Selenium
Anxiety, hair loss, elevated thyroid antibodies
Thiamine
Fatigue, low blood pressure, adrenal issues, blood sugar swings
Vitamin D
Low levels on test, autoimmunity, seasonal affective disorder/depression
Zinc
Poor wound healing, impaired T4 to T3 conversion, impaired smell, acne, low alkaline phosphatase, poor appetite, skin rashes, hair loss
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Selenium
Selenium is a trace mineral that plays a critical role in thyroid function, and deficiency in it has widely been recognized as an environmental trigger for Hashimoto’s. Selenium acts as catalyst to convert inactive T4 to biologically active T3 and helps protect thyroid cells from the damaging effects of hydrogen peroxide, which is generated for the synthesis of thyroid hormones.
Most people with Hashimoto’s are at risk for this deficiency. Other populations at high risk include those with IBS and celiac disease and those who consume grain-free diets!
Supplemental selenium has been found to decrease Hashimoto’s antibodies, reduce Hashimoto’s symptoms, improve Graves’ disease outcomes, and reduce the incidence of postpartum thyroiditis when taken during pregnancy. I credit selenium supplementation and blood-sugar balance with lowering my thyroid antibodies and helping me get rid of panic attacks. My clients report the same results over and over again as well as fewer palpitations, more energy, and less hair loss.
A common misconception I hear around selenium is that Brazil nuts are the best option for replenishment. The problem with this approach is that selenium content in Brazil nuts can vary tenfold, meaning they can contain anywhere from 55 mcg to 550 mcg of the nutrient. It all depends on where they were grown (proof that nutrient absorption from different soils and farming practices can make a huge difference!). Unless your Brazil nuts were tested for selenium content, you might be unknowingly overdosing or underdosing yourself. Plus, you may also be sensitive to nuts! With supplemental selenium, you can get a specific dose and avoid potential sensitivities.
Selenium is a nutrient with a narrow therapeutic index, so the dose has to be just right to ensure efficacy and prevent toxicity. Doses of 200–400 mcg are considered safe and beneficial for most people with Hashimoto’s, while those above 800 mcg are considered toxic. Most people can safely take selenium supplements, and most tests for a deficiency are generally not reliable. If you have an adverse reaction to selenium (which is rare), you may be iodine deficient and may benefit from a low-dose iodine supplement (150–250 mcg). Visit the Advanced Protocols in Hashimoto’s Protocol for more detailed information on iodine supplementation.
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USING SUPPLEMENTS
If you have Hashimoto’s, it’s not always possible to get all the nutrients you need from diet alone, since multiple food sensitivities, nutrient depleting infections, and digestive difficulties can interfere with absorption. Adding to the problem is our current food supply, which is not as nutrient rich as it was in decades past, due to soil depletion and farming practices. In some cases, megadoses of nutrients may help address symptoms and conditions, and supplements might present the only way to achieve the necessary doses. This is why I frequently recommend supplements to address outstanding symptoms.
My journey into using supplements began in 2009 when I was diagnosed with Hashimoto’s thyroiditis. Despite debilitating symptoms that didn’t budge with the use of medications, I was told that there was nothing more I could do to feel better.
As a pharmacist, I was trained in physiology, biochemistry, pharmacology, and the cause and effect of diseases, yet my education in lifestyle changes and using supplements was lacking. During my training as a pharmacist, I was taught that supplements were at best ineffective and at worst dangerous; only medications were tested to be safe and effective. Yet my personal experimentation and research led me to discover that proper nutrition and the use of high-quality supplements could restore my energy and vitality and optimize my brainpower in a profound way that medications never did.
What I’ve learned is that not all supplements are created equal. As a pharmacist, I can tell you that many supplements are ineffective, and some are even downright unsafe. The truth is that most supplements do not undergo the same scrutiny and testing that pharmaceutical products do, because many of the tests that are required of pharmaceutical companies are “voluntary” for supplement companies. For this reason, most supplement companies do not take the extra steps to test their products to ensure safety and purity.
Evaluating the safety, efficacy, and cost of various treatments was a large part of my training as a pharmacist. I have put my training to good use in overcoming Hashimoto’s, researching the best supplement brands and, now, in the development of my own supplement line, Rootcology. Rootcology is a blend of my two passions and areas of expertise, root causes and pharmacology: root—going after the root cause of disease—and cology (as in pharmacology)—understanding how tiny amounts of substances affect the human body! Rootcology is dedicated to creating innovative, bioavailable products that are made with the greatest care and with the highest-quality ingredients available. All of the supplement ingredients have been carefully chosen by yours truly to address the needs and sensitivities of people with autoimmune thyroid disease.
All Rootcology supplements are:
–Gluten free
–Dairy free
–Soy free
–Pesticide free
–Toxin free
–Pharmaceutical grade
–Free from potentially harmful fillers
Furthermore, all Rootcology supplements undergo third-party testing to ensure that the ingredients on the label are safe and effective and match what’s actually inside the bottle. I created Rootcology to give you a trusted source of supplements that are safe and helpful for people with multiple sensitivities and chronic health conditions.
Throughout this book, you’ll find charts that contain the supplements I recommend as well as the specific brands, my own and others’, to use. I hope that this information is helpful in your journey!
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Magnesium
Magnesium has been shown to help improve form and function in damaged thyroid glands; it also supports detoxification pathways in the liver and is essential to the production of hundreds of enzymes utilized by the body. People with Hashimoto’s who follow a grain-free diet, thereby omitting cereals that have been fortified with magnesium, or exclude natural dietary sources of magnesium such as nuts, seeds, and legumes may become inadvertently deficient. Deficiency can cause migraines, headaches, insomnia, menstrual cramps, anxiety, joint pain, and a whole host of other symptoms (like intolerance to loud noises).
Magnesium helped me personally resolve horrific menstrual cramps. My clients have also experienced relief from migraines, palpitations, constipation, insomnia, anxiety, and muscle cramps with magnesium supplementation. Studies show that long-term use can also help with normalizing the thyroid gland appearance on ultrasound, and magnesium may also help for thyroid and breast nodules.
The usual starting-dose ranges for magnesium are magnesium citrate at 400 mg or magnesium glycinate at 100 mg; you can increase your dosage according to the recommendations of the manufacturer.
I recommend two specific forms of magnesium: magnesium citrate or magnesium glycinate. Choose citrate if you tend to be constipated; glycinate, if your stools tend to be on the looser side. Also, for some people glycinate can worsen anxiety while citrate can reduce anxiety and promote sleep.
Be sure to give yourself four hours between your thyroid medications and magnesium dose. For most clients, I recommend taking magnesium at bedtime, especially if they have trouble sleeping. If you experience diarrhea, this could be an indication that you are getting too much magnesium and that you should lower your dose or perhaps switch to the glycinate version. Please note, for pain relief benefits, magnesium should be taken daily preventatively, and the d
ose can be increased in times of increased pain or stress.
Zinc
Zinc is an essential element required for detoxification and thyroid function. You also need zinc to form TSH, which is why people with hypothyroidism—those who are constantly producing TSH—are more likely to develop deficiencies. A deficiency can lead to poor wound healing, impaired T4 to T3 conversion, increased intestinal permeability, susceptibility to infections, reduced bacterial detoxification, impaired smell, acne, and low alkaline phosphatase. If you have celiac disease or any other malabsorption syndrome that has caused intestinal damage, you may have an impaired ability to absorb zinc.
You can supplement with zinc to address deficiency, but doses should be no more than 30 mg per day without a doctor’s supervision. Doses above 30 mg may cause a depletion in copper levels. I recommend zinc picolinate, because of its improved absorption profile compared to other forms. To ensure optimal absorption, zinc supplements should be taken with food.
Supplements That Require Lab Testing
Other nutrient deficiencies require lab testing prior to supplementation. This is the case with certain minerals and fat-soluble vitamins that may accumulate in the body, leading to excess. Lab results can help determine the specific dosing and duration that are right for you. The three most important nutrient tests I always recommend for people with Hashimoto’s: vitamin D, B12, and ferritin. These require testing before supplementing and during supplementing to track progress.
Most doctors will order these tests for you if you ask, and the tests should be covered by your insurance. If you do not have a doctor who is willing to order the tests for you or if you have a high-deductible insurance plan, please visit www.thyroidpharmacist.com/resources for self-order options.
Please note, the lab interpretation guide I provide below is based on optimal labs. In some cases, doctors may consider your numbers “normal” when you are indeed deficient. Your doctor may not be familiar with research that shows that suboptimal levels can produce numerous symptoms! Make sure to be an educated and empowered patient, and always ask for a copy of your own labs so that you don’t miss out on the life-changing effects of these important nutrients!
Vitamin D3
Vitamin D is an important immune modulator, which could explain why a deficiency of this vitamin is connected to various autoimmune diseases, including Hashimoto’s. A vitamin D3 deficiency may not present any obvious symptoms and will need to be revealed via testing, although people who live in a northern climate; have fat malabsorption, low intake of fatty fish, low exposure to sunlight, and a history of Hashimoto’s; or are prone to depression likely need vitamin D.
Vitamin D supplements can improve our mood and can help us reduce thyroid antibodies. Both TPO and TG antibodies were reduced in a Polish trial of 18 women who were supplementing with vitamin D to reach a target of 60 ng/ml. I’ve personally found that most of my clients who are in remission from Hashimoto’s keep their levels of vitamin D between 60 and 80 ng/ml.
A vitamin D3 deficiency is common among the general population and even more commonly found in people with Hashimoto’s—68 percent of my readers with Hashimoto’s reported also being diagnosed with vitamin D deficiency—and vitamin D deficiency has been correlated with the presence of thyroid antibodies. Research done in Turkey found that 92 percent of Hashimoto’s patients were deficient in vitamin D, and two additional 2017 studies found that low vitamin D levels were associated with higher thyroid antibodies and worse disease prognosis.
I recommend testing for vitamin D deficiency using the Vitamin D, 25-OH and retesting within three months once you start supplementing to make sure that you are getting enough—but not too much. In contrast to most vitamins, which are water soluble and are excreted by the body in excess, vitamin D is fat soluble and can build up.
I recommend spending time in the sunshine to get more vitamin D if you have Hashimoto’s. If you don’t live in a warm climate, get to one! You have an official prescription for a beach vacation from yours truly! Tanning beds will also do in a bind. (Yes, I said tanning beds.)
Vitamin B12
Vitamin B12 helps us with our energy production, and low levels are commonly associated with Hashimoto’s and may lead to fatigue, depression, neurological issues, brain fog, tingling extremities, nerve damage, digestive deficiencies, seizures, and anemia. People with Hashimoto’s report more energy, improved memory and mood, and much less extremity tingling with adequate supplementation.
Vegans and vegetarians are at greatest risk for deficiency due to the fact that B12 is only found in animal foods and cannot be synthesized by the human body. But people with pernicious anemia (a type of autoimmune condition), low levels of stomach acid, and various gut infections common in those with Hashimoto’s, including Helicobacter pylori and SIBO, can also be susceptible.
Although B12 is water soluble and you technically can’t overdose on it, I recommend testing for B12 deficiency and monitoring your levels to ensure that supplementation is sufficient. B12 is readily available in animal proteins, but many people with Hashimoto’s may not be able to absorb it properly (especially those with pernicious anemia), and even oral supplements may not be able to restore levels. I recommend either sublingual B12 in methylcobalamin form or B12 injections to ensure proper absorption.
If you have pernicious anemia, please note that it’s often caused by the gut infection H. pylori, which can trigger both Hashimoto’s and pernicious anemia. Treatment can reverse both conditions!
Ferritin
Ferritin is our iron-storage protein, which has many important roles, including supporting the utilization of T3 and the transport of T3 to cell nuclei. Low levels are a hidden indicator of iron-deficiency anemia and may lead to fatigue, pale skin, cold intolerance, difficulty breathing, tongue abnormalities, big-time hair loss, and ice or carrot cravings (strange, right?).
Women who menstruate or are postpartum may be at increased risk due to blood loss. Additionally, SIBO, H. pylori, low stomach acid, a vegan/vegetarian diet, a manganese deficiency, and copper and heavy-metal toxicity can cause low ferritin levels.
Ferritin levels may be low even if all other screening tests for iron and anemia come out within the reference range. You need to request for ferritin to be tested specifically. This is something that can be ordered individually or added to a blood panel.
Food can be an excellent source of iron and ferritin, so if you discover that you are low in ferritin, you can also work on restoring levels by eating cooked liver or beef a few times per week. You might also consider eating a vitamin C–rich food along with an iron-rich food to increase absorption. One option might be to eat a serving of organic steak with a hearty serving of broccoli, a cruciferous vegetable that’s surprisingly rich in vitamin C. You can also take a vitamin C tablet and/or betaine with pepsin (more on this in Chapter 3) just after eating iron-rich foods to optimize absorption. Please note, even with an iron-rich diet many people may require additional supplementation, and some may even benefit from iron injections.
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GUIDE FOR VITAMIN D, VITAMIN B12, AND FERRITIN
NUTRIENT TEST
REFERENCE RANGE
OPTIMAL RANGE
TYPE/DOSE
BRAND
Vitamin B12
200–900 pg/mL
700–800 pg/mL
5000 mcg under the tongue daily x 10 days, then 5000 mcg under the tongue once per week x 4 weeks, then 5000 mcg under the tongue monthly for maintenance
B12 methylcobalamin, Pure Encapsulations. If you have the COMT V158M gene mutation or mitochondrial issues, the Adenosyl/Hydroxy B12 liquid from Pure Encapsulations may work better.
Vitamin D (25, OH)
30–100 ng/mL
60–80 ng/mL
5000–10,000 IU per day
Vitamin D by Rootcology; Vitamin D, Pure Encapsulations
Ferritin (iron storage)
12–150 ng/mL
90–110 ng/mL
Foll
ow package instructions or your practitioner’s advice. Iron supplements are the most common supplements indicated in overdose.
Iron Bisglycinate, Thorne; Ferrochel Iron Chelate, Designs for Health; Opti-Ferin C, Pure Encapsulations
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Ferritin is often something that can be deficient due to numerous root causes, so if supplementing didn’t address your levels, you will need to do some more digging. I have more information in the Advanced Protocols in Hashimoto’s Protocol.
If you have elevated ferritin levels, you may have iron overload and may benefit from blood donations. Be sure to retest your levels of ferritin, as it can build up in the body and be toxic. Keep this supplement out of reach of children and pets!
BEFORE YOU BEGIN
When I meet with clients, I share with them much of the same information I’ve shared with you in this chapter. Some people receive this information and are excited, because they finally have a starting point from which to approach feeling better. Others are overwhelmed, especially those who are dealing with debilitating fatigue, because they wonder how they’re going to find the energy to incorporate a new diet into their lives. Still others have a reaction that falls somewhere in between these two—they’re cautiously optimistic.
What I tell my clients and what I want to tell you is that, no matter what, you have to remember that these dietary plans are not for all of eternity. They are approaches to healing your body from Hashimoto’s, but they should be seen as fluid and not fixed; you can try them as they are designed, and then you can let them morph into what works best for your unique body.
It’s also important to keep in mind that healing may take longer than we want it to, but there is a reason for this: Hashimoto’s doesn’t happen overnight, and our healing will take time too. In fact, studies have shown that thyroid antibodies indicative of Hashimoto’s can be present for as long as a decade before the person develops impaired thyroid function. Thankfully, symptom improvement and even full recovery often take a great deal less time than this.
Hashimoto’s Food Pharmacology Page 8