Is It Menopause or My Thyroid?

Michelle Sands, ND

Yes, of course. And Jen, thank you so much for having me first of all and thank you for putting on this really important event. If I had had an event like this when I was growing up, it could have saved me a whole lot of trouble. Back when I was a child, there was not like the Internet. There was the Internet, but we did not have access to it. We did not have all this information. So as a child, I had kind of a sick childhood. My family was not super privy to help my mom. She was an Italian mom from New York so we ate a lot of pizza, pasta, pastries, bread at every meal and eating well in our family meant eating a lot of food. And so there was no focus on anti-inflammatory foods and fruits and vegetables and to be quite honest, after a meal, my dad would always go lay down on the couch, unbuckle his belt and take a nap. 

So I thought, “Oh, you know, everybody kind of feels crappy after they eat.” That is normal because I always had, like, digestive problems. I always felt bloated after I ate and I just thought it was normal. And my mom, on the other hand, hardly ate anything. She would just take out food because she would also have digestive issues. And so I just thought it was normal. I’d go to family affairs and aunts and uncles be popping Tums and popping antacids and talking about their stomach hurting and just a very normal thing. And then as I got to junior high, I developed a weight problem. So, I was overweight, had acne and I was self-conscious about myself. So like any girl ideal, I joined the track team, well, I tried to join the track team and I thought, well, at least I can like exercise and maybe I could lose some weight, but I cannot run. I did not have any shoes, but the track coach was super passionate about helping people, and she is kind of what I referred to as a hippie at that time because she had like her garden and she was very like, I always like peace, love and everything and super sweet. And that was the opposite of my family because my family was very negative. Everything was an argument, everyone was complaining about their health problems. And so she was kind of like a beacon of light. So that is another reason why I wanted to join the track teams. I want to be near her. And she saw that was what I was doing. And she said, “Michelle, you know, you can do anything you want to and you just have to feed your body, train your body, and believe in your body.”  And I’m like, wow, that is like so different that my dad’s life sucks and then you die, a sense of it but I would hear all the time at my house. So she is like, “Well, what are you eating for lunch?” And I showed her in my lunch that my mom packed and it was literally two cans of Coca-Cola, a bag of chips like Ruffles or Doritos. 

And then I’d have a hostess snack cake, either like a Twinkie or like a knockoff, like Little Debbie snack cakes, and then I have a baloney sandwich. And so she is like, “Michelle, how are you expecting to run fast and to feel good when you are eating all this crap?” And I did not understand what she meant because that was food in my house. The only vegetable we ever had was canned corn. So I was like, “I do not know what you are talking about.” So she brought me vegetables from her garden and then she just kind of convinced me that would be a good idea to trade in my lunch with some of the other kids. So I’d trade. I was that bad kid that was giving your child the cupcake for their orange and the chips for their carrots and celery. And so that was kind of how I got some of my nutrition in high school. 

And I did feel a little better as I was eating a little better and I started running a little faster. I ended up getting a track scholarship to college. I was the first person, on both sides of my family to go anything past high school. So it was like a big deal for me to be able to get, one out of my house and out of that negative environment and into a positive environment. But I still had all my health problems, so I did change a little bit with my nutrition, but that was only at school lunch. I still had all the bad nutrition when I went home and I was taking ibuprofen in the morning because I had track practice in the morning and I had track practice after class. I was on a scholarship so I was in a special dorm and they kind of owned me when it came to like I can not choose if I want to go to practice or not. 

I had to go to practice, otherwise, my scholarship would be in jeopardy. So I would have to take like six to eight ibuprofen in the morning, just so like deal with my joint pain. And then I would take a whole bunch of energy like it was NoDoz at that time. It was caffeine pills. And I’d also drink Diet Coke to try to wake me up, and then I’d always have to be popping Tums or some type of antacid, just like keep my stomach settled and I would not eat at all until after my second track practice because if I ate anything, I would probably poop my pants while I was running. So I went through this like cycle of basically looking from the outside. She is on the track team, she is getting good grades, everything is perfect. Then inside I was like dying on the inside. So I was depending on all these over-the-counter pharmaceuticals, basically just to get me through the day, I took things. Help me sleep, help me poop to help me stop pooping. I name it. I was taking it. And like the ibuprofen, I had no idea that that was causing more problems in my gut than it was helping but I had to do it just to get by. In the freshman year, I actually passed out during track practice. When I was at the track we were running laps, it was actually a warm-up and I just passed out. It is probably because I was not eating, I was dehydrated. All the things I was doing, it just caught up to me and so they took me to the dormitory nurse at the college clinic and they ran some tests and basically told me I was fine. And I broke down in tears. I started crying. I started telling my whole story to anyone that would listen inside the clinic, the nurses, the physician assistants and I was just explaining how I was taking all these pills. And I never had my period in like four months, and I just did not know what to do. I have headaches all the time. I was tired all the time, all these things. 

And so they said, okay, and that was to quiet me down. And they said, well, why do not you make an appointment and we’ll run some tests? And so I came back, they ran tests, and then I got a phone call from one of the doctors telling me that he was hoping that I was not expecting to have kids because being a mom was not in the cards for me. He told me I had ovarian failure and I was at menopause. And this is, I was 19 years old. I was a freshman in college. This is when all my friends are trying not to get pregnant and then I heard that I would never be able to get pregnant. That actually crushed me because I felt like there was something like innately like unfeminine about me now. Like I was less of a woman. I can not do the thing that every woman on the planet can do, having a child. And even though I was not planning to be a mom anytime soon, I had that dream like growing up as a little girl. 

I always planned that I would get married and have kids and all those things, and that was kind of taken away from me. And on top of that, it still does not explain all the problems I was having that fatigue, and my hair was falling out. I had pain in my joints all the time, my ankles hurt, my knees hurt and yes I was not running a lot because I was on track. So I kind of attribute it to that, but I could not eat like normal food. It was just a real big mess. And so I kind of kept quiet about it for a while. I did not tell anyone about, like my infertility or anything and that and not even my mom and I would be like, Mother’s Day would come around and I’d hear like the radio commercials and see like the ads for like, oh, the child is the bond between mother and child is like the most important thing. And I would just, like, die inside. 

But one Mother’s Day, I said, “Okay, I’m going to do something about that.” So I started going to like all the different healers I can find. Reiki specialists, chiropractors, homeopaths, dieticians, all the different people I can find have access to. And even I was a marketing major at the time, but I went over to the medical side of my college and like started asking questions and I did learn a little bit about nutrition. And actually the dietitian, the nutritionist was the one who helped me the most because she pulled gluten and dairy out of my diet. And I was like, “Oh, my god, this is amazing.” After because that was my whole diet basically for most of my life. Italian girl from New York, we eat bread at every meal like a different type of bread. It is pizza, it is pastry, it is pasta, it is all bread. And so pulling that out made a huge difference in my digestion. Like a lot of things, I felt improved, my skin cleared up, but I still was not feeling quite right. But I knew there is something to that. There was something more about what’s going on. The doctors that told me there is nothing I can do. I actually went to after that doctor at the clinic told me I had an ovarian failure. I went to like several other doctors and they all confirmed that. And none of them gave me any solutions. They gave me antidepressants. They gave me stuff for my stomach. They told me I can be on pain medication, but they never gave me any solutions for all the things that were going on. So the door kind of opened with the nutrition. And then when my dad had the life sucks and then he died subsequently but he also had the sense of that If I do want something right, done right, do it for yourself. So I decided to go back to school and just try to figure out some of the things going on with me. I really just wanted to eat a meal and digest it normally, That was like my goal. I did not think I’d ever be able to do anything about my ovarian failure or any of the other things, the fatigue that I felt all the time. I did not think. I thought that was just going to be me. I thought I had chronic fatigue syndrome and all these other things. 

And little by little, going back to school for not having medicine, you learn about all the systems in my body, you learn about the gut and the immune system, you learn about your mitochondria, you learn about detoxification, you learn about nutrients and how different nutrients affect different organs in the body. And it is really kind of just fascinating how it is all connected. And so that kind of turned on some light bulbs that if I can heal my gut, I might be able to affect my thyroid, might be able to affect these other things. And we also had access to so much testing, and I found out I had heavy metal toxicity, lots of mercury, and I found out that I had Hashimoto’s thyroid. I did not even know what that was, never heard of it. And it is an autoimmune condition that affects your thyroid that is very much tied to eating gluten. And we got in all these other things. And so I found that out. I found out how genetic propensity to be really sick from mold my body did not detox mold very well and that I was exposed to mold most of my childhood. And so these little things I started working on in. So about ten years, I was working little by little on these things. 

And eventually, I met my husband, who I’m married till today, and I told him, “You do not want to marry me because I can not give you children.” And he is like, “Oh, it doesn’t matter, do not worry about it.” And so we got engaged and we went on a trip and we went to Mexico and I started getting sick and I’m like, oh, it is the water. But after a few days, my husband’s like, “You are pregnant.” I’m like, “No. There is no way I can not get pregnant.” So we go to the clinic in Mexico, which is really interesting because you just put your name on a Post-it note and then they do all the tests. There is no like big form to fill out it. Just write your name down. They take you back to the test. And when I came back, I was pregnant. So it is like, what in the world? And we got like really good care for my pregnancy. Everything was completely normal. I have my son now. He is eight years old now, Paxton Sands. Completely normal pregnancy and that is a testament to the fact that do not let doctors tell you that there is that something is can never happen because it did but my periods started having normal and things just started working out again. And one of the big things was finding out about the Hashimoto’s because that was a huge autoimmune condition that was really affecting so many different things in my life. I know it is a long story and there is a lot involved, but the message from the story, and I always like to tell my patients is never let anyone write your story for you. They can write a prescription, but they can not write your future. And there are so many cases of there is never nothing you can do. There is always something you can do because your body is constantly rebuilding and repairing and healing and you are constantly getting new cells. And so to say that there is nothing you can do, run from that doctor because it is something you can do. But there is like Hashimoto’s, a lot of people will say, oh, well, once you have it, you’ll always have it or even hypothyroidism, you are always going to be on thyroid medication. Well, that is not absolutely true. There are some cases where it might be in your best interest to stay on medication, whether you are missing part of your thyroid, or you just do not have the ability to make it, but it is never a one-and-done. It is never a one size fits all situation. 

And we have many patients in our practice who have reversed Hashimoto’s, who have reversed hypothyroidism and now are on no medication. And so it is not a judgment about like whether you should be on medication or not, but there is always something you can do to feel better and have your energy back. And the truth is, women in this country, like one in five women, have Hashimoto’s Thyroiditis and a bigger number have hypothyroidism. And more than half of the women who are being treated for their thyroid condition are still feeling like crap because they are ignoring all of the systems in the body. All those systems I talked about earlier, like the immune system, detoxification in your liver, your mitochondria, your adrenals, all those things play into how well your body can make thyroid hormone, how well you can use your thyroid hormone, whether it gets into the cell, into a nucleus, actually acts on your cells, and whether you can convert it into a usable form. And all these things are so important for how you feel. So if you are listening right now and you are being treated for a thyroid condition and you still feel bad, just know that that is not how it is supposed to be.

Jen Pfleghaar, DO, FACEP

Absolutely. Thank you for sharing your story that is, it is beautiful. And it is amazing when we can look back and be like, oh, my goodness, look at all these things that just played out. And I can not believe you had that awesome coach that kind of started doing. Yeah, that is just so beautiful. So I think that another thing is to share your story. Anyone out there listening to that has Hashimoto’s they are here because they are reversing it or they want to share your story with your mom’s group, with your friends, with your church, wherever you are, because you never know who has that same story and just needs someone to talk about it because they are stuck. So I love that. 

Michelle Sands, ND

It is unfortunate because the time I grew up, I was born in the seventies and early eighties. The thing is, I grew up at a time where, like, you did what the doctor said and you did not question it. And I know a lot of people in my age group, a lot of women now in perimenopause and menopause, like that is what you think. So you go to the doctor like there is nothing you can do, and you are like, okay, you take that as gospel or take this medication, like, okay, I’m going to be a good patient. I’m going to take that medication, and you do not question. But the thing is, I always. question. Nobody knows your body better than you do. If you have that little inkling of like, what for I wonder if there is possible there is something more. Yes, there is something more. And do not just take it. No doctor should be offended if you ask questions. No doctor should be offended if you ask for an alternative or if you want to know how the medication works or what your options are. And so I just always tell people, to run the other way. If a doctor gets offended by your questions and just know it is your body and nobody is going to care about your body more. And so, yeah, that was one thing in the beginning. I was afraid to ask questions. I did not want to. I even would sneak around when I was getting second opinions. 

They went to like seven doctors to confirm. I was fearful that the first doctor would find out that I was going to the next doctor because they are going to get mad at me because they are this big doctor with this authority. And luckily now with the Internet and all the groups out there on these types of summits, I think people are starting to realize like, you really have to take your health into your own hands, like our health care system is there as an emergency like insurance. If you think about your health insurance, it is not there to make sure that everything is bright and shiny and looks perfect and everything is functioning well. It is there if your house burns down or there is a flood. And so that is really what your health insurance as far as there and gets a catastrophic something catastrophic happens to your body that is not there to keep you running well to keep you functioning while I keep you vibrant and healthy. That is our responsibility. That is your own responsibility. 

And a lot of times your thyroid testing will be very suboptimal. Doctors will just test your TSH, your thyroid stimulating hormone, and they might just test your TH energy. But you really need your full thyroid test and it might not be covered under your insurance. But if you are still questioning, like, is there more I can do, if you are being put on medication or a treatment plan that is not serving you or not making you feel well, then look into even ordering the test yourself now and many services online you can, you do not even need a doctor to order a test. There are practices in that people order tests that they want without any having to talk to us first. 

Because I think it is really important that you get that information for yourself and like a full thyroid panel, what that looks like is your test your TSH but you want your free T3, which is you are free and available after thyroid hormone, you want your free T4 and then you want something called reverse T3. Reverse T3 is like putting the brakes on your thyroid and it inactivates the active thyroid hormone, and that is there for a reason. It is there as a security mechanism in your body. For some reason, the body feels like you are extending. If there is like a famine or there is an emergency or there is like some type of catastrophic, like a bomb is on the planet and you need to conserve your energy, your body is going to lower your T3 so that you are not burning so much energy and you can stay alive longer. But it also happens in cases of stress, in cases of infections, if you have toxicity like from heavy metals or mold that can turn on your reverse T3 and that can inactivate the thyroid hormone. So your thyroid might be putting out enough thyroid hormone, but you are not able to utilize that. And so just getting like a TFH or T4 is going to give you that information. And of course, with autoimmune thyroid, the whole problem with autoimmune thyroid in the way it is treated in this country is it is treated as a thyroid problem. So whether you have an autoimmune thyroid problem or just a low thyroid output, you are usually put on synthroid, which is synthetic T4 if the most popular prescribed medication in this country. Unfortunately, that does nothing to address the fact that your immune system is acting up and actually attacking your thyroid gland. That is an immune problem and that is not a thyroid problem. Yes, it is attacking your thyroid. But in order to resolve that, you really have to address what’s causing that immune flare. You have to heal and seal the gap so that you are not permeating the, you have a kind of like, a bodyguard bouncer in your gut. 

And so there is a semi-permeable membrane and it is supposed to let nutrients and keep the bad stuff out. But in some cases that is not working well. So it can open up and let the bad things in and then that can form those antibodies which then can attack your thyroid. So healing and sealing the gut is so important. In the case of really overcoming Hashimoto’s, I’m putting out that it is absolutely possible to reverse antibodies down to nearly nothing. My antibodies are over 400, and one of us is 400, and the other one is 800. And I got them down to less than nine now. And so not to say that I couldn’t fall back because if I started eating a lot of poor food, if I started exposing myself to a lot of toxicity, I started being under a lot of stress, then that could trigger again and I can fall back. So it is really a maintenance stance, really knowing your body and there is just so much you can do.

Jen Pfleghaar, DO, FACEP

Those are amazing points. And I know when I was diagnosed with Hashimoto’s they told me there is nothing I could do and I was in medical school so I thought that everything that the doctor said was what was true. So I love that you just need to keep looking in, even ordering your own tests, being a part of your health and an advocate because it is your body.

Michelle Sands, ND

It is not really easy because when they say there is nothing you can do, they really are saying there is nothing they can do. Because the fact of the matter is, in the standard of care and medicine, any thyroid problem, whether it is due to just low thyroid output, hypothyroidism or autoimmune thyroid, the treatment is the same. Like when they look at the code, the treatment is the same. In conventional medicine, it really is about covering up symptoms. If you have depression, they are going to give you an antidepressant. They are not going to say, hey, why are you depressed? If you have diarrhea, they are going to give you something to stop the diarrhea, but they are not going to look at it. Are you drinking that water? So there is this just the conventional medicine mentality and they are there to help you like they want to solve your problem. It is just a symptom treatment instead of a system treatment. And in naturopathic medicine, we look at the systems of the body and we are looking to remove dysfunction and improve function so that we can actually treat the reason why you are having those symptoms. And that is really what a healthy building plan is about and there is nothing wrong with treating the symptom at that is to do that while you are also looking at the root cause and while you are also addressing the systems. But unfortunately, it usually ends with the medication. And that is it. And there is no real inquiry or investigation or the goal to solve the initial root cause problem and that is why a lot of people struggle with Hashimoto’s.

Jen Pfleghaar, DO, FACEP

Yeah. And it is also frustrating because there are a lot of articles, studies on how diet and Hashimoto’s are related and it is out there for these endocrinologists, these conventional medicine doctors treating these diseases, it is out there for them to read. I share them when I lecture to primary care doctors. I’ve shared with them that there are things that you can do for Hashimoto’s. You do not tell them that there isn’t. So I think that it will catch up eventually. In 20 years this will be normal. Maybe it will be even in the conventional plan. But these guidelines by these societies, they lie.

Michelle Sands, ND

So seriously. 17 to 20 years. If 17 to 20 years before the research gets into the standard of care practice, that is just how long it takes. That is unfortunate because even a really well-meaning, well-educated physician, they have to practice standard of care. Otherwise, they can get hit with malpractice so they could even know that you should be changing your diet. But they can not really counsel you on that because it is not their standard of care. They can kind of off-label do it or as an aside, but they still have to prescribe the medication only. So it is really that why you see so many physicians switching over to functional medicine because it gives you more freedom to actually practice with what you know and what you need in your gut in the client’s best interests.

Jen Pfleghaar, DO, FACEP

Yeah, it is more in the toolbox, for sure. So let’s talk about menopause and perimenopause. So sometimes Hashimoto’s and hypothyroidism, they are missed in these women. And I hear that a lot of women will come in perimenopause and they are like, oh, they just told me, I have to deal with it because I’m going through life changes and they do not even look at their thyroid.

Michelle Sands, ND

Yeah, well, you know, it is so true because the typical symptoms, perimenopause, and menopause, you are going to have fatigue, you have weight gain, depression, anxiety, digestive issues, muscle and joint pain, and stiffness. These are all, hair loss. These are all symptoms of thyroid issues as well. But once a woman gets in that age range, she is kind of written off. And it is really frustrating to see women go to the doctor and get gaslighted and get kind of like brushed off because they are getting older. It is really frustrating and unfortunately, these doctors aren’t even testing hormone levels or thyroid levels. So a lot of times women are just getting written off as being in perimenopause or menopause and they just have to suck it up, which they absolutely do not like. In our practice, we do not really have that at all. Definitely. We look at testing. We also do a symptom analysis to see what it might be. But we are going to test your hormones and we are going to test your thyroid hormone to see what’s actually going on. And a lot of times, too, when hormone drop, when estrogen and progesterone drop, that can also put a strain on the thyroid as well. In times of perimenopause and menopause, but also post-pregnancy to the fluctuation. The steep fluctuation in hormones can also be a trigger for crashing motors as well. So it puts women in that category in a huge disadvantage if they do not have a doctor that is actually really working with them, really looking at what’s going on and really helping them get to the root cause of what’s happening with them.

Jen Pfleghaar, DO, FACEP

And when you go in to see your doctor and ask for a thyroid panel, you touched on this a little bit more. You can not just ask for that. You need to specifically come in with the thyroid labs you want to be written down, I would suggest, or like you said, just order them on your own, because a lot of the time they are just going to order a TSH, and like you said, with these hormonal fluctuations, you want to check the antibodies. If your antibodies are up, you probably have intestinal permeability or leaky gut and need to fix that and look for root causes.

Michelle Sands, ND

Just so everyone knows, like when you are asking for a full thyroid panel, TSH, it is thyroid stimulating hormone, that is actually a pituitary hormone. So that is a signal from your brain to your thyroid to make thyroid hormone. Now, if you are not making very much thyroid hormone, your brain’s going to send that message stronger. And so that is when your TSH will go up. So it does it give you a good little bit of influence into what the thyroid is doing? But it is not actually even a thyroid marker, it is a brain marker. The problem with TSH is that the conventional medicine range, I believe is like 0.45 to 4.5. So anywhere in that range, you are considering your normal. And in our practice, anything over 2.5 we are looking at as an issue. So we like to see it between one and 2.5 and that is a like first indicator. But we are never just running TSH by itself because like I said, you can have other things going on. 

So you want to look at your TSH put in combination with your free in total T4, your free T3, a reverse T3, and then your two antibodies. So thyroid peroxidase antibodies, also known as TPO on your test and then you want your thyroid globulin antibodies as well. And those two antibodies sometimes might come up not elevated and you might still have Hashimoto’s and they might come up very elevated and it might be just a flu. So I always will test those twice because sometimes with Hashimoto’s especially, you can have a situation where you are making a lot of thyroid hormone over a period of time where like you are actually overproducing and then you dip down, now you are under-producing, so it can fluctuate a little bit. And so one test might not be the be-all, end-all like your numbers might look okay and your doctors like, oh, you are fine. But if you have all the symptoms, if you have the cold hands and feet, the hair loss, if your eyebrows are thinning like I had to tattoo my eyebrows on because I actually lost most of my eyebrow hair from years and years and years of undiagnosed Hashimoto’s. So that is why, especially at the outer third of your eyebrows going away, that is a pretty telltale sign that you probably have thyroid function and hair thinning, especially it is all over your head. That is pretty classic thyroid. If you are receding at the hairline, that could be hormone like estrogen, testosterone balanced so that there is some overlap there of fatigue, constipation, and just like dry skin, brittle nails, all of these things are pretty classic thyroid symptoms, sometimes even headaches can be part of it. 

So if you have those symptoms and your tests show like normal, again with the reference ranges, you want to look at the functional reference ranges versus the standard reference ranges because functional ranges are going to be much more narrow because we are looking at where you are actually functioning well versus a snapshot of everybody who took the test. Because if you are taking a thyroid test, chances are you, it is because you might have a symptom or two. And so you do not want to be in the common normal range like the norm for everybody range. You want to be in the optimal range. And so those are very different. And so it is really important to look at as well and you can easily match those up online. I actually have a guy that gives you this as well on my website, so there is a lot of different resources to get optimal thyroid ranges and it is good for you to know these because when you are looking at your test of your doctor, it is nice for you to say, oh, isn’t it better if my TSH is over three, right or something? That is good to say that because in my practice I notice under a 2.9 or three on the free T3, that is like where you start feeling like not so good, but you can be at two in your doctor will say, oh, that is normal and you get and so it is really important to know like what optimal is and it is going to be different for everybody. I have a client who doesn’t feel good unless her free T3 is like 4.2. 

And she went to before she worked with me, she worked with many doctors and they were medicating her, but they are only let her get to three on her free T3, and she never quite felt well. Well, we did her genetics and her genetics show that she actually needs to have a higher amount of T3 than the regular population. There is a lot of genes like the DIO3 gene that will tell us what we convert, T4 to T3  very well or whether you need help with that. And so there is a lot of things going on in the body that you are born with that might make you maybe have to have a different level than your neighbor. And it is where you feel good, is where you want to be, not just what your doctor says you should be.

Jen Pfleghaar, DO, FACEP

Yeah, that is a great point, because your optimal thyroid labs are probably different than mine. We both had Hashimoto’s and just looking not in range, but also some patients, they are surprised when I’m like, right, we got your labs. I’m like, I’m not happy with where some of the numbers are. And they are like, Really? They are all in range. And I’m like, But they are not optimal. So I think even now I have to do teaching about optimal ranges because we have just been kind of groomed in this medical community that this is the range and if you are in there, you are good. And they did the TSH too, so they actually made the TSH even higher. Now it used to be like now it is like 5.5. be

Michelle Sands, ND

Is it that higher? Oh my goodness. That is not only because you’ve probably seen this too in your practice, but I can not tell you how many times I’ve been talking with a prospective patient. And like we are going through like Holly, maybe they are telling me their symptoms, like, well, you know, it sounds like thyroid and they are like, oh, now I have my thyroid tested and it is fine. I hear that all the time. They are like, well, why is Tammy your thyroid is at risk? Let’s look at it and it is TFA, right? If that is, it is because their doctor is testing it. So even if you had a test, it might not be a complete test. And then like you are saying, it might be in range, but that range is so ginormous and they do keep increasing it just like they keep increasing with the normal body fat percentage is for people. And it is like as the population grows sicker, which we are and our population is more than 53% obese. Now, it did not used to be that way, and that is just what’s documented. There might be more. 

And so as we are getting unhealthy, more unhealthy, they are increasing what’s normal for their ranges to make you think that it is normal to be unhealthy, which is unfortunate. Like we should really be going in the opposite direction. As technology improves, we have more access to all of this biohacking and all of these wonderful, and grounding plates and all this cool stuff that we now can have access to. It should be getting better, but it is actually getting worse if you allow yourself to just like listen to the masses and not do your research. But if you are watching this, you are doing your research on security in the top one percent.. So chances are you are going to have much better outcomes.

Jen Pfleghaar, DO, FACEP

Yeah, you are totally right. We want you guys that are listening today to be in that top percent of people feeling healthy because yeah, I mean, Americans, we are chronically ill. And I think what’s the hardest thing that I see is women that are going through perimenopause, which could be up to ten years, in my age range. And they feel like crap. They but it is okay. Like everyone complains about feeling tired, feeling like crap. Oh, I need three coffees a day. No, we are not. This is not the normal we do not deserve to feel like this. We need to do better, especially for women. And Hashimoto’s is affecting mostly women. So that is what like this summit and talking to you, we want to scream it from the rooftops like you can feel better and there is a way to do that. So would you be able to talk a little bit more about perimenopause? So for those listening out there, like what age could it start out? How long does it last and how will it affect our past.

Michelle Sands, ND

Perimenopause doesn’t get a lot of talk. Not many people are talking about perimenopause, that it is probably more life impactful than menopause is, because even though half the population works, variance hormone decline in on that way to hormone decline before you hit menopause is once you haven’t had a period for 12 months and your ovaries are no longer producing the time leading up to menopause, the time around menopause is perimenopause. So that is the year when your ovaries stop producing optimally and they start going a little slower and now you are not making as much progesterone and estrogen and things are starting to decline. That can be ten, 15 years and it can start as early as age 30 and some women younger. But the average age for menopause is 51 in our country. And so the average age for starting perimenopause is about 39, 40. And so the funny thing is, like I said, half the population will go through this, but still this giant surprise, women start feeling like crap and nobody is really talking about it. The first symptoms are usually difficulty in sleeping, a little bit of anxiety and then usually periods will start to get irregular. Maybe you’ll get two periods in one month and they are like, What the heck is going on? And then like, you would not get your period for a couple of months. You are like, oh my God, am I pregnant? And then it’ll get normal for a while. And then they will spread out, they will get closer together, and then eventually you’ll start skipping periods and start skipping months at a time. 

And you might think, I’ve gone four months without my period, I’m on menopause and boom you get your period and then you have to wait. The clock starts over, you have to have 12 consecutive months without a period then you can be considered in menopause. There is also other markers. You can measure your luteinizing hormone and your follicle-stimulating hormone, and you can kind of know at just like TSH, like FSH and stuff of stimulating hormones. So that is what tells the ovaries to make a follicle, to make an estrogen. And so when it is not doing that, then your FSH gets out just like when your thyroid is not making thyroid hormone, your TSH goes up. So we can look at those as well. But most commonly, you are just going to know by whether or not you had a period. But perimenopause can be devastating because women think they are losing their minds. Because you start to get brain fog and you start to get aches and pains, you are not you are kind of irritable, like for people who you want to be around, then they are starting to annoy you and the skin care products that you want to use in the past that love, all of a sudden they are making your skin breakout. 

Like, what the heck’s going on? Because your skin texture changes the amount of oil and your skin changes and you start to get dry skin. You started aches and pains. And the funny thing is, we know this is going to happen to almost every woman and everybody will have every symptom. So there are a lot of things based on your lifestyle, your diet, your stress levels and how you are taking care of yourself, whether you exercise or not, how well you sleep. Those will impact like how severe symptoms are going to be. It kind of is kind of a roll of the dice. I know women who are the best sleepers, eaters, and workouts. 

They got all in line and then perimenopause hits them later, their life just gets turned upside down because the hormone fluctuations are so important. Estrogen is anti-inflammatory as the surgeon helps your muscles contract so you can have muscle tone. Estrogen helps your collagen and elastin your skin, helps support your bones, helps your body temperature regulation helps your serotonin in your brain. So your feel-good hormone, so many different things, and they all are affected by these hormones. And so just like any woman on this and who’s watching who may have had PMS before her period or fluctuations throughout the month, those hard fluctuations are real. You can get weepy, you can get irritable, you can feel bloated, you can feel tired, lethargic, and all these things. And that happens in perimenopause. And it is kind of unpredictable because it is not like, oh, it is only for a period. So now I know it can kind of be unpredictable, but, in our practice, we help a lot of women in perimenopause with some low-dose hormone replacement therapy to kind of top them off. So they do not have those fluctuations as bad and they do not have to, like, gradually get worse as they lead towards menopause. And now they have osteoporosis and they have the risk for Alzheimer’s and heart disease and libido and their relationships are messed up and all these things. But the thing is, when you hit perimenopause, that is oftentimes when your immune system goes haywire, too. And so you can, it can be a trigger for Hashimoto’s thyroiditis or even just low thyroid because your body depends on progesterone to help your thyroid work and also depends on estrogen to rebuild the thyroid gland cells. And so too much estrogen that can be bad because that can form a goiter that can be causing thyroid issues. And too little estrogen can make you not be able to produce enough thyroid hormone. And progesterone is really important for progesterone and it helps the thyroid actually produce thyroid hormone and bind the thyroid hormones and bind to its carrier proteins so it can deliver throughout the body. So everything’s connected.

Jen Pfleghaar, DO, FACEP

Yeah. Now, when women go into menopause, what have you found with their thyroid? What happens then? What are the changes?

Michelle Sands, ND

So usually we see a lot of hypothyroidism if they do not have it already. A lot of times when they are in it, it won’t happen. like the day they go into menopause, it usually be gradually happening as that because your hormones are gradually declining and then at menopause, they are pretty low, almost zero. They are never a zero, but they are pretty, pretty low and then they just stay that way, post-menopause. And we do see a lot of women through that transition, through that perimenopause transition, started with the thyroid issues. And so and hypothyroidism whether it is Hashimoto’s or just straight hypothyroidism, although most cases of hypothyroidism are Hashimoto’s, it is the most common. So we do see it quite a bit in it is almost always next. It is almost always not diagnosed.

Jen Pfleghaar, DO, FACEP

And that is the thing that is kind of scary is that you are having all these overlapping symptoms, but the thyroid isn’t being checked. And when we say optimize hormones, thyroid hormones.

Michelle Sands, ND

Exactly.

Jen Pfleghaar, DO, FACEP

Even in the whole picture.

Michelle Sands, ND

Well, and the thing to note, too, about perimenopause and menopause and why it is triggering these thyroid problems, is that because when you are experiencing, hormone decline, you are going to have trouble sleeping. So lack of sleep is a stressor to the thyroid and the adrenals. You are going to have difficulty with digesting foods because your gut motility changes and estrogen anti-inflammatory going to have increased inflammation. And so it is not so much just the hormone levels like on the test, the hormone levels dropping, it is all of the ancillary functions in the body that are affected by these hormones dropping that also is a kind of trigger for that thyroid to have an issue as well. And vice versa too, when the thyroid is having struggles, you can have issues with ovulating, you can have issues with fertility Hashimoto’s. It is a very, very common cause of infertility. And so it really is a two-way street. It is not just your estrogen and progesterone, your testosterone affecting the thyroid, they affect each other. 

So think of your hormones like a baseball team. So you got your thyroid hormones, you got your adrenal hormones, you got your estrogen, progesterone, testosterone, you got your pancreas. These are your players. And so if one of your players is not doing this, like not doing anything, showed up drunk to the game, you are probably not going to win because the balls are in a goal past them when they are in the field, they are not going to be able to hit the ball. And so just have you think of it like a team, your endocrine system team, and they really do drive the body like it drives all function the body. Your hormones are so important for pretty much everything when you think about your heart’s healthy or bone health, your brain health and your mood, your libido, the way you work, and your body composition, everything is connected to your hormones.

So it is not just about treating one. You really have to support all of them. And it is not just hormone replacement therapy for women in menopause. There is so much you can do. Exercise like weight training can help to help put your blood sugar balance because muscles use your blood sugar to help reduce inflammation, it can help with muscle tone, and it can help with energy, and help you sleep better. So like, that is just one component. Like we have our diet, we have our stress reduction and our rest and recovery. We have our exercise and movement, we have our mindfulness and meditation, we have our supplementation. So all of these and you have your relationships and all of these components are kind of like the foundations. 

And so just when working on all of those, you can definitely impact how you feel and how your hormones work with each other and your production, how your hormones convert in the body, how they detox and so it really is multifaceted. But the good news is you do not have to have a long list of, okay, you have to do these things from my thyroid. And then you have this other long list over here. I have to do these things for my estrogen and then I can do these things for my adrenals. It is all the same thing. They are helpful. And so it is not as overwhelming as it sounds. You know, the first step I would do would probably be to do an elimination diet, get rid of gluten. Gluten is often tied to you and actually, Hashimoto’s thyroid is because of the fact that gluten enhances the permeability of your intestinal permeability. So it has something called Zonulin and that opens at the selective transfer. So the things that shouldn’t be in your bloodstream get into your bloodstream. And then also gluten has a very similar biochemical molecular structure that shares thyroid hormone. So when your body is like, oh, that gluten is bad, it is tagging that as something to get taken away. And then it also sometimes mistakenly tells the thyroid she is so gluten dairy case and the case in a dairy has a very similar effect for some people as gluten does.

And then soy can sometimes be quite organic, especially if you are using like not organic soy. It is not too much of a problem if you eat it in moderation, but too much of it can be a bad thing. And the sugar, eliminating the sugar. So that is the first thing I would do. And then I would really look into my gut health because like I said, intestinal permeability is a huge thing. So leaky gut. And what I found for Hashimoto’s is you have to have a few things in place to have Hashimoto’s actually happen. One of them is a leaky gut and another one is a genetic predisposition. So you have to have some genetic predisposition to even have autoimmunity because some people will and some people have the luckiest guy in the world and they will eat all the gluten. I will never eat Hashimoto’s because they have the genes that do not let that happen. 

And so it is not something you can control. You either have it or you do not. But so if you have that genetic predisposition, you have to make sure that you do not get a leaky gut. And then you also have to avoid the triggers and triggers can be anything from stress to toxins to allergens in the environment to nutritional deficiencies. And so those are all triggers. So you have them the trigger, the genetic propensity, and the intestinal permeability or leaky gut in order for that Hashimoto’s to happen. But in order to get rid of it, you can not do anything about your genetics. We were some. That is fine here until the leaky gut removes the triggers and then you’ll be glad.

Jen Pfleghaar, DO, FACEP

Yeah. And it makes such a difference. So many patients I’ve seen, they’ve reversed their Hashimoto’s, they’ve improved their thyroid, gotten off of meds by changing diet and lifestyle and stress, like you were saying, the adrenal glands. I love how you brought up blood glucose balance because that if you are on a blood sugar rollercoaster all day long, up and down, then that is going to affect your adrenal glands because of cortisol. That is a stress. But also, if you are stressed out all the time, that can impact your blood sugar. So it is just actually since the pandemic, I have just seen hormones, a little bit of a mess just from all this external stress. So what can you do? Like you said, control your diet, try an elimination diet, make sure you are just the basics. Sleep, and make sure your exercising, doing breathwork, and meditating. So your health is in your hands. It is right there. So do not let anyone tell you it is not because it definitely is.

Michelle Sands, ND

Absolutely. And you do not have to do it all at once, right? You do not have to do all of that and everything happens that way. You start with the eliminating gluten and dairy first, I just eliminate them and I know it can sound hard, but there is just so many excellent gluten-free options these days. Like if you can just focus on whole real foods, it is going to help all your systems in your body. It did not used to be like 50 years ago, we did not have to say no to like a hundred different processed foods because they are just not around. But now, I just find, like in our world today, there are so many things for convenience and we have to say no to so many things instead of like when my grandma was a little girl, they did not have this. They have like a cup, one brand of cereal, like one brand of like, I do not know, a couple of things, but like now we have aisles and aisles of like sugar-packed processed foods that are not really even food. It is like processed food, like material that is not actually a food. So I just think we have to say no a lot more to things that if we just focus on like whole real foods and focus on what is actually nourishing to our body and mind. 

And that includes like watching the news that it is annoying you or they are scaring you about things or maybe if you are religious, you can put on like a devotional. If you are not, if you are spiritual, you can put on like a meditation. If you are not, you can put on a comedy show that makes you laugh. Like laughter is actually excellent medicine. So there is something for everybody. It is not just one way, and you do not have to follow a paleo diet or a vegan diet, or the latest intermittent fasting routine. Just eat whole real foods, eat until you are satisfied. And that is going to take you really far because there is whole real foods that are also going to have the nutrients that you need. The iodine, the selenium, the magnesium, the omega three, the probiotic foods, all those things, you know, help support your thyroid as well. So you do not necessarily have to take a whole, you know, list of supplements on the side of free eating those foods. Of course, supplementing can be helpful and that can make things easier, especially if you have digestive problems as well. So that is something I like. And but yeah, I can sound overwhelming, especially if you are watching and listening to a bunch of different people give you all these different protocols that it really is. It is just no, it is so simple. If you just like listen to the basics. If you go on the foundations, a diet, the rest, the stress reduction, the mindfulness, and focus on relationships, focus on things that make you happy and that will take so far.

Jen Pfleghaar, DO, FACEP

Love it. So beautiful. And if you are eating just unprocessed food, you do not have to spend hours reading all the different labels, right? Yeah, that is.

Michelle Sands, ND

A that is true.

Jen Pfleghaar, DO, FACEP

That is the these,  those labels. I’m like, it is hard. It is hard to read on.

Michelle Sands, ND

And to be honest, like in the beginning when I was dealing with Hashimoto’s, I eliminated like religiously, religiously, because I knew it was like a poison to my body. I just thought of it as that is not food that is like harm to me. However, it is like once I got it under control, and like now once in a while, there is gluten. Make it into my life. It does, but I usually feel kind of crappy about it and then I do not do it again. But in from other things like 80-20 rule is what we do in our practice. We believe in like enjoying your life. And the whole reason why you are trying to have good health is so you can enjoy your life. So it is not about being a slave to your health routine. So we practice the 80-20 rule like is it? Will I ever have a check? Yes, I will. Like 20% of the time. I have things that are enjoyable and then 80% of the time I have my staples.

I know I’m getting all my nutrients, all my Omega as I’m getting enough protein and getting enough fiber. And then if I want to have a treat, that is okay, because now my liver is detoxed and it can process those things as we have this amazing detoxification system in our body so we can be exposed to some level of suboptimal things. But I usually make better choices. Like if I have like a dessert, it is usually a healthier version of it, even though for me it is a treat. But I try necessarily cut junk in my body if at all possible. It is just like if you had a baby, would you be, like, feeding it like Coca-Cola? No. You live either baby as pure food as you can. So why is that? When we are adults, we do not do that for ourselves. You know.

Jen Pfleghaar, DO, FACEP

You are so right. And remember, if you just got diagnosed with Hashimoto’s, there might be a, you know, maybe six months even of a phase where you do have to be a little bit more mature. Then you can relax and do 80-20. So when I.

Michelle Sands, ND

Do that if you notice that it is not affecting you, right, because you might be like, okay, it is time for me to relax. And then you have something that, you know, the symptoms come back. So that is like instant feedback from your body saying are your symptoms, are you just your body saying, hey, there is something wrong, you need to do something differently and so just listen to your body. I think we have become so numb to like listening to our body signals, like ignoring them and just kind of sucking. And I feel like I think that like, just like listening to the doctors a lot of times in my childhood it up. I was told, like, you just do not complain, just suck it out, just deal with it. But no, do not deal with that. Actually, listen and observe the signals of your body and that is your best clue.

Jen Pfleghaar, DO, FACEP

Yes, absolutely. So, Dr. Sands, thank you so much for this awesome interview and for teaching us so much about perimenopause, menopause in the thyroid. I would love for you to share where we could find you if you hang out on social media. Where is your website? All of that.

Michelle Sands, ND

Yeah. So you can find me at glownaturalwellness.com is my website. I’m social. I’m usually at Dr. Michelle Sands and then if you want to learn more about hormones,  fixhormones.com and we have a lot of free resources there.

Jen Pfleghaar, DO, FACEP

Awesome. We will check that out. Thank you so much.

Michelle Sands, ND

You are welcome. Thank you so much for having me.