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spk_0: 0:00
postpartum tirade itis and Hashimoto's. Rather, there's a lot of overlap there. And so it's like, You know, that might be that some of the people who have postpartum thyroid itis actually had some underlying Hashimoto's that we just didn't know about because nobody checked their approximate that globulin antibodies before getting pregnant, which is pretty common.
spk_1: 0:17
Welcome to the less stressed life podcast, where our only priority is providing those ah ha moments toe up level your life, health and happiness. Your host, Integrative dietitian nutritionist Krista Bigler, helps health conscious women reduce the stress and confusion around food, fatigue, digestive and skin issues at less stress. Patrician dot com Now onto the show While most of us think about taking a prenatal vitamin during pregnancy, taking one both postpartum and starting one of the moment you are thinking about conceiving as just as important before pregnancy, the quality of your egg health can be influenced at least three months before conception affecting fertility and nutrients are doing much of this egg health work. Nutrition needs postpartum are often increased, especially of mama's pumping or breast feeding, plus, taking on the stresses of a new baby at home, all of these things are highly dependent on nutrients, and you can feel better when you go beyond a low dose, prenatal or gummy. That isn't really meeting your needs for all these stages of change in your body. Full circle Prenatal was developed as a two year labor of love by my friend, mentor and colleague Caleb Armor. Ah, highly trained integrative dietitian, nutritionist specializing in women's health and fertility. She took special care in sourcing the best quality nutrients and evidence based quantities to truly give you the best bang for your buck and a comprehensive prenatal. Specifically, she ensures that there's a great amount of one of my favorite underrated nutrients, coleene, which is essential for skin, brain and liver health. But intake is often inadequate in over 90% of pregnant women. Other prenatal vitamins often undercut magnesium and calcium as well, because of their large size in a supplement. But this compromises your dental and bone health needs, while creating a baby or feeding one and not having enough magnesium can also lead to a cascade of issues with sleep, the nervous system and even digestive problems. There is no other prenatal on the market like full circle prenatal, and I'm proud to welcome this company of integrity as a sponsor for the less stress Life podcast. You can use the discount code less stressed at checkout for 15% off full circle prenatal at full circle, prenatal dot com, and you can find all discount codes and links for everything mentioned in the podcast over at krista Bigler dot com forward slash shop Okay, today on the less Stress Life we have a very lovely doctor with us today. Dr Christine Maren, who is an action packed epic physician and the founder of a functional medicine practice in Colorado, Michigan and Texas. She's also the co founder of Hey Mommy and Online Resource. To help women navigate a healthy and happy mommy hood, she was introduced to function medicine after struggling with pregnancy complication and recurrent miscarriages. A functional medicine approached helped her address underlying health issues associated with gut infections, food sensitivities, hypothyroidism, hormone imbalance and mold exposure. Now she's a mother of three, and she's devoted to her professional life, helping other women optimize their health during pregnancy, thrive in their postpartum time and get their life back. Just such a voice that we need to hear more of about postpartum health. So Dr Maran is board certified in family medicine and is an institute for functional Medicine. Certify practitioner. Welcome, Dr Maren.
spk_0: 3:25
Thank you. Glad to be here.
spk_1: 3:27
Yes. So we met at an event. It was after a hormone conference. You weren't there for the hormone conference. We were in Portland and we got to me in person, which is such a lovely way to me. But she's really a neighbor over in Denver, although practices virtually in a few different states. So if people want to see Dr Man, that can do that. And today we're talking about such an important topic, which is really thyroid issues after people have their babies. But let's talk about your story a little bit first, because it's really how this all started, right? So tell me a little bit more about how you got into this area. I know that you have some really specific thyroid family history as well.
spk_0: 4:02
Yeah, I do sure have some thyroid specific family history going way back when my sister's. Actually, it's Hashimoto's and the other sister has grave. I have hypothyroidism, as does every other woman in my family. So it's unfortunately very common amongst emails, as you probably know, and I tend Thio have a specific passion for it just because it kind of affects everybody that's really close to me. But my story really kind of goes back to pregnancy complications. That's really what sent me down, sort of the rabbit hole of functional medicine. I really went to medicine, actually with a very holistic mindset, which is part of the reason I went to Osteopathic Medical School. My mission was always to be a more holistic minded positions, and I wasn't introduced to functional medicine until I started having issues with pregnancy complications specifically pregnant the law. So I had my first daughter in ahead gestational diabetes. That's really when I dealt in Thio nutrition. I knew that it didn't make any sense that my blood sugar was high because I didn't have the risk factors. And I knew that the conventional dietary advice surrounding gestational diabetes was kind of crazy. So I really took a dive into nutrition at that point was like checking my blood sugar four times a day and really became attuned toe you know, carbohydrates
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and that those did to my blood, sugar and different types of carbs and all that. But it wasn't till years later when my husband and I tried for our second baby that I experienced recurrent pregnancy loss. And at that point, I really like went down the function of the Somme path and went through all the things. So thyroid and hormone balancing and guts and environmental toxins in the mold exposure and all of those things became relevant my life and took me a couple of years to get my health back. I mean, I'm still on that path, you know. It's still everyday, do things for my health. And it's a big focus of mine. Yeah, I mean, sort of my professional and my personal lives collided at that point, and I knew that function medicine Waas Not only the path I needed for my health, but the way it could best help other people.
spk_1: 5:55
So it was a really kind of almost I would say it's I think it's appropriate to say it was a traumatic experience. What led you down that path, Really? And yeah, said so. I guess my question is for you Off the bat is after you had your first baby, How was your thyroid? Would Did you already have a suppressed or hypo thyroid prior to program?
spk_0: 6:12
No, I actually didn't know enough at that time. I don't know. I think it was probably sub optimal viral function, but I don't know. I mean, my th with normal was on my radar because my sister's both had autoimmune thyroid disease and so I would have my t s h tracked and my tears h waas within a normal range, but as well talk about, I'm sure of it. That doesn't always mean a lot. So that time it waas normal ish. But later on, I mean, firing medication changed my life overnight, so yeah, I don't know. I don't know how long I was really going on for me, that it was like, sub optimal thyroid function. I do not have overt autumn and diarrhea disease, so yeah, it's a little more subtle, but life changing nonetheless.
spk_1: 6:54
Yeah, I would agree that I always encourage people if you need like, you really should just have your thyroid checked appropriately, because if you are not, if you need thyroid medication and you're not on it, it is more dangerous to not be on it right, so so people should not feel guilty about that, even if they're trying not to medicate that much. That's definitely not something to feel guilty about something I was surprised to learn many years ago was asked my oldest best friend, who's the pharmacist about the most commonly prescribed drugs. And she said thyroid medicine was number one, and I wasn't expecting that because I worked in more diabetes. Take care of that time. And so I just when you're surrounded by something, you think that that's the most common thing. I still think I'm jaded in the world. Yeah, I still feel like the things I'm addressing now are very, very common. And so do you know much about prevalence of thyroid disease? And it's totally fine if you don't. And then let's talk about that whole testing because just testing T S
H is certainly not a comprehensive way to assess Total that reaction,
spk_0: 7:48
right? Yeah, I don't know. I can't tell you off the bat. Like what? The prevalence is overt tirade, disease and of our disease among females and then of Hashimoto's. We know that the most common cause of over hypothyroidism is autoimmune, which is Hashimoto's. But I don't know the numbers.
spk_1: 8:05
Well, you know, we should really define them as well before we were and talk about testing a little bit because we're throwing these around. So hypothyroidism is I'm gonna let you define hyperthyroidism, and then the different three Hashimoto's and griefs.
spk_0: 8:16
Yeah. Okay. So, hypothyroidism from a conventional standpoint, when we think of people who have, like, over hypothyroidism, what that means is that there t s h falls outside of a normal reference range, and the T s h goes high. T s h is like your brain's waved of trying to stimulate your thyroid to make hormones. So when that TSA just Hi, it's our picture into thing that your brain is like telling her thyroid I need more hormone. And so what? Somebody who hasn't worked high Both. I redid them. We see a high T S H in a low free T four, somebody who has subclinical hyperthyroidism. That's another definition in conventional medicine, something I was taught in residency. So subclinical hyperthyroidism would be somebody with a T S h outside of the normal reference range. But a normal tea for so tea forests, a hormone that your fiery gives off. And so then you know people with subclinical hyperthyroidism. Generally, people just sort of watch them until they become overtly hypo thyroid and are really struggling and then medicate after that. And most of the people go on to develop over hypothyroidism. And then I keep saying this sub optimal thyroid function sub optimal thyroid function is really more of like a functional medicine definition. That is when you're T S H might be in the normal reference range, but it's not the optimal range. It's outside of that optimum range, and that could make a big difference for people. There's a lot of controversy around that range, and you know there's some literature which supports making that range more narrow, but ultimately it hasn't been made more narrow except for purposes of fertility. So there's research, looking at people who are trying to get pregnant and that a tighter reference range is needed for fertility purposes. But basically, unless you're trying to get pregnant like that, reference rate is pretty broad.
spk_1: 9:54
Okay, let's talk about what the reference range is conventionally, and then if we're looking at sub optimal hyperthyroidism. How does the reference range change for
spk_0: 10:01
Yeah, so Okay, so if you are looking at a conventional lab or you're looking at, you know your quest or left or left, the reference range for T S H is generally about 0.5 to 4.5. It's meat might be off by a couple points, depending on the lap, but somewhere
in between there, I say, an optimal reference ridge is more like 1 to 2, if not closer to one or maybe just a little below one. So generally you want your teeth each around one. If it's 2.5 or three or 3.5, even though it won't be flagged as abnormal in the lab, you might have been. And then when we get to free T four and then the other components of a full thyroid panel, the optimal reference range changes a lot. Though free T four. When you're in a conventional lab, the lower limit of the reference range is 40.8 and the upper limit. I'm need to pull up some labs, but I think it's like 1.6 or so he needs 1.8 I usually, you know free tea for my optimal range is like 1.121 point for.
spk_1: 10:56
So what does it feel like when someone has hypothyroidism? Underactive thyroid?
spk_0: 11:02
Yeah, so there's a lot of different symptoms. Generally fatigue, feeling exhausted, feeling cold to the bone that's like it. Like that chill where you just can't warm up. Um, thinning of the outer third of the eyebrows. Sitting or dry hair dry cracking skin. Sometimes constipation doesn't always have to be constipation that sometimes people experience other kinds of digestive issues because the fire it also guides the metabolism of the viscera. Basically meaning like your digestive organs, the motility is a factor, but also the way that they expressed. I just been designs and vile and things like that. There could also be sort of like mysterious skin conditions and rashes that come up sometimes brain fog. Some people are more sensitive to the effects of low thyroid on mood, and so little experience, either depression and or anxiety. Low libido could be an issue and then metabolism, so either weight gain or just the inability to lose weight. But accompanied with that also there could be issues with blood sugar or issues with high cholesterol. What help he Sometimes people have, like, muscle pain goes along with sleep issues. Sometimes mood swings periods to the big one. So menstrual cycle. If that's your regular a lot of times higher, it could potentially be a component. And then low heart rate is another one. And low body temperature. Yeah, it's a big mess, right?
spk_1: 12:19
Yeah, It's a big net in general because these symptoms, of course, as usual, overlap into other things as well. But there are some, like, I think, some of these We kind of feel like you're a little bit more dead ringer. Sort of kind of, You know, the gun dried hair and the kind of fatigue kind of cold. I feel like those a really common things that you hear a lot about. Um So how do you feel? So what normally happens? I feel like you are. This is what I see is people have a t S h checked. And if that's abnormal, then maybe you get your other thyroid labs checked. How do you feel about that approach?
spk_0: 12:49
Yes. So, normally, some doctors will order a T S h with reflex. And what that means is that they draw T S h and if it's outside of the reference range than the labral reflex to draw three t four generally in conventional medicine Free T three and Reverse T three is not regularly checked. Nor are thyroid antibodies like fire a proximity with Tyra globulin. I don't think I ever answered your question earlier about Hashimoto's, but we'll get into that. But you know, there's autoimmune conditions of the thyroid. Hashimoto's. There's also grade, but those will produce antibodies against. But I read so, like if you do a full fire a panel, those were nice to have. But generally what's check did the T F H. And then you go to your doctor and your T S. H is abnormal, and they haven't reflected too afraid before. They might draw 3 to 4, but that's usually about as far as they go.
spk_1: 13:33
This is tricky because some people have a normal T S H and then have very abnormal thyroid antibodies. And so it's very hard to get to that point, right? People have to fight to get to their right. That happens. Yep, let's talk about what's going on with antibodies. What is an antibody and what's going on? Hashimoto's and Gravesen.
spk_0: 13:50
Yeah, so with autumn and thyroid disease basically, with auto immunity, it's your body's immune system attacking your own tissues. So it's like an aberrant immune response. Hush motors. Are they very common, one. Among females, graves is less common. Hashimoto's generally presence with low thyroid function over time, whereas Grave, the opposite graves is making usually tired receptor antibodies and somebody's hyper fiery. So that's like the opposite symptoms were hyperthyroidism. They'll be like anxious and fast heart rate, using much weight and sweaty all those kinds of things. So their metabolisms way revved up. Hashimoto's is much more common and causes sort of more of the symptoms we're talking about today with the Hypo Thyroid type picture.
spk_1: 14:29
Yeah, and it's interesting that you get to have just a little bit of everything in your family. You know, a little bit of it all. You guys were just kind of interesting. Uh, yeah. Okay, so I think you know, we've kind of been walking around this topic, but so why is it that thyroid issues really go untreated
spk_0: 14:49
so often? Yeah, Well, I mean, because the full thyroid panel is not checked. And so I can't tell you how many women I've seen on men who have had symptoms for years, and they've said to me, I know something's wrong. They keep telling me I'm fine. And this isn't to, like, put down other physicians because I think that physicians are really intelligent. They trained for a heck of a long time. But unfortunately with the current medical model, it limits their time with stations and also sometimes limits what they're allowed to order.
spk_1: 15:21
Right. So, insurance policies?
spk_0: 15:22
Yeah. I mean, they don't like people to order a lot of lab. And I will tell you I have cash rates to request a free T three is like 20 bucks. I mean, it's not super expensive, but that is sort of the paradigm. It's like
save money and be cost conscious, and, you know, there might be a time and place for that. But I don't think that there it is, one of them anyhow. You know, in residency or in medical training, we're not really taught. That's if there's an autoimmune condition of the thyroid. It doesn't matter. You're still gonna treat it with Synthroid so they don't necessarily test for those auto immune markers. So somebody might know that they're hot Bible if I worried. But they have no idea if it's their high. Both married because they have environmental toxins or iodine deficiency. Or if they're high Cliff. I read because they actually have an autoimmune condition. In my world is a functional medicine doctor. That makes a big difference because somebody has auto immunity. I treat that differently. I have a specific approach for that, you know. But in conventional medicine, it's just not in their toolbox is not the thing they dio. And so you know, when a normal doctor orders a T S h and A T S h is in this what's called normal range, which is way too wide to begin with. A lot of fire in patients get missed, and it just becomes sort of a bit of a tragedy for some people who lived for 10 years with sub optimal Byron function and are depressed or think they have postpartum depression or whatever other like thing there might be on statins for their cholesterol. When really we could just address the pirate issue.
spk_1: 16:47
Yeah, that's a great point, because that one definitely I don't hear people talk about that one as much about kind of Banda Gene thesis. I'd FX in terms of cholesterol, which is definitely problematic. And 100% agree with you that when it's autoimmune thyroid issues, that's a very different ballpark of, Like what? The strategy and the linear approach that you're gonna take with someone versus just hypothyroidism. So, yeah, not that it's just type of thyroid is, um, so we're talking specifically about We can wrap this two ways. We're gonna talk about post babies. Why people hyperthyroidism in general. I mean, we may have already addresses in general. What do you think causes hyperthyroidism and how is that different when you're postpartum?
spk_0: 17:27
Okay, so in general, I think there's kind of two schools of thought will not really like two big buckets. So number one would be autoimmune fire, a disease like Hashimoto's. So Hashimoto's itself is not a pirate problem. That's an immune problem. But over time it causes Saira destruction and causes the fiery toe under produce hormones. And so that is one very common cause, especially when you see over hypothyroidism when it's more sub optimal. I think a lot of it is related to environmental toxins. Our pirate is like a magnet for toxins and to nutrient deficiencies. So some of those toxins and or nutrient deficiencies or the combination of both will make your pirate underperform. So your thyroid needs and relies on specific nutrients in order to make hormones. So one of those nutrients is iodine. We know that iodine has been deficient for a long time. That's why we started ionizing insults. I believe it was in the fifties, but we've sort of stopped eating iodized salt, and many of us are still iodine deficient. I kind of pretty controversial one. So it's like Too little or too much is both problematic for the thyroid. But nonetheless, we needed at least some iodine to make thyroid hormone. So T four's made of. There's four item molecules there, and then you strip one to make T three, so we need iodine. But there's other environmental toxins that are very common in our life, which resemble iodine, and they're right next to it on the periodic table, and they'll kick iodine in the fiery when you're exposed to a lot of it. So that's things like Corinne or chloride Lorene or fluoride roaming or bromide. So if we get exposed to those things and we do every day, that sort of compounds the issue with, like, iodine deficiency Hey, light dominance. And then let's tack on some heavy metals, right? So heavy metals will play a part two when it comes to thyroid function, because they can inhibit the conversion between t 43 also they can affect the production of Higher it. Norma.
spk_1: 19:22
Well, I love how, like sitting on a couch you describe that you're like, You know what? They just kick it off. If one comes in, they just kick one off and they start cause problems. And I'm like, That is fantastic. I love the way you describe that. Very good to do
spk_0: 19:35
some sort of thing on a couch with that.
spk_1: 19:38
So that's good. I like that. Like this'll. Very comfortable, Comfortable like a you know, like CIA. Don't. Theo needs you right now. All right, Here. Yeah, exactly. Like got this other friend that showed up so iodine. And you talked about the other things that affect that. But what are some other nutrients that play a
spk_0: 19:58
role. Yeah, so thank you for bringing that up. So I don't see one Iron tiger. See, Entire. Seems actually to me. No ass it. Zinc and selenium are big ones. Certain other vitamins, like vitamin E, B two, b three, b six. I didn't see vitamin d, even plays a role, and then vitamin A, the big one to vitamin A actually could improve the cellular sensitivity to thyroid hormone.
spk_1: 20:20
So iron give you just It's not too hard to get some B's and C's in a knot commonly at the doctor. But are these things that you check for completely or you only checking for some of these because
spk_0: 20:31
they're not a
spk_1: 20:32
lot of companies that do micronutrient testing and to be quite as it is. I'm actually surprised at how little options there are for this.
spk_0: 20:39
Yeah, yeah, I checked these three quest or through lab court. So I checked a vitamin A and vitamin D in the serum. Sometimes we'll do an RBC selenium and Orrin RBC Zinc, sometimes in the serum will trick these depends. I prefer to do functional medicine testing. So I do organic acid testing, which is in the urine to pick
up on a lot of the B vitamins. But one of the markers I look at in blood is called homocysteine. And so homocysteine, sort of a functional marker of B two, B six, B 12 collate and coleene, the homos sitting one way. Sometimes I'll check you to or be six in the serum as well, depending on what function of some lamp the patient's doing. So yeah, I do check a lot of nutrients. That's a lot of blood work. Like every RBC nutrient you order is its own tube of blood. And so they add up.
spk_1: 21:23
Right? And as you mentioned home, assisting there, which is kind of just a flag for some other ones, is actually a little bit more of a common one that's tested for inflammatory markers. Yeah. Okay, so we're talking about in general causes of hypothyroidism. Now, let's talk about what happens Postpartum specifically. Oh, yeah, They may be, like, very much overlapped a little bit, but what happened specifically? Postpartum.
spk_0: 21:46
Yeah. So postpartum is this. Well, number one, you got a lot of nutrient deficiency postpartum. You've gone through pregnancy and then you're nursing and So that is one factor compounded with stress. There's a lot of stress is we're not sleeping and we're trying to learn how to take care of a baby, and we're up every two hours, breast feeding or whatever. So I think those all play a role but also postpartum thyroid itis. So postpartum tirade itis is an interesting one. It's like an inflammatory autoimmune condition that happens specifically on the postpartum timeframe with thyroid antibodies. So unifier approx today's orthe ira globulin, and it must happen in that first year postpartum. So by definition, it excludes women who did not have over Bible with every disease prior to getting pregnant. So you know somebody who has known Hashimoto's or known over thyroid disease part of pregnancy. We don't call that postpartum pirate itis, but it's really common, like postpartum pirate itis, and Hashimoto's. Rather, there's a lot of overlap there. And so it's like, you know, it might be that some of the people who have postpartum thyroid itis actually had some underlying Hashimoto's that we just didn't know about, because nobody checked their approximate that globulin antibodies before getting pregnant, which is pretty common. I would say the rule now. Postpartum fired itis, they said earlier, was calm. And that's not necessarily true. Depends what you read, I think. I mean, I have read statistics anywhere from, like, 3% toe. Like I think the higher one was either 12 or 15%. Don't quote me on that, but that prevalence has come all over the map. I'm not sure what it is, but it could be a pretty hard thing to go through on top of an already hard time. You know, you're trying to, like, nurse your baby and it classically, it starts with this transient, hyper thyroid state. So somebody might be like, really anxious and like, ravenous and super hungry and their metabolism like crazy and they lose all their baby weight. And then weeks later, it goes into this transit hypo Tirade state where they're like, just dragging and exhausted. And it can be confusing because we have so many other things we're dealing with postpartum as a new mommy. You know, you're dealing with all these other sorts of symptoms that you don't know. You know what's fire it and what's just like the stress of being a new mom. So anyhow, you fired itis results
spk_1: 23:56
actually didn't know that postpartum thyroid itis was its, like, own unique diagnosis. Yeah, it sounds like it just, like fits under one of the other ones, you know? Yeah, I know. It was its own code. Like, Hey, you know, you are specific, and you're just used to hang out here for a little bit. I feel like this could easily get missed all the time. Because one as a new mom, you are like, Well, I'm supposed to be tired. Me, That makes sense. That makes sense of it, right? Like you're not sleeping. I mean, there's just so many things. It's like everything is broken right now. And I'm like Abel slowly come back together. And so I cannot imagine how complicated. And really if people find out they have this, who knows what kind of tools of any they would be equipped with, I guess, to manager, like, how did you become the kind of passion about postpartum thyroid itis? I think that will help uncover. Yeah,
spk_0: 24:41
well, I'm just talking about helping women who are postpartum, because I think women in this post part of time frame are really forgotten about It's like you have a baby and then you're just sort of like That's it like you want to see the baby. Good luck with that, you know. So I am passionate about helping women in that stage of life because I think we deserve it and we don't have a lot of help. There are villages sort of gone, I mean, honestly, even a cog. So the American College of Obstetrics and Gynecology issued a new statement. I don't know. I think it's in 2017 80 2018 calling for better care after Baby is delivered. But insurance companies don't reimbursed for that. So it's really like it's an uphill battle this point like redefining what postpartum care really looks like. But you know this postpartum timeframe. Generally, I find that a lot of women are experiencing symptoms that are hard to deal with in there. Austin ignored because they're postpartum. You had a baby that you're fine. It's because you're tired. You haven't slept your nursing. You'll be fine. Wait a year. Yeah,
spk_1: 25:44
I couldn't resonate with more with it. I don't even have to say about it because oh my gosh, it's a challenge either. Before this episode or right after this episode, there's one all about. It's called Beyond the Keagle, about political or dysfunction. And so when we talk, of course, about the same thing where we need such better like this is Pellet. Florida's function and dioceses wrecked I and just like the muscle, like everything is going unnoticed, untreated maybe for years, because no one really gets follow up care. And
that's like, I mean, I feel like that's as important, if not more important, postpartum than some of the care. Of course, all the prenatal care is very, very important and really, before anyone is pregnant really important. We know that. But, man, it just does not stop. You need so much postpartum need more support. If anything, I don't know in the house to summarize it because there's so many bullet points that go underneath of it. If for anyone I know dress and
spk_0: 26:33
I feel like you, you know your postpartum, your home with your baby, it's like you're just not sometimes it's just that women aren't even thinking of themselves, you know, they're like whatever. I just got to take care of this baby and like, get through it. So unless things were really bad, generally they're not necessarily been seeking care. And then it's like, Who do you go to your O B delivered you, But they're sort of like, well, you know, CIA. I mean, they are, they're postpartum care. But, you know, I show guys, Yeah, cool has been accomplished. Now you know. So that's where I love virtual medics. I'm like, nurse your baby Toxie through the camera and we will figure this out well
spk_1: 27:09
and that that is the thing. I mean, you've now gone to the doctor every week, this last month. I think that's what it is. It's been a while for me. I don't even know anymore. It's like every month long. It's every couple weeks Senate's every week of every. And it's like the last thing you wanted. Thio. Just go back in and be like I think something's wrong. But I don't know what it is because we've all been there were really okay, you know, we don't have toe talk about that necessarily, but I guess my question for us Is there really a postpartum protocol? I mean, we see someone six weeks later. What are the things that are supposed to be checked for, and then there's really nothing else After that, there's really no other. I mean, a cognitive said like, Hey, we should have better post natal care but didn't really provide any guidelines around it. It's like the first stuff that will take many, many, many years before something changes. I mean, truly
spk_0: 27:51
Yeah, works, Yeah, I mean, honestly, a cog has guidance. It's just a matter of implementing it and what that ought to look like and actually been some of their guidance. They've talked about implementing virtual like telemedicine visits and that your two week visit doesn't need to be in person. It can be over the phone, but it's just a matter of like, what does that really look like? And how do doctors get reimbursed for that time that they spend with patients? That's tricky. So yes, so the ACOG bulletins it does provide guidance. But as of now, I have a 19 month old at home. I'm Mommy of three. So when I had my last baby, you know, I went in at, like, six weeks and I was like, You're like, OK, good, you're still breathing. Feel t an extra right. Like I mean, it was sort of just a brief sort of thing to make sure you're still kind of alive. And it was kind of it. Yeah.
spk_1: 28:36
Were you assigned so they do creation?
spk_0: 28:38
Yes. I was going to say they did screen. I mean, I think they do a pretty decent job screening for postpartum depression. I think that Toby Joan's are aware of that and compassionate to that for sure. But I also have this whole what is postpartum depression, and it's a very real thing. But like, what's the cause? I think a lot of that is, by road related in many instances or just nutrient inflation. So, yeah,
spk_1: 28:59
Extensible part of our goal today is to really bring awareness to something where I'm like, Hey, I didn't actually allows its individual diagnosis. I thought it was under the umbrella of other thyroid conditions or it was like, Hey, it just happens afterwards. And now you're gonna have this now, Essentially. So let's transition to some positive things because we like to be positive because we don't want to be like crap, you know, this'll sucks. So let's talk about a success story, either with postpartum thyroid itis Can you share a story about, like Hashimoto's, which is comment about remission and eliminating these issues? If your son
spk_0: 29:32
Yes, I just encourage anybody who has Hashimoto's that remission is a real thing. And it is completely possible, and I see it often. So one of the things that I do in my clinical practice is obviously a check, you know, check a full fire panel. So what that means is T S h three tea for free. T three reversed e 3 30 Proxies are bloody land bodies. Still like those six laps I check my thyroid pate will pretty much all my new patients as well, because I want to catch any of these things that might kind of go under the radar. So one patient I am thinking of in particular, she came to me wanting to get pregnant. She had a history of recurrent pregnancy loss, and she just wanted to make sure that she was doing everything she could thio improve her chances of having a healthy pregnancy and maintaining a healthy pregnancy. So anyways, we found that she had Hashimoto, um should her thyroid function was really not terrible. It was like you were to look at her CSH. It was still within a reference range, but by fertility standards it was above the range that we would want. I think it's like around 3.5, so we started her on thyroid medication. In her case, she was on armor. Armor is like a natural, desiccated thyroid that's a combination of tea for anti three. But the point is, is every time I see patients, or at least every three months who have Hashimoto's, I'm checking their thyroid antibodies even in like integrative medicine conferences that her people say it doesn't matter, like when you check it once you know they have Hashimoto's, it doesn't matter what it's going to be. But I just disagree with that because what tells me I'm doing, I'm going in the right direction. That my patient were working together in the right direction is like I see they're into
bodies decreasing and there is a trend downward trend and sometimes that can go away in like, three months. Sometimes it takes a lot longer. I'm gonna have a number of patients where, you know, maybe they're CPO. Antibodies were like 700. We got them down to 200 but they're really like, halted and can't go away. But this particular patient I'm talking about went from antibodies of like 3 50 down T 90 down to 200 down to 1 60 down to 1 30 so on. So every time I saw her, they decreased. And now she's been in remission for years, and she had a healthy baby. She just had her baby recently. But I just wanna really sort of give encouragement to those people who have Hashimoto's that there is a way to put that into remission. But like we're talking about by Reno in this particular interview. But like this is a whole other thing, right? This is like This is immune system stuff. So when we're talking about autoimmune stuff, the approach is really like, Yes, there's a genetic predisposition, but there's an environmental trigger, and there is some sort of like intestinal permeability, leaky gut that's going on. And so with this particular patient, really, we just focused on her guts. You know, I work on all the environmental stuff, too, which is stuff you want to do whenever you're getting pregnant. Everybody should be working toward it, right? But like, especially during pregnancy, where you're in eliminating the chemicals in your homes and things like that. So we worked on the environmental stuff, but there was nothing super major like mold exposure in her case. Really? What we did was we worked on her underlying digestive issues and, you know, over time, like her food sensitivities improved and her autoimmune markers went down.
spk_1: 32:27
Yeah, and by the way, these don't always present as digestive issues. Right? So that's the annoying part, not the tricky part with people. They're like, I don't have any digestive issues, Mike. Well, Hashimoto's has really related got issues, so I think we should still check the of. It's usually the situation. So I know I said we wanted to go positive and we will finish on a positive note. But I forgot to things that I think are important. What is the mechanism? What do you think is going on with thyroid conditions that causes or creates a miscarriage?
spk_0: 32:53
Yeah, so that is a good question. One I need to, like, really read about to be able to give you a super school to answer but a piece of it is that the fetus. So when you get pregnant, you have a lot of hormones happening. And when you have more estrogen on board, you also make a lot more something called sex hormone binding globulin as you make more sex with combining globulin that bind up free hormone, which therefore means you're free tea for and you're free. T three are lower, and so that plays a role. Baby's brain development relies very heavily on T four, specifically more so than T three. So that probably plays a role. When there's an immune component like Hashimoto's that probably plays a role as well. Like there's a lot of immune system kind of dysfunction that can happen around recurrent pregnancy loss. Yeah, I don't know. Do you have any other anything else to add?
spk_1: 33:39
I don't really have anything else to add. I just thought it was part of the stories and came up with your case study as well, and I thought, you know, she just talked about it a little bit, and I think it's reasonable that you don't have, like, there is no one answer. They're probably just like with fertility. It's like, Well, your body has got some stuff going on. Shunting resource is away from this because it doesn't think that it's work. Yeah, you know, like nobody's tried to protect you. Typically, Yeah,
spk_0: 34:02
always. Yeah. And I do want to say to like So for women who are on thyroid medication, we know in conventional medicine like a student to get pregnant, your thyroid men need to be increased, usually by like, 25% because of that affects from the lighting globulin. So we know that pregnant women require a higher dose of fire medication.
spk_1: 34:19
Yeah, it's good to have a really solid relationship with any provider that you have. And this is like, Why would you know that otherwise right? And so, um, yeah, it's great to have a great provider. Something that we also did not discuss very much is we're talking about postpartum and how people have nutrient efficiencies and stresses increased. But I really like to say like, it's not just that I like to talk about the physiology that's going on. Mr. Yeah, what's the physiology that's happening with increased dress that is creating the cascade of thyroid issues.
spk_0: 34:45
Okay, so your HP access refers to it when we talked about earlier that t s h that comes from here. So hypothalamus and pituitary hp and then a is adrenals which stood atop your kidney but its hp a t g so hypothalamus, pituitary adrenal t s pirogi is going answer ovaries so that relaxes can be very sensitive to stress. And so there could be HP axes, dysfunction, which plays a role with all of this. And it's also the reason why tirade and hormones and adrenals are all linked.
spk_1: 35:15
Yeah, totally. I love it. That was good enough for me. And so hypothalamic pituitary adrenal access Also linking into communication between thyroid and going out So t g not to be confused with thyroid globulin antibodies. I should have said this before. I know people were like madly scribbling because we've had this conversation of this conversation with other people are like in other settings, not even on the podcast, for people like scribbling those out really quickly. I'm like, Okay, I've got notes. I'll put them in the show notes. Okay, this is what you test for the thyroid panel. It's what you asked for. So finally, let's end on some other positive notes. We talked about a lot of things. Wonderful interview. Look forward to having you back. But if someone is hearing this
and they're like, Oh, crap, like I feel like that was me and or whatever. Like, what is your gut reaction pun intended? If someone was like cash of this woman's talking to me, what would you tell her? So her life could be better today Or she can move toward awesomeness today, like is there is something she can do
spk_0: 36:11
now. I mean, I think get your fiery tested. And if your provider won't do it, you can either find a provider who will, or you can order it yourself. That becomes a little bit troublesome because they need order yourself. Like, how do we interpret this? This is not like this is I'm a doctor. I do this for a living, like I do it every day, right, So that can be hard. But at the very least, you can either find reassurance or find more confirmation like, Hey, this isn't right. So yeah, So generally I say, you know, just find a doctor who's willing to work with you and at the very least they could order a free T for in a free T three. Some tirade antibodies reverse t three. Maybe they won't want to do that, and that's not the end of the world. But I'll tell you, you make sure you're free t three. Then the threes, because some people were like, Get this fool fired panel and they come to me and they're like, I did it and I'm good and I'm like But you're not, You're free. T three is like 2.4 and the reference range. We didn't talk about this earlier, but the reference range for free T three is like really big, and it goes down. I think it's 2.2 is the lower limit of that rough and strange, but that's really low on. People feel pretty terrible with the free T three of 2.2. So, like get your free t three in the threes. If it's in the threes like you're pretty Stahler And if your fatigue then keep finding out why that iron deficiency is it mighta control dysfunction is it? Hormone abounds. There's other things that can cause similar symptoms, and that's why I think testing in such a big deal
spk_1: 37:35
totally. And you might hit one roadblock, but it's not impossible to do by any means. You can get it yourself. And you can take it back to your doctor if you'd like, or to someone who looks at them. And, yeah, you could look at the same set of labs with different eyes and see different things, So yeah. Okay, so, Dr Christine, where can people find you online?
spk_0: 37:50
So I met Dr Christine Maren dot com. It's m a r e n and you'll find me on instagram at the same So Dr Christine Maren And also stay tuned for hey, mommy dot com or Hey, Mommy, got life if you're on instagram because that's gonna have lots of awesome information, We have a really, really great pirate article that's gonna kick, but I'll tell you everything you need to know. So we're super excited to lunch that very soon, and we've been working on a lot behind the scenes. That's my business partner and I. So I am working with another physician who's an M deal 100 Carrasco. So, yeah, it's gonna be exciting, and we really hope we're gonna help lots of women have a healthier and happier money hood,
spk_1: 38:30
and just so people know it's possible. This This may be live when by the time the interview publishes and hey, Mommy is spelled H E Y, and then it's m a M I, which is a little different than some people would. Totally So, yeah, I do have those handles in the show notes as well, so those will be there for you. And what a noble cause. Thank you so much for your diligence and your work in this area, because we all know how important and underserved it is. And I just really appreciate when people find those areas and take action. So thank you so much
spk_0: 39:02
for sure, thank you.
spk_1: 39:03
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