Katie: [00:00:00] Welcome everyone. My name is Katie. I am part of the team at Paloma Health, who is hosting this event. And for those of you that are new here, maybe you heard about the event through one of our speakers. Paloma health is the first online medical practice focused exclusively on hypothyroidism.

We offer at-home thyroid test kits, virtual consultations with thyroid doctors and thyroid nutritionists. We have a Daily Thyroid Care vitamin supplement t o support your thyroid and our doctors are also able to manage your prescriptions. So we're an end-to-end medical practice for hypothyroidism.

And we do a monthly event on a different topic related to hypothyroidism, where we feature two experts in women's health every month on this specific topic. So we've got Dr. Maboubeh and Dr.  Mahtani, who we'll introduce in a second as our speakers on today's topic, which is how to get your energy back with hypothyroidism.

We know that fatigue and low energy and being tired is symptom for so many people. And so we're going to learn some practical ways to improve that today. Mary Shomon is my cohost. She is a patient advocate, for thyroid health and hormonal health. She'll be moderating our event.

It's about 60 minutes long. We're going to hear from both speakers and then we're going to open it up to Q and A at the end. So if you guys have questions or comments, feel free to leave those in the chat feature at the bottom of your screen. And we will get to as many of them as possible at the end. Mary, I'm going to let you introduce herself here.

Tell us a bit more about who you are, what you do. And then we will go to our speakers.

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Mary: [00:01:41] Great. Thank you, Katie. I'm Mary Shomon and I am a patient advocate. I've written 15 books about thyroid disease and hormonal health. And I am so excited to be here to help moderate this really fascinating conversation on a topic that is near and dear to my heart, which is

energy and how to get your energy back, because I don't know about you all, but I've had my cup, a couple of cups of coffee today already, and am trying my very best to be awakened and alive. And weekends are tough. I know some of us get extra tired, so we're going to learn some really important information from our two doctors today to help us.

Get our energy back and keep our energy going when we're hypothyroid, because that's oftentimes one of them, the most common complaints. So I'm going to give you a little, a bit of background on our two speakers and you're going to be impressed. Dr. Hashemi is the co-founder of Conscious Human Medicine.

She's a licensed naturopathic doctor and a California Naturopathic Doctors Association, Board member. So she's got the credentials. She's also board certified in biofeedback and the co-founder of her state-of-the-art clinic, providing integrative care, using the power of naturopathic medicine and innovative technologies.

And she's located in Santa Monica, California. So all of you, west coast, people, you know who to go see, she is dedicated to really helping women live well, feel well and have true wellbeing, by listening, letting their stories be heard. And personalizing medicine that looks at the root cause of their problems.

So we are welcoming, Dr. M. SHe's going to be giving us some wonderful information in just a moment. We also have with us, Dr. Pooja Mahtani. And Dr. Pooja is the founder of Pooja Matatani Wellness, a functional medicine, clinical nutrition practice. It's a virtual practice specializing in gut immune and hormonal health.

So it's going right to the heart of some of the issues that many of us are dealing with. Dr. Pooja has got some experience with this because she had her own health struggles with polycystic ovary syndrome, NAFLD, IBS, and she discovered the immense and incredible healing power of food. So Dr. Pooja has now transformed that into her own mission to really help women

optimize their health by bringing them a combination of cutting-edge nutrition and lifestyle changes. So again, Dr. Mahboubeh , she is here to empower women with information so they can live and feel well. We welcome these two amazing powerhouse women, and we're gonna get started with a brief presentation from Dr. M

who's going to be talking to us about some of her thoughts about this idea of how to regain and rebuild our energy. So if you're tired of being tired, start listening now, yawn, get out, get a little bit of energy, take a deep breath. And here we go.

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Dr. Mahboubeh: [00:04:51] Thank you so much, Mary. That was a great introduction and hello to all of our listeners.

And  let me actually do a screen share. Excellent. All right. Yes, I am Dr. Mahboubeh. It's so good to be with all of you here today. And I'm going to take you through a brief presentation. If I walked through a topic fast, please feel free to jot it down and ask some questions at the end.

I'll be more than happy to answer them to the best of my ability. So a little bit about me. I was born in Iran, grew up in Dubai. At first, actually, I went into engineering. And, got my bio engineering degree from University of California, San Diego. And, as much as I loved science and I still do and love that investigative part and understanding the root cause the piece that was missing for me was the sharing.

So I love to understand these complex topics, but then break them down and share them with other people. Which is why I was, intentional in going to the type of medicine that I did, getting my doctorate was naturopathic degree, because, we focused so much on patient education and, empowering people, which we'll talk about, briefly in a moment I'm also board certified in bio feedback.

And, as you heard, I'm the co-founder of our clinic here in Santa Monica, Conscious Human Medicine, I specialize in longevity medicine, focusing on two pillars:  increasing your lifespan as well as your health span, meaning not just extending your life, but also improving the quality of your life, which is why we're all here today.

As you listen to me and I'm sure Dr. Pooja, and whether it's doing a presentation or throughout, just keep in mind are many caveats and much more nuance that we're not going to get a chance to get into. But the overarching theme is that your body is an amazing interconnected, self healing, self regenerating system.

And what we need to do is to create an optimal environment for it, which is what we're going to talk about. And, what I'm going to be discussing during the presentation is on improving your energy, for those of us who are struggling with hypothyroidism or even, autoimmunities  related to the  thyroid.

But I'm not going to keep mentioning that. So just keep that in mind that it's all relevant. But for the sake of time, I'm not going to talk about it, repeatedly mention that. So we can not talk about ways of improving energy without talking about sources of energy depletion. In this case, being stressed.

Why talk about stress? Being in a constant state of hyper-vigilance or fight or flight is a short way of leaking and depleting your energy. When your body is under a constant source of stress, whether it's real or perceived, it's only objective becomes survival, meaning fighting infections, digesting your food, producing hormones, having a sex drive, none of that really takes priority anymore.

So during times of stress, especially repeated chronic long-term stress, your body will deal with the stress at the cost of, and with the resources that it would otherwise put towards other wider functions of the body. And when we talk about our hormonal system, which is really quite connected, your thyroid being one, adrenal, sex hormones, especially your thyroid gland, especially sensitive towards stress.

So again, keeping that in mind, as we talk about this topic and also important to note is that when we talk about stress, it's not just the stimuli, meaning that stressor, but also your response. So the way your body and mind interprets. The signal is as important, which is actually an empowering thing to think about because by changing that by changing potentially how we interpret that environment, we can put, potentially change our stress response.

When we, when I talk about stress, I'm talking about both the physical or physiological as well as psychological forms of stress. Which tells us that the base to mitigate or alleviate stress have to have both the physical and the psychological component in them. And, even though on the slide, they're separate, there's truly so much overlap in them.

And, we'll talk about some examples, so they don't think about them as just these clearcut, separate, entities. And again, knowing that chronic stress is quite costly and expensive process for your body. So real quick, you cannot always eliminate stress really. I can't think of any one of us that living in the modern lifestyle that we do can totally eliminate stress and have zero.

And the goal also is not to now stress about not stressing, which I see often as well. Keep in mind, do the things that you can change, especially if you're at the beginning of your journey, your health journey, not overwhelming yourself is key. Do the things that you can't change, the things that you can and are under your control and be okay with letting go of the rest for now.

And you can overtime add complexity. Ways to mitigating physical stress or physiological stress: minimizing your toxic exposure, improving your gut health, adopting healthy lifestyle choices, which lovely Dr. Pooja is going to talk about as well. Nourishing your mitochondria. And when we were talking again, each of these can be a lecture on their own.

So I'm just mentioning the topics, physiologically, sorry, psychologically cultivating self-awareness, which we'll touch on in a second and adopting stress management and healthy coping skills, healthy coping strategies, and beyond coping, truly these, things will allow you to have an edge and build resilience.

And we were talking about dealing with stress when we cannot eliminate it. The next best thing or reduce it. The next best thing is to build resiliency in the body to be able to handle it well. So I want to introduce a topic of biofeedback, in relationship to managing stress and enhancing performance.

So what is it, your biology, bio, constantly communicate with you in response to what it's sensing from your environment feedback. And so what are these signals, that communicate with us? They're your brainwaves, your heart rate and rhythm, your breathing rate and rhythm, your muscle tension, and, temperature and perspiration and the extremities.

And these signals are normally mild. But when you have sensors connected to different parts of your body, these signals are picked up and amplified magnified and fit back to you in real time. And what they tell us is which aspect of your autonomic nervous system, whether the sympathetic or parasympathetic, so sympathetic being fight or flight or parasympathetic thing, rest and digest, or the branches that you're residing in more often.

And because these things are being fed to you and real time you can implement changes. So these things are more so obviously physiological or physical signals, you can change this physical set of signals and by changing them, you can actually change your psychological response or your psychology. So you change your physiology to positively impact your psychology and that's Through this, you will be creating new ways of responding to life without having to constantly relying on your willpower and exhausting yourself. And you'll be able to create sustainable change as a result. And this is truly the magic of biofeedback very briefly. And lastly, hyperbaric oxygen therapy for improving energy and reducing inflammation.

And both of those, reducing inflammation automatically means improving our energy along with a lot of other things. So concept of the concept of hyperbaric  At sea level, we're breathing in air at one atmospheres, which, and that means you're taking in about 20% of the oxygen that you breathe.

The beauty of HBOG or hyperbaric oxygen is that it pressurizes. So it can be either pure oxygen or ambient air, but that process of pressurization allows not just the red blood cells or the hemoglobin aspect of your blood, but also the plasma. A portion of your blood now carrying oxygen. And just know that at normal pressures at sea level, the plasma portion of the blood does not have the ability to carry oxygen.

So it carries oxygen. Now you have almost twice as much capability of delivering this oxygen to your cells. And they thrive on it. So the benefits are that you simulate production of body STEM cells, you decrease inflammation, you improve or enhance the detoxification process. And we reduce fatigue, all the things that we want and go under that energy enhancement piece.

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Mary: [00:13:44] Thank you, Dr.  Mahboubeh. We really appreciate that really interesting presentation. And now we're going to hear from Dr. Pooja, with some thoughts about this issue of approaches to help build and maintain energy.

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Dr. Mahtani: [00:14:00] Hey, everyone. It's amazing to be here with you all today. Thank you so much for having me, Dr.Mahboubeh, an amazing presentation, and I thank you for introducing the topic of stress. We actually had a chance to connect on Friday afternoon to review kind of our notes and to prepare for this talk. And we both were like 100% aligned on the fact that. Stress is such a big player on the impact of  , it's just a big impact on your thyroid hormones and then ultimately, your impact downstream.

So I think we were both like, okay, this is what we need to talk about and really emphasize, especially this year. Cause we all know it's been a bit of a wild journey. I'm just going to take one moment to reiterate a few of the general concepts that Dr.  Mahboubeh just outlined. And then I'm going to go into some of the, interventions that I normally use in my practice.

So just to, go back over this really quickly. So the types of stressors I wanted to emphasize that we have both external and internal, and I think many times we tend to think, pretend to think more internal in the sense of other, sorry, external in the sense that we think more of our emotional response to things, whether it's like maybe a hectic day at work, you have to meet a deadline or you have, obligations with family or friends and the day just gets a little bit crazy.

So we think more, external, but we have to understand that when we say stress from this. concept of functional medicine or integrative medicine. We also have to keep in mind the internal stressors, which are, Things like blood sugar imbalance, because that's going to create an entire rollercoaster and cause your cortisol to surge or a persistent infections.

Like maybe you have a candida overgrowth or a parasite in your gut microbiome, or even environmental toxins . So we always want to emphasize organic food, right? Where possible and heavy metals and so forth. just wanted to reiterate that we have both external and internal stressors and we really need to  be able to get an optimal adrenal response.

We have to go after both of these. And then, again like Dr. Mahboubeh, how you said, you mentioned it's all about how the body responds to these stressors, right? So I wanted to take it a step further and say that initially the body will be able to compensate for, whatever stress that's ongoing and, and really meet the demands of this stress.

But over time, if this trigger or this stressor is persistent, the body will eventually, begin to lose the stress resiliency. And that's when we'll start to see this imbalance and the stressor will continue, but really the body now, it's not really capable of matching that tone. And as soon as that massive imbalance occurs is when we'll start to see a lot more of these symptoms.

And especially if you already have hypothyroidism, it can exaggerate, all of the hypothyroid symptoms like fatigue, Being number one. but then also maybe, losing the plumpness of your skin. Your digestion begins a little bit more worrisome and so forth. I just wanted to talk about those two concepts.

And then, in my practice I use, adaptogens quite heavily. Adaptogens are herbs. And I refer to them as nature's anecdote to stress and these herbs themselves. They live in harsh environments all over the world as a meaning that they've pretty much learned how to cope within these stressful environments.

And now, lucky for us when we ingest these, and when we take these adaptogens, that resiliency of these herbs carries through and it can really impact us as well in a positive way. So in order to be characterized as an adaptogen and herbs actually has to meet three different criteria. The number one, it has to be safe and normal therapeutic doses.

It has to help your body naturally resist a wide variety of stressors and it has to have a normalizing effect on your overall body function. AKA has to help you maintain or achieve homeostasis or balance. And examples of adaptogens include, or it's like reishi mushroom, Holy basil, Rhodiola ashwagandha.

And you can find all of these separately, or I think that the word is out on adaptogens. So I've been seeing like more and more combinations hit the market. You may be able to find one formula that works especially well for you. And, and you can see how, by implementing this into your lifestyle, you'll be able to sense it won't be, maybe a dramatic effect right away.

But I think as you let it do its work and its magic, you'll start to see that it, has a really amazing gentle effect on lowering your stress response. And then, you just being able to be a little bit more resilient towards the stress that comes your way. AKA you freak out a little bit less and maybe, you freak out a little slower as well.

And then you're able to recover faster in response to this stress. and then one last thing about adaptogens. There was actually a really interesting study that took place in 2018, where they took about 50 people and they did an eight week study comparing the effects of ashwagandha, in people that already had hypothyroidism.

And I think I was really blown away when I saw the results here, but it's not only did the ashwagandha group see an improvement in their T3 and T4 levels. It also helps to suppress TSH a little bit as well. So it worked on the main aspects of hypothyroidism. One thing also is that, ashwagandha is a night shade.

So if you're a sensitive to night shades, if you're already aware that you are sensitive or you're following the AIP diets, then I would, temporarily avoid this. But, there's so much more that could be said about adaptogens and I use them regularly, for myself. ESspecially I doubled up, in the last couple months just cause I knew I needed a little bit more of it.

Like Dr. Mahboubeh, you said that you can't necessarily escape the stress, right? It's the modern lifestyle, the modern world that we're living in, but, there are ways that we can learn to cope with it and use strategies to really build our adrenal resilience. And I think I'm close to time, but I just wanted to touch on a couple of lifestyle strategies.

We're going to go into sleep I believe a little bit later on, but there's a lot that could be said about sleep and how to get the most restorative sleep. But right now I just want to touch quickly on exercise and, maybe implementing a short meditative or deep breathing exercise as well. So one thing about exercise that's for some people, it depends on the type of exercise that could be really stressful on your body.

So if you're doing like CrossFit every day or high intensity every day, that could potentially have a major stress response on your body and,  the key here is that if it takes you about half day or full day to recover after your HIIT or a CrossFit workout, then you know that workout is not for you, at least not at this time in your life.

So it's better to switch over to something like yoga or Pilates, or even doing like a 15, 20 minutes strength training workout would be much more gentle to your adrenals. And then in turn that has feedback loops back to the thyroid and then your energy levels overall. And then with meditation, I think it is really challenging, always to implement a new, routine.

It's just hard to add something new to your life and I always, I think we jumped the gun when we say, okay, I have to set aside 30 minutes to listen to this Headspace app or whatever it may be. So I can get in this meditative zone, but you really can just start with five minutes. And I have seen wonders with five minutes.

I think if we over commit in the beginning, we're setting ourselves up for failure. But if we can say I'll do five minutes this week and then build. Following week, you can do 10 minutes. Like you'll see such, transformative change by implementing these small steps. So I'll leave it at that.

And then we'll go into sleep a little bit later, but, stress is going to be key here.

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Mary: [00:22:29] That was very informative, some really good tips and ideas and information for us to keep in mind as we are trying to manage our energy. I see we've got some good questions coming in. So keep those coming.

Cause we're going to cover a couple of questions that we had from the Paloma headquarters. And after we go through a couple of those questions, then we're going to open it up to audience Q and A, and we will be getting to as many of your questions as we possibly can. So please keep sending those in.

We'll be keeping track of those. My first question that we have for you is for Dr. Mahboubeh. We're wondering are there, cause we, we obviously have a lot of thyroid patients that are on this webinar tonight and they really are looking for information about which thyroid hormone replacement approaches have you found

might be better or best at helping people improve energy and resolve their fatigue. Do you, can you categorically say T4/T3 combinations are better or natural desiccated thyroid versus levothyroxine alone? Or do you find that it really is a one size does not fit all and you've got to gauge each patient on, are there, is there any generalizations that you can give us on this?

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Dr. Mahboubeh: [00:23:50] Thank you so much, Mary. That was a great and very important question. So before I talk about medication, I want to take a minute to talk about testing because it's so important. I'm want to encourage all of our listeners to be working with doctors that not just look at your TSH. And remember, TSH is your pituitary hormone, your brain hormones, signaling to your thyroid.

Gland to make thyroid hormone, and then you have your thyroid gland making T4. And to some extent, T3. And so you want to be looking at your TSH, free T3, free T4, as well as your antibodies which is what makes Paloma Health's test kit so great is because you have all of those combined under the same umbrella.

And it's important that the doctor is familiar with interpreting them and being able to treat accordingly. Having said that when it comes to medication, You have, T4, like you said, so you have synthetic, whether it's levothyroxine, Synthroid, and other brands that are synthetic T4, and then you have bioidentical desiccated thyroid, that is a combo of T3 and T4.

And then you have a compounded version. So you have T3/T4 that is compounded that in that case, it will be synthetic. Like you said, Mary, it's really, we are at our clinic, a big believer in personalizing medicine, individualized medicine, meaning you have to understand what the state of health of the patient is.

And so as a result of what medication at what dose would best suit them at this point in time, Having said that this scene often that the combo of T3 and T4 can work better. And I'll tell you. so we have patients that come in with having been diagnosed and be put on T4, synthetic T4, and their labs might start to look normal.

Especially if you're simply just looking at TSH, what's symptomatically, they are not improving. And that's when we introduce, and if you're, if our audience is wondering why that is because T4 is the inactive form of thyroid and has a longer shelf life, or half-life in the body.

Versus T3 is the active, meaning your body has to do the job of converting T4 to T3 in order for yourself to be able to use up that thyroid and do their magic. Now, where does this conversion happen? So your gut, your liver are the main areas as well as other peripheral. Basically everywhere, but mainly it's happening in the gut and liver.

And often when we're dealing with hormonal imbalances, chronic issues. These organs are at the mostly affected. So the conversion is not happening.  When we give a little bit of T3, meaning lifting the burden off of these organs and helping the body, we see improvement in mood, in cognitive function and, often when we associate brain fog with low energy and low mood, as well as energy overall. Last thing that I want to say is that  between desiccated versus, compounded, meaning synthetic T3, T4, or the quote unquote bioidentical, please keep in mind

bioidentical or natural does not necessarily always mean better. And synthetic does not always mean worse. Your doctor has to work with you because for example, we've seen sometimes in the case of auto-immunity were bio identical because these hormones are, or the formulation has taken from, the gland  of porks.

It can potentially, in some cases, exacerbate autoimmune symptoms. In that case, then you go to other options and there's obviously a lot more to be said on that, but did I, to some extent, get to your question?

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Mary: [00:27:46] Absolutely. Absolutely. I appreciate that. And so I think the key message that patients need to know is the best thyroid medication for you is the one that safely works best for you.

Yes. Yes. And it may be any one of these meds, brands, combinations, dosage levels. But if you're working with a smart thyroid savvy practitioner, they are going to help you find those medicines at the right doses to get you to the optimal point.

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Dr. Mahboubeh: [00:28:15] Yes. And before I let you go, I just want to add this point.

And that is, it could be that you are on the right medication, but the issue is that you're not properly absorbing. So a lot of times, in the cases of hypothyroidism or Hashimoto's, we're not secreting enough or producing enough hydrochloric acid, we're not absorbing a lot of things.

Why we're in instead of nutritional deficiency, in addition, including our medications. So sometimes it's actually addressing some of the lifestyle factors will actually allow you to make use, make the best of the medication that you're on.

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Mary: [00:28:53] Great. Great information. We're gonna pop over to Dr. Pooja here and ask about one of my favorite supplements and some of her favorite supplements. One of the supplements that always was so exciting to me was when I saw all the research about the impact of thiamine, vitamin B1 on fatigue and energy in thyroid patients.

and I am wondering if thiamine is something that you regularly recommend to your people with a high hypothyroidism-related fatigue. And, what other supplements in particular that you recommend to your hypothyroid patients to help them get their energy back? Dr. Pooja?

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Dr. Mahtani: [00:29:40] Yes, this is one of my favorite topics as well.

cause I can talk about diet and supplementation all day long. I did look up the research on thiamine and its impact on hypothyroidism and energy. And I think that, that is certainly one option, but I would actually take it a step further and suggest a B complex, which is going to be a lot more comprehensive in nature and cover all of the bases.

And so I'm, as a practitioner, I'm always weary of my client's finances and what they would be willing to stay compliant with because of a long laundry list of supplements with the medication on board, it just tends to be a lot at times. So rather than dosing individually, I'm a huge fan of the B-complex and B vitamins in general, can be very helpful for energy.

And then, also a step further to that. I especially. need to understand are my clients absorbing? What is their digestion? What is their gut looking like? And, if I say that, think that's okay, then really evaluating their diet and thinking, okay, are you following more of a vegan, vegetarian diet?

Because it's not only. the B vitamins that we need to be concerned with, we also need to be worried about, I can say B12, but then that kind of falls under the B vitamins. We also need to be worried about zinc and iron and iodine. So all of these are going to be, critical players with thyroid physiology as well.

So depending on what your diet looks like, you may already be deficient in some of these nutrients, so important to supplement. Accordingly based on, what it is that your diet looks like. And then also, I like to do micronutrient testing in my practice and really digging in to see, if we can't really get a good idea from your intake form or what it is that you're eating on a day-to-day basis, then we need to take it a step further and test to see.

where the deficiencies lie, because it's all comes down to the micro cellular level and where the deficiencies lie. On one hand I'm a huge fan of the B vitamins but I also know that it would be important to incorporate testing at some point to know what it is that are your specific deficiencies versus just

taking a fistful of those supplements every day and not knowing which one really work, moving the needle, and making that shift for you. So I hope that question.

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Mary: [00:32:08] Absolutely. Thank you. Thank you. Dr. Mahboubeh , do you have any particular supplements that are your favorites for your fatigue type of thyroid patients?

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Dr. Mahboubeh: [00:32:20] I'm just going to add to, the amazing explanation that Dr. Pooja gave on thiamine, because, in literature, we actually see that see it's being used, for autoimmunities,  let's sayMS. as well as, if you consider a fibromyalgia an auto-immunity, but fibromyalgia, IBD, so Crohn's and colitis also, exercise-induced fatigue and, fatigue induced after stroke.

The reason that if you understand what something does and we can understand maybe potentially why B1 might not be just a magic pill. And like she said, we need to have a comprehensive plan and have B1 to be a part of that. But B1 basically allows us to more efficiently use energy.

So it breaks down carbohydrates, but it's down fats and proteins and helps us produce, or sorry, release, hydrochloric acid. So all of these things are extremely important in us being able to generate energy across the board, whether we're dealing with thyroid or not. So it very well can be. And the other interesting piece with thiamine is even if  you run it,

Dr. Pooja was talking about micronutrient testing, it appears that thiamine deficiency is found rarely because you can have adequate blood levels of B1. However, because the uptake by the cells is a complex process, that piece might not be happening. And remember just like the thyroid, we need these nutrients, these hormones to get entered the cell in order to be doing their wonder and the goal or the philosophy, or the idea behind supplementing that

B1 is that now you're flooding the blood or the body with B1 so you're no longer just relying on normal transport, but passive diffusion from the blood into the cell. And the cell can use that up. So  in addition to everything that Dr. Pooja Said, and in terms of additional supplements, we are a big fan of cocuten.

We've seen always, amazing results. It's quite safe. Most of us can benefit. I briefly mentioned mitochondrial health in my presentation and cocuten think about it as food for your mitochondria. Those powerhouses of yourselves, vitamin D is extremely crucial. It really is a signaling molecule.

It's a hormone. In addition to being a vitamin, we have B5 or pathogenic acid that is for your adrenal glands. And we all know that close connection between the adrenal gland. The health of the adrenal gland and thyroid health, magnesium, and, is also, it's we talk about it a lot, but we can not talk about it enough at the same time.

As well as sometimes in some cases NAC or N-acetylcysteine or NAC can be very helpful. Although again, all of these things are best done individualized. Like Dr. Pooja said, understanding who you're dealing with and what their specific deficiencies and needs are.

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Mary: [00:35:12] Great. Thank you. very helpful information.

All right, we're going to move on to, back to Dr. Pooja. Can you give us just a hit list of the foods that are most likely to make our fatigue worse and the foods that are most likely to improve our energy when we're hypothyroid?

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Dr. Mahtani: [00:35:32] Okay. Yes. So I promise I will get to a list, but I do want to share one, foundational concept, which I did touch on earlier.

And that's blood sugar regulation. I feel like it's not sexy at all because you're not removing a food. You're not adding a superfood, but I can tell you that it is absolutely foundational. If we don't get this part right then everything else downstream, it's just going to have a minimal effect. So when I say a blood sugar regulation, I think I can share to at least from my perspective, clinical signs that maybe, people can part with and they can

find out if that's something that's going on in their own life. So number one, a key sign, if you have, what's known as insulin resistance, would be if you have fatigue after your meals and that's essentially, is insulin resistance is when your cells aren't able to uptake the glucose as effectively because the cells are now resistant to insulin and insulin is your escorts molecule for glucose to be able to get into the cell.

Again, fatigue after meals. and I know with this whole talk, it's I had, I have hypothyroidism. I'm kinda tired all day long, but, imagine your fatigue just going like 10 X worse after a meal, that's what I'm referring to or another, imbalance is hypoglycemia. And that is, a sign for that would be fatigue before meals.

So do you get a little shaky, a little jittery, really tired and then you eat and you feel so much better. That's also another type of blood sugar imbalance. And certainly I also incorporate some labs in my practice. I'll always look at  fasting glucose, fasting insulin, hemoglobin A1C, glycomark.

So I'll look at all of these, to see where the needle is. Is there, is it going towards more insulin resistant or hypoglycemia? So not sexy, but I think this is super critical. And if we don't get this right, then it's going to lead to a surge in cortisol. Cortisol is our stress hormone, and it'll continue to cause this stress vicious cycle to keep going, and then that'll just have downstream negative effects on your energy.

Long-term, so that's number one. And then, okay. Now the list. So I would say that if you happen to have Hashimoto's, so the auto-immune version of hypothyroidism and close to, I believe in the literature, it says about 90% of all hypothyroid cases. Eventually can turn into, if not already is more of the auto-immune presentation.

so in that case, the number one food that you'd want to eliminate would be gluten or wheat. And the reason for that is because gluten shares a lot of the same amino acids or protein as your own thyroid gland. So every time you're ingesting gluten, your body thinks that if your body's already identified gluten as a kind of a foreign invader, then every time you ingest it, not only will it attack the gluten itself, but it'll also attack your thyroid.

And that will, be that active pathology will keep going every single time you eat gluten and make your thyroid symptoms a lot worse. So that is my number one food that I would suggest to eliminate if you're already on the autoimmune spectrum. And then certainly if you feel that, I have some clients that will say this changed my entire life, just removing this one food.

Sometimes we need to take it a step further. And at that point I may suggest the autoimmune paleo diet, which is going to be a lot more restrictive in nature. It's going to remove a lot of the common. Food sensitivities are allergens like gluten, dairy, corn, soy, eggs, nightshades, and all of that.

And the one thing I want to share about the AIP diet, because it is really popular and it is, there's literally, I think, research behind it now, actually. So it has been shown to be effective, but if you're on the AIP diet for, let's say longer than 30 days, And you're having a really hard time reintroducing some of these foods back into your diet.

And I will say caveat, gluten, maybe something that you can may never be able to add back into your diet, but something like a night shade, you should be able to, let's say. And, in that case, if you're doing it for long enough, and you're not able to add some of these foods back in at that point, I do suggest that you work with an expert

who's able to really guide you further along in your journey because it's difficult to live with a restrictive diet longterm. I don't think that's necessarily the healthiest approach long-term yeah.

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Mary: [00:40:14] Okay. We've got a lot of folks that have a bunch of questions, but I want to just ask one last question.

And this is, this is a quick one to both of you. When we are looking at the issue of sleep, you have people out there that swear I only need four hours of sleep a night. And then I look at all the science and I see that anything less than seven hours a night is considered short sleep and has a whole long list of health-related problems.

Then you have people saying I'm hypothyroid and I'm tired, but you ask them how long they're sleeping. And they said they sleeping five hours a night. Very quickly, each one of you, Dr. Mahboubeh,  you go first, how much sleep do we absolutely need to get at minimum in order to at least provide a foundation for getting our energy back?

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Dr. Mahboubeh: [00:41:06] Sure. So again, one of those questions then, individuality is key, really understanding the needs of a patient and what, how depleted they are when you started working with them. Having said that, I agree with you, Mary, that less than seven hours. There are studies. Now there have been studies looking at women with five hours of sleep and their

immune response and their susceptibility to catching pneumonia and that it increases your risk by certain percentage. And so it's absolutely key. And remember, we were talking about the impact of stress. So sleep deprivation, especially chronic sleep deprivation is a form of physiological and eventually, psychological stress.

There's a reason why it's form of torture and  there's a lot of amazing, interesting studies coming out now looking at so many facets of stress that I wish we had time to go. So I sleep, I wish we had time to get into, but seven hours. I would say, if you're going to, so the other, extreme ward and interval of it, if you're going all the way to nine, 10 hours, and you're still not feeling rested, because that really is one of the more important things.

How do you feel upon waking up? And how have you built default asleep and stay asleep? So if you're getting supposedly nine, 10 hours, either in bed or sleep and you're still feeling tired, then we have to look deeper. We have to understand what are the potential underlying reasons as to why you might not be able to, you might not get, be getting quality sleep because after some level we've seen in research that.

Higher levels of sleep that do not correlate with optimal health. Actually, they can be going through other way and increasing risk of mortality again, with caveats in there. And I want to put two things. One of them might not be, popular, and that is, making sure we have some sort of a winding down process in the evening.

The way sleep functions physiologically is not like turning off the switch and that's how you know, and the lights go off and that's how your brain works. We need to prepare our bodies and brains. So having some sort of a ritual or a practice, it could be deep breathing. It could be a meditation, it could be stretching.

It could be gentle, not extremely mentally engaging, reading, listening to meditative music. And not going, and being on social media and all of that until the last one. So having that buffer between daytime or life events and sleep and honoring that is key.

And the other thing that might not be popular and often we use it  to knock ourselves out and lose consciousness is alcohol, which can actually interrupt our sleep. So if we can, and I'm not here really to absolutely  tell any of us, especially, some of the stress levels that people might be going through to not do this or do that, but just so that I put information out there and all of us can make our own decisions, but we have seen that it amplifies that the sympathetic or the fight or flight aspect of your nervous system, and it really interrupts our sleep.

Even if we do not realize it, then we sleep through the night.

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Mary: [00:44:31] Okay. I think we're going to jump into the questions and we have so many of them and just so you know, docs, you've got a fan club here because some of the readers, our viewers are writing in the doctors are great, I wish they could be my doctors.

So you are obviously making a great impression as  is no surprise.  So here's a question from one of our viewers. We have the supplements like ashwagandha and there's, the stinging nettles and the reishi mushrooms and various things to support the immune system, support, fatigue, support the adrenals.

Do we take them all the time on a daily basis or only when we are, dealing with obvious stress and, do we need to clear this, obviously with our healthcare providers? Do I need to call my endocrinologist or my GP or whoever it is, that's prescribing my thyroid hormone replacement treatment and say, I want to take this combination energy supplement or this adrenal supplement or this or that?

Do, what do I need to do? So doctor dr. Pooja, I'm going to send that one to you. What are your thoughts about. The using them all the time or just when needed. And do we need to clear this ahead of time with the docs?

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Dr. Mahtani: [00:45:51] Okay. Yeah, I'd be happy to answer that. Number one, I suggest that any supplements that you're going to add on to as part of your daily regiment, especially if you're already taking some medications, it's super important to have that kind of cleared or okayed by your,

let's say maybe it's your endocrinologist or maybe it's your primary care provider or a naturopathic doctor. I completely wholeheartedly believe that they should be in, on this care team with you. And that they're, they should be made aware that the fact that you're, taking some supplements that have been shown to help with our health.

That's number one. Number two, so I am a big fan of taking it every day and then doubling up when you know that you're in the midst of a stress flare, let's call it. As it is in our modern lives, it's just really hard to avoid it. So if we can't avoid this stress, can't run away from it, then it's better to build our resiliency.

So I do suggest taking it on a daily basis and then doubling up, if you need to.

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Mary: [00:46:55] Okay. Great. Thank you very much. So we have, some questions about the emotional impact of fatigue and Dr. Mahboubeh, one of our viewers wanted to know if childhood trauma or even adult trauma has an impact on our fatigue level and our perception of fatigue.

And if that is even a contributing factor to auto-immune disease and, some of the reasons why people develop thyroid conditions?

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Dr. Mahboubeh: [00:47:29] Yes. yes. And yes. To all of it. Absolutely. It's interesting, Mary, we do not even have to have looked at any studies, which now there are ample amounts of, to intuitively know that's the case.

Remember I was talking to you during the presentation that so long as we're, it's not that the sympathetic or being in fight or flight is bad, and parasympathetic or rest and digest is always good. There's nothing bad or good about these multitude of, or the spectrum of, nervous system capability or emotional capability that we have.

It's when the imbalance is happening, that's when the problem, or the health consequences start happening for us or being experienced by us. Yes. A hundred percent. Think about it. If you're constantly in that fight or flight, if your environment, whether you at this point, know it consciously or subconsciously is not safe for you.

You are leaking energy. You're depleting your energy without even knowing it. And not only that by doing that your threshold, so your resilience, your threshold for being able to take in life decreases. So now the slightest of things, oftentimes, in the naturopathic medicine or functional medicine, With a systematic approach.

We realized, you know, we asked our patients, especially in the case of auto-immunity, what was going on at that point in your time. That's why we do a timeline on inpatients. And often what we see is a lot might've happened that, whether it's lifestyle-related or otherwise that kind of put them on that path.

However, there was that event, whether it's a divorce, a loss of job or a breakup or some traumatic accident, that was just the last straw that broke the camel's back. Yes, absolutely. And I can go on and on, but I want to be respectful of our time. And if there's any followup questions, I would be more than happy to answer.

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Mary: [00:49:31] Okay. Thank you. Yeah. I completely understand that. Been there and done that myself on the auto-immune situation.

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Dr. Mahboubeh: [00:49:38] Yes. Sorry. I apologize. The most important message to take away is though that do not have to live with this. There's a lot that can be done. Your brain is quite neuroplastic. You can develop new neural patterns, new ways of responding to life.

So do not take that as something that you have to accept for the rest of your life.

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Mary: [00:50:01] Exactly good advice. I'm gonna combine two of our viewer questions for you, Dr. Pooja. The question starts with how important is being hydrated to dealing with fatigue? Because I think we know the answer to that, but you can give us a little bit of background on that.

And then this is an interesting question, because I actually had a conversation with an endocrinologist this week about alkaline water and it's become the latest fad, the latest trend. Everybody loves it. They want to change the pH of their bloodstream, et cetera. She said, alkaline water is fine, but don't take your thyroid medicine with the alkaline water because it's messing up the absorption of the thyroid meds and she's seeing it.

Every week now with her patients that are on heavy alkaline water. So I'm wondering if you can address first of all, the issue of hydration and fatigue, and then, maybe whether or not alkaline water is even necessary, or if we are going to do it, maybe we're going to keep it apart from our thyroid meds.

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Dr. Mahtani: [00:51:04] Okay. So hydration is fundamental. This is as important as we take in food everyday, we have to take in water every day, but I actually always talk to my clients and tell them that you may be drinking. And this is more often than not my clients are drinking, let's say they're eight glasses of water a day, but they're still dehydrated, which is a little bit hard to believe because thinking, wait a minute, I'm doing myself a favor.

I'm really conscious about. Adding or drinking these eight glasses of water every day. but if our cells are not getting that water, then our cells are dehydrated. And so regardless of how much water you drink in a day, we're just peeing it out and we're still dehydrated. And the missing link here would be electrolytes.

So your sodium, your potassium, your magnesium, all of these electrolytes are going to open up the cell wall to allow the water in. So I would say, I'm going to combine my answers as well and say, more important than alkaline water. I would say, make sure that you're getting your electrolytes, because all of this water that we're drinking today, I think, again, we've all been more, we're more educated.

Now we know that there's a lot of toxins in our water, so we're all actively taking steps to filter our water. And regardless of the type of filter that you're using, It's not bringing those electrolytes back in. And so we have to be able to replace them. So I'm a huge fan of, the electrolyte water.

And I think a key sign to know if you need electrolytes. And also a way to know if they're working is to drink eight ounces of water and then wait and see how long it takes for you to essentially urinate those, that glass of water out. And the key here that you should be able to hold this liquid in your system for up to two hours.

And that's a good gauge for whether or not you need to add them to your, add electrolytes to your system and also a good gauge to know how well they're working for you. So that's my take on hydration. I'm more of a fan of the electrolytes. I will be completely honest. I actually haven't had too many, clients on alkaline water.

So I haven't seen that correlation between alkaline water and thyroid hormone. Interesting to see these anecdotes pop up and certainly something that I can look into more myself and, get back to Paloma Health. And then maybe you can send out this message over email because I don't know the answer to that.

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Mary: [00:53:32] Okay. Sure. Dr. Mahboubeh,  do you have any insights into this issue of the alkaline water?

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Dr. Mahboubeh: [00:53:40] Yes, it's interesting. It is now the, It used to actually be, I feel like a lot more, some years ago, I agree with, everything Dr. Pooja said, and I personally am not a big fan of alkaline water just because, your blood pH is quite a sensitive measure.

And it's tightly very tightly regulated by a lot of biochemical processes that are happening taking place, in the body, including your breathing. So to now, want to be artificially manipulating that again, diet as a separate piece, and, outside of the scope of this question, but I personally believe w e actually operate better, more optimally if we are slightly on the acidic side.

So it's not all the way here or all the way there. So I'm not a big fan, especially because, we need, I mentioned it a couple of times already that we need our hydrochloric acid as well as. Production of proper pancreatic and other digestive enzymes to break down, not just the medication, but also the food that we're eating.

So that kind of is my take, and I'm almost once a week asked this question and, just that last week by my students, and so that's the short clips on alkalinizing odor.

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Mary: [00:55:02] Okay. Thank you. I think we could probably keep going for another hour or two with all of the different questions.

And one of the things I do want to mention to folks, and Katie, maybe you can jump in with a URL for folks, but some of the questions that have been coming in related to menopause and fertility, and iodine, et cetera. And I would love folks to go take a look at some of our previous Paloma Speaker Series, because we've tackled some of these other issues and gotten in, into the in-depth with some of the, some of the issues and some of the questions that folks have.

So I don't want you to think that we're not covering your questions. It's just, can't do them all in one hour. But I want to thank, Dr.Mahboubeh  and Dr. Pooja for all of their wisdom and all of their amazing energy.

Katie, where can people go to find back episodes of our amazing speaker series, as well as all sorts of articles and information, we shared a few of them in the comments, but there were there's lots of articles and blog posts, and fact sheets for people on all of these amazing issues.

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Katie: [00:56:14] I just shared the link to our previous speaker series in the chat there. And I've also shared t o individual people, a couple articles that might be helpful, a link to our Daily Thyroid Care supplement. And we will send out a replay email, in the next day or two.

So people know where to access both of our speakers they'll know where to access you, Mary and we hope this has been helpful to each of you. We know that energy and fatigue is such a struggle, a challenge for people with hypothyroidism and Hashimoto's. And so we hope that people have taken even just one thing today that they can start doing tomorrow to improve their energy.

So thank you to each of you, our speakers and Mary, and, thank you to all of you that have joined us on your Sunday. I hope, that you enjoy the rest of your evening, and have a good week and we will send out the replay and include information about our next speaker series coming up next month.

Thank you so much, everyone. We will talk to you soon.

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Mary: [00:57:08] Thanks everybody.

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Dr. Mahboubeh: [00:57:10] Thank you so much, ladies, for all the hard work. Thank you for having us and your listeners.