Did you know that women with PCOS are three times more likely to have an autoimmune version of thyroid disease called Hashimoto’s Thyroidosis? And many of the symptoms and remedies overlap closely with PCOS. Dr. Izabella Wentz is an internationally acclaimed thyroid specialist and licensed pharmacist who has dedicated her career to addressing the root causes of autoimmune thyroid disease. She joins the podcast to discuss how food can be used as medicine and much more. Listen in (or read the transcript) as we discuss:
- the symptoms of Hashimoto’s Thyroidosis
- thyroid labs to request and why TSH test is not sufficient
- practical tips to advocate for yourself at the doctor’s office
- impact of specific foods on symptoms
Mentioned in Podcast:
PCOS Diva Podcast # 22: Got PCOS? What You Need to Know About Hashimoto’s & Hypothyroid
PCOS Diva Podcast # 61: PCOS and Hashimoto’s Shared Healing Protocol
Dr. Wentz’s new book: Hashimoto’s Food Pharmacology
Amy: Today I’m so thrilled to have one of my favorite guests, Dr. Izabella Wentz, back on the podcast. She is actually the only person that’s been on three times, and if you’re interested, you can listen to podcast 22 and podcast 61, where she talks in-depth about managing PCOS and Hashimoto’s. But today, I’m going to have her back on the show to talk about her brand-new book, Hashimoto’s Food Pharmacology, and we’re going to be talking a lot about food as medicine. Be sure to stay tuned. Dr. Wentz, welcome to the PCOS Diva podcast.
Dr. Izabella W.: Thank you so much for having me back on, Amy. I’m so excited to be here with you.
Amy: Well, let me just tell everybody a little bit about you. You are an internationally acclaimed thyroid specialist and licensed pharmacist who has dedicated your career to address the root causes of autoimmune thyroid disease after being diagnosed with Hashimoto’s in 2009. You are the author of two bestselling patient guides, the Hashimoto’s Thyroidosis: Lifestyle Interventions for Finding and Treating the Root Cause, and then, also your Hashimoto’s Protocol, which I know you talked about on that podcast episode 61. I am so excited about your new book. I got a sneak peek of it, and it’s absolutely beautiful. It’s kind of a fusion between like, a lifestyle book and a cookbook, and I can’t wait for you to tell us more about it.
Dr. Izabella W.: Thank you so much.
Amy: Why don’t we start, for those listening that don’t know what Hashimoto’s Thyroidosis is, I was hoping that you can kind of give us an overview. I will say that it affects … women with PCOS are three times more likely to have this autoimmune version of thyroid disease. Tell us more about Hashimoto’s.
Dr. Izabella W.: Absolutely. You’re right. The two conditions tend to go hand-in-hand very commonly, so women with Hashimoto’s are more likely to have PCOS, and women with PCOS are more likely to have Hashimoto’s. Some of the most common symptoms of Hashimoto’s that we see are going to be weight gain, brain fog, mood changes such as depression or anxiety. A lot of times, women will report that they’re very fatigued. It’s just like, “I can’t get out of bed” tired, and you just feel like you’re dragging yourself around the whole day. Dry skin, constipation, hair loss, muscle cramps, joint pain. A loss of the outer-third eyebrow is going to be one of those telling signs that is most likely thyroid specific, changes in menstrual period. So, you might have a heavier period, or your period might become more irregular. Some women may struggle with fertility issues, so they may have multiple miscarriages. They may have a hard time becoming pregnant. Overall, feeling weak, having palpitations, heat or cold intolerance are going to be some of the symptoms that we might see. This is because the thyroid gland manages our metabolism and our heat production in the body.
Then we’re going to see some kind of non-specific symptoms that are related to autoimmunity or the inflammatory component of Hashimoto’s. These are going to include irritable bowel syndrome, acid reflux, multiple food sensitivities, and adrenal fatigue. Then there’s some recent, very recent research that just came out connecting various types of swollen eyes, puffy eyes, and itchy eyes to a variant of Hashimoto’s as well.
Amy: So many of those symptoms overlap with PCOS. I know that, if you look at statistics on PCOS, 70% of women that have it don’t know they have it. I’m wondering if there’s any similar statistic available for Hashimoto’s.
Dr. Izabella W.: I don’t know that there’s a specific statistic out there with how many people don’t know that they have thyroid conditions when they actually have them. But I could tell you that it takes an average of about 10 years to get to diagnosed from the time that you start having symptoms until you get the proper diagnosis. A lot of women are misdiagnosed with depression, with anxiety, with irritable bowel syndrome. They’re told that it’s all in their head. This can go on for five, 10, 15 years, in many cases. I believe the average time to diagnosis is about 10 years, with, if looking at the latest research.
Amy: Well, I do recommend that women with PCOS get a full thyroid panel, and maybe. I know you do, too, because I’ve read it in your books. For those that are listening to those symptoms, and they’re sort of checking multiple symptoms off, maybe you could kind of walk us through how to get a diagnosis.
Dr. Izabella W.: This is something that, a lot of times, get missed, because there’s one test that’s a screening test for thyroid disease known as the TSH test. It’s called Thyroid Stimulating Hormone. Whenever you go to your doctor’s office and you ask to be tested for thyroid disease, that’s the test they’re going to run. It’s kind of backwards, because that test is generally going to be the last test that’s affected when you have a thyroid condition. There are more specific tests that can be done for Hashimoto’s that are going to be elevated and abnormal at a much later time. Like I said, sometimes five, 10, 15 years before we see that change in the TSH. These include thyroid antibody tests. So TPO antibodies and TG antibodies, those are the abbreviations, because the long words are thyroid peroxidase or thyroglobulin antibodies. These are going to be elevated in the majority of people with thyroid disease, and they’re going to show up sometimes decades before we have a change in that TSH. A lot of times, doctors will only run those tests when the TSH is abnormal. Like I said, that’s a bit backwards, because the antibodies get elevated first, and these antibodies are a sign that our body has started to attack the thyroid gland and started producing this autoimmune response.
The other two labs I like to recommend are going to be Free T3 and Free T4. This just looks at how much of the available thyroid hormone we have in our body to interact with thyroid receptors. Then, another thing that may be helpful, and I would recommend for most people to do it at least once in their lifetime, is to do a thyroid ultrasound, to see what their thyroid gland looks like. In some cases, people may not have thyroid antibodies, but they still will have Hashimoto’s. This is known as seronegative Hashimoto’s, and this will oftentimes show up on a thyroid ultrasound. Again, the labs to ask for are going to be TPO antibodies, TG antibodies, TSH, Free T3, and Free T4.
Another kind of caveat here to consider is going to be that the TSH test, if you look at your lab, if you just had that one test done, a lot of times, doctors might say that it’s “normal”. However, the TSH might actually be elevated, and may be indicative of thyroid disease. The latest kind of guidelines talk about most people, most women should have a TSH somewhere between 0.5 and 2, whereas some of the labs will have higher reference ranges, sometimes as high as 4.5, sometimes as high as 8. Anything above a 2.5, I would say, would be a suspect for that TSH that you might have a thyroid condition. I know when I was looking for answers for some of my symptoms, I have a thyroid test done, the TSH test, and mine was at 4.5, and the doctor said that I was normal, yet I was sleeping for 12 hours a day and felt like a sloth. So, just something to consider there, and make sure that you are always asking for a copy of your own lab tests. You can cross-reference the information online. I have an extensive blog post on how to interpret your own lab tests, if you’re ever curious.
Amy: I have a question for you. I know I had to fight with my doctor to actually test my antibodies. If you’re saying that the antibodies sort of show up first, before the elevated thyroid, regular thyroid hormones, like, do you have any tips for us to advocate for ourselves at the doctor’s office?
Dr. Izabella W.: Some great things that you can ask for is, one of the things that I say is, I’ll say that I have a family history of autoimmune disease and thyroid disease, and I’d like to request that those labs be done. I generally don’t have too many doctors that aren’t willing to work with that, but if you do run into that situation, one thing you can do is, you can ask for them to write it in your record that you requested this test and they denied it. In case anything were to ever happen, and they show that they denied something, they don’t typically like to have that go on record, and they should be more likely to order those tests. I’m also a big advocate for patients self-ordering labs, and for patients having that freedom and access to their own health information. I do recommend working with different lab companies out there that allow patients to self-order. I think this is a huge benefit to us.
Amy: Yeah. Those are great tips. I would love for you to share a bit about your story. I know it’s, in some way, parallel to mine and my journey with PCOS, and realizing that food really had the power to heal. I wasn’t able to tolerate the pharmaceuticals that are recommended for PCOS, and I think that so many medical professionals sometimes disregard the food as a way … I mean, as the nutrients really heal. Like you say, it impacts your biology in the same way as pharmaceuticals, in some ways. I know that, even as late as this year, there’s some new PCOS guidelines that came out. They’re still recommending the birth control pill as the first-line therapy for PCOS. Going on a diet and lifestyle intervention is still important, but I still think that the idea that food can really affect your biology isn’t really recognized, and I love that your book is bringing that concept front and center. But I would love for you to kind of to give us a little bit of your background and your journey with Hashimoto’s, and how you kind of came to that realization.
Dr. Izabella W.: Sure. In full disclosure, I was never really interested in the thyroid during pharmacy school. I thought if a person had thyroid disease, you either give them more thyroid or through medication, or you give them medication to make them make less thyroid. I was like, “That’s it. That’s all you got to do for it.” It wasn’t really until I was diagnosed myself with Hashimoto’s is when I really became really appreciative of the intricacies of thyroid disease, and all of the different things that people need to do to make themselves feel better, and just began to realize that medications are just the tip of the iceberg, and like, for some people with Hashimoto’s, just as you weren’t able to tolerate the medications, some people with Hashimoto’s may not be able to tolerate the standard of care either.
My personal story was that I started to get sick during my first year in undergrad. I went from a bubbly, bright-eyed, and bushy-tailed freshman to all of a sudden just being exhausted all the time. I even felt depressed. I could barely get out of bed. I missed my classes. I almost missed a final exam. This isn’t something that a type-A type of student does at a big-10 university. And so, my parents definitely thought something was off, but we went to doctors, and nothing was discovered. I kind of just went on my merry way. Every year, I sort of began to adapt. If I was more tired, then I would go out less, and spend less time with friends, and just really focus on studying. I became really efficient at that. Eventually, every year, I started to get more and more symptoms, to the point where I was in pharmacy school with irritable bowel syndrome and panic attacks, and then I got … I finished pharmacy school, and I ended up with cold intolerance, hair loss, brain fog, acid reflux, and carpal tunnel syndrome, on top of the IBS and panic attacks, and chronic fatigue.
I kept going from doctor to doctor. I was a good girl. I was a pharmacist at that point, so I was very appreciative of the medical model, and I kept asking, “What’s wrong with me? Can you do some tests?” At one point, I thought I had Alzheimer’s, because my brain fog got so bad. I just got these ridiculous answers, and some of them were, “You’re just tired. Everybody’s tired,” “You’re stressed out,” “Maybe you’re depressed.” I think the best answer I got was, “You’re just getting older.” This is when I was 25, right? Eventually, I got the right diagnosis, and at that point, I thought, “Okay, great. I have something to work with. I have a thyroid condition. Then I just take medications.” It’s a really simple, right? Well, it wasn’t that simple. The medications did help a little bit, so I went from sleeping 12 hours to 11 hours, which was an improvement, of course. Then I no longer had to wear two sweaters and a scarf in Southern California. I was able to just wear one sweater. But I still struggled with all these other symptoms. I still had the irritable bowel syndrome. I was still super tired. I still had the hair loss and the brain fog.
At that point, I realized there was something that caused this condition. “What if I can figure out what the causes? What if I could figure out some lifestyle changes I can do?” Because, at the time when I was diagnosed, there was no lifestyle. It was just, “You take a pill.” That’s when I started to become sort of a Hashimoto’s expert/human guinea pig. I just started to do my own research. I used sort of the brain and the skills I had in my consultant pharmacist role to try to decipher what was going on with me. I used to work with people with rare disorders, and there were oftentimes not a lot of guidelines for what kind of care they needed. So, we were reliant on patient forums and parents, and a lot of times on just the latest research. And so, that’s what I did for my own condition. I, finally, after months of paralysis by analysis, I decided to cut out dairy and gluten, and lo and behold, many of the symptoms that I had for years, months, decades disappeared. So, within three days, my irritable bowel syndrome and acid reflux completely gone. Within three months, my carpal tunnel was gone. I just kept seeing more and more improvements.
Really, at that point, I thought, “Okay, I can’t keep my mouth shut. I need to get the word out about this. I need to let the world know that there are more things you can do for Hashimoto’s than just take a pill.” Here I am today, right? Eventually, I was able to get myself into remission. I have a ton of energy most days, when I’m not taking care of a little baby, and I feel happy, healthy, calm, and fit.
Amy: Yeah. It’s amazing how your story parallels so many other women that I hear from, including myself. Gluten and dairy are two foods, food groups that really wreak havoc on PCOS for most women as well. You’re right, it’s amazing what can happen when you take those inflammatory foods, I think for a lot of us, out of your diet.
Dr. Izabella W.: Yeah. It’s crazy just the amazing thing that food can do. I’m a big proponent of functional medicine, and really get to the root cause of what’s causing the different types of imbalances and conditions. The standard approach to thyroid disease and Hashimoto’s uses … we talked about that one TSH test, and then, there’s only one medication that people get, and if that doesn’t help, they’re told that they need to go see a psychiatrist for their depression, a dermatologist for their hair loss, or rheumatologist for their pain, a gastroenterologist for their irritable bowel syndrome, and when all of that is thyroid-related. There’s really none of that lifestyle recommendation, where, I’m a big proponent of really, this patient-centered, whole person approach to look at comprehensive testing to look at what’s going on within the thyroid. I recommend using optimal and functional ranges for thyroid hormones, to make sure people are dosed properly. Oftentimes, I’ll recommend tailoring the medication to the person, so not just taking the Levothyroxine, which contains the T4 hormone, but in some cases, taking T3 as well as even T1 and T2 hormones to make sure that everybody has a mix of those thyroid hormones.
Then, nutrition, stress response, detoxification, gut health, looking at people’s unique triggers. These are all the different things that I look at and appreciate the whole person. Sometimes, that doesn’t require investigative work, and working with the functional medicine provider to, especially for things like toxins and infections. But majority of what we can do, and the foundations, are going to be focused in lifestyle. These are things that people can do in their very own homes, in their very own kitchens. That’s why I’m so passionate about food.
Amy: I love that a root … I know you call it the root cause approach. I know one of the questions that I get asked a lot is, “Where can I find a doctor that will help me with my PCOS and/or thyroid issue using this more functional-based root cause approach?” Do you have any tips for listeners on how they can find a doctor?
Dr. Izabella W.: Well, I do have a database on my websites, so I’ve just started collecting doctor information on ThyroidPharmacist.com. They could check under Resources, and we will have different patients submit their doctors that they liked on there. Really look for a doctor that has functional medicine training or integrative training, might be a naturopathic doctor. It might be doctor of chiropractic. Just sort of being aware that the endocrinologists might not always be the best expert for you, and being open to that.
Amy: Can you tell us a little bit more about your book, and how it’s structured? Tell us more about some of your favorite recipes, because there’s some really amazing recipes. The food photography is beautiful. It’s kind of like a coffee table book.
Dr. Izabella W.: Thank you so much. I really wanted to create the most useful and practical and hands-on sort of book, to make it easy for people. Because I remember how hard it was for me to start changing my diet. There were just so many objections I had. First, it was like figuring out what exactly I could eat and what I couldn’t eat. And so, I have that in the book, and that’s going to be the first section of the book goes through, “What is the optimal diet? What should your diet include?” I also go through how to tailor the diet to your own success. There might be certain symptoms, for example, that may indicate a particular food may not work for you. We see a lot of people with joint pains, for example, may not be able to tolerate really good foods such as tomatoes and potatoes, because of their nightshade content, which can aggravate some joint pains. And so, I have information like that on how to tailor your diet.
Then I also have ways, kind of what I like to call like success guarantees. A lot of times, you may not feel good on certain foods because you may lack the digestive enzymes to break them down. And so, some people will say that they don’t feel good on a diet that’s lower in carbohydrates. This could oftentimes be because they’re deficient in protein and/or fat digestive enzymes. And so, they’re not able to extract energy from their foods, and the carbohydrates that they’re eating are putting them on a roller coaster, and yet, they’re not getting the amino acids and the good fats that are required for our body to work properly. And so, I talk about how to use digestive enzymes.
Amy: I was just going to say, I thought that was a wonderful section of your book, and information that I haven’t really been able to kind of find all in one place anywhere else.
Dr. Izabella W.: Thank you so much. It’s a common pitfall I see, where people will start a diet like the Paleo diet, and then they’ll say, “Oh, it didn’t work for me, because I was more tired.” Then, I’m like, “But did you try digestive enzymes, because you just might be one small pill from feeling amazing, right?”
Amy: Yeah. I was wondering if you could just speak to the low stomach acid, and how that plays. I think that’s a cause of a lot of women with PCOS’s digestive distress sometimes.
Dr. Izabella W.: It’s really, really prevalent to have low stomach acid. When I was a practicing pharmacist, I really thought the opposite was true, that everybody just had, was running around with these excessive amounts of acid, and that’s why we needed to give them acid-suppressing medications. I thought that acid reflux was because people had excess acid. It’s truly not the case. The research shows, for example, on Hashimoto’s, that most people with thyroid conditions have low stomach acid or no stomach acid. This could lead them to be walking around fatigued, walking around with joint pains, walking around even depressed, because they’re not properly breaking down their foods, and they’re not extracting amino acids from their proteins. Amino acids help us, they’re the precursors for our neurotransmitters, for, they help with our gut lining. They actually help produce thyroid hormones. Tyrosine, for example, is a precursor to dopamine, one of our feel-good hormones, as well as to thyroid hormone. And so, just taking a digestive enzyme, like Betaine with Pepsin with our protein-containing meals can turn that around, where all of a sudden, our body’s able to break down the food properly, and get those nutrients that we need, and not have this, I guess, digestive weight on us. A lot of times, people will say that they feel very tired after they eat. That’s usually a signal that their body’s not digesting properly.
The low stomach acid is just one of the things that I’ve found to be common in people with thyroid disease. There’s also deficiencies in pancreatic enzymes. There’s deficiencies in … Some people have challenges in digesting fats especially, and then, some people have challenges with digesting veggies and fiber. And so, I talk about how to know which one you might have and what to do about it.
Amy: Yeah. It’s really great information. Like I said, haven’t really seen that all in one place anywhere else. And so, tell us a bit about your favorite recipes, because there are some amazing recipes. I was just saying how I’m dying to try the pulled pork with, is it tart cherries? It looks really delicious.
Dr. Izabella W.: Mm-hmm (affirmative)-
Dr. Izabella W.: Thank you. Yeah, that was when I developed when I was pregnant, and I was craving a lot of iron-rich foods. A lot of times, people with thyroid disease are low in iron, so that’s going to be great for boosting those iron levels, getting beautiful hair, and boosting some of those energy levels. My favorite parts, some of my favorite recipes, I really do share a part of my heritage, part of my heart in the cookbook. I have a lot of traditional Polish recipes. I have, some of the family favorites are going to be stuffed cabbage rolls, and they’re traditionally made with rice, but I have a riced cauliflower recipe instead that even my dad, my harshest food critic, has loved. There’s hunter’s stew recipes. This is something that’s naturally gluten and dairy-free. It’s amazing to eat in the middle of the winter. This is something you could place on a slow cooker and let the flavors simmer for many hours, and tastes quite delicious. It’s going to be a mix of cabbage, different veggies, different meats, and herbs and spices.
Another, some of the other things you’ll find in there are going to be baked goods. Very berry autoimmune pie. I used to be a very big-time baker before I was diagnosed with Hashimoto’s and before I became gluten-free. So you’ll see some fun recipes in there as well. Especially if you miss traditional pies and baked goods, you’ll be able to find quite a few of those in there.
Amy: Yeah. I wanted to just mentioned to everyone that the recipes in Dr. Wentz’s book are all really PCOS Diva-friendly, so they would fit right into your PCOS Diva lifestyle. I was wondering if you, I wanted to make sure you had the opportunity to let listeners know where they can find out more about your work, and where they can get your book.
Dr. Izabella W.: Sure. ThyroidPharmacist.com is a website where you can get the latest articles and research. I do try to put out any kind of latest things out there, and any things that I think are going to be helpful in your journey on a weekly basis. And I have over 200 articles at this point just tailored to helping people through their thyroid journeys. Then, you can find my new book, Hashimoto’s Food Pharmacology, on Amazon, Barnes & Noble, or wherever books are sold.
Amy: Awesome. It was so nice to have you back on the show. I’m just really excited about your book, and I can’t wait. I have a digital copy right now, but I can’t wait to get the hard copy in my hands. When is it going to be available?
Dr. Izabella W.: It’s going to be available at the end of March.
Amy: Perfect. Well, I just want to thank you again for coming back on, and thank you everyone for listening. I look forward to being with you again soon.
Dr. Izabella W.: Thank you.