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S2 E2: Supporting Optimal Thyroid Health with Kaely, RD

podcast Jan 23, 2022
 

Listen on Apple Podcasts

Intro:
Amanda: Hey, this is Amanda, women’s health dietitian.
Emily: And I’m Emily, nutritional therapy practitioner.
Amanda: And this is the Are You Menstrual? podcast where we help you navigate the confusing world of women’s hormones and teach you how to have healthy periods.
Emily: Each week we will be diving into a different topic on women’s health and sharing our perspective using nutrition, female physiology, and metabolic health.
Amanda: Our goal is to help you wade through conflicting health information and empower you on your healing journey.
Emily: We hope you enjoy it.

00:36 
Amanda: In this episode, we are diving deeper into how the thyroid functions, what impacts it, and how you can support optimal thyroid health. To cover this topic. I'm joined by Kaely McDevitt. Kaely is a registered dietitian specializing in women's health. She owns a virtual private practice where she and her team help their clients overcome hormone and digestive issues through personalized nutrition. Having experienced the pitfalls of a conventional approach to women's health firsthand, Kaely is passionate about empowering women to take the driver's seat over their health and well-being.

You guys, if you've been listening to the podcast for a little while, you'll definitely remember Kaely. She was actually on for episode 18, and she helped us break down, like, what the stress response is in the body and how we can help our bodies improve that resilience and the ability to handle stress. So definitely check out episode 18 if you haven't already—you're going to learn that it's, stress is very connected to thyroid health. We're going to talk about that today. But thank you so much for being with me, Kaely.

Kaely: Yeah, thanks for having me back again.

01:35
Amanda: I know I was like, who are we going to talk about thyroid health with? And Kaely is actually the person that introduced me to iodine testing and utilizing iodine therapy. And that's basically changed my life as I'm sure we'll talk about. So I was like, we got to have Kaely on to spread thyroid knowledge.

Kaely: I was excited to chat about it. And like you mentioned, it's like such a good piggyback off of our last convo on here.

Amanda: Yeah, and one thing if you guys, like, haven't heard Kaely's story, she talked about it pretty in depth on the last one. It's pretty similar to mine with the whole birth control piece. One of the other big reasons is the majority, I would say majority of your clients probably have thyroid issues. Do you see that a lot?

Kaely: Oh, yeah, a vast majority, whether it's actually diagnosed or just in symptoms and not yet diagnosed. We see a lot of hypothyroid specifically type symptoms.

02:23
Amanda: Yeah, and I feel like hypothyroidism or honestly, like, any thyroid issue is just not diagnosed often unless it's really, really bad and far gone. So do you want to give us some background? We'll start with like, what does our thyroid do, because I think people think of thyroid health and they're like, well, I don't have a thyroid issue. And I’m like, but, like, you, you could have this other mineral deficiency or imbalance or something that is impacting how your thyroid is functioning. And it just hasn't shown up on your lab work yet. And we'll talk about how to test your thyroid at the end. But what is our thyroid actually do in the body?

03:00
Kaely: Yeah, so the thyroid is like a butterfly-shaped gland at the front of your neck. And it's an endocrine gland which means it secretes hormones that communicate with other cells and tissues in the body. And for the most part the thyroid is setting like the metabolic pace of your body. So nearly every cell has a receptor for thyroid hormone, which means what's happening in that gland is affecting everything else in the body, like, wide-ranging effects from hormones to digestion, to brain health and development. Really nothing that the thyroid is not influential upon, because it's setting the rate at which the rest of our cells do their things. So I think, like you mentioned, it's common to treat thyroid issues as, like, kind of an isolated thing or a secondary thing. But really the thyroid function being optimal is the route of optimal health, because we can't have a healthy metabolism without a healthy thyroid.

03:50
Amanda: Specifically, how… I love I actually wrote down setting the metabolic pace for your body. I really liked that. I was like, that was a perfect way to describe what the thyroid does. I will definitely put that in one of the social media posts for this episode. And sometimes I feel like that concept can almost be so big that we're like, okay, great, like, what is that even mean? Or how is that going to show up for me symptom-wise? So how, how can we connect the thyroid with things like our digestion and our hormones? How is it specifically going to impact those parts of the body?

04:23 
Kaely: Yeah so we talked about pace. And I think, like, thinking about the pace of things being tied to the thyroid is a helpful way to connect these dots, particularly when we're talking about digestion. So we have something called peristalsis, which is like coordinated muscle contractions that keep things moving through your GI tract. Now when the thyroid is underactive, so slowed pace, we have a slowed pace of peristalsis. So we now are not moving things through as efficiently or as timely as we should, which makes digestive symptoms much more likely. So bloating, gas, indigestion, it also makes things like SIBO, so small intestinal bacterial overgrowth, more likely. Constipation is super common with hypothyroidism because again, things are just moving really slow. There's also a big impact on, like, bile flow and function with hypothyroidism. Which, aside from iodine, another passion area of mine is gallbladder so I had to bring that in. But if we're impairing bile flow, now we're not absorbing particularly fats and fat-soluble vitamins very well, but that's also an important detox route for us.

Your thyroid is intimately related to sex hormones, too. So not only is it controlling the speed and efficiency at which sex hormones are made, but we're also having a direct relationship between thyroid output and progesterone production. And that goes both ways. I know we'll get into that later. And then really, when we think about the thyroid’s effects on, like, stress and sex hormones that OAT or OAT axis, ovarian adrenal thyroid axis is a helpful way to remember that. And I know Amanda has really great graphics on this that I'm sure she'll link to, but basically your adrenal axis, your thyroid axis, and your ovarian axis are all intimately related and get feedback from one another. So any issues in any one of those areas is going to spread to the other. So when we've got thyroid stuff going on, we're also likely to have adrenal and sex hormone stuff too.

06:13
Amanda: Again, I see so many women that are like, I can't get rid of, like, this estrogen and progesterone imbalance or these gut issues, I really get SIBO over and over, you know, no, no matter how many like crazy intense like gut protocols I do. And it, the issue comes up where their thyroid is they're like, oh, no, it's not my thyroid, my thyroid looks normal on bloodwork. And it's like, okay, but that, that's only one way to look at your thyroid. And then if you ask them, like, oh, are you cold frequently, you know, how's your basal body temperature, that sort of thing. They'll have, like, all the other signs of hypothyroidism, but just because it doesn't match up to their labs, it's like, well, that's definitely not the issue. And it just kind of shows you, and I, I've said this so many times, people are probably, like, gonna be so angry, like, stop saying that on this podcast—but everything is connected, nothing is happening in isolation.

And it’s one of the reasons we want to do this whole series on your thyroid is because it is so connected to everything else. And it's one of those parts of the systems in the body where it's, like, unless it's really, really off, it's really hard to get help with. I love that you talked about the OAT axis—I think that's essential. Like, they all impact each other, right? It's not like, we have, like, having adequate progesterone, like, that's going to be helpful for your thyroid, but having adequate thyroid hormone that's going to impact that. Thyroid impacts our cholesterol, you know. High cholesterol is usually one of the first things I'll see on lab work that's, like, yelling that, hey, your thyroid probably needs some help.

So what is going to impact how our thyroid functions? I think this is where some of the confusion can come in. Where it's like, well, I don't have hypothyroidism, like, they don't have an actual issue with the gland. But what are some other things that can impact how our thyroid works, especially when it comes to nutrition?

07:58 
Kaely: Yeah, for sure. So really, when we think about a healthy metabolism—and I know we talked about this extensively on our first interview together—but it really comes down to whether or not the body's feeling safe, right. If a body's not feeling safe, we get into, like, energy conservation mode where we're not going to want to be revving up metabolism because we want to conserve energy. So from a food standpoint, if we're undereating chronically, that is a really strong signal to the brain and then, therefore, the thyroid, that now's not the time to crank out more thyroid hormone, because then we're going to start burning through fuel faster and there's not enough coming in in the first place.

So the first thing that we work up in any client with suboptimal thyroid function is are we eating enough consistently? From there we move on to making sure blood sugar is balanced. So carbs, proteins, fats together at regular predictable intervals throughout the day. Making sure that breakfast is happening within an hour of waking and not before, or before coffee, not coffee first, because that's a really significant stress on the body too. So if our blood sugar's swinging all over the place, particularly those lows, that's enough stress to slow thyroid function. And then once we've got those two avenues carried away, we start to talk about individual nutrients and certain types of foods. We find, like, animal proteins being particularly helpful here. So, you know, one of the main ingredients of thyroid hormone is an amino acid called tyrosine. So we've got to be getting enough proteins that contain tyrosine. With animal proteins and organ meats, if you're up for it, we also get vitamin A in an important retinol form, which is part of this whole equation for a happy thyroid too. And then lots of mineral-rich fruits and veggies and adequate carbohydrates would be kind of our general nutrition approach to thyroid health.

09:38
Amanda: One thing I often see is women that have been dieting for a really long time, and then all of a sudden it's like 5-10 years later, then they have the thyroid issue. And it could be that it's actually diagnosed, maybe they're like, well my blood work’s not terrible but it's not amazing either. What is, how is that dieting and different type of diets, how is that gonna impact? Obviously you talked about undereating in general, but can different types also impact thyroid function?

10:06
Kaely: For sure. So if we do, like, chronic low fat dieting—which that's really not the craze anymore which is nice, but it definitely was when we were in school and, you know, years prior to that—you know, we're jeopardizing healthy fats and therefore fat-soluble vitamins. So the vitamin A is a really important piece of our whole thyroid conversation. And deficiencies in vitamin A is pretty well cited in the research to correlate with increased TSH, which is a sign of underactive thyroid hormone. We also with low carb dieting, which I would say is more common now over the last several decades, we run into some issues with thyroid hormone output too. Really at any intake less than about 150 grams per day, we start to potentially see decrease thyroid hormone output. Again, it depends a lot on the individual and what else is going on in their life, but any form of diet is a stress on the body. And that's all liable to affect thyroid hormone output.

10:57
Amanda: I find, like, plant-based or vegan diets, it's so tricky, because like you said, like, vitamin A in the retinol form. So that's the form that we're going to get from animal foods. We know now that that is essential for thyroid health. I've done like many posts on that. I'll have to, and I have a blog I'll link in the show notes. So we know vitamin A is essential, so that's like my first thought with plant-based and, like, vegan diets. But the protein is also really important.

11:24
Kaely: The potential for goitrogens being high when we're on a plant-based diet, too, is potentially part of the problem. And that's really just a group of foods that can block iodine uptake by the thyroid. So we're looking at some cruciferous veggies in, like, high quantities, particularly if eaten raw, and even soy being part of that problem, too. So oftentimes, our plant-based clients are getting the majority if not all of their protein from soy sources. So potentially an issue there too.

11:52 
Amanda: It's tricky. And then I think of, like, we need amino acids to do everything else in the body. So are the symptoms coming from thyroid? Are they coming from the lack of protein? Like, who knows? But I think that's an important distinction. And it's, like, we have to eat enough and having that balanced amount. Like, when I look at thyroid health, it's basically the same for hormone health, in that we don't want to go to extremes—like that's the goal, it's just not to go to extremes with your diet, and that will stress your body out less.

Kaely: Amen. It's the exact same.

12:22
Amanda: And then when you talked about, like, eating regularly, like, having that meal consistency throughout the day, I think one of the things people often, like, miss out on with thyroid is that, like…though, if you're extending those meal times one, you might not really be able to, because when we have thyroid issues we can actually have a hard time storing glucose in our liver, as that glycogen. And so you might not have as much glycogen to keep your blood sugar stable between meals or at night. If you're waking up and stuff at night, that can be a big red flag too. And in order to replenish that glycogen, it's, like, eating every three to four hours is really helpful. And so I'm always like, if you have thyroid issues or any concern or history, it's, like, try to eat consistently. And sometimes we can just take that advice and like, yeah, like, I'll try. But I'm like no, like, really listen to that one. It sounds simple. But I would say that's probably one of the best ways. Like, you talked about blood sugar, it's, it's the same thing. It's, like, it's going to reduce that stress, but it's also going to replenish that glycogen so that hopefully you can sleep through the night, you can have good energy, all that kind of stuff.

13:25
Kaely: For sure. And none of the rest of the thyroid support tips really do much for you in the absence of that solid nutrition. So it's, like, that has to be laid as a foundation first before you get fancier with it. And that's for some reason a hard message to receive. It certainly was for me back in the day too. I'm like, yeah, I'm fine, I don't have to pay that close attention to it. But it makes a world of difference.

13:47
Amanda: Yeah, and even I talked about this with my friend Jillian, we had like a PCOS, like, blood sugar podcast episode. And there's, there's a lot with, like, how your thyroid impacts insulin resistance and how that insulin resistance impacts thyroid hormone. So it's like, it's, it's, it's important for both things. But I find so many women with PCOS have hypothyroidism or struggle with their thyroid. So it's, like, either way, it's really important. And if you have insulin resistance on top of thyroid issues, then eating more frequently is even more important. Because the more insulin resistant you are, the harder the time you're going to have getting nutrients inside the cells and then it's, like, your thyroid needs a lot of nutrients.

And that's what I want to dig into next. We talked about vitamin A. What are some other really important micronutrients for thyroid?

14:35
Kaely: So I don't think we can talk about really anything without mentioning magnesium. I think it's on the list for anything that needs support. But specific to the thyroid, magnesium is part of what gets iodine to the thyroid gland. So that's, like, first step in the production sequence of thyroid hormone, so that's super important. And then it's also protecting against oxidative stress later on in some of the steps that iodine must undergo before it can become thyroid hormone. Not to mention, we talked a lot about how impactful stress can be on thyroid function and magnesium being like nature's anti stress. So magnesium is a big part of that.

Sodium and potassium, really, so we're hitting, like, our foundational minerals here, but sodium is involved in that iodine transport as well. There's something called the sodium iodide symporter, or like the NIS, that I know we'll talk about a little bit more. So without sufficient sodium, again, we can't get iodine where it needs to go. And then potassium is really helpful when it gets to actually getting thyroid hormone into the cell. So helping to sensitize the cells to, like, uptaking thyroid hormone. So you had mentioned, sometimes people have hypothyroid symptoms but their labs look normal. And you can have that when we have cellular hypothyroid, where we actually are making plenty of thyroid hormone, but we can't get it into the cell and potassium is part of that.

15:53 
We also have iron in the mix, with caution, but iron in the right place and used correctly is really helpful for converting inactive T4 to active T3. It's necessary for TPO, or thyroid peroxidase enzyme, too, which is part of the whole way we process iodine in order to make thyroid hormone. Selenium is a big one, again, part of the conversion of T4 to T3, and also it's helping to make sure that we mitigate the oxidative stress that's formed when we process iodine. We've got copper and zinc in the mix. Feel like I might be…oh, and iodine, of course, a big piece of that formula. I’m like, I know I'm missing one, the most important one. We use iodine to make thyroid hormone. So you've probably seen T4 and T3, if you, if you're lucky you've seen T4 and T3 on your thyroid labs. And that literally correlates to how many molecules of iodine are present. So T4 is four molecules of iodine T3 is three. So iodine is absolutely crucial. Like, if we don't have enough iodine, we're simply not making thyroid hormone.

16:56
Amanda: And I think the biggest thing to keep in mind, because people, they love hearing the isolated nutrients and they're like, perfect I’ll supplement with all those nutrients, right, like I'll just do that. But it's, in reality they all work together. Like, you talked about sodium, how that we need that for the iodide symporter and making sure that we can uptake and transport that iodine. And then magnesium, same thing, like, carries the iodine there. So when it comes to the micronutrients, how do you find is, like, the best way for people to get them in?

17:28
Kaely: Yeah, so I like mineral-rich fruits and veggies. So, you know fruits, root vegetables, those kinds of things. And then of course, making, like, adrenal cocktails or other mineral beverages makes it really easy to get more sodium, potassium, and magnesium in particularly. You also get some vitamin C that way too if you go the adrenal cocktail route, which is helpful for the thyroid as well. There's a lot of oxidative stress that can happen in the production of thyroid hormones, so the more antioxidants typically the better. And then if you're open to it, incorporating, like, either full fat dairy or some grass-fed organ meats, things to help make sure we're getting that vitamin A would be really helpful. You're also going to be getting zinc and copper and even some iron in all the right ratios if we go with those foods too. And then iodine, from a food standpoint, we can get from grass-fed dairy, we can get from seafood, of course, and seaweed, kelp flakes, those kinds of things. And then in certain instances does need to be supplemented, but we'll get into that a bit.

18:24
Amanda: I think that's the biggest thing is when you're eating those nutrient-dense foods. That's why I like that, I love the mix of animal and plant foods. I think that gives us the most nutrients and the most bang for our buck when we're eating. It's, it's more of, like, when I think of clients that have struggled with this, it's people that are coming from a restrictive background. Whether that is undereating, lots of dieting, or like lots of elimination diets, lots of food sensitivity testing, and saying that they can't eat X, Y, and Z. And so they've eliminated all these food sources of nutrients.

18:51
Kaely: Yep. And you can see why you would get stuck in like a ferris wheel of never-ending symptoms. Because let's say it's digestive symptoms, and you do food sensitivity testing or go on these really intense protocols. And you're pulling so many foods out, when we need the energy production of a healthy thyroid to even be able to heal and to get digestion moving normally, but we can't get access to the nutrients we need because we're on such a restricted diet and it just keeps going around.

19:15
Amanda: My head keeps going back to the gallbladder thing. This is, so this is, like, a little off topic, but I'm like, I feel like I need to ask about this. So, because now I'm thinking back to a lot of my clients that have, are diagnosed with hypothyroidism, and a lot of them don't have gall bladders. Do you see that a lot?

19:34
Kaely: Yes, and it's like a chicken or the egg situation with that for sure. But yeah, lots of, like, subclinical hypothyroidism for years could have been enough to create problems in the gallbladder. And it's pretty crazy when you look at, like, known risk factors for gallstone formation, like, how common that is, like, hormonal birth controls is high up on that list. I had no idea. And then hypothyroidism is high up on that list, too, because anything that’s slowing the flow of bile makes the risk of stone formation higher. And then we also get an increased concentration of cholesterol in that bile because we've messed with cholesterol metabolism. And then actually T4 influences the relaxation of that sphincter of Oddi, which is part of, like, bile release. So if that can't relax and release bile, it stays stuck and gets sludgy. So, yeah, big hypothyroidism gallbladder issue connection.

20:28
Amanda: Because now I'm, like, I mean, most of those people have hormone issues and they've been on birth control and stuff like that. And, like, of course, birth control is really common, like, leading to getting your gallbladder removed. And hormone imbalances in general, like, I think a lot of them have PCOS. But I'm like, oh my gosh, you know a lot about the bile connection. Now I'm like, this is something I didn't really, I knew that it could mess with the flow. I didn't know to the extent and I did not know that T4 controlled that sphincter that is…

Kaely: Isn’t that interesting?

Amanda: Do you have a highlight on your Instagram?

Kaely: I don't, but I should. I'm going to talk about this this week, because I realized that I don't think I have. I have a lot to say on that topic. So I will.

Amanda: Because you have some amazing posts on bile and gallbladder. So if you make a highlight, I'll put it in the show notes. I'm going to make myself a note now. So bile highlights, so I'll make sure that I grabbed that, just because it is a topic where I feel like people are kind of only concerned with their gallbladder if it's been removed, and bile. But if you have thyroid issues and digestive issues, kind of a classic, like, supporting digestion, has it helped, you might need to look a little bit deeper into that bile. Thanks for the side tangent.

Okay, so we talked about the micronutrients where you can get them in foods, even, like, you know, adrenal cocktails, I'll put the blog for that if you're like, what the heck is an adrenal cocktail? We talked about this in another episode as well. It's just, like, a mix of sodium, potassium, and whole food vitamin C in delicious drinks. Let's talk now since we kind of know what our thyroid needs, how it's going to impact our digestion and hormones. How does stress impact how our thyroid functions? You talked about this in the beginning, and especially specifically to blood sugar, but how is stress in general going to impact how that thyroid works?

22:13
Kaely: So that input of stress, again, comes back to whether or not the body's feeling safe. I feel like that's probably my most used phrase in any talk that I have. And when the body doesn't feel safe, we're going to slow energy production down. So we do get a direct effect on the thyroid output from that standpoint. And we talked about that OAT axis before about how there's an inner relationship between adrenal, ovarian, and thyroid function. And when we've got a really revved up HPA axis, so this was the one talking about adrenals and stress, and the end result of a revved up HPA axis is boatloads of cortisol, our stress hormone, in circulation. We actually get a blunting of our TSH, thyroid stimulating hormone, when there's an abundance of cortisol around. So this gets people in a tricky situation because almost always, unless you request more, your thyroid testing will only be TSH. And that's like the very tip of the iceberg when it comes to what's happening with the thyroid. But when cortisol is high TSH will be low, because we have that negative feedback loop, which means your thyroid labs will look good if we're only looking at TSH when stress is high. And I'd say you probably agree with this too, most of my clients that are not feeling well stress is high and they've got hypothyroidism symptoms, but they've been told that it's normal because TSH looked good.

23:31 
Amanda: Yeah, and then once they start making changes, like, food changes, supplement changes, reducing their stress, their TSH goes up and they freak out. They're like, what the heck, I feel so much better, but my TSH got worse. And it's like, that's because you don't have a bunch of cortisol reducing your TSH levels. And I think that's a, this is an important one to remember. Because it can be really hard to advocate for yourself when you're at the doctor or working with whatever practitioner you're working with. And they're like, no, TSH looks good so it's not your thyroid. This is when you want to think about, but it's interesting because there's so many different things that can impact my thyroid and we know that our thyroid is gonna trickle down and impact digestion and hormone production and detox and metabolism and all that stuff.

So it's, that's when it's, like, you do want to look further. And we're going to talk about that when we go into the labs, but that was my big thing. I was like, I want to emphasize that your, your TSH and your thyroid can look normal. And this is like a short-term thing. Eventually, once it gets, like, really off and once you've been stressed for a super long time, typically that's when it'll go up and then you're going to get that diagnosis. But it's, it's an important one to remember. Same thing with, like, your reverse T3 values. If you get your reverse T3 checked on blood work, then that's, like, a sign of, like, excessive and, like, chronic stress and that's just going to put the brakes on that thyroid hormone.

Mid-Episode Ad
Hey, Amanda here, just giving you a quick break, hopefully a break for your brain in the middle of this podcast episode to remind you that if you haven't gone through our free training, Optimizing Hormone Health Through Mineral Balance, we really do recommend starting there. And the main reason for that is because you're going to hear us say things like mineral foundation, having a solid foundation, are you putting the foundations in place, especially as we get deeper and deeper into different hormonal topics and specific imbalances in the body. The mineral foundation is always going to be so essential. So if you haven't watched the free training, you can find it in our show notes or you can go to hormonehealingrd.com and it's going to be right on that front page there. But we really recommend starting there so that you can understand how is your current mineral status, how do you assess this, and how to get started with all that just so you can get as much as you possibly can out of the rest of the podcast episodes. But that's it. I hope you enjoy the rest of this episode.

26:00
Amanda: So we talked about nutrition diets, specifically certain micronutrients, stress, we know stress will, like, blunt, the thyroid, make it look normal, but it's actually, that's not a good thing. So we need thyroid hormone, so we don't want your TSH to go, like, way down. What about things in our environment, specifically, halogens? How do they impact thyroid function?

26:21
Kaely: Yes, so halogens, if you took any kind of, like, science class in high school, you may remember the periodic table and the halogens are all elements in the same column. So iodine is part of that. We also have fluorine, bromine, and chlorine being the most common ones that we're getting exposed to. And so the more we are exposed to those, the more likely those halogens are to take spots on iodine receptors. So all the halogens are going to look, like, chemically very similar and act similar in the body and take up the same receptors. So because we get exposed to a ton of those on a daily basis from things like dental products, water—both drinking water or water that we use for cooking and even in our shower—and processed goods, particularly processed baked goods has bromine in the flour. And then of course, we've got chemicals elsewhere, like furniture and flame retardants and all kinds of fun stuff. But we're getting a lot of halogen exposure, but not a lot of iodine intake in our diet. So we have these halogens taking seats on iodine receptors in the body, which only increases our need for iodine. So the body can't use fluorine to make thyroid hormone. So fluorine is taking up the iodine receptor. Now we can't get the iodine in there to make thyroid hormone. So there's definitely a direct assault on thyroid function with exposure to halogens.

27:41
Amanda: And so you mentioned, like, water and dental products, certain foods that, that can be like the biggest exposure. What are some ways that you help your clients, like, minimize that? Like, what would you say, like, the top ones are that you would try to have people switch out?

27:56 
Kaely: Clean water is a big one. So whatever we can do to filter our drinking water, ideally, our shower water too, if we can. So there's all kinds of good water filters, both things that you'd actually get installed or just countertop filters that we could use with varying degrees of success of removing these compounds. And then showerhead filters can be used too. We've always looked at those whole, whole house filtration systems, but they're crazy expensive. So we opt for a shower head filter for showers. And then looking at what we're using for, like, dental care and finding fluoride-free options was a great way for us to reduce exposure and for a lot of our clients.

28:33
Amanda: Yeah, water I feel like is, that's one where I'm, like, it's gonna have the biggest return on investment, because we have so much exposure. And like you mentioned, it's not just drinking water. I feel like drinking water is pretty easy to filter, like, they make really good pitcher filters now, you know, like, you can filter a lot out. And it's, like, it's the fluoride and the chlorines that are really the biggest ones that we're thinking about with water. And you mentioned the whole house filter. So I've done a lot of research on this. We used to live in a tiny house and we were going to get the whole house filter then. When I talked, I like Pure Effect filters, yeah, they're, they're great. They have amazing filtration systems. And they have a different one, like, well water versus, like, city water, which is an important distinction. And so I was, like, talking to the guy I'm like, what should we do? And he's like, honestly, even when you use a whole house filter that, because of the shower, like, because it's like filtering through there and then going to the shower, and the shower, water's coming out so fast. He's like, I would personally still have a shower filter. And I was like, okay, then I'm not going to get the whole house filter. I'll just get shower filters and then a filter for underneath the sink or they make, like, on top of the counter filters. Those are my favorite ones because they have, like, the biggest range so it's, like, depending on your budget, you can get a cheaper countertop one, you can get a really nice under the counter one and that's the one we did for the tiny house. Now we have, like, the countertop one here for now, because we haven't figured out our new situation.

But that's just something to keep in mind. I feel like people, they're like, I need this, like, crazy filter. It's, like, you can get a decent shower filter and most of them, like, even if you get, like, Berkey, Pure Effect, they're like 80 bucks. So it's not that bad. And then I love baths. Are you a bath person?

Kaely: I am. I actually, it took me a year for some reason to get my act together in this house, but I just took a bath last night finally.

Amanda: You have like such a beautiful bathroom too.

Kaely: Yeah, it's embarrassing. I have nothing to say for myself. But yes, bath person finally rejoined the bath community.

30:36
Amanda: So, so I'm like obsessed with baths. And it's, in pregnancy you can't take, like, really hot ones, it's, like, torture. But I use a bath filter. I'm guessing you guys do too.

30:45
Kaely: So we don't on there yet, but I'm looking for it. So if you are in the absence of a filter, though, we can make use of, like, some vitamin C as a way to help mitigate the effects of those halogens or neutralize them. So chlorine’s really high in our water here. Like, you can smell it. I can feel it in my eyes before we installed our shower head filter. It was like a whole problem. So I put some vitamin C powder in my bath while it was filling.

31:11
Amanda: Yeah, a lot of people will do that with their shampoo, and, like, body wash and stuff too. Or I have a lot of people that really love swimming or hot tubs. Like, if they, like, you'll have a hot tub. It's like yeah, I can't really imagine not using it. And again, this isn't about, like, being perfect and eliminating all possible chemical exposures and halogen exposures. It's more just looking at where am I getting the most of these. And if you're a pool person, then then it's like, okay, I'm going to use some vitamin C powder after in the shower when I rinse off. If you really like baths, like, I love that you put that in there to neutralize it. I think that's super smart. The bath filters are great, too, like CuZn makes a good one you can get on Amazon. But yeah, they're, and they’re, it's like, the, the replacement filters are cheap too. So that's always nice. But those are some great options.

So I know someone will probably ask. So if you're going to do fluoride-free toothpaste, how are you going to prevent cavities?

32:06
Kaely: We could have a really long discussion about fluoride, but I think that's outside the scope of our session today. But, you know, mineral status is really important that at cavity prevention, like, our teeth are made of minerals. So I've tried probably every fluoride-free option out there and really settled on Rise Well. It has hydroxyapatite in it, so that's helpful to remineralize teeth or at least take care of the mineral aspect of teeth. In addition to the fact that I pay very close attention to mineral status in my day-to-day and, like, do routine HTMAs and make sure calcium is going into my bones and teeth. And then, of course, like, eating good food and practicing good dental hygiene, like brushing, flossing, tongue scraping, all of those things go really far toward cavity prevention. It's not just about fluoride.

32:50 
Amanda: And there's actually not amazing research on fluoride and cavities. And I remember when I was first digging into all this, I was diagnosed with hypothyroidism when I came off the pill and getting into functional nutrition and stuff. And I was like, well, dang, I've always used fluoridated toothpaste. My mom worked at a dental office for, like, 15 years. And I was like, what, this is crazy. And I switched over to the, like, Rise Well was like the hydroxyapatite beast, and I actually really like Wellnesse. Okay, so Wellness Mama makes it, her brand is like Wellnesse. with an extra se at the end. And I've called it Wellnessee, and then someone was like it's Wellnesse. So her brand is great. And the reason I like her toothpaste a little bit more than Rise Well’s because it's really minty. So I just and, like, my husband is just, like, he won't use something unless his mouth feels intensely clean after. So that one if you're having someone that's hard, a hard time transitioning people over, that's a really good brand but Rise Well is great. I, their mouthwash, like, nothing is better than…

Kaely: Oh my gosh, nothing is better than that mouthwash. I wish it came in bigger bottles because we go through it really fast.

Amanda: And they, they run out a lot too. But yeah, that it's like there are other ways and there's a lot of research and a lot of it's come, it comes out of Japan in a hydroxyapatite, but that also, that has like actually better cavity prevention than fluoride.

Kaely: Yeah, there's a lot of like unlearning there with the fluoride conversation.

34:19
Amanda: But, but not, not like too hard. And then if people, I know people like would worry about that if you have kids and stuff you're like, I don't want to, like, do anything that's gonna harm them. It's like, do your research. Rise Well has a lot of great stuff on their website too, like, research articles and stuff. How, so let's go back to the hormone piece, and how thyroid health can show up in your cycle. How did, how can our thyroid health show up as far as, like, symptoms, length of cycle, all that kind of stuff?

34:44
Kaely: So women with hypothyroidism tend to have more symptomatic or more irregular periods, because there's a couple of different things that can happen here. One of them is that, we mentioned it earlier on, there's a big connection between progesterone and thyroid hormone. And it goes both ways, so the better your progesterone production is, typically the better your thyroid function is and vice versa. So if the thyroid is subpar, progesterone production is going to be subpar. And that would be reflected in, like, heavy, painful PMS-type symptoms, because we've got low progesterone relative to estrogen in that second half of our cycle or the luteal phase. You, if you track your basal body temperatures, you'll likely not see a sufficient rise in BBTs in the luteal phase if we've got hypothyroidism, because we're not getting the stimulation of progesterone production either, and that's what causes that rise in temps.

I know that was certainly the case for me post-birth control too, I know there was some thyroid stuff going on. But all I saw was a TSH that looked normal. But my temps were super low, like, I was very concerned about how low they were. And then there's a big estrogen-thyroid connection too. So when estrogen is in excess, it actually increases our liver’s production of thyroid binding globulin, which is something that will, like the name implies, bind to thyroid hormone and make it inactive and not available for use. So the higher the estrogen, the less available thyroid hormone there is for use. And then, you know, we talked about the way that thyroid, hypothyroidism affects bile flow and how necessary bile flow is for getting excess estrogen out. So if we've got hypothyroidism and potentially exacerbated by high estrogen well now we can't get that estrogen out, because we don't have the bile flow and the regular bowel movements to do so. So we end up in this vicious cycle of estrogen dominance and insufficient progesterone output. So that's it—painful periods really.

36:39
Amanda: Yeah, and, like, digestive issues I'm sure people experience on top of that.

Kaely: Oh, yeah, for sure. So yeah, your classic PMS, heavy, painful symptomatic periods, or even irregular cycles too. And depending on the severity of that hypothyroidism or the length of time it's been present, we can totally have, like, a complete disruption of ovulation. When our body's cranking out a lot of TSH, we also make a lot of prolactin at the same time—it's coming out of the same place in the brain and that will influence LH and FSH production too. So that's potentially the other tie in with the PCOS hypothyroidism overlap is that we've got an elevation in prolactin messing with LH and FSH which is necessary for that ovulation event.

37:23 
Amanda: I get a lot of questions on high prolactin, and I'm like, yes, like yes, sometimes it is. It is a totally separate issue, it can be with, like, pituitary tumor, stuff like that, like, for sure. But more often than not, there's, there's no tumor present. And they're kind of like, my doctor is stumped, like, I don't know where this is coming from. And like you said, I'm thinking of someone in particular, she doesn't have a gallbladder, she has hypothyroidism, lots of iron issues and stuff. So it really is all connected. And it just kind of shows you like, yes, like, high prolactin is the big concern. It's the red flag that's come up for you, but is it coming from somewhere deeper?

Okay, so let's wrap this up with talking about how to assess your thyroid function. Because I think sometimes, sometimes people know. I have women that are like, I know something's off, I know it's my thyroid, I just can't figure out why or show anyone that it is. And then some people are like, my, it's not a thyroid issue, like, mine is normal. How, as far as like bloodwork goes, what should people be asking their doctor for if they want to get that nice, full picture of their thyroid health?

38:33
Kaely: Yeah. Yep, so you're gonna want to have TSH, free T3, free T4—T4 and T3 as well, but particularly the frees—reverse T3 would be great to see as well, and then we want our thyroid antibodies, so that's TPO and then thyroglobulin antibodies so TgAb is usually how that shows up on labs. So I usually have my clients, like, I'll send them that exact list, have them bring it to the doctor, and see what they can do with that. If that's not possible, there are a lot of direct to consumer lab companies now which is so awesome. Like, you can order it for yourself, it's not typically a huge expense, but of course if we can go through your doctor and go through your insurance that'll be the most cost-effective route—you just have to do some advocating for yourself there.

39:21
Amanda: Yeah, and it's it can be tricky too, like, sometimes you get the lab results back and it's off and your doctor’s like, yep don't know what to do about it, you know, I don't, I don't look at this lab so we're not going to address it from here. So there, but again, like, the basics are always important. So go back to listen to the beginning of the episode again, like, do not miss out on those basic things. The, especially, like, eating consistently, having a good mix of foods, getting enough protein, getting enough carbs, not eating less than that 150 grams, like, so many things, like that are helpful. So bloodwork is one way and that's really showing you more of, like, how much your thyroid’s producing, right?

39:58
Kaely: Yep, how much it's producing, are we having…like, it can help pinpoint where there might be a kink in the chain depending on what's off. Is it a production issue or a conversion issue or a deactivation issue? So that's helpful for us to decide what's the biggest priority for us to intervene with above and beyond those basics that you have to be doing regardless. But I like a lot, like, bloodwork for that aspect.

40:22
Amanda: Yeah, it's, it's, I do think it's a very important piece of the puzzle. Like, T4 can tell you are you making enough thyroid hormone or T3 is going to be more of are you converting it well. The reverse T3, like we talked about before, it can be an indicator of stress and, like, how much is that stress impacting your thyroid? So what about hair testing? Because we, you talked about a lot of minerals that are important. How can hair testing give you some insights into thyroid function?

40:47
Kaely: Gosh, I love hair testing with thyroid function. And Amanda, you got me into HTMAs, like, a couple years ago now, but it's been so helpful to do in conjunction with the bloodwork, like, I feel like we finally have a full picture there. So not only are we going to get an assessment of a lot of those key nutrients that we already discussed, like magnesium, sodium, potassium, selenium, like, those kinds of things are going to be on an HTMA. But there's also an important ratio on there called the thyroid ratio, and it's calcium to potassium. And that's really where we can start to see some answers for, like, the cellular hypothyroidism. So I will encourage you if you've had that comprehensive thyroid panel done, and it truly does check out, like, it looks fine but you don't feel fine, we should definitely do a hair test. Because my guess would be if you're not feeling fine, even though labs look good, there's an issue of actually getting that thyroid hormone into your cells. And that's really where that calcium to potassium ratio shines. In my opinion, it has solved a lot of mysteries for some of my hypothyroid clients.

41:45 
Amanda: And then if you think about the other, like, you talked about magnesium and zinc and copper and iron, and yes, iron is, we have a whole episode on iron, you guys, I think it's episode six on copper and iron and how that stuff works and, like, what bloodwork to look at for iron. So yes, iron is important on bloodwork, but you can also see, like, how is your copper on your hair test? How is, how are you using magnesium, you know. So it, they can just, like, give you a little bit more, as far as, like, yes, the calcium potassium, but then how are some of those other minerals like selenium—hair testing is great for that too. So bloodwork and hair testing. Bloodwork showing us more of what our thyroid is putting out, is it converting it? Hair testing is more like are our cells using the thyroid hormone? Can they use it? I love cellular hypothyroidism. I've actually never heard that term before so I'll put that definitely in one of the posts too.

Now, where does iodine testing come in? When the, and how do you do it? I think there's a lot of confusion around this.

42:42
Kaely: And that's because there's, like, in the health community a lot of confusion about this too. And there's a lot of ways that you could test iodine, you know, whether that's through urine, through blood, through dried blood spot. We don't see it directly in a hair test, but there's some secondary hints that iodine need. But my favorite way, just based on the information I've seen, is what's called an iodine loading test. And the lab I use for that is Hakala Labs. And you basically take a loading dose of iodine—it's a serious dose, 50 milligrams—and then you're collecting your urine in this massive jug for 24 hours, because we're seeing how much iodine you excrete after the loading dose.

And the premise of that kind of testing is that if your cells are fully topped off in their iodine store, we're going to just excrete what we don't need from that big loading dose. So you're getting a percentage of excretion rate when you get your results back, and anything less than 90% would indicate to us that we have some room to improve your iodine status. Anything over 90% is telling us that you've pretty well met your iodine needs. And I found that to be the most useful test. It's, it's a cost-effective test too, it's not expensive to do, it's a bit of a pain to pee and collect that for 24 hours in this big jug. So, like, do it on the weekend when you're at home and you're not toting that around at work.

44:00
Amanda: You have to keep it in the fridge too or they recommend that you do, so it doesn't smell at all if it's in the fridge. So if you're, like, worried about that, but I mean, imagine having that at work, like, in the work fridge or something.

Kaely: No, don't do that to yourself. Just do it on a weekend at home.

44:14
Amanda: So you talk it, I think the biggest thing, and I love this test, I've utilized it for myself, I'll do a whole episode on my pregnancy stuff. And I've done it throughout pregnancy as well to kind of let me know am I taking enough iodine? Is it safe for me to utilize more? So you talk about the loading aspect, because I, I, one of the big things I'll get from people is one, like, they're shocked that I'm recommending to look into iodine. They want to know why it's not on their hair test, but it's actually better read through your urine. But the big difference in this test is it’s iodine loading, right. And so I'll often get people sending me articles about how, like, urine tests for iodine aren't accurate, either. Really that iodine loading aspect, that makes it more accurate, right?

44:54
Kaely: Yes, and it's the period of time that we're collecting that too, so 24 hours. And we had talked about the issue with halogens occupying iodine receptors. And that's part of some of the issue with iodine testing, too, is that if we do have a big halogen burden, even with iodine loading tests we can actually get like false good-looking results if we don't spend some time prepping and, like, actually maybe even taking some iodine before we do that test. But it can be hard to get an accurate read on your iodine if your halogen burden is high, because we've got halogens taking place on those iodine receptors. And therefore, when we see that excretion rate being high, is it because we truly were topped off on iodine? Or was it that we had other things occupying those receptors so we did excrete the iodine? So even the iodine loading test is not perfect and has some strategy in how it needs to be done. But it is, at least according to the limited literature on iodine testing, the best option that we have.

45:50
Amanda: I have never seen a good result. I mean, until after someone's used iodine and, like, gone through a protocol and worked on that kind of stuff. But I've never seen, like, an initial test that was, like, looking optimal.

Kaely: Nope, me neither. Me neither.

46:04
Amanda: And so why, why is it that, so basically, and, like, we're not telling you guys to take iodine. If you have a thyroid history, do not take iodine. We actually would say you shouldn't utilize iodine, and there's a whole process to adding iodine in. And like Kaely mentioned, like, we need magnesium and zinc and copper and iron, like, all these, vitamin C, all these, like, really important cofactors that are going to go along with iodine…selenium, if you don't have those, then if you…like, I see a lot of people supplement with iodine are, like, it didn't do anything or I feel worse. And it's typically because you don't have those important cofactors to utilize it. So what is the controversy with iodine supplementation? And what made you decide to, like, explore it more and use it in your practice?

46:49
Kaely: Yeah, so I remember learning in school that we get plenty of our iodine through iodized salt, so you don't need to worry about it. And if we took an excessive amount of iodine, we would enlarge our thyroid gland, we could create nodules or cysts, we could end up in a hyperthyroid state. I just remember being, like, very afraid of iodine at the end of schooling, so it really wasn't on my radar for a long time. But much like really anything we end up adding to our practice toolbox, I was not getting people better with what I thought would make sense for them. And ended up reading one of Dr. Brownstein's books on iodine and then kind of went down many rabbit holes there and understood how the thyroid gland uses iodine and how every cell in the body actually takes up iodine—it's not just the thyroid. And particularly with reproductive tissue and any other endocrine glands, like, the need for iodine is so high. And working in women's health and, like, fertility counseling and things like that, how big of a deal it plays for mom and for baby.

And that really, the issues with iodine come from either, like, a detox reaction from dislodging halogens or because we didn't do the prep work and we don't have those other cofactors in place. Because if we take a ton of iodine but we haven't worked on those cofactors, we end up creating more oxidative stress in the thyroid, and we can feel worse and can damage the thyroid gland. And so, in my opinion, that's where, like, the stereotypes of iodine hurting the thyroid come from is: we didn't do our due diligence and we, as we typically do, look at an individual nutrient in isolation when really it's, like, a whole constellation of things that need to be supported together.

48:27
Amanda: It's not as scary if you don't have an autoimmune history. Like, I feel like people are not necessarily worried about it, their doctors never warn them, you know, not to utilize it if they just have your typical hypothyroidism or like subclinical or maybe they're not, it's not that bad. And then, but then there's the autoimmune group, right? Our Hashimotos people, our Graves people, and they are terrified of iodine. And they're even worried about getting too much in their diet, because somehow we got this idea in our head that it can cause autoimmune conditions. Do you utilize iodine therapy with people that have autoimmune issues? And like, if so, like, do you, why do you feel safe doing that?

49:11
Kaely: Yeah, yeah, so I do, but we do so carefully. So we're never, autoimmune disease or not, we're never just blindly putting somebody on iodine. And it's never the first thing that we do either. But in somebody with like Hashimotos, for example, we would get all the labs that we mentioned, full thyroid panel, a hair test, iodine loading test, make sure we knew okay, they do in fact, need iodine. But if we look at the steps that have to happen from, like, iodine intake into the thyroid to, like, the oxidation and organification of iodine to become thyroid hormone, usually where we see issues with, like, increased oxidative stress and potential for increasing antibodies against, like, TPO in particular, is if we're lacking things like selenium. We don't have iron in the right place. We don't have magnesium around. We don't have bioavailable copper. So as long as we've supported all of those other aspects, then we'll start really low and slow with iodine if it's warranted by their labs, and then we're retesting as we go. And with great outcomes.

50:10
Amanda: I've seen iodine therapy be so helpful for people, myself included. And it's one of those things where it's again, like, it's not the first thing you do and, like, you have to do food first, you have to add your other minerals in first. But I think that's why it can be such a great partner to hair testing. So it's, like, especially once you've gone through hair testing once, maybe you've worked on things, you've worked on getting your adrenal cocktails, and optimizing certain foods, and you're like, I feel better but there's something missing or my thyroid labs are still not where I want them to be. Or you still have, like, the PMS issues and stuff like that. Maybe you have, like, indicators on your hair tests, like, that are signs of iodine deficiency, then it's like, yeah, then do the testing. And that's a great place to like continue on. But it's never something where it's, like, you haven't worked on any of the steps and you add in iodine…like, you won't feel better. It's pretty amazing how not even a lot, like, a very small dose of it can be really helpful once you've already worked on a lot of other steps.

51:04 
Kaely: For sure. And it makes sense just how widely used it is and how, like, woefully insufficient the RDA for iodine is. And one other note, I did just want to say for anyone that is embarking on an iodine journey, one expected change in your labs when we start implementing iodine is you will likely see your TSH go up first, like, in that first six months or so of supplementation. And much like when people are working on their stress and taking care of themselves and they see their TSH go up and they freak out a little bit—that is an expected and normal and even good outcome. Because that's really just TSH increasing that sodium iodide symporter that we talked about. So that's literally, like, the bus that's driving iodide around and getting it into the thyroid. So it would make sense that if we're taking in more iodine, we need more buses to scoop that iodine up and get it into the thyroid and other cells too. So remembering that TSH isn't, like, it doesn't just have one function to stimulate the thyroid hormone. It has other stuff, one of them being increasing those iodide buses.

52:05
Amanda: I love that. I like the bus analogy too. And I liked how you said seats for the halogens, like, how fluoride takes a seat on the iodine receptor, I was like, I can visualize that. Because when we get into, like, the symporter and, like, different receptors for minerals and hormones, it can feel confusing. But I think when you think about okay, these things all work together, like, the halogen can make it so that your thyroid hormone can't bind, because it's already there. So this is why we want to minimize our exposure or, like, your TSH is probably going to go up. I don't see it in everyone, just some people, but then it's, like, it will likely, it's going to rebalance after and you'll see your T4 and T3 improve as a result of it and you'll feel better.

So the last thing, and you mentioned your body temperature, like, how you said you came off birth control, and you're like, my body temperatures are really low, it was a big concern for you, like, a big red flag. So how can people even just at home—that's my favorite thing for people to look at—how can people learn about their thyroid health from their basal body temperature?

53:02
Kaely: Yeah, I love this too. Because free at home things is just, like, so refreshing in a world of, like, typically expensive interventions. So tracking your basal body temperature, or first waking temperature, with like a, you don't have to get a fancy device for this, you can use a regular thermometer or you can get one on Amazon…is telling us about your thyroid function, because your thyroid function dictates the production of energy and therefore the production of heat in the body. So body temperature and thyroid go hand-in-hand. So if we're seeing, you know, temps consistently below 97.5, that's a pretty clear indication that we've got suboptimal thyroid function going on.

We can also of course, use that as part of fertility awareness method telling us more about our cycle and where we are. Insight into what progesterone production looks like in that luteal phase, too. But it's great to keep tabs on, how am I doing internally with all this work I'm doing on my thyroid, because it's not feasible to be doing lab tests, like, once a month. And you actually shouldn't, because things take longer than that to change. But your body temperature is giving you real time feedback, which I think is cool.

54:05
Amanda: You can also watch it improve. You know, it's great to do it in the beginning, even if you're like, oh, I feel like it's probably not in a good place. Track some now, otherwise, you're going to regret it. Because then when you track it later, and it's optimal, you're like, I wish I saw how much it had changed over time. But that's, that's another really awesome one that you can look at. So for follicular phase, you mentioned it's like 97.8-ish.

54:29
Kaely: Yeah, so I usually tell people not less than 97.5, like, at any point in the month, but yeah, 97.8-ish, and then into the 98s for the second half.

54:39
Amanda: Awesome. So that was a lot of information for people to take in. But the goal is just for you to understand, like, what impacts your thyroid? How is your thyroid connected to your hormones and digestion? Everyone should care about their thyroid health, especially women, in my opinion. It's one of those things that should be tested throughout your life so that you have that information and can compare it. I'm going to put a bunch of links in the show notes of, like, we talked about vitamin A, adrenal cocktails, iodine, a link to the book that Kaely mentioned, “Iodine and Why You Need it,” that's the one you're talking about, right? Yeah, so I'll link that one too. And then of course Kaely's IG and website. Anything else you want to leave people with?

55:16
Kaely: I just want, because this did get complicated and most things do, to just remind you that because everything is connected it's really good news. Because the same checklist of things that we're working on for hormone health really applies to the thyroid. And I just want to reiterate how much control you have over these things, which is cool. I think we often believe that once something's diagnosed, like, that's just our truth and our reality here on out, but there's so much control we have and a lot of it is, like, pretty simple stuff.

55:41 
Amanda: And just do one thing at a time. I know we talked about many things. The goal is to give you all the resources we can, but pick one thing and work on it. And let us know how it goes. If you enjoyed this episode, definitely tag Kaely and I on Instagram. She's @kaelyrd and we’ll reshare it. But it's just nice to see, like, what are people's biggest takeaways, what they love about the episode. Thank you so much for all your time and expertise, Kaely, I appreciate it. I'm sure I’ll have you on again.

Kaely: Sure, thank you for having me again. I appreciated it.

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