Dr. Krupka (00:01):
So I just had a situation with a patient. I thought I'd discuss it since we recently did a couple of thyroid hormone related videos. Had a patient call in today. We were going over some of her thyroid results. She deals with another practitioner to get her thyroid hormone prescribed. She takes NP thyroid, which is kind of a mix of T4 and T3. So there was a misunderstanding on the part of her practitioner, and it's a good example of what can happen if you don't understand what the different numbers mean. I'm just going to go over it with you real quick. Because she's taking thyroid hormone, her TSH is very low. Remember, TSH is how you ask for thyroid hormone. If you're taking pretty much everything you need for thyroid hormone, your pituitary doesn't have a reason to ask you to make more, right?
(00:56):
So your TSH is going to go very low. It's perfectly normal. We expect it. In fact, in cases where someone's had thyroid cancer, they'll give them enough T4...
Speaker 1 (00:03):
Autoimmune thyroid problems to some degree autoimmune problems in general, but I'm going to kind of try to keep it to Hashimoto's on this video. But how do they develop? What goes wrong? Can you do anything about it other than just replace hormone? Can you reverse it? Can you get back off thyroid hormone once you've been taking it? Let's tackle those issues in today's video. So I did a video previously about Hashimoto's. What is it? How you test for it? What are the criteria for diagnosing it? I'll put a link to that onto this one, but otherwise, just go back through my blog. You'll find it. It should be posted very close to when I'm posting this one. The intention is to post that one in the following week, post this one, so it shouldn't be hard to find, but assuming you remember all that or you took notes or you've just watched it.
(00:51):
Let's talk about how something like Hashimoto's would develop Hashimoto's. Again, quick reminder, it's antibodies to the...
(00:02):
Hypothyroidism, TPO antibodies, some lab numbers kind of criteria for diagnosis and the physiology of making thyroid hormone. Let's talk about that today. I've had some questions lately. I realize I haven't done one of these videos in quite a while, so let's knock this out. Hashimoto's is going to be a name used for the condition of having antibodies toward your thyroid. I'm going to get a little more specific with you, but I think in common terms, I think we've come to the point where if you have an autoimmune thyroid condition, they're just going to call it. I think that's probably fine. I don't think getting super specific about that really makes much of a difference. You'll see why I say that in a minute. So if you have an autoimmune attack on your thyroid, it's going to be called Hashimoto's. Now, let's go through how you make thyroid hormone so that we kind of have the same terminology as I talk about testing and diagnosing.
(01:00):
So you have a gland kind of tucked...
I received an article just recently written by Dr. Ron Grisanti and he is with Functional Medicine University. That's one of the places where I trained. So I get their articles from time to time. They are usually pretty good. They're very concise. So I want to share this one with you. This one's about a lab test called APO B or Apolipoprotein B. Now we're all used to doctors using a standard cholesterol panel or lipid panel to kind of judge the risk of cardiovascular disease. Well, if you've been seeing me for any length of time, you know that I kind of disagree with the utility of a basic lipid panel for that. I think you can learn some things from the triglycerides. There are a couple of ratios you can run, but it's limited in what it can give you. So one of the tests that's becoming more popular now, and we do it on our annual physical panel is called Apolipoprotein B, and it's proven to be more predictive of who's likely to have cardiovascular disease or plaque in the arteries...
So a question I get regularly from patients is, can they get their family practice doctor, or gynecologist, or endocrinologist, whomever, to run our lab panels instead of us running them? Which I don't mind. I tell the patients regularly, I don't care who orders it. As long as it's got the components that I need, it'll work for us. So that comes up regularly.
Well, there are several reasons why we've had very little success getting other doctors to run our lab panels. So I just want to run through this real quickly. It's, again, something I answer pretty regularly during an average week at the office.
So number one, understand that I do functional medicine, and the lab panels that we've put together are specifically geared toward finding underlying mechanisms. Looking for problems before they are so far down the road that they're diagnosable. Looking for indications that there's dysfunction even if there's not disease at this point.
That's, to a large...
Magnesium deficiency is probably the second most common nutritional deficiency in the industrialized world, right? Definitely in the us. Um, it, it kind of goes back and forth with vitamin D depending on who you talk to, but that's how it made its way onto our foundational five. We find magnesium deficiency in, I probably, I would say 50 or 60% of the patients in which we test magnesium. If they're not already supplementing with it, they end up being deficient in it. Um, vitamin D is probably a little bit higher than that. Um, and, and I don't know if that's just because more people are supplementing with magnesium, but it's an issue. So real quick testing for magnesium, uh, very specific test. You will get a magnesium test a lot of times in your regular lab work, but it is a serum magnesium test. The normal range will be somewhere between probably one and three, something like that.
(00:57)
Um, and, and that's not an appropriate test for magnesium. It's accurate...
Next on our list of the foundational five is vitamin D. I've done videos on vitamin D in the past. Please go find them. Um, they're gonna have more information than I can put in this video here, but I'm gonna give you kind of a, a, a rapid overview on vitamin D. So, vitamin D, anti-inflammatory, anti autoimmune, immune regulating, anti-cancer, um, not directly, but helps our body do all these things, right? It supports our body's natural mechanisms for doing all these things. Um, so very important to have. It's generally considered the most, if not in the top two. Uh, magnesium being the other, uh, nutritional deficiencies in our bodies. Uh, we make vitamin D from the sun. Sun has to hit our skin, not really showing your skin there and interact with cholesterol. And that makes the first conversion that it has to go to the liver, get converted to the kidneys, get converted, then you finally get active vitamin D.
(00:58)
So it's a multi-step process. Um, and...
So next on our list of the foundational five, we've already talked about multivitamins, we've talked about fish oil. This video, we're gonna talk about probiotics. And the next couple of videos we'll handle vitamin D and magnesium. So probiotics, those are the good bacteria that are supposed to be in our gut. Now, a couple of misconceptions about probiotics. Many people feel that when you take a probiotic, you are trying to colonize the gut with what you're taking. I mean, it wouldn't be bad if that happened. I think probably a little bit of that happens. But by and large, the reason you take a probiotic is that on its way through your system, while it's temporarily in there, it changes the environment somewhat. Those bacteria that you put in there, and sometimes nutritional yeast that you put in there, they ferment your food on their way through, and the byproducts of that fermentation set up an environment that's advantageous for your normal flora to kind of...
Continuing the foundational five series. The last video I did was on multivitamins. If you didn't catch it, look around wherever you're seeing this video and you'll find it. Today. I'm talking about the second component of the foundational five, and that's ul. So it as a recap, the foundational five generally supplements that I think everybody would benefit from. Same disclaimers I did on the last video. I'm not giving you medical advice. Take notes on what I'm telling you. If some of this is of interest or you think you want to take one of these, if there's any question about whether it's relevant for you or not, or safe for you or not, speak to your functional medicine practitioner, um, your nutritionist, somebody that understands supplementation. Alright? If you ask your regular family doctor about supplements, they may or may not have any knowledge at all about supplements in the information yet may be less relevant than what you're getting here, even though...
To me, there are five main supplements that, that I kind of call my foundational five that almost everybody would benefit from taking. Now I say almost everybody, so understand real quick disclaimer, I'm not giving you medical advice. I don't know your specific situation, so take notes on what I'm gonna say and know that these are generally good for everybody, but there may be some special circumstances for you. So discuss that with your functional medicine doctor or your clinician practitioner who's knowledgeable about nutrition and supplementation. Your regular family practice doctor might not know much of anything about supplementation and they're not always the best, um, resource for whether or not you should or can be taking something, find someone knowledgeable about supplementation. So that being said, the foundational five for me, uh, it's gonna consist of number one, a multivitamin of some sort, fish oil, probiotics, vitamin D, and magnesium.
(01:09)
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