Responding to Women’s World Critics

Important facts about the Woman’s World Article:

When Women’s World approached me for help with a story on a thyroid diet, I told them no because you can’t eat for your thyroid. Instead we agreed on a story about the diet for fatty liver disease and to debunk thyroid misinformation that Women’s World and others have published over the years.

In my practice, I see patients with fatigue or other symptoms from fatty liver disease that have been misdiagnosed as Hashimoto’s or other thyroid disorder. Sometimes these patients have seen functional medicine who denigrate mainstream medicine claiming these doctors gaslighted them and missed a diagnosis of a thyroid disorder. These patients may have been mistreated with magical thyroid diets and sold expensive thyroid supplements that do nothing. By the time I see them, they can be frustrated and hopeless.

Here is the background to the Women’s World story:

People who do not have a thyroid disorder can have nonspecific symptoms attributed to hypothyroidism. They see their PCP and are told thyroid levels are normal. They feel no better, feel ignored and seek out alternative or functional medicine. These patients can be mistreated with levothyroxine, liothyronine, and desiccated porcine thyroid. The functional medicine industry sells them thyroid supplements containing high amounts of iodine from kelp or other sea vegetables, or animal glandular products. They are told to follow a magical thyroid diet to reverse thyroid disease. Avoid gluten. Avoid dairy. Avoid soy. Avoid broccoli and kale. Avoid nightshade vegetables – tomatoes, peppers, and eggplant.

Really? Avoid broccoli, kale, tomatoes, peppers, and eggplant?

I see the patients that have fallen victim to these bogus “treatments” feeling no better after spending hundreds or thousands of dollars. The most unfortunate are the patients who have been overtreated to the point of biochemical and clinical hyperthyroidism. The alt-med provider tells the patient that the TSH is a bogus test and that you should treat the symptoms, not a number.

The internet and the functional medicine industry is filled with misinformation about thyroid disease. Mainstream medicine, especially endocrinologists are villainized, portraying us as uncaring, lacking empathy, obtuse, ignoring symptoms and only caring about numbers.

Mary Shomon is a well-known endocrinologist hater promotes the “Doctor’s Hall of Shame” claiming that the practice of endocrinology is a “scandal.” Shomon posts stories from patients who declare they have been mistreated and gaslighted by their doctors. A typical theme of these posts is exemplified in this quote in a “brutally honest” letter one patient sent to her doctor:

“I hope that one day you and your peers will be able to show empathy for patients such as myself, whether you’ve personally experienced hypothyroidism or not.”

Although Shomon has no medical background, functional medicine physicians have jumped on the endocrinology-bashing bandwagon echoing the message that mainstream medicine ignores symptoms and does not treat the root cause of disease. They sell supplements and overtreat with desiccated thyroid.

I have witnessed the repercussions of this trend over the last 20 years and see things getting worse. The fake news and misinformation seems to be at an all time high. The patients I see are not only overtreated with thyroid hormone but usually have testosterone pellets and are taking “adrenal” supplements and who knows what other supplements or compounded hormones.  

Some people have been critical of my collaboration with Women’s World. To be honest, I was surprised when the issue came out because I was not told this was the cover story and did not know about the bizarre headline with my name attached. I have worked with Women’s World for many years on a variety of stories that are usually in the back of the magazine. For an endocrinologist, the headline is a bit cringe-worthy, but I would respond that if you read the article, it explains that for many people it is not your thyroid. The title of the story was supposed to read, "It's not your thyroid, it's your liver." 

Fact-checking at Women’s World is like most media outlets and only covers the actual medical facts in the article.

Here is a summary of my contribution and the facts I confirmed for this article:

  1. Many people have symptoms attributed to a thyroid disorder but do not have a true thyroid disorder. 80 million Americans have fatty liver disease (10 times more common than hypothyroidism) where the most common symptom is fatigue. Prescription thyroid medications do not help fatty liver disease.

  2. When symptom are not from the thyroid it could be NAFLD. In fatty liver disease, intrahepatic hypothyroidism may contribute to symptoms. This describes the state within an injured fatty liver with dysfunctional thyroid hormone receptors (thyroid hormone resistance) & high reverse T3 from altered expression of deiodinases. 

    The term intrahepatic hypothyroidism was too complex for Women’s World readers. The magazine is written at a 4th grade reading level, so the term intrahepatic hypothyroidism was shortened to hepatic hypothyroidism. Some endocrinologists do not like the term hepatic hypothyroidism.

    Hepatic hypothyroidism also known as intrahepatic hypothyroidism is not a thyroid disorder.

  3. Losing weight can reverse fatty liver disease and improve symptoms of fatty liver disease.

  4. Treating fatty liver disease by losing weight improves intrahepatic thyroid dysfunction. 

  5. The most important concept for weight loss is “reducing calorie intake. To make it easy, you’ll fill up on lean protein and lots of veggies.”

  6. Avoid sugar, especially high-fructose corn syrup and highly processed starchy foods. Unhealthy carbohydrates increase hepatic insulin resistance and ectopic fat deposition. “Leftover fat that’s supposed to be shuttled to fat cells gets trapped inside the liver.”

  7. Drinking 2-4 cups of black coffee daily has been shown to be beneficial in liver disorders including NAFLD.

  8. Thyroid supplements are not necessary. You get enough iodine from iodized salt.

  9. Gluten-free diets are unnecessary for most people. Gluten free baked goods and gluten free processed foods are high in sugar and unhealthy carbohydrates. Gluten free foods are also high in arsenic and other heavy metals.

  10. The keto-diet with saturated fat foods like beef, butter and coconut oil are not recommended for fatty liver disease. You can have lean red meat in moderation, but balance with plant proteins.

I stand behind the medical facts in this article. I did not contribute to the patient stories or recipes. I do not like or approve of the headline or the titles. The recipes seem OK, but I do not know anything about the patient stories other than they claim to have followed this advice. I have no idea where they found these people or if their stories are true. These were the parts of the article not under my control.

I tried to ensure that Women’s World did not publish misinformation or bogus treatments in this article. I tried to debunk misinformation and provided an alternative narrative for patients who have been misdiagnosed and mistreated by functional medicine who vilify mainstream medicine as incompetent or uncaring. The diet advice in the article is sound. The titles are bizarre and not ideal, not what I would have liked to see. I regret that I did not try to exercise more control over the non-medical content of the article, especially the titles.

I have always promoted evidence-based medicine and have tried to debunk misinformation. I invite you to read my posts on Twitter, Facebook, LinkedIn, and my blog. I stand behind the information I have put in the public domain over my entire career. For those who have been critical of me being on the cover of Women’s World, I ask that before passing judgement, you look past the sensationalized cover headline and see the actual content of the article. And look at the entirety of everything I have promoted for more than 2 decades in the public space.

Scott Isaacs, MD

My suggestion for a better title:

Author
Scott Isaacs, MD Endocrinologist and Weight Loss Specialist

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