Although many of my patients with hyperthyroidism take methimazole, or a different type of antithyroid medication (i.e. PTU, carbimazole), when I was dealing with Graves’ disease I chose not to take medication.  The truth is that in some cases it is a wise choice to take antithyroid medication, and the goal of this blog post is to discuss this.  I will discuss the benefits and risks of taking antithyroid medication, as well as the benefits and risks of natural antithyroid agents.  So the goal of this blog post isn’t to convince those with hyperthyroidism to take the same approach I did and avoid antithyroid medication.  In fact, while it’s great when people can manage their symptoms naturally, one reason why I decided to write this is because there are some people who probably should take the medication, but refuse to do so, and as a result are putting their health at risk.

If you’re interested in learning about the different types of antithyroid medications I’d recommend checking out an article I wrote in 2017 entitled “Comparing The Different Types of Antithyroid Medications”.  In the United States methimazole is usually prescribed by most endocrinologists.  If someone is unable to tolerate methimazole then Propylthiouracil (PTU) might be prescribed, although some people react to both types of antithyroid medication.  Another scenario when PTU is usually given is during the first trimester of pregnancy.

What Are The Benefits of Taking Antithyroid Medication?

So let’s go ahead and take a look at some of the benefits of antithyroid medication:

• Antithyroid medication is usually effective in helping to manage the symptoms of hyperthyroidism.  In most people with hyperthyroidism, antithyroid medication does a good job of lowering thyroid hormone levels, which in turn will help with the symptoms of hyperthyroidism, including an elevated heart rate, palpitations, tremors, weight loss, loose stools, etc.
• Taking antithyroid medication can prevent many people from receiving radioactive iodine or thyroid surgery.  As you know, most endocrinologists recommend either antithyroid medication, radioactive iodine, or surgery to their patients with Graves’ disease and toxic multinodular goiter.  While all three of these options aren’t ideal, antithyroid medication is the least invasive of these, and many people have preserved the health of their thyroid gland by temporarily taking antithyroid medication.  So while it’s not offering a permanent solution in most cases, at the very least it can buy you time while trying to address the cause of the problem.
• Some people who take antithyroid medication will go into remission.  I just mentioned how antithyroid medication doesn’t offer a permanent solution, yet there are some people who take it and go into remission.  The problem is that many of these people who go into remission eventually relapse, and when this happens the endocrinologist is even more likely to pressure the person to receive radioactive iodine or surgery.  I realize that many people don’t know about natural treatment methods pertaining to hyperthyroidism, and so they’re just following the advice of their doctor and not trying to address the cause of the problem while taking the medication.  Of course most people reading this know that they should also be doing things to improve their health, and not just do things to manage their symptoms.

What Are The Risks of Taking Antithyroid Medication?

Now that you know some of the benefits of taking antithyroid medication, let’s take a look at some of the risks:

• Antithyroid medication frequently causes side effects. This is one of the primary problems with antithyroid medication, as while over the years I’ve had many patients take it without experiencing symptoms, I also have had a lot of patients who did experience one or more symptoms.  Some of the more common symptoms associated with methimazole/Tapazole include stomach upset, nausea, vomiting, skin rash/itching, headaches, dizziness, muscle/joint/nerve pain, swelling, and hair loss (1).  The symptoms are similar with other types of antithyroid drugs, including PTU (2).
• Antithyroid medication can cause an elevation of liver enzymes.  Both methimazole and PTU commonly cause an elevation of liver enzymes, which is an indication of damage taking place to the liver (3).  The three main enzymes commonly affected include alanine transaminase (ALT), aspartate transaminase (AST), and alkaline phosphatase (ALP). For more information on these enzymes you can check out my article entitled “How To decrease Elevated Liver Enzymes in Hyperthyroidism and Graves’ Disease“.
• Antithyroid medication doesn’t address the autoimmune component of Graves’ disease.  While some people with Graves’ disease do seem to get into remission while on antithyroid medication, it’s not because antithyroid medication removes the autoimmune triggers and corrects the underlying imbalances.  In addition to lowering thyroid hormone levels, methimazole does have some immunosuppressive effects (4), and as a result, some people who take it might experience a lowering of thyroid stimulating immunoglobulins, which are the antibodies associated with Graves’ disease.  The problem is that because it’s not addressing the cause of the autoimmunity, over time the person is likely to experience an elevation of these antibodies again, along with hyperthyroidism.
• Antithyroid medication doesn’t address the underlying cause of other types of hyperthyroidism.  If someone has a non-autoimmune hyperthyroid condition such as toxic multinodular goiter, taking antithyroid medication on a temporary basis may help to manage the symptoms, but just as is the case with Graves’ disease, it of course isn’t doing anything to address the underlying cause of the condition.

What Are The Benefits of Taking Natural Antithyroid Agents?

What I’d like to do is take a look at some of the benefits of natural antithyroid agents.  Bugleweed is the most popular antithyroid agent, and this herb is the most effective in lowering thyroid hormone levels.  L-carnitine also has antithyroid properties when taken in higher doses (i.e. 2 to 4 grams).  Lithium also has antithyroid properties.

• Natural antithyroid agents can help to manage the symptoms of hyperthyroidism.  When natural antithyroid agents effectively lower thyroid hormone levels it’s wonderful, as I know that when I took bugleweed it felt good to avoid taking medication while I was addressing the cause of the problem.
• Natural antithyroid agents don’t cause the same side effects as antithyroid medication.  This perhaps is the most important benefit of taking natural antithyroid agents, as side effects aren’t nearly as common as they are with antithyroid drugs.  This doesn’t mean that people never experience side effects, as it’s possible to react to any herb, and bugleweed is no exception.  And there are some people who experience side effects with other natural antithyroid agents (i.e. lithium).  But it’s still a lot less frequent when compared to antithyroid medication.
• Natural antithyroid agents usually don’t cause elevated liver enzymes.  This is yet another important benefit of taking natural antithyroid agents, as rarely does someone need to stop taking them due to the stress they’re putting on the liver.
• Mentally it feels good to avoid antithyroid medication.  As I mentioned earlier, when I took bugleweed for my Graves’ disease condition it felt good to avoid taking medication.  This isn’t meant to make those who are currently taking medication to feel bad or discouraged, as everything comes down to risks vs. benefits, and if someone has to take methimazole but at the same time they’re able to address the root cause of their condition then they should still feel pretty good about themselves.

What Are The Risks of Taking Natural Antithyroid Agents?

So let’s take a look at the risks of taking natural antithyroid agents:

• Natural antithyroid agents aren’t as effective as antithyroid medication.  There is no question that antithyroid medication is more effective in lowering thyroid hormone levels when compared to natural antithyroid agents.  For example, bugleweed is probably the most effective natural antithyroid agent for hyperthyroidism, and I see it work approximately 70-75% of the time.  But of course this means that 25-30% of the time it isn’t effective in lowering thyroid hormone levels.  Antithyroid medication such as methimazole is more likely to work, but as you know, it’s also more likely to cause side effects.
• Natural antithyroid agents don’t address the autoimmune component of Graves’ disease.  While it’s great to use natural antithyroid agents to lower thyroid hormone levels, just remember that it’s not doing anything to improve the health of the immune system for those who have Graves’ disease.  So you still need to find and remove the autoimmune triggers, as well as correct other underlying imbalances.
• Natural antithyroid agents don’t address the underlying cause of other types of hyperthyroidism.  Just as is the case with Graves’ disease, taking natural antithyroid agents don’t address the underlying cause of other hyperthyroid conditions, such as toxic multinodular goiter.

Choosing Between Medication and Natural Antithyroid Agents

So should you take antithyroid medication, or should you choose to manage your symptoms naturally?  Sometimes it can be a challenge to decide whether you should take antithyroid medication such as methimazole, or an antithyroid herb such as bugleweed.  As you know, when I was diagnosed with Graves’ disease I decided to take bugleweed, and if it didn’t help to manage my symptoms I would have considered taking methimazole.  Similarly, if one of my patients consults with me and initially they’re not taking anything to manage their symptoms, taking bugleweed is an option to consider.  Of course there is a risk they will take it and it won’t help, which means they might go a few additional weeks with an elevated heart rate.  But there is also a chance they can take methimazole and experience negative symptoms and/or an elevated heart rate.

It’s also important to mention that some people feel more comfortable taking antithyroid medication, and that’s perfectly fine.  If someone is taking methimazole and is doing well with it and it’s not causing elevated liver enzymes or a low WBC count then there’s nothing wrong with them continuing to take it.  Sometimes a patient of mine is taking methimazole when first consulting with me, and they’re doing fine with it, but they prefer to take bugleweed.  When this is the case I can’t tell the person to stop taking the antithyroid medication, but what some people do is to take both the methimazole and bugleweed at the same time, and the goal of doing this is to try to wean off of the methimazole sooner (under the guidance of their medical doctor).

The Risks of Uncontrolled Hyperthyroidism

While I can understand someone wanting to do everything they can to avoid taking medication, you also need to consider the risks of uncontrolled hyperthyroidism. So if you happen to be dealing with hyperthyroidism and aren’t doing anything to lower the thyroid hormone levels, while you certainly can try taking a natural approach with an herb such as bugleweed, if this doesn’t work (and assuming the dosage was high enough), then you should consider taking the medication.

It’s also worth mentioning that some people refuse to take antithyroid medication but are fine with taking a beta blocker. This of course can help to lower the heart rate, which is very important, and some beta blockers also can affect the conversion of T4 to T3, which is also a good thing in someone who has hyperthyroidism. However, just keep in mind that elevated thyroid hormone levels also have a negative effect on bone density, and so if you’re taking a beta blocker and still have high thyroid hormone levels, you still should consider taking something with antithyroid properties. Once again, natural antithyroid agents are an option to consider, but if they aren’t effective, then you should consider taking the medication.

Whether you take methimazole, bugleweed, or something else, eventually the goal is to be off of all antithyroid agents.  I personally took bugleweed for approximately 9 months, and I haven’t been on it since 2009.  The duration of taking bugleweed of course depends on the person.  While I took it for 9 months, others need to take it for a shorter period of time, and there are some people who take it for a longer period of time.

What Have You Done To Manage Your Hyperthyroid Symptoms?

For those with hyperthyroidism, including Graves’ disease, toxic multinodular goiter, and other types of hyperthyroidism, I’d like to know what you have done to manage your hyperthyroidism symptoms.  Did you take antithyroid medication such as methimazole, PTU, or carbimazole?  Or did you take natural antithyroid agents such as bugleweed, L-carnitine, lithium, etc.?  Perhaps you didn’t take anything with antithyroid properties, but took something else such as a beta blocker or motherwort.  Either way I’d love to hear about your experience in the comments section below.  Thank you!

2020 is here, and many people are already doing things to improve their health.  Most of this is centered around diet and exercise, as many are striving to eat a healthy diet, and of course the fitness clubs are usually packed in January and February.  While eating well and exercising regularly are both important, it’s also a good idea to focus on reducing your toxic load.  The truth is that eating certain foods can support detoxification, and even exercise can play a role, but there are other things you can and should do, which I’ll discuss in this blog post.

How do environmental toxins relate to thyroid health?  There are a few different ways.  First of all, healthy thyroid hormone levels are important for detoxification.  In addition, and as I’ll mention later in this post, phase 2 detoxification is important in order to detoxify thyroid hormone from the body, along with other hormones.  In addition, most of the conversion of T4 to T3 takes place in the liver, and if the liver isn’t working efficiently due to an increased toxic load then this conversion can be negatively affected.  And finally, certain environmental toxins (i.e. mercury) can be a trigger for the autoimmune thyroid conditions Graves’ disease and Hashimoto’s.

When it comes to reducing your toxic load, there are 3 things you need to focus on:

1. Reduce your exposure to environmental toxins

2. Increase your elimination of environmental toxins

3. Support phase 1 and 2 detoxification

There is overlap between #2 and #3, and I must admit that supporting phase 1 and 2 detoxification can be complex, and my goal is to try to keep the information in this blog post easy to understand.  And so while I’ll talk about some of the basics of phase 1 and 2 detoxification, if you want to learn more about these in greater detail please check out part 1 and part 2 of my blog posts on “How To Optimize Detoxification”.  So let’s start off by discussing what you can do to reduce your exposure to environmental toxins.

How To Reduce Your Exposure To Environmental Toxins

It makes sense that in order to reduce your exposure to environmental toxins, you need to be aware of the different types of chemicals you’re exposed to on a frequent basis.  To make it simple, there is indoor air pollution and outdoor air pollution.  You of course have much more control over the environmental toxins you’re exposed to indoors, especially those inside your home, and so this will be your main focus, although I’ll also discuss some ways to minimize your exposure to outdoor air pollution (besides staying indoors!).

Different Sources of Indoor air Pollution:

• The food you eat.  Pesticides and herbicides are found in larger amounts in non-organic fruits and vegetables, hormones and antibiotics are commonly fed to livestock, eating too much fish can be toxic (especially larger fish such as tuna, king mackerel, and swordfish), and of course more and more foods are being genetically modified.  Glyphosate is another big problem, as this is the active ingredient in the herbicide Roundup, and many processed/refined foods have glyphosate.
• The water you drink.  Try your best to avoid drinking tap water, as well as water out of plastic bottles.  Also, remember that just because something is BPA-free doesn’t mean that it’s free of xenoestrogens.  So if you regularly drink water out of BPA-free plastic bottles you should still switch to glass or stainless steel.
• The indoor air you breathe.  Of course there are a lot of different factors that can affect the air quality, some of which I’ll be discussing below.
• The cleaners and cosmetics you use.  These are yet another common source of chemical exposure, as there are plenty of chemicals included in cleaners, soaps, shampoos, shaving cream, toothpaste, etc.  The good news is that there are natural options for just about all of the cleaners and cosmetics you use.
• Carpeting.  Carpets contain numerous environmental chemicals, including VOCs and formaldehyde.  Even in low concentrations these chemicals can have a negative impact on your health.
• Mold.  Genetics plays a role as to how people will react to mold, as some people have difficulty eliminating mycotoxins produced by mold, which in turn can cause numerous symptoms.
• Dry cleaning.  Tetrachloroethylene is one of the common chemicals used in the dry cleaning industry.  According to the Agency for Toxic Substances & Disease Registry, “Exposure to very high concentrations of tetrachloroethylene can cause dizziness headaches, sleepiness, incoordination, confusion, nausea, unconsciousness, and even death”(1).
• New furniture.  Polybrominated diphenyl ethers (PBDEs) also known as flame retardants, are commonly found in furniture such as couches and mattresses.  Studies show that flame retardants can cause hormone disruption, thyroid cancer, and neurological toxicity (2) (3) (4).

How To Reduce Your Exposure To Indoor Air Pollution

The obvious way to reduce your exposure to indoor air pollution is to address the sources listed above.  Eat organic food, drink purified water and/or a good quality spring water out of a glass bottle (i.e. Mountain Valley Springs), use natural cleaners and cosmetics, etc.  If you have carpeting then consider replacing it, although I realize this isn’t always an option.  If you bring home dry cleaning don’t immediately put it in your closet, as ideally you want to let it air out first.  You might also want to consider using an organic dry cleaners.  If mold is an issue then remediation might be necessary, or in some cases moving might be the best option.  If you have new furniture you probably won’t rush to replace it, but if you’re thinking about purchasing new furniture in the future then consider purchasing more natural furniture.  For example, if you’re looking for a new mattress, there are natural and organic mattresses to choose from.

If there is a lot of indoor air pollution that you can’t address, then look into getting an air purification system.  An example would be if you happen to be renting, and therefore replacing the carpeting isn’t an option.  Blueair and IQAir are examples of good quality HEPA air purification systems.  Also look into getting one or more house plants, as the research shows that they can remove indoor air pollutants (5). If mold is an issue then getting an air purification system and/or house plants isn’t going to help much, but these can be good options for other sources of indoor air pollution.  One more thing I should mention is to not wear your shoes inside your home, as this can make a big difference.  In fact, one study showed that when shoes were worn inside the homes, heptane, acetic acid, nonane and styrene concentrations were statistically higher than that when shoes were out of the homes (6).

Now let’s take a look at some of the different sources of outdoor air pollution:

Different Sources of Outdoor air Pollution:

• Transportation: cars, buses, trucks
• Fuel consumption in stationary sources
• Industrial processes
• Solid waste disposal
• Chemical dumps
• Aerial spraying of farms
• Forest fires

How To Reduce Your Exposure To Outdoor Air Pollution

While you obviously won’t be able to completely eliminate your exposure to these outdoor air pollutants, there are a few things you can do to reduce your exposure to them.  First of all, for those who walk, jog, or ride a bike on a busy road, consider doing this in a park or a greenway so that you aren’t constantly inhaling the fumes from the cars and trucks while exercising.  I realize this might be an inconvenience, but it’s your health we’re talking about.  Another thing you can consider doing in the future is to move to a different location.  For example, if your home is located near a busy road or highway, you need to consider the negative impact this will have on your health over the years.  Even if you spend most of your time indoors you’ll still be exposed to the fumes from the cars and trucks passing by, and if you have a porch or backyard and spend time there the chemicals will have an even greater impact on your health.

Landfills are another source of outdoor air pollution.  Landfills generate different kinds of toxic chemicals which include carbon monoxide, hydrogen sulfide, xylene, dioxin, and polycyclic aromatic hydrocarbons (7). And research shows that people living closer to landfills experience more medical conditions when compared to those living far away from landfill sites (8) (9).  So this is yet another example of how the location of your home can contribute to your increased toxic load.

Let’s Not Forget About Heavy Metals

In order to reduce your toxic load you also want to reduce your exposure to heavy metals, including mercury, aluminum, lead, arsenic, and cadmium.  Many people still have mercury amalgams, and thus should consider working with a biological dentist (you can visit the website IAOMT.org to find one), as they will take the proper precautions to remove them.  Fish and vaccines are other common sources of mercury.  Aluminum is another toxic metal that is commonly high, and many people are exposed to aluminum through cooking with aluminum pots and pans, consuming food and beverages from aluminum cans, cooking with aluminum foil on a frequent basis, and using deodorants that have aluminum.  Some sources of lead exposure include cigarette smoke, tattoos, lead-based paints, and ceramic glazes.  Arsenic exposure is also common, as it’s found in foods such as chicken (due to the feed) and brown rice, in the drinking water, and it’s also found in pesticides and herbicides.

How To Increase Your Elimination Of Environmental Toxins

While you want to do everything you can to reduce your exposure to environmental toxins, the truth is that you still will be exposed to chemicals inside and outside of your home.  So you also want to do things to increase your body’s elimination of environmental toxins, and here are four things you can do to help with this:

1. Support glutathione production through food and supplementation.  I’ll briefly mention glutathione when discussing phase 2 detoxification, as one of the pathways involves “glutathione conjugation”.

2. Stay well hydrated.  Drinking plenty of water can help with the excretion of toxins.

3. Incorporate infrared sauna therapy.  Although sweating in general or during exercise can help with the elimination of toxins, sauna therapy seems to be more effective.  Steam saunas and dry-heat saunas can also aid in the elimination of toxins, but apparently infrared saunas utilize a unique heating element that makes it more effective.  More healthcare practitioners recommend far-infrared sauna therapy to their patients, although there are some practitioners who claim that near-infrared has the greatest tissue penetration.  I personally have used a far-infrared unit for over four years and have been happy with it.

 4. Consider doing coffee enemas.  Unlike everything I’ve discussed so far to help with the elimination of environmental toxins from the body, I can’t say that I personally do coffee enemas.  And while some practitioners don’t advocate coffee enemas due to the lack of published research, this doesn’t mean that they can’t be of benefit.  For example, Gerson therapy is a well known natural treatment regimen for cancer, and they aggressively use coffee enemas to help restore the health of people.  It’s important to understand that coffee enemas are not primarily used to empty the bowels, as they supposedly help support liver detoxification by increasing glutathione production.

I’m sure some people reading this are wondering if colon hydrotherapy can effectively remove toxins, and the answer is “yes”.  However, just as is the case with coffee enemas, there is controversy over the use of colon hydrotherapy.  The late Dr. Walter Crinnion was an expert on detoxification, and he is the author of the book “Clean, Green, and Lean”.  He was also my instructor for a detoxification and biotransformation class I took while going through my masters in nutrition degree, and he told us that if there was only one method he can use to remove toxins it would be colon hydrotherapy.  However, some are concerned about whether colon hydrotherapy has a negative effect on the gut microbiome.

Should Binding and/or Chelating Agents Be Used?

While it’s important to support phase 1 and phase 2 detoxification, sometimes it can be beneficial to use certain binding and/or chelating agents. This especially can be beneficial for heavy metals. For example, if someone is trying to detoxify mercury (i.e. after getting their mercury amalgams removed), they might choose to eat cilantro and/or chlorella to bind to the mercury, and perhaps take NAC or alpha lipoic acid. There are also prescription chelating agents such as dimercaptosuccinic acid (DMSA) and dimercaptopropane 1-sulfonate (DMPS). Ethylenediaminetetraacetic acid (EDTA) is another prescription chelator that is more commonly used for lead and cadmium. These prescription chelating agents can be taken orally or administered intravenously.

Getting back to some of the natural agents, silica can help bind to aluminum. Modified Citrus Pectin can help with the excretion of cadmium and lead. Zeolite and bentonite clay can not only bind to heavy metals, but to mycotoxins as well. The same is true with activated charcoal.

I need to let you know that there are risks of taking some of these agents…especially prescription chelating agents. One concern is redistribution of the heavy metals in different areas of the body. For example, one case report involving a person who received intravenous EDTA showed that they exhibited increased tissue lead burden after treatment (10). This is why it’s important to have healthy glutathione levels when doing any type of chelation therapy.

Another concern is the loss of minerals. For example, one study showed that EDTA chelation not only causes the excretion of lead and cadmium, but zinc and calcium as well (11). While taking a multimineral supplement is a good idea when using such chelating agents, this is yet another reason why it’s wise to work with a healthcare practitioner.

Support Phase 1 and Phase 2 Detoxification

Phase one detoxification involves the liver transforming fat soluble compounds into reactive intermediates, and in phase two these reactive intermediates are turned into water soluble molecules that are excreted in the bile and feces.  Cytochrome P450 enzymes play an important role in the biotransformation process, and while genetics can affect these enzymes, certain nutrients, herbs, and drugs can speed up or slow down these enzymes.  I discuss the specific nutrients in the blog posts I wrote on ” How To Optimize Detoxification”.  Having healthy levels of antioxidants is important for phase one detoxification, and of course you want to do as much as you can through diet (i.e. fruits, vegetables, green tea, etc.), but sometimes supplementation is necessary.  In the ” How To Optimize Detoxification” blog posts I also talk about downregulating the phase one enzymes through nutrients and herbs such as resveratrol, polyphenols, pomegranate, and garlic.

As for phase two detoxification, there are six different pathways:

1. Glucuronidation.  This pathway actually plays a role in the detoxification of thyroid hormone, along with other hormones.  Triiodothyronine (T3) influences some of the enzymes involved in this pathway.  In addition to thyroid hormone being important for glucuronidation, some of the nutrients and herbs that support this pathway include omega-3 fatty acids, magnesium, quercitin, curcumin, milk thistle, and hawthorn.

2. Sulfation.  Vitamin B6 and molybdenum are important cofactors, and a deficiency in either one of these can lead to food or chemical sensitivities.

3. Methylation. I’ve written a separate article on this topic entitled “Methylation, MTHFR, and Thyroid Health“.  But I’ll say here that three important nutrients that support methylation include folate, vitamin B12, and vitamin B6.

4. Glutathione Conjugation.  I already discussed how to increase glutathione levels above.

5. Amino Acid Conjugation.  This pathway requires amino acids such as glycine, taurine, and glutamine.

6. Acetylation.  Nutrients which support this pathway include vitamin C, B1, B2, B5, magnesium, and lipoic acid.

Once again, if you want to learn more about phase one and phase two detoxification I’d check out the following blog posts:

How To Optimize Detoxification Part 1

How To Optimize Detoxification Part 2

What About Electronic Pollution?

Electronic pollution, including electromagnetic fields (EMFs) is without question a concern, and this deserves its own blog post.  Over the last couple of years I’ve learned a great deal about electronic pollution, and so while I have written about this on a very basic level in the past, I definitely feel the need to come out with an updated blog post on this, especially with the advent of 5G.

What Have You Done To Reduce Your Toxic Load?

I’m sure many people reading this have done things to reduce their toxic load, and so please feel free to share your experience in the comments section below.  What have you done to reduce your exposure to environmental toxins?  What have you done to increase your body’s elimination of environmental toxins?  Whether your experience was positive or negative I’d love to hear from you.

Some people with thyroid and autoimmune thyroid conditions experience joint and/or muscle pain, and the goal of this blog post is to discuss some of the most common causes, along with natural treatment suggestions.  I should mention that of the “7 causes” listed below, some of them can cause both joint and muscle pain, while others are more likely to cause either muscle or joint pain.  For example, certain infections can cause muscle and/or joint pain, whereas nutrient deficiencies are more likely to affect the muscles, but usually don’t result in joint pain.  In any case, whether you have joint pain, muscle pain, or both of these I do think it’s a good idea to read this entire blog post.

So let’s take a look at 7 common causes of joint and muscle pain:

1. Thyroid Hormone Imbalances.  Although I can’t say that most of my patients with hypothyroidism and Hashimoto’s experience joint and/or muscle pain, some people do.  And while low thyroid hormone isn’t always the primary cause of joint and/or muscle pain, it’s a factor that shouldn’t be ignored.  There is a condition called “hypothyroid myopathy”, but keep in mind that this is much more common in those people with “overt” hypothyroidism (thyroid hormone levels below the lab reference range).  Many people with Hashimoto’s have thyroid hormone levels that are less than optimal, but not low enough to result in muscle pain and weakness.

It’s also important to mention that people with hyperthyroidism are more likely to develop adhesive capsulitis, also known as “frozen shoulder” (1).  I actually wrote a separate blog post on this entitled “Is Hyperthyroidism Causing Your Frozen Shoulder?”  Another thing I should mention is that for those with hyperthyroidism who are taking antithyroid medication such as Methimazole, sometimes this can result in joint pain (2).

2. Arthritis.  This of course is a very common cause of joint pain.  Rheumatoid arthritis is an autoimmune condition, and as I’ve mentioned numerous times in the past, someone with Graves’ disease or Hashimoto’s thyroiditis is more likely to develop other autoimmune conditions.  One study showed that there is an increased risk of thyroid dysfunction among those with rheumatoid arthritis (3).  Another study looked at the prevalence and risk of other autoimmune conditions in those with Graves’ disease and Hashimoto’s, and found that rheumatoid arthritis was the most common coexisting autoimmune disorder (4).  It’s worth mentioning that infections can potentially cause rheumatoid arthritis, including Porphyromonas gingivalis, Proteus mirabilis, and Epstein–Barr virus (5).

The Relationship Between Arthritis and the Gut Microbiome

It’s also important to mention that a few studies show a correlation between a disrupted gut microbiome and both rheumatoid and osteoarthritis (6) (7) (8).  So while many people associate arthritis with “old age”, having a healthy gut microbiome can be one of the main factors preventing you from developing both rheumatoid arthritis and osteoarthritis.

There is also some research that shows a possible connection between environmental toxins and arthritis.  One study showed that the concentrations of heavy metals in serum samples of those with rheumatoid arthritis and healthy control individuals differed significantly, as it showed that heavy metals may contribute towards the development of rheumatoid arthritis (9).  Another study found a significant positive, linear association between the persistent environmental contaminant Perfluorooctanoate (PFOA) and reported diagnosis of osteoarthritis (10).  Yet another study showed an association between exposure to some pesticides (including glyphosate) and rheumatoid arthritis in male farmers (11).

3. Infections.  This is an overlooked cause of both muscle and joint pain.  Lyme disease is notorious for causing migrating muscle and joint pain, but other infections associated with bacteria can also cause joint pain, including Staphylococcus aureus, Streptococcus pneumonia, and Mycobacterium tuberculosis (12).  Viruses can also cause joint pain, including parvovirus, hepatitis B, hepatitis C, and Epstein-Barr (13).  The research shows that some people with “viral arthritis” will have positive rheumatoid factor and antinuclear antibodies, but mentions that viral arthritis is milder than osteoarthritis or rheumatoid arthritis (13).  There is also some evidence that certain parasites can cause reactive arthritis, including Blastocystis hominis (14) (15).

Earlier I mentioned that having a disrupted gut microbiome can be a factor in the development of both osteoarthritis and rheumatoid arthritis.  Well, a healthy gut is also necessary for a healthy immune system, which is necessary to keep infections in check.  This is one reason why you want to do everything you can to improve the health of your gut.

4. Trauma.  Of course trauma can cause muscle and/or joint pain, and while the connection is usually made between muscle and/or joint pain and major traumas (i.e. a car accident), sometimes minor traumas are overlooked as potential causes.

5. Nutrient Deficiencies/Exposure to food allergens.  Eating a healthy diet will reduce the chances of developing muscle and/or joint pain for multiple reasons.  First of all, certain nutrient deficiencies can make it more likely that you will experience muscle pain.  While muscle cramping is common with a magnesium deficiency, a severe deficiency in this mineral can sometimes lead to persistent and severe pain (16). Calcium and vitamin D deficiencies can cause abnormal muscular function, including pain and weakness (17).  Although a potassium deficiency can cause muscle cramps, while doing research for this blog post I came across a case study which showed that a patient developed painful muscle cramps due to overeating mangos, and the author suspected this might be due to an excess of potassium (18).  Of course it’s also possible that the person had a food allergy or sensitivity to mangos, which in turn resulted in muscle cramps.

I’ve had some patients whose joint and muscle pain resolved upon eliminating gluten and/or dairy from their diet.  And so if you have muscle and/or joint pain and nothing you’ve tried has worked to eliminate the pain, in addition to considering the other factors I discussed in this blog post, make sure that you follow an anti-inflammatory diet for at least 30 days to see if this helps.

6. Overtraining.  There are many negative consequences of overtraining, and muscle and joint pain is one of these.  While it’s not unusual to be sore a day or two after an intense workout, it’s not normal to have pain persist for a week or longer.  As I discussed in past blog posts, overtraining also puts a lot of stress on your adrenals and immune system.  So while I definitely encourage people to exercise, make sure you don’t overdo it.

8. Poor posture/sleep habits.  Since I’m a chiropractor I felt the need to mention this, as having poor posture and/or sleep habits can lead to muscle pain.  I actually experienced this recently, as this past summer I went on an 11-day road trip with my older daughter and I forgot to bring my own pillow.  The pillows I used during this trip were horrible, and by the time we arrived home my neck was in a great deal of pain.  I’m sure it didn’t help that we went on a lot of roller coasters on our trip, but I think the pillows were a greater culprit, and this is the case with a lot of people.  Similarly, some people have low back pain due to the mattress they’re sleeping on.

Unfortunately many people sit all day…even those who work from home, and this can put a lot of stress on your neck and back.  But what can you do if you have to spend a lot of time on your computer?  I’ll discuss some tips below.

Is There A Relationship Between Fibromyalgia and Thyroid Health?

I didn’t list fibromyalgia as one of the causes of muscle pain in those with thyroid conditions, but without question some people with thyroid and autoimmune thyroid conditions also have fibromyalgia…most commonly those with Hashimoto’s.  In fact, a 2017 journal article mentioned that the prevalence of fibromyalgia is approximately 2-7% in the general global population and is 30-40% in those who have Hashimoto thyroiditis (19)!  This topic deserves its own blog post, and perhaps I’ll expand on this in the future, but I did want to briefly mention it here since fibromyalgia is so common.

Natural Treatment Solutions For Joint and Muscle Pain        

Correct any thyroid hormone imbalances.  If low thyroid hormone levels are causing muscle and/or joint pain, many times correcting this imbalance will eliminate the person’s pain.  However, the same can’t be said for most people with hyperthyroidism who have a frozen shoulder.  In other words, lowering the thyroid hormone levels many times won’t resolve the person’s shoulder pain and lack of mobility.  Once again, for more information I would read the blog post I wrote on this.

Address arthritis.  So how do you address conditions such as rheumatoid arthritis and osteoarthritis?  Well, in severe cases the damage caused from arthritis might not be able to be completely reversed, but this doesn’t mean that nothing can be done for the autoimmune component. Just as is the case with Graves’ disease and Hashimoto’s, the goal is to do everything you can to improve the health of the immune system.  If you have any type of immune system condition you want to eat a healthy diet and do other things to improve your gut microbiome health, address any infections, reduce your exposure to environmental toxins, etc.

Eradicate infections.  The truth is that not all infections can be completely eradicated.  For example, Epstein-Barr can’t be eliminated from your body, but you can do things to get it back into a dormant state.  It’s a similar situation with chronic Lyme disease.  For more information on Epstein-Barr and Lyme disease I would check out some of the blog posts on my website.

Correct nutrient deficiencies.  While eating a healthy diet is important for maintaining healthy nutrient levels, doing this alone usually isn’t sufficient to correct nutrient deficiencies.  Supplementation is almost always required.  In addition, it’s important to correct the cause of the nutrient deficiencies.  Poor absorption due to numerous factors can result in nutrient deficiencies.  Certain medications, including birth control, can result in nutrient deficiencies.

Minimize exposure to common food allergens.  Eating any type of inflammatory food can potentially cause muscle and/or joint pain.  And even if gluten, dairy, or another food allergen isn’t responsible for your muscle or joint pain, these allergens can negatively affect your health in other ways (i.e. can cause gut inflammation).  And if this is the case it will be very challenging to achieve an optimal state of health.  So if you haven’t done so already you might as well clean up your diet and take a break from the common food allergens.

Reduce your toxic load.  I mentioned how antithyroid medication can sometimes cause joint pain, and I also discussed the relationship between certain environmental chemicals and arthritis.  As a result, you want to do everything you can to reduce your exposure to environmental toxins.  Also, if you began experiencing muscle or joint pain shortly after starting a medication, it’s possible that this is responsible for the pain.  This might seem obvious, but sometimes the person doesn’t make the connection, especially if they don’t experience muscle and/or joint pain until a few days or weeks after starting the medication.

Don’t overtrain.  While regular exercise is important, please don’t overdo it.  If you’re not sure if you’re overtraining then it probably is best to work with a certified personal trainer, even if it’s just for a single session.

Improve your posture and sleep habits.  If your job involves sitting for prolonged periods of time there are a few things you can do.  First of all, try to take frequent breaks.  Set an alarm on your phone or computer to remind you to get up and walk around, or at the very least stand up at your workstation and stretch.   Another option is to invest in a standing desk, or you can take it a step further and get a treadmill desk, which is what I have.  Proper ergonomics is important, as you want to make sure the top of your computer screen is at eye level, make sure you have a ergonomic-friendly chair, and adjust your keyboard to a height where your elbows are bent approximately 90 degrees.

What’s Your Experience With Muscle and Joint Pain?

Have you experienced muscle and joint pain due to any of the factors I discussed in this blog post?  If so, please feel free to share your experience in the comments section below.  If you’re still experiencing muscle and/or joint pain please let me know!  And if you have dealt with muscle and/or joint pain but it’s a thing of the past please let me know!  Thank you!

Everyone at Natural Endocrine Solutions would like to wish you and your family a Happy Thanksgiving.  We are so thankful for the opportunity to serve you.  Many of you know that in the summer of 2018 I was diagnosed with chronic Lyme disease.  Although my symptoms weren’t too severe, I did experience some neurological symptoms, and one of the things that entered my mind was how my state of health would be in 2019 and beyond.

I’m thrilled to report that I currently feel great, and I have been feeling pretty good for most of 2019.  Although my practice doesn’t focus on Lyme disease, over the years I have worked with thyroid and autoimmune thyroid patients with Lyme disease who had debilitating symptoms, and so I’m of course grateful that I feel as good as I do.  I know many people reading this have certain health challenges, whether it’s dealing with Graves’ disease, Hashimoto’s, a non-autoimmune thyroid condition, or another health issue.  But regardless of our state of health, we all have things we can be grateful for, and I’d love to hear what you’re thankful for in the comments section below.

Happy Thanksgiving!!!

Both people with hypothyroidism and hyperthyroidism can experience anxiety.  Although one would suspect that the imbalance in thyroid hormone levels is the main reason for anxiety in those with thyroid and autoimmune thyroid conditions, there can be many other causes, and some people have multiple factors causing or contributing to their anxiety.  In this blog post I’ll discuss 4 main factors that can lead to anxiety.

Before discussing these four factors, it’s important to understand that there can be overlap, and sometimes we don’t know specifically what’s responsible for the person’s anxiety.  You’ll understand what I mean when reading through the four factors.  Of course if someone recently was diagnosed with Graves’ disease and they experienced anxiety shortly thereafter, there probably is a good chance that the elevated thyroid hormone levels were responsible for the anxiety, although this isn’t always the case.

A few days ago I sent an email letting my email subscribers know about an upcoming “Anxiety Summit”.  And while there will be a few dozen presenters discussing different topics, most of these topics fall under these four categories I’m going to discuss in this blog post.  With that being said, let’s take a look at the four main factors that can cause anxiety:

1. Thyroid hormone imbalances.  Most people reading this know that I see a lot of people with thyroid and autoimmune thyroid conditions.  And while I do have some patients with hypothyroidism and Hashimoto’s who experience anxiety, it is far more common in my hyperthyroid patients.  As far as the research that looks at the relationship between anxiety and thyroid health, one study looked at the psychiatric manifestations of Graves’ disease, including anxiety, and while resolving the hyperthyroidism associated with this condition may help, the authors also mentioned that a substantial number of patients have an altered mental state even after successful treatment of hyperthyroidism, which suggests that there might be other factors involved (1).  Another study looked at the relationship between anxiety and thyroid function in patients with panic disorder, and found that those with more severe panic attacks had a higher TSH, and that the severity of anxiety correlated negatively with free T4 levels (2).  In other words, the lower the free T4 levels, the greater the person’s anxiety.  Yet another study looked at the prevalence of anxiety and depressive symptoms among patients with hypothyroidism (3), and showed that psychiatric comorbidities such as depressive disorder, anxiety disorder, and disturbances in memory and learning are common in patients with hypothyroidism (3).

2. Inflammation.  Proinflammatory cytokines are associated with autoimmune conditions, such as Graves’ disease and Hashimoto’s, but the research also shows that they are present in generalized anxiety disorder (4).  Some of the research questions whether the inflammation can actually cause anxiety, but research suggests that proinflammatory cytokines can cause anxiety by modulating the metabolism of neurotransmitters, including dopamine and serotonin (5).  Another study showed that inflammation can affect anxiety-related brain regions including the amygdala, insula and anterior cingulate cortex, which may result from cytokine effects on monoamines and glutamate (6).

The problem is that a lot of things can cause inflammation.  This includes eating inflammatory foods, chronic stress, infections, poor oral health, environmental toxins, nutrient deficiencies, etc.  While taking certain supplements might help if someone has one or more nutrient deficiencies (i.e. vitamin D3, omega-3 fatty acids), many times this isn’t sufficient.  As a result, some detective work is usually needed to find the source of the inflammation.

3. Gut Dysbiosis.  In 2009 a journal article was written on the gut-brain axis (7), and since then there has been other articles that have discussed the connection between the influence of the gut microbiota on the brain, and vice versa.  The microbiota and the brain communicate with each other via various routes including the immune system, tryptophan metabolism, the vagus nerve and the enteric nervous system, involving microbial metabolites such as short-chain fatty acids, branched chain amino acids, and peptidoglycans (8).  There are many factors that can affect the gut bacteria earlier in our lives, as well as in adulthood.  This includes but isn’t limited to the food we eat, stress, infections, gut disrupting medications (i.e. antibiotics, PPIs), and gut-disrupting chemicals (i.e. glyphosate).

Based on what I just said, it shouldn’t be surprising that certain infections such as parasites (9), along with having a Candida overgrowth (10) and small intestinal bacterial overgrowth (11) have been associated with anxiety and other mood disorders in the research.  While addressing these infections and/or overgrowth of yeast and bacteria can potentially resolve anxiety, it’s not always that simple.  For example, if someone has parasites and takes prescription drugs, this may get rid the parasites, but the antibiotics will also harm the good bacteria in the gut.  Also, while SIBO and a Candida overgrowth might cause anxiety, there is question whether this is related to inflammation and/or decreased nutrient absorption (10).

4. Nutrient deficiencies.  Certain nutrient deficiencies can cause anxiety.  Let’s take a look at some of them.

Thiamine. Thiamine (vitamin B1) has been used to treat patients with anxiety, with a dosage of 250 mg/day used (12).

Selenium.  Although I commonly recommend selenium to help support the immune system and increase glutathione production, a few intervention studies show that selenium can improve mood and diminishes anxiety (13) (14).

Magnesium.  Magnesium has many important roles in the body, and since it has a calming effect it shouldn’t be surprising that it also can play a role in helping some people with anxiety (15).

Vitamin D.  Research shows that a vitamin D deficiency can play a role in anxiety (16) (17) (18).  Keep in mind that vitamin D also has anti-inflammatory effects, and so this very well might be how it helps to reduce anxiety (by reducing inflammation).

Omega-3 fatty acids.  The research shows that omega-3 supplementation can lower anxiety (19) (20), although it might accomplish this by reducing inflammation.

Folate and SAMe.  Methylenetetrahydrofolate reductase (MTHFR) is a key enzyme involved in the metabolism of folate, as it converts 5,10-methylenetetrahydrofolate to 5-methyltetrahydrofolate.  Having polymorphisms (genetic variations) of MTHFR is common, and they can play a role in anxiety (21).  Both folate and SAMe play an important role in methylation, which in turn is important for the production of neurotransmitters.  As a result, in some people with an MTHFR polymorphism, supplementing with methylated folate and/or SAMe might help with anxiety, although it’s worth mentioning that sometimes this can also worsen a person’s anxiety.

Can Taking Herbs Help With Anxiety?

While addressing the factors discussed in this blog post should help with most cases of anxiety, some people choose to take herbs and other natural agents.  While it’s fine to take herbs on a temporary basis to help decrease anxiety, you also want to make sure to correct any underlying imbalances causing or contributing to the anxiety.  That being said, here are some of the herbs and other natural agents (other than those nutrients mentioned above) that can help to decrease anxiety:

Kava.  A few studies show that kava can help with generalized anxiety disorder (22) (23).

Ashwagandha.  Ashwagandha is an adaptogenic herb, and a few studies show that it can help to reduce stress and anxiety (24) (25).  Some reading this might be concerned that ashwagandha is a member of the nightshade family, and I discussed this in a past article entitled “Should Ashwaghanda Be Avoided in Those With Graves’ Disease and Hashimoto’s Thyroiditis?”.

Rhodiola.  Rhodiola rosea is another adaptogenic herb, and a few studies show evidence that rhodiola can help with anxiety symptoms (26) (27).

Gamma-aminobutyric acid (GABA).  GABA is the primary inhibitory neurotransmitter known to counterbalance the action of the excitatory neurotransmitter glutamate (28), and a few studies show that it can help with anxiety (28) (29).  It’s worth mentioning that phenibut is a form of GABA that has a phenyl group, which in turn allows it to easily pass through the blood-brain barrier (30).

Valerian root.  This herb is commonly used for the treatment of insomnia and anxiety, as it modulates the GABA-A receptors (31).

L-theanine.  One study suggests that chronic (8-week) L-theanine administration is safe and has multiple beneficial effects on depressive symptoms, anxiety, sleep disturbance and cognitive impairments in patients with major depressive disorder (32).  However, a more recent study did not support the efficacy of L-theanine in the treatment of anxiety symptoms in Generalized Anxiety Disorder (33).  I’ll add that I’ve had some patients experience a reduction of anxiety when taking L-theanine.

Lavender.  The two primary terpenoid constituents of lavender essential oil, linalool and linalyl acetate, may produce an anxiolytic effect in combination via inhibition of voltage-gated calcium channels, reduction of 5HT1A receptor activity, and increased parasympathetic tone (34).  A few studies show that Lavender oil can be an effective and well tolerated alternative to benzodiazepines for reducing generalized anxiety (34) (35).

What’s Your Experience With Anxiety?

For those reading this who have dealt with (or currently deal with) anxiety, I’d love to hear about your experience.  Do you know what caused your anxiety, and can you share what did you do to overcome it?  Perhaps you incorporated one or more of the factors I discussed in this blog post, or did you do something I didn’t mention?  If you’re currently experiencing anxiety what are you doing to help with it?  Thank you for sharing your experience with everyone!