Aviva Jill Romm is a well-established name in the world of natural health. Her many books bear testament to her wide range of knowledge; par-ents in general and women in particular turn to her when pregnant: The Natural Pregnancy Book, currently in its 3rd edition), when recovering from birth: Natural Health After Birth, when they have questions about vaccines: Vaccinations: A Thoughtful Parent’s Guide, and when they are looking for herbal remedies: Botanical Medicine for Women’s Health. She prac- ticed for many years as a home birth midwife, has run a national herbalist association, and is a Yale-trained medical doctor.
In her newest book, Dr. Romm tackles a topic that has been quietly creating a buzz: thyroid and adrenal health. Many conventional medical doctors don’t fully understand or appreciate the degree to which hypo or hyperthyroidism can affect daily living, so when their patients come asking about what seem like very generalized symptoms—fatigue, brain fog, weight gain, insomnia, and more—many doctors simply do not make the connection.
For many of these women, the right set of tests can reveal a problem with the adrenal glands, the thyroid, or both. For others, deeper digging is required to determine the ultimate problem. And even once a problem is found, many doctors simply do what doctors do best: prescribe medication, which may or may not address the symptoms but do not actually fix the real root cause.
In The Adrenal Thyroid Revolution, Dr. Romm addresses these issues in depth. She discusses the primary causes of most adrenal and thyroid disease: stress, food allergies or intolerances, leaky gut and imbalanced gut flora, infections that might be undetected, environmental toxins, or a combination of several of the above. She delves into why these particular factors can throw off adrenal and thyroid health, and how the resulting impaired function can cause symptoms that many are told are all in their head.
“This is what I do in my practice, and in my book, is to take a look at what is going on,” says Dr. Romm. “There are factors going on that are beyond our control, and then there’s what we can control. Even if we can’t control everything, there’s a big chunk of what we can choose to be exposed to—whether that is 24/7 living, or chronic stress, or foods that are filled with pesticides and herbicides and processed, horrible ingredients—that really do have a major impact on our immune system. We can mitigate our risk factors by making small shifts.”
Thyroid dysfunction is an especially pertinent topic for women who are pregnant, trying to become pregnant, or in the postpartum period, as many of the common problems associated with hypo and hyperthyroidism have a more pronounced effect on these women. Thyroid disease is sometimes more common for women in this stage of life because hormones are such an important part of conception, pregnancy, and breastfeeding.
As a specialist in women’s health, Dr. Romm is well aware of the effect thyroid disease can have on these periods of time. Her new book is full of fantastic information, and Dr. Romm recently took the time to graciously answer some of the other questions we had.
NMN: When and how did you realize that thyroid disease might be a bigger issue than was openly acknowl-edged in conventional medicine?
AR: When I was in medical school, we were trained in it; and when I was a midwife, I saw it. And as the focus of my practice got more narrowed in on women and hormone problems, I started to have more women with thyroid problems coming in as collateral to that, because one, the thyroid does generate hormones, and two, women who have hormone problems often have it because they have a thyroid problem. And similarly, I started to see more women in my practice with adrenal issues and I started to write about it, and there is definitely a connection between adrenal and thyroid issues.
The other thing is that the rates of autoimmune disease in the U.S. have been skyrocketing in the past decade, and conventional medicine didn’t really have an answer for why women were feeling so tired and sluggish. Their hair was falling out and they were gaining weight and not able to lose it, they were depressed, and conventional medicine’s response was “you’re probably under a lot of stress” or “you need to exercise more and eat better,” or that maybe it was just depression and anxiety. My background in alternative and integrative approaches and my standard medical training made me a likely place for these women to turn; I’ve seen a lot of women who were falling through the cracks. It can take a woman, on average, five years to get a diagnosis on an auto- immune disorder, like Hashimoto’s.
NMN: Much of the book is directed towards women, as the majority of thyroid and adrenal problems are faced by women. Do men suffer from these issues as well, and children?
AR: Women are affected disproportionally by autoimmune disease; they are about eight times more likely to have autoimmune disease than men. And it’s shocking what we’re seeing in kids. We’ve seen a 30% increase in some autoimmune diseases in children! In my practice, I have a five-year-old with Hashimoto’s, as well as an eight-year-old and a twelve-year-old. Until the last ten or fifteen years, the only autoimmune disorder prevalent in kids was type 1 diabetes, and that was extremely rare. Now we’re seeing all these other diseases. In just the past year, I’ve had three children in my practice with rheumatoid arthritis.
NMN: How common are thyroid and adrenal problems?
AR: We know that at least 30 million Americans have Hashimoto’s or hypothyroidism, and it’s suspected that at least 50% more than that have it but do not know. Statistically, it’s expected that 15-30% of women who have depression actually have an undiagnosed thyroid condition.
NMN: Are thyroid problems more significant for women of child bearing age? How can thyroid disease affect fertility?
AR: Yes, it can. With the thyroid, we typically think about metabolism; we think about weight gain, fatigue, or depression. But one of the super-important things that the thyroid controls is brain function and brain growth. So in a developing fetus, where they’re growing all of their neural networks, all of their hardwiring for their nervous system including their brains, Hashimoto’s or hypothyroidism in pregnancy can have a significant impact on brain size and also on the ability to process information later on—intelligence. And when a mom has Hashimoto’s, she can pass on a predisposition to her baby, and the baby can then be born with hypothyroidism. Up to 17% of women in the US develop Hashimoto’s in the postpartum. And it’s even higher in women who have another auto-immune disease, up to 25%. And in women who have had postpartum thyroid problems in the past, even if it was undiagnosed, it goes up to 42%.
NMN: Do you believe every pregnant woman should be tested for thyroid problems?
AR: I personally do believe that. And increasingly, among endocrinologists, that is the recommendation. But it still remains controversial among obstetricians, who are usually the ones doing the prenatal testing. Most obstetricians are not routinely testing for either thyroid antibodies, which are the most sensitive indicator of a potential problem or an active problem in pregnancy, or thyroid-stimulating hormone. We also know that a third of women who do have a thyroid problem in pregnancy are completely being missed because proper testing is not being done.
NMN: What are typical pregnancy problems that you see in your patients with hypothyroidism? Do they see a prevalence of certain specific problems, or other issues?
AR: One of the big ones that we see is trouble getting pregnant, since thyroid problems can suppress your fertility and your normal cycle; women who have a harder time getting pregnant should definitely have their thyroid checked. For women who have had a miscarriage, or several miscarriages, thyroid disease is a risk factor, and there’s a chance it’s the cause. During pregnancy, difficulty going into labor may be related to thyroid problems—they may need to be induced. Postpartum depressiois a problem, and [thyroid disease] can really affect milk production.
NMN: What treatments are considered safe and effective for pregnant and breastfeeding women in dealing with thyroid issues?
AR: If a woman has hypothyroidism in pregnancy, the best thing to do for her health and safety, and baby’s health and safety, is to actually use thyroid hormone supplementation. I’m the first one to go to herbs and supplements and foods when you can, but there are some cases where pharmaceuticals really can make a life-or-death difference, especially with regard to a baby’s brain de- velopment. During pregnancy, we know that women who already have Hashimoto’s and are on thyroid medication need to increase the dose by 30-50%, although they should never do that on their own—work with your midwife or OB to make sure you get the right dose and proper testing. But women have higher thyroid demands while pregnant, so they need more thyroid hormone. Also, selenium is the only treatment (outside of a pharmaceutical) that has been shown to be beneficial. 200 micro- grams of selenium during pregnancy has been shown to reduce the risk, if you have thyroid antibodies, of developing Hashimoto’s or postpartum thyroiditis. Another thing is to make sure your iodine levels are normal. Pregnant women need about 250 micrograms of iodine a day during pregnancy to support normal thyroid function.
When new moms develop a thyroid problem after birth, they can take one of two options. Eighty percent of women who develop a thyroid problem in this time should know that it will spontaneously resolve within one year. So if you want to wait and see and just manage your symptoms, you can do that. But if you’re symptomatic to where you’re depressed, sluggish, gaining weight or not losing baby weight, having trouble producing milk, anything that’s affecting your wellbeing or quality of life… well, it’s better to not suffer through it and have a miserable experience. Remember you can always come off of thyroid supplements; it’s not something you’re stuck on for life, unless your thyroid doesn’t recover.
NMN: Does hypothyroidism affect birth in any way? Is there something pregnant women should be doing to increase their chances of having the kind of birth they want?
AR: The main thing about hypothyroidism is that it makes you really tired; so one of the biggest concerns would be not having enough energy and stamina. I don’t know of any data other than hormones possibly being impacted, regarding going into labor on time or going overdue.
NMN: What advice do you have for preparing for the postpartum period?
AR: ALL women should get good support, good help for postpartum. If you have a history of postpartum depression or postpartum thyroiditis, there’s a good chance history will repeat itself; statistically, 40-60% of women who have had the problem in the past will have it again. Have someone waiting in the wings who can help you get supplements if you do start developing symptoms. Lastly, just be aware. Be prepared to recognize the symptoms and be proactive if you do, to take care of yourself.
NMN: One of the biggest changes you advocate in your book is a major dietary overhaul, including both short-term and long-term adjustments. Can you talk a bit about some of your dietary recommendations during the reboot?
AR: The most important thing to do right away is to take out the triggers from our diet and our lifestyle. We know, for example, that certain pesticides, herbicides, and heavy metals not only cause inflammation but also do physical damage to the thyroid. So if you have a thyroid problem or are trying to prevent one, it’s important to take out non-organic foods. It’s really a pay now or pay later situation; the cost of developing a long-term health problem is massive. Focus on organic foods whenever possible; look to the Environmental Working Group’s “Dirty Dozen and Clean Fifteen.” The “DirtyDozen” are the foods most likely to be heavily contaminated, so if you can’t afford them organic, just avoid them. The “Clean Fifteen” are the ones that are the least likely to be heavily dosed with pesticides; you can eat them even if they’re not organic. Dairy, meat, butter—those should ideally also be organic. Fish with mercury is a huge problem, because mercury damages the thyroid. Mercury is a neurotoxin, and it’s directly down-loaded to the baby when pregnant.
We also know that chronic inflammation can have an impact on the thyroid. Things in our diet that cause high inflammation are too much sugar, processed carbohydrates, poor-quality fats. Cleaning all of those out of the diet is important. Avoid artificial sweeteners as well, as those have also been found to directly affect thyroid function. You want your diet to be as natural, whole foods-based as possible, especially if you’re trying to conceive, while you’re pregnant, and while you’re breastfeeding.
Another thing that is super important is to make sure to not get low blood sugar. Low blood sugar is a direct trigger to the brain that something is wrong, that you don’t have enough energy to burn. When your thyroid is getting messages from your brain that there isn’t enough energy because you’re not eating enough, the thyroid slows down so that it’s not burning fuel that you don’t have. Make sure that you are eating regularly throughout the day.
NMN: Why avoid nightshade vegetables, or legumes?
AR: In my experience, the legumes and the nightshades are typically more of a problem for people who have rheumatoid arthritis and joint pain. Some nuts can contribute to this, as well. I don’t usually recommend restricting those in pregnancy. Well, nightshades—eggplant, tomatoes, peppers, white potatoes—are not an essential part of the diet, so you can experiment by taking those out and seeing if it improves your symptoms. Legumes, on the other hand, are a really important part of the diet for pregnant and nursing women if they can tolerate them because they provide starches, iron, and protein, particularly for vegetarians and vegans. I usually leave those for last and change the diet in other ways first.
NMN: Many women feel a pressure to be the perfect mom, the mom who does it all and has her life in order. How can this mindset contribute to thyroid disease?
AR: I love this question! It’s funny, because my kids are grown now, but I was definitely that mom. I homeschooled, I breastfed, tandem breast-fed, made homemade everything, including their clothes. My kids are awesome, but they’re not… better than anyone else. Really, my bottom line is that it’s also got to be good for mom. We don’t have to exhaust ourselves into the ground to be good moms. Learning to delegate, to outsource… I have a motto, the KISS method—Keep It Simple, Sister—and really we need to pay attention to how we’re dealing. One of the best examples that we can give to our kids is that we value self-care. Our kids learn way more from what we’re actually doing and modeling than from what we’re saying. It’s really important for all moms to be honest. Being a mom is not happy snuggles and kisses 24/7. We need to be honest with what we want to do—and what we don’t want to do—and try not to be subjected to external pressures.