Dr. Katie Rothwell [00:00:00]:

Pregnancy is often or in postpartum period is often a trigger for autoimmune conditions. So for some women, we have this kind of maybe smoldering potential autoimmune condition. They get pregnant for the first time, they have their baby, and then in the postpartum period, their immune system goes into overdrive and kicks back in. And that is the initiating or spark that sets off this hashimoto's.

Georgie Kovacs [00:00:30]:

Welcome to Fempower Health. Georgie here. I've had the honor of speaking to so many thyroid experts on the podcast about thyroid disease, but as you well know, it is complicated. So today I bring to you another expert to speak about a different nuance and that is related to pregnancy. Dr. Katie Rothwell is a naturopathic doctor and educator who specializes in thyroid problems and pregnancy and will talk to you specifically about how thyroid plays an essential role in fertility, pregnancy, and postpartum. So let's take a listen to my conversation with Dr. Rothwell.

Georgie Kovacs [00:01:12]:

Katie, it is so nice to have you on the Femme Power Health podcast. And I had reached out to actually previous guests and said, okay, who else is an expert on thyroid disease that I must have on? Because January is Thyroid Awareness Month and it is such a complicated condition, especially with so many of the symptoms, and we're going to actually focus on those who are pregnant and thyroid disease. So this is an area we haven't covered yet. So why don't you first start by giving an introduction and then we can dive right in.

Dr. Katie Rothwell [00:01:44]:

Yeah, thank you so much. I'm thrilled to be here. So thanks for the invitation. My name is Dr. Katie Rothwell. I'm a naturopathic doctor and I live and work in Barry, Ontario, Canada. So I've been in practice for about eight years now, and most of that has been focused specifically on thyroid health. And because women are primarily affected with thyroid disease, my clinic is full of women with thyroid conditions.

Dr. Katie Rothwell [00:02:13]:

And it's been a really amazing and fulfilling eight years so far anyways. And I really strive as a naturopathic doctor to assess the whole person. We really focus closely on assessment and then we want to provide our patients with a full scope of options in terms of treatment. So a lot of my patients come in saying, I was diagnosed with hypothyroidism maybe 510, 15, even 20 years ago. I started a medication, I've never really felt well again. What are some other things that we can look at? What are some other things that we can do? So that is basically our entire journey together and helping these people and these women feel like themselves again because they feel like they have lost at least a piece of themselves along this thyroid journey and it has basically run their life for such a long time. So my kind of special pet project or passion going even more narrow is helping women around that fertility, getting pregnant, staying pregnant and postpartum when we're looking at thyroid diseases. And so there's such an additional depth and conversation and complication when we're combining these two fields and a lot of women are falling through the cracks.

Dr. Katie Rothwell [00:03:43]:

So it's such an important conversation that we're having today and I'm just very grateful to be here.

Georgie Kovacs [00:03:48]:

So I did want to just let folks know what has been discussed on the podcast so far, because I feel like the way I do these interviews, it's almost like chapters of a know. I cover general themes of a topic and then we get into so, so far, I've covered with Denise Roguez, who runs Thyroid Change. We talked about could your undiagnosed symptoms be thyroid disease? And so there we talk about some of the complications and why there's challenges in getting diagnosed. So if people are worried about that, please go to that. I also interviewed Victoria Gasparini and she is a patient. And as you mentioned, she is studying now to be a naturopathic doctor as well. And so she talks about that journey and her blog, et cetera. And then I also interviewed Rachel Hill and she talks about the real challenges.

Georgie Kovacs [00:04:39]:

And even when you're on medication, sometimes things don't work and there's a lot of nuances around the medications and she provides her experience there. So if anyone's interested in those, please do check out those episodes. So today we are going to focus on that pregnancy journey from fertility and beyond. Talk to us on let's start at a high level. Like, what's unique there? I mean, obviously there's the obvious that our hormones are in a different place, et cetera, but what are the things that may not be so obvious that are so important to understand in that pregnancy and fertility journey?

Dr. Katie Rothwell [00:05:19]:

Yeah, well, I think from an umbrella bird's eye view, we see that thyroid health and if we're going a little bit deeper, Hashimoto's specifically, which I think that you've covered in terms of what that is, your viewers are aware that Hashimoto's is that autoimmune form of hypothyroidism. So both hypothyroidism and Hashimoto's has a really big effect on a woman's ability to get pregnant, stay pregnant and have a healthy and happy postpartum period. So if we're not doing proper assessment, proper monitoring, we're really missing a huge area where we could be improving a woman's fertility, pregnancy and postpartum journey and experience.

Georgie Kovacs [00:06:05]:

So let's start with the fertility aspect because there's a lot of complications that are happening. So what I would assume is right now, we're not necessarily covering I'm on fertility treatments. What do I need to do? It's really I'm trying to get pregnant. How can one be proactive? Because there's the and this is why I did the episode with Denise, there's the I don't know what I don't know piece, right? And what should a woman know, do and even be proactive about, even if it's going to their OBGYN? And what are the questions they should be asking to make sure all things are sorted out, because I'm sure you mentioned seeing that woman who's come in and was on medication ten years ago and is having challenges. So I'm gathering a lot of the women who are struggling come to you. So what's that path to eliminate those delays?

Dr. Katie Rothwell [00:06:57]:

Yeah, so I would say from the top in terms of purely looking at our thyroid hormone levels. So looking at our TSH value in terms of a normal lab range, it's fairly broad, anywhere from 0.5 to 4.5, depending on the lab that we're using. Specifically from a getting pregnant and staying pregnant perspective, we actually want that TSH to be in a much more narrow range, so likely between a one and two. So a fraction of what that normal lab range is, actually. So a lot of women come in on thyroid medication, but their hormones are not optimized specifically for fertility. Maybe their TSH has been 3.5 for the last three years and it's not flagged by their family doctor. They're not told to increase their medication from a fertility perspective, but maybe it's been nine months or twelve months since trying to conceive and nothing's happened, or maybe they've even had a miscarriage or two at this point. So this is a real major gap where sometimes I'm seeing people for the first time, where this has been their story and just the really basic piece of it in terms of optimizing, that TSH hasn't yet been looked at.

Dr. Katie Rothwell [00:08:17]:

So I think for women who have hypothyroidism, have Hashimoto's or on thyroid medication, need to take a look at their blood work themselves. Be your own advocate, get informed about where those levels need to be and have a conversation with your primary care practitioner around what's optimal from a fertility standpoint, so we can avoid the waiting and the year or two that it might take for someone else to find that as an issue or potentially avoid a miscarriage. Which, obviously, if we could prevent even one miscarriage, then that would be an amazing feat.

Georgie Kovacs [00:08:57]:

Absolutely. Now you're mentioning TSH, and in all the interviews I have done, and I'm sure you'll get into this, there's other levels that give a whole picture of your thyroid story. And I've been hearing great concern over measuring just the TSH and how it doesn't give the full picture. And so are you speaking specifically about people who already know they have an issue, and at this point it can be the TSH that's really looked at?

Dr. Katie Rothwell [00:09:31]:

Yeah, I would say in most cases, although sometimes we are seeing people who are unaware that they have a thyroid issue at all, and they haven't yet gone through that thyroid screening from a fertility perspective, and they need to. But a lot of the patients that I see have already diagnosed are taking medication but are not on a proper dosing, and their TSH isn't within that optimal range. There's definitely a subsection of people where their TSH might look perfectly optimal, even to my eyes, and they are still experiencing symptoms and there are still issues that we need to address. But I think from a starting point, from a fertility perspective, we really just need to make sure that TSH is in that range. And then if it is and we're still having issues, then we keep looking, right? We keep digging. And like you said, there are other thyroid tests that need to be done. So I always recommend including a full thyroid panel for that reason, because TSH can give us valuable information. But it's not the whole story.

Dr. Katie Rothwell [00:10:42]:

It's the tip of the iceberg, if you will. So we also want to be looking at our free T four, our free T three, and probably most importantly, in my opinion, would be our thyroid antibodies. So the thyroid antibodies are what test for diagnose Hashimoto's. And if they're present, if we have somebody with positive thyroid antibodies and therefore they have Hashimoto's, this also impacts their ability to get pregnant and stay pregnant and also impact their postpartum health as well. So we see that the presence of antibodies in somebody can create actually local inflammation or changes in the ovaries and can impact the quality of health of our eggs. It can also impact our ovarian reserve. So ovarian reserve means essentially how many eggs we have left. So sometimes we see a lowered ovarian reserve or a premature ovarian insufficiency where women are, for lack of a better term, running out of eggs sooner than we would expect.

Dr. Katie Rothwell [00:12:01]:

So these are other things that we are noticing now in the research among women who have these positive antibodies and is really important to be aware of as a practitioner and a woman. If you have hashimoto's.

Georgie Kovacs [00:12:18]:

Interesting, when trying to get pregnant, there is a nuance in what your levels should look like. And so we shouldn't assume, let's say you do already know you have a thyroid condition. It sounds like there needs to be just a double check on where you are to optimize your fertility. And then I assume there's like a whole different category of if you don't even know you have a thyroid condition and need to get that diagnosed, that's probably a whole other discussion we can have. And I'm assuming a lot of the things we'll talk about will come out and help inform that lab values. So, so many of the practitioners I speak to have said, and these are MDS, naturopathic, doctors, you name it, have said we want patients to be their own advocate. I mean, we all live with our own bodies. We know our own body best.

Georgie Kovacs [00:13:13]:

You all have the training that helps us get our bodies to the place it should be. So it really does need to be that dual conversation. But I will tell you, I feel like I'm proactive and I've interviewed like 100 experts on every women's health condition. So I feel like I've got it down, but I still get stumped on these lab results because you have like the sheet and it'll say, here's the range and then where you are in the range. And with thyroid, I'm learning this is really tricky. And even when it's not thyroid, I'll see my level maybe out of the range, and my doctor's like, oh yeah, you're fine. And I'm like, am I really fine? And I'm like but I'm not an expert in this area. Like one time I think it might have been my liver.

Georgie Kovacs [00:13:59]:

So I'm like, do I have liver disease? Should I push on this? Do I now need to be educated? So it becomes really overwhelming and what in the world do I do with these lab results? So, because we now know the thyroid piece is so sensitive and so important to get right for a variety of health reasons, what do we do with these labs if we want to be proactive?

Dr. Katie Rothwell [00:14:19]:

Yeah, I think that's exactly what's happening in terms of sometimes that TSH range in terms of the lab is only going to flag it and alert a physician if it's over four. But from a fertility perspective, we probably don't want it to be too much higher than two. So it is up to us to get that lab report and look at our TSH and the value that we have been reported. Is it 0.8, is it 1.3, is it 2.5, is it 3.5? And aiming for one to two if we are somebody who is aiming for fertility conception in the very near future, and I would argue as well that most women I work with feel best when their TSH is in a more narrow range, regardless of whether their aiming or their goal is to have a baby. But certainly for this subpopulation, we want to be a little bit more picky. So having that conversation with your family doctor, if that is a goal of yours around, maybe. I've been trying to have a baby for three months and I'm worried my thyroid is affecting it. Can we look at changing our dose? Based on what the research is showing, what these associations show around recommendations for TSH, around fertility and pregnancy.

Dr. Katie Rothwell [00:15:49]:

Or perhaps asking for a referral to an endocrinologist or a fertility clinic. Who? Tend to have a little bit more of a stringent view around TSH and where we want to see that a lot of fertility clinics in terms of assisted reproductive technology, doing IUI and IVF, they will not let patients progress through that pathway unless their TSH is under 2.5. So that should tell you a whole lot right there that they are putting so much weight on the fact that a TSH is so valuable and so important to optimizing our thyroid function. They don't want patients to waste their time and money. And certainly it's a lot of energy and can tax our mental health unless their TSH is in that optimal range.

Georgie Kovacs [00:16:39]:

Could you have a TSH of 2.5 but still have other labs be off, like the antibodies, et cetera? And if that's the case, are you finding that the subspecialists, like the fertility clinics and endocrinologists, are they routinely looking at the whole picture?

Dr. Katie Rothwell [00:16:59]:

Yeah, part one of the answer is that for sure. Absolutely. You can have an absolutely normal TSH 1.5 looks beautiful and still have positive antibodies. This is a vast majority of patients that I'm working with who are medicated on Hashimoto's and what their labs are often telling us. And the other parts of conventional care in terms of family doctors, endocrinologists, reproductive endocrinologists are not commonly testing for those antibodies at this point. And positive antibodies can be a barrier to getting pregnant, as we mentioned. So Hashimoto's is one of the top causes of secondary infertility. So secondary infertility is a term that we use for people who have had a first baby, no problems, and then they go to maybe try to have a second baby and they start to have issues.

Dr. Katie Rothwell [00:17:58]:

Maybe it's taking a long time to get pregnant, or they get pregnant and have a miscarriage. And we find that positive antibodies and Hashimoto's is actually one of the leading causes of this. So it is something that's really valuable and important to be screening our patients for. And certainly some endocrinologists and fertility clinics are doing this, but I don't think that all of them certainly are, because a lot of women are still falling through the cracks and we're having to do this type of assessment when they come to see me and we're looking for more information.

Georgie Kovacs [00:18:36]:

Interesting. So let me ask you this then, since you're saying it's such a common factor in secondary infertility. What's happening? Is the woman's body changing once she has a child? And perhaps the Hashimoto's gets exasperated is the word that's coming to my mind. It's not the right word, but you get what I'm trying to say. Does it just come out and appear?

Dr. Katie Rothwell [00:19:04]:

Yeah. So I think there's two big factors that I think of. One is that pregnancy is often or in postpartum period is often a trigger for autoimmune conditions. So for some women, we have this kind of maybe smoldering potential autoimmune condition. They get pregnant for the first time, they have their baby, and then in the postpartum period, their immune system goes into overdrive and kicks back in. And that is the initiating or spark that sets off this Hashimoto's or autoimmune thyroid disease. So that is a possibility in that that first pregnancy might have been one of the triggers, and then we're finding the result or the end result of that affecting their second pregnancy. The other possibility is that maybe they've had Hashimoto's all along.

Dr. Katie Rothwell [00:20:01]:

And we see that the longer a woman is exposed to thyroid antibodies, the more likely it is to impact things like ovarian reserve and egg quality. So it may be just the length of time they've been exposed to these autoimmune factors in the body.

Georgie Kovacs [00:20:19]:

Now, since you said autoimmune, how has COVID played a role in this?

Dr. Katie Rothwell [00:20:24]:

Yeah, it's so interesting. I think it's such a spectrum of experiences. And I've certainly had patients who have experienced flares or exacerbations of their Hashimoto's and autoimmune diseases and symptoms following a COVID infection and viral infection like COVID, that virus seems to be really good at aggravating our immune system. So it can definitely be causing some worsening of preexisting issues and sometimes could be a trigger as well in terms of that spark setting off this pathway or process in terms of leading to a more pronounced autoimmune picture.

Georgie Kovacs [00:21:17]:

What might we need to cover in this pregnancy and postpartum phase that women should be proactively, aware of and prepared for?

Dr. Katie Rothwell [00:21:28]:

Yeah, so another one. So, if you are diagnosed, you have hypothyroidism, you're on thyroid medication. Our need for thyroid medication often increases when we become pregnant, so by 20 or 30%. So a significant amount. So this is another time where if you find out that you're pregnant, we want to be checking in with our doctor, certainly from a prenatal assessment, but also checking in on our thyroid levels and whether or not our medication needs to be adjusted, because that is a very common thing that needs to be done for women on thyroid medication. And I would argue that we're not just testing that TSH once in a pregnancy, but we need to be checking it repeatedly, especially if there's been a history of a TSH that's been fluctuating or somebody's had repeated miscarriages or they have Hashimoto's disease. There are a number of associations and recommendations that recommend testing TSH every four to six weeks over the first half of a pregnancy. And that's not only important in terms of maintaining pregnancy and preventing miscarriage, but also important for fetal or baby development.

Dr. Katie Rothwell [00:22:48]:

So up until about 20 weeks, and even beyond that, baby relies on mum's thyroid hormones to develop properly. Brain development, spinal development, nervous system development. All of this is so dependent on thyroid hormone exposure. So, again, if we're not getting adequate thyroid hormone, then this can be impacting health of us and potentially health of our baby as well.

Georgie Kovacs [00:23:14]:

Some may ask, what about medications, are they safe? So, clearly, getting the thyroids in the right thyroid levels in the right direction is critical, and you just explained why. But what about the dosing and just being on meds in the first place?

Dr. Katie Rothwell [00:23:29]:

Yeah, so our most common conventional medications being a levothyroxine, that's the vast majority of people are prescribed this type of medication. Lots of safety, lots of research that's been done on this medication. It's the most commonly prescribed, and certainly safer to be on it during pregnancy than not because of the reasons why I just mentioned there are other medications or other thyroid medications as well. We talk about combination thyroid medications that may contain T four, but also T three. These are also safe as long as we are supporting healthy T four levels. So we do want those T four levels to remain quite robust and in a quite healthy level because that is what the baby is able to use, is that T four hormone. So we want to make sure that if we're on a combination medication, our T four levels remain in a good healthy range.

Georgie Kovacs [00:24:35]:

From a reality perspective, are you finding that generally doctors understand this and are helping guide their patients, or do you see this as an area where proactivity is required as well?

Dr. Katie Rothwell [00:24:49]:

I think in the vast majority of cases, proactivity is is required. In terms of advocating for ourselves, certainly if we've had a history of challenges around either thyroid health or fertility, looking for more regular screening through pregnancy and then in that postpartum period as well. I spoke briefly about how that postpartum period can be another time where there can be a lot of changes and upset in thyroid function that tends to occur anywhere from three to six months postpartum. So this is at such a, I would say fragile time in that postpartum period. Right. A lot of women are experiencing fatigue, changes in mood, potentially postpartum anxiety or depression. There's so much going on in their life that's changed. And we don't always attribute those changes to thyroid health, but we really need to be screening our women in that time frame, especially if they have a known thyroid issue, to see if there has been any changes.

Dr. Katie Rothwell [00:25:58]:

Because a lot of time there is a role that the thyroid is playing there.

Georgie Kovacs [00:26:04]:

Is there anything that we should cover around the dynamics of because I'm assuming thyroid health doesn't fit in a neat, pretty box, that it's a complicated system. So is there anything that we should cover there that would be helpful for people to be aware of?

Dr. Katie Rothwell [00:26:20]:

Yeah, like you said, obviously all of our hormones are interconnected and they operate together and things like that. I will say that for a lot of women who have Hashimoto's in pregnancy, what happens is that our immune system kind of takes a backseat, so it kind of takes the next 910 months off and relaxes a little bit because we don't want to activate a strong immune response against our own baby. Right. That would not be good. So a lot of women actually feel amazing during pregnancy because they're not having this really strong immune response anymore in relationship to their Hashimoto's. However, like I said, that immune system kicks back in around that three month mark, and that can sometimes lead to some skyrocketing values in terms of antibodies and thyroid hormones. So that process is something that we definitely want to be aware of. And obviously we're seeing hormone drops in that postpartum period as well, which often will factor into that too.

Dr. Katie Rothwell [00:27:28]:

So our estrogen is dropping off our progesterone, is dropping off our prolactin, our mel cormone is increasing and this can have all of those hormone changes can impact thyroid health and vice versa. Thyroid health can impact all of those hormones as well. So milk supply and breastfeeding is another big one that if women are having issues with milk supply or initiating or maintaining milk supply, we should be screening their thyroid because it can absolutely impact ability to produce adequate milk for a baby.

Georgie Kovacs [00:28:08]:

Wow, this is interesting. I will say I had a really tough time nursing to the point of getting delusional, but I'm now so curious what was going on because I don't really remember any discussion of thyroid disease. It was me saying to the pediatrician I'm committed to breastfeeding and lactation consultants became my best friend.

Dr. Katie Rothwell [00:28:32]:

It was oh man, they are amazing. I could not have done without my lactation consultant either. They are incredible professionals. So essential.

Georgie Kovacs [00:28:44]:

What else might be missing? I'm hearing advocacy. Things change throughout the fertility pregnancy postpartum. Have we really covered it all?

Dr. Katie Rothwell [00:28:53]:

Yeah, I mean, I think we've talked a lot around how having thyroid issue may increase risk of certain things and we want to be on top of our labs and making sure we have antibodies tested. I think it's been maybe not so much like doom and gloom, but all kind of bad news for women who have thyroid issues around fertility and pregnancy. And important for people to know that there is so many things that we can do beyond just taking a medication in order to support this process as well. We've talked a lot about being on medication, making sure it's the right dose, but there is so much breadth beyond that as well that we work with our patients and are improving things like antibody levels and reducing inflammation. So we are reducing the impact that Hashimoto's is having on their bodies from a fertility perspective, reducing risk of postpartum thyroiditis and supporting them through this whole pathway.

Georgie Kovacs [00:29:53]:

What I also find interesting is until we know what's possible, we normalize, whatever our experience is, whether it's with the doctor or our day to day life. And what I'm finding really interesting is working with experts to say paint that picture of how we should be feeling or the types of things that can work or what the experience with the health professional should look like, so that we have things in an ideal state. So maybe that's how we can address this, because I think it's so important. I think Washington Post recently published an article about how pain is being normalized and interviewed so many experts and has a ton of data about that. So it is a real problem. So talk to us about what it should look like and what can be done.

Dr. Katie Rothwell [00:30:50]:

Yeah, what it should look like. Ideal World if I had a magic wand and every woman with Hashimoto's would get this conversation with their practitioner. Yeah. Okay. So what I would love women who have Hashimoto's and who are taking a thyroid medication, we talked about some of the ways that I'll take, for example, antibodies. So our thyroid antibodies, we talked about a couple of factors. We talked about the longer we're exposed to them, the more they may impact our long term fertility and our ability to have babies. We talked about antibodies in terms of the longer they stay positive through our pregnancy, where they are typically falling, that increases our risk of postpartum thyroiditis.

Dr. Katie Rothwell [00:31:40]:

So having a plan in place to no matter where you're meeting a patient, maybe they're 23 and not at all planning for pregnancy in the future, maybe they're 36 and want a baby tomorrow. But having a conversation around those thyroid antibodies and how we can support that autoimmune process and reducing that on the body and in turn improving how they feel is really a long term goal that I have with all of my patients. So we tend to look at, yes, we've covered the medication, optimal hormones. I feel like we've got a really good handle on that today. But we also can look at things that we have in full control in terms of our diet and lifestyle, as well as there are some really key supplements and nutrients that are really valuable for this population that we see coming up in the research again and again. And we need to be considering for these demographics and what might those be.

Georgie Kovacs [00:32:44]:

And by the way, I'm so glad you're saying there's research on a lot of these, because one of the discussions I see a lot on social media and I have these discussions as well is there is often such limited research and people are poo pooing what certain professionals may be doing. And my response is, like, in absence of data, what else are we supposed to do? I'll wait ten years for the clinical trial to happen, and then it being embedded into day to day practice when there are certain practitioners who do this every day and see what works and what doesn't. And granted, of course, we always want to be cautious, and I know there's a million caveats to that. So talk to us about some of those examples of things like the food, the supplements, et cetera.

Dr. Katie Rothwell [00:33:28]:

Yeah, so, I mean, from a dietary perspective, in terms of it's so hard to study nutrition and especially specific to thyroid health and Hashimoto's, we have a real lack of research and data on what type of diet is best for that condition. I think, overall, my general recommendation is focusing on an anti inflammatory, Mediterranean style diet. So our Mediterranean diet is probably the best research diet in terms of overall health, overall long term mortality, cardiovascular risk, things like cholesterol and blood sugar metrics and things like that in the long term. So we're focusing on an abundance of fruits and veggies. Of all colors, shapes and sizes. We're looking at healthy oils like our fish oils and our nuts and seeds and lots of olive oil. We're looking at reducing inflammatory foods. And by inflammatory foods, I'm talking about these major inflammatory foods that are causing issues for the vast majority of people in terms of an overabundance of saturated fats and red meats, potentially.

Dr. Katie Rothwell [00:34:45]:

We're talking about an overabundance of these highly refined, processed, sugar laden foods. And we're talking about alcohol. Like, this is another thing. I mean, in Canada, we've just revised our recommendation around alcohol intake because we now recognize it's one of the biggest carcinogens left in a lot of people's diet and lifestyle. And obviously it's hopefully not being consumed during pregnancy, but it's another conversation that we need to have as far as alcohol is a potential pro inflammatory carcinogenic thing that we're consuming. And if I had to say I'd rather you avoid alcohol or I know gluten gets talked a lot about for thyroid health or avoid gluten, I would pick alcohol hands down every time. That's how much I feel that we are under representing and underselling the impact that ongoing alcohol intake might have on our immune system and long term health. And we have so much more research for alcohol versus gluten where we're really missing those very clear connections between gluten and hashimoto's disease.

Georgie Kovacs [00:35:58]:

Wow. Okay, what about supplements? Yeah, talk to us about that because that's a hard one. All the brands are pitching that they're the most researched, the safest, the best. And I do notice none of them make claims on what condition they may or may not help. Right. But I'd love to know what types of supplements and even if you'd comment on what to look for in brands, because I still don't have a great answer on that one.

Dr. Katie Rothwell [00:36:26]:

Yeah, it's a tricky one for sure. And brands is challenging because there is such a role that marketing plays in that and how they're promoting themselves and how they're marketing themselves to patients. And we end up having a cupboard full of vitamins that we've been sold on Instagram and Facebook and we have no idea whether or not they're good or recommended for us. So I think that my ultimate recommendation would be working with someone who understands your history, your case, and is going to look at an evidence informed view in terms of what supplements are going to be perhaps the most advantageous or the most effective for you from a starting point. So I'm not talking about anything crazy or out of the ordinary as far as supplements, but something as simple as vitamin D. We see having a breadth of research when we're looking at autoimmune conditions in general, but also from a fertility perspective, miscarriage perspective, ovarian reserve perspective, and also hashimoto's. We see lower levels of vitamin D levels, lower levels of vitamin D in those with hashimoto's, and we see that giving vitamin D can help to lower thyroid antibodies. So this is something that's very simple, very easy to test through blood work and we can dose appropriately based on lab levels to get them into more of that ideal range if need be.

Dr. Katie Rothwell [00:38:06]:

I mean, I live in Canada, so the vast majority of people, come February, March, if they're not taking vitamin d supplements, are deficient. So this is something that is not generally covered or automatically tested for, for the vast majority of people, but something that can be really valuable. The other supplement that we have a lot of research on for thyroid health is selenium. So, very simple micronutrient. A bottle of Selenium may cost $14, right? This is not a very high end fancy supplement that we have to pay $100 a month for six months at a time or something like that. This is something that is widely available. Specifically, selenomethionine has been most researched in terms of supporting Hashimoto's antibody reduction and reducing the oxidative stress and inflammation that goes alongside that. So those are two nutrients that are definitely foundational that if you have Hashimoto's and you're working with a practitioner and you haven't explored those, you absolutely need to be because of what we are seeing in the research.

Georgie Kovacs [00:39:24]:

And I don't know if you want to comment anything specific about sleep or any other lifestyle factors.

Dr. Katie Rothwell [00:39:29]:

Yeah, I think the conversation around obviously we think about commonly sleep and stress, right? And how these are playing such a role in so many different areas of our body and in our long term health. So we definitely want to be supporting healthy sleep and getting at least 7 hours a night, ideally, is what we're shooting for. And then also looking at our stress levels and our length of time that maybe we've been under a source of chronic stress. And that doesn't necessarily always have to be emotional or psychological stress. It can be physical stress, it can be chronic pain, it can be an injury, it can be a surgery. We had like, anything that's putting our body into that stress response are also things that we need to take into.

Georgie Kovacs [00:40:19]:

Consideration from a stress perspective. I do want to just ask this question, which is, life can be hard, and sometimes I know there were points where I was under such severe stress and it's like, you have to manage stress. It's like, okay, duh. But how so what would you say are, I don't know, like, good tips to consider so that someone who may be at the point of that stress of I literally don't know what else to do, but I want to stop being stressed. What would be some realistic, helpful tips to give to someone who might be in that state?

Dr. Katie Rothwell [00:40:57]:

Yeah, it's a real challenge because as you mentioned, there are times in our lives where we have high stress and these are due to factors we have no control over. We cannot remove ourselves from these states of high stress, right? People can be like, oh, don't be so stressed, or you need to remove this thing that's causing you stress and it's like you simply can't. So it's about supporting ourselves in those small ways as much as possible in a way that's going to be manageable. I think it was Gretchen Rubin who she talks about the habits and things like that. So what you do every day is more important than what you do once a week or something like that. I'm probably butchering that. I'm so sorry, Gretchen, but if we can put in place even small things daily, that is what I talk about with my patients, very small, sustainable things. So this may be taking five minutes before bed and stretching on top of their bed, like not a big deal, right? Five minutes.

Dr. Katie Rothwell [00:42:02]:

It's hard to find someone who can't do five minutes of that. Or listening to a five minute body scan or meditation taking five minutes and just breathing. When you stop at a red light, take a deep breath. These are the small things that potentially can move the needle forward even when we're stuck in a state of really high stress, that we can't necessarily change those external stress at that time. So small sustainable changes. And I will say we can't out supplement our stress. We can't say, I'm just going to continue to live this stressful life, but I'll take some supplements so it'll be fine. But there are some that are great in terms of helping to allow our nervous system to relax at the end of the day, help to get more restful, sleep, especially in periods of short term stress where we know that the next three months are going to be balls to the wall crazy.

Dr. Katie Rothwell [00:43:02]:

I need to support my nervous system through this. I need my sleep habits to be on point. I'm going to take my magnesium every night before bed and do my five minutes of meditation, deep breathing, stretching. That's how I'm going to support myself. And those types of things can be so valuable. And I also can't underestimate the impact that talk therapy can have and the importance of having someone in your wellness circle that you can lean on for that specifically. I think it's an often underutilized tool for women and we look at our best friends and we talk to our family and having a professional in the wing for us can be such a wonderful gift that we give ourselves such.

Georgie Kovacs [00:43:50]:

Practical and helpful tips. And as you were talking, I have been taking very deep breaths since you mentioned that. I feel like even more relaxed. What would be the key takeaway that you would want someone to gather from this discussion or maybe even like a top tip?

Dr. Katie Rothwell [00:44:09]:

Almost always advocacy, because I feel like it's so valuable and so important. And I know you probably feel the same way in terms of getting your own lab results, asking your practitioners questions, feeling like you're part of your own care circle. These things are so empowering and so valuable and can really help us change our own health outcomes. So a lot of what we talked about today is information. And information is knowledge, information is power. And putting the power back into our hands and our patients hands really is so beneficial for long term management of some of these chronic conditions. So that is always a takeaway whenever I'm speaking about this.

Georgie Kovacs [00:45:02]:

How can people get in touch with you? I mean, this has been such a great conversation and you may be getting some folks reaching out, so I don't know if there's specific ask you may have of the listeners or tools and resources you like or that you've created yourself that you'd like to point people to.

Dr. Katie Rothwell [00:45:19]:

Yeah, easiest place to find me, to connect with me, to see what resources I have is on Instagram so you can find me at your thyroid Nd and then link in. Bio is basically a list of resources. Often there are webinars that we've done on variety of topics and I'm also lead the Thyroid Academy. So this is an educational platform primarily for professionals right now in terms of educating our next wave of health professionals around good thyroid care. But we are also expanding that into patient educational programs into 2023. So definitely stay tuned for that because we are going to be trying to reach a wider audience in the coming year.

Georgie Kovacs [00:46:13]:

That's so exciting. Thank you for sharing that. And I'll put links in the show notes for all of this information so people can even just go there and click on everything. And truly, thank you so much.

Dr. Katie Rothwell [00:46:26]:

Thank you for having me. It's been a pleasure talking and I think we covered some amazing things today and I'm just so happy to be here and share.