In 2016 I wrote a blog post entitled “5 Essential Oils That Can Benefit People With Thyroid Conditions”.  It was a very popular post, and so in 2017 I decided to write another well-researched article that focused on the benefits of Myrrh and Frankincense.  Perhaps I’ll write another blog post or article in the near future that focuses on other essential oils, but I’d like to know whether you have used essential oils, and if so, what has been your experience with them?

If you have had a positive experience when taking essential oils please let me know!  Or if for any reason you had a negative experience please let me know!  Of course it would be great if your experience relates to thyroid health, but even you used essential oils to improve your health in other ways feel free to share your comments below.

I’d also like to mention that a few months ago my friend Dr.  Eric Zielinski released a new book called “The Healing Power of Essential Oils“, and so if you want to learn even more about essential oils you might want to check this out.

When it comes to managing the symptoms of hyperthyroidism, many people rely on antithyroid medication such as methimazole or PTU.  But some people are unable to take antithyroid medication due to the side effects.  Others can tolerate antithyroid medication fine, but it might not be effective in lowering their thyroid hormone levels.  Bugleweed is an antithyroid herb that can help many people who experience side effects from antithyroid medication, but in some cases this herb isn’t effective either.  And when someone is unable to lower their thyroid hormone levels, the person’s endocrinologist is very likely to recommend radioactive iodine or thyroid surgery as the only option.

Of course the ultimate goal should be to address the cause of the underlying condition.  Although this is true, it takes time to accomplish this, and in the meantime it’s important to manage the hyperthyroid symptoms.  After all, there are numerous risks associated with uncontrolled hyperthyroidism, including arrhythmias, atrial fibrillation, and thyroid storm.

Some people who are unable to tolerate antithyroid medication will take beta blockers.  And while beta blockers can help to manage the cardiovascular symptoms commonly experienced by those with hyperthyroidism and Graves’ disease, they don’t lower thyroid hormone levels (although some beta blockers can affect the conversion of T4 to T3).  So while beta blockers decrease the risk of developing arrhythmias and atrial fibrillation, there still is a risk of thyroid storm, and elevated thyroid hormone levels can also lead to decreased muscle mass and bone density.  The point I’m trying to make is that while it’s important to manage the cardiac symptoms associated with hyperthyroidism, it’s also important to lower the thyroid hormone levels.

What Is Cholestyramine?                                                                                       

Cholestyramine is a bile acid sequestrant.  It binds to certain components of bile, which in turn disrupts the enterohepatic circulation of bile acids.  Bile acid sequestrants are commonly used for lowering cholesterol or for the treatment of chronic diarrhea (when the cause is due to bile acid malabsorption).  Cholestyramine can also bind to mycotoxins, and thus can be used as a treatment for toxic mold, although it of course is also important to remove the source of the mold.

How Can Cholestyramine Help With Hyperthyroidism?

Cholestyramine has been shown to interfere with the enterohepatic circulation of endogenous thyroid hormones, which is increased in hyperthyroidism (1).  Simply put, it binds to thyroid hormones and then the hormones are excreted by the body.  In fact, this is why those people with hypothyroidism and Hashimoto’s don’t want to take cholestyramine around the same time they take thyroid hormone replacement (i.e. levothyroxine).

 What Does The Research Show?

One study evaluated the efficacy and safety of high-dose cholestyramine added to antithyroid medication in order to control hyperthyroidism (2).  This was a small study, involving only five patients, all who took at least 30 mg of methimazole.  They were put on 4 grams of cholestyramine three times a day for four weeks.  When compared to a control group consisting of patients who only took methimazole, the group who took both the methimazole and cholestyramine showed a more rapid reduction of the T3 and T4 levels in nearly all subjects.

In another study, this one a randomized, double-blind, placebo-controlled trial involving 45 patients newly diagnosed with Graves’ disease, the patients were randomly assigned into three treatment protocols (3).  Group one took 2 grams of cholestyramine twice per day, group two took one gram of cholestyramine twice per day, and group three took a placebo powder.  All three groups took 30 mg of methimazole and 40 mg of propranolol each day.  The length of the study was 4 weeks, and the thyroid hormone levels decreased more rapidly and to a greater extent in the cholestyramine-treated groups.  In addition, all of the patients in group one had normal thyroid hormone levels at the end of the study.

These studies, along with a few case reports (4) (5), showed that cholestyramine can decrease thyroid hormone levels more rapidly when combined with methimazole.  But how about if cholestyramine is taken without any antithyroid medication?  I was able to find a case report involving a 36-year old woman who was diagnosed with Graves’disease, and was unable to take antithyroid medication due to side effects (6).  Four grams of cholestyramine was given every six hours, and while unfortunately the woman ended up receiving radioactive iodine, prior to receiving this treatment her free T4 levels improved significantly within five days.  Although this is only a single case study, it did provide some evidence that cholestyramine might be an effective monotherapy for those with hyperthyroidism who are unable to take antithyroid medication.

Can Cholestyramine Be Effective When Combined With Bugleweed?

As of writing this blog post I haven’t had any patients take cholestyramine along with bugleweed, and so I honestly don’t know if it would be effective when combined with this antithyroid herb.  However, earlier I did mention a case study that showed that cholestyramine was effective when taken without any antithyroid medication.  So it’s possible that you might not need to take either antithyroid medication or antithyroid herbs in combination with cholestyramine, but my guess is that combining it with bugleweed might help to lower the thyroid hormone levels quicker than just taking cholestyramine alone.

What Dosage Is Commonly Used?

In most cases the dosage of cholestyramine used was 4 grams three times per day.  This was the case when both antithyroid medication was used, as well as in the study where cholestyramine was taken without antithyroid meds.  However, another study involved taking either 1 or 2 grams of cholestyramine, and all of the patients who took 2 grams of it achieved a euthyroid state (normal thyroid hormone levels) by the end of the study.  It’s worth mentioning that the patients in the study also took 30 mg/day of methimazole, along with 40 mg/day of propranolol.

What Are The Side Effects of Cholestyramine?

There are a few downsides of cholestyramine.  First of all, it is only available in a powder form and doesn’t taste too good.  This of course isn’t a side effect, but I did want to mention it, as compliance might be an issue in some cases.  This is especially true with children and teenagers, but with some adults as well.  The main side effects of cholestyramine include constipation and abdominal discomfort.  One of the main concerns with antithyroid medication is that it can put stress on the liver and lead to elevated liver enzymes.  Although I’m not aware of evidence which shows that cholestyramine causes significant liver damage, mild elevations in the liver enzymes sometimes will occur (7).

How Can You Convince Your Doctor To Prescribe Cholestyramine?

I have been working with hyperthyroid patients since 2009, and I have never had an endocrinologist recommend cholestyramine to their patients.  My guess is that many aren’t even aware that it can be an effective treatment for hyperthyroidism, and as a result, it might be challenging to get a doctor to write a prescription for this.  Keep in mind that an endocrinologist doesn’t need to write a prescription, as any medical doctor can do this, and it usually is easier to find an open-minded primary care physician than an open-minded endocrinologist.

Either way, if your doctor has never heard of cholestyramine as a treatment for hyperthyroidism, then I would suggest showing them the research presented in this blog post.  Make sure you let them know that the research is from published journal articles, and they of course can access the studies by clicking on the links in this blog post.  If your doctor is strongly opposed to natural treatment options you can choose not to present the entire blog post but just show them the research.  After all, cholestyramine isn’t a natural treatment option, but is just a different option than antithyroid medication.

For those who are able to tolerate methimazole but find it to be ineffective in managing hyperthyroidism, you also might want to let the endocrinologist know that you would be willing to take the cholestyramine in combination with the antithyroid medication.  The reason I bring this up is because they might be more likely to prescribe cholestyramine if they know that you will continue taking the methimazole.  If anyone reading this is successful in getting a prescription for cholestyramine to help manage their hyperthyroidism, I ask you to please come back to this blog post to share your experience in the comments section below.

In summary, cholestyramine is a bile acid sequestrant, and it might be a treatment option in some people with hyperthyroidism and Graves’ disease.  This is especially true when antithyroid medication isn’t effective in lowering the thyroid hormone levels, although cholestyramine might also be effective when used as a monotherapy.  The main side effects of cholestyramine include constipation, abdominal discomfort, and in some cases it can cause mild elevations of the liver enzymes.  But everything comes down to risks vs. benefits, and if taking cholestyramine can help someone to avoid radioactive iodine or thyroid surgery then in my opinion the minor side effects would definitely be worth it, although while taking it you of course would want to continue to address the cause of your condition.

For those with thyroid and autoimmune thyroid conditions, nutritional supplements and herbs can be an important part of a natural treatment protocol.  But while many people greatly benefit from taking supplements, sometimes people don’t receive optimal results. In fact, some people don’t notice any improvement in their condition at all.  Sometimes this can be because the person isn’t taking the appropriate supplements, and the quality of the supplement is also something to consider.  In this blog post I’ll discuss seven reasons why the supplements you’re taking aren’t working.

Reason #1: You’re not eating a healthy diet.  Fortunately many of my new patients have already been eating a pretty healthy diet prior to seeing me for the first time, as many of them are gluten free, and some of them have followed an autoimmune Paleo diet for awhile.  On the other hand, others eat a very poor diet, and some of these people take many different nutritional supplements.  But if you want to achieve optimal results then you really need to eat well.  While one can make the argument that taking nutritional supplements is important for most people to receive great results, if funds are limited and you have a choice between spending money on healthy food or spending money on good quality supplements, there is no question that you should choose to spend the money on eating healthy food.

Reason #2: You’re not taking a high enough dosage.  While I would be cautious about taking massive doses of nutritional supplements and herbs, sometimes people are too conservative with the dosing of their supplements.  For example, many people take vitamin D supplements, and while labs commonly use a reference range of 30−100 ng/mL, you want the levels to be above 50 ng/mL, and some sources suggest for it to be between 60 and 80 ng/mL.  While some people are able to increase their vitamin D levels primarily through sun exposure, many others need to supplement with vitamin D.  And when this is the case, higher doses are usually required to get the levels above 50 ng/mL.

It’s the same concept with other nutrient deficiencies.  Of course you need to exercise caution, as it’s possible to overdose with certain nutrients and herbs.  On the other hand, some nutrients are relatively safe to take in higher doses, including magnesium, chromium, vitamin C, and vitamin B12.  That being said, it probably is a good idea to work with a competent healthcare practitioner before taking large doses of any nutrient or herb.

Reason #3: You’re not taking the supplements consistently.  While many of my patients do a great job of following the recommendations, it’s not uncommon for a patient of mine to tell me that they haven’t been taking some or all of the recommended supplements on a consistent basis.  For example, if I recommend for someone to take a specific supplement three times per day, they might only take it once or twice per day.  Or sometimes they will completely skip a day.  Of course this doesn’t describe everyone, and so if you’re reading this and are diligently following the supplement recommendations given by your healthcare practitioner then of course keep up the good work!

The truth is that missing a dose of a supplement every now and then might not be a big deal in some people.  On the other hand, for others it can make a difference in their progress.  And since there is no way of knowing which category you fall into, it is best to play it safe and take the supplements as recommended.

But what if you can’t afford to take the supplements as recommended?  Well, I would be honest with the practitioner you’re working with, as perhaps he or she can make modifications to the supplements you are taking.  For example, if someone has had ten different supplements recommended to them, and they are unable to take all of them as recommended, they might be tempted to take a reduced dosage of all of them, when a better option might be to take the full doses of four or five of the supplements.

Reason #4: You’re not taking the supplements correctly.  For example, some supplements are best taken with meals, while others are best taken on an empty stomach.  L-glutamine is an amino acid that is commonly recommended by healthcare practitioners for gut healing, and for this purpose it is best taken in between meals.

Reason #5: You haven’t taken the supplements long enough.  Although many people reading this blog post understand that it takes time to see results, some people have unrealistic expectations, as they expect to notice positive changes in their symptoms within a few days of taking supplements.  Don’t get me wrong, as some people do feel better quickly after taking supplements, but sometimes it can take a few days or weeks before there is symptomatic improvement.

As an example, let’s take a look at how someone with small intestinal bacterial overgrowth (SIBO) might respond when taking an herbal approach.  First of all, with SIBO, higher doses of certain antimicrobials very well might be needed to get significant results.  And in many cases the person with SIBO will need to take the herbs for at least a few weeks before they experience any positive changes.  The same concept can apply with a Candida overgrowth, as while some people who choose to take antifungal herbs notice positive changes in their symptoms sooner than later, for others it will take a few weeks or months before they start feeling better.

Let’s look at another example.  Some people with hyperthyroidism and Graves’ disease take the herbs bugleweed and motherwort for symptom management.  And while some people will notice a decrease in their hyperthyroid symptoms quickly, for others it will take a few weeks before they notice any positive changes.

How about if you are taking nutritional supplements to correct a nutrient deficiency?  In this situation it also can take some time before you notice an improvement in your symptoms.  One reason why some people have unrealistic expectations is because we are basing these expectations off of the results other people have had.  For example, you might visit a forum or Facebook group and see someone who took the same supplement you’re currently taking, and they noticed an improvement almost immediately, whereas you have been taking the same supplement for a few weeks and haven’t noticed any positive changes.  While it certainly is possible that the supplement isn’t effective in your case, it is also possible that biochemical individuality is accounting for the rapid symptomatic improvement of that person.

Reason #6: Your supplements are interacting with other supplements or medications.  Some medications can interfere with the supplements you’re taking, and sometimes there are also “supplement-supplement” interactions.  For example, if you’re taking any type of a binding agent, such as Cholestyramine or activated charcoal, this can bind to toxins, but these binding agents also can interfere with the absorption of certain supplements.  This is just one example of how your supplements might interact with other supplements or medications you’re taking.  While I can’t say I commonly see this with my patients, it does happen from time to time, and it’s something you need to be aware of.

Reason #7: You’re taking fake supplements.  This is a big problem, especially for those who purchase their supplements on online sites such as Amazon and Ebay.  This isn’t to suggest that there aren’t reputable sellers on these and other websites that sell supplements, but you need to be very careful.  After all, with all of the different products sold on Amazon and Ebay it is almost impossible for them to tell which supplements being sold are authentic and which ones are counterfeit.

What exactly do I mean by a “fake” supplement?  This simply means that the ingredients being used aren’t the ingredients being advertised on the label.  And the obvious reason why counterfeiters do this is to make a greater profit.  By the way, while it’s possible that the suppliers of these fake supplements will use harmful ingredients, in most cases this isn’t an issue, as they want to put fake ingredients that are safe so that you will continue buying their supplements.  But of course there is always the chance there can be harmful ingredients substituted as well, which is yet another reason to be cautious about buying your supplements through a random seller on Amazon or Ebay.

So when can you feel comfortable buying supplements on Amazon or Ebay?  Well, the only way I would feel comfortable purchasing supplements on these sites is if they are sold directly by the supplement manufacturer.  I suppose if someone has an online supplement store on Amazon and has hundreds of five star reviews then there is a good chance you can trust their supplements, although I’d still be cautious.

Other Reasons Why Your Supplements Aren’t Working

There can be other reasons than the ones I listed in this blog post.  For example, in the opening paragraph I mentioned that it’s important to take the appropriate supplements, and of course the quality of the supplement is also important.  Hopefully you’re taking the correct supplements, but there are circumstances when people are taking the wrong ones, or at the very least aren’t taking the ones that should be a priority in their situation.

For example, someone might have been told they have a leaky gut, and so they are taking supplements to improve their gut health.  And so perhaps they are taking L-glutamine, probiotics, digestive enzymes, and other supplements to support their gut.  But if they have a chronic infection that caused the leaky gut, they should focus on herbs to eradicate the infection, and then focus on healing their gut.

Earlier I mentioned how taking fake supplements is a concern, although some people are taking “authentic” supplements, but unfortunately it’s from a company that uses low quality ingredients.  Some examples of lower quality ingredients include magnesium oxide, cyanocobalamin, and synthetic folic acid.  Another thing to keep in mind is how the supplements are stored, as if you or the manufacturers aren’t storing the supplements properly then this can reduce the effectiveness.  This is especially true with probiotics and fish oils, although it can affect other supplements as well.

In summary, while nutritional supplements and herbs can be an important part of your recovery, there are times when supplements people take aren’t effective.  There can be numerous reasons for this, but some of the reasons discussed in this post include 1) you’re eating too much junk food, 2) the dosage isn’t high enough, 3) you’re not taking the supplements consistently, 4) you’re not taking the supplements correctly, and 5) your supplements are fake.

I’ve written about thyroid nodules in the past, as many people with thyroid and autoimmune thyroid conditions have nodules.  I’ve also written about insulin resistance, as this is also commonly seen in people with thyroid imbalances.  This is especially true for those people with hypothyroidism and Hashimoto’s thyroiditis, although it can also affect those with hyperthyroidism and Graves’ disease.  But there is also evidence that insulin resistance can be a factor in the development of thyroid nodules, which of course will be the focus of this blog post.

I’m frequently asked how to shrink thyroid nodules by patients and non patients.  The truth is that there is no specific natural treatment approach for all thyroid nodules.  The obvious goal should be to find and address the cause of the thyroid nodules, which isn’t always easy to do.

Other Causes of Thyroid Nodule Formation                                                  

Although the focus of this blog post will be to discuss the relationship between insulin resistance and thyroid nodules, there can be other causes.  Two of the more common ones are an iodine deficiency and problems with estrogen metabolism.  As a result, it makes sense to determine if someone has these imbalances.

There is no perfect method of determining whether someone has an iodine deficiency, although urinary testing is preferred by many healthcare practitioners, including myself.  For example, when I was diagnosed with Graves’ disease I ordered an iodine loading test.  The downside of this test is that it requires ingesting a 50mg tablet of potassium iodide, and not everyone does well when taking this.  Another option that doesn’t involve consuming iodine is an iodine spot test, which is a one-sample urinary iodine test.  Although some people test for iodine in the blood, normal serum iodine levels doesn’t rule out an iodine deficiency.

As for determining whether or not you have problems with estrogen metabolism, blood testing of course is one method that can be used to measure the estradiol levels.  Saliva and urine testing is also an option, and without question are superior options for cycling women.  The reason for this is because a cycling hormone panel allows cycling women to collect multiple saliva or urine samples throughout their cycle.  This is more accurate than collecting a single sample in the second half of the cycle, although it also is more expensive.

However, measuring the estradiol levels won’t always indicate whether someone has estrogen metabolism issues.  For example, the enzyme catechol-o-methyltransferase (COMT) is involved in estrogen metabolism.  As a result, if someone has a genetic polymorphism of the COMT gene then this can affect estrogen metabolism.  Having elevated levels of an enzyme called beta-glucuronidase can also prevent the excretion of estrogen.

What Is Insulin Resistance?

Although I would recommend to read other articles I’ve written on insulin resistance for more detailed information, I’ll briefly explain what this is here.  Insulin is a hormone that is produced by the beta cells of the pancreas.  As the name implies, insulin resistance is when the cells are no longer sensitive to insulin.  So this is actually a high insulin state, which is why this is associated with pre-diabetes and type 2 diabetes.  Although some doctors rely on a fasting glucose test to determine if someone has insulin resistance, other testing is recommended to make a diagnosis, including a fasting insulin and a hemoglobin A1C.  Sometimes a glucose tolerance test will also be used.  Elevated triglycerides on a lipid panel are frequently a sign of insulin resistance.

As for how insulin resistance develops, there is no question that eating a diet consisting of high amounts of refined carbohydrates and sugars is a factor.  A high intake of fructose can especially be problematic, as this can lead to an increase in fat deposition in the liver and skeletal muscle, thus increasing the risk of insulin resistance and type 2 diabetes (1).  And when I say that high amounts of fructose can be a factor in the development of insulin resistance, this is especially true when fructose is used as a sweetener in processed foods and beverages.  This doesn’t mean that you can’t overdo it with fruit, but eating a few servings of fruit per day isn’t going to cause insulin resistance in most people.

While one’s diet can play a big role in the development of insulin resistance, there can be other factors.  Inflammation is a big factor, and there are many different causes of inflammation.  Since the mitochondria play a role in glucose homeostasis, mitochondrial dysfunction can also be a factor.  There is even evidence that intestinal dysbiosis can cause insulin resistance (2), which is yet another reason to do everything you can to improve the health of your gut.

What Does The Research Show?                          

One study examined the prevalence of insulin resistance in a case-control study of patients with benign thyroid nodules (3).  These patients lived in an iodine-sufficient area, and as a result, an iodine deficiency was unlikely to be the culprit, although in my opinion it still would have been worth testing to determine if they had an iodine deficiency.  In any case, the study showed that there is an association between insulin resistance and benign thyroid nodules.  Another study looked at the association between insulin resistance and the vascularization of thyroid nodules (4).  The authors of the study concluded that there is a vital role of insulin resistance in the distribution, construction, and density of thyroid nodular vascularization, and that this in turn might contribute to the growth and the progression of thyroid nodules.

Yet another study looked at the relationship between insulin resistance in those with euthyroid nodular goiter (5).  For those who are unfamiliar with the term “euthyroid”, this refers to someone who has normal thyroid hormone levels.  In any case, the results showed that insulin resistance may cause an increase in thyroid cell proliferation and nodule volume, as well as nodule formation.  I’ll mention one more study that looked to see if there was a correlation between insulin resistance and thyroid nodules in those with type 2 diabetes (6).  The results of the study demonstrated that insulin resistance was a risk factor for thyroid nodule formation in patients with type 2 diabetes.

3 Steps You Should Take If You Have Thyroid Nodules

Based on the information presented in this article, if a thyroid ultrasound reveals that you have one or more thyroid nodules then you should take the following steps:

Step #1: Modify diet and lifestyle factors.  Regardless of what imbalances you have, it will benefit your overall health if you eat a healthy diet.  This is especially true if you have insulin resistance, although it can help with other health issues as well.  And of course it won’t hurt to address other lifestyle factors, which includes improving your stress handling skills and getting sufficient sleep.

Step #2: Do the appropriate testing.  In this blog post I discussed three factors that can lead to the formation of thyroid nodules, including an iodine deficiency, problems with estrogen metabolism, and insulin resistance.  I also discussed how to test for these imbalances.

Step #3: Correct any imbalances found through the testing.  You of course would want to correct any imbalances that show up on the testing.  Sometimes this is easier said than done.  For example, if you have an iodine deficiency, then you might need to improve other aspects of your heath before correcting this deficiency.  I’ve spoken about this in an article I wrote entitled “An Update on Iodine and Thyroid Health”.  As for how to correct a problem with estrogen metabolism, I would recommend reading an article I wrote entitled “7 Ways To Positively Influence Estrogen Metabolism”.

But of course the focus of this blog post is on insulin resistance as being a factor in the development of thyroid nodules.  And while many times following the first step will help with this, other times this won’t be sufficient.  Earlier I mentioned some of the other factors that can play a role in the development and perpetuation of insulin resistance, including inflammation, mitochondrial dysfunction, and intestinal dysbiosis.  I’ve discussed all of these factors in different articles and blog posts.

Will following these three steps result in the shrinking of your thyroid nodules?  Perhaps, although you need to keep a few things in mind.  First of all, it’s not always easy to find and correct these imbalances.  You need to find the imbalances that are responsible for the formation of thyroid nodules, which can be challenging at times.  And then even if you find the imbalances, correcting them can also be a challenge.  For example, I briefly mentioned the challenges of correcting an iodine deficiency earlier.

I also mentioned that there can be numerous causes of insulin resistance.  So even if you have confirmed that you have insulin resistance through testing, it isn’t always easy to find what specifically is causing the insulin resistance.  This doesn’t mean that you shouldn’t attempt to find out the cause, but just remember that doing so can be challenging at times.

So hopefully you have a better understanding of the relationship between insulin resistance and thyroid nodules.  Some of the common causes and contributing factors of insulin resistance include poor diet, inflammation, mitochondrial dysfunction, and intestinal dysbiosis.  Two other common causes of thyroid nodules include an iodine deficiency and problems with estrogen metabolism.  As a result, it makes sense to do the appropriate testing to find out what imbalances might be causing or contributing to your thyroid nodules, and then correct any imbalances that are found.

The oral cavity is home to billions of microorganisms (that’s right…billions!), including an estimated 750 different species of bacteria (1).  Problems with oral health can lead to numerous health issues, including cardiovascular disease, and even diabetes mellitus (2).  But while there is no question as to whether oral health is important to one’s overall state of health, some still question the claims that oil pulling can improve oral health.  I’m a big proponent of oil pulling, which is why I decided to put together this blog post.

I’d like to start out by discussing what oil pulling involves.  Essentially oil pulling involves taking a small amount of oil (i.e. coconut oil, sesame oil) and swishing it around your mouth for 10 to 20 minutes.  By swishing the oil in your mouth it is “pulled” between your teeth.  After you’re done you want to spit it out in a trash can or paper towel.  Don’t spit the oil in your sink…unless if you want to clog it!  Some sources also suggest to swish some warm water in your mouth a few times after oil pulling, and you can then brush your teeth afterwards.

When Should Oil Pulling Be Done?                                                

Some suggest that oil pulling should be performed in the morning, before your first meal, and prior to brushing your teeth.  This is when I usually will do it, as I will swish 1 tablespoon of coconut oil in my oil in my mouth while preparing green tea and making my smoothie.  I’ve had some patients tell me that they do oil pulling in the shower while getting ready for work.  I suppose you can even do oil pulling while you drive to work, and bring along some type of container to spit the oil in after you’re done.

Although some suggest that oil pulling should be performed before meals, I wonder if doing it after certain meals would be more beneficial.  For example, it might be beneficial to do oil pulling after eating fermented foods.  The reason for this is because fermented foods such as sauerkraut have Lactobacilli.  Lactobacilli are gram-positive, lactic acid bacteria, and they are very important for the health of the gut, along with the urinary system and vaginal tract.  However, some Lactobacillus species can cause dental cavities (3), as the lactic acid they produce can corrode the teeth.  Because of this, an argument can be made to incorporate oil pulling after eating fermented foods.

How Frequently Should You Do Oil Pulling?

Some sources suggest to do oil pulling daily, and perhaps even multiple times per day.  I can’t say that I do oil pulling on a daily basis, as I do it 3 or 4 times per week.

Which Oils Should You Use?

The truth is that you can use any type of oil for oil pulling, but of course it makes sense to use healthier types of oils, along with oils that have been shown in the research to have antimicrobial properties.  I’m going to discuss three specific oils:

Coconut oil.  Coconut oil contains lauric acid, which has antimicrobial and anti-inflammatory properties.  In vitro studies have shown coconut oil to be effective against Streptococcus mutans and Candida albicans (4).  The monolaurin in coconut oil has been shown to be effective against microorganisms such as Staphlococcus aureus, Candida, Helicobacter pylori, and Enterobacter spp (5).

Olive oil. The constituents of olive oil have antimicrobial, immunomodulatory, and antioxidative effects (5).

Sesame oil.  Sesame oil contains sesamin, sesamolin and sesaminol and has detoxification, antioxidant, and antibiotic actions (5).

Health Conditions That Can Benefit From Oil Pulling

While I’m sure you can understand how oil pulling can improve conditions directly related to oral health, it might also benefit other health conditions.  Here are some of the different health conditions that can benefit from oil pulling (6):

• Dental caries
• Plaque-induced gingivitis
• Halitosis (bad breath)
• Oral thrush
• Headaches and migraines
• Asthma
• Diabetes mellitus
• Eczema
• Thrombosis

What The Research Shows         

Let’s take a look at a few research studies which show the benefits of oil pulling.  You’ll notice that most of these studies focus on oral health benefits.

General antimicrobial effects.  One small study compared oil pulling using sesame oil with chlorhexidine mouthwash, and the results showed a statistically significant reduction in the Streptococcus mutans (S. mutans) count in the oil pulling group (7).  It’s important to mention that the chlorhexidine mouthwash group had a greater reduction in S. mutans, but of course we also need to consider the chemicals in the mouthwash.

Another study looked to assess the reduction in S. mutans and Lactobacillus species count in the saliva after ten minutes of oil gum massage therapy for three weeks with sesame oil, olive oil, and coconut oil (8).  The results of the study showed a significant reduction in mean S. mutans count, Lactobacillus count, plaque scores, and gingival scores.

Halitosis (bad breath).  One study evaluated the effect of oil pulling on halitosis and the microorganisms that could be responsible for it (9).  Sesame oil was used, and it was compared to chlorhexidine mouthwash.  The study showed that oil therapy is equally effective as chlorhexidine on halitosis and reducing the microorganisms associated with halitosis.

Another study compared the efficacy of oil pulling and chlorhexidine in reducing oral malodor and microbes (10).  The results showed that oil pulling with sesame oil is as effective as chlorhexidine in reducing oral malodor and microbes causing it.

Plaque-induced gingivitis.  One study evaluated the effect of oil pulling with sesame oil on plaque-induced gingivitis (11).  The study showed that oil pulling resulted in a reduction in the plaque index, modified gingival scores, and the total colony count of aerobic microorganisms.

Another study evaluated the effect of coconut oil pulling on plaque formation and plaque induced gingivitis (12).  There was a statistically significant decrease in the plaque and gingival indices, and thus the authors concluded that oil pulling using coconut oil could be an effective adjuvant procedure in decreasing plaque formation and plaque induced gingivitis.

Can Oil Pulling Benefit Those With Graves’ Disease and Hashimoto’s?

Not surprisingly, there are no studies demonstrating that oil pulling can directly benefit thyroid health, as well as autoimmune thyroid conditions such as Graves’ disease and Hashimoto’s thyroiditis.  So I can’t say that oil pulling is an essential component of restoring your health back to normal.  On the other hand, having good oral health is important for overall optimal health.

In addition, the research shows that proinflammatory cytokines are found in diseased periodontal tissues (13), and some of these same proinflammatory cytokines are a factor in autoimmunity.  There is also an increase in Th17 cells in periodontitis (14), and these are also present in autoimmune conditions.  And as I mentioned earlier, problems with oral health can have systemic effects.  So for example, if someone has an elevated C-reactive protein (CRP) marker, there is always the possibility that their oral health is responsible for this elevation, and if this is the case, then oil pulling may help, depending on the cause.  Keep in mind that there are many other factors that can cause an elevated CRP as well.

Doing Oil Pulling With Essential Oils

Although using the oils I mentioned earlier can benefit your oral health, some healthcare practitioners suggest that mixing in essential oils can be of further benefit.  Although I couldn’t find any studies showing this, it makes sense when you think about it, as certain essential oils also have antimicrobial properties.  So for example, you can mix one drop of tea tree oil with coconut oil.  Dr. Eric Zielinski is an expert when it comes to essential oils, and in an article he wrote he suggested adding one drop each of clove, orange, lemon, and peppermint with 1 to 2 tablespoons of coconut oil.  In the past I wrote an article on the benefits of Frankincense and myrrh oil, and Dr. Zielinski also mentioned how these can be mixed with essential oils.

Are There Any Risks of Doing Oil Pulling?

If you read the research it seems that oil pulling is very safe, and that there are no risks involved.  The only concern I have is whether it possibly can also affect some of the good bacteria in the mouth.  In other words, is it possible to overdo it with oil pulling?  I’m not sure what the answer is, as it might be fine to do oil pulling once or twice per day, but as I mentioned earlier, I do it 3 or 4 times per week.  And perhaps this also is overdoing it, but I’ll add that there is no evidence I’m aware of demonstrating that doing oil pulling on a daily basis can cause any type of oral dysbiosis.  I’m sure there is a greater risk of this happening with chemical mouthwashes.

It’s also important to mention that after you oil pull, you don’t want to swallow the oil.  The reason for this is because you want to spit out any bacteria or toxins that are in the oil.  Of course swallowing the oil isn’t going to kill you, but it’s best to spit it out.

Final Thoughts:

I started doing oil pulling a few years ago, and while I haven’t had any cavities since, because I brush and floss regularly it’s hard to say if the oil pulling has been the primary factor.  But based on some of the research I presented it does seem to help reduce some of the harmful microorganisms in the mouth.  In addition, oil pulling is easy to do and is inexpensive, and so I do recommend trying to get into the routine of doing this.  And of course if anyone has a positive (or negative) experience to share regarding oil pulling please feel free to post a comment below.