Thyroid Care - A Nine Step Program For Busy Women

Thyroid Care:
A Nine-Step Program for

Busy Woman
by Anisa Abeytia, M.S.
A&Y Publishing by Anisa Abeytia 2024

Dedication
-to all the women worldwide who silently suffer from thyroid dysfunction & my
children who patiently waited for dinner as I wrote this book.
Table of Contents
i. Dedication
ii. Table of Contents
ix. Forward
Chapter 1 Introduction 9
10 Introduction
11 Problem Statement
11 Purpose
11 Thesis statement
11 Theoretical Framework
12 Research Questions
13 Nutritional, Herbs, Lifestyle Choices to Avoid or Promote
Chapter 2 Literature Review 16
16 Literature Review
19 Background Statistics
Chapter 3 Therapies 21
21 Traditional Diagnostic Tools and a Clinical Approach
22 Thyroid Panel (Traditional)
23 Thyroid Panel (Modified)
24 Clinical Approach
24 Case Study 1: Hashimoto's and the Thyroid
24 The Broda Barn’s Method
25 Achilles Reflex
25 Pulse Rate
25 Thyroid Palpitation
25 Iodine Urine Test
26 Iodine Patch Test
26 Symptomologies
28 Primary and Secondary Hypothyroidism Causes and Triggers
30 Biochemical Individuality
30 The Thyroid Gland and Its Function
Chapter 4 Results 34
34 Conventional Approach to Treatment
The 9 Step Protocol 36
Chapter 5 Step 1: Identify Food Sensitivities and Assessing Digestive Health 37
38 Intestinal Permeability (Leaky Gut)
39 Celiac Disease (CD)
40 Case Study 2: A Family Affair
40 Sugar and Impaired Glycogenolysis
42 Case Study 3: Gestational Diabetes

42 Functional Testing
Chapter 6 Step 2: Identify and Resolve Chronic Infection 44
44 The Role of Chronic and Low Grade Infection
46 Case Study 4: Too Much Going On
46 Chronic Inflammation
47 Gut Flora and Gut Associated Lymphatic Tissue (GALT)
Chapter 7 Step 3: Reducing Toxic Load 48
50 Genotype and Phenotype
51 Case Study 5: Iodized Antiseptic Triggers Hypothyroidism?
51 Iodine 131
53 Fluoride
53 Calcium
51 Iron
54 Life Style Changes
Chapter 8 Step 4: The Liver and Detoxification Pathways 57

58 The Role of Emotional Detoxification
59 Case Study 6: Monkey in the Middle
62 Case Study 7: I'm Just So Angry
62 The Process of Detoxification

65 The Liver and Thyroid Function
65 Supporting the Detoxification System
66 Herbs and Supplements
Chapter 9 Step 5: The Adrenal Connection 69
70 Cortisol and Stress
72 Adrenal Fatigue/Exhaustion
73 Stages of Adrenal Fatigue
74 Pregnenolone Steal
Chapter 10 Step 6: Balancing the Endocrine System 76
76 Menstrual Irregularities
77 Estrogen Dominance and Low Progesterone
79 Stress
80 Phytoestrogens: Soy
81 Xenoestrogens
82 Plastics
82 Pesticides
83 Hormones
83 Diet
Chapter 11 Step 7: Eating for Health 85
86 Eating for Health vs. Eating for Weight Loss
87 Sugar
88 The Macronutrients
89 Fats
89 Proteins
90 Carbohydrates
90 Super Foods
91 Water
91 Fiber
92 Sea Salt
92 Sea Vegetables
93 Herbs
94 Coconut Oil
94 Fermented Vegetables/Sauerkraut/Yogurt/Keifer
94 Vegetable and Bone Broth
95 Foods to Include and Avoid

95 Foods to Include
95 Oils
95 Nuts and Seeds
95 Vegetables
96 Fruit
97 Sweeteners
97 Grains
97 Beans
97 Herbs
99 Fish, Poultry and Meat
99 Other
99 Foods to Avoid
Chapter 12 Step 8: Supplements, Herbs and Holistic Therapies 101
101 Herbs and Fungi
102 Nutrients
103 Supplements
105 Homeopathic Remedies
106 Holistic Therapies
107 Case Study 8: I Put It All Behind Me
107 Body work
108 Life Style Changes
Chapter 13 Step 9: Exercise 110

111 Stage 1
111 Stage 2
111 Stage 3
Chapter 14 Conclusion 113
Appendices 115
116 Appendix 1 Self Care Bodywork
119 Appendix 2 Tea Preparation and Dosage
120 Appendix 3 Deep Breathing Exercise with Corpse Position and Child’s
Pose
123 Appendix 4 Hair Oil and Hydrating Body Oil
124 Appendix 5 Reflexology Points
122 Appendix 6 Three Day Menu Plan
136 Appendix 7 9 Step Supplementation and Practical Application
Suggestions
142 Appendix 8 Basic Dietary and Lifestyle Guidelines: Strategies
For Health
144 Appendix 9 Questionnaire: Thyroid Care: What Other Factors Might
Be Contributing to Your Hypothyroidism?
146 Appendix 10 Supplements and Dosage Amounts
148 Appendix 11 Drugs that Inhibit Thyroid Replacement Hormone
Bibliography
159 Bibliography
Forward
The prevalence of abnormal thyroid function (hypothyroidism) in the United States is at an

increase, despite inadequate screening methods, which leave the true numbers in question.
Amongst those that are diagnosed and treated for hypothyroidism there remains a significant
population that does not respond to conventional treatment. There are also those who are
undiagnosed and are considered subclinical and remain untreated, many progress to
hypothyroidism. These two groups may suffer from secondary hypothyroidism (not stemming
from an organic disturbance in the pituitary or thyroid gland), the natural history of which may
be unknown. Currently there is a lack of a comprehensive, clinically holistic approach to
regaining thyroid health. The literature reflects a unidimensional approach to treatment or a
primary dependence on pharmaceuticals. The current attempts at approaching the topic
holistically either lack a clear process or exclude important aspects of treatment (i.e. nutrition
and the psychological aspects). As such, the author was prompted to create a Nine Step program
to address issues that surround thyroid health.
This book outlines a Nine Step Program to regain thyroid health that is developed from both a
review of the literature as well as from case studies gathered from working with hypothyroid
clients. The author includes aspects that are neglected in other protocols and includes a three day
menu plan as well as a Nine Step Supplementation and Practical Application Suggestions to
insure clinical relevance of the program.
This book should not be used outside of medical care and is not intended to replace the advice of
a physician. Before starting any healing protocol, always inform your physician or medical
professional. Additionally, this book was authored in 2009 as a graduate thesis and is being made
available as a reference.
Chapter 1:
Introduction
Searching for answers to my own health concerns, I discovered that there was no well designed
program for maintaining and regaining thyroid health. As a busy mother of four, it was a
daunting task to formulate my own program from scientific studies, thyroid experts, patient
advocates and popular media. As I pursued my M.S. in Holistic Nutrition, I met many mothers
with the same “ailments” that I once suffered from. They also did not know what to do and
above all they did not know what to eat.
What I discovered was that almost every mother I met with was experiencing or
experienced some form of thyroid dysfunction that many times was accompanied by dysfunction
of the adrenal glands. Sometimes this manifested as a diagnosed condition like hypothyroidism,
but many times it did not. When asked, most women could point to the birth of a child as the
triggering event, some pointed to marriage. Without exception, all lamented the lack of a support
network and the inability to form strong and lasting bonds with other women. I found that
women who lacked a social network, or what I call a circle of women, corresponded with the
severity of the person’s self reported symptomologies. Simply put, the women who felt
supported by other women experienced more robust health, even if they were diagnosed with
hypothyroidism. It gave them hope that someone cared and that help was available. They also
derived strength from their relationship with their partner, but they thrived with the friendship of
other women, particularly relatives.
In the small sampling of women I spoke to (roughly 130), from various ethnic back
grounds, religions, nationalities and a broad age range (23-86); I found a striking similarity in
lifestyle. In almost every instance there was little time devoted to self care. Since there was such
diversity among the women I spoke with, I had to infer that these behavior patterns reached
beyond social conventions, since many of their traditional or tribal approaches allotted mothers
much more time and emphasized self care, particularly postpartum, it had to manifest from a
more modern sensibility. These women all were of roughly the same economic standing, middle
to upper class and it would have been interesting to include women of various economic
backgrounds. Only one woman was a single mother, two were previously divorced, but had
remarried. It is from these women that I derived my case studies and my inspiration to write this
book.
Problem Statement
The current challenges are that hypothyroidism is under-diagnosed and is only treated when a
diagnosis is made, leaving those with sub-clinical or functional hypothyroidism to continue to
remain in a state of less than optimal health. Biochemical individuality is over looked and there
is not enough emphasis on clinical symptomologies. The whole person approach is not utilized
enough in clinical settings and as a result, even those with a diagnosis of hypothyroidism or
Hashimoto's seldom regain health.
Purpose
The purpose of this book is to synthesize information I gathered over the years in discussion with
mothers about their health concerns, thyroid/hormonal imbalance issues, and from a survey of
the literature concerning thyroid disorder. This book will focus only on secondary
hypothyroidism (not caused by the thyroid or pituitary) and briefly touch upon Hashimoto’s auto
immune disease, since the two overlap at various points.
Thesis statement
Is secondary hypothyroidism mainly caused by “unknown causes” or by one causative factor?

Are there environmental and lifestyle factors that play a larger role in causing hypothyroidism?
How does one assess and affect healing in hypothyroidism, both diagnosed and subclinical?
Theoretical Framework
I conducted a two and a half year literature review that included broadcasted interviews, books,
magazine articles, internet articles, conferences, as well as scientific studies. I conducted a search
on both Pub Med as well as Google Scholar. The literature review provided various integrative
and holistic therapies that might prove useful in healing secondary hypothyroidism.
Scientific studies focus on unidimensional causes or treatments of hypothyroidism. They
are useful in developing new understandings of the causes and new treatments for
hypothyroidism. Yet, secondary hypothyroidism is not caused or treated effectively by one
thing, but by an holistic and integrative approach. As a result I turned to books that dealt with
the subject to gain an idea as to how to approach hypothyroidism holistically.
Currently the only book that attempts to address hypothyroidism from a multi-faceted
approach only addresses Hashimoto’s. The authors outline a 10-step program, but do not include
a nutritional protocol and only place cursory attention to herbal therapies. Depression, emotional
wellbeing and supportive lifestyle approaches are not addressed in the 10-step program proper,
but as an additional chapter at the end of the book. Although useful, the book does not address
non-Hashimoto or functional/subclinical hypothyroidism.
The other books surveyed all placed a large part of their emphasis on the proper dosage
of thyroid medication. This is not to say that this approach may not prove useful is certain
instances, but not when dealing with all manifestations of hypothyroidism.
Much of the interests of this book grew organically out of conversations I had with
women about their health, desires, goals and dreams for themselves and their families. These
were conversation and not interviews and as such were candid and no-linear.
Out of these conversations, I delved deeper with those who were diagnosed with
hypothyroidism/Hashimoto’s and those who seemed to have functional hypothyroidism. These
were conducted in a more linear, interview style. These interviews developed into case studies
and are included as part of this book.
Research Questions
These research questions are grouped according to relevant topic groups to allow for an
understanding of how these questions may be interconnected. In this book I will succinctly
target recognized triggers and include a large sampling of holistic approaches with a particular
emphasis on nutrition, which is not adequately addressed anywhere in the literature. These
questions emerged both out of my review of the literature and from my case studies.
1. What role does pregnancy play in the onset of hypothyroidism?
2. Is estrogen dominance a key marker to look for before the onset of hypothyroidism?
3. What are the current methods for recognizing hypothyroidism?
4. Are these current diagnostic methods meaningful?
5. What role does food sensitivities play in hypothyroidism?
6. Is chronic infection a trigger for hypothyroidism?
7. Do environmental toxins, like mercury and iodine 131 play a causative role in
hypothyroidism?
8. What is the role of the liver in the function of the thyroid?
9. Is there an adrenal connection to thyroid dysfunction?
10. Can a dysfunction of the thyroid affect the entire endocrine system?
11. What foods are beneficial to the thyroid?
12. What foods are detrimental to thyroid health?
13. What supplements support the thyroid?
14. Does iodine status play a role?
15. What herbs support the thyroid?
16. What lifestyle changes and holistic therapies are supportive to the thyroid?
17. What role does exercise play?
Nutritional Support
A main emphasis of this book is the development of a comprehensive nutritional approach to the
treatment of hypothyroidism. Here are listed, a truncated list foods to consume, as well as
supplements and herbs that exhibit beneficial effects on the thyroid. I also include a list of foods
that exhibit a deleterious effect on the thyroid:
Foods to Include
• Water
• Whole grains, sprouted whole grains
• Organic fruits
• Organic Vegetables
• Sea salt, particularly Himalayan
• Sea vegetables (Giant kelp, brown seaweed)
• Coconut oil
• Yogurk/keifer
• Fermented vegetables
• Vegetable and bone broth
• Foods to Avoid
• Soy
• Sugar
• White flour
• White rice
• Fast foods
• Soda
• Hydrogenated oils
• Cruciferous vegetables
Supplements
• High potency B complex vitamin

• Sub lingual vitamin B 12
• Vitamin C and bioflavonoid
• Vitamin D
• Vitamin A and carotenes
• Magnesium
• Vitamin E
• Selenium
• Zinc
• Cod liver oil or Udo’s Oil
• Amino Acids- Particularly Tyrosine which is essential to thyroid function.
Almandine, L-Arginine, L-Aspartic Acid, L-Cystine, L-Glutamic Acid, L-Clycine,
LHistidine,L-Isoleucine, L-Luceine, L-Lysine, L-Methionine, L-Phenylalanine, L-
Proline, L-Serine, L-Taurine, L-Theronine, L-Tryptophan, L-Tyrosine, L-Valine
• Iodine
• Digestive enzymes
• Bromelain to decrease inflammation
• Herbs
• Guggul (an Ayurvedic herb)
• Adaptogenic herbs like astragalus, ginseng.
• Burdock, dandelion, milk thistle
• Chamomile, marshmallow
• Curcumin to decrease inflammation
• Raw ginger, garlic and onions for their anti inflammatory and anti oxidant function
• Reiki
• Shiitake
• Maitake
• Poolridge Teas (Adrea-Stim, Thyroid Tea, Fem Cycle, Live-Endo, Digest-Stim)
Chapter 2:
Literature Review
As I conducted the literature review I discovered a lack of an easy-to-follow program to address

hypothyroidism. What I found was a plethora of information, sometimes conflicting (soy yes,
soy no), many times unspecific and almost at every juncture too much emphasis was placed on
pharmaceuticals.
The amount of information available is staggering and Oprah Winfrey's 2007 assertion
that her weight gain can be attributed to hypothyroidism was an opportunity for information and
misinformation. That aside, universally there is agreement from the former editor-in-chief of the
official publication of the American Thyroid Association, endocrinologist, Arem Ridha, M.D. to
herbalist Ryan Drum, that more attention should be given to thyroid health. The approaches are
what differ.
Perhaps the difficulty in setting an approach stems from the complicated nature of the
endocrine system and the tentacle-like affect the thyroid exhibits on the body. There seems to be
no smoking gun when it comes to secondary hypothyroidism or functional hypothyroidism, and
this may come as no surprise to health care practitioners using a holistic approach. There is not
one trigger, but there seems to be the preverbal straw that broke the camel's back. For many
women, that straw is pregnancy. This quilt work approach to the cause and healing approaches to
secondary hypothyroidism approaches art, but that does not exclude science or assume that the
two are mutually exclusive. It may be simpler to prescribe various pharmaceutical from thyroid
medication, statins and anti-depressants and hope for improvement rather than to take the
approach I am suggesting.
Various authors like Dr. Glenn Rothfeld, Dr. Richard Shames, Dr. Ridha Arem, patient
advocate Mary Shomon and herbalist Ryan Drum assert to various degrees that both primary and
secondary hypothyroidism are not “treated optimally,” even when there is a diagnosis (Shames,
2001). The works of the authors mentioned above, in addition to Janet Lang, DC, and Dr. Broda
Barnes’ pioneering work, will be the focus here because I feel they represent the various veins of
research and approaches to working with hypothyroidism. Some, like in the case of the Shames’,
only address what they term “simple” hypothyroidism caused by Hashimoto’s, although my
focus is secondary hypothyroidism and functional hypothyroidism, I find their work useful.
Thyroid Power by Richard Shames, M.D. and Karilee Shames, R.N., PhD, does attempt
to provide a 10-Step program, but is primarily focused on Hashimoto's autoimmune disease.
They also assert that “virtually all cases of low thyroid is not so much a faulty thyroid gland as it
is an overzealous immune system” (Shames, 2001). It does not address diet in any significant
way, instead it asks its reader to consult with a “good nutritionist” (Shames, 2001). The
emotional and personality aspects of hypothyroidism are only addressed in a cursory manner and
are not part of the 10 step program. Their work is a welcomed addition to any thyroid library, but
it still is not a step-by-step approach, and only focuses on Hashimoto’s.
Dr. Arem’s book The Thyroid Solution is refreshing in its thoughtful focus on the mind –
body approach that must be used when a patient does not respond to thyroid medication. He also
adds in a new dimension to how the thyroid can shape our personality and our sexual being that
profoundly affect our interpersonal relationships. His case studies are extremely useful in
demonstrating these points and reinforce the need for holistic therapies, although he does not
endorse any. Dr. Arem’s approach still largely focuses on the exclusive use of thyroid
medication (not natural Armor) and anti-depressants, because this approach works largely with
primary hypothyroidism, most of the time. He offers various protocols for pharmaceuticals,
which are not useful to most people suffering from secondary hypothyroidism and which are not
prescribed to people with functional hypothyroidism. There is also no step-by-step approach to
healing. The focus is on “treating,” rather than treating the whole person.
The work of Ryan Drum, an herbalist, is holistic and food based. His research centers on
the environmental contaminant iodine 131 and the insufficient intake of iodine in human
populations. His work includes both hyper and hypothyroidism, but does not trace out a blue
print for healing. His focus in on lack of dietary iodine and the prevalence of iodine 131 as well
as other environmental contaminants (fluoride, heavy metals-mercury and lead) and their
negative effects on the thyroid gland. This is in no way to dismiss his very important work.
Drum recommends kelp, particularly from the northern latitudes to insure adequate iodine levels.
The purpose of my book is to compile various triggers to help people eliminate them from their
environment and to protect themselves from their harmful effects. As such, I include his work as
part of Step Three.
In her role as patient advocate, Mary Shomon has compiled a plethora of information
regarding hypothyroidism. She has written books, Living Well with Hypothyroidism and The
Thyroid Diet and she maintains the largest online resources about.thyroid.com and thyroid-
info.com (2000; 2004). She pulls from a staggering number of sources and offers an unbiased
approach in presenting her findings. The sheer amount of information available in her books and
web sites can be overwhelming. Since she is not a health care practitioner, she does not offer a
program or make any recommendations, this is not her role. She offers possibilities, but it would
be a daunting task to try to put together a healing program for yourself, especially if you are
pressed for time or are a busy mother. Some of the women I work with have seven to nine
children.
Janet Lang, DC also addresses the issue of iodine insufficiency as well as what she
terms, supporting nutrients. She is a proponent of iodine loading, but unlike Drum, she does not
mention iodine 131 in her online works and does not use seaweeds as the main source of iodine.
She provides a comprehensive approach to accomplishing iodine loading.
Thyroid Balance by Glenn Rothfeld , MD and Deborah Romaine bring the encyclopedic
approach of Shomon and meld it with suggestions as well as a specific plan. Although useful, it
still does not approach the level of use-ability that I appreciated in a book like Adrenal Fatigue
by James Wilson or The Cortisol Connection Diet: The Breakthrough Program to Control Stress
and Lose Weight by Shawn Talbott and Heidi Skolnik.
Pioneer Dr. Broda Barnes’ contribution to the field of hypothyroidism cannot be

overstated. Today many practitioners continue to use his basal body temperature method as a
means of diagnosing hypothyroidism. Yet, more current research suggests that lifestyle factors
and environmental contaminants play just as large a role as genetics. That is to say, someone
may not be fated to suffer from hypothyroidism due to a genetic disposition. As Jeffery Bland
points out, food can act as the on and off switches when it comes to gene expression and Roger
Williams’ research also points to vitamin and mineral deficiencies as causative and preventative
factors in disease (Bland, 1999; Williams 1998).
Barnes' additional legacy is his use of basal body temperature as a diagnostic tool,
although to his credit he also emphasizes the importance of following clinical symptomologies
and blood work in diagnosing hypothyroidism. It is not a method I employ, since it is not always
accurate and cumbersome to women with small children.
Background Statistics
A dysfunction of the thyroid is common in the United States (4.6% of the population) as reported
by the Third National Health and Nutritional Examination Survey. Overtly hypothyroidism was
found to be at 0.3% and subclinical at 4.3 % (Hoogendoorn et al., 2006).
Worldwide, the most common cause of hypothyroidism is iodine deficiency. However,
Hashimoto's remains the most common cause of spontaneous hypothyroidism in areas of
adequate iodine intake. According to the Johns Hopkins Auto Immune Research Center, the
incidence of Hashimoto’s worldwide is 0.3–1.5 cases per 1,000 per year. Hashimoto's is the most
common cause of hypothyroidism in the United States after the age of 6 years, with incidence
estimated to be 1.3% in a series of 5000 children aged 11-18 years. In adults, incidence is
estimated to be 3.5 per 1000 per year in women and 0.8 per 1000 per year in men. Incidence may
be as high as 6% in the Appalachian region. In the Colorado Thyroid Disease Prevalence Study
involving 25,862 adults, the prevalence of elevated TSH in both symptomatic and asymptomatic
adults was 9.5%, with a greater percentage of those involved being women (Shoman, 2000). The
prevalence of hypothyroidism and thyroid disease in general increases with age.
Some experts claim that 1-4% of the population is hypothyroid while others site 10-12%
as their estimate. There are various estimations as to the prevalence of thyroid dysfunction in the
general population. Out of the clinically diagnosed cases of thyroid disorder, 90% are attributed
to hypothyroidism. Since 90% of all thyroid conditions are associated with hypothyroidism, it is
useful to look at those numbers as well. Thyroid disease, as of 2003, saw thirteen million people
receiving treatment. This means that roughly eight million people are not receiving treatment
(Rothfeld, 2003).
I have seen statistics range from one out of every two people to one out of seven as being
affected with hypothyroidism. I believe that these widely varied estimates demonstrate how
much is not know, but also the almost endemic nature of this condition. These estimates typically
are concerned with those being treated or those whose blood work would indicate
hypothyroidism. There are a significant number of others who fall under the rubric of subclinical
hypothyroidism, meaning that their symptoms may be too subtle to be diagnosed by conventional
means. I believe the higher estimates include this sub clinical group.
Chapter 3:
Diagnostic Tools
Traditional Diagnostic Tools and a Clinical Approach
Currently a blood test or thyroid panel is the gold standard for diagnosing hypothyroidism.
Various practitioners approach the thyroid panel differently, as well as the way in which they
interpret the results. The current mode of screening for hypothyroidism is inadequate and leaves
many people, primarily women, at risk for further health complications and a diminished quality
of life.
Although useful in identifying some forms of hypothyroidism, a blood test is not

sensitive enough to identify cases of hypothyroidism that stem from the body's inability to use
thyroid hormone or an imbalance caused by co-existing adrenal fatigue, not to mention
nutritional deficiencies or an over burdened liver. A clinical approach should be adopted to
enable the practitioner to identify subclinical hypothyroidism and to include those whose blood
work fall within the normal ranges, but exhibit symptomologies associated with hypothyroidism.
In a joint statement issued by the American Association of Clinical Endocrinologists, The

American Thyroid Association and the Endocrine Society state that although, " Subclinical
thyroid dysfunction is a common clinical problem," they were in "consensus . . . against routine
treatment of patients with subclinical hypothyroidism with serum TSH levels of 4.5–10 mU/liter,
but indicated that treatment was reasonable for patients with TSH levels greater than 10
mU/liter" (2005). They add, "The correct approach to subclinical thyroid dysfunction
remains unsettled" (2005). There are no recommendations made to the clinician on how to
treat patients with less than optimal thyroid function, leaving these women at risk to develop
further health conditions and progressing to clinically diagnosed hypothyroidism. In addition
Knudsen et al. state "The optimal level for thyroid hormones and TSH in serum to attain physical
and mental well being has not been established, but the trend these years is to narrow the range
of serum TSH, regarded as optimal" (1999). According to Dr. Arem, "30 percent of women with
TSH levels in this normal to high range (2-4.5) become hypothyroid" (1999).
Dr. Arem has treated three women, a mother and her two daughters, with symptoms of
hypothyroidism, but who had normal blood work. Their symptoms improved with thyroid
hormone (Arem, 1999). Both Dr. Gordon R. B. Skinner in the British Medical Journal and Dr.
Steven Hotze in his book Hormones, Health and Happiness, advocate treating with a trial of
thyroid hormone for people with symptoms, but who's blood work may be normal (Skinner,
2007; Hotze, 2005).
Thyroid Panel (Traditional)
There are two traditional thyroid panels. One is limited to assessing the amounts of T4 in the
blood and typically assesses the function of the thyroid gland by measuring Thyroid Stimulating
Hormone (THS). It is unclear the number of doctors who only asses these two. Despite the
availability of additional markers to be tested (T3, rT3 etc . . .), many doctors continue to only
assess these two parameters. Some doctors continue to adhere to the older standard of
interpreting thyroid numbers as well. The interpretation of such data follows table 1.
Table 1: Range of TSH In milli-international units/liters
> 20 Moderate to severe

hypothyroidism
4.5-20 Low-grade
hypothyroidism
2.1-4.4 Normal, but may signal

hypothyroidism with
symptoms of
hypothyroidism
0.4-2.0 Normal
Case Study 1: Hashimoto's and the Thyroid

Aishah was diagnosed with Hashimoto's after the birth of her first child. After five years of care
in the United States and France, only her T4 levels are assessed. Her medication is adjusted
exclusively to T4 amounts. She does not receive relief and attempts to discuss it with her doctor
and asks for her T3 levels to be checked. The doctor refuses. She discontinues her use of thyroid
medication for one week and no longer is anxious and jittery, but her fatigue increases. She
changes doctors and again asks for her T3 levels to be checked and again the doctor refuses.
Returning to France, she again asks her doctor to check her T3 levels, and again it is refused
(second French doctor).
This case study demonstrates that despite changing doctors and countries, many medical doctors
do not test beyond T4 levels.
Thyroid Panel (Modified)
The second traditional thyroid panel includes the addition of T3,T4 and TSH. The diagnostic
success of this approach is also inadequate as it is not sensitive enough to diagnosis many thyroid
disorders. The modified thyroid panel includes, both T4 and T3 as well as Free T4 (FT4), FT4
Index, Total Free and Bound T4 (TT4), Total Free and Bound (TT3) Reverse T3 (RT3U) and
TSH. The following table gives a complete view of the parameters of the modified thyroid panel.
According to Dr. Rothfeld, a doctor reading a thyroid panel will make a diagnosis of
hypothyroidism based on these results (2003):
Table 2: Modified Thyroid Panel
Low T4 (under 4.6)
Low T3 (under 80)
High TSH (above 5.5)
High rT3
Low radioactive iodine uptake

In addition, Thyroid Releasing Hormone (TRH) should be measured to assess the
functioning level of the pituitary when THS levels are normal and there is a goiter and
symptomologies present (Arem, 1999).
A Clinical Approach
The various thyroid panels have proven to be useful in diagnosing hypothyroidism in cases
where the blood work is outside of "normal parameters." However, not everyone is the same, or
requires the same amounts of thyroid hormone. The thyroid is a gland that is in continual flux
and during times of stress, this can be emotional, illness, menstruation or pregnancy, the demand
placed on the thyroid increases (Drum, 2008).
Hansen et al. and Peeters et al work with Danish twins demonstrated that there is a
genetic component when addressing the function of the thyroid gland (2004; 2006). The work of
Douyon & Schteingart also attests to the validity of Roger William's concept of biochemical
individuality (we are all unique and require different amount of nutrients to be healthy) and
brings it to bear, indirectly to thyroid function (2002). Dr. Arem also had to assert that when
treating the three women in the case mentioned above (a mother and her two daughters), that a
genetic component "might have been causing them to suffer from an ineffective use of thyroid
hormone by their bodies" (Arem, 1999).
In the past various methods have been employed to detect hypothyroidism as well as
newer methods that deal with adequate iodine intake and absorption. Most, if not all of these
methods have been discredited by the modern medical establishment, although some are still
employed like assessing high cholesterol levels. These approaches were clinical diagnostic tools
and paid attention to clinical symptomologies. Today there are doctors and healthcare
practitioners that continue to utilize these approaches and as a result enjoy greater success with
their clients. As such, here I hope to provide various clinical approaches that can be used in the
management and identification of hypothyroidism.
The Broda Barnes’ Method
Although Dr. Barnes later in his career did not use this method exclusively to establish the
presence of thyroid dysfunction, it is still in use and some practitioners find it clinically useful.
Dr. Barnes established a method to measure basal body temperature as a maker for thyroid
health. His method works on the supposition that one of the various functions of the thyroid is to
maintain body temperature at 97.8 to 98.2 degrees F. By measuring the body temperature under
the arm with a mercury filled thermometer, before rising out of the bed first thing in the morning,
the patient can determine if their basal body temperature is within normal range, 96 degrees F is
below average. If out of normal range, then hypothyroidism may be indicated. The Barnes
Method also takes into account the menstrual cycle in which a woman’s body temperature may
be temporarily raised. Barnes recommends that women use his method during the second day of
menstruation (Barnes, 1976).
Achilles Reflex
Another clinical marker is the Achilles reflex. The reaction time is slower in a hypothyroid
person. The Achilles reflex is accomplished by tapping on the Achilles tendon (Arem, 1999).
Pulse Rate
Dr. Arem uses the pulse rate as a clinical indication of hypothyroidism. He notes that it is slower
in hypothyroid people because the heart is very sensitive to thyroid hormone (Arem, 1999).
Thyroid Palpitation (Thyroid Neck Check)
The function of thyroid palpitation is twofold; 1) to establish if there are thyroid nodules, and 2)
to establish if there is enlargement of the thyroid gland. According to Dr. Arem, this is a
clinically useful practice, although it is not routinely practiced (Arem 1999).
Iodine Urine Test
Herbalist Ryan Drum and Janet Lang, DC, both use this method as a functional test to determine
iodine status (2008; 2008).
Lang measures the uptake of iodine by the thyroid by collecting urine samples over a 24
hour period. Lang uses an iodine solution, 50mg of Iodoral with a glass of water taken first thing
in the morning. If there is sufficient iodine in the body, then 90 percent of the iodine solution
should be excreted via the urine. There should be10 percent retention rate of a 50 mg solution, or
5mg and an excretion of 45mg. Levels below 90 percent are indicative of iodine deficiency
(2008).
Iodine Patch Test
A solution of iodine, iodine tincture is orange, not clear, is smeared on the inner arm, inner thigh
or abdomen, as a 3x3 inch patch, directly applied to the skin. The results are measured by how
much and at what rate the iodine is taken up. A properly functioning thyroid gland will uptake
the iodine over a 24 hour period and not overnight. If during the morning of the next day there is
no iodine remaining, there is an iodine deficiency. As the day progresses, check the rate the color
of the patch for changes. If the color remains until bedtime, the test is complete and there is no
deficiency present. The color should fade over the next few days (2008).
This functional method promises to be a more accurate and sensitive way to measure
thyroid dysfunction when it is caused by iodine insufficiency.
Symptomologies
The most important clinical assessment tool available to practitioners is the client’s
symptomologies. The symptomologies reported by hypothyroid people are divers and may seem
unrelated to the untrained eye. These symptoms are often overlooked, ignored or misdiagnosed.
Since the most affected group are women, their symptoms are often dismissed as "female
complaints" or as complaining (Arem, 1999). So a person with hypothyroidism oftentimes needs
to aggressively pursue her health care practitioners to receive adequate diagnosis and treatment.
The symptoms associated with hypothyroidism are varied, but typically involve a
constellation of the following:
• Extreme fatigue
• Muscle and joint pain
• Weight gain for no reason and inability to lose weight

• Dry skin and hair
• Hair loss
• Loss of the outer eyebrows
• Infertility
• Miscarriage
• Inadequate breast milk
• Mood swings
• Depression
• Brain fog and forgetfulness
• Change in sex drive
• Anxiety
• Anger
• Swelling of tissue, puffy face or eyes
• Intolerance to cold
• Constipation
• Carpal Tunnel Syndrome
• PMS/hormonal imbalance
• Slowed heart rate
• High cholesterol
• High triglycerides
• Inability to enjoy life
• Discharge from the ear
Primary and Secondary Hypothyroidism Causes and Triggers
Many holistic practitioners view what allopathic term "disease states" as imbalances or a
disruption of the delicate balance between body systems. Herbalist K.P. Khalsa states
hypothyroidism is a "generalized chaos in the endocrine system, a chronic endocrine
deregulation" (Shomon, 2000). Experts do not agree as to the etiology of hypothyroidism or what
has caused the sharp rise in cases of it. It does seem clear that it is linked to a combination of
genetic susceptibility, environment factors (particularly environmental contaminants) and
nutritional deficiencies.
Also, a percentage of hypothyroidism is caused by an auto immune response. As such, the
dysfunction does not stem from an organic disturbance of the thyroid and its inability to produce
thyroid hormone or the pituitary gland’s inability to produce thyroid stimulating hormone (TSH).
This is termed secondary hypothyroidism and in this instance, synthetic or natural thyroid
medications may not prove useful. Secondary hypothyroidism is caused by other factors and are
various in their teleology. Secondary hypothyroidism does not respond well to pharmaceuticals,
adjunct approaches must be incorporated. It is reported that one third of patients on thyroid
medication do not receive a relief of symptomologies (Rothfeld, 2003).
Primary hypothyroidism is caused by a malfunction of the thyroid gland itself.

The thyroid gland is not producing adequate amounts of thyroid hormones. This can be caused
by:
• Thyroid cancer
• Removal or destruction of the thyroid gland
• Unknown
• Radiation
• Malfunction of the hypothalamus., insufficient TRH (extremely rare)
• Malfunction of the pituitary gland, insufficient TSH
Secondary hypothyroidism can be caused by various disturbances in many body systems.
This is a wide field to work with. Various risk factors associated with secondary
hypothyroidism are:
• Unknown
• Adrenal exhaustion
• Nutritional deficiencies, iodine, tyrosine, selenium , zinc, copper iron, magnesium,
vitamin A, E, C, D, the B vitamins and essential fatty acids,
• Environmental contamination, radiation, perchlotate (rocket fuel) Fluoride, chlorine , can
interfere with the body's ability to convert the thyroid hormone. Mercury, can disable the
body's ability to convert T4 to T3 (Shomon, 2000).
• Malfunctioning liver, large body burden over taxes the liver and a large portion of T4 is
converted to T3 in the liver. Cellular inability to use T3. Each cell has receptor sites for
T3, if t T3 is unable to bind, the cell cannot use the T3.
• Disrupted mitochondria respiration caused by lack of T2 (binding sites in Mitochondria
( Rothfeld, 2003)
• Pregnancy
• Menopause
• Stress
• Over consumption of goitergens (raw cabbage, spinach, soy)
• Estrogen dominance. T3 and estrogen share the same receptor sites in the cell (Rothfeld,
2003)
• Infection (Yersinia, Epstein-Barr virus, mononucleosis)
• Life threatening snake bite.
• Disruption of hormone balance
• Disruption of the Immune System
• Disruption of the Nervous System
• Inability to adapt to stress
• Food sensitivity, particularly gluten (Celiac Disease)
• Emotional Trauma
• Age
• Pregnancy
• Drugs ,glucocorticoids/adrenal steroids, Propranolol (beta-blocker),
Aminoglutethimide (breast and prostate cancer, Ketoconazole (an antifungal),

Paraaminosalcylic(tuberculosis drug), Sulfonamine drugs, sulfadiazine, sulfasoxazole,
acetazoleamide (used in diuretics and anti biotics, Sulfonylureas, including,
tolbutamide, chlorpropamide (used in diabetes drugs), Raloxifene/Evista, (used for
osteoporosis drugs), Carbamazepine, oxcarbazepine and valproate (used in epilepsy
drugs) (Shomon, 2000)
• Smoking/Stopping Smoking
• Excessive oxidative damage
• Family history of Auto immune disease
• Exposure to radiation
• Suppression of Natural Killer Cells (Solerte et al., 1999; Holbrook et al., 1987)
• Deranged T cells.
In addition to these various factors, the function of the adrenal glands should be assed
using a saliva test as opposed to a blood or urine test. The adrenals and the thyroid glands share a
similar axes-pituitary-thyroid-adrenals and a dysfunction in one can cause a dysfunction in the
other. Also, it is important to note that thyroid medication, particularly Synthroid, is not
effective when accompanied by adrenal insufficiency (Lang, 2008).
Biochemical Individuality
"Variations in thyroid function are seen between individuals also within the normal range, documented by relatively
small individual variations in serum levels of thyroid hormones and TSH between measurements in the same
individual compared with variations between individuals. Such differences in individual thyroid function are caused
by a combination of genetic and environmental factors." Knudsen et al., 2005
I would like to briefly touch on Roger William's concept of biochemical individuality and how it
applies to thyroid function. Decades of research by Williams revealed that we all have unique
physiological needs that govern the amount of vitamins and minerals we need to function
optimally. He also states that, not only are we biochemically unique, physically we are unique as
well. Organs in our bodies may be larger or smaller than other people’s and be placed in various
positions. As such, it is appropriate to say that this biochemical uniqueness extends to every
aspect of our makeup, including the thyroid gland (1998). In thyroid literature this is addressed
as a "set point," so it is not a concept that is foreign, just little known (Bernadette et al., 2003).
Even in a study amongst Danish twins, there appeared to be "considerable interindividual
variability" (Hansen et. al, 2004).
Due to the metamorphic nature of the thyroid gland, the thyroid expands and contracts in
response to stressful events occurring in the body, biochemical individuality is even more
applicable in understanding thyroid dysfunction. If the thyroid gland is unable to meet the
body's new demand or diminished demand for thyroid hormone, the body will not function
properly, i.e. hyperthyroidism or hypothyroidism. We all respond differently to stressors that we
encounter (environmental, emotional, physical) and as such our physiological responses will
vary as well. It is of paramount importance to understand this.
When addressing hypothyroidism, biochemical individuality becomes clinically

applicable particularly in cases where blood test results return within the normal range, but
symptomologies are present. Taking a detailed client intake may reveal that a person was under
extreme stress, perhaps for years and may indicate that there is a higher need for thyroid
hormone that is not currently being met.
The Thyroid Gland and Its Functions
Thyroid hormone is necessary in virtually every gland, organ and cell to function optimally. So
the function or dysfunction of the thyroid gland can exhibit a number of deleterious effects on
the body, mind and personality. The thyroid regulates the rates of metabolism (how the body
utilizes energy from food), digestion, consumption of oxygen and has a profound effect on the
immune system and brain chemistry. The thyroid gland is also involved in the following
processes:
• Proper function of muscular system
• Aids in the function of the cardiovascular system
• Aids in the function of the brain (including mood and emotion)
• Sexual development and function
• Skeletal system
• Digestive process
• Maintaining healthy skin and hair
• Regulates body temperature
• Regulates weight gain and loss.
When the thyroid gland does not function properly, the person quickly fails to thrive.
The thyroid gland is a butterfly shaped organ located at the base of the Adam's apple or
roughly at mid throat. A healthy thyroid will not be visible nor palpable to touch, but due to
disease, can become engorged and produce goiters and nodules. The thyroid gland is governed
by the anterior pituitary gland (which is governed by the hypothalamus) that secretes TSH to
stimulate the production of thyroxin (T4) in the thyroid itself.
The thyroid gland is responsible for various functions in the body, but the most note
worthy is its task of regulating metabolism down to the cellular level. It does this by assisting the
cells in converting oxygen into energy. This in turn is linked to the thyroid hormones’ role in
processing carbohydrates that is linked to the production of adenosine tiphosphate (ATP). It is
responsible for the combustion of glucose in this process that fuels the cells. Thyroid hormone is
responsible for the cell’s ability to use or up take oxygen. This oxygen then combines with other
substances, like glucose to produce fuel for the cells, more specifically, in the mitochondria of
the cells.
All blood passes through the thyroid gland every 18 minutes (Drum, 2008). The thyroid
gland is physiologically dynamic and the largest endocrine gland, weighting one half to one
ounce and is extremely vascular. Interestingly the thyroid has the capability to change its shape
according to the body’s immediate needs. This adaptation can be witnessed in women during the
monthly menstrual cycle and during pregnancy. These physiologically stressful situations would
require the thyroid to adapt and support the body to maintain health (Drum, 2008).
In order for the thyroid gland to function properly, there must be an adequate supply of
iodine, too much or too little can cause derangement of the gland. The human body is iodine
conservative and does not allow the body to excrete iodine readily, (Drum 2008). The thyroid is
the only organ that uses iodine. T3 and T4 derive their names from the amount of iodine atoms
attached to them. T4 converts to T3 by the removal of an iodine atom. The process is termed
monodeiodination. T4 comprises 80% of the biologically active hormone, T3 comprises 20%.
Although there are various other thyroid hormones, these two are the most significant. The
thyroid must also have sufficient amounts of the amino acid tyrosine.
The thyroid system operates on a negative feedback loop, meaning that it acts as a
thermostat measuring when there is excessive T4, thus shutting off or producing more TSH when
it measures a deficiency. T4 is then converted in the liver into the more active form
triiodothyronine (T3).
Chapter 4
Results
Hypothyroidism can present as an intricate complex of unrelated symptoms, making it both

difficult to diagnose and heal. When one brings in an holistic approach to healing, this method
may appear overwhelming and not useful. Due to the complicated diagnostic, symptomatologic
and healing approaches that are warranted when dealing with hypothyroidism, a simplistic,
almost check list approach is useful. Many holistic healers are aware of these various diagnostic
and healing protocols, but none have codified them or presented them in an easy to follow
format.
This becomes extremely important when involving the client in the healing process.
Providing easy to follow, step-by-step instructions to hypothyroid clients can affect a successful
outcome. When someone is suffering from hypothyroidism two of the prevailing symptoms are
fatigue and inabilities to concentrate- hypothyroid clients do not need more complications. Yet,
they do want to be involved in the healing process and above all, understand what is occurring in
their bodies.
The holistic practitioner has various tools and approaches to draw on when working with
hypothyroid clients and I will address these in this chapter. Conventional treatment of
hypothyroidism is limited in its approach and treatment options as we shall see.
Conventional Approach to Treatment
Today the main approach to treating hypothyroidism is supplementation with thyroid

hormones. In addition, anti-depressants as well as cholesterol lowering drugs may be prescribed.
The most popular synthetic forms of thyroid hormone replacement are:
• Levothyroxine –synthetic T4
• Synthroid-Synthetic T4
• Levoxyl Synthetic T4
• Levothroid, Synthetic T4
• PMS-Levothyroxine
• Unithroid
• Eltroxin
• Liothyroxine T3
• Brand name: Cytomel
• Liotrix: T4 T3
There are combinations of levothyroxin and liothyronine (the brand name is Thyrolar)
available. Compounded thyroid drugs are also available from compound pharmacies and can be
customized to a client's need. A holistic practitioner would recommend non-synthetic thyroid-
taken from the thyroid gland of pigs, it contains T4, T3 and other components. They are:
• Armor
• Naturethroid
• Westroid
• Bitech
In the past beef and sheep thyroid glands were used to produce these more natural thyroid
medications. There seems no medical reason why beef and sheep glands could not be used. It
was the unsanitary way in which cows were raised that made beef glandular fall out of fashion.
Sheep offer another alternative for those who prefer not to ingest porcine glandular.
There is ample evidence in the literature to support therapies other than thyroid
medication. The plethora of causative factors also lends credence to the belief that both primary,
secondary and functional hypothyroidism are divers. One case –in-point is the well documented
link between Celiac disease and hypothyroidism and supports the link between food sensitivities
and hypothyroidism (Ch'ng et al., 2007).
The 9 Step Protocol
Chapter 5
Step 1: Identify Food Sensitivities and Assess Digestive Health
Although food sensitivities and digestive health are the first step, there is no specific order to
begin this program. One step is not more important than another. They are meant to build upon
each other to reveal a full clinical picture. Food sensitivities may only be one component to
assist a client's body to heal. Even if there is a complete remission after completing this step, it is
still important to apply the other steps, particularly supplementation. Often the body may quickly
respond to removing offending foods, but symptoms may resurface months later to the same or
lesser extent. Years of nutritional deficiencies may have built up; gut flora may be out of
balance. These may be some of the issues that may need to be addressed.
Food sensitivities can prove to be an active component in the natural history of

hypothyroidism, particularly with autoimmune hypothyroidism, wheat (Celiac Disease)
sensitivity can act as the main trigger (Ch'ng et al., 2007). Although not well researched,
excessive consumption of sugar may well prove to be a trigger and warrants clinical
investigation. Digestive health is also a factor in thyroid health.
Intestine Permeability (Leaky Gut)
Intestinal permeability or leaky gut is a condition in which the lining of the intestines
have lost integrity and allow the contents of the stomach to "leak" out of the digestive track. The
most common cause of leaky gut is food sensitivities. Over time irritating foods that are ingested
into the digestive track can cause a breakdown of the tight junctions in the intestinal walls that
prevent leaking from happening. As this occurs, large food molecules enter the blood stream and
trigger an immune response (causing inflammation). Every time the offending food (wheat, milk,
corn etc. . .) is ingested, the body becomes conditioned to recognize it as a harmful substance and
symptoms occur (Lipski, 2000).
Leaky gut can prevent the absorption of nutrients that are required for optimal thyroid
health (malabsorption). This in itself may not cause hypothyroidism, but the body’s inability to
assimilate vital nutrients can lead to deficiencies that have a causative effect. Leaky gut can
trigger an immune response and cause an auto immune disease.
There is no clear research as to the number of people who are suffering from various
states of hypothyroidism who also have intestinal permeability (Fasano, 2006). Intestinal
permeability is the starting point of Celiac Disease (CD) and it can be safely extrapolated from
data regarding CD that there is a component of intestinal permeability occurring in people with
hypothyroidism. A large component of healing includes resolving any issues of intestinal
permeability. Any program that does not first address and resolve this issue will find that there is
little improvement and may aggravate the underlying problem with the introduction of difficult
to digest foods and supplements.
When working with hypothyroid clients, I assume that they are experiencing digestive
issues and use Metegenics Comprehensive Health Profile questionnaire to rule out the possibility
as well as clinical markers such as transit time (how fast or slow waste leaves the body). In a
clinical setting, I assess the tongue for markers of digestive weakness, such as a pronounced line
down the center, weakness-shaking tongue, pale pink color, heavy white coat at the back of the
tongue and if there is cold dampness or hot dampness. There is also lab work that can test for
markers of inflammation, such as IGg.
I will not address or outline a healing protocol for leaky gut here since there are many
excellent books addressing this topic. I recommend to them to refer to Liz Lipski's book
Digestive Wellness for further research (2000).
Celiac Disease (CD)
Celiac Disease is a gluten-sensitivity induced by dietary wheat gliadin and related

proteins in genetically susceptible individuals (Tiboni, 2006). There is a definite link between
wheat/gluten sensitivities and hypothyroidism (particularly Hashimoto’s). CD and wheat
sensitivity occur quite commonly with hypothyroidism (see Table 2). There is a genetic
component to Celiac disease, 90-95 percent is associated with thegeneHLA-DQ2 and a 5 to 10
percent occurrence rate with HLA-DQ8 (Lipski, 2000). As Jeffery Bland's work demonstrates,
foods act as gene modulators, essentially turning on and off traits that are expressed in the
phenotype (disease markers), but not in the genotype, such as hair color, eye color (Bland,1999).
The inflammation and constant irritation of ingesting a substance that the body cannot
tolerate , like gluten in the case of hypothyroidism/Hashimoto, begins a cycle of heightened
immunity. Eventually these large food molecules enter general circulation and are identified as
pathogens and the immune system is activated and what was only a problem in the GI track now
becomes systemic. Once in general circulation, the large molecules of food have access to all
parts of the body. If it lodges near or in the thyroid gland, the immune system will attack the
thyroid gland.
Table 2. Prevalence of celiac disease (CD) in autoimmune thyroid disorders.

Author Year of publication Population screened Prevalence of CD
Collin et al (1994) 83 autoimmune thyroid disease 4.8%
Sategna-Guidetti et al (1998) 152 autoimmune thyroid disease 3.3%
Cuoco et al (1999) 22 Hashimoto’s disease 4.3%
23 Graves’ disease
Valentino et al (1999) 150 autoimmune thyroid disease 3.3%
Berti et al (2000) 172 autoimmune thyroid disease 3.5%
Volta et al (2001) 220 autoimmune thyroid disease 3.2%
Larizza et al (2001) 90 Pediatric autoimmune thyroid disease 7.8%
Meloni et al (2001) 297 autoimmune thyroid disease 4.4%
Mainardi et al (2002) 100 autoimmune thyroid disease 2%
Ch’ng et al (2005) 115 Graves’ disease 4.5%
(Ch'ng et al., 2007)
Studies indicate both a complete remission of hypothyroidism with a gluten free diet
(Mainardi et al., 2002; Sategna-Guidetti et al.,2001) and no significant change with adherence to
a gluten free diet (Ch'ng et al., 2007). Perhaps the amount of time that a person is diagnosed with
CD affects the outcome. Also, the duration of compliance to a gluten free diet may be a factor.
The results reported by Sategna-Guidetti did state that there was poor compliability while the
Ch'ng study did not address this (2002; 2001). There may also be additional unrecognized food
sensitivities or vitamin and mineral deficiencies that also play a factor. Checking for additional
sensitivities using a blood test, pulse point or an elimination diet may prove useful. Also
suggesting blood work or functional assessments to determine nutritional status may also prove
fruitful.
Case Study 2: A Family Affair
A family of eight, mother, father and six adult children have a propensity towards
hypothyroidism. The father, in his late fifties experienced a cardio infarction. The mother, in her
late fifties has non insulin dependent diabetes and hypothyroidism. The oldest daughter, 33 at the
time of diagnosis, is diagnosed with both hypothyroidism and Celiac Disease. She has no
children. The second sister was diagnosed with hypothyroidism, post partum. The third sister
does not have hypothyroidism and does not have children. The fourth sister was diagnosed
hypothyroid post partum. The fifth sister was diagnosed with hypothyroidism in her early teens.
The son was diagnosis with Wagner's in his early 20's. Of the eight family members, only one
presents with CD. When asked what might have been the factor/s that affected her diagnosis she
pointed to her young childhood in Jordan. She said her consumption of soda was excessive due
to the undrinkability of the water. She also has an addition to caffeine.
The importance of both biochemical individuality and the role diet plays in the development of
disease is highlighted in this case study.
Sugar and Impaired Glycogenolysis
Both Barnes and Rothfeld assert that hypothyroidism is an ancient challenge, but never before in
human history have we consumed so many simple, refined carbohydrates (Barnes, 1976;
Rothfeld, 2003). White sugar, white rice and refined grains are now known to contribute to
diabetes as well as depression. They are foods that negatively affect gene modulation. These
same foods appear to act as negative modulator of thyroid health. Sugar is a pro inflammatory
and immuno depressing substance. It is also feeds cancer cells. Sugar cravings can signal a
serotonin deficiency or adrenal exhaustion. The negative effects of sugar are well documented
and should be limited if not eliminated from the diets of people suffering from hypothyroidism
(Des Maisons, 1999).
It is fairly well documented that people with hypothyroidism experience impaired
glycogenolysis via the skeletal muscle when samples are taken.(McDaniel et al., 1977; Tuncel et
al, 2008; Zmire et al. 1999). Blood fasting levels may be normal, but since there is insufficient
thyroid hormone in the cells, the metabolic process is not functioning optimal and sugar is not
adequately used. Over time this can prove to be an acutely stressful event taxing an already
impaired thyroid gland. In addition the thyroid function has been linked to insulin sensitivity and
insulin resistance occurs commonly with hypothyroidism (Fernandez-Real et al., 2006).
Research indicates that hypothyroid people have an inability to metabolize carbohydrates
effectively, which will be discussed later.
Various studies have revealed a link between the occurrence of hypothyroidism and
people diagnosed with depression, schizophrenia and bi-polar disorders. In a study of 250
patients with some degree of hypothyroidism, two patients (less than 1%) were identified with
grade 1 (overt); nine patients (3.6%), grade 2 (mild); and ten patients (4%), grade 3 (subclinical)
hypothyroidism. The authors state "These results suggest that a significant proportion of patients
with depression and anxiety may have early hypothyroidism, the cases of about half of which are
detected only by thyrotropin-releasing hormone (TRH) testing" (Gold et al., 1981).
In another study conducted with 65 patients with bi-polar disorder 65 patients a panel of
thyroid measures, including thyroid-stimulating hormone (TSH), thyroxine, triiodothyronine
resin uptake, and free thyroxine index (FTI), were determined before treatment. The authors
states "Our results suggest that nearly three-quarters of patients with bipolar disorder have a
thyroid profile that may be suboptimal for antidepressant response. It remains to be seen whether
pharmacological enhancement of thyroid function will facilitate recovery from bipolar
depression" (Cole et al., 2002).
There may be a genetic component that has to do with depression and low serotonin that
may manifest in people who have a propensity for being/becoming hypothyroid. This could
possibly be used successfully to predict susceptibility to hypothyroidism (Arem, 1999). Dr.
Arem asserts that so important is thyroid hormone to our mental wellbeing that "thyroid hormone
may even be the serotonin of the new millennium" (Arem, 1999).
The work of Katheren DeMaisons discusses the link between depression and low
serotonin and describes the use of sugar and alcohol (another simple carbohydrate) as means of
self medicating. Sugar blocks emotional pain and acts as a pain killer (DesMaisons, 1999). Of
course not everyone with low serotonin status is fated to become hypothyroid, but it is a link that
is little researched and merits further investigation. Again, it may affect those with a genetic
disposition towards hypothyroidism and sugar may act as an inflammatory substance, literally
and figuratively and may play a part in the natural history of both Hashimoto's and
hypothyroidism.
Adrenal fatigue can also cause cravings for simple carbohydrates, so it is important to
assess a client’s relationship to sugar. I will discuss the connection between adrenal fatigue and
hypothyroidism at Step 5
Case Study 3: Gestational Diabetes
Aishah, mother of two young children, has Hashimoto's and showed all the clinical signs of
having a gluten sensitivity as well as a sensitivity to sugar (hypoglycemia). A food allergy panel
was not done and she also was reluctant to eliminate gluten and sugar from her diet. They were
staples in her diet. Before we could begin our work in earnest she became pregnant and returned
to France so her family could assist her. Since she moved back home and was no longer
cooking, she ate what was provided and eventually her hypoglycemia progressed to gestational
diabetes.
Functional Testing
• Acid-Alkaline Balance pH Test

• Comprehensive Digestive Stool Analysis (CDSA)
• Parasitological Testing
• Elimination-Provocative Food Sensitivity Test
• Food/Allergy/ Sensitivity Testing
• Intestinal Permeability Testing
• Heidelberg Capsule Test
• HIC Acid Test
• Functional Liver Profile
• Small Bowel Bacterial Overgrowth Test
• Pulse Point or Electrical Acupuncture Voltage Testing (EVA)
• Organic Acid Testing
Chapter 6
Step 2: Identify and Resolve Chronic Infection
Immune health can be linked to hypothyroidism and particularly Hashimoto's. Researchers find
that immune system health plays a significant role in Hashimoto’s. If hypothyroidism is not
tended to, it can progress to Hashimoto's as in the case of one of my clients. There are different
camps of researchers that propose various reasons why the autoimmune form of hypothyroidism
is caused by the immune system. I will briefly touch on these theories in this paper to emphasize
the overlapping nature of various triggers.
Hypothyroid people have a propensity for respiratory infections as well as various

infectious diseases (Barnes,1976). Their lack of a robust immune system (excluding
Hashimoto's) may cause them to suffer from chronic infections that have a long recovery period
or never fully recover before progressing to the next infection. There may not be a propensity for
chronic infections, but instead, they may suffer with low grade infections that continually keep
the immune system on alert. This, as well as other immune system triggers, such as food
sensitivities, can cause there to be an inflammatory cascade that transforms this condition into an
immune mediated disease (O'Kane et al., 2006).
The Role of Chronic and Low Grade Infection
At times, people originally diagnosed with hypothyroidism progressed to the auto

immune form- Hashimoto's. It is for this reason that I have included immune health as a step,
despite its close association primarily with Hashimoto's. Also, as Barnes mentioned, a common
clinical symptom in hypothyroid people is a compromised or challenged immune system.
There are various theories as to what causes the immune system to become over active
and perhaps due to biochemical individuality, multiple theories are plausible. I present these
theories as a means of preventing hypothyroidism from progressing to Hashimoto's.
One such theory is infection by a “stealth pathogen.” It occurs when a pathogen is able to
mutate, it is believed due to over exposure to antibiotics, and it is able to shed its cell wall.
Once it has shed its cell wall, it also has shed the antigen that the immune system marked it with.
It is now free to roam the blood stream unchecked. Yet, the immune system realizes there is a
problem and begins to target healthy cells and tissue in an attempt to rid the body of the
pathogen. Unfortunately the end result of this process finds the immune system attacking the
thyroid gland (Shames, 2000).
Food sensitivities over time can cause the tight junctures of the Gastro Intestinal
(GI) Track to become lose and permeable. The inflammation and constant irritation of ingesting
a substance that the body cannot tolerate, like gluten in the case of CD, begins a cycle of
heightened immunity. Eventually these large food molecules enter general circulation and are
identified as pathogens and the immune system does its job and what was once only a problem in
the GI track now becomes systemic. Once in general circulation, the large molecule of food has
access to all parts of the body. If it lodges near or in the thyroid gland, the immune system will
attack the thyroid gland (Brenner et al, 2002; Fasano et al, 2006).
Jeffery Bland proposes that the issue is that the body, the DNA, or book of life as he calls
it, has been altered. This is due to a significant insult(s) to the body were the body literally is no
longer its self. It is a process similar in idea to the mutation of cancer cells. In the case of auto
immunity, as the body attempts to rid itself of cellular debris, healthy cells and tissue become
damaged. Once damaged, they no longer are recognized as self and the immune system targets
them for destruction (Bland, 2006).
Stress also plays an important role in the functioning of the immune system. This is a
process that is not limited to one system. It affects the immune system and nervous systems and
is a field termed Psychoneuroimmunology (PNI) and “It focuses on the relationship of stress
upon the hypothalamic-adrenal-pituitary (HPA) axis. Depletion of hormones and
neurotransmitters within the HPA-axis, as a result of stress, can lead to a multitude of diseases
and disorders" (Auvenshine, 1997). I only briefly mention it here, but I will address it further in
Step 5.
Case Study 4: Too Much Going On
I had been working with Samira for five months when she called me one morning. She had just
come back from a visit with her doctor and he informed her that her hypothyroidism progressed
to Hashimoto's.
As a mother of seven, she had little time to herself and it was difficult for her to
implement many of my suggestions and when she did, it was not consistent. Her life just did not
allow her to take care of herself. In addition to her being ill, two of her children were continually
ill and required her to spend much time driving back and forth to various doctors appointments.
Two of her sons had behavioral problems that disrupted an already stressful household. Her
marriage and her relationship with her family were shaky. Her relationship with her in-laws
was no existent. She had no support, her husband lived and worked in a different city and would
only come home on weekends, which sent the house into chaos upon his return on Thursday
night. She added to this by forcing herself to exercise. Her emotional and physical stress levels
were extreme.
After being diagnosed with Hashimoto's, she decided that she was going to do whatever it
took for her to regain her health. This time I could tell that she was very serious and I was
excited for her. She began, but yet again, life intervened. She began the process to file for
divorce and one of her children needed to be hospitalized for surgery. She continually had bouts
of respiratory infections at this time (including pneumonia) and decided to take anti-depressants
because she felt that was the only way she could function.
She hopes to continue after her daughter's surgery and I hope she can too.
This case study highlights the profound affect stress has on the immune and nervous
systems and the need to practice stress reducing techniques.
Chronic Inflammation
As stated in the previous section, chronic inflammation is present in many hypothyroid people
and is the main clinical marker for Hashimoto's. This inflammatory cascade is initiated by the
immune system in order to prevent the spread of possible pathogenic substances into general
circulation. This can be due to 1) food sensitivities (Atkinson et al., 2004) 2) presence of a
pathogenic substance 3) chronic stress (Tsigos et al., 2002).
In the body, inflammation can be categorized as "heat" and according to Traditional

Chinese Medicine, heat is the most destructive force to the human body. As such, inflammation,
if its presence is suspected, should be addressed in the first protocol designed for the client.
Gut flora and Gut Associated Lymphatic Tissue (GALT)
A large portion of the immune system (70%) is contained within the digestive track in the form
of Gut Associated Lymphatic Tissue (Lipski, 2000). This fact lends even more weight to the
importance of maintaining digestive health. The role that GALT plays in the immune system is
to act as the initial gatekeeper of what substances enter the digestive track and ultimately into
general circulation in the body. It accomplishes this via various specialized cells called Peyer's
patches. This system of cells is termed cell mediated immunity. Although not a part of the
immune system, proper balance of gut flora is essential to health as well as maintaining adequate
levels of hydrochloric acid (HIC) in the stomach.
The gut harbors various non-native organisms that can be beneficial, benign or harmful if
unchecked. The role of the beneficial flora (like lacto bacacus), is to help prevent opportunistic
organisms (like yeast) from occupying the lining of the large intestine and causing an over
growth or infestation of harmful or pathogens from anchoring in the large intestine. When this
occurs, these pathogens can compete with the host for nutritional sustenance, thus causing a
vitamin or mineral deficiency. The metabolic wastes of these pathogens can also overwhelm the
body’s detoxification system and cause a toxic buildup in the body that can cause health issues.
We will later see that overwhelming the hepatic function can impair the body's ability to convert
T4 to the active T3 form of thyroid hormone.
Low gastric acidity affects the immune system by allowing for large quantities of
pathogens to enter the digestive track. A proper amount of HIC sterilizes the contents of the
stomach and acts as a means of initially eliminating any harmful substances prior to the
activation of GALT. This, overtime and depending on the individual, will overwhelm the
capabilities of the body's immune system and cause dysfunction in it. (Lipski, 2000)
Functional Tests
• Comprehensive stool panel

• Viral
• Bacterial
• Candida (Yeast)
• Parasitic
• Cavities
Chapter 7
Step 3 Reducing Toxic Load
The secondary mechanism affecting this complex general systems response involves the accumulation of toxic
metals from the environment in the body's cells and tissues. This accumulation of toxic metals at a cell and tissue
level displaces and interferes with regulating nutrient mineral. By interfering with cellular energy production and
with neuroendocrine and immune system functions, the individual's psychological coping mechanisms are also
undermined. –Malter, 1994
The proliferation of an ever increasing number of toxic substances into our environment and
food supply is a concern not only to thyroid health, but to the overall health of the human body in
general. The body's detoxification system can be over burdened by the ever increasing numbers
of toxic substances that it is asked to handle. In addition many of these substances, which are
manmade, are petroleum based. The body's detoxification system is not equipped to adequately
remove lipid based toxins and these are of major concern (Brady, 2006). Stress caused by
environmental toxins, such as fluoridated water, radiation, excessive light, noise and carbon
emissions are additional sources. The list of substances, both man made and naturally occurring
is a long list.
The most problematic toxins for the thyroid are those producing estrogenic effects or that
exhibit a reaction in the endocrine system, mainly via the food supply, i.e., soy, plastic,
pesticides and hormones used for live stock and environmental, via iodine 131, as well as
fluoride and excessive calcium, also pose a challenge to healthy thyroid function.
As the body is over burdened with these toxins, the body's detoxification capacity to
remove them diminishes. As the body's ability diminishes, the entire body will not be able to
maintain health. If there are nutritional deficiencies, the outcome could be hastened due to the
body’s inability to construct the enzymes that are responsible to remove waste. It is at this point
that the body has reached its body burden limit and these dangerous substances are then allowed
to "pour out" into the blood stream and cause damage to the entire organism.
Food sensitivities, due to the inflammatory cascade that they trigger and the waste
produced are potential means of causing an over burden to the body. Chronic infection and the
metabolic waste produced by such infections also produce a surplus of toxins that will act
negatively on the body’s detoxification pathways when in excess. Emotional stress, due to the
effect it potentially creates in the endocrine system is also another source of toxic substances. As
we have seen and will further explore, these are potential triggers for hypothyroidism and in of
themselves can cause a toxic overload. It is not uncommon for these triggers to occur
simultaneously, or one may contribute to the presence of others. This will place a larger burden
on the liver, lymph, lungs, bowel, kidney and skin (the detoxification pathways) and impair the
liver’s ability to produce thyroid hormone as well as impair the ability of the endocrine system
(which the liver is part of) from working effectively. Natural pathways may also be affected, due
to various toxic substances that act on the nervous system, such as pesticides and heavy metals
that also affect the reproductive system. Certain vitamins and minerals, can also prove “toxic” to
the thyroid and are included in this section.
In this section I will discuss strategies to reduce the body's burden of toxic substances as
well as the health risk posed by iodine 131 and fluoride to the thyroid. I will not be addressing
phyto or xeno estrogens here, as they are discussed in a subsequent section.
Genotype and Phenotype
Toxins can not only affect human health, they can also act as means of altering DNA and gene
expression. This becomes important in understanding one theory of autoimmunity. The most
potential damage affects the phenotype, or how genes are turned on or off-gene expression.
Phenotype can be altered be environmental toxins as well as food choices. Genotype, determine
height, hair color, eye color etc, is not as readily alterable.
Toxins can elicit a mutagenic affect on DNA or alter gene expression. Savaging oxidants
are potent mutagens that can cause normal cells to mutate into cancer cells. Radioactive isotopes
are also known to be potent mutagens. The well documented case of DDT as a mutagen lead to
its eventual ban in the United States, but is still in use in developing countries. Even foods can
potentially alter gene expression. Fava beans, which are consumed in large quantities throughout
the Mediterranean, Middle East and Gulf regions can cause disease in susceptible individuals of
that population group (Bland, 1999).
This pertains to thyroid health in the perspective of genetic susceptibility to thyroid

dysfunction. Regardless if the genetic marker exists in a person that signals a family propensity
for thyroid disorder, that gene must be activated. These various mutagens or substances that can
alter gene expression can activate disease modulating genes. Avoidance and awareness of such
substances can make the difference between health and illness.
Case Study 5: Iodized Antiseptic Triggers Hypothyroidism?
Aishah delivered her first child in France and was diagnosed with hypothyroidism. Prior to
diagnosis, she did not display any symptomologies of hypothyroidism. Her father is
hyperthyroid, so there is a family history of thyroid disorder. It is interesting to note a study by
Zahai et al. that point to the use of iodized antiseptics in French hospitals and its possible
causative affect on mothers and newborns to trigger hypothyroidism.
Iodine 131
The human body has adapted to use iodine 127 for thyroid functions and for thousands of years,
there was no other form of iodine to compete for uptake into the thyroid gland. The advent of
nuclear fission introduced iodine 131, a radioisotope and artificial form of iodine. There are no
natural isotopes of iodine. According to herbalist Ryan Drum, it is the 60 year release of
radioactive 131 into the environment that has caused today’s surge in thyroid disorders. As a
result, the human population is exposed to a continual low grade amount of iodine 131 (2008).
Drum also points out that the noble gas xenon is a potential risk to health despite popular opinion
amongst the scientific community (2008).
The destructive power of iodine 131 is well known amongst the medical community,
since it is used regularly to induce hypothyroidism amongst hyperthyroid patients and to destroy
the thyroid in cases of thyroid cancer (ablation/ thyroidectomy). The medical community regards
this procedure so dangerous that patients undergoing thyroidectomy are warned against contact
with other humans for at least six weeks. Suggestions include: no nursing, no intimacy, no
hugging, and no sharing of toothbrushes or towels. Drum questions, “it is curious that the
procedure is safe for the patient but potentially deadly for anyone (including pets) who come
within 10 feet. In truth, there may be no safe low exposure to either Beta particles or gamma
radiation; we do not really know.” Drum sates “everyone, everything, everywhere is dusted
continually with small amounts of Iodine131” (Drum, 2008). The deleterious effects of iodine
131 are not disputable, yet, there continue to be regular releases of this isotope into the
environment because it is deemed as “safe.”
Iodine 131 (radioactive) is not a threat to thyroid health when there is not an iodine
deficiency. The body uses iodine 127 and if there is an adequate supply, then other forms of
radioactive iodine pose no threat to the thyroid. However, X-rays (dental, chest and Cat Scans)
are another mode of exposure to radioactive isotopes that can prove damaging to the thyroid.
Thankfully, many x-ray facilities now provide an apron with a neck collar to provide protection
to the thyroid when undergoing the procedure. However, there are no safe levels of radiation
(Drum, 2008).
It is the cumulative effect of exposure to these radioactive isotopes that are of concern,
rather than a sudden blast as with ablation of the thyroid or a catastrophic event like Chernobyl.
Fluoride
The dangers of fluoride, even naturally occurring are historically known. In locations where
there were high levels of fluoride in the water, the populations were chronically ill, aged
prematurely, suffered from arthritis, mental retardation, and infertility. It was documented in the
19th century that communities in Argentina, India and Turkey, who had high levels of natural
fluorides in the water experienced such ill health effects. In 1926 Leon Goldemberg’s work in
Argentina showed that fluoride was not only causing illness amongst the community, but
fluoride was displacing iodine; thus causing hypothyroidism (Durrant-Peatfield, 2005).
In the 1930s Litzka and Gorlitzer von Mundy began to use fluoride preparations to treat
hyperthyroidism. The patients drank fluoridated water, swallowed fluoride pills or were bathed
in fluoridated bath water to suppress their thyroid function. As a result in 1937 the use of
fluorotyrosine was proven to be effective in treating overactive thyroid, but the effectiveness was
difficult to predict and many patients suffered total thyroid loss (Durrant-Peatfield, 2005).
Dr Barry Durrant-Peatfield (2005) outlines four main problems that fluoride possesses to
thyroid health:
1. The enzyme manufacture of thyroid hormones within the thyroid gland itself. The process by
which iodine is attached to the amino acid tyrosine and converted to the two significant thyroid
hormones, thyroxine (T4) and liothyronine (T3), is slowed.
2. The stimulation of certain G proteins from the toxic effect of fluoride (whose function is to
govern uptake of substances into each of the cells of the body), has the effect of switching off the
uptake into the cell of the active thyroid hormone.
3. The thyroid control mechanism is compromised. The thyroid stimulating hormone output from
the pituitary gland is inhibited by fluoride, thus reducing thyroid output of thyroid hormones.
4. Fluoride competes for the receptor sites on the thyroid gland which respond to the thyroid
stimulating hormone; so that less of this hormone reaches the thyroid gland and so less thyroid
hormone is manufactured.
Calcium
Calcium intake should be monitored in people suffering from hypothyroidism. Malter states that
a Trace Mineral Analysis suggests that most women are slow oxidizers and adding significant
amounts of calcium to their dietary intake will very likely exacerbate tendencies toward
hypothyroidism and adrenal insufficiency" (Malter, 1994). Also, an increase in calcium intake in
this population will result in increased accumulation of copper. This phenomenon is intensified
by the use of birth control pills and estrogen replacement (Malter, 1994).
Iron
Iron as well as calcium can interfere with the body's ability to use thyroid hormone by reducing
the amount in the blood stream via the digestive track. Dr. Glenn Rothfield recommends taking
any iron or calcium supplements 2 hours before or after taking thyroid medication (Rothfield,
2003).
It is important to understand that inadequate intake of dietary iron is only

one cause of anemia that seems to plague people with hypothyroidism. Blood loss due to
excessive menstrual bleeding or internal bleeding caused by a peptic ulcer or large doses
of aspirin, tumors or hook worm or a B 12 deficiency, it is important to rule these out as
the source of iron deficiency. Iron may be abundant in the blood stream, but it may be an
insufficiency of red blood cells that is causing anemia.
Dr. Barnes believes that anemia in some people with hypothyroidism could stem from the
low body basal temperature that is often times associated with this condition and the temperature
inside the bone marrow where red blood cells are manufactured (1976). The upper part of the
legs and arms are where the red blood cells are made, but lower in the bones, the marrow turns
white. He based his theory on research conducted at the University of Chicago. The study used a
white rat whose tail was white and formed no red blood. They surgically implanted the tip of the
rat's tail into its belly and with the increase in temperature, the tip began to produce blood, while
the cooler temperature tail, remained white. Dr. Barnes found in his thirty five years of practice
that he was able to correct anemia in patients with proper care of their hypothyroidism (Barnes,
1976).
In chronic inflammatory conditions, like autoimmune diseases

(Hashimoto's, Rheumatoid Arthritis), even though iron levels and iron binding capacity is
low, Dr. Michael Murray sates that iron supplementation is of little value "and may
actually promote further free radical damage." He suggests that iron supplementation is
not indicated unless there is blood loss (Murray, 1999).
Life Style Changes
As the body accumulates an excess of toxins, particularly with Hashimoto’s, it becomes more
difficult for the body to adapt to stress and it compromises the immune and endocrine systems.
We cannot control every factor, but we can reduce our toxic load by taking simple measures to
make our home and office as toxic free as possible. There are various lifestyle changes that can
be made to reduce the toxic load on the body. This step tends to be a starting point for many
clients who are unable to begin with dietary changes. I tend to begin with laundry supplies, than
home cleaning supplies, personal care products, water filtration system and a hepa filter vacuum
cleaner. There are additional concerns that are more of an investment and I suggest them, but
leave them to the clients discretion to implement.
• Removing, replacing out-gassing from paint, carpet glue and from mattress
• Remove dental amalgams
• Drink unfluorinated water
• Wear clothes made of natural fibers
• Changing laundry, cleaning and personal care products to natural to organic plant based
products
• Installing water filters for drinking and for bathing
• Seeking out green dry cleaners or hanging dry cleaning outside for a few hours to allow
the clothes to out gas
• Eating organic produce, dairy, eggs, fish and meat can help reduce toxic load.
• Hepa filter on the vacuum cleaner reduces the circulation of harmful substances,
• Not using a microwave
• Reducing use of wireless technology/cell phone with a head set
• Avoiding plastic
• Eliminate food allergies,
• Cleaning the heating and cooling ducts in the house once a year,
• Removing shoes before entering the house can help reduce the toxins tracked in the home
Pets can also be a source of toxic over load because of dander, toxic substances they may
introduce into the home as well as pathogens.
• Do not allow pets to sleep in your bed,
• Wash hands after contact and
• Avoid having them lick your face.
The role of stress in the development of disease cannot be over emphasized.

The mounting research all suggest that “living with continual stress or just feeling like
you cannot get out from under stress is enough to cause disease “(Vanderhaeghe, 2001). I will
address these further in Step 8, but here are a few suggestions:
• Exercise
• Practice Deep Breathing
Breathing deeply allows the body to relax and enter a sympathetic mode. Auto immune
conditions are commonly associated with parasympathetic dominance. When this
happens, the body is not allowed to heal itself in the sympathetic mode (Smith et al.,
2002). The lymphatic system is also supported. As we breath in deeply, it causes the
micelles of the chest and the abdomen to push against the lymph and speeds up the
movement of the lymph fluid. The lymph fluid removes waste from the blood, so when
this system is over loaded or becomes stagnant, the body can no longer remove toxins
and cellular debris (Murray, 2001). The thyroid is responsible for the body’s use of
oxygen. When we take in more oxygen, we make more oxygen available to the body,
supporting the functions of the cells and potentially reducing fatigue. When the body is
under stress, we tend to breath shallow. Each day for five minutes, find a comfortable
place and practice breathing. As you breath in imagine that a string in attached to the top
of your head and is pulling you upwards, feel your chest expand. As you exhale, push
your stomach out.
Functional Tests
Hair Analysis
Trace Mineral Analysis

Chapter 8
Step 4: The Liver and Detoxification Path Ways
The various pathways of detoxification, bowel, lymph, kidney and liver should be supported so
they can function optimally as opposed to actively stimulating detoxification. When the body’s
detoxification pathways are not clear, the passages become sluggish and can become congested
according to Dr. David Brady (2006).
If there is pathologic detoxification during Phase I or a sluggish Phase II, the body will be
working overtime without clearing any waste. The waste will be reabsorbed and reenter the
blood stream, beginning the process over again. (Brady, 2006)
Detoxification seems to be a catch all phrase, these days for curing whatever ailment
someone is suffering from. Popular, glossy magazines are plastered with many suggestions,
many of which are irresponsible, on the proper way to detoxify. Much of the information
circulating in the media today is gimmicky fads meant to suck money out of people’s pockets.
This is not to say that the need for detoxification is a hoax. On the contrary, the world we live in
is ever increasingly toxic, so much so that human breast milk is one of the most toxic soups on
earth (Steingraber, 2001). The air we breathe, the water we drink, and bathe in, the food we eat,
and the clothes we ware are all potential contact points for toxic exposure.
Not very long ago in the United States wooden backyard play sets distributed by whole
sale giant Costco were recalled for having dangerous levels of arsenic on them. China has
admitted to placing lead in Thomas the Tank Engine toys as well as excessive amounts of
formaldehyde on children’s clothes. This type of exposure is cumulative and over time can
become toxic. This is often the case with our everyday exposures. The little daily exposures add
up to a life time of poisoning. Here is a list of situations that could lead to toxic exposure that
was compiled by Dr. David Brady ( 2006)
• Physical-injury, inflammation and excess exercise (excess lactic acid).

• Nutritional- excess food, additives, alcohol and transfatty acids.
• Infection- bacterial, fungal and parasitic
• Chemical-xenobiotics, like plastics and organic substances.
I would also add emotional stress from our interactions with other people and our response to it.
As in every matter, the approach is critical. The professional irresponsibility in

recommending detoxification to everyone is wide spread and worrisome. Not everyone should
detoxify, but everyone should support their body's ability to move waste out, to detoxify and
cleanse.
Detoxification should never be attempted during pregnancy, while nursing or planning to

become pregnant. The chronically ill, those recovering from a chronic or acute illness, should
first build up nutritional stores before detoxifying. Also, before embarking on any new treatment,
please consult a certified health care practitioner. Detoxification should never be attempted
without the supervision of a certified health care practitioner.
The Role of Emotional Detoxification
When one embarks on a path of detoxification, a process of emotional purging and spiritual
cleansing occurs simultaneously. Even when one is only attempting to support the body's
detoxification process, these issues often come-up and should be addressed appropriately.
I begin with emotional detoxification because the women that I have worked with seemed
to all begin here. It became a critical part of their protocol and resurfaced with a vengeance when
ignored. Many times old hurts that were suppressed reappear and need to be resolved. This is the
body's way of alerting as to what needs to be addressed. It is important that these emotional
blocks are removed because they are "waste." It is also important to remove them so they do not
become stuck and stagnant in the body. This stagnation can and often leads to physical ailments.
Dr. Dietrich Klinghardt notes that emotional trauma lodges in our very tissue and can cause
dysfunction. If these toxic emotions are not addressed constructively, the detoxification/healing
process will cease or be ineffective. The client should be made aware of this and be given
resources to deal with this. He has developed as program and a bodywork style that allows his
patients, many of who are terminally ill, to regain their health (Klinghardt, 2006).
Case Study 6: Monkey in the Middle
Faith was a vibrant, dynamic and optimistic woman and looked forward to her life after
graduate school. She went away for college, which suited her fine because of the continual stress
at home. She thrived in an environment away from home, away from stress. After completing her
degree, she returned home and slept. She was exhausted and she figured that this was normal,
considering all the time and effort she had just placed into her graduate work. Even though she
slept most of the day, by the end of the week she does not feel refreshed; she is still exhausted.
The first warning sign comes one day when her mother tries to wake her up, but Faith will not
wake up. Then she finds that she is cold all the time, even though it is summer and she lives in
the desert. She also becomes a bit scattered in her thinking and is unable to carry out her normal
life. She looks for answers, but finds none. She is increasingly frustrated because she is too tired
and confused to hold down a job. Everyone thinks she is being lazy. She is finally diagnosed with
hypothyroidism and is overjoyed and is sure that that whole year will not be repeated, but she
does not get better. Now everyone around her is sure she is just unmotivated and lazy.
When I first met with her there seemed to be no reason why she should become ill so
suddenly. She described a hectic schedule that she had once pursued rigorously. She was seldom
ill and never had a health complaint before this. Then she began to describe her home life. Her
father was a strict man and very cultural (he did not budge from tradition) and her eldest
brother was not. This became the tension point in the house and Faith found herself being the
referee between her father and her brother. This went on for years and she said that looking
back this is when her symptoms, particularly being cold started to appear. She just ignored them
because so much was going on in her life. After returning from college the stress of being a
referee once more got the better of her. She remains optimistic and she continually is looking for
ways to improve her health. Her father is now also diagnosed with hypothyroidism.
I found homeopathic remedies, movement and bodywork effective here. The Native
Americans also have a rich herbal tradition that address such issues and is termed butterfly
medicine to emblemize the metamorphosis that the person is undertaking. These herbals assist in
that transition, because it can often be frightening time due to the uncertainty involved.
A client may also fall prey to old vices at this time because there is comfort in what is
familiar. This is why spiritual cleansing must take place, because without it we cannot move
forward. Most faith traditions offer such support and guidance. Islam has much to offer the world
on this topic and is addressed richly by the Sufi masters. It can be suggested to the client to seek
out sound literature that will aid in this process.
Emotional stress is a trigger and should be assessed in each client as this case study
highlights.
Depending on the individual, the process of emotional detoxification will proceed

differently. However, there seems to be a pattern, at least with the women I have worked with. In
the end, it really does end up being a journey of self discovery and is well worth the effort.
1. Examination of Inadequacies in Current Life
There may be many or a few, but as one examines their current life, the client must be
encouraged to use re-framing and positive self speak or this turns into a “kick me
fest,” which when dwelt on is as unproductive as self pity.
2. Self Pity-No Progress Made
Self pity really plays no role here because it only reinforces a sense of
helplessness and promotes inactivity. When self pity is over indulged, it leads to
no forward progress.
3. Old Hurts Resurface
Depending on the nature of the “hurts,” and the person’s accessibility to the one who
inflicted it, this stage can be passed quickly, but resurface. This is a process that
works in cycles. As the client passes through each cycle, the intensity of the emotion
should dwindle until they reach acceptance/forgiveness. If not, the client is dwelling
in the past instead of moving forward with the healing process. Dwelling in the past
should also be avoided because it drains energy from the person. One should view the
past as that, something that should be moved out of. The more you put energy into
something, the stronger it becomes. Seeking counseling or turning to a faith tradition
can prove useful. Movement, walking, dance, massage and bodywork all assist in
speeding along this process. The more stagnation there is, the longer the client is
likely to remain in a particular cycle. Typically physical healing will follow the ebbs
and flow of this cycle.
4. Physical Healing Begins
Again, this may be a cyclical process that is linked to emotional healing. As a

practitioner, it may be frustrating to start and stop again, but during these
“plateau” periods, deep healing and understanding is being reached on the part of
the client. The client may become unmotivated and will need to be reassured and
encouraged. Nutritional support in the form of deeply nourishing super foods,
seasonal foods and water should be the focus here. Supplements should include
the anti oxidants, especially vitamin C, bio flavinoids, the B complex vitamins
and magnesium. The body at this time will be under stress and these supplements
will help support it. Sulfur rich foods also help to support the detoxification
system. Also, adaptogenic herbs as well as herbs such as lavender, chamomile,
lemon balm, hops and passion flower can help the body adapt as well as bring a
sense of calm. Aromatherapy is even of more use than whole herbs because of its
affects on the spirit/soul/chi. There are special blends available on the market. A
client should first smell the essential oil before purchasing because what may be a
pleasant smell to someone may not be to another. Scents also have the ability to
help us recall memories. Grapefruit is usually a starting point. These oils can be
incorporated into cleaning supplies, body care products and can be used in a
diffuser.
5. Acceptance/Forgiveness and Stabilization

Once the client reaches a point when they can accept and/or forgive what once pained
them, they can reach a time where they have stabilization. This is a time when a client
begins to heal physically as well as emotionally.
Case Study 7: I'm Just So Angry
One night I received a call from Samira, a client of mine, her voice was tense and shaky. She just
returned home where her daughter had undergone surgery and her mother had just left to return
to the US. It was the first time in seven years that she had seen her mother. What should have
been a happy reunion turned into a nightmare after 24 hours. Samira remembered why she had
not visited sooner. She was enraged and felt cheated by her mother. She remembered all of the
pain her mother caused her and was continuing to cause her because of her lack of maturity and
consideration. Samira was livid and did not know how to control it. Up until this point, her focus
had been on her husband, but in all honesty, he did not seem to be the “real” problem. This
focus became obsession and she became ineffective in healing physically or emotionally. She was
stuck in a cycle. Her mother’s visit changed that. Her focus was now her mother and how she
had turned into her mother. This turned out to be a positive thing. Until then, she was looking for
someone to come and “fix” her life for her. She did not want to be responsible for herself, her
marriage or her children. She wanted a different life, but she just could not be proactive and take
charge-she waited. Her mother’s visit acted as a catalyst to ignite her into action. She was
shocked at what she had become and seeing her mother as herself, she decided to do something
about it. I do not know how long she will be in this cycle, but it caused the other cycles in her
life, husband, children and self, to be affected in positive ways. Samira now has taken charge
and is ready to try.
The Process of Detoxification
Typically only liver function is considered when discussing supporting detoxification, but the
entire body serves as a site for detoxification. Dr. David Brady, at a conference I attended titled,
"The Role of Detoxification and the Gastrointestinal Environment in Chronic Disease," linked
many chronic diseases to the body’s inability to remove waste efficiently (2006). So let us briefly
look at the physical structures involved in this process.
The various systems the body uses to carry away harmful substances include the skin,
sweat glands, lymph nodes, tears, nose, gastro intestinal (GI) track, throat, lungs, kidney,
gallbladder and the liver. A dysfunction in one system can lead to an overburden and failure of
another system, so they all must function synergistically. Toxins that are not eliminated by other
systems are passed to the liver where they enter Phase I and Phase II conjugation to be excreted.
In Phase I the liver selects appropriate enzymes to take apart the molecule it is presented
with. If Phase I is not functioning properly and is slow, the body can slowly poison itself. Many
times the substance being changed is more toxic than the original one, so it must go through
Phase II. This is another reason why detoxification should only be attempted under the care of a
trained health care professional.
During Phase II, once again, the liver selects the best enzyme to convert the substance
into something harmless the body can then excretes. We do not have an endless supply of
enzymes. The body must make these enzymes from nutrients in the body. If the body is deficient
in any one of the nutrients needed, the enzyme will not be formed properly. Some very important
nutrients to have in abundance in the body are the antioxidants, vitamins C, E, beta-carotene, A,
selenium, zinc, B12, other B vitamins as well as sulfur. As I stated earlier, it is critical that one
builds up reserves of these nutrients to support the detoxification systems.
It is important to note that the body has difficulty in excreting many chemicals because
they are oil based. Our bodies use water as the means to break down chemicals. If the chemical is
not water based, it settles in our body (Brady, 2006). Mercury is infamous for lodging in the fatty
tissues of our body like the brain and reproductive organs.
A toxic overload in the body can cause such symptoms like:
• Tremors
• Dizziness
• Fatigue
• Dark circles around the eyes
• Anemia
• Pallor
• Indigestion
• Poor coordination
• Depression
• Insomnia
• Hyper-excitability
• Red dots on the tounge
• Swollen tounge with scalop marks
• Scraches on the sides of the tounge
• Cognitive-disorders
• Rashes, eczema, inching
• Psychiatric disturbances
• Speech and language deficits
• Sensory abnormalities
• Motor disorders
• Cognitive disorders
• Unusual behavior- sleep difficulties, agitation, crying spells, ADHD, head banging
• Physical disturbances- diarrhea, abdominal pain, abnormal reflexes
• Biochemical-altered mitochondria, inhibits enzymes
• Immune system- could cause allergies, autoimmune like symptoms
• Central nervous system disturbances, prevents serotonin release and transport
The Liver and Thyroid Function
We have discussed the effect of over burdening the detoxification pathways and how it can lead
to thyroid dysfunction. This is a subsequent consequence, but the liver also plays a direct role in
thyroid health.
In some people suffering from hypothyroidism, the body may be making adequate
amounts of TSH and T4, however due to the liver’s lack of 5' -deiodinase , the liver is unable to
convert the inactive T4 into the active T3 form (Dommisse, 1993). A sluggish liver or a liver
lacking proper nutrients to create this enzyme will not support thyroid function.
A sluggish liver can also produce an excess of cholesterol, a key clinical marker for
hypothyroidism (Shames, 2001).
Supporting the Detoxification System
There are various methods, foods, herbs and nutrients that can help remove waste. However, it is
of paramount importance to build up the body by giving it proper foods, clean water and a
healthy lifestyle. Below is a list of suggestions to assist the detoxification pathways:
• Having a positive self image and positive outlook on life. Self doubt is toxic, as are all
negative emotions.
• Green and red powders are supper foods that are dehydrated herbs, fruits and vegetables.
There are various types available at health food stores. They are fun to experiment with
and many companies sell single servings. I like these powders because it is a quick and
easy way to provide your body with most of the phyto (plant) nutrient it needs in 1-2
tablespoons.
• Probiotics (life giving) as opposed to anti-biotics (against life) provide the body with the
healthy bacteria it needs to break down and utilize foods and prevent infection.
• Fiber is extremely important because it binds toxins to it so they can be excreted. Fiber is
found in leafy greens, fruit, and flax seeds. One table spoon of ground flax seeds in 8 oz
of water is usually enough, to begin with and in place of red or green powder. Remember
if you are not accustom to consuming large amounts of fiber, go slowly. Do not over do
it like I did. The consequences can be very painful. Avoid most commercially available
fiber products.
• Sulfur rich foods such as garlic and onion, avoiding coniferous vegetables.
• Dry brushes made of natural fibers can be used to move the lymphatic system that lies
just below the skin. This is a great way to get things moving. Start on the right side of
your body and gently use upward strokes, always towards the heart. Drink plenty of water
after.
• A simple hot bath once a week or even once a month, can do much by opening pores,
especially if you remain in the bath until the bath cools. Adding relaxing herbs like
lavender, chamomile and lemon balm help alleviate stress. This is particularly helpful
with Hashimoto’s.
• Some helpful herbs to support the liver are dandelion, burdock root, milk thistle seeds.
They can be taken as teas or ground and sprinkled over food.
• Some body work methods are sauna, self massage with oil after bath, reflexology,
acupressure, acupuncture. Something that I benefited the most from was jin shin jyutu.
• Exercising 3-5 times a day for 15-30 minutes helps the liver and gets things flowing.
• Lastly and most importantly is water. Without water, no process in the body can take
place. To find out how much water you should be consuming divide your body weight in
pounds by two and drink that amount in ounces. If you weight 160 lbs, you would drink
80 oz of water.
Herbs/Supplements
Blood
• Alfalfa
• Dandelion
Liver and Gallbladder

• Dandelion
• Licorice Root (DGL for those with hypertension/high blood pressure)
• Burdock Root
• Cascara Sagrada
• Milk Thistle
Lungs
• Licorice Root
• Comfrey
• Mullein
• Garlic
• Fennel
• Anise
Kidney
• Marshmellow
• Dandelion
• Parsley
Lymph System
• Dandelion
• Garlic
Colon
• Cascara Sagrada
• Black Walnut Hulls
• Flax Seed
• Garlic
Aloe
• Marshmellow
Functional Tests
• Transit time
• Tongue analysis (red dots on tongue, swollen tongue, teeth marks on side of tongue)
• Functional Liver Assessment Questionnaire
Chapter 9
Step 5: The Adrenal Connection
The Primary mechanism by which psychological factors predispose one towards a disease process is by means of
the stress response and its effect on nutrient minerals at the cell and tissue levels. The stress response involves a
general systems response relating psychological, neurological, endocrine, and immune system phenomena. These
phenomena are reflected in certain types of nutrient mineral patterns involving levels of specific minerals and ratios
between pairs of minerals- Malter, 1994
The thyroid and the adrenal glands share a similar axis (pituitary-adrenal-thyroid) and as such are
tied together in sickness and in health (Hansen et al., 2004). In order for the thyroid to function
properly, the adrenal glands need to be functioning optimally as well. In most cases, adrenal
fatigue and sometimes atrophy can occur alongside hypothyroidism. It is commonly overlooked
in a clinical setting, yet without addressing adrenal health, the thyroid may not regain proper
function (Shames 2005).
When the adrenals are taxed, they have an effect on production of insulin and estrogen.
Estrogen can then become dominate and compete with T3 for receptor sites within the cells
(Rothfeld, 2003). So profound can the effects of stress be on the body that they can render the
target tissues resistant to TSH secretion and suppress 5' deiodinase (which is responsible for
converting the inactive T4 to the active form T3). Stress also promotes insulin resistance. (Tsigos
et al., 2001). According to Dr. Ron Manzanero, due to the connection between the two glands or
the feedback loop, dysfunctional adrenal glands (excess of cortisol levels) can cause an under
conversion of T4 to T3 or a suppression of T4 production (Shomon, 2000). The feedback loop is
designed not to “destroy” the other organ in Dr. Bruce Rind’s words. This way T3 levels are
inhibited from causing damage to the adrenal glands.
Conversely, according to Dr. Rind, T3 is one of the “strongest stressors to the adrenal
glands” (Shomon, 2000). The presence of adrenal fatigue or adrenal exhaustion can also render
the use of thyroid hormone replacement ineffective. When there is an improper understanding of
this on the part of the doctor or the patient, then they may believe that there is not an issue with
the thyroid or that a problem does not exist and the patient may be left to languish with ill health.
This is a situation that is not unknown to the pharmaceutical companies. Lang points out that on
the packaging of Synthroid which states “Use of Synthroid in patients with diabetes mellitus,
diabetes insipidus or adrenal cortical insufficiency may aggravate the intensity of symptoms
(Lang, 2002). As such, adrenal health should be a primary consideration, particularly when a
client is not responding to thyroid hormone replacement.
Cortisol and Stress

Stress can stem from various sources, environmental, emotional, physical and in a combination.
This was discussed in great detail in Step 4. Cortisol and the adrenal glands play a key part in the
body’s ability to adapt and cope to such stressors. Cortisol is an important and helpful part of the
body’s response to stress, but it is important that the body’s relaxation response be activated so
the body’s functions can return to normal following a stressful event (Smith et al., 2002).
Sustained levels of high cortisol destroys healthy muscle and bone, slows down healing
and normal cell regeneration, co-opt biochemicals needed to make other vital hormones, impairs
digestion, metabolism and mental function, interferes with healthy endocrine function and
weakens the immune system. Unfortunately, in our high-stress culture, the body’s stress response
is activated so often that the body is not always afforded the opportunity to return to normal,
resulting in a state of chronic stress. This will have a negative effect on brain function, memory,
learning and mood. This is especially true if this condition is chronic.
Adrenal fatigue may be a factor in many related conditions, including fibromyalgia,

hypothyroidism, chronic fatigue syndrome, arthritis, premature menopause and others. It may
also produce a host of other unpleasant symptoms, from acne to hair loss.
Higher and more prolonged levels of cortisol in the bloodstream, affect the entire
endocrine system. A disruption in one area of the endocrine system usually coincides with a
disruption in another area, this is why addressing the adrenal glands along with the thyroid
produce successful outcomes. Due to the continual state of stress the body is under, the
sympathetic nervous system may be suppressed and there is a state of parasympathetic
dominance (Smith et al., 2002). The body can not heal adequately in the parasympathetic mode
associated with chronic stress have been shown to have negative effects, such as:
• Impaired cognitive performance
• Memory loss
• Suppressed thyroid function
• Blood sugar imbalances such as hyperglycemia
• Decreased bone density
• Decrease in muscle tissue
• Higher blood pressure
• Lowered immunity and inflammatory responses in the body, slowed wound healing, and
other health consequences
• Increased abdominal fat/pear shaped body, which is associated with a greater amount of
health problems than fat deposited in other areas of the body. Some of the health
problems associated with increased stomach fat are heart attacks, strokes, the
development of higher levels of cholesterol (LDL) and lower levels of cholesterol
(HDL), which can lead to other health problems.
Cortisol secretion varies among individuals. People are biologically ‘wired’ to react
differently to stress. One person may secrete higher levels of cortisol than another in the
same situation. Studies have also shown that people who secrete higher levels of cortisol in
response to stress also tend to eat more food, and food that is higher in carbohydrates than
people who secrete less cortisol. If someone is more sensitive to stress, it is especially
important for them to learn stress management techniques and maintain a low stress lifestyle.
Adrenal Fatigue/Exhaustion
Symptoms of adrenal fatigue may be more prominent than hypothyroid symptoms and should
indicate to the clinician that adrenal fatigue is a factor. Symptoms are:
• Difficulty getting up in the morning, but after a few hours, the person is able to function.
People suffering from hypothyroid are not able to get out of bed and once out do not
regain energy.
• Continual fatigue that is not relived by sleep
• Cravings for salty foods.
• Cravings for sugar and refined carbohydrates. These both provide the adrenal glands with
a quick lift
• Dependency on caffeine drinks. This causes the adrenals into force labor, for awhile. The
caffeine acts like a whip that beats the already exhausted adrenal glands.
• Lack of energy or stamina
• Lethargy
• Daily tasks require more effort
• Light headedness, feeling faint when standing up quickly
• Inability to handle stress
• Decreased sex drive
• Recovery time form illness increased
• Mild depression
• Inability to enjoy life
• Pre Menstrual Syndrome (PMS)
• Hypoglycemia
• Decrease in memory
• Inability to remained focused
• Constant mind chatter, especially when lying in bed
• Decreased tolerance
• Sensitivity to light
• Sensitivity to noise
• Increased energy after 6PM or after evening meal
• Low energy between 3-4PM
• Waking between 2-4 AM
• Unresponsiveness to thyroid hormone replacement (when hypothyroidism is present)
• Lines of dark pigmentation on the nails
• Startling easily
• Weaned digestion
• Food sensitivities
• Environmental allergies
Stages of Adrenal Exhaustion
Adrenal exhaustion progresses in three stages:

• Stage I is distinguished by an increase in output of Adrenocorticotropic Hormone
(ACTH). This increased cortisol output increases the probabilities of pregnenolone steal
and decreased DHEA. When in a chronic stress response, pregnenolone, the common
precursor to cortisol, DHEA and other hormones is preferentially diverted to cortisol
production at the expense of the rest of the steroidal hormones. Generally in Stage I
cortisol increases and DHEA and its metabolites decrease or an imbalance occurs
especially between testosterone and estrogen.
• Stage II adrenal exhaustion is marked by the transition from increased to decreased
cortisol output. This stage is characterized by continuing high levels of ACTH and
adrenocortical stimulation, normal total cortisol output, low or borderline low morning,
noon or afternoon cortisol levels, normal nighttime cortisol level, and an increased
probability of pregnenolone steal and a further decrease in DHEA. This is a transitional
phase in which although ACTH stimulation remains high or even increases. The adrenal
output of cortisol declines due to the adrenal fatigue associated with continued hyper
stimulation.
• Stage III adrenal exhaustion is an advanced stage of adrenal exhaustion characterized by
decreased total cortisol output. This stage is characterized by continuing high levels of
ACTH and thus adrenocortical stimulation, low total cortisol output, and increased
probability of a low nighttime cortisol level and pregnenolone steal and even further
decrease in DHEA. The adrenal glands are now exhausted to the point that even though
there is ongoing hyperstimulation (high ACTH); they continue to lose their capacity and
reserve to produce enough cortisol. The eventual result is a crash of the hypothalamic-
pituitary-adrenal axis (HPAA) in which essential neuroendocrine feedback loops are
unable to return the system to homeostasis. The adrenal glands may even atrophy.
Pregnenolone Steal
All sex hormones, adrenal hormone and kidney hormone production comes from cholesterol.
Cholesterol is an essential chemical in our body. It provides the necessary cofactors to form the
hormone pregnenolone. In a non-stressed individual, pregnenolone flows in a downward
direction for the production of DHEA. DHEA is then converted to either testosterone, or the
three different estrogens (estradiol, estriol, or estrone) depending on the body’s demand. Some of
this pregnenolone is always shuttled in a secondary fashion to progesterone which, as needed,
will convert to cortisol. Cortisol is then free to carry out its biological activities as discussed
above. When estrogen, testosterone, and progesterone are being produced in normal amounts,
this indicates a healthy and balanced hormonal system. However, in our fast-paced, stress filled
society this normal scenario very rarely occurs leading the way for hormonal imbalances and a
predisposition to ill health.
When the body is under stress, we tend to produce more and more cortisol. Over time we
enter a phase called "pregnenolone steal" in which our body is stealing pregnenolone away from
its normal hormone production in preference of cortisol.
Eventually the demand on the adrenal glands for stress hormone production (cortisol) is
so great that our adrenal gland begins to weaken. Over time, this scenario leads to adrenal fatigue
and eventually adrenal exhaustion. In the adrenal exhaustion phase we have lost our ability to
compensate for acute stressful events and we are left feeling fatigued, lethargic, and susceptible
to chronic illness.
Supporting the endocrine system and feeding the adrenal glands are key factors to
address in approaching a healing protocol. A disruption in one area of the endocrine system
usually coincides with a disruption in another area, this is why addressing the adrenal glands
along with the thyroid produces successful outcomes. Nutritional and lifestyle interventions can
do much to meet the challenges of the client with hypothyroidism. Adequate nutrition, stress
management and an exercise program may be enough to reverse some thyroid issues that are
caused by non-physiological complications. Nutritional intervention along with supplementation
of vitamins, minerals may at times be enough to produce spontaneous remission of
hypothyroidism, including Hashimoto's autoimmune disease. This may be the exception and not
the rule, so one must be careful not to give clients false hope, but to inform them of all
possibilities. Hope, as we know, can produce a strong placebo effect, so, it is good medicine.
Functional Test:
Saliva Test
Metagenics Comprehensive Health Profile Questionnaire

Chapter 10
Step 6: Balancing the Endocrine System
Although this may be the “primary” dysfunction manifesting in the client, this Step may not be
the initial starting point in a healing protocol. It is crucial to initially:
• Reduce Inflammation
• Heal the Gut and Repair Digestion
• Clear Detoxification Pathways
• Insure the Function of Detoxification Pathways
Thyroid disorders can be categorizes as a general chaos in the endocrine system (Shoman,
2000). Imbalance of estrogen/progesterone and menstrual disturbances are amongst the early
signs of potential thyroid dysfunction. Estrogen dominance can also mimic symptoms of thyroid
disorder. Since estrogen dominance can mimic hypothyroidism, menstrual patterns are of
significant note in identifying hormone imbalance. Here I will take some time discuss the two in
further depth.
Menstrual Irregularities
Many women do not take much note of their menstrual cycles and many symptoms that should
be considered a concern are considered normal, unless these symptoms are new. If these
symptoms are new, there is usually great concern. Common irregularities include (these may be
repeated or extended in the next section):
• Clotting
• Cramps
• Bloating
• Mood Swings
• PMS
• Heavy Bleeding
• Long Periods
Any change in the usual menstrual pattern of a woman signals a change in her body and should
be well noted in the client's initial intake. A cause of such an occurrence can be caused by
hormonal imbalance such as excess estrogen or low progesterone.
Estrogen Dominance/Low Progesterone
Estrogen dominance occurs when there are excessive amounts of estrogen in the body. This
typically is coupled with a decrease in the hormone progesterone (it is involved with preparing
the body for pregnancy, amongst other things). When we hear the word "estrogen," it is
commonly associated with women; yet, estrogen dominance affects both men and women.
Children are also susceptible because of their size and fluctuating hormones.
Another factor in low progesterone production is pregnancy. During pregnancy

the body produces more estrogen and progesterone, so there is a balance of the two. After
pregnancy, there is a decline in the production of progesterone, but there may be an
excess of estrogen in the body. It is after pregnancy that it is common to see symptoms of
estrogen dominance due to this. Pregnenolone steal and its effects on progesterone
production are discussed in Step 5 of the previous section and how it can lead to estrogen
dominance, so I will not detail it again. Symptoms of estrogen dominance may include:
• Miscarriage (typically in the 1st trimester)

• Premature Aging
• Breast Tenderness
• Cervical Dysplasia
• Cold Hands and Feet
• Excess Copper (a sign is curly hair becomes straight)
• Decreased Sex Drive
• Depression with Anxiety or Anger
• Dry Eyes
• Early Onset of Menstruation
• Weight Gain (usually around the stomach, hips and thighs, pear shaped body)
• Fatigue
• Foggy Thinking
• Hair Loss
• Headaches/Migraine
• Increased Blood Clotting
• Infertility
• Irregular Menstrual Periods
• Irritability
• Insomnia
• Magnesium Deficiency
• Memory Problems
• Mood Swings
• Premenopausal Bone Loss
• Pre Menstrual Syndrome (PMS)
• Sluggish Metabolism
• Water Retention/Bloating
• Zinc Deficiency
Conditions Associated with Estrogen Dominance:
• Autoimmune Disorders
• Osteoporosis
• Polycystic Ovaries
• Thyroid Dysfunction
• Prostate Cancer
• Hypoglycemia
• Gallbladder Disease
• Fibrocystic Breasts
• Allergies (asthma, hives, rashes, sinus congestion)
• Breast Cancer
• Uterine Fibroids
• Endometrial/Uterine Cancer
There are no conclusive statistics regarding the rates of estrogen dominance, but if we look at
the symptoms and conditions associated with estrogen dominance, we can see that it is wide
spread. There are various causes of estrogen dominance and there is usually more than one
cause at play. The common causes are:
• Stress
Xenohormone/Xeonestrogen Exposure
• Use of Oral or Injected Contraceptives
• Conventional Hormone Replacement Therapy (of estrogen)
• Adrenal Fatigue
• Poor Diet
• Consumption of Hydrogenated Oils
• Nutritional Deficiencies (especially magnesium, zinc, copper and B complex vitamins)
• Insufficiency Progesterone
• Anovulatory cycles (cycle where menstruation occurs, but no ovulation, and therefore no
ovarian progesterone is produced)
• Obesity (particularly at the abdominal, waist, hips and upper thighs, pear shaped body).
Stress
According to clinical psychologist Dr. Richard Malter, not only does stress affect the nervous
system, it also affects the endocrine system. In the previous section I discussed this mechanism
and how it leads to adrenal fatigue and estrogen dominance. In addition, stress also causes
nutritional deficiencies (1994).
Stressful situations, particularly prolonged stress also causes nutritional deficiencies,

especially magnesium, zinc, copper, B complex vitamins and vitamin C. Initially stress
reduction is difficult to accomplish and a supplement protocol to support the body as well as
replace nutritional deficiencies can assist in this process. Taking supplements, especially
supplements designed particularly for stress assists the body in adjusting to stressful situations.
Functional foods (green powders, sea weeds, red powders or Spirulina) are also another way to
provide the body with additional nutritional support. There is also a class of herbs called
adaptogenic that facilitate adaptation during times of stress. Some examples are astragalus, the
different ginsengs, licorice and ashwagandha.
Phytoestrogen: Soy
It is true that both females and males produce estrogen, however today there are other sources of
estrogen other than invivo. One main source that has infiltrated the food supply at an alarming
rate is soy. Soy is classified as a phytoestrogen (plant estrogen) as well as endocrine disrupters
(Daniel, 2005).
Fermented soy foods like soy sauce, miso and tempe, soy lethicin (in small amounts) are
not a concern at this time, but should be limited in the diets of hypothyroid people. I have one
client who becomes physically ill after consuming soy sauce. But soy oil, edamame beans, soy
infant formula, soy milk, soy protean, soy flour as well as tofu (because it is consumed in high
amounts and is a refined food). It is recommended that these foods be removed from the diets of
people suffering from endocrine imbalance disorders.
As certain cancer rates increased, many health experts looked to East Asia,
who had low incidents of breast, uterine and prostate cancers (but suffered from cancer of
the thyroid, stomach and esophagus) for clues to help stop the rising tide of breast,
uterine and prostate cancer cases. One such approach these health experts implemented
was the introduction of soy based foods into the Western diet. It was assumed that the
East Asian diet, which traditionally contained small amounts of fermented soy products
in the form of tempe, tofu, miso and soy sauce (not more than 18 grams a day in Japan),
might be the "magic bullet" they were looking for. Yet, instead of looking at the totality
of the Asian diet and lifestyle-only soy was selected. It was not even selected in the way
it was traditionally eaten; Asians were not eating tofu hotdogs or consuming soy milk.
Yet this Western trend affected the eating habits of Asia with alarming effects as well.
According to an article published in the China Post in March 2009, Taiwan saw a rise of
22% in breast cancer, uterine cancer increased by 31% while prostate cancer saw a rise as well.
In 2007, China announced it too has seen an increase in cases of breast cancer. These new
findings, along with a study conducted on Japanese males living in Hawaii who consumed large
amount of soy (which increased their rates of having Alzheimer's), suggests that soy foods are
not the panacea they were thought to be.
Soybeans contain high amounts of digestive enzyme inhibitors, particularly blocking the
enzyme trypsin. These inhibitors cannot be “cooked out” of the bean. Soaking and sprouting
also have no effect (Fallon, 2000) Also soybeans with their high levels of phytic acid cause a
deficiency in zinc, calcium, magnesium and iron. These are all common mineral deficiencies
seen in developing countries with diets rich in soy (Bernardini, 2003). Lecithin in soy
compromises the gastrointestinal track as well as the immune system (Colpo, 2005). Then there
are the negative effects of soy on thyroid function. Daniel points out in her book, The Whole Soy
Story that the rise in thyroid diseases corresponds with the introduction of soy into infant formula
(2005).
Current research into the consumption of soy foods and thyroid dysfunction are mixed
and conflicting. Soy is found to disturb the absorption of thyroid medications and it is
recommended that doses be adjusted when soy foods are consumed.
A baby whose only source of food is soy based formula is being subjected to the same
amount of hormones found in four birth control pills (Setchel, 1998).
Xenoestrogen: Plastics, Pesticides and Animal Growth Hormone
The idea that naturally occurring chemicals can alter hormone function and affect health is an old one. Human
cultures from antiquity to the present sought remedies and drugs from plants they knew had the power to heal or
hurt. Some of these plants, such as mold, clover, fruits, and legumes (soy), contain estrogen-like chemicals. The
mimics can cause infertility and other reproductive problems as well as impede or encourage disease in domestic
animals and human. -e. hormone.com
Plastics
Xenoestrogens means foreign estrogens or from outside the body. The largest sources in our
diets are plastic, pesticides and animal growth hormone. Not only do these substances lead to
estrogen dominance, they also profoundly affect the entire body and add to the body's total toxic
load.
Thin plastic wraps that are used in packaging foods leech into the food that they contain
and become part of the food. The use of plastic bags, containers and thin plastic wraps to store
food are the main sources of plastic in the human diet. In recent years plastic water bottles have
become a major concern. Many times plastic cannot be avoided, but there are a few things we
can do to protect ourselves.
Packaged food can be unwrapped then stored in glass containers (they can be recycled
glass jars) or you can use a plastic container with the wrapped in wax paper or parchment to
prevent leaching from the plastic. Plastic also should never be heated. The thinner the plastic is,
the more susceptible it will be to leaching xenoestrogens into your food.
Even if plastic is completely removed, exposure is not entirely removed. As plastic is

disposed in landfills it decompose into "estrogen gas" and released into the air we breath in. Yet,
it is important to reduce our use and consumption of plastic. A unique feature of xenoestrogens is
that they fit into the estrogen receptor site on each cell like a key fits into a lock. Yet since they
are not boidentical, the key breaks off in the lock and the body is deceived into thinking that it
should permanently produce estrogen. It becomes a vicious cycle.
Pestasides
Commercially grown foods are continually sprayed with pesticides that can act as Endocrine
Disrupters (EDs) or as Endocrine Disrupting Chemicals(EDCs) that block or obscure
communication throughout the body. This is an old problem and in the 1930’s a study verified
that synthetic bisphenol A, synthesized in the 1920’s, did mimic estrogens (Dodds et al 1936,
1938). Pesticides that are used by commercial farmers work on the premise of targeting pest’s
immune and endocrine system as well as other signaling systems. These synthetic and sometimes
natural substances also can and do affect human signaling systems. Rachel Carlson in her book
Silent Springs was a pioneer on the subject of the effects of synthetic compounds on both
wildlife and humans (1962). To date there are over 80,000 known pesticides, drugs, foods,
additives and industrial chemical and although it is uncertain as to how many of these substances
are EDs or EDCs, there is a unified consensus amongst scientist aligned with Wingspread that,
“synthetic chemicals could interfere with hormones of animals, and possibly people. Fetuses and
the young were at the greatest risk for disease, abnormalities, and reproductive problems that
were already manifesting in wildlife” (Wingspread Statement, 1991).
Hormones
The use of hormones in industrial raised animals is an additional source of hormones that has
invaded the food chain. The additional burden these hormones place on the endocrine system and
the detoxification pathways continue to be debated amongst certain scientist. However, their
affects on humans is well documented, but not always accepted (Bernardini, 2003; Schmid,
2003). Clients should be encouraged to replace animal and animal derived products (milk,
chesses, etc) with organic sources to reduce exposure and restore endocrine health.
Diet
Diets high in refined grains, white rice, sugar and hydrogenated oils contribute to the excess
production of estrogen. These, as mentioned before should be eliminated from the diet or greatly
reduced.
Coconut oil, according to Dr. Bruce Fife, author of The Coconut Oil Miracle, helps the
body pull excess estrogen out. Eating 3-4 tablespoons of coconut oil a day by using it in cooking
will help accomplish this. Fiber in the form of fruits, vegetables, beans, legumes or whole grains
are also needed to aid the body in ridding itself of waste. An average intake recommendation is
between 20-30 grams of fiber a day. Water is also critical because it helps the body's
detoxification system in removing waste, like excess estrogen (Fife, 2004).
Coffee contributes to estrogen dominance. The way that it contributes may be by making
the body more acidic. Once our bodies are too acidic, the production processes of all hormones
are altered. It appears that when a woman’s body is too acidic, it produces excess amounts of
estrogen and insufficient amounts of progesterone. Dr. Michael Lam of the American Academy
of Anti-Aging Research reports that in a small study of 500 women, those who consumed four or
five cups of coffee per day had 70% more estrogen that those who drank less than one cup per
day (Frazer, 2007).
There is no research that proves that drinking coffee reduces progesterone production but
there are anecdotal reports from women that suggest that this is true. Kerri-Lynn Lapointe, N.D.,
writes in Menopause Myths Debunked that coffee and stress force the body to convert
progesterone to cortisol which suggests a link between coffee and progesterone deficiency.
Whatever the cause of a progesterone deficiency is, drinking coffee will make estrogen
dominance worse by increasing the estrogen levels (2007).
Functional Tests
Saliva Test
Menstrual Cycle
Chapter 11
Step 7 Eating for Health
Physical ailments attack and harm the body and alter its normal function, because of an excess amount of
substance. This type constitutes the majority of diseases and occurs because of overeating or consuming more than
what the body needs, that which brings about little benefit or is not digested easily, or due to complex meals
–ibn Qayyim
There is an old adage that states, “you are what you eat.” We are recreating ourselves everyday
with what we place into our mouths and then with what our bodies are able to assimilate. The
building blocks of life carbohydrates, fatty acids (fats, both saturated and unsaturated) and amino
acids (proteins) often lack vital energy in the diet’s of Americans and at a growing rate in the
diet’s of people living in developing counties. When the body is not adequately provided with
quality nutrients, we are recreating and changing ourselves from the state we were in at birth into
something inferior due to our poor food choices. Not only are more people making poor food
choices, they are also over consuming these foods.
There is power in food because the very act of cooking is alchemical. The nutritional
values of foods are reduced by the methods used by commercial farmers. The way foods are also
processed can render them un-nutritious. Our food choices alter our bodies in positive or
negative ways. Our poor food choices are “genetically modifying” human DNA. Twenty years
ago in the US, 1 in 10,000 children had autism. Today, it is 1 in every 166 children. In England 1
in every 60 children has autism. These figures led Dr. Mary Megson, MD and autism expert, to
state that we have altered the human genome (2006). This is a dramatic statement when we take
into consideration that the human genome is altered 1 percent every 100 years. The incidence of
hypothyroidism has increased greatly and food is in part the cause.
Eating for Health vs. Eating for Weight Loss
To date, there is no comprehensive approach to eating when dealing with hypothyroidism. The
foods to avoid when someone is hypothyroid may be widely available, but not always known to
people suffering from thyroid disease. As one hypothyroid client proudly told me," I eat raw
cabbage every day." The thyroid blocking affects of cabbage is well documented in the literature,
but there still remains a disconnect and patients are not all receiving this information from their
doctors.
Mary Shomon's book about thyroid diet focuses on weight loss rather than an eating plan.
Although it is helpful as a reference, it is far too encompassing to be very useful to women that I
have worked with (Shomon, 2004). The main focus is also on caloric restriction. There are no
other significant works that address diet and I have found little that address the role of food in
hypothyroidism, comprehensively.
A thyroid diet should be anabolic and building without including much arachidonic acid
which promotes inflammation (if inflammation is present). It should focus on eliminating any
food sensitivities by using lab tests, an elimination diet or pulse test. Optimally the client should
be encouraged to consume only organic foods. Whole foods are a very important component for
providing the body with the raw materials required to heal and repair cellular and tissue damage.
Including digestive enzymes may prove beneficial in working with clients with
impaired digestion and insufficient hydrochloric acid. Digestive enzymes will allow their
bodies to take full advantage of the full spectrum of nutrients in their diet. Eating organic will
also reduce the toxic load the liver must remove from the body, lowering the toxic load and
freeing up energy to focus on healing. Organic and locally produced foods will also support the
body by providing vitamins, minerals, trace minerals and their co factors.
Although weight loss is desirable in many hypothyroid clients, caloric restriction should
not be the main emphasis (For a three day menu plan see appendix 6). Instead the diet should
focus on:
• Diversity
• Fresh Fruits and Vegetables
• Both animal and non animal sources of protein
• Adequate intake of fat
• Nutrient dense
• Bio available
• Seasonal
• When possible, be organic
• Water intake
Sugar
I would like to pause here and highlight a substance that presents a challenge for the hypothyroid
client-sugar. Every effort should be made to help clients eliminate sugar from their diet for at
least some time period. This is at times difficult because of its wide spread use and addictive
qualities.
In many hypothyroid clients I have seen, there is also a component to sugar sensitivity
and dependency. This is not surprising since insulin (insulin resistance) plays a role in thyroid
disorders and many diabetics are hypothyroid (Shomon, 2004). Hypothyroid people suffer from
various forms of stress, which attributes to a desire to consume food that break down to glucose
quickly. The stress of illness, emotional stress and environmental stress all act to stimulate the
production of cortisol and elicit a stress response by itself. Cortisol, when produced excessively
acts on the body's ability to use insulin.
DesMaisons explains in her book Potatoes not Prozac that some people are sugar
sensitive, meaning that their bodies react differently to simple carbohydrates (1999). What drives
sugar sensitive people to crave sweets is low serotonin, a hormone, and low beta-endorphins, a
neurotransmitter. Sugar acts as a replacement for these two substances that the brain needs. The
problem is that sugar only makes matters worse. And it is not just sugar sensitive people that are
affected adversely, children are particularly susceptible. As children consume sweets at a
younger age and in excessive amounts, they become susceptible to this cycle, as well as
hormonal disturbances.
Sugar affects the natural ebb and flow of hormones and neurotransmitters causing a Dr.
Jekyll and Mr. Hyde syndrome. "Sugar sensitive people have a greater reaction to all things that
evoke a beta-endorphin response . . ." which can lead to compulsive behavior (DesMaisons, 69).
Another important thing about serotonin is that it "also increases impulse control, which allows
you to more easily 'just say no'. People with low serotonin do not have good impulse control"
(DesMaisons, 65). This may pose a challenge to a person who is attempting to change their diet
or make lifestyle changes. Care must be given to insuring that the diet of a hypothyroid person is
rich in protein and fat to increase their chances to succeed in eliminating sugar.
Research also shows that hypothyroid people suffer from an inability to metabolize
carbohydrates effectively (McDaniel et al., 1977; Tuncel et al., 1999). This further lends
credibility that many hypothyroid people have difficulty with sugar/glucose.
Sugar is an anti-nutrient and pulls vitamins and minerals from our bodies and requires the
body to utilize vitamins and minerals in much higher quantities. Sugar particularly causes a
higher need of the B vitamins and magnesium which are already chronically deficient in diets
high in refined white foods.
Sugar, in addition to contributing to poor nutrition, affects every organ in the body and is
the cause of inflammation, which is linked to almost every degenerative disease. Sugar feeds
cancer cells. One teaspoon of sugar can lower the immune system for up to an hour and the
average can of soda contains 10 teaspoons of sugar (Vanderhaeghe, 2001).
The Macronutrients
Vitamin and mineral supplements are a large component to this protocol, but of paramount
importance is the adequate intake of the macronutrients, fats, proteins and carbohydrates. A lack
of these will render supplements useless and in the end, the best source of vital nutrients is food.
Hypothyroid people tend to have diets that are excessive in refined carbohydrates, rancid
fats and commercially raised animal protein. Introducing healthy fats is a step that is relatively
easy for a client to implement and can yield many beneficial effects such as assisting in the
regulation of blood sugar, satiate appetite longer and reduce inflammation.
Fats
Due to a wide campaign, most people in an effort to maintain health use corn, canola and
other vegetable oils to cook with. These oils are highly reactive and become rancid due to
exposure to heat, light and poor extracting methods. Canola oil is also inflammatory (Enig,2000).
The Journal of the Indian Medical Association has reported that Type II diabetes in India has
increased as the people have abandoned traditional oils, like coconut oil, in favor of
polyunsaturated vegetable oils which have been promoted as "heart-friendly" (Fife,
2004). Inflammation is a potential issue with hypothyroidism and removing those oils is a wise
choice.
Oils that are suitable for cooking are; butter, ghee, unrefined palm oil and unrefined
coconut oil. Anecdotal evidence supports the use of coconut oil as a thyroid supporting food
(Fife, 2004). Safflower and sunflower seed oil can also be used occasionally for baking.
Additional oils that can be used raw are olive oil, sesame seed oil, flax seed oil and Udo's oil.
These oils should be cold pressed and be in dark, opaque bottles. Flax seed oil should be
purchased and stored in a refrigerator. These oils are more reactive to both heat and light, so
precautions should be taken to protect them from such exposure. Three to four tablespoons of fat
a day may be a useful starting point for most people, but the amount may vary. Also, this amount
should be gradually added into the client's diet over a period of weeks or months.
Proteins
Animal studies have indicated thyroid function diminishes with a low protein diet (Ramos et al,
2000). The body uses approximately 28 different Amino Acids, some of which are obtained from
the protein rich foods and others are manufactured inside the body from adequate reserve of
nutrients. Amino acids and having a diversity of them are important, but tyrosine is most critical
to thyroid health.
Dieting, as in calorie restriction can also pose a problem, since both fats and proteins are
seen as fatty foods. Work done in the field of eating disorders has shown that this chronic
insufficient intake of calories can trigger hypothyroidism (Beker et al, 1999; Douyon et al, 2002;
Tiller et al., 1994).
An amount of protein varies from person to person, but chicken, fatty fish, turkey, eggs
and nuts are sources to include in the diet.
Carbohydrates
If the client's diet is rich in simple carbohydrates, they should be transitioned to whole
grains, vegetables and fruits. If there is a gluten sensitivity, gluten containing grains should be
substituted for non gluten grains. Most of the diet protocol deals with introducing new
carbohydrates into the client's diet. This will allow for a hypo allergenic diet that is alkanalizing.
This is an important component since the amount of protein is to be increased, it can bring about
excessive acid build up. The cleansing attributes of these carbohydrates should counter any
congesting affects of protein. Also, many hypothyroid people suffer from constipation, lose
bowel movement or an alternation between the two. The increased fiber intake will also assist in
regulating the bowel function. Whole grains, fruits and vegetables, especially when organic,
seasonal and locally grown are the richest source of vitamins and minerals. Since they are in
their whole form, they are also more readily available to the body and contain all of their co-
factors, so are easily absorbed by the body.
Super Foods
There are many foods available on the markets that are branded as "fortified." Their health
benefits are questionable and their additives are many times synthetic. These synthetic vitamins
may not be able to be assimilated by the body and in some cases are toxic, as in Vitamin D
(Thomas, 1998). Super foods that are readily available are naturally "fortified" with many
beneficial substances that the body requires to remain health. The following is a list of food that
have anecdotally shown to improve the health of hypothyroid people:
• Water
• Fiber
• Sea Salt
• Sea Vegetables
• Herbs
• Coconut Oil
• Fermented Foods
• Vegetable and bone Broth
Water
The Standard American Diet (SAD) is very deficient in intake of water. Most of what
Americans drink, in the form of juice, coffee, black tea and soda are diuretics. Americans also
consume a diet high in animal protein, which requires water to digest, and highly processed
foods and large quantities of sugar all require the body to take in more water.
Once the cycle of chronic dehydration is established, the body may no longer signal
dehydration. The body can not remove waste without water. Disease, especial autoimmune
conditions are believed to be caused by an over load of toxins in the body. (Batmanghelidi,
2001).
Fiber
Fiber assists in the detoxification process as well as weight balance. This is accomplished in two
different ways and these two ways hinge on the ways soluble and insoluble fibers work in the
body.
Both soluble and insoluble fibers are not digested or used as a fuel source by our bodies. Instead
soluble fiber combined with water forms a gel (apples, oranges, flax seeds, oats and barley) and
helps slow down the emptying of the stomach and induces satiation. When adequate fiber is
consumed, there will be less propensity to over eat. Insoluble fiber helps keep bowl movements
regular and maintains the pH level in the large intestine and deters harmful microbes from taking
up residency there.
Extra pounds can be caused by excess feces in the colon. The colon can hold between 5-15 lbs
(2.3 - 6.8 kg) of waste in "normal" situations. If the person is chronically constipated, as with
hypothyroidism, the feces can become impacted and the colon can hold up to 25 lbs (11.3 kg) on
the high end.
A good goal to set for fiber consumption is 35 grams (1.2 oz) a day. Fruit, vegetables and
whole grains are the best dietary source of fiber. There are supplements, green and red powders
that one can also consume. When increasing fiber intake, remember your colon is a muscle just
like the biceps, so the colon must be “exercised” slowly to condition it. If the client eats one
serving of vegetables a day, add in two. Also, water balance needs to be maintained to avoid
constipation.
Sea salt, particularly Himalayan
Sea, pink Himalayan, Celtic, French, salts, all provide important trace minerals that your body
needs and is often lacking in most foods, even organic. They cost more, but see it as little grains
of multi vitamins. I like to alternate types to increase diversity in nutrients.
Sea vegetables (Giant kelp, brown seaweed)
The use of iodine rich foods and supplements may be warranted for hypothyroid clients, if there
is a deficiency. The patch test described in this book is one such method to asses iodine status. It
should not be assumed that there is an iodine deficiency. An excess of dietary iodine can result in
hyperthyroidism (Konno et al., 1995).
Ryan Drum suggests a total intake from all seaweed should be 5-10 grams. He also
recommends mixing various seaweeds and to include red and brown seaweeds (Drum, 2008).
Herbs
Add nutrient dense herbs (nettle, raspberry leaf, astragals) and herb teas to soups, broths and
stews also will naturally fortified food.
Coconut oil
It is unclear what the mechanism or component(s) found in coconut oil that may benefit people
suffering from hypothyroidism. No study has been conducted as to the beneficial effect of
coconut oil on the thyroid. It may be that the structure of coconut oil may be acting as a general
tonic. Its structure as a Medium Chain Fatty Acid may act to stabilize cell membrane structure
and improve nervous system activity. The immune system may also be bolstered by caprylic
and lauric acids present in the oil. There is anecdotal evidence that coconut oil can assist the
body in removing estrogen. Coconut oil can also assist in cases of insulin issues due to its ability
to regulate blood sugar, thus lessening the effects of the disease. Coconut oil also does not over
use enzyme production of the pancreas. "This lessens the stress on the pancreas during mealtime
when insulin is produced most heavily, thus allowing the organ to function more efficiently.
Coconut Oil also helps supply energy to cells because it is easily absorbed without the need of
enzymes or insulin" (Fife, 2004)
Fermented Vegetables/Sauerkraut/Yogurt/Keifer
Fermented foods and fermented vegetables can be of benefit to people suffering from
hypothyroidism in two ways. Primarily for those suffering from leaky gut syndrome or from a
lack of healthy gut bacteria, these rich probiotic foods will help to alleviate and resolve both
issues. Secondly, fermented foods are vitamin rich and many of the vitamins that exist in
fermented foods only exist in the fermented form. In addition, the bacteria that are responsible
for all of these benefits also make these foods easy to digest because the bacteria has predigested
them (Katz, 2003).
Vegetable and Bone Broth
In a diet protocol designed for a hypothyroid client, there is little room for empty calories. Every
calorie must be nutrient dense and "fortified," when possible with these super foods. Both
vegetable and bone broths are another way to introduce additional nutritional value to a meal.
Foods to Include and Avoid
Foods to Include
Oils
For Cooking
• Unrefined Coconut Oil
• Sugar free young, green, coconut water
• Ghee
• Butter
Non Cooking Oils-Do Not Heat
• Olive Oil
• Cod Liver Oil
• Omega- 3 Oil
• Udo’s Oil
Nuts & Seeds

• Brazil Nuts
• Almonds
• Sunflower Seeds
• Pumpkin Seeds
• Flax Seeds
Vegetables (non starchy)

• Kale
• Collards
• Swiss chard
• Spinach (cooked)
• Rainbow Chard
• Beet greens
• Cabbage (cooked and sparingly)
• Purple cabbage (cooked and sparingly)
• Arugula
• Mixed Salad greens
• Radish greens
• Roasted Beets
• Cauliflower
• Zucchini (summer squash)
• Acorn Squash
• Broccoli
• Butternut Squash
• Onion
• Garlic
• Red Skin Potatoes
• French potatoes
• Parsnip
• Carrots
• Turnips
• Brussels Sprouts (cooked and sparingly)
• Alfalfa, sunflower sprouts, broccoli sprouts etc . . .
• Celery
• Fennel
• Spaghetti Squash
• Butternut Squash
• Green Beans
• Avocado
• Asparagus
• Leeks
• Daikon
• Sea Vegetables (Kelp, Kombu, Dulse, Sea Palm, sea crunchies etc . . .)
• Agar Agar
• Red, Yellow, Orange, Green Bell Peppers
• Sauerkraut/kim chi
• Fermented root vegetables (carrots, beets, turnips)
• Green & Red powders
• Burdock Root
Fruit
• Lemons
• Cranberries
• Limes
• Olives
• Blueberries
• Strawberries
• Raspberries
• Blackberries
• Cherries
• Apples
• Oranges (not grapefruit)
• Kiwi
• Gogi berries
• Peaches
• plumbs
• Acai berries
• Raw, unsweetened chocolate
• Banana
• Papaya
• Pineapple
Sweeteners
• Stevia
• Xylitol
Grains
• Amaranth
• Brown Rice
• Quinoa
• Brown Rice & Quinoa Pasta
• Buckwheat
• Millet
Beans
• Lima
• Lentil (French, green & red)
• Garbanzo
• Fava
• Pinto
• Black
• White northern beans
• White & red kidney beans
• Christmas lima beans
• Wax beans
• Mung
• Azuki
Herbs
• Astragalus
• Mint
• Cilantro
• Parsley
• Basil
• Oregano
• Thyme
• Rosemary
• Sage
• Turmeric
• Ginger
• Cinnamon
• Dill
• Cumin
• Nettle
• Stevia
• Rose Hip
• Fenugreek
• Curry
• Bay Leaf
• Herbal Teas
• Hibiscus
• Marshmellow (herb)
• Burdock root
• Chamomile
• Nettle
• Raspberry Leaf
Fish, Poultry & Meat

• Salmon
• Tuna (Whole Foods)
• Any cold water fatty fish
• Fish Oil
• Eggs (Marin Sun Farms-Planet Organics)
• Chicken
• Lamb Shoulder
• Beef
• Clams
• Mussels
• Scallops
• Halibut
• Shrimp
• Liver
• Turkey
Other
• Raw (unpasteurized) Apple Cider Vinegar
• Kefir
• Chlorophyll
• Water
• Sea Salt
Foods to Avoid
• Soy
• Sugar
• White flour
• White rice
• Fast foods
• Soda
• Hydrogenated oils
• Cruciferous vegetables (especially raw)
• Raw Spinach
• Caffeine
• Alcohol
• Canola (Rapeseed) Oil
• Corn Oil
• Fluoridated water and fluoride containing oral hygiene products

Chapter 12
Step 8 Supplements, Herbs and Holistic Therapies
Supplements, herbs and holistic therapies are a substantial portion of a hypothyroid healing
protocol. Again, because of the nature of Hashimoto's, secondary and subclinical
hypothyroidism, many hypothyroid clients respond well when using herbs (Rothfeld, 2003).
There is a vast array to select from and according to what each client's need might be, the
supplement, herb or therapy can be adjusted.
Herbs and Fungi:

Various herbs and fungi have profound effects on psychoneuroimmunity. They allow us to adapt
to stressful situations, stimulate the circulation, support organ function and strengthen the total
body. Herbs and spices make food more flavorful, but they also make meals more nutritionally
dense. Fresh herbs tend to have a weaker medicinal effect relative to dry herbs. Fresh herbs, used
in season and organic can also stimulate the body’s natural instinct to heal. Fresh herbs can
produce well being by gently reminding the body, organs, tissue and cells of their functions.
Some dried herbs may be too potent at first and elicit too strong an effect, so I recommend fresh
herbs to begin introducing them into your diet. These herbs are specifically useful in healing
hypothyroidism:
• Bladder wrack, iodine deficiency
• Kelp, iodine deficiency
• Irish Moss, iodine deficiency
• Coleus Forskohlii (Makandi)
• Guggul (an Ayurvedic herb)
• Adaptogenic herbs like astragalus, ginseng, and aswaganda. Some adaptogenic herbs
maybe too strong so begin slowly and consider starting with dried astragalus.
• Milk thistle, silymarin to support liver function (Davis-Searles et al. 2005; Jacobs 2002).
• Bromelain to decrease inflammation (German Commission E, approved bromelain for the
treatment of swelling/inflammation of the nose and sinuses caused by injuries and
surgery in 1993)
• Curcummin to decrease inflammation (Bland, 1999)
• Raw ginger, garlic and onions for their anti inflammatory and anti oxidant function
(Bland, 1999)
• Reiki, immune support
• Shiitake, immune support
• Maitake, immune support
• Pool ridge Teas-Adrea-Stim, Thyroid Tea, Fem Cycle, Live-Endo, Digest-Stim (please
see appendix 2 for tea preparation and dosage).
• Oatstraw, nourishes the body and supports the immune system

• Alfalfa, supports and nourishes the body, may be too heating for some
• Nettle, nourishes the body, may be too heating for some
Nutrients
Vitamins and minerals are typically deficient in hypothyroid people, due to various reasons that
were discuses in previous Steps in this book. Nutritional status must be monitored vigilantly with
hypothyroid clients. Initial improvements may be felt immediately by some clients, like the
introduction of vitamin C, the B vitamins and magnesium. Depending on the client's nutritional
status, the supplement protocol my not result in significant improvements for three, six, nine
months or up to a year. It is important to continually encourage the client to regularly take their
supplements, even if they do not see significant results. If there is an adverse effect, the
supplement should be discontinued.
Digestive enzymes, green and red powders as well as a liquid supplement should
compose the first one to three months of the protocol, also bromelain if inflammation is
suspected. Depending on the digestive status of the client, many supplements in pill form will
not be suitable because the client will not be able to digest or absorb them. Nourishing teas (Min-
Rich), Intramin (minerals only), Intramax are liquid supplements that I have used successfully
and have yielded result within three months, when the client is compliant. There are various
thyroid supplements available, but I have not used them, so I have no experience with them. The
vast majority of my clients do not consume pork, so I do not use glandulars, so I will not attempt
to address them here.
Supplements
These nutrients have shown to be needed or deficient in people suffering from hypothyroidism
(refer to appendix 10 for dosage amounts).
• B Complex
It supports the immune system, metabolism, supports the body during times of stress. It is a
necessary vitamin for proper thyroid function. It is most commonly found in whole grains
and is extremely deficient in the American/ processed food diet (Vanderhaeghe, 2001).
• B6 (Pyridoxine) Assists the body convert iodine into thyroid hormone. All B vitamins
should be supplemented since they work in concert with each other.
• B2 (Riboflavin) - The endocrine system can become dysfunctional with an insufficiency
of B2. It is essential to the thyroid and adrenal glands.
• B3 (Niacin) Assists in delivering nutrients to the cells.
• Vitamin C
Is a potent anti oxidant and is more effective when taken with bioflavinoids (found in the
white pith of citrus fruit) and other anti oxidants. It fuels the adrenal glands and thus supports
the thyroid-adrenal-pituitary axes. It supports the immune system. It is also anti-
inflammatory. It is essential to the adrenal glands and the thyroid and adrenal glands are
partners. One should dose to bowl tolerance and then reduce the amount by 20% to find your
daily dose of vitamin C. It is also a powerful anti oxidant (Wilson, 2001.) Vitamin C is easily
damaged by light and heat. Vitamin C in most commonly found in broccoli, kale, red chili
and guavas.
• D
It is supportive to the proper function of the pituitary gland and may be involved in the
conversion of T4 into T3 (Shomon, 2000). Found in fish and exposing skin to sunlight.
• Magnesium
Is one of the most abundant minerals in the body and is needed in over 200 processes in the
body. It allows the muscles to relax, while calcium causes contraction. It is used particularly
during times of stress. The body attempts to maintain levels of magnesium in the blood as
stable as possible, so blood work may not reveal a deficiency. If it does, it is a marker of the
extreme stress the body is under. Kelp, wheat bran, raw chocolate and black strap molasses
are rich sources (Murray, 1996).
• Vitamin D is essential for proper function of the thyroid and for proper immune function.
There is a higher rate of Hashimoto’s and hypothyroidism in the northern hemisphere
(Vanderhaeghe, 2001).
• Vitamin A and Carotenes
They support the immune system. Vitamin A supports the maintaining of the mucosal
surfaces of the body while the carotenes enhance the thymus. Vitamin A also acts
synergistically with E. Good food sources are red, yellow and orange produce as well as liver
and dandelion root (Murray, 1996).
• Vitamin E
Oxidative damage is a key marker in the development of auto immune disease. It works
synergistically with other anti-oxidants. It is necessary for the health of the cellular
membrane and provides protection against heavy metals. It plays a critical role in protecting
the body from oxidative damage during disease and supports the immune system (Murray
1996). Food sources include nuts, seeds, avocado, asparagus and berries.
• Selenium - Insufficient intake of selenium can trigger autoimmune thyroid disease.
Selenium initiates the enzyme (hepatic type I iodothyronine deiodinase) that is used in
the conversion of T4 to T3 (Negro et al., 2007).
• Zinc is required in over 200 enzymes in the body and is found in every cell. It is critical
to the endocrine system and is used by the body for repair (Murray, 1996). Food sources
include fresh oysters, shellfish, pumpkin seeds, ginger root and Brazil nuts zinc is needed
at the intracellular level to help the thyroid nuclear receptors attach and drive the reading
of the DNA genetic code. Keep in mind that the main function of thyroid hormone is to
help put the genetic code into action (Shomon, 2000).
• Iodine is solely used by the thyroid gland to produce thyroid hormones. Three iodine
molecules are added to make T3 (triiodothyronine), and four for T4 (thyroxine) -- the two
key hormones produced by the thyroid gland. Iodine is essential to the production of
these two hormones of the master gland of metabolism. Experts are not clear on the
amount of iodine to be consumed to maintain thyroid healthy. The common source of
iodine in the diet is iodine fortified salt. Iodine is found in produce grown 100 miles from
the sea. Sea foods, sea vegetables and agar agar are all natural sources of iodine (Drum,
2008; Lang, 2008).
• Amino Acids- Particularly Tyrosine which is essential to thyroid function.-Almandine,
L-Arginine, L-Aspartic Acid, L-Cystine, L-Glutamic Acid, L-Clycine, LHistidine,L-
Isoleucine, L-Luceine, L-Lysine, L-Methionine, L-Phenylalanine, L-Proline,L-Serine, L-
Taurine, L-Theronine, L-Tryptophan, L-Tyrosine, L-Valine (Shomon, 2000)
• Full Spectrum Digestive Enzymes
• Bromelain to decrease inflammation
Homeopathic Remedies
Common Homeopathic remedies include:
• Alcare phos.
• Ammonium muriaticum
• Badiaga
• Baryta carbonica
• Calcarea iodatum
• Ferru iodatum
• Focus
• Ignatia
• Iodium
• Lapis alb
• Lycopus virginicus
• Spongia tosta
• Sulfuricum iodatum
• Thyroidinum
Homeopathic remedies should not be taken without consulting a trained Homeopathic doctor
(www-thyroid.com).
Holistic Therapies
The clients I have worked with all had a component of extreme emotional stress and trauma that
was unresolved. As a result they were not able to progress in their process of healing. Their
emotional trauma literally was lodged in their body and was thwarting their healing process. It
may be that a trigger for secondary hypothyroidism involves substantial emotional stress. This is
a topic that is little addressed in thyroid literature, but should be considered as a major trigger in
some people and should be screened for in the initial client intake. The works of Dr. Dietrich
Klinghardt suggest that not only is such a connection is probable, but exists and will inhibit the
healing process (2001, 2006).
I have found that there is little compliability with a healing protocol (even when broken
into steps) by the client until they address emotional stress and trauma. Typically a client will
initially begin the protocol, take supplements and eat breakfast, but soon after their life spirals
out of control. Since they are already suffering from years of stress and attempting to begin a
healing protocol, any event in their lives is an additional stress that cannot be handled. I have
also found that "talking" about it does not produce adequate results, although some form of
counseling is beneficial. What I have found to work in drawing out this emotional trauma and
eliminating it is body work.
Case Study 8: I Put It All Behind Me
Violet was a very challenging case because she was very compliant in following her protocol,
but was not progressing as I would have liked to see. She suffered from chronic bouts of illness,
low blood pressure, fatigue and obesity, I suspected hypothyroidism and she went into do the
blood work to check. It came back negative, but I still suspected hypothyroidism. I suggested that
we support her thyroid and adrenal, but for some reason, she did not want to. I also suspected
emotional trauma, but her continual mantra was "I put it all behind me." After a year and a half
of working together I suggested that she consult with someone else who had more expertise than
me. After a year she returned to my care and in worse condition. Her hair was falling out, her
skin was dry, she had difficulty getting out of bed, she gained more weight and her mind was
always racing-all symptoms of adrenal fatigue and hypothyroidism. She also seemed depressed.
We discussed the same issues, but she said, "I put it all behind me." We adjusted her diet and
started a supplement protocol, but not much was improved. After another year of hearing her
mantra, "I put it all behind me," I had an idea. Although she was overweight, by far, her behind
was disproportionately large. I began to believe that she literally had placed all of her emotional
trauma "behind her." At this stage she was also chronically ill again. I called her up and asked
her if she thought if my "hypothesis" made any sense to her. She did not respond for a while and
then she said she agreed. Two days later I received a call that the flu she had been battling with
for months was gone. We began body work treatments and she had her thyroid re tested-she was
now hypothyroid, but borderline. I am happy to say that she is now doing well and has lost over
20 pounds and no longer is putting her emotional trauma behind her.
Body Work
There are various forms of body work that may work for various people. The following is a list
of bodywork therapies that I have found most useful. I do not recommend acupuncture for people
experiencing this type of stress. I find it to be too invasive and aggressive for such people and the
purging effect it illicit is far too strong. I prefer gentle, but effective bodywork for such clients,
they are:
• Network chiropractic
• Jin jin shitzu
• Acupressure
• Reflexology
In Addition there are self care body work techniques that can be used (please refer to
appendices 1,3 and 5).
Life Style Suggestions
The lifestyle suggestions made for a client will vary, but typically stress reduction, relaxation
techniques and time management skills are needed (refer to appendix 8 for further suggestions).
Among the women that I spoke with, primarily mothers, so much of their healing
included sharing their stories. The act of speaking with someone who was actively listening, in a
few instances, was enough to make huge lifestyle changes and begin the healing process. Many
of these women, at some time in their life, felt like they had no voice and were subject to the
wants of their families. I cannot emphasize how integral a part this type of active dialoguing and
clinical intake makes when working with women suffering from secondary hypothyroidism and
Hashimoto’s. It is usually the starting point.
The isolation they feel and low self esteem, coupled with depression is a strong barrier to
implementing any healing protocol and needs to be addressed, usually along with bodywork. A
few techniques I have employed include:
• Alone Time at least once a week to allow for recharging

• Meditate or reflect daily at least for five minutes (daily alone time)
• Eliminating Energy Robbers
This can be accomplished by writing the names of people whom you feel, tired or tense
after interacting with. If you can not completely remove them, then reduce contact as
much as possible.
• Eliminating Toxic Emotions
This can be accomplished by writing a list of these emotions and situations that they
occur in.
• Counseling/group therapy
• Reframing/Using Positive Self Speak/Gaining a Fresh Perspective
• Setting Priorities
• Establish a Support Network
• Find the sources of joy in your life
• Sleep for at least 8 hours each night. Try to be in bed no later than 10 P.M. Keep your
room as a space for sleep so that your body becomes conditioned to sleeping in that
room. The body heals itself when we sleep and we cannot “make up” our body’s repair
time, we just go into sleep debt. Additional sleep may be required as the body attempts to
shut down functions to focus on the healing process. Allow yourself the time to sleep and
heal.
• Smile
• Optimism
• Express emotions like fear, anger and sadness in productive ways
• Do what you love
• Surround yourself with beauty and find the beauty that is already around you
• Connect to something greater than yourself.
• Ask for help, do not take on more than you can comfortably handle.
• Body Work
Chapter 13
Step 9 Exercise
The effects of moderate exercise on the human body and its systems are well researched. What is
of interests in this paper are the beneficial effect of exercise on the immune, detoxification and
nervous systems.
Moderate exercise supports the immune system by gently stimulating it. Repeated
strenuous physical stress can have the adverse affect (Goetz-Hoffman and Klarlund Pedersen,
1996). If chronic infections are involved or suspected as part of the thyroid disorder, immune
system support it warranted.
Exercise stimulates the detoxification pathways, such as the liver and bowel (Peters et al.,
2001). As the body attempts to eliminate waste via the liver and the bowel, movement, as in
exercise allows these pathways to work more effectively. Estrogen dominance is a commonly
occurring condition with hypothyroidism. As such, the liver will have to remove excess estrogen.
Also the liver is responsible for converting the inactive T4 into the active form of T3. A heavy
body burden of toxic substances may also be contributing to hypothyroidism, in which case the
liver and bowel are required to work optimally to conjugate and remove the excessive
substances. Exercise also stimulates perspiration, another detoxification pathway associated with
the skin.
The lymphatic system, also part of the detoxification process, is stimulated by exercise.
Unlike the circulatory system that moves blood throughout the body, the lymph fluid is moved
through the lymph vessels by compression of the surrounding muscles (Smith, 1995). In order
for this to occur, there must be movement of the muscles. As the lymphatic fluid is moved, it
removes impurities from the body and allows the lymph nodes to remain uncongested.
Moderate exercise allows the body to cope with stress more effectively. Exercise
stimulates nervous impulse to become faster, increases response, and increases pain tolerance
(Christensen et al., 1983). It also releases endorphins that allow increased resistance to stress
and reduces the negative psychological effect of stress (Farioli el al., 1980; Golfarb et al. 1997).
Strenuous exercise sustained for long periods of time does not support the immune system or
the nervous systems, as it mimics the process of excessive stress (Goetz-Hoffman and Klarlund
Pedersen, 1996). Gentle exercise like yoga, stretching, Tai Chi and walking are more
appropriate (Murray 2001).
The exercises that I selected are set in three stages that begin with gradual movement and
increase in intensity and strenuousness.
Stage 1
• Stretching
• Yoga
• Tai Chi
• Chi Gong
• Pilates
• Movement Therapy
Stage 2
• Walking or water resistance training
• Weight training
Stage 3
• Hiking
• Dance
• Swimming
• Cycling
Relaxation is a required precursor to beginning an exercise program. Many people suffering from
hypothyroidism, particularly those I work with, lead very physically strenuous lives. I initially
begin with relaxation techniques, like alone time, a warm bath, self body care techniques ( refer
to appendices, 1, 3 and 5), meditation and deep breathing .
Chapter 12
Conclusion
Various studies have confirmed that there are various triggers or causes of secondary
hypothyroidism. These studies have also confirmed that these causes are not unknown. The
connection between the adrenal glands and the thyroid are explored by Zahidi et al. and
nutritional status by Azizi (1999, 2004). Also addressed in the literature are the negative effects
of goitrogenic foods (Doerge et al., 2002). Low protein diets have been researched by Ramos et
al. and environmental contaminates by Boas et al. (2000, 2006). The role of chronic infection
like Hepatitis C has been discussed by Antonelli et al. Stress as a trigger has been shown in the
works of Azizi, Lazarus et al., Stagnaro (2005, 2005, 1996, 2000). How the mind is influenced
by thyroid hormone is also well documented (O'Kane, et al., 2006; Tsigos et al., 2002). Caloric
restriction as in the eating disorder anorexia have been shown to be an independent trigger for
hypothyroidism (Tiller et al., 1994; Beker et al., 1999) and thyroid atrophy caused by eating
disorders (Munoz et al., 2002) and the effects of starvation and obesity as triggers are all well
researched (Douyon et al., 2002). Both family history and genetics are addressed by Hansen et.
al’s work with twins as well as by Peeters et al’s work (2004; 2006). Nutritional deficiencies
are well established triggers (Negro et al., 2007; Mancici et al., 2005). The idea of a thyroid set
point is also discussed by Biondi et al. and Hansen et al (2005; 2004). Insulin sensitivity was
researched by Fernandez-Real et al (2006).
The information presented in this book is not controversial. Each Step is supported by
scientific studies that are all accepted. The scientific studies that delve into the topic of
hypothyroidism address causative factors as well as the efficacy of possible treatments.
However, each study is a singular unit that does not expand or join other possible causes or
“cures” that would be beyond their scope. This book has set out to compile various known
triggers and healing approaches to hypothyroidism in a holistic approach to both diagnosis and
healing. A large emphasis is placed not only on clinical application for practitioners, but also
usability for the hypothyroid sufferer as well. Unlike books that have sought to address this
topic, here you find both diet and alternative therapies that address emotional trauma.
The Nine Step program developed here provides flexibility as well as a structure to
follow as opposed to a confusing or haphazard approach. There also is not an emphasis placed on
the use of pharmaceuticals, although useful to some, such information is provided in detail by
other sources and by qualified physicians.
In addition, unlike other sources, this book acknowledges the difficulty sugar/refined
carbohydrates consumption plays as a symptom and a trigger in hypothyroidism, as well as the
role of emotional stress. These are two veins of research that should be further pursued,
particularly since many hypothyroid people become diabetic and/or suffer from depression and
other psychological disturbances.
Despite the well-documented nature of each Step presented in this book, many health
care practitioners and hypothyroid sufferers are not aware of them. It is the ultimate aim of this
book to promote and popularize these findings.
Appendices
Appendix 1 Self Care Bodywork
Self care body work can be an integral part of a healing protocol. This will include the client and
assist the client in becoming more aware of their body as well as with their emotional state.
The Chakras
The use of the chakras includes stimulating both the front and back chakras. To stimulate
these points, place the finger tips of the right hand over the chakra. The back and front chakras
can be stimulated at the same time or separately. The back chakra is located on the backside of
the body opposite to the frontal chakra. These points are held until the person feels relaxed or
feels a sense of release.
I have not used the base chakra, so we will begin with the sacral chakra for balancing the
female hormones and stimulating the primal life force. The solar plexus is the seat of emotions.
The heart chakra can help in calming anxiety or strengthening resolve. The throat chakra shares
the same space as the thyroid gland and also assists those who have difficulty speaking up for
themselves. The third eye centers the person and brings clarity of purpose. The crown chakra
should be used with caution as it can open up the person beyond a point that they are ready for.
Healing is at first an inner looking process and the crown chakra can force the person outward.
Jin jin Shitzu
All of the body work associated with Jin jin shitzu can be self applied. For clients who are
dealing with emotional stress, there is a simple daily application of Jin jin shitzu that will assist
the body in removing toxic emotions and events. This can be done before getting out of bed, or
anytime of the day.
Step 1
11 Take the index finger and hold it with the left hand. This finger is associated with
fear and since it is the right finger, it will deal with anger in the right side of the body. Do not
squeeze, just hold it. It can be held it for up to 10 minutes.
Step 2
Take the middle finger and hold it with the left hand. This finger is associated
with anger, particularly anger on the right side of the body.
Step 3
Take the ring finger and hold it with the left hand. This finger is associated with
sadness.
Step 4
Take the pinky and hold it in your left hand. This finger is associated with
uncertainty.
Step 5 Repeat this with the left hand.

Appendix 2 Tea Preparation and Dosage
Tea Preparation and Dosage
The Pool Ridge teas should be taken in the following manner for medicinal doses:
• Month 1 take the tea once a week. Brew 1tsp-2tsp in 8 oz water for 10 minutes, covered. There is
a large range here. Always start at the lowest dose, but it can be adjusted to up to 2tsp.
• Week 5, take the tea twice a day at 2-3tsps (3 if 2 tsps was the previous dose). Brew in 8 oz water
for 15 minutes.
• Week 6 take the tea three times a week at 3 tsps. Brew in 9-10 oz water for 15-20 minutes. Check
to see how you feel. Are there any "strange" sensations like dizziness? If so brew for less time or
decrease the amount of tea.
• Week 7 take the tea four times a week 3 tsps. Brew in 9-10 oz water for 15-20 minutes. Check to
see how you feel. Are there any "strange" sensations like dizziness? If so brew for less time or
decrease the amount of tea.
• Week 8 take the tea five times at 3 tsps. Brew in 9-10 oz water for 15-20 minutes. Check to see
how you feel. Are there any "strange" sensations? If so brew for less time or decrease the amount
of tea.
• Month 3 take the tea five times 3 tsps. Brew in 9-10 oz water for 15-20 minutes. Check to see
how you feel. Are there any "strange" sensations? If so brew for less time or decrease the amount
of tea.
• Month 4 take the tea four times a week 3 tsps. Brew in 9-10 oz water for 15-20 minutes.
• Month 5 take the tea three times a week at 3 tsps. Brew in 9-10 oz water for 15-20 minutes.
• Month 6 take the tea twice a day at 2-3tsps (3 if 2 tsps was the previous dose). Brew in 8 oz water
for 15 minutes.
• Months 7-11 take the tea once a week. Brew 1tsp-2tsp in 8 oz water for 10 minutes, covered.
• Month 12 take the tea once a month, 3 tablespoons in 9 oz of water and let seep for 30 minutes.
This is the maintenance does. It can be taken every month for another year, if needed, but
typically every 6 months the second year is recommended.
Appendix 3 Deep Breathing Exercise with Yoga Poses
The Corpse Position*
This yoga pose not only brings peace and calm

to the mind, it also brings it to the body as well.
When dealing with thyroid or adrenal issues,
finding a sense of calm can be a challenge.
Many times there is continual mind chatter,
particularly at bed time or thoughts are scattered
and there is disjuncture. This pose is best
performed before sleeping to prepare the mind and body for rest. It can also be done at anytime
during the day.
• Find a quite spot.

• Lie flat on the back on the ground.
• Straighten legs and make sure that the back is still evenly flat on the ground.
• Feet should be shoulder width apart. (1/2 meter or 2 feet apart).
• Relax arms and place them away from the body at 45-degree (approximate) angle, palms
upward and fingers slightly curled.
• Close eyes and begin to focus on each inhalation and exhalation.
• The entire body is completely relaxed.
• Mind is focused on breathing.
• Empty the mind and breath in through your nose and exhale through the mouth, allowing
all tension and stress to escapee with each breath.
• Inhale, abdomen rises.
• Exhale abdomen falls.
• Continue to breath only through the nose.
• Imagine a gentle warmth begin to spread from the top of the head.
• Lift the eyebrows and let stress fall from each one.
• Drop the chin to chest. Open the mouth, slightly and release any tension in the jaw.
• Slowly lift up the head and run the finger tips up the back on the neck to the nape of the
neck.
• Feel the warmth move down to the shoulders and the chest.
• Notice the beating of the heart. Feel it slow and with each breath.
• Feel the warmth move down the arms and to the finger tips.
• Feel the warmth spread down through the abdomen and continue to breathe deeply
• The warmth now moves down the legs and to the feet and toes.
• Lie in this position and feel a deep sense of calm.
*Modified Position during pregnancy will have the person lie on their right side with a pillow
between their legs.
Child’s Pose*
This pose helps relax the mind and body, while

grounding and bringing a deep sense of calm.
Touching the head to the floor releases daily
stress.
Find a quite spot and kneel on the floor, heels

shoulder width apart.
Inhale and then exhale, bending forward from the waist and touch the forehead to the ground.
Broaden your sacrum across the back of your pelvis. With each inhalation, lengthen the spine
from the tailbone to the back of the pelvis while you lift the base of your skull away from the
back of your neck.
Place the hands on the floor alongside the torso, palms up, and release the shoulders toward
the floor. Feel the weight of the front shoulders pull the shoulder blades wide across back.
Remain in this resting pose from 30 seconds to a few minutes.
*Modified position during pregnancy, spread the legs far enough apart to make room for the
belly and place hands forward on the ground as opposed to at the sides.
Appendix 4 Hair Oil
Hair Oil
This hair oil assists in the regrowing of hair when applied at the root. Black cumin seed oil,
unlike any other oil, is able to enter the blood stream when applied topically. It also has the
ability to balance the endocrine system and has a profound effect on the immune system. I have
used this hair oil successfully with women suffering from hormonal imbalances, including
hypothyroidism.
Ingredients:
2 oz Cold Pressed, virgin Olive Oil
2 oz Organic Black Cumin Seed Oil
10-15 drops Lavender Essential Oil
5-10 drops Rosemary Essential Oil
1, 4 oz bottle with a dropper or a pouring spout
Method:
Combine the first two ingredients in the 4 oz bottle. Before you add the essential oil, smell each
one to make sure that they are not offensive to you. Then, one drop at a time, add the lavender
and then the rosemary essential oils. Take care not to put more essential oil than you can tolerate.
If you are sensitive to scents, add one drop of each, as it “matures” the sent will become more
potent. If you feel that this is too weak, add in a few more drops. If you do not care for either
sent, omit them.
How To Use:
To use the oil, apply 5-15 drops to the scalp, depending on the length and texture of your hair.
You can apply it overnight or a few hours before taking a shower. Apply 3-5 times a week for a
month. This can then be used as a hair treatment every 1-3 months.
Store the oil in a cool, dry place.

Appendix 5 Reflexology Points
There are various points on the feet that can be stimulated to assist with thyroid health. Also,
depending on the symptoms, supportive areas/points can also be stimulated.
Locate the thyroid and adrenal points on both feet.

Step 1
Step 2 In order to stimulate these points, begin with one point on the right foot and
progress to the left foot when complete. Always alternate and do not stimulate
more than one point at a time. Use the thumb and gently push on one point for 10-15
seconds. This can be done every day, three times a day.
Step 3 If there is a digestive issue or a liver issues, locate the point for the stomach,
liver, gallbladder and spleen on both feet and stimulate these points, separately.
If the pituitary is involved, locate it on both big toes and stimulate. Stimulate
Step 4
the point on each foot and then progress to the corresponding point on the
opposite foot.
Appendix 6 Three Day Menu Plan
Day 1 Day 2 Day 3
Breakfast Breakfast Breakfast
Green eggs, sweet bell pepper salsa, Creamy quinoa topped with 2-3 egg omelet w/ kelp sautéed
avocado cream, & sauerkraut. pumpkin seeds and coconut oil vegetables in parsley, cilantro
mint sauce.
Lunch Lunch Lunch
Salmon w/ caramelized onions, sweet Tajeen of artichokes olives and Garlicky ginger stir fried
bell pepper salsa, avocado cream in a minted quinoa broccoli bok choy and brown
brown rice, spelt or whole wheat wrap. rice noodles
Dinner Dinner Dinner
Shell fish stew in Charmula, tossed Lamb Curry , cauliflower & Stuffed Bell Peppers and salad
mixed green salad with herbed salad parsnip stew, olives and unbrown w/ lemon mint salad dressing
dressing rice
Recipes
Day 1
Breakfast
Green Eggs
2-3 organic eggs

1/2 cup greens (collards, chard, spinach, kale) with the spines removed and torn in half
1 tablespoon dry oregano & thyme.
1 tablespoon unrefined organic coconut oil
Salt and pepper to taste
Kelp to sprinkle on top
Place all of the ingredients in a blender, except coconut oil and kelp. Blend until the greens are
fine and meld into the egg. Pre heat a cast-iron skillet and add the coconut oil. The oil should not
smoke. Pour the eggs and greens into the skillet and fry. Sprinkle with kelp flakes and serve.
Sweet Bell Pepper Salsa
2 green bell peppers

1 purple bell pepper
1 red bell pepper, all diced and de-seeded
1 or 1/2 whole onion, diced
1 handful cilantro, diced
1 clove garlic, minced
2 teaspoons fresh grated ginger
Sea salt and pepper to taste.
Place all ingredients in a stainless steel or glass bowl. Using a wooden spoon stir the contents
until completely blended. Place in a glass gar for storage. It should keep in the refrigerator for 6-
8 days.
Avocado Cream
From Rebecca Katz
2 ripe avocados
5-8 sprigs of mint, diced
1 clove garlic
Remove the skin and pits from the avocado. Reserve one pit. Mash the avocados and add in the
mint, garlic, salt and pepper. Adjust taste to your liking. Place the avocado cream in a glass jar
and place the avocado pit in the center. The pit will keep the avocado from oxidizing (turning
brown). It should keep in the refrigerator for 3-5 days. You can use this as a dip for raw
vegetables as well.
Lunch
Greens for the Masses

This is my version of Rebecca Katz recipe in her wonderful
cookbook One Bite at a Time.
1-3 teaspoons Coconut oil, ghee or butter

Half an onion, sliced thin
1 bunch kale, Swiss chard, collards or any other leafy green
1 bunch spinach
3-4 tablespoons water
Salt to taste
Pre-heat a large frying pan then add your oil of choice. Do not be
afraid of these healthy fats. It is very rare to have the genetic
mutation that causes cholesterol to build up excessively.
Caramelize the onions on low for about 20 minutes. Add the
greens, spinach and broth. Cover and let steam for 15 minutes.
Add salt to taste.
Dinner
For years fish at my house meant baking it or frying it.

Sometimes I would b-bq it, but nothing really adventurous. This
made it really hard to eat fish often. Well, the first thing I did was
talk to the guy behind the fish counter. I told him I was interested
in learning new ways to cook fish and asked him how he prepares
fish. Next, I talked to the people standing in line to buy fish. One
woman told me about a Tai fish soup. She did not have a recipe,
but here is the one I came up with.
Chermoula
1-2 garlic cloves, crushed

juice of two lemons
1 tbls cumin
1 tbls coriander
2 tsp paprika
1 tsp salt
handful of cilantro sprigs, diced, no stems
handful of parsley sprigs, diced, no stems
1/4-1/2 cup olive oil
Place everything in a bowl and mix. Add the fish and let in
marinade, the longer, the better. With that base, you can make
this soup:
Seafood Soup (You can throw anything in here) serves 6-8

1 lb fish stew
1/2 shell fish mix
9 cups water
Chermoula
1 red bell pepper without seeds
4 tomatoes, skinned and chopped up
handful of parsley and cilantro sprigs with stems
1 onion, sliced
1/3 cup olive oil
salt.
Place the fish and shellfish in the chermoula and coat everything
well. Let sit for 30 minutes. Place the olive oil in the pan with the
onion, cilantro, parsley, tomatoes and 1 tsp of salt. Add 9 cups
water and bring to a boil. Simmer uncovered for 30 minutes.
Add the fish and shellfish mix 3-4 minutes until cooked and all the
shellfish opens. Discard any that do not open. Add salt or lemon
to taste and serve.
Herbed Salad Dressing
Makes 2-5 servings
3 tablespoons Olive, Flax or Udo's oil (or a tablespoon each)

2 tablespoons apple cider vinegar
1 tablespoon oregano, chili flakes, dill, thyme, rosemary & salt
Place all ingredients in a glass masons jar and cover with a lid. Shake until blended and adjust
taste to your liking. Pour over salads or cold pasta salads.

Day 2
Breakfast
Creamy quinoa
1/3 cup quinoa
2/3 cup Min-Rich, water or Mineral Broth
Place the quinoa in a non-reactive sauce pan (stainless steel, ceramic), turn on to low heat and
slowly add the water.. You want to continually stir it or it will get bumpy. Once the mixture is
thick, remove from heat and pour into a bowl. Top with 1 tablespoon coconut oil and blend.
Then top with 2 tablespoons pumpkin seeds.
Lunch
Tajeen of Artichokes
Serves 2-3
This makes a nice weekend lunch.
6 artichokes, spiky tops and stem trimmed and peel away the rougher leaves
2-3 tablespoons of extra virgin olive oil
2 teaspoons paprika
1 whole onion, sliced
1-2 cup water
1-2 teaspoon salt
Place all contents in a ceramic tajeen, or stew pot, except water. Blend all ingredients until the
artichokes are coated well. Pile the onions on top and add water so it reaches half way up the
artichokes. Cover and simmer for 1-2 hours in a tajeen or 45-1 1/2 hour in a stew pot. Serve with
minted quinoa. Add chopped mint to the quinoa.
Dinner
Lamb Curry
Serves 4-6
2-3 pounds of lamb for stew with bone

2-3 cups Mineral Broth or water with kombu and astragalus added
1 whole onion, sliced
1 can of tomato paste
3-4 tablespoons coconut oil
2-4 tablespoons minced garlic
2-4 tablespoons minced ginger
1-2 tablespoon Organic, Bombay sweet curry
1-2 teaspoons chili flakes
1-3 teaspoons of agar- agar to thicken, if needed
Cilantro sprigs, chopped
In a non reactive frying pan heat the coconut oil. Add in the onions and place a dash of salt on
top. Caramelize the onions on a medium low heat for 15-20 minutes. After that, add in the lamb
and brown. Before the browning is complete, add in the garlic and then the ginger; add in a pinch
of salt. Add in the curry and the chili flakes. Pour enough Mineral broth to cover the meat, add a
pinch of salt. Add in the tomato paste, add a pinch of salt. Bring to a boil then reduce heat and
cover. Let simmer until the oil forms an iridescent film over the curry. Garnish with fresh
cilantro to aid digestion.
Cauliflower & Parsnip Stew
1 head cauliflower, washed and chopped into 2 inch pieces
2-3 small parsnips, peeled and cut into quarters

1 tablespoon coconut oil
1/2-2/3 cup Mineral Broth
2 teaspoon cumin seed
1 teaspoon ground coriander
Fresh mint, chopped to garnish
Heat the coconut oil in a firing pan. Add in the cumin seeds and fry for a few moments. Add in
the cauliflower and the parsnips and a pinch of salt. Pour enough Mineral Broth to just come half
way up the vegetables. Adding ground coriander and a pinch of salt. Bring to a boil, reduce heat
and cover. Garnish with fresh mint to aid digestion.
Un-brown Rice
4 cups brown rice

6 cups water
1 strip kombu
2 tablespoons butter
1/2 onion diced
4 garlic cloves, minced
1 pinch saffron
1 teaspoon turmeric
Salt
Butter
In a stock pot, heat butter and add in onions. Fry for 1-2 minutes. Add in garlic and fry for 1-2
minutes. Add in a pinch of salt. Pour in the water and add in the kombu, 1 tablespoon butter and
enough salt to taste. Bring to a boil. Add in turmeric and saffron and rice. Cover (leave a space
for the steam to escape) and let boil for 15-20 minutes. Keep an eye on it and add water if need
be. Reduce heat to medium and let cook for 15 minutes. Reduce heat to a simmer and let cook
for another 15 minutes. Remove from heat and let sit until absolutely tender.
Reserve enough for diner on day 3
Day 3
Breakfast
Eggs
Sprinkle the kelp on the eggs as they cook
Select a few vegetables like zucchini or asparagus to sauté in coconut oil
Parsley, Cilantro & Mint Sauce
1/2 onion, diced
1.5 cups water
2 tablespoons parsley
2 tablespoons cilantro
2 tablespoons mint
1 tablespoon olive or flax seed oil
1/4 cup chives
Juice of 1/2 a lemon
Sea salt
Place all ingredients, except oil, in a blender and puree. Add in oil and blend just enough to
blend. Store in a glass jar.
Lunch
Garlicky- Ginger Stir Fry and Brown Rice Noodles
1 bag stir fry vegetables

2 tablespoons fresh, grated ginger
2 tablespoons minced garlic
1/2 onion cut in large pieces
1 tablespoon coconut oil
1/2 -2/3 cup water
1-2 teaspoons soy sauce
2-3 teaspoons agar agar
Green onions to garnish
Heat the oil in a pan and add in garlic and fry 1-2 minutes. Add in onion and do the same. Add in
the ginger. Add in vegetables fry for 1-2 minutes. Pour in water and soy sauce, bring to a boil
and reduce heat. Add in the agar agar and simmer covered. As you wait for the vegetables to be
ready, prepare the brown rice noodles according to the package directions.
Dinner
Stuffed Bell Peppers
Serves 4-6
10 medium bell peppers

4-6 cups cooked Brown rice
1 lb ground lamb or beef cooked
1 cup water
1/2 can diced tomatoes
Salt to taste
Remove the tops and seeds from the bell peppers. In a large bowl, mix rice and ground meat.
Stuff bell peppers and place in a pot. In a large measuring cup add water, tomatoes and salt.
Make sure the mixture has enough salt; the peppers will absorb the flavor of the water. Pour as
much mixture in the pot so 1 inch of the bottom of the peppers are covered. Reserve the rest.
Bring to a slow boil, covered, then bring down to a simmer. Add more liquid if needed. Let
steam 30-45 minutes.
Minted Salad Dressing
Serves 6-8
¼ cup diced fresh mint leaves
Juice of 1 lemon
¼ cup Organic, Cold-Pressed olive oil
Salt to taste
In a small mixing bowl add other ingredients and mix well.
Appendix 7 9 Step Supplementation and Practical
Application Suggestions
Although there is no set application of this protocol, this section is designed to help guide the
development of a protocol using this 9 Step Program. It will outline a year format assuming that
all steps are required by the client. It also must be understood that many times such an
application of a step may overlap into another and that the steps may not fall “neatly” within a
one month parameter, some issues may take longer to resolve. The supplement recommendations
are general and the amounts may need to be adjusted.
Month 1 Diagnostic Measures
• Initial client intake
• Complete Functional Testing to Asses Client’s Health Challenges
• Introduce protocol
• Increase healthy fats intake by 1 tablespoon
• Restock pantry
• Introduce transitional foods, like rapadura sugar
• Replace toxic cleaning supplies
• Reduce inflammation
• Set priorities
• Supplements:
Intramax or Intramin (Hashimoto’s)
Bromiline
Full Spectrum Digestive Enzymes
Month 2 Focus on Food Sensitivities
• Begin body work
• Have client prepare 1-2 meals a week from the Menu Planner
• Remove food sensitivities, if possible sugar
• Introduce supper foods
• Coconut Oil (1 tablespoon)
• Replace toxic body care products
• Reduce estrogen intake
• Alone time
• Supplements:
GI Revive
Calcium-d gluterate or DIM 1 cap/3xs daily
Month 3 Diet, Counseling and Stage 1 Exercises
• Focus on breakfast
• Stage 1 exercises
• Continue to reduce toxic load-replace microwave with a toaster oven, place filters on taps
or have a household water filtration system installed.
• Lifestyle approaches- Counseling, relaxation and self bodywork
• Seasonal foods
• Check thyroid medication
• Supplements
Progesterone Cream
Adaptogenic Herbs
Vitamin C
Anti Oxidant supplement- glycerin tincture (Grapeseed or Green Tea)
Magnesium
Adrin Stim Tea
Adrenatone, Stress Arrest (Designs for Health)
Month 4 Repair Gut
• Focus on snacks
• Introduce probotic foods
• Increase food diversity
• Eliminate energy robbers
• Increase protein intake, if protein is low
• Remove sugar, replace with stivia and xylitol
• Supplements:
Green and Red Powder, work up to 3 tablespoons daily
Maca 1 tablet/2xs daily
Amino Acid supplementation
Flaxseed or Fish Oils, 1 tablespoon. Check menstrual flow to make sure it is not
too heavy, this may be due to the fish oil.
B 12, sublingual or injections
Month 5 Support Detoxification Pathways
• Focus on Lunch
• Stage 2 Exercises
• Continue to reduce toxic load
• Dry Brush
• Hot Bath
• Sauna
• Sulfur rich foods
• Vegetables
• Eliminate toxic emotions/reframing
• Massage
• Supplements:
Herbs that support the detoxification system (see page 65-67 for a list of herbs)
Month 6 Sixth Month Assessment/ Resolve Chronic Infection
• Focus on Dinner
• Stress reduction, setting priorities, finding the joy in life
• Lifestyle Changes-meditation, establish support network
• Supplements
Immune supporting herbs and supplements will vary depending on the
type of infection. Here is a list of general supplements that support the immune
system:
Hydrochloric Acid (HIC) if needed
Host Defense or Breath (by New Chapter)
Echinacea
Olive Leaf
Months 7 – 11 Client Maintains Protocol-Lifestyle Changes
• Once a month maintenance sessions
• Stage 3 exercises
• Continue with lifestyle changes
• Continue with improving diet

• Continue with counseling
• Continue with weekly bodywork
• Supplements:
Thyroid Tea
Liv-Endo Tea (refer to appendix 2 for tea preparation and dosage)
Month 12 One Year Assessment
• Retesting of Functional Tests
• Reassess Protocol
Appendix 8: Strategies for Health
• Establish "alone time" at least once a week. This will be your time to
recharge.
• Reduce sugar intake.
• Eat whole foods, such as brown rice and whole grain breads, fruits and vegetables 3-5
times a week.
• Drink water and herbal teas. A rule of thumb on water consumption is divide your
weight by 2 and your answer will be what you should drink in ounces each day just to
maintain typical body functions. This does not include pregnancy, nursing, strenuous
physical activity, illness or menstruation.
• Try coconut oil for popping pop corn, frying and sautéing and butter from grass fed cows
on toast and vegetables.
• Chew your food well! Don't bite off more than you can chew. This aids your body in
digestion and absorption.
• Meditate or reflect daily at least for five minutes (daily alone time).
• Make your own lunch and avoid eating out.
• Eat sitting down in a calm and relaxed manner.
• Eat live yogurt, fermented foods and keifer to boost your body’s ability to function
optimally.
• Try organic. Take a look at this chart to see what non organic produce to avoid:
The "Dirty Dozen"(starting with the worst) The "Cleanest 12" (starting with the best)
peaches onions
apples avocados
sweet bell peppers sweet corn (frozen)
celery pineapples
nectarines mangoes
strawberries asparagus
cherries sweet peas (frozen)
pears kiwi fruit
grapes (imported) bananas
spinach cabbage
lettuce broccoli
potatoes papaya
The key to making changes is to set up realistic and tangible goals. For instance, say your goal is
to exercise more that is vague. Instead say; "I will walk three times a week for 20 minutes." Set
yourself up for success by taking small steps. You might even say, "I will walk once a week for
30 minutes.” The goals that are quickly abandoned are those that
reach too high, too fast. When you set a goal that you can reach, the benefit is that you feel good
about your abilities to make changes in your life. When you feel successful, you want to set more
ambitious goals. It becomes contagious and easy!
Also, remember that everyone is different. So what may work for someone else, may not work
for you. This is not about starting a new diet, it is about finding a way of life that is healthy for
you and your family.
Appendix 9: Questionnaire
Thyroid Care: What Other Factors Might Be Contributing To

Your Hypothyroidism?
1. Do you feel sluggish or sleepy after having a meal? Do you experience mood swings
(depression, anger) after consuming certain foods? Do you experience skin eruptions
after eating certain foods? If yes, you may have food allergies.
2. Do you have trouble eating rice and meat together (carbohydrates and proteins)? Do you
often suffer from gas or bloating? Do you frequently have lose bowel movements or
constipation? Do you feel nauseated after eating? If you answered yes to one of these
questions, your digestion may be weak and may be playing a role in your
hypothyroidism.
3. Do you always feel run down and tired? Do you always feel like you are coming down
with an illness? Do you experience discharge from your ear. Are your teeth sensitive to
sweet, cold or hot foods? Do you never seem to get over the last cold you caught or catch
every cold and flu going around? Does it take you a long time to recover from an illness?
If you answered yes, then your immune system may not be working optimally or you
may have a chronic infection.
4. Do you have dark circles around your eyes? Do you have allergies that you never had
before (perfume, pet dander, dust)? Are you angry for no reason? Then your
detoxification pathways may be congested or blocked.
5. Are you no longer able to handle stress and fall apart during mildly stressful situations?
Do you always feel on edge and ready to snap? Do you cry a lot? Does life overwhelm
you? Do you have a burst of energy after 6 PM? Do you crave sweets or refined
carbohydrates? Do you crave salty foods? Do you suffer from extreme fatigue? Then
your adrenal glands may be at play in your hypothyroidism.
6. Do you suffer from P.M.S.? Do you experience clotting during your period? Have you
had a miscarriage (within the 1st trimester)? Do you eat non organic foods? Do you
regularly use plastic storage containers and/or plastic wrap? Do you have a pear shaped
body? Do you use birth control pills or shots? Do you have difficulty losing weight? If
you answered yes, then resolving estrogen dominance may be part of your healing
process.
7. Do you often crave pasta, bread, white rice and other refined carbohydrates? Do you eat
sweets more than 3 times a week? Do you skip meals or eat in a rush? Do you gulp your
food down? Do you eat at irregular times? Do you eat in a rush? Do you often feel tired
after eating? If you answered yes to any of these questions, then your diet may be causing
your hypothyroidism.
Appendix 10: Supplements and Dosage Amounts
• High Potency B Complex

Two caps daily with meal. One additional if there is trouble sleeping.
• Vitamin B 2 (Riboflavin) 5-10 mg/day
• Vitamin B3 (Niacin) 100 mg/day. Due to its ability to impair glucose tolerance, care
should be used when recommending it to diabetics. Inositol hexaniacinate, a form of B3
can be taken in a slow time release form to avoid other unwanted side effects (flushing,
nausea, liver damage, gastric irritation).
• Vitamin B6 (Pyridoxine) 50 mg/ day in divided doses. Works synergistically with
magnesium.
• B12 1,000- 5, 000mg/day sublingual or via injections
• Buffered Vitamin C 1000 mg three times a day or take 1000 mg every two hours until
you reach your bowel tolerance (when you pass lose stool). You then reduce your intake
by ¼. So if you took 10,000 mg and that is bowel tolerance, you would take 8, 000 mg a
day in divided doses. This is the best way to inure you are taking enough vitamin C.
• Magnesium 12 mg per 2.2 pounds ( a 110 lb person would take 600 mg) It also can be
dosed to bowel tolerance. Taken in divided doses. (Murray).
• Vitamin D
Found in fish, fish oils and from the sun. As a supplement, 3 tablespoons daily. Begin
with one and increase each week. As food, consume 3 servings of cold water fatty fish
like sardines, mackerel or salmon. Our skin also naturally produces vitamin D from the
sun. It is a fat soluble vitamin so it is stored by our body.
• Vitamin E 400-800 I.U. a day
• Vitamin A for men 5,000 I.U. and for women 2,500 I.U. Can be potentially toxic in
doses over 50,000 I.U. Do not exceed 10,000 I.U. in pregnant women.
• Zinc 15-25 mg a day. Taken in doses higher than 150 mg a day can result in toxicity.
• Iodine varies
• Selenium 200-400mg/day
• Digestive enzymes 1 three times a day before meals
• Maca 1 tablet/2xs daily
• Progesterone Cream (bio identical)
• Bromaline 500 mg/ 3 time/day
• DIM one time/day with meals. Gradually increase to 1 cap/3 times/day
• Calcium d-glucarate 1 time/day with meals. Gradually increase to 1 cap/3 times/day
• Intramax/Intramin use the more is less protocol
• Adreanatone three caps a day
• Stress Arrest three times a day
Appendix 11: Drugs that Inhibit Thyroid Replacement
Hormone
Be sure to consult with a health care professional and discuss potential adverse drug interaction.
Amiodarone (reduces heart

rate)
Ethionamide
Androgens and anabolic
hormones Furosenmide Perphenazine
Asparaginase Glucocorticoids Phenobarbital
Carbamazepine Heparin Phenylbutazone
Choral hydrate Insulin Phenytoin
Cholestyramine Levodopa Resorcinol
Clofibrate Lithium Rifampin
Diazepam Lovastatin Somatostatin analogs
Dopamine and dopamine Meclofenamic acid Sulfonamides

agonist (heart disease and Methadone Sulfonylureas
Parkinson’s disease)
Metoclopramide Tamoxifen
Estrogen (birth control pills
and hormone replacement Nonsteroidal anti Thiazide diur
therapy) inflammatory agents
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Thyroid Care:

A Nine-Step Program for

by Anisa Abeytia, M.S.

A&Y Publishing by Anisa Abeytia 2024

40 Sugar and Impaired Glycogenolysis

42 Case Study 3: Gestational Diabetes

Chapter 8 Step 4: The Liver and Detoxification Pathways 57

62 Case Study 7: I'm Just So Angry

62 The Process of Detoxification

Chapter 9 Step 5: The Adrenal Connection 69

70 Cortisol and Stress

73 Stages of Adrenal Fatigue

Chapter 10 Step 6: Balancing the Endocrine System 76

77 Estrogen Dominance and Low Progesterone

Chapter 11 Step 7: Eating for Health 85

86 Eating for Health vs. Eating for Weight Loss

94 Vegetable and Bone Broth

95 Foods to Include and Avoid

95 Nuts and Seeds

99 Fish, Poultry and Meat

Chapter 12 Step 8: Supplements, Herbs and Holistic Therapies 101

101 Herbs and Fungi

105 Homeopathic Remedies

106 Holistic Therapies

107 Case Study 8: I Put It All Behind Me

107 Body work

108 Life Style Changes

Chapter 13 Step 9: Exercise 110

146 Appendix 10 Supplements and Dosage Amounts

148 Appendix 11 Drugs that Inhibit Thyroid Replacement Hormone

The prevalence of abnormal thyroid function (hypothyroidism) in the United States is at an

Is secondary hypothyroidism mainly caused by “unknown causes” or by one causative factor?

• High potency B complex vitamin

As I conducted the literature review I discovered a lack of an easy-to-follow program to address

Pioneer Dr. Broda Barnes’ contribution to the field of hypothyroidism cannot be

Traditional Diagnostic Tools and a Clinical Approach

Although useful in identifying some forms of hypothyroidism, a blood test is not

In a joint statement issued by the American Association of Clinical Endocrinologists, The

Thyroid Panel (Traditional)

Table 1: Range of TSH In milli-international units/liters

> 20 Moderate to severe

2.1-4.4 Normal, but may signal

Case Study 1: Hashimoto's and the Thyroid

Thyroid Panel (Modified)

Table 2: Modified Thyroid Panel

Low T4 (under 4.6)

Low T3 (under 80)

High TSH (above 5.5)

Low radioactive iodine uptake

The Broda Barnes’ Method

Thyroid Palpitation (Thyroid Neck Check)

Iodine Urine Test

Iodine Patch Test

• Muscle and joint pain

• Weight gain for no reason and inability to lose weight

• Loss of the outer eyebrows

• Inadequate breast milk

• Brain fog and forgetfulness