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Gut or thyroid first when you are in chronic freeze? The repair order, with Dr. Amie Hornaman (Part 2)

  • 3 hours ago
  • 12 min read

This is Part 2 of a two part conversation. Part 1 is here


Start with the thyroid. When the gut and the thyroid are both struggling, the thyroid is the one governing gut motility, which means a slow thyroid is often what produced the bloating, the constipation and even the SIBO you have been treating from the other end. Gut work still helps, because some conversion of T4 into active T3 happens there, and it will not carry a thyroid problem by itself.


You have been doing the work. The therapy, the somatic practices, the self-care. And your body still will not come online.


Whether stored trauma contributed to your thyroid issues or not, the thyroid is now a biology piece holding you back. It decides how much energy every other system in your body is allowed to have, including your nervous system.


Dr. Amie Hornaman is known as the Thyroid Fixer. She holds a doctorate in clinical nutrition and functional medicine, founded the Better Thyroid and Hormone Institute, and is the author of The Thyroid Fix. She was misdiagnosed six different times in her twenties before the seventh doctor gave her an answer.


A gut protocol on its own will not resolve a thyroid problem. Some T4 to T3 conversion does happen in the gut, so gut work helps, but the thyroid governs gut motility, which means a slow thyroid can be what produced the bloating, constipation and SIBO in the first place. Dr. Hornaman's position is that both systems often need treating at the same time, and that the same is true of stored stress and the thyroid. She also argues that adrenal fatigue is overdiagnosed, and that a single morning cortisol reading tells you almost nothing.
































When the gut and the thyroid are both struggling, which do I start with?


Start with the thyroid, because the gut is one place conversion happens and the thyroid is what governs the gut in the first place.


Some of the conversion of T4 into active T3 does take place in the gut, so supporting it is worth doing. Dr. Hornaman is careful about how much: "we really don't know the percentage... I don't think there's a way to actually test that."


What gets missed is the direction of travel. The thyroid is the master gland for motility. When it runs low and slow, things stop moving, and the symptoms people chase with a gut protocol were downstream of the thyroid the whole time.


Her conclusion keeps gut work in the plan while stopping short of asking it to carry a thyroid problem alone. Both systems often need attention at once.



Can a slow thyroid cause constipation and SIBO?


Yes, and the association is well documented.


When thyroid function drops, gut motility slows. Food sits longer, fermentation follows, and the conditions for small intestinal bacterial overgrowth are set. Dr. Hornaman adds detoxification to the picture: a low and slow thyroid makes it harder to process and clear.


The research supports the association. The original study found SIBO in 54 percent of hypothyroid patients against 5 percent of controls. Larger and more recent cohorts put the gap at roughly 33 percent against 15 percent, which is the figure to work from.


Gut motility: the coordinated muscular movement that carries food through the digestive tract. It is set in large part by thyroid hormone, which is why a slow thyroid shows up as constipation, bloating and, over time, bacterial overgrowth.



Why is selenium the nutrient she comes back to?


Because the enzymes that convert T4 into active T3 are built from selenium.


Her image for it is a hand under the thyroid, holding it up: "selenium is just there like holding the thyroid going, it's going to be okay." The biochemistry underneath that image is real. The deiodinase enzymes that perform the conversion are selenoproteins, and without enough selenium they cannot do the work. She prefers the selenomethionine form.



Which nutrients support the conversion from T4 to T3?


Selenium, magnesium, vitamin D and iodine are the ones she calls foundational.


She describes them as the supplements there is no real argument about, the ones she expects a person to be taking daily before anything more targeted is considered: "I call him the no duh supplements. Like of course, duh. We're going to take these every day."


Iodine is the one people tend to feel first, often within a couple of weeks, ahead of hormone replacement building in the system. She flags it as contested and dose-sensitive in the same breath.



How do I know if it is adrenal fatigue or my thyroid?


You run both panels, because the symptoms overlap almost completely and neither can be told from how you feel.


For the adrenals that means a four-point saliva cortisol panel, which shows the shape of output across a whole day. A single morning reading is what she sees most people build a diagnosis on, and it tells you almost nothing.


For the thyroid it means a full panel rather than a TSH alone. A free T3 sitting at the low end of normal is the one she sees missed, along with TPO and thyroglobulin antibodies that were never ordered. The optimal ranges she works to are published in her book.


Her position on the adrenal side is worth stating plainly. She thinks the label is applied far more often than the pattern appears, and that genuine adrenal exhaustion, the flat bottomed-out shape across a whole day, is rare.



Why does she say adrenal fatigue is overdiagnosed?


Because the label gets applied from one reading far more often than the pattern actually appears.


Her frustration is with the market that has grown around it: "this little adrenal supplement that the IG influencer is pushing on a reel is not the be all, end all". Cortisol itself she defends. It is a needed hormone, and suppressing it is not a strategy.


There is a narrow case where the adrenals genuinely are bottomed out, and there she uses T3 strategically to support the morning awakening response.



What does it mean when two systems are feeding each other?


It means neither one will resolve while the other is left alone.


The gut and the thyroid are the clean example. The thyroid slows, motility slows, the gut becomes inflamed, and an inflamed gut converts less T4 into T3. Each turn makes the next turn worse.


The same shape shows up with stored stress. As Dr. Aimie puts it in the episode, you cannot neglect stress and trauma and treat the thyroid alone, or treat the thyroid and leave the stress unaddressed, because by then they are feeding each other.


Two systems feeding each other: when a slowed system creates the conditions that slow a second, and the second then deepens the first. Neither is malfunctioning. Both have adapted to what the body was handed, which is why working one alone does not hold.



How long before I feel a difference in my stress resilience?


Energy, mood, brain function and stress resilience are the first things to move, and she puts that at roughly thirty to sixty days.


The hedge belongs with the number. She scopes it to patients being optimized under her care, and opens by noting that everyone is an n of 1 and responses differ. Weight tends to sit between months two and six. Hair is more like six months to a year.


Iodine is the exception she names, where people often report a lift within a couple of weeks.



Key Takeaways


  • A gut protocol will not carry a thyroid problem on its own.

  • Some T4 to T3 conversion happens in the gut, though the proportion is not established and cannot currently be tested.

  • The thyroid governs gut motility, so a slow thyroid can produce the constipation, bloating and SIBO you have been treating.

  • Hypothyroidism roughly doubles the likelihood of SIBO in the larger cohorts.

  • The enzymes that convert T4 into T3 are built from selenium.

  • Selenium, magnesium, vitamin D and iodine are the foundational nutrients she starts everyone on.

  • Iodine is the one people tend to feel fastest, and it remains contested and dose-sensitive.

  • A single morning cortisol reading does not describe adrenal output across a day.

  • Genuine adrenal exhaustion is rare, and the label is applied far more often than the pattern appears.

  • Cortisol is a needed hormone, and suppressing it is not a strategy.

  • Test rather than guess, and read the numbers against optimal ranges rather than reference ranges.

  • Energy, mood and stress resilience are among the first things to shift when thyroid function is addressed.



Notable Quotes


Each of these stands alone. Verified against the final edited transcript.


  1. "People will get the message that all you have to do is heal your gut, and that will resolve all of your thyroid problems. And it's like, well, but the thyroid again, is the master gland. It controls gut motility."


  1. "So sometimes we actually have to be treating the low thyroid function up top to get more motion, going to get more motility going through the gut so that we can process, digest, detox, assimilate, not let food just sit there and ferment..."


  1. "I call them the no duh supplements. Like of course, duh. We're going to take these every day. So that's selenium, magnesium, vitamin D, iodine."


  1. "So I think the term adrenal fatigue gets thrown around way too much. And I think adrenal problems are overhyped."


  1. "One marker in the morning. That does not tell us anything about your adrenal output through the whole day. You have to do that four point saliva panel so that we can see what's it doing through the day..."


  1. "...it's not just, okay, what can we do to sprinkle adrenal fairy dust on ourselves and heal the adrenals? It's not about that. It's about addressing the trauma. It's about addressing the systems that might be off and not just hyper focusing on this gland..."


  1. "I was misdiagnosed six different times, I know that frustration of going from doctor to doctor to doctor, getting the same answer, or getting a band aid medication. I was handed antidepressants. I was handed sleeping pills. I was in my twenties."


  1. "You know your body more than anyone with a white coat. You know when something is off."



Episode Takeaway


I want to say something to the person who has been doing this properly and getting nowhere.


You found the practitioner. You ran the protocol. You did the eliminations, took the things in the right order, gave it the months it asked for. And the exhaustion is still there when you wake up.


The conclusion most people draw is that they did it wrong, or that they are the exception, or that this is simply what their body is now. I do not think any of those are usually true. What I see far more often is a right intervention aimed at the wrong system, because nobody asked what was upstream.


That is what this conversation with Dr. Hornaman is really about. The gut and the thyroid are the clearest example I know of two systems that feed each other. Work the gut alone and you improve a little of the conversion while leaving the motility problem in place. Work the thyroid alone and you leave an inflamed gut converting less than it should. Neither system is malfunctioning. Both have adapted to what they were handed, and each adaptation makes the other one's job harder.


Once you see that shape, you start seeing it everywhere. It is the shape of stored stress and biology.


Your body responds to what it has lived through by changing what it produces. It slows what it cannot afford to run. It stops making what it does not have the materials for. Those are sensible decisions made by a system trying to keep you alive, and they leave you with a biology that cannot do what your healing work is asking of it. This is why people can be years into good therapy, doing everything asked of them, and still have nothing in the tank. They are asking a depleted system to produce a response it does not currently have the capacity to make, and the work stalls there for reasons that have nothing to do with how well they are doing it.


So the answer starts with finding out what your body is actually carrying, and supporting the biology alongside that rather than after it.


If you are not sure whether what you are dealing with is stress or something your body has stored, that distinction changes what you do next, and it is worth getting clear before you spend another six months on the wrong end of the problem. The Stress or Trauma Guide walks you through it.


And some of you will read all of this and realise something else. That you do not actually know your body well enough to answer any of it. That you have been reading labs and protocols because reading your own signals has never been on offer.


This is why I start everyone with pre-work before we go anywhere deep. In the Foundational Journey we lay the foundational skills of getting to know, feel, track and shift your body and its states. Those skills are what make everything after them possible.


Your pace is the right pace. Start where the body actually is.



FAQ


Does healing my gut resolve my thyroid problems? No. Gut work supports the conversion of T4 into T3, so it helps, but the thyroid governs gut motility and often needs addressing at the same time.


Can hypothyroidism cause SIBO? The association is well documented. Slowed motility from low thyroid function creates the conditions for bacterial overgrowth. Larger cohorts put SIBO at roughly 33 percent in hypothyroid patients against 15 percent in controls.


Which comes first, the gut problem or the thyroid problem? Dr. Hornaman's position is that the order matters less than treating both. Where the thyroid is low, expect motility, bloating and constipation to be downstream of it.


What form of selenium does Dr. Hornaman use? Selenomethionine.


Which foundational nutrients does she start people on? Selenium, magnesium, vitamin D and iodine.


Why does iodine seem to work faster than thyroid hormone? She observes patients noticing a lift within a couple of weeks on iodine, ahead of hormone replacement building in the system. She also names iodine as contested and dose-sensitive.


Why does Dr. Hornaman say adrenal fatigue is overdiagnosed? Because the label is usually applied from one morning cortisol reading. True adrenal exhaustion, the flat bottomed-out shape across a whole day, she calls rare.


What test does she use for adrenals? A four-point saliva cortisol panel, which shows output across a day rather than one morning reading.


How long before I feel a difference? Energy, mood and stress resilience are the first to move, at roughly thirty to sixty days, scoped to patients being optimized under her care. Weight tends to sit between months two and six. Hair is six months to a year.



In this episode


  • 01:25 Why selenium, and which form she uses

  • 02:25 The foundational nutrients she starts everyone on

  • 03:03 Where T4 converts into T3, and how much of it happens in the gut

  • 04:07 Why healing the gut alone does not resolve the thyroid

  • 04:33 How a slow thyroid produces constipation, bloating and SIBO

  • 05:17 Why both systems often have to be treated at once

  • 06:25 Why she thinks adrenal fatigue is overdiagnosed

  • 07:16 What a single morning cortisol reading cannot tell you

  • 08:47 Why the adrenal glands do not decide on their own

  • 09:12 Cortisol is a needed hormone, and the trauma underneath it

  • 11:30 When T3 is used strategically for bottomed-out cortisol

  • 12:32 Moving from surviving to optimizing

  • 13:13 Iodine, and what people notice first

  • 14:16 Test, do not guess, and reading optimal ranges

  • 14:43 Free T3, thyroid antibodies and finding Hashimoto's

  • 15:10 The thyroid and your capacity to generate a stress response

  • 17:18 How long before energy and stress resilience shift

  • 18:39 Her six misdiagnoses, and why she kept going

  • 20:25 Doing your trauma work alongside the biology



Resources and guides




Related Podcast Episodes



About the guest

Dr. Amie Hornaman, known as the Thyroid Fixer, holds a doctorate in clinical nutrition and functional medicine. She is the founder and CEO of the Better Thyroid and Hormone Institute, with a telehealth practice serving all fifty states, and the originator of the FIX Method. She has spent more than twenty-five years in private clinical practice and hosts The Thyroid Fixer podcast. Her book is The Thyroid Fix: The No-Nonsense Guide to Fix Fatigue, Fogginess, and Fat That Won't Budge.



Research



Disclaimer

By listening to this podcast, you agree not to use this podcast as medical, psychological, or mental health advice to treat any medical or psychological condition in yourself or others. This podcast is for informational and educational purposes only and does not constitute professional advice, diagnosis, or treatment. Always consult your own physician, therapist, psychiatrist, or other qualified health provider regarding any physical or mental health issues you may be experiencing.


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