‘Oh, wait. You just moved here from France, and your levels were normal over there?”
My endocrinologist peered at me through the camera, expectantly. It was my first (virtual) appointment with an Endocrinologist since we had moved back to the United States about six months ago. I had made this appointment to establish myself with a new provider, knowing I needed help managing my medications and blood draws.
I had been diagnosed with Grave’s disease in 2020, and my thyroid was removed a few months after the diagnosis. It was a decision I made in order to move forward as quickly as possible to start a family; we had already been trying for a few years when we discovered my ovulation was affected by my thyroid disease.
Post surgery, life had pretty much moved forward without a hitch when it came to my Grave’s disease. I had two babies over the last three years, which required some more frequent monitoring of labs and changes in thyroid medication doses, but for the most part, everything felt pretty status-quo.
A few weeks prior, my helpful OBGYN agreed to order a lab draw for me in anticipation of my appointment with my endocrinologist. I would have lab values ready to discuss once we met. To my surprise, my most recent blood draw showed that my TSH (Thyroid Stimulating Hormone, a hormone monitored when taking thyroid medicine or getting thyroid therapy) was elevated. It had been normal for the last couple of years.
Thankfully, I was asymptomatic, but I was eager to have my levels corrected soon. I knew a fluctuation in my levels could impact my hunger, heat and cold tolerance, heart rate, and my weight. It could also affect my skin hydration, energy levels, and just generally make me feel…blah. I was already chasing two babies around most of the day and the primary caretaker of our home, so I wanted my health in tip-top shape. I didn’t have time to be tired due to an off-level medication.
I assumed the change in my TSH level was a normal fluctuation or related to changes in my weight (though, to be honest, I hadn’t weighed myself in years, nor felt the need to).
I anticipated a five-minute appointment and hadn’t even planned for childcare during it. However, the doctor seemed to come to a screeching halt in his assessment when he discovered my levels had been steady in France.
He reviewed the self-assessment I had completed online prior to our visit. “Okay, so you’re having diarrhea, right?”. I had almost omitted that, purely out of embarrassment, but it seemed to be giving him a clue. “Yeah,” I admitted. “Pretty much since arriving in the US.”
His next sentence caught me completely by surprise, and I wondered if I had heard him right.
“It’s the food. The food in the United States is why your thyroid levels are all wonky.”
“…huh?”
He went on to explain. “Your gut health is being affected by the food here in the US. For whatever reason, we add all kinds of things into our food here which aren’t legal in the E.U. For example, gums and preservatives, even pesticides. I’m not an expert on the nutritional value of foods, but I can tell you from experience that this is why your levels are off. It’s why you’re having digestive problems. And because of that, your body is unable to absorb your medication appropriately.”
I sat there, blinking into the computer. I was suddenly extra grateful that my mom had popped over unexpectedly to hang out with the kids during my appointment. I explained to my new doctor that I couldn’t eat gluten, dairy or soy in the US, but when I moved to France I could magically start eating bread and dairy again. He nodded. “I have taken care of patients during my career who have moved around the world. This doesn’t surprise me.”
He thought for a moment, then said, “And I have a son in Germany.”
I also learned he had grandchildren living there, and this opened the door for further discussions. We talked more about the differences in food and my experiences living in Paris. I described my encounters with the health care system (including two births and an open-heart surgery), my ability to pay for child care, and the ability to travel and afford groceries.
“Why the heck did you move back?” he asked, after illustrating to me why his son was more interested in staying in Germany - where he had parental leave, affordable childcare and socialized healthcare - then moving back to the US where he could get more childcare support from family members.
We talked a bit more and finally concluded that I would increase my medication levels; unfortunately, this likely wouldn’t make a big difference until I also adjusted my diet. I was already making my own bread at home a few times a week and eating organic when I could, but now I would have to take a second look at my diet. I’d probably need to avoid enriched-flour, processed foods, and all pastas that were made with wheat.
He also recommended that I look up something called FODMAP, an app which helps you create a more favorable gut microbiome. It reminded me of the elimination diet I completed when I first discovered I had Grave’s Disease.
I felt bewildered, and a bit deflated. I didn’t have the energy to pick apart my diet again. I didn’t want to be the person at gatherings with particular diet requirements. I wanted to enjoy going out to eat without worrying about my gut health. I could eat nearly everything I wanted to in France – why couldn’t I do that here!?!
I was already convinced that the toxins in our foods and environment in the US had “turned on” my auto-immune disease (which ultimately led to the removal of my thyroid). It was a punch in the stomach that I had moved back to the US and still had to worry about how these toxins affect my thyroid hormones, even after removing it via surgery.
It felt ridiculous and silly, and yet it reminded me of a story a friend shared with me while in France. She was also diagnosed with thyroid disease, but instead of removing her thyroid she controlled her levels with a “anti-thyroid” medication.
She had to adjust levels based on where she was living; when she returned to the US to visit family, she significantly increased her medications as she was suddenly exposed to a higher amount of toxins. It was a system that worked well for her.
My family had already had a tumultuous return to the country, with an unexpected death of a precious family member, an extreme health diagnosis of our child, and financial hardships from healthcare we could afford previously (in France). I wasn’t ready to add something else to the pile.
I was angry, and my fury eventually led to my resolve that one day we would move out of the US again. I didn’t want my children’s quality of life to suffer because of the country we lived in. I didn’t want them to suffer under healthcare costs which bankrupt so many Americans. I wanted them to be relieved of the mental burden which follows us into every American grocery store.
Don’t we have better things to do than pick apart nutrition labels and worry about pesticides in our oatmeal?
“You know, Black Bird Baking Company has excellent quality of bread,” the doctor said, breaking my train of angry thoughts. “You can make your own sourdough, too. Bob’s Red Mills and King Arthur are trust-worthy brands.”
His words softened me, and I was reminded that life isn’t over just because I can’t walk to the nearest boulangerie and order a baguette for a euro. “Thanks, I’ll try that,” I responded, knowing I already had both brands of flour in my pantry downstairs.
We agreed to meet in six weeks, and I would recheck my levels again via blood draw. We hoped that some diet changes would allow my gut to rest a bit and absorb my medicine better. I shared with him how debilitated I felt the first two weeks we moved back – I had so much pain in my joints, even my back ached.
I wondered if taking another look at my diet would also help with my knee pain, which returned after we moved back from France.
I checked my watch – he had spent 45 minutes talking with me about bread, Europe, and childcare costs. We had even dabbled in discussions about an upcoming trip I was making with my mom and our babies to Paris…for healthcare.
“You know, you should write about all this,” he said, after learning that I enjoy journaling and sharing my experiences. “This could really ruffle some feathers.”
I thanked him for his time, and noted that though it currently felt like my feathers had received a decent ruffling, I could channel my energy into my writing. With any luck, it could help promote discussions and change.
After saying goodbye, I walked downstairs, peering around the corner of the stairs to watch my toddlers cackle in delight as they chased each other, intermittently stopping for my mom to tickle them. I smiled.
I sneaked into the kitchen and opened the pantry doors. The King Arthur bag of flour was leaning on the Organic Whole Wheat Bob’s Mills bag, both patiently waiting to be used. Sitting next to them was another bag of flour. It declared “Carrefour Bio, Farine de blé, français T65”; an organic bread flour I had smuggled back with me from Paris in my luggage months ago.
Later, my gut could pretend we were back in France. We’d have homemade bread with dinner tonight!
