Many people with thyroid and autoimmune thyroid conditions have problems with their adrenal glands.  Although eating well, doing a good job of managing one’s stress, and getting sufficient sleep are probably the three most important factors when it comes to having healthy adrenals, sometimes supplementation can help to restore the health of compromised adrenals when combined with these other factors.  In this post I’m going to discuss six supplements and herbs which can benefit people with adrenal problems.

1. Vitamin C.  The adrenal glands have one of the highest concentrations of vitamin C in the body (1).  Ascorbic acid is a cofactor required both in catecholamine biosynthesis and in adrenal steroidogenesis (1).  As a result, anyone who deals with a good amount of stress needs to make sure they eat foods rich in vitamin C.  However, in my opinion it usually is a good idea to also have the person take a vitamin C supplement.  Most vitamin C is sold as ascorbic acid, but I usually recommend a whole food vitamin C supplement for two reasons.  The first reason is because ascorbic acid is just one component of vitamin C, and you want to consume the required cofactors as well.  The second reason is because ascorbic acid supplements are made from corn syrup, and most corn in the United States is genetically modified.

2. Vitamin B.  The B vitamins are also beneficial for those who are constantly “stressed out”.  Like vitamin C, in most cases there is little risk in taking a B complex supplement since the B vitamins are water soluble.  However, taking high doses of some of the individual B vitamins can cause problems.  Like vitamin C, some of the B vitamins also play a role in the synthesis of hormones important to adrenal health.  For example, vitamin B3 is involved in the synthesis of adrenal hormones.  Vitamin B5 is also important for adrenal health, and can aid in the secretion of the steroid hormones.  Vitamin B6 is involved in the synthesis of norepinephrine.  When someone is stressed out these vitamins will become depleted, and so if someone is dealing with chronic stress then it usually is a good idea to supplement with a vitamin B complex.

3. Ashwagandha.  Ashwagandha (Withania somnifera) is one of the most beneficial herbs for the adrenals.  Although this herb can potentially stimulate thyroid hormone production in hypothyroid conditions, in most cases it doesn’t seem to exacerbate one’s hyperthyroid condition.  As a result, Ashwagandha can usually be used for adrenal support in both people with hypothyroidism and Hashimoto’s Thyroiditis, or hyperthyroidism and Graves’ Disease.  If someone has elevated cortisol then giving Ashwagandha and Rehmannia can help to lower the cortisol levels.  However, Ashwagandha can also benefit people with depressed cortisol levels.  In addition to benefiting people with adrenal problems, Ashwagandha has many other benefits, as I have written about in my article “Ashwagandha and Thyroid Health“:

4. Licorice.  Licorice is an herb I frequently recommend for those people who have depressed cortisol levels.  Glycyrrhizin is the main compound in licorice root, and is what helps to lower cortisol levels by inhibiting the enzyme responsible for the conversion of cortisol to cortisone.  However, licorice also can cause an elevation of blood pressure, and so it typically is contraindicated in those with hypertension.  Licorice also can help to decrease inflammation of the gastrointestinal tract as well.  For more information on Licorice you can read my article entitled “Licorice and Thyroid Health“:

5. Eleuthero.  Eleuthero (Siberian Ginseng) is a great herb for those who deal with chronic stress on a daily basis.  Of course this describes just about everyone, but this doesn’t mean that everyone should take Eleuthero.  I usually recommend this herb to those patients who deal with a lot of stress AND do a poor job of handling it.  Of course the goal is to work on improving one’s stress handling skills so they don’t have to rely on taking Eleuthero.  There is some concern that taking Eleuthero might increase the production of thyroid hormone, but most people with hyperthyroid conditions do fine when taking it.  In fact, when I was following a natural treatment protocol for my Graves’ Disease condition I personally took Eleuthero for a number of months without any problem.  But of course everyone is different, and so if someone who has a hyperthyroid condition takes this herb and feels that it’s exacerbating their condition then of course I would advise them to stop taking it. For more information on Eleuthero check out my article entitled “How Eleuthero Can Help People With Thyroid and Autoimmune Thyroid Conditions“.

6. Phosphatidylserine.  Phosphatidylserine is produced naturally by the body, although you can also get this from foods.  It can also be taken as a supplement.  It is important in maintaining cellular function.  I frequently will recommend this for those who have high cortisol levels.  Clinical studies show that phosphatidylserine can weaken the cortisol response (2) (3).  And although these studies involved giving phosphatidylserine to those who had high cortisol levels due to exercise-induced stress, in my experience it doesn’t matter what type of stress resulted in the elevated cortisol levels.

Which Of These Supplements/Herbs Should You Take?

As I suggested in the beginning of this blog post, while taking certain supplements and herbs can help with the recovery process, taking supplements isn’t a substitute for eating well, getting sufficient sleep, or managing stress.  These factors are without question more important than taking supplements.  In fact, in some cases just eating well and improving one’s stress handling skills can do wonders for the adrenals.  With that being said, sometimes it is can be beneficial to take one or more of the supplements I discussed.

If someone is dealing with chronic stress on a daily basis and is having a difficult time handling the stress, then in addition to working on their stress handling skills they might benefit from taking a vitamin B and vitamin C supplement.  Taking either Ashwagandha or Eleuthero can also be beneficial in helping someone to better deal with stress.  If someone has depressed cortisol levels (and they don’t have hypertension) then taking an herb such as licorice can be beneficial.  On the other hand, if high cortisol levels are an issue then they might want to consider taking Phosphatidylserine, or if they prefer an herbal approach then taking the herbs Ashwagandha and Rehmannia can also help to lower elevated cortisol levels.

As usual, I do think it’s a good idea to work with a competent natural healthcare professional, as they will evaluate your adrenals, and if you have compromised adrenals they will determine which of these supplements and herbs are best for you.  Of course I realize that many people aren’t going to take my advice and will self treat their condition, and if this describes you then just make sure you start with very small doses, especially when taking any of the herbs I mentioned.  Although most people do fine taking the herbs, everyone is different, and every now and then someone will experience a negative reaction.  For the most part vitamin B and vitamin C are safe to take, although I still would be cautious about taking very high doses of these on your own.

Plus, keep in mind that there are other supplements and herbs which can help with adrenal health.  For example, the herb rhodiola is an excellent herb which can benefit people with compromised adrenals.  Biotin can also be beneficial for adrenal problems.  Some people can also benefit from taking an adrenal glandular, although you usually don’t want to take these for a prolonged period of time.

In summary, there are numerous supplements and herbs which can benefit people with compromised adrenals.  Although eating well, getting sufficient sleep, and doing a good job of managing stress are all important factors, taking supplements and/or herbs can frequently help to speed up the recovery process.  While taking a vitamin B and C supplement usually won’t cause problems, I would recommend working with a competent natural healthcare professional before taking the herbs I discussed.  Even though most people do fine when taking the herbs I discussed, every now and then someone will have a negative reaction.

When you think about it, the job that the immune system does in protecting us is simply incredible.  We are constantly being exposed to different pathogens, toxins, and food allergens, and our immune system does an amazing job of making sure these factors don’t cause us any harm, while at the same time differentiating self from non-self.  There are numerous regulatory mechanisms which help to maintain immune homeostasis and prevent the development of autoimmune thyroid conditions such as Graves’ Disease and Hashimoto’s Thyroiditis.  And one of the main components of the immune system which helps to prevent autoimmunity is the regulatory T cells.

Maintaining self-tolerance while at the same time mounting immune responses against pathogens is a complex process.  Regulatory T cells (Tregs) are widely regarded as the primary mediators of peripheral tolerance (1).  Tregs originate in the thymus, although they also can derive from peripheral CD4+ T cells (2).  A healthy immune system will have an abundance of these Tregs.  On the other hand, autoimmunity involves an imbalance of the Th1 and Th2 pathways, and also involves Th17 cells (3).  As a result, when dealing with someone who has an autoimmune thyroid condition, the goal should be to increase the number and activity of the Tregs, while at the same time doing things to help suppress the Th17 cytokines.  Later in this post I’ll discuss some of the nutrients which can increase the number of Tregs and suppress the Th17 cells.

What is FoxP3?

FoxP3 is a transcription factor that is required for the development, maintenance, and function of Tregs (4).  Deficiency or mutation in Foxp3 in humans and mice leads to a decrease in Tregs, which in turn leads to an early onset, highly aggressive and fatal autoimmune disease affecting various tissues (5).  What’s important to understand is that Foxp3 plays an important role in the development and function of regulatory T cells, and both Foxp3 and Tregs are important in preventing the development of autoimmunity.

How To Increase The Number/Activity of Regulatory T Cells

Dr. Alex Vasquez is a chiropractor, naturopath, and osteopath who focuses on autoimmunity.  He is a contributing author of the Institute of Functional Medicine textbook, and he has written numerous journal articles.  In his book “Functional Immunology and Nutritional Immunomodulation” he discusses the nutritional induction of regulatory T cells by using certain nutrients.  What I’m going to do is list these nutrients, but I also have done my own research to see how these influence the Tregs, and of course will share these studies with you.

Vitamin A. Retinoic acid is a metabolite of vitamin A.  A few different studies show that retinoic acid induces Tregs in the presence of transforming growth factor Beta (6) (7).  The same studies reveal that retinoic acid can also inhibit the differentiation of Th17 cells, which as I mentioned earlier, play a big role in autoimmunity.  Some people with Graves’ Disease and Hashimoto’s Thyroiditis can benefit from taking 10,000 IU to 25,000 IU/day of vitamin A.  However, one does need to be cautious, as taking too high of a dosage of vitamin A for an extended period of time can lead to a toxicity.  And women who are pregnant, or are trying to become pregnant need to be especially cautious about taking high doses of vitamin A.  In the past I have written an article entitled “Vitamin A and Thyroid Health“.

Vitamin D. I’ve written numerous articles and blog posts about the benefits of vitamin D.  25-OH vitamin D is what most doctors test for to determine whether someone has a vitamin D deficiency.  Although the lower end of most lab reference ranges for 25-OH vitamin D is 30 ng/mL, for optimal immune system health you want the levels to be at least 50 ng/mL.  Numerous studies show that vitamin D supplementation can help to increase the number of Tregs and therefore might help to prevent the development of autoimmune conditions (8) (9) (10).

Probiotics. Many people take probiotics due to the benefits they have on the health of the gut.  Although this is true, let’s not forget that approximately 70% of the immune system is located in the gut.  As a result, taking probiotics can have a huge impact on the health of the immune system.  And certain strains of probiotics can increase regulatory T cells and help balance the Th1 and Th2 cytokines (11) (12).  If you read the second study you’ll notice that not all species have this effect, as both Lactobacillus reuteri and Lactobacillus casei induced the development of Treg cells, but not Lactobacillus plantarum.

Green Tea. Not too many people think of drinking green tea as a way to prevent autoimmunity.  Well, numerous studies show that the main ingredient of green tea, which is epigallocatechin-3-gallate (EGCG), interfered with the differentiation of Th1 and Th17 cells, and prevented IL-6 induced inhibition of Treg development (13) (14).  And so drinking green tea can increase the number of regulatory T cells and inhibit pro-inflammatory cytokines.  Even though the focus of this post is on autoimmunity, one very small clinical trial suggested that green tea can modulate circulating Tregs in the early stages of chronic lymphocytic leukemia and can potentially prevent the progression of the disease (15).

Omega 3 Fatty Acids. I recommend for just about all of my patients to take omega 3 fatty acids, usually in the form of fish oils.  Omega 3 fatty acids can do a great job of controlling the inflammation, and there is also evidence that they can lead to an increased number of Tregs (16) (17) (18).  However, this admittedly is controversial, as it also has been observed that DHA inhibited the suppressive effect of Tregs.

Lipoic Acid. Alpha lipoic acid can also help to increase the number of Treg cells while inhibiting Th1 and Th17 cells (19).  Although I like alpha lipoic acid and do recommend it to some of my patients, in most cases I focus on giving some of the other nutrients listed here, and only have someone supplement with alpha lipoic acid if I feel it’s necessary.  However, one thing to keep in mind is that alpha lipoic acid can also increase glutathione levels (20) (21).  As I’ve discussed in other articles and blog posts, glutathione is a powerful antioxidant that has numerous functions, especially with regards to detoxification.

Turmeric and Resveratrol. I’ve spoken about both turmeric and resveratrol in past articles and blog posts.  These nutrients have numerous benefits, and there is also evidence that they can help to increase Tregs (22) (23).

While giving these nutrients can help to increase the number of Tregs, other factors most likely need to be addressed as well.  For example, if someone has a leaky gut due to consuming gluten, or exposure to a pathogen, then just giving nutrients to increase the number of Tregs won’t help much.  In other words, before one focuses on increasing the number of Tregs, it’s important to remove the factor which triggered the autoimmune response in the first place.  Once this has been accomplished then the person can take some of these nutrients to help suppress the autoimmune component and keep the immune system in balance.

Low Dose Naltrexone and Regulatory T Cells

For those who are familiar with Low Dose Naltrexone (LDN), this affects the opiate receptors in the brain, and this apparently results in an increase of regulatory T cells.  So this essentially is how LDN can help to modulate the immune system.  However, LDN does nothing to address the autoimmune trigger, which means that people will need to take LDN on a continuous basis.  And this is assuming that it works, as while LDN has helped many people, it isn’t always effective in suppressing the autoimmune component.

In summary, regulatory T cells help to keep the immune system in balance and prevent an autoimmune condition from developing.  People with Graves’ Disease and Hashimoto’s Thyroiditis typically have a lower number of Tregs, and so increasing these cells is important in order to suppress the autoimmune component of the condition.  Certain nutrients can help to accomplish this such as vitamin A, vitamin D, probiotics, and green tea.  However, as I have mentioned in previous blog posts and articles, one also needs to address the cause of these conditions in order to restore the person’s health back to normal.

When someone with a thyroid or autoimmune thyroid condition is trying to restore their health back to normal, it of course is important to eat well, do a good job of managing their stress, get proper sleep, etc.  However, nutritional supplementation is almost always required.  There are a few reasons for this, but perhaps the main one is because even if someone eats mostly organic food it still is difficult to correct nutritional imbalances through diet alone.  One problem is that many people rely too much on supplements and herbs, and although adverse reactions are rare, they do occur at times.

Of course adverse reactions are pretty common with both over-the-counter and prescription drugs.  In fact, according to the CDC, every day in the United States, 105 people die due to a drug overdose, and another 6,748 are treated in emergency departments for the misuse or abuse of drugs (1).  To be fair, not all of these are due to medication, but about 60% are due to pharmaceuticals, which is still a very high number.  As a society we have become so used to people having adverse reactions from taking prescription drugs that we don’t tend to think much of it when this happens.  On the other hand, whenever there are any reports about nutritional supplements or herbs which resulted in a negative reaction it usually gets a lot of attention.

The Similarities Between Peanuts and Herbs

There is no question that side effects and adverse reactions are much less common with nutritional supplements and herbs when compared to medication.  However, this doesn’t mean that adverse reactions don’t occur.  Just as some people can be allergic to certain foods, some people can be allergic to the ingredients in certain supplements, as well as herbs.  I’m not just talking about a food intolerance, but a true allergy.  For example, if someone has a peanut allergy and eats peanuts, the consequences can be severe, and can even be life-threatening at times.  The same can also be true with certain herbs.  One example involves echinacea, which is a well known herb found in most health food stores, as well as in many pharmacies and retail stores.  I realize there is controversy over taking echinacea when one has an autoimmune condition, but I’m not going to discuss this right now.  What I do want to discuss is how if someone has an allergy to plants in the daisy family then they might experience an allergic reaction to echinacea.  Anaphylaxis is also possible in some cases if someone has an allergy to echinacea.  Once again, most people who take echinacea do fine, and I’m not trying to single out echinacea, as people can have an allergic reaction to other supplements as well.

This actually happened to one of my patients recently.  I have been recommending the herb bugleweed to patients with hyperthyroidism and Graves’ Disease for years without a problem.  However, recently one of my patients experienced what appeared to be an allergic reaction to this herb.  Fortunately nothing serious happened, and she simply stopped taking the bugleweed.  I’m not bringing this up to scare anyone, but just to make you aware that there are risks to taking certain supplements and herbs.  With regards to herbs, even though adverse reactions are possible, I still recommend them to my patients.  Everything of course comes down to risks vs. benefits, and whenever taking any supplement or herb you need to consider this.

While it is possible to have an allergic reaction to a specific nutrient or herb in a supplement, having a sensitivity is more common.  So for example, someone might not have an IgE-mediated allergy when consuming a certain supplement, but they instead might have a delayed reaction to one or more of the ingredients.  Sometimes it’s not the actual nutrients or herbs that they’re reacting to, but the fillers in the supplements.  This can happen with medication as well, as someone might not feel well when taking thyroid medication, and in some cases it’s not the medication itself that is causing the problem, but the fillers in the medication.

Are There Heavy Metals In Your Supplements?

In addition to experiencing a severe allergy to taking supplements or herbs, certain toxicities are also possible.  For example, in the past I wrote an article entitled “Peripheral Neuropathy and Thyroid Health“, and I brought up a case of peripheral neuropathy related to arsenic toxicity, which might have been caused by excessive intake of dietary supplements (2).  This involved a 74-year old woman who was taking large amounts of fish oils and glucosamine sulfate supplements, which were identified as possible sources of arsenic.  Upon stopping the supplements the urine arsenic levels had reduced, and there was an improvement in the patient’s symptoms. Another case study revealed that kelp supplements taken by a 54-year old woman had high arsenic levels (3).  Within weeks of discontinuing the supplements her symptoms resolved and her arsenic blood and urine levels were undetectable.

Does this mean we should stop taking nutritional supplements?  Of course not, as one can argue that there are also toxins in the food we eat, the air we breathe, etc.  We’re obviously not going to completely eliminate our exposure to toxins no matter how hard we try.  However, you do need to be cautious when purchasing supplements, as the quality does matter.  In addition, if someone is taking a specific supplement and has a negative reaction, one needs to consider that they might not be sensitive to the actual nutrient or herb they’re taking, but instead might be reacting to toxins in that supplement.  For example, if someone is taking a fish oil supplement high in arsenic, and they begin to develop symptoms they didn’t have prior to taking this supplement, they might conclude that they shouldn’t take fish oils, when the problem wasn’t with the fish oils, but instead was with the toxins in the specific fish oil supplement they were taking.

High Doses of Synthetic Supplements Can Be Toxic

Besides the fact that some supplements have toxins such as heavy metals, taking large doses of certain nutrients alone can cause adverse reactions.  Some examples of vitamins and minerals which can cause a toxicity when taken in higher doses include vitamin A, selenium, and iron.  And of course everyone is different, so there is really no way to tell who will experience a negative reaction to a higher dosage.  For example, someone might do fine when taking 800 mcg of selenium, while another person might experience toxicity reactions when taking 400 mcg of selenium.  And the same is true with other nutrients.

One also needs to be aware that sometimes the supplement manufacturers can make mistakes which can lead to serious problems.  For example, in 2008 there was a case were 201 individuals had adverse reactions to nutritional supplements which contained an excess amount of selenium and chromium (4).  When the supplements were tested it was found that they had almost 200 times the reported amount of selenium.  Some of the selenium toxicity symptoms people experienced included alopecia, fingernail changes, gastrointestinal symptoms, and memory difficulties (4).  Fortunately none of the patients required hospitalization.  Obviously this is a rare situation, but it’s another reason to purchase supplements from reputable companies.  Of course this doesn’t mean that it can’t happen with a good company, but this is less likely to happen with a company that has good quality control standards.

How Can You Avoid An Adverse Reaction From Taking Supplements?

If you are taking supplements as part of a natural treatment protocol, or just on a wellness basis, then you might be wondering what you can do to avoid having an adverse reaction from any supplements you ingest.  There really is no way to completely avoid having an adverse reaction, but here are some things you can do to minimize the chances of this happening:

1. Purchase supplements and herbs from reputable companies. I would definitely recommend to only purchase supplements from companies with a good reputation.  Of course this doesn’t guarantee that there won’t be any toxins in the products, as there have been a few instances of well known companies where testing revealed high amounts of toxins in some of their products.  But going with a company who has good quality control measures will greatly reduce the risk of taking supplements with toxins.

2. Be cautious about taking larger doses of nutrients and herbs unless under the supervision of a healthcare professional. There is a lot of information on the internet and in books, and it’s not uncommon for some people to recommend taking higher doses of supplements and herbs.  For example, if you get a 25-OH vitamin D test and if it’s determined you have a vitamin D deficiency, then you might do some searching online and find some information which recommends for you to take 10,000 IU to 15,000 IU/day of vitamin D3 for a short period of time to increase the vitamin D levels.  However, if someone has a condition such as hypercalcemia then you don’t want to take high doses of vitamin D3.  And even if someone doesn’t have hypercalcemia they would want to be cautious about taking high doses of this vitamin without any supervision.  Another example involves iron, as someone might get an iron panel and see they are low in iron, and based on this decide to take iron supplements.  However, too much iron can cause oxidative damage.  So you definitely need to be cautious.

3. Consider starting with smaller doses of supplements and herbs. The advantage of starting with lower doses is that it can minimize your chances of having an adverse reaction if you are either allergic to an ingredient in the supplement, or if the supplement has toxins.  Earlier I gave an example of one person who was fine taking 800 mcg of selenium, whereas another person had an adverse reaction when taking 400 mcg of selenium.  If you haven’t taken selenium before then you might not know if you can handle higher doses, and so if you decide to take a selenium supplement it might be wise to start with 200 mcg, or even 100 mcg.  Then if all goes well you can slowly increase the dosage.

4. If you need to take multiple supplements, consider taking one at a time. I commonly recommend for my patients to take multiple supplements simultaneously.  And while most people do fine taking multiple supplements at the same time, other people don’t do well.  If you are following a natural treatment protocol then the disadvantage of starting with one supplement at a time is that it might take longer for you to experience positive changes in your condition.  The advantage of starting with one supplement is that if you happen to experience an adverse reaction to one of the supplements you’re taking then it will be easier to screen out.  For example, if you take eight supplements all at once and then experience some headaches or digestive problems, then assuming one of the supplements was responsible for this you really have no way of knowing which of the supplements caused these symptoms.  On the other hand, if you begin with one supplement and then reintroduce another one every few days there is a much greater chance of figuring out which supplement you are reacting to.

In summary, while nutritional supplements and herbs are usually safer to take than most prescription drugs, adverse reactions are still possible.  Some people can have an allergic reaction to certain herbs.  And one needs to be aware of the possibility of toxins in the products they use, which is why you want to choose a supplement company with good quality control measures.  Also be aware that taking high doses of certain vitamins and minerals can lead to a toxicity.  In order to minimize an adverse reaction you want to purchase supplements and herbs from companies with a good reputation, be cautious about taking larger doses of supplements, and consider taking one supplement at a time when beginning a natural treatment protocol.

Part of the challenges of being a healthcare professional is determining which tests a patient actually needs.  When someone is suspected of having a thyroid or autoimmune thyroid condition, then certain tests obviously should be performed, such as a thyroid panel.  Other serum tests can also be valuable, such as a CBC with differential, a complete metabolic profile, a lipid panel, and a test for 25-OH vitamin D.  Most healthcare professionals would agree that these tests are valuable, but from this point on there is a dramatic difference in opinions with regards to which tests are necessary.

For example, many medical doctors will only recommend the blood tests I listed above, and won’t order additional tests.  In fact, some medical doctors will only order a thyroid panel, and won’t order other serum tests.  In my opinion EVERYONE should obtain the tests I listed above.  And of course if someone already has a chronic health condition such as Graves’ Disease or Hashimoto’s Thyroiditis, then they probably will need some of these tests measured on a frequent basis.

Is There An Overreliance of Tests By Natural Healthcare Professionals?

While some will argue that many medical doctors don’t do enough testing, others feel that some healthcare professionals do too much testing.  Other than the serum blood tests recommended by most other doctors, I usually recommend a few other tests, most commonly saliva testing and the “controversial” hair mineral analysis test.  There are times when I will recommend other types of testing, but these are the most common ones I recommend to my patients.  Some natural healthcare professionals will recommend much more testing than this, and sometimes it can run the patient thousands of dollars for the tests.

The goal of this post isn’t to criticize other healthcare professionals for recommending too many tests.  After all, I’m sure some might accuse myself of doing too much testing, although I personally don’t feel this is the case.  I’ve had a few people tell me that a competent healthcare professional shouldn’t rely on using tests, but instead should rely more on their diagnostic skills.  I agree that it’s important to have good diagnostic skills, as one needs to not only be able to take a good case history, but they also need to do a good job of interpreting the information, as well as evaluating the patient’s signs and symptoms.  However, when trying to find out the cause of a person’s thyroid or autoimmune thyroid condition, many times more information is required.  So in my opinion, a combination of good diagnostic skills and the appropriate testing is required to find out what the cause of the condition is.

This of course is easier said than done, as different healthcare professionals will have different opinions with regards to which tests are “appropriate”.  As I mentioned earlier, I usually recommend saliva testing and a hair mineral analysis test to my patients.  Some healthcare professionals laugh at the thought of using a hair mineral analysis, yet use other “controversial” methods of testing, such as food intolerance testing or micronutrient testing, both of which are also controversial, and are also very expensive.  Obviously each natural healthcare professional will have their own personal biases with regards to testing, and the most important factor is the results one receives with their patients.  I know numerous healthcare professionals who utilizing testing which is controversial, yet they receive excellent results with their patients.  For example, even though I don’t routinely do food intolerance testing, I know some healthcare professionals who routinely recommend this type of testing with their patients and receive excellent results.  And of course I wouldn’t recommend hair mineral analysis testing if I didn’t think it had some value in helping my patients restore their health.

What Are The Limitations Of The Different Tests?

What I’d like to do is take a look at some of the different types of tests and discuss some of their limitations.

Salivary cortisol testing. I recommend for just about all of my patients to do saliva testing to measure the cortisol levels throughout the day.  I also commonly test for other things through the saliva, but the focus here will be on the cortisol levels.  I find the cortisol testing to be accurate, meaning that when I test someone initially and find the cortisol levels to be elevated or depressed, frequently on a follow-up test I see the cortisol levels improve.  Of course this isn’t the case with everyone, and when someone isn’t showing improvement then we want to find out the reason why.

One of the most important factors to consider when measuring saliva cortisol levels is that cortisol responds to stress.  When someone has chronic stress, cortisol will become elevated for quite some time, sometimes for many years.  As the adrenals weaken over time the cortisol levels will become depressed, along with the DHEA levels.  However, “abnormal” stress can have a negative effect on such testing.  For example, if someone is collecting the saliva samples and gets into an argument with someone on the day of collecting the samples, there is a good chance this will result in a false elevation of cortisol levels, and will therefore lead to an inaccurate result.  Similarly, if someone is collecting the samples and has a migraine, this will also lead to a false elevation of cortisol.

As a result, it’s important to collect the saliva samples on a “normal” day.  Now when I say “normal”, keep in mind I’m not suggesting that you have to wait for a stress free day.  If this were the case then most of my patients would never be able to collect the samples.  If someone’s day is normally very stressful, then it’s fine to collect the saliva samples on this day.  On the other hand, if there is an unusual amount of stress then it’s best to not collect the saliva samples, and if you have already started to collect the samples on this abnormally stressful day then it’s best to start over.

By the way, even though I’m focusing on “salivary” cortisol testing, this also applies to serum cortisol.  For example, some people will get a one-sample serum cortisol test done at the doctor’s office, and because they get stressed out when they visit the doctor this will falsely elevate their cortisol levels.  Some will even get stressed out when receiving the injection to get the blood drawn, which once again can elevate the cortisol levels, thus leading to false results.

Obviously taking cortisol will affect the results of the testing.  And even certain nutrients can affect the results, which is why when collecting a saliva sample you always want to carefully read the instructions which come with the collection kit.  Saliva testing can provide some wonderful information, although hopefully you now understand some of the potential drawbacks of such testing as well.

Hair mineral analysis. This is another test I commonly recommend to my patients.  And I admit that it is a very controversial test, and if you are relying on a hair mineral analysis test to tell you about all of the minerals and whether you are sufficient or deficient in them, you will be disappointed.  The truth is that the hair mineral analysis can be a wonderful, low cost method of looking at certain mineral imbalances, as well as heavy metal toxicities.  However, there definitely are some limitations as well.

For example, most hair analysis companies will test for the mineral iron.  The problem is that you can’t rely on the hair mineral analysis when it comes to evaluating the iron levels.  Many times I find the iron to be low on a hair mineral analysis test, yet on an iron panel consisting of serum iron, ferritin, and iron saturation, everything is well within the normal limits.  In other words, these values are well with the “functional” reference range on a serum iron panel, yet iron might look completely depleted on a hair mineral analysis.  And iron is one of those minerals that you don’t want to take if you don’t need it.  Copper is another mineral which might appear as low on a hair mineral analysis test, but the person might not be deficient, and in some cases they might actually have a copper toxicity.  As a result, when interpreting copper in the hair  you want to look at some of the other values, such as zinc and calcium.  Just keep in mind that some of the minerals on a hair mineral analysis can appear to be low, but they might be biounavailable.

Another drawback of a hair mineral analysis is that certain external factors can cause a false elevation of the minerals.  For example, if someone has a water softener, then this can spike up the sodium levels on a hair mineral analysis.  As a result, if someone has a water softener then they will want to wash their hair in an alternative source (i.e. distilled water) for at least a few days before collecting the hair sample.  If someone is using a shampoo for dandruff, which commonly is high in selenium sulfide, this will mostly likely elevate the selenium levels.  Using pubic hair can elevate the phosphorus levels.

You might wonder why you can’t just do serum testing to look at the minerals.  Well, the problem is that serum testing isn’t completely accurate for most minerals.  And one reason for this is that with some of the minerals, the body will do everything it can to keep the minerals at a normal level.  For example, serum calcium will almost always be normal, even if someone has a calcium deficiency.  And the same is true with magnesium, along with some of the other minerals.  In any case, the hair mineral analysis isn’t perfect, but if someone takes the proper precautions (i.e. doesn’t wash their hair with a water softener or use dandruff shampoos), AND if the healthcare professional knows how to interpret it correctly, then it could be a very valuable tool.

Heavy Metal Testing. In addition to looking at the minerals, I also use the hair mineral analysis test to look at the toxic metals, such as aluminum, mercury, cadmium, arsenic, and lead.  One can also use urine and serum testing to look at toxic metals.  Serum tests are usually good for detecting acute heavy metal exposure, whereas both hair and urine are used for testing heavy metals that are stored in the tissues.  Although I think both urine testing and hair testing has value, the limitations of these tests is that they won’t reveal everything, as there will be always toxic metals stored in the tissues on the body which don’t show up on these tests.  Plus, when it comes to testing for mercury, the hair does a better job of testing for organic mercury, also known as methylmercury.  This type of mercury is more commonly found in fish.  On the other hand, urine testing for toxic metals is more accurate for determining levels of inorganic mercury, which is the type found in dental amalgams.  Thiomersal, which is still used in some vaccines, is a form of organic mercury.  Keep in mind that inorganic mercury is converted to organic mercury, and is considered to be more toxic than organic mercury.

Food intolerance testing. I know many healthcare professionals who require all of their patients to order a food intolerance panel.  In fact, when I was still in chiropractic school I had one of these done for the first time, and if I recall correctly I think I spent about $600 for this test.  There are different variations of these panels, as the most commonly recommended food intolerance panels utilize IgG testing.  Another common test is called the ALCAT”, which utilizes a different technology that involves something called the “Coulter” method, which involves “measuring white blood cells using the electronic principle of particle counting and sizing”.

Keep in mind that I have nothing against food intolerance testing.  In fact, if I knew for certain that such testing would be accurate I would recommend this type of testing to all of my patients.  After all, if there was a way to detect all of the food allergies and intolerances in a person that would be wonderful.  However, false results are very common with these tests.  This is especially true if someone has an increase in intestinal permeability (a leaky gut).  But even for those who don’t have a leaky gut, I can’t justify having my patients spend hundreds of dollars on a test which is likely to provide false results.

Once again, I’m not suggesting that these tests are completely inaccurate.  I’ve known some people who have obtained such testing and agreed with the positive findings.  In other words, upon eliminating the foods which came out positive on the food intolerance test they noticed an improvement in their symptoms.  However, false negatives are common, and so there is a decent chance of the person testing positive for certain foods, which might be accurate, yet they might have some false negatives.  And so what of course will happen in this scenario is that the person will avoid the foods they test positive for, but they will continue eating some foods which they might be sensitive to, yet didn’t show up as being positive on the test.

And as I mentioned earlier, having a leaky gut can completely throw off the results of the test.  Dr. Natasha Campbell McBride, who developed the GAPS diet, discusses this.  Here is what she has to say about leaky gut and food intolerances: “The reason for allergies and food intolerances is so-called ‘leaky gut’ when the gut lining is damaged by abnormal micro flora. Foods do not get the chance to be digested properly before they get absorbed through this damaged wall and cause the immune system to react to them. Many people try to identify, which foods they react to. However, with a damaged gut wall they are likely to absorb most of their foods partially digested, which may cause an immediate reaction or a delayed reaction (a day, a few days or even a couple of weeks later). As these reactions overlap with each other, you can never be sure what exactly you are reacting to on any given day. Testing for food allergies is notoriously unreliable: if one had enough resources to test twice a day for two weeks, they would find that they are “allergic” to everything they eat. As long as the gut wall is damaged and stays damaged, you can be juggling your diet forever removing different foods and never get anywhere.”

Stool testing for pathogens.  There are times when I will use stool testing for pathogens.  And when someone has a positive finding for certain pathogens, such as yeast, parasites, or other pathogens, there is an excellent chance that this is a true finding.  However, false results aren’t uncommon.  In other words, someone might test negative for yeast, even though they have a Candida infection.  As I mentioned in my article on Candida entitled “Candida and Thyroid Autoimmunity“, stool testing isn’t the best method of detecting a Candida infection.  One can also have parasites and test negative for these on a stool panel.  This seems to be true even with the newer technology some of the labs are using.  So does this mean such testing shouldn’t be utilized?  Well, I think there is value in doing such testing at times, but these are also expensive tests, costing hundreds of dollars.  And so it’s not one I would routinely run on all of my patients.  On the other hand, I know some natural healthcare professionals who do recommend stool panels to all of their patients.

Micronutrient testing.  I mentioned some of the flaws with the hair mineral analysis test, but what about micronutrient testing?  This type of testing looks for intracellular deficiencies.  In other words, it measures how certain nutrients are functioning within the white blood cells.  This type of testing evaluates all of the vitamins, minerals, amino acids, and numerous antioxidants.  I was very excited when I found out about this method of testing.  The problem is that the research is still lacking.  If there was a test which could accurately detect all of the nutrient deficiencies of my patients I would recommend this type of testing to everyone.  And although I find micronutrient testing to be interesting, I once again have a hard time recommending such expensive testing to everyone if I’m not certain that the results are accurate.  Keep in mind that I’m not saying that this type of testing isn’t accurate, but simply that there is no research I’m aware of which proves that this type of testing is accurate.

Organic acids testing. The company Metametrix is one of the companies which offers testing for organic acids, and gives the following definition of such testing: “Organic acids are metabolic intermediates produced in pathways of central energy production, detoxification, neurotransmitter breakdown, and intestinal microbial activity. Accumulation of specific organic acids in urine often signals a metabolic inhibition or block. This abnormality may be due to a nutrient deficiency, an inherited enzyme deficit, toxic build-up, or drug effect. Testing for organic acids helps reveal activity and changes at the metabolic level, helping practitioners discover hidden issues and pinpoint where therapeutic focus is needed.”  There are other labs which offer this type of testing, such as Great Plain Laboratories.

The organic acids test does have some value.  However, it is another expensive test, and false results are possible as well.  Plus, there is also controversy over the different types of methodologies used, which is GC/MS (Gas Chromatography/Mass Spectrometry) or LC/MS/MS (Liquid Chromatography/Tandem Mass Spectrometry). LC/MS/MS is the newer type of technology, but this doesn’t necessarily mean it’s the more accurate one.  One of the labs which utilizes the GC/MS technology wrote a paper why this technology is superior to the LC/MS/MS.  The paper is convincing, but of course has a biased view.

Applied kinesiology.  This isn’t the same as the other types of testing listed here.  As described by the website www.appliedkinesiology.com, “Applied kinesiology (AK) is a form of diagnosis using muscle testing as a primary feedback mechanism to examine how a person’s body is functioning.”  The reason I brought this up is because I know of numerous healthcare professionals who won’t do any of the testing I mentioned above, but will only utilize applied kinesiology on their patients.  In fact, some won’t even recommend blood testing, and so if someone has a suspected thyroid or autoimmune thyroid condition, they will just do applied kinesiology on the patient, and nothing else.  And the reason why they don’t do any additional testing is because it won’t change their recommendations.  This doesn’t describe everyone who uses applied kinesiology, as I know healthcare professionals who use this, but also require blood testing on all of their patients.

I have a good friend who practices applied kinesiology in his practice.  And I’ve worked with numerous patients who have seen one of these practitioners and received very good results with them.  The problem is that this type of “testing” solely relies on the skill of the practitioner.  While this might be fine for someone who is competent and has been using this technique for many years, in my opinion it probably shouldn’t be relied on with someone who doesn’t have as much experience.  Once again, I didn’t list this technique here because I disapprove of it.  After all, let’s not forget I also listed the saliva testing and hair mineral analysis as having limitations, even though I recommend these tests to my patients.  I decided to mention this in this post because even though those doctors who utilize this technique have the utmost confidence that it will provide them with the information they need to restore the person’s health back to normal, it still has limitations as well.

There are other tests I haven’t listed here which have limitations, but these are some of the most well known ones.  And this doesn’t mean that these tests don’t have value.  Obviously I wouldn’t continue recommending the saliva testing and hair mineral analysis to my patients if I didn’t think they provided information which helped to restore their health back to normal.  Similarly, other healthcare professionals utilize other types of testing which have limitations, but provide them with valuable information.  My goal wasn’t to try to criticize any specific testing method or technique, but was just to make you aware of some of the limitations and controversies involved.

When it comes to avoiding specific foods, I truly believe that if you do enough research you can find a reason to not eat anything.  If you follow a strict Paleo diet then you will be avoiding dairy and grains.  If you’re a vegan then you of course don’t eat meat, fish, dairy, or eggs.  In addition to this, if you have gut problems and are trying to avoid lectins, phytic acid, and other antinutrients, then besides avoiding grains you will want to cut out nuts, seeds, and legumes.  Let’s not forget sugar, and so we might as well cut out the fruit.  And it probably would be a good idea to stop eating nightshade vegetables since they can be inflammatory.  And if you’re hypothyroid then you might want to cut out the goitrogenic foods too.

The focus of this blog post is on spinach, which of course is a very healthy food.  While it might not give you a boost in strength like it does with Popeye, eating spinach is high in nutrients such as vitamin A, magnesium, folate, and vitamin K.  In fact, I frequently add spinach to my smoothies.  Sometimes I will also eat spinach in a salad, along with other greens.  And when I have the forbidden pizza, I enjoy adding spinach and garlic to it.  Even my vegetable-hating children “tolerate” spinach.

If spinach is so wonderful, why did I decide to write a blog post which questions whether people with thyroid conditions should avoid spinach?  Well, there are definitely worse foods you can eat other than spinach.  And as I mentioned before, if you do enough research you can make a case for avoiding just about any food.  But as much as I like spinach, there are risks of eating it with both hypothyroid and hyperthyroid conditions.

Spinach and Hypothyroidism. Spinach supposedly has goitrogenic properties.  However, it’s not as goitrogenic as other foods, such as the cruciferous vegetables.  For more information on goitrogens I would check out my articles entitled “Goitrogens: Thyroid Inhibiting Foods You Should Avoid” and “An Update on Goitrogenic Foods and Their Impact On Thyroid Health“.  If you read these articles you’ll realize that a number of years ago I was opposed to people with hypothyroid conditions eating any goitrogens, but based on the lack of human research studies involving goitrogenic foods I have eased up a bit on this.  Although I’m still cautious about people with hypothyroid conditions eating a lot of goitrogenic foods, in most people, eating a normal amount of these foods shouldn’t cause any problems.

So let’s ask the question “should people with hypothyroid conditions avoid eating spinach?”  As I just mentioned, if someone has a hypothyroid condition then I think it’s fine for them to have one or two servings per day of goitrogenic foods.  However, this also assumes they don’t have an iodine deficiency, as goitrogens interfere with iodine metabolism.  Assuming someone with hypothyroidism or Hashimoto’s Thyroiditis is iodine sufficient then I think it’s fine for them to eat spinach, along with other goitrogenic foods such as broccoli, kale, and cauliflower.

Spinach and Hyperthyroidism. Since spinach is goitrogenic and can therefore inhibit thyroid hormone production if eaten in large quantities, then it might make sense for people with hyperthyroidism and Graves’ Disease to load up on spinach!  From a goitrogenic standpoint I’m not at all concerned about people with hyperthyroidism eating spinach.  So why would there be any problem with people who have hyperthyroid conditions eating this green leafy vegetable?

Well, one of the main concerns with hyperthyroidism is that over a period of time it can lead to a decrease in bone density.  This yet another reason why unmanaged hyperthyroidism can cause problems.  In my articles and blog posts I tend to focus a great deal on the cardiac symptoms, but a decrease in bone density can also be a big concern.  This is even true after the thyroid hormone levels are back within the normal range.  So for example, if someone has elevated thyroid hormone levels for six months which causes a decrease in bone density, then just normalizing the thyroid hormone levels won’t necessarily correct the bone density problem.  So someone can still be more susceptible to suffering from a fracture.

At this point you might be thinking to yourself “what does this have to do with spinach consumption?”  Well, one of the nutrients which is important for strong bones is calcium.  And while other nutrients are also important for proper bone health, such as magnesium, phosphorus, and vitamin D, if someone has a calcium deficiency then this without question can affect bone density.  The good news is that spinach is high in calcium.  The bad news is that it also is high in something called oxalate, which binds to calcium, and therefore reduces its absorption.  As a result, eating a lot of spinach can actually cause a calcium deficiency, and therefore affect bone density.

Spinach Isn’t The Only High-Oxalate Food

Spinach isn’t the only food which has high amounts of oxalates.  Many other foods are high in oxalates, including blueberries, blackberries, raspberries, beets, okra, almonds, cashews, and other whole foods are high in oxalates.  The topic of oxalates probably deserves a separate article or blog post, but just understand that most people are fine eating foods with oxalates.  Although some people have conditions which require a low oxalate diet (no more than 50 milligrams per day), this isn’t a concern for most people.

However, there are risks with eating high amounts of oxalates.  I mentioned how they can potentially affect the absorption of certain nutrients such as calcium.  However, there is also evidence that consuming high levels of oxalates can lead to kidney stones (1) (2).  Once again, this doesn’t mean that eating normal amounts of blueberries, raspberries, spinach, and other high oxalate foods will lead to kidney stones.  One problem is that we’re in a “smoothie era”, and many people load up their smoothies with these foods.  I’m guilty of this myself, as I love smoothies, and in the past I would add 1/2 cup of berries, along with a full cup of spinach on a frequent basis.  I still include the berries, and while I do add some raw spinach every now and then to my smoothies, I don’t do this on a daily basis, as I rotate the vegetables that I add to them.

So let’s ask the question “should people with hyperthyroid conditions avoid eating spinach?”  Well, one thing I should add is that although cooking does seem to reduce the goitrogenic activity of spinach and other goitrogenic foods, cooking doesn’t seem to reduce the oxalate content.  And so from this standpoint it really doesn’t matter if you eat raw or cooked spinach.  I think it’s fine for most people with hyperthyroid conditions to eat spinach, but it probably would be a good idea to not load up on this food.  There are so many different vegetables out there, and while some vegetables other than spinach have a high oxalate content, there are many vegetables with a low oxalate content such as cucumbers, arugula, asparagus, broccoli, cabbage, cauliflower, romaine lettuce, and squash.

In summary, spinach is considered by most people to be a healthy food.  The purpose behind this blog post wasn’t to discourage anyone from eating spinach.  I still eat spinach, and think it’s fine for most people to continue to do so, regardless of whether they have a hypothyroid or hyperthyroid condition.  The main reason I decided to write this post is to demonstrate that there can be risks with eating large amounts of healthy foods.  This doesn’t necessarily mean that eating high amounts of spinach on a frequent basis will inhibit thyroid activity or eventually lead to osteoporosis or kidney stones, but in some people eating a lot of spinach will cause problems.   This is one reason why it’s best to try to eat a wide variety of foods whenever possible, and try your best to avoid eating large amounts of a single food on an everyday basis.

Most people with overt hypothyroid conditions have high TSH levels, and low or depressed thyroid hormone levels.  Then there are people with subclinical hypothyroidism, characterized by an elevated TSH and normal thyroid hormone levels.  Many people with Hashimoto’s Thyroiditis are considered to have subclinical hypothyroidism, as while the damage the immune system is causing to the thyroid gland usually results in high TSH levels, it usually takes many years before the thyroid hormone levels become depressed.  However, a small percentage of people have the condition known as thyroid resistance.

Thyroid hormone resistance is characterized by elevated thyroid hormone levels (free T3 and/or free T4), and normal or elevated levels of TSH (1).  It’s not uncommon for people with this condition to have a goiter, but the hypothyroid symptoms usually are very mild, and sometimes the person doesn’t experience any hypothyroid symptoms at all.  In the past I’ve spoken numerous times about insulin resistance, where the cells don’t respond to the actions of this hormone.  In other words, the body produces normal amounts of insulin, but the body becomes resistant to the effects of this hormone and is unable to utilize it efficiently.  It’s a similar situation with thyroid resistance, as there might be sufficient levels of free T3 and free T4, but the cells don’t respond to the actions of thyroid hormone.

What Causes Thyroid Resistance?

Although genetics can play a role in insulin resistance, this condition is commonly caused by lifestyle factors, such as eating too many refined foods and sugars.  With thyroid hormone resistance, there can be numerous causes.  Some of the potential causes include genetic mutations, drugs, chemicals, metabolites, and autoimmune antibodies that may impair thyroid hormone action in the cell (2).  In addition, certain conditions such as chronic fatigue syndrome and chronic renal failure can be accompanied by acquired thyroid hormone resistance caused by inhibition of thyroid hormone metabolism, cell uptake, and thyroid hormone receptor binding and transcription (2).  As I’ll discuss later in this post, certain nutrient deficiencies can also play a role in thyroid hormone resistance.

Sometimes it can be challenging enough to find out if someone has thyroid hormone resistance, but even if this has been determined, how can one find out the cause of this condition?  This also can be a challenge, as I’m not aware of any specific testing which is available to patients or healthcare professionals which will determine if someone has a genetic mutation which is causing this.  Certain environmental toxins such as PCBs and dioxins might cause thyroid resistance, although such chemicals might play a greater role in congenital hypothyroidism (3). Other toxins might also inhibit the binding of thyroid hormone to the receptor (4).  While it is possible to test for some of these environmental toxins, doing so can be quite expensive, and so it’s probably more cost effective to just do things to detoxify your body.  Other substances that might affect the thyroid receptors including iodocontrast agents (5), amiarodone (6), and phloretin (7).  A few different drugs can also bind to specific thyroid receptors (8), and so if someone started taking a certain medication and soon thereafter developed a thyroid condition, one has to consider the possibility that taking this drug was responsible for this.

Can Natural Treatment Methods Help With Thyroid Resistance?

If someone has a genetic polymorphism which is causing thyroid hormone resistance then there isn’t a way to reverse this problem.  However, this is rare, and many cases of thyroid resistance can be helped through natural methods.  As I mentioned earlier, certain environmental chemicals can bind to the thyroid receptors and cause thyroid resistance, and so doing things to detoxify your body would be a good place for many people to start.  I discussed this in a blog post I previously wrote entitled “3 Ways People with Thyroid and Autoimmune Thyroid Conditions Can Detoxify Their Body“.  Detoxification can also help someone who developed thyroid resistance due to a certain medication they’re taking, although if someone suspects that a prescription drug is responsible for their thyroid condition then it would be a good idea to run this by their medical doctor so they can take the person off of the drug, or perhaps switch them to a different drug which hopefully won’t have the same side effect.

Certain nutrients can affect the thyroid receptors and can alter the effect of T3 at the gene transcription level (9).  Since the binding of T3 to the receptor is retinoic acid-dependent (10), taking vitamin A might benefit people with thyroid hormone resistance.  Of course you want to be careful about taking high doses of vitamin A, as this can be toxic.  The T3 receptor is thought to require zinc to adopt its biologically active conformation (11), and so a zinc deficiency can play a role in thyroid resistance. There is also evidence that taking fish oils can support the thyroid receptors as well (12).

This isn’t to suggest that everyone with thyroid hormone resistance should “load up” on vitamin A, zinc, and fish oils.  The first thing one should do is make sure they’re eating a diet consisting of whole foods, while minimizing the refined foods and sugars.  If someone is deficient in these and other nutrients it’s usually due to a poor diet, although it can also be due to absorption problems.  If this is the case then the absorption issue needs to be addressed in order to obtain maximum benefits from the food you eat, and any supplements you might take.

In summary, thyroid resistance is a condition characterized by elevated thyroid hormone levels, and normal or elevated TSH levels. Numerous factors can cause thyroid resistance, such as mutations, drugs, environmental toxins, and nutrient deficiencies.  Many cases of thyroid resistance can be helped naturally.  Since toxins are a common cause of this condition, doing things to detoxify your body and increase glutathione levels would be a good idea for most people.  If a medication is responsible for this condition then of course this needs to be addressed.  Certain nutrients affect the thyroid receptors, such as vitamin A, zinc, and fatty acids, and so making sure you’re getting these nutrients in your diet is also very important.

Most people with thyroid and autoimmune thyroid conditions don’t have a good understanding when it comes to the different types of serum tests used to evaluate thyroid health. Although it is true that blood tests don’t tell the entire story, I do think it’s important for people who choose to follow a natural treatment protocol to at least have a basic knowledge of the different types of blood tests. As a result, I’ve decided to put together a post which discusses the most important “thyroid” blood tests.

Thyroid stimulating hormone (TSH). Although many medical doctors primarily pay attention to the TSH, it’s important to understand that the TSH is actually a pituitary hormone. The role of the TSH is to stimulate the thyroid gland to produce the thyroid hormones (T3 and T4). It is synthesized and released by the anterior pituitary gland. So when someone has a hypothyroid condition, which is characterized by low or depressed thyroid hormone levels, the pituitary gland will secrete more TSH. This explains why the TSH is high in hypothyroid conditions. Due to the decrease in thyroid hormone, greater amounts of TSH will be released. On the other hand, if someone has a hyperthyroid condition, this of course is characterized by an excess of thyroid hormone. As a result, the pituitary gland will stop secreting TSH because it doesn’t want to stimulate the thyroid gland to produce more thyroid hormone. Because of this the TSH will be depressed.

Why do most medical doctors focus on the TSH when someone with hypothyroidism or Hashimoto’s Thyroiditis is taking synthetic thyroid hormone (i.e. levothyroxine)? The reason is because taking synthetic thyroid hormone will usually help to lower the TSH, but it won’t have an effect on the actual thyroid hormone levels. So when someone has Hashimoto’s Thyroiditis and is given synthetic thyroid hormone, most medical doctors will ignore the autoimmune response, as their primarily goal is to get the TSH within the normal reference range.

There of course are a few problems with this. The first problem is that taking thyroid hormone isn’t doing anything to address the autoimmune response. Another issue is that the upper end of the lab reference ranges tend to be too high with regards to TSH. For example, a common lab reference range is between .8 and 4.5 mlU/L. However, the functional reference range is between 1.0 and 3.0, and some claim that it should be between 1.0 and 2.0. But even if you get someone’s TSH between the functional reference range, many people still don’t feel well because the underlying cause of their condition hasn’t been addressed.

Free T3 and Total T3. Triiodothyronine, also known as T3, is a type of thyroid hormone. This is the active form of thyroid hormone which is important in regulating the body’s metabolism. The free T3 represents the free form of triiodothyronine in the blood. On the other hand the total T3 represents both the free and bound form of triiodothyronine. Over 90% of T3 is bound to proteins, and while I do think there is value in testing the total T3, because the free T3 is the active form of the hormone then it makes sense to test this as well. Although some T3 is produced directly from the thyroid gland, most of the T3 is produced through the conversion of T4. In hyperthyroid conditions the free T3 and total T3 are usually high, while in hypothyroid conditions the free T3 and total T3 are usually on the low side.

Which of these two values should be tested? Well, ideally it would be great for both of them to be tested. However, if someone has to choose between the two then it really depends on what one is looking for. As an example, if someone wants to monitor the thyroid hormone levels to see if someone has high or low thyroid hormone levels, it is usually preferable to test for the Free T3 since it is the unbound form of the hormone and thus is what produces a biological response. For example, if someone has hyperthyroidism, ultimately it’s the high levels of Free T3 which lead to the hyperthyroid symptoms. On the other hand, if someone wants to determine whether T4 is being properly converted into T3, then either the total T3 or the free T3 will be fine to measure. Or they might want to look at the reverse T3, which I will discuss shortly.

T3 Uptake. Thyroid-binding globulin (TBG) is what binds thyroid hormone, and helps to carry both T3 and T4 in the bloodstream. The T3 uptake test tells us how much TBG is bound by T4. For example, when TBG concentration is decreased, less TBG is available to bind labeled triiodothyronine (T3), and more labeled T3 reagent binds to the solid-phase material (increased T3 uptake) (1). T3 uptake is typically increased with hyperthyroid conditions, and decreased with hypothyroid conditions. Keep in mind that other factors can cause an increase in T3 uptake (i.e. anabolic steroids such as testosterone), while some other factors can cause a decrease in T3 uptake, such as xenoestrogens.

Free T4 and Total T4. Thyroxine, also known as T4, is a type of thyroid hormone. Just as is the case with T3, the free T4 represents the free form of thyroxine in the blood, whereas the total T4 represents both the free and bound form of thyroxine. As I mentioned before, T4 is converted into T3. In hyperthyroid conditions the free T4 and total T4 are elevated, while in hypothyroid conditions the free T4 and total T4 are on the low side.

It’s also important to understand that synthetic thyroid hormone consists of T4. Even though it is synthetic, the body can still convert it to triiodothyronine (T3). However, some people have problems with the conversion process and are given synthetic T3 (i.e. Cytomel). Natural thyroid hormone consists of both T4 and T3, as well as T1 and T2, which I won’t be discussing in this blog post.

Which of these two values should be tested? Free T4 or total T4? As I mentioned with triiodothyronine, it would be wonderful if both the total T4 and free T4 can be tested. But if choosing only one of these tests then one wants to look at the free form of the hormone. Fortunately most endocrinologists realize this and will test for free T4. However, there are some who will only test for total T4 and not free T4.

Thyroid-Binding Globulin (TBG). I briefly mentioned this test earlier, as this is a protein that moves the thyroid hormones throughout your body. One will typically see increased TBG levels in hypothyroidism, and decreased TBG levels in hyperthyroidism. However, other factors can cause this to increase or decrease. For example, certain drugs can increase TBG levels such as oral contraceptives. Liver disease can also increase these levels, and TBG levels are normally increased during pregnancy. On the other hand, certain drugs such as prednisone, dilantin, and high doses of salicylates can decrease TBG levels.

Free Thyroxine Index (FTI). The free thyroxine index was used more commonly before the free T3 and free T4 tests were made available. It is obtained by multiplying the total T4 with the T3 uptake, and might be useful to measure thyroid function when there are abnormalities in plasma protein binding. The free thyroxine index is typically high in hyperthyroidism, and usually low in hypothyroidism.

Reverse T3 (RT3). As I mentioned earlier, T4 is converted to T3. However, some T4 is also converted to reverse T3. I won’t get into much detail about reverse T3 here, as for more information you can read a separate article I wrote entitled “Reverse T3: What You Need To Know About It“. What I will say here is that some reverse T3 is normal, but you don’t want to have too much, as this usually indicates a conversion problem between T4 and T3. And as I mentioned in the article, chronic stress frequently leads to high RT3 levels. The reason for this is because elevated cortisol levels can inhibit the conversion of T4 to T3. Since the liver is also responsible for the conversion of T4 to T3, having a liver that isn’t functioning optimally can also lead to higher levels of RT3.

Thyroid peroxidase (TPO) antibodies. Thyroid peroxidase, also known as thyroperoxidase, is an enzyme produced by the thyroid gland which helps with the production of thyroid hormone. In fact, when someone takes antithyroid medication (i.e. methimazole or PTU), this essentially is inhibiting this enzyme. Thyroid peroxidase antibodies inhibit thyroid peroxidase, and so the thyroid gland is unable to produce sufficient amounts of thyroid hormone. This typically results in elevated TSH levels. And while taking synthetic or natural thyroid hormone can help to lower the TSH, it won’t do anything to address the autoimmune response, and thus lower these antibodies. TPO antibodies are frequently high in Hashimoto’s Thyroiditis, although it’s not uncommon for those with Graves’ Disease to have elevated levels of these antibodies as well.

Thyroglobulin antibodies. Thyroglobulin (Tg) is a glycoprotein homodimer produced predominantly by the thyroid gland (2). It acts as a substrate for the synthesis of thyroxine and triiodothyronine as well as the storage of the inactive forms of thyroid hormone and iodine (2). In other words, thyroglobulin is a protein produced by the thyroid gland, and it is important for the synthesis of T3 and T4. Thyroglobulin antibodies attack and damage this protein, which leads to the decreased production of thyroid hormone. Elevated thyroglobulin antibodies are common in people with Hashimoto’s Thyroiditis, although some people with Graves’ Disease can have these antibodies as well.

TSH receptor antibodies (TRAbs). There are two types of TSH receptor antibodies. Thyroid stimulating antibodies (TSAb), also known as thyroid stimulating immunoglobulins (TSI), are the main antibodies associated with Graves’ Disease. They stimulate or bind to the TSH receptors, which in turn cause the thyroid gland to produce excessive amounts of thyroid hormone. These antibodies can also attack the tissues of the eye, and can therefore cause thyroid eye disease, also known as Graves’ opthalmopathy. There are also TSH-stimulation blocking antibodies( TSBAb), which causes hypothyroidism. TSBAb-positive patients with hypothyroidism and Graves’ patients with hyperthyroidism may have both TSBAb and TSAb (3).

One important thing to keep in mind is that the absence of thyroid antibodies doesn’t necessarily rule out autoimmune thyroid disease. While testing positive for these antibodies will confirm the presence of an autoimmune thyroid condition, these antibodies can fluctuate, which is why you never want to rely on a single reading. As a result, if an autoimmune thyroid condition is suspected, yet the person tests negative for thyroid autoantibodies, it would be a good idea to test these again in a few months.

So hopefully you have a better understanding of the different types of thyroid blood tests available. While some medical doctors only test for the TSH and thyroid hormone levels, the other tests do have some value. However, also keep in mind that while these tests can provide valuable information, one can’t rely on blood tests alone. For example, just because someone has their TSH and thyroid hormone levels within the normal reference range doesn’t mean they don’t have a problem with the thyroid gland. Remember that the thyroid antibodies will develop before the TSH and thyroid hormone levels become out of range. In fact, with a condition such as Hashimoto’s Thyroiditis, the thyroid antibodies might be elevated for many years before they cause significant damage to raise the TSH and eventually decrease the thyroid hormone levels.

In last week’s blog post I discussed some of the most common causes of gut problems.  This included a poor diet, antibiotic use, chronic stress, pathogens, and toxins.  I also discussed how having a compromised gut can lead to an autoimmune condition such as Graves’ Disease and Hashimoto’s Thyroiditis.  As a result, for many people with an autoimmune thyroid condition, restoring the health of their gut can in turn restore their thyroid health.  In this post I’m going to discuss some of the things you can do to have a healthy gut.

Strategy #1: It all starts with eating well. One of the most common reasons why so many people have gastrointestinal problems is due to eating poorly.  Obviously you need to eat a diet consisting of whole foods, while avoiding the refined foods and sugars.  Common allergens such as gluten and dairy should also be avoided while trying to restore your health.  Having an intolerance to other foods is also possible, and many times it can be a challenge to find out which foods people are sensitive to.  Although food intolerance testing is available, these panels are expensive and aren’t complete accurate.  Many times an elimination diet is the best option, although it of course takes time going this route, and one can’t always rely on symptoms to determine if there are food intolerances.  In addition to avoiding common food allergens and being cautious about other food sensitivities, some people need to avoid other foods.  For example, if someone has small intestinal bacterial overgrowth or a different condition then they might need to be on a low FODMAPS diet. Some people have problems with oxalates and/or salicylates and therefore need to eat foods which are low in these.

Some people can benefit from following a protocol similar to the GAPS diet, which can be an effective diet, although it is very strict.  I usually have my patients follow a Paleo type diet.  If someone has a lot of food intolerances then this is when I will commonly recommend the GAPS diet.

While I’m sure many people reading this information have already made some wonderful changes to their eating habits, one thing to keep in mind is that if someone has been eating poorly for many years, then sometimes changing their diet alone won’t be sufficient to restore their gut health back to normal.  For example, growing up my diet was horrible, as I ate refined foods and sugars on a daily basis, drank plenty of cow’s milk, soda, and fruit punch, and frequently ate fast food.  I did this for about two decades of my life, and while I don’t recall having a lot of bloating or gas, I did have chronic constipation.  And when I eventually changed my eating habits it took many months to experience positive changes in my bowel movements.  But they still were far from normal, and it wasn’t until years later (after I was diagnosed with Graves’ Disease) when I began making further changes to my daily eating habits that I was able to have daily bowel movements.

Strategy #2: Do everything you can to avoid taking antibiotics and NSAIDS. Although there are other prescription drugs which can have a negative impact on your gut heath, probably the two worse drugs to take with regards to gut health are antibiotics and NSAIDS.  I realize that sometimes taking antibiotics are necessary, but many people take antibiotics when they don’t truly need to.  If someone absolutely needs to take antibiotics then they want to take a good quality probiotic supplement during this time.  It also is a good idea to eat plenty of fermented foods.  Then once they are done taking the antibiotic they will want to continue taking the probiotic supplement at least for a few months, and of course continue to eat fermented foods.  For more information on probiotics I recommend reading my article entitled “Can Taking Probiotics Improve Thyroid Health?“.

And of course NSAIDS should be avoided whenever possible.  Once again, I realize that there might be times when someone needs to take this medication.  But they should be taken on a short term basis due to the severe side effects associated with this prescription drug.  If at all possible someone should try to substitute antibiotics and NSAIDS with natural antimicrobials and natural anti-inflammatory foods and supplements.  I’ll talk more about natural antimicrobials shortly when I discuss pathogens.  As for natural anti-inflammatory foods and supplements, eating plenty of fresh vegetables, drinking green tea, and consuming omega-3 fatty acids, turmeric, ginger, and resveratrol can help greatly with the inflammation.  Vitamin D can also play a very important role in inflammation, and many people are deficient in vitamin D.

Strategy #3: Become an expert in managing stress. In last week’s blog post I discussed how chronic stress can affect the gastrointestinal tract.  I talked about how stress can cause problems with gastrointestinal motility, have a negative effect on the regenerative capacity of the GI mucosa, and can lead to a leaky gut.  So even if you are eating an almost perfect diet, if you are stressed out all of the time then this can affect the health of the gut.

In this day and age it’s a challenge to effectively manage stress.  But doing so is necessary for anyone who is looking to restore their health by following a natural treatment protocol.  Part of the problem is that many people don’t block out any time for stress handling.  It’s a catch-22 situation, as many people are so busy with their job and/or taking care of their family that it’s a challenge to find the time to work on improving their stress handling skills.  But doing so is necessary in order to achieve optimal health.

I’m in such a situation, as between consulting with patients, responding to emails, writing articles and blog posts, and trying to spend time with my family I don’t have much time to work on my stress handling skills.  But I block out at least 10 to 15 minutes each day to do this, and most people can do this too.  Even if you start out with five minutes per day this is better than nothing.  And then once you’re in the routine of managing your stress on a daily basis you can gradually increase the amount of time dedicated to this.

As for what you can specifically do to manage your stress, I’ll refer you to an article I previously wrote entitled “7 Stress Management Tips To Help Restore Your Thyroid Health“.  Although three of the tips involve 1) being aware of the impact stress has on your health, 2) eating a healthy diet, and 3) exercising regularly, in addition to doing these, just about everyone should incorporate at least one additional stress management technique into their daily routine.  I personally do biofeedback, but others might do some deep breathing and meditation on their own, while other people might prefer to do yoga, tai chi, or something else on a daily basis to manage their stress.  But it is important to do this every day, even if it is only 10 to 15 minutes per day.  Obviously it would be better to block out 15 to 30 minutes a couple of times per day, but even spending 10 minutes per day on stress management will be beneficial.

Strategy #4: Cautiously eradicate pathogens. Since pathogens can potentially trigger an autoimmune response, then it would make sense to eradicate any pathogens which are present, right?  Well, if someone with an autoimmune thyroid condition has a pathogen such as H. Pylori present then I agree it needs to be eradicated.  However, there are a few things you need to keep in mind.  First of all, antibiotics are frequently used to eradicate pathogens.  And as I mentioned earlier, one should try to avoid taking antibiotics whenever possible.  In most cases antibiotics should be reserved for acute infections (although not everyone who has an acute infection needs to take an antibiotic).

However, if someone has a chronic gastrointestinal infection, while antibiotics might help, they will also disrupt the gut flora.  And so whenever possible I will first try to use natural antimicrobials such as garlic, turmeric, oregano oil, and/or berberine.  Be aware that some natural antimicrobials can cause problems with the good bacteria of the gut.  For example, taking high doses of citrus seed extract can affect both good bacteria and bad bacteria.  I mentioned garlic and turmeric before, which are relatively safe.  But I also mentioned oregano oil and berberine, and while I commonly use these as antimicrobials, taking high doses of these for a prolonged period of time might have a negative effect on the gut flora.  In addition, certain herbs can be toxic if taken for too long, including wormwood, which is commonly recommended by natural healthcare professionals (including myself) to help with parasites.

While taking natural antimicrobials can be beneficial, probably the most important thing you can do is to improve the overall health of your immune system.  And while one can take immune modulating supplements and herbs on a short term basis to help with this, the best way to improve the health of your immune system is by following all of the other advice I have given in this post.  In other words, eating well, managing your stress, and minimizing your exposure to toxins will do wonders in keeping your immune system healthy and strong.  Getting sufficient sleep is also very important.

Strategy #5.  Detoxify your body on a frequent basis. There are so many different toxins we’re exposed to on a daily  basis, and while you can do things to help minimize your exposure to toxins, you also need to do things to help detoxify toxins from your body.  Eating mostly organic food, using natural household products, and doing other things to minimize your exposure to toxins can help.  Just keep in mind that organic food isn’t completely toxin free, and of course many homes are toxic as well.  And even if you take measures to minimize the toxins in your home, simply stepping outside of your house and breathing the “fresh” air will expose you to numerous toxins.  As a result, you always need to work on eliminating toxins from your body.

I have written a separate blog post entitled “3 Ways People With Thyroid and Autoimmune Thyroid Conditions Can Detoxify Their Body“.  In this post I spoke about how you can detoxify your liver through eating certain foods such as cruciferous vegetables, garlic, and cilantro.  You can also take certain supplements and herbs if necessary such as chlorella, milk thistle, and N-acetylcysteine.  I also discussed colon cleansing and sauna therapy.

However, if someone has a condition such as leaky gut syndrome then they want to be cautious when detoxifying their body.  While doing things to increase glutathione levels and eliminate toxins is usually fine, I would refrain from using more aggressive detoxification methods such as colon hydrotherapy.  Keep in mind that I’m not opposed to colonics, as they can be a very effective method of eliminating toxins.  But if someone has an increase in intestinal permeability then this should be addressed first.

Strategy #6.  Implement gut repair strategies (if necessary). If someone has a condition such as leaky gut syndrome then eating well can help, but it also might be necessary do certain things to assist with the gut repair.  L-glutamine is one of the most commonly used nutrients to help repair the gut, as it serves as fuel for the enterocytes.  Certain probiotics can also help with gut repair, such as Saccharomyces Boulardii.  You can also heal the gut by eating certain foods such as bone broth.

Strategy #7: Don’t forget about the gallbladder. The gallbladder plays a big role in digestive health, as it stores bile, which is important with regards to the digestion of fats.  Even though bile is stored in the gallbladder, it is actually produced by the liver.  Some classic gallbladder symptoms include pain between the shoulder blades, although the person might also experience some discomfort on the upper right side of the belly.  Sometimes the pain can become quite severe.  Frequently there are digestive problems upon eating greasy foods, and sometimes even healthy fats.  Hundreds of thousands of people have their gallbladder removed each year, and most of these could have been prevented if the person were to clean up their diet and receive support for the liver and gallbladder.

In summary, having gut problems can lead to many chronic health conditions, including autoimmune thyroid disorders such as Graves’ Disease and Hashimoto’s Thyroiditis.  As a result, you want to do what is necessary to restore the health of the gut, such as eat well, manage your stress, try to avoid taking antibiotics and NSAIDS, be cautious when eradicating pathogens, detoxify your body on a frequent basis, implement gut repair strategies when necessary, and to optimize the health of your gallbladder.  All of these factors can be important when it comes to restoring the health of your gut.  Of course there are other factors I didn’t discuss in this post which can have an impact on gut health, and I will cover many of these factors in future articles and blog posts.

Millions of people have problems with their gastrointestinal tract. Some of these people have overt symptoms such as bloating, gas, abdominal pain, constipation and/or diarrhea. On the other hand, not everyone with gut problems experiences digestive symptoms, as they might present with other types of symptoms such as fatigue, brain fog, muscle and joint pain, neurological problems, or numerous other symptoms. The goal of this blog post is to discuss why so many people have “gut problems”. Then in the next post I will discuss what you can do to overcome these gut problems, which in many cases is the most important factor in restoring one’s immune system health.

But before I do this, I’d like to briefly discuss the importance of having a healthy gut in people with thyroid conditions. Most thyroid conditions are autoimmune in nature. In other words, the autoimmune component of Graves’ Disease or Hashimoto’s Thyroiditis is what’s responsible for the thyroid hormone imbalance. So what is looked at as being “thyroid conditions” are really “immune system conditions”. Approximately 70% of the immune system is in the gut. And if someone has a compromised gut, this needs to be addressed in order to have a healthy immune system.

So let’s go ahead and look at five of the main reasons why many people have problems with the gut:

1) Poor diet. It of course all starts with one’s eating habits. While I’m sure many people reading this information have made some wonderful changes to their diet, the truth is that most people don’t eat well. It’s not uncommon for me to speak with someone who is eating a whole foods diet that is mostly organic, gluten free, etc. Yet many of these people still have digestive issues. And the reason for this is because most chronic health conditions take years to develop, yet most of these people made these changes after the development of their health issues. This described myself as well, as while I ate better than most people before being diagnosed with Graves’ Disease, I still was eating a decent amount of processed foods. It wasn’t until after I was diagnosed with an autoimmune thyroid condition that I made such dramatic changes.

Of course there are some people who were eating well for many years before they were diagnosed with a chronic health condition, yet still currently have gut problems. And I’ll talk about some of the other reasons why this could happen. In fact, I’d like to talk about one of these reasons now, which has to do with food intolerances. The truth is that it is possible to have an intolerance to any type of food. And if someone has a condition such as leaky gut syndrome then it’s not uncommon to have multiple food intolerances, and it can be a challenge to determine which foods someone is reacting to.

However, even if someone doesn’t have a leaky gut they can be sensitive to certain foods, which of course eventually can lead to a leaky gut. For example, although someone can be sensitive to any food, some of the most common food allergens include gluten, dairy, eggs, corn, and soy. Obviously people can have sensitivities to other foods, but these are the most common allergens, and many people who are eating a healthy diet are eating some of these foods. So for example, someone might be eating an organic diet and be 100% gluten free, yet they might be eating some dairy products. And while one can argue that some dairy products are healthier than others (i.e. raw dairy), if someone is sensitive to casein, then this can cause gut issues in some people regardless of the type of dairy they’re consuming. Similarly, if someone is both gluten free and dairy free but is eating foods with corn, and if they happen to have an intolerance to corn, then this can lead to gut issues.

The focus so far has been on people who have been eating somewhat healthy diets yet still might have gut issues, but of course the majority of people who have gut issues don’t eat well. Most people eat too many refined foods and sugars, too much fast food, and they don’t eat enough fruits and vegetables. I didn’t want to focus on this here because most people reading this know that they should avoid the processed foods, and eat mostly whole foods. But they might not be aware that in some cases eating a healthy diet can still cause health issues if the person has an intolerance to one or more of the foods they commonly eat.

2) Antibiotic use. The bacterial flora are very important when it comes to maintaining the health of the gastrointestinal tract. While I’m thankful that we have antibiotics, as there are times when they are necessary, taking antibiotics will disrupt the gut flora, thus resulting in overgrowth by pathogens, invasion and translocation of toxins, and in some cases life-threatening infections (1). And it’s not just the gut that is being affected, as a study which involved 70 females with urinary tract infections treated with antibiotics showed that after antibiotic therapy, the lactobacillus population had not been restored in the majority of patients, and uropathogenic bacteria were found to dominate the urethra and introitus (2). The same study suggested that artificial supplementation of indigenous bacteria (probiotics) is necessary to restore the flora back to normality.

The problem is that most people who take antibiotics don’t end up taking probiotics to help restore the normal gut flora. And as I discussed in my article entitled “Can Taking Probiotics Improve Thyroid Health?“, not all probiotics are the same, and some people who take probiotics aren’t getting sufficient amounts due to either low potency, low viability, or a combination of both factors. And the truth is that antibiotics are overprescribed. For example, if someone has a cold with some of the classic symptoms (i.e. fever, runny nose, sore throat, etc.) and they visit their primary care physician, there is a good chance that they will be prescribed antibiotics. However, if the pathogen which caused the illness was viral then taking the antibiotic won’t help. And even if the pathogen is a bacteria, most of the time medication isn’t necessary to take, as the body’s immune system will frequently be able to eradicate the pathogen. Once again, I’m not suggesting that antibiotics aren’t necessary, as if someone has a bad infection then they might need to take antibiotics. But most people who take antibiotics don’t think of the consequences this will have on their gut health.

I came across an article which discussed whether the rise in asthma and allergies can be at least partially related to antibiotic use (3). The article mentioned how epidemiologic studies have found strong connections between receiving treatment with antibiotics and the development of asthma and allergies. In this article the following question was asked: “How do changes in gut flora influence respiratory allergies?”. And the response was something called “oral tolerance”, which involves the immune system responding upon the ingestion of certain allergens, and this immune system response allows the rest of the body to be tolerant of allergens so that allergic reactions don’t occur. So in other words, if the gut flora is compromised, then this will have a negative effect on oral tolerance, and thus will make someone more susceptible to developing a food sensitivity.

Another study looked into how early antibiotic administration affects oral tolerance (4). The results of the study suggest that taking antibiotics early in life has a negative effect on tolerance to a specific antigen when this antigen is introduced while the person is taking antibiotics. The study hypothesized that “antibiotic treatment early in life might facilitate allergic sensitization to novel food antigens”. The authors of the study suggested that if an infant needs to take antibiotics then it might be a good idea to avoid the introduction of new food ingredients in order to minimize the risk of them developing a food allergy.

3) Chronic stress. Although stress seems to be blamed for the cause of many different conditions, there is plenty of evidence which shows that stress can cause problems with the gastrointestinal tract. The enteric nervous system is the intrinsic nerve supply of the gastrointestinal tract, and the enteric nervous system is connected to the brain by parasympathetic and sympathetic pathways forming the brain-gut axis (5). Corticotropin releasing factor (CRF) is a hormone which helps to regulate the central stress response, and it has been demonstrated that stress can cause an increase in intestinal permeability and can lead to an increased susceptibility to colonic inflammation (5). Physical and psychological stresses are widely accepted as potential triggers of certain gastrointestinal conditions such as peptic ulcer, irritable bowel syndrome, or inflammatory bowel disease (6).

I just mentioned how stress can potentially cause a leaky gut to occur. As for the mechanism behind this, it is thought that stress leads to the altered release or response to neuroendocrine factors (such as corticotrophin-releasing hormone) in the intestinal mucosa, and this either directly or indirectly acts on the cells of the small intestine, which causes intestinal barrier dysfunction and the uptake of proinflammatory material from the gut lumen (7).

Another journal article I came across stated that the major effects of stress on gut physiology include: 1) alterations in gastrointestinal motility; 2) increase in visceral perception; 3) changes in gastrointestinal secretion; 4) increase in intestinal permeability; 5) negative effects on regenerative capacity of gastrointestinal mucosa and mucosal blood flow; and 6) negative effects on intestinal microbiota (8). The same article discusses how melatonin can have protective effects against stress-induced lesions in the gastrointestinal tract, and how taking probiotics might affect the brain-gut interactions and attenuate the development of stress-induced disorders in both the upper and lower gastrointestinal tract. With regards to melatonin, many people use this hormone to help with sleep-related issues, but there is plenty of research which shows that melatonin can also benefit the health of the gastrointestinal tract (9) (10) (11).

4) Pathogens . Of course certain pathogens can have a negative effect on gastrointestinal health. For example, viruses such as norovirus and rotavirus can affect the gastrointestinal tract. Some bacteria which can have a negative effect on the GI tract include shigella, campylobacteria, and C. difficile. Giardia and cryptosporidium are parasites which can affect the gut. Although we can’t completely avoid all of these pathogens, some of the things we can do to minimize our exposure to these and other pathogens include practicing proper hygiene and avoiding uncooked or undercooked meat. With regards to hygiene, a lot of people rely on hand sanitizers, but they aren’t a substitute for soap and water.

While being exposed to certain pathogens can affect the health of the gut, having a compromised gastrointestinal tract will make one more susceptible to an infection by a pathogen. For example, if someone eats a poor diet and/or deals with chronic stress on a daily basis, this can affect the gut and immune system, making them more susceptible to an infection by a virus, bacteria, or parasite. Of course I realize that in some cases people will get an infection even with a healthy gut and immune system, but having a healthy body will of course reduce the likelihood of getting such infections.

5) Toxins. There is still a lot that isn’t known about the impact of toxins on gastrointestinal health. With regards to the routes of entry, environmental toxins taken orally may be modified in the GI tract by gastric pH, digestive enzymes, or even bacteria that live in the intestines (12). Environmental toxins that are internalized by skin absorption or by inhalation may be secreted into the lumen through the biliary system and lead to toxicity (12). Also, toxins suspended in air make their way into the intestinal tract by drainage from the sinuses into the pharynx and esophagus (12).

When talking about toxins, one can’t overlook the effect that certain medications have on the gastrointestinal tract. Pharmaceutical agents of several types interact with the small bowel mucosa causing impairment of transport processes for fluid and electrolytes, amino acid, lipid and sugars as well as vitamins (13). It is well known that NSAIDs have a negative effect on the gastrointestinal tract (14) (15) (16). But other prescription drugs can cause problems with the gut, and even over the counter drugs such as aspirin can cause gastrointestinal injury in some cases (17).

So hopefully you have a better idea as to why problems with the gastrointestinal tract are so common. In the next blog post I will discuss what you can do to have an optimally functioning gastrointestinal tract. While there can be numerous factors which can lead to the development of an autoimmune thyroid condition such as Graves’ Disease or Hashimoto’s Thyroiditis, the truth is that many people will be able to restore their immune system health just with the information included in this blog post, along with the second part I will be releasing.

For those people with Graves’ Disease and Hashimoto’s Thyroiditis who choose to follow a natural treatment protocol, the ultimate goal is to get these people to the point where the immune system is balanced.  In other words, the goal is to suppress the autoimmune component of the condition while addressing compromised areas of the body (i.e. adrenals, gut, etc.).  At this point the person’s symptoms have disappeared, their thyroid hormone levels will be normal and the thyroid antibodies will be negative.  Some might refer to this as a cure, but since there is a genetic component which can potentially be triggered again then it’s probably best to refer to this as a state of remission.  And of course once remission is achieved, the goal is to help the person maintain their health so that a relapse doesn’t occur.

But how can one maintain their health after remission is achieved?  After all, if there is a genetic predisposition then isn’t there the possibility that eating poorly, experiencing a stressful event or some other lifestyle or environmental factor can cause a relapse?  Without question this is possible, but once someone has restored their health back to normal there are numerous things they can do to help reduce the likelihood of having a relapse occur.  So let’s go ahead and discuss some of the more important factors to help maintain your health.

1. Make sure that your condition is stable. Some people think they are in remission even though this is not the case.  First of all, just because someone is symptom free and has a normal TSH and thyroid hormone levels doesn’t mean they are in remission.  You of course want the thyroid antibodies to be negative too, although since these can fluctuate you can’t always rely on a single test result.  If saliva testing was done then ideally you want these results to be normal too.  So for example, if someone presented with elevated cortisol levels, a depressed DHEA, and a depressed secretory IgA then the obvious goal is to get these to within normal limits.  If someone has a leaky gut then this should be healed before someone declares that they’re in remission.

Of course everyone wants to restore their health quickly.  And while it’s my goal to help people achieve optimal results as fast as possible, the truth is that it takes time for this to happen. Let’s not forget that with autoimmune thyroid conditions it frequently take years to develop, and so it will take time for someone’s symptoms to improve, and for the blood and saliva tests to normalize.  And if someone has a condition such as leaky gut syndrome, or toxic overload, then these conditions also take time to address.

2. You want to eat well most of the time. When following a natural treatment protocol you need to be very strict with your eating habits.  Once someone has restored their health it still is important to eat well, although in most cases it is fine to indulge every now and then.  When someone restores their health back to normal what I commonly see is the person eat well for a few months, but then frequently they will slowly incorporate more and more junk food into their diet.  It’s easy to get into bad habits, and I’d be lying if I told you I don’t give into the temptations every now and then.

While most natural healthcare professionals would like to give you the impression they eat well 100% of the time, the truth is that just about everyone indulges every now and then.  I frequently attend nutritional seminars and conferences, and it’s very common to see natural healthcare professionals drinking Starbucks lattes, eating unhealthy food for lunch, etc.  Once again, I’m not trying to criticize natural healthcare professionals who do this, as while I don’t care for Starbucks, and although I usually bring some of my own healthy snacks at these seminars and conferences, I’d be lying if I told you that I never eat some unhealthy foods when attending these conferences.

The point I’m trying to make is that most people who have already restored their health back to normal can get away with eating unhealthy foods on an occasional basis without having to worry about relapsing.  So while you should eat mostly healthy foods and try to avoid the refined foods and sugars, indulging every now and then should be fine after remission is achieved.  I’m sure some people reading this will want to know if this includes common allergens, such as gluten and dairy.  In other words, if someone avoided gluten and/or dairy while following a natural treatment protocol, after they restore their health is it okay to have some gluten based foods every now and then?

This is controversial, and it really depends on the person.  Of course if someone has a condition such as Celiac Disease then they really do need to avoid gluten on a permanent basis.  If someone has a non-autoimmune gluten sensitivity then this is where it gets more controversial.  Dr. Tom O’Bryan is an expert when it comes to gluten, and he feels that anyone with any type of gluten sensitivity should permanently avoid gluten. However, I’m still not sure of this.  For example, if someone developed a gluten sensitivity due to a leaky gut, but corrected this problem, then it might be fine for this person to have some gluten every now and then.  But perhaps this is just due to my own personal bias since every now and then I’m guilty of having a slice of non gluten-free pizza or a non-gluten free dessert.

I think many would agree that the problem with most people isn’t that they eat poorly once in a while.  The primary reason why there is a high prevalence of these chronic health conditions is because most people make it a daily habit of eating refined foods and sugars, fast food, common allergens such as gluten and dairy, etc.  So for those who ate poorly before being diagnosed with Graves’ Disease or Hashimoto’s Thyroiditis, if you changed your diet as part of a natural treatment protocol and then restored your health back to normal, you need to understand that while perfection isn’t necessary, you will need to eat well on a regular basis for the rest of your life if you want to maintain your health.

3. Become a master at handling stress. Managing one’s stress is just as important, if not more important than eating well.  It’s very common for people with these autoimmune thyroid conditions to link the onset of their condition to a stressful event.  There is no question that stress has an effect on the immune system.  While acute stress will lead to elevated cortisol levels and thus immunosuppression, chronic, prolonged stress has been associated with an increase in proinflammatory cytokines, which is also a component of autoimmunity.

I’ve spoken about the impact of stress in other articles and posts.  Stress is a factor in just about everyone’s life, and in many cases it’s not possible to reduce the stress levels.  And so what we need to do is change how we handle the stress.  Unfortunately most people don’t do a good job of handling the stress in their life.  And many people who think they are doing a good job of managing their stress really aren’t doing a sufficient job in this area.

So how about if you currently have low stress levels and feel that you are doing a good job of managing your stress?  As I just mentioned, just because you think you are currently doing a good job of managing your stress doesn’t mean that this actually is the case.  But even if this is true, you never know what the future will bring.  For example, I once had a patient who was doing great on the natural treatment protocol.  Her symptoms improved quickly, and her blood tests normalized after only three months on the protocol, which is great.  But then she was dealing with a close relative who had health problems and eventually passed away, and she relapsed.  It obviously is difficult to prepare for a situation like this, and chances are her condition wasn’t yet stable at this point.  But I brought this example up to demonstrate how important it is to be proactive in managing your stress.

Although eating well, exercising regular, and being aware of the impact stress can have on your health is important, you need to incorporate other stress management techniques into your daily routine.  At the very least you need to block out 10 to 15 minutes once or twice each day to work on managing your stress.  If you can block out 30 minutes each time this would be even better.  I spoke about this in detail in a blog post entitled “Blocking Out Time To Manage Your Stress Is Essential“.

4. Detoxify your body on a regular basis. We are constantly being exposed to toxins, and as a result, we need to do things to 1) minimize our exposure to toxins, and 2) do things to eliminate toxins from our body.  I have also spoken about this in a separate post entitled “3 Ways People With Thyroid and Autoimmune Thyroid Conditions Can Detoxify Their Body“.

5.   Take advantage of natural antimicrobials. Pathogens are also a potential trigger for an autoimmune condition.  We’re all going to be exposed to pathogens, and the in order to minimize the risk of getting an infection you should 1) practice proper hygiene, 2) improve the health of your immune system, and 3) take natural antimicrobials.  I’m not going to talk about hygiene here.  With regards to immune system health, those who are in a true state of remission should have a healthy immune system, and you can maintain its health by following the advice I have given so far in this post.  If you eat well and manage your stress you will maintain the health of your gut and adrenals, which will help greatly in maintaining the health of your immune system.  And of course minimizing your exposure to toxins and eliminating them from your body will also help with immunity.

With regards to natural antimicrobials, there are three that I’m going to mention here.  One of them is garlic, as this is one of the best natural antimicrobials available.  I would try to eat one clove of raw garlic per day, or if you don’t want to do this then take a garlic supplement.  I have written an article entitled “Can Garlic Benefit Thyroid Health?“.  Turmeric is another wonderful herb that has antimicrobial properties.  And so I would also consume some turmeric each day.  I’ve written an article entitled “Turmeric and Thyroid Health“.

The final antimicrobial I’d like to discuss is the controversial mineral iodine.  I’m not suggesting that everyone should take iodine on a wellness basis.  I’m sure some people reading this post were in agreement with most of what I said until I mentioned iodine!  In previous articles and blog posts I’ve mentioned that iodine isn’t for everyone.  Iodine is a potent antimicrobial, and is also effective in penetrating the biofilm of certain pathogens.  But of course there is also evidence of iodine triggering an autoimmune response in some people, and so while I’m pro-iodine, some people should avoid supplementing with this mineral.  In any case, when it comes to fending off pathogens, I would definitely make garlic and turmeric a part of your daily routine, and some people might also want to consider a small amount of iodine.

There are of course other factors which are important to maintaining one’s health.  It’s important to obtain quality sleep each night, as I would try to get at least seven to eight hours of sleep per night.  It is also important to exercise on a regular basis, although I realize that some people won’t be able to do this until they have restored their health back to normal.  However, you want to be careful not to overexert yourself, as this can put stress on the immune system as well.

In summary, without question it is a challenge for people with autoimmune thyroid conditions to restore their health back to normal.  Doing this takes a good amount of time, and requires extreme changes in lifestyle factors.  Maintaining one’s health also can be a challenge, although it doesn’t require being as strict as when one is following a natural treatment protocol.  With that being said, once someone has restored their health back to normal they want to continue to eat well, work on their stress handling skills, continue to minimize their exposure to toxins and do things to help eliminate toxins, take advantage of natural antimicrobials, get ample sleep, and exercise on a regular basis.  Once again, doing all of these things can be a challenge, but doing so is necessary to maintain your health and prevent a relapse from occurring.