Is Hashimoto’s The First Stop To Breast Cancer?

Jennifer Simmons, MD

Thank you, I’m so happy to be here.

Keesha Ewers, PhD, ARNP-FNP-C, AAP, IFM-C​

So you will often say that autoimmunity and especially Hashimoto’s is a dock along the way to breast cancer. Can you talk a little bit about that?

Jennifer Simmons, MD

I sure can. So, there have been several studies looking at the link between them, and when you compare, especially Hashimoto’s, but all autoimmune thyroiditis, when you look at that population and you compare that to the general population that does not have autoimmune thyroid disease, the incidence of breast cancer in that group is at least doubled. And in some studies, it’s even more than that. So there is undeniably a link between autoimmune thyroid disease and the development of breast cancer. And I suspect that the reason is on a multitude of levels, but not the least of which is that from an enzymatic standpoint, our bodies were meant to function optimally at a certain temperature. So it’s not the exact same for everyone, but somewhere around that 98.6 range is where our enzymes are able to function the best. 

And that means that our immune systems are also able to function optimally at that temperature. People with hypothyroidism across the board have temperature dysregulation and their bodies live at a lower temperature. And at that temperature, our metabolic function is not nearly as efficient. So those people have higher blood sugars, which we know are associated with the development of breast cancer. They have higher circulating insulin levels, which we know are associated with the development of breast cancer. Their enzymes do not break down as well. And cancer cells secrete a capsule around them that requires our enzymes in order to break them down. So for that reason, it has a higher association with breast cancer. And so our traditional medical system has not asked the why. So they learn about the thyroid dysfunction although there are many people who do not know that they have thyroid dysfunction until they get a diagnosis of breast cancer.

Keesha Ewers, PhD, ARNP-FNP-C, AAP, IFM-C​

Their doctors don’t even check for autoimmune markers when they have hypothyroid disorders, it drives me bonkers.

Jennifer Simmons, MD

They don’t, they don’t. And many of them, even the traditional endocrinologists, they’re not ordering the spectrum of labs. They are not looking-

Keesha Ewers, PhD, ARNP-FNP-C, AAP, IFM-C​

They’re just doing a TSH.

Jennifer Simmons, MD

They’re just doing a TSH.

Keesha Ewers, PhD, ARNP-FNP-C, AAP, IFM-C​

Yeah.

Jennifer Simmons, MD

And if you fall outside of the range, they’re given synthetic hormones, they’re given Synthroid, and then they’re not really followed to be euthyroid. Their temperatures are not being followed and they’re not asking where the thyroid dysfunction is coming from. So unless you get to the root cause, unless you discover where the thyroid dysfunction is coming from, you’re not removing that nidus, you’re not removing the stimulus. You’re not changing why the dysfunction is there in the first place. And so it just follows that the next dysfunction develops.

Keesha Ewers, PhD, ARNP-FNP-C, AAP, IFM-C​

Yep.

Jennifer Simmons, MD

And so-

Keesha Ewers, PhD, ARNP-FNP-C, AAP, IFM-C​

And that can be a 75% risk for another autoimmune disease. It can be cancer, yeah.

Jennifer Simmons, MD

That’s exactly right. That’s exactly right. And they go hand in hand with one another until you stop the cycle and determine where is the imbalance coming from.

Keesha Ewers, PhD, ARNP-FNP-C, AAP, IFM-C​

So where do you dig to find out where the imbalance is coming from?

Jennifer Simmons, MD

Yeah, so I know that we’ve discussed this before. Like I come by this knowledge very personally, as you come by your knowledge very personally. So I was probably 15 or so years into my surgical career when I was diagnosed with Graves’ disease. And I went from being a super high functioning surgeon, ran the cancer program for my hospital, wife, mother, friend, philanthropist, athlete. Like I went from super high functioning with 18 balls in the air, to dropping them all. And I couldn’t walk across a room without becoming winded. So in a day, in an instant, my health got taken away from me. And it was only then, that I learned about functional medicine. I mean, that’s how I came to it. And so I went on a journey to heal myself, and in that journey discovered functional medicine. But really my delving into functional medicine was to heal myself. 

It was to figure out how I could get better and I could become healthy again because I didn’t, something inherently said to me, that even though these treatments were used universally surgery, radiation chemotherapy, and in terms of Graves’ disease, I somehow knew they weren’t for me. And it was in pursuing my own health, that I discovered the bio individuality of all health. So what led to my disease is not what led to someone else’s disease or another person’s disease. And so it’s really about approaching that person individually every time. Now, we know that there are certain things that are universal triggers for people. So like prolonged chronic stress isn’t good for anyone. So we know that we have to help everyone with prolonged chronic stress.

Keesha Ewers, PhD, ARNP-FNP-C, AAP, IFM-C​

And I’m going to say, add into that, it’s not really the stress, but it’s your relationship to it of calling it stress.

Jennifer Simmons, MD

Right, it’s what you make it. It’s your internalization, it’s your personal perception of that stress, that determines the impact that that stress has.

Keesha Ewers, PhD, ARNP-FNP-C, AAP, IFM-C​

I’m overwhelmed, I’m stressed out. I don’t have enough gas in the tank. I can’t do this. All of that is what then your consciousness and your mind you’re listening to, and then they send those neuro hormones to say okay everybody, right, and-

Jennifer Simmons, MD

Like, we can’t do this.

Keesha Ewers, PhD, ARNP-FNP-C, AAP, IFM-C​

Can’t do this.

Jennifer Simmons, MD

We can’t do this, we’re breaking down.

Keesha Ewers, PhD, ARNP-FNP-C, AAP, IFM-C​

Yeah.

Jennifer Simmons, MD

And so the story in you tell yourself absolutely matters. And the way in which you allow things in and allow meaning for things matters. But we know that there is a triad for autoimmune disease, Alessio Fasano, a gastroenterologist at Harvard has written extensively on this. So there’s genetic predisposition. There is some kind of toxin, and then there’s intestinal permeability. Now I know a lot of people like to cling to that genetic part, but the truth is that that’s only 20% of the picture, which means that 80% of that autoimmune triad is in our control. And that’s a really important point and really empowering for the person that wants to reach out and grasp that.

Keesha Ewers, PhD, ARNP-FNP-C, AAP, IFM-C​

Right, I’ve added one to Fasano’s and that is trauma. That the research on that is you can think as large ship with it.

Jennifer Simmons, MD

Yeah, for sure. And trauma can be-

Keesha Ewers, PhD, ARNP-FNP-C, AAP, IFM-C​

You can heal that.

Jennifer Simmons, MD

It can be denied as for intestinal permeability.

Keesha Ewers, PhD, ARNP-FNP-C, AAP, IFM-C​

Yeah.

Jennifer Simmons, MD

Right? So that alone can cause leaky gut. And when we have leaky gut, that allows for things to enter into our circulation to come into contact with our immune system, that normally wouldn’t be a problem. But suddenly they’re in direct contact with our immune system. And now they’re in a place where they don’t belong.

Keesha Ewers, PhD, ARNP-FNP-C, AAP, IFM-C​

And immune system isn’t malfunctioning. it’s saying, wait a second, you’re not me. You’re not self, so it does what it’s designed to do.

Jennifer Simmons, MD

That’s exactly right.

Keesha Ewers, PhD, ARNP-FNP-C, AAP, IFM-C​

Go after whatever’s not you.

Jennifer Simmons, MD

Yeah.

Keesha Ewers, PhD, ARNP-FNP-C, AAP, IFM-C​

Yeah. 

Jennifer Simmons, MD

But then the flip side is that there are things that are universally toxic. Like I think we can all agree, the glyphosate is toxic.

Keesha Ewers, PhD, ARNP-FNP-C, AAP, IFM-C​

Yes, we can.

Jennifer Simmons, MD

And not eating things that are coded with glyphosate is good for everyone.

Keesha Ewers, PhD, ARNP-FNP-C, AAP, IFM-C​

Yeah.

Jennifer Simmons, MD

Right? And then there are the things that are not so universal. Like we can take gluten, for example, although it’s hard to have a conversation about gluten in this country. So let’s talk about Einkorn wheat which is the wheat of our ancestors. So that is a wheat that we generally recognize the protein in, the gluten in, because it has been around for so many thousands of years, but there are still going to be people that will respond negatively to that.

Keesha Ewers, PhD, ARNP-FNP-C, AAP, IFM-C​

Well, I do genetic testing on all of my patients and there’s one section in there that says what your relationship to gluten is going to be. And it doesn’t matter if it’s Einkorn or if it’s… And so that’s helpful because then it takes out the question about whether to gluten or not to gluten. So that’s nice. And I like that, like I like that clarity. Okay, you don’t have the genetic snip necessary to break this down. So that’s good to know. Or whether how they metabolize caffeine or cannabis or where their liver detoxification pathways phase one and phase two, are they matched well, or are they mismatched. There’s just a lot in there that’s nice because we can build detours around areas that are congested.

Jennifer Simmons, MD

Yep, absolutely. I think that that’s something really important is that people should have a knowledge of what their genetics are capable of. So that you’re not pushing a Boulder uphill all the time. So, because there are going to be people that simply do not metabolize caffeine.

Keesha Ewers, PhD, ARNP-FNP-C, AAP, IFM-C​

Right, and alcohol.

Jennifer Simmons, MD

And alcohol.

Keesha Ewers, PhD, ARNP-FNP-C, AAP, IFM-C​

Alcohol is in there too. And animal protein, ApoE2, 3, or 4’s. So helpful to know that.

Jennifer Simmons, MD

Yes, absolutely, absolutely. And you can really help people to tailor their lives around how their genetics will perform best, really how to nurture their nature.

Keesha Ewers, PhD, ARNP-FNP-C, AAP, IFM-C​

Right, that’s the value individuality.

Jennifer Simmons, MD

Absolutely. That said, an inflamed person is going to respond to almost everything. So I’m not a huge fan of food sensitivity testing, especially when I first meet someone because that person generally isn’t coming to me ’cause things are hunky-dory, right? These people are coming to me because the shit has hit the fan at that point. And so that person is gonna be really reactive to everything. So I’m not gonna food test that person and see what their sensitivities look like. Now, year later, once we’ve worked together and done a lot of healing and they’re still reacting, that’s a different story. But I find that doing those genetics and helping to build a program for people that is bio-individual to them and allowing them some time to like, be with themselves and be with the right program, and kind of calm and nurture and nourish, and most people get better.

Keesha Ewers, PhD, ARNP-FNP-C, AAP, IFM-C​

Right, yes. And that’s another question people will say is, I mean, the name of the summit series we’re on round five of it is reverse autoimmune disease. Though, the often asked question is, oh, you mean I can get my Graves’ or my Hashimoto’s markers to come down? Is that?

Jennifer Simmons, MD

I think it’s such a foreign concept because of the way-

Keesha Ewers, PhD, ARNP-FNP-C, AAP, IFM-C​

Even endocrinologists of the world are saying no.

Jennifer Simmons, MD

Right, because with their paradigm, the answer is no. Like if all you’re doing for that person is either on the Grave’s side of things, like giving them a Farmazol, or on the Hashimoto’s or hypothyroid side of things, giving them Levothyroxine, then you haven’t done anything to intervene as to why the disease developed in the first place.

Keesha Ewers, PhD, ARNP-FNP-C, AAP, IFM-C​

And I will give a Farmazol, if there’s a fire going, I wanna get that to back off while we’re working on those root causes. So I don’t want people-

Jennifer Simmons, MD

For sure.

Keesha Ewers, PhD, ARNP-FNP-C, AAP, IFM-C​

To think it’s an either or so.

Jennifer Simmons, MD

Right, but that’s all you’re doing, then there’s no other possible outcome, right? That’s the definition of insanity, continuing to do the same thing and expecting a different outcome. So if all you’re doing is adding in and on the Synthroid part of things, if all you’re doing is adding in synthetic thyroid hormone, you’re not changing anything for anyone. So those people are not gonna get better. You may get them to a closer to you thyroid state, but they’re not getting better.

Keesha Ewers, PhD, ARNP-FNP-C, AAP, IFM-C​

You’re not gonna to do anything about the autoimmunity. And I think that’s another, that’s paradigm that says, you take this until your thyroid gets burned out by your immune system is a wrongheaded way of thinking about things.

Jennifer Simmons, MD

Yeah, but that is what is almost universally done.

Keesha Ewers, PhD, ARNP-FNP-C, AAP, IFM-C​

Yeah.

Jennifer Simmons, MD

And I think people are getting smarter. I think they want more. They’re a little reluctant to believe because that message that once you have autoimmune disease, it’s permanent, it cannot be reversed. That message has been well ingrained in people. And so they’re reluctant. And if you’ve had your thyroid removed, like there’s nothing we can do to really regrow it. Or you’ve had radioactive iodine, or some kind of holy destructive measure.

Keesha Ewers, PhD, ARNP-FNP-C, AAP, IFM-C​

But we can keep your immune system from attacking another organ in your body or gland or a tissue.

Jennifer Simmons, MD

That’s exactly right. But even in that person that you can’t restore their thyroid, what you can do is restore the health of their immune system. And that ends up being really important so that they don’t go on to develop that next autoimmune disease so that they don’t go on to develop breast cancer. Because again, it’s the definition of insanity, doing the same thing and expecting a different outcome. What we have to do is we have to get these people off this path and put them on another one, put them on a better one.

Keesha Ewers, PhD, ARNP-FNP-C, AAP, IFM-C​

And when the thyroid has been removed, we can support the rest of the endocrine system so that it remains healthy.

Jennifer Simmons, MD

Yes, yes, absolutely. And it’s a symphony, right? And so you can’t just play one instrument. You have to look at the system as a whole and how all these hormones are interacting with one another, and help people to find their balance. And it is an individual journey. There’s no one size fits all. And what’s happening with one person isn’t necessarily happening with another.

Keesha Ewers, PhD, ARNP-FNP-C, AAP, IFM-C​

Right, so can women and men really decrease their chances of getting breast cancer by improving thyroid function?

Jennifer Simmons, MD

Without question. And it is important to get people to be euthyroid because of all of the enzymatic and insulin and glucose indications, that we talked about in the beginning, but it’s equally as important to calm the immune system and get rid of whatever is triggering it. So helping people to work on and resolve that trauma, giving people the tools in order to manage the stressors in their environment and allowing them to be able to consciously decide what does and doesn’t have an impact on them. And then helping them to manage their toxic load, whether it’s food or chemicals or however the toxins are coming in, unless-

Keesha Ewers, PhD, ARNP-FNP-C, AAP, IFM-C​

those.

Jennifer Simmons, MD

Yeah, we’re not gonna agree to all of them. We are living in a sea of toxins. It’s just the reality of 2022. And it’s only getting worse. It’s only getting worse.

Keesha Ewers, PhD, ARNP-FNP-C, AAP, IFM-C​

There is one we can really manage though without having to rely on the outside environment. And that’s the toxins. I mean, I noticed with Hashi a lot that there’s an energetic component to this of not speaking up, perhaps on your own behalf setting good boundaries and what are the toxic thoughts and belief patterns, and perhaps early trauma that has created a fear of that. Do you notice that? Your thyroid is really so much around your voice?

Jennifer Simmons, MD

I couldn’t agree more.

Keesha Ewers, PhD, ARNP-FNP-C, AAP, IFM-C​

Yeah.

Jennifer Simmons, MD

That it’s it… And I find that there are a lot many, if not all of my breast cancer patients, when you talk to them in the six to 24 months proceeding their diagnosis, they have all had some major, major emotional trauma challenge, whatever you want to call it that proceeded that diagnosis. And whether it’s death of a loved one or being a caregiver, which is so very, very, very difficult or a divorce, some kind of toxic relationship, abuse, a toxic work environment, all of these situations. I mean, listen, when you’re caring for a parent or a child or someone who is dear to you, but you’re caring for them, in an end of life kind of situation, these are the deepest, hardest challenges really that we face. And while you don’t really have a voice at that stage, in that situation. You’re just doing your best to try to meet the needs of your loved one. And it is probably the hardest job there is to do. And you do it out of love and out of a sense of loyalty to this person. But it’s a very, very, very hard job. And you lose yourself during that period of time. And I have countless, countless breast cancer patients that came to me after caring for an ailing parent, spouse, child. And the effects of trauma, they’re very, very real. And they do manifest themselves physically because unless you’re able to successfully process that emotional trauma, unless you’re able to successfully process it, it is going to manifest as a physical ailment.

Keesha Ewers, PhD, ARNP-FNP-C, AAP, IFM-C​

And diabetic medicine, 10,000 years ago, they called it undigested emotion. And I like that terminology even better than processing, it’s like, yeah, if we don’t digest our food and we’re constipated, then we get all kinds of physical ramifications that we’re fully aware of, but tend to not think about it when we have emotional constipation. When we are not digesting our experiences, our emotions, our meanings, and our beliefs, we get the same sort of downstream ramifications from that too.

Jennifer Simmons, MD

And it’s often seen in sleep disruption and anxiety. It manifests itself in a variety of ways. But sleep disturbance, anxiety, depression, they are all on the spectrum of the development of autoimmune disease and breast cancer.

Keesha Ewers, PhD, ARNP-FNP-C, AAP, IFM-C​

Yeah.

Jennifer Simmons, MD

And so it’s recognizing that inflammation in its infancy that is so important as to not let it become a chronic situation that only expands.

Keesha Ewers, PhD, ARNP-FNP-C, AAP, IFM-C​

Now, we started out talking about Hashimoto’s as a stepping stone along the way to breast cancer, and also mentioned that many traditional endocrinologists will only test TSH every six to 12 months. So is following just a TSH enough to know if you’re reducing your risk for breast cancer?

Jennifer Simmons, MD

Well, so I don’t think it’s enough.

Keesha Ewers, PhD, ARNP-FNP-C, AAP, IFM-C​

I don’t either, no.

Jennifer Simmons, MD

And so my goal with the people that I’m working with, I mean, I am checking a TSH because I think it’s one indication, but I’m also looking at their free T4, their total T3, their free T3, their reverse T3. I wanna know if they are making enough thyroid hormone, but not converting enough to its active form. I wanna know if they’re just not making enough and conversion isn’t their issue, but production is their issue. And I wanna know where their thyroid antibodies are. And if their thyroid antibodies are elevated, then I am pretty frequently checking to make sure that we’re moving in the right direction. And we are figuring out what their triggers are and eliminating them.

Keesha Ewers, PhD, ARNP-FNP-C, AAP, IFM-C​

Yep.

Jennifer Simmons, MD

And when you do that, you will see a response in the thyroid antibodies.

Keesha Ewers, PhD, ARNP-FNP-C, AAP, IFM-C​

Only if you’re checking them though. And that’s the thing is, like physicians won’t check though, ’cause they say, well, you have Hashimoto’s, obviously you’re gonna have autoimmune markers, so we don’t need to check them. But you know, I’m always explaining to my patients, no, that’s how you tell the inroads we’re making, we have to come back and check those autoantibodies and make sure they’re coming down. So it just only makes sense. So thank you for speaking to that.

Jennifer Simmons, MD

Of course, of course. And I don’t know about you, I’m also looking at markers of metabolism to make sure that people are having good insulin sensitivity and are not developing insulin resistance. And so I’m checking fasting glucose and fasting insulins and A1Cs. And I’m also looking at other markers of inflammation like C-reactive protein.

Keesha Ewers, PhD, ARNP-FNP-C, AAP, IFM-C​

I look for ANA and rheumatoid factor too. Just making sure that the body is doing okay in that inflammatory zone.

Jennifer Simmons, MD

Now once, do you follow ANA over time or do you just do it-

Keesha Ewers, PhD, ARNP-FNP-C, AAP, IFM-C​

I do. Because the same idea as the TPO that you can make it go negative. Once it’s been positive, I wanna come back in six months and check it when we’ve done our interventions to make sure it’s shutting off. Because it’s a very nonspecific, ANAs are nonspecific, everybody. But it’s a nice way to say, oh, it was positive now it’s negative. Which indicates something, just like bringing a high sensitivity C-reactive protein, indicate something when it’s coming down. And we want all those things, almost those things to come down. So for me, an ANA is one of those indicators, yeah. Is there anything that we haven’t touched on that you really want our audience to hear?

Jennifer Simmons, MD

Yeah, I think that we’ve so normalized Hashimoto’s especially hypothyroidism, right? Like we’ve said, oh yeah, so many people get that. And we’ve normalized it. And I wanna be clear that it’s not normal and that you don’t have to be hyperthyroid. And this is a signal. This is your body telling you that there’s something happening in your environment that is not working for your body. And instead of seeing it as a punishment or a nuisance, to see it as an opportunity to do some self discovery, to figure out what is not working for you, because we should all have the energy that we want, the health that we want. And it is achievable, it is.

Keesha Ewers, PhD, ARNP-FNP-C, AAP, IFM-C​

It is.

Jennifer Simmons, MD

But it does take some work and some personalization but it is achievable.

Keesha Ewers, PhD, ARNP-FNP-C, AAP, IFM-C​

Thank you. I know you have a free gift for our audience, a checklist.

Jennifer Simmons, MD

I do.

Keesha Ewers, PhD, ARNP-FNP-C, AAP, IFM-C​

For them.

Jennifer Simmons, MD

Yes, I have your weekly checklist where you can just go and look down it and just make sure that you’ve checked all your boxes for the week. And it’s just a general guide to health promotion and healthy living.

Keesha Ewers, PhD, ARNP-FNP-C, AAP, IFM-C​

Well, I deeply appreciate your work in the world and for joining us today to share that.

Jennifer Simmons, MD

It’s my pleasure. So happy to be with you as always.

Keesha Ewers, PhD, ARNP-FNP-C, AAP, IFM-C​

All right, everybody until next time, be well.