I’ve never been a big coffee drinker, but since many people with thyroid and autoimmune thyroid conditions consume caffeine in the form of coffee, tea, and other caffeinated beverages, I figured it would be a good idea to write an updated post on this topic.  Plus, since my wife drinks coffee on a daily basis I’m sure she’ll appreciate this blog post as well!  I usually recommend for my patients to initially avoid caffeine (especially coffee) while trying to restore their health, and not surprisingly, many people find this to be very challenging.  While there are certain risks of consuming caffeine, numerous studies show that caffeine does have some health benefits.

Caffeine is the most widely consumed psychostimulant substance (1).  As I mentioned in the opening paragraph, I have never been a coffee drinker, although my wife loves coffee, our dog Lexi loves coffee (just kidding), and many of my patients also enjoy drinking coffee on a daily basis.  I do consume caffeine in other ways, such as by drinking green tea and eating some dark chocolate.  Perhaps the main reason why I have most of my patients avoid caffeine initially is because it causes an elevation of ACTH and cortisol, along with the catecholamines.  And since most of my patients have adrenal problems I think it’s a good idea for many of them to refrain from consuming caffeine while trying to improve their health.

Here are some of the common beverages and foods with the approximate caffeine content (2) (3) (4):

Coffee (brewed): one 8-ounce cup has approximately 107 to 150 mg of caffeine

Black tea: one 8-ounce cup has approximately 28 to 46mg of caffeine

Green tea: one 8-ounce cup has approximately 25mg of caffeine

Starbucks Grande Cafe Mocha: one 16-ounce cup has approximately 175mg of caffeine

Coca-Cola Classic: one 12-ounce bottle has approximately 34 mg

Pepsi Cola: one 12-ounce bottle has approximately 40mg of caffeine

Dark Chocolate: one ounce has approximately 12mg of caffeine.

What Does The Research Show?

What I’d like to do now is discuss some of the research studies associated with the consumption of caffeine.

Caffeine and cardiovascular health.  One study involving 52 healthy adults aged 18-29 years of age examined the stress reactivity following caffeine consumption (5).  The study showed that both men and women had an increase in systolic blood pressure and cortisol levels after consuming caffeine, although the CRP levels weren’t affected.  Just as a reminder, CRP is a marker of inflammation.  Another study examined whether a single ingestion of caffeine improves microvascular function in healthy subjects (6).  The results showed that caffeine contained in a cup of coffee enhances microvascular function in healthy individuals.  A couple of meta-analyses showed an inverse relationship between coffee consumption and cardiovascular disease (7) (8).  One of these studies showed that the lowest cardiovascular risk occurred with the consumption of 3 to 5 cups of coffee per day, and concluded that heavy coffee consumption was not associated with an elevated risk of cardiovascular disease (8).

Caffeine and Glucose Metabolism.  How does caffeine affect glucose metabolism?  Well, one study evaluated the effect of consuming 200mg of caffeine taken twice per day for seven days on glucose metabolism, as well as on serum cortisol, DHEA, androstenedione, and nighttime salivary melatonin (9).  The study involved 16 healthy adults aged 18 to 22 with a history of caffeine consumption.  The results of the study showed that the insulin levels were significantly higher, while insulin sensitivity was reduced.  There were no differences in glucose, DHEA, androstenedione, and melatonin.  Based on this study you would think that people with insulin resistance or type 2 diabetes should avoid drinking coffee, but a few studies have shown that coffee has a protective effect on the risk of type 2 diabetes, probably by affecting postprandial glucose homeostasis (10) (11).

Caffeine and Cortisol.  One study measured the cortisol levels at eight times on days when healthy men and women consumed 250mg of caffeine 3x/day and underwent either mental stress or dynamic exercise protocols, followed by a midday meal (12).  The study showed that caffeine in combination with the mental stress further increased cortisol levels, whereas exercise alone didn’t increase cortisol, but caffeine taken before exercise elevated cortisol in both men and women.  Another study looked to show whether tolerance develops with the daily intake of caffeine (13).  It involved 48 men and 48 women, and after five days of avoiding caffeine, challenges with caffeine caused a robust increase in cortisol across the test day.  However, 5 days of consuming caffeine (300mg and 600 mg/day) abolished the morning cortisol response, although the cortisol levels were elevated later in the day.  So the study showed that cortisol responses to caffeine are reduced, although not entirely eliminated, in healthy young men and women who consume caffeine on a daily basis.

Caffeine and the immune system.  A number of in vitro and in vivo studies have demonstrated that caffeine modulates both the innate and adaptive immune responses (14).  Caffeine has been reported to decrease the production of both Th1 and Th2 cytokines (15).  Since these cytokines play a role in autoimmune conditions such as Graves’ Disease and Hashimoto’s Thyroiditis, it is possible that caffeine consumption can benefit many people with these conditions by decreasing pro-inflammatory cytokines.  Another study showed that chronic caffeine treatment attenuates experimental autoimmune encephalomyelitis (15).  It might accomplish this by causing a shift in the Th1/Th2 pathways.

Caffeine and Sleep.  One study evaluated the effects of 200mg and 400mg of caffeine on sleep in young and middle-aged adults (16).  The results of the study showed that compared to young adults, middle-aged adults are generally more sensitive to the effects of a high dose of caffeine on sleep quantity and quality (16).  However, another study found that low to moderate amounts of caffeine consumed in the home environment, mostly during morning hours, had little effect on sleep (17).  The ages of the participants ranged from 20 to 50 years.

Caffeine and Cancer.  One study looked at the incidence of breast cancer in relation to caffeine consumption in Sweden (18).  The findings suggested that coffee consumption and caffeine intake is negatively associated with the risk of breast cancer, whereas tea consumption is positively associated with the risk of breast cancer (18).   Another study evaluated the association of caffeine and coffee consumption with regards to melanoma risk (19).  After adjustment for other risk factors, higher total caffeine intake was associated with a lower risk of melanoma (19).

Caffeine and Alzheimer’s Disease.  Numerous studies show that caffeine can have a protective effect against dementia and Alzheimer’s disease (20) (21) (22).  These studies were based specifically on the consumption of coffee, and one of the studies mentioned that 500mg of caffeine daily (equal to 4 or 5 cups of coffee per day) can protect against or treat Alzheimer’s disease (22).  Another one of these studies mentioned that the protective effects against cognitive decline/dementia are less evident in tea drinkers (21).

Caffeine and Thyroid Health.  There aren’t many studies which show a direct correlation between caffeine and thyroid health.  I did come across a study which showed that coffee consumption may play a protective role against the development of benign or malignant thyroid neoplasms, possibly by the stimulatory effect of caffeine on the intracellular cyclic AMP production (23).  However, there is some evidence that coffee can interfere with the intestinal absorption of thyroid hormone medication (24).  This was based on a small study consisting of eight women, but it probably would be wise not to take thyroid hormone medication with coffee.

Genetic Polymorphisms and Caffeine Metabolism

Caffeine is metabolized by the cytochrome P450 1A2 (CYP1A2) enzyme.  Many people have  a genetic polymorphism for this enzyme, and those with certain genetic polymorphisms of the CYP1A2 enzyme are “rapid” caffeine metabolizers, whereas those with other genetic polymorphisms of the CYP1A2 enzyme are “slow” caffeine metabolizers (25).  So what does this mean?  Well those people who are “rapid” caffeine metabolizers break down and excrete caffeine quickly, whereas those who are “slow” caffeine metabolizers break down and excrete caffeine slowly.  Studies show that those who are slow metabolizers of caffeine have an increased risk of myocardial infarction (26) and impaired fasting glucose (27).  So being a slow metabolizer of caffeine is associated with certain health risks, and while many people can tell this by the way they feel after consuming caffeine, some labs offer genetic testing available to confirm this.

How is this interpreted on an genetic lab report?  Well, if you’re reading the interpretation from a 23andme test you should see CYP1A2 with an rsID listed as rs762551.  You’ll also see a column that says “alleles”, which is what you want to pay attention to.  If someone has the AA allele then they are considered to be a fast metabolizer (28).  If someone has the AC or CC allele then they are considered to be a slow metabolizer (28).

Who Should Avoid Caffeine?                      

As I mentioned earlier, initially I recommend for just about all of my patients to avoid caffeine, especially in the form of coffee.  Obviously not everyone takes my advice, although many people do.  However, not everyone needs to avoid caffeine on a long-term basis.  Those people who have adrenal problems will probably want to stay away from caffeine, at least until the health of their adrenals have been restored.  And if someone is a slow metabolizer of caffeine then it also is a good idea to avoid consuming large amounts of caffeine.

When Can Caffeine Be Reintroduced?

Many people who eliminate caffeine from their diet eventually would like to reintroduce it.  But when is the ideal time for someone to do this?  Well, it does depend on the person.  As I mentioned before, if someone has adrenal problems then it would be ideal for them to wait until the health of their adrenals have been restored before reintroducing caffeine.  This is especially true with coffee since it is high in caffeine, but it probably is a good idea to limit one’s consumption of caffeine altogether until their adrenal health has significantly improved.  If someone is a slow metabolizer of caffeine then it really is a good idea to minimize their consumption of caffeine on a permanent basis.  This doesn’t mean that slow metabolizers can never drink coffee again, but it probably would be wise to limit your consumption if this is the case.

In summary, many people consume caffeine on a regular basis, and this of course includes people with thyroid and autoimmune thyroid conditions.  Caffeine can have a negative effect on adrenal health, and thus probably should be avoided with those who have adrenal problems.  On the other hand, caffeine modulates the immune system and might actually benefit some people with Graves’ Disease and Hashimoto’s Thyroiditis by decreasing pro-inflammatory cytokines.  Coffee consumption might also decrease the risk of developing certain types of cancers.  Since coffee can interfere with the intestinal absorption of thyroid hormone, if you are taking thyroid hormone medication it would be best not to consume coffee when taking this.  Some people have a genetic polymorphism involving the CYP1A2 enzyme, and as a result can either be a “fast” metabolizer of caffeine, or a “slow” metabolizer of it.  Those who are a “fast” metabolizer will be able to tolerate larger amounts of caffeine, whereas those who are “slow” metabolizers will have problems breaking down and excreting caffeine, and thus should minimize their consumption of it.

Royal jelly is a substance produced by bees, and studies show that it has numerous health benefits.  With regards to thyroid health, there is evidence that royal jelly can benefit people with Graves’ Disease.  But unlike other supplements commonly taken by people with Graves’ Disease such as bugleweed, motherwort, and lemon balm, royal jelly seems to affect the autoimmune component of the condition.  In addition, royal jelly can also benefit many people with other types of health conditions as well, which I’ll discuss in this post.

Royal jelly is mainly secreted by the hypopharyngeal and mandibular glands of worker honeybees between the sixth and twelfth days of their life and is an essential food for the development of the queen honeybee (1) (2).  Royal jelly is a complex substance containing a unique combination of proteins (12-15%), sugars (10-12%), lipids (3-7%), amino acids, vitamins, and minerals (2).  What I’d like to do below is discuss some of the benefits of royal jelly.

Graves’ Disease and other autoimmune conditions.  A small study looked at the effects of royal jelly on the autoimmune component of Graves’ Disease (3).  Graves’ Disease is considered to be a Th2 dominant condition in most cases, and this study showed that royal jelly shifted the Th1/Th2 cytokine ratio to the side of the Th1 pathways, and caused a significant decrease in the TSH receptor antibodies associated with Graves’ Disease.  The authors concluded that royal jelly may be effective as an immunomodulatory agent in Graves’ Disease.

In addition to Graves’ Disease, people with other autoimmune conditions might also benefit from taking royal jelly.  One study in mice showed that royal jelly may be beneficial in the prevention of the early onset of systemic lupus erythematosus (SLE), along with the control of the active progression of this condition (4).  Like Graves’ Disease, SLE is usually considered to be a Th2 dominant condition (5).  Pro-inflammatory cytokines are present in autoimmune conditions, and another study showed that royal jelly inhibits the production of proinflammatory cytokines (6).  In other words, royal jelly can help to reduce inflammation.

Dry eyes.  A study looked at the effects of honey bee products on tear secretion capacity in dry eyes (7).  The study showed that royal jelly restored the tear secretion capacity to the largest extent when compared to raw honey and propolis.

Premenstrual Syndrome.  One study consisting of 110 medical sciences students with PMS looked at the effects of royal jelly (8).  Each participant took one 1,000 mg royal jelly capsule per day for two months.  The results of the study showed that taking the royal jelly supplement for two months was effective in reducing PMS.

Glycemic control.  A study involving 50 female volunteers with type 2 diabetes looked at the effects of royal jelly on glycemic control and oxidative stress (9).  The participants took a 1,000 mg royal jelly supplement for 8 weeks.  The results showed that the mean fasting blood glucose decreased remarkably, and supplementing with royal jelly also resulted in significant reduction in the average hemoglobin A1C levels and increased the mean total antioxidant capacity.  The authors concluded that royal jelly supplementation may be beneficial in controlling diabetes outcomes.

Periodontal disease.  Since royal jelly has been shown to prevent osteoporosis in rats and also has anti-inflammatory effects, some authors hypothesized that royal jelly can help with the prevention or treatment of periodontal diseases (10).  They conducted a study in mice and concluded that royal jelly can provide benefits for the treatment and prevention of periodontal diseases.

Male Infertility.  A few studies have shown that royal jelly might be beneficial in some cases of male infertility.  One study evaluated the protective effect of royal jelly on sperm parameters and testosterone levels in mice, and concluded that royal jelly may help to improve oxidative stress and male infertility (11).  Another study showed that royal jelly may be useful for diabetic patients who suffer from sexual impotence by producing anti-diabetic activity and exhibiting fertility enhancing properties (12).

Royal Jelly vs. Bee propolis

Propolis is a resinous substance produced by honeybees as defense against intruders (13).  I’m sure some people reading this are wondering if bee propolis offers similar benefits.  Propolis doesn’t offer the same exact benefits as royal jelly, although there is evidence that it has antimicrobial, antioxidant, anti-inflammatory, antidiabetic, dermatoprotective, anti-allergic, laxative, and immunomodulatory properties (14).  There is also evidence that propolis has anticancer activity (15) (16).  Propolis can also provide protection against the damaging effects of radiation (17) (18).

In summary, royal jelly is a substance produced by bees that has many different health benefits.  There is evidence that royal jelly may help to modulate the immune system in people with Graves’ Disease, along with other autoimmune conditions.  Royal jelly might also be beneficial in people with dry eyes, blood sugar imbalances, premenstrual syndrome, periodontal disease, and male infertility.  Bee propolis is also produced by honeybees, and like royal jelly it also has numerous health benefits.

For many people with thyroid and autoimmune thyroid conditions, it’s a challenge to choose good quality nutritional supplements and herbs. Some people choose a supplement or herb based on price alone, and while the most expensive supplements aren’t always of the highest quality, the cheapest supplements are frequently of the lowest quality. The problem is that most people don’t know what to look for, and so the goal of this post is to give some tips to help make choosing a good quality supplement a little bit easier.

So what I’m going to do is to list some of the things you can do to improve your chances of choosing good quality nutritional supplements and herbs:

1. Choose a company that uses high quality ingredients. Obviously this can be challenging for someone who doesn’t know what high quality ingredients to look for. And so I’ll give a few examples. Magnesium oxide is poorly absorbed, yet because it is cheap it is commonly used by many supplement manufacturers. The same concept applies to cyanocobalamin, which is a lower quality form of vitamin B12. Keep in mind that this doesn’t mean that these nutrients won’t get absorbed at all, but better quality forms of magnesium include magnesium orotate, magnesium malate, and magnesium citrate. Methylcobalamin and hydroxocobalamin are higher quality forms of vitamin B12. Synthetic folic acid is also of low quality, as you ideally want the supplement to include natural folate. These are just a few examples, but if you look at the multivitamin from your favorite supplement company and it includes magnesium oxide, cyanocobalamin, and/or folic acid, then this is usually a good indication that this company doesn’t use high quality ingredients.

Although many people purchase supplements from well known retail stores, this doesn’t guarantee that these supplements will be of high quality. In fact, an article in the New York Times showed that laboratory tests run on some herbal supplements at Walmart, Walgreens, Target, and GNC showed that four out of the five products tested contained none of the herbs listed on their labels! This is why you need to be very careful when choosing a supplement or herb, as if you don’t receive good results when taking a certain supplement then you might attribute this to the nutrients and/or herbs which are included in the supplement as not being effective, when the problem might have been that the product you took didn’t have the actual nutrients and/or herbs that were listed on the label.

2. Choose supplements and herbs that work. This might seem like common sense, but many people just randomly purchase supplements without doing any research. The obvious question you might have is “what type of research is necessary to find out whether or not the supplements I purchase are effective?” Well, there are a few things you can do. As I’ll discuss later in this post, choosing a company that has their supplements tested by a third party can help to confirm that all of the ingredients listed on the label of their supplements are actually included. Besides doing this, before taking any supplement or herb you can take a few minutes to perform an internet search using your favorite search engine (i.e. Google, Bing, etc.) Try to find some reviews from people who have taken the supplement before. Although I’m not a big fan of purchasing supplements on Amazon (I’ll explain why later in this post), this can be a great place to do some research and see what others are saying about the supplement you purchased. However, you need to be cautious, as reviews can be artificially manufactured. And so you might need to make sure the reviews were from someone who actually purchased the product (a verified purchase), and in most cases the more positive reviews a product has the better, although this isn’t always the case.

If you can’t find any information or reviews on a specific supplement or herb then search for a few different supplements or herbs from the same manufacturer. If there are a lot of positive reviews for other supplements from the same company then this is a good sign that the company has good quality supplements. I realize that doing this type of “research” takes some time, but when spending your hard earned money on trying to improve your health it definitely is worth it. If you are working with a healthcare professional you can trust and know they have had success helping others, then you might not have to do all of this work, as you might simply take the supplements and herbs that they recommend, especially if you know they have been effective in helping others with a similar condition.

3. The supplements should have minimal fillers. Fillers are commonly added by supplement manufacturers, and while many of them are harmless, others are more controversial. Obviously you want to avoid supplements which have artificial ingredients. In most cases I’m not too concerned about a supplement having a couple of fillers, but it depends on what these are.

4. Are the supplements third party tested? In 2007 the FDA published something called “Current Good Manufacturing Practices” (cGMPs) for nutritional supplements and herbs. While it’s great to have these guidelines, there are also a few third party companies which test the quality of supplements. NSF International is one of these third party organizations, as they test thousands of supplements and herbs to not only make sure the supplements contain the ingredients listed on the label, but they also conduct a toxicology and contaminant review.

Australia’s Therapeutic Goods Administration (TGA) is the pharmaceutical regulatory agency of the Government of Australia, and it’s supposed to be one of the toughest regulatory agencies around the world. While many supplement companies are NSF certified, fewer companies are TGA certified. Once again, this doesn’t mean that supplement companies who aren’t certified by third party agencies don’t sell good quality supplements, and I admit that there are some supplement companies I use that aren’t certified by a third party. But if you are choosing a supplement company on your own and are concerned about the supplements not including ingredients that are on the label and/or having a high level of toxins, then it might be best to choose a supplement company that has been tested by a third party.

5. Be cautious about purchasing nutritional supplements and herbs on Amazon and Ebay. Although I recommended using Amazon to look at the reviews of supplements you are interested in purchasing, I’d be cautious about purchasing supplements on Amazon, as well as on Ebay. I’m not suggesting that you can’t find good quality supplements on Amazon and Ebay. But there can be a few potential problems with purchasing supplements on Amazon and Ebay, as well as through some other online websites. First of all, you don’t know how the seller is storing the supplements, which can be important. If you’re purchasing from a seller on Amazon or Ebay who sells supplements for a living then perhaps there is a greater chance that they take better care of their supplements (although there still isn’t a guarantee of this). On the other hand, if you purchase from someone who is randomly selling a supplement you’re looking for then there is a greater chance of the supplement not being stored properly (i.e. being exposed to sunlight and/or heat). Another concern is that there have been many cases of counterfeit supplements being sold on Amazon and Ebay. For example, you might spend money on what you perceive as being a high quality supplement, but are unaware that the seller has substituted a lower quality product in its place. I’m not saying that this happens frequently, but it does occur more often than you think. Natural News wrote a good article about this that I would recommend reading:

6. Work with a natural healthcare professional with a strong background in nutrition. Although I’d like to think that every natural healthcare professional recommends good quality supplements and herbs, this of course isn’t always the case. When I was focusing on chiropractic I didn’t have a good deal of knowledge with regards to high quality nutritional supplements and herbs. It wasn’t until I was personally diagnosed with Graves’ Disease and restored my health that I began increasing my knowledge, and just as is the case with any healthcare professional who deals with nutrition and functional medicine, over the years my knowledge has increased even further. Working with a healthcare professional whose patients get excellent results is a pretty good indication that the supplements they recommend are of high quality. But it still doesn’t hurt to ask the doctor what supplements they use, and why they choose to use them. Also, if you work with a healthcare professional then hopefully they recommend supplements from different companies. Don’t get me wrong, as just like most natural healthcare professionals I have my favorite supplement companies, but I also realize that different supplement companies have different strengths and weaknesses, and as a result I recommend supplements from a few different companies.

In summary, choosing good quality nutritional supplements and herbs can be a challenge. One of the most important things you can do is to choose a supplement company that uses high quality ingredients. While a few fillers usually is okay (although it depends on the fillers used), you want to be cautious about companies that include a lot of fillers in their supplements, and of course avoid supplements which include any artificial ingredients. You also want to be cautious about purchasing supplements and herbs from online retailers such as Amazon and Ebay. More and more supplement companies are hiring third party companies to test their supplements. If you still don’t feel comfortable choosing supplements on your own after reading this information then you might want to consider working with a natural healthcare professional with a strong background in nutrition.

There is controversy over whether the cells of the thyroid gland can regenerate.  Some claim that any damage to the thyroid gland is permanent, although others like myself do think it is possible for the thyroid gland to heal if the trigger has been removed.  But it does seem to depend on the patient, as while some people who are taking thyroid hormone medication are eventually able to wean off of it once the autoimmune component has been suppressed, others will need to remain on thyroid hormone even after restoring their immune system health.

There is no question that different areas of the body will heal at a different rate.  For example, the liver has a remarkable regenerative capacity after a partial hepatectomy (1).  On the other hand, as I mentioned earlier, many don’t consider the thyroid gland as being a regenerative organ.  For example, whereas the liver usually returns to close its original weight after a partial hepatectomy, after a partial thyroidectomy the thyroid gland exhibits hypertrophy and hyperplasia (2), but it doesn’t return to its original weight as the liver does.  However, hyperplasia is an increase in cell production, and so this suggests that regeneration of this gland is possible, although admittedly it’s not a quick process when compared to other parts of the body.  And it also seems to depend on how much damage takes place to the thyroid gland, as I’m not suggesting that someone who has received a partial thyroidectomy can expect complete regeneration to occur.

Even if the thyroid gland can heal on its own, if there are methods that can speed up the healing process, or cause tissue regeneration to occur when it normally wouldn’t happen on its own, then it makes sense to consider such a treatment.  Many people are familiar with the benefits of cold laser therapy with regards to helping people with musculoskeletal conditions, pain, and wound healing.  However, most people aren’t aware that cold laser therapy can potentially benefit thyroid health by helping with the regeneration of thyroid tissue.  Before specifically talking about this, it probably would be a good idea to briefly talk about how cold laser therapy works.

How Does Cold Laser Therapy Work?

Lasers were actually discovered in the 1960s, and not too long after this it was found that laser therapy can help with wound healing, pain reduction, decreased inflammation, etc.  Studies were first conducted on mice, where it was demonstrated that lasers can help to speed up wound healing.  Eventually studies were conducted on humans and it was also found that laser stimulation helped with wound healing (3) (4).  Low level light therapy involves exposing cells or tissues to low levels of red and near infrared (NIR) light (5).  It is also known as “cold laser” therapy because the power densities used are lower than those needed to produce heating of tissue (5).

Although low level laser therapy (LLLT) has been proven to help with numerous conditions, there are controversies surrounding it.  First of all, the exact biological mechanism still isn’t completely known.  In addition, a large number of parameters such as the wavelength, fluence, power density, pulse structure, and timing of the applied light must be chosen for each treatment (5). A less than optimal choice of parameters can result in reduced effectiveness of the treatment, or even a negative therapeutic outcome (5).  This is important to understand, as some studies have demonstrated that LLLT wasn’t effective for certain conditions, but the reason might have been due to an inappropriate light source and dosage.

How Can Cold Laser Therapy Help People With Thyroid Conditions?

There are a few small studies which show that using cold laser therapy can help to improve vascularization and perhaps help to regenerate the thyroid cells in some people with hypothyroidism.  One of these studies involved 43 patients with autoimmune thyroiditis who were on levothyroxine, and the results suggested that LLLT can improve thyroid parenchyma vascularization (6).  The same study showed a significant difference in the average levothyroxine dose required between those who received the treatment, and those who received a placebo treatment (6).  They not only had an improvement in thyroid function, but the group treated by LLLT also had lower TPO antibodies, although there wasn’t a change in the thyroglobulin antibodies.  Another study involving fifteen patients who had hypothyroidism caused by autoimmune thyroiditis showed that LLLT promotes the improvement of thyroid function, as patients experienced a decreased need for levothyroxine, a reduction in the TPO antibodies, and an increase in parenchymal echogenicity (7).

Of course more studies need to be conducted to show further proof of the benefits of LLLT on thyroid health, but these results seem very promising.  One important thing to keep in mind is that even if LLLT can help to regenerate the tissue of the thyroid gland, it still won’t do anything to remove the underlying cause.  For example, if someone has Hashimoto’s Thyroiditis due to an infection, which in turn caused a leaky gut, these factors need to be addressed.  And while the studies demonstrated a decrease in TPO antibodies, they didn’t help at all with elevated thyroglobulin antibodies, which also demonstrates that the cause of the condition needs to be detected and removed.

If you have Graves’ Disease then you might wonder if  LLLT can be beneficial.  Although it’s common for people with Graves’ Disease to have elevated TPO antibodies, the primary autoantibody associated with this condition is the TSH receptor antibody…specifically thyroid stimulating immunoglobulins.  There is no evidence I’m aware of which shows that LLLT can lower these antibodies.  And the TSH receptor antibodies aren’t causing damage to the thyroid gland, as they are stimulating or binding to the TSH receptors, which in turn causes the excess production of thyroid hormone.  However, if someone with Graves’ Disease also has thyroid peroxidase (TPO) antibodies then they might benefit from receiving LLLT.

Other Chronic Conditions Which Can Benefit From Cold Laser Therapy

In addition to benefiting people with thyroid conditions, cold laser therapy can potentially help with other conditions as well.

Rheumatoid arthritis.  One study I came across showed that LLLT is able to help people with both early and late stages of rheumatoid arthritis by modulating the inflammatory response (8).

Trigeminal neuralgia.  This can be a very painful condition, and studies show that laser therapy was associated with significant reduction in the intensity and frequency of pain, and therefore LLLT can be considered for the treatment of trigeminal neuralgia without any side effects (9).

Discoid lupus erythematosus.  This condition is restricted to the skin, mostly the face.  And a small study involving 16 patients with this condition showed that laser therapy helped to improve the itching, erythema, scaling, scarring, and pain (10).

Hair loss.  A few studies have shown that LLLT can help with hair loss.  One study involved LLLT in the treatment of male and female pattern hair loss, and the authors concluded that LLLT may be an effective option to treat pattern hair loss in both men and women (11).  Another small study showed that LLLT may be a promising treatment option for patients to help with hair growth, although the technology appears to work better for some people than for others (12).

Acne Vulgaris.  This is a common skin condition, and in one study involving 28 patients, two different wavelenghts of LLLT (630 and 890 nm) were used (13).  Ten weeks after treatment the acne lesions were significantly decreased in those who were treated with 630 nm, but the decrease was not significant in those treated with 890 nm (13).

Bone repair.  A number of rat studies show that LLLT can help with bone fractures by augmenting bone tissue formation (14) (15) (16).  But of course it would be nice to see some human studies demonstrating this as well.

In summary, cold laser therapy can help with wound healing, pain reduction, decrease inflammation, and can therefore potentially benefit people with different conditions such as rheumatoid arthritis, acne, bone fractures, and other conditions.  There is also the possibility that cold laser therapy can help to regenerate thyroid tissue, which of course can benefit many people with Hashimoto’s Thyroiditis.  However, larger studies need to be conducted, and it’s important to keep in mind that even if cold laser therapy can help to regenerate thyroid tissue, it won’t do anything to address the underlying cause of the condition.

There are thousands of people with thyroid and autoimmune thyroid conditions who would like to follow a natural treatment protocol, yet don’t have a lot of money to spend. And let’s face it, when it comes to eating healthy foods, taking good quality supplements, ordering tests, and consulting with a natural healthcare professional, it can become quite expensive. Without question this is an investment in your health, but even though this is true, some people simply can’t afford this investment. Others can afford this type of treatment, but they have to make other financial sacrifices. So I decided to put together a post which discusses how to follow a natural treatment protocol on a budget.

1. Only take those supplements which are truly necessary. Although I take nutritional supplements and herbs on a wellness basis, and also recommend them to my patients who are taking a natural treatment approach, it’s easy to find yourself in a situation where you are taking too many supplements. There is so much information available, and so it’s common to read an article or watch a video or webinar which discusses a specific supplement, and then based on this information you can easily convince yourself that it would be a good idea to take that supplement. This happens to myself every now and then as well, as whenever I attend a nutritional conference it seems like I end up adding a few supplements to my daily regime. But if you’re not careful you can find yourself taking dozens of different supplements, many of which are unnecessary.

I’m sure most people reading this understand that while taking nutritional supplements and herbs can be beneficial, this doesn’t mean that you should take dozens of different supplements. Of course the challenge is finding out which supplements are absolutely necessary to take. And to be honest, this will vary from person to person, although there are a few supplements that most people can benefit from taking. Some examples include a probiotic and an omega-3 fatty acid supplement. Many people don’t get enough magnesium from their diet and therefore can benefit from taking a magnesium supplement. If someone has a confirmed nutrient deficiency such as vitamin D or vitamin B12 then they will usually need to supplement with these nutrients. Of course the quality of the supplement is important, as if you are taking magnesium you usually will want to avoid magnesium oxide due to the low quality, and if you take vitamin B12, in most cases taking methylcobalamin, adenosylcobalamin, or hydroxycobalamin will be the best option.

But how about other nutritional supplements and herbs? There are many others that can be beneficial to take, including L-glutamine, turmeric, zinc, selenium, digestive enzymes, CoQ10, garlic, rhodiola, etc. These are just a few of the common supplements and herbs people commonly take, and there are times when taking one or more of these can be beneficial. However, I’ll consult with at least a few new patients each month who seem to be taking all of these I listed, plus many other supplements and herbs. The supplements someone needs to take will depend on what imbalances they have. For example, if someone has weak adrenals then they might benefit from taking herbs such as licorice and rhodiola, vitamin C and pantothenic acid, etc. If they have a leaky gut then in addition to a probiotic they probably can benefit from taking L-glutamine and vitamin A. If they have other imbalances then other supplements might be necessary to take.

2. Utilize the dirty dozen and clean fifteen lists. Ideally you want to eat as many organic foods as you can. However, this of course can become very expensive, and not everyone can afford to eat a 100% organic diet. If you eat meat, eggs, and dairy products then I would try to eat organic whenever you can. But with regards to eating fruits and vegetables, if you are unable to afford to buy these organic then I would recommend to utilize the dirty dozen and clean fifteen lists from the Environmental Working Group (www.ewg.org). The dirty dozen list includes the top twelve fruits and vegetables with the greatest amount of pesticides, while the clean fifteen list includes the top fifteen fruits and vegetables with the least amount of pesticides. And so if you are unable to afford to purchase organic fruits and vegetables, make sure to avoid those foods that are on the dirty dozen list, and stick to those foods that are on the clean fifteen list.

3. Focus on healing the gut. With most chronic health conditions, especially autoimmune conditions such as Hashimoto’s Thyroiditis and Graves’ Disease, having a healthy gut will play a key role in restoring the health of the person. And while it sometimes can be challenging to know where to start, simply going on an elimination diet while at the same time doing things to heal the gut can help a great deal. For example, consider cutting out the common allergens for one month such as gluten, dairy, eggs, corn, and soy. If you want to take this one step further you can also avoid grains, legumes, nuts and seeds. I realize this can be very challenging, and I’m not suggesting that everyone has to do this in order to restore their health. But many people have benefited greatly from following such a diet, while at the same time eating foods such as bone broth and/or sauerkraut to heal the gut, along with supplements such as a probiotic, L-glutamine, and zinc.

Taking this approach won’t always work, as there are times when it’s challenging to identify the source of gut inflammation, or the factor which is responsible for increasing the intestinal permeability. But following an elimination diet and doing some things to heal the gut usually won’t hurt, and many times can make a big difference. Although there can be other imbalances people have (i.e. adrenals, sex hormones, toxic overload, etc.), it is essential to have a healthy gut in order to achieve an optimal state of health.

4. Don’t underestimate the importance of getting sufficient sleep and managing your stress. Getting quality sleep is important, and while some people have problems falling and/or staying asleep, others intentionally neglect their sleep. Most people should aim to get at least 7 to 8 hours of quality sleep each night. And while too much sleep isn’t a good thing for many people, some people with chronic health conditions can benefit from getting more than eight hours of sleep per night until their health improves.

As for managing one’s stress levels, this is something that is very cost effective, yet many people don’t do a good job of managing their stress. There are three main reasons why most people don’t block out time for stress. The first reason is because they don’t think that managing stress is important, even though there are many research studies which show a correlation between chronic stress and different health conditions. A second reason is because some people think they do a good job of managing the stress, even when this isn’t the case. Sometimes it can be challenging to know if stress is having a negative impact on your health, and so regardless of whether someone thinks they are doing a good job of managing their stress levels I recommend for people to block out time to manage stress.

A final reason why many people don’t block out time for stress management is because they can’t find the time to do so. Either they work very long hours, or perhaps they are a stay-at-home mom (or stay-at-home-dad) and have a few young children to tend to throughout the day and at night. The problem is that those people who can’t find the time to focus on stress management usually need this the most. The truth is that most people can block out at least 10 to 15 minutes per day to manage stress, but many don’t do so not because they don’t have the time, but because this isn’t a priority. For more information on this I would refer to the blog post I created entitled “Blocking Out Time To Manage Your Stress Is Essential“:

5. Price around before ordering tests. When it comes to ordering tests, it is a good idea to contact different labs. This is especially true if you pay out of pocket for blood tests, as there can be a big difference between the pricing of different labs. There are numerous online companies such as www.directlabs.com and www.privatemdlabs.com that offer blood tests at a discounted price. And what’s even better is that you don’t need a doctor’s order for these companies. The downside is that ordering blood tests online isn’t available in all states. If you are able to get an order from a doctor but pay out of pocket, then it might be a good idea to call some of the local labs, including any small hospitals, as you very well might find a lab that is willing to give you a nice discount on your blood tests.

As for other types of tests, such as a saliva test for the adrenals, you can of course shop around for these as well. However, keep in mind that different saliva panels include different tests, which will be a factor in the price. For example, you might choose an adrenal saliva test based on price alone, but then realize that it only tests for the cortisol levels, whereas another lab offers a more comprehensive adrenal panel which also includes tests for DHEA, 17-OH progesterone, and secretory IgA.

6. Eat as many whole foods as possible. You no doubt have heard of the phrase “food is medicine”, and while eating a healthy diet alone many times won’t be enough to restore one’s health, eating a diet consisting of whole foods while minimizing the refined foods and sugars will benefit your health. Earlier I mentioned how certain foods such as bone broth and sauerkraut can help to heal the gut. Similarly, certain foods such as broccoli, kale, and garlic can increase glutathione levels, which can help with the elimination toxins. Overall you want to eat foods that are nutrient dense, and try to eat a good variety of vegetables in order to get most of the phytonutrients which are essential for optimal health.

7. Do other things to improve your health. There are many other things you can do to improve your health which won’t cost a lot of money. For example, besides eating whole foods to help eliminate toxins, you of course want to try doing everything else you can do to minimize your exposure to toxins. This not only includes chemicals (i.e. pesticides, toxic metals, etc.), but electromagnetic fields (EMFs). Earthing can also be beneficial and is free, and I’ll discuss this in a future article. Take advantage of any free webinars on thyroid health, as many times these can provide some valuable information. If you have more time than money you also might benefit from visiting some thyroid health forums and/or facebook groups. And of course try to do your best to stay positive, as while it isn’t always easy to have a positive attitude when dealing with a thyroid or autoimmune thyroid condition, doing so can make a big difference.

In summary, if you are looking to follow a natural treatment protocol but are on a budget, there are still many things you can do to improve your health. Make sure you don’t take more supplements than you need, utilize the dirty dozen and clean fifteen lists, and focus on healing the gut. You also want to make sure to get sufficient sleep and block out time to manage your stress. Make sure you eat plenty of whole foods, and if you order tests and pay out of pocket for them consider contacting different labs in order to get the best price. You also want to minimize your exposure to toxins, consider doing earthing, and try your best to keep a positive attitude.

In the last blog post I spoke about how following an elimination diet can benefit a lot of people by determining which foods someone might be sensitive to.  After someone has gone on an elimination diet for three or four weeks the next step is to reintroduce foods.  While some people will want to continue following the elimination diet after three or four weeks, eventually just about everyone will want to reintroduce certain foods into their diet.

How should you go about reintroducing foods?  Well, you always want to reintroduce one new food at a time.  The obvious reason for this is because if you were to reintroduce more than one food on the same day and then experienced a negative reaction, you wouldn’t know which food was responsible.  It also is a good idea to eat the food you reintroduce a couple of times on the same day, and then wait an additional two days before reintroducing the next food.  The reason for this is because it is possible to have a delayed reaction to a food.  If all goes well when reintroducing a certain food then you can continue eating that food on a regular basis and can reintroduce the next food.

So for example, let’s say you followed the elimination diet for 28 days.  On day #29 you decide to reintroduce eggs, and have an egg for breakfast and another egg with lunch.  If by the end of day #31 you experience no negative symptoms, then on day #32 you can reintroduce a new food.  On the other hand, if you did experience a negative reaction to the eggs then you would wait until the symptoms subside before reintroducing the next food.

Which Foods Should You Reintroduce First?

It’s usually not necessary to reintroduce foods in a certain order, although some sources will recommend to first reintroduce the foods least likely to give a severe reaction, and to save foods such as gluten, dairy, and corn for last, if you choose to reintroduce these.  Many times I will recommend reintroducing eggs first if the person enjoys eating eggs, as they are very nutrient dense.  Of course you can choose to reintroduce a different food first if you prefer.  For obvious reasons you want to only reintroduce whole foods for now.  The reason is because if you reintroduce any type of processed food then you most likely will be reintroducing more than one ingredient.  For example, if you reintroduce pizza as one of the first few foods, and you had a negative reaction, you wouldn’t know if the negative reaction was due to the wheat (or other type of grains if it was gluten free), cheese, sauce, or other ingredients in the pizza.

This brings up another important point, as you don’t necessarily want to reintroduce ALL of the foods you originally eliminated.  So for example, certain foods are not eliminated because they are allergenic, but instead because they have compounds which can cause issues with the permeability of the gut.  Examples include nuts, seeds, legumes, grains, and the nightshade vegetables.  While sometimes eating these foods can produce symptoms (i.e. the nightshades commonly cause joint pain), the lack of symptoms doesn’t mean that it’s fine to continue eating these.

This doesn’t mean that everyone will need to completely avoid nuts, seeds, legumes, grains, and the nightshade vegetables.  If someone chooses to follow a strict autoimmune paleo diet then they will avoid these foods, along with dairy and eggs.  On the other hand, there are some people who are able to eat small amounts of these foods without a problem.  If someone has obvious gastrointestinal issues or has tested positive for a leaky gut then I do think these foods should be avoided until the gut has been healed.

When Can Dairy Be Reintroduced?

Dairy is one of the main foods that a lot of people commonly want to reintroduce first.  Although there are health benefits of dairy, I’m very cautious about people reintroducing it while trying to restore their health, mainly because many people are sensitive to the proteins of dairy, specifically casein.  And remember that is possible for someone to reintroduce a food they are reacting to and not experience any negative symptoms.  With that being said, some people do fine with raw dairy, and a good quality whey protein is an excellent source of glutathione.  And so if someone insists on adding dairy I would recommend starting with raw dairy (i.e. raw milk), and then perhaps they can add a good quality whey protein.  However, if someone is fine not reintroducing dairy I will usually encourage them to go as long as they can without consuming it, letting them know that they will eventually be able to reintroduce dairy products again, if they choose to do so.

What Are Some Symptoms You Might Experience When Reintroducing Foods?

If all goes well then you shouldn’t experience any negative reaction when reintroducing a specific food.  On the other hand, if you do have a negative reaction then you want to look out for symptoms such as bloating, gas, abdominal discomfort, headaches, fatigue, muscle or joint pain, insomnia, skin problems, sinus congestion, etc.  One question you might have is “if I experience a specific symptom how do I know for certain it’s related to the food I reintroduced?”  For example, if someone reintroduces a new food and experiences severe gas and bloating, then there is a good chance it’s related to the food.  On the other hand, if they were to experience a headache or a increase in fatigue then it might be related to the food, but there is a also a chance that these symptoms weren’t related.

If you’re not certain if a symptom is related to the food being reintroduced then I would recommend to stop eating the food for a few weeks and then reintroduce it again in the future.  So for example, if you reintroduce eggs and experience a headache on the same day, it is possible that you coincidentally had a headache that was unrelated to the food.  On the other hand, if you avoid eggs for a couple of weeks and then reintroduce them again, and experience headaches again, then chances are it’s the eggs which are responsible for the headaches.

Should Gluten Be Reintroduced At All?            

Gluten is a common allergen, and many healthcare professionals will recommend for their patients to permanently avoid gluten.  Others will recommend for them to first heal their gut and restore their health, and then later will give the patient the option to reintroduce gluten.  I’ve also taken this approach with my patients, but the problem is that if they are sensitive to gluten but aren’t aware of this, one can argue that it might be best to find out sooner than later.  In other words, sometimes it might be best to have the person reintroduce gluten after following an elimination diet, and then if they have a negative reaction this will confirm that they should continue avoiding gluten while trying to restore their health, and perhaps even after their gut has been healed.

However, a possible flaw with this approach is that a leaky gut can cause food sensitivities.  In other words, a person might develop a food sensitivity due to a leaky gut, and just because someone is sensitive to a certain food initially doesn’t mean that they will be sensitive to the same food after the gut is healed.  And so a person might develop a gluten sensitivity after developing a leaky gut, but it is possible for the gluten sensitivity to no longer be present after the gut has been healed.  I’ve spoken to the doctors at Cyrex Labs, as they offer comprehensive testing for gluten, and they recommend that if someone tests positive for gluten on one of their Arrays for them to avoid gluten permanently…even if after healing a leaky gut.  Another theory is that if you eat even a small amount of gluten you can have gut inflammation for up to six months, and so based on this you would want to be cautious about reintroducing gluten at all.  Plus, since you can’t always go by symptoms there is a chance that someone who has a gluten sensitivity will reintroduce it and feel fine, and because of the lack of symptoms will continue to consume it, thus causing inflammation.  So while many people choose to eventually reintroduce gluten, there are risks of doing this.

It can get confusing, and without question there are some people who are sensitive to gluten and will need to avoid it permanently, yet many of these people don’t know they have a gluten sensitivity issue.  And so it definitely is a dilemma, as we’re pretty much faced with two different scenarios.  Scenario #1 is to reintroduce gluten after eliminating it, and if you have a negative reaction just realize you might experience an increase in gut inflammation for a few months.  Scenario #2 is to reintroduce gluten after healing your gut, but then if you are sensitive you might undo some of the positive benefits you received from the gut healing program.

Food sensitivity testing is an option to consider, although there are a few drawbacks to this.  One drawback is that it can be very expensive to do this type of testing.  Another drawback is that false negatives are common, and so you can have a gluten sensitivity but it might not be picked up by the test.  A final drawback is that you need to be consuming gluten in order for this type of test to be accurate.  And so if you are on a gluten free diet and do a food sensitivity test for gluten then you are essentially wasting your money.

The Final Verdict on Gluten

I didn’t mean to spend so much time on gluten, but I realize that there is a lot of controversy around this common allergen.  My current approach is to have people initially avoid gluten, and ideally I will have them continue to avoid it while following the natural treatment protocol.  On the other hand, if someone insists on reintroducing gluten soon after the elimination diet then I will let them know that there is a chance that they can be sensitive to gluten, yet they might not experience any symptoms upon reintroducing it.  I will also let them know that if they do fine upon reintroducing gluten from a symptomatic perspective, and choose to continue to eat it, I would still recommend minimizing their consumption of gluten, and of course to try to eat mostly whole foods, which won’t contain any gluten.

In summary, after your elimination diet you want to reintroduce one food at a time.  If after three days you don’t experience a negative reaction you can continue eating this food, and can then reintroduce the next food.  If you react to a specific food then the symptoms can vary, as some people will experience digestive symptoms, while others might experience symptoms such as fatigue, headaches, brain fog, muscle and joint pain, skin problems, etc.  And sometimes the person won’t experience any symptoms.  Although food sensitivity testing is an option, this also isn’t completely reliable, and can be very expensive.  As for reintroducing gluten and dairy, I usually encourage my patients to continue avoiding gluten and dairy while trying to restore their health, although some of my patients choose to reintroduce one or both of these.

When taking a natural treatment approach it of course is important to eat a healthy diet.  Although most endocrinologists dismiss dietary factors as playing a role in thyroid or autoimmune thyroid conditions, the truth is that eating a lot of refined foods and fast food on a frequent basis can lead to many different health issues.  However, some people don’t improve even when eating a healthy diet, and while it’s possible that there can be other factors affecting their health (i.e. stress, lack of sleep, an infection, toxins, etc.), in order to achieve optimal health it is important to avoid eating any foods you might be reacting to.

An obvious question you might have is “what foods should I eliminate?”  Not surprisingly you will get different opinions from different healthcare professionals.  But most will agree that the most common allergens should be eliminated, along with a few other foods.  This includes gluten, dairy, corn, eggs, soy, shellfish, peanuts, and refined sugar.  And because most refined foods and fast food include one or more of these allergens it is best to stick with eating whole foods while on an elimination diet.  Some healthcare professionals will also recommend avoiding foods such as beef, pork, coffee, tea, citrus fruits, and chocolate during an elimination diet.

An Elimination Diet For Those With Autoimmune Thyroid Conditions

Many people reading this are familiar with the autoimmune paleo diet.  This recommends for people to avoid most of the common allergens I listed above (gluten, dairy, corn, eggs, soy, peanuts, refined sugar, coffee), but also recommends avoiding legumes, nuts and seeds, along with the nightshade vegetables.  This of course makes the diet even more challenging to follow, but because legumes, nuts, seeds, and the nightshades have compounds which can potentially increase the permeability of the gut it probably is a good idea for most people with Graves’ Disease and Hashimoto’s Thyroiditis to avoid these foods.

I do think following an autoimmune paleo diet as an elimination diet is a good idea for many people with Graves’ Disease and Hashimoto’s Thyroiditis.  And of course those who do well with this diet can choose to continue following it until their health has been restored back to normal.  However, there are a few issues with this diet.  One problem is that it’s a very restrictive diet, as it essentially allows the person to only eat vegetables, fruits, lean meats and fish, coconut products, and some healthy oils (i.e. coconut oil).  Even with these restrictions many people are able to follow such a diet, especially on a short term basis, although it can be very challenging.  This is true for most people, but it is especially true for vegans and vegetarians.  And regardless of whether someone eats meat or not, some people don’t do well on an autoimmune paleo diet, even when it’s followed for a short period of time.

The other dilemma is that it is possible for people to have an allergy or sensitivity to one of the “allowed” foods.  In other words, someone might be sensitive to chicken, avocados, or kale, which are all permitted on an autoimmune paleo diet.  While these sensitivities are much less common, it still is possible to be sensitive to these and other foods.  Of course one can do food allergy and/or sensitivity testing, but this can get expensive, and the accuracy of such tests is controversial.  Research shows that the ALCAT testing is controversial (1), and although I have done IgG testing in the past, it’s not something I do on everyone, mainly because they are very expensive tests and I still question whether such testing is completely accurate.  I do like the new Multiple Food Immune Reactivity Screen from Cyrex Labs, although this test is also very expensive and has some limitations.

What I personally do is have most of my patients follow a strict autoimmune paleo diet initially, and then after the first month if they are struggling I’m usually open to them reintroducing some foods that typically aren’t allowed.  For example, eggs aren’t typically allowed on an autoimmune paleo diet, and I discussed the reason behind this in my blog post entitled ” Can People With Graves’ Disease and Hashimoto’s Thyroiditis Safely Eat Eggs? “.  But many people do fine eating eggs, especially the egg yolks, and in most cases, those who don’t do well will experience some symptoms upon reintroducing eggs.  Although nuts, seeds, and grains (even gluten free) are also not part of an autoimmune paleo diet, there are some people who choose to reintroduce small amounts of these foods and have no problems.  On the other hand, there are also people who reintroduce these foods and don’t do well, and eventually need to eliminate them from their diet again.

Below I have listed some of the main foods I recommend to be avoided initially, and I also include which ones are allowed when following an elimination diet for those with thyroid and autoimmune thyroid conditions.  Once again, I realize this can be very challenging for many people, and in the next post I’ll discuss reintroducing foods.

FOODS WHICH SHOULD BE AVOIDED:                                           

Gluten

Dairy

Corn

Grains (even gluten free)

Eggs

Soy

Shellfish

Peanuts

Refined sugar

Coffee

Chocolate

Legumes

Nuts

Seeds

Nightshades

FOODS WHICH CAN BE EATEN:

Vegetables (excluding the nightshades)

Fruits (some elimination diets recommend to avoid citrus fruits)

Poultry (chicken, turkey, etc.)

Lamb

Other Meat

Wild fish low in mercury and other toxins

Some coconut products (i.e. unsweetened coconut milk and yogurt)

Healthy oils: olive oil, coconut oil

If you want a more complete list of the foods that are allowed and “forbidden” on an autoimmune paleo diet I would recommend reading the book “The Paleo Approach” by Sarah Ballantyne.  In this book she gives some comprehensive lists regarding the foods you can and can’t eat.  Although beef and pork are allowed on an autoimmune paleo diet, some elimination diets exclude these foods.  And while I didn’t discuss the quality of these foods, you of course want to try eating organic whenever possible, consider eating pasture-raised eggs and poultry, and if you eat beef then choose 100% grass fed.

Obviously if you have a known allergy or sensitivity to one of the “allowed” foods then I would avoid it.  Also, even though I listed coconut products here, keep in mind that many coconut products sold in health food stores have other added ingredients that might cause health issues (i.e. carrageenan).  As a result, if you are going to eat coconut products such as coconut milk and/or coconut yogurt during the elimination diet it is best to make your own.

How Long Should You Follow An Elimination Diet For?

You want to follow such a diet for at least three or four weeks.  The reason for this is because the antibodies take at least three weeks to significantly decrease.  So for example, if someone has a sensitivity to eggs and eliminates them for only one week, this won’t be a sufficient amount of time to reduce the antibodies, and thus the person who is sensitive to eggs probably won’t notice a difference upon reintroducing them.  On the other hand, after approximately three weeks of eliminating eggs the antibodies should greatly decrease, and so if the person with an egg sensitivity reintroduces eggs they most likely will experience some negative symptoms.  As a result, after three or four weeks most people can begin reintroducing some foods, which I will discuss in the next blog post.

Will You Experience Any Negative Symptoms While On The Diet?

Some people do experience negative symptoms when initially beginning an elimination diet.  These symptoms can include fatigue, headaches, lightheadedness, and gastrointestinal symptoms.  These symptoms usually only last for a few days, and not everyone experiences them.

Can I Expect Any Improvement In My Symptoms?

While some people experience a worsening of symptoms initially, many notice an improvement in their symptoms after a few days or a few weeks.  Some of the common symptomatic improvements reported by those following an elimination diet include an increase in energy, a decrease in brain fog, better sleep, a decrease in gastrointestinal symptoms, and a decrease in pain.  Keep in mind that just because you’re not noticing an improvement in certain symptoms doesn’t mean that you’re not benefiting from the elimination diet.  For example, you might have low energy levels and/or sleep issues due to weak adrenals and HPA axis dysregulation, and while eliminating certain foods might help to reduce inflammation, going on an elimination diet alone usually won’t restore the health of the adrenals.  Similarly, if someone has a leaky gut due to an infection such as H. Pylori, just following an elimination diet isn’t going to help with this.

Based on what I just said you might ask the question “why not just do some testing first to see if someone has problems with the adrenals, a leaky gut, an infection, etc?”  Although I do some testing initially, what you need to keep in mind is that it is common for someone to have more than one health issue.  And sometimes it can be challenging to know what is specifically triggering one’s condition.  For example, someone might have a leaky gut that was caused by chronic stress or an infection, but they might also have a food sensitivity such as dairy that is contributing to their gut inflammation.  And so the obvious goal would be to address all factors which can cause gut inflammation and thus is preventing the leaky gut from healing.

Is It Okay To Cheat Once Or Twice During The Elimination Diet?

While many people follow an elimination diet without a problem, for others it is a big challenge.  And it’s not uncommon for someone to ask me if they are able to cheat while following it.  Or sometimes they won’t ask me, but instead will send an email letting me know that they strayed from the diet.  For example, someone might be following an elimination diet and then have a piece of birthday cake to celebrate a family member’s birthday (or their own birthday).  Or they might have been invited to a wedding and ate some foods they weren’t supposed to eat.  Or perhaps they planned the elimination diet around the holiday season and they were invited to a party where it was almost impossible to strictly follow this diet.

Cheating even once can be an issue if you the food you consume has an ingredient you are sensitive to.  And one of the main reasons for following an elimination diet is to try to determine which foods you might react to.  As a result, you really do want to be 100% compliant during this time.  The best thing you can do is to plan ahead, as if there is a special occasion where you know you won’t be fully compliant and you can’t change your plans, then postpone the elimination diet if necessary.  For example, if you have a vacation planned in a couple of weeks, then it probably is best to hold off on following the elimination diet until after the vacation.  If there is a party or another special event coming up soon that you need to attend and you don’t think you will be fully compliant with the elimination diet, then wait until after the party is over with.

Do You Really Need To Stop Drinking Coffee?

Many of my patients find it difficult to give up drinking coffee.  It’s common for someone to say that they can strictly follow the elimination diet, but they can’t give up their coffee!  I know it isn’t easy for some people to stop drinking coffee, even if it’s only on a temporary basis.  And while some people do fine drinking coffee, not everyone does okay, which is why it’s a good idea to eliminate the coffee for at least three weeks, and preferably longer than this.  I realize that some people have problems going cold turkey, and so what you might need to do first is to gradually reduce the amount of coffee you drink until you have weaned off.  For example, if you drink three cups of coffee per day then perhaps you can reduce it to two cups per day for one or two weeks, and then cut it down to one cup/day for one or two weeks until you have weaned off of the coffee.  Another option is to drink half caffeinated and half decaffeinated coffee (organic preferred), and then after one or two weeks make it 3/4 decaffeinated and 1/4 caffeinated, and then once you are drinking decaffeinated coffee it should be much easier to wean off of it.

What are the potential consequences if you continue to drink coffee?  As I briefly mentioned earlier, some people do fine drinking coffee.  But the same can also be said for other foods that are eliminated.  Some people do fine with dairy, eggs, gluten free grains, etc.  The truth is that many people do much better when eliminating the coffee.  Obviously if you have a sensitivity to coffee then continuing to drink it can be a problem.  But even if you don’t have a sensitivity, if you have adrenal issues then drinking coffee usually isn’t a good idea.  And so if you choose to follow an elimination diet please try to do your best to eliminate the coffee, even if it means taking a few weeks to wean off of it before starting the elimination diet.

Remember That The Goal Isn’t To Restrict Calories

Some people think that the primary goal of an elimination diet is to lose weight, and they not only avoid the “forbidden” foods, but limit their consumption of the “allowed” foods.  Even if your main goal is to lose weight, restricting calories isn’t the best method of accomplishing this.  While it is common for people to lose weight while following the elimination diet, the main goal is to find out which foods you might be sensitive to.  And so you don’t need to restrict the amount of foods on the “allowed” list.

Should You Continue Taking Nutritional Supplements and Herbs?

In many cases I’ve had patients take certain nutritional supplements and herbs while following an elimination diet.  However, feel free to take a break from your supplements and herbs during this time, and if someone has a lot of known sensitivities it probably is best to avoid most supplements and herbs during an elimination diet.  After all, there is always the possibility that someone can be sensitive to one or more of the supplements they are taking.  Sometimes it’s not the actual nutrient or herb that they’re sensitive to, but one of the other ingredients (i.e. fillers, gums, etc.).  This of course can also be true with medication, as someone might be having gut inflammation due to the synthetic ingredients in the one or more of the prescription drugs they’re taking.  Obviously I’m not suggesting for people to stop taking their medication while doing an elimination diet, but this is something to keep in mind.

Should Everyone With Graves’ Disease and Hashimoto’s Thyroiditis Follow An Elimination Diet?

Although I think most people with an autoimmune thyroid condition can benefit from following an elimination diet, this doesn’t mean that everyone needs to do this in order to receive good results when following a natural treatment protocol.  Not all of my patients have followed an elimination diet, but those people who are experiencing symptoms such as gastrointestinal discomfort (bloating, gas, increased or decreased bowel movements, etc.), severe fatigue, headaches, muscle and/or joint pain, and other moderate to severe symptoms not related to their thyroid hormone imbalance should consider following an elimination diet.  Once again, this doesn’t mean that a food sensitivity is definitely the cause of these symptoms, but if a food sensitivity is the culprit then obviously this needs to be detected and then removed.

Other Important Tips

In order the get the most benefits from your elimination diet there are a few other things I would recommend.  First of all, I would try to eat as many organic foods as you can.  The main reason is because there are less toxins in organic food, and in some cases someone will have a negative reaction not because of the food itself, but because of a specific toxin.  For example, someone might feel lousy at times when eating non-organic apples, but at other times might be fine.  And while they might assume they have a sensitivity to apples, the problem could be due to the high amount of pesticides found on non-organic apples.

You also want to drink plenty of water each day.  Drink purified water, or a good quality spring water out of a glass bottle.  Try to get sufficient sleep each night.  Of course there are many people who have sleep issues and therefore have problems falling and/or staying asleep.  But there are also many people who fall asleep fine but intentionally stay up much later than they should.  This isn’t too big of a deal if done on an occasional basis, but you obviously want to get a good amount of sleep on a regular basis.  Some light exercise is usually fine, but you don’t want to exercise excessively, as this is common, and too much exercise can do more harm than good.

In summary, going on an elimination diet can help to determine which foods you have a negative reaction to.  Although taking this approach isn’t 100% reliable, the same is true with other methods such as food sensitivity testing, and of course an elimination diet is much more cost effective, although it does admittedly take time and discipline.  When I recommend an elimination diet to my patients with Graves’ Disease and Hashimoto’s Thyroiditis, I essentially have them follow an autoimmune paleo diet for three or four weeks before reintroducing certain foods.  I realize this makes the diet very restrictive, but doing so is essential in some cases, and after three or four weeks most people can start reintroducing some other foods.  Please remember that you don’t want to restrict calories while following an elimination diet, and you also should try eating as many organic foods as you can, drink plenty of water, get sufficient sleep, and not exercise excessively during this time.

Thyroid eye disease, which is also known as Graves’ ophthalmopathy, affects approximately 50% of those people with Graves’ Disease.  And while in most cases the condition isn’t severe, this isn’t always the case.  Common symptoms include eye swelling, eye bulging (exophthalmos), and sometimes even blurriness and double vision.  While steroids such as prednisone are commonly given to help with the inflammation, certain natural approaches can also benefit the patient, without them having the side effects of steroid medications.  Research shows that selenium can be very effective in helping with thyroid eye disease, which I’ll discuss in this post.

But why is selenium so effective in helping with thyroid eye disease?  In order to better understand why selenium can help it probably is a good idea to briefly talk about the pathophysiology of thyroid eye disease.  Research clearly shows that Graves’ ophthalmopathy isn’t due to the hyperthyroidism associated with Graves’ Disease, but instead is due to the autoimmune response (1).  The same autoimmune response involved in Graves’ Disease is also responsible for damaging the tissues of the eyes.  Some of the more common symptoms include a dry and gritty ocular sensation, sensitive to light, excessive tearing, double vision, and a pressure sensation behind the eyes (2). The most common clinical features of Graves’ ophthalmopathy are upper eyelid retraction, edema, and erythema of the periorbital tissues and conjunctivae, and bulging of the eyes (2).

Just to summarize, in Graves’ Disease it is the immune system which attacks the TSH receptors, which in turn leads to the excess production of thyroid hormone.  And in Graves’ ophthalmopathy the immune system also causes damage to the tissues of the eyes, which in turn cause the signs and symptoms associated with Graves’ Disease.  And so the obvious goal should be to modulate the immune system and decrease the TSH receptor antibodies.  Glucocorticoids are commonly prescribed by medical doctors to help reduce the inflammation associated with thyroid eye disease, as well as suppress the immune system, which in turn can lower the TSH receptor antibodies (3).  But there are negative health consequences of steroids, such as glucose intolerance, gastritis, hypertension, hepatitis, and depression (3).

How Can Selenium Specifically Help With Thyroid Eye Disease?

Although the focus of this post is on thyroid eye disease, selenium has been shown to be effective in the prevention and/or treatment of many other conditions including cardiovascular disease, osteoarthritis, rheumatoid arthritis, hypothyroidism, stroke, atherosclerosis, cancer susceptibility and treatment, HIV, AIDS, neuronal diseases such as Alzheimer’s disease and amyotrophic lateral sclerosis, pancreatitis, depression, and diabetes (4).  Selenium might even be able to decrease the progression of thyroid cancer (5) (6).  But how can one mineral have such a dramatic impact on these conditions?  Well, selenium has numerous functions, as it is a powerful antioxidant which in turn can help to reduce oxidative stress, it is involved in modulating the immune system, it is an enzymatic cofactor, and it is also involved in gene expression.  So it is very likely that a deficiency of this mineral will make someone more susceptible to developing other chronic health conditions.

As for how selenium can specifically help with thyroid eye disease, although the exact mechanism isn’t known, an increase in oxidative stress has been observed in both acute and chronic phases of thyroid disease with raised tissue concentrations of reactive oxygen species (7).  Selenium is important for the formation of selenoproteins.  These selenoproteins are powerful antioxidants and help to neutralize the effects of oxidative stress by reducing these free radicals (8).  Glutathione peroxidase and thioredoxin reductase are the two main seleno-enzyme systems which are responsible for the reduction of free radicals (7) (9).  These free radicals lead to an increase in proinflammatory cytokines, which as I have discussed in past articles and blog posts, are associated with autoimmune conditions (10).  So essentially what happens is that if someone has a selenium deficiency, this will result in a decrease in selenoproteins, and this in turn will result in the accumulation of hydrogen peroxide, which will cause tissue inflammation (11).  In addition, a deficiency of these selenoproteins can cause dysregulation of the immune system (12).  All of this can lead to tissue injury.

Remember that it’s the immune system attacking the TSH receptors which is responsible not only for the hyperthyroid symptoms of Graves’ Disease, but the immune system also attacks the fibroblasts of the orbit, which results in the symptoms associated with thyroid eye disease.  The TSH receptor antibodies are secreted by activated B cells due to immune system dysregulation.  But a sufficient amount of selenium can help to regulate the immune system, as it can help restore both innate and humoral immune functions (13) (14).

How Much Selenium Should You Take?

As for the dosage of selenium, it depends on the individual.  A typical dosage to help with these conditions is 200 mcg/day, as this frequently is sufficient enough to result in a therapeutic effect without causing a selenium toxicity.  Some people don’t respond unless if higher doses of selenium are taken (i.e. 400 mcg/day).  However, too much selenium can be toxic, and so you do want to be cautious.  Although you can try to get enough selenium through eating selenium-rich foods such as Brazil nuts, it might be best to take a selenium supplement.  The reason for this is because the dosage of selenium will vary in the food depend on the source.  For example, a Brazil nut that wasn’t grown in selenium-rich soil will of course have a lower amount of selenium than a Brazil nut that was grown in selenium-rich soil.

It also is a good idea to do other things to modulate the immune system, and not just rely on taking selenium.  Other nutrients which can decrease oxidative stress and suppress the autoimmune response include curcumin, resveratrol, fish oils, green tea, and vitamin D.  While taking supplements can help, in order to reverse thyroid eye disease one of course will need to remove the autoimmune trigger that is responsible for the elevated TSH receptor antibodies.

In summary, thyroid eye disease is common in Graves’ Disease, and this condition involves the immune system attacking the tissues of the eyes.  Selenium is a powerful antioxidant which reduces oxidative stress and can modulate the immune system, and it’s an important cofactor for glutathione production.  Essentially what selenium is doing is helping to regulate the immune system, which will decrease the damage caused to the tissues of the eyes.  Keep in mind that other nutrients can also help with this process, and it’s also essential to remove the autoimmune trigger.

There is no question that engaging in regular exercise is important.  Exercise has many benefits, as it can decrease the risk of developing cardiovascular disease, improve insulin sensitivity, increase bone density, etc.  However, while many people don’t exercise enough, there are some people who exercise excessively, which also isn’t a good thing.  As I’ll discuss in this post, too much strenuous exercise can have a negative effect on the immune system and might potentially be a factor in the development of an autoimmune thyroid condition such as Graves’ Disease or Hashimoto’s Thyroiditis.

Although the focus of this post will be on the risks of overtraining in those with autoimmune thyroid conditions, moderate exercise seems to offer a protective effect on the immune system (1).  For example, while strenuous exercise can theoretically make someone more susceptible to an upper respiratory tract infection by temporarily suppressing the immune system defenses, moderate exercise can actually protect against upper respiratory infections (2).  Exercise has effects on both the humoral and the cellular immune system (2).

What Are The Potential Consequences Of Excessive Exercise?

Although there are no studies confirming that excessive exercise causes thyroid autoimmunity, there is no question that overtraining does affect the cytokines of the immune system.  And as I have discussed in other articles, these cytokines play a role in different autoimmune conditions, including Graves’ Disease and Hashimoto’s Thyroiditis.  In a properly functioning immune system you ideally want to have a healthy balance between T-helper 1 (Th1) and T-helper 2 (Th2) activity.  But certain factors can affect these pathways, and make someone Th1 or Th2 dominant.  This in turn can increase the chances of the person developing either Graves’ Disease or Hashimoto’s Thyroiditis.

Most cases of Hashimoto’s Thyroiditis are Th1 dominant conditions, whereas most cases of Graves’ Disease are Th2 dominant conditions.  However, this isn’t always the case, and the only way to know for certain is to test the cytokines.  A few years ago such testing was more common, as some natural healthcare professionals would test the cytokines through the blood to determine if someone was Th1 or Th2 dominant and then they would recommend specific nutrients or herbs to balance these pathways.  Although some healthcare professionals continue to do such testing on their patients, this remains controversial, and isn’t as commonly practiced these days.

So how does exercise specifically affect the cytokines and the Th1/Th2 balance?  Well, exercise of moderate intensity seems to cause a slight shift towards a Th1 profile, thus reducing inflammation and reducing the risk of infections (3).  However, it appears that acute exercise, as well as chronic moderate exercise, shifts the immune response towards a Th2 profile (3) (4).  Prolonged intense exercise may shift the balance towards Th2 to an even greater extent (3) (4).

What this is saying is that short bouts of intense exercise and chronic moderate exercise slightly shifts the immune response towards a Th2 profile, and excessive exercise seems to shift the immune system balance too much towards Th2.  Since most cases of Graves’ Disease are Th2 dominant conditions, this would suggest that excessive exercise can potentially trigger Graves’ Disease in those people who have a genetic predisposition for this condition.  However, the Th1 immune response offers protection against pathogens (i.e. viruses), and so this shift towards Th2 can make the person more susceptible to an infection, which can be a factor with either Graves’ Disease or Hashimoto’s Thyroiditis.  So excessive exercise might trigger Graves’ Disease by shifting the person to a Th2 dominant state, but it also might indirectly lead to Hashimoto’s Thyroiditis by making the person more susceptible to viruses and other infections.  For example, if someone with a genetic predisposition to Hashimoto’s exercises excessively this can weaken their immune system defenses, making them more susceptible to an infection, which in turn can lead to the development of Hashimoto’s Thyroiditis.

More About Excessive Exercise and Infections

Since infections can play a role in the development of autoimmune thyroid conditions I’d like to further discuss how excessive exercise can make someone more susceptible to developing an infection.  Secretory IgA plays an important role in providing protection by binding to pathogens, including viruses (5).  In other words, it is a first line of defense against pathogens.  However, prolonged strenuous exercise can cause a decrease in secretory IgA (6), which in turn can increase the chances of the person developing an infection.

So there are two mechanisms in which overtraining can increase the risk of developing an infection, which in turn can trigger autoimmunity.  The Th1 pathway is important to help prevent someone from getting an infection, but excessive exercise can shift the immune system towards a Th2 dominant state, which will make someone more susceptible to developing an infection.  In addition, excessive exercise can also lead to a decrease in secretory IgA, which plays a big role in providing protection against pathogens, including viruses.

The Impact Of Excessive Exercise On The Cardiovascular System

Although the focus of this post is on the risks that excessive exercise can have on the immune system, and how it can potentially trigger an autoimmune thyroid condition, there are other risks of overtraining as well.  Although there is no question that moderate cardiovascular exercise has some great health benefits, and that high intensity interval training can also be beneficial, too much exercise can cause harm to the cardiovascular system.  Excessive exercise can cause oxidative stress and increase the risk of atrial fibrillation, coronary artery disease, and malignant ventricular arrhythmias (7) (8).  So while it’s important to exercise regularly, you don’t want to overdo it.

Overtraining and Adrenal Insufficiency

The chronic stress that results from overtraining can also cause problems with the adrenal glands, and can even lead to adrenal insufficiency in some cases (9).  However, it appears that excessive exercise alone isn’t the only factor, as in order for adrenal insufficiency to develop it takes a combination of chronic overtraining along with a triggering stressful event (9).  But of course many people deal with a great amount of stress in their lives, and sometimes they use excessive exercise as a way of managing their stress.  In other words, someone who is dealing with a great amount of stress might initially feel better when overtraining, not realizing that they are actually worsening their health.

How Much Exercise Is Too Much?

The question you might have at this point is “how much exercise is considered to be too much?”  Well, further research is still needed in this area, but if you are engaging in moderate aerobic activity then you should be able to hold a conversation while exercising.  However, you might not be able to hold a conversation while engaging in high intensity interval training, although you shouldn’t be working out at a very high intensity for longer than a few minutes consecutively.  Just as a reminder, high intensity interval training involves short bouts (i.e. 30 seconds to a few minutes) of high-intensity exercise separated by one to five minutes of recovery (which involves either no or low intensity exercise).  Although doing this is fine in most healthy individuals, if someone participates in continuous high intensity exercise for prolonged periods of time (i.e. five minutes or greater) then this will increase the risk of causing problems with the immune system, cardiovascular system, and possibly other areas as well.

In addition, if you have a condition such as Graves’ Disease or Hashimoto’s Thyroiditis then you probably need to be extra cautious about overtraining, and in some cases even engaging in moderate exercise can cause problems.  For example, if someone has Graves’ Disease and has an elevated heart rate, then they need to be very cautious when doing any type of cardiovascular exercise.  This might seem obvious to many people, but I have worked with patients who had an elevated heart rate who asked if it was okay to engage in high intensity aerobic exercise a few days per week.  On the other hand, while someone with Hashimoto’s Thyroiditis might not need to worry about an elevated heart rate, if they have compromised adrenals then they will want to be cautious about engaging in vigorous exercise, even if they aren’t overtraining.  I mentioned earlier how someone who engages in excessive exercise and deals with a high amount of stress has a greater risk of developing adrenal insufficiency, and so it shouldn’t be surprising that someone who already has compromised adrenals will be doing more harm than good by overtraining.

In summary, while exercising on a regular basis is important and can provide many health benefits, exercising too much can do more harm than good.  With regards to the immune system, excessive exercise can cause an imbalance of the cytokines and decrease secretory IgA, which can increase the risk of developing either Graves’ Disease or Hashimoto’s Thyroiditis.  In addition, overtraining can have a negative impact on cardiovascular health, as well as the adrenals.  And so you need to be very cautious about exercising too much, and this is especially true if you have an autoimmune thyroid condition.

Note: This is the transcript from an interview I conducted with Dr. Izabella Wentz.  Dr. Wentz is the author of the book Hashimoto’s Thyroiditis: Lifestyle Interventions for Finding and Treating the Root Cause.

Dr. Eric: Hello everyone. I’d like to introduce you to our special guest, Dr. Izabella Wentz. She is a pharmacist who has dedicated herself to addressing root causes of autoimmune thyroid disease after being diagnosed with Hashimoto’s in 2009. She’s the author of the New York Times bestseller patient guide, Hashimoto’s Thyroiditis: Lifestyle Interventions for Finding and Treating the Root Cause. And she is an ardent champion of incorporating lifestyle change and functional medicine into the treatment of autoimmune disease.

How are you doing today Dr. Izabella?

Dr. Izabella: I’m doing great Dr. Eric and thank you so much for having me.

Dr. Eric: You’re welcome, and it’s great to have you. I really do look forward to interviewing you, and before asking you some specific questions I’d like to start by having you take a few minutes and explain your thyroid story and what motivated you to write your bestselling book.

Dr. Izabella: It’s kind of a funny story because people will ask me if I always had this big interest in the thyroid and I didn’t. When I was going through pharmacy school we learned about the thyroid gland and thyroid medications but it was just something that we learned in one day.

It was basically if you have a thyroid condition you take thyroid medications and that was it. I think there was some mention about it being autoimmune but nothing else besides that. And I was commonly dispensing thyroid medications when I worked in the community pharmacy and never realized the amount of suffering and pain people went through when they actually had thyroid disorders.

So I was diagnosed myself in 2009 and at that point I was fatigued, losing my hair, having joint pains, I had irritable bowel syndrome and all of these really strange symptoms that made me feel like my life was slowly falling apart. I went from being a relatively healthy person to where slowly my health was deteriorating and I was still in my 20’s. I went to my doctor who basically told me that I was getting older and losing my memory and hair, and gaining weight, and all these other things were part of getting older. Of course, I was only 26 at the time.

I eventually kept pushing and asking questions and going to different doctors, doctor shopping and trying to get some answers for all the symptoms I was experiencing. Then I was diagnosed with Hashimoto’s. At first I was relieved because I thought “okay, I have an answer to my problem and I can start on medication and I won’t be so tired anymore, and maybe I won’t be losing my hair”. But at the same time, the medication only helped a little bit and I was also interested in figuring out what I had done to develop this condition at such a young age because I thought I was leading a really healthy life. I was eating whole grains, low fat dairy, I was exercising and not smoking or drinking and I was just shocked. I wanted to know if there were any lifestyle factors that brought this condition on and if I could do anything to reverse or slow its progression.

And that’s how I got on this journey, I wanted to figure out if there was anything I could do on my own and I started digging for some answers and some lifestyle changes. One of the first things I discovered was the gluten free diet, which can make a drastic change in people in how they feel and look, and some people can actually put their condition into remission with a gluten free diet.

We went from there and my mom saw some improvements in my health. She’s a medical doctor trained in Poland and she told me that I needed to start writing things down so we can get this information over to my cousins and family members in Poland who had also been diagnosed. That’s kind of how the Hashimoto’s Patient Guide came to be. I was writing down things, I was researching and working on this to get myself better and I’m just really glad it’s been able to help other people as well along the way.

Dr. Eric: That’s a great story, and so from what I understand you were writing the book not necessarily to write a book, but to just write your own experience to benefit others and then turned it into a book?

Dr. Izabella: That’s kind of what was happening. When I was first diagnosed I had this brain fog like a lot of people do and I would research things on the internet, I’d go to the medical journals and get all of this great information and then I would forget it the next day. So it was really important for me to keep all of these things in a central place.

So the guide was kind of my own healing guide as well, and now it’s turned into that for other people.

Dr. Eric: Fantastic! Let’s get rolling with some questions. One of the questions I wanted to ask you is if you think it’s possible for the thyroid gland to regenerate if someone is able to suppress the autoimmune component of the condition?

Dr. Izabella: Absolutely, and I’ve seen it over and over again. So in some cases when people remove the triggers and they remove the root causes, or whatever is causing their immune system to attack their thyroid gland, thyroid tissue can regenerate. The challenging thing is that in different people it happens at a different rate. So one person may go gluten free and within 3 months they may need to start reducing their thyroid medications and get completely off their thyroid medications.

I collect a lot of remission stories from people on my website and we have a few people like that who basically changed their lifestyle and were able to get off thyroid medications because their thyroid function returned. Then we have other people who will do all of the right things and will see a reduction or even a remission in their thyroid antibodies but still may require the use of thyroid medications.

I wish there was a magic formula, and I used to think that it was younger people who had the condition for a shorter amount of time that were more likely to regenerate their thyroid tissue, but I’ve also had some people in their 50’s who have had the condition for 20 years who treated an infection they had and were able to get off thyroid medication. I don’t think there are any hard and fast rules, but definitely eliminating your triggers and supporting your body will help.

Dr. Eric: I agree. You first have to find and remove the trigger. And like you mentioned, I also haven’t noticed a set pattern. It can be someone who had the condition for a couple of years and someone else who had it for 20 years. Like you said, the person on thyroid medication for 20 years might able to get off the medication, whereas the person taking it for only a couple of years might be unable to.

And the challenge too, as you know, is if even if someone thinks they only had their condition for two years, chances are they’ve had it for quite some time. It takes time for the autoantibodies to be present and most of the time, as you know, they don’t test for the autoantibodies and usually they just do a thyroid panel. And so the autoantibodies might have been present five years prior to the TSH being affected and the person went through that time unaware of the condition.

Dr. Izabella: Yes absolutely! Some things that I found to be helpful is making sure you have your ferritin levels optimized, and have your adrenals optimized so that you’re not in a fight or flight mode, and you’re in a rest and digest mode, and just making sure you’re nourishing yourself properly.

Those are the things that are going to be helpful no matter if they help you get off thyroid medication or not. But like you said, it’s hard to prove, and some people will have thyroid antibodies for 10 or maybe 20 years before they actually start seeing a change in the TSH.

Dr. Eric: Exactly. Since you’re a pharmacist I want to ask you a few pharmaceutical questions. First, do you have a preference when it comes to patients with Hashimoto’s taking Armour vs. a compounded T4 or T3 product?

Dr. Izabella: I found that most people do very well with a combination of T4 and T3, and with Armour in a very, very small percentage of people. Some people might see an increase in thyroid antibodies with Armour, and so in that case I’d recommend doing the T4 and T3 compounded medication. Then we also might have potential problems with some of the fillers used in Armour. Some of the Armour products used to be corn-based, and some people who are very corn sensitive weren’t able to tolerate it. So in that case doing a compounded T4 and T3 medication may be beneficial.

The problem with compounded T4 and T3 medications is that they have to be made by specially trained compounded pharmacists. And you want to make sure the compounding pharmacist uses something called PCCA as a starter because thyroid medications are dosed in micrograms and so that’s like 1/1000th of a milligram. Most pills out there if you take Ibuprofen or Advil that’s 200 milligrams. So thyroid medications are dosed in 1/1000th of that and so it’s really easy to get the dosage wrong if you’re not using these specific starters that have the starting material very, very diluted. So that makes it very difficult to make the dose inaccurate.

If you go to your chain drugstore, even if they offer compounding medications they may not be doing them as accurately. So I’d always recommend working with a pharmacy that uses PCCA starters. Then making sure you ask for the medication to be prepared filler-free. A lot of times they can do that for you and make it gluten, dairy and soy free. There’s also 2 different types of fillers that can be used, Avicel and Methocel. And so the Methocel is extended release and some people with gut issues, which is mostly everyone with Hashimoto’s, may have trouble absorbing that medication.

I have seen people who were put on a compounded that was a suspend or release medication and they were not absorbing any of it. I would want to make sure you talk to your pharmacist about not including any kind of fillers that might impair the absorption of the medication.

Dr. Eric: What is the best way, in your opinion, to find a doctor who is willing to prescribe either Armour or compounded T4 and T3? Because most of them will just write a prescription for synthetic thyroid hormone medication such as Synthroid. What advice can you give with regards to finding a doctor who is more open minded to prescribe either natural thyroid hormone or the compounded thyroid hormone?

Dr. Izabella: Synthroid is the direct choice when you look at all the guidelines that most endocrinologists and physicians get. They’ll say that most people will do well on Synthroid and it’s the first drug you need to prescribe. There are some concerns, and back in the day Armour wasn’t standardized correctly. This hasn’t been an issue for many years now and the Armour and all of these other medications are going to be just as safe and potentially more effective for most people with Hashimoto’s.

I actually have a kind of pharmacist trick for this. In order to find a doctor in your area who prescribes this kind of medication then I suggest people work backwards and call their local compounding pharmacy, or call their local pharmacy, and I usually recommend working with independent pharmacies because the staff and people there actually want to take the time to get to know their customers, clients and patients vs. people who work in a community pharmacy, as they’re usually much more short staffed. If you’re working with the big chain boxes like CVS and Walgreens unfortunately people there don’t have enough time to interact with their patients.

So you call and ask them for a list of doctors in the area that prescribe these kinds of medications that you’re interested in getting. That will shorten your homework and research because when you just go through your insurance you’ll get a list of doctors and then you’d have to call each one and ask them if this doctor is open to prescribing these kinds of medications. Whereas, if you go through your pharmacy you’ll get a list of doctors that the pharmacists will know are good with exploring alternative thyroid medications and not just Synthroid.

For most doctors, if they haven’t prescribed something before then they’re not going to feel very comfortable with it because it’s a liability for them. And you probably don’t want to be the first patient they try on something either. So it’s good to go to a doctor who has a lot of experience with those kinds of medications.

Dr. Eric: You make an excellent point, because most people choose a doctor based on their insurance plan, and even if they don’t have health insurance they’ll just go to a doctor who is convenient. But starting with the pharmacist is probably a good idea. Even if you called some of the offices of the doctors, the doctor won’t actually speak with you. The receptionist will probably know what the doctor prescribes, but sometimes they won’t know.

So you might have to actually make an appointment to find out that the doctor’s only going to recommend Synthroid or another type of synthetic thyroid hormone. But that’s a good point to actually contact the pharmacist first and ask them for their list of doctors who will be willing to send you back to the pharmacist, and so that’s great advice.

Dr. Izabella: Just a little trick, right?

Dr. Eric: Yes, and thanks for that. I know you mentioned Armour with the fillers, but how about comparing Armour with Nature-Throid. Isn’t Nature-Throid a little more hypoallergenic than Armor?

Dr. Izabella: Yes, and so Nature-Throid is going to be a little bit cleaner and have fewer fillers compared to Armour. Then WP Thyroid which is made by the same company as Nature-Throid is going to be even cleaner and so that will have even fewer fillers.

So some people may react poorly to one of these medications, and I always want to make sure they’re reacting to the medication and not the fillers. So if they don‘t do well on Armour then they may want to consider doing something like Nature-Throid or the WP Thyroid medication, and that may absorb better for them. But if you’re someone who has a reaction to a filler in a medication, that may prevent you from properly absorbing the medication.

Dr. Eric: Okay that makes sense. WP Thyroid…is that the same as Westhroid?

Dr. Izabella: Yes, they kind of did this weird thing where they rebranded and what not, but yes, it’s through RLC Lab and that’s the new name they’ve had for the last 2 years or so. One thing about pharmacists is we always like our old names and so it’s taken awhile for me to call it that. But that’s a medication you can get that has fewer fillers and they call it WP Thyroid. They used to call it Westhroid Pure but there was some confusion with the other Westhroid and so it’s just WP Thyroid now.

Dr. Eric: Okay. For some reason I thought the ingredients were pretty much identical with Nature-Throid and Westhroid or WP Thyroid but it’s a little cleaner according to what you’re saying. So the WP Thyroid is cleaner than the Nature-Throid?

Dr. Izabella: Yes, and so it’s got even fewer fillers, and the fewer the better is my opinion on medications.

Dr. Eric: Great, and thanks for that as well. I commonly recommend the product Thytrophin PMG to my patients with Hashimoto’s and have done so for many years. I found it interesting that you mention it in your book. I wondered if this is also something you commonly use in your practice to help neutralize the effects of the thyroid antibodies?

Dr. Izabella: Yes, I found it very helpful. I’ve seen people reduce their thyroid antibodies by taking that supplement. It’s interesting because the science behind it is kind of weird. You try to look at the description from the company and basically what it says is that it neutralizes the antibodies and it helps to regenerate thyroid tissue and then it gives basically a blueprint for what a healthy thyroid gland is supposed to look like.

I kind of thought it was a very interesting mechanism of action but that’s all I was able to find on it. I tried it myself and have had clients who have tried it and most people have reported very positive results from reducing thyroid antibodies and feeling better. What has been your experience with it?

Dr. Eric: As I said, I’ve used it for a number of years and it does a pretty good job of neutralizing the effects of the antibodies. Of course it’s not removing the trigger, which is important to mention too. And just taking the Thytrophin PMG, if that’s all you do then it might minimize the effects of the immune system attacking the thyroid gland, but you still need to change your lifestyle and diet and try to find the trigger and remove it. But I’m still using it in my practice and recommend it to many of my patients.

Dr. Izabella: Good. I like to think of it as a decoy, right?

Dr. Eric: Yes.

Dr. Izabella: To distract the immune system from your actual thyroid gland while you work on all these other things. But it’s not something, like you said, that should be used on its own. Unfortunately, if there was a magic pill that’s not necessarily it.

Dr. Eric: I agree, and it’s good that you describe it as a decoy because from what I understand that’s what it does. The immune system actually attacks the Thytrophin PMG and so it’s just taking a lot of burden off the actual thyroid gland, thus allowing the thyroid tissue to regenerate as you were talking about. Once again, we do need to focus on removing the trigger, and so thanks for mentioning that as far as a decoy goes.

Obviously Hashimoto’s thyroiditis is an immune system condition even though some people perceive it as being a thyroid condition. In your experience, on average, and I know it varies from person to person, but how long on average does it usually take to rebalance the immune system once the cause of the condition has been addressed?

Dr. Izabella: It depends on the root cause. So for example, if someone had Celiac disease and that was their root cause, sometimes they get off gluten and dairy and within 3 months they don’t have any thyroid antibodies anymore and they start feeling amazing within a few days. I think that’s one of the best case scenarios where we identify the trigger and remove it right away.

With other things it can be progressive, and so let’s say if you have an H. Pylori infection that you treat. You might see a trend in reducing thyroid antibodies over the course of a few months but might not see the full effects for a year. But I’d say for every intervention, and I even recommend people to test their thyroid antibodies on a monthly basis when they’re actively doing different interventions trying to reduce them, you should see a trend of them going down in that first month.

Dr. Eric: I agree and ideally you want to see them consistently go down. Now sometimes I do see them fluctuate, but ultimately the goal is to get them where they’re going down and, of course, are eventually normal. Every now and then there will be someone who tests negative for antibodies the first time and then when you test them again they’re positive…so that’s another thing to bring up which you’ve probably have seen as well.

My point is that you can’t just go by one single antibody test if someone has an elevated TSH they get the thyroglobulin and thyroid peroxidase antibodies and both are negative. I’m sure you’ve seen where these might present as negative but then later on are positive. Have you seen that with some patients?

Dr. Izabella: Yes, absolutely and the thought is basically the autoimmune destruction of the thyroid may still be happening without any thyroid antibodies, and so that’s kind of one part of it. Then if your immune cells are out of balance and let’s say you don’t have enough white blood cells on board because overall your immune system is suppressed then you won’t be showing as many thyroid antibodies. As you get healthier and get a healthier level of white blood cells you might actually see a higher level of the thyroid antibodies as well, which some people might think is a negative but at the same time…you want to look at the whole picture.

How is the person feeling? If a person comes to me and they don’t have any thyroid antibodies and are feeling horrible, then of course we want to look at getting them to feel better and so we’re not going to say “well, your numbers look fine so I can’t do anything else for you”. And the reverse is also true, as if they’re feeling amazing and even if we see an increase in thyroid antibodies, of course we want to monitor that but we want to make sure that overall the first goal is to get the person to feel good, to get rid of their symptoms and then working on correcting all of the imbalances.

Dr. Eric: That’s an excellent point, as you have to look at the whole picture and not just the antibodies. As you said, if someone has antibodies that are decreasing but they’re still not feeling good, or for any reason they’re feeling worse, then obviously you want to address that. You’re not just treating the blood test results but you’re helping the person, and so that’s an excellent point there.

Let’s talk a little bit about selenium now. Can you talk about selenium and how it can potentially decrease thyroid autoantibodies in some cases? Perhaps you can discuss whether the average person can get enough selenium through food, or whether they need to take selenium supplements.

Dr. Izabella: Selenium is one of those things that I recommend for just about everybody with thyroid disorders. There are multiple studies that have shown that selenium can reduce thyroid antibodies in people with Hashimoto’s, and studies have also shown a positive effect on Grave’s Disease. Additionally, selenium has shown a positive effect on pregnancy and in preventing post-partum thyroiditis after pregnancy.

The different studies seem to show there’s a magic dose of it and so that’s going to be around 200 micrograms per day. A dose of 100 micrograms doesn’t work as well, and selenium is also one of those Goldilocks supplements that if you get too much of it, it can be toxic. So I will generally recommend anywhere between 200 and 400 micrograms per day of the selenium as a selenomethionine supplement.

The studies have shown that you’ll see a reduction of thyroid antibodies by about half at the 3 month mark. So if someone had 1,000 TPO antibodies, by taking the selenium they should see the antibodies drop to about 500. Selenium deficiency has been deemed as an environmental trigger for Hashimoto’s. What’s interesting is people with Celiac disease, people with Crohn’s Disease, people with any kind of irritable bowel issues are going to have a harder time absorbing selenium from their foods. As we know, the gut and thyroid are very much connected and this is a big thing that I always recommend for just about everybody in making sure they take a selenium supplement if they develop a thyroid condition.

Most multi-vitamins are not going to contain enough selenium in them and different things can impair its absorption. I can probably talk about multi-vitamins another time, but basically you put everything in one pill and all these different nutrients interact with each other for absorption and then you don’t end up absorbing anything when you take a multi-vitamin in a lot of cases. Some things do get absorbed but selenium absorption may not happen appropriately from the multi-vitamin.

I usually recommend taking the selenium supplement on an empty stomach in the morning. You do want to space your thyroid medications by about 30 minutes if you take those. What I’ve seen with clients is a lot of times they’ll say they feel a lot less anxious and their mood is going to be improved once they start taking a selenium supplement. If they’re monitoring their thyroid antibodies they’re going to see a reduction in their thyroid antibodies with that.

Another interesting thing to note that I just learned a couple of years ago is that gluten free diets, which are of course another big recommendation for people with Hashimoto’s, may make a person deficient in selenium as well. Some of the richest sources of selenium may include grains, as well as Brazil nuts. I know a lot of people have said they’ll take Brazil nuts to get their daily selenium dosage, but the only issue with that is that the content of the selenium in the Brazil nut is going to depend on where the Brazil nut was grown. If it was grown in a selenium rich soil it’s going to have more selenium, and if it’s grown in a soil that doesn’t have enough selenium then it’s not going to have an adequate dose of selenium. So people can actually under or over dose themselves with Brazil nuts given that we really don’t know how much selenium is in them.

A lot of times I’ll say to try to get most of your nutrients from food, but with selenium, because it’s such an important nutrient for thyroid function and because it has a neuro therapeutic index I’ll say skip the Brazil nuts and take a selenium supplement.

Dr. Eric: To summarize you said the average dosage would be between 200 and 400 micrograms. Is that correct? And then selenomethionine is typically what you recommend?

Dr. Izabella: Yes, that’s usually going to be my recommendation. Most people will do very well with that and the only exception is if someone is both iodine and selenium deficient, which is not very common, but selenium deficiency might exacerbate an iodine deficiency and so that would be the only thing.

So if you’re someone who reacted poorly to a selenium supplement and probably out of 1,000 people I’ve seen maybe one person like that, then there is a potential you may be iodine deficient.

Dr. Eric: I also found it interesting that you recommend taking it on an empty stomach because usually I recommend taking it with food. So I need to test it on an empty stomach with my patients and see if there’s a difference with the effectiveness. So you said to take it in the morning without food, such as a half hour after thyroid medication if they’re taking thyroid medication?

Dr. Izabella: Yes. I used to recommend it with thyroid medication and I had a couple of people, and I don’t know if their selenium had some calcium in it, the supplement they were taking had calcium and then that person reported that their TSH numbers got a little off balance. Now I recommend spacing it out about 30 minutes from the thyroid medications just to be sure. Thyroid medications are very finicky with absorption.

Dr. Eric: I agree with spacing it out and not taking with the thyroid medication. I haven’t given it to my patients on an empty stomach and so it’s something I’m going to test and see.

Dr. Izabella: Okay.

Dr. Eric: So just to clarify, if someone is on thyroid hormone medication you have them wait a half hour, they take selenium and then do you have them wait another half hour until they have breakfast?

Dr. Izabella: Basically, first thing when you wake up you’d take your thyroid medication and then you’d wait about 30 minutes to take your selenium and then wait another 30 minutes. I used to also recommend just waiting 30 minutes for thyroid medication but I found that not most people, but a lot of people actually need that hour before starting to eat because, like we said, thyroid medication can be finicky with their absorption.

Dr. Eric: Let’s talk about goitrogenic foods. Do you believe that people with Hashimoto’s should completely avoid goitrogens such as soy, and other goitrogens such as cruciferous vegetables?

Dr. Izabella: That’s such a great question and it’s one of those myths I like to bust. The word goitrogen is an old kind of word and it’s used to describe basically things that can enlarge the thyroid gland, but it can be done by a lot of different mechanisms.

Unfortunately, they’ve put these wonderful Brassica vegetables into this category like broccoli and cauliflower. A lot of people with thyroid disease think they can absolutely not have any broccoli which isn’t true. Basically, there’s a compound in these vegetables that could potentially interfere with iodine absorption into the thyroid gland. Well, if people are already taking thyroid medications or they have Hashimoto’s, iodine deficiency is sometimes the root cause, but in most cases it’s not. So usually eating these vegetables is not going to be an issue for most people.

I’ve just done a survey of about 2000 people with the kinds of foods they react to and what kind of reactions they were having with their foods. There was a huge percentage of people who reacted to gluten and dairy and soy and those kinds of foods, but as far as broccoli and cauliflower and foods like that, very few people reported that they actually reacted to those foods.

What I would suggest is that if someone isn’t on thyroid medication and is subclinical hypothyroid and maybe has an iodine deficiency, they may find that these vegetables slow things down for them a little bit more. So in that case you would just have to see them to break down the goitrogenic compound. But other than that, most people with Hashimoto’s can eat plenty of veggies. And so eat plenty of broccoli and cauliflower, raw or steamed or whatnot, it will be helpful with detoxification.

The only exception, of course, is soy. Soy works as a goitrogen because of a different mechanism, and so it interacts with thyroid peroxidase. They did studies in children who were fed a soy formula instead of breast milk and found these children were more likely to develop thyroid antibodies later on in life. So soy has been connected to Hashimoto’s and potentially inducing Hashimoto’s. So that’s one thing I definitely recommend avoiding.

In contrast, things like dairy or gluten, where people will often feel it in their stomach or gut when they eat this food. You may not have that kind of reaction to soy, but a day or two later after you eat it you might feel a little edgy or feel really tired. That’s because of its way of acting on the thyroid gland. So for most people with Hashimoto’s I recommend staying away from soy.

Dr. Eric: Yes, I agree. A few years ago I actually wrote some articles talking about goitrogens and I was telling people to minimize their consumption of goitrogenic foods. But that was not due to any research I did, but was based on information I learned from nutritional conferences I attended, and people who I perceived as being experts in thyroid health telling their patients not to eat goitrogens.

But then the more research I did and have done over the years I just realized that pretty much all of the studies have been on animals with regards to cruciferous vegetables, and usually involve large doses. Every now and then you’ll get a person who says when eating broccoli their thyroid swells. And like you said, if someone notices a difference they might want to ease up, but these are very healthy foods. So to deprive people of broccoli, kale and cauliflower… I think most people can definitely eat these foods without a problem.

And with soy, besides the goitrogenic properties, most soy is genetically modified. But even if you’re consuming non GMO fermented soy you still have to deal with the goitrogenic properties, and it also has some anti nutrients which also is a factor. So I agree with you about trying to not eat, or to limit the consumption of soy. Thanks for sharing that.

You’ve mentioned iodine a few times briefly so I want to talk a little more about iodine as far as some of the risks and potential benefits of iodine intake, and whether you think people with Hashimoto’s should completely avoid iodine, or if taking a small amount of iodine is okay.

Dr. Izabella: Wow we’re covering all the myths and controversies today. With iodine I know there are a lot of advocates out there who will say that high dose iodine can be very, very helpful for every thyroid disorder. I’m not going to disagree with that. I think everybody has to do what’s right for them, and iodine can help people with thyroid disorders.

The issue with Hashimoto’s, however, is that your thyroid gland, which is supposed to process iodine, is actually impaired. So when you give a person with Hashimoto’s who has an inflamed thyroid gland more work to do by giving it more iodine that can cause further inflammation.

In surveying my clients and readers about this…I’ll give you an example. About 80% of people said that going gluten free made them feel better and nobody said it made them feel worse. With high dose iodine I had about 25% of people saying it made them feel better and then 25% of people said it made them feel worse. So it’s kind of dangerous, I think, to be recommending it when you don’t really know and are just playing a guessing game, because for some people it may help them feel better and it may help especially if they’re iodine deficient and so you give them a high dose and it may actually make them feel better.

But then you have the other half of the people, which happen to be a lot of clients I’ve seen and I always try to recommend something safe first and safety is always my big thing. Let’s make sure everything is safe. And I’ve had clients who on their own or working with other practitioners they took very high doses of iodine and some had their thyroid antibodies skyrocket, going from a 200 or 300 range to the multiple thousand range. One woman’s TSH jumped to 98 and her T4 was at like zero, believe it or not, and she was bedridden because of the high dose of iodine.

I get super nervous about it, about these high doses of iodine, and studies have shown that it can accelerate thyroid tissue damage. On the other hand, the dosages you would get in a multi-vitamin is something like 150 micrograms. These dosages will actually be safe for most people with Hashimoto’s and will be helpful and they haven‘t shown any increase in thyroid antibodies when you just take a very tiny low dose of 150 micrograms per day, which is the recommended daily allowance.

Other studies have shown that people who actually go on an iodine restriction with Hashimoto’s may be able to improve their thyroid function as well. Where I am with that is for most people I’ll recommend working on these. I usually try to work on the things I know are very safe and very effective like the gluten free diet. Then if we’re still working with some of these issues then we may recommend a multi-vitamin. If someone has been on this super high dose iodine then I may recommend that person to just try to repair the damage and get off iodine for a short term period.

I wish I had a straightforward answer to say this is what we do every single time, but it’s not always so easy, and as you’re well aware there are a lot of different nutrients that act in synergy with one another. I always want to make sure everyone has their selenium on board, they’ve got their B vitamins and vitamin C on board and all these other things before we move on to the iodine. And iodine wouldn’t be a first level recommendation, it would be something like…okay we’re still struggling and we did this gluten free diet and we tried to address any infections and we’re still struggling…what else can we do?

But that is my stance in a nutshell for Hashimoto’s.

Dr. Eric: That’s great. I’m probably more pro iodine than you, but I’m also cautious with iodine, and I agree with you that some healthcare professionals will recommend high doses of iodine to all of their patients, or some people will take on their own a 50 milligram tablet of Iodoral daily without any testing. Some people will do fine, but some people don’t do well, and there’s really no way to predict who will do well and who won’t, and so I am cautious. And when I do recommend iodine I recommend testing, and even if someone is deficient I’ll recommend smaller doses and not have someone start out with very high doses. I usually don’t ever have people reach that high of a dose as I just mentioned such as 50 milligrams. So thanks for sharing that with us.

Alright, the last question I wanted to ask has to do with some of the common infections you see with your patients.

Dr. Izabella: For me, when I think about Hashimoto’s in general it’s in two parts, and one part is that your body is in a weakened state because maybe you’re nutrient deficient and/or maybe you’re eating foods you’re reacting to. Or maybe you’re under a lot of stress, or maybe you’ve been exposed to toxins, and that’s one thing that a lot of the lifestyle factors can address by getting you the right nutrients, getting you on the right diet, by taking supplements or doing some detoxifying.

The other part is the chronic infections. There’s a theory of autoimmunity called Molecular Mimicry where basically what is happening in very simple terms is that the immune system begins to recognize our thyroid glands as a foreign invader because there’s something else in our body that has invaded our body that looks similar to the thyroid gland. So different bacteria, viruses, potentially parasites might have protein structures that are similar to the thyroid gland, and so as the immune system… I like to think of it as walking around with a little IPhone and it takes a little picture of the protein sequence and then when it sees a similar protein sequence it will start attacking.

So there are a few different infections that have been identified as having a similar sequence to Hashimoto’s. H. Pylori and Yersinia are similar to the thyroid gland and have been identified. The most common infections that I’ll see are going to be H. Pylori, Epstein Barr Virus, and then parasitic infections in the gut. And so blastocystis hominis is a very common one too.

What we’ll find a lot of times is when you identify and treat that infection the person will feel better and in some cases they will see a reduction in thyroid antibodies and in some cases you’ll see the person going into remission. Those are the most common infections and I recommend doing stool testing. There is a company called BioHealth Labs that does the H. Pylori test and they also test for blastocystis hominis and you can have your doctor run a Epstein Barr virus panel. Most people have had Epstein Barr virus infections but they can become reactivated in people with Hashimoto’s and sometimes can keep the autoimmune response happening when they’re infected with that.

But research has connected so many different infections, and many are looking for that one infection, but it’s not always that one infection. I think it’s a combination of genes and maybe not having the right kind of natural flora, and the infection will determine what kind of disease you get.

Dr. Eric: With the stool testing, especially for parasites, do you typically have patients collect a stool sample on multiple days, such as collecting 3 or 4 different stool samples to increase the accuracy?

Dr. Izabella: Yes, that’s a really important question because a lot of times people will say I had a stool test and it was negative and they may have just had one stool test. The important thing to note is that the parasites may not shed in every stool or in every bowel movement, so the more stool samples you do the better your chances are at catching the parasites. So I actually recommend doing at least 4 stool samples on 4 consecutive days. You can also half that by doing it over 8 days where you put a little bit of a stool sample into each vial where you put 2 days worth of stool into one vial and that way you have a higher likelihood of potentially picking up the gut parasite.

I know this sounds nasty and gross and I didn’t want to believe it myself because we think we live in the Western world and we don’t have these kinds of things but it’s very common in people to have gut parasites and gut infections. They can then lead to all kinds of problems such as irritable bowel syndrome and having multiple food sensitivities, which then increases the antigenic load in Hashimoto’s.

Dr. Eric: Okay. One last question relating to the infections: do you take more of a natural approach, or do you prefer antibiotics, or does it depend on what type of infection?

Dr. Izabella: I’d say it depends on the person and it depends on the infection too. So whenever I write about it or I talk to clients about it I always want them to work with their own physicians and healthcare practitioners and I’ll give them a list of recommended therapies. So you may take a medication and then follow it with herbs, or you may take just the medication or just the herbs. I just give people some information on what some of the more effective ones that I know of and let them take this information to their doctor and make the decision on their own, because some people feel much more comfortable with antibiotics and others don’t feel comfortable with them at all. And there are certain infections that may not be susceptible to herbs, or it may take a really long time to eradicate them the herbal way of 2 to 3 months vs. 2 to 3 days on a medication.

So it’s different drugs for different bugs as I like to think of it.

Dr. Eric: I like that. Different drugs for different bugs. Thanks Dr. Izabella for answering these questions and I’m sure everyone found this information to be useful.

What I’d like you to do now is take a few minutes and talk about your excellent book, Root Cause. I’m sure many people reading this blog post have already read it, but I’m sure there are some who haven’t read it. So if you can talk a little bit about your book.

Dr. Izabella: Sure, and I think it has the longest title ever. It’s called Hashimoto’s Thyroiditis: Lifestyle Interventions for Finding and Treating the Root Cause. It’s available on Amazon. If you look for Hashimoto’s Root Cause or Izabella Wentz you’ll find it.

Basically it’s a patient guide to help people find out what the root causes and triggers may be and it gives people information on lifestyle changes they can start implementing on their own. So supplements they can take and different nutritional things they can do on their own, as well as more information so they can take it to working with doctors like yourself.

I think it’s really important for people to be empowered and be their own health advocates and be on board with what’s happening within their own bodies. And working with a physician is excellent but you don’t want the change to come from you because you can tell a person what to do and you have all this wonderful knowledge and experience with patients over so many years, but it’s really up to the patient to do it right in many cases.

Dr. Eric: Yes.

Dr. Izabella: To change their diets, to take that supplement and take that test. So the Patient Guide is all about how to figure out what’s going on with your body and the things you can do on your own to get yourself better.

I have a website too and its www.ThyroidPharmacist.com and I have lots of great information on there. I try to write a new blog post every week. I’m a big research nerd and so I’m always researching different types of infections and different root causes. As we both know, it’s not always the same thing for every person that triggers their Hashimoto’s but at the same time there are a lot of universal things that we can recommend that will help most people feel much better.

Dr. Eric: Great, and for anyone listening who hasn’t read her book I would definitely get it. I’m not saying that just because I’m interviewing you, but it is one of the best books I’ve ever read on Hashimoto’s. It’s one of those must reads for anyone with this condition.

Dr. Izabella: Thank you so much for that. I forgot to mention I also have a free book chapter if people go to www.ThyroidPharmacist.com/gift they can get the Nutrient Depletions and Digestions chapter and get a gluten free quick start diet as well as some recipes. When I first tried to go gluten free I did it all wrong. I was eating all this junk food and setting my blood sugar on fire.

Thank you so much for having me and I hope everybody found this information helpful.

Dr. Eric: Great and thank you again Dr. Izabella for sharing this information. Again, visit ThyroidPharmacist.com/gift for the free chapter in her book and ThyroidPharmacist.com for the weekly blog post. Then go to Amazon if you want to read the book which I highly recommend.

Again, thanks again for doing this interview. I thought it was great and I’m sure everyone has benefited from this information.

Dr. Izabella: Thanks so much Dr. Eric.

Dr. Eric: Thank you.