Sock Doc 13: Thyroid Health, Part 2 – Hidden Risks, Nutrient Needs, Training Ideas, Self-Care and More

September 10, 2021


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On this episode we have The Sock Doc, Dr. Steve Gangemi, joining us. Steve is a natural health care doctor who founded and practices at Systems Health Care, an integrative wellness center in Chapel Hill, NC. Steve is also a longtime endurance athlete and is a wealth of knowledge for athletes looking to optimize wellness.

In part 2 of this 2-part series we take a deeper dive into thyroid health. If you haven’t already,

Thyroid Recovery Outside the Box

Putting aside medications since we talked about that last episode, from a more holistic and natural perspective what are areas we can look at to help promote healthy thyroid function and/or things to avoid in your environment that have an association with thyroid hormone disruption:

  • Study mention: Environmental Exposures and Autoimmune Thyroid Disease
  • Water quality
    • Safety, water testing and water filtration starting in our homes
    • Water can be a “slow poison” that doesn’t show harmful effects for decades 
    • Everywhere on earth you can now find polyfluoroalkyl substances (PFASs)—even places you may not expect like newborns and breastmilk. Comes from Teflon.
    • The halogens: chlorine, fluorine and bromine compete with iodine and displace it; iodine won’t be available to make thyroid hormones T4 and T3.
    • Drinking clean water is vital but testing isn’t always straight forward.
    • You can find companies that check for pesticides, metals, bacteria, hardness, pH, iron, silica, nickel, etc… and these run about $200-$300.
    • But PFASs tests that run 13+ substances isn’t as cheap usually. Steve used Babcock labs and these tests can be a bit more tricky for personal home testing.
    • Why Steve chose to test the well water at his home right away upon moving in.
    • Not all filters are created equal and won’t filter out everything; different filters work on different substances. So testing is key and find out what you’re dealing with before choosing what kind of filtration system you need. 
    • How to troubleshoot if you find out you’ve been drinking, using, consuming poor-quality water that has some kind of contaminant or so.
    • If drinking “contaminated” water, it depends on how it’s manifested in your body and health (what are your symptoms?). Look to improve immune function, liver detox and in-depth health tests. 
    • When evaluating home health, look to what would be the biggest offenders first like water and other things like personal-care and hygiene products. In other words, in this case BIG and then taper down to the small things. Eg) start with water, cookware, personal care/hygiene  then down the line look to cleaning products, home materials, and so on…
  • Fluoride in water and dental products 
    • Study mention: Impact of Drinking Water Fluoride on Human Thyroid Hormones: A Case- Control Study
      • Discussing fluoride’s effects on thyroid, and a correlation between higher fluoride and higher levels of TSH.
    • Fluoride is byproduct of certain types of industrial work and mining, and can be a major contaminant. And worse, this source of fluoride is also sold and used… but it’s not the same as naturally occurring fluoride that you will find in some foods and naturally in water.
  • Personal care products
    • Stinky body odors is mineral deficiency or liver detox issue
    • Beware of: Aluminum, parabens, phthalates, sulfates, etc.
    • Also be weary of antibacterial products especially those with triclosan, with known risks associated.

Thyroid-Friendly Nutrition

  • Generally speaking
    • Needs to be individualized and a case-by-case approach on finding best diet practices.
    • Start with eating clean, fresh foods, less processed foods. 
    • Cruicerferous veggies aren’t as “dangerous” for thyroid as they were once thought to be.
    • Insulin will repress thyroid so foods that will better manage insulin, glucose levels are key.
    • Monitor caffeine- not too much.
    • Test for gut issues as well as make sure any food senstivity, intolerance and/or allergy is addressed because that food can wreack havoc (unique to everyone). 
    • When it is on the autoimmune spectrum, then removing some of the big offenders and allergenic foods like gluten, dairy, soy, corn, wheat, etc, can be beneficial.
  • Gut, hormones and nutrient deficiencies
    • Birth control, HRT and even copper IUDs can be problematic.
    • Elevated cortisol, elevated estrogen, elevated insulin is the trifecta that plays a hugely negative impact on thyroid.
    • Gut issues can affect how we are metabolizing thyroid hormones that can contribute to issue.
    • How can we better metabolize thyroid hormones and everything else? Find out the big offenders that are slowing down your natural ability to detox and optimize health. Like water. 
    • Look to stress, medications (BC, HRT), etc…
    • Nutrients that can HELP thyroid
      • Zinc
      • Selenium
      • These combine with iodine to make thyroid hormone and help T4 to convert to T3 and prevent conversion to RT3.
    • Lots of zinc deficiency these days.
    • Supplementing with selenium needs to be a bit more conservative than with zinc.
    • Steve explains more on our body’s natural balance of nutrients.
    • If you’re deficient in something, you have to fill in the reserve 5-7 fold just to get back what you were low in, plus what your body normally needs, plus how that nutrient is helping you heal from something.
    • Also fully understanding your own body’s ratios of nutrients is difficult to achieve. (Moral is, don’t worry too much in most cases.)
    • Bottom line is- with supplements you have a pretty big room for error as long as you don’t have some kind of co-morbidity, ie causing new imbalances isn’t as easy as one might tell you.

Listener Questions & Training Tips

Suzanne asks:

I just listened to your thyroid episode with the Sock Doc and am looking forward to the next one!  I’m hoping I can sneak in this question:

Quick background: 40 years old female being treated for Hashimoto’s for the past 10 years.  I’ve been “stable” taking 88mcg synthroid and 5 mcg cytomel for my Hashimoto’s after a few rollercoaster years where I was over-medicated and constantly having my medication doses adjusted.  I feel better than I felt a few years ago but I also feel like I’m “settling” health-wise, and that something is still off.  My TSH is usually around 1.1 and the labs refuse to test my free T3 and T4 these days (in the past my fT3 was always on the low end).  I have lingering fatigue, sluggish digestion and always feel like I need a back massage.  I was really into running in the past but seem to feel better with light strength work, HIIT type workouts and walking these days.

I’ve heard multiple times that having poor iron status will affect thyroid functioning and I’m wondering if this is my missing link.  But what can I do if I simply can’t get my ferritin up? I take iron supplements religiously every second day and have tried many different formulations over the years and pay careful attention to when I take them and how.  I eat almost completely gluten-free, with tons of veggies, meat several times/week and I even choke down some liver once in a while.  I was tested once for celiac a few years back and it was negative.  My periods are a little on the heavy side but nothing crazy.  I also had some other gut testing with a naturopath last year and nothing really came up.  I sometimes wonder whether I should stop taking iron supplements since they don’t seem to help but I’m worried about becoming full-on anemic in that case…Any advice?

Thanks so much for the work that you do.  I hope you have a fabulous summer!

What we say:

  • Lab testing and doing it out of pocket if you have to.
  • On the Synthroid T4/cytomel T3 medication that she’s on…
    • 12:1 is a healthy T4:T3 level, but often too much T4 is given.
  • Ferritin/iron
    • This is always a tough one to balance; too much can be very toxic, though many women are too low.
  • Body naturally makes hydrogen peroxide.
    • H2o2 combines with iodine and other minerals like iron and makes thyroid peroxidase and goes on to make T4
    • In other words iron helps to make T4 thyroid hormone. (we also make antibodies to thyroid peroxidase that can lead to autoimmune thyroid issues).
  • Check trace mineral levels.
  • Check co-infections:
    • An infection like Lyme can “eat up” your iron so more testing is usually warranted if numbers aren’t going the right direction, ie find out the root problem.
  • Pondering the correlation between anemia and thyroid issues and the importance of testing thyroid regularly if you are dealing with anemia… and on that: why aren’t thyroid labs more commonly added to basic blood labs.

Katherine asks:

LOVED Part 1! Thank you thank you!

Great info – I appreciated the in depth explanations behind the general knowledge.

Question: Can you please address the effects of Intermittent Fasting and/or Time Restricted Eating on thyroid and hormones, particularly for peri/post menopausal women?

I think I really screwed mine up. What can I do to help it recover?

(I’m currently on 125mcg synthroid daily and TSH / T3/ T4 all come back “normal”. But I don’t feel normal – still foggy minded and slow in the mornings and having a hard time dropping any weight. I take great vitamin supplements, eat healthy and also take an SSRI antidepressant, duloextine.)


I’m a 53 year old runner who has been hypothyroid since I had my kids, 25 years ago. I also suffer from SAD and clinical depression – which became issues around the same time as the hypothyroidism hit – which I manage as well as I can through diet/nutrition, exercise and stress management (journaling and yoga). Love summer – struggle in January and February here in the Dakotas!

I grew up as an athlete and gained weight in my 40’s from stress and poor lifestyle/food choices.

At age 49/50, in 2017, I lost 92 pounds through nutritional changes and was able to start working out again. I was eating 6 times a day, portion controls, and felt like my thyroid was finally healed. In 2018 I started to run and workout regularly. I ran a 10K and things were great. In late 2018 I started experimenting with IF (black coffee and water only until noon). I work out in the mornings, ran fasted, and was in great shape (high LBM, 18% bf and running half marathons) in 2019 and first half of 2020. Then came an overuse injury…. Less exercise, and a fast 40 pound weight gain from Oct ‘20 – April 2021.

Last fall, I was trying to keep the weight off by restricting my eating even further to 2pm-8pm after the injury, and then just felt even worse and lost nothing but gained more. In April – after starting to work with Julie (wildandwell), I started eating a little again in the mornings and cut out coffee.

Thanks again for covering this topic!!!

What we say:

  • Go back to health, diet and training history and see what you were doing when things were working and body was at it’s best.
    • In this case when she was eating smaller more frequent meals that is when she tended to be at her best.
  • IF and time-restricted eating can often be too stressful on the body and “more is better” doesn’t always apply here. Can result in other disruptions like excess cortisol and stress imbalance (HPA Axis).
  • High cortisol can contribute to elevated estrogen/estrogen dominance, but also affecting serotonin
  • High estrogen can hinder conversion of T4 to T3, and can hinder serotonin production (i.e. contributes to neurotransmitter imbalance).
    • Estrogen imbalance contributes to serotonin imbalance most likely from high cortisol or high stress to body (caffeine, IF).
  • Addressing estrogen dominance is key because this also has an effect on weight gain, and more downstream effects, especially in menopausal women. Test don’t guess.
  • On training:
    • Monitor training intensity and levels—sometimes what we think seems like the best plan may not be for our current situation.
    • In this case: MAF/chronic high volume endurance training isn’t always a great fit if sex hormones and thyroid hormones are out whack or healing still. Too many hours even at aerobic levels may be counterintuitive at certain times in one’s life and health journey. In this case, instead consider less volume and more HIIT type workouts, strength training and gentle walking.

Monitoring Thyroid Going Forward

  • If a past history or making adjustments to get to more optimal – no shorter than 6 weeks (or every 2-3 months).
  • Otherwise, if just monitoring, checking annually is fine.
  • Other things to monitor and watch for:
    • If doing MAF, a regular MAF test is telling 
    • Monitor sleep quality… if up a lot, that tells a lot
    • Overall energy and snappy
    • Cravings: sugar, salt, caffeine (no need to avoid these things, but if craving them likely crazy that’s a different story)
  • These things align with adrenal health/HPA axis function…
  • If adrenal glands are stressed out for too long, your thyroid will naturally “drown itself” (naturally suppress itself)—whether protective or secondary issue
  • How blood tests need to be carefully planned because of acute fluctuations in markers we test (thyroid, testosterone, etc).
  • Testosterone tangent.


Have questions? Want a part 3? More on peri/post menopause? Email us at!

One Comment

  • Bri Henderson says:

    I can’t thank you enough for these podcasts! I saw quite a few people before I found someone locally that understood this and hearing it on the podcast gave me confidence we were on the right track. Keep doing what you do- we appreciate you guys so much!

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