Gut-Thyroid-Nutrient Axis & Natural Thyroid Supports - Dr. Michael Ruscio, DC

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Gut-Thyroid-Nutrient Axis & Natural Thyroid Supports

Optimize your gut and thyroid health through adaptogenic herbs, elimination diets, and probiotics

Did you know that gut health is more likely to be a problem than thyroid health? What’s tricky is that gut and thyroid symptoms often overlap. In my new thyroid course, I make it simple. I’ll explain how to interpret thyroid lab results, improve gut and thyroid symptoms, and reduce or wean off of thyroid medication. 

In this episode, I cover the power of dietary and lifestyle interventions for a healthier gut and thyroid. Listen in to learn how you can naturally support your thyroid and gut health.

In This Episode

Thyroid Course…00:50
Using Labs vs Symptoms to Evaluate Hypothyroidism…03:26
Why You Should Look at Your Gut…07:49
The Overdiagnosis of Hypothyroidism…12:32
Healing the Gut-Thyroid Connection…13:40
Diet for Thyroid Health…15:05
Supplements for Thyroid Health…21:20

Hey everyone. In today’s podcast, I’m extremely excited to announce that we are launching a thyroid self-help course. We’ll go into some detail in the body of the podcast regarding what you will learn. But if you sign up early beforehand, you can get 20% off. This discount is only running up until September 8th. If you head to, you can get that early bird discount. And I cannot wait for you to go through the materials. We’ve talked about many of these concepts on the podcast before, but this course will put them all together with additional details that sometimes are beyond the context or practicality of a podcast, because some of the nuances of care are really personalized to the individual. 

There are symptoms in their labs, which this course does exactly that. Pre-registration or early bird is up until September 8th. So if you wanna get the 20% off, go over to and sign up. And I am so, so excited to be releasing this as you know, a thorn in my side is the way many thyroid patients are treated, not with mal intent, but because there is such a better way. And now there is a way for you to access that and go through it at your own pace. So very excited about that and more to follow here during the body of the show. Okay. Thanks.

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Welcome to Dr. Ruscio, DC radio, providing practical and science-based solutions to feeling your best. To stay up to date on the latest topics, as well as all of our prior episodes, make sure to subscribe in your podcast player. For weekly updates, visit That’s The following discussion is for educational purposes only and is not intended to diagnose or treat any disease. Please do not apply any of this information without first speaking with your doctor. Now let’s head to the show.

Thyroid Course

Dr Ruscio, DC:

Hey everyone. In today’s podcast, I’m extremely excited to announce that we are launching a thyroid self-help course. We’ll go into some detail in the body of the podcast regarding what you will learn, but if you sign up early beforehand, you can get 20% off. This discount is only running up until September 8th. If you head to, you can get that early bird discount. And I can’t wait for you to go through the materials. We’ve talked about many of these concepts on the podcast before, but this course will put them all together with additional details that sometimes are beyond the context or practicality of a podcast. Because some of the nuances of care are really personalized to the individual (their symptoms and their labs), which this course does exactly that. Pre-registration or early bird is up until September 8th, and then the course officially opens on September 9th. So if you want to get the 20% off, go over to and sign up. And I am so, so excited to be releasing this. As you know, a thorn in my side is the way many thyroid patients are treated, not with mal intent, but because there is such a better way. And now there is a way for you to access that and go through it at your own pace. So, very excited about that, and more to follow here during the body of the show. Okay, thanks.

Dr Ruscio, DC:

Hi everyone. Welcome back to Dr. Ruscio, DC radio. This is Dr. Michael Ruscio, and let’s talk more today about thyroid. Specifically, the thyroid course that I have recently released and which I am exceedingly excited about. There are 12 modules in this course, as we’ve discussed in the past. And the fourth module goes into symptoms. We provide an evidence-based questionnaire that looks at quality of life, thyroid, and digestive health symptoms. And this is something that, as you go through the course, you will take this quiz or this symptom survey at the beginning and then once at the end—after you’ve gone through the self-help plan. So you can have a nice quantification of how your symptoms have improved over that course.

Using Symptoms vs Labs to Evaluate Hypothyroidism

Dr Ruscio, DC:

One of the things that is disheartening about some of the alternative medicine messaging is people using symptoms as one of the primary diagnostic indicators of hypothyroidism. Now, I say this as someone who believes that symptoms are more important to use in most realms of gastrointestinal care. Because many of the assessments, especially when it comes to things like dysbiosis or enzyme function or inflammation in the gut, are best assessed in terms of how one responds to treatment, [by] reading their symptoms. So that’s an area where the diagnostic repertoire is so in its nascency that we can’t put a lot of value on the lab tests. However, as it pertains to hypothyroid, lab markers and blood levels are actually more accurate and will oftentimes express perturbations before symptoms even appear. So this is one exceptional case where the symptoms are not incredibly informative. And, thankfully, we have pretty good data on lab values and lab interpretation.

Dr Ruscio, DC:

So as to allow us to do the diagnosis the correct way and not use symptoms to center the diagnosis. Which, as we’ve discussed in the past, might be why there’s a surprisingly large subset of people who do not have hypothyroidism who have been told that they have—because they have a few symptoms and the appropriate cross referencing with lab work has not been done. So we go over what are the five symptoms with the best predictive value or correlation to hypothyroid. And, more importantly, we provide a grading system so that you can make the important delineation that it’s not one or two symptoms. In fact, if one has three or more symptoms, there’s a 16% risk from this list. If someone has four to six symptoms, there’s a 90% risk. So as hopefully you become accustomed to with our discussions on thyroid care—it’s not a binary, it’s not all or one. It’s about this risk quantification and understanding the individual (who you are, how you feel) and using that to understand what your situation is.

Dr Ruscio, DC:

If you have something like tiredness and dry skin alone, this may not be enough to really tip the gauge into the realm of concern. But if there are three or more, or if there’s between four and six, now cause for concern is raised. So we go through these specific symptoms and, more importantly, how you use the number of these symptoms you have present to help you have an understanding of your risk. And we juxtapose that with, as we discussed in one of the last podcasts, the correct way to interpret lab work. Which again, this is one area where it’s quite sad how often this is incorrectly done, especially in integrative medicine. And, like we’ve discussed on the podcast in the past, between 36% to 61% of individuals are on thyroid medication that they don’t need—meaning they’re experiencing no symptomatic improvement. And this matters because we don’t want someone to think they have a condition for which they don’t. And we want to direct their attention and their focus toward the things that can improve their health, and address the cause of those symptoms.

Why You Should Look at Your Gut

Dr Ruscio, DC:

So it’s important to not get wrapped into misinterpretation of your thyroid situation, and give you the straight talk and help you get to what’s really driving your symptoms. This is where module five comes in—an overlooked cause of many thyroid symptoms and autoimmunity, which is someone’s gut. And this is what has been so interesting to observe over the past few years in the clinic, how many symptoms are actually a derivative of what’s going on in the gut. And let’s say you are correctly diagnosed. Perhaps the reason why your TSH or your thyroid hormone levels are inconsistent, or your medication needs are oscillating.

Dr Ruscio, DC:

This can be because of inconsistent absorption of the thyroid hormone medication. So both symptoms that are persisting, or inconsistencies in your blood levels or your medication dose required, can be a derivative of what’s going on in the gut. Not to mention, as many of us probably understand already, there is a sizeable impact of (or from) one’s gut on their immune system and autoimmunity. So this is an area that we really want to get correct. And we have a few schematics here that lay this out. But hypothyroidism, again, affects 0.3% of the population, as we’ve discussed in the past. Now, irritable bowel syndrome (gas, bloating, indigestion, constipation, diarrhea) affects 15% of the population. Why this matters, is it helps us understand [your symptoms]. It gives us biostats data to appreciate that your gut health is more likely to be dysfunctional than your thyroid. And we want to be attentive to that.

Dr Ruscio, DC:

It’s not to say that we don’t want to look at both, we do. But all too often, it seems that there’s this strong emphasis on the thyroid and a real de-emphasis, or kind of glossing over, what’s going on in the gut. And this is the six-patient case series that we published in the IMJC, where these patients who had seen some of the best thyroid doctors were still suffering because the health of their gut was overlooked. So we walk through this, and we give you the data in a very kind of clear overview that you need to know. One of the points—which is encapsulated in a graphic—is looking, side-by-side, at the fact that fatigue, mood issues, brain fog, weight gain, and constipation can all be associated to either hypothyroid or gastrointestinal problems. So again, really important that we’re looking at this correctly. So we don’t attribute [the] cause to thyroid when it may not come from thyroid. And also appreciate that some of the thyroid dysfunction is actually happening secondary to what’s going on in the gut. So this gut-thyroid and gut-nutrient-thyroid connection [is] crucially important and oftentimes not given the amount of attention that it really does deserve.

The Overdiagnosis of Hypothyroidism

Dr Ruscio, DC:

And we cover, again, one of the studies that we’ve discussed in the past (two of the studies really) that are just so worth echoing. The 2021 meta-analysis that found, it was technically 37% of individuals, could stop their thyroid hormone medication and maintain normal levels—even after being followed for five years—and maintain the same level of health. And another study from 2018 that found 61% of patients could do the same. So again, we want to give you the straight talk—are you really hypothyroid or not? Let’s understand this. And this is a crucially important aspect of improving your health. Because if you need hormone, we want you on it. We also want to make sure that your gut is healthy, so you metabolize and absorb it correctly. And if you’re not hypothyroid, we want to empower you with that knowledge and give you the other system to focus on (your gut) that can address the symptoms that you’re being plagued with that have perhaps roused suspicion that there’s a thyroid problem.

Healing the Gut-Thyroid Connection

Dr Ruscio, DC:

And we go through—and much of this we’ve published—the fact that many of the symptoms that can be attributed to thyroid can also be attributed to [your gut], and, more importantly, improved from using things like low FODMAP dieting, which has been shown to improve pain, anxiety, and quality of life. Or from things like probiotics, which have been demonstrated to improve depression and anxiety. Probiotics can also improve MCI, or mild cognitive impairment, and fatigue. So we really lay out this inner connectivity between your gut, your immune system, your thyroid, and your symptoms. And more importantly, in the action plan that we come to later, this is all incorporated into, okay, what do you now do to improve these things? We also outline how gut care, as I alluded to a moment ago, can reduce the amount of thyroid hormone medication required. Yay, this is a huge win.

Dr Ruscio, DC:

And this is one of the things in the first module, [where] we discuss a couple cases of patients who actually were able to quite significantly reduce their dose of thyroid hormone medication, and, at the same time, felt better. So this is one of the reasons why I’m so excited. I want this to get out there to more people and help more individuals.

Diet for Thyroid Health

Dr Ruscio, DC:

Okay, so we also go into some interesting information on dietary options for thyroid health. One of the things that I find disheartening is [that] anytime someone goes on a diet that is more restrictive than they need, that’s a real impediment to someone’s wellbeing. Because it’s hard, it’s more expensive, it’s more laborious, and—key phrase—if they don’t need it, it doesn’t improve how they’re feeling. So you’re doing more for no additional benefit. So we walk through the tenets of an elimination diet, and we cover gluten as one of the most commonly avoided foods (and rightfully so—gluten should be avoided).

Dr Ruscio, DC:

However, as you’re probably accustomed to me outlining, over-avoidance of gluten is also a problem. So we want to find that balance point. And we go through a very clear overview of the stats—how many people have non-celiac gluten sensitivity? How many people with thyroid autoimmunity also have non-celiac gluten sensitivity? And (hint) it is far less than 50%. So what this means is, yes, going gluten-free could be very helpful for you. If so, wonderful. The more we can do with dietary and lifestyle interventions, the better. However, we also don’t want someone to avoid gluten based upon faith or fear. So we go through the straight talk of how to determine if gluten is something that you should or should not be on. And this is very well organized into the action plan. So we cover gluten in some detail, [and] we go through the tens of an elimination diet.

Dr Ruscio, DC:

However, we also tie in [another component], and this is one of the things that I think eludes a lot of thyroid patients. We go through the low FODMAP diet as something that a surprising number of thyroid patients overlook. Because they’re only thinking through the framework of autoimmunity and, maybe, the autoimmune paleo diet. Which isn’t even necessarily the best diet for autoimmunity, but the name leads one to sometimes incorrectly make that connection. And the low FODMAP diet can be quite pivotal for gut health. And if we’ve come to understand the substantial importance of gut health for autoimmunity, thyroid hormone absorption, [and] thyroid hormone metabolism, then we want to make sure we’re incorporating into our dietary recommendations, dietary changes that can improve one’s gut health. While simultaneously doing so within a paradigm that’s not advocating for perpetuity avoidance, meaning avoiding these things forever. So we outline the low FODMAP diet.

Dr Ruscio, DC:

We also discuss the autoimmune paleo diet. And there’s some very important items here that we unpack that helps the individual to better understand how, while a trial on the autoimmune paleo diet may be warranted—and we’ll give you the exact sequence to try these things in the action plan—the autoimmune paleo diet is not the best for all people with autoimmunity. And where I think this becomes the most pernicious is when people would be fine on eggs, nuts, seeds, and/or nightshade vegetables. And they’re avoiding them because somewhere they heard or read or got in their head [that], because this diet contains the term “autoimmune” in the title, it’s the best for all autoimmune. In fact, Dr. Robert Abbott from our clinic published the landmark study here that found when patients went from a healthy baseline elimination diet, then on to an autoimmune paleo diet, there was no improvement in their Hashimoto’s.

Dr Ruscio, DC:

This matters—we can use the AIP diet, it can help, but we don’t want to, again, lead one to believe they should be avoiding foods that they don’t need to. We want to aim for the minimal dietary intervention for the maximum effect. Of course, within a diet of healthy, unprocessed, preferably organic (when possible), whole, and fresh foods.

Supplements for Thyroid Health

Dr Ruscio, DC:

[In our online thyroid course] we also discuss some key nutrients that can help with thyroid autoimmunity, and provide specific guidelines for how to obtain these nutrients from your diet. So we kind of pivot here to, okay, there’s some aspects of avoidance that we want to incorporate, yes. However, there’s also some things that we want to eat our way to and eat more of. And again, I hope this continues with the theme of empowerment. Sure, [there is] some stuff to avoid, but we’re not going to go too narrow with the avoidance. And we’re also going to give you things to focus on that can be healing and can be regenerative, rather than just “avoid, avoid cut, cut.” So we go into some detail there. And next we go into module seven—what are the best natural treatment approaches? And you’d be surprised to hear that there are many items that are on offer to help with thyroid, but we want to use the items that are going to have the most impact and will also be intervening the furthest upstream. There’s maybe twenty-odd substances—from ashwagandha, to black cumin, through vitamin D, through probiotics, to NAD—there’s all these things. But what the individual really needs is, what are the small core, the vital few, that will have the most impact and will help treat dysfunction and heal one’s system as far upstream as possible.

Dr Ruscio, DC:

And that’s what we lay out here—the best of the therapeutics on offer with the supporting evidence in terms of, how do these things impact your TSH in a positive way? How do they impact your antibodies? What dose? For how long? What form (if perhaps there’s debate on one form versus another)? So this is outlined. And another important aspect of this is the sequencing. Hydrochloric acid—as we discussed in the last podcast on the thyroid course—is a consideration, because anywhere from maybe 20% to 40% of individuals with Hashimoto’s will have lower HCl. So some people will benefit from supplementation, but what we don’t want to do is paint with this broad brush and represent this as everyone needs to go on HCl. If you utilize the HCl at the right time in the sequence, we make it much more clear. If you do (or do not) need the HCl, we have to lay some groundwork and clear some symptomatic noise first, before it makes sense to utilize or trial HCl.

Dr Ruscio, DC:

So we help sketch out the “why” and the “when,” regarding HCl. And of course, this is very clearly conified into the action plan, which we come to in later modules. We also discuss adrenal support, which is important to recognize that many of the symptoms of adrenal dysfunction can be caused either upstream from a thyroid dysfunction or from gut dysfunction, but there is a time and a place for certain adrenal or adaptogenic nutrients and/or herbs. So we talk about the “what, why, and when,” regarding adrenal support. And what I’ll do in our next podcast, is go through modules 8, 9, 10, 11, and 12 (or maybe not all of those in one podcast), but we’ll start talking [this] through. Now that we understand the state of thyroid care, we’ve gone through some hopefull case studies, we’ve established what labs to order [and] how to interpret them, we’ve discussed what therapeutics to use from a dietary perspective, [and] what natural agents and supplements and herbs can be used.

Dr Ruscio, DC:

Now, we go to work on putting this into the appropriate sequence, and we also personalize it based upon the individual. Because, remember, there’s the “A, B, C, D” scenarios in terms of hypothyroid, subclinical hypothyroid, Hashimoto’s, or sluggish thyroid (or a combination of those). And so once we know that, we can now give you the dietary, lifestyle, and supplemental recommendations based upon which scenario you’re in and covered in the correct sequence. And that’s what we’ll go into more in a future podcast. But again, I really encourage you sign up for the thyroid course [so you can] get the information that you need. And like I’ve said before, I stand behind that with a money back guarantee if you’re not satisfied—that’s how confident I am. Because I see this weekly in the clinic and patients are always so appreciative. So again, very excited to be able to share this and encourage you to check it out. Okay guys, I’ll speak with you next time. Bye bye.


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➕ Dr. Ruscio’s, DC Notes

The Importance of Thyroid Labs

  • Lab markers inform clinicians about hypothyroidism 
  • Lab results need to be interpreted correctly to avoid a false diagnosis of hypothyroidism


Thyroid-Gut Connection

  • Gut health is more likely to be a problem than thyroid health. 
    • Only .3% of the population has hypothyroidism whereas 15% of the population has IBS
  • Gut care can reduce thyroid hormone and help with thyroid autoimmunity


Natural Thyroid Support

  • Diet: 
    • Elimination diet to pinpoint inflammatory foods
    • Low FODMAP diet
    • Autoimmune Paleo diet
  • Supplements
    • Probiotics
    • Ashwagandha 
    • Black cumin


Approaches to Treating Thyroid Health

  • Care is specific to the individual 
  • The goal is to use the most minimal dietary intervention for the most maximum effect 
  • There’s a right time and place for supplementation
    • Make sure that gut health is optimal first, so key nutrients can be obtained
    • Implement HCL and/or adaptogenic herbs when/if the time is right

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