The Thyroid Episode of the Quiet the Diet podcast with Michelle Shapiro RD

QTD: Functional Nutrition for Thyroid Health

Season 2 Episode 8 of the Quiet the Diet Podcast with Michelle Shapiro, RD

QTD: Functional Nutrition for Thyroid Health

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In this episode, Michelle sits down with Liz Wolfe, NTP and Stephanie Greunke, RD to discuss the history and evolution of the Paleo Diet over the past 15 years. They touch on its history and health benefits, but also its downsides and what the paleo movement spiraled into.

They discuss: 

  • What is the Paleo diet & why was it created? 
  • The response of different nutrition communities
  • Strict Paleo rules vs. general principles 
  • Downsides of the movement
  • Its ties to orthorexia/ eating disorders/ diet culture
  • Evolution of the Paleo diet into a functional health approach 
  • Where we go from here – finding a “structured flexibility” approach
The Thyroid Episode of the Quiet the Diet podcast with Michelle Shapiro RD


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The Thyroid Episode with Kaely McDevitt, RD, LD, MS

I know I don’t have to tell you this but this episode is only for educational purposes. It is not nutrition or personalized medical advice. We want you to get the most from the episode!

Michelle Shapiro RD

I am so excited to bring on the amazing Kaely McDevitt, who is an incredible functional dietitian. Kaely you know, I’ve not only been a colleague and, as we were just saying, Instagram friends now for a long time, but I am a huge fan of your work. Your approach, your personality, just so much of what you offer. So it is my honor to have you here today.

So when I think of thyroid health in general, I usually have this connotation or understanding from clients or people in the public that we have this thyroid gland. It produces hormones for whatever reason that stops functioning, and then we take a medication, which is the literal hormone that we take exogenously to replace it.

Tell me, how does that differ in many ways? I’m sure from kind of the functional medicine perspective, how you look at thyroid, and just to start on this very high level about how you think that differs – the conventional from the functional.

What is the Thyroid

Kaely McDevitt RD

For sure. Yeah, so if this is a new topic for anybody, the thyroid is like a butterfly shaped gland in your throat or in your neck, and it makes thyroid hormone for us. And thyroid hormone’s job is really to set the pace of function of all the cells of our body. So if we hear the term metabolism being thrown around a lot in the health and Instagram world, your thyroid controls the rate of the metabolism, so energy production and utilization like you mentioned, Michelle.

There’s this misconception that like, at some point this thing just kind of goes off line, stops doing its job, and incredibly common, especially in the women’s health space. Depending on the source, you look at levothyroxine, or Synthroid, which is one of the most common medications used for it, is in the top five most prescribed drugs in the United States. So super common.

I’m sure you see at a time in your clients, we certainly do here, too, and idea is the thyroid’s not keeping up with its workload, so energy production and function in the body slows. so we’re going to take exogenous thyroid hormone to do the work load for the thyroid for us. Now, the lens that we always like to view this through is if the thyroid has slowed down function for whatever reason, why? You know the body does not do anything by accident. There’s always a reason for this and I’m sure this is what we will be talking about most of our chat today.

We would rather look at what’s going on with the thyroid. What are some reasons why this might have slowed down? Because that’s very real. It does happen. And then what can we do to help the thyroid get into a place where it has safety, the raw materials, the green light to go ahead, and when we take medication for it, which not anti-medication, time and place for it Absolutely.

But when we take medication and don’t look at the reasons why we got in that place in the first place, we often don’t see symptom resolution. So people take Synthroid all the time without feeling any less hypothyroid. So we would rather look at what’s going on and what can we do to support that from the root?

Michelle Shapiro RD

Which is the functional medicine or nutrition approach, is always understanding why a problem happened and targeting it and facilitating the body’s own ability to heal and produce those hormones.

Why Does the Thyroid Slow Down?

So when it comes to our thyroid specifically, I think this is going to be a weird way of phrasing this. You have to roll with me. I think of the thyroid’s function often almost more as a symptom than a diagnosis because I think that so many different things can affect our thyroid that I don’t often think or see thyroid conditions being a root cause in it of itself.

Kaely McDevitt RD

For sure, and I completely agree to know thyroid issues are secondary to other processes are things that got out of whack. I don’t think it would exist in nature for the thyroid independently to start having problems. There’s usually something that came before that and some of the most common things we see in clients and I know you do too, from conversations we’ve had is chronic dieting.

1. Chronic Dieting

It’s like this weight loss restricting over exercising under eating culture. And if we think about the fact that the thyroid sets the rate of energy utilization with the body, If there’s not enough energy around, one of the best ways your body can look out for you is actually slowing down the function of your thyroid. Because hey, we don’t have a lot of energy around. Let’s not burn through resources irresponsibly So that’s one of the most common reasons why we see the thyroid function down grade.

2. Nutrient Deficiencies

A couple other really common things would be nutrient deficiencies of the nutrients required for the steps of creating, converting and uptaking thyroid hormone into the cell. Chronic high cortisol is a big culprit for poor thyroid function too. So really anything that’s communicating to the brain that we’re not safe, we don’t have the green light to burn and use energy. We lack resources. Any of those types of signals of lack or lack of safety would be reason why that thyroid would slow down.

Michelle Shapiro RD

I think this for some people is a very novel concept, and for some people is not that our thyroid is not just something that genetically you know, is driven to combust and that you know, I think like the drastic rates. Like you said, it’s one of the top five most popular medications prescribed. So thyroid dysfunction doesn’t happen randomly, but that, like you said, there’s all of these steps before.

Thyroid Labs: A Functional Nutrition Approach

By the time you start to see your thyroid labs get a little bit wonky, how long do you think there could have been a problem underneath the surface?

Kaely McDevitt RD

Oh gosh, years maybe decades at that point, and it’s a slow gradual decline. It’s not going to be like one day I do something the next day the thyroid is showing up wonky on labs. It’s a slow process and that’s I think why this gets missed so often or we don’t see it until things are actually pretty dire. We’re not going to see changes in lab values that cross that clinical threshold until we’re in some hot water there.

Michelle Shapiro RD

And when you say, cross that clinical threshold for people who are new to this concept. So in functional medicine, versus what I’ll call conventional Western modern medicine, the ranges of labs that we use are quite different. This is something that Kaely and I pretty much constantly talk about on our Instagrams.

Thyroid Stimulating Hormone (TSH)

So the clinical definition of labs is the average of all people the issue with that. So when you see this range for, let’s say TSH, and it says 0-4.5, That range is the average for people. The problem is most people in our country are quite sick, so functional ranges are really smaller and more narrow to say we want you to be in this specific range so that it’s more optimal.

Do you have a number you use for different thyroid labs that you feel comfortable sharing?

Kaely McDevitt RD

For sure, we like to see TSH somewhere between 1-2. Typically there’s room for error above and below that of course, and how that client feels and functions is always going to what we see on their labs. But we definitely want to see what appears to be optimal. Thyroid function, not just these broader conventional ranges, which like you said, are based on largely sick population, but there also designed to identify disease. They’re not designed to identify optimal function.

It’s like a “yes or no” for thyroid issues. Not: Are we headed in the wrong direction? Is there room to improve this? Especially if someone’s really symptomatic. So usually in that 1-2 range for TSH, which is sometimes the only thyroid marker you’ll get if you want a thyroid assessment. And it’s very much the tip of the iceberg when it comes to really looking at what’s going on with thyroid.

Triiodothyronine (T3) and Thyroxine (T4)

Ideally, we’d also get a chance to look at free T3 and T4. These are our actual thyroid hormone, with free T3 being the active one that’s actually acting on the cells and doing the work that we associate with the thyroid, and for both of those, we just like to see them in the upper thyroid of whatever reference range that lab is using, which is a good rule of thumb for those.

Michelle Shapiro RD

So this idea also that we are prescribing medication based on TSH alone, and making interventions based on TSH alone. Where are we going wrong with that? And what could the potential issues be with that?

How Do Thyroid Hormones Work?

Kaely McDevitt RD

Yeah, great question and like we were talking about, with TSH being the tip of the iceberg, so if we were to look at thyroid hormone production and conversion in the body, it would start at the top in the brain. Actually, with the pituitary gland making TSH. And TSH is like telling the thyroid hey, do this work. And the higher that TSH goes, the more we know the cells and the periphery of the body is like yelling: Hey, we don’t have enough down here. Let’s speed this up. So TSH will start to rise now.

TSH acts on the thyroid, and the thyroid spits out primarily T4, and a little bit of T3. T4 is still inactive and that T4 is going to be converted in peripheral tissues to T3, which is active. And now we can start to use it.

So if all we ever look at is TSH, all we’re really getting insight on is what is the brain signal to the thyroid like? And sometimes we don’t see issues there, especially if high cortisol and high stress is part of the picture for you, which is very often just being a human today, and also a human with thyroid symptoms.

So if we’re prescribing medication based off that, we actually don’t know the whole story. We don’t know what production looks like from the thyroid. We don’t know what conversion looks like from T4 to T3, and we definitely don’t know what actual uptake of T3 looks like at the cells, so we’re kind of flying blind and we’re pumping the system with T4, which is what Synthroid and Levothyroxine is.

Instead, we should be like, Hey, what what was going on here in the first place? And where actually is the problem? And there’s a lot of different flavors of thyroid dysfunction. And there’s production, conversion, and uptake, and that’s how we would really want to look at it before we intervened.

Michelle Shapiro RD

And TSH doesn’t really tell you about any of those unfortunately. So I think that there’s of course this challenge with clients because so many people listening to this just said Hey, my TSH is a 4.0 and my doctor keeps saying that it’s totally fine. Which is, I know a really frustrating experience for people.

Thyroid Labs To Request

I think that the take away is the TSH is not the full picture, and trying to, when possible, inquire that free T4, free T3, and thyroid antibodies, which will talk about, might just be best if you’re not feeling well to support the thyroid in the ways that will, of course, talk about too, because it’s not always possible.

And it’s such a laborious emotional task for people to first of all, even get a diagnosis of hypothyroidism or Hashimoto’s. I know there’s so much hope and people are like I can’t lose weight – I’d love to have a thyroid diagnosis.

So when they see that their thyroid is functioning perfectly like the doctor says, and it doesn’t line up with their symptoms. So kind of two different routes people can go there, but we understand that, although Doctor should definitely be running more comprehensive thyroid panels, it’s not always possible for people to get them.

Kaely McDevitt RD

Yeah, totally yeah. In my world, there would be just remember that like you are the expert of you. And if something isn’t feeling right, you’re right about that and it’s hard. it’s hard to get information. It’s hard to get full comprehensive panels, and sometimes really hard to even be heard. But what we’ll get into with supporting the thyroid is applicable with or without lab testing, and honestly would just be how to support a healthy body overall.

Symptoms of Hypothyroidism and Hashimoto’s 

Michelle Shapiro RD

When we think of hypothyroidism, we think of Hashimoto’s. What symptoms do you generally see people presenting with?

1. Weight Loss Resistance

Kaely McDevitt RD

Yeah, so weight loss resistance, like you mentioned is a pretty common one, so a slowed metabolic rate.

2. Constipation & Bloating

And we have to think of hypothyroidism as a state of really everything being slow, so we tend to see constipation, so food moving really slowly through the GI tract a lot of times and bloating with that.

Why Does Hypothyroid Cause Constipation?

There’s a couple of mechanisms one will probably talk about more than anybody cares. And it’s related to bile flow, so we have to have adequate thyroid hormone to relax the Sphincter of Oddi, which is what releases bile into the gut. And bile comes from the gallbladder made from the liver, and it is how we digest and absorb fats and fat soluble vitamins. It’s also how we keep pathogens out of the gut. It’s all a trigger for stomach acid production.

So if we don’t have good bile flow and release, kind of that whole system of digestion breaks down. We also need adequate thyroid hormone for the peristalsis of the whole GI tract to happen, which is what moves food through the tract. And without enough thyroid hormone, it literally is going to be slow, so not only are we not releasing digestive juices that help us absorb and break down nutrients that would have helped the thyroid, and also would have prevented pathogens from sneaking their way in, but we also are literally moving those muscles slower through the process, so that leaves us with constipation.

It leaves us with a lot more likelihood for bloating, indigestion, and discomfort, because food is literally sitting longer, and then we’re getting really impaired nutrient extraction.

3. Hair Loss, Brittle Nails, and Poor Wound Healing

Michelle Shapiro RD

I think people notice these symptoms and they can feel very um, isolating and they can feel very like there’s something wrong with me and I’m being gaslit by the world that there’s something wrong with me.

And with thyroid specific symptoms, I also think of like hair loss and brittle nails, and things that can feel again, very aesthetic for people, and with seemingly no explanation, so I also really empathize with people when they can’t get those answers too.

Why Does Hypothyroid Cause Hair Loss, Brittle Nails, and Poor Wound Healing?

Kaely McDevitt RD

Right, yeah, they’re very broad and kind of wide ranging and seem unrelated, but it’s really just everything moving slow, so hair growth moving slow, nail growth moving slow, even noticing, like scratches and scrapes, just really taking a long time to heal or like a paper cut. You’re like dude. I’ve had this paper cut for like three weeks on my hand. It makes no sense, but the cell turnover is slow in the absence of enough thyroid hormone.

4. PMS and Heavy Periods

And then there’s a big thyroid sex hormone connection too, so the thyroid and estrogen have a bidirectional relationship that we might notice more symptomatic cycles, so higher estrogen levels more PMS, heavier, more painful periods.

5. Low Body Temperature

We might, if we track basal body temperature, notice that those temps run low. So with less thyroid hormone were making less heat, so we’re going to feel cold hands and feet, but overall body temperature is likely pretty low too.

Michelle Shapiro RD

There’s this the sensation when we think of hypothyroidism that I’m feeling, which is like you said, the sluggishness, the slowness, and I get the feeling when I think of hypothyroidism that before that hypothyroidism comes in, there’s probably a period of a lot of overheating, a lot of quick moving, a lot of weight, low stress, all of these things, or attempts at weight loss, starvation, all of these things.

Ultimately hypothyroidism is kind of a symptom of that bottoming out almost. Where it’s like I’m kind of over you at this point and I’m kind of over what you put me through and I’m kind of scared that you’re never going to give me this what I need again, so I’m just going to make things super preserved, keep things as safe and as easy as possible.

What is Hashimoto’s Autoimmune Hypothyroidism?

So, I’ll say that’s one way I kind of see from like again, very conceptual level of what I see happening with thyroid. Tell me in the kind of Hashimoto’s category and the autoimmune category what the disease process looks like there, and how it might be the same as hypothyroidism or a little different. Tell me about that.

Kaely McDevitt RD

Yeah, so Hashimoto’s is the autoimmune variety of hypothyroidism. We’ve got some stuff on the other end of the spectrum to hyperthyroidism, but hypothyroidism is definitely much more common in Hashimoto’s. It’s a really really common diagnosis amongst women, especially postpartum when we have these immune shifts.

So in Hashimoto’s, specifically, we start to degrade thyroid function because the immune system builds antibodies against the thyroid itself and we can see elevation in antibodies. Oftentimes, like years before, there’s actually damage enough to the thyroid gland that we see thyroid function diminished, which is why testing for antibodies can be a really great thing.

Why Does Hashimoto’s Develop?

Because we can catch this before there’s been damage done to the thyroid. So we can have antibodies without hypothyroid symptoms for a period of time. It varies quite a bit from person to person, and with Hashimoto’s, I think there’s definitely some overlap. I think a lot of the same lifestyle stuff that led to any variety of hypothyroidism is still at play and the autoimmune component of it is, I think still pretty debated of what’s driving it.

But there are a couple interesting theories, one of them being we have an enzyme called TPO in the thyroid gland that actually converts iodide to iodine. So it’s an oxidative step and we create a lot of free radicals in that step of conversion. And if we lack the antioxidant presence in the body and in the thyroid gland, that conversion step can actually create a lot of damage and inflammation in the thyroid.

So one theory is that if that’s happening and we’re actually hurting ourselves by doing the process of the thyroid, the immune system is like Hey, we’re going to make antibodies against that enzyme because it’s causing problems in there. That’s one of the reasons why things like selenium, a potent antioxidant can be really helpful at bringing antibodies down in Hashimoto’s.

So that’s the theory that’s most interesting to me because my personal philosophy, not based on any science research is just that the body is not doing anything by accident. I think there’s always a reason for it.

Michelle Shapiro RD

I think that’s based in so much science and research actually, and very strong understanding of bio chemistry as well. I want people to start to get this visual of our thyroid as something that’s not existing in isolation. So when we think of it in conventional medicine, we think of our thyroid as being this gland that’s sitting there. It’s just not working. As if you have to give your body some exogenous hormones because it’s not functioning.

Things That Trigger Hashimoto’s Autoimmune Dysfunction

I almost have this vision of a body that’s lit up in all these different areas that the thyroid is interrelated with, because it’s in some ways it’s kind of the command center. I mean, first at the brain is really the command center. Obviously, but the trickledown effects of what it’s being directed to do so in so many ways again. Something as silly as you know, eating too infrequently, doing intermittent fasting for a short period of time. Something like a low carb diet for an extended period of time can cause thyroid distress for people.

There might actually be partially a genetic piece when it comes to the autoimmune component. It’s still epigenetic, obviously, but I think there is maybe more from the Hashimoto’s end. But again, by the time you’re starting to see that hypothyroidism, especially, if you have Hashimoto’s, that means that you were probably running hot for a really long time before you started to experience that sluggishness.

How Does Gluten Affect Thyroid Function?

This autoimmune attack is we think of our body in some ways attacking something within ourselves that it should or shouldn’t be attacking. It’s mistaking for something else, so I have to bring this up. Let’s be gentle. Let’s tread lightly. The biological mimicry and gluten, let’s talk about this for a second.

Kaely McDevitt RD

So if you were to get a Hashimoto’s diagnosis and hit Google, you are going to come across some recommendations to go gluten free, and possibly gluten and dairy free. With Hashimoto’s  and several autoimmune conditions, there’s potentially biochemical mimicry. Biological mimicry is where the immune system is reacting unfavorably to gluten or to dairy, and somehow getting confused with thyroid gland tissue or other tissues in the body and other conditions.

While I definitely am not a fan of blanket food elimination recommendations, throughout the years, we’ve had a number of clients see reduction in antibodies with taking gluten out, but that’s not everybody. So this is not a Hashimoto’s diagnosis equals I’m living gluten free for the rest of my life, or dairy free. But it is one possible tool to explore and see how you feel.

And I know there are several thyroid experts that would disagree with me because they just immediately pull gluten. And you know I don’t think we’re losing out on any super important nutrients just from taking wheat out of somebody’s diet. Like we can live a full life. There are a lot of really great gluten free options out there now. But I haven’t seen it be necessary for 100% of people, at least in our practice.

Michelle Shapiro RD

And I think obviously we’re on the Quiet the Diet podcast, so the goal is always to, when we’re thinking of food recommendations, be as gentle as possible. However, at the same exact time, I want to give people scientific information that could potentially protect them. So, if for someone they’re obviously struggling with some sort of an eating disorder, severe disordered eating, and they’re not eligible for any food restrictions, please pass through this information.

It’s not the right time or season for you to take that on. That being said, I really have seen like you said, a tremendous reduction antibodies. In layman’s terms gluten kind of looks like your thyroid hormone. So your body can mistake and try to attack what is gluten, thinking this isn’t right and not supposed to be here. So it starts attacking your thyroid hormones at the same time, potentially attacking the lining of your gut.

What is Leaky Gut?

So let’s talk about that aspect of gut health and thyroid causing leaky gut.

Kaely McDevitt RD

If you’re talking about anything going on with the immune system, we’ve got to have at least a brief conversation about the gut. And that’s because you know upwards of 70% of our immune system is mediated in the gut, so whenever we want to know what’s up with the immune system, we’ve got to look there too.

Under healthy conditions, we have a great barrier that creates space between things passing through the intestinal lumen and where the immune system is hanging out, and also the bloodstream. But due to stress, which comes up over and over again in hypothyroidism anad all of these things that reduce energy and safety in the body or create a state of inflammation. So of course different foods and inflammatory compounds can do this as well.

We can start to get gaps between the cells that line are endothelium. And this is called leaky gut. I think it’s kind of like a gross term. And like you said, it’s very icky for me now because it’s just been so used. So maybe we’ll just call it like increased intestinal permeability to just be more formal about it.

But we’re literally seeing spaces, these gap junctions between the cells, getting bigger. And that means that if we’ve got inflammatory compounds being released in the gut, if we’ve got the immune system responding to threats in the gut, or even pathogens and bacteria that don’t belong, they release their own inflammatory stuff that can now start to leak into the systemic circulation.

There’s a measure called Zonulin, which is looking at the gap junctions. And there is a big correlation between elevated Zonulin and autoimmune conditions, because we’re now seeing a breakdown between that barrier that would normally keep reactions to food pathogens and bacteria separate from what’s going on elsewhere. And now we’ve got that mixing in with what’s going on with the immune system and entering the bloodstream.

How Can Hypothyroidism Cause Leaky Gut?

Michelle Shapiro RD

It’s like you have a bunch of soldiers at the lining of your gut. If basically you put a couple feet of space in between them, if any toxins came into your gut, those toxins and even normal hormones and things that we don’t want to leave the gut, can leak out. What would happen when they cross that line is either they’re going to get through and wreak havoc on whatever we’re protecting, or your body is going to mount even more responses to try to get them.

So a little bit of you know an army battleground for sure, at the lining of our gut. And what we’re talking about is again if there’s enough space in between, a lot can get through and that can cause a lot of systemic issues.

Our thyroid has a bidirectional relationship with every hormone, all components of our immune system, and our gut. If something that you eat impacts your gut, it’s going to impact your thyroid. If something impacts your thyroid directly, it’s going to impact your gut. So it’s kind of this circular relationship.

Why You Feel Sluggish With Hypothyroidism

Kaely McDevitt RD

I think there is nothing in the body that’s not impacted by the thyroid or doesn’t impact the thyroid, because everything about the body is energy, right? We need energy to make hormones, to digest food, to run enzymes to run detoxx pathways in the liver. It is energy currency, and your thyroid is what’s calling the shots on that energy production.

So anything that requires energy requires the thyroid, and anything that messes energy messes with the thyroid. So I think that’s why, even though it isn’t like the command center, it is still like a higher order process that impacts everything else.

Michelle Shapiro RD

There are definitely these huge regulation mechanisms for our thyroid, and our thyroid does direct so much energy utilization In our body, which is also why we feel fatigue when we have hypothyroidism, too, which is a symptom. I don’t even know if we mentioned, but of course people experience that sluggishness.

When TSH is like 2.5-3.5, it tells me your body is starting to show us a little something here. How do you interpret that information?

How Hypothyroidism Can Leave You Feeling Depleted

Kaely McDevitt RD

I just I have such a soft spot for this state because I think that this speaks to like culture as a whole, and how deeply burnt out and disconnected from their body, and literally playing on a separate team from their body. So many people, not just women but people are today, and that sluggish thyroid state is literally someone that is trying to put up a shield against life.

And there’s like not much left to give, and it’s also a state of not really getting to be an active participant in life anymore, like we don’t have the energy to show up and be present. We’re just trying to get through the day. I think a lot about the individuals that go to work, and a lot is asked of them, and they come home and there’s like nothing left in the tank anymore for hobbies for community for anything.

And the fact that so many people are hanging out in that state is really a heart breaking thing. So I think of it like that like a protection against life. That’s asking a lot and just not having much left in the tank.

Michelle Shapiro RD

I think of it in a very similar way and I was very moved when you said that too, Because it’s awesome to talk about the numbers. It’s awesome to talk about that, but in reality we’re talking about real people and real experiences. And you know I’ve worked with over a thousand clients.

In reality the amazingly positive thing about this is that I see it in my clients who are the person who does everything for everyone else. You’re the person who’s overworked, You’re the person who’s under-nourished, a lot of perfectionist tendencies for sure. And for those people, like you said, it wouldn’t matter how much willpower they had. And that’s the frustrating and devastating part of that is that they’re tapping out at that point and they have no idea why.

And for me, it’s usually the most amazing people in the world who show up with these labs. And I love when someone comes in and you can almost predict you’re like, Oh, you’re a. You’re going to be a 2.5. You can tell. Or you can kind of see where someone’s at. So these are a lot of the same people actually do have hypothyroid diagnoses.

When Thyroid Medication Isn’t Enough to Fix Your Symptoms

They’ve been put on Synthroid, levothyroxine. Would those medications do enough generally to support this very intricate system? Would that help with nutrient deficiencies? Gut inflammation. All of those things?

Kaely McDevitt RD

Unfortunately, no. So it might give some initial symptom relief, and occasionally this is enough to enable the energy to do the work necessary to fix all the underlying stuff. So there’s definitely a time and a place. I’m not here to shame anybody for that, but we’re literally just supplementing T4 for example. So if we had a shortage of T4 cool, we’re going to feel an impact from having that added in.

But all the processes that led to it, the inflammation in the gut, the nutrient deficiencies, the impaired gut health, none of that gets fixed just from introducing some T4 into the system. You might find initial symptom improvement, and then over time that person tires again, and maybe the dose needs to get raised.

And then if your issue wasn’t a shortage of T4, but more an issue with converting T4 to T3 or getting T3 into the cell, it will really have no impact on those symptoms. And I’m sure you see this, too. People have been on Synthroid or Levothyroxine for a long time, and they’re like: I mean, my TSH looks better, but I feel exactly the same.

Michelle Shapiro RD

Oh yeah, it’s almost all of our clients. So my clients that I work with are people who are dealing with either anxiety, gut issues, or having weight lost resistance issues. It’s extremely rare that I see someone with like a gorgeously perfect thyroid panel because all of these things are again all of the same family, and so intricately connected.

Eating to Improve Thyroid Health

So I just want to hammer in this idea that you can take thyroid hormone and still not have a reduction in symptoms. And if that is you, that is real! You are actually experiencing that. So what would the functional nutrition approach be to thyroid dysfunction? What do we actually do then? If medication great, work with your doctor. We’re not saying to stop taking your medication please. Absolutely not.

What is our functional nutrition approach? What’s our best bet here supporting our lovely thyroids?

Eat Enough Nutrients, Consistently  

    Kaely McDevitt RD

    Yeah, well, we have to start with the lowest of hanging fruit and make sure we’re eating enough on a consistent basis, because if we don’t start there, nothing else really matters. We could have like beautiful supplementation.

    We could do all of the things to support the gap, but if we’re not eating enough, we’re not putting enough energy into the system to even have a fighting chance here. we’re going to really be spinning our wheels, and that can be a really hard entry point

    Michelle Shapiro RD

    So obviously we know that listeners of this podcast may or may not have experienced at some point in time some weight, either relational issues, physical weight issues. So when people here, I know my clients who are super hard core executive types. When they hear I’m not eating enough, they’re like, Get out of here. I’m “overweight,” I’m eating obviously enough.

    You Can be “Overweight” and Undernourished

    What if someone’s occupying a larger body? Is it possible for them to still be undernourished?

    Kaely McDevitt RD

    Absolutely. I mean more often than not, at least in our client population too, and if we think about the fact that a sluggish thyroid is going to create an environment where it’s likely that we store excess body fat and really struggle to get it off. We create a really tricky scenario to be in because everything we’ve been told up into this point is like.

    Well, if I’m in a bigger body, my way out of this is to eat less or move more. So I’m going to do that and then that’s sinking the thyroid further. And then we got to do it harder, and then we’re sinking it further.

    And it can be a really uncomfortable and sometimes scary thing to think like. Well, maybe I’m not eating enough, and if it means eating more, what does that mean for the body that I occupy? And like to trust doing something completely opposite of what the typical recommendation is in that place can be really scary. So I do. I understand that and our clients feel that fear too.

    Michelle Shapiro RD

    So how do you actually crack into that cycle Because some people also have debilitating fear of gaining more weight, which again is going to be addressed in a practitioner’s office. The fear element of it, and the urgency of it. For sure.

    Overcoming the Fear of Weight Gain While Eating For Thyroid Health

    When you’re saying eating more, I’m actually getting a vision of also really attacking micro nutrients, almost more than macronutrients. What are we missing out on so much when you say we’re not eating enough? What does that really mean?

    Kaely McDevitt RD

    Yeah, so we would want to make sure that we’re getting adequate representation from our macronutrients: Cabrs, proteins, and fats, because all three of them play a role in this conversation, and specifically carbohydrates come up a lot as a reason why we might see impaired thyroid function.

    We need enough carbs to actually convert T4 to T3, which is a big deal if we want active thyroid hormone. And we’re coming off like we went through the low fat stuff, kind of when we were going through school, and then we went into like a high fat thing, and sort of coming out of that now collectively, which is good.

    So we just see a lot of clients that have been pretty afraid of carbohydrates, are actively restricting them to make changes to body composition, and that’s something that will definitely start bringing some balance back into it. So carbs, proteins and fats represented at all meals. We get our building blocks for thyroid hormone, amongst other things, and we’re keeping blood sugar nice and steady, being the goal and then micronutrients, like you mentioned.

    So there are a lot of them involved production, conversion and uptake of thyroid hormones, so we want to make sure that the foods that we’re getting are nourishing nutrient dense, like bio available, access to these nutrients, so the body is not having to work extra hard to extract then. Because when we’re in that type of thyroid state, our nutrient extraction is not awesome, so we don’t want to be eating things that are hard to get to nutrient wise.

    So we take sa omewhat ancestral approach to nutrition. In our practice, I hate putting any kind of label on any of it. But nourishing nutrient rich animal products and proteins. Incorporating organ meats, if you’re down to get weird with that. Bone broths, those types of things that pack so many nutrients in a very usable form because we’ve got to be efficient with that, especially in the start when extraction of nutrients is poor.

    Michelle Shapiro RD

    So this is an interesting dichotomy from the conversation we were having before too in ways of, let’s say, gluten or something like that. So if you’re having poor nutrient extraction and your body is running a little hot from inflammation, do you think it would look totally different to eat something like a sweet potato for someone’s thyroid versus a doughnut?

    Kaely McDevitt RD

    Oh yeah, for sure, for sure. You had said something about adequate nourishment and I always think of this picture of like the food being gentle and like we’re not working so hard to extract nutrients and it’s bringing actual nutrient. It’s not taking nutrients from us. It’s not coming in with compounds or chemicals or things that are inflammatory. So that’s part of this picture too, is that we’re eating good, real food for the nutrients, but also because we’re leaving out the things that might also be detrimental to the system like refined foods in the standard American diet.

    Weight Loss is More Complicated than Just Calories In, Calories Out (CICO)

    Michelle Shapiro RD

    That brings me to something that I really want to loop in here, which is you know, I’m going to say one of the most dreadful phrases you’ll ever hear me say in this podcast because I don’t mean it. You’ll see why, but, the calories in, calories out situation.

    How not applicable is that to someone experiencing any sort of thyroid disorder? And why is it not really applicable again? A leading question.

    Kaely McDevitt RD

    Yeah, yeah, so as much as it would make everyone’s life easier for this to be purely a math scenario like we could have cut out a lot of years of education to be in this space if this was the case. But if you’re listening to this podcast, you’ve lived the experience that calories in calories that does not work out in real time. So not only is estimating what we need, not a perfect science by any stretch. We have so many other factors that influence it that can’t be accounted for inside an equation. And when we are in a high thyroid state, our burn rate of energy is very skewed, so these calculations are not going to be super helpful for us.

    And one of the things we keep circling around with the thyroid is that energy availability is going to be one of the strongest nods to the thyroid that it can do it’s job freely. So if we are undereating those baseline needs, we’re never going to see that come back on line, so we really can’t approach this from the calories in calories out standpoint.

    Typically, that mindset was part of what got us into this place in the first place, and we have to be creating signals of safety at any opportunity that we have, and that is eating enough, and that is typically above and beyond like a basal metabolic rate calculation, even though those are far from perfect.

    Michelle Shapiro RD

    Exactly. And I have this vision for calories in calories out that our bodies are like a car, and our fuel tank is how much energy we have. And often people are like well, it only matters how much fuel you put in the tank. Well, it’s like if the car is literally off, it doesn’t matter because the fuel is going to sit there anyway, and thyroid disorder is one of the first places we know the car is turned off or it’s working really really slowly.

    Like you said, the actual nutrient extraction might be altered. The actual calories you get from the calories you’re eating because of the gut disruption might be altered, which means that two people who are eating the same exact way will have different calorie extraction from the same foods they’re eating. And our thyroid dysfunction is a huge signal.

    How to Get More Nutrients For Thyroid Health

    The keys are either taken out of the car all together or the car is operating very very slowly. The other piece of this thyroid picture again is this micronutrient piece. I think there’s when we think of getting enough nutrients. What’s our issue? Why are we not able to get enough nutrients in our food? What’s going on with that?

    Kaely McDevitt RD

    Well, there’s a big problem with the degradation of mineral content in the soil, which, I mean, we could go down very long rabbit holes with that. But it’s a scary thing because we could be eating all the “right foods,” but we’re literally getting less minerals from those foods today than we were fifty or a hundred years ago. And as much as I like to opt for food whenever possible, and be pretty minimalist when it comes to supplements, we are at a point where I feel like it’s it’s kind of possible to have no supplementation, especially from a mineral standpoint.

    Because it’s hard to get enough from food, so we are not getting as much from the food that we eat. This is not just vegetables grown in the soil, but also the animals that eat the vegetables grown from depleted soil. So all the whole system is losing minerals.

    And then we’ve also hinted at the fact that being a human is a lot more stressful these days, and stress is something that is going to sap nutrients, especially minerals from you. So we’re in this scenario where we’re getting less from food and we’re burning more through stress, so we’ve got to work like an uphill battle to overcome some of these nutrient losses.

    And then with the thyroid state specifically, if we have impaired nutrient extraction, we’ve got to go even above and beyond what’s present in food to get enough from that because we’re not pulling it all out, so we do have to work extra hard at this nutrient piece in the context of hypothyroidism.

    How to Overcome Weight Loss Resistance in Hypothyroidism

    Michelle Shapiro RD

    It’s also again, this very frustrating feedback bidirectional relationship where your thyroid requires nutrients to work, so it requires carbohydrates to work. But then when you’re consuming those things, your thyroid’s not extracting the nutrient from it as well, so you kind of have to, in some ways just over supply for your body when you have that already, until your body then has enough to get the system running efficiently, and then you can kind of ease up.

    I think that really, what I’ve learned for myself and I know in your practice too, is really the functional nutrition approach. It’s not so much only you know how do we get the body to function properly, but there is a kind of compensation period that you have to realize that while you’re refilling these nutrients, your thyroid is still not functioning well yet, so there’s kind of a lead time with it. Which is very frustrating for people, I think.

    Kaely McDevitt RD

    Yeah, It’s uncomfortable and it involves a complete reframe of how we view our relationship to our body and it creates a really beautiful opportunity to come into partnership with it. Right like that’s a beautiful act to be like: Hey, I might be uncomfortable in the body that I’m living in and I’ve got all these symptoms. I’m just not engaging with life the way I want to right now, but I’m going to take whatever time it takes to eat enough into like surplus, these nutrients.

    And even while I’m not feeling good and trust that that’s my way through instead of the opposite being on different teams, feeling like my body is failing me or being a victim to a thyroid that just decided on its own accord that it doesn’t want to do its job. It’s a very different way to think about it in relationship with your body.

    Michelle Shapiro RD

    And I think from a spiritual perspective you know, our thyroids are so essential and so special to us, and we demand so much from them. And by the time again that you’re having that hypothyroid, by the time you’re seeing your actual labs being degraded, there’s been a lot going on probably in your body and life.

    Stress Plays a Big Role in Thyroid Function

    I think what’s really hard for people, especially New Yorkers (I’m shouting all of you out) is we do not believe that stress is real. We do not believe that stress impacts our health. And one of the first ways that stress impacts us on a physical plane is, I think through our thyroid, too.

    It is a very hard message for people (hilariously) that we deserve to have these nutrients that we deserve to reduce stress. Would you say that it would be extremely hard for someone to support their thyroid without addressing kind of that, that spiritual component to it, that stress component?

    Kaely McDevitt RD

    Yeah, and man, I think when I was like a baby dietitian, I didn’t give that enough weight. Over the years, the biggest lesson has been how big of a deal the stress and nervous system component of healing is. It makes sense if we think of it from like how we got into a depleted state standpoint because it’s like we’re trying to fill up a bathtub with the drain open in the bottom.

    You know where we’re extending the healing length of time if we’re not working on that aspect too. I think the type A perfection and grind/hustle Culture is a big part of why thyroid issues are so rampant, and why that’s the descriptions we would use for most of the clients that we serve.

    And if we’re not working on that, I mean, we’re going to be throwing nutrients and things till we’re blue in the face and it’s going to be really hard to see that.

    Functional Nutrition Strategies For Thyroid Health

    Michelle Shapiro RD

    I also want to give people hope by the way, and that I think thyroid issues are able to be solved. They’re not something that’s so mysterious to us. I just want people to understand that taking even the steps that we laid out here: renourishing from a micronutrient and macronutrient perspective, reducing inflammation when possible, reducing stress when possible, and managing blood sugar.

    It’s frustrating for people to hear also because they’re like, I’m already doing these. These are such silly recommendations. But these foundations – I don’t see in any of my clients when they come in. These are not what I see. But just so you know, I think Kaely, like, don’t you feel pretty confident around the thyroid stuff? I feel good.

    Kaely McDevitt RD

    Oh yeah. it’s great. It’s sometimes almost nice to see because it does impact so many other body systems and you’re like cool cool. We just got to work on this and everything else will fall into line.

    Michelle Shapiro RD

    Totally yeah, and again there are mysterious conditions that pop up, but Hypothyrodism and Hashimoto’s are not as mysterious as we think. I think there’s some amazing new mechanisms that were looking at that are super interesting. But if you support the foundations of your health and you show your body that safety and respect and compassion, the likelihood is the thyroid does come into place.

    Kaely McDevitt RD

    Yeah, I mean, yeah, you are divinely created. It is like such a beautiful system that, like you said really beautifully, just respect and nourishment. It goes such a long way, and your body always wants to be working optimally and is always trying to get back to that. So if we can just align with that same team, things go a lot faster.

    Hacks For Thyroid Health

    Michelle Shapiro RD

    Do you have any fun little hacks for the thyroid? I hate that question, but I know people want it, but it’s a bad question. I understand,

    Kaely McDevitt RD

    So we could get a little bit more specific on those nutrients and maybe talk about some things that we can bring in. I always find that fun work because people associate health with what I’m going to have to remove from my life, and we actually spend a lot more time bringing things back in.

    But if we look at the thyroid physiology as we understand it, there’s a lot of nutrients, especially minerals that are involved in all of those steps, and there’s some pretty cool research about aloe vera juice and Hashimoto’s.

    1. Minerals: Sodium, Potassium, Magnesium

    Aloe vera is exceptionally high in potassium, so it’s one thought of why that might be helpful, but getting more sodium, potassium, and magnesium in the day, so we can make like some tasty mineral cocktails, or you’ve probably come across the term of Adrenal Cocktail on Instagram, because it’s having a moment.

    But those types of like fun beverages are easy to bring in. It’s more exciting than plain water and can really go a long way for thyroid function. Because we need those minerals in most steps of production, conversion, and uptake, so we usually will incorporate those with clients.

    2. Sunshine and Time in Nature

    Getting some time in the sun, time and nature goes a long way and doesn’t get mentioned all that often, because I don’t know. It doesn’t feel as like tactical as a nutrient that you’re bringing in, but goes a long way for just quality of life and stress and nervous system.

    3. Socialization and Joy

    Time and community time with other people, time, playing and laughing, and like experience, Joy goes a really long way too.

    4. Iodine

    And I’m a big iodine fan. Very polarizing, so we won’t go too far down the iodine direction. But we usually do explore that with clients with Hypothyroidism, And we may not go crazy with iodine in all cases, because it’s not always appropriate, but iodine is literally the component of thyroid hormones.

    It’s got to be part of the conversation and assessment, and sometimes it’s bringing iodine-rich foods back into the diet which are relatively uncommon for Americans. Sometimes it’s targeted supplementation based on labs, But that’s another direction we might go.

    Michelle Shapiro RD

    We’ve got to have some dried seaweed once in a while. I love how you and I are so foundations based that the hacks were still foundations.

    Kaely McDevitt RD

    I know they’re lame.

    Michelle Shapiro RD

    They’re not lame. It’s the fact that you and I have a refusal of hacks. That was a very rude question that I asked haha.

    5. Positive Communication With Your Body

    I would say, also, just adding into your beautiful messaging too is I just think people communicating with their thyroid sometimes and just being like: Oh my gosh, thank you so much for working so freaking hard all these years. I’m going to get you what you need. Almost like a sweet little rescue mission.

    Talking to your thyroid like: I’m coming down there. I’m getting you what you need. Working with your thyroid as opposed to judging it for what it hasn’t done. Think of again how involved the thyroid is with the rest of our bodies. How demanding its job is? It’s the hardest working gland.

    I think that just really talking directly to your thyroid too can be can be really sweet and helpful for people.

    Kaely, You’re a freaking rockstar. Where can anyone find you? How can people work with you? You are by a landslide, one of my favorite people on Instagram, so obviously, linking your Instagram in the show notes, and just a darling angel person.

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