#413 Thyroid Disease Explained

Adi Benito, M.D.

Adi Benito, M.D. explains thyroid disease and its treatment.

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DISCLAIMER: This text is the output of AI based transcribing from an audio recording. Although the transcription is largely accurate, in some cases it is incomplete or inaccurate due to inaudible passages or transcription errors and should not be treated as an authoritative record. Nothing that you read here constitutes advice medical or otherwise. Always consult with a healthcare professional before making changes to a healthcare plan.

Scott Benner 0:07
Hello, everyone and welcome to Episode 413 of the Juicebox Podcast. On today's show, I have Dr. Adi Benito, and he's gonna share so much information today about thyroid disease, you're going to just understand it from the back by the time you're done. If you're living with type one diabetes, and don't currently have thyroid disease, I still think this episode has a lot to offer you. Please remember that nothing new here on the Juicebox Podcast should be considered advice, medical or otherwise, always consult a physician before making any changes to your health care plan, or becoming bold with insulin. Dr. Benito is board certified in endocrinology, diabetes and metabolism. addict attended medical school in Spain and completed a residency in internal medicine at Pennsylvania hospital at the University of Pennsylvania health system and a fellowship in endocrinology, diabetes and metabolism at the University of Pennsylvania. She has also completed a two year fellowship in integrative medicine at the University of Arizona Center of Excellence in integrative medicine, where she is a guest faculty member, and has developed the curriculum for an integrative endocrinology module, which has been incorporated to the fellowship. This episode of The Juicebox Podcast is sponsored by the Omni pod tubeless insulin pump, you can get yourself a free no obligation demo of the Omni pod today by going to my Omni pod.com Ford slash juice box. And to learn more about the Dexcom g six continuous glucose monitor, go to dexcom.com Ford slash juice box become acquainted with the great work that's done at touched by type one at their website on Facebook, or Instagram touched by type one.org

Adi Benito, M.D. 2:00
My name is Adi Benito, I am an endocrinologist and I in particular practice what are called integrative endocrinology, which is using hormones as well as nutrition, herbs, botanicals and supplements. I studied herbal medicine, as well as integrative medicine. And that's what I practice.

Scott Benner 2:22
All right now, I found you because my daughter was diagnosed with hypothyroidism A number of years ago. And people who listen to the podcast knows she's had other ailments like just joint soreness and things like that. So we have tried to thoughtfully break Arden down into segments and and go through them slowly and try to pick through them because I found that when you try to go with everything at the same time, it gets confusing, right? There's you never know if if the success or failure you're seeing is anecdotal or if you're misunderstanding where it's coming from. So we obviously I mean, the podcast is wrapped around using it. So when we first figured that out Arden's a one C's been five to six for about six years now. sheets, whatever, you know, she don't limit her, her nutrition to get her to that. Which might mean like yesterday, Arden had a pretty big salad for dinner and the day before she had a lawful. So she'd survived a wide variety of foods. But our first run in Well, before we knew you was she got her she started with Synthroid, she got Synthroid, all of her symptoms went away. And Arden symptoms By the way, when when we figured out she had hypothyroidism was she basically couldn't hold her head up anymore. It was just like she was on a dimmer and someone was turning her down slowly and she just didn't have the energy to come back up again. The Synthroid brought her right back. And then she grew significantly, which I'm going to ask you about later if it's common or not. But Arden was at one time the smallest child in her school. And she is now probably one of the tallest girls in high school, which is fascinate. She went from like five when she was five, one, maybe 75 pounds. And she went to over five, seven, like 130. Yeah, so when she started having these joint issues, we thought, Oh, it's because she's growing so quickly. And then she stopped growing. And that didn't end up being it. And, you know, then you kind of go back to your endocrinologist that handles the diabetes, like maybe you know, is the thyroid medication not right. I hear from a lot of people that it's more of a science, it's more of an art than a science and, and none Oh, it's fine. Her labs look good, which was always the answer, right? She's in range, right. And then a person who listens to the show, who I've had come a little friendly with Vicki said to me one day that her thyroid issue was always a mess until she started to think outside of the box and she told me that the way she did that was to Find a doctor who would be more thoughtful and holistic about it. And that idea led us to finding you. So I told people I was gonna ask you to come on the show and I know I sent you the questions and they asked a ton of questions, but I think before we get to them and maybe like you said in your note, possibly a lot of these questions are gonna get answered while you're speaking. Can you can you please just do what you do explain hypothyroidism, hyperthyroidism? hashimotos this whole thing that no one seems to understand. Yeah.

Adi Benito, M.D. 5:35
So, if you think of thyroid, thyroid disorders, the most common are those of thyroid function. So these function the thyroid and that includes both hypo low thyroid and hyper high thyroid. So within dos hypo is more common hypo low thyroid is more common than hyper thyroidism. In the whole world, when we talk about hypothyroidism, the most likely cause is iodine deficiency in the entire world. Now in the US, because we still are considered iodine sufficient, meaning we still have enough iodine in our diets in general, the most likely cause of hypothyroidism is autoimmune thyroid disease. And that is hashimotos thyroiditis. The second most likely cause is actually radiation, both external beam radiation so what would you would have if you had cancer or your neck or former, but also radioactive iodine, which patients with hyperthyroidism actually are treated with many, many times. So within the realm of owning immune thyroid disease, hypothyroidism is one aspect hyper is the other. So it means our disease encompasses both hashimotos thyroiditis, and Graves' disease. hashimotos thyroiditis tends to cause hypothyroidism. Graves disease always causes hyperthyroidism, until later on in the disease, or because of the treatment, you can end up with hypothyroidism. There are some patients who have hashimotos thyroiditis, who will develop hyperthyroidism, and we call that Hashi. toxicosis, toxicosis meaning just too much. So, autoimmune thyroid disease, like any other autoimmune condition is purely genetic, and probably environmental of the genes that cause autoimmune thyroid disease, we've have really advanced tremendously. And if you look at the genes that actually are linked between autoimmune thyroid disease and type one diabetes, there are many common genes. And that's why actually, those two conditions happen in clusters in families to have one member with type one diabetes, and a different member of the family with autoimmune thyroid disease. If you think of the risk of autoimmune thyroid disease in the general population is close to 10%. If you have a relative with Type One Diabetes, that risk is 48%. Much higher, well,

Scott Benner 8:07
that's almost a significantly higher, that's almost a

Adi Benito, M.D. 8:09
s. Yep. And if you yourself have type one diabetes, the risk of having autoimmune thyroid disease is 50%. And if you have autoimmune thyroid disease, the risk of developing clinical disease so either hypo or hyper, is also 50%. So think of for people with type one diabetes, two of them will have autoimmune thyroid disease, one out of the four will develop clinical thyroid disease. Now, autoimmune thyroid disease, usually is characterized by antibodies. So getting these protein that your body makes, usually to defend yourself, but in the case of autoimmunity is sort of like attacking your own body. Right? So antibodies are sort of the hallmark of autoimmune thyroid disease. However, they is up to 20% of people with hashimotos who don't have antibodies. So not having antibodies doesn't mean you don't have autoimmune thyroid disease. But if you have the antibodies is a marker for autoimmune thyroid disease. So finding them is helpful, not finding them not that helpful.

Scott Benner 9:19
That makes your job interesting.

Adi Benito, M.D. 9:21
Right? It does, yeah. Because then you have to think, am I seeing autoimmune thyroid disease that is not showing with antibodies? And sometimes I may use an ultrasound to tell me that or am I seeing nutritional deficiency? So I then deficiency and maybe iron, which is a cofactor, for iodine in the production of thyroid hormone. Yeah.

Scott Benner 9:44
I have to say that, given that I'm beginning to understand why most people can't seem to get to a resolution that is valuable, completely valuable for them, because having worked with you for art and for Kelly, the internet 30 of our interaction in time and and information and they're not being large gaps in between when we spoke I found to be It was exciting actually, because I felt like this was the I felt like my, our interaction with you was sort of like other people's interaction with a podcast in that it wasn't. I'll go to the endo, they'll test my agency, I'll make some adjustments come back in three months notice nothing happened. Try again. Two years later, my a Wednesday, still seven and a half. It was the intensity and the ability to get to you more directly, because you have a an uncommon practice if you're completely private practice, right? So yes, like we paid you in cash, like you don't take insurance. But with that comes the ability to send you an email, which is lovely, because then there's no big gaps, and you can move along kind of quickly. I guess my question to you is, why is what you know, so difficult to find? When the issue is so common?

Adi Benito, M.D. 11:07
It's a good question. I don't really know the answer, to be honest, I mean, I practice I was part of pen for me, I try not pen and then work the pen. And I have to tell you that when I worked up pen, you know, you have we usually with somebody with hypo or hyperthyroidism, we assume that it's autoimmune. We don't tend to test for antibodies. I don't even remember testing people for other autoimmune conditions, which now is part of my routine practice. If I find somebody with autoimmune thyroid disease, even with that type one diabetes, I will be screening those patients for celiac, as well as for something called autoimmune gastritis, which can lead to low iron and low b 12. And many times, it's actually the cause of their symptoms, not the thyroid itself. So you have to think of the person in its entirety. It's not just one aspect, especially when you're thinking about immunity. Because it can affect many parts of you of your body. And if your life, I

Scott Benner 12:01
don't know, how much of the history of this disease that you're aware of, I'm assuming more than me. So I'm gonna ask, how is this becoming more common as time goes on? Or is it just we're noticing it now? No, no.

Adi Benito, M.D. 12:13
So even type one diabetes, we're finding that is, you know, people are calling that an epidemic in the 21st century. And you would think, you know, when we talk about autoimmune conditions, we're talking about genes, but we're talking about environment, there's a complex interaction between genes and the environment. Now, the genes don't change that quickly. You know, in just 100 years, the genes are not going to change that are going to make somebody half more likely to have type one diabetes, and, you know, hundred years ago, so there's something in the environment that we are, we're not, we're not sure what it is, you know, it can tell you that we definitely think of viruses, we think of bacteria as triggering those genes to sort of manifest and cause the conditions. We, for in the case of the thyroid, having too much iodine, we know is a risk factor for developing both autoimmune thyroid disease. And for developing hypothyroidism, maybe you have hashimotos. So just making sure that you don't take any one supplement from the store just because it says iodine, and you think it's good for you. Now, it's a little hard to overdose with, you know, food. So you don't have to worry about whether you're eating too much fish or shrimp or you know, normally, that's not going to happen, it's more with someone. So it's that complex interaction between the environment and the genes are, we're still trying to understand, we've made some advances into the genes, we don't really understand what in the environment is causing people to develop motilium diseases, I would bet that there's a lot of endocrine disrupting chemicals we call them. So these chemicals in the environment that disrupt how hormones work, that probably have a role in this increased prevalence of autoimmune conditions.

Scott Benner 13:49
But it builds you imagine it builds over generations, not just like, my mom used Tupperware, so my daughter has diabetes, like, Yes, okay.

Adi Benito, M.D. 13:57
No, no, he actually goes, Yeah, you can see that's, transgenerational, you can see that. So you actually see in there Stephanie studies in the grandmothers, they use these Teflon pans. So this coated pans are the non stick ones, and then their granddaughters developing diabetes and mean, these obesity. So they actually goes through generations. Wow, that's, that's the really difficult piece about this. endocrine disrupting chemicals is not just what you're exposed to is what your grandparents might have been exposed to. And that it transmits to you.

Scott Benner 14:28
Have you tried to make a ridiculous example to make a different point you're like, no,

Unknown Speaker 14:33
that's right. No, no.

Adi Benito, M.D. 14:34
Yeah. You're you're into something.

Scott Benner 14:37
Okay. All right. So but it is it is that is it more prevalent here? Because I guess that makes sense. And if it's more prevalent in the US the auto immune piece of this, it's probably because we're more quote unquote, advanced and things like, like you just said, like a nonstick pan or I mean, should people be throwing their nonstick pans away? Do you own a nonsense? Like, man is my question.

Adi Benito, M.D. 15:01
I don't know. I don't know. I don't know. I don't I actually think people should throw him away. I think, yeah, I think you can use other pans that are nonstick.

Scott Benner 15:11
Yeah. I did that with, um, it's funny like it like 10 or so years ago, I just said to Kelly, I'm like, I'm getting rid of all these nonstick pans. I'm just gonna buy like, just regular, you know, stainless steel? Yeah. And she's like, but I like them because they don't stick and I'm like, I don't care. I'm like, well wash them. It'll be okay. You know, like, it just, and I don't know why I didn't know anything. When I did it. It was really just a feeling like, you know, your daughter gets type one diabetes. All right, well, let me start thinking about how people live before this happened all the time, you know, and try to go backwards a little bit anyway. Alright, so obviously, the people listening to the podcast are into the, you know, in the sweet spot for, for this issue as well. And I'm hard pressed to know, you know, anybody who doesn't have type one diabetes, who doesn't also have another autoimmune issue. It's not always thyroidism but have different different issues with their thyroid. But when people are diagnosed with type one, it's sometimes the very first time they realize that there's autoimmune problems in their family line. It's one of the questions I ask every time I talk to somebody, I'm like, you know, were you the first one? And oh, yeah, I was definitely the first one. Nobody has celiac. Oh, well, my grandmother does have celiac. Oh, like and then you start finding you can see it, you know. But anyway, when it becomes obvious to them that there's an issue, they start becoming more hyper aware of other things, they start paying attention. So what are the kind of telltale signs that people should be looking for if they're thyroids on its way out?

Adi Benito, M.D. 16:47
So what you notice with Arden is pretty common lack of growth. So that's pretty typical, both actually type one or even with that type one diabetes, kids who have thyroid disease will not grow. So that's pretty common. If you have a child with Type One Diabetes, in addition to not growing, they actually may develop more hypoglycemic episodes. hypoglycemia is a big one. And that's really that's a pretty big one for almost any other autoimmune condition with celiac, whether it's Addison's disease, which is the lack of adrenal hormone, thyroid, actually both even hyperthyroidism sometimes can cause hypoglycemia. It can also goes into the ketoacidosis part. But so hypoglycemia, when before you had a child that was well controlled, suddenly, with the same, you know, whatever you're using is causing hypoglycemia and more episodes, that should be a sign that something is not quite right. Either your kid is not absorbing glucose well from their gut, and there's some gut issue like celiac or autoimmune gastritis, or your metabolism has changed and metabolism is affected by thyroid. Wow. Okay.

Scott Benner 17:49
All right. So now, here comes the issue, right? I noticed that I go to the doctor, hey, I was listening to a podcast. These people told me that if this was happening, it might be thyroid. My kids seems to fit the bill. I fit the bill. And I test and then the doctor comes back and says, No, I'm sorry, you're in range. Now, we knew what to do when arm was tested, quote, unquote, in range and had symptoms but we only knew because my poor wife went untreated for I think, seven years, while while honestly while hypothyroidism ravaged my wife. It really it just it just really decimated her. We would go to doctors say Look, she has all the obvious signs of this. They test her and say she's in range. It's not that it was was honestly one day in an office. We were so desperate. I wouldn't say I threatened the doctor. But what I what I said was, will the medicine hurt her if she doesn't have hypothyroidism? And he said no, and I'm like, well, then for God's sakes, give it to her. You know, and I'm not gonna I there's no reason to over exaggerate between four days in a week, turned back into the person I know. It was it was really, really fascinating. But some of the stuff that happened to her she just she's having trouble like still to this day rebounding from, but because of that experience, when the doctor said No Arden's and range, I said, I don't care. Give her Synthroid, and boom, she came right back. But not most people. Most people aren't assholes, like me, I guess is what I'm saying. They're not gonna sit there. And just be like, No, I don't care. Because that's a real problem, that white coat problem, right, like people won't stand up, they won't push back. What do you use? Like if you were a doctor in that position? What argument would get you to think all right, I will say these people and try this.

Adi Benito, M.D. 19:44
So the first one, I will look for some goiter with that person had a goiter enlarged thyroid gland, that to me will be a sign that the body's really trying to do something they can't. Right so you think of a goiter. The theory has become enlarged and there's a reason for that either. You don't have enough iodine. You don't have enough thyroid hormone. Something is going on. If you have a history of autoimmunity, if you have either autoimmune thyroid disease already, you already have antibodies. And I see nothing else, you know, I'm going to be looking. So what I want to make sure when it says somebody who has, as you say, maybe perfectly normal thyroid, and we'll talk about what normal really means. I want to be sure that I'm not missing something else that I could be treated. So whether you're iron deficiency, which I think is very common in women, not just anemia, you don't have to be anemic, to have iron deficiency and iron deficiency causes many symptoms that you see with hypothyroidism. So brain fog, fatigue, muscle fatigue, ability, hair loss, all this happened with low iron, similar to low thyroid so that I'm going to look for definitely my practice. But then if somebody comes to me, and I've looked at everything, and I don't see anything, I just saw a woman recently who was feeling really not well, she was having joint pains. I actually sent it to a rheumatologist thinking it was an autoimmune, rheumatoid condition. And I knew that this woman had hashimotos, she doesn't have antibodies, but she has the look of autoimmune thyroid on her ultrasound of the thyroid. So when she came up in there, with tears in her eyes, saying, you know, she didn't find anything. I said latency without reformer, it's not gonna hurt you. I know how to do that. I'm not going to hurt you. Let's see how this works. lifted your trial, there's nothing wrong. Just like with Kelly with your wife, you know, within a few weeks, she was feeling better. So sometimes you have to bite the bullet and say, you know, have we looked elsewhere? And if we have and we have no one, sir, would it be like you said, Would it be wrong to do auto pharma? Would it be wrong? Again, if you know how to treat with every hormone, there's, there's no wrong, there really isn't?

Scott Benner 21:40
Well, after Arden's big growth spurt, she began to say interesting, I'm kind of telling the story. So people understand how your brain will trick you, she starts having the same symptoms again. But because in my mind, now she's on Synthroid, this must be a new thing. It has nothing to do with a thyroid hormone. I don't know why I still in retrospect, can figure out why it didn't occur to us that she'd put on so much weight that our dose probably wasn't high enough. But there she was, again, struggling to get out of bed, struggling to make it through the day at school, she'd come home and come like, I have so many pictures of Arden asleep at a countertop, like sitting in a bench chair, wow. Weighing forward asleep on a piece of stone, you know, which is you know, just out. And then her blood pressure started to fall. And we went to the doctor. And then the doctor saw the low blood pressure and their mind went right to heart. And now we're spending weeks going to specialists giving Arden tests, maybe she has I forgot one of the things pots maybe or something they had a raising her legs and doing all this stuff. And it took me a couple of weeks. And I finally said to Kelly, I'm like, this is just the thyroid medication. Like why did we not think of this? So I said to the doctor, well, let's test for this first and check on this. Maybe we should get her down to children's. And I'm like, whoa, wait a minute. Why don't we just adjust this? No, no, her labs are okay. And so one day I just said I don't care. And I took a bunch of pills. I didn't know what I was doing. I cut some of them in half. And I started giving her a pill and a half. And in a few days, she was okay. And I called her endocrinologist back before you and I said look, like it or not. This is what I did. She's alright. Now I need a different prescription for. Again, I don't think that's something most people would do. But I don't think you're right. I just have this. And it's the diabetes. I think I've been trained by having a child so young with type one diabetes in another medical area where people don't give you a ton of good actionable advice, right? So it just has come to me and I'm like, Look, I'm not waiting anymore. Like I'm not I just I took everything I knew when I thought I'm not going to hurt her. I'll give her a tiny bit more. She pepped up now it's really important after that to like find out, you know, you got to get labs done, because too much as we you know, throws or the other direction, which is obviously not not gonna work as well. And I'm not saying people should just willy nilly take their medication. This is just what happened here. It was a, you know, it's a good example of my labs look good. So it can't be bad. And this just seems like one of these issues that doesn't play by those rules frequently. What else goes into it say we have our thyroid medications good. Talk about the the supplements and the vitamins that that you like to incorporate as well?

Adi Benito, M.D. 24:35
Yeah, so somebody has an autoimmune thyroid disease. We now have several studies, looking at the use of supplements, minerals, vitamins to help and I'm going to say that none of these have been shown to help prevent thyroid disease. So in other words, if you have antibodies and you're looking for ways to protect yourself from developing thyroid disease, these have not studied haven't been studied and so we don't know that will prevent you from developing thyroid disease. But once you have autoimmune thyroid, and your thyroid levels start to to be a little bit off. Things like Selenium. Selenium has a lot of studies on autoimmune thyroid disease in particular in Hershey motors, but there are also studies on graves disease. Most of the studies on Selenium are positive studies, meaning they have a beneficial effect. They help with the antibodies, they help with the way the thyroid looks on the ultrasound. And they also help with well being. So to me, that's usually something that I will use in people with autoimmune thyroid disease. In the beginning, when the studies were done, the doses that were use of selenium were quite high, but about 200 micrograms, and it's part of the country we're not really deficient in Selenium. So the concern was good Selenium. Because high Selenium can also be linked to type two diabetes, not type one, type two, but also glaucoma. Most Recent studies don't seem to indicate that that's as much of a concern as we initially thought, but it's still you know, one issue I'm not giving somebody too much Selenium. Most Recent studies on Selenium have even used 80 micrograms, which is what you probably find now multiple vitamin with Selenium. That's a pretty nice those for autoimmune thyroid disease. That our study is not using a combination of selenium and something called Myo inositol. inositol is substance if someone's in the beef trifecta B vitamin, but it's in the B family. And it's both a thyroid hormone sensitizer and an insulin sensitizer. So it's been also used in patients with Hashimoto thyroiditis, and the combination of selenium about 80 micrograms with inositol, it really helps people bring the TSH down, it also lowers the antibodies. There, of course, we know about the connection between vitamin D, and thyroid as well as type one diabetes or something with a vitamin D receptor, that there's something that is not completely right. So I'll also use vitamin D to help with this or immunity of the body. And then there's there's a study a couple of studies on something called black cumin seeds, and that is the, the herb or the seed itself is called meet gala, sativa. And black cumin seed, as a seed itself as a powder has been used in people with hashimotos. To help them with their TSH also help with their cholesterol. And as well as weight, it helped people lose weight, when that was used after two months. Those are probably the ones that we have the most data for. And the ones that I will use more commonly, I also talk to people about not having too much iodine as a supplement. But enough iodine because again, I get that it's important for thyroid hormone production. So just enough, not too much.

Scott Benner 27:45
Well, I have to say, I just want to stop you for a second. It's so nice to hear information like this coming from someone with your background and I not that other people saying things like this, you know, aren't writer or well informed. But when we hear supplements, I think people tend to think oh, hippies, quacks you know, like, like that kind of thing. Nobody really thinks about, you know, the medical field paying attention to stuff like this. And you're a, you're a legit Doctor Who has a has a really impressive background, and through some of the institutions, you've been out as well. And so I'm glad you're talking about it, because it really is. I mean, look, I know nothing about nothing, but COVID came, and I went out and found a good source of vitamin D, zinc, and a couple of other basic vitamins, and I was like, I'm taking these, I don't care, you know, like, and I've done really well over the last nine months or so.

Adi Benito, M.D. 28:43
Yeah, I think, you know, it's always the question. And that's one of the answers when I studied at universities on on my board of medicine fellowship, you know, it's always about risk versus benefit. So to the semedo, we're talking about the thyroid hormone before for organ, you know, or for my patient. What's the risk? What's the benefit? The same thing with supplements? What's the risk? What's the benefit? My concern with specially with botanicals is are you taking other medications? And are they botanicals going to interfere with your medications are they going to interact? That to me is a big concern. I treat herbs like I treat medicine, they are medicine, they should be treated as equal. I you know, I think it's really funny when somebody will say oh, this herb is gonna cause some interaction with your medicine, but it's not really worth it, it's not really going to do anything. My point is like if it's able to cause any interaction is able to come action. So, you know, it's there. I think when I started working more different integrative, integrative practice. There was not a whole lot that I could actually offer patients. I mean, I could often botanicals that have used you know, the herbalist have used for millenia, but there wasn't a lot of there were not a lot of studies that you know, except for Selenium and vitamin D there was not a whole lot that had come out. Now we have studies like a talk on inositol we actually have cited on ashwagandha and on in particular for hybl for Excuse me for Hashimoto for hypothyroidism. ashwagandha seems to work. You know, up to a few years ago, we only have studies on animals. Now we have studies on humans. So I think there's actually more of an interest as well in the in the researchers in trying to understand how this botanicals and supplements do work.

Scott Benner 30:16
Well, I, I'm Emma, what you said just makes a ton of sense to me. I think it's labeling that confuses people, right. So if if a substance is controlled by the government, and therefore it can be, you know, manufactured by a pharmaceutical company, and then sold to you through your insurance, that's a reasonable thing to take. But, you know, this thing over here that, you know, we can't make any money off of that must not be valuable at all. And I just don't think that that's the case. And maybe it is for some things and not for others, I'm sure there are plenty of prescription medications that are not as valuable as people say they are. And vice versa, but that it's being looked at by people who are thoughtful about it, is the part that makes me excited. You know, it's not just somebody yelling, try some dandy lion, you know, they mean, like, yeah, you know, I took it once, and I felt there's a basis for it. Right? Right, there's a real reason to think this thing, like you said, is causing an action, and is that action, something that's valuable for the person taking it. And if it is great, and if it's not, whatever, great, you know, like, I was told, and you know a bit about this, because we've had to talk about it about art. And but over the last two years, I've been struggling with not being able to retain iron in my, in my sister, my ferritin drops really, really low. And I was told this is genetic, you're not going to be able to impact this with with Don't even try, you know, with any kind of supplements. But what I did was I researched, well made vitamins. And I started taking an iron supplement along with an A sorbic acid at the same time. And voila, turns out I can absorb iron. If I take a supplement. Right? I was being told you can't you can't, your body won't do that. And it was true. I was taking the iron and nothing was happening. Add an absorbent acid to it, boom, suddenly, my body can take it up. Why don't even care why it just works. So I now I actually had to be careful. Like, I got my next blood tests back and my heart was so high. I was like, well, it's working too well. And you know, and so I cut it back. But it's an example.

Adi Benito, M.D. 32:22
I mean, invest something. Yep, it is. And I think if you if you understand a bit about how people who have autoimmune thyroid disease, type one diabetes, sometimes both beside risk for these immune gastritis, which is really the lack of stomach acid. And because you don't have stomach acid, you actually don't absorb. So that sort of what you just said, Yes, brings me to think of, you know, people also thinking about that potential complication or another quick system, autoimmune condition that may not allow them to absorb iron or be 12, or, you know, anything else really, right. So it's really important to be aware of that. Apps. It's,

Scott Benner 33:04
I feel like I'm doing better now. Like, I feel like I'm slowly moving into the best health of my life, which is ridiculous, because I'm not in like, I'm not, you know, not working out constantly. I'm not one of those people not like micronutrients and things like that. I'm just living a pretty normal existence. But just prior to this, I had issues. And I had such a blue collar mentality about it, like, and by that I mean, like, put your head down, keep moving forward. Don't stop do this till you die. Like don't give up you know, anything like that hurts. Don't think about it, can't lift your head up. Don't worry, keep going, keep going, you know, and, and now I'm like, you know, I'm not gonna make it much farther like that. Like, it'll be an impressive story for the five people that remember me. But I'd like, you know, I don't want to keep going. Like, yeah, it turns out he had no, yes, we do take that as like, we're badges of honor to you go to the doctor. And they say something like, I don't even know how you're standing. And you're like, that's right. Yeah. I'm standing right person was 13. Scroll my life. Yeah, right, right. But meanwhile, I wasn't standing, I ended up in the emergency room eventually, because I bent over to pick up, my head almost went to the floor along with my hand, I was like, ooh, I just couldn't stay a lot more. And then, speaking of anecdotally, then we start having everybody in the family tested, just to see what's up, you know, and Ardennes ends up being really low too. But then we kind of realize that might be because of heavy bleeding from our periods. So we get our jack back up again with an infusion and she is still drifting down, but she's not falling the way I want. She's not going from up to down. And so I think the assumption is going to be after one more blood test that Arden is going to need to take an iron supplement, as well probably along with an absorbing gas and maybe a couple of times a week, but and I say do this all the time about the podcast itself. And I know you don't listen to the show, but this podcast helps people use insulin. It's really valuable to them. But I only came to the information because of luck. Stay at home dad, my background aligned with being able to kind of figure things out. Most people, this stuff is just coming at them a million miles an hour, they do what they're told when it doesn't work, they go that didn't work, they walk away from it. Most people don't come to an answer. And that's the that's why I wanted to have you on like, I want to teach people how to come to some sort of a resolution when they find that they have a thyroid issue. And most people aren't going to find you. I mean, I I basically had to beg you to see art and you were full. You know what I mean? When when I found you? Yeah, and most people aren't thinking about these things. So where do you think the conversation should go from here? Do you think we should jump into people's questions? Or do you have more you'd like that?

Unknown Speaker 36:01
Yeah. No, you're like I got them, we can do that.

Scott Benner 36:06
The dexcom g six continuous glucose monitor is the tool that I lean on the most for making decisions about my daughter's insulin. We use the information that Dexcom provides. And that's what her blood sugar is. And what direction if any, it's moving in, not just what direction, but how fast in that direction. So I can tell is this an 85 blood sugar that's super stable, where's it falling, or rising, knowing that makes bolusing bazel adjustments and meal times so much easier. You can learn more about the dexcom g six continuous glucose monitor@dexcom.com Ford slash juice box B can't remember that there are links right there in the show notes of your podcast player. And at Juicebox podcast.com. Check out the Dexcom g six today are using pens or syringes. And thinking about trying an insulin pump. My suggestion would be to try the Omni pod tubeless. And on top, it's the only pump without tubing. And it's super simple to wear discreetly if you'd like. The great thing about Omni pod is that you don't have to take my or someone else's word for it. You can actually try Omni pod, we'll send you a free no obligation demo of their insulin pump so that you can wear it around the house or wherever else you are. Although let's be honest, we're all pretty much around the house right now. And see if you like it, you'll be able to put it on. Go about your days. bave Oh yeah, you could bake with it. And you could actually swim with it if you wanted to. Omni pod allows you to continue to get your insulin, even during bathing and swimming. It's the only insulin pump that can say that. So if you're currently on MDI, and you're thinking, yeah, I mean, I'd like a pump, but I don't like that idea of not having my bazel and some all the time. With Omni pod, you absolutely can. And you will. My daughter has been using an omni pod tubeless insulin pump since she was four years old, and she's 16 right now. That means she's been wearing it on the pod every day, for over 12 years, check it out, it's super simple to do, it'll take you five minutes at my Omni pod.com forward slash juice box to get that demo sent directly to you. Last thing if you love watching people do nice stuff. For other people with type one diabetes, you should check out touched by type one.org. They're a great organization, doing wonderful things for people living with type one touched by type one.org. Or check them out on Instagram, or Facebook.

Once again, the people that listen to this podcast were really great, and asked a ton of questions that I think most of them are valuable. Why are thyroid antibodies seen in so many kids with audio immune disorders who don't have thyroid disease, and subsequently, do you expect that those will eventually end up with thyroid disease.

Adi Benito, M.D. 39:22
So antibodies might be the first sign of these autoimmune thyroid disease that again, in only 50% of the cases will lead to thyroid disease, the other 50% and we'll never develop our disease. At the same time, you actually could have antibodies that are positive just because your body has an odor immunity in it. In other words, you think of your immune system sort of like almost like fireworks, and it's almost like throwing little you know, these sort of fireworks in different directions. And one of them could be an antibody for thyroid without you having the disease without you really having autoimmune thyroid disease. So that can happen. I'm going to look at what level of antibody you have. If you're like you know a little bit high, I might not really worry that much, I may keep an eye on it. If you're high, I'm going to say that most likely is true autoimmune thyroid disease, and I'm going to keep a closer eye on you. In general, when people have autoimmune markers, so antibodies for thyroid, and their TSH is a bit off. It's more likely for them to develop therapy sees that if they only have antibodies, but not have an abnormal TSH. So it's worth it's worth keeping an eye on both over time just to make sure that you've detected

Scott Benner 40:37
but if you see those antibodies, you're about a coin flip to end up with thyroid disease.

Adi Benito, M.D. 40:43
Correct? Yeah. Okay. Can it get diabetes? It is in the case of type one diabetes. Okay.

Scott Benner 40:48
And then, how common is it to have happened? What happened to Arden and Kelly, which is they're in range, but they're experiencing symptoms? So I guess the first question is, is that common? As a as what people notice? And can we talk about what in range really means and how to interpret that?

Adi Benito, M.D. 41:07
So both? Good question. So I don't think there are any studies looking at if you're in range, how likely to have you have actually called for a disease? Is it the autoimmunity itself that is affecting you, and if you treat with our hormone, the immune system will actually do better and you feel better? So we don't really know the answer to if you're in range. You know how likely it is that you that you'll find people who need that hormone, or benefit from terraform. We don't have that data. We do definitely know that TSH, which is our main marker for thyroid function, and TSH is a pituitary hormone. So the B two eteri gland, which is our master gland, makes TSH and TSH stimulates the thyroid gland to make thyroid hormones t four and T three, I think of TSH as the thermostat of the house. So think of your third house to set your thermostat in the house is called your therapist and make enough thyroid hormone. The thermostat goes up so TSH goes up. So a high TSH is usually an indicator of thyroid dysfunction. And we use that because of the relationship between thyroid hormones. And TSH, there is this relationship that makes whenever you have a very small change in your thyroid hormone from the thyroid gland is going to make a high a big change in your TC. So it's going to be reflecting a much larger change. So when you look at the reference range for TSH, most labs will give you 0.45 to 4.5. That's your range. That's a reference range and I call the reference normal. If you look at what we think is ideal, probably a 2.5 for TSH is ideal. Alright, so 0.45 to 2.5. So we think it's ideal, if it started to see at TSR is over two or 2.5, that may be an indicator that something is about to happen or could happen or it's likely to happen. You don't know when but it could happen. We definitely are much more strict with that TSH, when a woman is trying to get pregnant, we definitely don't want that Tz to be anywhere above 2.5 sometimes or even above two. So when you kind of reference when you say I'm in range, my question is always Are you really in? Are you optimal for TSH? Are you in range, but not really optimal? Are you 3.5? Are you four? I don't think that's really optimal. I think people have up to four as we may have symptoms. So it's good to keep in mind, Where exactly are you just being normal doesn't mean that you truly are normal. And that would have been almost my first question with both Arden and Kelly, when they were when they were

Scott Benner 43:41
diagnosed. So try to think of it as the reference range, which just means where most people fall when they're tested. And an optimal range, which is more indicative of where your body is going to do.

Adi Benito, M.D. 43:53
Yeah, and if you if you may think give me a bit of the background of how that reference range was, you know, came about you'll you'll see exactly what you're saying. The bad data comes from a big large study in the US where they took a lot of, you know, people in the US and they just asked them, Do you have thyroid disease? Now, okay, you get tested, you have to know you get tested. So they said everybody, and that's what they came up with that range 0.54 or five to 4.5. Then they said, Okay, let's test people who have antibodies, this thyroid antibodies. Alright, let's remove those from now, our range. When they did that the range went from 0.5 to 2.5. That's where their weights comes from. So you don't have antibodies, you have a tier so that it's usually more in range, then you have antibodies because you probably have already developed mild thyroid disease. So the progression of thyroid disease is that you develop first the immunity, you have the antibodies or the look of the thyroid disease, maybe an ultrasound over time, that develops into having a high TSH, maybe still within range, but higher and then over time, that's his case on off rage and that's You usually get diagnosed and treated.

Scott Benner 45:02
You said that it's very important while you're pregnant. Can you give me why that is?

Adi Benito, M.D. 45:08
Yeah. So first for conception so to get pregnant, you need a good TSH, women with higher TSH will usually have. They're not able to make enough progesterone, which is actually what helps, you know, keep the baby or, you know, hold to the baby. But there's also higher risk that higher risk of miscarriage there's a higher risk of complications later in pregnancy when there's preeclampsia or other there are complications in pregnancy. When the teacher says hi, so yeah.

Scott Benner 45:38
So there's a question here that I think leans into what I said earlier about just soldiering on. And the question is, what are the health implications of poorly managed thyroid disease? And this person says, It would also be great to get an explanation of the different types of hypothyroidism, which, obviously, we've covered already. So what are the implications of just ignoring this?

Adi Benito, M.D. 45:58
Yeah, so I don't think it's good to ignore it. We definitely have no sets of levels of TSH when we think it's actually dangerous to ignore it. So if you're over seven, don't ignore it. And you're young and young, I mean, younger than 65. So younger than 65 to six or seven that increase your risk for stroke and heart disease. As simple as that. So if you are in like I said, before, you know, TSH affects fertility, it affects women cycles, women's probably tend to have cycles that are a bit heavier when the TSH is higher. But definitely Heart Heart is is a big one high TSH usually also affects insulin resistance, the higher TSH the more insulin resistance you are. And that's also been shown now with a TSH again, that is in that reference range, but it's at the high end of the reference range, because again, we know that that's not really an optimal TSH, it's been linked to insulin resistance is being linked to fatty liver, which is quite common in the population as well. Fatty

Scott Benner 47:01
livers.

Adi Benito, M.D. 47:02
Yep, yeah.

Scott Benner 47:04
Okay, so if the TSH is too high, then I could see insulin resistance. And that's especially for this population makes everything more difficult again, there's another question here. That's interesting. Most of it's been answered already. But at the very end, this person says that my daughter has T one D and celiac. I have T one D and hypothyroidism. But the last part of the question is where I want to ask the question that she says, did one cause the other? And I know that one doesn't cause the other. I know that you already said that. That autoimmune disease is kind of, you know, clustered together faster. But it's such a common question for people people have such an anecdotal relationship with what they see, like I got this, and then this happened. So this must have caused that. That's not the case, though, right?

Adi Benito, M.D. 47:52
No, the they have been a concern and having actually some initial research into whether celiac actually could cause autoimmune thyroid disease. And the third was, could people with celiac disease not absorbed Selenium? And then we talked before Selenium modulates thyroid? Could it be that when you have celiac even having a millennium and then Selenium causes autoimmune thyroid? It's never really been explored further money initial sort of question study. I think, you know, it's really interesting, right? It's a celiac, you know, somebody has a question as well on leaky gut. If you think of, you know what leaky gut represents, basically, you think of cells in the gut, the cells are tight to each other, right there next to each other, there is tight junctions between the cells. And when you absorb nutrients in your gut, from the gut into the bloodstream, they don't get absorbed in between the cells, they get absorbed through the cells. Now, imagine that those cells are not tightly together, they're separated. There's a gap between the cells, that's leaky gut, that says your cells have a gap in between them. So things that were not able to come through the cells not coming between the cells, things meaning proteins or other anything that you're you're taking those trigger a reaction in the body that has an inflammatory reaction. And those is where the idea of molecular mimicry comes in. Meaning there are things that can look like other things that your body will react against. So something comes into through the gut, in the body things that is to be something foreign, a toxic, and in the process of doing that is creamy santai to have an attack your thyroid and other organs. That's the idea of molecular mimicry and leaky gut. Could it be that celiac does something like it? We don't know that? Is it a possibility? Sure. It could be we just don't know enough.

Scott Benner 49:43
That's fascinating that the chain of events feels like it's so far away from the thyroid, get, you know, right, but the one thing creates the antibodies, the antibodies, then go do the wrong thing. That's fascinating. Our bodies are amazing and scary.

Adi Benito, M.D. 50:01
Hopefully not,

Scott Benner 50:03
hopefully not right. And so the idea really is, if you're more listening, if you have autoimmune issues, you're not going to stop them most likely. But there is hopefully a way to tame them or to draw them more into into line just to give yourself better outcomes. And not just think, because I think that happens a lot, you know, to people who, you know, for instance, don't listen to the podcast, who have type one diabetes, they do this thing I talk about all the time, I'm always telling people, please don't just say, Oh, that's just diabetes. Oh, my blood sugar just goes to 350 and stays there for a few hours. This is what happens. I have type one diabetes, I'm like, No, that's not what happens. Like, you didn't use the insulin correctly, we can stop that, you know, but it becomes, again, it happens over and over. And it makes them feel like well, this is just part of it. So if you have these thyroid issues, yes, you're going to run into a lack of understanding very likely at your doctor. And there may be more for you to do to, to get through the process. What I'm thinking is we're talking is that I'm gonna bug you for like a checklist for people to take with them, like, like talking points are so good to put along with this. Because that really is my concern. Like, we can educate people as much as we want. But if they hit a firewall at their physician, none of this is gonna matter. You know, understand, they're just gonna understand what's wrong. It's not going to help them fix it.

Adi Benito, M.D. 51:32
Yeah, I so my, my thought process. And this is not just the way I work, but this is actually from guidelines by the European thyroid Association. They talk about how when somebody has this is somebody has a perfectly normal TSH, they're being treated with a requirement to have a perfectly normal TSH, but you don't feel well. So now what right? What do you do with that? So first thing, you have to make sure that your TC is truly in range that you're really in that you know, one to two, maybe up to 2.5, you're really within the optimal range. In spite of that, we do know that patients with thyroid disease, up to 15% of patients who have a perfectly normal TSH will not feel well. And they're still have some especially neurocognitive deficits. So what's next? So first, look for other other things that can actually come along with thyroid that could be causing the symptoms. And the first one I will look for will be iron and B 12. And you could ask your doctors, could this be an iron and a beach deficiency? Could I have anything like that? I know that they're more likely people with thyroid disease, and only me and thyroid could have that. And that's about touch, you can check like you did Scott, your ferritin. And you could also take a b 12. level, that's pretty easy. Then you could ask, could this be that you have another autoimmune condition. And again, cilia can be silent, you may not have any sense of celiac. You know, as a kid, you might not grow up as an adult, you might not have any symptoms. Same with autoimmune gastritis, you may have no symptoms except the lack of absorption of certain minerals and vitamins. So it's always worthwhile asking your doctor, could this be a different autoimmune? I know that I'm at risk for autoimmune conditions, should I be checked for celiac or autoimmune gastritis or something else? And then I will go back if others have been checked, and you have no other autoimmune, your audio is perfectly fine. And I like to talk a bit about iron and a little bit. Then the question is, could you be somebody who in addition to taking legal thyroxin, which is the standard of care for hypothyroidism, should you be treated with my authority t three, is that is that a rule 43. In general guidelines, from many societies do not recommend using t three. However, there is a little spot in one in a test for by the American Association, where they say that an individual case to case basis 43 could be not maybe not encouraged, but could be thought of let's say. So some of the there was perhaps a discussion within the group that wasn't the task force. And some of the people in the test for writing this guidelines really thought that if you're not feeling well, in everything has been looked at, you could consider taking t three. Now. T three is the active hormone in thyroid so your body, our bodies make tea for our thyroid make tea for a little bit of T three, mostly t four and then t four which is again legal fireworks and pills, if you wish sort of the equivalent, t four gets converted to T three in the cells. T three is what gives you your actual energy. So we don't understand exactly why. But that are certainly people with thyroid disease with hypothyroidism who in spite of taken before in spite of having normal levels do not feel well. It's a subset of those people feel better when they take two three Along with T four. So you could then ask the question, am I a candidate for t three? Could this be something that we could explore? Could I add some t three to my T four, could I just take some t three, maybe a little bit less t four, just to make one for the T three, it's always a consideration. If you're somebody who's pregnant, I would, I would not recommend that the baby brain needs t four. And it's a bit, sort of partially impermeable to T three. So if you're pregnant or trying to get pregnant, I would not recommend t three. But if you're somebody who has cardiac arrhythmias, meaning your heart goes into an irregular heartbeat, especially when you go fast, to please not recommend because tip three is going to make those more likely to come back and to happen. But in spite of is when you don't have those is something that you could think of asking your doctor.

Scott Benner 55:45
And for perspective, t three works for my wife, but didn't work for her.

Adi Benito, M.D. 55:49
So that's exactly right. And it's completely an individualized approach. It's not really based on blood test. So I can take somebody's t three level before they give them t three, and they have a perfectly normal t three. So it's a T three levels that's in terms of it needs, it doesn't need it, t three is actually inside yourself. So you really don't get to measure that it's more of a clinical decision. And it's almost like a trial, basically, is what you have to do,

Scott Benner 56:13
as you're explaining it. And I see how detailed it is. And I have to be honest with you, I've had this conversation for years now around my wife around my daughter here today. I still think if you gave me a quiz about t three and T four, and what's making what and what my I think I'd get maybe like 70% of it right. But I do wonder if that's not part of the issue at the physician side. And especially because endocrinology is interesting, right? Like, it's such a blanket, you know, they do so much like how do you be, you know, a thought leader on this one tiny piece of it. I can see that. And for the people listening, it's confusing, you know, TSH, T, three, t four, thyroid goitre, they're like, wow, there's a lot of lingo, there's a lot of like, you know, it can be overwhelming a little bit. And especially in a society, like, let's be honest, we're a light switch society, we want to, we want the pill to go in, we want everything to be done. And that, that, you know, so having to put in the work, I think is incredibly valuable. I'll tell you that. I'm so passionate about this. Because I see the other side of it, like I know, what happens to my wife, and what happens to my daughter, if they're not managed well with this? And it really is, it's a dampening of their life. Like it really it really is it takes significantly away from them. And

Adi Benito, M.D. 57:39
perhaps they Yeah, sorry, the message is to say, Don't give up, you know, if you're not feeling well, you know, fight for what you think, you know, you know how to feel well is if you're not feeling well, nobody's going to be in your body to know if you're feeling well or not. But if you if you don't feel well keep at it. So if it's not one condition, it could be another and if it's not that then, you know, go back and say could be managed differently in the way that I've been treated.

Scott Benner 58:04
Don't give up but look for information in different places. Mm hmm. And, and I will, I will say this, there is a thing that happens when you haven't felt Well, for so long. You do forget a little about what well is because I have to say that when someone gave me an iron infusion, and I could feel its full effects, which takes a little bit of time because your red blood cells have to pick it up and remake cells again, with sufficient iron, it takes a little while. It's then hard to remember how bad you felt so resilient. We are you know what I mean? Like, yes, it's hard to go apples. And like, I know, I was tired. I know, I would run up the steps and be out of breath, which was ridiculous. But that's how bad my low iron was like I if I ascended the stairs, I couldn't talk on the phone at the same time. And you know, but yeah,

Adi Benito, M.D. 58:54
so I want to talk about about about that a little bit. You know, when most people talk about iron, they'll talk about, of your doctors talk about it and talk about red cell count. It's not what you and I are talking about, we're talking about ferritin and ferritin is how your body stores iron. So the average ferritin in us women is 22. Now, I'll tell you, adolescent girls who have levels less than 35 pass out, there's definitely data on that. And we think based on one study that for women, a level of 55 zero is perhaps optimal for energy, if you're looking for hair growth, that's about 70 to 84 ferritin. And again, I'm telling you average women are around 22 that's the average because we menstruate because we you know, children we grow and we miss trade and we'll have kids and all that takes iron.

Scott Benner 59:43
Yeah. Yeah, women's bodies are they get used up by by life in a way that doesn't get replenished all the time. And I don't know if that's some nature plan or anything but I on that You don't have to walk around tired like I had a bunch of kids. It's okay. This is not a great you know, like,

Adi Benito, M.D. 1:00:05
I agree, do something yourself

Scott Benner 1:00:06
help our medicine has improved. You should you should take advantage of it, I changed my life getting an iron infusion. And I think it's

Adi Benito, M.D. 1:00:16
a lot of my patients lives. I've definitely seen a lot of my patients for iron infusions, when I cannot get their iron up, or they're really really low in iron.

Scott Benner 1:00:26
It goes it's not pleasant. As my iron gets lower, I lose my ability to i don't know i'm not measured anymore. Everything either makes me upset or sad. Or like I just it's fascinating to watch how I devolve when it goes down

Adi Benito, M.D. 1:00:43
I I find it really fascinating you think of all the things that lack of iron can do so for women lack of funding is actually more linked to PMS premenstrual syndrome lack of funding is definitely has to do with depression lack of associated with low libido in women you know lack of iron can really cause muscle the muscles not to feel right you know somebody who's running and the starts to get tired like you did you know you're going up the stairs, I'm be short of breath, passing out feeling lightheaded. You know, all those things? I do to look like a buyer. It's really important.

Scott Benner 1:01:16
No kidding. I'm a huge fan of paying attention. A question is, can hypothyroidism hashimotos hide symptoms of a slow or late onset of Type One Diabetes like Lada if type one has started making hashimotos anybody's but it's not symptomatic, is it just a waiting game at that point.

Adi Benito, M.D. 1:01:37
So definitely type one diabetes and hashimotos are linked through these same genes. Again, hashimotos. If you don't have if you're not hypothyroid, I don't think hashimotos by itself is going to affect your glucose metabolism. But having hypothyroidism literally can affect your glucose metabolism, you know, just think of if you think of hypo as being low, just think of a low metabolism. So you're going to AppStore things more slowly, you're gonna not be able to clear medications as fast from your body. So all that is going to play a role into how your sugars are gonna get affected. Basically, Lada is actually photos a risk factor for hashimotos. They don't seem to have the same genes, it's more of our risk factors a little bit different than actually even when it's close to type one, it's not exactly type one, the genes those seem to be the same. And again, we talked before the wedding gave me Yes, a 50% chance of developing thyroid disease. If you are type one, you have type one diabetes.

Scott Benner 1:02:47
So this next question is interesting, because I think we covered some of it, but not the whole thing. The question is my son's bloodwork shows he has the markers. So the endo has put him on a low dose of thyroid. Is this a protocol because he has no symptoms? So we've talked about if you're, if your ranges, quote unquote, good, but you have symptoms, yes, you need it. But what about if you don't have symptoms, but you have the markers? Right?

Adi Benito, M.D. 1:03:10
So maybe that's it. And again, I would like to go back and take a look at that TSH was a TSH at the high end of normal. Does that person habitually avoider, enlarged thyroid gland, that actually is an indication to treat even without symptoms? If somebody has antibodies, and they have an enlarged thyroid gland, there's an indication to treat even without symptoms. And that's at that point working on the body is really trying to push to work too hard.

Scott Benner 1:03:35
What do you recommend? Like once people get their medications set up? What's the maintenance for it? Because this person asks, Is it good enough to just test my T TSH every year? Or should I be doing other things?

Adi Benito, M.D. 1:03:47
Right? So guidelines are that you check once a year, I'm a little bit more OCD. And I'll check people twice a year, I still see them in my office once a year, you know when we can meet in person, but I'll take them twice a year and I have a very low threshold, I do tell them if you feel different. And I just say that different than what you normally feel and it doesn't go away, just have have a low threshold, check your levels. I also tell them if you're taking a new medication or a new supplement, I want you to tell me what you're going to be to get for that I know there are certain medications that can actually interfere with it either the absorption or the metabolism of thyroid hormone. So that we can even a birth control pill can actually affect you know how much sorry hormone you need. So there are things that that we know can have an interruption or have an effect on sorry, so I want to know about them so that we can, you know, be more you know, proactive about them.

Scott Benner 1:04:36
Yeah. Well, I think that one of the most amazing things about working with you is is that there's no there's only enough pausing to see what works. So if it's get a blood test, find out where we are, add the medication way to appropriate on time, but usually just about 30 days, blood test again, keep moving like that is such a valuable perspective on it. And yeah,

Adi Benito, M.D. 1:04:58
if you know that level three Roxane, which is what sort of care is, takes about six weeks to take any effect? That's all you're gonna you know, that's that's all you have to wait if you're changing your dose or something it's introduced just six weeks doesn't take that long.

Scott Benner 1:05:12
Yeah, no. And actually, interestingly enough, COVID making people's connections more instantaneous, right, not having to wait for as long for an appointment, right? Being able to get in and out of conversations, I actually think there's a couple of things that are going to come from all this. That's good. And I think this is one of them. Doctors, seeing people like this, I think is going to speed people up to resolutions, because it gives them the access at the at the intervals that I think are more necessary. So I definitely found that. Yeah. This one's interesting. Do people tell you not to eat soy sauce? If

Adi Benito, M.D. 1:05:50
you have? Oh, that's a good question Is it so you so few things on so one is if you take that requirement, if you take legal thyroxin, whether generic or Brandon would talk about that as well dinner, you can brand, you should not take your federal government at the same time as taking soy, soy, it does affect the absorption of thyroid hormone. So not at the same time. If you're already taking a reformer, you can take you can have your miso soup, or your tofu or, you know, at a different time, that's perfectly fine. There have been many studies on soy and thyroid, the initial concern was actually babies who were fed soy milk, you know, when they were infants, I guess. And soy actually is even having of iodine is actually going to affect thyroid function. So but if you have enough iodine, soy will not cause any problem with the thyroid. There has been only one study where they use quite a bit of soy. So there were people having soy for breakfast, lunch and dinner. Those people had an under a mildly underactive thyroid, they became much more than thereafter after eating a lot of soy. And again, it was so breakfast, lunch and dinner. It was a lot of soy, right? So if you're somebody has a mild dysfunction in your thyroid, you're trying to avoid taking foreign form. And you really want to try to do this naturally for yourself. Don't overdo it on soy is what I would say.

Scott Benner 1:07:12
Okay, that's interesting. So like, I can't wait, I don't want to, well, let's talk about the medication for a second because you just alluded to something that we found. Synthroid works fine for my wife, that generic, Synthroid doesn't touch her at all, for some reason. We've bounced through multiple medications for art and just looking to see if she had an interaction with one of them, which she didn't end up having. But she now takes Harrison which is, I think, has no fit even. I don't think Synthroid has that many fillers, but cireson has none of them nothing. Yeah. So, you know, do you see that first of all between generic and non generic?

Adi Benito, M.D. 1:07:50
Right, so generic, it's legal thyroxin. And the concern with generics, if I write a prescription for generic just for, I guess, right, legal thyroxin, the pharmacies will give you what they have in stock, which means that the first time you feel these generic A, then the next one could be generic B and the next generic seat, each one of the generics gets absorbed differently. So from going from A to B to C, your levels are going to change just because you're sorted differently. Same is true of brands, if you go and see him for the first month and then the voxel the second time in a unit for the third month, that's also going to change. So if we write brand like Synthroid, let's say, the pharmacy will honor that and they always give you a Synthroid. Now I have a way sometimes somebody has a hard time paying for medication for brand, right? legal thyroxin by x. And my x will be let's say mainland, which I like it because it's gluten free and lactose free. So what I tell my patients is gonna just like you know, be an advocate, right, so thyroid hormone pills, tablets are color coded and shaped coded. The color tells you the dose, every single 50 microgram pill is white, every single 100 is yellow 112 is pink 137 years Brown, you know, they all have a color that's a dose doesn't matter what the brand is, doesn't matter what the generic is, the color tells you the dose. Now that shape tells you who makes it. So synthesizer which round the voxel is almost like a thyroid shape, some like a butterfly type thing. You know, so if you go to the pharmacy, and now you pick your pills, and last month, they were white and round, and now they are purple and oval. They give you a different dose, and a different manufacturer. And that's how you know and if your doctor didn't tell you that we're changing it, you better call back your pharmacist and your doctor and tell them they give me something that I was not supposed to be taking.

Scott Benner 1:09:40
That is rock solid real life advice. I did not realize so maybe Kelly's issue back then when she was using generic wasn't so much that generic wouldn't work for it was the cheapest be getting something different every time there was no consistency.

Adi Benito, M.D. 1:09:54
Right. And some dinners will have gluten or lactose which many patients with Hashimoto said So if not celiac fully, they might be intolerant. There's more likelihood of being intolerant to gluten and to lactose when you have Hashimoto somewhat, you don't have hashimotos.

Scott Benner 1:10:08
So there's a question here that I feel like has been answered. But the second part of it, again, is valuable to still bring up. It sounds like this person has a doctor who tells them that you should try to get off of all medications, which obviously, if you need this hormone, you need it. Right. But it does beg the question. If you're, are there safe ways to titrate? up? titrate? down? Are there other ways to take medication that they this medication that you can't like? Can I just pop them in? Or do like how does that work, like if you're moving up at a dose or switching from one to the other,

Adi Benito, M.D. 1:10:43
right, so usually, when we need to change somebody, those because our three levels are not, right, they're not optimal. Usually, we go one level up and one level is about 12.5 micrograms up, and that most of you Your, your thyroid medications have those levels, most normal, Sabrina and you have 75, you have 88, you have 100, you have 112 125 137 150. So you're totally gone in 12.5 13 microgram increments, 50 to 75, there's no nothing in between 15 to 25, you know, going down, there's nothing in between. So there are a couple of them have nothing in between by usually one level up is 2.5 micrograms. And that's usually how we go up unless somebody started that was really, really off. And you have to go up quite a bit. Fabric hormone level thyroxin is long acting. Meaning if you miss one pill one day, take to the next day, that's perfectly fine. It's not a problem to go away for the weekend, you forgot your pills, when you come back, make up what you missed. So make up your Saturday, or Sunday, that's not a problem. Let's say somebody is has been given thyroid hormone, and they want to see whether because I thought it was wear off. And they want to see if they actually needed and can they come off it. So if you have been taking thyroid hormone, and you suddenly stop it, your thyroid levels are going to rebound, you're actually going to have a high TSH, and that's just a normal physiologic effect. Even if you don't need it, your body's going to do that. So it's going to bump up your TSH. So instead of getting off abruptly, what I have people do is actually have them take one pill less per week. So one day, a week, they miss their pill, the lunar for about two months, I'll test them and see what the TSH is their standard range. I'd say okay, take one pill away again, another missing two pills per week. Two months later, we'll do the same thing. So very slow process, but it really works. And he tells me what's the dose you need if you need it? Or can you actually be without it. So and that's particularly true, because sometimes when you have a high TSH, it doesn't always mean you have a thyroid disease, high TSH could happen because you are sick, could be 30 days, not the chronic that is hashimotos, but sub acute. So something that really is caused by a virus that causes your TSH to go high for a couple of months, and then your tissues will go back to normal. But if somebody gets given fabrik at that point, then do you still need it two months later? Or could you actually come off it?

Scott Benner 1:13:05
Can we talk about that for a second? Because I think you believe that happened to Arden this year, right? Yes. Right. So she gets some sort of a virus. She fights it off. But then she starts having real impactful thyroid, like issues. And as we tracked them, medication wasn't the answer. Not that time was the answer. Right. Yeah. So is that what people call a thyroid storm?

Adi Benito, M.D. 1:13:32
Oh, no. So Pepperidge Farm is what happens when you have graves disease, and suddenly your thyroid releases a lot of the fabric hormone that you've had in storage that happens on graves that is not treated, which is why graves disease should always be treated. You know, we talked before about when you treat when you're hypothyroidism graves disease in my mind should always be treated because fairy storms are they can really, you can end up dead without restore. So to prevent that, so that's different. That's sorry, data's, which is what we call this will be a subacute thyroiditis mean, it's subacute means that it lasts for a short time. They're usually painless, meaning you don't have any pain in your thyroid. A virus happens about two months prior, a cold, flu, something usually some cold like virus about two months before and then suddenly your body starts to release, a lot of thermal has been stored. So you just have a lot of releasing your personal making more favourably just releasing what's has been stored in your body just a lot of it and once that makes it person hyperthyroid because the thyroid gland has only about two months storage of thyroid hormone, once that power has released everything that's in storage, now the thyroid goes hypo thyroid and then nobody sort of kicks in and regulates itself and you normally usually go back to normal sometimes people actually end up a bit hypothyroid after that happens, so it's usually hyper hypo normal. So that's a typical pattern that's

Scott Benner 1:15:02
interested in that. Can that not happen to people who don't have thyroid disease? Does that not? Yes,

Adi Benito, M.D. 1:15:07
yeah. If

Scott Benner 1:15:08
I don't have thyroid disease, I would never see any of this happen.

Adi Benito, M.D. 1:15:11
No, actually sorry. You can still have a beautiful holiday season. Yeah,

Scott Benner 1:15:15
it could happen. Still. It could happen. It's fascinating, too, because like you said, it's months of one direction and then swing back the other way, and then a leveling eventually.

Adi Benito, M.D. 1:15:24
And I don't know why. But I've seen a lot of those cases this year. I have to say, I don't usually see as many cases I've had. Many, many, many of my patients have actually had that happen to them this year when it became hypothyroid. And then we would have two more months. I mean, we get adjusted, they're fairly close, and they wouldn't be as hyperthyroid then we'll have to readjust back. Because they weren't getting hypothyroid. It's been interesting, huh? Yeah.

Scott Benner 1:15:48
Are you in firing? COVID? Or no,

Adi Benito, M.D. 1:15:51
no. And those people that say what testing that many of them did not have? COVID. So is it stress that we know can affect thyroid, the distress affect the immune system? And then effect was another virus that was happened at the same time as COVID? I really don't have an answer.

Scott Benner 1:16:04
No kidding. Yeah. Because we did check Arden for COVID to during this whole process, and she's never had it. So, Mike. Really? Wow. You talked about leaky gut earlier. And this person's asking, does healing leaky gut help thyroid symptoms? Which I think the question the answer, there's pretty clearly Yes. But how do you go about that? And what kind of a doctor do you see? And how do you even know that's happening?

Adi Benito, M.D. 1:16:28
Yeah, so I would say still not into the, you know, completely accepted by more of the Western medicine, if you wish. So probably a functional medicine provider is the one that will test for leaky gut. There are some blood tests that can help that are sometimes stool tests that will do it. But it's not a routine that you can go to a labcorp request and you know, at a hospital and get tested for I think,

Scott Benner 1:16:54
let me jump in for a second. I think what I learned by watching you help the girls was that doctors in a Western situation, they look for results, numbers that tell them for sure this is a thing. What I watched you do was test a bunch of different stuff, and then use your knowledge to infer a little bit from it. Yeah. Is that fair?

Unknown Speaker 1:17:17
It is Yeah,

Scott Benner 1:17:18
yeah. Yeah. So you're looking

Adi Benito, M.D. 1:17:20
at and sometimes I will not treat I will not buy, I will not make the testing for the leaky gut. But I will say, you know, could this be leaky gut and in the way I think of leaky gut sometimes that if you start to have reactions to almost anything that you're, you're either eating or taken. That to me suggests pretty strongly leaky gut, because it means that things are just coming into your body, your body's reacting against it, why would anybody do that? It shouldn't do that normal, right? There are, you know, stress can trigger leaky gut infections can trigger leaky gut. So if you have any of those a history of having had significant stress in your life, or just a recent gut infections, and I'm going to be more suspicious of leaky gut, there's, you know, people will use even bone broth that can be very much mentorship from leaky gut that there are some some of the the protests in the in the bone broth actually help with leaky gut. glutamine is one of the big ones for leaky gut. Interestingly, there's one herb that is used for leaky gut co it's not right now. It's a it's a, it's a semi so called an alkaloid that come from plant is called berberine. berberine, comes from goldenseal and tennies, coptis and rest, blocking minima, the other one, but anyway, berberine is, is this chemical that has been shown to help leaky gut, but it also has stayed actually, for hashimotos. The data actually is not in, in clinic call so that they were not doing the study to see whether your symptoms got better the status itself, so suddenly self study, so like what we call, you know, petri dish if you were studied, but it's interesting that that same compound helps but hashimotos only keyguard. And, you know, the question is, could this be because you're helping the guy you're helping them to hashimotos unclear, but it's a, you know, is definitely a question that is worth exploring. In the future.

Scott Benner 1:19:06
Well, okay, I feel like we've done a lot. Did we miss anything? That you're like thinking, Oh, how did we not talk about this one thing?

Adi Benito, M.D. 1:19:15
All right. So I'm going to go back a little bit to the generic versus brand versus terrorism. I just want to make a mention on that. So when we talk about generics and how, as long as it's going to seem generic, that may not be so much of an issue as long as you're okay with all the fillers and the colors. Again, white doesn't give you a color. So usually whites are easy. terrorists and sort of the newest, legal thyroxin on the market. And Harrison is beautiful, lukasik capsule, and it means that by being a capsule doesn't mean it's like acid to be absorbed. So it also has the fewest ingredients. It has gelatine and water. So sometimes your kid would tell it and then you could take 2% terrorism is usually not covered by insurance companies unless You failed legal thyroxin or if you have gut issues that don't allow you to make enough stomach acid. So my patients with celiac disease, I put them on Terra sent my patients with autoimmune gastritis. When they don't have enough stomach acid, I put them on terrorism's. Even if you're taking one of those personal pump inhibitors, my personal pride looks like one of those does actually block your stomach acid. Terrorism, this is the way to go. Otherwise, your your absorption is too erratic. I'm going to say that I have even patients who if I can get to rescind approve, they'll feel a ton better and terrorism that they felt only will thyroxin perhaps because of the absorption difference, perhaps because I don't have as many fillers. Okay.

Scott Benner 1:20:40
And what about just the taking of the medication? Because it's me, we talked about a lot of like, down deep idea saying this is a really basic one. But I see people ask all the time, does it need to be the same time of day should absolutely be without food? How long before? If so, all that stuff.

Adi Benito, M.D. 1:20:57
Okay, so the ideal is I do take them around the same time every day around, so morning, afternoon or evening. Ideally, the thought is that you take it about 30 minutes before breakfast. And that's because if you have food with it is going to decrease the absorption a little bit. There's a recent study where they looked at whether you took your thyroid hormone, half an hour before breakfast, an hour before your main meal, or three hours after dinner. Most of those were very similar, the best time was had something before breakfast, then three hours after dinner, and then the one hour before your meal. You know, when I trained, my mentor would say to the patients who were taking thyroid hormone, do whatever you do, get a rhythm will adjust your thyroid hormone, meaning if you take your legal fabrics and your Synthroid with breakfast, what you might mean is that I might need to give you a bit of a higher dose to compensate for your fabric, my being sort of bound to that what you're eating. If you're eating about the same thing, every breakfast, your levels will get you know will even out. If you're eating different things, it might be a difference. So what I usually tell my patients that don't have it with something that has a lot of fiber, if you have a high fiber breakfast, you have a smoothie with a fiber supplement, that's really going to bind your thyroid hormone. Don't do that. Right. So if you're having that type of breakfast, definitely do it half hour before your breakfast. Again, if you miss one pill take to the next day. The things that really are no no, for thyroid hormone, when you take it is any minerals, you cannot take karma with magnesium, or with iron or calcium, they're going to bind your thyroid hormone, they're not going to let it get absorbed. Those have to be separated about three hours, even chromium. Some people take chromium, or you know, it's between type two diabetes, or insulin resistance. So those have to be three hours away from your thyroid hormone so that you have enough time to let the thyroid hormone be absorbed and then put the minerals in the in the gut.

Scott Benner 1:23:02
Can I have it in the morning with my vitamins like or is it just those things you just mentioned? I shouldn't mix them with I get to have it

Adi Benito, M.D. 1:23:09
exactly. Yeah, vitamin B, vitamin B 12, four D, they're gone. You know, I always have people look at the bottle mission, there's nothing else in that. There's no D with calcium, or there's not a b 12 with a prebiotic that is fiber base, you know, something like that? Just take a look at the bottom make sure there's nothing else What about birth control pills, you can take them at the same time. So the effect of the birth control pill on thyroids, not really, because they bind in the stomach, it's actually a binding issue by with the protein. So our bodies make these, what we call thyroid binding globin these are proteins that help you carry the thyroid hormone throughout the blood into itself. So when you take a birth control pill or women take a birth control pill, the thyroid binding globulin goes up. So now you have more of these proteins binding to the thyroid hormone. So let's say that your body is taking a certain amount of fabric hormone, you're gonna if you take a birth control pill, you have no more of those binding proteins, you have less free hormone available to you. Which is why if you were not taking a birth control pill and suddenly you go and control pill, you might need a higher dose of your fabric. Because with the same amount now you're binding more you have less free.

Scott Benner 1:24:21
This is probably a good time to tell you that Oh, Arden might need a blood test in a month then.

Unknown Speaker 1:24:24
Yeah.

Scott Benner 1:24:26
That's what I always tell people they might not affected. But just to make sure give it four to six weeks, take your salary levels, you can even increase mobility because So the one thing that Arden also has, by the way, we joke about it all the time on the podcast, so don't feel weird about this. I know it's kind of a strange intersection because you're helping Arden too. But we always joke that the whole world knows about Arden's soulcycle. But so Arden gets her period too frequently. It'll sometimes come twice in a month or it'll last a long time so long that it feels like the next time It came as twice in a month. So we did just start on Monday with the first day of her cycle of low Lester in the very, very low dose of control pill. And we're treating it the same way as everything else. We're gonna try it and see if it brings or any kind of relief. And if it does great, and if it doesn't, she'll Stop faking it. But yeah,

Adi Benito, M.D. 1:25:18
Lisa will help her iron in it as often or as or as much she will, you know, her iron will stay up a little bit more than, you know, just always been, you know, consumed.

Scott Benner 1:25:28
Right? So, again, we're just we're taking a very small pieces at a time even,

Unknown Speaker 1:25:33
you know, you've

Scott Benner 1:25:34
suggested ardency rheumatologists, which we're, I meant to get back to you actually, it's odd, but it's not as easy as you would think for a younger person.

Unknown Speaker 1:25:42
Like, you know, I'm

Scott Benner 1:25:44
having trouble finding a doctor that wants to help somebody under 18. It's very, very interesting. And, you know, for things like like, this morning, Arden woke up, she's in the middle of her period, she's like, my ankle hurts, my knee hurts, like, you know, can, you just might, but it's not both of her. It's not both of her legs. It's one of them, you know, so you just, it's, I'll tell you, I have to tell you like a side of all the great information that you shared with everybody today that I really want to thank you for the part that nobody can make you ready for? Is that horrible feeling? Like you're not finding the answer? And that every day you're thinking about this stuff? And that not finding the answer is leaving somebody at one or multiple different deficits in their life. And I try really hard because, you know, she's my daughter. I don't know if I would try this hard for myself. I have to be honest. I don't know. I don't know. Yeah, I've got a few more years with her. And it's my goal to set her on the best path possible for when I'm assuming she leaves here, never talk and

Adi Benito, M.D. 1:26:46
just think that with Arlen, you know, because we know that he had this iron deficiency. If she's having her cycles, he's gonna drop iron once she's having her cycle. And that actually, by itself can actually cause her to have some pain. Usually it's more muscle than joint. But I wouldn't put it past that, that it could be an iron deficiency,

Scott Benner 1:27:03
why actually have come to the conclusion now that I've seen my body pick the iron up with the absorbing gas, and I'm going to start her on maybe just once a week, and then twice, and then we'll check her again and see, you know, where she gets to? Because I think there is a way with the supplements, the holder in that range, like, in my mind, tell me if I'm wrong. I'm shooting for that, like 70 range where you said hair growth?

Adi Benito, M.D. 1:27:26
I would? I would and I think I think every single woman who's having cycles should take some iron. Yeah, I really think so. I mean, unless you have an iron issue in your own body, that your body sort of makes too much iron. Right? If you had that been done, but most people don't have that issue. So you're a woman and you're having cycles, you know, have iron. Yes. You know, iron can get absorbed easily every other day. You don't have to take it every day. It also allows your guts not to get so constipated with it if you wish. And yeah, you should vitamin C or something acidic. Something with vitamin C will help you to absorb Valium better.

Scott Benner 1:28:00
Well, I can't thank you enough for doing this. I I have to tell you that the idea of you being on is the most excited. I've seen the people online. And I knew how good you are. So I've been super excited to do it. I've been very worried that I was going to screw this up. But I feel like I did. All right. So

Adi Benito, M.D. 1:28:18
well, everything is great. We answered people's questions. You know, happy to come back if people have more questions or something we didn't touch upon. And somebody had asked about nutritional deficiencies. We'll talk a bit a little bit about that. You know how Yeah, definitely iodine can be you know, it's still the US, is it done sufficient. But also you're vegan and you have no dairy, you could be even deficient. And if you do that you could also be iron deficient in iodine and iron are both really important for thyroid production.

Scott Benner 1:28:48
You know, I was gonna ask you, if you could pick a style of eating, and you have thyroid disease? Is there one that lends best to it?

Adi Benito, M.D. 1:28:57
You know, it's interesting people have actually look abroad. There's a lot of talk about paleo, as well as autoimmune paleo. Not many studies, there's actually one study was done many years ago using palya for people who have high TSH, and the teachers got better. Now, I don't know those people actually have thyroid disease, or they will just inflamed because inflammation can also cause a high TSH. So how do you know if you take away a lot of your pastas and your processed foods, you're gonna lower the inflammation. To me, it makes sense that you decide for yourself what I will call an anti inflammatory diet. So one when you have lots of vegetables, lots of different colors of the rainbow, mostly because that in addition to being anti inflammatory, and each color giving you a different anti inflammatory compound, they also help you make good gut flora and have good gut flora is less like you have leaky gut. In addition to the rest of us, you can use you know healthy protein, whatever that protein is for you. But there is Fish, maybe a little bit chicken, maybe your grass fed beef. And then nuts, seats, healthy oils, avocados, things that are very rich in this polyunsaturated fats. So the healthy fats if you wish, that's also beneficial for us. So it then you figure out what works for you. I think we're all different. And we all have a best way of eating, you know, I don't think burgers and chips and you know, pasta, our way of eating. And so you never eat those, but I don't think it's healthy. Yeah,

Scott Benner 1:30:32
I've been I've just started doing a series where people come on and talk about different ways they've been we've had a person come on talk about carnivore plant based, I just interviewed a flexitarian the other day, which, you know, so I'm trying to, as the podcast has grown, it's grown beyond my expectation. So when I was first doing it, I was like, Look, I'll show people how to use insulin. So they can have lower, like more stable, a one season less variability. And then my, I feel like my responsibility has grown, because I always start with the idea. Like, I'm a very, I guess this makes me a capitalist in some way. But But, but the way I think about it is, is there's probably a better way for people to do things. But I don't have the power to influence that. So at its core, I want them to know how to use insulin. So if they decide to eat a cupcake, they can use insulin, if they want to be a vegan, they know how to use their insulin, if they want to eat a carnivore diet, they understand that protein breaks down and gets picked up as glucose and they'll need insulin for that. And so as it's been growing, I was like, wow, I I start feeling that responsibility of like, now I've told them they can do this. Now I should, you know, illuminate other ideas. So, and thyroids been one for a while, the way thyroid is talked about is kind of criminal. It seriously is like the the lack of understanding that most people or physicians have. It breaks my heart. So I'm thrilled you did this. I want to ask one last question before I let you go, and I will end up I will take you up on it and have you back someday for a follow up. But how do I find the you where I live? Do you know what I mean? Like I know it's easy to say like, Well, no, but but that's not that easy, isn't it?

Unknown Speaker 1:32:19
No, no.

Adi Benito, M.D. 1:32:23
You know, and I don't, you know, I don't think that you need to find somebody who will tell you about Selenium or vitamin D or you know, vitamin it's really quite common, but or inositol or ashwagandha. It's not really what you I think the most important part of your journey is it's not really the supplements, I think it's having somebody who will listen, and who you like you said, even with your thyroid levels, not looking off, that will be willing to explore, and we're willing to look outside the box, and we'll take the journey with you. I think that's what we all want is to have somebody who's our partner, who is not just somebody who has knowledge, but who also is willing to partner with us and trying to figure out what's what's going on. I think I'm looking for somebody who's more compassionate, and is going to be word of mouth is going to be between the people either within the podcast or outside of the podcast, just knowing what doctors both listen to, and sit down with you for an extra five minutes even just to to get to know you and to get to know what is not right. And how can they help you.

Scott Benner 1:33:21
That's to tell you I watching you work, I have this tiny bit of connection with how the podcast makes me feel because I know right now that I could gather up 10 people who are having no success with their blood sugars, and I can fix it. Like I know how I know how to like, I know how to explain it to them. I know how to put them on the right path. I know how to get them going in the right way. But I only have so much time. And so I use the podcast to try to reach more people and it's you know, I think that somebody who has such good has so much good knowledge the way you do, you must run into that too. Just the idea of like you could talk to people all day, but really At what point do you have a life as well? And and how do you help more people?

Adi Benito, M.D. 1:34:01
You know, people with type one diabetes are really the masters of their own condition of their own, you know, bccp wish. And really many times you will type one diabetes, no word on their doctors. No, my mind and anybody. I think that's very clear.

Scott Benner 1:34:15
Well, I definitely believe that it's easier to ask for forgiveness than permission. That's for sure. And I tell people all the time like I'm like what what are you waiting for? You need more basal insulin, and like Well, I'm gonna wait to see what the doctor says I was like you're looking at it right there. You don't have enough Faisal Islam. You know, you don't ask the doctor before your boss at a meal, but they want to but they want to it's you have so I think that's a great thing to end on. Because I felt like you said something really important that there are doctors out there that may not have your level of understanding. But if you can be a partner in the situation and hopefully something in here leads you to ask the right questions, and to be a little more direct. I think you'll find that most physicians want you to be better. They're not like you know, unless you get one of those old crotchety guys is like this is how I've been Do it forever and you just leave me alone. You know, like, but but if you say to somebody, look, I'd like to test my blood more frequently, every four to six weeks, I want to get an idea of what's really happening here. I don't think anyone's gonna say no, you know, you just have to have the nerve to, to ask and and when people say no, I'm a proponent of why, if somebody says no to me, ask them why because sometimes they don't know why they're saying no, other than that's just how we do it and you've asked something outside of our norm, but that doesn't mean you can't. Anyway, that's the that's what you get. If you listen, I really, really appreciate this. Thank you so much.

Adi Benito, M.D. 1:35:37
It was my pleasure.

Scott Benner 1:35:42
I want to first thank Dr. Benito because she has a thriving practice that's full. She's not looking for new patients. She's not selling a book. She's not out doing anything trying to drum up attention for herself. She was just very willing to spend the last hour and a half sharing what she knows about thyroid with you. I just can't thank her enough. I also want to thank Omni pod Dexcom and touched by type one for being longtime sponsors of the show. Check out that Dexcom G six@dexcom.com Ford slash juice box. Get your free no obligation demo of the Omni pod tubeless insulin pump at my Omni pod.com Ford slash juice box and of course touched by type one. Is it touched by type one org. They're also on Facebook and Instagram.

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