Thyroid Controversies Podcast With Dr. Alan Christianson

Thyroid Controversies: Iodine Safety, Hashimoto’s & More | Dr. Alan Christianson & Dr. Childs

Thyroid Controversies Explained and Debunked with Dr. Alan Christianson | Podcast Interview

Show Notes & Links From the Video/Podcast

Today I am joined by Dr. Alan Christianson. Dr. Alan Christianson is a Board Certified Naturopathic Endocrinologist who focuses on Thyroid care. He is a New York Times bestselling author whose recent titles include The Thyroid Reset Diet and the Metabolism Reset Diet.

You can learn more about Dr. Christianson here:

In this podcast episode, we discuss the following topics: 

  • What got Dr. Christianson interested in medicine and in the thyroid
  • Why so many thyroid patients are struggling to feel better despite taking thyroid medication and doing what's "right"
  • The 3 main issues that keep thyroid patients from feeling better
  • Why there is so much controversy surrounding iodine in the setting of thyroid disease
  • The difference between the RDA requirement for iodine and iodine tolerance
  • What causes the difference in tolerance of iodine between thyroid patients and what that means for iodine dosing
  • What's the role that iodine plays in Hashimoto's and whether or not Hashimoto's patients should avoid iodine
  • Stories about extremely high doses of iodine triggering autoimmune thyroid disease such as Hashimoto's and Graves' disease
  • The role that selenium plays in Hashimoto's, thyroid antibodies, and in protecting the thyroid gland
  • What causes autoimmune thyroid disease and does finding the root cause actually matter? 
  • Do H. pylori infections or EBV infections cause Hashimoto's thyroiditis?
  • Where does iodine avoidance fit into the treatment of patients with thyroid disease
  • How the body eliminates iodine and why it's easy to get more than you think on a daily basis
  • How taking thyroid medication impacts your body's ability to utilize iodine
  • How to know if you are someone who will benefit from iodine avoidance & whether or not it may help you get off of your thyroid medication
  • How to find doctors to help patients adjust their thyroid medication and iodine intake
  • Hidden sources of iodine and why you are probably consuming more iodine than you think
  • How much iodine is getting absorbed through the skin via cosmetics
  • Is iodine testing accurate? When does it make sense to test your iodine level and what does that value actually mean
  • Is it safe to get an iodine testing challenge test or should it be avoided? 
  • Are optimal thyroid lab tests something that should be used for thyroid patients?
  • How important are free thyroid hormone levels compared to the TSH? 
  • Where to get Dr. Christianson's latest book and how to ask questions to him via his podcast/youtube channel

Audio Transcript

Dr. Childs:

Hey guys. It's Dr. Childs here. Today, I am joined by a very special guest and that is Dr. Alan Christianson. Dr. Alan Christianson is a board certified naturopathic endocrinologist who focuses on thyroid care. He is a New York Times bestselling author, whose recent titles include The Thyroid Reset Diet and The Metabolism Reset Diet.

Dr. Childs:

Dr. Christianson has been featured on countless media outlets with appearances on Dr. Oz, The Doctors and The Today Show. He is the founding president of the Endocrine Association of Naturopathic Physicians and the American College of Thyroidology. Dr. C, welcome to the show.

Dr. Christianson:

Hey, Westin. Thank you so much for having me. Good to be with you.

Dr. Childs:

No problem. I think we're going to have some great conversations here about thyroid controversies, which is what we're going to be talking. Not so much controversy between you and I, but just controversial topics in general, right?

Dr. Childs:

What I wanted to do, actually, just on a personal note here, Dr. C, I just want to tell you that I'm very grateful for all the information that you've provided. I think anybody who has been following me or probably is aware of your work and you've done some amazing work and just in research in general. I'm really grateful for what you've done, and it's pretty obvious to me that you care a lot about thyroid patients. Thank you for all the stuff that you've done.

Dr. Christianson:

I appreciate that. Thank you.

Dr. Childs:

No problem. What I'd like to do is just get started a little bit, so people, maybe if they don't know you, just to get to know you a little bit better. Could you tell us a little bit about your own story and maybe what led you to getting into helping thyroid people and people with adrenal problems and kind of focusing on the things that you do?

Dr. Christianson:

Yeah. Thank you for that. I had callings toward medicine early long in life. I was an epileptic kid, likely had cerebral palsy, pretty bad coordination issues and put on a ton of weight in adolescence. I hit a real crisis. I mean, adolescence is tough, oftentimes best case scenarios, but yeah, I moved a lot. I was always the new kid. I was a fat kid. I was ostracized. It was not as common of a thing then and fat shaming was just normal. It wasn't like really anything unusual.

Dr. Christianson:

I was always nerdy and into books. Somewhere along the way, I started grabbing health books and I don't know, it changed my life. I realized that my health affected my quality of life. It affected how I was seen socially and that information could change that.

Dr. Christianson:

It was this huge, empowerment's kind of a cheesy term, I guess, but it really was that. I realized that I could take control over this and that things that I learned could make a difference. It made me want to go into this whole field. I came into medicine. I learned about the naturopathic medical profession that could allow me to put a lot of lifestyle emphasis onto it.

Dr. Christianson:

Then, early along, I saw that thyroid disease was so radically differently viewed. There were some just, now, some of the ideas even then were even further apart. Normal ranges for TSH was as high as 12 when I started practicing.

Dr. Childs:

Wow.

Dr. Christianson:

So many were suffering and there was also approaches that were blatantly unsafe. People were dying from some of the other radical views that were being done. I saw people that they were struggling with the same things I'd struggled with, but lifestyle alone wasn't enough. They had to really get things right before some of those things could work and it just really drove me that direction. That was, yeah, 25 years of practice focusing on that. It's been a real calling.

Dr. Childs:

Yeah. You've done a lot of work in those years, I have to say. Like I said, I'm very grateful for that. One of the things that you've touched on I think is so huge. That's this idea that the impact that the thyroid can have, especially on things that impact your, how self-conscious you are, things like hair loss, things like your weight, and these are real big issues for a lot of people, right?

Dr. Christianson:

Mm-hmm (affirmative).

Dr. Childs:

I'm sure you've seen it. I see it a lot. My heart breaks for these people because I know that's such a tough thing to live with. Obviously, this is something that you've gone through personally. That's why I think it's easy to get passionate behind these things because if you take somebody who has, let's say, dealt with these symptoms for 10 plus years, and that's not uncommon timeframe, right?

Dr. Christianson:

Yeah.

Dr. Childs:

We're talking about people who have had these issues for so long and it helped them to get out of these things or to improve their hair, their hair growth, or to help them lose weight, I think it goes a long way and it feels good. There's not a lot of big wins per se in medicine, if you're like treating blood pressure or something like that.

Dr. Christianson:

Right.

Dr. Childs:

It's hard to see, try to feel that on the side of the patient. Thank you for that introduction. What I'd like to do is talk a little bit more about thyroid patients and what I refer to as getting back to 100%. In my experience, I kind of see a lot of thyroid patients who are continuing to struggle, right? They're doing the things that are right and yet they still have persistent symptoms, a lot of different things that they're dealing with.

Dr. Childs:

Do you have any explanation for why that may be? Do you believe perhaps that they're being mismanaged, undertreated? Do you think it's caused by something else? What is explaining this discrepancy between thyroid patients who are on treatment, but not feeling 100%?

Dr. Christianson:

That's such a glaring problem and the [inaudible 00:04:36] is very aware of it. I think we'll talk about a lot of these topics in more detail, but I'll first give a quick high level overview about them. The three big things I think are relevant are many are put in medicines that they were never really candidates to begin with. The medicines probably weren't expected to help them given the details of their scenario.

Dr. Christianson:

The question is, how do I get the medicine right but the deeper question is, was that even going to be helpful in the first place? Then, when they're on the medicine, sometimes not only is it not a solution, but it can become a barrier. It can become an impediment for them. If they're on them, that's sort of figuring out do you really need that. If you do, so be it, it should be right. If you don't, it should still be right during a transition process.

Dr. Christianson:

That's something to where it's not the most important part, but it's something that's a real barrier and you're taking a pill every day. It's got to be one that's going to be not a barrier and helpful if it can be. If not, you should be in a process of changing that. That's one of the first steps I think about.

Dr. Christianson:

Second one would be really getting iodine right. We'll talk a lot more depth about that. It can really make the body not respond well to thyroid hormones, wherever they're coming from. The third one, I call these the comorbidities, the secondary conditions. There's been massive dataset showing that people with thyroid disease have any number of 15 different disease states that can be present along with that. There's things like latent iron depletion, there's parathyroid disease, there's sleep apnea. There's early fatty liver.

Dr. Christianson:

Each of these 15 conditions, there's more than 5% bidirectional overlap between them and thyroid disease. All too often, someone with thyroid disease has real symptoms and they're trying so hard to get these levels right for their thyroid. That may not be the thing causing these symptoms or it may be partially causing it. I think all too often, those things can get missed and people over focus on just the one factor.

Dr. Christianson:

Those are the big three. If you're on a pill, it's got to be one that's not getting in your way. If you don't need it, you should know that, getting the iodine right, understanding and addressing any of those secondary conditions.

Dr. Childs:

Okay. That's awesome by the way. Let's definitely dive into each of these in a little more detail, like you mentioned, because I love the way you laid that out. The first one I want to do is let's jump into iodine because I think…

Dr. Christianson:

Sure.

Dr. Childs:

... at least from the perspective of thyroid patients, tons of, let's say controversial opinions on iodine. Let's sort of get a little deeper into that. Now, the way that I kind of see at the landscape is that we have a lot of different viewpoints on iodine, right? We have doctors who are telling patients, that you should avoid iodine 100%. We have some people who are saying, let's use the RDA sort of dose of iodine. Then, we have people who are saying, let's take really high doses of iodine.

Dr. Childs:

You kind of have these different, and there's probably some different camps in between and we'll talk about these as we go. What is the story from your perspective on iodine? How do you view iodine in the setting of thyroid disease? Then, maybe we'll talk about Hashimoto's as we go, but where does iodine fit into this whole story?

Dr. Christianson:

First, address that. Then, I'll very briefly mention how things have come to view where they are in the present and all the different views that we have. The first thing is we got to differentiate iodine requirements from iodine tolerance. That's a very important distinction to make.

Dr. Christianson:

Iodine requirements and I should also back up, this is the most studied nutrient on the planet, bar none. We've studied this for longer amounts of time, larger datasets than any other nutrient. It's also the least intuitive nutrient on the planet. There's a lot of ways in which it defies the common rules of other nutrients. Vitamin C, the RDA is often not optimal. We can do well with more than that. You're not likely to be harmed from it. It's easy to get good amounts, but so many of those principles don't apply to iodine.

Dr. Christianson:

Yeah, requirements don't really differ past simple things like body weight and age and gender, they're pretty predictable, but tolerance differs tremendously. The World Health Organization has tracked thousands and thousands of instances where iodine levels change throughout populations. They found that iodine intolerance for some is between about like 50 and 200 micrograms. That's those who are prone to thyroid disease.

Dr. Christianson:

Now, those who are clearly not prone to thyroid disease, they probably have a tolerance up to about 1,100 micrograms on occasion. No real ill effects. They don't need more, but more won't really hurt them. It's not a matter of it being a good thing or a bad thing, we need some, but we just happen to need some and win a window. The most bizarre thing about it is that, that window is so narrow. For every other nutrient, the tolerance and the requirement windows are quite different.

Dr. Christianson:

Vitamin C are tolerance in requirements. There's a thousand or 10,000 fold difference there. You're not going to, the amount you need is not close to too much, but for some people, the amount you need is close to too much for iodine. That's the bizarre part. We don't need none. We don't need massive amounts, but there's a range. For some people, that range is narrower than others.

Dr. Christianson:

Very briefly in terms of the fact that we have a controversy for quite a few years, iodine was used for a lot of things in medicine. It's an antimicrobial, it's an antiseptic. It does a lot of useful things, but generally those applications kept going by the wayside when medicine found just safer ways to do all that and became more aware of the toxicity of iodine.

Dr. Christianson:

The old medicine bottles with skull and cross bones, iodine was a leading cause of suicide. It was the most popular means of suicide for quite a while. It's used in medicine narrowed down. There were always a few in medicine who kind of hung onto those old uses and said, "We can still use iodine as antiseptic. We can still use it for treating zits," or all these various things that were kind of very old folklore uses.

Dr. Christianson:

But around the late nineties, there was a gynecologist kind man who became very enamored by iodine because of some papers of its use for treating fibrocystic breast disease. He wrote some massive documents. He called the Iodine Project. He influenced some other doctors. He himself has passed on. I spoke to him a lot in detail about this, went through all of his works, and was intrigued by it but it really pushed me to look into the published, known literature about iodine as well as the speculative literature.

Dr. Christianson:

Sadly, a lot of the speculative literature is very intuitive. It seems very to make sense and it's gone viral. A lot of the ideas that are popular now are based upon these speculations, but in many cases, they're pretty much the opposite of what we have from this massive data set of knowledge of iodine.

Dr. Childs:

Yeah. Intuition is somewhat dangerous in medicine, right?

Dr. Christianson:

Mm-hmm (affirmative).

Dr. Childs:

You can think things are intuitive and that could cause you to do things. Surely, the body must need this because of X, Y, and Z, right?

Dr. Christianson:

Mm-hmm (affirmative).

Dr. Childs:

But that intuition, this is the reason we have these studies. We have double-blind placebo controlled studies because you can't always trust your intuition when it comes to anything related to your health. Also, consistency is a key, right? What may work for one person, if you can't apply it to thousands, potentially millions of people, then, you kind of have to evaluate this all in context, right?

Dr. Childs:

Now, I really was interested in something that you mentioned before and intuitively, going back to this intuition thing, it makes sense that everyone has a different level of tolerance to iodine. Now, do you have any idea what would potentially cause that tolerance? Is this related to perhaps genetics or some other cause maybe other nutrient and status? What's your sort of feeling or idea as to why people have different tolerance levels to iodine?

Dr. Christianson:

Those are both relevant. The big picture, since we think, is that humans have two main genotypes relative to the iodine is importer, the sodium iodine is importer. The idea is that we probably had humans that developed mostly near aquatic areas that were near oceansides. They had a lot of shellfish, a lot of seafood, probably sea vegetables in their diets. They needed a larger iodine tolerance.

Dr. Christianson:

The flip side of that is the broader your tolerance of iodine is, the harder it is for you to get by on meager amounts of iodine. The other groups of humans are probably more inland and some of them even like higher elevations, around more fresh water. They had to do better at using every little spec of iodine they got. They had to compromise their iodine tolerance. We think those, that's the reason we got the main gene types that are present.

Dr. Christianson:

We know certain genes that are associated with deiodinase pathways, but there's really not perfect gene test that can say where someone falls in those categories. There's no way a perfectly to predict that. It's really just whether or not someone's prone to thyroid disease.

Dr. Christianson:

You mentioned nutrients, we know for sure that once someone has their own given tolerance, if they're low in certain accessory nutrients that buffer iodine, especially selenium, that can make their tolerance even narrower. You have certain things selenium, zinc, or iron are low, whatever their personal genetic tolerance is, that may be narrowed even further.

Dr. Childs:

Okay. Yeah. That kind of leads me in a little bit to the next topic, which is Hashimoto's and iodine. We have, I think a lot of people out there at what have been told to avoid iodine if they have Hashimoto's, what is the connection between iodine intake and Hashimoto's? Is there a connection? Is there a way to prevent that connection? What's your sort of take on that connection there?

Dr. Christianson:

When I think about causal length, it's nice to have convergent multiple lines of evidence. I think about, is there a mechanistic explanation for it? Is there some population studies that support an idea and are there interventional trials, all various types of data that you mentioned?

Dr. Christianson:

When we think first about the mechanistic link, we know that the thyroid makes hormones by basically stapling iodine onto a protein called thyroglobulin. The enzyme thyroid peroxidase oxidizes iode into iodine and makes it single and ready to mingle and then it sticks on a thyroglobulin.

Dr. Christianson:

If thyroglobulin has roughly 13 Thyrozol residues that are sites applicable for iodine to sit but I think about the old videos of like all the clowns climbing into the little Volkswagen beetle or something, you can get more than 13, but they're not all in the right place.

Dr. Christianson:

In a high iodine state, there can be as many as 60 iodine atoms that are somehow chemically associated with each molecule of thyroglobulin. They're not on proper Thyrozol binding sites. What happens is these recently oxidized iodine atoms are a source of free radicals and they can change thyroglobulin itself. They can make it antigenic, so the immune system treats it as foreign and they can cause a higher rate of cell death by the thyroid.

Dr. Christianson:

The net consequence of that is it recruits the immune cells to attack thyroglobulin sometimes also to attack thyroid peroxidase. That's the main model of onset of Hashimoto's today. In terms of population studies, just to, I'll highlight very briefly, in the US, we started fortifying with iodine in 1924, mostly Michigan. It was all elective and the following decades, the rate of Hashimoto's amongst women in their adulthood years went up 26 fold. It was a rare disease before fortification.

Dr. Christianson:

Denmark was the last big country to fortify. They did it in the year 2000. They did it flawlessly. They exactly went up by about 50 micrograms per day on target but for the 17 years in which it was tracked, each year, the rates of thyroid disease went up by about 50% and they track that in terms of prescriptions, diagnosis, procedures, all these things show this uptick of thyroid disease and there's plenty of other examples of that.

Dr. Christianson:

Then, interventional studies, we've now had trials showing that people who are supplemented with iodine have emergent autoimmune thyroid disease that's at a dose response curve. Yeah, we see this converge from mechanistic models, population studies and also interventional trials.

Dr. Childs:

I would say, actually, and I'm sure you've seen this as well from an anecdotal standpoint, I've absolutely seen people who have what seems to be triggering Hashimoto's or at least autoimmune thyroid disease, either Graves or Hashimoto's from really high doses of iodine.

Dr. Christianson:

Yeah.

Dr. Childs:

I'm sure you've heard this story where somebody takes 50 milligrams of iodine for X amount of weeks, X amount of days and now all of a sudden their thyroid antibodies are high. We have anecdotal is evidence is weak evidence, but…

Dr. Christianson:

Sure.

Dr. Childs:

... it's something that I'm seeing, you've probably seen as well.

Dr. Christianson:

That's what got me into this whole thing. There's a patient I remember very well, he was mid-70s, like the healthiest guy you can imagine like, "Wow, I want to be you when I'm older."

Dr. Childs:

Yeah. Yeah.

Dr. Christianson:

He was a snowbird. He was back and forth. I'm in Arizona and he was back and forth parts of the year. One year he came back down and he's got a toxic nodular goiter. I'm like, "What's up with that?" It came on after he was given a high dose of iodine for an iodine challenge test. This was like 2001 or so. It was all new stuff to me. That's what got me going down the whole rabbit hole. Yeah, like you said, I've seen that countless of times.

Dr. Childs:

I do want to talk about the iodine challenge test a little bit later, but before I do, because we'll get into iodine testing in just a second here, just reviewing my notes here. What I wanted to talk about a little bit was the connection between selenium and Hashimoto's just for a second because I know that they're, and maybe you can speak to these studies and if you think that they're significant or relevant, but they're have been some studies that show that taking selenium may help to reduce thyroid antibodies, what do you make of those studies? And do you think it's through this mechanism of somehow selenium is protective, but only in certain cases? What do you make of those studies because I'm sure you've seen them?

Dr. Christianson:

Sure. Yeah. Good data on that, beneficial to all facets of thyroid disease. We know that selenium is, that thyroid itself, imagine like the scientists with those massive long tongs and that smoking cauldron at the end of the tongs?

Dr. Childs:

Yeah.

Dr. Christianson:

That's how the body treats iodine. It circulates in the form of iodide and that's pretty safe, but we only make iodine deliberately in specific places. We've got a pump to pull it in. We've got an enzyme to activate it. That's when we've got the tongs out. Because iodine is such a powerful source of free radicals, that allows it to make strong chemical reactions, which is good, but it's also harmful because of all the free radicals.

Dr. Christianson:

Then, we, our own internal antioxidants, superoxide dismutase, glutathione, and RF2, many of these are selenium-dependent. That's a big factor for tolerating it. Then, that's the internal production. Then, we've got peripheral metabolism. Thyroid hormones are so powerful, they're controlled from above and below, throughout the whole body. Most all those peripheral regulatory pathways are also selenium-dependent. Selenium's incredible and important for all facets of that.

Dr. Christianson:

There's been data too, showing that in areas that have endemic low selenium in soils, we'll also see higher rates of thyroid disease and more rates of negative reactions to iodine at levels that otherwise shouldn't be a problem.

Dr. Childs:

Okay. Then, one last question sort of on this topic of Hashimoto's, do you think that there's anything else that can account for the rise in the cases of Hashimoto's as iodine intake increases or is it pretty clear that these things are connected or could any potential other explanation, maybe other environmental factors, maybe just more testing, is there anything else that can account for that or has that been taken into account for the studies?

Dr. Christianson:

Well, more testing is always something to think about. Are we just catching more of it or is there more really there? We also have to differentiate things that cause Hashimoto's from things that are associated with it and things that are also then comorbidities or things that may be contributors to system symptomology, those are all different concepts, but a lot of things that I'll see in functional medicine kind of conflate them all together…

Dr. Childs:

Sure.

Dr. Christianson:

... treat them all as if they're causes. One recent meta analysis went to set out to answer the question of just what causes autoimmune thyroid disease? Their conclusions were that there's two existential causes, things that we can't really control and that's age and gender. The older we become, female gender, those things are big known drivers of that.

Dr. Christianson:

Then, they argued that of all the other, there's many other things that could be possible causes or contributors, but many of them are not relevant after the fact. There's a saying how the horse is out of the barn. Well, closing the barn door won't bring the horse back.

Dr. Childs:

Right, right.

Dr. Christianson:

The cause was, the door was left open, but closing the door doesn't really fix the problem anymore. A lot of issues are thought to be like that. Radiation, back when people would have their tonsils radiated for a sore throat, that could give rise to thyroid cancer but that's not really something you can treat with radiation or by simply avoiding radiation.

Dr. Childs:

Right.

Dr. Christianson:

They argued that iodine was the one other thing that was a clear non-irrefutable cause that also led to actionable treatment options. They went on to say that of all the other causes or contributors to thyroid disease, not only were none as relevant of iodine, but they argued that all of them combined were not as relevant as iodine.

Dr. Childs:

Yeah. Iodine is playing a huge role in addition to those other factors you mentioned, was it gender and age, right?

Dr. Christianson:

Age.

Dr. Childs:

Gender and age, okay. Now, what you said was amazing, because intuitively I've sort of come to this conclusion as I've helped patients over the years, but you just said in a much more eloquent way with the barn door analogy, which I love. Thank you for that.

Dr. Childs:

In the case of causes of Hashimoto, Epstein bar virus, H. pylori, these get brought up a lot, would these fall more into the camp of associated conditions or would these be causal potential causes or where did those sort of fit in here?

Dr. Christianson:

They've been explored causes and they have been things to be shown to be associated, but not so much the direct links and not so much the clear reversal by addressing them. I want to say too that many of these other things are quite relevant to someone's health and wellbeing.

Dr. Childs:

Of course.

Dr. Christianson:

I don't want to say that you should ignore any other problems.

Dr. Childs:

Yeah.

Dr. Christianson:

I'm just saying, there's no clear data saying that this is the smoking gun for most thyroid disease and that fixing that fixes the thyroid. Yeah, fix a problem if you got it, but just know that maybe more than that to help your thyroid.

Dr. Childs:

For sure. I think people, have come to this conclusion as they've treated them or tried to treat themselves, right? Because I see a lot of people as they seem to have some sort of event and then they have Hashimoto's or at least they correspond temporarily to one another, but then treating whatever cause that doesn't reverse to Hashimoto's. That's like that barn door analogy, right? Maybe genetics are playing a role there and susceptibility to environmental factors and things like that. Oftentimes, it's hard to know for sure. We probably will never know, you know?

Dr. Christianson:

Mm-hmm (affirmative).

Dr. Childs:

We just have this data, as you mentioned, to help sort of guide us. Now, what I do want to talk about is sort of shift into this idea of iodine avoidance. We talked about these groups sort of briefly before where some people are, let's avoid iodine 100%, let's take massive doses of iodine. Let's take sort of just the RDA doses of iodine that 50 to maybe 250 microgram dose range. I've seen some of your work, which suggests iodine avoidance may be a potential therapy as well. Maybe could you speak to this idea of…

Dr. Christianson:

Sure.

Dr. Childs:

... iodine avoidance and where that fits in?

Dr. Christianson:

Sure. Back to just to mention the RDA, the recommended dietary intakes, those are fine for most people. In terms of looking at populations, the World Health Organization has broken down six distinct iodine levels. They've shown that those vulnerable to thyroid disease stay safest between about 50 and 200 micrograms per day.

Dr. Christianson:

I want to expand too, people often think about how much they would take in supplements. That's your total day's intake. That's not the dose on a bottle of supplements because you're getting it from food, we'll talk about topical, there's cosmetic sources of that.

Dr. Christianson:

Then, the amount in supplements is often much greater than expected. Some foods can have a lot more than you'd think. That's the total day's intake. That's not how much you want to see on a label of a supplement bottle. Yeah, 50 to 200 is probably safe for someone who has thyroid disease or is prone to it.

Dr. Christianson:

Now, what's kind of the newer chapter in a lot of my work is that there can be a deliberate strategy of going lower to help reverse the problem and there's good data supporting that. This is not saying everyone should avoid all iodine. All foods have some iodine. No one can avoid all iodine and iodine's not a bad guy.

Dr. Childs:

Right.

Dr. Christianson:

But as a strategy, there's a window of somewhere below about 100 micrograms in which adult thyroid disease has a very high rate of reversal. That's not true for all adults with thyroid disease, but for many it is, and it's a safe strategy to test out.

Dr. Childs:

Okay. The idea behind this idea would be potentially, if you are in that population, which is sensitive to or intolerant to iodine, I will say, and you have probably perhaps been exposed to more iodine than you're even aware of and this has potentially triggered your thyroid disease and therefore removing it, or at least avoiding it for some period of time or lowering your iodine dose may be therapeutic in the sense that it may be curative to your thyroid condition. Is that sort of a correct sequence of events?

Dr. Christianson:

That's totally true. Here's a few more mechanisms to expand upon that. We talked before about how iodine causes this oxidative harm within the thyroid. The thyroid gets rid of iodine in two ways. One of which is making thyroid hormone. The other one is non-hormonal iodine excretion. Number two, it's there and I'm a little OCD, so I can't ignore things that are there…

Dr. Childs:

Sure. Yeah.

Dr. Christianson:

... but it's almost not there.

Dr. Childs:

I see.

Dr. Christianson:

There's really almost no non-hormonal iodine excretion.

Dr. Childs:

Like a percent.

Dr. Christianson:

The amount is almost infinitesimal, even less than that probably.

Dr. Childs:

Okay. Yeah. It's, yeah.

Dr. Christianson:

If someone has hypothyroidism, they're on medication for that, by and large, they're already putting out two little thyroid hormone and their medication supply is a lot of their body's needs.

Dr. Childs:

Right.

Dr. Christianson:

They're not eliminating much iodine. Whatever excess they got, they might not have had a crazy amount, but they might have hit some threshold by which now there's too much in the gland and they don't have an opportunity to reverse that excess because through medication, through even a rather reasonable intake, there's just a threshold coming in by which they can't get rid of the excess. There's no gradient. You've got to get below some threshold to allow that gradient to get that excess out of the gland.

Dr. Childs:

That makes perfect sense, especially if you understand thyroid physiology, as I'm sure you do. Any patient who is a thyroid patient who's listening to this, as Alan has said, when you take thyroid medication, you're supplementing what your body would be producing naturally. If you're taking that, your body's not producing it, which means iodine is, if I'm understanding this and following this correctly, is going to cause a buildup, because what else can it do?

Dr. Christianson:

Right. You can't get rid of it.

Dr. Childs:

Yeah.

Dr. Christianson:

You're not making hormone.

Dr. Childs:

Then, your tolerance would be even lower, right?

Dr. Christianson:

Mm-hmm (affirmative).

Dr. Childs:

Because you would be, let's say, if you were at that 50 microgram register 200, maybe you're consuming 150, but maybe it needs to be 75 or 50 or even potentially lower [crosstalk 00:26:07].

Dr. Christianson:

Well, the 150 might have never been harmful to begin with, but it may not be low enough to reverse the situation. It might not be a big enough deficit to where you can clear out that excess.

Dr. Childs:

Yeah. I love this approach, because it's basically saying let's take a minimally invasive approach to see if this is a solvable problem for you. If it can potentially lead to thyroid patients getting off of their thyroid medication, that's great, right?

Dr. Christianson:

Mm-hmm (affirmative).

Dr. Childs:

That would be a great goal. In terms of statistics and how often you are seeing this happen, is there any way to sort of predict who would fit into this category? Because as you mentioned, it's not all thyroid patients, how can we or is there any way aside from just trial and error to figure out who is in this group and how big is this group by the way?

Dr. Christianson:

Yeah. Yeah. I want to pull out two populations. There's those who are on medication, those who are not, quite simply. They're called medication naive or medication tolerant. Those who are not yet on medication, the clinical trials have shown that disease reversal happens to about 90, I'm sorry, disease improvement, I should say, occurs to about 95 or 97% of people who embark upon lower iodine diets.

Dr. Childs:

That's awesome.

Dr. Christianson:

One big paper detail that one showed that people that had average TSH scores of 14.1 and had been roughly there for the last several years, they did nothing other than getting below that iodine target. Now, not everyone achieved that. We'll come back to them but the group as a whole, 78.3% of them, had totally normal thyroid function, average TSH scores below three, by the definition of this study, within three months. That was all they did. Now, many people had TSH scores in the 50, 5-0, to 200 range.

Dr. Childs:

Yeah. Wow.

Dr. Christianson:

Many of them were not in that 78%. They weren't in that category, but they improved a lot. They probably just needed more time. Then, also many people who are not at 70.3%, didn't achieve the target. They weren't totally compliant. They weren't well enough informed, whatever. If you look at those who were compliant and if you define that as big improvements, that was that 97%. Most are radical improvements.

Dr. Christianson:

Now, the other big category is those that are already on medication. You asked about how to predict who can improve and who cannot. There have been several recent studies on the idea of deprescribing. In conventional medicine, they're realizing that a whole lot of folks out there are on thyroid medication. It's not helping them and they probably never need did to begin with. What do we do with all these people? They're trying to figure that out.

Dr. Childs:

Yeah.

Dr. Christianson:

Well, those who are likely to not need the medicine, we can exclude those who lack a thyroid, right?

Dr. Childs:

Mm-hmm (affirmative). Yeah.

Dr. Christianson:

They're not likely... I actually have seen that believe it or not.

Dr. Childs:

Oh really? Do they have extra thyroidal gland tissue somewhere?

Dr. Christianson:

Yeah. They likely did get all of it. They did have some regrow and they needed no medication. That was weird. That's very abnormal.

Dr. Childs:

Yeah. Yeah. Right. It's unusual.

Dr. Christianson:

Let's put them to the side.

Dr. Childs:

Okay.

Dr. Christianson:

Of those who are on medication, the higher their TSH score time of diagnosis, it predicts their likelihood of needing to stay on it when they have overt hypothyroidism. That means they also had a T4 that was below range. When they had subclinical disease, meaning their T4 was not yet below range, the level of TSH elevation is not a predictor. It's not really a big factor that way.

Dr. Christianson:

The other big consideration is how high is their dose relative to their body's requirements? If someone's taking a dose that's as much or more than their body would ever make, given their age, size, gender, or other factors and their still breaking even, there's not a lot of residual hormone output, but on the other end, if you're an amount that's smaller than they would need and they're stable, you know they're making some.

Dr. Christianson:

Those are two things that make someone more or less likely, but many papers have shown that of those on medication, even ignoring those factors, somewhere around 40% can do nothing strategic whatsoever, just lower the doses on a schedule and to be fine without it.

Dr. Childs:

That's huge.

Dr. Christianson:

One paper gave very basic recommendations for iodine avoidance and they saw that roughly 84% of people could do less medication or no medication and not have a worsening of their labs or their symptoms.

Dr. Childs:

This is amazing information for thyroid patients, I think. This is why I say I'm really grateful for this work that you're doing, pushing this information out there, because a lot of this, I kind of had some understanding existed, but not to the degree that you're sort of explaining here. I'm grateful.

Dr. Christianson:

It's blown me away too. It's pretty cool.

Dr. Childs:

Yeah. This is awesome stuff because we don't really want to have people on medication if we have to, right?

Dr. Christianson:

Mm-hmm (affirmative).

Dr. Childs:

Especially with all these issues and reformulations and supply chain issues, you don't want to have to be reliant on something if you don't have to. To the point you mentioned previously, there may be some patients out there thinking, "Well, if I was put on thy medication, that must mean that I need it." I can't tell you I've lost track of the number of stories where I hear patients who have been on thyroid medication for 20, 30 years, they don't even have any idea why they're put on it in the beginning and perhaps these are some of the people you're talking about in here where maybe they never needed to be on it to begin with.

Dr. Childs:

Thyroid management has changed and probably will continue to at least tighten, especially with the emergence of this information over the next 5 to 10 years, I would imagine. You can imagine what happened maybe 30, 40 years ago. Yeah, to anyone out there listening, this is a good potential option.

Dr. Childs:

Now, I would say, Alan, how would somebody, if they're interested in this, what would this, can this be done with a conventional doctor? Is this an easy thing to do? How could you help guide somebody do this sort of thing if they wanted to try and deprescribe?

Dr. Christianson:

I've looked at some of your work as well, and you've done some a lot of really good things and you've lamented about just the lack of understanding amongst a lot of doctors out there. I'm with you on that. I recently founded a nonprofit, the American College of Thyroidology. We're volunteer-led, and we try to train doctors and practitioners on things like this. That's one resource that's available, but you're right, many are not aware of this potential of this.

Dr. Childs:

Mm-hmm (affirmative). Yeah, which is unfortunate. You kind of have to, I guess, go to a physician maybe who is aware of this within using the guidelines that you mentioned before, that was the American College of Thyroidology?

Dr. Christianson:

Mm-hmm (affirmative). Yeah, actthyroid.org.

Dr. Childs:

Okay. If anyone's interested in that, I recommend using that resource to try and find a physician then, it sounds like. Alan, another thing that I wanted to ask you about, whether these potential, you kind of brush on it a little bit previously, but I want to go into a little more detail and that is this idea of hidden sources of iodine.

Dr. Childs:

Maybe you could expand on, there's a lot of people, I think, who are looking at just the back of their supplements and saying, "Okay, it's 100 micrograms of iodine. That must be my daily dose." But I think there's more to that. Could you maybe outline what you were referring to when you said there's they are in potentially cosmetics and other medications and supplements may not be as forthright as you might think with the total iodine content found within them? Could you expand on that topic?

Dr. Christianson:

Sure. To hit the last point, iodine's a tough thing to process because it's so chemically unstable. One paper took a list of 120 popular prenatal multivitamins, and randomly selected 70 of them to ask, say their iodine content. It compared the actual measured iodine content against the labeled content, not one of the 60 was within 10% of the labeled content.

Dr. Childs:

Wow.

Dr. Christianson:

Many had three or four times above their labeled content.

Dr. Childs:

Geez. Okay.

Dr. Christianson:

Yeah, you really don't need to add in more than what you're getting already with supplements, but if you do, you're probably getting more than you think.

Dr. Childs:

Right, right.

Dr. Christianson:

You mentioned cosmetics.

Dr. Childs:

Mm-hmm (affirmative).

Dr. Christianson:

Iodine, again, it's a really useful chemical. It does a great job at making creams stay silky smooth and not get infected and not have things settle out of them but, when we look at the math, even the smallest amounts of it in a cream, even though that they may be 1 or 2% of a cream might be an iodine ingredient, even though that ingredient might only be 12% iodine, even though our skin only absorbs 4% of it, once we convert gram things down to my micrograms, it still adds up.

Dr. Christianson:

Polyvinylpyrrolidone or PVP is one of the most common sources in a lot of cosmetics. If you get natural cosmetics, it's the same thing, but they call it sea vegetable extract or kelp extract. It's a useful ingredient in the creams, but if you run the math and I thought this through, a woman's going to use like 10, 20 grams of conditioner on her hair, that'll sit in place for a couple minutes and that's going to cover a fair amount of skin surface area.

Dr. Christianson:

Given like 1% PVP in a conditioner and given 12% iodine and PVP, given 4% intact skin absorption, that 20 grams ends up being about 2,300 micrograms of iodine in the bloodstream, like 10 times above a safer limit from one shampoo application.

Dr. Childs:

Yeah.

Dr. Christianson:

It's in a lot of personal care products. A lot of them I don't think are relevant because many things, the volume we use is small and the amount of skin contact is minuscule, probably like mascara or hairspray could be big examples of that, rarely absorbing that much, but other things, yeah, conditioner, body lotions, face creams, you're eating that stuff. The amounts you're eating are appreciable.

Dr. Childs:

Yeah. I think patients tend to forget, the skin is an organ, it's a tissue and it has absorbable properties. Generally speaking, it's designed to keep things from getting in, but things do make it through. We put medications on topically and I remember I had this experience where I was, before I sort of understood things a little bit better, but I was treating perioral dermatitis and I was using a hydrocortisone cream. I was having this person put it around their eyes because that's where this was. I didn't know at the time, I eventually learned later, but you could actually get a lot of absorption when you put things around the eyes compared to other places of your body, right?

Dr. Christianson:

Yeah.

Dr. Childs:

The skin is really thin there. The venous system is superficial, so it gets in there. You're absorbing more than you would, let's say, on the back of your arm or on your hand or something like that. When you put things even on your scalp, which again, has a very complex venous system and arterial system, you're probably going to absorb more than potentially you would other places of the body. That's really, I think a good thing to mention and to know.

Dr. Childs:

Now, along these lines, we have this idea of iodine testing. I know that you've talked a lot about iodine testing in the past. If, maybe you're a thyroid patient listening to this, you're thinking, "Well, surely I should be able to test and figure out how much iodine I have in my body to see if I need to go down or potentially use more," which doesn't seem to always be the case, especially for the population we're talking about, but where does iodine testing fit into this? How accurate is it? If somebody was to use an iodine test, which one would they use?

Dr. Christianson:

Well, Westin, here's the thing, if I could give you an answer that I'd like to give you, it would be this, it would be, iodine tests are perfectly accurate. They're readily available. They're non-invasive. You could do them at home and you can know exactly where you are. That's what I'd love to give you.

Dr. Childs:

Well, all right. Well, I guess we're not going there though.

Dr. Christianson:

But here's the truth, there's three goals for iodine testing. There's nutritional status, there's toxicology and there's iodine excretion. There's how much your body has compared to what it needs, whether or not you're a level that's actually damaging your organs, and then how much of it you're dumping. Those are three different things you can measure for.

Dr. Childs:

Okay.

Dr. Christianson:

The other grid to put out is, there's tests for people and there's tests for populations. Tests for populations, what's good about them is that a test for a person could be incredibly variable but if you're testing a thousand people, all that, and you just want to know the status of that group, all the variability means nothing because it's all going to average itself out and you'll still know the group status. There's a lot of very good nutritional test for iodine for populations. The simplest one is around random urinary iodine, also 24-hour urinary iodine levels are used quite a bit.

Dr. Christianson:

Now, when those tests are tried to be translated individuals, it takes multiple tests to be within a certain threshold. If a goal is to be within 90% accuracy, it takes a little over 300 random urinary iodine tests. Now, if someone wants to dig deeper into a 24-hour urinary iodine that helps. Now, you only have to do about 270 tests to be within 90% accuracy.

Dr. Childs:

Wow. Great. Yeah. [crosstalk 00:37:48] manageable.

Dr. Christianson:

Nothing practical. Now, iodine toxicity, this mostly comes up from medication called amiodarone. That's one used for regulating cardiac rhythm. Some people have just debilitating, even fatal side effects months and months after using it. Amiodarone is iodine-based and it has hundreds of micrograms of iodine per pill. Most of the complications come from the iodine. People can take months to excrete it.

Dr. Christianson:

When there's so much in your body that your kidneys can no longer get rid of as much as it's coming in, then your serum levels will finally start to build up. Serum levels do reflect iodine toxicity. They have no relationship at all to nutritional status of iodine. You could be marginally iodine deficient. You could be marginally iodine excess and your serum could be anywhere. It's only when you're at overt toxicity that serum levels come up.

Dr. Christianson:

The last goal is iodine excretion. If someone is doing a low iodine diet, either to help improve their thyroid or because they're going to do an iodine uptake scan or radioactive iodine ablation, they may need to know how readily they're excreting iodine. In those cases, you can do urinary iodine and creatinine ratio tests. The goal of being at a low iodine window for all those applications is typically below 100 micrograms of iodine per gram of creatinine.

Dr. Christianson:

It doesn't say your nutritional status. It just shows are you dumping a lot of it. The only time I really find that useful is if someone's doing a low iodine diet to help with thyroid, they're three months into it, and they're seeing no improvement. Then, they can do that test.

Dr. Christianson:

If they're still above that threshold, either they need more time to see the benefits, because there was so much there, or there's some hidden sources they've not identified just yet but some of the studies showing that low iodine diets could reverse thyroid disease, they did try to check people beforehand and see, "Oh, maybe the non-responders were low in iodine going into it, or maybe the good responders were high in iodine." There was no relationship. There's really not a test that you can do to say, "Oh, this would help me or this would not."

Dr. Childs:

Yeah. Go ahead. Yes, sir.

Dr. Christianson:

I'm sorry. OCD thing again.

Dr. Childs:

No, you're good.

Dr. Christianson:

The completion one, I won't talk about the skin iodine unless you're curious, but there is also serum thyroglobulin. Not anti-thyroglobulin, but serum thyroglobulin, and also ultrasound thyroid volume. Both of these have a good inverse relationship to iodine status, but the difficulty is they're not accurate in those with autoimmune thyroid disease. Yeah, that's pretty much the lay the land for iodine testing.

Dr. Childs:

Yeah, which is unfortunate, right? Because I think patients might think to themselves, "Well, if we can test it, then we can have an idea of what to do," but it sounds like it's not that clear cut.

Dr. Christianson:

It's not helpful.

Dr. Childs:

Yeah. Not exactly. I wanted to come back to something you mentioned, I believe it was the gentleman that you were treating in the 70s. That was the guy who had the iodine challenge test, correct?

Dr. Christianson:

Yup.

Dr. Childs:

Yeah. Maybe could you speak to this, because if we're talking about iodine and we're talking about this tolerance, which is lower than the average population, and now we have a lot of, let's say integrative, functional minded, natural medicine practitioners who are recommending certain iodine testing, which may sort of conflict with this idea that you've put forth here. This is the idea of iodine challenge testing, right?

Dr. Christianson:

Right.

Dr. Childs:

What would you say to somebody who is thinking about getting this iodine challenge testing done? Maybe you could explain what that is a little bit more and perhaps why they may want to consider another option.

Dr. Christianson:

I'm glad you mentioned that because it is commonly available for people and they do ask about that. The rationale, and this goes back to a group that launched a lot of these new iodine ideas, the rationale makes enough sense. The idea was that if you take a lot of iodine, your body needs it, you won't excrete as much. Your body will hold onto it and you won't have as much show up in your urine afterward.

Dr. Christianson:

But if you take a high dose and you don't need it, you'll excrete more of it. That seems intuitive and rational enough but the funny thing is, if we were to think about like BPA, like plastic toxins or mercury, you wouldn't say take a bunch and see if your body needs it.

Dr. Childs:

Right. Yeah.

Dr. Christianson:

You wouldn't say, if it's stuck there, you must have needed it, you wouldn't think that.

Dr. Childs:

No, definitely not. Yeah.

Dr. Christianson:

We now know that when we take a bunch of iodine, we do get rid of more iodine, but not through the urine. We get rid of more of it through the sweat and through the stool. Then, also it takes this time to get rid of it. Population studies have shown that when the intake of iodine increases, urinary excretion increases, but it might be three or six months later. It's not all by tomorrow.

Dr. Christianson:

In fact, ZRT laboratories, they did a study on this exact proposition and they took individuals and give the prescribed, in this case, they gave a 25 milligram or 25,000 microgram dose of iodine and they followed that with 24-hour urinary iodine tests. What they did differently is they kept doing 24 urinary iodine levels for two weeks. What they saw was people that took a lot, peed a lot more out, but not all tomorrow. They were peeing a lot out as long as they were testing it. Yeah.

Dr. Childs:

I would say just given the information we've discussed here, probably not a good idea to undergo that test, given the fact that iodine testing, in general, is not very accurate. It doesn't give you necessarily the information you're looking for and has the potential to be harmful in the sense that you're consuming a significant amount. Now, oh, sorry. Did you have a comment on that?

Dr. Christianson:

Well, I'll just expand on that.

Dr. Childs:

Yeah.

Dr. Christianson:

These are micrograms. A gram is like a paperclip and a microgram is like a thousandth of that, I'm sorry, a millionth of that. Halfway between is a milligram, which is like a grain of salt. A milligram to a microgram is like a paperclip to a cow, as far as the mass change.

Dr. Childs:

Right. Yeah.

Dr. Christianson:

A grain of salt to a microgram is like, yeah, paperclip to a cow the other way. These are tiny amounts and people are consuming 25,000 micrograms. This is like 400 times a safe upper limit for anyone prone to thyroid disease or not. These things are commonly used.

Dr. Childs:

Yeah. I've seen that as well. I mean, obviously, and they can potentially cause problems as you've mentioned in your experience with that gentleman. Then, I've also seen that anecdotally as well. One thing that you mentioned that I wanted to talk about just for a second, was this idea that you were saying, iodine can potentially get excreted through the sweat and the stool. Did I understand that correctly?

Dr. Christianson:

Mm-hmm (affirmative). Yup.

Dr. Childs:

If that's the case then, this, I think probably has implications for further iodine retention because especially in the case of low thyroid function, constipation and so on, is there a physiologic mechanism by which the body will reabsorb that iodine if it stays in the stool too long? Will constipation lead to an exacerbation to those levels or does that play a role at all here?

Dr. Christianson:

You know it's plausible. Iodine gets in and out any way. We can actually breathe in iodine.

Dr. Childs:

Okay.

Dr. Christianson:

People living by big beds of sea vegetables have more in their bodies than they would have. Yeah, we can breathe it in. We can excrete it by any mechanism. We know that the excretion is normally primarily renal, but at the exposure to higher amounts, then things change.

Dr. Childs:

I see.

Dr. Christianson:

I'm aware of the rate of fecal excretion via biliary routes increasing after the renal threshold's been passed, as far as reabsorption ... I've not heard that either way, but it can absorb across the colon lining. We do see that when item was used for, in some retention enemas in the past, or also an item is used in bladder installations, so not plausible.

Dr. Childs:

Okay. I just didn't know if there was any literature on that or whatever. Just, it might play a role potentially, but it doesn't sound like it's a big thing. The next thing I kind of want to jump to, just in the last couple minutes here, is just this idea and I want to get your opinion on this since, see kind of where you fit, but there's this idea in medicine about optimal thyroid lab tests.

Dr. Childs:

There's this idea that patients are not feeling well, they're taking their medication and we'll talk maybe about the comorbidities, well, I don't know if we'll have time, maybe we'll have to do that in another episode, which would've been a great topic to talk about, but there's these people who are trying to explain a way this idea that they're not feeling well by stating that they're not within these optimal ranges. This exists for TSH, free T3, free T4.

Dr. Childs:

Now, where do you sort of fit on this idea? Now, do you believe there's any merit to this idea? Is it mostly inconsistent with what you're seeing practically and clinically or is there any merit to it? Where do you kind of sit on that idea [crosstalk 00:45:50]?

Dr. Christianson:

Yeah, we could have a long talk about this to do. It's a fun one.

Dr. Childs:

Yeah. It is, for sure.

Dr. Christianson:

I'll break this out into a couple of categories too. There's those, thinking about this as a template to fine tune medication dosages and there's thinking about this as determine who should start medication, so two very different things.

Dr. Childs:

Absolutely. Yeah.

Dr. Christianson:

I wouldn't talk about optimal as being worthwhile for starting medications. We could talk a lot about that, but in terms of those who are on medications, there is good data arguing that they have different symptom panels and different risk outcomes per their levels, even within the normal range. There's good data on that.

Dr. Christianson:

I should expand, too. You talked about TSH, free T3, free T4. The bulk of this literature is on TSH levels and a lot of people in natural medicine talk about the free hormones and arguing that if TSH should be low normal, which is largely true in this optimal lens, then the others should be high normal. That also seems intuitive.

Dr. Christianson:

I used to teach about the TSH and the free hormones sitting on a seesaw, like when one's high, the other's low. The drawback is, there was one recent paper that showed that for every hundredfold change for TSH, there's a twofold change in T3 and T4. That's because the T3 and T4 are so highly buffered by the body.

Dr. Christianson:

When there's too much, you'll first see the TSH dip long, long, long before you'll ever see the other of hormones elevate because the body excretes them faster and breaks them down more quickly and buffers in a lot of ways. Then, vice versa is also true. When the TSH gets higher, it gets high for a long ways before you ever see the other hormones drop because the body holds them longer and buffers them and utilizes them differently.

Dr. Christianson:

You can juggle a long ways with the T3 and T4. They're simply less sensitive. They're meaningful. They're not meaningless. Then, also, when we look at healthy populations, those that don't have thyroid disease, we don't see that they consistently have high levels of the free hormones. They do generally have lower levels of TSH, still normal, but generally lower.

Dr. Christianson:

Then, furthermore, there have been studies looking at populations that have higher levels of T3 and T4. They're not the healthiest people. They have higher rates of certain health problems. The thought in endocrinology is, how can we mimic the healthy population as much as possible? What are the markers that are found there?

Dr. Christianson:

Yes, if someone is on treatment and they're on a dose that keeps their TSH on the high side of the normal range, that may be an opportunity for improvement, both for wellbeing and also for less strain on their thyroid. If someone's not yet on treatment, I don't think about the optimal ranges as goal posts to initiate therapy, because that would have everyone on thyroid medication.

Dr. Childs:

Exactly. I'm glad you brought that up because I think that's a potentially big problem. There's this mindset of why haven't conventional doctors adopted this mindset. Why is there so much resistance there? I think, as you just mentioned, that's a big reason. If you took those optimal ranges in a lot of people, and I'm guilty of doing this as well as recommending these ranges, if we took that and just test to 100 people, we'd probably find that 80, 90% of people would be hypothyroid when in reality they're not. I think also just by-

Dr. Christianson:

No. Even if they were, the deeper question is would the medication improve their health in some way.

Dr. Childs:

Exactly. Yeah, exactly. If we put these people on thyroid medication, it might cause more harm than good, and you have a lot of other issues. I think separating it is kind of the same sort of way that I've come to this, is that if somebody's taking thyroid medication, they probably should be looked at a little differently than the general population for that very reason.

Dr. Childs:

It sounds like there is some merit to this idea of optimizing it, depending on where you fit, right. Not the people who haven't been diagnosed. As a screening test, it would operate very poorly, but potentially in treating those people who have active thyroid disease who are taking thyroid medication, it might have some relevance in that population

Dr. Christianson:

There's population differences per age, per gender, per pregnancy status, per past structural thyroid disease, cardiovascular disease. There's certain things that influence and associate how that would come out but yeah, there's still relevance to it.

Dr. Childs:

Okay. Yeah. Like you said, we could talk about this for a long time. In fact, we probably have to, probably have to do another one if you have time, because I think we could talk for, like I said, hours on these topics, but Alan, it's been awesome having you.

Dr. Childs:

I know there's probably going to be questions from people and they're going to want to know how to get in touch with you, could you tell people how to get in touch with you, maybe more information about your website or any other things that you have going on, books, et cetera?

Dr. Christianson:

Sure. The latest book is the Thyroid Reset Diet. That one really details how one can eat healthy food. You can follow the diet you're on if you're already on one, but you can get to this low iodine window and often reverse thyroid disease. That's out there.

Dr. Christianson:

In terms of asking me questions, simplest thing, most Mondays, I do a thing I call office hours live. I get on Instagram and Facebook and I just answer live questions. That's…

Dr. Childs:

Awesome.

Dr. Christianson:

... typically right now, it's at 3:00 Pacific and yeah, Dr. Alan Christianson, Instagram and Facebook, and you can find me there and you can ask questions in real time, just free thing, happy to help out.

Dr. Childs:

Awesome. As I said before, I think Dr. Christianson, thank you so much for what you do. You have taught me so much and this interview has been amazing. You're just a wealth of knowledge. Like I said, I don't know that anybody does more research onto these topics than you. All the thyroid patients out there are so grateful to have you, including me. Thank you so much for your time.

Dr. Christianson:

I appreciate that.

Dr. Childs:

No problem. That's all I have for you guys today. Otherwise, we'll see in the next one.

Thyroid controversies: iodine intake, causes of Hashimoto's & more

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About Dr. Westin Childs

Hey! I'm Westin Childs D.O. (former Osteopathic Physician). I don't practice medicine anymore and instead specialize in helping people like YOU who have thyroid problems, hormone imbalances, and weight loss resistance. I love to write and share what I've learned over the years. I also happen to formulate the best supplements on the market (well, at least in my opinion!) and I'm proud to say that over 70,000+ people have used them over the last 6 years. You can read more about my own personal health journey and why I am so passionate about what I do here.

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