Over the years I’ve had numerous patients ask me about the potential benefits of maca, also known as Lepidium meyenii.  Of course there are many beneficial herbs that people can take, such as ashwagandha, eleuthero, rhodiola, etc.  However, this doesn’t mean that everyone with a thyroid or autoimmune thyroid condition should take all of these herbs.  And to be honest, while I’ll be discussing some of the benefits of maca root in this blog post, I can’t say that I commonly use this herb in my practice, although over this past year I have been recommending it more frequently to my patients.

Maca is an Andean plant that belongs to the brassica family. Some of the more common uses is to help improve sexual function and fertility (1) (2).  It seems that maca can be beneficial for both men and women.  For example, one small study showed that maca improved sperm production and sperm motility (3).  Another study showed that maca lowers measures of sexual dysfunction in postmenopausal women independent of estrogenic and androgenic activity (4).  These were both very small studies, and there are other small studies which show that maca can be effective in men and perimenopausal women.

More About Maca

There are actually a lot of studies on maca, although without question, larger trials need to be conducted.  But most of the studies I came across showed that maca has some great benefits.  Differences have been shown between the effects of the black, yellow and red maca varieties, as black maca shows the best results on spermatogenesis, memory and fatigue, while red maca is the variety that reverses benign prostatic hyperplasia and experimentally induced osteoporosis (5). In addition, maca reduces the glucose levels, and its consumption is related to the lowering of blood pressure and an improved health score (5). For those who are concerned about whether taking maca is safe on a long term basis, studies have demonstrated that short and long term consumption don’t show in vivo and in vitro toxicity.

Experimental scientific evidence showed that maca has nutritional, energizer, and fertility-enhancer properties, and it acts on sexual dysfunctions, osteoporosis, benign prostatic hyperplasia, memory and learning, and protects skin against ultraviolet radiation (6). A few different trials have shown that maca can help to reduce the symptoms of depression (7) (8), and can also improve diastolic blood pressure (8).  One study showed that maca can even affect the cytokines, as consumption of maca was associated with low serum IL-6 levels (9).

How Does Maca Work?

Initially it was thought that Maca root worked via phytoestrogens, but it looks like the mechanism of action is through numerous alkaloids, and not its plant hormones (10).  However, other components also can play a role such as sterols (campesterol, stigmasterol and beta-sitosterol), as well as polyunsaturated acids and their amides, called “macaenes” and “macamides”, as well as aromatic glucosinolates (10).  Although the exact mechanism of how maca root works still isn’t known, maca apparently affects the hypothalamus and pituitary gland (11).  And of course the hypothalamus and pituitary gland affect the output of the adrenal hormones, thyroid hormones, as well as hormones secreted by the ovaries and testes.

Can Maca Benefit People With Thyroid and Autoimmune Thyroid Conditions?

As I already mentioned in this post, maca seems to affect the hypothalamus and pituitary gland.  These of course both play a role in thyroid health, as the hypothalamus releases thyrotropin-releasing hormone (TRH), which in turn stimulates the pituitary gland to release TSH, which stimulates the thyroid gland to release thyroid hormone.  In this matter it is possible that taking maca root can affect thyroid health, and perhaps even help to increase the output of thyroid hormone in some people with hypothyroid conditions.  However, maca doesn’t seem to directly affect the thyroid gland, and so if someone with hyperthyroidism or Graves’ Disease were to take maca it shouldn’t increase the output of thyroid hormone.  With that being said, every now then I’ll receive an email from someone with hyperthyroidism who took an adaptogenic herb such as maca or eleuthero and claimed it increased the hyperthyroid symptoms.  Although this isn’t something my patients commonly experience when taking adaptogenic herbs, if this does happen to you then obviously I would discontinue taking the herb.

Maca does have a very small amount of iodine, and so those who are trying to completely avoid iodine might want to avoid taking maca.  With that being said, taking a few grams of maca doesn’t seem to cause problems in most people with autoimmune thyroid conditions such as Graves’ Disease and Hashimoto’s Thyroiditis.  But of course everyone is different, and so if you take maca and feel as if it’s worsening your condition then obviously I would advise you to stop taking it.  As I briefly mentioned earlier, maca is part of the brassica family, which also includes broccoli, kale, cauliflower, etc.  Many people with hypothyroid conditions avoid these foods due to their goitrogenic properties, although taking maca is unlikely to inhibit thyroid hormone production in most people.

Many people with thyroid and autoimmune thyroid conditions have problems with the adrenals and sex hormones (i.e. estrogen, progesterone, testosterone).  And since maca affects the hypothalamus and pituitary glands, it not only can affect thyroid health, but since the pituitary gland also secretes hormones such as FSH, LH, and ACTH, maca can also potentially affect the output of these hormones as well.

As for what dosage of maca to take, this will vary from person to person.  Most of the studies have used anywhere from 2 grams to 10 grams per day of maca.  If you decide to take maca it probably would be best to start with a smaller dose and then gradually increase it if necessary.  This is especially true if you’re taking maca to help with hot flashes, as if the dose is too high then it might actually increase the number of hot flashes in some women.  Plus, while some notice an improvement in their symptoms in as little as three or four days, in some people it can take a week or longer before noticing a positive change.

In summary, the use of maca root is growing in popularity, as some of its benefits include helping to improve sexual function and fertility, reducing glucose levels, lowering blood pressure, reducing hot flashes, and in decreasing depression.  Maca apparently affects the hypothalamus and pituitary gland, and thus can not only potentially affect thyroid health, but can also affect the output of adrenal hormones, as well as estrogen, progesterone, and testosterone.  Most people who take maca should begin with a small dosage and gradually increase it if necessary.

Bile is a fluid that is produced by the liver, and stored and concentrated in the gallbladder. It plays a role in digestion, specifically helping to break down fats into fatty acids. Many people have thick and sluggish bile, which commonly results in gallbladder surgery. But of course the surgery isn’t doing anything for the actual cause of the thick and sluggish bile. When you think about it, there is a lot in common with both gallbladder surgeries and thyroidectomies, as there are hundreds of thousands of these surgeries performed each year, and many of these could be avoided by addressing the actual cause of the condition.

There are approximately 500,000 gallbladder surgeries performed each year. But when someone has a problem such as gallstones, the problem usually isn’t with the gallbladder itself. If this is the case, then why is the gallbladder frequently removed when someone experiences recurrent cases of gallstones? Of course the main reason is because most medical doctors don’t know what else to do. To be fair, although many gallbladder problems can be prevented, sometimes the person reaches the point where gallbladder surgery might be necessary. While many times changing one’s diet or doing other things can help to prevent surgery, sometimes surgery is unavoidable.

Why Do Many People Have Gallbladder Problems?

Before I discuss some of the reasons why many people have gallbladder problems, I’d like to expand on the importance of bile. As you already know, bile helps to break down fats into fatty acids. Because of this, if someone has problems with bile, they will have problems breaking down fat soluble vitamins such as vitamins A, E, K, and D. They also might have problems digesting fish oil supplements, as well as other types of fats, such as the healthy fats present in avocados. Hopefully you are beginning to understand how problems with bile production can lead to nutrient deficiencies. And since removing the gallbladder won’t correct the bile problem, these people will still have problems breaking down fat soluble vitamins from the foods they eat.

In moderate to severe cases the person might experience certain symptoms when eating fatty foods, and thus might avoid not only greasy foods, but healthy fats such as nuts, seeds, and avocados. However, just because you’re not experiencing symptoms when eating these foods doesn’t mean that you aren’t having any problems with bile production. In fact, some people with mild to moderate bile production problems will have no symptoms. On the other hand, some of the common symptoms of gallbladder problems include bloating, gas, nausea, fatty stools, pain between the shoulder blades, and abdominal pain.

In addition to helping to break down fats, bile also plays an important role in the excretion of waste products. What happens is that the liver metabolizes toxins, and bile excretes them. This not only includes numerous environmental toxins, such as heavy metals, but also drug metabolites, and even the steroid hormones. This is how problems with bile relates to estrogen dominance, as if someone has estrogen dominance due to the buildup of bioidentical estradiol and/or xenoestrogens in the tissues, then this will lead to bile that is thick and sluggish. However, it’s not just estradiol which can change the properties of bile, as there is evidence that estriol, which is the main estrogen in pregnancy, produces profound changes in bile salt dependent flow and can lead to increased gallstone formation (1).

The Components of Bile

There are three main components of bile, and this includes 1) bilirubin, 2) bile acids and salts, and 3) cholesterol. Most people reading this are familiar with cholesterol, but you might not be familiar with the other two main components of bile. Bilirubin is the toxic catabolic product of heme metabolism, and the goal of bile is to help with the excretion of bilirubin. However, certain factors can cause a disturbance of bilirubin transport, which causes increased levels of bilirubin in the blood (hyperbilirubinemia), which in turn can lead to jaundice if the levels become high enough. Gallstones are a common reason for cholestasis, which is when there is a disruption of the flow of bile from the liver to the small intestine, although there can be other factors involved as well.

I’ve already mentioned some of the benefits of the bile acids/bile salts already, but they have numerous other functions as well. In fact, the bile salts play a big role in inhibiting the growth of bacteria in the small intestine (2). As a result, if someone has problems with the production of bile, then this can increase the risk of developing a condition such as small intestinal bacterial overgrowth (SIBO). Because of this it would make sense to give bile salts to those who currently have SIBO. This isn’t to suggest that the primary cause of SIBO has to do with low bile acids. Other factors can cause SIBO such as low or absent production of gastric acid, a deficiency of the pancreatic digestive enzymes, problems with the immune system, motility disorders, and other health issues. In addition to preventing the growth of bacteria in the small intestine, bile also might have antimicrobial properties against H. Pylori. Although bile acids are conjugated with taurine or glycine in the liver to form bile salts, there is some evidence that unconjugated dihydroxy bile acids has antibacterial activity against H. Pylori (3).

There is also evidence that bile acids play a role in preventing insulin resistance, as they appear to be signaling molecules that play important roles in glucose and lipid metabolism (4) (5). I of course mentioned earlier how bile is important for breaking down fats into fatty acids. It’s actually the bile receptors FXR and TGR5 which help to regulate lipid and carbohydrate metabolism, as well as inflammatory responses (6) (7). However, it’s the bile acids which activate these receptors. So having proper bile production can play a role in preventing insulin resistance and conditions such as non-alcoholic fatty liver disease.

Why Do Gallstones Form?

Because so many people develop gallstones, it probably is a good idea to discuss why gallstones form. Could it possibly be related to problems with bile production? It might be best to begin with a brief anatomy lesson, as I mentioned earlier that it’s the liver that produces bile, and the gallbladder stores and concentrates it. Your gallbladder will then release bile through a tube called the common bile duct. This duct connects your gallbladder and liver to the small intestine. Gallstones form when substances in bile harden, and this gallstone can block the flow of bile through the bile ducts, and this usually results in symptoms such as nausea, pain in the mid-back or abdomen, and sometimes vomiting.

There are two main types of gallstones. Gallstones made from cholesterol are the most common type, and are not related to cholesterol levels in the blood (8). One can also have gallstones made from bilirubin, which occur when red blood cells are destroyed and too much bilirubin is in the bile (8). Most medical doctors don’t think the formation of gallstones can be prevented, and while this might be the case in some situations, this isn’t true for the majority of gallbladder problems involving gallstones.

Diet of course is one of the main causes, as there is evidence that dietary factors can increase the risk of developing cholesterol gallstones. Dietary factors that may increase risk include cholesterol, saturated fat, trans fatty acids, refined sugar, and possibly legumes (9). Gallstones are also common in obesity (10) (11). Another study suggested that dietary constituents are important determinants for the formation of lithogenic bile (12). This doesn’t mean that eating a healthy diet will completely eliminate the risk of developing gallstones, but I think it’s safe to say that eating well will greatly reduce the likelihood of developing gallstones.

However, there are other factors to consider as well. For example, since estrogen dominance can make bile thick and sluggish and thus lead to the formation of gallstones, it shouldn’t be a surprise that there is evidence that those who take oral contraceptives are at an increased risk for gallbladder disease (13) (14). And while there are currently no studies which show a correlation between xenoestrogens and gallstones, there is no question that xenoestrogens can cause estrogen dominance, and since high levels of estrogen will affect bile production I think it’s just a matter of time before we see some clinical trials showing a correlation between the two.

What Are The Benefits and Risks of Gallbladder Surgery?

The obvious benefits of gallbladder surgery is that it will help to resolve the symptoms associated with the gallstones. However, as I mentioned earlier, surgically removing the gallbladder doesn’t do anything for the actual cause of the problem. And although most gallbladder surgeries are successful, there still are potential risks, such as injury to the common bile duct, injury to the small intestine, an infection, or internal bleeding. In addition, 5% to 40% of people who have the gallbladder removed may experience symptoms of postcholecystectomy syndrome which can include upset stomach, nausea, vomiting, gas, bloating, diarrhea, and persistent pain in the upper right abdomen (15).

But the main problem with gallbladder surgery isn’t the potential risks of the surgery, nor is it the symptoms associated with postcholecystectomy. The main issue is that removing the gallbladder won’t correct the bile problem. So if you have a condition such as estrogen dominance which caused problems with bile production and resulted in gallstones, removing the gallbladder obviously won’t correct the estrogen dominance problem. Similarly, if you are not efficiently breaking down fats into fatty acids, then getting gallbladder surgery isn’t going to help with this either.

What Role Does Bile Play In Thyroid Health?

So how does bile relate to thyroid health? First of all, thyroid hormones alter bile acid metabolism in humans (16) (17). In addition, a small study showed that bile acids play a role in human energy metabolism and in thyroid hormone control (18). However, larger studies are needed to confirm this. As for how hypothyroidism and hyperthyroidism affect bile, one smaller study showed that hypothyroidism may result in delayed emptying of the biliary tract (19). The same study suggested that this might be the cause for the increased prevalence of common bile duct stone formation in hypothyroidism. With regards to hyperthyroidism and Graves’ Disease, bile acid malabsorption can be associated with some people who have hyperthyroid conditions (20).

There are also indirect relationships between bile production and thyroid health. For example, earlier I discussed how problems with bile production can lead to deficiencies in the fat soluble vitamins. And both vitamin A and vitamin D play an indirect role in thyroid health. Not too long ago I wrote an article entitled “Can a Vitamin D deficiency Cause an Autoimmune Thyroid Condition?” I discussed how a vitamin D deficiency can make someone more susceptible to developing an autoimmune thyroid condition such as Graves’ Disease or Hashimoto’s Thyroiditis. Vitamin A is also important for the health of the immune system, but it’s also important for the health of the gut, as a deficiency of vitamin A might be a factor in the development of a leaky gut (21).

How To Have Healthy Bile Production

So what can someone do to improve the health of their bile? Obviously eating well is important, as you want to avoid refined foods and trans fats. Numerous studies also have shown that taking vitamin C supplements can help to prevent the formation of gallstones (22) (23) (24), and so this is also something to consider. Eating beets or taking supplements which contain beets can help, and choline can also be beneficial. Certain herbs which can help improve biliary function include dandelion root, fringe tree, and globe artichoke.

In the textbook “Nutritional Medicine” by Dr. Alan Gaby, he discusses the impact of food allergies on gallbladder health, and how the gallbladder can be a target organ for allergic reactions. He also mentioned an uncontrolled study where identification and avoidance of allergenic foods eliminated gallbladder symptoms in 100% of patients (69 in total) with gallstones or postcholecystectomy syndrome (25). So this is yet another reason to consider avoiding common allergens such as gluten, dairy, corn, etc.

Since estrogen dominance can make bile thick and sluggish, if you have this condition you will want to address it. For example, I mentioned how oral contraceptives can lead to the formation of gallstones. And many people reading this are already aware of the impact of xenoestrogens on our health, and so minimizing your exposure to these toxins can lead to healthy bile production and a decreased incidence of gallstones.

Doing a gallbladder flush may be beneficial. Although there is controversy over whether or not these truly will result in the passing of gallstones, numerous people have been helped by doing a gallbladder flush. However, while a gallbladder flush can be beneficial, there are potential risks involved. For example, if you have a large gallstone, it can possibly block the bile duct when trying to expel it with a gallbladder flush, which can result in a medical emergency. This is rare, although still is something to keep in mind.

What Should You Do If You Don’t Have a Gallbladder?

If you have had your gallbladder surgically removed, then you still will want to follow the advice given in this post. After all, remember that removing your gallbladder didn’t do anything for the bile problem, and so even after gallbladder surgery you want to do things to help improve biliary function.

So hopefully you now have a better understanding of how important normal bile production is not only to thyroid health, but having problems in this area can affect other areas of your health as well. There are way too many gallbladder surgeries performed, and while some of them are necessary, most of these “gallbladder problems” could be prevented by eating well, along with being aware of other factors which can affect bile production, such as taking oral contraceptives. As I discussed in this post, bile is important for breaking down fats into fatty acids, plays an important role in the excretion of waste products, and bile also has antimicrobial properties. If someone is trying to prevent the formation of gallstones, or even if they already have gallstones, one will want to eat a healthy diet, avoid common food allergens, consider supplementing with vitamin C, incorporate beets and/or choline into the diet, minimize their exposure to xenoestrogens, and there are times when they might want to consider doing a gallbladder flush.

For those people with Graves’ Disease and Hashimoto’s Thyroiditis who follow a natural treatment protocol, one of the primary goals should be to suppress the autoimmune response.  As you probably know, most endocrinologists don’t pay attention to the autoimmune component, as they just focus on getting the TSH and thyroid hormone levels within the normal lab reference range.  But remember that Graves’ Disease and Hashimoto’s Thyroiditis are not thyroid conditions, but instead they are autoimmune conditions which affect the thyroid gland.  Although not everyone with an autoimmune thyroid condition will test positive for thyroid antibodies, many people do have elevated levels.  And it’s not uncommon for these antibodies to remain high even after following a natural treatment protocol for a prolonged period of time.  Why is this the case?

Before I answer this question, let’s briefly discuss the different types of thyroid autoantibodies.  Hashimoto’s Thyroiditis is characterized by thyroid peroxidase antibodies and/or thyroglobulin antibodies.  Graves’ Disease is characterized by TSH receptor antibodies, also known as TSI antibodies.  There are a few other types of thyroid antibodies, but these are the most common ones associated with these conditions.  It’s also possible for people to have both types of antibodies, as I’ll frequently see people have both TSI antibodies and TPO antibodies, and every now and then I’ll see someone with all three of these antibodies.

What Causes Elevated Thyroid Antibodies?

In order to better understand why thyroid antibodies might remain elevated after following a natural treatment protocol, it is probably a good idea to discuss why these antibodies become elevated in the first place.  Once again, Graves’ Disease and Hashimoto’s Thyroiditis are autoimmune conditions.  There are many different types of autoimmune conditions, and the primary difference is that each one attacks different tissues of the body.  While Hashimoto’s Thyroiditis involves antibodies that attack and damage the thyroid gland, the TSH receptor antibodies of Graves’ Disease attack the TSH receptors.  Other autoimmune conditions will attack other parts of the body.  For example, with multiple sclerosis the immune system attacks the myelin, which covers the nerve cells of the brain and spinal cord.  Another example involves rheumatoid arthritis, which is a condition where the immune system attacks the synovial joints.

Although autoimmunity involves a genetic component in most cases, not everyone with a genetic marker develops an autoimmune condition.  It takes a combination of genetic, lifestyle, and environmental factors to trigger an autoimmune condition.  This isn’t just my opinion, as there are many journal articles which discuss this as well, and studies involving identical twins prove that genetics alone won’t lead to the development of an autoimmune condition.  So when someone develops an autoimmune condition, they most likely had a genetic predisposition, but something triggered the autoimmune response, and this causes the formation of thyroid antibodies.

Removing The Autoimmune Trigger Is The Key

If someone follows a natural treatment protocol and if their thyroid antibodies remain elevated, this usually indicates one of the following three problems:

1) The autoimmune trigger hasn’t been removed. This probably is the most common reason why elevated thyroid antibodies will remain high.  For example, one of the common autoimmune triggers is a leaky gut.  As a result, if I confirm that someone has a leaky gut and then help the person correct this problem by removing the leaky gut trigger and repair the gut, if this was the one and only trigger then it should  resolve the autoimmunity issue, and thus normalize the thyroid antibodies.  However, it is possible for someone to have multiple triggers.  In other words, it is possible for someone to have a leaky gut, but perhaps the main factor which triggered the autoimmune response was a certain toxin.  In this scenario, while it’s important to correct the leaky gut, the toxin issue would need to be addressed in order to normalize the thyroid antibodies.

This has happened to me numerous times while working with patients, as I’ve dealt with many people who have leaky gut syndrome, and while correcting this problem will frequently be the key in restoring the person’s health back to normal, this isn’t always the case.  Having multiple triggers admittedly is frustrating to both the doctor and patient.  And sometimes it can be a challenge to find all of the triggers.  This is especially true with a factor such as toxins, as there are so many toxins we’re exposed to, and it’s impossible to test for all of them.  Plus, even if it were possible to measure all of them, we need to keep in mind that not everyone reacts the same to toxins.  This is demonstrated by the Chemical Immune Reactivity Screen from Cyrex Labs, as this test measures the immune system response to certain toxins.  For example, one person might not have any problems when being exposed to large amounts of formaldehyde, whereas another person might have a negative reaction when exposed to smaller amounts of this toxin.  And the same concept applies with other toxins.

2) The autoimmune response hasn’t been suppressed. Many times just removing the trigger alone won’t “balance” the immune system.  So for example, if someone has a leaky gut due to eating gluten, if the person completely removes gluten from their diet and successfully goes through a gut repair protocol, the autoimmune component still might be active.  Another example involves exposure to a pathogen which triggered the autoimmune response, as while addressing the pathogenic infection is necessary, doing so might not suppress the autoimmune response.  In a previous blog post entitled “The Role Of Cytokines In Autoimmune Thyroid Conditions“, I spoke about something called nuclear factor kappa B (NFkappaB).  I discussed how this becomes chronically activated in autoimmunity, and while it is essential to remove the autoimmune trigger in order to restore the person’s health back to normal, NFkappaB might remain active even after removing this trigger.  When this scenario arises it becomes necessary to do things to help suppress the autoimmune component of the condition.  Certain nutrients which can help with this vitamin D, omega 3 fatty acids, curcumin, and resveratrol.

3) Other compromised areas of the body need to be healed. Getting back to the leaky gut example, if a pathogen such as H. Pylori or candida caused a leaky gut, then not only is it important to get rid of the pathogen, but it is also important to restore the health of the gut.  Some will assume that removing the trigger which caused the leaky gut is enough, but many times this isn’t the case.  Another example involves gluten, as if someone has a condition such as Celiac disease and consumes gluten, and this in turn caused a leaky gut over time, in addition to eliminating gluten from that person’s diet, certain measures usually need to be taken to repair the gut.  Another example involves stress.  Let’s look at the scenario where someone is dealing with chronic stress, which in turn causes HPA-axis dysregulation and weakened adrenal glands, thus making the person more susceptible to inflammation and resulting in autoimmunity.  While the person needs to improve their stress handling skills, doing this alone won’t always restore the health of the adrenals and the HPA-axis.

So in summary, in order to reverse autoimmunity and thus lower elevated antibodies one needs to 1) remove any autoimmune triggers, 2) suppress the autoimmune response, and 3) address other compromised areas of the body which might be contributing to the autoimmune component.  This can be very challenging, which is why I recommend for those looking to restore their health to work with a competent natural healthcare professional who has experience dealing with these conditions.  But even when working with someone it can be a challenge.  Although some people gradually improve with no setbacks, other cases are more challenging.  Obviously poor patient compliance can be a big issue, but some people don’t receive optimal results even when they are fully compliant.  And when this is the case one needs to look at these three factors I just mentioned.

Warning: The Thyroid Antibodies Can Fluctuate

While it’s great to see the thyroid antibodies gradually decrease as someone’s health improves, this doesn’t always happen.  In some people the thyroid antibodies will fluctuate, and so it’s not uncommon to see them decrease, and then to do another blood test one or two months later and see the antibodies increase.  This not only can become frustrating to the patient, but at times it can also become confusing, as their TSH and thyroid hormone levels might be improving, yet the thyroid antibodies will sometimes further increase.  Just remember that the thyroid antibodies don’t always gradually decrease, and they probably won’t normalize until the trigger has been removed and the autoimmune response has been suppressed.

Should The Autoantibodies Be Zero In A Healthy Person?

A question I get asked every now and then is whether or not the thyroid antibodies should be zero, or is just having them fall below the reference range sufficient?  First of all, if someone is negative for thyroid antibodies, many times the lab won’t give a specific value.  For example, for the thyroglobulin antibodies a common reference range used is between 0 to 40 IU/mL (keep in mind that the reference range may differ depending on the lab you use), and you might show up as being less than 20.  In this example you would be considered to be negative, although you wouldn’t know the exact number, and there is the possibility that the value wouldn’t be zero.   To me this is satisfactory.  However, if someone has TSI antibodies of 125%, and the normal reference range is <140%, one might not consider this to be satisfactory since they still have some TSH receptor antibodies present.  If someone has TSI antibodies of 400 and then this eventually gets them down to 125 and it remains there, then in my opinion this is considered to be excellent progress, although I of course would prefer to see them get even lower than this.

Just remember what I said earlier about the antibodies fluctuating.  Some people do experience a gradual decrease in their antibodies, and so for example, if someone had TPO antibodies that were 1,500, and then they gradually decreased over time until they were undetectable, then this would of course be a positive finding.  However, if they were 1,500 and then one month later they were undetectable, then I would be more suspicious of the levels fluctuating.  Either way I would want to retest the levels in a month or two, but if someone experienced a gradual decrease in the antibodies over a number of months until they eventually were undetectable I would be more confident about the autoimmune response being suppressed.

Another thing to keep in mind is that not everyone with an active autoimmune component will test positive for thyroid antibodies.  Although the majority of people with Graves’ Disease and Hashimoto’s will have positive thyroid antibodies, some people with autoimmunity don’t test positive for elevated autoantibodies.  When this is the case this obviously makes it more challenging to determine if the autoimmune response has been suppressed.  But even if someone has elevated thyroid antibodies you don’t just want to rely on this alone to monitor their progress.  This is why other types of testing is important, as if someone has tested positive for a leaky gut or compromised adrenals, then of course you want these conditions to be corrected.  And even though you don’t want to rely on signs and symptoms, this can be important.  For example, if someone has a depressed TSH and elevated thyroid hormone levels, negative TSI antibodies, but they have swelling and bulging of the eyes, then this is a pretty god indication that they have Graves’ Disease, even though the TSH receptor antibodies tested as negative.  In this scenario one would look for an improvement not only with the TSH and thyroid hormone levels, but with the eye symptoms as well.

In summary, for those with an autoimmune thyroid condition who are following a natural treatment protocol, one of the goals is to normalize the thyroid antibodies.  However, if the thyroid antibodies remain elevated after following a natural treatment protocol, this means that either the autoimmune trigger hasn’t been removed, the autoimmune response hasn’t been suppressed, and/or other compromised areas of the body need to be healed.  It’s also important to understand that not everyone with Graves’ Disease or Hashimoto’s Thyroiditis has elevated thyroid antibodies, and it also is important to understand that the thyroid antibodies can fluctuate.  Even though it can be challenging to reverse autoimmunity, this is possible to accomplish.

One of the most common questions I receive from people with thyroid and autoimmune thyroid conditions is “What type of diet should I follow?”  There is of course so much conflicting information out there, and so it definitely can be confusing.  Many healthcare professionals will recommend a Paleo-type diet, whereas others will recommend a Mediterranean diet.  Some healthcare professionals will recommend a vegetarian diet for any type of chronic health condition, including thyroid conditions, as well as autoimmune thyroid conditions such as Graves’ Disease and Hashimoto’s Thyroiditis.  Between working with many patients over the years with these conditions, and through the knowledge I’ve obtained through receiving my master’s in nutrition degree, getting numerous nutrition certifications, and attending countless nutritional seminars, I feel as if I have some valuable information to share with you on this topic.

There are so many different diets out there, and so I can’t possibly discuss all of them here.  But I’m going to specifically focus on five of them in this post.  And then at the end of this blog post I will mention the diet I prefer for people with thyroid and autoimmune thyroid conditions to follow.  I realize you might be tempted to skip to the end of the blog post and see what my final conclusion is, but if you are truly interested in expanding your knowledge on nutrition I would recommend reading all of the information.

Autoimmune Paleo diet. Many people are familiar with a Paleo diet.  This is based on the diet of our Paleolithic ancestors.  The main foods allowed with this diet include grass-fed pasture-raised meats, eggs, fish, fruit, vegetables, and nuts and seeds.  Foods that are excluded include grains, legumes, potatoes, dairy products, and of course any type of refined foods, included processed oils.  An autoimmune Paleo diet involves the same exclusions, but according to this diet the person should also avoid eggs, nuts and seeds, along with the nightshades.

But what’s the rationale behind eliminating these foods?  Well, as I mentioned earlier, the Paleo diet is based on the diet of our ancestors, and since they didn’t consume grains, legumes, potatoes, and dairy products it is assumed that we don’t need to consume these foods either.  I definitely can’t argue with this, as while these foods do have some health benefits, those who exclude these foods can still get the necessary nutrients and live a very healthy life.  But why are other foods excluded with an autoimmune Paleo diet?  Well, the goal is to avoid foods which might result in inflammation and/or affect the health of the gut.  Eggs are a very healthy food, and thus are included on a standard Paleo diet.  However, egg allergies are common, which is why these are excluded on an autoimmune Paleo diet.  Numerous people react to the nightshade family of foods as well.  As for nuts and seeds, they have antinutrients such as lectins and phytic acid, and thus can affect the absorption of nutrients, and also can have a negative impact on the health of the gut.  And since many people with autoimmune thyroid conditions such as Graves’ Disease and Hashimoto’s Thyroiditis (along with other autoimmune conditions) have a leaky gut, these foods are not part of an autoimmune Paleo diet.

My Thoughts: So what’s my opinion of the autoimmune Paleo diet?  I must admit that I do like this diet.  However, I have found that for some people it is too restrictive.  Plus, although it’s eliminating most of the foods people commonly react to, it’s also eliminating some healthy foods which not everyone needs to avoid eating, such as eggs.  Once again, many people shouldn’t eat eggs, and I usually do have my patients avoid eggs for a period of time initially.  However, some people with an autoimmune condition do fine when eating eggs, which is a great source of nutrients.

Mediterranean diet. The Mediterranean diet is another well known diet, and there is a lot of research which shows that it can help to improve the health of people with certain conditions, such as those with heart disease and cancer (1) (2) (3) (4).  This type of diet involves eating a lot of plant-based meals, grains, fresh fruits and vegetables, nuts, legumes, fish, and olive oil.  Certain dairy foods such as yogurt and cheese are allowed.  Red wine is also permitted.  Obviously refined foods and other junk food aren’t allowed.  Small amounts of red meat and eggs are permitted.

My Thoughts: The Mediterranean diet is without question healthier than the typical diet eaten by most people…especially those in the United States.  Of course there are many foods which are forbidden on an “autoimmune Paleo diet” which are allowed on the Mediterranean diet, including grains, nuts, legumes, and dairy products.  While one can argue that some people with an autoimmune thyroid condition can receive good results while following this diet, if they are sensitive to the proteins of dairy and/or have a leaky gut then they probably wouldn’t achieve optimal results while following this diet.

On the other hand, if someone has a non-autoimmune thyroid condition then they might be able to follow a modified Paleo-Mediterranean type diet, which perhaps allows the person to consume some dairy products, and allows a small amount of properly prepared grains, nuts, seeds, and legumes (preferably soaking them to reduce the antinutrients).  Some people with Graves’ Disease and Hashimoto’s Thyroiditis seem to do fine following this type of diet, but I usually take a conservative approach and recommend for my patients to be more strict with their diet, especially in the beginning phases.

Vegetarian or Vegan diet. If someone is on a strict vegetarian or vegan diet then little explanation is necessary.  A strict vegetarian diet would exclude all meat, fish, and any type of “animal flesh”, while a strict vegan diet would avoid all animal products, including eggs and dairy.  Lacto-ovo vegetarians are able to eat eggs and dairy.  Lacto-vegetarians eat dairy but not eggs.  Pescatarians avoid meat, eggs, and dairy, but they eat fish and other types of seafood.

My Thoughts: Although most of the patients I work with eat meat, I have worked with numerous vegans and vegetarians over the years, and if someone eats a healthy vegan or vegetarian diet then they can receive pretty good results.  While some healthcare professionals don’t feel as if someone can restore their health without eating meat, this isn’t always the case.  For example, if someone developed a leaky gut due to eating gluten, an infection, or chronic stress, and if this in turn caused the person to develop a leaky gut, then it is possible for a vegan or vegetarian to heal their gut and suppress the autoimmune component of their condition.

However, in order to accomplish this one not only needs to eat a healthy vegan or vegetarian diet and take any necessary supplements (i.e. vitamin B12), but they do need to be careful about eating too many foods which can impair gut healing.  For example, the reason why grains, legumes, nuts, and seeds should be avoided when someone has a leaky gut is because they contain antinutrients which can affect the absorption of important nutrients, and they also can directly cause damage to the gut.  And of course many vegans and vegetarians rely on eating these foods.  Although I recommend for people to avoid these foods when repairing their gut, I’ve had some patients continue eating small amounts of properly prepared nuts, seeds, and legumes and still heal their gut.  The problem is that some people don’t do well until they eliminate these foods, and because of this I usually recommend for my patients to avoid them if at possible.

Another problem is that while some vegetarians and vegans eat very healthy, some of them eat an unhealthy diet.  I have worked with vegetarians and vegans who only ate a couple of servings of vegetables per day, but ate a lot of grains and legumes.  And even if the grains are gluten free, eating large amounts of grains can decrease the absorption of nutrients and affect the health of the gut.  And the same is true when it comes to eating large amounts of nuts, seeds, and legumes.  Once again, I’m not opposed to some people eating these foods in moderation, but as I have already mentioned, if someone with an autoimmune thyroid condition who has a leaky gut eats large amounts of these foods on a daily basis then it will be difficult to receive optimal benefits.

SCD diet. I’ve had a number of people ask me about the Specific Carbohydrate Diet.  Although this isn’t specific for autoimmune conditions, it was designed to help with gastrointestinal conditions such as inflammatory bowel disease, and it can benefit people with other chronic health conditions.  Foods which are excluded include cereal grains, potatoes, and dairy products which contain lactose.  Of course fresh fruits and vegetables are allowed, as well as meat, nuts and seeds.  I’m not going to discuss this diet in detail here, but if you visit the website www.breakingtheviciouscycle.info you can find out specifically which foods are “legal” and “illegal”, and it will give an explanation why certain foods aren’t permitted.  The diet has some similarities to the Paleo diet, although there are a few major differences, as with the SCD diet certain forms of dairy are allowed (i.e. homemade yogurt), and legumes are also allowed if they are properly prepared.

My Thoughts: Overall I think this is a great diet.  Although it is restrictive, for some people with autoimmune conditions it isn’t restrictive enough, as it allows the consumption of eggs, nuts and seeds, along with some types of dairy products.  While there are health benefits to these foods, not everyone with a thyroid or autoimmune thyroid condition can tolerate these foods.   By reading this some might think I’m anti-dairy, and while I realize that there are some good health benefits to consuming raw and fermented dairy, many people are sensitive to the proteins of dairy, which is why I recommend for most people to at least go on a dairy-free trial.  However, as I mentioned earlier, there are some people with thyroid and autoimmune thyroid conditions who can tolerate certain types of dairy such as raw milk, whey protein, goat milk, etc.  I discussed dairy in greater detail in my blog post entitled “Should People With Graves’ Disease and Hashimoto’s Thyroiditis Avoid Dairy?”.

GAPS diet. GAPS stands for “Gut and Psychology Syndrome”, which involves an imbalance between the digestive system and the brain.  Dr. Natasha Campbell-McBride is the founder of the GAPS diet, and this diet is well known for helping many children and adults with both neurological and psychiatric conditions.  The way it accomplishes this is through the healing of the gut.  And since an unhealthy gut is a big factor with many chronic conditions, including thyroid and autoimmune thyroid conditions, many people with these conditions can benefit from following the GAPS diet.

I’m not going to get into great detail about this diet, as there is plenty of information online, and there is also a wonderful book available on the GAPS diet.  But it’s recommended for people to first follow an “Introduction Diet”, especially those with digestive symptoms, as well as those who have food intolerances.  The diet involves eating a lot of meat, fish, as well as fermented dairy and vegetables.  Homemade meat and fish stock is one of the primary foods used to help heal the gut.  But fermented foods are also very important.  Organ meats, eggs, and fruits are part of this diet.  The diet goes in stages, as someone will begin the first stage, and then eventually go through the second stage, followed by the third stage, etc.  A great benefit of this diet is that minimal nutritional supplements are required.

My Thoughts: I’m a big advocate of the GAPS diet.  However, it is a very challenging diet to follow, and although I think most people can benefit from following the GAPS diet, I don’t think it’s necessary for everyone with a thyroid or autoimmune thyroid condition to follow this.  This is true even when someone has a leaky gut, as while following the GAPS diet can without question help heal the gut, I usually don’t have my patients with a leaky gut follow a strict GAPS diet.  So when do I recommend the GAPS diet to my patients?  I usually will recommend this diet to extremely “tough cases”.  For example, if someone has a lot of food intolerances and/or a multiple chemical sensitivity then I will frequently recommend for them to follow this type of diet.  Once again, this doesn’t mean that other people can’t benefit from following the GAPS diet, but I find that compliance is low, and usually those who have tried many different natural protocols and haven’t receive good results are more likely to follow through with this diet.

However, just because someone doesn’t follow the GAPS diet strictly doesn’t mean they can’t benefit from following certain components of this diet.  For example, most people can benefit from eating bone broth, as well as fermented foods.  If more people consumed bone broth on a regular basis and ate a good amount of fermented foods daily, along with minimizing their consumption of common food allergens such as gluten, there would be less cases of leaky gut syndrome, and therefore less incidences of autoimmunity.

Obviously there is a lot more to these diets than I covered, as I pretty much gave an overview of each one.  In addition, there are some other things I didn’t cover in this blog post which can be important to certain people with thyroid conditions.  For example, many people with autoimmune thyroid conditions are concerned about eating foods high in goitrogens, such as broccoli, kale, cauliflower, cabbage, and spinach.   I’ve discussed this in greater detail in other articles, and while a few years ago I was completely opposed to people with hypothyroidism and Hashimoto’s Thyroiditis eating goitrogenic foods, I think it’s fine for most people with hypothyroid conditions to eat normal amounts of goitrogenic foods.  On the other hand, if someone with hypothyroidism has a moderate to severe iodine deficiency then they might want to be cautious about eating any raw goitrogenic foods.  For more information I would read my article entitled “An Update On Goitrogenic Foods and Their Impact on Thyroid Health“.

The Keys To Any Successful Diet

Although it’s nice to have a specific diet to follow which tells you which foods you should specifically eat and which foods you should avoid, there are a few key factors which apply to pretty much any healthy diet:

1. Eat whole foods. Every healthy diet will encourage you to eat whole, healthy foods, while avoiding the refined foods and sugars.  Arguably the biggest reason why many people have chronic health issues is because they eat too many refined foods and sugars, as well as too much fast food.  So regardless of whether you choose to follow a Paleo diet, the GAPS diet, or if you want to eat a vegetarian diet, you want to focus on eating whole foods.

2. Avoid common allergens. Food allergies and intolerances can be major problems, and the reason for this is because a person can be intolerant to any type of food.  And of course not all of the diets eliminate all of the common allergens.  For example, while a Paleo diet eliminates gluten and dairy, it includes other common allergens, such as eggs.  Of course that’s the purpose of an autoimmune Paleo diet, as this is even stricter than a “standard” Paleo diet.  The Mediterranean and SCD diets allow the person to eat some forms of dairy.  But once again, even if someone eliminates all of the common food allergens, it is possible to be sensitive to a food which is allowed with most of the diets.  And while someone can obtain a food intolerance panel, these are expensive, and false results are common.

3. Eat plenty of vegetables. Every healthy diet I know of encourages people to eat plenty of vegetables.  However, this still remains the primary challenge I see with my patients, as while some of them do an excellent job of eating fresh vegetables on a daily basis, most still don’t eat enough veggies.  This is even true for some people who eat vegetables daily with lunch and dinner, as someone might have a small salad each day with their lunch and a serving of steamed vegetables with dinner and think they are doing a good job of eating vegetables.  This is true when compared with most people, but everyone should eat at least three servings of vegetables on a daily basis, although eating five or six servings would be even better.  And to be honest, for someone with a chronic health condition who has multiple nutrient deficiencies, eating five or six servings of vegetables per day might not be enough.  For example, Dr. Terry Wahls is a functional medicine doctor who was diagnosed with multiple sclerosis, and she feels that people with autoimmune conditions should consume six to nine cups of vegetables per day.

4. Biochemical Individuality. Dr. Roger Williams came up with the term Biochemical Individuality.  While it would be great if everyone with an autoimmune thyroid condition did great when following an autoimmune Paleo diet, the GAPS diet, or any other specific diet, the truth is that not everyone needs to be on the exact same diet.  This still leaves many unanswered questions.  Does everyone need to eat meat and vegetables, while going grain-free?  Or is having some grains, legumes, nuts, and seeds okay for those with conditions such as Graves’ Disease and Hashimoto’s Thyroiditis?  Or perhaps a vegetarian or vegan diet is the most effective?  Unfortunately there is not one diet that perfectly fits everyone, as while I do recommend an autoimmune Paleo diet to most my patients, I’ve learned that not everyone responds well when following this type of diet.  Plus, keep in mind that we all have our personal biases, as if someone has been thriving on a vegetarian or vegan diet for many years then it’s natural for them to assume that most other people will do equally well on the same type of diet.  And the same concept applies to a Paleo-type diet, or any other diet.

In summary, there is a lot of confusion when it comes to the type of diet people with thyroid and autoimmune thyroid conditions should follow.  In this blog post I’ve discussed the benefits of an autoimmune Paleo diet, the Mediterranean diet, a vegan or vegetarian diet, the SCD diet, and the GAPS diet.  There are pros and cons to each of these diets, and of course there are many other diets out there other than these, such as the Zone Diet, Blood type diet, etc.  Regardless of which diet you choose, you of course want to make sure to eat whole foods, which includes eating plenty of vegetables.  You also want to try avoiding common allergens, which can be challenging since different people will have different food intolerances.  And of course it’s important to consider the concept of biochemical individuality, as while I would love to say that everyone with a thyroid or autoimmune thyroid condition should follow a specific diet, the truth is that there is no diet that is a perfect fit for any specific condition.

FODMAP stands for fermentable oligosaccharides, disaccharides, monosaccharides and polyols.  This is yet another category of foods some people can have problems with.  This is especially true with those who have irritable bowel syndrome (IBS).  And some people with thyroid and autoimmune thyroid conditions should be cautious about eating foods high in FODMAPs.

Before I discuss who can benefit from a low FODMAP diet, let’s first discuss why some people have problems consuming these foods.  Certain conditions such as IBS involve imbalances in the gut flora, and there is a higher prevalence of small intestinal bacterial overgrowth (SIBO).  I have written a separate article entitled “SIBO and Thyroid Health“, and so I’m not going to discuss SIBO in this post.  In any case, certain changes in the gut flora causes the person to react differently to specific types of foods.  A study conducted a few years ago confirmed that FODMAPs are poorly absorbed in the small intestine (1).  But once again, this doesn’t pertain to everyone, as only a small percentage of people need to eat foods low in FODMAPs.

What Are The Richest Food Sources of FODMAP Carbohydrates?

I came across a table from a well-researched journal article which lists the richest food sources of FODMAP carbohydrates (2).  When you look at the table you’ll see that there are six categories of FODMAPs.  These include Fructo-oligosaccharides (fructans), Galacto-oligosaccharides (GOS), lactose, fructose, sorbitol, and mannitol.  You’ll also notice that some of the foods which fall under the different categories include wheat, rye, onions, garlic, legumes, milk, honey, apples, watermelon, mushrooms, and cauliflower.

Many people reading this are already on a restrictive diet, as some are gluten and dairy free, others might be grain free, of course vegans and vegetarians don’t consume meat, etc.  And so it might be frustrating to realize that there is another category of foods you might need to avoid.  Although those people following a gluten and dairy free diet are already avoiding wheat, rye, milk, and other foods which fall within these two categories, they might be consuming legumes, apples, garlic, and some of these other foods on a regular basis.  Just remember that most people with thyroid and autoimmune thyroid conditions don’t need to follow a low-FODMAP diet.

In addition, those who should eat low FODMAP foods might not necessarily need to avoid foods in all of the categories listed in the table.  The bad news is that foods which fall into the fructans and GOS category will need to be excluded by anyone trying to follow a low-FODMAP diet, as these foods are always malabsorbed and fermented by intestinal microflora (2).  On the other hand, some people will be able to tolerate foods such as honey, apples, pears, and watermelon.  For a more comprehensive list click here.  For the most part I agree with the list, although this lists coconut as a low FODMAP food, while other sources list coconut milk and other sources of coconut as high in FODMAPs.  So this is something you might need to experiment with, or if you want to play it safe you can avoid coconut milk.

Which FODMAP Foods Should Be Avoided?

But how does someone who needs to follow a low-FODMAPs diet know which foods they can and can’t eat?  Well, as I just mentioned, everyone who needs to follow a low-FODMAPs diet will probably need to avoid eating foods in the fructans and GOS category.  As for whether they are able to eat foods in the other categories, there are a few different ways to find this out.  One way is through a breath test.  For example, if someone wants to find out if they have problems absorbing fructose then they can do a breath test to determine this.  They can also choose to do a breath test for lactose and sorbitol.  There currently isn’t a breath test available for mannitol.

Another way to determine if someone can tolerate these other foods is through an elimination diet.  And so what someone can do is to avoid all foods high in FODMAPs for one month, and then slowly reintroduce one at a time to see how they respond.  Once again, if they know they need to follow a low-FODMAPs diet but aren’t exactly sure which foods they will need to avoid, just remember that everyone who needs to be on a low-FODMAPs diet will need to avoid foods in the fructans and GOS category.  But how about if someone loves apples, pears, and watermelon and wants to see if they can tolerate these foods?  After avoiding them for one month the person will want to reintroduce one food at a time for at least three consecutive days and see how they respond.  So for example, they might want to start with apples, as perhaps they will want to eat an apple or two daily for three days in a row and see if they have a negative reaction.  If all goes well then they are probably fine eating that food, and can then try reintroducing pears.  On the other hand, if they experience symptoms then they will want to avoid eating apples, and will want to wait until the symptoms subside before reintroducing pears.

Do You Need To Be On A Low-FODMAP Diet?

At this point you might be wondering whether you need to be on a low-FODMAP diet.  After all, I discussed what FODMAPs are, and I also mentioned how people who follow a low-FODMAP diet need to avoid certain foods but might be able to tolerate other “FODMAP foods”.  However, I haven’t mentioned who should follow such a diet.  Should all people with thyroid conditions follow this type of diet?  Or perhaps only those with autoimmune thyroid conditions such as Graves’ Disease and Hashimoto’s Thyroiditis?

Well, anyone who is certain that they have IBS will want to experiment with a low-FODMAP diet, as most people who do this will notice a significant improvement in their digestive symptoms.  However, even if someone isn’t sure whether or not they have IBS but if they are experiencing digestive symptoms such as frequent bloating and gas, stomach pain, and other digestive symptoms, then it still might be a good idea to consider experimenting with this type of diet.  As I mentioned earlier, someone can consider going on an elimination diet, but if they have a lot of digestive symptoms I would recommend for them to avoid all of the common allergens (i.e. gluten, dairy, corn, soy, eggs, etc.) for 30 days, and they can also follow a low-FODMAP diet during this time, and then after the 30 days then can slowly reintroduce these foods one at a time.

I realize that this would be a very restrictive diet, but if you are sensitive to any of these foods then it is important to eliminate them from your diet.  Of course another option is to just focus on eliminating the common allergens first and not worry about high FODMAP foods initially.  After all, if you don’t have IBS then you very well might be fine eating these foods.  And just remember that if you need to follow a low FODMAP diet this isn’t necessarily permanent.  For example, if someone has intestinal dysbiosis and as a result they’re unable to tolerate high FODMAP foods, then correcting the intestinal dysbiosis will most likely allow them to eat these foods again.

So hopefully you have a better understanding about what FODMAPs are, and why some people have problems with these foods.  The six categories of FODMAPs include fructans, GOS, lactose, fructose, sorbitol, and mannitol.  Those who need to follow a low FODMAP diet don’t necessarily need to avoid all of these foods, and they might need to either do a breath test to determine if they have problems absorbing certain foods, or they can simply follow an elimination diet.  Fortunately most people with a thyroid or autoimmune thyroid condition don’t need to follow a low-FODMAP diet, but if someone is having a lot of digestive issues and eliminating common allergens such as gluten, dairy, eggs, and corn doesn’t help, then it’s something to consider.

Most people with thyroid and autoimmune thyroid conditions have nutrient deficiencies.  In some cases these nutrient deficiencies might be directly causing the thyroid condition, while in other cases nutrient imbalances might indirectly lead to these conditions.  In this blog post I’ll discuss some of the more common reasons for nutrient deficiencies, and I’ll explain what you can do to correct these deficiencies and prevent future deficiencies from developing.

Before I talk about some of the causes of nutrient deficiencies, I’d like to talk about some of the more common types of these deficiencies.  Obviously someone can be deficient in any vitamin, mineral, or other nutrient, but some of the more common nutrient deficiencies include magnesium, zinc, chromium, selenium, iron, iodine, vitamin D, vitamin A, the B vitamins, and omega 3 fatty acids.  How can one determine if someone has one or more nutrient deficiencies?  Well, there are different tests available, such as regular serum testing, micronutrient testing, a hair mineral analysis, and urine testing.  What’s important to keep in mind is that all of these methods have limitations, and there is no single method of testing that will accurately reveal all nutrient deficiencies.

For example, serum testing can be valuable for looking at nutrients such as vitamin D, as well as iron (through an iron panel evaluating ferritin, iron saturation, along with serum iron), and vitamin B12 (through methylmalonic acid).  However, for most other nutrients, serum testing isn’t reliable for determining whether someone has a mild to moderate deficiency.  A good example of this is magnesium, which usually won’t show up as being depressed in the blood unless if someone has a severe deficiency.  Micronutrient testing measures all of the different nutrients, but there are no research studies I’m aware of which prove this type of testing is accurate.  I use hair mineral analysis testing, although I realize that there are limitations to this test as well with regards to the minerals.  Organic acid testing can also be used to determine certain nutrient imbalances, and can provide other useful markers as well.

How Do Nutrient Deficiencies Affect Thyroid Health?

As I briefly mentioned in the opening paragraph, nutrient deficiencies can both directly and indirectly affect thyroid health.  Certain nutrients such as iodine, zinc, selenium, and iron are essential for thyroid hormone production.  As a result, if any of these nutrients are deficient then they can lead to a hypothyroid condition.  In addition, many nutrient deficiencies can have a negative effect on the health of the immune system.  For example, selenium, zinc, vitamin D, and vitamin A are all important for optimal immune system health.  As a result, if someone is deficient in one or more of these nutrients, then this can make them more susceptible to an autoimmune condition such as Graves’ Disease or Hashimoto’s Thyroiditis.

In fact, over the last few decades the prevalence of autoimmune conditions have skyrocketed, and so has the consumption of refined foods and sugars.  So it is very possible that the increase in nutrient deficiencies is at least partially responsible for the rise in autoimmunity.  Obviously other factors need to be considered as well, such as an increased exposure to toxins.  I think it’s a combination of different factors which have contributed to this, as if someone has a weakened immune system due to multiple nutrient deficiencies, then it makes sense that other factors such as toxins and infections would make them more likely to develop an autoimmune condition.

4 Common Reasons For Nutrient Deficiencies

There are numerous reasons why many people have nutrient deficiencies, and I’m going to focus on four of the more common reasons:

Reason #1: Overconsumption of refined foods. Many of the people I work with have already made some wonderful changes to their diet before speaking with me for the first time.  While this is great, a high percentage of my patients ate an abundance of refined foods and sugars for many years prior to speaking with me for the first time.  And when this is the case, it will take a good amount of time to correct nutritional deficiencies.  So for example, if someone was eating refined foods for 20+ years, but then switched to a whole foods diet, it can take a few years to correct these deficiencies.  This is why supplementation is usually required to help correct moderate to severe nutritional deficiencies.  But even when taking supplements it will take time to correct these deficiencies.

Reason #2: Soils depleted of nutrients. Crops which were grown many years ago were much richer in nutrients than the crops of today.  The reason for this is due to the agricultural methods used today, as they strip a lot of nutrients from the soil, which affects foods grown in this soil.  The truth is that the focus isn’t on the nutrient density of food, but instead is to try to do things to increase the size and growth rate of these foods, and to make them resistant to pests.  One of the benefits of using organic growing methods is the increased nutrient density, yet even organic foods aren’t as nutrient dense as they were in the past.

Reason #3: Antinutrients. Recently I wrote a blog post on this topic entitled “Antinutrients and Thyroid Health“.  Certain antinutrients, such as phytic acid, will interfere with the absorption of nutrients such as calcium, magnesium, zinc, and iron.  These antinutrients are commonly found in grains, and this is a major reason why you want to minimize your consumption of grains…even if they are gluten free.  However, there are antinutrients in other foods as well, such as legumes, nuts, and seeds.  Of course these foods have some great health benefits, but when eaten in excess they can prevent the absorption of nutrients, and over a period of time can cause or contribute to nutritional deficiencies.

Reason #4: Digestive and absorption problems. Many people have problems with digestion and absorption, and this obviously can lead to nutrient deficiencies.  For example, if someone has low levels of hydrochloric acid due to an H. Pylori infection, then they will have a difficult time breaking down protein and other nutrients.  If they have a condition such as small intestinal bacterial overgrowth (SIBO) then this can lead to malabsorption of nutrients.  A condition such as Celiac Disease can cause many nutritional deficiencies.  I’ve spoken about leaky gut syndrome numerous times, and this condition can also affect the absorption of nutrients.

How Can You Correct and Prevent Nutrient Deficiencies?

Based on the reasons I just gave for nutrient deficiencies, the following methods of correcting and preventing nutritional deficiencies shouldn’t be surprising:

1. Minimize your consumption or refined foods and sugars. I probably don’t need to expand on this, as most people reading this realize that it’s best to eat whole foods, and try to avoid the refined foods and sugars.  You especially want to focus on eating a lot of vegetables, both raw and cooked, and a wide variety of them.  Eating nutrient dense foods is important, which includes organ meats, other types of meats, nuts and seeds, avocados, kale, spinach, arugula, and eggs.

2. Eat more organic foods. Even though organic foods of today aren’t as nutrient dense as they were in past, they still have more nutrients than non-organic foods.  And of course with organic foods you don’t need to worry as much about toxins, although even organic foods aren’t completely toxin free.  But eating organic foods isn’t just about minimizing your exposure to toxins, as you are getting more nutrient dense foods.

3. Don’t eat too many grains, legumes, nuts, and seeds. Although nuts and seeds are nutrient dense foods, since they have antinutrients such as lectins and phytic acid you want to minimize your consumption of them.  Plus, if you do eat nuts and seeds, as well as legumes, it’s a good idea to soak them, as this will decrease the amount of antinutrients.  As for grains, although people don’t need to eat grains to survive, I realize that some people enjoy eating grains.  This includes myself, as I’m not 100% grain free.  However, I do limit my consumption of grains, and I don’t eat them on a daily basis.  I remember many years ago when I routinely loaded up on grains for breakfast, as I would have cold cereal and toast on a regular basis.  In fact, I often had a couple of bowls of cereal in a single day, one large bowl of cereal for breakfast, and frequently another one as a snack.

This describes many people, and eating processed cereals, bread, and baked goods on a daily basis can lead to nutrient deficiencies over time.  Some might question this since many of the processed foods add vitamins and minerals after the refining process.  However, this still isn’t sufficient to maintain a healthy state.  Similarly, one can’t replace the nutrient values of whole foods by taking a good quality multivitamin.  This doesn’t mean that taking a daily multivitamin can’t be beneficial, but of course if you eat a lot of foods with antinutrients then these will interfere with the nutrients in the multivitamin as well.

This is important to understand for those people like myself who have smoothies on a daily basis.  Some people will load up their smoothies with chia seeds, and may even add other nuts and seeds.  Having a small amount of these foods won’t cause problems with most people, but if you add a lot of nuts and seeds to your smoothies then this can interfere with the absorption of the nutrients from the fruits and vegetables which you add to your smoothies.  Once again, I’m not suggesting that people can’t add nuts and seeds to their smoothies, but you don’t want to overdo it.   If you eat nuts and seeds it might be best to eat them as a snack, in between meals, rather than add them to your smoothies.  And those with gut problems ideally should avoid eating nuts and seeds until the gut is healed, which I’m about to discuss.

4. Heal the gut. If someone has gut issues that is affecting the absorption of nutrients, then of course this needs to be resolved.  For example, if someone has intestinal dysbiosis due to a Candida infection or SIBO, then it’s important to address these health conditions.  I’ve written separate articles on both Candida and SIBO, but there are other pathogenic infections which can affect the absorption of nutrients.  Earlier I mentioned H. Pylori, which is another common pathogen which can affect nutrient absorption.  I also briefly spoke about Celiac disease, which is an autoimmune condition involving gluten that will cause damage to the cells of the small intestine if the person continues to consume gluten.

Speaking of which, other food intolerances can lead to gut inflammation and thus affect the absorption of nutrients.  So what you want to do is cautiously eradicate any pathogens, avoid foods which are causing inflammation, and if someone has a leaky gut then this of course needs to be corrected.

In summary, it’s common for people with thyroid and autoimmune thyroid conditions to have nutrient deficiencies.  Some of the more common nutrient deficiencies include zinc, magnesium, chromium, selenium, iron, iodine, vitamin D, the B vitamins, vitamin A, and omega 3 fatty acids.  Four common reasons for nutrient deficiencies include 1) overconsumption of refined foods, 2) the soils are depleted of nutrients, 3) antinutrients are in certain foods, and 4) many people have gut problems which affect the absorption of nutrients.  As a result, in order to correct and prevent nutrient deficiencies it’s important to minimize the consumption of refined foods and sugars, eat more organic foods, don’t eat too many foods with antinutrients, and you need to restore the health of the gut.

Even though I’m a chiropractor, most people who have been reading my articles and blog posts for awhile know that I don’t speak much about chiropractic.  When I first graduated from chiropractic school in March of 1999 and envisioned opening up my practice, I didn’t consider doing much with nutrition and the other lifestyle factors.  And for the first few years of my practice I didn’t do much with regards to nutrition, stress management, detoxification, etc.  It wasn’t until I began helping people with fibromyalgia a few years into practicing when I realized that many people need more than chiropractic care.  And of course my life changed dramatically when I personally was diagnosed with an autoimmune thyroid condition.

Although I’m still a big advocate of chiropractic care, these days I’m admittedly more of a nutritionist and functional medicine practitioner than I am a chiropractor.  Since being diagnosed with Graves’ Disease I went on to achieve numerous certifications in nutrition and herbal therapy, also received a masters of science degree in human nutrition and functional medicine, and I plan to continue receiving ongoing education and training in the years to come, as I’m always looking to expand my knowledge and keep up with the latest research.  Although I still love chiropractic, when trying to restore the health of someone with a thyroid or autoimmune thyroid condition, it is of course important for the person to eat well, take certain nutritional supplements, improve their stress handling skills, minimize their exposure to environmental toxins, etc.

Is Chiropractic Care Necessary For Optimal Thyroid Health?

Most people reading this wouldn’t associate chiropractic care with optimal thyroid function.  And of course most thyroid conditions are actually autoimmune conditions which affect the thyroid gland.  But either way, what the heck does chiropractic have to do with improving the health of the immune system, or someone’s thyroid health directly for those cases which aren’t autoimmune?  Truth to be told, most people with thyroid and autoimmune thyroid conditions don’t need to receive chiropractic care in order to restore their health back to normal.

With that being said, if you understand that chiropractic is more than just cracking backs and twisting and popping necks then you will realize that chiropractic can be important for anyone to achieve optimal health.  This might sound hypocritical of someone who rarely talks about chiropractic in his articles, blog posts, and webinars.  Once again, I’m not suggesting that receiving chiropractic care is necessary in order to restore the health of someone with a thyroid or autoimmune thyroid condition.  On the other hand, chiropractic is about balancing the nervous system.  And the nervous system innervates every cell and tissue in the body.  So if there happens to be “interference” with the nerves which innervate the thyroid gland, then this possibly can result in malfunctioning of the thyroid gland.  Although this probably isn’t a common cause of thyroid malfunction, it’s something to be aware of.  This is especially true for someone who is eating extremely well, has taken many different types of good quality supplements, does a good job of managing their stress, yet still has problems with their thyroid health.

In addition, if someone has a nervous system that is out of balance, since the nervous system controls the immune system, then this person very well might have an immune system that is out of balance as well.  As a result of this weakened immune system, the person will be more likely to develop a chronic infection, which in turn can trigger an autoimmune response.  Or perhaps the nervous system imbalance is making the person more susceptible to the effects of stress, which in turn caused a leaky gut, which in turn caused an autoimmune thyroid condition.  Once again, I’m not suggesting that spinal subluxations (misalignments of the spine causing nerve interference) are common causes of thyroid autoimmunity.  But if you understand the anatomy and physiology of the body then you will realize that a nervous system imbalance can cause a lot of different health conditions.

So why go to a chiropractor for a nervous system imbalance?  After all, isn’t a neurologist a specialist of the nervous system?  Although I’m sometimes critical of medical doctors who don’t try to get to the root cause of the problem, I realize that they have an important role.  And the same holds true of neurologists, as there are many excellent medical doctors who specialize in neurology, and some chiropractors and neurologists have a working relationship and refer their patients to one another.  This really is how it should be, as if a chiropractor is working with a patient and the patient isn’t receiving optimal results then there is a time and place for referring that patient to a medical doctor.  Similarly, if a neurologist is working with a patient who isn’t responding then they should consider referring the patient to a chiropractor at times.  In any case, both chiropractors and neurologists deal with nervous system imbalances in different ways.  I’m not going to say that one way is better than another, although to no surprise I’m more biased with regards to chiropractic care since that is my background.  If someone has a nervous system imbalance and is trying to get to the root cause of their condition, then I think it’s best for them to see a chiropractor initially.  But of course this also depends on what neurological condition the patient is dealing with, as sometimes it is best to see a neurologist first.

Are All Chiropractors Alike?

Chiropractors definitely are not all alike.  I realize that the same holds true with other healthcare professionals, as one can make the argument that no two dentists are alike, as everyone has their individual practice style.  However, with most dentists the routine will be very similar, and the same is true with many other healthcare professionals.  On the other hand, with chiropractors you never know what you’ll get.  I’m not saying this is a bad thing, but you can go to two different chiropractors and have a completely different experience.

For example, there are over one hundred different chiropractic techniques.  Although many chiropractors treat the entire spine, others only focus on certain areas of the spine.  For example, some chiropractors are referred to as “upper cervical spine specialists” and will only treat the patient’s cervical spine, which consists of the bones in the neck.   Although I use the word “treat” because everyone is familiar with the term, chiropractors actually don’t “treat” the spine, as they deliver what’s called a spinal adjustment.  And so from this point forward I will use the word “adjust” rather than “treat”.  Anyway, getting back to some of the different ways chiropractors adjust the spine, many will use their hands, but some will use instruments to adjust the spine.  Many will use x-rays to detect spinal subluxations, while others will rely on muscle testing, leg checks, computerized scans, and there are other methods as well.

Some chiropractors see a high volume of patients per day and might spend only one or two minutes with each patient.  Others might spend between five and ten minutes with each of their patients, while others will spend 30 minutes or longer with their patients.  Some chiropractors don’t incorporate nutrition into their practice, while others offer a lot of nutritional advice and will try to educate everyone about eating well, avoiding refined foods and sugars, etc.  So hopefully you now realize that different chiropractors have different practice styles.

Should Everyone With A Thyroid or Autoimmune Thyroid Condition Seek Chiropractic Care?

As I mentioned already, most people with a thyroid or autoimmune thyroid condition don’t need to receive chiropractic care in order to restore their health back to normal.  However, there is no question that having a healthy nervous system is important, and since the nervous system controls the thyroid gland, immune system, and other areas of the body, one can argue that it would make sense for many people to at least get checked by a competent chiropractor.  Of course since I’m a chiropractor I’m biased, and I feel that everyone can benefit from chiropractic care.

But what if you had a bad experience with a chiropractor?  Well, all I can say is that when someone has a bad experience with a medical doctor, dentist, or a different type of healthcare professional they usually don’t stop seeing that type of doctor.  For example, if someone has a bad experience with a dentist they very well might not seek dental care, but there is a good chance they will simply give a different dentist a try.  Remember what I said earlier, as different chiropractors practice differently, and so you might need to visit a few different chiropractors before you find one who you’re comfortable with.  I would of course recommend trying to find someone who evaluates everyone individually rather than hire a chiropractor who recommends the same exact treatment plan for  everyone.

For example, a young adult who has a fairly healthy spine probably shouldn’t need as extensive care as an elderly person who has more chronic problems.  While it’s true that some older adults are in better shape than younger adults, the point I’m trying to make is that different people should require different treatment plans.  This of course not only applies to chiropractic care, as I also discuss this from time to time when talking about following a natural treatment protocol for a thyroid or autoimmune thyroid condition.  Regardless of what type of healthcare professional you see, you ideally want to work with someone who will give specific recommendations based on your specific condition.  While there might be some overlap from patient to patient, different people will require different protocols.

In summary, since I’m a chiropractor it’s not surprising that I’m a big advocate of chiropractic.  Although most people with thyroid and autoimmune thyroid conditions don’t need to receive chiropractic care in order to restore their health back to normal, in some cases having a spinal imbalance can lead to thyroid dysfunction and/or a weakened immune system.  After all, the nervous system controls every cell and tissue in the body, and therefore a less than optimal functioning nervous system can lead to numerous health issues.  And so even though most people with a hypothyroid or hyperthyroid condition don’t require chiropractic care to restore their health, many people can benefit from chiropractic care, and one can argue that receiving chiropractic care is necessary to help people to achieve optimal health.

Grains, nuts, seeds, and legumes have numerous health benefits. However, many people are unaware that these foods also contain antinutrients which can interfere with the absorption of other nutrients you consume.  And so while I love eating nuts and seeds, and I’m not “anti-grain”, I do think it’s important for people to realize why they should minimize their consumption of these foods.  And so what I plan on doing in this blog post is to discuss the most common antinutrients, and hopefully after reading this you will have a better understanding as to why you should only eat minimal amounts of these foods.

Before I discuss these antinutrients, you might be wondering “why do these foods have anti-nutrients?”.  Well, some of these antinutrients are included in plants as a form of protection.  This includes lectins, protease inhibitors, and saponins.  These secondary metabolites help to ensure the survival of the seed.  However, they have other functions as well.  What I’d like to do now is discuss some of the more common antinutrients.

Lectins. These are probably the most well known of the different antinutrients, and I have put together a separate article on this entitled “Should People With Thyroid And Autoimmune Thyroid Conditions Avoid Foods With Lectins?“.  Lectins are carbohydrate binding glycoproteins which can affect the turnover and loss of gut epithelial cells, damage the luminal membranes of the epithelium, interfere with nutrient digestion and absorption, stimulate shifts in the bacterial flora and modulate the immune state of the digestive tract (1). Systemically, they can disrupt lipid, carbohydrate and protein metabolism, promote enlargement and/or atrophy of key internal organs and tissues and alter the hormonal and immunological status (1). At high intakes, lectins can seriously threaten the growth and health of consuming animals (1).  In summary, lectins can have a negative effect on the lining of the gastrointestinal tract, as well as the gut flora, which in turn can affect the absorption of nutrients.  Plus they can also affect the breakdown of fats, carbohydrates, and proteins.

Phytic acid. This is a major phosphorus storage compound found in nuts and seeds, as well as grains and legumes.  Phytic acid has the strong ability to chelate certain minerals, especially zinc, calcium, and iron (2). There is also evidence that phytic acid can bind to magnesium and affect its absorption as well (3).  The binding can result in very insoluble salts that are poorly absorbed from the gastrointestinal tract, which results in poor bioavailability of minerals (2).  In summary, phytic acid will affect the absorption of numerous minerals, which obviously isn’t a good thing.

Protease Inhibitors. These can inhibit the proteolytic activity of certain enzymes.  In other words, they will interfere with the breakdown of protein.  For example, certain legumes such as navy beans, red kidney beans, and adzuki beans have trypsin inhibitors (4).  Soybeans and chickpeas also have trypsin inhibitors (5).  Trypsin is an enzyme which breaks down numerous proteins.  What’s important to understand is that eating a lot of foods with trypsin inhibitors can affect the breakdown of proteins.

Oxalates.  These are naturally-occurring substances which belong to a group of molecules called organic acids.  Some of the foods with high amounts of oxalates include spinach, blueberries, blackberries, and almonds.  Foods high in oxalates can affect the absorption of certain nutrients, such as calcium.  Most people can eat normal amounts of foods with oxalates, although people with certain conditions, such as enteric and primary hyperoxaluria, need to eat a low oxalate diet.  I mentioned that spinach and blueberries are high in oxalates, and for those who routinely make smoothies, adding some spinach and/or blueberries is fine for most people.  However, you probably want to avoid adding large amounts of these foods to your smoothies, especially if you have one or two smoothies on a daily basis as I do.  I spoke about oxalates in a blog post I wrote entitled “Should Spinach Be Avoided In People With Thyroid Conditions?”

Saponins.  These are naturally occurring compounds that are widely distributed in all cells of legume plants, and derive their name from their ability to form stable, soaplike foams in aqueous solutions (6).  Although saponins have some health benefits, they also can impair the digestion of protein and the uptake of vitamins and minerals in the gut, and can also cause hypoglycemia (7).  They can also lead to the development of a leaky gut (8).

Solanine.  This is a glycoalkaloid found in species of the nightshades, which include foods such as potatoes, tomatoes, eggplant, and peppers.  Although many people who eat these foods seem to do fine, because they can lead to inflammation and other problems, most autoimmune diets don’t include the nightshade vegetables.  One of the best articles I’ve read on the nightshades is from Dr. Garrett Smith of the Weston Price Foundation.

These are some of the most common antinutrients, although there are a few I didn’t list.  A couple of additional ones worth mentioning are tannins and salicylates.  Tannins might inhibit the digestion of dietary proteins, and might also have some systemic effects.  Salicylates are phytochemicals found in fruits, vegetables, some other foods, and in some over-the-counter medications and prescription drugs.  Most people can eat normal amounts of salicylates, but some people are unable to tolerate smaller amounts.

How Do Antinutrients Affect Thyroid Health?

Loren Cordain has a wonderful article entitled “Cereal Grains: Humanity’s Double-Edged Sword“.  In this article he talks about some of the antinutrients and focuses on the risks of cereal grains.  Towards the end of this article he discusses how cereal grain consumption can lead to the development of autoimmune conditions.  As he discusses in his article, the genetic component that is most closely associated with the expression of autoimmune conditions are those genes which code for the human leukocyte antigens (HLA).  The HLA is subdivided into different classes, and Dr. Cordain discusses how lectins are potent inducers of HLA class II molecules.  I also mentioned earlier how certain antinutrients, such as lectins and saponins, can potentially cause a leaky gut, which in turn can trigger an autoimmune response.

In his article Dr. Cordain also talks about how these antinutrients “might induce cross-reactivity and hence autoimmunity by virtue of peptide structures homologous to those in the host”.  In other words, the structures of these antinutrients might be similar to certain structures in the human body, and as a result the body might produce autoantibodies.  This is known as molecular mimicry, which has been proposed as a pathogenic mechanism for autoimmune disease.

There isn’t much evidence when it comes to direct effects of these anti-nutrients on thyroid health.  In other words, while consuming some of these anti-nutrients might cause a leaky gut and trigger an autoimmune response, they don’t seem to directly stimulate or inhibit thyroid activity.  However, there is evidence that soyasaponins, which were isolated from soybeans, increased the levels of serum thyroid hormones, which lead to lipid peroxidation (9).  Lipid peroxidation involves damage to the membranes of fats, and has been implicated in conditions such as atherosclerosis, irritable bowel disease, retinopathy of prematurity (ROP), borderline personality disorder, asthma, Parkinson’s disease, kidney damage, preeclampsia and other conditions (10).

Is It Best To Completely Avoid These Foods?

I definitely don’t think that most people permanently need to avoid nuts, seeds, and beans.  But I do think it’s a good idea to minimize one’s consumption of these foods.  I love nuts and seeds, and I can easily eat a few cups per day, but most people probably should limit their consumption to half a cup per day total.  As for grains, although there are some healthy nutrients in grains, we don’t need to eat grains to survive.  Plus, although there are some healthy nutrients in grains, remember that the antinutrients will reduce the absorption of these nutrients.  With that being said, I think that eating a small amount of grains is fine for many people, preferably gluten free grains.  On the other hand, many people seem to thrive when eliminating grains from their diet.

Soaking And Sprouting Can Improve Nutrient Absorption

Soaking and sprouting nuts, seeds, beans, and grains can help to reduce the anti-nutrient content of these foods.  This in turn can improve the contents of certain essential amino acids, total sugars and B-group vitamins (11).  Of course many people aren’t willing to take the time to do this, and keep in mind that this won’t completely eliminate the anti-nutrient content of these foods.  As a result, it’s best to minimize your consumption of these foods, and if someone has gut issues then it’s probably a good idea to avoid eating them altogether until the gut is healed.  With that being said, if someone is a vegetarian or vegan it can be challenging to follow a gut repair diet and completely eliminate all of the foods with antinutrients, and so eating soaked nuts, seeds, beans, and grains can make it a lot easier to follow such a diet.  I’ve had some people follow a gut repair diet and do okay while eating small amounts of these soaked and sprouted foods.  On the other hand, some people aren’t able to heal the gut unless if they completely eliminate these foods from their diet.

In summary, due to the antinutrients present in nuts, seeds, legumes, and grains, one wants to try to minimize their consumption of these foods.  The reason is because these antinutrients can interfere with the absorption of certain nutrients such as zinc, calcium, iron, and magnesium, and can also lead to certain health issues, such as a leaky gut.  Although all people need to be careful not to eat too many of these foods, people with autoimmune conditions such as Graves’ Disease and Hashimoto’s Thyroiditis will especially want to reduce their intake, and in many cases it’s best to avoid these foods altogether.

Lipopolysaccharides (LPS) are referred to as endotoxins, and they are large molecules found in gram-negative bacteria.  Although most people with thyroid and autoimmune thyroid conditions have never heard of lipopolysaccharides, these can have a profound effect on one’s health.  This is especially true for those people with Graves’ Disease and Hashimoto’s Thyroiditis, although they can also affect those with non-autoimmune thyroid conditions.

LPS are the major components of the cell wall of gram-negative bacteria (1).  Under normal circumstances they protect the cell membrane.  However, when a gram-negative bacteria dies, the LPS of this bacteria is released.  LPS can cause numerous biological effects, such as fever, leukocytosis (high number of white blood cells), iron deficiency, platelet aggregation, thrombocytopenia, and blood clotting disorders (2).  LPS from gram-negative bacteria is one of the most potent innate immune-activating stimuli known.  An alteration in the LPS response may play a role in the pathogenesis of a number of inflammatory diseases (3).

The Role of LPS In Autoimmunity and Leaky Gut Syndrome

Lipopolysaccharides can lead to an increase in intestinal permeability, also known as a leaky gut (4) (5).  I’ve spoken about the relationship between leaky gut syndrome and thyroid autoimmunity in other articles and blog posts.  There are numerous factors which can cause a leaky gut, and lipopolysaccharides are one of these factors.  So having high levels of LPS can increase one’s chances of developing a leaky gut, and this in turn can increase one’s chances of developing Graves’ Disease or Hashimoto’s Thyroiditis.

The company Cyrex Labs has an intestinal permeability test that measures the antibodies against LPS.  When this shows positive findings for LPS it usually means that there has been infiltration through the intestinal barrier into the systemic circulation.  In other words, there will be the presence of lipopolysaccharides in the bloodstream, and the person will usually have an increase in intestinal permeability (a leaky gut).  However, I’ve had some patients test positive for LPS antibodies on a Cyrex Labs test, but not show any signs of hyperpermeability.

For those who aren’t familiar with Cyrex Labs, their Intestinal Antigenic Permeability Screen tests for the presence of three types of antibodies that are associated with an increase in intestinal permeability.  These include the Actomyosin antibodies, the Occludin/Zonulin antibodies, and the Lipopolysaccharides (LPS).  Both the Actomyosin and Occludin/Zonulin antibodies directly relate to the presence of a leaky gut.  So in other words, if either of these two antibodies are outside of the normal range then this indicates that someone has a leaky gut.

However, the presence of LPS alone doesn’t necessarily indicate that someone has a leaky gut.  The presence of LPS does indicate intestinal dysbiosis (an imbalance of the gut flora), and dysbiosis is commonly associated with a leaky gut.  As a result, if someone does the Cyrex Labs test and has a positive test for LPS, but both the Actomyosin and Occludin/Zonulin antibodies are negative, then this means the person has intestinal dysbiosis in the absence of a leaky gut.  Of course this is assuming the person doesn’t have suppressed immunoglobulins, which can result in a false negative on the Cyrex Labs test and is something to be aware of.

What Are The Causes Of Elevated LPS?

Remember that lipopolysaccharides are endotoxins which are found in gram-negative bacteria, and that LPS is released when a gram-negative bacteria dies.  When someone has high levels of LPS this is associated with intestinal dysbiosis.  And there are numerous causes of intestinal dysbiosis, and some of the more common causes include antibiotics, chronic stress, and food allergens (6).

LPS and Thyroid Health

LPS can affect thyroid health in numerous ways.  As I have already mentioned, LPS can lead to the development of a leaky gut, which can in turn trigger an autoimmune thyroid condition.  However, there is also evidence that LPS can suppress the hypothalamic-pituitary-thyroid axis (7).  Remember that the hypothalamus produces thyrotropin-releasing hormone (TRH), which stimulates the pituitary gland to secrete TSH, which in turn signals the thyroid gland to secrete thyroid hormone.  A more recent study shows that LPS can downregulate pituitary and thyroid function (8).  In addition to decreasing TSH secretion, it also affects secretion in follicular cells directly (8).  In other words, LPS can decrease thyroid function not only by affecting the pituitary gland, but also by directly affecting the cells of the thyroid gland.  However, while it seems to result in a decrease in thyroxine (T4), it doesn’t seem to decrease the conversion of T4 to T3.

In summary, lipopolysaccharides are large molecules found in gram-negative bacteria, and they are elevated in intestinal dysbiosis.  LPS activate the innate immune system, and can lead to the development of inflammatory conditions, as well as a leaky gut.  This can in turn trigger an autoimmune response, leading to a condition such as Graves’ Disease or Hashimoto’s Thyroiditis.  There is also evidence that LPS can suppress the hypothalamic-pituitary-thyroid axis.

I’ve discussed leaky gut syndrome in the past, as this is commonly associated with conditions such as Graves’ Disease and Hashimoto’s Thyroiditis.  In fact, some researchers believe that ALL autoimmune conditions are associated with an increase in intestinal permeability (a leaky gut).  I’m not sure if I agree with this, as while I don’t test every single one of my patients for a leaky gut, of those people I have tested for this who have elevated autoantibodies, a few of them have come back with negative results.   In any case, if it is determined that someone has a leaky gut then you want to consider implementing the 4R protocol.

But what is the 4R protocol?  Before talking about this I would briefly like to remind everyone reading this what happens when someone has a leaky gut.  In a normal, healthy gut, the cells of the intestines (enterocytes) should be held close together by tight junctions.  Tight junctions regulate the permeability of ions, macro molecules, and cells via the paracellular pathway (1).  In other words, these tight junctions prevent larger molecules and other substances from passing between the cells of the intestine.

However, certain factors can break down these tight junctions, and thus lead to what’s referred to as an “increase in intestinal permeability”.  An “increase in intestinal permeability” is synonymous with a “leaky gut”.  So disruption of these tight junctions leads to an inadequate epithelial barrier, and this in turn results in an incontrollable water and electrolyte loss, and is implicated in the pathogenesis of numerous autoimmune and inflammatory diseases (1).

In the past I’ve discussed the intestinal permeability test from Cyrex Labs, which can measure the antibodies against these tight junction proteins.  Occludin and zonulin are two tight junction proteins.  Occludin is part of the main component of proteins which hold together the tight junctions, while zonulin is a protein which regulates the permeability of the intestine (2).  When someone has a leaky gut, there will be elevated antibodies to both occludin and zonulin, and this is what the test from Cyrex Labs measures.  This test also detects antibodies against actomyosin, which helps to regulate intestinal barrier function.

Hopefully you now have a better understanding of what a leaky gut entails.  Now let’s take a look at what the 4R protocol involves:

1. Remove.  First of all, you want to remove the factor or factors which caused the increase in intestinal permeability.  So for example, gluten is a common factor which can lead to an increase in intestinal permeability.  However, there can be other factors which can cause a leaky gut to occur.  In addition to gluten, other food allergens can be a factor.  Certain pathogens can also compromise the tight junctions, thus causing an increase in intestinal permeability.  Unfortunately stress can also be a factor, as high cortisol levels can lead to a decreased secretory IgA, making someone more susceptible to developing a leaky gut.  Certain medications such as NSAIDs can also cause a leaky gut.

Sometimes it admittedly can be a challenge to determine what is causing the increase in intestinal permeability.  Although it’s easy enough to avoid gluten and dairy, what if another food is responsible for the leaky gut?  There are many different types of pathogens, and so how can one determine if a specific pathogen is the culprit?  Everyone deals with stress, and so how do you know if this is the trigger?  Some detective work is usually required, which is one reason why it’s not recommended to self treat your condition.  Although finding the trigger under the guidance of a natural healthcare professional can still be challenging, in my opinion it still is best to work with someone who has the knowledge and experience dealing with these conditions.

After removing the factor or factors which caused the leaky gut, you want to focus on the next 3 components of the 4R protocol:

2. Replace. You want to replace those factors which are necessary for proper digestion.  Some examples include digestive enzymes, betaine HCL, and dietary fiber.  I frequently give digestive enzymes to my patients and recommend for them to consume enough dietary fiber.  As for betaine HCL, whether someone should take this or not depends on the patient.  The goal isn’t for the person to take digestive enzymes and/or betaine HCL on a permanent basis, but many times it is a good idea for patients to take these while following a natural treatment protocol to make sure they’re digesting the food they’re eating and the nutrients from the supplements they’re taking.

3. Reinoculate. This is where prebiotics and probiotics come into play.  Remember that the probiotic strain does make a big difference.  For example, bifidobacterium lactis HN019 is great for intestinal dysbiosis, while Saccharomyces boulardii can help with a yeast infection and play a role in gut repair.  Prebiotics such as inulin can help to enhance the growth of the beneficial bacteria.  For more information on probiotics I recommend checking out my article entitled “Can Taking Probiotics Improve Thyroid Health?“.

4. Repair. It of course is important to repair the gut.  L-glutamine is an amino acid, and this is one of the best nutrients used for gut repair.  When I’m working with someone who has a leaky gut I’ll commonly recommend at least 5,000 mg of L-glutamine per day, and with some people I’ll recommend higher doses.  I mentioned before that Saccharomyces boulardii can help with gut repair.  Certain herbs can help with the mucosal lining such as slippery elm, marshmallow root, and aloe vera.  Zinc can also be beneficial.  However, certain foods can help with the healing of the gut as well, including bone broth, cabbage juice, and fermented foods such as sauerkraut and kimchi.

In the opening paragraph of this post I discussed how some researchers hypothesize that in addition to genetic and environmental factors, loss of intestinal barrier function (a leaky gut) is necessary to develop autoimmunity (3).  However, these same researchers also feel that once the autoimmune process is activated, it is not auto-perpetuating, but rather can be modulated or even reversed by preventing the continuous interplay between genes and environment (3).  In other words, not only can a leaky gut be cured, but the autoimmune process can be modulated and in many cases even reversed.

I’ve been mentioning this for many years due to my personal experience with Graves’ Disease, along with the experiences of many of my patients with autoimmune thyroid conditions.  But even though the research shows that the autoimmune process can be modulated, most medical doctors don’t do anything to address the autoimmune component of Graves’ Disease and Hashimoto’s Thyroiditis, as they just focus on managing the thyroid symptoms.  This doesn’t mean that addressing autoimmunity is an easy process, as it can be a challenge finding out what the trigger is.  And if someone has a condition such as leaky gut syndrome it can take a good amount of time to correct the problem.  But in most cases it is worth the “hassle”, especially when compared to receiving radioactive iodine and/or having to take thyroid hormone medication for the rest of your life.

In summary, leaky gut syndrome is common in autoimmune conditions such as Graves’ Disease and Hashimoto’s Thyroiditis.  And when dealing with a leaky gut, one wants to implement the 4R protocol.  Doing so not only can help to correct the leaky gut, but if this is what’s responsible for one’s autoimmune condition then it can be the key factor in restoring their overall health back to normal.