So, Izabella, first of all, welcome to The Diabetes Summit! It s great to see you!

Transcription

1 The Thyroid Connection to Type II Diabetes Guest: Izabella Wentz, PharmD The following presentation is for informational purposes only and is not intended to diagnose, treat, or cure your condition or to be a substitute for advice from your physician or other healthcare professional. Dr. Mowll: Hello! And welcome back to The Diabetes Summit This is Dr. Brian Mowll, the diabetes coach, certified diabetes educator, and IFM certified functional medicine practitioner. And I have with me today the thyroid pharmacist, Izabella Wentz. And Izabella and I are going to be discussing the connection, the very important connection, between thyroid health and diabetes today. So, Izabella, first of all, welcome to The Diabetes Summit! It s great to see you! Izabella: Hey, Brian, so great to see you again! Thank you for having me! Dr. Mowll: You are welcome! And it is all my pleasure. And you guys are going to love Izabella because this information is so powerful and so important. And she is the go-to person. So we re going to get into this content in just a few minutes. First, I want to do a more formal introduction. Izabella Wentz, PharmD, is a passionate, innovative, and solution-focused clinical pharmacist. She has a passion for healthcare from a very early age inspired by her mother Dr.Oh boy, can you pronounce her name? Izabella: Yes, it s Marta Nowosadzka. Polish. Dr. Mowll: All right. Beautiful. Fascinated by science and the impact of substances on the human body, Izabella decided to pursue a degree in pharmacy with a dream of one day finding a cure for disease. An avid learner and goal-oriented student, she received the PharmD degree that s doctor of pharmacy from the Midwestern University of Chicago College of Pharmacy at 2015 SweetLife Diabetes Health Centers, LLC. All rights reserved. 1

2 the age of just twenty-three. After graduation, she excelled at numerous roles, including working as a community pharmacist, a clinical consulting pharmacist, and later a medication safety pharmacist. She s a fellow of the American Society of Consultant Pharmacists and holds certifications in Medication Therapy Management, as well as Advanced Diabetes Care. During her time as a consultant pharmacist, Dr. Wentz worked as part of an interdisciplinary team consulting on thousands of complicated patient cases, often caused by rare disorders. She was regarded as an expert in clinical pharmacology and would be called to investigate cause and effect by performing comprehensive medication therapy reviews to help identify and resolve adverse drug events. She quickly became well versed in finding and evaluating emerging research to help address her clients unique challenges. And although trained as a pharmacist, she was an ardent champion for lifestyle interventions, which often helped patients much more than any medications. And I think that is important to realize because here is someone sitting before us who is trained clinically and conventionally in the world of pharmacy. And diabetes care, obviously, the standard treatment is largely medication based, which I think is important. But it s limited. And as her bio says, Dr. Wentz discovered the power of lifestyle intervention. And in diabetes, as well as in thyroid care, lifestyle intervention can be lifesaving. And you really can make a huge impact on your disease state, your condition by changing your lifestyle. So Dr. Izabella hosted The Hashimoto s Institute. It was a summit all about autoimmune thyroid. And she can be found at ThyroidPharmacist.com. So again, Dr. Wentz, it s great to have you as part of The Diabetes Summit. And thanks for joining us! Dr. Wentz: Thank you so much for having me! Dr. Mowll: You re welcome. I did your whole talk for you. But so we re going to 2015 SweetLife Diabetes Health Centers, LLC. All rights reserved. 2

3 jump in and get started. And let s first just talk about this connection between thyroid and diabetes. It s mind boggling. But a lot of people still don t realize that there is a really strong tie between thyroid disorders and both type I and type II diabetes. So could you talk about that for just a few minutes? Dr. Wentz: Yeah. Absolutely. So we know that thyroid disorders are very common in the general population. And they seem to affect depending on the study you look at anywhere from ten to twenty percent of the general population. However, this risk for thyroid disease actually increases almost to double in people who have diabetes. And about thirty percent of people with type I diabetes also have autoimmune thyroid disease. So this is something that s very important to keep in mind. On the other hand, people with Hashimoto s and thyroid disease are often at risk for having either diabetes or dysglycemia. So a study in Poland showed that about over fifty percent of people either had diabetes or impaired glucose tolerance. Dr. Mowll: Wow! That s amazing. So lots of people dealing with thyroid disorders have blood sugar imbalances and vice versa. Could you talk just for a few minutes before we jump into some of the thyroid information, the connection again between type I and Hashimoto s. Do you think there s a similar root cause there? Why do you think there s a lot of people dealing with both of those conditions? Dr. Wentz: Absolutely. As the listeners probably know, type I diabetes is an autoimmune condition. And so is Hashimoto s. And research shows that if you have one autoimmune condition, you re more likely to have another autoimmune condition. So some of the potential root causes are going to be the same. And it just depends on your genes as to which types of autoimmune conditions you ll develop, as well as the triggers in your environment. Dr. Mowll: Okay. So both autoimmune diseases and could potentially have some of the same root causes and, obviously, the genes play a role. Some 2015 SweetLife Diabetes Health Centers, LLC. All rights reserved. 3

4 people carry strong genetic tendencies towards diabetes. For others, it might be rheumatoid arthritis. Others, it might be different types of autoimmune. Thyroid, Hashimoto s, of course, being the most common. And do you want to get into any of the root causes of autoimmune disease and maybe some of the drivers there, talk a little bit about that? Dr. Wentz: So looking at a lot of the root causes, autoimmune disease has been described as a three-legged stool. And you need three things for it to manifest. So the first part of that is going to be the genes. So you need to have the right [inaudible] develop autoimmune disease. The second part is going to be an environmental trigger. And sometimes this can be some sort of an infection. It can be a toxin, stress. Nutrient deficiencies have also been described as triggers. And the third puzzle piece part of the stool that makes it stand is intestinal permeability. So for one reason or another, a person may have something that s known as leaky gut where their gut doesn t properly hold its contents. And then people are at risk for getting these things into their circulation and setting off an immune response. This is something that is present, according to recent studies, in every single autoimmune condition, be it Hashimoto s or be it type I diabetes. So this is something that I recommend for everybody with an autoimmune condition to focus on. So in my experience what I found is working specifically with people with Hashimoto s is that they usually have a combination of nutrient deficiencies, food sensitivities, impaired [inaudible]. They may have infections and also the intestinal permeability. So those are some of the things that I always look at for in people with Hashimoto s to look at whether or not we can take away some of these triggers and help the person get into remission. Dr. Mowll: So do you think people with type I diabetes would have some of the similar success maybe at preserving beta cell function if it s caught early enough or at least maybe regulating blood sugar a little bit better? Or maybe some cases like the latent adult-onset autoimmune diabetes or what s called 2015 SweetLife Diabetes Health Centers, LLC. All rights reserved. 4

5 LADA, do you think maybe some of those people could prevent some of that damage or turn things around to a certain degree if they follow some of that same advice? Dr. Wentz: I definitely believe so. So a lot of the autoimmune triggers, you can suspend autoimmune disease. Obviously, if your thyroid has been completely destroyed or another organ has been completely destroyed, it s really hard to reverse that damage. But you can definitely slow down the progression of the condition or you can stop the progression of the condition. So I specifically work with people with Hashimoto s. And we have been able to help them get all their autoimmune conditions into remission, as well. So a lot of times, it s the same underlying root causes or triggers that are causing the immune system to attack a whole bunch of things, not just your thyroid or your pancreas. Dr. Mowll: Interesting. So I think one of the reasons that it s important to talk about Hashimoto s is that it really is a very common cause of hypothyroidism. And maybe you can shed some light on just how common. But a lot of people with diabetes type I or type II have unknown thyroid problems and typically have low thyroid function. We see that the T3 hormone is oftentimes low in people with blood sugar problems or as you said dysglycemia. What are you seeing as far as the percentages of people with Hashimoto s as opposed to just a clinical hypothyroidism without autoimmune disease? Dr. Wentz: That s a really excellent question. And worldwide iodine deficiency is the primary cause of low thyroid or hypothyroidism. But in the United States and Europe and just about every single country that adds iodine to the salt supply, Hashimoto s is actually the primary cause. So depending on the references you look at, you will have somewhere between ninety and ninetyseven percent of people who have hypothyroidism actually have Hashimoto s SweetLife Diabetes Health Centers, LLC. All rights reserved. 5

6 And whenever I talk to people about the work that I do when I talk about Hashimoto s, they ll say, Wow, that s a really rare condition. It sounds so exotic. And then come to find out, I ll start asking [inaudible] more about what it is. And it turns out that either they re on thyroid medications or they know somebody that s on thyroid medications because chances are if you re somebody that has low thyroid or you re taking thyroid medications, you have Hashimoto s. You just have not been told that. Oftentimes, you ll be told that your thyroid is sluggish or that you have hypothyroidism. But doctors oftentimes will not tell people why they develop this condition. So I encourage everybody to ask, to have a test done for Hashimoto s. Dr. Mowll: Well, yeah, I remember in school, you learned about Hashimoto s with a whole bunch of other endocrine disorders like Cushing s and Addison s and so forth. And I don t think it was ever described how common it was. So you re looking for these cardinal signs of Hashimoto s the big puffy face and all that. And in clinical practice, it doesn t always look that way. People don t come in necessarily with all the characteristics of that particular condition or, at least, the way it s taught in endocrinology. So when you run the labs, then you start to realize, Boy, this is a lot more common than what I was taught and maybe what conventionally is thought. And it s a real issue. And I think whether people are having symptoms or not, it s important to know that there s an autoimmune condition there, number one. And then secondly, a lot of times people are having symptoms, but they don t know that it s related to the thyroid. So what are some of the tests that need to be done for anybody who, perhaps, has a concern about this or even just being proactive? What are some of the tests that need to be done to screen for Hashimoto s and also for low thyroidism? 2015 SweetLife Diabetes Health Centers, LLC. All rights reserved. 6

7 Dr. Wentz: You know before we get into the tests, you just reminded me of my pharmacy school education where we had a picture of a woman in one of our textbooks. And the woman was basically cut in half. And on one side, she had the puffy face and she was forgetful. On the other side, she was anxious and she was losing weight. And this was basically what we were taught about hypothyroidism versus hyperthyroidism. And when I actually in full disclosure I was never really interested in the thyroid until I got diagnosed myself. When I actually got diagnosed, I had a mixture of the symptoms on either side. So I was really, really tired. My hair was falling out. But I was also anxious and I had palpitations. So the classical symptoms of hypothyroidism are going to be cold intolerance. So if you re the woman that s in your office wearing an extra sweater when everybody else is in short sleeves, that would be a good indication. You re starting to lose your hair, especially the third upper part of the eyebrow. That is a really good indication that you may have thyroid disease. Of course, fatigue is one of the biggest things people complain about. They re just so tired. And sometimes they re very unmotivated, as well. So a lot of times you ll take a woman who s very ambitious a go-getter and all of a sudden, Ugh! Nothing in life is important enough to get out of bed and get out of my yoga pants. The other things that are very common are going to be weight gain or an inability to lose weight. And this is a really big one that a lot of women struggle with and men, as well. Libido hypothyroidism can definitely impact libido and fertility. So this is something that s really sad. And I m personally very passionate about women of childbearing age to have a test done for Hashimoto s and hypothyroidism because if your thyroid is not working properly, you may be at risk for losing your baby. You may be at risk for not getting pregnant. And another thing that happens with thyroid disorders is that people can feel 2015 SweetLife Diabetes Health Centers, LLC. All rights reserved. 7

8 like they re going crazy. So you may feel super anxious. You may feel like you are very depressed. I ve seen people who have been diagnosed for psychotic disorders or bipolar disorders or even schizophrenia. Because in the initial stages of Hashimoto s, what s happening is your immune system is attacking the thyroid gland. And all of a sudden, all of these packets of thyroid hormone get rushed into your bloodstream. And then you have these spikes up. So thyroid hormone makes us more active, makes us more awake. And once that s cleared out, then you get really sluggish. And this can look like bipolar disorder to the average clinician. So now that we ve talked about all the fun things that can occur with Hashimoto s, I want to, first of all, I want to let you know that all of these symptoms are one hundred percent reversible. The other part is knowing that you have this condition. So if you re experiencing any of these things, if you have family members that are experiencing any kind of mental disorders, depression, anxiety, bipolar disorder, make sure they get their thyroid test and don t just have them do the basic panel. To give you my personal story, I had chronic fatigue for about nine/ten years where I was sleeping for ten to fourteen hours each night. And I was going from multiple doctors. And they were saying, Okay, we tested you for anemia. We tested you for thyroid. Everything is normal. Everything is great. Go on your merry way, maybe stop at the psychiatrist, pick up some antidepressants because clearly there s something wrong with you if you re tired. And we can t find anything medically wrong. And the thing is they were only testing my TSH. So TSH thyroid stimulating hormone is the basic screening test for hypothyroidism. The good thing about this test is that when it s really, really elevated, you know that a hundred percent you have hypothyroidism. But, unfortunately, in most cases, this test will not pick up on Hashimoto s in the early stages. And also doctors used to use an old reference range SweetLife Diabetes Health Centers, LLC. All rights reserved. 8

9 So back in the day when I was going and trying to get tested, the normal reference range was as high as a TSH of ten. And my TSH was a 4.5. And I was twenty-five. They were telling me that I was perfectly normal. Yet, I was sleeping for twelve hours a night. New research has redefined this normal range to no greater than 2.5 as your TSH. And most patients, most thyroid patients, actually feel best with a TSH between 0.5 and Some doctors would even argue to say that 1.00 should be where you re at. So to give you a little perspective, when I had a TSH of 4.5, my hair was falling out. I was anxious. I was sleeping a lot. And I was just not my usual motivated self. When I got my TSH to a 1.00, all of a sudden, I was happy. I was extroverted. My hair started growing back. And lo and behold, I was sleeping for eight to ten hours instead of the ten to fourteen that I used to. So one is the TSH test. Make sure you ask for that. But the other important tests are going to be thyroid antibodies. So there are thyroid peroxidase antibodies and thyroglobulin antibodies. You can write these down as TPO and TG antibodies. And these are going to be the tests that are going to be indicative of whether or not you have Hashimoto s. The interesting thing about them is these tests are going to be elevated for sometimes five to ten years before you see a test in TSH. What I really love about these tests is that if you can pick up on that you have Hashimoto s before you have a change in TSH, you can actually prevent thyroid damage to your thyroid gland if you do the right things. So I recommend doing those tests. The other tests are going to be free T3 and free T4. Sometimes there may be a pituitary component that basically there s a breakdown in communication from your pituitary gland to your thyroid gland and the TSH may be normal. But, in fact, you don t have the right amounts of thyroid problems circulating. So free T3 and free T4 are going to measure that SweetLife Diabetes Health Centers, LLC. All rights reserved. 9

10 And the last test, which I think everybody should get at least one time in their life, is a thyroid ultrasound test. Now, studies have shown that eighty to ninety percent of people with Hashimoto s will be positive for thyroid antibodies. But there are also those people with Hashimoto s who will not have these antibodies show up for whatever reason. And the way to find out if they have Hashimoto s is to do an ultrasound in that case. So just to summarize, the TSH test, TPO antibodies, TG antibodies, free T3 and free T4, as well as the thyroid ultrasound, they re going to be your top six tests for Hashimoto s. Dr. Mowll: Now, let me ask you a little bit more about these tests because I ve heard There s a couple of things I want to ask you about. One is the ranges of the thyroid antibodies because we ve tested a lot of people. And they re all over the board. Some are present, but normal. Well, within a normal range, I should say. Some are slightly over the normal range. And then once in a while, you get one that is 3,000 or something. And then, some labs don t even measure that high. So how do you figure out if it s a problem or not? Are any levels of antibodies an issue? Do you combine that with symptoms? How do you place your clinical judgment there in determining whether they should be treated or not, I guess? Dr. Wentz: So I would say that there s some schools of thought that, basically, circulating thyroid antibodies serve as some sort of a physiological function so that people might have some. But when you get above thirty-five is when most clinicians begin to get concerned. And, just so you know for the listeners at home, there s a few different reference ranges. But the most common one uses greater than thirty-five as an indication of being positive for thyroid antibodies. So anytime I see them above thirty-five is when I start wanting to work on getting them reduced. Something above one hundred Basically, the higher the antibodies, the greater your risk of developing hypothyroidism within the 2015 SweetLife Diabetes Health Centers, LLC. All rights reserved. 10

11 next one to five years. So it s the Thyroid Events Amsterdam score. And I have that on my website, Thyroid Pharmacist. You can search for THEA. And that s basically a risk assessment that if you look at how many relatives you have with hypothyroidism, what your TSH is like, as well as your thyroid antibodies, you can get a number that will help accurately predict what chance of developing hypothyroidism you have. So basically the more antibodies you have, the more aggressive the attack on the thyroid is the current school of thought. Dr. Mowll: Sure. That certainly makes sense to me. I don t know that that s agreed on conventionally completely, but certainly that makes sense from a functional perspective. The other thing that I think people come and tell me, patients come and tell me all the time is that their doctor will say something like Well, I think there s sort of this assumption or feeling that thyroid care is pretty easy. You just put the person on Synthroid and all is good. I ve even had patients who have a nodule. It s not cancerous. But the doctor says, Let s just take it out. And we ll just put you on Synthroid, as if it s no big deal. But clinically, to me, it seems like managing thyroid levels is one of the most challenging things because there s this range and sometimes it s a narrow range of when people feel their best. And trying to get the T4 and the T3 balanced and the thyroid antibodies and not pushing one too high versus the other, it seems to be quite a trick. So I wanted to get your perspective on that. Dr. Wentz: Sure. In conventional wisdom and when I was in pharmacy school, we just had this very short lecture on thyroid disorders. And Levothyroxine was the drug of choice. And they re super easy to treat, send them out the door, goodbye. And that s the conventional school of thought, unfortunately. But working as a pharmacist for many years and having been diagnosed myself and now working specifically with people with Hashimoto s is, sure, 2015 SweetLife Diabetes Health Centers, LLC. All rights reserved. 11

12 Synthroid works really well for a lot of people. Some people take it and all of their symptoms go away. They feel great. And it actually helps to reduce some of the attack on the thyroid gland because it makes it less visible to the immune system. But I may be biased. But I find that the majority of my clients actually don t have that experience. So some people are not able to properly convert Synthroid. The active ingredient of that is known as T4. In pharmacology, we call it a prodrug because it needs to be converted to something known as T3, which is the more biologically active hormone. And not everybody does that correctly. And not everybody does that efficiently. So we ll see a lot of times people will get on these medications. And their hair keeps falling out. And they just can t lose weight. So for those people, we would recommend doing something like a natural desiccated thyroid medication or a compounded thyroid medication. That just means T4 and T3. So as you can imagine, some of the active hormone is already in that medication. It s pre-converted. So the person can just take it and start feeling better right away. And I ve just seen miracle stories from people who switched on to this medication, which has fallen out of favor because it s an older medication. It s available as a generic. And back in the day when they first developed it, they were looking at the iodine content in it, rather than the thyroxine content. So you weren t getting different batches. You were taking one batch of medications and you were hyperthyroid. The next batch you d be hypothyroid. All of that has been taken care of now. So now the dosages are very stable. But, yeah, so taking medication like Armour or WP Thyroid or taking something like a compounded T4, T3 can be very helpful for a lot of people. The other part of this and this is sort of my area of passion is that a lot of people will be told that they have a sluggish thyroid. They ll be given medications. And then they ll be sent off until a year, five years, ten years, twenty years down the line, they develop another autoimmune condition like 2015 SweetLife Diabetes Health Centers, LLC. All rights reserved. 12

13 lupus or rheumatoid arthritis because they didn t address the root cause of the Hashimoto s. So conventional medicine basically says, Okay, so you ve got this problem. Here s a drug for it. Goodbye. That should solve all your problems. But really the medications, as important as they are in people who have an underactive thyroid, really just masks the symptoms of the underlying attack on the thyroid. And I think this is part of the reason why a lot of doctors won t test you for Hashimoto s because once you find out that your own body is attacking your thyroid, then how do I stop this attack on my thyroid? And this is what I said when I found out I had an autoimmune condition. And this has been the focus of my work is trying to figure out how do we stop your body from attacking itself? How do we clear that damage? Can we reverse this condition? Dr. Mowll: Good segue. So let s talk a little bit about that. How do you, number one, stop the attack on the thyroid? How do you control autoimmune disease? And then what do you think s the best way to balance the thyroid levels, in addition to obviously, thyroid replacement, if necessary? Dr. Wentz: So one of the big things that always triggers autoimmune disease and just about every disease that you could probably think of is stress. So one important thing that I recommend for people with Hashimoto s is try to reduce the stress in your life. So whatever is causing you stress that s not necessary, try to cut it out, also start working on yourself. Because sometimes the stress that we take on as our own, the drama in other people s lives, that s just not necessary. Or maybe looking at a person as they re driving a car and they cut you off and you start getting really angry. And your stress hormones are coming up. Try to think of the positives, keep a gratitude journal, start meditating, start doing yoga, do some running, whatever you can do to help manage the stress because stress is not helping you with anything SweetLife Diabetes Health Centers, LLC. All rights reserved. 13

14 Most people are not going to be able to a hundred percent completely reverse their autoimmune conditions by letting go of stress. But some people have. So just the power of having a good mindset is so important. So that s a good place to start is try to be grateful for where you are, who you are, who you have in your life and work on meditation, work on trying to reduce the stress in your life. Another source of stress, actually, comes from food. So looking at your diet is one of the very first things I recommend with people with Hashimoto s, balancing your blood sugar is very, very important, not just for Hashimoto s, but also for diabetes. So a lot of my symptoms of anxiety and hair loss and palpitations, I was able to stabilize those symptoms by stabilizing my blood sugar. Blood sugar swings actually cause an uprise in thyroid antibodies. It s really quite amazing the connection between those two. So what I recommend is you can do a green smoothie for breakfast that has plenty of good fats and plenty of protein. I have a recipe on my website. And you want to cut down the starchy foods. You want to cut down all of these things, even fruit. If you re somebody that s drinking a lot of fruit juice for breakfast, that could be causing a lot of blood sugar swings. And I m sure, Brian, you re going to be focusing on that a lot. So the other things that I do and that I recommend is looking at your food sensitivities and the foods that are causing your immune system to react. So celiac disease has been known as the great imitator. And what that means is that when somebody has celiac disease and when they re eating gluten, their body recognizes it as a foreign substance and begins to launch an attack against the gluten. And sometimes this results in an attack and anything that looks like the gluten, which sometimes is the thyroid gland. One of the very first articles I came across for lifestyle interventions that can reduce or eliminate thyroid disease is looking at Hashimoto s and people with celiac disease. So people who had subclinical hypothyroidism and Hashimoto s were put on a gluten-free diet. About three months after that, 2015 SweetLife Diabetes Health Centers, LLC. All rights reserved. 14

15 these people twenty percent of them were actually able to eliminate their thyroid antibodies and their thyroid function returned to normal. And that wasn t really a beginning of my journey. But what I found in my work is that it s not just people with celiac disease, but most people with autoimmunity and most people with Hashimoto s actually do better on a gluten-free diet. So their thyroid antibodies will go down. A lot of their symptoms will go away. So I had chronic acid reflux. That went away once I went gluten-free. I don t have celiac disease. And I don t have the horrible reaction that people with celiac disease do. But my thyroid numbers look better and I feel much better off of gluten. And that seems to be the case for a lot of people with Hashimoto s. Now, gluten is not the only triggering food. Another big food is actually dairy. And I ve seen studies with type I diabetes that have shown that dairy can be a trigger for it. There are not a lot of studies for Hashimoto s yet. But anecdotally this has been a really big trigger for people with Hashimoto s, myself, as well. So I used to have carpal tunnel in both arms and bloating and irritable bowel syndrome that went away after I cut the dairy out of my diet. Some of the other triggers are going to be eggs, grains, nightshades, which include tomatoes and peppers and potatoes, nuts and seeds. And looking at doing something like food sensitivity testing, I d recommend Alletess Labs. Or an elimination diet can be very, very helpful in figuring out your food triggers. I ve seen people who have been able to completely reverse their condition by trying a diet like a gluten-free, dairy-free, soy-free diet, a diet like the Paleo diet or Autoimmune Paleo Diet. For some people this is all they need to do is really take care of their nutrition. And that reverses their condition. And I forgot one. So soy is a really big one. So that s like poison to the thyroid gland SweetLife Diabetes Health Centers, LLC. All rights reserved. 15

16 The other thing that I recommend looking at is whether or not you have nutrient deficiencies. Some of the bigger nutrient deficiencies are going to be selenium. Taking selenium supplements has shown to reduce thyroid antibodies by about fifty percent over a ninety-day course if taking 200 micrograms of selenium. And that can help with the hair loss and the anxiety a lot, as well as the fatigue. The other big deficiency and this was kind of my a-ha moment is actually stomach acid. So I was diagnosed with acid reflux as many people with Hashimoto s are. When I used to work in the pharmacy, it was like, Here are the thyroid pills. Here s the Nexium. Let s just put them next to each other because we dispense them so commonly. And what is happening actually And there s a lot of studies to back this up. I don t talk studies in my talk, but they re all in my book. Hypothyroidism actually results in having no stomach acid or low stomach acid, which means that you re not properly breaking down your food, which means that you then might have some of these symptoms that look like stomach acid because you re going to be regurgitating things and also results in you getting more food sensitivities so taking something that helps support stomach acid. I like a supplement called betaine with pepsin can make a dramatic difference. For me, I went from being on thyroid meds sleeping for ten hours a night, which was, of course, an improvement over my twelve, to waking up brighteyed and bushy-tailed after eight hours of sleep just on the betaine with pepsin and just having so much more energy. I have information about how to take this supplement on my website. If you go to ThyroidPharmacist.com/gift, you can get that information. And so, those are some of the two biggest things. Looking at your adrenals So we, of course, talked about stress and blood sugar and any kind of food sensitivities that may be setting off your adrenals. The other thing that is often commonly found in people with Hashimoto s so I ll say if you do the diet thing for ninety days and you get better, but you re 2015 SweetLife Diabetes Health Centers, LLC. All rights reserved. 16

17 not in remission, start looking at your gut and whether or not you have infections in your body. So there s this autoimmune theory known as molecular mimicry, which basically states that our immune system will react to a bacteria or virus that we have and will launch an attack on those bacteria or virus or whatever pathogen you might have. And when that pathogen might have a protein sequence that s similar to a part of our body like the thyroid gland, then your system will also mistakenly attack that body part. So this is known as molecular mimicry. And there are a variety of different infections that have been implicated with triggering Hashimoto s. Epstein-Barr virus, H. pylori are two of the most wellknown ones. As well as Yersinia is another one that s been implicated in both Hashimoto s and Graves disease. And a lot of times, I ve seen people who treat these infections and they get into remission from Hashimoto s. So they ll work with either their conventional medical doctors who are a bit more open-minded. Or they ll work with their functional practitioners and will get either on antibiotics or herbal [inaudible] these infections, which then results in the body no longer attacking themselves. The other thing that is very common is an impaired ability to get rid of toxins. So there s a specific gene mutation that a lot of people have, MTHFR gene. And, basically, it makes us not be able to get rid of toxins as quickly. So what I recommend is taking methylated B vitamins. So methylfolate would be one example and not eating a lot of processed foods that add folic acid in because in those cases, the people often cannot metabolize that folic acid anyway. And that s it in a nutshell. And I have a lot of information on my website and in my book, I think it breaks things down because if this is seeming overwhelming to you, I really encourage you to really educate yourself and work with a functional practitioner to get to the root cause SweetLife Diabetes Health Centers, LLC. All rights reserved. 17

18 Dr. Mowll: Yeah, it s incredible information. You have a lot of that laid out on the home page of your website. And as I was looking at that, I was thinking, Boy, this is a prescription for just about any chronic disease, including diabetes. So you ve got the six steps listed. Find the correct diagnosis, which in diabetes, you d think would be open and closed, but many times its not. And it s not just knowing it of diabetes. It s understanding the root cause of why you can t control your blood sugar because there s many, many reasons for that. Medication management, which I think, again, in diabetes is a great starting place. But it s not a great place to end. So you ve got to be able to get your blood sugar down, but then heal the root cause, heal the underlying mechanism. And then, hopefully, you can free yourself from the medication as much as possible. Food pharmacology which I love that word we always say food is the best medicine and getting your diet right and your foods right is essential. Balancing the adrenals, and I would add thyroid to that with diabetes for obvious reasons. Healing the gut. There seems to be a central theme throughout this summit. And it s diabetes and the gut because there s been so many studies over the last couple of years about the connection between the gut microbiome and insulin resistance and diabetes and, of course, how impaired gut health can trigger type I diabetes. So that s essentially as you just talked about. And then removing toxins so helping the body to cleanse itself on a cellular level through those detoxification pathways like methylation and the others to allow the body to be able to function normally and do its job, which regulating blood sugar is one of those. So that s great information. That s all available at ThyroidPharmacist.com, right on your website. One last thing I wanted to ask you before we wrap up. Again, there s a common thing that I see with people with type II diabetes and type I who are 2015 SweetLife Diabetes Health Centers, LLC. All rights reserved. 18

19 having a hard time regulating their blood sugar. Maybe their lipids are coming up a little too high. And that s that low T3. When you see low T3, what is your recommendation? Is it just a medication fix? Or is there something that they can do to help improve T3 levels? Dr. Wentz: Yeah. Sure. So there s actually a few different root causes for low T3, as well. Definitely taking a T3-containing medication can be helpful in the short term. Looking at reasons why they re not properly making enough T3, a lot of times it s stress. So stress causes us to make more reverse T3. So I like to think of T3 as the go and the reverse T3 as the stop. So sometimes your body will be making enough. But your body will start converting it more to the reverse T3 and saying, Okay, let s not get carried away. We need to slow down a bit. So looking at stress is a really big factor for adrenal function, as well as some nutrient deficiencies. So zinc is one particular nutrient that it can be commonly implicated with not properly converting, as well as selenium, but really looking at the whole picture and trying to figure out what is causing that person s T3 to be low is something I recommend. And, of course, whenever people have diabetes, they re also going to be at greater risk for having lipid abnormalities with increased cholesterol, increased triglycerides. And actually thyroid disorders, when you have hypothyroidism, the same thing happens. So if you have elevated LDL cholesterol, elevated triglycerides, you really need to look at your thyroid and make sure that it s properly optimized and managed because you may be able to get those normalized just by getting on the right dosage and the right type of thyroid medication or doing some of these functional medicine things that don t work overnight because they re not magic pills. But they can make a tremendous amount of difference in the long run. Dr. Mowll: Absolutely. Well, Izabella, this has been incredible! So first of all, I want to just thank you for taking the time to do this and for being part of The Diabetes Summit SweetLife Diabetes Health Centers, LLC. All rights reserved. 19

20 Dr. Wentz: Well, thank you so much, Brian, for having me. And thank you for doing this. I m very passionate about diabetes. And I m so glad that you re getting this message out to the world. Dr. Mowll: Thank you. And could you let people know the name of your book, how to get that because that is just a great resource of incredible information and maybe mention your website again and anything else that you think would be powerful or important for people to check out. Dr. Wentz: Absolutely! So my book has a very long title. It s called Hashimoto s Thyroiditis: Lifestyle Interventions for Finding and Treating the Root Cause. And you can find it on Amazon just by searching for thyroid or Izabella Wentz or Hashimoto s. You ll find that book right there. My website is ThyroidPharmacist.com. And I also have a free book chapter for you guys if you go to ThyroidPharmacist.com/gift. And I also have a glutenfree quick start guide on there for you guys because I know, personally, I made so many mistakes going gluten-free that I don t want the same thing to happen to you. And then I have some gluten-free nutrient-dense recipes on there. And that s going to be ThyroidPharmacist.com/gift. Dr. Mowll: All right. Great. So definitely go check out those resources at ThyroidPharmacist.com. Izabella, again, thank you for spending the time with us. Thank all of you for being with us for The 2015 Diabetes Summit. Stay tuned for the next session. And remember to keep climbing and to never give up. Thanks guys! 2015 SweetLife Diabetes Health Centers, LLC. All rights reserved. 20