July 14, 2010

Podcast #103 from https://bengreenfieldfitness.com/2010/07/episode-103-how-to-manage-a-low-thyroid-ketogenic-diets-and-more/

Introduction: In this episode from Ben Greenfield Fitness: how to manage a low thyroid, are ketogenic diets helpful for fat loss? The link between magnesium and testosterone, budgeting your supplement intake, how to improve circulation, knee strengthening exercises and how to eat during an Ironman triathlon.

Ben: Hey podcast listeners, this is Ben Greenfield. The day before I’m about to head out for a 10-day flurry of trips across Oregon and California for various business meetings and family reunions. So, over the next couple of weeks, am I still going to be bringing you the podcast? You bet. I have some great interviews lined up. Last week, I asked you to tell  me who you wanted to see on the show. You gave me great feedback and I’m lining up a fantastic series of podcasts for the next couple of months so look forward to still getting the podcast even though I’ll be rushing around, and the audio might change a little bit as I use portable microphones and iPhones to record the podcast, but either way we’ll make it work. So, in today’s podcast, I’ll be interviewing Dr. Roby Mitchell who is an expert on many forms of natural medicine, but is going to share some insightful tips on managing a low thyroid and low metabolism today. And why you should even care about your thyroid, even if you don’t have hypothyroidism. I’m also going to be answering listener questions – both call in questions and write-in questions that cover a variety of topics. Before we get into that, we’ll have a special announcement feature, a special message and then the Listener Q and A. Enjoy.

So here’s what we’ve got going for today’s special announcements. First of all, you may remember that last week I mentioned that I’ll be teaching a triathlon camp in Texas. The 2011 Austin Triathlon Camp. You’re not going to want to miss that if you’re a half Ironman or Ironman triathlete who’s preparing for a 2011 event. It’s a blast. It’s all inclusive. That means your lodging, your meals, your nights out on the town, your training, your segue in. Everything is paid for so be sure to check that out. In addition, I’ve been getting fantastic donations from listeners. I’ve been sending out lots of free T-shirts and lots of goodies along with those T-shirts. And you can donate to the show by going to the Shownote episodes where I always put lots of goodies and links and resources that have to do with whatever information we covered during the podcast. You can go to the episode Shownotes for episode 103. Scroll down to the bottom and that’s where you can donate to the show. In other news, I am still accepting just a couple more people for the trip to Thailand that I’m organizing. A two-week trip to Thailand for anybody who’s interested in doing an Olympic distance or a half Ironman triathlon over there. I’ll be helping you organize your trip and putting together some social events as well as organizing some of the logistical difficulties of racing in Thailand for you. So for any of that, email me [email protected]. Whether you are a triathlete, or you just want to shed a few tones, you’re not going to want to miss the Q and A and featured topic coming right up.

So folks, if you have a question, you can email [email protected]. If you’re in the US, you can call toll free to 8772099439 or if you are international and you want to use the fantastic free conferencing software called Skype that you can download from skype.com, my user name is Pacific Fit. That’s Pacific like the ocean, Fit like fitness. So Pacific Fit. The first question is from listener Sean, and listener Sean actually had a very long question about some struggles he’s been having with low testosterone. But he finishes by saying…

Sean asks: My question is do you have any literature or information about athletes with low testosterone and how it affects their training? I’ve listened to your podcast about your own bottle with low T. Besides any supplements or medication, do you think it takes a guy like me more time to reach the desired results due to my low testosterone?

Ben answers: Well Sean, it’s a great question and just to clarify, you say I’ve been battling with low T – I personally had testosterone levels that weren’t ideal for the level of competition for triathlon that I wanted to into. But from the letter that you wrote me, you’ve got far more clinical issues when it comes to your testosterone levels. I see that you’re trying a lot of different things like the testosterone patch and different types of supplements. But what I would recommend is that instead of coming to me for advice on hormone therapy or medical testosterone management, which I’m really not an expert in, you go to two different people. One, the guy that is going to be on the show today, Dr. Roby Mitchell. And you can find information on him and information on hormones that he provides at www.drfitt.com. You can also go look at the company Bioletics, which is where I get the OptiMale testosterone supplement that I take on a daily basis. I actually cycle on it. Five days on, two days off. It did double my testosterone levels. I’m not saying that it’s going to do that for you, but it’s worth looking into that and also maybe trying to arrange a consultation with Dr. Cohen over there, who’s also an expert on testosterone management and bringing testosterone up. I can tell you that with the athletes I’ve consulted and the individuals I’ve consulted with who are attempting to battle low T, especially males who have testosterone levels that are in the tank – it does take several months and sometimes more than a year to really get things optimized in terms of all the different things that have to take place within your body to get your testosterone levels back up to where they should be. But because your question does have to do with testosterone, I wanted to talk to you about an interesting study that I just came across in Alan Aragon’s research review. And Alan Aragon is actually going to be coming on the show to talk about the top ten myths in nutrition and training here in a couple of weeks. But he talks about a study that was published in Biology of Trace Elements Research in March of 2010. The title of the study was The Effects of Magnesium Supplementation on Testosterone Levels of Athletes and Sedentary Subjects at Rest and After Exhaustion. The results of that study showed that the free testosterone levels increased at exhaustion, that’s after a hard workout, before and after magnesium supplementation compared to resting levels. The conclusions were that supplementation with magnesium increased both free and total testosterone in sedentary individuals and in athletes. And those of you who have been listening to the show know for a while that I have recommended magnesium on the show. Dr. Cohen has, Dr. Caroline Dean has, Dr. DiMarco has. Lots of different physicians are really recommending magnesium and more magnesium than what you’re going to see in most dietary guidelines. We’re talking about magnesium levels… as a matter of fact, in this study, the actual dosage was 10 milligrams per kilogram of body weight. So for example, for a guy like me that’s between 700 and 800 milligrams of magnesium. Now between the food and the supplements that I take, that’s about what I get on a daily basis. But a lot of people aren’t even taking 100 milligrams of magnesium. The way that I do it is I use a combination of topical and oral magnesium. I’ll put a link to the topical magnesium that I use in the episode Shownotes, and the oral magnesium that I use – I’ll put a link to that as well. I’m not saying that the increased levels of testosterone are necessarily going to enhance performance. As a matter of fact, this study shows and Alan Aragon on his notes on the study mentioned that it didn’t exactly mean that you were going to be a better athlete or perform better, but there was an increase in testosterone. And I have yet to see that be a bad thing. So, I’ll put a link to a couple forms of magnesium in the Shownotes for you and also check out Dr. Cohen and Dr. Fitt. So we’re going to move on to the next question. This question is from listener Patrick.

Patrick asks: How much fitness is really gained in the last big month for a long distance training plan? I’m on your Triathlon Dominator plan and I’m three weeks into the last five week kick of volume. I’d be interested to know how much all this volume really amounts to on race day. I get the feeling that it might not make much of a difference from a fitness perspective, but perhaps help a lot from a mental perspective.

Ben answers: Well Patrick, you’re on the right track in that if you’re going to do something like an Ironman triathlon, whether or not it’s going to help you to sit in a bike saddle for five hours before a race from a physical perspective – you definitely have to have some amount of mental fortuitiveness to actually make it through that event. Just by training and doing a few long sessions. However, you need to take into consideration a few things. For example, during the marathon, you are going to be on your feet for at least three hours. For most people, closer to four hours and sometimes more than four hours. If you’ve never spent that much time on your feet, moving on your feet and you’ve never spent even close to that time moving on your feet, then you may not have the actual strength in your ligaments, in your bones, in your soft tissue to actually support you during that event. Especially after you’ve been on your bike for five to six hours. The same goes for the swim. If you’ve never been horizontal in a pool or in the open water for an hour or an hour and a half or however long it’s going to take you to swim 2.4 miles, you may find some hip flexor and some core fatigue that you didn’t experience from shorter swim sessions. That’s why including some volume is important. But it goes even farther than that. Understand that there are lots of adaptations to endurance training. You gain in your oxygen capacity and your ability to use oxygen. You gain in your ability to be able to buffer lactic acid and also shuttle that lactic acid up to the liver to be reconverted and reused as fuel. You improve in your exercise economy, meaning that if you’re training to swim, cycle and run you’re going to become more efficient neuromuscularly at swimming, cycling or running. Whether it be your stride length or your push off when you’re running, your swimming technique, your body position on the bicycle, your ability to push and pull the pedals. You also develop a greater ability to use fat as a fuel during a higher intensity exercise, meaning that you get a carbohydrate sparing effect. You’re able to go longer on less fuel. You get a conversion of your fast explosive – what are called type two muscle fibers into type one muscle fibers, which are slow twitch muscle fibers that take a much longer time to fatigue. So I could go on. You get increased capillarization which means your blood vessels that feed into the muscles become more dense and larger. You get an increased size and density of the mitochondria in your cells which are the part of your cells that are able to take oxygen and convert it into energy. You get increased stroke volume in your heart meaning that your heart can pump more blood per beat, delivering more oxygen to your tissues and your tissues can become enhanced in their ability to extract that oxygen from the blood as it rushes past. All sorts of things happen in your body that if you did not engage in heavy training up to the race, you would not gain all of those results. Now, there’s also the use it or lose it philosophy in exercise. What that means is all those aerobic capacity benefits that I talked about tend to disappear after a certain amount of time spent in de-training. There has been a study that looked at well-conditioned athletes who trained regularly for a year and in that study, they stopped those athletes from exercising and after three months they lost half of their aerobic conditioning, which means if you really neglect your fitness in the 12 weeks leading up to the race, you’re going to lose a lot. And your muscles can tend to atrophy after they haven’t been stimulated for 72 hours. That’s how short a time period you have to really be able to stimulate your muscles and to do exercises that use the muscles that you’re planning on using during the race. So there are a lot of physical benefits that maintain a sharpness for triathlon in your body that you’re going to lose if you don’t engage in the workouts. Now as far as the mad volume goes, like on the Triathlon Dominator plan, there is an 18-mile in there. There’s a 100 mile bike in there. Could you go out and do an Ironman triathlon without doing those? Yeah probably. But you wouldn’t do as if you had because you’re not going to have the mental wherewithal, and you’re not going to have that neuromuscular training and it’s likely that something called the central governor in your brain – which is the part of your brain that says “Okay, I’m tired now, this is all I can do” – it’s likely that that’s going to kick in a little bit earlier if you haven’t gotten yourself close to that marker of long-distance fatigue. So there’s a lot of reasons to be sure you include the volume. Any single training plan that you look at – whether it be a volume or intensity training plan definitely has some workout that stimulates something close to race distance in those final eight weeks leading up to something like an Ironman triathlon. So great question.

A question from listener Gabe.

Gabe asks: I’m on a budget but committed to improving my health. If you had to choose, would you take the EnerPrime supplement as a first priority or the Living Fuel Super Greens supplement? Also, which supplements would you say are the most valuable to you in order of priority?

Ben answers: Well, for those of you who aren’t familiar with the two supplements that Gabe just mentioned, I will put a link to those in the Shownotes. But to answer the first question, you have to understand the difference between those green supplements. They both contain super foods, greens, things like chorela and spirolina, blue-green algae, all sorts of basically alkalinic super foods that help the body fight off inflammation, have a less acidic state, give you a little bit more energy and they’re very, very nutrient dense forms of nutrition meaning that there are not a lot of calories but a high amount of nutrients and minerals and vitamins. Now the difference between the two is that the Living Fuel Super Greens is formulated to be a meal replacement, meaning that it’s got carbohydrates. It’s got proteins, it’s got a couple hundred calories per serving. The EnerPrime supplement is designed to be just a green supplement meaning it doesn’t have the carbohydrates, the proteins and the calories. Now my entire philosophy of life and nutrition is to try and get my meals from real foods as much as possible and then supplement that real food with the things I need to fill in the holes. Now although I think that both of those supplements that were mentioned, the EnerPrime and the Living Fuel Super Greens are both excellent supplements I would tend to have to go with the EnerPrime just because I like to have salad, fresh fruit, things of that nature. Post-workout I try and have a real meal like chicken and quinoa or brown rice with a little bit of nuts, almonds, things of that nature. So for me to have a post-workout drink is pretty uncommon. That’s why if I had to choose from a budget perspective between the EnerPrime and the Living Fuels Super Greens, I would go for the EnerPrime. That being said, I do use both. I use a serving of that Living Fuel Super Greens typically about once every couple of days, I’ll have that as a meal. Usually when I’m on the go and I’m real busy. And I do the EnerPrime powder every single day. I stir that powder into a glass of water every morning.

So the second part of your question.

Gabe asks: What would I do if I had to budget my supplements?

Ben answers: It’s a pretty simple answer. In this order, I would take my greens supplement, I would take a vitamin D supplement and I take the NanoSpray from Bioletics. I would take a magnesium supplement and I’d take a fish oil supplement. All four of those are supplements that are very effective, that are not super expensive. If we took them all together, you’d easily be under $100 a month and all of them are well proven to really help out with your overall health and your performance. So that’s what I would do if I were you. Take a green supplement, take a vitamin D, take magnesium, take a fish oil and then eat lots of fruits and vegetables. Lots of real food, real nutrient dense food.

Laurel asks: I just pulled something in my back doing squats, putting the weights down when I was done. I am trying to get my left quad back from an ACL energy and I think squats are some of the better exercises, but are there safer ones to do at home?

Ben answers: Well Laurel, the interesting thing about strengthening your legs is that any body builder will tell you that they do a lot of reps when they want to build up leg muscles. They’ll do 12, 15, 20 reps and that results in hypertrophy in development of the leg musculature and you actually don’t need a squat rack or a barbell to do those amounts of reps. You can use things like kettle bells, dumbbells. I have something called a gym stick that I use. You can check that out at www.bengreenfieldfitness.com/gymstick. However, if you’re rehabbing your quad from an ACL injury, I don’t think that heavy squats are necessarily going to get you the most bang for your buck compared to single-leg exercises, which are going to actually train your knee to move properly so you don’t risk tearing your ACL again or doing damage to your ACL again, whatever it is that you did to it. So, you would want to do what are called propeoceptive exercises, which means you’re doing things where you’re standing on one foot. Whether it means starting off with walking lunges, supporting yourself in the middle of the walking lunge by standing on one leg and then dropping into that lunge pattern, doing single-leg squats starting by supporting yourself using a wall or a stability ball and then gradually getting to the level where you can do so without holding on to something. And then using things like pillows and bosu balls and elements that you stand on that make you balance and not even worrying too much about doing leg exercises per se but just standing and balancing. I have some people who have weak knees and I have them stand on one foot while they’re brushing their teeth just to improve the propeoception in that leg and the ability of the elements around the knee to develop the awareness that’s necessary to support the body. Dropping off of low level surfaces like the bottom of your stairs and practicing landing in a controlled pattern can also help out your knees quite a bit. You can do that double leg and then progress to doing it single leg. When I was in college, I did an internship down at the Nike Sports Performance Center in Duke University, and there were a couple athletes that I worked with… NFL football players, both rehabbing from ACL injuries and half the work that we did was things that if you looked at, you would have thought they were pansies because all we were doing was doing real light weights on one leg, doing balancing on balance pillows. We were even doing some water running and some aqua jogging, some light plyometrics meaning those jumping and landing type of activities and some light change of direction type of activities out in the field. But not a lot of squatting 600, 700 pounds or anything like that. So sometimes brute strength is not what you need to protect a weak link in your body as much as the awareness that’s necessary to keep that injury from occurring again and help your body to protect itself.

Now you had a second part of your question.

Laurel asks: There are so many slang terms for exercises. Is there a place to look them up?

Ben answers: There are tons of different exercise resources that are out there, Laurel. YouTube of course is the most popular one that comes to mind. You always want to be careful because obviously anybody and their dog can throw exercises out on YouTube. I have a full exercise database – exercise photo and video database at my Web site www.pacificfit.net. I’ll put a link to that in the episode Shownotes for you. I also have several workouts, recipes, videos, tons of different things at my YouTube channel. That’s at www.youtube.com/bengreenfieldfitness. I’ll put a link to that in the Shownotes as well.

So we have a question from listener Patrick.

Patrick asks: What is your opinion on very low carbohydrate ketogenic diets? In studying for my CISSN test (and that’s a Certified International Society of Sports Nutritionist test) and reading a chapter on very low carbohydrate ketogenic diets – they basically praise it to the skies as a new cutting edge way to increase your metabolism and lose weight, saying that it’s safe and effective in terms of promoting weight or fat loss, improving metabolic and cardiovascular risk factors and compatible with a physically active lifestyle.

Ben answers: Okay, I guess the best place to start here is to explain listeners what a very low carbohydrate ketogenic diet actually is. What ketosis actually is. Basically when the amount of carbohydrate that your body burns drops below a critical level – so the fuel that your body needs drops below a critical level, your body turns to protein and fat reserves for energy. So if you’re on a low carbohydrate diet, that’s basically what’s going to happen. Your body will take protein into a process called gluconeogenesis – convert it into carbohydrate energy and fat through a process called beta oxidation, also convert that into energy. So when you convert protein into energy, you do get some nitrogen released into your bloodstream and your kidneys do have to excrete some excess urine due to sodium loss from that nitrogen. When you break out fat, you also produce something called ketones, which also puts a little bit of a burden on the kidneys. So the idea behind people who slam the low carbohydrate ketogenic diet is that if ketosis continues for a long time with this very low carbohydrate diet, there can be some damage to the liver and the kidneys. Now there has been some research done that shows that ketones in the bloodstream actually can inhibit the release of insulin and the release of cortisol. So you can get some blood sugar stabilization, you can get some calming of your hunger. They’ve shown that it can help prevent epileptic seizures because keytones actually can help calm down your brain cells and at the same time, it’s kind of interesting because there are also some problems with ketogenic diets such as increasing your risk of kidney stones. Definitely not recommended for kids. There’s been some research that shows that it can retard growth. It can lower bone density. For some people, they get a little bit of what’s called acidosis, hypoglycemia and low blood sugar especially in diabetic or pre-diabetic people – this is not really such a good idea. And interestingly, it can also be associated with kidney stones because of the excess calcium that occurs in the urine which happens when you get increased bone demineralization that occurs with that’s called acidosis or an acid state from the breakdown of all the fats and the proteins. Now the interesting thing about the ketogenic diet is that the question is, is it the low, low carbohydrate intake that is helping you to lose weight on a diet like that and to stabilize your insulin levels? Or is it the higher levels of protein intake? There has been a study that looked at low carbohydrate diets that included a high amount of protein intake and regular carbohydrate diets that contained a high amount of protein intake and the regular carbohydrate with the higher protein intake actually improved the body composition more than the low carbohydrate diet – the ketogenic diet with the high protein intake. So, the idea in ketogenesis for me when it comes down to the nutrition plans that I write and the help that I give to people is I always look at it from an energetic standpoint. If you have a hard exercise session – if you’re lifting weights, if you’re engaging in a high amount of endurance activity, this diet is not for you. There’s way too much use of carbohydrate that’s going on. There’s way too much reliance on glucose and glycogen that’s going on. For you to be able to justify either tearing through your muscle tissue or lowering your body fat or just burning too much fat in general, which will form all those excess ketones – for you to justify doing it. It’s simply not healthy. A low, low carbohydrate diet for an active population, it doesn’t even make sense. It’s not the way that the Earth is built. There’s fruit and starchy vegetables all over the place. There’s potatoes and yams and peanuts and all sorts of things for you to eat that can contain carbohydrates. Why the heck would you fight against nature and not consume carbohydrate energy that’s plentiful around you? As long as you’re doing it in moderation. Now if somebody really needs to lose a lot of weight quickly, I don’t have a problem with going high protein. I did it when I was body building. I went very low carbohydrate. I probably got to the point of ketogenesis. A lot of times your breath starts to smell a little bit when you get to that point. Almost like nail polish due to the state of acidosis and the ketones in your bloodstream. I didn’t feel all that hot. I felt horrible actually for the last few weeks leading up to my bodybuilding show. And I had very low energy, very low sex drive, did not feel healthy. So, what I would say from my perspective is that although I haven’t pored through over all the research significantly to compare the ketogenic diets with a regular carbohydrate diet with high protein, I would tend to lean toward the direction of consuming as I’ve recommended in the past somewhere in the range of 40 to 50% carbohydrate if you’re going to consume a controlled carbohydrate diet and then make sure you get lots of high quality proteins in and continue to consume anywhere in the range of 20 to 30% fat primarily from healthy fat sources. So, it all comes down to really depending on who you are but if you’re an active individual and I know that most of the people who listen to the show are active individuals, you’d be better off going medium carbohydrate, high protein rather than low, low carbohydrate; high, high protein.

Jennifer Roe asks: Hi Ben, my name is Jennifer Roe and I have a question about circulation. I like to do a lot of hiking, skiing in high elevation peaks in Colorado. And I have always had this problem with – as soon as I finish exercising, my body cools down really fast and basically the blood leaves my fingers. My fingers turn white. They are kind of swollen and they become very, very painful with cold. So, I was wondering if there’s any supplements out there or nutrition or tips that I could do to improve my circulation so I don’t have this problem. I’ve tried using different pairs of gloves and mittens to try and keep the problem from happening and I have it all the time, even in the summertime during my exercise. So if you can let me know of anything I could do, that would be great. Thanks a lot, love your podcast. Bye.

Ben answers: Jennifer, there’s absolutely some supplements that can help with circulation but I wouldn’t put all your eggs in one basket and just rely on nutrition supplements to help with circulation. That being said a fish oil and Omega 3 fatty acids would definitely be something that you could take. Bioletics puts out a great fish oil. There’s another one called Ener-EFA, that’s a flax oil. You can find both of those – I’ll put a link to them in the Shownotes for you. Ginko biloba can help with circulation. That’s basically a herb that you can find at most health food stores. Topical magnesium which I already mentioned earlier in this episode can help. But I would also look into something like a muscle warming lotion. There’s one that I use in cold weather triathlons made by a company called Greyhound at www.greyhoundjuice.com. I’ll put a link to that in the Shownotes. But that’s actually got cayenne pepper and other essential oils in it that help draw blood to the extremities and improve circulation. So I would definitely look into that. I would also look into my favorite type of glove that I wear when I’m doing cold weather cycling or skate skiing or anything where I’ve got to have my hands out there in the elements. That’s Lobster Gloves. A little bit different than mittens, a little bit different than regular gloves. You’ve basically got two fingers on one side and two fingers on the other side and then your thumb in its own compartment. Those tend to work really well. Google those. “Lobster Gloves.” They work really well. So I’ll put a link to those other things in the Shownotes and that’s a great question and I hope you do well with that. But Greyhound is something that definitely I would try.

Jason asks: Ben, hey my name is Jason and I just want to say that I’m a huge fan of your podcast. My question is about Ironman nutrition. I’m planning on doing Ironman (inaudible) at the end of August. I just wondered if you could possibly divulge some of your insight into fueling pre-race, during the race and maybe recovery from the race all the way from the nutritional way down to (inaudible). Hey, I appreciate it. My name is Jason.

Ben asks: So, Jason. That is a very, very loaded question. You may suspect that that’s a very, very loaded question. I could fill probably several hours worth of audio answering that question. And I hate to do this, but I need to tell you that I have answered your question. I have several CDs out there and audio products that go into great detail – every tiny, little element that you need to consider for the last eight weeks leading up to Ironman all the way up to race day, race morning, what to eat, what to drink, what to take in during the race, what to put in your swim to bike bag, bike to run bag, bike special needs bag, run special needs bag, morning swim bag. Everything. Every pill, every capsule, everything. That is basically what Triathlon Dominator is. So rather than go into great detail on Ironman fueling in this podcast, you need to go check out Triathlon Dominator because that’s information that I’ve put so much work into that I have a hard time going on with an hour long response on the podcast when I’ve really already given that response on a program that I’ve designed to be comprehensive for Ironman. So I’ll put a link to that. www.triathlondominator.com. Sorry to not answer your question in detail. It’s just too big man. I can’t answer that question on this podcast. So, that being said we’re going to go on. I actually didn’t receive any questions – really any questions that were that good or that weren’t repeat questions from Twitter this week. But again, if you ask me a question on Twitter, then I will send you a free T-shirt if I answer your question on the podcast and choose it as the best question. How can you do that? Go to www.twitter.com/bengreenfield, hit the “follow” button, then write a message and ask me a question. So we’re going to move on to this week’s interview with Dr. Roby Mitchell, and remember to leave a comment on the episode Shownotes if you have feedback on this interview.

Hey podcast listeners, this is Ben Greenfield and I am here once again with Dr. Roby Mitchell, aka Dr. Fitt. Straight from Texas, this natural healing physician has a ton of experience working with both athletes and the general population. He’s a triathlete himself. He also happens to be an expert on thyroid activity and hypothyroidism and the effect that that can have on your metabolism and on your health and some of the solutions that are out there and alternatives that are out there for treating your thyroid. So, Dr. Mitchell, thank you for coming on the call.

Dr. Roby Mitchell: Oh, it’s great to be on, Ben.

Ben: So, the most important thing to start off with – just as a refresher for people is the thyroid itself and why proper thyroid activity is actually important. So can you give your overview of how you in your words would say people should think about their thyroids and the importance of the thyroid?

Dr. Roby Mitchell: So, the thyroid gland is a gland that’s located right there at the bottom of your neck. It’s right over your trachea and that gland produces a hormone called thyroid hormone. The reason thyroid hormone is so important is because that is the – you think of it as the sparkplug in an engine or the electricity in your home. That is your energy source. So that is the hormone that goes into your cell and asks as a sparkplug for these organelles that are inside each cell. These little power plants that are called mitochondria. Now the mitochondria are the actual energy makers, so think of the mitochondria as the engine, but you have to have that sparkplug in there in order to kick off the energy producing process. So, as thyroid levels go down, then energy goes down and we see stuff start to build up in the system and the motor doesn’t run well.

Ben: Interesting. So, for the same reason that someone would say exercise to keep the mitochondria dense and keep a high level of cellular activity, that’s the same reason why someone would want to make sure their thyroid activity is optimized.

Dr. Roby Mitchell: No question, and actually there’s a dovetail in there in that exercise improves the conversion of T4 to T3, and we’ll talk about why that’s important here in just a minute.

Ben: Gotcha. So, in a previous podcast episode when you were on the show and I’ll make sure I link to that in the Shownotes for people, you talked about when somebody walks into your office how you look for a range of symptoms. Things that you can see just by looking at them without doing a lot of blood testing to identify that they may have low thyroid activity. Can you briefly review some of the things, some of the most important parameters that you look at?

Dr. Roby Mitchell: Again, thyroid – one of the major things that it does is it creates cellular energy. So one of the primary complaints that people with hypothyroidism come in with is low energy, no energy. I’m tired all the time. For athletes, this will manifest in an inability to recover. Your recovery time will start to slow down and we see this as people get older. I started to notice it in my 30s. It started taking me a little longer to recover from a triathlon event. Another thing that people will notice is hair loss, constipation is a very common symptom. Again, and actually one of the very common thing is muscle cramps. If you start having muscle cramps on a regular basis, charley horses, that’s an indication of either low magnesium or low thyroid. Cold hands and feet, again the thyroid is very important for peripheral circulation so when you start getting cold hands and feet that’s an indication also. Some of these clinical features like high blood pressure and high cholesterol and so forth – when I see a person, I look at their – I automatically scan people for these physical symptoms. So one is the ridging on the nails. If people have these longitudinal ridging in their nails, that’s a clue for me. If they’re losing their eyebrows on the periphery, that’s a clue for me. Just a pot belly is an indication of low thyroid. Swelling in the hands or legs. If their rings are getting tight or when you take off your socks, there’s an indentation from your socks or pantyhose for women. You take off your sandals or shoes, if there’s indentation there that means that you’re holding on to excess fluid. Skin manifestations – so things like eczema and hives and psoriasis. Even athlete’s feet. People think that’s something you catch. It’s not something really that you catch, it’s something that you are prone to. So those fungi that cause that particular problem – what we call dermatophytes, they are opportunistic organisms. So if they see an opening, they’ll jump in. Everybody that’s using that same shower doesn’t get the athlete’s feet, right? It’ll just be the person that has again kind of a crack in the armor. A lowness in their ability for the immune system to keep them healthy because of low thyroid.

Ben: Interesting. Can the same be said for other fungal thyroid issues like yeast growth?

Dr. Roby Mitchell: No question. No question. So that is a big under riding factor for proliferation of candida is the dropping of thyroid levels. The dropping of the thyroid – that is the first domino. And then things just spread from there. The yeast starts to grow and then you get the inflammation and from there, once that inflammation starts in any particular place – that is the (unintelligible) for all these diseases that we talk about like coronary heart disease or Alzheimer’s or gastrointestinal problems, diabetes, osteoporosis. If you link any of those terms – if you go up and Google whatever your favorite disease is and inflammation, you’ll always see inflammation as the common denominator and that inflammation again is sparked by that overgrowth of yeast and then your immune system’s response to that.

Ben: Interesting. I also think that’s interesting what you said about the cramping issue because there are several athletes out there who I know have done quite a bit of work on their electrolytes and their hydration intake who cramp frequently who may not have looked at their thyroid activity. Now, when you’re talking about the options for people who have hypothyroidism, I know that Synthroid for example is one popular pharmaceutical drug that’s used quite a bit, I’m curious what types of treatments you incorporate and what type of alternatives there are out there to prescription drugs for hypothyroidism?

Dr. Roby Mitchell: So, first let’s distinguish between drugs and hormones. So, thyroid replacement is a hormone replacement therapy. A bioidentical hormone therapy. So we have to put back into the body the exact same molecule that your normal thyroid would normally produce. Now, a hormone is something that your body recognizes and it has a biochemical specificity, just like what your body normally produces and hormones facilitate normal biochemical reactions whereas drugs are chemicals that are foreign to human biochemistry and they’re designed to inhibit normal biochemistry. So when we do thyroid replacement whether it’s synthetic or the natural ones that we’re talking about, that is a hormone replacement therapy rather than a drug therapy. That being said, there are several different choices out there. So now the actual thyroid hormone – when we talk about what your mitochondria wants – the type of sparkplug they want to fuel the engine, it wants T3 which is this amino acid terasine with three molecules of iodine on it. That’s T3. That’s the actual thyroid hormone. Now, your thyroid gland though produces it in the form of T4 and that T4 has to be directed – it flows through the blood stream to the cell or to the liver and it’s converted to T3 and then again that T3, that’s where the action is. So even though – but a lot of people don’t make that conversion from the T4 to the T3. So they’ll get put on T4 Synthroid or one of these other brands of levothyroxine, it’s the generic name – they’ll be treated but then they’ll go to my Web site and go through the checklist and they’ll find they still have lots of symptoms of low thyroid. Their blood test will be so that they’re balanced and everything and normal, but they’ll still have all these symptoms of hypothyroidism.

Ben: Interesting. Why is that?

Dr. Roby Mitchell: Again, because they’re not converting the T4 into T3, right? So if we just give them the – it’s like you take that oil that’s spilling there in the gulf, you use gasoline in your car right? And oil is made from gasoline. Why don’t we just take out the middleman and put the oil in your gas tank? Well your gas tank won’t convert oil into gasoline, right? A very similar thing with the T4. Many people are given T4 but they don’t convert it into T3.

Ben: So at some point you have to get from the – do you go for the T4 to the T3 conversion? Do you attack it from that level or do you try to get T3 into someone or can that only be done in the body? That conversion?

Dr. Roby Mitchell: So, you can attempt to do both. So one of the things  we just alluded to earlier was that exercise improves that conversion of T4 to T3. So regular exercise is very important. Not just for us athletes, but for everybody. Testosterone is a key element in converting T4 into T3. That’s why in most sports, we separate men and women. We have a little bit of an advantage as far as energy and strength output and so forth because our testosterone being able to make us get a little bit more bang out of the buck for thyroid. Selenium is very important. There’s an enzyme that makes that conversion for T4 to T3. That enzyme is dependent on selenium. So if you’re low selenium, then you’re not going to have an optimum conversion of T4 to T3. Now, the next step from that though is to give a product rather than one that just has T4, has a combination of T4 and T3 to prime the pump so to speak and that can get things going. So Armor Thyroid is a prescription product that fits that combination of T4 plus T3. Armor Thyroid has been on the market for a long time. Lots and lots of people take that. It’s an extract from whole porcine thyroid. Thyrolar is a synthetic form of the same thing. It’s a T4,T3 product. It’s just a synthetic form and then a pharmacist – and then the next step – I have patients who have such an inability to convert T4 to T3, we have to give them just pure T3. A pharmacist can compound a product to us that’s just pure T3.

Ben: Do you just go to a compounding pharmacist and they make pure T3?

Dr. Roby Mitchell: Yes, now your doctor has to prescribe it, right? That’s not the thing that you jump right to. That’s why you need to go to someone who has some expertise in using these thyroid products, but the pure T3 product – many times for some of my patients, that is just a bit of icing on the cake. So we get them 95% optimized and they’re not quite there so we sprinkle in a bit of this pure T3 and we get them hitting on all cylinders.

Ben: Now what’s the ThyroPak that I saw you email out about a few weeks ago?

Dr. Roby Mitchell: Now, ThyroPak is very similar to the Armor Thyroid, the prescription thyroid with two exceptions. One is that it’s derived from whole beef thyroid glands rather than the porcine or the pig thyroid. The other is that it’s non-prescription, but even though it’s over the counter, it’s still a thyroid product. Again, it’s very similar to the Armor Thyroid, and it’s able to be purchased over the counter because it’s kind of a loophole in what we call the DSHEA act that allows things that are natural in nature to be able to be bought over the counter. Initially the story I hear is that it was outlawed. The FDA did. But the guy that was producing it down there in Mexico had enough money to take them to court and overcame the injunction. So that product is available over the counter now.

Ben: Interesting. So in terms of if someone’s unable to find Armor Thyroid, that might be something that they could look for – not that we’re prescribing medical advice on the show but that’d be an alternative to something like Armor Thyroid?

Dr. Roby Mitchell: Yes, it would. I would recommend to anybody that goes to my Web site and they come out with all these symptoms checked and it’s an indication that they have low thyroid – the first thing that I would do is I would get this book called Type 2 Hypothyroidism by Dr. Mark Starr. Read through that so you can get educated. Don’t just run off and start trying to find a thyroid product, or even go to your doctor without getting educated first. Because most doctors are not educated on this particular topic well enough to matriculate patients through successfully. So a patient needs to go in with a little bit of knowledge about how things should go. They should know what symptoms are associated with hypothyroidism. They should know a lot more than just a doctor doing a blood test and well, this looks normal. That’s not enough. Once the patient gets that information under their belt, then the next thing I would do is go to a practitioner. Try and find a practitioner. It can be your family doctor, but you just need to find somebody that is open-minded, that is going to work with you, not be dismissive of you, not treat you like an idiot or somebody who has no idea what they’re doing. Find a doctor like that to work with. It doesn’t have to be a specialist. Again, it can just be your family practitioner or an internist. And then work with that person. You two work in conjunction to get it where you start to bring down the level of many of these symptoms that you’re having from being low thyroid.

Ben: Interesting. So people can find out more information about how to access Dr. Fitt’s list of thyroid symptoms, and I’ll also put a link to some of the other resources that he talked about in the Shownotes to this episode. Now, is there anything else that you’d like to share that you feel will be important for people?

Dr. Roby Mitchell: Again, the ThyroPak is something that is over the counter. Even so, I wouldn’t recommend that people try to orchestrate their own thyroid therapy. You need to get with somebody who knows what they’re doing and will graduate you along in order to get the proper results because it’s not just about replacing thyroid. If you’re having low thyroid, there’s a strong possibility that there are other things that are out of balance also. Again, I mentioned the selenium. There can be thyroid imbalances also particularly with women. The estrogen that women have, that tends to block thyroid. So if you have an imbalance in your estrogen and progesterone, you have to get that right. There’s cortisol, also. Many times there’s a combination of low thyroid and low cortisol. You won’t optimize thyroid unless you optimize cortisol. So that has to be looked at also. Even though this ThyroPak is over the counter, right? It doesn’t give people a license to go in and try and do their own thyroid replacement therapy.

Ben: Gotcha. Alright, well folks if you have questions for Dr. Fitt, then go to the episode Shownotes and leave a comment or question and let me know what you think and if you have some things that you’d still like to hear about from Dr. Fitt about hypothyroidism. So thank you for coming on the call today Roby.

Dr. Roby Mitchell: Oh, certainly. Again, always a pleasure.

Ben: Alright. Until next time folks, this is Ben Greenfield and Roby Mitchell signing out.

Alright folks, that is going to wrap up this week’s podcast. Remember to go to iTunes. Do a search for Ben Greenfield on iTunes. Leave a ranking or rating on the podcast and while you’re at it, check out my other podcast over at the Quick and Dirty Tips network. Little five to ten snippets on basic fitness concepts. Actually there’s some pretty advanced concepts on there as well. But much shorter than this podcast and still a great deal of information put into a very dense five to ten minutes. So check that out at www.quickanddirtytips.com/getfitguy or just do a search for “get fit guy” in iTunes and that will come up. That’s just another free podcast. So remember to go to the episode Shownotes. I make sure I put all the information that you need in those and you can access them at www.bengreenfieldfitness.com. For this particular episode, you go to www.bengreenfieldfitness.com and click on episode number 103. So, I think that’s about it. Last thing is I did get an email from a listener this week who wanted to know if there was a way he could not listen to these episodes sitting in front of his computer. Absolutely. You can download any of these by subscribing to iTunes or by looking at the “how to subscribe” link that’s right there at www.bengreenfieldfitness.com. And it’s all free, but absolutely. You can get these on your mp3 player, listen to them while you bike, run, lift, drive your car, do laundry, clean your house, whatever. So that being said, until next time, this is Ben Greenfield signing out.

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