S2 E1 Q + A #1 – Thyroid medication, Hashimoto’s remission, and finding balance with AIP

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Welcome to The Autoimmune Wellness Podcast Season 2! We’ve created this podcast as a free resource to accompany our book, The Autoimmune Wellness Handbook: A DIY Guide to Living Well with Chronic Illness.

Season 2 Episode 1 Q + A #1 is the first installment of our new Q + A format. In these episodes, we’re answering questions you submitted to us via social media! This season, the podcast will alternate between Q + A episodes like this and interview episodes featuring the voices of real AIPers just like you.

We cover a lot of ground in this first Q + A episode! Topics discussed include thyroid hormone replacement, AIP dogma, our personal reintroduction journeys, balance over perfection, adrenal support, and diet modifications for neurological disorders. Scroll down for the full episode transcript.

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Full Transcript:

Mickey Trescott: Welcome to the Autoimmune Wellness podcast, a complimentary resource for those on the road to recovery. I’m Mickey Trescott, a nutritional therapy practitioner living well with autoimmune disease in Oregon. I’ve got both Hashimoto’s and Celiac disease.

Angie Alt: And I’m Angie Alt, a certified health coach and nutritional therapy consultant, also living well with autoimmune disease in Maryland. I have endometriosis, lichen sclerosis, and Celiac disease. After recovering our health by combining the best of conventional medicine with effective and natural dietary and lifestyle interventions, Mickey and I started blogging at www.Autimmune-Paleo.com, where our collective mission is seeking wellness and building community.

Mickey Trescott: This podcast is sponsored by The Autoimmune Wellness Handbook; our co-authored guide to living well with chronic illness. We saw the need for a comprehensive resource that goes beyond nutrition to connect savvy patients, just like you, to the resources they need to achieve vibrant health. Through the use of self assessments, checklists, handy guides and templates, you get to experience the joy of discovery; finding out which areas to prioritize on your healing journey. Pick up a copy wherever books are sold.

Angie Alt: A quick disclaimer: The content in this podcast is intended as general information only, and is not to be substituted for medical advice, diagnosis, or treatment. Onto the podcast!

1. Thyroid hormone replacement [6:29]
2. Dogmatic AIP; elimination and reintroduction [11:54]
3. Weaning off thyroid hormone replacement [17:21]
4. Mickey and Angie’s personal reintroduction journey [21:37]
5. Iodine supplementation for thyroid [28:13]
6. Balance over perfection [29:32]
7. Non-AIP fillers in medications [33.10]
8. Adrenal support [35:23]
9. AIP and autoimmune neurological disorders [43:11]

Mickey Trescott: Hey everybody! Mickey here, and welcome back to the Autoimmune Wellness podcast, season two. We had some really awesome feedback from you guys; it was really overwhelming on our blog posts, our Instagram accounts, and also the reviews in iTunes. So thank you guys so much for sharing. And we decided to bring things back for another round, since you guys told us that it was so helpful. So we’ve got a little bit of a program ready for you. Angie; should we tell everyone what we’ve been up to since the last season of our podcast ended?

Angie Alt: Yeah, sure. We’re trying not to get too chatty on you guys for this podcast. We’ve had a pretty fun few months, and we wanted to update you. The Autoimmune Wellness Handbook came out in November; woot, woot! And we had a great time on our 5-city book tour. We’re so grateful for everyone’s support; it was a great experience getting to meet so many of you, and hearing your stories, and watching your local communities kind of take shape and seeing you meet each other and sharing stories together at those book signings. Mickey, what was your favorite part of the tour?

Mickey Trescott: I loved the events with the food. So of course, I liked all the events; but enjoying AIP food with an AIP community is such a rare thing, that it was just really fun, those bookend events. So our first event was at Mission Heirloom and they just made this delicious meal for us, which is so fun to hang out with a bunch of other AIP people. I actually think that those two events; so then we did Hu Kitchen in New York City; both of them had almost 100 people, which I’ve never had the experience to hang out with 100 of my friends that eat like me, so that was really powerful.

Angie Alt: {laughs}

Mickey Trescott: And really fun. What about you, Angie?

Angie Alt: Yeah. A big, big thank you to Mission Heirloom and Hu Kitchen; that was amazing. We really appreciated that support for our peeps. I don’t know what my favorite part was. I think getting to hear everybody’s stories, and see the way our work is impacting real live people out there; that’s really exciting. Getting stranded on train tracks was pretty fun; do you remember that, Mickey?

Mickey Trescott: {laughs}

Angie Alt: {laughs}

Mickey Trescott: Yeah, we almost didn’t make it to D. C., but we made it happen.

Angie Alt: Yeah. Let’s see; what else have we been up to since the book tour?

Mickey Trescott: Yeah, so you know, the first thing we did was take a chill period. You know, we spent some time resting and relaxing, taking care of ourselves; because we spent the better part of two years writing that book, and it was a big labor of love, but I think we needed to have a little season of kind of coming down off of that epic workload situation.

Angie Alt: Right. But, we did put in a little bit of work. One of our big projects that we worked on for the beginning of 2017 was relaunching our website under the brand Autoimmune Wellness. Hopefully, you guys are seeing that out there. We just think that the name really suits our mission, and will help us take our message to a more mainstream audience; viva la revolution, people.

Mickey Trescott: Woot, woot!

Angie Alt: We’re really focused on eventually making AIP this mainstream option for folks with autoimmune disease, and we feel like Autoimmune Wellness will help us get there. Let’s see; what else have we been up to, Mickey?

Mickey Trescott: So, we have recently been working on a special project that those of you that are health coaches; so nutritional therapy practitioners, or other kind of practitioners in the natural health scene, will be really interested in. so make sure that you guys are on our email list to be the first to hear about it. You can sign up at our website; www.autoimmunewellness.com, or the old website, www.autoimmune-paleo.com, will redirect there, and you can opt in and you’ll be the first to hear about it. And I’m sorry we can’t share any more details, but it’s going to be really fun.

Angie Alt: Super secret squirrel.

Mickey Trescott: Secret squirrel; that’s one of Angie’s favorite phrases. So back to the podcast; we want to tell you guys a little bit about what to expect this season, because our format is going to be a little different this time around.

Angie Alt: Yeah, so this season we’re going to be alternating between Q&A episodes, where Mickey and I are just going to take as many of your questions as we can and answer them for you guys. and then we’re going to be doing interview with real people who are going to share their journeys to autoimmune wellness, and what it’s actually been like for them. Just regular people out in the community who are using this method of working toward healing.

Today is our first Q&A episode, and we asked you guys to submit your questions; I think we took these mostly on Instagram, right Mickey?

Mickey Trescott: Yep.

Angie Alt: And boy; you guys gave us a lot of questions.

Mickey Trescott: A lot of questions. {laughs}

1. Thyroid hormone replacement [6:29]

Angie Alt: We’re going to do our very best to get through as many as we can, so let’s get started. Let’s see; so we have some thyroid questions. Mickey, let me ask you this first one. It looks like Hannah asked, “At what point should you ask to start taking thyroid hormone; especially if you feel good about 25% of the time and your labs are within normal range, and you’ve followed the protocol for a while. And once you start taking it, do you have to continue for a while? “

Mickey Trescott: Yeah, so this is a really good question for anyone with thyroid issues or Hashimoto’s, listen up. The autoimmune protocol does a really great job for most people taking out that inflammatory process, and taking out all those foods that are irritating to the gut. It does not reverse the damage that has been done to your thyroid, and it is not a replacement for thyroid hormone therapy if you need it.

So, a lot of us; if you have thyroid disease, it’s possible that you have Hashimoto’s, which is an autoimmune thyroid disease. And Hashimoto’s is actually the cause of 80% of hypothyroidism. So if you’ve been diagnosed at any time in the past with hypothyroidism, and you haven’t really been told about the cause, but you’ve been told to take thyroid hormone, it’s very likely that you have Hashimoto’s. and you haven’t ever had your antibodies tested, it’s a good idea to get those checked.

So what happens in Hashimoto’s is your immune system starts to destroy your thyroid slowly, over time. For a lot of people, it can take decades before they even start to get symptoms. But by the time people get diagnosed, and they notice the symptoms, and they get their labs done and their thyroid is suboptimal, they usually get on thyroid medication. And this medication is to replace the thyroid hormone that their thyroid would normally be making. So a part of the casualty of Hashimoto’s; there are some other reasons for thyroid dysfunction, but a lot of the time, it just means that your thyroid is not making enough hormone. And that thyroid hormone is needed by every cell in your body. So it’s really important if you need it to get a prescription and take it.

So, I would encourage anyone who is on the autoimmune protocol, who knows that they have Hashimoto’s disease or thyroid dysfunction, if they’ve tried the elimination diet for a little while; like it sounds like Hannah, she’s been on the protocol for a while, and she is only feeling well 25% of the time. The catch here is she says her labs are within the normal range. Now, a lot of people are told their labs are within the normal range, when they aren’t.

so this is probably a situation where Hannah, you should find a more open minded doctor that is willing to do thorough testing. So for thyroid disease, you really want to be testing free hormone levels; so free T3, free T4, in addition to the usually ordered TSH, sometimes reverse T3 can be helpful; and then again those antibodies to kind of tell how the autoimmune process is going. And then, you want to find a doctor who doesn’t believe in the conventional ranges, but who treats based on a little bit more of a narrow, functional range. And this can be hard to find; it doesn’t have to be a functional medicine doctor. It can be a savvy regular medical doctor; it could be a naturopath.

But I’ll tell you; I went to 6 doctors who told me my levels were normal before I found the one who said; “You know what, they’re not.” And that thyroid hormone replacement, that medication, was the difference between me feeling 60-70% better and 90-95% better. So it can make a really big effect, even if you’re doing the diet and everything.

So, I don’t think that people should be denying themselves thyroid medication. Like I said, it is something that every cell in your body needs, and if you need that and you need to eat a certain way to feel well; that’s what I do personally, there is no harm in that. And you should continue as long as your doctor, and your labs, and your symptoms indicate that you should. So, I know that’s kind of a long answer, but the thyroid stuff can get kind of complicated. And a lot of times, it’s not either/or; a lot times, that’s just another tool that we have in our tool box to live well with thyroid conditions.

Angie Alt: Yeah, right. We’re fans of the both/and, right?

Mickey Trescott: Yeah, totally. I mean, if you know that there is something you can do that’s going to help you feel better, why would you not use it? A lot of medications have side effects, but thyroid medication is actually a lot of times bioidentical to what your body would actually be producing. And so it doesn’t have the same mechanism. Most medications work by inhibiting something, or stopping something. But thyroid medication, it’s almost like a nutrient in that way. Your body needs a certain amount, and if you’re not getting enough, you’re just going to have symptoms. So I’m very pro- working that out.

And you know, some people might not need thyroid medication. But if you think you might need it, it’s really worthy of investigation. So, let’s move on to a question for you, Angie.

Angie Alt: Sure.

2. Dogmatic AIP; elimination and reintroduction [11:54]

Mickey Trescott: So we have a question from Jay, and it’s about balance, which is one of your awesome expertise. “I’d love to hear the benefits and problems with staying on AIP with no reintroductions. I’m hoping AIP is a bridge to healing, and that I can add back a lot of the foods I’ve eliminated. Eggs, nightshades, and occasional grains. But the AIP community at large seems so dogmatic about this being a lifestyle, and a forever thing. What’s the point of forever elimination?”

Angie Alt: Oh boy.

Mickey Trescott: Who are you talking about, Jay? {laughs} Hopefully not us.

Angie Alt: Jay, you need to give us their name and number, and we’re going to go tell them what we think about that. No, I’m just kidding. I’m really sorry that you’ve encountered this feeling in the AIP community that it’s dogmatic, and that we believe that you should be in the elimination phase forever. That’s definitely not what we’re hoping to promote in the community, and it’s definitely not how the protocol is laid out. So the protocol is an elimination AND reintroduction protocol; so that’s really important to understand that part of the healing process is reintroducing foods.

I think it could be maybe a little bit of a misunderstanding of the idea “lifestyle”, of making AIP a lifestyle. By that, it’s more talking about healing in general, and incorporating more than just diet into your autoimmune wellness journey. So hopefully it’s just a misunderstanding and you’re not, hopefully, running into too many people that are being super dogmatic about staying in elimination forever.

So, you know you wanted to hear about the benefits and problems of staying in AIP with no reintroductions. I honestly don’t think that there are benefits to staying on the elimination phase of AIP forever. I think, actually, you’re really limiting diversity in your diet, and it’s also psychologically really hard. Not to mention, in our modern world, it’s not the most convenient thing to have to be in that kind of restricted zone that long.

Generally, you’re looking to stay on the protocol; the elimination part of the protocol, for at least 30 days. That’s enough time to kind of clean your slate, and make it so that you can understand foods that are a problem for you as you begin to reintroduce, versus foods that really work for your body. Ideally, it would probably be better if you shot for more like 60 to 90 days. Most folks need a little more time than 30 days, so it’s not unusual to stay in that zone for another month to two months past the 30-day process.

If you get to 90 days, and you’re not having the kind of progress you would have expected with AIP, it’s a good time to get some people on your team who you can collaborate with. Doctors or other kinds of practitioners that can help you dig a little bit deeper, and see if there are some root issues that are kind of preventing progress with the protocol. You know, for instance, a really common example in the autoimmune community would be maybe having small intestine bacterial overgrowth, or something called SIBO. A lot of folks are dealing with an underlier there, and it can’t be corrected with diet alone, and it needs to be treated through either conventional or herbal antibiotics with a practitioner.

So there can be issues underlying like that that need to be uncovered. In that case, maybe you would stay on the elimination a little bit longer; so you kind of keep the process clean. You limit variables, and you kind of figure out what that root is. And then once you deal with those, you move on to reintroductions. Definitely; we don’t believe you should stay in elimination forever. The benefits of reintroducing foods is a lot of nutrient density, variety, it emotionally feels better to have a little wider diet, and it’s easier. It’s more convenient in our world.

Mickey Trescott: Yeah, it really changes things when you can start to eat out, and you can start to experiment more with those gray-area foods. I think being too restricted usually comes from a place of fear for a lot of people, and we don’t want to have that relationship with our food. We want to think of our food as something that’s very powerful and lifegiving. I mean, we have this opportunity three or more times a day to actually decide how our body is going to interact with all of these chemicals and nutrients, and it’s a very powerful thing. But I don’t think it’s something we should be afraid of. We should see it as an opportunity.

And you know, the fear with reintroduction is a big thing with a lot of people, and they like to kind of make other people suffer by promoting that idea that they also need to be afraid and be on it forever; but it’s not like that. And Angie and I, hopefully, in what we’ve written in our books, and on the blog, and in the podcast, we’re trying to put this to rest that the reintroduction is 50% of the whole protocol. That’s why it’s called a protocol, and not a diet. A diet is something that people adopt for long-term, and a protocol is a process that you go through with an end result.

Angie Alt: Right. You know, Jay, I think the thing I say to my clients pretty often; probably I say this at least once a day. The point of this whole process is to help heal our bodies, not develop burdened hearts and minds.

Mickey Trescott: Well said.

3. Weaning off thyroid hormone replacement [17:21]

Angie Alt: Alright. Let’s see; so we’ve got some more thyroid questions Mickey, are you ready?

Mickey Trescott: Yeah.

Angie Alt: Ok. So Julia wrote in and said, “A Hashimoto’s question. My doctor put me on medication, levothyroxine, a year ago when I got diagnosed, and I’ve since increased. I obviously wouldn’t stop taking it without doctor’s orders, but I was wondering if it is possible to get off of the thyroid hormone supplement after being on it. I’ve heard of people with stories of healing their bodies naturally without ever going on medication, but was wondering of the possibility of coming off of it after taking it for an extended period of time.”

Mickey Trescott: Yeah, so this is a good question Julia, and you know, you’re right to know not to change anything up without your doctor. It sounds like you have a pretty reasonable expectation about what to expect; you’re knowing that maybe you will be able to go off it, maybe not. And honestly, no one will really be able to know until you try changing your diet and managing your lifestyle better. I have personally not been able to go off my thyroid medication, but I have changed my dose a lot.

So when I was first diagnosed, I was put on a certain blend of T4 and T3, and I stayed consistent on that for almost 2 years, and then I started reacting to the T3. And my suspicion is that the conversion of T4 to T3 is very dependent on a few nutrients; mostly zinc and selenium. The autoimmune protocol is actually really plentiful in these nutrients, and I think I had just started getting too much T3, because my body started converted sufficiently, something that a lot of people have, very poor conversion. So I started reacting to the T3, so my doctor took out that part of my prescription, and I’ve been on the same dose ever since.

I’ve remained pretty stable on my thyroid hormone, and I would say that the clients that I’ve worked with with Hashimoto’s tend to remain pretty stable, or decrease their medication. A lot of them aren’t every single year, you know, steadily going up and up and up. But that’s not to say that that’s you, that’s a failure. I would just be open to kind of whatever situation happens, because a lot of things can change over your life that would impact your need for thyroid medication. Certain factors might be kind of how that autoimmunity is progressing. I mean, a lot of people go to the point where they get that inflammation down so far that maybe they’re just kind of holding steady at whatever their thyroid is outputting.

And intuitively, not medically speaking because I’m not a medical practitioner, but intuitively I feel like that’s what’s going on in my body. But I’m not holding out hope that I can just one day ditch that thyroid medication so that I can feel good about myself. I, like I said before, I accept it as a part of my healing journey, and I’m grateful to have the opportunity to take that thyroid medication, and you know; I’m open to whatever happens in the future. Maybe if I go through a period of extreme stress, you know put some stress on the adrenals, that might be a situation where I might need some more thyroid hormone. Or you know, maybe I will start reacting to the amount of T4 I’m taking and I’ll need less. But I have no way of really knowing, and I guess I can just tell you as a practitioner, that I’ve kind of seen a lot of different things happen with people, and I have seen people try the autoimmune protocol and actually completely go off their medication. But I wouldn’t say that’s typical, so I would just be open minded and accept it as part of your healing process.

You know, for anyone with Hashimoto’s or thyroid disease; having a good doctor and being monitored regularly, and being willing to be open and change, depending on your symptoms and the seasons and whatever your going on in your life; that’s the best way to navigate it.

Angie Alt: Great answer, Mickey.

Mickey Trescott: Cool. Well, we’ve got another balance question for you.

Angie Alt: Sure; let’s hear it.

4. Mickey and Angie’s personal reintroduction journey [21:37]

Mickey Trescott: So Julie says, “Are you ladies AIP compliant all the time? Or have you reintroduced foods? If so, which ones have you been successful at reintroducing, and what are your recommendations? I’ve got Hashi’s.”

Angie Alt: Ok, so were we compliant with AIP while we were in the elimination phase? Sure we were. We were both pretty dedicated to the process, because we wanted to see if it could help us with our healing, and sure enough it did, which was very motivational to keep going. Now, we are still compliant with AIP; we are in the reintroduction phase. We’re well into the reintroduction phase; I would say actually Mickey and I are kind of post-reintroduction, actually. And we’ve sort of fine-tuned our diets, and found out what bioindividually works for each of us.

The foods that I’ve reintroduced are kind of across the board. Some examples are white rice, white potato; I can do quite a bit and variety of dairy. Let’s see; eggs are definitely in, I can do most of the nuts and seeds, I can do a little alcohol. There’s not really any super big standouts other than obviously I didn’t go with the grains beyond white rice, and I don’t do most of the legumes, and the nightshades other than white potato have not been my friend. How about you Mickey; can you tell her about your reintroductions?

Mickey Trescott: Yeah. So the first foods I successfully reintroduced were egg yolks, seed spices; then whole nuts and seeds, the oils from them. That was, you know, probably the initial. It took me about a year and a half; so a little bit longer on the autoimmune protocol with those reintroductions before I started tolerating the egg whites. And then I started tolerating white rice and potatoes pretty shortly after. Small amounts of alcohol. I’ve never been able to tolerate even the most clarified ghee; I’m very allergic to dairy, still. So that’s never changed for me.

But the nightshades, at about 3 years in, I started experimenting with paprika and cayenne pepper in small quantities of the spices; and now I’m to the point where I can even have some raw peppers, but I cannot have tomatoes. So Angie and I are pretty different about what we can tolerate, but we’ve both been in this phase probably 3 or 4 years now. And I think post-reintroduction is a little bit more kind of knowing where your boundaries are and knowing quantities, and situations, and combinations. We’ve “reintroduced” so many times, because every time we’re at a conference, or we’re at a restaurant, and we’re like, “Hmm, should I have conventional eggs and potatoes in the same meal?” {laughs} You know, there has just been a lot of opportunity to kind of mix and match and kind of figure out. Since we already know the basics about those triggers, you know, we eat a pretty varied gluten free diet. Sometimes, for me, it’s not even paleo, and I’m still feeling great and I know my boundaries, you know?

Angie Alt: Right. I think once you kind of get into reintroduction, and especially kind of, I guess you would call it post-reintroduction; AIP becomes more about the ebb and flow. We write about this a lot in our new book, The Autoimmune Wellness Handbook, that you kind of start to realize when there will be points in your life where it’s better if you’re kind of tightening down things, and really careful and maybe even basically elimination phase style eating, just best support your health; and then you’re more aware of the times when you’re health is just in a really great place, and you’re stress is low, and it’s a time when you can open up and enjoy all those reintroduced foods fully and not really worry that it will impact your health too much. I think it’s the whole process of learning to hear your body talk, and have that communication going. Which, that’s the whole thing that happens, while you go through reintroductions.

You know; Julie did kind of mention that she has Hashimoto’s, and that’s one thing that we could probably touch on a little bit about reintroductions. For some folks, depending on their diseases and their disease presentations, sometimes the reintroduction process can be a little harder to gauge, and I think Hashi’s folks are among those people; because I think reactions can be a little slower. What do you have to say about that, Mickey?

Mickey Trescott: Yeah, so what I recommend for people with Hashi’s is to get really into journaling, and really try to find as many concrete signs as you can. So, for instance, journaling and saying “My energy today was good,” is probably not going to help you over the long term. But saying, “My energy was 7,” or, “My energy was 6.” You can notice a trend over months when you use numbers.

You can also try things like taking your temperature first thing in the morning before you get out of bed. That’s a great indicator of thyroid function. It will go up and down a little bit as your cycle fluctuates, but for the most part, if you start tracking that over a period of months, you’ll start to see a warming trend when you are feeling a little bit better, having more energy.

Other things are like your bowel movements; so using Bristol stool chart, tracking your bowel movements. Noticing things like your mood. You can also say, how was my anxiety today, or was I feeling happy? You can notice your skin. That’s a big thing for thyroid people. Noticing your shedding. And again, you can rate it on a 1-10 scale to give yourself really a good scale of tracking that for the long-term, and kind of making those; connecting those dots. Because with Hashi’s, we have what are called nonspecific symptoms. So they’re things that, this is a reason why a lot of doctors don’t take us very seriously because we go in and we say; “oh, well I’m tired and I’m constipated, but not really constipated, and my skin is dull, and my hair is falling out.” And they’re kind of like; “well, that doesn’t really give me much to work with.” You know?

Angie Alt: Right. So, that can, yeah, kind of make it a little bit tough with the reintroduction process. But I think you had some good tips there.

Mickey Trescott: Cool.

5. Iodine supplementation for Hashimoto’s [28:13]

Angie Alt: Ok. Another Hashi’s question. Ashely asks; “Hashimoto’s question. My functional doctor has me taking iodine supplementation. In your opinion, is iodine supplementation a good or bad thing for someone with Hashimoto’s and adrenal fatigue?”

Mickey Trescott: In my opinion, it is a bad thing. So iodine, a lot of people think that taking iodine is good. There are a lot of practitioners out there that really believe in putting their Hashimoto’s patients on iodine. It’s kind of like pouring gasoline onto a fire. So it can really cause a bad flare. I personally have done this to myself. I did the iodine protocol; I read about how iodine can really screw with you when you have Hashimoto’s, then I read a lot of stories of people that were really raving about it and I tried it. I had a massive, massive flare. It took me 3 months to recover from it. And this is consistent with a lot of the research that I have read from really tried and true Hashi’s resources that iodine is really not a good idea.

I would just say that maybe in small doses, with a practitioner who is very knowledgeable and very willing to monitor you. But yeah; I would say no go on the iodine.

Angie Alt: Yeah, it is a little tricky; iodine.

6. Balance over perfection [29:32]

Mickey Trescott: Mm-hmm. So, Christine wants to know, Angie; “What does balance look like practically? How do you strive for balance over perfection? You can follow the right diet, take supplements, and change your lifestyle, but how does that all fit with seeking emotional and mental health, as well?”

Angie Alt: So, you know. What does this look like practically? This is a little bit tough, because it looks a little different for everyone. Everybody’s balance is going to be a little different. But I think the main thing is kind of what we were talking about with the earlier balance question about whether or not AIP is dogmatic, and that you should stay in elimination phase forever. It’s this whole idea that we’re seeking healing with this process; we’re not trying to burden our hearts and our minds. If you find that following this process is leading you down a path where you’re unable to think about anything else, or you’re kind of just emotionally weighted down by it day in and day out, I’d say that it’s time to get some people on your team who can help you make it a more balanced process, or consider coming back to AIP at a time when you’re more able to tackle it.

There’s probably a couple of people out there listening and going, “Oh my gosh, what’s going on? The AIP queens are telling us to maybe think about AIP at a later time, what’s going on?” {laughs} What I’m saying is, if it’s making you that imbalanced, and you’re struggling with it in that way, you’re not going to get the benefits of the process and the protocol. It would be better to return to it at a time when you’re more able to tackle it. That said, don’t just let any tiny challenge along the way kind of prevent you from really pursuing healing with this. If that’s the case; if it’s feeling a little overwhelming. If it’s feeling like a bigger challenge than you thought it would be, but you want to pursue it and you want to do it in a balanced and happy way; get support. You know? Find people to be your cheerleaders; maybe consider getting a coach to help you go through the process. You could join a group program, like my SAD to AIP in 6. Whatever will give you the support you need.

Tap into this big community that we have and find places where you can vent; and say, “Guys, this is so hard to do, and I’m really struggling with trying to do it perfectly!” And then this whole community, and there are thousands of us, can say, “Don’t worry about perfection! Just keep going!” we can help give you messages that can make it a little bit easier. I think supporting your mental and emotional health through the process is just as important, you know. Stress is not going to help you get any further down the healing road, no matter how perfect your diet and supplementation is. What do you think about that, Mickey?

Mickey Trescott: I think that was a great answer. I mean, perfection has no role in this. It’s not about being perfect. I’ve noticed that’s kind of going back to the dogma question; some people use AIP as more perfect paleo, and it kind of satisfies a little bit of a disordered sensibility in them, and you know, like Angie said; if that’s kind of the road you’re going down; get help, get community, get support. But it’s really not about being perfect, it’s about living life. And we’re not perfect, you know?

Angie Alt: Yep, exactly. We’re human beings, not robots. Not AIP robots. {laughs}

Mickey Trescott: Nope.

7. Non-AIP fillers in medications [33.10]

Angie Alt: Alright, let’s see. We’ve got another thyroid question. This is our last thyroid question. The lady asks; “My thyroid medication, levothyroxine, contains lactose and corn starch. How important is full AIP compliance in a situation like this? How big an impact will it make on my chances of healing and remission?” What do you say, Mickey?

Mickey Trescott: Yeah, so corn and dairy are pretty high up there in the potential triggers. That being said, it’s a pretty small amount in thyroid medication, and thyroid medication is usually necessary for people feeling their best. So what I would suggest, if this woman was my client and I had taken history and everything; I would probably say, you know, try AIP for 30 days and see how you feel. If you don’t feel any different after 30 days, then I would ask you to go back to your doctor, talk to them about the elimination diet you’re trying, seeing if they would be open to doing a trial of like a compounded medication where they put the levothyroxine in a filler that is a little bit more benign. Sometimes you can find a pharmacy that will put it in ginger powder; I have mine in microcrystalline cellulose, which some people are sensitive to if they have serious gut issues. But from an autoimmune standpoint it’s usually fine for most people. So that’s another option.

So yes, if you are sensitive to the lactose and the corn starch, that could be an issue for you. But I would probably give it 30 days before going through all that effort of going to your doctor and getting a new prescription and everything; because that is a really big change for your body. The way that your body actually digests and uses that thyroid medication, it changes with what it’s filled with. So it could be that that medication is actually working really well for you, and I’d hate to see you change it if that’s the case. So that’s what I would say.

Angie Alt: Great. What do you think, Mickey, should we move on to a few more questions?

Mickey Trescott: Yeah, I think we have two more we have time to hit.

Angie Alt: Great.

8. Adrenal support [35:23]

Mickey Trescott: So Kate says; what are some of the best way to support the adrenals through diet and supplements, for someone with adrenal insufficiency that also has an underactive thyroid.

Angie Alt: Ok, so; Kate, this is all kind of interconnected. We sort of have a little bit of a triangle, for lack of a better term, that’s happening with our adrenals and our thyroid, and also another important part of our body; our blood sugar regulation.

So, the very first thing that somebody who is trying to support adrenal health would do is work on blood sugar regulation. You can think of this as, every time your blood sugar gets too low, your adrenal glands have to basically come to the rescue. They have to pump up a bunch of cortisol into your system to help your body release enough glucose to basically solve this low blood sugar crisis that you’re having. So you want to end that rollercoaster ride, where the adrenals have to hop in there and do that for.

Some ways to do that in the beginning are to eat within a half hour of getting out of bed; probably think about having six times a day that you’re eating; so every 3 hours eating something. So your three main meals, and then maybe some small snacks in between. Eventually you won’t have to do this as your blood sugar gets regulated, but these are some steps in the beginning. Make sure that those meals and snacks include a little bit of protein and fat, because that protein and fat is like a log on your internal fire, and it burns nice and steady and keeps your blood sugar really even, so it doesn’t have one of those dips where the adrenals have to work so hard and come to your rescue.

Another smart thing to do here is to avoid, obviously, lots of sugar. Because every time the blood sugar goes way, way up, what goes up must come down, and then you’ll have that crash and the adrenals will have to come to the rescue. That includes sugar from fruits, so you’ll want to keep your fruit consumption kind of limited. Maybe one to two pieces a day; preferably not dried fruits or the tropical fruits, which tend to be really high in sugar. You might want to think about things like berries and other kind of low-sugar fruits.

Those are kind of the big ideas about how to keep blood sugar regulated. You would want to kind of start there rather than start with supplementation. The other side of this equation is getting enough rest. There’s kind of this idea that certain people suffer from adrenal fatigue; but the reality is, pretty much all of us suffer from adrenal fatigue, and it’s because of the lifestyles that we lead in our modern lives. You know, we’re running around all the time, we don’t get enough sleep. We’re plugged into our devices all the time and not really ever resting our brains. Sometimes the things we’re seeing on our devices or on the TVs or hearing on the radio are very stressful things. We’re commuting; commutes are very stressful. We have really plugged in work lives that often don’t allow any downtime, you know? So the other side of this coin to help achieve some better balance with the adrenals is to really work on rest and relaxation; do things to manage our stress actively, so that those adrenals don’t have to fire so often. Mickey, how would you explain kind of the adrenal insufficiency running into the thyroid issue?

Mickey Trescott: Yeah, so the adrenals and the thyroid, this is really, really common for people with thyroid issues to even have more complicated adrenal issues, because they’re both the systems of the body that are responsible for energy production. And when one of them isn’t doing well, the other one kind of has to pick up the slack, and a lot of times when the thyroid starts to have dysfunction early on, the adrenals just pick up the slack and you don’t really know that that’s different. But over time, your adrenals burn out, and that’s usually when people get the first signs of thyroid disease. They get a diagnosis of thyroid issues, and then they kind of start there, but they don’t really realize that they kind of need to work on both systems and bring them both back to health before they’re going to really feel that complete return of their energy.

So, like we’ve been talking a lot about medication this episode, making sure that you are being properly treated for your underactive thyroid so your adrenals don’t have to do so much work. That is a really important part of the process.

Another thing that I would mention that can be kind of tricky with managing that blood sugar, is to make sure that you’re not going completely low carb of ketogenic.

Angie Alt: Ah, that’s a good one!

Mickey Trescott: It can be a really tricky line, because if you’re eating too many carbs and too much sugar, that’s going to make those peaks and valleys and make your blood sugar go up and down; but if you’re eating just enough complex carbohydrates to keep your insulin at a normal level, that’s going to keep your thyroid hormone conversion where it should be. So for a lot of people, they can get really sluggish, and their thyroid can put a lot of that work on the adrenals if they’re not eating enough carbs.

So a lot of people will say; “tell me exactly how much I need to eat?” This level is pretty individual. {laughs} So for some people, half a sweet potato, maybe one sweet potato a day does it; some people need a little bit more. So you might have to kind of play with that level and see where you’re at, track your food for a little while and kind of see what produces the most energy for you and also doesn’t really have you run into the blood sugar issues.

The other thing I want to say too is; a lot of people that reverse these adrenal issues, they don’t do it with supplements, right? There are a lot of products out on the market, and I want to send a warning for anyone with autoimmune disease. A lot of herbs, in particular that are helpful for the adrenals, are actually powerful immune stimulants, which can be really problematic for people with autoimmune disease. So for a lot of people, these supplements; especially things like ashwagandha; it’s a nightshade. So this is one of these herbs that a lot of these formulas use. It’s very hard to find a supplement that actually follows the autoimmune protocol, it doesn’t have any immune stimulating herbs, and honestly a lot of people that are recovering, are doing it through the diet and lifestyle changes. Supplement is sometimes a little bit helpful with some nutrients, but really if you’re not changing your lifestyle, it’s not going to be a sustainable change.

Angie Alt: Right.

Mickey Trescott: So that’s what I would say there.

Angie Alt: Womp, womp; we didn’t recommend a supplement. But no, seriously. Starting with your food, working on your diet and lifestyle; that’s the way to heal the adrenals.

Mickey Trescott: And I would say, too; people, I will mention rhodiola rosea is one herb that I have found that I’ve used with a few people, and I’ve used it personally that isn’t a nightshade. It is an adaptogen, meaning it kind of helps you find that even keel; and it’s not immune stimulating. So for what’s it worth, it might be one to look for blends with that herb in it. But like I said, I would probably save my money in the initial stages and work on some more self-care and stress management, and sleep before resorting to supplementation.

9. AIP and autoimmune neurological disorders [43:11]

Angie Alt: Right. Alright, one more question here. They say; it looks like her name might be Sylvia? She says, “My question is about specific recommendations for autoimmune neurological disorders. I was diagnosed with myasthenia gravis, and have been on immunosuppressants for almost one year. I feel better, although still on medication. I did the 8-week AIP elimination diet last October and November, and didn’t find major changes. I’m working on other key aspects of autoimmune wellness, such as sleep, rest, and exercise. Are there specific recommendations for neuromuscular conditions? Thanks.”

Mickey Trescott: Yes! So, what I would say with a disease like myasthenia gravis, or anyone else who is on an immunosuppressant medication; this is not to say that any other autoimmune diseases aren’t here yet, they are not severe. But a lot of these diseases have some pretty intense symptoms that could potentially be life threatening, and this is why the choice for using a very powerful immunosuppressant medication is warranted.

So for anyone in this situation, like what Sylvia is doing, trying to do some dietary changes in conjunction with conventional medication; always talking to your doctor about what you’re trying. This is always the best approach. You don’t need to feel like you need to go off your medication before you try AIP. Trying AIP with your doctor’s permission, while you’re on the medication, and having positive changes there is the way to go before you have the conversation with your doctor about potentially weaning. Some people might be able to wean, some people might not. That’s totally a discussion you have to have with your doctor. But I just wanted to say that note for anyone also there.

Some diseases are, depending on how long you’ve had this process going on in your body, for a long time it might be pretty severe, you know? Autoimmune neurological diseases. So things like multiple sclerosis; they take a little bit longer. Because you know, that myelin, that tissue in your brain; the nerve tissue, that is something that is actually very, very difficult for the body to heal. And it’s not to say that AIP doesn’t work; I mean, look at Terry Wahls. If you guys haven’t seen her TED Talk yet; which she has; what she has accomplished in the few years, even now when I’ve seen her in person, just year to year she just looks younger and younger and is more capable and more strong, and just incredible. It’s possible; but I want to say, too, that usually people dealing with these more complex and deeper seated conditions; time might be a variable for you.

So I would suggest making sure you have good help; so making sure have a functional medicine practitioner, making sure you have a doctor on your team who is open to advising you about the interaction between the diet, making sure that your medication is going to play nice with anything else that you’re trying on your own. So the other variable is time. So this is a case where I do think it’s necessary for some people to be on maybe a modified elimination diet for a longer period of time, just because of how difficult that nerve tissue is to heal. And so I would definitely try and work with someone; I wouldn’t try and do that on my own. Because like we’ve been talking about this whole episode; there is a lot of mental and emotional stuff you run up against when you try to do the elimination long term. So I wouldn’t do that without help.

The third thing is; you know, those key aspects that you’re talking about; that sleep, that rest, that exercise. That’s going to help you too, but also some nutrients might be really important to your healing process. So that’s where getting a practitioner involved. You know, like Terry Wahls, I know part of her protocol was taking large amounts of B vitamins, and some antioxidants like Glutathione and other things. So working with, like I said, a functional medicine practitioner who can help you maybe add in some of those nutrients and supplements that might actually help you get sufficient in that area a little faster.

And then I’ll end, too, by saying; for me personally, I never got diagnosed with multiple sclerosis, but there was a point in my journey where they suspected it; my doctors suspected it. I did have a lot of inflammation in my brain, and Angie and I shared this; we both had really bad nerve damage in our fingers and our feet; we started slurring our speech. And for me, one of the things that did not resolve very early when I started the autoimmune protocol was any of those symptoms. So I actually had this nerve damage in my fingers and my feet where I couldn’t really feel my fingertips. And even; gosh, I want to say a year and a half into AIP, I still had that feeling. And I even went to my doctor, and I said, “Doc, everything else has changed. Literally, my body feels like a completely new body except I cannot feel my fingertips. Is this ever going to go away?” And they said, “Oh, that nerve tissue, it doesn’t heal. It probably can’t come back; it’s probably damaged.” And I was grateful for what I had achieved, and ok fine.

But I can tell you 5 years later, slowly that went away and I have feeling there now, and I don’t have that problem anymore. So that healing came very late, and I’m guessing that it came from just eating a nutrient dense diet for so long. So going back to that balance between, “How long do I stay on the elimination diet;” I don’t think you necessarily need to be on the elimination diet forever to achieve a change like that. But trying to figure out which diet is best supportive of your health while reintroducing some foods and kind of focusing on that nutrient density; those organ meats and bone broth and all of that nutrient sufficiency, I think in the long term is the thing that really is going to help turn around these deeper seated, long-term, potentially serious conditions. So hopefully that’s helpful.

Angie Alt: That was great. Lots of good tips in there. Alright; our time is kind of up for answering questions today. We definitely didn’t get to all of them, so we’ll be addressing them in our next podcast. We’re going to be doing lots of these Q&As this season; we hope you guys will tune in again. Have a great day everyone, and we will see you next week with a personal interview.

Mickey Trescott: Bye guys!


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Check out the previous episode, Bonus Ep: Cooking For Life, Multiple Sclerosis, and a research update w/ Dr. Terry Wahls. For the full podcast archive, click here.


About Mickey Trescott

Mickey Trescott is a co-founder here at Autoimmune Wellness and a co-teacher of AIP Certified Coach. After recovering from her own struggle with both Celiac and Hashimoto’s disease, adrenal fatigue, and multiple vitamin deficiencies, Mickey started to write about her experience to share with others and help them realize they are not alone in their struggles. She has a Master's degree in Human Nutrition and Functional Nutrition, and is the author of three best-selling books--The Autoimmune Paleo Cookbook, The Autoimmune Wellness Handbook, and The Nutrient-Dense Kitchen. You can watch her AIP cooking demos by following her on Instagram.


  • Sarah says

    It’s important to note that if you feel like your eating is becoming disordered on this diet, you’ll find objective help and support outside of the AIP community, free of bias. Listen to your mom, listen to your doctor, listen to your friends.

    • Mickey Trescott says

      We are not into promoting disordered eating over here at Autoimmune Wellness and have had this complex conversation at many points in our books, podcasts, and here on the blog. Yes, being on an elimination diet can be triggering for those who struggle with disordered eating, and we always argue for the least amount of restriction that produces the best results. As Angie says up above “The point of this whole process is to help heal our bodies, not develop burdened hearts and minds.”

  • Mary says

    I have celiac, Hashimotos, lichen planus (in my mouth), Raynauds and I don’t know what else. I have been on the GAPs diet mostly (I kind of switch from AIP to GAPs) for many years (I’m 55 now). I’ve been sick since I had my fourth baby (23 years ago) but didn’t have a clue about gluten till 2006. Ii was already off grains, but then I learned that gluten is in so many other things.

    My question is, even though I am on 150 mcg. of Levoxyl every morning, my thyroid gland pains me constantly. I asked my doctor about removing my thyroid gland, and she said that the thyroid gland isn’t making the antibodies. I find this very confusing. My antibodies are over 2,000 overall. My understanding about antibodies is that, although the thyroid gland doesn’t produce the antibodies, the antibodies cause the thyroid to malfunction. So if the thyroid gland is removed, the antibodies have nowhere to go, and thus die off.
    I understand that you are not doctors, but in your opinion, do you know anything I can do to help my thyroid not to hurt. I am very strict on the diet. I literally never cheat–no sugar, no grains, no potatoes except when I’m on vacation and there is nothing else to eat, no other nightshades ever. Just wondering if you have any ideas.

    I have beef bone broth every day (soup for breakfast), which has helped me very much. I have less flare-ups, and when I do get flare-ups they don’t seem to last as long. I was hoping, honestly, that the bone broth would do more. Was I expecting too much? I thought my antibodies would go down, and they haven’t.

    Thanks. BTW, love your cookbook!

    • Mickey Trescott says

      Hi Mary! I am so sorry to hear of your continuing struggles. A couple ideas – has your doctor ordered a thyroid ultrasound to check for nodules? These can sometimes become quite large and occasionally painful with those who have Hashimoto’s, and the first thing I’d do is rule them out. Next I’d consider some environmental allergens as something you could be reacting to – mold in your house, chemicals in cleaning products, flouride in water, etc. I don’t recommend trying to live in a bubble and drive yourself crazy, but I have heard accounts of people discovering that they were being exposed to something causing specific symptoms (most recently it was a woman who had major symptoms dissipate the day she changed a 30-year old water heater!). Lastly, I’d ask your doctor to get worked up for Epstein-Barr virus and consider that maybe the pain could be your lymph nodes and not your thyroid. Hang in there, and I hope you find some answers soon!

  • Beth says

    Ohhh, such an awesome pu pu platter of topics. I love the insight and back and forth as you both share insights. Favorite words: squirrel secret, and bioindividuality!

  • Rosie says

    Hi Ladies! Thank you so much for all that you do! You have been SO helpful to me and many others!! Everything you present to us is so thorough and well-done – it’s very impressive!
    I have Hashimoto’s and am planning to start AIP again very soon. I was wondering – I have recently had my food sensitivities tested and I am not sensitive to some foods that are not allowed on the elimination part of AIP (tomatoes, eggs)… Would you recommend still staying away from these foods or would it be okay to incorporate them?

    Thanks so much! I can’t wait to hear more from Season Two! 🙂

    • Mickey Trescott says

      Hi Rosie! Food sensitivity/allergy testing does not replace elimination and reintroduction in our book. You will find a really informative article on this topic here: https://autoimmunewellness.com/why-food-intolerance-testing-doesnt-work/

      • Rosie says

        Thank you so much for the response! I wish I had seen that article before having the testing done! So, based on what the article says, it seems that it would be okay for me to incorporate AIP approved foods that my testing said I was sensitive to (bananas, pineapple, etc.)?

        Thanks again! I really appreciate you taking the time to respond!

        • Mickey Trescott says

          Hi Rosie! Generally what I do with my clients who have had this kind of testing is avoid the foods that came up on the test for the first 2-3 weeks of the elimination diet, and then reintroduce before the other reintroductions. Depending on how many foods the client is looking at eliminating (for instance those who also are following low-FODMAP for SIBO) we might pick and choose, or ignore the food testing. If you have any intuition about a specific food it is good to leave it out. Hope it helps!

          • Rosie says

            Thank you so much Mickey! That helps a lot! 🙂

  • Christiane says

    In response to the person asking about corn and lactose in thyroid medication, I have Hashimoto’s and Celiac, and could not heal until I switched to thyroid medication without those fillers. My T4 medication (Tirosint) has only gelatin, glycerin, and water as the filler ingredients. It’s more expensive than Synthroid, but was so worth it because my gut finally started to heal on Tirosint when it hadn’t done so before. My T3 medication is a generic liothyronine made by Perrigo, which also does not contain lactose, corn, or gluten (I called the company to confirm this). Switching medications made a world of difference for me, but not all endocrinologists know about these other brands because Synthroid is marketed so aggressively. Avoiding dairy, gluten, corn, and soy (including the small amounts contained in medication fillers) was the only way I could heal. My antibody counts refused to come down until I addressed the medication issue, and after I did, the antibodies went to negative.

    • Mickey Trescott says

      Thanks for sharing your experience Christiane!

  • Rena says

    Is it ok to take rhodiola rosea on it’s own? I can’t find a blend with the rhodiola rosea, but without the ashwagandha. I’m on a blend called Adrene Vive and when I go off it, I feel really weak and shaky so I do need something. Can you suggest a specific brand/product that does not have the ashwagandha? Thanks

    • Mickey Trescott says

      Hi Rena! Always important to check with your doctor first, but I’ve personally taken Rhodiola by itself made by Eclectic Institute as prescribed by my ND.

      • Rena says

        Yes, I have been talking to my doctor about taking Rhodiola by itself. thank you

  • […] Listen to The Autoimmune Wellness Podcast Season 2 Episode #1  […]

  • Annabelle says

    This is really helpful! I am about to start on thyroid medication for my Hashimotos. Just not sure what one is the best. I’ve been to my regular doctor, an endocrinologist and my naturopath. Is there much of a difference between Desiccated Thyroid Hormone Replacement and a Synthetic Thyroid replacement?

    • Mickey Trescott says

      Hi Annabelle! What is best for you will have to be determined by working closely with your doctor and some trial and error. There is no medication that works best for everyone across the board. A lot of folks like desiccated, but I tried it any my antibodies increased, so I’m now on synthetic compounded. That doesn’t mean it won’t work for you – make sure you have a collaborative doc on board and don’t be afraid to try different things and make adjustments! Good luck!

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