Gut-Thyroid Connection: Your gut microbiome influences hypothyroidism and the autoimmune subtype, Hashimoto’s Disease, and how a plant-based diet can help - with Dr. Travis Cox and Roslyn Kent on The Gut Plant Powered Gut Show

In Episode #8 I feature Roslyn Kent’s podcast, The Plant Powered Gut Show, and our recent interview where we discussed how eating a plant-based diet can positively impact your gut-thyroid connection and so much more!

In this conversation we also discussed:

- What the thyroid hormone pathway does for your health.

- The most common signs and symptoms in hypothyroidism.

- What blood tests to consider for measuring your thyroid health. 

- How your gut microbiome can influence your thyroid hormones, for better or worse!

- SIBO, dysbiosis and gallbladder issues and the thyroid. 

- Diet and lifestyle strategies to consider for managing autoimmune hypothyroidism. 

Resources:

Roslyn Kent is a plant based Registered Holistic Nutritionist living in Vancouver, BC. She specializes in the microbiome and gut health and through her online programs and courses, Roslyn helps ambitious women struggling with IBS and similar imbalances conquer their symptoms through evidence based, plant based nutrition strategies when conventional medicine has failed them. When Roslyn isn’t working with clients online, you can find her in the mountains backcountry skiing, hiking in the alpine, or mountain biking.
- The Plant Powered Gut Show - https://podcasts.apple.com/ca/podcast/the-plant-powered-gut-show/id1542786237

- Plants First Holistic Nutrition - https://plantsfirst.ca/

- Microbiome in Hashimoto’s - https://pubmed.ncbi.nlm.nih.gov/28903182/

- Changes in gut microbiota with hypothyroidism - https://pubmed.ncbi.nlm.nih.gov/29320965/

- Thyroid hormone balance via the gut microbiota - https://pubmed.ncbi.nlm.nih.gov/25516464/

- Thyroid hormone metabolism & the gut microbiota - https://pubmed.ncbi.nlm.nih.gov/28167127/

- Hashimoto’s and Gall bladder connection - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6129049/

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About your host: Dr. Travis Cox - BA, DC, MSc is a Doctor of Chiropractic with a focus on Functional Medicine and plant-based nutrition. He is the creator of PBandHealthy.com and host of the Plant-Based and Healthy podcast. Connect with him on Instagram, Twitter and Facebook @yourvegandoc #pbandhealthy. And remember, individuals inspire and communities create change!

Audio credit: Thank you @katetrajanmusic for your lovely voice on the intro/outro and @craigritchiemusic for the super catchy music track for the intro/outro... many thanks!

Transcript

Dr. Travis Cox:

Welcome back, listeners, to another episode of Plant-based and Healthy. On today's episode, I'm actually featuring an interview I recently did with Roslyn Kent on her podcast, The Plant Powered Gut Show, and we talk about the thyroid and gut connection. Roslyn Kent is a registered holistic nutritionist, living and practicing in Vancouver, British Columbia, where she specializes in gut microbiome and gut health, and she focuses more specifically on ambitious women struggling with IBS and similar imbalances in their gut. And her podcast is full of wonderful guests and tidbits of information on simplifying gut health and gut microbiome nuances of what to look out for in your health, as well as what to do about it, and does some deep dives with particular guests. So check out her podcast, The Plant Powered Gut Show, and of course, enjoy today's episode about the thyroid gut connection.

Roslyn Kent:

Hello, Travis, thank you so much for being here on The Plant Powered Gut Show. How are you doing today?

Dr. Travis Cox:

Very well. Thanks for having me.

Roslyn Kent:

Yeah, of course. Happy to have you here. So we're going to be talking about the thyroid a little bit today, or a lot a bit, I guess, and we're going to dive in into all the nuances and how that's also connected to gut health. So why don't you first start by explaining a little bit more so people are on the same page, everyone's on the same page here. What is the thyroid? Because a lot of people have heard certain things and maybe not others, and you can explain it in a little bit more depth, and what's its role in the body?

Dr. Travis Cox:

Absolutely. So yeah, for those that don't know, the thyroid gland is a butterfly shaped gland, endocrine gland, that sits at the base of your throat, and it's considered the master to metabolic rate setting part of the body. So what it does actually produces thyroxin or thyroid hormone, and that hormone actually goes to every cell in the body. Interestingly, every cell in the body has receptor sites for thyroid hormone, and in fact, these thyroid hormone receptors are located on the nucleus of the cell. They have a direct traffic directly to that nucleus of a cell to actually control basal metabolic rate. For those of you who don't know, basal metabolic is a resting expenditure of energy just to keep general tissues functioning, and a natural byproduct of that is body heat. So it also is involved with body temperature regulation too. Those are the main roles of thyroid hormone but there's many more elements of what it has to do in the body, but those are the main functions.

Roslyn Kent:

And so if someone's suspecting that their thyroid is out of balance and maybe their doctor or their practitioner is expecting that as well, what are some of the signs and symptoms that your thyroid is out of balance? And I know it can go both ways, because we could be talking about hyper or hypothyroid, but do you want to explain on both sides of things, if you don't mind?

Dr. Travis Cox:

So just stepping back, looking at how prevalent hypothyroidism is, is about one in 1,000 [inaudible 00:02:49] worldwide. So we're talking about adults, one in 1000 doesn't seem that prevalent, but when you look at more of the autoimmune side of it, which is your body is attacking itself, and particularly your thyroid gland, it actually occurs in about 15% to 25% of the adult population in westernized countries like Canada and U.S. So it's a lot more abundant than we like to think or acknowledge, and interestingly, over 90% of hypothyroidism cases is related to the autoimmune type called Hashimotos.

 Now unfortunately, most family doctors or medical doctors are trained to identify hypothyroidism via checking your blood labs for TSH. TSH is thyroid simulating hormone, which is what your pituitary gland if your brain produces, it tells your thyroid gland to produce more thyroid hormone. So they look at that marker and say, "Hey, is it elevated?" Because if it is, then your thyroid gland might be not producing enough thyroid hormone causing some of those symptoms that you might be suffering from, and then of course, they treat you with a medication.

 Now unfortunately, they don't look at the autoimmune side because if they did see that there was autoimmune against the thyroid gland in a case of hypothyroidism, i.e. Hashimotos, they're not going to treat it any differently because there's no current standard of practice to treat Hashimotos differently than hypothyroidism, so there's no point to even see if it's there in the first place.

Roslyn Kent:

That's wild. So is it just because we don't have research or information and knowledge on how to approach this? Are we lacking there? I know it takes a long time for the current research in any field, well specifically in the health world, to reach a practitioner's office, but what's going on there? Because it's I think like you said, it's the most common part of thyroid imbalances is we're seeing a lot more Hashimotos so why is that a thing?

Dr. Travis Cox:

That's a great question. I don't have the answer to that. It gives evidence. If you look at the scientific literature on the topic, which hopefully we'll touch on a bit today, it's abundantly clear that they should be. I mean, to be honest, a lot of autoimmunity is challenging. It's very complicated. There's a lot of multisystem and [inaudible 00:04:49] biology overlapping, imbalances that can occur at the same time, and a lot of the approaches to actually make an impact for an individual with any kind of autoimmunity, not just Hashimotos, involves diet, lifestyle, and nutrition, and that's not their forte. That might be part of the reason, but beyond that, there's no specific medication to treat Hashimotos beyond looking at just the hypothyroidism element of it. So that's my understanding as to why, but I wish they would consider other options.

Roslyn Kent:

Yeah, no kidding.

Dr. Travis Cox:

Beyond that. But you did ask a question, I don't want to not answer it, but you mentioned what are the symptoms of hypothyroidism? Though in my clinical experience, when a patient presents with Hashimotos or hypothyroidism, and honestly, if someone has hypothyroidism, I assume it's Hashimotos based on the statistics, is that the two top symptoms they're going to have are cold hands and feet, or cold extremities, or maybe just running cold, not easily warmed up, and fatigue. Fatigue is a big one. So someone has fatigue and has this coldness in their hands, nose, or toes sort of thing, that's a reoccurring, not just a one off from being outside in minus 25 or something, then that's to me a kind of a red flag clinically to say, "Hey, they might have hypothyroidism. Let's look into that further."

Roslyn Kent:

Constipation is something I often deal with in the gut health world, and I've actually been really tripped up by this because I've had clients who present, or they have hypothyroidism, but they are ... Or it's, sorry, they have constipation and I assume that their thyroid panel, we know that it may be imbalanced and it comes back that they're hyperthyroid and not hypothyroid. So because you think that okay, everything is going to be slowing down with a hypothyroid situation, but I guess it's not always the case, is it?

Dr. Travis Cox:

It's not. Typically, what I find is that if an individual does have the, again, Hashimotos variety of hypothyroidism is that your thyroid gland isn't just at a constant rate, it's not just always producing the same amount of thyroid hormone and indirectly the brain telling the thyroid gland to produce thyroid hormone via TSH isn't always going to be the same level either. So if you were to, let's say, take a lab panel of me today, my TSH level is going to fluctuate throughout the day, and my T4 or thyroid hormones are as well. So if I were to do a blood panel, it might not be a good snapshot of what actually is happening behind the scenes. But if you do so over time, you can maybe perhaps see a trend, especially if you start to correlate it with symptoms.

 And as an aside, if someone does have Hashimotos, they're going to have these hyperthyroid flares because when you get that thyroid gland destruction from the autoimmune side of it, it's going to cause as temporary acute releases of thyroid hormones, it's going to cause us hyperthyroid state where we'll get senses of heart palpitations or racing heart or mind where you get anxiety and for unknown reasons. And unfortunately, we get a lot of patients that go into their family doctor with concern about their heart, because again, kind of panic attacks. And it turns out ... They do the EKG and the whole [inaudible 00:07:40] and there's nothing wrong with them according to the cardiovascular pathophysiology, what's going on, and it turns out it's probably because they're getting these flares. So that might be why you might see your clients where they might have normal panels for thyroid hormone pathways, but they actually in fact might still have hypothyroidism or Hashimotos

Roslyn Kent:

Interesting. I actually didn't know that about the blood work because I've had clients come back and it can be wildly different. I've worked with a client who had an incredibly low TSH and then it bumped up quite a bit the next time we tested, and there was a lot of things we implemented, but I actually didn't even know that it was in that we had to look at multiple tests. I didn't realize that, so that's really helpful.

 So speaking of testing though, there's definitely some flaws, I think in terms of how we test for thyroid imbalances, so do you want to elaborate on that a little bit and speak to what are some of those cons and what's going wrong with testing? And what are some things that people might miss if they just go to their doctor and they're given results and they're told everything's fine when they maybe are not fine?

Dr. Travis Cox:

Absolutely. So like I mentioned earlier with TSH levels fluctuating, especially with an unstable case of Hashimotos, that's not going to be as telling, so that's one sign. So it's recommended one would get tested multiple times, perhaps one in two weeks, once in another two weeks. Also, looking at things like T4, that's your thyroxin or thyroid hormone, would be helpful. But in honesty, I find that TSH levels are rather telling along with symptoms, but also the antibodies against those common thyroid related tissues that are related to Hashimotos because that way you can screen to see if someone has Hashimotos versus your run of the mill hypothyroidism because they're treated completely differently. And that's what you really want to understand clinically, so you can target the right approach because autoimmunity is a totally different ballgame than it is just the hormone pathway.

Roslyn Kent:

Okay, so you don't even really recommend end for all people that they need to have a full thyroid panel? Because I thought always that was one of the flaws was that a lot of doctors will take your blood and they'll look at TSH and then it'll be say a four and a half and then they're like, "Oh, it's normal." And so they don't send them in for further testing. So do you think ... Okay, so first off, do you think the ranges are too wide? And then again, so if someone's thyroid is that out of balance, would you just get the antibody testing or would you go further for T4, T3 testing?

Dr. Travis Cox:

Yeah, to answer your question, I would most certainly recommend looking at TSH levels in a more narrow optimal range because it's more telling. Yeah, if it's on the higher end, even if it's within normal reference range, but it's on the higher end of that spectrum, let's say it's 3.5 and above. Honestly, if it's above three, I think of that as a concern, but especially if it's four or above, that's a bit of an indication that it is hypothyroidism. Every physician is a bit different. I've had patients that go into their family doctor and they say, "Oh yeah, you're 4.5 TSH levels. Oh, that's fine. I don't think it's hypothyroidism." But in fact it is. So I would be a little bit concerned about maybe that interpretation of that result. And you can look at things like T4, T3, thyroglobulin, which is ... Thyroglobulin is the protein in your blood that is the taxi cab that lets thyroxin or thyroid hormones get in the back for a ride and brings it to the tissue to deliver it.

 That's also helpful, and again, those antibody against thyroid tissues like thyroid peroxidase antibodies or TPO antibodies, and thyroglobulin antibodies or TG antibodies. Those antibodies I think are more helpful, but if someone were to for sure be diagnosed with hypothyroidism and you want to better understand where is the imbalance that's interfering, like is it conversion, a T4 to T3 because T3 is more of an active form of thyroid hormone. There's certain other tissues or micronutrients that interact with that mechanism. Versus is it a thyroid hormone receptor sensitivity issue, kind of like insulin sensitivity issue, that sort of thing. Again, you can kind of look in the microscope a bit more detailed and understand where the mechanism that worked properly lives, but always screen for the Hashimotos variety because that's going to be way more helpful if you could rule it in or out from the beginning.

Roslyn Kent:

That makes sense, and I think that there's definitely an opportunity here to talk about how we might address some of these imbalances after. But I wanted to dive into the gut thyroid connection because you and I were chatting before this and I was like what is the gut thyroid connection? I know that there is one and it's something that I don't know a ton about and you know a ton about, so I thought you could shed some light on that because I don't think a lot of people understand the depth of this connection.

Dr. Travis Cox:

The thyroid gland actually develops in the same tissue as the gut in a fetus, so the embryo tissue is primitive gut cells and they divide at a certain stage in the embryonic journey. So they actually have a lot of similarities that most people don't know about. Beyond that, your thyroid gland is an endocrine gland that secretes hormones, but your gut has some of those similar functions. So they have some communication to one another. And beyond that, your gut microbiota or gut microbiome that lives in the colon is actually a big influencer over the thyroid hormone pathway, like thyroid hormone metabolism. It can reactivate hormones in the gut because as you know, all your hormones in your body, sex hormones and thyroid hormones included, gets over time used up and gets metabolized by your liver and gets detoxified to be able to be excreted out of the feces and urine.

 So if your gut microbiota isn't working properly, let's say you have dysbiosis or you have some other kind of subtle gut infection, or CBO, et cetera, that can definitely interact with the microbiomes ability to properly metabolize thyroid hormones. And that's of course, one of many things that could be not working properly. But interestingly, beyond that, there's actually some cool research on the fact that hypothyroid patients with the autoimmune variety Hashimotos, they actually have a decreased diversity of those microorganisms in the gut. And as we know with decreased diversity, and decreased abundance for that matter, we are going to have more health issues with that, whether it's increased intestine permeability or leaky gut, or you're going to have increased insulin resistance and inability to properly metabolize blood sugars and fats, or/and even having issues with not producing enough of those lovely byproducts of those gut microbes like short chain fatty acids, which are critical for keeping the lining of your gut intact, as well as fueling those epithelial colonal sites to do their jobs.

Roslyn Kent:

Wow, that's so fascinating. There's so much there.

Dr. Travis Cox:

There is, yeah.

Roslyn Kent:

And I think it's really cool how we're starting to understand so much more about the gut and how it truly is connected to a lot of things. And I don't like to use that as a blanket term, it's not like the gut solves everything. If you solve your gut, you'll solve every imbalance. That's not true at all, but it is really cool to talk about these connections and how they might be impacting one another. So do you see this in your practice? Are you seeing a lot of overlap between gut health imbalances and thyroid imbalances or is it less of a thing?

Dr. Travis Cox:

I do. I do. And I don't want to forget to mention that similar to what you were saying a moment ago is that fix any kind of gut health issues or to focus on the gut in approaching any hypothyroidism isn't going to be the be all, end all. With hypothyroidism, especially the autoimmune variety that we're talking about, it actually has five different systems of the body that can be heavily involved. So the immune system is one of course, for the autoimmune stuff. You're looking at your liver and the Hashimoto's connection. Looking at the brain Hashimoto's connection, things with the metabolism of those byproducts and the metabolites in the liver via biotransformation and detoxification. And there's a few more with blood sugar regulation can influence Hashimotos. So the gut isn't the only answer, but it's one of the commonly overlooked ones and not for any good reason because research does show that there's a lot of involvement.

Roslyn Kent:

So speaking of how we can approach a hypothyroid situation, because I'm pointing towards hypothyroid more than hyperthyroid, because it's a lot more common like you said. There's a lot of, especially women, dealing with hypothyroidism and Hashimotos more than anything. So in terms of addressing that from a dietary and lifestyle, and perhaps, I mean, supplements can come into play here, but how would you address specifically for looking at someone who has Hashimotos because you said it's a little bit more complex. What are some of the things that you might recommend in those categories for a patient of yours?

Dr. Travis Cox:

I would say the first thing is to look for those pattern of symptoms if someone has, because I mentioned two but there's more than that. We mentioned the fatigue, the cold hands and feet. Those are like ... I mean, I see that most commonly, but another set of symptoms that are very important to acknowledge in evaluation of these health states is going to be the motility of the gut. You want to look for any kind of episodes of constipation and infrequent bowel movements or struggling to have a proper bowel movement or fully evacuate your bowels. And even reoccurring if you have a patient or client with SIBO and it's chronically reoccurring, that can commonly be involved with Hashimotos as well because the migratory motor complex and its influence from the vagus nerve via the thyroid brain connection.

 And of course, with that in mind, there's actually of the gallbladder. The gall bladder, which secretes bile, which is in charge of emulsifying fats so it allows you to absorb fats and fat soluble vitamins. The gallbladder cannot actually contract properly because of a similar migratory motor complex, and when it doesn't contract properly, you're prone to having gallbladder sludge or/and gall stones, and inability to properly absorb fat soluble vitamins, like vitamin D and vitamin A and vitamin E. And interestingly, those vitamins as mentioned, those actually influence the immune system. So if it negatively affects the immune system, that could actually cause a vicious cycle with exacerbating that autoimmune dysregulation of Hashimotos, which is again, a whole big issue in and of itself.

 I did mention the brain. The thyroid actually helps influence ability to be able to think clearly, and of course, be able to recall memories or/and names easily in different parts of the brain, as well as having the ability to ... Well, if you have depression or episodes of blues and sadness, that can actually be related to Hashimotos too. So that's why it's so important to get properly diagnosed with hypothyroidism, especially Hashimotos, because if you go into your family doctor and say, "Hey, I have all these symptoms," like I just mentioned, and they don't see that you have Hashimotos or hypothyroidism, they're just going to treat those symptoms individually.

 So they're going to treat your depression within a SSRI perhaps, or they're going to give you laxative for your constipation, or the list goes on. And they're going to compartmentalize those symptoms and miss the bigger picture, and you wonder why you're going to perpetuate the problem. And sadly, that even happens when the medical care takes care of patients with hypothyroidism, because you're not looking at the autoimmune side of it. So they're just giving patients the Synthroid or the thyroid hormone replacement essentially to help try to get the body to do a better job, but it still isn't the only answer, so it gets complicated pretty fast.

Roslyn Kent:

Yeah, no kidding, eh? Wow, there's so much to it, and it sounds like this is so multifaceted and I think we probably didn't even look at the thyroid at this angle before even that long ago, and so much has changed in terms of how we're understanding how to help this and how to approach healing the thyroid and whether or not that ends. And I wanted to ask you later whether or not we can actually do that without medication, but so in terms of we're looking at symptoms now. Okay, so now when you see a patient of yours and you suspect Hashimotos, you get the testing done, it's confirmed, what are some of the first things that you're going to do with them?

Dr. Travis Cox:

Absolutely. So I look at that with those web of interconnected systems in the body, see which one is the more prevalent or more important one to work with, so it might be the blood sugar, it might be the gut microbiota, might be the gut brain thyroid axis. It might just be the brain. Determine which one of those systems is most out of balance relating to the symptoms and start looking at strategies for that. And of course, if it's Hashimotos, there's three things you want to do right out of the gate. One is to decrease sodium intake, so research shows that sodium intake actually can cause autoimmune flare ups, including those of Hashimotos. So you don't want to get those flareups because any autoimmune disease, you can't cure it.

 There's no cure for autoimmune disease, including Hashimotos. The only thing you can do is try to increase the length of period of relapses and decrease the flares or those ... Pardon me, decrease the relapse and increase the remission duration or to maintain as much as possible. And you need to identify what those triggers are, whether it's stress, whether it's being in a bad relationship, whether it's things like gluten, which is related because of the HLDQ genotypes that can be predisposed of being sensitive to gluten, and there is a lot of overlap with the Hashimotos and celiac disease, by the way. So there's certain foods you definitely want to avoid. Again, gluten is one of them. We mentioned the sodium intake, and if you are going to eat any foods that have a lot of salt in them, I recommend taking a potassium supplement with it because that will offset the absorption of the sodium so you don't actually get that cause of a flare or that relapse of your Hashimotos.

 And the last thing I'd recommend, well, there's probably two more things to recommend, but one of them would be to decrease iodine intake, which is a bit counterintuitive in the naturopathic space and herbal medicines and approaches to these sorts of issues with nutrition in other clinical settings. They often recommend iodine because if you look back historically, hypothyroidism was most common with regions of the world that had deficiency in iodine and iodine is a key mineral that's seen to make thyroid hormone. And if you have a deficiency in iodine, you can get a goiter, an enlargement of the thyroid gland and that can cause or be related to hypothyroidism.

 So naturally, most people thought okay, if someone has hypothyroidism and they must need iodine, but actually iodine can actually put fuel on the fire of the Hashimotos variety so iodine is something to actually avoid and not to supplement with, which is unfortunate because there's still a lot of clinicians and practitioners to this day that think they're doing their patients a favor by giving them iodine supplementation, or increasing iodine intake in their foods. And me being vegan and anyone else that's predominantly plant-based, there's even talk in the community of vegans and plant-based dietetics that you should watch out for iodine intake because it's a micronutrient of concern. But in fact, if you have Hashimotos, it's a micronutrient of a concern for a different reason and you should avoid it.

Roslyn Kent:

So this is Hashimotos specifically, is this not just a general hypothyroid situation?

Dr. Travis Cox:

Correct. They were speaking specifically about Hashimotos, the autoimmune type of hypothyroidism, but keep in mind, 90% of hypothyroidism cases are Hashimotos related.

Roslyn Kent:

A hundred percent.

Dr. Travis Cox:

And don't go diagnosed. So if you have hypothyroidism or someone has hypothyroidism, I would say assume it's Hashimotos because chances are you have it and it's not commonly tested for it, unless you go out of your way to test it via those antibodies you mentioned.

Roslyn Kent:

Okay, so you would recommend of course, then if you can get tested, get tested.

Dr. Travis Cox:

Exactly.

Roslyn Kent:

Because then you kind of know what beast you're dealing with here.

Dr. Travis Cox:

Exactly.

Roslyn Kent:

Do you why it fuels the fire? Do you know anything about that specifically? I mean, I know you may not, but it's just really fascinating.

Dr. Travis Cox:

Yeah. I don't off the top of my head, I could definitely send you a link with the research paper that goes in that kind of mechanism bit more.

Roslyn Kent:

Yeah, please do.

Dr. Travis Cox:

And if you want to include it in the show notes, what have you, anyone else could read up on it. But my understanding, I mean, essentially iodine is required for ... T4 stands for basically having four of the iodine molecules in the thyroid hormone, so actually iodine is required to make it. So if you're giving yourself an ingredient to produce production of it, it's going to be in the valve of the cells like a thyroid peroxidase enzyme that's involved with producing thyroid hormone, thyroxin, and when you give iodine, it's actually going to be basically stimulating that pathway more causing increased production of thyroid peroxidase enzyme, and that's going to cause more antibodies or attack it causing a flare up. So that's my understanding of it but I might be a little wrong, so I'll share that article in case it's missing some information there.

Roslyn Kent:

Now from a gut health perspective, if someone comes to you with extreme dysbiosis, maybe they have a long history of antibiotic use and all of the dietary and lifestyle habits that they're following right now are just not conducive to a healthy gut or a healthy hormone balance. Would you start with trying to work on the gut first for someone like that? Or would you go straight to supporting their thyroid with some of these more concrete recommendations that you've kind of laid out there?

Dr. Travis Cox:

Yeah, I would double check to see if they have sensitivity of certain foods. Like for example, if you have dysbiosis and you have any kind of intestinal issues over a longer period of time, you're more at risk of losing oral tolerance, which means you're going to be reacting with an immune response in a negative way against certain food proteins. And I mean, casing protein in dairy and gluten, which is a protein found commonly in various grains is that of course, are the ... They're the most commonly known reactive foods that could be causing problems, but there are others too. So it'd be good to identify what those foods are.

 Now I know you like to tell people what not to do, which I agree is to not eliminate certain foods because if you eliminate a lot of commonly involved foods that can cause these problems without knowing if they are or not, you're going to be losing that ability to diversify your fiber and polyphenol and micronutrient intake, and that's going to decrease diversity further. So if it's a restrictive diet like autoimmune paleo, or let's say it was a SIBO specific diet or elimination diet, or things are of that nature, it's going to be a counterproductive time to try to get your health better, but you're going to decrease your microbiome ... Pardon me, microbiome diversity further and it's going to cause further problems.

 So that's good if you can identify what those foods are, and then the next thing you do would be to actually look at getting an increased intake of fiber for your gut so your gut microbiome can actually produce more of those lovely byproducts, those short chain fatty acids, and of course, do their job and doing all the wonderful things that they do. And the more diverse fiber you can get in your diet, the better. So I recommend patients consider if they can, again, based on the food sensitivity issue, is to do what's called a microbiome mashup, which is a particular method I recommend to get that diversity of fiber in their diet in an easy, convenient way.

Roslyn Kent:

Well, you can't leave us hanging. I mean, I know we're talking about the thyroid here, but what the heck is the food microbiome mashup?

Dr. Travis Cox:

So this ... Yeah, that's a good question. So this is something that a mentor of mine taught me, Dr. Datis Kharrazian, who is a functional neurologist, functional medicine practitioner who practices out of California. He came up with this and it works really well. So microbiome mashup is let's say okay, Roslyn, you're going to go to the produce section of your local grocery store today and you're going to pick the top ten vegetables out the produce aisle, and it doesn't matter. I mean, but they can't be the same, they all have to be different, and you can choose all your favorites, but try to pick ones that you've never tried before.

 So bring them home and you're going to dice them all up. You're going to basically get them as fine as you can, and if you want to use a food processor, great. But you're not going to cook them and you're not going to put them in a juicer or anything like that, you're just going to simply chop them up and make them smaller basically. And then what you're going to do is you're going to put them all together, all these little bits of all the vegetables that you chose, and you're going to mix them up in probably a rather big bowl or multiple bowls and then you're going to actually put them into little ideally glass containers, not plastic, but you're going to put that in the freezer. And then ideally you're going to take a serving size, let's say, I would say probably only one to two cups based on your ability to tolerate it.

 If you had dysbiosis, you'd probably want to start with a lower amount because you don't want to overwhelm yourself with too much fiber at once in case you have a reaction to it. Some people might depending on what's going on, and then you're going to just mix it with about 16 ounces of water, blend it up, and probably chug it back because it's not going to taste that pleasant, but just drink it as if it were any other type of medicine that you don't like. And then do that on a regular basis for a period of time and try to increase your dose in addition to eating whole food plant-based majority of the time otherwise.

Roslyn Kent:

Oh, this is so funny. I've never heard ... I've heard everything in the book I feel like when it comes to gut health, that's something I have never heard about. That's great. Wait, sorry. So just to clarify, are you cooking this or are you just blending it raw?

Dr. Travis Cox:

I recommend blend it raw, if you can tolerate it. Some people already have got issues like we were mentioning, they have an inability to digest it properly so you could cook it. I mean, arguably there's some nutrients you're going to lose. Or if you have your supplement part of your pantry, grab your digestive enzymes and pop one or two, whatever the dose is on that, just to help your body break it down more easily. But ideally because you chopped it up finely, it's going to be rather easy to digest and you're putting it in a blender so it liquefies it, so it shouldn't be too bad. Again, unless you have a reaction or a food sensitivity to one of those different types of vegetables, and then of course, you want to identify by which one those are and you want to avoid it.

Roslyn Kent:

Okay. Well, everyone listening, I guess you're going to have to go try the microbiome mashup. That is a first. I love it. That's a great idea.

Dr. Travis Cox:

Totally. Yeah.

Roslyn Kent:

Okay. So shifting back to the thyroid for a second here. So you told us a little bit about some specific food things, now I'm curious about lifestyle mindset and in terms of stress specifically and how that might impact someone who's trying to overcome or just really repair their thyroid and support it, I guess I should say. So what is the main connection between the adrenal glands and stress and the thyroid, and what do you recommend for those people? Are there specific strategies or are things ... I mean, I know we live in a stressful world. There's lots that we could all do, but is there anything specific there?

Dr. Travis Cox:

Well, you know what? I'm going to give you an example of one of the mechanisms that the stress from the brain, psychosocial stress or psychological stress, if it's perceived stress, it's going to affect your, like you said, the hypothalamo pituitary adrenal axis, the brain talking to the adrenals, which sit on top of the kidneys and secrete those lovely cortisol hormones to tell us to go fight or flight, right? But interestingly, what's going to happen as well is that your brain is going to talk to your gut via the vagus nerve, so that bidirectional two way street connection from your brain to your gut.

 And then what's going to happen is you're going to increase intestine permeability or leakiness in the gut, and that's actually going to cause it to be more stressed because you're going to have an influx of these toxins or bad metabolites from these bad gut bugs that do exist in our gut in a healthy way usually. But if they get past the gut, it's going to cause a systemic or whole body immune response to some degree, and that immune response is going to cause a flare up or aggravation or worsening, if you will, of the Hashimotos autoimmune thyroiditis situation.

 And on top of that, if you look at purely the benefits of a healthy microbiome, when you have increased intestinal permeability and from stress, you're going to have some disruption of that microbiome diversity over time too, which is going to cause worsening again, as we look to short chain fatty acids, and some of these things translocating, getting into the bloodstream, and that's what also causes or contributes towards that loss of oral tolerance, the ability to tolerate different food proteins.

 And if you can't tolerate ... Let's say you can't tolerate gluten and you ingest gluten but you're not celiac, it's going to cause an immune response. And that immune response is going to worsen things of the thyroid gland. So there are some other thyroid specific imbalances that can be worsened from that, that are not related to the immune side, but I want to paint the picture that the stress you have affects the gut and that affects your immune system dramatically, which then affects Hashimotos type of hypothyroidism.

Roslyn Kent:

And do you recommend breath work or anything to your clients who are suffering from a lot of anxiety and stress or anything like that?

Dr. Travis Cox:

Definitely. Yeah, so whatever you're ... Look at your menu options, whether it's breathing or mindfulness or meditation or forest bathing, whatever the case might be, go find your favorite item on the menu there and go do it on a regular basis. And interestingly, a lot of times with stress, we're talking about perceived stress, so we're talking about your beliefs around them so it's good to have a healthy network or community of people you can chat with. They kind of converse about that to get a better perspective, and ideally it's not a group of people you just commiserate with that you're just like, "Oh yeah, life sucks." And just kind of reinforcing it, you want to find kind of something that's more uplifting and inspiring.

 So there's a whole variety of other things you could do, at least that's as far as I go with my patients. And if it's beyond that, because sometimes I find, especially with autoimmune cases is that there is a potential influence of a negative relationship. So if someone is in a negative relationship, that is a very huge stress that's usually suppressed because you feel like you can't escape, you can't get out of the situation for various reasons. Maybe they're abusive. Maybe they help contribute towards your financial income and you can't afford to not live with them sort of thing. Whatever the case may be.

 Maybe you have kids with them and you're afraid of going through a divorce and having your kids be in two different places, what have you. It's very stressful and that can be a big contributing factor towards the autoimmune flare up. And I don't know why, but I see that more often than not, when I have patients with Hashimotos or other types of autoimmunity is they often have a history of, or currently in, a negative relationship. And that isn't always a romantic relationship, it could be their work relationship or otherwise, but I usually can identify that and that's where there's more work to be done to improve that influence over the immune flare ups.

Roslyn Kent:

So the last question I want to ask you, because Synthroid is handed out like candy it seems like. You talk to so many women who are ... Well, I talk to a lot of women in my life and I realize oh yeah, they're on Synthroid and they're on Synthroid and they're on Synthroid. So for someone who's ... I mean, obviously, Hashimotos, you said there's no cure and that's something that is going to be managed for a long time and there's ways to manage it, as you've pointed out. But when it comes to just classic hypothyroidism and ruling out Hashimotos, is there hope for people who are put on Synthroid? Can they come off that Synthroid or can they do things to try and bring the ... I should say their thyroid back into balance so that they don't have to take the Synthroid?

Dr. Travis Cox:

So first and foremost, I am not able to prescribe medications, including Synthroid, so I can always speak about it from a scientific literature viewpoint, I can't ever tell my patients to go on or off medications. And of course, whatever I'm saying here is purely just based on my understanding of the literature just to let you know. That said, if we're talking about Hashimotos specifically, you definitely want to be on a type of medication that could help regulate your thyroid hormone pathway because if you go through a hypothyroid state without medication and you have Hashimotos, that's going to cause a positive feedback loop flare up of the immune element of the Hashimotos imbalance because in and of itself, it is stressful.

 So if you experience the symptoms of hypothyroidism from Hashimotos, like we talked about before, the fatigue, the cold hands and feet, the depression, the constipation, et cetera, that's actually going to be a big stress in your body and that's going to cause is it to be more of a flare up and worsening up the condition over time. So in my opinion, if you already have Hashimotos and hypothyroidism, you just want to manage it the best you can and you cannot pass go and collect those $200, so to speak, unless you're on a medication, in my opinion, based on that mechanism alone. And I see patients that do choose to not take their doctor's recommendations and not go on the medication or try to get off it or wean themselves off of it, but I see it always doesn't work in my attempt to help them get better, it often backfires or just causes a delay of our ability to realize it's important enough to take, and then we can get some traction with the other strategies we roll out.

Roslyn Kent:

So that makes sense. I would say from a Hashimoto's perspective. Well, I think a lot of people actually don't know that because there's a lot of fear around medication and I come from a family and a background where stepdad is an oral surgeon, mom is a nurse, and very much a balance of conventional and natural in my mind, but there's a lot of fear being pushed around about medication is bad, medication is good, or medication is this and it's never a blend. And I think you're so right that we can do all these things that you're talking about, and there's a lot of other dietary and lifestyle things I'm sure that you haven't talked about that you could support the body with, but medication isn't always a bad thing, especially if we're talking about an autoimmune condition. So thank you for sharing that.

Dr. Travis Cox:

I might just add that I think a more important question in my opinion, for a patient that's considering Synthroid or medication for their Hashimotos and hypothyroidism is which type of medication works best because you need to get that TSH level under control and thyroid hormone pathway under control from an endocrine gland standpoint before you can work on the autoimmune side and that medication, it might not be the best fit for you, it might not work well enough. So there are other medications you can consider that are bioidentical perhaps or Synthroid or a combination of T4 and T3 because Synthroid is mostly just T4.

 So that's what would be a more important question to ask your doctor about would be which medication works best because the general standard of practice is if let's say you're diagnosed with hypothyroidism today and okay, take Synthroid, let's monitor your TSH levels in a year and at your annual check up, and see where it's at. If it's not under control, maybe you need more of a dose, but if you continuously need a higher dose every time you get that checked, it probably means that medication is not right for you and that's a conversation you need to have with your doctor. And there are other options out there beyond Synthroid because that is kind of the default just go to Synthroid right away, but it might not be the best option.

Roslyn Kent:

Okay, good to know, and I'm sure a lot of people will be happy to hear that because I mean, doctors don't always give you options or it's usually like, "Hey, here's the medication instead of here are your options." So that's a really important conversation to have. Well, thank you so much for being here on the show, Travis. It's been a pleasure. You are a wealth of knowledge, and you can go into so much depth so I appreciate you. And thank you to everyone for listening and being here on the show, and we will catch you, or I will catch you, at the next episode. Bye, everyone.