A Naturopathic View of Thyroid and Hormone Balance

Interview with Naturopathic Physician Dr. Kevin Passero

Kevin Passero, naturopath, naturopathic
Kevin Passero

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.

Dr. Passero's Background

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. 

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. 

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. 

What is a Naturopath?

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 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. 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 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 a past president of the Maryland Association of Naturopathic Physicians, this issue hits very close to home for me as I have diligently worked 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. 

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.

Integrative Approaches

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: 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. .

Mary Shomon: Do you feel like the current way of diagnosing thyroid disease, such as TSH tests 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.

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.

Lab Tests for Thyroid

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 percent 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 percent 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.

Importance of the Adrenals and Other Hormones

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 have 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: 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.

The Best Thyroid Medication

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.

Thyroid Controversies

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.

Weight Challenges

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: 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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