When Gerald came to my practice, he was confused and frustrated. An architect in his mid-50s, he had been diagnosed about 15 years earlier with hypothyroidism, a condition in which the thyroid gland fails to produce enough of its hormones to energize the body or help stabilize weight and mood. Gerald’s doctor had prescribed a synthetic thyroid hormone, and his dosage had been rising steadily. He had been feeling good enough — until recently, when he found himself thoroughly exhausted, 12 pounds heavier, and overwhelmed by depression.
Gerald couldn’t understand why such debilitating conditions would overtake him so suddenly. His firm had recently landed a couple of exciting commissions, and he had been feeling hopeful and inspired. His doctor rechecked his labs and insisted his thyroid hormones were in the normal range and his supplemental hormone was at the right level. He offered to put Gerald on antidepressants.
But Gerald wasn’t interested in that, so he came to my functional-medicine clinic in Austin, Texas, where we focus on a variety of approaches to resolve thyroid dysfunction. When I ran Gerald’s labs, I discovered a common situation: The results were in the normal ranges, but they weren’t optimal.
It’s not uncommon to learn your thyroid lab numbers are normal, even though you have thyroid symptoms and feel lousy. This is partly because standard ranges were developed in reference to patients with malfunctioning thyroids, which is like developing healthy blood-sugar standards based only on people with diabetes.
The “thyroid signaling system” is complex; it doesn’t work in a linear way. Even a small departure from optimal hormone levels can have big effects, producing exhaustion and depression — as it did for Gerald and does for many others. It’s estimated that at least 20 million Americans suffer from thyroid dysfunction.
What’s more, there’s no universal treatment that works for everyone. I analyze lab results and tweak supplements to determine what’s right for each of my patients based on individual sensitivity to each intervention. Even optimal hormonal ranges vary from person to person.
I do, however, have a food-and-lifestyle protocol I recommend for anyone dealing with thyroid issues, because this gland — perhaps more than any other organ — does not operate in isolation. It’s uniquely sensitive to food and stress, as well as environmental toxins, and it affects us at the most basic level: by determining how much available energy we have to live our lives.
What is the Thyroid
If I offered prizes to different body parts, I’d give the thyroid the Most Important Yet Most Underappreciated Award. This small, butterfly-shaped gland in your neck is the true powerhouse for your entire body. Every cell has a receptor for thyroid hormone, which is like gas in your tank — you need a steady stream of it to fuel each cell.
When thyroid function is optimal, you feel terrific: vital, energized, optimistic. When it’s off, you can feel beyond rotten. Your cells can’t reproduce properly without exactly the right amount and type of thyroid hormone. Your organs cannot operate effectively.
It’s not enough to have “some” thyroid hormone, either. Every cell needs exactly the right amount. Too little, and your metabolism bogs down — which is hypothyroidism. You become cold, depressed, listless, and constipated, with mind-fuddling brain fog. You gain weight easily. Your sex hormones get out of whack.
Too much, and your metabolism revs up to warp speed — hyperthyroidism. You become panicky, anxious, and plagued by frequent bowel movements. You lose weight even when you eat constantly. Your muscles feel weak and your hands shake.
Your need for thyroid hormone is multifaceted and dynamic. On days when you are active, extra stressed, or fighting a cold, your thyroid works harder. It suffers when you don’t get enough sleep or eat foods that stress your digestive or immune system.
And when your hormone balance changes — due to pregnancy, childbirth, perimenopause, menopause, or andropause — your thyroid also takes a hit. (Most of these hormonal transitions affect women; they are five to eight times more likely than men to be diagnosed with thyroid issues.)
Once you understand how to support your thyroid, you can make sure this vital organ gets everything it needs to do its high-pressure job.
The Thyroid Network
The thyroid works in partnership with other organs, so I prefer to think of it as the thyroid signaling system.
It all starts with the hypothalamus. This part of the brain is your body’s air-traffic controller. It regulates hunger, thirst, sleep, and body temperature, and it directs the production of a variety of hormones, including all forms of thyroid hormone.
To keep your thyroid on task, the hypothalamus monitors hormone levels in your blood. If levels are too low, it dispatches a messenger to the pituitary gland called thyrotropin-releasing hormone, or TRH.
The pituitary is a pea-size gland located at the base of the brain, just below the hypothalamus, that regulates growth, reproduction, lactation, and stress. When it receives TRH from the hypothalamus, it releases thyroid-stimulating hormone, or TSH. This stimulates the thyroid to produce more of its energy-regulating cocktail of hormones. (TSH is a crucial indicator of how well your thyroid is functioning. If levels are too high on a lab test, it suggests your thyroid needs extra stimulation.)
So thyroid function involves not one but three body parts: the hypothalamus, the pituitary, and the thyroid itself. Sex and stress hormones, as well as the gut and immune system, play their own roles in the process.
Don’t just think thyroid; think network.
A number of things can cause your thyroid signaling system to get off balance: consumption of foods your body doesn’t tolerate, a lack of thyroid-supportive nutrients, an imbalance of sex or stress hormones, excessive exercise or stress, sleep deprivation, a long-simmering infection, or exposure to environmental toxins. But the primary culprit is autoimmunity.
If your thyroid is underactive, you may have Hashimoto’s disease, an autoimmune condition that causes the body to attack and destroy its own thyroid tissue. Adjustments to diet and lifestyle can often correct the imbalance, though supplemental hormones are sometimes necessary to help you feel truly great — especially if you’ve had symptoms for a long time.
A less common autoimmune condition is Graves’ disease, the result of an overactive thyroid — and its outcomes can be serious. I was diagnosed with this and was on the verge of liver failure before I got my symptoms under control. (Other long-term effects can include osteoporosis and heart failure.) An overactive thyroid can be harder to treat — I compare it to catching a runaway horse versus coaxing a reluctant one out of the barn — but the same basic principles apply: Adjust food and lifestyle and add supplemental herbs and medication when needed.
Because the thyroid signaling system interacts with all your other hormones, when your signals are off, you don’t process stress well, your sexual function gets disrupted (low libido, diminished fertility), and your mood, memory, and focus all tank.
That gives you an idea of all the ways the thyroid needs support. Read on to learn how you can provide it.
Boost Your Thyroid
When I treat thyroid disorders, I put all my patients on a 28-day program designed to eliminate thyroid triggers, supply critical nutrients, and heal leaky gut syndrome, which commonly afflicts people with thyroid imbalance. You can find the full plan in my book The Thyroid Connection, where I also explain the nitty-gritty of different types of thyroid hormone — like regular and reverse T3 and T4, which are often ignored by conventional practitioners — as well as how to work with your health practitioner to get the testing you need.
If you struggle with thyroid issues, I strongly recommend seeking the support of a functional-medicine practitioner who is willing to see beyond the numbers and work with you to find a solution that makes you feel truly better.
These are the basics of my 28-day plan, which you can try on your own right now.
Focus on Nutrients
Your thyroid can go haywire with a nutrient-poor diet or a lack of dietary diversity. To keep your thyroid signaling system optimal, you need the following:
• Iodine and protein. Iodine is a key building block of thyroid hormone, and protein helps keep you sated and off the blood-sugar roller coaster; this supports healthy metabolic function. For protein, choose high-quality, pasture-raised meat and wild-caught fish; get iodine from sea vegetables like kelp and dulse, which are easy to add to soup stocks.
• Iron, selenium, and zinc. These minerals support proper function of the thyroid signaling system: Iron makes iodide (a component of iodine) available to the thyroid, selenium helps regulate excessive immune responses, and zinc supports white blood cell production. Food sources include spinach, grassfed beef, and pork, which contain all three nutrients; Brazil nuts are high in selenium.
• Omega-3 fats. Without enough healthy fats, your cell walls lose their integrity. Coldwater fish, like salmon, and fish- and flax-oil supplements are good sources.
• Vitamin A. This is vital to helping T3 enter your cells. Food sources include orange vegetables and fruits, such as carrots, sweet potatoes, winter squash, mangoes, and apricots.
• B vitamins and vitamin D. B vitamins are critical to mitochondrial function; vitamin D helps promote T-cell production. Leafy green vegetables and broccoli (cooked to avoid a thyroid-suppressive effect), as well as beets and grassfed meat and liver, have plenty of Bs. Vitamin D comes mainly from sunshine and supplements, though it’s also found in fatty fish and portobello mushrooms.
Avoid Inflammatory Foods
If the attacks on your immune system continue — from food intolerances, simmering infections, environmental toxins, and chronic stress — the attacks from your immune system will keep coming. This is how autoimmunity develops; your beleaguered immune system starts attacking you.
A damaged gut is one of the most common sources of chronic inflammation because up to 80 percent of the immune system is located there. (Most threats to the system come from what we eat and drink.) So, to heal thyroid dysfunction, we need to heal leaky gut syndrome, which is one of the primary triggers for all autoimmune disease, according to the pioneering physician Alessio Fasano, MD.
Leaky gut occurs when stressors damage the small intestine and it begins to leak undigested proteins into the bloodstream. This puts the immune system on constant alert.
To heal the gut, avoid foods that might be damaging it. In addition to cutting out processed and fast foods, sugar, and caffeine — all of which are extremely inflammatory — I suggest eliminating these common food allergens:
• Gluten. This highly inflammatory protein found in many grains and seeds (including wheat, barley, and rye) also mimics thyroid tissue, setting off autoimmune reactions.
• Dairy. Like gluten, the casein in dairy can provoke autoimmunity, and the growth hormones farmers give to many dairy animals are thyroid disruptors.
• Eggs. These are a common allergic trigger and can create low-grade inflammation.
• Nightshades, nuts and seeds, all grains, legumes, and soy. These foods contain antinutrients, including phytic acid and lectin, which can aggravate autoimmune issues.
I also advise eliminating gluten and dairy permanently, because their proteins are similar to thyroid tissue, and they can double the damage of an autoimmune reaction. (For more on this, see “Molecular Mimicry”, below.)
I believe it’s best to avoid grains and legumes if you have an autoimmune condition. If not, you can gradually add those foods — as well as eggs, nuts, nightshades, and soy — back into your diet when the 28-day plan is done. (You can find guidance for reintroducing and testing foods in my book.)
Tame the Toxins
Food is medicine because everything your body absorbs has a crucial impact on your health. Unfortunately, there’s a downside to that principle: We also take in the industrial chemicals that saturate our air, water, and soil.
Every day, we’re exposed to hundreds of toxins that can disrupt the body’s thyroid function, as well as its immune system, digestion, and overall wellness. If we don’t take steps to combat this threat, this toxic burden can sabotage all the effects of our other healthy choices.
Because toxins are everywhere, there’s a limit to what we can do to prevent and recover from them. We are exposed to airborne chemicals from industrial polluters, and endocrine-disrupting chemicals have been found in ATM receipts, conventional cleaning products, personal-care products, home furnishings, and more.
Still, we can protect our thyroid’s health, both by eliminating toxic exposure when possible and by improving the body’s ability to detoxify. Here’s my toxin-defense plan at a glance.
Prevention: Reduce your exposure to toxins.
• Clean your air with a HEPA filter.
• Filter all your water, including for showers and baths.
• Buy organic and pasture-raised foods whenever possible.
• Use clean, plant-based body-care products.
• Have your dentist remove mercury dental amalgams.
Detoxification: Support your body’s ability to shed toxins.
• Learn if you have any gene mutations so you can determine the supplements you need to support your detox pathways. (For more on this, see “Making Sense of SNPs“.)
• Care for your liver with a non-inflammatory diet.
• Heal your gut.
• Support your body’s natural daily detox: elimination and sweat.
Stress relief: Stress of all types disrupts thyroid and immune function in multiple ways, including by slowing the production of thyroid hormone and making thyroid receptors less sensitive. For my patients, I prescribe some combination of magnesium (which gets excreted during high stress), B-complex vitamins (the adrenals use them to build stress hormones), and vitamin C (a shortage can trigger excess cortisol production) to rebuild depleted physical reserves. I suggest working with a functional-medicine provider to ensure you’re getting the right dosage of each.
I also recommend exercise in appropriate amounts. If you have hypothyroidism and are completely drained, a calm yoga session or a walk with a friend will be far more restorative than a vigorous bike ride. If you have hyperthyroidism, extreme exercise may exhaust you. Stick with movement that builds your energy, rather than depletes it.
Sleep: Perhaps the most critical thing you can do to support your healing is getting plenty of deep, regular sleep. Insufficient or irregular sleep boosts stress hormones, which can result in even more difficulty with sleeping. Here are my “sleep hygiene” suggestions:
• Get as much natural light as you can during the day to help reset your circadian rhythms.
• Go to bed and get up at about the same time each day.
• After sundown, use amber lightbulbs and avoid screens. If you must look at a screen, use a f.lux filter to shift the color of the device’s light from blue to orange. This makes it less stimulating.
• Keep your bedroom as dark as possible, and ban all electronics. Wake up with an alarm clock rather than your phone.
• Give yourself adequate time in the morning to start each day calmly.
These actions alone can make a surprising difference in how you feel day to day. I want you to have the support you need to make your thyroid, gut, and immune system all function at their best, so you can feel energized, glowing, and optimistic.
That’s the optimal health that is your birthright.
How Stress Affects the Thyroid
Just like the thyroid, your adrenal glands are regulated by the hypothalamus and pituitary glands along a pathway known as the HPA axis. When you experience intense stress, the adrenals produce a cascade of hormones, prompting you to fight or flee. If this process never abates, your body stays in panic mode, and you end up with adrenal dysfunction, which involves an overproduction — followed by diminished production — of stress hormones, such as cortisol.
Your thyroid also takes a hit. High cortisol levels tell your hypothalamus that survival is paramount, and you’d better store calories to avoid starvation. When the message reaches the thyroid, it curtails its hormone production, which governs metabolism.
Metabolism then becomes sluggish to help your body retain the fat needed to survive lean times. You may feel foggy, unmotivated, and fatigued, but the whole process prevents you from expending energy that you might not be able to replace.
Molecular Mimicry and Your Thyroid
When your body is exposed to a dangerous pathogen, your immune system memorizes the structure so it’s prepared to defend you more effectively during the next encounter. But its memory and recognition aren’t perfect. If one molecule’s structure and protein sequences are similar enough to another’s, the immune system can be fooled into attacking the look-alike molecules — even if they’re your body’s own tissues. This is called molecular mimicry, and it’s one of the most common triggers for autoimmune response.
Unfortunately for the thyroid, it has a common dopplegänger: gluten, which has a protein structure similar to thyroid tissue. So when someone suffering from Hashimoto’s hypothyroidism — a condition in which the body attacks its own thyroid tissue — encounters gluten, their body goes on full offensive, attacking the gluten and the thyroid. What’s more, 50 percent of people with gluten-sensitivity are also sensitive to casein, the protein found in dairy foods.
Even if a thyroid disorder is not autoimmune, the body can still fall prey to molecular mimicry and step up its attacks on the thyroid. That’s why I recommend all my patients remove gluten and dairy from their diets, autoimmune or not.