Micronutrients are important for proper thyroid function
Hypothyroidism affects nearly 10% of the US population. That’s upwards of 35 million people. And Hashimoto’s is believed to be the leading cause.
In actuality, hypothyroidism can be caused by many other factors, as well. And to complicate matters, both of these conditions can lead to the other.
Prolonged, chronic hypothyroidism can become Hashimoto’s and virtually everyone with Hashimoto’s becomes hypothyroid eventually because their thyroids are gradually destroyed by their immune system.
One common factor that we see with both patient populations is deficiencies of important micronutrients such as selenium, zinc, iron, Vitamin D, B Vitamins, Vitamin A and Vitamin E.
(Iodine is also an important nutrient that is sometimes deficient, but it is also quite controversial due to it’s ability to rapidly cause an increase in both TSH and antibody levels, and in some cases, increase in hypothyroid symptoms. People with Hashimoto’s, MUST, therefore be extra cautious hen supplementing with iodine. As a general rule you should test first, then, if you need to supplement, work with someone who knows what they are doing.)
In this 2 part post we will first explore some of the causes of nutrient deficiencies, and, then in part 2, best practices for supplementing and correcting them. And of course, as always, why it matters.
If you are a follower of our blog, you know that I’m always interested in why things happen, so before we look at the actual nutrients, let’s look at the most common causes of nutrient deficiencies in the body.
1. Low Stomach Acid
2. Leaky Gut or Intestinal Permeability
3. Soda Consumption
4. Tea and Coffee
5. MTHFR and VDR Gene Mutations
With Hashimoto’s and hypothyroidism, a very common problem is that too little gastrin and stomach acid (hydrochloric acid or HCL) are produced. This can result in a number of things that can lead to micronutrient deficiencies.
(For an in depth read on this problem, check out this post.
For example, one thing that HCL is important for is the absorption of vital nutrients like B12, iron, and calcium and for breaking down and absorbing protein.
Too little HCL can also lead to inflammation, lesions and infections in the intestines.
All of that leads to poor absorption of these nutrients and thyroid hormone, leading to a vicious cycle that leads to more hypothyroidism and more nutrient deficiencies.
It’s a positive feedback loop of repeated deficiencies making each other worse.
The following micronutrients depend on proper stomach acid levels in order to be absorbed in the small intestine:
Chromium
Copper
Iron
Magnesium
Manganese
Molybdenum
Selenium (selenite form is not pH dependent)
Zinc
B 12
And it’s also important to note that medication that reduces and/or eliminates acid reflux like proton pump inhibitors and antacids, may also cause poor absorption of these vitamins and minerals.
When the lining of the digestive tract is inflamed, the connections between the pieces of lining known as “tight junctions” break down and allow large, undigested compounds—toxins and bacteria—to leak into the bloodstream.
These substances all react with the intestine’s immune system and cause an exaggerated immune response. This over-reaction by the immune system becomes another vicious cycle that leads to more intestinal damage.
And as this problem grows, diet, lifestyle, medications, and infections can cause further intestinal inflammation that can ultimately lead to more serious problems.
In addition, after the intestinal lining becomes damaged, the damaged cells become unable to properly digest food and produce the enzymes necessary for digestion.
This damage can lead to micronutrient deficiencies, malnourishment, hypothyroidism and more autoimmune disease.
It’s another positive feedback loop perpetuating further damage and further deficiencies. This is a problem because so many things are absorbed in the gut, mostly through the small intestines.
For example:
Approximately 80% of water is absorbed by the small intestine, 10% by the large intestine and the remaining 10% excreted in the feces.
All of the important electrolytes are absorbed in the small intestine: chloride, iodine, calcium (these are absorbed with the help of vitamin D), iron, magnesium and potassium.
Vitamins including fat soluble ones (Vitamins A, D, E and K) are absorbed together with dietary fats.
Water soluble vitamins like vitamins B and C are absorbed by diffusion. Vitamin B12 combined with intrinsic factor (from the stomach) is absorbed by active transport.
Of these iron is absorbed in the duodenum, most are absorbed in the jejunum and Vitamin B12 and bile salts are absorbed in the later part of the ileum.
So you can see, when this process is damaged or impaired there are a lot of potential consequences.
There are several micronutrient deficiencies that a recent Brazilian review published in 2012 by Teixeira TF et al found to be associated with leaky gut and obesity, specifically vitamin A, magnesium, zinc, vitamin D, and calcium.
Vitamin A, zinc, and magnesium all help maintain tight junctions in the intestine and regulate endothelial cells in the gut, while vitamin D stimulates intestinal lining rebuilding and it can slow the damage by calming and regulating the immune system.
Vitamin D and calcium play a joint role in maintaining the protective barrier of the intestines by helping ATP (the cell’s energy source) mechanisms in the intestinal cells.
In obesity (which is found in some hypothyroid and Hashimoto’s patients), intake of these micronutrients is sometimes low, so deficiencies could play a major role in making leaky gut conditions worse, especially when combined with an unhealthy intestinal ecosystem and poor food choices.
What that all means is that having a good intake of these micronutrients could be protective against the development of leaky gut and the inflammation and eventual obesity it can cause.
Most popular sodas (like Coke, Pepsi, Dr. Pepper and Mountain Dew, etc.) are loaded with sugar, and caffeine and this mixture is suspended in phosphoric acid, which actually allows you digest it.
Here’s what happens in your body when you drink one of these drinks:
First, about 10 teaspoons of sugar hit your system (roughly 100% of what you’re supposed to consume in a day). This causes a massive spike in insulin and your liver freaks out and turns all of this excess sugar immediately into fat.
Then the caffeine kicks in and causes a massive burst of stress hormones to be released from the adrenals, which causes the liver to kick all that sugar into your bloodstream and causes a massive release of cortisol to try and deal with it.
This cortisol release also reduces stomach acid levels, impairs your immune response and, ultimately, causes your intestinal lining to be further compromised.
Sugar, caffeine and phosphoric acid all impair absorption of vital nutrients like iron, calcium and zinc. And the phosphoric acid actually binds to these minerals.
Then the diuretic properties of caffeine kick in and you pee all these valuable nutrients out.
This is pretty much the same as soda, minus the added problems caused by phosphoric acid.
Let’s take a look at how caffeine can lead to deficiencies in important micronutrients.
Calcium
As we discussed above, caffeine is a diuretic. It makes you pee. Caffeine causes calcium to be excreted in the urine and feces. According to “Effects of caffeine on health and nutrition: A Review” by Tsedeke Wolde, for every 150 mg of caffeine ingested, about the amount in one cup of coffee, an estimated 5 mg of calcium is lost.
Caffeine also inhibits the amount of calcium that is absorbed through the intestinal tract and depletes the amount retained by the bones. In fact, one study of postmenopausal women found that those who drank more than 300 mg of caffeine lost more bone in their spines than women who did not drink as much.
Vitamin D
Caffeine also inhibits vitamin D receptors, which means less may be absorbed. Because vitamin D is important in the absorption and use of calcium in building bone, this could also decrease bone mineral density, resulting in an increased risk for osteoporosis.
Iron
Caffeine interferes with the body’s absorption of iron (sugar does too), which is important for many processes in the body like red blood cell production, and carrying thyroid hormone to the cells.
Tea reduces iron absorption significantly more than coffee, but both impair absorption. Tannins in tea can also bind to iron, and prevent absorption of calcium and thyroid hormone, as well.
B Vitamins
Water soluble vitamins, such as the B-vitamins, can be depleted by the fluid loss caused by the diuretic effects of caffeine. In addition, it interferes with the metabolism of some B-vitamins, such as thiamine (vitamin B1).
Caffeine may also reduce the absorption of manganese, zinc and copper. It also increases the excretion of the minerals magnesium, potassium, sodium and phosphate. There is also evidence that caffeine interferes with the action of vitamin A.
Basically, what the MTHFR gene does is produce an enzyme with the same really long name (methylenetetrahydrofolate reductase).
Genes produce enzymes and these enzymes do all the heavy lifting, they do the work.
Without enzymes we wouldn’t have physiological function.
The job for the MTHFR enzyme is to convert one form of folate into the most active and usable form of folate in the human body – in every cell in the body. This type of folate is called methyltetrahydrofolate or more commonly by it’s nickname methylfolate.
Another really common finding that I see in analyzing blood test results from Hashimoto’s patients is that they have high levels of homocysteine.
As it turns out, low activity of the MTHFR enzyme may also lead to this. High homocysteine is a major risk factor for heart disease, inflammation, difficult pregnancies, birth defects, and more.
Nutrient deficiencies in Folate B6, and B12 have been linked to high homocysteine.
To matters more complicated, people with MTHFR issues may have a difficult time processing certain types of folic acid like those found in processed food and cheap supplements.
VDR gene defects can lead to poor absorption and utilization of vitamin D in the body, which can lead to a more active immune system, worse symptoms and a faster progression of Hashimoto’s and hypothyroidism.
You see, more positive feedback loops resulting in more vicious cycles reinforcing an existing problem.
The big takeaway here is that all the factors mentioned in this article can lead to positive feedback loops or repeated problems that make each other worse. So if you have low stomach acid, leaky gut and you drink sodas, coffee and tea, you may be, unwittingly, causing your own health to decline.
And in this situation, taking supplements containing these vitamins and minerals may not do much good if you don’t address the root causes of the problems (like the low stomach acid and leaky gut) and start working on reducing the positive feedback loops that lead to this in the first place.
Because here’s the thing, these positive feedback loops can be reversed and you can achieve positive healing momentum if you get to the bottom of this and correct the underlying imbalances. I write all about how to do this in my new book, Roadmap to Remission.
In part 2 of this post, we’ll explore these micronutrients and look at best practices for correcting the causes of deficiencies and for supplementing them with food and supplements.
http://www.ncbi.nlm.nih.gov/pubmed/18341376 -Coffee interferes with T4 absorption
Benvenga, S. et. al. “Altered Intestinal Absorption of L-Thyroxine Caused by Coffee.” Thyroid. Volume 18 Issue 3, pages 293-301. March 2008 Abstract.
Mazzaferri, MD MACP, Ernest. “Thyroid Hormone Therapy,” Clinical Thyroidology for Patients: Summaries for Patients from Clinical Thyroidology. August 2008 Vol 1, Iss 1.
Sindoni, Alessandro et. al. “Case Report: Coffee Impairs intestinal Absorption of Levothyroxine: Report of Additional Cases,” Hot Thyroidology, Article 5/09
http://www.ncbi.nlm.nih.gov/pubmed/23039890 – Severity of Hashimoto’s corresponds with genetic defect
http://www.ncbi.nlm.nih.gov/pubmed/17669709 Effect of proton pump inhibitors on absorption of levothyroxine
http://link.springer.com/article/10.1007/BF01297127
http://www.ncbi.nlm.nih.gov/pubmed/23084636 Obesity and nutrient deficiencies linked to leaky gut
http://www.appliedneuroscience.com.au/resources/Documents/NN%20156%20intes%20permeab%20malabsorb.pdf
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2084394/ -Intestinal crosstalk, very interesting article on how this is all connected
http://www.ncbi.nlm.nih.gov/pubmed/7599455 caffeine and calcium
http://www.ncbi.nlm.nih.gov/pubmed/1564564 calcium, coffee and oesteoporisis
http://www.ncbi.nlm.nih.gov/pubmed/16758142 Swedish cohort on oesteoporosis and caffeine
http://www.ncbi.nlm.nih.gov/pubmed/6402915 inhibition of food iron by coffee
http://www.ncbi.nlm.nih.gov/pubmed/6896705 Effects of various drinks on iron absorption
Effects of caffeine on health and nutrition: A Review, Tsedeke Wolde Lecturer of Nutrition, Department of Public Health, College of Medical and Health Sciences, Wollega University, Nekemte, Ethiopia
The Thyroid, A Fundamental and Clinical Text, Ninth Edition. Lewis E. Braverman and Robert D. Utiger 2005
http://hypothyroidmom.com/11-ways-coffee-can-impact-your-thyroid/
With Hashimoto’s, sometimes the things that cause the most problems are the things we are most attached to. Dairy certainly falls into this category.
In this post we’ll look at the potential problems caused by dairy and Hashimoto’s. And, yes, that may include cheese and ice cream.
There are 2 distinctly different problems that can be caused by dairy consumption. The first is caused by milk proteins, the second is caused by milk sugars.
Let’s take a look at both.
Milk Proteins Have A Similar Structure to Gluten
Unless you’ve been living under a rock, you’ve probably heard about the benefits of going gluten free for people with Hashimoto’s. If this is a new concept to you, check out my previous post on this here.
Well, milk based products have a host of proteins that also can and do cause immune reactions. These include casein (alpha & beta), casomorphin (a protein that closely resembles morphine), milk butyrophilin, and whey.
These proteins are known as “cross-reactors” because they closely resemble gluten proteins and can cause a similar immune response in the body.
In a lot of cases these are undiagnosed and people continue to eat these foods and/or are advised to eat these foods and they end up hurting themselves by damaging their intestines and robbing themselves of important nutrients.
There are different parts of the immune system that react to these foods; IgE, IgA and IgG reactions.
Food allergies are mediated by the IgE part of the immune system. These generally casue an immediate reaction and are often what is called a “true allergy” by doctors and other medical professionals. However, this is not the only type of food reaction your body can have.
IgA and IgG systems can also lead to hypersensitivities. These are sometimes termed “food intolerance” or “food sensitivity.”
The important thing to understand is that they are much different in their mechanism and ability to wreak havoc in your body.
IgA Food Reactions
IgA food intolerance is the more severe reaction and happens mostly in the intestines. It is an abnormal response of the intestines to certain foods in genetically predisposed individuals. The intolerances may manifest themselves early in childhood, or later in life.
IgA food intolerance results in irritation and inflammation of the intestinal tract every time that particular food is consumed. This results in damage to the intestines, and eventually it hurts your ability to absorb nutrients, and can increase the risk of autoimmune diseases, cancer, and accelerate aging through increased intestinal permeability or leaky gut.
IgA food intolerances can also vary in their symptoms considerably. They may be asymptomatic, may be neurological or they may present with the following symptoms: diarrhea, loose stools, constipation, acid reflux, malabsorption of nutrients from foods, and increased intestinal permeability.
They can cause IBS, gas, nausea, skin rashes (including eczema), acne, respiratory conditions such as asthma, nasal congestion, headache, irritability, cognitive problems and vitamin/mineral deficiencies.
The most famous IgA food reaction is “celiac” disease, and it is an intolerance to gluten, the protein found in wheat. We have looked into how this impacts Hashimoto’s extensively. Check out our previous post here.
However, dairy protein, egg, and soy protein IgA intolerances are also extremely common in people with Hashimoto’s. These intolerances do not have a specific name, and may be confused with other, less severe food absorption syndromes.
IgG Food Reactions
These are antibodies that provide long-term resistance to infections, called Immunoglobulin G (IgG), and they have a much longer half-life than the traditional IgE allergy. These reactions can be much more subtle and people can live with them for years, if not their entire lives.
Symptoms, ranging from headache and nausea to seizure and hyperactivity, or simply just fatigue, bloating, mood changes brain fog, memory problems or dark circles under the eyes. They may occur hours or even days after the problem food has been ingested.
Food allergy tests like the ALCAT test, test both IgA and IgG reactions to foods. A positive or equivocal finding of IgG against foods may indicate that the person has been repeatedly exposed to food proteins recognized as foreign by the immune system.
This matters with thyroid autoimmunity because this process can fire up the very same parts of the immune system that are already attacking our own tissue. In fact, Antithyroglobulin antibodies (TgAb) and antithyroperoxidase antibodies (TPOAb), predominantly of the immunoglobulin (Ig) G class, are hallmarks of Hashimoto’s.
Researchers have recently discovered that there are 2 types of IgG proteins, IgG4-positive and IgG4-negative. Further studies are needed to determine exactly what the difference between them is. But this may have clinical and treatment ramifications.
The degree and severity of symptoms vary greatly because of the genetic makeup of the individual. The complete elimination of IgG positive foods may bring about important improvements in Hashimoto’s symptoms because this can be a key factor in calming autoimmunity.
Often people confuse the food immune reactions to dairy mentioned above and milk intolerance which is caused by milk sugars known as lactose.
One thing that people don’t always realize is that even tiny amounts of lactose can have a major impact on our ability to absorb thyroid medications. Worst of all, some thyroid medications actually contain lactose, defeating their own purpose!
Lactose Can Make Thyroid Hormone Not Work As Well
A recent study published in 2014 by Asik and colleagues found that lactose intolerant Hashimoto’s patients who were taking levothyroxine showed a decrease in TSH after lactose restriction.
In other words, removing lactose improved how their levothyroxine was working.
Another study from August 2014 had a similar finding. This was published in the Journal of Clinical Endocrinology and Metabolism by Cellini and colleagues and found that lactose intolerance increased the need for more thyroid medications.
The researchers found that the average person with Hashimoto’s required an average dose of 1.31 mcg/kg/day of levothyroxine to get to an average TSH right around 1 mU/L (that would be right around 75 mcg of levothyroxine for a 125 pound person), while a person with Hashimoto’s and lactose intolerance who continued to consume lactose needed a dose of 1.72 mcg/kg/day to reach the same goal (that would be like 100 mcg of levothyroxine for the same 125 pound person- that’s quite a bit more).
In addition, patients who had other gut disorders in addition to lactose intolerance required an even higher dose to get to their goal TSH 2.04 mcg/kg/day, or around 116 mcg for a 125 pound person. So you can see, the more gut related issues the higher the dose to achieve the same effect.
If your TSH levels are jumping up and down and you’re having a hard time controlling them, dairy protein immune responses and lactose intolerance should be top on your list of suspects.
Lactose intolerance rates in Caucasians have been reported to be between 7% to 20%, and much higher those in those of Asian and African descent. Lactose intolerance can be secondary to other conditions and reversible or it can be genetic and permanent.
A recent 2014 study by Asik and colleagues tested 83 Hashimoto’s patients for lactose intolerance and found lactose intolerance in 75.9% of the patients. I’d say that would qualify as pretty darn common!
38 of those patients were instructed to start a lactose free diet for 8 weeks, and the researchers found that over this time, the patients’ TSH dropped, meaning, they were absorbing their thyroid medication better.
For some lactose intolerant people, even tiny amounts of lactose that are found in thyroid medications can be an issue, causing impaired absorption of thyroid medications. Yes, what we’re saying is that thyroid medications could be undermining their own absorption if they contain even teeny amounts of lactose.
So if you are someone that can’t get his/her TSH into your “Goldilocks zone” – where it’s just right (there is much debate about where this is, but general consensus is that TSH should be somewhere between 0.5-2 mU/L for people to feel best) despite taking higher and higher doses of thyroid medications, consider lactose intolerance and the possibility that the lactose in your diet or even in your thyroid medication may be hindering its absorption.
And here’s the thing, the reality is you could have both lactose intolerance and be having an immune reaction to diary proteins. This is a potent and destructive double whammy for people with Hashimoto’s. Which, as you should know, is an autoimmune disease of the thyroid!
So dairy can potentially wind up autoimmune tissue destruction and prevent thyroid hormone from working. The result is a rapidly accelerating decline in thyroid function.
Some people will ask, “What about Lactaid?” They sometimes ask this because they can’t bear the idea of living without dairy products such as cheese and ice cream. And the logic makes sense to some degree. The problem is it doesn’t really solve the long term damage and potential problems.
It’s a little bit like an alcoholic taking the drug Antabuse and continuing to drink. The real problem is alcohol. And the real problem for some people is dairy.
As far as diet, I have seen tremendous improvements in my own health and the health of my clients and readers on a dairy free diet, so this is something that I strongly recommend for everyone with Hashimoto’s.
If you weren’t aware of it, here are some common medications that contain lactose as a filler and some that are lactose free.
· Synthroid
· Euthyrox
· WP Thyroid
· Nature-Throid
· Most generic brands of levothyroxine
· Some compounded medications- check with your pharmacist
· Tirosint
· Armour Thyroid
· Cytomel
· Levoxyl
· Some compounded medications may use lactose as a filler – check with your pharmacist
Of all of the T4 containing medications, Tirosint has the fewest fillers that may affect absorption, and this medication was designed for people with these types of intolerance. This medication is recommended if you suspect you may have problems with dairy and lactose.
Of course, some people do better with the addition of T3. Of all of the T4/T3 combination medications, WP Thyroid has the fewest fillers that can impair absorption. However, it does contain trace amounts of lactose, as well.
Armour thyroid does not contain lactose, but contains corn derived ingredients that can be problematic in corn sensitive individuals and can trigger a gluten like reaction.
When they changed their formulation a few years ago, some people did very poorly with the new mixture, and one of the reasons was this corn based filler.
Another really interesting research finding is that high TSH can simply be caused by absorption disorders like lactose intolerance, celiac disease, atrophic gastritis, H. Pylori infections, inflammatory bowel disease and/or parasites.
All of these issues commonly prevent people from getting their Hashimoto’s into remission, as well. These are more positive feedback loops and they cause vicious cycles that lead to poor results in different systems of the body.
This is a perfect example of how this is not just a thyroid problem. Thyroid hormone metabolism is dependent on other systems of the body.
A 2012 Polish study by Ruchala and colleagues reported that thyroid patients who need more that 2 mcg/kg/day of levothyroxine with an increased TSH should be suspected of having an absorption disorder like the ones mentioned above.
Get off of dairy 100%. Treat it the same way you treat gluten and understand that the misery it can cause if not worth the buzz of an ice cream cone or some cheese on crackers.
Also understand that having “just a little bit” is not really solving the problem at all. A tiny amount can be a tsunami to your immune system and can lead to a whole cascade of problems.
Being “sort of dairy free” is like being “sort of pregnant”. It’s not a real thing.
http://www.ncbi.nlm.nih.gov/pubmed/23992023 IgG proteins in Hashimoto’s
http://www.researchgate.net/publication/271022933_Thyroxine_softgel_capsule_in_patients_with_gastric-related_T4_malabsorption – The influence of lactose intolerance and other gastro-intestinal tract disorders on L-thyroxine absorption. Endokrynol Pol. 2012;63(4):318-23.
http://www.ncbi.nlm.nih.gov/pubmed/24078411 Asik, et al study
http://press.endocrine.org/action/doSearch?AllField=lactose+intolerance+and+thyroxine – Systematic appraisal of lactose intolerance as cause of increased need for oral thyroxine. J Clin Endocrinol Metab. 2014 Aug;99(8):E1454-8. doi: 10.1210/jc.2014-1217. Epub 2014 May 5. PMID: 24796930
http://www.ncbi.nlm.nih.gov/pubmed/17123345 Lactose intolerance revealed by severe resistance to treatment with levothyroxine. Thyroid. 2006 Nov;16(11):1171-3.
http://labeling.pfizer.com/ShowLabeling.aspx?id=688&mc_cid=3f79b51f37&mc_eid=c1f303f62b Levoxyl – Levoxyl
http://www.rxlist.com/tirosint-drug.htm – Tirosint
http://www.pdr.net/full-prescribing-information/wp-thyroid?druglabelid=3202 – WP Thyroid
Gliadin, a gluten protein
However, because of misinformation and the inconvenience of going gluten free, many people ignore these warnings or don’t think this really applies to them.
I have had a number of people write me and tell me during consultations that they need to see “peer reviewed studies” about gluten and Hashimoto’s before they are going to commit to going gluten free.
In this post we examine a boat load of research on this subject and we seek to demonstrate, once and for all, why eating gluten is not a luxury you and your thyroid (and lots of other important parts of your body – like your brain) can afford.
Celiac Disease is an Autoimmune Disorder
According to the Celiac Support Association “Celiac disease, also known as celiac sprue or gluten-sensitive enteropathy, is a genetically linked autoimmune disorder that can affect both children and adults…”
Yes, celiac disease is an autoimmune disease. It’s not just a food allergy or sensitivity.
What do we know about autoimmune disease?
When you have one, it’s easy to get others.
Like Hashimoto’s, for example.
To read more about this, check out my previous post that looks into this in depth.
“…In people with celiac disease, eating certain types of grain-based products sets off an immune mediated response that causes measurable damage to the small intestine.”
Another key point. I and many other specialists in this field believe that the small intestine is ground zero for autoimmune diseases of all kinds.
This damage to the small intestines has systemic consequences.
These include the immune system, the endocrine system, the nervous system and the brain. This is no small matter (pun intended).
“…This, in turn, interferes with the small intestine’s ability to absorb nutrients in food, leading to malnutrition and a variety of other complications.”
Yes, the other complications include an inability to convert and absorb thyroid hormone, major deficiencies in important vitamins and minerals like iodine, iron, selenium, magnesium and vitamins like B, D and plenty more.
Pretty much guaranteeing hypothyroidism and thyroid gland dysfunction.
“…The offending amino acid sequences are collectively called “gluten” and are found in wheat, barley, rye, and to a lesser extent, oats* (WBRO). Related proteins are found in triticale, spelt, and Kamut.”
Indeed, these “offending amino acid sequences” are not just found in these grains, they are found in many foods like dairy, soy, coffee, corn, potatoes, and lots more.
The reality is gluten may just be the tip of the iceberg and going gluten free may not be enough to effectively treat autoimmune disease.
Some people do not get better by only going gluten free. This is not because they don’t have a problem with gluten.
There are many other foods that have a similar amino acid sequence to gluten and these may also be a problem.
Because it is these amino acid sequences that the immune system attacks and that resemble our own tissues. (To learn more about this, check out this previous post).
Tissue transglutaminase is an enzyme that repairs damage in the body. People with celiac disease often make antibodies that attack this enzyme.
Well, studies have shown that people with transglutaminase and gliadin antibodies also have a much higher levels of TPO and TgAB antibodies.
Celiac Disease and autoimmune thyroid disorders share a common genetic link, namely, the DQ2 allele.
This is a subtype of a region of cells called the HLA (or Human Leucocyte Antigen) System.
There is a region on cells located on some of our genes called the HLA. Many of these are located on chromosome 6 (for those of you keeping count).
Mutations or defects of HLA have been linked to many different autoimmune diseases.
Exactly what happens is not known, there are numerous theories, but the end result is that our own tissue gets attacked and destroyed by the immune system.
With Celiac disease and autoimmune thyroid diseases we see an increase in both types of antibodies that lead to attack on these tissues.
Collin et al found 5.4% of 335 adult celiac patients, of whom 83% complied with a gluten-free diet, had autoimmune thyroid disease (autoimmune hypothyroidism or Graves’ disease).
Counsell et al found that 14% (15 out of 107) of celiac patients had thyroid disorders (3.7% hyperthyroid and 10.3% hypothyroid).
The same authors also noted a high prevalence of thyroglobulin antibodies (11%) and thyroid microsomal (TPO) antibodies (15%) in their CD patients.
Likewise, Velluzzi et al found the prevalence of thyroid peroxidase antibodies to be higher in CD (29.7%, 14 out of 47 patients) than in healthy controls (9.6%).
This is another area of misinformation. Most doctors test for 2-4 gluten antibodies.
Current testing for Gluten-Reactivity and Celiac disease (CD) includes serum IgG and IgA against gliadin and tissue transglutaminase-2 (tTG2).
These antibodies are measured against minor components of a wheat protein called alpha-gliadin.
Here’s the thing, wheat consists of multiple proteins and peptides including, alpha-gliadin, omega-gliadin, glutenin, gluteomorphin, prodynorphin, and agglutinins.
And there are many we still do not know about.
And the important thing to understand is that any of these antigens can cause an immune response.
So, even if you tested negative to celiac, you could still have gluten sensitivity or silent celiac disease because you may not have tested for the right thing.
This is a really interesting question that is controversial and no one really knows.
But, here’s what we do know.
Autoimmunity doesn’t just happen for no reason. It is the result of a perfect storm of factors.
You need the genetic predisposition (like the HLA DQ2 allele mentioned above), you need exposure to some antigen (Often Yersenia, Epstein Barr, Coxsackie, Lyme disease or some other pathogen), these produce antibodies and somehow you get the breakdown of mucosal IgA and tight junction proteins.
Ground zero is the intestinal mucosa.
One theory is that gluten, which is sticky and invasive (like a thief who can get into anywhere it wants), gets into the intestines, into the spaces between the intestines (the tight junctions) and eventually into the bloodstream.
Then the immune system kicks in.
Antigen presenting cells like macrophages (those Pac man cells that munch the bad guys) start attacking and they stimulate the T helper cells.
These are either TH-1 or Th-2 (check out this previous post that describes this works with Hashimoto’s in detail) and these lead to pro-inflammatory immune cells and proteins, more antibodies, cross reactions – generally, all hell breaking loose.
And, finally as this plays out and is repeated over and over again every time you eat a piece of bread, a pastry, some cake, a doughnut, etc. you are unknowingly pushing your body further and further into autoimmunity.
Your immune system is so juiced it doesn’t know which way is up and eventually, you loose self tolerance.
And loss of self tolerance means the immune system starts attacking your own tissue.
Another problem caused by gluten is that it makes thyroid hormone less effective.
An interesting study published by the American Thyroid Association found “…This study examined 68 patients with Hashimoto’s thyroiditis alone and 35 patients with Hashimoto’s thyroiditis and celiac disease.
The average dose of levothyroxine needed to treat patients with Hashimoto’s thyroiditis alone was lower than the average dose required to treat patients with Hashimoto’s and celiac disease.
When the patients with celiac disease went on a gluten-free diet while staying on the same dose of thyroxine, their TSH level decreased, indicating that their absorption of thyroxine had improved.”
We see this clinically all the time.
When patients go gluten free, they often must reduce their dosage of thyroid replacement hormone because it starts to work so much better.
Well, thyroid hormone produced by your thyroid and thyroid replacement hormone have the same structure.
Gluten prevents thyroid hormone produced by your thyroid from being absorbed, as well.
One idea that is often discussed in this context is something called molecular mimicry.
This is what happens when the immune system identifies certain proteins or protein fragments (amino acid sequences) and then attacks everything that has that amino acid sequence.
With autoimmunity, when the immune system attacks a virus like Epstein Barr, for example, it activates certain kinds of B cells.
These differentiate into plasma cells and one theory is that these may also stimulate anti-self B cells.
These are present in normal people and are there because our immune system constantly gets rid of old dead cells from our body.
But somehow these viral fragments cause other immune proteins called complement to stick to our own tissue and when they accumulate the immune system starts attacking that living tissue as well.
Viruses may also down regulate the T suppressor cells that call off the attack and this keeps the carnage going.
This is what happens to the thyroid. Thyroid cells get attacked as does the enzyme thyroid peroxidase and the protein thyroglobulin.
There is plenty of evidence that gluten is involved with firing up autoimmunity, but I could not find any actual research to support the claim that gliadin proteins closely resemble thyroid tissue (which is something that many bloggers in this area repeat).
There is no question exposure to gluten leads to autoimmunity, destruction of the small intestine, systemic inflammation and destruction of the thyroid.
But whether this type of molecular mimicry is at play is not clear. (I invite any readers to show me this actual research.)
However, at the end of the day, this hardly matters. There are so many other reasons not to eat gluten. And here’s another really big one.
Another really good reason to stay far away from gluten is that it has been linked to destruction of the brain, especially the cerebellum.
The brain is profoundly impacted by Hashimoto’s.
Check out this video (SAVE YOUR BRAIN (FROM HASHIMOTO’S) to learn more.
This is the reason why the second most common symptom for people with Hashimoto’s is brain fog and memory issues. (The most common symptom is fatigue.)
A condition of advanced neurodegeneration that results from Hashimoto’s is called Hashimoto’s Encephalopathy.
This destroys parts of the brain in much the same way that Alzheimer’s does.
And this is caused by autoimmunity in the brain.
One area of the brain that can be impacted is the cerebellum. And a common symptom of impairment to the cerebellum is ataxia.
Ataxia is uncoordinated movement is due to a muscle control problem.
It leads to a jerky, unsteady, to-and-fro motion of the middle of the body (trunk) and an unsteady gait (walking style). It can also affect the limbs.
You can test this by doing the DUI test. Close your eyes and imagine you are walking on a tight rope, put one foot in front of the other.
If you lose your balance or fall over, this may indicate some impairment of the cerebellum.
Guess what else causes ataxia?
Gluten.
In fact, a study from Brain a Journal of Neurology, 2003 found “Gluten ataxia is therefore the single most common cause of sporadic idiopathic ataxia.”
The most common cause of ataxia that has no known explanation.
So when you combine Hashimoto’s with brain autoimmunity and gluten, you have a recipe for really bad things.
The final pièce de résistance of this post is something that is related to gluten but adds a whole other layer of badness.
That is glyphosate or Monsanto’s marquee product Roundup.
Glyphosate is sprayed on wheat and many other grain crops just before harvesting to make them dry out more uniformly.
Well, it turns out that this chemical also does a number on the small intestine, may be responsible all by itself for the destruction of the intestinal lining and the initiation of a host of diseases.
Fish exposed to glyphosate develop digestive problems that are a lot like celiac disease.
Celiac disease is associated with imbalances in gut bacteria that can be fully explained by the known effects of glyphosate on gut bacteria.
Characteristics of celiac disease point to impairment in many cytochrome P450 enzymes, which are involved with detoxifying environmental toxins, activating vitamin D3, catabolizing vitamin A, and maintaining bile acid production and sulfate supplies to the gut.
Glyphosate is known to inhibit cytochrome P450 enzymes.
Deficiencies in iron, cobalt, molybdenum, copper and other rare metals associated with celiac disease can be attributed to glyphosate’s strong ability to chelate these elements.
Deficiencies in tryptophan, tyrosine, methionine and selenomethionine associated with celiac disease match glyphosate’s known depletion of these amino acids.
Celiac disease patients have an increased risk to non-Hodgkin’s lymphoma, which has also been implicated in glyphosate exposure.
So Let’s Review:
Here are 5 reasons to never touch gluten as long as you live that are supported by about 30 peer review studies listed below.
1. Celiac Disease is an Autoimmune Disease with striking similarities to Autoimmune Thyroid Disease.
2. People with Celiac, and Gluten Sensitivity have higher levels of thyroid antibodies and visa versa.
3. Gluten can destroy your small intestines and cause deficiencies in important nutrients, vitamins, and minerals absolutely necessary for proper thyroid function.
4. Gluten and Celiac Disease block the absorption of thyroid hormone.
5. Gluten can cause neurodegeneration in your brain.
And a Bonus
6. Commercial wheat also has lots of glyphosate, a chemical that can make all of what we have just mentioned a whole lot worse.
In life we must always make decisions based on risk and benefit.
The risk of the destruction that gluten can cause in people with Hashimoto’s so far outweighs the benefit that it is really no contest.
http://www.csaceliacs.org/celiac_disease_defined.jsp
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2111403/ Celiac Disease and Autoimmune thyroid disease
http://www.ncbi.nlm.nih.gov/pubmed/18176874 North Italian prevelance of CD in autoimmune thyroid
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC96126/: CD and autoimmune endocrinopathies
http://www.eje-online.org/content/130/2/137.abstract Autoimmune thyroid disorders and celiac disease
http://www.ncbi.nlm.nih.gov/pubmed/15244201 Antigliadin antibodies in celiac disease
http://www.ncbi.nlm.nih.gov/pubmed/9872614 Autoimmune thyroid diseases and celiac disease
http://www.ncbi.nlm.nih.gov/pubmed/12919165 Risk factors of thyroid autoimmunity
http://www.ncbi.nlm.nih.gov/pubmed/11768252 Autoimmune thyroid disease in celiac patients
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3725235/ Celiac disease and autoimmunity: excellent overview
http://cvi.asm.org/content/8/4/678.full Celiac related autoimmune endocrinopathies
http://www.direct-ms.org/pdf/LeakyGutMS/Fasano%20Celiac%20other%20autoimmune%20disease.pdf Systemic Autoimmune disease and celiac
http://en.wikipedia.org/wiki/Anti-transglutaminase_antibodies EMA and transglutaminase antibodies
http://www.thyroid.org/patient-thyroid-information/ct-for-patients/vol-5-issue-6/vol-5-issue-6-p-3-4/ The effect of celiac disease on levothyroxine dosage
http://www.nature.com/cmi/journal/v8/n2/full/cmi201065a.html Antibodies in Celiac disease, implications beyond diagnosis
http://www.wjgnet.com/1007-9327/13/1715.asp Dutch study of patients with Hashimoto’s and Celiac disease
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2730948/ Celiac disease and autoimmunity in the gut and elsewhere
http://jeffreydachmd.com/2014/01/hashimotos-thyroid-disease-molecular-mimicry/
http://www.todaysdietitian.com/newarchives/110310p52.shtml Research connects Celiac and Hashimoto’s
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1808742/ Gliadin, TPO and other antibodies in latent autoimmune diabetes patients
https://www.enterolab.com/StaticPages/EarlyDiagnosis.aspx Before the Villi Are Gone
http://en.wikipedia.org/wiki/Human_leukocyte_antigen Define HLA
http://thyroidbook.com/eating-gluten-increases-need-thyroid-hormones/
http://www.hindawi.com/journals/ijad/2011/865432/ Transglutaminase enzyme involved in Alzheimer’s
http://www.csaceliacs.org/celiac_disease_defined.jsp
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2077662/ Hashimoto’s Encepheopathy and Cerebellar Ataxia
http://www.ncbi.nlm.nih.gov/pubmed/12566288 Gluten Ataxia
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3945755/ Glyphosate, pathways to modern disease: Celiac sprue and gluten intolerance
https://www.cyrexlabs.com/Portals/0/Docs/ClinicalApplications/ClinicalAppArray3.pdf
“Why Isn’t My Brain Working”, Dr. Datis Kharrazian, 2013 Elephant Press
In our previous post, we took a look at the relationship between Hashimoto’s and SIBO (small intestine bacterial overgrowth), if you have not yet read that or aren’t familiar with SIBO please read it here.
SIBO, see part 1 for larger image
In this post we are going to discuss SIBO treatment and solutions. This information came from a lecture I attended in November 2014 taught by Dr. Datis Kharrazian and entitled The Neuroendocrine Immunology of Small Intestine Bacterial Overgrowth.
One important lesson that I have learned after working with over 750 people with Hashimoto’s is that there are 2 things that are really important for getting good clinical results:
#1. Figure out the mechanism. In other words, where’s the problem? With Hashimoto’s it is often in multiple places and it’s not only the thyroid.
#2. Figure out how advanced it is. Hashimoto’s, like all autoimmune disease, is progressive. We have identified 3 stages of progression. (Read here to learn more ).
In a general sense, the further it has progressed the more you must do.
Another really valuable lesson I have learned is that, often, some of the most effective treatments and solutions come from subtraction.
Many common health problems are problems of excess. Too much sugar, too much stress, too much inflammation, too much salt, too many chemicals.
A simple and effective way of treating too much is by taking things away.
If you have insulin resistance or Type 2 diabetes, stop eating sugar and refined carbohydrates.
If stress is killing you, stop doing the things that cause you so much stress.
If you have too much inflammation, stop eating and behaving in a way that causes so much inflammation.
If your sick from too much salt, stop eating salt.
If pollution is killing us and our world, stop using so many chemicals.
Such a simple solution, so hard to actually do.
At first.
The reason is that we are conditioned to be consumers, not subtractors.
However, if you have Hashimoto’s, learning the habit of being content with less (sometimes a lot less) may just be the key to your healing.
Nowhere is this more true than in the treatment of SIBO
Diet Must Be the Foundation of Treatment
With SIBO, the foundation of treatment is diet because many of the bacteria feed on foods that are common in our diets.
And if you’re like a lot of people I’ve worked with you might be asking yourself, “Why not just wipe them out with antibiotics?”
According to the American Journal of Gastroenterology, recurrence of small intestine bacteria after antibiotics is quite high (the most commonly prescribed being Rifaximin).
Many people have to keep taking antibiotics over and over again for months with limited results.
And there is a tremendous cost to your immune system and to your future ability to defend yourself.
(There is no better way to be defeated by an enemy than to give him repeated opportunities to adapt to your weapons.)
The only thing that really works is to do the diet as a foundation and then use something to eradicate the bacteria along with it.
There are a number of herbs that are quite effective for this. Particularly those in the berberine family like goldenseal, coptis, etc.
A pilot study by Spanish researchers found that probiotics worked better than pharmaceutical therapy for patients with chronic abdominal distention and SIBO.
“Based on this pilot study results, we can suggest that the probitoic herein (Lactobacillus casei, Lactobacillus plantarum, Streptococcus faecalis, Bifidobacterium brevis) used has a higher efficacy than metronidazonal in the early clinical response of patients with chronic abdominal distention and SIBO.”
The SIBO diet is a terrific exercise in subtraction and should generally be done for a month or so to get the best results.
Since there are many foods that feed these bacteria, there are many foods that must be eliminated from your diet for this initial period of time.
Foods to Avoid:
Fructose: sugars, artificial sweeteners, corn syrup
Grains: rice, wheat, quinoa, millet, amaranth, and some non grains like tapioca
Legumes/Galactans: beans, peas, chickpeas, soybeans, lentils
Fructan-containing Vegetables: lettuce, onions, artichokes, beets, broccoli, cabbage, brussels sprouts, peas, asparagus, okra, shallots, mushrooms, green peppers, cauliflower
High-fructose fruits: grapes, apples, watermelon, cherries, kiwifruit, bananas, blueberries, mangos
Meat products: Breaded or processed meats such as hot dogs, bologna, potted meats, most cold cuts (added starches) and there are some who say to also avoid beef, pork and lamb.
Foods to Eat:
Nuts: All nuts except pistachios
Vegetables: All vegetables except those listed above
Low Fructose Fruits: apricots, avocados, cantaloupes, grapefruit, honeydew melons, nectarines, oranges, peaches, pineapples, raspberries, strawberries, tomatoes
Meats: chicken, fish, eggs, (and beef, lamb and pork in moderation)
Fats: Animal fat, oils
The first step of treatment involves the diet as foundation and something to address the bacteria (like the herbs mentioned above).
Either during or after that Spartan menu, it is important to address the root causes and related issues of SIBO (read about these in Part I )
These problems include:
1. Too little stomach acid. Here’s the exception to the healing by subtraction rule. If you have too little stomach acid, you need more.
A simple treatment is to take things that boost stomach acid levels such as apple cider vinegar, lemon juice and ginger root.
Supplementing with Betain HCL may also be beneficial (consult your doctor for this).
2. An immune suppressed gut. Often the cause of this is too much corticosteroid treatment and/or too much cortisol from stress.
Here the subtraction rule works quite well. Stop the corticosteroids (unless you have a condition where you must take them) and do something about stress.
A great daily exercise in doing less? Silent seated meditation.
3. Injury to the gut nervous system (The Enteric Nervous System)
This type of neurodegeneration is permanent. However, this nervous system also has remarkable plasticity and a capacity to rewire itself.
There are couple of really important things to do here:
#1. Vigorous, (I mean really vigorous to the point of tears) gargling. Gargle with several glasses of water throughout the day.
This activates part of the nervous system connected to the vagus nerve which has a very strong connection to the gut.
#2. Stimulate your gag reflex. Order some wooden tongue depressors online and gently stimulate this reflex by pressing down on the tongue.
#3. Coffee enemas. Make sure the coffee isn’t too hot, and hold as long as possible. This causes nerve firing in the brain.
Start with a moderate amount and mild coffee, you can gradually increase both the amount of liquid and the strength of the coffee.
(Best to do it in the bathtub if you have one, so you are close to the toilet.)
Good question. You need to treat it for as long as it takes. And you may have to revisit this periodically. Generally speaking, the more severe it is, the longer and more committed you must be to healing it.
This may take several months.
It’s also true that the better you are at really following the diet and not cheating, the better the outcome and the faster your results.
Apex Energetics has recently released 5 new SIBO products and we have started using them with promising results. Click here to purchase from our online store.
What’s exciting for me as a practitioner is that they have adapted some of the formulas we have already used with excellent results and given us another option for people who have complications.
Clearvite-GL
Clearvite-GL: ClearVite-GL™ (K95) is based on Apex’s popular ClearVite™ formula and is designed to offer gastrointestinal and metabolic support.
This formula includes the powerful combination of hypoallergenic nutrients, amino acids, and minerals that other ClearVite™ products have, but excludes sources of rice and pea protein for those with sensitivities to grains or peas, or who require low carbohydrate content.
It also contains no sugars, which makes it ideal for anti-yeast diets. ClearVite-GL™ is also intended to support liver detoxication and chemical biotransformation with targeted nutritional cofactors.
Suggested use: Mix 1 scoop with up to 4-6 ounces of water. Mix well before drinking. Use once a day, or as directed by your healthcare professional.
Repairvite SE
Repairvite SE: RepairVite-SE™ (K98) is based on Apex’s popular RepairVite™ formula and is intended to offer targeted intestinal support.
This product includes a limited amount of ingredients to offer support for those with certain dietary restrictions.
A high-quality, selective blend that includes brush border enzymes, L-glutamine, and zinc carnosine is incorporated to help support intestinal cell metabolism and the intestinal microbial environment.
Suggested use: Mix 1 scoop with up to 4-6 ounces of water. Mix well before drinking. Use once a day, or as directed by your healthcare professional.
Sibotica
Sibotica: Sibotica™ (K97) incorporates key strains of probiotics that are intended to support the intestinal microbial environment, as well as the intestinal mucosal barrier.
This product may also help support the immune system via certain immune pathways. Key ingredients include Lactobacillus casei, Bifidobacterium breve, and Lactobacillus plantarum.
Suggested use: Take 1 capsule once a day, or as directed by your healthcare professional.
Enzymixpro
EnzymixPro: EnzymixPro™ (K99) incorporates a special proprietary blend of various enzymes, including brush border enzymes, that has been designed to support the gastrointestinal system.
This formula combines a broad spectrum of enzymes to help support the digestion of sugars, starches, fibers, proteins, and fats. It also includes HCl for further digestive support.
Proprietary Blend: 1372 mg of Betaine HCI, Pepsin (porcine), Bromelain, Protease I, Protease II, Protease III, Protease IV, Glucoamylase, Cellulase, Sucrase (invertase), Maltase, Phytase, Pectinase, Lactase, Alpha-galactosidase, Lipase, Amylase I, Amylase II, Peptidase.
Suggested use: Take 1-2 capsules once a day, or as directed by your healthcare professional.
Enterovite
Enterovite: EnteroVite™ (K100) incorporates nutrients and a proprietary blend of fatty acids in a formulation intended to support the intestines and intestinal cell function.
This unique formulation is designed for those who are sensitive to certain food components, such as certain starches and fibers, and who want additional intestinal support.
Short-chain fatty acids (SCFAs), normal bacterial end products of complex carbohydrates, play important roles in intestinal microbial balance and function.
Diets that are low in resistant starch and fiber can result in a low production of SCFAs. Key ingredients include butyric acid and calcium propionate.
Ingredients: Vitamin E (as d-alpha tocopherol acetate), Calcium (as calcium ß-hydroxy ß-methyl butyrate & calcium propionate) and a Propriety Blend: 575 mg* of Butyric Acid (as calcium ß-hydroxy ß-methyl butyrate), Calcium Propionate.
Suggested use: Take 1 capsule once a day, or as directed by your healthcare professional.
The Neuroendocrine Immunology of Small Intestine Bacterial Overgrowth, by Dr. Datis Kharrazian, DC, 2014
For many people who struggle with Hashimoto’s, diet is a huge issue.
Yet, many doctors ignore the role of diet in the initiation, and progression of this and other autoimmune diseases.
But, if you have Hashimoto’s, and you are like a lot of people we’ve worked with, then you know that what you eat has a huge impact on your health and how you feel.
This just makes sense. Where is your immune system in your body?
Over 70% is found in and around your digestive tract. This is where it lives.
What you eat has a profound impact on autoimmune diseases like Hashimoto’s.
In this series of posts, we’ll examine a key factor in healing your Hashimoto’s by looking into something that is really common but often overlooked.
SIBO or small intestine bacterial overgrowth.
I recently attended a lecture taught by my teacher and mentor, Dr. Datis Kharrazian.
Dr. Kharrazian is a relentless researcher.
He is always exploring other people’s research and doing his own in order to help us understand why people are getting sick and how we can fix it.
In a recent lecture that I attended called “The Neuroendocrine Immunology of Small Intestine Bacterial Overgrowth”, he shared a lot of really valuable information on many aspects of SIBO that new research has revealed.
Determining whether not you have SIBO can be really, really important for people with Hashimoto’s because of the role that the small intestines play in thyroid hormone conversion and absorption.
When you have Hashimoto’s and hypothyroidism this leads to problems with motor functions in the small intestine.
There are thyroid hormone receptors all over the gut. The vagus nerve fires into the gut.
If they aren’t getting enough thyroid hormone, things don’t move as well through there and that leads to overgrowth of bacteria.
And too much of this bacteria can interfere with levothyroxine absorption.
This is why some people take Synthroid, Armour, Cytomel, Naturethroid or another thyroid replacement hormone and it doesn’t feel like it’s working.
That’s because it isn’t.
With SIBO you can’t absorb thyroid hormone very well.
And autoimmunity shuts down T3 receptors.
Again, thyroid hormone doesn’t work if it can’t bind to receptors and can’t be absorbed.
So, even though you are taking thyroid hormone, it isn’t working – you have all the symptoms like fatigue, brain fog and memory issues, weight gain, hair loss, depression, etc.
Many researchers also believe that autoimmune disease originates in the intestines.
A leaky gut or damaged intestine has been found in every autoimmune disease that has been tested including rheumatoid arthritis, ankylosing spondylitis, inflammatory bowel disease (Crohn’s disease and ulcerative colitis), celiac disease, multiple sclerosis, type I diabetes and, yes, Hashimoto’s.
In the small intestine this damage leads to immune system stimulation, the wrong types of things in the blood stream and, ultimately, a systemic problem that results in the loss of self-tolerance.
This means that the immune system gets so overwhelmed it can’t tell what is our tissue and what is a bad guy that must be attacked.
There are many causes of the breakdown of the intestines.
These include NSAID use, alcohol, gluten and other dietary proteins, bacterial overgrowth, environmental toxins and more.
And once this breaks down it alters the whole ecosystem of the gut.
It’s hard to know which came first.
And at the end of the day, it doesn’t really matter.
What matters is what causes it and what we can do to heal it.
SIBO has a number of possible symptoms, but mostly these involve bloating, gas, diarrhea and/or constipation.
The hallmark symptom is bloating and discomfort after eating certain foods.
Basically here’s what happens.
The wrong type of bacteria end up getting into the small intestine. The migrate from the large intestine and take over.
They feed on certain types of foods like sugars, galactans, fructans and starch.
In reality, SIBO should be considered with abdominal discomfort after eating any of the following things:
– Starches
– Sugars/fructose
– Fructans
– Prebiotics
– Probiotics
– Fiber supplements
– Rice or pea powder from metabolic powders
– Galactans
You may notice that many of the foods listed here can also aggravate candida. And sometimes candida is blamed for what is actually SIBO.
The causes of SIBO matter because when we understand the causes, we can figure out how to fix them.
These include:
1. Too little stomach acid.
Hashimoto’s and hypothyroidism leads to lower production of gastrin and stomach acid. This is super common.
And ironically, many people develop GERD or acid reflux and are prescribed proton pump inhibitors and antacids that just make everything worse.
(We’ve discussed this in depth in this post)
2. An immune suppressed gut.
Many factors can lead to immune suppression in the gut. 2 important ones are long term corticosteroid treatment and chronic stress.
In either case, lots of cortisol or corticosteroids cause the immune system to shut down and allows the party to get out of control.
With Hashimoto’s the body is under a great deal of physiological stress, all the time. So extra emotional stress and abnormally stressful events often result in people getting a lot sicker.
This is one of the reasons why.
3. Injury to the gut nervous system (known as the ENS or enteric nervous system)
The gut has been called the body’s “second brain” because it has it’s own nervous system and produces many of the neurotransmitters that are also produced in the brain.
Well, just like our other brain this can degenerate and break down with age and with diseases like chronic celiac disease, sceleroderma and IBS.
And just like neurodegeneration in the brain, this can be permanent. But also, just like the brain this second brain has remarkable plasticity and it can relearn things and rewire itself, too.
The gut brain and our main brain are both loaded with thyroid hormone receptors. With Hashimoto’s and hypothyroidism, there is often too little thyroid hormone or it’s not getting absorbed properly.
This can result in damage to the enteric nervous system (the gut brain).
4. Problems with the Vagus nerve
The Vagus nerve is a central highway for communication between the brain and the gut. When the vagus nerve stops firing into the gut this slows down everything.
This is a major cause of slower motility and constipation.
Thyroid hormone has a direct affect on movement through the entire gastrointestinal tract.
Thyroid hormones increase intestinal neurotransmitters, increase blood flow to the intestines and support the repair and regeneration of the intestines.
Hypothyroidism can slow movement through the esophagus, can affect muscle function in this area and can affect the nerves that cause movement.
Hypothyroidism also has an affect on the vagus nerve and this can lead both directly and indirectly to slowing movement through the intestines.
5. Anatomical or structural changes to the small intestines or illeosecal valve
Surgery to the gut (like appendectomy or resection), diverticulitis and scarring due to inflammatory bowel disease can all lead to this.
Hypothyroidism can lead to the loss of control of the ileosecal valve that is the doorway between the large and small intestine.
When this stops working as it should it lets lots of critters from the large intestine into the small intestine.
Just like Hashimoto’s, SIBO has different degrees of severity. These are important because the more serious it is the more work you may have to do to resolve it.
I. Asymptomatic:
Abnormal small intestine bacterial overgrowth tests and mild or no symptoms.
Bloating after meals.
II. Moderate Symptoms:
Bloating with malnutrition and constipation.
Bloating with nutritional deficiencies.
III. Severe Symptoms:
Bloating with anemia, low albumin, low cholesterol
Bloating with weight loss, chronic diarrhea and malabsorption
If you are a person who has trouble taking supplements because you just react to everything, then you may fall into the more severe symptoms category.
Here’s an overview from the Journal of Clinical Gastroenterology on the prevalence of SIBO in other conditions:
15% of the elderly
33% of people with chronic diarrhea
34% of people with chronic pancreatitis
53% of people using antacid medication
66% of patients with celiac disease with persistent symptoms.
78% of people with IBS
90% of alcoholics
What really stands out for me there are 2 of those statistics.
More than half the people on antacid medication and 9 out of 10 alcoholics suffer from SIBO.
That shows you how destructive alcohol can be to the small intestines.
And, the fact is that alcohol degenerates the enteric nervous system of the gut very aggressively.
In the conventional medical model there are 2 types of testing for SIBO.
Both are flawed and not definitive.
1. Direct: Endoscopic Aspiration and Culture
This is a direct endoscopic aspiration and culture of the small intestine.
This requires a gastroenterologist, it’s expensive, it’s invasive (they have to go in and get a sample).
The problem with this is that many of the bacteria removed from the small intestine can’t be analyzed because they don’t survive in culture.
Samples must be handled properly for accurate results.
To recap: It’s expensive, it’s invasive and sometimes tests don’t reveal all the bacteria involved.
2. Indirect: Breath Testing for Hydrogen and Methane
This type of testing involves breath testing for hydrogen and methane.
This test can be inaccurate if someone has recently had antibiotics.
It may not be useful in determining all species of bacteria.
The optimal window for timing for collection is different for different people because transit time is different for different people.
To recap: You may get false negatives due to different transit times or antibiotic use.
Actually, the best test for SIBO is a trial diet and/or a stool test that looks for invasive species.
In our next post, we’ll look at this diet and how to treat all 5 different causes of SIBO and the various levels of seriousness.
http://www.ncbi.nlm.nih.gov/pubmed/17698907 – SIBO and hypothyroidism -antibiotic therapy didn’t affect thyroid hormone levels
http://www.ijem.in/article.asp?issn=2230-8210;year=2014;volume=18;issue=3;spage=307;epage=309;aulast=Patil
Link between SIBO and hypothyroidism
http://journals.lww.com/theendocrinologist/abstract/1995/05000/absorption_of_oral_thyroxine.9.aspx –
“It is markedly decreased in conditions in which there is a decrease in the effective small intestinal absorptive surface, including short bowel syndromes sprue, and other malabsorptive conditions.”
http://www.europeanreview.org/wp/wp-content/uploads/451-4561.pdf – Levothyroxine absorption in health and disease
http://gutcritters.com/thyroid-function-and-gastrointestinal-distress/ – LPS and thyroid receptors
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3099351/ SIBO Study
http://www.ncbi.nlm.nih.gov/pubmed/12388159?dopt=Abstract – Infection leads to poor thyroid hormone absorption
http://www.ncbi.nlm.nih.gov/pubmed/18372241 – LPS reduced T3
http://chriskresser.com/inflammation-strikes-again – Low T3 Syndrome
http://www.naturalendocrinesolutions.com/articles/sibo-thyroid-health/
http://neurosciencestuff.tumblr.com/post/38271759345/gut-instincts-the-secrets-of-your-second-brain Great article on the enteric nervous system
http://www.ncbi.nlm.nih.gov/pubmed/16336493 : glial cels in the gut cause neurodegeneration
http://www.jneuroinflammation.com/content/7/1/37 : neurodegeneration in IBD
http://ajpgi.physiology.org/content/ajpgi/303/8/G887.full.pdf : enteric glia cells are protective, damage to them leads to neurodegeneration
Prevalence of small intestine bacterial overgrowth diagnosed by quantitative culture of intestinal aspirate in celiac disease. J Clin Gastroenterol, 2009 Feb; 43 (2): 157-161
The Neuroendocrine Immunology of Small Intestine Bacterial Overgrowth, lecture notes, Dr. Datis Kharrazian, November 2014.
The Paleo Approach, Sarah Ballantyne, PhD, Victory Belt Publishing 2013
Polycystic ovaries and Hashimoto’s have a lot in common.
Hashimoto’s is the most common cause of hypothyroidism worldwide and research has shown that it also has many similarities to PCOS or Polycystic Ovarian Syndrome.
What’s really interesting about these 2 interacting health challenges is what they reveal about how interconnected everything in the body is.
In this post we explore these connections and how, once again, Hashimoto’s is so much more than a thyroid problem.
In order to be diagnosed with PCOS you must have 2 of the 3 following criteria.
(These are what is known as the Rotterdam criteria)
1) No period (Anovulation) or Irregular Periods
2) High levels of testosterone (Hyper-androgenism)
OR
Clinical hyper-androgenism: adult acne, hirsutism (a male pattern of body or facial hair), or hair loss (androgenic alopecia)
3) Polycystic (multiple cysts) appearing ovaries on ultrasound, containing multiple small follicles
Many women with PCOS are overweight, find it difficult to lose weight, and suffer with fatigue, depression and anxiety and either have excess hair or hair loss.
Many women who suffer from Hashimoto’s are also overweight, find it difficult to lose weight, suffer from fatigue, depression and/or anxiety and they struggle with hair loss.
Is it a coincidence? Well, in a word, no.
There is a clear connection between Hashimoto’s thyroiditis and PCOS.
A 2013 meta-analysis found that in a total of 6 studies involving 1605 women, there was a significant increase in the prevalence of Hashimoto’s, increased serum TSH, increased anti TPO antibodies, and anti TG antibodies in women with PCOS when compared to control groups.
A 2012 study found that women with PCOS had a 65% increase in thyroid peroxidase antibodies, and a 26.6% increase in the incidence of goiter, when compared to other subjects in the same age group.
Both Hashimoto’s and PCOS can also lead to infertility and another recent study showed that women suffering with PCOS-related infertility who also had high anti-TPO levels were significantly more likely to not respond to treatment.
There are a number of common causes that make both PCOS and Hashimoto’s worse and they reveal some important clues into treatment strategies.
Here are some common factors:
1. Blood sugar imbalances
2. Low progesterone
3. High Estrogen
4. Hypothyroidism
5. Inflammation: The Root of All Evil
I have written extensively about how sugar imbalances can be major triggers for Hashimoto’s and if you don’t take this seriously you won’t get better. It’s just that simple.
If you missed my previous blog post on this check it out here.
50-70% of women suffering from PCOS have blood sugar issues.
And one of the most common is insulin resistance.
This is basically caused by too much sugar in your blood. Or your classic high carbohydrate diet.
Insulin is a hormone that tells muscle and fatty tissue to take up glucose (sugar) from the bloodstream and to store it as fat or energy.
When the body tissues are “resistant” to insulin, the pancreas simply pumps out more to try and keep the blood sugar levels controlled.
And a woman with PCOS will often have much higher insulin levels in their blood than normal for this reason.
With PCOS, even though other tissues in the body are resistant to insulin, the ovaries and pituitary gland remain very sensitive to it.
The pituitary is a master endocrine gland and it must read and make decisions on many important organs including the adrenals, the thyroid, ovaries and lots more.
It is very sensitive to many different hormones and has been shown to absorb these hormones differently than many other cells in the body.
This is one of the reasons why TSH testing can be so inaccurate – it comes from the pituitary.
A recent research study looked at the role of the pituitary-ovary, adrenal, and thyroid axes in PCOS.
The researchers found through testing TRH (Thyroid Releasing Hormone) that PCOS groups had higher TSH and prolactin and lower free T4.
And adrenal stress may contribute to both high testosterone and insulin resistance, in part because of the impact of this pituitary axis .
High insulin levels also cause the pituitary gland to make too much luteinizing hormone (LH), and too much LH causes the overproduction of testosterone, which causes problems with ovulation.
In addition, insulin surges cause an enzyme (17, 20 lyase) to increase activity and this promotes the development of cysts and more production of testosterone.
What is also interesting is that estrogen is transformed into testosterone in fat cells by an enzyme called aromatase.
This is very common in overweight women who are insulin resistant and who are hypothyroid.
Drugs that lower insulin levels like metformin have been shown to be beneficial in the treatment of PCOS in some women because of this connection.
They lower insulin and aromatase levels which helps lower testosterone levels and, thus, cyst formation.
As part of a vicious cycle, the high testosterone in PCOS sparks even more insulin resistance.
And research has shown that this is not a one way street.
Low thyroid function (higher TSH) actually makes insulin resistance worse in women with PCOS.
Boil this all down to one thing?
Too much sugar is like adding gasoline to the flame of both PCOS and Hashimoto’s.
(If you get nothing else from this post, burn that into your brain.)
Also, it is interesting to note that one of the most common factors of hair loss in women with Hashimoto’s is blood sugar imbalances and insulin resistance.
Low progesterone is another thing that is very common in both PCOS and Hashimoto’s.
It is difficult to know which came first, but there are some common factors.
Usually in their mid-thirties, women’s progesterone levels begin to fall more quickly than their estrogen levels, creating what is known as “estrogen dominance”.
If left uncorrected, this imbalance of progesterone and estrogen can get worse over time and all kinds of issues can appear, including: premenstrual headaches (often migraine-like) fluid retention, fibrocystic breast disease, uterine fibroids, heavy, painful menstrual periods, endometriosis and functional hypothyroidism.
Estrogen dominance also causes the liver to produce high levels of a protein called “thyroid binding globulin”, which, you guessed it, binds to thyroid hormone.
When this happens the amount of thyroid hormone that can be used by the cells of the body goes down.
What does this lead to? Low thyroid function and all of the negative side effects that come along with it.
A 2009 study looked at a group of 337 women with PCOS. All of the women were assessed for the key markers of PCOS, including hirsutism, acne, and menstrual irregularity.
What the researchers found was that women with the highest TSH levels tended to have the most severe insulin resistance. Interestingly, this was not related to weight: hypothyroidism caused insulin resistance in women in all weight categories.
The study concluded that a TSH above 2 miU/L was associated with insulin resistance in PCOS.
It seems that for women with PCOS, an optimal TSH range may be below 2-2.5 mIU/L.
While the research on this topic is generally focused on TSH, it is also makes sense that an optimal range also exists for free T3 and free T4 in PCOS.
In my practice, I have found that values at the top part of the range may provide benefit for some women with PCOS.
And, once again, this is not a one way street.
Low thyroid function leads to low progesterone and high estrogen.
This can lead to weight gain and insulin resistance which can lead to estrogen getting transformed into testosterone and too much LH which can all lead to PCOS.
And correcting hypothyroidism can improve and sometimes resolve PCOS.
Do you see how this is all connected into a massive vicious cycle?
Dear reader, if you know me and my work, you know where I’m going with this.
The root of all evil is inflammation.
Both Hashimoto’s and PCOS are driven by inflammation.
Nodules and thyroid inflammation and cysts on the ovaries are both caused by inflammation.
We’ve seen how sugar and inflammation go together like gamblers and con men.
Well, inflammation, Hashimoto’s and PCOS go together like gamblers, pick pockets and con men.
Recent research has shown that there are common inflammatory markers in both PCOS and Hashimoto’s.
(Read this post to learn more about what is happening with the immune system and Hashimoto’s.)
C-reactive protein levels are 96% higher in PCOS patients than in healthy controls. It has also been found to be significantly elevated in patients with subacute thyroiditis.
Interleukin 18 (IL-18) is high with obesity and insulin resistance. IL-18 is a major culprit in the initiation and progression of Hashimoto’s, especially those with severe symptoms that don’t respond to levothyroxine treatment.
Polymorphisms (genetics variations) of the IL-1a, IL-1b and IL-6 genes have also been associated with PCOS.
IL-6 is also elevated with insulin resistance, PCOS and Hashimoto’s and is thought to be a major factor in the initiation and progression of both disorders.
PCOS and Hashimoto’s have many common factors and symptoms and when you boil it all down have very similar origins.
They are made worse by blood sugar imbalances, especially insulin resistance and by inflammation.
So the best way to treat them is?
Conventional treatment for PCOS is to prescribe oral contraceptives to shrink cysts and falsely normalize menstrual patterns.
But many times, this is not a good long term solution because it does not address the underlying causes of the problem.
If the underlying causes are thyroid related, then proper thyroid management will often resolve the cysts.
In addition, the following strategies should be implemented:
Balance blood sugar, improve insulin receptor sensitivity and reduce systemic inflammation.
This is the holy trinity.
Hashimoto’s is an progressive autoimmune disease and, over time, it becomes way more than a thyroid problem.
As this post clearly demonstrates, many different systems of the body get involved and affect each other.
When these start to malfunction, they can cause a web of problems that result in a downward spiral that causes you to get worse and worse.
It is possible to turn this downward spiral on it’s head.
But you need an understanding of what is going on, you need an approach that can help you deal with everything and fix it and you need support in making all these changes.
That’s why I created my program, the 5 Elements of Thyroid Health. It is 3 pronged approach that:
1. First, teaches you what is happening in your body,
2. Then we work with you to create an action plan to fix those problems, and
3. Finally, we also work on creating a lifestyle that will sustain and support those changes to give you the best chances for success.
Click this link to watch a video to learn more.
(The European Society for Human Reproduction and Embryology (ESHRE) and the American Society for Reproductive Medicine (ASRM) cosponsored the Rotterdam polycystic ovary syndrome (PCOS) consensus workshop to come up with the Rotterdam Criteria in 2004).
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3683210/ – Thyroid disorders in PCOS
http://www.ncbi.nlm.nih.gov/pubmed/24260593 – 2013 meta-analysis
http://www.ncbi.nlm.nih.gov/pubmed/21866332 – 2012 study
http://www.ncbi.nlm.nih.gov/pubmed/20638057 – poor response to treatment
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3002408/ – Origins of PCOS
http://www.ncbi.nlm.nih.gov/pubmed/12477517 – Metformin treatment in PCOS
http://www.ncbi.nlm.nih.gov/pubmed/19654109 – High TSH leads to more insulin resistance
http://www.ncbi.nlm.nih.gov/pubmed/22553983 – PCOS and Chronic Inflammation
http://www.jofamericanscience.org/journals/am-sci/am0706/175_6025am0706_1156_1162.pdf – IL-6 and IL-15 elevated in hashimoto’s
A recent study published in the the Journal of Interdisciplinary Toxicology (Vol. 6(4): 159–184. by Anthony Samsel and Stephanie Seneff looks at the health impact on glyphosates, the main ingredient in Monsanto’s marquee product Roundup.
This is a popular herbicide used for many purposes including domination of the world’s seed supply.
Here what they found.
This stuff is everywhere and it is used by farmers on wheat crops 2-3 days before harvesting to dry everything out and make it easier to harvest.
Why let it dry in the sun when you can spray it with toxic chemicals?
This is now also used on all grain crops, rice, seeds, dried beans and peas, sugar cane, sweet potatoes, and sugar beets.
It is also used on genetically modified crops like corn and soy, extensively.
Well, it turns out that glyphosate is a known endocrine disruptor, not good news for all us thyroid hormone fans and it has a lot of other really bad effects on our bodies.
Samsel & Seneff have carefully researched the known (published) effects of glyphosate along with the known (published) pathologies associated with celiac disease, gluten intolerance and irritable bowel syndrome.
They have identified chemical and biological pathways where glyphosate can be the cause.
These are: disruption of the gut bacteria; breakdown in the junctions of the intestinal wall; depletion of vital minerals, vitamins and nutrients; and impairment of cytochrome enzymes that aid the liver in detoxifying environmental toxins, thus multiplying the negative effect of other environmental toxins to which we are exposed in increasing amounts.
Translation: Glyphosate may lead to leaky gut, which allows glyphosate soaked gluten to get into your blood stream and your brain, where it does major damage.
This begs the question, is the problem gluten or Roundup?
The answer for you and me?
It doesn’t matter, because they are now one in the same. Go 100% gluten free people.
It’s just not worth the damage it causes.
http://sustainablepulse.com/wp-content/uploads/2014/02/Glyphosate_II_Samsel-Seneff.pdf
Converted to formaldehyde
Diet soda and other products that contain sugar substitutes can have a harmful effect on the thyroid.
The issue here, in my opinion, is the conversion of artificial sweeteners, like aspartame, into formaldehyde. Like many environmental toxins, this causes inflammation and an immune response.
A case report presented at the American Association of Clinical Endocrinologists (AACE) 22nd Annual Scientific and Clinical Congress. Issac Sachmechi, M.D., F.A.C.E., F.A.C.P., of New Hyde Park, New York, treated a patient diagnosed with Hashimoto’s thyroiditis that resolved completely with the elimination of artificial sweeteners including Sweet’N Low, Equal, SPLENDA®, and diet sodas.
“An overabundance of sugar-substituted beverages could pose a serious health risk if you are a thyroid patient,” says Dr. Sachmechi. “While the issue is being studied more in-depth, thyroid patients should manage their intake of sugar substitutes while consulting their endocrinologist,” he adds.
Formaldehyde, widely known as an embalming fluid, is a by product of the breakdown of aspartame in the liver and may be associated with immune system disorders.
Your Body Can’t Clear These Toxins Normally
It is important to understand how the body clears environmental toxins, pollutants, and chemicals. In our bodies this happens primarily in the liver.
However, although the liver has hundreds of enzymes to clear many compounds, it still does not have enough to clear everything out of your body. And, unfortunately, many of the most common and most toxic environmental compounds can not be cleared by the liver.
What Happens When the Liver Doesn’t Clear These Toxins, Pollutants and Chemicals?
They become lodged in the body and activate inflammation and disrupt the immune system. This can lead to chronic pain and inflammation, cancer growth and autoimmunity.
Recent research has led us to discover several important ways that your body deals with exposure to these toxins.
Toxic Chemicals Affect the Body in the Following Ways
1. They deplete glutathione.
2. They initiate inflammation, cancer and auto-immune disease through a signaling system in your DNA called NF-Kappa B.
3. They clog your liver and make the liver work harder at clearing toxins and they make liver detoxification not work as well.
4. They cause leaky gut syndrome.
5. They lead to loss of chemical tolerance and multiple food allergies and sensitivities to chemicals, smells and things that never used to bother you (which some researchers think may be the beginning of auto-immune disease).
The unintended consequences of better living through chemistry, people.
Frappuccino with low thyroid function
Did you know that low thyroid function is often caused by some other condition first, and often adrenal gland stress and blood sugar problems are the culprits?
Translation? High sugar, high caffeine beverages (coffee drinks, energy drinks, etc.). These stimulate the adrenal stress response and cause serious blood sugar imbalances.
* Affect communication between the brain and glands that produce hormones. The hypothalamus and pituitary gland are the directors of hormone production and chronic adrenal stress can mess up communication with the thyroid.
* Increase thyroid binding activity, keeping thyroid hormones from getting absorbed by the cells of the body.
* Interfere with the conversion of T4 to active forms of T3 that the body can use.
* Affect detoxification pathways that clear out unnecessary thyroid hormone, when these get stuck in the body you can develop thyroid hormone resistance making cells lose their sensitivity to thyroid hormones.
* Weaken the immune barriers of the gut, lungs, and brain and weaken the immune system, in general. When this happens, you can have more immune flare ups and this can trigger your Hashimoto’s and make it worse.
Cause cortisol to be released to try to restore blood sugar balance (see the connection between the adrenals and blood sugar?)
* 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.
So put down that frozen frappuccino hypothyroid drink and your thyroid will thank you!
The truth hurts
In this post we’re going to break down the stomach, stomach acid, and, of course, it’s relationship to the thyroid and Hashimoto’s.
What does the stomach do?
It’s role is really to take food that has been chewed (hopefully well) and mixed with saliva and to break it down.
Break it down! Like James Brown!
Break it down, stomach! Do the mashed potato. Ok, what breaks all this food down?
Hydrochloric acid. This is vitally important for breaking down vitamins, minerals (like iron) and vital nutrients so that they can be absorbed by your small intestine.
A lot of people, misled by advertising, think that stomach acid is bad. 2 of the top 10 most prescribed drugs in the US are Nexium and Prevacid.
These are designed to block the production of stomach acid and are called proton pump inhibitors.
These proton pump inhibitors work by completely blocking the production of stomach acid. They do this by inhibiting (shutting down) a system in the stomach known as the proton pump.
Because we don’t need that.
No, actually, it’s hugely important.
Having enough stomach acid prevents food poisoning, parasites and other critters from taking over your digestive tract.
Enough hydrochloric acid also stimulates gall bladder and pancreas function to complete digestion and keep everybody in the digestive tract happy, happy, happy.
Proton pump inhibitors also affect thyroid hormone absorption and a study from Endocrinology Practice, the official journal of the Endocrine Society of America found their impact is so significant that patients taking these drugs and thyroid hormone may need to adjust their dosage.
What I’m saying is you actually do need hydrochloric acid or HCL and it’s production depends on the hormone gastrin.
And guess what else has an impact on gastrin? Thyroid hormone.
So hypothyroidism causes less gastrin to be produced, which leads to lower amounts of hydrochloric acid which, in turn leads to heartburn, bloating, gas and..wait for it…….!
Why, yes I did.
But didn’t you also say too little hydrochloric acid?
Why, yes I did.
Let me explain…mechanisms, people. It’s how things work.
It turns out, having enough stomach acid actually prevents heartburn by helping to thoroughly digest your food.
The burning is felt in the lower esophagus.
The burning sensation that people feel from heartburn is actually from the poorly digested food rotting in your gut and shooting up into your esophagus, where there is no protection from the acid.
Even a small amount of acid will cause problems there.
In an editorial published in the journal Gastroenterology first published online in 2009, the author remarked:
Treating gastroesophageal reflux disease with profound acid inhibition (which the popular drugs are) will never be ideal because acid secretion is not the primary underlying defect.
You see, there is the truth rearing it’s ugly little head. Another study referenced below suggests the actual cause of GERD is pressure on the abdomen (often made worse by weight gain and obesity) not too much acid.
For decades the medical establishment has been directing its attention at how to reduce stomach acid secretion in people suffering from heartburn and GERD, even though it’s well-known that these conditions are not caused by excess stomach acid.
Advertising, people. Great for making money, not so good for healing.
Another thing that HCL is important for is the absorption of vital nutrients like B12, iron, and calcium and for breaking down and absorbing protein.
Too little HCL can also lead to inflammation, lesions and infections in the intestines.
All of that leads to poor absorption of thyroid hormone, leading to…this one is a gimmee….(yup, you guessed it) normal lab tests but hypothyroid symptoms.
With too little stomach acid, also called hypochlorhydria, 2 important factors lead to GERD and acid reflux.
The first is bacterial overgrowth. Stomach acid acts like the police of the digestive tract. It keeps the riff raff out. When you don’t have enough you can get overgrowth of bacterial species that cause problems like copious amounts of gas. (Whew!)
The second problem that too little stomach acid causes is that it can lead to poor digestion, especially of carbohydrates. And these 2 problems feed each other because these problem bacteria really like to feed on carbohydrates.
So you wind with yet another vicious cycle.
This is also why people with acid reflux often feel better after going off of gluten (and other carbs). You stop feeding the problem.
I am very fortunate to have a robust community of Hashimoto’s folks at our Facebook support group.
I asked them how many of them experienced symptoms of acid reflux or GERD. And of the 75 respondents, virtually all of them had symptoms related to issues involving stomach acid.
Here’s a chart that illustrates their symptoms.
3 Symptoms of Acid Reflux – SURVEY TABULATION – January 13 2
And a second chart that looks at what helped.
3 Symptoms of Acid Reflux – SURVEY TABULATION – January 13 4
While this is hardly a scientific study, it is emblematic of how common these problems are among this population. Notice how many people improved by going off of gluten and wheat and/or going Paleo. All approaches that limited the number of carbs. Also notice how many are on proton pump inhibitors.
Too little stomach acid also leads to anemia because you can’t absorb B12, and you can’t properly absorb iron.
Couple this with heavy bleeding during your cycle which can also be caused by too little thyroid hormone (more on that in an upcoming post) and you have a recipe for iron deficiency anemia.
The stomach is important for breaking down and digesting foods and for allowing the body to absorb important vitamins, minerals and protein.
Too little stomach acid can lead to a host of problems: like heartburn (counter-intuitive but true), anemia, iron and protein deficiency.
All of this creates a vicious cycle of less conversion and utilization of thyroid hormone and lower stomach acid. Not good.
So glad you asked.
Let’s use logic, even though it can be counter intuitive. If you have too little stomach acid and this is the cause of the problem then….yup, that’s right, do something to increase the stomach acid when you eat.
Some simple natural solutions include:
* Going gluten free or Paleo (to cut out the carbs)
* Apple cider vinegar (to increase stomach acid)
*Lemon or Lime juice in some water (to increase stomach acid)
*Fresh Ginger or ginger tea (to increase stomach acid secretion)
*HCL supplements (to boost HCL levels)
How much really depends on how bad you’ve got it and on whether or not there are other things going on. And all the things that increase stomach acid should be done with your meal, not on an empty stomach.
H. Pylori
There are some other things that can make resolving this more difficult. One of the most common is the bacteria Heliobactor Pylori also known as H. Pylori.
This little critter can take over when there is not enough stomach acid in your stomach. So be sure to test for it to rule it out if you have these symptoms.
Alkaline Water
This stuff is often marketed as the answer. “Cancer can’t grow in an alkaline environment.”
Here’s the thing. Different parts of your body have different acid and alkaline requirements. Your stomach needs to be acidic.
When you drink lots of alkaline water, especially if it’s with your meal, you may wind up causing everything I have just described.
Don’t believe the hype, acid ain’t all bad.
Once again we see how there is an explanation for what’s gong on and the conventional medical approach or the multi-marketed hype, while profitable, is actually counterproductive to healing.
I envision a day, sometime in the future when medicine actually becomes about healing and resolving people’s issues.
Wait! It’s here… at Hashimoto’s Healing where we provide hope, help and healing for Hashimoto’s and the varied ways that it wreaks havoc on our bodies. For example check out my program The 5 Elements of Thyroid Health.
Please, please, please! Give your body a chance to heal by learning the truth. Question the drug companies and the marketers who are talkin’ loud and sayin’ nothin’.
(I will give a free 30 minute consultation to anyone who can identify the numerous allusions to James Brown songs and/or dances that I have in this post.)
http://www.natap.org/2009/HIV/070409_02.htm :Article on how proton pump inhibitors actually cause the problem they are supposed to fix
http://www.gastrojournal.org/article/S0016-5085(07)01843-4/preview : The real cause of GERD
http://www.ncbi.nlm.nih.gov/pubmed/9079271 : Study showing how antibiotics can improve gastric reflux
http://www.ncbi.nlm.nih.gov/pubmed/16871438 : An interesting study showing that a low carb diet improves acid reflux
http://www.ncbi.nlm.nih.gov/pubmed/17669709 : Study showing how proton pump inhibitors affect thyroid hormone absorption
The Thyroid, A Fundamental and Clinical Text, Ninth Edition. Lewis E. Braverman and Robert D. Utiger 2005