Low-Thyroid Help: Natural Support for Hypothyroidism

1. Low THYROID Help Natural Support for Hypothyroidism P E A R LW I S E

2. Low-Thyroid Help: Natural Support for Hypothyroidism By Pearl Wise Pearl’s W ebsite ©2018 Pearl Wise. All rights reserved. Copyright Notice: This eBook/PDF may be freely shared and distributed by any means, but it must remain in its original form regarding content. Any references to this eBook, or excerpts taken from this eBook, must include credit to Pearl Wise. For simplicity’s sake: This eBook’s format may be changed from PDF to ePub or .mobi etc, but the information contained herein must remain unaltered, and Pearl Wise must be credited as the sole author. Medical Disclaimer: The information in this eBook is not intended or implied to be a substitute for professional medical advice, diagnosis, or treatment. All content contained in this eBook; including text, graphics, images, and information, is for general information purposes only. Pearl Wise makes no representation and assumes no responsibility for the accuracy of information contained in this eBook; and such information is subject to change without notice. You are encouraged to confirm any information obtained from this eBook with other sources, and review all information regarding any medical condition or treatment with your physician. WARNING: Pregnant or breastfeeding women should not attempt to implement any of the natural supplement plans laid out in this eBook without first consulting a medical doctor in order to avoid potential harm to unborn babies and/or breastfeeding infants. All other persons are advised to consult a medical doctor before trying any natural supplement regimen as laid out herein; to avoid negative interaction with current medications, and because regular blood tests are necessary to monitor the levels of certain vitamins and minerals in the body, and thyroid gland activity must be regularly monitored.

3. Table of Contents By Pearl Wise.................................................................................................................................................1 Introduction....................................................................................................................................................4 The Thyroid Gland....................................................................................................................................5 Thyroid Hormones................................................................................................................................5 Types of Hypothyroidism.....................................................................................................................6 Conventional Treatment for Hypothyroidism.......................................................................................8 Causes of Excessive RT3......................................................................................................................9 Dealing With Excessive RT3...............................................................................................................9 Why Diet Doesn’t Matter........................................................................................................................10 Healing the Gut...................................................................................................................................11 SIBO...............................................................................................................................................12 Parts of the Small Intestine............................................................................................................14 Feeding Gut Flora..........................................................................................................................14 Probiotics........................................................................................................................................16 Glutamine.......................................................................................................................................17 How to Dose Glutamine............................................................................................................18 Thyroid-Specific Nutrition......................................................................................................................19 Iodine and Selenium...........................................................................................................................19 A Word About the Patch Test.........................................................................................................21 Zinc.....................................................................................................................................................22 Magnesium..........................................................................................................................................22 Back to Magnesium............................................................................................................................24 Iron......................................................................................................................................................25 Vitamin D3.........................................................................................................................................26 Vitamin A............................................................................................................................................27 B Vitamins..........................................................................................................................................28 B1 (Thiamine)................................................................................................................................29 B2 (Riboflavin)..............................................................................................................................29 B3 (Niacin).....................................................................................................................................29 B6 (Pyridoxine)..............................................................................................................................30 B12.................................................................................................................................................30 Tyrosine...............................................................................................................................................31 Arginine..............................................................................................................................................32 Herbs for Hypothyroidism.......................................................................................................................32 Ashwagandha.................................................................................................................................32 Olive Leaf.......................................................................................................................................33 Sage................................................................................................................................................33 Liver and Thyroid Health........................................................................................................................33 Insulin Resistance and Thyroid Health....................................................................................................35 Women and Insulin Resistance...........................................................................................................37 Men and Insulin Resistance................................................................................................................39 Improving Insulin Resistance in Both Men and Women....................................................................41 High Cholesterol and Hypothyroidism....................................................................................................43 HIIT.........................................................................................................................................................44 Low-Thyroid Help 2

4. Introduction This eBook is the result of my own struggle with hypothyroidism. Of course, I didn’t know I had it because most of my doctors didn’t take my symptoms seriously, and they certainly didn't take me seriously as a patient. The usual advice I was given was to lose weight, despite making it known that I couldn’t, take anti-depressants, take pain medicine, go for “beauty treatments” as pick-me-ups, and quite a lot of other nonsense. I even had one doctor tell me I’d feel better if I found myself a husband. It was ludicrous—all of it, and maddening. I began to question and doubt myself. A dear friend of mine, who’d witnessed my decline, snapped me out of that state of denial. I had validation, so I went looking for a real doctor, one who was both professional and compassionate. Little did I know how difficult that search would be. I never did find the type of doctor I was looking for, but I did find one who was willing to run a few tests. My T4 was too low, and my TSH was too high. I had hypothyroidism. I was so excited to have a real diagnosis, but the euphoria didn’t last. I was prescribed Synthroid and sent on my way. The medication stopped my hair loss and normalized my high blood pressure, but I didn’t feel better. I was still fatigued, still gaining weight, and still had constant muscle soreness. I explained my symptoms during my next doctor visit and was given the all-too-familiar speech about exercising and watching my diet. I’d already explained that exercise was almost impossible, but my words fell on deaf ears. As for my diet, I’d been a lacto-ovo vegetarian for years. I thought I was already eating a good diet. I felt totally lost. I didn’t want to risk finding another doctor out of fear of finding another bad one. At least the one I had took a moderate interest in my health. I was fed up with feeling ill. I was tired of watching my life pass me by. I decided to take control of my own health. I began doing my own research. I experimented with various “remedies,” one of which landed me in the hospital. (Be extremely cautious with iodine supplements. People with hypothyroidism are very susceptible to negative side effects.) It took some time, but I finally found a system that worked for me. I decided to put what I learned in this eBook. Everyone’s body is different; everyone’s health is different, and the strategies laid out here were written with those differences in mind. Use what works for you and throw out what doesn’t. But one thing you must not do is doubt yourself. Don’t let some disinterested condescending physician make you believe it’s all in your mind. If you feel unwell, then you ARE unwell. I’m not a doctor, and I don’t work in a medical field. I’m just a low-thyroid sufferer, and I’m sharing my journey of discovery with you in the hopes that you find it beneficial in some way. This eBook was written by a lay person for lay people. The language is simple and the subject matter applies to adults with hypothyroidism. It wasn’t written with children in mind. My goal was to explain hypothyroidism and its related illnesses in basic terms so that people like me, who have no medical training or knowledge, can gain a fundamental understanding of a very complex illness, and use that knowledge as a foundation for further, deeper research. The information in this eBook isn’t meant to replace conventional medical treatment; in fact, it’s meant to work cooperatively with conventional treatment. Discuss everything with your doctor before trying anything new. Be well, ~Pearl Wise Low-Thyroid Help 3

5. The Thyroid Gland The human thyroid gland is a brownish-red, butterfly-shaped organ, approximately two inches in length, located in the neck below the Adam’s apple. The “wings” of the butterfly are called lobes, and the central piece of tissue connecting the lobes is called the isthmus. The two lobes of the thyroid wrap around the windpipe, also known as the trachea, which is a tube that allows air to pass into the lungs. There is a natural variation in some people where the thyroid gland has no isthmus; this is normal and does not affect glandular function. The thyroid gland helps to regulate numerous bodily functions including: • Growth and Maturation Public Domain Image by Don Bliss Breathing • Heart rate • The Endocrine System Metabolism • Menstrual Cycles • Body Temperature • Cholesterol levels • Mood • And more! • The thyroid gland is part of the endocrine system. The endocrine system includes all of the organs called glands in the human body. Glands are responsible for the production of hormones. Public Domain Image Low-Thyroid Help 4

6. Thyroid Hormones The 3 main hormones produced by the thyroid are: • Calcitonin, which controls the level of calcium in the body. • T4, also known as thyroxine or tetraiodothyronine. • T3, also known as triiodothyronine. T4 is the primary thyroid hormone. It's an inactive hormone, meaning that it does little to nothing by itself or while it remains in its original form. Underproduction of T4 is called hypothyroidism, or more commonly called an under-active thyroid. T3 is the active form of thyroid hormone and is produced from T4. As the active hormone, T3 is responsible for speeding up the metabolism. People have more energy, feel better, and can manage weight better when there is a sufficient amount of T3 in the body. T3 has a secondary inactive form called Reverse T3, or RT3, which is produced by the liver. RT3 is basically a mirror of T3 except that it slows the metabolism instead of speeding it up. RT3 is essentially a brake meaning that it stops overproduction of T3, which prevents the metabolism from speeding out of control. A healthy thyroid will carefully balance T3 and RT3. Many physicians ignore RT3 assuming that the body will correctly handle the production and use of it, but that's not always the case for people with hypothyroidism. Types of Hypothyroidism There are two main types of hypothyroidism: autoimmune and non-autoimmune, but there are two more types of hypothyroidism that could be considered sub-types. For the purposes of discussion, all four will be discussed as a separate type of thyroid dysfunction: • Euthyroid Sick Syndrome • Maternal Hypothyroidism • Autoimmune Hypothyroidism, often called Hashimoto's Thyroiditis. • Non-autoimmune Hypothyroidism Euthyroid Sick Syndrome, ESS, occurs when there is hypothyroid dysfunction caused by a sudden severe illness, or a long-standing illness. Low T3 is more common in ESS, but low T4 production can happen in patients that suffer from lengthy illnesses. In ESS, hypothyroidism is secondary to another illness. Typically thyroid stimulating hormone (TSH) levels are normal in people with ESS. TSH is a hormone produced in the pituitary gland, and it tells the thyroid when it needs to make hormones. Conversion of T4 to T3 can be decreased in people with ESS, and there can be diminished elimination of RT3. Sudden acute ESS is most likely to be correctly diagnosed. But ESS caused by long-standing, or chronic, illnesses might get missed. That's not to say the physician isn't doing his/her job. Let's put forth a hypothetical situation in order to clarify the previous statement. *Let's say that Patient A is suffering from severe fatigue, a symptom of hypothyroidism as well as many other illnesses. Patient A's doctor runs tests and discovers that Patient A is suffering from a chronic illness. Low-Thyroid Help 5

7. The doctor prescribes a treatment plan. When Patient A returns for a follow-up visit, his/her fatigue has not resolved. Patient A's doctor might not think to test for hypothyroidism and might instead think that either Patient A isn't following the treatment plan correctly, or that Patient A needs to make lifestyle adjustments.* As you can see by the above example, missing a diagnosis for hypothyroidism isn't entirely unreasonable in certain circumstances. Maternal Hypothyroidism is low-thyroid function that is present during pregnancy. It can begin with the pregnancy, but is most often already present in the mother prior to her pregnancy. Sometimes only the mother is affected with maternal hypothyroidism, sometimes both the mother and the fetus are affected, and sometimes only the fetus is affected, which is called fetal hypothyroidism. Children born with hypothyroidism have congenital hypothyroidism. The most common cause of maternal hypothyroidism is the presence of the condition in the mother prior to her pregnancy. Another common cause is iodine deficiency, as iodine is required for the thyroid to make hormones. (More on iodine in later chapters.) It's possible for the mother to have enough iodine for her own thyroid hormone production, but not enough to keep up with the increased demand that her baby requires. A human fetus is totally dependent on the mother's thyroid hormone production for the first trimester of pregnancy. Insufficient iodine in the diet will cause a deficiency, but eating too many goitrogenic foods can also cause iodine deficiency. Goitrogens are substances found in certain foods, mostly cruciferous vegetables, that interfere with iodine uptake. Foods high in goitrogens should be greatly reduced or altogether avoided by pregnant women with hypothyroidism. Autoimmune Hypothyroidism, commonly called Hashimoto's Thyroiditis, occurs when the immune system attacks the thyroid gland. The exact cause of this condition is unknown, but it often presents alongside other types of autoimmune diseases like diabetes, celiac disease, and Addison's disease. Like most forms of hypothyroidism, there are usually no symptoms in the early stages of the disease. Later stages sometimes present with a goiter, which is the visible swelling of the thyroid gland. Painless inflammation of the thyroid gland is a common symptom and is called chronic lymphocytic thyroiditis. Like other forms of hypothyroidism, there is diminished production of T4. Middle-aged women are most likely to develop Hashimoto's thyroiditis, but it can affect both males and females of any age. People with chromosomal disorders like Down's syndrome are at higher risk of developing Hashimoto's disease. Non-Autoimmune Hypothyroidism is under-active thyroid function that's not caused by an underlying disease. In other words, the primary disease is hypothyroidism itself. The main causes of this condition are long-term lack of exercise, and long-term poor diet. Chronic alcohol consumption and smoking can also contribute to this condition. Symptoms of hypothyroidism are: • Fatigue • Weight Gain • Sore muscles Low-Thyroid Help 6

8. Muscle weakness Painful and/or stiff joints Heart palpitations Puffy face Intolerance to cold Mild difficulty with short-term memory Mild trouble learning new things Depression Anxiety Cold hands and feet Lowered heart rate Fluid retention Bloating Hair Loss Constipation Hoarse voice Dry skin High cholesterol Infertility Lowered libido Irregular menstrual cycles Brittle nails/Ridged nails Swollen tongue Pressure in the neck Difficulty swallowing Itchy skin/rashes/hives not caused by allergens. Difficulty with concentration Thinning hair at outer eyebrows • • • • • • • • • • • • • • • • • • • • • • • • • • • • Conventional Treatment for Hypothyroidism Assessment of symptoms is usually the first step toward a diagnosis of hypothyroidism. The next step would be blood tests to measure the amount of TSH (thyroid stimulating hormone) in the body, and the amount of T4 in the body. If the thyroid is not producing enough T4, the pituitary gland will produce more TSH in an attempt to stimulate the thyroid gland. Blood tests will show low T4 levels and high TSH levels in hypothyroid patients. Doctors will prescribe synthetic T4, known as levothyroxine (it has many different brand names). There is also a naturally derived medication that some patients opt for: desiccated thyroid taken from dead pigs. Desiccated thyroid contains both T4 and T3. There is also a non-prescription NDT (natural desiccated thyroid) called Thyro-Gold™. This product is manufactured in New Zealand and is taken from cows. The next round of bloods tests, taken a few months after starting medication, should show lowered TSH levels and higher T4 levels. Barring adjustments in the T4 dosage, some doctors will cease to delve more deeply into their patient's condition even when hypothyroid symptoms don't improve as expected. At this Low-Thyroid Help 7

9. point, many doctors will assume the patient's diet is poor and that is the reason for a lack of improvement. (More on diet in later chapters.) Unfortunately it's often assumed that supplementing T4 is all a hypothyroid patient needs, but that's not always the case. In some hypothyroid patients, T4 isn't converted properly into T3, which is the active thyroid hormone that boosts metabolism and improves overall health. Some hypothyroid sufferers instead produce too much RT3, which causes continued hypothyroid symptoms, and many doctors won't take the time to look for it. There is a specific blood test to determine the level of RT3 in the body, but it's not part of the routine thyroid lab tests and many doctors won't order it. There are some general criteria that can help determine if there is too much RT3. This method is far less accurate than the blood test, but can be still be helpful. There's cause to be suspicious when one has persistent hypothyroid symptoms, even with treatment, combined with any of the following: • Low free T3, because RT3 is blocking T3 from attaching to cell receptor sites. • Free T4 level in the high range • High free T3 plus low T4; this is called "pooling" because T3 isn't getting into cell receptor cites and is "pooling" or collecting in the blood. Causes of Excessive RT3 An excess of RT3 has numerous causes, but the most common are these: • Chronic illness • Temporary acute illness; e.g. the flu • Severe physical injury—more than a bump or bruise • Having an autoimmune disease like diabetes • Long-term use of certain medications like beta blockers • Extreme or long-term emotional stress • Extreme calorie restriction/starvation • Yo-yo dieting Essentially the body is attempting to preserve itself by using RT3 to slow the metabolism because stress, whether physical or emotional, drains bodily resources. Sometimes this mechanism of self-preservation goes out-of-control and medical intervention is needed. Dealing With Excessive RT3 Conventional treatment for excess RT3 is the addition of prescription synthetic T3 (liothyronine, or L- triiodothyronine, or LT3). Persons taking NDT will usually have their dose raised or lowered as needed because NDT has both T4 and T3. Sometimes LT3 is added to NDT if more T3 is needed, but T4 levels are optimal. The extra T3 or LT3 in the body will "flush out" the RT3 allowing T3 to bind to its cell receptors and boost metabolism, thereby improving overall health and reducing hypothyroid symptoms. LT3 is usually prescribed for short term use. How long will depend on individual needs as determined by a medical doctor. Too much T3 or LT3 can produce overactive symptoms, in other words symptoms change from hypothyroid to hyperthyroid. One short-term LT3 treatment is often enough to reset the Low-Thyroid Help 8

10. thyroid's hormone balance, but sometimes hypothyroid symptoms return after treatment is over. Onset of hypothyroid symptoms can be fast or gradual. Return of RT3 imbalance if often a signal of nutritional problems. (More on nutrition in later chapters.) Synthetic T4 side-note: Different manufacturers use different additives in their Levothyroxine recipes. If you suddenly develop allergy-type symptoms like sore throat, rashes, coughing, or congestion without another identifiable cause, it could be your medication. Your pharmacy might have changed suppliers or, in the case of changed dosages where the pills are color coded, you might be reacting to the colored dye. Allergic-type symptoms can sometimes be accompanied by worsening of hypothyroid symptoms; if there are no positive blood tests to support a change in your condition, you might be reacting badly to additives in your medication. You can ask your doctor for a different prescription, or you can ask your pharmacist if your medication can be sourced from a different manufacturer. Be warned that there might be added costs involved with sourcing medication from a different supplier. Why Diet Doesn’t Matter For an eBook that is focused on nutritional support for hypothyroidism, saying that diet is unimportant seems strange, but there is a major factor that affects diet and nutritional support: malabsorption. Hypothyroidism itself causes digestive troubles; it slows down the metabolism, which in turn slows the motility of the intestines. Intestines are something like snakes in that they move by a series of muscular contractions. Obviously intestines aren’t separate organisms that can move away and live on their own, but their movement is what passes waste out of the body. Without this intestinal motility, people get constipated; a common symptom of hypothyroidism. But intestines do more than just pass waste, they also draw out and absorb important vitamins and minerals from the food we eat. More specifically, good bacteria and fungi that populate the intestines break down food and pull-out nutrients, which are then absorbed by the intestines and get sent to the parts of the body that need them. Any disruption in the balance of good intestinal flora can cause gastrointestinal problems and, potentially, malabsorption issues. Anyone who has had radiation treatments, chemotherapy, or has been prescribed antibiotics likely has an imbalance of intestinal flora. But the digestive problems aren’t confined to the intestines. An under-active thyroid also inhibits the production of both saliva and stomach acid. The act of chewing mixes food with saliva, which is the first step in breaking down food for digestion. This pre-digested food then travels to the stomach where it’s further broken down by stomach acid. Too little stomach acid means that food isn’t broken down enough, making it harder for the intestines to do their job. Eating the healthiest diet known to humanity will be only marginally beneficial if much-needed nutrients aren’t being absorbed properly. Symptoms of low stomach acid: Low-Thyroid Help 9

11. Heartburn • Indigestion • Constipation/Diarrhea (It can be one or the other, or they can alternate.) • Bloating/Belching/Flatulence after meals • Undigested food in stool • Acid reflux • Healing the Gut From a nutritional standpoint, the fist step to improving thyroid health is healing the gut and improving digestion. This is a good place to repeat the medical warning stated in the beginning of this eBook. WARNING: Pregnant or breastfeeding women should not attempt to implement any of the natural supplement plans laid out in this ebook without first consulting a medical doctor in order to avoid potential harm to unborn babies and/or breastfeeding infants. All other persons are advised to consult a medical doctor before trying any natural supplement regimen as laid out herein; to avoid negative interaction with current medications, and because regular blood tests are necessary to monitor the levels of certain vitamins and minerals in the body, and thyroid gland activity must be regularly monitored. Stomach Acid: There are two simple ways to increase stomach acid. The first way is to drink unfiltered, raw, organic, unpasteurized apple cider vinegar. It’s the ugly brownish stuff. (Ugh! I hear you say.) Braggs® is a popular brand, but Heinz® also makes it and theirs is more readily available in some areas. Drink one tsp to one tbsp, whichever is best tolerated, of apple cider vinegar diluted in two to four ounces of water, fifteen to thirty minutes before meals. It’s to be consumed before full meals, small snacks can be eaten without vinegar. Some people dilute the vinegar in as much as eight ounces of water. Apple cider vinegar is acidic, and it will encourage the stomach to produce acid of its own. If drinking vinegar pre- meal is intolerable, it can be drunk mid-meal, or immediately post meal; however, the results will not be as good as drinking it before meals. *Don’t drink undiluted vinegar; it can burn the mouth and throat, and cause stomach upset. Distilled vinegar, commonly called white vinegar although it’s actually clear, will not produce the same beneficial effects as unfiltered apple cider vinegar, and its taste is much more harsh even when diluted. White vinegar that has 5% to 7% acetic acid is edible. Concentrated white vinegar with 25% acetic acid is not edible, nor is it safe to touch as it will burn skin, but it is an excellent household cleanser and is particularly good for cleaning windows. Although unfiltered apple cider vinegar isn’t teeming with vitamins and minerals as touted by some, it does have trace amounts of beneficial nutrients and good bacteria and acts as a pre-biotic, or food source, for probiotics. White vinegar doesn’t have these beneficial nutrients, nor is it a pre-biotic. Apple cider vinegar also lowers post-meal blood sugar levels. It’s possible that other types of vinegar could also lower blood sugar because they contain acetic acid, which blocks some sugar from being absorbed during digestion. Apple cider vinegar is unique in that it contains pectin, which acts as a food source for Low-Thyroid Help 10

12. beneficial bacteria in the intestines and colon. White vinegar doesn’t have pectin. Diabetics and people with unstable blood sugar will need to be cautious about drinking apple cider vinegar due to its glucose- lowering effect. The second way to increase stomach acid is to supplement with betain hydrochloride (HCL). Like vinegar, betain HCL should be taken before meals; it doesn’t work as well when taken post meal. And it should only be taken before full protein-laden meals. Light meals and snacks with little to no protein don’t require much stomach acid. It also works best when combined with pepsin, a digestive enzyme that helps breakdown proteins. Unlike vinegar, betain HCL should be taken immediately prior to eating, not fifteen or thirty minutes early. Betain HCL is an inexpensive supplement that’s made by several reputable manufacturers, including NOWFoods® and ThorneResearch® and is often sold in a combined preparation with pepsin. The dosage of betain HCL is tricky because it’s different for everyone. Betain HCL comes in capsule form. The most common single capsule dose ranges from 350mg to 650mg. It’s best to start with a lower dose and slowly work up to the appropriate beneficial dose. Most adults need to take four to seven capsules at a dosage of 650mg. (Yes, that’s a lot of pills.) Start by taking a single capsule in any dosage of 650mg or less before a large meal. If no negative symptoms are observed, then increase to two pills the following day. That’s the following day, not the following meal. Keep the same dosage before each large meal in a single day. Increase one pill per day until negative symptoms occur. Look for symptoms like a heaviness in the stomach, a hot feeling in the stomach and/or intestines, a burning sensation in the stomach and/or intestines, diarrhea, or anything that feels uncomfortable even if very mild. When negative symptoms begin, reduce the dosage of betain HCL by one pill; that is the optimal individual dose. *Don’t combine betaine HCL with any kind of vinegar; doing so can damage the stomach lining. Don’t give betaine HCL to children without first consulting a medical doctor. People who regularly take medications that can damage the lining of the stomach or the intestines should NOT take betaine HCL as it can cause serious damage to the stomach and/or intestines. Examples of medications that can damage the stomach or intestine lining are anti-inflammatories like NSAIDS; e.g. corticosteroids, aspirin, or ibuprofen. Once improved digestion has been achieved, it’s time tobegin healing any potential gut problems. One of the most difficult areas of the gut to heal is the small intestine because so few over-the-counter products (OTC), meaning products available without a doctor’s prescription, can survive through stomach acid and travel in large enough amounts to affect the small intestine. SIBO Before delving into natural ways to improve gut health, we have to discuss a condition called SIBO, or small intestinal bacterial overgrowth. SIBO is exactly what the name suggests it is, too much bacteria in the small intestine. People who’ve been treated with radiation, chemotherapy, and/or antibiotics are at risk for developing this condition. Diabetics, people with pancreatitis, and people who suffer from intestinal conditions like celiac disease, diverticulitis, irritable bowel syndrome, and Crohn’s disease are also at risk. Unfortunately treatment for this illness means more antibiotics and, in some cases, an anti-parasitic because internal parasites can also contribute to SIBO. It’s difficult to near impossible to treat this condition without the correct prescription antibiotic, which will be dependent on the type of bacteria that’s being targeted. Low-Thyroid Help 11

13. Symptoms of SIBO are numerous. Here are a few of them: • Diarrhea • Nausea • Vomiting • Flatulence • Bloating • Fatigue • Malnutrition • Weight loss Parts of the Small Intestine Pubic Domain Image Feeding Gut Flora Once SIBO is successfully treated or is otherwise not an issue, it’s time to “feed” the good intestinal flora so they will flourish and crowd out the bad flora. Animal products like meat, fish, and poultry have few nutrients that directly feed intestinal flora. Most of the best “gut food,” or pre-biotics, are found in fruits and vegetables. Fiber is an excellent food source for good gut flora. But if the gut isn’t healthy, there might not be enough flora to break the fiber down, and that will cause indigestion, malabsorption issues, and other gut problems—all things we’re trying to stop or avoid. At this point, reintroduction of good intestinal flora, or probiotics, seems like a good idea. But guess what? It isn’t. Low-Thyroid Help 12

14. Introducing probiotics to an unhealthy gut is just a waste of money. New probiotics will be killed by established colonies of bad bacteria and fungi in the gut, or will pass through the intestines and out of the body via waste matter without having had a chance to colonize and proliferate, and without having done anything positive. For probiotics to do their jobs, they must a have a cozy home where they can colonize and increase their numbers. To make the intestines and gut more hospitable to probiotics, it’s important to introduce nutrients that are beneficial to probiotics and harmful to bad bacteria. The apple cider vinegar we discussed earlier is a good start because it promotes probiotic health and creates a hostile environment for bad bacteria, but it isn’t enough by itself. There are numerous herbs and oils recommended for improving gut health like coconut oil, oregano oil, turmeric, cinnamon, clove, pumpkins seeds, fresh garlic and garlic oil, and many many more. Most of them are wonderful and really do help, but one thing most of them don’t do well is clean up the entirety of the small intestine; it’s just too large and too full of harsh gastric juices. To be effective, one has to regularly consume large amounts of fresh herbs and edible plant oils, which isn’t good when starting out because it makes it difficult to pinpoint what works, what doesn’t work, and what is causing unpleasant side effects. It’s always best to introduce one new thing at a time so the body isn’t overwhelmed, and to make it easy to identify a problem-causer. Fresh herbs have many nutrients that are harmful to bad bacteria, but they are too numerous to discuss at length. Other nutrients that bad bacteria don’t like are fatty acids, many of which have strong fungicidal and bactericidal properties; let’s focus on some of the most important ones. Lauric acid: This fatty acid is found in copious amounts in coconut oil, coconut milk, palm kernel oil, and laurel oil. Caprylic acid: This fatty acid is found in the milk of many mammals like cows and humans. It’s also found in small amounts in coconut oil and palm kernel oil. Capric acid: This is also found in the milk of certain mammals, and in coconut and palm kernel oils. Caproic acid: This is found in the same places as capric and caprylic acids. These four fatty acids are called medium-chain fatty acids and, unlike short and long-chain fatty acids, they bypass the digestive tract and are broken down in the liver. Each of them have bactericidal and fungicidal properties and many people use them to get intestinal candida infections under control. The medical community is divided as to whether candida infections can occur in people who don’t have severely compromised immune systems; but real or not, many people use these four fatty acids to improve gut health and get positive results. Of the four fatty acids named above, caprylic acid is considered the most potent for killing bad gut flora, but it’s also known for causing digestive upset when taken in large doses. In fact, all four can cause bad side effects when taken in very large doses. In moderate doses, with moderate being adherence to the instructions on the product labeling, all four fatty acids are safe to ingest. There is yet another fatty acid that is six times more potent than caprylic acid and is safer to use at higher doses; it’s called undecenoic acid. This medium-chain fatty acid is derived from castor oil, which comes Low-Thyroid Help 13

15. from castor beans, and is also found in human breast milk and human sweat. Castor oil is a good source for undecenoic acid, but most people find the taste of castor oil to be vile; it’s also a potent laxative so drink plenty of water with it. Castor oil’s laxative effects are usually very fast. The maximum dose for castor oil is two tablespoons in a twenty-four-hour period. It’s not advised to start off with the maximum dose. Start with a teaspoon and slowly increase to the maximum dose, if that dosage is desired. A single tbsp per day is fine for most adults. Castor oil can be put into empty capsules to avoid the horrid taste. Another way to get undecenoic acid is to buy it in a formulated preparation. One of the best manufacturers of undecenoic acid is ThorneResearch® and their product is called Formula SF722. Five gelcaps are equivalent to 250mg of undecenoic acid, and Thorne recommends taking five gelcaps two to three times per day. Side effects from this product are very rare and usually mild, such as minor stomach upset and feeling mild malaise. Negative side effects are usually caused by what the product is doing and not from the product itself, meaning it’s killing bad bugs in the gut. Undecenoic acid works to kill bad flora in the entirety of the small intestine, the colon, and the vagina. Take it for a minimum of one to two weeks before starting probiotics. Some people might need more time, others less. Work up to the maximum safe dosage. When there are no negative side effects, it’s time to add probiotics. Probiotics There are two ways to get probiotics, buy them or make them. Fermented foods are great sources of probiotics, and they’re generally hardier than the packaged varieties. Generally speaking, probiotics from fermented foods are more likely to survive stomach acid, and are more successful at colonizing the intestines. Fermented food options include: • Sauerkraut • Kimchi • Kombucha • Kefir • Tempeh • Miso • Natto • Traditionally made pickles, not the pickles made in vinegar that are so common in grocery stores. *There is divided opinion as to whether fermented foods made from soy or cruciferous vegetables are still goitrogenic. Some nutrition experts advocate avoidance, others advocate eating iodine-rich foods together with fermented goitrogenic foods to reduce their goitrogenic activity. People with thyroid disease have to be cautious of their iodine intake as too much can aggravate their condition. Eaten infrequently and in small amounts, goitrogenic foods are generally not harmful to the thyroid. Store-bought probiotic options are numerous and some are better than others. Look for labels that mention CFU’s. CFU stands for colony forming units; these are probiotics that can reproduce in the gut. Some products have probiotics that are not able to reproduce, and they only stay in the gut for a few days before leaving with bodily waste. Another important thing is enteric coating, without it many of the individual probiotic cells die in stomach acid and not enough of them get into the small intestine, which amounts to Low-Thyroid Help 14

16. wasted money. Some good probiotic brands include: ThorneResearch®, RenewLife® Ultimate Flora, NOWFoods®, and Jarrow Formulas®. Whether from food or from capsules, probiotics can cause digestive complaints; the usual ones being bloating, nausea, flatulence, and diarrhea. Most of the time this means the probiotics are busily killing bad gut flora, and the negative side effects usually stop within a week, or two at the most. Sometimes negative side effects aren’t caused by the probiotics but by additives in the capsules. Many manufacturers include pre-biotic material in the probiotc capsules to feed the good bacteria. Some people react badly to the pre- biotics. If this happens, try another brand, or try reducing the probiotic dose. Once the probiotics stop causing side effects, it’s time to start eating more fresh fruits and vegetables, except for the goitrogenic ones; they can be eaten, but in moderation. Cooking goitrogenic foods reduces the goitrogens by roughly one-third. If the fiber from all that fresh produce is still too much to handle, try making smoothies. The liquidized food will be easier to digest, and is a good way to eat foods that are healthy but unpalatable. There are many smoothie recipes on YouTube.com and on numerous health-food blogs. It’s also time to start adding more fresh herbs to meals. Herbs are packed with nutrients, and many are bactericidal, fungicidal, and anti-parasitic. Don’t forget to add extra virgin coconut oil to meals to get more fatty acids. Coconut oil lends a wonderful taste to foods and smells divine; some people put it on their skin and in their hair. Glutamine The final piece of the gut-health puzzle is glutamine, which is an amino acid. Amino acids are compounds found in foods, or are made in the body. Essential amino acids must be provided by food sources and can’t be made in the body. Non-essential amino acids are made in the body with nutrients derived from foods; in other words, the body pulls out the nutrients it needs from food to make amino acids. Amino acids have a profound effect on overall health and are involved in wound-healing, skin and hair health, metabolism, bone formation and strength, hormone regulation, immune health, and more. Glutamine is considered a non-essential amino acid because the human body can make it; it’s synthesized in muscle tissue. Glutamine is also considered a conditionally essential amino acid because requirement of it varies depending on health and activity level. People who are very ill, whether short term or long term, require more glutamine than when they’re healthy. Bodybuilders and high-level athletes often supplement glutamine, generally taking between five to ten grams of glutamine per day because their bodies can’t produce enough to keep up with the high demand. Intense exercise depletes glutamine stores in the body. Critically ill patients are often given glutamine to prevent muscle wasting. Glutamine is an enormously important amino acid and most people require large amounts of it. One important function of glutamine, and the one that most applies to this eBook, is its effect on gastrointestinal health. Glutamine is used in rebuilding intestinal lining. The intestines are lined with epithelial cells, which are responsible for extracting nutrients from foods and absorbing them into the body for use elsewhere. Good intestinal flora and epithelial cells work together to collect nutrients. Intestinal flora help break foods down, and epithelial cells draw nutrients from those digested foods. In the small intestine, epithelial cells are mounted on what might be termed as tiny mucosal “arms” called villi, which aid in nutrient absorption. Every three to five days the small intestine’s epithelial cells regenerate, and they need copious amounts of glutamine to support that regeneration. Any damage to the Low-Thyroid Help 15

17. intestinal lining, whether by disease or through the use of certain medications like NSAIDs or antibiotics, will require even greater amounts of glutamine so supplementation can be beneficial to certain people. Allergy to glutamine is unlikely because the body makes it. Any allergic symptoms from glutamine supplements like hives, itching, or swelling of the throat or tongue usually isn’t caused by the glutamine itself, but by additives introduced in the manufacturing process. It’s important to get as pure a powder as possible. Check the label’s ingredients for known allergens like tree nuts or dairy products. Underneath the list of ingredients—typically in very small print—is usually a statement about the manufacturing facility and whether other products that contain allergens are processed in the facility. If unsure, it’s always best to contact the company directly and ask if the product has, or is made in a facility, with allergens. Sometimes there can be cross-contamination between products. Here are a few companies that are known for good quality glutamine: Optimum Nutrition®, Bulk Supplements®, NOWFoods®, Body Fortress®, and MET-Rx®. Although allergic reactions to glutamine are very uncommon, it does have some side effects; abdominal pain, bloating, and diarrhea are the most common, but usually only happen with too high a dose. The average person needs only two to five grams of supplemental glutamine per day. Glutamine can be bought in capsule form or in loose powder. To start, it might be best to use capsules because the dosage is smaller, and work up to two to five grams, at which point the bulk powder would be more cost effective. How to Dose Glutamine Start with a single 500mg capsule and test for a reaction; there isn’t likely to be any, but everyone is different. If there are no side effects, proceed to one 500mg capsule two to three times a day. From there, move up to one gram (1000mg) once or twice a day. The end result should be a maximum of five grams in a single dose, or in two split doses per day. If five grams isn’t tolerated, then reduce the dose to two or three grams total in a day. Only very sick or very athletic people might need to move up to ten grams and the dose should be split; five grams in the morning and another five grams in the evening. Mix glutamine powder with cold liquids as it’s damaged by heat. Some experts recommend taking free-form glutamine with food for better digestion, others recommend taking it on an empty stomach. Do what is best for you. Long-term glutamine supplementation can reduce the amount of B vitamins in the body, especially B12. Consider supplementing with B12 or a B-complex. Glutamine is generally safe, but it is known to interact with a few medications: some types of chemotherapy, anti-convulsants, and medications that reduce ammonia in the body like Laculose. The body eventually changes glutamine into ammonia, which reduces the effectiveness of drugs like Laculose. It’s good practice to use an online drug-interaction checker like the one from Drugs.com before mixing any OTC medications or supplements with prescription medication. Also, ask a medical doctor or pharmacist about safety. Intestinal illnesses like Crohn’s disease, irritable bowel syndrome, ulcerative colitis, and celiac disease might benefit from glutamine supplementation, but sufferers shouldn’t take glutamine without consulting a medical doctor. People with intestinal problems might need higher doses than the average person. Some medical practitioners suggest people with intestinal illnesses take as much as 40 grams of glutamine a day in split doses; that is a very high dose and one that should not be tried without a proper medical consultation. Low-Thyroid Help 16

18. Some other beneficial effects from glutamine are the lowering of blood sugar and sensitizing the body to insulin; this translates to better use of dietary sugars and, with proper diet and exercise, better fat loss. Thyroid-Specific Nutrition Once digestion has been addressed and improved, it’s time to focus on nutrition that directly aids thyroid function. Although thyroid nutrition needs to be approached in a comprehensive manner, it’s important to understand how nutrients individually affect the thyroid gland, and how they interact with each other. *All of the following supplements interfere with absorption of prescription thyroid medication like synthetic T4. Take any supplements or herbal medications 2 to 4 hours before or after thyroid medication. Iodine and Selenium Iodine and selenium are probably the two most important minerals for healthy thyroid function, and people are often deficient in them. Iodine deficiency is so common throughout the world that many countries have made iodized salt available to citizens to combat the problem. The United States was the first to do this when Morton’s Salt company introduced the first commercially available, iodized, table salt in 1924. This iodized salt all but eliminated iodine-deficient hypothyroidism in what was then known as the goiter belt, which was most of the Northern United States. In recent decades, changing diet fads have introduced what are supposedly healthier diets, and among these dietary changes was a ban on sodium. Too high an intake of sodium is undeniably bad, but many dieters cut too much salt out of their diets and reduced their iodine intakes to dangerously low levels, unwittingly reintroducing the well-known problem of iodine-deficient hypothyroidism. But there are other ways to add iodine into the diet without resorting to heavy use of iodized table salt. Saltwater fish and sea vegetables like seaweed, bladderwrack, dulse, nori, and kelp are good sources of dietary iodine and of trace minerals. One serving of a seaweed snack called Kim Nori provides the recommended daily allowance (RDA)—also called recommended daily value (RDV)—of iodine for adults, which is 150mcg. Iodine can also be found in small amounts in raw animal milk like cow’s or goat’s milk, and also in other dairy products. Kelp supplements are another popular way to get iodine, but the dosages are often very high. Before we go any further, it’s important to understand the proper dosages. Iodine is typically eaten and supplemented in micrograms (mcg or ug, both abbreviations refer to micrograms) which are 1/1000th of a milligram (mg). A milligram is 1/1000th of a gram. The American Thyroid Association (ATA) recommends less than 500mcg of iodine per day, with a maximum safe dose being 1100mcg per day. Taking iodine in milligram-level dosages is extremely dangerous unless it’s been prescribed for short-term use to remedy a deficiency. Getting iodine through diet is the safest route, but it can be supplemented. Before supplementing with iodine, or any other vitamin or mineral, it’s important to go to a doctor and get blood tests to determine if there’s a deficiency. Supplementing vitamins and minerals without a deficiency can be very dangerous and cause a myriad of health problems, in some cases even death. Supplementation with iodine is particularly dangerous for people with thyroid conditions. Too much iodine can cause thyroid disease, worsen existing thyroid disease, or cause a life-threatening condition called thyroid storm. Low-Thyroid Help 17

19. Iodine is typically supplemented in a form called potassium iodide. The word ‘iodide’ means that elemental iodine has bonded with something else. For example, iodine bonded with potassium becomes potassium iodide. Elemental iodine is extremely caustic and will burn skin; it can’t be safely ingested. Potassium iodide is the preferred form of supplemental iodine and the form used by the thyroid gland. Up to 80% of the total iodine in the body is stored in the thyroid gland, but the thyroid isn't the only part of the body that uses it. Other parts of the body that need iodine to function properly include the stomach, skin, breasts, pancreas, salivary glands, and the brain. Low levels of iodine can cause dysfunction in any area of the body that requires it; for example, brain fog can occur, dry skin and/or difficulty sweating, low saliva production because the salivary glands can’t function properly; and as we discussed earlier, saliva is the start of the digestive process. Before supplementing with or increasing dietary iodine, it’s important to have sufficient selenium levels. Again, a blood test will reveal a deficiency and indicate the proper dosage to rectify it. Selenium is a trace mineral, and we need only small amounts of it. The RDA of selenium for adults is 55mcg from all sources; pregnant and lactating women need up to 70mcg per day. Selenium is found in the soil and in water. Some places in the world have large amounts of selenium in the soil, like the Northwestern United States; and other places have little to none, like Keshan province in Northeastern China. In fact, the soil selenium levels in Keshan Province are so low a heart condition called congestive cardiomyopathy is common there; the condition is linked with low selenium levels and is called Keshan Disease. Severe or prolonged infection will decrease selenium levels in the body, which reduces T4, T3, and TSH levels, thereby creating a hypothyroid state. Too much selenium is toxic, and toxicity can occur with a single overdose, or it can happen with long- term supplementation. The upper safe limit for most adults is 400mcg per day and should only be supplemented for short periods as overdose can occur with long-term supplementation. 100-200mcg a day is generally a safer dosage for most adults, but this too should only be used as needed. Symptoms of selenium overdose include: loss of hair, brittle nails and nail discoloration, fatigue, and foul breath similar to “garlic breath.” A great dietary source for selenium are Brazil nuts, which are very high in the mineral. Six Brazil nuts can contain as much as 500-600mcg of selenium. Generally, one to two Brazil nuts a day provides enough selenium for most people. Sources of selenium: • Sunflower seeds • Tuna • Halibut • Ham • Shrimp • Beef steak • Beef liver • Turkey • Chicken • Cottage cheese Low-Thyroid Help 18

20. The largest store of selenium in the body is in the thyroid gland. As iodine is necessary to make T4, selenium is needed to convert T4 into T3, but it has another important role. When the thyroid uses iodine to make T4, it also makes hydrogen peroxide to help with T4 synthesis. Hydrogen peroxide is caustic to bodily tissues including thyroid tissue. Selenium acts as a protective agent against the oxidative damage that hydrogen peroxide causes; this is why it’s important to have sufficient stores of selenium before attempting to supplement or increase dietary iodine. Expect two to four weeks of selenium supplementation before introducing or increasing iodine intake. It might be tempting to take a multi-vitamin containing selenium because of the ease of use, but be aware that certain minerals compete with or block selenium absorption. Zinc and selenium compete for absorption so shouldn’t be taken together; take them two to four hours apart. Caffeine slows the absorption of selenium and numerous other vitamins and minerals. Magnesium blocks absorption of both selenium and zinc. As for iodine absorption, supplements or dietary sources of iodine shouldn’t be combined with goitrogenic foods. Goitrogens block iodine from being absorbed. Cooking will reduce goitrogenic compounds by approximately one-third. Examples of goitrogenic foods are: • Soy products • Broccoli • Turnip • Kale • Collard greens • Cauliflower • Radishes Another chemical that blocks iodine absorption is bromide, and it’s found in pesticides and foods. It’s common in the United Sates for produce to be sprayed with the pesticide methyl bromide. Better food choices would be organically grown produce and grass-fed meats. Brominated vegetable oil is a form of bromide used in many soft drinks like Mountain Dew™, Fresca™, and Gatorade™. Potassium bromide is used in commercial baked goods like breads because it allegedly improves the texture of the dough. As known endocrine disruptors, all of these forms of bromide should be avoided as much as possible. A Word About the Patch Test Before moving on to other important thyroid nutrients, we have to discuss the patch test. There is a common “test” for iodine deficiency called “the iodine patch test,” and it requires wiping a one-inch- square patch of skin with an iodine solution, typically the 2% stuff that can be found with first-aid supplies in a pharmacy or chemist shop. Theoretically the faster the yellow-orange iodine color disappears, the more iodine deficient a person is. The patch test is inaccurate at best and shouldn’t be relied upon. A simple blood or urine test is much more accurate. Different liquid iodine solutions will evaporate more quickly than others, and the ambient temperature also affects iodine evaporation. If the room is hot, the iodine will evaporate more quickly. Also, human skin can convert the yellowish iodine to iodide, which is white and not visible to the naked eye, making it appear as though the iodine has been absorbed when it hasn’t. External application of iodine is an Low-Thyroid Help 19

21. excellent antiseptic for minor abrasions and insect bites, but not a good indicator of iodine deficiency. Also, very small amounts of iodine will be absorbed through topical iodine application, but supplementation or dietary increase of iodine are much better ways to increase iodine stores. Zinc Zinc is a trace mineral and is used in converting T4 to T3. Low levels of zinc can cause hypothyroidism, but existing hypothyroidism can prevent dietary zinc from being absorbed. Too much zinc supplementation can cause a deficiency in copper. Symptoms of low copper are: fatigue, hair loss, skin lesions or sores, anemia, joint pain, and muscle soreness. Copper deficiency is not common in developed nations, but can occur in people with intestinal problems like Crohn’s disease and irritable bowel syndrome because nutrient absorption is impaired. Most healthy people with a varied diet are not deficient in zinc. Blood tests are the best way to determine deficiency and the appropriate supplement dosage to correct a deficiency. The RDA for zinc, from all sources, is 11mg for men and 8mg for women. In the United States, the maximum safe dose for most people is 40mg a day, but that is very high and not needed by most people. The Department of Health in the UK limits the safe, maximum, zinc intake to 25mg per day. Supplementing zinc in too high a dose or for too long a period can cause an overdose. Symptoms of zinc overdose include: abdominal pain, dizziness, nausea, vomiting, and diarrhea. Supplementation with higher doses of zinc shouldn’t exceed one to two weeks unless otherwise advised by a physician. Absorption of zinc will be impaired if taken together with magnesium, iron, calcium, or selenium. Alcohol consumption also reduces zinc absorption. Zinc supplements often cause upset stomach and nausea, and should be taken with food to reduce negative side effects. If side effects are more than a mild nuisance, it’s probably best to stop taking zinc supplements altogether. More intense negative side effects like extreme nausea, abdominal pain, vomiting, and/or diarrhea might require a trip to a hospital emergency room. Diet is the safest way to get zinc. Zinc is not stored in the body and must be sourced from food on a daily basis. Excess zinc is excreted through urine and feces. Dietary sources of zinc are: • Red meat • Poultry • Shellfish • Legumes • Eggs • Dairy products Magnesium Magnesium helps with the absorption of iodine and the conversion of vitamin D3 into its active form. The human body stores about 25grams of magnesium; 50-60% of which is stored in bone and the rest in soft tissue. Less than 1% of total magnesium is found in blood. Magnesium helps with the production of T4 and with converting T4 to T3. It also helps with proper insulin usage and maintaining healthy blood sugar levels. Most people eating the common Western diet of pizza, burgers, large portions of animal meats, and low portions of organic produce tend to be low in magnesium and too high in calcium. Magnesium affects a huge number of processes in the body so deficiency in it causes numerous symptoms: Low-Thyroid Help 20

22. Goiter(enlarged thyroid gland, which can also be caused by low iodine intake.) Headaches/migraines Tremors/muscle twitches Anxiety Muscles aches and weakness Constipation Fatigue Trouble swallowing Sensitivity to loud noises Leg or hand cramps Trouble sleeping Heart palpitations or flutters And more! • • • • • • • • • • • • • Goiter Low magnesium levels lead to high calcium levels, which can cause kidney stones and/or atherosclerosis (fatty deposits, or plaque, in the arteries). Too much magnesium can cause calcium and potassium levels to drop too low. Obviously balance is key to optimum health. For most minerals, blood tests are the best way to reveal any deficiencies, but blood tests for magnesium typically only test the amount of magnesium in the blood and don’t accurately reflect the magnesium levels in bone and/or soft tissues. Public Domain Image Potassium is easy to get in the diet by eating enough produce. Plant matter is often high in potassium, although animal products do contain potassium too. Potassium supplements are not a good way to increase potassium levels and should be avoided unless prescribed by a physician; they are caustic to tissue and overdosing is easy. It’s impossible for healthy people to overdose potassium from foods; the body flushes what isn’t needed. *People with certain health conditions like kidney disease need to moderate their potassium intake. Follow doctors orders regarding potassium intake. There is no RDA for potassium, but as a general rule most adults need a minimum of 2000mg of potassium a day. Contrary to popular belief, bananas are not the best source of potassium. A medium-sized banana has about 400mg of potassium, but is also high in sugar making it a poor choice for diabetics or others with high blood sugar. 1 cup of cooked winter squash has about 900mg of potassium. 1 medium-sized baked sweet potato has 700mg of potassium. 1 medium-sized baked potato with skin has about 600mg. 8oz. Of fat-free yogurt has 580mg. 8oz. Of orange juice has 500mg. • • • • • Most of us know that calcium is important for healthy teeth and bones, but it’s also important for healthy heart and thyroid function. Since this eBook is about hypothyroidism, we’ll focus on calcium in relation to the thyroid gland. Public Domain Image Low-Thyroid Help 21

23. The thyroid itself does not regulate calcium uptake or the balance of calcium with other minerals like magnesium and phosphorus; the parathyroid glands to that. But the thyroid does produce and release a hormone called calcitonin (CT) when there is too much calcium in the blood. CT reduces the blood calcium levels, but can only work properly in the presence of parathyroid hormones. People who have hypothyroidism sometimes are deficient in CT. It’s also possible to have too much CT. Any imbalance of CT production can cause a disruption of calcium uptake. Too much or too little calcium will cause an imbalance of phosphorus and magnesium, which in turn will exacerbate or cause thyroid dysfunction, and potentially cause heart and/or bone-health problems. It’s a complex issue and balance is vital to good health. Testing for this hormone imbalance is not standard for hypothyroid patients, so it might benefit some patients to discuss the issue with their doctors. Prescription medication is sometimes needed to correct an imbalance of CT. The RDA for calcium is 1000mg for adults 19-70yrs, and 1200mg for adults 71+yrs old. The maximum safe amount for most healthy adults is 2500mg, but this amount shouldn’t be supplemented without a known need for it, and it should be combined with an equal magnesium supplement. *Note that high doses of magnesium tend to cause diarrhea. Good sources of dietary calcium are: • Organic dairy products • Figs • Oranges • Almonds • Navy beans • Salmon • Sardines • Dark leafy-green vegetables tend to be very high in calcium, but many are also goitrogenic like kale and collards. Back to Magnesium For calcium to be absorbed and used properly, there must be an adequate amount of magnesium in the body. It was once thought that a 2:1 ratio was ideal, but newer medical research indicates that calcium and magnesium are best taken in equal amounts when supplemented, or even in a 1:2 ratio, with magnesium being the higher amount. Calcium and magnesium compete for absorption when taken together in doses higher than 250mg. Insufficient magnesium can lead to high calcium levels, which can lead to calcification of soft tissues like arteries and glandular tissues, as well as the formation of kidney stones. Magnesium produces a feeling of relaxation so many people take it before going to bed, so calcium can be taken earlier in the day for better absorption. The RDA for magnesium is 400-420mg for men and 310-320mg for women, with pregnant women needing the slightly higher amount of 350mg. The average American gets less than 300mg of magnesium a day from diet. Good dietary sources for magnesium are: • Seeds and nuts • Whole grains Low-Thyroid Help 22

24. Leafy-green vegetables. (Watch out for the goitrogenic ones.) • Magnesium interferes with antibiotics, some cardiac medications, and thyroid medications. It can also block the uptake of calcium, selenium, and zinc when supplements are taken together. It’s often best to take supplements two to four hours apart. Some OTC products like laxatives and heartburn medication contain magnesium and can lead to overdose if taken with magnesium supplements. Always read product labels. For most healthy adults, 100-200mg of magnesium a day is generally safe, but dietary sources are always best. The safe upper limit of magnesium per day is 400mg from all sources. Too much supplemental magnesium causes diarrhea, which is often accompanied by a burning sensation and very smelly flatulence. Magnesium overdose, whether taken in a single large dose or accumulated over long-term supplementation, can be fatal. Magnesium oxide is inexpensive and common in supplement form, but isn’t the best type of magnesium to take as it’s difficult to absorb; however, it works well as a laxative. Magnesium citrate is more easily absorbed than the oxide form and also works well as a laxative. Magnesium glycinate and magnesium taurate are easily absorbed and are less likely to act as laxatives. Iron Adequate iron levels are essential to thyroid health. Iron helps with the absorption of iodine, so low iron translates to low iodine. Thyroid peroxidase (TPO) is an enzyme found in the thyroid gland, and it helps with the production of thyroid hormones. Iron directly affects how much TPO is made and how much thyroid hormone production TPO stimulates, so low iron equals low TPO. Low iron is linked to low T3 production and increased RT3 production. Symptoms of low iron are similar to those of hypothyroidism: • Fatigue • Hair loss/ poor hair growth • Exercise intolerance • Depression • Heart palpitations • Low sex drive • Brain fog Iron should not be supplemented unless there is a known need for it. Too much iron is toxic. The only way the body can eliminate excess iron is via blood loss. Iron dosage is need dependent, so blood tests are essential. The RDA for iron is 8mg for adults with menstruating women needing 18mg. Iron supplements come in multiple forms, but most cause constipation. Ferrous bisglycinate is less likely than other forms of iron to cause constipation. Liquid iron is tolerated better than supplements, but can damage teeth. Increasing dietary sources of iron is an option, but will take longer to raise iron levels in the body. Sources of iron in food: • Red meat • Liver • Seeds and nuts Low-Thyroid Help 23

25. Eggs Dried fruits (also high in sugar) • • Iron is very difficult to absorb, whether as a supplement or from food sources; having digestion issues will increase the difficulty. Ingesting acidic foods or beverages with iron will help the body absorb it. Apple cider vinegar and lemon juice are great choices, orange juice is also a good choice. Apple cider vinegar, diluted in water as discussed earlier, can be combined with a tbsp of lemon juice for increased acid and iron absorption. Vitamin D3 People with hypothyroidism are often very deficient in vitamin D3. If D3 deficiency is low enough, doctors will usually prescribe a different form of vitamin D called ergocalciferol (D2). A common dosage of D2 is 50,000IU taken once a week until deficiency is rectified. IU, or International Unit, is a unit of measure for certain types of fat-soluble vitamins, hormones, and enzymes. IU is based on biological activity so the measurement will be different for different substances. For example, 10mg of magnesium is the same amount as 10mg of calcium, but 10IU of D3 is not the same amount as 10IU of vitamin A. Signs that a D2 dose is too high, or that deficiency has improved and the dosage needs to be lowered are: • Muscle pain • Muscle weakness • Joint pain • Metallic taste in the mouth • Nausea • Constipation • Vomiting D3 is made by the skin when there is adequate exposure to sunlight. The amount of time in the sun needed to make sufficient D3 varies with climate and skin color. Dark-skinned people have natural protection from the sun and make less D3 in low-sun environments than light-skinned people. The more skin exposed to the sun, the more D3 can be made. Spending more time in the sun seems like the obvious solution to increase D3, but there are some health problems that inhibit D3 absorption. Intestinal health issues like Crohn’s disease and celiac disease make absorption of D3 difficult. Intestinal issues are very common in people with hypothyroidism. High cortisol can reduce D3 levels because of the competition for cholesterol. Both the stress hormone cortisol and D3 are made from cholesterol. If stress levels are high or steroid medication is being taken, cortisol levels rise and the body uses cholesterol to make the cortisol instead of D3. Aging causes a reduction in the ability to make D3 from sunlight. Low magnesium reduces D3 conversion into the active form that the body uses. Obesity causes D3 to be absorbed by fat cells and not enough is available for other important functions, so obese people can have high D3 levels, but see no benefit from it. People on low-fat diets, or who have trouble digesting dietary fats, have lower D3 because, as a fat-soluble vitamin, D3 needs dietary fat to be absorbed by the body. • • • • • • Low-Thyroid Help 24

26. Adequate D3 levels are necessary for proper absorption of calcium, so low D3 can lead to an imbalance of calcium and magnesium. D3 affects insulin sensitivity and production, and supplementation can help improve insulin resistance. D3 also helps regulate immune function. The RDA for D3 is 600IU for adults, but many health professionals advocate supplementing with 1000- 2000IU per day. There are few dietary sources for D3 except for foods that have been fortified with it like orange juice and milk. Cod liver oil is an exception and one tablespoon contains 1300IU. Egg yolk has a small amount of D3, usually in the neighborhood of 40IU. Oily fish like salmon, cod, and mackerel are good sources of dietary D3. D3 supplements can interact with some medications like those for blood pressure, diabetes, weight loss, and inflammation. Always check with a medical doctor or pharmacist before taking any vitamins, herbs, or supplements. Online drug-interaction checkers are excellent resources. Vitamin A Vitamin A is another fat-soluble vitamin like D3, meaning it needs dietary fats for proper absorption, and it’s stored in the body’s fat cells. There also needs to be adequate intake of protein for vitamin A absorption. Many people with hypothyroidism are deficient in vitamin A. In fact, one of the symptoms of low vitamin A is thyroid disease, including both hypothyroidism and hyperthyroidism. Vitamin A helps with T3 conversion, can help shrink goiter even when there is insufficient iodine, and can help reduce the autoimmune activity in Hashimoto’s Thyroiditis. Vitamin A helps boost immune function and supports healthy skin and eyes. Healthy vitamin A levels are necessary for proper use of dietary iron. Most Vitamin A supplements are actually beta carotene, which is the orange to reddish-orange pigment in vegetables like carrots. Beta carotene is not vitamin A, but is a precursor to it; meaning the body converts beta carotene into retinol, which is vitamin A. Beta carotene is sometimes referred to as carotenoid vitamin A. Eating more carrots or other vegetables and fruits with beta carotene seems like an easy way to increase vitamin A, and it usually is for most people, but people with hypothyroidism often have difficulty converting beta carotene into retinol. The thyroid hormone thyroxine, or natural T4, is needed to convert beta carotene into vitamin A. Theoretically, medicating hypothyroid patients with synthetic T4 (levothyroxine) should fix any beta carotene conversion issues, but it doesn't always. Symptoms of Vitamin A deficiency include: • Thyroid disease • Blurry vision • Night blindness • Dry eyes • Dry skin • Dry hair • Gastrointestinal problems like inflammatory bowel diseases • Frequent colds and viruses The RDA for vitamin A in the form of retinol is 700mcg/ug, or 2300IU, for women; and 900mcg/ug, or 3000IU, for men. Many supplements contain much higher amounts of vitamin A than is needed so understanding the product label is essential. Products that contain inactive vitamin A, which is beta carotene, can be listed as pro vitamin A, mixed carotenoids, vitamin A carotenoid, beta carotene, alpha Low-Thyroid Help 25

27. carotene, lycopene, or lutein; all of these forms require conversion into retinol, which defeats the purpose of taking them when conversion of beta carotene is an issue. Also, 100mcg/ug of any form of beta carotene is not equivalent to 100mcg/ug of retinol/vitamin A. The conversion rate of beta carotene into retinol varies considerably from person to person, even those without thyroid problems. Even as a general rule, conversion rates vary depending on the type of carotenoid. Beta carotene converts at a 12:1 ratio, meaning 12mcg/ug of beta carotene can convert to a maximum of 1mcg of vitamin A/retinol. Alpha carotene converts at a 24:1 ratio, meaning 24mcg/ug of alpha carotene converts to a maximum of 1mcg/ug of retinol/vitamin A. One of the benefits of taking beta carotene instead of supplemental retinol, is the body will stop converting to retinol when it has an adequate supply, and it will flush the excess beta carotene out, making overdose less likely. Vitamin A that doesn’t need conversion into an active form can be listed on product labels in several ways: preformed vitamin A, retinol, retinal, vitamin A palmitate, or vitamin A acetate. These forms of vitamin A are immediately available to the body for storage and/or use, making potential overdose more likely as the body can’t flush out excess vitamin A/retinol. The maximum safe dosage of vitamin A for adults, from all sources, is 3000mcg/ug, or 10,000IU, per day. Since vitamin A/retinol is stored in the body, short-term supplementation of higher doses is the best approach to avoid an overdose unless otherwise advised by a medical doctor. Keeping supplemental dosages closer to the RDA is a wiser choice for most people. Symptoms of too much vitamin A: • Liver damage as some vitamin A is stored in the liver. • Excessive sleepiness • Confusion • Severe nausea and vomiting • Coma • Headache • Dizziness • *Too much vitamin A during pregnancy causes birth defects. Dietary sources of carotenoids are: • Carrots • Sweet potato • Winter squash • Mango • Spinach (Spinach is mildly goitrogenic.) • Kale (Kale is a goitrogen.) • Apricots (Especially dried, but they are high in sugar.) • Plums • Tomato • Red and Yellow peppers • Nori Dietary sources of vitamin A are: • Beef liver • Cod liver and cod liver oil Low-Thyroid Help 26

28. Cod, salmon, and other oily fish, particularly their livers Milk (organic from grass-fed cows) Eggs Tuna Butter (organic from grass-fed cows) • • • • • B Vitamins All B vitamins play a role in energy production, metabolism, and immune function. They are also vital for thyroid health. B1 (Thiamine) Vitamin B1 helps improve appetite and digestion. It also helps the body use dietary sugars for energy. Low levels of B1 are common in both hypothyroid and hyperthyroid patients. B1 has a calming effect and is sometimes used to treat anxiety and stress. The RDA for B1 is 1.2mg for men, and 1.1mg for women. Sources of B1: • Brewer’s yeast • Nuts and seeds • Whole grains • Legumes • Meat, fish, and poultry, especially organ meats • Enriched flour and cereals • Mushrooms B2 (Riboflavin) Low levels of B2 suppress both thyroid and adrenal function. B2 helps the body metabolize fats and breakdown protein into amino acids. The RDA for B2 is 1.3mg for men and 1.1mg for women. Sources of B2: • Sweet potato • Almonds • Leafy green vegetables (Watch out for the goitrogenic ones.) • Mushrooms • Natural organic yogurt • Milk • Beef liver B3 (Niacin) B3 is the vitamin that turns urine a neon yellow or a greenish neon yellow when taken in supplement form. The altered color in urine is the excess B3 the body doesn’t need; it can be seen approximately two hours after taking a B3 supplement. Like its fellow B vitamins, B3 helps with energy production, immune function, and nervous system health and is important for keeping hair, skin, and nails healthy. It also helps maintain and improve good cholesterol, or HDL, levels. Low-Thyroid Help 27

29. B3 supplements can cause anxiety and elevated blood pressure in some people, so those with heart or blood pressure problems, or anxiety disorders should be cautious about supplementing with B3. Too much supplemented B3 can cause liver problems. Supplementing with B3 while pregnant or lactating should not be done without medical supervision. The RDA for B3 is 16mg for men and 14mg for women. Sources of B3: • Beef and particularly beef liver • Shiitaki mushrooms • Salmon • Tuna • Turkey • Chicken breast • Sunflower seeds • Peanuts B6 (Pyridoxine) Vitamin B6 is particularly important to thyroid health, without it the thyroid gland can’t use iodine to make thyroid hormones. People with either hypothyroidism or hyperthyroidism can be deficient in B6. Low B6 levels result in muscle weakness. B6 helps balance mood, maintain energy levels, and detoxify the liver. It can reduce side effects from radiation treatments. The RDA for B6 is 1.3mg for both men and women. Sources of B6 are: • Breakfast cereal fortified with B6 • Lean meat, fish, and poultry • Pistachio nuts • Sunflower seeds • Sesame seeds • Pinto beans • Avacado • Blackstrap molasses B12 People with hypothyroidism can’t absorb sufficient amounts of B12 because an under-active thyroid slows down digestion and reduces stomach acid, which is needed to pull B12 out of food, so supplementation is often a good choice. B12 is stored in the liver. The best sources of B12 come from animal meats and other animal products like dairy and eggs. It can take years for symptoms of B12 deficiency to become noticeable, which is why many vegetarians and vegans claim that non-animal sources of B12 are sufficient. Because it takes so long for symptoms to arise, many vegetarians and vegans don’t realize that they are deficient, and they think that the small amounts of B12 they get from plants is enough to maintain good health. It is possible to live a vegetarian or vegan lifestyle by eating foods fortified with B12, or by taking B12 supplements. Relying solely on plant-sourced B12 is not enough to maintain good health particularly for pregnant and nursing women, or for babies and children. B12 is difficult to absorb even for healthy people, and the body seems to prefer small amounts rather than large. Ability to absorb B12 decreases with age. People with intestinal problems and malabsorption issues, Low-Thyroid Help 28

30. those who live a vegetarian or vegan lifestyle, and the elderly are at higher risk for developing B12 deficiency. Early signs of B12 deficiency are fatigue, constipation, depression, poor memory, and tingling sensations in the extremities. Health problems from severe B12 deficiency are very serious: nerve damage, psychiatric disorders, dementia, and pernicious anemia are a few of them. The RDA for B12 is 2.4mcg for both men and women. Sources of B12: • Meat, fish, and poultry • Clams are very high in B12 • Beef liver • Eggs contain a small amount of B12 in the yolk. • Fortified grains • Fortified breakfast cereal • Fortified yeast • Some types of seaweed, especially purple laver nori (B12 content in seaweed is highly variable and can’t be relied upon as a sole source. Seaweed is also high in iodine and people with hypothyroidism need to monitor their iodine intake.) • Tempeh (High in B12 due to bacterial action during fermentation, but some health professionals view tempeh as goitrogenic.) • Shiitake mushrooms • Black trumpet mushrooms (Craterellus cornucopioides) • Golden chanterelle mushrooms (Cantharellus cibarius) B vitamins can be taken individually as needed, or in a complex. B-50 or B-100 complex supplements are good choices because all of the B vitamins are in the correct ratios allowing them to better work together. People who are sensitive to B3(niacin) should avoid B complexes. B vitamins can cause stomach upset so they should be taken with food. Tyrosine Tyrosine is a non-essential amino acid; the body makes it in the liver. Tyrosine is combined with iodine to make thyroid hormone. Supplementing with tyrosine can increase T4 production, which is why it’s of interest to people with hypothyroidism. Theoretically, improved T4 production due to tyrosine supplementation can result in a lower dose of prescription T4. Supplementing with 500mg or less of tyrosine per day is generally safe for most people. People with hyperthyroidism, or Grave’s disease, shouldn’t take tyrosine supplements. Side effects of tyrosine supplements include: nervousness, insomnia, anxiety, agitation, heart palpitations, increased blood pressure, and headache. People taking prescription thyroid hormone, synthetic T4 or levothyroxine, risk having too much T4 in their system if they also take tyrosine. It’s important to closely monitor potential side effects from tyrosine supplements and have regular blood tests to monitor T4 levels. People with anxiety disorders, heart or blood pressure problems, or those prone to mania, should not take tyrosine supplements as they can raise blood pressure and cause anxiety in some people. Low-Thyroid Help 29

31. Tyrosine, and other amino acids, are usually listed on product containers with an ‘L’ as in l-tyrosine. The L refers to the amino acid being in it’s free form, meaning it’s not attached to anything else. Amino acids that are linked to other amino acids, or amino acid chains, form proteins; and the body has to break them down to get individually needed amino acids. Free-form amino acids are preferred because the body can readily use them. Sources of tyrosine are: • Meat, poultry, and fish • Dairy products • Seeds and nuts Arginine Arginine is a conditionally essential, or semi-essential, amino acid. Children must have arginine supplied from food; adults can synthesize their own. Adults who are or have been very ill, are under stress, or who have small-intestine damage, or digestive problems might need to supplement arginine, or increase dietary sources of it. Arginine stimulates thyroid hormone production and helps to balance thyroid hormones. Some nutrition experts believe that arginine balances the T4-boosting activity of tyrosine, which theoretically can moderate overproduction of both tyrosine and T4. Arginine also stimulates the release of insulin and of growth hormone. Arginine is used as medicine for some cardiac conditions, some kidney issues, migraines, and erectile dysfunction. It boosts immune function, is an anti-inflammatory, and is a vasodilator, meaning it relaxes blood vessels. Dosage for arginine varies widely depending on usage. 500-1000mg a day for hypothyroid patients is generally considered safe, but always check with a medical doctor before taking this or any other supplement. Cardiac patients can take as much as 20grams a day in split doses. Arginine can interact with some cardiac medications, blood pressure medications, and medications for erectile dysfunction. Arginine supplements are not recommended for asthmatics. Side effects of arginine supplementation include abdominal pain, bloating, and diarrhea, and are usually the result of too high a dose. Sources of arginine are: • Meat, fish, and poultry • Milk and other dairy products • Eggs • Seeds and Nuts Herbs for Hypothyroidism Ashwagandha Ashwagandha (withania somnifera), also known as Indian ginseng, poison gooseberry, and winter cherry, is a tonic herb that has long been used in Ayurvedic medicine. Physalis alkekengi is also known as winter cherry, but is a different plant with different properties. Ashwagandha improves TSH levels and improves T4 production. It can potentially cause an excess of T4 if used with prescription T4 (levothyroxine). Ashwagandha is a potent anti-inflammatory and is used both orally and topically to reduce painful swelling. Orally it’s used to improve brain function, concentration, and increase alertness. It can also Low-Thyroid Help 30

32. reduce anxiety and improve mood. Ashwagandha is used to balance hormones and shouldn’t be taken by pregnant or nursing women because of its hormonal effect. This herb is toxic when taken in high doses. Known safe doses range from 300-500mg per day. Look for products that list 2-5% standardized extract of anolides for the best potency. Anolides are chemicals in the plant that exert a medicinal effect on the body; they are purported to stop the growth of tumors. This herb interacts with anxiety medications, sedatives, immunosuppressants, and possibly with thyroid medications. Olive Leaf Olive Leaf is a potent antioxidant, anti-viral, anti-bacterial, anti-fungal, and an anti-inflammatory. This herb encourages production of T4, lowers production of TSH, and increases conversion of T4 into T3. Toxicity for this herb isn’t known, but therapeutic doses range between 500-2000mg per day. Effects of olive leaf on unborn babies or breastfeeding infants isn’t known, so avoid this one during pregnancy or if breastfeeding. There are no known interactions between this herb and synthetic T4 (levothyroxine). Olive leaf can lower blood sugar in some people and might interact with diabetes medication, but there is no factual evidence to support a negative interaction. This herb has anti-hypertensive properties, so those who are taking blood pressure medication need to be careful with olive leaf and take it only under medical supervision. Cautious use and regular monitoring of potential side effects is recommended if using this herb. If buying this herb, look for labels stating at least 6% oleuropein for the best potency. Oleuropein is a compound found in both olive leaves and in olive oil, but is less concentrated in the oil. Organic, extra- virgin olive oil is the best type. Refined olive oil is of lesser quality and many of the healthy compounds in olive oil is lost in the refinement process. Sage Historical uses for sage (salvia officinalis) are: reduction of sweating, improving appetite, improving digestion, relieving gastritis, improving memory, relieving depression, and easing heartburn. Many of sage’s medicinal properties remain intact after cooking, so it can be used in food and as a medicinal tea. Sage is an anti-bacterial, anti-fungal, and an anti-viral. Women have historically used sage to relieve menstrual pain and to increase production of breast milk. Religious/spiritual folks burn sage to cleanse places of evil spirits or negative entities. Sage balances progesterone and testosterone; an imbalance of these hormones is common with hypothyroidism. It can also improve symptoms of depression that are common in hypothyroid patients. Sage is known to lower TSH, which tends to be high in people with hypothyroidism. Lowering TSH levels is one step in balancing thyroid hormones. Like most herbs, sage is rich in vitamins and minerals. Common sage is high thujone, which is a compound found in some other herbs like yarrow and wormwood; it’s also found in varying amounts in the alcoholic drink Absinthe, commonly known as the green fairy. There is divided opinion as to the safety of thujone and its potential psychoactivity. It’s thought by some that high amounts of thujone can cause hallucinations and seizures. Ingestion of very high amounts of thujone or wormwood are known to be toxic. Low-Thyroid Help 31

33. Sage (salvia officinalis) supplements as high as 2grams a day, in split doses, have been used safely with little to no side effects. Sage can interact with medications for diabetes, blood pressure, seizures, and sedation. Liver and Thyroid Health Most people don’t think about the liver when they have thyroid issues, but a healthy liver is essential for thyroid health. Up to 20% of T3 is converted in the liver. The liver can also convert T4 to RT3. Hypothyroidism slows the body’s metabolism, and it also slows down liver function. Over time, hypothyroidism can cause clinical liver dysfunction that needs direct medical treatment. The liver acts as a filter for the body; it filters and removes certain types of waste products. If we eat too much junk food, or drink too much alcohol or sugary soft drinks, it’s the liver that cleans us up. Even a slightly sluggish liver can wreak havoc on general health. Slow filtration of waste products means toxins are hanging around longer than they should. Important hormones like T3 don’t get produced as fast or in the quantities that they should when liver function is too slow. Sugar is stored in the liver and is released as fuel when the body needs it. Because an under-active thyroid slows metabolism, it also slows the release and usage of stored sugars, causing the liver to store lots of sugar and also fat, because a slow metabolism doesn't burn fat the way it should. This excess sugar doesn’t cause, but can contribute to, high blood sugar and insulin resistance; a problem that is all too common among people with hypothyroidism. (More on that later.) A clean diet and regular exercise are good ways to improve liver function, but sometimes diet and exercise just aren’t enough. Fortunately there are easy ways to improve liver function through the use of herbs. The one herb that stands out is milk thistle, also known as silymarin, holy thistle, and Mary thistle. Milk thistle is used to treat a variety of liver diseases like cirrhosis, jaundice, and even hepatitis. It’s an anti-oxidant and anti-inflammatory, and can lower LDL, or bad cholesterol, and it can improve insulin resistance in diabetics. Silymarin is the compound in milk thistle that’s responsible for the herb’s medicinal qualities. Milk thistle is generally safe to take with prescription cholesterol-lowering drugs called statins, but it’s best to discuss the issue with a medical doctor before taking the herb. Statins can cause elevated liver enzymes, and milk thistle can help reduce the enzymes and balance liver function. Milk thistle can be drunk as a tea or taken in capsule form. The typical dose for milk thistle is 100-200mg 1-3 times per day. Look for products that contain 80% standardized silymarin extract for the best potency. If nausea, diarrhea, or other abdominal side effects occur, the dosage is too high and needs to be reduced. Rashes, hives, itchiness, or trouble breathing indicate an allergy and supplementation should be stopped. If symptoms are severe, go to a hospital emergency room. Milk thistle is in the ragweed family, so people who are allergic to ragweed might also be allergic to milk thistle. Side effects from milk thistle are rare and are usually related to stomach upset due to doses that are too high. The herb can be taken with or without food and with many types of medications, but it does interact with some things so always check with a medical doctor or pharmacist before taking it. Milk thistle acts as an anti-histamine and can interact with OTC and/or prescription anti-histamines. It can also interact with some antibiotics. Milk thistle has mild estrogenic effects, so people with certain types of cancer should not take it. Pregnant or nursing women shouldn't take milk thistle. Low-Thyroid Help 32

34. For those who can’t tolerate milk thistle, turmeric is a great alternative. Turmeric is a spice from the ginger family of plants and is used in traditional medicine to treat a wide variety of ailments like jaundice, Crohn’s disease and other stomach and digestive ailments, arthritis, stomach ulcers, and more. It’s also used topically to treat acne, swelling, fungal infections, insect bites, and infections. Turmeric is also a liver tonic, meaning it helps improve liver function much like milk thistle does. The food-grade turmeric spice can be eaten daily in normal food amounts, and/or drunk in a tea without worry of overdose. Eating or drinking excessive amounts of turmeric will cause stomach upset, heartburn, and/or diarrhea. The supplement form of turmeric is concentrated and overdose can cause liver damage. Curcumin is the compound in turmeric that has medicinal properties; this is concentrated when in supplement form. Food-grade turmeric contains about 3-5% curcuminoids, or curcumin compounds. Turmeric supplements contain as much as 95% curcuminoids. Turmeric with 95% curcuminoid extract is generally safe for most people when taken in moderate amounts, and a typical dose would be 400-600mg 1-3 times a day. Curcumin can be difficult for intestines to absorb. Some nutrition experts say that turmeric is best taken on an empty stomach, others state that it should be taken with meals containing fats or fatty oils like olive oil to aid digestion. Some recommend taking turmeric with black pepper as it contains piperine, which aids in the absorption of curcumin. Milk thistle and turmeric can be found in combined formulations. Turmeric can lower blood sugar so diabetics need to be cautious with it. People with gallstones or gallbladder blockages need to avoid turmeric as it can cause gallbladder contractions. Turmeric interacts with anticoagulant medications, which can cause excessive bleeding. People with bile duct problems shouldn’t take turmeric. Insulin Resistance and Thyroid Health Insulin resistance is more commonly associated with diabetes or poly-cystic ovarian syndrome (PCOS), people don’t think of it in relation to hypothyroidism. Having diabetes is a risk factor in developing a thyroid condition, either hyper-active or hypo-active. Thyroid conditions are more common among diabetics than among the general population, so there is obviously a connection between these illnesses. Thyroid hormone activity strongly influences insulin activity. Too much thyroid hormone pushes insulin out of the body too quickly. Too little thyroid hormone keeps insulin around too long, which can lead to hypoglycemia, or low blood sugar. But hypothyroidism is also linked to insulin resistance and high blood sugar. An under-active thyroid slows the body’s metabolism, which means that the activity of the body’s cells are slowed, and they don’t absorb sugar the way they should even when insulin is present. As we discussed at the start of this eBook, hypothyroidism affects digestion so sugar doesn’t get absorbed properly by the intestines and floats around in places it shouldn’t, wreaking havoc on the body. All of this extra sugar puts a huge strain the pancreas, adrenal glands, and the liver. Insulin resistance happens when the body’s cells are not reacting to insulin the way they should; the result is high blood sugar, which causes a cascade of other negative symptoms. Low-Thyroid Help 33

35. Insulin is a hormone made in the pancreas. When people eat, their blood sugar rises. The pancreas releases insulin in response to the blood sugar. The insulin tells the liver to collect the blood sugar and store it for later use. The liver can also make its own sugar, and insulin tells it when to stop. Insulin also ushers sugar into the body’s cells, which use the sugar for fuel. This harmonious activity keeps blood sugar stable. When the body’s cells are resistant to insulin, they can’t absorb sugar and it stays in the bloodstream. The excess sugar causes the pancreas to make more insulin to help the cells absorb sugar. Over time, the cells become more and more resistant to the effects of insulin and blood sugar continues to rise. Eventually the pancreas is unable to make enough insulin and a person progresses from insulin-resistant pre-diabetes to having type 2 diabetes. When the body is unable to use sugar properly, it also becomes unable to burn fat resulting in uncontrolled weight gain. High insulin levels tell the kidneys to retain salt, which causes fluid retention and high blood pressure. Public Domain Image Quick recap: Low thyroid hormone causes slow metabolism = slow sugar absorption by cells = high insulin = high blood sugar, fat storage, high salt levels, fluid retention, and high blood pressure. Although it’s a fuel source, sugar is toxic to the body when not used properly, or when we eat too much of it. Sudden high surges in blood sugar signal a crisis and the body responds by making the adrenal glands pump out cortisol, known as the stress or fight-or-flight hormone. Cortisol opposes insulin and keeps it from storing sugar in cells. Cortisol readies the body for immediate use of sugar creating the fight-or-flight reaction. In other words, people feel “wired” when the adrenals send out cortisol. Cortisol production in relation to eating sugar creates the feeling of a sugar “high.” The rapid use of sugar as fuel causes a sugar “crash.” Sugar gets burned up rapidly causing a feeling of low blood sugar and fatigue, which makes people eat more sugar and the cycle starts again. Public Domain Image Low-Thyroid Help 34

36. There is another scenario where cortisol’s function is a little different. We’ve already established that cortisol appears when the body is stressed in some way. Long-term stress makes cortisol behave a little differently. Stress makes the adrenal glands pump out cortisol, which keeps lots of sugar in the bloodstream for immediate use. If the stress isn’t resolved, cortisol continues to be made, and it keeps the blood sugar high, and it continues to suppress the action of insulin, creating long-term high blood sugar. High cortisol suppresses insulin. Without proper insulin activity the liver doesn't have anything to tell it to stop making and storing sugar, and stop storing fat. https://www.wpclipart.com/medical/anatomy/kidney/ Kidney_and_Adrenal_Gland.jpg.html High cortisol tells the pituitary gland to stop making TSH, which lowers thyroid hormone production. Cortisol also inhibits conversion of T4 into T3 and increases conversion of RT3. Quick recap: High cortisol = high blood sugar, low T4 and T3, and increased RT3. Some aspects of insulin resistance affect men and women differently so we’ll discuss them separately, starting with the ladies. Women and Insulin Resistance Women with insulin resistance often have high testosterone, and this can happen for a few reasons. Lack of strength training can cause an imbalance of hormones. While it’s true that intense exercise raises testosterone levels for both women and men, this is natural and doesn't usually contribute to a hormone imbalance, in fact it often helps to restore balance. Exercise also helps make the body’s cells more sensitive to insulin. Lowered insulin translates to lower testosterone. Don’t be afraid to pick up those weights, but do use them judiciously. If a hormone imbalance is already present, weight training won’t fix it, but it is a useful tool in a comprehensive approach to better health. Obesity contributes to high testosterone in women. Fat cells actually make hormones including testosterone and estrogen. Obese women can have high levels of testosterone and high levels of estrogen. Any imbalance with a single hormone will cause a ripple effect with the rest of the body’s hormone production. Obesity without thyroid disease or diabetes will cause high testosterone. Even without insulin resistance, fat cells will produce too much testosterone; the more fat, the more testosterone the female body makes. The hormonal disruption that obesity causes will eventually lead to insulin resistance and diabetes, and potentially thyroid disease. As long as a metabolic or glandular disease is not present, eating a clean diet and getting regular exercise is usually enough to restore hormonal balance and promote weight loss. Insulin resistance itself causes obesity and the inability to lose weight even with proper diet and exercise. Diabetic women are already insulin resistant and at risk for an imbalance of estrogen and testosterone. Low-Thyroid Help 35

37. Diabetes also predisposes both women and men to thyroid disease, and thyroid disease is a risk factor in developing diabetes. A healthy diet and regular exercise are helpful, but usually not enough to fix the problem. Quick recap: High insulin = fat storage = too much testosterone, and possibly too much estrogen. Symptoms of high testosterone in women are: • Irritability • Depression • Weight gain • Urinary incontinence • Frequent urinary tract infections (UTI) • Acne, particularly around the jawline • Male-pattern baldness • Excessive body and facial hair • Deepened voice • Increased muscle mass • Enlarged clitoris • Increased or decreased libido • Infertility • Cardiac issues • High blood pressure Natural ways to reduce testosterone in women: • Reduce dietary sugar. • Regular high-intensity exercise. (If healthy enough) • Eat licorice root (glycyrrhiza glabra) – Licorice reduces testosterone and promotes estrogen production. Excessive intake of licorice causes potassium depletion, fluid retention, and high blood pressure. This herb interacts with diuretics and some cardiac medications. Pregnant women should not take licorice. People with heart, liver, or kidney problems should avoid licorice. • Drink spearmint tea – 16oz. a day – Spearmint reduces free testosterone, but doesn’t stop testosterone production. It can be made into a hot or cold tea. Peppermint also reduces testosterone, but isn’t as potent as spearmint. Both types of mint can be combined for greater potency, and both can reduce blood sugar. Mint has little effect on male testosterone levels unless there is very high consumption, which will cause stomach upset in most people. • Supplement with saw palmetto – Saw palmetto reduces dihydrotestosterone (DHT), which is a powerful androgen made from testosterone. DHT is thought to cause enlarged prostate in men and cause head-hair loss in both men and women; it can also contribute to facial hair in women. Saw palmetto can help reduce the effects of DHT like excess facial and body hair. Look for products that are made from the berry part of the plant and standardized to 80-95% plant sterols. Follow label directions for dosage. Saw palmetto can reduce estrogen in men and women. It can interact with NSAIDs and blood thinners. • Marjoram Tea – 16oz. Per day can reduce free androgen levels in women. This herb is used in cooking and some people use it as an alternative to oregano. Marjoram can reduce blood sugar. • Red Reishi Mushrooms – Reishi mushrooms block the conversion of testosterone into DHT. They can be brewed in a tea or used in cooking. • Flax seeds – Flax seeds have strong anti-androgen effects on women. They should be ground into a paste and mixed into foods. Whole flax seeds can pass through the digestive tract unaltered, Low-Thyroid Help 36

38. which has no beneficial effect; they must be properly digested to work. Flax seed oil is a much less potent anti-androgen. Insulin resistance can cause high cortisol levels, and it does this by causing high blood sugar, which the body interprets as stress. Long-term high cortisol reduces the ability of the liver to remove excess estrogen from the body. High estrogen levels cause the body to produce too much of a protein called thyroid binding globulin(TBG). TBG is made in the liver and binds to thyroid hormone to take it through the body via the bloodstream. Think of TBG as a chauffeur. The problem with TBG is that thyroid hormone is inactive while it’s bound to it. Too much TBG results in too little usable T4 and too little T3. Low thyroid hormone contributes to insulin resistance. Birth control pills and hormone replacement medications can also cause too much estrogen. Quick recap: Insulin resistance can lead to high cortisol = high estrogen = high TBG = low thyroid hormone, which reinforces insulin resistance. Symptoms of high estrogen, or estrogen dominance, in women are: • Mood swings • Weight gain • Symptoms of hypothyroidism • Fatigue • Insomnia • Water retention • Irregular periods • Decreased libido • Inability to build or maintain muscle mass despite exercise • Sore or fibrocystic breasts • Thinning head hair • Excess facial hair (Yes, just like with high testosterone; this is why blood tests are so important in identifying the problem.) Sometimes estrogen dominance is actually a result of too little progesterone. This often occurs during peri-menopause and/or menopause. Using plant-based progesterone creams can sometimes balance things out, but discuss this with a doctor first to avoid creating a worse problem. Women who have, or have had, hormone-dependent cancers shouldn’t supplement with progesterone even in topical cream form. NOWFoods® and Source Naturals® both make good progesterone creams from wild yam, but there are many other manufacturers. Follow the directions on the product container for the best dosage unless otherwise directed by a physician. Men and Insulin Resistance In men, insulin resistance can lead to low testosterone and high estrogen. We know insulin resistance causes fat storage, but that fat does more than just pile up. Fat cells produce hormones. For women, obesity tends to cause high levels of testosterone; it’s the opposite for men. That extra belly fat that just won’t leave no matter what is busily producing estrogen 24/7 and feminizing the male body. Low-Thyroid Help 37

39. High estrogen, in itself, can cause insulin resistance. High estrogen levels cause the body to produce too much of a protein called thyroid binding globulin(TBG). TBG is made in the liver and binds to thyroid hormone to take it through the body via the bloodstream. Think of TBG as a chauffeur. The problem with TBG is that thyroid hormone is inactive while it’s bound to it. Too much TBG results in too little usable T4 and too little T3. Too little thyroid hormone slows metabolism, which slows the ability of cells to absorb sugar, eventually creating insulin resistance. High estrogen signals the production of a hormone called aldosterone, which causes water retention. Just like in women, high cortisol levels can lead to high estrogen because cortisol blocks the liver from removing excess estrogen from the body. Quick recap: High estrogen = low thyroid hormone = high blood sugar = insulin resistance, which reinforces high estrogen production. Symptoms of high estrogen in men are: • Depression • Weight gain • Increased potential for stroke • Increased potential for heart disease • Prostate enlargement and/or cancer • Urinary incontinence/urinary retention caused by prostate enlargement • Sexual dysfunction • Decreased libido • Growth of breast tissue • Fatigue • Inability to retain or grow muscle tissue Sometimes men can produce a normal amount of testosterone, but too much of it gets converted into estrogen. The conversion of testosterone into estrogen is normal in men and women, but the amount of estrogen men need is very small. When too much estrogen is made it causes the male body to store fat, and too much fat makes even more estrogen. Too much sugar in the diet is a common cause of high estrogen in men. High levels of sugar signal the body to make an enzyme called aromatase, which is made in glandular tissue, fat cells, and in the brain. Aromatase is responsible for converting testosterone into estrogen. Production of aromatase is normal; it’s only when too much of it is made that hormonal imbalances occur. For men who are producing normal amounts of testosterone but have high estrogen, sugar might be the culprit. For men who are not diabetic and don’t have a thyroid condition, cutting down dietary sugar and increasing exercise is often enough to restore hormonal balance, which will lead to healthy blood sugar levels and fat loss. Obesity without thyroid disease or diabetes will cause high estrogen. Even without insulin resistance, fat cells will produce too much estrogen; the more fat, the more estrogen the male body makes. The hormonal disruption that obesity causes will eventually lead to insulin resistance and diabetes, and potentially thyroid disease. As long as a metabolic or glandular disease is not present, eating a clean diet and getting regular exercise is usually enough to restore hormonal balance and promote weight loss. Low-Thyroid Help 38

40. Diabetic men are already insulin resistant and are at higher risk for having high estrogen levels. Diabetics, both men and women, are at risk for developing thyroid disease. The opposite is also true. People with thyroid disease are at risk for developing insulin resistance, which can lead to diabetes. For men who are already diabetic or who already suffer from thyroid disease, diet and exercise is often not enough to restore hormonal balance or encourage weight loss. Men over forty can have low testosterone due to the aging process; it’s called andropause and it actually happens to women too, generally at the same time as menopause. Andropause causes a natural lowering of androgens, and sometimes causes an imbalance between estrogen and testosterone where estrogen becomes dominant and wreaks all kinds of havoc on the male body. Statin medications, which are prescription drugs that lower cholesterol, can also cause low testosterone, which leads to high estrogen. Natural ways to reduce estrogen in men: • Reduce dietary sugar. • Regular high-intensity exercise (If healthy enough) • Take vitamin D3 – D3 can boost testosterone and can help balance hormones in both men and women. Take 1000-2000IU per day unless deficient, then take 5000IU twice a day. • Milk thistle and/or turmeric supplements. These are liver tonics. The liver flushes out excess estrogen. A sluggish liver will hold on to estrogen. • Grape Seed Extract – This is a natural aromatase inhibitor that blocks conversion of androgen/testosterone into estrogen for both men and women. It’s used often by menopausal women. 100-300mg a day are the most common doses, but up to 600mg a day has been used safely. Side effects are rare and usually involve stomach upset. Grape seed extract can interact with some blood thinners, cardiac medications, and NSAIDs. Diabetics need to be cautious as this supplement can lower blood sugar. • Saw Palmetto can reduce estrogen in men, but it also reduces DHT (dihydrotestosterone) which is a very potent androgen and men need its effects. Blocking DHT can be beneficial in some cases like for treating enlarged prostate or excess DHT levels. Look for products that are made from the berry part of the plant and standardized to 80-95% plant sterols. Follow label directions for dosage. This herb can interact with NSAIDs and blood thinners. Improving Insulin Resistance in Both Men and Women There are numerous other health issues that can cause imbalances in testosterone and/or estrogen in men and women, but they are outside the scope of this eBook. We will focus on insulin resistance and thyroid dysfunction as the causes of these hormone imbalances. The best way to get testosterone and estrogen back in balance is to improve thyroid activity and improve insulin sensitivity. Insulin resistance contributes to thyroid dysfunction, and thyroid dysfunction contributes to insulin resistance. Determining which one caused the other is difficult to near impossible so it’s often best to address both issues simultaneously. Reducing dietary sugars is a good start, but won’t correct any issues by itself. We’ve already discussed the best vitamins, minerals, and herbs to help improve thyroid function in the beginning of this eBook, so now we’ll focus on improving insulin resistance. Low-Thyroid Help 39

41. As we discussed earlier, the herb milk thistle and the spice turmeric can help improve insulin resistance and lower blood sugar. They are also liver tonics. Since the liver plays an important role in the function of insulin, in sugar usage, and in hormone balance, these two supplements are probably the most important. Some people might want to lower blood sugar and there are some supplements that can help with that. Generally speaking, herbs that can improve insulin sensitivity are more importation than just lowering blood sugar, but some people might need both—at least for the short term. Diabetics need to exercise great caution with supplements that affect blood sugar. Always discuss things with a medical doctor before taking supplements. Many culinary herbs and spices can lower blood sugar. Here are some supplements that are particularly good for reducing blood glucose: • Apple cider vinegar can lower post-meal blood sugar. 1 tsp to a maximum of 2 tbsp diluted in 2-4 oz. of water and taken before a meal. • Gymnema sylvestra – This herb’s effect on blood sugar is potent. It’s probably the single best choice for lowering blood sugar. It’s best taken before a meal to lower post-meal blood glucose. If taken between meals, it can cause blood sugar to drop too low. This herb might improve the pancreas’ ability to produce insulin, but more research is needed for confirmation. This herb is of particular interest to diabetics as some have managed to reduce, or even eliminate, their diabetes medication with appropriate dosing. The average dose is 100mg taken before each meal. This herb can act as a diuretic and a laxative. Gymnema sylvestra can interact with anti-depressants. Those with milkweed allergies might be allergic to this herb. • Cinnamon – This popular spice can be used in food, made into a tea, or taken as a supplement. There are two types of cinnamon: cassia, the common type found in grocery stores; and ceylon, which is much more expensive and harder to find. Both types can help reduce blood sugar, but too much of cassia cinnamon can cause liver toxicity. There is no recommended dosage for these herbs, so use them moderately. • Cloves (syzygium aromaticum) – To be clear, this is not garlic. Clove is a flower bud from an Indonesian tree. This spice is used to treat a wide variety of ailments like: reducing inflammation, numbing toothaches, easing arthritis pain, improving digestion, and it’s used topically for bruises, insect bites, and minor abrasions. Clove can be used in food, made in a tea, put in a capsule and taken as a supplement, and used topically as a paste. Cloves can reduce blood sugar in most people. This spice interacts with a variety of medications so talk to a doctor or pharmacist, and use a drug-interaction checker before taking this spice. Clove oil is very potent and concentrated, and is best used topically in small amounts and diluted in a carrier oil like coconut, or olive oil, or almond oil. • Fiber – Plant fiber is an often overlooked component of a healthy diet. Fiber feeds good intestinal flora, it helps move bodily waste through the gut, and it slows the amount of sugar that enters the bloodstream. Fiber is a very important tool in blood sugar control. The U.S. RDA for fiber is 35grams (35,000mg) for men and 25grams (25,000mg) for women. Incorporating fresh herbs and spices into cooking is a good way to improve blood sugar levels and general health. To improve insulin sensitivity, we need supplements that do more than just lower blood sugar. You’ll notice in the following list that some supplements also improve liver and thyroid function while improving insulin sensitivity. Some supplements that improve insulin sensitivity in most people are: • Milk thistle (as we discussed previously) Low-Thyroid Help 40

42. Turmeric (as discussed previously) Vitamin D3 (as discussed previously) Gymnema Sylvestra (as discussed previously) Resveratrol – This is made from the skin of red grapes. Resveratrol lowers blood sugar and improves insulin sensitivity even in diabetics. Typical doses range from 250-500mg a day, but some people have taken as much 2grams (2000mg) without problems. Always start with a lower dose and work up so the body has time to adjust. Side effects from resveratrol are very rare and usually involve stomach upset and/or low blood sugar. This supplement might interact with some bloods thinners and NSAIDs. Berberine – This a compound found in several herbs and berries. Berberine is generally used for short-term supplementation, typically less than six months. Berberine lowers blood sugar and improves insulin sensitivity even in diabetics. It might have beneficial effect on the liver by shedding fat storage, but more research is needed regarding this. Typical doses are 500mg 2-3 times a day. Berberine has a strong negative interaction with cyclosporin, and it can interact with medications that are broken down in the liver like: viagra, halcion, levastatin, biaxin and others. Chromium – Low levels of this mineral are linked to insulin resistance and high blood sugar. The U.S. RDA for chromium is 35mcg for men and 25mcg for women. Most people who eat a varied diet get enough chromium. People with digestive problems can have difficulty absorbing chromium. People who eat a lot of processed foods can be deficient in this mineral. Zinc – Zinc deficiency is linked to insulin resistance and high blood sugar. Diabetics are often deficient in this mineral as are people with digestive ailments due to malabsorption. The U.S. RDA for zinc is 11mg for men and 8mg for women. Magnesium – Low magnesium impairs the absorption of iodine and negatively affects insulin sensitivity and sugar usage. Dietary sources of magnesium are leafy greens. People with hypothyroidism need to be wary as many leafy-green vegetables are goitrogenic. People taking blood thinners need to moderate their leafy-green vegetable intake because of the high level of vitamin K, which interferes with blood-thinning medication. Magnesium can interfere with blood pressure medication. The RDA for magnesium is 400mg; higher doses often cause diarrhea. • • • • • • • • High Cholesterol and Hypothyroidism The body makes cholesterol and uses it to make hormones and digestive enzymes. There are two main types of cholesterol: high-density lipoprotein, or HDL, commonly called good cholesterol; and low- density lipoprotein, or LDL, commonly called bad cholesterol. Thyroid hormones are used to make cholesterol and to remove excess cholesterol. Low thyroid hormone causes an imbalance of good and bad cholesterol and impairs the liver’s ability to remove excess cholesterol. So the body is left with too little HDL and too much LDL. Cholesterol moves through the body via the bloodstream. Too much LDL in the bloodstream eventually collects on the artery walls forming plaques, which leads to clogged arteries. All that artery-clogging gunk is called atherosclerosis, which leads to congestive heart disease. One of the most important, if not the single most important, supplements for reducing LDL is garlic. The blood-building effects of garlic have been touted for decades. Some recent studies have actually proven that garlic can lower LDL cholesterol, and over time it can also reverse congestive heart disease by dissolving those artery-clogging plaques. REFERENCE: UCLA Medical Center has been doing regarding the heart-health benefits of garlic. He and his team This YouTube.com video discusses the research that Dr. Michael Budoff, M.D. of the Low-Thyroid Help 41

43. discovered that over time garlic can reverse atherosclerosis. Dr. Budoff’s study confirmed that garlic is beneficial for overall vascular health. Garlic can be used fresh, in oil form, or in supplement form. Fresh garlic can be peeled and eaten whole, or crushed and eaten, or cooked with food. A minimum of two to three cloves of garlic a day will be needed to positively affect cholesterol levels. Garlic oil can be taken in capsule form or mixed into food. A minimum of 900mg a day of garlic is needed to lower LDL. The average dosage for supplemental garlic ranges from 1000mg to 2500mg a day. The positive effects of garlic are usually slow to appear, so patience is key. For most people, it will take 3-6 months before there is an improvement in LDL levels. For others, it might take up to a year to see any improvement at all. For people who have difficulty tolerating garlic, or who have breath and body odor issues, or digestive complaints due to garlic, there is the alternative of aged garlic. Kyolic® Aged Garlic Extract made by Wakunaga Pharmaceutical is an excellent alternative to fresh garlic or garlic oil. Aged garlic doesn't produce unpleasant side effects like bad breath and body odor, indigestion, or gas. Kyolic® is a well- established brand, and their products are good quality. It’s generally safe for pregnant women to ingest garlic in food amounts, meaning the amounts used to season or flavor food; however, the safety of taking garlic supplements during pregnancy is unknown. Garlic can thin the blood, so those on blood thinners need to be cautious. Always consult with a physician before taking supplements. Other herbs thought to improve cholesterol levels are: • Milk Thistle • Turmeric • Berberine HIIT High-intensity interval training, HIIT, encourages the thyroid to be more active. By itself, HIIT won’t improve clinical hypothyroidism, but used in conjunction with proper medication and nutritional support, HIIT can be very effective in improving thyroid function and overall health. HIIT are certain types of exercises performed at the highest possible intensity(This is different for everyone.) for a given span of time. When the time is up, the exercise doesn’t stop, but the intensity is reduced to a moderate level. Typical time frames for HIIT are thirty seconds to one minute of intense exercise, followed by one to two minutes of moderate exercise. Beginners start with easier exercises and Low-Thyroid Help 42

44. lower time spans. Even five seconds of high-intensity exercise followed by a minute of low-intensity exercise can be beneficial for beginners. It’s important to choose the right exercises and to do them properly. Hiring a personal trainer is a good option. For those who can’t hire a trainer or go to a gym, YouTube.com has numerous video resources to help with choosing the right exercises. This type of exercise is particularly difficult for people suffering from fatigue, one of the major symptoms of hypothyroidism, and that is why HIIT is the last entry in this eBook. Some people are just not healthy enough to do it. For those who can’t do HIIT exercises, it’s still important to get some exercise. Walking, low-intensity bicycling, swimming, and/or yoga are good low-intensity exercises to get the body moving. In Summary: 1. Address digestion and gut-health issues. 2. Introduce more fresh plant foods into the diet. 3. Take vitamin and/or mineral supplements as needed to address deficiency. 4. Address contributing conditions like insulin resistance and/or high cholesterol. 5. Get some exercise. 6. Feel better. References for the information in this eBook can be found on the LINKS page of the Low-Thyroid Help website . Low-Thyroid Help 43