T3 and Weight Loss Q & A for Hashimoto’s, Thyroidectomy, & Hypothyroidism with Dr. Amie Hornaman

Interview Q&A with Dr. Amie Hornaman on T3 and Weight Loss for All Thyroid Patients

Show notes & links from the video

Today I have Dr. Amie Hornaman on my podcast for a follow up Q & A based on our previous podcast! Dr. Amie is known as the thyroid fixer and both her and I share a similar philosophy when it comes to treating and managing hypothyroidism, Hashimoto’s, and thyroidectomy patients. 

Our conversation today focuses mostly on T3 thyroid medication, how to use it, who should use it, its safety, how it impacts thyroid lab tests, and much more. We also talk a lot about weight loss and common pitfalls that thyroid patients face when they try to lose weight. 

You can learn more about Dr. Amie Hornaman on her website.

If you have any additional questions please be sure to leave them below so we can do yet another follow-up Q and A. 

Topics and questions discussed in this video include:

• Do we all need T3?
• Using T3 if you have a thyroidectomy, is 5mcg a good starting dose, and should I worry about lowering my TSH? 
• Risks vs rewards of TSH suppression and low TSH
• Can you be hypothyroid with a low TSH
• When is the best time of day to take T3? Is taking T3 at night safe and effective?
• Is taking levothyroxine at night better than in the morning?
• Taking T3 before you drink coffee
• Making tweaks to your thyroid medication when you are completely optimized vs when you are trying to optimize your dose
• T3 and T4 sublingual absorption. Can you take your thyroid medication under your tongue? 
• How can I lose weight, balance immune function, and improve my thyroid numbers if I have Hashimoto’s? 
• How thyroid function impairs other hormones downstream which then makes losing eight more difficult
• When to use sustained release T3 and how it compares to immediate release T3
• I can’t lose weight even when eating 1650 calories per day, what can I do to lose weight? 
• Why reducing your calories as a hypothyroid patient can lead to thyroid damage and problems with reverse T3
• What is a good starting dose of berberine for weight loss? 

Audio Transcript

Dr. Childs:

Hey guys, Dr. Childs here. Today I am joined with Dr. Amie Hornaman. Dr. Amie Hornaman and I, we had an interview podcast a couple of months ago, I think now and it was received pretty well. We had a ton of follow-up questions. And so what we wanted to do today is get back together and go over a lot of those questions and answer some of the things that you guys had or that were pressing on your mind. So, Dr. Amie, welcome to the show. It’s so good to have you again.

Dr. Amie:

Hey, Dr. Westin, thanks for having me on. Thanks for joining me, and this should be a lot of fun, because I got a ton of questions too.

Dr. Childs:

Good. Good. And by the way, just so everyone knows, this will be a joint podcast like our last one. So it’s going to go up on my podcast. It’ll go up on hers as well. So you can listen to it in either place. It’ll also end up on YouTube and a couple of other places. So, Dr. Amie, she has a bunch of questions, so I’m going to hand it over to her, and then we’ll just go back and forth on these questions and it should be pretty good.

Dr. Amie:

Sounds great. So, when we were talking last time, you and I dove into T3, because we both love it. We both use it, we recommend it. So I had a lot of questions on T3 that I’m just going to throw out there and you and I can discuss. We can go back and forth. So the very first question and I find this interesting because it’s true. Do we all need T3? What is your take on that?

Dr. Childs:

Yeah. So the way that I like to approach these things is I like to, sorry about that, I like to look at physiology. Okay. And so if you look at the thyroid physiology itself, it says a lot. And then what I do is I work backward from there. So if I know for instance that a younger person has X amount of testosterone, X amount of progesterone, estrogen, and thyroid hormone, and then I look at that as the prototype of what I would want somebody to have in order to feel optimal.

Dr. Childs:

And so when you look at thyroid physiology, the physiology shows that humans, they produce some amount of T3. Now, when you look at the studies, it’s variable. I like to use the 20% rule. So the thyroid gland is producing about 20% T3 and about 80% T4. So when you look at it in those terms, my response is if you are going to replace lost thyroid hormone, because you’re hypothyroid, meaning your thyroid is not producing enough thyroid hormone, then you better probably at least approximate what the body would do in that natural state.

Dr. Childs:

So with that in mind, I like to use that 20% production of T3 thyroid hormone from the thyroid gland as a starting point for most people. So my general recommendation for most patients and this isn’t true universally and we’ll probably talk about this as we go, is that you at least think about adding in 20% T3 to whatever amount of T4 that you are taking. Now that amount can be variable, but that’s how I think about it in those terms. Now we can go even deeper and say, do people require T3?

Dr. Childs:

Well, yeah. People do require T3, but they don’t have to take T3 necessarily to get that T3 and I think that’s where a lot of the confusion comes in and that’s this concept of T4 to T3 conversion and where that occurs and how much you need and how well you’re able to convert and so on. But from a philosophical level and a physiologic level, yeah I do think people, obviously, they need T3. I think people benefit from the addition of T3 with their T4. So that’s where I sit. What do you think?

Dr. Amie:

Well, 100%. I mean, that’s why we jive so well together because we agree on so many things and we say so many of the same things. So, I say the very similar thing, 80/20 split from your thyroid gland when it is working, when it’s producing the correct amounts of T4 and T3. We see in general, like you said, an 80/20 split. So if we consider the fact that every cell in our body has a receptor side on it for T3, if you’re not converting T4 to T3 or, and this is going to lead into our next question, if you’ve had a total thyroidectomy and we remove the gland that was producing T3 and we remove the main conversion gland and we take that away, then T3 is necessary.

Dr. Amie:

I would go so far as to say required. I see a lot of practitioners just using T4 in total thyroidectomy patients, which is wrong. So yes, just like you, I believe we need T3. I do see improvements when we use T3, especially in patients that are having trouble converting, definitely in patients that have had a total thyroidectomy, radioactive iodine, even partial thyroidectomy because you removed part of the thyroid glands. So yeah. That’s where I stand there.

Dr. Childs:

Go ahead. Sorry. Let me not interrupt.

Dr. Amie:

Oh, I was just going to say that leads into the next question of having a total thyroidectomy and her doctor only giving her five micrograms of T3, but go ahead, finish your thought. We can dive into that.

Dr. Childs:

It’s perfect actually. It goes right into this. So I did an article where I talked about using T4 only in the cases of thyroidectomy. And so it shows that when you take people who don’t have a thyroid and you give them level thyroxin, which I think everyone knows this, but level thyroxin contains only T4. When we talk about T3, these are special medications that contain T3. We’ll talk about those cytomel and liothyronine, even some natural desiccated thyroid formulations, and so on.

Dr. Childs:

But most patients who have no thyroid, they are given only levothyroxine, which is T4. And when you look at these patients and then you look at healthy cohorts and you compare them, you see that the people who no longer have a thyroid taking only T4, never have the same level of T3 as those people who have healthy thyroids. This leads us to believe, or at least this leads me to believe, the conclusion I draw from that is there’s something special about the thyroid gland that’s necessary to get those T3 to healthy levels.

Dr. Childs:

Okay. So what you were talking about, I absolutely agree with, and that is if you have no thyroid and also I would include in here, those who are in End-Stage Hashimoto’s, which I do think those people get neglected a little bit. Not neglected, but I think they get… They’re included in this group. I think that those patients benefit tremendously from the addition of T3.

Dr. Childs:

Now this question is also I think, a good one which I think we’re going to talk into or talk about in just a second and that is how much T3 do you actually need? Because five micrograms, like we’re going to talk about is a baby dose. That’s a micro dose. So, I just wanted to mention that, but yeah, go to the question.

Dr. Amie:

Yeah. I mean, so she had a total thyroidectomy, the doctor will only give her five micrograms of T3 and she still has hypo symptoms, but her doctor is saying he does not want to give her more due to TSH already being suppressed. So there are two questions in one there.

Dr. Childs:

Yeah. So I guess the question is, and we talked about this previously. We talked about the idea of lowering your TSH, suppressing your TSH, and whether or not that’s dangerous or whether or not you should do that in that setting. Now, I will say this, when it comes to T3 dosing, I think that’s a little bit separate than the TSH suppression thing. But I will talk about that first then we’ll talk about the T3.

Dr. Childs:

First of all, I would say that T3, the five micrograms is pretty much a baby dose. I think, if you’re familiar with T3, which most doctors are not, that’s what they do. Endocrinologists will say, “Oh, you’re on 100 micrograms of low thyroxin and you’re you probably have low T3.” And they’re like, “Well, what am I going to do here?” And so they’re like, “Let’s throw in five micrograms of T3 and see where that puts you.” But that’s not doing anything. In a way, it’s like peeing into the Atlantic Ocean. It’s not going to change anything there.

Dr. Childs:

And so they get a little worried about that because the endocrinologist knows that as they increase the total amount of thyroid hormone that you’re taking, that will lower the TSH even further. It doesn’t always make sense because the whole idea in a lot of cases, especially if you had your thyroid removed, you’re aiming for that TSH suppression. They want that because that reduces the risk of cancer occurrence.

Dr. Childs:

So if on one hand, you’re going to say, “I’m afraid to give you T3 because I don’t want to suppress your thyroid.” And at the same time, you’re thinking in your head, “I need to suppress the thyroid because we don’t want to increase the risk of cancer.” These things don’t really jive with one another. You’re not making sense. It’s a little hypocritical. And so I think that’s where you can point to a doctor and say, “Do you really know what you’re talking about? Because this doesn’t really make sense.” Physiologically, it’s okay to suppress it. So why do you care if it’s suppressed with T4 or T3? That shouldn’t matter.

Dr. Childs:

If I do need suppression, because you’re worried about the risk of cancer, then why do you care how I get there? I guess, what was she talking about in this question, I glossed over that. Was she saying she was not feeling very well regardless of taking this?

Dr. Amie:

Correct? Yep. Still having hypo symptoms.

Dr. Childs:

Still having hypo symptoms. So yeah, that would be very common and that leads back to what I was saying previously, and that is a baby dose. All right. So if you go back to what we talked about previously with thyroid physiology, the 80/20 rule, if you’re taking 100 micrograms of T4, you want about 20 micrograms of T3. And that, by the way, is just the starting point. You might have people who need 30%, 40%, 50% of T3 compared to their T4, even 100% of T3. You have this metric of T4 over here and T3 over here and they can go up and down depending on the individual. I just start here and then figure out what I need to do.

Dr. Childs:

I would say, yeah, it doesn’t really matter even if you have a suppressed TSH, even if you’re on T3, if that dose of T3 is insufficient. So it’s a complicated topic, but that’s what I would say to her briefly. What about you? What are your thoughts on that?

Dr. Amie:

I agree. Coming back to basic physiology, let’s remember what TSH is. I think so many doctors, they get out of med school, they start practicing and if they’re not specializing that she’s seeing an endocrinologist, I get that. But as you and I know most endos don’t deeply know the thyroid and thyroid function. So if we go back and we look at, okay, remember TSH is a pituitary hormone. It’s not a thyroid hormone. So we can’t measure whether this woman is hyper, which I’m sure her doctor is saying that she’s hypo because her TSH is suppressed.

Dr. Amie:

We can’t measure that on TSH alone. We have to look at now, she didn’t provide what her Free T3 and Free T4 numbers were or her Reverse T3, but when we look at that whole picture of taking into account, all of the different thyroid values, and then asking that person, how do you feel? And there’s still that presence of hypothyroid symptoms that haven’t been alleviated yet, then we get that full picture instead of just being tunnel vision into the TSH alone, which I think is the incorrect way to treat a person.

Dr. Childs:

Yeah, absolutely. I think there’s a lot of confusion. And even with the language that we use, by the way, I feel like we need to come out and state what a hyperthyroid state is, what a hypothyroid state is because endocrinologists who will tell patients they’re hyperthyroid, then they’ll come to me and I’m like, you’re hypothyroid. And then you’ll have hyperthyroid patients with Graves’ disease who have their thyroid removed and they’ll be saying, “I’m hyperthyroid.” I’m like, “No, no, no. If your thyroid has been removed or ablated, you are not hyperthyroid.

Dr. Childs:

You may become hyperthyroid if you’re taking excessive thyroid medication, but in the current landscape, that’s very rare. Most people are underdosed, not overdosed. And so the language I think in this setting matters. And what you hear and how you hear it also matters. So in this case, a lot of endocrinologists will be telling patients their hyperthyroid because their TSH is low. And as you just said, I think perfectly that often is not the case. In fact, you can have a lower suppressed TSH and still be hypothyroid, and that’s probably more common than taking level thyroxin and becoming hyperthyroid.

Dr. Childs:

So, in the case of a low TSH, but in the absence of hyperthyroid symptoms, hair loss, weight gain, well different types of hair loss usually, but diarrhea, weight gain, hand tremors, rapid heartbeat, heart palpitations, et cetera. I can almost guarantee you are not hyperthyroid even with a low TSH. You could take 500 micrograms of level thyroxin and I promise you that will drop your TSH to a suppressible level and yet you will not feel well. Most people probably will not. And so it’s not until you actually tweak that dose of T4 and T3 to get those dialed in that you will then start to alleviate those hypothyroid symptoms.

Dr. Childs:

And yes, you might end up with a lower suppress TSH, which is what we talked about previously, but that may not be a problem. Or at the very least, it may be the thing you’re willing to risk for the benefit of having a healthy life and living your life in an optimal way. And so I think that’s really, really, really important when it comes to thyroid. And so often just glossed over by an endocrinologist. They take this stance where they’re like, “No, this is the way we’re going to do it. Your TSH must be here. And if you have symptoms and weight gain and depression and hair loss and whatever it is, then that’s just it. You’re just going to have to deal with that.” I think that’s an unacceptable way to approach that risk versus reward payoff of thyroid management.

Dr. Amie:

If you look at the whole picture, the amount of people, the amount of lab results, thyroid lab results that you and I have seen over the years, how many times do we see a suppressed TSH, including myself, most likely and your wife too, because we touched on her the last podcast that there’s no indication whatsoever of hyper? None, zero zip. So even from a research standpoint, when we’re taking that amount of data, and we’re looking at all of these people, let’s say there are 100 people between the two of us. All of them have suppressed TSH values. None of them are experiencing hyper symptoms. None of the other thyroid lab results are indicating hyper. I mean, that completely rules out going by TSH alone to diagnose.

Dr. Childs:

I agree completely. And nowadays, there’s wearable technology. My wife was going crazy. I threw it across the road cause it wouldn’t shut up. I couldn’t turn it off, but that’s a wearable technology, which gives you a measurement of your heart rate. Okay. So if you were actually worried, we have 24/7 moderating of your heart rate. If you were worried that you were hyperthyroid, this would be reflected in your heart rate. And if you were sleeping and your resting heart rate is 65/70 or even 50 in the hypothyroid case, and it’s not 90, 100, 120. Then there is basically zero chance that you’re hyperthyroid.

Dr. Childs:

Now yes, heart rate is not a perfect reflection of thyroid function, but it’s a pretty good proxy reflection and it can be used in certain cases. And so what you’ll see if you’ve ever treated a hyperthyroid patient, I know you probably have, but as a patient, you probably would never see this, but they come in and their heart rate resting is 130/140. Okay? So how can they tell you that you are hyperthyroid with a resting heart rate of 65, 70? That’s half of what it would be if you were truly hyperthyroid and with wearable technology like that, just grab a Fitbit, grab an Apple watch, whatever it is and put it on. And you can look for yourself. It tracks it 24/7.

Dr. Childs:

It’s a really simple, easy proxy for determining where your thyroid is at. Not perfect. Don’t assume that this is going to say, “Well, my thyroid is good or bad because of this.” Because it can be influenced by medications, beta, blockers, et cetera. But it’s a pretty good way to just start there. And then there are other measurements as well as if you were really worried about which we talked about last time echocardiogram and DEXA scanning for the bone density and whatnot. So there are things that you can do as well.

Dr. Amie:

Exactly, exactly. I love that. So moving into timing of T3, which I actually find this interesting too, because personally, so I’m on T3 only. We talked about that last time and I dose mine first thing upon waking. So that’s usually around like 6:00 or 6:30 am. I take my second dose around 2:00 PM. I cannot go 12 hours because if I took my second dose of T3 at 6:00 PM, I already have sleep issues. That’s the last thing I need is for T3 to be peaking at 10:00 PM and then screwing up my sleep. Now I know some advocates say you need that 12-hour. You need the same time every day, and it has to be 12 hours apart. So this question is when spacing T3, what is the ideal time to take the next dose?

Dr. Childs:

Yeah. I’m going to probably go against the grain here. This is just based off my own experience. And so, what you’ll find by the way, as you’re listening to this is that different practitioners, providers they lean in certain ways and it’s fine. I think a lot of thyroid patients will get confused and they’ll be like, well, he said this and she said that or whatever and they’re like, “Who’s right?” I’m like, “There’s a world in which we can all be right in whatever microcosm we live in. And so this is what I would generally do.

Dr. Childs:

I actually, previously I’m not practicing or providing medication right now, but I had a lot of experience in doing this in the previous years. I use a lot of T3. I would actually tend to recommend using T3 in the evening provided it did not interrupt your sleep. So it sounds like you are probably one of those sensitive people who tend to, I shouldn’t even say sensitive, but it just tends to amp you up a little bit. That definitely happens in some percentage of people. I think a lot of people can handle it. My logic behind this was number one, I put priority on T3 pretty much in every aspect.

Dr. Childs:

And so when it comes to absorption, I like it to be given in the night because I think it allows for unopposed absorption throughout the entire evening and a rise in T3 around the time that cortisol would be rising as well. Not exactly as you said, it’s probably peaking truly in the middle of the night, but at least it’s coming down and cortisol is supposed to be peaking in the morning as well.

Dr. Childs:

So my philosophy there was let’s not put anything in the mix in terms of food or other supplements or anything like that, which could interfere with this absorption. We’ll maximize absorption and then try and peak it around the same time as cortisol. And then if they were taking another T4, T3 combo, which would be usually like NDT or Tirosint which is what I would prefer to use if you are taking T4 that would be taken in the morning. So I would do a night morning sort of thing.

Dr. Childs:

That’s where I would start. And then from there, you can determine, okay, are you somebody who has an afternoon slump or a morning slump, or a mid-afternoon slump? Do you need to take it two times per day? Do take it three times per day? Do we need to split your T3 dose total and take some in the night and some in the morning and vice versa? And so you have to play around with it and my philosophy will start there and then determine how you can play around with it at that point.

Dr. Childs:

I will say this too, just because I want to put this out there for those people listening. I’ve really never found a thyroid patient that couldn’t find success with tweaking all of these variables. So there’s so many little levers and knobs that you can pull, that you can twist, that you can turn. And between all these things, different medications, different formulations, sustained release, immediate release, and so on taking it, three times per day, four times per day, once per day, you have so many options available to you that you can pretty much always find something that works for every single person.

Dr. Childs:

Now I will hear people that will say, “Oh, I tried so many different things that didn’t work.” I’m like, “There are hundreds of variations that you can do.” And as long as you have somebody that will just keep pounding that door down and pounding their head against it, you will find something that works for you. So that’s where I start. It sounds like we are somewhat different in that approach, but I like to hear what you think about that.

Dr. Amie:

Well, not totally different. I say the same thing about the variations and combinations and ways to do it. I mean, there’s so many. You can’t get stuck in what you first learned when you were first diagnosed, which was here, take Synthroid. Take it in the morning, call it a day. Because there’s so much more we can do. There are different medications. There’s different timings of the medications. There’s different combinations. Like you mentioned earlier, we can even change that ratio of T4 to T3 if you’re taking an NDT and we add T3 in, now we’ve changed that 80/20 ratio to maybe a 60/40 or a 50/50 split. So there’s so many different things we can do.

Dr. Amie:

Now, that being said, what you just said, two comments, number one, I will try to take my T3 right before bed because I’ve only ever tried it later in the day. I’ve done like 4:00, 5:00, 6:00 PM mark. So it was a 12-hour split. So I will give it a try and I’ll let you know how it goes taking it right before bed, because maybe if you take it then it won’t interfere with my sleep because my trouble is getting to sleep, not staying asleep. So I will give that a try. Now I did see a study and I’ll have to dig it up. I’ve saved it somewhere because it was that interesting. And of course, whenever you’re looking at the medical literature, research papers, you have to really look at the variables and what is the actual standard deviation and how much difference did the results actually make.

Dr. Amie:

But there was one study that I found that I should be taking T4 right before bed, just like you said, Westin, improved absorption. We have that TSH circadian rhythm where TSH rises right before bed. And then of course just better… Nothing in your stomach. Most of us don’t eat an hour or so before bed. So you go to bed on an empty stomach, you take your T4 before bed, and then it has time to work. Now you’re not going to have the same cortisol response in the morning as if you took T3 before bed. But I also heard that T4 is better taken before bed. Have you ever seen that or read that study?

Dr. Childs:

Yeah. In fact, In almost all my articles, I always recommend people take all thyroid medication at night to start with. Because I’ve seen it happens so many times that… So let me take a step back and look at thyroid patients as a whole. They’re frustrated, they’re struggling. A lot of them are. I try to come up with just simple little tweaks that I can recommend to them that’s within their control. Because a lot of the things we’re talking about to get T3, you probably need a doctor and you need someone to prescribe it. But if all you have to do is switch from taking your T4 from the morning to the night, that’s something you could do. That does have potentially a profound effect on the person taking it.

Dr. Childs:

So I do talk about this a lot in a lot of the articles that I write. Because I’m like, “Hey, you don’t really have anything to lose. Take it at night, right before you go to bed.” And there are some people, it’s a small percentage, maybe five to 10% of people who see a really big difference just with that one change. I will say too, let’s think about our lifestyle. What do people do when they first wake up? A lot of people, they have some form of coffee or caffeine. Caffeine, I don’t know or tea, stuff like that. Energy drinks, whatever it is. Those things stimulate the gastrointestinal tract, which means that if we’re thinking about this in terms of thyroid medication, you take your thyroid medication. Even if you take it an hour or two, before you have your coffee, it’s still going to be in there absorbing through some period of time.

Dr. Childs:

If you accelerate the rate at which it travels through the GI tract, that’s less time it spends getting complete absorption. So the philosophy here for me is to take it right before bed. Literally right before bed. Put it right on your nightstand. There’s nothing else there. Glass of water nightstand, because yes, you’re going to have dinner. Maybe you have dinner at 7:00 PM, but the last thing you do right before you lay down in your bed is usually not have a snack, at least for most people. So if you just take it right before you lay down in bed, I think that then you have the entire night to allow that absorption.

Dr. Childs:

And then also going back to what I said previously, most people have their bowel movement in the morning. A lot of people use coffee to stimulate that. So that’s why I do recommend the evening dosing of thyroid medication with the caveat that if you are one of those people that it keeps up, then definitely don’t do it because the downside will outweigh the benefit if you are somebody who can’t sleep. Because sleep is so important for virtually every aspect of health.

Dr. Amie:

I love that. Now I’m going to try it. I’m going to try. I’m going to try right for that.

Dr. Childs:

Don’t get mad at me if you stay up all night.

Dr. Amie:

But it is true though. I mean, I do tend to, and with T3 and you can tell me if you agree on this or not, with T3 you have a little more leeway than you do with T4 when it comes to coffee. So I can take my T3 in the morning and I can drink coffee, maybe half an hour to 45 minutes later. Now it maybe it’s the dose I’m on. Maybe it’s because I’ve been on it for 20 years. Maybe it’s because my body’s just optimized that some of it’s not getting absorbed and I just don’t even know it because I feel good.

Dr. Amie:

Don’t do you agree or have you seen the T3? You have a little bit more, I hate to say this because then people start doing it. You have a little more leeway with T3 than T4 in terms of coffee?

Dr. Childs:

I think that’s probably true generally. I can say it with somewhat with some hesitancy because I’m like, oh, what are people going to do now? Because it’s a fickle thing. And here’s another thing too. This might work for 25% of people and not the other 75%. So if you have this huge number of people trying this and then it doesn’t work for the rest of them, and we’re like, “This didn’t work.” But yeah, I think that’s probably true because I do think it’s absorbed rapidly, especially compared to T4. I don’t know why that is. I just think it’s probably more immediate absorption compared to T4.

Dr. Childs:

So yes, I would agree with that statement generally, but just for anyone listening to it, just play around with it. Pay attention to what is happening in your body. If you take it and you feel worse or you notice you’re going down, well then maybe you’re not those people that can do this. So again, just pay attention to your own health. I think that’s probably one of the most important things I could say to people is that, your health is the most important thing you have. So spend some time reflecting on it and seeing what works for you and what doesn’t work for you. And when you spend that time and energy on your health, it’ll be paid back to you tenfold, I think. 

Dr. Amie:

I would say, if you are still suffering with symptoms, don’t even try to shorten that timeframe. You want as much time between that thyroid med and coffee, supplements, food, because you want that 100% absorption if we can get there.

Dr. Childs:

Absolutely. Yeah. I didn’t even think about that, but that’s totally true. The situation that you are in, the situation that my wife is in, you guys are already optimized. You’ve been optimized for a long time, years. Most people aren’t even anywhere close out optimization. Their goal is to become even like, 75% optimized. But if you know your body probably significantly better than I would say, the majority of thyroid patients as does my wife. And so I just, because they have more guidance and they maybe have a little more experience doing this thing, but yeah, if you’re not optimized, I agree with you. Do not even mess around with that. Try the evening thing before, because that’s something that could potentially improve your optimization.

Dr. Childs:

This is something that has maybe some impact on your routine and your schedule and your quality of life, but may come at the cost of some reduction in symptoms or increase in symptoms depending on how you absorb and your intestinal tract and whatnot. And also, I think another important thing is your gut function. You probably have pretty good gut function. You know how to eat. You’ve probably been eating this way for a long time. And if you’re somebody who has disordered gut problems or intestinal overgrowth syndromes, or whatever it is, then taking it like this is probably not a good idea either because your absorption is already compromised. So I’d add that thought in there as well.

Dr. Amie:

Yeah, no, definitely. Very, very true. Very true. And that leads me to my last question, then I want to get to some of your viewers/listeners questions. Tn terms of taking T3, and this is good. This is just a great segue. What about putting it under your tongue? Does putting T3 under your tongue and letting it dissolve, say you do have a gut issue, does putting T3 under your tongue actually help with absorption versus swallowing it?

Dr. Childs:

Yeah. So I did an article on this as well recently, so I’d recommend that for a more in depth evaluation of this, I would recommend looking at that. So here’s the way to think about that. The question as to whether or not thyroid hormone is small enough to be absorbed sublingually and has the right properties, can actually be absorbed under the tongue. And the answer is yes. Theoretically, it can be. Whenever you’re looking about sublingual absorption of things, you have to think about the size of it because here’s the idea, the idea is that certain medications can be absorbed under the tongue because there’s a rich network of capillaries under the there. So when something dissolves, it’s plausible that this substance can go into those capillaries, be absorbed in your blood and then push throughout the rest of your body.

Dr. Childs:

So people are like, “Okay, well then why don’t I just put everything under my tongue?” Well, it doesn’t quite work that way. There’s a membrane there. It must be absorbable. There must have certain properties. The outside of the molecule or the compound must be a compound that doesn’t reject that absorption because it either can’t pass through the memory, because it’s too big or because it’s charged and it’s getting attached to saliva or other proteins inside of your mouth. There are a lot of factors to think about. But when you look at actual T4 and T3 thyroid hormone, yeah, it turns out they are small enough to theoretically be absorbed under the tongue.

Dr. Childs:

Now the question is, is that actually plausible? Does it actually happen when you do it? I think the answer is it’s probably 50/50 depending on the person. I say that because there’s a lot of different factors, the pH of your mouth matters. How little can you get the compound? So if you think about the tablet of a T3 or a capsule, even depending on how you’re getting it, but let’s just think about it in terms of a tablet. If you were to crush that tablet into pieces, into a fine powder, you could put that under there. And that would increase the surface area because you have decreased the total size of this thing. You’ve smashed it out.

Dr. Childs:

So you’re increasing the chance that it could make it through that membrane. But if you chewed it up in your mouth and then put it under your tongue, that probably wouldn’t work very well. Likewise, if you wanted to get even more precise about it, you could do a liquid version like a Tirosint or something like that. That actually believe comes in a gel cap. You could break that up or you could get Tirosint-Sol and then you could put that under your tongue, because that’s already liquid. It’s already been mashed up and dissolved into a liquid.

Dr. Childs:

So yes, it can potentially work. There are also other things that you can do. I can’t remember them off the top of my head, but you can do things. I think it’s like increase the acidity of the saliva inside of your mouth. You can take it with some sort of acid to try and improve that absorption and so on. So are things you can try to do to tweak it. My general recommendation is give it a try. It’s one of those things that you can try and see, because worst case scenario, you mash it up or put it in a powder, stick in your mouth, leave it on your tongue for a couple minutes, five to 10 minutes where whatever it is.

Dr. Childs:

If it doesn’t get absorbed under the tongue, well, then it’s going to be washed in the back of your throat and you’re going to swallow it. It’s going to go down to your intestinal tract anyway. So it’s worth giving it a shot and seeing how it works for you. If I could distill down my article, that’s essentially what I say in there. So give it a try and if it works for you great, if it doesn’t, then that’s fine too. It’s like taking your thyroid medication in the evening. If it works for you, great. And if it doesn’t well, no harm, no foul. It didn’t hurt you in the process. So what do you think about that? Have you tried this before?

Dr. Amie:

I use that method on patients that have really disastrous GI tracks. So let’s say we did a GI map on them and they have H. pylori and there’s SIBO or there’s candida, especially candida.

Dr. Childs:

Pretty common.

Dr. Amie:

Yeah. Really common. I mean, it’s really hard to do with NDT because let’s face it, it doesn’t even smell good let alone putting it under your tongue. Oh, my goodness. But in the case of T3, if it is like you said, not a capsule, an actual pill. A hard pill, then try it. Yeah. Give it a try because if we can even increase your warp of that T3 by 20%, that’s huge. That’s a big deal in terms of your symptoms, in terms of moving numbers. So again, why not give it a try if you really have a messed up gut and it. Even if you have indigestion all the time. If you’re gassy and bloated after every single meal. I mean, granted you want to do some gut healing and address that, but if that is you and you’re on thyroid medication, put it under your tongue and see.

Dr. Childs:

This just adds one other variable that you can tweak in your regimen. So we have the time of the day that you take your thyroid medication. Whether or not you take it under your tongue, how you are taking. Are you mashing it up? Are you masticating it with your teeth or are you mortal and pestle it, putting it into a fine powder. And then the variations of T4 and T3, and then the formulations of T4 and T3. So like between all these variables, there are hundreds of different combinations that you can come up with. I promise you, there is some combination in there that will work for you, the person listening to this who is like, “Well, I’ve tried this and that and this and this.” No, I promise as long as you have somebody who is willing to go with you and guide you through this, you will find something that works for you. Did you have any thoughts or do you want to jump into some of these questions, but these have been good.

Dr. Amie:

No. Let’s jump into some of your questions.

Dr. Childs:

Okay. So I got some other good ones. So these ones focus a lot on weight loss, and actually we came over some of these, but okay. So let me read this one to you. And then I’ll throw this one over to you because I think this’ll be a good one for you. So it says, is there anything I can do to help let go of the weight while getting to a normal immune response and work on my thyroid numbers, in my own quotations, in the setting of Hashimoto’s. So essentially this person’s trying to lose weight and improve immune function and thyroid function with Hashimoto’s. So how can this person do that in your opinion?

Dr. Amie:

Oh, okay. All right. So for me, I start at the top. So let’s make sure that you’re optimized. You’re on the right medication. You’re taking it the right way. We’re doing all the different tweaks that you and I just talked about in terms of dosing and timing and time of day and delivery. And then we go down from there and we say, listen, most Hashimoto patients in my experience about 95% of them have some insulin resistance, because if the thyroid is off, then the insulin signaling will be off. Even the sex hormones are going to be off.

Dr. Amie:

So we have to now drop down and say, “Are you insulin resistant? Do you need to be on a low carb diet? Do you need to be on berberine to lower that insulin to allow your body to actually tap into your own fat stores for fuel?” And then when you do that, you’re taking down inflammation because insulin is so inflammatory. So right now you’re dealing with an autoimmune condition and you’re talking about your own immunity. Well, okay. There are things that we can do for our immunity and check those boxes like vitamin D and zinc and vitamin C. We can use black cumin seed oil or LDN to lower your Hashimoto antibodies. But then on the other side, we have to think about what are we doing to support all of your hormonal functions?

Dr. Amie:

If your insulin is high, that’s going to create inflammation and that’s going to drive autoimmune to go on attack, that’ll drive your soldiers that you have for Hashimoto’s. I always use the analogy of soldier that are going out and attacking your thyroid gland. Any inflammation in the body is going to spur on an autoimmune attack. So we know that gluten is a molecular mimicker to the thyroid gland. We know that that is going to spur an autoimmune attack, but I would argue as well, the inflammatory grains, the pufas, the bad oils, all of those things that increase insulin, not only is that going to make you gain more weight, prevent you from losing weight, but that’s going to kick up an autoimmune attack, which then down regulates your thyroid, which then down regulates your metabolism, and it’s just this vicious, vicious cycle.

Dr. Amie:

So thyroid first, insulin, sex hormones, progesterone, estrogen, testosterone, DHA, cortisol. We have to look at all of those. Once we balance all of that provided you’re doing the nutrients over here. Things start to happen and your body actually starts to tap into your fat stores for fuel and allows you to burn fat for energy. Yeah, how about you?

Dr. Childs:

No. That was amazing. That was a masterclass in how to treat Hashimoto’s essentially. 

Dr. Amie:

No, no, that was really good. That was awesome. Yeah. So agreeing with everything you just said, what I would add to that is I wouldn’t actually add on anything that I would just give my own philosophy, because like I said, that was perfect. First of all, a lot of thyroid patients, they struggle with weight gain. I get that because you have to think about what is the thyroid doing for your body? It’s regulating your metabolism. The majority of your metabolism is regulated the thyroid. So people will say, “Well, how can I lose weight with my thyroid?” You have to optimize your thyroid. End a story. If you’re taking level thyroxin, which most people are, and your TSH is like two and two and a half, losing weight…

Dr. Amie:

It’s like trying to run a marathon with, I don’t know, a tire strapped your back or something or pressing the gas and the brakes simultaneously. It’s just not going to work. So I usually talk to patients. I’m like, “Look, yes, we can absolutely help you lose weight. That is absolutely going to happen. But first, we need to optimize your thyroid.” And then what I think you have mentioned before, and we’ve talked about this, or at least alluded to it in previous questions and topics that we talked about is that the thyroid regulates a lot of other things downstream.

Dr. Amie:

And so what I will usually say is I’m like, “Look, let’s start with the thyroid.” If we optimize your medication, first and foremost, we put back in the things that the thyroid gland needs, we’ll find that a lot of these things will be cleaned up. A lot of them. You might even see improvement in sex hormones, your menstrual cycle might start to regulate itself. You’ll see at least some improvement in weight. It doesn’t usually completely reverse its help by fixing thyroid. You need to do other things like you said, insulin and so on leptin and resistance and whatnot. But some people do at least see some improvement in their weight.

Dr. Amie:

They’ll see these things start to be cleaned up as they approach or as they fix their thyroid function. And that usually starts with thyroid medication for most people. There’s a lot of people who want to do the natural route and I have nothing against the natural route. I just think that when it comes to managing thyroid function, you can get the best and most immediate return on your investment by starting thyroid medication first. And then if you want to down later on in six to 12 months, once your weight is normalized, once all these other problems have been cleaned up, we can start to wean you off of thyroid medication. See how that goes. But that’s where I always start.

Dr. Amie:

And if someone’s coming to me, in the past, that’s probably what they’re looking for. But if you’re somebody who wants to go natural and treat it, try and do it with diet and foods and things like that without touching medication, you can do that. It’s just going to take a little bit longer. The journey’s going to be a little more difficult. It’s going to have a little more bumps. It’s going to be slower. That’s fine though. It’s all philosophical. It’s whatever you want to do.

Dr. Amie:

So yeah, I don’t have much to add to what you said except that yeah, I would think about it in those terms. Fix the thyroid first, then the weight loss will come. Not because you are fixing the thyroid, because the thyroid is regulating other things like insulin and leptin and your sex hormones and your testosterone and everything else downstream. And those are the things that usually have the biggest impact in thyroid patients on their weight. It’s not actually the thyroid. I think it’s a cascade. I think it’s like the thyroid causes all these problems underneath it, and then these things contribute to the weight. But fixing the thyroid, you could still be overweight even though the thyroid is fixed, because you haven’t fixed the thing underneath it. So that’s how I look at that. Anything to add on that?

Dr. Amie:

No, I 100% agree. I always say both and, so we have to do the thyroid and change your diet and fix the insulin and fix the hormones. Because if we fix your thyroid all day long, we can optimize your thyroid and you’re still hitting McDonald’s, no you’re not going to lose weight. It’s not going to work. You’re going to evolve inflammation and your Hashimoto’s is going to spur on.

Dr. Childs:

This is something that I’ve been frustrated with because I think again, coming back to the language that people use is, and I’m sure you’ve probably seen this, but I talk to people and they always are thinking they’re eating healthy. They’ll tell me they’re doing things. We just must have different definitions of what these things are. I do my best to try and explain them. When I say this, this is really what I mean. I think that a lot of people who are like, “Oh, this makes sense to me. I’m already doing a lot of these things.”

Dr. Childs:

You probably are not. If you’re not seeing the results that you’re hoping for, reducing inflammatory oils. If that doesn’t make sense to you, if you’re listening to this and you’re thinking, “What are inflammatory oil oils?” Figure that out and remove those from your diet. We could explain it to you, but you have to be able to look at them. You have to be able to educate yourself enough, to look at these things and remove the inflammatory oils, to remove the process and refine carbohydrates and the sugars and the things that we’re talking about and these things that are causing inflammation and triggering all these down downstream like Amie said.

Dr. Childs:

So I just want to throw that little tidbit out there. Let’s do this because we already talked… I’m going to skip a couple of these just in the interest of time here. Let’s go to this one. This one says, what are your thoughts on sustained release T3? What do you think Amie?

Dr. Amie:

I have a feeling that we agree on this, but in general, I only use the sustained release T3 in patients that are super, super sensitive. So let’s say we’re using regular T3. We’re using cytomel liothyronine and maybe we’re starting at five. Now we said earlier, that is a baby dose, and I agree. That’s enough for your pinky finger, but we want to start somewhere and get you used to it and then gradually increase.

Dr. Amie:

So let’s say we start with that five micrograms once a day, twice a day. And you’re like, “Oh my gosh, my heart’s racing. I can’t take it. I have anxiety. I don’t know what to do. I feel like I’m crawling out of my skin.” Okay, well then let’s try the slow release because maybe you just need that trickle into your body very slowly through the day to get you used to it. But in general, someone let’s say optimal dose of T3 is 25, twice a day, 50 twice a day, 75, twice a day, slow release T3 is not going to cut it. You just have to take those double doses or the multi-dose through the day, however you want to time it and get that full dose in.

Dr. Amie:

I don’t think slow release really cuts it. I also see issues with different compounding pharmacies. Some are good. Some are man, not so good. I’ve had compounding pharmacies mess up the dosing in my patient’s medication. So unless you have a really good compounding pharmacy that you trust, you’ve been using for a while, you know they’re A1M1 and they will compound that slow release perfectly to the right dose for you, fine. But I than that, I’d like to try to avoid it when I can.

Dr. Childs:

Yeah. It’s funny we agree on almost everything exactly. But yeah, I would say that’s exactly how I think about it. There are people and I just want to throw this out there because people will say, “Oh, well, what’s a starting dose? What should I be on? If five micrograms isn’t enough, what should I be on?” I will tell you, I have seen people on anywhere from doses of as small as one half of a microgram, all the way up to 100 plus micrograms of T3, and everywhere in between.

Dr. Childs:

So it’s really hard to just say, well, the dose that you need five isn’t working, but it’s going to be 15. If I look at your labs and do some calculation, I can figure out what it is. It does not work that way. I wish it did, but it just doesn’t. You need to go through, you need to do some trial and error. You need to figure it out. So I would add that as a preface to what I’m going to say. The other reason that I don’t like using sustained release T3 or SRT3 is because I think only a fraction of it is actually getting absorbed.

Dr. Childs:

The whole point of using this medication or compounding in this way is to slow down the absorption. You’re making it intentionally more difficult to absorb inside the intestinal tract so that the system doesn’t get flushed with T3. Now that can be good if you’re somebody, like you said, who is very sensitive and gets heart palpitations and so on, which, by the way, heart palpitations aren’t even necessarily a harmful thing. It’s just a sensation. Most people will assume their heart palpitation means that they must be having heart pain or a rapid heart rate. That’s not true at all.

Dr. Childs:

Most heart palpitations are not even associated with a rapid heart rate. It’s just a sensation that your heart is beating fast. So I would push back on the idea that heart palpitations are somehow dangerous in any way, but some people are uncomfortable and I respect that. So that’s why this does have a place in some situations, but by reducing or slowing down its absorption, that can cut both ways. You might give somebody a 50 microgram dose of T3 and only get 20, 25 30 micrograms of that total dose inside of your body, compound that with the idea that, like you said, not all compounding pharmacies that are created equal, therefore you might even get some fraction of that fraction.

Dr. Childs:

And then by that point, you’re like, “Well, how much am I actually getting? What is going into my body? How can we use this? So for those reasons, I don’t like starting with it, but I have used it and I have used it many times. I do think it has a place like anything. It’s just not my preferred method. I think Liothyronine and Cytomel tend to be better. They’re more regulated in terms of the dosing where they have to fall and whatnot and they just seem to work, I think, for most people. So, yeah, that’s where I’m at now. All right. This one, I think, is going to be up your alley since we talked about this a little bit, and this might be the last one. Can we do maybe one?

Dr. Amie:

We can do a couple more. Yeah.

Dr. Childs:

Couple more. Okay. All right. Okay. So this one says, I keep gaining weight on 1,650 calories and work out every day. Why can’t I lose weight? So what do you think about that?

Dr. Amie:

All right. So let’s start with calories don’t matter. Calories in calories out have been debunked. We got to get out of the 1980s out of the 1990s, out of our way of thinking back then about counting calories. I could easily give you 1,200 or even, let’s go down. Let’s go with 1,000. Let’s go a calorie deficit. I can give you 1,000 calories a day in Oreos, pasta and bread, or I could give you 2,500 calories a day in clean grass fed meat, in avocados, in good fats, in vegetables with olive oil. And you would gain weight on the 1000 calories, a day of garbage and insulin spiking food and you would lose weight on the 2,500 calorie day diet of clean low carb, I would say.low carbohydrate, moderate carbohydrate, no processed food diet, because it’s what the food does when it gets into our body.

Dr. Amie:

So we talked about insulin earlier, especially if you are a hypothyroid Hashimoto patient and you are insulin resistant and you’re not addressing that yet. It really doesn’t matter what you eat. Your body’s going to be insulin resistant to that foods. So you’re going to be producing insulin in response to the food that you eat. That insulin’s going out, trying to lower your blood glucose. It’s not because you’re insulin resistant. Can’t get into the cell. Now you have this excess hormone that is the fat storage hormone. It’s needed for life, but it is the fat storage hormone when it’s in excess.

Dr. Amie:

So it doesn’t matter what you eat or how many calories you eat, you’re always going to be storing as fat. So we have to address that and then we have to address the type of food that is in that 1,600 calorie day diet. Because if it is high carbohydrate and it’s spiking your insulin, if it’s inflammatory going back to the pufas and the bad oils, then you’re going to continue gaining weight. It doesn’t matter the calories in, calories out equation. It’s the quality of the food and what it’s doing when it actually enters your body on a physiological level.

Dr. Childs:

Yeah. Again, 100% agree with that. I would say what I think people misunderstand about this, let put this into a different context as well. So I think when you look at like social media and Instagram, especially, I think there’s a lot of influencers out there. I don’t know if this is pervasive in that circle because I don’t spend a lot of time on there, but there used to be this concept of if it fits your macros. Is that still a thing that’s around?

Dr. Amie:

I try to stay off social media, but I think the macro thing is floating around because I’ll get those questions. Like what should my macros be?

Dr. Childs:

Yeah. So, well, there was an idea and this goes on your point, was that, look, it doesn’t actually matter what kind of food you’re putting in your mouth, as long as it fits some set of macros. This idea that this would essentially be that food or the quality of food doesn’t matter. But what you’re trying to say, what I’m agreeing with here is that the quality of the food matters a lot. A lot of people have a hard time wrapping their head around this, but let’s just think about it for a second. Let’s imagine that you’re following this and you’re thinking, “Okay, well I’m going to eat my 1,650 calories, but look, I got to have pop tarts. I got to have something like that.”

Dr. Childs:

Something that has inflammatory oils, processed foods and sugars and something like that. So just imagine what happens when that gets inside of your body. It’s going to cause a spike in insulin which can trigger or exacerbate insulin resistance. It’s going to trigger inflammation. So if you have, let’s say, Hashimoto’s, you’re putting something in your body which is pro-inflammatory, which could lower thyroid function.

Dr. Childs:

So we have two ways just in this one example, in which this could impact your hormones negatively, that control your weight. You’re putting something in that’s lowering thyroid function, which regulates metabolism. So you’re lowering your metabolism if you’re eating less calories. Then you have something that’s just spiking your insulin causing insulin resistance, which is causing you to store fat. So this is how I want you guys to wrap your head around this.

Dr. Childs:

It’s not the calories per se, as so much as it is the quality of that food, which is exactly what Amie is saying here. I’m just trying to draw the line between what happens once this food goes into your body and how it impacts these hormones, which then regulate your body weight. So you could be eating 1,650 calories. I see people eating 1,200 calories and they can’t lose weight. This happens very frequently within hypothyroid patients. I think a lot of this is because when we talked about the very beginning, the thyroid controls these other sex hormones.

Dr. Childs:

At least to some degree, regulates insulin, leptin, cortisol, estrogen, progesterone, testosterone. All these things are being somewhat regulated at the level of the thyroid. So if the thyroid is down because you’re putting some inflammatory food in, which is drawing down the thyroid, then all of these things are going to suffer as a result. And then you’re going to be left wondering, “Why can’t I lose weight and I’m reducing my calories?” But you’re not eating the right type of food. And your thyroid is not regulated. So like I said, everything you said I 100% agree with. I just wanted to string that along. Yeah, go ahead.

Dr. Amie:

Let me add one more thing too, because I just saw this last week. I think this is a tendency of frustrated, hypothyroid patients who aren’t yet optimized to do. You keep reducing your calories out of frustration. You think maybe less food, less food, less food. I had one patient that without telling me, went down into 800 calories a day because… We were just starting. I mean, it’s like month one. We don’t even have her fire burning yet in her metabolism. So we’re just climbing up and getting her optimized and she’s figured, “Well, I’ll just drop my calories even more. That will help.”

Dr. Amie:

What that did is actually put her body in a survival mode and it increased her reverse T3. Because her body basically said, “Listen, if you’re going to starve me, no I’m not going to let fat stores go. We need to hold onto these fat stores for dear life because this is a starvation time. It made whole situation worse and actually dropped her metabolism and increased her reverse T3.

Dr. Childs:

Yeah. And then you have to clean up that mess. What I would say is to people is a caution, please do not do that because yes, you may have some temporary relief sometimes. You might temporarily lose some weight, but it comes at a cost to your thyroid. Someone like Dr. Amie is going to have to come and clean that up. It doesn’t happen quickly always. This could take months and sometimes even years, depending on how severe that was. In the case of my wife, it took several years, by the way, to get her metabolism back up. I know you had a different way of getting there, but similar with your competitions and whatnot, but I don’t know how long it took you to normalize that, but it’s usually not quick.

Dr. Amie:

It’s not fast. And people think that it’s going to be. I’m glad you said that.

Dr. Childs:

Yeah. Having those expectations. You do not want to mess with the metabolism. It’s a slow mover. Right. Anyway, I know we’re on time. You want one more?

Dr. Amie:

It’s so much fun. Let’s just do one more question, then we’ll go.

Dr. Childs:

Okay. Let me see. Let’s do this one. This one’s actually fairly easy. Well, this one just says what’s a good starting dose of berberine? 

Dr. Amie:

Okay. So, for me, and I know we both love berberine especially for insulin resistance and it has so many different properties, gut healing antioxidant. So I like starting off with a minimum of 1,200 milligrams per day. So whether you split that up, if your berberine comes in 400, take it three times. If it comes in 600 it two times, but that’s where I really like the starting dose to be.

Dr. Childs:

Yeah, it’s pretty straightforward. I would say it depends on what you’re taking it with. I’m a huge fan. In the case of like, let’s say we’re using berberine and we’re using it for something like insulin resistance and weight loss. I would combine it with other things. So I generally don’t just take one thing by themselves. I’d say, look, let’s take a couple different things that work via a slightly different mechanism so that they can augment one another. Because what you do see happen, and the same thing happens with Metformin is you get diminishing returns on higher doses.

Dr. Childs:

So from let’s say zero to like 1,000 you might get a 90% benefit. And then if you go from 1,000 to 2,000, then you get a 5% benefit. I’m just making these numbers up, but this is the idea of diminishing returns. And so this concept occurs with Metformin. So my philosophy is okay, understanding that there are diminishing returns there, I say, look, let’s get the maximum amount that we can from some dose. So I think it’s about 1,000, 1200, we’re we’re right around that same range there. And then what we’ll do is let’s add something else. Let’s add alpha-lipoic acid, let’s add fish oil, let’s add turmeric, something like this, which can also help treat the insulin resistance and try and get them minimize or maximize the benefit at this at the lowest possible dose, which 1,000 is not a big dose. I don’t think so. Some people take 2000, 500, but I think that’s how I philosophically approach dosing these things.

Dr. Childs:

So don’t just use one thing, try and complex it with another, because you might to find your body does really well on one and marginally good on another. They usually don’t cause any harm especially berberine. I don’t know that I’ve ever seen anyone have negative reactions to berberine that I can think of. But yeah, that’s how I think about that.

Dr. Amie:

And where someone might be intolerant to Metformin, you might be tolerant to berberine. So if your doctor even prescribed you let’s say, 1,500 mil milligrams of Metformin and you’re like, “No, I just can’t do it. I have GI distress. I have diarrhea constantly. It’s not stomping.” Then you can drop down to berberine and start with 400, 500, 600, and then gradually work your way up to that 1,500 dose that was Metformin. It works very similarly, if not almost the same as Metformin, just with different properties. And then I guess my question to you would be, do you ever use Metformin and berberine together?

Dr. Childs:

For sure. Yeah, absolutely. Yeah. I’m a big fan of what I would call layering therapies. And so I would say, look, if we know insulin is a problem for you, you could do Metformin. It’s a cheap and sometimes effective drug. It’s not a universally effective drug on everybody, but it’s cheap. It’s like four bucks or five bucks. I don’t know. It’s really cheap. So throw it on there and just see what happens. Use it with berberine, fish oil, like I was saying, alpha-lipoic acid. You can complex these all together and you can see even better results.

Dr. Childs:

And then by the way, if you can reduce the total amount of dose that you’re taking of any individual thing that you’re taking, you’re also simultaneously minimizing side effects. So if you’re taking three things at a minimal dose, the minimal effective dose and not having to quadruple whatever the recommended bottle dose is, which does happen sometimes, and it can be effective by the way. I just think it’s safer to use that philosophy. Let’s use 500 to 1,000 milligrams of Metformin instead of 2,000 or 2,500 and complex it with, 500 to 1000 milligrams of berberine, and you have a much better combo than either of those by themselves. So that’s how I look at that.

Dr. Childs:

Well, okay. I guess we’ll stop it there, but for anyone listening to this, if you guys enjoyed this, please leave any more questions or comments that you have because I’d love to get together with Dr. Amie again. I think her and I, we jive on a lot of the things that we talk about and so it’s really fun to have these conversations. And if there are other things that you maybe want us to who elaborate on, leave them in the comments below, do whatever it is. And go check out Dr. Amie’s podcast. What is it called? Thyroid Fixer.

Dr. Amie:

The Thyroid Fixer podcast. Yep. And yours is Dr. Westin Childs.

Dr. Childs:

Yep. Mine’s you just search Dr. Westin Childs and yeah. Check out Dr. Amie Hornaman. She is awesome. We have a lot of similar philosophies in terms of how we treat and she does a lot of great stuff with our patients. Also, if you need anybody to help you, go check her out, because you are seeing people, right?

Dr. Amie:

I am seeing people. Yep.

Dr. Childs:

Okay. So check her out. She knows her stuff obviously, as you can tell throughout this discussion. So definitely check her out and thank you so much for coming on. Dr. Amie, it was a pleasure chat with you.

Dr. Amie:

Oh, this was so much fun. We definitely have to do it again.

Dr. Childs:

I think so, too. All right. We’ll see you later.