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Welcome to The Smartest Doctor in the Room podcast. I’m your host, Dr. Dean Mitchell. This podcast has been on the air two and a half years with a focus on getting expert advice from top medical doctors and researchers around the country.

Today, for the first time I’m reaching out to someone who is not a physician, but who has developed a following as a leading advocate for patients suffering with thyroid disease. Her name is Mary Shomon and she has published many popular books on thyroid disease and weight loss, including The Thyroid Diet and The Thyroid Diet Revolution.

Thyroid Disease Diet with Mary Shomon

Dr. Mitchell:

I tell my patients all the time that in pursuit of medical knowledge, especially holistic and natural healing, that I will travel anywhere and I will listen to anyone that I believe has good ideas, that makes sense, and that have scientific merit. To quote again my idol, which I’ve done on several podcasts, Dr. Bernie Siegel, who’s the author of many books, including his bestseller Love, Medicine and Miracles, he has this wonderful line. He said, “In traveling to the foreign land of illness just remember the doctor is the tourist, but the patient is the true native of the land.” I see Mary nodding in agreement.

As doctors, what I always tell my patients you could look up so many things about illnesses on the internet and learn a lot of information, which I think is great and that helps the discussion with your doctor, but as a doctor I do see hundreds and sometimes thousands of patients coming through with different illnesses and so I share my experience, what I think is going to work best, but I do always tell a patient, “If you can find a friend, a colleague, someone who has that same medical condition they live with that every day and they can hopefully give you a lot of insight and help.” With that introduction, I would love to welcome the native of the thyroid disease land, Mary Shomon, to the podcast.

Mary Shomon:

Thank you so much for that introduction and like you I am a great fan of Dr. Siegel’s and I think I’m going to paraphrase it, but he always said something that I thought was fantastic, which was, “The patients that survive and thrive are the ones who are a real pain in the neck for the medical establishment.”

Dr. Mitchell:

That’s right. That’s right. I love when he say that. He goes, “Be a pain. Be a” … Well, also funny, father used to always say, “The squeaky wheel gets the grease.”

I like to say, “The squeaky wheel makes a lot of noise,” but in this case I do agree with Dr. Siegel. I think you have to be your own advocate to get the best care.

Mary, I’d like to start off the podcast, which again when I was reading your book, The Thyroid Diet Revolution, when you talk about your own personal story. I think the listeners will enjoy this because it involves a wedding dress. Maybe could you share again how you ended up finding out that you had a thyroid problem.

How Mary Discovered She Had a Thyroid Issue

Mary Shomon:

Oh, the famous wedding dress and-

Dr. Mitchell:

What color was it? It was white I assume, right?

Mary Shomon:

It was white, yes. It was a traditional wedding dress and I was in my very early 30s and I had gotten engaged and was so excited about the wedding and found a great dress and ended up going for the first fitting. They fit your dress. They take the measurements. They do everything, so they start the process. Then you go back a couple times before the actual wedding to get fit again. Every time I went for a fitting they had to increase the dress size by another size. Now most brides are super worried.

They want to look great. They’re losing weight. They’re working out.

Oftentimes, the dress has to be tightened up a little and brought in because they’ve lost a little bit or tightened up and slimmed up. In my case, the dress kept getting bigger and bigger. At the same time, I’m supposed to be excited. I’m getting married. I wasn’t a bridezilla. I wasn’t freaking out. I was happy, but I’m stressed out, exhausted, and feeling depressed. I went to my doctor and I said, “Something’s going on. I’m gaining weight.” I had never been somebody that was gaining weight that easily. I was tired. My hair was getting strange. My skin was different. Everything seemed a bit off and that was the beginning of my journey into thyroid land as we spoke.

Dr. Mitchell:

He took you seriously?

Mary Shomon:

Actually, it was a woman and she said to me, “Yeah, there’s something going on.” The first time she said, “Well, let’s watch” and then about the second visit, I think about two months in up to this process she said, “I’m just going to run a thyroid test to see what’s going on.” At this point, I don’t even really know what a thyroid is. I’m completely new to the topic. She ran my thyroid test and like so many patients I got a phone call left on my voicemail. “Oh, the doc found you had a thyroid problem. She called in a prescription. Go get it filled or pick it up at the pharmacy.” I’m thinking everything’s going to be back to normal. A couple of weeks, I’ll be fine. It’s like taking an aspirin or taking an antibiotic for an infection. 10 days, two weeks, I’ll be normal again. Things will be great.

Dr. Mitchell:

When she actually diagnosed you with I assume an underactive thyroid, did she explain to you at that time certain things about what your blood test shows, let’s say an elevated TSH, were you in the normal range? No, she just said go get some thyroid medicine?

Mary Shomon:

Yeah. At that point this is in the early 90s and my TSH was significantly elevated, so there wasn’t a need. My TSH was about 16 or 17, so pretty high when I was diagnosed.

Dr. Mitchell:

So it was very high? Yeah, that was very straightforward.

Mary Shomon:

It was obvious hypothyroidism.

She said, “Yeah, you’re hypothyroid and go ahead and get the prescription filled.” It wasn’t until about three or four months later when I went in for a follow up and said, “This isn’t helping. Something’s not working. I’m still feeling tired. I’m still gaining weight. I’m still feeling low and blue and brain foggy.” And then she said, “Well, let’s start thinking about what the numbers are and how to kind of delve into it,” and then that’s when I started to realize I’m going to have to do my own research. I’m going to have to learn.

The doctor got me into the reference range, so I was probably about midpoint of the hypothyroidism reference range, which most doctors would think that are normal. Like a two. I think about a two and a half or so. She said, “Well, we’ve gotten you into the range,” but I still wasn’t having any symptom relief. The numbers were responding to the medication, but the symptoms were not.

Treating Thyroid Disease – Why It’s Not as Easy as You May Think

Dr. Mitchell:

That’s a really important point I want the listeners to understand because again I’m sure so many of them when they’re first told that they have a thyroid disease that again it seems just so straightforward. It’s almost like blood pressure or something else. Okay, you just take some medicine and it’ll be all fine, but there are a lot of nuances. I always like to tell my patients, “Everybody is an experiment of one.”

What works for one person might not work for the next person. You were still on your journey. The journey had not ended.

We’re probably going to get into more of your journey as I’m going to go through some questions. You said something interesting and that made me actually kind of smile when I was reading your book that back in the day thyroid was sort of like a dirty medical word and what I mean by that is on TV, on comedy, they would joke about women who were portrayed as having … Oh, I have a glandular problem.

A thyroid problem, because again they were trying to scoot around the word like oh there’s an issue of obesity. I’m sure a lot of doctors had women that came into them and said, “I can’t lose weight. I’m doing everything I can,” even if they are still eating the wrong foods and the doctor saying, “Okay, it could be a glandular problem.” I bet also there for a while a lot of “weight loss” doctors that were prescribing a lot of thyroid medication to patients, just to try to get them to lose weight. I think that’s where that all became associated with … But why did you bring that up? Why did you feel that thyroid was a dirty medical word?

Mary Shomon:

I think part of the problem that you’re talking about too is that we had this era in sort of the Valley of the Dolls period of the 60s when there were some unscrupulous diet doctors who were handing out amphetamines and thyroid, sort of hand in hand together for weight loss, but it was a very small number of doctors. Most doctors are not looking at thyroid medicine as a weight loss treatment, but I think it got a bad rap in the broader medical world that people were looking for thyroid medication as a diet cure. That’s a myth that’s pervaded the entire thyroid world still now 40, 50 years later. It’s also gotten a dirty word I think because thyroid is a condition that affects women primarily. It affects mostly women in their perimenopausal and menopausal years for the most part, 40 plus, and it’s associated with things like hair loss and weight gain and fatigue and depression. Who wants to walk around with a big book while they’re on the subway or out at the beach that says my thyroid. It feels embarrassing to a lot of women. Celebrities don’t admit it as readily. There are celebrities who would rather tell you they have cancer than they have hypothyroidism.

Dr. Mitchell:

Interesting. Wow, interesting. I know you mentioned that. You just brought up also a lot of the symptoms that I think the listeners should be on the lookout because they are very common symptoms. Again, in my practice and I just interviewed Dr. Jacob Teitelbaum about chronic fatigue syndrome, I see a lot of those in my practice, but of course a lot of these symptoms are seen in multiple illnesses, not just thyroid disease or thyroid could be the cause. As you mentioned, hair loss, which again really freaks out women, men as well.

Fatigue, weakness. I think the other things that a little bit more subtle, which sometimes doctors didn’t always want to hear about were poor concentration. They’ll say, “I just can’t do the numbers and the math and the computations that I normally do.” Constipation, which again I’m always amazed how many patients, especially women, who live with constipation for years, not realizing the medical issues with that whole microbiome discussion.

“Oh, it’s just normal. I have to go to the counter. I have to use laxatives all the time.” I think the other thing are skin rashes. There are certain skin rashes that are sometimes be associated with thyroid and other related autoimmune diseases, so what did you do? What was your next step as far as diet or what did you do to help yourself?

Mary Shomon:

Well, my next step was to become educated. I sort of adopted a motto that I still have today. One that I really try to encourage other patients to take on, which is that, “I am the CEO of this particular operation.”

I need to bring in the best people for my particular organization, so my doctor was very open-minded and willing to learn, but she hadn’t been dealing with that much hypothyroidism and Hashimoto’s et cetera. She was willing to learn along with me. I dived in. I went online in the earliest days of the internet and started connecting with other thyroid patients to hear their stories.

Dr. Mitchell:

It really was, gosh, it was in its infancy. I mean, that’s the best way of putting it.

Today I know anybody, even my mom, God bless her, she’ll go online and she’ll Google any kind of aches or pains that she has. She gives you a whole list of things. It becomes an immediate authority, but back in 1995, that wasn’t so easy.

Mary Shomon:

Oh. No.

Dr. Mitchell:

There was no Facebook groups, so right.

Mary Shomon:

Exactly. I remember dialing into the National Library of Medicine and looking at DOS listings of articles, trying to find things that I wanted to read, so it was quite an adventure, but I was able to connect with other patients and find out that I was not the only one who wasn’t feeling well on.

Well, in those days we had the Usenet support groups, which were these online forums that were very rudimentary, but you could post something and people could comment back to you.

It was an early chat room type of an approach.

That was the early days of AOL, so AOL had some chat rooms as well, devoted to thyroid. I was able to start connecting with patients, connecting with practitioners. Then, eventually started one of the first websites dedicated to fibroid disease back in 1995.

Advice to Individuals Who Think They Have a Thyroid Issue

Dr. Mitchell:

Well, the reason I’m asking this too because it’s what’s so interesting what I see in my practice because I do see a lot of thyroid cases because my wife and I, Dr. Ricki Mitchell, we do holistic medicine in New York, along with conventional medicine.

It’s very interesting because I think also it depends. That’s why I was interested in you as such a leader among patients. That depends who they see. If a patient sees sometimes and not to really be critical, but sees an endocrinologist, they could have some of the symptoms we’re describing. They could have a TSH of four or five and say, “You know what? You’re okay. This is not the problem.”

Whereas if they see a functional medicine doctor like myself, like Dr. Kent Holtorf out in California, Dr. Teitelbaum in Hawaii, then they’re saying, “You know what? This should be treated.” So, that’s why I was curious.

Again, you were such an early proponent of being an advocate for yourself and for thyroid patients. What would you tell a friend now if they called up and said, I’m not feeling so great. I have fatigue. I have constipation.” She’s sharing you intimate stuff. “I know I read your books. I got my thyroid tests. My doctor just did a TSH. He didn’t do the other ones, Free T3, Reverse T3. All that that we look at. It’s like four or five. What would you tell that friend to do?

Mary Shomon:

Well, I would start by saying, “You’re not a lab value. You’re a person. Number one. Number two, the reference range is for reference purposes. It’s not an arbiter of everyone’s treatment and how you feel.”

I would urge her to probably jump out of her current relationship with the doctor that she’s seeing. Find someone who’s more knowledgeable about managing more subtle hypothyroidism and who recognizes that there’s an optimal range. Not just the normal range.

Dr. Mitchell:

Yeah. You know what I love? You bring up a great point. Jacob Teitelbaum when he gives some of his lectures, he’s very charismatic. He likes to always say, “When you go to a shoe store,” he goes, “The sizes for men could be from 8 to 12.” He says, “That is the range, but,” he goes, “if you are a size 8, you don’t want to be walking around in size 12 shoes.”

I really learned a lot from him too that when you’re talking about a range of lab values, which obviously there’s a usefulness to it, but they change. Depending on what your range is that fits in with your symptoms, that’s how you have to be treated by your doctor.

Mary Shomon:

Exactly. Well. Then, of course, there was also a lot of hoopla a few years back because most of the integrative and functional medicine doctors like you, like Dr. Holtorf, like Dr. Teitelbaum, know that levels at four and five and six on a TSH are usually evidence that someone already has something percolating.

That their thyroid’s already not working properly. Even the clinical laboratory guidelines, people were looking at that issue and looking to tighten up that reference range and cut it off much lower.

For about a year, we had those new guidelines where they said, “Look, anything above three is hypothyroid.” Then, sort of mysteriously all of a sudden it went out the window and went back to the much broader range.

Dr. Mitchell:

It has to be politics. I’ll tell you why though also because I noticed people with cholesterol every year or two, they keep on lowering the reference range for the bad cholesterol, like LDL and everything? I said, “My God, they’re going to have 10% of the people left because who has a LDL of 80?” It really that’s most of the outliers.

I think that with thyroid, I think they were a little worried that there would be this avalanche of patients getting thyroid medication who they… Maybe they were worried shouldn’t get it, but what I like to use, I’m just curious about your opinion. Again, a typical thing that I would look at very carefully obviously is the clinical symptoms.

I mean, the patient’s history is so critical and that’s really what you want a good health professional for. I mean, if they did have what I consider elevated TSH over two and a half or three, and if they had what we call the thyroid antibodies, like thyroid peroxidase antibodies, which is consistent with Hashimoto’s. I’m not saying every patient has to be treated, but when all of those things start to add up, why wait until they end up in failure or that they have such severe symptoms that I think there’s enough literature and experience that these patients should be treated earlier. Would you agree?

Mary Shomon:

I agree a hundred percent, especially because we see there is research that says that even if someone has normal TSH Free T4, Free T3 levels showing that the circulating thyroid hormone levels are at this point, normal. If they have elevated antibodies, they can prevent progression to overt hypothyroidism with very low level of treatment.

They can resolve symptoms with low level treatment. It’s especially important as you and I know for women in reproductive age who are trying to get pregnant, maintain a pregnancy, prevent early miscarriages to have very good control over their thyroid, especially if they have antibodies because it becomes even more important during that fertility, preconception, fertility and pregnancy period, that that thyroid level is very carefully controlled and maintained.

So I am all in favor of having an open mind and looking at the complete picture, the family history, the personal history, the symptoms.

Dr. Mitchell:

Yes. That’s also important too, right? It’s not unusual to have a pretty strong family history, especially on the maternal side.

Mary Shomon:

Oh yeah. Mom, grandma, sisters, daughters. They all come in and have the same issues.

Best Diet for Thyroid Disease / Thyroid Issues

Dr. Mitchell:

Yeah. Let’s move on to something which isn’t related. It’s related to your books about what diet.

There are dozens of diets out there that promote weight loss. There’s paleo, there’s Atkins which has been around a long time, there’s keto, which I’m not the biggest fan of, but it does help people lose weight.

What is your essential diet plan? I mean, I read your book, but I’d like to hear from you for a patient that suffers with thyroid disease or especially an underactive thyroid what’s your sort of your basis because people get so confused.

It’s very threatening to patients, when we do a lot of nutritional work in my practice because we deal a lot with candida and yeast patients and a lot of that avoids having them have wheat and gluten and sugar. Things that they… Not the greatest things for people in general anyway, but it is restrictive and it’s frightening to patients.

So what do you feel? Let’s say again, looking back at you’re talking to your younger Mary Shomon self thing, “This is how I should be eating.” If I know I have a thyroid problem.

Mary Shomon:

Well, I think it’s… This is like everything with thyroid, it’s not a one size fits all because there never is for thyroid. There’s no one set of rules that are going to work for everyone from the weight standpoint, but I think the bottom line and foundation of all of it is number one, we have to be getting optimal thyroid treatment.

If the thyroid levels are all over the place, if we’re really deficient in T3, the active thyroid hormone at the cellular level, then we can be doing everything right on the diet and exercise front and we’re going to be pushing the rock up the hill.

Dr. Mitchell:

Good point. Right. Good point. Diet can only do so much. Right.

Mary Shomon:

Exactly. So diet, all we need to do with thyroid is level the playing field. I also run into the opposite problem where people think, “Oh, the minute I get my thyroid optimized, the weight’s going to fly off and I’m going to be a size four again.”

I’m like, “No. All it’s going to do is make your diet and exercise work instead of be completely pointless,” because I’ve talked with people that were marathon runners and eating as clean and as calorie controlled diet as possible.

They were gaining weight because their hypothyroidism wasn’t being treated, but once they got their thyroid treated, it wasn’t as if the weight flew off, but all that exercise and healthy eating started to work.

That’s something I always try to make sure people understand. It’s not a magic diet pill. It’s never going to be, but when women, especially women or men too, are struggling with their thyroid and are not able to lose weight. They’ve gotten their fibroid fundamentally optimized. The other thing I always want them to look at are the other hormones because as we know, the hormones really work in tandem.

Dr. Mitchell:

Absolutely. That’s right. Super important.

Mary Shomon:

I want to look at the adrenals. I want to look at the blood sugar and insulin, the body’s ability to handle that. I also want to talk about the sex hormones, especially in women over 40 because that estrogen, progesterone shifts, testosterone shifts in men.

Then, when we’re talking blood sugar issues, thyroid, you throw it all together. Then, stress that we’re living with chronic physical and emotional stress and poor nutrition. We’ve got all the hormones in flux, so we want to look at those hormones and get them in line.

Dr. Mitchell:

I do want to return to diet though for a second. I mean, there’s always a lot of, I don’t know whether there’s misconceptions or concerns excess of eating soy can make a hypothyroid worse. The cruciferous vegetables like cauliflower and broccoli, which are typically good foods to eat. Obviously, of course, the big factor, and I’ve had a podcast about this, I’m having another one in a few weeks with a super top person from Harvard: gluten.

I mean, because again, we worried about the autoimmune and the whole leaky gut issue causing these, “autoimmune diseases.” So, I was just curious because in reading through your book, I wasn’t sure I was … I mean, you were mentioning things, but do you have people cut back on these things? Do you feel that’s important?

Mary Shomon:

Absolutely. I think the most important thing for people, for weight loss with thyroid and really probably in general for most, just healthy diet in general, is cutting back on simple carbohydrates and sugar. We’re looking at all of the different sources of sugars and the simple carbohydrates. And simple carbohydrates almost by definition starts to eliminate a lot of the process grains, the pasta, the cereal, the cookies, the breads that are low fiber.

I mean, I’m from New York, give me a slice of pizza and some pasta. But at the same time, with thyroid, we also have to look at some of the other issues. As you mentioned, things like the goitrogenic or cruciferous vegetables, which a lot of people, they get a bad rap, but they actually are only a problem if we are eating them in very large quantities raw.

Dr. Mitchell:

That’s a great point. Thank you for bringing that out. It’s so funny because I had a colleague of mine who was actually a medical student. And one day I was looking at her, we were studying, and I saw her hands and her hands were bright orange. And I said, “Wow.” This is before I had all my medical knowledge. She was getting tremendous amount of beta-carotene in her skin. She was eating tons of raw carrots and tomatoes, which are all high in carotenoid.

Because again, broccoli and cauliflower, they’re good foods. I mean, they have so many anticancer properties we love too, but I guess the raw is an issue. And what about the soy? There are some people for a long time who, when milk was considered bad for people, and they went to soy milk and they drank a lot of that. Do you think there’s an issue there, about the phytoestrogen effect type of thing or?

Mary Shomon:

I do. I do. But I don’t think that we need to be fanatical about soy, unless somebody has an allergy to it. But what I don’t agree with, with soy is using it as a primary protein replacement. If you look at the way the Asians eat soy, they eat it as a condiment, a little bit of tofu, a little bit of soy sauce.

It is not soy burgers, soy protein powder, soy shakes, soy milk. They’re not getting it in large concentrated amounts. Anything that we take in excess can start to have effects we don’t want.

With soy, because soy has the ability to interfere with the body’s ability to absorb thyroid hormone, we have to be careful about that. I know a lot of folks that are trying to lose weight, they’ve got a thyroid problem and they go on these soy-based protein shake diets.

And they’re doing soy burgers, and soy shakes, and high concentrated forms of soy. And they end up gaining weight and their thyroid goes through the roof with hypothyroidism and they’re trying to figure out what’s going wrong. The problem is that they’re actually sabotaging themselves by slowing their thyroid down further with the soy. Healthy amounts of soy, the way Asians eat it, is fine in my book.

Dr. Mitchell:

That’s really good advice. Let’s also talk about, because it’s related to supplements, and I learned stuff from your book, which really got me focused. I checked a lot of like mineral and vitamins levels on patients before I’m starting therapy. One of the things that I commonly see, especially in young women who are menstruating is low iron stores, which is reflected as low ferritin levels.

Closing Statements

Being an advocate, a coach, you’re probably, again you’re the native of the land. You’re hearing what’s going on out there. And sometimes your medicine, that’s when it comes to our doctor’s attention. When people say we’re hearing this. We’re seeing in these areas where people whatever, have to rely on these things. Or they live in a certain area, where we’re seeing a lot more thyroid disease. It just doesn’t make sense.

So I’m just going to give a little bit of a summary, even though I think it was pretty super clear cut. But thyroid disease is very prevalent and it’s frequently underdiagnosed. So make sure that you have a doctor that’s experienced and is going to work with you, in treating your thyroid disease. Dietary choices can be important, in helping you to lose weight with thyroid disease. So listen to some of the things that Mary and I discussed.

Proper mineral and vitamin supplements, are also important in helping your thyroid medication work for you. Learn about what your TSH level is, the same way everybody knows what their cholesterol level is. And maybe also even know what your free T3, your free T4. And even in some cases, reverse T3 levels. Because the more you become knowledgeable, you can have a better discussion with your doctors. Instead of just being on the receiving end of the information. And as Mary mentioned and I mentioned, again not to be antagonistic with doctors. But question your doctor, if you aren’t feeling better on your current regimen of thyroid medication. You might do better with a glandular product, versus the synthetic Synthroid or levothyroxine that you’re taking. So there are options out there. And with all of this, you can hopefully get the best possible outcome.

Learn more about thyroid disease and the thyroid diet by purchasing one of Mary’s books.
            

 

About the Author – Dr. Dean Mitchell, M.D.

Dr. Dean Mitchell, M.D.

Dr. Dean Mitchell M.D. is a Board-Certified and Immunologist based out of NYC. He graduated from the Sackler School of Medicine and completed training at the Robert Cooke Allergy Institute in New York City. He is also a Professor of Clinical Immunology at Touro College of Osteopathic Medicine, a fellow of the American Academy of Allergy, Asthma and Immunology, and the author of Allergy and Asthma Solution: The Ultimate Program for Reversing Your Symptoms One Drop at a Time. Dr. Dean Mitchell, M.D. has also been featured in The New York Times, The Huffington Post, Fitness Magazine, Dr. Oz and News NY 1. Dr. Mitchell also hosts the podcast The Smartest Doctor in the Room – a combination of a lively, personal and in-depth interview with top healthcare specialists.

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