Dietary and Lifestyle Interventions to Support Functional Hypothyroidism

Functional hypothyroidism contributes to the risk for CVD and may cause learning disabilities. It has been associated with atrial fibrillation in older persons, reduced bone mineral density, palpitations, and can potentially exacerbate or complicate many other conditions. (Fibromyalgia and affective disorders may be manifestations of suppressed TRH production, rather than functional hypothyroidism.)

Experts agree, to some extent, that nutrition plays a critical role. The ATA maintains, as do alternative practitioners, that iodine, either too much or too little, can affect thyroid hormone function, but disagrees, unlike alternative practitioners, that soy and other goitrogens can cause hypothyroidism, or that supplemental key nutrients can restore thyroid function.

Alternative practitioners focus on 1) supporting the health of and balancing all the body systems, 2) supporting proper conversion of T4 to T3, 3) avoiding and eliminating toxins, and 4) and mitigating factors, physical and environmental, that cause stress. Alternative practitioners may combine conventional serum tests with less conventional tests to assess thyroid hormone function, or simply look at symptoms. Many have found that compounded slow release T3 used in combination with T4 can help to mitigate many of the symptoms of functional hypothyroidism and improve the quality of life in persons suffering from these symptoms. Still others, by supporting the thyroid with proper nutrients, obviate the need for supplemental hormones. The use of T3 alone is not an accepted treatment by most practitioners, conventional or alternative, but slow-release T3 may be recommended.

Regardless of the methods employed, diet plays a key role. Because blood tests do not pinpoint functional hypothyroidism, and because the axillary temperature test isn’t always accurate, assessments, such as questionnaires and saliva tests, and food journals will be useful to the clinical nutrition consultant. Often it is going to be simply a matter of how the client feels.

Thyroid Health-Promoting Protocol

Assessments will be useful in pinpointing functional hypothyroidism. Focus on total body health, digestive health, medical history, hypoglycemia, and thyroid self assessment. Have amalgams removed one at a time followed by a three-day minimum amalgam removal detoxification protocol. Address digestive issues, particularly hypochlorhydria. Address any chronic or acute infections, particularly candida. Consider an elimination diet to rule out food allergies and food insensitivities, especially to gluten. Assess adrenal insufficiency. If adrenal fatigue is likely, confirm using saliva tests. If the assessment indicates mild fatigue, support with whole foods, otherwise consider a glandular (not suitable for vegans and vegetarians).

The axillary temperature that measures the BMR may not be accurate, especially when using a digital thermometer. Advise clients to keep a diary of foods and beverages consumed, physical activity, basal body temperature, and to note how they feel.

The diet should be a plant based, whole foods diet that is high in complete, biologically available protein, and optimum levels of vitamins, minerals, antioxidants, phytonutrients, and complex carbohydrates. It should include organic free range and grass fed meat, poultry and dairy products, wild-caught cold water fish (favor those species at the bottom of the food chain, such as bristling sardines, herring, and mackerel), organic fresh whole grains, fruits and vegetables, and leafy greens. Keeping the diet alkaline, supporting digestion, supporting the liver, especially if thyroxine is being taken, supplying adequate soluble fiber, regulating blood glucose levels, and eliminating toxins will support the health of the thyroid gland.

The following protocol can be adapted to meet individual biochemical needs. Recommend a few things at a time and introduce new foods gradually, making use of the food journal to gauge results.

• Support digestion. Avoid drinking beverages for 15 minutes before and after eating. Eat without distraction in a relaxed manner and chew food thoroughly. This engages the parasympathetic nervous system and aids digestion. Include cultured and fermented foods for beneficial bacteria. Goat dairy may be easier to digest. Gentian, in addition to stimulating the secretion of digestive juices, has the added benefit of normalizing thyroid hormone production and being an antimicrobial. Apple cider vinegar before meals will stimulate the secretion of stomach acid. Supplement with digestive enzymes. Lacto-fermenting legumes before cooking predigests the sugars, making them easier to digest, and lacto-fermented foods increase stomach acid secretion.

• Avoid or reduce exposure to environmental toxins. Eat organic foods only and avoid exposure to toxins from yard chemicals, household cleaners, personal hygiene products, plastics, and other chemicals. Home Safe Home by Debra Lynn Dadd is a valuable resource. Toxins disrupt thyroid hormone production, but indoles found in cruciferous vegetables will support the liver and help it to detoxify the body. Eggs provide sulfur-containing amino acids methionine and cysteine, and molybdenum, a mineral coenzyme, all required for the liver's detoxification pathways. Plant foods high in Vitamin C and soluble fiber support detoxification. Herbal teas support the liver and gallbladder, key organs of detoxification.

• Water eight to ten eight-ounce glasses. Drink filtered water only. (See www.mercola.com.) Carry a stainless steel water bottle filled with water you have filtered yourself.

• An alkaline diet supports health. Replace trace minerals in filtered water with Concentrace® and unrefined sea salt. Vegetable and bone broths are good sources of trace minerals, required for thyroid hormone production and activation of thyroid hormone. Fresh vegetable juices with a big handful of fresh parsley will support the thyroid. Herbal teas, dandelion root and leaf and nettle, will aid in detoxification.

• Eat moderate amounts of high quality protein with each meal and snack. Protein is required for the production of thyroid hormone and liver detoxification. Best sources are from meat, poultry, sea foods, and dairy products. These are also the best sources of zinc and selenium, minerals required for thyroid hormone production. The protein in an egg is considered by experts to be 100% biologically available, but the protein in properly processed whey protein powder is as much as 159% biologically available (Null and Martin 66, In-Tele-Health “Whey Protein”). Plant sources, though complete, may not be as biologically available. Spirulina and nutritional yeast may be acceptable sources of protein for vegans – consider also supplementing with a complete amino acid supplement and an additional multi-mineral formula.

• Eat Foods high in Soluble Fiber to help balance blood sugar. Fresh whole fruits and vegetables, leafy greens, nuts and seeds, and whole grains are good sources of soluble fiber, which can help regulate blood sugar levels.

• Supplement with EPA and DHA fish oils. Many health conditions may be attributed to essential fatty acid deficiencies. Essential fatty acids are required constituents of every membrane in the body. The body uses ALA for many purposes. But current research indicates that as little as 5% may be available for conversion to EPA and then to DHA (In-Tele-Health Path: “Alpha-Linolenic Acid” “Conversion”). Ultra purified fish oil (3 g/day independently tested for rancidity, heavy metals, dioxins and PCB’s) are the best sources of EPA and DHA. Spirulina may be an acceptable source of EPA and DHA for ovo-lacto vegetarians and vegans.

• Pre-formed Vitamin A supports thyroid function. Persons with low thyroid function because of a zinc or vitamin E deficiency may have trouble converting beta carotene, found in brightly colored vegetables and fruits, to preformed Vitamin A. (Murray, Encyclopedia 19, 22.) Cod liver oil is a source of vitamins A and D, supportive of optimal thyroid hormone function.  

• Exercise regularly and avoid stress. Stress can contribute to elevated blood sugar levels. In addition to helping to manage stress, exercise increases thyroid hormone production and tissue sensitivity. Yoga poses, shoulder stand for example, stimulate the thyroid gland. Deep breathing and yoga engage the parasympathetic nervous system. Adaptogenic herbs enhance long-term ability to cope with physical and environmental stressors. Specific nutrients, such as B vitamins and zinc, help mitigate the effects of stress. 

• Don’t diet. Dieting slows metabolism.  

• Aromatherapy. Clary sage helps to balance hormones. 

• Supplement Recommendations. Supplements may include a multivitamin mineral with antioxidants, additional selenium, Vitamin C, and Vitamin E , a high potency B complex, sublingual Vitamin B12, digestive bitters, EPA/DHA fish oil, digestive enzymes, probiotics, and free-form amino acids. Consult with a licensed health care practitioner before taking supplements.

Foods to Include

Organic foods are higher in nutrients required to support the thyroid gland, including the trace minerals zinc, copper, iodine, manganese and selenium, Vitamin A, Vitamin C, Vitamin D, Vitamin E, potassium and the amino acids tyrosine and phenylalanine. Good sources include meat, liver, seafood, especially shrimp and oysters, poultry, especially dark meat, eggs, dairy products, especially butter, beans and legumes, especially garbanzo beans, whole grains, especially buckwheat, amaranth, quinoa, brown rice and oats, apples, strawberries, pears, pineapple, kiwi fruit, apricots, spinach, romaine, cinnamon, black pepper, turmeric, parsley, goat milk kefir and yogurt, Brussels sprouts, broccoli, cabbage, cauliflower, red and orange bell peppers, sweet potatoes, citrus fruits, acerola berries, fresh dandelion (leaf and roots), dandelion leaf and root tea, coconut oil, crimini mushrooms, nuts and seeds, especially unshelled Brazil nuts and pumpkin seeds, walnuts, almonds, almond butter, ground flax seeds (small amounts), sesame and hemp seeds, avocados, spirulina, chlorella, dulse, cod liver oil, nutritional yeast, blackstrap molasses, eggs, whey protein, miso, tempeh, sauerkraut and umeboshi. Protein sources for vegans will include legumes, passion flower, almonds, mustard seeds, fennel, garlic, bananas, spirulina, kale and natto.

Foods and substances to limit or avoid

Limit refined carbohydrates, including sugar, and high glycemic foods. These can raise blood glucose levels. Elevated blood sugar contributes to insulin resistance, which can inhibit the passage of nutrients into the cell. Limit fruit to two whole a day and choose low glycemic sources (see foods to include). Avoid excessive fiber from supplements such as psyllium and wheat, as these can bind to available thyroid hormone. Some foods contain goitrogens and other substances that can interfere with the body’s ability make thyroid hormones. Goitrogenic foods include broccoli, Brussels sprouts, cabbage, cassava root, cauliflower, collard greens, flax seeds, horseradish, kale, kohlrabi, mustard greens and seeds, millet, peaches, peanuts, pine nuts, radishes, rape seeds (canola oil), rutabaga, soybeans and soy products, spinach, strawberries, and turnips. These substances are generally inactivated during cooking. Limit to less than one serving cooked per day and one cup raw per week.

Refined and processed foods are sources of oxidized cholesterol, hidden sugar, trans fats, excess sodium, excess amounts of Omega 6 fats, and artificial sweeteners, all of which can interfere with nutrient absorption and promote inflammation and oxidative damage to tissues. For good health balance Omega 6 to Omega 3 fats in a ratio of 2:1 or 1:1. Hemp seeds provide a good balance of Omega 6 to Omega 3 fats. Include sources of healthy cholesterol to support synthesis of sex hormones from eggs, butter, dairy, and shrimp.

Iodine and tyrosine, a non-essential amino acid, are required for the cellular conversion of T4 to T3, the active hormone. Excessive iodine can depress thyroid hormone production and conversion to the active form, especially in persons taking synthetic T4. High-iodine intake has been implicated as a cause of hypothyroidism in one case study (Werbach 217). Fast foods contain excessive amounts of iodine (Dunne 39). Limit consumption of iodine to food sources and don’t consume in excess. Choose low heat processed sources of protein. The protein in hydrolyzed whey protein and plant-based protein powders can be denatured (damaged) and processed whey protein frequently contains additives.

Avoid alcohol, as it can contribute to decreased thyroid hormone production and slow metabolism. Tap water contains chemicals that are toxic to the thyroid gland.

References

1. American Thyroid Association. “American Thyroid Association Statement on ‘Wilson’s Syndrome’.” 24 May 2005. thyroid.org. 19 Oct. 2009 .

2. American Thyroid Association. “Thyroid Function Tests.” 2005. thyroid.org. 19 Oct. 2009 .

3. American Thyroid Association. “Thyroid Problems Increase Risk of Heart Disease and Death.” ATA News Release. 01 Oct 2004. thyroid.org. 24 Sept. 2009 .

4. American Thyroid Association. “ATA Hypothyroidism Booklet.” 2003. thyroid.org. 24 Sept. 2009. .

5. American Thyroid Association. “Thyroid and Erectile Dysfunction.” Clinical Thyroidology for Patients. 1:1. (2008). 30 Sept 2009 < http://www.thyroid.org/patients/notes/aug08/08_08_22.html>.

6. American Thyroid Association. “Thyroid Hormone.” Clinical Thyroidology for Patients. 2:1. (2009). 30 Sept 2009 < http://thyroid.org/patients/ct/volume2/issue1/ct_patients_v21_3.html>.

7. American Thyroid Association. “Hypothyroidism.” Clinical Thyroidology for Patients. 2:3. (2009). 30 Sept 2009 < http://thyroid.org/patients/ct/volume2/issue3/ct_patients_v23_5.html>.

8. Ananthakrishanan, Sonia and Elizabeth Pearce. “Hypothyroidism and Hyperthyroidism: Review Questions.” Hospital Physician. May 2007. 24 Aug 2009 .

9. Anderson, Robert. “Psychoneruoimmunoendocrinology Review and Commentary.” Townsend Letter. 305 (2008): 62-65.

10. Arafah, B.M. and M.P. Nasrallah. “Pituitary tumors: pathophysiology, clinical manifestations and management.” Endocrine-Related Cancer. 8 (2001): 287-305.

11. Billica, Roger and Catherine Willner. “Molecules of Behavior II: Diagnosis & Treatment of Neurotransmitter Imbalances.” Designs for Health, Inc. 21 June 2008.

12. Brady, David. “Functional Thyroid Disorders, Part I.” Dynamic Chiropractic. 18:7 (2000).

13. Braverman, Eric, et al. The Healing Nutrients Within. Laguna Beach: Basic Health Publications, Inc., 2003.

14. Brinker, Francis. Herb Contraindications & Drug Interactions. 3rd Ed. Sandy, OR: Eclectic Medical Publications, 2001.

15. Cowan, Tom. “Ask the Doctor About Hypothyroidism.” 31 Mar. 2001. westonaprice.org. 29 Aug. 2007 < http://www.westonaprice.org/askdoctor/hypothyroidism.html>.

16. Daniel, Kaayla. The Whole Soy Story, the dark side of America’s favorite health food. Washington, D.C.: New Trends Publishing, 2007. 

17. Dunne, Lavon. Nutrition Almanac. 5th Ed. New York: McGraw-Hill, 2002.

18. Fallon, Sally and Mary Enig. Nourishing Traditions. Rev. 2nd Ed. Washington, DC: New Trends Publishing, 2001.

19. Fisher, D. A. et al. “The Hypothalamic-Pituitary-Thyroid Negative Feedback Control Axis in Children with Treated Congenital Hypothyroidism.” Journal of Clinical Endocrinology & Metabolism. 85:8. (2000): 2722-27.

20. Forest Laboratories, Inc. “Frequently Asked Questions.” 2009. armourthyroid.com. 11 Apr. 2008 < http://www.armourthyroid.com/con_faqs.aspx>.

21. Greenstein, Ben and Diana Wood. The Endocrine System at a Glance. 2 Ed. Malden, MA: Blackwell Publishing, 2006.

22. Hedberg, Nicholas. “Understanding Thyroid Imbalances.” Hawthorn University Live Webinar. 28 April 2009.

23. Hedberg, Nikolas. “Understanding Thyroid Imbalances, Part 2.” Hawthorn University Live Webinar. 09 June 2009.

24. Hedberg, Nikolas. “Fibromyalgia.” Hawthorn University Live Webinar. 29 Sept 2009.

25. Higgins, Thomas. “Thyroid Function Tests.” 2006. bouldermedicalcenter.com. 28 Oct. 2009 .

26. Hollander, Jason, and Jeffrey Mechanick. “Nutrition Support and the Chronic Critical Illness Syndrome. Nutrition in Clinical Practice. 21. (2006): 587-604.

27. Howdeshell, Kembra. “Endocrine Disruptors. A Model of the Development of the Brain as a Construct of the Thyroid System.” Environmental Health Perspectives. 110:3. (2002): 337-48.

28. HyperHealth Pro v. 8.0 – Encyclopedia of Nutrition and Natural Health. CD-ROM. Hansville, WA: In-Tele-Health, 2008.

29. Karstens, Connie. Personal Interview. 30 March 2009.

30. Kharrazian, Datis. “The Real Cause of Hypothyroidism.” Townsend Letter. 316 (2009): 88-9.

31. Kitchen, Judy. “Hyphchlorhydria: A Review, part 1.” Townsend Letter for Doctors and Patients. 219-221. (2001). 13 Sept 2009 .

32. Kohlstadt, Ingrid. “Hypothyroidism: More Seaweed, Less Soy, and a Closer, Potentially Life-Saving Look at Iodine.” Townsend Letter. 305 (2008): 62-65.

33. Krohn, Jacqueline and Frances Taylor. Natural Detoxification. Pt. Roberts, WA: Hartley and Marks Publishers Inc., 2000.

34. Ladenson, Paul, et al. “American Thyroid Association Guidelines for Detection of Thyroid Dysfunction.” Archives of Internal Medicine. 160 (2000): 1373-75.

35. Lieberman, Shari. The Real Vitamin & Mineral Book. 3rd Ed. New York: Avery, 2003.

1. Lipski, Elizabeth. Digestive Wellness. 3rd Ed. New York: McGraw Hill, 2004.

37. Liska, DeAnn, Ed., et al. Clinical Nutrition, A Functional Approach. Gig Harbor: The Institute for Functional Medicine, 2004. 

38. Mateljan, George. The World’s Healthiest Foods. 1st Ed. Seattle: George Mateljan Foundation, 2007. 

39. McDermott, Michael and E. Ridgway. “Subclinical Hypothyroidism Is Mild Thyroid Failure and Should be Treated.” 2001. jcem.endojournals.org. 14 July 2009 < http://jcem.endojournals.org>.

40. Milner, Martin. “Hypothyroidism: Optimizing Medication with Slow-Release Compounded Thyroid Replacement.” Townsend Letter. Feb/Mar 2007. 30 July 2009 .

41. Murray, Michael. Encyclopedia of Nutritional Supplements. N.Y.: Random House, 2001.

42. Murray, Michael. Total Body Tune-Up. New York: Bantam Books, 2000.

43. Murray, Michael and Peter Bongiorno. “Eleutherococcus Senticosus.” Ed. Pizzorno, Joseph and Murray, Michael. Textbook of Natural Medicine. 3rd Ed. New York: Churchill Livingstone, 2006.

44. Murray, Michael. “Hair Loss in Women.” Ed. Pizzorno, Joseph and Murray, Michael. Textbook of Natural Medicine. 3rd Ed. New York: Churchill Livingstone, 2006. 

45. Murray, Michael and Peter Bongiorno. “Hypothyroidism.” Ed. Pizzorno, Joseph and Murray, Michael. Textbook of Natural Medicine. 3rd Ed. New York: Churchill Livingstone, 2006. 

46. Murray, Michael and Peter Bongiorno. “Hyperthyroidism.” Ed. Pizzorno, Joseph and Murray, Michael. Textbook of Natural Medicine. 3rd Ed. New York: Churchill Livingstone, 2006. 

47. Murray, Michael and Peter Bongiorno. “Affective Disorders.” Ed. Pizzorno, Joseph and Murray, Michael. Textbook of Natural Medicine. 3rd Ed. New York: Churchill Livingstone, 2006. 

48. Murray, Michael and Joseph Pizzorno. “Stress Management.” Ed. Pizzorno, Joseph and Murray, Michael. Textbook of Natural Medicine. 3rd Ed. New York: Churchill Livingstone, 2006. 

49. Nadeau, Andre. “Subclinical Thyroid Disease: A laboratory Finding of Clinical Relevance?” Canadian Journal of CME. July 2001: 89-98. 

50. Norman, Anthony and Gerald Litwack. Hormones. 2nd Ed. New York: Academic Press, 1997.

51. Null, Gary and Martin Feldman. “The Argument for a Vegetarian Diet, Part One.” Townsend Letter. 310 (2009): 63-68.

52. Olateju, Tolulope and Mark Vanderpump. “Thyroid Hormone Resistance.” Annals of Clinical Biochemistry. 43 (2006): 431-40.

53. Paoletti, Jim. “Hypothyroidism, Functional Hypothyroidism, and Functional Metabolism.” International Journal of Pharmaceutical Compounding. 12:6 (2008): 489-97.

54. Panaretou, Dernellis. “Effects of thyroid replacement therapy on arterial blood pressure in patients with hypertension and hypothyroidism.” Am Heart J. 143. (2002): 718-24.

55. Paul, Cristiana. “L-Tyrosine. What we Should Know About This Important Amino Acid.” Product Tech Sheet. designsforhealth.com. 2009.

56. Pirkle, James. “CDC’s Perchlorate Biomonitoring Activities and Study Results.” CDC Congressional Testimony before the Committee on Energy and Commerce Subcommittee on Environment and Hazardous Materials, United States House of Rep. 25 Aug 2007 < http://www.cdc.gov/search.do?queryText=perchlorate&action=search>.

57. “ Reference Ranges for Blood Tests.” Wikipedia, the Free Encyclopedia. (28 Oct. 2009). Wikimedia Foundation, Inc. 08 Oct 2009 < http://en.wikipedia.org/wiki/Reference_ranges_for_blood_tests#Hormones> .

58. Ritchason, Jack. The Little Herb Encyclopeids. 3rd Ed. Pleasant Grove, Utah: Woodland Health Books, 1995.

59. Rybacki, James. The Essential Guide to Prescription Drugs 2006. New York: HarperCollins, 2006. 

60. Schmid, Ronald. Traditional Foods Are Your Best Medicine. Rochester, VT: Healing Arts Press, 1997. 

61. Shackelton, Mary. Personal Interview. 02 July 2007. 

62. Shames, Richard and Karilee Shames. Thyroid Power. 1st Ed. New York: HarperCollins, 2001. 

63. Shoman, Mary. “The Metabolic Detective: A Look at Nutrition for Your Thyroid, Interview with Dr. Edward Bauman.” 11 Nov. 2007. thyroid-info.com. 01 Nov. 2009 . 

64. Standard in Natural Solutions, LLC. “An Encyclopedia of Natural Medicine.” HealthQuest Database. CD-ROM. Ft. Collins, CO: HealthQuest, Inc., 2004.

65. Schneider, Michael, and David Brady. “Fibromyalgia Syndrome: A New Paradigm for Differential Diagnosis and Treatment.” Journal of Manipulative and Physiological Therapeutics. 24:8. (2001): 530-41.

66. Starr, Mark. Hypothyroidism Type 2: The Epidemic. Columbia: Mark Starr Trust, 2009.

67. Teitelbaum, Jacob. “Pain Free 1-2-3! Treat the Patient – Not the Blood Tests!” Townsend Letter. 306. (2009): 121-4.

68. “Thyroxine.” Wikipedia, the Free Encyclopedia. (31 Oct. 2009). Wikimedia Foundation, Inc. 26 June 2008 .

69. United States Department of Health and Human Services, Public Health Services, Agency for Toxic Substances and Disease Registry. “ToxGuide® for Perchlorate and Perchlorate Salts.” 14 July 2009 .

70. Vanderhaege, Lorna. Healthy Immunity. New York. Kensington Publishing: 2001.ypothyroidism Type 2: The E pidemic.ICcCC`CColum

71. Venes, Donald, Ed. et al. Taber’s Cyclopedic Medical Dictionary. 20th Ed. Philadelphia: F.A. Davis Company, 2005.

72. Werbach, Melvin. Case Studies in Natural Medicine. Tarzana, CA: Third Line Press, 2002.

73. Whitney, Eleanor and Sharon Rolfes. Understanding Nutrition. 9th edition. Belmont, CA: Thompson-Wadsworth, 2005.

74. Williams, Roger. Biochemical Individuality. New Canaan, CN: Keats, 1998.

75. Wilson, James. Adrenal Fatigue. The 21st Century Stress Syndrome. Petaluma, CA: Smart Publications, 2001.

76. Wood, Matthew. Excerpt from unpublished book. Handbook of Traditional Western Herbalism, Vol II. Minnestra, Mn: 2004.

77. Wood, Rebecca. The New Whole Foods Encyclopedia. New York: Penguin Books, 1999.

78. Yarnell, Eric and Kathy Abascal. “Urtica dioica (Stinging Nettle).” Ed. Pizzorno, Joseph and Murray, Michael. Textbook of Natural Medicine. 3rd Ed. New York: Churchill Livingstone, 2006.

79. Zimmerman, Michael, et al. “The Effects of Vitamin A Deficiency and Vitamin A Supplementation on Thyroid Function in Goitrous Children.” Journal of Clinical Endocrinology and Metabolism. 89:11. (2004): 5441-7.

1.) As in chronic autoimmune thyroiditis (Hashimoto’s disease), postradioactive iodine treatment (used to treat Grave’s disease), and thyroidectomy.

2.) Iodine deficiency can still occur in the U.S. in areas where the soil is iodine-depleted (Paoletti 3).

3.) Excess cortisol also inhibits the production of TSH, a factor in clinical hypothyroidism.

4.) Milli-International Units per milliliter.

The use of terms that describe the methods used by licensed healthcare practitioners to diagnose and treat thyroid disorders in no way implies, nor is the use of these terms to be interpreted to mean, that nutrition consultants diagnose or treat disease, patients, disorders or symptoms.