HHHK 294: The Gut-Thyroid Connection with Dr Christine Maren

[Music] Hi, I'm Steph Lo and welcome to Health Happiness and Human Kind. Each week I speak with experts from all over the world in the areas of nutrition, microbiome health, environmental sustainability, psychology, meditation and more. Together we'll teach you the answers to becoming healthy, happy and a more conscious human, and why your contribution to the planet truly matters. If you love the show, please rate and review us on iTunes and hit share to send today's episode to a friend or two. And now, without further ado, let's dive in to today's episode. In today's episode, we are joined by Dr. Christine Morene, functional medical physician to explore the gut thyroid connection. You will learn how every aspect of gastrointestinal function from saliva production, acid and enzyme production, bowel motility and bowel integrity can be impacted by alterations in cellular thyroid physiology. We discuss leaky gut and hypothyroidism, Hashimoto's and autoimmune thyroid, the impact of gluten, the role of blood testing and our current reference ranges, complementary tests including microbiome, SIBO and genetic testing, how to fix your thyroid and become medication free and so much more. Hi Christine and welcome to the show. Hi thanks for having me. I'm really looking forward to this topic today and certainly introducing you to our listeners. Before we dive in, can I get you to tell us a little bit more about yourself and certainly your training and what your professional life looks like now. Yeah, so I am a functional medicine deal, so I'm a doctor of osteopathy by training and board certified in functional medicine and I'm also trained through the institute for functional medicine, I'm an IFMCP practitioner, such as means I'm certified in functional medicine through that training, but I have a functional medicine practice which is in Colorado, Michigan and Texas, where I see my patients virtually and do a lot of consultation related to thyroid health, gut and hormones. I also work with a lot of people on fertility and sort of preconception and postpartum health. A lot of my story is sort of related to that and really intertwined and everything I do, I'm a thyroid patient myself, so as my sister and my other sister and my mom and my mother in law and so many of the women I know and so many of the patients I treat and so I'm pretty passionate about thyroid and gut. Both of these are sort of my, you know, I've been my big struggles personally and so just sort of something I wanted to conquer for my own life and what I do is a real collision sort of of my personal passions and you know my professional life's likely really ties into that. Yeah, like a lot of us out on personal story, on covers out passions and really inspires us to share that with the world essentially, so I love that story. Now the topic today of course is for us to explore not just the thyroid but certainly the link between the thyroid and almicrobion or our gut and I would really like you to set this scene for us with, you know, to explain this connection and help us understand why it is of so much relevance. Yeah, there are so many interesting components here and I really think there is so much relevance because your gut function relies on appropriate thyroid function but if you don't have good thyroid function it can really sabotage the gut and if you don't have good gut function it can really sabotage the thyroid. So there's just this big, you know, it can become a vicious cycle so you just have to step out of that and make sure you're treating both sides of it. So the way that they're sort of tied in, it's on a number of different levels, I'll just, you know, very simply absorption of nutrients. I mean, our gut is responsible for assimilation of nutrients that we get for nutrition and supplementation. So things like iron, insolentium, and zinc, and vitamin A and some of the B vitamins and tyrosine, which is an amino acid, these are all really important components of thyroid function. I didn't even mention iodine and then, you know, other sorts of antioxidants but all these nutrients are really key to not only producing thyroid hormone, which is T4, but also to converting that T4 to T3. And so, you know, just very simply nutrient absorption as a big piece. I've mentioned that conversion piece between T4 and T3 and that is likely very much tied into our gut bacteria. We really rely on gut bacteria for that conversion piece. And I think that piece is really under recognized and underappreciated by a lot of people. And a lot of practitioners, I mean, in my training, I didn't really know back when I trained in family medicine. I didn't really learn about T3. That was something I learned about later and I think is something that's really key to successful thyroid treatment. Other ways that it's influenced is, you know, as our gut bacteria, we make something called lipopolysaccharides or LPS. And that can create a lot of inflammation, but it can also inhibit the enzyme that converts those hormones. So that's a diodenase enzyme. But, you know, we know that that plays a role too. So just looking back at the literature, you know, we know that gut bacteria, influences LPS, influences our conversion. We also know there's even specific bacterial infections, which are associated with things like Hashimoto's. Hashimoto's is the adenine disease that attacks the thyroid and can create hybothyroidism over time. But certain bacteria like helicobacter pylori or Hpylori, we know our associated also your sinia is a infection that, you know, I don't honestly see all that often, but we know in the literature there's some association between your sinia and Hashimoto's and then potentially also lime. So three really important areas I'd like to just touch on in a little more detail if that's okay with you. Certainly to speak to the T4 to T3 conversion, like I'm curious of what your personal experiences or even now your professional experience. But in terms of the understanding of that, like at least in Australia when someone's wanting to investigate their thyroid more and they first start with what is a conventional route. Really, the most they'll ever get tested is TSH, though thyroid simulating hormone and maybe if they're lucky T4. And then of course, without T3, we can't see that conversion picture and we really don't have a full understanding of what is going on with thyroid function. And I often think that it's completely missed because one, our testing is a little inadequate and then two, our reference ranges are really about, you know, just excluding a disease rather than looking at anything subquinicle, which if identified early could certainly prevent all immune diseases or these, you know, issues, these thyroid issues that then take many years to resolve when we're reactive rather than proactive. Yeah, you nailed it. It's the same way here. So in my training, I'm just thinking back to, you know, when I was a resident and family medicine, check TSH. And sometimes what we would order as a TSH with a reflex to free T4. And that meant that if TSH was outside of the normal range, which is way too high, then the lab would then test free T4. So you wouldn't always get a free T4 tested, but, you know, if your TSH was five, potentially that level would come back. And I really do think that's very inadequate. And as I'm sure we both agree, like thyroid and appropriate thyroid management is a huge quality of life piece. It affects us on so many levels, not only our gut function, our mood, our metabolism, our weight, our fertility, our menstrual cycles. I mean, it influences so many different things. And so getting that regulated is a big deal. Now, the conventional perspective was that. And that's still what I see is that, you know, they're checking TSH and sometimes T4. And I think that is probably related just to the toolbox that they have for treatment. I mean, they're treating it with leave-up-iroxine. And if it's autoimmune in nature, there's not really a different way that they manage it. Whereas my perspective as a functional medicine practitioner is, if it's autoimmune, I actually have a whole other kind of treatment plan for that where we really look into gut function and intestinal permeability. And I'm sure we'll touch on this. But there's that autoimmune component that I'm working on. But there's also the thyroid function piece and replacing that hormone or getting that hormone to appropriate or optimal levels is always my goal. And so like you mentioned, that reference range through the labs is really huge. It's quite broad. When somebody is interested in fertility, that reference range gets a little bit more narrow, but it's still quite broad. And so really I try to get people around a TSH of one, I try not to suppress it, but I also don't like it high. Make sure their gland is making enough T4, but also measuring free T3, because that tells me about the conversion piece. And looking at reverse T3, because that tells me how much somebody's basically slamming on the brakes, reverse T3 is kind of the brakes and free T3 is the gas. So really getting all that picture along with looking at thyroid hormones, thyroid peroxidase and thyroid glowylinian antibodies, they think is really helpful. And also really helpful for medication management. Yeah, I love that. So I agree, all of those markers for store and I was going to ask you your thoughts on reverse or R-T3, because yeah, again, without that piece, you can't see if the conversions, you know, further inadequate. And I love that analogy of the brakes, because what I see a lot with reverse T3 when that's high is, yeah, a whole host of health issues. Like we know that the thyroid controls our energy and our metabolism and our motility and our temperature regulation and fertility, as you said. So, you know, even just working with a lot of weight loss clients, reverse T3 is rarely tested. That's how it's a huge roadblock, not to mention how it can impact the fertility goals long term. Yeah. And I think it's important, I mean, there's no like quick fix for reverse T3. It's not like you can just take a supplement and like it gets better. It's really like working on all of the other things. I think of it from a very holistic perspective, because the things that increase conversion of T4 to reverse T3 are stress, trauma, locality diet, inflammation, toxins, infections, like all the things we work on anyways through functional medicine. Yeah, that's a good point. It doesn't necessarily need a specific treatment, but knowing that it is or it has been accounted for, we are creating optimal health. You know, I often talk to my clients and let's say they've come to me for a microbiome test. And we're really focusing on, you know, the results and the protocol, the program that is then implemented. And the question might come up about, oh, but what about my hormones? We haven't spoken about that in great detail. And I like great question. And we need to, but know that when we're looking at overall health and rebalancing the microbiome and getting rid of inflammation and infection, as you said, that of course, like almost always, everything else comes into balance again. And that's what's so beautiful about functional medicine or holistic health. Yeah, I totally agree with you. Awesome. So let's talk about LPS or LIFE and Polysaccharides because obviously they're a really important component of the cell wall. But when those bacteria or when certain bacteria die, and LPS is released into the gut, in excess is obviously really inflammatory. And I think that's an important missing piece of the microbiome conversation because at least in my space, the testing has really up until recently, only really looked at an imbalance of microbes. So what was in excess or what was missing and that sort of dysbiosis picture. And now with the evolution of microbiome testing and certainly, let us you know, mix sequencing and what, no, biome and microbiome are doing globally, we're really starting now to measure these metabolites of which LPS is one and understand how the metabolites can be anti-inflammatory or pro-inflammatory and what that does to our health and certainly our thyroid and inflammatory conditions. So I'd love you to speak to LPS in relation to the thyroid. Well, I guess what you're seeing in clinic and how we might manage this. Yeah, so what I see, you know, it's not something I test for in the past I've used some of, like, Syriots testing that would identify it. But it's more, you know, if people have dysbiosis and we suspect elevated LPS and inflammation, I would expect to see two things. Number one, is an increased conversion between T4 and reverse T3, so sort of shunting the resources to the brakes. And also, we know that LPS is, can inhibit the enzyme. It's called Iodothyronine diodenase, but it's the enzyme that is responsible for conversion of thyroid hormone. And so you can decrease the amount of active T3 in circulation. I think by those two ways. So by inhibition of that enzyme, but also by really shunting it toward reverse T3, just nearly by inflammation, more of like, you know, if you think of it from a more holistic perspective, it's, it's causing a lot of sort of inflammatory processes. So I think that with dysbiosis or even chlamontist and bacterial overgrowth, much of the literature really looks at things like zonulin. That's something I sometimes do measure more than LPS, because zonulin, as we know, can influence the tight junctions in the gut. And so definitely if there's somebody with autoimmune thyroid issues, such as Hashimoto's, I'm always thinking about that, zonulin, and that, you know, we know that intestinal exposure to, or I'm sorry, small intestinal exposure to bacteria and gluten also can really influence that. Yeah, yeah, for sure. And I wanted to talk to you more about, about gluten, because of course there's a huge conversation as it has been for years, but people are resistant to hear it, I think, because everyone likes bread. But also because there's almost like this, it won't happen to me kind of mantra, because it is everywhere in certain foods that we eat in the West at least. And then of course, with the research of Dr. Alessio Passano, as you mentioned, identifying zonulin and how that really can create intestinal permeability or leaky gut. Of course, there's a huge link there to autoimmune conditions. But I'm curious to hear like what your advice is. I know it's going to be really individual based on, you know, labs and obviously the whole clinical picture. But you know, how do you determine if someone needs to be gluten free? Is it highs on your levels? I, if they have autoimmunity, I recommend gluten free diet. Like any autoimmune markers, I would recommend gluten free. There's kind of, there's a couple things I love for autoimmunity, food sensitivities, and just frank digestive symptoms. So any three of those will, I will suggest that they try a gluten free diet in this case. And I hear you, people are sometimes resistant to it or they're just sick of hearing it because it's like, it is not the only thing you have to do, right? There's so much other work to be done. When you take out the gluten, you've got to remove the bacteria and replace the enzymes and all of this other stuff when we're treating gut infections. But I do think it's a really important piece of the puzzle for a lot of people. And I mean, my theory with a lot of the food reactivity is that, you know, unfortunately, gut infections cause us to react to food. Food should be benign, but if it's not, and if we're reacting to gluten, we really have to address the underlying cause of that. Of course, there are other, you know, in autoimmune disease like celiac where people really, I mean, the underlying cause is gluten, right? But in most cases, if somebody has something like Hashimoto's, it's just one piece of the puzzle. Yeah. When you mention those three categories though, so obviously, um, highs on your learn, thyroid condition or digestive issues, like that's most people run. Yeah, right? Yeah. Right. You know, you see, right? Yeah. Yeah. I mean, I mean, actually, well, not everybody has to be gluten free. And sometimes I think, maybe it's better not to be because if you replace gluten with a bunch of rice flour and sugar, you know, that's not great either. But, um, but most of the people who come see me have suit sensitivities, digestive problems or our immunity. Yeah. For sure. And, and why not see how different you feel after 30 days because the proof will be in the pudding or it won't, right? And I think in testing that and being open to committing to that is so powerful because both a lot of people lack myself included, it can be night and day. And so that's an important part to, to identify and to experience for yourself. Yes. And the risk is very low, right? I mean, whenever I have an intervention, I kind of look at like, what's the risk with the benefit? And if the risk outweighs the benefit, I probably'm not going to try that. But if the benefit outweighs the risk and the risks are quite low, like taking gluten out of your diet, at least, I think it's worth a try. Yeah, I agree. And I love when I see the lot bold go off from my clients when, instead of being like gluten free, which means you can't eat XYZ. The way I like to reframe it is, well, if we are following a whole food diet, if we are focusing on food that comes out of the ground, off a tree or from an animal and the latter is a personal preference, of course. But if that is our focus, then, you know, we're going to be almost always gluten free anyway. So we want to focus on what we're eating. And remember that food is to provide nutrients. So focusing on those nutrient dense whole foods, excuse me, those nutrient dense whole foods is key because that's how we get the most out of the food that we put in our mouth. Yeah, 100%. Beautiful. So why don't you go back to the third area that we were discussing earlier about how certain gut microbes or infections impact our systemic pathology. And the researchers obviously quite knew, but you mentioned your sinnea and that being connected to autoimmune conditions of the thyroid, like Hashimoto's or Graves. And I find this space really fascinating because I don't think it's understood enough, but I love that we're really starting to understand all right. If we have an autoimmune condition, there is, is there more to the picture? So of course, we go to the gut to look for a specific infection. Now, imagine it's only quite correlated at this stage, as in not everyone who has Hashimoto's, has usinnea and as a despiotic overgrowth, but we're certainly needing to at least rule out this overgrowth. Is that a pretty good summary? Yeah, I think so. I mean, I think in clinical practice, I honestly don't see it come up very often, but it's also not in all the tests that I do. And so I used to use a different type of stool tests than I use now. And the test I've used for the last year and a half doesn't actually even test for your sinnea. So many would say like, why not? But the reality is, as you said, it's still correlative. We're just not sure. I do think it's really interesting, though, to really think about like, well, how do infections impact our immune system long-term? And are they a set up for problems? Can they be, you know, caused chronic issues? And I really do think like, maybe this is something good that can come from COVID, because I think we're going to understand post-COVID, potentially there are issues for people, and at least that's something that's on a radar and we're studying. So I think in the same, in the same light, it's like, you know, if edstein bar virus, you know, potentially could cause issues for people, you're sinnea. I mean, the association with your sinnea is basically, there was a study that said people with Hashimoto's were 14 times more likely to have antibodies, which represents a prior infection to your sinnea than people who didn't have Hashimoto's. And so, as you said, it's correlative. But the theory there has to do with something called molecular mimicry, where basically our body is, your sinnea membranes have a site that binds TSH, thyroid stimulating hormone, and so they think that potentially there might be some sort of molecular mimicry going on. The clinical relevance for this is like, I don't know. I mean, I can't say that I've, you know, seen a ton of patients, but they're sinnea and treated them and their Hashimoto's got better, but I think it's an interesting thing to explore. Yeah, it's not on the stool test that I never done. So, I'm interested if that's just a function of how I'll fresh the research is, and if we'll see that evolve with time. But I've only ever had one client come back with your sinnea, and that was a completely different stool test that you've done with her sort of JPE. So, not on any of the GI maps. Yeah, okay. So, I use GA map also. Yeah. Come up was when I did Dr.'s data stool test. It's C-Sap times three. It was like a three-series stool test, and they did culture. And so it was different than doing PCR, but as you know, like, you know, doing some of them, then they were testing with PCR. That one doesn't come up there. Maybe they'll put it on there. I imagine so if this conversation continues. Right. For sure. Is there anything else that you wanted to mention about autoimmunity? Because we touched on the tests, obviously the thyroid antibodies and the relevance of gluten eye grade, would you certainly any autoimmune condition I'd be prescribing gluten free? But I wanted to probably add on the permeability conversation, a little bit more about leaky gut. Of course, I'm going to show all the time, but I'd love to hear sort of your your expertise on this. Yeah. So, as you said, Alessio Fassano did this research and identified a protein called Zonulin. We know that Zonulin is released in the presence of small intestine exposure to bacteria and to gluten. So these two infections, I think there are likely other infections which cause Zonulin to be elevated. So in the case of autoimmune conditions, I'm always looking at three things. There's a triad. So number one is intestinal permeability. And that's really my focus. Number two is environmental triggers. And that's also my focus, you know, even if that's stress or if that's maybe mold exposure or something like that. And the third one is a genetic predisposition. And that's not necessarily we can do a ton about, but we can really focus on the gut first and think about that intestinal permeability piece. And so my approach with any patient who has autoimmunity is yes to remove gluten, but also to identify what is the underlying infection causing us to be sensitive to gluten. Is it small intestine bacterial overgrowth or maybe it's small intestine fungal overgrowth or just an overgrowth of yeast or other types of fungus? Sometimes there's parasites, you know, something like that we'll see on GI map. So you know, just really identifying the gut infection, it's not always one. Sometimes it's several. And addressing those infections will remove gluten and adding in some enzymes and some enzymes. I'll add some HCl to support stomach acid depending on the patient. But that's sort of like in a nutshell, how I address somebody who has the autoimmune component. Now at the same time, I try to replace their thyroid hormone or get their thyroid working appropriately because it has a profound influence on all these other aspects of GI function such as motility. So if we don't want the SIBO or the bacterial overgrowth to come back, we've got to address the motility component which has something to do with the thyroid. Yeah, I love that. And I love that you said what is the underlying infection that causes this to be sensitive to gluten? Because again, this is the piece that I don't think is discussed enough. Like I'm sure you've met clients who have had a food intolerance and gone, you know, low-fod-map or taken out certain foods and then had more intolerances and taken out more foods and ended up being so restrictive. Looking at the food only, rather than taking that deeper dive and understanding, okay, I'm reacting to this food because an underlying infection, this biosis, you know, as you said, parasites, etc. So we've got to keep having this conversation because it breaks my heart when people are eating like two to five foods and they have things sometime. Like that's the last thing. So really, 100%. It's so hard. And I mean, removing gluten or dairy or sugar is one thing, right? But like if you can eat potatoes and peppers, I mean, I don't know, I just like for a short term that could definitely be helpful, but long term, it's not a great solution. Yeah, I totally agree. So let's talk about just to kind of go a little bit more broader about our gastrointestinal functions. So, you know, obviously this saliva production is the one of the first pieces after we view our foods and then we need, you know, pancreatic enzymes and bile. And we're going through this sort of gastrointestinal tract looking at things like motility as you've touched on integrity of the gut, which is that leaky gut picture. But I think it's really important to have a discussion like at all of these aspects could be impacted by poor thyroid health. And so you've been talking about a couple of things like you've been saying enzymes and HCL and I do want to talk about, you know, sort of treatment steps at some stage. But of course supplements are great, but if we really identify that it's our thyroid that plays a huge role here, then that's what we need to focus on addressing. Yeah, totally. I agree. I mean, I think one of the one of the things I really love to do is actually go back through the conventional literature and look for this stuff because it exists. It's just not really practiced much. So right now I'm looking at a paper from 2009 in the World Journal of Gastroenterology called Consequences of Disphyridism on the Digestive Tract Invisera. And you know, I've read through this paper and I really appreciate it and so when I quote a lot, but they, you know, the first sentences, thyroid hormones define basal metabolism throughout the body, particularly in the intestine and viscera. So gastrointestinal benefits stations of abnormal thyroid function are numerous. So essentially, I mean, we know that thyroid is a really big deal to optimal digestion. Any patient who struggles with digestive issues has got to look at their thyroid really closely and get that, you know, tuned up if necessary. So so yeah, I mean, I think I think we just kind of start from the top and we think about, um, obviously as you mentioned, digestion starts in the mouth and that's a whole other story like your oral microbiome. I talk about that a lot too, but pay attention to your dentition, right? Like your whatever's in your mouth is a big deal because you're swollen all day. But stomach acid production, we know there's some link between hypothyroidism and low stomach acid or hypoclarhydrine. The literature there is less clear. There's literature to establish a link between atrophic gastritis and autoimmune thyroid disease. But importantly, we know clinically that people with low thyroid function often benefit from some supplementation with with HCl. We have to use it safely, but you know, when used appropriately, it can be a pretty safe one, not safe for people with hepticals or disease and people who are on a ton of like ibuprofen or NSAIDs. But in general, you know, it can be helpful for some people. But then also think about enzyme production. So our pancreas makes pancreatic enzymes to break down food. If we don't break down our food and our gut with enzymes and acids, It's basically larger food proteins travel into the intestines and can elicit more of an immune response. That literature comes from just looking at KPI use. So proton pump inhibitors which block stomach acid are associated with more food allergies. We know that hypo thyroid also can impair bile flow from the gallbladder. And bile is huge and I think super underappreciated. It's obviously important for fat digestion of fats but also absorption of fat soluble vitamins. But I think the piece that's underappreciated is that it's also antimicrobial. It's acidic and antimicrobial so I think it also plays a role in SIBO. So for those people who have recurrent SIBO, maybe they treat it, goes away, but then it comes right back. We've got to think about all of these things. And then how's it influenced by thyroid and I didn't even mention the motility piece because we know that thyroid hormones can alter GI motility. One of the primary symptoms of somebody who has really bad hyplofyridism is constipation. Totally. Yeah and I guess again, I was just putting it all together. I keep thinking about the people who aren't getting the right tests as well because again they're missing all of this and wondering why they've got these symptoms or recurring symptoms as you said no matter what sort of top level of treatment is. Yeah, we really need to be asking for the right tests. So you did mention we went through the TSH, free T3, free T4, reverse T3, the two thyroid antibodies. We've spoken about obviously doing stool testing for dysbiosis or looking at the microbiome. Is there anything else that you would be doing quite regularly in the typical clients that you see? Yeah, so I mean I think all those thyroid tests, I like to test for some nutrients. And so if I'm just doing regular blood work that might be something like homocysteine which can be a functional marker for some of the B vitamins. Sometimes I'll test a serum iodine. It's not a perfect test, a 24 hour iodine. I'll do some more advanced iodine testing with certain people but I like to just get a spot serum iodine. I want to be really careful with but I do like to test it. I like to look at an RBC zinc, an RBC selenium, and a vitamin D level. You know, those are all really important. And sometimes I'll check a vitamin A level in the blood too. That's an easy one to do. It's a fasting lab but quite easy. And so if I'm looking at nutrients, those are nice. I really like organic acid testing as well. So if I'm thinking about anybody who has a gut infection or any of my clients who have hashesmodos or some autoimmune component, I'm going to do organic acid testing which is a urine test. The first page of that test looks at metabolites, so markers of yeast and bungal overgrowth. And then there are some markers to affect your overgrowth there. It's also a nice test to just differentiate. So if I have a patient with thyroid condition or maybe somebody who suspects thyroid is an issue because they have fatigue, I like to look at an organic acid test also to assess mitochondrial function. So if I see a lot of mitochondrial issues, you know, some people with fatigue, it's thyroid, sometimes it's mitochondrous, sometimes it's both. And so those are both helpful. G.I.M.A.M.A.P. like you mentioned with the stool testing. And then I'll do a C-Vo-Breath test in a lot of patients too, kind of depending on the symptoms and where they're at. But I think those are, that would be, you know, if I had a patient with hypothyroidism and hashamodos, it would be all those thyroid labs with antibodies, some nutrients in the blood. And then probably an organic acid tested G.I.M.A.P. and a C-Vo-Breath test. That's just a lot, right? It is a lot. Yeah. We always say tests don't guess those. So for people, I'm sure you're seeing clients that, you know, they haven't started feeling unwell yesterday. It's been for a number of years, if not longer. And lots of money spent on different supplements and programs and practitioners. And they're probably at the point where they really get willing to get all the information and to have a really well developed holistic approach to treatment. Yeah, totally. So I wanted to talk a little bit more about healing from these conditions. So let's say if it is hypothyroidism, what would be like your top three suggestions for healing? Oh, that's a hard one. I think, like you said, it's like putting it all together, right? So I think if we're dealing with maybe Hashimoto's, it would be treating the gut infections, getting on the right medication and going gluten free. I mean, I think there's also this huge lifestyle component. And very simply put, it's just like adopting a low-talk lifestyle, right? It's a clean water, a clean air, a clean food, which sounds a lot more simple than it is. And thinking too, I mean, I know I'm going past three. I know, maybe three will in the right number. Can we do 10 instead? Yeah. Having metals, I mean, I think having metals can be an issue for people who have thyroid issues too. It's not even something we addressed here, but you know, that's something I think about too is if people have silver fillings in their mouth. Sometimes it's something that needs to come out with the right dentist who can do it safely. You know, when stress and sleep and all that, I think spending time in nature. I mean, there's free things, right? There's a lot of free things people can do. Like they can get outside and meditate and work on getting really good sleep and do yoga and open their windows and not where they're shoes in their house. And then there's all this advanced stuff where we can get air filters and water filters and medications and functional medicine labs and all that. Yeah. I guess it does again highlight how big the approach needs to be, but they're all the steps that we would all create implement to create optimal health. You know, they're all the steps and I know that you've been doing yoga for nearly 20 years. I'm probably coming close to that and I've recently done my meditation teacher training and I just keep thinking about. Yeah, like I want to write this prescription for meditation to everyone, you know, because of course we know that stress is linked with all disease and you know, it's again. Unfortunately in the West, like we're really used to prescriptions that are pharmaceutical and we know they need it in many cases or we're not many, but we know they need it and, you know, we need to be co-prescribing the pharmaceuticals with the meditation. Yeah. Yes, I mean, it's a really like it's a lifestyle change. I just had a patient today who was like, okay, so what's the next step? This is, she said this is just a quick fix though right and I was like, no, it's really not. The never is. And then as you said, it didn't take you didn't get her overnight. I mean, unfortunately it took, it just it takes work and paid my patients are amazing. I mean, they do a lot of hard work and some of them are willing to go on diets that I can't do, you know, like I myself have been really resistant to ever doing an AIP diet just because I felt like, oh my, I just, I don't know, I have a real. I just had a hard time with that one, but my patients are, I mean, you know, I practice what I preach, I do all this stuff, but that was sort of where I drew the line. I'm like, I just can't, I can't do that. I'm the same. I've never done, I've never done auto me in palli, I've never done gaps, but I've got lots of clients that have done it. And I was having a conversation yesterday with the client and we were talking about some of the foods he's reacting to and I said to him like, I hand on heart, do not have another client and haven't in over 10 years of practicing who has been as dedicated as you have been to resolving this like the amount of work he's put on put in is incredible. And, you know, I take my hat off to these people because as we've been saying like, I haven't taken that deeper dive. I don't necessarily think I've needed to. But yeah, clients of mine that do, I have utmost respect for that. Yeah, totally. Yeah, awesome. So I wanted to give you the space to add anything else to the conversation that you wanted to, but then certainly direct us to your online home and where we can learn more about you and stay connected. Yeah, well, I think we've covered a lot. I think what I, one of the messages I tell people is just try to be your own advocate, understand enough so you can advocate for yourself. And really that's what it takes. I've even been in the shoes of being a patient and honestly I sort of went through the drill just to go through the drill. I was a doctor and I just kind of wanted to see what would happen when I went and saw different specialists. And that's not a knock on specialist. I mean, they have a really important role. But ultimately if they're, if they don't really have a great solution, I think you just have to keep looking. And when it comes to thyroid in particular, I think it's important to find a practitioner who not only will order all of these labs, but then knows what to do with them. Sometimes I see people who were like, yeah, you know, my primary care doctor super nice, they agreed to order a free tea three and everything looks normal, but they're free tea three is like 2.3. So it's technically in a normal range, but it's still really stinking low. So just, you know, find somebody you can work with who can help you down that path. and understand that your doctors are not against you. They just didn't really learn this kind of way of thinking, right? They know a lot of other things like how to deal with surgery and yeah, other things like that. So, anyways, advocate for yourself. I think you're from all the story there. Yeah. So people can find me. I met Dr. Christine Marin on Instagram and Facebook. You'll find me on Instagram these days, more than Facebook for sure. And I also have a new project launching called Hey Mommy. It's M-A-M-I, like Hey Mommy. And that is really a place to support women through the different phases of motherhood, whether they're in this preconception phase or postpartum and struggling and things like that. And that's lunch with a colleague of mine. Dr. Alts Crosscoe. So my website is dr Christine Marin.com and Hey Mommy.com. Awesome. I'll pop all those links in the show notes so our listeners can head there now to learn more. You do have a beautiful Instagram page and so much knowledge being shared there. So I do our encourage listeners to go and say hi. And I've just so enjoyed our conversation today. We were talking before we recorded about how you ended up in your aircon on. Could you start into the sweat? Yeah. I'm here recording in this non glamorous safe freezing because I have a cold snap in at least, warrior and Tasmania. And it's always so cool to connect with people from the other side of the globe where we do have a lot of similarities but there are obviously vast contrasts. Contrast in things like our climates. Yeah. Totally. Yes. Awesome. So again, thank you for your time. It was so great to have you. Thank you. If you are looking for personal support to find your voice and achieve your dream career as a health practitioner, I currently have limited spaces available in my one-on-one mentoring program. To find out more and book a complimentary exploration call, please visit stefflow.com/mentoring. Health, happiness and humankind is not intended to be medical advice. So as always, please consult your practitioner before making any changes to your health. [BLANK_AUDIO]