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!

This time of year I get asked a lot of questions about the flu virus, also known as influenza.  Not surprisingly, many people ask about the flu vaccine, and I’ve written a past blog post on this topic where I have given my thoughts.  Another question I commonly get asked is what options are there other than the flu shot?  In other words, what can someone do naturally to prevent themselves from getting the flu, and what can be done from a natural standpoint if someone already has the flu?

Of course preventing yourself from getting the flu in the first place is preferred.  So let’s go ahead and first discuss some flu prevention strategies, and then I’ll discuss some natural flu remedies for those who currently have the flu.  Although this blog post was written specifically to help my patients with Graves’ disease and Hashimoto’s, anyone who is looking for flu prevention strategies and/or natural flu remedies can benefit from this information.

7 Flu Prevention Strategies

1. Reduce stress and increase sleep.  Chronic stress and sleep deprivation will both weaken your adrenals and immune system, thus making you more susceptible to getting the flu.  Chronic stress and lack of sleep frequently go hand in hand, as many people have difficulty falling and/or staying asleep due to chronic stress, while others will have sleep problems due to other reasons (i.e. blood sugar imbalances).  Either way, you want to make sure you’re getting at least 7 to 8 hours of quality sleep each night, and if this isn’t the case then you’ll want to do what’s necessary to get more sleep.  Sometimes it’s just a matter of changing your habits, but other times you’ll need to work with a healthcare practitioner to find out what imbalances you have that are causing and/or contributing to your sleep difficulties.

As for dealing with chronic stress, I’ve spoken about this in past blog posts, and so I won’t go into detail here.  But while it would be great if you were able to reduce the stressors in your life, for some people this isn’t an option.  An example of this is someone who is a caretaker for a family member.  And of course there are other examples where someone won’t be able to reduce their stressors, and when this is the case, you’ll want to do everything you can to improve your stress handling skills.  In fact, even if you ARE able to reduce your stressors, you still should do everything you can to become an expert in managing your stress.  This will greatly help to reduce your chances of getting the flu, as well as other infections.

2. Maintain optimal vitamin D levels.  This is yet another topic I’ve spoken about numerous times, and fortunately many people reading this are already aware of the importance of vitamin D with regards to immune system health.  Just remember that you don’t want to rely on the lab reference range, which is commonly 30 to 100 ng/mL, although it will vary depending on the lab.  You want your vitamin D levels to be at least 50 ng/mL, and some will suggest that it should be between 60 and 80 ng/mL.  Some healthcare practitioners even suggest it to be between 80 and 100 ng/mL.  My levels are usually in the upper 50s/lower 60s.

So how can you maintain healthy vitamin D levels?  Well, internal vitamin D synthesis occurs primarily through sunlight exposure, and so getting 15 minutes of sun exposure between the hours of 11am and 3pm at least two to three days per week might be sufficient to maintain healthy vitamin D levels in some people, although those with darker skin will require more time in the sun, while those with very fair skin might require less (1).  However, it’s important to keep in mind that certain factors can prevent someone from getting enough vitamin D from the sun, including air pollution and/or living in a northern latitude (2) (3).  Having a genetic polymorphism of the vitamin D receptor might also make it difficult for someone to get enough vitamin D from sun exposure alone.  So in some cases, supplementation with vitamin D3 is necessary to maintain healthy levels.

3. Don’t overtrain.  While it’s important to exercise regularly, you don’t want to overdo it, as this will also have a negative impact on your adrenals and immune system.  It’s a big challenge for some people to know how much exercise is “too much”.  If you’re ready to collapse right after a workout I think it’s safe to say that you’re overtraining.  However, if someone already has compromised adrenals, then even moderate aerobic exercise can cause problems.  For example, I’m a proponent of high intensity interval training, but I don’t think someone with compromised adrenals should be doing this type of exercise.  And the only way to know for certain if you have compromised adrenals is through testing.

4. Support your gut microbiome.  Most of your immune system cells are located within the gut, and so having a healthy gut is necessary in order to have a healthy immune system.   But how do you optimize the health of your gut microbiome?  I would definitely check out the blog post I wrote on the 5-R protocol, but I’ll give a brief summary here:

Remove: you want to remove any factor that is having a negative effect on the health of your gut microbiome.  This of course includes unhealthy foods, but you also want to address any gut infections, minimize exposure to gut-disrupting drugs and chemicals, etc.  We all know that antibiotics can disrupt the good bacteria in the gut, but so can other medications, including proton pump inhibitors (4).  As far as environmental toxins go, many reading this are familiar with the herbicide glyphosate, and this also can disrupt the gut microbiota (5).  This is yet another reason why you want to try eating as many organic foods as possible.  Also, keep in mind that just because something is non-GMO verified doesn’t mean it’s free of glyphosate.

Replace: Being deficient in digestive enzymes, hydrochloric acid, bile salts, and even dietary fiber can all have a negative effect on your gut microbiome.  Of course you want to try to do as much as you can through diet, especially when it comes to getting enough fiber, although supplementing with digestive enzymes, HCL, and/or bile salts might be necessary while you correct other imbalances.

Reinoculate: Eating prebiotic and probiotic foods can greatly benefit the gut microbiome.  When it comes to feeding the good bacteria in your gut, eating a wide variety of fiber-rich vegetables is important.  Although I try to practice what I preach by eating a wide variety of vegetables, I also take prebiotic and probiotic supplements.

Repair: While the gut can heal on its own when you remove the factors disrupting the intestinal barrier and causing gut inflammation, you can speed up the process by consuming gut-healing foods and supplements.  Many people drink bone broth for gut healing, but cabbage juice also can help heal the gut.  Supplements that can help with gut healing include L-glutamine, zinc, and vitamin A.

Rebalance: This component involves getting enough sleep, doing a good job of managing your stress, exercising regularly, etc.

5. Incorporate sauna therapy: First of all, sauna therapy will help to reduce your toxic load by sweating out chemicals, which in turn will improve your immune system health.  But in addition, heating up the body through sauna might also have anti-viral effects.  To be honest, while this makes sense, there isn’t much research in this area, although an older study demonstrated that regular sauna therapy reduced the incidence of common colds (6).  I personally do infrared sauna therapy twice per week, usually for 25 to 30 minutes.

6. Don’t overlook the impact of electronic pollution and mycotoxins.  Electromagnetic fields (EMFs) can disrupt the immune system (7) (8), and thus make you more susceptible to the flu and other infections.  While you probably won’t be able to eliminate your exposure to EMFs, you want to do everything you can to minimize your exposure.  Start with unplugging the wifi at night, and stop using electronic devices at least one hour before going to bed, and two hours would be even better.

Mycotoxins from mold can also suppress the immune system.  For those interested in learning more about the consequences of mycotoxins on human health I’d check out this journal article.  I’ve also written an article entitled “Mycotoxins, CIRS, and Thyroid Health“.  Exposure from mycotoxins usually comes from food and/or air.  As for food sources of mold, I discuss this in my article, as mycotoxins usually get into the food in the field, or during storage.  And water damage is the most common cause of the inhalation of mycotoxins in the air.

7. Supplementation.  Consider some of the following supplements to support your immune system.

• Vitamin D3.  Many people need to supplement with vitamin D3 in order to maintain optimal levels.  The dosage will vary depending on the person.  For example, I take 5,000 IU/day of vitamin D3 (along with vitamin K2), but I’m also guilty of not getting enough sun.  I test my 25-OH vitamin D levels at least once per year to make sure my levels don’t get too low or too high.
• Vitamin A.  This isn’t necessarily something you have to supplement with every day, and I know some people are concerned about vitamin A toxicity, and as a result, they will take beta carotene instead of active vitamin A.  The problem is that many people have problems converting beta carotene into active vitamin A.  I take 10,000 IU of active vitamin A two to three times per week.
• Zinc.  Consider taking 15 to 20 mg of zinc per day to help prevent getting a viral infection.
• Vitamin C.  If you deal with a lot of stress then it probably is a good idea to take vitamin C.  There are a few different options, as if you are trying to prevent yourself from getting a viral infection then you can take a food-based vitamin C supplement.  On the other hand, if you’re trying to be more aggressive (i.e. everyone in the household has the flu) and/or are already dealing with the flu, then taking 1,000 mg of liposomal vitamin C multiple times per day can help.
• Selenium.  Not everyone needs to take a separate selenium supplement (or a multivitamin with selenium), as some will get enough by eating foods high in selenium, such as Brazil nuts and sardines.  Of course the amount of selenium you’re getting from these and other food sources will vary depending on numerous factors, including the size of the Brazil nut, if it was grown in organic soil, etc.
• Probiotics.  While eating fermented foods is a good idea, I also think it’s wise to take a probiotic supplement consisting of a wide variety of strains and a potency of at least 30 billion CFU.  This will help to modulate the immune system.  One study showed that supplementing with probiotics significantly reduced the incidence of upper respiratory infections and flu-like symptoms when compared to the placebo group (9).  And while I can’t say that I’m a big fan of the flu vaccine (which is why I’ve written this post), a few studies have shown that taking probiotics can increase the effectiveness of the flu vaccine (10) (11).  So even if you choose to get the flu vaccine it can be beneficial to take a probiotic supplement.
• Monolaurin.  This also can help to modulate the immune response and interfere with viral replication.  There’s a product called Lauricidin that I like, and one scoop equals 3,000 mg of monolaurin.  Designs for Health also has a good quality monolaurin supplement that I’ve taken.
• Colloidal/bioactive silver.  In the past I only took silver when I started feeling a cold coming on, but since being diagnosed with chronic Lyme disease in 2018 I take it regularly..   One in vitro study looked at the inhibitory effects of silver nanoparticles on H1N1 influenza A virus (12), and the study demonstrated that silver nanoparticles have anti-H1N1 influenza A virus activities.  Another study showed that silver nanoparticles have beneficial effects in preventing H3N2 influenza virus infection both in vitro and in vivo, and can be used to inhibit outbreaks of influenza (13).

Natural Remedies For Those Who Currently Have The Flu

When discussing “natural flu remedies” there will be some overlap with the last “flu prevention strategy” I mentioned, as some of the same supplements that can help prevent the flu from developing can also help when someone already has the flu.  Once again, I wouldn’t suggest taking everything listed below.

• Liposomal vitamin C.  I discussed vitamin C earlier, as many people take vitamin C when they have a common cold or the flu.  I mentioned how taking 1,000 mg of liposomal vitamin C multiple times per day can be beneficial.
• Echinacea.  Echinacea is very well known for helping with the common cold and flu.  However, there is controversy over using echinacea in Th1-dominant autoimmune conditions, as some healthcare practitioners are concerned about echinacea stimulating the immune system, and thus, exacerbating the autoimmune response.  In 2014 I discussed this in a blog post entitled “Echinacea: Harmful for Hashimoto’s, Beneficial For Graves’ Disease?“
• Elderberry.  Sambucus nigra is a member of the Caprifoliaceae or honeysuckle family (14), and numerous studies have shown that the extracts of the berries (elderberry) are used primary as antiviral agents for colds, influenza, and Herpes virus infections  (15) (16) (17).  As for the dosage, one study involved adults taking four tablespoons (60 mL) per day, with children taking two tablespoons.
• Zinc.  If you already have the flu then consider taking 50mg of zinc for the duration of your illness.  While high doses of zinc can cause an imbalance in copper, taking 50mg/day of zinc for a few days, or even a week or two, shouldn’t cause a copper deficiency.
• High dose probiotics.  As I mentioned earlier, probiotics modulate the immune system, and while I mentioned how you might want to consider taking at least 30 billion CFU per day on a wellness basis, if dealing with the flu I would consider taking at least 100 billion CFU per day of probiotics.
• Colloidal/bioactive silver.  This is my family’s biggest “go to” when dealing with colds, and it can also help with the flu too.  Earlier I mentioned how I take silver regularly to support my immune system and keep my Lyme disease in check, and if dealing with the flu you should consider taking a teaspoon of silver every few hours for the duration of your illness.  One of the concerns people have is a condition called argyria, which is caused by the excessive consumption of silver. This shouldn’t be a problem if you take silver multiple times throughout the day for a week or two while dealing with the flu. Is it a concern for someone who takes silver daily on a wellness basis? I’m not concerned about developing argyria, especially after learning more about silver at a nutritional conference I attended in 2018. But if you’re thinking about taking silver on a regular basis it probably would be wise to first consult with a healthcare practitioner.
• High dose vitamin A.  When going through my masters in nutrition degree, one of my instructors was Dr. Alex Vasquez, who has a great deal of knowledge when it comes to viruses.  In fact, he has written an excellent book entitled “Antiviral Nutrition”, although I need to let you know that some of the information in the book is advanced.  Anyway, Dr. Vasquez commonly recommends 100,000 IU/day of active vitamin A for a period of 10 days.  I realize that this is an extremely high dosage, and many will be concerned about vitamin A toxicity.  I can’t say that I’ve taken this high of a dosage when dealing with the common cold, but I’ll add that I’ve heard a few other practitioners recommend very high doses of active vitamin A over a short period of time to modulate the immune system.
• Sauna.  As I mentioned earlier, sauna therapy not only can help with the removal of chemicals from the body by “sweating them out”, but it might also reduce the chances of developing a viral infection, including the flu.  As for whether sauna can help with your recovery if you already have the flu, I’m honestly not sure, but it’s something I’ve tried when dealing with the common cold, and I do think it was beneficial.

What’s Your Experience With The Flu?

Have you taken any natural remedies either for flu prevention, or to support your immune system while already dealing with the flu?  If so, please feel free to share your comments below, as not only would I love to see what you did, but sharing your experience may also benefit others looking to prevent the flu, or reduce the severity of their symptoms if their already dealing with the flu.  Thank you for sharing your experience with everyone!

For those with thyroid and autoimmune thyroid conditions, there is no diet that fits everyone perfectly.  But I do think it’s a good idea for most people to follow an elimination diet.  For those with Graves’ disease and Hashimoto’s thyroiditis, I frequently recommend an autoimmune Paleo diet initially, which also serves as an elimination diet, as it not only eliminates the most common allergens (i.e. gluten, dairy, corn, soy), but it also removes foods that can interfere with gut healing (i.e. nightshades).

Even though I have written articles and blog posts on eliminating and reintroducing foods, I still commonly get asked questions about this, and so I figured I’d put together a blog post that answers some of the most commonly asked questions.  If there are other questions you have about eliminating and/or reintroducing foods that haven’t been addressed in this blog post please feel free to ask them in the comments section below.

I need to mention that I have gained a lot of my knowledge in this area from Sarah Ballantyne, and so for even more information please visit her website (www.thepaleomom.com).  Another great resource is www.autoimmunewellness.com, as both Mickey Trescott and Angie Alt have used the AIP/elimination diet to help get their health back.  So in this blog post there will be times when I will include links to their respective resources to answer some of these questions.

What’s The Purpose of Following an Elimination Diet?

There are a few reasons why people follow an elimination/reintroduction diet.  First of all, you are trying to see if you’re reacting to certain foods that can be a trigger of your autoimmune condition.  In addition, you are avoiding certain foods which can have a negative effect on gut healing.  This is important because according to the triad of autoimmunity, an increase in intestinal permeability (a leaky gut) is a factor in all autoimmune conditions.

Why Should You Consider Following An Elimination Diet?

As I mentioned in the opening paragraph, an elimination diet will allow you to avoid common food allergens (i.e. gluten, dairy, corn, soy), which in turn can be inflammatory and prevent you from healing.  Similarly, you will avoid unhealthy foods such as refined sugars, fast food, and unhealthy oils for the same reason.  Some healthier foods are also eliminated (i.e. eggs, nightshades, nuts, seeds) because they can potentially interfere with gut healing.

What Foods Should You Eliminate?

If you want detailed information on the foods you can eat and which ones you should avoid, I would highly recommend checking out Sarah Ballantyne’s excellent book “The Paleo Approach”.  There is also some great information on her website, and if you sign up for the Autoimmune Wellness newsletter you’ll be sent some specific lists as well.

That being said, here are the categories of foods you will want to avoid during the elimination process:

• Beans and Legumes
• Grains (including gluten free grains)
• Dairy
• Eggs
• Nightshades
• Nuts and seeds
• Alcohol
• Certain spices

How Long Should You Eliminate These Foods For?

Ideally you want to eliminate these foods for a minimum of 30 days.  Sarah Ballantyne recommends eliminating these foods for 30-90 days.  While many people struggle to follow an elimination diet for 30 to 90 days, some feel so good that they choose to follow it for a longer period of time.

Are There Risks of Following An AIP/Elimination Diet?

When following an AIP/elimination diet you want to eat plenty of fiber-rich vegetables.  If you don’t eat a sufficient amount of these veggies on a daily basis this can have a negative effect on your gut microbiome, as the good bacteria in your gut need the fiber to flourish.  There is also a similar concern with following a ketogenic diet long-term.

When Should You Start Reintroducing Foods?

As I already mentioned, most people will follow the elimination diet for 30-90 days, and then you can start reintroducing foods.

How Do You Know If You Should Follow An Elimination Diet For 30, 60, or 90 Days?

Sometimes it can be challenging to know exactly how long to follow an elimination diet for.  As an example, if you follow the diet for 30 days and notice some positive changes in your health and if you’re not stressed out about following the diet, then it makes sense to go another month or two.  On the other hand, if after 30 days someone doesn’t notice any symptomatic improvement, does this mean they should stop?  Maybe, as while eliminating certain foods can do wonders for someone’s health, many people have other triggers and imbalances that need to be addressed before they start feeling better.  In addition, if someone is stressed out about following this diet then this also needs to be considered, as it’s not a good thing to be in a chronic state of stress over any diet.

What Symptoms Should You Look For When Reintroducing Foods?

Of course not everyone will experience symptoms when reintroducing foods.  For those who do experience symptoms, because everyone is different, the symptoms will also differ from person to person.  For example, someone might experience headaches when reintroducing a specific food, while someone else might experience digestive symptoms when reintroducing the same food.  Here is a list of symptoms that people commonly experience when reacting to a food they are reintroducing:

• Headaches
• Fatigue
• Bloating/gas
• Diarrhea
• Rashes
• Muscle/joint aches or pains
• Sugar cravings
• Caffeine cravings
• Nausea
• Depression

When Reintroducing A “Family of Foods” (i.e. nightshades, nuts) Do You Need To Reintroduce Them Individually?

You do want to reintroduce each food within a family individually.  For example, when reintroducing nightshades, you wouldn’t want to eat tomatoes, eggplant, peppers, and white potatoes all at once.  The reason for this is because you might do fine with one or two of these but react to the others, and if this is the case, you wouldn’t know which of these foods were responsible for the symptoms if you reintroduced them all at the same time.  For the same reason you would want to reintroduce each nut individually.

How Many Days Should You Wait Between Reintroducing Foods?

You want wait at least 3 to 5 days before reintroducing foods.  For example, if you reintroduced egg yolks on Monday, you wouldn’t want to reintroduce the next food until Thursday at the earliest.  In this example, if you experienced symptoms upon reintroducing egg yolks then you would want to wait for the symptoms to resolve before reintroducing the next food.

How Important Is It To Wait 3 to 5 Days Between Reintroductions?

It is very important to wait 3 to 5 days between reintroductions, and the reason for this is because it’s possible to have a delayed reaction to a food.  For example, if you reintroduced egg yolks on Monday and then reintroduced macadamia oil on Wednesday morning, and experienced a headache Wednesday afternoon, while it’s possible the macadamia oil was responsible for the headache, it’s also possible that the person had a delayed reaction to the egg yolks.

How Do You Know The Symptom Is Caused By The Food You Reintroduced?

In the example given above, how would you know that the headaches were caused by the food, and weren’t just coincidental?  The truth is that there is no way to know for certain, and if you experience a symptom that you’re uncertain is related to the food you reintroduce, then I would still recommend to stop eating that food, document the symptom you experienced, and then you can try to reintroduce the same food in the future and see if you experience the same symptom.

What Should You Do If You React To A Certain Food?

Of course you should avoid that food, but this doesn’t necessarily mean that you will need to permanently avoid that food.  If you are certain that you are reacting to a specific food it would be wise to avoid that food for at least 3 to 6 months before attempting to reintroduce it back into your diet.

How Much of The Food Should You Eat During the Reintroduction?

Sarah Ballantyne recommends to go very slowly with reintroducing foods, starting with half a teaspoon and seeing if there are any reactions after 15 minutes.  If not then you can eat a full teaspoon and wait another 15 minutes, and if there are still no reactions to eat 1 1/2 teaspoons, and if all goes well you can reintroduce the next food in 3 to 5 days.

What Order Should You Reintroduce Foods?

Ultimately this is up to you, but it makes sense to start with foods that are most nutrient dense first, and hold off on those that are most likely to result in inflammation.  Sarah Ballantyne divides the reintroduction into four stages, which you can read about in this article (you’ll need to scroll down to the middle):

When Reintroducing Alcohol, Does It Matter What Kind?

Red or white wine is a good place to start, and I would make sure not to reintroduce any grain-based alcohols (i.e. beer, ale), at least initially.  Besides wine, other alcoholic beverages that are not derived from grains include rum, tequila, brandy, sherry, and cognac.

When Can Foods That Aren’t Included In The Reintroduction Stages Be Reintroduced?

This ultimately is your decision, but many advocates of the AIP diet recommend to avoid certain foods on a permanent basis, including gluten, peanuts, etc.  This doesn’t mean that you can’t successfully eat these foods again, but some foods are riskier to reintroduce than others.

Can You Do Food Sensitivity Testing Instead of The Elimination/Reintroduction Diet?

While food sensitivity testing is an option to consider, I don’t recommend this initially for a few reasons.  First of all, false results are common.  Second of all, it’s expensive, especially when you use a good quality company such as Cyrex Labs.  Also, if you do food sensitivity testing, please keep in mind that you need to be eating the food you’re testing for.  As an example, if you have been 100% dairy free for 6 months and did a food sensitivity panel, even if you have a dairy sensitivity you should expect the dairy markers to be negative, and the reason for this is because by not consuming dairy your body won’t produce antibodies.  It’s similar with other food allergens.

When I mention how false results are common with food sensitivity testing, some will argue that the elimination diet also isn’t perfect.  Without question this is true, but it also doesn’t cost hundreds of dollars.  But once again, it’s not just the cost, as the truth is that if food sensitivity testing was even 95% accurate I probably would have most of my patients do it initially.

What’s Your Experience With Eliminating and Reintroducing Foods?

Have you gone on an elimination diet?  If so, please feel free to share your comments below.  How long did you follow the elimination diet for?  Did you have any problems when reintroducing foods?  Thank you for sharing your experience with everyone.

Most people with hypothyroidism have Hashimoto’s, which is an autoimmune condition where the immune system attacks and damages the thyroid gland.  But while Hashimoto’s is the number one cause of hypothyroidism, certain nutrients are important for the production of thyroid hormones.  As a result, having a moderate to severe deficiency in any of these nutrients can also lead to hypothyroidism.  In addition to discussing the nutrients which are important for thyroid hormone production in this blog post, I’m also going to discuss some nutrients which play a role in converting T4 into T3, as well as supporting the thyroid hormone receptor.

Nutrients That Support Thyroid Hormone Production

1. Iodine.  In the world of thyroid health there is a lot of controversy surrounding iodine.  While iodine can potentially trigger or exacerbate the autoimmune response in those people with Hashimoto’s thyroiditis, there is no question that iodine is important for thyroid hormone production.  As a result, a moderate to severe iodine deficiency can cause hypothyroidism.  Iodine specifically combines with tyrosine to form T4 and T3.  There are four iodine atoms in thyroxine (T4), and three iodine atoms in triiodothyronine (T3).

The question many people with hypothyroidism have is whether or not they should supplement with iodine.  Some healthcare practitioners advise everyone with hypothyroidism to avoid iodine supplementation, while others will encourage their patients to supplement with iodine.  In my opinion, any mineral deficiency should eventually be corrected, but there is no doubt that not everyone does well with iodine.  Before anyone supplements with iodine I would recommend conducting a urinary test for iodine, and even if you are deficient I would take at least a month or two to increase your antioxidant status.  It’s also wise to work with a competent natural healthcare practitioner before supplementing with iodine.

2. Iron.  Thyroid peroxidase is an enzyme that plays a role in the production of both T3 and T4.  Thyroid peroxidase converts iodide to iodine, and as I mentioned earlier, the iodine in turn combines with tyrosine, which forms T4 and T3.  As for why iron is important, the reason for this is because thyroid peroxidase requires iron to function properly.  Thus, an iron deficiency can have a negative effect on thyroid hormone metabolism by reducing the activity of this enzyme (1) (2).

I recommend an iron panel (ferritin, serum iron, iron saturation, TIBC) to just about all of my patients.  While iron supplementation might be required if someone is deficient in iron, this isn’t always the case.  It depends on the cause of the deficiency, as well as how severe the iron deficiency is.  Since vitamin C and stomach acid help with iron absorption, many times it makes sense to have the person supplement with vitamin C and do things to improve stomach acid production, such as consume apple cider vinegar, bitter herbs, and/or betaine HCL.

It’s also important to mention that you can’t rely on the lab reference ranges when determining if someone has an iron deficiency.  I’ve seen many cases where someone’s ferritin or iron saturation was borderline low, yet was ignored by the physician who ordered the test.  In my book “Hashimoto’s Triggers” I dedicate an entire chapter discussing both the lab reference range and optimal reference range of many different blood markers, including those in an iron panel.

3. Tyrosine.  You already know the importance of tyrosine in thyroid hormone production, and how it combines with iodine to form T4 and T3.  While one can choose to take a tyrosine supplement, I wouldn’t recommend doing this unless a tyrosine deficiency has been confirmed.  But of course it’s a good idea to make sure you’re getting sufficient tyrosine from your diet, and some food sources include chicken, turkey, fish, and eggs, although there are also vegetarian sources (i.e. avocados, spinach, and seaweed).

How can you test for a tyrosine deficiency?  Although I can’t say that I commonly recommend amino acid testing to my patients, there are specialty labs that offer amino acid panels.  These panels not only test for tyrosine, but for other amino acids as well.  Genova Diagnostics is one company that offers such testing.

I’d like to briefly summarize the importance of these three nutrients, as in the thyroid epithelial cell, iodide is converted to iodine, and this is catalyzed by the enzyme thyroid peroxidase, which as I mentioned earlier, is dependent on iron.  Iodine then combines with tyrosine to form T4 and T3.  So if there is a moderate to severe deficiency in any of these nutrients there is a good chance it will eventually impact thyroid hormone production.

The Role of Selenium in Thyroid Hormone Conversion

I’ve written past blog posts where I discussed factors that affect the conversion of T4 to T3.  But just to summarize, the thyroid gland manufacturers mostly thyroxine (T4), and this gets converted into triiodothyronine (T3), which is the active form of thyroid hormone.  Approximately 60% of this conversion takes place in the liver, while approximately 20% takes place in the gut.  As a result, having an unhealthy liver and/or gut can affect the conversion of T4 to T3.

The deiodinases are enzymes that activate or inactive thyroid hormone.  There are 3 main types of deiodinases, including deodinase type I, deodinase type II, and deodinase type III.  The type 1 and type II deiodinase enzymes are responsible for the conversion of T4 to T3.  On the other hand, the type III deiodinase enzyme is involved in the inactivation of T4 and T3.  A selenium deficiency can decrease the activity of type I and type II deiodinases, which can result in a decreased conversion of T4 into T3 (3) (4).

It’s also worth mentioning that a few studies have shown that selenium supplementation (200 mcg) can decrease thyroid peroxidase (TPO) antibodies (5) (6).  Selenium is a cofactor of glutathione peroxidase, which can decrease oxidative stress, and thus help with the autoimmune response.  So having healthy selenium levels can not only play a role in T4 to T3 conversion, but can also help minimize the damage done to the thyroid gland by the immune system for those who have Hashimoto’s.

Nutrients That Support the Thyroid Hormone Receptor

Whereas overt hypothyroidism is characterized by an elevated TSH and low thyroid hormone levels, thyroid hormone resistance is characterized by a normal or elevated TSH along with elevated free T3 and/or free T4 levels.  While there are a few different factors that can cause thyroid hormone resistance, certain nutrient deficiencies can play a role, specifically vitamin A and zinc:

1. Vitamin A.  The binding of T3 to the thyroid receptor is retinoic acid-dependent (7).  As a result, having a vitamin A deficiency can be a factor in thyroid hormone resistance.  Some people are understandably concerned about vitamin A toxicity, and thus, when supplementing they will choose to take beta carotene.  Just keep in mind that some people have problems converting beta carotene into active vitamin A (8).

2. Zinc.  Zinc appears to play a role in the health of the T3 receptor (9), and so it would make sense that a zinc deficiency can cause thyroid hormone resistance.

So hopefully you have a better understanding of the different nutrients required for thyroid hormone production, the conversion of T4 to T3, and for supporting the thyroid hormone receptors.  Being deficient in any of these can result in subclinical or overt hypothyroidism.  Please feel free to share your experience regarding these nutrients in the common section below.