Many people suffer from chronic constipation.  And while I have written articles and blog posts on this topic, in this blog post I’m going to focus on those people who had regular bowel movements prior to starting the autoimmune Paleo (AIP) diet, but then became constipated shortly after starting it.  After all, while there are many factors that can cause constipation, certain dietary changes can be a culprit.

Why do some people experience constipation when following an AIP diet?  Well, a big reason is because an AIP diet excludes many foods that are high in fiber.  This includes the following three categories of foods:

• Nuts and seeds
• Grains
• Legumes

The good news is that most people don’t need to eat these three categories of foods to have regular bowel movements.  The bad news is that many people don’t eat enough AIP-friendly foods that are high in fiber.  One of the main reasons for this is because most people with Graves’ disease and Hashimoto’s don’t know which foods they should eat.  For example, someone might eat a lot of green leafy vegetables in the form of salads and smoothies.  And while I definitely encourage my patients to eat green leafy vegetables, these are low in fiber when compared to other vegetables, which I’ll discuss shortly.

Is Low Fiber Really The Main Problem?

Some healthcare practitioners disagree that the decrease in dietary fiber is the main reason why many people experience constipation when following an AIP diet.  And while I’ll list some other common reasons for constipation below, if someone had regular bowel movements and then began to experience constipation soon after starting an AIP diet, there is a very good chance that the decrease in fiber was the culprit.  While it’s true that some people who experience constipation while following an AIP-diet don’t experience an increase in bowel movements when eating more fiber, it’s still something to consider.

I look at many food diaries of my patients, and the truth is that it’s common for people to not eat enough vegetables overall, let alone vegetables that are high in fiber.  Another common scenario involves someone who eats a few daily servings of AIP-friendly foods high in fiber (i.e. broccoli, sweet potatoes), but not enough.  Sure, everyone is different, and I’m not suggesting that everyone needs to eat a large amount of high fiber foods on a daily basis to avoid constipation, but as I’ve mentioned numerous times already, if constipation wasn’t a factor prior to starting the AIP diet then increasing your fiber needs to be strongly considered.

What AIP-Friendly Foods Are High In Fiber?

I listed some of the AIP-friendly foods high in fiber in a blog post I wrote entitled “What Thyroid Sufferers Need To Know About Fiber, Resistant Starch, and SCFA“, but I’ll list the foods again below:

• Apples
• Artichokes
• Avocados
• Blackberries
• Broccoli
• Coconut
• Brussels Sprouts
• Figs (dried)
• Pears
• Plantains
• Raspberries
• Sweet potatoes

The Role of Fiber In Bacterial Diversity

One of the ways in which fiber can help with constipation is by increasing the bulk of the stools.  However, fiber can also help with bacterial diversity, which in turn can help someone to have regular bowel movements.  In other words, the greater the variety of bacteria you have in your gut the better.  What’s important to understand is that different strains of bacteria prefer different types of fiber.  This is why it’s a good idea to eat a wide variety of fiber-rich foods, mostly in the form of vegetables.

So one problem with an AIP diet is that by decreasing fiber, it decreases bacterial diversity.  And there is evidence that this decrease in bacterial diversity can happen very quickly.  As a result, if you started to experience constipation a few days after starting the AIP diet then this very well could be a factor.

Other Causes of Constipation

While not eating enough fiber is a big factor for those who experience constipation upon following an AIP diet, here are a few other common causes of constipation you need to consider:

• Not drinking enough fluids.  This is a common problem, as while some people do a wonderful job of drinking plenty of water on a daily basis, many people don’t drink enough water.  Please make sure you drink at least half your weight in ounces of water every day.
• Decreased caffeine consumption.  In addition to giving up some foods that are high in fiber, most people who are following a strict AIP diet also avoid caffeine.  And the reason why this can lead to constipation is because caffeine can cause a bowel movement by increasing rectal tone (1).  Of course the goal should be to have regular bowel movements without relying on consuming caffeine.
• Inactivity.  If someone experienced constipation shortly after following an AIP diet then inactivity probably wasn’t the main factor.  But I still think it’s important to mention that not being active can cause or contribute to constipation.  Keep in mind that exercising a few days per week and being inactive the rest of the time isn’t sufficient, as regular movement is important.  I realize that this can be challenging for some people who work desk jobs, as in this scenario you should try to take frequent breaks, and when you’re not at work you should try to be active as much as you can.
• Hypothyroidism.  Once again, if someone experienced constipation shortly after starting an AIP diet then having low or depressed thyroid hormone levels probably isn’t the main reason.  But since a lot of people with hypothyroidism and Hashimoto’s thyroiditis read my blog posts I thought it was important to mention it here.

What About Other Causes of Constipation?

There definitely can be other causes of constipation, although keep in mind that we’re focusing on constipation that was caused by following an AIP diet.  For example, many people with small intestinal bacterial overgrowth (SIBO) experience constipation, but following an AIP diet isn’t going to cause SIBO, which is why I didn’t bring it up here.  Similarly, there are other causes of constipation that I won’t bring up in this post because it’s not related to following an AIP diet.

How To Overcome Constipation When Following An AIP Diet

1. Eat AIP-friendly foods high in fiber.  How much fiber should you consume each day to have regular bowel movements?  This depends on the person, although I would aim for at least 25 to 30 grams per day.  Just keep in mind that some people need less than this to have regular bowel movements, while others might need to consume more fiber, and so you need to listen to your body.

2. Do other things to increase your gut diversity.  Eating fiber-rich foods isn’t the only way to increase your gut diversity.  Eating fermented foods (i.e. sauerkraut, kimchi, pickles) and/or taking probiotic supplements can help.  And while plant-based foods act as probiotics, some people can benefit from taking a prebiotic supplement.  Every now and then someone will ask me about green food powders, and while I wouldn’t consider this to be an adequate substitute for eating vegetables, it’s fine to use certain green food powders as one source of prebiotics.  Of course you want to make sure to choose a good quality green food powder, and ideally one that uses organic vegetables.

3. Drink plenty of fluids.  As I mentioned earlier, being well-hydrated is important in order to avoid constipation.

4. Choose green tea over coffee.  I do recommend for some of my patients to avoid caffeinated green tea, especially those with adrenal imbalances.  However, if someone absolutely feels the need to drink a caffeinated beverage to help move their bowels then I would encourage you to drink a cup or two of green tea each morning.  While both coffee and green tea have numerous health benefits, green tea arguably has more health benefits than coffee, and without question has less caffeine.

5. Take a 15-minute walk after each meal.  I spoke about the importance of being active, and even if inactivity isn’t the main cause of your constipation, many people find that taking a 15 minute walk after meals can help them have a bowel movement.

Can You Eventually Reintroduce Nuts, Grains, and Legumes?

If you’re following a strict AIP diet, you might wonder if you will eventually be able to reintroduce some of the excluded foods.  While many foods are excluded on an AIP diet, I want to focus on nuts, grains, and legumes, as these are good sources of dietary fiber.  First of all, when a patient of mine is following an AIP diet, one of my goals is to have them transition to a “standard” Paleo diet.  Keep in mind that nuts are part of a “standard” Paleo diet, while grains and legumes aren’t.

That being said, some people are able to reintroduce grains and legumes without a problem.  In fact, while I’m not big into legumes, I can’t say that I’ve been grain free since being in remission from Graves’ disease.  Although I did avoid grains while getting into remission, I reintroduced grains after restoring my health and I do fine eating them occasionally.  As for whether or not you will be fine reintroducing these foods, there really is no way to know for certain.  This is part of the reintroduction phase, as while some people successfully reintroduce nuts, grains, and legumes after restoring your health, others aren’t able to reintroduce all of these.

Some healthcare practitioners advise anyone with an autoimmune condition to permanently give up grains.  The truth is that we don’t need to eat grains, and without question there are some people who do better when completely avoiding grains after getting into remission.  In fact, some people experience severe symptoms when eating grains.  So you need to listen to your body, and I’ll admit that you can’t always go by symptoms.  For example, some people will reintroduce grains and legumes before getting into remission, and while they might not experience any symptoms upon doing this, if their health isn’t improving then I would suggest to take a break from these foods and see if this is what’s affecting your progress.

In summary, some people develop constipation shortly after starting an AIP diet.  One of the main reasons for this is due to the decreased consumption of fiber-rich foods.  When this is the case then eating AIP-friendly foods that are high in fiber can help many people have regular bowel movements.  Fiber not only increases the bulk of the stools, but it also increases bacterial diversity, which can help with defecation.  Some other common causes of constipation include not staying hydrated, decreased caffeine consumption, and inactivity.  Addressing these areas while increasing your fiber intake can help many people overcome constipation.

Have you experienced constipation while following the AIP diet?  If so then please feel free to share your experience in the comments section below.

 

Every now and then someone will ask me if the chemicals from the pots and pans they use can have a negative effect on their thyroid and immune system health.  And so I figured I’d put together a blog post that discusses the different types of cookware.  I’ll start out by talking about the safe types of cookware, and then I’ll talk about the ones you should avoid.  I’ll also discuss the relationship between some of these chemicals and thyroid/immune system health.  As usual, I’d love to hear your comments below, and so please feel free to let me know your thoughts on this post, the type of cookware you use, etc.

Also, keep in mind that I’m not necessarily listing the cookware in any particular order.  For example, when discussing the safest cookware, I’m going to start off with stainless steel, simply because this is what I use.  I’ll add that I wouldn’t be using it if I didn’t think it was safe, and while many other healthcare practitioners use stainless steel pots and pans, some prefer other types of cookware, such as ceramic.

Which Cookware is The Safest?

STAINLESS STEEL

Pros of stainless steel cookware.  As I just mentioned, this is what I use, and have used stainless steel for many years.  Stainless steel is very popular, as it’s cost effective, durable and long lasting, easier to clean when compared to some other cookware choices (i.e. cast iron), you can put it in the dishwasher without a problem, and good quality stainless steel cookware doesn’t react with acidic foods.

Cons of stainless steel cookware.  There are a few potential concerns of stainless steel cookware.  One concern some people have is that many stainless steel pots include an aluminum core.  However, this is not the same as cooking in aluminum pots and pans, as in stainless steel cookware with an aluminum core, the aluminum is sandwiched  in between layers of stainless steel.  As far as I know there is no evidence of the aluminum leaching out.  Speaking of metals leaching out, some people are concerned about stainless steel leaching nickel, which can be a concern if someone has a nickel allergy.  One study I came across showed that stainless steel cookware can be an overlooked source of nickel (and chromium), where the contribution is dependent on stainless steel grade, cooking time, and cookware usage (1).

This is why you want to purchase good quality stainless steel cookware.  Regarding the grade of stainless steel, this relates to the quality, durability, and temperature resistance.  Grades are divided into 200 series, 300 series, and 400 series.  The 300 series represent a high quality grade.  You’ll also see numbers such as “18/8” and “18/10”, and this represents the percentage of chromium and nickel.  Many of the good quality stainless steel cookware has an 18/10 interior.

CERAMIC

Although we have a stainless steel cookware set, we also have a ceramic saucepan!  Truth to be told, while I’m happy with stainless steel, if I were looking to purchase new cookware I would strongly consider ceramic.

Pros of ceramic cookware.  Some consider ceramic to be the safest type of cookware, as you don’t have to worry about leaching.  It is also very easy to clean, and it doesn’t scratch.  In addition, ceramic cookware is safe to use in the oven, on the stove top, in the microwave, and in the dishwasher.

Cons of ceramic cookware.  One of the big downsides is that ceramic cookware is more fragile than stainless steel or cast iron.  That being said, the quality of ceramic is better these days than in the past.  Another downside of using ceramic is that it takes longer to heat up.

CAST IRON

Pros of cast iron cookware.  Cast iron is another good choice, although there are some healthcare professionals who would disagree.  There is no question that cast iron is durable.  Another benefit of cast iron is that it provides great conductivity.  I can’t say I have experience cooking with cast iron pots and pans, but from what I have read, as long as you season the cookware well the food is unlikely to stick.  Of course if anyone has any experience using cast iron cookware I’d love to hear from you in the comments below!

Cons of cast iron cookware.  Probably the main controversy with using cast iron is that the iron can leach into the food you’re cooking.  Some think getting iron in this manner can be a health benefit, and if someone has an iron deficiency it can be, although I think it’s safe to say that you should try to get your iron through food whenever possible.  That being said, the small amount of iron shouldn’t be a problem with most people, although it can be problematic if someone has an iron overload issue.  Cast iron cookware is also extremely heavy, and it can rust if not properly maintained.

GLASS

Pros of glass cookware.  Glass cookware doesn’t seem to be very popular, although glass is very safe for cooking, as you don’t have to worry about leaching anything into food.  You can put glass cookware in the microwave if you’d like.  Another advantage of glass cookware is that the food can be watched while covered.  We do have some glass pans that we use in our home.

Cons of glass cookware.  One disadvantage of glass cookware is that it is more fragile than stainless steel or cast iron.  The heat distribution also isn’t as good as with other types of cookware, and glass also can be more challenging to clean (I can tell you from personal experience!). 

Which Cookware Should You Avoid?

ALUMINUM COOKWARE

Aluminum pots and pans are very popular because they conduct heat well, and they are very cost effective.  Of course the big concern is aluminum leaching into the water or food when cooking.  Some will argue that the small amount of aluminum you get from cookware isn’t harmful, but since there is evidence of aluminum causing neurotoxicity (2) (3) it probably is best to do everything you can to reduce your exposure to this heavy metal.

Can Aluminum Affect Thyroid Health?

I couldn’t find any evidence that aluminum can directly affect thyroid health.  Interestingly, while doing research for this blog post I came across a journal article which showed that aluminum is in Synthroid, which many of my hypothyroid patients take, although apparently the maximum aluminum levels are well below the FDA-determined minimal risk level for chronic oral aluminum exposure (4).

Is there any evidence that aluminum can trigger an autoimmune condition such as Graves’ disease or Hashimoto’s?  This is controversial, as while there are no studies directly linking aluminum with thyroid autoimmunity, there is concern about aluminum adjuvants found in vaccines being a possible autoimmune trigger (5) (6).  Of course the focus of this blog post is on cookware, not vaccines, and while I would recommend to avoid using aluminum cookware, I don’t think using such cookware would cause a thyroid or autoimmune thyroid condition, although it might lead to other health conditions over a prolonged period of time.

NONSTICK COOKWARE

The main reason why many people use nonstick cookware is because it’s easier to clean.  But there is a big concern over the chemicals.  Teflon is the most well known, as it’s made with a chemical called polytetrafluoroethylene (PTFE).  This does a wonderful job of preventing food from sticking in pans when cooking, and the cookware is also easy to wash.  But even at normal cooking temperatures, PTFE-coated cookware releases various gases and chemicals that present mild to severe toxicity (7).

PFOA (Perfluorooctanoic Acid) is used in the synthesis of PTFE.  PFOA has been replaced with other chemicals such as GenX, but these alternatives are also suspected to have similar toxicity (7).  It’s the same old story, as one toxic chemical is replaced with another toxic chemical.  Bisphenol A (BPA) is a good example of this, as now you see BPA-free plastic bottles everywhere, but unfortunately these plastics have other equally toxic chemicals, which I discussed in a blog post entitled “Why BPA-Free Products Might Still Harm Your Thyroid Gland“.  So just because something is listed as “PTFE free” doesn’t mean it doesn’t have any harmful chemicals.

Can PTFE or PTOA Affect Thyroid Health?

A few journal articles show that perfluorooctanoic acid (PFOA) has thyroid and endocrine-disrupting properties (8) (9) (10).  The most recent article was a review that showed that an accumulation of PFOA was documented in thyroid cells, and a cytotoxic effect was observed after exposure to extremely high concentrations of these compounds (8).  While a single use of a teflon pot or pan probably doesn’t involve high concentrations of PFOA, I would be very cautious about using such cookware on a regular basis.

The Risks of Eating Out

While you can control what cookware you use while in your home, this of course isn’t the case when you eat out.  I’m not suggesting that you should never eat out, but while I’m sure many people reading this try to eat healthy even when eating out, many restaurants use aluminum pots and pans, and perhaps even nonstick cookware.  Once again, I realize that we live in a toxic world, and regardless of what you do you’ll be exposed to chemicals on a daily basis.  But this doesn’t mean that you should do everything you can to minimize your exposure to these chemicals.   Besides trying to eat at home as much as you can, if you have a favorite restaurant you go to on a regular basis you might want to find out what type of cookware they use.

What Cookware Do You Use?

Please let me know what cookware you use in the comments section below.  Most of my experience is with stainless steel cookware, and so I’d be especially interested in hearing your experience with other type of cookware.  Perhaps you have experience with a type of cookware I didn’t discuss in this blog post, such as stoneware?  Either way, please share your experience below.

Whether you have hyperthyroidism/Graves’ disease or hypothyroidism/Hashimoto’s thyroiditis, there is a good chance that you have been faced with the decision as to whether or not you should take thyroid medication.  And while many people with thyroid and autoimmune thyroid conditions have already made the decision to take or not to take thyroid hormone replacement (i.e. levothyroxine, Nature-Throid) or antithyroid medication (i.e. methimazole, carbimazole), I’m sure there are some reading this who haven’t yet made this decision, and aren’t sure what they should do.  There also are some people taking thyroid medication who are wondering if they are doing the right thing.

Since the medication someone takes will differ depending on whether they have a hyperthyroid or hypothyroid condition, what I’m going to do is separately talk about the risks and benefits of thyroid hormone replacement, and the risks and benefits of antithyroid medication.  As a result, if you have hyperthyroidism or Graves’ disease then of course you’ll want to focus on the section where I talk about antithyroid medication, and if you have hypothyroidism or Hashimoto’s you’ll want to focus on the section where I talk about thyroid hormone replacement.

Benefits of Taking Antithyroid Medication

The obvious benefit of taking antithyroid medication is that it can help to lower the thyroid hormone levels. This in turn can greatly help to reduce the hyperthyroid symptoms (i.e. high resting pulse rate, heart palpitations, weight loss, etc.).  High thyroid hormone levels can also have a negative effect on bone density, and so this is another benefit of taking antithyroid medication.

Risks of Taking Antithyroid Medication

There are a few different risks of taking antithyroid medication:

Risk #1: Side effects are common.  Although I’ve worked with a lot of people who did fine taking methimazole, common side effects include dizziness, headaches, hives, itching, nausea, rashes, and vomiting.

Risk #2: Elevated liver enzymes.  Everyone who takes antithyroid medication should have their liver enzymes monitored on a periodic basis.  Not too long ago I wrote an article entitled “How To Decrease Elevated Liver Enzymes In Hyperthyroidism and Graves’ Disease“, and so you might want to check this out if you haven’t done so already.

Risk #3: Agranulocytosis.  This refers to an extreme reduction in the production of white blood cells.  Although not everyone with agranulocytosis experiences symptoms, some will experience a high fever and a sore throat.

Risk #4: Temporary hypothyroidism.  This is especially common in those taking large doses of antithyroid medication, although I’ve also had a few patients become hypothyroid with lower doses.  This can lead to symptoms such as increase in fatigue, brain fog, and weight gain.  The good news is that this is usually temporary, as once the dosage of antithyroid medication has been decreased the hypothyroidism resolves.

Risk #5: Not doing anything to address the cause of the problem.  This should be obvious, but it’s common for endocrinologists to tell their hyperthyroid patients that they might get into remission when taking antithyroid medication.  While taking the medication can help to normalize the thyroid hormone levels, because it doesn’t address the underlying cause of the problem the person is likely to relapse in the future.

Should You Take Antithyroid Medication?

As for whether or not you should take antithyroid medication, of course this is ultimately your decision.  Although I personally didn’t take antithyroid medication when I was dealing with Graves’ disease, this doesn’t mean that this is the right decision for everyone else with hyperthyroidism.  Even if your goal is to address the underlying cause of your condition, while doing this you want to be safe.  In other words, uncontrolled hyperthyroidism shouldn’t be taken lightly.

If you’re already taking antithyroid medication and are doing well on it then it might be a good idea to stay on it, as not everyone can have their symptoms effectively managed by herbs such as bugleweed.  On the other hand, if you’re not currently taking anything to lower your thyroid hormone levels and prefer not to take medication you can start with bugleweed and see if this helps.  I’ll add that I’ve worked with patients who were taking antithyroid medication but wanted to switch to bugleweed, and what I usually recommend in this situation is to take both at the same time (i.e. methimazole along with bugleweed), and then work with your endocrinologist to gradually decrease the dosage of the antithyroid medication as your thyroid panel results improve.

Benefits of Taking Thyroid Hormone Replacement

One of the main reasons people take thyroid hormone replacement is to help with the hypothyroid symptoms.  And in many cases thyroid hormone replacement can do a good job of helping people who experience fatigue, brain fog, weight gain, and other symptoms related to hypothyroidism.  However, besides helping with symptoms, you need to understand how important thyroid hormone is to our health.  There are thyroid hormone receptors everywhere in our body, and the reason for this is because thyroid hormone acts on most cells.

Here are some of the functions of thyroid hormone:

• Increases the metabolic rate
• Affects gene expression
• Plays a role in protein, fat, and carbohydrate metabolism
• Required for skeletal development and establishment of peak bone mass
• Important for reproduction
• Plays a role in peripheral nerve regeneration
• Wound healing

Risks of Taking Thyroid Hormone Replacement

I can’t say that serious risks are common when taking thyroid hormone replacement, especially when compared with other prescription medications.  This doesn’t mean that there are no concerns.  First of all, not everyone does well on thyroid hormone replacement.  There can be a few reasons for this.  One reason is that someone might react to one of the fillers or inactive ingredients.  In this case the person can switch to a hypoallergenic brand of thyroid hormone, such as Tirosint if they’re taking synthetic thyroid hormone, or WP Thyroid if they’re taking desiccated thyroid hormone.  Another option is to get a prescription through a compounding pharmacy.

Many people have a problem converting T4 to T3.  I discussed this in greater detail in a blog post entitled “6 Factors Which Can Affect The Conversion of T4 to T3”.  On a blood test this will present as normal T4 levels and low or depressed T3 levels.  If someone is taking synthetic thyroid hormone they might benefit from taking synthetic T3 (i.e. Cytomel), or switching to desiccated thyroid hormone.  Of course the goal should be to address the conversion problem, but this usually will take time to accomplish.

Another risk of taking thyroid hormone replacement is that too high of a dosage can make someone hyperthyroid.  Fortunately this usually is temporary, as frequently the patient will alert the prescribing doctor that they are experiencing anxiety, an increased resting heart rate, palpitations, etc.  If not then this probably will be detected on a future thyroid panel.

Of course one of the main problems with thyroid hormone replacement is that it’s not doing anything to address the cause of the condition.  For example, most people with hypothyroidism have Hashimoto’s thyroiditis, which is an autoimmune condition.   While taking thyroid hormone might be necessary for many people with Hashimoto’s, this isn’t doing anything for the cause of the problem.  And unfortunately most medical doctors don’t do anything to address the underlying cause, as they simply recommend thyroid hormone replacement while ignoring the autoimmune component.

Should You Take Thyroid Hormone Replacement?

Some people understandably don’t want to take thyroid hormone replacement because it isn’t doing anything for the cause of the problem.  Others are concerned that they will become dependent on it.  But if your thyroid hormone levels are very low then it usually is a good idea to take thyroid hormone replacement due to the importance of thyroid hormone that I discussed earlier.  While most people who have depressed  thyroid hormone levels experience hypothyroid symptoms, occasionally I’ll work with a patient with overt hypothyroidism (depressed thyroid hormone levels) who feels fine.  Even when this is the case it’s wise to take thyroid hormone replacement in those who have depressed thyroid hormone levels.  Of course while doing this you also want to work on addressing the underlying cause of the problem.

What should you do if you have thyroid hormone levels that are within the lab reference range, but are less than optimal?  In this situation it can be more challenging.  Many medical doctors pay more attention to the thyroid stimulating hormone (TSH).  Thus, they will recommend thyroid hormone replacement if the TSH is elevated, regardless of what the thyroid hormone levels look like.  And while elevated TSH levels are frequently a good indication of hypothyroidism, there can be other reasons for an elevated TSH, such as a pituitary adenoma and dysregulation of the hypothalamic-pituitary-thyroid (HPT) axis.

The truth is that there is no solution that fits everyone perfectly.  When someone has an elevated TSH and thyroid hormone levels that are within the lab reference range, this is referred to as subclinical hypothyroidism.  If someone with subclinical hypothyroidism is experiencing hypothyroid symptoms then in some cases it might be a good idea to put them on thyroid hormone replacement while trying to address the cause of the problem.  Another situation where taking thyroid hormone replacement is warranted in someone with subclinical hypothyroidism is pregnancy.

However, what approach should be taken if someone has subclinical hypothyroidism, is asymptomatic, and isn’t pregnant?  Once again, there isn’t an answer that fits everyone perfectly, and different natural healthcare practitioners will have different opinions.  While it can be argued that some people who have subclinical hypothyroidism don’t need to be on thyroid hormone replacement, we also need to remember the importance of thyroid hormone.  So for example, if someone has a TSH of 4.86 μIU/mL, a free T4 of 0.94 ng/dL, and a free T3 of 2.6 pg/mL, some natural healthcare practitioners would recommend for the patient to take thyroid hormone replacement, even if they are feeling fine from a symptomatic standpoint.  And the reason for this is because the free T3 is less than optimal.

What’s The Deal With Low Dose Naltrexone?

I’ve spoken about low dose naltrexone (LDN) in previous articles and blog posts.  This is a medication that can modulate the immune system, and in some cases it works so well that people with Graves’disease and Hashimoto’s don’t need to take medication.  Just keep in mind that this is a best case scenario, and the downside is that LDN isn’t always effective.  But the reason I brought it up here is because in some cases LDN can be an alternative to thyroid medication, although some people with Graves’ disease and Hashimoto’s take LDN in combination with thyroid medication.

For those with Hashimoto’s thyroiditis, LDN can potentially slow down the damage taking place to the thyroid gland, which is something that thyroid hormone replacement doesn’t do.  And in those with Graves’ disease, LDN can prevent the immune system from attacking the TSH receptors, and it doesn’t cause the side effects commonly associated with antithyroid medication.  I know for some people reading this it might sound too good to be true, but while many people with autoimmune thyroid conditions (and other autoimmune conditions) have benefited from LDN, as I mentioned earlier, LDN isn’t always effective, which is one reason why it’s not commonly recommended instead of thyroid medication.

Another thing to keep in mind is that if someone with Hashimoto’s has overt hypothyroidism, LDN may help to stop or slow down the damage the immune system is causing to the thyroid gland, but if the thyroid hormone levels are depressed then the person probably still needs to take thyroid hormone replacement.  On the other hand, if someone with Graves’ disease who is on antithyroid medication takes LDN and it works, they very well might be able to stop taking antithyroid medication, or at the very least decrease the dosage.

It’s important to understand that someone who is taking either thyroid hormone replacement or antithyroid medication and then starts taking LDN will need to monitor their thyroid hormone levels on a frequent basis.  The reason for this is because by modulating the immune system, some people with hypothyroidism and hyperthyroidism will experience an improvement in their thyroid hormone levels.  While this is a good thing, if they are also taking thyroid hormone replacement or antithyroid medication then this can make someone with hypothyroidism become “hyper”, and someone with hyperthyroidism become “hypo”.

So hopefully you have a better understanding of the benefits and risks of thyroid medication.  Regarding hyperthyroidism and Graves’ disease, antithyroid medication can do a great job of lowering the thyroid hormone levels, which in turn usually helps to reduce the symptoms associated with hyperthyroidism.  Some of the risks of taking antithyroid medication include elevated liver enzymes, agranulocytosis, temporary hypothyroidism, and not doing anything to address the underlying cause.  Regarding hypothyroidism and Hashimoto’s, thyroid hormone replacement not only can help with the hypothyroid symptoms many people experience, but thyroid hormone also has many important roles in the body.  The “risks” of thyroid hormone replacement is that some people don’t do well when taking it, it doesn’t address a T4 to T3 conversion problem, and just as is the case with antithyroid medication, thyroid hormone replacement doesn’t address the cause of the condition.

Please feel free to share your experience with thyroid medication in the comments section below.

In the last blog post I spoke about shingles and the varicella-zoster virus.  In this blog post I’m going to talk about a different type of infection, and while you might not think Lyme disease is factor in your health, the truth is that many people have Lyme disease and don’t know it.  According to the CDC, approximately 30,000 cases of Lyme disease are REPORTED by state health departments (1).  However, the CDC suggests that the actual number of people DIAGNOSED with Lyme disease in the United States alone is around 300,000.  And there are many more people who have Lyme disease but have not been diagnosed.

Once again, many people with thyroid and autoimmune thyroid conditions won’t think this article is relevant to them because they’re confident they don’t have Lyme disease.  But this blog post may be one of the most important ones you have ever read for the following three reasons:

Reason #1: The bacteria associated with Lyme disease (Borrelia Burgdorferi) can lie dormant.  While many people feel symptomatic immediately after being bitten by a tick that has Borrelia Burgdorferi and other coinfections, some people don’t experience symptoms until months or years later.  In other words, Borrelia Burgdorferi can lie dormant in your body, which means that some people have chronic Lyme disease and don’t know it.

Reason #2: You might experience a tick bite in the future.  Assuming you don’t currently have Lyme disease, there is always a risk of getting it in the future.  And as I’ll discuss below, it doesn’t matter where you live or how cautious you are.  Sure, some areas are safer than others, and if you are taking certain precautions then without question this will greatly reduce the chances of you getting Lyme disease and/or its associated coinfections.  So my goal isn’t to make you feel paranoid about getting Lyme disease, as I just want to increase your awareness.

Reason #3: You might have a family member or friend who gets Lyme disease.  Remember that approximately 300,000 new cases of Lyme disease are diagnosed in the United States alone.  And arguably there are hundreds of thousands more that aren’t diagnosed.  So in your lifetime there is a strong likelihood you’ll know someone with Lyme disease, and while you might think there is nothing you can do to help them, encouraging them to read this blog post might be a game changer.

Why A Negative ELISA or Western Blot Test Doesn’t Always Rule Out Lyme Disease

If you suspected Lyme disease and did some testing which came back negative, keep in mind that false negatives are very common for the following reasons:

• It takes time for antibodies to form.  If acute Lyme disease is suspected you need to keep in mind that after someone gets bit by a tick and contracts Borrelia Burgdorferi (and other coinfections), it takes 4 to 6 weeks for antibodies to show up on one of these panels.  So for example, if someone gets bit by a tick and gets tested within the first 3 weeks, we would expect these test results to come back negative, even if the person has Lyme disease.  The earliest we’ll usually see these tests come out positive is 4 weeks after being bit by a tick.
• Depressed immunoglobulins.  Immunoglobulins are also known as antibodies.  If someone has a compromised immune system this can lead to one or more depressed immunoglobulins, which once again, can lead to a false negative result.  Fortunately you can test the immunoglobulins separately through the blood.  The ones you want to focus on are immunoglobulin G (IgG) and immunoglobulin M (IgM).  If one or both of these are depressed it can cause false negative results on the ELISA or Western Blot.  This is one reason why some people with chronic Lyme disease will test negative.
• Taking antibiotics and/or natural antimicrobials can cause a false negative.  If you have acute Lyme disease then taking antibiotics or natural antimicrobials can potentially eradicate Lyme disease and its coinfections, and of course this can result in a “true” negative result, which would be great news.  However, taking these agents can also cause a false negative result, which isn’t a good thing.
• There are multiple strains of Borrelia Burgdorferi.  Conventional panels only test for a single strain of Borrelia Burgdorferi, and so if you don’t have this strain then your Western Blot test will come back negative.  So just to clarify, you can have Lyme disease but test negative because the panel isn’t testing for the specific strain of Borrelia Burgdorferi that you have.

What To Do If You Have a Negative Test

So what approach should you take if you suspect that you have Lyme disease, but both the ELISA and Western Blot have come out negative?  Well, it depends on the situation.  If you know you have been bitten by a tick recently and it’s been less than six weeks, then you now understand that false negatives are not only common, but are likely.  Regardless of whether the testing is positive or negative, if you know for certain you were bitten by a tick and/or have the classic bull’s-eye rash, then it would be a good idea to seek treatment, which I’ll discuss later in this post.

But how about if you are having symptoms that might suggest Lyme disease, but if there is no history of a tick bite and no bull’s-eye rash?  Since many people with Lyme disease don’t recall getting bitten by a tick, and at least half don’t have the classic bull’s-eye rash, it can be a tough decision knowing whether or not you should receive treatment.  I do know that the sooner you treat Lyme disease the better, and so if you think there is a good chance you have Lyme disease but aren’t 100% certain, in some cases it might be a good idea to receive treatment.

So for example, let’s say you are experiencing symptoms suggestive of Lyme disease but the testing comes out negative, you don’t have a bull’s-eye rash, and there is no evidence of a tick bite.  If you’re experiencing a lot of neurological symptoms you might see a medical doctor who decides that the best approach is to see a neurologist, who in turn might run a bunch of tests (MRIs, nerve conduction studies, etc.).  The problem with this approach is if you have Lyme disease then it probably will take a few weeks before you will see a specialist and have these tests done.  This delay might not be an issue if you have chronic Lyme disease, but if you have acute Lyme disease this needs to be treated as soon as possible.  It admittedly is a tough decision, as you don’t want to take antibiotics if you don’t have Lyme disease, but if you have acute Lyme disease you don’t want to go too long without treating it.

Lyme Disease vs. Multiple Sclerosis

Lyme disease is known as the “great imitator”, as it can mimic a lot of different health conditions.  One of these is the autoimmune condition multiple sclerosis, and so let’s revisit the above situation where someone is having neurological symptoms and thinks it might be Lyme disease, but there also is a chance it can be something else, such as multiple sclerosis.  In fact, a few studies have shown that Lyme neuroborreliosis can resemble multiple sclerosis (2) (3).  And there is also the possibility that someone can have both Lyme disease and multiple sclerosis.

This is where seeing a competent healthcare practitioner becomes very important, but the truth is that sometimes it is very hard for even good doctors to diagnose someone with Lyme disease since the conventional tests are far from perfect, and you can’t always know by the symptoms.  So at times it becomes a judgment call, and in this situation it’s arguably better to work with a doctor who is good at differential diagnosis rather than a doctor who relies on testing.  Don’t get me wrong, as I think testing is important, and I definitely recommend tests to my patients.  But when it comes to Lyme disease, too many doctors rely too much on testing, which as you now know, is far from perfect.

Other Testing Options For Lyme Disease

If both the ELISA and Western Blot come back negative there are other tests you can consider getting.  One of the most well known labs used by Lyme disease specialists is IGeneX.  One of the advantages of using IGeneX is that it tests for multiple strains of Borrelia burgdorferi.  It’s a very expensive test, and so it makes sense to first do the ELISA and Western Blot and see if either of these comes out positive.  If not then you might consider looking into a lab such as IGeneX.

Lyme Disease Is EVERYWHERE

You might think that you can’t possibly get Lyme disease because you live in an area where Lyme disease isn’t common.  While some areas are riskier than others, the truth is that there is a risk of getting Lyme disease no matter where you live.  And this isn’t just my opinion, as the research shows that Lyme disease is becoming more and more common in locations that in the past weren’t associated with this condition.

Plus, keep in mind that all it takes is A SINGLE exposure to get Lyme disease.  So for example, you might live in an area where there seems to be minimal risk of getting bit by a tick, and in addition you don’t normally walk in the grass or do anything else that would put you at risk of getting Lyme disease.  But all it takes is one hike in the woods, one barefoot walk in the grass, etc.  Plus, if you have pets that go outside then of course they can also bring ticks into your home, thereby increasing the likelihood of you getting a tick bite.

Not Everyone Has “Classic” Lyme Disease Symptoms

I’m certainly not suggesting that most people reading this blog post, or even the majority have Lyme disease.  However, there are some people who wouldn’t think they have Lyme disease because they don’t have the “typical” symptoms associated with this condition.  For example, while many people with Lyme disease will experience fatigue, cognitive symptoms, and migrating muscle and joint pain, not everyone experiences these and other “classic” symptoms.  In fact, some people with Lyme disease don’t experience any of the classic symptoms.

Below are some of the symptoms people with Lyme disease commonly experience.  Keep in mind that the symptoms someone experiences may depend on whether they have acute or chronic Lyme disease.  In addition, some people with Lyme disease won’t experience any of the following symptoms, as there are many other symptoms one can experience:

• Low grade fever
• Flu-like symptoms
• Chills
• Headaches
• Neck stiffness
• Fatigue
• Migrating muscle and joint pain
• Partial facial paralysis
• Cognitive problems/brain fog
• Lightheadedness
• Sleep disturbances
• Heart complications (palpitations)
• Weakness
• Eye symptoms (blurry vision, eye pressure)
• Numbness and/or tingling
• Shooting pains
• Shortness of breath
• Weight gain or loss
• Bladder dysfunction
• Digestive issues

If You Have Already Been Diagnosed With Lyme Disease…

So far this blog post has focused on those people who aren’t yet aware that they have Lyme disease.  But I’m sure there are some reading this who already have been diagnosed with this condition, along with one or more coinfections.  The goal of this blog post was twofold.  First, to make those who don’t think Lyme disease is a concern to realize that it might be.  Even if you’re 100% certain you don’t have Lyme disease, you want to be aware of some of the things I mentioned, and at the same time take the proper precautions to make sure that you don’t ever suffer from this condition.

The second goal was to talk about the different treatment options that might benefit those people with Lyme disease.  And while I’ll of course talk about antibiotics and herbal remedies, there are other treatments worth considering.

There actually is a third goal, and that is to encourage those who already have Lyme disease to share their experience in the comment sections below.  While everyone is different, telling people what treatments did or didn’t work for you can be helpful for others with Lyme disease.  And those reading this who currently have Lyme disease probably couldn’t imagine that they would be suffering from this condition prior to getting it, and so it would also be great to encourage those who don’t have Lyme disease to take the proper precautions so they don’t have to suffer from this condition.

Let’s Not Forget About Other Tick-Borne Coinfections

I’m not going to get into great detail about the coinfections that are commonly present along with Lyme disease, but here are some of the more common ones:

• Anaplasma
• Bartonella
• Babesia
• Chlamydia
• Ehrlichia
• Mycoplasma
• Rickettsia

Although the focus of this blog post is on Lyme disease, the symptoms from these coinfections can be just as bad, and in some cases even worse.  It’s also worth mentioning that some people with Lyme disease and related coinfections also have reactivated viral infections, such as Epstein-Barr and herpes simplex.

How Is Lyme Disease Related To Thyroid Health?

There is evidence that Borrelia burgdorferi can be a potential trigger of thyroid autoimmunity in those who are genetically susceptible (4) (5).  Although more research is needed in this area, there apparently is a molecular mimicry mechanism between the proteins associated with Borrelia burgdorferi and thyroid cells.  Molecular mimicry means that a foreign antigen (i.e. Borrelia burgdorferi) shares an amino acid sequence or structural similarities with self-antigens (i.e. thyroid tissue).

So in this situation it seems that there is similarity between some of the amino acids of Borrelia burgdorferi and the amino acids of the thyroid gland, which in turn causes the immune system to attack both Borrelia and the thyroid gland.  There is also evidence that some of the coinfections associated with Lyme disease can trigger thyroid autoimmunity through similar mechanisms (6) (7).  Although there is an increased risk of developing Graves’ disease or Hashimoto’s in someone who has Lyme disease or its associated coinfections, this of course doesn’t mean that most people with Lyme disease will develop an autoimmune condition.  That being said, if you have Lyme disease then you not only want to do things aimed at eradicating the infection, but you also want to reduce inflammation and modulate the immune system.

Conventional Treatment Options For Acute and Chronic Lyme Disease

There are three stages of Lyme disease, and not surprisingly, the sooner you treat it the better the outcome.  However, this doesn’t mean that those with early disseminated or chronic Lyme disease can’t receive good results.  But in most cases, the earlier you begin treating it the quicker you are to heal.  One problem is because Lyme disease is commonly misdiagnosed, many people don’t treat it until it becomes chronic.  In addition, some people have dormant forms of Borrelia burgdorferi in their body, and because they don’t experience any symptoms they understandably don’t seek treatment.

Acute Lyme disease.  Acute Lyme disease is treated conventionally through antibiotics.  Doxycycline is commonly given for a period of 2 to 4 weeks, although some people instead take Amoxicillin or Cefuroxime.  Although I’m not a big fan of antibiotics, this very well may be the best option for the acute stage, especially if you have obvious signs of Lyme disease (i.e. tick bite, bull’s-eye rash).

However, many people with Lyme disease never find a tick and don’t have a bull’s-eye rash.  So if Lyme disease is suspected but there are no obvious signs, what approach should you take?  It’s a tough decision, as while natural herbs might do the trick, if Lyme disease is strongly suspected one can make a good argument that antibiotics might be the best option.  As I’ve said in numerous other blog posts, everything comes down to risks vs. benefits, and while there is a definite risk of taking antibiotics, there is also a big risk of not adequately treating acute Lyme disease.

Early disseminated Lyme disease.  This is the second stage of Lyme disease, and it usually occurs within a few weeks of a tick bite.  At this point the bacterial infection is widespread, and therefore is more challenging to treat.  Just as is the case with stage #1, antibiotics are usually recommended in early disseminated Lyme disease.  While oral antibiotics are common, in this stage intravenous antibiotics are also given to some people.  While the standard course of treatment for stage #2 is 14 to 21 days of oral antibiotics, in many cases this isn’t enough to get the person well again.

Chronic Lyme disease.  This is the third stage of Lyme disease, and is the most difficult to treat.  Long-term antibiotics are commonly recommended for patients with chronic Lyme disease.  And while some people respond, many people don’t.  In fact, I’ve consulted with some Lyme disease patients who worked with Lyme disease specialists, and most of them have received long courses of antibiotics.  This is even true with a few well known Lyme specialists who incorporate alternative methods.  In other words, they combine alternative therapies with antibiotics.

Although I realize that antibiotics have their time and place, and I can understand people in stage one receiving antibiotics, and even those in stage two, I’m not a big fan of people with chronic Lyme disease taking very long courses of antibiotics (i.e. 6+ months).  Sure, there might be some exceptions, and I realize that some patients actually feel better on long-term antibiotics.  I’ve worked with patients who were on antibiotics for chronic Lyme disease for many months who didn’t feel great, but they felt even worse when not taking them.

It’s a tough situation, as we all know the negative effects that antibiotics have on the microbiome.  That being said, if anyone reading this has been treated with antibiotics on a long-term basis for their chronic Lyme disease condition and felt like they benefited greatly please share your experience in the comments below.  After all, my goal isn’t to criticize any type of treatment, and I also realize that some people with chronic Lyme disease do really well when taking a few months worth of antibiotics, and many can’t afford some of the other options I’ll discuss below.  But there are some patients with chronic Lyme disease who have been receiving antibiotics for well over a year, and in some cases a few years.

So just to clarify, I don’t want you to get the impression that I’m opposed to people with chronic Lyme disease taking antibiotics.  I definitely think that people with acute Lyme disease can benefit from taking antibiotics, and I also know there is a role of antibiotics in chronic Lyme disease.  I realize that there are people with chronic Lyme disease who have benefited from 3 to 6 months of antibiotic therapy.  But I’m just not sure what the benefit is of being on antibiotics for longer than this, although once again, I’m open to hearing what others have to say about this.

Can Herbs Eradicate Lyme Disease?

Many people reading this know that certain herbs have antimicrobial properties against infections.  Herbs can eradicate early stages of Lyme disease, although the problem is that 1) not everyone responds to the same herbs and 2) you need to make sure the dosing is high enough, although not too high.  My point is that herbs alone might be able to help someone with acute Lyme disease, but the same herbs that work for person #1 might not work for person #2.  So even in acute Lyme disease a good approach might be a combination of antibiotics and herbs, although if anyone reading this has overcome Lyme disease without taking antibiotics please share your experience in the comments section below.

As for stages #2 and #3 of Lyme disease (especially stage #3), herbs in some cases might be the best treatment option for Lyme disease, but there is controversy over whether Borrelia burgdorferi can actually be eradicated in those with chronic Lyme disease.  Some studies show that those “successfully” treated with chronic Lyme disease still have Borrelia burgdorferi in their body many years later (8) (9).  On the other hand, other studies show that Borrelia burgdorferi do not persist after conventional treatment with antibiotics (10) (11).

What herbs can specifically help with Lyme disease?  There are numerous protocols involving different herbs, and here are some of the most well known Lyme Disease protocols:

• The Zhang Protocol
• The Cowden Protocol
• Stephen Buhner Protocol
• Byron White formulas

Bio-Botanical Research also has some great herbs that can help with Lyme disease, and I’m sure there are numerous other protocols I didn’t list here.  You can learn more about these by searching online, although one of the best books I have read on this topic was by herbalist Stephen Buhner entitled “Healing Lyme”, as he gives his “core protocol” for Lyme disease, and he also gives additional herbal recommendations based on whether someone has severe brain/CNS involvement, Bell’s palsy, seizures, anxiety, and many other symptoms and conditions.  I consider this a must-read book for those with Lyme disease.

Other Treatment Options For Lyme Disease

Although herbs can be a very effective treatment method for many people, some people don’t receive good results with herbs alone.  Some people with Lyme disease aren’t able to tolerate herbs, or they might only be able to tolerate doses too small to have a therapeutic effect.  If you have tried herbs but haven’t had much success, or if you are unable to tolerate herbs, then you might want to look into some of the following alternative treatments:

Homeopathy.  While you might have a hard time believing that homeopathy can benefit those with chronic Lyme disease, homeopathy can be amazingly effective for some people.  While I couldn’t find any published studies demonstrating that homeopathy can help with acute or chronic Lyme disease, if you do some searching you’ll find some people who have done extremely well using homeopathy when conventional methods didn’t work.

Ozone therapy.  Ozone therapy is a treatment that is designed to increase the amount of oxygen in the body.  It can be administered in a few different ways, including intravenously and rectally through ozone suppositories.  When done intravenously the blood is drawn from the patient, exposed to ozone, and then re-injected.  It can help with resistant pathogens such as Borrelia burgdorferi, along with viruses.

Hyperbaric oxygen therapy.  Hyperbaric oxygen therapy involves intermittently breathing pure oxygen in a pressurized room or tube, and thus it increases the amount of oxygen in your blood.  It’s used to treat numerous medical conditions, and while it’s commonly used for wound healing, there is some research that shows that it can be an effective treatment for Lyme disease (12).

Peptide therapy.  During the 2017 International Lyme and Associated Diseases Society (ILADS) conference, Dr. Kent Holtorf gave a presentation where he discussed the benefits of peptide therapy in Lyme disease.  This is a bit complex to explain, and so I’ll include a link to his website that discusses this in greater detail.

Don’t Forget to Balance Other Compromised Areas of the Body

When trying to overcome any chronic infection, some people overlook the impact that other compromised areas of the body can have in restoring your health.  For example, if you don’t have healthy adrenals you can’t have a healthy immune system.  And while taking adrenal support might be beneficial, lifestyle factors such as eating well, getting sufficient sleep, and doing a good job of handling stress are all essential.  Supporting mitochondria can be important, especially if someone is taking an antibiotic such as doxycycline, as the research shows that these drugs impair mitochondrial function (13) (14).  Decreasing your toxic load also can make a big difference in your recovery.

Let’s not forget about the importance of thyroid hormone, which affects every cell in the body.  If someone has Lyme disease it is important that they have healthy levels of thyroid hormone.  Too much thyroid hormone isn’t a good thing (for those with hyperthyroidism and Graves’ disease), but if you want to heal from Lyme disease you also don’t want to have low or depressed thyroid hormone levels.

What’s Your Experience With Lyme Disease?

For those reading this who have already been diagnosed with Lyme disease, please share your experience in the comments section below.  Feel free to share what treatment options worked and didn’t work for you.  The goal here is to help others who are suffering from Lyme disease, and so if you have received excellent results through antibiotics, herbs, homeopathy, ozone therapy, etc., then please let others know about this.  And if you haven’t received good results and are still suffering from the symptoms associated with Lyme disease and its coinfections, I still encourage you to share your experience with others.  If you haven’t been diagnosed with Lyme disease then perhaps you can share the experience of a family member or friend who dealt with this.