I decided to create a series of episodes covering the different factors that can help you lower and eventually normalize your thyroid antibodies. In today’s sixth and final part of my series, I’m discussing the crucial link between gut health and thyroid antibodies. I’m talking about how the gut impacts autoimmune thyroid conditions, the concept of leaky gut, the 5R protocol for gut healing, strategies for supporting gut health, my approach to testing, and more. If you would prefer to listen to this part, you can access it by Clicking Here [1].
There are a few reasons why healing the gut is essential to lower and eventually normalize the thyroid antibodies associated with Graves’ and Hashimoto’s.
First of all, most of the immune system cells are located in the gut. As a result, you really do need to have a healthy gut in order to have a healthy immune system.
I have also mentioned in other episodes the triad of autoimmunity. Remember, it involves three components necessary for autoimmunity to develop. Component #1 is a genetic predisposition. Second is an exposure to one or more environmental triggers. The third one is an increase in intestinal permeability, also known as leaky gut.
That leaky gut is necessary for autoimmunity to develop. Healing the leaky gut is also necessary to reverse autoimmunity and therefore lower those antibodies, eventually normalizing them.
Let me briefly explain what a leaky gut is. You have these tight junctions, which connect adjacent cells of the small intestine and prevent larger molecules from passing through. What I like to do is use my hand and show my fingers. Think of my fingers as the cells of the small intestine. You have these tight junctions in between the fingers/cells of the small intestine, holding them together. When you have that leaky gut, you have damage to the tight junctions. If you open up those fingers or have the spaces in between the small intestine become larger, this allows proteins and other larger molecules to pass into the bloodstream, which causes an immune system response.
What causes a leaky gut? There are a number of factors. This leads us into a discussion of the 5R protocol. This discusses the different things you need to do to heal the gut.
The first component also relates to some of the causes of the leaky gut. That very first component is Remove. You want to remove those factors that can cause a leaky gut.
Food is one of the factors. I have an episode in this series dedicated to food triggers, such as gluten, corn, others.
Certain infections can also cause a leaky gut. I have an episode in this podcast series on lowering and normalizing thyroid antibodies that talks about infections. Not all infections cause a leaky gut. In that episode, not every infection I discuss will cause a leaky gut. Ones that are specific to the gut can cause a leaky gut.
Not necessarily infections, but SIBO or yeast overgrowth also could be a factor.
Certain environmental toxins. I have an episode on environmental toxins when it comes to lowering and normalizing antibodies. It doesn’t mean every single environmental toxin will cause a leaky gut. One that potentially can is glyphosate.
Glyphosate, to be honest, I don’t know if there is evidence of it directing a leaky gut. It definitely seems to cause dysbiosis, an imbalance in the gut flora. That seems to go hand in hand with the leaky gut. You could have imbalance in the gut flora without having a leaky gut. Many times, when you have that imbalance, you have a leaky gut.
Medications like antibiotics, proton pump inhibitors, even antithyroid medication such as methimazole or PTU. There is a time and place for medications, including antithyroid medication. They can not only cause that dysbiosis, but there is some evidence that shows they can affect the intestinal barrier, those tight junctions.
It is important to understand you can have a leaky gut without experiencing any symptoms. If you are having symptoms such as bloating, gas, stomach pain, you could have other things going on such as parasites, H-pylori. H-pylori will typically cause heartburn and reflux, but you also might not have symptoms. The point is, you can have a leaky gut in the absence of digestive symptoms.
That’s the first R of the 5R protocol. Some of those factors can be a cause of a leaky gut, so you want to remove those factors.
The second R is Replace. You might need to replace things like digestive enzymes. A lot of people have low stomach acid. Maybe taking something like butane HCl or some bitter herbs, those are some examples of things that you might have to replace. Even dietary fiber falls under that replace component.
The third R is is Reinoculate. You want to reinoculate the good flora with probiotics, prebiotics. The question you might have is should I do this through food? Should I do this through supplementation? You definitely want to do as much as you can through food. If you enjoy eating fermented foods for example, and you are able to tolerate fermented foods such as sauerkraut and fermented pickles, then by all means, eat these foods.
Prebiotics, eat plenty of foods that are high in fiber, and that will provide prebiotics. For example, if you are eating green, leafy vegetables, which I do add to my smoothie, they are not the best source of dietary fiber. They are not high in prebiotics. Other types of vegetables like cruciferous vegetables are high in fiber.
Some people might not be able to tolerate cruciferous vegetables, especially if they have something like SIBO. You just have to listen to your body. Same thing with fermented foods. It could also be histamine intolerance.
Definitely try to do as much as you can through diet. That being said, I do like supplements. I have been taking a probiotic supplement for quite some time. I would recommend if you take a probiotic, take one that has a decent potency, at least 25-30 billion CFU, colony forming units.
Also, make sure it lists multiple strains, not just a species. An example of this is Lactobacillus acidophilus, which is a species. Lactobacillus acidophilous LA-14 is a specific strain. You could look at the label, and if you see the species name, usually with the strain, you will see a letter/number combo. It might just be numbers or extra letters. You definitely want to list a strain and not just a species.
When I dealt with Graves’ in 2008/2009, I did not add extra prebiotics. I tried to get what I could through diet. For the last six or seven years, I have been adding prebiotics to my smoothie. The ones I get are inexpensive, especially compared to probiotics. They are providing some extra prebiotics. I try to get as many prebiotics as I can from food as well.
The fourth R is Repair. You want to do things to repair your gut. A lot of people just jump right into repair. They will do things like drink bone broth or take supplements such as L-glutamine or other gut healing supplements. If you’re a vegan/vegetarian, and you are not going to drink bone broth, cabbage juice is an option also to help to heal the gut.
Again, you need to address the first three R’s. Don’t necessarily need to do these in order. You could remove, replace, reinoculate, and at the same time, repair. If you just jump to repair, and are drinking bone broth or taking a gut healing supplement like my SMT GI Restore, which is a great supplement, but if that’s all you’re doing, and you’re not doing things to address the cause of the leaky gut, replace, and reinoculate, you won’t be successful in healing the gut.
Repair is important, but a lot of people jump right into that. They don’t address the other ones. They might take probiotics. I see a lot of people when they work with me who are already taking a probiotic, a digestive enzyme, and maybe drinking bone broth. They haven’t done as much as they could to address that first R, remove.
The fifth R is Rebalance. Rebalance the parasympathetic nervous system. You could do this through mind/body medicine. Vagus nerve exercises. With mind/body medicine, meditation, yoga, even deep breathing. When you talk about Vagus nerve exercises, singing loud, either in the shower or in your car or wherever. Vigorous gargling also stimulates the Vagus nerve. Taking cold showers as well, which is something I do.
Those are the five components of the 5R protocol. This is necessary for optimal gut health. Some people will say you need to go beyond the 5R protocol in some cases. Maybe, but you always need to incorporate the 5R protocol. I’m not saying that in every case, if you just incorporate the 5R protocol, that alone is going to heal the gut. Many times, it will. If you try to do other things and not incorporate the components of the 5R protocol, you won’t be successful in healing the gut.
I also want you to be aware of childhood factors that could impact the gut. For example, C section versus a natural birth.
Being bottle-fed, which was the case with me. I was never breastfed. If you’re breastfed, that has beneficial impact on the gut microbiota.
Antibiotic use when younger. I took a lot of antibiotics when I was younger, which definitely wasn’t beneficial to my gut microbiome.
Proton pump inhibitors. I don’t know the statistics with children, but you’d be surprised how many children take acid blockers. A lot of children aren’t eating well, so a lot of it does come down to diet. If they have symptoms, many times, the practitioner won’t look to make recommendations- I would hope a natural healthcare practitioner would be making dietary recommendations, but going to a conventional medical doctor or nurse practitioner, some of them are open-minded, but not all of them. They might just recommend some medication, which can have a negative impact on the gut.
There is a time and place for antibiotics. When I was growing up, I’m sure some of the antibiotics I took maybe were necessary, but definitely not all of them. That’s a big problem, not just with children, but adults as well, taking too many medications overall, not just antibiotics.
Should you test the gut microbiome? I think it depends on the person. There are natural healthcare practitioners who will test everybody’s gut microbiome. I won’t say that’s a big thing. Doing functional medicine testing isn’t cheap. Everything adds up. To me, it’s a matter of prioritizing. There are practitioners who will recommend leaky gut testing for everyone. There are practitioners who will recommend a comprehensive stool panel for everyone. That’s just their approach. I am not saying anything negative.
With regard to leaky gut testing, at one point, I tested everybody for a leaky gut. I would do usually the Array #2 from Cyrex Labs. That’s their intestinal permeability test, which is a blood test. You could do zonulin in the stool, which is not a perfect marker. Lactulose mannitol test is a more classic test, which is not perfect. Even Array #2 is pretty good, but I’m sure not perfect. No test is perfect.
I will say that most people tested positive for a leaky gut, which made sense. I do work with some people with non-autoimmune thyroid conditions, but most of my patients have Graves’ or Hashimoto’s. According to the triad of autoimmunity, you’d think they would have a leaky gut. Most people did.
What I decided to do is stop doing it. It’s great for the person to see they have a leaky gut, but it’s a couple hundred dollars for the test. Why don’t they spend that money elsewhere, and we will assume they have a leaky gut?
The one upside to doing leaky gut testing upfront is if it’s positive, later on, you can retest and see if it improves, which it hopefully will. Now you could still do a leaky gut test later, even if you don’t do an initial test. You wouldn’t know if it’s positive to begin with.
I will say that most people test positive for a leaky gut. If they were negative for a leaky gut, I would question whether it was a true negative or a false negative. I just make the assumption that people have a leaky gut. A lot of practitioners take this approach as well.
There are other types of tests, like comprehensive stool panels. GI Map by Diagnostic Solutions and GI Effects by Genovva Diagnostics are two of the most well-known tests. There is a newer one from Doctor’s Data.
I like the GI Map and GI Effects. Those are my two favorite tests. I don’t recommend these tests to everybody. There are some practitioners who do. They’re expensive tests. That’s not the reason I won’t recommend it. If I think someone needs a test, I will recommend it.
The challenge is sometimes you don’t know. You can’t always go by symptom. You can use that for justification that everyone should get a comprehensive stool panel for example.
When I dealt with Graves’, I didn’t get a comprehensive stool panel or a leaky gut test or any gut-related tests. I did an adrenal saliva test, which did look at a marker called secretory IGA, which lines the mucosal surfaces of the gut. Mine was depressed, so I did have that test. I didn’t have any specific gut testing like a leaky gut test or a stool panel. I did find I was able to get into remission, and I have taken that approach with a lot of people.
If someone has obvious digestive symptoms, then I will usually recommend some type of gut test, whether it’s a comprehensive stool test or a SIBO breath test. Maybe doing an organic acids test, which is really good for looking at yeast overgrowth.
I will do some testing. Many times, I will give an option. I will list a comprehensive stool panel as an optional test, and someone might choose to do it. If someone doesn’t choose to do it, yes, there is always a chance they might need to do it later on. That’s why I also give it as an option. To force everybody to spend $300+ on a comprehensive stool test for example when many of these people won’t need it, I don’t feel comfortable doing that. If someone absolutely wants to do it, or if I feel like they need to do it, then I will give that recommendation.
You can’t always go by symptom. Sometimes, I won’t recommend it. The person might not be progressing or might hit a roadblock, and we recommend it later on. Would have been great if they did it initially. Like I said, that’s my approach, where I don’t recommend it to every single person.
If you’re listening to this and in the future decide to work with me, keep in mind, it’s up to you. You can do it. I will usually list it as an option when I send my follow-up recommendations.
There are also tests looking at the diversity of the gut microbiome. A GI Map or GI Effects looks at some of the good flora of the body, but its main focus is looking for pathogens and opportunistic bacteria, things like H-pylori. Even with the GI Effects, that’s an add-on. Parasites; certain opportunistic bacteria like Streptococcus, Staphylococcus, Klebsiella, Pseudomonas. It also looks at markers related to digestion like pancreatic elastase; secretory IgA; calprotectin. I do find the test to be valuable, even though I don’t do it on everybody.
The stool tests that look at diversity, they’re focusing on the number of different microorganisms. You want to make sure that they’re in good amounts, that they’re not too high or low. A comprehensive stool panel is called “comprehensive” because it looks at lots of things.
If you are just looking at the diversity, Viome is not my favorite, but that test is looking at the diversity. They are not looking at things like H-pylori or parasites. It’s not that I dislike Viome; it’s just that they give recommendations based on AI. It’s still not perfected. Nothing bad about Viome.
The information on the diversity is accurate, but when they give recommendations on foods you should eat and not eat based on your gut microbiome and some other information, I’m not sure it’s accurate. This is also based on what they have said, listening to some of their webinars, admitting they are still using a lot of AI to come up with those recommendations.
Next question you might have is how do you know if the gut has been healed? This is a very common question that I get asked. There are a few different ways. One is if you did that initial leaky gut test, then you could do a retest and see if it’s been healed.
Even if you didn’t do a leaky gut test, let’s say you made that assumption that someone had a leaky gut. You could still do a leaky gut test later on and see what that shows. If it’s positive, that person’s gut has not been healed. If it’s negative, assuming you believe in the results, false negatives are possible.
When I dealt with Graves’, I did secretory IgA on the saliva test, which was really low, less than detectable. Eventually, I retested. The first time I retested, it still remained undetectable. Then I made some changes to my diet. At the time, I was eating paleo because there was no AIP diet back in 2008-2009. When I retested after avoiding nuts for a few months, my secretory IgA was normal. I am not 100% sure, but I was pretty sure it was due to the nuts because that was the only change I made.
Let’s say you have Graves’ or Hashimoto’s, and your thyroid hormones are in balance. Your antibodies are normal. You’re not experiencing gut symptoms. When you get to this point, maybe you didn’t have gut symptoms to begin with, but you had elevated thyroid antibodies associated with Graves’ or Hashimoto’s or both. Either way, if everything seems to be in balance, and if you were experiencing gut symptoms but no longer are, you could definitely do that.
That’s what I used. I did look at secretory IgA in saliva. It’s not like I absolutely did no testing. As I mentioned earlier, I didn’t do a comprehensive stool test or a specific leaky gut test. When secretory IgA is low, that usually correlates with a leaky gut, but it’s not a specific leaky gut test.
Hopefully, you enjoyed this presentation on lowering thyroid antibodies by healing the gut. I also hope you enjoyed the entire series on how to lower and normalize thyroid antibodies. Just remember that it’s not always easy to lower and normalize thyroid antibodies, but it is very possible.
Thanks again for tuning in. I look forward to catching you in the next episode.