When someone gets a dental implant, it is commonly made out of titanium.  And titanium is also used in other procedures, as some hip replacements use titanium alloys.  While many people with these implants seem to do fine, some people have asked whether titanium can be a trigger for Graves’ Disease, Hashimoto’s Thyroiditis, or another autoimmune condition.

Before I answer this, you might wonder why titanium is commonly used in the first place.  One reason why it is commonly used is due to its high resistance to corrosion (1), which obviously is very important.  Another reason is because most people seem to have a low sensitivity to titanium when compared to other metals.  In fact, one study showed that all casting alloys seem to have a potential for eliciting adverse reactions in individual hypersensitive patients, although it listed titanium as being a possible exception (2).  However, as I’m about to discuss, some people do in fact react to titanium, and of course this can be a big problem for someone who has a dental implant, or titanium as part of a hip or knee replacement.

Why Is Titanium Problematic In Some People?

Although most people don’t have a problem with titanium implants, a small percentage of people are sensitive.  A clinical study involving 1,500 people who received dental implants showed that nine of these patients demonstrated a titanium allergy (3).  The good news is that only 0.6% of these patients experienced problems with the dental implants.  On the other hand, if titanium can lead to certain chronic health conditions, then even a small percentage o f negative reactions might be too high.  Another study involved fifty-six patients who developed clinical symptoms after receiving titanium-based implants, and 21 of these tested positive for a titanium allergy, with another 16 showing ambiguous results (4).  Sometimes someone will experience symptoms caused by these implants but they won’t make the connection, and many times their doctors also won’t be able to figure this out..

For example, a few years ago it was revealed that the actor Dick Van Dyke had experienced severe headaches which affected his sleep and caused chronic fatigue.  Over a seven year period he saw numerous healthcare professionals, received a CAT scan, MRI, and a spinal tap, along with other tests, but everything came back negative.  It wasn’t until his dental implants were removed that he finally received relief from his symptoms.

Once again, most people do fine with titanium implants.  But these patient experiences I mentioned show that in some cases, titanium can lead to severe symptoms.  In some cases the symptoms can be debilitating.  And many times people live with these symptoms for years before it is figured out that the problem is due to titanium.

Can Titanium Trigger Autoimmunity?

There is no concrete evidence that having titanium implants can trigger an autoimmune response.  However, this doesn’t mean that it’s not possible, as other metals such as mercury and nickel have been associated with thyroid autoimmunity (5) (6).  As a result,  if someone with Graves’ Disease or Hashimoto’s Thyroiditis was diagnosed with their condition after getting an implant which consisted of titanium, then this is a factor that should be considered.  Of course it can be difficult to make such a connection, as someone can be in the “silent” autoimmune stage for years, which means they might have elevated antibodies for many years, yet no positive tests or symptoms.  As a result, even if someone with an autoimmune thyroid condition began presenting with symptoms shortly after getting a titanium implant, this doesn’t necessarily mean the implant was responsible for the development of their condition.  With that being said, if you have a titanium implant and then developed an autoimmune thyroid condition, then it might be worth doing some testing to see if you have a sensitivity to titanium.

What Other Options Are There?

Before someone gets a dental implant, or a hip or knee replacement which involves titanium, it probably would be a good idea to get a metal allergy assessment along with some allergy testing.  Skin testing is an option, as the sensitivity of patch tests has been shown to be about 75% for a type IV metal allergy, although so far no study related to dental implant allergies has used this method (7).  A lymphocyte transformation test is another option, although false-positive results are possible (7).  There is also a Memory lymphocyte immuno-stimulation assay (MELISA) test (8), which can determine if someone has an allergy to a metal such as titanium.  In my opinion it should be routine to get such testing before getting a metal implant.

Another option is to use something else other than titanium.  Zirconia is a ceramic and is an option to consider.  It has been used to replace hip joints, and can also be an option to consider with dental implants.  However, even though one is less likely to be sensitive to zirconia, a sensitivity is still possible.  But if I were getting a dental implant I probably would choose a zirconia implant over a titanium implant.

In summary, although many people do fine with titanium implants, there are some people who have a titanium allergy.  And in some cases titanium can cause severe symptoms.  Although there is no research which shows that titanium can trigger an autoimmune thyroid condition such as Graves’ Disease or Hashimoto’s Thyroiditis, if someone received a titanium implant and then developed an autoimmune thyroid condition, it might be a good idea to do some testing to see if they have a sensitivity to titanium.  For those who are sensitive, zirconia can be an alternative option to consider.

Millions of people have thyroid and autoimmune thyroid conditions, and while most of these people won’t consider natural treatment methods, more and more people are choosing a natural treatment approach.  But sometimes it can be confusing to know what type of healthcare professional you should see for your condition.  And so the goal of this post is to discuss the different types of healthcare professionals so that you can be better informed when choosing one to help restore your health.

Before I discuss the different types of natural healthcare professionals I want to mention a few things.  First of all, you ideally want to work with someone who has a lot of experience with thyroid and autoimmune thyroid conditions.  This is especially true if you have hyperthyroidism or Graves’ Disease, but it’s also a good idea for those with hypothyroidism and Hashimoto’s Thyroiditis.  Although some “general” practitioners can help people with these conditions, autoimmune thyroid conditions can be very complex at times.  It can even be challenging for someone like myself who focuses on these conditions, let alone a healthcare professional who sees someone with an autoimmune thyroid condition every now and then.

How Can You Find A Natural Healthcare Practitioner Who Focuses On Thyroid Health?

But how can you know for certain if someone is an expert in thyroid and autoimmune thyroid conditions?  Well, there are a few different ways to find out.  One way is to simply call the office and ask the staff person to name the top three conditions the doctor focuses on.  If one of these conditions isn’t thyroid or autoimmune thyroid conditions then I would call another office.  Another option is to do a Google search for the doctor’s name and check out his or her website to see if they really do focus on thyroid conditions.  Keep in mind that just because they have a website which focuses on thyroid health doesn’t mean their entire practice focuses on this condition, as some healthcare professionals will have multiple websites, each focusing on a different condition.

So for example, if you visit Google and type in “Eric Osansky” or “Dr. Eric Osansky”, pretty much everything will relate to thyroid health, as on the top of the page the website www.naturalendocrinesolutions.com will be listed, my book on hyperthyroidism and Graves’ Disease should be there, etc.  And if you call my office and ask either of my assistants Cindy or Kate which condition I focus on they will say thyroid conditions.

Also, if you have hyperthyroidism or Graves’ disease it will be more challenging to find a natural healthcare professional who has a lot of experience working with hyperthyroid conditions.  It is far more common to find someone who has experience working with hypothyroidism and Hashimoto’s Thyroiditis.  And the reason for this is because many natural healthcare professionals are uncomfortable working with people who have hyperthyroid conditions due to the high pulse rate and heart palpitations most people with hyperthyroidism experience.

With that being said I’d like to go ahead and discuss some of the more common natural healthcare professionals to choose from:

Medical doctor who practices functional medicine.  The main advantage of working with a medical doctor who practices functional medicine is that they are able to prescribe medication.  So for example, if someone with hypothyroidism prefers to take natural thyroid hormone medication and their endocrinologist is unwilling to prescribe this, many medical doctors who practice functional medicine are willing to write a prescription for Armour or Nature-Throid.  With regards to hyperthyroidism and Graves’ Disease, even though a medical doctor who practices functional medicine can prescribe antithyroid medication and/or beta blockers if necessary, many will feel uncomfortable working with hyperthyroid cases and will insist on the person working with an endocrinologist.

Another advantage of working with a medical doctor who practices functional medicine is that they are usually more open to doing things to address the cause of the condition.  Whereas most medical doctors won’t even want to talk about nutrition, a medical doctor who practices functional medicine will usually encourage you to eat well, will give dietary suggestions and supplement recommendations, and will give other lifestyle recommendations to help improve your health.  Yet if they feel that medication is necessary they have the ability to prescribe what you need.  For example, if someone has a severe Candida infection they can prescribe an antifungal medication such as Nystatin, and at the same time give dietary recommendations and other advice to help address the cause of the problem.

However, there are a few potential downsides of working with a medical doctor who practices functional medicine.  First of all, just because they claim to practice functional medicine doesn’t mean they truly do so.  For example, a doctor might have attended a few functional medicine conferences and as a result labels themselves as a functional medicine practitioner, even though they don’t have much experience practicing functional medicine.  Finding a medical doctor who has gone through a functional medicine certification program will make it more likely that he or she is truly a “functional medicine practitioner”.  However, even this doesn’t guarantee that the doctor will be competent in functional medicine, as while passing a certification exam is great, the real knowledge is gained by applying what they learned in their practice.  In fact, while I’m proud of the degrees and certificates I have obtained, the only way someone is going to become truly competent is not by obtaining degrees and certifications, but by applying what they learn in practice.

Another potential downside is that some medical doctors who practice functional medicine rely too much on prescription medication.  Remember that many of these medical doctors were practicing conventional medicine for many years before they decided to learn about functional medicine.  While it’s fine to prescribe thyroid medication and other types of drugs when necessary, some medical doctors will recommend prescription drugs more frequently than they should.  Although one of the main benefits of working with a holistic medical doctor is that they can prescribe medication if needed, you of course want to make sure they try to address the cause of the problem, and not just recommend a different drug for each symptom that you have while making a few natural recommendations.

Naturopath.  Out of all of the different types of natural healthcare professionals, naturopaths who have attended an accredited naturopathic college are the most prepared to help people naturally upon graduating from school.  Most medical doctors don’t learn about nutrition and functional medicine while in medical school, as they need to learn this information after graduating.  Chiropractors do learn some nutrition while in chiropractic school, but in most cases it’s not comparable to the training received by naturopaths.  This isn’t meant to be a knock on chiropractors, as most people reading this know that I’m a doctor of chiropractic, and I’ll be talking more about chiropractors next.

But getting back to naturopaths, if you can find one who has a good amount of experience working with thyroid and autoimmune thyroid conditions then this can be a very good option.  And for those with hypothyroid conditions, in some states naturopaths are able to prescribe thyroid hormone medication.  This of course is great for those who need to take thyroid hormone medication, as if they are able to see a naturopath who can prescribe thyroid hormone medication then they don’t need to see two separate doctors.  In fact, if given the choice between seeing a medical doctor who practices functional medicine and a naturopath, both who have been in practice for an equal amount of years, in most cases I would go with the naturopath.

However, this doesn’t mean that all naturopaths are competent with regards to thyroid and autoimmune thyroid conditions, or other types of conditions.  For example, a few years before I began focusing on thyroid and autoimmune thyroid conditions I had hired a recent graduate of an accredited naturopathic college (Bastyr University) to help me with the nutritional aspect of my practice.  At the time she was more competent than me with regards to nutrition, but her lack of experience showed.  Obviously everyone has to start somewhere, as the only way to get experience is to actually work with patients.  And so I’m not suggesting that someone who recently graduated from naturopathic school can’t help a person with a thyroid or autoimmune thyroid condition.  All I’m saying is that many times experience does matter.

Chiropractor.  As I mentioned earlier, while chiropractors take some nutrition classes in chiropractic school, they don’t graduate with the same amount of knowledge in nutrition and herbal medicine as naturopaths.  This isn’t surprising, as a chiropractor’s main focus is to balance the nervous system by correcting vertebral subluxations.  However, a lot of chiropractors improve their knowledge of nutrition and functional medicine upon graduating.  And so while in most cases they don’t have the same amount of knowledge as a naturopath upon graduating from chiropractic school, they do have more knowledge in nutrition than most medical doctors.

However, many practicing chiropractors will attend nutritional seminars, and they might sell supplements in their practice, but some don’t really have a good understanding of nutrition and functional medicine.  Don’t get me wrong, as there are some chiropractors who have a great deal of knowledge and experience in nutrition and functional medicine.  But many will learn the information without applying it in practice.  In fact, some chiropractors will attend nutritional seminars mainly to fulfill their continuing education requirements, even though they don’t utilize much nutrition in their practice.

In addition, while some chiropractors like myself do have a lot of experience working with thyroid and autoimmune thyroid conditions, other chiropractors have “thyroid websites”, but don’t have much experience working with people who have thyroid conditions.  In other words, some chiropractors have a main practice website, but then have a separate “thyroid health website” which gives the impression that their practice focuses on thyroid conditions.  But if you were to call the phone number listed on their main website and ask the receptionist to list the top three conditions the chiropractor focuses on, there is a very good chance that “thyroid conditions” won’t be one of them.  And so you need to be careful, as some people have paid a lot of money for “thyroid programs” by chiropractors who didn’t have much experience working with thyroid conditions.

Once again, there are chiropractors who truly do have a lot of experience working with thyroid conditions.  And so I’m not suggesting that every chiropractor with a “thyroid health website” isn’t truly a “thyroid expert”.  All I’m saying is that you need to do your research, and while someone who is very knowledgeable about thyroid health might be able to do a good job of screening natural healthcare professionals to determine who truly has experience working with thyroid conditions, many people aren’t able to figure out the difference between an expert and an amateur.

Different type of natural healthcare professional (i.e. acupuncturist, etc.).  Other types of natural healthcare professionals can also be competent with regards to thyroid health.  For example, some acupuncturists are more knowledgeable than holistic medical doctors and chiropractors with regards to nutrition and functional medicine.  And so just because someone isn’t a doctor doesn’t mean they don’t have the knowledge and experience to help you.  The challenge is finding out whether the person is truly competent.

Credentials Are Important, But Experience Is Even More Important

When I first began helping people with thyroid and autoimmune thyroid conditions, the only credentials I had was being a doctor of chiropractic.  And as I mentioned earlier, just being a chiropractor doesn’t mean that someone is competent in nutrition and functional medicine.  At that point most of my knowledge was obtained through my own personal experience with an autoimmune thyroid condition, along with attending nutrition seminars and conferences, but over the years I felt it was important to obtain additional degrees and certificates related to nutrition and functional medicine.

But even though having numerous degrees and certifications looks impressive to some people, it really is the experience that matters the most.  While I have learned a great amount of information getting my degrees, certifications, and attending seminars and conferences in nutrition and functional medicine, applying this information over the years is what has made me competent.  In other words, while it’s great to learn new information, the information is much more valuable if you apply it in practice.

For example, every now and then a patient will ask me about essential oils, and I admit that this is an area where I’m not competent in.  I did attend an essential oils summit recently, but even if I went through an “essential oils” certification program this still wouldn’t make me “competent”, although it probably would greatly increase my knowledge on the topic.  But in order to truly become competent I would need to start taking essential oils and recommending them to my patients, and then over a period of months and years I would become more and more competent in this area.

And the same concept is true with regards to nutrition, Chinese herbs, functional medicine, etc.  While there are plenty of books, seminars, and even certification programs on these topics, one doesn’t actually become competent until they have applied in practice what they have learned over a period of months and years.  So when choosing a natural healthcare professional for your thyroid or autoimmune thyroid condition, while it’s understandable to choose someone based on their credentials, you ideally want to make sure to choose someone who has a decent amount of experience helping people with these conditions.

Eggs are very nutrient dense.  As a result, if someone likes to eat eggs and can eat eggs without a problem then it makes sense for them to eat eggs.  However, eggs are not part of an autoimmune paleo diet, which would suggest that those people with autoimmune thyroid conditions such as Graves’ Disease and Hashimoto’s Thyroiditis should avoid eating eggs.  But why is this the case, and does this mean that people with these conditions need to avoid eggs while trying to restore their health back to normal?

Before answering this question, let’s look at the reasons why eating eggs might cause problems in some people with an autoimmune thyroid condition, as well as those people with other autoimmune conditions.  First of all, regardless of whether someone has an autoimmune condition or not, eggs are a common allergen.  However, most egg allergies are in infants and young children (1) (2), although overall most infants and children don’t have egg allergies.  Keep in mind that there is a difference between a true egg allergy and an egg sensitivity.  An egg allergy is usually IgE-mediated, but it’s usually not as serious as other IgE-mediated allergies such as peanuts.

Whereas IgE-mediated allergies are immediate, IgG egg sensitivities involve a delayed reaction.  What this means is that if someone has an IgE-mediated egg allergy and eats an egg, they will experience a reaction almost immediately.  On the other hand, someone with an IgG-mediated egg sensitivity can take a few hours or even a few days before having a negative reaction.  And just because someone experiences a “negative reaction” doesn’t mean they will present with overt symptoms.

Why Eating Egg Yolks Might Be Better Than Eating Egg Whites

In addition to someone having a possible egg allergy or egg sensitivity, there are compounds in egg whites which can have a negative effect on gut health, specifically a protease called lysozyme.  Sarah Ballantyne, author of the excellent book “The Paleo Approach”, has an article on eggs which discusses the problems with lysozyme.  Lysozyme is a proteolytic enzyme with 129 amino acid residues, and it’s also produced in mucosal secretions such as saliva and tears (3).  In her article, Sarah explains how “lysozyme has the ability to form strong complexes with other proteins”, and how it is “resistant to digestion by our digestive enzymes”.  She also explains how when lysozyme passes through the intestinal barrier, other proteins can bind to it and pass through into the blood stream, where they shouldn’t be, and therefore can trigger an immune system response.  So essentially the problem isn’t with lysozyme itself, but the protein complexes it forms, which in turn pass through the cells of the small intestine.  Another disadvantage of egg whites is that it has a glycoprotein called avidin, which binds to biotin and can prevent its absorption (4) (5).  However, this is only an issue when eating raw egg whites.

Although eating egg whites can be problematic due to the reasons just given, some people with autoimmune conditions such Graves’ Disease and Hashimoto’s Thyroiditis are able to eat egg yolks without a problem.  The reason is because while some people still might have a sensitivity to egg yolks, the yolks don’t have compounds which will have a negative effect on gut health.  As a result, if someone doesn’t have an egg allergy or sensitivity then they might be fine eating egg yolks, although they might not do well eating egg whites.  I usually recommend for my patients with autoimmune thyroid conditions to completely avoid eggs while trying to restore their health, but if someone is struggling with the diet after one or two months I’m usually fine with them reintroducing eggs.  As long as their health continues to improve then of course I have no problem with them continuing to eat eggs.  And based on the information I presented in this post it might be best to start with egg yolks, although I’ve had patients eat the egg whites as well and still do fine.

Can One Test For An Egg Allergy or Sensitivity?

Some people reading this might wonder if they can simply do a test to see if they have an egg allergy or sensitivity.  Without question this is possible, and if someone tests positive for an egg allergy or sensitivity then it probably is a good idea for them to avoid eggs.  However, just keep in mind that even if someone tests negative for a food allergy or sensitivity, besides the fact that false negatives are always possible, one also needs to keep in mind that the compounds from egg whites can still have a negative effect on their gut health.

To try to make this easier to understand I’m going to briefly talk about almonds, which is another whole food that is excluded from an autoimmune paleo diet.  Almonds (along with other nuts) can cause problems in those with an autoimmune condition because they have compounds (lectins and phytic acid) which can have a negative effect on gut health.  As a result, it doesn’t matter if someone with Graves’ Disease or Hashimoto’s Thyroiditis has an allergy or sensitivity to almonds, as if they are trying to follow a strict autoimmune paleo diet then they should avoid eating almonds, along with other nuts and seeds.  Yes, I realize that soaking and sprouting nuts and seeds will help to reduce the negative impact these foods will have on the gut, but my point is that with both eggs and almonds, while it is possible to do IgE and IgG food allergy/sensitivity testing, a negative result doesn’t mean that the person with an autoimmune thyroid condition can safely eat these foods.

What’s The Final Verdict On Eggs and Thyroid Autoimmunity?

Just in case you’re still confused over whether or not you should eat eggs, I’ll give a brief summary of what I have stated so far.  Even though eggs are nutrient dense, they are a common allergen, and the egg whites have compounds which can have a negative effect on gut health by increasing intestinal permeability.  Because of this, eggs are not part of an autoimmune paleo diet.  As I’ve discussed in past articles and blog posts, some researchers speculate that everyone with an autoimmune condition has a leaky gut, and while this is controversial, if someone with Graves’ Disease or Hashimoto’s Thyroiditis is looking to restore their health then it might be best to avoid eggs until their health improves due to the reasons I mentioned earlier.

However, I also spoke about how some people with autoimmune thyroid conditions might be fine eating egg yolks while avoiding egg whites.  And the reason for this is because while egg whites have compounds which can have a negative effect on gut health, this isn’t the case with egg yolks.  As a result, if someone is following an autoimmune paleo diet and decides to reintroduce eggs, it might be best to start by reintroducing egg yolks.  As I briefly mentioned earlier, I have had patients who reintroduced the entire egg (both egg yolk and egg white) into their diet and their health still improved, which proves that everyone is different, and also demonstrates that there isn’t a specific diet that is a perfect fit for everyone.

So hopefully you have a better understanding as to why eggs aren’t part of an autoimmune paleo diet.  Although eggs are a healthy food, if someone has an egg allergy then this will result in inflammation, which in turn will have a negative effect on their progress.  But even if someone doesn’t have an egg allergy or sensitivity, compounds in egg whites can affect the health of the gut.  And since a leaky gut is a common finding in autoimmune conditions, and might be a factor in every autoimmune condition (even though I haven’t found this to be the case), those with Graves’ Disease and Hashimoto’s Thyroiditis who choose to reintroduce eggs might want to start with egg yolks, and be cautious about eating egg whites.

Radioactive iodine treatment is commonly recommended by endocrinologists as a “cure” for hyperthyroidism and Graves’ Disease.  While many people who receive this treatment seem to do fine, others regret the decision to have received this treatment method.  And for those who are considering to receive radioactive iodine, there of course is no way to predict who will do well after receiving the treatment, and who will be miserable.  I receive emails from both categories of people, as sometimes I’ll get an email from someone who received RAI and they are very happy with their decision.  On the other hand, every week I receive at least a few emails from people who received RAI and regretted their decision.  And some of these people want to know if following a natural treatment protocol can restore their thyroid health, which I’ll discuss in this post.

The truth is, when someone receives radioactive iodine there really is no way to predict whether or not their thyroid health can be restored back to normal.  This depends on how much damage has been done to the thyroid gland.  And this in turn depends on a few different factors.  One obvious factor is the dosage of radioactive iodine that was used during treatment.  If a very high dose was used then this will increase the chances of the person becoming permanently hypothyroid.  Sometimes what will happen is that a lower dose will be used, and if it doesn’t make the person hypothyroid then the doctor will recommend another session of RAI.  So receiving a very large dose of RAI and/or receiving multiple RAI treatments will decrease the chances of your thyroid gland secreting a normal amount of thyroid hormone.

Why Can’t The Effects Of Radioactive Iodine Always Be Reversed?

In order to understand why the effects of RAI can’t always be reversed, it probably would be a good idea to explain what happens when someone receives this type of treatment.  Radioactive iodine is also known as iodine-131.  When someone receives this treatment, it is taken up by the body as if it were the mineral iodine.  So it will travel through the bloodstream to the thyroid gland.  But unlike the mineral iodine, RAI will destroy the cells of the thyroid gland.  Obviously the larger the dose of RAI that is used, the more thyroid cells that will be destroyed, thus increasing the chance that the person will become permanently hypothyroid.

But isn’t it possible to regenerate the cells of the thyroid gland?  Well, it is thought by many that the thyroid gland doesn’t have the ability to regenerate.  However, not only have I helped patients who sustained significant damage to their thyroid gland through radioactive iodine, but numerous other natural healthcare professionals have had similar experiences.  Obviously there will be people who receive RAI who can’t have their thyroid health restored back to normal, but there also will be some people who receive RAI, and after following a natural treatment protocol they are able to wean off of their thyroid hormone medication.

Plus, remember that even if someone who received RAI can’t have their thyroid health restored back to normal, this doesn’t mean that they can’t benefit from following a natural treatment protocol.  After all, I think most people reading this would agree that hyperthyroidism typically isn’t due to a deficiency of radioactive iodine.  Most hyperthyroid conditions are due to Graves’ Disease, which is an autoimmune condition that affects the thyroid gland.  And as a result, receiving RAI might eliminate the hyperthyroidism, but it won’t do anything for the autoimmune component.

But how about if someone received radioactive iodine due to a non-autoimmune hyperthyroid condition, such as toxic multinodular goiter?  Well, even if there isn’t an autoimmune component, many people with multinodular goiter have other imbalances, such as adrenal weakness, toxic overload, etc.  The point I’m trying to make is that radioactive iodine uses radiation to kill thyroid cells, but in no way does it do anything to restore one’s health.  Whether someone develops Graves’ Disease or multinodular goiter, RAI doesn’t address the underlying cause of the problem.

How Can You Determine If You’d Benefit From Natural Treatment Methods?

So if you have received RAI, how can you find out if you would benefit from following a natural treatment protocol?  Well, being a natural healthcare professional I’m going to be biased, as in my opinion I think most people who receive RAI can benefit from natural treatment methods.  Keep in mind that I’m not suggesting that everyone who has received this treatment method can restore their thyroid health and therefore avoid taking thyroid hormone medication.  Although this without question is possible in some people, there is also the possibility that you will need to be on synthetic or natural thyroid hormone.

With that being said, I still feel that it’s important to address the cause of the condition whenever possible.  While this is true with all chronic health conditions, this is especially true with autoimmune conditions such as Graves’ Disease.  And the reason for this is because the research clearly shows that someone who has one autoimmune condition has a greater likelihood of developing another autoimmune condition in the future.  And since RAI doesn’t do anything to address the underlying cause of the autoimmunity associated with Graves’ Disease it would make sense to do everything you can to address the cause.

In summary, some people who have received radioactive iodine would like to know if their thyroid health can be restored after following a natural treatment protocol.  Although some people can have their thyroid health restored after receiving RAI, there is no way to predict if this will happen, as it depends on a few factors, including how much damage has occurred to the thyroid gland.  If the person has certain nutrient deficiencies then this can also affect the healing process.  But even if someone’s thyroid health can’t be completely restored back to normal, since RAI doesn’t do anything to address the underlying cause of the condition, most people who have received this procedure can still benefit from natural treatment methods.

In the last blog post I discussed a diet for hyperthyroidism and Graves’ Disease, and so it’s only fair that I take some time to discuss the ideal type of diet for those with hypothyroidism and Hashimoto’s Thyroiditis.  Although many people with Hashimoto’s Thyroiditis do great when following an autoimmune paleo diet, others need to make certain modifications.  If you read last week’s blog post you’ll notice that in this post there is a good amount of overlap in the dietary recommendations, although just keep in mind that everyone is different, and not everyone will respond well to the same exact diet.

Just like I did in last week’s post, I’ll attempt to make this easier to understand, as what I’ll do is go through each category of food, and discuss some of the main foods within each category which can commonly be consumed, and which ones should usually be avoided.

Vegetables.  Most people with hypothyroidism and Hashimoto’s Thyroiditis should eat a wide variety of vegetables each day.  I would try to eat at least five servings of vegetables per day, and more than this would be even better.  This includes vegetables such as artichoke, asparagus, broccoli, carrots, celery, kale, lettuce, onions, spinach, squash, sweet potatoes, and zucchini.  Some people reading this probably are wondering if it is a good idea to eat cruciferous vegetables, such as broccoli, cabbage, and kale. A number of years ago I did recommend for anyone with a hypothyroid condition to completely avoid these foods, but the more research I have done, the more I have realized that all of the research studies on goitrogenic vegetables involve giving large amounts of these foods to rodents.  I’m not suggesting that people with hypothyroid conditions should eat large amounts of raw cruciferous veggies, but these are very healthy foods, and in most cases, eating a few servings per day won’t cause any issues in those people with hypothyroidism and Hashimoto’s Thyroiditis.

Those people with Hashimoto’s Thyroiditis will want to be cautious about eating the nightshades, which include tomatoes, eggplant, white potatoes, and peppers.  And the reason for this is because these foods contain compounds which can have a negative effect on the health of the gut.  I discussed this in greater detail in my article entitled “Nightshades and Thyroid Health“.

You might wonder if it is essential to eat all organic vegetables.  Of course this is ideal, although I realize that in some areas it can be difficult to purchase organic food, and it is also more expensive than non-organic food.  However, you really do want to minimize your exposure to pesticides, and while rinsing your vegetables can help, eating organic is best.  If you don’t have access to organic food, or if you can’t afford to purchase organic food, then I would recommend to obtain the Dirty Dozen list from the Environmental Working Group and avoid those non-organic foods which are on the “Dirty Dozen list”, and try to eat vegetables which are on the “Clean Fifteen” list.

Sea Vegetables.  Kelp and other sea vegetables have some health benefits, although they are also very high in iodine.  Although eating foods rich in iodine is different than taking high dose iodine supplements, some people with Hashimoto’s Thyroiditis don’t do well even when eating iodine-rich foods.  This sometimes can be related to a selenium deficiency, as antioxidants such as glutathione are selenium dependent, and these antioxidants are necessary to offset the oxidation reaction caused by iodine.  And so unless if someone with Hashimoto’s Thyroiditis is certain that they have sufficient levels of glutathione and other antioxidants (i.e. vitamin C) I would recommend for those people with this condition to minimize their consumption of these foods.

Fruit.  Most people with hypothyroidism and Hashimoto’s can have a few servings of low glycemic fruits per day, which include apples, avocados, blueberries, raspberries, blackberries, cherries, grapes, peaches, pears, etc.  But how about other fruits such as bananas, watermelon, and cantaloupe?  It really does depend on the person, as while these definitely have some health benefits, bananas have a high sugar content, and melons have a higher glycemic index.  As a result, if someone has blood sugar imbalances it is best to minimize their consumption of these fruits.

I would also recommend to eat at least twice as many vegetables than fruit.  I bring this up because I commonly see the opposite pattern, as it is common for people to eat four or five servings of fruit per day, and sometimes more than this, yet only eat a couple of servings of vegetables on a daily basis.

Dairy products and eggs.  If someone has Hashimoto’s Thyroiditis and is following a strict autoimmune paleo diet, then they will want to avoid all dairy products and eggs.  And there are a few reasons for this.  With regards to dairy, many people are sensitive to the proteins of dairy, especially casein.  Some people do fine when consuming raw dairy, but not everyone.  And the same is true with regards to milk from a goat or sheep.  However, if someone has a casein sensitivity then they might react to all types of dairy, regardless of whether it is raw or pasteurized, or if it comes from a cow, goat, or sheep.  I discussed dairy in detail in a past blog post entitled “Should People With Graves’ Disease and Hashimoto’s Thyroiditis Avoid Dairy?“.  As for eggs, although eggs are very nutrient dense, egg allergies are common, and egg whites include compounds which can have a negative effect on gut health.  With that being said, many people do fine consuming egg yolks.  My current approach is to have people with Hashimoto’s Thyroiditis avoid these foods for one month, and if they are struggling with the diet then they can try to reintroduce egg yolks.

Fermented foods.  Most people with hypothyroidism and Hashimoto’s Thyroiditis can benefit from eating some non-dairy fermented foods on a regular basis.  This includes kimchi, kombucha tea, sauerkraut, and unsweetened coconut yogurt.  Although fermented dairy products such as kefir and yogurt can also benefit one’s health, since I typically have my patients avoid dairy I recommend for them to avoided fermented dairy products.  If someone has a condition such as small intestinal bacterial overgrowth (SIBO) then they probably won’t be able to tolerate fermented foods until this problem is addressed.

Coconut products.  Most people with hypothyroidism and Hashimoto’s Thyroiditis do fine when consuming coconut products, which include coconut butter, coconut milk, coconut oil, coconut flakes, and coconut yogurt.  Plus, there is some evidence that coconut can help to increase the metabolism, which might offer yet another benefit to those with an underactive thyroid.  With regards to coconut milk and coconut yogurt, although you can purchase these at most health food stores, you need to be careful about other ingredients which might be included that you shouldn’t consume, and as a result it might be best to make your own coconut milk and yogurt.  As is the case with fermented foods, if someone has SIBO then they might not tolerate coconut products.

Meat.  Most types of meat are fine to eat, including beef, chicken, turkey, lamb, and pork, although the quality of the meat is of course important. For example, if someone is going to eat beef then ideally they will want to choose 100% grass fed beef.  If someone is eating poultry then organic pasture raised is preferred, although this admittedly is challenging to find in some areas.

Organ meats are very nutrient dense, and so if you like organ meats such as liver and heart then feel free to eat these.  Of course you want to make sure the organ meats are from a good quality source.

Seafood.  There is a lot of controversy over eating fish.  First of all, fish are high in mercury, as well as other toxins.  This is especially true with larger fish, but toxins affect the smaller fish as well, although to a lesser extent.  While some natural healthcare professionals claim that fish which are high in selenium help to offset any adverse effects of mercury, I still recommend to limit one’s consumption of fish to three times per week, and to try to eat fish with a low mercury content.  I’ve discussed this in greater detail in an article I wrote entitled “Seafood and Thyroid Health“.

Nuts and Seeds.  Although nuts and seeds are nutrient dense, they also have lectins and phytic acid, which can have a negative effect on gut health.  As a result, if someone has a leaky gut or another gastrointestinal issue then it probably is best to avoid nuts and seeds.  This is the main reason why nuts and seeds aren’t part of an autoimmune paleo diet, as a leaky gut is common in autoimmune conditions such as Hashimoto’s Thyroiditis, and some feel that a leaky gut is a necessary prerequisite to develop autoimmunity.  If someone is pretty certain they don’t have a leaky gut or other digestive issues, I would still make sure not to eat too many nuts and seeds, although having one or two servings per day is probably fine for most people.  Soaking nuts and seeds will help to reduce the antinutrients and make them easier to digest, although someone with a leaky gut still should be cautious about eating soaked nuts and seeds.  I’m sure some people who add chia seeds and or flax seeds to their smoothies will wonder if this is okay, but if you are dealing with a leaky gut then these should also be avoided, as these also have compounds which can affect the permeability of the gut.

Gluten-Free Grains.  Although some people seem to do fine eating a small amount of gluten-free grains such as brown rice, buckwheat, and the psuedograin quinoa, these also include compounds which can affect the health of the gut.  As a result, anyone dealing with a leaky gut should ideally go grain-free, at least until the gut has been healed.

Legumes.  These should ideally be avoided while trying to restore one’s health since they also have compounds which can affect intestinal permeability.  This includes black beans, lentils, peanuts, pinto beans, and soybeans.

Soy.  This is yet another controversial topic in the world of thyroid health.  Although a small amount of fermented non-GMO soy might be okay depending on the person, one’s overall consumption of soy should be minimized.  I would definitely look to avoid processed soy products such as soy protein powder, soy burgers and chicken nuggets, soy milk, etc.  I’m not too concerned about a small amount of soy lecithin being consumed, as long as it’s from a non-GMO source.  With that being said, some people react negatively to all types of soy, even soy lecithin.

Sugars.  Having a very small amount of natural sweeteners such as honey, pure maple syrup, molasses, or stevia is usually fine, although there are exceptions.  On the other hand, other sweeteners such as agave, corn syrup, high fructose corn syrup, and sucrose should be avoided.  The sugar alcohols are controversial, as while many people seem to do fine with them, they might have a negative effect on gut health, and they usually lead to bloating and gas in those with small intestinal bacterial overgrowth.  For more information on this I’d check out my blog post entitled “Natural Sugars, Sweeteners, and Thyroid Health“:

Herbs and spices.  Some herbs and spices are usually fine to consume, such as cilantro, garlic, cinnamon, ginger, oregano leaves, and rosemary.  Sarah Ballantyne (author of the wonderful book The Paleo Approach) has done a lot of research in this area, and she has put together a comprehensive list of what herbs and spices are fine to eat, which ones you should be cautious about, and which ones should be avoided.

Oils.  With regards to cooking, consider using coconut oil, although if someone has problems with coconut oil then they can use lard or duck fat as alternatives.  Olive oil shouldn’t be used for cooking, but it makes an excellent salad dressing (I personally use an olive oil/garlic combination on my salads).  Although there is some controversy over flax oil, I think adding some organic flax oil (not flax seeds) to your salad or smoothie is fine in most cases.

Processed Foods.  Obviously these should be avoided while trying to restore one’s health back to normal.  While some people are able to get away with eating processed foods, for others it will have a negative effect on their recovery.  After someone has restored their health back to normal they of course should still to eat mostly whole foods, although if someone has a healthy gut then eating some processed foods on an occasional basis probably won’t be a big deal.

Remember That There Is No Specific Hypothyroid Diet For Everyone

Although these are some general guidelines, just keep in mind that everyone is different.  As a result, there might be some people who are unable to eat the “allowed” foods due to food sensitivities, a yeast or bacterial overgrowth, etc.  On the other hand, some people eat some of the “forbidden” foods yet still receive good results.  The problem is that it is impossible to predict who will do fine when straying from the diet, and who won’t show a significant improvement in their health.  And so while I realize the diet is strict, especially for someone who has gut issues, I would recommend to try to be strict in order to achieve optimal benefits.

So if you have hypothyroidism/Hashimoto’s, then hopefully you have a better idea as to what you can eat, and which foods you should avoid while trying to restore your health.  While the overall goal should be to eat whole foods while avoiding the refined foods and sugars, the type of whole foods you eat can be an important factor in your recovery.

As I mentioned, you ideally want to eat at least twice as many vegetables as fruits, and if at all possible try to buy meats, fruits, and vegetables that are organic.  If this isn’t possible then at least try to buy healthier meats while trying to avoid fruits and vegetables that are on the Dirty Dozen List.  Although following these dietary recommendations alone probably won’t be enough to restore the health of most people, making these changes can lead to a huge improvement in your health, and when combined with other factors will greatly increase your chances of restoring your health back to normal.

Although I commonly recommend an autoimmune paleo diet to my patients with hyperthyroidism or Graves’ Disease, not everyone will need to follow the same exact diet.  For example, while someone with Graves’ Disease can usually benefit from following an autoimmune paleo diet, if someone has a condition such as toxic multinodular goiter or subacute thyroiditis without an autoimmune component, then their diet usually doesn’t need to be as strict.  Regardless of what type of hyperthyroid condition you have, hopefully after reading this blog post you will have a better understanding when it comes to the foods you should eat, and which foods you should avoid.

You’ll notice that below I list each category of food (i.e. vegetables, fruits, meats, etc.), and I not only tell you which foods should be eaten in most cases, which foods should be eaten with caution, and which foods should be completely avoided, but I will also explain the reasoning behind my recommendations.

Vegetables.  I look at many food diaries of my patients, and most people don’t eat enough vegetables.  Probably the average person I work with eats two to three servings of vegetables, and I would recommend to at least twice this amount.  It’s also important to eat a wide variety of vegetables.  This includes vegetables such as artichoke, asparagus, broccoli, carrots, celery, kale, lettuce, onions, spinach, squash, sweet potatoes, and zucchini.  Try to eat organic vegetables if possible, although if this isn’t possible then visit the website for the Environmental Working Group and get the Dirty Dozen and Clean Fifteen lists, and make sure to avoid those vegetables (and fruits) which are on the Dirty Dozen list.  If someone has Graves’ Disease and is trying to follow a strict autoimmune paleo diet then they will want to avoid the nightshades, as these include compounds which can have a negative effect on gut health.  And so you might need to avoid tomatoes, eggplant, peppers, and white potatoes.  For more information on this I would read my article entitled “Nightshades and Thyroid Health“.

Every now and then someone with a hyperthyroid condition will ask me if they should eat a larger amount of raw cruciferous vegetables in an attempt to decrease thyroid hormone production.  In most cases, eating a few servings of raw cruciferous vegetables won’t lower thyroid hormone levels.  In some people eating a large amount of raw broccoli, kale, or other cruciferous vegetables might help, although even if it does help this of course isn’t doing anything to address the cause of the problem.

Sea Vegetables.  There is a lot of controversy when it comes to iodine and thyroid health.  Most endocrinologists will recommend for patients with hyperthyroidism and Graves’ Disease to avoid iodine since it’s involved in the formation of thyroid hormone.  However, iodine usually does not lead to an increase in thyroid hormone levels unless large doses are taken, and many people with Graves’ Disease are able to eat some sea vegetables, which are iodine-rich.  On the other hand, some people with hyperthyroidism and Graves’ Disease don’t do well with any iodine, and of course if this is the case then I would avoid these foods while trying to restore one’s health back to normal.

Fruit.  Although I try to eat at least five or six servings of vegetables per day, I’ve always enjoyed eating fruit more than vegetables.  And this describes a lot of people, as I commonly see people eating more fruit than vegetables, although ideally you want to eat at least twice as many vegetables than fruit.  With that being said it’s fine for most people to have a few servings of fruits which have a low glycemic index, although if someone doesn’t have blood sugar imbalances then it might be fine to have some fruits with a higher glycemic index occasionally, such as watermelon and cantaloupe.  But for the most part you want to focus on eating fruits such as apples, avocados, berries (blueberries, blackberries, raspberries, strawberries), cherries, grapes, peaches, pears, etc.  However, if someone has a yeast or bacterial overgrowth then they might need to avoid some of these fruits as well.  And just as is the case with vegetables, make sure you avoid those foods which are on the Dirty Dozen list, and try to stick with fruits on the Clean Fifteen list.

Dairy products and eggs.  I receive a lot of questions about dairy, and although dairy products have some health benefits, many people are sensitive to the proteins of dairy.  As a result, I usually recommend for my patients to avoid dairy products while trying to restore their health back to normal.  Some will ask if it’s okay to eat raw dairy products, or dairy from a sheep or a goat.  The truth is, some people do fine on these other types of dairy, but if someone is sensitive to casein then they still might react to raw milk, or milk from a goat or sheep.  Keep in mind that I’m not suggesting that everyone will need to avoid dairy on a permanent basis, and for more information I would read a blog post I wrote entitled “”Should People With Graves’ Disease and Hashimoto’s Thyroiditis Avoid Dairy?“.

How about eggs?  Although eggs are allowed on a standard paleo diet, if you choose to follow an autoimmune paleo diet then eggs are excluded.  And there are a couple of reasons for this.  First of all, egg allergies are common.  But another reason is because egg whites have compounds which can cause or contribute to a leaky gut.  With that being said, eggs are very nutrient dense, and so I usually recommend for my patients to avoid eggs for at least one month, and after this time if they feel the need to reintroduce other foods I will tell them to reintroduce egg yolks and see how they do.

Fermented foods.  These have numerous health benefits, and as a result, most people with hyperthyroidism and Graves’ Disease can consume fermented foods.  If avoiding dairy then of course I wouldn’t consume fermented dairy such as yogurt or kefir, although non-dairy fermented foods such as kimchi, kombucha, sauerkraut, and unsweetened coconut yogurt are usually fine.  However, there are some people who don’t tolerate fermented foods well, including most people with small intestinal bacterial overgrowth (SIBO), and if someone has a severe yeast infection then they also might not do well with fermented foods.

Coconut products.  This includes coconut butter, coconut milk, coconut oil, coconut flakes, and unsweetened coconut yogurt.  Although some sources claim that coconut can increase metabolism, and thus benefit people with hypothyroid conditions, I haven’t come across anyone with hyperthyroidism or Graves’ Disease who experienced an increase in hyperthyroid symptoms due to consuming coconut products.  However, some people with small intestinal bacterial overgrowth are unable to tolerate coconut products, although this doesn’t describe everyone with this condition.

Meat.  If you’re a strict vegetarian or vegan then of course you can skip this section.  One of the biggest problems with hyperthyroid conditions is that in many people it leads to extreme weight loss, and thus eating nutrient dense foods is important.  Although vegetables and fruits are nutrient dense, meat is one of the most nutrient dense foods. And so feel free to eat beef, chicken, turkey, lamb, pork, and other types of meats.  And if you like organ meats then you can eat this as well, as they are even more nutrient dense than “regular” meat.   Of course  one does need to pay attention to the quality of the meat, and try to eat organic whenever possible.  This will help to minimize the toxins you consume, and ideally you also want to choose grass-fed/pasture-raised meat.

Seafood.  Although fish is nutrient dense and is an excellent source of omega 3 fatty acids, due to the mercury and other toxins I usually recommend to minimize one’s consumption of fish to two to three times per week.  Others argue that it depends on what type of fish you consume, as eating fish high in selenium might help to offset the negative effect of mercury and other toxins.  This remains controversial, and so while I’m not opposed to people eating fish a few times per week, I usually don’t recommend eating fish on a daily basis.  And although I’m focusing on fish, this applies to other types of seafood as well.  I talk more about this in an article I put together entitled “Seafood and Thyroid Health“.

Nuts and seeds.  I mentioned earlier how I like fruit, but I enjoy eating nuts and seeds even more.  While I like all types of nuts and seeds, cashews are without question my favorite.  And while nuts and seeds have a lot of nutrients and are part of a standard paleo diet, eating nuts and seeds aren’t allowed for those following an autoimmune paleo diet.  And the reason is because nuts and seeds have compounds such as lectins and phytic acid, which have a negative effect on gut health.  Although soaking nuts and seeds will make them easier to digest and reduce the antinutrient content, if someone has a leaky gut, or another type of digestive issue, it really is best to avoid the nuts and seeds.  To be honest, I’ve had some people with a leaky gut do fine when eating small amounts of nuts and seeds, but I’ve also had people who didn’t do well until they eliminated the nuts and seeds from their diet.

Gluten-Free Grains.  It’s challenging for many people to give up gluten, and for these people it’s obviously even more challenging to avoid grains altogether.  Although someone who is gluten sensitive might do fine eating some gluten-free grains such as brown rice, buckwheat, and the pseudograin quinoa, these can also affect the permeability of the gut.  In other words, even if someone doesn’t have a sensitivity to grains, these potentially can have a negative effect on gut health.

Legumes.  These also have compounds which can cause or contribute to a leaky gut.  As a result, they should be avoided for anyone who has a confirmed or suspected gut condition.  Some examples of legumes which should be avoided include black beans, lentils, peanuts, pinto beans, and soybeans.

Soy.  While fermented soy products which are not genetically modified might have some health benefits, soy also has compounds which can have a negative effect on gut health, and thus it really is a good idea to minimize one’s consumption of soy products.  While some people do fine eating a small amount of fermented soy, I would make sure not to eat any nonfermented or processed soy products such as soy milk, soy protein powder, soy chicken nuggets, soy ice cream, etc.  For most people, having a small amount of non-GMO soy lecithin isn’t an issue.

Natural Sweeteners.  This is yet another controversial area, as some sources recommend to avoid all sweeteners, even those that are natural.  Many people with hyperthyroidism and Graves’ Disease seem to do okay with small amounts of natural sweeteners such as honey, pure maple syrup, molasses, and stevia.  Some people do okay with small amounts of sugar alcohols, although they might have a negative effect on gut health, and are usually problematic if someone has a condition such as SIBO.  You should try to avoid other sweeteners such as agave, corn syrup, high fructose corn syrup, and sucrose.

Herbs and spices.  Many herbs and spices are fine to use, including garlic, cilantro, ginger, cinnamon, oregano leaves, and rosemary.  Sarah Ballantyne, who is author of the wonderful book The Paleo Approach, has done a lot of research in this area, and she has an article where she listed those herbs and spices which can be safely consumed in those with autoimmune conditions such as Graves’ Disease, and those herbs which should be avoided or used with caution.

Oils.  Coconut oil is usually the best option for cooking, although if someone is unable to tolerate coconut oil then they can instead use lard or duck fat.  I don’t recommend olive oil for cooking, although you can add olive oil to your smoothie, or use it as a salad dressing.  Organic flax oil is usually fine to consume as well.

Refined foods and sugars.  Just about everyone reading this knows that processed foods shouldn’t be consumed when trying to restore one’s health back to normal.  I’d be lying if I told you that I never eat any processed foods, but I still try to eat mostly whole foods, and when trying to restore one’s health you really do want to be strict.  It’s not uncommon to receive emails from my patients asking if it’s okay to cheat every now and then and have a slice of pizza, a piece of birthday cake, some ice cream, etc.  The truth is that some people who are trying to restore their health back to normal cheat every now and then and don’t experience any adverse effects, while others who stray from the diet don’t do well and suffer serious setbacks.  Since it’s impossible to know who will do fine when cheating and who will suffer consequences, I recommend for everyone to be strict and avoid the refined foods and sugars when trying to restore their health.

Reminder: There Is No Specific Hyperthyroid Diet That Fits Everyone

While it would be great if there was a single diet that fit everyone with hyperthyroidism and Graves’ Disease, the truth is that since everyone is different, it is common for people to follow slightly different diets.  For example, after initially avoiding eggs, one person might be able to successfully reintroduce eggs or egg yolks, while another person might need to avoid eggs completely.  Or if someone has a condition such as SIBO they might need to avoid eating fermented foods and certain fruits which are high in FODMAPS.  While many people with Graves’ Disease can benefit from following an autoimmune paleo diet, those with hyperthyroid conditions who don’t have autoantibodies can usually do fine following a standard paleo diet, which means they probably will do fine eating foods such as eggs, nuts, seeds, and the nightshade vegetables.

As I mentioned earlier, it’s common for people to ask if they can reintroduce foods that normally should be avoided.  And of course some of my patients don’t ask, as I’ll have some patients who simply eat foods they know they shouldn’t eat.  Remember that I’ve been through this as well, and so I know from self experience that it is challenging to eat a strict diet.  Just remember that certain foods are forbidden for a reason, and after you have restored your health you should be able to eat a wider variety of foods again.

So hopefully you now have a better understanding of the foods you can and can’t eat while trying to restore the health of your hyperthyroid condition.  Obviously the overall goal is to eat whole foods while avoiding the processed foods and sugars, but this doesn’t mean that all whole foods are allowed.  Certain whole foods can be problematic, which is why some people with Graves’ Disease will need to avoid them while restoring your health.  Also keep in mind that while eating well is essential to receive optimal benefits, other factors are also important such as doing a good job of managing stress, taking quality nutritional supplements, minimizing one’s exposure to toxins, etc.

There are numerous occasions when eating healthy is a challenge. There are birthday parties, weddings, Thanksgiving day, Valentine’s day, and other reasons why people choose to indulge in junk food. And then there’s the challenge of eating well when going out of town on an extended vacation. For someone with Graves’ Disease or Hashimoto’s Thyroiditis who is following a strict diet, having a single cheat day can have a negative effect on their recovery. But when someone goes on a vacation for a few days or longer, and chooses to eat poorly most of the time, it can completely ruin what they’re trying to accomplish. And so the goal of this blog post is to discuss how you can eat well while on vacation, and still have a good time.

Keep in mind that I’m not trying to be a “party pooper”, as I’d be lying if I told you that I don’t eat some bad foods when I’m on vacation. However, while it’s usually not a problem indulging every now and then after someone has restored their health back to normal, if you are in the process of trying to restore your health then you really do want to try to be as strict as possible. An ideal situation would be to either plan your vacation before following a natural treatment protocol, or after you have restored your health back to normal. With that being said, I realize that some people won’t follow this advice and will go on a vacation a few months after starting a strict diet, and I’ll list some tips to help keep you on track while you’re out of town.

Is Eating Unhealthy Necessary To Enjoy Your Vacation?

Different people will perceive this question differently. Many people eat unhealthy all of the time, but eat even worse when they are on vacation. Other people eat healthy while at home, but eat a lot of junk food while out of town. Other people will try to have some healthy meals while on vacation, although they will eat more junk food while away from home. And some super healthy people will eat the same regardless of whether they are at home or on vacation.

Most people can have an enjoyable vacation even when eating healthy. After all, I think it’s safe to say that the main reason people go on vacation isn’t so they can eat unhealthy foods. They usually go on vacation to relax, spend time with friends and family, do some type of activity, etc. And in most cases, poor planning and the inconvenience of the situation is a big reason why most people eat poorly while on vacation. Keep in mind that I’m not trying to be critical of those who indulge on vacation, as remember I admitted earlier that I don’t eat a perfect diet when I’m on vacation. But I eat better than most people while traveling, and the reason has nothing to do with greater willpower, but instead has to do with proper planning. When I eat junk food of some type, usually I know ahead of time that I’m going to indulge, although I admit that this isn’t always the case. So what are some of the things you can do in order to improve the chances of eating well while on vacation?

1. Stay somewhere with a refrigerator and kitchenette. If you plan on eating healthy most of the time while on vacation it usually is best to prepare most of your meals. But wait, doesn’t this defeat the purpose of going on vacation? If you consider cooking to be hard work then I understand that you might not want to cook while on vacation. And I’m not suggesting that you have to spend hours preparing meals. At the very least you can buy healthier pre-made options at a local health food store for some of the major meals, and if you bring some of your own pots and pans and/or a blender (or stay somewhere that already has these) you can start the day with a healthy smoothie or some eggs, both which aren’t too time consuming.
2. If you plan on eating out, do some research to find restaurants with healthier options. This is best done beforehand, as you can visit some websites to find some restaurants which have healthier options. Some examples include www.urbanspoon.com and www.findmeglutenfree.com.

Another thing you can do is to simply visit Google and do some searching for specific keywords involving healthy foods. So for example, if you’re taking a vacation to Orlando Florida you can type in “grass fed beef restaurant Orlando”, or “gluten free restaurant Orlando”. Something else you can do is look up a few of the local health food stores and contact them, as the people who work there hopefully will have some ideas about healthy places to eat.

3. Bring healthy snacks. While driving or flying to your destination, make sure you bring your own healthier snacks. And if it’s going to be a long drive or flight which involves you eating meals, I once again would try to do some planning to see which restaurants along the way or at the airport have healthier choices, gluten free options, etc. Obviously I would try to avoid fast food, but if the only options are common restaurant chains such as Chili’s, Applebees, etc., then I would eat something such as a grilled chicken salad without the croutons, perhaps a turkey burger without the bun with a side of steamed broccoli, etc.
4. Try to go on vacation with immediate family members. If you are trying to stick to a strict diet it can be challenging going on vacation with friends, unless if they have a more natural mindset. Truth to be told, it sometimes can be challenging going on vacation with immediate family members as well, as they might be fine eating well while at home, but plan on indulging when on vacation. If this is the case then at least try to convince them to eat a few healthy meals, and I would still try to plan ahead when it comes to eating out at restaurants. Once again, if you end up at a restaurant which doesn’t have healthier food choices I would at least try to stick to eating whole foods. And if you haven’t already done so I would visit the website for the Environmental Working Group and download the “dirty dozen” and “clean fifteen” lists, as the “dirty dozen” lists the fruits and vegetables with the greatest amount of pesticides, while the “clean fifteen” lists the top fifteen foods with the least amount of pesticides.
5. If necessary, postpone your vacation. I realize this isn’t always possible, and even when it is possible it is not desirable. After all, life is short, and you have a right to get some rest and relaxation. With that being said, if postponing one’s vacation will improve your chances of restoring your health, and therefore will result in you being better able to enjoy future vacations, then it probably is worth it. But once again, if you plan ahead and are flexible with regards to where you go and where you can stay, then it is possible to eat healthy.

In fact, when deciding to go on vacation perhaps you can use this as an opportunity to visit a city where there are plenty of health food stores and healthier restaurants. In other words, instead of just randomly choosing a location due to the proximity, or based on an attraction you want to visit, do some searching for cities which have numerous health food stores and healthier restaurant options. This combined with a hotel/motel which has a refrigerator and small kitchenette will make eating healthier. And rather than calling it a vacation, refer to it as a “healthy retreat”, or something similar.

Keep in mind that the above tips are mainly for when you are following a strict natural protocol to restore your health. Of course this doesn’t mean that you shouldn’t try to eat somewhat healthy while on future vacations as well, but as I’ve mentioned in past articles and blog posts, there is more room to indulge after someone has restored their health back to normal. On the other hand, if you are currently dealing with weak adrenals, a leaky gut, and/or other compromised areas of your body, it really is a good idea to be as strict as possible while trying to get healthy again.

In summary, eating healthy is a challenge for many people, but is even more challenging when going on vacation. However, most people can enjoy their vacation even when eating healthy foods. The key to eating healthy while away from home is to do some proper planning, which might include choosing a place to visit which has plenty of health food stores and restaurants with healthier food choices. Just remember that I’m not saying that you should never indulge when on vacation, but for those people who are following a natural treatment protocol, being strict with your diet is important to receive optimal benefits, and as a result you don’t want to wreck your diet while on vacation.

Many people with hypothyroidism experience a significant improvement in their symptoms upon taking thyroid hormone medication.  However, some people actually feel worse when taking thyroid hormone medication.  Some people feel worse when taking synthetic thyroid hormone and feel better when taking natural thyroid hormone, although there are some people whose symptoms worsen when taking natural thyroid hormone.  There are numerous reasons why someone can experience a worsening of their symptoms when taking thyroid hormone, and in this blog post I’ll discuss some of the more common reasons.

Fillers and other ingredients.  One of the main reasons why someone might feel worse upon taking synthetic or natural thyroid hormone is because they are reacting to one of the fillers or other ingredients.  For example, many brands of synthetic thyroid hormone include ingredients people can react to.  Synthroid is probably the most well known brand of synthetic thyroid hormone, and it includes corn starch, lactose monohydrate, as well as artificial coloring.  And so if someone has an allergy to corn or dairy, or if they have a reaction to the artificial colors, then they probably will feel lousy when taking Synthroid.  There are also fillers in some brands of natural thyroid hormone, such as Armour.  I discussed the ingredients in greater detail in an article I wrote entitled “Synthetic vs. Natural Thyroid Hormone: Breaking Down The Ingredients“.

But what can someone do if they are reacting to one or more of these ingredients?  Well, there are a few different options.  One option is to ask your medical doctor to switch you to a different brand of synthetic or natural thyroid hormone medication.  For example, Tirosint is a brand of synthetic thyroid hormone that doesn’t have all of the fillers and artificial colorings that Synthroid has.  As a result, someone might do poorly when taking Synthroid, but do well when taking Tirosint.  With regards to natural thyroid hormone, some people don’t do well when taking Armour, but do fine when taking Nature-Throid.  Another option is to visit a compound pharmacist, as they should be able to put together a hypoallergenic form of synthetic or natural thyroid hormone medication.

Conversion problem.  If someone has a problem converting T4 into T3 then they might not do well when taking certain forms of thyroid hormone medication.  Remember that most people are told to take thyroxine, which is T4.  And so if someone is taking levothyroxine, which is synthetic T4, and they are unable to efficiently convert this into T3 then they will most likely continue to experience hypothyroid symptoms.  Switching to a natural form of thyroid hormone very well might improve the symptoms since this form includes both T4 and T3.  However, taking natural thyroid hormone won’t do anything to address the cause of the conversion problem, which can be due to high cortisol levels, a selenium deficiency, gut dysbiosis, or other problems.  I discussed this in greater detail in a blog post I wrote entitled “6 Factors Which Can Affect The Conversion of T4 to T3“.

Autoimmune Response To Thyroid Hormone.  If someone takes natural thyroid hormone (i.e. Armour, Nature-Throid) and feels significantly worse, this might be due to an autoimmune response to thyroid hormone.  In other words, your immune system can produce antibodies towards T3 and T4.  This is one reason why some doctors won’t prescribe natural thyroid hormone to any of their patients.  I find this to be rare, although over the years I have had a few patients feel horrible when taking natural thyroid hormone and I suspected their immune system might have been reacting to it.  While in most cases I still prefer natural thyroid hormone over synthetic thyroid hormone, this is something to be aware of.

Adrenal Problems.  Although an elevated TSH usually is related to a hypothyroid condition, in some cases it can be due to problems with the adrenals.  One study examining three case reports linked adrenal insufficiency with subclinical hypothyroidism (1), while another study showed a relationship between the TSH and cortisol (2).   As it result, if someone has subclinical hypothyroidism (high TSH and normal thyroid hormone levels) and the thyroid antibodies are normal, then it probably would be a good idea to address any adrenal problems before the person takes thyroid hormone medication.

Thyroid Hormone Resistance.  Thyroid hormone resistance is when the thyroid receptors are not responsive to the actions of thyroid hormone.  If someone has this condition then taking thyroid hormone medication probably won’t cause their symptoms to worsen, although they most likely won’t notice an improvement in their symptoms when taking thyroid hormone.  I discussed this condition in greater detail in a blog post entitled “Thyroid Resistance and Natural Treatment Methods“:

In summary, when someone with hypothyroidism has a worsening of symptoms after taking thyroid hormone medication there can be numerous reasons for this.  Some of the most common reasons include the person reacting to fillers and other ingredients, having a conversion issue, an adrenal problem, or perhaps thyroid resistance.  In addition, for those taking natural thyroid hormone it is possible to experience an autoimmune response to the thyroid hormones.  Sometimes it can be challenging to determine why someone is having a negative reaction to thyroid hormone medication, and while there can be causes other than the ones I listed in this post, initially it’s a good idea to look into these factors I discussed.

In the last post I spoke about some of the main causes of insulin resistance.  In this post I am going to focus more on hypoglycemia.  I will then discuss seven factors which can help to balance blood sugar levels.  These will be important regardless of whether you have insulin resistance or hypoglycemia.

Hypoglycemia refers to low blood sugar levels, typically less than 70 mg/dL.  What happens is that either the body’s glucose is used up too quickly, is released into the bloodstream too slowly, or too much insulin is released into the bloodstream (1).  Some of the causes of hypoglycemia include alcohol consumption, an infection, hypothyroidism or hypoadrenalism, and severe heart, kidney, or liver failure (1).  I’ll talk more about these causes shortly.  Some of the common symptoms associated with low blood sugar levels include weakness, fatigue, sweating, disorientation, and shakiness (2).

Reactive hypoglycemia is an exaggerated fall in the blood glucose levels, and is due to excessive insulin secretion in response to a meal.  Dr. Alan Gaby has dedicated a chapter to reactive hypoglycemia in his excellent book “Nutritional Medicine”, and he discusses how if the blood glucose levels fall too rapidly then the body compensates by releasing adrenaline, as well as other compounds which raise the blood glucose levels.  This in turn results in “fight or flight” symptoms such as anxiety, panic attacks, hunger, palpitations, tachycardia, tremors, sweating, and even abdominal pain.  Dr. Gaby also talks about the symptoms presented when the blood glucose levels fall slowly over a period of hours, as this can lead to symptoms such as headaches, fatigue, blurred vision, mental confusion, impaired memory, and even seizures.  These symptoms usually are worse before meals, and frequently are relieved by eating.

Keep in mind that not everyone who has hypoglycemic symptoms will have low blood glucose levels or an abnormal glucose tolerance test.  And so this can be a challenging condition to diagnose.  I briefly mentioned some of the causes of hypoglycemia earlier, but there are other factors which might play a role in this condition, such as food allergies or sensitivities.

The following are some of the potential causes of hypoglycemia:

1) Eating refined foods and sugars.  Most people reading this know that eating a lot of refined foods and sugars will affect the blood sugar levels.  Eating a lot of refined sugars over a period of time will usually lead to hyperglycemia/insulin resistance, and eventually can set the stage for a condition such as type 2 diabetes.  However, in some people it can also lead to hypoglycemia.  Skipping meals frequently also can have a negative effect on the blood sugar levels and lead to hypoglycemic episodes.

2) Alcohol consumption.  Alcohol has a hypoglycemic effect, which is probably caused by the inhibition of gluconeogenesis in the liver (3) (4).  Gluconeogenesis involves the production of sugars (primarily glucose).  While having an occasional alcoholic beverage usually won’t lead to hypoglycemia, frequent consumption of alcoholic beverages can cause blood sugar imbalances.  And if anyone currently has blood sugar imbalances it probably would be a good idea to completely eliminate any alcohol consumption.

3) Thyroid hormone imbalance.  There is evidence that hypothyroidism can be a factor in hypoglycemia (5).  However, it is also possible that having hypoglycemia can inhibit the pituitary-thyroid axis (6).  And while hyperthyroidism isn’t usually associated with hypoglycemia, hyperthyroidism with congestive heart failure or liver dysfunction can induce hypoglycemia, although this is very rare (7).

4) Adrenal Insufficiency.  Hypoglycemia is one of the clinical manifestations of chronic primary adrenal insufficiency (8) (9).  Most cases of primary adrenal insufficiency are considered to be Addison’s disease, which is an autoimmune condition involving the adrenals.  However, secondary causes of adrenal insufficiency can also cause hypoglycemia (10) (11).  And so if someone has low cortisol levels, a low serum ACTH, and/or low DHEA levels, then this can be responsible for the hypoglycemic symptoms.

5) Acute infections.  Most cases of hypoglycemia aren’t caused by infections.  However, in some cases hypoglycemia can occur in bacterial sepsis (12) (13), or in bacteremic pneumococcal infections (14).

6) Food allergies or sensitivities.  Earlier I mentioned the book “Nutritional Medicine” by Dr. Alan Gaby.  In this book he mentions that “the ingestion of allergenic foods can trigger a hypoglycemic response in some people”.  Sometimes this can be challenging to determine, and in people with Hashimoto’s Thyroiditis and Graves’ Disease food sensitivities are common, although many times they are the result of a leaky gut, and don’t cause hypoglycemia.  However, if someone notices hypoglycemic symptoms upon eating a certain food, and if this pattern occurs every time after eating this food then one obviously should suspect that this food is responsible for the hypoglycemic effect.

How Can Blood Sugar Imbalances Be Corrected?

Diet.  Regardless of whether someone has hyperglycemia/insulin resistance, or hypoglycemia, eating well is very important.  Obviously you want to eat whole foods, and minimize the refined foods and sugars.  You also want to minimize your overall carbohydrate intake, and this is especially true if you’re suffering from insulin resistance, as when this is the case you will usually want to consume less than 150 grams of carbohydrates per day, and eating less than 100 grams of carbohydrates per day is sometimes necessary.  Keep in mind that I’m not suggesting that everyone should eat a low carbohydrate diet, but a big problem is that many people eat too many carbohydrates, which is one of the main reasons for the high incidence of insulin resistance and type 2 diabetes.

Although I love eating fruit, eating a lot of servings of fruit per day can cause problems in some people, and this is especially true in those with blood sugar issues.  If you are dealing with blood sugar imbalances it probably is a good idea to limit your consumption of fruit to one or two servings per day.  Even though fruit is high in phytonutrients and consists of natural sugars, you can still overdo it by eating too much fruit.

You also want to eat regularly throughout the day.  This is especially important for those who have hypoglycemia, although I think it’s important for most people to eat breakfast within one hour of waking up, and then every two to three hours after this.  Some people reading this might bring up the benefits of caloric restriction and intermittent fasting, which I wrote about in an article entitled “Intermittent Fasting and Thyroid Health“.  I agree that intermittent fasting can be beneficial, although it probably isn’t a good idea in someone who has hypoglycemia.

Address food sensitivities.  This seems to be more of a trigger with regards to hypoglycemic conditions, but of course even if someone doesn’t have any blood sugar imbalances they want to try to avoid any foods they are reacting to.  It can be very difficult to determine which foods you are sensitive to.  There is testing available such as IgE testing for food allergies, an IgG panel for delayed food sensitivities, and other types of testing such as the ALCAT.  These all can be valuable, but they also all have limitations.  And testing for food sensitivities can be very expensive, yet still provide false results.  I usually recommend an elimination diet for 3 to 4 weeks, followed by reintroducing the “suspicious” foods one at a time over a three day period.  This also has certain limitations, and of course takes more time than conducting a test for food sensitivities.

Improve insulin sensitivity.  It is also important to do things to improve insulin sensitivity.  This is especially important with insulin resistance, although it also can benefit those who have hypoglycemia as well.  Some of the best nutrients which can help to increase insulin sensitivity include chromium (15) (16) (17), magnesium (18) (19), and alpha lipoic acid (20) (21).  Vanadium (22) (23) and bitter melon (24) can also increase insulin sensitivity.  Berberine can benefit those with insulin resistance and type 2 diabetes by lowering blood glucose levels, and it might do this by modulating the microbiota (25).  The herb gymnema sylvestre can help to balance the blood sugar levels (26) (27).  You can also improve insulin sensitivity through exercise, which I’ll discuss next.

Exercise.  We all know that regular exercise is beneficial.  Although there are many nutrients which can increase insulin sensitivity, there is plenty of evidence which shows that exercise can also help to increase insulin sensitivity (28) (29) (30).  A big problem is that many people who exercise regularly also spend a good part of their day sitting.  So for example, someone might have a job that involves sitting behind a desk for most of the day, and then they expect three or four sessions of exercise each week to offset all of this inactivity.  Unfortunately this isn’t the way this works, as regular movement is very important.

Decrease inflammation.  Earlier I discussed how inflammation is a big factor in insulin resistance, and so one needs to do things to reduce the inflammatory process.  Obviously eating a healthy diet can help to reduce inflammation.  But it frequently is necessary to take nutrients to help break the inflammatory process.  I spoke about this in my blog post entitled “The Role of Cytokines In Autoimmune Thyroid Conditions“, as there is a transcription factor called Nuclear Factor Kappa B (NF-kB), and this needs to be downregulated.  Certain nutrients which can help with this include vitamin D, fish oils, turmeric, resveratrol, gamma-linolenic acid, ginger, and green tea.

Reduce oxidative stress. I also discussed how oxidative stress and mitochondrial dysfunction can play a role in insulin resistance.  And so doing things to reduce oxidative stress and improve the health of the mitochondria can be beneficial.  Some nutrients which can help with this include vitamin C, lipoic acid, acetyl-l-carnitine, CoQ10, resveratrol, and omega 3 fatty acids.

Correct dysbiosis.  Since intestinal dysbiosis can play a role in inflammation and insulin resistance, it is necessary to address this problem.  As I mentioned earlier, I have written a separate article on this topic, and so I would refer to this when you get the chance.

So hopefully you have a better understanding of the different factors which can cause insulin resistance and hypoglycemia, as well as some of the things you can do to address these health conditions.  Insulin resistance is when the body no longer is responsive to the effects of insulin, and some of the factors which play a role in the development of insulin resistance include inflammation, mitochondrial dysfunction, lipotoxicity, gut dysbiosis, circadian disruption, and genetics.  Hypoglycemia involves low blood sugar levels, and some of the potential causes of this condition include alcohol consumption, an infection, hypothyroidism, hypoadrenalism, as well as food allergies or intolerances.  Eating well and exercising regularly are both important factors when trying to regulate blood sugar imbalances, but some of these other factors I discussed in this post also need to be considered.

Many people with thyroid and autoimmune thyroid conditions have blood sugar imbalances.  However, there are different types of these imbalances.  Two of the most common health issues involving blood sugar imbalances are hypoglycemia and insulin resistance.  In the past I’ve spoken about these in separate articles, but since so many people suffer from blood sugar problems I figured it would be a good idea to talk about the similarities and differences between these two conditions.  In this post I will focus on insulin resistance, and then in the next post I will talk about hypoglycemia, and I will also discuss what you can do to correct blood sugar imbalances.

Glycemia refers to the presence of glucose in the blood.  As the name implies, hypoglycemia is a condition characterized by low blood sugar levels, whereas insulin resistance is more characteristic of hyperglycemia, which of course involves high blood sugar levels.  And the solution might seem simple, as if someone has high blood sugar levels  then they obviously want to reduce their sugar intake, and if someone has low blood sugar levels they will want to eat more regularly, right?  For the most part this is true, but while dietary factors are obviously important with both hypoglycemia and insulin resistance, these conditions are frequently complex and require more than simple dietary changes.

Before talking about insulin resistance I’d like to briefly talk about insulin.  Insulin is a hormone that is produced by the beta cells of the pancreas.  Insulin has numerous roles, but one of the primary roles is the regulation of blood glucose levels.  So when someone eats a meal, this will cause their blood sugar levels to rise, and the beta cells will secrete insulin to help the body utilize or store the glucose.

As for how insulin reduces blood glucose, it does so by inducing glucose uptake into insulin-sensitive tissues such as skeletal muscle, fat, and heart (1).  Insulin also inhibits glucose production in the liver, kidney, and small intestine in the control of blood glucose (1).  Insulin has other functions, as it stimulates the synthesis of fatty acids and glycogen (2), and it also plays a role in mitochondrial function.  What happens with insulin resistance is that the body is no longer responsive to the effects of insulin.  This in turn can lead to other conditions such as type 2 diabetes, accelerated atherosclerosis, hypertension or polycystic ovarian syndrome (3).

What Causes Insulin Resistance?                                                    

But in order to understand how to correct insulin resistance, it’s important to understand how insulin resistance develops.  Although eating a poor diet and a lack of exercise are definitely factors in many people, the development of insulin resistance is usually more complex.  Here are some of the factors which are thought to cause or contribute to insulin resistance:

1) Inflammation.  Inflammation is one of the biggest factors associated with insulin resistance, and this is one of the primary reasons why weight loss is so challenging in those with autoimmune thyroid conditions.  The following information is going to be somewhat advanced, but then I’m going to do my best to clarify it so that you better understand it.  Activation of immune cells is closely associated with insulin sensitivity, and research shows that classically activated (M1) macrophages sustain insulin sensitivity, whereas alternatively activated (M2) macrophages induce insulin resistance through the secretion of proinflammatory cytokines (4).  Apparently in a lean state Th2 cells, regulatory T cells, natural killer cells, or eosinophils contribute to the M2 activation of macrophages, whereas obesity causes alteration of the constituent immune cells, in which Th1 cells, B cells, neutrophils, or mast cells induce M1 activation of macrophages (4).

So what exactly does this mean?  Essentially the activation of certain immune system cells will cause insulin resistance, while the activation of others will decrease insulin resistance.  One of the main takeaways is that Th1 dominant conditions are more commonly associated with insulin resistance, whereas Th2 dominant conditions involve an increase in insulin sensitivity.  Since most people with Hashimoto’s Thyroiditis are Th1 dominant, this can be another mechanism which makes it difficult for people with this condition to lose weight.  If this is the case, the main factor which will help with losing weight is to suppress the autoimmune component and decrease the inflammation, which can be very challenging, and has been discussed in other blog posts and articles.  Graves’ Disease is in most cases a Th2 dominant condition, although this doesn’t mean that people with this condition can’t develop insulin resistance.

2) Mitochondrial dysfunction.  Mitochondria are located in the cytoplasm of our cells, and they are where cellular respiration occurs.  I’ve written a separate article on Mitochondria entitled “The Relationship Between Mitochondria and Thyroid Health“, and so if you’re not familiar with mitochondria I would read this article when you get the chance.  There is evidence that dysfunction of the mitochondria can play a role in insulin resistance (5) (6) (7).  But how can damage to the mitochondria cause insulin resistance?  Well, adipocytes (fat cells) play an important role in regulating energy metabolism and glucose homeostasis, and it appears that free radicals which are caused by mitochondrial dysfunction causes impairment of the function of adipocytes in maintaining glucose homeostasis (7).  So what this is essentially saying is that the mitochondria helps to regulate glucose homeostasis in fat cells, but when there is mitochondrial dysfunction, this causes free radicals, which in turn impairs the fat cells.

As a result, if someone has insulin resistance then it probably would be a good idea to do some things to help improve the health of the mitochondria.  But how can one tell if they have mitochondrial dysfunction?  Well, this can be challenging, and one of the methods of determining problems with the mitochondria is through an organic acids test, although other testing methods which can be useful include an amino acid analysis and a carnitine analysis (8).

3) Lipotoxicity.  Lipotoxicity refers to an excess of free fatty acids in certain tissues, which can include skeletal and cardiac muscle cells, hepatocytes (liver cells), and pancreatic beta cells (9) (10).  This can be a factor in insulin resistance and metabolic syndrome, and it will typically show up as elevated triglycerides on a lipid panel.  A good example of a condition associated with lipotoxicity is nonalcoholic fatty liver disease (NAFLD), which not surprisingly is usually associated with insulin resistance.  I’ve written a separate article on NAFLD entitled “Nonalcoholic Fatty Liver Disease and Thyroid Health“.  But just as a reminder, these fatty acids can accumulate in other cells as well, and not just the liver cells.

4) Gut dysbiosis.  Accumulating evidence indicates that the gut microbiota play a significant role in the development of obesity, obesity-associated inflammation, and insulin resistance (11).  Many people with thyroid and autoimmune thyroid conditions have gut dysbiosis, which I discussed in an article I wrote entitled “Intestinal Dysbiosis and Thyroid Health“.  I’ve also spoken about PCOS in the past, which is characterized by insulin resistance.  And there is evidence that gut dysbiosis can cause activation of the immune system, thus interfering with insulin receptor function, driving up serum insulin levels (12).

5) Circadian disruption.  I’ve spoken about the circadian rhythm in the past when discussing the adrenals and cortisol.  Circadian rhythms follow a 24-hour cycle.  So for example, cortisol is normally at the highest levels when a person first wakes up, and should be at the lowest levels right before going to bed.  The opposite is true with melatonin, as this hormone should be at the lowest levels upon waking up, and at the highest levels upon going to bed.  Many hormones that modulate insulin secretion and glucose homeostasis are regulated by the circadian system, and in addition to cortisol and melatonin, this includes hormones such as leptin, glucagon, growth hormone, and the catecholamines (13).  Disruptions in the circadian rhythm can lead to an increase in body weight, elevated leptin levels, and increased insulin secretion (14) (15).  As a result, if you are having problems with sleep, you most likely have problems with the circadian rhythm, which can be a cause of insulin resistance.

6) Genetics.  Yes, genetics is also a factor in insulin resistance.  However, just as is the case with most other chronic health conditions, lifestyle and environmental factors usually trigger the genetics.  Although some people are more susceptible to developing insulin resistance due to genetic factors, the good news is that it is possible to change the expression of our genes by modifying our lifestyle and environment.

So hopefully you have a better understanding with regards to the different factors that can cause insulin resistance.  In the next post I’m going to talk about hypoglycemia.  And then at the end of the post I will discuss seven factors which can help to balance the blood sugar levels.