Dr. Bojana Jankovic Weatherly is an award-winning physician, and double board-certified in internal and integrative medicine. After completing an internal medicine residency, she did a fellowship in integrative medicine, trained in functional medicine, nutrition, and mindfulness. Her approach is rooted in evidence-based medicine that is personalized to each individual she works with. She partners with her patients to discover and address the root causes of their conditions and develops individualized plans to support and empower each individual to achieve her or his health goals. She has a specific passion for working with women who have various thyroid conditions, and in this episode, Dr. Bojana gives us a fascinating and insightful Thyroid 101 lesson.
Dr. Bojana Jankovic Weatherly is an award-winning physician, and double board-certified in internal and integrative medicine. After completing an internal medicine residency, she did a fellowship in integrative medicine, trained in functional medicine, nutrition, and mindfulness. Her approach is rooted in evidence-based medicine that is personalized to each individual she works with. She partners with her patients to discover and address the root causes of their conditions and develops individualized plans to support and empower each individual to achieve her or his health goals. She has a specific passion for working with women who have various thyroid conditions, and in this episode, Dr. Bojana gives us a fascinating and insightful Thyroid 101 lesson.
spk_0: 0:13
Hi, everyone. We're arena and era and welcome to Fertility. Ford were part of the wellness team at Army of New York, a fertility clinic affiliated with Mount Sinai Hospital in New York City. Are Fertility for a podcast? Brings together advice for medical professionals, mental health specialists, wellness experts and patients because knowledge is power and you are your own best advocate.
spk_1: 0:36
Dr Boy on a Yankovic, Weatherly is an award winning physician double board certified in internal and integrative medicine. She completed medical school master of science and bachelor of science degrees at the University of British Columbia in Vancouver, Canada. She then completed her internal medicine residency at Cedars Sinai Medical Center in West L. A. Veterans Affairs in Los Angeles. Ah, lifelong learner, she completed a fellowship and integrative medicine established by Dr Andrew Weil at the University of Arizona and continues to train and functional medicine. Her approach is rooted in evidence based medicine that is personalized to each individual she works with throughout her academic career. Doctor Boy on and perform research in endocrinology and oncology, has published papers and peer review journals and has presented her work at various academic conferences. She partners with her patients who discovered address the root causes of their conditions and develops individualized plans to support and empower each unique individual to achieve her or his health goals. She's a specific passion and working with women who have very Styria conditions. On today's episode, we discuss how the thyroid, other immune conditions and stress can all impact fertility. We also discussed the signs and symptoms to look for regarding potential thyroid issues and also address the importance of a thorough panel to help a physician see the whole picture regarding the thyroid. I am over the moon toe Have my dear friend on today, Dr Biljana Yankovic Weatherly. She's a friend of mine from school. We were matched up together as buddies when she moved from California to New York. She is born in Serbia. The G grew up in Canada. Hopefully I'm not rooting this, but I'm so excited today. The have you on to speak about the thyroid?
spk_2: 2:30
I'm so excited to be here. Thank you so much for having us. And I'm so glad that they paired us up his buddies. Now, a little over two years ago when we moved here and happy that our paths there not only crossing personally, but also professionally. And this is such an important topic, and so happy to be here to talk about it,
spk_1: 2:51
so happy to have you. So you are a internist, and what else do you dio?
spk_2: 2:58
So I went to medical school in Canada and went on Teoh do my internal medicine residency training. By the time I already moved to Los Angeles at Cedar Sinai and then after practicing medicine as a primary care physician, I just realized over time that I wanted to find ways to bring more value to my patients in the way of lifestyle transformation and helping to provide guidance in terms of nutrition and stress management and sleep. Because these are all areas that are so important when it comes to not only chronic disease but just overall in health, optimization and living our best lives. And I was finding that often times I would be seeing nations for chronic fatigue, depression, anxiety, other chronic gut symptoms or auto immunity, and they were just not improving, and conventional medicine had reached the peak of what it was able to provide. So I really went on this path toe, learn what else is there? What else has been studied and practiced? And so this is how I discovered integrative medicine, which I then went on to do a fellowship in at University of Arizona at a program that was started by Dr Andrew Weil, who was the pioneer and integrative medicine and then went on to get board certified and and went on to study functional medicine and mindfulness based stress reduction and all these wonderful, wonderful modalities. So now what I do is I incorporate all of these different modalities into visits with my patients and into the customized plans that I create for my patients.
spk_0: 4:43
Well, you sound like my dream, doctor.
spk_2: 4:45
Thank you. Accept Sparta
spk_1: 4:47
actually connects everything together to learn the stem. The reason why the root cause off a certain conditions. So not just treating, but also looking at where could have come from. Was it stress related? Is it related to something else and not necessarily going straight for that? The medical route?
spk_2: 5:08
Absolutely. And you know, I was really shocked on the one hand. Shopped, on the other hand, not so surprised by the statistic that 75 to 90% of medical visits are, in one way or another related to stress. So when you're talking about that root cause, that is an area that we always have to address. How much is this currently impacting? What's going on with our symptoms? How are we gonna manage that stress to to deal with the symptoms? Because again, a lot of chronic conditions such as chronic pain as well as other auto immune conditions as well as conditions of, you know, one of the things that were going to be discussing the thyroid in the context of fertility again, all of these things cause a significant amount of stress burden. And we can always improve and learn on how do we cope? How do we be our best cells despite these things that are going on? And how do we make the best out of any situation but also be mindful of how stress is affecting those conditions
spk_0: 6:13
and symptoms for? I mean, that's what I think that comes up a lot of my work with patients, you know, different mental health perspective. How much of a role distress play they all ask. Well, then a procedure not work because I was stressed. So I guess from your perspective, what would you say to that? I
spk_2: 6:29
was just about when you said that I was just about to ask you. I'm so curious what you say. I mean, that's a great and I get that question a lot when it comes to other physical symptoms that people may have. So I don't think there could be a clear cut answer of yes or no. And I think that certainly stress is not to blame for everything there needs to be. You know, there's this concept of the AL a static load that I often like to refer to. What and that refers to How much can we take before something breaks down? Right. So this al a static load may refer to our environment maybe the processed or junk food that we're consuming the unhealthy relationships that were engaging in the toxic work environment or whatever that might be. And as you again increase that burden off, not really just stress in the in the kind of form that we usually refer to stress. But if you consider toxins that we're adjusting our body a stress we can kind of reach reach this peak, and I think it's that cumulative effect. So So the way that I usually talk to my patients about it is that I often start with, you know, what do you think? Because I think that we are all our best as Muchas physicians and dieticians and therapists. We all have our areas of expertise and areas that we study and we're up to date on our evidence on and that we have clinical experience with. However, the patient is the expert in there condition, and they are really the only ones that truly know. Okay, well, how is stress really impacting me? What do I feel when I feel stressed out and my constantly having palpitations and waking up in the middle of the night? And is my digestion off when I get really stressed out? So oftentimes I'll start by asking the patient to gain more insight if I haven't yet into how much stress plays a role, and then we discuss that it's one piece of the puzzle, and again, in some people it's more and others it's less. But I often here and again, this is really very anecdotal because fertility per se is not my area of expertise, so not all of my patients are struggling with fertility. But I often have heard anecdotally that just when a couple gives up is when it actually happens. And I wonder how often you guys see that in practice because it's something that you see all the time. And I wonder if again there is sort of something that just happens energetically or with our nervous system, or how it effects are Seidel kinds, which are, you know, inflammatory signals and so on.
spk_0: 9:15
Sure, I mean, I definitely a lot of my practice units, those patients who they first started out there doing kind of everything they can to control the process, you know, visit there, eating a start, being very regimented there. I mean, the pineapple core which is, you know, fertility. They're exercising in a certain way. They're trying to get, you know, a specific amount of sleep, and then after a while they're not getting the results they want, they screw it. I'm gonna go mini pizza. I'm going. Teoh, do what I want. I'm gonna relax a little bit and right. That's when they then come back and they say Oh, my test was positive, and I say I knew it because I see it happened a lot,
spk_1: 9:52
right? Vacation. That's when I often see success. My patients is when they we could see that there really busy at work. And it's not that a acute stresses that chronic long term stress from work from home life from trying to get pregnant. And then when they go on vacation, which I always try to encourage, it doesn't have to be somewhere far or expensive. But just taking that time, whether it's for themselves or with their partner or with a close family friend that's often with it, is more likely to happen. Or at least what I see. Because you, whether they're not thinking about it all day long,
spk_2: 10:25
right? Right. I think that completely makes sense. You know, we let her guard down, and and interestingly, now that you mention that vacation concept, I often that's that's kind of again one of those questions that I ask and I often will hear. Well, my gut symptoms got better when I was on vacation, so we clearly know Okay, well, let's look it but your life. Let's look at your day today. Yeah, and
spk_1: 10:49
I'm sure, besides the stress, it also connects with sleep, which I know you. We've spoken a lot about how sleep also can play a role in elevating stress, elevating certain hormones and hunger hormones as well.
spk_2: 11:02
Exactly. Yeah, in just changing the elected and growing hormones that are involved in in our satiety and hunger and also in terms of affecting our immune system, you know, And I think, and then our cognitive performance memory. I mean, I think sleep is the number one. I always tell my patients if they're if we're working on kind of looking at optimizing lifestyle and optimizing habits that are going to get them to certain health results, Sleep is always my number one Meditation is important. Very, very, very important. If they're going to start with one thing, it's sleep because when you get a great night of sleep, you're gonna make better decisions about your food, about how you spend your time about how efficient you are at work with your relationships, you're gonna be more present. You're gonna show up, you're gonna process stress better. So I always say, Start with sleep, and then we'll do everything else. If that's if sleep habits to be a problem area, I
spk_1: 11:59
often say that to you could eat all the great food in the world. But if you're not getting great, sleep your food hope flow. Your food may not be digesting properly your hormones, the hormones that you don't want to be elevated, maybe elevated or just be in non balance, right? Exactly. Yeah.
spk_0: 12:15
So what would you say is an optimal man asleep?
spk_2: 12:18
So I person, I think that for each individual it varies. I think that generally, if you know people are in the ballpark of eight hours, I think that's great. There's some studies on the immune system, so looking at, they actually believe it or not that these studies where they would inoculate people with the virus with a respiratory virus and just put it in their nasal passages and then they would quarantine these people and see whether there was a correlation between the number of hours of sleep and who presented with clinical symptoms of an upper respiratory infection because they were literally just infected and they found that people who slept more than seven hours did a lot better. So had a lot less symptoms than people who slept less than five hours. So their studies like that where we can look at for specific distinctions. I think it's all up grayscale. But in general I would say eight hours is great again. If somebody's needing 10 hours asleep and they're still waking up tired, then I start to think, Okay, well, what else is going on? Is there obstructive sleep apnea? Is there something else going on some other type of sleeping disorder? Thyroid issues? And that's when I start to kind of worry that a little too much.
spk_1: 13:28
Yeah, so that's a great said weight into it. I know blander. You're very passionate. You are so knowledge ball in terms of speaking about thyroid conditions, and it's really a complex system. Very complex. I know The thyroid gland is connected to a lot of different things. In our body comes metabolism is going to the listeners a basic 101 about the thyroid. Sure.
spk_2: 13:55
Eso fire. It is one of my favorite Perkins on land. It's a gland. The gland. Yeah, so yeah, I guess we should maybe back that up. So that rate is my favorite gland, and it's, Ah, butterfly shaped gland in the base of our neck. And it's really special because it produces thyroid hormones, which are implicated in a number of different processes in our body. So the thyroid hormones regulate in part or heart rate. They also regulate our digestive system. They regulate our skin, even our hair and off course. They also are implicated in our energy levels, right? We know that people who have an under active thyroid gland, they tend to be very tired, and it's usually one of the first presenting symptoms off hypothyroidism. Hypothyroidism, meaning underactive thyroid. One of the first presenting symptoms is fatigue. But before we get into the different there were disorders. Let's just talk a little bit more about thyroid hormones, so the thyroid gland is the only gland. The only part of our body that will actually take up I it on, and why iodine is important is because iodine is a building block. It's part of the thyroid hormones that the thyroid gland produces, so the thyroid gland, what it does is it puts tyrosine amino acid together with four different iodine atoms to create Ah third hormone, called T four. And then there's another, more active kind of thyroid hormone called T three that has again that same tyrosine amino acid linked with three iodine Adams. So very easy. Three I nines, You've got a T 34 I don't. You have a T four and those were the two, the two major t for being the predominant type of hormone that thyroid gland produces. Now what happens? I mentioned that DeForest the dominant one, but then the T three is more active. So what happens there? Well, what happens is the T four then travels through our body and it gets converted to the more active 43 which then acts on and organs. So whether that be or gut or hard or whatnot, that conversion t four to t three happens in the liver. It happens in the gut. It happens in several different parts of our body. That conversion is really important. For the most part, it should be very, very tightly regulated and really be regulated in such a wayto to kind of help us optimally function. However, when we're dealing with nutrient deficiencies, when we're dealing with extreme stressors with extreme calorie deprivation, week and run into problems in converting that t four into the active form T three. Now the other really important point is in. And again, I really don't like to make the distinction because I practice both the integrative and the conventional medicine. But previously when I was only doing conventional medicine, I would Onley truck for TSH that I read stimulating hormone which is the gold standard of how we measure thyroid function. And if that was abnormal, then we would check the 54 hormone I now tend to, especially if patients are persistently symptomatic and we can talk a little bit more about the symptoms. I tend to do a full thyroid hormone panel because oftentimes the subtleties like this conversion t four to t three. There can be blockages in that way and oftentimes we don't obviously recognize them. If we don't check so
spk_1: 17:34
betters in check to ask for a full panel. When you say full panel to a doctor to endocrinologist and you do you track them or is it something that endocrinologist checks are both
spk_2: 17:45
Great question. Yes, So I check, then endocrinologists check them and I would say general internal medicine doctors as well as primary care physicians to maybe family medicine also would check them. But the standard of care is really only to check the TSH that I would stimulating
spk_1: 18:02
Mila mode a minimum. Did that made it. So you can take an active approach. And if you feel like your thyroid is other underactive or overactive toe, ask for a full panel.
spk_2: 18:13
Exactly. So what I generally would I would recommend you know, the cases in what you really want to kind of ask your health care provider, you know, is when when you're still having significant symptoms. So let's say so. We can kind of dive into the Hypo Thyroid symptoms, so this means underactive thyroid symptoms. These would include, as I mentioned, fatigue either weight gain or inability to lose weight, despite various strategies that normally would be effective. Also, oftentimes, people feel that there is the cognitive slowing. Their memory isn't quite there. They might also notice mood changes. They might be depressed. They may find that they need to sleep more and again, or just not feeling restored or just not having the energy. They also may find that their skin is dry. They may experience hair loss. They might also experience constipation, so these are some of their heart rate may slow down. So these are some of the symptoms that I would say if these symptoms air persistent and that TSH value, which is a screening test which may be perfectly adequate for somebody who is not having these symptoms. But if you're having these persistent symptoms and then especially I would see infertility, it's very, very important toe. Have the whole panel tracked. Then I would say, Ask your health care provider, Can we check my thyroid hormones as well to get the complete picture off what is going on in my body? And there's
spk_1: 19:45
also a free T four and free teeth. It's so you know, I'm a dietitian, not is medical, and I went into an event once with Giuliana teaching. Ask more about the thyroid and it's a very complex system, But it's interesting if one things out of whack, something else usually takes over. And that's when sometimes those symptoms can manifest
spk_2: 20:07
absolutely. And then the other thing that we were talking about stress and how that can affect the thyroid Well, stress hormones can actually effect that ts age the thyroid stimulating hormone, which I didn't mention before. But this is produced by the pituitary gland, which then signals to the thyroid gland. Make thyroid hormone makes thyroid hormone. So TSA just kind of like this signal that tells us, how strongly do we have to stimulate the thyroid gland toe to squeeze out to produce and squeeze out more thyroid hormone? So DS ages within the normal level? Generally it means that there are no and this is why it's the gold standard tests. Generally, it means that there's no disorder, no thyroid disorder, because downstream everything is very tightly regulated except in extreme stress, calorie deprivation, infections and nutritional deficiencies. Where we may see that again, that regulation isn't optimal because of those stressors that I mentioned and then off course, with the stress hormones affecting the TSH. There it stimulating hormone. You can imagine that that signal to the thyroid isn't sufficiently saying okay May thyroid hormone so we can affect the rhythm production. But it can also stress hormones can also affect the reform on conversion from T four to t three. So it's all, and unfortunately, we don't have a visual here But there are. If you imagine in your head there are all these feedback loops, you know, going into the thyroid, then going to the thyroid hormones, because again where Bond tries to do it, it tries to stay in a state of home. You stay says, or a state of balance. So all of these systems are far more intelligently designed than what we could ever come up with at least now in terms of fine tuning our bodies already doing that for us. But when we have something externally that throws the system out of balance, that's really agreed. Opportunity toe intervene.
spk_1: 22:09
And there's different types also of Hypo Thyroid. There's ones that could be, I believe, genetic and then ones that are auto immune.
spk_2: 22:17
So the auto it means of the most common type of hypothyroidism is Hashimoto's married itis, which is an autoimmune process. And it's characterized by and again. We don't routinely biopsy people's thyroid glands to prove that they have Hashimoto's or autoimmune thyroid itis. But if we were to do that, it's characterized by white blood cells infiltrating or going into the thyroid gland, and so we see that there's an attack so to speak on the actual thyroid gland. And because of this attack on the thyroid gland, we see that over time when there is this auto immune attack over time, many individuals will then develop what's clinical hypo thyroid ism or underactive thyroid? Because if you imagine if you're attacking and killing the thyroid gland, eventually you're going to deplete and diminish, really, its ability to produce enough thyroid hormone for the normal body function. So autoimmune thyroid itis is in part genetic. But there is also an environmental component, and this is an area that has been studied. But I think that there's still so much opportunity and much need for research. The auto immune thyroid notice, interestingly, has also been linked. Teoh various infections such as the Epstein Barr virus infection, other viral infections, parasite infections. So there are a lot of case reports and their studies coming out, but again, it's oftentimes difficult to pinpoint and say, Well, this one particular thing caused it. Oftentimes it's we see it running and families so often times I'll have patients say, Well, my mom had this, and my grandma had it so often times there is definitely a genetic component. But then there's also something else, or a number of other things that are environmental triggers.
spk_1: 24:10
So they may have the gene, but it may not be turned on, and, you know, until there's some sort of whether stress or an environmental factor that can actually trigger it. Exactly an issue exactly,
spk_0: 24:23
yes and Hashimoto's work and play a role in for toe
spk_2: 24:26
right? Absolutely so with Hashimoto's the one of the elements that I didn't mention in terms of presenting symptoms. It can definitely play a role in cycles, so we definitely can see that when in cycles will change with either hypo or hyperthyroidism. And they may have heavier cycles in Hashimoto's. But it'll also affect thyroid conditions will also affect population.
spk_1: 24:49
And that's what I I see. That was a lot of my patients that have population issues, and they're coming in. Presenting with Hashimoto's or even Grave's disease, which is the overactive
spk_2: 24:59
exactly. Graves is the overactive so with Hashimoto's. Typically, I told you what we don't do, but I didn't see what we do do, so we don't dig biopsies of thyroids, but we check for antibodies that are very sensitive upwards of 80 to 90% sensitive for Hashimoto's. So, typically, the antibodies checked our TVO antibody and IRA globulin antibody, and one or both may be positive, and it is very likely to be positive in individuals with Hashimoto's thyroid itis. Now, with graves, it's the opposite end of the spectrum. It's when people have antibodies called the thyroid stimulating immuno globulin that stimulate the thyroid so it's still an antibody and still an auto immune mediated process. But it goes in the other direction because it stimulates the thyroid gland to release more, more thyroid hormone. And this is where we see symptoms to be the opposite of what I just said for underactive thyroid reading. Exactly the sweating. And if you've ever seen a patient who was just about to get radioactive iodine ablation or pre treatment, you'll often see that they're shaking their very excited, very sweaty. Their heart rate makes meaner. That's actually because it's in the 1 21 thirties. They're hungry all the time, yet losing weight and having more frequent bowel movements. And so their presentation is the opposite of that. But that's definitely and bacon, and against you know, the way that it impacts our mental health. Is that so? While people was had both thyroid ism, me tend towards depression, people with hyperthyroidism actually may tend towards mania. So the other end of the spectrum And so and this is one of the reasons to me why, if I read, is so fast, the meeting is that it affect all these different systems that we think are unrelated. But yet it is kind of all. It really kind of helps are the different body systems kind of orchestrates them. It's like this beautiful symphony when everything is going right with the thyroid hormones and when not there are many different areas to go that are just completely out of order.
spk_1: 27:07
So I know with my patients a lot of them who Hashimoto's or grace there typically put on a medication particle, Synthroid or perhaps another type of protocol. But in terms of other areas that they can naturally, I know what I do. But it is a bland. I'm sure you have a specific protocol in the nonmedical Rome.
spk_2: 27:29
Yeah, that's a great question. So again, another area of it really warrants further study and investigation. So a lot of practitioners in the functional medicine world. You know, when we talk about different nutritional protocols, we often talk about different types of elimination diets with the goal off, removing any possible toxins or any possible triggers to auto immunity. And part of this just to back up a little bit, is is really the concept that a lot of the kind of one of the leading factors in why auto immunity develops besides the genetic predisposition, which is absolutely there is the whole got connection. So when we think about God, of course we think about nutrition and what we're ingesting. But we also think about that interface between the inside of our got the inside of her intestine. And then how does that communicate Teoh to the rest of our body? And so what happens is normally are got lining is such that we should have a very tight seal that is very selective in terms of what goes from the gut into the bloodstream and versus what doesn't pass through. And this seal is kept by something called tight junctions that really bind the cells of the gut lining together. What happens is when and again this could be due to a number of different reasons. Infections, stress, small intestinal bacterial overgrowth, toxins that we're investing in our body and poor diet. All of these things over use of antibiotics sometimes as well, that white powder normal gut flora. What can happen is these tight junctions start to not be so effective anymore, doing their jobs. So we're getting a lot of talks in exposure. Felt like he got a leaky got exactly So this intestinal permeability or leaky God concept. So we're getting a lot of the stocks and exposure, and then our got associate ID immune system starts to react to it and starts to be inflamed as a result. And so this is why a lot of the times and this is why I think in particular, it's so important to do for the research on how infections, especially got infections, are connected with auto immune disorders. Because we do see that oftentimes, that linkage between a gut infection that triggered the autoimmune disorder. And again, it's all about that Allah static load. If you have enough insults and finally reached that peak of what you're able to withstand, you will see clinical disease or you're going to see something breakdown. So let's say it's the infection. That kind of just tips, though. The scale the other way. Well, oftentimes, when the infection is healed, we see that the auto immunity also tends to call him down. So you know this is what's important to the attention of the God and therefore pay attention to nutrition to them. Calm down the inflammatory process, which, and then at the very least, hopefully stabilize the process.
spk_1: 30:28
But isn't it true? Also in terms of sorry for interrupting in terms of autumn unity? Usually, if you have underactive, are overactive thyroid, which is auto immune, you know, something like celiac disease or also being autoimmune issue. And so that could be potentially connected.
spk_2: 30:46
Absolutely. I'm glad you mentioned that it is actually connected that yeah, so bad He said it. So it is so Celia Disease is definitely connected with autoimmune thyroid Addis, and actually they're. Some of the guidelines actually say that in every individual that is diagnosed with autoimmune thyroid Ettus, they should be screened for celiac disease. Even though steelier disease is only about 1% of the total population, it is more prevalent in individuals with autoimmune thyroid itis, And that is definitely something that with the auto immunity and if somebody is actively interesting gluten, if they don't know they have celiac. Or maybe they're having a hard time sticking to a gluten free diet there, absolutely causing damage to those intestinal veil id Teoh and making it more difficult to absorb nutrients. And so, yes, there is absolutely that link it,
spk_1: 31:31
or even a gluten intolerant if it's not necessarily a defined celiac. But if they're more sensitive to gluten, So that's often I know I talked to my patients about trying to minimize or even possibly tryingto eliminate and see how they feel.
spk_2: 31:48
Definitely. And we're seeing gluten sensitivity more and more. And I think that, and I mean it's it's really kind of an interesting topic on its own. I'll just share very briefly from research that I've reviewed and from other leading physicians and experts in the functional medicine space, kind of what the bullet points are so with gluten. So there's several factors that are thought to contribute to this increase in gluten intolerance. One of them is just the way that gluten containing crops are now and the way that they're hybridized to contain more Gilead and protein than before. The way that food that containing gluten such as pasta and bread, the way that it's prepared now compared to how it used to be before or even how it's still prepared In Europe, usually, yeast is used in the process of making bread and pasta, and or maybe just in making bread like over. So usually yeast is used in the process of making bread. And so just to give you an example, typically the cease would be kept overnight so that it can start digesting some of these glia and proteins. However, now we're speeding up that process. And again, the gluten that were exposed to is so, so different from what it used to be. Not to mention, if we're consuming a product that's not again excellent work that's sprinkled with a little bit of glyphosate, which is in round up, let's decide we're seeing that that is affecting intestinal permeability, gluten and glyphosate together. So
spk_1: 33:27
it's the combination. The combination get even more detrimental, and also I think we're having a lot more a greater portion of Fred consumption and pasta, especially in America.
spk_2: 33:38
Exactly the sad. The standard American diet is so different from how our ancestors, you stated water body is used. Teoh. And so this is one of the things that initiated this again kind of movement in. Okay, well, what is the ideal autoimmune protocol? And so there is an actual autoimmune protocol that I know. There was a recent study that was done, and I actually listened to a great podcast by Chris Crestor, where he's, ah, leading functional medicine professional. And he interviewed a group that performed a small study on individuals with hushing motors, thyroid itis, where they looked at the impact of the auto immune protocol died. And in the autoimmune protocol, you are eliminating some of the foods that are thought to be inflammatories. So these may include eggs, night shades, seeds, not Steri. Exactly. So So there are a lot of things that are limited, obviously gluten, And so they have found again. It was a small study, and they did find that a subset of patients seems to have gotten better, but they didn't really get as significant results. So again, I think that it's it's still something that we need to actively research and look at the evidence. But would I generally counsel my patients to Dio is, isn't so, in part, with the elimination died. It's really on trial and error process. And with any nutrition plan, it's important to keep in mind that if we're going to restrict somebody's diet and I'm sure you have the same philosophy as well, we shouldn't do that for a long term. You know, the general consensus is that we all should have a colorful diet. It all should be rich and plans and know there are certain subtleties of well is this pro or anti inflammatory. And there's also a lot of conflicting nutrition. Research, in part is based on poor quality, off data collection and of collecting food frequency questionnaires, which we know are not are far from perfect. I mean, if somebody asked me to tell them what I had last week or even on Monday, I don't think that I would reliably tell them So there are great limitations to this research and that in part as well as the population had originated and looking at the different populations. That's why a lot of the times it, it seems, is that we're getting conflicting results. But we all can agree. You know, whether somebody is in the paleo are vegan camp or veto or anything. We all can agree that eating more plants is good for you.
spk_1: 36:11
Yeah, I think its true what you said in terms of not necessarily focusing on the negative of the things that you have to get rid off, right, perhaps flipping it and saying, What are the things that you can and should incorporate? So video admitting some of those potential triggers like the gluten and dairy. But instead of focusing on you can't have that, perhaps focusing on what you can, what
spk_2: 36:32
you can have. Yes, there was a really interesting study done in curry show, where they looked at individuals with autoimmune thyroid itis, and they looked at what these individuals consumed. And they found that people who consumed more vegetables more plant based foods did a lot better in terms of their Sirait antibodies compared to individuals that consumed more dairy.
spk_1: 36:58
So that you see jeez yes, your parents and defended you when you're younger and find fun ways that make them interesting doesn't have to be steamed or raw. You can grill a roast them, I'm sure.
spk_2: 37:11
Exactly. And then just also, like use spices use. I mean, there's so many different ways in which we can prepare, and I find that that often really can be a barrier. But it's one of those things that's that really should be the most important. Because literally, what we're putting in our body is the information that speeding every single cell in our body toe communicate to what are we in a safe place? Are we anti inflammatory? Are we increasing and promoting inflammation and disease?
spk_1: 37:41
E feeling So the patients that I work but they tend to be quite stress coming in. What do I do? Which I not Teoh on? I think you actually said it best at the beginning. You mentioned that you should listen to your your own body. You know yourself more than anyone else. Yes. And if something doesn't feel right, stop eating it or try something else.
spk_2: 38:02
Absolutely, yes. And a couple of new trains specifically that I wanted to touch on. I mean, there are a number of different nutrients that affect the thyroid gland thyroid function, and I actually wrote an article talking about more than what I'm gonna mention now, but just briefly about iodine. So we know that I mentioned that I dine is the building block of these thyroid hormones, right? So we definitely want to make sure that we're ingesting enough iodine at the same time I dine. Excess can also cause more problems and more thyroid auto immunity, on the other hand, so it's really important to either have your iodine levels tracked. If you suspect that you may not be consuming enough iodine a lot of the times now, I mean, we're getting it from iodide assaults from consuming C. Wade it really? But it is in the guidelines that 150 micrograms of ID and should be part of every prenatal vitamin formula. But I think that it doesn't hurt to check levels if you suspect that again. If either thyroid function tests are abnormal, or if you suspect that you may be a risk of deficiency and just asking your physician. Another question that I often get and that often comes up is about selenium. So selenium is a great antioxidant. It's it has the potential in individuals who are low in selenium and have autoimmune thyroid itis. It has the ability to lower those thyroid antibodies. But again, if you have enough selenium and you start supplementing, there is a risk of side effects. So much exactly so another thing really important to discuss with your dietician, your physician. Do you need levels tracked? Do you need it supplemented, or can you just have a couple of Brazil nuts and call it a day? Because it excellent source of selenium.
spk_1: 39:48
Also good for men for sperm. So all you need is, I believe, a portion sizes three. So you don't need to be consuming all that much. Every too happy to the high percent. That's it. Yes, exactly. Yeah, that's great. So selenium is important, and I don is important and potentially being mindful of flu and and potentially be mindful of dairy?
spk_2: 40:10
Exactly. Yes. And again, I would say with any nutritional protocol, anything like that. I always advised the people be under the guidance off a health care provider and qualified health care professional, because again we dio by eliminating too many things we do run the risk of nutritional deficiencies. I mean, we all know that we should be eliminating processed foods and sugar and that kind of stuff. But if I think that if anyone listening they feel that, well, you know, I have multiple triggers, definitely talk to someone before changing your diet to make sure that you're still going to get a nutrient dense diet. Even if you try an elimination diet protocol, I think it's so important to do it under professional guidance.
spk_1: 40:52
I agree, and also getting that support. So you're not doing it alone. You're having someone's champion you along the way because it can seem overwhelming. I feel like that's really the fire Glenn with. We just touched upon it, that much more to it. But I appreciate you being here today, Biljana, to give us that little taste. So the way we always end our sessions is asking you what you're grateful for today. So a little bit of gratitude, which I know there's a lot to be grateful for about what are you grateful for at this moment?
spk_2: 41:20
Oh, I love that. I am grateful for the fact that my mom is actually coming to visit today from Serbia under to Canada, and we're expecting her in a couple of hours and actually the kids and I. So she's really big into Halloween and loves all the scary stuff. And although we normally don't do this yesterday we went to the Halloween store and we got all this scary stuff that we decorated the house with. So my kids are going to scare her when she arrives. Todo I have so excited and grateful for that experience today
spk_0: 41:53
is gonna be fun. Oh, no. Well, you know, I'm so grateful to have someone so smart and knowledgeable like you planning to come on it feel like I was just listening and soaking everything. And I think this was fascinating and really Astaire's that really just a taste on the fire. It is a mix of important there.
spk_1: 42:11
I'm grateful for my friendship with Boy Ana. I feel like it was serendipitous that we were connected at school and found out that we have so much in common growing up in Canada being in the health world, and I really, I you were a wealth of information, and it's just so great to be friends with you until learn from you and work in the same environment. So thank you.
spk_2: 42:33
Thank you. It's really been such a pleasure. And I'm so grateful to know you and so happy to have made in today.
spk_1: 42:40
We need to have you back. So yes, thanks. Thank you so much for listening today. And always remember, practice gratitude. Give a little love to someone else and yourself. And remember, you are not alone. Find us on Instagram at fertility. Underscore forward. And if you're looking for more support, visit us at www dot r m a n y dot com and tune in next week for more fertility forward.