The human body is a wonderfully complex playground where hormones, immune cells, neurotransmitters, red and white blood cells, bacteria, and more all frolic.
With Hashimoto’s that playground gets invaded by a hurricane of inflammation and this disrupts many of the systems that produce these things.
In today’s post, we focus on how blood sugar problems can impact the thyroid and how Hashimoto’s and hypothyroidism can also make blood sugar problems worse.
It’s a two way street, people.
The endocrine gland that is responsible for helping maintain blood sugar balance is the pancreas. The poor, dear, much beleaguered pancreas.
What does the pancreas do? Quite a lot actually, we really should be nicer to it. It does endocrine stuff and non-endocrine or exocrine stuff.
On the endocrine side it produces insulin, glucagon and somatostatin. Insulin and glucagon are involved in blood sugar metabolism and somatostatin is involved in intestinal absorption.
The exocrine functions include secreting digestive enzymes into the small intestines. These breakdown proteins, fats and carbs in the diet.
Studies have found pancreatic function was significantly reduced in patients with hypothyroidism.
And, in many people today, the pancreas is under siege.
Americans are addicted to sugar. In some measure, it’s their own doing. In other ways, it is the food industry and public health officials who decided that fat was evil when it was discovered that cholesterol was linked to heart disease in the 1980s. The National Academy of Science made sweeping recommendations at that time to get rid of dietary fat.
So fat was taken out of many processed, fast foods and in an effort to make it taste less like an old ping pong table, it was replaced with sugar.
Carb Roller Coaster
What has since developed is a nation of carb and sugar addicts riding the roller coaster of sugar highs and crashes.
On average, Americans hammer about 200 pounds of sugar a year, and diabetes is a serious threat to bankrupt our healthcare system in the next 20 years.
It is estimated that almost half the population born after 2000 will become diabetic.
This is almost entirely due to diet. As Thomas Edison said, “We’re digging our graves with our teeth.”
Health is really all about balance. And nowhere is this idea more evident than when you look at blood sugar balance.
There are really 2 different kinds of blood sugar problems and many people have a mixture of both. These are hypoglycemia (or too little sugar in the blood) and insulin resistance (or too much sugar in the blood).
With Hashimoto’s either one or both of these blood sugar problems can make things worse. And just to remind you that this goes in both directions; its important to understand that hypothyroidism can also cause blood sugar problems all by itself.
(We have the makings of a vicious cycle.)
Hypoglycemia
Your body is programmed to recognize low blood sugar as a threat because severe or long term hypoglycemia can cause seizures, coma, and death.
When your blood sugar levels drop below normal, your adrenal glands respond by secreting cortisol. Cortisol then tells the liver to make more glucose, bringing blood sugar levels back to normal.
Hypoglycemia is a condition in which there is not enough cortisol to raise blood sugar into the normal range.
The problem is that cortisol (along with epinephrine) is also a sympathetic nervous system stimulant involved in the “flight or fight” response. This can end up wearing out the adrenals.
In fact, we often see adrenal fatigue and hypoglycemia together.
Cortisol’s job is to increase the amount of glucose available to the brain, enhance tissue repair, and slow other functions – like digestion, growth and reproduction – that aren’t so important when you are running from hungry lions on the African Savannah (flight).
Unfortunately for these people, repeated cortisol release caused by low blood sugar can also suppress pituitary function.
And the pituitary is the master gland that instructs the thyroid. If this function isn’t working properly, then “Houston, we have a problem.”
And where do we have a problem? In the thyroid.
Cortisol directly inhibits the enzyme (5’-deiodinase) which converts inactive T4 into active T3. This can lead to low T3 levels.
In addition, elevated cortisol will cause thyroid hormone receptor insensitivity meaning that even if T3 levels are high enough, they may not be able to bind normally to receptor sites. And when this happens it doesn’t get into the cells.
Cortisol will also increase the production of reverse T3 (rT3) which is inactive. (It’s kind of like the anti-hormone.)
rT3 can cause an increase in the production of substances known as thyronamines that can cause hypothyroid symptoms (like, low basal body temperature,fatigue, depression, etc.) along with insulin resistance symptoms of increased blood sugar.
Cortisol can also lower the levels of protein that binds to thyroid hormone so it can circulate in a stable structure.
And finally, elevated cortisol will slow TSH production by messing with hypothalamic-pituitary feedback leading to lower TSH production.
In my previous post on the adrenal glands we learned about the HPA (hypothalmus-pituitary-adrenal) axis.
Well, there is also an HPT (hypothalmus-pituitary-thyroid) axis.
And much like wires going through a transformer on an electric grid, the HPT and HPA axis are very closely related and problems in one area can affect the other.
“When things go wrong, wrong with you, it hurts me too.” sings the HPA to the HPT axis.
Common symptoms of hypoglycemia include (These come from a form called a Metabolic Assessment Form that I use in my practice that I got from studying with Dr. Datis Kharrazian):
(Many of these symptoms improve when you eat )
*Craving sweets
*Irritable if meals are missed
*Depend on coffee or other kinds of caffeine for energy
*Eating relives fatigue
*Feel shaky, or jittery
*Feel agitated or nervous
*Get upset easily
*Poor memory, forgetful
*Blurred vision
It’s important for hypoglycemics to eat often throughout the day and not skip meals. Each meal should be a combination of protein, carbohydrates and fats. And, for these people, too many carbs will often cause serious problems with their blood sugar levels.
When you eat too many carbs and too much sugar, the pancreas secretes insulin to move extra glucose from the blood into the cells where glucose is used to produce energy.
But over time, the cells lose the ability to respond to insulin. It’s like insulin is a little dog barking outside the cell, but the cell won’t let it in.
“I hear you barking, but you can’t come in.”
The pancreas responds by pumping out even more insulin (barking louder) in an effort to get glucose into the cells, and this eventually causes insulin resistance.
Studies have shown that the repeated insulin surges that come with insulin resistance increase the destruction of the thyroid gland in people with autoimmune thyroid disease.
Let me repeat that, insulin resistance increases the destruction of the thyroid gland in autoimmune thyroid disease (Hashimoto’s).
As the thyroid gland is destroyed, what happens? Thyroid hormone production falls. And this causes hypothyroidism. Not good.
Insulin resistance can also cause a reduced conversion of T4 to T3 hormones.
When this is addressed, the cells can once again start using glucose for energy and T3 production picks up.
So for a person who is insulin resistant, a lower carbohydrate diet may help restore better T4 to T3 conversion and often these people lose weight in the process ( a nice side effect).
For other people, other things like long-term chronic stress may be affecting their response to low carb diets. As we have seen in my previous post, chronic stress can interfere with thyroid hormones in several ways.
(These are also from that form mentioned above):
(Eating generally doesn’t improve these symptoms )
* Fatigue after meals (this is the hallmark symptom)
* General fatigue
* Constant hunger
* Craving for sweets that isn’t relieved when you eat sweets
* Must have sweets after meals
* Waist girth equal to or larger than hip girth
* Frequent urination
* Increased appetite and thirst
* Difficulty losing weight
* Migrating aches and pains
Life is not a textbook. Many people are somewhere in the middle of this blood sugar odyssey and they have some symptoms of hypoglycemia and some symptoms of insulin resistance.
I put this question to my Facebook Support Group and of the 66 respondents with Hashimoto’s, 24 reported symptoms of hypoglycemia and 14 reported symptoms of insulin resistance.
16 reported some symptoms of both.
While this is hardly a scientific study, it does demonstrate how common this problem is in this population.
On thing that’s important to understand is that whether you have high or low blood sugar, you probably have some amount of insulin resistance.
I explained how high blood sugar causes insulin resistance above, but insulin resistance can also cause low blood sugar.
This condition, called reactive hypoglycemia, happens when the body secretes excess insulin in response to a high sugar and carbohydrate meal.
For example: A burger on a sesame seed bun, french fries and a soda – causing blood sugar levels to spike and then drop below normal. (I’m not lovin’ it!)
If you eat like this and you have Hashimoto’s (and hypothyroidism), you are setting yourself up for a world of hurt.
Hypo-function of the thyroid can cause everything we just talked about because:
These mechanisms present clinically as hypoglycemia. When you’re hypothyroid, your cells aren’t very sensitive to glucose (they are resistant).
So although you may have normal levels of glucose in your blood, you’ll have the symptoms of hypoglycemia (fatigue, headache, hunger, irritability, etc.).
And since your cells aren’t getting the glucose they need, your adrenals will release cortisol to increase the amount of glucose available to them.
This causes a chronic stress response, as I described in a previous post, that suppresses thyroid function.
Does this sound familiar?
In another post on Synthroid, TSH and T4, I wrote about how some people are functionally hypothyroid. In other words, they have enough thyroid hormone, but it’s not getting into the cells.
Many of these people also have enough sugar in their blood but its not getting into the cells. Its another vicious cycle.
And let me tell you this from clinical experience. It is really, really, really, really, really, really, really, hard to manage a Hashimoto’s patient or someone with functional hypothyroidism if he or she doesn’t stop this sugar happy carb fest.
In fact, I’m going to say it. It’s a deal breaker.
If this high sugar diet isn’t stopped, you might as well throw in the towel, pack it in, wave the white flag, say “Uncle”, hear the fat lady sing, and give up, because you’re done.
All the money you’re spending on supplements and therapies won’t work. Instead, the first thing you need to do is to balance your blood sugar.
When balancing blood sugar, there are two things to consider. The first is fasting blood glucose, which can be measured first thing in the morning before eating or drinking anything.
In functional medicine we define normal range for fasting blood glucose as 75 – 95 mg/dL. Although 100 is often considered the top of the range for normal, studies have shown that fasting blood sugar levels in the mid-90s may set the table for future diabetes a decade later.
And although 80 mg/dL is often defined as low end of the range, plenty of healthy people have fasting blood sugar in the mid-to-high 70s (especially if they follow a low-carb diet – all you Paleo fans- time to do the wave).
The second, and more important thing to measure is post-prandial blood glucose. This is measured 1-2 hours after a meal.
Several studies have shown that post-prandial blood glucose is the most accurate predictor of future diabetes and is the first marker (before fasting blood glucose and Hb1Ac) to indicate blood sugar imbalances.
Normal post-prandial blood sugar one to two hours after a meal is 120 mg/dL, but most normal people are under 100 mg/dL two hours after a meal.
How does this apply to you? If you’re hypoglycemic, your challenge is to keep your blood sugar above 75 throughout the day.
The best way to do this is to eat a low-to-moderate carbohydrate diet (to prevent the blood sugar fluctuations I described above), and to eat frequent, small meals every 2-3 hours (to ensure a continuous supply of energy to the body.
If you’re insulin resistant, your challenge is to keep your blood sugar below 120 two hours after a meal.
The only way you’re going to be able to do this is to restrict carbohydrates.
Everyone should buy a blood glucose meter. The technology has gotten to the point where they are very precise and quite inexpensive.
How low-carb do you need to go?
Its different for everyone. (But, for most people with Hashimoto’s it is recommended to reduce carbs significantly.)
First, figure out your carbohydrate tolerance by buying a blood glucose meter and testing your blood sugar after various meals.
If you’ve eaten too many carbs, your blood sugar will remain above 120 mg/dL two hours after your meal.
Finally, if you have Hashimoto’s, it’s also important that you take steps to make sure your thyroid is properly balanced as well.
As you have seen, this thing works in both directions.
Sugar problems can mess with thyroid function, and thyroid disorders like Hashimoto’s can cause sugar problems and put you at greater risk for hypoglycemia, insulin resistance and if nothing is corrected, diabetes.
As you can also see, there are layers and layers here that may need to be addressed and worked on.
Hashimoto’s is so much more than a thyroid problem. Its a multi-system problem and it requires a multi-system approach.
That’s why I created my program: Healing Hashimoto’s: The 5 Elements of Thyroid Health.
In it you will discover how all these systems interact and cause vicious cycles and you will also learn how to correct these imbalances and heal.
In the meantime, put down the happy meal and step from away from the counter! 🙂
http://www.ncbi.nlm.nih.gov/pubmed/16530289: Study on insulin resistance and inflammation
http://www.eje-online.org/content/134/1/21.extract : Cytokines and autoimmune disease
http://www.ncbi.nlm.nih.gov/pubmed/3500324: Impact of immune cells on TSH
http://care.diabetesjournals.org/content/24/8/1448.full: Study on Glucose Tolerance and Neuropathy
http://nahypothyroidism.org/insulin-resistance-can-trigger-hashimotos-disease/
http://chriskresser.com/thyroid-blood-sugar-metabolic-syndrome
http://diabetes.niddk.nih.gov/dm/pubs/statistics/
http://www.ncbi.nlm.nih.gov/pubmed/939192 : Study on impact of thyroid hormone on insulin secretion.
http://www.ncbi.nlm.nih.gov/pubmed/2013384 : Influence of the thyroid on pancreatic function
http://diabetes.diabetesjournals.org/content/16/9/643.full.pdf+html: Effects of thyroid function on insulin secretion
http://www.ncbi.nlm.nih.gov/pubmed/19364696 : Excess thyroid hormone and carbohydrate metabolism
http://www.huffingtonpost.com/t-colin-campbell/low-fat-diets-are-grossly_b_740543.html
The Thyroid: A Fundamental and Clinical Text, Lewis E. Braverman & Robert D. Utiger, Ninth Edition, Lippincott, Williams & Wilkins, 2005
Why Do I Still Have Thyroid Symptoms? (When My Lab Tests Are Normal), Dr. Datis Kharrazian, Elephant Printing 2010
The human body, like the planet earth, is made of many ecosystems all interacting and influencing each other. With Hashimoto’s many of these ecosystems are altered and dysfunctional.
And one example of this is the interaction between the adrenal glands and the thyroid.
The adrenals are two little glands, about almond size that sit on top of the kidneys.
The one on the right kidney has a triangular shape and the one on the left kidney has a sort of half moon shape.
Each of the adrenals has different inner and outer parts or zones. The inner zone or the medulla is what secretes adrenalin and norepinephrine and just the right amount of dopamine.
These are the stress hormones.
The outer zone……(cue Rod Serling)
You’re traveling through another dimension — a dimension not only of sight and sound but of mind. A journey into a wondrous land whose boundaries are that of the imagination. That’s a signpost up ahead: your next stop……
The outer zone of the adrenal cortex,
this is where 3 different types of hormones are secreted: glucocorticoids, mineralcorticoids and androgens.
These hormones are all made from cholesterol (See? It does do good things.) and are critical to every day function.
Of the glucocorticoids, cortisol is the star.
It is stimulated by ACTH from the pituitary. This is very much like the relationship between TSH (also secreted by the pituitary) and T4.
ACTH and cortisol are the analogous hormones of the adrenals.
What does cortisol do?
It regulates blood sugar levels, increases body fat, defends the body against infections and helps the body adapt to stress. It also helps to convert food into energy and is anti-inflammatory.
What doesn’t it do might be a better question.
There are other hormones produced by the adrenals, but let’s not go there right now. Keep your focus here on the cortisol’s reason for being (or raison d’être, as the French would say).
Ok, so let’s take a look at few different ways that stress, the femme fatale of the body, causes hypothyroid symptoms.
Most people are aware of the obvious forms of stress that affect the adrenal glands: impossibly full schedules, driving in traffic, financial problems, divorce, losing a job, moving, losing a loved one and the many other emotional and psychological challenges of modern life.
But other things you don’t normally think of, also place just as much of a burden on the adrenal glands.
These include blood sugar swings, gut dysfunction, leaky gut, food intolerances (especially gluten), chronic infections, environmental toxins, autoimmune problems and inflammation.
All of these conditions sound the alarm and cause the adrenals to pump out more stress hormones.
So really, stress can be thought of as anything that disturbs the body’s natural balance (or if you like, homeostasis).
Adrenal stress is one of the most common problems encountered in modern clinical practice, because nearly everyone is dealing with at least one of the things I just discussed.
Symptoms of adrenal stress are many, because the adrenals (like its buddy, the thyroid) can affect every system in the body.
Symptoms of Adrenal Stress
Some of the more common symptoms are:
* Fatigue, also a thyroid symptom
* Headaches, splitting headaches especially
* Decreased immunity
* Sleep issues. Difficulty falling asleep, staying asleep and waking up feeling exhausted even after you had enough sleep.
* Mood swings
* Sugar and caffeine cravings, (have a hankering for a Red Bull? It could be your adrenals)
* Irritability or lightheadedness between meals, a blood sugar and adrenal problem
* Eating to relieve fatigue, another blood sugar problem
* Dizziness when moving from sitting or lying to standing, it affects your blood pressure
* Gastric ulcers, ulcers in the stomach can be caused by the adrenals
Weak adrenals can cause hypothyroid symptoms alone without any problem in the thyroid gland itself.
In such cases, working on the adrenals themselves may be the key to improving thyroid function.
The most significant indirect effect the adrenals have on thyroid function is through their affect on blood sugar.
Low or high cortisol – caused by any of the chronic stressors listed above – can cause hypoglycemica, insulin resistance or both.
Blood sugar imbalances cause hypothyroid symptoms in a variety of ways. (More on this in an upcoming post).
But adrenal stress also has more direct impacts on thyroid function. And, (darn the luck!) hypothyroidism has a direct impact on adrenal function. (I feel a vicious cycle coming on!)
Let’s reflect on non-linearity for a moment, none of this happens in one direction. Hypothyroidism impacts adrenal function and adrenal function, in turn, impacts the thyroid.
First, what happens with the adrenals when the body is in a hypothyroid or functionally hypothyroid state?
There is a very clear link between hypothyroidism and hypoadrenalism. When there is trouble from this, it is often linked to problems in a part of the brain called the hypothalmus.
The hypothalamus is really like the boss of the boss. (The pituitary is the master or boss endocrine gland and the hypothalamus is the pituitary’s boss.)
You know, like when the boss is real arrogant and always doing bossy things and then, all of a sudden, the boss’s boss shows up and he gets put in his place?
Well, the pituitary and the hypothalamus’ relationship is nothing like that. (Just wanted to see if you were paying attention.) 😉
Their relationship is more like, “Hey, we have this amazingly complex, super complicated body to run, do you want to help each other? Cool. Oh and by the way, this is not linear.”
With the adrenals, this little benevolent, enlightened dictatorship is called the hypothalmic-pituitary-adrenal axis or the HPA axis. These 3 run the whole show.
The HPA axis plays a major role in regulating immune function, digestion, energy use, mood and thrill of thrills, sexuality.
This HPA axis is controlled by hormones (in a non-linear fashion) and it is totally manipulated by stress.
Stress is like the femme fatale of the HPA axis. It’s the mean wife of the boss’ boss.
Where am I going with all of this?
Well, a dysfunctional HPA axis, like the troubled empire ruled by the mean boss’ wife, can cause all kinds of problems.
With Hashimoto’s, one of the reasons why people continue to feel exhausted even though they are taking thyroid hormones is because of a messed up HPA axis.
And adrenal stress can lead directly to a messed up HPA axis.
Hypothryoidism also impacts the HPA axis. When you are hypothyroid it leads to elevated cortisol due to decreased clearance and a negative feedback loop (The HPA axis doesn’t work properly.)
This, in turn, inhibits thyroid function because cortisol inhibits the enzyme (5’ deodinase) that is responsible for converting T4 to the form the body uses, T3.
It can also inhibit TSH. Hmmmm…..
Something else no one ever tells you is that treatment with T4, like Synthroid or Levothyroxine, can cause adrenal problems.
If someone has adrenal insufficiency, then they are at risk for thyroxine making the problem worse!
Even if the adrenal insufficiency is not that bad, it may have an effect on thyroid conversion, tissue uptake, and thyroid response. And not in a good way.
If the T4 to T3 conversion doesn’t happen as it should, the body can become overloaded with unused T4.
If it is converted, but the T3 cannot enter the cell walls due to adrenal insufficiency or iron deficiency, the T3 cannot be used, and may pool or build up in the blood.
Studies have shown that very high levels of T3 can be toxic to the liver.
Sometimes this T3 pools and then releases or dumps into the blood stream. When this happens, you may suddenly feel all the hyper symptoms like heart palpitations, insomnia, nervousness, etc. This is one of the reasons why some Hashimoto’s people experience hyper to hypo cycles.
In many cases, T4 and TSH blood tests will appear normal, but the patient will feel really lousy.
If a doctor raises the thyroxine dose in this situation, things may become worse. How bad depends on the degree of adrenal insufficiency.
Symptoms may include all the symptoms mentioned above.
And check this out! (This comes from the warning label for Synthroid, but is true of all synthetic T4 drugs.)
“Patients with concomitant adrenal insufficiency should be treated with replacement glucocorticoids prior to initiation of treatment with levothyroxine sodium.
Failure to do so may precipitate an acute adrenal crisis when thyroid hormone therapy is initiated, due to increased metabolic clearance of glucocorticoids by thyroid hormone.”
What this means, in plain English, is that in cases of hypothyroidism, the adrenals need to be evaluated before putting patients on thyroid replacement hormone.
How many people with Hashimoto’s and hypothyroidism do you think have adrenal insufficiency?
I put this question to my Facebook support group and 100% of the 85 respondents with Hashimoto’s said they had most of the symptoms of adrenal insufficiency mentioned in the list I posted above. Granted, that’s not a scientific study, but it certainly is emblematic of this problem.
Have you ever heard of a doctor checking for this prior to beginning treatment?
It’s not very common, believe you me. Many doctors dismiss adrenal insufficiency as one of those make believe disorders.
The other side of this is the many ways that adrenal stress can cause hypothyroidism.
As we discussed above, it messes with the HPA axis and this, in turn, messes with the HPT (hypothamus-pituitary-thyroid) axis. Communication gets all garbled all around.
And we all know how important good communication is. Especially when you have a super complicated body to run.
Adrenal Stress Can Lead to Autoimmunity
The GI tract, lungs and the blood-brain barrier are the main immune barriers in the body.
They prevent the bad guys from entering the bloodstream and the brain.
Adrenal stress weakens these barriers, weakens the immune system in general, and promotes poor immune system regulation.
Cortisol can impact this in both directions. Too little cortisol causes the immune system to rev up and can lead to an over aggressive immune response.
Too much cortisol can weaken the immune system and make you more vulnerable to attacks or unable to defend yourself.
When these immune barriers are breached large proteins and other antigens are able to pass into the bloodstream or brain where they don’t belong.
If this happens over and over again, the immune system gets thrown out of whack and we become more prone to autoimmune diseases – such as Hashimoto’s.
Adrenal Stress Leads to Thyroid Hormone Resistance
In order for thyroid hormone circulating in blood to work, it must first activate receptors on cells.
Inflammatory immune cells called cytokines have been shown to make thyroid receptor sites less sensitive.
With insulin resistance, where the cells gradually lose their sensitivity to insulin, we see a similar pattern. There it is insulin, here it is thyroid hormone.
It’s like thyroid hormone is knocking on the cell’s door, but the cells don’t answer.
“I hear you knockin’ but you cain’t come in.”
A perfect example of this in practice is the Hashimoto’s patient who is taking replacement hormones but still suffers from hypothyroid symptoms – often in spite of repeated changes in the dose and type of medication.
In these patients, inflammation is depressing thyroid receptor site sensitivity and producing hypothyroid symptoms, even though lab markers like TSH, T4 and T3 may be normal.
Adrenal stress reduces conversion of T4 to T3
93% of the hormone produced by the thyroid gland is T4, it is inactive in that form and must be converted into T3 before it can be used by the cells.
The inflammatory cytokines I just mentioned not only disrupt the HPA axis, they also interfere with the conversion of T4 to T3.
The enzyme 5″-deiodinase is responsible for the conversion of T4 into T3 in peripheral tissues such as the liver and the gut.
Both Th1 and Th2 inflammatory cytokines – IL-6, TNF-alpha, IFN-gamma and IL-1 beta – have been shown to suppress the conversion of T4 to T3.
In patients without thyroid illness, as levels of IL-6 (a marker for inflammation) rise, levels of serum T3 fall.
These inflammatory immune cells make T3 and TSH levels go down and reverse T3 levels go up.
So, adrenal insufficiency leads to poor conversion and adrenal stress due to inflammation can lead to this, as well. Giving us a lovely double whammy.
Adrenal stress causes hormonal imbalances
Cortisol also acts on the liver. When it is high, caused by chronic stress, this decreases the liver’s ability to clear certain hormones, like excess estrogens from the blood.
Excess estrogen increases levels of thyroid binding globulin (TBG), the proteins that thyroid hormone is attached to as it’s transported through the body.
When thyroid hormone is bound to TBG, it is inactive. Meaning it doesn’t work.
It must be taken from TBG to become “free” before it can activate the receptors on cells. (These are the free-fraction thyroid hormones that you see on lab tests as “free T4 [FT4]” and “free T3 [FT3]“.)
When TBG levels are high, the percentage of free thyroid hormones drops. This shows up on labs as low T3 uptake and low free T4/T3.
When stress is not the cause, the most common reason for elevated TBG are birth control pills and estrogen replacement (i.e. Premarin).
Here’s the tricky thing about adrenal stress: it’s almost always caused – at least in part – by something else.
These causes include anemia, blood sugar swings, gut inflammation, food intolerances (especially gluten), essential fatty acid deficiencies, environmental toxins, and of course, chronic emotional and psychological stress.
Sound familiar?
These are also all the things that make Hashimoto’s worse.
You can’t ignore them or pretend like they aren’t there like so many doctors do. We have to deal with all of them.
All of them. Half measures don’t lead to half results, they often lead to no results.
When they exist, these conditions must be addressed or any attempt to support the adrenals directly will either fail or be only partially successful.
So much more than a thyroid problem. Hashimoto’s is a multi-system problem.
Need help? I offer a free 30 minute Hashimoto’s Healing Strategy Session. In it you can share where you are, where you want to be and I can give you some recommendations that will help right away.
Book your session now: https://hashimotoshealing.as.me/strategy
This has been a long, exhausting blog post. It’s time to rest (for the sake of our adrenals). In an upcoming post I’ll look at all the things we can do to love our adrenals back to health. 🙂 Stay tuned!
References:
http://www.rxlist.com/synthroid-drug/warnings-precautions.htm
https://cfids-cab.org/cfs-inform/Neuroendocrin/tsigos.chrousos02.pdf – Adrenal stress leads to Hashimoto’s
http://www.karger.com/Article/Abstract/87001 -HPT and HPA responses during repeated stress
The Thyroid: A Fundamental and Clinical Text, Lewis E. Braverman & Robert D. Utiger, Ninth Edition, Lippincott, Williams & Wilkins, 2005
Hashimoto’s Thryoiditis, Izabella Wentz, Wentz LLC publishing, 2013
http://www.holtorfmed.com/blog/adrenal-health-understanding-the-adrenal-and-thyroid-connection/
http://articles.mercola.com/sites/articles/archive/2000/08/27/adrenals.aspx
http://www.ncbi.nlm.nih.gov/pubmed/3527687
http://www.ncbi.nlm.nih.gov/pubmed/3500324
There is no question that exercise is a very important part of any healthy lifestyle. This is especially true if you have an autoimmune disease. However, when you exercise with Hashimoto’s you must be careful to do it properly or you can wind up doing more harm than good.
In this post we examine new research on exercise and look at the best type of exercise program for people with Hashimoto’s.
Exercise has many health benefits and many of these are hugely important if you suffer from Hashimoto’s. In my last post, I mentioned a lecture I attended that was taught by Dr. Datis Kharrazian, here is some additional information I learned and how I think it applies to Hashimoto’s people. According to Dr. Kharrazian, the benefits of exercise include:
* Growth Hormone Release
* Opioid Response
* Nitric Oxide Synthase (eNOS) Responses
* Brain-Derived Neurotrophic Factor Release
* Insuline Receptor Sensitivity
* Immune Enhancement
Growth hormone stimulates cell reproduction and regeneration, and growth in our bodies. It also has a number of positive effects on our nervous, endocrine, and immune systems
A lot of growth hormone’s effects are felt in the liver where it can improve the burning of body fat, improve blood glucose levels and increase protein synthesis.
It also has important effects on the nervous system where it can improve synapses in the brain. It also improves heart function, immune function and decreases recovery time.
In addition, it has been found to increase calcium absorption and improve bone density.
Studies have shown that growth hormone release is increased with increased exercise intensity. (So walking on a treadmill and watching t.v. probably won’t result in much being released.)
Hypothyroidism can cause increases in body fat and alter lipid metabolism, and can lead to poorer absorption of calcium and protein. So these effects can be very beneficial for Hashimoto’s patients.
Exercise has been found to release the body’s natural opioids called endorphins and enkephalins. This is commonly known as the “runner’s high” or that blissful feeling that you get after certain kinds of exercise and sports.
Endorphins have many positive effects including pain relief, stress reduction, and improving our moods. Exercise can also result in the release of more dopamine and serotonin both of which are responsible for happiness and satisfaction with life and relationships.
Studies have shown that moderately high to high intensity exercise stimulates the release of these natural proteins. It also seems to depend on the individual with some people needing to do more than others.
Hypothyroidism can lead to declines in dopamine and serotonin and to feelings of depression and overwhelm. Some of the most widely prescribed drugs for Hashimoto’s people are anti-depressants, so exercise can have huge benefits for these people, as well.
Nitric Oxide Synthases (NOS) are enzymes that can do both good and bad things in the body. Increased eNOS (endothethelial NOS) increases blood flow which can get more blood to the brain, can improve heart health and can get more nutrients and oxygen to our bodies’ cells. This results in tissue repair and more energy.
Increased nNOS (neuronal NOS) causes more muscle contraction and brain focus which results in improved performance in various activities.
On the other hand, increased iNOS (inducible NOS) can result in a host of bad things like: surges in destructive immune cells called cytokines, damage to mitochondria and inflammation. Too much of this can lead to injury, muscle wasting and breakdown and pain.
(Arginine is an important nutrient for iNOS and should be avoided before exercise.)
NOS plays a key role in cardiovascular, immune and brain function. All things that can be compromised in Hashimoto’s people.
It seems that the right amount of exercise is key for getting the right amounts of the right kinds of NOS. Too little and you won’t get the benefits, too much and you get the damaging consequences mentioned above. One again, the key is high intensity, but not for too long.
BDNF helps with nerve growth and differentiation in the brian. It is very important in building new nerve pathways and preserving and keeping healthy old ones. So it is critically important in maintaining a healthy brain and in slowing the destruction of nerves in the brain that can lead to dementia and Alzheimer’s.
Exercise increases levels of BDNF and also improves brain function. Once again (are you seeing a trend emerging?), the amount released is dependent on the intensity of the exercise.
Brain fog and neuro-degeneration are very common complaints from people with Hashimoto’s. This is caused by numerous things, but the underlying mechanism is inflammation caused by immune cells and the destruction of brain cells.
Problems with insulin resistance are very common in today’s society and are a driving force in the initiation of Hashimoto’s. It can also prevent people from getting any better once they have developed the disease.
Insulin normally helps sugar get into cells, when people become insulin resistant because they are exposed to too much sugar, the cells of the body start blocking insulin because they can’t deal with so much sugar.
This person feels like she needs to nap after every meal, and may actually fall asleep after eating a carbohydrate rich meal. This person will also have belly fat and will complain of insomnia.
Insulin resistance can drag down thyroid function and contributes to diabetes, heart disease, sleep apnea, hormone problems, obesity and certain types of cancer.
Aerobic and strength-training exercises improve insulin sensitivity by increasing the number of protein molecules called glucose transporters (GLUT), which allow your cells to better respond to insulin.
Hashimoto’s is an autoimmune disease. The immune system has short circuited and attacks the thyroid as if it were a foreign invader.
Exercise can be very beneficial for improving immune function. The right kind of exercise can be helpful in healing the gut and in improving gastrointestinal immunity. Since 70% of the immune system lives in the gut, this can be very beneficial.
But, excessive exercise can actually cause major problems with immune function. And if you have Hashimoto’s it is very important not to overtrain or you can wipe out all of the benefits and actually make many things worse.
It is clear that exercise can be very beneficial for Hashimoto’s patients, but what is the right kind and the right amount?
According to research, the optimal exercise level to achieve all the health benefits described above is high intensity: when doing this you will:
* Break a sweat after 3-5 minutes
* Breathe deeply and rapidly
* Only talk in short phrases while you are doing this.
You want to go hard enough to achieve 70% or greater of your maximum heart rate. This can be calculated by this simple equation: 220 – your age in years = your maximum heart rate.
There is a fine line between the right amount of exercise which can really improve health and too much which can actually cause more health problems.
The key point is this: The more intense the exercise, the greater the potential for health benefits that include everything mentioned above, but also the greater risk of doing too much and this results in the loss of all those benefits.
This is especially true if you suffer from an autoimmune disease like Hashimoto’s because you may not be able to exercise like a normal person and you may reach the threshold of maximum benefit sooner than people who do not have this condition.
Dr. Kharrazian also noted that there are a number of things that can make exercise not work for you. If you have any of these conditions, you must be very careful not to overdo it when working out.
These conditions include:
* Pre-existing high or low cortisol levels
* Pre-existing systemic inflammation
* Pre-existing immune weakness
* Pre-existing intestinal permeability
* Pre-existing hormone imbalance
* Pre-existing nutrient deficiencies
* Pre-existing obesity
People who suffer from Hashimoto’s often have a majority of conditions from that list, which means they are very vulnerable to getting worse as the result of exercise.
There are a number of signs and symptoms that can help you identify if you are working out too much.
Performance Signs and Symptoms
If you have a hard time recovering from workouts, can’t complete your workouts, notice your performance is declining or that you have more injuries then you may be doing too much.
Psychological Signs and Symptoms
If you are exercising frequently and you notice a loss of motivation and enthusiasm, a loss of competitive drive, depression, irritability or aggression for minor reasons then you may be doing too much.
Physical Signs and Symptoms
If you are exercising regularly and you notice that you have a weakened immune system, a loss of libido, loss of menstrual cycle, decreased muscle strength or unexplained increases or decreases in weight then you may be over doing it.
The Best Workout: Maximum Results With Minimal Energy Expenditure
An article in the May-June issue of the American College of Sports Medicine’s Health & Fitness Journal offers an example of an optimal 7 minute workout that can be used as a starting point for Hashimoto’s patients and can be utilized to achieve all the health benefits without causing any of the negative effects of overtraining.
I really like this workout because it can help you achieve all the health benefits we have discussed in a very short time, it works on your entire body and it can be modified so that you can do more or less.
This entire workout can be done at home, in a hotel room or anywhere that has an open room and a chair. You don’t need to purchase any equipment and you can do it by yourself without having to hire a personal trainer or therapist.
The entire workout is 7 minutes and you can repeat the circuit up to 3 times. It consists of 12 different exercises each done at high intensity for 30 seconds.
For people with Hashimoto’s, I recommend starting with one cycle and seeing how you feel. For some, even a 7 minute workout will prove to be too much. If that is the case, cut the 30 second intervals in half.
If you are able to do all 12 exercises as suggested for 30 seconds then do one interval for one to 2 weeks (a minimum of 4 times per week). Repeat the entire sequence after 2 weeks and then add a third repetition after an additional 2 weeks. If pressed for time, you can simply do 1 round of 7 minutes.
The optimal time to get most benefit is within 10 minutes after you wake up, before you have had breakfast. This is the perfect time to exercise because you can take advantage of your body’s natural cortisol surge and exercising before breakfast will also help you burn fat more efficiently and help reduce insulin resistance.
For my patients and myself, I recommend taking a drink that provides electrolytes (not Gatorade – which is loaded with sugar). Here’s a recipe for a simple Electrolyte Lemonade:
Electrolyte Lemonade:
3 organic lemons, peeled, but leave white pith intact
3 tablespoons coconut oil, olive oil or flax oil
1 organic pear, cored
1 tablespoon Celtic sea salt or Himalayan Salt
6 cups filtered water
Blend everything well in a Vitamixer, makes 1 pitcher
Drink 1 glass before your workout.
It is also recommended to support nitric oxide synthase production. The following nutrients and co-factors can do this: ATP, N-Acetyl L-Carnitine, Huperzine A, Alpha-GPC, Vinpocetine and Xanithol Nicotinate. This will help boost eNOS and nNos.
After the workout take something that will reduce inflammation and support the immune system like turmeric and/or resveratrol and another glass of electrolyte lemonade.
Hashimoto’s is a complicated condition that can impact all the major systems of the body. In order to treat it effectively, you really need to adopt a lifestyle that supports you with the right kind of diet, exercise and supplement regimen to get you feeling your best and to slow or stop the destructive progress of the autoimmune disease.
Would like help in designing the right kind of diet, exercise and supplement regimen from someone who has worked with over 2,000 people with Hashimoto’s?
I offer a free 30 minute Hashimoto’s Healing Strategy Session. In it you can share where you are, where you want to be and I can give you some recommendations that will help right away.
Book your session now: https://hashimotoshealing.as.me/strategy
The Neuroendocrine Immunology of Exercise, Dr. Datis Kharrazian, 2013
Opioids and Exercise. An Update. Sports Med. 1989 Feb;7(2):109-124
Life Food Recipe Book, Annie Padden Jubb and David Jubb, North Atlantic Books, 2003, page 186, Electrolyte Lemonade
Hashimoto’s is the most common autoimmune disease in the United States. And one of the most common complaints for people with Hashimoto’s and hypothyroidism is that they have difficulty with weight loss.
This is even true for people who are taking thyroid replacement hormone (especially T4), exercising and eating well. It seems that no matter what they do they just can not get the weight off.
There are many reasons for this and in this post I will explore 4 secrets to weight loss that new research has revealed.
The old model of your metabolism and hormone levels, alone, being the reasons for success or failure of your weight problems is proving to be outdated.
In the old model, the primary reasons for difficulty with weight loss are: eating too much, or eating too much food laced with sugar, fat and salt ( this is a still a real problem for many). In addition, a lack of exercise and hormone related problems like not enough thyroid hormone or excess cortisol.
While these are very real issues and should be considered in any weight related treatment, they have been shown to not be the answer for many women (and men ) with Hashimoto’s struggling with their weight.
I recently attended a seminar taught by Dr. Datis Kharrazian, one of the world’s leading experts on the treatment of thyroid issues with functional medicine, called The Neuroendocrine Immunology of Exercise and he taught us about this new research that has discovered an entirely new model of causes for stubborn weight gain.
This model involves causes of weight problems that are related to the immune system. And this makes sense for people with Hashimoto’s because it is an autoimmune disease and a thyroid disorder.
If blood tests show that your TSH and T4 levels are “normal”, you are eating well and exercising and you still can’t lose weight, then this may be exactly what is going on with you.
According to Dr. Kharrazian, in the immune system model, there are 4 main reasons for stubborn weight gain.
They are:
* The mix of bacteria in your gut
* Intestinal permeability (also known as leaky gut)
* Low grade inflammation
* Immune reactive dietary proteins
Let’s explore each one of these in more detail.
An important thing to understand is that your body is an ecosystem, or really, a lot of interconnected ecosystems. And the digestive tract is one of the most complex and dynamic of them all.
Each one of us has their own unique mix of bacteria and other organisms that live in our guts. This mix is determined by our genetic profile, our diets, what medications we have taken and our environment.
There are an estimated 100 trillion different cells and over 1,000 different species of bacteria. 90% of these species belong to 2 families: Firmicutes and Bacteriodetes.
New research has shown that the balance of these 2 bacterial species matters for whether or not you are able to lose weight.
In obese and overweight people, there is more Firmicutes than Bacteriodetes. The balance between these 2 species of bacteria generates certain signals to specific genes in the intestines that produce more fat cells.
It is also interesting to note that, according to the research, Lactobacillus bacteria (the most common species sold in over the counter probiotics) actually increases body weight. Both dairy and non-dairy sources.
What that means is that while probiotics may be beneficial for the ecosystem of your gut they are not that helpful in helping you shed the pounds.
Firmicutes really like junk food. To feed them and gain weight, eat like your average American. To starve them and lose weight, read on.
The more important question is: how do you increase the Bacteriodetes? It seems these little critters really like plants. And the best way to increase their number is to increase the amount of plant based foods and fiber in your diet.
Especially oligosaccharides (found in Jerulsalem artichokes, and onions, leeks, garlic asparagus and jicama, etc.) and monosaccharides (found in pears, grapes, peaches, apples, pineapples, apricots, bananas, yams, carrots, onions, and sweet potatoes). And other plant based fibers that come from green leafy vegetables, green tea, etc.
These get fermented in the colon by the good guys and help you to become a mean, lean weight loss machine! But, just so you know, this is not something you can change in 5 minutes or 5 days. It may take a few months to alter this environment.
While it is true that people with Hashimoto’s often suffer from intestinal permeability or leaky gut syndrome, new research shows that this can also lead to fat around the organs.
In leaky gut, the intestines lose their ability to keep tiny particles of all sorts of stuff out of the bloodstream. It turns out that there may be a connection between a fatty liver and the breakdown of the gut barrier system.
In addition, zonulin, a protein that is used by the intestines to bind tight junctions, leaks into the blood stream when people have a breakdown of this barrier. It is also increased with obesity associated insulin resistance.
Finally, the toxins that are produced by bacteria known as lipopolysaccharides have also been linked to obesity and the onset of diabetes.
Bottom line: If you want a smaller gut, you need to heal your leaky gut.
Autoimmune disease is a disease that is closely linked to inflammation. So is type 2 diabetes, so is eating a lousy diet and eating too much sugar, salt and fat.
What research is now showing us, is that obesity is also an inflammatory condition. It is becoming less clear which came first. One thing we now know is that adipose tissue (fat tissue) produces inflammation in the body all by itself.
So you have the creation of this destructive cycle of abnormal gut bacteria and leaky gut leading to a process (insulin and leptin resistance) which makes glucose not able to enter cells. When glucose can’t enter cells it gets converted into fat in the liver (triglycerides). These fat cells start the whole process all over again.
Leptin is one of the main hormones involved in hunger, metabolism and the control of how energy from carbs and fats get stored and used. It comes from the Greek word ‘leptos’ meaning thin.
The amount of leptin produced directly correlates with weight loss or weight gain. (Women have significantly higher circulating leptin than men).
Leptin resistance is very similar to insulin resistance. With insulin resistance, long term elevated levels of insulin make your muscle and fat cells more resistance to the action of insulin.
Chronic elevated levels of leptin end up making you eat way too much. And abnormal gut bacteria and leaky gut feed this process as well (pun intended ;)).
This whole process creates more fat tissue which causes more inflammation, and on and on it goes, snow balling and making it harder and harder to lose weight.
So you can see, while this is kind of complicated, it is hugely important to do everything you can to reduce inflammation that is the root cause of everything that we have just examined.
Certain proteins can also add gasoline to the flames of inflammation.
Everything that is living in our world is made of proteins. With autoimmune disease the immune system confuses our own proteins with that of an invader like a virus or a food we are allergic to.
There are some proteins in our diet that can cause an immune response that can also lead to inflammation and add more insult to injury.
These proteins are found in gluten, dairy and soy and in some other foods called cross reactors. You can learn more about them in this post.
These need to be eliminated from the diet if you want to lose weight because this will begin to unwind the vicious cycle of inflammation at the root of the immune system’s influence on weight gain.
Bye bye inflammation, bye bye weight.
Have you had trouble losing the pounds even though your lab test numbers look “normal”?
Do you eat well and exercise, but still can’t lose the pounds?
Do you experience the common symptoms of inflammation like brain fog (inflammation of the brain), joint pain (inflammation of the joints), thyroid nodules (inflammation of the thyroid) and weight gain (body wide inflammation).
Need help? Schedule a 30 minute Hashimoto’s Healing Discovery Session: Click here to set up a time to chat.
The Neuroendocrine Immunology of Exercise, Dr. Datis Kharrazian, 2013
Diabetes. 2007 Jul; 56(7): 1762-1772. Metabolic endotoxemia initiates obesity and insulin resistaence.
Interleukin 18; An Immune Protein That Causes Inflammation in Hashimoto’s
Hashimoto’s is the most common autoimmune disease in the United States, but very few doctors, alternative practitioners or patients understand what is happening to the immune system or what to do about it.
As a result, treatment largely ignores the autoimmune part of the disease. In this post, I break down the basics of the immune system, explain how it affects people with Hashimoto’s and why it matters.
The immune system protects us from foreign invaders. Its like our body’s military. It finds the bad guys (like bacteria, fungus, parasites and viruses) and it kills them. It also cleans things up by destroying our own dead and dying cells. This is called cellular apoptosis, and if this process stops working, cancer develops.
In addition, the immune system creates inflammation as part of the process of healing after an injury. Recent research has shown that immune system has the ability to communicate with the nervous system, the endocrine system and digestive system and that it is actively modulating and influencing the body all the time.
The immune system has many different parts, but the 2 important parts are called non-specific and specific immunity.
Non-Specific Immunity
The non-specific immune system is our immediate attack response. These are the front line soldiers that hang out in our borders (the mucous membranes of our lungs, digestive tract, skin and brain) and kill invaders.
This part of our immune system is called the T-Helper 1 (or TH-1) response. These are the macrophages (the Pac-man cells) and Killer T cells, the elite squads that are pathogen killing machines.
TH-1 is also broken down into messenger proteins like Interleukin-12 (IL 12), Interleukin 2 (IL-2), Interferon Gamma (IFN) and Tumor Necrosis Factor (TNF). These are the bad ass cells that get the job done.
IL-12 is a commander and facilitator that is responsible for helping cytotoxic lymphocytes, natural killer cells mature and it also supplies growth factor to help certain cells grow into the killers that they are.
It is also involved in turning on genes that result in attacks on specific organs and has been implicated as an important player in Hashimoto’s.
IL-2 is synthesized by CD 4 T cells, it increases antibody production, improves bone marrow responses to other immune cells and is used in the treatment of HIV.
A close relative of IL-2, IL-15, has been shown to be low in Hashimoto’s and treatment with levothyroxine increases IL-15 levels, as do some Chinese herbs.
Here is a perfect example of the contradictory nature of the immune system. Increasing IL-15, some theorize, may reduce the destruction of thyroid cells in Hashimoto’s.
Interferon Gamma is another commander that fights viruses and prevents their RNA from passing on genetic information, it activates the pacman cells (macrophages) to destroy organisms that get inside of cells and it kills tumor cells.
Tumor Necrosis Factor (alpha) also kills tumor cells, it turns on angiogenesis (the hallmark of malignant tumors), promotes fibroblasts and is involved in wound healing.
TNF (beta) is another commander who helps kill tumor cells, activates genes, and it helps instruct CD8 T cells, NK cells, and helper-killer T cells to induce them to fatally injure their targets.
A TNF receptor called CD95, which is responsible for cell death, has been found to be very high in patients with Hashimoto’s.
Specific Immunity
The specific immune system produces antibodies that label the bad guys. This part of the immune system is like the C.I.A., it gathers intelligence on the invaders and it labels them with an antibody. Once a foreign invader has been labeled by an antibody, its much easier for the killer cells to destroy it.
And like the C.I.A., it takes a while for them to gather the intelligence, so this process is usually delayed for a period of time. This part of the immune system is called T-Helper 2 (or TH-2).
These cells also do more than just labeling, they also attach themselves to certain cells like viruses to keep them from entering into our cells. This is important because once they are in our cells, they are much harder to kill and they can replicate more quickly.
TH-2 is also broken down into interleukins. The proteins IL-10 and IL-4 being 2 important ones.
IL-10 has been implicated in numerous autoimmune disease such as type I diabetes and multiple sclerosis. But it is another perfect example of the unpredictability of the immune system. It turns on some immune functions and shuts off others. It can block IL-1, IL-6 and TNF alpha, but turns on IL-2 and IL-4.
IL-4 is produced by CD 4 T cells and activates IgE, an immunoglobin important for creating immunity to parasites and involved in allergies.
To further complicate matters we have other parts of the immune system driving the immune attack and this is the family of interleukins that belong to IL-1. IL-1 is released by the pacman cells that are the front line attackers.
IL-18 belongs in this family of proteins and there is a lot of it in Hashimoto’s patients, especially those with severe symptoms that don’t respond to levothyroxine treatment. It may be responsible for severe inflammation.
Both parts of the immune system are needed for certain types of invaders. For example, viruses are often very small and can sneak past the border security. Then the TH-2 system uses it’s cellular informants to sniff them out and it tags them.
This can take several days to initiate and this is why it takes most people a few days to fight the common cold, which is caused by a virus.
In a general sense, the TH-1 system is considered inflammatory and the TH-2 system is considered anti-inflammatory. But in reality, they are both involved in the process of inflammation. And IL-12 and IL-18 are important drivers of inflammation in Hashimoto’s.
Recent research has shown that there are other parts of the immune system that play important roles in this process. T-Helper 3 (TH-3) cells are the regulatory part of the immune system. They help to orchestrate TH-1 and TH-2 cells and act as kind of cellular general to call off or calm the attack.
T-Helper 17 (TH-17) cells are instigators and they rev up the attack and can make the damage and the carnage much more intense. A delicate balance of all parts of the immune system is important and with an autoimmune disease, like Hashimoto’s, this balance is lost.
There are many possible reasons for the immune system to start labeling the thyroid as foreign tissue and create autoimmune thyroid conditions (including genetics, environment, endocrine imbalance, chemical exposure, responses to viruses and other antigens, stress responses and more).
It is probably some combination of those many factors that lead to the loss of self tolerance and the immune system attacking the body’s own tissue.
In most cases of Hashimoto’s, some combination of the factors mentioned above lead to a slow, gradual attack against the thyroid. This eventually leads to the loss of enough thyroid cells that the condition presents as primary hypothyroidism and is seen on a blood test as high TSH.
TSH becomes high because, when the thyroid is not working properly, the pituitary gland increases production of TSH to increase thyroid gland activity. For most people with Hashimoto’s, the thyroid never develops overactive symptoms. Over time, they develop symptoms of low thyroid function and get put on thyroid replacement hormone.
The issue of the autoimmune attack is never addressed. Instead, they are considered to be properly managed by having normalized TSH.
In a sense, these patients are having their TSH managed, but they are not managing the underlying problem. Over time, they lose more and more thyroid cells and they need more thyroid replacement hormone.
The result, for many people, is that they continue to have all the hypothyroid symptoms (like fatigue, hair loss, depression, constipation, cold hands and feet, etc.) because the root cause has been largely ignored.
Since the thyroid is being destroyed, there is less thyroid hormone production. The immune system needs thyroid hormones to modulate TH-1 and TH-2 activity, so when this happens, the immune system can short circuit.
This leads to a larger number of TH cells, and autoantibody producing B cells. These cells accumulate in the thyroid and kill thyroid cells.
There are many possible scenarios that can lead to this outcome. For example:
In his book, Why Do I Still Have Thyroid Symptoms When My Lab Tests Are Normal, Dr. Datis Kharrazian gives some examples of things that can cause this:
* The T suppressor cells that regulate the immune response could be too few in number, and like a weak general that has lost control of his troops, this can lead to unchecked attacks by the immune system. And tissue like the thyroid becomes a casualty.
* TH-1 has a number of different soldiers, known as interleukins. These all have specific jobs. For example, interleukin 2 (IL-2) is a messenger chemical that sends out orders for the killer cells to start killing.
Some people make too much IL-2 and this creates a frenzy of destruction that can lead to the death of the thyroid cells. Chronic viral infections can cause too much IL-2 to be made and have been linked to the development of autoimmune thyroid disease.
* TH-2 also has lots of different soldiers. Interleukin 4 (IL-4) deploys B cells. Like some rouge C.I.A. agents, these cells can go crazy and tag the wrong proteins, and destruction of thyroid tissue is the result. Parasites and food allergies can cause too much IL-4 to be made.
* Too much sugar can cause the body to rapidly release insulin. These spikes in insulin can stimulate the production of too many B cells, they start tagging too many things, and this can lead to destruction of the thyroid.
And this is just the tip of the iceberg. In reality, there are many variables and many potential reasons for the immune system to short circuit. This is what makes treatment and management so challenging. And this is also why you must have a multi-pronged approach.
In most cases of Hashimoto’s, researchers think TH-1 cells become overactive (but this is not true for everyone and is an oversimplification). It seems IL-18 and IL-12 also act together to throw a beating to the thyroid.
Look for development of drugs that inhibit these 2 interleukins. In the meantime, stay tuned to learn about herbs and foods that can accomplish that naturally!
Hashimoto’s people also often have a weak TH-3 regulatory system and their TH-2 may or may not be out of control. TH-17 is also often wound up, making the attack more intense. And none of this happens in a vacuum.
This is all taking place in the context of the body where the immune system is interacting with the endocrine system, the digestive system and the nervous system. Further complicating the task of unwinding this mess. Its no wonder patients and doctors alike get frustrated and overwhelmed.
The reality is that your Hashimoto’s is not the same as anyone else’s. You may have an overactive TH-1 system or you may not. You may also have a weak TH-2 system or you may not. TH-3 is probably weak and TH-17 is also probably revved up.
And you may have leaky gut, and/or blood sugar issues, and/or adrenal fatigue, and/or anemia, and/or some active parasite or latent viral infection. It goes on and on.
You need an individualized approach that will create a unique action plan for your unique set of circumstances.
This is why I have created my 3 month program: Healing Hashimoto’s: The 5 Elements of Thyroid Health. In this program you will learn how to develop your own unique template for healing your Hashimoto’s and, most importantly, how to calm, balance and manage your immune system.
Here’s a video of a webinar I did called Introduction to the 5 Elements of Thyroid Health that you might enjoy.
In my next post, I will discuss how this is done and we’ll look at some real examples to see how all of these different pieces fit together.
Resources:
http://chriskresser.com/basics-of-immune-balancing-for-hashimotos
http://thyroidbook.com/blog/nitric-oxide-modulation-for-autoimmune-disease/
Drugarin D. The pattern of Th1 cytokine in autoimmune thyroiditis. Immunol Letts, 2000; 71: 73-77
Autoimmune Disease and Chinese Medicine, M.M. Van Benschoten, O.M.D. 9/13/2003
Why Do I Still Have Thyroid Symptoms? When My Lab Tests Are Normal, Dr. Datis Kharrazian, DHSc., DC, MS, Morgan James Publishing, 2010, page 46
Hashimoto’s is an autoimmune disease and a thyroid disease. But the autoimmune part of the disease is often poorly understood and sometimes completely ignored.
There are many reasons for this, but the result is that there is a huge void in our healthcare model for treating, managing and, even, properly understanding this condition. In this post I will explore many aspects of autoimmune disease and why it should matter to you.
There is a a global epidemic of autoimmune disease taking place right now. Its shocking how little attention it is getting. According to the American Autoimmune Related Disease Association’s current statistics: 1 out of every 12 men and 1 out of every 9 women have autoimmune disease.
This is especially shocking when you understand how autoimmune disease is defined. An autoimmune disease is officially recognized when about 70 to 90% of the target disease is destroyed. You don’t just go from 0% to 70% destruction overnight. How many people do you think have undiagnosed autoimmune disease? Millions and millions.
Why aren’t more people talking about this? Is it because its not life threatening? No. Actually, autoimmune disease is the one of the top 10 leading causes of death in female children and women in all age groups up to 64 years of age.
And the numbers are higher than other major diseases: the NIH (National Institute of Health) thinks that up to 23.5 million Americans have autoimmune disease. 9 million have cancer, 22 million have heart disease.
In the US, thyroid autoimmune disease is the most common of all autoimmune disorders, affecting 7 – 8% of the U.S. population. By some estimates, autoimmune disease accounts for approximately 90% of all hypothyroid disorders and these are mostly due to Hashimoto’s.
One thing that is important to understand about autoimmune disease is that it is incurable. The condition can go into remission, but it never goes away. Unfortunately, some healthcare practitioners and patients believe this remission is a cure.
Let me put it to you simply: Anyone who tells you that they can cure your autoimmune disease is either a liar, a con artist or they don’t understand what is going on.
To date, there is no “off switch” to the autoimmune process. Once you have crossed over into autoimmunity you can not turn back. You can learn to manage it effectively, you can calm the attack, but you can never reverse the loss of self-tolerance.
The immune system doesn’t work that way. Once something has been labeled as a bad guy by the immune system, you can’t miraculously change that.
This is true of all autoimmune diseases. We are composed of tissue made of proteins. These proteins have specific amino acid sequences. There are only a finite number of amino acids, so there many places where sequences from one tissue to another have the same sequences.
If your immune system identifies one protein as a bad guy, its not hard for it to mistake another that looks pretty similar. And this is also a natural process, part of the job of your immune system is to get rid of old dead cells.
Let’s take a look at Hashimoto’s as an example:
According to a study from the UK, 14.3 % of Hashimoto’s patients had another autoimmune diseases, with rheumatoid arthritis being the most common. Here’s a list of other common autoimmune diseases that this population could have:
According to Dr. Datis Kharrazian, DC, autoimmune disease is a progressive disease that goes through 3 stages. While these are not recognized by the general medical community, they are very useful clinically.
As I stated above, autoimmune disease is not officially recognized until close to 70 to 90% of the target tissue is destroyed. Wouldn’t it be better to have some other way to identify these diseases before they destroy the target tissue? For my way of thinking the answer is YES!
Stage 1: Silent Autoimmunity
In this stage, the body has lost tolerance to its own tissue, but there are no symptoms yet and it doesn’t really affect the way that the system functions. This stage can, however, be identified by lab tests that show elevated antibodies.
People can stay in this stage for years. This is the best place to begin some sort of treatment because your odds of getting good results are highest.
Stage 2: Autoimmune Reactivity
In this stage, the destruction of the target tissue has begun. There are elevated antibodies and some symptoms. However, the destruction is not significant enough to actually be labeled autoimmune disease because 70 to 90% of the target tissue has not yet been destroyed.
This stage is where a lot of Hashimoto’s patients are. They may or may not have been placed on thyroid replacement hormone and that may or may not have normalized their thyroid lab results. However, the destructive autoimmune process is active and is progressing.
This is a very important stage for treating the immune dysfunction because you have a greater chance to slow or stop the destruction of that tissue and slow the progression to other autoimmune diseases.
Stage 3: Autoimmune Disease
This is the stage where Western medicine finally acknowledges that this is an autoimmune disease. And it takes this long because you need significant destruction of tissue in order to see the destruction with an MRI or ultrasound.
Other findings include elevated antibodies, serious and significant symptoms, lab results, and special studies that all confirm a loss of function.
Unfortunately, this is really late in the game. With Hashimoto’s, this is the stage where the thyroid is almost completely destroyed. Most people don’t reach this stage before they have been given thyroid replacement hormone because the symptoms have already become so serious that they will have sought out a doctor to help them before they got here.
Research on the effects of thyroid hormone therapy suggest that L-T4 (Levothyroxine) does reduce goiter size and autoantibody levels, however it does not seem to have an effect on specific immune cells that are known to be involved in autoimmune attacks.
That being said, there is evidence that taking thyroid hormone replacement in Stage 1 or Stage 2 may help slow the progression of the disease and this includes its progression to other diseases.
According the Mary Shomon, thyroid advocate, “The practice of treating patients who have Hashimoto’s thyroiditis but normal range thyroid function tests is supported by a study, reported on in the March 2001 issue of the journal Thyroid.
In this study, German researchers reported that use of levothyroxine treatment for cases of Hashimoto’s autoimmune thyroiditis where TSH had not yet elevated beyond normal range (people who were considered “euthyroid”) could reduce the incidence and degree of autoimmune disease progression.
In the study of 21 patients with euthyroid Hashimoto’s Thyroiditis (normal range TSH, but elevated antibodies), half of the patients were treated with levothyroxine for a year, the other half were not treated.
After 1 year of therapy with levothyroxine, the antibody levels and lymphocytes (evidence of inflammation) decreased significantly only in the group receiving the medication. Among the untreated group, the antibody levels rose or remained the same.
The researchers concluded that preventative treatment of normal TSH range patients with Hashimoto’s disease reduced the various markers of autoimmune thyroiditis, and speculated that that such treatment might even be able to stop the progression of Hashimoto’s disease, or perhaps even prevent development of the hypothyroidism.”
Thyroid hormone may definitely provide some benefits, and there are also natural sources of thyroid hormone for those in stage 1 or stage 2 who may want to go the natural approach.
In my practice, we use a product that has thyroid glandular and a number of other herbs and supplements that support the thyroid gland, thyroid hormone function, thyroid hormone receptor binding and promotes healthy T3 and T4 levels.
Even though the research mentioned above has shown that there may be some benefit to thyroid replacement therapy, for many people it is not enough. The reasons for this is simple, they are doing nothing to stop the triggers that drive flare ups of the autoimmune attack and they are not working to balance the immune system.
For example, there are many things that can be done to strengthen the regulatory part of the immune system (this is the part that slows the attack). It is also important to assess and treat the parts of the immune system that are responsible for the assault on your own tissue.
In future posts in this series I will go in depth about how this works and give you some real clinical examples for how we assess, treat and balance the immune system.
Autoimmune disease is on the rise. It must be taken seriously and anyone with hypothyroid symptoms should be tested for thyroid autoimmune antibodies to rule out Hashimoto’s. Thyroid hormone may help slow the destructive inflammatory process, but by itself it is not enough.
There is a lot you can do to balance your immune system and heal your Hashimoto’s. Because I have Hashimoto’s and another autoimmune disease (Ankylosing Spondylitis) myself I have had to focus on healing and managing autoimmunity.
I’m happy to speak without you about how you can do this effectively, as well. Click here to set up a time to chat: Click here to book a session with Marc
What are your thoughts, comments, questions about this issue?
http://www.ncbi.nlm.nih.gov/pubmed/20103030
https://www.jstage.jst.go.jp/article/endocrj/52/3/52_3_337/_pdf
http://hypothyroidmom.com/hashimotos-your-body-is-not-supposed-to-destroy-itself-right/
http://thyroid.about.com/bio/Mary-Shomon-350.htm
http://www.ncbi.nlm.nih.gov/pubmed/16006728
http://www.thyroidweek.com/en/be-thyroid-aware.html