The PCOS-Thyroid Link Explained with Dr. Erica Armstrong

Unlock the secrets to managing PCOS and thyroid issues with  guest, Dr. Erica Armstrong, a leading expert in functional medicine and author of "The PCOS Thyroid Connection: A Functional Medicine Approach to Treating the Root Cause." Discover why women with PCOS are three times more likely to develop thyroid disease, specifically Hashimoto’s thyroiditis, and learn about the shared root causes like inflammation, gut health, and nutrient deficiencies. Dr. Armstrong emphasizes the importance of comprehensive thyroid screening and a functional medicine approach that includes advanced lab testing and collaboration between healthcare providers.

Navigate the often confusing world of dietary recommendations for PCOS with practical advice from Dr. Armstrong. Say goodbye to ineffective fad diets like keto or carnivore and learn how balancing blood sugar through key nutrients like magnesium, zinc, B vitamins, and omega-3s can make a significant difference. We debunk myths about the harm of cruciferous vegetables, highlighting their crucial role in estrogen metabolism and gut health. Plus, get valuable tips on advocating for yourself in medical settings to ensure you receive the necessary thyroid tests.

Experience the transformative impact of integrating functional medicine into traditional healthcare practices. Dr. Armstrong shares her passion for providing personalized care and the importance of a holistic approach, from advanced testing to nutrition. 

Mentioned in the episode:

The book: https://amzn.to/4etfaZ9
Thyroid Test Kit: https://s.thorne.com/I2xbM
Find Dr Erica Armstrong: https://rootfunctionalmedicine.com/  
Ig: @rootfunctionalmedicine

Transcript

Speaker 1: 0:38

Welcome back to an Amber a day. I'm your host, amber Fisher, and today I have a very special guest. I have Dr Erica Armstrong, who is Institute for Functional Medicine certified practitioner. She is also the author of the PCOS thyroid connection a functional medicine approach to treating the root cause. And guys, I read this book. I sat down and read it, even though I you know my attention span is like this these days. This book gripped me. I told her before we started recording. I was genuinely so impressed with this book, with the amount of detail, even just as a resource for PCOS Take the thyroid piece out of it. It's a great resource for PCOS. So I will have a link in the description or the show notes. So if you guys want to take a look at this book I know it's on Amazon and stuff like that, so highly highly recommend. But we're going to talk a little bit about it soon. Erica, would you introduce yourself to us? Tell us a little bit about you.

Speaker 2: 1:39

Yes, and thank you so much for the kind words. I am founder and CEO of Root Functional Medicine, which is a nationwide telehealth practice where every member has both a doctor and a dietician nutritionist. If you're not familiar with functional medicine, the core is finding the root cause. So we put the whole picture together, connect the body systems and figure out what actually is driving disease so that we can reverse it and optimize health. So we specialize in PCOS, thyroid, gut health, hormone balance and autoimmune conditions and other things, but those are the top things that we treat.

Speaker 1: 2:19

Amazing. That's really cool. So you guys work nationwide. I like that. You have a dietician with everybody. That's nice. Nutritionists love that.

Speaker 2: 2:30

Nutrition is core to functional medicine. Since we started.

Speaker 1: 2:33

Yes, I love that. Okay, so we're here today to talk about the PCOS and thyroid connection, which I know is a hot topic. I get asked about this a lot and I'll admit that I don't know as much about the thyroid as I would like to, but I know that these two things overlap a lot. I see it all the time in my practice. So I'm anxious to kind of get your expertise on how that works, what the connection is and maybe some things that our audience can implement now. So can you explain a little bit about PCOS and thyroid issues and kind of how they connect or what the overlaps are there?

Speaker 2: 3:13

Yeah, so at baseline. These are the two of the most common hormonal issues. Women with PCOS are three times more likely to also have a thyroid disease than women without PCOS, in particular, hashimoto's, which is the most common type of hypothyroidism. Over 90% of those with hypothyroidism in the US have Hashimoto's. That's an autoimmune condition where your thyroid is being attacked and then unable to produce enough thyroid hormone over time, and so one study actually showed that Hashimoto's was present in 23% of women with PCOS almost a quarter of women with PCOS. So it's really important, if you have PCOS, to have thyroid on your radar for screening. So there's a lot of ways that these conditions overlap, but the largest one, especially that we see in our functional medicine practice, is that they share root causes, and so in our practice we have the doctor and the dietician working together, putting the whole story together, figuring out root causes and utilizing advanced lab testing as well as the conventional testing, which includes full thyroid panels for everyone with PCOS, and so that is how we were able to figure out over time that, hey, these conditions are popping up all the time and they're sharing root causes, and we've actually diagnosed a lot of thyroid disease when there has been previous PCOS or diagnosed both of them together. Because of this, we feel that it's important for everyone with PCOS to have a full thyroid panel as part of their yearly health maintenance and then, if symptoms warrant it.

Speaker 2: 4:48

So, um, there's several root causes, um, why these conditions occur together. Um, I wrote about this in my book and broke it down by chapter of you know the most common root causes. Thank, thank you. So the biggest root cause is inflammation, which is usually coming from the gut, because that's where the majority of the immune system lies and it's. Some other root causes are adrenal health, nutrient deficiencies or insulin resistance, but that's why it's important to also work with a functional medicine team, so that you can work with someone with advanced training in these root causes, like gut health and microbiome balance or adrenal testing, and so we can put the whole picture together.

Speaker 2: 5:33

The other root cause I didn't mention was mitochondrial health and mitochondria you may remember as a powerhouse of the cell. It's the energy producing part of the cell. Each egg in the ovary has almost 600,000 mitochondria in it to produce enough energy for ovulation to occur, and so that is why taking care of the mitochondria are very important, so that you ovulate. Then, after ovulation, comes the natural period. So that is the synopsis of the root cause.

Speaker 1: 6:05

Yeah, that's great, that's most. That's all the stuff that we love to talk about on this podcast all the time, and I love that. You know that. I that makes a lot of sense to me that the thyroid connection with PCOS would have a lot to do with inflammation and inflammation has a lot to do with gut health. And speaking of mitochondrial health, shout out to we did a podcast. It was published. Well, let's see when this one comes out. Look back to January. But we did a podcast on PCOS and mitochondrial health, which might be interesting to you if that really resonated with you. So, yes, I am fascinated.

Speaker 1: 6:43

Okay, so we know that this occurs a lot. We know that there's a lot of connections here. What I'm curious about are let's say, you have PCOS, because this is a functional PCOS podcast, right? So everyone listening probably has PCOS. So if you suspect that you might also have thyroid issues, what are some signs of that? I know that a lot of the symptoms, like irregular periods and things like that, can overlap, but what are some of the thyroid specific signs that we should look for to ask for more testing?

Speaker 2: 7:12

Yeah, this is where it gets tricky because a lot of them, a lot of the symptoms, are common. So both can cause irregular menses. Both can cause ovarian cysts. With hypothyroidism, the ovaries can even appear polycystic on ultrasound due to the infrequent ovulation. With hypothyroidism, both can lead to infertility. Insulin resistance is actually found in both conditions. It's well documented with PCOS but not as commonly known with hypothyroidism. But thyroid hormone affects how your cells break down sugar and how well your cells can take up sugar and insulin into the into the cell. So that can affect your energy. Both cause weight gain or the inability to lose weight and both can cause hair loss.

Speaker 2: 7:59

So it is so fun, yeah, yeah, to differentiate what might, what might be going on. But I would say, if, if you're not improving with basic PCOS guidance, or you know your labs are looking great but you're still having symptoms, it's time to dig deeper. Or, like I mentioned earlier, like I think, at least once a year have a full thyroid panel. I know we'll probably talk more about you know how to get that done.

Speaker 1: 8:27

Yeah, I mean I think that's such a good tip because what I've noticed I don't run the labs myself but I partner with doctors who will run them for my clients and a lot of you know. Conventional medical practitioners will just run a TSH right, and then what they're looking for is a range that, like you mentioned in your book, is a really exaggerated range. And what we're looking for in functional medicine, functional nutrition, is a much smaller range, which I believe in your book you go up to 2.5, right For TSH. So conventional med is usually like up to four and they don't worry. So I see a lot of people who are like three right, and you know they're kind of hanging out in that like subclinical hypothyroidism range where they're not getting appropriate treatment. But perhaps if they had a full panel you could really kind of see what's going on with. Let's tell our audience what is a full panel. You could really kind of see what's going on. Let's tell our audience what is a full panel, what things would be tested for.

Speaker 2: 9:27

Yeah, you're going to get a lot of different advice, but the four core things that you really need are the TSH, the free T4, which is the majority of the hormone that the thyroid is producing. The free T3, your thyroid produces a little T3, but most of it is converted from T4. And then thyroid antibodies, in particular the Hashimoto's antibodies, which are TPO. So those four are. You're going to get your your best bang for your buck on those four tests.

Speaker 1: 9:54

Yeah, and that the antibodies one is key because there can be folks that at least that I've seen, and tell me if this is your experience too, where the rest of the panel looks relatively normal, ish, um, but the antibodies are really high and then sometimes, like even the, the prescription thyroid medications, if the, if the antibodies are really high, it almost seems like it just doesn't do that much or it doesn't really help that much, because Hashimoto's is, you know, autoimmune in nature and there's that inflammation connection and so if we're not treating that root cause, you know, you're just kind of throwing thyroid hormone and it might help a little, but it doesn't usually kind of treat the root.

Speaker 2: 10:39

Yes, the inflammation is still brewing if there's antibodies there. But that is a great point. That is exactly when we want to catch it. When the antibodies are high, it's usually early because the rest of the thyroid hasn't been affected yet. It hasn't attacked the gland enough to make the thyroid low functioning. But we catch it with the antibodies are high. Really key in on the gut health and try to stop the production of thyroid antibodies.

Speaker 1: 11:04

Why do you well, I know you know inflammation, gut health, all of that but why do you tend to see high antibodies in folks? Is it like go back to just purely gut health? Are there like food allergies that play often? Are there? Is there an adrenal connection there? What do you think?

Speaker 2: 11:22

Yeah, I think all of the above. I know this is a little controversial in the PCOS community, but in particular with Hashimoto's, there's plenty of evidence that gluten ingestion can lead to higher thyroid antibodies, and so one of the things we would likely recommend is a trial off of gluten or screening for celiac disease first.

Speaker 1: 11:45

Yeah, you are touching on a controversial topic, but personally I've seen enough issues with gluten intolerance, dairy intolerance in my PCOS clients that it's usually something that we want to look into, especially if there are thyroid antibodies. If there's any kind of autoimmunity, I usually see that there's some sort of food allergy or severe food sensitivity at play, because that's part of where that inflammation from the gut is coming from and it's kind of a little bit of a chicken or an egg situation. The food sensitivity there first and then that kind of made the gut you know all that stuff. Or was it the other way around? Probably that, but nevertheless, you've got that going on. You're going to have to do something about it in order for you to really actually make progress. So I agree, I'm a fan of the approach.

Speaker 1: 12:41

This leads into our next kind of topic. So there are some diet recommendations for PCOS that personally, I stay away from in my practice, but they are common and so some people may have tried them. Things like super low carb diets, keto carnivore diet I've seen um well, I've seen a lot of people also talk about like dangers of eating too many cruciferous vegetables and stuff because of the goitrogens. So are there any commonly recommended nutrition practices or diets or whatever for PCOS that you don't like, for you know these two things together don't like, for you know these two things together?

Speaker 2: 13:22

Yeah, great question. So, kind of to start at the top, I think you started with some of the fad diets. Fad diets usually don't work, that's why they're fads. And so we do have some core nutrition advice that we start with and then we personalize it to the individual. So, starting with number one, balancing blood sugar.

Speaker 2: 13:37

Whether or not you have insulin resistant type PCOS or not, even at the adrenal PCOS, balancing the blood sugar is going to be step one, and it's also important for thyroid, since it can affect both things. So, and then we want to replace the important nutrients, so especially magnesium, zinc, b vitamins these are all been found to be much lower in women with PCOS and then omega-3s for inflammation and coenzyme Q10, as we were talking about that mitochondria. That is the first nutrient that starts the energy production, and so it's very important for ovulation. And then, like we were just talking about, screening for celiac or gluten sensitivity, especially if you have thyroid disease or Hashimoto's antibodies Celiac is actually five times more likely in people with Hashimoto's. So then we would personalize that advice whether or not gluten should be avoided. And then eating for gut health, so increasing fiber as tolerated and that diversity of phytonutrients.

Speaker 2: 14:34

So, that is the way we approach nutrition at Root. A couple of things about the cruciferous veggies you mentioned. Um, you would have to eat a ton of cruciferous veggies to be worried about a goitrogen, which means it can lead to a goiter or like a thyroid nodule. Um, but I think the benefits of cruciferous veggies far outweigh any potential theoretical harm, because they're anti-inflammatory, they're detoxifying, especially for estrogens. They're fiber-filled, blood sugar balancing. So if you want to further reduce your risk, you can just cook them, which will break down those compounds.

Speaker 1: 15:11

Yeah, I was going to mention that in your book you talk a bit about the astrabalome, which is, you know, the gut based kind of estrogen metabolism and detoxifying process, how important cruciferous vegetables are for us to actually be able to metabolize our estrogen properly. And that's also that's one reason why it's key that our gut, you know, is balanced and that we have the right balance of bacteria in there, and then we eat to support those with fiber, like you mentioned, because all those excessive estrogens can cause a lot of issues. So cruciferous veggies are pretty amazing. Do not avoid them. Now, I could see like a potential if somebody was like chugging, I don't know, broccoli sprout powder or something like maybe, but it's just, it's kind of like this thing that I see.

Speaker 1: 15:58

I see a lot of people really villainizing different parts of food. You know like lectins or you know things like that, and it's just, I think we get, we lose the plot a bit with all of this stuff with nutrition. I think sometimes when you know too much about nutrition, you start to kind of like dig down a little bit too much and kind of I don't know, you villainize, you start villainizing stuff when the reality is that look at what the majority of people are eating on a day-to-day basis, right, and how could we make this a more whole foods diet? How can we make this more appropriate? It's like we really don't need to worry about all of this other stuff.

Speaker 1: 16:36

One thing I do want to talk to you about is a common complaint that I get from clients, which is that they know about full thyroid panels. They know about the connection between PCOS and thyroid issues, they've done their research right and they struggle to get the testing. I sometimes have people go in with a list of labs and, by the way, in the book you have a great list of labs to ask for, which are all things that I would ask myself. So the issue is not the knowledge base or having the resources to know what to ask for. It's getting their requests met. So they go to the doctor and the doctor's like you don't need that, or that's not medically necessary, whatever. So any advice for those situations?

Speaker 2: 17:21

Yes, I do have a benefit of a previous history in the conventional world. I was a practicing family medicine doctor before I jumped ship and realized that functional medicine was the way. So it is unfortunate that people are feeling dismissed and that this becomes a negotiation. But let me give you a couple of key points from the doctor's perspective why they're hesitant. So the number one reason is that they'll order this test and then insurance won't cover them and the patient will get a large bill and they'll end up mad at the doctor.

Speaker 2: 17:54

After that happens to you a few times and people are real mad at you, you kind of put up your guard like I'm not sure if I should order this because you're going to get a bill, sometimes like over a thousand dollars. So that happens. And then the second big reason they won't order it is they don't have any time outside of the visit to review it, and so if you have a lot of labs that's piling up in their inbox, they're only paid for the time they spend in the visit. Okay, so, knowing that from my previous history, the way to ask is to tell them that or to actually try to figure out the cost of labs through your insurance before you ask for them, tell them you're aware it might not be covered and you're okay with an out-of-pocket bill if you are so that's a really good tip.

Speaker 1: 18:38

Yeah, I, I love that. I actually I have. I asked that question a lot and nobody's ever said that. But you know a good friend of mine who I run group programs with. Her name is Hannah Mule, the conscious nutritionist. She is a PA and so she's. You know she's talked a lot about the perspective being on the conventional side, because we tend to sometimes more alternative people get, they tend to really villainize you know, conventional medical and the system has issues, don't get me wrong, but it's. It's usually not the practitioner's fault, well, not always the practitioner's fault. A lot of people go into conventional medicine with, you know, big hearts. They want to help, they want to do what they can, and then they're kind of like chained to the system that they can't really fix from the inside.

Speaker 2: 19:21

Yeah, and then you know, offering to review them in a follow-up visit, which is good, to have a discussion and get your questions answered. Anyway, I think that will squash the number one and number two hesitation that your doctor may have. And if you do call your insurance and find out they're going to be super expensive. There are direct ordering websites out there that you could use it. You know, if you're saying, hey, I can get this, can I follow up with you with the results?

Speaker 1: 19:44

Right, and I do know of Thorne does have a full thyroid panel home kit. That can be done. So there are some home kits and things that you can get. I do recommend always having somebody with knowledge here to review things with, because you can get the tests run all day. But if you don't know how to interpret them, then but that's where, if you're able to, a functional medicine practitioner is so nice to have on your team. I know it's not feasible for everyone the way that things currently are, but If you can manage it it is really really helpful. Let me ask you this actually so what inspired you to start work really focusing on PCOS and thyroid Was?

Speaker 1: 20:33

it just that you saw it so often.

Speaker 2: 20:35

That was a big part of it. But actually back when I was practicing family medicine, which was about seven years ago, I kept seeing this pattern in women in particular, who they just didn't feel their best. They were struggling with fatigue or hair loss or skin issues or bloating and conventional medicine, and I didn't have the answers. I was literally that doctor who told you your labs are normal, I don't know what's going on or you can be referred to this specialist. They ended up with colonoscopies. They were normal and they would end up back in my lap and I would be like I want to help you.

Speaker 2: 21:08

I feel like we're missing something here. I feel like there is something driving this. Woman after woman can't keep saying this to me. I hear you, I believe you, and I had to go to functional medicine and figure out how to approach this differently, with a completely different mindset and a completely different model of care.

Speaker 2: 21:26

And the more I learned, the more it made sense and I started putting a little bit of that into my family practice within the limitations that I could, and the results that I was getting were so much better than I had in years and I was like, okay, there's something to this, it really works.

Speaker 2: 21:41

I need more time with people, I need restrictions lifted, I need to be able to order the tests I want. I got to do this on my own, so I jumped ship and started root about six years ago with a dietician, because nutrition is core to functional medicine. And there, as we were able to do this advanced testing, we were diagnosing so much PCOS, which is completely on under diagnosed, as well as thyroid and, and diagnosing them together. And it was like it was just clicking and um, we were. We were getting women to have regular periods. Within two or three months, they were getting pregnant after even failing IVF, and the results were so uplifting that it just became my passion, like, okay, we do have answers, you know they're, they're feeling better and they're achieving their goals and and I need to share this with the world so I'm let's put it in a book I love that.

Speaker 1: 22:37

I mean that that's a very similar story to me. It's. It's so nice. I mean, a lot of us get into this kind of work because we do want to help, and I know for myself.

Speaker 1: 22:49

I had a lot of health issues related to my own PCOS. I had endometrial cancer when I was younger and so I went through a lot. I didn't want anybody else to have to experience that. But it's so frustrating to be within certain confines. You know, even in like the dietetic world, right, there are some confines with like what we would traditionally recommend for PCOS, for example, and it just didn't ring true for me. It was so frustrating to kind of run up against these walls and then when you finally discover like, okay, this is how the system works, this is the body systems, right, this is how it's all connected, and then you start, you know, being able to kind of like figure out where things are going wrong and make changes. It's such a wonderful feeling and it's so empowering.

Speaker 1: 23:37

I love getting like pictures of, you know, ultrasounds and all that stuff. It's such a nice, it's just so such a one. 80 from from the previous experience, right, so, um, I love that and I think that that passion is is, um, what's really nice and it's really important, and I and we need more people doing this kind of work. I love that you're really honing in and specializing on this like particular topic too, because I think, um, at least from my experience, you know, I started out more broadly looking at like functional nutrition Right, and as I kind of went along, I just kind of got more and more specialized because I think there's just so much to be said just about this particular issue, right, like you wrote a whole book about it, like there's so much, um, we need people who like really really are thinking thoughtfully about these conditions and everything. So, anyway, I think it's really cool. So, um, speaking of the book, tell us about this lovely book that I have read, that I really like.

Speaker 2: 24:41

So it's based both on our clinical experience doctors and dietitians at root functional medicinectional Medicine and it's research-backed. There's citations throughout the book. We didn't just make this up and so it breaks down the root causes. It helps you figure out what yours might be and then it gives you steps that you can actually do to start to reverse those root causes. Um and so it does include even some uh blood sugar balancing recipes and a supplement schedule, a list of labs that you should have. Um and um. Yeah, I mean it's. It's a great place to get started, um for anyone. And then, if you do decide you need more personalization or more testing, that's when you know people reach out directly to people like you and us at Root.

Speaker 1: 25:27

And you, yeah. So and you said you're, you guys work nationwide, correct?

Speaker 2: 25:34

Yes, we are a telehealth practice, so all of the visits are done via computer or phone and then messaging in between as needed.

Speaker 1: 25:41

Okay, cool. So if anyone's listening and they wanted to work one onone with someone in your practice, they'd be able to do that. But I love that, you know. The book is nice too because you know you and I both know functional work can be a little bit the sticker price can be a little bit tough for people at the beginning and I think, long-term most of us kind of come around to realize that your health is worth investing in and it plays out later with cost savings down the road.

Speaker 1: 26:15

But at the beginning it might be nice to have a resource like this where you can really read and learn and implement some strategies and actually see in your own body like, oh yeah, this is working or there is something to this. And then if you get stuck or you know you can't, um, can't, dive deeper on your own, then you can, you know, reach out and work with somebody. But, um, yeah, I really like it's very step-by-step. The first actually the majority of the book I would say is like just it's really deep conscious information about the connection between these things. So I, like I said I will have that linked in the show notes. Um, but if we want to find you, where can we find you? Where are you online?

Speaker 2: 27:02

Yes, so our website is root functional medicinecom and I'd say, on social, we're most active on Instagram, so at root functional medicine, and then we do have a free get to the root quiz on the homepage too. That's easy, and then you'll get just a few emails with steps that you can implement based on your answers there. So cool.

Speaker 1: 27:21

I will have all that linked in the show notes. Thank you so much for being here. Erica, Appreciate it. It's a really good conversation.

Speaker 2: 27:30

Yes, thank you so much, of course.