Having Hashimoto’s is a lot like being an alcoholic. It never goes away and you have to make big changes in your life that may involve giving up people, places and things. You have to create room to heal.
What’s your Hashimoment? Please leave a comment below.
Hashimoto’s is an autoimmune disease.
Did you know that a specific antigen can stimulate the autoimmune attack? For example, a food, mold, bacteria, a chronic virus or a parasite are all examples.
These are Hashimoto’s triggers, they instigate the attack on your tissue by your immune system.
Your immune system attacks proteins and all proteins are made of a sequence of amino acids. There aren’t that many amino acids in nature, so there are certain sequences that are the same.
If antibodies have been created to specific amino acid sequences, then anything that has this same sequence may be attacked. Sometimes, our own tissue has the same amino acid sequences as foods or other things in our environment.
Gluten, is, of course, a perfect example of a trigger. Every time someone who is gluten sensitive eats gluten, it provokes an attack on their thyroid. Gluten has also been found to be very similar in structure to cerebellar tissue. So when you eat gluten, your brain also gets attacked.
Here’s a longer blog post I wrote on this topic.
People can also develop an immune response to environmental toxins and heavy metals. In this case, your body can develop antibodies to a combination of your own tissue and this toxin.
So when you are exposed to these triggers, your immune system responds and your tissue is collateral damage. This can be true of common objects in your house like foam in your pillows or formaldehyde in your furniture.
There is a variety of testing available to find out which of these triggers you may have. With my patients I order tests to test for gluten antibodies (over 24 different proteins), antibodies for environmental toxins and antibodies for other foods that may behave like gluten.
Another thing you can do is to keep a journal. You should note what you eat, what you have been doing, what you were exposed to and how you felt. Over time you may be able to identify some of the common triggers in your diet and your immediate environment.
I spent the weekend at a spiritual retreat and was reminded of the importance of forgiveness. We must forgive our immune systems for attacking our body, forgive those who don’t understand what we are going through, forgive ourselves for not being perfect. It is in forgiveness that we find healing.
Hashimoto’s is the most common cause of hypothyroidism in the United States. An estimated 20 million people suffer from some form of thyroid disease.
Up to 60 per cent have no idea that they have a thyroid problem.Women are five to eight times more likely than men to have thyroid issues.
Fibromyalgia is a multi-symptom disorder that affects an estimated 5 million Americans 18 or older. Between 80 and 90 percent of people diagnosed with fibromyalgia are also women.
This week, I was thinking about the number of patients that I have seen that have been diagnosed with both conditions.
I put the question to my Facebook support group and 74 people with Hashimoto’s responded.
Almost all of them confirmed that they had been diagnosed with both or had all of the symptoms of fibromyalgia.
This is hardly a scientific study, but it does give us some evidence that there is a lot of overlap between the 2 conditions.
As I said, several patients have come to me with a pre-existing diagnosis of fibromyalgia, or FMS, for which they have received little effective treatment or relief.
Many doctors treat these symptoms using drugs rather than uncovering the root cause of the patient’s issues.
Diagnosing fibromyalgia is admittedly difficult. For years it has involved assessing the presence in the patient of multiple symptoms that indicate the syndrome.
Currently, there are three main symptoms which must be present for a fibromyalgia diagnosis. They are:
1. Widespread pain
2. Sleep problems
3. Fatigue
The only existing blood test available is the FM/a, which tests for a lowered cytokine level suggestive of fibromyalgia, but the test is controversial and not yet considered definitive.
I do not mean to diminish or discount a diagnosis of fibromyalgia. What I am curious about is the link between FMS and Hashimoto’s.
Studies have come to indicate there is a component of thyroid dysfunction associated with FMS. A 2007 study by the Division of Rheumatology at the Department of Internal Medicine at the University of Pisa looked into a possible link between fibromyalgia and Hashimoto’s Hypothyroidism. It concluded that the presence of thyroid autoimmunity may predispose one to fibromyalgia.
This opens up the possibility that the opposite may be true: what if in some cases the various symptoms that point to a diagnosis of fibromyalgia are, in fact, just Hashimoto’s (which is often undiagnosed)?
In my own experience, I can tell you that a lot of fibromyalgia symptoms are present in my Hashimoto’s patients.
Is there a connection between the two?
In a review published in Thyroid Science by John C. Lowe and Jackie Yellin at the Fibromylgia Research Foundation, the authors wrote that, based on the available research, “inadequate thyroid hormone regulation is the most likely underlying mechanism of the symptoms and objective abnormalities of patients who meet the criteria for FMS.”
In the authors’ view, only hormone therapy has been seen to result in the mitigation of fibromyalgia symptoms. This, obviously, points to a connection between fibromyalgia and thyroid autoimmunity.
In fact, 2 neuroscientists at Stanford (Dr. Ian Carroll, MD and Dr. Jarred Younger PhD) are currently doing a clinical trial investigating T3 treatment for fibromyalgia.
So, at the very least, FMS and Hashimoto’s share a great number of symptoms. If you are diagnosed with FMS, it is highly advisable that you be tested for Hashimoto’s.
If you aren’t familiar with which tests to order for Hashimoto’s, check out my previous blog post for an in depth discussion on this.
Since there is so much overlap, I have decided to illustrate how virtually all the common symptoms of fibromyalgia can be caused by hypothyroidism (and, often, Hashimoto’s).
According to WebMD the most common symptoms of fibromyalgia are those in italics below. We will examine how hypothyroidism leads to each group of symptoms and why.
• Chronic muscle pain, muscle spasms, or tightness: Muscle-related symptoms are common with patients with hypothyroidism. The symptoms vary, but in a recent series of studies 79% of patients reported some kind of myopathy (muscle pain).
The exact reasons why are not known, theories include impaired glycogenolysis (the breakdown of glycogen to glucose – a reminder of why blood sugar balance is so important), reduced mitochondrial activity (mitochondria are the cell’s energy producers) and a decrease in production of ATP (Adeosine triphosphate), the actual fuel in the cell.
A recent study also showed increased lactate production during exercise with hypothyroid patients – this is also consistent with mitochondria problems.
• Tension or migraine headaches: Any of the causes above or below can lead to tension and headaches.
• Jaw and facial tenderness: Jaw and facial tenderness can also be caused by the same factors that lead to other muscle pain.
• Moderate or severe fatigue and decreased energy: Fatigue and decreased energy are some of the most common symptoms of hypothyroidism and Hashimoto’s.
There are many factors that lead to this including too little thyroid hormone production, the affect of too little thyroid hormone on the adrenals and blood sugar metabolism and the problems with ATP and mitochondria mentioned above.
• Insomnia or waking up feeling just as tired as when you went to sleep: Sleep issues are also incredibly common with hypothyroidism. Instability of thyroid hormone levels due to poorly managed autoimmunity, T3 building up and being released into the bloodstream, and the thyroid’s affect on the adrenals can all lead to insomnia.
With hypothyroidism, too little T4 can lead to a slower breakdown of cortisol. It then builds up in the body and this impacts the HPA axis (hypothalmus-pituitary-adrenal axis). See my past blog post for an in depth look at this.
• Stiffness upon waking or after staying in one position for too long: Hypothyroidism tends to cause a slower relaxation of tendons and some studies have shown high serum creatinine kinase levels. The levels are almost invariably in the MM isoenzyme that is the type of creatinine kinase found in skeletal muscles.
High levels of this enzyme are normally found in people who have been under extreme stress or who have just completed heavy exercise.
• Reduced tolerance for exercise and muscle pain after exercise: This certainly could be caused by what we just discussed. In addition, there are a host of issues that hypothyroidism can cause that relate to reduced tolerance for exercise. Check out my previous post on this.
• Difficulty remembering, concentrating, and performing simple mental tasks (“fibro fog”): According to Dr. Datis Kharrazian, the role of the thyroid on the brain is profound. Thyroid function impacts brain inflammation, plasticity, neurotransmitter activity and general brain function.
Thyroid hormone impacts all neurotransmitter receptors in men and women.
All of them.
So hypothyroidism can impact serotonin, dopamine, acetylcholine and gaba levels.
These neurotransmitters have a huge influence on memory, concentration and mood. Especially acetylcholine. Hypothyroidism can lead to acetylcholine deficiency and inefficient nerve firing.
This can cause memory loss and poor concentration.
Brain fog is brain inflammation, plain and simple. It is really important not to ignore it, like many doctors do. The consequences can be really bad.
• Feeling anxious or depressed: As we just discussed, thyroid hormone impacts all neurotransmitter receptors. Gaba is an inhibitory neurotransmitter, it keeps you calm.
Hypothyroidism can impact gaba synthesis, release and reuptake. All of this can lead to increased anxiety.
Dopamine and serotonin are responsible for enabling us to experience joy and enjoy activities in our life and to get pleasure out of what we do. Hypothyroidism can also impact these neurotransmitters and can lead to deficiencies in both serotonin and dopamine.
• Increase in urinary urgency or frequency (irritable bladder): Acetylcholine deficiency can impact urinary urgency and frequency.
• Abdominal pain, bloating, nausea, and constipation alternating with diarrhea (irritable bowel syndrome): Studies in human and dogs of hypothyroid patients have demonstrated a decrease in the electric and motor activity of the esophagus, stomach, small intestine and colon.
Digestive dysfunction is also incredibly common with hypothyroid patients. Leaky gut has been implicated in the formation and progression of various autoimmune diseases including Hashimoto’s.
Neuropathic symptoms including parasthesias (tingling or prickling sensation caused by issues with peripheral nerves) and painful dysthesias (an abnormal, uncomfortable sense of touch) are also common with hypothyroidism.
The most common type of neurological symptom in hypothyroid patients is carpal tunnel syndrome.
• Sensitivity to one or more of the following: odors, noise, bright lights, medications, certain foods, and cold: Neuropathies involving the cranial nerves (those that control smell, hearing, vision) have all been reported. Hearing loss due to hypothyroidism is the most common and has been reported in 31%-85% of patients.
There are many theories on how hypothyroidism impacts nerves, but some studies have shown demyelination (the loss of the coating around nerve fibers), and axonal degeneration (degeneration of the nerve branches).
• Numbness or tingling in the face, arms, hands, legs, or feet: Certainly, this can be caused by what we just discussed.
• A feeling of swelling (without actual swelling) in the hands and feet: This could be neurological or it could simply be caused by the destructive inflammatory process that is at the root of Hashimoto’s.
As you can see, there is a plausible argument to be made that almost all of the symptoms of fibromyalgia could be rooted in hypothyroidism and Hashimoto’s.
Of course, this begs the question of what to do.
As with all things related to this disease, we are once again reminded that this is a multi-system disorder.
It’s much more than just a thyroid problem and it requires a multi-system approach if you want to manage it successfully.
This is exactly why I created my program: Healing Hashimoto’s: The 5 Elelments of Thyroid Health.
In it, I teach a step by step strategy for finding and healing your issues in all of these systems.
For more information, check out my program here.
References:
http://www.thyroid.org/media-main/about-hypothyroidism/ : Statistics on thyroid disease
https://med.stanford.edu/clinicaltrials/trials/NCT00903877 : Clinical study using T3 to treat fibromyalgia
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1856434/?tool=pubmed : Paper on leaky gut
http://69.89.19.190/thyroidscience/reviews/lowe.yellin.6.17.08/ithr.review.6.17.08.pdf
: A review of the evidence on the link between fibromyalgia and hypothyroidism
http://www.ncbi.nlm.nih.gov/pubmed/21085966 : Study linking fibromyalgia and autoimmune thyroid disease
Rodcolico C, Toscano A, Benvenga S, et al. Myopathy as the persistently isolated symptomaology of primary autoimmune thyroidism. Thyroid 1998;8:1033
Monzani F, Caraccio N, Siciliano G, et al. Clinical and biochemical features of muscle dysfunction in subclinical hypothyroidism. J. Clinical Endocrinol Metab 1997;82:3315
Goti I. Serum creatinine phosphokinase isoenzymes in hypothyroidism, comvulsions, myocardial infarction and other diseases. Clin Chim Acta 1974;52:325
Kowalewski K, Kolodej A. Myoelectrical and mechanical activity of the stomach and intestine in hypothyroid dogs. Am J Dig Dis 1977;22;235
Bhatia PL, Gupta DP, Agrawal MK, et al. Audiological and vestibular function tests in hypothyroidism. Laryngoscope 1977;87:2082
Dyck PJ, Lambert ED. Polyneuropathy associated with hypothyroidism. J Neuropathl Exp Neurol 1970;29:631
The Thyroid: A Fundamental and Clinical Text, Lewis E. Braverman & Robert D. Utiger, Ninth Edition, Lippincott, Williams & Wilkins, 2005
Why Isn’t My Brain Working? Dr. Datis Kharrazian, Elephant Press, 2013
Hashimoto’s: The Liver and the Thyroid
Hashimoto’s can cause a host of problems all over the body, but one place in particular where we can see it’s influence is on the liver and gall bladder.
In this post we explore these relationships and explain why a healthy liver is so important for healing your Hashimoto’s.
The body is not a machine, like our earth it is a group of interacting ecosystems that all talk to one another and influence each other in both good and bad ways.
The liver and the thyroid are a perfect example of this. Here is a brief breakdown of how they interact:
* 60% of thyroid hormone is converted from T4 to T3 in the liver. Both T3 and T4 are glucoronidated and sulfated there. (More on that in a minute).
* Thyroid hormone influences the way that cholesterol and other lipids are synthesized and broken down (and where does this happen? – yes, the liver). With Hashimoto’s and hypothyroidism, this is often slowed down resulting in high cholesterol and other lipids like LDL and triglycerides.
* Thyroid hormone affects detoxification pathways in the liver and affects insulin growth factor and cytochrome P450 enzymes which metabolize lots of drugs and environmental toxins. When this slows you can have toxins build up.
* On the autoimmune side, research has shown a link between autoimmune thyroid and autoimmune liver diseases.
*Very high levels of thyroid hormone (T3) can raise bilirubin levels and can actually be toxic to the liver because it damages mitochondria.
The liver has several pathways through which it metabolizes hormones, filters toxins, and cleans the blood. Byproducts from these processes are dumped into the gall bladder to help get them out of the body.
Low thyroid function slows down this whole process, making the liver and gall bladder sluggish and congested and helping to make gallstones.
Gallbladder x-rays in hypothyroid patients can show a bloated gall bladder that contracts sluggishly. This slows down the flow of bile which can lead to slower breakdown of fats and cholesterol and other toxins that are broken down in the liver.
This whole process can also lead to the formation of gall stones. Many people with Hashimoto’s have gall bladder issues.
Thyroid hormones are converted into their usable form in the liver (60% happens there), you can see how low thyroid function can create a vicious cycle.
Hypothyroidism messes with liver function and fewer thyroid hormones become active. So it goes until you have all of the common symptoms of too little thyroid hormone: fatigue, brain fog, joint pain, hair loss, weight gain, depression, etc.
Thyroid hormone is converted primarily through 2 processes:
Glucornidation and sulfation, let’s break these down:
According to Dr. Datis Kharrazian, DC, these processes are supported in the following ways:
Glucoronidation
Glucoronidation is an important process for converting thyroid hormone.
This pathway is supported by B vitamins, magnesium, and glysine, click here to learn about food sources of B vitamins and magnesium.
Sulfation
Sulfation involves binding things partially broken down in the liver with sulfur containing compounds. It is one of the major detoxification pathways for neurotransmitters, toxins, and hormones (like thyroid hormones). Vitamin B6 and magnesium are important for sulfur amino acid metabolism, as are foods containing sulfur such as: eggs, cheese, meat, poultry, nuts and legumes. Click here to learn more about food sources of vitamins and minerals.
Its important to choose animals products wisely, buy organic whenever possible because organic foods have far fewer toxins like antibiotics, hormones, and pesticides which can all cause problems of their own.
Another important point about sulfating is that it requires sulfate which is often poorly absorbed by the digestive system, especially by people with Hashimoto’s who often suffer from intestinal permeability or leaky gut syndrome. Sulfate is the oxidized, inorganic form of sulfur produced by an oxidation step called (you guessed it) sulfoxidation.
This step is made possible by an enzyme that is called sulfite oxidase which uses the essential mineral molybdenum, click here to see food sources of molybdenum. Problems with sulfoxidation can be seen in people who are sensitive to foods that contain sulfites (garlic) or dugs and food additives (in dried fruit and herbs, preservatives, in salad bars used to keep vegetables looking fresh).
(These people may also have an abnormally strong odor in their urine after eating asparagus. For these people one should consider molybdenum supplementation or organic sulfates like sodium sulfate or magnesium sulfate.)
In Chinese medicine, we view interactions in the body in the context of body, mind and spirit. This can be really helpful to see how these physical problems can affect you emotionally and psychologically.
In the book, Between Heaven and Earth by Harriet Beinfeld, L.Ac. and Efrem Korngold, L.Ac., the liver is described as something like a military commander in the body. It formulates tactics and strategies, moving blood and energy (qi) throughout the body.
The thyroid is part of the endocrine system which is viewed as qi and is derived from the yang energy of the kidneys. So the ancient Chinese recognized this relationship and how important one is for the other. The liver needs that qi to have the energy to do its job, and if it is clogged or blocked it can’t facilitate the movement of that energy throughout the body.
When the liver gets stuck or clogged, the most common emotion that people experience is anger. This can be directed outwardly at people you know (usually people closest to you: family, co-workers, or friends), or this anger can be directed inwardly and result in depression and feeling of self-hatred and low self-worth. Or sometimes you have a combination of these two.
It is also interesting to note that in Chinese medicine the nervous system, tendons and ligaments and the eyes are thought to be part of the sphere of influence of the liver. So many people with Hashimoto’s also have issues in all of these areas: eye problems, tendon issues, and cognitive issues affecting the brain.
Gall Bladder Issues Make You Unable to Make Decisions
The Gall Bladder stores and secretes bile, this stimulates flow through the stomach and intestines and is very important in helping us to absorb and eliminate different foods as well as different ideas and concepts.
So proper bile flow and production also help us with proper judgment, clear thinking and decision making. If there are Liver/Gall Bladder issues we can end up taking actions without thinking them through, or making decisions and not following through on them or simply getting stuck, unable to decide what to do.
Here are some important herbs for helping the liver and gall bladder.
Ginger: this common food contains chemicals that have been shown to increase bile secretion and to reduce cholesterol levels by up regulating an enzyme responsible for bile acid production (cholesterol-7-alpha-hydorxylase).
Dandelion: The root of this common weed promotes the production of bile and its delivery to the gall bladder. It causes the gall bladder to contract and release bile.
Milk Thistle: This herb increases the solubility of bile and has been shown to significantly lower cholesterol concentrations in the gall bladder. It has potent anti-oxidant activity which supports detoxification and it prevents depletion of glutathione in the liver, which is often depleted in people with Hashimoto’s. It also has anti-inflammatory properties and it promotes protein synthesis to replace damaged liver cells.
Panax ginseng:This herb has been shown in several studies to have numerous positive impacts on liver function. It has been shown to reverse fatty liver in animals and can be really helpful in cleaning toxins out of the liver. It also has really important benefits for the immune system like promoting Kupffer cells (specialized immune cells located in the liver) and can be beneficial in balancing the immune system by increasing key proteins like IL-8.
Herba sargassi, Laminaria Kun Bu: These seaweeds have important detoxification properties and can be used to treat metabolic toxicosis with arthritis, rheumatism, dermatitis and psoriasis. They are quite mild and have very few if any side effects. In addition, they are rich in trace minerals and are helpful in reducing swelling, particularly in the lymphatic glands.
A word of caution with seaweeds: They contain iodine which can be problematic with some Hashimoto’s folks.
Fructus Gardeniae: This herb is the seed pod of the gardenia plant. It has potent anti-bacterial and anti-viral properties and can be used to reduce liver and gallblader congestion and infections.
Caution: Liver infections can be quite serious, consult a trained physician if you suspect that you have any form of hepatitis or liver disease.
Rhubarb Root: This herb is a potent laxative that can be used to treat acute gall bladder and pancreatic infections. It has potent anti-bacterial, anti-fungal and anti-viral properties.
Dosage is critical with this herb and too much can cause gastric pain and diarrhea. Never use during pregnancy or lactation or with gout, hemorrhoids or oxalic acid stones. Consult a trained professional before using this herb.
Herbs That Help With Anger and Irritability
There is a very effective herbal formula in Chinese Medicine whose name is translated as Rambling Powder. The name comes from the title the first chapter of a book by Zhuang Zi, “Rambling Without A Destination” that includes stories about wandering freely with an open mind. It is a reference to how this combination of herbs can help one feel less constrained emotionally, feel happy and less stressed.
It has several variations and contains a number of herbs that are very helpful for the liver including buplerum, mint, atractylodes and more. With modifications, it has also been used successfully to treat eye issues, hypertension, hepatitis, anemia, depression, irritability and anger.
Hashimoto’s has so many moving parts and affects so many systems of the body that you really need to have a treatment strategy that looks at all these different areas and gives you solutions for all of them.
That’s why I developed my program: Healing Hashimoto’s: The 5 Elements of Thyroid Health. In in we explore the 5 major systems of the body and learn how they impact us physically, emotionally and spiritually.
Because true healing requires more than simply taking a few pills or herbs. It requires a complete overhaul of your body, mind and spirit. And it is a tremendous opportunity for growth and for healing all aspects of your life. Click here to learn more.
Between Heaven and Earth, Harriet Beinfeld, L.Ac. and Efrem Korngold, L.Ac., Ballantine Books, New York, 1991
Chinese Herbal Medicine Formulas and Strategies, Dan Bensky & Randall Barolet, Eastland Press, 1990
Why Do I Still Have Thyroid Symptoms When My Lab Tests Are Normal? Datis Kharrazian, DC, Morgan James Publishing, 2010
The Thyroid, A Fundamental and Clinical Text, Ninth Edition, Lewis E. Braverman and Robert D. Utiger, 2005 Lippincott Williams and Wilkins
Severe hyperthyroidism induces mitochondria-mediated apoptosis in rat liver.
Upadhyay G, Singh R, Kumar A, Kumar S, Kapoor A, Godbole MM.
Source: Department of Endocrinology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India.
Laukkarinen J, Kiudelis G, Lempinen M, Raty S, Pelli H, Sand J, Kemppainen E, Haglund C, Nordback I. Increased prevalence of subclinical hypothyroidism in common bile duct stone patients. J Clin Endocrinol Metab. 2007 Nov;92(11):4260-4. Epub 2007 Aug 28
Inkinen J, Sand J, Nordback I. Association between common bile duct stones and treated hypothyroidism. Hepatogastroenterology. 2000 Jul-Aug:47(34):919-21
Wouldn’t it be great to have a list of food sources of vitamins? Well, look no further! In our continuing effort to provide you with all things healthy and beneficial here’s a pretty comprehensive list.
A word of caution: If you are following an autoimmune protocol there will be some foods here that you can not eat. However, I wanted to provide a pretty comprehensive list so that you can get a sense what’s available outside of a multi-vitamin.
VITAMIN A: red pepper, dandelion greens, carrot, apricot, kale, mustard greens, watercress, sweet potato, parsley, spinach, turnip, swiss chard, cantaloupe, broccoli
VITAMIN B1: rice bran, wheat germ, sunflower seeds, peanut, soybean, pinto bean, peas, millet, lentils, almonds, turnip greens, collard greens, kale, asparagus
VITAMIN B2: salmon, trout, cod, mackerel, perch, oysters, mushrooms, almonds, hijiki
VITAMIN B3: rice bran, peanuts, red pepper, wild rice, kelp, sesame seed, peaches, brown rice, mushrooms, barley, almonds, apricot
VITAMIN B5 (PANTOTHENIC ACID): beef, chicken, salmon, mackerel, sardines, barley, rice, avocado, plums, raisins, almonds, dates
VITAMIN B6: banana, barley, brewer’s yeast, molasses, soybeans, wheat bran, brown rice, liver, beef, cabbage, carrots, potato, yams
VITAMIN B12: beef liver, beef kidney, ham, sole, scallops, eggs, oats, soybean
miso, soy sauce, tempeh, pickles, amasake, nut and seed yogurts, sourdough bread, algae, spirulina and chlorella, brewer’s yeast
BIOTIN: beef liver, peanuts, eggs, peas, cauliflower, mushrooms, filberts
VITAMIN C: red pepper, currants, kale, parsley, turnip greens, mustard, spinach, green bell pepper, broccoli, Brussels sprouts, cauliflower, lemon, orange, red cabbage
VITAMIN E: soybean oil, corn oil, navy bean, oatmeal, green peas, brown rice, turnip greens, sweet potatoes, parsley
VITAMIN K: spinach, cauliflower, cabbage, carrots, soybeans, liver, oats
BIOFLAVONOIDS: lemon, lime, grapefruit, orange, red pepper, prune, parsley, apricot, plum, cherry, walnut, buckwheat
BORON: soybeans, prunes, raisins, almonds, rosehips, peanuts, hazelnuts, dates, honey, wine
CALCIUM: sesame seed, kelp, agar, dulse, collard greens, kale, turnip greens, almond, soybean, mustard greens, filbert, parsley, dandelion greens, brazil nut, spoon cabbage, watercress, chickpea, white bean, pinto bean, horseradish, pistachio, red pepper, figs, sunflower seed
CHROMIUM: beer, brewer’s yeast, brown rice, beans, mushrooms, potatoes
COPPER: oysters, liver, chocolate, cocoa, mushrooms, almonds, pecans, avocado, rye, walnuts
FLOURIDE: seafood, seaweed
FLOURINE: tea, sardines, salmon, mackerel, shrimp, kale, potatoes, spinach, apples
FOLIC ACID: liver, asparagus, lima beans, spinach, swiss chard, kale, cabbage, sweet corn
IODINE: kelp, dulse, agar, swiss chard, turnip greens, summer squash, mustard greens, watermelon, cucumber, spinach, asparagus, kale, turnip
IRON: dulse, kelp, rice bran, pumpkin seeds, beans, lentil, parsley, walnut, apricot, almond, raisins, swiss chard, spinach, dates, fig, kale, cucumber, cauliflower, cabbage
LYSINE: chicken, yoghurt, ricotta, cheese, avocado
MAGNESIUM: kelp, wheat bran, wheat germ, almonds, cashews, soybeans, brazilnut, dulse, peanut, walnut, filbert, sesame seed, lima beans, peas, millet
MANGANESE: oatmeal, whole wheat, peas, beans, egg yolk, spinach, kale, bananas, nuts, pineapple, sunflower seeds
MOLYBDENUM: buckwheat, eggs, oats, soybean, lima beans, barley, lentils, sunflower seeds, liver
PANTHOTHENIC ACID: liver, broccoli, mushrooms, eggs, peanuts, oils, peas, soybeans, sweet potatoe
POTASSIUM: dulse, kelp, soybean, lima bean, rice bran, banana, red pepper, white bean, pinto bean, apricot, peach, prune, sunflower seed, chickpea, lentil, almond, raisin, parsley, sesame seed, avocado
SELENIUM: brazil nuts, brown rice, brewer’s yeast, eggs, garlic, liver
SULFUR: kale, watercress, brussels sprouts, horseradish, cabbage, cranberry, turnip, cauliflower, raspberry, spinach, red cabbage, kelp, parsnip, leek, radish, cucumber, celery
ZINC: oysters, herring, liver, oatmeal, wheat bran, maple syrup, brewer’s yeast, sunflower seeds, soybeans, mushrooms, sardines, pecans, pumpkin seeds
Hashimoto’s is one of the most common autoimmune diseases in the US. It is routinely undiagnosed or under-diagnosed and when it is treated, the gold standard of treatment is to give patients Synthroid or Levothyroxine (Synthetic T4).
To monitor whether or not this is working most doctors periodically test TSH.
This approach often does not work and, more importantly, millions of women and men with Hashimoto’s who are being treated this way do not feel any better, or feel better for a period of time, then end up feeling really lousy.
They wind up feeling all the symptoms of hypothyroidism like being tired all the time, they can’t lose weight, they have lots of joint and muscle pain, they suffer from brain fog, anxiety and depression, their hair falls out, they feel cold, they have no sex drive and their lives become miserable.
And many of them have blood test results that look normal.
In this post I will examine why TSH is not a good measure of whether or not thyroid hormone is absorbed by the cells of the body and discuss some better alternatives to testing, supplementation and monitoring of whether or not a given approach is working.
How Does Thyroid Hormone Work in The Body?
Before we look at how most people are treated, it’s important to understand how thyroid hormone works in the body.
TSH is thyroid stimulating hormone. This is released by the pituitary gland to stimulate the thyroid so that more thyroid peroxidase (an enzyme) is made. This enzyme combines with iodine to make thyroid hormone, T4 and T3. About 97% is T4 and 3% is T3.
The body can’t really use T4, so it has to convert this into T3 which is the form that the cells of the body can use to do stuff. 60% of T4 is converted by cells in the liver, another 20% by cells in the gut and the remaining 20 or so % is converted by cells in the peripheral tissues of the body (muscles, fat, etc.)
Why Is Synthroid (Levothyroxine) Sold As The Answer?
Because most of the hormone that is made in the thyroid is T4, the logic is that for those with Hashimoto’s (an autoimmune disease that slowly destroys the thyroid) and hypothyroidism (low thyroid activity) giving a synthetic form of T4 such as Synthroid or Levothyroxine will replace what the body is not doing for itself.
Then, theoretically, the rest of the process will happen as it should – the liver will do it’s thing, the gut will do it’s thing, and the rest of the peripheral tissues will do what they are supposed to do.
Oh, if it were only as simple as that!
Many Things Hinder the Conversion of T4 to T3
There are many, many factors that can cause problems all along the way in getting this synthetic hormone into a form that the body can use and, getting the tissues of the body to effectively absorb it.
And for millions of people, this process just does not work. This is because there are so many things that disrupt thyroid hormone’s ability get into cells, these include: dieting, anxiety, stress, insulin resistance, obesity, diabetes, depression and bipolar disorder, high cholesterol and triglycerides, chronic fatigue syndrome, fibromyalgia, neurodegenerative diseases (Alzheimer’s, Parkinson’s and multiple sclerosis), migraines, cardiomyopathy, and aging.
(Here’s a really interesting graph that shows how this works.)
Testing TSH, T3 and T4 Doesn’t Measure Thyroid Hormone In The Cells
What most doctors learn in medical school is that testing TSH and total T3 and total T4 will tell you how the thyroid is functioning or how well thyroid hormone replacement is working.
This is just not true. This false idea is based on assumptions about how thyroid hormone gets into the cells of the body. In the old, out dated theory, it is thought that thyroid hormone simples diffuses or is absorbed like soda from a straw into the hungry mouths of eager cells.
More recent research has shown that its not diffusion at all, but rather active transport that requires energy from the cells to get the hormone in. What this means is that anything that compromises energy production in the cells (mitochondria make energy in the cell – so things that mess with the mitochondria) will cause less thyroid hormones to get into cells.
These include all of the list of conditions mentioned above and stress is one of the most profound blockers of this process.
In addition, the different thyroid hormones require different amounts of energy to get into the cells. For example, T4 takes more energy to get into cells than T3. (This is why many people do better on T3 only supplementation or combinations of hormones that combine T3 and T4.)
So if you have any or some combination of these conditions: dieting, anxiety, stress, insulin resistance, obesity, diabetes, depression and bipolar disorder, high cholesterol and triglycerides, chronic fatigue syndrome, fibromyalgia, neurodegenerative diseases (Alzheimer’s, Parkinson’s and multiple sclerosis), migraines, cardiomyopathy, and/or aging, and you are taking T4 only, you are going to have a very hard time getting that into the cells of your body.
Almost Everybody Has This Problem
That pretty much covers most of the population on thyroid replacement hormones.
This is important because T4 has to get into cells to be converted. What’s also interesting is that measuring serum T4 (T4 in the blood) won’t tell you anything about how much of it is getting into the cells. Instead, you have to measure Reverse T3 and free T3 levels and measure their ratio. (More on this in a moment).
This is also why some people have normal numbers but still have lots of hypothyroid symptoms (fatigue, hair loss, joint pain, brain fog, constipation, depression, low libido, etc.) even though their lab results are normal.
They have low T4 levels in their cells and more in their serum. So everything looks hunky dory, but they feel terrible. TSH testing will not pick up this problem because TSH is produced in the pituitary and this gland absorbs thyroid hormone very differently than the rest of the body.
The Pituitary Not the Thyroid Determines TSH Levels
The pituitary is much more sensitive to thyroid hormones and transports thyroid hormone differently than all other cells in the body.
In the pituitary, thyroid hormone does not depend on energy to get into the cells. The transporters for T4 and T3 in the pituitary are also not inhibited by numerous environmental toxins and substances produced by the body during physiologic stress and dieting, things that inhibit thyroid transport into other cells in the body, including bilirubin and fatty acids.
In other words, all of the stuff that prevents the cells in the rest of the body, do not affect the absorption of T3 and T4 in the pituitary. So TSH does not reflect the hypothyroid state in the rest of the body and is really only a good measure of thyroid hormone IN THE PITUITARY.
Thyroid hormone is absorbed into the cells of the liver differently than it is by the cells of the pituitary. This is really important to understand and most doctors and endocrinologists do not know this. Since 60% of T4 is converted in the liver, this makes a huge difference.
Why Dieting Can Make Thyroid Hormone Less Available
Many overweight people with Hashimoto’s try to lose weight and are just not able to. This has lead to a huge industry of weight loss drugs, products and procedures.
But what many people do not understand is that the reason that weight loss may be so difficult for these people is that the very process of trying to lose weight may be preventing them from being able to absorb thyroid hormone into their cells.
This creates a vicious cycle of dieting, yo-yo weight loss and gain and miserable results. And all those things actually create a state of a slower, more sluggish metabolism that all but dooms them to failure.
If thyroid hormone is not being absorbed by the cells, then you have a state of cellular hypothyroidism and your body slows down and does not lose weight. And this state of poor cellular absorption of thyroid hormone is not seen in laboratory results unless free T3 and Reverse T3 levels are done.
A very interesting study published in the American Journal of Physiology-Endocrinology and Metabolism, Van der Heyden et al studied the effect of dieting on the transport of T4 and T3 into the cell.
It was found that dieting obese individuals had a 50% reduction of T4 into the cell and a 25% reduction of T3 into the cell due to less energy in their cells, showing that in such patients standard thyroid blood tests are not good indicators of thyroid hormone levels inside the cells.
This also demonstrates why it is very difficult for obese patients to lose weight; as calories are decreased, metabolism drops.
This will, however, not be detected by standard TSH, T4 and T3 testing. In addition, there are increased levels of free fatty acids in the blood with chronic dieting, which further suppresses T4 absorption into the cells and this causes more cellular hypothyroidism.
How You Feel Is More Important Than What Your Lab Tests Say
Another interesting study published in the Journal of Clinical Endocrinology and Metabolism, by Zulewski et al clearly shows that TSH is not a useful measure of proper thyroid replacement because there was no connection between TSH and tissue thyroid levels.
Levels of T3 and T4 were better, and T3 was the best indicator. However, a thorough assessment of how patients felt determined by how many signs and symptoms of hypothyroidism they had (i.e. weight gain, fatigue, hair loss, depression, low libido, brain fog, etc.) was shown to be the most accurate method to determine proper thyroid hormone replacement dosage.
How you feel is a lot more important than what your TSH test results say.
This Is Why You Are So Tired All The Time
What all of this means is that people with Hashimoto’s and hypothyroidism who are on T4 only thyroid replacement hormone feel tired all the time, are losing their hair, can’t lose weight, etc. and just generally feel like crap because this hormone is not getting into the cells of their body.
When thyroid hormone doesn’t get into the body’s cells, it can’t do its job.
There Is Another Way
It doesn’t have to be this way. You can change this by, first, testing appropriately to see how well your cells are absorbing thyroid hormone and then by making changes in your diet, lifestyle and medications (if necessary) to make sure that you are converting and absorbing enough thyroid hormone for it to work in your body.
The proper way to test whether of not your cells are absorbing thyroid hormone is to order free T3 (fT3) and/or T3 and reverse T3 (rT3). And then to measure their ratio: the proper ratio of free T3 to reverse T3 is greater than 20. The proper ratio of T3 to reverse T3 is greater than 10.
If your numbers demonstrate that you have high reverse T3 and a low ratio, then you are not absorbing thyroid hormone into the cells of your body.
The next step is to improve the function of the areas that convert thyroid hormone and to clean up your diet and alter your lifestyle to support proper absorption of thyroid hormone.
Since 60% of T4 is converted into T3 in the liver is vitally important to make sure that you improve liver function and make sure that your liver is working properly. A good liver detox and changes in diet can accomplish this.
The next step is to clean up your gut and make sure that you don’t have intestinal problems or inflammation of the intestines that can slow or prevent proper absorption and conversion of thyroid hormone.
Next, you need to supplement and gradually heal the body so that the many conditions that can slow or stop absorption of thyroid hormone are reversed and make sure the cells of your body have enough energy to get thyroid hormone into your cells.
Lastly, you may need to start taking T3 or try a thyroid hormone that contains both T4 and T3. This will insure that enough T3 is getting into the cells of your body.
30 Minute Confidential Telephone Consultation
I am offering a 30 minute telephone consultation if you would like to learn more and discover whether or not you have issues that may be preventing your cells from absorbing thyroid hormone.
Click on this link to schedule the consultation.
Its Not Easy, But The Results Can Be Dramatic
This is not a simple process and you need to work with someone who understands how to guide you through this process.
That’s why I have created a simple 60 day program that can dramatically improve the way the cells of your body absorb thyroid hormone:
This program includes:
* Free T3 (fT3) and reverse T3 (rT3) testing
* A 30 day liver detox program
* A 30 day gut healing program that incorporates the Hashimoto’s Diet Plan
* Supplementation and guidance to improve cellular energy production.
* Follow Up testing
Click on this link to schedule a confidential 30 minute consultation.
References:
http://nahypothyroidism.org/thyroid-hormone-transport/
http://nahypothyroidism.org/files/thyroid_transport_graph_3.pdf
http://www.stopthethyroidmadness.com/rt3-ratio/
Zulewski H, Muller B, Exer P, et al. Estimation of tissue hypothyrodisim by a new clinical score: Evaluation of patients with various grades of hypothyroidism and controls. J Clin Endocrinol Metab 1997;82(3):771-776.
Kharrazian, Datis, DC, Why Do I Still Have Thyroid Symptoms When My Lab Tests Are Normal? 2010, Elephant Printing
Hashimoto’s is the most common autoimmune disease in the United States. It is a thyroid disorder and an autoimmune disease. The autoimmune part of the equation makes virtually everything a challenge and this is particularly true when it comes to trying to figure out what to eat.
One of the absolute truths about Hashimoto’s is that no 2 people have the same version of the disease. There are too many variables, people are at different stages of progression, and they have other autoimmune, endocrine, digestive or systemic problems.
So, generalizing about what kind of diet is the best is kind of like asking, “Where do I build my house on this minefield?”
You build it where it won’t set off the mines. Some people estimate that 70 – 80% of the immune system is found in the gut.
Whatever the actual percentage, there is no doubt that what goes through your digestive system has a huge impact on your immune system. Huge.
This concept is just common sense, but many doctors and health care practitioners ignore it. Why? One doctor friend of mine put it to me this way.
He said, “I don’t bother trying to change people’s diets. It’s easier to get an alcoholic to stop drinking than to get people to change the way they eat.”
People are attached to food. It has cultural, emotional and psychological roots that run deep. However, if you have Hashimoto’s and you want to learn to manage it properly, you need to abandon all of that. It will not serve you.
Many people with Hashimoto’s also have intestinal permeability, also known as leaky gut. A healthy GI tract is one that one has a lush forrest of villi, all held tightly together.
This keeps the bad guys, like bacteria, chemicals, environmental toxins and undigested food out of the blood stream. Unfortunately, chronic inflammation turns this lush forrest into a desert and poor diet, blood sugar imbalances and chronic stress open up wide chasms that a molecular 18 wheeler could drive through.
Many people believe that this actually sets the stage for the onset of autoimmune disease when the immune system shorts circuits and starts confusing other stuff with our own tissue. The one food that is most often implicated in this is gluten.
Many people also believe that the best way to heal autoimmune disease is by healing the gut. ( I am one of those people. ) So this begs the question, what heals the gut?
The first step to healing the GI tract is to remove all the foods that are creating chronic immune responses. Eventually, you can add them back in one at a time (hopefully). When you do you will begin to discover your own unique set of land mines.
And instead of rummaging around in the dark there are now also diagnostic tests available to help determine which foods cause an autoimmune response in you (More on this in a moment). This can save you a lot of trial and error and can help you identify the really bad ones.
The foods that tend to be the worst are those that you, invariably, love the most. Like ice cream, cheese, bread, and pasta. And there is a biological reason for this. Both foods made from gluten and milk have proteins that are very similar in structure to morphine.
They are called casomorphin in milk and gluteomorphin or gliadorphin in wheat products. Now wonder we love them, we’re freakin’ addicted to them!
There are a few different camps out there for autoimmune disease diets. Most of them involve elimination and provocation. In other words, you take foods out and put foods back. The biggest differences seem to be which foods you put back.
Once again, the reality is that some people can put some foods back and others can’t. Remember, your Hashimoto’s is not your brother’s or sister’s Hashimoto’s. You have to find your own way. There are some foods that some people will have to eliminate from their diets forever. FOREVER.
And this is the real challenge. Because some people will suffer more from cheating than others. But, even if you feel like the damage wasn’t so bad and you can live with it, it may be destroying valuable tissue like your brain or something that you might want to use later in life.
Cheating can have serious and, sometimes, silent consequences, like the destruction of important tissue.
Here’s a quick overview of the most popular diets currently being used.
The Paleo diet or Paleolithic diet, also called the Cave man diet or Hunter-Gatherer diet, is one in which you are told to eat like our nomadic ancestors. Centered around common modern foods, this diet consists mainly of fish, grass-fed pasture raised meats, eggs, vegetables, fruit, fungi, roots, and nuts, and excludes grains, legumes, dairy products, potatoes, refined salt, refined sugar, and processed oils.
Critics argue that this diet is essentially just the Atkins diet with a few updates, but it has a loyal following. And if you really ate like our Paleolithic brethren, that is, you hunted around the African plains with a spear and a few rocks, you would eat a diet that was largely plant based with a few lucky days of meat binging thrown in.
And you would spend a lot of time running and doing old school cross fit maneuvers as you escaped hungry lions and hyenas. Definitely a formula for good health – if you didn’t get eaten.
The autoimmune version of this diet removes grains, eggs, beans, legumes, dairy, soy, refined sugar and salt, all processed oils and nut based oils, and night shades (tomatoes, eggplants, peppers and potatoes) and, sometimes, nuts.
Its really restrictive, but can be quite effective. The real issue seems to be – can you come up with a diet plan that isn’t basically all meat all the time? And you definitely can. You need to make a conscious effort to have plenty of fruit and vegetables.
Some people with Hashimoto’s do very well on this diet and it can dramatically improve the health of your gut on its own. Add some supplements that heal the intestines, as well, and you could have a winning formula. (More on that in an upcoming post)
The flip side of Paleo is the Vegan autoimmune diet. It is, essentially a gluten and, in some cases, grain free vegan diet. No meat, no dairy, no eggs, no animals, and no fish. And in some cases, no grains or beans.
Critics of this diet argue that you don’t get enough amino acids from plants alone and many Hashimoto’s folks are also iron, B12 and Vitamin D deficient and its hard to virtually impossible to effectively keep those levels up without animal products or supplementation.
It also takes a lot of things, pardon the pun, off the table. So it doesn’t leave you a lot left to eat.
But this diet also has its loyal fans and can be very effective in reducing the inflammation that drives the autoimmune process and destruction of the gut. If supplements are added here, and you eat enough, you can also have a winning formula with this approach.
Some people think that one way to figure out which version of the autoimmune diet is best for you might be to use blood typing. Those with blood types that need meat (Type O) might do better on Paleo, those who are not big meat eaters (Type A) may do better with the Vegan version.
The remaining blood types (B and AB) might need some hybrid of the two. Which ever you chose it is vitally important to eat as much variety as you can within all these restrictions and to supplement with iron, Vitamin B12 and Vitamin D as it becomes necessary.
All of these autoimmune diets remove lectins. Lectins are nature’s answer to insects long before Monsanto began its evil march towards domination of our food supply.
They are, basically, natural pesticides that live in plants to help them survive the ravages of fungi, bacteria and viruses. They are kind of like natural toxins.
Lectins are carb binding proteins that protect plants and have other functions like protein synthesis and delivery in animals. They’re pretty sticky molecules, which makes them cause problems in our intestines because they get stuck there and start eating away at the walls.
It is believed that lectins leave leaky gut in their wake, in a trail of savaged villi. Once they have wrought their carnage, they breach the walls of the intestines and leak into the bloodstream with lots of other unwanted particles. And the immune system goes nuts trying to deal with it all.
Foods with the highest amounts of lectins are: grains of all kinds (wheat being the worst), legumes (soy being the worst), nightshades (mentioned earlier), and oils made from seeds. GMO foods also have lots of lectins because they are used in genetic modification to enhance pest and fungal resistance.
Salt: Recent studies have indicated that that high salt levels may push the initiation of autoimmunity by driving the TH-17 pathways. Basically, its an on switch.
Problem. Lots of Hashimoto’s people have low blood pressure and desperately need salt. Iodine can also be bad for some Hashimoto’s people. Answer: Moderate salt without iodine (unless you are iodine deficient – there’s always a caveat).
Sugar Issues: Many Hashimoto’s people have blood sugar issues and if their blood sugar goes too high or too low it can really impede their progress. Some of these diets are so restrictive that people’s blood sugars end up dropping and spiking and they wind up defeating the very program that they are on.
Answer: Find the foods you like, eat them often. Start the day with a protein. Don’t ever skip meals.
Anemia: Many Hashimoto’s patients develop anemia for a host of reasons. This can completely undermine any dietary changes you are trying to make. Test for iron deficiency and red blood cell counts and make sure you are supplementing with iron if necessary (especially if you are choosing the vegan route). Vitamin C can also enhance iron absorption.
Cross Reactors: These are foods that have a similar protein structure to gluten and our own tissue. Like gluten, they may have to permanently avoided because they drive the autoimmune attack and disease progression.
Parasites, Candida and Other Critters: Some people with Hashimoto’s may also also require additional treatment of the ecosystem of their intestines. These can further complicate dietary restrictions and supplementation.
Adrenal Issues: The adrenals play a critical role in intestinal permeability and with insulin resistance. Cortisol causes the intestinal walls to open further and it makes insulin not work a well. So stress management and adrenal love are also really important.
Other Autoimmune Diseases: Many Hashimoto’s people have other autoimmune diseases in various stages of progression and some of these can have a huge impact on the digestive system, such as Type I diabetes, adrenal autoimmunity, liver autoimmune, Crohn’s disease and more. If these factors are present, adjustments must be made accordingly.
And this is just an overview to give you a sense of the complexity, difficulty and variability of what you are dealing with. There are many more issues that can come into play and undermine your progress. These include, the gall bladder, neurotransmitters and the brain, low stomach acid and more!
There is some terrific diagnostic testing available today that can help to decipher some of these puzzles. We can test for intestinal permeability, cross reactors, additional autoimmune issues, etc. These tests are not that expensive if your doctor won’t order them or doesn’t know that they exist.
Diet is critically important in the successful treatment of Hashimoto’s, but a diet that works for someone else may not work for you. You need a program that is tailor made for your unique set of circumstances and related issues.
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
http://www.biomedcentral.com/1472-6823/5/10
http://www.marksdailyapple.com/lectins/#axzz2O1CpwpQ5
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1115659/
Prevalence of celiac disease in autoimmune thyroiditis. Minerva Endocrinol 2007 Dec;32(4):239-43
Celiac disease and autoimmune thyroid disease. Clin Med Res 2007 Oct;5(3):184-92. Review
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
Hashimoto’s and pregnancy are linked in many ways. Hashimoto’s is the most common autoimmune disease in the United States and pregnancy is one of the factors that can lead to it. Many people do not know that thyroid hormones can also affect the hormones that are responsible for fertility and successful pregnancies. In this blog post, I will explore how the thyroid and thyroid hormones may affect a woman’s ability to have a baby.
Before we look at how thyroid hormones can affect pregnancy, let’s review some of the basics of the hormones used to make babies and how they work.
Estrogen
Estrogen rises and falls and helps to orchestrate a woman’s cycle. It makes the lining of the uterus thick so that an egg can be implanted and can grow happily there. The body signals the pituitary gland which helps to control the increase and decrease of this hormone. At the end of the cycle a sharp fall in estrogen and progesterone signals the uterus that there is no pregnancy.
Follicle Stimulating Hormone (FSH)
As its name implies, Follicle Stimulating hormone stimulates the follicles in the ovaries to grow. When estrogen levels drop at the end of the cycle, FSH levels go up (this is what is called a negative feedback loop) to start the process all over again. Once the follicles in the ovaries are stimulated, one becomes dominant and it starts secreting estrogen. This is when the effects of estrogen on the lining of the uterus take place and prepare it for nurturing the egg.
Luteinizing Hormone (LH)
At mid cycle (about day 14), the lining of the uterus stimulates a large and sudden release of luteinizing hormone. When this happens, there is a sudden rise in body temperature and this is a sign that ovulation is about to happen. This surge also causes the follicle to break open and release an egg into the fallopian tubes.
Progesterone
When the follicle breaks open, its walls collapse and this cavity is called the corpus luteum. After ovulation, the corpus luteum begins secreting large amounts of progesterone, which helps prepare the lining of the uterus for the fertilized egg.
Human Chorionic Gonadatropin (HCG)
Made popular by the recent diet fad, this hormone is released once the egg is fertilized. It keeps the corpus luteum healthy so that it can continue to pump out more estrogen and progesterone. This keeps the lining of the uterus healthy. After about 6 to 8 weeks of gestation, the newly formed placenta takes over the secretion of progesterone.
As you can see, a lot of things must happen to have a healthy egg implanted in a healthy uterus to make a healthy baby. If there are problems with any of these hormones or their release, then there will be problems with pregnancy and fertilization. As it turns out, thyroid hormone can affect all of these hormones.
When women have hypothyroidism, a common problem is an increase of another hormone called prolactin. This causes less of a release of LH, and a loss of progesterone receptor site sensitivity, and a loss in sensitivity to FSH in the follicle. All of these losses lead to problems with ovulation, and they also mess with the communication to the pituitary gland.
Using birth control pills on top of this can further harm the communication and feedback loops in this system. Using herbs to stimulate the ovaries or the reproductive system will also not work unless the hypothyroid issues are corrected.
Studies have found that even mild hypothyroidism may cause ovarian problems. Testing thyroid function is very important with women who suffer from infertility, especially if they have elevated prolactin or they can’t ovulate.
Hypothyroidism may lead to low FSH levels, which may lead to immature follicles and infertility. Suppressed LH levels will often lead to problems with ovulation in timing or abnormal luteal phase progesterone levels. These changes may cause miscarriage, depression in the second half of your cycle, or migraines in the second half of your cycle.
To summarize, hypothyroidism can cause:
* A decrease in FSH release and FSH receptor sensitivity, this leads to problems with the development of the follicle and infertility
* Suppressed LH which leads to problems with ovulation and abnormal progesterone levels, this leads to abnormal cycles and infertility
* Progesterone receptor insensitivity which also leads to abnormal cycles and infertility
* Increased Prolactin, which leads to problems with ovulation, abnormal menstrual cycles and infertility
First of all, don’t assume your OB/Gyn or endocrinologist have any idea about this. Some do, but many do not, that’s the sad truth.
Secondly, visit this website: www.hypothyroidmom.com, this is a excellent site full of great information from a woman who has been through it.
Let me summarize her suggestions because they are brilliant:
Get a full thyroid panel (TSH, free T4, free T3, and antibodies if you haven’t tested for them before). Some doctors recommend the range for TSH prior to conception of 1.0-2.0 mIU/L. This is in keeping with the Guidelines of the American Thyroid Association for the Diagnosis and Management of Thyroid Disease During Pregnancy and Postpartum.
Here is their actual recommendation:
“RECOMMENDATION 15 – Treated hypothyroid patients (receiving thyroid hormone replacement medication) who are planning pregnancy should have their dose adjusted by their provider in order to optimize serum TSH values to <2.5 mIU/L preconception. Lower preconception TSH values (within the non-pregnant reference range) reduce the risk of TSH elevation during the first trimester.”
Your chances of success are better if you know your body and how it is working. Women with Hashimoto’s or hypothyroidism often have lower than normal body temperature. Keep track and find out when your body temperature goes up because, as I stated above, this signals ovulation, the best time to make babies.
Don’t wait to have no period, buy lots of pregnancy tests and test early and often. The developing fetus relies almost entirely on the mother for thyroid hormone. Hypothyroid Mom, Dana Trentini, sums it up beautifully:
“In a person with healthy thyroid function, her body is able to meet the extra demands of pregnancy to provide the fetus with the necessary hormones. In a woman with thyroid dysfunction, her body may not be able to meet the increased demand for thyroid hormone during pregnancy. According to the Endocrine Society’s 2007 Clinical Guidelines for the Management of Thyroid Dysfunction during Pregnancy and Postpartum, thyroid replacement dosage usually needs to be incremented by 4-6 week gestation and may require a 30-50% increase in dosage.”
This is HUGELY IMPORTANT. Because if your TSH levels or T4 levels get too low, it can seriously threaten your baby and you could lose him or her.
According to the Guidelines of the American Thyroid Association for the Diagnosis and Management of Thyroid Disease during Pregnancy and Postpartum:
RECOMMENDATION 2 – Trimester-specific reference ranges for TSH are recommended: first trimester, 0.1–2.5 mIU/L; second trimester, 0.2–3.0 mIU/L; third trimester, 0.3–3.0 mIU/L.
RECOMMENDATION 16 – In pregnant patients with treated hypothyroidism, maternal serum TSH should be monitored approximately every 4 weeks during the first half of pregnancy because further dose adjustments are often required.
RECOMMENDATION 17 – In pregnant patients with treated hypothyroidism, maternal TSH should be checked at least once between 26 and 32 weeks gestation
Like so many things that involve Hashimoto’s, you need to be proactive and armed with knowledge and information to deal with your condition because many doctors and practitioners out there don’t know how to deal with you. This is why I have created Healing Hashimoto’s: The 5 Elements of Thyroid Health, an effective system for understanding and managing your Hashimoto’s. Click on the link to the right to watch my 4 part video series and learn more.
References:
http://hypothyroidmom.com/hypothyroid-moms-story-of-hope-her-miracle-babies/
Stagnaro-Green, A., Abalovich, M., Alexander, E., Azizi, F., Mestman, J., Negro, R., Nixon, A., Pearce, E.N., Soldin, O.P., Sullivan, S., and Wiersinga, W. Guidelines of the American Thyroid Association for the Diagnosis and Management of Thyroid Disease During Pregnancy and Postpartum