Nursing Mother’s Formulary

This summer, I’m excited to finally share some of the new and gentle protocols for thyroid support for nursing moms that I developed in the last few years. 🙂 You may know that I am now a mom to an awesome six-year-old son, and many of the protocols evolved from my original, more aggressive protocols, that I learned about and tailored to my needs during the time I was a breastfeeding mom. In honor of August being World Breastfeeding Awareness Month, I am sharing my new protocols. 👩‍

In my early days of working as a pharmacist, I often encountered worried moms who wanted to know if the medications and supplements they were taking were safe for their little nurslings. I remember assuring one mom that thyroid medications were safe and helpful while breastfeeding, and counseling another mom about the need to take her seizure medication, even if that meant she could no longer breastfeed.

When I was in pharmacy school, I somehow had it in my head that babies only needed to nurse for three months, and that after that, they were supposed to be given formula. While I’m a big proponent of “fed is best” (the idea that it’s most important that the baby is fed properly, and it doesn’t matter which way), there are many benefits to exclusive nursing and extended nursing.

When I first began working with women, I didn’t take on any clients who were pregnant or nursing, as I thought that women could just wait to address their health after weaning. Of course, becoming a mother gave me a different perspective.

I personally realized the need for helpful protocols for nursing moms when I myself was four months postpartum and began to have a hoarse voice, new food sensitivities, elevated thyroid antibodies, and hair loss. I knew I was either having a major Hashimoto’s flare-up or postpartum thyroiditis, and luckily, I knew the common causes of flare-ups. 🙂

I completed a GI-MAP test and notably, I had an elevation of H. pylori. I get super excited about finding H. pylori on stool tests, as I know it’s usually responsible for a whole host of symptoms, including hoarse voice, food sensitivities, elevated thyroid antibodies, and hair loss (the exact symptoms I had).

Due to antimicrobial concerns, I prefer to use natural therapies when addressing infections instead of the triple antibiotic therapy used by conventional medicine. I have an excellent protocol that works really well for H pylori. However, I wasn’t sure if the supplements I normally used would be safe for nursing.

I am grateful for the wonderful friends and practitioners in my network that I was able to consult. Dr. Maya Shetreat, who is an MD, pediatric neurologist, and herbalist, gave me a safe and effective H. pylori protocol that was safe for nursing. Within a few short weeks, my hoarse voice and hair loss were gone, and my thyroid antibodies began to drop. Furthermore, the food sensitivities began to lessen as well. Had I not connected with Dr. Shetreat, I would have needed to either wean my son (my goal was to nurse for six months), take antibiotics and alter his microbiome, take supplements that were potentially harmful to a baby, or do nothing and live with the symptoms. If I did nothing, my hair loss, my thyroid antibodies, and food sensitivities would have likely flared up.

In my work with clients, the ones with H. pylori tend to have the highest antibodies (i.e. over 1000 IU/mL, some as high as 10,000 IU/mL). Additionally, as H. pylori can be passed on in breast milk, it could have caused a lot of issues in my baby, even potentially failure to thrive.

A few years ago, I shared the functional medicine approach to mastitis on Instagram (follow me there, as I can often share quick solutions there before I can write a comprehensive article), but mom life got in the way of sharing more about all of the other things I learned about taking care of your health when you have Hashimoto’s while nursing a baby.

I have wanted to create this special nursing mother’s formulary for my fellow moms with Hashimoto’s for quite some time. I have spent countless hours researching various options, as well as consulted with some of my brilliant and beautiful friends to make this list.

I hope it helps other moms with Hashimoto’s and really any nursing or postpartum moms who need a little extra support! Please share with your mom friends. 🙂

In this article, I will discuss how to safely support the major areas of health (for Hashimoto’s mamas and their little ones) while nursing, including:

• Using thyroid medications when pregnant and breastfeeding
• Addressing nutrient depletions common in Hashimoto’s
• Supporting adrenal health
• Supporting the gut and identifying food sensitivities
• Addressing infections that may trigger thyroid symptoms
• How to safely address toxic overload and liver support

Hashimoto’s and Breastfeeding

Whether you choose to breastfeed one baby for three months, or five babies for five years each, there may be a time when you need to address your own health. I wanted to provide some solutions for you so that you can thrive during this delicate and beautiful time!

I hate to see moms weaning their babies and not meeting their breastfeeding goals just because they feel like they have to stop nursing due to an issue that often has a simple solution.

In the postpartum period, we may have flare-ups of Hashimoto’s, new onset of Hashimoto’s, or a condition known as postpartum thyroiditis. Postpartum thyroiditis self-resolves in 80 percent of people, but some end up with Hashimoto’s. ^[1]

My hope with this guide is also to help address all three situations that are common with Hashimoto’s mamas.

Food sensitivities, nutrient depletions, infections, gut health, adrenal dysfunction, and toxic overload are all important triggers and exacerbating factors for thyroid health. Furthermore, they may affect a woman at any point during and after pregnancy, and may lead to thyroid symptoms.

In my own postpartum period, in addition to monitoring my thyroid function, I was faced with an infection (H. pylori) and adrenal dysfunction. I wasn’t quite sure if my usual recommendations would be safe, so I had to educate myself a bit more. I hope this guide will help you with some gentle ideas of how to support yourself (whether you’re breastfeeding or not).

Through addressing a few key pieces of health, you can support your thyroid and Hashimoto’s during the postpartum period and beyond.

1. Address Thyroid Hormone Levels

Keeping thyroid hormones at optimal levels is important throughout pregnancy and in the postpartum period, not only for your health and well-being, but also to keep up milk supply. Hypothyroidism can cause low milk supply, while hyperthyroidism can actually cause an overproduction of milk. ^[2] (Notably, thyroid issues can lead to issues with breastfeeding, and I hope to share some more information on solving breastfeeding problems in a future article. For now, I would recommend Making More Milk by Lisa Marasco and Diana West if you’re looking for guidance on that.)

Most thyroid hormone replacement is safe and beneficial in breastfeeding, as long as we are using it in the right amounts. The amount of thyroid hormone in breast milk is not enough to cause harm to your baby, especially if you’ve been stable on your current dose prior to pregnancy.

As I mentioned, hypothyroidism can cause suppressed milk production, because it alters the hormones prolactin and oxytocin, both of which are required to produce milk. Suppressed milk production is also likely due to the loss of iodine and thyroid hormones to the milk. Appropriate levothyroxine (T4) replacement can help with this. ^[3]

Most of the research regarding breastfeeding has been done on levothyroxine, and generally conventional medicine practitioners have been fearful of using natural desiccated thyroid hormone (NDT). NDT is a combination of both T4 and T3 which can be really helpful for some people who have trouble converting T4 to T3. While a small amount of thyroid hormone is transferred in breast milk, research has found that this does not have a meaningful impact on the baby’s thyroid hormone status.

The American Thyroid Association (ATA) concluded that the amount of thyroxine transferred to a baby during breastfeeding is around one percent of the total daily requirement (based on 2017 ATA Guidelines). ^[4]

The ATA recommends that both subclinical hypothyroidism and overt hypothyroidism be treated with levothyroxine in lactating women planning to breastfeed. ^[5]

Recommended Testing

There is no general rule relating to thyroid medication dosing adjustments that apply to every woman during breastfeeding. However, the period at three to four months postpartum is especially important, as postpartum thyroiditis typically occurs up to four months after giving birth. ^[6]

Testing can be helpful for finding the cause, especially if one is symptomatic. Sometimes you’re tired because you’re a new mom, sometimes you might be tired because your thyroid is out of balance!

Depending on test results and symptoms, some women may need to decrease the dosage, while others will increase it or keep it the same.

I always recommend women get a phlebotomist to come to their house to do their labs if that helps make it easier for them to do lab testing on a regular basis.

If for any reason your doctor is unable or unwilling to order a full thyroid panel, I recommend a self order option like Ulta Labs. You want to make sure to include TSH, free T4, free T3, and antibodies.

Here are my recommended optimal ranges for each marker:

TSH: Between 0.5 and 2 μIU/mL

Free T4: Between 15 to 23 pmol/L

Free T3: Between 5 to 7 pmol/L

TPO and TG Antibodies: <2 IU/mL

2. Address Nutrient Depletions

We often take prenatals during pregnancy, but it’s also important to take enough vitamins and minerals postpartum to ensure you and the baby have enough, as some vitamin requirements increase during breastfeeding. Furthermore, some vitamin and nutrient deficiencies are commonly associated with thyroid conditions, and can even be the cause of thyroid symptoms or the thyroid condition. This is especially important if a woman is following a restrictive diet, or if a woman has other health complications which can make her vulnerable to nutrient deficiencies.

For Hashimoto’s mamas specifically, supplementing can:

• Help meet mom’s daily nutrient requirements to optimize her health
• Support thyroid health
• Help lower thyroid antibody levels
• Support lactation
• Increase nutrient concentrations in breast milk (for the baby’s health)

To give you an idea of how a mom with nutrient deficiencies can impact her nursling, one study estimated the percentage of recommended daily intake that infants fed by a nutrient-deficient mother could obtain from her milk. The estimates were 80 percent for vitamin B6, 60 percent for thiamine, 56 percent for choline, 53 percent for riboflavin, and only 15 percent for vitamin B12. Considering breast milk is an infant’s only means to obtain these nutrients, you can see how important mom’s nutrient status can be. ^[7]

If you have a prenatal vitamin you love, consider taking it while breastfeeding as well. I do want to highlight some nutrients that may require higher doses while breastfeeding or may be relevant to Hashimoto’s and/or thyroid symptoms.

I often recommend these core nutrients for Hashimoto’s, though others may be needed as well. Please consult your doctor, pharmacist, or lactation consultant when introducing new supplements, especially when breastfeeding.

Here are my top nutrient recommendations:

Vitamin A

Vitamin A is supportive of the thyroid, as it helps keep the immune system balanced, and it’s also involved in the activation, proliferation, and differentiation of regulatory T cells. ^[8]

The recommended dietary intake of vitamin A for lactating women is greater than during pregnancy (1300 mcg versus 770 mcg). A high amount of vitamin A is secreted into breast milk. Lactating mothers may need to supplement for themselves and their infants (under six months) at a recommended daily intake of 400 mcg. Daily doses of up to 1500 mcg should not harm the breastfed baby, but doses above 3000 mcg should be avoided, as the vitamin is fat-soluble. Extremely high doses in pregnancy may be linked to serious fetal defects. ^[9]

It’s important to note that some individuals may not be able to properly utilize the beta-carotene version of vitamin A, and the retinyl palmitate version may be more bioavailable. ^[10] Most prenatal vitamins do contain vitamin A already, and I would choose one that has both beta-carotene and retinyl palmitate. For example, Thorne Prenatal has 1050 mcg (1.05 mg) of vitamin A as a mix of beta-carotene and palmitate (it’s available via Fullscript – if you don’t have a Fullscript account, you can sign up with my credentials here).

Vitamin B12

Vitamin B12 is an essential water-soluble vitamin commonly found in animal proteins such as fish, shellfish, meat, eggs, and dairy products. It’s so important for a growing baby’s brain, and sadly may be commonly deficient in women with thyroid disease. One sad case study describes severe B12 deficiency in an exclusively breastfed infant that resulted in “poor weight gain, feeding difficulties, severe pallor, muscle hypotonia, and excessive sleepiness.” He also had an enlarged liver and spleen, and showed significant developmental delays and delays in communication. ^[11]

Individuals with autoimmune thyroid disease also have a high prevalence of vitamin B12 deficiency. One study found that 28 percent of individuals with autoimmune thyroid disease (in a sample pool of 115 patients), had a B12 deficiency. ^[12]

Some of the most common medications prescribed to people with Hashimoto’s are notorious for both altering one’s gut flora and depleting the body of nutrients. These include medications for acid reflux, synthetic estrogens, progesterone, (such as the birth control pill), and antibiotics.

Altered gut flora, or dysbiosis, can also reduce or prevent the extraction of nutrients (such as B12) from food.

The recommended dietary allowance for adults is 2.4 mcg per day, although women who are pregnant or breastfeeding often require more. Some practitioners recommend 5.5 mcg per day during lactation. ^[13]

It’s extremely important to have sufficient vitamin B12 levels, as exclusively breastfed infants can have neurological issues if deficiency is present in breast milk. ^[14]

This is why I recommend testing to ensure you have proper levels. To find out if you have low levels of B12, you can ask your healthcare provider for the B12 (or cobalamin) test. This test can be ordered individually or added to a blood panel. Your levels may be low, even if all other screening tests for iron/ferritin and anemia are within the reference range.

Alternatively, you can self-order the B12 test via Ulta Lab Tests. When you receive your test results, it’s important to note that optimal B12 levels should be between 700 and 900 pg/mL. Please note that most labs will not flag B12 levels unless they are under 200 pg/mL.

Additionally, testing for biomarkers such as methylmalonic acid (MMA), may provide valuable insight and help catch B12 deficiency in the earlier stages — you can also self-order an MMA lab test via Ulta Lab Tests.

There are a few options for supplementation, including tablets, sublingual (under the tongue) liquids, and injections. Please note that some individuals (such as those with SIBO, H. pylori or pernicious anemia) may not be able to absorb oral versions of B12, and may require injections or sublingual dosing.

I don’t personally know anyone who loves injections, so I was excited to learn that sublingual doses of 5 mg (5000 mcg) of B12, daily for ten days, then 5 mg once per week for four weeks, then 5 mg monthly, have been found to be effective in restoring B12 levels in those with a deficiency.

Pure Encapsulations B12 comes in a convenient liquid form that can be administered sublingually for optimal absorption. The active form of B12 in this formulation is methylated and, thus, highly bioavailable. It has also been shown to support neurological function, nerve cell health, healthy cognitive and nerve function, memory, and emotional well-being.

Carnitine

Carnitine is one of my top supplements for Hashimoto’s. It’s incredibly supportive for the brain and for muscle function. ^[15] I have personally seen people awaken from a brain-foggy “sloth-mode” when they start supplementing with carnitine. I also have a very personal connection – my own postpartum muscle weakness, aches, and pains were reversed with carnitine!

Carnitine deficiency is common in pregnant and recently postpartum women, as well as in those with Hashimoto’s. ^[16]

It’s also interesting to note that there has been research focused on the effects of carnitine supplementation on preemies (premature babies).

Carnitine is transferred across the placenta, primarily during the third trimester, so preterm infants often develop carnitine deficiencies. Breast milk and infant formulas contain carnitine, but parenteral nutrition that preemies often get (through an IV) does not routinely contain carnitine. ^[17]

In one 2006 study, 29 premature newborns were split into control and placebo groups, and studied for up to eight weeks. ^[18] The control group was given carnitine supplementation at 20 mg/kg/day, which resulted in increased plasma concentrations of total carnitine. More exciting still, carnitine supplementation had a positive effect on catch-up growth, with the infants regaining their birth weight more rapidly than the placebo group (without carnitine supplementation).

Though there is some conflicting research on this topic, given the other potential health benefits and safety profile of carnitine, a woman might want to discuss the use of carnitine with her doctor as a treatment option should she have a preterm infant.

It appears unlikely that maternal supplementation during nursing would be harmful to the infant, but until more research data is available, you may wish to discuss this with your doctor. ^[19]

I generally recommend Rootcology’s Carnitine Blend, which uniquely combines L-carnitine and acetyl-L-carnitine into one convenient 500 mg capsule. (The recommended dose for hypothyroidism is 1800 mg per day. Remember that some 75 percent of the usual carnitine intake comes from diet, and about 25 percent comes from the body’s own synthesis.)

While it’s always better to work with a good functional practitioner for interpretation, you can order a wide variety of helpful labs yourself. I often recommend Ulta Lab Tests, because you can self-order the tests and later submit the charges to your insurance for possible reimbursement (different insurance plans may or may not cover this, so always check with yours).

When checking your carnitine levels, you could also check another common marker that points to developing carnitine deficiencies, which is having low ferritin (stored iron) levels. This can be especially helpful if you are experiencing specific (and maddening!) symptoms of low ferritin, like hair loss. Remember that iron is a cofactor nutrient that the body needs to manufacture carnitine. The two tests I like are the Ulta Lab Carnitine test and Ulta Lab Ferritin test.

Choline

Choline is a nutrient that can be found in beef liver and egg yolks, but is deficient in many diets. It is essential to have adequate levels of choline during pregnancy, as it is critical for fetal brain development. ^[20]

Lactating women often have deficiencies in choline. In particular, women following strict vegetarian or vegan diets, as well as low-fat diets, may be deficient.

Choline is not only safe while breastfeeding, but the CDC recommends that lactating mothers take 550 mg of choline daily throughout the first year postpartum. ^[21]

If you have Hashimoto’s, you know how debilitating the brain fog and mental fatigue can be. Choline is an essential nutrient for brain function, and can be helpful if you’re experiencing these symptoms. And if you’re a new mom, you know they don’t call it “mom brain” for nothing!

Citicoline is a bioavailable version of choline that has been well-studied to be less toxic and more effective than other versions. Numerous clinical studies have shown that citicoline boosts mental energy by improving cerebral blood flow and protecting brain cells from free radical damage. ^[22] In fact, its effects on the brain are so powerful that it’s used to enhance cognitive function in patients damaged by neurological disorders or brain trauma.

I love Vital Nutrients Citicoline. The usual daily therapeutic dosage of citicoline is 500-2,000 mg, taken daily.

Chromium

The mineral chromium is involved in carb and fat metabolism, and also helps control blood sugar levels. A lack of chromium may make one more intolerant to carbohydrates, so it’s important to have adequate levels. This is especially important during pregnancy if you’re diabetic or develop gestational diabetes. Low chromium levels are associated with gestational diabetes.

Some research suggests that chromium supplementation can help with depression, and may be helpful in preventing postpartum depression, however more research is needed here. ^[23]

It’s considered safe to take during breastfeeding and may support continued healthy blood sugar levels (and maybe even mood!).

Some, but not all, prenatals contain chromium. It is recommended that prenatal supplements contain at least 100 μg/day, though women who develop gestational diabetes or who have diabetes may benefit from doses up to 200 μg/day. ^[24]

Talk to your practitioner about taking an additional chromium supplement if your prenatal does not include it, or has a low amount.

Fish Oil

Omega-3s are essential fatty acids that are crucial for keeping inflammation under control, managing autoimmunity, promoting blood vessel health, supporting healthy skin growth, providing the precursors to balance hormones, and supporting healthy brain and nervous system function. ^[25]

Due to their role in immune function, omega-3 fatty acids are especially important for anyone with an autoimmune disease like Hashimoto’s.

While taking omega-3 acids in the form of fish oil or cod liver oil has been found to be helpful in a variety of autoimmune conditions, few studies have directly focused on the benefits of fish oil for thyroid issues and Hashimoto’s. One rodent study did find that a long-term diet rich in omega-3 EFAs lowered serum triglycerides and cholesterol while enhancing thyroid hormone signaling pathways in the liver. ^[26]

Another study compared the number of thyroid antibodies in pregnant and postpartum women who ate oily fish high in omega-3 acids (such as sardines) versus swordfish. Thyroid antibody levels were found to be lowest in the group that consumed fish that were high in omega-3 acids, suggesting that oily fish that are high in omega-3 acids can be beneficial for preventing autoimmune thyroid issues after pregnancy. ^[27]

Higher DHA in breast milk has been associated with better vision, cognition, and neurodevelopmental outcomes, though studies are inconclusive. ^[28] Lactating moms taking omega-3 supplementation in safe amounts (up to three grams daily, per the FDA) had increased DHA and EPA levels in their breast milk. ^[29]

Other research found a possible correlation between increased fatty acids in breastfeeding and reduced allergic reactions in babies, but this research is also not conclusive. ^[30]

According to the Therapeutic Research Center Natural Medicines Database, fish oil is likely safe when taken at the recommended level, approximately 1.4 grams/day in pregnancy, and 1.3 grams/day during lactation. Taking it in larger amounts, or eating larger fish (eg: shark, swordfish, king mackerel, and tilefish) could lead to mercury exposure.

My favorite professional quality fish oil supplements are those that have been molecularly distilled and filtered, such as EPA/DHA Essentials by Pure Encapsulations or OmegAvail™ Synergy by Designs for Health. This process ensures purity and helps eliminate contaminants including heavy metals, pesticides, solvents, and PCBs.

Cod liver oil provides another option that combines EPA and DHA with vitamins A and D, but I would talk to a practitioner before using it.

Iodine

Iodine needs may be slightly higher for women who are lactating. The recommended dietary amount of iodine for lactating women is 290 mcg per day, compared to 220 mcg during pregnancy, and 150 mcg for prenatal support.

If you’ve been following my work, you likely know that I advise against high doses of iodine for those with Hashimoto’s, as it has been found to trigger Hashimoto’s. (You can read more about that in my article on iodine and Hashimoto’s.)

That said, the dosage of iodine found in multivitamins and prenatal vitamins (150– 220 mcg) is not considered high, and is not likely to be an issue for most women with Hashimoto’s. The benefits of small doses of iodine likely outweigh the risks during pregnancy and lactation, but I would caution against using higher doses of iodine, as this can exacerbate Hashimoto’s.

Breast milk iodine concentration is determined by dietary intake (iodized salt, dairy products, goitrogen consumption, and supplementation) and either iodine excess or iodine deficiency in the infant can cause neonatal hypothyroidism. ^[31]

For breastfeeding moms, most practitioners recommend iodine supplements at levels found in many prenatal vitamins (most contain between 150 mcg–220 mcg), rather than megadoses of iodine.

Iron

Iron is often depleted during pregnancy and postpartum, which can lead to poor utilization of thyroid hormone, as well as symptoms like brain fog, depression, fatigue, and hair loss – despite taking thyroid medications. Dr. Oscar Sellerach, author of The Postnatal Depletion Cure, mentions that it’s the most common deficiency he sees in postpartum women who are struggling. I have found that anemia is very common in people with Hashimoto’s, and research has also found that anemia frequently occurs with thyroid disease. ^[32]

As an essential mineral, iron is important for many reasons related to thyroid metabolism. Iron transports and affects the body’s utilization of T3. When ferritin levels are low, this can cause elevated reverse T3 levels, which block receptors for free T3 (our active thyroid hormone), resulting in thyroid symptoms. ^[33] Low iron may also reduce the binding ability of free T3.^[34] This can occur even if someone is on levothyroxine, leading to that common dilemma of having thyroid symptoms, despite taking thyroid medications. I personally believe iron deficiency also contributes to the development of autoimmune hypothyroidism.

Additionally, some studies suggest that iron deficiency can inhibit the conversion of T4 to the active T3 thyroid hormone. ^[35]

Iron deficiency is often missed by lab tests and I’m a proponent of using a ferritin test, the iron storage marker, to determine if someone is deficient. Many people with Hashimoto’s who have low ferritin stand to benefit from boosting their levels. Having adequate ferritin levels can support healthy thyroid function, reduce fatigue, stop hair loss, and reduce mental fatigue. ^[36]

A 2018 study on women taking levothyroxine who still had persistent symptoms of hypothyroidism despite the levothyroxine therapy, found that two-thirds were able to eliminate their symptoms when they got their ferritin levels over 100 µg/L. ^[37]

Some studies indicate that the body’s demand for iron increases during breastfeeding, but others indicate it decreases (due to cessation of menstrual blood loss). Of course not all women experience a loss of menses while breastfeeding, so I think this may vary. It’s important to note that many women are anemic during pregnancy, pregnancy increases the demand for iron, and giving birth leads to a huge loss of iron – thus, many women come into postpartum with extreme iron deficiency.

Whether iron is excreted in breast milk isn’t entirely clear. One study found that when mothers supplemented with iron, it did not result in an increased concentration of iron in their breast milk (but the mothers still experienced benefits from the increased iron). ^[38] Another study said that maternal supplementation can increase the concentration in milk. ^[39] And yet another study suggested that a woman’s iron status during pregnancy may affect the quantity of iron later during lactation. ^[40]

Per the Therapeutic Research Center’s Natural Medicines Database (NMD) pregnancy and lactation checker, iron is safe for pregnant and breastfeeding individuals below 45 mg day (UL), but may be unsafe in higher doses. ^[41]

Baby formula is usually fortified with iron, but iron supplementation is often recommended for breastfed babies, regardless of whether mom is deficient. (Delayed cord clamping, can be another method to ensure the baby has adequate iron). Supplements can be helpful for babies, especially around four months, when they are more prone to deficiency. Iron deficiency in infancy may lead to poor psychomotor development. ^[42]

I recommend testing your ferritin levels, as this is often a more accurate reflection of iron available to the body. Normal ferritin levels for women are between 20 and 200 ng/mL. According to some experts, ferritin levels of at least 40 ng/mL are required to stop hair loss, while levels of at least 70 ng/mL are needed for hair regrowth. The optimal ferritin level for thyroid function is between 90 and 110 ng/mL.

You can check your ferritin levels easily with Ulta Lab Tests.

Thorne’s Iron Bisglycinate is a popular iron supplement used for people with anemia (it’s available here via Fullscript. If you don’t have a Fullscript account you can sign up with my credentials here. Please note that supplementation doesn’t always guarantee a boost in levels, and there are many other ways to boost your iron levels.

I take a deep dive into iron deficiency anemia in this article, where I cover many potential contributing factors and ways to boost iron and ferritin levels.

Magnesium

Low magnesium levels are associated with thyroglobulin antibody (TGAb) positivity, Hashimoto’s thyroiditis, and hypothyroidism. ^[43] A magnesium deficiency can put those with Hashimoto’s at a higher risk of developing symptoms.

Magnesium is crucial for liver health, and adrenal function — two key areas I always recommend those with thyroid dysfunction address. In fact, magnesium supplementation is one of the core recommendations in my Adrenal Transformation Protocol, which has helped thousands of my readers restore optimal adrenal function. (More on the adrenals in the next section).

Research has shown that magnesium deficiency can have a direct impact on thyroid function.

In one study, 11 patients with an elevated TSH (range of 2.3 – 21 mIU/L, average of 7.67 mIU/L), received magnesium citrate for six weeks. Every patient had a drop in TSH (the resulting range was 1.6 – 4 mIU/L). The average drop was by five points, resulting in an average TSH of 2.67 mIU/L after treatment. The highest drop was from a TSH of 21 mIU/L to a TSH of 4 mIU/L! ^[44]

Magnesium is safe to use during breastfeeding, and may provide additional benefits like improved sleep, better relaxation, less anxiety, and help with constipation. ^[45]

Oral absorption of magnesium by infants is poor, so maternal magnesium citrate is not expected to affect the breastfed infants’ serum magnesium levels. Magnesium citrate supplementation during pregnancy might delay the onset of lactation, but it can be taken during breastfeeding with no specific precautions. ^[46]

Additionally, magnesium can be incredibly helpful in relieving breastfeeding aversion, where women experience negative thoughts triggered by breastfeeding. I personally noticed it helped me, especially during my period. It may be a coincidence, but I also think it helped my baby poop!

I recommend Rootcology’s Magnesium Citrate Powder with an upper limit dose of 350 mg daily for those who are pregnant or breastfeeding.

I generally don’t test people for magnesium deficiency, as not all tests are reliable and my experience has shown that most people with Hashimoto’s are deficient in magnesium.

Additionally, it is generally safe to take without testing. If you have low mood, anxiety, fatigue, excess stress, difficulty concentrating, muscle cramps, or frequent headaches or migraines, supplementing with magnesium is usually recommended. ^[47]

MTHFR

While not a nutrient per se, having an MTHFR gene variation can impact your ability to absorb and utilize key nutrients. Specifically, elevated homocysteine levels often caused by the MTHFR gene variation have been associated with nutrient deficiencies in vitamins B2, B6, B9 (folate), and B12. ^[48]

Another key thing to note is that this gene variation prevents people from properly methylating, which is one of the body’s key detox processes that helps them get rid of toxins. Methylation impairment can result in an impaired ability to clear out certain toxins such as mercury and arsenic, and may lead to estrogen dominance. Symptoms like brain fog, multiple chemical sensitivities, depression, irritability, and anxiety are related to impaired methylation. These symptoms are all too common in Hashimoto’s.

The MTHFR gene variation is relatively common in the general population, but does appear more commonly in those with hypothyroidism.

Individuals with one or two copies of the genetic variation and low activity of the MTHFR enzyme may have pregnancy complications, and even miscarriages. Higher rates of Down syndrome and birth defects in offspring have been noted in those with the MTHFR gene variation, as well as other issues that may manifest later on in life, such as depression, an increased risk of blood clots, and a higher risk of certain cancers. ^[49]

If you do have the MTHFR gene variation, it can be incredibly important to support methylation and ensure proper levels of the B vitamins listed above.

Rootcology’s MTHFR Pathways contains methylated B vitamins and synergistic nutrients that work together to support healthy metabolism of homocysteine.* Please always consult with your doctor, pharmacist, or lactation consultant before starting a new supplement.

It’s important to test for both homocysteine levels and the MTHFR gene variation because, while you may not have the gene that affects the methylation pathways, you may still have elevated homocysteine levels, which tells us the level of inflammation in our bodies. Elevated homocysteine levels may also indicate a deficiency in B vitamins.

Testing for homocysteine levels is now available through many labs and can be assessed with a blood test.

There are differing parameters for what may be considered optimal reference ranges for homocysteine levels. Depending on the lab, some reference ranges may define homocysteine excess as greater than 10 or 11 µmol/L, and levels under 4, 5, or even 6 µmol/L may be considered too low.

Other reference ranges, such as the one reported by Medscape, break down homocysteine levels by age and gender. (Levels of homocysteine generally increase with age.)

• Age 0-30 years: 4.6-8.1 µmol/L
• Age 30-59 years: 6.3-11.2 µmol/L (males); 4.5-7.9 µmol/L (females)
• Age >59 years: 5.8-11.9 µmol/L

According to functional ranges, however, the optimal homocysteine levels range seems to be somewhere between 5 and 7 µmol/L. I imagine that, as with most labs, homocysteine levels are simply numbers to consider when looking at the big picture of overall health, and individual variations need to be considered.

As for testing for the MTHFR genetic variation, many labs also offer tests for this gene. For example, you can order a genetic saliva test kit from 23andme.com, or see if you can get a genetic test from your physician, which may be covered by insurance. You can upload your results to geneticgenie.org, which will then tell you if you have the genetic variation.

Many prenatals contain enough methylfolate for breastfeeding, but please check the ingredients in your prenatal. Some may contain folic acid instead, a version that may not absorb as well.

For those that may need more methylation support, I developed the Rootcology MTHFR Pathways supplement, which contains methylfolate, betaine, activated B12, and other synergistic nutrients that support healthy homocysteine pathways, including activated forms of B2 and B6, and L-serine.*

Betaine supports digestion, but it also provides an alternate pathway for clearing homocysteine. It has been found to reduce the likelihood of obesity in children when used by breastfeeding mothers. A 2021 study found an association between lower levels of betaine in breast milk and rapid growth during the baby’s first few months of life, which is a risk factor for obesity in childhood. ^[50] When the mother supplemented with betaine and raised levels in her milk, it moderated growth. These benefits appear to carry over into adulthood, improving metabolism and reducing inflammatory markers. This could be due to the effect on the microbiome, specifically by increasing levels of the beneficial gut bacteria Akkermansia.

If you are currently taking betaine and your baby’s weight gain has slowed or they are showing signs of failure to thrive, I would consider pausing betaine to see if it helps them gain an appropriate amount of weight.

An important note about vitamin B6: B6 supplementation is safe in breastfeeding and beneficial for baby’s brain development. Maternal supplementation rapidly increases the amount in milk. (Note that if mom was deficient during pregnancy, the infant will not have the appropriate level of gestation-accumulated stores and may be deficient.) Mothers may want to limit their intake to 50 mg per day, as higher doses may suppress prolactin levels, and therefore lactation (according to one 1979 study). While the data is conflicting, I say better safe than sorry. 🙂

Myo-Inositol

Myo-inositol is an important nutrient that serves key functions relating to hormone signal transduction throughout our endocrine system. As such, myo-inositol plays an important regulatory role relating to thyroid health (regulating the thyroid-stimulating hormone, or TSH) and reproductive health (regulating the follicle-stimulating hormone, or FSH). It also regulates glucose uptake and may be involved in serotonin uptake (our happy and calming hormone). ^[51]

Myo-inositol has been found to provide many valuable health effects, including anti-inflammatory, anti-oxidant, anti-diabetic, and anticancer effects. ^[52] Because of its ability to support blood sugar balance, myo-inositol is especially supportive and often recommended for women with PCOS. ^[53]

Serum concentrations of myo-inositol in neonates are greater than in adults and are directly influenced by myo-inositol intake during breastfeeding (more than with bottle-fed). ^[54] Taking myo-inositol while breastfeeding can help boost milk supply and support your baby’s brain health.

In fact, research has found that the myo-inositol present in human breast milk increases brain connectivity in infants, increasing the size and abundance of synapses. ^[55] The studied babies who were breastfed, performed higher on intelligence tests later in life.

Generally, you do not need to test your own levels of myo-inositol.

Research shows that supplementing with myo-inositol (especially when combined with selenium) reduces TSH and thyroid antibodies. ^[56] It can also help promote relaxation and restful sleep (we new mamas need as much as we can get!), as well as balance hormones. ^[57]

If you’re experiencing high blood sugar, myo-inositol can be helpful in improving insulin sensitivity and carbohydrate metabolism. ^[58] The dose studied for Hashimoto’s is around 600 mg per day, while higher doses have been used for OCD and PCOS. I have seen lactation supplements that use myo-inositol in doses as high as 2000mg. Myo-inositol can increase milk supply in the case of insulin resistance and PCOS (and I believe may help with thyroid-related lactation issues), but if you have an oversupply, it’s wise to check with a lactation consultant as to whether you should use myo-inositol.

It can be taken as a standalone supplement as Myo-Inositol Powder. This form is great for anyone who doesn’t like taking pills or who wants to replace sugar or other sweeteners in their tea or coffee, as myo-inositol has half of the sweetness of table sugar and may just do the trick! If you’re looking for the combined benefits with selenium, try Selenium + Myo-Inositol. For anyone looking to support immune health, hormone balance, and metabolic health, in addition to their thyroid, this combo is a great option. ^[59]

As a side note, while it’s not been studied in Hashimoto’s, D-chiro-inositol is another form of inositol that is often used in PCOS. I did some genetic testing for my son that showed he might benefit from D-chiro-inositol and decided to have him start taking it when he was around three years old, while I was still breastfeeding him. Lo and behold, he finally began sleeping through the night! I attribute this miracle to the D-chiro-inositol and moving from beautiful Boulder, CO to sunny Los Angeles, which is at sea level. Elevation makes people more likely to suffer from insomnia, even babies!

Selenium

Selenium deficiency is one of the most common nutrient deficiencies that I see in people with Hashimoto’s, and research suggests that thyroid disease is linked to selenium deficiency. ^[60]

In my clinical experience, most people with Hashimoto’s have a deficiency in selenium, and being deficient in this key thyroid nutrient is a very common and widely recognized trigger of autoimmune thyroid conditions!

The good news is that supplementing with selenium at a therapeutic dosage, has been found to reduce thyroid antibodies, reduce thyroid symptoms, and improve overall well-being. ^[61]

When I surveyed my Root Cause readers, 63 percent of respondents said that taking a selenium supplement helped them feel better.

As an added bonus, selenium has been shown to help reduce anxiety as well. Interestingly, a 2004 study found an association between the presence of an anxiety or mood disorder, and the presence of thyroid peroxidase (TPO) antibodies. ^[62]

Beyond Hashimoto’s, other populations at risk for selenium deficiency include: people on certain diets (grain-free, gluten-free – just the type of diets that we usually find to be helpful for those with Hashimoto’s!), people with celiac disease or gluten sensitivities, those with IBS or Graves’ disease, women who are pregnant or experiencing postpartum thyroiditis, and people with thyroid eye disease. ^[63]

Women who have thyroid antibodies in the initial trimester of pregnancy have a higher risk (33 to 50 percent) of developing postpartum thyroiditis. A 2019 study found that selenium supplementation of 83 mcg daily during pregnancy and postpartum, is both safe and helpful for preventing both postpartum increases in TPO antibody levels and postpartum thyroiditis. ^[64] Selenium in breast milk appears to be safe for infants, even in higher amounts. ^[65]

While there isn’t specific testing I would recommend relating to measuring selenium levels, taking a consistent, therapeutic dosage of selenium each day has been shown to reduce thyroid antibodies, reduce symptoms (including anxiety), and improve overall well-being.

Pure Encapsulations makes a high-quality standalone Selenium supplement at a dose of 200 mcg or as I mentioned above, I formulated Rootcology Selenium + Myo-Inositol in the therapeutic doses of 83 mcg and 600 mg that have been studied in Hashimoto’s. The synergistic effects of these two nutrients work together to support optimal thyroid function. When combined with myo-inositol, doses of 83 mcg of selenium per day support thyroid function.

As a standalone supplement, a dose of 83 mcg-400 mcg of selenium has been studied to be therapeutic. On its own, selenium is usually recommended at doses of 200 mcg for thyroid support, and doses of up to 400 mcg per day have been shown to be safe in breastfeeding. ^[66]

While rare, some of my readers and clients have reported that prolonged use of selenium at the higher end of the dose led to symptoms like losing hair. I have not seen this with the lower dose, but lower doses tend to work best when combined with myo-inositol.

Thiamine

I often see thiamine deficiency in those with Hashimoto’s, and it can lead to some pretty significant fatigue!

Thiamine is one of the B vitamins, known as B1. Its main responsibility is to change carbohydrates into energy. Thiamine also helps with the digestion of proteins and fats, as it is necessary for the proper release of hydrochloric acid in our stomachs (which is required for proper protein digestion).

Given that most people with Hashimoto’s have low stomach acid or do not release any stomach acid at all, it’s important to have optimal levels of thiamine.

Italian clinicians Dr. Antonio Costantini and nurse Maria Immacolata Pala, have hypothesized that the chronic fatigue that accompanies inflammatory and autoimmune diseases may be a result of a mild thiamine deficiency. ^[67] They had already found that thiamine helped relieve fatigue in people with ulcerative colitis (an autoimmune condition that affects the gut), and decided to try using thiamine in three women with Hashimoto’s who were on thyroid medications but continued to experience fatigue. ^[68]

Two of the women were given an oral dose of thiamine (600 mg) per day, while the third was given an injection of 100 mg, every four days.

All of the women were given a survey to rate their fatigue before starting the thiamine, and filled out the same questionnaire 20 days into the treatment. During the second survey, all three reported that they experienced a relief in their fatigue — and two had a complete remission of their fatigue!

The woman who had the injection felt that her fatigue was lifted within six hours of receiving it, while the women who took the oral dose of thiamine felt relief within three to five days. Interestingly, none of the women had thiamine deficiency on standard lab tests that are used to measure thiamine status.

I have seen women awaken from decades of debilitating fatigue by using thiamine just for three days! Thiamine is also critical for the health of our babies! In 2003, a thiamine-deficient formula was marketed in Israel, and there were numerous reports of infants who were fed this formula who ended up with neurological damage, and some even died. ^[69]

Dietary intake of thiamine in breastfeeding mothers is directly correlated to levels of thiamine in breast milk. Mothers with low thiamine intake produce milk that is low in thiamine. This can put exclusively breastfed infants at a high risk of developing beriberi (thiamine deficiency). ^[70] Even if thiamine deficiency is not severe enough to cause beriberi, it can still negatively affect the cognitive development and functioning of an infant.

Unfortunately, standard lab tests for thiamine deficiency will not show if someone is mildly deficient — they only screen for severe deficiencies.

If you’ve been struggling with fatigue, low stomach acid, carbohydrate intolerance, low blood pressure, and symptoms related to your adrenals, you may have a thiamine deficiency and may benefit from extra B1 intake. (Generally, most people can supplement with thiamine without prior testing.)

The supplement I have taken for thyroid fatigue and recommend, is the highly absorbable BenfoMax by Pure Encapsulations.

As I mentioned earlier, research studies have shown that a daily 600 mg dose of thiamine, for as little as three to five days, can produce benefits such as more energy, better brain function, stabilized blood pressure, and improved blood sugar tolerance. Doses of up to 10 mg per day have been studied to be safe and beneficial for breastfed children. One study even found that 10 mg per day of vitamin B1 in breastfeeding mothers aids in language development in infants, and higher B1 concentrations in breast milk are associated with better fine motor skills. ^[71] I don’t have any reason to believe that the extra high doses would be problematic.

Vitamin C

This powerful antioxidant helps support the adrenals, mitochondria, collagen production, and the suppression of a reactivated Epstein-Barr virus infection, along with many other potential viruses. ^[72]

Seeing as adrenal dysfunction and infections are two major root cause triggers of Hashimoto’s, I consider vitamin C an important nutrient.

When it comes to breastfeeding, vitamin C is deemed safe, and important to immune health (for both mom and baby). The recommended vitamin C intake in lactating women is 120 mg daily (versus pregnant women requiring 85 mg). ^[73] Note that the maternal doses of vitamin C in many multi-vitamins may provide mothers with more vitamin C, but will not alter milk concentration levels. However, high daily doses of up to 1000 mg have been found to increase milk concentration levels and have resulted in no safety concerns for the breastfeeding infant. ^[74] Breastfed infants can develop deficiencies in water-soluble vitamins such as vitamin C.

I generally don’t recommend testing for vitamin C, as it’s a water-soluble vitamin.

As for supplementation, I recommend NOW Brand Vitamin C-500 tablets.

My other favorite way to get vitamin C is through Rootcology’s Electrolyte Blend, as it’s important for adrenal function to stay hydrated and keep our electrolytes in balance. Being hydrated is also essential for milk production!

I recommend doses of 500 mg to 3,000 mg per day, as tolerated.

Vitamin D

In my experience of performing case reviews for people with Hashimoto’s, vitamin D is the most common deficiency. However, as vitamin D excess can be problematic, I always recommend testing before supplementing.

Numerous studies have connected low vitamin D levels to various autoimmune conditions, including Hashimoto’s. ^[75]

Vitamin D may be beneficial in balancing the immune system through supporting the production of T-regulatory cells, and suppressing the Epstein-Barr virus, a virus that has been tied to numerous autoimmune conditions, including Hashimoto’s. Research has also shown that vitamin D actively prevents the development of autoimmunity in animal models. ^[76]

Furthermore, there is a strong connection between vitamin D deficiency and various thyroid conditions. Vitamin D deficiency has been documented in Hashimoto’s, Graves’ disease, thyroid cancer, as well as postpartum thyroiditis.

One study in Turkey found that 92 percent of Hashimoto’s patients were deficient in vitamin D! ^[77] In 2015, I surveyed 2332 of my readers with Hashimoto’s, and found that 68 percent of them reported being diagnosed with vitamin D deficiency.

Vitamin D is vital for a newborn’s health. The American Academy of Pediatrics (AAP) actually recommends that all breastfed infants receive a daily supplement of vitamin D of 10 micrograms (400 IU) per day, beginning soon after birth. ^[78] You can purchase liquid vitamin D drops for infants at the pharmacy or from reputable online retailers like Fullscript.

As an alternative to giving their baby supplements, lactating mothers can take a high dose of vitamin D (6000 IU, per day) to increase the concentration in breast milk and ensure that there is enough for her baby.

There are two available tests to check your vitamin D levels: 1,25 (OH)D (which checks for the active form of vitamin D) and 25(OH)D (which checks for both D2 and D3). The 25(OH)D (25-hydroxyvitamin D) test is preferred, as it tests for both vitamin D2 and D3 levels and more accurately reflects one’s vitamin D status.

If you have Hashimoto’s and have not had your vitamin D levels checked, I recommend testing as soon as possible. When supplementing, I recommend testing every 3 to 6 months to ensure you are getting adequate amounts, and then testing again in the winter season.

Options for vitamin D supplements include:

• Pure Encapsulations Vitamin D 5000 IU (without Vitamin K) — you can also purchase this through Fullscript. If you don’t have a Fullscript account, you can sign up with my credentials here.
• Designs for Health Vitamin D Supreme (with Vitamin K*) — you can also purchase this through Fullscript. If you don’t have a Fullscript account, you can sign up with my credentials here.

You can also boost your levels by simply spending time in the sun. Vitamin D advocates recommend 15 minutes of unexposed skin, without sunscreen, around noon. Please note that this does not apply to your baby — infants under six months should be kept out of direct sunlight.

You may also continue any prenatal vitamins you were taking during pregnancy, throughout breastfeeding, and postpartum. A few of my favorites are Thorne’s Basic Prenatal (available via Fullscript – you can sign up with my credentials here), PreNatal Nutrients by Pure Encapsulations, and Prenatal Pro by Designs For Health.

Zinc

Zinc is an essential element for thyroid function.

A depletion in zinc prevents the conversion of the T4 hormone into the active T3 version. This could lead to symptoms like hair loss, fatigue, and weight gain, even while taking thyroid medications like Synthroid. (You can read more about the effects of insufficient T3 levels here.)

Zinc is also needed to form TSH, which is why those with hypothyroidism and who are constantly producing TSH, are more likely to develop deficiencies in this important mineral. When taken with selenium, zinc has been shown to improve thyroid function.

In 2015, a study was conducted with 68 overweight or obese female hypothyroid patients who received either a zinc supplement, a selenium supplement, placebo pills, or both zinc and selenium supplements taken together. ^[79] Three months later, it was noted that those taking both zinc and selenium, as well as those just taking zinc supplements, saw a significant increase in their free T3 levels. Those taking both zinc and selenium experienced a significant decrease in their TSH and an increase in T4 levels. The study concluded that zinc, when taken alone as well as in combination with selenium, can have a positive effect on thyroid function in overweight or obese patients with hypothyroidism.

The benefits of zinc supplementation in thyroid patients were also confirmed when I surveyed over 2,000 of my readers and asked them what interventions worked for them. Fifty-two percent of them said taking a daily dose of 30 mg of zinc made them feel better. Fifty-eight percent said they saw an improvement in energy, 48 percent in their mood, 30 percent in their lab results, and 25 percent in skin changes.

Zinc is also important for a growing baby.

Breastfed infants between four and six months may have a risk of zinc deficiency, and that risk is associated with maternal zinc status and breast milk zinc concentrations. Zinc deficiency in infants may result in a compromised immune system, and may also impact growth. ^[80]

I was deficient in zinc while nursing, but thanks to Dr. Serrallach’s recommendation, I used a supplement, which helped my son’s appetite. Some research supports that both zinc and iron supplementation can improve appetite in toddlers. ^[81]

Zinc picolinate, such as the one made by Pure Encapsulations, has an improved absorption profile compared to other forms. Supplemental zinc should be under 30 mg per day. Higher doses should only be taken under the supervision of a practitioner.

3. Address Adrenal Health

Too much stress and too little sleep is a perfect recipe for burnout and adrenal dysfunction – and this is often what mothers with newborns are dealing with! Supporting the adrenals will be crucial for your own health and well-being, and for producing enough milk for your baby.

Stress and adrenal dysfunction are very common triggers for Hashimoto’s. In fact, I personally did not completely resolve my thyroid symptoms until I finally addressed the health of my adrenals.

I’ve now experienced three bouts of adrenal dysfunction – the last time being after the birth of my son.

The adrenal dysfunction protocols that had worked for me in the past (like getting 12+ hours of sleep and avoiding caffeine) seemed unfathomable (laughable), with a newborn. Additionally, I wasn’t comfortable taking adrenal hormones like DHEA while I was breastfeeding. So, I had to tweak my protocols and find some new strategies to support my adrenals during this precious postpartum period.

This led to the development of my Adrenal Transformation Program (which thousands of people have now been through, with amazing results, and you don’t have to be a new mom. If you’re experiencing chronic stress or still experiencing unresolved Hashimoto’s symptoms, it can be helpful for you, too.)

Rather than focusing on tips for a “perfect,” unattainable lifestyle to see results, the ATP focuses on sending safety signals to the body and building our resilience so we can thrive in the modern world. This approach acknowledges the real‐world challenges that prevent us from pursuing some sort of “perfect” diet or lifestyle, since pursuing perfection can just create more stress (especially for new moms!).

Here are the fundamental ideas behind the program:

• No Tests Required. To make this program as accessible as possible, we’ll skip the functional medicine adrenal saliva and urine testing during the four‐week program. While these tests can be a helpful guide when it comes to understanding possible treatments, they are not required to resolve symptoms for most people. I know that these tests are not widely accessible to many people, and my goal with the ATP is to share easy‐to‐implement protocols that do not require testing for you to see benefits.
• Cutting Caffeine Is Optional, as is Sleeping for Long Periods. While there are certainly unquestionable benefits of getting lots of sleep and minimizing caffeine, you do not need to sleep for 10 to 12 hours each night, nor do you need to quit caffeine… which is great news for new moms, because getting enough sleep is nearly impossible with a newborn, and caffeine might be your best friend right now. 🙂

I’ve now realized that sleep deprivation and caffeine addiction are symptoms of adrenal dysfunction, and not necessarily the root cause. To get at the root causes, we will focus on solutions that optimize the circadian rhythm, so you can have a lot of energy during the day, and so that you can rest at night. After a few weeks of the adrenal protocol, you should find yourself less reliant on caffeine. If you feel ready to cut back, you’ll have an option to do so, but it’s just that, an option.

• Hormone Supplementation Isn’t Necessary. We won’t be using hormones like pregnenolone, DHEA, and hydrocortisone. While hormones like pregnenolone and DHEA are available for purchase without a prescription in many countries, they require one‐on‐one personalized, professional guidance to be used safely, and may not be right for everyone, including breastfeeding mothers. Instead, we will rebalance these hormones naturally, with the use of complementary healing modalities, including nutrition, circadian rhythm balance, self‐care strategies, and personal transformation work, as well as targeted root‐cause interventions.
• Targeted, Effective Supplementation. I always recommend what I call the ABCs of adrenals – adaptogens, B vitamins, and vitamin C (not all adaptogens are safe for breastfeeding – see below for safe options). Beyond that, the supplement protocol for my Adrenal Transformation Program utilizes broad‐spectrum, multipurpose supplements to solve the most common causes of adrenal dysfunction (such as blood sugar imbalance, sleep deprivation, inflammation, and mitochondrial stress). While these are not required, in my experience, the best outcomes happen when people use supplements, in addition to the other elements of the program. There are notes throughout which indicate which supplements and adaptogens are safe for breastfeeding mamas.
• Focus on Making Your Body Feel Safe. I firmly believe that adrenal dysfunction develops as an adaptive mechanism to us not feeling safe in our environment. The ATP will restore balance by replacing danger signaling patterns and daily habits that no longer serve us, with new ones that support safety and healing.
• Tools to Transform Your Mindset. Last but not least, sustainable adrenal hormone balance often requires deep, resilience‐building transformational work. Without it, we risk falling into the same old ways and routines that contributed to our adrenal dysfunction and burning ourselves out again and again. Shedding my past self, letting go of outdated childhood beliefs, and no longer accepting things that don’t work for me have been necessary parts of breaking the vicious cycle of healing and crashing my adrenals. Learning how to make the body stronger physically and mentally, shifting into a more self-compassionate mindset, establishing healthy boundaries, and addressing trauma, among other transformative practices, will rewire the way you respond to stress, allowing you to thrive in our modern world. This is especially important as a mom, when your time and energy are limited, and your priorities start shifting.

Adaptogens

Adaptogens are herbs known to support the adrenals, and help bring the hypothalamus-pituitary-adrenal (HPA) axis into balance. They are incorporated into the Adrenal Transformation Program. It’s important to note that there are quite a few adaptogens, and not all have been studied extensively in pregnancy and breastfeeding. Some have been used by nursing moms for centuries to support milk production and to get through the sleep deprivation that happens when we are doing our best to care for those adorable tiny humans.

Though I support the claims of traditional medicine, I do advise you to proceed with caution, as some of these adaptogens have not been researched extensively. Always consult with your doctor before introducing a new supplement.

You may consider utilizing standalone adaptogens such as holy basil (tulsi), shatavari (available via Fullscript – you can sign up with my credentials here), reishi, or rhodiola, starting with one herb at a time. These four are the gentlest of the adaptogens and most often used in lactation (but of course, always check with a lactation consultant, as some lactation supplements can produce an oversupply!).

Holy Basil (Tulsi)

In Persian traditional medicine, holy basil (tulsi) has been used to decrease an oversupply of milk, but it may also be a galactagogue. ^[82] Limited clinical data exists on the overall safety of holy basil for nursing moms and their babies, but it is “generally recognized as safe” (GRAS) by the FDA, in amounts found in food.

Estragole is an active ingredient that could be problematic if holy basil is used in excessive amounts.

I find tulsi tea great for stress management, and it was a go-to adaptogen for me during lactation. Pre-clinical studies have also suggested that holy basil has anti-stress constituents and may also help with metabolic disorders, immunity, mood, and infections. ^[83] The amounts found in teas like this should be safe for breastfeeding. However, holy basil could lower blood sugar or thyroxine levels.

Shatavari (Asparagus racemosus or Wild Asparagus)

I always giggle when I think about what the name shatavari means (“woman of a thousand husbands” – like darn, she must be so tired!). I often recommend this adrenal adaptogen for women, in dealing with psychological stress and reproductive issues. It has a long Ayurvedic history of safe use in infertility, lactation, and menopause. Animal research has found that it may have unsafe effects in pregnancy, especially in the first trimester; however, using it in later trimesters or while breastfeeding appears to be safe. ^[84]

Historically, shatavari has deep roots relating to its ability to address psychological stress, as well as inflammation of the female reproductive system. ^[85]

It may also have antiulcer, antitussive, antioxidant, antidiabetic, antidiarrheal, antibacterial, antiprotozoal, anti-inflammatory, antidepressant, and immunomodulatory properties. ^[86]

Some clinical evidence in animal studies shows that it may increase prolactin and lactation; however, limited data means that this is inconclusive. Long-term high doses in mice led to fatalities – however these were extremely high doses, so as long as it’s taken in appropriate doses, it should not pose harm to humans. ^[87]

A high-quality supplement like Organic India’s Shatavari is a good option (available via Fullscript – you can sign up with my credentials here).

Reishi
Reishi is a medicinal mushroom that has been used for over 2000 years. I have seen good results using reishi mushroom for its immune-boosting effects (in particular for upper respiratory viral infections), as well as for reducing overall stress. It has a long history of use in traditional Eastern medicine, and has been shown to have antiviral, antibacterial, anti-inflammatory, anticancer, and immunomodulating effects. Studies (mostly in animals) have also suggested that reishi helps in modulating blood glucose levels as well as has a hepatoprotective effect. ^[88]

While the general sentiment is that there isn’t enough research to deem reishi safe to be taken during pregnancy and breastfeeding, practitioners who are trained in Eastern and Chinese medicine say that it is safe to take in moderate doses. There is even a phenomenon called “reishi babies” – babies whose mothers take reishi during their pregnancy. It’s reported that these babies are born with a super calm, alert, and peaceful demeanor. ^[89]

The hot cacao with reishi from Four Sigmatic is a lovely way to add it to your routine.

Rhodiola (Golden Root)

Rhodiola is a wonderful adaptogen that not only helps us maintain a healthy stress response, but has been found to improve depressive symptoms, insomnia, low mood, and mood instability. ^[90] I think of rhodiola as the adaptogen focused on our nervous system health. In animal studies, rhodiola has also been shown to have an inhibitory effect on the development of hypertension and hyperglycemia. ^[91]

I have found rhodiola to be a gentle adaptogen that is safe for nursing mothers, but research is limited. Some sources say that it’s okay and useful for nursing mothers, while others say breastfeeding mothers should avoid using it.

Rhodiola is available as a standalone supplement: Rhodiola Rosea by Pure Encapsulations.

Adaptogen Blends

I love adaptogen blends like Rootcology Adrenal Support for most women with Hashimoto’s who aren’t breastfeeding, but don’t recommend them for nursing moms due to potentially problematic ingredients like the ginseng, vitamin B6, and eleuthero.

There are no human studies on the safety of Panax ginseng during lactation. Animal studies report minimal risk, but due to the lack of data, it should be avoided. ^[92] It may also lower milk production, and there have been reported pediatric cases of tachycardia and hypertension that seem to be associated with the maternal use of Panax ginseng.

Vitamin B6 in excess of 50 mg per day can lower prolactin levels (impacting milk supply), while eleuthero can lead to excess bleeding and worsen estrogen dominance.

Adrenal-Supportive Nutrients

Though not adaptogens, I often use B vitamins and vitamin C in combination with adaptogens for adrenal support. You may wish to use a B‑­complex vitamin like the one by Pure Encapsulations that has under 50 mg of vitamin B6 (again, higher doses can suppress prolactin levels and lower milk production), or use individual B vitamins. Vitamin C supplements are generally safe for nursing moms and may help as well. See the Tired Mommy Protocol below.

Always check with your doctor, pharmacist, or lactation consultant before introducing a new supplement.

Tired Mommy Adrenal Protocol

I came up with this protocol after being a tired mommy myself. 🙂 These strategies help support the adrenals, and are also breastfeeding-friendly. Always check with your doctor and watch your baby, but the following recommendations are generally considered to be safe for nursing moms and their nurslings:

• Get lots of bright light, preferably outside in the morning. The bright lights will give you more energy and will help with your baby’s circadian rhythm, so he/she can sleep better at night… a win-win all around. Some moms like stroller walks first thing in the morning, and I liked sipping coffee outside on my porch in Colorado. 🙂
• Grandparents, aunts, and uncles — enough said!
• Carnitine, choline, omega‐3s, and thiamine can help restore mom’s brain and energy levels from sleep deprivation, and may also benefit nurslings (be sure to check with your pediatrician before taking these supplements).
• Supplement with B12 and ferritin, as they are often depleted after giving birth and during lactation.
• Instead of the ABCs, consider gentle nursing‐friendly adaptogens and a B-Complex:
  • Reishi – I like taking Four Sigmatic Mushroom Hot Cacao with Reishi, one packet a day.
  • Rhodiola is a gentle adaptogen that is generally considered safe for nursing mothers.
  • Tulsi tea is my go‐to adaptogen during lactation. It also acts as a galactagogue and can help raise cortisol levels when needed. I like the one from Organic India, and I suggest using one or two tea bags per day.
  • Shatavari by Organic India, one to two capsules, two times per day.

My newest book, Adrenal Transformation Protocol, walks you through the fundamentals of the program and offers specific support and guidance for implementing these safety signals into your life. I highly recommend it for anyone experiencing adrenal dysfunction, those with Hashimoto’s, and those who are new moms. 🙂

4. Address Gut Health

In the areas of natural and functional medicine, there is a widely held understanding that all disease (and thereby all healing) begins in the gut. And for good reason!

The gut performs the all-important role of digesting and absorbing the nutrients we take in, but it is also responsible for helping the immune system recognize foreign invaders from self-antigens, thereby facilitating the control of pathogens and preventing autoimmune reactions. When the health of our gut is compromised, it’s likely that other aspects of our health are affected as well.

Interestingly, the fetal origin of the thyroid gland is the same as the stomach, digestive tract, and tongue. ^[93] Because of this shared cellular origin, it would seem to make sense that improving digestive function often leads to a significant improvement in thyroid symptoms. This is encouraging news for those experiencing gut and thyroid issues!

While not everyone dealing with Hashimoto’s or leaky gut will experience bloating, stomach pains, irritable bowel syndrome, and acid reflux like I did, most people with Hashimoto’s do have some degree of intestinal permeability. Even those who have no apparent gut symptoms may be experiencing intestinal permeability, and for anyone living with an autoimmune condition, addressing gut function might be the best place to start to bring healing to the body.

Much of our immune system lies in the gut, so gut support for breastfeeding moms is very important. Additionally, gut infections can sneak up on us during times of stress, or anytime there is an imbalance in the microbiome. I personally discovered I had an H. pylori infection a few months postpartum, which also caused a Hashimoto’s flare. Once I eradicated the infection using a breastfeeding-friendly protocol, my thyroid symptoms subsided.

Here are my top recommendations for gut support, that are also safe and supportive for nursing mamas:

Digestive Enzymes

Enzymes are a form of protein present throughout the body. They manage cell metabolism by making the chemical reactions that keep us alive, happen more efficiently.

Digestive enzymes help the body break down larger complex molecules into smaller molecules to be used as fuel. In doing so, they can help the digestive system better absorb and utilize nutrients, making them helpful for nutrient deficiencies (commonly observed in those with Hashimoto’s).

Poor gut health is linked to altered enzyme production. We know that everyone with Hashimoto’s has some degree of intestinal permeability, or leaky gut, which occurs when poorly digested molecules of food or other toxins permeate the intestinal lining and become absorbed into the bloodstream. When this occurs, the body may recognize them as foreign invaders. This causes inflammation in the body as it begins to attack the intruders, and eventually leads to autoimmunity.

Intestinal permeability can be a result of poor digestion caused by a reduction in enzymes that help break down food. Many people with Hashimoto’s experience acid reflux, bloating, and constipation, along with fatigue, brain fog, joint pain, and many other symptoms that may be caused by poor digestive function.

One of the key “aha” moments on my road to recovery from Hashimoto’s, came when I decided to try a betaine with pepsin supplement to support protein digestion. I woke up the next morning with more energy than I had felt in a decade! I was finally able to digest my food properly.

Adding digestive enzymes that help the body break down food, can be a critical tool for improving digestive health, boosting nutrient uptake, and reducing the symptoms of Hashimoto’s.

There isn’t a lot of research on using digestive enzymes such as betaine with pepsin for nursing moms; however, researchers have proposed that using pancreatic enzymes can help breastfed babies with reactions to milk proteins. Researchers reported that the enzymes are not absorbed by the mother (rather, they help her digest the food she is eating, so that they would not be transferred in breast milk). ^[94]

Some bitter herbs may impact the production or taste of breast milk, so they may not be appropriate for use, but using digestion-supporting foods such as hot lemon water or apple cider vinegar may help with digestion.

I worked with a functional nutritionist who recommended TherBiotic VitalZymes for me with great results when my son was around six months old. However, I am not aware of research in using them in pregnancy, so I would advise checking with your own practitioner.

Probiotics

Probiotics are one of my key recommendations for Hashimoto’s, as they help balance our flora! Mothers can pass on both good and bad bacteria to the baby. Breast milk is loaded with potentially probiotic and commensal bacteria such as Lactobacillus spp., Bifidobacterium spp., Clostridiales spp., as well as other maternal milk factors such as secretory IgA, milk oligosaccharides (prebiotics) and anti-microbial factors that may help support a healthy infant gastrointestinal (GI) microbiota and immune system. ^[95]

We can supplement with probiotics during nursing to provide further support. Probiotics for mom are also generally safe for baby. In fact, probiotics are frequently given to premature babies to help bump up their immune system.

There is a lot of fascinating research relating to how breastfeeding positively shapes a baby’s gut microbiota in early life, how that may be helpful in improving an infant’s immune response, and how it may even help with allergy prevention. ^[96]

Researchers have found that exclusively breastfed infants develop a healthier Bifidobacteria-dominated microbiome, even if they had a cesarean birth. (Cesarean births result in a very different bacteria population – bacteria from the hospital setting and from healthcare workers rather than mom – that has been deemed as less protective of a baby’s immune health.) ^[97]

Interestingly, mastitis (painful inflammation of breast tissue that commonly affects women who are breast-feeding) is a breast infection caused by the bacteria Staphylococcus. A number of studies have demonstrated that the administration of probiotic bacteria, particularly the Lactobacilli strain isolated from human milk, has the potential to prevent and treat maternal breast infections caused by Staphylococcus aureus. ^[98]

You can displace Staph (and other pathogenic bacteria) with a probiotic.

I like the Target B2 probiotic from Klaire Labs (no relation to Target, the store, another mom favorite ;-)). It’s available here via Fullscript. If you don’t have a Fullscript account, you can sign up with my credentials here.

Please note that for those with small intestinal bacterial overgrowth (SIBO), some probiotics may make symptoms worse. See the Infections section below for my recommendations for SIBO.

Fermented Foods

One of the easiest ways to introduce more beneficial bacteria to your microbiome is to eat fermented foods (like my friend and mentor Donna Gates recommends).

Here are some of my favorite tried and trusted brands that I incorporated into my own postpartum diet:

• Fermented coconut yogurt: CoCoYo Coconut Milk Yogurt, So Delicious Dairy Free, and Cocojune are options sold in the United States.
• Fermented coconut water: I love CocoBiotic by Body Ecology.
• Fermented cabbage: Check your organic grocery store and make sure you get the kind that is refrigerated, as the probiotic bacteria only survive for a couple of weeks at room temperature. To order online, try Superkrauts, which is a great brand that ships its products, chilled to your home (for convenience for postpartum mamas).

If you are up for the task, you can also make your own fermented foods in the comfort of your own home. Not only is making your own fermented food simpler than you might think, it’s also delicious and will save you money at the grocery store! I have many delicious recipes in my book Hashimoto’s Food Pharmacology.

Increasing the amount of fermented foods you eat is a simple strategy for supporting your gut and increasing the amount of good bacteria in your microbiome.

Recommended Testing

Gut testing can give you valuable insight into levels of beneficial and pathogenic bacteria in your gut. My current favorite gut tests are the GI-MAP stool test, and I’ve recently started using the Gut Zoomer test (work with your practitioner to interpret these) as well.

5. Address Food Sensitivities

Food sensitivities are incredibly common in Hashimoto’s (and for some, are their root cause). They generally occur when we eat the same foods over and over, in the presence of intestinal permeability (leaky gut). Leaky gut can be ongoing or acute, and can be caused by stress, toxins, triggering foods, and infections.

When our gut is compromised — for instance, when we’re under stress, or when we have an infection like H. pylori — the body is more likely to recognize certain proteins as foreign and make antibodies, thus resulting in the development of new food sensitivities.

The good news is that, unlike true allergies, most food sensitivities can be reversed by removing the triggering foods for three to six months, then rotating them in your diet, and eating them in moderation. The idea here is to reduce the inflammation in the gut and give it a chance to heal; once that is resolved, food sensitivities may resolve as well.

Gluten and dairy are the two most common food sensitivities for those with Hashimoto’s, and most people feel significantly better when they remove these foods from their diet. In my survey of over 2000 people with Hashimoto’s, 88 percent of people who went gluten free felt better and 79 percent of those who tried the dairy-free diet felt better.

Going gluten and dairy free is generally safe for breastfeeding mothers, as long as their babies are in good health. This may even help your baby’s health if they are experiencing digestive symptoms or skin issues like eczema.

A Paleo diet is another dietary approach that many people with Hashimoto’s use and feel better with. Of those who took my survey, 71 percent noticed an improved mood, 79 percent experienced more energy, and 60 percent reported positive weight changes on a Paleo-style diet. This type of diet is also generally safe for breastfeeding mothers with healthy babies.

The Autoimmune Paleo (AIP) diet, which eliminates grains along with other common food triggers including corn and nightshades, helped 75 percent of my survey participants feel better. The AIP diet is a more advanced and more restrictive kind of diet, so I only recommend doing this if you have an older baby who is established on solid foods.

Removing food sensitivities from your diet can be incredibly helpful for thyroid symptoms, but while breastfeeding it’s important to not be too restrictive with your diet, and ensure you’re eating plenty of nutrient-dense food to keep your milk supply up. Additionally, diversity of foods is very important, as anyone with a gentle gut (such as a baby), can become sensitized when the same foods are eaten over and over again!

Some research suggests that breastfed babies may react to foods that their mothers eat if their mothers react to them, and oftentimes moms and their babies feel better when on a gluten-free, soy-free and dairy-free diet. This is of course a big topic in its own right, but I have found that food sensitivity testing for mom can help improve symptoms for baby as well!

Recommended Testing

Some food sensitivities can be harder than others to pinpoint, and some people may need to see the numbers on paper before they are able to accept that they will need to give up a food they love in order to feel better. In those cases, I recommend food sensitivity testing through a lab. While most conventional medical professionals and insurance companies consider food sensitivity tests to be “experimental,” I can testify that as I “experimented” with removing the foods the tests found to be reactive for me, I felt dramatically better! I recall that I ended up doing this test again when I was breastfeeding and my son was having some digestive symptoms. The test revealed that I was sensitive to oats, and sure enough, removing them from my diet helped my son’s symptoms.

If you’d like to test, I suggest the Alletess Food Sensitivity tests. You can test for the most common 96 foods or dive deeper with the 184 foods panel.

6. Address Infections

Chronic infections are the Hashimoto’s triggers that get the least amount of attention, yet identifying and treating them can result in a complete remission. Unfortunately, some of the infections can be progressive, leading to more and more symptoms, if not identified and treated accordingly.

As I’ve mentioned, I developed an H. pylori infection after I gave birth to my son and experienced a flare-up of my Hashimoto’s symptoms. After I eradicated the infection, my symptoms improved and my antibodies lowered.

Here are some of the most common infections that I see trigger Hashimoto’s, and how to address them safely as a nursing mother.

H. pylori

Many of the treatments typically used to treat H. pylori are not safe to take while breastfeeding. When I discovered I had H. pylori while I was breastfeeding, I reached out to my friend and colleague Dr. Maya Shetreat-Klein, and learned that black seed oil could be used against H. pylori.

It worked! Within a few weeks, my hoarse voice was gone, my hair stopped falling out, and my follow-up tests showed no more H. pylori.

As an added bonus, my thyroid antibodies were reduced. One of black seed oil’s components, thymoquinone (TQ), has impressive pharmacologic and biologic effects, including antioxidant, antimicrobial, antihistamine, anti-inflammatory, and antifungal effects. It also can modulate the immune system. ^[99] While breastfeeding-specific data isn’t readily available, it has been shown to be generally well tolerated and have a low level of adverse effects.

Microbiome Labs makes high-quality supplements, including spore-based probiotics, that can be helpful as well. Two products specifically made for H. pylori that I love are:

• MegaGuard – Contains licorice flavonoids (GutGard™), artichoke leaf extract, and ginger extract. GutGard has been shown in clinical studies to rebalance H. pylori, and help alleviate functional dyspepsia. This blend can also be helpful for indigestion, acid reflux, ulcers, nausea, and gastric mucosal inflammation. The licorice flavonoids in this blend do not impact blood pressure, making it a safer option for those who are pregnant or nursing.
• PyloGuard – Can help support bacteria levels in the stomach and the elimination of unwanted bacteria in the gut. It contains Lactobacillus reuteri DSM17648, a probiotic which has a unique ability to attract specific organisms in the intestine, and support their removal. This particular strain of L. reuteri can bind to H. pylori in the stomach, and has been shown to be effective in eradicating H. pylori, with a lower rate of side effects than antibiotic treatment.

SIBO

Small intestinal bacterial overgrowth (SIBO) is another common trigger of Hashimoto’s. A SIBO overgrowth can be caused by issues such as low stomach acid (sometimes due to H. pylori), antibiotic use, the use of acid-suppressing medications, slowed gut transit (where food moves along the gastrointestinal tract too slowly), and food poisoning, among others. ^[100] All of these things can suppress digestion and slow the passage of food through the intestinal tract, giving bacteria time to “set up shop” and colonize the small intestines.

Antibiotics, herbal remedies, and the elemental diet are potential options for treating SIBO. I generally like using herbs in women with Hashimoto’s, but in the case of SIBO, I would probably opt for an antibiotic instead.

The antibiotic rifaximin, which is not absorbed systemically, has not been studied extensively in breastfeeding, but is rated as a low-risk drug according to the E-lactation website. ^[101]

In contrast, the most common herbs for clearing SIBO – berberine and oil of oregano – may be potentially problematic for breastfeeding. Animal studies showed that berberine can lead to toxicity when passed in breast milk, while oil of oregano used in therapeutic doses may suppress the milk supply. ^[102]

The one herb that might be better tolerated is garlic oil. Garlic possesses antimicrobial, antioxidant, anticancer, and antibacterial properties, and it can be helpful in clearing SIBO. ^[103] I like a Garlic extract supplement like Allicillin.

Garlic falls under the generally recognized as safe (GRAS) category — safe during both pregnancy and lactation. Its odor is transmitted to mom’s breast milk, which appears to be appealing to babies – studies say it increases infant sucking time – at least initially. ^[104] It is really interesting to me that infants with no previous exposure to garlic go wild over it, but those with previous exposure reduce their interest in it. Researchers aren’t sure why, but it is interesting that they change their behavior based on smell. That said, I don’t know just how effective garlic will be as a standalone for SIBO.

The elemental diet is also an option for SIBO, and could in theory help with digestive struggles, but I worry that it could be too restrictive and may lead to a suppression of breast milk production. I would not recommend embarking on it on your own, unless you are working with a trained professional.

That all said, if you’ve been following my work for a while, you will know that I often recommend supporting gut motility, focusing on stomach acid production, clearing H. pylori, and addressing protozoal infections to prevent and treat SIBO. Carnitine and thiamine do wonders for gut motility, and thiamine also targets stomach acid production.

Blasto

Blastocystis hominis (Blasto) is a common protozoan parasite that has been implicated in Hashimoto’s, chronic hives, and irritable bowel syndrome. In my case, it was likely the root cause of all three, and I have found this to be a trigger for many thyroid, gut, and skin issues! You can read more about this parasite at the linked article.

While the bugger can be quite resistant to various medications, I have found that S. boulardii can help clear Blasto. It doesn’t contribute to the overgrowth of bacteria like a probiotic might. Instead, S. boulardii works to clear out the existing bacteria in the small intestine, which speeds up the process of resolving the gut infection. It also helps reduce gut inflammation, boosts our own defense system, and may help reduce brain fog, blood sugar swings, anxiety, and joint pain. ^[105] It hasn’t been studied extensively in breastfeeding, but most practitioners agree it is low risk.

I recommend starting out slow and building up with time. Some quality options include Rootcology S. Boulardii, Designs for Health Floramyces, and Pure Encapsulations Saccharomyces Boulardii. Please note it should be avoided by those who have Crohn’s disease.

Recommended Testing

One of the tests I’ve used most often to test for gut infections is the GI-MAP stool test, and I’ve recently started using the Gut Zoomer test as well.

I also recommend testing for SIBO. SIBO testing is done via breath testing, like the Small Intestinal Bacterial Overgrowth 3-Hr Lactulose – Genova Kit. Unfortunately, current stool tests do not test for SIBO, and SIBO breath tests will not reveal infections in the stool.

7. Address Toxic Overload

Liver support is one of the first protocols I recommend for all of my Hashimoto’s clients, as I’ve found most people with thyroid conditions have impaired detoxification.

If your liver is impaired, your body may be unable to efficiently convert T4 to the active T3 hormone. This can cause a variety of symptoms, including the very common issue of developing food sensitivities.

When the liver is supported, this can result in improved vitamin and mineral absorption (providing nutrients that increase access to T3), which is beneficial to anyone with Hashimoto’s, as well as nursing mothers.

When it comes to pregnancy and breastfeeding, toxins are passed from the mother to her developing baby through the placenta, and after birth in her breast milk. The healthier a mother’s liver is, enabling efficient detox, the healthier she will be, and her baby will benefit as well.

Toxins can easily be passed along in utero and to nurslings. Minimizing exposure to toxins such as pesticides, toxins, and heavy metals like mercury, can be helpful. Mercury in particular is both highly absorbed from the maternal diet and readily transferred into breast milk, where it can disrupt cognitive development in infants. ^[106]

One research project conducted in 2005 by the Environmental Working Group and Commonweal revealed that 287 chemicals were found in the umbilical cord blood of 10 children. Subsequent studies show similar findings, with some chemicals that have been banned still showing up in cord blood. In our modern environment, infants are exposed to all kinds of chemicals before and after birth, including through breast milk. ^[107]

One of the best things new moms can do (or hopefully have already been doing) is to keep their liver healthy and support their detox pathways. The first step is to reduce your exposure to toxins in your everyday life (so that your liver has less work to do). Here are my recommendations for cleaning up your environment and reducing your exposure to common toxins:

• Swap conventional cleaning products, personal care products, and makeup for non-toxic versions. These products have tons of chemicals that we absorb through our skin daily. Check out my articles on non-toxic home products and beauty products for great alternatives.
• Consider buying organic food, including meats, fruits, and vegetables, whenever possible. Unfortunately, our agriculture system uses hundreds of herbicides and pesticides that are known to contribute to our toxic burden, with conventional produce.
• Invest in an air filter. Our indoor air contains a ton of toxins, and we spend so much time indoors, especially as a new mom and baby. I recommend getting an air purifier for your home (especially your bedroom where you sleep) to clear out airborne toxins. I love the AirDoctor and Jaspr (use code DRWENTZ for 10% off your purchase).
• Use a water filter. Another source of a wide range of toxins, including fluoride, which is known to disrupt thyroid function, is our tap water. ^[108] There are many options for water filters, but they don’t all filter fluoride. My favorite options are AquaTru’s countertop filter and Clearly Filtered.

In addition to reducing our toxic exposure, we can also give our liver a little extra love and support. It’s important to utilize gentle detox methods, as I do not generally recommend intensive detox programs during pregnancy or breastfeeding. My friend and colleague Dr. Jill Carnahan, MD, has some ideas for gentle detoxification for lactating moms.

She recommends:

• ION* Gut Support: Clears the herbicide glyphosate. 1 teaspoon 2-3 times per day. Again, talk to your doctor before using any new products during pregnancy or breastfeeding.
• Skin brushing (dry brushing): This stimulates the lymphatic system and helps unclog skin pores, improving one’s ability to sweat and detox from the skin.
• Infrared sauna: I love infrared saunas for gentle detoxification, as they are so much less forceful than other methods. I used saunas years ago to help detox arsenic from my system, and commonly recommend them for detox support. You can use saunas if you are lactating, but generally want to pump your milk afterwards and get rid of it (“pump and dump”). Some experts suggest pumping twice afterwards. While not sauna-specific, an older study found that far-infrared radiation delivered via ceramic disks may be effective in improving lactation. ^[109] Please note, saunas should not be used during pregnancy. Sunlighten saunas are my favorite in-home saunas, and Therasage offers wonderful portable options.
• Epsom salt bath: One of my favorite detoxifying relaxation treats! The magnesium in the Epsom salts helps with sleep as well. I use these Epsom salts.

I developed my Root Cause Reset to help people with Hashimoto’s support their liver and detoxification system. This is a great program that focuses on a real food diet that’s not too restrictive, cleaning up your toxic exposure, and implementing gentle ways to support the detox pathways. While the supplements in the program are not recommended for nursing moms, the rest of the recommendations can help.

Recommended Testing

For mold, a common trigger of Hashimoto’s, I recommend the MycoTOX test, which identifies mold metabolites in your urine and determines if mold has taken up residence in your body. It can detect 11 different mycotoxins from 40 species of mold, so this can help you determine specific protocols. The Organic Acids Test (OAT) can also be useful, as it checks for colonization of mold in your body (whether that is in your gut, your sinuses, or somewhere else).

You can test for levels of glyphosate with a urine test from Mosaic Laboratories.

Takeaway

Breastfeeding is one of the most important things you can do for your new baby (if you are able), and is recommended for at least six months given there are so many benefits for both mom and baby.

Breastfeeding mothers need to continue their focus on thyroid health and support those areas that are often found to be root causes for thyroid dysfunction and Hashimoto’s.

Women should continue with thyroid hormone medications and have regular thyroid testing done, as many may have to adjust their dose both during pregnancy and postpartum. Even if you are not currently taking thyroid medications, you should still have a full thyroid panel taken prior to attempting to conceive, and then again during the first trimester of pregnancy. If you’re already on thyroid medications, you will need more regular monitoring.

Always talk to your doctor, lactation specialist, pharmacist, and/or herbalist prior to taking new medications or supplements (prescription, over-the-counter meds, supplements, or herbs), especially when pregnant or breastfeeding. Read labels, check reputable sources online, and ask questions!

Note that medications can be contraindicated for pregnancy but okay for breastfeeding, and vice versa. Know that sometimes there won’t be a lot of data specific to pregnancy or lactating, which is why you need a trusted resource and someone who knows about your particular health status, to consult with.

Along with thyroid medications, vitamins, minerals, and supplements that support the root cause health areas I discussed in this article, there are many lifestyle practices you can be doing while breastfeeding (as well as prior to trying to conceive) that will benefit you and your little one! Some have been highlighted here, and please check out the linked articles for additional protocols and recommendations.

Again, thanks to my wonderful friends and colleagues for their help and insights relating to this very important topic.

In future articles, I hope to cover some unique, functional medicine solutions to:

• Lactation failure
• Low milk supply
• Reducing milk supply
• Mastitis (see my Instagram post on this)
• Babies’ feeding aversion
• Overactive letdown
• Mom’s nursing aversion (spoiler alert – magnesium helps)
• High-lipase milk

Let me know if you have topics you’d be interested in hearing more about as well.

Enjoy the special time with your little one… it truly does go by too fast!

As always, I wish you the best on your journey.

I love interacting with my readers on social media, and I encourage you to join my Facebook, Instagram, TikTok, and Pinterest community pages to stay on top of thyroid health updates and meet others who are following similar health journeys. For recipes, a FREE Thyroid Diet start guide, and notifications about upcoming events, be sure to sign up for my email list!

References

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^[24]Ibid
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