Multiple autoimmune syndrome involves someone having three or more autoimmune conditions.  I’ve mentioned in past blog posts how someone who has one autoimmune condition has a good chance of developing additional autoimmune conditions.  In fact, even though I primarily see people with Graves’ disease and Hashimoto’s thyroiditis, it’s common for people with these conditions to have other autoantibodies.

But why do some people develop multiple autoantibodies?  Is it because they are exposed to multiple triggers?  Or does a single environmental factor cause the development of multiple autoantibodies?  Either one of these scenarios is a possibility.  For example, certain infections such as Epstein-Barr and Cytomegalovirus can lead to the development of different types of autoantibodies.  In other words, Epstein-Barr and Cytomegalovirus can trigger multiple autoimmune conditions in the same person.  However, it’s also possible for someone to have multiple triggers which are responsible for different autoantibodies.

The Triad of Autoimmunity

In the past I discussed the triad of autoimmunity.  According to this triad the following three components are necessary in order for someone to develop an autoimmune condition:

1. A genetic predisposition

2. An environmental trigger

3. A leaky gut

So according to the triad of autoimmunity, in order for someone to develop multiple autoimmune conditions they need to have a genetic predisposition for each of these conditions.  As I mentioned earlier, some of these people will have multiple autoimmune triggers, while others will have one or two environmental triggers which caused the development of all of the person’s autoantibodies.  Either way the goal should be to detect and remove these triggers.

The third component of the triad of autoimmunity is a leaky gut, which is also known as an increase in intestinal permeability.  So even if someone has a genetic predisposition for one or more autoimmune conditions AND they’re exposed to one or more environmental triggers, according to the triad of autoimmunity, the person won’t develop an autoimmune condition if they don’t have a leaky gut.  This is one reason why it’s important to try to avoid anything that can cause a leaky gut while trying to restore your health.  An example of this is gluten, as even if you remove the environmental trigger but continue to eat gluten (or other foods which can increase gut permeability), then you most likely won’t reverse the autoimmune component.

3 Categories of Multiple Autoimmune Syndrome                

Multiple autoimmune syndrome (MAS) is classified into three groups:

Type 1: type 1 MAS includes myasthenia gravis, thymoma, polymyositis and giant cell myocarditis

Type 2: type 2 MAS includes Sjögren’s syndrome, rheumatoid arthritis, primary biliary cirrhosis, scleroderma, and autoimmune thyroid disease

Type 3: type 3 MAS groups together autoimmune thyroid disease, myasthenia gravis and/or thymoma, Sjögren’s syndrome, pernicious anemia, idiopathic thrombopenic purpura, Addison’s disease, type 1 diabetes mellitus, vitiligo, autoimmune hemolytic anemia, systemic lupus erythematosus, and dermatitis herpetiformis.

You’ll notice that autoimmune thyroid conditions are in the second and third categories of multiple autoimmune syndrome.  So if someone has Graves’disease or Hashimoto’s thyroiditis, depending on their genetic predisposition they might be more likely to develop one or more of the other autoimmune conditions listed under the second category (Sjögren’s syndrome, rheumatoid arthritis, primary biliary cirrhosis, scleroderma), or they might develop one or more of the autoimmune conditions listed in the third category.

Which Autoimmune Conditions Are Commonly Associated with Graves’ Disease and Hashimoto’s?

Sjögren’s syndrome.  This is a systemic autoimmune condition, and one study showed that Sjögren’s syndrome was 10 times more frequent in patients with autoimmune thyroid disease, and autoimmune thyroiditis was 9 times more frequent in Sjögren’s syndrome (1).

Celiac disease.  I’ve written a separate article entitled “Celiac Disease and Thyroid Health“, and how this condition is more common in those people with Graves’ disease and Hashimoto’s.  There is some evidence that the risk of thyroid disease is threefold higher in those with Celiac disease (2).  I should mention that while Celiac disease is common in those with autoimmune thyroid conditions, Celiac disease is not included in the classification of multiple autoimmune syndrome.

Vitiligo.  In many people with multiple autoimmune syndrome vitiligo is the first autoimmune disease to be diagnosed.  This shouldn’t be too surprising since vitiligo represents the most common cause of acquired skin, hair, and oral depigmentation, affecting 0.5–1% of the population worldwide (3).  A few different studies show that vitiligo is more common in Graves’ disease and Hashimoto’s thyroiditis (4) (5) (6).

Systemic lupus erythematosus.  Many people with systemic lupus erythematosus (SLE) have thyroid autoantibodies.  One study I came across showed that the prevalence of Hashimoto’s thyroiditis in those with SLE was 12.6% (7).  Another study showed that patients with SLE had a higher prevalence of hypothyroidism and than hyperthyrodism (8). I did come across a case study where a woman developed SLE one year after being diagnosed with Graves’ disease (9).

Rheumatoid arthritis.  The prevalence of thyroid autoimmunity in those with rheumatoid arthritis has ranged from 0.5% in Morocco (10) to 27% in Slovakia (11).  Not only does the incidence vary between regions, but ethnicities as well.  One study involving 800 patients with rheumatoid arthritis showed that 37.8% had thyroid peroxidase antibodies and 20.8% had elevated thyroblogulin antibodies (12).

Type 1 diabetes mellitus.  There are numerous journal articles that show a relationship between type 1 diabetes and thyroid autoimmunity.  A few of these studies show an association between type 1 diabetes and Hashimoto’s (13) (14), while a couple of other studies show a link between type 1 diabetes and Graves’ disease (15) (16).

Conventional vs. Natural Treatment Options

Is there a different treatment approach when someone has multiple autoimmune conditions?  Not necessarily, as regardless of whether someone has a single autoimmune condition or multiple autoimmune conditions, the goal is to find and remove the triggers.  I commonly have patients who have the autoantibodies for both Graves’ disease and Hashimoto’s thyroiditis.  While the management of these two conditions differ, finding the triggers involve a similar process.  That being said, someone with autoantibodies for both Graves’ disease and Hashimoto’s very well might have multiple triggers.  This is one reason why you might see one type of autoantibody decrease while other antibodies don’t decrease.

For example, some people have thyroid peroxidase antibodies, thyroglobulin antibodies, and thyroid stimulating immunoglobulins.  While ideally you want to see all of these gradually decrease over time, this isn’t always the case.  While fluctuations in thyroid antibodies commonly occur, when you see one or two of these antibodies decrease consistently and yet another antibody not decrease, then this very well might be because one or two environmental triggers have been detected and removed, but another one remains.

In summary, if you have Graves’ disease or Hashimoto’s, then there is an increased risk of having additional autoimmune conditions.  If you have three or more autoimmune conditions then this is classified as multiple autoimmune syndrome.  In this blog post I discussed the 3 categories of multiple autoimmune syndrome, along with some autoimmune conditions that are commonly associated with Graves’ disease and Hashimoto’s.  I also discussed how some people have a single trigger responsible for all of their autoimmune conditions, although it’s more common to have multiple triggers, which can make it more challenging to restore one’s health.

Do you have more than one autoimmune condition? If so please feel free to share your experience in the comments below!

Many people suffer from chronic constipation.  And while I have written articles and blog posts on this topic, in this blog post I’m going to focus on those people who had regular bowel movements prior to starting the autoimmune Paleo (AIP) diet, but then became constipated shortly after starting it.  After all, while there are many factors that can cause constipation, certain dietary changes can be a culprit.

Why do some people experience constipation when following an AIP diet?  Well, a big reason is because an AIP diet excludes many foods that are high in fiber.  This includes the following three categories of foods:

• Nuts and seeds
• Grains
• Legumes

The good news is that most people don’t need to eat these three categories of foods to have regular bowel movements.  The bad news is that many people don’t eat enough AIP-friendly foods that are high in fiber.  One of the main reasons for this is because most people with Graves’ disease and Hashimoto’s don’t know which foods they should eat.  For example, someone might eat a lot of green leafy vegetables in the form of salads and smoothies.  And while I definitely encourage my patients to eat green leafy vegetables, these are low in fiber when compared to other vegetables, which I’ll discuss shortly.

Is Low Fiber Really The Main Problem?

Some healthcare practitioners disagree that the decrease in dietary fiber is the main reason why many people experience constipation when following an AIP diet.  And while I’ll list some other common reasons for constipation below, if someone had regular bowel movements and then began to experience constipation soon after starting an AIP diet, there is a very good chance that the decrease in fiber was the culprit.  While it’s true that some people who experience constipation while following an AIP-diet don’t experience an increase in bowel movements when eating more fiber, it’s still something to consider.

I look at many food diaries of my patients, and the truth is that it’s common for people to not eat enough vegetables overall, let alone vegetables that are high in fiber.  Another common scenario involves someone who eats a few daily servings of AIP-friendly foods high in fiber (i.e. broccoli, sweet potatoes), but not enough.  Sure, everyone is different, and I’m not suggesting that everyone needs to eat a large amount of high fiber foods on a daily basis to avoid constipation, but as I’ve mentioned numerous times already, if constipation wasn’t a factor prior to starting the AIP diet then increasing your fiber needs to be strongly considered.

What AIP-Friendly Foods Are High In Fiber?

I listed some of the AIP-friendly foods high in fiber in a blog post I wrote entitled “What Thyroid Sufferers Need To Know About Fiber, Resistant Starch, and SCFA“, but I’ll list the foods again below:

• Apples
• Artichokes
• Avocados
• Blackberries
• Broccoli
• Coconut
• Brussels Sprouts
• Figs (dried)
• Pears
• Plantains
• Raspberries
• Sweet potatoes

The Role of Fiber In Bacterial Diversity

One of the ways in which fiber can help with constipation is by increasing the bulk of the stools.  However, fiber can also help with bacterial diversity, which in turn can help someone to have regular bowel movements.  In other words, the greater the variety of bacteria you have in your gut the better.  What’s important to understand is that different strains of bacteria prefer different types of fiber.  This is why it’s a good idea to eat a wide variety of fiber-rich foods, mostly in the form of vegetables.

So one problem with an AIP diet is that by decreasing fiber, it decreases bacterial diversity.  And there is evidence that this decrease in bacterial diversity can happen very quickly.  As a result, if you started to experience constipation a few days after starting the AIP diet then this very well could be a factor.

Other Causes of Constipation

While not eating enough fiber is a big factor for those who experience constipation upon following an AIP diet, here are a few other common causes of constipation you need to consider:

• Not drinking enough fluids.  This is a common problem, as while some people do a wonderful job of drinking plenty of water on a daily basis, many people don’t drink enough water.  Please make sure you drink at least half your weight in ounces of water every day.
• Decreased caffeine consumption.  In addition to giving up some foods that are high in fiber, most people who are following a strict AIP diet also avoid caffeine.  And the reason why this can lead to constipation is because caffeine can cause a bowel movement by increasing rectal tone (1).  Of course the goal should be to have regular bowel movements without relying on consuming caffeine.
• Inactivity.  If someone experienced constipation shortly after following an AIP diet then inactivity probably wasn’t the main factor.  But I still think it’s important to mention that not being active can cause or contribute to constipation.  Keep in mind that exercising a few days per week and being inactive the rest of the time isn’t sufficient, as regular movement is important.  I realize that this can be challenging for some people who work desk jobs, as in this scenario you should try to take frequent breaks, and when you’re not at work you should try to be active as much as you can.
• Hypothyroidism.  Once again, if someone experienced constipation shortly after starting an AIP diet then having low or depressed thyroid hormone levels probably isn’t the main reason.  But since a lot of people with hypothyroidism and Hashimoto’s thyroiditis read my blog posts I thought it was important to mention it here.

What About Other Causes of Constipation?

There definitely can be other causes of constipation, although keep in mind that we’re focusing on constipation that was caused by following an AIP diet.  For example, many people with small intestinal bacterial overgrowth (SIBO) experience constipation, but following an AIP diet isn’t going to cause SIBO, which is why I didn’t bring it up here.  Similarly, there are other causes of constipation that I won’t bring up in this post because it’s not related to following an AIP diet.

How To Overcome Constipation When Following An AIP Diet

1. Eat AIP-friendly foods high in fiber.  How much fiber should you consume each day to have regular bowel movements?  This depends on the person, although I would aim for at least 25 to 30 grams per day.  Just keep in mind that some people need less than this to have regular bowel movements, while others might need to consume more fiber, and so you need to listen to your body.

2. Do other things to increase your gut diversity.  Eating fiber-rich foods isn’t the only way to increase your gut diversity.  Eating fermented foods (i.e. sauerkraut, kimchi, pickles) and/or taking probiotic supplements can help.  And while plant-based foods act as probiotics, some people can benefit from taking a prebiotic supplement.  Every now and then someone will ask me about green food powders, and while I wouldn’t consider this to be an adequate substitute for eating vegetables, it’s fine to use certain green food powders as one source of prebiotics.  Of course you want to make sure to choose a good quality green food powder, and ideally one that uses organic vegetables.

3. Drink plenty of fluids.  As I mentioned earlier, being well-hydrated is important in order to avoid constipation.

4. Choose green tea over coffee.  I do recommend for some of my patients to avoid caffeinated green tea, especially those with adrenal imbalances.  However, if someone absolutely feels the need to drink a caffeinated beverage to help move their bowels then I would encourage you to drink a cup or two of green tea each morning.  While both coffee and green tea have numerous health benefits, green tea arguably has more health benefits than coffee, and without question has less caffeine.

5. Take a 15-minute walk after each meal.  I spoke about the importance of being active, and even if inactivity isn’t the main cause of your constipation, many people find that taking a 15 minute walk after meals can help them have a bowel movement.

Can You Eventually Reintroduce Nuts, Grains, and Legumes?

If you’re following a strict AIP diet, you might wonder if you will eventually be able to reintroduce some of the excluded foods.  While many foods are excluded on an AIP diet, I want to focus on nuts, grains, and legumes, as these are good sources of dietary fiber.  First of all, when a patient of mine is following an AIP diet, one of my goals is to have them transition to a “standard” Paleo diet.  Keep in mind that nuts are part of a “standard” Paleo diet, while grains and legumes aren’t.

That being said, some people are able to reintroduce grains and legumes without a problem.  In fact, while I’m not big into legumes, I can’t say that I’ve been grain free since being in remission from Graves’ disease.  Although I did avoid grains while getting into remission, I reintroduced grains after restoring my health and I do fine eating them occasionally.  As for whether or not you will be fine reintroducing these foods, there really is no way to know for certain.  This is part of the reintroduction phase, as while some people successfully reintroduce nuts, grains, and legumes after restoring your health, others aren’t able to reintroduce all of these.

Some healthcare practitioners advise anyone with an autoimmune condition to permanently give up grains.  The truth is that we don’t need to eat grains, and without question there are some people who do better when completely avoiding grains after getting into remission.  In fact, some people experience severe symptoms when eating grains.  So you need to listen to your body, and I’ll admit that you can’t always go by symptoms.  For example, some people will reintroduce grains and legumes before getting into remission, and while they might not experience any symptoms upon doing this, if their health isn’t improving then I would suggest to take a break from these foods and see if this is what’s affecting your progress.

In summary, some people develop constipation shortly after starting an AIP diet.  One of the main reasons for this is due to the decreased consumption of fiber-rich foods.  When this is the case then eating AIP-friendly foods that are high in fiber can help many people have regular bowel movements.  Fiber not only increases the bulk of the stools, but it also increases bacterial diversity, which can help with defecation.  Some other common causes of constipation include not staying hydrated, decreased caffeine consumption, and inactivity.  Addressing these areas while increasing your fiber intake can help many people overcome constipation.

Have you experienced constipation while following the AIP diet?  If so then please feel free to share your experience in the comments section below.

 

Every now and then someone will ask me if the chemicals from the pots and pans they use can have a negative effect on their thyroid and immune system health.  And so I figured I’d put together a blog post that discusses the different types of cookware.  I’ll start out by talking about the safe types of cookware, and then I’ll talk about the ones you should avoid.  I’ll also discuss the relationship between some of these chemicals and thyroid/immune system health.  As usual, I’d love to hear your comments below, and so please feel free to let me know your thoughts on this post, the type of cookware you use, etc.

Also, keep in mind that I’m not necessarily listing the cookware in any particular order.  For example, when discussing the safest cookware, I’m going to start off with stainless steel, simply because this is what I use.  I’ll add that I wouldn’t be using it if I didn’t think it was safe, and while many other healthcare practitioners use stainless steel pots and pans, some prefer other types of cookware, such as ceramic.

Which Cookware is The Safest?

STAINLESS STEEL

Pros of stainless steel cookware.  As I just mentioned, this is what I use, and have used stainless steel for many years.  Stainless steel is very popular, as it’s cost effective, durable and long lasting, easier to clean when compared to some other cookware choices (i.e. cast iron), you can put it in the dishwasher without a problem, and good quality stainless steel cookware doesn’t react with acidic foods.

Cons of stainless steel cookware.  There are a few potential concerns of stainless steel cookware.  One concern some people have is that many stainless steel pots include an aluminum core.  However, this is not the same as cooking in aluminum pots and pans, as in stainless steel cookware with an aluminum core, the aluminum is sandwiched  in between layers of stainless steel.  As far as I know there is no evidence of the aluminum leaching out.  Speaking of metals leaching out, some people are concerned about stainless steel leaching nickel, which can be a concern if someone has a nickel allergy.  One study I came across showed that stainless steel cookware can be an overlooked source of nickel (and chromium), where the contribution is dependent on stainless steel grade, cooking time, and cookware usage (1).

This is why you want to purchase good quality stainless steel cookware.  Regarding the grade of stainless steel, this relates to the quality, durability, and temperature resistance.  Grades are divided into 200 series, 300 series, and 400 series.  The 300 series represent a high quality grade.  You’ll also see numbers such as “18/8” and “18/10”, and this represents the percentage of chromium and nickel.  Many of the good quality stainless steel cookware has an 18/10 interior.

CERAMIC

Although we have a stainless steel cookware set, we also have a ceramic saucepan!  Truth to be told, while I’m happy with stainless steel, if I were looking to purchase new cookware I would strongly consider ceramic.

Pros of ceramic cookware.  Some consider ceramic to be the safest type of cookware, as you don’t have to worry about leaching.  It is also very easy to clean, and it doesn’t scratch.  In addition, ceramic cookware is safe to use in the oven, on the stove top, in the microwave, and in the dishwasher.

Cons of ceramic cookware.  One of the big downsides is that ceramic cookware is more fragile than stainless steel or cast iron.  That being said, the quality of ceramic is better these days than in the past.  Another downside of using ceramic is that it takes longer to heat up.

CAST IRON

Pros of cast iron cookware.  Cast iron is another good choice, although there are some healthcare professionals who would disagree.  There is no question that cast iron is durable.  Another benefit of cast iron is that it provides great conductivity.  I can’t say I have experience cooking with cast iron pots and pans, but from what I have read, as long as you season the cookware well the food is unlikely to stick.  Of course if anyone has any experience using cast iron cookware I’d love to hear from you in the comments below!

Cons of cast iron cookware.  Probably the main controversy with using cast iron is that the iron can leach into the food you’re cooking.  Some think getting iron in this manner can be a health benefit, and if someone has an iron deficiency it can be, although I think it’s safe to say that you should try to get your iron through food whenever possible.  That being said, the small amount of iron shouldn’t be a problem with most people, although it can be problematic if someone has an iron overload issue.  Cast iron cookware is also extremely heavy, and it can rust if not properly maintained.

GLASS

Pros of glass cookware.  Glass cookware doesn’t seem to be very popular, although glass is very safe for cooking, as you don’t have to worry about leaching anything into food.  You can put glass cookware in the microwave if you’d like.  Another advantage of glass cookware is that the food can be watched while covered.  We do have some glass pans that we use in our home.

Cons of glass cookware.  One disadvantage of glass cookware is that it is more fragile than stainless steel or cast iron.  The heat distribution also isn’t as good as with other types of cookware, and glass also can be more challenging to clean (I can tell you from personal experience!). 

Which Cookware Should You Avoid?

ALUMINUM COOKWARE

Aluminum pots and pans are very popular because they conduct heat well, and they are very cost effective.  Of course the big concern is aluminum leaching into the water or food when cooking.  Some will argue that the small amount of aluminum you get from cookware isn’t harmful, but since there is evidence of aluminum causing neurotoxicity (2) (3) it probably is best to do everything you can to reduce your exposure to this heavy metal.

Can Aluminum Affect Thyroid Health?

I couldn’t find any evidence that aluminum can directly affect thyroid health.  Interestingly, while doing research for this blog post I came across a journal article which showed that aluminum is in Synthroid, which many of my hypothyroid patients take, although apparently the maximum aluminum levels are well below the FDA-determined minimal risk level for chronic oral aluminum exposure (4).

Is there any evidence that aluminum can trigger an autoimmune condition such as Graves’ disease or Hashimoto’s?  This is controversial, as while there are no studies directly linking aluminum with thyroid autoimmunity, there is concern about aluminum adjuvants found in vaccines being a possible autoimmune trigger (5) (6).  Of course the focus of this blog post is on cookware, not vaccines, and while I would recommend to avoid using aluminum cookware, I don’t think using such cookware would cause a thyroid or autoimmune thyroid condition, although it might lead to other health conditions over a prolonged period of time.

NONSTICK COOKWARE

The main reason why many people use nonstick cookware is because it’s easier to clean.  But there is a big concern over the chemicals.  Teflon is the most well known, as it’s made with a chemical called polytetrafluoroethylene (PTFE).  This does a wonderful job of preventing food from sticking in pans when cooking, and the cookware is also easy to wash.  But even at normal cooking temperatures, PTFE-coated cookware releases various gases and chemicals that present mild to severe toxicity (7).

PFOA (Perfluorooctanoic Acid) is used in the synthesis of PTFE.  PFOA has been replaced with other chemicals such as GenX, but these alternatives are also suspected to have similar toxicity (7).  It’s the same old story, as one toxic chemical is replaced with another toxic chemical.  Bisphenol A (BPA) is a good example of this, as now you see BPA-free plastic bottles everywhere, but unfortunately these plastics have other equally toxic chemicals, which I discussed in a blog post entitled “Why BPA-Free Products Might Still Harm Your Thyroid Gland“.  So just because something is listed as “PTFE free” doesn’t mean it doesn’t have any harmful chemicals.

Can PTFE or PTOA Affect Thyroid Health?

A few journal articles show that perfluorooctanoic acid (PFOA) has thyroid and endocrine-disrupting properties (8) (9) (10).  The most recent article was a review that showed that an accumulation of PFOA was documented in thyroid cells, and a cytotoxic effect was observed after exposure to extremely high concentrations of these compounds (8).  While a single use of a teflon pot or pan probably doesn’t involve high concentrations of PFOA, I would be very cautious about using such cookware on a regular basis.

The Risks of Eating Out

While you can control what cookware you use while in your home, this of course isn’t the case when you eat out.  I’m not suggesting that you should never eat out, but while I’m sure many people reading this try to eat healthy even when eating out, many restaurants use aluminum pots and pans, and perhaps even nonstick cookware.  Once again, I realize that we live in a toxic world, and regardless of what you do you’ll be exposed to chemicals on a daily basis.  But this doesn’t mean that you should do everything you can to minimize your exposure to these chemicals.   Besides trying to eat at home as much as you can, if you have a favorite restaurant you go to on a regular basis you might want to find out what type of cookware they use.

What Cookware Do You Use?

Please let me know what cookware you use in the comments section below.  Most of my experience is with stainless steel cookware, and so I’d be especially interested in hearing your experience with other type of cookware.  Perhaps you have experience with a type of cookware I didn’t discuss in this blog post, such as stoneware?  Either way, please share your experience below.

Whether you have hyperthyroidism/Graves’ disease or hypothyroidism/Hashimoto’s thyroiditis, there is a good chance that you have been faced with the decision as to whether or not you should take thyroid medication.  And while many people with thyroid and autoimmune thyroid conditions have already made the decision to take or not to take thyroid hormone replacement (i.e. levothyroxine, Nature-Throid) or antithyroid medication (i.e. methimazole, carbimazole), I’m sure there are some reading this who haven’t yet made this decision, and aren’t sure what they should do.  There also are some people taking thyroid medication who are wondering if they are doing the right thing.

Since the medication someone takes will differ depending on whether they have a hyperthyroid or hypothyroid condition, what I’m going to do is separately talk about the risks and benefits of thyroid hormone replacement, and the risks and benefits of antithyroid medication.  As a result, if you have hyperthyroidism or Graves’ disease then of course you’ll want to focus on the section where I talk about antithyroid medication, and if you have hypothyroidism or Hashimoto’s you’ll want to focus on the section where I talk about thyroid hormone replacement.

Benefits of Taking Antithyroid Medication

The obvious benefit of taking antithyroid medication is that it can help to lower the thyroid hormone levels. This in turn can greatly help to reduce the hyperthyroid symptoms (i.e. high resting pulse rate, heart palpitations, weight loss, etc.).  High thyroid hormone levels can also have a negative effect on bone density, and so this is another benefit of taking antithyroid medication.

Risks of Taking Antithyroid Medication

There are a few different risks of taking antithyroid medication:

Risk #1: Side effects are common.  Although I’ve worked with a lot of people who did fine taking methimazole, common side effects include dizziness, headaches, hives, itching, nausea, rashes, and vomiting.

Risk #2: Elevated liver enzymes.  Everyone who takes antithyroid medication should have their liver enzymes monitored on a periodic basis.  Not too long ago I wrote an article entitled “How To Decrease Elevated Liver Enzymes In Hyperthyroidism and Graves’ Disease“, and so you might want to check this out if you haven’t done so already.

Risk #3: Agranulocytosis.  This refers to an extreme reduction in the production of white blood cells.  Although not everyone with agranulocytosis experiences symptoms, some will experience a high fever and a sore throat.

Risk #4: Temporary hypothyroidism.  This is especially common in those taking large doses of antithyroid medication, although I’ve also had a few patients become hypothyroid with lower doses.  This can lead to symptoms such as increase in fatigue, brain fog, and weight gain.  The good news is that this is usually temporary, as once the dosage of antithyroid medication has been decreased the hypothyroidism resolves.

Risk #5: Not doing anything to address the cause of the problem.  This should be obvious, but it’s common for endocrinologists to tell their hyperthyroid patients that they might get into remission when taking antithyroid medication.  While taking the medication can help to normalize the thyroid hormone levels, because it doesn’t address the underlying cause of the problem the person is likely to relapse in the future.

Should You Take Antithyroid Medication?

As for whether or not you should take antithyroid medication, of course this is ultimately your decision.  Although I personally didn’t take antithyroid medication when I was dealing with Graves’ disease, this doesn’t mean that this is the right decision for everyone else with hyperthyroidism.  Even if your goal is to address the underlying cause of your condition, while doing this you want to be safe.  In other words, uncontrolled hyperthyroidism shouldn’t be taken lightly.

If you’re already taking antithyroid medication and are doing well on it then it might be a good idea to stay on it, as not everyone can have their symptoms effectively managed by herbs such as bugleweed.  On the other hand, if you’re not currently taking anything to lower your thyroid hormone levels and prefer not to take medication you can start with bugleweed and see if this helps.  I’ll add that I’ve worked with patients who were taking antithyroid medication but wanted to switch to bugleweed, and what I usually recommend in this situation is to take both at the same time (i.e. methimazole along with bugleweed), and then work with your endocrinologist to gradually decrease the dosage of the antithyroid medication as your thyroid panel results improve.

Benefits of Taking Thyroid Hormone Replacement

One of the main reasons people take thyroid hormone replacement is to help with the hypothyroid symptoms.  And in many cases thyroid hormone replacement can do a good job of helping people who experience fatigue, brain fog, weight gain, and other symptoms related to hypothyroidism.  However, besides helping with symptoms, you need to understand how important thyroid hormone is to our health.  There are thyroid hormone receptors everywhere in our body, and the reason for this is because thyroid hormone acts on most cells.

Here are some of the functions of thyroid hormone:

• Increases the metabolic rate
• Affects gene expression
• Plays a role in protein, fat, and carbohydrate metabolism
• Required for skeletal development and establishment of peak bone mass
• Important for reproduction
• Plays a role in peripheral nerve regeneration
• Wound healing

Risks of Taking Thyroid Hormone Replacement

I can’t say that serious risks are common when taking thyroid hormone replacement, especially when compared with other prescription medications.  This doesn’t mean that there are no concerns.  First of all, not everyone does well on thyroid hormone replacement.  There can be a few reasons for this.  One reason is that someone might react to one of the fillers or inactive ingredients.  In this case the person can switch to a hypoallergenic brand of thyroid hormone, such as Tirosint if they’re taking synthetic thyroid hormone, or WP Thyroid if they’re taking desiccated thyroid hormone.  Another option is to get a prescription through a compounding pharmacy.

Many people have a problem converting T4 to T3.  I discussed this in greater detail in a blog post entitled “6 Factors Which Can Affect The Conversion of T4 to T3”.  On a blood test this will present as normal T4 levels and low or depressed T3 levels.  If someone is taking synthetic thyroid hormone they might benefit from taking synthetic T3 (i.e. Cytomel), or switching to desiccated thyroid hormone.  Of course the goal should be to address the conversion problem, but this usually will take time to accomplish.

Another risk of taking thyroid hormone replacement is that too high of a dosage can make someone hyperthyroid.  Fortunately this usually is temporary, as frequently the patient will alert the prescribing doctor that they are experiencing anxiety, an increased resting heart rate, palpitations, etc.  If not then this probably will be detected on a future thyroid panel.

Of course one of the main problems with thyroid hormone replacement is that it’s not doing anything to address the cause of the condition.  For example, most people with hypothyroidism have Hashimoto’s thyroiditis, which is an autoimmune condition.   While taking thyroid hormone might be necessary for many people with Hashimoto’s, this isn’t doing anything for the cause of the problem.  And unfortunately most medical doctors don’t do anything to address the underlying cause, as they simply recommend thyroid hormone replacement while ignoring the autoimmune component.

Should You Take Thyroid Hormone Replacement?

Some people understandably don’t want to take thyroid hormone replacement because it isn’t doing anything for the cause of the problem.  Others are concerned that they will become dependent on it.  But if your thyroid hormone levels are very low then it usually is a good idea to take thyroid hormone replacement due to the importance of thyroid hormone that I discussed earlier.  While most people who have depressed  thyroid hormone levels experience hypothyroid symptoms, occasionally I’ll work with a patient with overt hypothyroidism (depressed thyroid hormone levels) who feels fine.  Even when this is the case it’s wise to take thyroid hormone replacement in those who have depressed thyroid hormone levels.  Of course while doing this you also want to work on addressing the underlying cause of the problem.

What should you do if you have thyroid hormone levels that are within the lab reference range, but are less than optimal?  In this situation it can be more challenging.  Many medical doctors pay more attention to the thyroid stimulating hormone (TSH).  Thus, they will recommend thyroid hormone replacement if the TSH is elevated, regardless of what the thyroid hormone levels look like.  And while elevated TSH levels are frequently a good indication of hypothyroidism, there can be other reasons for an elevated TSH, such as a pituitary adenoma and dysregulation of the hypothalamic-pituitary-thyroid (HPT) axis.

The truth is that there is no solution that fits everyone perfectly.  When someone has an elevated TSH and thyroid hormone levels that are within the lab reference range, this is referred to as subclinical hypothyroidism.  If someone with subclinical hypothyroidism is experiencing hypothyroid symptoms then in some cases it might be a good idea to put them on thyroid hormone replacement while trying to address the cause of the problem.  Another situation where taking thyroid hormone replacement is warranted in someone with subclinical hypothyroidism is pregnancy.

However, what approach should be taken if someone has subclinical hypothyroidism, is asymptomatic, and isn’t pregnant?  Once again, there isn’t an answer that fits everyone perfectly, and different natural healthcare practitioners will have different opinions.  While it can be argued that some people who have subclinical hypothyroidism don’t need to be on thyroid hormone replacement, we also need to remember the importance of thyroid hormone.  So for example, if someone has a TSH of 4.86 μIU/mL, a free T4 of 0.94 ng/dL, and a free T3 of 2.6 pg/mL, some natural healthcare practitioners would recommend for the patient to take thyroid hormone replacement, even if they are feeling fine from a symptomatic standpoint.  And the reason for this is because the free T3 is less than optimal.

What’s The Deal With Low Dose Naltrexone?

I’ve spoken about low dose naltrexone (LDN) in previous articles and blog posts.  This is a medication that can modulate the immune system, and in some cases it works so well that people with Graves’disease and Hashimoto’s don’t need to take medication.  Just keep in mind that this is a best case scenario, and the downside is that LDN isn’t always effective.  But the reason I brought it up here is because in some cases LDN can be an alternative to thyroid medication, although some people with Graves’ disease and Hashimoto’s take LDN in combination with thyroid medication.

For those with Hashimoto’s thyroiditis, LDN can potentially slow down the damage taking place to the thyroid gland, which is something that thyroid hormone replacement doesn’t do.  And in those with Graves’ disease, LDN can prevent the immune system from attacking the TSH receptors, and it doesn’t cause the side effects commonly associated with antithyroid medication.  I know for some people reading this it might sound too good to be true, but while many people with autoimmune thyroid conditions (and other autoimmune conditions) have benefited from LDN, as I mentioned earlier, LDN isn’t always effective, which is one reason why it’s not commonly recommended instead of thyroid medication.

Another thing to keep in mind is that if someone with Hashimoto’s has overt hypothyroidism, LDN may help to stop or slow down the damage the immune system is causing to the thyroid gland, but if the thyroid hormone levels are depressed then the person probably still needs to take thyroid hormone replacement.  On the other hand, if someone with Graves’ disease who is on antithyroid medication takes LDN and it works, they very well might be able to stop taking antithyroid medication, or at the very least decrease the dosage.

It’s important to understand that someone who is taking either thyroid hormone replacement or antithyroid medication and then starts taking LDN will need to monitor their thyroid hormone levels on a frequent basis.  The reason for this is because by modulating the immune system, some people with hypothyroidism and hyperthyroidism will experience an improvement in their thyroid hormone levels.  While this is a good thing, if they are also taking thyroid hormone replacement or antithyroid medication then this can make someone with hypothyroidism become “hyper”, and someone with hyperthyroidism become “hypo”.

So hopefully you have a better understanding of the benefits and risks of thyroid medication.  Regarding hyperthyroidism and Graves’ disease, antithyroid medication can do a great job of lowering the thyroid hormone levels, which in turn usually helps to reduce the symptoms associated with hyperthyroidism.  Some of the risks of taking antithyroid medication include elevated liver enzymes, agranulocytosis, temporary hypothyroidism, and not doing anything to address the underlying cause.  Regarding hypothyroidism and Hashimoto’s, thyroid hormone replacement not only can help with the hypothyroid symptoms many people experience, but thyroid hormone also has many important roles in the body.  The “risks” of thyroid hormone replacement is that some people don’t do well when taking it, it doesn’t address a T4 to T3 conversion problem, and just as is the case with antithyroid medication, thyroid hormone replacement doesn’t address the cause of the condition.

Please feel free to share your experience with thyroid medication in the comments section below.

In the last blog post I spoke about shingles and the varicella-zoster virus.  In this blog post I’m going to talk about a different type of infection, and while you might not think Lyme disease is factor in your health, the truth is that many people have Lyme disease and don’t know it.  According to the CDC, approximately 30,000 cases of Lyme disease are REPORTED by state health departments (1).  However, the CDC suggests that the actual number of people DIAGNOSED with Lyme disease in the United States alone is around 300,000.  And there are many more people who have Lyme disease but have not been diagnosed.

Once again, many people with thyroid and autoimmune thyroid conditions won’t think this article is relevant to them because they’re confident they don’t have Lyme disease.  But this blog post may be one of the most important ones you have ever read for the following three reasons:

Reason #1: The bacteria associated with Lyme disease (Borrelia Burgdorferi) can lie dormant.  While many people feel symptomatic immediately after being bitten by a tick that has Borrelia Burgdorferi and other coinfections, some people don’t experience symptoms until months or years later.  In other words, Borrelia Burgdorferi can lie dormant in your body, which means that some people have chronic Lyme disease and don’t know it.

Reason #2: You might experience a tick bite in the future.  Assuming you don’t currently have Lyme disease, there is always a risk of getting it in the future.  And as I’ll discuss below, it doesn’t matter where you live or how cautious you are.  Sure, some areas are safer than others, and if you are taking certain precautions then without question this will greatly reduce the chances of you getting Lyme disease and/or its associated coinfections.  So my goal isn’t to make you feel paranoid about getting Lyme disease, as I just want to increase your awareness.

Reason #3: You might have a family member or friend who gets Lyme disease.  Remember that approximately 300,000 new cases of Lyme disease are diagnosed in the United States alone.  And arguably there are hundreds of thousands more that aren’t diagnosed.  So in your lifetime there is a strong likelihood you’ll know someone with Lyme disease, and while you might think there is nothing you can do to help them, encouraging them to read this blog post might be a game changer.

Why A Negative ELISA or Western Blot Test Doesn’t Always Rule Out Lyme Disease

If you suspected Lyme disease and did some testing which came back negative, keep in mind that false negatives are very common for the following reasons:

• It takes time for antibodies to form.  If acute Lyme disease is suspected you need to keep in mind that after someone gets bit by a tick and contracts Borrelia Burgdorferi (and other coinfections), it takes 4 to 6 weeks for antibodies to show up on one of these panels.  So for example, if someone gets bit by a tick and gets tested within the first 3 weeks, we would expect these test results to come back negative, even if the person has Lyme disease.  The earliest we’ll usually see these tests come out positive is 4 weeks after being bit by a tick.
• Depressed immunoglobulins.  Immunoglobulins are also known as antibodies.  If someone has a compromised immune system this can lead to one or more depressed immunoglobulins, which once again, can lead to a false negative result.  Fortunately you can test the immunoglobulins separately through the blood.  The ones you want to focus on are immunoglobulin G (IgG) and immunoglobulin M (IgM).  If one or both of these are depressed it can cause false negative results on the ELISA or Western Blot.  This is one reason why some people with chronic Lyme disease will test negative.
• Taking antibiotics and/or natural antimicrobials can cause a false negative.  If you have acute Lyme disease then taking antibiotics or natural antimicrobials can potentially eradicate Lyme disease and its coinfections, and of course this can result in a “true” negative result, which would be great news.  However, taking these agents can also cause a false negative result, which isn’t a good thing.
• There are multiple strains of Borrelia Burgdorferi.  Conventional panels only test for a single strain of Borrelia Burgdorferi, and so if you don’t have this strain then your Western Blot test will come back negative.  So just to clarify, you can have Lyme disease but test negative because the panel isn’t testing for the specific strain of Borrelia Burgdorferi that you have.

What To Do If You Have a Negative Test

So what approach should you take if you suspect that you have Lyme disease, but both the ELISA and Western Blot have come out negative?  Well, it depends on the situation.  If you know you have been bitten by a tick recently and it’s been less than six weeks, then you now understand that false negatives are not only common, but are likely.  Regardless of whether the testing is positive or negative, if you know for certain you were bitten by a tick and/or have the classic bull’s-eye rash, then it would be a good idea to seek treatment, which I’ll discuss later in this post.

But how about if you are having symptoms that might suggest Lyme disease, but if there is no history of a tick bite and no bull’s-eye rash?  Since many people with Lyme disease don’t recall getting bitten by a tick, and at least half don’t have the classic bull’s-eye rash, it can be a tough decision knowing whether or not you should receive treatment.  I do know that the sooner you treat Lyme disease the better, and so if you think there is a good chance you have Lyme disease but aren’t 100% certain, in some cases it might be a good idea to receive treatment.

So for example, let’s say you are experiencing symptoms suggestive of Lyme disease but the testing comes out negative, you don’t have a bull’s-eye rash, and there is no evidence of a tick bite.  If you’re experiencing a lot of neurological symptoms you might see a medical doctor who decides that the best approach is to see a neurologist, who in turn might run a bunch of tests (MRIs, nerve conduction studies, etc.).  The problem with this approach is if you have Lyme disease then it probably will take a few weeks before you will see a specialist and have these tests done.  This delay might not be an issue if you have chronic Lyme disease, but if you have acute Lyme disease this needs to be treated as soon as possible.  It admittedly is a tough decision, as you don’t want to take antibiotics if you don’t have Lyme disease, but if you have acute Lyme disease you don’t want to go too long without treating it.

Lyme Disease vs. Multiple Sclerosis

Lyme disease is known as the “great imitator”, as it can mimic a lot of different health conditions.  One of these is the autoimmune condition multiple sclerosis, and so let’s revisit the above situation where someone is having neurological symptoms and thinks it might be Lyme disease, but there also is a chance it can be something else, such as multiple sclerosis.  In fact, a few studies have shown that Lyme neuroborreliosis can resemble multiple sclerosis (2) (3).  And there is also the possibility that someone can have both Lyme disease and multiple sclerosis.

This is where seeing a competent healthcare practitioner becomes very important, but the truth is that sometimes it is very hard for even good doctors to diagnose someone with Lyme disease since the conventional tests are far from perfect, and you can’t always know by the symptoms.  So at times it becomes a judgment call, and in this situation it’s arguably better to work with a doctor who is good at differential diagnosis rather than a doctor who relies on testing.  Don’t get me wrong, as I think testing is important, and I definitely recommend tests to my patients.  But when it comes to Lyme disease, too many doctors rely too much on testing, which as you now know, is far from perfect.

Other Testing Options For Lyme Disease

If both the ELISA and Western Blot come back negative there are other tests you can consider getting.  One of the most well known labs used by Lyme disease specialists is IGeneX.  One of the advantages of using IGeneX is that it tests for multiple strains of Borrelia burgdorferi.  It’s a very expensive test, and so it makes sense to first do the ELISA and Western Blot and see if either of these comes out positive.  If not then you might consider looking into a lab such as IGeneX.

Lyme Disease Is EVERYWHERE

You might think that you can’t possibly get Lyme disease because you live in an area where Lyme disease isn’t common.  While some areas are riskier than others, the truth is that there is a risk of getting Lyme disease no matter where you live.  And this isn’t just my opinion, as the research shows that Lyme disease is becoming more and more common in locations that in the past weren’t associated with this condition.

Plus, keep in mind that all it takes is A SINGLE exposure to get Lyme disease.  So for example, you might live in an area where there seems to be minimal risk of getting bit by a tick, and in addition you don’t normally walk in the grass or do anything else that would put you at risk of getting Lyme disease.  But all it takes is one hike in the woods, one barefoot walk in the grass, etc.  Plus, if you have pets that go outside then of course they can also bring ticks into your home, thereby increasing the likelihood of you getting a tick bite.

Not Everyone Has “Classic” Lyme Disease Symptoms

I’m certainly not suggesting that most people reading this blog post, or even the majority have Lyme disease.  However, there are some people who wouldn’t think they have Lyme disease because they don’t have the “typical” symptoms associated with this condition.  For example, while many people with Lyme disease will experience fatigue, cognitive symptoms, and migrating muscle and joint pain, not everyone experiences these and other “classic” symptoms.  In fact, some people with Lyme disease don’t experience any of the classic symptoms.

Below are some of the symptoms people with Lyme disease commonly experience.  Keep in mind that the symptoms someone experiences may depend on whether they have acute or chronic Lyme disease.  In addition, some people with Lyme disease won’t experience any of the following symptoms, as there are many other symptoms one can experience:

• Low grade fever
• Flu-like symptoms
• Chills
• Headaches
• Neck stiffness
• Fatigue
• Migrating muscle and joint pain
• Partial facial paralysis
• Cognitive problems/brain fog
• Lightheadedness
• Sleep disturbances
• Heart complications (palpitations)
• Weakness
• Eye symptoms (blurry vision, eye pressure)
• Numbness and/or tingling
• Shooting pains
• Shortness of breath
• Weight gain or loss
• Bladder dysfunction
• Digestive issues

If You Have Already Been Diagnosed With Lyme Disease…

So far this blog post has focused on those people who aren’t yet aware that they have Lyme disease.  But I’m sure there are some reading this who already have been diagnosed with this condition, along with one or more coinfections.  The goal of this blog post was twofold.  First, to make those who don’t think Lyme disease is a concern to realize that it might be.  Even if you’re 100% certain you don’t have Lyme disease, you want to be aware of some of the things I mentioned, and at the same time take the proper precautions to make sure that you don’t ever suffer from this condition.

The second goal was to talk about the different treatment options that might benefit those people with Lyme disease.  And while I’ll of course talk about antibiotics and herbal remedies, there are other treatments worth considering.

There actually is a third goal, and that is to encourage those who already have Lyme disease to share their experience in the comment sections below.  While everyone is different, telling people what treatments did or didn’t work for you can be helpful for others with Lyme disease.  And those reading this who currently have Lyme disease probably couldn’t imagine that they would be suffering from this condition prior to getting it, and so it would also be great to encourage those who don’t have Lyme disease to take the proper precautions so they don’t have to suffer from this condition.

Let’s Not Forget About Other Tick-Borne Coinfections

I’m not going to get into great detail about the coinfections that are commonly present along with Lyme disease, but here are some of the more common ones:

• Anaplasma
• Bartonella
• Babesia
• Chlamydia
• Ehrlichia
• Mycoplasma
• Rickettsia

Although the focus of this blog post is on Lyme disease, the symptoms from these coinfections can be just as bad, and in some cases even worse.  It’s also worth mentioning that some people with Lyme disease and related coinfections also have reactivated viral infections, such as Epstein-Barr and herpes simplex.

How Is Lyme Disease Related To Thyroid Health?

There is evidence that Borrelia burgdorferi can be a potential trigger of thyroid autoimmunity in those who are genetically susceptible (4) (5).  Although more research is needed in this area, there apparently is a molecular mimicry mechanism between the proteins associated with Borrelia burgdorferi and thyroid cells.  Molecular mimicry means that a foreign antigen (i.e. Borrelia burgdorferi) shares an amino acid sequence or structural similarities with self-antigens (i.e. thyroid tissue).

So in this situation it seems that there is similarity between some of the amino acids of Borrelia burgdorferi and the amino acids of the thyroid gland, which in turn causes the immune system to attack both Borrelia and the thyroid gland.  There is also evidence that some of the coinfections associated with Lyme disease can trigger thyroid autoimmunity through similar mechanisms (6) (7).  Although there is an increased risk of developing Graves’ disease or Hashimoto’s in someone who has Lyme disease or its associated coinfections, this of course doesn’t mean that most people with Lyme disease will develop an autoimmune condition.  That being said, if you have Lyme disease then you not only want to do things aimed at eradicating the infection, but you also want to reduce inflammation and modulate the immune system.

Conventional Treatment Options For Acute and Chronic Lyme Disease

There are three stages of Lyme disease, and not surprisingly, the sooner you treat it the better the outcome.  However, this doesn’t mean that those with early disseminated or chronic Lyme disease can’t receive good results.  But in most cases, the earlier you begin treating it the quicker you are to heal.  One problem is because Lyme disease is commonly misdiagnosed, many people don’t treat it until it becomes chronic.  In addition, some people have dormant forms of Borrelia burgdorferi in their body, and because they don’t experience any symptoms they understandably don’t seek treatment.

Acute Lyme disease.  Acute Lyme disease is treated conventionally through antibiotics.  Doxycycline is commonly given for a period of 2 to 4 weeks, although some people instead take Amoxicillin or Cefuroxime.  Although I’m not a big fan of antibiotics, this very well may be the best option for the acute stage, especially if you have obvious signs of Lyme disease (i.e. tick bite, bull’s-eye rash).

However, many people with Lyme disease never find a tick and don’t have a bull’s-eye rash.  So if Lyme disease is suspected but there are no obvious signs, what approach should you take?  It’s a tough decision, as while natural herbs might do the trick, if Lyme disease is strongly suspected one can make a good argument that antibiotics might be the best option.  As I’ve said in numerous other blog posts, everything comes down to risks vs. benefits, and while there is a definite risk of taking antibiotics, there is also a big risk of not adequately treating acute Lyme disease.

Early disseminated Lyme disease.  This is the second stage of Lyme disease, and it usually occurs within a few weeks of a tick bite.  At this point the bacterial infection is widespread, and therefore is more challenging to treat.  Just as is the case with stage #1, antibiotics are usually recommended in early disseminated Lyme disease.  While oral antibiotics are common, in this stage intravenous antibiotics are also given to some people.  While the standard course of treatment for stage #2 is 14 to 21 days of oral antibiotics, in many cases this isn’t enough to get the person well again.

Chronic Lyme disease.  This is the third stage of Lyme disease, and is the most difficult to treat.  Long-term antibiotics are commonly recommended for patients with chronic Lyme disease.  And while some people respond, many people don’t.  In fact, I’ve consulted with some Lyme disease patients who worked with Lyme disease specialists, and most of them have received long courses of antibiotics.  This is even true with a few well known Lyme specialists who incorporate alternative methods.  In other words, they combine alternative therapies with antibiotics.

Although I realize that antibiotics have their time and place, and I can understand people in stage one receiving antibiotics, and even those in stage two, I’m not a big fan of people with chronic Lyme disease taking very long courses of antibiotics (i.e. 6+ months).  Sure, there might be some exceptions, and I realize that some patients actually feel better on long-term antibiotics.  I’ve worked with patients who were on antibiotics for chronic Lyme disease for many months who didn’t feel great, but they felt even worse when not taking them.

It’s a tough situation, as we all know the negative effects that antibiotics have on the microbiome.  That being said, if anyone reading this has been treated with antibiotics on a long-term basis for their chronic Lyme disease condition and felt like they benefited greatly please share your experience in the comments below.  After all, my goal isn’t to criticize any type of treatment, and I also realize that some people with chronic Lyme disease do really well when taking a few months worth of antibiotics, and many can’t afford some of the other options I’ll discuss below.  But there are some patients with chronic Lyme disease who have been receiving antibiotics for well over a year, and in some cases a few years.

So just to clarify, I don’t want you to get the impression that I’m opposed to people with chronic Lyme disease taking antibiotics.  I definitely think that people with acute Lyme disease can benefit from taking antibiotics, and I also know there is a role of antibiotics in chronic Lyme disease.  I realize that there are people with chronic Lyme disease who have benefited from 3 to 6 months of antibiotic therapy.  But I’m just not sure what the benefit is of being on antibiotics for longer than this, although once again, I’m open to hearing what others have to say about this.

Can Herbs Eradicate Lyme Disease?

Many people reading this know that certain herbs have antimicrobial properties against infections.  Herbs can eradicate early stages of Lyme disease, although the problem is that 1) not everyone responds to the same herbs and 2) you need to make sure the dosing is high enough, although not too high.  My point is that herbs alone might be able to help someone with acute Lyme disease, but the same herbs that work for person #1 might not work for person #2.  So even in acute Lyme disease a good approach might be a combination of antibiotics and herbs, although if anyone reading this has overcome Lyme disease without taking antibiotics please share your experience in the comments section below.

As for stages #2 and #3 of Lyme disease (especially stage #3), herbs in some cases might be the best treatment option for Lyme disease, but there is controversy over whether Borrelia burgdorferi can actually be eradicated in those with chronic Lyme disease.  Some studies show that those “successfully” treated with chronic Lyme disease still have Borrelia burgdorferi in their body many years later (8) (9).  On the other hand, other studies show that Borrelia burgdorferi do not persist after conventional treatment with antibiotics (10) (11).

What herbs can specifically help with Lyme disease?  There are numerous protocols involving different herbs, and here are some of the most well known Lyme Disease protocols:

• The Zhang Protocol
• The Cowden Protocol
• Stephen Buhner Protocol
• Byron White formulas

Bio-Botanical Research also has some great herbs that can help with Lyme disease, and I’m sure there are numerous other protocols I didn’t list here.  You can learn more about these by searching online, although one of the best books I have read on this topic was by herbalist Stephen Buhner entitled “Healing Lyme”, as he gives his “core protocol” for Lyme disease, and he also gives additional herbal recommendations based on whether someone has severe brain/CNS involvement, Bell’s palsy, seizures, anxiety, and many other symptoms and conditions.  I consider this a must-read book for those with Lyme disease.

Other Treatment Options For Lyme Disease

Although herbs can be a very effective treatment method for many people, some people don’t receive good results with herbs alone.  Some people with Lyme disease aren’t able to tolerate herbs, or they might only be able to tolerate doses too small to have a therapeutic effect.  If you have tried herbs but haven’t had much success, or if you are unable to tolerate herbs, then you might want to look into some of the following alternative treatments:

Homeopathy.  While you might have a hard time believing that homeopathy can benefit those with chronic Lyme disease, homeopathy can be amazingly effective for some people.  While I couldn’t find any published studies demonstrating that homeopathy can help with acute or chronic Lyme disease, if you do some searching you’ll find some people who have done extremely well using homeopathy when conventional methods didn’t work.

Ozone therapy.  Ozone therapy is a treatment that is designed to increase the amount of oxygen in the body.  It can be administered in a few different ways, including intravenously and rectally through ozone suppositories.  When done intravenously the blood is drawn from the patient, exposed to ozone, and then re-injected.  It can help with resistant pathogens such as Borrelia burgdorferi, along with viruses.

Hyperbaric oxygen therapy.  Hyperbaric oxygen therapy involves intermittently breathing pure oxygen in a pressurized room or tube, and thus it increases the amount of oxygen in your blood.  It’s used to treat numerous medical conditions, and while it’s commonly used for wound healing, there is some research that shows that it can be an effective treatment for Lyme disease (12).

Peptide therapy.  During the 2017 International Lyme and Associated Diseases Society (ILADS) conference, Dr. Kent Holtorf gave a presentation where he discussed the benefits of peptide therapy in Lyme disease.  This is a bit complex to explain, and so I’ll include a link to his website that discusses this in greater detail.

Don’t Forget to Balance Other Compromised Areas of the Body

When trying to overcome any chronic infection, some people overlook the impact that other compromised areas of the body can have in restoring your health.  For example, if you don’t have healthy adrenals you can’t have a healthy immune system.  And while taking adrenal support might be beneficial, lifestyle factors such as eating well, getting sufficient sleep, and doing a good job of handling stress are all essential.  Supporting mitochondria can be important, especially if someone is taking an antibiotic such as doxycycline, as the research shows that these drugs impair mitochondrial function (13) (14).  Decreasing your toxic load also can make a big difference in your recovery.

Let’s not forget about the importance of thyroid hormone, which affects every cell in the body.  If someone has Lyme disease it is important that they have healthy levels of thyroid hormone.  Too much thyroid hormone isn’t a good thing (for those with hyperthyroidism and Graves’ disease), but if you want to heal from Lyme disease you also don’t want to have low or depressed thyroid hormone levels.

What’s Your Experience With Lyme Disease?

For those reading this who have already been diagnosed with Lyme disease, please share your experience in the comments section below.  Feel free to share what treatment options worked and didn’t work for you.  The goal here is to help others who are suffering from Lyme disease, and so if you have received excellent results through antibiotics, herbs, homeopathy, ozone therapy, etc., then please let others know about this.  And if you haven’t received good results and are still suffering from the symptoms associated with Lyme disease and its coinfections, I still encourage you to share your experience with others.  If you haven’t been diagnosed with Lyme disease then perhaps you can share the experience of a family member or friend who dealt with this.

Although I’ve been in remission from Graves’ disease since 2009, this doesn’t mean that I haven’t had some close calls regarding a relapse. One of these was in September of 2016, when I experienced my very first bout of shingles.  It was a very stressful year, as besides selling our house and moving into a new one, which was a very stressful process, that summer I broke my fifth metatarsal and was in a walking boot for a couple of months.  I’m sure the chronic stress that year was a big factor in weakening my immune system.

While I’m sure many reading this already know what shingles is, and some probably have experienced it themselves, for those unfamiliar with shingles I’ll briefly explain what it is.  Shingles is caused by the same virus that causes chickenpox…the varicella-zoster virus.  After someone gets chickenpox this virus stays dormant in the body in the nerve roots.  Years later the varicella-zoster virus can become active, thus causing shingles.

Shingles presents as a painful rash along the skin, and it usually affects one side of the body.  This was the case with me when I was dealing with shingles.  I also experienced persistent headaches a few days before the rash appeared, and since I rarely get headaches this was the first sign that something was wrong.  Most cases of shingles will last 2 to 4 weeks.

My case wasn’t too severe from both a pain-perspective and a duration perspective.  The concern I had was that the virus was around my auditory (hearing) nerves and did temporarily affect my hearing, and like many others with shingles, I was concerned that it would affect my eyes.  Yet another concern was that it might cause a relapse of my Graves’ disease condition, which fortunately didn’t happen, and I’ll elaborate on this later in this post.

Other Symptoms Associated With Shingles

I mentioned how in my case I had headaches, which not everyone with shingles experiences.  I then developed the rash.  Before getting the rash some people experience an increase in fatigue, and some will also have a slight fever.  There might be tingling sensations under the skin.  The rashes turn into small blisters and may or may not itch.  This stage can last up to five days.

After this stage the blisters dry up, and it can take two to ten days for this to happen.  As I mentioned earlier, shingles usually runs its course in two to four weeks, although some people do experience further complications.  I also should add that while shingles can develop anywhere on your body it most commonly affects the neck and chest.  And as I mentioned earlier, it can also affect the eyes and ears.

About The Varicella-Zoster Virus

Varicella-zoster virus is a member of the herpes virus family.  You no doubt are familiar with some of the other members of this family, which include herpes simplex virus type 1 and 2, along with Epstein-Barr and cytomegalovirus.  All of these viruses are very common, and just as is the case with varicella-zoster, these other viruses stay inactive in your body, but they can become active if your immune system becomes weakened.

What Triggers Shingles?

Just as a reminder, shingles is caused by reactivation of the varicella-zoster virus.  But since most people have this virus in their body (in a dormant state) why do some people get shingles and others don’t?  The main reason is due to a weakened or compromised immune system.  This is one reason why shingles is more common in the elderly, but my experience proves that it can affect anyone, as I was 45 years old when I had shingles.  And there’s no doubt in my mind that chronic stress was what weakened my immune system, as I mentioned in the opening paragraph.

Why Didn’t My Graves’ Disease Condition Return?

Infections are a potential trigger of autoimmune conditions such as Graves’ disease and Hashimoto’s, and this includes viruses.  But how can infections trigger autoimmunity, and why didn’t I suffer a relapse of my Graves’ disease condition when I was dealing with shingles?  Luck certainly played a role, but perhaps another reason relates to the Th1/Th2 balance of the body, which I discussed in a past blog post entitled “Should You Get Tested For Cytokines?”.  But just to briefly summarize here, most autoimmune conditions involve a shift toward the Th1 pathways, which is often referred to as “Th1 dominance”.  Th1 cytokines are involved in the eradication of intracellular pathogens.  In other words, the same type of immune response that kills infections can also drive autoimmunity.

However, many cases of Graves’ disease have been found to be “Th2 dominant” in the literature.  I personally didn’t have my cytokines tested when I was dealing with Graves’ disease, but assuming I was Th2 dominant, and if shingles causes a Th1 dominant state, then this may explain why I didn’t experience a relapse.  Of course this is just a theory, and there can be other factors that prevented a relapse from occurring.  As another example, according to the triad of autoimmunity, a leaky gut is a necessary component of an autoimmune condition.  As a result, if someone has a healthy gut and gets any type of infection that leads to a Th1 response, this shouldn’t lead to autoimmunity.

Balancing the immune system involves more than just Th1 and Th2, as in past articles and blog posts I’ve also discussed Th17 cells and regulatory T (Treg) cells, which also need to be in balance to prevent autoimmunity from developing.  While Tregs play an important role in preventing autoimmunity and can also benefit people with viral infections by suppressing tissue damage caused by virus-specific T cells (1), lowering the T cell numbers can also make it more challenging to eradicate the infection.  Similarly, Th17 cells also play a role in eradicating infections, but too many Th17 cells can lead to autoimmunity.

This is what can make shingles and other viruses challenging to treat in someone who has Hashimoto’s thyroiditis, which is typically a Th1 dominant condition.  Normally with Hashimoto’s you want to do things to increase Tregs in order to dampen both the Th1 and Th17 response, but this can also make it challenging to eradicate infections.   If this is confusing to you then join the club, as many practitioners also find this to be complex, and there’s still a lot we don’t know about managing infections in autoimmunity.  With regards to viruses, probably the best approach is to take something to inhibit or decrease the replication of the virus, and then incorporate dietary and lifestyle changes to improve the health of the immune system.

Does The Research Show Any Relationship Between Shingles and Thyroid Autoimmunity?

Although there is research showing that Epstein-Barr and other viruses can be triggers of autoimmune thyroid conditions, I wasn’t able to find any evidence specifically showing that shingles can trigger Graves’ disease or Hashimoto’s. However, there is evidence that other autoimmune conditions are associated with varicella-zoster, including lupus, rheumatoid arthritis, and inflammatory bowel disease. But this doesn’t mean that shingles can’t be a potential trigger, although as I suggested above, since viruses cause a shift towards a Th1 dominant state it probably is more likely to trigger Hashimoto’s thyroiditis. However, it’s important to mention that like Hashimoto’s, Graves’ disease also involves an imbalance between Th17 and Treg cells, which is associated with the reactivation of varicella-zoster. So in all likelihood shingles can cause the development of Hashimoto’s autoantibodies in some cases, and perhaps even Graves’ disease autoantibodies.

Can You Get Shingles More Than Once?

I’m not a big fan of seeing medical doctors, and initially I wasn’t going to see one when I developed shingles, but my wife strongly urged me to go, and so I reluctantly went.  The doctor I spoke with also had experience with shingles, as he told me that he had it three times!  I mention this because some sources will say that those who get shingles will usually only get it once in their lifetime.  But since the virus remains dormant in your body it is possible to have multiple reactivations.  This is yet another reason to constantly work on improving your immune system health.

What Is Post-Herpetic Neuralgia?

Although most people who get shingles fully recover, which fortunately includes myself, a small percentage (10 to 20%) experience something called “post-herpetic neuralgia”.  This is characterized by severe pain from the nerve damage caused by the virus.  This pain can last from a few weeks to a few years in some cases, and the risk of getting this is almost 30% higher in people older than age 50 (2).  Later in this post I’ll discuss some natural treatment alternatives that can treat and prevent post-herpetic neuralgia.

Conventional Treatment Options For Shingles

Not surprisingly, conventional treatment options don’t do anything to improve the health of the person’s immune system, but instead are aimed at stopping the virus from replicating.  Most medical doctors will treat shingles with antiviral medication.  It is advised to start antiviral therapy no later than 72 hours after the rash starts, and this potentially can help to speed up recovery time and also help with the pain.  It can also reduce the chance of developing post-herpetic neuralgia.

There are times when antiviral medication is warranted, but of course everything comes down to risks vs. benefits.  Although losing your vision or hearing is rare due to shingles, it’s a possibility, and so if the virus has affected the auditory or visual nerves then this might be a situation when it’s wise to take the medication.  If someone is dealing with severe pain then this might be another reason to consider the antiviral meds, not only to help with the pain, but it can reduce the chances of developing post-herpetic neuralgia.

The antiviral meds most commonly given include acyclovir (Zovirax), valacyclovir (Valtrex), and famciclovir (Famvir Novartis). Just as is the case with other medications, side effects are possible with these antiviral drugs.  For example, some of the common side effects of acyclovir include nausea, vomiting, diarrhea, loss of appetite, stomach pain, headaches, lightheadedness, and swelling in your hands and feet (3).  In rare cases this drug can cause kidney problems (3).

It’s also important to mention that if someone is experiencing a lot of pain, some doctors will recommend corticosteriods (i.e. Prednisone) to help.  This very controversial, even in the literature, and the reason for this is because while these drugs might help to lessen the severity of the pain, corticosteroids suppress the immune system, which isn’t a good thing when dealing with an active viral infection.  So in most cases it’s probably a good idea to steer clear from corticosteroids, as there are other things you can take if the pain is severe.

Combining Conventional vs. Natural Treatment Options

Below I’ll talk about natural treatment options for shingles, but I should add that you don’t necessarily have to choose between conventional and natural treatment options.  If you decide to stick solely with a natural treatment approach that’s fine, but if you choose to take antiviral meds you still want to do things to improve the health of your immune system.  This is important not only to prevent shingles from coming back in the future, but of course keeping your immune system healthy will reduce the likelihood of other viruses in your body from reactivating, along with preventing new infections from developing.

Should You Consider Getting The Shingles Vaccine?

Yet another controversial topic is whether people should get the shingles vaccine.  As of writing this blog post there are two vaccines for shingles.  Zostavax has been in use since 2006, and involves the use of an attenuated (weakened) live virus).  According to the CDC this vaccine reduces the risk of developing shingles by 51% and post-herpetic neuralgia by 67%, and protection last for about five years (4).  It is recommended for people 60 through 69 years of age.

A new shingles vaccine called Shingrix was licensed by the FDA in 2017, and this involves a dead virus.  This is the preferred vaccine according to the CDC, as according to them this vaccine is more than 90% effective at preventing shingles and post-herpetic neuralgia (5).  They also claim that protection stays above 85% for at least the first four years after being vaccinated (5).

Of course everything comes down to risks vs. benefits, and while I’m not a big fan of vaccines, this ultimately is a decision you need to make.  The truth is that the shingles vaccine very well might help to reduce the likelihood of getting shingles, and the overt side effects of the vaccine seem to be minimal.  But you shouldn’t overlook the “inactive” ingredients included in these and other vaccines, as this is where a lot of the controversy lies.  There is also some controversy as to whether vaccines should be administered in those with autoimmune conditions, and while the CDC doesn’t list autoimmunity as a contraindication, many health experts would disagree with this.

As you probably know, your immune system doesn’t instantly become unhealthy once you reach age 50, which is when the CDC recommends people to get the new shingles vaccine.  That being said, many people aged 50 or older have an unhealthy immune system because they don’t eat well, don’t get sufficient sleep, do a poor job of managing their stress, etc.  In this case the shingles vaccine may help, but of course it won’t do anything to improve your immune system health.  In fact, even if you decide to get the shingles vaccine you should do things to improve your immune system health, which I’ll discuss towards the end of this blog post.

Natural Treatment Options For Shingles

Just as is the case with all other viruses, you can’t eradicate the varicella-zoster virus from your body.  When it’s active the goal is to do things to slow down the replication in order to put it in an inactive state, while improving the health of the immune system to prevent it from reactivating in the future.   So what I’m going to do is divide the following into two parts, as I’ll first discuss some herbs and nutrients that can help inhibit viral replication, and then I’ll discuss a few things you can do to improve your immune system health.

Herbs and Nutrients To Prevent Viral Replication

Although I’m listing multiple herbs and nutrients below, this doesn’t mean that those with shingles should take all of them.  What I’ll do is first list herbs and nutrients that have been shown to help with the varicella-zoster virus in the literature, and then I’ll list other natural agents with antiviral properties.  It’s important to understand that the lack of studies for certain agents doesn’t mean that it can’t have antiviral activity against varicella-zoster.  For example, quercetin is listed below, and while I couldn’t find any studies which showed that it has antiviral activity specifically against varicella-zoster, I also didn’t come across any studies which demonstrated that it lacked antiviral activity against this virus.  Perhaps future studies will be conducted to determine whether quercetin and other natural agents can be beneficial for preventing replication of the varicella-zoster virus.

Licorice root.  I really do like the herb licorice, and while I commonly recommend licorice root to my patients who have depressed cortisol levels, this herb also has antiviral activity. One study showed that licorice has low antiviral activity against varicella-zoster compared with acyclovir (6).  Licorice root can potentially increase blood pressure, and so if someone has a history of hypertension taking this herb wouldn’t be a good idea.

Resveratrol.  I don’t usually recommend resveratrol for anti-viral purposes, but I came across one in vitro study that showed that resveratrol can inhibit the replication of the varicella-zoster virus (7).

Vitamin D.  I’ve spoken about the importance of vitamin D numerous times in past articles and blog posts, and a few studies show that it might affect the course of shingles and post-herpetic neuralgia (8) (9).

Vitamin C.  A few studies have shown that administering vitamin C intravenously can help with the pain of shingles and post-herpetic neuralgia (10) (11).  One of these was a case report where the patient didn’t respond to conventional treatment, but IV vitamin C resulted in an immediate reduction in the pain.

Quercetin.  Although quercetin is known for its anti-histamine properties, it also has antiviral activity.  Unfortunately I wasn’t able to find any studies showing that it can inactivate the varicella-zoster virus, but there is evidence of it helping with other types of viruses (12) (13).

St. John’s Wort.  Although this herb is commonly known for its anti-depressive properties, it also has antiviral properties (14), but I also wasn’t able to find evidence of it helping with varicella-zoster.  There are a lot of herb-drug interactions involving St. John’s Wort, and so I’d be cautious about taking it on your own.

Lysine.  Although there is evidence that lysine can inhibit the replication of herpes simplex virus (15) (16), I couldn’t find evidence of it helping with varicella-zoster.  Once again, this doesn’t mean that it can’t be of benefit, but I’m not sure if taking lysine will prevent the onset of shingles.

Other natural agents.  Other natural agents that have antiviral properties, although not necessarily against varicella-zoster, include garlic, turmeric, monolaurin, and certain essential oils.

Can Ozone Therapy and UV Light Help With Shingles?

I can’t say I have much experience with ozone therapy, and while there is some evidence that ozone can help with the inactivation of viruses (17), I couldn’t find anything specific related to shingles, although you might want to check out this video.  I did come across a study that showed that broad band ultraviolet light B (UVB) might play a role in the prevention and treatment of post-herpetic neuralgia (18).

How To Improve Your Immune System Health

There are many different things you can do to improve your immune system health.  While I just listed a few nutrients and herbs that can help to inhibit viral replication, I don’t recommend loading up on supplements to improve your immune system health.  This doesn’t mean that supplements can’t play a role, but you want to make sure you cover the basics:

1. Improve your stress handling skills.  Although eating a healthy diet probably should be on top of this list, I started with stress because this is a big reason why many people develop shingles.  This was true in my case, and I’m pretty sure it was the case with the medical doctor I saw who had shingles three separate times.  Sure, chronic stress isn’t the only reason for the reactivation of viruses, but it’s a big reason.  As a result, you want to make sure you block out time for stress management on a regular basis.

2. Get sufficient sleep.  If you don’t get sufficient sleep then this will compromise both your adrenals and immune system.  Once again, supplements can help in some cases, but even when this is the case you only want to take supplements on a temporary basis.  In the past I wrote an article where I discussed how to get optimal sleep without taking supplements, and if you haven’t read this I definitely would do so when you get the chance.

3. Eat well.  Eating healthy whole foods is important for optimal immune system health.  I probably don’t have to talk much about this here, and I have written plenty of articles and blog posts on my website related to this topic.  However, I should say that while I commonly recommend restrictive diets such as the autoimmune Paleo (AIP) diet, it’s common for people to get stressed out about this diet when trying to restore their health.  Just keep in mind that an AIP diet isn’t meant to be a long-term diet, and of course the most important factor is to try to eat mostly whole foods while avoiding fast food, refined foods and sugars, etc.

4. Improve your gut health.  Since 70 to 80% of the immune system cells are located in the gastrointestinal tract, it makes sense that you would need a healthy gut to have a healthy immune system. Of course eating well is the big key to having a healthy gut, although infections, Candida overgrowth, and certain chemicals (i.e. glyphosate) can cause intestinal dysbiosis, and so these need to be addressed.  To achieve optimal gut health I recommend following the 5-R protocol.

In summary, many people will develop shingles, which can be a very painful condition.  Varicella-zoster is the virus associated with shingles, and the main risk factor for developing shingles is a weakened immune system, with stress being a big factor.  Some people with shingles develop post-herpetic neuralgia, which is characterized by severe pain from the nerve damage caused by the virus. Conventional treatment options for shingles usually involve taking antiviral medication, and the new shingles vaccine is commonly recommended for people aged 50 and older.  Natural treatment options can also help, and even if you choose to take antiviral drugs you can combine this with natural treatment methods, and you still want to do things to improve the health of your immune system.

I hope you enjoyed this blog post, and if you have had shingles in the past please feel free to share your experience in the comments section below.

Although I’ve written numerous articles and blog posts on thyroid antibodies, I’ve decided to dedicate a blog post to thyroid peroxidase (TPO) antibodies.  There are a few different types of thyroid antibodies, but I’d like to focus on TPO antibodies because they are the most common type of thyroid antibody.  Although they are more commonly associated with Hashimoto’s thyroiditis, TPO antibodies are frequently elevated in Graves’ disease as well.

So what are TPO antibodies, and what differentiates them from other types of autoantibodies?  First of all, TPO antibodies develop when the immune system attacks thyroid peroxidase.  What is thyroid peroxidase?  Thyroid peroxidase is an enzyme that plays a major role in the synthesis of thyroid hormone.  This enzyme converts iodide to iodine, and the iodine combines with tyrosine on thyroglobulin, which forms thyroxine (T4) and triiodothyronine (T3).  So when someone has elevated TPO antibodies, this indicates that the immune system is attacking the thyroid peroxidase enzyme, which in turn can inhibit the production of thyroid hormone, thus eventually leading to hypothyroidism.

It’s worth mentioning that there also is a thyroid peroxidase (TPO) gene.  Some people will have genetic polymorphisms (mutations) of the TPO gene, which can lead to severe defects in thyroid hormone production due to total iodide organification defects or partial iodide organification defects (1).  One study identified six different genetic defects of the TPO gene, and found that three of these are significantly associated with hypothyroidism (1).

Are people with Hashimoto’s and Graves’ disease who have anti-TPO antibodies more likely to have genetic polymorphisms of the TPO gene?  The studies are conflicting, as some show no association, while other studies did demonstrate an association between TPO genetic defects and anti-TPO antibodies (2).  With genetic testing more popular these days you might wonder if you can get tested to see if you have any TPO polymorphisms.  As of writing this article I’m unaware of any labs available to the public which conducts this type of testing, although I’m sure it’s only a matter of time before it becomes readily available.

TPO Antibodies In Other Autoimmune Conditions

According to the research, anti-TPO antibodies are detected in 90 to 95% of those with autoimmune thyroid conditions, including 80% in those who have Graves’ disease (3).  It’s common for those with other autoimmune conditions to have elevated anti-TPO antibodies, as one study showed that anti-TPO antibodies were present in 37% of those with rheumatoid arthritis (4).  Another study showed that approximately 39.6% of people with type 1 diabetes had anti-TPO antibodies (5).  In celiac patients, anti-TPO antibodies have been detected in 11.7 to 30.5% of patients (6), although other studies have shown a higher percentage (7).

What Causes Elevated TPO Antibodies?

In other blog posts and articles I’ve discussed the triad of autoimmunity.  This is also known as the 3-legged stool of autoimmunity, and it includes 1) a genetic predisposition, 2) exposure to an environmental trigger, and 3) an increase in intestinal permeability (a leaky gut).  So the reason why one person might develop elevated anti-TPO antibodies, while another person will develop thyroid stimulating immunoglobulins, is because they have different genetics that predispose them to different autoimmune conditions, and thus different autoantibodies.  Some people have both anti-TPO antibodies and thyroid stimulating immunoglobulins, which means they have the genetic markers for these two autoantibodies.

But just because someone has a genetic predisposition for developing anti-TPO antibodies doesn’t mean they will develop them.  Once again, according to the triad of autoimmunity, they also need to be exposed to a trigger and at the same time have a leaky gut.  I have discussed some of the different triggers of thyroid autoimmunity in different articles and blog posts, as well as in my books on Graves’ disease and Hashimoto’s.  I’ve also written numerous articles and blog posts on leaky gut syndrome, with my latest one entitled “5 Things To Know About Leaky Gut Syndrome”.

What Is The Reference Range?

Just as is the case with other markers, different labs will have different reference ranges.  For example, the TPO antibodies reference range for Quest Diagnostics is <9 IU/mL.  On the other hand, the reference range for Labcorp is 0−34 IU/mL.  You might wonder what the “optimal” reference range is, and while this is debatable, there is no question that you want to see this value as low as possible, and so I prefer to see it <9 IU/mL.

It’s also important to mention that higher TPO antibodies don’t necessarily correlate with how much damage is taking place to the thyroid gland.  Don’t get me wrong, as just like most natural healthcare practitioners, I like to see these and other autoantibodies decrease, and eventually normalize.  But if someone’s TPO antibodies is 1,000 IU/mL, this doesn’t mean that it’s ten times more severe than someone whose TPO antibodies are 100 IU/mL.

The Relationship Between Thyroid Peroxidase and Iron

Thyroid peroxidase is a heme-containing enzyme (8), which means that it requires iron to function properly.  As a result, it shouldn’t be surprising that a few studies show that iron deficiency anemia can impair thyroid metabolism by reducing TPO activity (8) (9).  Another study showed that iron deficiency anemia not only can lead to hypothyroidism, but elevated TPO antibodies (10).

Iron deficiency anemia is so important that a few years ago I dedicated an article on this topic.  One of the big problems is that many medical doctors will only test for serum iron or ferritin, instead of ordering a full iron panel.  Another problem is that most will rely on the lab reference ranges.  So for example, someone might present with a ferritin of 18 ng/mL, which is considered to be normal by most labs, yet is well below optimal.  Also keep in mind that inflammation can increase ferritin, and so if someone has normal or high ferritin levels, this alone won’t rule out an iron deficiency.

How Can You Decrease TPO Antibodies?

If you have elevated anti-TPO antibodies, or any other type of autoantibody, you will need to do the following to decrease and normalize these:

1. Remove the autoimmune trigger.  It makes sense that the autoimmune trigger needs to be removed in order to decrease autoantibodies and to help the person get into a state of remission.  It can be challenging to find someone’s triggers.  In fact, that’s why I wrote and released the book Hashimoto’s Triggers earlier this year!  My goal isn’t to plug my book here, but I really do believe it’s the most comprehensive book on finding and detecting autoimmune triggers.  And while the book was written for Hashimoto’s patients, a lot of the information can also benefit people with other autoimmune conditions, including Graves’ disease.

2. Heal the gut.  Since a leaky gut is part of the triad of autoimmunity, it shouldn’t be surprising that healing the gut is also necessary to decrease TPO antibodies.  While it’s common for people to take gut healing nutrients such as L-glutamine, and consume gut healing foods such as bone broth, for optimal gut health you need to reduce the factor that is causing the leaky gut in the first place.  For example, if you have a gut infection that is causing a leaky gut, you can supplement with L-glutamine and drink bone broth every day and you won’t heal your gut until the infection has been eradicated.

3. Reduce proinflammatory cytokines and increase glutathione levels.  Proinflammatory cytokines are a factor in autoimmunity, and while removing the trigger and healing the gut can help to reduce inflammation, you might have to do other things to reduce proinflammatory cytokines.  Speaking of proinflammatory cytokines, an interleukin called IL-17 plays a key role in autoimmunity, and when IL-17 binds to its receptor it causes the production of other proinflammatory cytokines, including IL-1, IL-6, and TNF-alpha.  Some of the factors which can decrease proinflammatory cytokines include vitamin D, fish oils, and curcumin.

Vitamin A also can play an important role in reducing IL-17.  It does so by turning on something called FOXP3, which will lead to a greater production of regulatory T cells (Tregs) and less Th17 cells.  Th17 cells are one of the IL-17 producing cells.  On the other hand, Tregs play a role in suppressing autoimmunity.  So essentially you want a lot of Tregs and a low number of Th17 cells.

As for glutathione, this is a potent antioxidant that can help to reduce oxidative stress associated with autoimmunity.  Glutathione peroxidase can help to reduce free radicals (11), which can also decrease proinflammatory cytokines.  Many people with autoimmune conditions such Graves’ disease and Hashimoto’s have a glutathione deficiency.  This is important to bring up, as if someone has a glutathione deficiency but does other things to reduce proinflammatory cytokines (i.e. take fish oils), then this alone won’t be sufficient to decrease TPO antibodies. This is one reason why a few studies show that taking selenium can decrease thyroid antibodies (12) (13).  Selenium is a cofactor of glutathione peroxidase, and thus a selenium deficiency can cause a glutathione deficiency.

While it’s important to increase glutathione levels, which can be accomplished through diet and/or supplementation, you also want to address the cause of what’s depleting the glutathione.  In a recent article I wrote entitled “Glutathione and Thyroid Autoimmunity” I discussed some of the factors that can deplete glutathione, which includes environmental toxins, acetaminophen and other medications, alcohol consumption, and nutrient deficiencies.

4. Correct other imbalances.  While arguably the first three things mentioned here are the most important factors when trying to decrease TPO antibodies, you also want to correct other imbalances that may be present.  As an example, cortisol plays an important role in controlling inflammation.  As a result, if someone has compromised adrenals that presents as depressed cortisol levels, then it will be challenging to decrease proinflammatory cytokines.

I’ve written a few blog posts where I discussed the relationship between oral health and thyroid health.  A few studies have shown that periodontal disease can cause an increase in Th17 cells (14) (15), which are associated with Hashimoto’s and other autoimmune conditions.  And while more research has focused on the correlation between rheumatoid arthritis and periodontal disease (16) (17), there is also evidence that Hashimoto’s thyroiditis can be associated with periodontal disease (18).  More research is needed in this area as well, but if you have inflamed gums it’s possible this needs to be addressed in order to restore your health.

Are TPO Antibodies Protective Against Breast Cancer?

I found it interesting that some studies show that there is a protective effect of anti-TPO antibodies for women with breast cancer (19).  The studies show that women with breast cancer who also had elevated TPO antibodies had better survival rates (20).  The authors of one study hypothesized that breast TPO may participate in the regulation of oxidative stress in breast tissue (21).

In summary, thyroid peroxidase (TPO) antibodies are the most common type of thyroid antibody.  Although they are more strongly associated with Hashimoto’s, 80% of those with Graves’ disease will have elevated TPO antibodies.  As for what causes elevated TPO antibodies, according to the triad of autoimmunity someone needs to have a genetic predisposition, exposure to an environmental trigger, and a leaky gut in order to develop autoimmunity, and thus elevated autoantibodies. As a result, in order to decrease TPO antibodies you need to find and remove the autoimmune trigger, heal the gut, and you might also need to do other things to reduce proinflammatory cytokines and increase glutathione levels.  As discussed in this blog post, correcting other imbalances might also be necessary to lower TPO antibodies.

For many years stevia has been considered to be a safe sugar substitute, but recently there has been some controversy over this natural sweetener.  In fact, some healthcare professionals now recommend for their patients to avoid stevia.  Some of my thyroid and autoimmune thyroid patients have also questioned whether or not it’s safe to consume stevia, and so I figured I’d dive into the research and put together a blog post on this topic.

Before discussing the health benefits and potential risks of stevia I’d like to cover a few basics.  First of all, stevia is a plant that has been used as a sweetener for hundreds of years.  However, it’s only been recent that many products have included it as a sugar substitute.  Some of the products that include stevia include soft drinks, ice cream and other desserts, protein powders, and many other products.

Whole plant stevia is also known as Stevia rebaudiana Bertoni.  Stevia extract refers to a preparation that is made by steeping the leaves of the stevia plant, which in turn extracts the compounds responsible for the plant’s sweet taste.  These compounds are called steviol glycosides.  There are 11 major steviol glycosides, and rebaudioside A and stevioside are the most abundant (1).  High-purity stevia extracts consisting of 95% or greater steviol glycosides are required to meet US and European regulatory approvals and safety standards for foods and beverage use.

Health Benefits of Stevia

The truth is that many people don’t use stevia for any specific health benefits.  For example, many people add stevia to coffee or tea as a substitute for white sugar and/or artificial sweeteners.  But there is research demonstrating specific health benefits of stevia, which I’ll discuss below:

Diabetes Mellitus.  One rat study looked at the effects of stevia leaves and its extracted polyphenols on diabetes (2).  The results of the study showed a reduction of blood glucose, the liver enzymes (ALT and AST) and insulin, and suggested that stevia leaves not only have a hypoglycemic effect, but can also alleviate liver and kidney damage.  Another study showed that aqueous extract of stevia has anti-diabetic effects in albino rats (3).

Hypertension.  A few animal studies show evidence that stevia may help to reduce blood pressure.  One study showed that stevioside given intravenously to hypertensive rats was effective in blood pressure reduction (4), while another study on hypertensive dogs showed that stevioside is an effective antihypertensive natural product (5).  A human study investigated the long-term efficacy and tolerability of stevioside in patients with mild essential hypertension (6).  The study showed that after 2 years, the stevioside group had significant decreases in systolic and diastolic blood pressure.

Cancer.  Although a few in vitro studies demonstrated that Stevia rebaudiana extracts have antiproliferative and proapoptotic properties on cancer cells (7) (8), including pancreatic cancer cell lines (9) (10), another study showed no impact of stevia on the pancreatic cancer (11).

Inflammation.  A few studies show that stevioside possesses anti-inflammatory and immunomodulatory properties by decreasing the synthesis of proinflammatory cytokines (12) (13).  And since an increase in proinflammatory cytokines is associated with autoimmune conditions, perhaps stevia can benefit people with Graves’ disease and Hashimoto’s.

Obesity.  There is evidence that by lowering energy intake, stevia may lead to the reduction and prevention of obesity (14).

Lyme disease.  One study looked at the effectiveness of whole leaf Stevia extract against Borrelia burgdorferi species, which are associated with Lyme disease (15).  The results of the study demonstrated that Stevia had significant effect in eliminating Borrelia burgdorferi spirochetes and persisters, and therefore might be an effective agent in helping people with Lyme disease.

Tooth decay.  Stevia is non-cariogenic, and when used over table sugar it can be a way of preventing dental caries (16).  In addition, some of the stevia extracts exhibits antimicrobial properties against the bacteria that play a role in tooth decay (17).

What Are The Risks of Stevia Consumption?

Over the last few years there has been some controversy related to stevia.  Here are a few of the controversies associated with stevia:

1. Stevia and fertility.  There is an animal study that showed that chronic administration of a stevia extract may decrease the fertility of male rats (18).  There are a few problems with this study.  First of all, it was a single study that hasn’t been reproduced.  Second, it was conducted on rats, and animal studies don’t always translate to humans.  And third, the abstract didn’t specify how much stevia was given to the rats over the 60 day period.  The truth is that more research is needed, but if someone is having fertility problems and consumes stevia regularly then it probably is best to stop consuming it, just to play it safe.

2. Stevia and gut bacteria.  One study evaluated the influence of stevia glycosides on the growth of Lactobacillus reuteri strains (19).  According to the study, two stevia glycosides impaired the growth of the analyzed strains.  This doesn’t mean that consuming stevia will affect all of the strains of Lactbacillus retueri, let alone other strains of bacteria.  Once again, more research is needed, and even the study concluded that it’s necessariy to evaluate the influence of stevia glycosides on other groups of micro-organisms.

3. Stevia and Cytochrome P450 enzymes.  I came across a study which showed that steviol caused a weak inhibition of CYP3A4 and CYP2C9 (20).  These enzymes play a role in the metabolism of certain drugs.  As a result, food-drug interactions can be a concern when taking stevia.

4. Stevia and ragweed allergies.  Although I haven’t come across any research that has showed an association between stevia and ragweed allergies, I’ve read some blog post comments suggesting that people were unable to tolerate stevia for this reason.  Stevia is part of the Asteraceae/Compositae plant family, which includes ragweed, chrysanthemums, marigolds, daisies, and other plants (21).  In theory, people who have allergies to ragweed and other plants in the same family may also react to stevia.

Other Natural Sugars and Sweeteners To Consider

For those who choose not to consume stevia, you might wonder which other natural sweeteners are safe to consume.  I’ll refer you to a blog post I wrote in the past entitled “Natural Sugars, Sweeteners, and Thyroid Health”, as I discuss the different natural sweeteners.  I even discussed stevia, although this current blog post goes into much greater detail.  Even though I recommend reading the blog post I wrote on natural sweeteners, here are four natural sugars and sweeteners to consider using:

• Honey
• Maple syrup
• Molasses
• Luo han (monk fruit)

Beware of “Hybrid” Stevia Products

If you choose to consume stevia, ideally it should be 100% whole leaf stevia without added ingredients.  Some products will include stevia, but will also include other sweeteners such as sugar alcohols or agave, both of which I discuss in the blog post I’ve written in the past on natural sugars and sweeteners.  Dextrose is another ingredient added to some stevia products, and this is commonly derived from genetically engineered corn.  Not only do you need to be aware of other ingredients included, but some of these are highly processed using numerous chemicals to extract the steviol glycosides from the leaf.

Should You Avoid Stevia?

I personally have reduced my consumption of stevia recently, although I don’t completely avoid it.  I used to add stevia regularly to my green tea and herbal teas, but over the years I have learned to enjoy these without stevia…or any other sweeteners.  So I don’t add honey to my tea, or any other sweeteners.  I do I use an electrolyte powder that has stevia (after my sauna therapy sessions).

The truth is that more research is needed, but probably the same is true for many other herbs.  After all, while herbs such as ashwagandha, rhodiola, milk thistle, etc., are overall considered to be safe, there are some people who don’t tolerate these and other herbs.  As for whether stevia can affect fertility, more research is definitely needed, but my guess is that there have been many people who were able to conceive while consuming stevia.  That being said, if someone is having a difficult time conceiving then it might be wise to take a break from stevia.

My biggest concern with stevia is the evidence showing that a few stevia glycosides inhibited Lactobacillus reuteri strains.  And I mentioned earlier that one of the benefits of stevia is in preventing tooth decay by inhibiting certain bacteria, which includes Streptococcus mutans and Lactobacillus acidophilus.  Keep in mind that this doesn’t confirm that consuming small amounts of stevia will cause gut dysbiosis, and we need to keep in mind that there are other herbs that also possess antimicrobial properties, including oregano and berberine.

Overall I think 100% whole leaf stevia is a safe option for many people when taken in small amounts.  This doesn’t mean that everyone will tolerate it well, but the same is true when taking herbs, as many people do fine when taking certain herbs, while some people have a negative reaction.  And so you need to listen to your body.  As I mentioned earlier, if someone is trying to conceive it might be best to take a break from stevia, although if anyone reading this has conceived while consuming stevia regularly please feel free to share this in the comments section below.

In summary, many people use stevia as a natural sweetener.  Stevia can potentially benefit those with diabetes mellitus, high blood pressure, cancer, inflammation, obesity, Lyme disease, and even tooth decay.  There is some evidence that stevia can decrease fertility and have a negative effect on some of the good bacteria.  However, more research is needed in these areas.  My opinion is that stevia is similar to other herbs in that it offers some good benefits when taken in small amounts, but there are also potential risks.  And just as is the case with other herbs, some people may have an allergy to stevia.  If you choose to consume stevia it’s best to use 100% whole leaf stevia.

Please feel free to share your thoughts about stevia in the comments section below!

Although it’s a wonderful feeling to help someone with hyperthyroidism avoid radioactive iodine and thyroid surgery, there are certain precautions you need to take when trying to restore your health.  This is true whether you have Graves’ disease, or a different hyperthyroid condition (i.e. toxic multinodular goiter).  In this blog post I’m going to specifically focus on five precautions you should take when trying to reverse your hyperthyroid condition through a natural treatment approach.

Precaution #1: Safely manage your symptoms.  Although not everyone with hyperthyroidism experiences an elevated resting heart rate, many people do.  Some people have a resting heart rate between 80 and 100 beats per minute, while others have a resting heart rate well over 100 BPM.  I’ve worked with some patients whose resting heart rate was around 150 BPM when they weren’t taking anything.

Without question there is a risk of uncontrolled hyperthyroidism.  When I was dealing with Graves’ disease back in 2008/2009 I was able to effectively manage my symptoms by taking bugleweed and motherwort.  Some people choose to manage their symptoms by taking antithyroid medication and/or beta blockers.  Others prefer to manage their symptoms naturally like I did.  Others attempt to manage their symptoms with bugleweed, motherwort, and/or other herbs but are unable to do so, and need to resort to taking the medication.

In any case, while there might not be as big of a concern if your resting heart rate is slightly elevated, if it is moderately or severely elevated (i.e. greater than 90 BPM) then you want to do something to manage the symptoms.  This might involve taking antithyroid medication (i.e. Methimazole) and/or beta blockers, or in some cases nutritional supplements and herbs such as bugleweed, motherwort, lemon balm, and/or L-carnitine.

Precaution #2: Monitor your liver enzymes.  Many people with hyperthyroidism have elevated liver enzymes.  This is especially true for those who take antithyroid medication such as Methimazole or Propylthiouracyl (PTU).  However, some people with hyperthyroidism have elevated liver enzymes even when not taking antithyroid medication.

Ordering a liver function panel is a good idea for anyone with hyperthyroidism.  This can be ordered separately, although it’s also part of a comprehensive metabolic panel.  The two main liver markers it tests for are alanine aminotransferase (ALT) and aspartate aminotransferase (AST).  Alkaline phosphatase is also commonly elevated, although an elevation of this enzyme doesn’t always indicate a problem with the liver.

I wrote a separate article that focused on these liver markers, and in the article I also discuss what you can do to lower elevated liver enzymes.  The name of the article is entitled “How To Decrease Liver Enzymes in Hyperthyroidism and Graves’ Disease“.

Precaution #3: Monitor your white blood cell count.  Agranulocytosis is a serious condition involving a severe lowering of the white blood cell (WBC) count, which is also known as leukopenia.  There are a few different drugs that can cause this condition, with one of them being antithyroid medications (1).  An absolute neutrophil count of <500/μl while taking antithyroid drugs establishes the diagnosis (2).

The way agranulocytosis is diagnosed is through a complete blood count (CBC) with differential.  This is also a good reason to obtain this test prior to being on antithyroid medication, and then again thereafter, as if someone has a normal WBC count prior to taking the meds but then it becomes depressed after being on the medication, then it’s highly likely that the medication is what caused the decrease.  In this case the antithyroid medication needs to be stopped.

Precaution #4: Don’t overexert yourself.  Although I’m in favor of people being active, those with hyperthyroidism shouldn’t overdo it.  The problem is that many people don’t realize that they are overexerting themselves.  This is especially true for those who exercise on a regular basis.  For example, prior to being diagnosed with Graves’ disease I was overtraining, but at the time I didn’t realize this.  And while I don’t think this was the sole reason why I developed Graves’ disease, overtraining causes dysregulation of the immune system and weakens the adrenals, and so without question it could have been a contributing factor.

Upon being diagnosed with hyperthyroidism I definitely took it easier, and the same is true with many of my patients.  But some people still work out too hard AFTER being diagnosed with hyperthyroidism.  While most people with hyperthyroidism are able to do some light walking and weightlifting while trying to restore their health, you should be cautious about engaging in activity that will significantly result in an increase in your heart rate.  This is true even for those who are taking antithyroid medication, beta blockers, and/or herbs (i.e. bugleweed, motherwort) to help lower the resting heart rate.

Precaution #5: Be aware of thyroid storm signs and symptoms.  Thyroid storm is a rare state of acute hyperthyroidism that can be life-threatening, and some of the potential triggers include trauma, myocardial infarction, surgery, an infection, and iodinated contrast medium (3).  This is especially a concern in cases of uncontrolled hyperthyroidism, such as someone who refuses to take antithyroid medication to manage their symptoms.  Some of the clinical manifestations of thyroid storm include fever, cardiac arrhythmias, vomiting, and impaired mental status (3).

If you are experiencing any of the symptoms I mentioned above it is critical to visit the nearest emergency room.  Treatment of thyroid storm usually involves decreasing the thyroid hormone levels with antithyroid medication and lowering the resting heart rate by taking beta blockers.  If someone is unable to tolerate antithyroid medication they might receive large amounts of potassium iodide to inhibit thyroid hormone production, or therapeutic plasma exchange (4).

Share These Precautions With Your Healthcare Practitioner

In addition to taking the precautions I mentioned in this blog post, I really do think it’s wise for those with hyperthyroidism to work with a competent natural healthcare professional.  Some may think I’m “tooting my own horn”, and while I do work with people who have hyperthyroidism and Graves’ disease, I’m not mentioning this here as a way to promote my practice.  The truth is that many functional medicine doctors are capable of helping people with Graves’ disease improve their immune system health.  However, besides the fact that not everyone with hyperthyroidism has Graves’ disease, many healthcare professionals are afraid to work with people who have hyperthyroidism.

This is one of the reasons why it’s much more common to see functional medicine practitioners who see people with hypothyroidism/Hashimoto’s.  Another reason is because more people have hypothyroidism than hyperthyroidism.  But the primary reason is because most healthcare practitioners are uncomfortable working with hyperthyroid patients.  This is also true with many endocrinologists, and is one of the reasons why they commonly recommend radioactive iodine and thyroid surgery to many of their hyperthyroid patients as the primary treatment option.  They feel that it’s easier (and safer) to manage hypothyroidism when compared to hyperthyroidism.

If you happen to be working with a chiropractor, naturopath, or a different healthcare practitioner who doesn’t have a lot of experience working with hyperthyroid conditions, I urge you to share this blog post with him or her.  Even if they tell you that they are comfortable with treating hyperthyroidism naturally, I’d still ask them to read this blog post so that they understand the importance of having their patients with hyperthyroidism take these precautions.  Because while it’s important to address the underlying cause of your condition, you want to be safe while taking a natural treatment approach.