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Gut Health and Hypothyroidism

Hear from functional medicine physician Dr. Christine Maren and nutritional therapy practitioner Alison Marras about why gut health is important for optimal thyroid function.

Katie: [00:00:00] Hi, everyone. Welcome. We are just going to give everyone a few minutes to get logged in and settled and then we'll get started. My name is Katie. I am part of the team at Paloma Health. And Paloma is the first online medical practice focused exclusively on hypothyroidism.

We offer at-home thyroid test kits, virtual consultations with thyroid doctors and nutritionists, prescription management, and a vitamin supplement.

And I manage our content and community, which means that I get to put on fun events like this for you. I spent a lot of my time engaging with our community online and I create and source a lot of our content that is hopefully, educational and resourceful and helpful to you on your journey to health and wellbeing.

And today's event was born out of our virtual retreat that happened last month. That retreat was a three hour event. We had 10 speakers speaking on a variety of topics. And what we learned and heard from you is that you want a deeper dive into some of those topics. And so we're introducing a monthly speaker series.

Each month we will, talk on a different topic and feature, women's health experts and advocates on that topic and today's topic is gut health and why gut health is so important for optimal thyroid function. And we'll talk a little bit about leaky gut in there also.

Mary Shomon is here co-hosting with me and I'll introduce her in just a second. And our speakers today are Dr. Christine Maren and Alison Marras of Food by Mars. They're each gonna speak for about 20 minutes and then we will open it up to live Q and A. So you can use the chat feature at the bottom of the screen. You can think about what you want to ask now, or maybe what comes up while they're speaking. And we'll save some time for that at the end and get to as many questions as possible.

Dr. Maren also has a worksheet that we sent out ahead of time. That might be helpful while you follow along to her presentation. It's not necessary, but maybe helpful. If you did not get that email or signed up in the last hour or so, feel free to drop your email in the chat feature and our team will send you that worksheet.

And without further ado, I'll introduce Mary Shomon. Mary is  a patient advocate and health coach and a New York times bestselling author. She's written 15 books on health and wellness. And we feel really honored that she's here with us today. So Mary, I'll let you share a little bit more about who you are and what you do, and then we can get started with our speakers.

Mary Shomon: [00:02:26] I don't want to spend too much time on me because we want to get to the good stuff. I am Mary Shomon and, as Katie mentioned, I am an author, advocate, a patient educator, and I'm out there trying to fast forward everyone up the learning curve to get to the part where we live and feel well with thyroid disease and hormonal imbalances. And, so I am thrilled to be, working with, Katie here to moderate this terrific event. I'm really excited to have our opportunity to hear from Dr. Maren and  Alison.

We've got our two guests and they're going to be giving us some amazing information about gut health. So let's jump in and we're going to start with. Dr. Christine Maren. And I'm just going to give you a little bit of background. Christine is a board-certified physician and an Institute for Functional Medicine Certified Practitioner.

She is the founder of a virtual functional medicine practice in three States and the co-founder of, Hey Mami, a platform for women who are navigating the stages of motherhood. She  was struggling with pregnancy complications and recurrent miscarriages, and is now the mother of three. And she's devoted her professional life to helping other moms optimize their health before pregnancy, during pregnancy thriving, postpartum, and getting their life back.

So she is one busy mom. Yeah. As we can tell. And so I want to welcome first, Dr. Christine Maren to our Paloma Health  Speaker Series. And she's going to be talking to us a little bit more about her perspectives on gut health and how they relate to the thyroid.

Dr. Christine Maren: [00:04:16] Awesome. Thank you, Mary. And thanks Katie for having me.

I'm excited to be here. Thyroid is near and dear to my heart. I have Hashimoto's myself. I have a sister with Hashimoto's. I have another sister with Graves' disease. And I've worked with lots of patients who have thyroid disorders. It's something I talk about every day so I want to just take you through what I think about and the functional medicine approach to thyroid and gut health and why they're so important and so interconnected, because there is a very important connection there that I think gets lost a lot of times.

Today, I'm going to briefly go through all of that and then make sure we have time so Alison can talk about all of the awesome  kind of ways to implement this in terms of nutrition and practical takeaways for that. So we'll talk about gut health and why it's important to your thyroid.

I have three primary reasons for that. We'll talk about the triad of auto-immunity and we'll talk about ways to improve gut health. And then if you have a gut health problem, talk about a functional medicine approach. It's called a five R approach and how we do that in functional medicine and then, we'll have time for questions at the end.

So first of all, and like Katie said, there is a worksheet. If you'd like to follow along, if you want to, if it's easier for you to be an active listener like that, that is there for you. So let's first talk about the top three reasons why I  think thyroid and gut health are intimately related.

So you have probably heard the saying before you are what you eat. In functional medicine, we take it a step further and we say, you are what you eat and then what you absorb. And then what you do or you do not detoxify. And so all of those things underlie why gut health is a big deal. But we'll talk about then how they're related to thyroid.

So number one, yes, nutrition is a cornerstone, but in order to get nutrition from your food, you have to be able to assimilate it. So your digestion has to be intact. So you can take the absorption of micronutrients and macronutrients, which influence your thyroid function. So your thyroid function, production of hormone, conversion of thyroid from T4 to T3, all of those rely on different nutrients.

So specifically we think about things like iron, selenium, zinc, vitamin A, some of the B vitamins and others. And so number one, nutrition.

Number two detoxification. I always tell my patients, our thyroid is like a magnet for environmental chemicals. So some of those might be, halides like fluoride or chlorine.

And then heavy metals, also, will influence thyroid. And your gut is going to directly impact how you detoxify.

And then number three is the big one. And that's what we'll spend a lot of time talking about today and that's intestinal permeability and the relationship to auto-immunity. And so that is a  relatively recent finding and in the medical literature, it's not really something that is practiced yet among, your traditional standard doctor. As a functional medicine doctor, it is a much of my practice. So we'll dive into sort of that auto-immune connection and why gut health is linked to Hashimoto's.

I just want to underscore Hashimoto's is an immune system problem. It creates a thyroid problem over time, but Hashimoto's, isn't a problem with your thyroid. So let's just talk quickly about the first two. I mentioned a triad with auto-immunity, so it's gut health is the primary one. We'll talk about today, but number one and our genetics and environment, and then we'll talk gut health.

So just quickly, like genetics. We can't do a ton about genetics. There is a field of epigenetics where we can potentially influence the way that our genes are expressed. But, we say genes load the gun, environment pulls the trigger. So genetics, that explains to some extent why to people who have the same genetics, one might only get sick.

So if you have a twin study, you have one person who has autoimmunity, the other one might be fine. But genetics have long been recognized and proven to play a role in autoimmune conditions. The second one is environment. I said environmental pulls the triggers. So those triggers can be different for everybody.

It might be heavy metals from a dental procedure from amalgam fillings. It could be pesticides from lawn care. It could be chlorine cause you've been a lifeguard all summer. And then food sensitivities play somewhat of a role here also in gut health. It could also be things like radiation exposure, chronic stress, or one of the things I talk about a lot is mold exposure.

And so that's a big environmental trigger. But the third one is gut health. When I'm working with any patient who has autoimmune disease and specifically Hashimoto's, even if there's not digestive symptoms, I'm always looking at gut health. And this is why. So about 10 years ago, a researcher and physician named Alessio Fasano found this third causal factor, intestinal permeability.

So I think of intestinal permeability, or your gut, is the grout and tiles in your shower. And as that grout becomes leaky, that barrier breaks down. And when that barrier breaks down, it messes with our equilibrium between the tolerance to immunity and non-self antigen. Essentially your gut is this tube.

It's a hollow tube, but it should be intact. Impermeability is a big deal. And when permeability is compromised, that's when we have problems with the immune system and our body's ability to regulate our immune response. So specifically, what Dr. Fasano saw is this protein called zonulin.

And so zonulin is released in the presence of gluten. That's why, for my patients with autoimmune disease, I always recommend a gluten-free diet. And of course, with Hashimoto's, and then it's also influenced by the presence of small intestine exposure to bacteria, probably also yeast and different gut infections.

And so we'll talk about, that in a moment, but zonulin messes with that growth. So it influences the tight junctions in the gut causing an increase in intestinal permeability, and autoimmune disease in genetically susceptible individuals. So that's where the big deal comes in. So we're going to come back and talk about some of those gut infections when I go through that five R program, the functional medicine approach for gut health.

But let's just talk some negative inputs for gut health and positive inputs. If you're not somebody who's really struggling with a gut infection, maybe you don't even have Hashimoto's. Maybe you just have suboptimal thyroid function because you have other issues going on or poor conversion or whatever it might be,  you still need to maintain good gut health.

So some of the big ones for some negative inputs for gut health: antibiotic use is a huge one. So people who take antibiotics yearly for frequent sinus infections or whatever, it might be, obviously antibiotics have benefits, but they also have risks.

And gut health is a big one. I think a lot about yeast for people who've had a lot of antibiotic use. Another one is acid blocking medications. So they're called proton pump inhibitors, PPIs. Things like Nexium, Omeprazole, things like this. Again, sometimes there are benefits. But there are obvious risks, especially with long-term use, and to want to have gut health, other things that can influence gut health include birth control pills, household chemicals, environmental pollution mycotoxins or mold exposure.

Like I alluded to earlier, pesticides. So when we eat foods that have a lot of pesticides, those act basically as an antibiotic, just processed foods like that standard American diet, lots of high sugar, toxic fats, processed foods can mess with gut health. We've seen studies actually looking at a change in diet and how that influences gut health in a positive way, in just a matter of days, chronic stress, C-section birth, smoking, all of those things can negatively influence gut health.

So positive influence for gut health: of course, diet is huge. And Alison's going to talk about that a lot. Fiber, prebiotics, resistant starch, all of those things feed the good gut bugs, or the good buddies. Probiotics are the buddies. Those are inoculating your gut with more of those good bacteria.

Other things that we don't always think about are things like polyphenols things we get from maybe dark chocolate or red wine or green tea or blueberries also antioxidants. Vitamins A and C and E, vitamin D, essential fatty acids, zinc, glutamine. Those are all important. Nutrients for gut health and a diverse diet is also a big deal.

So I think a lot of times, there's a definite time and place for an elimination diet. I recommend them often, but I don't always recommend them longterm. And if I do, I'm always underscoring the importance of diversity because getting diversity in your diet is really important for that microbiome.

And then the other ones that are less talked about: pets. I just got a puppy. Kind of like for my microbiome and for my kid's microbiome. Also because COVID like, whatever, what better time to get a puppy? Gardening is great for microbiome. So getting out there and getting dirty. The opposite side of that is the hygiene hypothesis, which I worry a lot with COVID. We're all so clean. wWe don't get exposed to much. We're cleaning things all the time and again, risk benefit. I'm not saying we shouldn't do that at this moment in time, but how is that going to influence our gut microbiome long-term is something I've been thinking about. And the other one is exercise.

Exercising every day is important for gut health. It's also important for your cell receptor sensitivity to thyroid hormone. So if I have a patient who's struggling with autoimmunity, like I said, I'm always thinking gut health and a functional medicine approach to gut health is really this five R program.

So what that stands for is number one, REMOVE, and I'll talk about in detail, what these mean. Number two, REPLACE. Number three, REINOCULATE. Number four, REPAIR. And number five, REBALANCE. So we'll go through those one by one. And I'll put you in the mindset of what I think about as a functional medicine physician when I see somebody who has auto-immunity and specifically Hashimoto's.

Number one: remove. When I talk about remove, I'm talking about removing infections and removing the foods we're sensitive to. Common infections I see in people and, specifically in patients who have Hashimoto's, a huge one is SIBO.

That's small intestine bacterial overgrowth. Many people who have IBS actually have SIBO and/or something called SIFO. SIFO is less talked about but this is fungal overgrowth in the small intestine. And like I mentioned earlier, antibiotics are a huge risk factor for that. You could have co-existing SIFO and SIBO.

You could have one or the other. That's where we do functional medicine testing to really differentiate . Dysbiosis is just abnormal life. So the abnormal bacteria, sometimes when we get rid of the bad or the good bacteria, the bad bacteria flourishes. And so having more of that undesirable bacteria can play a role.

Sometimes there are parasites, like I mentioned earlier with the puppy. Puppies have parasites, like dogs have parasites too. And so you think in the United States, like there's not a lot of parasitic infections, but it's actually quite prevalent among people who have autoimmune disease. I don't think everybody has it, but I definitely find it, especially with international travel and animals in our house and all of that.

So removing those infections is really the first step, along with removing some of the foods that we're sensitive to. Primarily that's gluten because of that reaction to zonulin. It might also be dairy. Often, it's also sugar. Sometimes other people are more sensitive to certain things. So the longer that somebody had gut problems, the more food sensitivities I see.

And anytime I see somebody with food sensitivities, my number one question is what's going on with your intestinal permeability to cause this type of immune reaction? I think we have to always address that gut infection, and it becomes a vicious cycle. We continue to eat gluten or we have a gut infection, then we get more food sensitivities and then, we're limited to very few kinds of foods.

Once I've really taken those out, I usually concurrently replace. And so replace is actually really associated, there's this vicious cycle with thyroid. So when I say replace, I'm talking about digestive enzymes, I'm talking about stomach acid and I'm talking about motility and gallbladder functions.

So the thing that's under appreciated is that your thyroid controls your metabolism, including the metabolism of your viscera. And viscera is like your liver and gallbladder and your intestines. And so for people, we know that people who have hypothyroidism often have constipation and that's because your gut motility is affected, but hypothyroidism can also cause issues with low digestive enzyme function.

The lower that function, the less you break down food. The bigger or larger protein, goes into your small intestine and the more the immune reaction is. You can look at the research that's done on people taking acid blocking medications and how that influences food allergies.

We know that acid blocking medications are a risk factor for food allergies, but they're also a risk factor for small intestine bacterial overgrowth. And a risk factor for small intestine fungal overgrowth. So optimizing that thyroid function by replacing hormone appropriately is important for your gut function.

But I also use things like digestive enzymes. I use a lot of pancreatic enzymes. I'll use Detain HCL. I'll have my patients test stomach acid. Not all of them need it, but if they do, it's a cornerstone to really healing after gut infection. And then really thinking about gallbladder function.

Bitters is a big deal there. Bitters helps your gallbladder and then motility. Motility and injection of all that, there's a lot of things that influence it. Thyroid is a huge influencer. So is that parasympathetic nervous systems. So thinking about that parasympathetic and sympathetic balance.

Sympathetic dominance is like that high stress go. Whereas parasympathetic is rest and digest. So really thinking about that. So that's number one and two. And that's the start. When I work with a patient who has a gut infection later on, that's when we reinoculate.

If you've tried a probiotic and thought, oh my gosh, this probiotic actually makes me more bloated and I don't feel good, that's because you might have a gut infection. And if you put that in too soon, sometimes it's a problem. I personally use certain types of spore forming probiotics when I'm treating patients who have these infections cause they're well tolerated.

But if you use some of the traditional stuff too early, like bifidobacterium lactis bacillus species, those can become a problem. The same thing is with a FODMAP diet. People with IBS sometimes follow this low FODMAP diet, and that takes out some of the more soluble fibers and sugars that can irritate the gut  if there's an infection in there.

Anyway, number three, you think about reinoculate. I'm bringing in some of that, those good inputs. So fiber, prebiotics like onions and garlic, asparagus, makes prebiotics feed the good gut bacteria. Resistant starch is one of my favorites. Green bananas are a great way to do that.

Cooked and cooled sweet potatoes, cooked and cooled rice, even plantains. But resistant starch preferentially resists digestion in the small intestine and feeds that bacteria in the large intestine and then probiotic foods like kifer, kimchi, kombucha, pickled vegetables, sauerkraut, that sort of thing.

Probiotics actually reinoculate with the good bacteria. And then, like I mentioned, actually probiotic supplements you can use too.

Number four would be repair. So really thinking about that lining of the GI tract and what we need to give our gut in order to heal. And a lot of those nutrients, zinc and some of those antioxidants, A, C, ,E omega-3 fatty acids, like fish oil, and there's an amino acid called glutamine that help.

There's lots of different ways to get those through nutrition and then supplemental as well. And then number five is rebalance. And that's where we really have to pay attention to lifestyle choices because sleep and exercise and stress can all have an effect on GI tract. All have an effect on that parasympathetic and sympathetic dominance.

And so really just like that's where long-term lifestyle changes come into play. So that's a lot, I know it's a mouthful. I'm gonna pass it over to Alison so she can talk about practical ways to implement all of that.

Mary Shomon: [00:19:39] Okay. Alison, are you, ready for an introduction here?

Alison Marras: [00:19:44] Ready.

Mary Shomon: [00:19:44] Terrific. Thank you so much, Christine for that incredible overview. It was, I don't know, very organized and I've never heard anyone go through the issues of gut health in quite that way. And I found it extremely informative.

So I'm hoping that everyone watching found it as helpful and useful. And I've got tons of questions for when we get to the question and answer section, that came up for me. And I know we had a few questions coming in while you were speaking as well. So we'll. look forward to getting back around to the Q and A part to find out a little bit more.

But right now, we are going to move on to Alison Marras. And Alison wears a lot of hats. She's a nutritional therapy practitioner, restorative wellness practitioner, and home chef. She really works with women with food sensitivities to help them master cooking, beat bloat, boost energy. Her specializations are hormonal health, thyroid health, auto-immune disease, and adrenal fatigue.

So she's right up our alley here at Paloma. She curates a beautiful website called Food with Mars that is filled with all sorts of delicious and nutritional recipes, health-related articles, and her focus really is that getting in tune with our body is one of the most important ways to heal and that food and nutrition can be an important part of that.

So I want to welcome Alison to our Speaker Series and we are very excited, Alison, to hear what you have to say about the gut health issue.

Alison Marras: [00:21:24] Thank you so much for having me ladies and, Dr. Marin, it was wonderful hearing from everything. I just want to echo that everything was so concise. This is a very loaded topic.

Yeah. And it's so helpful to be able to simplify and organize these things. You don't get overwhelmed and you're not operating from that stressed out sympathetic state all the time.

Yes, my name is Alison Marras. I'm so happy to be here with you all. You guys are my people.Gut health, Hashimoto's is my world.

I have Hashimoto's myself as well. I just had my first baby a year ago. She just turned a year. And I was definitely that kid who grew up on the Standard American Diet. Saw a lot of family members with auto-immunity, cancer. And I was like, that's not going to be me. And it was. It was totally that thing of genes load the gun and environment pulls the trigger.

Birth control pills, a lifetime of antibiotics, eating poorly, stress, working hard, playing hard. I'm in New York City so that's the name of the game over here. So that all happened. Hashimoto's came about and all the while I was building my blog and figuring out that I had food sensitivities, leaky gut, SIBO, all the things.

So in order to use nutrition, food and to support. Leaky gut and healing the gut and everything to do with Hashimoto's that Dr. Maren just went through. It's really key to approach it with a positive mindset. So I just want to say your diet goes hand in hand with your mindset. And I think that's really key.

Because when you are removing foods and changing your lifestyle and going through the checklist, of how do I heal, it can get very overwhelming.

You can lose your love of food, and  that's not going to help you in the long run. And the reason I say that just from the get go is because I see it so often in my practice, women coming to me that have done the Whole30, gone gluten-free, done all these things and they forget to re-introduce foods. So I'm so happy that Dr. Maren highlighted that it is so important

to reintroduce foods. If you are continuously removing and never re-introducing, what do you, what are we doing here? We're supposed to be healing so that we can get and challenge things back.

So something that I work with in my practice a lot is mindfulness. And so I'm going to take you guys through that a little bit as well. First things first in terms of how to eat, Dr. Maren touched on this a lot, but at a bare minimum, definitely removing refined sugar, processed foods, gluten, and dairy to  start with.

And as we spoke about, the zonulin response, but then also for thyroid, specifically, the protein and gluten actually mimics the protein of your thyroid. And so if, the thyroid tissue is getting attacked, then there's going to be an inflammation and an attack every time you're ingesting gluten, it looks just like that.

So that's really key for going gluten free. I'm also soy free is really a big deal as well for thyroid health. Really the paleo diet is an ideal template to start with, and I just want to highlight template because everyone is so unique.

So for example, grains are not included on the paleo diet because they can be very difficult to process when we have leaky gut conditions. A grain itself is already very processed by the time it gets to you, because we can't really eat it in its natural form. It would be eating grass. It would be being wheat or hay.  The whole premise of going grain-free and paleo is really that these things can be inflammatory if our gut is already compromised and leaky from years on the Standard American Diet, antibiotics, PPI's, whatever it is, a lot of refined sugar.

We really need to remove the things that are causing more distress to the gut so that we can heal. And that's where you start to work with a practitioner and go through those steps of healing as  you remove. So it's never just remove, keep yo-yoing and never getting things back you remove while you heal.

And after you  started to heal, you've addressed any infections, SIBO, candida, parasites, things like that. You've built up that, stomach acid. You're taking digestive enzymes, you're drinking the bone broth and the fermented foods and all that good stuff that we talked about, that's when you start to challenge reintroductions, you do that with a food journal.

There's, a few different ways you can do it, but you do want to try and start to get those things back. A step further, especially for auto-immunity is the autoimmune paleo protocol. And this is definitely meant to do short-term because it further removes foods from the paleo diet. I create recipes for paleo, AIP, whole 30, because they are so healing for the gut. And, I love food and when I took these diets on, I took it as like a food network, chopped challenge for anyone who watches that show.

And so you can have fun with it, but it is basically meat, fish, vegetables. Because nuts and seeds ,they're even removed. Certain vegetables like night shades, so tomatoes, potatoes, white potatoes, other things like spices that fall into the nightshade category: paprika, chili powder, things like that. All these things can be causing further inflammation to the gut. So again, it is just a short-term removal, usually around six weeks.

And then you do want to start removing it's so important that you do sometimes you'll feel so good. And you'll be focusing on getting your antibodies into a range that you want to keep doing it and keep going harder. I'm here to say that will not end well because you're not diversifying. And that was one of the key things as Dr. Maren explained is so important for our gut.

We need a diverse microbiome. We don't need less. Just like the antibiotics ,we're removing things. We don't want to keep removing all the good diversity in the gut.

So it's important to challenge reintroductions. And just look at it as a learning process. As a chopped challenge, shall we say, and not as too much deprivation, because then we start stressing out.

If food's not fun, we don't want to cook. We want  to make sure that we're bringing joy into the kitchen and bringing joy into our healing journeys so that we can have fun with the food and really let it nourish us. Like, we were saying, you are what you absorb. And a big part of absorption is what's happening in your mind.

That's the next part that I would love to go through with you. The next part is how we eat. I talked a little bit about what w e can do those Paleo, gluten-free, dairy-free, even AIP types of diets to challenge and remove while we heal. Then we start reintroductions.

But how are we eating throughout all of this?

So I touched a little bit on positive mindset, right? Approaching this with open arms, we're learning, we're seeing what feels good. And we are definitely diversifying. So we're rotating foods. We're making sure we're trying new things. What's seasonal? What's like a weird vegetable? Let me try it. Like you want to have fun with it and really include  diverse things and not lean too heavily on the same old foods.

We are creatures of habit. Whenever I look at someone's food journal, it's  like the same six things that we bought that week. And it's really important too vary it up as much as you can rotate things because when we do have leaky gut, we just get more susceptible to food sensitivities.

When you're having that never ending list of food sensitivities, you really need to bring things back in and rotate.

Okay. So rotate really would just mean if you're eating sweet potato a lot, maybe you skip a day here and there, and you don't eat the same thing every single day. It's really tempting to do that, but we want to be careful with that.

And then we want to practice mindful eating. This is something I talk a lot about because it's not just helpful to enjoy the food and to bring that positive mindset to food, but it's also quite technically how you're going to be able to digest successfully. We need to be in a parasympathetic state. State of mind, which is also called the rest and digest state.

I'm sure you've heard of the fight or flight state. And that is the sympathetic state, the stressed out state that so many of us operate in like a lot of the day, we're rushing, maybe, when travel was a thing, we were maybe eating in our cars or in between meetings and, scarfing down our lunch. That was not being digested a hundred percent. There's just no way, because you were not in the proper state of mind.

So one thing to know, and remember digestion begins in the brain, not in the mouth, not in the stomach, it begins in the brain. So you really have to bring that a game with mindset, slow down, sit down. Take some deep belly breaths. I really like to take three deep belly breaths before I'm about to eat. If you like to practice grace, say a prayer before food, or just look at the food in front of you and notice it and be grateful for it, that would be a great way to slow down  and, get those deep breaths in, that effectively sending that message to your belly.

With those 3d belly breaths is telling your body I am safe, we can now go into the parasympathetic state of mind. We can rest and digest. It's really sending a message from the brain to the rest of the organs--which there are a lot in the digestive process--to get ready to do its thing.

So that's number one, you want to put your devices away, put the cell phone away, put the laptop away. It takes 10 minutes to eat. Seriously. everything will be there for you when you are done eating. We can take all the digestive enzymes in the world, can do the HCL challenge, build up your stomach acid, get you eating all the healthy food, but if you do not slow down and you do not eat mindfully, it's not going to digest and absorb.

So that's really key. That's always 101 for me with my clients.

And what else can, Oh, and then the other thing that I want to talk to you about is rhythmic eating. Like a fasting schedule. And so this is really important, especially with Hashimoto's because like we talked about constipation and motility tends to be such an issue.

So you do want to give yourself a good amount of time overnight from between dinner and then breakfast to really be able to digest, let your body do what it needs to do to detox, do all the great things that it needs to do while we sleep, it will also help your sleep. If sleep, is it a challenge for you?

Something that I really like to do is end my dinner and last meal of the day, three hours before I'm going to go to bed as a rule of thumb. And I really like to plan for about 14 hours fasting between dinner and breakfast. And that's pretty reasonable.

You might already be doing it, but I would definitely challenge you to just double-check. And at least get 12 hours, but optimally 14 hours of a fast. And I know fasting and intermittent fasting can be a very hot topic these days. It does not need to be that complicated should eat when you're hungry, but try to keep it within a decent window where you can absorb and digest and have a daily bowel movement and not get constipated.

So that's really key too. and those are my big tips. So I'm totally here for any questions or anything else.

Mary Shomon: [00:33:05] Great information, Alison. Really helpful. And, understandable, I think, for those of us who are out there in the wilderness, trying to figure out what to do and get healthy. I think that was some really incredibly, useful information. Katie, are we ready to move into the Q and a portion of today's  speaker event?

Katie: [00:33:26] Yep. I just sent you a couple of questions and if anyone has questions, feel free to leave them in the chat feature , and I will track them. And Mary will ask questions to Allison and Christine.

Mary Shomon: [00:33:41] Great. Okay. So this is a quest a question for Dr. Christine Maren. And Christine, what we want to know is what is the research showing us about the link or correlation between auto-immunity and reducing symptoms. So if we lower our TPO antibodies, for example, does that, eliminate or reduce the symptoms of a thyroid issue that we've got?

Dr. Christine Maren: [00:34:08] Yeah. this is one of the things that I've been in different seminars and people are like, if you go to a conventional doctor, most of the time, they're not rechecking thyroid antibodies, but that's how I know. I can tell if a patient's feeling better by looking at their labs before I talk to them, most of the time.

There are other factors that come into play, but I can tell okay, we're moving in the right direction. We've treated the gut infection. Intestinal permeability is better because those TPO antibodies or thyroglobulin antibodies are decreasing. So yes, most of the time that is true. I don't know that there is any specific research that is tracking TPO antibodies with zonulin.

Side-by-side, that'd be a really interesting study actually, but I've never seen anything like that. Alessio Fasano would be the one to do it if somebody had looked at that. But yeah, for sure. I think symptoms, when you see TPO antibodies go down, symptoms are usually improving.

I think though, if I can just kind of separate that a little bit. I want to make sure people understand that there's kind of two symptoms at play. One of them is the auto-immune piece, which is immune system -- that's a lot of like inflammation and immune response. So that immune response might be improving. But if somebody hasn't addressed the loss of thyroid function with appropriate hormone replacement, perhaps symptoms aren't better.

Because maybe their immune system's getting better, but yeah, t3 is still in the garbage and they feel super tired. So I think those are two separate issues.

Mary Shomon: [00:35:36] Okay. I want to circle back around to one of the basic issues and we have a couple of different people that have raised this question in some form or another, which is what are the tests that we need to get to evaluate this? And we also have a particular question from someone who had to jump off the chat, but said she would check back in to get the answer. And she wanted to know, are there any non-blood tests? She's got a needle phobia and so she avoids any kind of blood draws. She only gets one blood draw a year.

So are there other tests besides blood tests that are available? And number two, when you do go into evaluate this auto-immune situation and particularly the gut health, what are the best tests? So how do we know if we've got these issues that we're talking about?

Dr. Christine Maren: [00:36:32] So I think we know if we have leaky gut. If you have autoimmunity, you have leaky gut.

We can just make that assumption most of the time. And certainly, if you have digestive symptoms or food sensitivities, you have leaky gut. So if somebody says, do I have leaky gut or not? Do you have a lot of food sensitivities? Do you have digestive symptoms like bloating, loose stools, constipation?

Do you have auto-immunity? Those are my top three and that's when I know somebody, yeah, you've got leaky gut. There are some tests we can do, to look at levels for zonulin. I actually don't use them a ton, but they can be tested in the stool and in the urine and sometimes I do use them, but just overall, I found like the cost benefit, it's better to spend money on the test to identify what the infection actually is.

So the tests that I do in my practice are mostly urine. Sometimes we'll often stool, as well. So in somebody who has a digestive issue or auto-immune, I'm looking at an organic acid test. And I'm looking at a stool test. So that's urine and stool, for different kinds of gut infections that we're going to treat on the stool test.

I see markers for gluten activity. There are markers for zonulin. You can add on which I sometimes do, which is like your marker for  leaky gut. T there's markers for inflammation in the gut, immune system of the gut, and pancreatic enzyme function. And that malabsorption and things like that as well.

But yes, there's plenty of ways to test. I think if you're looking at blood, I like to test, if you're doing thyroid hormone replacement, I think it's important to test your blood after you switch up your hormone replacement. So it depends on how often your thyroid dose might be changing.

Mary Shomon: [00:37:59] Very helpful. Awesome. Yeah. Alison, do you have any tests that you are doing from a nutritional standpoint or anything else that you have found helpful?

Alison Marras: [00:38:09] I agree. I also, I think you might be describing the GI map. I usually use the GI map. I will sometimes use the MRT food sensitivity test, but yeah, to the point about gluten, it's just always a gluten-free. So I, I usually don't spend time testing that.  

Mary Shomon: [00:38:29] We had a question from Sarah and she wanted to know, she said she's got Hashimoto's and several other autoimmune diseases. Is this more intensive focus on gut health something that she, and all of us, are going to be doing forever, or is there a specific timeframe in which we can heal the gut and be in a situation where we don't have to be focusing on it anymore?

And what she said was she had taken a lot of antibiotics as a kid as well. Many people did and she knows she's got it, but she also doesn't want to take 20 supplements a day, potentially for the rest of her life and have to be over-focused on it. So what's the timeframe to get this under control, and are we going to live this with this forever? Or can we reasonably get back on

Dr. Christine Maren: [00:39:19] Like everything, it depends. I think it depends on how long somebody has been struggling with a condition and then the complicating factors. And so if there's somebody who has just struggled for a couple of years, that's much easier to fix somebody who's maybe been sick for 20 years.

Like I would give it a good couple of years to fix that. I think that the idea is not to take this many supplements for the rest of your life and to be really like trying to heal the gut for the rest of your life, but it is a total lifestyle change. And I think that lifestyle is like a commitment that you stick to.

Gluten-free, I would say, yeah, that's that's for the rest of it. I think when somebody gets their auto immune markers in a normal range, That doesn't mean that their auto-immune disease disease is gone. It just means that it's in remission and there'll be ebbs and flows. My autoimmune markers just went up with quarantine cause I drank too much wine.

Like things happen, right? Like sometimes things ebb and flow. We might lose somebody in our family and have a lot of stress, or lose a job, or go through COVID, or whatever happens. We have stress. And so those things ebb and flow. And so lifestyle's important. And sometimes we might have flares and might need to readdress some things, but I think, upfront, you hit it hard.

Work on removing that gut infection. And then, Allison was saying, you hopefully re-introduce foods and start to open up your diet. And I think there are certainly supplements that maintain health, maybe four or five that might help with thyroid function, rather than 20, but sometimes 20. You got to do that upfront and then ease off.

Mary Shomon: [00:40:48] Absolutely. I know there've been periods in my life when I've taken more than 20, but then, get into a good place and you can go into a maintenance level within things flare up and your ramp back up, but I'd rather take the supplements, then struggle with the symptoms. So I don't know.

I hope that other people share that approach. While we're talking, Christine, I would like to add in another question here, Michelle is asking, she is hypothyroid and she's pregnant, and she said she is having headaches and UTI. And she's wondering if this may be gluten related during the pregnancy?.

Dr. Christine Maren: [00:41:30] First of all, hypothyroidism during pregnancy, your thyroid hormone needs increased by 30 to 50%. So I think it's really important that anybody who is trying to conceive has optimal thyroid function. And as soon as you're pregnant, working with a doctor very closely to increase your thyroid medication and have those labs really followed closely.

So that's very important. Your baby needs a lot of T4 in particular. So it's a big deal when you're pregnant. And then the gluten, if you're hyperthyroid, usually I recommend, I mean, it depends on the cause of your hypothyroidism. I'm going to assume you have Hashimoto's. In which case I would always recommend a gluten-free diet. And headaches in pregnancy can be really multifactorial.

I think it depends on what stage you're in. Third trimester, it might be more worried about blood pressure and things like that. Preeclampsia. So I would say, definitely talk to your doctor, make sure you get labs checked, get your blood pressure checked, get your urine checked. If you're spilling protein, that could be an issue.

And I think right now, especially with COVID people are avoiding going to the doctor and not having as many labs drawn. So I think that's probably an important, if you're having symptoms, that's an important one to do and determine if it's thyroid or something else.

Mary Shomon: [00:42:35] Okay. Thank you. Alison, we have a question that I think might be, bright up your area of expertise.

Sonya wants to know if we really need to be vegetarian, or is vegetarian better, should we go vegetarian? And, I know this is a controversial topic because some of the paleo diets and things tend to not be as vegetarian. Where do you stand on the vegetarian, non-vegetarian, and auto-immunity, and in particular, the thyroid issue?

Alison Marras: [00:43:10] Yeah, that's a great question. As mentioned, iron and selenium are some of the key nutrients that our thyroid needs. So just in terms of like thyroid health, it's difficult to go vegetarian or vegan successfully, for most people. So no matter what everyone is so unique and there's bio-individuality to consider.

So it's not a hard and fast 100% rule that just doesn't exist at all. I know we wish it did. but I often see low energy, hypoglycemia, sugar addiction with a lot of vegetarian mixed, especially with these conditions.

So I'm a big proponent for animal protein. If it is, a choice, like you're not going to have animal protein, whether it's, more of a social justice impact choice, or you're completely turned off by it, or, whatever it is.

There's certainly ways. I would say to look into amino acid therapy and definitely ensure you are getting a good multivitamin and taking supplements because something needs to be. Taken care of there. You're not going to get it all from  plant-based sources of protein, like pea and hemp.

They're definitely good. I definitely use them, but I would say to depend on that completely. I think the energy is going to tank. I think it's going to be hard to really get the nutrients that you need for the thyroid. That's just based on what I've seen personally, professionally, I try to be vegetarian once, tried to be vegan once.

I love food. I wished I could have sustained it, but my symptoms were the worst I'd ever been. I was losing a lot of hair. My skin was really, it was just, it was a very tough time. And so once I was able to eat meat, find properly sourced meat, feel good about it, use it nose to tail, make my own bone broth, just really, make the most out of it and be very grateful for everything.

I just, I feel amazing when I do eat it. So I would just say, you deserve to find out, do what you can do, what's available to you and what you feel comfortable with. And if worst comes to worse, seek out amino acid therapy.

Mary Shomon: [00:45:16] Great. Now, one question again for you, Alison. One of our viewers said that she's got Hashimoto's, but she noticed that she's waking up in the morning with joint stiffness in her hands with some inflammation.

And she's wondering, if, and we'll ask, Dr. Maren this as well, but she's wondering if she should go gluten free. And is this a sign to eliminate gluten?

Alison Marras: [00:45:42] If you're on this call, I'm going to bet you need to go gluten free. For all these conditions that we've talked about between leaky gut, between Hashimoto's, there's just so many reasons why. What's funny is I'll often encounter women were like, yeah, but I should get a test to confirm for really, you can just stop eating it and see how you feel if that inflammation and joint pain goes away or that  skin irritation goes away, your brain fog goes away.

That is your answer. Like you said, getting in tune with your body, and back to that question about, is this a lifelong thing or like, when is this going to end already? When do I heal this? We are so used to a magic pill in this society.

And I think that. We can't put a timeline on it, unfortunately. Absolutely. Yes. It depends on what's going on, but this is also, we have chronic illness amongst us here. And so chronic, the very nature of it is it's going to flare up. It's going to go away. It's going to, you don't have your good days.

You're gonna have your bad days. So just really adopting this as more of a lifestyle versus just looking for okay, cool, I'm going to do the five hours. I'm going to check this off my list. I'm going to do this diet. It's just opening yourself up to the possibility that this is a lifestyle and you can totally be successful with it.

You just take it at your own pace, know thyself. And bring a positive attitude towards it. So yeah, go gluten free. There's plenty of gluten-free recipes. Gluten-free products that it's way easier to go gluten free now than it was in years past.

But I think that would really help. And then the other thing that comes to mind with the joint pain inflammation, just to add that in that  night shades can sometimes really be a thing with that migraines. Anything that's just like quick onset of pain and inflammation like that. So I would consider it, if you eat a lot of tomatoes, red sauce, white potatoes, peppers, spicy food, I would do an experiment and remove that and see how that feels as well.

Mary Shomon: [00:47:39] Okay, great. Dr. Maren, do you have any additional thoughts on this issue? Because I'm sure you have a lot of patients that come to you with a joint pain hands, feet, morning inflammation, and that's a pretty, that's a pretty common symptom.

Dr. Christine Maren: [00:47:55] Yeah, a hundred percent. I agree with Allison. I think too, make sure your thyroid function looks good, make sure you're not functionally hypothyroid and that your T3 is, and I'm up in an optimal level sometimes, hypothyroidism itself can cause that, but yes, I think gluten-free, the only thing I would add is just like, when you're doing gluten-free products, be careful that you're not choosing like the gluten free muffins that's full of sugar and rice flour.

That kind of stuff, because a lot of gluten-free stuff is often just because it's gluten free doesn't mean it's healthy. So usually looking for something that's like more paleo, is healthier. So an example of that would be like, if you're going to make pasta, I liked this Capello's brand.

That's like an almond flour pasta versus like a rice flour thing. Same thing with crackers, like Simple Mills, great crackers, they're almond flour. I can eat a whole box.

Mary Shomon: [00:48:42] Sounds good. Sounds good. You're making me hungry now. A question that I have about, probiotics, because there's some controversy out there about whether you can get all of the good bacteria, those, happy, wonderful buddies that we need in our gut, from food alone or whether we really do in many cases, especially if we have a dysbiosis and imbalance really need to include a probiotic supplement? And I'm wondering if you could thoughts about

Dr. Christine Maren: [00:49:20] People who have an otherwise pretty healthy, intact gut, I think they can get their beneficial bacteria from foods if they're eating a good diverse diet. But I think there's a time and place for probiotics. And I think one of those is when people are suffering from gut infection or I've taken a lot of antibiotics and mixed literature looking at whether probiotics can even help to reinoculate the gut. That is why I use a spore forming probiotic.

I'm a fan of MegaSpore biotic. I don't know if Alison is or not, but that's my go-to especially in a patient with auto-immunity and with gut infections. I use it myself. It's not tolerated in every patient. And some people don't do well with it. And so I just usually start it, start that away from other kinds of therapies.

I'm not going to start somebody on like an antifungal medication in a probiotic MegaSpore biotic at the same exact time. Cause I like to know if there's an issue. So spacing it out by a couple of days, just like you would with food reinroduction. But yeah, I think that people with gut infections benefit generally from adding something like MegaSpore.

Mary Shomon: [00:50:17] Great. Thank you. I love the spore probiotics myself. I found them so effective. I can really feel the difference. I love probiotic foods and I try to do a combination of both, but I'm always adding in a supplement.

Alison, I want to jump back to you and find out, cause we have a question from one of the viewers about how we go about re-introducing foods back in after we've gone to a more restrictive diet. Do we have to do it really slowly? Do we do it food by food? If we cut out the nightshades, can we add tomatoes and peppers and eggplants back in at the same time? Or do we go individually vegetable by vegetable at that rate, it's going to be, about 10 years before we can actually have a full salad or something.

How do we work this out t o protect our health, but not to be completely neurotic about it at the same time?

Alison Marras: [00:51:09] Absolutely. Yeah. I would say organize it. You're going to want to journal and you're going to want to space it out by about two to three days.

And you do, it's just like an experiment, right? You don't want to do everything all at once because then if you do have a reaction, which one was it? Was it the tomato? Was it the pepper? And now you're back at square one. So it might seem like, oh, I got to share it all. I have to put this on my calendar. I got to like space this all out. And to your point, is it gonna take 10 years for me to build a full-on salad?

But it will serve you better in the long run. If you are patient, patience is a virtue to just space it out and get the read on it. So keep a food journal jot down and it's not just going to be a digestive thing. See if digestion changes, see if your skin changes, your mood, brain, like brain fog, and also like joint pain kind of stuff.

See if there's a change in any of that, keep a journal and then take a look at it after a few days, and then you can make your best educated guess, but it's really going to serve you to get in tune with your body like that. It's a good, worthy experiment.

Mary Shomon: [00:52:16] Okay,  Dr. Marin, I'm going to go back to Dr. Christine Maren for this question. From Sarah, her perimenopausal hormones are being tested, and she said that she's had Hashimoto's for 20 plus years, but in the most recent year, she's noticed that she has a much stronger urine smell. The odor of her urine is much stronger and that's been a mystery to her.

And she said, I can tell my hormone balance is off. What tests should I ask my doctor to check for? Besides my usual thyroid tests? She said she's also going to try gluten-free. So Sarah in Texas is going gluten-free. Good luck, Sarah with that.

But Dr. Maren, what do you think when we're talking about urine, that's changed it's odor and some hormone issues and in a perimenopausal woman, what might be going on and what should she be looking at with her doctor?

Dr. Christine Maren: [00:53:11] So the biggest one is if somebody has low estrogen, we tend to have vaginal dryness can lead to, or I'm sorry, in, to urine infection to UTI. And so I asked for a urine culture primarily. Generally we're looking at symptoms also of a UTI, so pain, incomplete voiding, maybe blood in the urine, things like that.

But if there's a strange odor, I'd ask for urine culture in your analysis, especially if there's vaginal dryness. Make sure you're urinating after intercourse, and that you're using appropriate lubrication. The other thing I think about is just dehydration and hydration status or urine becomes more concentrated when you don't have enough fluid on board.

I don't really see how that's related to perimenopause, unless there's like crazy hot flashes and sweating. I don't think that's gonna really make you dehydrated though. But if your fluid status isn't awesome and drink a lot of water, even if you do have a really low grade UTI, that can help cause you're just flushing out your bladder.

Mary Shomon: [00:54:03] And with our auto-immune patients, especially in perimenopause or women in their forties and older, do we also need to really maybe mention or pay attention to blood sugar issues because of increased risk of type two diabetes in this group?

Dr. Christine Maren: [00:54:18] So maybe. I think everybody, if we have low thyroid function and we're not having appropriate hormone replacement, we see decrease in metabolism and high blood sugar and high cholesterol and things like that. If our hormone is replaced adequately and correctly and monitor over time, I don't think that should necessarily be a risk factor.

But, obviously if you have a risk factor with Hashimoto's and you have auto-immunity there you're, you have to think about other autoimmune diseases as well. I don't know. Tell me what you're thinking, Mary.

Mary Shomon: [00:54:47] I'm just thinking that, I know that there are some studies that have shown that there is a higher incidence of type two diabetes in people, even with treated hypothyroidism because of some underlying metabolic mechanisms, we're just, we're insulin resistance, a higher risk. And obviously we have a large population of people with insulin resistance out there, irrespective of their thyroid status.

Dr. Christine Maren: [00:55:08] Yes, totally. And people who don't know it. There's no idea. So I like to test a fasting insulin on patients because you'll see that different, they will see that change before a hemoglobin A1C.

So for people who are listening at A1C is like a three month average of blood sugar. And if you can just get that insight into your fasting insulin and you see that level above eight, even if it's in a normal range, it's too high. And keeping that insulin in check is really big deal. So yes, eating for blood sugar balance is important.

And urine, like usually some of the symptoms we see in people who have blood sugar issues is that they peel out at night. So it's called nocturia. So if you're waking up at night to urinate, like several times, you should. Regardless, I think everybody should have their blood sugar checked, but that would be a reason that your insurance might pay for it.

Mary Shomon: [00:55:53] Sure. Absolutely. Thank you.

Alison Marras: [00:55:54] I would also add, cause I feel like we've been dancing around it with that whole topic, but adrenal health is closely linked with blood sugar balance as well.

And that's also going to be the two foundations of hormone balance in general. So if we're talking about hormonal imbalances, we're talking about thyroid health, we have to support our adrenals with stress management, and then yes, a blood sugar balancing diet.

Mary Shomon: [00:56:16] Katie, should we, before we finish up for our session here, should we have an opportunity for, both Dr. Maren and Alison to share where they can, where people can find them and, what they've got available? Are we about ready to wrap things up at this point?

Katie: [00:56:33] Yes, we're going to wrap up obviously an hour is not enough time to get all of the information about everything. So Alison and Christine, maybe if you guys can share where people can find you, if they have more questions about what you've spoken about. And then we'll wrap up a little bit from there.

Dr. Christine Maren: [00:56:48] Sounds good. I am at drchristinemaren.com. I'm on Instagram a lot and that's @drchristinemaren and Facebook is the same thing @drchristinemaren. So I am there. I see patients in Colorado, Michigan, and Texas. I've been doing all virtual medicine and tele-health for the last five years. And long story short, I was married to a military doctor, so we moved around, but I'm home in Colorado. That's where I'm based and where I'll stay, but I'm licensed in those other states. And I have a nutritionist who works with me as well and can see patients worldwide.

Alison Marras: [00:57:19] Awesome. I'm Alison, once again, and you can find me @foodbymars, like the planet. My website is foodbymars.com. I'm on Instagram a lot as well. I share a lot of what I'm eating, cooking tips, things like that. And I also have a Facebook group. It's called Food by Mars Nation, and I have a lot of women with Hashimoto's in there. We talk a lot about food sensitivities and all the things, so yeah, you can hit me up there. I have recipes, meal plans, challenges, all that good stuff.

Katie: [00:57:53] That's awesome. Thanks guys. Thank you to all three of you for being here today and for sharing what you know. This event has been super valuable and helpful to us. And thank you to everyone who's joined us today who has watched and asked questions. We know that it's a strange time in the middle of a Monday. It's almost kid bedtime on e the east coast, it's the middle the workday on the west coast. So thank you for joining us and thank you really for taking time for yourself

today.

We have an exciting project upcoming. Paloma Health is working on developing a mobile app to help with some of this gut health, food sensitivity, detective work. We're hoping to give you a sustainable framework for elimination and introduction.

We don't have a date for this yet, but if this is something that you might be interested in beta testing, feel free to send an email to contact at palomahealth dot com. And we will get you that information when it's available.

I will also send out a replay of this event via email so keep an eye on your email. You'll also get some goodies from our speakers in there, and then keep an eye out for our next event next month. Thank you so much again for being here. We had a really good time and we hope you did too, and we'll see you soon.

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