Although I think it’s a good idea to express gratitude on a daily basis, since today is Thanksgiving I figured I’d share ten things I’m thankful for:

1. My wonderful wife

2. My two beautiful daughters

3. The rest of my family

4. My excellent staff (Kate and Carson)

5. My terrific patients

6. My loyal email and Facebook subscribers

7. Continuing to maintain a state of wellness

8. Being in a profession that I absolutely love

9. Putting the finishing touches on my upcoming book on Hashimoto’s Thyroiditis!

10. Not traveling for Thanksgiving (we travel just about every year, and so it’s nice to take a break)

I’m sure there are a few other things I could have listed that I’m grateful for, but these are the ones that immediately come to mind.

Please feel free to share some of the things you’re most grateful for in the comments section below.

Have a Happy Thanksgiving!!!

Last month I released a blog post entitled “Can The Flu Shot Trigger Graves’ Disease and Hashimoto’s Thyroiditis?“.  Even though it was a very controversial post, it was also a popular one.  And the reason for this is because most people have a strong opinion about vaccines.  Of course many people are in favor of everyone receiving vaccines, while others are completely opposed to all vaccines.  A small percentage of people fall somewhere in the middle where they perhaps aren’t opposed to vaccines, but they also don’t agree with the current vaccine schedule.

Either way I figured I’d get the opinions of others who have received the flu shot, along with other vaccines.  I realize that many people who receive vaccines don’t experience negative side effects.  However, some people do, and I’d like to hear both sides of the story.

And so if you had a positive experience in the past when getting vaccines, please let me know!  And if you had a negative experience when getting the flu shot and/or other vaccines please let me know!  If you personally haven’t had a negative experience but have close friends or family members who haven’t done well with vaccines feel free to share this as well!  Thank you so much for sharing your experience with others.

With the holiday season approaching I figured it would be a good idea to discuss some “healthy eating strategies” for those who are following a strict diet.  When I dealt with Graves’ Disease many years ago I started my natural treatment protocol in the fall, and so I also had to avoid many of the foods I was accustomed to eating during Thanksgiving and the rest of the holiday season.  It admittedly was a challenge, but believe me when I say that it is worth making the sacrifice.  And it’s also important to understand that you can still have a wonderful holiday season even when eating a restricted diet.

When I talk about a “restrictive” diet I’m mainly referring to an autoimmune Paleo diet.  However, even following a standard Paleo diet is challenging for many people.  Of course this depends on the person, as if someone is following an autoimmune Paleo diet for a couple of months and then makes the transition to a standard Paleo diet, many of these people will find the standard Paleo diet easy to follow since they have a few more food choices.  On the other hand, if someone is used to eating a lot of refined foods and sugars, along with fast food, then they probably will find a standard Paleo diet to be very challenging to follow.

Is Cheating Allowed During The Holiday Season?

I know that for some people this question will seem like a silly one to ask.  But every year I get asked this question from at least a few patients.  Of course they might not use the word “cheating”, as everyone will word this question differently.  By the way, some people hate using the word “cheating” when it comes to eating foods that are not permitted on a specific diet.  And I can understand this, as most people associate the word “cheating” with being dishonest, and one of the definitions of cheating is to “act dishonestly or unfairly in order to gain an advantage”.  So perhaps it would be best not to use the word “cheating” and instead ask if “straying” from the diet is allowed.

Here are a just a few examples of how people will ask if they can stray from the diet they are following:

• Is it okay if I eat a few of the excluded foods during the holiday season?
• There will be a few holiday parties at work and I was wondering if eating a small amount of gluten or other forbidden foods will set me back?
• Can I have some gluten free pecan pie on Thanksgiving?
• Will my progress be affected if I eat a bad meal once or twice during the holidays?

Although you can make the argument that the holiday season is one of the toughest times to follow a strict diet, the truth is that throughout the year there are many occasions where you can try to justify straying from the diet.  Here is just a short list:

• Your birthday
• Other people’s birthdays
• Going on vacation
• Weekend road trips
• Summer cookouts
• Wedding anniversary
• Valentine’s Day
• Halloween party
• Other occasions (weddings, bar mitzvahs, etc.)

I realize that most people want to get well, and many people are willing to follow a strict diet, regardless of the time of year.  On the other hand, many people will postpone getting well until after the holiday season, which I think is a big mistake.  For most people the holiday season starts around Thanksgiving and ends after the New Year, and so we’re talking about delaying your quest to improve your health for 5 to 6 weeks.  Instead of doing this, just think of how good you will feel on the first day of 2018 if you spend the holiday season focusing on improving your health, and not doing things that will worsen it.

Yes, I realize that for some people this is easier said than done, but that’s why I decided to write this blog post.  For those who are striving to get into a state of remission, I want to not only encourage you to eat well during the holiday season, but I also want to give you some useful information to make it a little easier to eat well during this time.  So with that being said, here are ten action steps you can take to set yourself up for success during the holiday season:

1. Try to eat at home as much as you can.  This is the best way to ensure that you will stick to the diet, as you of course can control what you bring into your own home.  This is assuming that the rest of your family is on board.  While I realize that everyone in the household may not follow the same restrictive diet (i.e. autoimmune Paleo diet), hopefully you can at least convince them to give up the main common allergens, including gluten and dairy.

2. If traveling for the holidays, stay somewhere where you can cook your own meals.  It can be very challenging to follow a strict diet while out of town, but you can do it if you prepare ahead of time.  For example, if you are staying at a hotel, try to stay at a place where there is a kitchenette so that you have access not only to a refrigerator, but a stove as well.  And it would be great if the place you’re staying at is located within driving distance of a Whole Foods, Trader Joes, or another health food store.  Of course these days most other grocery stores sell organic and gluten free food, but you will usually have a better selection of organic food at a health food store.

If you would like to go out to eat while out of town, do some research ahead of time.  While you can start by looking up some of the local restaurants, another approach is to call a few local health food stores and ask if they have any suggestions with regards to healthier restaurants that have organic and/or gluten free options.

If you are staying with friends or family members for the holiday season, then hopefully they understand your situation and are open to you preparing your own meals, or to at least assist with the cooking.  They might even be willing to prepare some dishes that you can eat, although this is where you have to be careful, as if they aren’t health-oriented then they might unintentionally add ingredients that include some of the excluded foods.  For example, if they make a turkey for Thanksgiving, they might add seasoning that has one or more “forbidden” ingredients, such as gluten.  I realize that some people will feel too embarrassed to explain their dietary restrictions to the host, but doing so can be important in order to avoid being exposed to an ingredient that might have a negative effect on your health.

3. If invited to someone’s home for the holidays either decline, or ask if you can bring your own dish.  While you understandably might feel the need to go to a holiday party hosted by a close friend or family member, if someone who isn’t a family member or close friend invites you to a party feel free to decline.  Of course it’s up to you as to whether or not you tell them why you can’t go.  Another option is to ask the host if you can bring your own dish.  This way you will know that you will at least be able to eat one entree while at the party.

4. Never go to a holiday party hungry.  If you get invited to a holiday party and decide to go, or have one at your place of work, try not to show up to the party hungry.  I know it might seem rude to eat a meal before going to a party, or to bring some healthy snacks along.  Depending on the size of the party the host might not even notice that you’re not eating anything, and perhaps you’ll get lucky and there will be something there you can eat.  But since you won’t know this until you arrive at the party it’s best to be prepared beforehand by eating something before you leave.

5. Not eating is better than eating unhealthy foods.  If you’re in a situation where you are surrounded by unhealthy foods, don’t feel like you need to eat something.  For example, let’s pretend that you were invited the last minute to a holiday party but you didn’t have time to eat a meal beforehand, and you forgot to bring a healthy snack.  So you’re faced with a situation where you either have to eat some unhealthy foods, or you need to skip a meal.  I realize this is an unlikely scenario for most people, but if the scenario arises feel free to skip the meal!

6. Always carry some healthy snacks.  In order to prevent a situation like the one I just described, try to carry one or two snacks with you at all times.  Even if you don’t plan on being out for a long time you never know how the day will turn out.  For example, you might get stuck in a major traffic jam for a couple of hours or get a flat tire.  For some healthy snack suggestions please read a blog post I wrote entitled “9 Healthy Snacks For Graves’ Disease and Hashimoto’s Thyroiditis”.

7. If you eat out take a gluten-digesting enzyme with your meal.  Although you want to do everything you can to avoid eating any “excluded” foods, if you’re in a situation where you might be exposed to gluten or dairy then consider taking a digestive enzyme that breaks these down, as there are a few different companies that sell these.  Just keep in mind that these enzymes don’t completely degrade the proteins of gluten and dairy, and as a result it is not intended for those with Celiac disease or a non-Celiac gluten sensitivity, or those with a dairy allergy or sensitivity.

8. Try to get creative with your cooking.  One of the big problems many people have with following a restrictive diet is the lack of variety.  In other words, they eat the same foods every day, and as a result they get bored.  I honestly can’t say that I’m creative in the kitchen (quite the opposite), but this doesn’t mean that YOU can’t be creative.  Purchase a few recipe books, and if necessary do some batch cooking.  So for example, if you don’t have time to prepare meals during the week you can block out a few hours on the weekend and prepare all of your meals ahead of time for the upcoming week.

9. Mentally prepare yourself for the holiday season.  Just about everyone can follow a strict diet during the holiday season, but some people have a more challenging time doing this than others.  And while stress and other factors can play a role, many times the reason why people stray from the diet is because they aren’t mentally prepared.  I realize that this might be easier said than done, but I know that when I followed a strict diet for my Graves’ Disease condition I didn’t start this diet the day after I was diagnosed.  Although there was no question in my mind that I was going to succeed with the diet, I needed to mentally prepare myself and set a starting date.

And I do the same thing whenever I choose to follow a 21-day detoxification, which also involves following a strict diet.  While I’m sure that some people might spontaneously decide to follow a strict diet immediately, many people need to set a start date, and then mentally prepare themselves for this.  And while many people set a start date of January 1^st, you of course can choose any date you’d like, and as mentioned earlier I encourage you to start sooner than later if at all possible.

10. If you stray from the diet simply get back on track.  Regardless of the amount of preparation someone makes, they still might stray from the diet.  Although I would try to be as strict as you can, if you do happen to stray from the diet don’t get stressed out or feel guilty.  Sure, it might set you back a little, but the only thing you can do is get back on track.

So for those who are planning to follow a strict diet during the upcoming holiday season, I’m hoping that this post not only will provide you with some action steps you can take, but hopefully it will also motivate you and give you a feeling that you can succeed. Sure, I realize that following a strict diet during the holiday season isn’t easy.  But let’s face it, following a strict diet isn’t easy regardless of the time of year.  And the benefit of following a strict diet during the holiday season is that once the New Year arrives you will know that the toughest days are likely behind you.  And I didn’t even mention that after one or two months you might be able to reintroduce some other foods, which of course will make it even easier to follow.

If you drink coffee or consume other forms of caffeine (i.e. green tea, dark chocolate), then I think you’ll find this blog post to be interesting.  I’ll be discussing five things about caffeine, with an emphasis on coffee.  And while not all five points will relate to thyroid health, I do think those who drink coffee daily or consume other forms of caffeine will find the information in this post to be valuable.

So let’s get started…

1. Caffeine is the most widely consumed psychostimulant substance.  This is why many people with thyroid and autoimmune thyroid conditions love their morning coffee.  And as a result of this, there are many people who are willing to give up gluten and dairy, but refuse to give up drinking coffee.  Others are willing to give up coffee, but it’s a major struggle.  This of course brings up the question “does everyone with a thyroid or autoimmune thyroid condition need to give up coffee?”

The truth is that everyone is different, and some people are able to get away with drinking coffee, while others aren’t.  But the same thing holds true with other foods, including eggs, nightshades, nuts and seeds, grains, etc.  But because it’s hard to predict whose health will improve while continuing to drink coffee, and who won’t progress while drinking it, in most cases I will recommend for my patients to take a break from it while trying to restore their health.

2. Caffeine might benefit the immune system of those with Graves’ Disease and Hashimoto’s Thyroiditis.  This might sound exciting for those who have an autoimmune thyroid condition, as there is research which shows that caffeine can decrease both Th1 and Th2 cytokines (1) (2).  Hashimoto’s Thyroiditis is typically characterized by an increase in Th1 cytokines, while most cases of Graves’ Disease involve an increase in Th2 cytokines.  This doesn’t mean that drinking a few cups of coffee will suppress the autoimmune component, although it suggests that drinking coffee, green tea, or eating dark chocolate won’t exacerbate the autoimmune response.

I’ll add that there was also a 2017 journal article where the authors mentioned that while coffee consumption may exert a protective role against multiple sclerosis, primary sclerosing cholangitis, and ulcerative colitis, it might increase the risk of developing rheumatoid arthritis and type 1 diabetes mellitus (3).  However, when I did research on rheumatoid arthritis and coffee consumption I came across a few studies which showed that there was no significant association between coffee consumption (caffeinated or decaffeinated) and rheumatoid arthritis (4) (5).  And I also wasn’t able to find evidence that coffee consumption increased the risk of type 1 diabetes, although there were numerous studies which showed that coffee and caffeine might significantly reduce the risk of developing type 2 diabetes (6) (7).

3. Instant coffee can cause an increase in gluten antibodies.  A study showed that significant immune reactivity was observed when gliadin antibodies were applied to cow’s milk, milk chocolate, milk butyrophilin, whey protein, casein, yeast, oats, corn, millet, instant coffee, and rice (8).  Gliadin is a protein found in gluten, and what I mentioned here is an example of something called cross-reactivity.

This study was conducted by Dr. Aristo Vojdani, who is the Chief Scientific Advisor of Cyrex Labs.  And this research is the basis behind the Cyrex Labs Gluten-Associated Cross-Reactive Foods and Foods Sensitivity test, which is also known as their Array #4.  It’s also important to mention that in the study they used instant coffee, and according to Dr. Vojdani, if you drink a good quality organic coffee then you probably don’t have to be concerned about this cross reacting with gluten.

4. Coffee can interfere with the intestinal absorption of thyroid hormone replacement.  Studies show that drinking coffee can decrease the intestinal absorption of thyroxine (9) (10).  Although these studies used levothyroxine, which is synthetic T4, if you are taking natural thyroid hormone replacement (i.e. Armour, Nature-Throid, WP-Thyroid) it still is a good idea not to drink coffee at the same time.  As for how long should you wait to drink coffee after taking thyroid hormone replacement, the research suggests to wait one hour.   Just to be clear, these studies were specific to coffee, and not caffeine in general.  And so for those who drink caffeinated green tea, this doesn’t seem to interfere with thyroid hormone absorption, and I wasn’t able to find any studies which suggested that it does this.

5. Caffeine should be avoided by those who have adrenal problems.  This is the main reason why I recommend for my patients with Graves’ Disease and Hashimoto’s Thyroiditis to take a break from caffeine while restoring their health, as it can have a negative effect on the health of the adrenals by increasing cortisol secretion (11) (12).  And of course many people with these conditions have adrenal problems.

Since caffeine can increase cortisol secretion, it makes sense for those who have elevated cortisol to avoid caffeine.  But does this mean that it’s okay for those who have depressed cortisol levels to consume caffeine?  Well, we need to keep in mind that taking something like caffeine that stimulates cortisol production isn’t addressing the cause of the problem.  But more importantly, consuming caffeine in those with depressed cortisol levels can worsen the adrenal problem, and so you really do want to do things to improve the health of the adrenals.

It’s also worth mentioning that caffeine is metabolized differently by different people.  In other words, some people are considered to be “fast metabolizers” of caffeine, while others are “slow metabolizers”.   Regardless of whether someone is a “fast” or “slow” metabolizer of caffeine I recommend for them to take a break from drinking coffee while restoring their health.  But if someone is a “fast metabolizer” of caffeine then they probably can reintroduce it in the future without a problem.   On the other hand, if someone is a “slow metabolizer” then they might want to consider giving up coffee for good, or at least minimizing their consumption of it.  And the reason for this is because there are certain health risks associated with being a slow metabolizer of caffeine, including an increased risk of having a heart attack (13).

But how can you tell if you are a “slow” or “fast” metabolizer of caffeine?  If you feel wired after drinking coffee then there is a pretty good chance that you are a slow metabolizer.  Or if you have problems falling asleep even if you drink coffee earlier in the day, then this is another sign, although of course the sleep problems can be related to something else.  On the other hand, if you are able to drink coffee later in the day and sleep like a baby, then chances are you are a fast metabolizer.

Genetic testing can also determine if someone is a “slow” or “fast” metabolizer of caffeine, as caffeine is measured by an enzyme called cytochrome P450 1A2, which is also known as CYP1A2.  If someone has the A/A genotype then this means they are a fast metabolizer of caffeine.  On the other hand, having either the A/C or C/C genotype means that they are a slow metabolizer.

So hopefully you have learned a few things about caffeine and coffee that you didn’t know before.  Many people love drinking coffee, and while I recommend for most of my patients to take a break from it while restoring their health, I realize that some people need to wean off slowly.  And although coffee and caffeine might have some health benefits, caffeine can cause problems in those who have adrenal imbalances and/or those who are slow metabolizers of caffeine.  In addition, coffee can interfere with the absorption of thyroid hormone medication, and so you definitely don’t want to drink coffee around the same time you take levothyroxine or desiccated thyroid.

Around this time of year I always have a few of my patients ask if they should get the flu shot.  I personally have never had the flu shot, and my wife and two daughters have never had the flu shot, and so this should give you a pretty good idea of what I think about this vaccine.  Whereas years ago the flu shot was only available by going to your medical doctor, these days you can walk into a local pharmacy and get a flu shot.  And I realize that many corporations encourage their employees to get the flu shot, while some people have jobs which require them to get the flu shot.

Although I have my biases, rather than use this entire post to bash the flu shot, what I’d like to do is go ahead and discuss the benefits and risks of getting this vaccine.  This way you can make an informed decision, although I encourage you to do some research on your own.  I’ll then talk about some of the more commonly recommended flu shots, along with some of the ingredients.  And then towards the end of this post I’ll give my opinion as to whether those with Graves’ Disease and Hashimoto’s Thyroiditis should receive this shot annually.

The influenza (flu) shot is unique when compared with other vaccines in that this vaccine needs to be updated on a periodic basis to match the vaccine strains with the current influenza strains.  In other words, every year or two different influenza vaccines need to be formulated with different virus antigens.  But as you’ll read, the main concern isn’t with the virus antigens that are in the vaccine, but the other ingredients.

Reasons To Consider Getting The Flu Shot

1. Influenza can sometimes lead to hospitalization, and in rare cases death.  According to the CDC website, flu-related hospitalizations since 2010 ranged from 140,000 to 710,000, while flu-related deaths are estimated to have ranged from 12,000 to 56,000.  However, this apparently includes cases of pneumonia, and the reason is because some deaths related to influenza are due to secondary complications, although not all cases of pneumonia are related to influenza.

2. In some cases getting the flu vaccine can reduce your risk of getting the flu virus, as well as spreading it to others.  Of course when I talk about reasons to consider avoiding the flu shot I’ll talk about how there are different strains of the flu, and as a result, getting the flu shot won’t significantly reduce your risk of getting Influenza.

3. If everyone gets the flu shot annually at their local pharmacy then this will greatly decrease the chance of places like Walgreens and CVS going out of business.  Okay, I admit that I’m being a wise guy here, but the reason I’m bringing this up is because I came across a journal article which looked to compare the cost benefit of receiving the flu shot.  It mentioned that an influenza immunization program will be cost beneficial for employers when more than 37% of employees receive vaccines in non-traditional settings such as pharmacies (1). But when you look under “competing interests” you’ll notice that this research was funded by Walgreens, and that the authors of the journal article are employed or contracted by Walgreens.  This is why you need to be extremely careful when reading the research.

Reasons To Consider Avoiding The Flu Shot

1. There are different strains of the flu.  Because of this, getting the flu shot won’t completely protect you from getting the flu.  In fact, it’s not uncommon for people to get the flu, even after getting the flu shot.

2. There are harmful ingredients in the flu vaccine.  To no surprise, the CDC doesn’t talk about some of the harmful effects of the ingredients in this vaccine.  While it is true that these ingredients are present in small amounts, this doesn’t mean they are safe.  In addition, one also needs to consider the synergistic effects of these chemicals.  In toxicology, synergism refers to the effect caused when exposure to multiple chemicals at as time results in health effects that are greater than the effects of the individual chemicals.  Common ingredients found in vaccines overall (not just the flu shot) include formaldehyde, mercury, egg protein, aluminum, neomycin, monosodium glutamate (MSG), and polysorbate 80.  The good news is that the flu shot doesn’t include all of these, and later in this post I’ll discuss the ingredients that are more specific to this vaccine.

3. Side effects are common when getting the flu vaccine.  Most of the time the side effects are minor, such as local swelling, redness, and pain at the site of the injection.  Other symptoms that have been reported include headaches, nausea, fatigue, muscle pain, and neuropathy, just to name a few.

4. Vaccines can potentially trigger or exacerbate the autoimmune response.  I’ll discuss the research shortly, and while this does seem to be rare, it still should make anyone with an existing autoimmune thyroid condition think twice about getting the annual flu vaccine.

5. You can protect yourself naturally from the flu.  While it’s true that doing things to improve your immune system health won’t guarantee that you won’t get the flu, the same is true when getting the flu vaccine.  Plus it won’t hurt to eat a good diet, improve your stress handling skills, do things to improve the health of your gut (where most of your immune system cells are located), make sure you have healthy levels of vitamin D, take vitamin C and other nutrients and herbs that can improve your immune system health, etc.

Some reading this might also be familiar with nosodes, which is a homeopathic alternative to vaccines.  I can’t say that I have a great deal of knowledge in this area, and while you can find some information about this online, if this interests you then it probably would be best to work with a homeopathic practitioner.  If anyone reading this has experience with using homeopathy as a substitute for the flu shot (or any other vaccine) please feel free to share your experience in the comments section below.

How Does The Flu Vaccine Work?

Vaccines usually use either live attenuated pathogens (i.e. viruses), or inactivated pathogens.  Live attenuated vaccines elicit strong and cellular antibody responses and usually result in immunity against the pathogen that lasts for decades (2).  On the other hand, many vaccines that use inactivated pathogens include substances called adjuvants.  As of writing this blog post, all flu vaccines currently consist of the inactivated influenza virus, although the only flu vaccine that has an adjuvant is FLUAD, which is a trivalent vaccine that has an adjuvant called MF59, which consists of squalene oil.  This vaccine is only approved for those people who are 65 years and older.  The nasal spray influenza vaccine used a live attenuated virus, but the CDC stopped recommending this.

If You Choose To Get The Flu Shot, Which Ones Are Available?

This changes every year, but as of writing this blog post there are injectable influenza vaccines which include both inactivated influenza vaccines and recombinant influenza vaccines.  Although there is a nasal spray flu vaccine, as I just mentioned, the CDC recommends not using this during 2016-2017.  Flu vaccines can also be trivalent or quadrivalent.  Trivalent flu vaccines are approved for people 65 and older and protect against three different strains of the flu virus.  Quadrivalent vaccines are approved for people 18 through 64, and they protect against four different strains.

What Are Adjuvants?

I briefly mentioned adjuvants earlier, and an adjuvant is an ingredient that is added to a vaccine in order to help create a stronger immune response by the person who receives the vaccine.  This is especially true when a vaccine consists of an inactivated bacteria or virus, which is the case with most vaccines.  And so the adjuvant helps to enhance the immune response against the inactivated virus that is in the vaccine, which in turn will cause the person to develop antibodies against the virus.   As I have already mentioned, although the flu vaccine uses inactivated viruses, only one type (Influenza FLUAD) uses an adjuvant.

What Ingredients Are Included In The Flu Vaccine?

This isn’t an easy question to answer, mainly because there are a few different types of flu vaccines.  If you check out this document by the CDC you’ll see that they have eleven different flu shots listed, and the ingredients will vary with each one.  I had my staff person Kate call a local CVS and Walgreens to find out which flu vaccine they use, and here is what they told her:

CVS: They mainly use Fluarix, but they also use Flucelvax.

Walgreens: They told Kate that they use Flucelvax and Fluvirin.

Here are the ingredients of these three vaccines:

1. Influenza Fluarix (GSK): octoxynol-10 (TRITON X-100), α-tocopheryl hydrogen succinate, polysorbate 80, hydrocortisone, gentamicin sulfate, ovalbumin, formaldehyde, sodium deoxycholate, sodium phosphate-buffered isotonic sodium chloride

2. Influenza Flucelvax: Madin Darby Canine Kidney (MDCK) cell protein, protein other than HA, MDCK cell DNA, polysorbate 80, cetyltrimethlyammonium bromide, and β-propiolactone

3. Influenza Fluvirin: ovalbumin, polymyxin, neomycin, betapropiolactone, nonylphenol ethoxylate, thimerosal

Let’s take a look at some of these ingredients included in these vaccines.  Just as a reminder, not all of the ingredients listed below are included in all of the different flu vaccines.  As a result, if you do choose to get the flu shot you might want to find out which type will be used so you can first read the ingredients.  If you are required by your job to get the flu vaccine it still might be worth looking into the ingredients, as while all of the flu vaccines have chemicals, some are worse than others.  And you might have the option of choosing a specific flu vaccine, and if not, perhaps they will allow you to get one on your own and then simply provide the necessary documentation.  For example, Flucelvax doesn’t include either thimerosal or formaldehyde, and so this might be the best option, although it does include Madin Darby Canine Kidney (MDCK) cell protein and MDCK cell DNA, along with polysorbate 80 and a few other ingredients.

Octoxynol-10 (TRITON X-100).  This is an ethoxylated alkyl phenol, and it’s found in some personal care products.  Speaking of which, according to the Skin Deep website from the Environmental Working group, this ingredient has a moderate overall hazard.

Thimerosal.  This is an ethyl mercury-based preservative used in vials that contain more than one dose of a vaccine to prevent germs, bacteria and/or fungi from contaminating the vaccine.  According to the CDC, while flu vaccines in multi-dose vials contain thimerosal to safeguard against contamination of the vial, most single-dose vials and pre-filled syringes of the flu shot do not contain a preservative because they are intended to be used only used once.  Material Safety Data Sheets (MSDS) are produced by companies that manufacture hazardous substances, and they provide information that includes the physical properties, toxicity, and reactivity of many different chemicals.  The MSDS says that thimerosal may be toxic to the kidneys, liver, spleen, bone marrow, and central nervous system, and that repeated or prolonged exposure to the substance can produce target organs damage.

Formaldehyde.  The MSDS lists formaldehyde as being very hazardous in case of eye contact or ingestion.  It also lists it as a probable human carcinogen.  This ingredient is also listed on the Skin Deep website, and its overall hazard is high, and the Environmental Working Group also lists it as being a high risk in cancer formation, along with organ system toxicity.  Some will argue that formaldehyde can be broken down when ingested, which is true, but it apparently can remain in its whole form when injected.             

β-propiolactone.  According to the MSDS, this is very hazardous in case of ingestion or inhalation, and is hazardous in case of skin contact or eye contact. 

Neomycin.  This is an antibiotic, and these are added to some inactivated influenza virus vaccines to prevent the growth of bacteria during production and storage of the vaccine.

Polysorbate 80.  This is a surfactant and emulsifier used in cleaners and personal care products.  The Environmental Working Group lists the overall hazard as low.  The MSDS lists it as being slightly hazardous in case of skin contact, of eye contact, of ingestion, or inhalation.  On the surface it doesn’t seem to be as bad of an ingredient when compared to the others, although apparently it is used by the pharmaceutical industry to help drugs get past the blood brain barrier, and there is a concern that it can also bind to some of the ingredients that are present in the vaccine.

Ovalbumin.  This is the main protein found in egg whites.  If someone has an egg allergy then getting a vaccine with this ingredient can be problematic, although if the ovalbumin concentration is low then those with egg allergies might be able to get it without a problem (3).

Who Should Get The Flu Shot According To The CDC?

The CDC recommends for everyone six months and older to get the flu shot every year, although they emphasize that it is particularly important for people who are at high risk of serious complications if they were to get influenza.  According to their list this includes children younger than 5, adults 65 years of age and older, pregnant women, residents of nursing homes, and people with certain medical conditions including asthma, heart disease, diabetes mellitus, kidney disorders, liver disorders, a weakened immune system (i.e. HIV, cancer), and people with extreme obesity.

Who Should NOT Get The Flu Shot According To The CDC?

According to the CDC, the only two categories of people who should not get the flu shot include children younger than six months, and those people with severe, life-threatening allergies to the flu vaccine or any ingredient in the vaccine.  Of course sometimes the person doesn’t know if they have an allergy to certain ingredients.

Should People With Graves’ Disease and Hashimoto’s Receive The Flu Shot?

To answer this question we’ll take a look at what the research shows.  And while my focus is on thyroid autoimmunity, this information applies to those with any autoimmune condition.  Keep in mind that it can be difficult to make a direct link between vaccinations and autoimmunity, and correlation doesn’t always mean causation.  And while it’s probably safe to say that in most cases getting a vaccine won’t trigger an autoimmune response, numerous studies suggest that vaccines can occasionally stimulate autoantibody production, and in some cases the adjuvants in the vaccines can cause a condition known as autoimmune/inflammatory syndrome (4) (5) (6).  Not all of these studies relate to the flu vaccine, although the last referenced study did discuss how “transiently or persistently increased levels of autoantibodies or the appearance of new autoantibodies was demonstrated in up to 15% of apparently healthy adults after the influenza vaccination”.

I also came across a journal review article which looked at autoimmune/inflammatory syndrome caused by vaccine adjuvants and the relationship between autoimmune thyroid conditions (7).  Other than a few case reports there honestly isn’t a lot of evidence showing a direct link between vaccine adjuvants and autoimmunity, although the authors did conclude that physicians need to be aware that thyroiditis and other thyroid conditions can be induced by vaccine adjuvants, and therefore should reconsider non-essential vaccination (7).  Plus, we also need to keep in mind that in autoimmune conditions it can take many years before someone presents with noticeable symptoms after receiving a vaccine, which is why it is difficult to prove a direct relationship.  This is especially true with Hashimoto’s Thyroiditis.  Of course earlier I mentioned that most flu vaccines don’t have adjuvants, although other ingredients such as thimerosal and formaldehyde are toxic.

Should YOU Receive The Flu Vaccine?

Whether or not you should personally get the flu vaccine is of course ultimately up to you.  As I mentioned in the opening paragraph, I personally have never received the flu shot.  And the reason for this is because I personally don’t think the benefits of getting the flu shot is greater than the potential risks.  I realize that in some cases it can be challenging to know if the benefits outweigh the risks.  For example, the CDC recommends for all pregnant women to get the flu shot, and while my wife didn’t receive the flu shot during either of her two pregnancies, many women choose to follow the advice of their medical doctor and get the flu shot during pregnancy.  I will add that the research shows that the influenza vaccine provides only moderate protection from influenza infection in pregnant women (8), but to be honest, the main purpose of this blog post isn’t to convince you that the flu vaccine is ineffective.

The truth is that if someone has received the flu vaccine and they are exposed to the same strain that’s in the vaccine, there is a good chance that they won’t get the flu.  With that being said, the main reasons why I’m opposed to the flu vaccine is because 1) there are many other strains of influenza, and so it is very possible for someone to get the flu even after getting the vaccine, and 2) some of the ingredients included in the vaccine can be harmful.  Some healthcare practitioners also express concern about these chemicals being more harmful when injected.

This last point shouldn’t be taken lightly, as when talking about certain ingredients in vaccines such as mercury, some will argue that the amounts of these chemicals are so small that they won’t cause any harm.  But besides the fact that small amounts of some of these chemicals can potentially cause harm if ingested, they might even cause more harm when injected.  Finally, as I mentioned earlier, we can’t dismiss the potential synergistic effects of the chemicals included in the vaccine.

In summary, millions of people get the flu shot each year, and while at times the flu vaccine can reduce the risk of someone getting the flu virus, since there are many different strains of the flu overall the vaccine isn’t too effective.  In addition, one can’t dismiss the potentially harmful ingredients that are included in flu vaccines.  With regards to autoimmune conditions such as Graves’ Disease and Hashimoto’s Thyroiditis, while in most cases getting a vaccine won’t trigger an autoimmune response, this doesn’t mean that there aren’t any risks.  Studies do show that vaccines can occasionally lead to the production of autoantibodies.  And the concern isn’t just whether the flu virus can be an autoimmune trigger, as other health conditions are associated with some of the chemicals included in the vaccine.

Nuts and seeds are my favorite snack.  I love eating cashews, almonds, walnuts, pistachios, sunflower seeds, pumpkin seeds, as well as other nuts and seeds.  However, nuts and seeds are excluded from an autoimmune Paleo (AIP) diet.  But why is this the case?  In this blog post I’ll discuss why nuts and seeds are excluded from an AIP diet, and when you can safely reintroduce them back into your diet.

In a blog post I wrote in 2014 entitled “Can Eating Nuts and Seeds Be Detrimental To Thyroid Health?“, I discussed the health benefits of many of the different nuts and seeds.  As a result, I don’t plan on discussing this here, as if you’re interested in learning about the health benefits of the different nuts and seeds you can simply refer to this past article.  In this current article I want to focus more on why nuts and seeds are excluded from an autoimmune Paleo diet, and whether they SHOULD be excluded.

The Problem With Eating TOO MANY Nuts And Seeds

There is no question that nuts and seeds have some good health benefits, which is why they are part of a standard Paleo diet.  However, you do want to be cautious about eating too many nuts and seeds due to the following five reasons:

1. Nuts and seeds are high in omega 6 fatty acids.  Although omega 6 fatty acids get a bad rap, it’s normal to have a higher ratio of omega 6 to omega 3 fatty acids.  The problem is that in most people the ratio is way too high.  In most cases this isn’t due to eating too many nuts and seeds, but instead is due to eating too many processed foods, including fast food, unhealthy oils, etc.  However, eating a lot of nuts and seeds can increase this ratio.  On the other hand, if someone is eating a relatively healthy diet and has an omega 3 index greater than 8%, then eating a few ounces of nuts per day shouldn’t cause a problem in this area.

So based on what I just said, if you haven’t recently tested your omega-3 index then you might want to consider doing so.  Or you might even want to take this a step further and get a complete fatty acid profile.  This not only will look at the omega 3 index, but it will evaluate other markers such as the ratio of arachidonic acid to eicosapentaenoic acid (EPA), the total omega-3 fatty acids, and the total omega-6 fatty acids.

2. Nuts and seeds are higher in lectins when compared to many other foods.  This supposedly is one of the main reasons why nuts and seeds are excluded from an autoimmune Paleo diet.  Lectins are compounds that are present in a variety of plants and seeds, and they serve as a defense mechanism.  They are considered to be a type of anti-nutrient, and besides most lectins being resistant to heat and digestive enzymes, they can bind to different cells and potentially cause damage to numerous organs (1).  There is also a concern about lectins causing an increase in intestinal permeability (a leaky gut).

However, lectins are found in many foods, and so their presence alone doesn’t mean that you should avoid a certain food.  Not all foods have an equal amount of lectins, which is one reason why foods with higher amounts of lectins are excluded from a standard Paleo diet (i.e. legumes), while others such as nuts are allowed.  Finally, there is no evidence I’m aware of which shows that eating nuts and seeds will cause an increase an intestinal permeability.

If this is the case, then why are nuts and seeds excluded from an autoimmune Paleo diet?  To be honest I’m not 100% certain why, but one potential reason why nuts and seeds are allowed on a standard Paleo diet, but are excluded from an autoimmune Paleo diet, is that they can interfere with gut healing.  In other words, while there is no evidence I’m aware of that eating nuts and seeds can cause a leaky gut, eating nuts and seeds might prevent an existing leaky gut from healing.  And according to the triad of autoimmunity, everyone with Graves’ Disease and Hashimoto’s has a leaky gut.

But this might also depend on 1) the quantity of nuts and seeds eaten, and 2) how they are prepared.  If someone with a leaky gut eats a large amount of raw nuts and seeds on a frequent basis then this will make it more difficult for their gut to heal when compared to someone who eats a small amount of nuts and seeds per day and also soaks and sprouts them.  The problem is that many people eat too many nuts and seeds, and most people who eat them don’t properly prepare them.  One can make the same argument with other foods, such as legumes.

3. Nuts and seeds are high in phytic acid.  Phytic acid is the major storage form of phosphorous in cereals, legumes, seeds and nuts (2). One of the main concerns with phytic acid is that it can inhibit the absorption of certain minerals such as iron, zinc, and calcium.  And there is also a concern that large amounts of phytic acid can be a factor in a leaky gut.  However, if someone eats a small amount of nuts and seeds, while minimizing or avoiding other higher sources of phytic acid, such as grains, then they still might be able to heal the gut.  Of course the key word is “might”, as everyone is different, and some people are able to get away with eating small amounts of nuts and seeds, while others will need to completely eliminate them.

It’s also important to note that soaking and sprouting nuts and seeds will dramatically reduce the levels of phytate (3).  So once again, properly preparing nuts and seeds can make them much easier to digest, and reduce both the lectins and phytates, along with other compounds.  One more thing I should mention is that phytic acid does seem to have some health benefits, as some studies show that it can have immunoregulatory effects and decrease proinflammatory cytokines (4).

4. Tree nuts are common allergens.  Although many people are aware that peanuts are a common allergen, many people also have tree nut allergies.  I came across a study which showed that walnuts and cashews are the most allergenic tree nuts in the United States, whereas hazelnut is the most common nut allergy in Europe, and Brazil nuts, almonds and walnuts are the most common tree nut allergies in the United Kingdom (5).  Speaking of peanuts, they are considered to be a legume, which is why they are excluded from both an AIP and standard Paleo diet.  This is also the reason why when a patient of mine asks if they can reintroduce peanut butter back into their diet I try to direct them towards other types of nut butters, such as almond butter.

5. Nuts and seeds are high in oxalates.  Oxalates are small molecules that have the ability to form crystals, which in turn can deposit in different areas of the body, including the thyroid gland. One of the main concerns is that having high levels of oxalates can lead to the development of kidney stones.  While having problems with oxalate metabolism and/or having a yeast overgrowth can lead to high oxalates, certain foods can also cause high oxalate levels.  And unfortunately this includes nuts such as almonds, cashews, and walnuts.  This is yet another reason to be cautious about eating large amounts of nuts on a daily basis.  As for seeds, their oxalate content is high when compared to many other foods, although lower than nuts.  This not only includes common seeds such as sunflower seeds, but chia seeds as well.

I think it’s also worth mentioning that there have been a couple of case reports showing a correlation between oxalate nephropathy and nuts (6) (7). One of these involved cashews, and the other peanuts, which as I mentioned earlier, is actually a legume and not a nut.  An oxalate nephropathy is characterized by extensive calcium oxalate deposition in the renal tubules, resulting in kidney injury (8). Fortunately this condition is rare, and so I’m not suggesting that eating a lot of nuts is likely to result in kidney problems, but if someone does have kidney issues and eats a lot of high oxalate foods then this can be a potential cause to consider.

What’s The Deal With Nut Milks and Nut Butters?

When someone first realizes that nuts and seeds are excluded from an autoimmune Paleo diet, it’s quite common for them to ask me if they can eat nut and seed butters (i.e. almond butter, sunflower seed butter, etc.), as well as nut milks (i.e. almond milk, cashew milk, etc.).  If you are trying to follow a strict autoimmune Paleo diet, then in addition to not eating nuts and seeds, you will also want to avoid all nut milks and nut butters.  After all, nut milks and butters that you purchase at a local store or online will usually consist of raw nuts, and thus will be high in phytic acid and lectins.  On the other hand, if you make your own nut milks and nut butters then of course you have the option of soaking and sprouting the nuts first.  Another advantage of making your own nut milks and nut butters is that you don’t have to worry about some ingredients that are commonly included in these products sold in stores.

Can You Eat Soaked and Sprouted Nuts and Seeds?

For those who aren’t familiar with the process of soaking and sprouting nuts and seeds you can check out this article.  But one question you still might have is whether you can eat soaked and sprouted nuts and seeds when following an autoimmune Paleo diet.  After all, I mentioned earlier how soaking and sprouting nuts and seeds will greatly help to reduce the lectins and phytates.  Although this is true, I still recommend following a strict autoimmune Paleo diet for at least 30 days, which means eliminating the nuts and seeds during this time.  If you are struggling with the diet after this time then I think it’s fine to reintroduce some of the foods you eliminated, include nuts and seeds.

A Brief Explanation of Soaking and Sprouting

Although I realize that some people reading this are already familiar with soaking and sprouting, I’m sure there are others that aren’t familiar with this, and so I’ll give a brief explanation of these below.  I’ll admit that I’m not an expert in this area, and so if you want to learn more about soaking and sprouting there are books and free videos on YouTube where you can learn to do this.  But just as is the case with anything else, the key to becoming an expert is to actually start doing it!

Soaking.  This is quite simple, as you can put your nuts and seeds in a glass jar with water, and add a small amount of sea salt.  When first starting out you might want to begin with a small amount of nuts (i.e. one cup), but once you get into the routine of doing this you’ll probably want to make larger batches at a time.  As for how long you should soak the nuts and seeds, the times vary depending on what you’re soaking. I’d refer to the article I mentioned above, which lists the different soaking times for different nuts and seeds.

Note:  If you want to make the nuts and seeds crunchy after soaking you can put them in a dehydrator for 12 to 24 hours.  If you don’t have a dehydrator you can use your oven, but make sure the temperature doesn’t exceed 115 degrees.

Sprouting. This takes more time, although this essentially just involves soaking the nuts and seeds for longer periods of time, and then rinsing them with water every few hours, or at the very least two or three times per day.  Then within a few days they will germinate and sprout, which further enhances their digestibility and makes them more nutrient dense.  One concern is that mold can form on the nuts and seeds during this process, and to reduce the chances of this happening you want to keep the nuts and seeds refrigerated after sprouting, and dehydrating them will also help to prevent this.  It’s also important to know that not all nuts and seeds can be sprouted.  For example, some of the nuts which can be soaked but not sprouted include walnuts, pecans, Brazil nuts, and macadamian nuts.  Pumpkin seeds and sunflower seeds can be soaked and sprouted.

When Can You Reintroduce Nuts and Seeds?

If you choose to follow a strict autoimmune Paleo diet and therefore eliminate nuts and seeds from your diet, when are you able to reintroduce them?  As I mentioned earlier, for those with Graves’ Disease and Hashimoto’s Thyroiditis, I would recommend to eliminate nuts and seeds from your diet for at least 30 days.  After this point if you are doing well on the diet then it makes sense to continue for a little longer.  On the other hand, if you are struggling with the diet then you can try to reintroduce certain foods.

But you might still wonder when you can specifically reintroduce nuts and seeds back into your diet?  This really does depend on the person.  Sarah Ballantyne is an expert when it comes to the autoimmune Paleo diet, and she has a 4-stage approach to reintroducing foods, which depends on the how most people react to certain foods, and which foods are the most nutrient dense.  In other words, those foods that people are more likely to have a negative reaction to will be reintroduced towards the end, but she also considers the nutrient density of these foods.  Although she does allow seed and nut oils (i.e. macadamia oil) to be reintroduced in stage #1, she doesn’t recommend for whole nuts and seeds to be reintroduced until stage #2.  And certain nuts such as cashews and pistachios shouldn’t be reintroduced until stage #3 according to her reintroduction plan.  I can’t say that I agree 100% with these recommendations, but it’s definitely worth checking out.  Click here to gain access her to free reintroduction quick start guide.

Should You Consider Food Sensitivity Testing For Nuts and Seeds?

Every now and then someone will ask if they should do food sensitivity testing for nuts and seeds instead of eliminating them.  This way they can see if they are reacting to the nuts and seeds, and if this is the case then they can simply eliminate them from their diet.  And if the test shows they aren’t sensitive to them then they can continue eating them.  Although I’m not opposed to food sensitivity testing, there are limitations to this approach.  First of all, food sensitivity testing isn’t perfect, as false negatives are common.  So it’s possible for you to test negative for certain nuts and seeds, yet still be positive.

But let’s assume that you do such testing and everything comes out negative, and it’s a “true” negative.  Just because you don’t have an allergy or sensitivity to nuts and seeds doesn’t mean that they can’t interfere with gut healing.  This is also a limitation of an elimination diet, as someone might feel fine when reintroducing a certain food, but just because they don’t have a negative reaction doesn’t mean that it isn’t interfering with gut healing.

The Final Verdict On Nuts, Seeds, and A Leaky Gut

Many people with Graves’ Disease and Hashimoto’s Thyroiditis are able to successfully reintroduce nuts and seeds back into their diet prior to getting into remission.  However, this doesn’t describe everyone, and when you do choose to reintroduce nuts and seeds I would make sure to do so one at a time.  For example, you can start by reintroducing sunflower seeds, and then wait three days before adding another seed or nut.  If you have any type of negative reaction then stop eating the specific nut or seed, and then wait until your symptoms subside before reintroducing the next one.

Also, while I can’t honestly tell you that I always soak and sprout nuts and seeds before eating them, this can make a big difference in some people.  In fact, when I was dealing with Graves’ Disease initially I didn’t eliminate nuts and seeds from my diet, and while overall I was progressing nicely, I eventually hit a roadblock and ended up eliminating nuts and seeds.  However, I was eating raw nuts and seeds at the time, and so perhaps I wouldn’t have had any problems if I prepared them properly.  Once again, I do recommend for those with autoimmune thyroid conditions to avoid eating nuts and seeds for at least the first month, but when reintroducing them I would strongly suggest soaking and sprouting them.

But how about if you reintroduce raw nuts and seeds and don’t experience any negative symptoms?  Does this mean it’s fine to continue to eat them?  This is where it can get tricky, as I described my situation where I was eating raw nuts and seeds initially when dealing with Graves’ Disease.  I personally didn’t experience any adverse symptoms, but the secretory IgA that was initially depressed remained depressed upon retesting, and didn’t decrease until I stopped eating nuts and seeds.  The point I’m trying to make here is that eating raw nuts and seeds might interfere with gut healing in some people, although you might not experience any negative symptoms when you eat these foods.  Instead you might hit a roadblock like I did.

And if you’re questioning whether my lack of progress was truly caused by eating nuts and seeds, I agree that there is a chance that there could have been another factor which resulted in the secretory IgA not increasing.  However, I’ll add that in the past I did a good amount of leaky gut testing on my patients using the Array #2 from Cyrex Labs, and there were some patients whose gut didn’t heal until they eliminated nuts and seeds.  On the other hand, there were also people whose leaky gut healed even though they continued to eat nuts and seeds.  And while it admittedly can be challenging to make a correlation between someone eating nuts and their gut not healing, it’s still something to keep in mind.

While the focus here is on nuts and seeds, this can also apply to other excluded foods, including eggs, nightshades, and even grains and legumes.  In other words, even if you don’t experience negative symptoms when eating these foods, there is always the possibility that they are interfering with gut healing.  And so if you are following more of a standard Paleo diet and your test results aren’t improving, there is the chance that it’s due to one or more foods that you are eating.  Sure, there can be other factors as well, but before spending a lot of money on additional testing, it makes sense to experiment with eliminating certain foods that can potentially interfere with gut healing.

Should YOU Eat Nuts and Seeds?

If you have Graves’ Disease or Hashimoto’s Thyroiditis, or any other autoimmune condition, then I recommend for you to strictly avoid nuts and seeds for at least 30 days.  If you have a non-autoimmune thyroid condition but have obvious gut issues (i.e. gas, bloating, and/or stomach pain) then I would also eliminate the nuts and seeds for at least 30 days.  But I would also recommend to avoid other foods that can affect gut healing for this 30-day period.

While the autoimmune Paleo diet isn’t meant to be a long term diet, earlier I mentioned that if after 30 days of following this diet you’re thriving then by all means feel free to continue for an extra couple of months.  On the other hand, if you are struggling with the AIP diet, which is common, then feel free to reintroduce some foods.  I usually start my patients with egg yolks (for those who like eating eggs), and I just want to remind you that when you decide to reintroduce nuts and seeds you should reintroduce a different nut or seed at a time, as not all nuts and seeds are created equally, and some people do fine when eating certain nuts and seeds, but they don’t do well when eating other nuts and seeds.

I also mentioned earlier that you should consider eating soaked and sprouted nuts and seeds, at least until your gut has fully healed.  If you don’t want to do this on your own there are some companies that will do this for you, although they are significantly more expensive than buying regular raw nuts and seeds.  But Nate’s Raw Harvest is one company that sells organic nuts and seeds that are soaked and sprouted.  Wilderness Family Naturals also has organic nuts and seeds that are soaked and dried, although they aren’t sprouted.  It’s also worth mentioning that even if you soak the nuts and seeds and don’t sprout them this will still reduce some of the compounds I’ve discussed in this post and will make them easier to digest.

In summary, while nuts and seeds have some good health benefits, they are excluded from an autoimmune Paleo diet mainly because they are common allergens and they have compounds that can potentially interfere with gut healing.  The same is true with nut milks and nut butters.  However, many people with Graves’ Disease and Hashimoto’s are able to successfully reintroduce nuts and seeds before getting into a state of remission, although not everyone.  In addition, soaking and sprouting them will make them much easier to digest, and so this is something to consider doing.

Nightshades are members of a family of plants called Solanacea.  Some of the most common nightshades include tomatoes, eggplant, peppers, white potatoes, and the herb ashwagandha.  These foods are excluded from an autoimmune Paleo diet.  However, while some people with Graves’ Disease and Hashimoto’s Thyroiditis have negative reactions to one or more of the nightshades, many people with these conditions don’t seem to have a problem with them.

If you want to learn more about why nightshades are excluded from an autoimmune Paleo diet you can read my article entitled nightshades and thyroid health.  But the primary goal of this blog post is to find out what your experience has been with nightshades.  While I realize that you can’t always go by symptoms, many people who have problems with the nightshades become symptomatic when consuming them.  Other people are able to get into remission while continuing to eat nightshades, or upon reintroducing them back after initially eliminating them.

If you have problems with some or all of the different nightshades please let me know!  If this is the case, please feel free to be specific and let me know what nightshades you have a negative reaction to.  If you feel fine when consuming nightshades, please feel free to share this as well.  Thank you so much for sharing your experience with everyone.

There are numerous factors that can trigger an autoimmune response, and lead to the development of a condition such as Graves’ Disease and Hashimoto’s Thyroidits.  Infections are one of these factors, and in this blog post I am going to discuss four specific gut infections that can lead to the development of an autoimmune thyroid condition.  While there are other infections that can trigger thyroid autoimmunity, the ones I will be discussing are some of the more common ones.

If you’re wondering how infections can cause an autoimmune thyroid condition, I spoke about this in greater detail in a past article I wrote on viruses and thyroid autoimmunity.  In this article I discussed three different mechanisms in which an infection can ultimately lead to a condition such as Graves’ Disease or Hashimoto’s Thyroiditis.  I realize that most people reading this won’t be interested in learning these mechanisms, but for those who are interested I’d check out this article.

Speaking of viruses, for those wondering why I don’t talk about certain viruses in this blog post such as Epstein Barr, the reason is because I’m focusing specifically on gut infections.  However, I should mention that certain viruses can affect the health of the gastrointestinal tract as well.  In fact, although Epstein Barr isn’t considered to be a “gut infection”, this virus can affect the gastrointestinal tract.  In addition, cytomegalovirus and herpes simplex virus can potentially cause ulcerative disease of the gastrointestinal tract (1).

With that being said, let’s go ahead and discuss these four gut infections:

1. Yersinia enterocolitica.  Yersinia enterocolitica is a gram negative bacteria that is a common cause of human gastroenteritis (2).  Some of the common symptoms include diarrhea, abdominal pain, fever, and sometimes vomiting (3).  Complications are rare and can include a skin rash, joint pain, or the spreading of bacteria to the bloodstream (4). As for how this bacteria is transmitted, the most common method is by eating contaminated food, such as raw or undercooked pork, although sometimes drinking contaminated milk or water can be a cause.  A few studies show a correlation between this pathogenic bacteria and thyroid autoimmunity (5) (6) (7).

How Is Yersinia Enterocolitica Detected?

An infection of this pathogen is usually diagnosed through the stool, although the antibodies can be tested through the blood.

Treatment For Yersinia Enterocolitica

The conventional medical approach usually involves prescription antibiotics.  These are usually effective, although the obvious downside is that these antibiotics also eradicate beneficial bacteria as well.  Natural agents which can be effective against Yersinia include oregano oil, berberine, and garlic.

2. Helicobacter Pylori.  Helicobacter pylori is a gram-negative bacteria that infects the stomachs of humans, and it is associated with peptic ulcer disease, gastric carcinoma, and gastric lymphoma (8).  Keep in mind that while some people will experience symptoms such as heartburn, indigestion, and nausea, the absence of symptoms doesn’t rule out H. Pylori.  As for how it is transmitted, the most common method is the oral-oral route (i.e. kissing), and the fecal-oral route (i.e. contaminated water) (9).  A few studies show a correlation between H. Pylori and thyroid autoimmunity (10) (11).

How Is An H. Pylori Infection Diagnosed?

H. Pylori can be tested for through the blood, saliva, stool, and through a urea breath test. Blood and saliva testing measure the H. Pylori antibodies, while stool testing and the urea breath test can detect the actual presence of this bacteria. If someone has recently tested positive for H. Pylori then the antibodies can remain detectable for months after eradication, and as a result they should test for H. Pylori through the stool or the breath test.

Treatment for H. Pylori

Conventional treatment usually involves triple therapy consisting of two antibiotics and a proton-pump inhibitor (12).  Sometimes quadruple therapy is used, as this also involves bismuth, a heavy metal that has antimicrobial activity against H. Pylori (12).  With regards to natural treatment methods, a few studies show that mastic gum can eradicate H. Pylori (13) (14), and this is something I have used in my practice.  Other natural agents I have used include berberine, black cumin seed, garlic, and matula tea.  H. Pylori can form biofilms, and N-acetylcysteine (NAC) can be an effective biofilm disruptor in those with an H. Pylori infection (15) (16).

3. Blastocystis hominis.  Blastocystis hominis is an enteric parasite, and some of the symptoms commonly associated with Blastocystis hominis include abdominal pain, pruritus, flatulence, malaise, anorexia and diarrhea (17).  How Blastocystis is transmitted is not known for certain, although a fecal-oral route through contaminated food or water is the most likely cause (18).

In the past there has been some controversy over whether this is a harmful parasite, or if it is commensal.  But more recently it has been recognized that this is indeed a pathogenic parasite, and in addition to increasing proinflammatory cytokines, Blastocystis hominis can also cause a leaky gut, which is a factor in autoimmune conditions such as Graves’ Disease and Hashimoto’s Thyroiditis.  With regards to thyroid autoimmunity, there is one case report that shows that someone with Hashimoto’s went into remission upon eradicating Blastocystis hominis (19).  Of course this is only a single case report, but over the years I have worked with a few autoimmune thyroid patients who tested positive for this parasite and went into remission upon eradicating it.

How Is A Blastocystis Hominis Infection Diagnosed?

Blastocystis Hominis is typically tested for through the stool.

Treatment for Blastocystis Hominis

From a conventional treatment standpoint, Metronidazole is usually the first drug given, although other prescription drugs that may be given include trimethoprim-sulfamethoxazole, paromomycin, and furazolidone (20).  Some of the natural agents which can be effective in treating Blastocystis hominis include oregano oil, wormwood, clove, garlic, black walnut, and saccharomyces boulardii.  With regards to S. boulardii, one study involving symptomatic children with Blastocystis hominis showed that this was more effective than Metronidazole (21).

4. Candida.  Although Candida is listed here, it’s important to understand that Candida albicans are normal inhabitants of the skin, mucous membranes, gastrointestinal tract, and genitourinary tract.  But if something disrupts the gut flora then this can lead to a Candida overgrowth.  Many people are aware that taking antibiotics can increase the risk of developing a Candida overgrowth, but there can be other factors as well, including chronic stress, glucocorticoids, and even cigarette smoking.

In fact, anything that either suppresses the immune system or disrupts the good bacteria of the gut can lead to a Candida overgrowth.  Some of the symptoms associated with a Candida overgrowth include fatigue, brain fog, gastrointestinal symptoms, allergies, and joint pain.  Those with a moderate to severe Candida overgrowth will also commonly have a thick white coating on their tongue.  On the other hand, a thin white coating on the tongue is not an indication of a yeast infection.

There is controversy over whether Candida is a direct trigger of thyroid autoimmunity.  There is evidence in the research of Candida causing an increase in autoantibodies, although not specific to Graves’ Disease or Hashimoto’s Thyroiditis.  A Candida overgrowth can also cause an increase in proinflammatory cytokines, which is associated with autoimmunity.  However, an overgrowth of Candida can lead to an increase in intestinal permeability, which can make someone more susceptible to developing Graves’ Disease or Hashimoto’s Thyroiditis.

How Is A Candida Overgrowth Diagnosed?

I have found that the best way to test for a Candida overgrowth is through organic acids testing, which is a urine test that measures different metabolites related to yeast, with arabinose more specific to Candida albicans.  Blood and stool testing are also options, although false negatives are common with these methods.

Treatment for a Candida Overgrowth

Conventional treatment methods consist of prescription antifungals such as Nystatin or Diflucan.  Natural treatment usually involves a strict “Candida diet”.  Like most diets, this involves eating whole foods while avoiding the processed foods, although it also eliminates most sources of sugar, and in some cases all sources, including fruits.  It also is advised to minimize or eliminate starchy vegetables such as white potatoes, sweet potatoes, and winter squash.  Natural antifungals can also be beneficial, including oregano oil, caprylic acid, olive leaf, garlic, and uva ursi.

Conventional vs. Natural Treatments: Which Should You Choose?

If you test positive for one or more of these pathogens, you might have a difficult time deciding if you should take the conventional medical treatment approach, which usually involves taking prescription drugs, or if you should take a natural treatment approach.  Not surprisingly, in most cases I prefer a natural approach, although one has to consider the benefits and advantages of both.

For example, the advantage of taking prescription antibiotics or antifungals is that they usually work much faster than natural agents.  Another advantage is that in many cases it is less expensive to take a prescription drug when compared to purchasing nutritional supplements and herbs.  This is especially true for those who have health insurance coverage.

Of course one of the big downsides of prescription drugs is the potential side effects.  This is especially true with antibiotics, as while there is no question that they are sometimes necessary, they are overused.  This is why more and more bacteria are becoming resistant to antibiotics, and it also explains why multiple antibiotics are sometimes needed, which as mentioned earlier is the case with H. Pylori.

The reason why I prefer natural antimicrobials is because they are almost always less harsh on the body when compared to prescription drugs.  However, the fact that natural agents usually take longer to eradicate infections can’t be overlooked.

Although I prefer a natural treatment approach, my patients are the ones who ultimately make the decision.  For example, while I have recommended a natural treatment approach to many patients with different types of infections, recently I had a patient get diagnosed with H. Pylori, and not surprisingly her medical doctor recommended for her to take prescription antibiotics.  I explained the pros and cons, and since she wanted to eradicate H. Pylori quickly she chose to take the antibiotics, even though she realized that this would be harsher on her gut flora.  Keep in mind that some natural agents can also have a negative effect on the good bacteria, although they usually aren’t as harmful as prescription drugs.

In summary, infections can be an autoimmune trigger, and in this blog post I discussed four common gut infections in those with Hashimoto’s Thyroiditis.  These include Yersinia enterocolitica, H. Pylori, Blastocystis hominis, and a Candida overgrowth.  The last one isn’t considered an infectious process, but since it’s so common in people with Graves’ Disease and Hashimoto’s I decided to include it here.  When choosing between a conventional and natural treatment approach you need to consider the pros and cons of each, which I discussed in this blog post.

An ultrasound uses sound waves to develop images, and it is the most sensitive imaging modality available for examining the thyroid gland.  A thyroid ultrasound also has the benefit of being non-invasive, it doesn’t use ionizing radiation, and it is less expensive than other imaging techniques such as an MRI and CT scan.  But does this mean that everyone with a suspected or confirmed thyroid or autoimmune thyroid condition should consider getting a thyroid ultrasound?  I’ll of course answer this and other questions you may have in this blog post.

When I was diagnosed with Graves’ Disease, the endocrinologist I saw didn’t want to do a thyroid ultrasound.  After palpating my thyroid gland she didn’t detect any thyroid nodules, and while I appreciated her trying not to recommend any unnecessary tests, I talked her into doing a thyroid ultrasound.  Other than some thyroid swelling it came back clean, as I had no thyroid nodules.

Since I requested a thyroid ultrasound even though my endocrinologist didn’t think it was necessary, does this mean that I recommend for everyone with a thyroid or autoimmune thyroid condition to get an ultrasound?  I can’t say that I recommend for all of my patients to order a thyroid ultrasound.

The reason I chose to get a thyroid ultrasound is because I don’t think that palpating the thyroid gland is always sufficient to detect thyroid nodules.  But even if I had one or more thyroid nodules show up on an ultrasound, would I have done anything differently while taking a natural treatment approach?  The honest answer is probably not.  And even if I had one or more thyroid nodules, I probably would not have had them biopsied, although this would depend on the characteristics, which I’ll talk about shortly.

When Is A Thyroid Ultrasound Indicated?                         

According to the American Association of Clinical Endocrinologists (AACE), a thyroid ultrasound is indicated in the following situations (1):

1. To confirm the presence of a thyroid nodule when the physical examination is equivocal.  So if the physical exam is inconclusive for thyroid nodules then a thyroid ultrasound would be indicated.

2. To characterize a thyroid nodule.  In other words, to measure the dimensions accurately and to identify internal structure and vascularization.

3. To determine whether a thyroid nodule is benign or malignant.  Although an ultrasound can’t always differentiate between a malignant and thyroid nodule, sometimes this can be determined based on the appearance of the nodule.

4. To differentiate between thyroid nodules and other cervical masses.  While thyroid nodules are the main focus of a thyroid ultrasound, other masses that can show up include enlarged lymph nodes, a thyroglossal cyst, or a cystic hygroma.

5. To evaluate diffuse changes in the thyroid parenchyma.  What is the thyroid parenchyma?  The thyroid parenchyma is simply the tissues that comprise the thyroid gland.

6. To detect post-operative residual or recurrent thyroid tumor or metastases to the neck lymph nodes.  For example, if someone has thyroid surgery to remove a malignant nodule, then a follow-up thyroid ultrasound would understandably be indicated.

7. To screen high risk patients for a thyroid malignancy.  This includes people with a family history of thyroid cancer, or perhaps if someone had radiation exposure to their neck in childhood.

8. To guide diagnostic and therapeutic interventional procedures.  For example, if someone needs to get a biopsy of a thyroid nodule then an ultrasound may be used to help guide the placement of the needle within a nodule.

Getting Back To My Situation…

If you read the eight indications above then you’ll notice that the first one mentions that a thyroid ultrasound is indicated “to confirm the presence of a thyroid nodule when the physical examination is equivocal”.  When I received my thyroid examination the endocrinologist seemed pretty confident that I didn’t have any thyroid nodules, yet I overruled her and asked for a thyroid ultrasound anyway.  And even though I paid out of pocket for the ultrasound, I didn’t have any regrets, as I didn’t want to rely on the palpation skills of the endocrinologist, and I had peace of mind knowing that I didn’t have thyroid nodules.

But what approach would I have taken if the ultrasound revealed thyroid nodules?  Earlier I mentioned that if the thyroid ultrasound I received revealed one or more thyroid nodules I probably wouldn’t have done anything different with regards to the natural treatment protocol I followed.  I also mentioned how I probably wouldn’t have had a biopsy done.  However, one benefit is that I could have done a follow-up ultrasound in the future to monitor the thyroid nodules and make sure that they weren’t getting larger.

Ultimately the decision to request a thyroid ultrasound is up to you.  If the endocrinologist you are working with recommends an ultrasound due to one of the indications I listed above, then it probably is a good idea to get one.  On the other hand, if after palpating your thyroid gland they are confident that you don’t need a thyroid ultrasound, then it’s fine not to get one.  If you’re skeptical like I was and want to get one anyway then of course there is nothing wrong with politely asking the doctor.

You might think that the endocrinologist I was working with was willing to order the thyroid ultrasound because I’m a chiropractor, but I actually didn’t tell her my profession, and I didn’t put it down on the health history form.  The reason I didn’t let her know my profession is because I wanted to see how she treated someone who wasn’t a healthcare professional.  And I must admit that she was very pleasant to work with, although I only saw her for that single visit.  Probably the main reason she was willing to order a thyroid ultrasound is because not only did I ask her politely for it, as I told her that it would give me peace of mind, but she also knew that I was paying out of pocket for it.  As a result, from a health insurance perspective there was no concern as to whether the ultrasound was medically necessary.

Hashimoto’s, Graves’ Disease, and Thyroid Ultrasounds

What I’d like to do next is specifically talk about both Hashimoto’s Thyroiditis and Graves’ Disease, and when a thyroid ultrasound should be considered.  But wait, shouldn’t the indications I listed above apply to these two autoimmune thyroid conditions?  Well yes, these indications do apply, but there are other circumstances when getting a thyroid ultrasound might be a good idea, especially with Hashimoto’s Thyroiditis.

Hashimoto’s Thyroiditis.  Although the diagnosis of Hashimoto’s is usually confirmed by an elevated TSH combined with the presence of thyroid peroxidase and/or thyroglobulin antibodies, these antibodies are not always positive in those with Hashimoto’s.  When this is the case, getting a thyroid ultrasound can be beneficial, as many times this can confirm the presence of Hashimoto’s Thyroiditis.

Graves’ Disease.  Just as is the case with Hashimoto’s, most cases of Graves’ Disease are characterized by elevated thyroid antibodies…specifically TSH receptor antibodies, with the most common type being thyroid stimulating immunoglobulins.  While I can’t say that everyone with Graves’ Disease needs to get a thyroid ultrasound, I did want to mention that many doctors recommend for people with hyperthyroidism to get a radioactive iodine uptake test.  This involves taking a small dose of radioactive iodine, and the justification for this test is that a high uptake reading can confirm Graves’ Disease, and this test can also reveal if someone has thyroid nodules, and give an idea as to whether they are benign or malignant.

The reason why I’m not a big fan of this test is because 1) Graves’ Disease can usually be diagnosed by the presence of elevated thyroid stimulating immunoglobulins, and 2) a thyroid ultrasound can detect the presence of thyroid nodules, and can also give a good idea as to whether the nodules are benign or malignant.  And of course the thyroid ultrasound is less invasive than the radioactive iodine uptake test, which is why I’m more in favor of getting an ultrasound.

Understanding Ultrasound Terminology

Remember that ultrasound involves waves, which are formed in the head of the instrument the doctor or radiologist applies to the body, which is also known as a transducer.  Echogenicity of the tissue refers to the ability to reflect or transmit ultrasound waves in the context of surrounding tissues (2).  Based on echogenicity, a structure can be characterized as hyperechoic (white on the screen), hypoechoic (gray on the screen) and anechoic (black on the screen) (2).  Cartilage appears hypoechoic, including thyroid cartilage, and on an ultrasound Hashimoto’s Thyroiditis usually presents as diffuse enlargement of the thyroid gland, along with heterogeneous and hypoechoic parenchymal echo pattern.  Graves’ Disease actually presents with a similar pattern.  Thyroid blood vessels appear black or anechoic.

The thyroid gland is highly vascular, and certain types of ultrasound devices (i.e. Doppler ultrasound) can measure the vascularization of the thyroid gland, and so you might also see this on an ultrasound report.  Hypervascularization means that there is an increased blood flow to the area, while hypovascularization refers to a decreased blood flow.  Graves’ Disease is usually characterized by very high vascularity on an ultrasound.  While you might expect Hashimoto’s and hypothyroidism to be of low vascularity, most cases of hypothyroidism are also characterized by high vascularity.  If the ultrasound shows a small atrophied gland then this usually indicates that the person has had extensive damage to the thyroid gland, and this is sometimes referred to as “end stage” Hashimoto’s Thyroiditis.

What’s The Thyroid Ultrasound Pattern for Multinodular Goiter?

Although most of my patients have either Graves’ Disease or Hashimoto’s Thyroiditis, multinodular goiter is the most common cause of diffuse asymmetric enlargement of the thyroid gland (1).  Not surprisingly, in people with multinodular goiter a thyroid ultrasound will reveal a diffusely enlarged thyroid gland, along with multiple nodules.  I spoke about the vascularity of Graves’ Disease and Hashimoto’s, and the vascularity can help to differentiate multinodular goiter from a carcinoma, as someone who has thyroid nodules with an increased blood flow has a higher risk of malignancy (3).

More About Thyroid Nodules…

Although I have written separate articles on thyroid nodules and I don’t want to focus too much on this here, I do want to add that it is very common to have thyroid nodules.  So while I requested a thyroid ultrasound from my endocrinologist because I was concerned about having thyroid nodules, what I didn’t realize at the time was that more than 50% of people will have thyroid nodules on an ultrasound (4).  The good news is that most of these thyroid nodules are benign.  And so please don’t get stressed out if you have one or more thyroid nodules show up on an ultrasound.

While a thyroid biopsy is used to confirm whether a suspicious thyroid nodule is benign or malignant, one of the indications I listed earlier mentioned how a thyroid ultrasound can give an idea as to whether a thyroid nodule is benign or malignant.  And the way it does this is by looking at the following characteristics:

• The size of the nodule
• The presence of microcalcifications
• Irregular margins
• Solid composition
• Marked hypoechogenicity

So while a biopsy might be indicated to confirm whether a “suspicious” thyroid nodule is benign or malignant, most people who have one or more thyroid nodules don’t need to get a biopsy.  Plus, keep in mind that biopsies aren’t perfect, as they don’t always confirm or rule out a malignancy.  One more thing I want to add is that the presence of multiple nodules doesn’t increase the likelihood of a malignancy.  In other words, if someone has five thyroid nodules, each nodule will have an equal risk of being benign or malignant when compared to someone who has one or two nodules.

In summary, an ultrasound is the most sensitive imaging modality used to examine the thyroid gland.  Some of the indications for a thyroid ultrasound include to confirm the presence of a thyroid nodule when the physical exam is inconclusive, to characterize a thyroid nodule, and to differentiate between thyroid nodules and other cervical masses.  Many people with Graves’ Disease are told to get a radioactive iodine uptake scan when many times a thyroid ultrasound (along with testing the thyroid stimulating immunoglobulins) would be sufficient.  And sometimes an ultrasound can be used to diagnose Hashimoto’s Thyroiditis when the person has negative thyroid antibodies.