Episode 77: Natural Medicine Solutions for Hypothyroidism You Need to Know with Dr. Kevin Passero, ND
Show Summary:
Thyroid disorders are one of the most pervasive conditions in the US, contributing to symptoms of fatigue, stubborn weight, chronic constipation, and hair loss.
Today we are joined by Dr. Kevin Passero to dive into the world of thyroid health. We are going to discuss why thyroid disorders are commonly underdiagnosed, symptoms of different thyroid conditions, and how to heal from thyroid conditions using lifestyle medicine.
Dr. Passero is a Naturopathic Doctor who focuses on an individualized approach to medicine. His goal is to help people uncover the answers as to why their body is in distress and find the solutions necessary to restore optimal health.’
If you or a loved one is dealing with a thyroid condition and would like to understand root causes and lifestyle medicine solutions, this conversation is for you.
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Full Transcript:
Dr. Kevin Passero:
I'm looking at a person from a standpoint beyond their thyroid, like you can look at the gland is dysfunctional, but you have to understand that there's a huge influence of thyroid hormone balancing that's occurring in the other cells of the body specifically as a result of the different stressors that that person is under. So looking at their digestive and gut health, looking at their nutrition and then the the inflammation burden that their body is under certain medications that they're on these things are critical.
Dr. Andrew Wong:
thyroid disorders are one of the most pervasive conditions in the United States, contributing to symptoms of fatigue, weight gain, chronic constipation, irregular periods, brain fog, hair loss, and much more. Today we're joined by Dr. Kevin Passero: to dive into the world of thyroid health. We are going to discuss why thyroid disorders are commonly under diagnosed symptoms of different thyroid conditions, and how to heal from thyroid conditions using lifestyle and Integrative Medicine. Dr. Pissarro is a licensed naturopathic doctor who focuses on an individualized approach to medical care. His goal is to help people uncover the answers as to why their body is in distress, and find the solutions necessary to restore optimal health. And he is an expert in the diagnosis and treatment of thyroid disorders. My name is Dr. Andrew Wong:, co founder of capital Integrative Health. This is a podcast that is dedicated to transforming the consciousness around what it means to be healthy, and understanding the root causes of both disease and wellness. If you or a loved one is dealing with a thyroid condition, and would like to understand root causes and natural medicine solutions, this conversation is for you. Welcome Kevin to the CH podcast. So glad to see you and have you on today.
Dr. Kevin Passero:
Yeah, thanks for having me, Andy. Appreciate it.
Dr. Andrew Wong:
So yeah, it's it's been a while since we've talked to them Person of the pandemic, you know, it's happened and everything but you know, you've been practicing naturopathic medicine now for for many years. Let's talk first about before we get into our topic today, we're just thyroid health, what drew you to become a naturopathic doctor? And what do you enjoy most about what you do?
Dr. Kevin Passero:
Hmm, well, I think medicine was always going to be a path I was going to go down come from a family of dentists, so got very interested in just all different forms of medicine. And then when I started to narrow down on what kind of training I wanted to get, like dental school, like the traditional schools, and my undergraduate training was pretty steeped in environmental biology was really my major. So pre med track, but it really started to introduce me to the idea of there being a synergy in nature, between plants and animals, and the ideas of naturopathic medicine and utilizing that synergy in nature to support health became incredibly inspiring for me. And so when it was time to choose a path, the path I chose was one that focused the fundamentals of training, specifically, based on that synergy, and naturopathic physicians and naturopathic training is really the best training out there, if that's where your fundamental wants fundamental principles want to be. So that's what I chose.
Dr. Andrew Wong:
Awesome. Thanks for the explanation story. The other the other thing is that, you know, just kind of segue to thyroid health, you know, as you know, as we're humans and humans are animals, and we know, we're part of nature, you know, we're kind of always interacting interfacing with the rest of nature. And you know, thyroid is one of those really key organs in our in our bodies that is going to tell us how aligned we are with with the natural world in a way just based on thyroid health.
Dr. Kevin Passero:
Oh, definitely. And, you know, that's some of the questions we'll talk about today. You know, I think when you think about thyroid health, you have to expand your perception beyond just the gland and just looking at this one area of the body because thyroid health is regulated by every cell in your body to a large degree. So it really is a good barometer, in many ways of how much homeostasis or how balanced you are in your environment, whether that be your nutritional environment, physical environment, because, you know, stress toxins, as we'll talk about all play a major role in thyroid balance.
Dr. Andrew Wong:
So I think you're saying something revolutionary that we've said a couple of times, it's a podcast, but essentially, the body is connected. There's no, there's not like a silo in the body between different organs.
Dr. Kevin Passero:
Yeah, it's easy to think about it that way. Right? It creates a very mechanistic, easy to conceptualize idea that this one system and this one system and this one system, but in reality, when you look at really getting people well and trying to be a provider that can create treatment paths and roadmaps to the recovery. You start to quickly learn that they're all connected. did and then I mean, when you start digging in the medical literature, all the research is validating it. It's just not actually what gets primarily practiced in primarily, you know, in mainstream models. So it's not that it's not getting practices. It's not scientifically validated. It just, it's not convenient, takes a lot of time takes a lot of digging, and it mashes everybody together. And that's a difficult way to look at things.
Dr. Andrew Wong:
Yeah, it's not convenience medicine for sure. What does the thyroid do in our body? That's kind of go to some basic questions first, and then maybe some common, like hypo versus hyperthyroid. What does that mean to people?
Dr. Kevin Passero:
Yeah. So I mean, thyroid sets metabolism, basically, I mean, thyroid hormone is what triggers increased activity, it triggers our DNA to upregulate, the activity of our mitochondria, which makes something called ATP, which drives every single cellular reaction on our body. So thyroid hormone is the key for driving metabolism. And metabolism isn't just about losing weight, right? metabolic activity needs to be present in every cell in order for optimal function. So thinking clearly requires the appropriate metabolic energy of your neurons in your brain. Having good bone density requires proper metabolic energy of the cells of your bone. proper digestion requires adequate metabolic energy that cells your digestive system. So metabolism, we have to think about is just you know, the ability of a cell to function properly. Now in hypothyroidism, the thyroid function either by the gland or you know, the primary, secondary, tertiary, these different levels are in the cells, it's down regulated, something's not working correctly, and there's not enough stimulation that is triggering metabolism. So people tend to feel low metabolism which yes, equals weight gain. But there's a whole host of other super common symptoms, right there's brain fog because the brain isn't getting metabolic energy, constipation, low body temperature, because metabolic energy regulates our body temperature. So when we get cold and temperature drops, we got to keep are very few people keep their house at 98.6 degrees Celsius Fahrenheit, right so any drop below that our body has to make energy in order to increase thermogenesis and keep our body temperature up. So people that are hypothyroidism hyper have hope I have hypothyroidism and have low body temperature, constipation. It can be dry skin, dry hair, brittle nails, you know, weight gain, fatigue, brain fog, we've talked about these. That's the classic picture and that's the predominant form of thyroid dysfunction that we see. Hyper on the other side, metabolism is revved up. So typically, you'll see people with weight loss diarrhea, so increased bowel motility, sweating. They feel way overstimulated, I guess if you had to explain kind of what it felt like I just tell people it kind of sort of feels like if you were to go into a coffee shop and take like five shots of espresso. There's usually some energy edginess jitteriness. Just feeling a little bit overstimulated.
Dr. Andrew Wong:
Except these are five shots we probably don't want to take because they have other negative downstream consequences, right?
Dr. Kevin Passero:
Oh, definitely. Yeah, I mean, you know, you don't want to overdose on caffeine, right. But thyroid hormone plays a lot of other important regulatory roles, like on your cardiac function, particularly, your heart tissue. And your cardiac system is very unique in that it requires it doesn't do a lot of internal conversion of t 43. It's very, very sensitive. So irregularities in thyroid hormone can have a very profound effect on the heart and the cardiovascular system. So you have this is not something you really want to mess with. It's easy to tinker with, in regulating hormone levels and prescribing thyroid hormones and trying to tinker with things but you do have to be careful and you do have to look at it very holistically.
Dr. Andrew Wong:
So let's go to that's a great segue into the next question, which is what is the difference between health conventional medicine versus a more integrative functional naturopathic medical approach? You know, how do we deal with thyroid?
Dr. Kevin Passero:
Yeah, well, it relates back to like the question that you sort of just asked me about, you know, things being very straightforward and the body systems not looking at being connected in more traditional models, the traditional conventional approach to thyroid management and diagnosis, very linear. There's the pituitary gland in your brain, which releases thyroid stimulating hormone or TSH, and that triggers your thyroid to make more or less hormone, the more TSH the more thyroid hormones being produced, and there's a negative feedback loop. So if the TSH level is elevated, it means that the brain is calling for more thyroid hormone to be produced. And in traditional medicine, TSH is really the main diagnostic value that's used to determine whether or not somebody is in a in a hypo thyroid state, a euthyroid state which is sort of balanced or normal or a hyperthyroid state. And the problem in here lies in that TSH is not a great marker for looking at cellular levels of thyroid balance outside of the brain. The pituitary has some very specialized functions that make it much more sensitive to thyroid hormones that are not present in our cells. And we know that there can be major changes in the cellular levels of thyroid hormone with a normal TSH. And that can create a lot of misdiagnosis under diagnosis over diagnosis and that linear model really breaks down when it comes to looking at people holistically. Now the treatment option in traditional medicine is also very linear. If somebody needs treatment, they get synthetic tea for so brand name levothyroxine is generic their Synthroid, which is branded, Tierra sent, which is branded, they're all the same class and medication ideas is that well, the thyroid gland isn't doing what it's supposed to do, we give some supplemental hormone, we have mechanisms in our cells that have the ability to convert t 43. But there's a lack of understanding or attention paid to the fact that different physiological circumstances going on in somebody's body may be dramatically affecting the activity of those enzymes. And you're only giving one form of hormone, which is a pre hormone T for is actually a pre hormone that the body decides to convert into active thyroid hormone, which is T three. Some people do great on that, but a lot of people, some of you out there listening may have recognized this and Dr. Wong and his team may have helped you fixed it. But some people are diagnosed with hypothyroidism put on the medication the TSH normalizes because the brain systems for sensing thyroid hormone are very sensitive and respond very quickly. But everything still feels hypothyroid the brain fog didn't go away, the weight gain didn't stop, the body temperature never came up, the constipation didn't resolve, the dry skin is still dry, the fatigue is still present, but the labs look normal. And they're told by their prescribing doctor endocrinologist or other primary that, hey, listen, we've corrected the thyroid imbalance, we've put you on the right dose of medication, any residual symptoms that you're having, are due to something else, you need to eat less, you need to exercise more, maybe we should refer you to psychiatry, maybe you should try an antidepressant. I don't know what it is, but I've done my job. Thank you very much. The holistic model really needs to look at a much broader view of diagnostics. So you have to number one go outside of the TSH paradigm. In order to evaluate the thyroid, you need to look at the T four levels, the T three levels, the free T four levels, the free T three levels are really important thyroid hormone called reverse T three, which can affect cellular activity, you need to look for the antibodies to understand that there's an autoimmune reaction occurring or not, which sometimes conventional doctors don't do. So again, we're building this holistic model. There's other things to look at too, like adrenal hormones, sex hormones, gut health, signs of hypoxia, like sleep apnea, all these things can dramatically shift the thyroid hormone balance in your body. And so we're starting to look at it from a body wide perspective. Now with treatment. Of course, if you find things in that larger evaluation, got problems in a holistic model, you're going to treat it if you find evidence of hypoxia, you're going to work on the sleep apnea. If you find other markers of inflammation, you're going to work on getting those down. All of these things are important factors. But when it comes to also just something as simple, because the reality is a lot of people do need some thyroid hormone replacement depending on what kind of hypothyroidism condition they have. You still need to understand that different people may need different combinations of hormone replacement and you have to also be skilled, not just in the diagnosis and evaluation. But in the proper administration and regulation of a variety of thyroid hormones, none of which are the right answer. The right answer. what's right or wrong isn't what Holistic Medicine says versus allopathic medicine. what's right or wrong is what works for the person that you're trying to help. And that is individual based on their genetics based on a whole bunch of different things. So you sometimes see for works great, like Synthroid or terrorist scent, or levothyroxine. Sometimes you need to combine some T four with T three. Sometimes you need to use just T three by itself. Sometimes you need to use desiccated thyroid extract, there are all these different options and to really do a good job. You have to be somewhat masterful and understanding them all because they all work a little bit differently and they all have to be dosed a little bit differently, and they all affect the labs a little bit differently. So that's the overview of a more very linear conventional to a much more holistic minded integrative approach.
Dr. Andrew Wong:
Thank you, Kevin. It's almost like if we're listening to a symphony, and we heard the tuba, right, and you heard that one note versus like, oh, there's actually the violin and the harp and all these other percussion instruments, the thyroid is part of that hormone, Symphony readily. And of course, that's also affected by like you said, the gut and the immune system like so many different other definitely systems. I did have a question about intracellular thyroid hormone function. There was a machine I tried it for a while and I couldn't tell if it was working or not called the thyroid flex, which I think measure breaker, radiologists, radiologists, we flex time, basically. I guess, I'm wondering if you know, we know about TSH, of course, and conventional and then you know, we're adding on course, like you said, t 43, Roversi, three antibodies. How do you figure out where or how to measure intracellular thyroid, thyroid hormone levels, because even those serum levels, even those more advanced, you know, levels that we often test and the kind of medicine that both you and I practice? Yeah. How do you how do you figure out, you know, intracellular levels?
Dr. Kevin Passero:
No, I mean, it's a great, it's a great point. And that is, so key intracellular levels, because that's where the thyroid hormone has to act. Yeah, right. Hormones interesting. And not only does it have to get through the outside of the cell membrane, it actually has its action in the nucleus. So it has to go through a binding and absorption process through the outer cell membrane. And unlike most other all other hormones, it actually has to bind them to the nuclear membrane. So very, very specific. And what's going on inside that cell is really important. Because we know Andy, like, I could be sitting here inside this room where I'm doing this interview, and it could be a comfortable 73 degrees, right, and I call a friend and they say, Oh, you're in Maryland, I heard it's freezing in Maryland, it's only 20 degrees, they're gonna say, Well, I'm perfectly comfortable. Right inside my cell inside my house, it's really warm. But right outside that window, it's freezing cold out. And that can be the exact scenario of what's happening inside the cell, versus what's happening inside the bloodstream. And like you pointed out every single test that I mentioned, all these super fancy integrative, you know, holistic, advanced thyroid evaluations are still only measuring blood levels, not intracellular, and to date, I do not know of any reliable and clinically validated tests or tools available for accurately measuring intracellular hormone levels. Now, the good news is, is that the good Lord gave us some very important gifts as physicians, and those are our ears, and our eyes and our minds and our hearts. And I know that we can't practice all medicine just based on how people feel. But if you really tune in and you listen to people, and you do a good job safely monitoring the labs and safely working with different therapies, you can oftentimes tell when intracellular levels of thyroid hormone have balanced out, because you'll finally see the clinical resolution of the problems that the person is presenting with. So hopefully in time, we will come up with tests and ways to really accurately assess intracellular levels. But I don't think we have I used to do breakout radiologists testing on reflexes all the time, and Achilles tendons are even considered to be more accurate. That was the one that I was taught. Before doctors had blood serum serology to measure hypo and hyperthyroidism, they diagnosed it based on the Achilles tendon reflex. And by the reaction of the flex and the relaxed, you could tell if somebody was low in T three, and it was pretty accurate. I don't do it that much anymore, because I also found that you could ascertain very similar results by just being a good listening attentive clinician.
Dr. Andrew Wong:
So Kevin, I think what you're saying is that you and I still, for a while, we still have jobs still.
Dr. Kevin Passero:
AI for now. Yeah. Until AIS take over. And
Dr. Andrew Wong:
it makes sense to listen to the patient actually physically examine the patient. I think in COVID times, I'm kind of even more grateful now to be able to examine patients. You know, I think I took that for granted before.
Dr. Kevin Passero:
Yeah, it's definitely nice to be in person. And you just bring up a great point. That is what people struggling with thyroid issues need to understand. Because what they're told over and over again, is they look at their numbers. And then they wonder what's going on. And they come in and talk to me about all the time, the well educated thyroid patients with Dr. Becerra, what's, what about my ratio of reverse T three to T three and my ratio of free T three to total T three. And I think there are a lot of interesting calculations that can help you understand some things, but sometimes you just need to take a step back and just think logically and think clearly and use the intuitive tools that were given to us to really look at and connect with somebody in the context of some of the different lab work. But people need to understand that even if their labs are not even if their labs look perfect, and they're not feeling good, we need to explore what else is going on.
Dr. Andrew Wong:
I love what that just to emphasize that point you made Kevin is that you know, all these labs that were running all these fancy integrative labs, etc, have to be put in a clinical context, because at the end of the day, it's the patient that matters.
Dr. Kevin Passero:
Yep. 100%. And that's, you know, I mean, hopefully, we'll get into it. But that, that really becomes the crux of the issue. And that becomes the crux of a lot of confusion. Some thyroid cases are very straightforward person was diagnosed, they're hypothyroid, they were put on synthetic T for they never felt good, we switch them over to something else, they don't have a lot of pre existing issues. And boom, they respond beautifully. Every single resolves, and they feel great. And then there's a lot of other people that are more complex, they have other issues going on in their body that are preventing the optimal balance of tissue, thyroid hormone. And that's where a lot of the boat gets missed. And people get very focused on their hypothyroid diagnosis, and all the different things related to that not looking at these other factors in their body that play a major role on what's going on cellularly with thyroid hormone balance, because we know that yeah, go ahead. Oh, go ahead, that's okay.
Well, I mean, we just The research is clear that like stress, any kind of stress, infection, inflammation, toxins, like it dramatically impacts the how the enzymes in the body work with thyroid hormone conversion. And we know that there's a condition when somebody is in starvation, or when they have a very severe disease not related to the thyroid, you'll see this down regulation of thyroid hormone in the cells. It's a known physiological reaction documented every single endocrinology textbook. And it has to do with the protection mechanism, particularly we know with starvation, right, if the body is starving, and there's not enough food around, it needs to slow down the metabolic rate. So we're not burning as much fuel so we can survive the period of famine for longer. Now, the interesting part and is that the part that gets down regulated in the cells, the deiodinase, enzymes that get down regulating the cells, the D one i Odonates enzymes, they prevent that conversion of T four to T three, the brain in the pituitary uses a different di Miss enzyme that doesn't get shut down during starvation. So the brain and the pituitary still thinks that high hormone levels everywhere are fine, but they're dropping in the periphery. So what you see is basically, relatively normal labs on serology, or maybe the T four and T three are a little bit on the lower end with the T four is normal, and the T three is dropping, but the TSH is normal. And the expectation is that if the system is under functioning, the feedback loop would make the TSH go up. So that's why stress. And I'm not just talking about oh, what's going on with my bank account, and COVID and politics and all that kind of stuff. There's a lot of physiological stress that our bodies face in the modern age, that will significantly trigger that same reaction and create a cellular functional hypothyroidism. And it becomes very confusing because you'll see people their TSH is almost looking hyper, but their hormone levels are low. What's going on? You know, it's like, we have to look outside that box.
Dr. Andrew Wong:
Okay, Kevin, what are some of those physiological stressors that we're facing now?
Dr. Kevin Passero:
Right, so I mean, you know, infection is a big one. So all sorts of low grade infections, toxins, hypoxia, inflammation is probably the biggest one because most people are just pretty inflamed. If they're not living a really healthy lifestyle. The number one Mediator of inflammation in our body that I found is nutrition and what you decide to put in your mouth, who will come into my clinic doesn't matter what health condition they have, thyroid issue, arthritis issues, other autoimmune issues, infection issues. I mean, you name it, digestive issues, if we can really clean up their diet and get them on a super healthy, clean diet. inflammation levels just drop. They drop physically, the person feels less inflamed, but I see it on the labs too. And we measure markers on the labs. So gut, so when we talk about infection, there's all these different layers of it that we can talk about. gut microbiome issues play a role. I mean, it goes on and on, right? There's a lot of different stressors, and we can't control all of them. But if we are intentional about the way that we choose to live our lives, and we seek out guidance and help from providers that are educated in looking for other sources of inflammation. We can start tackling this doesn't mean you have to live in some bubble where there's no toxins, no news, no EMF, no this no that like, we can't live like that. Right. Our bodies are robust enough that if you just give your body a chance, it will respond in a way that is so powerful that most people can rebalance out physiologically enough to the degree agree that they can feel pretty darn good on a day to day basis.
Dr. Andrew Wong:
That's awesome. Thank you so much, Kevin. And in terms of thyroid health, what nutrients are important to, you know, give our bodies enough push to optimize that thyroid health care? Yeah. attrition or it could be my chance, depending on where you're gonna go.
Dr. Kevin Passero:
Well, I mean, when people think nutrients, of course, they you know, we're a very pop a pill culture, right. And, you know, people think well, what supplements should I take, and there are some that are useful, Selenium super useful, those enzymes that convert T four to T three are all selenium dependent and selenium helps reduce the oxidative burst that happens in the thyroid when iodine gets converted to an active form. So there's all sorts of really good benefits of selenium, we'll see a lot of research a couple 100 micrograms of selenium can reduce thyroid antibodies and improve thyroid function. Iodine is critically important. Iodine can be a little tricky, like too much is not good for your thyroid and not enough is not good for your thyroid. So I really don't recommend people go out and just start taking a bunch of iodine supplementation. There's a lot of doctors and books out there that promote high dose iodine therapy, that will it will solve all thyroid problems. And I strictly disagree with that just based on my 20 years of clinical observation and working with patients and observing how people do, it seems a bit unpredictable, who's going to have a good response and who's not, which means that it should be approached with some caution doesn't mean it's bad or good, but you have to be careful about people selling books or selling things that are promoting a mono solution for everyone. But it is an incredibly important nutrient. A thyroid hormone, T four is a tyrosine, which is another incredibly important amino acid with four iodine attached to it. And T three happens when those deodorants enzymes just pull off an iodine and you have a tyrosine with three iodine is on it. So iodine is incredibly important. Diet is a great source. So doesn't come from many places like except for from the sea. So seaweed, fish, you know, wild fish can have iodine sources, maybe not a bad idea, since everybody loves sea salt to maybe get an icy salt for a little bit. It really just depends on the situation. And then as I talked about tyrosine and then I really think glutathione is an underutilized nutrients specifically for thyroid health. Because if you understand how the thyroid gland works, and how it pieces together these building blocks of tyrosine and iodine into actual thyroid hormone in the thyroid cells, it's based on a reaction that creates a large burst of oxidative stress peroxides, basically, and oxygen free radicals. And that in this day and age where we're under so many other influences that raise oxidative stress and aren't under a lot of influences that lower oxidative stress. Glutathione can be a very important nutrient for helping to lower that oxidative stress burden and support thyroid function in addition to have been an amazing support for overall detoxification. And we know for sure that a lot of the major industrial chemicals and toxins in our culture, things in plastics and flame retardants and pesticides and herbicides, they are endocrine disruptors, and many of them are specifically focused on disruption related to the thyroid gland. So detoxification is also very, very important.
Dr. Andrew Wong:
You know, about gut, I'm sorry, we always talked about in medicine we do about how the thyroid is like the canary in the coal mine when you're talking about, you know, detox and toxins that might be affecting different organs that thyroid is so vulnerable to these toxins and may be affected. First, more than other organs.
Dr. Kevin Passero:
Very vulnerable. Very, very sensitive to a lot of these different toxins. And, I mean, I think our endocrine system in general. In my opinion, hormones work, they're incredibly fine tuned messages to the cells. So it's like, you know, hitting the tuning fork and hearing the right pitch, it's like if there's disruption and inflammation and imbalance, that clear signal can't come through. And if those that clear signal can't come through, that's the equivalent of those hormones not being able to do what they need to do. And when we get inflammation and stress and all these things building up. It's like trying to hear a pitch of a tuning fork with all this other noise around you, you're never going to pick it up. So it has to be very clear and very precise.
Dr. Andrew Wong:
So many, good. Oh, sorry. Go ahead.
Dr. Kevin Passero:
I was gonna say from a nutrition perspective, you know, that has to be fundamental and that's got to be something that everybody you know, needs to look at. When it comes to thyroid health. You have to eat a diet that reduces inflammation and increases nutrients city and provides a lot of antioxidants. So it's like, we could spend hours and hours talking about diet but it's like pulling out the major inflammatory foods, the high allergen foods, the high sugar foods, the highly processed foods and putting in The foods that the human body was made to thrive on, basically starting with plants as your fundamental building block of everything. Because that builds not just a diet that is sort of lower in caloric burden and much higher in phytonutrients, vital vitamins, minerals and phytochemicals, but also really high in the appropriate amounts of fiber that are critical for establishing the gut micro flora, which is a huge component of thyroid health.
Dr. Andrew Wong:
Alright, so microbiome and that that kind of brings us to segue with talking about a scientist that was from Japan called Hashimotos. A Hashimoto, I think, discovered what's called now Hashimotos thyroiditis or autoimmune hypothyroidism, where there's a type of hypothyroidism or low thyroid where there's an autoimmune attack going on. Can we talk about a little bit about Hashimotos? I'd love to also hear your thoughts about about gluten and dairy in relation to Hashimoto. Yeah,
Dr. Kevin Passero:
so I mean, Hashimoto is number one, it's the most common cause of hypothyroidism, the majority of thyroid cases are hypo under functioning, not hyper, which is why we're spending more time talking about the hypo side, and at least 80% of hypothyroid cases are due to this autoimmune reaction. So it's very, very common. And it's very important to know whether or not your thyroid issue was caused by that. In traditional approaches to managing thyroid, a lot of times those markers aren't measured simply because they don't impact the clinical management of the condition, because giving thyroid hormone does nothing for downregulating autoimmunity. Whereas for you and Dr. Huang, we have a whole arsenal and a whole host of approaches for balancing immune function and can do a lot of good work and helping to tone down that autoimmunity, which means we can preserve a person's thyroid function much better as they go through their progressive decades of life. Now, triggers for Hashimotos. I mean, there's a lot of different things, it can be due to infections, stress, for sure, there's a huge component of genetics. So just because you got Hashimotos, if there's a strong family history, don't beat yourself up. If I didn't eat the right diet, I was exposed to too many toxins, I should have done this. I should have done that. Some people live perfectly healthy lives and they still get autoimmune thyroid issues. There's a very, very strong genetic component. You know, when it comes to the gut, dysbiosis has something to do with it. gluten and dairy are big factors because they are high allergen foods. And gluten particularly has a structure that potentially has what's called some molecular mimicry to the cells in your thyroid gland. So if your immune system starts responding to the portion of gluten that's antigenic, that protein structure actually looks kind of similar to the protein structure on your thyroid cells. So when your body makes an antibody to that gluten protein, that antibody circulates all around your body, and when it comes across thyroid tissue, it starts binding to that as well, and triggering other types of immune reactions that can perpetuate that autoimmunity and casein, the protein and dairy can have a very similar effect as well, not to mention that 70% of your immune system is located in your gut. So even if you're driving just a localized immunological reaction that's going to drive higher auto immune reactivity in your body in general, more antibody responses, more inflammation, and you can exacerbate an already established autoimmune process that's going on with the thyroid. It's like there's a little fire and then you kind of take a little bit of, you know, gasoline, and you throw it on there, and you get a big puff. So you and I oftentimes, see when people pull certain foods out of their diet, it will go down, I'll just tell you clap. Tactically, you'll read on all the blogs and all the books like cut gluten out in your Hashimotos will go away. I will say there's a percentage of people that when they cut gluten out, they get a significant drop in their antibody levels. There's a percentage of people that don't. Now that doesn't mean that the percentage of people that don't get the antibody dropped don't feel better to some degree because it if it's related to inflammation, they will feel better in general. But I like to just poke holes in some of these myths because people kind of read things and people put things out there that our attention grabbers, headline grabbers. I think the average attention span of a human being is now less than a goldfish, I think of goldfish is four seconds, the average humans three now, if you don't grab somebody's attention with something interesting on a headline, nobody's looking at your blog, nobody's clicking on your YouTube video. But some of its perpetuate myths that patients come in and talk about and I'm like, alright, well, let's just like get practical about it, you know, and let's really explore it and then the gut microbiome also plays an important role because about 20% of the T four to T three conversion that you need for your cells does happen as a result of the gut microflora and if you don't have healthy gut microflora, you are down regulating your overall T four to T three conversion your pre hormones, the active hormone, and gut dysbiosis can be perpetuated by food allergies and medications and inflammation, and then we don't have time, but there's also the issue of the inflammation and how it causes leaky gut. And then you get some leaking of different protein structures right across the little thin lining of your intestines. And right behind that thin lining of your intestines is lymph tissue, which is immune tissue. So you get proteins migrating through and getting into the lymph tissue. It's normal for the body to start up regulating immune reactions. And if you again start up regulating overall immune reactions, and you've got a little autoimmunity going on, you're going to upregulate that auto immunity. It's like the highest boat only goes as high as the highest tide. It's like they raised together, you know, so you bring that down, and the activity goes down, you drive that inflammation and immunity reaction up, it's going to drive the auto immunity up.
Dr. Andrew Wong:
So we want low tide, and it sounds like I remember Dr. Alessio, Fasano, right he was the one that kind of said that with leaky gut, you know, that's going to be one of the preconditions may not be the only thing needed, but but it is one of the preconditions to autoimmune disease in general.
Dr. Kevin Passero:
Definitely. And, you know, he clearly proved we know that was celiac disease, which is a frank intolerance to gluten based on an autoimmune reaction, those patients have a much higher rate of other autoimmune diseases and specifically of hypothyroidism, Hashimotos hypothyroidism. So there's that molecular mimicry and a very, very strong connection between what's happening in the gut, and what's happening in the thyroid. And if you're holistically managing somebody for a thyroid issue, and you're not talking about diet, nutrition, gut, biome, you know, inflammation, leaky gut, you know, dysbiosis, you're not doing the whole picture.
Dr. Andrew Wong:
We want to definitely see the whole picture. The other thing that Sarah, that we would like to just clarify for the listeners is that someone doesn't have to have celiac disease to be sensitive to gluten and to have that affect the thyroid, right. Is that correct?
Dr. Kevin Passero:
No, no, there's a lot of people that have a, what's called non celiac gluten sensitivity. And this has been established in the medical literature. And there are a lot of clear indicated responses where somebody falls short of being full blown celiac, they don't have that autoimmune response. It's specifically damaging the epithelial internal lining of their small intestine, but it's creating immunological inflammation outside of that. And so there is a definite and that's what I'm diagnosing in my clinic. You know, most of the time when I'm looking at Gluten is a non celiac gluten sensitivity. And it is very real.
Dr. Andrew Wong:
So so this is not a podcast that you know, officially replaces, of course, medical diagnosis and treatment, but in general, which you have, if someone's out there listening that I have thyroid issues, which are recommended talk to their practitioners about, hey, maybe think about the effect of gluten or dairy on on their thyroid? Yeah, you
Dr. Kevin Passero:
have to be thinking about it, you have to be thinking about food and food elimination. If you're going to work on the thyroid, and any holistic person approaching thyroid health is usually going to recommend somebody do a trial at least have some sort of elimination diet to see how that affects the testing and serology to definitively diagnose food sensitivities that drive these kinds of inflammatory reactions are a little bit difficult. There are a lot of times not covered by insurance, so they're always not accessible. And number two, they can be somewhat unpredictable in their rates of false positives and false negatives. So for me in my clinic after 20 years of fiddling with different tests, and I still use some of them, the gold standard is always trial elimination and reintroduction. So sometimes you just have to bite the bullet and just say, Listen, you know, what's more important your tastebuds or your health? So sometimes people just have to go through that process.
Dr. Andrew Wong:
Well, that's great, great point, I also find the same thing and sometimes it's about figuring out what the body reacts to those tests are not always 100%. But let's talk about exercise for a second because I know that that's one lifestyle things that a lot of people do do. Maybe it's still early in the year, maybe people have joined the gym already. Again, you know, for their resolutions or other goals for the year. How does exercise or movement affects thyroid health?
Dr. Kevin Passero:
Well, I mean, I think more I think more about the opposite way around, like how does thyroid health effect Exercise and Movement to a degree, I mean, moving is important no matter what. Now, if your adrenals exhausted and your thyroid is not working right, and you're trying to regain your energy by joining some sort of Beachbody High Intensity Interval Training Program at your gym, you're gonna feel like crap. You have to move to stimulate muscle growth to stimulate mitochondrial function to stimulate ATP synthesis. But I suggest that people move within the boundaries of how they how they feel. If you go do an exercise regimen, whatever it is, and you're completely exhausted and wiped out for the entire rest of the day and feel horrible. You did too much you did more than what your body could handle. Exercise should make you tired for a little bit afterwards but in general should be somewhat energized. Same once it says one thing I learned from, from another doctor that I trained with who was a specialist in thyroid health was for people to take their body temperature before they exercise. And then to check it again about 45 minutes to an hour about an hour after they finished their exercise, if their body temperature is the same or higher, they tolerated it well. If their body temperature is lower than it was too much of a strain on their system, you can't exercise your way to good health. I'm sorry. That's, yeah, that's, it's just not the patients in my clinic that have had the most massive transformations in their health, it was not achieved. by shoving them into crazy exercise programs. Our favorite exercise at our clinic is walking. Low Intensity steady state exercise is one of the most fundamental and energy building exercises that you can do. And the best way to do low intensity Steady, steady state exercise is still walk half hour, 40 minutes, you get strong an hour, hour and a half, two hours, you can get yourself in phenomenal shape. By doing that it preferentially burns fat over anything else, low intensity steady state. And thyroid patients do have to be careful with too much exercise and activity because it can really wear them out. I don't really, most of my patients aren't doing any sort of crazy exercises, you just have to motivate them to do it anyway. I just start with walking, if they're doing really high intensity exercise and trying to get that weight off that they can't because their thyroid isn't working right. We just talked about how that can be pretty counterproductive. And we'll see people stalling their weight loss goals if they pick up a high intensity Weight Loss Program, or high intensity interval training program because it can drive a lot of inflammation and a lot of problems not saying they're bad. Just just like everything else, your approach to Exercise and Movement has to be holistically viewed in the context of a picture rather than just one size fits all, but the gentlest, and easiest is probably walking.
Dr. Andrew Wong:
Yeah, yeah, that's a great point walking is really the best exercise. And what do you think practitioners in general, they know sometimes we have practitioners listening to our podcast as well. What do you think practitioners might be missing when they're treating people with thyroid conditions?
Dr. Kevin Passero:
Ah, let's see. I mean, all the things we've talked about, I mean, I think, looking at a person from a standpoint beyond their thyroid, like you can look at the gland is dysfunctional, but you have to understand that there's a huge influence of thyroid hormone balancing that's occurring in the other cells of the body specifically as a result of the different stressors that that person is under. So looking at their digestive and gut health, looking at their nutrition and and the the inflammation burden that their body is under certain medications that they're on these things are critical. The other thing that I see that some doctors don't have a lot of experience with is working with all the different forms of thyroid hormone replacement. I have done a lot and still do a lot even though it's a little harder to access with desiccated thyroid extract, which is one option of thyroid hormone replacement. And I find that a lot of people don't see the nuances and how to properly regulate doses of thyroid extract to get the maximum clinical benefit. So it's another nuanced conversation, but making sure that you're fluent in all the thyroid hormone languages, because a lot of patients that have had long standing Hashimotos, which as we said as the most common cause of hypothyroidism, they've had portions of their thyroid gland destroyed from the autoimmune activity. So they're very likely going to need some supplemental hormone therapy unless you're catching them within the first six months of their diagnosis, which, as I'm sure you know, Dr. Wong is not usually the case. So they're going to need some form of thyroid hormone replacement, oftentimes for the rest of their life most likely. So if you can't fluently speak, all those different languages have Synthroid and Tierra synth and desiccated thyroid extract and T three and slow release T three and combination t 43. You are limiting your ability to find a solution that works for someone because there's one thing that I've learned in 20 years of doing this is that you cannot assume or predict what is going to be the best solution for that individual sitting there with you. They are their own person. How many billions of human beings has existed in the course of time, none of them and none of them Dr. One will ever be as unique as you. You are your own unique person. We all are. So everybody needs to consider that and be able to work through these different solutions to find the thing that works for somebody if they're not getting where they need to be with what's been presented.
Dr. Andrew Wong:
Yes, I have to follow up with one other question about that. Where are you with herbal therapies for thyroid health? So I know we talked about some of the Selenium glutathione is short and of course talked about it Right and synthetics where you with herbals.
Dr. Kevin Passero:
So herbal therapies and nutrients can be a great way to augment or in some situations replace the need for hormone therapy because you can use herbals and natural therapies to up regulate some of the T 43. Conversions if somebody's on T four and you want to make it more effective, or if you're just looking to generally increase their overall presence of T three in the body or you're looking to drive a little bit of thyroid function, you can use certain herbs like you know, that naturally contain iodine kelp is one, the resinous herbs do a very good job of driving T four to T three conversion. So we're talking about bus Wailea, we're talking about mer, Google lipids and Google extracts. These are useful when combined with nutrients to help upregulate thyroid function Ashwagandha is an herb that's known to work really well for supporting thyroid function, I will tell you that clinically, sometimes it can be a little bit unpredictable. And you have to pick and choose what you decide to use. Because some patients will come in, it's pretty clear they have a thyroid issue. If you use the botanicals, you may need two or three months to see how it's going to play out. And I found as a clinician, sometimes you have a certain attention span of a patient in which time you have to make a positive change in their life in order for them to stay trusting and engaged with you and to trust you with guiding them and other important things with their health. So sometimes, you know, you have to be mindful of how quickly you're going to help somebody feel well, just in the interest of maintaining a good trusting relationship, because they're coming to you in hopes that you're going to help them. So sometimes I may use the herbs. But I may augment the herbs with some stronger therapies, if that seems necessary, like little tiny doses of thyroid hormone to start stimulating the system if it's necessary, but the herbs and the nutrients play a huge role. I would say even more important than that, rather than going out and buying thyroid supportive supplements and T four to T three converting supplements, change your diet, change your diet, cut out allergens, do a very good food elimination focused on whole foods, cut out the processed food, cut out the gluten cut out the dairy tons of plants do it in a well structured manner because that by itself starts to really change the Cellular Physiology fundamentally, in a way that creates a lot of upregulation of thyroid hormone and all of your hormones. I mean, for men that are somewhat low testosterone, I won't even consider a supplement or testosterone hormone replacement therapy until they've changed their diet. Because I have seen so many men in my clinic have their testosterone levels go up 150 250 300 points before we touch anything for testosterone boosting just by reducing their inflammation and cleaning up their diet. And that has to do with that analogy I gave you of the endocrine system being this super fine tuned system. And if there's all this inflammation and stress and other issues going on, the signals can't get through.
Dr. Andrew Wong:
Thank you so much. And basically food first reduce that noise and then the body heals itself
Dr. Kevin Passero:
on the inflammation. Just inflammation is a word that people who aren't in medicine understand its approach to calming down the systemic inflammation that people come in. And they just say, Doc, I just I feel inflamed and swollen and my joints and they just don't even know why. But they just they feel inflamed. And that's what those approaches do. It's calming down inflammation. And when you calm down inflammation, you relieve stress. And as we talked about earlier, we know that the body has set mechanisms in place that down regulate thyroid hormone activity under times of stress, and inflammation is a major cellular stress.
Dr. Andrew Wong:
Thank you. But that's answers the question I was about to ask. We didn't even pre rehearse this, but the one thing to know about thyroid health is calm down that inflammation. That sounds like yeah, big time.
Dr. Kevin Passero:
Yep. And that could be from infections, you know, all the low grade, you know, Epstein Barr Virus cytomegalovirus, Lyme co infections, herpes viruses. These are things that when you're I see chronic stress, one of the primary culprits of chronic stress physiologic is low grade, sort of infections that get missed in diagnoses and workup most people are walking around with some and they create very specific reactions in the body and release certain things into the bloodstream things that are called PAMPs, which are these little pathogen associated particles that float around in the bloodstream. And they found that the thyroid gland has the ability to create an immune response to these pathogen particles independent of any other immune activity. And that's sort of unique to the thyroid. So driving Hashimotos and auto immune reactivity from that is a big deal. There's also something called damps which are damaged cellular material that starts circulating that's part of the body's response to chronic stress that the thyroid gland can also immunologically react to in the absence of any other immune activity. So like looking at the body as a whole, the stress, the inflammation, the toxicity, the low grade infections, I know it seems really confusing, and it makes people overwhelmed. Sometimes you're like, oh, how am I gonna get all this straightened out? The reality is, is that if you focus on some key lifestyle issues, and you focus on having a nutrition program that strives for nutritional excellence, your body can start doing a lot of the groundwork healing on its own. And you may need somebody like me, your doctor wants to help the doctor one, how many patients that come in that are eating an amazing diet, like an amazing diet? How much easier are they to work with, once they've switched to that? Or if they're already doing that? Absolutely. clinical outcomes that we're able to achieve are so much easier, because hey, we're not that smart. Like, we're not that smart. We're not amazing. We're not miracle workers. We can
Dr. Andrew Wong:
it's the body itself, right? That's what it is. And improving that terrain, I think is is kind of what's happening with the nutritional optimization. Yeah. So thank you so much, Kevin, for coming on today, and really discussing and quite a bit of depth, even though you know, we've been kind of running short on time here really about a really important topic, thyroid health, part of our mission at ch capital of your health is making integrated health care more accessible, and focusing on the small steps we can take to improve our health. So we'd love to hear from you the $20 bill questions. So this is what is one thing under $20 It's funny, because someone had recently answered this question and said, well, with inflation, and it's got to be $100. Now, but I'll just say 20 Unless
Dr. Kevin Passero:
you correct? No, I can still do it for 100 or for 29. Okay, so
Dr. Andrew Wong:
what is one thing under 20? That dollars that you feel has really transformed your health personally?
Dr. Kevin Passero:
Well, I would say that for under $20, one of the most impactful things that somebody can do is Well, number one, change their lifestyle, because everything that we talked about, like buying vegetables is cheaper than buying a box of processed food. So that's that, but for one single item under $20, I would say start with castor oil packs. They're super old school, classic naturopathic tradition for supporting detoxification and lymphatic. And I have yet to find a patient who commits to doing castor oil packs on an incredibly regular basis, that doesn't notice some significant improvement in their overall vitality after 12 to 24 weeks of consistently doing it. It's inexpensive, it's easy to do, it requires no specialized equipment, and you can pretty much get the entire bottle of castor oil and a good little flannel pack for under 20 bucks still
Dr. Andrew Wong:
awesome. Are we putting this on the liver area where we're putting this? Well, for
Dr. Kevin Passero:
most people, I tell them to start just on the general abdomen because even just Deke decongesting, the lymphatics of the general gut, just slap it over your belly button area, okay, that's a great way to start the liver definitely intensifies that. But if people go right to the liver, and they have a fair burden of toxicity, they can kind of get some pretty strong detox reactions, they can get breakout in pimples or feel pretty sick. So I always just kind of ease people in and I say, just keep it simple, if you will, where's my liver? Is it exactly positioned here, just keep it simple. Just slap it on your abdomen, because most of that lymph is is that gut associated lymphatic tissue, it's still going to move all that and just basically decongest the pressure in the gut and move the lymphatics which is incredibly detoxifying. You can't detoxify without lymph movement.
Dr. Andrew Wong:
Great. Thank you so much, Kevin, and Kevin. Dr. Procera. Thank you so much again, how can listeners learn more about you and work with you?
Dr. Kevin Passero:
Yeah, so I mean, couple couple of things, you can check out my practice. I have offices in Maryland and DC, you know, similar to to Dr. Wong, that's green healing now.com. That's my practice. So you can go there and see about, you know, looking to become a patient if you're interested in working with me in that capacity. I've also launched a new project this year, which I'm really excited about, which is a subscription based educational platform. So we're creating a community, a wellness community. It's about $39 a month and myself and my nutritionist are going to lead live educational webinars, we're going to do a book club every other month, where we're going to discuss pick popular books related to health, wellness inspiration, and read them and discuss them in live calls. We're going to do community calls once a month where people can submit questions and just talk about the things that people are really wondering about health. We've got an amazing newsletter that we send out every month that isn't just about health, but it's designed to have things that inspire people to live healthier, you can't hate yourself into health. getting healthy has to be fun, and it has to feel inspiring. Those are the ways that I've made the biggest breakthroughs in my health. So we're trying to create a community and you can learn more by going to inspired Health Institute dot o RG. We launched in March and if anybody's interested, you know, join the community and join us. And then another project I just started was I partnered with a entrepreneur in the nutraceutical industry and health advocate and had been a able to bring some of my most effective formulas to a larger scale nutraceutical market. So we started a company called Live durable. And it is some of the formulas that I have had the most success with over my clinical practice formulated into different supplements. So we've got a pain product, and I'd love to talk to your, you know, subscribers or podcast listeners about pain because there's some really neat nutrients for pain management, my favorite sleep formula, my favorite antioxidant formula. So for anybody interested, if you use the coupon code, durable 20, you can just go to www dot live durable.com. And you can get 20% off everything there. So that's been a really exciting project because these formulas have been in my clinic for almost 20 years. And now we're able to just get them out using the ingredients that I preferentially choose different ways
Dr. Andrew Wong:
and access as well. Thank you so much again, Kevin, for coming on. And we'll definitely have to do a podcast on pain and some of the things you can do to approach that.
Dr. Kevin Passero:
That'd be great. Well, thanks so much, Dr. Wong for having me. It was great being here.
Dr. Andrew Wong:
You too. Thanks so much. Thank you for taking the time to listen to us today. If you enjoyed this conversation, please take a moment to leave us review. It helps our podcasts to reach more listeners. Don't forget to subscribe so you don't miss our next episodes and conversations. And thank you so much again for being with us.
Transcribed by https://otter.ai