A Naturopathic View of Thyroid and Hormone Balance

Interview with Dr. Kevin Passero - Naturopathic Physician

Young woman hiking in majestic landscape

Kevin Passero, ND is a naturopathic physician in practice in the Washington, DC metropolitan area and Annapolis, Maryland, who specializes in working with patients with thyroid and hormonal imbalances. Dr. Dr. Passero is also the host of the popular radio show "The Essentials of Healthy Living," which airs weekly in the Washington DC area. I asked Dr. Passero to share some thoughts about naturopathy, his philosophy as a practitioner, and his approaches to hormone balance.

Mary Shomon: Can you share a bit about your educational background?

Kevin Passero, ND: My college major was Biology, which fulfilled all of my pre-med prerequisites but introduced me to a world of study specifically focused on environmental biology. A lot of time was spent studying dynamic ecosystem environments and how all of the plants, animals and natural resources of that environment had to be in perfect balance in order for the system to thrive. Little did I know at the time that this would introduce me to fundamental concepts I use in my medical practice every day. I see the body as its own unique ecosystem, and like in the larger environment around us, everything needs to be in balance within the micro-environment of our body in order for health to thrive.

After college, I completed a four year doctoral program to become a licensed Naturopathic Doctor (ND). At the time of my enrollment in 1999, there were only two accredited Naturopathic medical schools in the country and I had to travel to Portland, Oregon to get my education.

At this time, there are now five Naturopathic medical schools in the country with another one slated to open in California within two years.

Mary Shomon: Why did you decide to become a naturopathic doctor?

Kevin Passero, ND: The core philosophy of naturopathic medicine had great appeal to me. It operates under the principle that the body is a self-healing, self-regulating organism, and that the job of the doctor is to identify the underlying causes that have contributed to health imbalances and work to remove those causes while at the same time supporting the self-healing mechanism.

For me, this concept was groundbreaking. For many people, illness is a mystery. We don't know why our body has manifested with a set of symptoms and we are simply given a diagnosis and medicated in a way to cover up those symptoms. It was fascinating to me to study a philosophy of medicine that works to understand the healing mechanisms in our body and create strategies to maximize them so that the body can express health on its own. It is hugely gratifying for the practitioner and hugely empowering for the patients. It restores faith in the human form and results in truly vibrant health and not just the suppression of symptoms.

I was also fascinated with the world of natural remedies. Vitamins, minerals, herbs and homeopathics all interested me as tools for assisting health. I had a deep conviction that these tools provided to us by nature surely needed to play some role in relieving suffering and assisting people in their journey to restore health and vitality. My environmental biology training taught me the dynamic relationships between plants and animals that have evolved over human history and I felt that this connection to the natural world must certainly offer some valuable tools for healing.

Mary Shomon: Can you explain briefly what a naturopath is, for those who may not be familiar with this particular type of medical practice?

Kevin Passero, ND: Naturopathic doctors, or naturopathic physicians, depending on what state you are in, are clinicians that have been trained as primary care doctors with an emphasis on utilizing natural means of healing and focus on the prevention of disease states.

At this time, the term Naturopathic Doctor is used loosely and may refer to a variety of practitioners. I represent the type of Naturopath that has been trained at a four year Naturopathic Medical school recognized by the Department of Education and is eligible for licensure as a Naturopathic Doctor/Physician in 16 states and the District of Columbia.

In the states where we are licensed, we operate as primary care physicians with the rights of most medical doctors (MDs) and doctors of osteopathy (DOs), including the ability to order any type of diagnostic test or image, perform physical examinations, perform minor surgical procedures and prescribe an array of prescription medications.

Our process of case evaluation may be similar to an MD's or DO's approach, in regard to blood tests, diagnostic imaging and physical exams, but often differs in several other areas. Most notably, this difference is seen when looking at the treatments we utilize. Although NDs are able to prescribe certain medications in licensed states, it is our preference to first utilize natural methods of healing, including nutrition, herbs, homeopathy, bio-identical hormones, vitamins and minerals.

Another major difference between what to expect from an ND vs. an allopathic doctor is the degree of time spent listening to patients and trying to understand their unique health challenges. Also, NDs frequently utilize cutting-edge functional tests that are not typically done in a traditional medical setting to identify a person's unique set of circumstances contributing to their health problems.

Some practitioners who use the term Naturopathic Doctor have acquired their education via online correspondence programs. They are not required to have the same pre-medical prerequisites as medical doctors or an undergraduate degree and are not trained to the standards necessary to provide comprehensive case management. They are also not eligible for licensure in any state or jurisdiction in North America. If these education differences are important to someone seeking care from a Naturopathic Doctor, it is important to check the doctor's credentials prior to scheduling an appointment.

Mary Shomon: What is your favorite part about being a naturopath?

Kevin Passero, ND: There are many things I enjoy about the naturopathic discipline of medicine. I truly enjoy the collaborative relationship that is established with my patients. A unique partnership is formed as a result of spending so much time with each patient working to understand all aspects of their life and health challenges. For many people, this is the first time they have experienced such openness and willingness to listen from a medical professional and it is something that is valued and respected.

Another aspect of my work I greatly enjoy revolves around my role as a teacher. It is my goal with every patient to not only help them improve their health, but also to help them understand their health. Understanding your health condition, and understanding how the tests and tools I use are going to help you overcome it, help to empower people and enhance the process of healing. It amazes me how many people with thyroid disorders who have been treated for years by other doctors do not know the slightest things about their thyroid, the thyroid tests they are given, or the thyroid medication they take. I feel that as a doctor, I must also be a teacher. If you understand your body, your illness, your medicines, and your test results, you now have a new power over your health and the health decisions you make in the future. No matter what doctor’s office you enter, you will know the basics of how to direct your care and what aspects of care are the most important for you. An empowered, educated patient ALWAYS has better outcomes and I feel it is my job to make sure each person is empowered through education.

In the interest of not having the interview be too long, I will list one more thing I find deeply satisfying about being a Naturopathic doctor -- choices. In the work that I do, I am not limited to only pharmaceutical options to help someone. I have at my disposal thousands of herbs, thousands of homeopathic remedies, vitamin therapies, minerals and many other modalities of healing to rely upon. Each person is an individual and each individual (even if they have the same health condition) may need an individualized approach to healing. What might work in one person for depression might not work in another, and the same is true for thyroid disorders or autoimmune disease or gastrointestinal problems. I have so many tools to choose from that I can customize every single person’s treatment regimen based on what is right for their body. There is no cookie-cutter approach to Naturopathic medicine. Each person is treated uniquely and we, as Naturopathic doctors, have ample tools to do this. For me, this prevents any aspect of boredom that might come from doing the same thing day in and day out. Each case has dynamics unique to that person and requires critical thinking and analysis.

Mary Shomon: What is the most frustrating part of being a naturopath for you?

Kevin Passero, ND: The most frustrating part has to do with how little recognition Naturopathic Medicine currently has in the United States. Many people have not heard the term and have no idea that there are primary care doctors trained in holistic medicine out there practicing.

Like osteopathschiropractors, and acupuncturists in the past, our profession has had to fight for recognition in each state to achieve legitimate licensure, which is why our ability to practice to our full scope is limited to 16 states and the District of Colombia.

As the immediate past president of the Maryland Association of Naturopathic Physicians, this issue hits very close to home for me as I have been diligently working for the past four years to have Naturopathic Doctors recognized and licensed in my home state of Maryland. I have learned that the politics of medicine does not line up with what is best for patients. The state medical society and traditionally trained physicians have worked very hard to limit healthcare choices for the residents of Maryland and many other states. They fight a turf battle that hopes to exclude other health care practitioners from gaining access to their patients. They do this in spite of the volumes of literature we have presented to them regarding our rigorous training, national board examinations, clinical experience and record of safety. In some states, Naturopathic doctors have been fully licensed since the mid-1900s and have displayed the most impeccable standards of safety and the ability to significantly lower health care expenditures based on our primarily preventative approach to healthcare.

I have learned that medical societies have enormous financial resources and typically have huge influence over politics. The desire of a few to block access to safe holistic care prevents millions from having access to a form of medicine that could help save the healthcare disaster going on in America. It is truly the fight of David vs. Goliath.

On a positive note, we are making progress. In Maryland, for example, we've been able to convince many legislators that the people of Maryland deserve access to well-trained holistic physicians. This year we made massive progress in both the Maryland Senate and House of Delegates. In fact, our bill passed a critical Senate subcommittee vote 9-2. We as a profession are unrelenting in our mission and believe that our training, our integrity, and the desire people have for healthcare choices will overcome our obstacles. We have had thousands of Maryland residents devote their time and efforts to make this a reality and have had many Maryland-based medical doctors come to our defense and testify to the extensive level of training and skill Naturopathic doctors bring to the healthcare setting.

Mary Shomon: What do you feel that a holistic, integrative practitioner like yourself brings to thyroid care, in contrast to conventional practitioners?

Kevin Passero, ND: As we have discussed throughout the interview, I think one of the most valuable things I bring to the table when dealing with thyroid care is an approach that is tailored to each person's specific needs. This is based on many different factors including lab tests, feedback from patients, and thorough assessments of all aspects of their health. No part of your body operates in complete isolation from the rest of the system so one must truly take a holistic perspective when addressing a health concern.

With every patient, I discuss the aspects of how nutrition affects thyroid disorders and make sure everyone has a diet plan that will work to support their thyroid health. In addition, detailed evaluation and treatment of other related systems (sex hormones and adrenals) are absolutely necessary to achieve optimal outcomes when working with thyroid disease.

In addition, I work with patients to determine which option is the best for their thyroid situation. There are many different types of thyroid medication available as well as natural treatments for certain thyroid conditions, and different people need different ones in order to thrive. The biggest problem with traditional thyroid care is that it is approached as a one-size-fits-all condition. Nothing could be further from the truth when it comes to working with thyroid disorders. A holistic/integrative approach to thyroid dysfunction is essential for most people to have optimal outcomes.

Mary Shomon: Do you feel like the current way of diagnosing thyroid disease -- the TSH test with the "official" normal range of .5 to 5.0 -- is adequate, or is it missing people who have thyroid disease?

Kevin Passero, ND: This topic is hotly debated amongst various health care professionals and I firmly stand by the position that the current TSH range is far too broad and leads to millions of people missing a critical diagnosis that could significantly impact their health. In fact, the American Association of Clinical Endocrinologists announced in 2002 that the range of TSH should be narrowed to 0.3 - 3.0, which would have essentially doubled the amount of people in North America who would fit the criteria of hypothyroid. Mary, you have written about this numerous times and I encourage people to read your full analysis of this finding.

The scary thing is that even though the recognized experts in thyroid disorders made this announcement ten years ago, little has changed. Most labs still list the reference range as 0.5-5.0 and most doctors never got the memo that the criteria for diagnosing hypothyroidism had shifted. Every week I have people coming into my office with symptoms of hypothyroidism who have no idea their thyroid gland is having any influence over their health because their TSH was between 0.5-5.0 and their doctor said it was normal. In fact, I routinely see people with all the symptoms of thyroid disorders with TSH levels over 5.0 who have been told their thyroid is fine and they should wait 3 to 6 moths and retest! Meanwhile, the individual is miserable and scared because nobody can explain why they are fatigued all the time, gaining weight, having trouble focusing and rapidly losing their quality of life.

It is also critical to remember that doctors should be treating people, not lab tests. Every person is unique regarding where they feel best within that broad range and feedback from the patient, along with careful analysis of the lab report, is the key to properly managing and supporting thyroid issues.

Mary Shomon: What lab tests do you feel are essential to making an accurate and thorough thyroid diagnosis?

Kevin Passero, ND: I lecture on this all the time and teach these principles to all of my thyroid patients so that they have the tools to take control of their health. It is essential to have the following tests:

  • TSH (Thyroid stimulating hormone) -- this is the hormone your brain releases in order to stimulate your thyroid to produce thyroid hormone
  • Free T4 (Thyroxine) -- T4 is the main thyroid hormone produced by the thyroid gland. I like to refer to it as a pre-hormone because it is only about 10% metabolically active even though it represents roughly 90% of circulating thyroid hormone. The "free" part does not refer to the price, but rather to the fact that we want to measure the quantity of hormone not bound to other proteins in the blood. Only the free hormones can interact with our cells and help us to produce energy.
  • Free T3 (Triiodothyronine) -- T3 represents our body's most active thyroid hormone. The T4 in circulation is converted by our organs and our cells into T3 in order to stimulate cellular metabolism. T3 represents only about 10% of circulating thyroid hormone but is about 90% active. Again, we want to make sure we measure the free levels of this hormone to properly assess what is available to our cells. This is one of the most important and frequently overlooked thyroid tests. It is absolutely essential when making decisions about thyroid function and for monitoring the progress of treatment.
  • Thyroid antibodies (TPO, ATA, TSI) -- These antibodies play a critical role in many thyroid conditions. Eighty percent of women that have hypothyroidism have it due to an autoimmune condition referred to as Hashimoto's Disease. The TPO (thyroid peroxidase antibodies) and the ATA (anti-thyroglobulin antibodies) are two critical markers that are present when an autoimmune process is at play. Many allopathic doctors do not see the need to test for these antibodies because they have no treatment options in which to address it. I strongly disagree with this approach because I have been trained in a holistic manner and given the tools necessary to identify possible immune triggers and work to lessen the autoimmune response. This results in significantly improved outcomes for people suffering with hypothyroidism due to an autoimmune process. The TSI antibody is related to an autoimmune hyperthyroid state called Graves' disease.
  • Reverse T3 -- This is where things get a bit confusing. If under stress, your body can convert the T4 hormone into reverse T3 instead of regular T3. The reverse T3 will bind to the T3 receptor site but will not activate it. In the process, reverse T3 blocks these receptor sites from regular T3 and the net effect is your body having less T3 stimulation and reduced metabolism. A good analogy is that of a key and a lock. Reverse T3 is that key on your keychain that fits into the lock but will not turn and unlock it, and until you remove it, it is effectively blocking that lock from being activated by the correct key. Why would your body want to do this? Under certain circumstances of stress, our body needs to preserve energy and slow down metabolism for survival. Although this mechanism for survival is not particularly relevant in modern living conditions, it was useful thousands of years ago when our food supply was less stable. Stress in our daily lives can trigger these survival mechanisms and stimulate a person's body to make excessive amounts of reverse T3, which ends up slowing down the metabolism pathways.

Mary Shomon: What else do you feel is particularly important to your thyroid evaluation of patients?

Kevin Passero, ND: There is no other system related to thyroid health more overlooked than the adrenal glands. These small glands located above the kidneys are responsible for managing all stress in your body. What most people don't understand is that thyroid hormone in its own way is a stress on the body. Take, for example, a person who has been prescribed a slight overdose of thyroid medicine. They feel anxious and jittery, have trouble sleeping and often experience heart racing... all symptoms related to stress. The point is that if the adrenal system is not strong, the thyroid will automatically alter its function to accommodate a weaker resilience to stress. I have seen many people with borderline thyroid issues have those issues fully resolved just by doing appropriate therapy with the adrenal system. In the majority of the other thyroid cases, I see the adrenal system plays an equally important role even though the thyroid needs to be addressed directly. The interplay of adrenal hormones, particularly cortisol, and thyroid hormones are so closely related it is a huge disservice to not take both into account. Properly testing and assessing adrenal hormones is a critical part of managing thyroid disorders.

Sex hormones, particularly estrogen, also play an important role in thyroid hormone balance and thyroid function. It is a well-known fact that thyroid function can change drastically during pregnancy due to estrogen surges. This interplay between the hormones can play out in a more subtle but equally important fashion when sex hormone imbalances exist. Properly testing and assessing sex hormones is a critical part of managing thyroid disorders.

Lastly, diet and nutrition has a significant impact on thyroid function. For example, food sensitivities, particularly reactions to gluten, play a critical role in the autoimmune process associated with Hashimoto's disease. The nutrient content of food including selenium, zinc, vitamin D, omega 3 fatty acids, B6 and iodine are also very important when it comes to thyroid function and thyroid hormone balance. Proper testing of nutritional status and evaluation of diet is critical in order to have people enjoy the best possible outcomes.

Mary Shomon: What is the best medication for thyroid hormone replacement, in your opinion?

Kevin Passero, ND: Through my years of experience, I have learned there is no one answer to this question. In order to have the best outcomes, every person needs to be evaluated on a case by case basis. In my early years, I might have said that natural desiccated thyroid drugs like Armour thyroid and Nature-throid were the best, and standard prescriptions like Synthroid were less ideal, but I have learned that these views do not reflect what plays out in clinical practice. I will say that the majority of people with hypothyroidism have only been prescribed the most common thyroid medication, Synthroid, and feel there is something to be desired. I agree wholeheartedly and find that the majority of these people often need that prescription augmented or changed entirely to feel their best. With that said, I have met many patients that thrive on Synthroid and other synthetic T4 analogues and I have learned to take an approach that always puts the patient's needs first and removes any pre-determined bias on my part.

Mary Shomon: When you see a woman who is suffering from fatigue, depression or mood changes, struggling to lose weight or other similar symptoms, besides blood tests, what process do you typically go through to get to a diagnosis?

Kevin Passero, ND: Many different factors can contribute to the symptoms you have listed above. Thyroid disorder is certainly one of them and typically the most accurate way to diagnose that type of health problem is through a blood test.

However, many other imbalances in the body can result in the presentation of those symptoms so first and foremost, it is critical to listen and take a detailed health history. This is one of the most important parts of understanding a case and working to identify the root cause of the issue.

This health history is what helps me decide what other diagnostic tools I will need to utilize to accurately assess the situation. Salivary hormone testing, diagnostic imaging, neurotransmitter evaluations, heavy metal testing and food sensitivity testing are just a few potentially valuable tools that can help shed light on the root cause of someone's health concern. Without a detailed health history, it is impossible to know which ones to utilize.

Lastly, a good physical exam is very important as well. This is a way for the clinician to evaluate the body and its different systems in real time. Did you know that before blood tests were available, doctors would diagnose thyroid disorders using an Achilles tendon reflex test? To this day, this is still a valuable way to assess thyroid hormone balance. This is only one example of many very useful physical exam techniques that give great insight into the functioning of the body.

Mary Shomon: How is your treatment of thyroid patients changing since you went into practice?

Kevin Passero, ND: The most important thing I have learned is that every person truly is a unique case. You cannot put these issues into a box. For example, it cannot be assumed that everybody with a thyroid issue needs Armour or should be on Synthroid or that everybody should fall in the same range of TSH. These issues will vary for each person and should be determined on a case by case basis primarily based on feedback from the patient.

The other most important thing I have learned is that thyroid issues rarely exist in isolation. There is a very delicate balance between the thyroid system, the adrenal system, and the sex hormones. If one is out of balance, the others are likely affected and it is best practices to evaluate all systems properly to decide the best treatment options.

Mary Shomon: Do you have a philosophy or overall approach to treating thyroid/adrenal/reproductive hormone imbalances?

Kevin Passero, ND: First and foremost, one must recognize that these systems operate in balance with each other, not in isolation of each other. As I have explained, dysfunction in one area will affect the others. Imagine a triangle, and at each intersection of lines, there is one of these organ systems.

If you tip one end of the triangle, you will cause a resultant tip at the other ends of the triangle. This is a simple way to understand how an imbalance in one area will affect the other areas. These three systems are intimately interrelated and it is critical to create balance in all three in order to achieve balance in your triangle.

Additionally, my philosophy as a whole also reflects the heart of my naturopathic training, which emphasizes a core belief that the body has a profound ability to heal and restore balance from within. My tools and therapies are intended to support that process and remove the obstacles blocking that healing process from occurring.

Mary Shomon: How do you feel about opinionated/empowered thyroid patients who come in with ideas about what they want, in terms of treatment?

Kevin Passero, NDEmpowered patients are typically the people who are very well-educated about their health concerns. These are very rewarding relationships for me. They already understand the process happening in their body and have ideas, often times based on personal experience, regarding what will work best for them. They simply need someone with the proper training and the right set of tools to help guide them through the process. I pride myself on being very open-minded with patients regarding treatment options and am willing to explore many different scenarios until we find the one that is just right.

Of course, like all relationships, there must be mutual respect in order for both parties to feel fulfilled. As much as I work to respect each person and their opinions, it is equally important that they try to respect my viewpoint as well.

Mary Shomon: Thyroid disease is often written off as a whiny, overweight, middle-aged women's disease. Or it's simplified as "easy to diagnose, easy to treat." Why do you think thyroid disease is so misunderstood by patients and physicians?

Kevin Passero, ND: I think that the standard approach to thyroid disease is still operating in the context of medicine 30 years ago. Aside from advances in diagnostic imaging and surgical techniques, not much has really changed. The standard medications are the same and the standard lab tests used are the same. If we contain thyroid issues to only these methods of diagnosis and treatment, it is gross oversimplification of what I have found to be a very dynamic and complex health condition to manage.

Here is a perfect example. For a long time, Free T3 tests were very expensive and insurance companies refused to cover them. Due to this, doctors did not order them so as not to burden their patients with thousands of dollars of out of pocket expenses. Instead, they did what seemed reasonable and worked to manage thyroid problems with the tools they were given. This then became the standard of care. Each doctor doing their residency and learning how to treat thyroid disease learned from their instructor this standard of care. Eventually, that student became an instructor and taught the same thing. Fast forward 30 years and now Free T3 levels are not expensive to run and most insurance companies will pay for the cost. However, the paradigm has been set and the established "standard of care" that ignores this important test persists.

The other issue that has confused the proper diagnosis of thyroid problems is the issue of the TSH range. We have already discussed this issue but in the context of why doctors and patients seem to misunderstand this disease, it is important to bring up again. If your doctor tells you that the most reliable test available used to determine if your thyroid is functioning adequately is normal, who are you to argue with them? After all, you are there seeking their advice. With the technological advances that have been made in medicine, it is a rare exception that someone can suffer so significantly from a health concern while at the same time test "normal" on laboratory workup. Doctors rely heavily on lab tests to evaluate cases and treatment decisions because most of the time it is an excellent way to address a medical problem. With thyroid disorders, this is clearly not the case. The lack of willingness to further explore all thyroid testing options and the absence of weighing these results in the context of how someone feels significantly contributes to why so many people are not appropriately diagnosed and treated.

If doctors just practiced by the guidelines set forth by their own acknowledged experts in thyroid care (the American Association of Clinical Endocrinologists) by setting the upper limit of TSH at 3.0, so much needless suffering would be avoided. However, it is still important to note that even setting the upper limit of TSH at 3.0 still is inadequate for many people.

Of course, patients are the ones that suffer the most. Many thyroid patients that still have thyroid issues going on are told repeatedly that their issues are not related to their thyroid based on "normal" lab tests. So these patients are left suffering with health concerns and have little or no recourse or ideas on what direction to take to regain their health. Confusion, frustration and desperation are often what they are left with until they find a resource that can guide them down a new path.

Mary Shomon: Many thyroid patients struggle with and complain about weight issues. What factors do you consider in patients who face this challenge?

Kevin Passero, NDWeight issues are often the number one concern in thyroid patients so it is very important to understand all of the factors that might be contributing. These are some of the key issues to consider:

  1. Proper thyroid hormone balance must be established in the body. Detailed evaluations of all thyroid related hormones, including TSH, Free T3, Free T4 and Reverse T3, must be performed and checked to make sure the proper thyroid hormone balance is present. This is probably the most common reason many thyroid patients cannot lose weight despite being on thyroid medication. It is critical to consider several additional issues related to thyroid hormone balance:
    • One major factor is a person's ability to convert T4 to T3. Because T3 is your most active thyroid hormone, if your body has trouble with conversion you may be lacking the key signal for firing metabolism and weight loss. You body's ability to carry out this conversion can vary based on a variety of factors. Genetic makeup, nutrient and mineral status, and the influence of other hormones like cortisol all play a significant role in conversion rates.
    • As I have previously mentioned, stress hormones like cortisol can cause problems with thyroid hormone balance by affecting T4 to T3 conversion, increased reverse T3 production and reduced TSH output. It is critically important to take into consideration the amount of stress someone is under, how their adrenal system is handling it, and if cortisol levels are elevated or depressed.
    • Sex hormones are another important piece of the puzzle. In particular, estrogen can significantly impact thyroid hormone balance and female hormone balance must be taken into consideration.
  2. Different types of thyroid medication can create different reactions from person to person. I have seen many people have a thyroid hormone prescription exacerbate weight gain even though it might have helped with the low energy or brain fog issues associated with their thyroid disorder. In other people, no improvements in symptoms are seen when the medication is started, and yet in other cases, people actually report feeling worse when the medication is started. Keep in mind that in every example I just listed the TSH and T4 levels will normalize and look perfect on lab tests. This adds to the intense confusion regarding this condition and is a major factor contributing to why so many people being "appropriately treated" are still suffering so immensely. In these cases, other medication options must be considered, and when the correct match is found, weight loss and symptom management improves dramatically.
  3. Diet and lifestyle factors also play an important role in how the body manages weight. Combining the right advice regarding nutrition and exercise with proper thyroid management will usually result in successful weight loss.

Mary Shomon: You have a particular interest in neurotransmitter balance. Can you talk about how this comes into play for thyroid patients -- in particular, people with Hashimoto's disease and Graves' disease?

Kevin Passero, ND: Neurotransmitters play a key role in how our brain functions. They dictate things like mood, focus, concentration and memory. Many people suffer from neurotransmitter imbalances due to a variety of reasons, including genetics, nutritional deficiencies, hormonal imbalances, drug use, and disease states.

Thyroid hormone imbalances can play a role in neurotransmitter balance and for some thyroid patients it can be incredibly useful to include strategies to regulate neurotransmitters while working to manage the thyroid issues. Anxiety, depression, insomnia, PMS, ADD and ADHD are some of the main issues that will manifest if neurotransmitters are out of balance.

My approach does not utilize any pharmaceutical interventions. I rely on something called Targeted Amino Acid Therapy (TAAT) which is sometimes referred to as orthomolecular medicine. This unique approach takes advantage of the biochemical fact that just about all neurotransmitters are made from simple amino acids. By supplementing with the right amino acids in combination with the correct vitamin and mineral cofactors, we can boost or reduce desired neurotransmitters in the body and have a significant impact on neurotransmitter related disorders.

Mary Shomon: What is your favorite kind of patient?

Kevin Passero, ND: My favorite kind of patient is someone who is committed to making meaningful changes to improve their overall health. I greatly enjoy my work and have spent years acquiring information and education in an effort to help people thrive. Patients who are truly committed to the process of healing are the ones who are able to fully utilize the information I share with them and therefore, typically have the most positive outcomes. For me, there is no greater gratification than being the person who helped facilitate a significant improvement in someone's life.

Mary Shomon: Do you have any tips to make a visit more productive for you and your patients?

Kevin Passero, ND: Come ready to learn and to be engaged in the process. Bringing recent lab tests and accurate accounts of any supplements or medications you are taking is also important. I will spend two hours with a new patient making sure I understand your thyroid problem and how it is affecting you in addition to educating you about your condition, reviewing nutritional considerations and laying out a clear plan to guide you back to health. Being ready to take notes and to be attentive is a great start.

Mary Shomon: If you had just one piece of advice for thyroid patients, what would it be?

Kevin Passero, ND: Try not to get frustrated and know that you can enjoy amazing and vibrant health. Managing a thyroid disorder can be complicated. There are many different tests and medications to consider and other dynamic processes occurring in your body that will affect the overall outcome. Under the right guidance, this complexity becomes a valuable asset. If each consideration is properly evaluated and addressed, you end up with an individualized approach to your condition that has been tailored in a way to exactly meet what your body needs. The cookie cutter approach to managing thyroid disease falls by the wayside and you end up with a strategy that will nurture your body and your health for many years.

Kevin Passero, ND has offices in Maryland and the District of Columbia, and his website is www.GreenHealingWellness.com. His email is: greenhealinginc@gmail.com and phone number is 443-433-5540

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