Season 5, Episode 7: Healing Hashimotos and Supporting Adrenals with Dr. Izabella Wentz

Evelyne: I am so excited to talk to you. Do you know it’s been 10 years since I last interviewed you?

Dr. Izabella Wentz: Unbelievable.

Evelyne: I know.

Dr. Izabella Wentz: How are we still 25, right?

Evelyne: So much has happened and yet it feels like it hasn’t been 10 years at the same time. It’s just crazy. I’m so excited to talk to you. You’ve released quite a few books since then. Before I tell you more about Izabella, just a quick reminder that we have the full transcript of every show on our website. That’s podcast.designsforhealth.com. So if you want to take some notes, that’s a very, very useful resource.

Dr. Izabella Wentz is an integrative pharmacist dedicated to finding the root causes of chronic health conditions. Her passion stems from her own diagnosis with Hashimoto’s thyroiditis in 2009, following a decade of debilitating symptoms. As an accomplished author, Dr. Wentz has written several bestselling books including Hashimoto’s Thyroiditis: Lifestyle Interventions for Finding and Treating the Root Cause, Hashimoto’s Protocol: A 90-Day Plan for Reversing Thyroid Symptoms and Getting Your Life Back, Hashimoto’s Food Pharmacology: Nutrition Protocols and Healing Recipes to Take Charge of Your Thyroid Health. And her latest book is Adrenal Transformation Protocol, which focuses on resetting the body’s stress response through targeted safety signals and features a four-week program that has already helped over 3,500 individuals. It has an impressive success rate, with over 80% of participants improving their brain fog, fatigue, anxiety, irritability, sleep issues, and libido.

So, Izabella, I’d love to hear more about your story first. So you got diagnosed with Hashimoto’s and then that led you to write all of these books and help truly so many people. I feel like now everybody knows what it is. I have friends in the medical field who have used your programs, who are aware of Hashimoto’s. So you’ve truly had such an impact. I’m curious with your story, what then led you to write the Adrenal Protocol?

Dr. Izabella Wentz: Sure. I was diagnosed with Hashimoto’s in my 20s after almost a decade of some really frustrating “mystery symptoms,” where I was struggling with chronic fatigue, irritable bowel syndrome, anxiety, panic attacks, hair loss. It just felt like every other month I was starting to get new symptoms. I had carpal tunnel in both arms, I had acid reflux. And when I finally got diagnosed with Hashimoto’s being a pharmacist, I had already been a practicing pharmacist for a couple of years, I was excited. I was like, “Okay, great. I get to take medications and they will help so much.” And spoiler alert, the medications did help but not that much.

So I went from sleeping for 12 hours a night to 11 hours a night. Sure, that was an improvement, but I still didn’t feel fully human. I went from wearing two sweaters in Southern California to just one sweater, and sure that was an improvement again, but I still was struggling with so many residual symptoms and I wanted to figure out if there was anything I can do to make myself feel better. If there was anything that I can do to reverse all of the symptoms that I was dealing with and potentially address this autoimmune component of my condition.

I knew that some autoimmune conditions could get into remission, but there was really no information on how Hashimoto’s could get into remission. And so this is essentially, I started doing some research through PubMed, visiting all kinds of healers, from integrative doctors to traditional doctors to all kinds of strange people, and really started becoming a bit of a human Guinea pig. And that’s how I became a Hashimoto’s expert is just through my own health journey and figuring out what worked and what didn’t work the hard way.

I ended up releasing my first book, Hashimoto’s the Root Cause in 2013 because I have a cousin who is much younger than me, and she was diagnosed with Hashimoto’s when she was still a teenager. And she lives in Poland. And so I thought, okay, if I write this book, then maybe my mom can translate it and my cousin can have a guide for healing. And it ended up being really a way for me to write down what helped me and helped me stay on track. And the research gave me a bit of a purpose where I thought maybe this disease can help me help other people.

I always wanted to help people with their health. As a pharmacist, I dreamed about finding a new drug or some kind of a cure for a disease at some point for people. And so then I thought maybe this is my opportunity to take just this diagnosis, which was quite devastating for me. And all the symptoms were quite awful, to take it and turn it into something positive through helping others.

And so that’s how my first three books on Hashimoto’s were born. A big part of healing Hashimoto’s is also supporting the stress response and the adrenals. And I thought I had pretty good plans for how to do so. I would utilize hormones like DHEA and pregnenolone. I would recommend some extreme life changes like cutting out all caffeine or sleeping for 10 to 12 hours a night for 30 days straight and decommitting. And these protocols, I feel like they worked very, very well for the right people. But then there were always, of course, people that couldn’t take hormones, weren’t able to sleep the 10 to 12 hours, weren’t able to decommit.

And I definitely felt for them, but I didn’t really have as much of an insight until I was one of those people when I had a new baby. When my son was about eight months old, he wasn’t sleeping very well and I felt like my adrenals just crashed. And I knew that that was going to be troublesome for me, as every practitioner knows, stress is oftentimes what precedes illness. And so I thought, can I do anything other than take hormones? I can’t take a lot of supplements, and I definitely wasn’t able to sleep 12 hours straight each night with a little bundle of joy that needed me all throughout the night.

And I wasn’t able to go to Bali for four months and just sit by the beach as lovely as that would’ve been because I did have responsibilities and commitments. And so that’s how the Adrenal Transformation Protocol was born. It was finding new ways to really shift the stress response into more of a safety space. And I ended up piloting it with some of my clients. And it worked out so well that I ended up coming out of maternity leave to write a book about it, and it was the Adrenal Transformation Protocol.

I’m from Eastern Europe, so our maternity leave, I’m used to a five-year maternity leave, so I had to cut it short by starting to write a book when he was four. And I was able to share that with people. And grateful again to have had that opportunity of using my own healing journey and some of my own struggles to help others.

Evelyne: Yeah. Do you think it’s sometimes unavoidable to go into this pattern of dysfunction? I feel like I’m in it right now. And I can see the light of the tunnel, and I honestly don’t even know how I could have prevented getting to this point with all the things on my plate. And I feel like whether it’s some of our friends who have written books or, I mean practitioners are just very busy taking care of a lot of people, a lot of them are parents, a lot of people are also taking care, not just of their kids, but of aging parents. And so I feel like there are times in our lives where that just happens. I don’t know, do you agree with that? That it’s like even you’ll go through it and then you might heal, but then it’s unavoidable to have it happen again?

Dr. Izabella Wentz: Yeah, absolutely. I mean, life has its ups and life has its downs, and we have all kinds of stressors. Some of them are really positive stressors like getting married or moving into your dream home or having a baby, or starting a new business, going to graduate school. These are wonderful “stressors,” but they do impact our stress response, whether that’s through some of the sleep deprivation or some of the extra work on our plate that we have to do where maybe we’re not able to rest as much and we feel like we constantly need to be busy.

And then there’s also the other types of stressors that occur, which are not so positive, such as losing somebody or a divorce or accidents or bankruptcies and so on and so forth. And these I feel like are oftentimes a little bit harder to come back from where, for example, you move into a new home and it’s going to be stressful, but eventually you figure it out. But then losing somebody, that might be such a traumatic stressor that it can keep you stuck for a long time and you may not be able to come out of that as quickly.

There’s no hard and fast rules, but life throws challenges at us, and I feel like having… The last few years, the pandemic was stressful for everybody, no matter how fit they were, no matter how great relationships they were in and what great health they were in, those are going to be stressors that we can’t avoid. I think my approach in the past was focused on trying to make your life as low stress as possible. My newer approach within the last few years has been more about building resilience and really focusing on how do we not let those stressors destroy us? How do we recover from them?

Because there’s always going to be times when we’re stressed out in life and there are certain predictable patterns that happen in our bodies whenever we’re stressed out. For example, we’re going to be depleting our B vitamins, we’re going to be depleting our magnesium, our vitamin C, our gut lining is going to be impacted, the secretory IgA in the gut is going to become more susceptible to infections.

And so thinking about these things as much as we can, whether that’s for prevention or for treatments or coming back from an adrenal fatigue crisis or dysfunction crisis, these are the things that I mostly focus on these days.

Evelyne: Yeah, let’s talk about that term, the adrenal fatigue. You do use that term a bit in the book, but you do explain the terminology. And I learned quite a few years ago, probably like a decade or so ago now, that we shouldn’t use that term adrenal fatigue anymore because it’s incorrect and we should use HPA axis dysfunction. Do you still think it’s useful for patients to understand it? How have you changed your mind or adapted your terminology over time?

Dr. Izabella Wentz: I’ve always referred to it as hypothalamic pituitary adrenal axis dysfunction, and I never learned it the other way. I know adrenal fatigue was in vogue many years ago, and that was before I came into integrative medicine. And so I’ve always thought of it as HPA axis dysfunction. Looking at the research that’s how it’s always been termed. And I think there’s some controversy around the term adrenal fatigue because the adrenals don’t actually get tired, they’re not sleepy. It’s more of an adaptation that happens between our brain and our body.

And I think that’s a very important distinction for practitioners because that allows us to figure out what the optimal treatments are. I feel though sometimes we get really caught up in the terminology as practitioners where it may not matter as much to patients. With patients, I feel like adrenal fatigue is a very convenient way to describe a cluster of symptoms. So, I’ll still use I guess all that terminology interchangeably. But if anybody really wanted to know, I do explain that in my book and on my website what is actually happening in “adrenal fatigue.”

And so I know it’s a bit controversial, and I know there’s people that have debates on this. And I’m like, you know what? It’s a legacy term. It’s convenient. We might as well use it because people know it. And people are fatigued when they have HPA axis dysfunction. So, I feel like it still works. Right?

Evelyne: Yeah. And I do want to get into the testing and everything that happens, but I want to go back to what you said about hormones. Like you, I also learned back a long time ago now to support HPA axis dysfunction with hormones like DHEA and pregnenolone, mostly those, but I’m not a licensed prescriber, so I never felt truly comfortable recommending those. Now you’re a pharmacist, so of course you can, a lot of our practitioners listening can prescribe, it’s probably half-and-half who can prescribe and who can’t prescribe. And so I think they are available as supplements, so they can be great. But what made you shift away from using those and using other things?

Dr. Izabella Wentz: I think they can work really, really well. I have had some clients who unfortunately had a history of breast cancer or a family history of breast cancer or things where they felt concerned that DHEA may drive up that pathway. For some women, I know me being one of them, DHEA can also stimulate chin hair production, which is never, never fun or acne. So that can cause that hirsutism in some individuals.

And then I was a breastfeeding mom, so of course I didn’t want to give my baby chest hair with DHEA. I had no idea what the effects of that were going to be. And some people, I would say whenever I used to use those protocols, and I’m not saying I don’t use them anymore and I wouldn’t use them, and the challenges I’ve seen is, I would have a person that would come in with a cluster of symptoms and then I would be like, “Okay, well let’s do some testing.” Because we would need to do either adrenal saliva testing or DUTCH testing to figure out the right dosages of the hormones.

And sometimes that test when you’re in adrenal fatigue, you’re so overwhelmed sometimes that test would be sitting on their shelf for six months. And then by the time they got their test results and they reviewed them with me and then I would recommend a treatment, maybe they would start the treatment or maybe it would cause some side effects. And so it was a really long, I guess, timeline from the time they came to me with the symptoms to when we went through everything.

Typically, DHEA and pregnenolone, I would say about three months of treatment is when you would start seeing their symptoms really just normalize. And the methods that I focused on, they don’t require testing. As soon as a person presents with these symptoms, I can give you a list of lifestyle changes and say, “Here, you do these 14 things and you’re going to feel better in two to three weeks.”

And so these lifestyle changes are so foundational and they work so well that even if you wanted to do all the testing in the world, you can do that and you can layer the lifestyle changes with utilizing some of the hormones. Or if you have people that can’t take hormones or just maybe are not willing to test or unable to afford testing, whatever the scenario might be, you still can give them a solid list of lifestyle recommendations that they’re actually going to enjoy that are not like, no coffee and sleep all day type of recommendations. And that’s when I realized, “Huh, maybe I’m onto something.” And I decided to release it as a book versus just working on it with my own clients.

Evelyne: That’s great. I thought it was interesting that you wrote that, “We’re not sick because we’re anxious or coffee addicted or have insomnia, rather, those are the consequences and adaptations that we develop as part of the stress response.”

Dr. Izabella Wentz: Yeah, I mean humans, we’re smart critters. So we try to go and self-medicate ourselves. Humans have done that for centuries, going after herbs and whatnot to figure out how to make ourselves feel better. And I feel like people that are stressed out and depleted are going to oftentimes reach for things that make them feel better, whether that is wine to calm down an anxious mind or magnesium when you’re magnesium deficient and stressed, so you’re reaching for chocolate, not magnesium.

And a lot of times if you have that morning fatigue, if you have the all day fatigue, you’re going to end up getting addicted to coffee and caffeine because it’s readily available and that’s something that you’re going to come across.

I know I used to have clients that I would work with who were saying, “Hey, I can’t sleep and I have headaches all the time and I’m so tired throughout the day.” And they would say They drink six espressos a day. And I was like, “Well, I know what you need to do, just give up the coffee.” And I would be so sure of that that was the reason for their dysfunction. But then they would be like, “Okay, so I quit the coffee now, I still can’t sleep. I’m even more irritable now than I was before and I’m still tired all day and I still have those headaches.”

And so I realized, you know what, a lot of times people are self-medicating with some of these uppers or downers to try to balance their adrenals, but we have better ways of doing that.

Evelyne: I want to go back to the testing for a moment. You just still run an adrenal salivary index sometimes on people, right? And do you find it useful, and I’m curious which one you use, but also I guess you probably don’t need to use it because you can tell which stage of adrenal dysfunction somebody is in based on their symptoms. Right?

Dr. Izabella Wentz: Of course. I started running the ZRT lab tests and Biohealth adrenal saliva tests many moons ago, and after a certain time period I would be able to, the person would describe their symptoms to me after running so many of them, and I would be like, “Okay, let me draw your adrenal CAR.” So if you have morning fatigue, that’s going to be low. If you get anxious this time of day, that means you’re probably going to be dropping your cortisol or you’re going to have some kind of a spike. And then if you can’t sleep at night, then probably you’re going to have a higher cortisol at night than you should.”

And so I still definitely utilize those with people. And the DUTCH tests, if it were up to me, I would have everybody take 100 tests just because I love data so much. But of course, I’m always mindful of what my clients want. Some of them don’t really want to do a whole bunch of testing, they’re not as excited about it as I am. And so I do try to work my best with them with what they have.

With regard to the adrenal transformation protocol strategies, I primarily don’t need to do testing to recommend most of those. If I were to recommend pregnenolone or DHEA, I would consider doing some definitely a DUTCH or a saliva test just to make sure we were getting the dosage correct.

Evelyne: So, Izabella, since you’re a thyroid expert, can you talk about the connection between adrenal dysfunction and thyroid health?

Dr. Izabella Wentz: There’s a huge connection and a huge overlap with, in my experience, I see the majority of people with hypothyroidism and Hashimoto’s, they have some degree of adrenal dysfunction. I know people primarily talk about, social media these days, talks about high cortisol and everybody has high cortisol. “You have high cortisol, that’s why you have belly fat and that’s why you’re stressed and overweight.” And so I think people oftentimes assume that they have high cortisol when they have any kind of health challenge.

In my experience, I’ve actually seen more people with hypothyroidism and chronic fatigue syndrome, fibromyalgia, and they tend to have lower cortisol, so they’re going to be at more of that flat-lined adrenal curve compared to just high cortisol throughout the day.

A majority of times, I would say 80 to 90% of the time, this is what I’m seeing in individuals with hypothyroidism. Part of that is because there’s a feedback loop between thyroid hormones and cortisol. And thyroid hormones can actually speed up the clearance of cortisol.

So many times I would find people, they might have “normal” cortisol levels before they are medicated with thyroid hormones just because of the compensation, but once they get on the thyroid hormones, they’re like, “This is great. I’m going to feel so much better.” And they do feel better at first, and then they end up crashing. A lot of times it’s because of that thyroid hormone that increases the cortisol clearance. And so they end up becoming, I guess their adrenal dysfunction becomes unmasked once they get on thyroid hormones. And then we realized that’s one more thing we have to address to get the person back into balance.

Evelyne: Interesting. What would you say are the top types of chronic stress or chronic stressors that cause adrenal issues?

Dr. Izabella Wentz: Definitely looking at some of the major chronic stressors, I would say blood sugar imbalances are going to be a really, really big stressor. Anything that causes inflammation. So this could be infections, this could be things like mold exposure, this could be toxins. I guess any kind of current stress that people have, like psychological stress, but also past stress, history of trauma, this could lead to an ongoing issue with the HPA axis.

And then sleep deprivation. Sleep deprivation is one of the most common and fastest ways to get into that adrenal dysfunction. This is how they induce adrenal dysfunction in lab animals. And to your point about can we get into adrenal dysfunction at any point? Absolutely. So even if you were to test your cortisol on a daily basis, and overall your cortisol looked great, you had a perfectly healthy cortisol curve, but if you had a week where you did not sleep, that cortisol curve would become impacted rather quickly.

And so the good news is that we can actually get it improved rather quickly as well. So just as quickly as we can get into it, we can get out of it just as quickly.

Evelyne: And let’s talk about some of those areas. I’d love to start with supplements. So, from a supplement perspective, what would you say are the most important areas to address?

Dr. Izabella Wentz: I really love the ABCs and magnesium. The ABCs are going to be adrenal adaptogens, and they help to make people more resilient. B vitamins, vitamin C, and magnesium are going to be commonly depleted during a stress response. I do like to replenish those. Electrolytes are also going to be commonly depleted. So these are great to have on board.

I do like to utilize mitochondrial nutrients as well. Specifically I found carnitine and acetyl-L-carnitine can really, really help with that energy production and some of the brain fog that people experience.

And then one that I think people are often surprised about is Saccharomyces boulardii. Because what happens a lot of times in adrenal dysfunction is our secretory IgA gets impacted. And so our immune response in the gut ends up becoming impaired, and we are more likely to have infections like protozoal infections, dysbiosis, we’re more likely to have food sensitivities and inflammation from food reactions. So Saccharomyces boulardii is a great way to raise that secretory IgA, and that helps to replenish what stress took away from our intestinal function.

And then myo-inositol just because it’s so great for helping to balance the blood sugar. And a lot of my clients do struggle with anxiety, insomnia and blood sugar issues. So that’s part of my protocol. I really, when I look at supplements, I look at, “Okay, how does this one work? Which pathways does it work on and what benefits can it offer?” Because I try not to get people on 700 supplements at once.

My brother calls it Pilbo Baggins from the Lord of the Rings, but it’s essentially, sometimes patients take so many different supplements that they just get overwhelmed with them and they don’t know what’s helping anymore, and it just becomes difficult to incorporate it into your lifestyle, especially when you’re already overwhelmed, which is a symptom of that adrenal dysfunction.

Evelyne: I love that you called it the ABCs, the adaptogens, B vitamins and vitamin C. I think that’s great and so easy to remember.

Speaking of narrowing it down to maybe the top supplements, if somebody is just super overwhelmed, would you say the top three are an adaptogen B and C blend, and then what would be the other ones? Would it be the electrolytes, the carnitine, the inositol, the Saccharomyces? What would be the other top two?

Dr. Izabella Wentz: Definitely magnesium for most people. And the other thing I would look at is what symptoms are you dealing with? If you’re dealing with digestive issues, then I would probably say Saccharomyces boulardii. If you’re really struggling with brain fog and muscle fatigue, then I would say carnitine.

Because a lot of times there is this plethora of symptoms people can experience when they’re in that adrenal dysfunction catabolic state, and so it could really impact their physical body or their mind, and so I would really look at where they were struggling. If it was something like a lot of anxiety and sleep issues, then I might say maybe some more myo-inositol. Right?

Evelyne: Yeah. I’d love to talk a little bit more about the Hashimoto’s aspect because you obviously have so much experience. And I’m assuming that many of the people that you’re working on the adrenal dysfunction with are also your Hashimoto’s clients, right?

Dr. Izabella Wentz: Yes. Many of them are, the people that I primarily serve are women with Hashimoto’s, although I do have additional clients that are gentlemen of course, and primarily they are people that identify as chronically ill or they might have chronic fatigue syndrome, fibromyalgia or some kind of autoimmune dysfunction. I don’t work with bodybuilders on becoming more fit or anything like that, but I wish I did. Maybe I could become more fit if I had all those life hacks.

Evelyne: Hey, maybe in your next iteration of you’re constantly reinventing yourself. Do think that Hashimoto’s is curable or is it mainly manageable? And what is the goal when people are doing your Hashimoto’s protocol? Is it remission? Is it symptom management? Is it reversal? And then can you talk about just the supplement aspect, the medication aspect, and just how you do all of that?

Dr. Izabella Wentz: Yeah, for sure. I think it depends on the person and what their goals are, whether or not they’re looking for symptom management, whether they’re looking for reversal or complete “functional cure.” I will say that with what I know and what we know, most people can get rid of all of their symptoms of Hashimoto’s, and many of my protocols are very much focused on symptoms.

A majority of people can also get into remission. And what does that mean? That means that they maybe had thyroid antibodies that were 2, 3, 4,000 and now they’re at 50 to 200. Or some of them can get an elimination in their thyroid antibodies and their symptoms. And then there’s a small percentage of people that can actually get off of their thyroid medications. But I’m never promising to people, “Hey, just do this instead of taking thyroid medications.” That’s not my message, that’s not what I’m about.

The issue with people with Hashimoto’s, most of them is that a lot of times their condition is discovered in the fourth stage, sometimes the fifth stage where they’ve already had damage to their thyroid gland over the course of 5, 10, sometimes 15 years. And their thyroid gland is unfortunately so damaged that of course we can get the symptoms resolved. The fastest way to address a lot of symptoms is with thyroid hormone, and then we can get some of the other imbalances back on track. We could figure out maybe what was driving the initial immune response against the thyroid gland.

A lot of times it’s a protozoal infection of some sort. And we can resolve that, and so we don’t have that autoimmune response. But then thyroid tissue regeneration is a whole other set of protocols and it’s not something I would say I could guarantee for everybody, and it’s not even a realistic goal for some people.

That said, for some individuals if they’ve maybe had postpartum thyroiditis, if they’ve only had thyroid antibodies or Hashimoto’s for a short amount of time or in their subclinical hypothyroidism, you can actually get off of thyroid medications or lower your dosage or prevent the need for thyroid hormones. I would say though, in my experience, 90 to 100% of people I feel we can get rid of their symptoms. And then another 60 to 80% can get into remission. Probably about 10 to 20% could get off of thyroid meds just in my sort of estimations.

Evelyne: When it comes to the people you’ve worked with, about how long do you see that it takes to get a reduction in thyroid antibodies?

Dr. Izabella Wentz: Generally, we see trends within the first month. So, if let’s say one of the big things I recommend is a gluten-free and dairy-free and soy-free diet, and if that is the main thing that the dietary triggers are driving your symptoms and antibodies, then you can do a test within a month and then you can see if your levels have lowered. For the full impact of most interventions it takes about 90 days. The exception seems to be with H. pylori, if you have an H. Pylori infection, treating that, I mean it’s like sometimes nine months plus where you see the full effect of that intervention.

Evelyne: Very interesting. I feel like with Hashimoto’s, I think in the past when I’ve worked with people and given them supplements and recommended going dairy and gluten-free, I think I expected that, oh, the thyroid antibodies would eventually go away, but hearing you say, “No, they might still be around 50 or 100 and it might never fully go down, but they feel so much better.” And I feel like that’s probably what’s most important.

Dr. Izabella Wentz: I think so. And I think there’s additional ways people can get their thyroid antibodies down. Some people do get their antibodies down to zero or 1 or 5. With the lifestyle interventions, I really love utilizing systemic enzymes. They can be incredibly helpful for thyroid antibodies, low dose naltrexone. I always say there’s more than one way to skin a cat or more than one way to peel a potato just because there’s so many different protocols.

I find nutrition is a really, really great place to start, but if that doesn’t move the needle completely, and for some people it absolutely does. I’ve had people where I’m, “Just go gluten-free.” And they’re like, “Eureka, no more antibodies, no more symptoms. I’m throwing my thyroid meds in the trash.” For some people it is that simple and straightforward, but for a lot of people it gets a little bit more complicated where we have to think about what’s really driving that immune response. And it can be infections or toxins or sometimes these circulating immune complexes, and that’s why I love systemic enzymes for those.

Evelyne: Yeah, that’s very helpful, thank you. I got this question from a nutritionist who works with Hashimoto’s clients also, and she asked, “What does realistic weight loss look like?” She says, “I have several patients who have Hashimoto’s thyroiditis and who have a terrible time losing weight.” I was wondering if you could talk about that.

Dr. Izabella Wentz: Weight loss can be tricky. So many drivers of weight, so it could be perimenopause hormones, so that could be estrogen dominance could be driving it, it could be toxins, it could be adrenals, it could be a person’s diet, it could be their physical activity. A lot of times a great place to start is to lower inflammation because that is a big contributor of weight gain as well.

I typically will have people following the liver reset protocol, the adrenal protocol, and then the gut protocol. And it takes about 90 days to get through all of them. And I will say most people will lose maybe two to three pounds a week-

Evelyne: Oh wow.

Dr. Izabella Wentz: … during each of those protocols, maybe one to three pounds I should say.

Evelyne: That’s pretty significant.

Dr. Izabella Wentz: They do. It’s like a lot of times we’re changing their nutrition, so we’re giving them a lot more protein. We’re getting off of the inflammatory foods. And a big, big shift I’ve seen is, and maybe that’s just because they last longer, but a lot of times with the gut protocols when we really start to adjust their microbiome, people can essentially eat the same foods but absorb less calories from just changing up their microbiome.

So, I do see the gut oftentimes is going to be one of the places that’s a big place where people lose weight. Part of my gut protocols is I oftentimes use berberine too, and that can be very, very helpful for weight loss with thyroid issues. There isn’t a lot of studies on berberine with Hashimoto’s, although I think there should be. And a lot of practitioners, I feel they see that it can really help their patients with Hashimoto’s.

Evelyne: That’s helpful. And you mentioned exercise briefly or not working with athletes, but I want to talk about exercise a little bit because I think sometimes the type of exercise that people do can lead to adrenal dysfunction. And so what type of exercise do you recommend in terms of volume, intensity and type of training for people with HPA axis dysfunction?

Dr. Izabella Wentz: Definitely the HPA axis dysfunction, depending on where you are, if your cortisol levels are too high versus too low can impact how you respond to exercise. The research has shown that high cortisol responds really well to aerobic exercise, whereas with people that are in that low cortisol state, I primarily focus on muscle building and yoga and more of gentle exercises. So when we think about the type of exercise, catabolic versus anabolic, I would primarily focus on more anabolic exercise like weight lifting. So you’re not doing running or marathon training.

It was interesting. I had one of my clients many, many moons ago had struggled with weight was one of her primary issues, and the things she was doing was she was taking cortisol lowering supplements, so she was taking some phosphatidylserine containing supplements, and then she was doing a lot of power walking. And one of the recommendations for her was to switch up her supplements and to stop walking. And she was so fearful, “But I’m supposed to exercise more, I’m trying to lose weight.”

Thankfully she did trust me and she was like, “Okay, I’m chilling and I’m just doing some stretches and yoga and I switched my supplements around and I’m losing weight.” You get the right medicine for you in the right dose, and that can really be a big needle mover versus another person, they might really benefit from that aerobic exercise and running. Right?

Evelyne: Yeah, it’s so interesting. We’re all quite different. Okay. I want to talk about the psychological stress aspect for a few moments. You talk a lot in the book about feeling safe and sending safety signals to your body. What are some of the top modalities that you recommend that maybe you’ve used to address those parts of the equation?

Dr. Izabella Wentz: I definitely love EMDR, so it’s eye movement desensitization and reprocessing. And this is a way to reprocess past traumas so they become less reactive for people. And this is a great way to build resilience. I love neurofeedback too for helping balance the brain. And I think one of my favorite modalities and a lot of my clients’ favorite is pleasurable activities. And it’s as simple as it sounds where you just do things you enjoy, you just schedule time to do things you like and you make it a priority.

As you mentioned, a lot of us are burning the candle at both ends and people are in that, I guess, sandwich generation where they have their children they need to care for, their clients, patients that they need to care for, their aging parents and perhaps their spouses, people they’re in a relationship with, and they end up becoming very depleted with very little time and space for themselves. And so they’re just walking from commitment to commitment and they don’t have time to stop and smell the roses, and so this was whatever you of enjoy.

For a lot of my ladies, they would start painting or doing adult coloring books or just browsing shops or museums, spending time with a loved one, going to the beach, so on and so forth. The one caveat at that is that it can’t be something that you monetize. I think there’s this girl boss culture that’s been around for a while.

I used to write to relax myself. I was always a creative writer. Writing does not relax me anymore. Let me tell you that. Now that I’m a professional author and I have a blog and a books and stuff. It’s like I’ve got gray hairs because of writing. This is not my way to unwind, so I’ll do painting because I’m very terrible at it, and it’s like, I know this will never turn into something that I can girl boss into.

Evelyne: I love that. I’m going to go back to the supplements for a moment, because something that I forgot to ask you more about, but going back to adaptogens. I love adaptogens. I think you can see behind me I’ve got a bunch of adaptogen books and some of them are upstairs in my room. Can you tell us about some of your favorite adaptogens that personally helped you?

Dr. Izabella Wentz: Oh my gosh, so many great adaptogens out there. I know ashwagandha was a really big game changer for me, and I think for a lot of thyroid patients as well. This can be great for supporting those energy levels throughout the day and supporting our stress response. I know I always joke that everybody around you becomes less annoying when you take ashwagandha yourself. It’s like, oh, that magic, right? So that can be a really big game changer for people.

Holy basil is one that’s super gentle that I love for a lot of people, especially people that maybe have trouble sleeping at night. I love reishi. Reishi is something that you can take in the evening if you need a little bit more energy, but don’t want to do caffeine.

And then of course there’s various adaptogens depending on where you are in life. I know these days I’m loving Vitex because I am in that age above 25. And other women might reach for maca or other libido-boosting adaptogens too, depending on what their needs might be.

Evelyne: I want to go back to ashwagandha for a moment because I feel like in thyroid issues it is a little bit controversial. Some people say not to use it. What are your thoughts on that?

Dr. Izabella Wentz: I think some of the controversies stem from that it is a nightshade, and so there is this, one of the protocols for Hashimoto’s and for autoimmunities, the autoimmune paleo protocol, which is a fantastic protocol. Does everybody need to be on that protocol? Not necessarily do they need to be on that protocol forever, even if they do need it, not necessarily. This is a 30 to 60 day protocol where I think some patient advocates understood it as something that you need to be on forever, and then you would want to avoid anything that could have a nightshade in it.

Personally, for myself and many of my clients, nightshade might not be an issue, but it might be something that you might avoid if you’re doing an elimination diet for 30 days, and then you would see if, “Hey, are tomatoes and peppers are nightshades reactive for me.” And the majority of the people I’ve worked with, they do tolerate ashwagandha really well. And of course there’s so many other adaptogens out there where even if they don’t, they can still utilize something like holy basil or reishi. Right?

Evelyne: Yeah. Since you brought up the autoimmune paleo protocol, I am curious, I think that you are eliminating, you talked about dairy, gluten, and soy, right? Do you consider that a lifelong change or do you also have people eliminate them for, maybe not 30 days, but longer than 30 days and then bring them back, or are those just off the table?

Dr. Izabella Wentz: I used to think that those were forever gone foods. In my experience now, soy and dairy can be mostly brought back. I haven’t been able to bring gluten back for anybody in my experience so far. I’m working on it, so ask me again in a few years, but as of right now, I would say for most people, they do need to be off of gluten long-term if they have Hashimoto’s.

Evelyne: Yeah, that’s interesting too because I feel like so much of the advice out there is to be off, I don’t know, 8, 9, 10 different foods, and maybe that’s not necessary, even though it can be helpful for a short time at the beginning.

Dr. Izabella Wentz: I think it can be life-changing in the beginning when you have so many reactive foods. And I used to think that the foods were causing the autoimmunity, and then I realized that the food reactions are more of a symptom of the autoimmune condition. And so when you get that under control… And my next book is about irritable bowel syndrome and some of the drivers of that, and a big part of it, spoiler alert, is infections in the gut, and that can really impair your ability to absorb foods properly. And if you have intestinal permeability, you’re going to be sensitive to all kinds of foods, typically whatever is in your diet.

And so what I found is really focusing on those chronic infections and what’s driving the intestinal permeability. Then once you take care of that, then a person after a short-term elimination of reactive foods, they should be able to reintroduce them back. And I would say 90 days would be the longest that I would eliminate foods for.

Evelyne: It’s interesting. It’s like no matter who I talk to, whether we’re talking about mold or Hashimoto’s or these things, it’s more about the immune activation and the inflammation and getting that down versus some of these other things, right? Because it’s like we should be able to get to a point where our system isn’t so reactive all the time.

Dr. Izabella Wentz: Yeah. It’s like, I don’t want people living in a bubble. I want them to enjoy life and travel and be able to go to Europe and use whatever products and try all the different foods, versus being somebody that has to be so careful about everything that they can’t leave their own house. Right?

Evelyne: Right.

Dr. Izabella Wentz: That’s not healthy either.

Evelyne: Yeah. I was going to ask you what you’re working on next, but you answer that. So, another book. I have a question tangential to that. So if you could design the ultimate study and publish it for anything, what would it be?

Dr. Izabella Wentz: I love that question. Gosh, I would probably have a really deep study into various types of pathogens in the gut and how they drive various immune reactions, whether that is to foods or auto immunity. I would focus on that.

Evelyne: That would be really cool to see. Before I ask you our questions that I ask every guest, I have a side question, but in your book you mentioned something interesting. I just did a two-part interview on hemochromatosis because I have the main gene for it, with Dr. Christy Sutton. And it was really fascinating. And so in your book you talk about how your husband, Michael was diagnosed with it, though it wasn’t the usual gene, but the reason I’m bringing it up is this didn’t come up on the podcast with her, and I thought it was just fascinating. Can you share how you resolved Michael’s hemochromatosis?

Dr. Izabella Wentz: Yeah, so it was a lot of late nights and trying to find different studies and what could have been driving his hemochromatosis. We ended up doing some genomic testing with Bob Miller, and he was found to have type four hemochromatosis, which is a ferroportin export gene variation, where essentially his body doesn’t export iron as well.

And because we were living in Boulder, Colorado, which is really high up in the mountains, generally when you live in the mountains, you’re going to become hypoxic, and that drives EPO production to produce more red blood cells and more iron. Most people can balance that out, so they’re like, “More iron coming in, okay, let’s bring more iron out.” And people with this ferroportin issue, the more iron is coming in, but none of it’s coming out.

And so we lived in Boulder for about six years, but the first few years we traveled a lot, so we didn’t have a little one. We just had our dog and he was great at traveling with us, and we had great dog sitters too, and so we were always visiting family or going to conferences or going on really great vacations. And then once we had our son, we really hunkered down and stayed present in that space. And we realized my husband stopped sleeping and he started to have some inflammation and joint pain. And we ended up testing his ferritin levels and they were super, super high, maybe 400, maybe more than that.

Evelyne: Wow.

Dr. Izabella Wentz: And he was doing therapeutic phlebotomies which would help, but then the symptoms would start crawling back up. After we went on our first vacation with our son who was 15 months old at the time. We went to California for two weeks and my husband was sleeping and he was feeling better and he wasn’t in pain, and we’re like, “Oh, we’re just so much more relaxed because we’re on vacation we,” right?

Evelyne: Mm-hmm.

Dr. Izabella Wentz: And so it took us a little while. I think my mom actually found an article about elevation causing high ferritin or hemochromatosis. And apparently it happens all the time in the Andes and in South America and whatnot, and it’s not been as well described in Boulder Colorado, but we ended up moving to California and within three months his ferritin normalized. And he hasn’t needed a therapeutic phlebotomy.

Since moving to sea level we do miss the mountains. We do love the mountains. We do love Boulder, we love hiking, but it looks like we’re going to be living at sea level from this point on just because we don’t want that pesky iron to build up in his blood. Right?

Evelyne: Yeah. What’s so interesting. When I saw that, I’m like, “Oh my gosh, we have to talk about that for a moment.” We have some questions that we like to ask every guest on the show. These are just rapid fire questions. The first one is, what are your top three supplements that you’re taking right now?

Dr. Izabella Wentz: Well, definitely berberine, so that’s helpful for blood sugar balance and for everything for gut health. Omega-3, they’re great for lowering inflammation in the body. They’re just very, very, I guess all around have a ton of great benefits. And then carnitine for brain function and muscle function.

Evelyne: And what are your top health practices right now for your personal health and wellbeing? Because I guess you’re writing another book, you’ve got your son, you have a lot going on. What are you doing for yourself?

Dr. Izabella Wentz: What am I doing for myself? I love spending a lot of time in nature, just in general. As far as the health practices, doing yoga once a week, Pilates once a week, going on hikes. These are some of the things that really, really help me. I get as much sleep as I possibly can. I love to spend time in the pool and swimming. And if I ever get overwhelmed, I love utilizing like adaptogens or neural feedback. Those are the main things. I loved taking methylene blue while I was writing my book too.

Evelyne: I have not tried it. That’s definitely popular here.

Dr. Izabella Wentz: It really helps with brain function and focusing.

Evelyne: That’s great. And what is something you’ve changed your mind about through all of your years in practice?

Dr. Izabella Wentz: I think a big shift for me has been dairy. I thought that no human should eat dairy. And when I utilized carnitine and alfalfa, I found that this somehow resolved my dairy sensitivities, and that it’s helped some of my clients at that point. So I’ve had a big shift about dairy. I thought it was something that was just evil and only for baby cows, and now I’m like, “I actually see the value in it again.”

And I think when I was first getting into functional nutrition, I thought there were bad foods and good foods, where now I’m more of the sense of which foods work in your body and how do we get your body to be more accepting of all foods. Not to say that I think anybody should be on an all junk food and mojito diet or anything like that, but just being a little bit more mindful of what works for your body.

Evelyne: Izabella, you’re not the first person to mention the dairy in answer to this question.

Dr. Izabella Wentz: Interesting.

Evelyne: Yeah. Well, thank you so much for this conversation today. I learned a lot from you, and I just want to say thank you for all of the books you’ve written. I’ve recommended them to so many people, both practitioners and friends. I just think they’re absolutely amazing resources, and I know how much time and care and attention and love goes into writing those, so thank you.

Dr. Izabella Wentz: Thank you so much for having me. It’s just such a joy connecting with you, and thank you for all the heart and care and brilliance that you bring.

Evelyne: Oh, thanks, Izabella. Where can practitioners learn more about you?

Dr. Izabella Wentz: I have a website called Thyroid Pharmacist.com, and they could learn more about me there. And I put out articles, deep dive articles on some of the research in Hashimoto’s and some of the patterns that I’m seeing if you’re interested in learning more.

Evelyne: Great. Thank you. Also, I wanted to remind you that on the Designs for Health website, we now have our Drug Nutrient Depletion and Interaction Checker for the top 25 most commonly prescribed medications. And you can access that on designsforhealth.com when you’re logged in as a practitioner. And Izabella, I’m not sure if you’ve seen it, but I thought that as a pharmacist that you would appreciate that.

Dr. Izabella Wentz: That’s really, really exciting. It’s such an important tool. Thank you for sharing that with us.

Evelyne: Yeah. Thank you for tuning into Conversations for Health today. Check out the show notes for resources from today’s conversation. Please share this podcast with your colleagues. Follow, rate or leave a review wherever you listen or watch. And thank you for designing a well world with us.

Voiceover: This is Conversations for Health with Evelyne Lambrecht. Dedicated to engaging discussions with industry experts, exploring evidence-based cutting-edge research and practical tips.