Izabella Wentz

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(1)Getting to the Root Cause of Hypersomnia and Thyroid Fatigue Guest: Dr. Izabella Wentz The purpose of this presentation is to convey information. It is not intended to diagnose, treat, or cure your condition or to be a substitute for advice from your physician or other healthcare professional . Dr. Breus: So welcome, everyone. I have one of my all-time favorite people here with me, Dr. Izabella Wentz. And so Dr. Wentz is a pharmacist and she is a thyroid expert, specifically in the world of Hashimoto’s hypothyroidism and she’s going to explain a lot of that to us. So first of all, welcome Izabella. Dr. Wentz: Hi, Dr. Breus. It’s so great to be here. Thank you so much for having me. Dr. Breus: You are super-duper welcome. And you and I have kind of an interesting history because when we first met, you started talking to me a lot about your issues with sleep and sort of how that had started you on this journey. So I would love it, if you wouldn’t mind, telling our audience a little bit about your personal background in sleep and sort of what led you to where you are. Dr. Wentz: So I’ll give you kind of an example of the person I was in college. Dr. Breus: Please. Dr. Wentz: I would sleep until 12:00 noon or 1:00 every day on weekends. And if one of my classmates called before that, there was a good chance that I would either yell at her or hang up on her or say something really, really mean and inappropriate. And sometimes this was to people that I don’t even know as well. So it wasn’t even my good friends.. ©Mindworks, Inc. All rights reserved.. 1.

(2) But when I was in high school, I was very bright eyed and bushy tailed. I had a ton of energy. I was sleeping maybe like six hours, seven hours and then getting up like really early. And I spent – I think my dad used to say about three hours in the morning to get ready, so I could be in school by 08:00. So by – I had to wake up at… Dr. Breus: Three hours? Dr. Wentz: Pretty much, yeah. I’d do like full makeup. It’s like you were going to like a Vegas show or something. But my first year in college, something happened. Where all of a sudden, I went from like this person that was super high energy and super thriving on very little sleep to like a person that just was napping all the time, sleeping for very, very long amounts of time and feeling kind of brain-fogged and just not feeling my best. So I was sleeping initially, during my first year in college, probably for 12 to 14 hours. Dr. Breus: Wow. Dr. Wentz: One time, I came back from class and I had the midterm the next day. So I came back from class around 03:00. And I said, “Okay, I’m going to study for my midterm,” which was at 08:00 a.m. the next day. But first, I just need to take a little tiny, tiny nap, like a power nap. So I went to sleep at 03:00 and I woke up at like 08:15… Dr. Breus: Oh, my gosh. Dr. Wentz: …the following morning. And ended up going to my midterm not having studied and showing up late in tears. And so that was kind of a big mystery for me. The clinic at my university was kind of didn’t have a lot of answers for me. But eventually, a while into this, they were like, “Oh well, you had Epstein-Barr virus and so that’s probably what it was, that probably made you tired and now it’s going to get better.” But it never really got better. So I mean, I went from sleeping for like 14 to 15 hours to sleeping to 12 hours. That entire summer, after my freshman year in undergrad, I was going to bet at like 06:00 or 07:00 and waking up at noon the next day. Dr. Breus: Wow. Dr. Wentz: And so, eventually, that kind of got better slowly over time and I actually learned how to compensate, so I spent a lot of my time sleeping. And then when I was awake, I would be studying or going to work or going to class. But I probably slept for about 11 to 13 hours for most of my 20s. © 2016 Mindworks, Inc. All rights reserved.. 2.

(3) Dr. Breus: Wow, that’s amazing. And so what kind of treatments did different doctors offer you? And kind of like what was the path that they put you on? Dr. Wentz: And I was in pharmacy school, so I was aware of different disorders and so on and so forth. And I was a good girl and I always went and had physicals and went to the doctor. And I didn’t really get a lot of help, so a lot of the things were, “You’re stressed. You’re depressed. Do you want some antidepressants? Do you want some stimulants like Provigil? Maybe you can do that.” And another one that I just think is kind of hilarious now, but I didn’t at the time, was that I was just getting older. Dr. Breus: Oh my gosh. Dr. Wentz: I’m like in my 20s, right? So like, “You’re just getting older, that kind of thing happens.” And so I just learned to compensate. And then I kind of had heard of chronic fatigue syndrome and I was looking at all the different drugs for insomnia in pharmacy school. But I was like, “Okay, what about hypersomnia? Why isn’t anybody talking about excess sleep?” like, “What’s going on here?” I finally had been working as a pharmacist for a few years and realized that not all doctors were created equally. And I was taking a certification exam for geriatrics and went to this like big intense course at UCLA about geriatrics. And I remember that course instructors were saying that, sleeping too much can be just as good as sleeping not enough. And I was like, “Oh wait, I thought I was doing a good job by sleeping more.” And then I ended up sort of talking to some of the instructors and some of the clinicians in the room. And they’re like, “You know, you really need to get that checked.” And I sought more comprehensive care. At which point, I was found to have Hashimoto’s thyroiditis and a subclinical hypothyroidism, which is we’ll get into. Dr. Breus: Wow. So that must have been kind of an eye-opener because all this time, you’d either been told that you’re old at age 20, which is the most ridiculous thing I think I’ve ever heard. Dr. Wentz: Well, I was about 25 to be fair. Dr. Breus: Oh okay. So that makes all the difference in the world – well, give me a break. And you thought that you were doing the right thing by sleeping more and more just figuring maybe your body needed more sleep or something like that. When in fact, it was actually a sign that something else was going on in your body, right? © 2016 Mindworks, Inc. All rights reserved.. 3.

(4) Dr. Wentz: Mm-hmm. Dr. Breus: And so once you were given that diagnosis, what made you become so aware and so interested that you were like, “Oh my gosh, we need to let more people know about like what’s going on with Hashimoto’s,” and how did all that happen? Dr. Wentz: When I got my diagnosis with Hashimoto’s, at first I was actually relieved, because I had been going to the doctors for years and they were like, “You’re not anemic. Everything’s normal. You’re fine. It’s in your head,” pretty much was “Get out of my office,” right? So I was finally getting a sense of validation that was really great that, “Okay, well you know what, there is something wrong,” which was nice to hear, as strange as it sounds. Dr. Breus: No. I’ve seen that happen quite a bit with people. Do they know what the root causes for Hashimoto’s are? Dr. Wentz: So the underlying cause of Hashimoto’s, we can kind of get into that. But wait, why don’t we back up a little bit and maybe define what it is. And so underling root cause of my major sleep issues was Hashimoto’s, which is an autoimmune disease that happens to attack the thyroid. So our immune system turns against our own thyroid gland and creates a situation where the thyroid cells are destroyed so that they’re no longer to produce their own thyroid hormones and this is also known as hypothyroidism. And so this sounds like a really exotic condition. I know when I came home and I told my husband about it, he said, “Hashimoto’s, that sounds like a Japanese sword fighter,” and it’s actually pretty common. So looking at the latest statistics, so I just downloaded a new article on my computer last night and I thought we were up to 28% of the general population in the U.S. that was the highest statistic I heard, So approximately one out of every four people with Hashimoto’s. This recent article was from Italy, 34% of the Italian population has already antibodies indicative of Hashimoto’s, so one in three Italians, potentially one in four Americans. Dr. Breus: Wow, that’s incredible. Dr. Wentz: Right. But most people are not told that they have Hashimoto’s. So people like me, it took me probably 10 to 20 years before I was actually © 2016 Mindworks, Inc. All rights reserved.. 4.

(5) diagnosed. So we talked about my bout with Mono or Epstein-Barr virus in college, that’s one of the triggers or root causes. Another root cause I had is I had exposure to Chernobyl at age three when I was living in Poland, close to the Ukrainian border, which is where I grew up. And so like, toxicity can be a trigger, different types of infections, food sensitivities, nutrient deficiencies, impaired stress response as well as the toxins that we talked about, those are all going to be the underlying root causes for Hashimoto’s. And most people’s Hashimoto’s is not identified until it’s very, very much advanced. But the condition actually has five different stages. And so, in the initial stages, what’s happening is your immune system is launching an attack against your thyroid but your thyroid test may still be normal. And this is what was happening to me. So for almost eight, nine years, I was going to the doctor and they were running tests on me and they were telling me my tests were normal. And that was because they were doing the standard tests. So they weren’t doing the advanced tests that can detect Hashimoto’s in the earlier stages, Now, of course, I was symptomatic. So we know that people even in those early stages of Hashimoto’s can have a ton of different symptoms. So of them, fatigue is a big symptom. Hypersomnia or sleeping too much is going to be a symptom. Brain fog or being very forgetful is going to be a symptom, which can also be caused by sleep deprivation. Weight issues, so an inability to lose weight or gaining weight even when you’re doing the same thing over and over can be a potential symptom. Depression or apathy, where you feel like you’re just not as motivated as you used to be, could be a potential symptom. And there’s a whole list of other things like hair loss, joint pain, loss of the eyebrows, acid reflux, irritable bowel syndrome, just a whole plethora of different symptoms that may be kind of considered nonspecific. So doctors might say like, “Oh, well, this is because of stress or depression or so on and so forth.” Dr. Breus: Right. Dr. Wentz: One good symptom that is a really good giveaway that somebody may have thyroid disease is cold intolerance, so a person that’s colder than the average. And now this is, of course, something that’s kind of hard to know that you feel colder than the average person on your own. So one of the things I recommend is just to kind of take an inventory of your surroundings. If you’re a woman that’s going into your office and all the other women are © 2016 Mindworks, Inc. All rights reserved.. 5.

(6) wearing short sleeves and you’ve got like a sweater and a scarf on, that’s probably an indication that your thyroid is underactive or that you have Hashimoto’s and you are not tolerating cold as well. So the thyroid is our metabolism gland and it produces energy, produces heat. And so a lot of times when we are deficient in thyroid hormone or the thyroid is under attack, we’re going to see that a person will have symptoms related to low metabolism such as low energy, weight gain, and then feeling cold. Dr. Breus: Well, let me ask you this, because this ties in with sleep very nicely. I have a lot of patient’s who show up and they tell me that they like their bedroom very warm or they have lots of covers, so they’re wearing socks and flannel pajamas in the middle of the summer. Would that be an indicator as well? Dr. Wentz: Yes. And that was me. So I was living in southern California at the time I was diagnosed. I was sleeping in like full pajamas, socks, and then two blankets. And my husband was like kind of sleeping with the covers off. Dr. Breus: Right. Dr. Wentz: And I’d be like, “Why did you turn the air down again, it’s freezing in here,” and he was like, “I don’t get it. What’s happening?” Dr. Breus: Right, “What is she talking about?” Dr. Wentz: Yeah. I was like, “What’s wrong with you?” Dr. Breus: Right. Dr. Wentz: And it was actually me all along. And once I got proper treatment, I was like, “Oh my goodness, I don’t need these blankets. Like I don’t need to have all these socks on.” So that’s actually a really, really good sign. Dr. Breus: Okay. Got it. All right, interesting. And so what are some of the solutions? First of all, how do you tell the difference between – well, no, I’m going to back, I’ve got a different question. Does sleep deprivation make all of these feel worse? Because my guess is that it probably does. Dr. Wentz: Absolutely. And so, I did a survey with my readers, and the biggest things that makes thyroid issues worse is sleep deprivation and stress. So these are kind of, I think, two sides of the same coin. So we know that when we’re sleep deprived, we’re not going to be tolerant of other people as much, so then things in our life are going to seem more stressful. © 2016 Mindworks, Inc. All rights reserved.. 6.

(7) Dr. Breus: For sure. Dr. Wentz: The way that kind of, I think, comes together is the adrenal glands. So adrenal glands very closely work in symphony with the thyroid gland. Dr. Breus: Sure. Dr. Wentz: And I was trained as a pharmacist and I used to think that adrenal glands and adrenal dysfunction were all like voodoo. And if you look at kind of like the Mayo Clinic website and all those things, they’ll say that there’s no such thing as adrenal dysfunction, there’s only Addison’s disease. So that’s not what I’m talking about, I’m not talking about Addison’s disease. I’m talking about adrenals are stress glands that produce our stress hormones. There are situations that can impair their function. And these are things that are not going to be detected on a blood test, but may be detected on like a functional medicine or naturopathic test like the saliva test. So adrenals are going to be dysfunctional because of a variety of reasons. So one of them could be because a person is overdoing it on caffeine, that actually makes the adrenals work harder but weakens them in the long term. Blood sugar imbalances, so if you’re eating a lot of carbohydrates, a lot of sugars, that’s going to cause an insulin response, which needs to be neutralized by the adrenals. Inflammation in the body is going to be very stressful for the adrenals as well, which produce our main anti-inflammatory hormone cortisol. And then lack of sleep is going to make the adrenals really, really stressed out. And we know that when the adrenals are stressed out, we do not handle everyday stresses as well as we normally would, so we’re going to be more likely infections and then our hormone output is going to be affected. Dr. Breus: That makes sense. Now my very rudimentary understanding of Hashimoto’s is, is that there are times where people have high thyroid function and then low thyroid function. And so in my world, high thyroid function or hyperthyroidism often times is a signal where we see it in insomnia, people’s inability to fall asleep. And then low thyroid function is when we have hypersomnia, which is I think what you experienced. When you went through your personal journey, did you have these kind of big ups and downs or was it more just on the downside, question number one. And then question number two is when you talk with your followers and © 2016 Mindworks, Inc. All rights reserved.. 7.

(8) people who are reading your books and things like that, do they also complain of both insomnia as well as hypersomnia? Dr. Wentz: Yeah, that’s a really great question. So Hashimoto’s, in the early stages, what’s happening is the immune system is attacking the thyroid gland and there’s a rush of thyroid hormones into the blood stream, which can cause a person to have too much thyroid hormone and then they become hyperthyroid. And so the symptoms of that could be irritability, palpitations, anxiety, insomnia can be another big symptom of that. Now, there’s also another condition known as Grave’s disease, where basically the immune system attacks like the control mechanism of thyroid hormone production, so just the thyroid just keeps producing hormone without hearing the stop. And so that can also manifests as that. So interestingly some people do have insomnia with that, whenever they h ave Grave’s disease or whatever they have Hashimoto’s in the flares, but that’s not going to be the case for everybody. So some people might have insomnia, some people might have hypersomnia, but they might have anxiety and irritability. Dr. Breus: Got it. And sometimes that anxiety and irritability could actually lead to even more poor sleep as well, I would imagine, because I see that a lot in my clinic, as well. Dr. Wentz: One of the ways – so a person may be sleeping for 12 to 14 hours, but they may be like a super light sleeper, so that if the dog rolls over, they get up and wake up and they’re like, “What happened?” or they might have multiple awakenings throughout the night because their stress response is tuned up and they’re basically in like stress overdrive and their body is really tensed and their thyroid function is really on high alert. They’re on high alert. They’re anxious. And then the time that they sleep is longer, but the quality is much, much worse. And then other people will have anxiety because of Hashimoto’s so that they might find that they’re ruminating more at night at bedtime. So instead of like a person just going to bed and feeling great, their anxiety might actually keep them awake at night. Dr. Breus: That makes perfect sense. I see that a lot with my patients. And a lot of people say they can’t turn off their brain. They’ve got these heart palpitations, like they don’t understand what’s going on. They’re exhausted. They kind of talk about this whole wired and tired feeling. And I think that might be part of what kind of you see happening with what you’re doing. © 2016 Mindworks, Inc. All rights reserved.. 8.

(9) Now, at one point, I have patients who actually have gone on some type of thyroid supplementation. Tell us a little bit about some of those treatments. And then also, I’m curious, because I had one patient tell me that they couldn’t take their thyroid supplementation or actually pharmaceutical thyroid, it was either an Armour or it was Tirosint or something like that. They couldn’t take in the morning because it made them too sleepy. They had to take it in the evenings. I wonder if you’ve ever had that experience with any of your followers. Dr. Wentz: Interesting. So thyroid medications can definitely be very, very helpful for people who have Hashimoto’s and some of the adv anced stages when it goes into hypothyroidism and sometimes, even in the initial stages they can be helpful with symptoms. Synthroid was the number one prescribed medication in 2013 and 2014. It was beat out by Vicodin in 2015, but it was [inaudible; crosstalk]. So we know that we that this is a very, very common problem that people have the underactive thyroid and most of the time it is Hashimoto’s. And of course, medication could be super, super helpful. But you want to make sure you’re on the right medication for you. So Synthroid is going to be the most commonly prescribed medication. It is synthetic thyroid hormone and it’s synthetic T4, which is one of the active thyroid hormones, but it’s not the main active thyroid hormone. So the main active thyroid hormone is T3. And T3 turns into T3 from T4 within the body. So in the perfect situation, if everything went according to the way it’s supposed to go, the way it’s written out in paper, you would take the synthetic thyroid medication and you would convert it to as much T3 as you need to make. And I’d like to think of T3 as then like the energy hormone, the grow your hair hormone, and feel good hormone. But for a variety of reasons, not everybody does this conversion properly, sometimes it’s a liver issue, sometimes it’s a gut issue, nutrient deficiency, stress. And so some people might actually benefit from a medication like Armour or Nature-throid that contains T4 and a little bit of the T3. So the active hormone is already like preconverted for you. So it just kind of gives you that kind of a little bit of instant energy when you take it. Generally, I recommend taking thyroid medications first thing in the morning on an empty stomach, and that seems to work well for most people. There are a few people, however, that they do feel better with taking thyroid hormones at night and it does seem to balance out their numbers better, their thyroid hormone levels, and their symptoms. So again, it’s really going back to the © 2016 Mindworks, Inc. All rights reserved.. 9.

(10) person as an individual where you’re looking at, okay, which medication is appropriate for them, which dosage is appropriate, and then how are dosing the medication and when are we taking the medication. Is it better to give it in the morning? That’s optimal for some people. Other people may need to take it in two doses throughout the day, so they may need to do like an 08:00 a.m. dose and a noon dose. Other people may need to an 08:00 a.m. and a 04:00 p.m. dose. And then other people may need to take all their medications at bedtime. So it really varies. I found sometimes when people do feel tired after their thyroid medications, it maybe because of adrenal issues, so the adrenals, again, may not be properly supported. So it happens if you have – and this is getting a little bit technical. Dr. Breus: No, it’s good. I love it. Dr. Wentz: Cortisol is one of our main adrenal hormones. And people think of cortisol as bad. But actually, having too much of it is bad as is not having enough of it. So cortisol is necessary for life. And we find that people with Hashimoto’s and autoimmune disease, especially in the later stages, will have low levels of cortisol. And when you have these low levels of cortisol, you’re going to be really tired throughout the day and you might have a burst of energy at night. And so that can create insomnia. What can happen when you take thyroid hormones, is they actually help you get rid of cortisol quicker. So a person who’s taking thyroid medications at a time when they’re low in cortisol may be making their cortisol during that time even lower. So if they have high cortisol at bedtime, which is preventing them from sleeping, taking thyroid medications at that time, may lower the cortisol a little bit allowing them to sleep better and then regenerate in the morning and then having cortisol that’s not really that’s not really touched by thyroid hormone. So that would be, in theory, one way how that can be explained. Dr. Breus: That would make sense, because the patient that I’m thinking of, she had Hashimoto’s and when she was taking the thyroid medication in the morning, she was just dragging all day. She could not get her energy levels up. And they were changing the medications, they were doing all these stuff. And I said, “You know, maybe there’s a circadian rhythm here. Maybe there’s something going on with you internal biological clock Let’s just try taking it in the evenings.” © 2016 Mindworks, Inc. All rights reserved.. 10.

(11) And she said it was like having a sleeping pill. She said would take it. She would knock out. She would sleep the whole night through, wake up the next day, and she would actually feel fairly energized and like – I’m guessing that her cortisol levels where at the appropriate stage then and that they were able to back them down at night. So that in of itself is pretty interesting. What happens though if you’re treating Hashimoto’s and you’re still feeling that level of fatigue? Obviously, there could be a sleep disorder going on something like sleep apnea or narcolepsy or something like that. But what are some of the things that you found in the research that you’d be recommending? Dr. Wentz: And I do want to spend a little of time on sleep apnea, because it’s one of those chicken and egg things with Hashimoto’s. And so we used to think about people who had thyroid disease were more likely to have sleep apnea and that perhaps the thyroid disease caused the sleep apnea. But now, what we’re finding is that sleep apnea actually seems to cause thyroid disease. Dr. Breus: Really? Dr. Wentz: Mm-hmm. Dr. Breus: Oh, that’s interesting. Dr. Wentz: And so studies have found that about 1.5% to 11% of people with sleep apnea have hypothyroidism. The people with hypothyroidism, about 25% to 35% of them, have been reported to have sleep apnea. And like looking at the rates of thyroid antibodies, which are markers of an immune attack against the thyroid gland, they found that people with sleep apnea had rates that were like five to eight times higher of thyroid antibodies compared to people with Hashimoto’s without sleep apnea. And it seems like the longer a person has sleep apnea, the sooner or the more likely they are to develop Hashimoto’s. A 2012 study found that 53.2% of people with sleep apnea were positive for either thyroid peroxidase or thyroid globulin antibodies, which are two of the main antibodies found in Hashimoto’s, which tell us the immune system is attacking their thyroid gland. And now, some of them still had like normal thyroid function, but the longer they had sleep apnea, the more likely their thyroid function was to progress. And we know that the higher the antibodies, the quicker the progression is going to happen. And another study found as many as 66% of men with sleep apnea had the Hashimoto’s antibodies. So if you’re a man and you have sleep apnea and © 2016 Mindworks, Inc. All rights reserved.. 11.

(12) you’re listening to this, there’s like probably a two in three chance that you probably have Hashimoto’s. And so the way that this could work is potentially sleep deprivation weakens our adrenals, which then causes us to be more susceptible to developing autoimmune thyroid disease. Dr. Breus: Fascinating. So let’s say that we've gone from your spectrum, where you’ve been identified as having Hashimoto’s and they’re still tired. Then, I guess, partially what could happen there is we would see maybe by doing an overnight sleep study or a home-based sleep test if they have sleep apnea or not, because what you’re saying, this data is fascinating, is that a lot of people who are out there who are tired even post treatment for Hashimoto’s, the sleep apnea could have actually been what was causing that Hashimoto’s and then vice versa seems to happen as well. But let’s say you don’t have sleep apnea, but you’re still feeling that fatigue or that sleepiness. What are some of the things that people should be talking with their doctors about? Dr. Wentz: Yeah. So once you’ve ruled that out, looking at nutrient depletions, food sensitivities. We already talked about the stress response, so perhaps getting – working with like a functional medicine doctor and getting an adrenal saliva test, looking at the health of your gut, looking at any exposure to toxins as well as chronic infections, which I think are very much an underappreciated cause of chronic fatigue. Dr. Breus: Like the Epstein-Barr type of thing? Dr. Wentz: Epstein-Barr virus, I think, gets a lot of attention. So I know when I was first struggling with all the sleep issues, I kind of came across chronic fatigue syndrome and it just seemed really hopeless, where I was almost like I didn’t want to have it because there was really no solution for it. And Epstein Barr is one that’s been very much implicated in that. And just for the listeners at home, there is definitely a solution for that so you can put the Epstein-Barr virus under control and you can get your energy back if that is something that is one of your root causes. So there are herbal protocols and then just really strengthening your body by addressing some of the other things we’ve talked about is going to be super helpful for keep ing the virus at bay and helping your energy levels. But other infections that are underappreciated are going to be things like parasitic infections, so such as like Giardia infection or Blastocystis hominis © 2016 Mindworks, Inc. All rights reserved.. 12.

(13) infection. So these are like tiny, tiny protozoa that can live inside of our gut. And if you’ve had an episode of like food poisoning or if you’ve gone abroad and you’ve travelled abroad where you experienced food poisoning, there’s a potential that you have one of these bugs that are living inside of you and then are causing inflammation within your body. And interesting, these types of infections have been identified as a trigger for chronic fatigue syndrome. And when I’ve seen then in my clients with Hashimoto’s even when Epstein-Barr virus may seem like the initial trigger, a lot of times when you take care of whatever infections that you have in the gut, they start feeling better and their energy comes backs. So we find that people that have are grinding their teeth at night, sometimes trouble sleeping. Their trouble with sleep is exacerbated by menstrual cycles or full moons, which I thought it was voodoo but apparently that’s when the parasites were more active. These are going to be the people that are going to be at greater risk for having a parasitic infection. And just to be like straightforward, I used to think that people living in the western world did not have these types of things. However, I found them in a big percentage of my client’s with Hashimoto’s that didn’t get better with addressing their nutrient deficiencies or addressing their food sensitivities. Dr. Breus: Wow, that’s pretty fascinating. Okay, so what are some of the things that can actually kind of sabotage your stress response that we’ve talking so much about? Dr. Wentz: So we definitely talked about caffeine. Dr. Breus: Right. That’s a big one, got to wean the bean. Dr. Wentz: Yeah. So it seems like people really rely on caffeine for energy, and it really is a drug. So it’s a stimulant drug. Dr. Breus: It’s like the biggest drug out there. It’s like the most abused drug. Dr. Wentz: It is and it is. And it’s readily available at – every store on the corner, you could go into a Starbucks and get your fix. And it seems like, in the short term, like it’s making a difference and it gets more people more energy, but it also makes them feel more tired in long term. So I recently had a client who was complaining to me that she was having a lot of fatigue and had a lot of trouble sleeping.. © 2016 Mindworks, Inc. All rights reserved.. 13.

(14) And so usually what I recommend are things like magnesium for sleep or sometimes even melatonin if the person really has a lot of trouble and that also helps anxiety. And she was complaining of a lot of symptoms like constipation, anxiety, fatigue, insomnia and so on and so forth. And I was kind of looking on her diet, her diet looked good and everything else. She seemed to be taking a lot – her supplements and medications. And then I kind of said, “Okay, so do you drink caffeine?” and she said, “I do.” And she was drinking eight espressos a day. Dr. Breus: Oh my God. Dr. Wentz: And then the latest one was at 10:00 at night and she was not able to fall asleep until 02:00 or 03:00 in the morning and the sleep that she had was very much fragmented. She said that she couldn’t function without the caffeine. And then what we found was basically weaning off of the caffeine gave her a lot of her function back and a lot of her energy back, but it really is a drug. And so I do recommend oftentimes weaning it slowly, so maybe going to like reducing by half. One excellent thing that people can do is take an herbal kind of concoction called Dandy Blend. It tastes like coffee and it looks like coffee and it smells like coffee, but it’s caffeine free and it’s herbal, and it supports your liver, so that helps to detoxify faster. And some people will say that they don’t have caffeine withdrawals when they do that. Dr. Breus: Interesting. Dr. Wentz: Another thing is doing hot lemon water in the morning, first thing in the morning when you wake up, instead of going the caffeine, because that actually helps to boost your liver and helps to moves some enzymes along. So a lot of times, I’ll recommend doing things like that. And people will say, within a few days to a few weeks, they actually have much more energy and they don’t need to rely on caffeine, they’re sleeping better and they’re less anxious. Dr. Breus: So there’s lots of really interesting data on caffeine. We know it is the most abused substance on the face of the earth for sure. There’s actually an MRI study where they looked at people who had been drinking large amounts of caffeine for over three years and what they discovered was that their brains actually don’t function well without caffeine on board. Like their brains have become so used to that substance being in there that it’s necessary for function. © 2016 Mindworks, Inc. All rights reserved.. 14.

(15) One of the things that is really interesting is there are two distinct systems for sleep and one of them is the sleep drive. And that drive is all represented by this neurochemical called adenosine, which is a cellular byproduct and that builds up in the brain and that’s why you become sleepy. It turns out that the molecular structure of adenosine is literally one molecule off of caffeine . Dr. Wentz: Interesting. Dr. Breus: And so caffeine scoots into the adenosine receptor in the brain and it blocks that adenosine. Dr. Wentz: Wow. Dr. Breus: Right. And that’s why people get that awakening feeling from caffeine. And then when they burn through that caffeine, also the adenosine goes flooding in and that’s where that big caffeine crash comes from. So you’re dead on when you’re talking about how can caffeine have a problem. And don’t get me wrong, if you want to have a cup of coffee in the morning, have a cup of coffee in the morning. But when you’ve got somebody who’s drinking eight espressos a day, that’s a real problem. I had a patient come to me in she was drinking three 3 liter bottles of CocaCola a day and she couldn’t understand why she wasn’t sleeping well. And so number one, she was definitely throwing herself into a state of diabetic and insulin resistance. But number two she was just ingesting tremendous amounts of caffeine and that where things can kind of go sideways. So other than caffeine, what are some of the other things that people can do to kind of help level them out from a Hashimoto’s standpoint? Dr. Wentz: So really addressing their adrenals is going to be looking at adrenal adaptogens. So these are herbs that can kind of balance out the adrenals, B vitamins, vitamin C can be very, very helpful for most people. The other things that I really look at are nutrient depletions. That’s going to be, oftentimes, a first step in helping a person feel better. One of the biggest most common nutrient deficiencies are going to be vitamin D, B12, as well as ferritin, which is the iron storage form of iron. Dr. Breus: Yeah. No, you’re right. So what’s really interesting about ferritin is when people have a ferritin deficiency, they get restless legs. So one of the first things I do when somebody turns to me and they say they have a creepy crawly feeling in their legs is I check their ferritin levels, because if it’s below 60 and it can be anywhere from like 300 to 200. If it’s below 60, we know that, © 2016 Mindworks, Inc. All rights reserved.. 15.

(16) that’s an easy way to treat restless leg symptoms without having to do like an antiparkinsonian medications or something like that. Dr. Wentz: Oh, that’s fascinating. I knew that small intestinal bacterial overgrowth was connected to restless leg syndrome, which can then deplete ferritin levels and deplete iron levels but you’ve just kind of added… Dr. Breus: Full circled. Dr. Wentz: Yeah, getting that full circle. So ferritin, with the iron storage protein, is going to be important for energy production and carrying thyroid hormones throughout the body, carrying oxygen throughout the body. And people, when they don’t have enough of that on board, they can feel very, very tired. So that's one of those easy things to address with your doctor, ask for vitamin D levels, ferritin levels, and then your B12 levels. So doing something like sublingual B12 is an option. There’s a methylcobalamin version of B12 that I feel is slightly better absorbed than the other versions, and I like it better than doing injections. So sometimes people will get B12 shots and they feel amazing after them. I’m personally not a super big fan of needles. This is why I went to pharmacy school not nursing school or medical school. So I prefer to do things under the tongue route, which gets better absorbed in the body. Dr. Breus: Sure. Dr. Wentz: So that’s one way to do it. And then looking at another interesting nutrient depletion that’s oftentimes connected to fatigue in people with thyroid disease and Hashimoto’s is thiamine. So thiamine is a B1, so it’s one of the B vitamins. And we used to think that it was only deficient in people who were alcoholics. And so I found out that I was deficient in thiamine and I was almost offended, because I’m like somebody that will have like a glass of wine, like if I made a nice dinner like once a month or if I go on vacation I might have like two Mojitos or something like that, but I was like, “What is going on?” But people with thyroid issues and autoimmune issues, Hashimoto’s, their gut is not going to be working properly. So they’re not going to be absorbing a lot of nutrients, and thiamine is one of them. A recent study found that taking thiamine in like mega dose, so like 600 milligrams per day, helped people with © 2016 Mindworks, Inc. All rights reserved.. 16.

(17) Hashimoto’s recover from fatigue almost like within three days. It’s amazing and that was my situation with it as well. So I was just like, I was doing the nutrition part right. And I thought I was doing all these things well and I was feeling really tired. And then I got a test for nutrients and I came out deficient with thiamine, and within three days, my energy levels were back to normal. And then we know that with some vitamins, you want to make sure you’re really careful with the dosing like the vitamin D, you can overdose on it. With thiamine and the B vitamins, what you don’t absorb, you urinate out. So that’s something that’s okay to be taken above the recommended daily allowance. And this is interesting because I’ve had people like come up to me at random at conferences and like pretty much give me hug and say like, “Oh my gosh, you’ve changed my life because you recommended thiamine in your website or on your blog.” And I’m like, “Who are you?” Yeah. So it’s something that can make a tremendous difference in people’s energy levels, all joking aside. Thiamine or befotiamine, which is a different kind of absorbable version of it, can make a really big difference. And you might have to take like one to six tablets a day, but you’ll be able to see within three to five days if it makes a difference in your energy levels. And for some people, that can just really turn them around very quickly and it’s one of those really easy and relatively inexpensive things, probably like $10 a bottle or something. Dr. Breus: Oh, that’s great. Well, you mentioned your website but I forgot to ask you about your website. Dr. Wentz: My website is thyroidpharamacist.com. And if people wanted to get more information on nutrient deficiencies and the type of diet I recommend, they can go to thyroidpharamacist.com/gift. Dr. Breus: Also, you’ve got great stuff going on your Facebook, right? And I think some on Twitter as well. So if people are out there, you should absolutely follow Dr. Wentz, what’s your handle on Twitter and what’s your Facebook page? Dr. Wentz: I actually don’t have a Twitter, so I’m not that, but I’m always on Facebook. So my Facebook page is Thyroid Pharmacist, Dr. Izabella Wentz. And if you go to Facebook/thyroidlifestyle, you’ll find me. I usually like to post once a day and then I’m always answering questions and interacting with © 2016 Mindworks, Inc. All rights reserved.. 17.

(18) everybody and kind of – I might have a slight Facebook addiction. One day I’ll go to Betty Ford for that, but for now I really enjoy talking to everybody with thyroid disease and helping them get to the other side and helping them get their life back. Dr. Breus: No, that’s great. And also you’ve got your book, which is a New York Times bestseller. And I think you just signed a new book deal and you’ve got another book coming out, right? So tell us a little bit about that. Dr. Wentz: So my first book, Hashimoto’s: The Root Cause, it’s been out for about three years now and it really takes the person through my story of how I was able to uncover the triggers that caused me to have thyroid disease and how I was able to get rid of all of my symptoms, get into remission, get my life back. So it’s full of strategies and tips you can utilize to get your life back. My second book is going to be focused on like recipes and kind of like specific interventions, whereas the first one will tell you like what diet you need to follow, like the second one will tell you how to like implement all those things. So the two books work really well together in complement. Dr. Breus: Nice. Okay, well you’ll have to let us know when those are due out, because we’re going to be looking for them. So Dr. Wentz, I know that you took The Power of When quiz, I’d love to hear what your results were and what you thought about the whole experience. Dr. Wentz: So I came out with being a bear. I was a little bit surprised with that because I thought I would be more of a wolf, because I tend to – especially when I write, I tend to do a lot of my writing at night, which may drive my husband a little bit nuts, because then I went to bed like 02:00 or 03:00 in the morning. But I came out with a bear, which was actually refreshing and reassuring to know that I am mostly a daytime creature and function in different types of environment. So it was refreshing to know that I was more flexible and resilient than I previously thought. So that was really nice. Dr. Breus: That’s good. So it’s interesting because a lot of my people who are very creative are wolves. Yet when I talk to people who are bears and they, “But hold on a second, I think that I’m more wolfish because my creativity seems to flow at night and sometimes I like to stay up late and then kind of sleep in.” Everybody can kind of lean a little bit in one direction or the other. But what the quiz really does is it looks at sort of you from the whole person perspective and kind of sees, “Okay, what would work for you, generally speaking.” So it © 2016 Mindworks, Inc. All rights reserved.. 18.

(19) sounds like you had a pretty good experience with it. Dr. Wentz: Yeah. Some of the things I definitely agreed with. So I’m definitely really easy going. Dr. Breus: Yes, you are. Dr. Wentz: I have a really even-keel attitude. So like people will say like, “You don’t ever get upset, do you?” and I’m like, “Yeah, I don’t really get upset.” I actually about things here and there, but I’m hardly ever the person that will be in a bad mood. I’m usually in a really great mood all the time and just kind of happy-go-lucky unless I‘m tried, then I’m a bear. Dr. Breus: Yeah, absolutely. Then you’re a different kind of bear. Dr. Wentz: Yeah. Dr. Breus: Now what are some of the things that you didn’t agree with? Dr. Wentz: Let’s see, there was definitely hitting the snooze button was true. So I am liking the snoozing. I didn’t – the BMI being average to high, so generally I found that my BMI was usually average or on the low side. Dr. Breus: The low. Right. Dr. Wentz: Yeah. So that was a little bit different. And then, I’m not always hungry in the morning. Sometimes I am. But sometimes I’m not. Dr. Breus: Yeah. So what’s interesting about that is, first of all, my guess would be about the BMI, that probably has a direct relationship to your thyroid issues, right? And so when you were able to get those under control – and you also may have always been sort of classically thinner type of person and so that’s one of those ones that kind of works, kind of doesn’t sometimes for people, so that doesn’t surprise me too much. What was the other one? Dr. Wentz: So I think I said, I do agree – I’m not always tired in the morning or I’m not always hungry in the morning, but like I could eat a lot, like I could eat a ton. And my wholes family’s built like greyhounds. Dr. Breus: Right. Dr. Wentz: So I think I am more body – body type, I think greyhounds are my spirit animal in that regard. Dr. Breus: I could see that. I’ve had a couple of meals with you. And you’re © 2016 Mindworks, Inc. All rights reserved.. 19.

(20) not shy at all when it comes to the food, so I think that’s awesome. No, I think it actually make a lot of sense, everything that you said. So thanks for taking the quiz. I’m glad you found like you got something out of it. The new book, The Power of When, it’s due out in September, so we’re super excited about that. So thanks again. Dr. Wentz: Yeah. Thank you so much for doing this quiz, it was really insightful. Dr. Breus: So thank you so much for being part of The Sleep Success Summit. This has been awesome. For all of you folks out there, I know there’s been a ton of information, if you look right below or on the side, there’s a banner that you can click on so you can download this information, keep it for yourself, share it with your friends. We’re super excited to have you on board. Thank you Dr. Wentz. This has been fantastic. We certainly appreciate your time. Dr. Wentz: Thank you so much, Dr. Breus. And for everybody listening at home, I hope this helps you on your journey.. © 2016 Mindworks, Inc. All rights reserved.. 20.

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