I first heard of Jill Grunewald, holistic nutrition coach and founder of Healthful Elements, when I was still working for Experience Life. Our health and nutrition editor, Anjula Razdan, was pitching a story on the hot topic of Hashimoto’s disease, an autoimmune condition that causes the body to attack its own thyroid. She named Jill as one of the go-to sources for treating the condition because of her specialization in the endocrine system and hormones — particularly thyroid function — and focus on natural and whole-foods therapies.
That story, “Repair Your Thyroid,” came to fruition in the November 2012 issue, and since then I’ve seen Jill crop up in a number of other places.
Including the gym. I had the pleasure of meeting up with her to talk both thyroid health and physical fitness, and the below interview was the result. For more, check out Jill’s popular ebook, Fire Your Thyroid, or look into booking a consultation with her.
Jen: What are some signs/symptoms of Hashimoto’s?
Jill: Hashimoto’s is autoimmune hypothyroidism (low thyroid function) and it’s estimated that 90 percent of people who have low thyroid function do, in fact, have Hashimoto’s. Having thyroid autoimmunity means that there are antibodies in the blood that are launching a “mission sabotage” on the thyroid gland. Whether hypothyroidism is due to Hashimoto’s or from iodine deficiency (the cause of the other 10 percent of hypothyroid cases), the telltale symptoms are the same: unwarranted fatigue (even after a full night’s rest), difficulty losing weight, gaining weight with no change in diet or exercise, hair loss and loss of hair luster, difficulty getting and staying warm, constipation, depression, brain fog, fluid retention (edema), poor ankle reflexes, and dry skin. You can read a lengthier list of symptoms here.
A significant difference between Hashimoto’s and iodine-deficient hypothyroidism is that in cases of Hashimoto’s, some people swing back and forth between hypothyroidism and hyperthyroidism — or overactive thyroid. So while the diagnosis may be low thyroid function, some experience a “push-pull” and have days where they feel hyperactive, energetic, anxious, and can have heart palpitations. This hyper state is a sign of excess thyroid hormones in the bloodstream due to increased autoimmune attack on the thyroid.
Jen: How do you get tested?
Jill: Thyroid testing includes a full range of thyroid labs (bloodwork) or an at-home BBT (basal body temperature) test, which involves taking your basal body temperature first thing in the morning for three days, then determining the average. If it’s less than 97.8, you’re likely hypothyroid. When it comes to labwork, it’s important to work with an open-minded, functional medicine doctor who isn’t TSH-happy. TSH stands for thyroid stimulating hormone and reveals very little of overall thyroid function. (See this link for the labs I recommend.) See “Testing in the Lab” in this Experience Life article for functional reference ranges, which can more readily determine an imbalance. You can also order bloodwork on your own. There are several online sources, and the one I recommend is HealthCheck USA. The Ultimate Panel includes the thyroid labs I feel are most telling of overall thyroid function.
We live in a numbers-happy society: “Numbers don’t lie.” Or, “You can’t manage what you don’t measure.” Yet some functional medicine doctors say that when it comes to managing hypothyroidism, the real litmus test of whether your thyroid is functioning optimally is how you FEEL. Hear hear!
Jen: Why did this happen (i.e., is it my fault)?
Jill: Many of my clients ask, “What did I do wrong? How did I cause myself to be hypothyroid? What did I do to myself to acquire autoimmunity?” For 10 percent of those with hypothyroidism, they’re simply iodine deficient. That’s an easy fix. (See below for dietary recommendations.) For those with autoimmunity, it’s more complex. There is a long list of autoimmune conditions, including lupus, multiple sclerosis, Type 1 diabetes, celiac, rheumatoid arthritis — the list goes on. One in twelve Americans has an autoimmune condition, making it more prevalent than heart disease and cancer. But it’s rarely talked about as an epidemic. While there are differing expert opinions on what has caused the drastic rise in autoimmune conditions, including genetic predisposition, scientists worldwide concur that the root cause is environmental — a result of our Industrial Age and 21st century lifestyles. Exposure to chemicals, toxins, pesticides, and processed foods has caused our immune cells to become confused and for some of us, to launch an attack on our own bodies. I realize this is sobering, but I don’t dwell on the doom and gloom — I like to look forward to ask what we can do today to heal and to protect ourselves. To learn more about the sudden rise in autoimmune diseases, I recommend Donna Jackson Nakazawa’s book, The Autoimmune Epidemic.
Jen: What’s the way out?
Jill: Autoimmunity or no autoimmunity, thyroid drugs or no thyroid drugs, there are several things you can do to jumpstart a sluggish thyroid and start alleviating symptoms. Diet is your first line of defense. And I don’t mean “dieting” — many people who are struggling with thyroid-related weight gain go on calorie-restrictive diets, which can backfire.
There is no pharmaceutical cure for any autoimmune disease and managing autoimmunity can be multi-faceted. Generally, it’s critical to rethink what you’re eating and to eat whole, unadulterated foods (steer clear of factory-made and factory-farmed food); eat organic as often as possible; supplement wisely; address the stressors in your life; and shield yourself as much as you can from everyday chemicals, including cleaning and bodycare products.
Jen: What foods should you avoid?
Jill: It depends on the level of hypothyroidism and the adrenal fatigue that typically accompanies hypothyroidism, but more often than not, it’s a good idea to stay away from sugar and caffeine, both of which can up the ante on the overproduction of stress hormones — namely adrenaline and cortisol — that can hinder thyroid function. Goitrogens — broccoli, Brussels sprouts, cabbage, cauliflower, kale, kohlrabi, rutabaga, and turnips are the heavy-hitters — can also hinder thyroid function by causing a goiter, or enlargement of the thyroid gland. While there is some controversy about the degree to which cooking inactivates goitrogenic compounds, generally, I believe that cooked goitrogens are fine. They’re certainly not deal-breakers. You’ll also hear wildly differing opinions on soy, and my opinion is that it’s fine if it’s fermented (tempeh, for example), in moderation. Being 100 percent gluten free is non-negotiable if you have Hashimoto’s. Because the molecular structure of gluten is almost identical to the molecular structure of thyroid tissue (so weird), ingesting gluten can make the body say, “Invader! Attack! Attack!” and increase the autoimmune assault on the thyroid.
In addition, do not eat a low-carbohydrate diet, which can contribute to brain fog, hair loss, and can inhibit your body temperature regulation. It can also inhibit T3 production and increase Reverse T3, which can block thyroid hormone receptors.
Jen: OK, so what should I eat?
Jill: Here is my shortlist:
- Get protein at each meal. Protein helps boost T3, your active thyroid hormone, and helps convert T4 to T3.
- Get plenty of wholesome, dietary fat. Fat and cholesterol help build proper hormonal pathways.
- Selenium, found primarily in Brazil nuts and sunflower seeds, helps boost T3 production. Zinc, copper, and iron are also important, as is a range of B vitamins, “the anti-stress vitamins.”
- Vitamin D is particularly important, and most people are deficient. Not only does Vitamin D help transport thyroid hormone into our cells and help contribute to proper hormonal pathways (it’s actually a hormone, not a vitamin), it’s also an immune modulator, meaning that it can help modulate and regulate wayward immune function.
For more information, see “Nutritional Dos and Don’ts” in this article.
For those with non-autoimmune hypothyroidism, amp up the dietary iodine intake with seafood and sea vegetables, the best sources. Seasnax, roasted sea vegetables, are strangely addictive. (I don’t recommend iodine supplementation, unless it’s food-based, as from kelp.)
Jen: Can you work out if you have Hashimoto’s?
Jill: Absolutely. While severe fatigue is often the case for those with low thyroid function, it’s important to move. For those with more advanced fatigue, walking and yoga are sufficient. Some functional medicine doctors say that for people who have severe adrenal dysfunction and crippling fatigue, it’s best to not exercise at all during the healing phase. Later, people can transition to restorative exercise – yoga, tai chi, light pilates, walking, or the biofeedback approach you take at Movement Minneapolis. White-knuckling exercise and having a “I gotta do this because I’m overweight” attitude can be counterproductive. I’ve given many clients permission to take a break from exercise and they’ve broken through weight loss barriers. Why? Because non-restorative, “distress” exercise can induce a stress response, which can cause overproduction of adrenaline and cortisol. Cortisol, nicknamed “the belly fat hormone,” then sets up camp around our midsection and also hinders thyroid function. So it’s a vicious cycle. “Eustress” exercise, on the other hand (thank you, Jen, and the other rock stars at Movement Minneapolis for introducing me to this term) is restorative and gets people better results.
Jen: What lifestyle changes can I make to support thyroid health?
Jill: There is a significant mind-body component to thyroid health. The thyroid gland corresponds with our 5th chakra, the throat chakra, and is between the 6th and 4th chakra, which are the head and heart chakras, respectively. Chakra means “wheel” or “turning” in Hindu and our chakras are energy centers in the body. Our throat chakra is associated with the ability to communicate clearly and effectively. When there is conflict between the head and heart, we can have a thyroid imbalance. The best way to work through this conflict is to journal, meditate, pray, breathe, or practice visualization. Any spiritual practice, including yoga, which was designed to support all of our chakras, will help resolve this imbalance.
Dr. Richard Shames, author of Thyroid Power, talks quite a bit about mind-body healing for the thyroid, including the mind-body-autoimmune connection. Dr. Shames says that our brains are constantly talking to our immune system, and our immune system constantly provides critical information to our brain and he says that the triggering of Hashimoto’s is possible from stress alone. I’ve found that a regular deep breathing practice can do wonders not only for stress, but also for taming the autoimmune response.