Getting to the Root Cause of Hypersomnia and

Thyroid Fatigue
Guest: Dr. Izabella Wentz
The purpose of this presentation is to convey
information. It is not intended to diagnose, treat, or cure
your condition or to be a substitute for advice from your
physician or other healthcare professional .
Dr. Breus: So welcome, everyone. I have one of my all-time favorite people
here with me, Dr. Izabella Wentz. And so Dr. Wentz is a pharmacist and she is
a thyroid expert, specifically in the world of Hashimotos hypothyroidism and
shes going to explain a lot of that to us. So first of all, welcome Izabella.
Dr. Wentz: Hi, Dr. Breus. Its so great to be here. Thank you so much for
having me.
Dr. Breus: You are super-duper welcome. And you and I have kind of an
interesting history because when we first met, you started talking to me a lot
about your issues with sleep and sort of how that had started you on this
journey. So I would love it, if you wouldnt mind, telling our audience a little
bit about your personal background in sleep and sort of what led you to where
you are.
Dr. Wentz: So Ill give you kind of an example of the person I was in college.
Dr. Breus: Please.
Dr. Wentz: I would sleep until 12:00 noon or 1:00 every day on weekends.
And if one of my classmates called before that, there was a good chance that I
would either yell at her or hang up on her or say something really, really mean
and inappropriate. And sometimes this was to people that I dont even know
as well. So it wasnt even my good friends.

Mindworks, Inc. All rights reserved.

But when I was in high school, I was very bright eyed and bushy tailed. I had
a ton of energy. I was sleeping maybe like six hours, seven hours and then
getting up like really early. And I spent I think my dad used to say about
three hours in the morning to get ready, so I could be in school by 08:00. So
by I had to wake up at
Dr. Breus: Three hours?
Dr. Wentz: Pretty much, yeah. Id do like full makeup. Its like you were going
to like a Vegas show or something. But my first year in college, something
happened. Where all of a sudden, I went from like this person that was super
high energy and super thriving on very little sleep to like a person that just
was napping all the time, sleeping for very, very long amounts of time and
feeling kind of brain-fogged and just not feeling my best. So I was sleeping
initially, during my first year in college, probably for 12 to 14 hours.
Dr. Breus: Wow.
Dr. Wentz: One time, I came back from class and I had the midterm the next
day. So I came back from class around 03:00. And I said, Okay, Im going to
study for my midterm, which was at 08:00 a.m. the next day. But first, I just
need to take a little tiny, tiny nap, like a power nap. So I went to sleep at
03:00 and I woke up at like 08:15
Dr. Breus: Oh, my gosh.
Dr. Wentz: the following morning. And ended up going to my midterm not
having studied and showing up late in tears. And so that was kind of a big
mystery for me. The clinic at my university was kind of didnt have a lot of
answers for me. But eventually, a while into this, they were like, Oh well, you
had Epstein-Barr virus and so thats probably what it was, that probably
made you tired and now its going to get better.
But it never really got better. So I mean, I went from sleeping for like 14 to 15
hours to sleeping to 12 hours. That entire summer, after my freshman year in
undergrad, I was going to bet at like 06:00 or 07:00 and waking up at noon
the next day.
Dr. Breus: Wow.
Dr. Wentz: And so, eventually, that kind of got better slowly over time and I
actually learned how to compensate, so I spent a lot of my time sleeping. And
then when I was awake, I would be studying or going to work or going to class.
But I probably slept for about 11 to 13 hours for most of my 20s.
2016 Mindworks, Inc. All rights reserved.

Dr. Breus: Wow, thats amazing. And so what kind of treatments did different
doctors offer you? And kind of like what was the path that they put you on?
Dr. Wentz: And I was in pharmacy school, so I was aware of different
disorders and so on and so forth. And I was a good girl and I always went and
had physicals and went to the doctor. And I didnt really get a lot of help, so a
lot of the things were, Youre stressed. Youre depressed. Do you want some
antidepressants? Do you want some stimulants like Provigil? Maybe you can
do that. And another one that I just think is kind of hilarious now, but I
didnt at the time, was that I was just getting older.
Dr. Breus: Oh my gosh.
Dr. Wentz: Im like in my 20s, right? So like, Youre just getting older, that
kind of thing happens. And so I just learned to compensate. And then I kind
of had heard of chronic fatigue syndrome and I was looking at all the different
drugs for insomnia in pharmacy school. But I was like, Okay, what about
hypersomnia? Why isnt anybody talking about excess sleep? like, Whats
going on here?
I finally had been working as a pharmacist for a few years and realized that
not all doctors were created equally. And I was taking a certification exam for
geriatrics and went to this like big intense course at UCLA about geriatrics.
And I remember that course instructors were saying that, sleeping too much
can be just as good as sleeping not enough.
And I was like, Oh wait, I thought I was doing a good job by sleeping more.
And then I ended up sort of talking to some of the instructors and some of the
clinicians in the room. And theyre like, You know, you really need to get that
checked. And I sought more comprehensive care. At which point, I was found
to have Hashimotos thyroiditis and a subclinical hypothyroidism, which is
well get into.
Dr. Breus: Wow. So that must have been kind of an eye-opener because all
this time, youd either been told that youre old at age 20, which is the most
ridiculous thing I think Ive ever heard.
Dr. Wentz: Well, I was about 25 to be fair.
Dr. Breus: Oh okay. So that makes all the difference in the world well, give
me a break. And you thought that you were doing the right thing by sleeping
more and more just figuring maybe your body needed more sleep or something
like that. When in fact, it was actually a sign that something else was going on
in your body, right?
2016 Mindworks, Inc. All rights reserved.

Dr. Wentz: Mm-hmm.

Dr. Breus: And so once you were given that diagnosis, what made you become
so aware and so interested that you were like, Oh my gosh, we need to let
more people know about like whats going on with Hashimotos, and how did
all that happen?
Dr. Wentz: When I got my diagnosis with Hashimotos, at first I was actually
relieved, because I had been going to the doctors for years and they were like,
Youre not anemic. Everythings normal. Youre fine. Its in your head, pretty
much was Get out of my office, right?
So I was finally getting a sense of validation that was really great that, Okay,
well you know what, there is something wrong, which was nice to hear, as
strange as it sounds.
Dr. Breus: No. Ive seen that happen quite a bit with people. Do they know
what the root causes for Hashimotos are?
Dr. Wentz: So the underlying cause of Hashimotos, we can kind of get into
that. But wait, why dont we back up a little bit and maybe define what it is.
And so underling root cause of my major sleep issues was Hashimotos, which
is an autoimmune disease that happens to attack the thyroid. So our immune
system turns against our own thyroid gland and creates a situation where the
thyroid cells are destroyed so that theyre no longer to produce their own
thyroid hormones and this is also known as hypothyroidism.
And so this sounds like a really exotic condition. I know when I came home
and I told my husband about it, he said, Hashimotos, that sounds like a
Japanese sword fighter, and its actually pretty common.
So looking at the latest statistics, so I just downloaded a new article on my
computer last night and I thought we were up to 28% of the general
population in the U.S. that was the highest statistic I heard, So approximately
one out of every four people with Hashimotos. This recent article was from
Italy, 34% of the Italian population has already antibodies indicative of
Hashimotos, so one in three Italians, potentially one in four Americans.
Dr. Breus: Wow, thats incredible.
Dr. Wentz: Right. But most people are not told that they have Hashimotos. So
people like me, it took me probably 10 to 20 years before I was actually
2016 Mindworks, Inc. All rights reserved.

diagnosed. So we talked about my bout with Mono or Epstein-Barr virus in

college, thats one of the triggers or root causes.
Another root cause I had is I had exposure to Chernobyl at age three when I
was living in Poland, close to the Ukrainian border, which is where I grew up.
And so like, toxicity can be a trigger, different types of infections, food
sensitivities, nutrient deficiencies, impaired stress response as well as the
toxins that we talked about, those are all going to be the underlying root
causes for Hashimotos. And most peoples Hashimotos is not identified until
its very, very much advanced. But the condition actually has five different
stages.
And so, in the initial stages, whats happening is your immune system is
launching an attack against your thyroid but your thyroid test may still be
normal. And this is what was happening to me. So for almost eight, nine
years, I was going to the doctor and they were running tests on me and they
were telling me my tests were normal. And that was because they were doing
the standard tests. So they werent doing the advanced tests that can detect
Hashimotos in the earlier stages,
Now, of course, I was symptomatic. So we know that people even in those
early stages of Hashimotos can have a ton of different symptoms. So of them,
fatigue is a big symptom. Hypersomnia or sleeping too much is going to be a
symptom. Brain fog or being very forgetful is going to be a symptom, which
can also be caused by sleep deprivation. Weight issues, so an inability to lose
weight or gaining weight even when youre doing the same thing over and over
can be a potential symptom.
Depression or apathy, where you feel like youre just not as motivated as you
used to be, could be a potential symptom. And theres a whole list of other
things like hair loss, joint pain, loss of the eyebrows, acid reflux, irritable
bowel syndrome, just a whole plethora of different symptoms that may be kind
of considered nonspecific. So doctors might say like, Oh, well, this is because
of stress or depression or so on and so forth.
Dr. Breus: Right.
Dr. Wentz: One good symptom that is a really good giveaway that somebody
may have thyroid disease is cold intolerance, so a person thats colder than
the average. And now this is, of course, something thats kind of hard to know
that you feel colder than the average person on your own. So one of the things
I recommend is just to kind of take an inventory of your surroundings. If
youre a woman thats going into your office and all the other women are
2016 Mindworks, Inc. All rights reserved.

wearing short sleeves and youve got like a sweater and a scarf on, thats
probably an indication that your thyroid is underactive or that you have
Hashimotos and you are not tolerating cold as well.
So the thyroid is our metabolism gland and it produces energy, produces heat.
And so a lot of times when we are deficient in thyroid hormone or the thyroid
is under attack, were going to see that a person will have symptoms related to
low metabolism such as low energy, weight gain, and then feeling cold.
Dr. Breus: Well, let me ask you this, because this ties in with sleep very
nicely. I have a lot of patients who show up and they tell me that they like
their bedroom very warm or they have lots of covers, so theyre wearing socks
and flannel pajamas in the middle of the summer. Would that be an indicator
as well?
Dr. Wentz: Yes. And that was me. So I was living in southern California at the
time I was diagnosed. I was sleeping in like full pajamas, socks, and then two
blankets. And my husband was like kind of sleeping with the covers off.
Dr. Breus: Right.
Dr. Wentz: And Id be like, Why did you turn the air down again, its freezing
in here, and he was like, I dont get it. Whats happening?
Dr. Breus: Right, What is she talking about?
Dr. Wentz: Yeah. I was like, Whats wrong with you?
Dr. Breus: Right.
Dr. Wentz: And it was actually me all along. And once I got proper treatment,
I was like, Oh my goodness, I dont need these blankets. Like I dont need to
have all these socks on. So thats actually a really, really good sign.
Dr. Breus: Okay. Got it. All right, interesting. And so what are some of the
solutions? First of all, how do you tell the difference between well, no, Im
going to back, Ive got a different question. Does sleep deprivation make all of
these feel worse? Because my guess is that it probably does.
Dr. Wentz: Absolutely. And so, I did a survey with my readers, and the biggest
things that makes thyroid issues worse is sleep deprivation and stress.
So these are kind of, I think, two sides of the same coin. So we know that
when were sleep deprived, were not going to be tolerant of other people as
much, so then things in our life are going to seem more stressful.
2016 Mindworks, Inc. All rights reserved.

Dr. Breus: For sure.

Dr. Wentz: The way that kind of, I think, comes together is the adrenal
glands. So adrenal glands very closely work in symphony with the thyroid
gland.
Dr. Breus: Sure.
Dr. Wentz: And I was trained as a pharmacist and I used to think that
adrenal glands and adrenal dysfunction were all like voodoo. And if you look
at kind of like the Mayo Clinic website and all those things, theyll say that
theres no such thing as adrenal dysfunction, theres only Addisons disease.
So thats not what Im talking about, Im not talking about Addisons disease.
Im talking about adrenals are stress glands that produce our stress
hormones.
There are situations that can impair their function. And these are things that
are not going to be detected on a blood test, but may be detected on like a
functional medicine or naturopathic test like the saliva test.
So adrenals are going to be dysfunctional because of a variety of reasons. So
one of them could be because a person is overdoing it on caffeine, that
actually makes the adrenals work harder but weakens them in the long term.
Blood sugar imbalances, so if youre eating a lot of carbohydrates, a lot of
sugars, thats going to cause an insulin response, which needs to be
neutralized by the adrenals.
Inflammation in the body is going to be very stressful for the adrenals as well,
which produce our main anti-inflammatory hormone cortisol. And then lack of
sleep is going to make the adrenals really, really stressed out. And we know
that when the adrenals are stressed out, we do not handle everyday stresses
as well as we normally would, so were going to be more likely infections and
then our hormone output is going to be affected.
Dr. Breus: That makes sense. Now my very rudimentary understanding of
Hashimotos is, is that there are times where people have high thyroid
function and then low thyroid function. And so in my world, high thyroid
function or hyperthyroidism often times is a signal where we see it in
insomnia, peoples inability to fall asleep. And then low thyroid function is
when we have hypersomnia, which is I think what you experienced.
When you went through your personal journey, did you have these kind of big
ups and downs or was it more just on the downside, question number one.
And then question number two is when you talk with your followers and
2016 Mindworks, Inc. All rights reserved.

people who are reading your books and things like that, do they also complain
of both insomnia as well as hypersomnia?
Dr. Wentz: Yeah, thats a really great question. So Hashimotos, in the early
stages, whats happening is the immune system is attacking the thyroid gland
and theres a rush of thyroid hormones into the blood stream, which can
cause a person to have too much thyroid hormone and then they become
hyperthyroid. And so the symptoms of that could be irritability, palpitations,
anxiety, insomnia can be another big symptom of that.
Now, theres also another condition known as Graves disease, where basically
the immune system attacks like the control mechanism of thyroid hormone
production, so just the thyroid just keeps producing hormone without hearing
the stop. And so that can also manifests as that.
So interestingly some people do have insomnia with that, whenever they h ave
Graves disease or whatever they have Hashimotos in the flares, but thats not
going to be the case for everybody. So some people might have insomnia, some
people might have hypersomnia, but they might have anxiety and irritability.
Dr. Breus: Got it. And sometimes that anxiety and irritability could actually
lead to even more poor sleep as well, I would imagine, because I see that a lot
in my clinic, as well.
Dr. Wentz: One of the ways so a person may be sleeping for 12 to 14 hours,
but they may be like a super light sleeper, so that if the dog rolls over, they get
up and wake up and theyre like, What happened? or they might have
multiple awakenings throughout the night because their stress response is
tuned up and theyre basically in like stress overdrive and their body is really
tensed and their thyroid function is really on high alert. Theyre on high alert.
Theyre anxious. And then the time that they sleep is longer, but the quality is
much, much worse.
And then other people will have anxiety because of Hashimotos so that they
might find that theyre ruminating more at night at bedtime. So instead of like
a person just going to bed and feeling great, their anxiety might actually keep
them awake at night.
Dr. Breus: That makes perfect sense. I see that a lot with my patients. And a
lot of people say they cant turn off their brain. Theyve got these heart
palpitations, like they dont understand whats going on. Theyre exhausted.
They kind of talk about this whole wired and tired feeling. And I think that
might be part of what kind of you see happening with what youre doing.
2016 Mindworks, Inc. All rights reserved.

Now, at one point, I have patients who actually have gone on some type of
thyroid supplementation. Tell us a little bit about some of those treatments.
And then also, Im curious, because I had one patient tell me that they
couldnt take their thyroid supplementation or actually pharmaceutical
thyroid, it was either an Armour or it was Tirosint or something like that. They
couldnt take in the morning because it made them too sleepy. They had to
take it in the evenings. I wonder if youve ever had that experience with any of
your followers.
Dr. Wentz: Interesting. So thyroid medications can definitely be very, very
helpful for people who have Hashimotos and some of the adv anced stages
when it goes into hypothyroidism and sometimes, even in the initial stages
they can be helpful with symptoms. Synthroid was the number one prescribed
medication in 2013 and 2014. It was beat out by Vicodin in 2015, but it was
[inaudible; crosstalk].
So we know that we that this is a very, very common problem that people have
the underactive thyroid and most of the time it is Hashimotos. And of course,
medication could be super, super helpful. But you want to make sure youre
on the right medication for you. So Synthroid is going to be the most
commonly prescribed medication. It is synthetic thyroid hormone and its
synthetic T4, which is one of the active thyroid hormones, but its not the
main active thyroid hormone.
So the main active thyroid hormone is T3. And T3 turns into T3 from T4
within the body. So in the perfect situation, if everything went according to the
way its supposed to go, the way its written out in paper, you would take the
synthetic thyroid medication and you would convert it to as much T3 as you
need to make. And Id like to think of T3 as then like the energy hormone, the
grow your hair hormone, and feel good hormone.
But for a variety of reasons, not everybody does this conversion properly,
sometimes its a liver issue, sometimes its a gut issue, nutrient deficiency,
stress. And so some people might actually benefit from a medication like
Armour or Nature-throid that contains T4 and a little bit of the T3. So the
active hormone is already like preconverted for you. So it just kind of gives you
that kind of a little bit of instant energy when you take it.
Generally, I recommend taking thyroid medications first thing in the morning
on an empty stomach, and that seems to work well for most people. There are
a few people, however, that they do feel better with taking thyroid hormones at
night and it does seem to balance out their numbers better, their thyroid
hormone levels, and their symptoms. So again, its really going back to the
2016 Mindworks, Inc. All rights reserved.

person as an individual where youre looking at, okay, which medication is

appropriate for them, which dosage is appropriate, and then how are dosing
the medication and when are we taking the medication.
Is it better to give it in the morning? Thats optimal for some people. Other
people may need to take it in two doses throughout the day, so they may need
to do like an 08:00 a.m. dose and a noon dose. Other people may need to an
08:00 a.m. and a 04:00 p.m. dose. And then other people may need to take all
their medications at bedtime.
So it really varies. I found sometimes when people do feel tired after their
thyroid medications, it maybe because of adrenal issues, so the adrenals,
again, may not be properly supported. So it happens if you have and this is
getting a little bit technical.
Dr. Breus: No, its good. I love it.
Dr. Wentz: Cortisol is one of our main adrenal hormones. And people think of
cortisol as bad. But actually, having too much of it is bad as is not having
enough of it. So cortisol is necessary for life. And we find that people with
Hashimotos and autoimmune disease, especially in the later stages, will have
low levels of cortisol. And when you have these low levels of cortisol, youre
going to be really tired throughout the day and you might have a burst of
energy at night. And so that can create insomnia.
What can happen when you take thyroid hormones, is they actually help you
get rid of cortisol quicker. So a person whos taking thyroid medications at a
time when theyre low in cortisol may be making their cortisol during that time
even lower.
So if they have high cortisol at bedtime, which is preventing them from
sleeping, taking thyroid medications at that time, may lower the cortisol a
little bit allowing them to sleep better and then regenerate in the morning and
then having cortisol thats not really thats not really touched by thyroid
hormone. So that would be, in theory, one way how that can be explained.
Dr. Breus: That would make sense, because the patient that Im thinking of,
she had Hashimotos and when she was taking the thyroid medication in the
morning, she was just dragging all day. She could not get her energy levels up.
And they were changing the medications, they were doing all these stuff. And I
said, You know, maybe theres a circadian rhythm here. Maybe theres
something going on with you internal biological clock Lets just try taking it in
the evenings.
2016 Mindworks, Inc. All rights reserved.

10

And she said it was like having a sleeping pill. She said would take it. She
would knock out. She would sleep the whole night through, wake up the next
day, and she would actually feel fairly energized and like Im guessing that
her cortisol levels where at the appropriate stage then and that they were able
to back them down at night. So that in of itself is pretty interesting.
What happens though if youre treating Hashimotos and youre still feeling
that level of fatigue? Obviously, there could be a sleep disorder going on
something like sleep apnea or narcolepsy or something like that. But what are
some of the things that you found in the research that youd be
recommending?
Dr. Wentz: And I do want to spend a little of time on sleep apnea, because its
one of those chicken and egg things with Hashimotos. And so we used to
think about people who had thyroid disease were more likely to have sleep
apnea and that perhaps the thyroid disease caused the sleep apnea. But now,
what were finding is that sleep apnea actually seems to cause thyroid disease.
Dr. Breus: Really?
Dr. Wentz: Mm-hmm.
Dr. Breus: Oh, thats interesting.
Dr. Wentz: And so studies have found that about 1.5% to 11% of people with
sleep apnea have hypothyroidism. The people with hypothyroidism, about 25%
to 35% of them, have been reported to have sleep apnea. And like looking at
the rates of thyroid antibodies, which are markers of an immune attack
against the thyroid gland, they found that people with sleep apnea had rates
that were like five to eight times higher of thyroid antibodies compared to
people with Hashimotos without sleep apnea. And it seems like the longer a
person has sleep apnea, the sooner or the more likely they are to develop
Hashimotos.
A 2012 study found that 53.2% of people with sleep apnea were positive for
either thyroid peroxidase or thyroid globulin antibodies, which are two of the
main antibodies found in Hashimotos, which tell us the immune system is
attacking their thyroid gland. And now, some of them still had like normal
thyroid function, but the longer they had sleep apnea, the more likely their
thyroid function was to progress. And we know that the higher the antibodies,
the quicker the progression is going to happen.
And another study found as many as 66% of men with sleep apnea had the
Hashimotos antibodies. So if youre a man and you have sleep apnea and
2016 Mindworks, Inc. All rights reserved.

11

youre listening to this, theres like probably a two in three chance that you
probably have Hashimotos.
And so the way that this could work is potentially sleep deprivation weakens
our adrenals, which then causes us to be more susceptible to developing
autoimmune thyroid disease.
Dr. Breus: Fascinating. So lets say that we've gone from your spectrum,
where youve been identified as having Hashimotos and theyre still tired.
Then, I guess, partially what could happen there is we would see maybe by
doing an overnight sleep study or a home-based sleep test if they have sleep
apnea or not, because what youre saying, this data is fascinating, is that a lot
of people who are out there who are tired even post treatment for Hashimotos,
the sleep apnea could have actually been what was causing that Hashimotos
and then vice versa seems to happen as well.
But lets say you dont have sleep apnea, but youre still feeling that fatigue or
that sleepiness. What are some of the things that people should be talking
with their doctors about?
Dr. Wentz: Yeah. So once youve ruled that out, looking at nutrient
depletions, food sensitivities. We already talked about the stress response, so
perhaps getting working with like a functional medicine doctor and getting
an adrenal saliva test, looking at the health of your gut, looking at any
exposure to toxins as well as chronic infections, which I think are very much
an underappreciated cause of chronic fatigue.
Dr. Breus: Like the Epstein-Barr type of thing?
Dr. Wentz: Epstein-Barr virus, I think, gets a lot of attention. So I know when
I was first struggling with all the sleep issues, I kind of came across chronic
fatigue syndrome and it just seemed really hopeless, where I was almost like I
didnt want to have it because there was really no solution for it. And Epstein Barr is one thats been very much implicated in that.
And just for the listeners at home, there is definitely a solution for that so you
can put the Epstein-Barr virus under control and you can get your energy
back if that is something that is one of your root causes. So there are herbal
protocols and then just really strengthening your body by addressing some of
the other things weve talked about is going to be super helpful for keep ing the
virus at bay and helping your energy levels.
But other infections that are underappreciated are going to be things like
parasitic infections, so such as like Giardia infection or Blastocystis hominis
2016 Mindworks, Inc. All rights reserved.

12

infection. So these are like tiny, tiny protozoa that can live inside of our gut.
And if youve had an episode of like food poisoning or if youve gone abroad
and youve travelled abroad where you experienced food poisoning, theres a
potential that you have one of these bugs that are living inside of you and then
are causing inflammation within your body.
And interesting, these types of infections have been identified as a trigger for
chronic fatigue syndrome. And when Ive seen then in my clients with
Hashimotos even when Epstein-Barr virus may seem like the initial trigger, a
lot of times when you take care of whatever infections that you have in the
gut, they start feeling better and their energy comes backs.
So we find that people that have are grinding their teeth at night, sometimes
trouble sleeping. Their trouble with sleep is exacerbated by menstrual cycles
or full moons, which I thought it was voodoo but apparently thats when the
parasites were more active. These are going to be the people that are going to
be at greater risk for having a parasitic infection.
And just to be like straightforward, I used to think that people living in the
western world did not have these types of things. However, I found them in a
big percentage of my clients with Hashimotos that didnt get better with
addressing their nutrient deficiencies or addressing their food sensitivities.
Dr. Breus: Wow, thats pretty fascinating. Okay, so what are some of the
things that can actually kind of sabotage your stress response that weve
talking so much about?
Dr. Wentz: So we definitely talked about caffeine.
Dr. Breus: Right. Thats a big one, got to wean the bean.
Dr. Wentz: Yeah. So it seems like people really rely on caffeine for energy, and
it really is a drug. So its a stimulant drug.
Dr. Breus: Its like the biggest drug out there. Its like the most abused drug.
Dr. Wentz: It is and it is. And its readily available at every store on the
corner, you could go into a Starbucks and get your fix. And it seems like, in
the short term, like its making a difference and it gets more people more
energy, but it also makes them feel more tired in long term. So I recently had a
client who was complaining to me that she was having a lot of fatigue and had
a lot of trouble sleeping.

2016 Mindworks, Inc. All rights reserved.

13

And so usually what I recommend are things like magnesium for sleep or
sometimes even melatonin if the person really has a lot of trouble and that
also helps anxiety. And she was complaining of a lot of symptoms like
constipation, anxiety, fatigue, insomnia and so on and so forth. And I was
kind of looking on her diet, her diet looked good and everything else. She
seemed to be taking a lot her supplements and medications. And then I kind
of said, Okay, so do you drink caffeine? and she said, I do. And she was
drinking eight espressos a day.
Dr. Breus: Oh my God.
Dr. Wentz: And then the latest one was at 10:00 at night and she was not
able to fall asleep until 02:00 or 03:00 in the morning and the sleep that she
had was very much fragmented. She said that she couldnt function without
the caffeine. And then what we found was basically weaning off of the caffeine
gave her a lot of her function back and a lot of her energy back, but it really is
a drug.
And so I do recommend oftentimes weaning it slowly, so maybe going to like
reducing by half. One excellent thing that people can do is take an herbal kind
of concoction called Dandy Blend. It tastes like coffee and it looks like coffee
and it smells like coffee, but its caffeine free and its herbal, and it supports
your liver, so that helps to detoxify faster. And some people will say that they
dont have caffeine withdrawals when they do that.
Dr. Breus: Interesting.
Dr. Wentz: Another thing is doing hot lemon water in the morning, first thing
in the morning when you wake up, instead of going the caffeine, because that
actually helps to boost your liver and helps to moves some enzymes along. So
a lot of times, Ill recommend doing things like that. And people will say,
within a few days to a few weeks, they actually have much more energy and
they dont need to rely on caffeine, theyre sleeping better and theyre less
anxious.
Dr. Breus: So theres lots of really interesting data on caffeine. We know it is
the most abused substance on the face of the earth for sure. Theres actually
an MRI study where they looked at people who had been drinking large
amounts of caffeine for over three years and what they discovered was that
their brains actually dont function well without caffeine on board. Like their
brains have become so used to that substance being in there that its
necessary for function.
2016 Mindworks, Inc. All rights reserved.

14

One of the things that is really interesting is there are two distinct systems for
sleep and one of them is the sleep drive. And that drive is all represented by
this neurochemical called adenosine, which is a cellular byproduct and that
builds up in the brain and thats why you become sleepy. It turns out that the
molecular structure of adenosine is literally one molecule off of caffeine .
Dr. Wentz: Interesting.
Dr. Breus: And so caffeine scoots into the adenosine receptor in the brain and
it blocks that adenosine.
Dr. Wentz: Wow.
Dr. Breus: Right. And thats why people get that awakening feeling from
caffeine. And then when they burn through that caffeine, also the adenosine
goes flooding in and thats where that big caffeine crash comes from. So youre
dead on when youre talking about how can caffeine have a problem. And
dont get me wrong, if you want to have a cup of coffee in the morning, have a
cup of coffee in the morning. But when youve got somebody whos drinking
eight espressos a day, thats a real problem.
I had a patient come to me in she was drinking three 3 liter bottles of CocaCola a day and she couldnt understand why she wasnt sleeping well. And so
number one, she was definitely throwing herself into a state of diabetic and
insulin resistance. But number two she was just ingesting tremendous
amounts of caffeine and that where things can kind of go sideways.
So other than caffeine, what are some of the other things that people can do to
kind of help level them out from a Hashimotos standpoint?
Dr. Wentz: So really addressing their adrenals is going to be looking at
adrenal adaptogens. So these are herbs that can kind of balance out the
adrenals, B vitamins, vitamin C can be very, very helpful for most people. The
other things that I really look at are nutrient depletions. Thats going to be,
oftentimes, a first step in helping a person feel better. One of the biggest most
common nutrient deficiencies are going to be vitamin D, B12, as well as
ferritin, which is the iron storage form of iron.
Dr. Breus: Yeah. No, youre right. So whats really interesting about ferritin is
when people have a ferritin deficiency, they get restless legs. So one of the first
things I do when somebody turns to me and they say they have a creepy
crawly feeling in their legs is I check their ferritin levels, because if its below
60 and it can be anywhere from like 300 to 200. If its below 60, we know that,
2016 Mindworks, Inc. All rights reserved.

15

thats an easy way to treat restless leg symptoms without having to do like an
antiparkinsonian medications or something like that.
Dr. Wentz: Oh, thats fascinating. I knew that small intestinal bacterial
overgrowth was connected to restless leg syndrome, which can then deplete
ferritin levels and deplete iron levels but youve just kind of added
Dr. Breus: Full circled.
Dr. Wentz: Yeah, getting that full circle. So ferritin, with the iron storage
protein, is going to be important for energy production and carrying thyroid
hormones throughout the body, carrying oxygen throughout the body. And
people, when they dont have enough of that on board, they can feel very, very
tired.
So that's one of those easy things to address with your doctor, ask for vitamin
D levels, ferritin levels, and then your B12 levels. So doing something like
sublingual B12 is an option. Theres a methylcobalamin version of B12 that I
feel is slightly better absorbed than the other versions, and I like it better than
doing injections.
So sometimes people will get B12 shots and they feel amazing after them. Im
personally not a super big fan of needles. This is why I went to pharmacy
school not nursing school or medical school. So I prefer to do things under the
tongue route, which gets better absorbed in the body.
Dr. Breus: Sure.
Dr. Wentz: So thats one way to do it. And then looking at another interesting
nutrient depletion thats oftentimes connected to fatigue in people with thyroid
disease and Hashimotos is thiamine. So thiamine is a B1, so its one of the B
vitamins. And we used to think that it was only deficient in people who were
alcoholics.
And so I found out that I was deficient in thiamine and I was almost offended,
because Im like somebody that will have like a glass of wine, like if I made a
nice dinner like once a month or if I go on vacation I might have like two
Mojitos or something like that, but I was like, What is going on?
But people with thyroid issues and autoimmune issues, Hashimotos, their gut
is not going to be working properly. So theyre not going to be absorbing a lot
of nutrients, and thiamine is one of them. A recent study found that taking
thiamine in like mega dose, so like 600 milligrams per day, helped people with
2016 Mindworks, Inc. All rights reserved.

16

Hashimotos recover from fatigue almost like within three days. Its amazing
and that was my situation with it as well.
So I was just like, I was doing the nutrition part right. And I thought I was
doing all these things well and I was feeling really tired. And then I got a test
for nutrients and I came out deficient with thiamine, and within three days,
my energy levels were back to normal.
And then we know that with some vitamins, you want to make sure youre
really careful with the dosing like the vitamin D, you can overdose on it. With
thiamine and the B vitamins, what you dont absorb, you urinate out. So
thats something thats okay to be taken above the recommended daily
allowance.
And this is interesting because Ive had people like come up to me at random
at conferences and like pretty much give me hug and say like, Oh my gosh,
youve changed my life because you recommended thiamine in your website or
on your blog. And Im like, Who are you?
Yeah. So its something that can make a tremendous difference in peoples
energy levels, all joking aside. Thiamine or befotiamine, which is a different
kind of absorbable version of it, can make a really big difference. And you
might have to take like one to six tablets a day, but youll be able to see within
three to five days if it makes a difference in your energy levels. And for some
people, that can just really turn them around very quickly and its one of those
really easy and relatively inexpensive things, probably like $10 a bottle or
something.
Dr. Breus: Oh, thats great. Well, you mentioned your website but I forgot to
ask you about your website.
Dr. Wentz: My website is thyroidpharamacist.com. And if people wanted to get
more information on nutrient deficiencies and the type of diet I recommend,
they can go to thyroidpharamacist.com/gift.
Dr. Breus: Also, youve got great stuff going on your Facebook, right? And I
think some on Twitter as well. So if people are out there, you should
absolutely follow Dr. Wentz, whats your handle on Twitter and whats your
Facebook page?
Dr. Wentz: I actually dont have a Twitter, so Im not that, but Im always on
Facebook. So my Facebook page is Thyroid Pharmacist, Dr. Izabella Wentz.
And if you go to Facebook/thyroidlifestyle, youll find me. I usually like to post
once a day and then Im always answering questions and interacting with
2016 Mindworks, Inc. All rights reserved.

17

everybody and kind of I might have a slight Facebook addiction. One day Ill
go to Betty Ford for that, but for now I really enjoy talking to everybody with
thyroid disease and helping them get to the other side and helping them get
their life back.
Dr. Breus: No, thats great. And also youve got your book, which is a New
York Times bestseller. And I think you just signed a new book deal and youve
got another book coming out, right? So tell us a little bit about that.
Dr. Wentz: So my first book, Hashimotos: The Root Cause, its been out for
about three years now and it really takes the person through my story of how I
was able to uncover the triggers that caused me to have thyroid disease and
how I was able to get rid of all of my symptoms, get into remission, get my life
back. So its full of strategies and tips you can utilize to get your life back.
My second book is going to be focused on like recipes and kind of like specific
interventions, whereas the first one will tell you like what diet you need to
follow, like the second one will tell you how to like implement all those things.
So the two books work really well together in complement.
Dr. Breus: Nice. Okay, well youll have to let us know when those are due out,
because were going to be looking for them. So Dr. Wentz, I know that you took
The Power of When quiz, Id love to hear what your results were and what you
thought about the whole experience.
Dr. Wentz: So I came out with being a bear. I was a little bit surprised with
that because I thought I would be more of a wolf, because I tend to especially
when I write, I tend to do a lot of my writing at night, which may drive my
husband a little bit nuts, because then I went to bed like 02:00 or 03:00 in the
morning. But I came out with a bear, which was actually refreshing and
reassuring to know that I am mostly a daytime creature and function in
different types of environment. So it was refreshing to know that I was more
flexible and resilient than I previously thought. So that was really nice.
Dr. Breus: Thats good. So its interesting because a lot of my people who are
very creative are wolves. Yet when I talk to people who are bears and they,
But hold on a second, I think that Im more wolfish because my creativity
seems to flow at night and sometimes I like to stay up late and then kind of
sleep in.
Everybody can kind of lean a little bit in one direction or the other. But what
the quiz really does is it looks at sort of you from the whole person perspective
and kind of sees, Okay, what would work for you, generally speaking. So it
2016 Mindworks, Inc. All rights reserved.

18

sounds like you had a pretty good experience with it.

Dr. Wentz: Yeah. Some of the things I definitely agreed with. So Im definitely
really easy going.
Dr. Breus: Yes, you are.
Dr. Wentz: I have a really even-keel attitude. So like people will say like, You
dont ever get upset, do you? and Im like, Yeah, I dont really get upset. I
actually about things here and there, but Im hardly ever the person that will
be in a bad mood. Im usually in a really great mood all the time and just kind
of happy-go-lucky unless Im tried, then Im a bear.
Dr. Breus: Yeah, absolutely. Then youre a different kind of bear.
Dr. Wentz: Yeah.
Dr. Breus: Now what are some of the things that you didnt agree with?
Dr. Wentz: Lets see, there was definitely hitting the snooze button was true.
So I am liking the snoozing. I didnt the BMI being average to high, so
generally I found that my BMI was usually average or on the low side.
Dr. Breus: The low. Right.
Dr. Wentz: Yeah. So that was a little bit different. And then, Im not always
hungry in the morning. Sometimes I am. But sometimes Im not.
Dr. Breus: Yeah. So whats interesting about that is, first of all, my guess
would be about the BMI, that probably has a direct relationship to your
thyroid issues, right? And so when you were able to get those under control
and you also may have always been sort of classically thinner type of person
and so thats one of those ones that kind of works, kind of doesnt sometimes
for people, so that doesnt surprise me too much. What was the other one?
Dr. Wentz: So I think I said, I do agree Im not always tired in the morning
or Im not always hungry in the morning, but like I could eat a lot, like I could
eat a ton. And my wholes familys built like greyhounds.
Dr. Breus: Right.
Dr. Wentz: So I think I am more body body type, I think greyhounds are my
spirit animal in that regard.
Dr. Breus: I could see that. Ive had a couple of meals with you. And youre
2016 Mindworks, Inc. All rights reserved.

19

not shy at all when it comes to the food, so I think thats awesome. No, I think
it actually make a lot of sense, everything that you said. So thanks for taking
the quiz. Im glad you found like you got something out of it. The new book,
The Power of When, its due out in September, so were super excited about
that. So thanks again.
Dr. Wentz: Yeah. Thank you so much for doing this quiz, it was really
insightful.
Dr. Breus: So thank you so much for being part of The Sleep Success
Summit. This has been awesome. For all of you folks out there, I know theres
been a ton of information, if you look right below or on the side, theres a
banner that you can click on so you can download this information, keep it for
yourself, share it with your friends. Were super excited to have you on board.
Thank you Dr. Wentz. This has been fantastic. We certainly appreciate your
time.
Dr. Wentz: Thank you so much, Dr. Breus. And for everybody listening at
home, I hope this helps you on your journey.

2016 Mindworks, Inc. All rights reserved.

20