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S2 E3: Supporting Autoimmune Thyroid Disorders with Nicole Fennell

podcast Jan 31, 2022

Listen on Apple Podcasts

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.

Amanda: In this episode of the Are You Menstrual? podcast we are continuing our conversation around thyroid health and focusing specifically on supporting autoimmune thyroid disorders. I invited my friend and colleague Nicole Fennell from @chewsfoodwisely on Instagram to discuss this topic. Since Nicole really specializes in autoimmunity, she's going to share her own journey with thyroid autoimmune disorder.

And if you're wondering who Nicole is, she's a registered dietitian and licensed nutritionist certified in integrative and functional medical nutrition therapy. After years of working as a clinical inpatient dietitian, her personal journey with thyroid autoimmunity led her to eventually start a private practice that challenged the status quo of what it means to be healthy since following the “diet rules” is what made her sick in the first place. Her work with those who have autoimmune thyroid disease is a root cause approach, marrying a flexible food framework and personalized lab data to create sustainable and realistic lifelong changes. Nicole takes a nourishment over deprivation approach and helps women mend their metabolism, banish brain fog, enhance energy, and redefine their relationship with food in their bodies.

So you can see why I would appreciate Nicole's approach. Everything that we've ever talked about in the podcast you basically summarized it in what you do. But thank you so much for being here, Nicole.

Nicole: Well, I'm so honored to be here with you and just continue that conversation around hypothyroidism but coming from the lens of autoimmunity. I feel like this is such an underserved and kind of misunderstood population. And so I want to shed some light into this because it's just so common.

Amanda: Yes, and we're going to talk about just how common it is in a little bit, but do you want to go first into your own health journey? Like, I'm just so curious of, like, how you got diagnosed with an autoimmune condition, what that looked like for you, and like, what were you going through at that time?

Nicole: Yeah, and I think that sharing this journey is such a valuable piece of many women's healing journey, because I feel like it mirrors so many people's path to diagnosis. And, you know, the diagnosis of autoimmunity, like, studies show that it can take up to seven years for people to identify their autoimmune disease. And the hypothyroid autoimmunity or Hashimoto's is especially tricky because the lab testing isn't always done. And so I think that knowing what to ask for, knowing what the symptoms are, and not just waiting until things are bad enough to have a concrete diagnosis is really important, because the immune system is malleable and flexible and adaptive. And so there is so much that you can do that's in your control.

But around the time of my diagnosis, I would say that symptoms were going on for years and years, but I was kind of being treated in a compartmentalized fashion. So, you know, having, I remember being just so tired and being told by the doctors that, you know, I'm just getting older or I'm just, like, stressed out. At the time I was working full time in long term acute care, which basically is like acute care setting, but people are there for a really long time. So it's sort of like people being in an ICU or an intensive care unit for a really long time. So it was really high acuity patients, and I was a baby dietitian, it was one of my first jobs, which, you know, is stressful in and of itself working alongside doctors and nurses who have been doing this for years and years. So I think that it was chalked up to being really stressed out which played a huge part in that. But I remember showing up to the ICU one day and having heart palpitations and being really scared and one of the nurses even hooked me up to the telemetry machine and, like, checked my heart rate and heartbeat and whatnot. I remember going to the doctor for migraines. I was getting migraines every single day, my cholesterol was elevated, and I'm like, what, that's so interesting. I'm a dietitian, like, I should know how to eat healthy, and I am eating healthy, hey, I'm vegan, I'm running marathons, like, I'm the epitome of health, or at least that's what we were taught at the time is like what is healthy.

And so it took a lot of time and a lot of diagnostics, and even going as far as taking steroids every day for 10 days to treat my daily migraine. So treating the symptoms but never really getting to the root of the issue. Honestly, I really just think it was fate or luck or coincidence that I happened to make an appointment with an OBGYN who was close to my hospital that I was working at. And I told her my symptoms and so she was forward thinking enough to run a full thyroid panel, look at some additional lab tests and said, hey, you have Hashimoto's. And I was like, oh, what the heck is that? I have no idea what that even is. And my only knowledge at that time of hypothyroidism was taking Synthroid and that's all I knew. So I feel like going through that journey which went on for years and years, and treating a lot of my symptoms with medications, including birth control and steroids and antibiotics and really getting worse throughout that entire process.

In working in the hospital setting, it was so valuable to really learn disease pathophysiology and, like, learn high level acuity patients, but I found that I was getting to people after the fact, you know, they were already really sick. And they were already kind of like at the end of their rope and not really getting to people or even connecting to people through food. Most of the people that I saw were on tube feedings or TPN. And so with my own journey, I decided, golly, like, there's this entire population of underserved and totally misunderstood people who are dealing with autoimmunity. One, without even being identified, but two, feeling like they're just kind of stuck. If they're lucky enough to be identified as having antibodies against their thyroid, and I'm saying, you know, lucky kind of in the context of having an autoimmune disease and hypothyroidism, but you know, a lot of times the recommendation is, we'll just wait until it's bad enough to go on medication, which, as somebody who's been in that, that seat is a really traumatizing thing to hear. I don't want to just sit idle while my body is breaking itself down, like, tell me what to do, because there's so much that is changeable and fixable with diet and lifestyle.

So it's with that and, like, combining that with the knowledge of nutritional science and the power of nutrition that I decided, gosh, there's, there's so many people dealing with this and, like, they need to know this information. Somebody opened my eyes to this, and I feel like it's my duty to pay it forward to other people. So that's where my private practice ballooned. And I've just been so fortunate to be able to help so many women just be less intimidated by food and really focus on nourishing their bodies as opposed to depriving their bodies, because I think that we're just so engrained with a deprivation mentality when it comes to diet.

Amanda: It, like, blows my mind that you found that OBGYN. The, how it's not even not an endocrinologist not, no, you know, what I mean? Like, no specific specialty for thyroid health. And she was, like, oh, let's run a full panel. And usually when you hear full panel, it's TSH. And then if your TSH is bad, then they'll automatically run for usually just T4, sometimes T3 but not antibodies.

Nicole: No, not at all. I feel like it's something that you really have to fight for. And that's why I feel like being in this position of empowering people through education and just teaching people who are dealing with these symptoms, what to look for, can really speed up that process to identifying the autoimmune activity. Ninety percent, or studies estimate that 90% of hypothyroidism is related to Hashimoto's or autoimmune thyroid disease. So that's a massive percentage of the population. Now, you know, I am not anti-doctor and I'm not anti-medication, but I am pro, like, informed consent and just know what's going on in your body. And that's why I consider myself an educator to teach people what to look for and what questions to ask. And so dietitians and nutritionists can really be a liaison between a patient and provider, so that they have the skill set to know what to ask for. Because a lot of the symptoms of hypothyroid, regardless of whether or not it's autoimmune or non-autoimmune, a lot of the symptoms are kind of vague: fatigue, weight gain, some hair loss, difficulty sleeping. Well, heck, that can be chalked up to a lot of stuff. And so sometimes if you don't know what to specifically ask for, the doctor may not pick up on that. So I think that it's important to know and to be really upfront with what you're requesting with your lab panels.

Amanda: And I think, too, the other frustrating piece is I get a lot of women that are like, I've asked my doctor, they run the labs, which is great, thank goodness, right? Because sometimes you have to really, really fight for that. But I have quite a few women that I've worked with or that are in my membership, that have great relationships with their doctors and their doctors trust them and will also advocate for them. But then they get the test results back and they're like, okay, like it's not necessarily going to change their plan of care, which I think is the frustrating part. But it's usually that you're going to a conventional medicine doctor and looking for a functional medicine solution.

And I mean, obviously I would love for those two worlds to collide and work together eventually, and have, since we know how much, especially for autoimmunity, just how much nutrition, gut health, genetics, stress, inflammation, like, impact it. It's, like, yeah, we'd love for them to kind of combine forces but until then if they really…it ends up, like, I think of my clients with endometriosis—they become like PhDs, you know, and, like, experts in that area. I, a lot of women with Hashimoto's, same thing, because they can't, they know they have this condition, they know that they're, they're, like, wondering why is their body attacking itself and what they can do about it. But I think that can kind of lead down to many rabbit holes, lots of food restrictions and stuff like that, which we'll get into.

But let's just talk about, like, how does someone know, how does someone know if they have an autoimmune thyroid condition and, like, what does it mean? Why is Hashimoto's hypothyroidism different from regular hypothyroidism? Same thing with Graves', the, you know, autoimmune version of hyperthyroid?

Nicole: Yeah, absolutely. So I mean, step one, when you've been diagnosed and/or suspect that you have hypothyroidism is testing and figuring out what camp you fall into. Are you autoimmune or non-autoimmune? And so the best way to do that is by testing what are called antibodies. And I think having a good understanding of what those antibodies are, are attacking is especially important. You know, the medication management of hypothyroidism really doesn't change regardless of the root cause—whether it's autoimmune or non-autoimmune. And so I think that that's where there's a lot of misunderstanding with how to manage if there are antibodies present. And so when I'm working with clients, if they suspect and/or have hypothyroidism diagnosed, taking that step and identifying what camp they fall into is important.

So while there are a lot of similarities in the management, nutritionally speaking, and with supplementation and lifestyle and all of that, there are a little bit of offshoots that are especially specific for autoimmunity. You know, when it comes to, like, the creation of thyroid hormone and, like, where autoimmune falls in, and, like, what to look at on a lab test. The main antibody or the main lab values to look at is going to be, number one, TPO antibodies or antithyroid peroxidase antibodies. And so this is going to be very specific and sensitive to the diagnosis of Hashimoto's. So some studies show that up to 95% of people who have Hashimoto's test positive for TPO, the thyroid peroxidase antibodies. The other antibody to look at is going to be the thyroglobulin or antithyroglobulin antibody. This one's not going to be as specific. Some studies show that it's like roughly 60-70% of people with Hashimoto's are going to have this one. Sometimes people with Hashimoto's have one, sometimes it's both.

One of the big things that I want to recommend is not trying to DIY your thyroid diagnosis, because there is some crossover with the presence of antibodies with Graves' disease, which would sort of be, like, the autoimmune hyperthyroid, hyperthyroidism I should say, versus the Hashimoto's hypothyroid. So there is a little bit of crossover there. And so the big thing to look out for when it comes to the Hashimoto's or Graves' diagnosis is whether or not there's the presence of the TSH receptor antibodies, sometimes called the thyrotropin receptor antibodies. And so that can be kind of, like, the defining antibody level. So you definitely, if you have the presence of one or more of those antibodies, you want to work with the doctor to, like, really solidify your diagnosis, because, you know, hyperthyroid and hypothyroid are completely different. And so I think having that understanding is going to be important.

But going back to the creation of thyroid hormone proper. And sometimes just, like, understanding what's going on behind the scenes and then understanding, like, the, the area in which the autoimmune activity happens…I don't know, maybe I'm nerdy, but I find that really, really fascinating, because it also helps you to appreciate how powerful nutrition and lifestyle can be for the management of autoimmunity. And so simply put, and sometimes seeing this visually can help if you're a visual person like I am, but basically, you know, our body is so dynamic and everything is connected in the body. But when it comes to creating thyroid hormones, you know, our, our bloodstream carries lots of nutrients, but our little follicles inside the thyroid hormone, the thyroid gland, pick up sodium and iodide and then it transports it all through there.

And then we have something called thyroglobulin, which is basically, I call it, like, the skeleton of thyroid hormone. It's kind of considered like a blank canvas, and it has a lot of tyrosine in it. So tyrosine is an amino acid. It's a conditionally essential amino acid, so we usually produce a lot of that, but under certain times, like a lot of stress, that tyrosine is just not going to be very abundant. So anyway, so thyroglobulin has to combine with iodine. And TPO, that thyroid peroxidase, really helps with that combination or the iodination of the thyroglobulin. And so when you have antibodies to that thyroid peroxidase, it can impact how well that's combining. The second place where the thyroid peroxidase is going to be active is coupling up. So you have thyroglobulin and it can either combine with one iodine or two iodine. And so from there, it can either turn into T3 which would be, you know, one iodine plus two equals T3 or two iodine plus two iodine equals T4. And so the autoimmune activity can happen there as well.

And so when you're measuring TPO, those are really the specific places that you're measuring. And then the antibody to the antithyroglobulin is to the thyroglobulin itself or that, like, pre-protein or, like, the skeleton to the thyroid hormone. Sometimes it can impact the endoplasmic reticulum inside the cell, but a lot of times it's going to be pretty specific to that thyroglobulin. And then I, as I mentioned, what will differentiate Graves' between, just on testing, is going to be the presence of the TSH receptor antibodies. So those are the three main antibodies to look at. So if you had the TPO and the TG but no TSH receptor, then that's going to be the Hashimoto's.

And this is especially important because you might be thinking, okay, well, one is hyperthyroid, and one is hypothyroid, so wouldn't that be totally obvious? But it's not, and I'll tell you why. There are kind of stages of autoimmunity. And I'm going to talk specifically about, like, the Hashimoto's autoimmune spectrum, because that's what I specialize in. Initially, you can have the presence of antibodies and no symptoms at all—that would be called silent. Stage two is going to be autoimmune with elevated antibodies and kind of like mild onset of symptoms. I find in this stage two is when women are going to kind of wax and wane between hyper and hypothyroidism. This happens because as the autoimmune attack happens, and there's thyroid site destruction or destruction of the thyroid follicle or the cell, the thyroid starts to release hormone into circulation. What that's going to do is kind of give, like, a false sense of hyperthyroidism. And so sometimes women will get misdiagnosed or diagnosed as Graves' disease, and then over time, get the destruction of the thyroid and eventually get that diagnosis of Hashimoto's. So that stage two autoimmune reactivity is kind of like the messy middle where it's really helpful to have all of those antibodies tested to just kind of fast track and solidify that diagnosis.

Amanda: That's a good point to test for all of them. Because I also feel like most of the time, when you ask for antibodies they assume Hashimoto's, because it definitely is more common. But like you said, it's like, you do want to rule that out. Because say you only have one of the Hashimoto's ones present, like, maybe it's not the TPO ones, but the other antithyroglobulin ones, then that could still be present with the TSH receptor ones that are also high with Graves'. So I love that you mentioned that and hopefully people wrote that down if they are trying to figure out if this is what's going on with them.

And really quick, I want to summarize, because that was, I think this is, people are kind of, like, what's the difference between hypothyroidism and autoimmune hypothyroidism, and you really stated it beautifully with the antibodies are attacking the specific sites of formation, right? So it's like, right before the iodine is gonna connect, and then as you're making the T3 and T4, that coupling. So that's different from, I mean, if you have kind of your conventional hypothyroidism, yes, stress impacts that for sure. And we'll talk about stress and autoimmunity in a bit. But it also, like, nutrition, which nutrition will impact autoimmune as well, but like nutrition deficiencies, stress, undereating, not getting enough of certain macronutrients, I feel like those are a little bit more specific to conventional hypothyroidism, where if you improve those things, then it could fix your issue. Whereas with autoimmunity, we're really looking at okay, these antibodies are present, they’re causing the problem. So it's more of figuring out how are we going to reduce these antibodies? It sounds like is the key for treating and improving it?

Nicole: For sure. Yeah, so there's definitely a lot of congruencies with the nutritional and lifestyle approaches, regardless of whether it's autoimmune or not autoimmune. But I think knowing that is important, because when you have Hashimoto's and you have hypothyroidism because of the Hashimoto's, it's an immune system issue first that's causing the thyroid issues. So if you jump straight to thyroid supporting supplementation and, you know, a thyroid diet and avoiding goitrogenic foods, like all of that stuff, like, sure that could be great, because that's sort of, like, the conventional management of hypothyroidism, which is a whole thing. But understanding your unique immune system issues, and everybody's immune system is completely different and is affected by different things. And we all go through different circumstances in our life, whether it's physical stress or emotional stress that shape our immune system.

So our bodies as humans, but just as like living beings, we're designed to adapt, and our, our adaptive immune system is what allows for the autoimmune disease to happen. So that can be a good thing or a bad thing. I like to empower people and teach them that your immune system is adaptive, and it can change. It learned how to attack your body, and it can unlearn that stuff—it just has to feel safe. There's a lot of stuff that's not in our control, but there's also a ton of stuff that we can control. So how you feed yourself and the level of stress that you're facing and how well you rest and the type of movement that you do. All of that has a positive impact on really shaping that adaptive immune system. So it can seem a little bit crippling to get an autoimmune diagnosis, because it's a lifelong diagnosis, but I like to flip the switch and just kind of change the mindset about getting that type of diagnosis.

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Amanda: Can you talk a little bit more about, like, what it means to have an autoimmune condition? Like, obviously, with thyroid it's, like, specifically impacting the thyroid. But in general, like you mentioned it's your immune system. What does that look like?

Nicole: Yeah, so, you know, your immune system doesn't discriminate. And so it will have a higher affinity for certain joints or glands, too, kind of dependent on the person. And so it's, like, part genetic predisposition part gut function, because so much of our immune system is housed inside of our GI tract. And then part tipping point, or you can kind of count tipping point as, like, stress which can be physical stress and emotional stress. And so autoimmunity is kind of a perfect storm of all of those things. You know, your genetics you can't change, but you can change how your genetics are manifesting themselves, which is called epigenetics. And so whether or not these genes turn on or off is going to be very much dictated by your environment. And your environment is not just, like, the environment in which you live, but the environment inside your body. So the state of your gut health, the thoughts that you have about yourself, and your relationships, and your body, and your food and all of that. So that's where, you know, dietitians and nutritionists can be really helpful is, you know, decreasing that load of stress on your body through your food choices and your relationship with yourself and with food and all of those things.

But anyway, going back to autoimmunity is, it's kind of like a confused immune system, if you will. In the case of Hashimoto's, it's specific to the thyroid, in which case there's enough destruction and inflammation that you don't produce enough thyroid hormone, and that leads to hypothyroidism or low thyroid function. Having autoimmunity will naturally predispose you to developing other autoimmune disease. So you can kind of consider it as a progressive disease. Again, not to scare anybody, but to just really hammer the point home of taking care of your body and alleviating stress as best as you can—again, both physical stress and emotional stress—and really finding ways to pour into your body, to nourish your body, to really calm it down and feel safe so that it's not having this hyperactive immune response.

Amanda: I love, like, how you, you've outlined this, like, a few, in a few places, like, on your blog and on your Instagram. But you talk about those major connections of, like, the genetic predispositions, the having poor gut health, which I want to dig into more, then, like, the tipping point. Can we talk about what are some of the genetic predispositions that can increase someone's chances of developing an autoimmune condition first, and then we'll kind of go into each area?

Nicole: Yeah, so there are a lot of genetic mutations. I could rattle off all the acronyms, but I, I'm sure that would bore people, I'm happy to send it to you to like put in the show notes. One of the other predisposing factors that you know, just as women, and this is for a variety of reasons, but women are much more susceptible to autoimmunity. And so some studies show that 70% of those diagnosed with autoimmunity are women, and that there's a 10:1 ratio of female to male when it comes specifically to autoimmune thyroid disease. So women are 10 times more likely to develop autoimmune thyroid issues, specifically Hashimoto's. One of the biggest reasons behind that or, like, one of the suspicions is our fluctuations in hormones. And that can be just, like, natural fluctuations and our menstrual cycle. But on top of that, hormonal fluctuations like puberty and pregnancy and postpartum and perimenopause…oddly enough, they all start with P. So you know being on the pill, having your period, being pregnant, postpartum and perimenopause, having period irregularities. So having like PCOS, all of that stuff. Because of the immunostimulant and immunosuppressive properties of our hormones, just by nature that leaves women a little bit more vulnerable to developing autoimmunity is those natural hormone fluctuations.

Amanda: I’ve seen, like, a lot of studies around developing it either during pregnancy or postpartum. I feel like that's probably one of the most common times. I didn't even think about menopause. But that's true, you have a huge drop in hormones and, like, shift in estrogen and progesterone. But around pregnancy, that, do you see that a lot in your clients that they're developing either during or after?

Nicole: Yeah, so I'm simplifying this a lot, and nothing with science, as much as we want it to be 100% it's just not, especially nutritional science, but simply put estrogen and prolactin are going to be a little bit more immunostimulating. And then testosterone and progesterone are a little bit more of an immunosuppressant, which makes sense. So think about during pregnancy, you know, you, you don't want your body to abort a baby. So your immune system is naturally going to be a little bit more suppressed, which is a natural phenomenon. And then after when you're postpartum, and you have that increase in prolactin, and then over time your estrogen is going to increase on top of the whirlwind of postpartum with stress and sleep deprivation. And that postpartum time is a really vulnerable time for the onset of autoimmunity. But what I do find clinically is that during pregnancy a lot of women's antibodies get a little bit lower. And then they kind of have a rebound during postpartum. A little bit is to be expected, but again, that's going to be a pretty vulnerable time for thyroid flares and postpartum thyroiditis where you're, like, having major Hashimoto's flares postpartum.

And there's a lot that you can do. So making sure that you're nourishing yourself and, you know, I'm saying this with a grain of salt of somebody who has three kids, like, postpartum is hard. And so just being gentle on yourself and getting nourishing food in and reframing your expectation of what postpartum could and should look like. Meaning like trying not to do too much just giving yourself a lot of downtime with having a baby. But, you know, like trying not to get all the laundry and the dishes and this and that done. And just like being really gentle with yourself postpartum.

Amanda: I love that. And I'm curious for you, were you diagnosed before you had kids or after?

Nicole: Before. Yeah, so I was actually, it was, like, right before my wedding, and I was, you know, trying to fit into my wedding dress. And so I was training for the Houston Marathon, I was following a vegan diet, I was on birth control, because I was, like, having really bad acne, and I didn't want to have acne on my wedding day. So just all of the things that I thought were the right thing to do. So I was diagnosed well before having kids, but I just, I find it so interesting that, and I tell people that, like, when I was doing all the things to be healthy was when I was actually my unhealthiest. And, like, that's when I had my diagnosis.

But I think just knowing how hormones impact your, not just your immune system, but also your thyroid health is really empowering information. Because as women, like, we're naturally going to have fluctuations in our hormones just during our cycle, but then also, like, in each season of life. So leading up to perimenopause and, like, menopause proper, you know, like, a lot of times that coincides with estrogen surges Well, hey, wait, if you have a relative estrogen dominance that increases thyroxin-binding globulin, which can lead to some hypothyroidism. And estrogen can also increase your risk of autoimmunity. And so I think just knowing this stuff can help you prepare for it, as opposed to being blindsided and trying to, like, pick up the pieces after the fact.

Amanda: I think that makes sense. And even just knowing like, okay, I'm being mindful of, like, the stress piece, because I feel like what's within your control, you know, during that time. And not, obviously not all stress, I don't think we need to eliminate all stress. I'm always talking about, like, building resiliency to stress. And like, you know, like you said, nourishing your body, supporting your minerals, you know, not letting yourself get completely depleted in that postpartum season, which you're already dealing with plenty of depletion, like, we don't need to, like, add anymore. I was just curious, though, with your journey, because I know you have three kids, and I was like, I wonder if it was, like, during that, maybe after one of them? Because I do I tend to see that a lot. But it was even before.

Nicole: Yeah, it was before. I do have to say, so with each pregnancy, you know, I was on a different medication routine and had completely different postpartum experiences. And also just the expectation that I put on myself between my first kid and my third kid. So first kid, I was trying to be supermom and, like, go to all the play dates and doing what I thought motherhood was supposed to look like at that time by having to experience real burnout. Realized, thankfully, by my third kid, that, like, it doesn't have to look like that. And, like, actually, it should look like taking care of yourself and resting and just being available for the baby. And like, that's all you have to worry about. So way different postpartum experiences, but also the medication management was completely different during and after. So that pertains to, like, milk supply and my energy level. And just, like, my ability to be present and energetic with my family. So it's been, it's been really interesting to go through that period.

Amanda: I bet, and, like, you know, the further with each pregnancy, I'm sure you learned more and more, had more of your own experience, like, clinical experience with clients and stuff like that. So like a lot more to apply to that situation. So we talked more about, like, genetic predispositions, women are much more likely to get an autoimmune condition, especially during the different seasons of life with the hormone fluctuations that come with those.

What about gut function? Because I do think that there is some knowledge around this. Not in, like, conventional medicine, but I think as soon as anyone starts doing any googling, any research on their own, they're gonna come across things, like, leaky gut and catchphrases like that and think, okay, this is the key to my autoimmunity. But can you talk about, like, how does our gut health impact autoimmunity, and, like, what specific things can kind of trigger that?

Nicole: Yeah, for sure. So, you know, gut health is so multifaceted and there are a lot of buzzwords like you alluded to. But I have to say, clinically, when I am interviewing clients, like, with one-on-one work and even when somebody is doing their, you know, own journey of figuring out their root causes of autoimmunity, like, really building a timeline of health history is crucial. And, you know, there are a lot of similarities between clients in terms of their level of stress growing up and traumas that they've been through, but also, like, some degree of gut dysfunction. And that could be related to medication usage. So steroid usage, or antibiotics, or antacids, and things that are kind of altering the integrity of gut function, and at the time could have been totally appropriate and needed.

But, you know, medications aren't without effects, not just side effects, but effects in the body. So evaluating that stress has a huge impact on gut health. So our brain and our body, and our brain and our gut specifically, are intimately connected. And so being able to recognize that stress impacts digestion, from enzyme secretion to just motility inside the gut. The types of foods that you're choosing to eat, so are they low in fiber or are they low in nutrient density. So in order to produce energy and extract nutrients from food and just the mechanical digestion, takes energy, and it takes nutrients. Most of our bodily functions, or I should say all of our bodily functions, require energy and nutrients that we, a lot of those we get from food. So if you envision your body kind of like a business, it takes money to make money. So if you're eating a ton of poor nutrient dense foods, you're actually using up a lot of your energy and nutrient reserves just to process that.

And then having prolonged nutritional deficiencies can really impact your gut function. So, you know, your gut is where you absorb nutrients that are required for the production of thyroid hormone, and the production of energy, and the production of hormones and all of that. So what causes gut dysfunction is pretty specific to the person. But I would say that stress, poor food quality, lack of fiber diversity, certain medications, nutrient deficiencies, those are really common factors into poor gut health. So it is helpful to, you know, work with somebody to kind of pull back the layers and figure out, like, what were the biggest contributors to your gut dysfunction? And how can we kind of mitigate the side effects of that? And we can't go back and change it, but what can we do to do a little bit of damage control? And then what can you do moving forward to maintain the composition and the integrity of your gut function, not only from the autoimmune standpoint, and again, because most of your immune system is housed inside your gut. But just, like, the absorption and the utilization and conversion of thyroid hormone takes place in the liver and gut, and so it's really important to maintain good gut function.

Amanda: Yeah, whether it's your typical hypothyroid or autoimmune, it's, it's going to be important for each one. You can definitely see how there's an added layer with autoimmunity, since that is where the majority of your immune system is. I'm curious, do you tend to see, do you do, like, stool testing and stuff with clients? Because I've done a lot of research on certain infections with autoimmune conditions especially Hashimoto's, and I'm curious if you see those on a regular basis with your clients?

Nicole: I do, yeah. So one of the biggest ones that I see is H. pylori. That one's really, really common, not just with hypothyroidism, but specifically the autoimmune standpoint. Parasitic infections are common, those are also really challenging to pick up on a stool test. And so, I mean, that's a whole topic into, unto itself. And then overall, putting it simply, I do see just a disproportionate amount of, like, opportunistic bacteria versus, like, “good bacteria,” so just that overall imbalance. One kind of, like, good bacteria, if you will, that I see that is commonly low, aside from like the lactobacillus and the bifido strains, is the Akkermansia. I see that one so commonly low or just, like, non-existent on a stool test.

In terms of, like, looking at the other digestive markers, the secretory IgA, I place a lot of value in that, and I find that there's not a consistent, like, high or low in autoimmunity, but just being off—it's either high or low. But it's also specific to where somebody is in their autoimmune journey. So if they know already that they have this autoimmunity, and they are putting steps in motion to manage it, I find that the secretory IgA being off is a lot less likely. Versus somebody who has no idea if they have autoimmunity, but they've been diagnosed with hypothyroidism, and they've been taking their medication, but otherwise haven't really put steps in motion to nourish the immune system. And so that's a tricky area.

Sorry, I'm kind of diverting. I find that so many people that I work with that have hypothyroidism and they're taking their medication aren't getting better. They're not feeling better, but they're also in a place where their medication is continuing to go higher and higher and higher and higher and they're like, what the heck, I don't know what's going on. Like, I'm taking my medication I should be better. And it's because they haven't identified, like, holy cow, this is immune system dysfunction and I'm not really doing much to identify nor prevent this progressive disease from happening. So yeah, it was kind of a diversion, but I felt like it was pertinent.

Amanda: It, I feel like it all flows together, because that's the thing, like, that is, obviously the GI map stool test is great. You can see pathogens, parasites, different types of bacteria, but you do also get to see how your immune system is working, that secretory IgA marker, which I love, and, like, how many digestive enzymes are you making, which I often see are very low with autoimmunity. I see a lot of low sigA levels with autoimmunity mainly because they've usually been on their journey for awhile, and their immune system is tired now because it's been overactive for so long. And I think people, they're like, I can't believe it's low. And I'm like, well, it you've been dealing with this for, I mean, who knows how long before they even got diagnosed, like you said, it can take seven years for someone to get an autoimmune diagnosis. So it can be there for a while. And even though, it doesn't mean you're not still overactive, it just means that you're not making as many of those secretory IgA markers.

I think it's a really helpful test, though. And I know people like to focus on the infections, like, they'll be like, oh, I have to like clear out everything in my gut for autoimmune conditions. But I'm like, that's not necessarily true. And, like, your immune system might not even be in a place where it's appropriate for you to do that. And so it's so important to…even just digestion. And I talk about this all the time. But, like, if you have poor digestion, you're going to have those large food particles, that's going to be setting off your immune system, it's also going to decrease your motility, it's going to lead to constipation, more overgrowth, and just, it's just a vicious cycle. So even if you're just kind of going back to that basic area of supporting digestion, it's, it's really helpful. And then eventually digging into some of those deeper infections if that is an issue for you. I do think that's essential for someone with an autoimmune disorder.

Nicole: Absolutely. Yeah, so, like, if there is major imbalance, and there is an infection, asking why it's there in the first place. And so I like to use antimicrobials or, like, any sort of gut killing as sparingly as possible. Because like you said, if your immune system and the state of your gut is not set up in a place where it can handle all of that, like, that's it, that's big, like, shifting bacteria and killing stuff. That's not something to be taken lightly. And so you're so right that with autoimmunity, it's so common to have that low secretory IgA. And so, like, if that's low and digestive capacity is low, and then you go in and you blast somebody's body with, like, heavy antimicrobials, like, that can make them worse. So I think that taking time to really pour good nutrition and really build up the body's resiliency is so important before going into any, like, bacteria killing or parasite cleansing or anything like that.

I am a huge believer in our bodies being completely resilient and so much more capable of things than we give them credit for sometimes. And so while it doesn't work in every situation, a lot of times building up the body and giving all the tools that it needs can lead to remission of a lot of things. Not everything, obviously, but I've had a lot of people who just focus on some of the basic, like, mealtime hygiene of, like, limiting distractions and focusing on chewing your food and taking time to eat your food. And that by itself alleviates so much digestive issues. Obviously not the case with every person, but I think that, like, focusing on those fundamentals is so important, but before moving on to more complex stuff, like bacteria killing and all that fun stuff, that's attractive, because it's, you know, different. But we can't do that without also doing the fundamentals.

Amanda: And I think especially if someone's dealing with this, like, they want a solution, they want to get to the true root cause, because, especially if they're doing any sort of reading from, like, a more functional approach of handling this, they're going to hear root cause over and over and over. And they're like, okay, this is my root cause. So this is what I have to do to get rid of it and then I'll be fine. But you really do have to support all those other systems in the body. Because then I think of the other big component, which is stress. And that can be any type of stress, right? And I would say physical stress as well, which, that's how I would look at gut issues like pathogen overgrowth, that sort of thing. Can you talk about that, like, you mentioned, like, tipping point? I think that there's a huge stress and autoimmunity component. But I'm just, I'm curious of your thoughts. It sounds like it because you're on your own journey. You talked about, like, all the stressors leading up to when you finally got your diagnosis.

Nicole: Absolutely, yeah. So stress is huge when it comes to autoimmunity. So not just emotional stress but also physical stress. So physical stressors on the body. It does encompass the gut dysfunction and poor digestion of food, the quality of the food that you're eating, undereating, undereating the right types of foods, eating inconsistently, exercising too much, or not exercising enough. So, you know, any extreme that you go to is not going to be good for most things, but especially with autoimmune disease. And then the emotional aspect of stress, like, there have been several studies done on the association of a traumatic event happening on kind of leading up to diagnosis of autoimmune disease. So there are some studies that show people who experienced adverse childhood events or adverse childhood experiences, or ACEs, are 70-90% more likely to develop autoimmune disease, and up to 80% of patients who diagnose, were diagnosed with autoimmunity reported having a kind of stressful event leading up to that. That could be a move, a divorce, a job change, a death in the family, and there's a lot of times that, like, a very tangible major life stressor that happened right before the diagnosis of autoimmunity.

The thing about stress is that it's not about having no stress, but knowing your stress, being aware of it. We all have a different threshold for how much we can tolerate. And that's going to change with each season of life. So I think being really cognizant and aware of what is kind of filling up your “bucket” is important. And you're never going to be in a completely stress-free situation. But knowing and implementing tactics to offload the amount of stress that you're under—both physical and emotional—and recognizing that you can't out supplement the stress. And so putting practices into place to kind of pull the release valve a little bit, if you will, when it comes to the amount of stress that you're under. But yeah, it's, it's huge. So not just for the immune system, but for thyroid hormone.

So our bodies again, are, are really smart. And although we're, like, a super modern day being now, we're still pretty primitive in our design, and we're designed to survive and adapt. And so if we are constantly sending the message to our body that, you know, we're running away from something, or there's not enough food, or we can't get into a deep sleep because there's a threat out there…our body senses stress and so what it's going to do is go into, like, a preservation efficiency mode. And so your thyroid is kind of like the puppet master of energy production. And so stress in and of itself, it can really, really dial back thyroid hormone production. And then if you have the autoimmune component it's kind of a double whammy, so stress management—physical and emotional—is huge.

Amanda: And what impact does stress have on the immune system?

Nicole: So it's kind of progressive. And so what's going to happen if there's, like, acute stress is that you're going to have sort of, like, an increase in your stress response to be protective. So think about, if you were, you know, hunting something and you were chasing after it, and you get this, like, natural stress response…let's say you cut yourself, well the increase in endorphins and immune system is to protect you from getting any sort of infection. And so we're totally adaptable to acute stressors, it's the chronic stress that’s a little bit more problematic. So you can envision that sort of, they're sort of, like, a bell curve when it comes to the impact that stress has on the immune system. So chronic stress is going to eventually lead to immune suppression or, like, immune confusion, if you will. If you are faced with a short-term acute stressor, that's normal, and like, you can't always control that. But evaluating what are the things that are stressing you out on a daily basis? Is it your relationships? Is it how you're eating? Is it the commute? Is it your environment, like, you're living in a lot of pollution? And that's where like, knowing your stress can be really important so that you can make changes.

Amanda: Yeah, and it's not, again, it's like, how can you respond better to that stress. And a lot of it, a lot of times in the beginning, if you're super sensitive and you feel like you can't tolerate stress as well as you used to—which is super common, especially when you've been dealing with a chronic illness for a long time—then it is, like, trying to minimize as many stressors as you can. But also, like, building up those reserves, resources, eating enough, not skipping meals, you know, drinking your adrenal cocktails, all that.

Nicole: I have mine!

Amanda: Do you have one right there? I love it. I had, like, 32 ounces of one today. So I'm, like, I won't have any more…stressful morning. But just kind of, like, combining the two I think is so important. But I was, I was just, I think it's helpful for people to hear like, oh, there is an immune reaction when we're dealing with stressors.

And that's, like, we don't know all the mechanisms with, there have been quite a few studies on stress and autoimmunity, but the mechanism is not perfectly defined still, which I find kind of fascinating. I'm like, how do we not know this yet, but it's definitely there. And like you said, a lot of people describe reaching this breaking point, having some big event happen before a diagnosis.

Let's go into the different sites of thyroid dysfunction if you have time to go through this, because I think a lot of people don't quite understand. Like, they think it's just the thyroid gland, whether it's, you know, autoimmunity or not, but can you walk us through those, like, four different sites of thyroid disruption. And you already talked about, like, the antibodies and everything, but I think people enjoy this.

Nicole: Yeah. So, I mean, I'm sure people who have listened to your podcast and done your trainings can appreciate now that everything is connected in the body—nothing happens in isolation or a vacuum. So when one thing is off, other things will be off, too. And so the thyroid, because it's involved in pretty much every metabolic function in the body and every cell in the body, when it's off it affects other things. So the production…or the overall, like, how to view optimal thyroid health comes down to production, absorption, conversion and utilization. And so there's specific areas where each one of those is a little bit more pertinent.

So first and foremost, like, the connection between brain and thyroid. So that communication between hypothalamus, pituitary, and thyroid is important, and a lot of times stress can be the biggest impactor there. Other things that I found to really impact that, nutritional deficiencies…So like, like I said, every communication pathway is dependent on different things, like minerals and different vitamins. And so, minerals especially, so that communication between brain and thyroid is essential. But yeah, I find a lot of times that stress is a big component there between the disconnect.

The second site of thyroid disruption is just going to be, like, the thyroid gland proper. So, like, is your thyroid producing enough, and if it's not, why? Is it related to the thyroid site destruction, which is consistent with autoimmune disease? Is there just maybe not enough of the basic essential tools, like nutrient deficiency, meaning that there's just not enough there to create the thyroid hormone?

The third place would be the conversion. So T4, the inactive or more inactive thyroid hormone, has to convert into T3, because that's really what gets inside the cell. And so that conversion can be highly impacted by stress, again, nutritional deficiency, inflammation is another really big one. So inflammation is one of the things that will impair the deiodinase, and so that plays a role in that conversion. And so you can have a lot of issues converting, whether you're converting your natural hormone that you're producing or the thyroid hormone medication that you're taking—which most common is going to be a T4, commonly is going to be a T4 medication. Inflammation and nutritional deficiency and stress are the biggest things that impact that conversion.

And then lastly, is some cellular resistance, which again, stress impacts that greatly, nutrient deficiency because nutrients, a lot of times act as transporters to get the, the hormone inside the cell. So to recap, it's brain-thyroid disconnection, thyroid gland disconnect, and then issues with conversion, and then actually getting it in to the cell. So I break it down to production, absorption, conversion, and utilization.

Amanda: Yes, and I think this is why we can't just go to, like, a one size fits all approach for thyroid health, because it's like, okay, well, you want to make sure you're addressing all these areas. And I would say, like, most treatment plans are not addressing all these areas. Even, even if you're covering nutrition, I feel like that can get a lot of them, but again, like, if you're ignoring the stress piece, the nervous system piece, then you could still have issues with that brain-thyroid disconnect. Even though you're eating perfectly, if you want to say that you're eating all the right foods, take your supplements, all that stuff. It's, like, if that piece is still there, then that's a huge issue. And then, of course, like you mentioned, like, liver and gut health—there's a lot of conversion happening there. And if you have really poor gut health, because maybe you have some infections and autoimmune present, then that could make it a lot more difficult to have all that T3 as well.

Nicole: Yeah, for sure. And I would say, because a lot all of this can sound really overwhelming, and, you know, you can kind of get that paralysis by analysis. It's like, holy moly, there is so much to do, and I don't even know where to start. So I recommend starting with the lowest hanging fruit, like, what are some of the fundamentals that you can put into play?

I boil it down, I call it I, the acronym that I come up with is BRAIN, which stands for blood sugar balance, like, how are you balancing your plate? And what is the timing of your meals during the day? What types of foods are you eating? Are you eating more nutrient dense foods or less nutrient dense foods. So that's the B is blood sugar balance. Regulating inflammation. So that's multifaceted in and of itself, but basically boils down to try to get more color on your plate, try to get more fiber on your plate, the more antioxidants the better. Adrenals. That's important, because that's going to encompass stress, but it's also going to encompass your electrolyte balance, like, your mineral balance. So adrenal resiliency is, is paramount. Intestinal support—we talked a lot about gut health. And then lastly, the end is nutrient repletion.

So those are kind of like the five, called, like, the pillars of nutrition of, like, if you don't know where to start, start with one of those, start with balancing your blood sugar. Once you feel like you've mastered that, then try to choose more anti-inflammatory foods or less inflammatory foods. So just kind of working progressively and handle what you can handle. Because what we don't want to do with nutritional therapy, is stress you out more, because then it's going to be counterproductive.

Amanda: That's why I don't like a lot of the super restrictive diets that are recommended, because I'm like, you shouldn't be focusing on what you're not eating. That is such a waste of energy, in my opinion. Like, we should be focusing on how can you add more nutrient dense foods in. Like, how can we get more vitamin A in—that's so important for your immune system, thyroid health. How can you get plenty of protein and all of your meals, which is going to help keep that blood sugar balanced. Not skipping meals, like, like, going to super strict diets and, like, fasting, I'm like, no, this is the opposite of everything we want to do to reduce your stress and get more nutrient dense foods in you to support yourself.

And I think, I, like, yes, it can sound complex, but it's also pretty simple, right? If you can really just focus on eating well, eating balanced, and feeding yourself appropriately, that's not only going to hit the macros and micros kind of component of it, but it's also going to help reduce your stress, because your body's not constantly looking for this energy source and trying to compensate. You know, trying to release that cortisol so we can get more glucose in the system, like, it'll already have it. So I feel like that's, it's, I get what you're saying it can feel overwhelming, but also, like, everything we've ever covered in this podcast applies. We are just taking a deeper autoimmune lens so that hopefully everyone listening or watching can have a better understanding of what does it mean, like, what does it mean if I have Hashimomto's.

Like, I just feel like when people understand, and even talking about, like, the sites of dysfunction, like, all, you know, what, I've really focused on all of these, but I have, I'm not super great about my adrenal cocktails or potassium. And that could affect, like, the cellular, like, uptake of the thyroid hormone. So maybe that's my focus. You know, it doesn't have to be, like, super complex.

I'm curious like, for, as far as, like, if someone is taking thyroid hormone, like, medication…you talked about T4 before. How come when women are taking T4 and levothyroxine they, they might not notice a difference in their…Why do you think we're constantly, like, upping that dose for so many people, or seeing that dose increase for them?

Nicole: Yeah, so I'd say the two main things that come to mind…one is not knowing whether or not they have autoimmunity, and therefore, like, not putting the steps into place to identify their specific immune system triggers. So, like you mentioned, the, the dietary recommendations for autoimmune versus just conventional hyper, hypothyroidism are very, very similar. But with that autoimmune facet, it's so unique to the person that it does take a little bit of extra thought to identify what the triggers are. Like, are you more sensitive to stress? Is it a specific food? A food group? And so when there are a lot of increases in medication, it's usually because there is progression in the autoimmune disease process that is continuing to worsen thyroid function and therefore creating more reliance on the thyroid medication intervention.

The second would be poor conversion of that T4 medication to T3, which is very dependent on energy that we get from food, especially getting adequate carbohydrates in your diet. But then also things like zinc and selenium and copper—like, all of that is really, really important. So, you know, when I was eating a vegan diet, like, my diet was really void of, of all of those things. And then eating a lot of foods that were high in kind of, like, anti-nutrients that would block that conversion. So eating a lot of soy and a lot of fake meat made from straight up gluten, and gluten was the first ingredient in a lot of those things. So not identified autoimmune disease would be one big reason. And then the second reason, it would be that impaired conversion of T4 to T3.

Amanda: And so would you say, like, if someone's not sure if that's their issue, like, if…because I think the hard part is when they go to get their labs looked at, it's just TSH. And sometimes I see T4 for people, but I very rarely see T3 unless someone's asking for it. So what would you, how would someone know if they have poor conversion?

Nicole: Yeah, I think the biggest thing is to continue to advocate for yourself and request, request, request. There are some direct to consumer labs that are available, and then otherwise working with a provider that can help you get access to labs. So depending on which state, dietitians or nutritional therapy practitioners are able to order those labs. There can't be a diagnosis made from that, but at least giving access to the information can be helpful, but I would say definitely testing is the way to go.

Amanda: And we talked about optimal levels of all those in our previous podcast with Kaely, so make sure you go check out that one as far as, like, TSH, free T3, free T4, we talked about antibodies, reverse T3. So if you do get any testing done, and then your doctor is, like, I don't know what to tell you about any of this, then definitely go listen to the podcast episode again. So that maybe you can identify like, oh, it is a conversion issue, so I'm going to really work on stress, eating more consistently, getting a good balance of protein and carbs. So you could if you did any hair testing, if you're inside the Master Your Minerals course, then you could look at your certain mineral status and see if there's any ones that you should probably optimize those that support that.

Last question, because when I was preparing for this podcast, and I was going through a bunch of your posts, I was like, oh, this is interesting. I kind of just want to pick her brain on this and see what your thoughts are. But you talked about, like, supplements for thyroid health and one that, for autoimmune thyroid specifically, one that you mentioned was inositol. And I was like, okay, I haven't actually heard, I know it can help with some nervous system stuff. So I was like, I wonder if that's why, and blood sugar. But what are your thoughts? Like, why do you like using that for those that struggle with Hashimoto's?

Nicole: Yeah, I call inositol kind of, like, the Swiss army knife of vitamins. And we actually produce inositol inside the body, but it's one of those, like…if there is a nutritional deficiency, a lot of times it's from supply and demand issues. And so demand goes up a lot when there's just stress. Again, physical and emotional stress is going to increase demand for certain vitamins and especially things like minerals. So inositol is one of those that can be used for anxiety. It can be used for insomnia. It's, like, really, really popular in the PCOS community, because it plays a role in improving insulin sensitivity, so how well your body utilizes insulin.

But inositol also plays a role in the kind of, like, TSH signaling. So if you have subpar levels of inositol for whatever reason, studies have shown that supplementing with inositol can improve your sensitivity to TSH. So basically when you are less sensitive to the effects of inositol, or I'm sorry, to, your body is less sensitive to TSH, it’s going to increase your requirement for inositol. And sometimes your body just can't keep up with production which is where supplementation can be helpful. And again, demand a lot of times it's going to go up in relationship to stress. But let's say you're a stressed out person who is also dealing with insulin resistance because you have PCOS…which PCOS and Hashimoto's really like to run together, and it's very common that those are kind of a tandem diagnosis. That's another reason that your inositol requirement would increase. So to back it up, the inositol plays a role in that TSH signaling and the inositol is important to make sure that your body is sensitized to the message that TSH is sending. If it's not sensitized, it's going to produce more and more and more TSH.

Amanda: I had no idea about the TSH. It makes sense because it does a similar thing for insulin.

Nicole: Yeah.

Amanda: But I was like, ooh, I'm, like, very curious of what, like, her kind of thought process is with that, but that's really, that's really neat. I'm gonna have to do some experimenting with that one. I feel like a lot of my Hashimoto's clients also have PCOS…

Nicole: Yeah.

Amanda: …so many of them are already utilizing it or, like, have tried it in the past. Do you see, like, improvements in TSH levels with clients when you're using it?

Nicole: Yeah, so inositol is interesting because not only does it improve the TSH signaling and sensitivity, it also has some immune modulating effects, meaning, which is really important when you have autoimmunity, so modulating think of, like, regulating. And so the studies that are done on inositol show that they help to improve TSH and antibody levels. And so TSH, or inositol, sorry, I'm getting confused with my words, inositol is kind of, like, a little messenger. So not only does it impact TSH, it also impacts insulin, and it impacts follicle stimulating hormone. So a lot of those hormones, which you know, sex hormones and thyroid hormones, like, everything is so connected in the body. But yeah, so inositol can help to decrease the antibodies. And so again, the antibodies are going to be the indicator of autoimmune activity.

Trending in antibodies is what, what's going to be the most important thing, and so a lot of times when I'm working with clients they’re like, oh my gosh, my antibodies are at 600, which seems like a lot if you look at the lab range. But it's important to take a step back and see, like, what their normal is and what their trends over time. Because somebody could have antibodies of like 70. And they're like, oh, not so bad. But for them, like, if that was a huge jump from 15 to 70, like, that’s significant for them. So I think that hammering that point in of like, don't compare your antibodies to anybody else. What your antibodies are trending over time is what's going to be the most important.

Amanda: And that goes for every lab. I love, that's, like, an important thing to highlight. And I know people are gonna ask, do you have a type of inositol, like, specific, you know, is it myo-inositol? D-Chiro? What's that look like? And do you have a brand that you like?

Nicole: Yeah, yeah, so the all the tests or, like, the research papers are done on myo-inositol. And so they either do like inositol in isolation or inositol combined with selenium. So myo-inositol.

Amanda: That's really, that's really interesting, I will make sure that I do a post on that as part of the kind of summary of the podcast, because I think that that's one that people might not necessarily know of, especially for, specifically for autoimmune. And I feel like that's a neat one. If someone's dealing with a lot of those other issues, too. It could be, it could be a supplement worth experimenting with, especially in the short term as they're trying to make changes and improve things in their body. You know, because it's, like, it's okay to manage symptoms in the short term when we're working on long term health. So, and I'm definitely not an advocate for adding a ton of supplements. But say, for example, that was able to reduce someone's antibodies, and that allowed them to have more energy and feel less fatigued and, like, do more, like, things to support their health. I feel like that's totally worth it.

Thank you so much, Nicole, this was amazing. I love how you explained everything, and you're really, really good at breaking it down, like, all the science, I think, in a simplified and digestible way. I think people are going to love this episode. I can't wait to hear everyone's feedback. Make sure you tag us. If you listen to Nicole, you can find her @chewsfoodwisely on Instagram. And I'm gonna put her website and Instagram in the show notes as well. And then is there anything you want to share with people? Anything you want to leave them with?

Nicole: Oh, gosh, put on the spot. I wish I had something to say that was really life changing or a sound bite? But, yeah, I've got nothing. I don't know. What do people say?

Amanda: I mean, you gave a lot of really kind words of wisdom throughout of, like, breaking stuff down and not feeling like you have to do everything, go for the lowest hanging fruit. I feel like that's your overall message even with everything you share online. And I mean, that's what most people need to hear. It's easy to want to run for the lab test, to want to run to all the restrictive diets, but you, is that really going to support your health and get you to where you want to be? Probably not.

Nicole: Yeah, I think just because, you know, with hypothyroidism, like, it's something that's super common, but it's not something, it's not considered normal. And so I think because hypothyroidism is so common, it's not really taken as seriously as it should be. And so I think that a lot of women especially deal with these debilitating symptoms for a really long time, and there's so much confusion about what to do that it's just human nature to reach for something that is a reach, you know. To reach for the newest supplement or to reach for a really hard diet, because doing things intuitively and organically and, like, naturally just seems a little bit too easy for the way that they've been feeling. But I think that, you know, with that can come a lot of detriment to health. And so I like to kind of dial it back and just really focus on the least restrictive diet possible.

And I feel like that's the goal of dietitians and nutritionists is to find the least restrictive yet the most effective diet possible for the person. Realizing that there may have to be some boundaries with food, and there may have to be some supplements, and there may have to be some foods that you avoid. But all the while really focusing on abundance and adopting that abundance mindset versus restriction. Because even that mindset shift can have such a big impact, not just on your thyroid and stress response, but your immune system. So that's my goal is to just really help women especially, like, redefine your relationship with food and, like, not be scared of food anymore. And use food as a tool and not something that you have to be resentful or scared of anymore.

Amanda: I love that. That was great. You said you didn't have anything, you had a lot. You had a lot to say. Well, thank you so much for being here and sharing all your time with us and all your knowledge. And we'll definitely have you back, because I'm sure we'll have questions based off this episode. And yeah, I just really appreciate you.

Nicole: Absolutely. Well, thanks for having me. It was really fun. Yeah, I feel like I could talk about inositol all day

Amanda: We can get into, we can do an extra nerdy autoimmune episode. Now that we have the basics laid. So we'll definitely have you back for sure.

Thank you for listening to the Are You Menstrual? podcast. If you enjoyed today's episode, please consider leaving us a review and sharing the podcast with someone you think it will help. If you are new here, we can't recommend enough to start with our mineral imbalance quiz. This is going to give you an idea if you are at low, moderate, or high risk for mineral imbalances. And then of course, make sure you follow us on Instagram @hormonehealingrd. And consider signing up for our newsletter if you like nerding out and you're just loving these podcasts but maybe you're a little bit more visual and you want to see things too. We go into a ton of detail in our weekly newsletter. So we would love to have you join us there. Alright, thank you and we will see you in the next episode.


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