Interview with Dr. Amie, Doctor of Clinical Nutrition and the Thyroid Fixer
This is a joint podcast that Dr. Amie and I did together on various thyroid topics.
Regardless of what type of thyroid problem you have, there should be some helpful information in here for you!
In this video, Dr. Amie and I discuss the following topics:
- Thyroid weight gain and what triggers it
- Reverse dieting and how it can help improve your metabolism
- Inflammation and its impact on thyroid disease (also the potential sources and causes of inflammation in thyroid patients)
- Adrenal fatigue and cortisol testing, the different ways you can test cortisol, and why I generally don’t recommend cortisol testing
- The iodine thyroid controversy, why I am generally against high dose iodine, the risks vs rewards of using high dose vs low dose iodine, and what range of iodine is important for thyroid patients
- Why TSH suppression isn’t always a bad thing but what to watch out for if you do suppress your TSH
- How to weigh the pros and cons of TSH suppression and determine if the risks are worth it for you
- Why optimizing your free T3 over your free T4 is important, why high free T3 levels aren’t necessarily a problem for most people
- The connection between osteoporosis and atrial fibrillation with thyroid disease
- How to balance the risks vs rewards of thyroid management
If you’d like to connect with Dr. Amie you can do that on her website.
Audio Transcript
Dr. Amie:
So, here we are together, Dr. Westin Childs and myself, Dr. Amie Hornaman. We have so much of alike thinking that we decided to come together and do a very unique kind of style of podcast. We’re doing a joint podcast. So, this will be heard on Dr. Westin Childs Podcast, which is Dr. Westin Childs, and my podcast, The Thyroid Fixer. Hey, Dr. Westin. Thank you so much for jumping on. This is going to be fun.
Dr. Childs:
I think so, too, and I’m happy to be here. I’m glad that we got in contact. It does sound like, as we were talking before, I think we have a lot in common in terms of how we look at thyroid patients, how we treat, and what we think is important, and so on. So, I think we’ll have a really good discussion here.
Dr. Amie:
Definitely, definitely. I know we both have our experiences. You want to just give kind of a little blurb on how you came into the thyroid space?
Dr. Childs:
Sure. Yeah. We were kind of talking about this before. I actually, when I first got out of residency, I wanted to do weight loss. That was like the thing that I was like, really wanting to do. It just so happened that all the patients that I was seeing had thyroid problems. They just kept coming into me and I just started treating them and then they started getting better. At the time, I had no idea that there was this lack of people willing to, or treat them correctly. I guess I just sort of filled that space and then people started coming.
Dr. Childs:
I kind of said this, I think before, but when you help people lose weight, especially so a lot of thyroid problems struggle with, or a lot of people with thyroid problems, they struggle with weight gain, and so I would help a couple of people lose 50 to 100 pounds and they just walk around, and they’re just like a walking billboard. So, they would just attract more of the same people with the same sort of problems.
Dr. Childs:
That’s just sort of how it happened. And then I just really enjoy it. I think it’s a really complex topic. I think there’s a lot of good things to talk about in terms of physiology, and I think it interconnects and it interweaves with the entire body and other hormone systems. It’s complex enough to maintain my interest, and I really enjoy kind of solving the problems that patients have and figuring out what’s going on. That’s really sort of how I got into it. And I’ve been doing it since, I think what I was saying, late 2015-ish or so. So, we’re talking five years or so, somewhere around that. That’s kind of about me. What about you?
Dr. Amie:
So, mine came through experience, of course. Back 20, 25 years ago, I was competing bodybuilding fitness figure. One of the shows that I was getting ready for, I knew what to do, I knew everything. I knew how to eat, it had worked before, a million times before. One of the shows I was getting ready for, I was putting on weight instead of losing. By the time the scale hit 20 plus pounds, I was like, there’s something wrong.
Dr. Amie:
Just like many of our listeners, I was misdiagnosed six times, and then finally diagnosed and stuck on Synthroid. So, I gave that about five months, and I went back to her and I said, “I’ve been reading about this T3 thing.” I don’t even remember the… I think we had like big Gateway computers at that time. Very limited access to information, but I started digging. I’m like, “This T3 seems to work really well with T4. Could we throw that together?” She goes, “No, I don’t do that.” I’m going to find somebody who does.
Dr. Amie:
That was my first experience with kind of integrative functional medicine. That man who saved my life became my mentor and then brought me into this whole functional medicine space. I got my master’s in clinical nutrition, a doctorate in clinical nutrition, and then certified in functional medicine, and now I do what you do. I love helping people who are struggling the same way that I was told, you’re fine, you’re normal. Everything’s good. Your labs look good. I don’t even know what labs they tested, but yeah, all those people just struggling and not getting answers.
Dr. Childs:
Yeah. There are a huge number of people. I think it’s a travesty just how many there are. I think actually we under-count them. I think if you look at statistically, I think it’s like, people will say there’s about 10% of the population that has thyroid problems. I think that’s people that have grossly abnormal thyroid lab tests, but I think there’s a whole, probably at least another 10% that sort of fit into that suboptimal range where they sort of get missed out, or even, you have people who have thyroid problems secondary to other medical conditions.
Dr. Childs:
So, they have thyroid problems that may not be the first and foremost problem, but it still gets dragged down in the process. One of the things that you mentioned here, I want to talk about that, so when you said you were gaining weight, but you were prepping for your competition, so were you in a calorie deficit at that time? What was your prep like? And then talk a little bit about that if you don’t mind because I’m just curious how that sort of worked out.
Dr. Amie:
Yeah. I mean, it was a definite caloric deficit. If I remember correctly, around 1200 calories a day, which is super low. Then, of course, you’re doing cardio, thoracic cardio in the morning, maybe another 20 minutes of cardio at night, that whole deal. It was the chicken, the broccoli, the asparagus. Back then, it was very low fat because we didn’t really realize the importance of fat back then. Very low fat. So, definite yeah, caloric deficit, for sure.
Dr. Childs:
Yeah. The reason I’m asking is because there’s a lot of thyroid patients, and that’s a very common story by the way. If you’re a thyroid patient listening to this, it is absolutely possible to gain weight in a caloric deficit. I think that’s something that runs against the grain of a lot of, or the current thinking, especially when it comes to conventional doctors and personal trainers and things like that.
Dr. Childs:
Their solution is to drop your calories and you’ll lose weight. But the problem is, if you continually drop your calories, you cause a lot of metabolic damage, at least that’s what I call it, which lowers your thyroid function, increases your Reverse T3, lowers Free T3 levels and total T3, and then you end up gaining weight when you’re trying to reduce your calories, and so that sounds like that happened to you.
Dr. Childs:
That actually happened to my wife too, as we were mentioned this before, she got there through an eating disorder, so a little bit of a different way, a different path, and that was when she was a teenager. But the problem is that this metabolic damage, as I call it, as I mentioned, sticks with you for a long time. So, what I want to know, or a question I have for you is, how did you fix that problem? What ended up being like the number one most important thing that you did? Because again, I think a lot of people listening to this will have that very same question. So, how were you able to fix your metabolism?
Dr. Amie:
Yeah. Honestly, if I think back, the key for me was that T3 component because I actually, through the years, I’m T3 only. So, I started off on Synthroid and then switched to Armour, and of course, Armour worked really well for a little while and then kind of stopped working. I don’t remember if it was back in like the 06′, kind of crash of Armour when all kind of went sour. But it just was not working for me. So, we switched to the synthetics again, T4 T3. And I want to ask you what your preferences in the meds, but T4, T3 combo.
Dr. Amie:
Then, just as we were going again, my out-of-the-box thinking doc realized that I had a Reverse T3 problem, and I also had PCOS. So, you had the high insulin, the low progesterone, a little bit elevated testosterone, but not bad. That wasn’t the key component. Really the insulin resistance was pushing on my Reverse T3, and I just simply wasn’t converting. Even when I would go down to 25 micrograms of T4, I would gain weight. If I would pull that out, everything would be fine and I would stay nice and steady.
Dr. Amie:
I ended up on T3 only, and I think that was the key. And then of course finding the PCOS, addressing the insulin resistance. Now I eat properly for my body, which I always talk about with people. It has to be the both and. You can’t do a diet over here, whether it’s caloric deficit, keto, acne, whatever, and go, well, that didn’t work for me. Well, no kidding. Because you’re walking around with high Reverse T3, low Free T3, or an undiagnosed thyroid problem. Yeah, that diet is not going to be the magic thing that makes you lose weight. You have to do both and.
Dr. Amie:
So, then I got rewarded for eating properly and I ate normally. I actually stopped competing and went into powerlifting instead, because it was much healthier. You didn’t have to diet down.
Dr. Childs:
Sure, yeah.
Dr. Amie:
But yeah, I would say just getting that right level, the right dose, the right med for me to support my thyroid function and finding those underlying causes like high estrogen, low progesterone insulin, all of that’s driving inflammation and driving the Reverse T3 up, that was that combination that helped me.
Dr. Childs:
It’s funny you mentioned all those, because whenever you look at thyroid patients, that’s pretty common, right? Low progesterone, high … Well, they may not have high estrogen necessarily, but they tend to have at least elements of estrogen dominance, insulin resistance follows, and so on. Same thing with my wife. She actually needed the T3, and she’s on pure T3 only as well. Somewhere between about 25 50 mics, around that dose or so, but it varies. In fact, I want to actually have her on to talk about how we kind of adjust her dose at some point, but yeah, that’s another story there.
Dr. Childs:
The other thing that I was going to ask you about, something that I have been doing a little bit that I’ve seen some success with is a reverse dieting. I’m not sure if you’re familiar with that term or not, but it’s sort of the idea that you essentially eat more calories than you would normally to sort of bring that metabolism back up. If you kind of think about it in this way, if you are calorically, or if you’re restricting calories, you’re reducing those calories and your metabolism will slowly follow.
Dr. Childs:
If you want to try and kill the metabolism in a way, you can increase those calories, which will kind of drive that back up. Now, the problem with that is you do gain weight. I’m wondering what your experience was. Did you see a lot of weight gain when you were trying to fix your metabolism or was it just strictly related to the thyroid medication? What did that kind of look like for you?
Dr. Amie:
It’s interesting you say that because we would always do the reverse dieting coming off of a show and coaches would always make us do that. So, yeah, you would have-
Dr. Childs:
Yeah, they were naturally doing it then.
Dr. Amie:
Yeah. You’re kind of naturally doing it because you’re coming out of that caloric deficit and you just want to be normal again. And then planning it out so that you don’t rebound by 20 pounds was the coach’s goal. So, you really do the reverse dieting by gradually increasing the calories. I just remember, once I got optimized, I could stay steady, where I wouldn’t … Before, it would be, oh my gosh, if I even just take a bite of a brownie, there’s five pounds. It’s like, I felt like I could actually live life again, and that’s really my goal when I’m working with people. Like, let’s get you to a level where you can go out to eat.
Dr. Amie:
You can go to the picnic, you can go to the party, you can enjoy Christmas and not constantly be anxious that, oh my gosh, at the end of this, I’m going to be 10 pounds heavier and then I’m going to have to work harder to get that off. I’m going to the gym twice a day. Like, no. Let’s not have you crush yourself to get off those 10 pounds. How about we just not gain the 10 because we have everything balanced and we have your metabolism working.
Dr. Childs:
Yeah. I think that weight fluctuation is really a thyroid problem. I don’t know a lot of other patient populations that deal with that, aside from like maybe heart failure where you’re retaining a ton of fluid, but I’ve had a number of patients who say that sort of same thing. If you think of conventional wisdom, they would say it’s impossible, right? Because if you want to gain a pound of fat, it’s something like 3,500 calories that you have to consume.
Dr. Childs:
But I don’t think it’s quite that simple. I do think calories are important and I do think they play a role, but I think more important is thyroid function, which regulates metabolism. When I’m interested, or I shouldn’t say interest, but when I’m helping somebody who is interested in weight loss, I think that’s one of the number one things. I guess a question I have for you though, is that a lot of people, I think get frustrated, especially thyroid patients.
Dr. Childs:
Because they hear us talking about it. They’ll hear us that someone’s on T3 only. Well, getting on T3 only can be quite difficult, depending on where you’re at. What kind of success do you see in terms of using just diet therapies and things like that? Supplements, other natural therapies aside from T3. Do you have any success like helping people, thyroid patients specifically lose weight in that setting? What are your thoughts?
Dr. Amie:
Goodness, definitely. I’m going to plug your thyroid adrenal complex that you have because we actually recommend that a lot, because when I’m looking at other adrenal supplements, yours just has that perfect combination. It’s like, that is exactly what I want my people taking. I don’t want them taking a ton of … This high dose of ashwagandha that they read on a Facebook forum, so they decided to throw it in and they don’t even know what their cortisol is.
Dr. Amie:
Yeah, I love that. I do. I have a lot of success actually keeping people off medications, if they’re right on that border. The right, the thyroid is just a little bit off. There’s no antibodies present. Or even if there are antibodies, we can still bring those down through dietary changes and supplements. I love addressing, I always see insulin resistance in 99% of hypothyroid patients. When you really address that my favorite is berberine for that. Berberine acid.
Dr. Childs:
One of my favorites too.
Dr. Amie:
Love it.
Dr. Childs:
Yeah. That’s funny. Yeah, I love both of those as well. Okay. You’re looking, I guess at, I guess if I could characterize that approach, you’re looking at other hormone systems that could be dragged down by thyroid function as well. Because a lot of thyroid patients, in addition to having hypothyroidism, or at least this is my understanding of it, if you have a different sort of idea of how it works, let me know. But I am of the mindset that as thyroid function gets pulled down, it is also dragging down other hormone systems with it.
Dr. Childs:
In addition to seeing your low thyroid function, which will cause decreased metabolism and weight gain by itself, now you’re having your adrenals being dragged down simultaneously, and cortisol imbalance either high or low can cause issues with that as well. In addition, you’re seeing progesterone being pulled down, estrogen may be increasing as well, or you may just have a widening gap between the two. I also see problems with leptin and so on.
Dr. Childs:
I guess, it sounds like your approach is, if you’re having a hard time getting that thyroid medication, you can at least address these other hormone imbalances. Is that kind of what you’re thinking?
Dr. Amie:
100%. Yeah. Let’s look at insulin. Let’s look at hormones. Let’s look at the zinc, the mag, the iodine, all those nutrients that are so important for your thyroid to function properly. Let’s look at the underlying infections. I’ve seen BARR virus, Lyme. Let’s look at it all so we get that whole picture, and I’m sure this drives you crazy too, but it drives me nuts when people will come in, patients will come in with half-ass Dunlaps. If they’re a woman they’ll have estrogen, but they won’t have progesterone or testosterone.
Dr. Amie:
Maybe they’ll be an LH FSH in there, and the doctor forgets that they have other hormones, or a Lyme panel will have just one marker. And it’s, oh my gosh, there’s so much more. So, really getting that full picture and treating those underlying conditions that are driving inflammation that essentially, that’s what shutting down thyroid function is inflammation, whether it’s your auto-immune, Hashimoto’s. Your immune system is just attacking your thyroid because it thinks it’s an invader, a bad guy. Or if it’s just inflammation from high insulin, from an underlying infection, from an inbound in nutrients, from your adrenals. I mean, do you see that a lot too, is just those core underlying conditions that are kind of inflaming the person to lower their thyroid function?
Dr. Childs:
Sure. Yeah. I think inflammation plays a big role, and I think finding the source of that information is really important, if possible. I think sometimes when you’re looking at it, it’s hard to identify what’s going on exactly. Because there can be so many different causes of inflammation. I think also, it can be a little more subtle. What I mean by that is sometimes it can be as simple as not getting enough sleep or having too much stress in your life.
Dr. Childs:
I’m not treating people right now, but in the past when I would talk to them and I would say, here are your issues, and we’ll go through the list. We’ll look for infections in the gut and we’ll look for high, obviously high inflammatory markers, ESR, CRP, even ferritin can be used as a non-specific inflammatory marker. You can look at these things and you can kind of get an idea. Maybe I can direct you towards one place.
Dr. Childs:
For instance, somebody has like high ESR and CRP, and they also have like a lot of abdominal issues or gut pain or things. Okay, well, you can get directed to that area. But sometimes you can tell that somebody is inflamed, they don’t have high inflammatory markers. At that point, it gets difficult to figure out where the inflammation is coming from because they’re symptomatically inflamed, but you can’t quite identify where it’s coming from.
Dr. Childs:
A lot of those times, when it gets to that point, it’s like, okay, I think the best approach is to look at the lifestyle issues. So, maybe then it’ll come out that this person’s not sleeping as much, or maybe they are sleeping, but due to hot flashes, or whatever, they’re not getting quality sleep or deep sleep. They also have stress problems or problems associated with stress in their social lives, so with family members and so on.
Dr. Childs:
I tend to see that very commonly among women who I think end up, I don’t know how to say this maybe in the right way, but it kind of seems like the women that I would treat, they would take on a lot of problems of other people. So, they’d have more than just their own problems. I don’t know how to quite define that. That’s never really been my strong suit there, but I would see a lot of that. So, I think that that sort of thing takes a toll emotionally, physically, and also on inflammation. Treating those things is very important. Sometimes finding out what the problem is, is also very difficult though.
Dr. Childs:
I definitely think that inflamed inflammatory component is good, if you can find it. I don’t know, what do you think? do you see those sorts of same problems when you’re treating people?
Dr. Amie:
Yeah. What I find is that women kind of downplay it. Oh yeah, I get enough sleep. It’s fine. And then we really talk about it, and it’s like, well, no, you’re getting five hours because you’re a night owl and you’re staying up until 11:00, 12:00, and you’re missing the recuperative time of sleep. And then you’re waking up early to get the kids on the school bus. I know, that’s not enough, or they will downplay the stress too. Oh, no, I’m okay. I’m just taking care of my elderly mother and I have four kids and I’m working. Like, wait a minute.
Dr. Childs:
That’s a lot. Yeah, that caretaker thing is a story that I’ve seen a lot too, by the way. I’ve seen a lot of people who they’re caretakers for their, someone in their family or maybe their mom or their dad. They do this for a number of years and then that issue gets resolved or fixes itself, and then they have a crash. You have these people crash, and then they’re like, I was doing fine up until 2005 after whatever happened. I was taking care of my mom and my dad. Then all of a sudden now, I gained 50 pounds.
Dr. Childs:
The body can really rally for a period of time when it’s necessary, and so I find that to be particularly common among people who are caretakers of family members, but then what happens is it all catches up to you. You’re going to pay the price one way or the other.
Dr. Amie:
Yeah. That’s what I was going to ask you. What is it? You know the adrenals a little bit better than I do, so what is it with the adrenals, where literally it will get a person through, it will get them through that caretaking time, it’ll get them through that stressor, and then after it ends, that is when they crash?
Dr. Childs:
Yeah. To be honest, I don’t think anyone really knows for sure. I have a theory that I can kind of talk about. But I think the problem is, especially when it comes to adrenal function, there’s a lot of, let’s say misconceptions, and people are looking at different sets of information, coming up with different conclusions. It was sort of thought traditionally that there was this idea of adrenal fatigue, which is you get under a lot of stress. You have some impact. Something happens to your adrenals, to your cortisol levels, and that causes a lot of fatigue, or the symptoms associated with adrenal fatigue.
Dr. Childs:
The problem is, when you actually look at people, you can have people with the same set of symptoms with high cortisol, with low cortisol, and normal cortisol. So, it’s really hard to nail down what is actually causing that problem. It used to be that people thought, okay, well, in the beginning, your body gets stressed, it has a high level of cortisol that gets pumped out. Then over time, the adrenals kind of poop out, and then it goes down.
Dr. Childs:
Depending on where you’re at in this cycle, if this is six months or five years, your cortisol might be high or it might be low. That’s sort of the conventional thought. As I said before, that it’s hard to kind of prove that point to be true because when you look at people that’s all over the place. I think that it’s probably more related to receptor sensitivity. What I mean by that is it has to do with how sensitive your cells are to cortisol.
Dr. Childs:
I think there are a number of factors that can influence that. This shouldn’t actually come as a surprise to a lot of people listening to this, you probably understand this concept very well, but it’s the same concept that occurs with insulin resistance, right? Your insulin is there. It’s just, your cells are not using it very well. We know this also exists with progesterone, by the way. We know this exists with leptin as well.
Dr. Childs:
I think it probably exists with cortisol. I believe that it’s probably has something to do with cortisol receptor sensitivity, which I think is also why adaptogens and glandulars, which are tools that you can use to treat adrenal function, they tend to work, sometimes regardless of what your cortisol level is. You could have somebody taking Rhodiola or ashwagandha for high cortisol and see benefits, just like somebody who has low cortisol as well.
Dr. Childs:
At some point, I don’t know that it necessarily matters what the pathophysiology is. I think we know what the treatment is. I think focusing more on those treatment aspects will get you better gains in that arena. That’s kind of the way that I look at it. In fact, I don’t get too obsessed with cortisol testing. I know a lot of people, I know a lot of people do.
Dr. Amie:
I don’t either.
Dr. Childs:
Yeah, so I don’t know where you fit on that spectrum. It doesn’t sound like, or it doesn’t sound like you’re in that. What I traditionally do is I’ll get a serum cortisol. There’s a lot of ideas as to whether or not serum is better than salivary cortisol, which is better than urinary cortisol, and so on. As I said, I don’t know how much information either of them give you, so I usually just throw in a serum cortisol at 8:00 AM when I get their labs checked with the thyroid function. So, then you can look at the cortisol in relation to thyroid function.
Dr. Childs:
When you do that, it’s like, okay, now you have a starting point and that you have something to compare it to. Then when you retest at the same time, you can say, okay, well, what is happening with the cortisol? I have no idea what’s happening at the cellular level, because there’s no way to test that really, but what you can do is you can see, okay, is there improvement in the cortisol, and does that improvement correlate with the symptoms that we’re seeing in that patient?
Dr. Childs:
That’s kind of how I look at it, or at least have in the past, but I do think that, no matter where you fall, I think it’s, or at least we probably both agree that I think … Well, not ashwagandha, but adrenal adaptogens and adrenal glandulars are really, really beneficial for thyroid patients. Do you kind of agree with that statement?
Dr. Amie:
Totally, totally, love them, love them. In that perfect combination, like I said earlier, I hate it when people just read that ashwagandha is good and they go out and they just take that. It’s like, no, let’s not just throw high dose supplements because you heard it on Dr. Oz. Let’s actually, yeah. Raspberry ketones flew off the shelves way back when. Yeah, let’s actually get that right combination to support. It’s about supporting the adrenals and supporting your cortisol function, and then it will naturally come back in alignment.
Dr. Childs:
Yeah. I think I see sort of the same thing. Actually, this leads me to another topic, I think, I’d like to ask you, but what do you think are the most beneficial supplements for thyroid patients? What do you see the most success with? Because I have sort of a list that, and obviously they’re putting my supplements for that reason, but I’m just curious if you see sort of the same thing. Because after using them on tens of thousands of people, you start to see a little bit of patterns, and obviously everyone’s an individual, and so you can’t just make a blanket statement like that, but there are definitely are some patterns that I’ve seen.
Dr. Childs:
I’m wondering, do you have some go-to supplements that you think thyroid patients should really consider, or at least look at, or lab tests that they should be trying to assess for nutrient deficiencies? Where do you land on that?
Dr. Amie:
Yeah, so the nutrients, the basic cores, the zinc, the mag, vitamin D. Yes, selenium, but not too high. Because I see a lot of people overdo selenium all the time. Yeah. Then vitamin D, all the Bs. I like a nice, just a nice B complex, methylated B complex. Iodine, I like testing iodine, and I still have not landed. So ,I just kind of dove into iodine, really like deep dove into it this year. I interviewed Dr. Christianson on my podcast, and I heard his side. I’ve also heard Dr. Brownstein side, and I’ve read and I’ve researched.
Dr. Amie:
Maybe you can jump in on the … Because you’re more of the research guy. I think it’s important. I don’t quite know exactly how to test, because there are so many different, like you said, there’s serum, there’s the challenge where you take 50 milligrams of Adderall and then do the 24-hour urine. There’s a basic 24-hour urine without the challenge. I mean, I’ll just go by serum. I have had a couple of patients do the serum and the 24-hour urine at the same time and we can compare a little bit.
Dr. Amie:
But I do, I think iodine is important, just not in excess. You don’t have to go crazy with it, but you also don’t want to avoid it. That’s my take, so you’ll have to jump in on nutrients. Then of course, like carnosine, Benfo. I like berberine because it helps with healing of the gut and it helps with insulin resistance that is probably present. Those are my like main core components, I would say.
Dr. Childs:
Yeah. I like that you get into berberine because that’s honestly one of my favorite ingredients. I actually complex with alpha lipoic acid. I think it’s incredibly powerful. I talk about it a lot. It’s one of those things that a lot of people, I don’t know that they necessarily know about it. I think it’s some sort of weird plant, alkaloid I believe, it’s a botanical. I don’t remember exactly, but it’s very, very good. In fact, I love using it specifically for weight loss, but like you said, it has other benefits, right? Because when you look at the studies, it shows it simultaneously helps build lean muscle mass and burn adipose tissue. Which is a problem that almost every patient has.
Dr. Childs:
I love berberine. If anyone takes anything away from this, get some berberine because it’s amazing. Like you said, it has other things. It actually has antifungal properties and anti-bacterial properties, which can help regulate gut function. Some cholesterol benefits. I’m kind of going off the top of my head here, but insulin resistance, as you mentioned, but all of those things. It’s great. I love berberine. And a lot of people don’t use it and they don’t even know about it.
Dr. Childs:
Going back to the iodine, I think, so yeah, what a controversial topic. Thanks for throwing me down there. No, I’m totally fine. No, so I actually don’t know what those other physicians that you mentioned think about this. At least in the past, I’ve heard Dr. Brownstein’s name. I don’t know his specific position, but I can tell you my, and same with Dr. Christianson, but I know my position, and it’s sort of what you mentioned previously. So, the way I look at it as this, I look at it from the perspective of physiology. We know from the physiologic perspective, a couple of things.
Dr. Childs:
Number one, iodine is required for humans. You cannot have a sustainable life without iodine. In fact, when you look back, when scientists and researchers look back at humans and the evolution of humans, they’re always trying to figure out, how does this human, this post whatever, I don’t know the timeframe here, but let’s say millions of years ago, this human, how did they get iodine? If they’re so far in coast, how do they get it? If we know that it’s concentrated in the coast. So, they have to come up with all sorts of crazy theories on how that these people can get iodine because it’s required for brain function.
Dr. Childs:
We know, physiologically speaking, that you must have iodine. There’s no getting around it. Your body cannot produce it. It must be consumed. So, you have to be getting it one way or the other. That’s sort of the basic framework under which I operate. Now, the problem is, it true that, even though iodine is required, taking night on can actually cause some problems. So, that’s where I think people get confused. But what you end up hearing is people will say, “I have an iodine allergy.” You absolutely do not have an iodine allergy. There’s no such thing.
Dr. Childs:
In fact, I’ve read a lot about the research on that. It is impossible to have an iodine allergy. Now, what you can have is you can have an allergy to something that is complex to iodine, and that’s called the hapten, and that can occur, which is probably what occurs with iodinated contrast dye. So, you can have allergies to other things connected to iodine, but having a true allergy to iodine is impossible. In fact, you wouldn’t be able to exist if that were the case because iodine is required all the time in your thyroid gland.
Dr. Childs:
There’s that component that you must be getting iodine. Now, again, as I mentioned, you can’t have negative reactions to it. Then, how do you explain the negative reactions to it? I believe that what ends up happening is that most of the negative reactions occur for a couple of reasons. Number one, because you have too many halides inside of your body, which are being detoxified out as you take it, so that’d be number one. And then number two would be that you don’t have the right amount of antioxidants or you don’t have a way to clean up the free radicals that can be produced when I’ve done is used inside of the thyroid gland.
Dr. Childs:
That kind of comes back to your previous point, which is you must be using kind of the right amount. I think that excessively high doses can be dangerous. I think avoiding it is absolutely dangerous and I think it’s a huge cause nowadays of low thyroid function. I would absolutely not recommend that you 100% avoid it. Now, if you wanted to avoid it temporarily while you increase the selenium levels and zinc levels and iron levels and so on, I think that, that’s a reasonable choice for maybe one or two months, but absolutely no longer than that.
Dr. Childs:
In terms of dosing, that’s where it gets complicated because I have seen, and maybe you have as well, I’ve seen higher doses work very well. I’ve seen the 12.5-milligram dose cause significant benefits to people, and where they have low thyroid function, they take this iodine, and they’re like, I’m better again. I’m like, well, okay, so high dose iodine has some merit. Now, where and when it’s used, that’s a whole nother story. What do you think? Do you see a benefit in using the higher doses of iodine or do you stick to the low doses? What do you think about that?
Dr. Amie:
Even when we go to actual high doses, according to Dr. Brownstein, that’s 50 milligrams, so he would…
Dr. Childs:
Yeah, that’s real high.
Dr. Amie:
All the way that’s high. So, 12.5 I would say is right in the middle. I’ll have people to start off just slow. So, especially if we’re using something like a Lugol’s. Just start with like two drops of the 2% solution and work your way up. And then once you get up higher and you’re at 12.5 and that’s you’re kind of riding an out dose, then you can switch to an Iodoral tablet at 12.5, or take a supplement that has 12.5, 10,000, or 12,000 micrograms, 10 to 12 milligrams per tablet. Something like … I mean, I think that’s the perfect dose.
Dr. Amie:
I think that’s just that perfect … And then there will be cases where people do need a little bit more. Maybe we go to 25, maybe we start to climb up higher, but most people are really, really good at 12.5.
Dr. Childs:
Yeah, I tend to personally not to like to go too much higher than 12.5 milligrams. Just for reference, so for those people listening, one milligram, when we say 25 milligrams, so one milligram is 1000 micrograms. The RDA, which is the set dose that the governmental institutions recommend is somewhere between 150 and 270 if you’re breastfeeding or lactating, or pregnant because you need more iodine in that case. When we’re talking about 150 to 250 micrograms versus 25 milligrams, that’s an order of magnitude much higher.
Dr. Childs:
So, it’d be 25,000 micrograms. So, this dose is significantly higher than what people recommend. And yet I do see improvement at that level. Now, what I will say, and this is sort of my argument is, even though it is true that some people do get better when they’re taking it, the risk versus reward may not be there for those really high doses. What I mean is there’s might be a good chance that you do get better, but there might be an equally bad chance that you get worse or trigger Hashimoto’s, or trigger more inflammatory conditions inside the thyroid gland.
Dr. Childs:
My recommendation generally is, unless you’re being supported by somebody like you or somebody else, or you can talk to talk to that person, don’t just go crazy on the iodine. In fact, I literally just had, I think I mentioned this in one of my more recent videos, but I had a doctor, I went to residency with, a physician friend of mine, he sent me an email about it, somebody who was taking a hundred milligrams, so really, really, really high doses. Yeah, I didn’t even know people were using that high.
Dr. Childs:
Anyway, he ends up with a TSH of 12 or 14, something like that, a high TSH. It’s higher than what you want it to be, obviously. It tracks perfectly. Because he was getting his labs chested during this time. As he was going up on his iodine, his THS was getting higher and higher. You can see these sorts of things happen. So, just be very, very cautious with the higher doses of iodine. lower doses of iodine I don’t think are necessarily a problem, but if you really want to really be sure, then just make sure that you have a sufficient amount of … That you take care of those nutrients that we talked about previously. If you do that, I think you’ll be okay. That’s sort of where I sit on the whole iodine thing.
Dr. Childs:
That’s an abbreviated version obviously. I have more in-depth videos if people want to look into that. I don’t get too wrapped up in that. I know people get really into the iodine controversy. To me, it seems like one piece of let’s say a larger problem, which is thyroid problems. So, that’s just one element. I don’t see the idea of getting so scooped up into it, other than, I think … There’s this idea out there that if people optimize iodine that maybe that will cure their thyroid. I think people get locked into that mindset. I’m not exactly sure why I’ve never been really into the iodine aspect of it, but that’s my best guess.
Dr. Amie:
Yeah. I do see Reverse T3 to go up with low iodine. I can see that connection for sure. But I’m with you. Let’s not get wrapped up in the controversy. Just find that middle ground. Find the middle ground and it’ll probably work in most cases where there are two extremes. That can be said for all of life.
Dr. Childs:
Yeah, absolutely. In fact, I think that that’s well said. I think that you can’t confuse the forest for the trees. I think you need to keep track of what you’re trying to do here. I think, at the end of the day, that is trying to feel better. I think that thyroid patients, and one of the things that I always want to make sure, and I don’t think I do a good job with this so I really want to make sure I say this now, but I think that thyroid patients don’t have to be neglected. They don’t have to live this life of misery. I think sometimes that’s projected on a thyroid patients through the things that they read or the people, or the resources that they look at, and so on.
Dr. Childs:
Honestly, I think that the outlook can be difficult for a thyroid patient because they are facing a lot of struggles. But I think at the end of the day, it’s absolutely possible, and the goal should always be to get back to 100% health or as close to possible as you can get. I do think that that is definitely possible. I’ve seen it to be the case. I guess I’d ask, I guess how do you feel? You’re somebody who has had … You’re taking T3, you have low thyroid function. Do you feel like you’re back to 100% and is that a goal that you take, or how do you think about that when you’re treating people?
Dr. Amie:
I do. I feel like, and I say the same thing that you just did. It’s not your fault. You don’t have to suffer. Just even if you were told by 10 doctors that you’re normal, you’re fine. It’s fine. Everything’s fine, or that, I mean, I’ve even heard some docs tell people, well, you’re just going to have to get used to living this way. You’re just going to have to get used to it. That’s my message I give all the time. No, you don’t. You don’t. There is something that we can do, whether it is changed diet, improve sleep, change lifestyle, decrease stress, support your adrenals, let’s look at nutrient function.
Dr. Amie:
Or let’s focus on thyroid and hormones. There’s something that we can do to improve because doctors always miss those four words, how do you feel? Let’s ask them actually how they feel before we treat them like a set of labs? The labs are great. I mean, you and I both love lab work. Give me labs all day long, but then give me the person talking about their symptoms and how they feel.
Dr. Childs:
Yeah. You brought up a really good point actually. I think that doesn’t get talked about enough. There’s a lot of people who I see, especially thyroid patients, and they’ll get their labs, right? Because they’ll read these blog posts that will say, you need Reverse T3 and Free T3 and Free T4 and TSH, and yada yada sex hormone-binding globulin, everything you need. So, they’ll get them, and then they’ll be like, okay, problem solved. I have my labs. Here they are.
Dr. Childs:
And they’ll just sort of throw them out there and be like, yeah, what do I do now? I’m like, it’s really not quite that simple. Now, labs are important absolutely, but they must be attached to the clinical picture, and I think people forget that part of it. They think that the labs are the end all be all. It’s like, no, the labs are really just the beginning. The labs, without clinical context, don’t really give you much information. In fact, you could have … I’ve had some people with higher TSHs than what I recommend people have, but they feel great.
Dr. Childs:
I don’t see the point in treating something if clinically they’re the same. In fact, when I was in residency, there was sort of this rule. I remember I had some really wise doctors teach to me, but they, and this gets abused obviously in the medical system, and I’ll explain in just a second, but they would say, don’t order a test unless you know what to do with the result. I think that’s a big problem with a lot of doctors because they don’t want to order your Reverse T3, because when it comes back abnormal, they have no idea what to do with it.
Dr. Amie:
Right.
Dr. Childs:
They’re going to be like lab. So, you see a lot of pushback from doctors for this very reason. Now, it can obviously be used as a dodge to stick your head in the sand and be like, well, if I don’t know it’s there, then I don’t have to treat it. And that’s a liability issue for doctors. But I think that the main thing I wanted to express here is that there is a correlation, or not even a correlation, but it’s necessary to combine the clinical picture, meaning how you’re feeling with those thyroid lab tests that you are getting.
Dr. Childs:
If you do not do that, if you’re just trying to throw out the labs and treat based off the labs, you may get lucky, you may get lucky and feel a little bit better, but it’s not as easy as you think. That actually leads me to a topic that I’d love to get your opinion on, something that I’ve been trying to talk about with some other people, but it seems that, I don’t know, maybe I’m alone in this, but I find that there’s this push. And even for me, I’m guilty of doing this, but to talk about optimal thyroid lab test.
Dr. Childs:
You probably know what I’m talking about, right? Free T3 should be within this range and Free T4 this range and TSH and so on. I do think there’s some merit to those ideas, but I have seen plenty of people, my wife included, by the way, which I can talk about it if there’s any interest in that, but I, and for instance, for her T3 level, I mean, it could be as high as 10 or 12, and I’m not worried about it at all. It’s way above the reference range, but she’s feeling great. There’s this disconnect between these optimal thyroid lab tests, and sometimes how people are feeling.
Dr. Childs:
I think that, that can get a little confusing for therapists. I guess what I would ask you is, do you see this sort of same thing, or are you somebody that’s like really like, no, the Free T3 must be optimized along with the Free T4 within this range? How do you think about that with your lab test?
Dr. Amie:
I love, love that you ask this. This is so great. Yeah, we need to talk about your wife too, because she and I are very similar, T3 only, very similar. We tanked our thyroids through different choices earlier in life. I do better with my Free T3, usually at like a five or six. I can pull off a four. I had it tested after Christmas and went through a lot of stress, and I was a caretaker for my mom, so yeah, I was on that other side. Whew. It went down a little bit, but I still felt okay, if I were to show an endo, these labs, they would …
Dr. Childs:
They freak.
Dr. Amie:
Freak out. They would call me hyper. They would pull my meds. Then I would go into a hypo state. Yeah, I say, and a lot of people even get hung up on T4, and it’s like, I really don’t care if that goes lower. If your free T3 is good, wherever your optimal is, I always say there’s optimal, and then there’s your optimal, and you’re feeling okay. If you’re telling me you’re feeling good and your Free T4 is point eight, I’m not going to up your T4. No, let’s just keep riding what we’re doing because you feel good. I’m so happy you brought that up. What do you see in labs that are wonky, but the person is feeling great?
Dr. Childs:
Yeah, I would say one of the most common is, well, so a couple of things. Number one, I think you hit the nail on the head. Depending on which type of medication that you’re using, you may see large or high levels of Free T3. I don’t think you necessarily need to freak out about that. I think you said your level was between five and six, is that kinda where your-
Dr. Amie:
That’s my happy, yeah.
Dr. Childs:
That’s where you’re like. I think, depending on what your lab you’re using, as far as I remember, I think the level was like, I don’t know, at 1.5 to 4.5, something like that. So, you’re getting flagged as high, right?
Dr. Amie:
Yep.
Dr. Childs:
Oka, just so we’re on the same page. Yes, so same with my wife. So, she was getting flagged in the 10 to 12 range as high. Now, as she was saying, if an endocrinologist saw that, they would get freaked out and they would say, you are absolutely hyperthyroid. You’re destroying your body. You’re going to have osteoporosis and atrial fibrillation and so on. But you can check for these things, and it doesn’t have to be something that you worry about, especially by checking your resting pulse, your resting heart rate.
Dr. Childs:
If you’re really worried about it, you could look at the size of your heart, because the only way you would get atrial fibrillation is if you have enlargement to the heart and that changes the structure of the heart and that changes how it pumps. Then same thing with your bones. If you really wanted to check and see if you were getting osteoporotic, you could get a DEXA scan. There really is no reason to overly freak out about these things, especially since they’re checkable.
Dr. Childs:
Now, that’s number one. Number two is there’s only a slight increase risk of developing these things. There’s no guarantee. And nobody even knows what that is by the way. It could be that your risk just living is, I’m just making this up, but let’s say your risk of getting atrial fibrillation is 1%, which it’s probably pretty accurate, just because. Just because we don’t know why. You just get it. 1% of the population does. Or it could be higher, but just go with me on that. Now, let’s say that you have Free T3 in the four, or five to six range. Okay, well, maybe your risk is higher, but maybe that risk is 1.5% instead of one.
Dr. Childs:
Now, would you rather take that half percent increased risk and have improved metabolism and get back to a normal weight and have all these benefits? I think most people would. I don’t really get too concerned about Free T3s being elevated in the absence of hyperthyroid symptoms, and if the patient, like in your case, you or anybody else, as long as they understand the potential risks involved with that and how you should follow up, getting an echocardiogram to look at the structure of the heart, getting a DEXA scan to look at bone density.
Dr. Childs:
So, there’s that component. That brings me to your former question, which is that I see high levels of free T3, which I don’t get too concerned about always. Sometimes it is a problem, but not always. The other thing that I see people get really hung up on, and by the way, that kind of also goes with a suppressed TSH, the suppressed TSH, high Free T3 level. The other thing that I see a lot of people get, that they really get zoned in on is Free T4 levels. What they want is they want both their Free T3 and Free T4 to be in this top 30% of the range.
Dr. Childs:
I’ve seen people jump through all sorts of hoops to try and get them within this range. Now, I don’t really see a lot of benefit to focusing on Free T4 at the expense of Free T3. Now, if you want to get your free T4 up and you feel better with your free T4, okay, fine, whatever. But if you’re trying to force your free T4 up because you’re, let’s say you’re taking NDT, and so you’re on, let’s say just two grants, I’m just making this up, but let’s say you’re done two grants, and so your Free T3 goes high but your free T4 goes low, but you’re freaking out. So, you’re trying to take more levothyroxine to push you up, you’re playing a weird game there of numbers without actually looking just at how you’re feeling clinically and symptomatically.
Dr. Childs:
I see this discordance between Free T3 and Free T4, especially when free T3 is high and Free T4 is low, that people really get, not everybody, but some people really get zoned in on that, and then of course, the high Free T3 level and the low TSH. So, people get really concerned about those. But as I mentioned, if you’re focusing on them and you’re really concerned, then just get a DEXA scan and get an echocardiogram so you can look at those functions, the heart function, as well as the density of your bones.
Dr. Childs:
I don’t think you need to get worried about that. One of the point worth mentioning too, is premenopausal women. We talk a lot about thyroid patients. Premenopausal women are virtually immune to bone-related problems. I have never seen, in fact, I’ve looked at a lot of research, I’ve never seen a study show that a premenopausal woman, meaning somebody who is still menstruating have problems with bone density, and probably even the heart. I haven’t looked at that specifically, but I’ve never seen anyone with osteoporosis, a premenopausal woman, regardless of whatever their TSH is. It seems that you could just drop that to, essentially as close to zero as possible, and you’re still essentially immune from developing that.
Dr. Childs:
Now, once you become menopausal, that’s a different story because estrogen provides a very protective benefit to both the heart and the bones. That’s kind of how I look at it. I don’t get too worried if you’re younger. Again, I think it’s a risk versus reward thing. If you can help somebody, let’s say lose 50 pounds when they’re 35 or 40 or 30, I mean, what is the benefit of that weight loss over the next 30 years? That’s a huge benefit to that person.
Dr. Childs:
Not only that, not only like physiologically, but also mentally. Weight is a terrible burden, I think, to carry. It’s not one that I personally have struggled with, but I have seen it from other people. I think that … Anyway, that’s kind of … It’s a risk versus reward thing is how I look at these lab tests and management and things like that. I don’t know. Do you kind of take a similar approach or what are your thoughts on that?
Dr. Amie:
Oh, no doubt. I mean, you would have to pry the T3 out of my dead cold hands …
Dr. Childs:
I love T3.
Dr. Amie:
Before I would give that up just to increase my, or decrease my risk of EFA by 0.5 percent, or whatever…
Dr. Childs:
Yeah. I made that number up, but it’s probably like, I don’t know. Maybe it’s 3% or 2%, but I doubt it’s 50. It’s not this huge increase…
Dr. Amie:
It’s about quality of life. I mean, you want to be able to live life. You mentioned TSH. What is your optimal range? Because I’ve heard you talk about this on your podcast. What is your optimal range of TSH? And are you okay with it going low? Because probably your wife, myself, there’s no way we can get our TSH back up to 0.5. It’s always going to be 0.00 something.
Dr. Childs:
Yeah. I would say a couple things about that. Now, generally, I think if … From the data that I’ve looked at and just personal experience and helping people, I tend to … I’ve seen that a low TSH tends to not be associated with any problems. So, you can have a low, but non suppress TSH, and then you can have a suppressed TSH, and these are two separate things. Suppressed basically just means that the TSH is so small that it can’t be recognized.
Dr. Childs:
The computer analysis is just like, I don’t know, some value less than 0.001. We don’t know. It could be 0.00000001, or 0.0 plus 20 zeros and one. It’s just so low that we can’t even quantify it. That’s one thing, that’s called a suppressed TSH. The other thing is just having a low TSH. So, you could have a low but not suppressed TSH that gets flagged as low. Now, when you look at low TSHs, so I think the range is usually 0.45 to 4.5. So, if you flagged as a 0.44 or a 0.40, you would get a low flag but you would have a non suppressed, but low TSH.
Dr. Childs:
Now, when you look at people who have these low TSHs, I don’t see any risk of atrial fibrillation, osteoporosis, or anything like that from the studies I’ve looked at. It isn’t until you start to get to that suppress range that then you even have to consider a worry about it. So, what my general recommendation is, aim for, if you need to, aim for the low, and if you do want to become suppressed, I think that, that is usually okay in many instances. Don’t just do it willy-nilly, and definitely don’t just do it by yourself.
Dr. Childs:
But if you are going to do that, then I think it becomes prudent for you to then start looking at your bone density, as well as cardiac function. Now, it’s very unlikely that you’re going to have problems in these areas, but if you’re going to do this, and you know that there’s a slight increased risk, we don’t know what that risk is, but at least pay attention to it. I at least look at the heart function and echocardiogram, get your bone density scan, and then if you start seeing changes, well, then you can go back up and you can reduce your dose.
Dr. Childs:
Maybe at that point, it’s not worth the risk. That kind of talks about the low but non-suppressed. Now, in terms of reference ranges, I’m actually a big fan of using the pregnancy TSH cells. I don’t know if you’ve ever heard that argument before.
Dr. Amie:
No, go ahead.
Dr. Childs:
It seems so obvious to me when I found out this out, I don’t know, a couple of years ago, but there’s a whole nother set of ranges for pregnant women and for TSH levels. What’s funny is that in the medical world, pregnant women are like, everybody is so afraid to mess with a pregnant woman, because they’re so afraid of having a problem with the fetus or the child. They’re so overly cautious with them that I know that if someone was recommending a low TSH, which by the way, it’s like, 0.12, I think, 1.0 or 0.5 or something like that is the recommended pregnancy TSH level.
Dr. Childs:
If you’re willing to suppress or to make the TSH low in a pregnant woman who is already at increased risk, increased liability for all the other issues, then why would you not apply that more generally and broadly to all people? That’s sort of a logic that I use. So, I prefer to look at the pregnancy ranges. I have the blog post that talks about those ranges. They’re based off trimesters first, second, and third. Off the top of my head, I don’t remember them exactly, but I think it’s like a 0.1 TSH to maybe like a 0.5, which again, would flag you as low for most of that range if you were another healthy adult.
Dr. Childs:
So, if you want to look at those specifically, you can, but I think if you’re within those range, if it’s good enough for a pregnant woman, I think it’s good enough for most people, that’s kind of my philosophy. Because there’s no way that a doctor would give an experimental drug to a pregnant woman. No way. Yeah, if they thought that it was going to cause any harm, they’d be like, “Nope, no way. It’s not worth it.” That’s because they’re so scared of liability. Again, if it makes sense for them to do it to pregnant women, I think it makes sense for most women, or men, even for that matter as well. That’s sort of my philosophy on TSH. Yeah. I don’t know, do you have a range that you prefer that you think works best for people? What do you think about that?
Dr. Amie:
No, I’m the same as you. I find if someone is on, I mean, we see this with T4, but more so whenever T3 is in the mix, whether it’s NDT or Cytomel, lio, coming in. That’s going to push the TSH down. So, it’s almost like, to a point where I don’t even really pay attention to I that much. I’ll glance on it, but it’ll come into play if, let’s say someone actually is in a hyper state and their Free T3 and Free T4 are through the roof, and they’re anxious and they’re jittery and they have insomnia and all that, that goes along with it, but losing weight.
Dr. Amie:
But most of the time, I don’t even pay attention to it. It’s like, oh yeah, it’s low. Then you take the thyroid cancer patients that had thyroidectomies, radioactive iodine, you want to keep their TSH low. So, there’s another argument. You had the pregnancy argument, then you have the thyroidectomy patient or post-cancer, post-thyroid cancer patient, where we want to keep that TSH low, if not suppressed, to reduce the regrowth of tissues. Again, if we could do it in them, okay, so we’re going to roll the dice in them and in pregnant women, but not in the normal population. It makes sense.
Dr. Childs:
I totally forgot about that, but that’s 100% true. I need to use that more as an argument because you’re right. If I could just elaborate just real quick. I know we’re probably running short on time here, but so what you’re saying is that … People who have had thyroid cancer, they intentionally suppress their TSH after their thyroid has been removed. The reason is simple. The TSH stands for thyroid-stimulating hormone. The last thing you would want to have happen in a patient with thyroid cancer is to leave a little bit of tissue, right?
Dr. Childs:
Because no matter how good your surgeon is, there’s always going to be a little bit of tissue leftover. And then to have a little bit of that tissue be sensitive to this TSH, the TSH comes and stimulates the thyroid cancer to grow. In which case, you have a worse scenario than you did originally, because it’s going to be hard to detect because there’s no gland there. So, it’s going to grow and get much larger. Endocrinologists know this. So, what they do is they intentionally suppress the TSH, so your body’s no longer producing that thyroid-stimulating hormone, and they do that by giving excessive medication.
Dr. Childs:
The argument is, if you’re willing to do that in a cancer patient, why would you not be willing to do it in other places? By the way, where’s the data showing all the cancer patients who have suppressed TSHs, how high levels of atrial fibrillation, and so on. By the way, you’re making the risk versus reward on behalf of the cancer patient without even really talking about them. Because what you’re saying is, I’m really okay with you having a slight increased risk of osteoporosis and atrial fibrillation, if they exist, for the benefit of you not having that thyroid cancer come back, right?
Dr. Childs:
That’s really the risk versus reward thing that they’re taking. Now, why doesn’t that exist for somebody who is, let’s say a 45-year-old woman who is 50 to 70 pounds overweight, and would rather have that slight increased risk, but be a normal weight and have more energy levels and be able to play with their children and grandkids and so on, probably not grandkids at 45, but you know what I’m saying. I think it needs to be thought of in those terms, and I think that would be a better discussion.
Dr. Childs:
As opposed to just saying TSH suppression, always bad all the time. Never do it. Also be scared of it. I really don’t like that argument. I think it’s a bad argument. I’ve never heard anybody counter those arguments, at least yet. I don’t know. Because I know some people are anti-suppressing the TSH, but what is the argument? What is the logic behind that? I don’t know where that argument stems from.
Dr. Amie:
That’s true. Yeah, they’ll stay there point, basically what they learned in med school, and then they won’t back that up. I mean, since you were there, my last question for you, since you were in med school and you went through all this, why don’t they give you like six months of thyroid training? Because it is the master gland. I mean, you’ve seen it in all of your work. If you fix that, if you balance that out, all of a sudden, hey, cholesterol numbers look better, insulin comes down. Oh, look at that. People are feeling better. Their blood pressure’s coming down. Oh, they don’t need that antidepressant. Why don’t they spend more time on the thyroid?
Dr. Childs:
I wish I had to go down for you to answer for you. I don’t know. You know what’s funny though, is there’s a discordance between thyroid physiology and the practice of medicine. This exists in a lot of places, by the way, in medicine as well. I remember having discussions. The thing is, when you’re a first-year medical student and you’re learning about physiology and anatomy, it’s just being thrown at you at such a rapid rate that it’s sort of like, a lot of it goes over your head. I mean, you’re memorizing it, you’re answering questions on tests and so on.
Dr. Childs:
But some of it is just so esoteric that it’s just flying over your head and you’re like, I don’t know what’s going on here, but we did talk a lot about thyroid function. I remember having that physiology class where we were saying, this is what T4 does. This is what T3 does. This is the conversion of T4 and T3. This is the enzymes which catalyze this reaction and so on. So, we talked about the physiology of it. The problem is the breakdown between the physiology to clinical practice. This happens quite a bit.
Dr. Childs:
So, you have an over oversimplification of a very complex physiologic system into something that’s just relegated to checking the TSH and then treating with levothyroxine. I think the disconnect is this gap, is physiology to practice. I tend to live more in the physiology area. I like to look at what is happening at the cellular level with direct function? How is T4 going to T3? What nutrients are required to catalyze the reaction between T4 and T3. Now, do people have deficiencies in that reaction? And so on.
Dr. Childs:
That I think is the … Well, I mean, I’m biased, but that’s how I think the best way to look at it is, because if you just look at it at the other end and say, well, the TSH levothyroxine, that’s all you need for this incredibly complex system, which took us hours to learn about. But at the end of the day, it gets distilled down to this, that just seems like a cop-out. Now, but again, I don’t have a good answer for you other than it’s just dogma, and dogma is incredibly hard to break. It’s hard to change, and it exists in a lot of other places in medicine, and even sciences. Breaking that dogmas is so, so, so difficult.
Dr. Childs:
There’s this infamous study that I study all the time, and it says that, basically it takes about 17 years for current research to make it into the hands of doctors. So, if research came out, what are we … 2021, it’s dangerous doing math, but let’s say so research that came out in 2004 is now finally being practiced by doctors in 2021, right? That’s the length of time it takes for the actual science to be practiced. People will look at you and I, and they’ll be like, “Well, if this were really true, my doctor would be doing it.”
Dr. Childs:
No, not really. There’s in fact, there’s a very high chance they wouldn’t. The thing is, there’s a lot of people, I’ve been on the other end, so I know that doctors, they’re not reading medical journals, they’re not doing what we do. We have to read, we have to understand, we have to experiment. We have to do these things. If anything, it’s going to be many, many years before they catch up. The soonest is 17. And then that doesn’t even count the fact that you have this massive force in the form of levothyroxine and Synthroid pharmaceutical companies trying to discredit all of this information to say, no, this isn’t correct. Like, don’t listen to this. It’s going to be levothyroxine and TSH for the next 50 years.
Dr. Childs:
Then, on the other end, you’ve got all these thyroid patients who are screaming, suffering, and all these surveys that I link to all the time and talk about just how unhappy thyroid patients are, and it’s like, what is happening? I don’t understand it completely. I just am in the middle of this, trying to wade through it and figure out what is going on between the doctors, the pharmaceutical companies, the thyroid patients, and then everything in between. I wish I had a good answer for you. I don’t know.
Dr. Amie:
No, that was pretty good though. I mean, I’ll expand just a little bit. I gave a talk to a group of integrative physicians. We talked about the testing, why not test Free T3 Reverse T3 and getting out of the Synthroid box. And I would say you guys are in the Synthroid box, right? If you have a patient that is depressed, you’ll try this antidepressant. If that doesn’t work, you’ll try another one. If that doesn’t work, you’ll try two of them, and we’ll tag on an anti-anxiety med.
Dr. Childs:
Exactly, yeah.
Dr. Amie:
But thyroid, you have one thing. You’re in the Synthroid box, the one doc raises his hand and goes, it’s all we’ve learned.
Dr. Childs:
Yeah. That’s unfortunately true.
Dr. Amie:
Thank you for the honesty, but yeah, it seems like … I have heard the theory that, like you said, pharmaceutical companies like Synthroid, kind of donate to med schools, who knows, and nudge, nudge, make sure you teach about T4 only and using Synthroid. I mean, who knows? I mean, there’s a million different theories that we could go into down a rabbit hole. But yeah, I mean, that’s what docs are being taught. So, it’s almost like you can blame them, but not blame them. You got to come out of med school and do your own research like have. You can’t just stick with what you learn in med school.
Dr. Amie:
I also heard one great med school professor stand up and say to the graduating class, in three years, 50% of what you learn here will be obsolete.
Dr. Childs:
Yeah. They taught us that to a medical school as well. But the problem is, it’s not countered by a lot of heavy research. In fact, I did a podcast with him with another, he’s an MD and he’s a good friend of mine, he practices, but he was in the conventional work for like 20 years. We talked a lot about this and what happens on the other end. It’s not as sinister or conspiratorial as people might think. It’s just that the majority of the money comes from pharmaceutical companies and they’re the ones funding the research.
Dr. Childs:
So, no pharmaceutical company, it’s this simple, no pharmaceutical company is going to pay, I don’t know, let’s just say $50 million to check if zinc and selenium and iodine, in combination with each other, is greater than levothyroxine. They have nothing to gain from that study. The only thing that they can gain from that … The best-case scenario is that it shows nothing. Worst care scenario is that it shows that zinc, selenium, and iodine are more effective than levothyroxine. I mean, I don’t think that would happen, but think about what they have to gain from that. Who else is going to be putting $50 million into it to test something like that? It’s just not going to happen.
Dr. Childs:
People are like, well, I’ll use it when it sets in. I’m like, you’re never going to use it. And there’s going to be a lot of other people who are feeling better and they’re doing the thing that maybe their doctor didn’t say, but people are just so dead set on following their endocrinologist or doctor. I mean, if that’s what you want to do, that’s fine. I just think that there’s different ways to look at this. I get frustrated with that sort of mentality because again, I don’t think it’s spiritual, I don’t think there’s anything sinister going on in the background. I think it’s just a simple money game. I think it’s just, that’s what gets the funding and that’s where we’re at.
Dr. Amie:
Yeah. Then our job is just to bring the information to the people and try to guide them and help them and kind of think outside of the box and do the research to present the information that is out there that can help you. Simple things like zinc, selenium, and iodine actually. Your thyroid. Yeah. Well, this has been great. I mean, I’ve enjoyed this so much, like I said, for … I mean, I’ve been listening to your podcast, and we sound so much alike. You’re like my male doppelganger in the thyroid world. So, I love doing this. This is great.
Dr. Childs:
Yeah. It was actually a lot of fun. I’m trying to remember all the things that we talked about, the long string of conversation topics that led us here, but yeah, we talked a lot about weight loss, weight gain, Reverse T3, thyroid lab testing, cortisol, and then also just the problem, I guess, with lab tests and TSH suppression and so on. But yeah, we had a really good conversation. So, thank you so much for inviting me. It was really enjoyable for me as well.
Dr. Amie:
Absolutely. Absolutely. We will have to do it again.
Dr. Childs:
Let’s do it.
