October 16, 2014

Better than 80/20 - Supplements

Hello again!

Welcome to the first of three posts wherein I detail what I’ve been doing differently that has me feeling better than I have in years. As promised last time, today’s installment: supplements.

I call myself a nutritionist. So why am I starting off talking about pills, and not food? Well, things started getting a little better when I cleaned up my diet, but what has really made a difference—a huge one—is my new supplement regimen. (And yes, the word we want for this is regimen. Not regiment, which is a military unit, and not regime, which is a political entity [usually a dictatorship], as in, “the Pinochet regime.” [Okay, actually, that last one can be used in the same context, but it’s weird. Don’t do it.] Regimen. Regimen. But none of my intelligent readers is saying “regiment” or “regime” in comments and on forums like the great grammatically unwashed, right? Right. The same way you never talk about how “your” not “loosing” weight.)

I am eating a bit differently than I was back when I posted about 80/20 being a step up from where I was, but in my somewhat educated opinion, I think the supplements are having the biggest impact. Well, no, not exactly. I think the changes to my diet and movement are having a big impact on my body, while the supplements are working their magic in my head.

So back to the pills: Sure, real, whole, unprocessed foods are generally the way we want to go, but when you’re already doing pretty well in that area and you feel like things are still a little off, it’s entirely possible that your healthy diet is falling short somewhere. This is especially true in 2014 America, where we’re chronically stressed, chronically worried, chronically sleep-deficient, and chronically joy-deficient. Sometimes our bodies—and even more so, our minds—need a little somethin’-somethin’ that even the best diet either isn’t providing at all, or isn’t providing enough of.  

When this is the case, there is no shame in supplementation. No shame. Better to admit that you need a little help than to resign yourself to feeling less-than-optimal because you think your sauerkraut, bone broth, and cod liver oil “should” be getting you all the way there. News flash: sometimes they don’t.

Being that the way I’ve been feeling for a few weeks now is like night and day from where I was a while back, clearly my body—and mind!—are now getting something—probably multiple somethings—that they were desperate for.

Shooting the Dark...and Not

The particular blend of supplements and the timing at which I take them was arrived at after a long time of experimenting, and quite a fair bit of money spent on supplements that didn’t work. One of my grad school professors liked to emphasize that supplements only help if your body needs them. If you’re not thiamine-deficient, for example, then extra thiamine probably won’t make a noticeable difference. But if you are deficient, then it’s not an exaggeration to say that giving your body what it needs can be life-changing. 

I used my best intuition as to what I needed. Based on my symptoms and my lifestyle, I tried a litany of supplements, including but not limited to: 5-HTP, DLPA, adrenal adaptogens, L-tyrosine, L-tryptophan, methylated B12, zinc, and high-DHA fish oil. None of these seemed to make any difference. (I was especially surprised that the 5-HTP and tryptophan had no effect, being that I could say yes to many symptoms of low serotonin.) I’ve mentioned in past posts that I had a drawer full of supplements I don’t take. Now you know why. Totally ineffective. (For me.)

I finally got rid of everything I wasn’t taking. And even though I won’t get that money back, in the grand scheme, I can consider it money well-spent, as the experimentation and process of elimination eventually landed me on the mix of things that is working—and working damn well. (It’s about time!) After all, the more possibilities you take off the table, the more easily you can zero in on what will be effective.

So my number one recommendation: don’t get discouraged! Keep experimenting. Keep trying things. Work with a knowledgeable practitioner if you can afford to. I was shooting in the dark by myself for a while before I finally wised up to the fact that it wasn’t going so well. I ended up going to a naturopathic doctor, whose services are not covered at all by my insurance. So I spent a fair bit out of pocket, and you know what? It was WORTH EVERY PENNY. (Based on how much better I’ve been feeling for a while now, I would say it was worth twice what I paid!) Put a price tag on your health and well-being. If you’ve felt like s**t for a long time, how much would you be willing to pay to stop feeling like s**t? Whatever your answer, double it! When it comes to feeling great—physically and psychologically—there is no such thing as too expensive.

Okay, Enough blather. On to what you came here for: how I was feeling, and what I’m doing now that has me feeling better.

TL;DR—I am VERY HAPPY with my new supplement regimen. If you’re not interested in the details, feel free to scroll way down to where I list what I’m taking.

If you are interested in the details, here are more than you could ever possibly want:

How I was Feeling

I have been lucky in that I’ve always had good physical energy and cognition, and been free of chronic pain. I don’t know what deep, abiding fatigue feels like. Sure, I’ve sometimes been too tired to hit the gym after work, but that’s just “tired,” not fatigued to the point where walking to the mailbox strikes me as an insurmountable obstacle. I’m not sure I’ve ever experienced “brain fog,” although I can understand and explain the concept. (What day is today? Don’t I have somewhere important to be later? Where did I leave my keys? I’ve read this paragraph three times already; how come I have no idea what it says?) My thinking is always clear, and I’ve always had a pretty strong memory. And I don’t know what it feels like to wake up and have trouble getting out of bed because my back, hips, sciatic nerve—or anything else—hurts.

But just because I wasn’t living in a physical haze doesn’t mean a little gray emotional cloud hadn’t taken up residence over me. Certainly not to the point where I needed medication to leave the house, hold down a job, and generally function in society. But I knew something wasn’t right. And it hadn’t been right for a long time. And I was sick of it. I went to a naturopath in DC a few months ago and got a pretty thorough battery of tests done. Neurotransmitters? Check. CBC? Check. Thyroid panel? Check. Cortisol? Check.

None of the results were surprising. I wasn’t particularly alarmed by any of them, and almost none were out of the “normal” range. The one that was probably the biggest problem was cortisol. I knew it would be high, but folks, let’s just say it was so high that it’s damn near a miracle I haven’t fight-or-flighted my way to an early grave. Holy moly, was that ever off the chart. It was elevated all day, but it was especially high at night, when it should be low. Egads!! (More on that in a bit.)

Let me reiterate: shockingly, none of my hormone levels (except cortisol) was out of range. However, some of these lab ranges are wide. For example, for luteal phase progesterone, the “normal” reference range stretches from 22-240pg/mL. That’s over a tenfold difference. So two women could have progesterone levels of 23 and 230pg/mL and both would be considered “normal.” Funny, huh? And maybe both of them feel like cr@p. My point is, just because a lab reading is “normal” doesn’t mean you’re going to feel well. “Normal”—especially as defined by modern medicine—does not necessarily mean optimal. This is such an important point that I will say it again: “Normal” doesn’t mean optimal. If your lab numbers are “normal,” but you still feel like dog excrement, don’t settle for normal. YOUR normal might be higher or lower than where you are. Find a qualified practitioner who can work with you to optimize things, based on how you feel now, and how you’d like to feel instead.

And this is why I love my naturopath so much. She sat with me for about 90 minutes during our first appointment, to ask questions, really listen to me, and understand my concerns. And when the test results came back, we spent another 90 minutes devising a plan to address those concerns, combining her medical and endocrinology expertise with my nutritional knowledge in order to get me to my goals. I cannot speak for all conventional MDs, but I suspect most conventional docs would have given my labwork a quick glance, noted that nothing was out of range, shrugged, and sent me on my way. (Possibly with a prescription for an anti-depressant and very likely a statin. Love it that my ND didn’t even bat an eye at my total cholesterol & LDL levels, which would have made a conventional MD reach for the prescription pad, stat—and maybe put me on the waiting list for an angioplasty…)

Before I get into what I’m now taking, let me explain how I was feeling:

As I explained earlier, most of what I was looking to improve wasn’t physical, but psychological. I was tired—so, so tired—of the negativity inside my head. I wasn’t clinically depressed, but I was definitely a gloomy gus, to say the least. (Eeyore from Winnie the Pooh comes to mind.) Compared to the unfortunate souls with true, deep depression—the kind that prevents them from getting out of bed, leaving the house, or doing much of anything at all—I was doing all right. But just because I didn’t feel like the emotional equivalent of road kill doesn’t mean I felt good. There’s a gigantic, interesting, beautiful, awesome world out there, and I was tired of not wanting to participate in it. So my mild depression was concern #1.

I suspected that the mild depression was most likely the result of sub-clinical hypothyroidism. Again, I was lucky that I had no major physical complaints that usually go hand-in-hand with a sluggish thyroid. But I had plenty of minor ones: cold all the time, hair loss (severe!), loss of the outer portion of my eyebrows, high cholesterol (we need thyroid hormone for proper functioning of the LDL receptor), difficulty losing weight (I suspect low-carbing is the only reason I wasn’t 300 pounds; I am convinced I would have headed in that direction had I been eating the standard American diet), slow heart rate, and low-ish blood pressure. (Low resting heart rate and low blood pressure are common in well-trained athletes and fit laypeople. I am the latter. My resting heart rate is often in the 50s, and my blood pressure is regularly 90-something over 60-something. In fact, I was turned away not long ago from donating blood, because my blood pressure was 88/55. The lab tech looked at me kind of funny…I think he was trying to make sure I was actually alive and breathing and not about to pass out right there in front of him.) The funny thing is, this never bothered me. I’ve never felt woozy or light-headed from low blood pressure—not even on the 88/55 day.

However, the one big physical complaint I did have was in lock-step with the whole body being sluggish when the thyroid isn’t up to snuff: chronic constipation. As I explained in the post about the large intestine from way back in the digestion series, chronic constipation can cause and exacerbate depression. And let me tell you, it is no fun being depressed and constipated. No wonder I didn’t want to be out in the world loving life.

Beyond the thyroid, I was also a bit concerned about my female hormones. I’d experienced estrogen dominance in the past, and it was no picnic. I felt like some of the symptoms were coming back, and I wanted to nip them in the bud before things got as bad as they were back when it first happened (circa 2011). What is one of the symptoms? Depression. Wow. Was there anything going on with me that didn’t bring depression with it? And back then, the depression was bad. I was in a dark, dark place, and I did not want to go back there. Another symptom is messed up menstrual cycles. (For example, back when it was at its worst, rather than the typical 28-30 day cycle, mine was in the range of 40-44 days.) So this time around, things weren’t as bad as they were when I first sought help for female hormone issues, but I could see it heading back in that direction and I wanted to do something about it long before it did.

Hormone Wackiness

Adding to the suspected low thyroid and female hormone imbalances, one thing I knew for sure was an issue was high cortisol. Yep. Off the charts. I am almost embarrassed to show this to you, but in the interest of full disclosure and helping people out there, here’s what my ASI (adrenal stress index) looked like – saliva collected 4 times during the day.

The reference range is between the two gray lines. My results are the red line. And no, this is not a joke.

I wasn’t surprised. I knew it would be high all through the day, but I was especially freaked out by just how high it was at night­—when it’s supposed to be lower. (All things considered, though, I’d rather it be high for most of the day than debilitatingly low. When you can’t produce enough cortisol, that’s when you can’t lift your head off the pillow and getting up, getting dressed, and going to work are damn near out of the question.)

General test results:

Female hormones: much better than I suspected! A little low on progesterone, but my estrogen levels were much better than they were when I sought help years earlier. Doc wasn’t concerned, and we agreed that these hormones would probably come into balance on their own, as we corrected the other things that were more pressing.

Cortisol: sky-high. Stratospheric.

Neurotransmitters: All okay. (Even serotonin, which was shocking to me.)

Thyroid: All in “normal” range, BUT—not optimal, for me.
          TSH: 0.51 (range 0.40-4.50 mIU/L) – so pretty low
          Free T3: 2.3 (range 2.3-4.2 pg/mL) – very bottom end of normal
          Free T4: 1.1 (range 0.8-1.8 ng/dL) – maybe a little low-ish
Thyroglobulin AB & thyroid peroxidase AB: <10 and <20 IU/mL, respectively. (“AB” meaning antibodies, suggesting no autoimmune process going on here, thank goodness.)

So nothing really out of whack, but enough on the lower end that the doc and I agreed I’d feel better if we could nudge those numbers a little higher. Now, the interesting thing is, my TSH was low, whereas we’re used to hearing people with hypothyroidism having high TSH. So right there, we could tell the problem was likely not with the thyroid gland itself, but farther up in the hormone production factory, namely, with the hypothalamus and pituitary gland. (The hypothalamus produces TRH - thyrotropin-releasing hormone, which stimulates the pituitary to produce TSH [thyroid stimulating hormone], which stimulates the thyroid to produce T4 and T3. So, low TSH means low T4 and T3, but the cause is actually upstream, at the level of the hypothalamus.)

What I'm Doing About it Now

And now, the million-dollar question: WHAT AM I DOING ABOUT IT ALL?

Here goes.

Note: these are MY supplements, and MY protocol, designed to address imbalances that are specific to ME. They may not work for you. I am only posting in case someone’s interested. What is working for me might not translate exactly to your situation, but at the very least, if you are experiencing any of the same things I was, maybe this will encourage you to get some testing done (if you suspect any imbalances) and give you some idea of things to experiment with in your search for improvement and healing.

Most of what I’m taking now is part of a protocol I designed for myself after attending  thyroid seminars by William Kleber, DC, and David Brownstein, MD. I am pleased to say I did a bang-up job and was feeling much better within just days of implementing the protocol, but I still felt I wasn’t all the way “there,” which is what led me to see the naturopath. I felt like a few pieces were still missing, and boy, did we fill them in. (Turns out that what I was taking was pretty good; I just needed more of it.)

My protocol is designed to address all the things I’d been feeling, with the minimum number of pills to be swallowed and timing to keep track of. Specifically, this is designed to address hypothyroidism secondary to adrenal cortical hyperfunction and pituitary/hypothalamic hypofunction. Meaning: my adrenals are pumping out cortisol like it’s going out of style, while my pituitary and hypothalamus are asleep at the wheel.

To put all the pieces together:  My thyroid wasn’t churning out adequate thyroid hormone because my hypothalamus and pituitary weren’t telling it to. And the reason they weren’t telling it to is because of feedback from all the cortisol. The cortisol was telling my body to go, go, go (fight or flee), and my adrenals—in order to protect themselves from burning out—were doing the only thing they could to stop the madness: they were pulling on the pituitary, begging it to slow things down. And like the obedient servant it is, it did, mostly by forcing a slowdown on production of thyroid hormone. Neat, huh? I wish I hadn’t had to learn this stuff the hard way, but you know what? In the end, this makes me a better practitioner. When you’ve been through something difficult, yourself, you tend to understand it a little better, and be better equipped to help someone else get out of the rut by addressing the symptoms and how the person tells you they feel, rather than just treating numbers on their lab report. Testing is hugely beneficial, but it is only the starting point, not the end game. The end game is the living, breathing human being.

Since this post is already a zillion pages long, I might as well make it just a tiny bit longer and explain something very quickly about thyroid issues. It seems like you can't turn around these days without bumping into someone who thinks they're hypothyroid. (At least, in the ancestral health circles.) And I do believe there are a lot of "things" going on with thyroid function, but right there's the rub: in many cases, the thyroid gland itself is just fine. It's those other "things" that are causing the problem, so confining treatment solely to the thyroid gland is asking for trouble. Sure, you might feel better in the short-term (and I am not denying how important that can be when you've spent a while feeling like you've been run over by a Mack truck), but ultimately, whatever the underlying "things" are, they're going to continue to wreak havoc. And because you have targeted the thyroid gland alone, and not addressed the underlying factors, over time, you will require more and more thyroid medication, higher and higher doses, until it stops working altogether and you fall apart, KAPLOWIE! 

So if you suspect your thyroid could use a good whipping, ask yourself WHY your thyroid is sluggish. Too much stress? Too little iodine? Too little tyrosine? The thyroid gland produces mostly T4, and a little bit of T3 (the latter being the much more bio-active form). The majority of the conversion of T4 to T3 happens inside other tissues. And some people have trouble making the conversion. Why? Not enough selenium? Some other reason? High TSH and low T4/T3 suggests a problem with the thyroid gland. Low TSH (with logically resulting low T4/T3) suggests the problem is farther upstream. Elevated reverse T3 suggests excessive stress (I was shocked my R-T3 was pretty good), while elevated thyroid antibodies suggest, of course, an autoimmune attack on the thyroid.

And now, finally, here’s what I’m taking:

(Please note, some of these links will take you to the main website for Biotics, rather than to the individual products. If you click on "Consumer Website," you should be able to bring up the individual products by coming back here and clicking on the links afterward.)
  • Cytozyme PT/HPT – for supporting the pituitary gland and hypothalamus – 2x/day, first thing in the morning, empty stomach. (Contains dessicated pituitary & hypothalamus.)
  • GTA Forte II – for thyroid support. 1/day, first thing in the morning, along with the Cytozyme PT/HPT. This is not a thyroid hormone replacement. It contains no actual thyroid hormone, but rather, actual dessicated thyroid gland (porcine). Nonetheless, when taken with accessory nutrients, it can be used in place of thyroid medication, such as NatureThroid®, Armour®, or Synthroid®. (Please remember I am not a medical doctor. This information comes from Dr. Kleber.) GTA Forte II® contains 0.25mg copper, compared to 1.0mg in a similar product, GTA Forte®. I deliberately chose the lower dose. Keep reading for more on copper.
  • Meda-Stim – specifically formulated to aid the conversion of T4 to T3. Also intended for sluggish thyroid that presents together with the mild depression and PMS associated with excess estrogen. (Hello? Is that me, or what?) 1-2/day, usually one mid-morning on an empty stomach (if I’ve skipped breakfast), and one around noon. (Not recommended past 2pm.)
  • Metabolic Synergy – high-dose multivitamin and mineral designed to support healthy blood sugar and overall wellness. 2-3/day, one per meal. *Contains no copper—keep reading.
  • GlucoBalance® – high-dose multivitamin and mineral specifically formulated for blood sugar regulation. GlucoBalance does contain copper. I had been taking Metabolic Synergy and GTA Forte II™ for a while, but I wanted to experiment with GlucoBalance, because the ingredients are very similar, and I wanted to see if I would feel any different from including some copper. Prior to that, I had been trying to limit excess copper from supplements because the symptoms of excess copper are quite similar to those of estrogen dominance, which I suspected was coming back. 2-3/day, one per meal. Here’s a very neat article about copper and the mind. (Note: I felt noticeably better with the GlucoBalance, so maybe my body needed the copper after all! Who knew?!) So now I do a mix: one Metabolic Synergy and one GlucoBalance per meal, for a total of 4-6 pills/day, depending on whether I have 2 or 3 meals. More on that in the next post, about diet.)
  • Iodizyme HP - high-dose iodine/iodide for thyroid support. This is the same formula as Iodoral, which you might be more familiar with. I don’t take this every day. Maybe 2x/week, when the mood strikes. (But I have also been consuming a lot more fish sauce, which is high in iodine. That’s fish sauce, not to be confused with fish oil.)
  • Phosphatidylserine – for lowering cortisol. 2/day, before bed.
  • Magnesium Citrate (in the form of Natural Calm, the fizzy drink) – 2-3 tsp in about ½ cup of water, before bed. This seems to be helping me have more restful sleep, as magnesium is well-known to do. However, the single most WONDERFUL thing about mag citrate is that I am now POOPING REGULARLY!! (Sorry if this is TMI, but frankly, if you have never been chronically constipated—and I mean bad, for a long time—then you cannot appreciate what a huge, huge win it is to regularly go number two without pharmaceutical intervention [via OTC laxatives] and have it be easy, complete, and all the other good stuff it’s supposed to be. Okay, so I’m pretty sure that is TMI, but so be it.) And like I mentioned earlier, there’s a big link between chronic constipation and feeling sluggish and stopped up pretty much all over, but most of all, feeling sluggish and stopped up in your heart/soul/mind, in the form of depression. I do not think it’s at all a coincidence that I have been feeling pretty damn great, emotionally, since I’ve been…um…going, regularly. So I feel better physically, but psychologically, it’s practically a godsend. (I had already been taking Natural Calm once in a while, but the ND said in no uncertain terms: “EVERY NIGHT!” See? This is where expert help comes in handy. I had also been diluting it too much, which is why until recently, I had generally experienced neither the laxative nor the calming effects.)

One of the greatest things about the combination of the phospho-serine and the magnesium is that I am no longer the coffee addict I thought I was hard-wired and genetically programmed to be. I still drink coffee, because I just plain love it, but I’m drinking less of it, and I’ve even gone a few days having none in the morning. I simply haven’t needed it. For my fellow coffee fiends out there, you can recognize what a big deal this is. I am not kidding when I say that until recently, some mornings, the only thing that got me out of bed was the thought of that delicious joe steeling me to face the day. So waking up calm, refreshed, and feeling human without coffee is damn near a miracle!!

I’m not that concerned with the female hormones these days, but back when I was, two things that helped a lot were:

(Both of the above are intended to help manage estrogen levels.)

Next installment: Diet

In the meantime, please feel free to contact me if you’d like more information on any of the supplements I’ve mentioned here. And, of course, I am accepting new clients, so if you'd like to work with someone who can help you navigate these complex kinds of issues, you know where to find me.

*Word of caution:* If you are interested in trying any of these supplements, please be sure to get them from a licensed practitioner or qualified provider who has professional accounts with these companies (Biotics® and Designs for Health®). You can often find their products “on the cheap” via Amazon and other mass-marketing sites, but you are not guaranteed that you are getting what you think you’re getting. There are unscrupulous re-sellers out there who will get their hands on packaging materials so you think you’re getting a certain thing, but they’ve filled the bottles with something sub-standard. You might get something less potent, or perhaps not even the product you were looking for. Yes, it is that bad out there. Your health and well-being are worth it. Spend the extra few dollars to be absolutely sure you’re getting the items you want. If you want to buy cheap-o toilet paper, or bargain brand trash bags, have at it. But when it comes to things intended to help restore your health, don’t mess around. There’s a reason you can’t get these things at CVS or Walgreens, and there’s a reason they are pricier. (These companies have rigorous potency and purity testing on a regular basis, so that what you think you’re getting really is what you’re getting.)

Remember: Amy Berger, M.S., NTP, is not a physician and Tuit Nutrition, LLC, is not a medical practice. The information contained on this site is not intended to diagnose, treat, cure, or prevent any medical condition.


  1. Interesting stuff. What do think about measurements of vitamins and minerals from urine or blood? I thought I had copper overload but according to whole red blood cell test I am low in copper, zinc, magnesium and good in selenium even though I supplemented with multivitamin, zinc 50 mg, magnesium 200 mg and no extra selenium. However, in urine test, all were fine.
    I eat liver, kidneys, heart, tongue or other cheap pasture raised beef and sardines, salmon or other fish with bones and eggs daily. No dairy, grains or legumes. Daily seeds, nuts, green leafy and other vegetables, starches more in exercise days.
    How about your fat profile? Mine was low in LA, ALA and GLA and high in AA, EPA and DHA. Omega-3 to omega-6 ratio was 1:1.7 without supplementing with fish oil.

    1. Hey N,

      I haven't had any vitamin/mineral levels tested, nor a fatty acid profile. I think they can be helpful if other, broader, higher-level interventions have not yielded positive results/improvements for someone. But for me, at the moment, I'm pretty happy with how things have been improving, so I don't feel a need to get more advanced testing done. Your fatty acids look great -- especially with no n-3 supplementation. You must have a pretty great diet!

    2. That sounds great. You have not dived to the endless laboratory testing well of some functional medicine. You have learned to listen your body.
      You wrote: "And because you have targeted the thyroid gland alone, and not addressed the underlying factors, over time, you will require more and more thyroid medication, higher and higher doses, until it stops working altogether and you fall apart, KAPLOWIE! "
      I am battling this. I was hoping that "great diet", herbs, supplements and drugs would repair in two years the damage of life time of antibiotics, NSAIDs, Accutane, Nexium, SAD, raw veganism, unfulfilling studies, work and now unemployment.
      Your experience is couraging. Will I find the way to lessen leaky gut, SIBO and thyroid problems that is to be seen.

  2. There are so many different kinds of supplements to take, how do you know what to take? My grandfather took a fistfull of vitamins and he lived a long healthy life so I suppose there really is something to them. (https://www.drlam.com/blog/reactive-metabolite-response-adrenal-fatigue/29186/)