Archive Monthly Archives: November 2014

Hashimoto’s and SIBO (Part 1 of 2)

Diet Matters with Hashimoto’s

For many people who struggle with Hashimoto’s, diet is a huge issue.

Yet, many doctors ignore the role of diet in the initiation, and progression of this and other autoimmune diseases.

But, if you have Hashimoto’s, and you are like a lot of people we’ve worked with, then you know that what you eat has a huge impact on your health and how you feel.

This just makes sense. Where is your immune system in your body?

Over 70% is found in and around your digestive tract. This is where it lives.

What you eat has a profound impact on autoimmune diseases like Hashimoto’s.

In this series of posts, we’ll examine a key factor in healing your Hashimoto’s by looking into something that is really common but often overlooked.

SIBO or small intestine bacterial overgrowth.

I recently attended a lecture taught by my teacher and mentor, Dr. Datis Kharrazian.

Dr. Kharrazian is a relentless researcher.

He is always exploring other people’s research and doing his own in order to help us understand why people are getting sick and how we can fix it.

In a recent lecture that I attended called “The Neuroendocrine Immunology of Small Intestine Bacterial Overgrowth”, he shared a lot of really valuable information on many aspects of SIBO that new research has revealed.

Why SIBO Matters to Someone with Hashimoto’s

Determining whether not you have SIBO can be really, really important for people with Hashimoto’s because of the role that the small intestines play in thyroid hormone conversion and absorption.

When you have Hashimoto’s and hypothyroidism this leads to problems with motor functions in the small intestine.

There are thyroid hormone receptors all over the gut. The vagus nerve fires into the gut.

If they aren’t getting enough thyroid hormone, things don’t move as well through there and that leads to overgrowth of bacteria.

And too much of this bacteria can interfere with levothyroxine absorption.

This is why some people take Synthroid, Armour, Cytomel, Naturethroid or another thyroid replacement hormone and it doesn’t feel like it’s working.

That’s because it isn’t.

With SIBO you can’t absorb thyroid hormone very well.

And autoimmunity shuts down T3 receptors.

Again, thyroid hormone doesn’t work if it can’t bind to receptors and can’t be absorbed.

So, even though you are taking thyroid hormone, it isn’t working – you have all the symptoms like fatigue, brain fog and memory issues, weight gain, hair loss, depression, etc.

The Small Intestine is Ground Zero for Autoimmunity

Many researchers also believe that autoimmune disease originates in the intestines.

A leaky gut or damaged intestine has been found in every autoimmune disease that has been tested including rheumatoid arthritis, ankylosing spondylitis, inflammatory bowel disease (Crohn’s disease and ulcerative colitis), celiac disease, multiple sclerosis, type I diabetes and, yes, Hashimoto’s.

In the small intestine this damage leads to immune system stimulation, the wrong types of things in the blood stream and, ultimately, a systemic problem that results in the loss of self-tolerance.

This means that the immune system gets so overwhelmed it can’t tell what is our tissue and what is a bad guy that must be attacked.

Which Came First Leaky Gut or SIBO?

There are many causes of the breakdown of the intestines.

These include NSAID use, alcohol, gluten and other dietary proteins, bacterial overgrowth, environmental toxins and more.

And once this breaks down it alters the whole ecosystem of the gut.

It’s hard to know which came first.

And at the end of the day, it doesn’t really matter.

What matters is what causes it and what we can do to heal it.

Symptoms of SIBO

SIBO has a number of possible symptoms, but mostly these involve bloating, gas, diarrhea and/or constipation.

The hallmark symptom is bloating and discomfort after eating certain foods.

Basically here’s what happens.

The wrong type of bacteria end up getting into the small intestine. The migrate from the large intestine and take over.

They feed on certain types of foods like sugars, galactans, fructans and starch.

In reality, SIBO should be considered with abdominal discomfort after eating any of the following things:

– Starches
– Sugars/fructose
– Fructans
– Prebiotics
– Probiotics
– Fiber supplements
– Rice or pea powder from metabolic powders
– Galactans

You may notice that many of the foods listed here can also aggravate candida. And sometimes candida is blamed for what is actually SIBO.

5 Main Causes of SIBO

The causes of SIBO matter because when we understand the causes, we can figure out how to fix them.

These include:

1. Too little stomach acid.

Hashimoto’s and hypothyroidism leads to lower production of gastrin and stomach acid. This is super common.

And ironically, many people develop GERD or acid reflux and are prescribed proton pump inhibitors and antacids that just make everything worse.

(We’ve discussed this in depth in this post)

2. An immune suppressed gut.

Many factors can lead to immune suppression in the gut. 2 important ones are long term corticosteroid treatment and chronic stress.

In either case, lots of cortisol or corticosteroids cause the immune system to shut down and allows the party to get out of control.

With Hashimoto’s the body is under a great deal of physiological stress, all the time. So extra emotional stress and abnormally stressful events often result in people getting a lot sicker.

This is one of the reasons why.

3. Injury to the gut nervous system (known as the ENS or enteric nervous system)

The gut has been called the body’s “second brain” because it has it’s own nervous system and produces many of the neurotransmitters that are also produced in the brain.

Well, just like our other brain this can degenerate and break down with age and with diseases like chronic celiac disease, sceleroderma and IBS.

And just like neurodegeneration in the brain, this can be permanent. But also, just like the brain this second brain has remarkable plasticity and it can relearn things and rewire itself, too.

The gut brain and our main brain are both loaded with thyroid hormone receptors. With Hashimoto’s and hypothyroidism, there is often too little thyroid hormone or it’s not getting absorbed properly.

This can result in damage to the enteric nervous system (the gut brain).

4. Problems with the Vagus nerve

The Vagus nerve is a central highway for communication between the brain and the gut. When the vagus nerve stops firing into the gut this slows down everything.

This is a major cause of slower motility and constipation.

Thyroid hormone has a direct affect on movement through the entire gastrointestinal tract.

Thyroid hormones increase intestinal neurotransmitters, increase blood flow to the intestines and support the repair and regeneration of the intestines.

Hypothyroidism can slow movement through the esophagus, can affect muscle function in this area and can affect the nerves that cause movement.

Hypothyroidism also has an affect on the vagus nerve and this can lead both directly and indirectly to slowing movement through the intestines.

5. Anatomical or structural changes to the small intestines or illeosecal valve

Surgery to the gut (like appendectomy or resection), diverticulitis and scarring due to inflammatory bowel disease can all lead to this.

Hypothyroidism can lead to the loss of control of the ileosecal valve that is the doorway between the large and small intestine.

When this stops working as it should it lets lots of critters from the large intestine into the small intestine.

SIBO Has Degrees of Severity

Just like Hashimoto’s, SIBO has different degrees of severity. These are important because the more serious it is the more work you may have to do to resolve it.

I. Asymptomatic:

Abnormal small intestine bacterial overgrowth tests and mild or no symptoms.

Bloating after meals.

II. Moderate Symptoms:

Bloating with malnutrition and constipation.

Bloating with nutritional deficiencies.

III. Severe Symptoms:

Bloating with anemia, low albumin, low cholesterol

Bloating with weight loss, chronic diarrhea and malabsorption

If you are a person who has trouble taking supplements because you just react to everything, then you may fall into the more severe symptoms category.

Who Has SIBO?

Here’s an overview from the Journal of Clinical Gastroenterology on the prevalence of SIBO in other conditions:

15% of the elderly

33% of people with chronic diarrhea

34% of people with chronic pancreatitis

53% of people using antacid medication

66% of patients with celiac disease with persistent symptoms.

78% of people with IBS

90% of alcoholics

What really stands out for me there are 2 of those statistics.

More than half the people on antacid medication and 9 out of 10 alcoholics suffer from SIBO.

That shows you how destructive alcohol can be to the small intestines.

And, the fact is that alcohol degenerates the enteric nervous system of the gut very aggressively.

How Do You Test for SIBO?

In the conventional medical model there are 2 types of testing for SIBO.

Both are flawed and not definitive.

1. Direct: Endoscopic Aspiration and Culture

This is a direct endoscopic aspiration and culture of the small intestine.

This requires a gastroenterologist, it’s expensive, it’s invasive (they have to go in and get a sample).

The problem with this is that many of the bacteria removed from the small intestine can’t be analyzed because they don’t survive in culture.

Samples must be handled properly for accurate results.

To recap: It’s expensive, it’s invasive and sometimes tests don’t reveal all the bacteria involved.

2. Indirect: Breath Testing for Hydrogen and Methane

This type of testing involves breath testing for hydrogen and methane.

This test can be inaccurate if someone has recently had antibiotics.

It may not be useful in determining all species of bacteria.

The optimal window for timing for collection is different for different people because transit time is different for different people.

To recap: You may get false negatives due to different transit times or antibiotic use.

Actually, the best test for SIBO is a trial diet and/or a stool test that looks for invasive species.

In our next post, we’ll look at this diet and how to treat all 5 different causes of SIBO and the various levels of seriousness.

References:

http://www.discoverymedicine.com/Kouki-Mori/2012/11/27/does-the-gut-microbiota-trigger-hashimotos-thyroiditis/

http://www.ncbi.nlm.nih.gov/pubmed/17698907 – SIBO and hypothyroidism -antibiotic therapy didn’t affect thyroid hormone levels

http://www.ijem.in/article.asp?issn=2230-8210;year=2014;volume=18;issue=3;spage=307;epage=309;aulast=Patil
Link between SIBO and hypothyroidism

http://journals.lww.com/theendocrinologist/abstract/1995/05000/absorption_of_oral_thyroxine.9.aspx

“It is markedly decreased in conditions in which there is a decrease in the effective small intestinal absorptive surface, including short bowel syndromes sprue, and other malabsorptive conditions.”

http://www.europeanreview.org/wp/wp-content/uploads/451-4561.pdf – Levothyroxine absorption in health and disease

http://gutcritters.com/thyroid-function-and-gastrointestinal-distress/ – LPS and thyroid receptors

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3099351/ SIBO Study

http://www.ncbi.nlm.nih.gov/pubmed/12388159?dopt=Abstract – Infection leads to poor thyroid hormone absorption

http://www.ncbi.nlm.nih.gov/pubmed/18372241 – LPS reduced T3

http://chriskresser.com/inflammation-strikes-again – Low T3 Syndrome

http://www.discoverymedicine.com/Kouki-Mori/2012/11/27/does-the-gut-microbiota-trigger-hashimotos-thyroiditis/

http://www.naturalendocrinesolutions.com/articles/sibo-thyroid-health/

http://neurosciencestuff.tumblr.com/post/38271759345/gut-instincts-the-secrets-of-your-second-brain Great article on the enteric nervous system

http://www.ncbi.nlm.nih.gov/pubmed/16336493 : glial cels in the gut cause neurodegeneration

http://www.jneuroinflammation.com/content/7/1/37 : neurodegeneration in IBD

http://ajpgi.physiology.org/content/ajpgi/303/8/G887.full.pdf : enteric glia cells are protective, damage to them leads to neurodegeneration

Prevalence of small intestine bacterial overgrowth diagnosed by quantitative culture of intestinal aspirate in celiac disease. J Clin Gastroenterol, 2009 Feb; 43 (2): 157-161

The Neuroendocrine Immunology of Small Intestine Bacterial Overgrowth, lecture notes, Dr. Datis Kharrazian, November 2014.

The Paleo Approach, Sarah Ballantyne, PhD, Victory Belt Publishing 2013

“Should I Get a Flu Shot If I Have Hashimoto’s?”

Vaccine - Preventive Medicine

Should You or Shouldn’t You?

Every year when flu season rolls around I get questions concerning whether or not to get a flu shot.

As with everything Hashimoto’s related, this is a seemingly simple question wrapped in a crazy complicated not-so-fast answer.

The Centers for Disease Control (CDC) recommends that everyone aged six years of age and older get a flu vaccine.

However, when you have Hashimoto’s you are not “everyone” and there are some unique challenges that need to be factored in first.

Some People with Hashimoto’s Get Wiped Out By the Flu Shot

In my experience in working with over 2,000 people with Hashimoto’s, I have found that some patients just get completed wiped out after getting the vaccine.

So, naturally, I have tried to figure out why. (‘Cause that’s how I roll.)

One person who has some great insight into this is infectious disease specialist Dr. Kent Holtorf, an MD I have a lot of respect for.

He’s a clinician and researcher and he operates outside of big pharma.

One thing he recommends is that people with mitochondrial dysfunction, chronic neurological illnesses, and fibromyalgia not get vaccinated because he has seen it “devastate” them.

I thought this was interesting because we have looked into the connection between fibromyalgia and Hashimoto’s (here’s a link if you missed that post) and these 2 patient populations have a lot in common.

So I would add Hashimoto’s patients to this list.

Because people with Hashimoto’s also have mitochondrial dysfunction, many have chronic neurological issues and more importantly, they also have an overzealous immune system.

Viruses and Hashimoto’s

And while viruses have not been definitively linked to the initiation of Hashimoto’s, upwards of 80% of the patients I have treated have been exposed to Epstein Barr virus somewhere in their history.

Of course, Epstein Barr (which is in the herpes family) and influenza virus are not the same.

However, the same part of the immune system is stimulated by the the influenza virus.

And if this is the part of the immune system that is over excited, then it stands to reason that bad things may happen if we make it mad.

It’s not nice to fool mother nature.

The Influenza B Virus and Hashimoto’s

In fact, there is also strong evidence that the Influenza B virus is also involved in the formation of Hashimoto’s, in some people.

So, what does that tell us?

That tells us that, for some people, the influenza vaccine (which is the exposure of dead fragments of the influenza virus to the immune system) may result in an aggressive immune response.

Which may result in a flare up of Hashimoto’s because this is also the part of the immune system that attacks the thyroid.

And for some of those people, that flare up may be “devastating”. I have seen this happen in my patients and this is precisely what Dr. Holthorf is describing, as well.

And these effects can be severe and long lasting because they may fire up the process that led to Hashimoto’s in the first place.

Of course this is not true of everyone. Some people with Hashimoto’s can tolerate the vaccine and do just fine.

Should You Get a Flu Shot?

Like so many things with Hashimoto’s, there is no simple yes or no answer.

If you are among the group that is triggered by viruses, then you run the risk of igniting the fire that already burnt you.

Another question is, what is your risk of exposure?

If you mostly stay home or work from home and have limited contact with other people, your risk of exposure to the flu will be small.

On the other hand, if you have school aged children who love to share every germ and virus imaginable, then your risk is considerably higher.

Also, there’s the question of whether or not you have other serious health conditions, in addition to Hashimoto’s.

If you have a serious chronic illness like emphysema, diabetes or heart disease, catching the flu could have life-threatening consequences for you.

You’ll have to weigh the risks of getting the vaccine and triggering a Hashimoto’s flare up against the potentially serious complications from catching the flu.

Generally, if you’ve had a flu shot in the past and didn’t have an adverse reaction, then you’re probably ok to have another.

Another thing to be aware of is that it’s kind of a crap shoot with the flu vaccine because the manufacturers simply make an educated guess about which strain will be prevalent next year.

And they are not always right.

What Can You Do If You Can’t Get the Vaccine?

What about those of us who don’t want to play with mother nature, but also don’t want to get the flu?

Fortunately, there are some really excellent natural solutions for this.

These include herbs and essential oils that have broad spectrum anti-viral properties and can help protect against both the cold and the flu.

Chinese Medicine to The Rescue

Chinese medicine has a wide variety of broad spectrum anti-bacterial and anti-viral herbs that have been used for centuries to treat many infectious diseases.

In fact, there are whole schools of Chinese medical thought that are based on some very famous texts that taught early Chinese doctors how to treat infectious diseases.

2 of the most famous are The Shan Han Lun  or On Cold Damage by Zhang Zhong Jing (thought by many to be the Hippocrates of Chinese Medicine) and Wen Bing Xue or Warm Disease Theory authored by five medical geniuses of the Qing Dynasty.

These texts were (and still are) the clinical manuals for generations of doctors who had to treat epidemics long before the advent of vaccines.

And they have saved countless lives.

Which Herbs Can You Use?

Let’s take a look at some effective herbs that you can use both to protect you from the flu and to treat it if you get it.

And I’ll also show you where you can get an excellent herbal formula that has these herbs in it.

Ban lan gen (Isatis indigtica root): Ban lan gen has broad spectrum anti-bacterial effects and has shown to be effective against influenza viruses.

Ye ju hua (Chrysanthemum indicum flower): Has both anti-viral and antibacterial properties. In one study, 501 patients were treated with good results.

Jin yin hua (Honeysuckle flowers): Very effective in treating colds and influenza. Broad spectrum antibiotic effects. In one study involving 393 children an herbal formula made with an herbal inhalant showed marked preventative effects.

Gang mei gen (Ilex asperella root): An effective herb for treating cough and lung issues.

There is an excellent herbal formula that I take whenever I travel or am around sick people and which I prescribe to my patients called Gan Mao Ling.

This formulation has all these herbs and a couple of others in it and it is available at this website: Click here to check it out!

Take 6-8 tablets prior to being around people who may be sick and 3-6 tablets 3-4 times a day if you feel like you are coming down with the flu.

Often this is preceded by a scratchy throat and congestion.

Essential Oil Inhalers:

Another way to protect yourself is to use an inhaler that has essential oils with anti-viral properties.

This is excellent for children and for traveling, as you can carry it with you and just take a quick inhale when you need it or fear that you may have had some exposure.

The influenza virus is air borne, so you can attack it where it lives.

Ravensarra is an excellent oil that is known for it’s broad spectrum anti-viral  and anti-bacterial properties. It is also great for asthma because it is anti-spasmodic and it’s an expectorant (helps clear out phlegm).

Mentha piperita or peppermint is also an excellent oil which is anti-microbial, analgesic, anti-infectious, it has broad spectrum anti-bacterial properties, and it’s great for clearing out mucous. It’s also very beneficial for your brain.

Eucalyptus oil is a great decongestant, aids breathing by opening up your airways.

Picea mariana or black spruce is anti-spasmodic, helps clear out mucous and is broad spectrum anti-fungal, anti-bacterial and anti-viral. and it’s a great anti-inflammatory!

Here’s a wonderful inhaler that has all these oils in it: Click here to check it out!

It’s great as a preventative and for clearing your sinuses when you have a cold or flu. I love using these when I travel, especially on a plane where you bound to get exposed to something.

You can take this as often as you need to. It’s pretty potent, a little goes a long way!

Those are 2 excellent solutions to the flu and they are quite effective.

The key is to take them before you have been exposed or as early as possible when you feel it coming on.

References:

http://www.healthcentral.com/chronic-pain/c/5949/145399/fibromyalgia/

http://www.ncbi.nlm.nih.gov/pubmed/12428064

http://www.thyroid-info.com/hashimotos-encephalopathy.htm

http://www.ncbi.nlm.nih.gov/pubmed/18240111

http://www.ncbi.nlm.nih.gov/pubmed/20625285

http://www.discoverymedicine.com/Kazuki-Morohoshi/2011/12/20/viral-infection-and-innate-pattern-recognition-receptors-in-induction-of-hashimotos-thyroiditis/

http://www.ncbi.nlm.nih.gov/pubmed/18788945?dopt=Abstract&holding=f1000,f1000m,isrctn

http://www.virologyj.com/content/6/1/5#B104

Chinese Medical Herbology and Pharmaclogy, John and Tina Chen, 2001

The Aromatherapy Practitioner reference Manual, Sylla Sheppard-Hanger 1994