Introduction to the Gut-Thyroid Connection

Most everyone has something that's out of balance. Some of us have more dysbiosis than others. Um, some of use have a higher immune reaction in our gut than other.

So some have us more fat malabsorption than the others, so really I always look at the symptoms and I'll always ask them what the quality of their stool is.

That also tells me that their gut's really inflamed. If they're having lots of diarrhea, lots a loose stool, we've got to address that. Welcome to Health Breakthroughs with Dr.

Stengler. I'm Dr Mark Stegler and each episode we cut through the noise to bring you practical, science-backed insights for more energy, better health and a life that feels like yours again.

Hey everybody, great to be with you. And my special guest happens to my wife, Dr Angela Stangler, and today we're going to talk about the gut connection to the thyroid.

So Angela, or Dr, Angela thanks for joining us. Well, thanks for inviting me. It's nice to hang out with you again today. So, hey, we're going to talk about, again, the gut kind of hormonal connection to the thyroid.

Let's just talk a bit about the kind patients that you see. You see a lot of patients, women, thyroid disorders, a ton of hypothyroid, autoimmune thyroid problems.

Tell the viewers a little bit more about what you'd see in terms of the connection between digestive health and thyroid function, if you would. Yeah, that's a good question, and it's an interesting question because today, interestingly enough, when I was talking to a patient and she was convinced that she had thyroid issues and had all these symptoms, her labs looked actually pretty good, but when we were talking about all of her symptoms I explained to her that we are not diagnosing her with a thyroid condition right now, we're diagnoses her a gut situation because her gut has a lot of bloating, she has lot pain, so those symptoms could definitely be reasons for why she feels very fatigued and some of her hair loss and things of that sort.

And then obviously, yes, I am testing her thyroid. Her mother has autoimmune thyroiditis, so there possibly could be that connection there. But this is the thing.

Why Gut Symptoms Can Mimic Thyroid Issues

In general, in integrative medicine, treating the entire person is very important. So I never like to just say, you just have a thyroid condition, because a lot of people come in and they want to hear that.

We're really, it is, we have to start with the gut because the got is very important. The liver is involved in the gap. Pancreas is in my gut. You obviously have your intestines in that got and that's all all connected to getting out toxins and making sure that we're metabolizing our hormones correctly.

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Of course, it can work the other way around. If people do have low thyroid, that can affect their digestive symptoms. The most common thing would be with low-thyroid constipation.

What do you see when people have thyroid imbalances that aren't treated? What kind of things do see affecting the gut? So a lot of things that I see if there is an undiagnosed thyroid disease or if someone is coming in on thyroid medication and their management is not very good, believe it or not, we were trained to test people's thyroid at least every six months.

A lot patients come in and they're barely even tested once a year. And so, yes, things like constipation is something that I commonly see as is weight gain and fatigue if someone's thyroid is not properly adjusted.

And, and we've talked about this before, you and I, it depends on the form of thyroid that they're on. because not all thyroid medications are created equally and not only that, but if your gut is not working correctly, you cannot absorb that thyroid medication like you should.

So it's all multifactorial for sure. Right, right, we've talked in a series about leaky gut syndrome and there is some literature in terms of leakey gut connected to thyroid problems, especially the autoimmune Hashimoto's thyroiditis and low thyroid.

Thyroid Dysfunction and Digestive Symptoms

Again, like you said, we're always looking at gut connection to all parts of the body, but what do you do with patients in terms of looking after this connection based on symptoms or maybe tests?

So first of all, we always listen to the patient because obviously they know their health history way better than I do. So it's really good to get a good health story with them.

If they do have thyroid disease, I always ask about the gut. And one of those main reasons like I just discussed is I wanna make sure that their medication is being absorbed correctly.

Otherwise, you know, it like they're taking something and they either not absorbing it at all or it going right through them if they happen to have some irritable bowel or something that's associated with that.

Well then, with the leaky gut, do you like to just go on their symptoms, you know, like get the gas floating, get your bowels moving? You know it's probably going to help their thyroid function directly or do tests at that time?

Well, I always like to do testing because it's a confirmation that there is something going on with the gut. And there's lot of options for testing. There's stool analysis, which is also very, very helpful to look at dysbiosis, inflammation, what the immune system is doing as far as the got goes.

If there are any parasites and things, there also food testing that we can do. A lot patients want to food to testing and they have gut issues. This is what I tell them.

especially if cost is an issue, I always say to them, let's test your stool instead of the foods, because you can't be sensitive to 100 foods. It's gotta be because of your gut, right?

And so I really try to make them understand that even if we do no testing, we need to focus on healing the gut. And I know you and I've talked before, you've had some patients with SIBO, small intestine bacterial overgrowth, where people get overgrowth of bacteria that shouldn't be in the small intestine actually coming out from the colon.

And I don't think that some patients where their main thyroid hormone, the free T3, was low. Then by addressing that, you've seen the main T 3 thyroid hormones come up and normalize.

Tell us about that. Yeah, it's actually quite fascinating. I see that more often than I realize when I kind of look back and it doesn't surprise me anymore.

People with abdominal distension, bloating, small intestinal bacterial overgrowth, quite often when i do their full thyroid panel, their free T3 is on the low side.

Testing the Gut: Stool Analysis and Food Sensitivities

And so obviously, you know, improving the gut health will help with their thyroid function, but I do end up giving a little bit of free tea to kind of boost that up a bit.

It makes a world of difference with patients. Very interesting observation. And you've got a lot of studies with the Hashimoto's thyroiditis. You've looked at a lotta the literature and this is, you know, an autoimmune condition that affects the thyroid, and then a person can be more prone to having thyroid issues, especially low thyroid.

There's conditions, autoimmunity, which can cause hyperthyroid too, not as common. Tell us about how you address that with patients. Maybe start with a gut, certain supplements.

What do you do to help all these, millions of people, or giving recommendations to millions people out there who have autoimmune thyroid problems and developing the low thyroid.

So that's a good question. This is what I always tell people, that there's four things that really affects our health and that stress, sugar, being sedentary and not sleeping well.

I also say health is partly genetics and your lifestyle. If you are taking care of your gut, most definitely you'll be able to sleep better for sure, making sure that you're not eating too close to bedtime because that will affect your sleep.

And so I really bring the gut into the entire protocol in itself because a lot of people don't realize that how important their gut is, you know. maybe they've just lived with having a bowel movement every four days.

And you know, they don't realize that that is not healthy. So really understanding that the whole function of the gut is to get out those toxins as well as making sure that you're assimilating and absorbing food.

That's another reason why I love the GI map, the other gut tests to kind of show if there's any fat malabsorption going on. When you look at the different bacteria that may be in balance, Some of them could be too low, which can then tell you, okay, you've got a little bit of leaky gut going on there.

There's like not a band-aid that's covering that intestine and like things can kind of go through and I find it fascinating and people are always shocked when they start feeling a lot better when I address the gut first and they don't even really look at treating, quote, unquote, the thyroid.

Now, if they actually do have hypothyroid, their TSH is too high, obviously I'm going to give them thyroid medication. But if it's a kind of on that edge where it is still in range, I'll treat their gut first, give some nutritional recommendations and see that T SH go down.

What are some of the nutrients you like to use for thyroid, just in general types of nutrition?

SIBO, Low T3, and Autoimmune Thyroiditis

I mean, besides a healthy diet, do you like selenium, myoinositol, vitamin D? What kind of things do like? Well, if they actually do have autoimmune thyroiditis, so those antibodies are high, then yes, we do give the selinium and the myoinosital.

That's really important. I do check iodine with all of my first-time patients that have concerns with auto-immune-thyroiditis. And if that's on the lower side, yes I give them a thyroid supplement that includes just the recommended amount of iodide.

The one thing, and I know you see this too, is that people come into the office and they honestly think that the thyroid is causing all their issues. And when you really get down to it, you find out that their digestion is not very good.

There's that understanding that you're not just a thyroid gland. I think, that that's kind of a challenge that I face every day, but the results are way better than just giving thyroid hormone.

You've got to treat the whole person. And how about all these patients on acid blocking medications, the PPIs, which suppress stomach acid, that people use for gastritis, acid reflux, GERD.

We know that can inhibit the absorption of, you know, a lot of nutrients that, could affect your thyroid too, because your, thyroid needs, certain nutrients, including iron as well, to make thyroid hormone.

What do you see with that in patients? So number one, it depends how long the person's been on that medication. Some people come in and they've been in it for like 20 years.

So it's kind of hard to convince them to decrease it or to get off it completely. And so the first thing that I do is I add some herbs and things to help support the GI system, help with inflammation.

certain things like deglycerides, licorice, aloe, glutamine, you know, all of those sorts of things, get them feeling better and then telling them, okay, go ahead and take half of what your dose is, or maybe skip the morning dose.

Because, they've been relying on this for many, many years, and they are a little afraid to get off it. And then they realize as they start healing their gut, that they don't need it as much.

Yeah. With these stool tests, how common are you seeing problems with the microbiome? What kind of do you see on all these tests you run in terms of the microbiome balance?

I would say most everyone has something that's out of balance. I mean, none of us are perfect, obviously. Some of have more dysbiosis than others. And some of a higher immune reaction in our gut than other.

Lifestyle Factors and Nutrients for Thyroid Health

So of more fat malabsorption than the others, so really, I always look at the symptoms and I'll always ask them what the quality of their stool is, which kind of shocks them.

They'll say, hey, was your stool a little bit loose? And they'll, say well, yeah, it was. And so that changes how you interpret these stool tests. That also tells me that their gut's really inflamed.

If they're having lots of diarrhea, lots a loose stool, we've got to address that. Are there certain supplements that you like to use to enhance digestive function?

So if we're looking at probiotics, I mean, do look at various probiotic to see if there's some out of balance or some not there at all. And one of them obviously is, you know, acromansia, if that's not even present in an adult's GI stool test, then we want to, increase that.

If someone's got like a really low secretory IgA, giving them a good general probiotique is a, is good idea. Like a higher dose, like 100 billion or something.

And incidentally, I mean, i'm sure you see this as well, but people came in on probiotics and there's maybe like two billion, you know, or four billion and you have no idea, what's actually active in there.

The other thing that I would do is if there is a lot of like higher amounts of the inflammatory type bacteria, then I want to give herbs and nutrients that, we just spoke about like the aloe and the glutamine and things to help decrease that inflammation, which is really important.

Do you use digestive enzymes at all? I only use Digestive Enzymes if the patient tells me that their stool was, you know, relatively on the harder side or really well formed and it shows that there enzyme activity is low.

If the enzyme activities shows it's low and they've got a super loose stool, then I can't be sure that that test was right, so in that case I just tell them to chew their food really, really But if they've got kind of a form stool or they're constipated and they got low enzyme activity, then absolutely.

And it makes a world of difference. Hey, everybody. I want to take just a quick moment and invite you to my website, DrStengler.com. Here we have the supplements that we've been using with our patients for many, many years.

High quality and high potency supplements, very pure. So if you're looking for high quality supplements where you can notice a difference, both in how you feel on your lab tests, go to our website at DrStengler dot com.

And then how commonly for the patients that you give supplements for their thyroid or medications for thier thyroid, I mean, how commonly do you find that in different digestive symptoms?

That's a really good question. In the SIBO patients, I will tell you that giving that extra T3 does make a difference.

PPIs, Microbiome Imbalance, and Digestive Support

It's one of the contributing factors that make it difference, it not only helps with their fatigue, that's the big one is their energy. Helps with the constipation, also helps their brain fog.

But the thing is, is it's not gonna work if I don't fix their gut. Because like we talked about before, we're not going to get that good absorption of medication.

And what kind of thyroid medications do you like to use with patients? Because there's different categories of them. Yeah, that's a hard question because everyone's so different.

And I mean, with me, when you and I were going through my journey with autoimmune thyroiditis, I think we tried three different forms of thyroid medication until I felt stable on one of then.

So number one, if someone comes in on already, usually stick with that, you know, unless they're not feeling well. But I always prefer the compounded T4 and T3 for many reasons.

Number one, I can control what additives are in there, which I really like. And number two, if I want the T-3 to be sustained release or extended release, that's really nice.

I like them separate so that I could adjust the doses if need to. you know some of the combination t three t fours i mean i'll use them if someone's already on them but they're not my favorite and i don't like synthetic hormone replacement at all i only like the bio identical thyroid hormone replace you tell the viewers what compounded hormones are.

Yeah, so that's quite the explanation. So basically, they do make up these thyroid medications in the lab, but they're bioidentical to what is in your body.

And so you're not getting any extra additives, any extras preservatives, things of that sort that are in these compounded hormones. No gluten, you can say no gluten.

Which is a big one. You can say no dyes, which is also a Big one no corn, Which Is a really big One as well like I said you could make it sustained release so here's a perfect example and and I can give my example since it's not a HIPAA violation but you know if I take regular t3 from the Pharmacy my heart starts going really really fast It's just too much of a release for me So I have to get my T3 from a compounding pharmacy so they can add something into it, just kind of like slow that release down so I get more of an even keel throughout the day.

So that's the differences that we have with the compounded T4 and the Compounded T-3.

Compounded Thyroid Hormones and Final Takeaways

Okay, good. Well, maybe just give us your, you know, final closing statements on, the association between a guide and thyroid function, if you would. Sure.

I mean, in general, you cannot have optimal health until you do treat that gut for many reasons. You know, if you're eating foods that are affecting your digestive system, that're affecting you absorption, number one, your not going to be able to absorb that thyroid medication that you are on very effectively.

So that's really, really important. The other thing is, remember, your liver, that's all responsible for converting that T4 to T3. We got to make sure that your body is functioning correctly.

So we have to talk about diet, things like decreasing alcohol and sugar and all those things that can affect your immune system. And, you know, in your book, it's so perfect because it does talk how, like, 70% of that immune systems in you gut.

and so we can't discount how important the digestive system is. And then you get someone in my age category, the whole menopause population here, and our microbiome has changed even more.

And you and I have always talked about something. You can't veer. Once we get older and we can eat like we used to, our portions need to be a little bit smaller.

Those things just kind of happen as we older. However, we could really optimize our health by Chewing our food very, very well, which is important because that's where all that digestion starts.

And then making sure that whatever you are putting in your body is very nutrient dense. If you're going to be on thyroid medication, remember, you still putting that in you body.

That's why I always use compounded hormones over something that is commercially available. Okay, great. Well, hey, thank you for the time. I know for the viewers out there who have thyroid problems, family members with thyroid problem, this will give them a lot of great insight, understanding that gut thyroid access.

So thank you, Dr. Angela. Thanks, Mark.

Angela Stengler

The Gut-Thyroid Connection: What Your Digestion Reveals About Your Thyroid