Do you have an underactive thyroid? You’re tired, you’re losing your hair, you can’t lose weight, you have bad moods and feel like crap. They said the bloodwork is all fine, it’s probably just stress. Hashimoto’s Thyroiditis is the most common cause of hypothyroidism or underactive thyroid and the most common autoimmune disease in the world. Unfortunately, it’s often not diagnosed properly and when it is, monitoring or medication are the only options offered.
As a result, many people suffer for months or even years without a diagnosis and those on medication may still feel unwell, unable to live their best life. But this doesn’t have to be the case. If you have an underactive thyroid, there is much you can do yourself to improve your symptoms and live more optimally. Your life should be more than just a matter of surviving day-to-day. Empower yourself so you can start to improve today, wherever you are on your healing journey.
This is The Author Hour Podcast, and I’m your host, Frank Garza. Today, I’m joined by Dr. Amy Gajjar, author of a brand-new book, Slow Butterfly: How Healing Your Thyroid Transforms Everything.
Frank Garza: Amy, welcome to the show.
Amy Gajjar: Hi Frank, thank you for inviting me.
Frank Garza: So to start, I’d just love to hear a little bit about your background and how that led to you writing this book.
Amy Gajjar: I’m from London. I am currently living in Sydney, Australia and I did my medical training at the Imperial College School of Medicine, University of London. During that time, I also did a bachelors in biochemistry. After my graduation, I did a few years of hospital medicine before deciding to embark upon a career in general practice or as a family physician, and I loved what being a family physician was all about.
You know, it was about that continuity of care. You’re getting to know people properly, you know, seeing someone from even, you know, a baby to adulthood and just that relationship that you can develop between doctor and patient. Over the years however, I found myself getting quite stressed and also quite frustrated within the system that I was working in. So, I was working in a system where I was seeing patients every 10 minutes.
You feel like in and out. I was in a particularly busy practice in inner city in London at the time and as well as doing various other types of work all over London, but that model of seeing patients every single 10 minutes, it started to take its toll. It started to feel, I guess, a little bit frustrating because I felt quite rushed, and I didn’t always feel like I was doing enough for patients.
You know, I was often giving out medications, which of course, were appropriate at times, but I also thought that it was just giving medications and sometimes giving the medications to get the side effects of those medications, and the main practice I was working in, being located where it was. There was a complex array of conditions and patients that there was a little ethnic minority, language issues, you know, just complex chronic conditions, addiction, asylum seekers, refugees, and it wasn’t fulfilling in the sense that I didn’t feel I was doing enough for patients that I could.
I had interest in various other things, such as nutrition at that point and I embarked upon little courses in nutrition and CBT and even like, medical acupuncture, and I tried to implement them where I could but even then, working within that busy timeframe, you know, just again, just short appointments. I didn’t feel as if even that was enough.
So, I guess, my interest in various things started there, but over the years, it got to a point where I thought, “You know what? I wonder what it would be like doing medicine in a different place, in a different country.” I’d always had a dream of traveling and working in different countries including Australia, and I’d also had quite a few friends who had done 6 months or 12 months in New Zealand, Australia and other countries and I thought, “Let me just try, let me just give it a go.”
It wasn’t a plan to immigrate or anything. So, I decided to come to Sydney, Australia and it was during my first year working as a family physician here, I came across this conference in nutritional medicine and I thought, “Wow, this is fantastic, this sounds amazing.” So, I went along to it and I loved the whole conference over the weekend and I spoke to other people who were doing some further training within this organization who had organized this conference.
So, this organization was called, ACNEM which is the Australasian College of Nutritional and Environmental Medicine and I found out that they had, you know, all sorts of further training that you do. So, I embarked upon their fellowship program and you know, I did their primary course, which is just, again, it was over a few days and it was really taking a look at the relevance of nutritional and environmental medicine in different aspects of medicine in pediatrics, women’s health, child, et cetera.
I was just like, “Well, why didn’t we learn this in medical school?” and I carried on and completed the fellowship. I also did some further training with ASLM which is the Australasian Lifestyle Medicine Association, and I also did training and attended conferences in the States with the Institute of Functional Medicine.
So even though the interest started in London, it really began to manifest when I came to Sydney and it has really transformed me as a person but also the way I practice medicine and it’s very different to how I used to work before, and I now love what I do. I’m passionate about what I do.
Frank Garza: So, you’ve written this book now about hypothyroidism and Hashimoto’s Thyroiditis. What led to you getting interested in that and writing a book like this?
Amy Gajjar: For me, it was the sheer numbers of patients that I began to see over time with similar issues. So, there were people presenting with common hypothyroidism symptoms of which there are many but the common ones are fatigue, brain fog, you know, gut issues, including constipation and in some cases, in many cases, people had already seen their GPs, their doctors, and had labs run but everything was normal.
Yet, they continue to still feel unwell, and you know, it was a curiosity as to why, what’s going on here. Then there was also a cohort of patients where they had been diagnosed with hypothyroidism or Hashimoto’s Thyroiditis, which is the autoimmune version which is actually the most common type of hypothyroidism. They’d been either been put on medication, which is generally Thyroxine or T4 or they’d been told, “Well, it’s not too bad, let’s just monitor and basically until it gets worse, then we’ll do something about it.”
So there were lots of patients in these categories, and it was a curiosity as to what is going on and so as I was embarking upon my training in functional medicine, it all slowly began to make sense because I was learning a lot more about biochemistry and physiology around the thyroid gland and you know, just all the related processes and thinking, “I didn’t learn this in medical school. I’m learning this now.”
But it’s then, it all started to make sense, and I was able to put the pieces together and then I was able to implement that in how I treated patients, in terms of being able to request the correct testing, sometimes more comprehensive testing than they may have ever done before but also to be able to interpret the test differently as well, not just looking at what’s in a range but actually looking, what’s optimal and that’s really where it started.
In terms of the writing, I’d always wanted to write. It was always soothing, and I felt quite passionate about, even from when I was at school and you know, over the years I’ve always wanted to write but it was this topic. I thought there needs to be awareness around it because it’s so common and even when I was speaking to friends and colleagues, you know, it was something that they were coming across as well.
So that’s why I decided to write it, also to be able to reach out to more people than I can see one-to-one.
An Overview of the Thyroid
Frank Garza: Great. So, in the first chapter of the book, you get into some of the basics that we need to understand about the thyroid and about these diseases. So, I want to ask you about a few of those. You know, the first one is just the thyroid gland. What’s the big picture overview when you don’t understand about the thyroid gland and how it functions?
Amy Gajjar: The thyroid gland, it’s a small gland in the neck, it’s butterfly shaped, hence the title and hypothyroidism is when it’s underactive. So that’s the most common picture that we tend to see. The thyroid gland has many functions and that’s also why there are so many potential symptoms.
So, the thyroid gland, it regulate cell metabolism. It increases your energy, you know, at the mitochondrial number and function. It helps neurotransmitters, it regulates our temperature. It helps to make proteins, it’s involved in gut function and gut mobility and also is involved in cholesterol metabolism.
So many functions and when things start to go wrong, and generally, as I said, in most cases, it’s underactive, and in most cases of underactive hypothyroidism, it is Hashimoto’s, which is the autoimmune version and the common symptoms that we tend to see is that sluggishness, it’s – imagine everything just slowing down and again, hence, the title of Slow Butterfly.
It’s a generalized slowing down, so there’s low energy, this fatigue, you know, the bowels can be slowed down and sometimes constipation may be the only symptom in someone who’s got hypothyroidism, but it may also be IBS and bloating and reflux. Women, especially, often complain of weight issues so they’re trying to do the right thing.
They got the right diet, they’re exercising but they’re still not shifting weight or you know, they’re putting weight on despite doing the right things. It may also be, you know, just brain fog and poor memory and forgetfulness. They’re just feeling not as sharp as they used to.
They may also be anxiety and depression as well and this is also really important one in the sense that somebody that probably also gets missed as well, there’s been no mental health. It’s on the increase and many people with anxiety and depression, they may also have other conditions, and it’s important to screen for that and vice-versa because the thyroid hormones are so important in the upward letting neurotransmitters.
Anxiety and depression you know is something that needs to be looked out for when people are experiencing hypothyroidism. There may also be gynecological issues. So, it is often heavy or painful periods, but it can also be endometriosis as well. There can be breast and ovarian cysts, cardiac symptoms like palpitations, or a low heart rate.
People may sometimes experience cold intolerances, so you know they feel that they just need more layers and clothing compared to other people. There may be hair loss, which is again, another common one with dry skin and dry hair and muscular aches and pains. So, either sometimes for no reason or they’re finding that after doing a gym session, it’s just taking that much longer for their body to recover.
There may also be current infections and poor immunity, so again, people finding that it’s just taking them that much longer to recover from coughs and colds or they are just getting ill quite frequently for no apparent reason.
Frank Garza: So is Hashimoto’s Thyroiditis, is that a type of hypothyroidism or are those two totally different things? Can you clarify what is the difference between those two things?
Amy Gajjar: So Hashimoto’s would be the most common form of hypothyroidism but they are separate in the sense that a hypothyroidism specifically refers to the thyroid gland being underactive. So, some people may have underactive thyroid and it is not Hashimoto’s and that’s a minority. Some people may have Hashimoto’s antibodies showing up on their blood test, but they may not yet have developed an underactive thyroid.
So, it is like a spectrum. So, in the early stages, the antibodies may be positive meaning that immune system activation has started but the thyroid gland is still functioning okay, but over time as that inflammation to the thyroid gland increases, the output of thyroid hormones from the thyroid gland will reduce. So, over time, people can experience hypothyroidism. So, the important thing here in early detection is that if we actually detected early by actually testing for the antibodies, we can say, “Okay. Well, there is something going on here.”
“There’s something triggered to be active, to the immune system, what is going on?” because if we can try and address things earlier on, then we can preserve that thyroid tissue and then also obviously get people feeling better quicker before it comes to the other end of the spectrum where people have not just the Hashimoto’s antibodies, but they’re also now having low output of thyroid hormones and they’re not able to function as well.
So early diagnosis is important and in conventional medicine often even if the antibodies have been done, it’s not always taken seriously and this is a key thing and a key message that I think it is important to do the appropriate testing, interpret them correctly, so that we can actually prevent and improve things at a much earlier stage rather than the thyroid gland becoming underactive and so inflamed that the symptoms manifest then, and at that stage, people may well need medication. So, it is a case of trying to diagnose it early and manage the symptoms earlier on.
Frank Garza: Okay, you spend a good part of the remainder of the book talking about different areas of your life and how that can impact people that have these conditions and how you can make some improvements in those areas and the first one is sleep. Why is sleep so important for people who have these conditions?
Amy Gajjar: Sleep is critical. Sleep is the elixir of life and I love the quote by Professor Mathew Walker based at Berkeley who says sleep is the tide that raises all the other health boats. It is an interesting one, sleep, because it is something that we all take for granted and it is important for not just Hashimoto’s but for everyone. You know, there is a reason why one third of our lives is meant to be for sleeping and so much happens when we sleep.
You know this hormonal balancing that happens, the detoxification that happens, you know in the same way that we have a lymphatic system in our body for drawing toxins, we have a lymphatic system in the brain that are these micro-channels that open up in certain hours during sleep time that just help the brain drain of toxins. Inflammation gets reduced when we sleep as well.
You know, our cortisol gets broken down, other emotional processing happens when you sleep so it is also so important just for our mental health as well. There’s also specific research on the link between sleep and thyroid issues. So basically, we need sleep for adequate production of thyroid hormones, and we also need thyroid hormones for adequate sleep. So, it can become a vicious circle if one thing is affected.
But because of the importance of sleep and recently so much great research on the importance of sleep, it is often one of the first things that I try to implement whenever I am seeing someone, sometimes even before looking at diet. You know, it is all important, all these aspects of lifestyle are important. They are foundations for good health, but sleep is a really critical one to optimize.
Food and the Thyroid
Frank Garza: Let us talk about food next and you mention how there’s not one diet that will suit everyone with Hashimoto’s, but there are many things that those diets may have in common. What are some of the most common things food-wise that help people?
Amy Gajjar: One of the key things here is not so much the name of the diet; it’s what we put in it, and I think it is also important to focus on what we are putting in and not just what we’re taking out because sometimes if people are presented with a list of foods that they can’t eat, it can get quite overwhelming. So overall, we want a healthy balanced diet. You know, if we think of for example the Mediterranean diet, that’s a general good healthy diet.
You know, fresh foods and vegetables, good sources of protein and eliminating processed foods with additives and preservatives and obviously excess caffeine, sugar, alcohol. In relation to Hashimoto’s specifically, there are some diets that have been shown to be helpful in the research and also anecdotally. For example, eliminating gluten from their diet has been shown to help to reduce the thyroid antibodies.
So again, that is not to say that someone needs to be gluten-free forever, but it can certainly be a really important first step in terms of helping to reduce inflammation and help to repair the gut, which is often compromised here as well in terms of helping to repair leaky gut. There is also what is known as the autoimmune protocol. This is much more strict in terms of it eliminates gluten, dairy, nuts and seeds, legumes, beans, and nightshade vegetables.
So, it is a lot more restrictive and not everyone needs to go there, but if the initial measures aren’t enough and sometimes we trial the autoimmune diet and research has shown that it does improve inflammatory markers as well. Again, it’s short term so ultimately, it’s about finding balance. It’s fine to use a restricted diet in the short term for a specific purpose but in the end, we want a balanced diet until we are getting all the relevant macro and micronutrients.
In particular plant-based foods, you know a whole food plant-based diet has been shown to be very healthy, and if we look at even general populations like the blue zones, who are the people who have been found to sort of lived the longest in the world, you know they predominantly have a whole food, plant-based diet and we know the importance of our gut microbiome and the gut is of particular relevance in Hashimoto’s because there is a gut thyroid access, in terms of we need the thyroid for gut function and vice-versa.
It’s plant foods that feed the gut microbiome, so that’s from vegetables, fruits but also beans, lentils, legumes, nuts, and sage. Obviously, not everyone can tolerate all of those, but the general principle is that we want a wide variety of different foods because that is what creates diversity in our gut microbiome and that’s key to good health.
Frank Garza: Well, writing a book is such a feat, and you’ve said you’ve always wanted to do it and now, you’ve done it so congratulations.
Amy Gajjar: Thank you.
Frank Garza: Before we wrap up, is there anything else about you or the book that you want to make sure our listeners know?
Amy Gajjar: I’m really hoping that this book helps to empower people on their healing journey. So, you know, it is directed towards people who may have those hypothyroid symptoms and you know, feel that they haven’t been listened to when their lab tests are normal. The doctors are saying there is nothing wrong with you, everything is fine. I also want to empower people who have already been diagnosed, have been put on medication but are still not feeling well, as well as those people who have just been told you don’t yet need medication and let’s just monitor.
So, what I want to do through this book is really help to empower people that they can take their health in their own hands. There’s a lot of advice and resources within this book that they can actually start to implement themselves. If I reflect on my own journey, it is about living in alignment and over the years, that’s something that I have strived to do from recognizing that I wasn’t living a balanced optimal life and not doing work that I was enjoying.
You know, it’s been a journey over many years to ultimately get to a point where I enjoy what I do, I love what I do and you know, it is a real one that I’ve had, the education that I’ve had to be able to impart this advice onto others. So yes, I am hoping that this really helps to empower people so they can live their best life and be the best version of themselves.
Frank Garza: Thank you so much, Amy, this has been such a pleasure. The book is called, Slow Butterfly: How Healing Your Thyroid Transforms Everything. Besides checking out the book, where can people find you?
Frank Garza: Thank you, Amy.
Amy Gajjar: Thank you, Frank, for having me.
Frank Garza: Thanks for joining us for this episode of Author Hour. You can find, Slow Butterfly on Amazon. A transcript of this episode as well as all of our previous episodes is available at authorhour.co. For more Author Hour, subscribe to this podcast on your favorite subscription service. Thanks for joining us. We’ll see you next time, same place, different author.