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 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.
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.
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 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.
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.
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.
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?
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.
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).
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.
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%).
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.
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.
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.
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.
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?
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.
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.
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.
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
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://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://www.hindawi.com/journals/ijad/2011/865432/ Transglutaminase enzyme involved in Alzheimer’s
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
“Why Isn’t My Brain Working”, Dr. Datis Kharrazian, 2013 Elephant Press
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.
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.
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.
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.
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.
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 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
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.)
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.
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™ (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™ (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™ (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™ (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™ (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.
The Neuroendocrine Immunology of Small Intestine Bacterial Overgrowth, by Dr. Datis Kharrazian, DC, 2014
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.
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.
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.
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.
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:
– Fiber supplements
– Rice or pea powder from metabolic powders
You may notice that many of the foods listed here can also aggravate candida. And sometimes candida is blamed for what is actually SIBO.
The causes of SIBO matter because when we understand the causes, we can figure out how to fix them.
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.
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.
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.
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.
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.
http://www.ncbi.nlm.nih.gov/pubmed/17698907 – SIBO and hypothyroidism -antibiotic therapy didn’t affect thyroid hormone levels
Link between SIBO and hypothyroidism
“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/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://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