run down every single day. If you clean up your diet, you can stop your medication.

[46:07] Diet is important, but it often goes much deeper than that, and you know sometimes. It's Hashimoto's, and so if it is, women will need. Sometimes women need thyroid medication for life, but there's a lot more more that goes into it than just diet. Hashimoto's only happens to older women.

[46:27] Absolutely not. I've seen it can happen to men. It can happen to children. Women are more likely to get it, but it can happen in anybody. So tell me, like how many people? Is there a any studies or anything that says how many people like You know, there's diagnosed Hashimoto's and then how many of us that are out there walking around with it that maybe think it's something else?

[46:49] Do you have a sense for like population-wise how many people have Hashimoto's? You know, I think that's really hard to say. I think in the past few years there has been an explosion of autoimmunity and so I honestly have not seen the statistics on that and I would be willing to bet that there needs to be a re-evaluation on that when it comes to true numbers but autoimmunity is really becoming It is running rampant, and so I know that now more than ever, you know, there's more and more people struggling with it every single day.

[47:18] So, lots of people, I catch it all the time in my practice. Women who never knew they had it, and we're we're running those antibodies, and sure enough, so yeah. So I'm I'm curious as you think about you know the the amount of people that are out there walking around, you know, that have Hashimoto's and then many of us that may.

[47:39] May not realize that you have it. Give us just the rundown one one last time. What are some things that we should be looking, you know, symptoms that we should be paying attention to, and that maybe like those clusters and you know what what we what tests we should make sure that we're getting.

[48:00] Yeah, so the symptoms really fatigue that doesn't that's not Fixed with a good night's sleep, brain fog, digestive issues. I've even seen hives and rashes, food sensitivities, body aches.

[48:16] I mean, it really can affect your entire body. So, if you're starting to feel like, gosh, there's just things here from head to toe. I'd definitely be wanting a your antibodies checked. So again, TPO and TG antibodies at the very least, right? Those that's Not the only autoimmune condition, but in terms of Hashimoto's, we need to be getting those antibodies.

[48:38] Absolutely. What do you think? I mean, the autoimmune explosion, is that largely our diet? Do you think? What what do you think is causing that? Yeah, I think it's our diet. I think it's obviously our our food supply, right, is really not great, and also stress.

[48:54] So many women are people in general are just. For so many reasons, under a lot of chronic stress these days, I think those two things combined are really the true root causes of of the autoimmunity piece here. Well, I so appreciate our conversation today.

[49:12] Like I said, there's I know so many women that that have Hashimoto's that have struggled with these these issues. It's not something that I hear talked about a lot, so I was so excited. To have the conversation with you, then that you were willing to come on the show and talk to us about this.

[49:30] So thank you so much for your time today. For those that are out there that want to connect, how do they find you? Yeah, I'm very active on social media. So my Instagram handle is at melissa.bunkers.np, or I'm on Facebook at revive functional medicine.

[49:49] Okay, and you serve remote. You you work nationwide, is that right? Yes, that's right. Yep, so we see women all over the U.S. We are all virtual, and I can prescribe for women in Iowa, South Dakota, and Minnesota. Wonderful. And for those that want to connect with you, do you have a website as well, Melissa?

[50:08] Yep, it's just www.melissabunkers.com. Wonderful. And so for your five-month program, just tell us a little bit. Like how often do you meet with somebody? What does that look like for someone who's curious and they're still thinking about connecting with you? Yeah, it's very high touch support, and so again, we're not just handing you a list of some supplements and a diet and saying see you later.

[50:29] Private chat messaging Monday through Friday, a weekly check-in, one-on-one sessions every other week, and I also have a dietitian, a couple of them, on the team who are really helping to guide that nutrition piece. So, very, very high level support. We keep our client list very small so that we can give you that personalized attention you need to really make the transformation you're looking for.

[50:51] I love that. Thank you so much again for being on the show. If you're watching on YouTube, make sure to click on the description. We will link to all of Melissa's social media accounts as well as her website below. So again, if you if you know someone or if you yourself have been struggling with stubborn weight, low energy, the tired and wired, like I feel like that's me every single night.

[51:14] I might need to connect with you after this. Make sure to connect with Melissa Bunkers at Revive Functional Medicine. Thank you again, Melissa, for being on the show. Really appreciate you. Thank you so much. It's been a pleasure. That's our show for today. If someone came to mind while you were listening, please send it to them.

[51:32] You never know when a little piece of information might change someone's life. Make sure to subscribe so you don't miss the next one as well. I'm Melissa Goodwin. Thank you so much for listening and for now. The line is open.