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The Thyroid-Brain Connection: Hashimoto’s, Brain Fog, and Healthy Aging

Dr. Heather Sandison, ND (00:00.694)
Welcome back to the Think Well, Age Well Podcast. I’m your host, Dr. Heather Sandison. And today we’re talking about something that affects millions of people, particularly women. And it can have a profound impact not only on metabolism and energy, hair, but also on how we think, how clearly we think, and how well our brains function as we age. My guest today is Dr. Anshul Gupta.

A board certified family medicine physician, he’s the best-selling author, researcher, and functional and integrative medicine expert who has become internationally known for his work in Hashimoto’s disease. Dr. Gupta previously worked in the Department of Functional Medicine at the Cleveland Clinic alongside Dr. Mark Hyman. His work now focuses on helping people understand and address the underlying drivers of Hashimoto’s and other chronic health conditions. He’s the author of Reversing Hashimoto’s.

And has a particular interest in something that I’m really excited to explore today. It’s this relationship between the thyroid and mitochondria, and what that relationship means for energy, for brain energy, for brain fog, cognitive function, and healthy aging. Dr. Gupta, welcome to Think Well, Age Well. I’m so delighted to have you.

Anshul Gupta MD (01:19.284)
Absolutely. Thank you so much for having me over here. You’re doing amazing work. Your podcast, you know, like shares so much great information to people, you know, who are looking to age well, you know, improve their memory and things. So thank you for having me.

Dr. Heather Sandison, ND (01:33.698)
Well, thank you for being here. I want to start with your story because you trained, you’re a medical doctor, you trained in very conventional family medicine, but then became deeply focused on Hashimoto’s and then functional medicine. I’m curious what took you down that path.

Anshul Gupta MD (01:49.566)
Absolutely. So this is kind of the joke, you know, in our functional medicine, like, you know, realm all the time, any particular MD who joins the functional medicine wagon, he or she has to have a story. So my story was like, you know, after completing my family medicine residency, you know, I was doing a great like, you know, work outside Richmond area into like a private family medicine clinic. But just a few years into my practice, I started noticing that, you know, my health was getting worse.

So I started gaining weight, you know, without even changing my diet or lifestyle. I was having this horrible stomach pain, which will just hit me randomly during the daytime, during the nighttime, doesn’t matter what I eat, you know, it will just not matter. Plus, you know, like I was tired or fatigued to the point that, you know, I had to take a nap, you during my lunch hour just to function through the whole clinic. And then after my clinic was done,

I was just feeling brain foggy that I could not concentrate on things. You my attention span was very less. And I was like, I don’t know what to do. Like, you know, why all these things are happening. My blood work was absolutely normal. You know, nothing was showing up, you know, on the scans that I did, you know, for the stomach pain, I started doing a PPI medication just so that, you know, maybe that is an acid reflux issue, but that was not getting better. I tried multiple things for several months. Nothing was changing.

This is where I thought maybe I’m not a smart doctor. need to see those specialists. So started seeing specialists after specialists and there is multiple testing endoscopies, ultrasounds, scans, more blood work. Even more medications were added. Nothing showed up. Everything was normal. At one point, you know, like all of my friends told me that maybe it is my head and nothing can be done. And I was only 32 years of age at that point of time. And I had no idea like, you know, whether I can survive how long this way.

Then somebody told me that, you know, functional medicine is a way to go. People like you find answers over there. So I started looking into functional medicine, got trained into it and started implementing a protocol. Made a few changes into my lifestyle, know, changed my diet. Sorry about that. So I made a few changes to my lifestyle, changed my diet, you know, started, you know, exercise routine, took some supplements. Within one month, my stomach pain was completely gone.

Dr. Heather Sandison, ND (04:00.716)
Yeah.

Anshul Gupta MD (04:09.955)
And then within six months, you know, I lost more than 40 pounds. My energy levels increased so much that I even participated in a rugged maniac. And for me, that was a big thing because I never had a third person. So that was a huge turning point. My brain capacity.

Dr. Heather Sandison, ND (04:24.353)
Wait, what was it? Say it again. What did you participate in?

Anshul Gupta MD (04:27.626)
It’s a 5K rugged maniac.

Dr. Heather Sandison, ND (04:30.151)
Rugged maniac. I don’t know that I’ve ever heard of that.

Anshul Gupta MD (04:31.682)
Yeah. Yeah, these are just obstacle courses, know, like, you know, it’s a 5K and then you have to do multiple things to complete that. So that was a kind of very interesting thing. You know, a couple of people in my clinic actually wanted to do it because, you know, they were into all these athletic things and they were joining the gyms. And I was very early into my fitness journey at that point of time. So for me to doing that was actually a big thing. So it was fun. But yeah.

Dr. Heather Sandison, ND (04:36.373)
Sempre.

Dr. Heather Sandison, ND (04:57.215)
Wow, you went for it. But you probably have that camaraderie and the people around you encouraging you and that’s really fun. How cool. But how brave.

Anshul Gupta MD (05:06.198)
I know, yeah, that was my first thing that I did with my kind of fitness journey. So that was huge and that was nice. But that was very fulfilling. And that’s what I realized that just making these few changes, my body responded so quickly, not only physically, but also emotionally. Mentally, I was in a better place at that point of time. And that’s where I wanted to share this with people around and everybody else. So I got this opportunity to work at the Cleveland Clinic Functional Medicine Department.

And I wanted to do more research, you know, into functional medicine model of care. And there I realized that I was attracting all of these females who had very similar health issues in mind. They were all gaining weight. They all had brain fog. They were all tired. And one thing was common. They all had thyroid disorders and they were all taking medications, but still not seeing the results. And then I looked closer and they all had Hashimoto’s disease. So I instantly obviously connected with them and I started researching into Hashimoto’s disease.

What exactly was going on? So I developed my three step process of helping all of these Hashimoto’s clients to get their life back, implemented it. We saw amazing results. Not only their symptoms improved, but we saw actually improvement in their lab numbers, their antibodies improved, their thyroid functions improved. So that’s what my journey has been. And that’s what I do now, help Hashimoto’s clients reverse it by following that three step process.

Dr. Heather Sandison, ND (06:34.359)
So I want people to understand how to know if they have Hashimoto’s. So what lab test to ask their doctor for? But also, you know, I think this this kind of bigger concept of thyroid, like our thyroid disease, thyroid issues, because you can have hop hypothyroid, low thyroid function without having Hashimoto’s. and then you can have Hashimoto’s and not really have hypothyroid, but actually have hyperthyroid symptoms.

So I want to go into some of that nuance and how you pick that apart in the in the clinic, but also I want to connect the dots because I think some people think of thyroid and their metabolism comes up. So weight and body temperature, maybe hair loss, feeling cold or hot, but not necessarily the brain. So can you connect the dots between thyroid function and brain health?

Anshul Gupta MD (07:26.048)
Absolutely. So again, you’re so correct that everybody thinks that, you know, people are gaining weight or they are depressed, you know, or hair loss issues, check the thyroid. But when people have brain fog issues, when they have ADHD, when they’re, you know, have dementia or Alzheimer’s, nobody thinks about like, OK, thyroid can be the driving factor. Well, in fact, thyroid hormone is really important for brain development to the point that when we were little into our mom’s belly,

If our mom doesn’t have enough thyroid hormone, we will literally not have any brain development. So thyroid hormone is so important for brain development. Now it is not only important when we were little, but even as we age, thyroid hormone plays significant role in myelination of our nervous system. So myelin sheath is very important. As we know, the myelin sheath can be damaged in Alzheimer’s as well as multiple sclerosis. So thyroid hormone plays a very significant role.

as well as maturation as well as recycling of several nervous system cells are again under the control of thyroid hormone. Now, interestingly, you know, our thyroid makes two different hormones. is T4, which is an inactive thyroid hormone, and one is T3, which is the active version. And our brain cells specifically have receptors for this T3 hormone. And it controls not only the metabolism of a brain cell, but also the mitochondrial health.

Now mitochondria is a powerhouse of our body, specifically our brain needs a lot of mitochondria so that it can produce energy and can function properly. And when our body doesn’t have enough T3 hormone or we have excess amount of T3 hormone that affects this mitochondrial functioning and again affects, you know, how our brain functions. So this is where thyroid hormone is very vital, not only when we are little, but also as we are aging for proper functioning of our brain and whenever

our thyroid hormone is not appropriate whether it is hyper or hypo in both situations brain fog or brain activity gets significant affected.

Dr. Heather Sandison, ND (09:28.321)
So then how does someone know if this is an issue for them? What test do they ask their doctor for?

Anshul Gupta MD (09:34.338)
a very important question because most people they will say that yes, you know, doctor, I got my thyroid check, but the only blood test they get is the TSH, which is a thyroid stimulating hormone. Now, just going back a little bit to the physiology of how our thyroid hormone is produced will help a lot of people to understand. Well, actually starts with our master endocrine gland, which is a pituitary gland, which is located in our brain, you know, which secretes this hormone called TSH, which is the signaling hormone.

your thyroid gland to produce thyroid hormone. It is not actual thyroid hormone. This TSH goes to your thyroid gland and the thyroid gland produces a hormone called T4. And as I said, that is an inactive thyroid hormone. What that means is that it circulates in your body and then it needs to be converted to T3, which is a more active form of thyroid hormone, which your body utilizes.

Now just imagine if a person only gets a TSH test, it is not even actually testing your thyroid hormone levels in a person’s body. So we need a complete thyroid profile. That means we need TSH, free T3, free T4, so that first of all, we know whether our thyroid hormone is in appropriate level. Now we need to go to the next level of also checking whether we have Hashimoto’s disease by checking those antibodies, which are two antibodies.

One is TPO, is a thyroid peroxidase antibodies, and the other one is thyroglobulin antibodies. And again, these are very basic tests. Each and every lab across the country can do it. So make sure when you are getting your complete thyroid profile checked, you check your antibodies. Because what research shows is that Hashimoto’s disease can go undetected for several years before actually the hypothyroidism finally shows up on blood tests.

And if you have Hashimoto’s disease, that means it is inflammation in your thyroid gland, which is damaging it. So the sooner you get to know about it, the sooner you can work on it and you can safeguard your thyroid gland from further damage. So these are the basic tests that everybody should get. One more test which does get a little bit of limelight is what we call is reverse T3. So the way to understand reverse T3 is that, you know, as I shared with you, the T3 is an active hormone. So T3 just imagine that is the gas pedal of your

Anshul Gupta MD (11:52.322)
and the reverse T3 is actually the brake pedal. In some people, their normal T3 levels are fine, but the reverse T3 is very much elevated and this reverse T3 doesn’t let your actual T3 hormone work in your body. So this is a little bit lesser known test, but if your doctor is open to it and if you can get a reverse T3 level checked, that will again help you in determining where your thyroid is having

Dr. Heather Sandison, ND (12:18.797)
So you talked about a three-step protocol to addressing Hashimoto’s disease. So if someone sees on their lab work that they’re either hypothyroid, hyperthyroid, or have positive they’re positive for Hashimoto’s antibodies, how do you help them navigate where to start and what to do about it?

Anshul Gupta MD (12:38.954)
Absolutely. So first of all, you know, what is Hashimoto’s disease? We just go back to the basics of it so that people everybody understand it. So Hashimoto’s is an autoimmune condition. What that means is that your body is making antibodies and that antibodies is starting a slow destruction of your thyroid gland. Now, after weeks, two months, two years, then finally you get diagnosed with hypothyroidism. What that means now is that

your thyroid gland is not able to produce enough thyroid hormone to keep up with your body’s demand. And this is where, you know, your doctor will start you on a thyroid replacement, which is your levothyroxine. That’s a typical thyroid medicine. But what most people don’t know is that levothyroxine or any other thyroid medicine is not doing anything to work on this underlying autoimmune process, which was the actual reason of starting the damage to the thyroid gland.

Now interesting fact is that 90 % of people who have hypothyroidism or low thyroid, the reason of them is actually Hashimoto’s disease. So it is rampant not only in the United States but across the whole world. So that’s the reason it’s very important to know about Hashimoto’s and work on it. Now the next question is that why did your body start developing antibodies and start this damage process? And this is the step one of knowing your root causes.

So I’ve identified five major root causes which leads to triggering of antibodies in a person’s body and that starts the whole Hashimoto’s process. So first thing to figure out what are those root causes which is causing, you know, like triggering of your immune system. And this is where most people have to realize they’re always looking for just one root cause and it is never just one root cause. It’s a combination of two to three root causes coming together leading to Hashimoto’s disease.

And it is just me, is actually research saying that all autoimmune conditions, whether Hashimoto’s or anything, it’s an interaction between your genetic pool with the environment around you. Now, most people, when they hear about it, they think, well, so Hashimoto’s is a genetic disease. Well, no, not really. A decade ago, Hashimoto’s was not even prevalent at all. And now suddenly, we are seeing an increased, almost like an epidemic rate of Hashimoto’s all around.

Anshul Gupta MD (15:00.482)
us. So the main reason is the environment around us which has changed dramatically and that is affecting our genetics in a negative way and leading to Hashimoto’s disease. So very first step knowing all those root causes are very important and those are five main root causes that are leading to Hashimoto’s disease.

Dr. Heather Sandison, ND (15:19.245)
And can you talk us through the five root causes?

Anshul Gupta MD (15:22.208)
Absolutely. So let’s talk about the root cause number one, which is the food. Okay. So food sensitivities is number one over here. We all have heard that food is medicine, which is absolutely great. But there are certain foods which can actually start damaging and also trigger immune system of our body. The number one is gluten or wheat. We already know that so many auto main diseases have been linked to gluten and things. So more and more people are actually

reacting to different foods around them. So gluten is number one over here. Second one is dairy. Now again, we have been sold that dairy is really healthy for our body, high in calcium, specifically older women’s are consuming high amount of dairy so that their bones can be healthy. But the modern day dairy is completely different from what we had before. And it is very inflammatory. It is filled with chemicals filled with hormones.

And that’s the reason more and more people are reacting to dairy. So that’s the second food most people get sensitive to. And the third food that we are seeing more sensitive towards is like soy and corn. Because more and more soy and corn are actually GMO food. So they have been completely genetically modified. And our body cannot recognize those genetically modified food and start reacting against them.

So these are like, you four or five top foods, obviously like, you know, high sugary food, processed food, you know, comes on that list also. But food sensitivity is a number one factor over here that we need to figure out which food a person is sensitive to, which is leading to leaky gut. And that leaky gut ultimately starts the whole autoimmune cascade of things. So that’s number one root cause. The second root cause, which happens in several of my people over here is nutritional deficiencies.

So not only our food is filled with chemicals, not only our food is genetically modified, unfortunately it is also deficient in nutrients. There was a research study done which compared nutrient density into our common foods from 1980s to 2010. And what we realized was that several vitamins and minerals like magnesium, like selenium, like zinc, which we need for a thyroid gland.

Anshul Gupta MD (17:38.172)
is deficient into our current food. So even though a person is eating very healthy, but the food itself might be nutrient deficient. So you might not need so you might not be getting those nutrients in your food. So nutrient deficiency specifically magnesium, selenium, zinc, obviously vitamin D and certain B vitamins are the second trigger which research shows can definitely lead to Hashimoto’s disease. The third trigger over here are toxins.

So toxins are everywhere around us. Each and every day we are adding more and more chemicals to our environment. And all of these toxins, you know, affects our immune system in a negative way. Now we already know what heavy metals like lead, mercury, arsenic being poisonous for our system for a very, very long time. But now we are adding new toxins, specifically mold toxins or mycotoxins.

In the last five to 10 years, we have to came to know about that mycotoxins, which were initially thought that they were only affecting our livestock is actually affecting humans in a negative way also. And certain mycotoxins have been associated with Hashimoto’s disease and triggering of autoimmunity over there. And then we have other chemical toxins like BPA is coming from plastics, glycosides, which are coming from insecticide, pesticide. And I can keep going on, obviously, like we have at least 100 different.

Toxins which can affect, you know, our thyroid gland in a negative way and almost 90 % of my patients will have one or the other toxins triggering their Hashimoto’s disease. So that’s the third big root cause over there. The fourth root cause is actually underlying infections. These infections can be either parasites in the gut. They can be overgrowth of bad bacteria in your gut.

or it can be viral infections like Epstein-Barr virus reactivation. We already have research studies that support that the Epstein-Barr virus reactivation can cause Hashimoto’s disease. And now we are actually seeing that post-COVID, lot of people being diagnosed with Hashimoto’s disease. And again, there is correlation between long COVID and also having Hashimoto’s disease too. So again, there are several underlying chronic infections.

Anshul Gupta MD (19:53.179)
which can again be responsible for Hashimoto’s disease. That’s the fourth root cause. And the fifth root cause over here is chronic exposure to stress. And this stress can be physical stress, can be psychological stress, can be emotional stress, any kind of stress your body goes through. And then your adrenals recognize that stress and chronically elevates your cortisol levels that affects your immune system in a negative way and again lead to Hashimoto’s disease.

lot of women actually, when they see these big hormonal shifts, specifically when they’re starting their menstrual periods, that is again a trigger for Hashimoto’s. When after pregnancy, they deliver the baby and again that hormonal shift happens, they get diagnosed with Hashimoto’s. And the third trigger can be obviously having menopause. And again, big hormonal shift happens and again, they get diagnosed with Hashimoto’s. These are hormonal shifts, but these are literally stress for a woman’s body and that again can lead to Hashimoto’s.

So these are five major root causes. again, remember not just one root cause, but most people have at least two to three root causes coming together, leading to Hashimoto’s disease.

Dr. Heather Sandison, ND (21:04.523)
And so I addressing these, you know, I feel like we could have a long conversation about each of those root causes. And I think many people will recognize that list in this approach to reversing Alzheimer’s, right? It there’s a lot of overlap. And I think what turns this on, whether you end up with Hashimoto’s or Alzheimer’s or cancer or whatever MS, like whatever it is that you you end up dealing with or being diagnosed with as you age, these root causes

are true kind of across the board, right? These are the those foundations of health that you have not too many toxins, not much of an infectious burden, that your nutrients are and your stressors are balanced, right? You went through each of these and and very eloquently. So I really appreciate that. And I think for a lot of people it’s easy to go, okay, so what supplement do I take for that? And I want to first touch on lifestyle.

Because I’m curious, you know, especially when you’re thinking about stress and your personal experience, how do you help people navigate the right amounts of exercise and sleep and stress regulation and muscle and metabolic health to influence and and protect and help to reverse Hashimoto’s or or to optimize thyroid function? Particularly, I think, when they’re not feeling well, right? How how do you navigate that?

Anshul Gupta MD (22:30.996)
Absolutely. So again, a very important point because you mentioned that, you know, people come to see us or anybody like, you know, even to you, they just give me that supplement or give me that peptide or give me like something which is just going to take care of things for me. Well, yes, you know, these are great tools, but your foundation is your lifestyle. Unless you improve your lifestyle, you’re not going to see long lasting benefits. So definitely everybody who works with us, you know, always tell them lifestyle is a foundation. This is where you start doing things.

And then obviously you add more along with it. So the pillars of lifestyle over here, let’s talk about food first, because again, everybody’s interested into food. What diet is best? know, and obviously there are so many different diets and everybody claims that their diet is the best. OK, but I go with the research in terms of, OK, well, what do we know the research suggests over here? So the basis of the diet is very simple for me is that remove the bad food and include the good ones. OK, so.

That’s very simple. We need to do those. So first, let’s talk about the bad ones, which is again making sure that we are removing the processed foods. Okay. So all those fried foods, all the processed foods that we’re eating, you know, in McDonald’s Burger Kings and things, we need to remove all that food because definitely that is very harmful for our body. Second of all, high sugary foods and also drinks. We actually cannot even imagine how much sugar

is being fed to our body in terms of all these sugary drinks that we drink as well as sugary foods we eat. So definitely we need to stay away from those because they lead to insulin resistance. Insulin spike will cause inflammation and triggering on things. So those are the two basic foods. And then beyond that, certain people who wants to go to the next level, then giving up gluten and also maybe giving up dairy and things might be the second step they can consider doing it. So those are the bad foods that definitely people should

you know work on removing those and beyond that, you know in limited quantities or even eliminating like alcohol and caffeine content can be useful for people at least in the short term basis when they’re starting their journey. The next step is obviously including foods, which is good for your body. So the first food over here is obviously everybody’s talking about good quality protein. So definitely we need all those amino acids amino acid called L tyrosine is very much important to make thyroid hormone.

Anshul Gupta MD (24:49.282)
So again, when you’re eating a good quality balanced protein rich meal, whether you are vegan, vegetarian, or whether you are eating like, you know, meat products, you can get protein from all different sources. So make sure you do include protein, good quality protein in your regular diet, you know, that will give you all the amino acids. Second over here is actually including non starchy vegetables, because non starchy vegetables will give you all the vitamins, all the minerals, as well as all the antioxidants needed

for your thyroid to function better. What most people don’t know is that each and every color that you see in a vegetable is actually a different antioxidant, which is working on a different pathway, not only to reduce inflammation, not only to address auto-immunity, but also supporting your thyroid functioning. So the more color you have in your diet, the better it is. So eight to nine colorful vegetables on the regular basis.

will give you a lot of these antioxidant foods to support your thyroid gland. Then comes the good fats. Again, we have been fat shamed for a long time. Fat is bad. Everybody should be on the low fat diet. It doesn’t work. And obviously you might have seen in your clinic that, know, literally your brain is made from fat. If you are not eating fat, your brain is not going to function. So we always, you know, need to know that it is good fat and that is bad.

So stay away from the bad fat, which is the trans fat, all those fried food and things, but you need to include good fats, all those fatty fishes, all those avocados, olive oils, if you are eating nuts and seeds, like almonds, walnuts, chia seeds, all those are good fats that you need to include on the regular basis. So not only you support your brain, but also support your thyroid gland. So that’s the basis of the diet, very simple to follow, of a few things, remove.

include good quality foods to support your thyroid gland. So that’s the first pillar. Then the second pillar we talk about the sleep. Very important. know, like, you know, the sleep quality directly affects your immune system. Your immune system is regenerating when you are having your deep sleep. And lot of people just looking for accountability of five to six hours of sleep. Well, seven to eight hours of sleep is very important, but also the quality of sleep is also mattering a lot.

Anshul Gupta MD (27:07.436)
because we need to get into that REM phase as well as the deep phase so that we can actually rejuvenate our immune system as well as our body in that phase. So dedicated time for sleeping, seven to eight hours, very important. Following a good sleep hygiene, again, no screen time, one to two hours before you sleep. Pick up a book or listen to some relaxing music or maybe just kind of do some relaxing exercises like deep breathing before you go to bed. That is definitely going to help you.

to sleep better. So pay attention to your sleep. If you are using a variable like an Apple watch or a ring or something, you can track your sleep. If not, that is fine. Just make sure you have dedicated time for sleep. So that’s the second thing. The third pillar, as you mentioned, is exercising and body movement. Now this is where again we get confusing signals or information, whether we should be doing cardio exercises, whether we should be doing weight training, should we do HIIT training and things.

So initially when people are too much inflamed and especially for thyroid patients, what I realized was that high intensity training is not really good for them because their body’s already broken down. And if you have too much pressure or stress on their body, they actually feel worse. So initial gentle body movement is the way to start with. And again, exercising is different for different person. A person who’s already running a marathon each and every day, for him or like her, like 20 minutes of exercising is not.

But a person who has never done exercising like I was before, you know, like never done exercising in my life. So for me, like, you know, doing 20 or 25 minutes of cardio exercising is still, you know, a lot. So start slow, build it up slowly. What I realized was that, you know, a combination of cardio and strength training is ultimately the best combination for majority of my patients, specifically if you are old older age females over the age of 40, because you need that muscle.

You need that cardio exercise so that you can lower inflammation and support your thyroid gland. So those will be the pillars. The fourth pillar obviously is working on your stress. OK. And again, everybody stressed out. know, whether you know what is going around us, you know, we just get bombarded with too much stress on the daily routine. So the goal is not to kind of avoid stress. The goal is to create resilience towards how your body responds to the stress.

Anshul Gupta MD (29:32.564)
Again, that can be very simple. You can do some deep breathing exercises. You can cultivate a hobby which, you know, relaxes being in nature, you know, just being in nature outside actually help you in, you know, relaxation also in that way. If we can do meditation, if you can do prayer or any other things which can help you that what we call is a me time for at least 15, 20 minutes and working on all the adrenal glands will help you definitely in reducing that cortisol levels in your system.

So those are my pillars of lifestyle changes that anybody who wants to start their journey with Hashimoto’s should start with these first.

Dr. Heather Sandison, ND (30:09.857)
I wanna ask about iodine because I think when I look out into the the world of thyroid, I see experts who are proponents of even high doses of iodine. And then you see other thyroid experts who really caution away from iodine. What is your stance on using iodine to support or really to maybe hurt the thyroid?

Anshul Gupta MD (30:35.01)
Absolutely. And this is one of the controversial topics, know, like, you hot topics and everybody has their own opinions. OK, and I’m giving you a little bit of a long answer over here. So, you know, people can pick and choose. And where is my reasoning? So research is very clear over here that people who are deficient in iodine, they have higher chance of Hashimoto’s disease and people who have high amount of iodine in their diets. They also have a higher chance of Hashimoto’s disease.

Dr. Heather Sandison, ND (30:40.929)
Yeah.

Anshul Gupta MD (31:03.18)
So that’s the problem over here. So we have to be right in the middle. And again, unfortunately, there is no perfect iodine test. So our blood iodine levels changes very quickly. So just getting a blood test to check your iodine levels is not the best way. The best way we can check is by 24-hour urine collection of iodine, which is a very painful process of actually checking your iodine. So most people will ultimately not.

So bottom line is that there is no perfect test. So again, checking your iodine status is also a very difficult thing to know about it. So my sense is that you do need some iodine in your diet. I’m not a big proponent of using high doses of iodine because definitely that can trigger Hashimoto’s disease. And we have seen, you know, actually people coming to see us, which they actually got worse after they started those high iodine dose protocol. But

There are certain people who do not have iodine in their diet at all. know, specifically like the only source of iodine for some people was that iodized salt. And again, they either like listen to some Instagram reel or some YouTube video. said, well, iodized salt is bad. Everybody’s, you know, using Himalayan salt, you know, or sea salt, which do not have iodine. So over the course of time, their iodine levels can also decrease. So first of all, look at your diet and see if you do have iodine rich foods in your diet.

So if you’re using seaweed, know, sea vegetables, or if you consume a lot of seafood, that is great. So then you do have enough iodine in your diet. You don’t need high dose of iodine supplementations. But if you’re that person who do not have any seafood, you do not eat any sea vegetables or seaweeds at all, and you’re not even eating iodized salt, then definitely start including some food with iodine in there, whether it is iodized salt.

or like, you know, just having like seaweed, you know, as a snack option, or then you can include, you know, an iodized supplement at a very low dosage, you know, typically around like, you know, 200 to 250 micrograms of iodized supplement. So at least you can get some iodine, you know, to support your thyroid.

Dr. Heather Sandison, ND (33:09.921)
Yeah, and so the micrograms are the important part there because I think some people will see think milligrams. And I I’m in full agreement with you. When I have people start supporting, you know, if they are low on iodine, if we think they’re low in their diet, then we’ll talk about maybe drops of a liquid iodine supplement or s very small capsules. We’re not you’ll see the 12.5 milligram dosing.

And we are in agreement. That is too high, way too high. You can actually cause problems if you start dosing with those very, very high doses. What about ski like using iodine on the skin? Some people use that as a test. some people will talk about absorbing iodine through the skin. Do you have an opinion about that?

Anshul Gupta MD (33:59.235)
So yes, again, that is very popular trend across the internet world where you can just apply a little bit of iodine on your skin. If it gets absorbed, that means you’re deficient. If it doesn’t get absorbed, you’re sufficient. Well, there is no research behind it. Everybody’s skin is different, so that is not a very reliable way. Even the color of the skin is very different, so you might not even notice a change to it. So I don’t recommend doing that iodine patch test.

in terms of determining the iodine source for it. Now, whether iodine can get absorbed through skin, yes, yes, it can get absorbed. But again, the absorption levels vary from person to person. So you cannot rely on that. So that’s again the reason oral absorption is the best. especially if you do have thyroid disorders, I will rely on either oral supplementation or oral foods as your iodine source, not the skin as a way to either test or get your iodine.

Dr. Heather Sandison, ND (34:56.033)
Now, if you’re navigating the world of thyroid medication, I know with Hashimoto’s you can sometimes swing between hypo and hyperthyroid symptoms. So help us understand. First, you mentioned levothyroxine, which is gonna be most commonly covered by insurance, what what the physicians will be most comfortable with, what they will have heard of. But then we also have synthetic, so if levothyroxine is our synthetic T4, as you mentioned, that’s

inactive thyroid hormone. We also have T3, which we can use prescription cytamel liothyrinine to support T3 levels. And then there’s all the desiccated thyroids. So how do you help people navigate when do I need this if I have Hashimoto’s? How do I know if I need it? And then which one? and then what if the pharmacy’s out or my insurance doesn’t cover it or I need to switch for some reason? Then what do I do and how do I navigate that?

Anshul Gupta MD (35:54.165)
Absolutely. So again, a very important question. So again, let’s understand what kind of medications are available. So as you mentioned, the most common medication is a levoteroxine. The brand name is obviously Synthroid. You know, if you go over there, that is only providing you T4 hormone. And the idea behind is that, you know, everybody converts the T4 to T3. But there are certain people, you know, who are not converting all of their T4 to T3. And, know, they need some support in that T3 level. So either you can add Cytomel.

you know, or some T3 hormone along with it, you know, along with your T4. That’s a synthetic route. Then we have these natural desiccated thyroid, know, which NP thyroid, Armour thyroid and the most common ones. And they have a combination of both T4 and T3. Major release T4 and a minor amount is T3 over there. But that gives you both the hormones. So obviously people tolerate those better also in that way. Now, the bigger question is that, you know, which is best? So obviously there has not been head to head trial in terms of one is better than the other.

But in terms of patient profiles, we do see that small amounts of T3 hormone, you know, our supports our patient in a better way. You know, their brain functions actually better, their mood clarity is better, their energy is better. So that way, again, if you can add a little bit of T3, I think that is always a better route to go in that way. Certain people also feel that when they shift from those synthetic medications to the more natural desiccated thyroid medications, their Hashimoto’s sees

is a little bit more stable and they will get less flare ups after that. The thought process is that because those are more natural, so they will not cause any flaring of your immune system. Plus, lot of these synthetic medications actually have fillers, fillers of even gluten and other chemical fillers, which again, people can react negatively. And the natural version of medications are better with that. But the downside is that lot of insurance companies might not cover it.

and certain medications come in and out in terms of their formulary. So certain people might be stuck that suddenly now there are an NP-thyroid and their dose of medication is out of stock. And now what do they do? So that’s the challenge that lot of people will face with that. But that’s where working with a local physician who can help you navigating the natural thyroid medication would be best choice. But if you don’t have one,

Anshul Gupta MD (38:20.163)
I feel that you know, being on the levoteroxine and adding a little bit of T3 hormone actually works equally good for lot of my patients.

Dr. Heather Sandison, ND (38:28.557)
Great. And you can get sometimes you can find it compounded, which a again a provider can help you with. I’m curious, for someone who is listening is like, this is me. I’m tired, my brain is foggy, I still don’t feel well, I probably have hypothyroidism or Hashimoto’s. What are three things they could begin doing today or tomorrow?

Anshul Gupta MD (38:50.434)
I’ll say the first thing that they should be working on is their diet. OK, so again, first of all, clean up your diet, include good foods which supports your brain as well as, you know, your mitochondrial health, which again, good fats are very important over here. You know, if you can include fatty fishes, good source of omega 3s, you know, your olive oil, your avocados as well as your chia flax and almonds and walnuts. That’s the first thing that you should be doing.

Good quality protein again to support your mitochondria as well as your brain health. So change your diet. That’s the first thing that everybody should be doing. Second of all, work on your stress. That is the number one thing which is going to give you mental clarity and improve your energy immensely. Just dedicating 10 to 15 minutes each and every day. Do this deep breathing exercise which is called four seven eight method. Very popular. You will find a lot of YouTube videos simple to do.

Basically, you inhale for four seconds, you hold your breath after that for seven seconds, and then you exhale for eight seconds. That’s one cycle. You repeat that for five to six cycles or even 10 cycles. That is going to see amazing results with rebalancing your cortisol and also rebalance your adrenal glands. So do that simple exercise. That’s the second thing that is going to definitely help you in improving your kind of Hashimoto’s and brain health. And the third thing will be

Just a gentle body movement is what I would like to get started on. Whether it is walking, jogging, running, or just kind of doing like, you know, some weight trainings, you know, at your home itself with your own body, some squats, some push-ups, you know, you can do. That is again going to help, you know, in boosting your mitochondrial health, because that exercise is going to boost your mitochondria, which again is going to ultimately help you with your brain activity. And also, obviously,

how you feel in general. So those are the three basic things that people can do. And then obviously there are supplements and things people can do after that. But these are the three basic things I would recommend people can start doing tomorrow itself.

Dr. Heather Sandison, ND (40:59.149)
I also want to know about you personally. Is there something you consistently do because you hope that your brain and body will function twenty, thirty, forty years from now?

Anshul Gupta MD (41:09.462)
So for me, actually, meditation has been the game changer. Because you and me and each and every provider over there work in a high stress environment. We are taking care of patients and so many other things. And definitely, that meditation kind of helps me in my mental clarity, rebalances my cortisol, give me that break that my body needs on the daily basis, and definitely rejuvenates my brain capacity. I’m able to actually concentrate better.

pay attention to more details. So for me, each and every day, even on my busy days, know, like, you know, if I have just five minutes in between the patients, I will just quick do either deep breathing or meditation exercise. And I think that keeps my brain going, you know, every day basis.

Dr. Heather Sandison, ND (41:57.312)
I love it, me too. 20 minutes in the morning, and I’m a different person. I I’m also curious, at this stage in your life, what brings you the most joy?

Anshul Gupta MD (42:07.479)
I think the joy is that each and every client that comes to see us who have been told time and again that they cannot do anything to improve Hashimoto’s, reverse Hashimoto’s disease or get the life that they deserve. And seeing them progress from there to actually living their life to the fullest, having so much mental clarity, having so much energy, literally feeling that after so many years, they’re able to live their life again.

So that just keeps me motivated each and every day, keeps me going. And that’s what the joy that brings me each and every day.

Dr. Heather Sandison, ND (42:45.791)
that’s beautiful. Dr. Gupta, thank you so much for being here. I just really appreciate the way that you’ve helped us connect some of the dots between Hashimoto’s and thyroid in ways that people don’t always think of them. You know, we talked about mitochondria, diet, immune system, and and it potential infections and the gut and leaky gut and the metabolism, and ultimately how all that impacts our brain. So I really hope that our listeners are here taking it away.

That these persistent symptoms, they are information. And if your labs have been called normal, and especially if the only lab you’ve gotten related to your thyroid is your TS TSH, but you still don’t feel like yourself, that doesn’t mean that the conversation and maybe the some of the detective work is over. It may mean that there’s additional pieces worth investigating with potentially a functional medicine doctor like yourself. So

I’m just delighted and grateful that you’ve taken the time to share your expertise here today. And thank you for doing the work that you’re doing and for delighting in the patience that you help and for joining me today on Think Well, Age Well.

Anshul Gupta MD (43:51.778)
Absolutely. It’s an honor to be here. Thank you so much for having me and thank you so much, you know, for all the good work that you’re doing.

Dr. Heather Sandison, ND (43:58.592)
If p listeners wanna learn more about you and about your book, where can they find it?

Anshul Gupta MD (44:05.026)
So the book is called Reversing Hashimoto’s. It is available on Amazon, so you can order from there. then plus, my website, my YouTube channel is a great way for people to learn more and simple tips that they can do today to kind of get better. My YouTube channel is Anshul Gupta MD, and that’s also my website. And again, the goal is to again share every day a few minutes that you can do and simple things that you can do to change your life and improve your health.

That’s the YouTube channel all about.

Dr. Heather Sandison, ND (44:36.183)
Fantastic. So to everyone listen listening, keep taking care of your brain you have today so that you can keep taking care it can keep taking care of you for decades to come. Thank you for being here. Please share this episode if it’s helped you or you can think of someone else who would get a lot from it. We’re so grateful to have you. Until next time, think well and age well.