[Music] I'm Marina Terasova and welcome to My Happy Thyroid, your source for all things thyroid health and wellness. My Happy Thyroid is presented by Paloma Health, the first online medical practice focused on living well with hypothyroidism. Today's topic is gut health and why gut health is so important for optimal thyroid function. We'll talk a little bit about leaky gut in there also. Mary Shomen is here co-hosting with me and I'll introduce her in just a second. Our speakers today are Dr. Christine Marin and Allison Mara's of Food by Mars. They're each going to speak for about 20 minutes and then we will open it up to Q&A, live Q&A. You can use the chat feature at the bottom of the screen. You can think about what you want to ask now or maybe what comes up while they're speaking. We'll save some time for that at the end and get to as many questions as possible. Dr. Marin also had a worksheet that we sent out ahead of time that might be helpful while you follow along to her presentation. It's not necessary but maybe helpful if you did not get that email or signed up in the last hour or so. Feel free to drop your email in the chat feature and our team will send you that worksheet. Without further ado, I'll introduce Mary Shomen. Mary is a patient advocate and health coach and a New York Times bestselling author. She's written 15 books on health and wellness and we feel really honored that she's here with us today. So Mary, I'll let you share a little bit more about who you are and what you do and then we can get started with our speakers. Well, I don't want to spend too much time on me because we want to get to the good stuff. I am Mary Shomen and as Katie mentioned, I am an author advocate, patient educator and I'm out there trying to fast forward everyone up the learning curve to get to the part where we live well and feel well with thyroid disease and hormonal imbalances. And so I am thrilled to be working with Katie here to moderate this terrific event. I'm really excited to have our opportunity to hear from Dr. Marin and Amy. Amy, is it Amy Allison? Okay, I'm sorry, I'm messing it up Allison. Why did I think Amy? But we've got our two guests and they're going to be giving us some amazing information about gut health. So let's jump in and we're going to start with Dr. Christine Marin and I'm just going to give you a little bit of background. Christine is a board certified position and an institute for functional medicine certified practitioner. She is the founder of a virtual functional medicine practice in three states and the co founder of Hay Mommy, a platform for women who are navigating the stages of motherhood. She was struggling with pregnancy complications and recurrent miscarriages and is now the mother of three and she's devoted her professional life to helping other moms optimize their health before pregnancy during pregnancy, thriving postpartum and getting their life back. She is one busy mommy as we can tell. And so I want to welcome first Dr. Christine Marin to our Paloma Health Speaker series and she's going to be talking to us a little bit more about her perspectives on gut health and how they relate to the thyroid. Awesome. Thank you Mary and thanks Katie for having me. I'm excited to be here. Thyroid is near and dear to my heart. I have Hashimoto's myself. I have a sister with Hashimoto's. I have another sister with raised these and I work with lots of patients who have thyroid disorders. So it's something I talk about every day. So I want to just kind of take you through what I think about and the functional medicine approach to a thyroid and got health and why they're so important and so interconnected because there is a very important connection there that I think it's lost a lot of times. So today I'm going to briefly sort of go through all of that and then make sure we have time so Allison can talk about all of the awesome kind of ways to implement this in terms of nutrition and sort of practical takeaways for that. So we'll talk about gut health, why it's important to your thyroid. I have three primary reasons for that. We'll talk about the triad of auto immunity and we'll talk about ways to improve gut health. And then if you have a gut health problem, I'll talk about a functional medicine approach. It's called a five hour approach and how we do that in functional medicine. And then you know, we'll have time for questions at the end. So first of all, and like Katie said, there is a worksheet if you'd like to follow along. If you want to, if it's easier for you to kind of be an active, what's your like that. That is there for you. So let's first sort of talk about like the top three reasons why I think thyroid and gut health are intimately related. So you have probably heard the saying before you are what you eat in functional medicine, we take it a step further and we say you are what you eat and then what you absorb and then what you do or you do not detoxify. And so all of those things sort of underlie why gut health is a big deal. But we'll talk about then how they're related to thyroid. So number one, yes, nutrition is a cornerstone. So you're a digestion has to be intact so you can take the absorption of micronutrients and macronutrients, which influence your thyroid function. So your thyroid function production of hormone conversion of thyroid from from T4 to T3. All of those rely on different nutrients. So specifically we think about things like iron, salineum, zinc vitamin A, some of the B vitamins and others. And number two detoxification, I always tell my patients are thyroid is like a magnet for environmental chemicals. So some of those might be halides like fluoride or chlorine and then heavy metals also will influence thyroid and your guts going to directly impact how you detoxify. And then number three is the big one and that's what we'll spend a lot of time talking about today and that's intestinal permeability and the relationship to auto-movity. So that is a relatively recent finding in literature and the medical literature is not really something that is practiced yet among your traditional standard doctor as a function medicine doctor. It is a much of my practice. So we'll dive into sort of that autoimmune connection and why gut health is linked to Hashimoto's. So I just want to underscore Hashimoto's is an immune system problem. It creates a thyroid problem over time, but Hashimoto's isn't a problem with your thyroid. So let's just talk quickly about the first two. So I mentioned a triad with auto-munity. So it's gut health is the primary one we'll talk about today. But number one and two are genetics and environment and then we'll talk about health. So just quickly like genetics. We can't do a ton about genetics. There is a field of epigenetics where we can potentially influence the way that our genes are expressed. But you know, we say genes load the gun environment pulls the trigger. So genetics that explains to some extent why two people who have the same genetics. You know, one might only get six. So if you have like a twin study, you know, you have one person who has autoimmune, you need another one might be fine. But genetics have long been recognized and proven to play a role in autoimmune conditions. The second one is environment. So I said environment pulls the trigger. So those triggers can be different for everybody. It might be heavy metals from a dental procedure from a mountain buildings. It could be pesticides from one care. It could be chlorine because you've been a lifeguard all summer. And then food sensitivities place somewhat of a role here also in gut health. It could also be things like radiation exposure or chronic stress or one of the things I talk about a lot is mold exposure. And so that's a big environmental trigger. But the third one is gut health. And so when I'm working with any patient who has autoimmune disease and specifically has tomatoes. Even if there's not digestive symptoms, I'm always looking at gut health. And this is why so about 10 years ago, researcher and physician named Alessio Fisano found this third causal factor in testinal permeability. So I kind of think of intestinal permeability or your gut. It's kind of like the grout and tiles in your shower. And as that grout becomes leaky, that barrier breaks down. And that barrier breaks down. It messes with our equilibrium between the tolerance to immunity and non-self-antigen. So I mean essentially your gut is this tube. It's a hollow tube, but it should be intact in term in permeability. It has a big deal. And when permeability is compromised, that's when we have problems with the immune system and our bodies ability to regulate our immune response. So specifically what Dr. Fisano saw is this protein called zanulin. And so zanulin is released in the presence of gluten. That's why you know for for my patients with autoimmune disease always recommended gluten free diet. And of course with passion, and then it's also influenced by the present of small intestine exposure to bacteria. And probably also yeast and different gut infections. And so we'll talk about that in a moment. But zanulin, zanulin messes with that grout. So it influences the tight junctions and the gut causing an increase in intestinal permeability and autoimmune disease and genetically susceptible individuals. So that's where the big deal comes in. So we're going to come back and talk about some of those gut infections when I go through that five hour program, the functional medicine approach for gut health. But let's just talk some negative inputs for gut health and positive input. So you know, if you're not somebody who's really struggling with a gut infection, maybe you don't even have Hashimoto's. Maybe you just have suboptimal thyroid function because you have other issues going on or poor conversion or whatever it might be. You still need to maintain good gut health. So some of the big ones for negative inputs for gut health and about a key sense of humor.
So people who take antibiotics, you know, yearly for a frequent sinus infections or whatever it might be, obviously, antibiotics have benefits, but they also have risks and got health. It's a big one. I think a lot about yeast for people who have a lot of antibiotic use. Another one is acid blocking medications. So they're called proton pump inhibitors, PPI, things like Nexium, OMAF Resolve, things like this. Again, sometimes there are benefits, but there are obvious risks, especially with long-term use, and to want to have that help. Other things that can influence gut health include birth control pills, household chemicals, environmental pollution, microtoxins, or mold exposure, like I alluded to earlier, pesticides. So when we eat foods that have a lot of pesticides, those act basically as an antibiotic. Just processed foods like that standard American diet, lots of high sugar, toxic fats, processed foods can, can mess with gut health. We've seen studies actually looking at a change in diet and how that influences gut health in a positive way in just a matter of days. Chronic stress, D-section birth, smoking. All those things can negatively influence gut health. So positive influences for gut health. Of course, diet is huge, and Allison's going to talk about that a lot. Fiber, prebiotics, resistant starch. All those things feed the good gut bugs, or the good buddies. Probiotics kind of are the buddies. Those are, you know, inoculating your gut with more of those good bacteria. Other things that we don't always think about are things like polyphenols, things we get from maybe dark chocolate, or red line, or green tea, or blueberries, also antioxidants. So vitamins A and C and E, vitamin D, essential fatty acids, zinc, glutamine. Those are all important nutrients for gut health. And diverse diet is also a big deal. So I think a lot of times there's a definite time and place for an elimination diet. I recommend them often, but I don't always recommend them long-term. And if I do, I'm always underscoring the importance of diversity because getting diversity in your diet is really important for your gut microbiome. And then the other ones that are less sort of talked about. So pets, I just got a puppy, kind of like for my microbiome and for my kids microbiome, right? Also because COVID, like whatever, what better time to get a puppy? Gardening is great for microbiomes. So getting out there and getting dirty. It's sort of, you know, the opposite side of that is the hygiene hypothesis, which I worry a lot with COVID. We're all so clean. We don't get exposed too much. We're cleaning things all the time. And, you know, again, risk benefit, I'm not saying we shouldn't do that at this moment in time, but how is that going to influence our gut microbiome long-term is something I've been thinking about. And the other one is exercise. So, you know, exercising every day is important for gut health. It's also important for your cell receptor sensitivity to thyroid hormone. So if I have a patient who's struggling with auto-unity, like I said, I'm always thinking gut health and a functional medicine approach to gut health is really this five-hour program. So what that stands for is number one, remove, and I'll talk about in detail what these need. Number two, replace. Number three, re-enoculate. Number four, repair. And number five, rebalance. So we'll go through those one by one, and I'll sort of put you in the mindset of like what what I think about as a functional medicine position when I see somebody who has auto-unity and specifically Hashimoto's. So number one, remove. So when I talk about remove, I'm talking about removing infections and removing the foods were sensitive to. So common infections I see in people and specifically in patients who have Hashimoto's. A huge one is SIBO, that small intestine bacterial overgrowth. Many people who have IBS actually have SIBO. And or something called SIFO. SIFO is less talked about, but this is fungal overgrowth than the small intestine. And so like I mentioned earlier, antibiotics are a huge risk factor for that. You could have coexisting SIFO and SIBO. You could have one or the other. That's where we do functional medicine testing to really differentiate. Disbiosis. Disbiosis is just abnormal life. So that abnormal bacteria, sometimes when we get rid of the bad or the good bacteria, the bad bacteria if lurshers. And so having more of that undesirable bacteria can play a role. Parasites. So sometimes are parasites. Like I mentioned earlier with the puppy. Hoppies have parasites like dogs have parasites too. And so even if you think in the United States, like there's not a lot of parasitic infections, but it's actually I think quite prevalent among people who have autoimmune disease. I don't think everybody has it, but I definitely find it, especially with international travel and animals on our house and all that. So removing those infections is really that first step, along with removing some of the foods that were sensitive to. So primarily that's gluten because of that reaction to zonulin. It might also be dairy. Often it's also sugar. Sometimes other people are more sensitive to certain things. So kind of the longer that somebody's had got problems, the more food sensitivities I see. And anytime I see somebody with food sensitivities, my number one question is what's going on with your intestinal permeability to cause this type of immune reaction. So I think we have to always address that that infection. And it becomes a vicious cycle. So like we continue to eat gluten or we have a gut infection, then we get more food sensitivities and then we're limited to very few kinds of foods. So once I've really taken those out, I usually concurrently replace. And so replaces actually really associated, there's this vicious cycle with thyroid. So what I say replace, I'm talking about digested enzymes. I'm talking about stomach acid. And I'm talking about motility and gallbladder function. So the thing that's underappreciated is that your thyroid controls your metabolism, including the metabolism of your vizcera, and vizcera is like your liver and gallbladder and your intestines. And so for people, we know that people who have hypothyroidism often have constipation. And that's because your gut mortality is affected. But hypothyroidism can also cause issues with low digestive enzyme function. The lower that function, the less you break down food, the bigger or larger protein goes into your small intestine, the more the immune reaction is. So it's similar. The research on this, really you can look at the research that's done on people taking acid blocking medications and how that influences food allergies. So we know that acid blocking medications are a risk factor for food allergies, but they're also a risk factor for small intestine bacterial overgrowth and a risk factor for small intestine fungal overgrowth. So optimizing that thyroid function by replacing hormone appropriately is important for your gut function. But I also use things like digestive enzymes. So I use a lot of pancreatic enzymes. I'll use the Tain HCl. I'll have my patients sort of test stomach acid, not all of them need it. But if they do, it's a cornerstone to really healing after gut infection. And then really think about gallbladder function. So that's like bitters is a big deal there. Bitters helps your gallbladder. And then motility. So motility and ejection of all that really kind of there's a lot of things that influence it. Thyroid is a huge influencer. So is that parasympathetic nervous system? So thinking about that parasympathetic and sympathetic balance, sympathetic dominance is like that stress, high stress, go, go, go, whereas parasympathetic is rest and digest. So really think about that. So that's number one and two. And that's the that's the start of when I work with a patient who has a gut infection. Later on, that's when we re-enoculate. And so if you've tried a probiotic and thought like, oh my gosh, this probiotic actually makes me more bloated and then don't feel good, that's because you might have a gut infection. And if you put that into soon, sometimes it's a problem. I personally use certain types of spore forming probiotics when I'm treating patients who have these infections, because they're well tolerated. But if you use some of the traditional stuff too early, like the phyto-backed or lactobacillus species, those can become a problem. The same thing is with like a fod-back diet. So people with IDS sometimes follow this low fod-mat diet and that takes out some of the more kind of soluble fibers and sugars that can irritate the gut if there's an infection in there. So anyways, number three, you think about re-enoculate and I'm bringing in some of those good inputs. So fiber, prebiotics like onions and garlic, asparagus, meats, prebatics, feed the good, good gut bacteria. Resistance starch is one of my favorites. Green bananas are a great way to do that. Cooked in cooled sweet potatoes, cooked in cooled rice even, plantains, but resistance starch preferentially, resist digestion in the small intestine and feeds that bacteria in the large intestine. And then probiotic foods like kefir, kimchi, kombucha, pickled vegetables, sourcrout, that sort of thing. Probiotics actually re-enoculate with the good bacteria. And then like I mentioned, actually probiotic supplements you can use too. Number four would be repair. So really thinking about that lining of the GI tract and what we need to give our gut in order to heal. And that really like a lot of those nutrients, zinc in some of those antioxidants, A-C-E, omega-3 fatty acids like fish oil. And there's an amino acid called glutamine that help. There's lots of different ways to get those through nutrition and then supplementally as well. And then kind of number five is this rebalance. And that's where we really have to pay attention to lifestyle choices because sleep and exercise and stress can all have an effect on GI tract. All have an effect on that parasympathetic and sympathetic dominance. And so really just like, that's where long-term lifestyle changes come into play. So that's a lot. I know it's kind of a mouthful. I'm going to pass it over to Alison so she can talk about, kind of, practical ways to implement all of that. Okay, Alison, are you ready for an introduction here? Ready. Terrific. Well, thank you so
So much Christine for that incredible, incredible overview. It was so, I don't know, very organized. And I've never heard anyone go through the issues of gut health in quite that way. And I found it extremely informative. So I'm hoping that everyone watching found it as helpful and useful. And I've got tons of questions for when we get to the question and answer section that came up for me. And I know we had a few questions coming in while you were speaking as well. So we'll look forward to getting back around to the Q&A part to find out a little bit more. But right now we are going to move on to Allison Maris. And Allison wears a lot of hats. She's a nutritional therapy practitioner, restorative wellness practitioner, and home chef. She really works with women with food sensitivities to help them master cooking, beat bloat, boost energy. Her specializations are hormonal health, thyroid health, autoimmune disease, adrenal fatigue. So she's right up our alley here at Paloma. She curates a beautiful website called Food With Mars that is filled with all sorts of delicious and nutritional recipes, health-related articles. And her focus really is that getting into with our body is one of the most important ways to heal. And that food and nutrition can be an important part of that. So I want to welcome Allison to our speaker series. And we are very excited, Allison, to hear what you have to say about the gut health issue. Thank you so much for having me, ladies. And Dr. Marin, it was wonderful hearing from everything. I just want to echo that everything was so concise. This is a very loaded topic. Yeah, and it's so helpful to be able to simplify and organize these things. I'm so-- I'm so-- Don't get overwhelmed, and you're not operating from that stressed out sympathetic state all the time. So yes, my name's Allison Maris. I'm so happy to be here with you all. You guys are my people. Got health Hashimoto's is my world. I have Hashimoto's myself as well. I just had my first baby a year ago. She just turned a year. And I was definitely that kid who grew up on the standard American diet. Saw a lot of family members with auto-immunity cancer. And I was like, that's not going to be me. And it was-- it kind of was totally that thing of genes, low bit gun, and environment pulls the trigger, right? So birth control pill, lifetime of antibiotics, eating poorly, stress, working hard, playing hard, I'm in New York City. So that's the name of the game over here. So that all happened. Hashimoto's came about. And all the while I was building my blog and figuring out that I had food sensitivities, leaky gut, SIBO, all the things. So in order to use nutrition, you know, food to listen to support leaky gut and healing the gut and everything to do with Hashimoto's that Dr. Maran just went through, it's really a key to approach it with a positive mindset. So I just want to say your diet goes hand in hand with your mindset. And I think that that's really key because when you are removing foods and changing your lifestyle and going through the checklist of how do I heal, it can get very overwhelming. You can lose your love of food and it's not-- that's not going to help you in the long run. And the reason I say that just from the get-go is because I see it so often in my practice, women coming to me that have done the whole '30s, gone gluten-free, done all these things, and they forget to reintroduce foods. So I'm so happy that Dr. Maran highlighted that. It is so important to reintroduce foods if you are continuously removing and never reintroducing what are we doing here? We're supposed to be healing so that we can get and challenge things back. So something that I work with in my practice a lot is mindfulness and so I'm going to take you guys through that a little bit as well. So first things first, in terms of how to eat, Dr. Maran touched on this a lot, but at a bare minimum, definitely removing refined sugar, processed foods, gluten, and dairy to start with. And as we spoke about the zonulin response, but then also for thyroid, specifically, the protein and gluten actually mimics the protein of your thyroid. And so if the thyroid tissue is getting attacked, then there's going to be an inflammation and an attack every time you're ingesting gluten, if it looks just like that. So that's really key for going gluten-free. Also soy-free is really a big deal as well for thyroid health. So really the paleo diet is an ideal template to start with. And I just want to highlight template because everyone is so unique. So for example, grains are not included on the paleo diet because they can be very difficult to process when we have leaky gut conditions. A grain itself is already very processed by the time it gets to you because we can't really eat it in its natural form. It would be eating grass. It would be eating wheat or hay, right? So the whole premise of going grain-free and paleo is really that these things can be inflammatory. If our gut's already compromised and leaky from years on the standard American diet, antibiotics, PPI, whatever it is, a lot of refined sugar, we really need to remove the things that are causing more distress to the gut so that we can heal. And that's where you start to work with a practitioner and go through those steps of healing as you remove. So it's never just remove, remove, remove, you know, keep kind of yo-yoing and never getting things back. You remove while you heal. And then so after you've started to heal, you've addressed any infections, SIBO, Candida, you know, parasites, things like that. You've built up that stomach acid. You're taking digestive enzymes. You're drinking the bone broth and the fermented foods and all that good stuff that we talked about. That's when you start to challenge reintroductions. You do that with a food journal. There's, you know, a few different ways you can do it, but you do want to try and start to get those things back. A step further, especially for auto-immunity, is the autoimmune paleo protocol. And this is definitely meant to do short-term because it further removes foods from the paleo diet. So I create recipes for paleo, AIP, whole 30 because they are so healing for the gut. And I love food. And when I took these diets on, I took it as a food network-chop challenge for anyone who watches that show. And so you can have fun with it, but it is basically meat, fish, vegetables because nuts and seeds are even removed. Certain vegetables like miteshade, so tomatoes, potatoes, white potatoes, that is, you know, other things like spices that fall into the miteshade category, paprika, chili powder, things like that. All these things can be causing further inflammation to the gut. So again, it is just a short-term removal usually around six weeks. And then you do want to start removing. It's so important that you do. Sometimes you'll feel so good and you'll be focusing on getting your antibodies into a range that you want to keep doing it and keep going harder. I'm here to say that will not end well because you're not diversifying, right? And that was one of the key things that Dr. Marin explained is so important for our gut. We need a diverse microbiome. We don't need less. Okay, just like the antibiotics were removing things. We don't want to keep removing all the good diversity in the gut. So it's important to challenge reintroductions and just look at it as a learning process, as a chopped challenge, shall we say, and not as too much deprivation because then we start stressing out. Food's not fun. We don't want to cook. We want to make sure that we're bringing joy into the kitchen and bringing joy into our healing journey so that we can have fun with the food and really let it nourish us. Like we were saying you are what you absorb and a big part of absorption is what's happening in your mind. And that's the next part that I would love to go through with you. So the next part is how we eat. So I talked a little bit about what, right? We can do those paleo gluten-free, dairy-free, even AIP types of diets to challenge and remove while we heal, right? Then we start reintroductions. But how are we eating throughout all this, right? So I touched a little bit on positive mindset, right? Approaching this with open arms. We're learning. We're seeing what feels good and we are definitely diversifying. So we're rotating foods. We're making sure. Try new things. What's seasonal? It looks like a weird vegetable. Let me try it, right? Like you want to have fun with it and really include diverse things and not lean too heavily on the same old foods. We are creatures of habit. Whenever I look at someone's food journal, it's like the same six things that we bought that week. And it's really important to vary it up as much as you can, rotate things. Because when we do have leaky gut, we just get more susceptible to food sensitivities. When you're having that never-ending list of food sensitivities, you really need to bring things back in and rotate. Okay?
would just mean like if you're eating sweet potato a lot, you know maybe you skip a day here and there and you don't eat the same thing every single day. It's really tempting to do that, but we want to be careful with that. And then we want to practice mindful eating. This is something I talk a lot about because it's not just helpful to enjoy the food and you know to bring that positive mindset to food, but it's also quite technically how you're going to be able to digest successfully. So we need to be in a parasympathetic state of mind, which is also called the rest in digest state. I'm sure you've heard of the fight or flight state, right? And that is the sympathetic state, the stressed out state that so many of us operate in like a lot of the day. We're rushing maybe you know when travel was a thing we were maybe eating in our cars or in between meetings and you know scarfing down our lunch, that was not being digested 100% there's just no way because you were not in the proper state of mind. So one thing to know and remember digestion begins in the brain, not in the mouth, not in the stomach, it begins in the brain. So you really have to bring that A game with mindset slow down sit down take some deep belly breaths. I really like to take three deep belly breaths before I'm about to eat. If you like to practice grace you know say a prayer before food or just look at the food in front of you and notice it and be grateful for it that would be a great way to slow down and you know get those deep breaths in. That effectively sending that message to your belly with those 3D belly breaths is telling your body I am safe. We can now go into the parasympathetic state of mind. We can rest in digest. It's really sending a message from the brain to the rest of the organs which there are a lot in the digestive process to get ready to do its thing. So that's number one you want to put your devices away put the cell phone away put the laptop away it takes like 10 minutes to eat. Seriously like everything will be there for you when you are done eating. So I can like we can take all the digestive enzymes in the world can do the HCL challenge build up your stomach acid get you eating all the healthy food but if you do not slow down and you do not eat my infility it's not going to digest and absorb. So that's really key that's always 101 for me with my clients. And what else can oh and then the other thing that I want to talk to you about is rhythmic eating so fasting like a fasting schedule and so this is really important especially with Hashimoto's because like we talked about constipation and motility tends to be such an issue. So you do want to give yourself a good amount of time overnight from between dinner and then breakfast to really be able to digest let your body do what it needs to do to detox do all the great things that needs to do while we sleep it will also help your sleep if sleep is a challenge for you. So something that I really like to do is end my dinner and last meal of the day three hours before I'm going to go to bed as a rule of thumb and I really like to plan for about 14 hours fasting between dinner and breakfast and that's pretty reasonable you might already be doing it but I would definitely challenge you to just double check and at least get 12 hours but optimally 14 hours of a fast and I know fasting and intermittent fasting can be a very hot topic these days it does not need to be that complicated should eat when you're hungry but try to keep it within a decent window where you can absorb and digest and have a daily bowel movement and not get constipated so that's really key too. And those are those are my big tips so I'm totally here for any questions or anything else. I think you're on mute Mary. Sorry great information Allison really really helpful and understandable I think for those of us who are sort of out there in the wilderness trying to figure out what to do and get get healthy I think that was some really incredibly useful information so I wanted to Katie are we ready to move into the Q&A portion of today's speaker event? Yep I just sent you a couple questions and if anyone has questions feel free to leave them it looks like we have the chat and Q&A features available. You're gonna drop them there and I will track them and Mary will ask questions to Allison and Christine. Great okay all right so this is a question for Dr. Christine Marin and Christine what we want to know is what is the research showing us about the link or correlation between auto-immunity and reducing symptoms so if we lower our TPO antibodies for example does that eliminate or reduce the symptoms of thyroid issue that we've got? Heck yeah this is one of the things that I've you know I've been in different seminars and people are like what if you go to a conventional doctor most of the time they're not rechecking thyroid antibodies but that's how I know I can tell if a patient's feeling better by looking at their labs before I talk to them most of the time because there are other factors you know that come into play but I can tell like okay we're moving in the right direction we've treated the gut infection and testinal permeability is better because those TPO antibodies or thyroid-globulin antibodies are decreasing so yes most of the time that is true I don't know that there is any specific research that is you know tracking TPO antibodies with disonulants side by side that'd be a really interesting study actually but I've never seen anything like that unless you have a sono would be the one to do it if if somebody had looked at that but but yeah for sure I think symptoms when you see TPO antibodies go down symptoms are usually improving great I think though if I can just kind of separate that a little bit I want to I want to make sure people understand that there's kind of two symptoms at play one of them is the autoimmune piece which is immune system that's a lot of like inflammation and immune response so that immune response might be improving but if somebody hasn't addressed the loss of thyroid function with appropriate hormone replacement perhaps symptoms aren't better right because if they're maybe their immune system is getting better but their T3 is still in the garbage and they feel super tired so I think those are two separate issues okay I want to circle a back around to one of the basic issues and we have a couple of different people that have raised this question in some form or another which is what are the tests that we need to get to evaluate this and we also have a particular question from someone who had to jump off the chap that said she would check back in to get the answer and she wanted to know are there any non-blood tests she's got a needle phobia and so she minimally avoids any kind of blood dosch and we get one blood draw a year so are there other tests besides blood tests that are available number one and number two when you do go into evaluate this autoimmune situation and particularly the gut health what are the best tests so how do we know if we've got these issues that we're talking about so I think we know if we have leaky guy if you have autoimmunity you have leaky gut I mean we can just make that assumption most of the time and certainly if you have digestive symptoms or food sensitivities you have leaky gut so if somebody you know somebody says do I leaky gut or not do you have a lot of food sensitivities give digestive symptoms like bloating you know loose stools constipation do you have autoimmunity those are sort of my top three and that's when I know somebody yeah you've got leaky gut there are some tests we can do to look at levels for zonulin I actually don't use them a ton but they can be tested in the stool and in the urine and sometimes they do use them but just overall I found like the cost benefit it's better to spend money on the test to identify what the infection actually is so the test that I do in my practice are mostly urine sometimes we'll often stool as well so and somebody who has a digestive issue or autoimmune I'm looking at an organic acid test and I'm looking at a stool test so that's urine and stool for different kinds of gut infections that we're going to treat on the stool test I do I see markers for gluten reactivity there there are markers for zonulin you can add on which I sometimes do which is like you're a marker for leaky gut there's markers for inflammation the gut immune system of the gut and pancreatic enzyme function and fat malabsorption things like that as well but but yes there's plenty of ways to test I think if you're looking at blood I like to test you know if you're doing thyroid hormone replacement I think it's important to test your blood after you have to switch up your hormone replacement so it depends on how often your thyroid dose might be changing very helpful yeah Alison do you have any tests that you are doing from a nutritional standpoint or anything else that you have been helpful no yeah I agree I also I think you might be describing the GI map I yeah I usually use the GI map I will sometimes use the MRT food sensitivity test but yeah I mean to the point about gluten it's just always a gluten free so I usually don't spend time testing that um yeah okay um we had a question from Sarah.
and she wanted to know, she said she's got Hashimoto's and several other autoimmune diseases. Is this more intensive focus on gut health something that she and all of us are gonna be doing forever or is there a specific timeframe in which we can heal the gut and sort of be in a situation where we don't have to be focusing on it anymore? What she said was she had taken a lot of antibiotics as a kid, as many people did, and she knows she's got it, but she also doesn't want to take 20 supplements a day, potentially for the rest of her life and have to be over-focused on it. So what's the timeframe to get this under control and are we gonna live this with this forever or can we reasonably get back on track? - Yeah, I mean like everything it depends. And so for somebody who, I think it depends on how long somebody's been struggling with a condition and then the complicating factors. And so if there's somebody who has just struggled for a couple of years, that's much easier to fix. Somebody who's maybe been sick for 20 years, like I would give it a good couple of years to fix that. So I think that no, the idea is not to take this many supplements for the rest of your life and to be really like trying to heal the gut for the rest of your life, but it is a total lifestyle change. And I think that lifestyle is like a commitment that you kind of stick to. Gluten free, I would say, yeah, that's kind of, that's for the rest of it. I think when somebody gets their autoimmune markers in a normal range, that doesn't mean that their autoimmune disease is gone. It just means that it's in remission and they'll be ebbs and flows. I mean, my autoimmune markers just went up with quarantine 'cause I drank too much wine. Like, you know, like things happen, right? Like sometimes things that have been flow, we might lose somebody in our family and have a lot of stress or lose a job or go through COVID or whatever happens, we have stress. And so those things ebbs flow and so lifestyle is important. And, you know, sometimes we might have flares and might need to readdress some things. But I think, you know, up front, you kind of hit it hard, work on removing that gut infection and then like Alton saying, you hopefully reintroduce foods and start to open up your diet. And I think there are certainly supplements that maintain health, you know, maybe like four or five that might help with thyroid function rather than 20, you know, but sometimes like sometimes 20, you gotta do that up front and then kind of ease off. - Absolutely, I know there have been periods in my life when I've taken more than 20, but then, you know, get into a good place and you can kind of go into a maintenance level and then things flare up and you ramp back up. But I'll rather take the supplements then struggle with the symptoms. So I don't know, I hope that other people share that approach. While we're talking Christine, I would like to add in another question here. Michelle is asking, she is hypothyroid and she's pregnant and she said she is having headaches and UTIs and she's wondering if this may be gluten related during the pregnancy. - So if you're hypothyroid, so first of all, hypothyroidism during pregnancy, your thyroid hormone needs increased by 30 to 50%. So I think it's really important that anybody who is trying to conceive has optimal thyroid function and as soon as you're pregnant, working with a doctor very closely to increase your thyroid medication and have those labs really followed closely. So that's very important. Your baby needs a lot of T4 in particular, so it's a big deal when you're pregnant. And then the gluten, I mean, you know, if you're hypothyroid, usually I recommend, it depends on the cause of your hypothyroidism. I'm gonna assume you have Hashimoto's, in which case I would always recommend a gluten-free diet. And headaches and pregnancy can be really multifactorial. I think it depends on what stage you're in, you know, third trimester might be more worried about blood pressure and things like that, pre-eclampsia. So I'd say definitely doctor, make sure you get labs checked, get your blood pressure checked, get your urine checked, you know, if you're schooling protein, that could be an issue. And I think right now, especially with COVID, people are avoiding going to the doctor and not having as many labs drawn. So I think that's probably an important, you know, if you're having symptoms, that's an important one to do and determine if it's thyroid or something else. - Okay, thank you. Allison, we have a question that I think might be right up your area of expertise. And Sonia wants to know if we really need to be vegetarian or is vegetarian better? Should we go vegetarian? And I know this is a controversial topic because, you know, some of the paleo diets and things tend to not be as vegetarian. So, you know, where do you stand on the vegetarian, non-vegetarian and auto-immunity and in particular the thyroid issue? - Yeah, that's a great question. So as mentioned, iron and selenium are some of the key nutrients that our thyroid needs. So just in terms of like thyroid health, it's difficult to, I think, go vegetarian or vegan successfully for most people. So no matter what everyone is so unique and there's bioindividuality to consider. So it's not a hard and fast 100% rule that just doesn't exist at all. I know we wish it did. But I often see low energy hypoglycemia sugar addiction with a lot of vegetarian mix, especially with these conditions. So I'm a big proponent for animal protein. So if it is, you know, a choice like you're not going to have animal protein, whether it's more of like a social justice impact choice or you're completely turned off by it or you know, whatever it is, there's certainly ways. I would say to look into amino acid therapy and definitely ensure you are getting a good multivitamin and taking supplements because something needs to be taking care of there. You're not going to get it all from like plant-based sources of protein like P and hemp. They're definitely good. I definitely use them. But I would say to depend on that completely, I think the energy is going to tank. I think it's going to be hard to really get the nutrients that you need for the thyroid. That's just based on what I've seen personally professionally. I tried to be vegetarian once. I tried to be vegan once. I love the food. I wished I could have sustained it, but my symptoms were the worst they had ever been. I was losing a lot of hair. My skin was really, it was just, it was a very tough time. And so once I was able to eat meat, find properly sourced meat, feel good about it. Use it nose to tail, make my own bone broth. You know, just really make the most out of it and be very grateful for everything. I just, I feel amazing when I do eat it. So I would just say, you know, you deserve to find out, do what you can, do what's available to you and what you feel comfortable with. And if horse comes to us, seek out amino acid therapy. (laughs) - Great. Now one question again for you, Allison. We have one of our viewers that said that she's got Hashimoto's, but she noticed that she's waking up in the morning with joint stiffness in her hands, with some inflammation. And she's wondering if, and we'll ask Dr. Marin this as well, but she's wondering if she should go gluten free. And is this a sign to eliminate gluten? - Yes. If you're on this call, I'm gonna bet you need to go gluten free or just be gluten free. Just for all these conditions that we've talked about, between Leaky God, between Hashimoto's, there's just so many reasons why. What's funny is I'll often encounter women who are like, "Yeah, but I should get a test to confirm, but really you can just stop eating and see how you feel." If that inflammation and joint pain goes away or that skin irritation goes away, your brain fog goes away, that is your answer. Kind of like you said, getting in tune with your body. You know, and back to that question about, is this a lifelong thing or like, "When is this gonna end already? When do I heal this?" We are so used to a magic pill in this society. And I think that we can't put a timeline on it, unfortunately, absolutely yes, it depends on what's going on. But this is also, you know, we have chronic illness amongst us here. And so chronic the very nature of it is it's gonna flare up, it's gonna go away, it's gonna, you know, you have, you have good days, you're gonna have your bad days. So just really adopting this is more of a lifestyle versus just kind of looking for like, "Okay, cool, I'm gonna do the five R's. I'm gonna check this off my list. I'm gonna, you know, do this diet. It's just opening yourself up to the possibility that this is a lifestyle and you can totally be successful with it. You just take it at your own pace, know thyself and bring a positive attitude towards it. So yeah, go gluten free. There's plenty of gluten free recipes, gluten free products that it's way easier to go gluten free now than it was in years past. But I think that would really help. And then the other thing that comes to mind with the joint pain inflammation, just to add that in. Nightshades can sometimes really be a thing with that. My grains, you know, anything that's just like quick onset of pain and inflammation like that. So I would consider, you know, if you eat a lot of tomatoes, red sauce, you know, white potatoes, peppers, you know, spicy food, I would do an experiment and remove that and see how that feels as well. - Okay, great. Dr. Maran, do you have any additional thoughts on this issue because
I'm sure you have a lot of patients that come to you with joint pain, hand, feet, morning inflammation, and that's a pretty common symptom. Yeah, 100 percent, I mean, I agree with Allison. I think to make sure your thyroid function looks good, make sure you're not functionally hypothyroid and your T3 is in an optimal level. Sometimes, you know, hypothyroidism itself can cause that, but yes, I think gluten-free. I mean, the only thing I would add is just like when you're doing gluten-free products, be careful that you're not choosing like the gluten-free muffins, that's full of sugar and rice flour, you know, that kind of stuff because a lot of gluten-free stuff is often just because it's gluten-free doesn't mean that's healthy. So usually looking for something that's like more paleo is healthier. So an example of that would be like if you're going to make pasta, like this capella is brand that's like an almond flour pasta versus like rice flour thing, you know, same thing with crackers, like simple melts, great crackers, they're almond flour. I can eat a whole box. Don't ask me to. Sounds good. Sounds good. You're making me hungry now. Question that I have about probiotics because there's some controversy out there about whether you can get all of the good bacteria, those, you know, happy, wonderful buddies that we need in our, in our gut from food alone or whether we really do in many cases, especially if we have a dysbiosis and imbalance, really need to include a probiotic supplement. And I'm wondering if you have thoughts about that. I tend to, I mean, it's sort of what you said for healthy people, people who have another rice pretty healthy intact gut, I think they can get their beneficial bacteria from foods if they're eating a good, diverse diet. But I think there's a time and place for probiotics. And I think one of those is when people are suffering from gut infection or have taken a lot of antibiotics. And there's mixed literature looking at whether probiotics can even help to re-enoculate the gut. That is kind of why I use a spore forming probiotic. I'm a fan of mega spore biotic. I don't know if Allison is or not, but that's sort of my go-to, especially in a patient with auto-immunity and with gut infections, I use it myself. It's not tolerated in every patient. And so, you know, some people don't do well with it. And so I just usually start it, you know, what, like start that away from other kinds of therapies. I'm not going to start somebody on like an antifungal medication and a probiotic mega spore biotic at the same exact time, because I like to know, you know, if there's issues. So spacing it out by a couple days, just like you would with food or introduction. But, but yeah, I think that people with gut infections benefit generally from adding something like mega spore. Great. Thank you. I love this for probiotics myself. They, I found them so effective. I can really feel the difference. So I love probiotic foods and I try to do a combination of both, but I'm always adding in a supplement. Allison, I want to jump back to you and find out, because we have a question from one of the viewers about how we go about reintroducing foods back in after we've gone to a more restrictive diet. Do we have to do it really slowly? Do we do it food by food? If we've cut out the nightshades, can we add tomatoes and peppers and plants back in at the same time? Or do we go individually vegetable by vegetable at that rate? It's going to be, you know, about 10 years before we can actually have a full salad or something. So how do we, how do we work this out to protect our health, but not to be completely neurotic about it at the same time? Absolutely. Yeah, I would say organize it. You're going to want a journal and you're going to want to space it out by about two to three days. And you do, it's just like an experiment, right? You don't want to do everything all at once, because then if you do have a reaction, well, which one was it? Was it this tomato? Was it the pepper? And now you're back at square one. So it might seem like, oh, I got to like journal. I have to put this on my calendar. I got to like space this all out into your point. Like it's going to take 10 years for me to build a full on salad. But it will, it will serve you better in the long run if you are patient. Patients is a virtue to just space it out and get the read on it. So keep a food journal. Chot down and you know, it's not just going to be a digestive thing. See if digestion changes, see if your skin changes, your mood, brain, you know, like brain fog. And also like joint pain kind of stuff. See if there's a change in any of that. Keep a journal. And then take a look at it after a few days and then you can make your best educated guess. But it's really going to serve you to get in tune with your body like that. It's a good worthy experiment. Okay. Dr. Marin, I'm going to go back to Dr. Christine Marin for this question from Sarah. Her perimenopausal hormones are being tested. And she said that she's had Hashimoto's for 20 plus years. But in the in the in the most recent year, she's noticed that she has a much stronger urine smell. The odor of her urine is much stronger. And that's been a mystery to her. And she said, I can tell my hormone balance is off. What test should I ask my doctor to check for besides my usual thyroid tests? She said she's also going to try gluten free. So Sarah and Texas is going gluten-free. Good luck Sarah with that. But Dr. Marin, what do you think when we're talking about urine that's changed its odor and some hormone issues and in a perimenopausal woman? What might be going on and what should she be looking at with her doctor? So the the biggest one is if somebody has low estrogen, we tend to have vaginal dryness. Vaginal dryness can lead to yeast or I'm sorry to urine infection to UTI. And so I'd ask for urine culture primarily. I mean generally we're looking at symptoms also of a UTI. So pain, incomplete voiding, you know, maybe blood in the urine like that. But if there's a string jowdard, ask for urine culture in your analysis. Especially if there's, you know, vaginal dryness makes sure you're urinating after intercourse and that you're using appropriate lubrication. The other thing I think about is dehydration and hydration status. Our urine becomes more concentrated when we don't have enough fluid on board. I don't think, I don't really see how that's related to perimenopause unless there's like crazy hot flashes and sweating out. I don't think that's going to really make you dehydrate it though. But if they're, you know, if your fluid status isn't awesome then drink a lot of water. Even if you do have a really low grade UTI that can help because you're just fleshing out your bladder. And with our auto immune patients, especially in perimenopause or women in their 40s and older, do we also need to really maybe mention or pay attention to blood sugar issues because of increased risk of type 2 diabetes in this group? So maybe, I mean, I think everybody, like if we have low thyroid function and we're not having appropriate hormone replacement, we see decrease in metabolism and high blood sugar and high cholesterol and things like that. If our hormones, our thyroid hormones replaced adequately and correctly in monitor over time, I don't think that should necessarily be, you know, a risk factor. But obviously, if you have a risk factor with Hashimoto's and you have auto immunity there, you're, you know, you have to think about other autoimmune diseases as well. I don't know. Tell me what you're thinking, Mary. Well, I'm just thinking that, I mean, I know that there are some studies that have shown that there is a higher incidence of type 2 diabetes in people, even with treated hypothyroidism because of some underlying metabolic mechanisms. We're just, we're insulin resistance, higher risk. And I mean, obviously, we have a large population of people with insulin resistance out there irrespective of their thyroid stat. Yes. Totally. And people who don't know it, right? Like there's no idea. Exactly. Yeah. So I like to test if fasting insulin on patients because you'll see that different, they'll see that change before a hemoglobin A1C. So for people who are listening at A1C, it's like a three month average of blood sugar. And if you can just get that insight into your fasting insulin and you see that level above eight, even if it's in a normal range, it's too high. And keeping that insulin in check is really a big deal. So, yes, eating for blood sugar balance is important. So yes. And urine, like usually some of the symptoms we see in people with blood sugar issues is that they peel out at night. So it's called nocturia. So if you're waking up at night to urinate like several times, you should, I mean, regardless, I think everybody should have their blood sugar checked, but that would be a reason that your insurance might pay for it. Sure. Absolutely. Thank you. I would also just quickly add, because I feel like we've been dancing around it with that whole topic, but adrenal health is closely linked with blood sugar balance as well. And that's also going to be the two foundations of hormone balance in general. So if we're talking about hormonal imbalances, we're talking about thyroid health, we have to support our adrenals with stress management. And then yes, a blood sugar balancing diet. Katie, should we, before we finish up for our session here, should we have an opportunity for both Dr. Maran and Allison to share where they can, where people can find them and what they've got available? Are we about ready to wrap things up at this point? Yes, we're going to wrap up. Obviously an hour is not enough time to get like all of the information about everything. So Allison and Christine, maybe if you guys can share where people can find you if they have more questions about what you've spoken about, and then we'll wrap up a little bit from there. Sounds good. I am, it's I'm at Dr. Christine Maran.com. I'm on Instagram a lot.
and that's at Dr. Christine Marin and Facebook is the same thing at Dr. Christine Marin. So I am there. I see patients in Colorado, Michigan, and Texas. I've been doing all virtual medicine and telehealth for like the last five years. And long story short, I was married to a military doctor. So we moved around, but I'm home in Colorado. This is where I'm based and where I'll stay. But I'm licensed in those other states and I have a nutritionist who works with me as well in the education world wide. Awesome. Awesome. I'm Allison once again and you can find me at Food by Mars like the planet. So my website is foodbymars.com. I'm honest to read them a lot as well. I share a lot of what I'm eating, cooking, tips, things like that. And I also have a Facebook group. It's called Food by Mars Nation. And I have a lot of women with Hashimoto's in there. We talk a lot about food sensitivities. All the things. So yeah, you can hit me up there. I have recipes, meal plans, challenges, all that good stuff. That's awesome. Thanks guys. Thank you to all three of you for being here today and for sharing what you know. This event has been super valuable and helpful to us. And thank you to everyone who's joined us today, who's who's watched and asked questions. We know that it's kind of a strange time in the middle of a Monday. You know, it's almost kid bedtime on East Coast and it's going to work day on the West Coast. So thank you for joining us and thank you really for taking time for yourself today. We have an exciting project upcoming. Paloma Health is working on developing an app to help with some of this gut health food sensitivity, detective work. We're hoping to give you a sustainable framework for elimination and reintroduction. So we don't have a date for this yet, but if this is something that you might be interested in beta testing, feel free to send an email to
[email protected]. And we will get you that information when it's available. We'll also send out a replay of this event via email. So keep an eye on your email. You'll also get some goodies from our speakers in there. And then keep an eye out for our next event next month. Thank you so much again for being here. We had a really good time and we hope you did too and we'll see you soon. A happy thyroid is presented by Paloma Health, the first online medical practice focused on living well with hypothyroidism. You can go to PalomaHealth.com to learn more. [Music]
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