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What is Hashimoto’s?

Hashimoto's illustration for  post top 10 foods to avoid for Hashimoto's

Hashimoto’s Thyroiditis is an autoimmune condition in which your body makes antibodies that attack the cells in your thyroid. This results in your thyroid not making enough hormones which can lead to a variety of symptoms such as weight gain, tiredness, muscle weakness, and sometimes an enlarged thyroid gland (goiter). 

Who is at Risk?

The anti-TPO antibodies are more common in women (13.9%) than in men (2.8%), causing women to be more at risk for Hashimoto’s. Another risk factor for this condition is being of middle age. Most reported cases tend to occur between the ages of 40 and 60. Hashimoto’s can also be hereditary, though no gene has been found that carries it.

The top 10 foods to avoid for Hashimoto's

Foods high in inflammation can trigger or worsen your immune system. Decreasing the amount of inflammatory foods in your diet can help relieve symptoms of Hashimoto’s and improve overall health. The following foods are considered to be inflammatory and should be avoided or limited:

Top 10 foods to avoid for Hashimoto's

What foods should you eat for Hashimoto's?

Not only should you avoid the foods listed above, but you should also incorporate more anti-inflammatory foods into your diet. It is important to eat nutrient-dense, whole foods that are high in bioflavonoids and antioxidants as well. These foods can boost your overall immune function and help lessen your symptoms from Hashimoto’s:

Helpful Supplements for Hashimoto’s

In conjunction with a healthy diet, including these supplements may be beneficial in people diagnosed with Hashimoto’s Thyroiditis:

The Bottom Line

Hashimoto’s thyroiditis is an autoimmune condition that can be managed with lifestyle modifications like an anti-inflammatory diet. Research shows that dietary and lifestyle changes can significantly improve your symptoms and boost your overall health.

References

Hashimoto’s Diet: Overview, Foods, Supplements, and Tips (2022). Healthline.

Hashimoto’s Thyroiditis Hair Loss and your Diet: What To Eat and What To Avoid. 

(2022). Stefanie Sandler Billette, MS, ACE-CHC.

Ostrowska L, GIer D, Zysk B. The Influence of Reducing Diets on Changes in Thyroid 

Parameters in Women Suffering from Obesity and Hashimoto’s Disease. Nutrients. 2021 Mar 5;13(3):862.

Guide to Hashimoto's

What are thyroid antibodies?

Thyroid antibodies indicate that you have an autoimmune thyroid condition. This means that your body attacks your thyroid cells. 

What are the different types of thyroid antibodies? 

There are several thyroid antibodies that are typically correlated with either hypothyroidism or hyperthyroidism.

Another autoimmune thyroid marker that we assess for is thyroglobulin antibody. This is a general marker that tells us if you have an autoimmune attack to your thyroid. While some patients with autoimmune thyroid disease usually have 1-2 of these markers positive or elevated, it’s not impossible to have a 3 and be diagnosed with both Hashimotos Thyroiditis and Graves’ Disease. 

How to lower your thyroid antibodies

How to Lower Your Thyroid Antibodies

Before we discuss the possible ways to reduce thyroid antibodies, we have to note that we have yet to see clinical symptoms correlate with thyroid antibodies. Some patients have extremely elevated thyroid antibodies, but with a proper treatment protocol experience little to few symptoms. Nonetheless, there is some research on several different protocols or ways to lower thyroid antibodies. 

1. A diet change  

There is some evidence that following a gluten-free diet can help lower thyroid antibodies. When someone has an autoimmune thyroid condition, their likelihood of co-morbidities like celiac disease increases.

However, that’s not to say that avoiding gluten, even if you’re not diagnosed with celiac disease, isn’t a good idea. In fact, gluten contains a protein known as gliadin that resembles an enzyme your thyroid produces, known as transglutaminase. The research shows that having celiac disease or gluten sensitivity can mistakenly cause your immune system to attack your thyroid when exposed to gluten.

It may be prudent to get tested for celiac disease, and even if you don’t have celiac disease, inquire about testing for gluten sensitivity. There is some data pointing towards an autoimmune paleo diet to help lower thyroid antibodies. However, the research is mixed, and the diet can be quite restrictive when following long-term.

Regarding diet, there is a general consensus that iodine in excess can wreak havoc on thyroid function. We recommend testing your urinary iodine/creatinine ratio to see whether you’re getting too much iodine. You can do this with Labcorp or Sonora Quest.

Given that so many foods on the shelves are often fortified with iodine, it’s less likely to be deficient. When it comes to iodine, you don’t want to exceed 150 mcg daily. Iodine sources include fish, eggs, seaweed, kelp, and spirulina. Other sources of iodine could be skincare and topical iodine used as an antiseptic. Your skin is your largest organ, and whether you are applying iodine topically or ingesting it in excess, it can cause complications regarding thyroid function and thyroid antibody levels. 

2. Supplements and medications  

When it comes to supplements and medications, there are a few things that have been shown to lower thyroid antibodies. Some certain nutrients and minerals have been researched for lowering thyroid antibodies.

Selenium

Selenium is a mineral found in the soil that can naturally be found in certain goods. There is research that points towards consumption of 200 mcg of selenium daily can not only improve some symptoms in those with Hashimoto's Thyroiditis but has also been shown to reduce antithyroid peroxidase (TPO).

You can check to see how much selenium your body has through a blood test. Certain foods like Brazil nuts and organ meats are very rich sources of selenium. Consuming 2-3 Brazil nuts daily should provide you with enough selenium to meet your daily requirements. 

Curcumin

Curcumin, a yellow pigment found primarily in turmeric, has antioxidant and anti-inflammatory properties. There have been many studies linking curcumin and chronic inflammation. Given its antioxidant and anti-inflammatory properties, some research indicates that it helps protect the thyroid gland.

Vitamin D

It has been shown that individuals with autoimmune thyroiditis generally have lower levels of Vitamin D. In fact, it has been shown that vitamin D deficiency has been linked with symptom severity in Hashimotos Thyroiditis.  

Other nutrients and vitamins that tend to be low in individuals with Hashimoto's Thyroiditis include vitamin B12, magnesium, and iron. Not only do these clinically present to be lower in individuals with Hashimotos Thyroiditis, but there is research supporting that supplementation with each of these (if necessary based on bloodwork) can lower thyroid antibodies and also improve symptom severity in patients. 

Black cumin seed oil

Another herb that should be highlighted is black cumin seed oil, also known as nigella sativa. A randomized control trial looked at 40 patients with autoimmune thyroiditis and gave half the participants nigella sativa and the other group a placebo for 8 weeks.

The study found that patients treated with nigella sativa had lower anti-thyroid peroxidase antibodies and lower levels of thyroid-stimulating hormone (TSH). The group treated with black seed oil also experienced a significant weight loss and reduction in their BMI. Most of the research on nigella sativa is on 1,000 mg (1 gram). 

Medication

When it comes to medication, Low Dose Naltrexone (also known as LDN) has been gaining a lot of traction in helping alleviate symptoms in those suffering from autoimmune diseases. LDN is an immune modulator that helps improve immune function by increasing the production of endogenous endorphins.

This increase in endorphins stimulates improved immune function. More specifically, LDN modulates or regulates certain immune markers and lowers a pro-inflammatory cell known as TH17, which is an autoimmune promoter!  In doing so, LDN has been shown to reduce thyroid antibodies in individuals with autoimmune thyroid disease significantly. 

Triggers to avoid 

While there is a list of things you can incorporate into your diet and lifestyle, there are also other triggers to avoid to help lower your thyroid antibodies. Stress has been shown to be an environmental trigger for Hashimoto's or any other autoimmune disease.

Research suggests that any type of stress, whether it is psychological or physiological, can impact the immune system, which can, in turn, aggravate the thyroid gland. A randomized control study looked at women with Hashimoto's Thyroiditis and stress's impact on their thyroid antibodies.

They split the group in which one group received the standard of care, and the other group was provided with stress management intervention. The study found that the group that was provided with the stress management intervention had decreased levels of stress, lowered thyroid antibodies, and improved lifestyle scores. 

So, there are many ways in which you can take action to lower your thyroid antibodies. Your thyroid antibodies are an indication of how your immune system is functioning, so reducing thyroid antibodies could imply an improved immune response. Speak to your Physician about all the different avenues you can take toward lowering your thyroid antibodies. 

Have you been on thyroid medication for years? Wanting to wean off? Unsure of whether or not you can just, stop cold turkey? Well hopefully, we can provide you with some insight so you can discuss your options with your Physician.

Why do some patients wean off mediation?

Some patients want to come off thyroid medicine for a variety of reasons. Depending on the thyroid medication someone is on, there may be some long-term adverse side effects. For example, some research shows that long-term use of high-dose Synthroid or levothyroxine (T4) could increase the risk of fracture incidence and osteoporosis.

Some people find it daunting to have to take medicine for the rest of their lives. Patients may have other reasons for wanting to stop taking thyroid medication; however, it must always be done as a wean and never discontinued cold turkey. Discontinuing your thyroid medicine cold turkey could lead to undesirable side effects, including changes in blood pressure and heart rate and significant fatigue.

What are the side effects of weaning off thyroid medication?

A person weighing on a scale: How to wean off thyroid medication

Suddenly stopping your thyroid medicine may cause rapid weight gain, delayed reflexes, hair loss, dry skin and brittle nails. Sudden discontinuation of thyroid medicine could also cause a shock to the thyroid, making it more challenging for your thyroid to work efficiently on its own and produce thyroid hormone. 

Depending on the dose and type of medication you are on, you may discuss options to wean off your thyroid medicine with your Physician. Your Physician will have to closely monitor your thyroid levels if you wean off your medication to ensure your thyroid is still efficiently producing thyroid hormone. Your Physician can do this by assessing your Thyroid Stimulating Hormone (TSH), Free T3, and Free T4.

How does your physician help you wean off thyroid medication?

Each physician will have a unique way of weaning your thyroid medicine, but with any medication wean, the slower, the better, in our opinion. The slower the wean, the more support your thyroid has to start functioning independently and producing hormones. 

So let’s say, for example, you’re taking Levothyroxine (T4) 50 mcg. Depending on your thyroid blood tests (TSH, FT3, and FT4), we might consider reducing your thyroid medicine to alternating 50 mcg with 25 mcg for 4 weeks. After those 4 weeks or so, it would be prudent to re-check your thyroid blood tests.

If your physician thinks your thyroid levels are within the normal range, then you may further reduce your medicine to 25 mcg for another 4 weeks. The process would proceed slowly while rechecking your thyroid labs are you decrease your medicine. 

Given that there are some hidden causes of hypothyroidism, like certain infections and nutrient deficiencies that may cause sluggish thyroid function, you may want to ask your physician to assess these other etiologies so that you can support your thyroid on all fronts. 

Some common places to look may be assessed for an infection, like Helicobacter pylori or Epstein Barr Virus. Even more recently, there have been links correlating COVID-19 infection with thyroid function.

You can also ask your physician to look at nutrient status, including iron (you can check iron, but also be sure to check ferritin). Ferritin is how much iron you’re able to store. You also want to ask your Physician to check your zinc levels, selenium, vitamin C, and urinary iodine.

By testing your nutrient status and for possible infections, you’re able to address potential root causes of your thyroid dysfunction. Even if you can’t fully discontinue thyroid medicine, addressing potential etiologies that may be impacting your thyroid could allow you to decrease the amount of thyroid medication you are on. 

How to wean off thyroid medication

Ever heard of the T2 thyroid hormone? You’ve likely heard of TSH, T4, and T3... but what is T2? Possibly another hormone to consider when looking at thyroid health. T4 (Thyroxine) and T3 (Triiodothyronine) are your main thyroid hormones.

While both play a major role in your body's metabolism, helping support brain function, digestion, energy metabolism, and more bodily processes, you may not want to neglect your other thyroid hormones. In fact, you also have T1 thyroid hormone.

Wonder why you’ve never had these hormones tested?

Well, the short answer is that both T1 and T2 thyroid hormone behaves as precursors/byproduct of your T4 and T3 hormones. What do all of these hormones (T1, T2, T3, and T4) have in common? Well, they are all made up of a protein known as thyroglobulin.

While it's been believed that T2 is a byproduct of your more active thyroid hormones (T4 and T3), there is some evidence that your thyroid actually produces T2. Not to complicate things even more, there are several forms of T2 that need to be explained.

It is generally considered that T2 is inactive, but this is too general of a statement, given that there are different forms of T2. In fact, one form of T2, 3,5-Diiodothyronine has been shown to play some interesting roles when it comes to the thyroid and metabolic function.

In fact, in rodent models, 3,5-T2 was administered, and it was found to rapidly increase not only the subjects’ resting metabolic rate, but also showed beneficial hypolipidemic effects. What does this mean?

Well, this research is indicating that 3,5-T2  may play a significant role in enhancing weight and fat loss by increasing how many calories the body burns at rest. This information is something to consider in patients with hypothyroidism or hypothyroid symptoms. 

T2 and cholesterol 

The thyroid gland: T2 Thyroid Hormone

The thyroid function plays a large role in cholesterol metabolism. Very often we see patients with hypothyroidism struggling with metabolic function, like breaking down and processing cholesterol. Oftentimes, we see patients with untreated hypothyroidism have elevated levels of cholesterol. It has been assumed that its the role of active T3 that primarily helps with metabolizing cholesterol; however, T2 may be playing a significant role in cholesterol metabolism.

There were rat studies done that showed short-term administration of 3,5-L diiodothyronine (T2) to hypothyroid rats that showed increased mitochondrial function by increasing ATP activity. What does this mean? ATP, also known as Adenosine triphosphate, is the energy-carrying molecule in your cells.

When your cells are functioning optimally, you’re better able to metabolize and have increased efficiency in losing weight. That T2 has been shown to play a significant role when it comes to energy metabolism and the proper breakdown of cholesterol.

T2... what are the benefits?

A lot of the research has been done on T2; however, most has been done primarily on animals. There has been a study on human subjects, though, who were supplemented with T2 with no other changes made to their thyroid medication. After slightly less than one month, there was a noted average weight loss of 9 pounds. 

While many studies on human subjects have not been done, this one study shows promising evidence that T2 can be very impactful in hypothyroid patients (specifically those experiencing metabolic issues). In fact, T2 has been found to active brown fat.

Brown fat is a special type of fat that produces heat and allows your body to burn more fat. So not only has T2 been shown to increase fat metabolism, help your body better process, and in effect, lower cholesterol, but its also been shown to potentially help stabilize blood sugar and maintain muscle mass. 

So how do you get T2?

The thyroid gland naturally makes T2, so you can find it in naturally desiccated thyroid. It's unclear the exact amount of T2 in naturally desiccated thyroid (NDT), however, we expect the amount to be consistent given that it's been standardized in the amount of T4 and T3.

This is derived from the thyroid of a pig, so unfortunately, if you have dietary restrictions or follow a vegan or vegetarian diet, it may not be the best option for you. However, suppose you feel like you’ve been on thyroid medication and still struggle with your metabolic rate and ability to lose weight. In that case, naturally desiccated thyroid may be a medication to consider. You should speak to your provider and see if this may be the right medication for you. 

What does this mean for me?

As we have been able to note from the research, there is a lot of evidence that points to the possible effects that T2 has, and that is not merely an inactivate byproduct of T4 and T3 metabolism. We see, based on animal and even human studies, that T2 can play a major role when it comes to increasing metabolic rate, lowering cholesterol, enhancing mitochondrial function, and aiding in significant weight and fat loss.

Obtaining standardized T2 in the marketplace is currently limited to natural desiccated thyroid (NDT) that will provide you with T2, T3, and T4 from the thyroid of a pig. While the T2 is not entirely standardized from our knowledge, it is consistent from pig to pig.

Based on the research, it seems there is still a significant amount of information to be learned when it comes to thyroid function. As Naturopathic Doctors, we don’t merely assess your TSH (thyroid stimulating hormone) to assess thyroid function. We look at your Free T3, Free T4 thyroid antibodies (TPO, thyroglobulin antibody, TSI), as well as your nutrient status in its role in your thyroid function.

As we see, there may be more pieces of the puzzle to assess when it comes to your thyroid function and the specific role each of your thyroid hormones places. This is promising to many individuals with hypothyroidism who seem to have “normal” thyroid levels but still exhibit significant thyroid symptoms. 

The effect of T2 Thyroid Hormone on your metabolism

Struggling with stubborn weight gain or an inability to lose weight? Have you tried fad diet after fad diet, and the scale still won’t budge? I’m here to tell you that it may not be your diet alone that’s preventing you from losing weight... At least not entirely.

We tend to look at weight loss as black and white. Calories in versus calories out. However, we’ve come to understand that it is not that simple. There can be many things contributing to weight gain, including your hormones. 

When was the last time your Doctor checked your bloodwork? Weight gain has so many causes, and it is important to assess the aetiology of your symptoms so you can make the best diet and lifestyle decisions uniquely for you.

Some comprehensive testing that you and your Physician should consider testing include a Complete Blood Count (CBC), Complete Metabolic Panel (CMP), Fasting Insulin, Thyroid Stimulating Hormone (TSH), Cholesterol, hsCRP, Free T4, Free T3, Reverse T3, AM Cortisol, HbA1c, Vitamin D, Vitamin B12, Folate, Vitamin C, Ferritin, Estradiol, Estrone, Progesterone, Testosterone, DHEA-S.

Other specialty testing, including a Comprehensive Stool Analysis, Salivary Cortisol Test, and Food Sensitivity Test may also be indicated. Of many of the causes of stubborn weight gain, adrenal fatigue or adrenal insufficiency may be one of them.

What is adrenal fatigue?

Well, to answer this question, we first need to speak about the adrenals and cortisol. 

What are your adrenal glands?:

How to Lose Weight When You Have Adrenal Fatigue
The endocrine system

Your adrenals glands are a pair of 2 glands located right above each kidney. Your adrenal glands produce several hormones responsible for many of your essential bodily functions. These functions include helping regulate your immune system, stress hormones, metabolism and blood pressure.

The adrenal glands have two parts: the adrenal cortex and the adrenal medulla. The cortex and medulla are each responsible for producing hormones. There are specific conditions associated with too little or too much production of adrenal hormones.

The adrenal cortex makes up most of your adrenal gland and is the outermost part of your adrenals. Your adrenal cortex is made up of 3 zones that each produces different hormones; these zones include the zona glomerulosa, zona fasciculata and zona reticularis.

The zona glomerulosa secretes aldosterone, the zona fasciculata secretes cortisol and the zona reticularis secretes both androgens (DHEA and androstenedione, both made from cholesterol)  and a small amount of glucocorticoids. Aldosterone is a steroid, released by the zona glomerulosa that is responsible for regulating the salt and water in your body, having an effect on your blood pressure. DHEA is a hormone that is a precursor to your other hormones, like testosterone and estrogen. 

The adrenal medulla, the innermost part of the adrenal gland, secretes primarily epinephrine and norepinephrine. Epinephrine and norepinephrine are your stress hormones and neurotransmitters  that are often released when you are in “fight or flight.”

These chemicals cause your blood pressure and heart rate to increase and your blood sugar to go up. Epinephrine has a greater effect on your heart, and norepinephrine affects your blood vessels, causing them to constrict which is why your blood pressure goes up. 

What is cortisol?

Cortisol is a glucocorticoid hormone that is produced and secreted by your adrenal glands. Cortisol is also known as your stress hormone. Your cortisol plays a large role in regulating your blood sugar, blood pressure, circadian rhythm, energy, metabolism and inflammation.

In normal adrenal function, cortisol should be highest in the morning and reduce as the day progresses. Cortisol is usually tested first thing in the morning (before 9 am); however, a more salivary test may be ordered that assesses your cortisol throughout the day.

What are ideal cortisol levels?

Typically, cortisol is tested first thing in the morning. The reason being is that your cortisol should be highest in the morning and drop as the day goes on. Morning cortisol levels should be between 6.2−19.4 μg/dL. If your cortisol is below that or at the bottom range of “normal,” it indicates you have a low cortisol awakening response. There can be many causes of this, some of which include Addison’s Disease, physiological burnout, chronic fatigue, poor sleep, or chronic pain. All of these can contribute to adrenal fatigue.

Back to adrenal fatigue... What is it exactly?

Adrenal fatigue is a condition whereby your adrenal glands have endured a lot of stress and have been overworked, causing them to produce less cortisol. When this happens, you experience symptoms associated with low or suboptimal cortisol. Some signs associated with adrenal fatigue include:

Your physician should assess you for a more serious condition, like Addison’s Disease, as the treatment will vary. Some signs of Addison’s Disease include:

How to lose weight with Adrenal fatigue

Magnesium and energy levels

Feeling fatigued, tired and lack of energy? Your magnesium, or lack thereof may be the answer. It is not uncommon to experience some of these symptoms, go to your Doctor, and have them tell you that everything in your blood work looks flawless.

Often times, however, Doctors are not looking at the status of your major vitamins and minerals. You would be surprised at how many times a patients severe fatigue and lethargy has been linked to a B12, Vitamin D, Vitamin C, Iron or Magnesium deficiency.

While this may not seem severe and can often be corrected with proper diet or supplementation, the symptoms that you experience, depending on the level of deficiency, may be severe. 

What is magnesium?

Magnesium is a major mineral in your body that is necessary for many of your enzymatic functions. Your body needs many minerals to function- including calcium, potassium, sodium, phosphorus, chloride, iron, magnesium, zinc, iodine, sulfur, colbant, copper, manganese, fluoride and selenium. 

What makes magnesium so important?

Magnesium is extremely important when it comes to the health of your bones and energy levels. Magnesium helps regulate the function of your nerves and muscles, helps maintain appropriate blood sugar and blood pressure levels and is important in DNA synthesis. Magnesium also helps in the activation of Vitamin D. The amount of magnesium that you need depends on your age and gender. Typically, as we get older, our bodies require more magnesium. You can find the recommended daily amount below:

The Importance of Magnesium for Energy and Overall Health

Signs and symptoms of magnesium deficiency may include:

Some signs that you may be deficient in magnesium include muscle twitching, muscle spasms, sore muscles, insomnia, fatigue, lack of energy, loss of appetite, weakness, pins and needles (also known as paresthesia), anxiety, high blood pressure, and irregular heartbeat. 

The older we get, the greater risk we are of magnesium deficiency. This is because aging causes inhibition in adequate magnesium absorption through the gut. Individuals with type 2 diabetes, absorption issues, or alcoholics are also at an increased risk of magnesium deficiency and should request that their Doctor test them. 

Where is magnesium found?:

Magnesium can be found in many different types of foods. However, the quality of our foods has changed over time, and our soil is not as rich in magnesium as it once was. That’s not to say that you can’t get magnesium through your diet because you absolutely can; however, it is best to test your levels and incorporate supplementation if necessary. 

Magnesium can be found naturally in many foods and has even been fortified in some foods. Some foods that naturally contain magnesium include: 

Want to optimize your magnesium levels? Snack on a fun, homemade trail mix of almonds, pumpkin seeds, popcorn, and peanuts. And you can even throw in some dark chocolate for a sweet magnesium boost! 

What are the different forms of magnesium?:

There are many different forms of magnesium, but some of the most common ones include:

Each form of magnesium has different benefits when it comes to your health-

For starters, magnesium glycinate is considered to be the most bioavailable form of magnesium and the most absorbable. It is also the least likely form of magnesium to induce diarrhea. We often recommend magnesium glycinate for patients with long-term deficiency due to its absorbability.

Magnesium glycinate has also been shown to have calming properties and help reduce symptoms related to stress, anxiety, and depression. Interestingly, magnesium glycinate has even been shown to help reduce PMS symptoms in menstruating women, maintain adequate heart rhythm, reduce pain and enhance exercise performance.

Different forms of Magnesium for The Importance of Magnesium for Energy and Overall Health

While magnesium glycinate is the most absorbable form of magnesium, you will often find magnesium citrate on your local health food store shelves. Magnesium citrate is actually also very easily absorbed and may be a good option, especially for those suffering from constipation. The citrate, or citric acid, in magnesium citrate will help loosen your stool, so it makes a great option for those with constipation or infrequent bowel movements. 

Let’s dive deeper into how magnesium can help increase energy levels:

Remember hearing about ATP in your 5th-grade science class? Let’s recap. ATP, also known as, Adenosine 5′-triphosphate, is an energy-carrying molecule that is found in all living things. ATP is responsible for storing and transferring energy in your cells.

In order for ATP to be active, it requires a magnesium ion to bind to. Cool, right? So the lack of adequate magnesium levels may inhibit the activation of ATP or energy! Magnesium acts as an antioxidant in your mitochondria (the powerhouse of your cells) and actually helps your body convert the glucose in your food to energy will help keep your energy levels stable, which can prevent those afternoon slumps! 

I want all the energy! How much magnesium can I take?:

When it comes to magnesium, you want to get your levels checked and follow the recommended daily allowance (RDA). “The Recommended Dietary Allowance (RDA) for adults 19-51+ years is 400-420 mg daily for men and 310-320 mg for women.

Pregnancy requires about 350-360 mg daily and lactation, 310-320 mg. Exceeding the recommended daily allowance for magnesium can lead to magnesium toxicity. Some signs of magnesium toxicity include:

This is why appropriate testing and monitoring with your Physician is key!

How do you test for magnesium?:

We test for magnesium in the blood. This does get more specific, however! Oftentimes, you can test for magnesium in the serum or plasma, but a more specific test looks at how much magnesium is actually in the red blood cell, and that test is called RBC Magnesium. A normal RBC magnesium ranges from 4.2 and 6.8 mg/dL. 

What to do after you test:

Once your magnesium RBC levels have been established, you can speak to your doctor about the appropriate supplementation! Magnesium supplements typically range from 150-500 mg. While you’re at it- you should ask your doctor to assess your other nutrients, as a deficiency in those nutrients has also been linked with low energy, depression, fatigue, brittle nails, and even hair loss! 

We’re sure you've heard that the acai berry is a superfood... But what does that really mean? Well, what if we told you that the acai berry can improve fertility outcomes?

What makes acai berries so special?

Acai berries have quite a special nutrient profile and are rich in minerals, antioxidants, tannins, polyphenols, and anthocyanins. Specifically, they’re rich in zinc, copper, iron, magnesium, potassium, and chromium.

Not only that, but their anthocyanin content makes them a rich source of antioxidants. Acai berries are native to the tropical south and Central America and typically grow in regions near the equator. 

Acai and fertility

What are antioxidants?:

An antioxidant is a natural substance that prevents and slows the production of free radicals.  Free radicals are atoms in your body that are unstable, causing cellular damage. When your body is consumed with too many free radicals, your body has a hard time getting rid of them; your body goes under what is called oxidative stress. Free radicals may be caused by environmental pollutants, cigarette smoking, air pollutants, ozone, pesticides, radiation, and x-rays.

Oxidative stress is a phenomenon that is caused by an imbalance in the oxygen-reactive species that is produced and accumulated in the cells. When there is too much oxidative stress in the body, the body is unable to detoxify the reactive products that are accumulating in the body.

When this accumulation occurs, the body is more likely to develop chronic conditions such as autoimmune disorders, diabetes, cancer, and neurodegenerative issues. In fact, there have been studies showing that people who ate few antioxidant-rich foods were at greater risk for developing chronic conditions. 

This is where antioxidants come to the rescue. By doing so, antioxidants are able to neutralize the free radicals and limit damage made to the cells. Interestingly enough, your body actually makes antioxidants for this purpose, but typically not enough. In fact, there is evidence that acai berries actually protect your ovaries from damage.

What foods are high in antioxidants?

There are thousands of different types of antioxidants, including but not limited to lignans, phenols, flavonoids, carotenoids, vitamin c, and vitamin e. A lot of these antioxidants can naturally be found in plant-based foods, including vegetables, fruits, seeds, nuts, and spices.

The specific antioxidants in these foods will depend on the color of the vegetable or fruit. For this reason, it is often recommended to diversify your diet with colorful fruits and veggies, so you provide your body with a range of antioxidants.

Why acai berries?

Many studies have been done on acai berries and have suggested that acai berries have more antioxidants than any other antioxidant-rich foods. The bioactive compounds found specifically in acai berries give them anti-proliferative, anti-inflammatory, and cardiac protective properties.

Acai berries are also rich in omega-3 fatty acids and can in fact improve brain health and physical and behavioral development in infants, making them an essential nutrient during pregnancy. 

Acai berries

There has been an ongoing study at CCRM, a clinic in Colorado that suggested women who had poor egg quality and going through in-vitro fertilization had improved outcomes after supplementing with Acai. Interestingly enough, oxidative stress has been shown to significantly reduce female egg quality and may contribute to ovarian dysfunction, which subsequently can negatively impact a woman’s fertility. 

The study done at CCRM, conducted by Dr. Katz-Jaffe consisted of 42 participants, aged between 28 and 44 years old with a median age of 37 years ago. All 42 women were supplemented with acai for 3 months prior to ovarian stimulation. The study found that women ages 39 and older had a 75% live birth rate compared to women under the age of 39 with a 78% live birth rate.

The clinical research study thus far has resulted in 81% of the study participants achieving ongoing clinical pregnancies. This number is promising, considering the average in the U.S. for a 37-year-old woman is merely 37.8%. The study also found that the number of eggs retrieved went from 15.8 with 8.1 fertilized  (previously failed cycle) to 20.6 with 11.5 fertilized eggs after supplementation with acai. 

Dr. Katz also looked at the effect acai supplementation had on mice to assess the impact it had on a molecular level. This study suggested that there was an increase in the expression of antioxidant genes, increased antioxidant pathways, and decreased cell death.

The study compared young and aged mice, finding that aged mice had fewer oocytes and reduced blastocyst development. While after being treated with acai, the oocyte numbers in the old mice didn’t increase, the blastocyst formation did, but it also alleviated an aging-related decrease in implantation potential and increased ovarian ER stress.

It is suggested that acai supplementation helped upregulate NFR2 (Nuclear factor erythroid 2-related factor 2), lessening the effects of ovarian aging. Nuclear factor erythroid 2-related factor 2 is a transcription factor that helps regulate your cells under normal and stressed conditions.

It plays a role in providing antioxidant protection against damage that is done to the cell. It has been targeted in many chronic conditions, including cardiovascular disease. 

What does this mean in relation to fertility?

This study shows promise in the effect acai has on fertility outcomes. That said, more research is needed, and the quality and amount of acai used are very important. A therapeutic dose needs to be established for supplementation, specifically to enhance in-vitro fertilization outcomes. 

Acai berries and fertility
Acai and Fertility

It should also be noted that the acai supplementation used in the study were specific CCRM Acai Supplements which are produced specifically to preserve the high-level of antioxidant activity in acai. The current research does, however, indicate that increasing one’s intake of antioxidant-rich foods not only has now been shown to improve fertility but plays an essential role in neutralizing free radicals and preventing oxidative damage to the cells.

Consuming antioxidant foods and eating a diverse diet filled with different types of fruits and vegetables can help prevent the onset of chronic conditions. 

What is serotonin?

Serotonin, also known as 5-hydroxytryptamine (5-HT), is a chemical neurotransmitter that also behaves like a hormone. Serotonin is made from one of your essential amino acids, known as tryptophan. Interestingly, because it is an essential amino acid, tryptophan can not be made by the body and must be consumed through diet.

3D model of Serotonin structure for How Diet and Lifestyle Affects Your Serotonin
Serotonin: C10H12N2O

Foods high in tryptophan include nuts, seeds, cheeses, and some meats like turkey and chicken. Because you need enough tryptophan to make serotonin, a deficiency in this essential amino acid can result in low levels of serotonin.

Typtophan 3D model
Chemical compound for Tryptophan

Not enough tryptophan has been associated with conditions including anxiety and depression. Serotonin carries messages between your central and peripheral nervous systems, helping regulate many of your body's functions.

Interestingly enough, most of your serotonin (about 90%) can be found in your intestines, and the brain makes up only about 10%. While serotonin cannot cross the blood-brain barrier, there is some research suggesting that serotonin production from the intestines could provide some promise in regard to treatment for low serotonin.

Serotonin is typically called your “happy hormone,” as it plays a major role in regulating your mood, sleep, and even digestion. Serotonin also has a role in other essential functions like bone health, wound healing, and sexual function.

Diet and Serotonin:

Assorted nuts

As we know, our diet profoundly impacts our hormones and overall well-being. As mentioned above, serotonin is made from tryptophan, which the diet can only supply. Foods high in tryptophan, which may contribute to serotonin production, include:

  1. Turkey- Ever wonder why you’re so tired after a big Thanksgiving meal? It is because turkey is very rich in tryptophan, packing 410 milligrams for two servings of turkey. 
  2. Nuts and Seeds- Not only do nuts and seeds contain tryptophan, but they also provide you with a good source of fiber and antioxidants.
  3. Tofu- Tofu and many soy products are great sources of tryptophan. 
  4. Eggs- Research has shown that whole eggs can significantly increase serum tryptophan levels.
  5. Other foods rich in tryptophan include salmon, cheese, poultry, pineapple, and spinach. 

Other factors that can increase serotonin levels naturally include:

  1. Exercise- Physical activity has been shown to release dopamine and serotonin, thus improving one's mood.
  2. Meditation- Several studies have looked at urinary serotonin breakdown levels in mice and found that they increased in mice after their meditation sessions. More specifically, a study looked at the impact that Transcendental Meditation made on serotonin levels and found increased serotonin levels with this meditation practice.
  3. Sunlight- Interestingly, a study looked at yeast extracts and found that exposure to sunlight had increased serotonin production in yeast. Generally speaking, most studies have found that serotonin levels in healthy adults are highest in the late summer and fall and reduce in the spring- likely due to the availability of sunlight. 
  4. Your mind matters- Studies have suggested that visualizing something that makes you happy, whether it is looking at a photograph or thinking about 

So now that you know foods and lifestyle habits that promote serotonin production, what foods deplete your serotonin?:

Ever wonder why you feel tired or maybe even a little down after eating processed foods high in trans fat and sugar? Well, there may be an explanation as to why you’re feeling this way... and we’ll give you tools to optimize your diet and lifestyle habits to ensure you’re supporting appropriate serotonin levels. 

Trans-fat foods that deplete serotonin
  1. Trans fats. Interestingly enough, high consumption of trans-fat foods has been shown to reduce serotonin. Trans fats have been shown to cause inflammation in your brain, which can actually reduce serotonin production in your brain, therefore increasing your chances for depression and a decrease in energy. 
  2. Processed foods- Processed foods are typically filled with unhealthy, inflammatory oils and salt and packed with sugar. Overconsumption of processed foods can wreak havoc on your gut. As mentioned previously in the article, most of your serotonin is made in your gut, so eating too many processed foods may impact your gut health. When it comes to processed foods, moderation is key. 
  3. Foods high in sugar. As we’ve seen, sugar is inflammatory, especially when eaten in excess. Excess sugar consumption decreases your tryptophan levels, inadvertently lowering your serotonin production. You should avoid added and processed sugars and instead focus on natural sugars that come from fruits and vegetables. 

Now that you know the impact your diet and lifestyle habits have on your serotonin levels, what do you do? Well... knowledge is power! Be mindful of the everyday practices that you do and how you feel.

Are you engaging in physical activity? Are you utilizing any mindful practices throughout the day? What are you choosing to snack on while you’re busy or working? While reaching for a sweet treat may be tempting, the long-term impact may not be worth it.

I challenge you to keep a mental track of how you feel after eating certain foods- are you feeling energized and happy or sad and tired? Knowing which foods can enhance your serotonin production gives you an upper hand when deciding what to eat.

Perhaps choosing a handful of nuts and seeds over a bag of potato chips may satisfy that craving for a nice salty crunch but still support healthy serotonin production. Craving something fatty? How about a grilled piece of salmon with sauteed spinach in olive oil? 

While these options may not seem “fun” at first, the way you feel after changing your diet will have you wanting to continue dialing in your diet to best support your health. When it comes to diet, moderation is key! 

Have a 30-minute lunch break? Go for a walk! Studies show that spending time outdoors and engaging in physical activity helps increase your serotonin levels. Not only that, but it can also help stabilize your blood sugar and support a healthy circadian rhythm and vitamin D levels! It’s the small changes that we make on a daily basis that lead to the greatest results.

Foods rich in Tryptophan

Struggling with anxiety, fatigue, constipation, bloating, or gas? While it seems that these symptoms are often deemed to be normal, I’m here to tell you that they’re not and may actually be a sign that you should have your Doctor do further investigation.

While one of the causes may be your parathyroid, it can also be caused by a slew of other conditions including but not limited to your thyroid, hormonal imbalances, adrenal issues, or blood sugar dysregulation.

Interestingly enough, anxiety disorders are the most common mental illness in the United States, affecting over 18% of the U.S. adult population. That is a huge statistic that seems to be rising each year. While anxiety disorder is very often considered a diagnosis and treated with SSRIs and SNRIs, what if it is actually a symptom of an underlying condition?

Rather than merely masking your anxiety, it may be prudent to investigate the root cause of your symptoms. Yes, there can be many causes of anxiety, and while medications or other therapies may be necessary in some cases, they may be masking the root cause of your anxiety. Some causes of anxiety may include:

There are many benefits to treating the potential underlying cause of your symptoms. Not only can you avoid being on medication for the rest of your life, but you may also be able to avoid side effects to some of these medications and symptoms and risks associated with some of these other conditions. 

What is your parathyroid?

An image showing the parathyroid glands

Your parathyroid glands are 2 pairs of small, 4 pea-sized, oval-shaped glands that sit next to your thyroid gland, which is located in your neck.

What do your parathyroid glands do?

Your parathyroid glands produce parathyroid hormone (PTH), which very closely regulates the calcium levels in your bloodstream. Specific areas in your body, like your kidneys, small intestine, and bones respond to PTH released by the parathyroid glands by increasing the calcium levels in your blood.

Parathyroid Hormone also helps regulate intestinal absorption of calcium, how much calcium your kidneys hold onto, and helps with the transformation of Vitamin D to its active form. 

What makes calcium so important?

Calcium is one of the most abundant minerals in your body that provides many vital functions. Calcium is an extremely essential mineral when it comes to the strength of your bones and teeth, cardiovascular health, muscle contraction, blood clotting, and nerve function.

Most of your calcium is stored in your bones, but about 1% is found in your blood, muscles, and other tissues. Your body tightly regulates the calcium in your body, specifically the amount of calcium floating around in your blood. Your body does this to avoid hypercalcemia, which can lead to weak bones, and kidney stones and potentially create cardiovascular emergencies. 

What else regulates your calcium?

What else regulates Calcium? for Hyperparathyroidism: A Potential Underlying Cause of Anxiety
Learn how your body regulates calcium

Your PTH and calcitonin regulate your calcium. PTH, also known as Parathyroid Hormone, is a hormone that your parathyroid glands produce and release to help control the amount of calcium circulating in your blood.

PTH stimulates the release of calcium into the blood, and also helps control the levels of both Vitamin D and phosphorus. When PTH levels are elevated, it can cause your serum calcium levels to rise. 

Calcitonin, on the other hand, is a hormone made by and released by parafollicular cells in your thyroid gland. Calcitonin helps regulate the calcium levels in your blood, preventing calcium in your blood from getting too high.

It does so by blocking the activity of osteoclasts, which are cells that are responsible for breaking down your bones. Preventing bone breakdown helps reduce the amount of calcium that gets released into the bloodstream. 

What is hyperparathyroidism?:

Hyperparathyroidism is when your parathyroid glands create too much parathyroid hormone (PTH)  in the bloodstream. There are two types of hyperparathyroidism- primary and secondary, indicating different etiologies.

In primary hyperparathyroidism, an enlargement of one or more of the parathyroid glands causes overproduction of the hormone. This causes high calcium levels in the blood, which can cause a variety of health problems. Surgery is the most common treatment for primary hyperparathyroidism.

Secondary hyperparathyroidism occurs due to another disease that first causes low calcium levels in the body. Over time, increased parathyroid hormone levels occur.

How can hyperparathyroidism cause anxiety?: 

When an individual has hyperparathyroidism, they have an excess amount of calcium in their blood, called hypercalcemia. Too much calcium in the blood will affect the nervous system, leading to a slew of nervous system conditions, including anxiety, forgetfulness, brain fog, and depression.

Interestingly enough, a study compared patients with hyperparathyroidism with a control group and found that the incidence of anxiety was higher in the subjects with hyperparathyroidism. Even more interesting was that once the subjects with hyperparathyroidism were treated with a parathyroidectomy, the incidence of anxiety decreased! About half of patients with hyperparathyroidism suffer from anxiety, and clinically, research is proving that higher blood calcium levels (hypercalcemia) are linked with anxiety. 

Hyperparathyroidism and depression:

Because elevated blood calcium levels have been shown to affect the nervous system, we see that not only does this cause anxiety, but may even be linked to depression in some individuals. A study looked at almost 400 patients with hyperparathyroidism over the course of several years.

The incidence of depression was found in about 10% of the patients. What's even more interesting is that after this set of patients underwent parathyroidectomy, 90% of those patients said that their symptoms of depression were no longer impacting their quality of life and ability to work. 

Hyperparathyroidism and IBS:

Given that the parathyroid glands regulate your plasma calcium levels, they’re able to have an influence on your digestive tract. Too much calcium due to hyperparathyroidism can cause gastric upset, including constipation, nausea and heartburn. Interestingly, some complications of hyperparathyroidism may include kidney stones (also known as nephrolithiasis), peptic ulcers, pancreatitis, and dehydration.

So if you're having IBS symptoms like abdominal pain, diarrhea, constipation, and bloating, make sure your Doctor rules out all other causes, including hyperparathyroidism, before diagnosing Irritable Bowel Syndrome (IBS). 

Hyperparathyroidism and fatigue:

Excess calcium in your blood will cause calcium to be leached out from your bones, causing bone weakness which predisposes you to fracture, bone and muscle pain. But as we mentioned earlier, it affects not only your bones but also your nervous system. Too much calcium in your blood interferes with your brain function, oftentimes causing memory loss, confusion, and fatigue. 

So now what? If you are experiencing any of these symptoms, like fatigue, depression, anxiety, abdominal pain, weak bones, or constipation- ask your Doctor to check your parathyroid! This can be first assessed through a standard blood test called a Complete Metabolic Panel or a CMP. This panel will look at your blood calcium level. Even if your calcium levels come back normal, this does not exclude a parathyroid condition.

You should also ask your Doctor to assess your PTH, also known as your parathyroid hormone. This will give a better indication if you need further evaluation. At that point, your Physician might order a SPECT scan, which is a CT scan that allows for a better visual of your parathyroid glands. 

Hyperparathyroidism: Explained

We’ve seen a lot of buzz around the ketogenic diet- but can it have long term side effects? Its quite possible.

What is the ketogenic diet?:

The ketogenic diet is a low carbohydrate, adequate protein and high fat diet. This means that a majority of your carbohydrates are coming from fats, a good amount from protein and very little from carbohydrates.

The premise of the ketogenic (or keto) diet is that by starving your body from its main glucose sources (carbohydrates), the body starts to rely on ketone bodies. Ketone bodies are fuel that your liver produces from store fat. Essentially, your body is focused on burning your fat for fuel, instead of dietary glucose from carbohydrates.

The ketogenic diet has gained popularity within the past few years and has helped many people successfully lose weight, reduce insulin resistance and even help manage some chronic conditions like epilepsy.

But is this diet safe long-term and safe for everyone? 

The short answer is no and you should consult with your Physician before initiating such a restrictive diet.

The ketogenic diet has you avoid carbohydrates. While avoiding or restricting refined carbohydrates is generally good for most people, avoiding all carbohydrates can put you at risk for becoming deficiencies in essential micronutrients.

healthy meal

Fruits and vegetables, while “good” carbohydrates, are still considered carbohydrates on the ketogenic diet and restricting them from your diet puts you at risk for missing out on some important vitamins and minerals. Short term, this may not have a big impact on your health, however, your thyroid needs an array of nutrients to function optimally.

Some of these nutrients include selenium, iodine, iron and zinc. You might be thinking- a lot of these nutrients you can get from animal proteins or nuts. Yes- you certainly can. But don’t forget about the other vitamins that are also important in the proper function of your thyroid.

Your other vitamins and minerals like magnesium, Vitamin C and your B Vitamins play an integral role in your thyroid function. But don’t forget- your thyroid doesn’t work alone! Your other glands, like your adrenal glands, for example, rely on adequate nutrition. If your adrenal glands aren’t functioning properly, your thyroid starts to suffer.

Look at your glands like a three-legged chair. For women, think of your adrenal glands, your thyroid gland and your ovaries. Men- think of your adrenal glands, your thyroid gland and testes. When one of these glands isn’t functioning optimally, the 3-legged chair is no longer stable and inadvertently the other glands start to compensate. 

What is your thyroid?

An image showing a thyroid gland
Your Thyroid Gland Illustrated

Your thyroid is a butterfly-shaped endocrine gland located at the base of your neck responsible for many aspects of how your body functions. Your thyroid is located at the front of your neck, along the front of your trachea, above your collarbone, and below your larynx. In males, the thyroid can be found directly below the Adam’s apple.

Your thyroid is responsible for many of your body’s functions. Your thyroid gland helps release and control your thyroid hormones which help regulate metabolism. Your thyroid hormones include thyroxine, also known as T4, and triiodothyronine or T3. Your thyroid hormones play a significant role in your body's metabolism, helping regulate your:

So how exactly can a ketogenic thyroid negatively affect your thyroid?

We’ve mentioned your two main thyroid hormones, T3 and T4. Well, you see your thyroid relies on glucose to not produce these hormones but also to convert them to their active form.

When you don’t eat enough carbohydrates in your diet, the production and conversion of your thyroid hormones is slowed down, putting more strain on your thyroid. By suddenly eliminating carbohydrates from your diet completely, your thyroid may make a hormone called reverse T3, which prevents you from producing the most active form of thyroid hormone T3.

Cinnamon rolIs for  the ketogenic diet safe for thyroid health?: The potential risks of a keto diet

This isn’t to say that you should be eating a ton of carbohydrates to optimize your thyroid function, but what we’re saying is to focus on high quality carbohydrates like fruits, vegetables, nuts, seeds and whole grains. By giving your body an appropriate amount of healthy carbohydrates that are rich in nutrients, antioxidants and fiber, you are setting your thyroid health up for success. 

And as if we didn’t emphasize the adrenal glands enough. Your adrenal glands produce a hormone called Cortisol. This is your stress hormone. Your body is unable to differentiate between “good” stress and bad stress. When your body is stressed, it is in a sympathetic state and always thinks you’re running away from a bear. For some people, a restrictive diet can put their body into this type of stress response.

Whether it be the drastic dietary change, a sudden lower intake of calories, or the absence of glucose, your adrenal glands start will start to produce your stress hormone, cortisol. When in excess, your other hormones like your sex hormones may begin to plummet. 

This is not to say that a ketogenic diet will cause hypothyroidism as that is too dramatic of a statement to make, however, there may be a connection with a long-term ketogenic diet and hindered thyroid function. What does this mean?

If you are following a ketogenic diet for other reasons, perhaps increase carbohydrates slightly and focus on net carbs instead of just carbs. Net carbs is the total amount of carbohydrates in a food minus the fiber content. This way you will ensure that you are obtaining an adequate amount of nutrients, fiber, minerals and antioxidants.

Also, make sure to check in and see how you’re feeling. Consult with your Doctor if you sense something is “off” and regularly get your thyroid levels checked. Be sure to ask your Doctor to check a full thyroid panel including thyroid stimulating hormone (TSH), Free T3, Free T4, Reverse T3, Anti-Thyroperoxidase and Thyroglobulin Antibody. Remember- the ketogenic diet is not intended to be done long-term so perhaps cycling in a ketogenic diet for a few weeks at a time may be more beneficial long-term.

Is Keto Really Safe for Your Thyroid?
Dr. Linda Khoshaba is the Leading Integrative Health and Hormone Doctor in Scottsdale, Arizona. She has extensive experience working in the field as a Hormone Specialist and Natural Endocrinologist.

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Scottsdale, AZ 85255
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