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Top 3 Clinical Pearls From This Last Year

 Marc Ryan, L.Ac. Founder of Hashimoto's Healing

Clinical Pearls from Working in the Trenches 

Hey, people!

Wow! Another year has flown by.

We’re celebrating the second anniversary of launching our website and Facebook group.

I am a big fan of looking back at the data and the experiences and analyzing what we learned.

And, hopefully, we can continue to build from that and improve what we are trying to do.

And that is to help and educate people to heal their Hashimoto’s.

Over 1,500 Consultations With People With Hashimoto’s

Over the course of these 2 years, I have had over 1,500 consultations with people with this disease.

I’ve listened as people described their symptoms, their struggles and their health histories and I’ve also taken a number of surveys and polls at our Facebook support group which has now reached 22,000 Likes.

I want to thank everyone who has joined us for their continued love and support!

This is something we could not have achieved without you.

You truly inspire me day in and day out!

A PRACTICE NOT ANALYZED IS NOT WORTH LIVING

In this blog post I’m going to summarize the top 3 things that I think are really important (from a clinical and practical point of view) and I’ll share a few odds and ends that are just really interesting to me.

And, just so you know…

Much of what we have learned over last 2 years will be summarized in my new book which is due out at the end of April 2015 called Road Map to Remission: A Practical Guide to Hashimoto’s Healing

It’s basically an owner’s manual for living with a Hashimoto’s body.

You can learn more about it here: Check out a video series on my new book.

If you haven’t yet done so, sign up to get on our email list so you can get all the latest updates, videos and research on Hashimoto’s.

Top 3 Clinical Pearls

Here are my top 3 clinical pearls and a little discussion on each and why I believe they matter to you.

Pearl #1: The Digestive Tract Is Ground Zero For Hashimoto’s and Autoimmunity

The more I work with people and help them turn their lives around, the more I realize that the digestive tract and, in particular, the intestines are ground zero for Hashimoto’s and autoimmunity.

And I can’t tell you how many people have shared with me that their doctors said that diet doesn’t matter.

Saying diet doesn’t matter for Hashimoto’s and hypothyroidism is kind of like saying alcohol doesn’t matter to an alcoholic.

The importance of diet can not be overstated and this is really a “no brainer”.

Yet, I am also continually surprised at how many people refuse to accept this or want to negotiate a kinder, gentler half way approach that doesn’t involve them changing their diet and, of course, their lives.

Hashimoto’s is an autoimmune disease and that means that your immune system is attacking your your own tissue.

Tissue attack and destruction is induced by immune system stimulation.

Where is your immune system?

An estimated 70 – 80 % lives in your digestive tract.

So everything that passes through there interacts with your immune system.

Also, there is a lot of research evidence that shows a clear link between “leaky gut” or intestinal permeability and autoimmune disease.

The breakdown of your intestines is a breakdown in the barrier to your immune system and this clearly is a factor in the initiation of autoimmune disease.

But it is also an important factor in people’s symptoms because if this is not addressed you have constant immune stimulation and constant tissue attack.

And this is not reserved for only the digestive system.

It’s effects are systemic. It has a ripple effect all over your body.

My advice is always get off of gluten, dairy and soy 100% and for many, because of the state of their intestines, this is not enough.

They need to do more.

For almost everyone, we recommend a version of the Autoimmune Paleo diet designed for autoimmune disease and Hashimoto’s, in particular.

And while you’re doing this, it’s a great time to work with someone like me because you can get a lot accomplished by working aggressively to heal the gut, clean up the liver and reduce systemic inflammation at the same time.

I have gotten messages on Facebook and emails from hundreds of different women and men who have credited this mind shift and change alone with completely transforming their lives.

If you’re on the fence about your diet, you’re just prolonging your misery needlessly.

It’s such a simple part of the solution.

Pearl #2 Hashimoto’s Has A Profound Impact On The Brain

This last year I became a bit obsessed with this area of study and research.

In fact, I did a video series and created a special program for it.

If you haven’t had a chance to see that yet, here’s a link: SAVE YOUR BRAIN (FROM HASHIMOTO’S)

(There’s 3 parts. The first 2 describe the issues and the third tells you about the solution.)

Why did I decide to give his so much attention?

Because, brain fog and memory issues are the number 2 problem for everyone with Hashimoto’s.

(Fatigue is number 1 and that is often brain based, as well. So you could argue that this is priority #1)

And here’s why it matters.

When you lose your brain, you lose everything.

The problems that Hashimoto’s can cause are relatively minor compared to what happens if neurodegeneration and autoimmunity inthe brain progresses past a certain point.

This can be a major factor in Alzheimer’s or Parkinson’s type symptoms and it can lead further to something like Hashimoto’s Encephalopathy.

Because Hashimoto’s (often the combination of hypothyroidism and autoimmunity) does a double whammy on the brain.

This leads to massive inflammation of the immune system in the brain which, in turn leads to major destruction of neurons and brain tissue.

The immune system in the brain is not like the immune system in the rest of the body.

It has 2 speeds, balls to the wall and calm. There’s no middle ground.

And there’s no off switch. No regulatory part of the immune system to calm it down.

It goes crazy until it can’t go crazy any more.

And when the immune cells in the brain (the microglia) get excited and activated, they chew up everything around them.

This is not good.

This process also has a profound impact on how you feel.

The anxiety, depression and inability to handle stress are not coincidences, they are another example of how this process upsets thebalance of your brain’s neurochemistry.

Neurotransmitters like serotonin, dopamine, acetylcholine, catecholamines and GABA are all impacted and can become deficient in people with Hashimoto’s.

These are you “molecules of emotion”.

They are directly responsible for your emotional health and well being.

And guess what else has a huge impact on the brain?

The gut.

The digestive tract is really the body’s second brain.

And these 2 interact with each in very important and significant ways.

So this is really one big pearl of wisdom.

Focusing on healing these 2 areas long term may just give you the greatest return on your investment of time, energy and money.

Pearl #3 A Relatively Small Number of Things Cause Most of Your Problems or the 80/20 Principle

Another epiphany I had this year was discovering something called the 80/20 principle.

This is often used in business and in marketing, but the idea has universal applications because it comes from a basic law of nature.

It’s also called the Pareto Principle because it came from an economist named Vilfredo Pareto.

He observed that 80% of the wealth in his country was owned by 20% of the people.

Ok, so what does this have to do with Hashimoto’s?

Stay with me for a moment…

Well, it turns out that this basic idea applies to just about everything in the natural world.

Look around you…

…Most people spend 80% of their time with 20% of their friends.

…Look in your closet, you wear 80% of those clothes 20% or less of the time.

And on and on.

You can apply this to everything, including your body and your health.

And it’s not about the numbers, ok?

It might not be exactly 80/20, it could be 85/15 OR 75/25.

The point is that there is an imbalance in cause and effect.

Relatively few things cause the majority of results.

Why does this matter?

Well with Hashimoto’s, this means 80% of our problems are caused by 20% of the things we need to work on.

Or let me put it another way:

If you are like many of the people that I have worked with, then 80% of your symptoms are caused by 20% of the choices you made today…

…now imagine if you could fix 80% of your symptoms fast by figuring out what those 20% are and then make some changes…

…and get that 20% to really count…

You see where I’m going with this?

Well, obviously, if this is true, we need to figure out what the 20% is.

And I believe that I have a good idea where to start.

Spoiler alert! You just learned 2 important parts of this 20%.

The brain and the gut.

If we had just 30 seconds together before I was whisked away in a black sedan by terrorists, here’s what I’d tell you.

The Key To Healing Is Often Doing Less

This seems like an over simplification, but it’s one of those things that is a fundamental truth.

Many of us who struggle with Hashimoto’s spend an enormous amount of time searching for the right information, the right doctor, the right drugs or combination of drugs and the right supplements.

But often the solution is right in front of us and it doesn’t require doing anything more.

It requires a steadfast devotion to doing less.

We’ve been conditioned in our consumer driven society to always want more.

And we’ve also been conditioned to think the answer is in a pill.

The pill that will deliver more is seductive and difficult to resist.

But the truth, for many, the most successful things you can do to feel better requires the ruthless application of simplifying your life.

If you really want to get better and find remission, become passionate about doing less.

And look at every part of your life. Especially at those things that you do compulsively.

Eat less sugar.

Watch less tv.

Read less news.

Spend less time with people who don’t support you or bring you joy.

Do less of the things that cause you stress.

And when you identify those things that are among the 20% that cause 80% of your misery.

Give them up 100%.

At the end of the day, this approach not only makes you healthier, it also gives you a much more rewarding life.

Odds and Ends

These were some interesting observations I have made:

1. More than 80% of the people I worked with had Mono and were exposed to the Epstein Barr Virus.

Clearly this virus is somehow involved in Hashimoto’s. How? The research is far from definitive. Theories include activation of NF Kappa Beta, activation of rouge B cells and proteins like IL-8.

Other common infections that are involved in the initiation of Hashimoto’s include Lyme disease, Yersenia and Herpes Viruses.

2. The most common symptom is fatigue.

Of all the many potential symptoms of Hashimoto’s fatigue is by far Public Enemy #1.

And fatigue is often brain based which means it is the result of neurodegeneration caused by hypothyroidism and autoimmunity in the brain that we mentioned above.

3. The disease is progressive. My teacher and mentor, Dr. Datis Kharrazian and others have identified 3 stages. Read this post to learn more about this.

4. Many people have more than one autoimmune disease or at the very least antibodies to other tissues.

The truth is that most doctors don’t test for or look for it. But, very often, it’s there.

One of the most common places for these additional antibodies is to brain tissue, especially cerebellar tissue.

And one thing I stress is that this matters because it means that the stakes are very high.

Autoimmunity to different parts of the body is the same basic process and it just finds different tissue.

And some of the places it can go can be life threatening.

This part of the equation must be taken very seriously.

And at it’s root what is autoimmunity?

Destructive inflammation.

And this means that reducing inflammation needs to be job 1.

And the best way to do that is to create an anti-inflammatory life.

This is without exception a simpler life because all the common excesses are known to cause more inflammation.

Well, that’s all for now.

I can’t wait to see what this next year will bring!

And if you’re not aware of it, I offer a free 30 minute Hashimoto’s Healing Discovery Session.

In it you can share your story with me. Tell me where you are and where you want to be.

I’ll make some recommendations that I think will help right away and we can discuss how else I might be able to help.

I set aside time every week to talk with people who have Hashimoto’s and I’d love to talk to you.

You can schedule a free session by clicking here.

Just a warning. These are all booked out 2 to 3 months in advance.

If you have a more pressing issue and you’re interested in working with me, shoot me an email at [email protected] and we’ll set aside time for you sooner.

Best,

Marc

Celiac Disease and Hashimoto’s

gliadin a protein attacked in celiac disease

Gliadin, a gluten protein

Many people who suffer from Hashimoto’s are aware that there may be problems caused by eating gluten and related proteins.

However, because of misinformation and the inconvenience of going gluten free, many people ignore these warnings or don’t think this really applies to them.

I have had a number of people write me and tell me during consultations that they need to see “peer reviewed studies” about gluten and Hashimoto’s before they are going to commit to going gluten free.

In this post we examine a boat load of research on this subject and we seek to demonstrate, once and for all, why eating gluten is not a luxury you and your thyroid (and lots of other important parts of your body – like your brain) can afford.

Celiac Disease is an Autoimmune Disorder

According to the Celiac Support Association “Celiac disease, also known as celiac sprue or gluten-sensitive enteropathy, is a genetically linked autoimmune disorder that can affect both children and adults…”

Yes, celiac disease is an autoimmune disease. It’s not just a food allergy or sensitivity.

What do we know about autoimmune disease?

When you have one, it’s easy to get others.

Like Hashimoto’s, for example.

To read more about this, check out my previous post that looks into this in depth.

“…In people with celiac disease, eating certain types of grain-based products sets off an immune mediated response that causes measurable damage to the small intestine.”

Another key point. I and many other specialists in this field believe that the small intestine is ground zero for autoimmune diseases of all kinds.

This damage to the small intestines has systemic consequences.

These include the immune system, the endocrine system, the nervous system and the brain. This is no small matter (pun intended).

“…This, in turn, interferes with the small intestine’s ability to absorb nutrients in food, leading to malnutrition and a variety of other complications.”

Yes, the other complications include an inability to convert and absorb thyroid hormone, major deficiencies in important vitamins and minerals like iodine, iron, selenium, magnesium and vitamins like B, D and plenty more.

Pretty much guaranteeing hypothyroidism and thyroid gland dysfunction.

“…The offending amino acid sequences are collectively called “gluten” and are found in wheat, barley, rye, and to a lesser extent, oats* (WBRO). Related proteins are found in triticale, spelt, and Kamut.”

Indeed, these “offending amino acid sequences” are not just found in these grains, they are found in many foods like dairy, soy, coffee, corn, potatoes, and lots more.

The reality is gluten may just be the tip of the iceberg and going gluten free may not be enough to effectively treat autoimmune disease.

Some people do not get better by only going gluten free. This is not because they don’t have a problem with gluten.

There are many other foods that have a similar amino acid sequence to gluten and these may also be a problem.

Because it is these amino acid sequences that the immune system attacks and that resemble our own tissues. (To learn more about this, check out this previous post).

Celiac Disease Creates Antibodies that Attack Tissue Transglutaminase

Tissue transglutaminase is an enzyme that repairs damage in the body. People with celiac disease often make antibodies that attack this enzyme.

Well, studies have shown that people with transglutaminase and gliadin antibodies also have a much higher levels of TPO and TgAB antibodies.

A Major Link Between Celiac Antibodies and Thyroid Antibodies and Autoimmunity

Celiac Disease and autoimmune thyroid disorders share a common genetic link, namely, the DQ2 allele.

This is a subtype of a region of cells called the HLA (or Human Leucocyte Antigen) System.

There is a region on cells located on some of our genes called the HLA. Many of these are located on chromosome 6 (for those of you keeping count).

Mutations or defects of HLA have been linked to many different autoimmune diseases.

Exactly what happens is not known, there are numerous theories, but the end result is that our own tissue gets attacked and destroyed by the immune system.

With Celiac disease and autoimmune thyroid diseases we see an increase in both types of antibodies that lead to attack on these tissues.

Collin et al found 5.4% of 335 adult celiac patients, of whom 83% complied with a gluten-free diet, had autoimmune thyroid disease (autoimmune hypothyroidism or Graves’ disease).

Counsell et al found that 14% (15 out of 107) of celiac patients had thyroid disorders (3.7% hyperthyroid and 10.3% hypothyroid).

The same authors also noted a high prevalence of thyroglobulin antibodies (11%) and thyroid microsomal (TPO) antibodies (15%) in their CD patients.

Likewise, Velluzzi et al found the prevalence of thyroid peroxidase antibodies to be higher in CD (29.7%, 14 out of 47 patients) than in healthy controls (9.6%).

“Yes, But I Was Tested For Gluten Antibodies and The Tests Were Negative”

This is another area of misinformation. Most doctors test for 2-4 gluten antibodies.

Current testing for Gluten-Reactivity and Celiac disease (CD) includes serum IgG and IgA against gliadin and tissue transglutaminase-2 (tTG2).

These antibodies are measured against minor components of a wheat protein called alpha-gliadin.

Here’s the thing, wheat consists of multiple proteins and peptides including, alpha-gliadin, omega-gliadin, glutenin, gluteomorphin, prodynorphin, and agglutinins.

And there are many we still do not know about.

And the important thing to understand is that any of these antigens can cause an immune response.

So, even if you tested negative to celiac, you could still have gluten sensitivity or silent celiac disease because you may not have tested for the right thing.

Which Came First, The Gluten or the Autoimmunity?

This is a really interesting question that is controversial and no one really knows.

But, here’s what we do know.

Autoimmunity doesn’t just happen for no reason. It is the result of a perfect storm of factors.

You need the genetic predisposition (like the HLA DQ2 allele mentioned above), you need exposure to some antigen (Often Yersenia, Epstein Barr, Coxsackie, Lyme disease or some other pathogen), these produce antibodies and somehow you get the breakdown of mucosal IgA and tight junction proteins.

Ground zero is the intestinal mucosa.

One theory is that gluten, which is sticky and invasive (like a thief who can get into anywhere it wants), gets into the intestines, into the spaces between the intestines (the tight junctions) and eventually into the bloodstream.

Then the immune system kicks in.

Antigen presenting cells like macrophages (those Pac man cells that munch the bad guys) start attacking and they stimulate the T helper cells.

These are either TH-1 or Th-2 (check out this previous post that describes this works with Hashimoto’s in detail) and these lead to pro-inflammatory immune cells and proteins, more antibodies, cross reactions – generally, all hell breaking loose.

And, finally as this plays out and is repeated over and over again every time you eat a piece of bread, a pastry, some cake, a doughnut, etc. you are unknowingly pushing your body further and further into autoimmunity.

Your immune system is so juiced it doesn’t know which way is up and eventually, you loose self tolerance.

And loss of self tolerance means the immune system starts attacking your own tissue.

Another problem caused by gluten is that it makes thyroid hormone less effective.

Celiac Disease Has A Major Impact on Thyroid Hormone Absorption

An interesting study published by the American Thyroid Association found “…This study examined 68 patients with Hashimoto’s thyroiditis alone and 35 patients with Hashimoto’s thyroiditis and celiac disease.

The average dose of levothyroxine needed to treat patients with Hashimoto’s thyroiditis alone was lower than the average dose required to treat patients with Hashimoto’s and celiac disease.

When the patients with celiac disease went on a gluten-free diet while staying on the same dose of thyroxine, their TSH level decreased, indicating that their absorption of thyroxine had improved.”

We see this clinically all the time.

When patients go gluten free, they often must reduce their dosage of thyroid replacement hormone because it starts to work so much better.

Well, thyroid hormone produced by your thyroid and thyroid replacement hormone have the same structure.

Gluten prevents thyroid hormone produced by your thyroid from being absorbed, as well.

Is There Evidence That Gluten Leads Directly To Destruction of the Thyroid?

One idea that is often discussed in this context is something called molecular mimicry.

This is what happens when the immune system identifies certain proteins or protein fragments (amino acid sequences) and then attacks everything that has that amino acid sequence.

With autoimmunity, when the immune system attacks a virus like Epstein Barr, for example, it activates certain kinds of B cells.

These differentiate into plasma cells and one theory is that these may also stimulate anti-self B cells.

These are present in normal people and are there because our immune system constantly gets rid of old dead cells from our body.

But somehow these viral fragments cause other immune proteins called complement to stick to our own tissue and when they accumulate the immune system starts attacking that living tissue as well.

Viruses may also down regulate the T suppressor cells that call off the attack and this keeps the carnage going.

This is what happens to the thyroid. Thyroid cells get attacked as does the enzyme thyroid peroxidase and the protein thyroglobulin.

There is plenty of evidence that gluten is involved with firing up autoimmunity, but I could not find any actual research to support the claim that gliadin proteins closely resemble thyroid tissue (which is something that many bloggers in this area repeat).

There is no question exposure to gluten leads to autoimmunity, destruction of the small intestine, systemic inflammation and destruction of the thyroid.

But whether this type of molecular mimicry is at play is not clear. (I invite any readers to show me this actual research.)

However, at the end of the day, this hardly matters. There are so many other reasons not to eat gluten. And here’s another really big one.

Gluten Causes Neurodegeneration in Your Brain

Another really good reason to stay far away from gluten is that it has been linked to destruction of the brain, especially the cerebellum.

The brain is profoundly impacted by Hashimoto’s.

Check out this video (SAVE YOUR BRAIN (FROM HASHIMOTO’S) to learn more.

This is the reason why the second most common symptom for people with Hashimoto’s is brain fog and memory issues. (The most common symptom is fatigue.)

A condition of advanced neurodegeneration that results from Hashimoto’s is called Hashimoto’s Encephalopathy.

This destroys parts of the brain in much the same way that Alzheimer’s does.

And this is caused by autoimmunity in the brain.

One area of the brain that can be impacted is the cerebellum. And a common symptom of impairment to the cerebellum is ataxia.

Ataxia is uncoordinated movement is due to a muscle control problem.

It leads to a jerky, unsteady, to-and-fro motion of the middle of the body (trunk) and an unsteady gait (walking style). It can also affect the limbs.

You can test this by doing the DUI test. Close your eyes and imagine you are walking on a tight rope, put one foot in front of the other.

If you lose your balance or fall over, this may indicate some impairment of the cerebellum.

Guess what else causes ataxia?

Gluten.

In fact, a study from Brain a Journal of Neurology, 2003 found “Gluten ataxia is therefore the single most common cause of sporadic idiopathic ataxia.”

The most common cause of ataxia that has no known explanation.

So when you combine Hashimoto’s with brain autoimmunity and gluten, you have a recipe for really bad things.

And Wait There’s More

The final pièce de résistance of this post is something that is related to gluten but adds a whole other layer of badness.

That is glyphosate or Monsanto’s marquee product Roundup.

Glyphosate is sprayed on wheat and many other grain crops just before harvesting to make them dry out more uniformly.

Well, it turns out that this chemical also does a number on the small intestine, may be responsible all by itself for the destruction of the intestinal lining and the initiation of a host of diseases.

Fish exposed to glyphosate develop digestive problems that are a lot like celiac disease.

Celiac disease is associated with imbalances in gut bacteria that can be fully explained by the known effects of glyphosate on gut bacteria.

Characteristics of celiac disease point to impairment in many cytochrome P450 enzymes, which are involved with detoxifying environmental toxins, activating vitamin D3, catabolizing vitamin A, and maintaining bile acid production and sulfate supplies to the gut.

Glyphosate is known to inhibit cytochrome P450 enzymes.

Deficiencies in iron, cobalt, molybdenum, copper and other rare metals associated with celiac disease can be attributed to glyphosate’s strong ability to chelate these elements.

Deficiencies in tryptophan, tyrosine, methionine and selenomethionine associated with celiac disease match glyphosate’s known depletion of these amino acids.

Celiac disease patients have an increased risk to non-Hodgkin’s lymphoma, which has also been implicated in glyphosate exposure.

So Let’s Review:

Here are 5 reasons to never touch gluten as long as you live that are supported by about 30 peer review studies listed below.

1. Celiac Disease is an Autoimmune Disease with striking similarities to Autoimmune Thyroid Disease.

2. People with Celiac, and Gluten Sensitivity have higher levels of thyroid antibodies and visa versa.

3. Gluten can destroy your small intestines and cause deficiencies in important nutrients, vitamins, and minerals absolutely necessary for proper thyroid function.

4. Gluten and Celiac Disease block the absorption of thyroid hormone.

5. Gluten can cause neurodegeneration in your brain.

And a Bonus

6. Commercial wheat also has lots of glyphosate, a chemical that can make all of what we have just mentioned a whole lot worse.

Bottom Line

In life we must always make decisions based on risk and benefit.

The risk of the destruction that gluten can cause in people with Hashimoto’s so far outweighs the benefit that it is really no contest.

References:

http://www.csaceliacs.org/celiac_disease_defined.jsp

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2111403/ Celiac Disease and Autoimmune thyroid disease

http://www.ncbi.nlm.nih.gov/pubmed/18176874 North Italian prevelance of CD in autoimmune thyroid

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC96126/: CD and autoimmune endocrinopathies

http://www.eje-online.org/content/130/2/137.abstract Autoimmune thyroid disorders and celiac disease

http://www.ncbi.nlm.nih.gov/pubmed/15244201 Antigliadin antibodies in celiac disease

http://www.ncbi.nlm.nih.gov/pubmed/9872614 Autoimmune thyroid diseases and celiac disease

http://www.ncbi.nlm.nih.gov/pubmed/12919165 Risk factors of thyroid autoimmunity

http://www.ncbi.nlm.nih.gov/pubmed/11768252 Autoimmune thyroid disease in celiac patients

The Gluten-Thyroid Connection

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3725235/ Celiac disease and autoimmunity: excellent overview

http://cvi.asm.org/content/8/4/678.full Celiac related autoimmune endocrinopathies

http://www.direct-ms.org/pdf/LeakyGutMS/Fasano%20Celiac%20other%20autoimmune%20disease.pdf Systemic Autoimmune disease and celiac

http://en.wikipedia.org/wiki/Anti-transglutaminase_antibodies EMA and transglutaminase antibodies

http://www.thyroid.org/patient-thyroid-information/ct-for-patients/vol-5-issue-6/vol-5-issue-6-p-3-4/ The effect of celiac disease on levothyroxine dosage

http://www.nature.com/cmi/journal/v8/n2/full/cmi201065a.html Antibodies in Celiac disease, implications beyond diagnosis

http://www.wjgnet.com/1007-9327/13/1715.asp Dutch study of patients with Hashimoto’s and Celiac disease

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2730948/ Celiac disease and autoimmunity in the gut and elsewhere

http://jeffreydachmd.com/2014/01/hashimotos-thyroid-disease-molecular-mimicry/

http://www.todaysdietitian.com/newarchives/110310p52.shtml Research connects Celiac and Hashimoto’s

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1808742/ Gliadin, TPO and other antibodies in latent autoimmune diabetes patients

https://www.enterolab.com/StaticPages/EarlyDiagnosis.aspx Before the Villi Are Gone

http://en.wikipedia.org/wiki/Human_leukocyte_antigen Define HLA

http://thyroidbook.com/eating-gluten-increases-need-thyroid-hormones/

http://www.hindawi.com/journals/ijad/2011/865432/ Transglutaminase enzyme involved in Alzheimer’s

http://www.csaceliacs.org/celiac_disease_defined.jsp

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2077662/ Hashimoto’s Encepheopathy and Cerebellar Ataxia

http://www.ncbi.nlm.nih.gov/pubmed/12566288 Gluten Ataxia

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3945755/ Glyphosate, pathways to modern disease: Celiac sprue and gluten intolerance

https://www.cyrexlabs.com/Portals/0/Docs/ClinicalApplications/ClinicalAppArray3.pdf

“Why Isn’t My Brain Working”, Dr. Datis Kharrazian, 2013 Elephant Press

Hashimoto’s and SIBO Treatment (Part 2 of 2)

In our previous post, we took a look at the relationship between Hashimoto’s and SIBO (small intestine bacterial overgrowth), if you have not yet read that or aren’t familiar with SIBO please read it here.

SIBO

SIBO, see part 1 for larger image

In this post we are going to discuss SIBO treatment and solutions. This information came from a lecture I attended in November 2014 taught by Dr. Datis Kharrazian and entitled The Neuroendocrine Immunology of Small Intestine Bacterial Overgrowth.

Treatment Depends on Where You Are in the Progression

One important lesson that I have learned after working with over 750 people with Hashimoto’s is that there are 2 things that are really important for getting good clinical results:

#1. Figure out the mechanism. In other words, where’s the problem? With Hashimoto’s it is often in multiple places and it’s not only the thyroid.

#2. Figure out how advanced it is. Hashimoto’s, like all autoimmune disease, is progressive. We have identified 3 stages of progression. (Read here to learn more ).

In a general sense, the further it has progressed the more you must do.

Healing By Subtraction

Another really valuable lesson I have learned is that, often, some of the most effective treatments and solutions come from subtraction.

Many common health problems are problems of excess. Too much sugar, too much stress, too much inflammation, too much salt, too many chemicals.

A simple and effective way of treating too much is by taking things away.

If you have insulin resistance or Type 2 diabetes, stop eating sugar and refined carbohydrates.

If stress is killing you, stop doing the things that cause you so much stress.

If you have too much inflammation, stop eating and behaving in a way that causes so much inflammation.

If your sick from too much salt, stop eating salt.

If pollution is killing us and our world, stop using so many chemicals.

Such a simple solution, so hard to actually do.

At first.

The reason is that we are conditioned to be consumers, not subtractors.

However, if you have Hashimoto’s, learning the habit of being content with less (sometimes a lot less) may just be the key to your healing.

Nowhere is this more true than in the treatment of SIBO

Diet Must Be the Foundation of Treatment

With SIBO, the foundation of treatment is diet because many of the bacteria feed on foods that are common in our diets.

And if you’re like a lot of people I’ve worked with you might be asking yourself, “Why not just wipe them out with antibiotics?”

According to the American Journal of Gastroenterology, recurrence of small intestine bacteria after antibiotics is quite high (the most commonly prescribed being Rifaximin).

Many people have to keep taking antibiotics over and over again for months with limited results.

And there is a tremendous cost to your immune system and to your future ability to defend yourself.

(There is no better way to be defeated by an enemy than to give him repeated opportunities to adapt to your weapons.)

The only thing that really works is to do the diet as a foundation and then use something to eradicate the bacteria along with it.

There are a number of herbs that are quite effective for this. Particularly those in the berberine family like goldenseal, coptis, etc.

Probiotics Can Also Be Beneficial

A pilot study by Spanish researchers found that probiotics worked better than pharmaceutical therapy for patients with chronic abdominal distention and SIBO.

“Based on this pilot study results, we can suggest that the probitoic herein (Lactobacillus casei, Lactobacillus plantarum, Streptococcus faecalis, Bifidobacterium brevis) used has a higher efficacy than metronidazonal in the early clinical response of patients with chronic abdominal distention and SIBO.”

The SIBO Diet

The SIBO diet is a terrific exercise in subtraction and should generally be done for a month or so to get the best results.

Since there are many foods that feed these bacteria, there are many foods that must be eliminated from your diet for this initial period of time.

Foods to Avoid:

Fructose: sugars, artificial sweeteners, corn syrup

Grains: rice, wheat, quinoa, millet, amaranth, and some non grains like tapioca

Legumes/Galactans: beans, peas, chickpeas, soybeans, lentils

Fructan-containing Vegetables: lettuce, onions, artichokes, beets, broccoli, cabbage, brussels sprouts, peas, asparagus, okra, shallots, mushrooms, green peppers, cauliflower

High-fructose fruits: grapes, apples, watermelon, cherries, kiwifruit, bananas, blueberries, mangos

Meat products: Breaded or processed meats such as hot dogs, bologna, potted meats, most cold cuts (added starches) and there are some who say to also avoid beef, pork and lamb.

Foods to Eat:

Nuts: All nuts except pistachios

Vegetables: All vegetables except those listed above

Low Fructose Fruits: apricots, avocados, cantaloupes, grapefruit, honeydew melons, nectarines, oranges, peaches, pineapples, raspberries, strawberries, tomatoes

Meats: chicken, fish, eggs, (and beef, lamb and pork in moderation)

Fats: Animal fat, oils

Steps of Treatment

The first step of treatment involves the diet as foundation and something to address the bacteria (like the herbs mentioned above).

Either during or after that Spartan menu, it is important to address the root causes and related issues of SIBO (read about these in Part I )

These problems include:

1. Too little stomach acid. Here’s the exception to the healing by subtraction rule. If you have too little stomach acid, you need more.

A simple treatment is to take things that boost stomach acid levels such as apple cider vinegar, lemon juice and ginger root.

Supplementing with Betain HCL may also be beneficial (consult your doctor for this).

2. An immune suppressed gut. Often the cause of this is too much corticosteroid treatment and/or too much cortisol from stress.

Here the subtraction rule works quite well. Stop the corticosteroids (unless you have a condition where you must take them) and do something about stress.

A great daily exercise in doing less? Silent seated meditation.

3. Injury to the gut nervous system (The Enteric Nervous System)

This type of neurodegeneration is permanent. However, this nervous system also has remarkable plasticity and a capacity to rewire itself.

There are couple of really important things to do here:

#1. Vigorous, (I mean really vigorous to the point of tears) gargling. Gargle with several glasses of water throughout the day.

This activates part of the nervous system connected to the vagus nerve which has a very strong connection to the gut.

#2. Stimulate your gag reflex. Order some wooden tongue depressors online and gently stimulate this reflex by pressing down on the tongue.

#3. Coffee enemas. Make sure the coffee isn’t too hot, and hold as long as possible. This causes nerve firing in the brain.

Start with a moderate amount and mild coffee, you can gradually increase both the amount of liquid and the strength of the coffee.

(Best to do it in the bathtub if you have one, so you are close to the toilet.)

How Long Do You Need to Treat SIBO?

Good question. You need to treat it for as long as it takes. And you may have to revisit this periodically. Generally speaking, the more severe it is, the longer and more committed you must be to healing it.

This may take several months.

It’s also true that the better you are at really following the diet and not cheating, the better the outcome and the faster your results.

Some Excellent New Supplements for SIBO

Apex Energetics has recently released 5 new SIBO products and we have started using them with promising results. Click here to purchase from our online store.

What’s exciting for me as a practitioner is that they have adapted some of the formulas we have already used with excellent results and given us another option for people who have complications.

Clearvite-GL

Clearvite-GL

 

Clearvite-GL: ClearVite-GL™ (K95) is based on Apex’s popular ClearVite™ formula and is designed to offer gastrointestinal and metabolic support.

This formula includes the powerful combination of hypoallergenic nutrients, amino acids, and minerals that other ClearVite™ products have, but excludes sources of rice and pea protein for those with sensitivities to grains or peas, or who require low carbohydrate content.

It also contains no sugars, which makes it ideal for anti-yeast diets. ClearVite-GL™ is also intended to support liver detoxication and chemical biotransformation with targeted nutritional cofactors.

Suggested use:  Mix 1 scoop with up to 4-6 ounces of water.  Mix well before drinking.  Use once a day, or as directed by your healthcare professional.

Repairvite SE

Repairvite SE

Repairvite SE: RepairVite-SE™ (K98) is based on Apex’s popular RepairVite™ formula and is intended to offer targeted intestinal support.

This product includes a limited amount of ingredients to offer support for those with certain dietary restrictions.

A high-quality, selective blend that includes brush border enzymes, L-glutamine, and zinc carnosine is incorporated to help support intestinal cell metabolism and the intestinal microbial environment.

Suggested use:  Mix 1 scoop with up to 4-6 ounces of water.   Mix well before drinking.  Use once a day, or as directed by your healthcare professional.

Sibotica

Sibotica

Sibotica: Sibotica™ (K97) incorporates key strains of probiotics that are intended to support the intestinal microbial environment, as well as the intestinal mucosal barrier.

This product may also help support the immune system via certain immune pathways. Key ingredients include Lactobacillus casei, Bifidobacterium breve, and Lactobacillus plantarum.

Suggested use: Take 1 capsule once a day, or as directed by your healthcare professional.

enzymixpro

Enzymixpro

EnzymixPro: EnzymixPro™ (K99) incorporates a special proprietary blend of various enzymes, including brush border enzymes, that has been designed to support the gastrointestinal system.

This formula combines a broad spectrum of enzymes to help support the digestion of sugars, starches, fibers, proteins, and fats.  It also includes HCl for further digestive support.

Proprietary Blend: 1372 mg of  Betaine HCI, Pepsin (porcine), Bromelain, Protease I, Protease II, Protease III, Protease IV, Glucoamylase, Cellulase, Sucrase (invertase), Maltase, Phytase, Pectinase, Lactase, Alpha-galactosidase, Lipase, Amylase I, Amylase II, Peptidase.

Suggested use:  Take 1-2 capsules once a day, or as directed by your healthcare professional.

enterovite

Enterovite

Enterovite: EnteroVite™ (K100) incorporates nutrients and a proprietary blend of fatty acids in a formulation intended to support the intestines and intestinal cell function.

This unique formulation is designed for those who are sensitive to certain food components, such as certain starches and fibers, and who want additional intestinal support.

Short-chain fatty acids (SCFAs), normal bacterial end products of complex carbohydrates, play important roles in intestinal microbial balance and function.

Diets that are low in resistant starch and fiber can result in a low production of SCFAs.  Key ingredients include butyric acid and calcium propionate.

Ingredients: Vitamin E (as d-alpha tocopherol acetate), Calcium (as calcium ß-hydroxy ß-methyl butyrate & calcium propionate) and a Propriety Blend: 575 mg* of  Butyric Acid (as calcium ß-hydroxy ß-methyl butyrate), Calcium Propionate.

Suggested use:  Take 1 capsule once a day, or as directed by your healthcare professional.

References:

orderapex.com

The Neuroendocrine Immunology of Small Intestine Bacterial Overgrowth, by Dr. Datis Kharrazian, DC, 2014

http://www.actagastro.org/actas/2010/n4/40_4_2010_7.pdf

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3610260/

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

Hashimoment: Do You Think Like A Fox or a Hedgehog?

Red Fox

Think Like A Fox

Hedgehog

Not Like A Hedgehog


I recently read a book called the Signal and the Noise by Nate Silver.

It’s an in depth look at how to use data and other information to make better predictions.

What does that have to do with Hashimoto’s?

Well, Hashimoto’s is very complex and there is an extraordinary amount of noise, that is information and advice that may or may not be helpful.

And as someone who is trying to solve problems and help others with this complex problem, I thought that learning how to better interpret the data and the information might give all of us some clues about how to get better results.

Ultimately, solving this problem requires that you be a detective and to be a good detective you have to look at the available information and be able to make predictions about whether or not what you are going to do will work.

Because if you are wrong, there are consequences.

And sometimes those consequences can result in you feeling a whole lot worse.

And pushing this thing in the wrong direction.

Our recent look at people’s experience with iodine is a perfect example of this (see our last post).

In the book there is a reference to a professor of psychology and political science named Philip Tetlock.

He identifies 2 distinct types of writers and thinkers: Foxes and Hedgehogs.

Hedgehogs are type A personalities who believe in Big Ideas – in governing principles about the world that behave as though they were physical laws and they are the foundation of everything.

Like Karl Marx and class struggle or Sigmund Freud and the subconscious. Or many MDs and Synthroid.

Foxes, on the other hand are scrappy creatures who believe in lots of little ideas and in taking a multitude of approaches toward a problem.

They tend to be more tolerant of nuance, uncertainty, complexity, and dissenting opinion.

If hedgehogs are looking for that one big meal, while foxes are gatherers.

Well, it turns out that foxes are a lot better at making accurate predictions.

And better predictions usually means better results.

So, to get better results with your Hashimoto’s, think like a fox.

How Foxes think:

They are multidisciplinary: They incorporate ideas from different places regardless of their origin on the ideological spectrum.

(Both doctors and alternative care practitioners are right about some things and wrong about others. Evaluate the message regardless of the messenger.)

They are adaptable: They find a new approach – or pursue multiple approaches at the same time – if they aren’t sure the original one is working.

(If lab tests show your TSH and antibodies going up as a result of a treatment, this is not necessarily a good thing. No matter how it is rationalized or justified.)

They are self-critical: They are sometimes willing (if rarely happy) to acknowledge their mistakes and accept responsibility for them. (Can your doctor admit when he or she is wrong or stumped?)

They are tolerant of complexity: They see the universe as complicated, perhaps to the point of seeing many problems being unpredictable.

(Hashimoto’s is the very definition of complexity.)

They are cautious: They express their predictions in terms of what will probably happen and qualify their opinions.

(There are no absolutely certain outcomes.)

They are empirical: They rely on observation and real data rather than theory.

(They use what exists, not what they want it to be or what will sell more of the products they created or endorse.)

Foxes are better forecasters and, therefore, get better results.

How Hedgehogs think:

They focus on one or 2 things that are the answer or the solution. They may view the opinions of “outsiders” skeptically.

(Synthroid is the only answer.)

They are stalwart: they stick to the same “all-in” approach – new data is used to refine their original model. To confirm their bias.

(See? You didn’t do well on Armour, Synthroid is the only answer.)

They are stubborn: Mistakes or bad decisions are blamed on bad luck or weird circumstances – a good theory had a bad day.

(Removing the thyroid removes the disease. And Synthroid is the only answer, you just need to increase the dosage.)

They are order seeking: They expect that the world will be found to follow a relatively simple set of rules.

(It’s just a thyroid problem. Synthroid is the only answer.)

They are confident: They rarely hedge their predictions and are reluctant to change them.

(You read too much on the internet. Synthroid is the only answer.)

They are ideological: The expect that solutions to many problems are manifestations of some grander theory or struggle.

(Sythroid is the only answer. It was the #1 prescribed drug in the US in 2013. I rest my case.)

Hedgehogs are weaker forecasters and, therefore, don’t get great results.

Here are 3 broad principles to be more fox-like:

1. Think probabilistically. In other words, think about a range of possible outcomes. Don’t make broad assumptions.

For example, take the theory that everyone needs more T3. Reality is more nuanced: Some people need more T3, others don’t and some people get worse with the addition of T3.

The same is obviously true of iodine and a number of other things. You may fall anywhere on that continuum. Find out what is true for you.

2. When the facts change, change your mind.

There’s nothing worse than stubbornly holding onto a belief that has been proven to be untrue.

This is why I’m opposed to protocols. They force you into a pre-existing solution.

There are so many variables, so many moving parts.

Let the facts on the ground dictate your approach.

3. Look for consensus.

Time and experience generally has a way of revealing the truth.

Sometimes there are big innovations, but these events are pretty rare.

Lastly, beware of magic bullet solutions.

With Hashimoto’s, after working with and talking to hundreds of people with this disease, I can tell you that there is nothing that works for everyone.

NOTHING.

You just need to learn to be like a fox and accept that.

Hashimoto’s and the MTHFR Gene

Pink and purple DNA strands on black background

You’re Not Crazy, It’s Your Genes

Hashimoto’s is a complicated condition. It’s not just a thyroid problem. It’s an autoimmune disease, it’s progressive and over time it can impact many different parts of your body.

This is true on the macroscopic where it affects major organs like the thyroid, liver, adrenal glands, brain, pancreas, stomach, small intestine, gall bladder and more.

And this is also true on the microscopic level where it affects immune cells, hormones, neurotransmitters, enzymes, proteins and even DNA and specific genes.

And with many of these influences, it is not a one way street.

One thing affects another and you sometimes have the creation of vicious cycles and problems and its hard to tell where they started.

The MotherFR Gene

In this post we will examine one of these vicious cycles on the microscopic level called the MTHFR gene.

MTHFR sounds a little scary and I like to think of it as the MotherFR gene because it can cause so many problems.

MTHFR is an abbreviation for a gene with a very long name, methylenetetrahydrofolate reductase.

(MotherFR is so much easier to remember.)

The MotherFR Enzyme

Basically, what the MTHFR gene does is produce an enzyme with the same really long name (methylenetetrahydrofolate reductase).

Genes produce enzymes and these enzymes do all the heavy lifting, they do the work.

They make stuff happen in the body. Without enzymes we wouldn’t have physiological function.

The job for the MTHFR enzyme is to convert one form of folate into the most active and usable form of folate in the human body – in every cell in the body.

This type of folate is called methyltetrahydrofolate  or more commonly by it’s nickname methylfolate.

Methylfolate Does 2 Important Jobs:

Firstly, it helps make neurotransmitters in your brain.

Neurotransmitters are our molecules of emotion.

They are what enable us to think, reason, laugh, cry, be happy, sad,  love, learn, crave and have crushes.

When methylfolate levels are low, so are your neurotransmitters.

And low levels of neurotransmitters like serotonin, dopamine, GABA and acetylcholine cause all kinds of unpleasant feelings and behavior.

Like depression, anxiety, bipolar disorders, ADHD, addictive behavior, irritability, insomnia, learning disorders and more.

With Hashimoto’s we often see depletions in these neurotransmitters.

This can be caused by too little thyroid hormones (both T3 and T4) and/or MTHFR defects.

The second thing methylfolate does is it allows us to make something called s-adenosylmethionine better known by its nickname SAMe.

SAMe is important because it helps regulate 200+ enzymes in the human body, its influence is second only to ATP which is every cell’s power source.

Basically what SAMe does is to take what is called a “methyl group” and give it away to these 200+ enzymes and this is what allows them to do their jobs.

Jobs like protect DNA, reduce histamine levels, maintain T and B cell responses, produce key components of cell membranes and about 196 other things.

Low Levels of SAMe – Not Good

Because SAMe is so important, when we are deficient in it, we are at higher risk for a lot of different diseases like: autoimmune disease, cancer, infertility, autism, down’s syndrome, thrombosis, high blood pressure and more.

And with autoimmune diseases, studies demonstrate the central role of SAM-dependent methylation ( I’ll explain this in a second) associated with T cell function and it is a key factor in maintaining T and B cell immune responses.

New T cell synthesis is needed in order for T cell clones to expand and respond properly to an immune assault. T cells are needed to help to control the B cells and to balance TH1 and TH2 responses.

If there are methylation cycle problems or mutations, you may have trouble making the bases that are needed for new DNA synthesis.

If you cannot make new DNA, then you cannot make new T cells and as a result you may lack immune system regulatory cells. This is like having a weak and ineffective general who can’t control his troops.

The immune system has many arms, but the B cell “arm” that makes antibodies, known as humoral immunity. I like to think of this part of the immune system as the C.I.A. It gathers intelligence and labels the bad guys.

There is also the T cell “arm” known as cellular immunity, these are like the elite soldiers of the front line. They do the attacking and killing. These are the cells that are often overzealous in Hashimoto’s.

For an in depth discussion on this, check out this post.

If you are having trouble making new T cells, in particular, T suppressor cells, then the immune response may become more heavily weighted in the direction of B cells.

B cell skewed individual has the ability to respond by making antibodies (or autoantibodies) in high numbers to attempt to overcome the T cell deficiency that fights infection.

This is one of the factors in high antibody counts in autoimmune disease.

Methylation Pathways – Follow the Yellow Brick Road

Methylation is how we get to Oz.

It is the act of taking a single carbon and 3 hydrogens – a methyl group – and attaching itself to an enzyme.

When this happens, the enzyme can do it’s thing.

One common example of this is the breakdown of histamine.

What happens here is a methylation group is made by the methylation pathway and it hangs around until it finds a specific enzyme to bind to.

In the case of histamine, when the methyl group binds to it, the histamine falls apart and goes bye bye.

On the other hand, if your methyl pathway is not making enough methyl groups, then histamine doesn’t break apart and this causes some pretty intense allergic reactions.

For some this may mean running nose and itchy eyes, for others it is full on hives and intolerable itching.

Histamine Intolerance and Hashimoto’s

One thing I have observed clinically is that there is a sub-group of people with Hashimoto’s who have histamine intolerance.

This can really complicate recovery and make some of the solutions that help others not work for them.

For example, the Paleo and Autoimmune Paleo diets both have a number of foods that are high in histamine, like bone broth.

So these people eat these foods, thinking that they are doing the right thing (and they are in theory) and they wind up feeling really crappy and just not getting better.

And the people with the most intense reactions may have higher levels of histamine and decreased methyl groups.

Research Shows Link Between More Severe Hashimoto’s and MTHFR

What is also interesting is that research has shown some correlation between more severe Hashimoto’s and some of these methylation defects.

Which kind of makes sense, because, as we have seen, SAMe is responsible for maintaining immune responses. And with autoimmune disease, these responses are out of control.

Well, this could be one reason why.

Methylation and Your Brain

Another key area where this is a concern is brain health. We’ve already seen the impact of methylation on neurotransmitters.

They also play a key role in keeping your myelin healthy.

Myelin coating on nerves is important for proper function of those nerves. Methylation of amino acids in myelin basic protein helps to stabilize it against degradation.

When you lose myelin or it starts to break down then your nerves and brain can’t communicate as well. Myelin is like the coating on the outside of a copper wire.

If a wire isn’t coated it can short out or get major interference from other electrical impulses. In you body this can lead to poor memory or more severe losses in function like those seen in Multiple Sclerosis ( an autoimmune disease caused by the breakdown of myelin).

Methylation and Glutathione

But, wait there’s more! Methylation is also really important for glutathione production.

Glutathione is our body’s body guard. It is involved in controlling inflammation and in getting every environmental toxins you can think of out of our systems through a process known as direct conjugation.

It is a major anti-oxidant, it regulates the nitric oxide cycle, it is essential for the immune system to operate properly.

It affects how antigens present to immune cells, it can strengthen the regulator part of the immune system.

It is involved in every major biochemical activity, especially those systems most impacted by Hashimoto’s: the immune system, the nervous system and the gastrointestinal system.

It’s importance can not be overstated.

Thyroid Health and MTHFR

With Hashimoto’s and hypothyroidism, some people develop a sluggish MTHFR enzyme.

This happens because thyroxine (T4) helps produce the body’s most active form of vitamin B2, flavin adenine dinucleotide know by its nickname FAD.

Vitamin B2 must be converted into active FAD by T4 so that the body can use it.

And, the MTHFR enzyme must have enough FAD in order to do its job. If FAD levels are low due to too little T4, then the MTHFR enzyme slows down, which leads to low methylfolate which leads to low neurotransmitters, which leads to low SAMe.

No bueno!

This becomes a vicious cycle.

MTHFR and High Homocysteine

Another really common finding that I see in analyzing blood test results from Hashimoto’s patients is that they have high levels of homocysteine.

As it turns out, low activity of the MTHFR enzyme may also lead to this. High homocysteine is a major risk factor for heart disease, inflammation, difficult pregnancies, birth defects, and more.

Nutrient deficiencies in Folate B6, and B12 have been linked to high homocysteine.

To matters more complicated, people with MTHFR issues may have a difficult time processing certain types of folic acid like those found in processed food and cheap supplements.

A better source is real food: asparagus, spinach, and liver. Both B12 and B6 are found in meat. And alcohol can deplete the body of B6.

Betaine is also helpful in metabolizing homocysteine.

If you are found to have the MTHFR gene variations and/or you have high homocysteine a better way to supplement is to use the activated version of folate, B6 and B12.

These are:

Methylfolate: (also known as L-5-MTHF Folate)

Pyridoxyl-5-Phosphate (P5P): B6

Methylcobalamine: B12

The Type of B12 Matters

(Thanks to Vicki Ross for sending me an email to help clarify this very important point.) Not everyone can tolerate methylcobalamine (B12). Just like not everyone can tolerate caffeine, some people don’t do with with methyl cobalamine. And the MTHFR results provide clues to how to determine who may not respond well.

The COMT & VDR genotypes determine WHICH B12 you should take. Most people can handle Hydroxocobalamin or Adenosylcobalamin, but may have problems with methyl B12.

Here is a breakdown of the 4 types of B12:

1. Methylcobalamin

This is the most active form in the human body. It converts homocysteine into methionine, which helps protect the cardiovascular system. Methylcobalamin also offers overall protection to the nervous system. This B12 form can also cross the blood-brain barrier–without assistance–to protect brain cells. It contributes essential methyl groups needed for detoxification and to start the body’s biochemical reactions.

2. Cyanocobalamin

This synthetic version of vitamin B12 is created in a lab, which makes it the cheapest supplement option. It offers the most stable form of B12, although it does so through the presence of a cyanide molecule. While the amount of cyanide is not dangerous, it does require the body to expend energy to convert and remove it.

3. Hydroxocobalamin

Bacteria naturally creates this form of vitamin B12, making it the main type found in most foods. It easily converts into methylcobalamin in the body. Hydroxocobalamin is commonly used via injection as a treatment for B12 deficiency as well as a treatment for cyanide poisoning.

4. Adenosylcobalamin

The energy formation that occurs during the Citric Acid cycle requires this form of B12. Although naturally occurring, it is the least stable of the four types of B12 outside the human body and does not translate well into a tablet-based supplement. It can be difficult to find this one in supplement form, although some supplements, like Vegansafe™, have been able to stabilize it.

What Do We Do to Fix All This?

Well, firstly, we have to do all the other stuff we do to insure that we are thyroid healthy. And, as all of us who have Hashimoto’s know, this is sometimes easier said than done with all the different systems affected and involved.

Key nutrients for thyroid function are magnesium, iodine (no end to the controversy there – more on this in a future post), selenium, zinc and tyrosine.

Methylfolate, produced by the MTHFR enzyme is also needed to convert tyrosine into active thyroid hormone.

So you can se, we have all the ingredients of a vicious cycle.

Where hypothyroidism leads to MTHFR not working as well, which leads to thyroid hormone not being converted properly and on and on.

Here are some basic tips to correct these challenges:

1. Consider supplementing with glutathione and Vitamin D.

2. Take the active forms of B vitamins mentioned above.

3. Incorporate organic grass fed meats and good fats into your diet.

4. Avoid processed foods and environmental chemical that compete for iodine receptors like fluoride, chlorine and bromine (bromide).

5. Avoid gluten, dairy and soy 100%

6. Avoid GMO foods.

7. Consider testing for homocysteine and the MTHFR gene mutations and defects.

Testing for homocysteine and the MTHFR gene variation is available through many labs. 23andme.com offers a test for the MTHFR gene and many individuals can get the tests from their physicians covered by insurance.

However, some people may be concerned ( and with good reason) with this genetic information getting reported on insurance or to employers.

A MTHFR variation or elevated homocysteine levels may affect future insurance coverage especially with the advances in personal data mining and sharing.

To find out more information about MTHFR testing – along with the ethical considerations of it – visit: MTHFR test options

References:

http://www.jimmunol.org/cgi/content/meeting_abstract/188/1_MeetingAbstracts/116.13 -SAMe and Autoimmune disease

http://www.ncbi.nlm.nih.gov/pubmed/23039890 – Severity of Hashimoto’s corresponds with defect

http://www.drkendalstewart.com/wp-content/uploads/2011/09/Methylation-Overview-for-Professionals-10.11.pdf

MTHFR Basics, Benjamin Lynch, ND

http://www.thyroidpharmacist.com/blog/mthfr-hashimotos-and-nutrients

http://mthfr.net/mthfr-test-optins-oral-swab-blood-test-orsaliva/2013/06/26/

http://www.globalhealingcenter.com/natural-health/four-types-vitamin-b12/

Hashimoto’s and PCOS: A Perfect Example of How It’s All Connected

polycystic ovaries, PCOS

Polycystic ovaries and Hashimoto’s have a lot in common.

Hashimoto’s is the most common cause of hypothyroidism worldwide and research has shown that it also has many similarities to PCOS or Polycystic Ovarian Syndrome.

What’s really interesting about these 2 interacting health challenges is what they reveal about how interconnected everything in the body is.

In this post we explore these connections and how, once again, Hashimoto’s is so much more than a thyroid problem.

What Is PCOS?

In order to be diagnosed with PCOS you must have 2 of the 3 following criteria.
(These are what is known as the Rotterdam criteria)

1) No period (Anovulation) or Irregular Periods

2) High levels of testosterone (Hyper-androgenism)

OR

Clinical hyper-androgenism: adult acne, hirsutism (a male pattern of body or facial hair), or hair loss (androgenic alopecia)

3) Polycystic (multiple cysts) appearing ovaries on ultrasound, containing multiple small follicles

Many women with PCOS are overweight, find it difficult to lose weight, and suffer with fatigue, depression and anxiety and either have excess hair or hair loss.

Sound Familiar?

Many women who suffer from Hashimoto’s are also overweight, find it difficult to lose weight, suffer from fatigue, depression and/or anxiety and they struggle with hair loss.

Is it a coincidence? Well, in a word, no.

There is a clear connection between Hashimoto’s thyroiditis and PCOS.

A 2013 meta-analysis found that in a total of 6 studies involving 1605 women, there was a significant increase in the prevalence of Hashimoto’s, increased serum TSH, increased anti TPO antibodies, and anti TG antibodies in women with PCOS when compared to control groups.

A 2012 study found that women with PCOS had a 65% increase in thyroid peroxidase antibodies, and a 26.6% increase in the incidence of goiter, when compared to other subjects in the same age group.

Both Hashimoto’s and PCOS can also lead to infertility and another recent study showed that women suffering with PCOS-related infertility who also had high anti-TPO levels were significantly more likely to not respond to treatment.

What Are the Common Causes?

There are a number of common causes that make both PCOS and Hashimoto’s worse and they reveal some important clues into treatment strategies.

Here are some common factors:

1. Blood sugar imbalances

2. Low progesterone

3. High Estrogen

4. Hypothyroidism

5. Inflammation: The Root of All Evil

Insulin Resistance: More Trouble In Sugar Land

I have written extensively about how sugar imbalances can be major triggers for Hashimoto’s and if you don’t take this seriously you won’t get better. It’s just that simple.

If you missed my previous blog post on this check it out here.

50-70% of women suffering from PCOS have blood sugar issues.

And one of the most common is insulin resistance.

This is basically caused by too much sugar in your blood. Or your classic high carbohydrate diet.

Insulin is a hormone that tells muscle and fatty tissue to take up glucose (sugar) from the bloodstream and to store it as fat or energy.

When the body tissues are “resistant” to insulin, the pancreas simply pumps out more to try and keep the blood sugar levels controlled.

And a woman with PCOS will often have much higher insulin levels in their blood than normal for this reason.

With PCOS, even though other tissues in the body are resistant to insulin, the ovaries and pituitary gland remain very sensitive to it.

The Pituitary, Again

The pituitary is a master endocrine gland and it must read and make decisions on many important organs including the adrenals, the thyroid, ovaries and lots more.

It is very sensitive to many different hormones and has been shown to absorb these hormones differently than many other cells in the body.

This is one of the reasons why TSH testing can be so inaccurate – it comes from the pituitary.

A recent research study looked at the role of the pituitary-ovary, adrenal, and thyroid axes in PCOS.

The researchers found through testing TRH (Thyroid Releasing Hormone) that PCOS groups had higher TSH and prolactin and lower free T4.

And adrenal stress may contribute to both high testosterone and insulin resistance, in part because of the impact of this pituitary axis .

High insulin levels also cause the pituitary gland to make too much luteinizing hormone (LH), and too much LH causes the overproduction of testosterone, which causes problems with ovulation.

In addition, insulin surges cause an enzyme (17, 20 lyase) to increase activity and this promotes the development of cysts and more production of testosterone.

Eh Tu, Estrogen?

What is also interesting is that estrogen is transformed into testosterone in fat cells by an enzyme called aromatase.

This is very common in overweight women who are insulin resistant and who are hypothyroid.

Drugs that lower insulin levels like metformin have been shown to be beneficial in the treatment of PCOS in some women because of this connection.

They lower insulin and aromatase levels which helps lower testosterone levels and, thus, cyst formation.

As part of a vicious cycle, the high testosterone in PCOS sparks even more insulin resistance.

And research has shown that this is not a one way street.

Low thyroid function (higher TSH) actually makes insulin resistance worse in women with PCOS.

Bottom Line Here? Sugar Is Not Your Friend

Boil this all down to one thing?

Too much sugar is like adding gasoline to the flame of both PCOS and Hashimoto’s.

(If you get nothing else from this post, burn that into your brain.)

Also, it is interesting to note that one of the most common factors of hair loss in women with Hashimoto’s is blood sugar imbalances and insulin resistance.

Low Progesterone

Low progesterone is another thing that is very common in both PCOS and Hashimoto’s.

It is difficult to know which came first, but there are some common factors.

Usually in their mid-thirties, women’s progesterone levels begin to fall more quickly than their estrogen levels, creating what is known as “estrogen dominance”.

If left uncorrected, this imbalance of progesterone and estrogen can get worse over time and all kinds of issues can appear, including: premenstrual headaches (often migraine-like) fluid retention, fibrocystic breast disease, uterine fibroids, heavy, painful menstrual periods, endometriosis and functional hypothyroidism.

High Estrogen

Estrogen dominance also causes the liver to produce high levels of a protein called “thyroid binding globulin”, which, you guessed it, binds to thyroid hormone.

When this happens the amount of thyroid hormone that can be used by the cells of the body goes down.

What does this lead to? Low thyroid function and all of the negative side effects that come along with it.

Hypothyroidism

A 2009 study looked at a group of 337 women with PCOS. All of the women were assessed for the key markers of PCOS, including hirsutism, acne, and menstrual irregularity.

What the researchers found was that women with the highest TSH levels tended to have the most severe insulin resistance. Interestingly, this was not related to weight: hypothyroidism caused insulin resistance in women in all weight categories.

The study concluded that a TSH above 2 miU/L was associated with insulin resistance in PCOS.

It seems that for women with PCOS, an optimal TSH range may be below 2-2.5 mIU/L.

While the research on this topic is generally focused on TSH, it is also makes sense that an optimal range also exists for free T3 and free T4 in PCOS.

In my practice, I have found that values at the top part of the range may provide benefit for some women with PCOS.

And, once again, this is not a one way street.

Low thyroid function leads to low progesterone and high estrogen.

This can lead to weight gain and insulin resistance which can lead to estrogen getting transformed into testosterone and too much LH which can all lead to PCOS.

And correcting hypothyroidism can improve and sometimes resolve PCOS.

Do you see how this is all connected into a massive vicious cycle?

What Is the Root of All Evil?

Dear reader, if you know me and my work, you know where I’m going with this.

The root of all evil is inflammation.

Both Hashimoto’s and PCOS are driven by inflammation.

Nodules and thyroid inflammation and cysts on the ovaries are both caused by inflammation.

We’ve seen how sugar and inflammation go together like gamblers and con men.

Well, inflammation, Hashimoto’s and PCOS go together like gamblers, pick pockets and con men.

Recent research has shown that there are common inflammatory markers in both PCOS and Hashimoto’s.

(Read this post to learn more about what is happening with the immune system and Hashimoto’s.)

C-reactive protein levels are 96% higher in PCOS patients than in healthy controls. It has also been found to be significantly elevated in patients with subacute thyroiditis.

Interleukin 18 (IL-18) is high with obesity and insulin resistance. IL-18 is a major culprit in the initiation and progression of Hashimoto’s, especially those with severe symptoms that don’t respond to levothyroxine treatment.

Polymorphisms (genetics variations) of the IL-1a, IL-1b and IL-6 genes have also been associated with PCOS.

IL-6 is also elevated with insulin resistance, PCOS and Hashimoto’s and is thought to be a major factor in the initiation and progression of both disorders.

It’s All Connected

PCOS and Hashimoto’s have many common factors and symptoms and when you boil it all down have very similar origins.

They are made worse by blood sugar imbalances, especially insulin resistance and by inflammation.

So the best way to treat them is?

Conventional treatment for PCOS is to prescribe oral contraceptives to shrink cysts and falsely normalize menstrual patterns.

But many times, this is not a good long term solution because it does not address the underlying causes of the problem.

If the underlying causes are thyroid related, then proper thyroid management will often resolve the cysts.

In addition, the following strategies should be implemented:

Balance blood sugar, improve insulin receptor sensitivity and reduce systemic inflammation.

This is the holy trinity.

Hashimoto’s is an progressive autoimmune disease and, over time, it becomes way more than a thyroid problem.

As this post clearly demonstrates, many different systems of the body get involved and affect each other.

When these start to malfunction, they can cause a web of problems that result in a downward spiral that causes you to get worse and worse.

It is possible to turn this downward spiral on it’s head.

But you need an understanding of what is going on, you need an approach that can help you deal with everything and fix it and you need support in making all these changes.

That’s why I created my program, the 5 Elements of Thyroid Health. It is 3 pronged approach that:

1. First, teaches you what is happening in your body,

2. Then we work with you to create an action plan to fix those problems, and

3. Finally, we also work on creating a lifestyle that will sustain and support those changes to give you the best chances for success.

Click this link to watch a video to learn more.

References:

(The European Society for Human Reproduction and Embryology (ESHRE) and the American Society for Reproductive Medicine (ASRM) cosponsored the Rotterdam polycystic ovary syndrome (PCOS) consensus workshop to come up with the Rotterdam Criteria in 2004).

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3683210/ – Thyroid disorders in PCOS

http://www.ncbi.nlm.nih.gov/pubmed/24260593 – 2013 meta-analysis

http://www.ncbi.nlm.nih.gov/pubmed/21866332 – 2012 study

http://www.ncbi.nlm.nih.gov/pubmed/20638057 – poor response to treatment

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3002408/ – Origins of PCOS

http://www.ncbi.nlm.nih.gov/pubmed/12477517 – Metformin treatment in PCOS

http://www.ncbi.nlm.nih.gov/pubmed/19654109 – High TSH leads to more insulin resistance

http://www.ncbi.nlm.nih.gov/pubmed/22553983 – PCOS and Chronic Inflammation

http://www.jofamericanscience.org/journals/am-sci/am0706/175_6025am0706_1156_1162.pdf – IL-6 and IL-15 elevated in hashimoto’s

http://www.eje-online.org/content/150/3/363.short

WHERE DO I BEGIN WITH HASHIMOTO’S?

Scanning of a thyroid of woman

Hashimoto’s Thyroiditis: An Autoimmune Disease 

I’ve worked with an awful lot of people with Hashimoto’s (this is all I do) and I’ve spent years studying and looking at research on how this condition impacts the body. And I’ve also lived with the disease, myself, for many years.

WHAT I’VE LEARNED FROM LIVING WITH & TREATING HASHIMOTO’S

By far, the most important thing I have learned is that Hashimoto’s is much more than a thyroid problem. It’s an autoimmune disease, but it’s not just an immune system problem either. It’s an all-over-your-body problem.

Your body is not a machine. Like the earth, it’s a complex group of ecosystems that all interact. And these ecosystems can all be adversely affected by Hashimoto’s. When this happens you get a downward spiral of vicious cycles all feeding on one another.

With Hashimoto’s and hypothyroidism you often wind up with a multi-system disorder. It creates webs that can lead to problems with virtually all the major systems of the body.

These include issues with the brain, the adrenals, the liver and gall bladder and problems with the digestive tract like acid reflux, leaky gut, as well as body wide pain and inflammation and more.

All of this can result in anxiety and depression, gall stones and poor liver detoxification, poor absorption of vitamins and nutrients, poor conversion of thyroid hormone, blood sugar imbalances, terrible fatigue and immune responses to various triggers from foods to environmental toxins and chemicals.

Hashimoto’s is not a simple condition that can just be fixed by some thyroid replacement hormone and/or a surgical removal of the thyroid. This works for some, but millions of others have done one or both of these things and don’t feel any better at all.

HOW DO YOU FIGURE OUT WHICH SYSTEMS ARE BREAKING DOWN?

You have to be able to see the big picture. Then you have you have to isolate each system and look at the interactions and start working on healing the whole body. This requires several steps.

The first thing you must do is find the most destructive triggers and eliminate them. After that, you need to identify which systems are involved and start repairing them.

When you do this, something magical happens. All of those vicious cycles get turned on their head and start having a positive impact on the other systems. When that happens, you can stop triggering the immune system and start to restore balance. Then the body can heal itself.

In the beginning, this will give you glimpses of more good days than bad ones and if you stay the course and work on the big picture you can even sometimes get this condition into a state that resembles remission. (But remember that’s not permission to go back to everything that got you sick in the first place.)

To put it another way. You must adopt a Hashimoto’s lifestyle. That is what I teach my patients and what I try to share about in my  Facebook support group and here on my blog. Healing Hashimoto’s requires you to go all in.

HERE ARE 5 KEYS TO HEALING YOUR HASHIMOTO’S

1. Step One: Understand Which Systems Are Impacted

The first step is to get a proper diagnosis that will lead you to understanding which systems make up your unique web of vicious cycles. The key is to work with someone who understands this.

In my practice, I specialize in treating people with Hashimoto’s. I know which diagnostic tests are appropriate and I have worked with hundreds of people with this disease and lived through it myself so I’ve seen a lot of permutations and variations.

2. Step Two: Take Your Diet Seriously

Hashimoto’s is an autoimmune disease. 70% of the immune system is found in your digestive tract. What you eat has a huge impact on the state, quality and severity of your autoimmune disease. Anyone who tells you otherwise has no idea what they are doing, plain and simple.

Some foods serve you, some cause you harm. In my practice I prescribe a special Hashimoto’s diet that is the foundation of the work we do. I have found that people who won’t make the dietary changes that they need to heal are just setting themselves up for failure.

3. Step Three: Heal Your Adrenals

For a lot of people with Hashimoto’s the adrenals are a critical piece of the puzzle. Did you know that the label on Synthroid and other thyroid replacement hormone warns that if a patient has adrenal insufficiency they should not be prescribed the drug?

That’s how important the adrenals are. They can be the difference between you turning this thing around and you treading water and not improving or just continuing to get worse. In my practice we do proper testing evaluation and treatment of the adrenals.

4. Step Four: Heal Your Gut

This is really closely related to Step Two. The gut is where your immune system lives. Many really smart people believe that issues in the gut like intestinal permeability (leaky gut) are actually one of the root causes of Hashimoto’s and other autoimmune diseases.

When you heal your gut, you heal everything else: your brain, your immune system, your thyroid, your adrenals and more.

5. Step Five: Remove the Triggers

You have to find and eliminate the triggers that drive your autoimmune flare ups and the progression and destruction of this autoimmune disease. We’ve already mentioned the dietary triggers. Where are the other ones?

Environmental toxins and chemicals (these include some drugs) can be triggers. Blood sugar imbalances can be another important trigger.

Stress can be another trigger and if ignored can torpedo your progress.

In my practice we take you through all of these steps and we teach you along the way how to identify what your unique set of issues, triggers and solutions are.

Then we create an action plan and help guide you out of the woods. You can heal your Hashimoto’s, but healing requires acceptance, and it requires adopting a new lifestyle that will support your body and your immune system and that will provide you with the foundation to get lasting results.

And last but not least, remember to have fun. To laugh and enjoy the life you have. There is a lot in this struggle that is not fun, but what we try to do is to empower you with the knowledge you need, but also make it enjoyable and entertaining.

Because there’s nothing worse than doing all this work and not being able to enjoy the process. A sense of humor can be healing all by itself.

Would you like some help?

Lastly, I offer a 30 minute Hashimoto’s Healing Discovery Session. In it you can share where you are and where you want to be. I can help by giving you some suggestions that will help right away and we can discuss which other programs or services may help you reach your goals.

Here’s a link to set up a time to chat.

I look forward to chatting with you!

Best,

Marc

5 Keys to Improving Thyroid Hormone Conversion

Hand with pen drawing the chemical formula of thyroxine

As many of you know, all I do is treat Hashimoto’s and over the last 4 years I have worked and spoken with over 2,000 people with Hashimoto’s.

Most of these conversations have happened during my consultations. In these, people share with me their struggles and I offer advice that helps them right away.

By far, the most common theme of these conversations is that they have normal lab results (this usually means TSH and T4 – to learn more about what are better tests to order read this post) and yet they have all the common hypothyroid symptoms.

In other words, they are fatigued, they have brain fog and memory issues, their hair is falling out, the may have depression, constipation, difficulty sleeping and muscle weakness or joint pain and more.

This Common Problem Is Often caused By Poor Thyroid Hormone Conversion

While researchers sometimes claim that this is rare, clinical experience and empirical data prove otherwise. I put this question to my Facebook support group on 2 occasions and over 300 people responded that they have some or all of the symptoms above and “normal” lab test results.

This situation isn’t rare, it’s very common.

Taking Thyroid Hormone But Still Have Symptoms

And the vast majority of these people are taking some type of thyroid replacement hormone. The prescriptions vary from Synthroid to Armour to Levothyroxine and sometimes there’s some Cytomel thrown in or they’re taking Naturethroid or Tyrosint.

But often, regardless of the prescription or the dosage, they still have all the hypothyroid symptoms. And some people are over-medicated so they have hyper symptoms, as well. Like, palpitations, insomnia, tachycardia, anxiety, etc.

And after a while you have to ask: What is going on here?

It’s the same story over and over again. The medications are different, the constellation of symptoms are different, but the basic pattern is the same.

The Problem Is Poor Conversion And Absorption

People are getting plenty of thyroid hormone, but it’s not getting into their cells and having the effect it is supposed to.

If it were, they’d have no hypothyroid symptoms. But virtually everyone does have hypothyroid symptoms.

In this post we examine why thyroid hormone conversion doesn’t happen the way it’s supposed to and what to do about it.

Let’s Review the Physiology

First of all, let’s look at basic physiology. In the body, normally, the thyroid is signaled by the pituitary with TSH (Thyroid Stimulating Hormone). The purpose of this is to goose the thyroid into producing more thyroid hormone.

This occurs because of signals from the body that it needs more. If it’s cold or you need your heart rate to increase, or your metabolism to rev up or you needs to get things moving for sex, etc.

When this happens the thyroid releases T4 (about 97%) and a little bit of T3 (do the math – yup, 3%).

And this is the basic premise of thyroid replacement hormones like Synthroid. It’s synthetic T4. The theory is that you just give it to the patient and tell them to call you in 6 months. An everything should be hunky dory.

In Reality It Doesn’t Work That Way

And the reason it doesn’t work is that thyroid hormone must be converted from T4 into T3 in order for the body to utilize it. This conversion happens differently in different parts of the body.

The problem with TSH only testing to determine thyroid hormone levels in the entire body is that the pituitary, which releases TSH, converts thyroid hormone differently than the rest of the body.

This is why you often see normal TSH with lots of hypothyroid symptoms.

Many doctors, somehow, are ignorant of this fact and instead of truly understanding what is happening physiologically, blame the patient for having symptoms when their lab tests say that they should be fine.

How Does T4 get Converted to T3?

There is an enzyme that is largely responsible for thyroid hormone conversion. It is called 5′ deodinase. And it actually comes in 3 forms: deodinase type I (D1), deodinase type II (D2)and deodinase type III (D3).

D1 and D2 Don’t Behave the Same Way

D1 converts inactive T4 to active T3 throughout the body. In the pituitary, D2 controls this conversion. These two forms behave very differently and are affected by different things.

D1 is suppressed and down-regulated (which means it decreases T4 to T3 conversion and increases reverse T3 levels) in response to stress (both  physiologic and emotional),  depression, dieting, weight gain and leptin resistance, insulin resistance, obesity and diabetes, inflammation from autoimmune disease or systemic illness, chronic fatigue syndrome and fibromyalgia, chronic pain, and exposure to toxins and plastics.

What did we just describe? Your average Hashimoto’s patient living in the modern world! Most people with Hashimoto’s have the majority of conditions mentioned above.

In addition,  D1 activity is also lower in females, making women more prone to tissue or functional hypothyroidism.

Sound familiar? Normal lab results but hypothyroidism at the cellular level.

And when you have these conditions, there are reduced tissue levels of active thyroid hormone in all tissues except the pituitary because D2 does not behave like this, at all.

D2 is 1,000 times more efficient at converting T4 to T3 than D1 in the rest of the body. And it isn’t suppressed and down regulated by any of the things we mentioned.

So TSH is within normal range because the pituitary is getting plenty of thyroid hormone, but the rest of the body is hurtin’ for certain.

D3 and D1 Don’t Play Well Together

D3 converts T4 into reverse T3. There is none of it in the pituitary. D3 also competes with D1. T4 can go either way. It can be converted to T3 which the body can use or into reverse T3 which is not active.

And reverse T3 blocks the effect of T3. It blocks T3 from binding to receptors and when this happens it doesn’t work. So your metabolism slows, and D1 is suppressed so it can’t do it’s job and convert T3 to T4. And D3 blocks T3 and T4 from getting absorbed into cells.

So the result is you have low T3 levels in the cells of your body and you get all the hypothyroid symptoms.

How Do You Fix It?

Like most things related to Hashimoto’s the solution is not simple and it requires a multi-prong approach.

As I have said and written many times, Hashimoto’s is way more than a thyroid problem and way more than a thyroid and autoimmune problem. It is a multi-system disorder that can only be healed using a multi-system approach.

Nowhere is this more evident than in trying to fix poor thyroid hormone conversion.

5 Key Areas for Improving Thyroid Hormone Conversion

There are 5 important areas that need to be assessed and addressed if you want better conversion of T4 to T3.

Let’s break it down:

1. Liver Detoxification and Other Metabolic Pathways

2. Increasing T3 and Lowering Reverse T3 Levels

3. The Gut and Thyroid Hormone Conversion

4. Adrenal Stress Can Cause Lower T3 and Higher Reverse T3

5. Systemic Inflammation Lowers T3

And as a bonus we’ll look at key nutrients that support better thyroid hormone conversion.

Liver Detoxification and Function

In the liver D1 is involved in converting T4 into T3 and selenium is an important part of this process. Reverse T3 is also broken down there.

So having enough selenium is essential. (It is recommend to take from 200 to 400 mcg. (micrograms) per day. Make sure you do not take selenium supplements that contain dairy or gluten based fillers.)

Other important factors that can prevent T4 to T3 conversion include stress (both emotional and physiological), poor nutrition, chronic illness and exposure to heavy metals like cadmium, mercury and lead.

Another important factor is lipid peroxidation and antioxidants in the liver. One of the most important in helping the body deal with the damage caused by these heavy metals and to nourish antioxidant enzyme systems is glutathione.

The best form to take orally is S-Acetyl-L-Glutathione. It can also be taken in liposomal cream form or in an IV.

In addition, there are 2 metabolic pathways in the liver that can have an impact on thyroid hormones. One such pathway is the glucoronidation pathway. This pathway is supported by B vitamins, magnesium, and glysine.

The second is sulfation. Sulfation involves binding things partially broken down in the liver with sulfur containing compounds. It is one of the major detoxification pathways for neurotransmitters, toxins, and hormones (like thyroid hormones).

Vitamin B6 and magnesium are important for sulfur amino acid metabolism, as are foods containing sulfur such as: eggs, meat, poultry, nuts and legumes. (Eggs, nuts and legumes might be a problem if you are on the Autoimmune diet.)

Increasing T3 and Lowering Reverse T3 Levels

Lowering reverse T3 levels and increasing T3 levels is not a simple thing. There are so many variables and other factors that may hinder this process that it’s hard to offer general things that will help.

To really do this properly, one must be tested, evaluated and treated according to what results, symptoms and patterns present themselves.

That being said, let’s look at some general things that may help.

Glucoronidation, mentioned above, has been shown to degrade reverse T3.

The addition of T3 to your thyroid replacement hormone regimen may also be helpful. There are those in the thyroid community that strongly advocate T3 only treatment. Some suggest doing with natural cortisol rhythms, some with time released T3 and others with slow and deliberate increases in T3 therapy.

This may or may not work and what they fail to say is that T3 can also be toxic to the liver in high doses. Again, proper assessment and treatment is required to determine if this course of action is a good idea for you.

Elevations in cortisol, catecholamines, and some cytokines (IL-6, TNF-a, and IFN-a), and low serum albumin levels have also been associated with low T3 syndrome.

The Gut and Thyroid Hormone Conversion

Gut bacteria is important for converting T4 into T3.

About 20 percent of T4 is converted to T3 in the GI tract, in the forms of T3 sulfate (T3S) and triidothyroacetic acid (T3AC). The conversion of T3S and T3AC into active T3 requires an enzyme called intestinal sulfatase.

Intestinal sulfatase comes from healthy gut bacteria. (Sulfur is an important nutrient for this, as well).

When you have an imbalance between good and bad bacteria in the gut, this may significantly reduce the conversion of T3S and T3AC to T3. This is one reason why people with poor gut function may have thyroid symptoms but normal lab results.

Inflammation in the gut also reduces T3 by raising cortisol. Cortisol decreases active T3 levels while increasing levels of inactive T3.

Studies have also shown that cell walls of intestinal bacteria, called lipopolysaccharides (LPS), negatively effect thyroid metabolism in several important ways.

LPS:

•    reduce thyroid hormone levels;

•    dull thyroid hormone receptor sites;

•    increase amounts of reverse T3;

•    decrease TSH; and

•    promote autoimmune thyroid disease (AITD).

 

Adrenal Stress Can Cause Lower T3 and Raise Reverse T3

With stress, cortisol levels often go up. The increased cortisol levels contribute to this disconnect in the body between the TSH and peripheral tissue T3 levels.

Stress reduces T3 levels in the tissues and increases reverse T3 and this results in tissue hypothyroidism and potential weight gain, fatigue, and depression.

This vicious cycle of weight gain, fatigue, and depression that is associated with stress may be prevented with supplementation with timed-released T3 according to some studies.

The reduced immunity from chronic stress has also been thought to be due to excess cortisol production; but the associated reduction in tissue thyroid levels are shown to play a larger role in the decreased immunity seen with stress.

As with stress, treatment with prednisone or other glucocorticoid will suppress D1 and stimulate D3, reducing T4 to T3 conversion and increasing T4 to reverse T3, causing a relative tissue hypothyroidism that is not detected by TSH testing.

This low cellular thyroid level certainly contributes to the weight gain and other associated side-effects with such treatment. Thus, in stressed patients or those treated with corticosteroids, there are reduced tissue T3 levels that are not reflected by the TSH level, making the TSH an inappropriate marker for tissue levels of T3.

So making sure that you have proper levels of DHEA and cortisol is very important.

As is changing the things in your life that cause you stress. With Hashimoto’s we have emptied our stress savings accounts. We have so much physiologic stress that added emotional stress is incredibly destructive. And one area, in particular, is in the impact of stress on tissue levels of T3.

Systemic Inflammation

Hashimoto’s is, at it’s root, a disease of inflammation. And research has found that the inflammatory immune cells (cytokines) and proteins like IL-1, Il-6, C-reactive protein (CRP), and TNF-alpha will significantly decrease D1 activity and reduce tissue T3 levels. Any person with an inflammatory condition – Hashimoto’s – will have a decreased T4 to T3 conversion in the body and a relative tissue hypothyroidism.

These immune proteins will, however, increase the activity of D2 and suppress the TSH despite reduced peripheral T3 levels; again, making a normal TSH an unreliable indicator of normal tissue thyroid levels.

There is also a direct inverse correlation between CRP and reduced tissue T3, so individuals with elevated CRP (greater than 3 mg/l) or other inflammatory cytokines may have a significant reduction in cellular T3 levels.

The suppression of T3 levels inside the cells is linked with the degree of elevation of CRP, despite serum thyroid tests being “normal”.

So, if any inflammation is present,  the body will have lower T3 levels in the cells and this can impact function; but the pituitary will have increased levels of T3, resulting in a lowering of the TSH so that, once again test results appear normal. (Have I made this point enough times?)

This really emphasizes the importance of anti-inflammatory strategies to improve T3 levels in the tissues. Anti-inflammatories like Turmeric, ginger, resveratrol, glutathione, and Vitamin D are all helpful.

Sometimes these are needed in rather high dosages.

Eliminating foods that cause inflammation is also absolutely critical: gluten, dairy, soy, sugar, alcohol, processed foods, pesticides and chemical additives should all be strictly eliminated.

The Autoimmune Paleo approach is an excellent diet for reducing systemic inflammation and increasing tissue T3 levels.

Other Helpful Herbs and Supplements to Support Conversion

Commiphora muku guggulu (Myrrh resin) Guggul produces a resinous sap known as gum guggul. The extract of this gum, called gugulipid, guggulipid or guglipid, has been used in Ayurvedic medicine, a for nearly 3,000 years in India. The active ingredient in the extract is the steroid guggulsterone. This has been shown to stimulate healthy synthesis of T3.

Selenium is a major cofactor for the enzyme 5′ deiodinase which is responsible for converting T4 into T3 as well as degrading reverse T3.

Low zinc status has been shown to compromise T3 production. Zinc can improve thyroid hormone production and play a role in reducing antibodies.

Lipid peroxidation and antioxidant enzyme systems have been shown to play a profound role peripheral thyroid hormone conversion. Glutathione is extremely effective in supporting peroxidation.

Lastly, it is essential to work with someone who understands the complexity of this situation and who can evaluate what is going on properly and who can determine which course of action and combination of things may be best for you.

 

References:

http://nahypothyroidism.org/deiodinases/

http://www.aaqm.org/Downloads/doc-qmuAUG08.pdf

http://www.chiro.org/nutrition/FULL/Peripheral_Metabolism_of_Thyroid.html

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