The Gut-Thyroid Connection

Most everyone has something that's out of balance. Some of us have more dispiosis than others. Um, some of us have a higher immune reaction in our gut than others. Some of us have more fat malabsorption than others. So really, I always look at the symptoms and I always ask them what the quality of their stool is. That also tells me that their gut's really inflamed. If they're having lots of diarrhea, lots of loose stool, we've got to address that. Welcome to Health Breakthroughs with Dr. Stangler. I'm Dr. Mark Stangler and each episode we cut through the noise to bring you practical sciencebacked insights for more energy, better health, and a life that feels like yours again. Hey everybody, great to be with you and my special guest happens to be my wife, Dr. Angela Stangler. And today we're going to talk about the gut connection to the thyroid. So Angela, Dr. Angela, thanks for joining us. Well, thanks for inviting me. It's nice to nice to hang out with you again today. So, hey, we're going to talk about again the gut, kind of the hormonal connection to the thyroid. Let's just talk a bit about, you know, the kind of patients that you see. You see a lot of patients, women, thyroid disorders, a lot of hypothyroid, autoimmune thyroid problems. Tell the viewers a bit more about, you know, what you see in terms of the connection between digestive health and and thyroid function, if you would. Yeah, that's a good question and it's an interesting question because today, interestingly enough, when I was talking to a patient and she was, you know, convinced that she had thyroid issues and she had all these symptoms. Her labs looked, you know, actually pretty good, but when we were talking about all of her symptoms, I explained to her that, you know, we we are not diagnosing her with a thyroid condition right now. We're diagnosing her with a gut situation because her gut she has a lot of bloating. She has a lot of pain. And so those symptoms could definitely be reasons for why she feels, you know, very fatigued and some of her hair loss and things of that sort. And then obviously, yes, I I am testing her thyroid. Her mother has autoimmune thyroiditis. So, you know, there possibly could be that connection there. But, you know, this is the thing in general in integrative medicine, you know, treating the entire person is very important. So I never like to just say you know you're just have a thyroid condition because a lot of people come in and they want to hear that where really it is we have to start with the gut because the gut is very important. The liver is involved in the gut, the pancreas is in the gut. You know obviously you have your intestines in the gut and that's all all connected to getting out toxins and making sure that we're metabolizing our hormones correctly. You've done [music] everything you were told to do and something still feels off. Health breakthroughs with Dr. Stangler. We go beyond symptom management to explore integrative sciencebacked approaches to the issues [music] that medicine too often overlooks. Chronic fatigue, brain fog, gut dysfunction, inflammation, hormone imbalance, and healthy aging. If you're ready for real answers and practical tools to support your health naturally, follow health breakthroughs with Dr. Stangler on Dr. Talks or wherever you listen to podcasts. And of course, it can work the other way around. But if people do have low thyroid that can affect their digestive symptoms. Most common thing would be with low thyroid constipation. What do you see when people have thyroid imbalances that aren't treating? What kind of things do you see affecting the gut? So a lot of things that I see if there is an undiagnosed thyroid disease or if someone is coming in on thyroid medication and their management is not very good. Believe it or not, I mean, we were trained to test people's thyroid at least every six months. A lot of patients come in and, you know, they're barely even treat um, you know, tested once a year. And so, yes, things like constipation is something that I commonly see, as is weight gain and fatigue if someone's thyroid is not properly uh, properly adjusted. And, and we've talked about this before, you and I, it depends on the form of thyroid that they're on. uh because not all thyroid medications are created different are created equally and not only that but if your gut is not working correctly you cannot absorb that thyroid medication like you should. So there's it's all multiffactorial for sure. Right. Right. Right. Well, we've talked in a series about leaky gut syndrome and there is some literature in terms of leaky gut connected to thyroid problems, especially the autoimmune Hashimoto thyroiditis and low thyroid. Again, like you said, we're always looking at gut connection to all parts of the body. But what do you do with patients in terms of looking at this connection based on symptoms or maybe tests? So first of all, we always listen to the patient because obviously they know their health history way better than I do. So it's really good to get a good health history with them. If they do have thyroid disease, I always ask about the gut and one of those main reasons like I just discuss discussed is I want to make sure that their medication is being absorbed correctly. Otherwise, you know, it's like they're taking something and they're either not absorbing it at all or it's going right through them if they happen to have some irritable bowel or something that's associated with that. Well, then with the leaky gut, do you like to just go on their symptoms? You know, like get the gas bloating, get their bowels moving, you know, it's probably going to help their thyroid function directly, or do you do test that time? Well, I always like to do testing because it's a confirmation that there is something going on with the gut and there's a lot of options for testing. There's a stool analysis which is also you know very very helpful to look at dispiosis inflammation what the immune system is doing you know as far as the gut goes if there's any parasites and things there's also food testing that you know that we can do a lot of patients want to do food testing and they have gut issues and this is what I tell them especially if cost is an issue I always say to them let's test your stool instead of the foods because you know you can't be sensitive to 100 foods It's got to be because of your gut, right? And so I really try to make them understand that even if we do no testing, we need to focus on healing the gut. And I know you and I have talked before, you've had some patients with SIBO, small intestine bacterial overgrowth where people get overgrowth of bacteria that shouldn't be in the small intestine actually coming up from the colon. And I know you had some patients where their main thyroid hormone, the free T3, was low. And then by addressing that, you've seen the main T3 thyroid hormone come up and and normalize. Tell us about that. Yeah, it's very it's actually quite fascinating. I see that more often than I realize when I kind of look back and it doesn't surprise me anymore. People with abdominal distension, bloating, small intestinal bacterial overgrowth. Quite often when I do their full thyroid panel, their free T3 is on the low side. And so obviously, you know, improving the gut health will help with their thyroid function, but I do end up giving a little bit of free tea to kind of like boost that up a little bit. It makes a world of difference with patients. It's very interesting observation. And you've done a lot of studies with the Hashimoto's thyroiditis. You've looked at a lot of the literature and this is, you know, an autoimmune condition that affects the thyroid. And in a person could be more prone to having thyroid issues. um you know especially low thyroid there's conditions autoimmunity which can cause hyper thyroid too not as common tell us about how you address that with patients maybe start with the gut certain supplements what do you do to help all these you know millions of people or giving recommendations to millions of people out there who have autoimmune thyroid problems and and developing the low thyroid so that's a good question so this is what I always tell people that there's four things that really affects our health and that's stress sugar being sedent ary and not sleeping well, you know, and I always also say, look, health is partly genetics and your lifestyle. And if you are taking care of your gut, most definitely you're going to be able to sleep better for sure. Making sure that you're not eating too close to bedtime because that will affect your sleep. And so, I really bring the gut into the entire protocol in itself because a lot of people don't realize that how important their gut is. you know, maybe they've just lived with having a bowel movement every 4 days and you know, they don't realize that that is not healthy. So, really understanding that the whole function of the gut is to get out those toxins as well as making sure that you're assimilating and absorbing food. And that's another reason why I love the GI map, the other gut tests to kind of show if there's any fat malabsorption going on. And when you look at the different bacteria that may be imbalanced, some of them could be too low, which can then tell you, okay, you've got a little bit of leaky gut going on there. There's like not a band-aid that's covering that intestine, and then things can kind of go through. And I I find it fascinating. And people are always shocked when they start feeling a lot better when I address the gut first and they don't even really look at treating quote unquote the thyroid. Now, if they actually do have, you know, hypothyroid, their TSH is too high, obviously, I'm going to give them thyroid medication. But if it's a kind of on that edge where it's, you know, still in range, I'll treat their gut first, give them some nutritional recommendations and and see that TSH go down. What are some of the nutrients you like to use uh for thyroid? Just gen in general types of nutrition. I mean, besides a healthy diet, do you like selenium, myinositol, vitamin D? What what kind of things do you like? Well, if they actually do have autoimmune thyroiditis, so those antibodies are high, then yes, we do give the selenium and the myinositol. That's really important. I do check iodine with all of my firsttime patients that have concerns with autoimmune thyroiditis. And if that's on the lower side, then yes, I give them a thyroid supplement that includes just the recommended amount of iodine. You know, the one thing, and I know you see this too, is that people come into the office and they they honestly think that the thyroid is causing all their issues, and when you really get down to it, you find out that their digestion is not very good. And so, you know, there's that understanding that you're not just a thyroid gland, you know, and I think that that's kind of a challenge that you and I face every day, but the results are way better than just giving thyroid hormone. You've got to treat the whole person. And how about all these patients on acid blocking medications, the PPIs which suppress stomach acid that people use for gastritis, acid reflux, gird, we know that can inhibit the absorption of you know a lot of nutrients that you know could affect your thyroid too because your your thyroid needs you know certain nutrients including iron as well you know to make thyroid hormone. What what do you see with that in patients? So number one it depends how long the person's been on that medication. Some people come in and they've been on it for like 20 years, you know, so it's kind of hard to convince them to decrease it or to get off it completely. And so the first thing that I do is I add some herbs and things to help support the GI system, help with inflammation. Um, you know, certain things like deerized licorice, aloe, glutamine, you know, all of those sorts of things. get them feeling better and then telling them, "Okay, go ahead and take half of what your dose is or maybe skip the morning dose because, you know, they've been relying on this for, you know, many, many, many years and they are a little afraid to get off it and then they realize as they start, you know, healing their gut, they don't need it as much." Yeah. And with these stool tests, how common are you seeing problems with the microbiome? What kind of things do you see on on a lot of these tests you run in terms of, you know, the microbiome balance? I would say most everyone has something that's out of balance. I mean, none of us are perfect, obviously. Some of us have more, you know, dispiosis than others. Some of us have a higher immune reaction in our gut than others. Some of us have more fat malabsorption than others. So, really, I always look at the symptoms and I always ask them what the quality of their stool is, which kind of shocks them. So, I'll say, "Hey, was your stool a little bit loose?" And they'll say, "Well, yeah, it was." And so that changes how you interpret the, you know, these stool tests. And that also tells me that their gut's really inflamed. I mean, if they're having lots of diarrhea, lots of loose stool, we've got to address that. And are there certain supplements that you like in terms of uh to use to enhance digestive function? So, if we're looking at probiotics, I mean, I I do look at various probiotics to see if there's some out of balance or some not there at all. And one of them obviously is, you know, acromancia. If that's not even present in an adult's GI stool test, then we want to, you know, increase that. If someone's got like a really secret low secrettory IGA, then giving them a good general probiotic is a is a good idea, like a higher dose like 100 billion or something. And incidentally, I mean, I'm sure you see this as well, but people come in on probiotics and there's maybe like two billion, you know, or four billion, and you have no idea, you know, what's actually active in there. The other thing that I would do is if there's a lot of like higher amounts of the inflammatory type bacteria, then I want to give herbs and nutrients that you know we just spoke about like the aloe and the glutamine and things to help you know decrease that inflammation which is really important. Uh do you use digestive enzymes at all? I only use digestive enzymes if the patient tells me that their stool was, you know, relatively on the harder side or really wellformed and it shows that their enzyme activity is low. If the enzyme activity shows it's low and they've got a super loose stool, then I can't be sure that that test was right, you know. So, in that case, I just tell them, you know, to chew their food really, really well. But, you know, if they've got, you know, kind of a form stool or they're constipated and they've got low enzyme activity, then absolutely. and it makes a world of difference. Hey everybody, I want to take just a quick moment and invite you to my website drstangler.com. Here we have the supplements that we've been using with our patients for many, many years. High quality and high potency supplements, very pure. So if you're looking for highquality supplements where you can notice a difference both in how you feel on your lab test, go to our website at drstangler.com. And then how commonly for the patients that you give supplements for their thyroid or medications for their thyroid? I mean how commonly do you find that improves different digestive symptoms? That's a really good question. In the SIBO patients, I will see tell you that giving that extra T3 does make a difference. It's it's one of the contributing factors that make a difference. I mean it not only helps with their fatigue, that's a big one is their energy, helps with their constipation. That's also also helps with their brain fog. But the thing is is it's not going to work if I don't fix their gut because like we talked about before, we're not going to get that good absorption of of the medication. And what kind of uh thyroid medications do you like to use with patients because there's different categories of them? Yeah, that's a hard question because everyone's so different. And I mean with me when you and I were going through my journey with autoimmune thyroiditis, I think we tried three different forms of thyroid medication until I felt stable on one of them. And so number one, if someone comes in on one already, I usually stick with that, you know, unless they're not feeling well. But I always prefer the compounded T4 and T3 for many reasons. Um, number one, I can control what additives are in there, which I really like. Number two, I can control if I want the T3 to be to be sustained released or extended release. So, that's really nice. And I like them separate so that I can adjust the doses if I need to. You know, some of the combination T3, T4s, I mean, I'll use them if someone's already on them, but they're not my favorite. And I don't like synthetic hormone replacement at all. I only like the bio identical thyroid hormone replacement. Can you tell the viewers what compounded hormones are? Yeah. So, that's a that's quite the explanation. So, basically, they do make up these thyroid medications, you know, in the lab, but they're bioididentical to what is in your body. And so, you're not getting any extra additives, any extra preservatives, things of that sort that are in these in these compounded hormones. So, you know, no gluten, you can say no gluten, uh, which is a big one. Uh, you can say no dyes, which is also a big one. No corn, which is a really big one as well. Like I said, you could make it sustained release. So, here's a perfect example and and I can give my example since it's not a hippo violation, but you know, if I take regular T3 from the pharmacy, my heart starts going really, really fast. It's just too much of a release for me. So I have to get my T3 from a compounding pharmacy. So they can add something into it just kind of like slow that release down so I get more of an even keel throughout the day. So that's the differences that we have with the compounded T4 and the compounded T3. Okay, good. Well, maybe just give us your, you know, final closing statements on, you know, the association between a gut and thyroid function if you would. Sure. I mean, in general, you cannot have optimal health until you do treat that gut. for many reasons. You know, if you're eating foods that are affecting your digestive system, that are affecting your absorption, number one, you're not going to be able to absorb that thyroid medication that you are on very effectively. So, that's really, really important. Um, the other thing is remember your liver, that's all responsible for converting that T4 to T3. We got to make sure that your body is functioning correctly. So, we have to talk about diet, things like decreasing alcohol and sugar and all those things that can affect your immune system. And you know, in your book, it's so perfect because it does talk about how like 70% of that immune system is in your gut. And so, we can't discount how important the digestive system is. And then you get someone, you know, in my age category, the whole menopause, you know, the whole menopause population here. And our microbiome has changed even more. And you know, you and I have always talked about something. You can't veer. You know, once we get older and we, you know, we can't eat like we used to. Our portions need to be a little bit smaller. Those things just kind of happen as we get older. However, we can really optimize our health by chewing our food very very well, which is important because that's where all that um you know digestion starts and then making sure that whatever you are putting in your body is very nutrientdense. And if you are going to be on thyroid medication, remember you're still putting that in your body. And that's why I always choose compounded hormones over, you know, something that's commercially available. Okay, great. Well, hey, thank you for the time and I know for the viewers out there who have thyroid problems, family members with thyroid problems, this will give them a lot of great insight understanding that gut thyroid access. So, thank you Dr. Angela. Thanks Mark. Thanks for listening to Health Breakthroughs with Dr. Stangler. [music] If today's episode resonated with you, please follow the show, share with someone who needs it, and leave a review. It helps more people find us. For more resources and wellness support, visit [music] drstangler.com.

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