Latest / Wellness by Designs - Practitioner Podcast / ENCORE: Holistic Treatment of Hashimoto's Thyroiditis with Dr Amy Gajjar

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ENCORE: Holistic Treatment of Hashimoto's Thyroiditis with Dr Amy Gajjar · Wellness by Designs - Practitioner Podcast

• 0:20
  Speaker 1: This is Wellness by Designs, and I'm your host, andrew Whitfield Cook.
• 0:24
  Speaker 1: Joining us today is Dr Amy Gajah.
• 0:27
  Speaker 1: She's a general practitioner that's equivalent to an MD in the States who has a special interest in Hashimoto's disease.
• 0:36
  Speaker 1: Welcome to Wellness by Designs, amy.
• 0:38
  Speaker 1: How are you?
• 0:40
  Speaker 2: Thank you, Andrew.
• 0:41
  Speaker 2: Thank you for having me and pleasure to be here.
• 0:44
  Speaker 1: It's a pleasure to have you.
• 0:45
  Speaker 1: It's been a long time getting you on.
• 0:47
  Speaker 1: I've got to say Tell us about being a doctor.
• 0:52
  Speaker 1: This always interests me.
• 0:54
  Speaker 1: Tell us about your journey to the dark side, to the integrative side.
• 0:59
  Speaker 1: What I find is that most people had an experience of illness, but there are some who are the seekers.
• 1:08
  Speaker 1: Which one are you?
• 1:11
  Speaker 2: I'd say I'm more the seeker, but I'd say definitely a little bit of both for sure.
• 1:16
  Speaker 2: My journey started being a normal GP in the UK.
• 1:25
  Speaker 2: I did my conventional medical training in London and did some time in hospital medicine and then really was drawn to general practice.
• 1:34
  Speaker 2: I could never actually make up my mind which specialty I liked.
• 1:37
  Speaker 2: I liked it all and I liked what general practice offered, with that talk to patient relationship, that continuity of care.
• 1:44
  Speaker 2: I embarked upon a Korean general practice the model I was working in at that time, which still exists.
• 1:58
  Speaker 2: But I was working in a busy inner city practice in London where the appointments were 10 minutes long.
• 2:04
  Speaker 2: It was literally just in and out.
• 2:06
  Speaker 2: Initially there was that excitement of being in general practice and everything, but as time went by I just felt as if patients were just in and out.
• 2:21
  Speaker 2: I was often just giving medications.
• 2:23
  Speaker 2: It became over time quite frustrating and quite stressful as well.
• 2:32
  Speaker 2: This is obviously a common reason for burnout in many doctors as well.
• 2:38
  Speaker 2: The population that we were dealing with was also quite an array of different, complex chronic conditions, I think minorities, language issues, addiction problems A lot of quite difficult, complex and chronic things to deal with.
• 3:00
  Speaker 2: I had an interest in different things.
• 3:02
  Speaker 2: I was interested in nutrition.
• 3:04
  Speaker 2: I'd also done biochemistry as part of my medical training.
• 3:08
  Speaker 2: I had done a nutritional biochemistry component.
• 3:10
  Speaker 2: I was also interested in NLP and coaching and a few different things, but I guess I never really knew where to take it.
• 3:18
  Speaker 2: I started just doing little courses.
• 3:20
  Speaker 2: I did a weekend medical acupuncture course and a CVT course for the GP.
• 3:26
  Speaker 2: I tried to dabble in whatever I could find that was available.
• 3:29
  Speaker 2: I tried to incorporate what I could into day-to-day practice.
• 3:34
  Speaker 2: Again, even with that 10-minute model, it was quite challenging.
• 3:39
  Speaker 2: Now and then I would try and extend the appointment speed.
• 3:42
  Speaker 2: Then it was still very much limited by time.
• 3:48
  Speaker 2: I wasn't really feeling that I was doing enough for patients.
• 3:52
  Speaker 2: Essentially, time went by.
• 3:57
  Speaker 2: I had always loved to travel.
• 4:00
  Speaker 2: The thought of traveling to New Zealand and Australia was always there.
• 4:04
  Speaker 2: I had a lot of friends who had done six months or a year in New Zealand and Australia.
• 4:09
  Speaker 2: I had just loved the experience.
• 4:11
  Speaker 2: I thought let me just try that.
• 4:13
  Speaker 2: Let me just do a year in New Zealand and a year in Australia.
• 4:15
  Speaker 2: Just see what it's like, get to travel, get to experience medicine in a different country.
• 4:21
  Speaker 2: For me, the turning point came when I was here in Sydney.
• 4:24
  Speaker 2: I was working as a normal GP.
• 4:26
  Speaker 2: I came across a conference in nutrition in medicine that had been organised by ACNAM, which is the Australian College of Nutritional and Environmental Medicine.
• 4:39
  Speaker 2: I went along to that.
• 4:40
  Speaker 2: I just loved the conference.
• 4:42
  Speaker 2: I thought, well, I can't believe there's actually something here.
• 4:44
  Speaker 2: This is just what I've been looking for.
• 4:46
  Speaker 2: It was a fascinating conference looking at the role of nutrition in different chronic illnesses.
• 4:54
  Speaker 2: I spoke to other delegates who were doing further training with ACNAM.
• 4:58
  Speaker 2: Later on they decided to embark upon that.
• 5:01
  Speaker 2: Then I also came across other similar organisations like the Institute of Functional Medicine that's based in the States, as well as the Lifestyle Medicine Association here.
• 5:11
  Speaker 2: Coming here was definitely a turning point.
• 5:13
  Speaker 2: The seeds were there, I guess from being in London.
• 5:17
  Speaker 2: I also grew up in an Indian background where I was exposed to a little bit of Ayurveda and herbs, but it's actually in the more recent years I've become interested in all these other things.
• 5:30
  Speaker 1: Right, I've got to ask you though.
• 5:32
  Speaker 1: You finished your training, but then you thought I need to do more for my patients.
• 5:38
  Speaker 2: Yes.
• 5:39
  Speaker 1: Not common.
• 5:40
  Speaker 1: It's not commonly thought, and you have this openness to try different things.
• 5:47
  Speaker 1: I'm going to guess that you were that sort of kid.
• 5:49
  Speaker 1: So I wonder if there's a big lesson that normal GPs can take away from this and just say you need to look further than what you think is the truth.
• 6:08
  Speaker 1: Because I was one of though not a GP, but I was of that mindset.
• 6:13
  Speaker 1: You know, I totally disdained any sort of complimentary or integrative view.
• 6:20
  Speaker 1: I used to actually tease somebody about it.
• 6:24
  Speaker 1: Years later, of course, I had to go back and apologize profusely because I'd opened my mind, but you obviously had this for quite some time.
• 6:35
  Speaker 1: I've got to ask you you said the words was I doing enough for my patients?
• 6:42
  Speaker 1: So you have that constant honor to look after their best interest in whatever way possible?
• 6:51
  Speaker 1: Did you see yourself very differently in your cohort, in your student cohort, when you were learning medicine?
• 7:01
  Speaker 2: Definitely a little bit.
• 7:02
  Speaker 2: For sure.
• 7:03
  Speaker 2: I had that sense during medical school that in terms of that very mainstream approach, in terms of just dealing with the symptoms and not really individualizing enough so we do award rounds.
• 7:21
  Speaker 2: Where it was a case of this, it was a case of that.
• 7:25
  Speaker 2: It wasn't about the patient, it wasn't their name, it was very yeah, it was quite odd if we'd look back to that, but it felt quite normal at the time.
• 7:35
  Speaker 2: So I had that sense of this isn't quite right for me, but is medicine right for me?
• 7:42
  Speaker 2: So I would have those questions now then.
• 7:44
  Speaker 2: For sure, even during medical school, and I guess I always kept that open mind and naturally found myself interested in lots of different things.
• 7:56
  Speaker 2: And I'm still like that now.
• 7:58
  Speaker 2: There's still loads of things I'd love to learn and if I didn't have to work I'd probably just carry on doing courses.
• 8:03
  Speaker 2: But I can certainly relate to what you just mentioned.
• 8:08
  Speaker 2: I remember sitting in the clinic and patients who had seen their naturopath or some other natural practitioner wanted all these testing done and I'm thinking, oh my God, I would roll my eyes.
• 8:18
  Speaker 2: So I was very much conventional at some point as well.
• 8:23
  Speaker 2: But there were always those seeds there and I guess for me I had to get to that point, where that point of frustration stress.
• 8:33
  Speaker 2: I think something has to change.
• 8:36
  Speaker 1: Yeah, it's an interesting point about what you're saying about all these tests and perhaps I'll ask this now.
• 8:42
  Speaker 1: It'll stop me coming back and circling back to it later.
• 8:45
  Speaker 1: What sort of lessons can we ask naturopaths to be aware of when requesting testing from GPs?
• 8:58
  Speaker 1: About the machine that you're in, about the restrictions that you face, that sort of ethical dilemmas, that sort of stuff?
• 9:05
  Speaker 2: Yeah, yeah.
• 9:06
  Speaker 2: So I think it's important to be aware that there are Medicare guidelines and ultimately, even though a practitioner can suggest to their patient that they see their GP and have all these tests done, it's still up to that doctor because medically, legally, they're responsible.
• 9:23
  Speaker 2: So I think that's a really important point.
• 9:26
  Speaker 2: And if that particular GP perhaps isn't as trained and integrated medicine and doesn't realize the implications of certain nutrients or certain other markers that we use zinc, comma, cysteine they're not your day-to-day ones.
• 9:39
  Speaker 2: I mean, it's becoming more aware, People are becoming more aware now, but ultimately it is the responsibility of that doctor and I think that that's important to bear in mind.
• 9:51
  Speaker 2: And, yes, there are Medicare regulations and if people go beyond that, then they can get investigated and that does happen.
• 10:01
  Speaker 1: That's right, that has happened.
• 10:02
  Speaker 1: So, for instance, vitamin D is restricted from screening now unless there's appropriate suspicion in a patient that they're not getting enough sunlight.
• 10:12
  Speaker 1: And B12 was taken off.
• 10:14
  Speaker 1: I think that was 2015 or so, yeah.
• 10:20
  Speaker 2: MTA2.
• 10:20
  Speaker 2: It was a more recent one, yeah, yeah.
• 10:25
  Speaker 1: So there's many things that which have restrictions placed on GPs about the level of testing that they can do because of the viewpoint of orthodoxy, one.
• 10:35
  Speaker 1: That which we'll get into specifically has to do with thyroid testing, but let's segue into that one now.
• 10:43
  Speaker 1: What picked your interest in Hashimoto's thyroiditis?
• 10:49
  Speaker 2: Yeah, it was more so when I started working in a clinic here in Northern Beaches which is my first job in, I guess, integrated Medicine, I guess I started seeing a different cohort of patients than I would have in standard general practice, and at that time I was also doing my acronym training.
• 11:08
  Speaker 2: So not only was I getting exposed and more and more of these patients, but as I learned more through the foundation course and through the thyroid and adrenal modules and everything, I actually began to understand what was going on as well.
• 11:21
  Speaker 2: So I guess it was the sheer number of patients I started to see thinking there's such a common issue and it's not being dealt with.
• 11:29
  Speaker 2: People are coming in with symptoms of hypothyroidism or Hashimoto's.
• 11:33
  Speaker 2: They've been told it's nothing, their bloods are normal, or they've been put on medication but they're still not feeling well.
• 11:41
  Speaker 2: Or they've had testing done such that the antibodies are positive but told well, there's nothing, there's no management for that, except staroxy in some cases.
• 11:50
  Speaker 2: So that, coupled with the fact that I was learning more myself and learning new biochemistry and physiology which hadn't been covered in medical school and it's all you know, this is all proper biochemistry and physiology of thyroid hormones and the T4 to T3 conversion and reverse T3.
• 12:09
  Speaker 2: And I'm thinking did I miss that lecture or?
• 12:12
  Speaker 2: But it wasn't taught at medical school and so, yeah, so realizing how common it was and what suffering it leads to you know people not feeling the optimal self, with ongoing fatigue, and you know these symptoms that they're suffering are affecting their day-to-day life and their personal life in their work life and wanting to really delve into what's actually going on here.
• 12:36
  Speaker 2: So, as I began to learn more and I was able to then impart some of that advice onto patients, yeah, just naturally became interested in that myself.
• 12:48
  Speaker 1: Right, I do take your point and I tell you what I'm glad that you did biochem because, as you say, I mean there's so much that isn't covered that I've learned since.
• 13:00
  Speaker 1: I mean I love my Leningers and my team of FlexiBooks.
• 13:04
  Speaker 1: They're my saviour and I love just looking up things when I thought I knew them.
• 13:08
  Speaker 1: But it takes a new study to.
• 13:11
  Speaker 1: I mean, this morning I was just thinking about the what is it?
• 13:14
  Speaker 1: Beta-3 adrenosceptors and what I thought.
• 13:18
  Speaker 1: There's only two types.
• 13:21
  Speaker 1: So things change as our knowledge progresses, but if we rest too much on our laurels we run the risk of falling behind.
• 13:29
  Speaker 1: So, with regards to patients, you say you saw a different cohort.
• 13:35
  Speaker 1: How do these patients present?
• 13:39
  Speaker 1: You were saying that you know that some of them were told by their I'm going to say it glibly again because it's a bit of a joke out there normal GP and I guess I need to explain that because I laugh at myself, because I was that orthodoxy, I was that skeptic, that person that dismissed complimentary medicine out of hand with my total arrogance and ignorance without even contemplating that it might be useful.
• 14:05
  Speaker 1: So can I ask how do your patients present, both typically and atypically?
• 14:13
  Speaker 1: Can you take us through some differential diagnosis?
• 14:19
  Speaker 2: Yeah, yeah.
• 14:20
  Speaker 2: So, as we know, the thyroid gland controls so many functions and so potentially that there can be hundreds of symptoms, but the common presentations that people will actually come in for often it's fatigue, low energy, weight issues in terms of weight gain or doing all the seemingly right things and still not losing weight.
• 14:40
  Speaker 2: There may be hair loss and also gut symptoms as well, including like IBS type symptoms or constipation reflux, and really nothing is really sort of found when they've been to their GPs.
• 14:52
  Speaker 2: But what we also find is, on further questioning, there can be potentially many other thyroid symptoms that they may not have presented with, but on questioning they say, yeah, they actually have dry skin or they do feel the cold, or they have cold hands, cold feet, you know, yeah, ongoing gut symptoms.
• 15:13
  Speaker 2: So often a lot more is discovered on further questioning, but that's a very typical picture.
• 15:24
  Speaker 1: One of the questions I always ask is are you the person at the party who's wearing the jumper where everybody else is wearing a T-shirt, and it's amazing how common it is.
• 15:35
  Speaker 2: Yeah, yeah.
• 15:36
  Speaker 2: And it's amazing how many symptoms that people normalise.
• 15:39
  Speaker 2: Like you know, many women normalise heavy, painful periods and it's like, well, no, actually that's not normal, but they're just so used to it because that's what their mum might have had, that their mum told them from the beginning that that's just how it is.
• 15:51
  Speaker 2: That's just part of being a woman, you know.
• 15:55
  Speaker 2: Or gut symptoms and people often you know, because they can just tolerate a little bit of discomfort here or they just almost learn to live with it.
• 16:03
  Speaker 2: It's not enough for them to present until it becomes a lot more.
• 16:09
  Speaker 1: Great, and so you know you're used to medical management.
• 16:13
  Speaker 1: Take us through some of the limitations that you just sort of hinted on with regards to orthodox medical management of Hashimoto's.
• 16:24
  Speaker 2: Yeah, so the main test for thyroid hormone is sorry the main thyroid hormone test is the TSH, which is the thyroid-stimulating hormone.
• 16:34
  Speaker 2: So that's a pituitary hormone.
• 16:36
  Speaker 2: So in the guidelines that you piece a data to, you know it's the TSH that's measured and if that's out of the range then there is justification for the T4 to be measured.
• 16:48
  Speaker 2: So T3, or thyroid antibodies are not routine testing as such.
• 16:53
  Speaker 2: So there's that reliance on TSH and that's partly why there are so many people with hyperthyroidism or Hashimoto's that have not been diagnosed or treated adequately.
• 17:09
  Speaker 2: And the guidelines kind of vary.
• 17:14
  Speaker 2: They are changing, and slowly they are changing, especially in the states.
• 17:18
  Speaker 2: But you know hyperthyroidism is about the TSH is more than 10.
• 17:22
  Speaker 2: And subclinical hyperthyroidism doesn't necessarily need to be treated, but so the ranges are quite wide.
• 17:33
  Speaker 2: So but these are the guidelines that that GPs follow.
• 17:41
  Speaker 1: This is one of my consternations with orthodoxy, and that is that the condition either is or isn't.
• 17:52
  Speaker 1: There is no pre-diabetes.
• 17:55
  Speaker 1: There is no destruction of thyroid to the point where it may be affecting your body.
• 18:03
  Speaker 1: You either have Hashimoto's or you don't.
• 18:06
  Speaker 1: I should be more.
• 18:09
  Speaker 1: You either have a thyroid problem or you don't.
• 18:11
  Speaker 1: There's no decline, there's a cliff.
• 18:15
  Speaker 1: Yes, why, why?
• 18:18
  Speaker 1: Yeah.
• 18:21
  Speaker 2: Yeah, as you know, there's always those great areas and medicine is very much.
• 18:27
  Speaker 2: You know, it's either extreme and I guess that the model on which mainstream medicine is built on is that acute model.
• 18:36
  Speaker 2: It's great for acute illnesses and emergencies, this is how you treat something, but given that we're seeing, you know, these is it's chronic illness.
• 18:47
  Speaker 2: Much of it, life is related, so we need a different paradigm.
• 18:51
  Speaker 2: So it's a great model for acute illnesses and emergencies, but not so much for chronic illness, and this is where we need to have that shift in thinking.
• 19:04
  Speaker 1: And you're saying it's shifting a little bit in the states.
• 19:05
  Speaker 1: Is that correct?
• 19:08
  Speaker 2: Yeah, slowly, slowly, and I'd say even here as well, but you know, especially as more and more evidence is coming out.
• 19:15
  Speaker 2: So I think there's a slow shift for sure.
• 19:20
  Speaker 1: You know it is happening but I'll say it's more so in the states.
• 19:23
  Speaker 1: Yeah, way beyond the times.
• 19:23
  Speaker 1: So are we finding that there is a shortening of the acceptable limits of normality and then, outside of that we need to be looking at, or are we seeing that there's a possible acceptance by orthodoxy that if it's at the quote lower lower end of normal or the upper end of normal that there is reasonable suspicion to look further?
• 19:54
  Speaker 2: Yeah, so suddenly the guidelines have been changing in terms of the actual range of the TSH.
• 19:59
  Speaker 2: So in most labs up to about four is the upper limit.
• 20:05
  Speaker 2: But having said that, even then we know that you know people can still have thyroid conditions even at a much lower TSH and there isn't necessarily as much appreciation of the fact that there can be other causes of hypothyroidism beyond the primary.
• 20:20
  Speaker 2: So you know, the TSH, for example, can reduce because of stress, which is so common these days.
• 20:26
  Speaker 2: So that will suppress the TSH and that also can mean that thyroid conditions don't get picked up and there isn't.
• 20:33
  Speaker 2: Again, it's in the guidelines but I won't say there's as much of appreciation of that in general practice.
• 20:39
  Speaker 1: Right, From a medical legal perspective, is it acceptable if anybody a GP yourself informs the patient that these other tests aren't covered by Medicare or may cause issues professionally and so you can ask for user pays?
• 21:06
  Speaker 1: Is that allowed?
• 21:07
  Speaker 1: Like, for instance, if you wanted to do a reverse T3 and a thyroid antibody test?
• 21:13
  Speaker 1: Can you say look, this will get me into trouble, but you can do them if you're willing to pay for them.
• 21:18
  Speaker 1: Is that allowed?
• 21:19
  Speaker 1: Are you okay to do that?
• 21:21
  Speaker 2: Yeah, that's how most practitioners do, and so the reverse.
• 21:25
  Speaker 2: T3 is a non-Medicare test anyhow, right, you're an iodine, so potentially the antibodies can be done under Medicaid.
• 21:34
  Speaker 2: But it is clinical indication.
• 21:35
  Speaker 2: So when I'm investigating someone, monitoring someone, it's important to put down that they may be on medication or they have clinical symptoms justifying that particular test.
• 21:46
  Speaker 2: But sure, if some GP is not comfortable with doing, for example, t3 or thyroid antibodies, that can be requested privately.
• 21:56
  Speaker 1: Gotcha Okay, but again we get back to this issue.
• 21:59
  Speaker 1: I've spoken to many patients who have been put on orthodox treatments and they communicate with their GP or their endocrinologist that they still feel tired, they still feel like crap.
• 22:12
  Speaker 1: Some of them are in pain.
• 22:13
  Speaker 1: So when is it appropriate for their medical practitioner to listen to them?
• 22:26
  Speaker 1: That seems such a what do you call it?
• 22:31
  Speaker 1: A guided question.
• 22:32
  Speaker 1: How do patients get the best out of medicine while still having the medical practitioner protect it?
• 22:42
  Speaker 1: What's happening?
• 22:44
  Speaker 2: There seems to be a disconnect, yeah yeah, yeah, and I guess this is how patients then filter onto us, because patients have been to their GPs, they may have even been referred to any chronologist and they're on that, on the medication, but still symptomatic.
• 23:00
  Speaker 2: Usually it's at that point where people, I feel, seek other help, so they may go and see a naturopath, they may go and see it into your doctor.
• 23:07
  Speaker 2: They start googling and looking into all the information that is out there and that's, I would say, it's how most patients present.
• 23:17
  Speaker 2: It's not initially, it's when they've already, you know, had these symptoms for a long time and no one's found the cause.
• 23:23
  Speaker 2: Or, yes, they've been put on thyroxine and they're still not feeling better.
• 23:28
  Speaker 2: And that's the point I would say people seek further help.
• 23:33
  Speaker 1: Gotcha, gotcha.
• 23:34
  Speaker 1: Okay, so let's go into treatment.
• 23:37
  Speaker 1: What can you add or use to help your patients that wouldn't be offered in an orthodox practice?
• 23:46
  Speaker 2: Yeah.
• 23:47
  Speaker 2: So in terms of of actual well, in terms of the general management, I always like to emphasize all the lifestyle things, initially as a foundation, because there's so much evidence for different aspects of lifestyle to improve any chronic illness, but it's including thyroid conditions for sure.
• 24:04
  Speaker 2: So you know diet, sleep, stress management, you know knowledge of an awareness of reducing environmental toxic load.
• 24:13
  Speaker 2: So all those lifestyle foundations are really important and I think no matter whatever we're using in future, I think there always has to be that foundation.
• 24:24
  Speaker 2: It's something I always try and go through every consult as well.
• 24:27
  Speaker 2: If someone is already on thyroxine, if they have, for example, a high reverse T3 and a low T3, you know it may be appropriate to add in additional T3.
• 24:41
  Speaker 2: And there is a medication T3 to troxine that is available as a pharmaceutical medication, but that's only prescribed by some endocrinologist and maybe some GPs.
• 24:51
  Speaker 2: But that is.
• 24:52
  Speaker 2: It is quite a high dose.
• 24:53
  Speaker 2: It's a 20 microgram dose.
• 24:54
  Speaker 2: So I, if indicated, I would start very, very low on on the usually compounded T3.
• 25:01
  Speaker 2: Personally, thyroid extract is well, it was the original treatment before thyroxine was available and that's porcine sorry, your porcine or bovine derives natural glacial extract and that can still be used and is still made by compounding pharmacy.
• 25:20
  Speaker 2: So again, that's not for everyone, but if if other treatments have been tried, then that is a potential treatment and I find that in the majority of people who are changed over to thyroid extract, most of them do better because that's giving them T4, t3, it's giving them other nutrients and other thyroid hormones as well.
• 25:40
  Speaker 2: Obviously we've got to be careful because it does contain iodine and that can trigger autoimmunity as well and some people can be quite sensitive to iodine as well.
• 25:48
  Speaker 2: So they're the main treatment in terms of hormones.
• 25:55
  Speaker 2: In terms of supplements, there's obviously various nutrients and herbs that can be used and again, that will be very individual depending on what's going on with the patient.
• 26:06
  Speaker 2: Looking at the guts, obviously that's paramount with thyroid because, again, there's a lot more evidence on the gut, thyroid axis specifically as well.
• 26:16
  Speaker 2: There are also, you know, there's also other things that we can use.
• 26:24
  Speaker 2: For example, there's LDN, which is low dose naltrexone, which has been shown to help to reduce antibodies and it's also been found to be beneficial in reducing pain in fibromyalgia and in rheumatoid arthritis, for example.
• 26:38
  Speaker 2: So again, these are not first-line treatments, but you know there are other other considerations that we can look into as well.
• 26:45
  Speaker 2: If people also have associated symptoms and illnesses, like you know, anxiety, insomnia and the metriosis, then there's also, you know, some justification for potentially using medical cannabis, for example.
• 27:03
  Speaker 2: So there's a whole array of treatments very individual to that person.
• 27:10
  Speaker 1: Gotcha just one question about glandulars, with concerns ongoing with variant.
• 27:18
  Speaker 1: What is it?
• 27:20
  Speaker 1: Jacob Krusefeld disease?
• 27:22
  Speaker 1: Is that right?
• 27:23
  Speaker 1: Yeah, yeah, krusefeld Jacob disease anyway, mad cow disease Are they an issue?
• 27:28
  Speaker 1: Or are we especially careful to use glands from animals in like Australia, new Zealand and nowhere else?
• 27:39
  Speaker 2: Yeah, I mean generally, I haven't had any problems in terms of the quality and again, also the compounding pharmacy that we use.
• 27:49
  Speaker 2: You know, I would use specific ones that I know and trust, and so I think that also is important as well where it source from in terms of the local compounding pharmacy.
• 28:02
  Speaker 1: Gotcha, and another one, low dose, naltrexone.
• 28:05
  Speaker 1: There was controversies.
• 28:07
  Speaker 1: There were controversies some years ago about doctors prescribing this, for you know, I mean, I think it started off with drug addictions, didn't it?
• 28:15
  Speaker 1: And then it's use expanded and there was this pushback.
• 28:19
  Speaker 1: There was this real resistance to doctors being able to prescribe it.
• 28:23
  Speaker 1: Any issues there?
• 28:24
  Speaker 1: Are you restricted in any way?
• 28:30
  Speaker 2: No, I mean again, it's not something I press for commonly, but it's more.
• 28:35
  Speaker 2: It can be prescribed if it indicated.
• 28:38
  Speaker 2: You know, if there's been ongoing chronic issues and you know many, many things have been tried and you know, because there is anecdotal evidence and also a lot of published research and more and more of it now, that it can be helpful, then it's at least worth a trial, with the patient's consent and again, as with anything, always starting the lower dose and working up as appropriate and always doing it as a trial.
• 29:03
  Speaker 1: Yeah, and I loved, obviously, what you said about lifestyle issues first, and you said earlier, right at the beginning, that you investigated cognitive behavior therapy, which it would have been interesting to see how many of your peers, your cohort, were also investigating that, seeing how important it is and how useful it's been shown.
• 29:23
  Speaker 1: And I might say just even though Dr Mark Donahoe hassles me every time I say it and he says it's it's mindfulness, but but with regards to CBT or other mindfulness therapies, how much bang for buck do you get using them with Hashimoto's, knowing that one of the major issues or triggers of antibodies is stress?
• 29:58
  Speaker 2: Yeah, I think it's so, so important for people to find something that works for them and yes, there's many different techniques that are available.
• 30:06
  Speaker 2: I think you know there's so much evidence now on on the benefits of meditation.
• 30:13
  Speaker 2: I sometimes quote a particular study done on a specific type of meditation where it was a 12 minutes a day.
• 30:22
  Speaker 2: It was a mantra based meditation, which they studied over eight weeks and they looked at blood markers and the brain scans that they found that not only was there symptomatic improvement in mood and sleep but it also switched on and off.
• 30:37
  Speaker 2: About 70 inflammatory genes increased you know telomerase, you know anti-aging enzyme by about 43 percent.
• 30:44
  Speaker 2: There were changes in the in the blood flow on the scan.
• 30:49
  Speaker 2: So to think that there was a 12 minute meditation and those results in a eight week period is fascinating.
• 30:56
  Speaker 2: And I think we also have to bear in mind that sometimes we're meditating we think nothing's happening, but there's so much happening in the background and these we know it feels, we know it feels good, but you know it's.
• 31:09
  Speaker 2: I still find it fascinating to read these studies because you know I mean yoga, meditation is one of my passions and it's always interesting seeing all these new studies coming out because there's so much going on in the background and it's just a case of that persistence and creating that habit, even if it's two minutes a day, even if it's just five minutes a day, and cultivating that habit, it's a great return on investment.
• 31:39
  Speaker 1: I have to ask about the iodine and selenium treatments available.
• 31:45
  Speaker 1: Years ago, over a decade, over two decades now, there was this, this thought of using this extremely high dose of iodine, massive doses, milligram doses, yeah, like 50 milligrams.
• 32:01
  Speaker 1: Where has this led?
• 32:03
  Speaker 1: What issues did we face, not just medico legally, but also obviously the biggest one, patients.
• 32:09
  Speaker 1: How did patients fare?
• 32:12
  Speaker 2: yeah, I mean suddenly, when I what was the rate of patients from other practitioners or through their own reading were taking high doses, I mean I could certainly see the antibody levels go off dramatically, absolutely, and people often would feel clinically worse.
• 32:30
  Speaker 2: So yeah, I'm quite conservative with that.
• 32:35
  Speaker 2: You know, I do like to measure the iodine and use it as appropriate and you know, obviously it's a U-shaped curve.
• 32:40
  Speaker 2: It is a very fine line like, yes, we need enough of it for steroid, but also ovaries and breasts and you know, all cells require iodine.
• 32:50
  Speaker 1: But it's just, you know, it's about just being sensible with it as well and so it is still an issue yes, so that's where I was going to lead to is we know that we need it.
• 33:03
  Speaker 1: I mean, kreswell Eastman's been tearing his hair out for years.
• 33:06
  Speaker 1: What literally has left but, um, trying to get GPs to wake up to the fact that pregnant women require a supplement of 150 micrograms, as well as food, because we just don't have enough for the requirements in pregnancy.
• 33:20
  Speaker 1: Yeah, and what is it?
• 33:24
  Speaker 1: The upper limit is is 1,100 micrograms upper limit of normal.
• 33:30
  Speaker 1: So where do you tread there?
• 33:34
  Speaker 1: With regards to Hashimoto's management, knowing that too much might fire somebody up, do you concentrate on foods like you know seaweed, eggs, etc yeah, I think, dietary as much as possible and also monitoring as well.
• 33:51
  Speaker 2: So you know, if they are very deficient in it, then you know there can be justification to certainly, you know, optimize the diet but potentially use a supplement.
• 34:02
  Speaker 2: And as long as this you know, you know if we have selenium, another antioxidant, on board then that can reduce that oxidative impact of iodine.
• 34:11
  Speaker 2: So I don't, I don't generally use iodine by itself but coupled with selenium and, and you know, the patient having a good, you know, antioxidant status, usually that would be fine.
• 34:21
  Speaker 2: But again, it's small amounts and and regular monitoring as well gotcha, I think it was a study by hope.
• 34:34
  Speaker 1: I get this author right.
• 34:35
  Speaker 1: Drutl et al.
• 34:36
  Speaker 1: Um, yeah, I'm hopeless with the years I'm going to say 2008 where selenium was used for thyroid orbitopathy.
• 34:46
  Speaker 2: Now, obviously, that's normally hyperthyroid, but yeah, is selenium a sort of buffer, a sort of buffer of safety margin, if you like, against iodine, against the issues with iodine yeah, and suddenly, quite, quite a few studies have shown that that if we have adequate selenium, that that can reduce the the the sort of the pro-opsin effects of of the iodine as well.
• 35:16
  Speaker 2: So it's always nice to sort of couple them and you know, we know that selenium does reduce the thyroid antibodies gotcha.
• 35:25
  Speaker 1: Can I also ask about the form of selenium?
• 35:27
  Speaker 1: There was a what Margaret Rayman I'm sorry, I'm weird on these things.
• 35:30
  Speaker 1: Margaret Rayman spoke about that.
• 35:32
  Speaker 1: You know the sort of accepted safer form of selenium was selenomethionine, but she also mentioned in an earlier paper that sodium selenite didn't enter the enzyme pool, and so in some instances it may be preferred, and I still get confused as to which one therefore is.
• 35:54
  Speaker 1: Is it more effective because it's more toxic?
• 35:58
  Speaker 1: Is the safer one less effective?
• 36:01
  Speaker 1: What are you?
• 36:03
  Speaker 1: How do you, how do you wind your way through that one?
• 36:07
  Speaker 2: yeah, I generally.
• 36:08
  Speaker 2: I generally use the, the selenomethionine, so I find that there's standard preparations.
• 36:14
  Speaker 2: It seems to work well, as well as obviously having that awareness of what's you know found in the foods as well.
• 36:20
  Speaker 2: So you know good old brazil nuts and obviously that that's not a, that's not that accurate.
• 36:26
  Speaker 2: You know there's so many factors there.
• 36:27
  Speaker 2: It depends on the soil in the country.
• 36:29
  Speaker 2: It's not, it's not the rule that four, four brazil nuts will be enough.
• 36:32
  Speaker 2: But you know to always still have that awareness that we're still getting getting that through the, through the diet as well wonderful.
• 36:40
  Speaker 1: There's so much obviously we can talk about and we can't cover today.
• 36:43
  Speaker 1: Amy, thank you so much for taking us through some real practical things that we as practitioners can do to help our patients, and indeed patients can do to help themselves.
• 36:52
  Speaker 1: But where can we find out more?
• 36:55
  Speaker 2: yeah, so I've recently released a book called slow butterfly how healing your thyroid transforms everything, and that's available through amazon and other online stores, but that was written out of out of this.
• 37:08
  Speaker 2: This you know experience and passion about.
• 37:11
  Speaker 2: You know how, how we need to be managing hyperthyroidism, hashi motives.
• 37:16
  Speaker 2: You know in a different way based on on my my experiences.
• 37:20
  Speaker 2: So you know it's it's really important to discuss those, those lifestyle aspects, and you know, have that awareness of different complementary therapies that can be useful as well.
• 37:32
  Speaker 1: Dr Amy Gajar, thank you so much for joining us today and taking us through this.
• 37:35
  Speaker 1: It's very important stuff, very common, all too common, and you obviously have a true dedication to finding out the real issues what's with what's going on with your patients and helping your patients by individualised treatments.
• 37:48
  Speaker 1: Thank you so much for joining us today on wellness by designs.
• 37:52
  Speaker 2: Great.
• 37:52
  Speaker 1: Thank you, andrew and thank you everyone for joining us.
• 37:56
  Speaker 1: Of course you can catch up on all the show notes.
• 37:59
  Speaker 1: We'll be putting up a lot of references with this.
• 38:01
  Speaker 1: It's so important to capture as much information as we can.
• 38:04
  Speaker 1: So the show notes and the other podcast, of course, on the Designs for Health website on Andrew Whitfield Cook, and this is wellness by designs.