Erica Peirson

Erica Peirson, ND

Thyroid Hormones and Brain Development

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[text_block style=”style_1.png” align=”left”]Mike: Erica Peirson thanks so much for being here on the Autism Intensive. I’m really excited to be with you. Today we are going to talk about the endocrinology of neurodevelopment. This is an area you specialize in and I want folks to really understand how the thyroid affects neurodevelopment. Maybe we can start out with how you got into this.

00:17 Hypothyroidism:

Dr. Peirson: My interest in this started out as a personal one. My son was born with mosaic Down syndrome eight years ago. My journey started with studying Down syndrome and the extra chromosome. As I got further into studying Down syndrome, I saw the symptoms of hypothyroidism very clearly. I had lots of conversations, shared studies back and forth with the board members of Down syndrome Options, that I am associated with now. The hypothyroidism came out really strong. Studies show with those children, that a certain percentage of them have hypothyroidism and what I see in my practice is nearly all of them have hypothyroidism. Then the picture of autism came in as well. I started to see the association of hypothyroidism in autism and brain development in general and dug for some studies and they are there, supporting hypothyroidism and that connection with children with autism as well.

Mike: That’s really fascinating. For our listeners that want to know why, like physiologically how does hypothyroidism lead to neurodevelopment issues in these kids? Can you please explain the back story on that?

Dr. Peirson: Yeah, so there are many things that are important for in utero brain development: proper B12, folate levels we know, iron levels, choline, fish oil is really important for brain development, but a really important piece that shouldn’t be missed is thyroid hormone. Thyroid hormone is super important for brain development and even short periods of hypothyroidism during pregnancy can lead to an impairment in brain development that, a little bit controversial, can be life-long, however, we always hold on to the notion that the brain is very plastic and healing and brain development is possible, certainly after birth, but in utero brain development, yeah, highly dependent upon thyroid hormone.

Mike: That’s really fascinating. People generally know that thyroid hormones, T3 and so forth, speeds up cellular metabolism, but what you are saying is that in utero it is very critical for that early development of brain neurons and so forth.

02:37 Sonic Hedgehog Genes

Dr. Peirson: More specifically, is that thyroid hormone controls genes. One of the many genes that it controls, we don’t know exactly which gene it controls because every gene does have a different epigenetic control mechanism to it, but we do know a fair amount of studies in evidence that T3, active thyroid hormone as you mentioned, controls the sonic hedgehog genes, which some of your viewers may or may not know what sonic hedgehog genes are. They are named after a video game character that the geneticist that discovered these genes was a fan of, so unfortunately, he named these really important genes after this video game character. But the sonic hedgehog genes are what control fetal development, embryological development, right down to skeletal development, brain development, organ development and so it’s really, as I understand it, the control that thyroid hormone has over the sonic hedgehog genes, of ten abbreviated as SHH genes, if anyone wants to look into them further.

Mom’s Hypothyroidism

Mike: So this is a really higher order control over our overall genetic expression, which is pretty powerful. Now, the prevalence of hypothyroidism is so pervasive typically in women, which are developing this fetus. Is there any data linking hypothyroidism in moms and neurodevelopment issues in babies?

Dr. Peirson: Unfortunately, yeah. There are quite a few studies. Some of them date back to the 1990s. We’ve known this for a long time that hypothyroidism in mothers not only leads to an increased rate of miscarriage, which some would say is a sign of birth defect, and hypothyroidism in mothers leads to other birth defects outside of neurodevelopmental issues. It does lead to an increased rate of having a child with Down syndrome and then, yeah, studies show that hypothyroidism is linked to autism as well, particularly autoimmune hypothyroidism in mothers.

Mike: Hashimoto’s and Graves or one of the other’s more commonly?

Dr. Peirson: Hashimoto’s is studied more because it is more common, but I have looked at a few studies that look at hyper and hypothyroidism and, yeah, hyperthyroidism is just as detrimental as hypothyroidism in utero.

04:56 Iodine Deficiency

Mike: Before I lose track of this thought, I want to talk about iodine, because we know that iodine, like vitamin D, is one of these micronutrients that’s so deficient commonly. Have you looked at some of the data linking iodine deficiency in children and mothers?

Dr. Peirson: Yeah, absolutely right. There are many factors that impair thyroid hormone, unfortunately. Iodine deficiency is one of them. I think we take for granted that we went through a period in our culture and our health mandates that salt was iodinized to address that, but we getting back into a high prevalence of iodine deficiency, as people start to avoid salt, eating less sea food, certainly not eating many sea vegetables, so iodine deficiency is a lot more prevalent than previously thought.

Mike: And speaking of iodine deficiency, the halogens are compounds that can interfere with iodine function, so how often do you look at halogens in mothers and children? Have you found any…?

06:01 Fluoride

Dr. Peirson: Totally, right? I see patients nationwide and I ask families “Is your water fluoridated? How long do you go to the pool? There is bromide in wheat. I think that a lot of people, perhaps avoiding wheat, maybe they are benefiting from the low bromide. Bromide is used as a dough conditioner. I am not sure exactly how it works, but avoiding all those halogens as you mentioned is important because they are all lined up on the periodic table of elements, as you know. Iodine, correct me if I am wrong, is the heaviest of those, I think. It’s on the bottom of that periodic table of elements and so it is very easily displaced by the lighter, we are talking kind of cellular chemical structures, but it is more easily displaced by fluoride. The studies are there. All of these people trying to put fluoride in our water. The studies are there that low IQ is linked to fluoride in the water. There was just a study that came out from the U.K. just posted on my FaceBook page that fluoride is linked to low IQ, and that, the root cause, I feel is the hypothyroidism, an iodine deficiency it is creating.

Mike: Gosh, this is really great information, Dr. Peirson. A lot of folks talked about the endocrine disrupting chemicals, the benzene, the toluene, organochlorides and so forth, and we know that those effect the endocrine system, the hormone system and also the thyroid glands, so is there a connection there that you’ve found? I know from a research prospective and clinically?

07:29 Endocrine Disruptors

Dr. Peirson: Unfortunately, like I mentioned there are many things that interfere with thyroid hormone function. We don’t understand all of them. I think admitting our arrogance is really important. Heavy metals, too, impairing thyroid hormone function and it’s not always direct. It’s not like the thyroid is taking a hit from these things. It can be indirect. These chemical compounds can affect the liver, which can create an elevated reverse T3, because a lot of reverse T3 is generated in the liver, but how they specifically work isn’t totally understood as far as I know, a lot of endocrine disruptors in our environment that we are exposed to: plastics, additives to gasoline, and certainly heavy metals.

Mike: And flame retardants in the furniture we are sitting on probably right now. It’s pretty scary. We have gotten rid of all the beds that had the brominated flame retardants. The last thing is the couch, because they are pretty expensive to get a nice organic couch and stuff like that.

Dr. Peirson: Right, right, yeah.

Mike: It can be really tough. So let’s go back to what you were saying right there, so it’s not just that these chemicals affect the thyroid gland output, they can affect peripheral metabolism, which is equally detrimental. I just want people to understand that because most practitioners, traditional practitioners just look at the brain to thyroid communication via TSH and I know you have some data there that’s great, but talk to us about some of the tests that you like to look at, including TSH, but particularly in children. This is a new area.

09:03 Thyroid Testing

Dr. Peirson: In terms of just routine thyroid, blood draw labs, the labs I like to run, great question, ‘cause this is such an important topic. If we can just get the right labs on people, so many doctors order just a TSH and then sometimes we’ll get the free T4 also, but that’s only checking half of the process. The TSH, of course, comes from the pituitary gland from the brain. T4 comes from the thyroid gland, but then what is happening after that? How well is that T4 being converted to T3? Is reverse T3 a part of the process? It goes even beyond that and so just those 4 labs are important to see, but there is so much more on the cellular level that we can’t see through a simple blood draw, but those are at least more comprehensive than conventional medical doctors will look at. And then, I want to look at iron levels, because they are important for thyroid hormone function, to have proper iron levels. I’ll definitely want to look a CBC because there are some markers in the CBC that can tell me if thyroid hormone is off, particularly platelet levels, platelet count. I don’t like it over 400. If I see platelets a little bit high sometimes, low also. I say aberrant platelet levels, platelet count, but if they are high in number and small in size, that can be a thyroid issue.

Mike: Let’s pause right there. Is that related to parasites then? What would you say?

Platelets

Dr. Peirson: So platelets, I don’t know the direct…I always want to know exactly what’s going on and I haven’t found it yet. It could be inflammation. There are some studies that show that inflammation causes high platelets, but then is that inflammation from hypothyroidism? I take the whole picture. I don’t just say “Oh, you’ve got high platelets. You’ve got hypothyroidism.” I look at every little clue. It’s like detective work. I look at more comprehensive labs. They are important.

Mike: That’s pretty fascinating. So, the platelet count, you look at both adults and children, is what we’re saying.

Dr. Peirson: Yeah.

Mike: To get a higher viewpoint of thyroid health, interesting. You often don’t hear about platelets. People talk about white blood cell counts and lymphocyte to neutrophil ratios, but platelets, that’s pretty…

Dr. Peirson: I want to hear about lymphocyte to neutrophil ratios too.

Mike: So you can kind of tease out is it viral, bacteria, or chronic or some of those things. My old mentor taught me that a long time ago, but let’s goes back to children. I have a 3 and a half year old and we both have children and I don’t remember getting any thyroid assessment, any workup, I think that is not really considered for a lot of pediatricians. We have interviewed one integrative pediatrician that you know, Paul Thomas and we talked about his labs. Who should be testing thyroid hormone..?

11:47 Infant Thyroid Screening

Dr. Peirson: Awesome. It is state mandated, state to state, that all newborns are and should be screened for hypothyroidism. Children are screened for a lot of genetic conditions when they are born: PKU, hypothyroidism, there may be a couple others, but it is different from state to state, number one, but they are screened for thyroid hormone and how they are screened is different state to state. When I looked back at my son’s records, all they did was a free T4, no TSH, no T3 and we can talk about reverse T3 in infancy, but screening for hypothyroidism is pretty much done for every child, but to go a little further there, it’s different state to state and every state has a different cutoff for their screening TSH. Some states are higher than others. If I could share a little more, for example, there is a mom who I am in touch with, her son was born in the state of Michigan and at the time of his birth, which was approximately 4 or 5 years ago, the cutoff for hypothyroidism in newborns was a TSH of 33, which as your viewers may know, a typical TSH certainly it can be slightly elevated in newborns, but for an adult a typical TSH is .5 to 2.5 is a healthy TSH. So a TSH of 33 is pretty high, so her son, his name is Micha, her website is Michaboygenious. She shares her story as far and wide as she can to help other children, but his TSH was 30. The cutoff was 33. He was sent home and many sick visits to the doctor’s office, ear infections, slow growth, all these things that we would expect, constipation, all these things we would expect in hypothyroidism didn’t get caught until he was 2, when his TSH was finally tested again at 2 years old. Two years went by. His TSH was 12 and he was put on thyroid hormone which quickly reversed many of his symptoms, but now he has the diagnosis of autism. His mom is a, I’m so proud of her, she is such a strong advocate and she is meeting with state representatives to try to get this TSH checked and lowered, so more children can be caught. Probably today, yesterday, sorry I get emotional, some children were born with hypothyroidism and they were sent home. So those children that were born that we know that just happened, they are going to get autism because of that congenital hypothyroidism that wasn’t caught. Jessica, she is working really hard to change that in her state and that is one of 50 states. I don’t know what other state mandates are for this, but that screening process is really important and just take it one step further, I think the screening is very important, but it is a number on a page and I don’t know where the training the doctors get, where it goes wrong, but they are not trained and they are not looking for hypothyroidism in children, because it is thought to be uncommon, but I don’t think it’s as uncommon as it once was. I think it’s a lot more common and so the symptoms of hypothyroidism aren’t being address. They are not looking at the kids, just looking at numbers on a page.

Mike: Right, and my follow up question to that would be, I guess commentary, having worked with physicians for the last 10 years is “Why do lab test if you don’t know what to do with it?” So I think a lot of physicians would be intimidated by hypothyroidism in an infant, in a child, like “I wasn’t trained to treat this particularly” so maybe I think that could, if you could elucidate on that, so let’s go back to Micha’s story. What would you have done if you were the physician working with that mother?

Dr. Peirson: I would look at the mom first. Was the mom experiencing hypothyroidism?   I don’t know Jessica’s health history, but as an example, was mom experiencing hypothyroidism in utero, during pregnancy, her history, her childhood even, maybe? Does she have a family history of hypothyroidism and can we break that cycle by maybe giving her some thyroid hormone at birth. Yes, that could indicate lifelong thyroid hormone dependency, but is that enough of a reason to not give it? I would look at the mom’s health, for sure. So what would I do with that infant? Is the child experiencing iodine deficiency? Does that child just need some iodine? Is it a selenium deficiency? Is it a zinc deficiency? Those things take time and the children I work with with Down syndrome particularly; I don’t want to waste any more time, so I give them thyroid hormone pretty early on, if the labs and everything warrant it. Would I have given him thyroid hormone from birth? Possibly, yeah, sure.

Mike: And still work on the accessory co-factors, like the zinc and selenium that you mentioned and iodine to really help, but you are saying that the impetus there to give this early, the thyroid hormone early is it is so critical in neurodevelopment, so why waste any time.

Dr. Peirson: Right. Right. Exactly. Exactly and so we don’t know what amount of time is okay. Can a child be hypothyroid for a week? Can it for a month? We don’t know what that period of time is. Good point. The root cause does need to be addressed, but at the same time, giving that child thyroid hormone can change the trajectory of their life.

Mike: In a very significant way. So I’m glad you…no one has brought this up. I mean this really interesting and I’ve gone to a lot of functional medicine conferences and no one has really addressed this, so I commend you for diving deep and spreading the word. This is awesome.

17:40 Mitochondria Function and Thyroid Hormone

Dr. Peirson: One thing that’s talked a lot about in the biomedical autism community conferences, research is mitochondria function. Really important, right? I’m sure some of your speakers for this lecture series have talked about mitochondria function and it’s very obvious. The studies are there. Really obvious support that thyroid hormone is needed for mitochondria function as well. Not only T3, but T2. Do a little PubMed search for T2 hormone and mitochondria function, really interesting, a lot of stuff comes up. The important piece there are those deiodinase enzymes that make those T3 and T2 from the T4 that comes from the thyroid and so those are needed for mitochondria function as well.

Mike: Let’s dive into that. No one has explained that. So we have T4, T3, T2….

Dr. Peirson: Yeah, there’s T1.

Mike: Let’s talk about that.

18:37 Thyroid Hormone Explained

Dr. Peirson: Thyroid hormone T4, it’s simple math. It’s called T4 because of the 4 iodine on it. One of these days I am going to make a big plush model or a cardboard something to show my patients. That T4 hormone based on its shape, is again, as far as we know, there are no receptors on the body that it fits into. Unless you know something, there are no receptors as far as we know that the T4 hormone turns anything on. One of those iodines has to be removed for T3 to exist and then T3 fits like a lock and a key right into the cell right onto the DNA, and then yet again another iodine can be removed so we get T2. That again, the studies show and a lot of support that a lot of those. It was really interesting when I did that search. I was like “Whoa”. T2 and mitochondria function and then T1 there is a lot less information about T1, thyroid hormone, but we take off another iodine you get T1 and all those iodines can be recycled to make more thyroid hormone too.

Mike: Interesting. That’s really fascinating. So, I wonder what happens then. I’m just thinking out loud, with reverse T3. Do we get the same T2 formation, because it’s like kicked out a different pathway, a different deiodinase enzyme. That’s interesting, the root cause, eventually of mitochondrial dysfunction could be from aberrant thyroid hormone metabolism, which is a really interesting discussion.

Dr. Peirson: It totally could be. There are many pieces to this puzzle. You mentioned those deiodinase enzymes as I mentioned being really important and that is where the selenium comes into play. They are actually called selenoproteins. If I could just mention one, there is this really great, another website from another mom talks about hypothyroidism in her son who was diagnosed with autism. He is in the process of recovery. It is very exciting watching her story as she shares with everyone. She mentioned that what was caught in him was a selenium protein receptor, oh, I knew it last night, SelenBP1 I think was the gene, for the selenium receptors and he had a defect in that gene and so he needed higher doses of selenium, so she is correcting his hypothyroidism. Again, he had a high TSH when he was young. She talks about her story, that it was ignored by doctors. They do a watch and wait. Let’s just watch and wait. Meanwhile, the child, they are losing their kid. So he just needed higher doses of selenium than normal. Because those deiodinase enzymes are so selenium dependent, as is glutathione and other areas of the body that need selenium.

SupplementalThyroid Hormone Dosage

Mike: This really reinforces this whole naturopathic/functional medicine approach, because it’s not just one thing. Everyone is individual and unique. You need to look at the big picture. Having that little snippet of information and diving deeper and doing the nutrogenomics and some of the SNP testing, really important, so thanks for sharing that. Let’s talk about dosing. For parents that maybe want to encourage their pediatrician to start their child on thyroid hormone, do you do a mix of T3/T4 micronized? Can you get into specifics?

Dr. Peirson: For my practice, I use a natural desiccated thyroid hormone. I do have a slight preference for naturethroid over armour thyroid. They are fairly equivalent. It’s just a slight clinical preference. I’ve just seen some better outcomes with it. So I use natural desiccated thyroid hormone that comes from pigs. We are genetically similar to pigs. That’s where we get insulin, heart valves from pigs. It’s kind of interesting. They secrete thyroid hormone from their thyroid gland in a 4 to 1 ratio. Our thyroid secretes thyroid hormone in a T4 to T3 in an 11 to 1 ratio, so we do get a little bit more T3 in the natural desiccated thyroid hormone, but for a child who is struggling, children with Down syndrome that I work with, children with autism, with gut dysfunction and oxidative stress, that works really nicely. We want a little bit. We don’t want to rely too much on that T4 to T3 conversion. When I do use thyroid hormone, I use natural desiccated thyroid hormone, I’ll use the compounded T4 and T3 if I am working with a family that’s kosher and they don’t want to do the thyroid hormone from a pig and so that’s what I use. In terms of dosing of that, oh and I never use levothyroxine. For some people it works, but these kids that I’m working with, a lot of kids that come to my practice, they are struggling in their health and so that levothyroxine doesn’t always work. So I tend to not use that. Dosing wise, natural desiccated thyroid hormone historically was dosed in what are called grains, quarter grain, half grain, ¾ of a grain, and up to 3 and 4 grains. Now we dose it in milligrams. We know that in ¼ grain of natural desiccated thyroid hormone is 16.25 milligrams of that natural desiccated thyroid hormone in the naturethroid. Many endocrinologists will tell parents that it is not standardized. We don’t know how much thyroid hormone it is. It’s not regulated. None of that is true. I can call CVS. It is FDA regulated. It comes from a pharmacy. Every pill, every batch is tested. We know that, at least in ¼ grain of the natural desiccated thyroid hormone there is 9 micrograms of T4 and 2.25 micrograms of T3. I do know exactly how much thyroid hormone is in there. A lot of those myths are just that. The endocrinologists are taught from the synthroid. They teach them this information that isn’t true. On a very young infant, certainly I’ll start them on the very lowest dose possible and then we titrate up. I’ll adjust dose based on symptoms, but then at some point we have to stop and wait. That’s the nail-biting couple of months that we have to wait to see labs. Did we get the dose right? It is a bit of a Goldilocks medication. You’ve got to get it just right, but once you do, it can really make a big difference for a lot of kids.

Mike: So you look for things like energy levels, constipation, what are the common symptoms?

25:19 Effects of Thyroid Hormone in Children

Dr. Peirson: The symptoms that I tell parents that we typically see the biggest change in, if the child is having issues in this area, are skin and digestion. If the child has circulation issues, my son used to get purple from his toes to his thighs, purple. I would rub his legs, horrible like purple hands, horrible circulation. If I could just go back in time. So we look for changes in circulation, because that can happen within a day. They just get pink and warm and if they have dry skin that can change pretty quickly. I’ve heard of hair even changing pretty quickly, if they have dry course hair. They will say it is like they put conditioner in their hair, but they didn’t. Their hair will get shinier and constipation. I’ve had parents tell me reflux is gone in a day. These are children that are refluxing every day, spitting up. Upper respiratory congestion can be gone in a day, because that upper respiratory congestion is often a consequence of the reflux. Those things can happen pretty quickly. Of course, growth, that’s going to take time. Increased muscle tone, that’s going to take time. Teeth coming in, that’s going to take time, but sometimes, if I have a parent coming to me, I’ve got some kids who are two and have no teeth yet, at 2. Sometimes they will still have an open fontanel at 3. The teeth are interesting. You know that they are just waiting there. They are just there ready to come in, just that delayed development is keeping those teeth from coming in, so I will tell parents, just get ready, because they are just going to be teething. They are just going to pop right in and they do often.

26:55 Thyroid Hormone in Infancy

Dr. Peirson: Thyroid hormone in infancy, I’m shifting gears here a little bit. Thyroid hormone in infancy works a little bit differently than in adulthood. In infancy and childhood, it’s a hormone of metamorphosis, those sonic hedgehog genes right in development, like literally when the tadpole loses its tail and gets its legs, that’s thyroid hormone. I’ve said this before. I know. That change in that tadpole, right? Same thing in children, their teeth come in, their face grows, their skeleton grows, their fontanel closes, that’s thyroid hormone and when that doesn’t happen, then that delayed growth, teeth not coming in, those are all signs of hypothyroidism. Some of those take time, but some can happen pretty quickly, changes, yeah.

27:44 Pre-pregnancy Strategies

Mike: This is really fascinating. Some things come to mind. Maybe we talked about, but birth control pills have no effect, peripheral thyroid hormone production, so if a mom is thinking of getting pregnant, I know it’s shifting gears, but just it’s just on the tip of my tongue, but I think it’s important, so if a grandparent is listening, a parent that is talking to their friend who wants to conceive and we know that the importance of thyroid hormone in the mother is so important for neurodevelopment and overall development and growth of a child, what pre-pregnancy tips, planning, strategies, dietary strategies specifically in the context of thyroid health, would you want them to know about?

Dr. Peirson: A lot of pressure on moms in order to have the healthy environment for a healthy baby, healthy conception. Being aware of hypothyroid symptoms for one thing, excessive fatigue, is there any hair loss, dry skin, losing the lateral eyebrows, thinning of the lateral eyebrows, inability to lose weight, did I mention excessive fatigue. Nutrients that are really important for thyroid hormone, where is your iodine coming from? What are your iron levels? Low iron really common in menstruating women, preconception, not to mention B12 and folate, that’s from a good healthy diet, so for example, I was a vegetarian for a number of years, 20 years, before and during. When I conceived my son, what where was my iodine coming from? I wasn’t eating fish. I wasn’t eating sea veggies all that often. My iron levels were low. I know during pregnancy they were low. I don’t know what they were before I even conceived my son. Stress was a big factor. Stress plays a big role on thyroid hormone function. What should moms be aware of is the symptoms of hypothyroidism, what is their family history of hypothyroidism, and are they currently experiencing any hypothyroidism? Some people have asked the question, should every mother be screened for thyroid hormone before they get pregnant? That’s a big step. It’s a little bit like a lot of people know their cholesterol level. I think we should all know our thyroid status. I don’t let anybody come to my office. It’s like their ticket to my office. You’ve got to bring your thyroid labs with you. Honestly, because that’s what I do and I want to know everyone’s thyroid status. Does every woman need to do that before she gets pregnant? Not necessarily, but if there are any concerns, run some labs, the full thyroid labs.

Mike: Yeah, that was my next question. So it’s not just about TSH, what are some other, what are you ideally, when you say, “If you want to be a patient of mine, this is what you have to do” what are those labs?

Dr. Peirson: For pregnant women or children?

Mike: Let’s do both.

30:42 Thyroid Labs

Dr. Peirson: So for women who are working on fertility, or who are currently pregnant, they are on my website, actually. It’s literally like you’ve got to get these labs done. TSH, free T4, free T3 and reverse T3, thyroid antibodies, TPO and TGAB (thyroglobulin antibodies), progesterone levels, pre-pregnancy or even during pregnancy. I track progesterone levels during pregnancy. I’ve got some charts I look at. Progesterone levels, CVC and a full iron panel, which is serum iron, percent saturation, TIBC, and ferritin. Of course, I’d always want more: vitamin D, B12, and just some basic labs before walking in the door. For kids it’s similar, but I have to worry about blood volume in children. We can’t just draw as much blood as we want from a child. So it’s the TSH, free T4, free T3, reverse T3, I always get those four. That’s what I do in my practice and a CVC and at least a ferritin in a small child. If we can do a full iron panel, we do, but those are the basic labs. Those are the ticket into my door, I guess.

Mike: That’s really fantastic. Are there any strategies, if you see reverse T3 high, we know there’s stress involved and cortisol and maybe even belly fat and that or do you jump into treatment. Want to talk about that?

32:03 Reverse T3 Levels

Dr. Peirson: This is, I feel, one of the most cutting edge things that I do in my practice. Now this is specific to Down syndrome, not autism, but this information certainly applies to children with autism as well. What I do in children with Down syndrome is checking for reverse T3 and what I’m finding is that in these children, reverse T3 is elevated, quite often in children who are certainly under the age of 2, nearly 100% of them. Why that is is that we are all born with a high reverse T3 in infancy, in utero. In utero, the fetus, embryo, infant has a high reverse T3 level to protect it from the large volume of thyroid hormone from the mother’s body. So that child is born and they will have a high reverse T3. They will have a high TSH, because that is their body kicking in to that 20 degree drop in temperature, 20+ degree drop in temperature. Their thyroid hormone goes “Whoa, we need to like heat up this baby.” And so the TSH will spike, but the reverse T3 is still there from in utero environment. There is one study, Mike, from 1975. This needs to be looked at again. It clearly states that they tested infants that by 9 to 11 days of life, it stated, that reverse T3 should come down to that of an adult. You can’t go longer than probably that period in a hypothyroid state. That infant needs to get its thyroid hormone working to the level of an adult. What I’m finding in the kids that I work with is that reverse T3 just doesn’t come down. It just stays high because of, in the kids I work with oxidative stress, gut issues, stress within the body that can contribute to that extended period of high reverse T3. It’s not studies in kids with autism either. I think it needs to be revisited. Reverse T3 in infancy, is it contributing to autism? I am sure it is contributing to a lot of the symptoms that children with Down syndrome have. I give these kids, these infants as early as 3 months old, not quite there yet, in terms of my comfort level before that, but at 3 months old, I’ll give them Liothyronine, T3 only medication. I’ve given it to some children without Down syndrome who clearly have symptoms of hypothyroidism and a high reverse T3 and their symptoms are greatly alleviated. I could share some cases with you of children without Down syndrome, when we give them Liothyronine, they’re choking, gagging, it’s really heartbreaking when I have an appointment and I see this child just sitting there struggling. They are not resting. They are not restful, because there is choking, gagging, reflux, delayed gut motility as a hallmark of hypothyroidism. I use T3 only medication, hopefully short term, get that process switched, get that reverse T3 down, which it will do pretty quickly, wean them off it, watch them closely, watch labs, maybe use natural desiccated thyroid hormone, if needed, but T3 only medication.

35:18 Hypothyroidism and the Gut

Mike: That’s amazing. So it brings up the question, because up to now, a lot of folks have talked about gut health and candida overgrowth and SIBO and all these different things but, if digestive motility, enzymatic secretion, hydrochloric acid, the whole bit is not working due to thyroid hormone, it makes you step back and say “Is a lot of the G.I. stuff that we are seeing now, is that really an endocrine affect from early life?” It’s pretty interesting. Have you ever pondered that question?

Dr. Peirson: So it’s tough. It’s a chicken and egg situation. I am sure a lot of people have used that term. It’s tough, right? One thing creates another deficiency, which creates another issue and then where do you, at what point do you intervene? Can we correct hypothyroidism, whether it’s NTIS, euthyroid sick syndrome or whether it’s overt hypothyroidism from an iodine deficiency, can you correct that just by treating candida, SIBO, microbiome, dysbiosis? Can that correct the underlying hypothyroidism while that child and person is in a state of hypothyroidism? That’s such a barrier to health, that hypothyroidism. For example, SIBO, bacterial overgrowth in the small intestine, the recurrence rate is high. You can treat it. You can throw antibiotics at it, antimicrobials, really not easily treatable, but it’s treatable, SIBO. The recurrence rate is high, because if you don’t address the underlying cause of gut motility issues, which can be mitochondrial dysfunction. It can be nerve damage from SIBO, but it can be hypothyroidism, if you’re not addressing the underlying cause, yeah, it’s going to return. It’s tough. I struggle with this too. Can I help this kid with this thyroid and I have this conversation with parents. I do all the time. What do you want to do? I share with them what I know and there is a decision-making process. Some kids, their thyroid labs and their thyroid function isn’t too bad and we’ll, as quickly as we can, address some underlying issues, but if it’s bad enough, I feel let’s get some thyroid hormone in there, correct that, do some healing in the hopes….my son takes thyroid hormone. He is on his healing journey. We are doing organic acid testing, something called a pallet expander, getting his breathing and his sleeping better, getting his cortisol down, in the hopes that someday we can get him off thyroid hormone.

Mike: Interesting. That’s fascinating. Another thing that comes to mind and you tacitly implied, when you were a vegetarian, you mentioned, you kind of emphasized soy protein and I want to talk about some the things, because there are a lot of different diets out there, vegans, vegetarians, and people have religious reasons as to why they are doing this. If you could go back in time, 20 years ago, you know you are going to have a child one day, what would you have done differently and still maybe had a vegan/vegetarian diet?

38:25 Shortfalls of Vegan/Vegetarian Nutrition

Dr. Peirson: That’s really great. Look, I understand vegans and vegetarians. When I have someone come to my practice, I do a little sssss, tough, but I get it. It was there. I am not a fan of current modern animal farming practices. They are brutal. What would I do if I could go back in time? I would eat meat. I would continue eating meat, maybe. Making different choices, when you are in your 20s you’re learning about the world and you are really excited about this new way of thinking and this new philosophy and way of eating. But really, I think there is a lot of nutritional benefit to meat, but if somebody wanted to remain a vegan or vegetarian, what they are missing in their diet, choline, one of our really important for brain development is choline, and our highest source of choline in our diet, we do get it from eggs. Vegetarians will eat eggs, vegans not so much. Meat also high in choline. Another nutrient that we get from meat is creatine. Creatine is really important for methylation. As far as I know, it’s not a methyl donor, but the body’s process of making creatine is one of the biggest draws on methylation within our body. The production of creatine within the body uses more methyl groups than all methylation processes combined. If we are not getting creatine in our diet, our body really has to make a lot of creatine. That’s a huge draw on methylation. We know that methylation is so important for neural tube development and general fetal development. So choline, creatine, another C one is carnitine. Carnitine is really important for mitochondrial function. It shuttles the fatty acids in the mitochondria. B12 and iron from meat. Any others that you know of? Those are some of the biggies. I would supplement with those.

40:28 Creatine

Mike: The creatine thing is so fascinating, because when people hear creatine, they think body builders and football players and you get muscle cramps and stuff and have kidney failure, which is not true. It’s really interesting. Ben Lynch mentioned the amount of demand that creatine places on methylation, so if I heard you correctly, I just want to really drill this in. If you are not getting creatine from your diet, then your body is going to over-compensate from a methylation standpoint to try and make more, which can then effect the transmitter production, detox…do you want to talk about that?

Dr. Peirson: What creatine does in the body too, really important, creatine is, anybody who has studied basic biochemistry and cell biology, creatine is a, creatine phosphate helps the cells and mitochondria within the body recycle ATP. ATP is the molecule of energy that every cell uses for energy. We need that creatine phosphate to help recycle that ATP. It’s a real energy contributor to the body and muscle function. It’s really necessary and fundamental to our body. Many things that are essential and fundamental to the body that are that essential, the body will make itself, in addition to getting it from our diet. It’s really important to compensate for that demand that our muscles need for energy by getting it in our diet. I’m not sure if I answered your question directly ,but I think what it does is really important too.

Mike: Let’s talk about supplemental standpoints. I didn’t want to interrupt you. You were going to a great place with iron, which I want to get back to. Let’s talk about supplementing with creatine. Have you ever looked at that?

Dr. Peirson: Absolutely. I look at urinary creatinine levels in children. Creatinine is how our body excretes creatine. Our body converts it from creatine to creatinine and then it is excreted in our urine. So I will look at creatinine levels as a guide to what their creatine levels are. It tends to be lower than adults, in children, but I’ve seen some really low creatinine levels in the urine. So I use that as a guide as well as symptoms. Certainly the children with Down syndrome that I work with, we want to support methylation wherever we can, not too much, of course but I do. I supplement it with creatine, small doses, of course, but supplementing with creatine.

Mike: That’s fantastic. Okay, so we are going back to the vegan diets. So back up a little bit. Vegan diets and iron and I think we were going to hit on soy a little bit, like other things that you want to catch up…?

43:09 Soy

Dr. Peirson: I know when I was a vegetarian, soy protein powders and lots of tofu and things and everything in moderation. Some people avoid soy like poison, a little bit. There are questions about GMO and how much of the GMO soy is leaking into the organic soy base, but everything in moderation. I used to eat a lot of soy. Yes, there are studies that show there are some health benefits to soy, but I think it also is detrimental to thyroid function and too much of a good thing isn’t such a good thing. A lot of vegan and vegetarian diets are heavy in soy. That can make an impact. Who knows? We will never know what exactly causes each individual’s thyroid dysfunction, perhaps. It’s a puzzle like everything else and soy is a piece of those puzzles, is a piece of that and I would avoid it. We eat soy in my family now once in a while, almost like a treat, but not as much as I used to, that’s for sure.

Mike: So the soy that you eat now, is that fermented? Is there anything different or special?

Dr. Peirson: Yeah, when we do eat soy, it’s tempeh, so it is fermented. I can’t speak specifically on how that impacts, maybe you know, but I do know that the fermenting process can, I think the phthalates, maybe can optimize your body’s ability to use the soy in a more healthy way.

Mike: Interesting. Yeah, I’ve heard and read about that. I used to be a big soy fan myself. Then that kind of spurred some health issues which got me into this industry, thankfully. So I want to thank soy for that discovery there. The thing about soy is it does have a good taste. I remember the soy protein. I loved the taste better than whey protein. I don’t touch it now. It’s really cheap, so that can be a hard thing for people who are on a budget and want a vegan protein and soy seems like a great option. You might hear some studies like the enterolactone made by soy and the gut bacteria and its good for you, but it’s really contaminated and I think the fermented soy, I believe and I could be mistaken here but I guess it has less enzyme inhibitors evidently. I’m one of those people. I avoid it after reading the book “The Whole Soy Story” that research out of University of New Mexico. I said “Okay, I’m done with this stuff.” Great info, so as we close up here, anything that we didn’t get to touch on that you feel is important to address or any closing statements that you want to jump to?

45:49 No Single Cause of Autism

Dr. Peirson: One thing that we didn’t touch upon as a whole. I know a lot of your other speakers have talked about microbiome and maybe autoimmune and stuff, but I think and maybe vaccines too. One thing that, there are studies that connect these dots, but autoimmunity in general is on the rise. Hypothyroidism in mothers and fathers, for that matter, it’s on the rise, autism on the rise, and they are all connected. What is the starting point? There is no one thing. That’s the thing. I know some of your other speakers have probably said this, everyone wants the answer. It’s really nice when science can do that. In medicine and science we want to put everything in little black and white boxes. This equals this. You have a headache, you take aspirin. This causes autism. I wish it was that simple. Don’t we all wish it was that simple? But it’s not. This hypothyroidism piece is just that. It’s a piece. Gut microbiome is a piece. Our microbiome as a whole is shrinking. The misuse of antibiotics is ridiculous and the impact that has on a mother’s health, her infant’s health, her future and that future infant’s health. There are many causes of autism. I think this thyroid piece is just that. It’s a piece and there is no one cause. I don’t want doctors, even biomed doctors, to dismiss this thyroid piece and to understand fully how thyroid hormone works within the body. All the pieces that are needed, I’m not saying that every child with autism needs thyroid hormone, by no means, but to understand how it works, where the dysfunction lies and to look at it in these kids. A lot of kids with autism aren’t getting their thyroids checked or their iodine or selenium.

Mike: And at least put it on the radar. I think people are really looking at gluten and corn and wheat and all that and missing this piece in children. That’s really important, because, like I said, no one has talked about this up until now in this summit and I’ve done a lot of podcasts and webinars with folks and hadn’t heard this. I want to commend you for introducing a new perspective and a way of looking at endocrinology and highlighting its importance in neurodevelopment, which is so critical. That’s really fascinating. Thanks for being on the show. If people want to reach out to you, check out your website and blog and learn more about you, where can they find more about your work.

48:31 Dr. Peirson’s Websites

Dr. Peirson: Certainly my website for my practice is Peirsoncenter.com and my last name is spelled Peirsoncenter.com. That’s my website for my practice. I also have a website called Downsyndrometreatment.net. That is in a little bit of a transition right now. I am hoping to fill it just with information for these kids and then FaceBook. I put a lot of stuff out on it as we all do these days, a lot of stuff. My FaceBook page for Peirson Center and Down Syndrome Treatment.net, I fill them with a lot of studies and literally when I post something, I’m thinking of specific parents and “You guys should read this. Check this out. It’s a new study.” Thanks.

Mike: We’ll have those links below this video, so if people want to check that out so. Keep doing the great work Dr. Peirson. Really enjoyed this conversation and all the work that you’re doing, so keep it up.

Dr. Peirson: Thanks for the opportunity, Mike[/text_block]

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