Subclinical Hypothyroidism

Subclinical Hypothyroidism – Controversial Treatment Recommendations Made Clear

Virtually all adults recognize the significance of having appropriate thyroid function, and many people suspect they may have thyroid dysfunction at some time during their lives. They may notice some inexplicable weight gain, fatigue, constipation, dry skin, loss of scalp hair, reduced libido and motivation, or cold intolerance – and their minds wonder if a thyroid gland malfunction is to blame.

Those symptoms are indeed consistent with a person with low thyroid, or hypothyroid, and the standard of care would be thorough testing of the thyroid gland and then an individualized treatment plan according to the results.  The tests one should get include a Free T3 and Free T4, TSH, Reverse T3, anti-TPO, and thyroglobulin antibodies. Optimal TSH is <2.5> and above the bottom of the lab’s reference range. Optimal Free T3 is at least 3.2, and the optimal Reverse T3 is in the bottom of the lab’s reference range.

With this being said, there is a rather special category of hypothyroidism, now known as “subclinical hypothyroidism”. Whether or not subclinical hypothyroidism should be treated is a controversial topic amongst many practitioners. Subclinical hypothyroidism refers to a TSH of 3 or more, but below 10.  The medical societies have recently come to the forefront stating that treatment should be withheld in these cases, as certain studies demonstrated the use of thyroid supplementation made no significant difference in outcome (1).  However, the official recommendation for pregnant women, and in those planning a pregnancy, is to obtain a TSH below 2.0 or 2.5, along with a Free T3 of at least a 3.2. Most functional medicine doctors would argue, if these are the values considered optimal for a pregnancy, why not consider this to be the case in all instances? This mentality, and due to the high likelihood that subclinical hypothyroidism will progress to clinical hypothyroidism, most of these practitioners will recommend and implement personalized treatment at this subclinical stage.

Thyroid malfunction, or simply suboptimal function, is not a good thing for one’s tissues, and patients with mildly reduced thyroid dysfunction cans how some subtle symptoms, often some degree of fatigue. The good news is, to achieve an optimal state of thyroid function, supporting the body’s ability to self-correct with diet and supplements for 6 weeks is often extremely successful, especially when accompanied by a 4 week detox.

Causes of a mildly hypothyroid state can include toxins, stress, autoimmune disease, and nutritional deficiencies. Some ways that toxins, which can disrupt thyroid function, can find their way into the body is through contact with household dust, plastics in contact with food and drink, and vinyl shower curtains. Early age contact with these endocrine disruptors can result in the malformation of thyroid receptors, preventing proper hormone-receptor engagement, and limited or inhibited functionality.

Stress can result in low thyroid function, as the physiological response to stress is to protect the body from a possible famine, by slowing the metabolism, and conserve energy. This happens by increasing the production of reverse T3. Reverse T3 will competitively bind withT3 receptors. So the higher the levels of Reverse T3, the fewer sites left for T3 to bind, effectively lowering the action of thyroid in the body, slowing metabolic functions. There are many ways to address stress. I enjoy guided imagery, while others use mediation, the emotional freedom technique, cognitive behavior therapy, yoga, progressive relaxation, homeopathy, and more! Just be sure to include this important piece of the therapeutic puzzle.

Autoimmune diseases of the thyroid include Hashimoto’s Thyroiditis and Grave’s Disease.  As this paper is focused on subclinical hypothyroidism, we’ll leave the topic of Grave’s Disease for another time. The reasons for the development of Hashimoto’s always will include impaired intestinal gut barrier function (leaky gut) and toxins. There are many such reasons  to begin with a great detox, and also to do the 5 R’s approach to gut healing – Remove, Repair, Replace, Re-inoculate, and Restore the mind and body.

Addressing nutritional deficiencies as a cause of subclinical hypothyroidism with supplementation can also yeild a significantly positive response, most often negating the need for thyroid hormone therapy. As such, the general recommendation is to always begin treatment for subclinical hypothyroidism by addressing the need for essential nutrients, rather than with a hormone prescription, except in pregnancy, where there is need for haste. The nutrients of greatest importance are iodine, selenium, and tyrosine. Iodine is a critically important mineral and deficient in most diets, around the world. It was recognized 100 years ago that iodine was essential for proper thyroid development and function, and that deficiency was not uncommon. This discovery led to the practice of iodine fortification of salt, which was used widely at the time. Fast forward 100 years and iodine deficiency remains prevalent, but few use iodized salt, or any salt for that matter.  There has been a great debate over the dosing of iodine. The lack of iodine in infancy leads to a severe state of mental retardation called cretinism, and in adults to goiters (enlarged thyroid glands) and poor function. As a result, some may believe high-dose iodine supplementation will improve health. However, as with most things in life, the key is finding the optimal dose. The minimum amount to survive is 150 micrograms daily, with 1 mg recommended daily to maintain optimal function. Another important thyroid nutrient is selenium, dosing at 200 mg, or just eat 2-3 Brazil nuts daily is sufficient for most patients. Other essential nutrients for a properly functioning thyroid include the amino acid, tyrosine; zinc; Vitamin E;  Vitamins B2; Vitamin B3; and Vitamin B6;  Vitamin D; Vitamin C; and iron.

If you still feel a bit confused and concerned with the concept and treatment of subclinical hypothyroidism,  remember, with the exception of pregnancy, in which the rule really is to treat with thyroid hormone;  in many cases of subclinical hypothyroidism, treating patients with a protocol to include a course of 4 week detoxification, toxin avoidance, stress management, an excellent diet and judicious supplementation, a prescription for thyroxine is often not needed.


1. Villar, H. C. C. E., Saconato, H., Valente, O., & Atallah, Á. N. (2007). Thyroid hormone replacement for subclinical hypothyroidism. The Cochrane Library.

Managing Multiple Disorders in One Body

Managing Multiple Disorders in One Body

Women with PCOS exhibit a very high degree of medical complexity, including dysfunctions of key metabolic and immune mechanisms, affecting a wide range of organ systems. Such dysfunctions can manifest as multiple disorders in one body! Identifying the root causes and common conditions that weave their way through these multiple disorders will facilitate finding a unifying remedy, and eventually a cure, for PCOS and its related conditions.

By understanding how foundational dysfunctions develop and then lead to a myriad of manifestations, we can take those crucial first steps. Conditions found at higher rates in PCOS women than in the general population includeautoimmune thyroid disease (Hashimoto’s Thyroiditis), endometriosis, uterine fibroids (leiomyomata), adenomyosis (uterine lining glands within the muscle of the uterus), and several cancers.

Are women with PCOS simply unlucky to have so many medical maladies in one body, or is there a common theme to explain this? Once you delve beneath the surface, you come to recognize that all of these conditions have similar underlying mechanisms. Uniting all of them are the following: an abnormally functioning immune system, marked by chronic inflammation with elevations of inflammatory signaling agents called inflammatory cytokines, early age exposures to environmental toxicants (chemical endocrine disruptors), nutritional deficiencies, and gut microbiome abnormalities (dysbiosis). The ultimate unifying and underlying cause for all of these maladies in PCOS women is a foundational hormonalproblem: a major dysfunction of estrogen and its receptors, including its production and metabolic degradation. Estrogen is the master hormone, essential for metabolic health,and this requires a properly regulated immune system.  Sadly, PCOS women do not have proper metabolic or immune health.

Let’s begin with a quick overview of the conditions mentioned above. Endometriosis involves a severe localized inflammation in the pelvis, with high levels of inflammatory cytokines within the intra-abdominal (peritoneal) fluid. Interestingly, most menstruating women have some uterine contents flow backwards with each menses, with fluids and tissue passing through and out the Fallopian Tubes. The body’s immune system normally dissolves and gobbles up that tissue, but in women with endometriosis, this process malfunctions, and little holes in the lining of the pelvis (the peritoneum) are created, allowing living cells from the uterine lining to implant and thrive.

This process is controlled by a system of enzymes, called Matrix Metalloproteinases (which remodel tissue) along with immune cells of the body. These cells and processes are under the control of estrogen, which in PCOS women is not functioning correctly. One type of theseimmune cells – the Mast Cell, which isalso controlled by estrogen – accumulates within the pelvis of women with endometriosis, releasingmassive quantities of inflammatory cytokines and chemokines (signaling agents which call other inflammatory white blood cells to the scene.) Thiscreates and sustainslocalized inflammation, promotinglocal estrogen production, and further stimulating growth of the ectopic endometrial cells.

In the case of uterine fibroids, malfunctioning Matrix Metalloproteinases and abnormal local production of estrogen and progesterone cause the muscle cells of the uterus to grow abnormally, creating muscle tumors – fibroids (leiomyomata). Likewise, adenomyosis involves the dysfunction of both the Matrix Metalloproteinases and of estrogen, resulting in the invasion of the endometrial (lining) cells into the muscle of the uterus.

Hashimoto’s Thyroiditis, an autoimmune disease, also involves dysfunction of the immune system, gut dysbiosis,and impaired gut permeability (leaky gut), all related to abnormal estrogen function. Lastly, cancer, the ultimate immune dysfunction, involves uncontrolled inflammation and estrogen malfunction or deficiency. Not surprisingly, the incidence of many cancers is substantially higher in women with estrogen dysfunctions – PCOS, adenomyosis, fibroids, and endometriosis – compared with the rest of the female population.

And what connects PCOS with those other conditions? What is the root cause of PCOS? We now understand that it involves chronic inflammation, gut dysbiosis, and leaky gut;and that estrogen malfunction is at the root of those problems. The cause for this estrogen malfunction involves exposures to endocrine disrupting chemicals at critical points of development – in utero, during infancy, and at puberty, in genetically susceptible women. This inflammatory state is exacerbated by continued chemical exposures and the consumption of a high fat/high sugar diet, filled with processed foods.

Despite all of this, there is substantial reason for hope. A fiber rich diet, stress control, exercise, timed eating and periodic fasting, along with the judicious use of bioidentical hormones, can ameliorate these problems. More on my PCOS protocols for health will be forthcoming in future articles.

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Eating fresh vegetables and oils help reduce risk of cardiovascular disease

Eating Fresh Vegetables and oils help reduce the risk of cardiovascular disease

A recent edition of the Journal of the American Heart Association stated that eating healthy fats lowers the risk of a cardiovascular event just as much as the use of statins does .

In most cases, I do not recommend statins, particularly for women with no history of a cardiovascular event, such as a heart attack or a stroke. There are definite downsides to the use of statins, including muscle pain, increased risks of diabetes and dementia, and rarely muscle breakdown – a condition known as rhabdomyolysis. That event can lead to renal failure and permanent kidney damage.

However, no such risks occur with eating fresh vegetables and their oils. I’d like to make a plea, however, to refrain from buying non-organic oils or oils chemically extracted. Only organic expeller-pressed oils should be eaten … or better yet … eat the whole food … like whole olives! I am a big believer in whole foods, so even oils are second-rate compared with the entire food entity, which has all the wonderful fiber and nutrients still within it!

It’s great to see a published article in a mainstream journal extol the benefits of food, and compare favorably the benefits of eating food with a pharmaceutical!! Hooray!!

Reference:Replacing Saturated Fats With Healthy Fats Lowers CVD Risk

Prolong Use Of Oral Contraceptive, Higher Risk Of Risk Of Hypertension

Prolong Use of Oral Contraceptives, Higher Risk of Hypertension

Nothing should be “too big to fail,” including the mega-industry of female contraceptives! It must be openly acknowledged that female hormones are essential for overall female health and that interfering with them – at any age, but particularly in young teens – is fraught with risks, both known and unknown.

Oral contraceptives and implantables with “pseudo-hormones” are chemical endocrine disruptors, specifically developed to interfere with the normal functioning of the female body. We must be honest in our discussion of these drugs – they are NOT HORMONES! There is not a hormone to be found in any oral contraceptive. They all contain endocrine disruptors – artificial chemicals designed to interfere with the normal functioning of the female body.

Sadly, reproduction and reproductive hormones are intimately linked to every function of the female body – metabolic, immune, cardiovascular, cognitive, mood, and more. Interfering with reproductive hormones disrupts and compromises much more than reproduction – in fact, their interference impacts every single body system – and for the worse.

The sad fact is that no one will openly broach this topic, as the use of oral contraceptives and such chemicals in a variety of formats has become ingrained into our social fabric. There are almost no long-term concerns being voiced about their use.

This article at least broaches the topic of oral contraceptive use and hypertension. It concludes that for every 5 years of pill use, the risk of developing hypertension increases by 13%. The limitations of this meta-analysis are significant, but at least this much was deciphered.

We must truly research other contraceptive options that are both reversible and that do not place toxic foreign chemicals in the bodies of women. While we do not want undesired pregnancies, the cost cannot be the health of the entire population of young women.

See article: Association between duration of oral contraceptive use and risk of hypertension: A meta-analysis

Do postmenopausal women need a laser treatment down there to stay sexually active

Do Postmenopausal Women Need a Laser Treatment “down there” to Stay Sexually Active?

The newly developed vaginal lasers for rejuvenation are getting more and more common in the US and I was given the opportunity to buy one at the very onset … and did not do so.

Here’s why:

1. Only a very small subset of women should truly not use hormones, particularly vaginal application of hormones. The laser folk make no claims that lasers are superior to hormones, they are just a novel approach. You know they create micro-injuries which Induce healing mechanisms to be instigated-increasing blood flow and tissue regeneration. I’ll not deny it may work. But it is not superior to hormones.

If I’m giving just vaginal hormones, then my preference is for Vaginal DHEA cream. Second is vaginal estriol, and last is vaginal estradiol.

2. I view the development of vaginal atrophy as the “canary in the room!” A woman with such damaged tissue from hormonal deficiency has many more sites of damage. The vagina is just the obvious issue.

I view menopause as the drying up of the woman – dry eyes, dry bladder, dry brain, dry arteries, dry GI tract … and yes … dry vagina. A vaginal laser will do nothing for those other sites!! I am not into just symptomatic treatment (though symptoms do matter), I’m into addressing the root cause of the problems which is a hormonal, not a laser, deficiency!!

3. I see the vaginal lasers and those who speak for them, as a money grabs on menopausal women still inappropriately fearful of hormones. In fact, the laser mentality further embeds the fears they have deeper – for why use a laser if hormones are safe?

4. The cost for the single purpose laser was $220,000 and I think it’s now $245,000. For a low price, I’d say, use it as a jump start only and also begin hormones for true rejuvenation. A doctor would have to push it like crazy to see a return on investment! I’d hate to see doctors who own these lasers working all the time trying to convince all women to get treatments!

If you give the vagina the hormones it needs, it stays healthy. Same for all organs.

I heartily believe in physiologic hormones. Cells do as they are told and hormones do the telling. It’s that simple to me! And estrogen is the master of metabolic homeostasis! To function like a healthy woman, you need healthy hormone levels!

So now you have my take on vaginal lasers!

Depression Improved with Diet and Lifestyle Changes

Depression Improved with Diet and Lifestyle Changes

A True Story

Today I met with a patient whose 17-year old son had been diagnosed with depression. When we’d last met, his son had been seen by a psychiatrist who determined from a short visit that he required treatment with an antidepressant. As none of the SSRI drugs ultimately worked, it was next decided to give tricyclics a try.

They were unsatisfactory as well and so atypical antipsychotics were begun.

On that regime, the son rapidly gained 45 pounds! These are very toxic drugs! And to make matters worse, he didn’t improve! And on that note, I happened to meet with my friend, the Dad.

I informed him that much data exists that depression can greatly be improved with the implementation of a healthy, plant-based diet and lifestyle changes. I recommended that his life activities be scheduled and adhered to every day.

The boy was sent to a wilderness camp for 2 months and he was weaned off the meds. He lost over 40 pounds and began to feel energy and joy again. He ate “real” food and hiked miles each day, in beautiful nature.

Back home again, he has continued to exercise daily and avoids all processed foods and sugars. He watches little television and isn’t on the computer too much. He’s doing well in school, has lost another 5 pounds, and has a fabulous relationship with his dad.

Yes … the brain needs proper care and nurturing!! Give it sunlight, proper nourishment, exercise, a loving environment with purpose … and it will thrive!! The epidemic of psychiatric illness is greatly impacted by our awful lifestyles, chemical food devoid of nutrients, sedentary existences, lack of human contact, a world of electrical devices, and poor sleep! These are modifiable factors and once things are placed in the right … the brain can recover!

This story so resonated with me that I felt the need to share it with you! This applies to children and adults with ADHD as well. Mental health isn’t an option to having a good life – it is life itself!

The Health Benefits of Sweet Potatoes

The Health Benefits of Sweet Potatoes

Sweet potatoes are available all over the world, and if you only eat these delicious root vegetables when they’ve been baked until they are virtually unrecognizable, then you are missing out on one of nature’s greatest nutritional gifts. They are not only rich in a vast range of nutrients, but they are also one of the best natural ways to regulate your blood sugar levels, making them an exceptionally beneficial food for diabetics. It also helps that they are absolutely scrumptious, and their sweet flavor is completely unlike any other found in the vegetable world. Indeed, sweet potatoes are so versatile that they’re sure to liven up a whole range of dishes, even desserts!

Selecting and Storing Sweet Potatoes

There are different varieties of sweet potato, and many come in different colorings and hues. Here are some tips for selecting, storing and preparing the vegetable, so that you can benefit from as much goodness as possible.

  1. Choose the darker variety of sweet potato at the grocery store if possible, because they have the higher carotene content, essential for the production of vitamin A. Purple sweet potatoes, more commonly found in Asia, are also a great source of nutrients. Paler varieties are healthy but don’t offer quite the same number of benefits as darker types, and many people often confuse them with yams.
  2. Avoid wrinkly, soft sweet potatoes and take time to select ones with good, firm flesh. If there are signs of green discoloring, then leave them alone.
  3. Store sweet potatoes in a cool, dark and well-ventilated place. Do not leave them in plastic bags, or keep them in the fridge. Consume within 7-10 days of purchase.
  4. Prepare sweet potatoes in the same way you would prepare normal white potatoes. However, bear in mind that the skin contains a large percentage of the nutrients, so try to leave it on if possible. You can make fantastic sweet potato fries by leaving the skin on, and chopping the vegetable into strips.
  5. You can steam, bake, boil or roast sweet potatoes, and still benefit from plenty of nutrients. But as with any vegetable preparation, try not to over-cook them.

Specific Health Benefits of Sweet Potatoes

Although they are soft, creamy and sweet enough to be used in some desserts, sweet potatoes offer a surprisingly huge range of nutritional benefits, many of which have specific health benefits.

1. Great for Heart HealthSpecific Health Benefits of Sweet Potatoes

The high levels of vitamin B6 and potassium found in sweet potatoes provide excellent benefits for your heart. B6 vitamins break down homocysteine, a substance which can harden blood vessels and block arteries. Potassium, meanwhile, helps balance fluid and blood pressure levels, while providing your body’s cells with electrolytes that help regulate your heart beat.

2. Great Source of Vitamin A

Sweet potatoes contain a huge amount of beta-carotene, a carotenoid that gives certain vegetables their orange color. The body can turn carotenoids into vitamin A, which is linked to cancer prevention, the maintenance of good vision, and also provides a number of anti-ageing benefits. Indeed, one large sweet potato is capable of providing 100% of your recommended daily intake of vitamin A according to the U.S. Food and Drug Administration.

3. Great for Blood Sugar Levels

Although they are sweet tasting, sweet potatoes are low on the glycemic index, which means they are a very good blood sugar regulator. Many starchy foods, including white potatoes, encourage blood sugar levels to spike and rise rapidly, but sweet potatoes release sugar into the bloodstream much more slowly. This makes them a great choice for diabetics, who can safely consume the carbohydrates without associated problems.

4. Great for Skin Care

Sweet potatoes can work to improve the appearance of your skin from both inside and outside your body. The high levels of vitamin C and E contained within sweet potatoes helps boost the body’s defenses against the sun’s harmful UV rays and encourages the production of collagen, which keeps the skin strong and supple.

But it isn’t only the consumption of sweet potatoes that can benefit your skin. If you boil them, don’t throw away the water afterwards. Take a cup and use your fingers to gently apply the water to your face. This can help clean your pores, remove impurities from the skin and even reduce dark circles around your eyes.

Health Benefits of Sweet Potatoes

5. Great for Digestion

Sweet potatoes are a great source of dietary fiber, while still being low in calorie content. Fiber promotes a healthy digestive tract, helping your body pass toxins and waste products out quickly and efficiently while guarding against constipation and bloatedness.

6. Great for Emphysema Prevention

Emphysema is a condition that gradually damages the air sacs in the lungs, leaving sufferers short of breath. It is often associated with smokers, or people exposed to smoking on a regular basis.  Smoking reduces levels of vitamin A, which helps regenerate the cells in the lungs. The beta-carotene contained within sweet potatoes encourages the production of vitamin A and helps heal the respiratory system.

7. Great Source of Vitamins and Minerals

Sweet potatoes contain a significant amount of vitamins C, E, B5, B6, riboflavin and copper. These nutrients offer a range of benefits for your immune system, red blood cell production, sleep patterns, mood, wound repair, disease prevention, muscle weakness and pain.

8. Great for Stress Relief

Sweet potatoes contain high amounts of magnesium, often considered to be one of the best minerals for promoting relaxation, calmness and improved mood. As we already know, they are also rich in potassium, which helps regulate your heart beat when you are anxious or stressed.

Why Sweet Potatoes a healthy alternative

Why Sweet Potatoes Are a Healthy Alternative

Sadly, many consider the sweet potato a bad food choice because it has carbohydrates and is very starchy. The unjustified maligning of this regal root vegetable needs to stop now!

Only processed carbs are evil! Natural starchy vegetables, eaten without deep frying them, are incredibly healthy and truly necessary to nurture and feed the critically important gut microbiome – that recently discovered complex civilization which resides deep within us in our gut. These workhorses for our wellbeing are living creatures and require food to live. Fiber and starch are what they need to survive!! Only processed carbohydrates turn rapidly into sugar. The delicious sweet potato does not.

Just be sure when you prepare them that you don’t add unhealthy ingredients, such as marshmallows or brown sugar! These marvels of the earth, when simply prepared, taste heavenly!

How your gut health impacts your overall health

How Your Gut Health Impacts Your Overall Health

A healthy gut impacts your overall health.

The gut microbiome is highly responsive to diet, and impacts every aspect of physiology from digestion to endocrine function.

In this video webinar for Pure Encapsulations, Dr. Felice L. Gersh discusses the clinical connections between the gut microbiome and women’s health, with a focus on nutritional support for ovarian function and metabolic homeostasis.*

Watch the video and learn:

  • Recognize gut health as a common barrier to successful interventions in women’s health care
  • Review important facts about the gut microbiome and its role in reproductive function and hormonal balance in women
  • Recognize food as both a hormone and a microbiome modifier that influences reproductive health
  • Understand the impact of meal timing on a woman’s microbiome and endocrine system
  • Learn how to support endocrine, ovarian and metabolic health using a nutritional approach that starts with the gut*

Watch the video and get great tips from Dr Gersh on how to eat right for optimal health!

Should we remove Fallopian tubes as a cancer preventative

Should We Remove Fallopian Tubes as a Cancer Preventative?

This is an interesting topic – the prophylactic removal of body structures to hopefully lower cancer incidence and mortality.

Removal of the Fallopian tubes has recently become a big topic of discussion in GYN circles as there is recent data showing that by doing so the risk of the development of ovarian cancer, rare but often deadly, appears to be reduced. The Fallopian tubes are now being removed at the time of a hysterectomy for benign disease, but it is now also being brought up that they can be removed as a sterilization procedure in place of a tubal ligation. As well, that the tubes could be removed in any woman no longer wishing fertility at the time of any elective or non-emergency abdominal surgery.

It does, however, make me think of the innumerable removals of the appendix, long believed to be a pointless structure and the source of major mortality and morbidity when appendicitis occurs. Now it turns out that the appendix is an important part of the gut immune system and the microbiome and the incidence of colon cancer is dramatically higher if the appendix is removed.

Perhaps Fallopian tubes are also important in ways not yet understood. Nothing can be assumed to have one purpose. Nothing is quite as straightforward to me as it once was. The human body is clearly filled with innumerable mysteries!! We think we know it all – we know next to nothing!! Still, we must take action based on the knowledge we have.

What is the best path to healthy longevity? We are still searching, but perhaps removing those innocent appearing Fallopian tubes is part of the answer … but do proceed with caution!!
Meanwhile … I will stay on high alert!


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