WEBVTT
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Welcome to episode 49.
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Today I'm gonna begin a multi-part series that focuses on the question of how food and food elimination actually fits into the treatment of Hashimoto's and thyroid disease.
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So if you've been diagnosed, chances are you've already heard,"Hey, you need to eliminate gluten or dairy." Or both, or follow an even more restrictive diet in order to feel better.
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And if you've tried that, you may have found that the results do not always match the promise.
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So in this series, I wanna step back from the noise and walk through this topic in a way that's grounded in science.
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And clinically useful and practical.
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So we're gonna look at what we actually know about food and inflammation, what we don't know, and how to make decisions without defaulting to something that's overly restrictive more than what you actually need that could do more harm than good.
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We'll also talk about how thyroid physiology, metabolic health, and food all interact and why starting in the right place really matters.
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Along the way, i'm gonna give you a framework that you can use to evaluate your own responses to food in a way that is structured and personalized and sustainable.
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This is not about perfection, it's about clarity.
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So let's dive in.
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You're listening to the Beyond the Thyroid podcast.
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I'm your host, Dr.
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Dana Gibbs.
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I'm an ENT surgeon and hormone specialist.
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For years, I struggled with my own unrecognized thyroid problems before and even after I was regularly performing thyroid surgeries.
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Then, one day, I learned something that turned my health around and opened my eyes to the limits of mainstream medicine in treating more subtle thyroid abnormalities.
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I spent the next 20 years fine tuning my hormone expertise in disorders like Hashimoto's disease, perimenopause, and stress related illness.
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Come join me as I share this new approach to hormones that empowers you to take control of your own thyroid and hormone imbalances.
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Let's dive in.
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I have Hashimoto's.
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Do I really need to eliminate gluten and dairy?
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Welcome to episode 49.
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This week on Beyond the Thyroid our topic is Food Eliminations in Hashimoto's Disease.
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When patients are first diagnosed with Hashimoto's, one of the very first pieces of advice they generally encounter is that they need to be eliminating gluten and dairy.
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And if they've spent any time at all reading online, they've heard this repeatedly and from a variety of sources.
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It's unequivocal.
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It's not nuanced at all, not a sometimes, but a very clear message that these foods are inflammatory, they're driving your autoimmune process, and that removing them is an essential part of treatment.
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Some of these sources seem pretty darn authoritative.
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And if you go a little further into that, you're gonna quickly come across some even more restrictive approaches like the autoimmune paleo diet, which expands that list significantly and insists on pretty long-term adherence until your symptoms resolve.
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This messaging is pretty consistent and really compelling.
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If you remove the right foods and you're strict enough about it, you can heal your thyroid.
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The problem is that when you step out of that framework and look at what actually happens in real patients, the results are pretty variable.
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Some people will feel some better.
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Select symptoms may resolve.
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Others may say, nah, it didn't help me.
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But another subset will actually feel worse, more restricted, more preoccupied with food, still dealing with the same weight changes, fatigue, brain fog, or other symptoms that led them to seek help in the first place.
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So we're left with this situation where the online recommendation is very strong and loud, but the real world response.
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It's highly variable and the science backed data is simply not there to support this across the board recommendation.
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There is another layer to this that I think is really important, and that's the emotional side of how people end up here.
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Many of the patients I see have been struggling with symptoms for years.
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And they're exhausted.
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They've had weight gain, cognitive changes, maybe pain, and this general sense that something is not right, and they've been told that everything is fine sometimes by several different medical providers before they finally get a diagnosis.
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But when they push back and advocate for themselves, they finally get it.
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A diagnosis, Hashimoto's.
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And for a moment, there's actually some relief in that.
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It gives a name to what you've been experiencing, but then what happens next is a real gut punch.
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They're told they can take levothyroxin or not take it.
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Depending on whether their labs are normal enough or abnormal enough, very little guidance is given to them beyond that of anything else that they can do.
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And regardless of whether they take the medicine or not, most of them don't feel better.
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Certainly not back to normal.
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And that's the point where people get desperate looking for answers on the internet.
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So they go online, they're looking for anything that explains what they're experiencing and puts them back into control when they search triggers.
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The algorithms will find for them a very different kind of message, and it's a validating message.
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It's, yes, you're right, something is absolutely wrong and you can fix it, and your doctors aren't telling you everything.
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But the solution that's offered is almost always the same.
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Buy my book.
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Buy my supplements or this coaching program and stick to it.
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If you do that, you can heal your thyroid and almost invariably that solution centers around food.
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There are entire ecosystems built around this idea that if you eliminate gluten and dairy or this even longer list of foods, you can cure your Hashimotos.
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But the common thread that is, if it doesn't work, the responsibility lies with the patient.
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If you're not getting better, it's because you haven't eliminated enough, you haven't been strict enough, you haven't done it the right way, and that's a pretty heavy burden for somebody who's already exhausted and struggling.
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So what I wanna do in today's episode is not just give you a blanket yes or no answer to the remove gluten or not remove gluten question.
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It's pretty nuanced.
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Instead, I wanna step back and introduce to you my approach to this entire topic so you'll have the information to make the decision for yourself.
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And we're gonna do this in digestible chunks because it's probably very different from anything you've heard before.
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Now.
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So this is part one in a series.
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If you are new, it is great to have you here.
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If you find this topic valuable, please be sure to subscribe to the podcast and share it with your friends or your relatives who might have Hashimoto's two.
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Alright.
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Our topic today is food restrictions in Hashimoto's Disease.
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Yes or no?
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If you've been trying to fix your Hashimoto's by being more restrictive with your diet and it's not working, it's probably not that you haven't been strict enough despite all this online.
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Talk about getting to the root cause.
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Here's the deal.
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Hashimoto's almost never comes from a single cause.
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It's the result of a polygenetic disposition towards autoimmune diseases combined with one or more environmental triggers that push the immune system in the wrong direction.
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The most common triggers I see clinically include chronic stress, certain infections shifts in hormone status such as pregnancy, perimenopause, and nutrient deficiencies that impair immune regulation.
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There are also well described associations with things like excess iodine exposure, and in some cases other medications that can alter immune signaling.
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But what's important is that these triggers don't act in isolation.
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You might have had a viral illness years ago, but the combination of that with the ongoing stress and the poor sleep and the metabolic strain is what leads to ongoing damage to the thyroid, which would, which is what Hashimoto's disease is.
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I also think it's critical to distinguish between what initiates Hashimoto's and what continues to drive it, because by the time I see a patient, we're often not able to do more than make.
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A sophisticated guess about the original trigger because it was years ago, but we're left to address the multiple ongoing factors, the physiology, the inflammation, and the impaired thyroid hormone conversion that keep you having symptoms.
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But wait, you may be asking, I heard gluten triggers the immune reaction.
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Shouldn't everyone who has this disease really be gluten and dairy free?
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You may have come across this idea that gluten looks like thyroid tissue and that the immune system gets confused and starts attacking the thyroid because of it.
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This is referred to molecular mimicry, and it's a simple and appealing explanation, but it doesn't actually hold up.
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When you look at how patients respond in the real world to Hashimoto's disease, if that were a major driver of Hashimoto's disease, then removing gluten would consistently lead to a clear and meaningful improvement, and that is just not what we see.
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The one important exception to that rule is celiac disease, where gluten does trigger a specific immune reaction and absolutely needs to be avoided a hundred percent.
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Outside of that, the idea that gluten is directly causing autoimmune disease in this way is largely theoretical.
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For most people, the real issue here is not necessarily gluten or dairy or any specific food.
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The real issue is that in Hashimoto's disease, there is this vacuum of actionable and widely effective treatments.
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It is natural to want there to just be one root cause of your problems in a simple, if not easy answer to fixing them.
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But unfortunately, Hashimoto's is this multifactorial disease with complex and widely varied presentation, and it can be hard to find valid information about how to help yourself, particularly when your doctor thinks it's cut and dried.
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Because food is something people can control.
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It often becomes their starting point when food may not be the primary driver of their disease process.
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And when we start in the wrong place, even if we're doing something that doesn't seem harmful, we can end up on a path that's unnecessarily restrictive and in some cases counterproductive.
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So what I see happen over time is that people tend to become more and more restrictive.
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They start with gluten than dairy, then sore, then other categories, and eventually they're eating this really narrow range of food, and frequently they still don't feel better.
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And at that point, it's not just frustrating, it's harmful because now we're not only dealing with the original symptoms, but also inadequate nutrition.
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Low protein intake deficiencies in minerals and other nutrients, unintentional calorie restriction, and then this growing sense of guilt and anxiety around food because you're not doing"enough", quote unquote.
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There's actually a medical term for when eating becomes this restricted and driven by fear rather than preference or appetite, and it's called our fit or avoidant restricted food.
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Intake disorder and it's one step away from an eating disorder while every patient is not in that category, you can start to see how easily somebody could move in that direction when the messaging is that the food is the cause of their illness.
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It does not have to be this way.
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I see a similar pattern, by the way, in other types of restrictive diets, like very low FODMAP protocols where something that's meant to be a short term because this very long extended term and the diet keeps getting narrower and narrow instead of expanding back again.
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So what I wanna do is say just really clearly, yes, food sensitivities are real, and if you have them, avoiding those foods can absolutely help you feel better and there are other and more important reasons why a certain pattern of eating, including possibly the avoidance of gluten and certain other foods that may help you if you have Hashimoto's disease, we're gonna go over each of them so you can make your own best decision without a blanket.
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You must eliminate gluten and dairy forever, a prescription.
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So what's actually going on?
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From a clinical standpoint, what I've found is that there's really three different layers to what's happening in Hashimotos.
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The first one is thyroid physiology itself, and I talk a lot about that on other episodes, how well somebody's converting T4 to T3, whether their reverse T3 is elevated, whether the tissues are actually seeing active thyroid hormone and whether that is responsible for, in this particular case, damaging your digestion.
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The second is metabolic health, which includes.
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Blood sugar regulation, insulin resistance and stress physiology.
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And then the third is food, both in terms of nutrition and the overall dietary pattern, and in some cases specific food sensitivities.
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And unfortunately, our most of our conversation is starting with that third layer.
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It assumes that if you're not feeling well, the most likely explanation is something specific that you're eating that's triggering the autoimmunity.
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But when we investigate in a more detailed way, that's not often where the biggest leverage is for the patient.
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So when we're jumping straight into elimination diets, we're asking people to make a pretty demanding change before we've even addressed the symptoms that determine how their body is functioning overall.
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It doesn't mean food sensitivities aren't important.
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They are and I think they can be more common in people with autoimmune disease.
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Why?
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Because it's the same branch of the immune system reactivity against something that isn't inherently harmful like a bacteria that creates allergy as creates autoimmune disease.
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So whether it's a part of your own body or a food that most people consume without consequence, it's basically the same part of our immune systems.
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One of the challenges when somebody makes a blanket statement, like all patients with Hashimoto's need to avoid gluten is this: what exactly is gluten supposed to be doing to damage your body?
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What lab parameters are we gonna see to tell us something substantial is changing when we remove that food?
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Specific eating plans and food elimination diets by their nature are very difficult to study using the kind of research designs that doctors typically rely on in medicine.
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You can't blind whole food, meaning the participant knows whether they're eating it or not.
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Most of the data comes from people recalling what they ate on a questionnaire.
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Researchers cannot control for every variable in somebody's diet or in their lifestyle, and they generally can't withhold other treatments that are known to be helpful while they're doing the study for long enough to see any meaningful response.
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So food research in general is very squishy and it's not terribly well respected as a field.
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In the wider world of medical research, the one condition where we can say reliably that gluten must be removed for recovery is celiac disease, where the disease process involves the immune system destroying the lining of the small intestine when it is exposed to a specific gluten based protein called gliadin.
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And even then, recovery is not guaranteed likely because of how difficult it is to totally avoid gluten, which is found in wheat, rye, and barley.
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So food elimination research is an area where the absence of strong evidence doesn't necessarily mean there's no effect.
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It often means that the kind of evidence we're used to generating is not well suited to the question.
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So the bottom line to that is there is no conclusive evidence that removal of any specific food is required for all Hashimoto's patients.
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But here are some of the kinds of food interactions I wanna talk to you guys about more in the next few episodes.
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Most people are familiar with classic allergic reactions, which are immediate and easy to recognize.
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Anaphylactic shock, hives, asthma attacks that occur immediately with exposure to a certain food.
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There are also very simple kinds of food reactions like lactose intolerance in which a person doesn't have the right enzyme to digest milk sugar or the proper enzyme to digest alcohol.
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Both of these kind of food sensitivities are pretty immediate.
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They are lifelong, they are genetic, and they're very straightforward to figure out.
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You eat it, you react to it same way every time.
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Some of you may have heard before that I spent much of my ENT career helping people with allergy and sensitivity disorders.
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So what I'm used to seeing more in the realm of immune mediated food sensitivity is something different than these first two.
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It's less straightforward, it's more chronic, it's more subtle, and it's a lot trickier.
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To identify.
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Sometimes these are referred to as non IgE mediated food sensitivity or delayed hypersensitivity reactions where repeated exposure to a food can create a kind of chronic low grade symptom pattern.
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That doesn't even trigger your suspicions until you remove that food for a while and then add it back.
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So this can manifest as a wide range of symptoms, surprisingly broad, and even include food cravings.
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The type of investigation we do for this is complex.
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It's open to interpretation.
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There's not a simple lab test that we can use.
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Although people would like to sell you one.
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It's very open to interpretation.
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And it's nearly impossible to study, but it's also occasionally incredibly helpful.
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So later in the series, I'm gonna teach you how I do this and how to do it for yourself because it doesn't require any tests just a calendar basically.
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There are also a few major reasons why changing your diet can help with Hashimoto's disease that don't have anything to do with an immune reaction.
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Gluten and certain other removal does produce some improvement, especially when they involve removing processed foods or lowering the glycemic load.
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It can reinforce this idea that specific foods were the main issue, but.
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At the same time, the underlying drivers like impaired, T4 to T3 conversion or the insulin resistance are still present.
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So the improvement can be partial at best, and the solution becomes restrict more, rather than stepping back and asking, are we addressing the right system?
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So one of the most important things that I want you guys to take away from the very beginning of this series is the potential harm from over restriction.
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I have seen many patients who arrive eating a very limited number of foods, not because they started out that way, but because each step along the way seemed.
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Reasonable remove gluten, then dairy, then soy, then nightshades, and over time the diet becomes so narrow that the patient can't even get enough nutrients.
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The intention is always to feel better, but the result.
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Can be the opposite.
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Inadequate protein intake, insufficient calories, deficiencies in essential minerals and vitamins, and a level of guilt and stress around food that becomes a stressor in its own right, and that stress is not benign.
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It has real physiologic effects, and including increasing cortisol, interfering with thyroid conversion, making you feel even tighter and gaining even more weight.
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So there's also a very practical and important point about gluten specifically.
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So if you or someone is considering eliminating gluten for more than just a few days, it is important to be tested for celiac first.
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The reason is that once gluten has been removed from your diet for several weeks or months, the standard tests that we use to diagnose celiac can become falsely negative.
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And that diagnosis really matters because celiac disease has well established implications for long-term poor health outcomes, and very clear management guidelines because mostly gluten-free isn't good enough when it comes to celiac.
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People don't get almost better, so short-term elimination as an experiment is one thing.
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Less than a week maybe, but long-term removal without testing can create a lot of confusion later in how strict you may or may not need to be.
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The other issue with starting elimination diets is that it places a really high burden.
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They're complicated on somebody who's already struggling with low energy, most patients with Hashimoto's have some degree of insulin resistance.
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Even if it hasn't been formally diagnosed, they may have disrupted sleep, elevated stress hormones, impaired metabolic flexibility and asking that person to implement a highly restrictive diet is often asking too much at the wrong time.
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Even if food is part of the picture, the body may not be in a position to even respond optimally to that intervention.
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This is why I tend to start with more foundational changes like stabilizing blood sugar and ensuring adequate nutrition, supporting thyroid physiology, and then if there are still patterns that suggest food sensitivities moving into a more targeted and time limited evaluation and removal.
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So over the course of this series, we're gonna go through all of these pieces in much more detail.
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We will look specifically in detail at gluten and what we actually know about its role.
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Outside of Celiac disease, we'll talk about dairy, which is often grouped together with gluten, but it's actually quite a bit more complex with several different mechanisms that can affect tolerance.
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We'll go through elimination diets, including the autoimmune paleo protocol and discuss what it does well, where they can lead people off track.
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And we'll also spend time on how food sensitivities actually present clinically, and a technique to evaluate them in a way that's structured, informative, and non restrictive rather than guess based.
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So given all this, the question becomes how to evaluate foods and eating in a way that's actually useful.
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So rather than starting with a broad and often overly restrictive elimination diet, I prefer to have my patients begin with observation, and one of the easiest ways to do that is through structured tracking, not in a way that judges or creates additional stress, but in a way that allows patterns to emerge.
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So in order to help with this challenge, I'm making a daily food and symptom tracker.
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It's an AI prompt that you can start using now or a more old school PDF sheet for handwritten version of the same thing.
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This is not about amounts or calories or macros.
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The basic principle of straightforward, if something goes in your mouth, it goes in the journal that includes everything you eat or drink each individual ingredient rather than just the name of the meal.
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Any snacks.
00:25:28.790 --> 00:25:36.471
Even something as tiny as a mint and any medications or supplements that are not part of your daily routine.
00:25:36.921 --> 00:25:45.020
So a long time that, alongside that, you note down any symptoms and the timing of those symptoms.
00:25:46.026 --> 00:25:49.415
This timing matters because food reactions can be delayed.
00:25:49.776 --> 00:25:57.516
They may not occur immediately after eating, but it can appear 24 to 48 hours later even, and without some kind of record.
00:25:57.786 --> 00:26:00.786
Those kind of patterns are really very difficult to figure out.
00:26:01.355 --> 00:26:10.000
So this can be even more helpful once you've made a few other simple changes to your eating pattern that we're gonna talk about next week.
00:26:10.480 --> 00:26:18.000
So this is a way to start observing rather than guessing, because these patterns are really difficult to see without a record.
00:26:18.750 --> 00:26:28.320
The old school way where the patient writes everything down and me trying to interpret those records manually is pretty time consuming and sometimes still inconclusive.
00:26:29.070 --> 00:26:37.351
So what's different now is that we can use tools that help organize and analyze that information very quickly and very effectively.
00:26:37.865 --> 00:26:51.726
So if you take nothing else from this episode, the main idea I want you to hold onto is that yes, food does matter, but it is not the whole story, and it is very often not the first place that I suggest people intervene.
00:26:52.296 --> 00:27:00.576
When we put it in the right context alongside thyroid physiology and metabolic health, it becomes much more useful and much less confusing.
00:27:01.266 --> 00:27:12.191
So in the next episode we're gonna start with the components of an anti-inflammatory diet and what actual evidence tells us about the effectiveness of this.
00:27:12.611 --> 00:27:21.911
It may not sound exciting, but it is the strongest evidence we have about how food can actually help in our pursuit of a better life with Hashimoto's.
00:27:22.441 --> 00:27:34.621
Then we'll dive into gluten because it's probably the most discussed and the most misunderstood part of this entire conversation, and it will give us a chance to apply this framework in a very concrete way.
00:27:35.040 --> 00:27:36.000
So have hope.
00:27:36.391 --> 00:27:37.411
Hope is on the way.
00:27:37.621 --> 00:27:41.431
If you find the information in this podcast valuable, please subscribe.
00:27:41.461 --> 00:27:47.760
Review the podcast, share it with your relatives'cause if you have Hashi, the chances are that so do they.
00:27:55.676 --> 00:27:58.616
Thank you for listening to this episode of Beyond the Thyroid.
00:27:58.981 --> 00:28:05.531
If you found this information valuable, it would mean so much to me to take a few seconds and give the podcast a five star review.
00:28:05.932 --> 00:28:10.632
It helps other people who need this information find the show and it's really easy.
00:28:10.902 --> 00:28:16.922
Just search and click on the name of the show, Beyond the Thyroid, and scroll to the bottom to ratings and reviews.
00:28:17.432 --> 00:28:19.382
I truly do read and appreciate.
00:28:20.666 --> 00:28:29.317
Remember, when it comes to hormones, there will always be more to discover, so follow the show so you get the next episode as soon as it's released.
00:28:29.727 --> 00:28:39.646
And if you or someone you care about needs a caring doctor to help figure out how to heal hormone problems that other doctors have dismissed, check out my website at www.
00:28:39.856 --> 00:28:40.017
danagibbsmd.
00:28:40.666 --> 00:28:40.787
com.
00:28:42.491 --> 00:28:47.832
And if you're not a physician, please keep in mind, while I'm a doctor, I'm not your doctor.
00:28:48.211 --> 00:28:54.192
The content of this podcast is my opinion and it's for educational and entertainment purposes only.
00:28:54.632 --> 00:29:02.201
This is not meant to be individual medical advice and you should consult your own physician for any medical issues or diagnoses that you may have.
00:29:03.011 --> 00:29:06.862
I look forward to continuing this journey with you beyond the thyroid.
00:00:02.160 --> 00:00:04.469
Welcome to episode 49.
00:00:04.589 --> 00:00:16.920
Today I'm gonna begin a multi-part series that focuses on the question of how food and food elimination actually fits into the treatment of Hashimoto's and thyroid disease.
00:00:17.129 --> 00:00:27.670
So if you've been diagnosed, chances are you've already heard,"Hey, you need to eliminate gluten or dairy." Or both, or follow an even more restrictive diet in order to feel better.
00:00:28.030 --> 00:00:32.770
And if you've tried that, you may have found that the results do not always match the promise.
00:00:32.829 --> 00:00:39.549
So in this series, I wanna step back from the noise and walk through this topic in a way that's grounded in science.
00:00:39.854 --> 00:00:42.734
And clinically useful and practical.
00:00:42.975 --> 00:00:57.700
So we're gonna look at what we actually know about food and inflammation, what we don't know, and how to make decisions without defaulting to something that's overly restrictive more than what you actually need that could do more harm than good.
00:00:58.335 --> 00:01:06.344
We'll also talk about how thyroid physiology, metabolic health, and food all interact and why starting in the right place really matters.
00:01:06.825 --> 00:01:17.415
Along the way, i'm gonna give you a framework that you can use to evaluate your own responses to food in a way that is structured and personalized and sustainable.
00:01:17.655 --> 00:01:21.194
This is not about perfection, it's about clarity.
00:01:21.734 --> 00:01:22.784
So let's dive in.
00:01:34.304 --> 00:01:36.953
You're listening to the Beyond the Thyroid podcast.
00:01:37.343 --> 00:01:38.513
I'm your host, Dr.
00:01:38.513 --> 00:01:39.254
Dana Gibbs.
00:01:39.364 --> 00:01:41.823
I'm an ENT surgeon and hormone specialist.
00:01:42.343 --> 00:01:49.974
For years, I struggled with my own unrecognized thyroid problems before and even after I was regularly performing thyroid surgeries.
00:01:50.459 --> 00:01:59.248
Then, one day, I learned something that turned my health around and opened my eyes to the limits of mainstream medicine in treating more subtle thyroid abnormalities.
00:01:59.259 --> 00:02:07.188
I spent the next 20 years fine tuning my hormone expertise in disorders like Hashimoto's disease, perimenopause, and stress related illness.
00:02:07.459 --> 00:02:14.788
Come join me as I share this new approach to hormones that empowers you to take control of your own thyroid and hormone imbalances.
00:02:15.459 --> 00:02:16.118
Let's dive in.
00:02:28.116 --> 00:02:29.347
I have Hashimoto's.
00:02:29.467 --> 00:02:32.287
Do I really need to eliminate gluten and dairy?
00:02:33.396 --> 00:02:35.317
Welcome to episode 49.
00:02:35.856 --> 00:02:41.016
This week on Beyond the Thyroid our topic is Food Eliminations in Hashimoto's Disease.
00:02:41.736 --> 00:02:51.469
When patients are first diagnosed with Hashimoto's, one of the very first pieces of advice they generally encounter is that they need to be eliminating gluten and dairy.
00:02:51.469 --> 00:02:57.729
And if they've spent any time at all reading online, they've heard this repeatedly and from a variety of sources.
00:02:57.789 --> 00:02:58.900
It's unequivocal.
00:02:58.900 --> 00:03:11.110
It's not nuanced at all, not a sometimes, but a very clear message that these foods are inflammatory, they're driving your autoimmune process, and that removing them is an essential part of treatment.
00:03:11.650 --> 00:03:13.960
Some of these sources seem pretty darn authoritative.
00:03:15.110 --> 00:03:32.810
And if you go a little further into that, you're gonna quickly come across some even more restrictive approaches like the autoimmune paleo diet, which expands that list significantly and insists on pretty long-term adherence until your symptoms resolve.
00:03:33.349 --> 00:03:37.129
This messaging is pretty consistent and really compelling.
00:03:37.550 --> 00:03:42.020
If you remove the right foods and you're strict enough about it, you can heal your thyroid.
00:03:42.377 --> 00:03:50.657
The problem is that when you step out of that framework and look at what actually happens in real patients, the results are pretty variable.
00:03:50.867 --> 00:03:52.877
Some people will feel some better.
00:03:53.207 --> 00:03:55.127
Select symptoms may resolve.
00:03:55.177 --> 00:03:57.247
Others may say, nah, it didn't help me.
00:03:57.668 --> 00:04:10.016
But another subset will actually feel worse, more restricted, more preoccupied with food, still dealing with the same weight changes, fatigue, brain fog, or other symptoms that led them to seek help in the first place.
00:04:10.556 --> 00:04:18.896
So we're left with this situation where the online recommendation is very strong and loud, but the real world response.
00:04:19.526 --> 00:04:27.206
It's highly variable and the science backed data is simply not there to support this across the board recommendation.
00:04:27.927 --> 00:04:34.166
There is another layer to this that I think is really important, and that's the emotional side of how people end up here.
00:04:34.504 --> 00:04:37.869
Many of the patients I see have been struggling with symptoms for years.
00:04:38.584 --> 00:04:39.874
And they're exhausted.
00:04:39.874 --> 00:04:56.254
They've had weight gain, cognitive changes, maybe pain, and this general sense that something is not right, and they've been told that everything is fine sometimes by several different medical providers before they finally get a diagnosis.
00:04:56.584 --> 00:05:00.754
But when they push back and advocate for themselves, they finally get it.
00:05:00.814 --> 00:05:02.673
A diagnosis, Hashimoto's.
00:05:03.394 --> 00:05:05.824
And for a moment, there's actually some relief in that.
00:05:05.973 --> 00:05:12.454
It gives a name to what you've been experiencing, but then what happens next is a real gut punch.
00:05:12.903 --> 00:05:16.504
They're told they can take levothyroxin or not take it.
00:05:16.713 --> 00:05:27.963
Depending on whether their labs are normal enough or abnormal enough, very little guidance is given to them beyond that of anything else that they can do.
00:05:28.803 --> 00:05:33.093
And regardless of whether they take the medicine or not, most of them don't feel better.
00:05:33.334 --> 00:05:34.894
Certainly not back to normal.
00:05:35.584 --> 00:05:40.593
And that's the point where people get desperate looking for answers on the internet.
00:05:41.103 --> 00:05:50.343
So they go online, they're looking for anything that explains what they're experiencing and puts them back into control when they search triggers.
00:05:50.427 --> 00:05:57.687
The algorithms will find for them a very different kind of message, and it's a validating message.
00:05:57.718 --> 00:06:04.617
It's, yes, you're right, something is absolutely wrong and you can fix it, and your doctors aren't telling you everything.
00:06:05.158 --> 00:06:08.997
But the solution that's offered is almost always the same.
00:06:09.437 --> 00:06:10.408
Buy my book.
00:06:10.653 --> 00:06:14.072
Buy my supplements or this coaching program and stick to it.
00:06:14.312 --> 00:06:20.942
If you do that, you can heal your thyroid and almost invariably that solution centers around food.
00:06:22.112 --> 00:06:31.653
There are entire ecosystems built around this idea that if you eliminate gluten and dairy or this even longer list of foods, you can cure your Hashimotos.
00:06:32.218 --> 00:06:37.858
But the common thread that is, if it doesn't work, the responsibility lies with the patient.
00:06:38.697 --> 00:06:48.927
If you're not getting better, it's because you haven't eliminated enough, you haven't been strict enough, you haven't done it the right way, and that's a pretty heavy burden for somebody who's already exhausted and struggling.
00:06:50.127 --> 00:06:58.408
So what I wanna do in today's episode is not just give you a blanket yes or no answer to the remove gluten or not remove gluten question.
00:06:58.617 --> 00:06:59.788
It's pretty nuanced.
00:07:00.237 --> 00:07:09.807
Instead, I wanna step back and introduce to you my approach to this entire topic so you'll have the information to make the decision for yourself.
00:07:10.017 --> 00:07:16.017
And we're gonna do this in digestible chunks because it's probably very different from anything you've heard before.
00:07:16.017 --> 00:07:16.288
Now.
00:07:16.978 --> 00:07:21.117
So this is part one in a series.
00:07:23.125 --> 00:07:25.785
If you are new, it is great to have you here.
00:07:25.814 --> 00:07:34.514
If you find this topic valuable, please be sure to subscribe to the podcast and share it with your friends or your relatives who might have Hashimoto's two.
00:07:35.264 --> 00:07:35.805
Alright.
00:07:36.149 --> 00:07:40.319
Our topic today is food restrictions in Hashimoto's Disease.
00:07:40.470 --> 00:07:41.579
Yes or no?
00:07:42.300 --> 00:07:55.230
If you've been trying to fix your Hashimoto's by being more restrictive with your diet and it's not working, it's probably not that you haven't been strict enough despite all this online.
00:07:55.230 --> 00:07:58.589
Talk about getting to the root cause.
00:07:59.420 --> 00:08:00.470
Here's the deal.
00:08:00.529 --> 00:08:03.769
Hashimoto's almost never comes from a single cause.
00:08:04.129 --> 00:08:15.889
It's the result of a polygenetic disposition towards autoimmune diseases combined with one or more environmental triggers that push the immune system in the wrong direction.
00:08:16.290 --> 00:08:30.209
The most common triggers I see clinically include chronic stress, certain infections shifts in hormone status such as pregnancy, perimenopause, and nutrient deficiencies that impair immune regulation.
00:08:30.779 --> 00:08:40.200
There are also well described associations with things like excess iodine exposure, and in some cases other medications that can alter immune signaling.
00:08:40.740 --> 00:08:45.149
But what's important is that these triggers don't act in isolation.
00:08:45.529 --> 00:09:00.620
You might have had a viral illness years ago, but the combination of that with the ongoing stress and the poor sleep and the metabolic strain is what leads to ongoing damage to the thyroid, which would, which is what Hashimoto's disease is.
00:09:01.220 --> 00:09:12.679
I also think it's critical to distinguish between what initiates Hashimoto's and what continues to drive it, because by the time I see a patient, we're often not able to do more than make.
00:09:13.365 --> 00:09:28.815
A sophisticated guess about the original trigger because it was years ago, but we're left to address the multiple ongoing factors, the physiology, the inflammation, and the impaired thyroid hormone conversion that keep you having symptoms.
00:09:29.715 --> 00:09:34.575
But wait, you may be asking, I heard gluten triggers the immune reaction.
00:09:34.575 --> 00:09:39.554
Shouldn't everyone who has this disease really be gluten and dairy free?
00:09:40.919 --> 00:09:50.789
You may have come across this idea that gluten looks like thyroid tissue and that the immune system gets confused and starts attacking the thyroid because of it.
00:09:51.210 --> 00:10:00.195
This is referred to molecular mimicry, and it's a simple and appealing explanation, but it doesn't actually hold up.
00:10:00.375 --> 00:10:17.475
When you look at how patients respond in the real world to Hashimoto's disease, if that were a major driver of Hashimoto's disease, then removing gluten would consistently lead to a clear and meaningful improvement, and that is just not what we see.
00:10:18.164 --> 00:10:29.715
The one important exception to that rule is celiac disease, where gluten does trigger a specific immune reaction and absolutely needs to be avoided a hundred percent.
00:10:30.254 --> 00:10:38.325
Outside of that, the idea that gluten is directly causing autoimmune disease in this way is largely theoretical.
00:10:38.936 --> 00:10:44.816
For most people, the real issue here is not necessarily gluten or dairy or any specific food.
00:10:45.086 --> 00:10:53.336
The real issue is that in Hashimoto's disease, there is this vacuum of actionable and widely effective treatments.
00:10:53.846 --> 00:11:01.711
It is natural to want there to just be one root cause of your problems in a simple, if not easy answer to fixing them.
00:11:01.951 --> 00:11:16.605
But unfortunately, Hashimoto's is this multifactorial disease with complex and widely varied presentation, and it can be hard to find valid information about how to help yourself, particularly when your doctor thinks it's cut and dried.
00:11:17.716 --> 00:11:20.806
Because food is something people can control.
00:11:21.015 --> 00:11:26.566
It often becomes their starting point when food may not be the primary driver of their disease process.
00:11:26.775 --> 00:11:38.416
And when we start in the wrong place, even if we're doing something that doesn't seem harmful, we can end up on a path that's unnecessarily restrictive and in some cases counterproductive.
00:11:39.250 --> 00:11:45.010
So what I see happen over time is that people tend to become more and more restrictive.
00:11:45.250 --> 00:11:55.181
They start with gluten than dairy, then sore, then other categories, and eventually they're eating this really narrow range of food, and frequently they still don't feel better.
00:11:55.600 --> 00:12:04.240
And at that point, it's not just frustrating, it's harmful because now we're not only dealing with the original symptoms, but also inadequate nutrition.
00:12:04.735 --> 00:12:18.196
Low protein intake deficiencies in minerals and other nutrients, unintentional calorie restriction, and then this growing sense of guilt and anxiety around food because you're not doing"enough", quote unquote.
00:12:18.885 --> 00:12:29.056
There's actually a medical term for when eating becomes this restricted and driven by fear rather than preference or appetite, and it's called our fit or avoidant restricted food.
00:12:29.150 --> 00:12:44.630
Intake disorder and it's one step away from an eating disorder while every patient is not in that category, you can start to see how easily somebody could move in that direction when the messaging is that the food is the cause of their illness.
00:12:44.961 --> 00:12:46.610
It does not have to be this way.
00:12:47.701 --> 00:13:05.171
I see a similar pattern, by the way, in other types of restrictive diets, like very low FODMAP protocols where something that's meant to be a short term because this very long extended term and the diet keeps getting narrower and narrow instead of expanding back again.
00:13:06.576 --> 00:13:35.666
So what I wanna do is say just really clearly, yes, food sensitivities are real, and if you have them, avoiding those foods can absolutely help you feel better and there are other and more important reasons why a certain pattern of eating, including possibly the avoidance of gluten and certain other foods that may help you if you have Hashimoto's disease, we're gonna go over each of them so you can make your own best decision without a blanket.
00:13:35.875 --> 00:13:39.716
You must eliminate gluten and dairy forever, a prescription.
00:13:41.336 --> 00:13:42.686
So what's actually going on?
00:13:43.191 --> 00:13:49.985
From a clinical standpoint, what I've found is that there's really three different layers to what's happening in Hashimotos.
00:13:50.541 --> 00:14:12.350
The first one is thyroid physiology itself, and I talk a lot about that on other episodes, how well somebody's converting T4 to T3, whether their reverse T3 is elevated, whether the tissues are actually seeing active thyroid hormone and whether that is responsible for, in this particular case, damaging your digestion.
00:14:12.980 --> 00:14:16.551
The second is metabolic health, which includes.
00:14:16.750 --> 00:14:20.620
Blood sugar regulation, insulin resistance and stress physiology.
00:14:20.831 --> 00:14:30.250
And then the third is food, both in terms of nutrition and the overall dietary pattern, and in some cases specific food sensitivities.
00:14:31.301 --> 00:14:35.980
And unfortunately, our most of our conversation is starting with that third layer.
00:14:36.485 --> 00:14:43.446
It assumes that if you're not feeling well, the most likely explanation is something specific that you're eating that's triggering the autoimmunity.
00:14:43.956 --> 00:14:50.255
But when we investigate in a more detailed way, that's not often where the biggest leverage is for the patient.
00:14:50.946 --> 00:15:03.846
So when we're jumping straight into elimination diets, we're asking people to make a pretty demanding change before we've even addressed the symptoms that determine how their body is functioning overall.
00:15:04.431 --> 00:15:07.250
It doesn't mean food sensitivities aren't important.
00:15:07.431 --> 00:15:12.740
They are and I think they can be more common in people with autoimmune disease.
00:15:12.980 --> 00:15:13.490
Why?
00:15:13.760 --> 00:15:26.061
Because it's the same branch of the immune system reactivity against something that isn't inherently harmful like a bacteria that creates allergy as creates autoimmune disease.
00:15:26.331 --> 00:15:35.750
So whether it's a part of your own body or a food that most people consume without consequence, it's basically the same part of our immune systems.
00:15:36.831 --> 00:15:48.645
One of the challenges when somebody makes a blanket statement, like all patients with Hashimoto's need to avoid gluten is this: what exactly is gluten supposed to be doing to damage your body?
00:15:48.946 --> 00:15:54.556
What lab parameters are we gonna see to tell us something substantial is changing when we remove that food?
00:15:55.515 --> 00:16:07.066
Specific eating plans and food elimination diets by their nature are very difficult to study using the kind of research designs that doctors typically rely on in medicine.
00:16:07.485 --> 00:16:12.645
You can't blind whole food, meaning the participant knows whether they're eating it or not.
00:16:13.275 --> 00:16:17.566
Most of the data comes from people recalling what they ate on a questionnaire.
00:16:17.895 --> 00:16:32.985
Researchers cannot control for every variable in somebody's diet or in their lifestyle, and they generally can't withhold other treatments that are known to be helpful while they're doing the study for long enough to see any meaningful response.
00:16:33.316 --> 00:16:41.145
So food research in general is very squishy and it's not terribly well respected as a field.
00:16:41.145 --> 00:17:03.241
In the wider world of medical research, the one condition where we can say reliably that gluten must be removed for recovery is celiac disease, where the disease process involves the immune system destroying the lining of the small intestine when it is exposed to a specific gluten based protein called gliadin.
00:17:03.692 --> 00:17:14.941
And even then, recovery is not guaranteed likely because of how difficult it is to totally avoid gluten, which is found in wheat, rye, and barley.
00:17:15.330 --> 00:17:23.881
So food elimination research is an area where the absence of strong evidence doesn't necessarily mean there's no effect.
00:17:24.300 --> 00:17:29.655
It often means that the kind of evidence we're used to generating is not well suited to the question.
00:17:30.586 --> 00:17:39.465
So the bottom line to that is there is no conclusive evidence that removal of any specific food is required for all Hashimoto's patients.
00:17:40.155 --> 00:17:47.566
But here are some of the kinds of food interactions I wanna talk to you guys about more in the next few episodes.
00:17:48.165 --> 00:17:54.286
Most people are familiar with classic allergic reactions, which are immediate and easy to recognize.
00:17:54.766 --> 00:18:01.671
Anaphylactic shock, hives, asthma attacks that occur immediately with exposure to a certain food.
00:18:02.691 --> 00:18:16.445
There are also very simple kinds of food reactions like lactose intolerance in which a person doesn't have the right enzyme to digest milk sugar or the proper enzyme to digest alcohol.
00:18:16.776 --> 00:18:20.286
Both of these kind of food sensitivities are pretty immediate.
00:18:20.496 --> 00:18:24.726
They are lifelong, they are genetic, and they're very straightforward to figure out.
00:18:24.996 --> 00:18:28.596
You eat it, you react to it same way every time.
00:18:29.826 --> 00:18:38.996
Some of you may have heard before that I spent much of my ENT career helping people with allergy and sensitivity disorders.
00:18:39.385 --> 00:18:47.066
So what I'm used to seeing more in the realm of immune mediated food sensitivity is something different than these first two.
00:18:47.395 --> 00:18:51.806
It's less straightforward, it's more chronic, it's more subtle, and it's a lot trickier.
00:18:51.955 --> 00:18:53.185
To identify.
00:18:53.605 --> 00:19:08.365
Sometimes these are referred to as non IgE mediated food sensitivity or delayed hypersensitivity reactions where repeated exposure to a food can create a kind of chronic low grade symptom pattern.
00:19:08.965 --> 00:19:13.736
That doesn't even trigger your suspicions until you remove that food for a while and then add it back.
00:19:14.185 --> 00:19:22.885
So this can manifest as a wide range of symptoms, surprisingly broad, and even include food cravings.
00:19:23.576 --> 00:19:26.726
The type of investigation we do for this is complex.
00:19:26.875 --> 00:19:28.675
It's open to interpretation.
00:19:28.705 --> 00:19:32.096
There's not a simple lab test that we can use.
00:19:32.615 --> 00:19:34.566
Although people would like to sell you one.
00:19:34.986 --> 00:19:36.935
It's very open to interpretation.
00:19:37.701 --> 00:19:43.461
And it's nearly impossible to study, but it's also occasionally incredibly helpful.
00:19:43.820 --> 00:19:53.885
So later in the series, I'm gonna teach you how I do this and how to do it for yourself because it doesn't require any tests just a calendar basically.
00:19:54.665 --> 00:20:03.486
There are also a few major reasons why changing your diet can help with Hashimoto's disease that don't have anything to do with an immune reaction.
00:20:04.026 --> 00:20:13.506
Gluten and certain other removal does produce some improvement, especially when they involve removing processed foods or lowering the glycemic load.
00:20:14.076 --> 00:20:18.695
It can reinforce this idea that specific foods were the main issue, but.
00:20:19.310 --> 00:20:27.830
At the same time, the underlying drivers like impaired, T4 to T3 conversion or the insulin resistance are still present.
00:20:28.161 --> 00:20:37.701
So the improvement can be partial at best, and the solution becomes restrict more, rather than stepping back and asking, are we addressing the right system?
00:20:38.142 --> 00:20:46.987
So one of the most important things that I want you guys to take away from the very beginning of this series is the potential harm from over restriction.
00:20:47.376 --> 00:20:58.207
I have seen many patients who arrive eating a very limited number of foods, not because they started out that way, but because each step along the way seemed.
00:20:58.446 --> 00:21:08.467
Reasonable remove gluten, then dairy, then soy, then nightshades, and over time the diet becomes so narrow that the patient can't even get enough nutrients.
00:21:08.977 --> 00:21:11.797
The intention is always to feel better, but the result.
00:21:12.396 --> 00:21:13.626
Can be the opposite.
00:21:13.656 --> 00:21:28.686
Inadequate protein intake, insufficient calories, deficiencies in essential minerals and vitamins, and a level of guilt and stress around food that becomes a stressor in its own right, and that stress is not benign.
00:21:28.896 --> 00:21:39.007
It has real physiologic effects, and including increasing cortisol, interfering with thyroid conversion, making you feel even tighter and gaining even more weight.
00:21:39.367 --> 00:21:44.971
So there's also a very practical and important point about gluten specifically.
00:21:45.270 --> 00:21:55.530
So if you or someone is considering eliminating gluten for more than just a few days, it is important to be tested for celiac first.
00:21:55.980 --> 00:22:06.931
The reason is that once gluten has been removed from your diet for several weeks or months, the standard tests that we use to diagnose celiac can become falsely negative.
00:22:07.256 --> 00:22:24.601
And that diagnosis really matters because celiac disease has well established implications for long-term poor health outcomes, and very clear management guidelines because mostly gluten-free isn't good enough when it comes to celiac.
00:22:24.961 --> 00:22:31.621
People don't get almost better, so short-term elimination as an experiment is one thing.
00:22:31.800 --> 00:22:43.006
Less than a week maybe, but long-term removal without testing can create a lot of confusion later in how strict you may or may not need to be.
00:22:43.816 --> 00:22:48.615
The other issue with starting elimination diets is that it places a really high burden.
00:22:48.645 --> 00:22:57.036
They're complicated on somebody who's already struggling with low energy, most patients with Hashimoto's have some degree of insulin resistance.
00:22:57.066 --> 00:23:11.211
Even if it hasn't been formally diagnosed, they may have disrupted sleep, elevated stress hormones, impaired metabolic flexibility and asking that person to implement a highly restrictive diet is often asking too much at the wrong time.
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Even if food is part of the picture, the body may not be in a position to even respond optimally to that intervention.
00:23:19.820 --> 00:23:40.875
This is why I tend to start with more foundational changes like stabilizing blood sugar and ensuring adequate nutrition, supporting thyroid physiology, and then if there are still patterns that suggest food sensitivities moving into a more targeted and time limited evaluation and removal.
00:23:41.415 --> 00:23:46.246
So over the course of this series, we're gonna go through all of these pieces in much more detail.
00:23:46.635 --> 00:23:52.336
We will look specifically in detail at gluten and what we actually know about its role.
00:23:52.836 --> 00:24:04.385
Outside of Celiac disease, we'll talk about dairy, which is often grouped together with gluten, but it's actually quite a bit more complex with several different mechanisms that can affect tolerance.
00:24:05.076 --> 00:24:14.885
We'll go through elimination diets, including the autoimmune paleo protocol and discuss what it does well, where they can lead people off track.
00:24:15.965 --> 00:24:28.566
And we'll also spend time on how food sensitivities actually present clinically, and a technique to evaluate them in a way that's structured, informative, and non restrictive rather than guess based.
00:24:29.375 --> 00:24:36.395
So given all this, the question becomes how to evaluate foods and eating in a way that's actually useful.
00:24:36.756 --> 00:24:57.090
So rather than starting with a broad and often overly restrictive elimination diet, I prefer to have my patients begin with observation, and one of the easiest ways to do that is through structured tracking, not in a way that judges or creates additional stress, but in a way that allows patterns to emerge.
00:24:57.721 --> 00:25:03.000
So in order to help with this challenge, I'm making a daily food and symptom tracker.
00:25:03.240 --> 00:25:11.820
It's an AI prompt that you can start using now or a more old school PDF sheet for handwritten version of the same thing.
00:25:12.230 --> 00:25:15.500
This is not about amounts or calories or macros.
00:25:15.530 --> 00:25:27.080
The basic principle of straightforward, if something goes in your mouth, it goes in the journal that includes everything you eat or drink each individual ingredient rather than just the name of the meal.
00:25:27.621 --> 00:25:28.490
Any snacks.
00:25:28.790 --> 00:25:36.471
Even something as tiny as a mint and any medications or supplements that are not part of your daily routine.
00:25:36.921 --> 00:25:45.020
So a long time that, alongside that, you note down any symptoms and the timing of those symptoms.
00:25:46.026 --> 00:25:49.415
This timing matters because food reactions can be delayed.
00:25:49.776 --> 00:25:57.516
They may not occur immediately after eating, but it can appear 24 to 48 hours later even, and without some kind of record.
00:25:57.786 --> 00:26:00.786
Those kind of patterns are really very difficult to figure out.
00:26:01.355 --> 00:26:10.000
So this can be even more helpful once you've made a few other simple changes to your eating pattern that we're gonna talk about next week.
00:26:10.480 --> 00:26:18.000
So this is a way to start observing rather than guessing, because these patterns are really difficult to see without a record.
00:26:18.750 --> 00:26:28.320
The old school way where the patient writes everything down and me trying to interpret those records manually is pretty time consuming and sometimes still inconclusive.
00:26:29.070 --> 00:26:37.351
So what's different now is that we can use tools that help organize and analyze that information very quickly and very effectively.
00:26:37.865 --> 00:26:51.726
So if you take nothing else from this episode, the main idea I want you to hold onto is that yes, food does matter, but it is not the whole story, and it is very often not the first place that I suggest people intervene.
00:26:52.296 --> 00:27:00.576
When we put it in the right context alongside thyroid physiology and metabolic health, it becomes much more useful and much less confusing.
00:27:01.266 --> 00:27:12.191
So in the next episode we're gonna start with the components of an anti-inflammatory diet and what actual evidence tells us about the effectiveness of this.
00:27:12.611 --> 00:27:21.911
It may not sound exciting, but it is the strongest evidence we have about how food can actually help in our pursuit of a better life with Hashimoto's.
00:27:22.441 --> 00:27:34.621
Then we'll dive into gluten because it's probably the most discussed and the most misunderstood part of this entire conversation, and it will give us a chance to apply this framework in a very concrete way.
00:27:35.040 --> 00:27:36.000
So have hope.
00:27:36.391 --> 00:27:37.411
Hope is on the way.
00:27:37.621 --> 00:27:41.431
If you find the information in this podcast valuable, please subscribe.
00:27:41.461 --> 00:27:47.760
Review the podcast, share it with your relatives'cause if you have Hashi, the chances are that so do they.
00:27:55.676 --> 00:27:58.616
Thank you for listening to this episode of Beyond the Thyroid.
00:27:58.981 --> 00:28:05.531
If you found this information valuable, it would mean so much to me to take a few seconds and give the podcast a five star review.
00:28:05.932 --> 00:28:10.632
It helps other people who need this information find the show and it's really easy.
00:28:10.902 --> 00:28:16.922
Just search and click on the name of the show, Beyond the Thyroid, and scroll to the bottom to ratings and reviews.
00:28:17.432 --> 00:28:19.382
I truly do read and appreciate.
00:28:20.666 --> 00:28:29.317
Remember, when it comes to hormones, there will always be more to discover, so follow the show so you get the next episode as soon as it's released.
00:28:29.727 --> 00:28:39.646
And if you or someone you care about needs a caring doctor to help figure out how to heal hormone problems that other doctors have dismissed, check out my website at www.
00:28:39.856 --> 00:28:40.017
danagibbsmd.
00:28:40.666 --> 00:28:40.787
com.
00:28:42.491 --> 00:28:47.832
And if you're not a physician, please keep in mind, while I'm a doctor, I'm not your doctor.
00:28:48.211 --> 00:28:54.192
The content of this podcast is my opinion and it's for educational and entertainment purposes only.
00:28:54.632 --> 00:29:02.201
This is not meant to be individual medical advice and you should consult your own physician for any medical issues or diagnoses that you may have.
00:29:03.011 --> 00:29:06.862
I look forward to continuing this journey with you beyond the thyroid.
