Working Out Without Burnout for Hashimoto’s

Emily Kiberd, DC

Yeah. I have been a chiropractor since 2007. And I was pregnant with my firstborn in 2015. And all the new mom symptoms that people tell you are new mom symptoms were really Hashimoto’s symptoms, fatigue, difficulty losing weight, hair loss, especially that outer third of the eyebrow, and brain fog, I would start a sentence and I could not remember how to finish it, and those symptoms lasted and people said, “You are a new mom.” Well, 18 months postpartum I was like, this cannot be my life, this cannot be the new mom symptoms. And I started to kind of walk that path of GP, endocrinologists, and a couple of functional medicine doctors until I met my current functional medicine doctor, Dr. Gabrielle Lyon, and really just started to dive into changing how I was eating. I was very New York, I was eating coffee and croissant in the morning and then crashing at two PM, surprise. And also trying to lose, I gained about 50 pounds of baby weight when I was pregnant and I was trying to lose it by doing back-to-back spin classes or I would go to a spin class and walk across the street and go to a high-intensity interval training and the weight was not coming off, I was like, this makes no sense, I am not eating that much and I am working out like a beast and my weight is not coming off. And really it was this pivotal moment of like, I have to do this better, this cannot be my life, I was not present with my kid, my husband was like, who is this woman? She is always laying on the couch tired and just starting to walk those steps of changing what I was eating, lifestyle changes, some route trigger changes, and then also exercise changes.

Jen Pfleghaar, DO, FACEP

That is such an amazing story. And I think it is such a common story, unfortunately, is that women, you have this newborn and they are like, “That is just normal. You are tired because you are a mom.”How many times have your clients heard that? And I have had patients come to me crying and they are like, “I knew something was wrong, thank you for looking.” Anyone out there that is a new mom and thinks they might have a thyroid problem and that is why you are here listening in the summit get tested, make sure that you are listening to your body, and do not let anyone tell you you are wrong. What should women with Hashimoto’s focus on if they want to boost their energy and lose weight with Hashimoto’s?

Emily Kiberd, DC

Yeah. I frame it around feeding your muscle tissue appropriately. Muscle tissue has mitochondria. The more muscle tissue you have the more energy you will have. And I think a lot of women with Hashimoto’s focus on losing fat which can feel very depriving, shaming, blaming. And if you spin it off like I am going to feed and nourish my muscle tissue it is going to give me more energy, the more muscle tissue I have the more calories are burned at rest. It is a more fulfilling way to look at your Hashimoto’s diagnosis, especially when it comes to energy and weight loss. I have women feed their muscle tissue through resistance training and then hitting their optimal protein targets at every meal.

Jen Pfleghaar, DO, FACEP

That is so important, especially as I have crossed into my 40s, I have been obsessed with weightlifting after I have my last son who is three now, I am like, heavyweight, I am going to increase my weight resistance, I am going to eat more protein. I think we lose sight of this and no one’s telling women to lift weights and eat protein and they should be. When women like, why should they focus on resistance training? What is the science behind that and why should they focus on resistance training and kind of let go of that HIIT workout and that cardio?

Emily Kiberd, DC

In the hypothyroid component of Hashimoto’s, every metabolic process in the body requires thyroid hormone including our muscle tissue. And if we are hypothyroid it is just harder to maintain our muscle tissue, to put it simply, it is just harder to keep meat on the bones. And if we are focusing, let us say we are only focusing on cardio. Well, cardio, especially if you do long bouts of cardio, will break down our muscle tissue and it is already hard for us to keep it on the bone so why do not we focus on maintaining the muscle and maybe potentially building the muscle which is actually very challenging. Women worry about bulking up but it is actually very challenging to put muscle on. And so through resistance training, we can grow the muscle, we can maintain our muscle mass, it is going to give us more energy and it helps with the turnover of our thyroid hormones. I think it is so important. I think culturally maybe we are in this mindset of lose weight, put on our running shoes, wherever that came from, or do more cardio. 

And yes, cardio is important for our cardiovascular health, and our heart health. But what I have noticed is that when women build this foundation of strength they feel better when they do their cardio. I have had women go for a walk and they are like right around the 30-minute mark my SI joints hurt, my back hurts and you put them on a strength program, a resistance training program three days a week, 30 minutes, it is not hours at a time at the gym, 30 minutes each session and they can walk further, their back does not hurt, their joints are more stable, they have more energy and they feel like they can even walk further than 30 minutes. There is no detriment to building muscle, it is only benefits upon benefits.

Jen Pfleghaar, DO, FACEP

It really is. And I will see a lot of times in my Hashimoto’s patients if they are going to trendy,  Orangetheory, or all these HIIT workout places that you want to keep your body in that stress like that high impact zone sometimes it is harder to lose weight. It is harder on your adrenals, sometimes you need that rest. With weightlifting, you are getting good benefits and you are breaking a sweat too, but you are not putting that stress on your adrenals which will then affect your thyroid. I really like weight training for my thyroid patients. It is so important. It is not really talked about a lot. That is why I love your space because you really hone in on this.

Emily Kiberd, DC

Yeah. I think an important differentiator between a well-programed resistance training, and strength training program versus a high-intensity interval Orangetheory is that there is proper rest. When you go to kind of that boutique fitness class you are not usually getting sufficient rest until 50 minutes later when the class is over, you are totally tanked out. And with a well-programmed strength training program between each set, you might take a minute, sometimes up to three minutes rest which a lot of women when they are not used to that. They are like, what am I supposed to do during this rest period? But that is how you can lift heavier. You can build your muscle without that feeling of extreme fatigue. 

I know same experience patients who have been going to that high-intensity interval training and they are like, I feel like I can not get off the couch for three days, there is probably stress in other aspects of your life and you are kind of tanking yourself out, you are burning the candle at both ends, you are probably giving yourself adrenal issues. And how can you still get that exercise and maintain your muscle, not break it down with high-intensity interval training, and still have that energy? Not feel like you can not get off the couch for three days after you exercised?

Jen Pfleghaar, DO, FACEP

That is definitely a red flag if you can not get off the couch. And I think people have to realize we do have to look at every one individually. And I sometimes throw in one hit workout a week but my Hashimoto’s is in remission. It is not like we are saying, you can not ever go to your favorite HIIT class again, I am not saying that I am just saying you need to do weights because we need muscle. And also, where are you at in your healing? Where are you at in your menstrual cycle even? Are you in your luteal phase? Should you chill out and maybe take a yoga class instead? I think when we look at it, it is not a one-size-fits-all either. Dr. Emily, when you program differently and train or you were kind of getting into this with the reps and the sets and the moves, what do you think for Hashimoto patients, how does that look exactly? Can you run us through maybe a little workout or something that is ideal?

Emily Kiberd, DC

Yeah, I like functional moves, full-body moves that recreate what we are doing in life. I call them the essential seven. It is a hinge, a deadlift, a squat, some push-pull, lunge, a carry, and then some anti-rotation. And with those moves, if you went to a traditional trainer they might do three sets of 15 because kind of the older research was 12 and above starts to work on muscle hypertrophy. Well, the newer research shows it does not matter how many reps you do you just have to hit fatigue. This perception of, if you rated it on a scale of zero to 10, maybe it is an eight like a seven or eight by the last couple of reps. Another way to think of it is by the last couple of reps you perceive I only have two more in the tank and that is it. You want to hit that sensation and you have to choose your weight appropriately to kind of hit that perceived exertion. 

And then I like to do less reps. You could do a thousand reps with a lightweight, you will probably give yourself an overuse injury or you could do less reps with a heavier weight and get that perceived exertion fatigue quicker. Especially for the woman who is not on the I am doing her training five days a week they are kind of deconditioned, maybe they only hit 2000 steps a day and they need to build their strength slowly. I might do three reps of a deadlift and then take a break and then next set scheme four reps and build slowly but you want to hit that perceived exertion, this is the most important piece. You can call it fatigue but people view fatigue differently of a seven or eight out of ten. That is how I program. And then between those sets, I like to give long rest breaks. Your heart rate goes up, you are more breathy and I like to give a minute, sometimes up to three minutes, depending on what your goals are, and how heavy you are lifting. If you are new to lifting journey and you fatigue easily or maybe your Hashimoto’s inflammatory load is not being managed, maybe you are not in remission. I like to play with how long you are taking a rest break based on those factors, how well you slept, what is your stress, all those things. 

And I find that women do really well because it is a very fine line to walk off. Some women work out and they feel those Hashi flare-up symptoms or extreme fatigue but they still want to challenge your body enough to put on the muscle. It is a very fine line to walk and you have to take in all those other stress factors. But I find that women feel so much better, their energy feels better, they feel more present, they do not have as much brain fog, and they have clarity of mind when they are lifting weights versus maybe the conventional recommendation which I have noticed is almost do low impact, do some yoga, Pilates, take a walk, do some chair stretching, and that is all great for the nervous system but it is not enough. And it is unfortunate that that is a common recommendation. And sometimes I feel like you can look at your doctor and know if they work out or not and kind of base, their recommendation is walking, well, that is probably what my doctor does and not much more. Yeah.

Jen Pfleghaar, DO, FACEP

Right, exactly. Practice what you preach. I have seen your Instagram videos, I mean, you are strong. And I think that that is what we have to realize, as we age and not just for Hashimoto’s patients. If you have had Hashimoto’s, it is in remission, I mean, you are still at higher risk of getting another autoimmune disease or having those antibodies come back so you want to stay strong. And muscle, as we age, is so important. I think that women have really it is been a disfavor to them going through different body types and what is beautiful and what is not. And you can lift a lot and still have an hourglass figure, it is actually going to help with that. I think that I love that you are talking about this and it is science-based too is also what people need to realize. Dr. Emily, can you just touch on the kettlebells a little bit? Because I recently the last couple of years, I think it was like during COVID that I ordered kettlebells and they are fun, they are so fun to work with. Can you tell us a little bit about your kettlebells?

Emily Kiberd, DC

Yeah, I love kettlebells because they are very forgiving when you are first learning form. Because I think that is a fear with women picking up weights are like, I do not know how to do it, we did not do this in high school, this was not a class in college. Kettlebells are very forgiving when you are first learning form. For example, if you think about a deadlift, if you did a dumbbell deadlift it is kind of awkward because the dumbbells are either too far away from your body and it is pulling on your back or they are kind of rubbing on your legs. A barbell, you have to have your form dialed in, your breath, your brace, you do not want to be rounding in your back and your lower back and kettlebells are just really forgiving when you are first to learn in form. The other thing is when you have a kettlebell in your hand and you can squeeze it, especially your ring in your pinky finger. Studies show that the more grip strength you have the stronger your grip, not only the more shoulder stability you have but you age better, your longevity is optimized. And kettlebells are great. For example, if you are carrying two kettlebells down towards your side like a farmer’s walk the kettlebells do not bump on your legs like dumbbells do. You can work on grip strength and shoulder stability, if you have neck pain you can literally do a farmer’s walk or heavy carry and get yourself out of neck pain because you are strengthening your shoulder.

Another thing about the kettlebell is this idea of this offset weight. If you are holding the kettlebell and the bells on the back of your forearm it actually activates certain, you can call them neurological centers in the body that creates stabilization that does not necessarily happen with a dumbbell. If you hold a kettlebell in the right position it will turn on, just by having the weight offset to the back of the arm, it will turn on all your shoulder stabilizers, your serratus, interior, and your lat, that just does not happen the same way if you are holding a dumbbell and the weight is kind of centralized in the hand. The last thing is that a lot of women really focus on like, “I got to get my cardio.” You can work up to learning kettlebell swings and ballistic moves. Kettlebell swings, snatches, cleans and get your heart rate up without that extreme fatigue that can happen if you are going for a 10-mile run. I used to do a lot of triathlons and marathon training so I know this well. But it is a great way to get in those ballistic moves to work on coordination and proprioception that does not necessarily happen. It is really hard to kettlebell swing a dumbbell. And if you think about a barbell snatch that is a lot of technique and can feel really intimidating for the woman who already feels intimidated picking up a weight. I really love them. They are great to travel with. I have literally flown to Brazil with kettlebells so I could work out. Yeah, it was during the world cup. My husband’s like, “You are insane.” I was like, “It is necessary.” And sure enough, when we were working out, he is like, “Can I use your kettlebell that you flew down here?” And I was like, “I guess.”

Jen Pfleghaar, DO, FACEP

Well, we have done that traveling, like to my parents for Christmas I will just put a couple of kettlebells in there because they are more versatile, I feel like they are than dumbbells. I think if anyone out there has a camper or something or you are going somewhere I think that would be nice. Now, I bring bands with me when I actually have to like check luggage because it is heavy like I can not believe you brought kettlebells. I think that is so much fun. But, yeah, they are very just versatile. I think they are really fun and less intimidating like you said. And if you get confident you could go to the gym and pick up a kettlebell there and show all the men your moves then.

Emily Kiberd, DC

Yeah, totally.

Jen Pfleghaar, DO, FACEP

What do you notice looking at women with Hashimoto’s from a movement and strength perspective?

Emily Kiberd, DC

Yeah. And I think a lot of women with Hashimoto’s do not get a workup or an analysis in this way, it is typically from functional medicine, blood work, lab work, they are sitting there chatting. And when I had my practice in New York City, I noticed that a lot of women that were coming to me had this element of hypermobility, tissue laxity, and joints that were not stable and it was not every woman with Hashimoto’s but it was probably 80% and there is no research on it. There is research on Ehlers-Danlos and that kind of clinical diagnosis. But I just notice a lot of the autoimmune population and the women with Hashimoto’s were coming in with joint laxity. And there is 10 points you can check in the body called a beta score in the physical therapy land and it is the elbows, the knees hyper-extend kind of back behind the ankles, the thumb touching towards the soft part of your forearm, the pinky bending back beyond 90 and then if you stood with your feet together, knees straight, bend forward, touch the floor, you could palm the floor and I know every yogi is like, “I can do that.” But that is actually too much mobility. And there is biomechanical, if you have been training it from a yoga perspective and then there is a genetic autoimmune perspective. And these women were coming in with hyper immobile joints, and tissue laxity, they could not stabilize, they kind of stand there and hang out on their knees and wonder why their back hurts and they all wanted massage because their joints hurt and their muscles ached and they wanted to get adjusted and they wanted me to teach them stretching and forming moves. I was like, “That is the last thing you need. We need strength, we need joint integrity, we need to make you feel more stable and strong, we need more muscle tissue to protect those joints.”

And usually, when I would put them on a strength training program the first 10 days they would be like, I feel really tight, and I was like, is it tightness or is it we are creating this joint integrity that you have never had before? And then after that, they would feel so much better, their anxiety would come down, they would feel stronger, they had more energy, and sometimes they would go back to a yoga class to fill the soul because it fills a soul, I am a yoga instructor too. And afterward, they would feel destroyed and it was like this realization, “Oh, this strength training there is something to it.” And that was a clinical observation. And I have bounced it off of some friends who are naturopathic functional medicine docs and they are like, “I have not noticed that” and I was like, “Yeah, but you have never watched someone walk, taken on through a full body kind of functional movement assessment, you have not had them step up to kettlebells and have them deadlift and see what they do in their movement patterns.” That was a clinical observation. And it is unfortunate. I wish Pilates or walking could clean something up like that but it can not, the only way is to pick up a heavyweight with amazing form, put it down, and do it again. And the hypermobility will kind of get reined in, it is still there. But I think the bigger thing is that they have more energy, and these women feel stronger. There is this element of hypermobility that kind of tanks your energy, it is exhausting to kind of not know where you are in time and space all day. That was a clinical observation. And the women who do resistance training on top of all the benefits of building muscle and maintaining muscle that was one piece that I noticed clinically.

Jen Pfleghaar, DO, FACEP

But that is really cool to hear. And that almost makes me want to start checking that when Hashimoto’s patients come in. But it fixes that whole perspective of autoimmune disease, I mean, it is all kind of tied in and you get this hypermobility piece in there. That is really fascinating. And strength training, yeah, I mean, I agree, you just feel better, you just feel good. How do you help women build the resilience of their nervous system through strength training?

Emily Kiberd, DC

Yeah. You hear a lot of people talk about managing their stress that dysregulation of their nervous system is such a big piece and is sometimes the last piece that is addressed, sometimes they are taking all the supplements, working on their gut health. And there are different programs to help the dysregulation of their nervous system. And my approach is that we do the hard things in small doses like pick up a weight and then use your rest break to calm your nervous system through different techniques. You could put your tongue on the roof of your mouth and extend your exhale through your nose. Because after you picked up a weight your heart rate is up, your breath rate is up, and that long slow exhale will put you back into that parasympathetic state. I have women hum during the rest breaks between sets or sing, it is just vagal toning, a lot of people do this to help when they are in that stressful state. Well, why not train it by adding a little stressor, picking up weight and exercise is a stressor, but then training your nervous system between those sets to drop back into that like everything’s okay, your vagal tone during those rest breaks and then pick up a weight again because that is really the beauty in stress is like how quickly can we experience the stress? It is always going to be there and then drop back into that, I am okay state. And I can not really think of a better avenue than to microdose, some heavy weights, and then use those techniques during your rest breaks to put yourself back into that calm state.

Jen Pfleghaar, DO, FACEP

Yeah. Training your body with that resilience is really cool. Maybe that is why some people sing while they are at the gym. I probably not but I am going to start doing that, you will see me, I am just going to start putting on music and not listening to a podcast while I work out, I need to start singing. But I do not know at the gym, if people look at you like, what are doing but you could just say I am training my nervous system.

Emily Kiberd, DC

Yeah, I am toning my vagus nerve.

Jen Pfleghaar, DO, FACEP

And they would probably leave you alone after that. I would be like, Okay.

Emily Kiberd, DC

Yeah.

Jen Pfleghaar, DO, FACEP

This is all been so interesting. It is such a great talk. Is there anything else that you want to discuss about your workout or where to start? I guess that is the one question I would have is if someone’s listening, there are Hashimoto’s patients, no matter where they are in their diagnosis, they have never picked up a weight before. Where should they start? Because this is a little overwhelming if no one has picked up a kettlebell or a weight before.

Emily Kiberd, DC

Yeah. I will give two recommendations. One is to start with the breath. And I think as women we focus on like when someone says in class, engage your core, we do not really know what that means, you are like, am I doing it? How about now? Am I doing it now? And no one really teaches how do you engage your core when you pick up a weight. You want to breathe down and wide into your belly, you want to create a brace, and then when you exhale you want to maintain that brace. And one of the best ways to do it is like with an audible exhale you can feel your core kind of go pew. A lot of women will pull their belly to the spine, they will draw up and in kind of a pilates cue and you do not want to do that when you pick up a weight because you will injure your back. If you look at a baby, how a baby stabilizes, you never see a baby sucked their belly to their spine, they are always kind of breathing down and wide and then doing their move and that actually pushes the spine out of extension and creates a rigid spine for when you do pick up the weight. Every woman I teach, the first thing I teach is to get your breath down there because a lot of women are breathing short and shallow. To get their breath down and wide, and then to learn how to kind of keep that fullness in their belly on their exhale. That would be one place to start. Another place to start that I get a lot of questions is like, what weight do I pick up? And I usually have women start with, if it is some pressing motion and eight kilos or a 10 kilo, and then if it is a deadlift I usually have women start with 12 kilos which is 50 pounds which a lot of women are like, “You are going to make me start with 50 pounds?” And “Yes, because you need enough resistance to have your hamstrings and your glutes turn on if you do not have enough, you are going to be using your low back, and your forearms going to be off. You need enough resistance to get the body to activate the muscles appropriately.” That is to two different places, two different ways to start.

Jen Pfleghaar, DO, FACEP

Those are great tips. I am sure everyone is just going to be all into weightlifting after listening to all the benefits. Thank you so much. I really appreciate you being on here, Dr. Emily. Can you tell us about what about your program? How do people find you?

Emily Kiberd, DC

Yeah. I have a program called “Thyroid Strong.” And it was born out of my own journey with Hashimoto’s and then treating women in person and then sharing it online. There is a six-week program and a 12-week program. And it literally takes you step by step from a beginner of how to pick up a weight. There are three workouts a week for six weeks. And the whole goal is to feed your muscle, to get you stronger so that you can have more energy to be present with the people that matter most in your life and things that are important to you. And I think one thing that is maybe different than other exercise programs out there is the cueing, if one cue of how to do the form properly worked for everyone, it would be a billion-dollar business, but different women when you say one thing and it happens for one woman and another woman’s like, I do not get it. 

The cueing is very specific, it is how to step your feet, where to turn your toes, where your knees should go, how to set your hips back, and how to breathe before you pick up a deadlift like all that happens and then we cue, it is not just step up to the bells, sit your hips back, stand up. The cueing from a medical person who is looked at forms with their patients for the last 14 years that is all in the program. And it is really a place to be a portal of entry to get women into working out, to have them feel confident such that after six weeks they can go to the gym and feel confident picking up weights and be like, my form’s on point, I know exactly what I am doing. And that is the goal is to really give them life skills so that they do not fear weights, they are confident around them.

Jen Pfleghaar, DO, FACEP

That is so amazing. I love what you are doing in the Hashimoto’s space. Thank you so much for being here and teaching us everything that you did today.

Emily Kiberd, DC

Yeah, thanks so much for having me.