Nightshades are members of a family of plants called Solanacea.  Some of the most common nightshades include tomatoes, eggplant, peppers, white potatoes, and the herb ashwagandha.  These foods are excluded from an autoimmune Paleo diet.  However, while some people with Graves’ Disease and Hashimoto’s Thyroiditis have negative reactions to one or more of the nightshades, many people with these conditions don’t seem to have a problem with them.

If you want to learn more about why nightshades are excluded from an autoimmune Paleo diet you can read my article entitled nightshades and thyroid health.  But the primary goal of this blog post is to find out what your experience has been with nightshades.  While I realize that you can’t always go by symptoms, many people who have problems with the nightshades become symptomatic when consuming them.  Other people are able to get into remission while continuing to eat nightshades, or upon reintroducing them back after initially eliminating them.

If you have problems with some or all of the different nightshades please let me know!  If this is the case, please feel free to be specific and let me know what nightshades you have a negative reaction to.  If you feel fine when consuming nightshades, please feel free to share this as well.  Thank you so much for sharing your experience with everyone.

There are numerous factors that can trigger an autoimmune response, and lead to the development of a condition such as Graves’ Disease and Hashimoto’s Thyroidits.  Infections are one of these factors, and in this blog post I am going to discuss four specific gut infections that can lead to the development of an autoimmune thyroid condition.  While there are other infections that can trigger thyroid autoimmunity, the ones I will be discussing are some of the more common ones.

If you’re wondering how infections can cause an autoimmune thyroid condition, I spoke about this in greater detail in a past article I wrote on viruses and thyroid autoimmunity.  In this article I discussed three different mechanisms in which an infection can ultimately lead to a condition such as Graves’ Disease or Hashimoto’s Thyroiditis.  I realize that most people reading this won’t be interested in learning these mechanisms, but for those who are interested I’d check out this article.

Speaking of viruses, for those wondering why I don’t talk about certain viruses in this blog post such as Epstein Barr, the reason is because I’m focusing specifically on gut infections.  However, I should mention that certain viruses can affect the health of the gastrointestinal tract as well.  In fact, although Epstein Barr isn’t considered to be a “gut infection”, this virus can affect the gastrointestinal tract.  In addition, cytomegalovirus and herpes simplex virus can potentially cause ulcerative disease of the gastrointestinal tract (1).

With that being said, let’s go ahead and discuss these four gut infections:

1. Yersinia enterocolitica.  Yersinia enterocolitica is a gram negative bacteria that is a common cause of human gastroenteritis (2).  Some of the common symptoms include diarrhea, abdominal pain, fever, and sometimes vomiting (3).  Complications are rare and can include a skin rash, joint pain, or the spreading of bacteria to the bloodstream (4). As for how this bacteria is transmitted, the most common method is by eating contaminated food, such as raw or undercooked pork, although sometimes drinking contaminated milk or water can be a cause.  A few studies show a correlation between this pathogenic bacteria and thyroid autoimmunity (5) (6) (7).

How Is Yersinia Enterocolitica Detected?

An infection of this pathogen is usually diagnosed through the stool, although the antibodies can be tested through the blood.

Treatment For Yersinia Enterocolitica

The conventional medical approach usually involves prescription antibiotics.  These are usually effective, although the obvious downside is that these antibiotics also eradicate beneficial bacteria as well.  Natural agents which can be effective against Yersinia include oregano oil, berberine, and garlic.

2. Helicobacter Pylori.  Helicobacter pylori is a gram-negative bacteria that infects the stomachs of humans, and it is associated with peptic ulcer disease, gastric carcinoma, and gastric lymphoma (8).  Keep in mind that while some people will experience symptoms such as heartburn, indigestion, and nausea, the absence of symptoms doesn’t rule out H. Pylori.  As for how it is transmitted, the most common method is the oral-oral route (i.e. kissing), and the fecal-oral route (i.e. contaminated water) (9).  A few studies show a correlation between H. Pylori and thyroid autoimmunity (10) (11).

How Is An H. Pylori Infection Diagnosed?

H. Pylori can be tested for through the blood, saliva, stool, and through a urea breath test. Blood and saliva testing measure the H. Pylori antibodies, while stool testing and the urea breath test can detect the actual presence of this bacteria. If someone has recently tested positive for H. Pylori then the antibodies can remain detectable for months after eradication, and as a result they should test for H. Pylori through the stool or the breath test.

Treatment for H. Pylori

Conventional treatment usually involves triple therapy consisting of two antibiotics and a proton-pump inhibitor (12).  Sometimes quadruple therapy is used, as this also involves bismuth, a heavy metal that has antimicrobial activity against H. Pylori (12).  With regards to natural treatment methods, a few studies show that mastic gum can eradicate H. Pylori (13) (14), and this is something I have used in my practice.  Other natural agents I have used include berberine, black cumin seed, garlic, and matula tea.  H. Pylori can form biofilms, and N-acetylcysteine (NAC) can be an effective biofilm disruptor in those with an H. Pylori infection (15) (16).

3. Blastocystis hominis.  Blastocystis hominis is an enteric parasite, and some of the symptoms commonly associated with Blastocystis hominis include abdominal pain, pruritus, flatulence, malaise, anorexia and diarrhea (17).  How Blastocystis is transmitted is not known for certain, although a fecal-oral route through contaminated food or water is the most likely cause (18).

In the past there has been some controversy over whether this is a harmful parasite, or if it is commensal.  But more recently it has been recognized that this is indeed a pathogenic parasite, and in addition to increasing proinflammatory cytokines, Blastocystis hominis can also cause a leaky gut, which is a factor in autoimmune conditions such as Graves’ Disease and Hashimoto’s Thyroiditis.  With regards to thyroid autoimmunity, there is one case report that shows that someone with Hashimoto’s went into remission upon eradicating Blastocystis hominis (19).  Of course this is only a single case report, but over the years I have worked with a few autoimmune thyroid patients who tested positive for this parasite and went into remission upon eradicating it.

How Is A Blastocystis Hominis Infection Diagnosed?

Blastocystis Hominis is typically tested for through the stool.

Treatment for Blastocystis Hominis

From a conventional treatment standpoint, Metronidazole is usually the first drug given, although other prescription drugs that may be given include trimethoprim-sulfamethoxazole, paromomycin, and furazolidone (20).  Some of the natural agents which can be effective in treating Blastocystis hominis include oregano oil, wormwood, clove, garlic, black walnut, and saccharomyces boulardii.  With regards to S. boulardii, one study involving symptomatic children with Blastocystis hominis showed that this was more effective than Metronidazole (21).

4. Candida.  Although Candida is listed here, it’s important to understand that Candida albicans are normal inhabitants of the skin, mucous membranes, gastrointestinal tract, and genitourinary tract.  But if something disrupts the gut flora then this can lead to a Candida overgrowth.  Many people are aware that taking antibiotics can increase the risk of developing a Candida overgrowth, but there can be other factors as well, including chronic stress, glucocorticoids, and even cigarette smoking.

In fact, anything that either suppresses the immune system or disrupts the good bacteria of the gut can lead to a Candida overgrowth.  Some of the symptoms associated with a Candida overgrowth include fatigue, brain fog, gastrointestinal symptoms, allergies, and joint pain.  Those with a moderate to severe Candida overgrowth will also commonly have a thick white coating on their tongue.  On the other hand, a thin white coating on the tongue is not an indication of a yeast infection.

There is controversy over whether Candida is a direct trigger of thyroid autoimmunity.  There is evidence in the research of Candida causing an increase in autoantibodies, although not specific to Graves’ Disease or Hashimoto’s Thyroiditis.  A Candida overgrowth can also cause an increase in proinflammatory cytokines, which is associated with autoimmunity.  However, an overgrowth of Candida can lead to an increase in intestinal permeability, which can make someone more susceptible to developing Graves’ Disease or Hashimoto’s Thyroiditis.

How Is A Candida Overgrowth Diagnosed?

I have found that the best way to test for a Candida overgrowth is through organic acids testing, which is a urine test that measures different metabolites related to yeast, with arabinose more specific to Candida albicans.  Blood and stool testing are also options, although false negatives are common with these methods.

Treatment for a Candida Overgrowth

Conventional treatment methods consist of prescription antifungals such as Nystatin or Diflucan.  Natural treatment usually involves a strict “Candida diet”.  Like most diets, this involves eating whole foods while avoiding the processed foods, although it also eliminates most sources of sugar, and in some cases all sources, including fruits.  It also is advised to minimize or eliminate starchy vegetables such as white potatoes, sweet potatoes, and winter squash.  Natural antifungals can also be beneficial, including oregano oil, caprylic acid, olive leaf, garlic, and uva ursi.

Conventional vs. Natural Treatments: Which Should You Choose?

If you test positive for one or more of these pathogens, you might have a difficult time deciding if you should take the conventional medical treatment approach, which usually involves taking prescription drugs, or if you should take a natural treatment approach.  Not surprisingly, in most cases I prefer a natural approach, although one has to consider the benefits and advantages of both.

For example, the advantage of taking prescription antibiotics or antifungals is that they usually work much faster than natural agents.  Another advantage is that in many cases it is less expensive to take a prescription drug when compared to purchasing nutritional supplements and herbs.  This is especially true for those who have health insurance coverage.

Of course one of the big downsides of prescription drugs is the potential side effects.  This is especially true with antibiotics, as while there is no question that they are sometimes necessary, they are overused.  This is why more and more bacteria are becoming resistant to antibiotics, and it also explains why multiple antibiotics are sometimes needed, which as mentioned earlier is the case with H. Pylori.

The reason why I prefer natural antimicrobials is because they are almost always less harsh on the body when compared to prescription drugs.  However, the fact that natural agents usually take longer to eradicate infections can’t be overlooked.

Although I prefer a natural treatment approach, my patients are the ones who ultimately make the decision.  For example, while I have recommended a natural treatment approach to many patients with different types of infections, recently I had a patient get diagnosed with H. Pylori, and not surprisingly her medical doctor recommended for her to take prescription antibiotics.  I explained the pros and cons, and since she wanted to eradicate H. Pylori quickly she chose to take the antibiotics, even though she realized that this would be harsher on her gut flora.  Keep in mind that some natural agents can also have a negative effect on the good bacteria, although they usually aren’t as harmful as prescription drugs.

In summary, infections can be an autoimmune trigger, and in this blog post I discussed four common gut infections in those with Hashimoto’s Thyroiditis.  These include Yersinia enterocolitica, H. Pylori, Blastocystis hominis, and a Candida overgrowth.  The last one isn’t considered an infectious process, but since it’s so common in people with Graves’ Disease and Hashimoto’s I decided to include it here.  When choosing between a conventional and natural treatment approach you need to consider the pros and cons of each, which I discussed in this blog post.

An ultrasound uses sound waves to develop images, and it is the most sensitive imaging modality available for examining the thyroid gland.  A thyroid ultrasound also has the benefit of being non-invasive, it doesn’t use ionizing radiation, and it is less expensive than other imaging techniques such as an MRI and CT scan.  But does this mean that everyone with a suspected or confirmed thyroid or autoimmune thyroid condition should consider getting a thyroid ultrasound?  I’ll of course answer this and other questions you may have in this blog post.

When I was diagnosed with Graves’ Disease, the endocrinologist I saw didn’t want to do a thyroid ultrasound.  After palpating my thyroid gland she didn’t detect any thyroid nodules, and while I appreciated her trying not to recommend any unnecessary tests, I talked her into doing a thyroid ultrasound.  Other than some thyroid swelling it came back clean, as I had no thyroid nodules.

Since I requested a thyroid ultrasound even though my endocrinologist didn’t think it was necessary, does this mean that I recommend for everyone with a thyroid or autoimmune thyroid condition to get an ultrasound?  I can’t say that I recommend for all of my patients to order a thyroid ultrasound.

The reason I chose to get a thyroid ultrasound is because I don’t think that palpating the thyroid gland is always sufficient to detect thyroid nodules.  But even if I had one or more thyroid nodules show up on an ultrasound, would I have done anything differently while taking a natural treatment approach?  The honest answer is probably not.  And even if I had one or more thyroid nodules, I probably would not have had them biopsied, although this would depend on the characteristics, which I’ll talk about shortly.

When Is A Thyroid Ultrasound Indicated?                         

According to the American Association of Clinical Endocrinologists (AACE), a thyroid ultrasound is indicated in the following situations (1):

1. To confirm the presence of a thyroid nodule when the physical examination is equivocal.  So if the physical exam is inconclusive for thyroid nodules then a thyroid ultrasound would be indicated.

2. To characterize a thyroid nodule.  In other words, to measure the dimensions accurately and to identify internal structure and vascularization.

3. To determine whether a thyroid nodule is benign or malignant.  Although an ultrasound can’t always differentiate between a malignant and thyroid nodule, sometimes this can be determined based on the appearance of the nodule.

4. To differentiate between thyroid nodules and other cervical masses.  While thyroid nodules are the main focus of a thyroid ultrasound, other masses that can show up include enlarged lymph nodes, a thyroglossal cyst, or a cystic hygroma.

5. To evaluate diffuse changes in the thyroid parenchyma.  What is the thyroid parenchyma?  The thyroid parenchyma is simply the tissues that comprise the thyroid gland.

6. To detect post-operative residual or recurrent thyroid tumor or metastases to the neck lymph nodes.  For example, if someone has thyroid surgery to remove a malignant nodule, then a follow-up thyroid ultrasound would understandably be indicated.

7. To screen high risk patients for a thyroid malignancy.  This includes people with a family history of thyroid cancer, or perhaps if someone had radiation exposure to their neck in childhood.

8. To guide diagnostic and therapeutic interventional procedures.  For example, if someone needs to get a biopsy of a thyroid nodule then an ultrasound may be used to help guide the placement of the needle within a nodule.

Getting Back To My Situation…

If you read the eight indications above then you’ll notice that the first one mentions that a thyroid ultrasound is indicated “to confirm the presence of a thyroid nodule when the physical examination is equivocal”.  When I received my thyroid examination the endocrinologist seemed pretty confident that I didn’t have any thyroid nodules, yet I overruled her and asked for a thyroid ultrasound anyway.  And even though I paid out of pocket for the ultrasound, I didn’t have any regrets, as I didn’t want to rely on the palpation skills of the endocrinologist, and I had peace of mind knowing that I didn’t have thyroid nodules.

But what approach would I have taken if the ultrasound revealed thyroid nodules?  Earlier I mentioned that if the thyroid ultrasound I received revealed one or more thyroid nodules I probably wouldn’t have done anything different with regards to the natural treatment protocol I followed.  I also mentioned how I probably wouldn’t have had a biopsy done.  However, one benefit is that I could have done a follow-up ultrasound in the future to monitor the thyroid nodules and make sure that they weren’t getting larger.

Ultimately the decision to request a thyroid ultrasound is up to you.  If the endocrinologist you are working with recommends an ultrasound due to one of the indications I listed above, then it probably is a good idea to get one.  On the other hand, if after palpating your thyroid gland they are confident that you don’t need a thyroid ultrasound, then it’s fine not to get one.  If you’re skeptical like I was and want to get one anyway then of course there is nothing wrong with politely asking the doctor.

You might think that the endocrinologist I was working with was willing to order the thyroid ultrasound because I’m a chiropractor, but I actually didn’t tell her my profession, and I didn’t put it down on the health history form.  The reason I didn’t let her know my profession is because I wanted to see how she treated someone who wasn’t a healthcare professional.  And I must admit that she was very pleasant to work with, although I only saw her for that single visit.  Probably the main reason she was willing to order a thyroid ultrasound is because not only did I ask her politely for it, as I told her that it would give me peace of mind, but she also knew that I was paying out of pocket for it.  As a result, from a health insurance perspective there was no concern as to whether the ultrasound was medically necessary.

Hashimoto’s, Graves’ Disease, and Thyroid Ultrasounds

What I’d like to do next is specifically talk about both Hashimoto’s Thyroiditis and Graves’ Disease, and when a thyroid ultrasound should be considered.  But wait, shouldn’t the indications I listed above apply to these two autoimmune thyroid conditions?  Well yes, these indications do apply, but there are other circumstances when getting a thyroid ultrasound might be a good idea, especially with Hashimoto’s Thyroiditis.

Hashimoto’s Thyroiditis.  Although the diagnosis of Hashimoto’s is usually confirmed by an elevated TSH combined with the presence of thyroid peroxidase and/or thyroglobulin antibodies, these antibodies are not always positive in those with Hashimoto’s.  When this is the case, getting a thyroid ultrasound can be beneficial, as many times this can confirm the presence of Hashimoto’s Thyroiditis.

Graves’ Disease.  Just as is the case with Hashimoto’s, most cases of Graves’ Disease are characterized by elevated thyroid antibodies…specifically TSH receptor antibodies, with the most common type being thyroid stimulating immunoglobulins.  While I can’t say that everyone with Graves’ Disease needs to get a thyroid ultrasound, I did want to mention that many doctors recommend for people with hyperthyroidism to get a radioactive iodine uptake test.  This involves taking a small dose of radioactive iodine, and the justification for this test is that a high uptake reading can confirm Graves’ Disease, and this test can also reveal if someone has thyroid nodules, and give an idea as to whether they are benign or malignant.

The reason why I’m not a big fan of this test is because 1) Graves’ Disease can usually be diagnosed by the presence of elevated thyroid stimulating immunoglobulins, and 2) a thyroid ultrasound can detect the presence of thyroid nodules, and can also give a good idea as to whether the nodules are benign or malignant.  And of course the thyroid ultrasound is less invasive than the radioactive iodine uptake test, which is why I’m more in favor of getting an ultrasound.

Understanding Ultrasound Terminology

Remember that ultrasound involves waves, which are formed in the head of the instrument the doctor or radiologist applies to the body, which is also known as a transducer.  Echogenicity of the tissue refers to the ability to reflect or transmit ultrasound waves in the context of surrounding tissues (2).  Based on echogenicity, a structure can be characterized as hyperechoic (white on the screen), hypoechoic (gray on the screen) and anechoic (black on the screen) (2).  Cartilage appears hypoechoic, including thyroid cartilage, and on an ultrasound Hashimoto’s Thyroiditis usually presents as diffuse enlargement of the thyroid gland, along with heterogeneous and hypoechoic parenchymal echo pattern.  Graves’ Disease actually presents with a similar pattern.  Thyroid blood vessels appear black or anechoic.

The thyroid gland is highly vascular, and certain types of ultrasound devices (i.e. Doppler ultrasound) can measure the vascularization of the thyroid gland, and so you might also see this on an ultrasound report.  Hypervascularization means that there is an increased blood flow to the area, while hypovascularization refers to a decreased blood flow.  Graves’ Disease is usually characterized by very high vascularity on an ultrasound.  While you might expect Hashimoto’s and hypothyroidism to be of low vascularity, most cases of hypothyroidism are also characterized by high vascularity.  If the ultrasound shows a small atrophied gland then this usually indicates that the person has had extensive damage to the thyroid gland, and this is sometimes referred to as “end stage” Hashimoto’s Thyroiditis.

What’s The Thyroid Ultrasound Pattern for Multinodular Goiter?

Although most of my patients have either Graves’ Disease or Hashimoto’s Thyroiditis, multinodular goiter is the most common cause of diffuse asymmetric enlargement of the thyroid gland (1).  Not surprisingly, in people with multinodular goiter a thyroid ultrasound will reveal a diffusely enlarged thyroid gland, along with multiple nodules.  I spoke about the vascularity of Graves’ Disease and Hashimoto’s, and the vascularity can help to differentiate multinodular goiter from a carcinoma, as someone who has thyroid nodules with an increased blood flow has a higher risk of malignancy (3).

More About Thyroid Nodules…

Although I have written separate articles on thyroid nodules and I don’t want to focus too much on this here, I do want to add that it is very common to have thyroid nodules.  So while I requested a thyroid ultrasound from my endocrinologist because I was concerned about having thyroid nodules, what I didn’t realize at the time was that more than 50% of people will have thyroid nodules on an ultrasound (4).  The good news is that most of these thyroid nodules are benign.  And so please don’t get stressed out if you have one or more thyroid nodules show up on an ultrasound.

While a thyroid biopsy is used to confirm whether a suspicious thyroid nodule is benign or malignant, one of the indications I listed earlier mentioned how a thyroid ultrasound can give an idea as to whether a thyroid nodule is benign or malignant.  And the way it does this is by looking at the following characteristics:

• The size of the nodule
• The presence of microcalcifications
• Irregular margins
• Solid composition
• Marked hypoechogenicity

So while a biopsy might be indicated to confirm whether a “suspicious” thyroid nodule is benign or malignant, most people who have one or more thyroid nodules don’t need to get a biopsy.  Plus, keep in mind that biopsies aren’t perfect, as they don’t always confirm or rule out a malignancy.  One more thing I want to add is that the presence of multiple nodules doesn’t increase the likelihood of a malignancy.  In other words, if someone has five thyroid nodules, each nodule will have an equal risk of being benign or malignant when compared to someone who has one or two nodules.

In summary, an ultrasound is the most sensitive imaging modality used to examine the thyroid gland.  Some of the indications for a thyroid ultrasound include to confirm the presence of a thyroid nodule when the physical exam is inconclusive, to characterize a thyroid nodule, and to differentiate between thyroid nodules and other cervical masses.  Many people with Graves’ Disease are told to get a radioactive iodine uptake scan when many times a thyroid ultrasound (along with testing the thyroid stimulating immunoglobulins) would be sufficient.  And sometimes an ultrasound can be used to diagnose Hashimoto’s Thyroiditis when the person has negative thyroid antibodies.

In past articles and blog posts I have briefly mentioned the triad of autoimmunity.  This is also known as the “three-legged stool” of autoimmunity, and it consists of a genetic component, an environmental trigger, and an increase in intestinal permeability (a leaky gut).  The theory is that all three of these are factors in the development of an autoimmune condition such as Graves’ Disease or Hashimoto’s Thyroiditis.  And if this is the case, then these factors need to be addressed when trying to restore someone’s health.

What I plan on doing in this blog post is to discuss the individual components of this triad, and hopefully give you a better understanding of what you can do to address the individual components.

Component #1: Genetics.  With regards to the three components of the triad of autoimmunity, genetics of course is the one component that can’t be modified.  This is the reason why I try not to use the word “cure” when I talk about treating these conditions naturally.  So when I talk about restoring one’s health back to normal, or reversing the autoimmune component, the goal is to get the person into a state of remission, and after this has been accomplished the next goal is to help them maintain a state of wellness.

But since the genetic component can’t be modified, you might wonder how it’s possible to get someone into a state of remission AND to help them maintain their health.  Perhaps this can best be explained by looking at a different autoimmune condition, Celiac disease.  With Celiac disease, the autoimmune trigger is gluten.  Of course I’ll talk in greater detail about environmental triggers shortly, but I’m bringing this up here because if someone with Celiac disease completely avoids gluten, then they will remain in remission from this autoimmune condition on a permanent basis.  This is true even though nothing can be done to change the genetics associated with Celiac disease.

Sticking with the example of Celiac disease, another thing to keep in mind is that just because someone has a genetic predisposition for Celiac disease doesn’t mean they will develop this condition.  In fact, even if someone with the genetic markers for Celiac disease eats gluten, this doesn’t guarantee that they will develop Celiac disease.  It’s a similar situation with those people who have Graves’ Disease and Hashimoto’s Thyroiditis.  Those with a genetic marker for these conditions, as well as other autoimmune conditions, won’t necessarily develop the specific condition unless they are exposed to an environmental trigger and they also have a leaky gut.

Component #2: Environmental trigger.  As I just discussed, while having a genetic predisposition seems to be necessary for the development of thyroid autoimmunity, other factors are also necessary, which of course is the basis behind the “triad of autoimmunity”.  So in addition to having a genetic predisposition, an environmental trigger is also necessary to cause the development of Graves’ Disease or Hashimoto’s Thyroiditis.  Earlier I spoke about Celiac disease, and unlike most other autoimmune conditions, with Celiac disease we know that the environmental trigger is gluten.  And while it’s not easy for many people to completely avoid gluten, it still is a huge advantage knowing what the specific autoimmune trigger is.

This is what makes it challenging to help people with other types of autoimmune conditions, including Graves’ Disease and Hashimoto’s Thyroiditis.  With these conditions the environmental trigger can differ from person to person.  The following are just a few examples of environmental triggers of thyroid autoimmunity:

• Stress
• Foods (i.e. gluten)
• Bacterial Infections (i.e. H. Pylori)
• Viral infections (i.e. Epstein Barr)
• Parasites (i.e. Blastocystic Hominis)
• Environmental toxins (i.e. mercury)
• Overtraining

So how do you find the environmental trigger?  As I mentioned earlier, this can be challenging, but it’s usually accomplished through a combination of a good health history and the appropriate testing.  For example, when I was diagnosed with Graves’ Disease, stress was a big factor in the development of my condition.  And this was verified through an adrenal saliva test I ordered, which showed that I had depressed cortisol levels, a depressed DHEA, and a depressed secretory IgA.  And while stress is a big factor with many others with autoimmune thyroid conditions, some people have other triggers.

Sometimes the person will test positive for multiple triggers.  For example, someone might choose to get an adrenal saliva test along with a comprehensive stool panel, and the results of the two tests reveal compromised adrenals and multiple infections.  Of course it is possible that only one of these factors was the “true” environmental trigger, but it’s challenging to know which is the primary trigger, and of course either way the goal should be to address all of these imbalances.  In other words, if someone has both adrenal problems and an infection, while it’s possible that dealing with a lot of stress weakened the person’s immune system and led to an infection, which in turn was the autoimmune trigger, the goal should be not only to eradicate the infection, but to help the person improve the health of their adrenals.

Component #3: Leaky gut.  Dr. Alessio Fasano is the researcher who came up with the theory that having an increase in intestinal permeability is a necessary factor in autoimmunity.  A few years ago I admittedly questioned this theory in a blog post I wrote entitled “Is a Leaky Gut Present In All Autoimmune Thyroid Conditions?”  A number of years ago I did more frequent testing for a leaky gut on my patients, and in this post I discussed how some people with elevated autoantibodies tested negative for a leaky gut, which either meant that the testing wasn’t completely accurate, or that Dr. Fasano’s theory was incorrect.

This blog post was written almost three years ago, and while Dr. Fasano’s theory still hasn’t been proven, it is widely accepted by many well known healthcare professionals.  And I agree that the mechanisms behind it make sense, which is why these days I don’t frequently test my patients for a leaky gut, and instead assume that this is a factor in those with Graves’ Disease and Hashimoto’s Thyroiditis.  After all, everything comes down to risks vs. benefits, and in my opinion it’s a greater risk to not give gut support to someone who has a leaky gut than to put someone who might not have a leaky gut on a gut repair protocol.  In other words, it isn’t harmful to treat someone for a leaky gut, even if they don’t have a leaky gut.

Removing The Leaky Gut Trigger

It’s important to understand that in order to heal the gut, it’s also necessary to find out the factor which caused the leaky gut in the first place.  This is where it can get confusing at times, as the “leaky gut trigger” can be the same as the environmental trigger I mentioned above, although this isn’t always the case.  For example, earlier I spoke about Celiac disease, and in this case gluten not only is the environmental trigger, but gluten also has been proven to cause an increase in intestinal permeability in everyone, regardless of whether or not they have a sensitivity to gluten.  In any case, with Celiac disease, gluten is both the “environmental” trigger and the “leaky gut” trigger.

However, there are situations where the leaky gut trigger might differ from the environmental trigger.  For example, someone with a genetic predisposition to Graves’ Disease or Hashimoto’s Thyroiditis might have a history of taking antibiotics, which can cause a leaky gut.  So this person has a genetic predisposition and a leaky gut, but the autoimmune process hasn’t started yet since they haven’t been exposed to an environmental trigger.  Then one day this person gets infected with Yersinia enterocolitica, which in this case is the environmental trigger, and they develop thyroid autoantibodies.  So in this example the antibiotics were the “leaky gut trigger”, but not the environmental trigger.

Differentiating Between The Environmental and Leaky Gut Trigger

The truth is that it can be challenging to differentiate between the environmental and leaky gut trigger.  In the example given above, while the excessive use of antibiotics might have caused the leaky gut, it’s also possible that the infection (Yersinia enterocolitica) caused the leaky gut.  So while gluten is both the environmental trigger and the leaky gut trigger in Celiac disease, it’s probably safe to say that in many cases of Graves’ Disease and Hashimoto’s Thyroiditis, the environmental trigger and the leaky gut trigger are also the same, although this isn’t always the case.  Hopefully you don’t find this to be too confusing, but the overall point is that the ultimate goal should be to remove anything that can be either an environmental trigger or a leaky gut trigger.

What Is Still Unclear About Environmental Triggers

While over the last decade we have learned a lot more about the different environmental triggers associated with autoimmunity, there is still a lot we don’t know.  For example, the research shows that Yersina Enterocolitica is a potential trigger of both Graves’ Disease and Hashimoto’s Thyroiditis (1) (2).  However, does this mean that everyone who has a genetic predisposition for thyroid autoimmunity and also has a leaky gut will develop Graves’ Disease or Hashimoto’s when exposed to this specific bacteria?

It would seem that this isn’t the case.  For example, not everyone who has a genetic predisposition to Hashimoto’s or Graves’ Disease has a negative reaction to iodine.  So this is one example of an environmental trigger which doesn’t trigger thyroid autoimmunity in everyone with a genetic predisposition (and a leaky gut).

Another example involves gluten, as this seems to be an environmental trigger in some people with autoimmune thyroid conditions, but not others.  In fact, you might have read posts in Facebook groups or in forums from people with Graves’ Disease or Hashimoto’s Thyroiditis who got into remission upon eliminating gluten alone.  On the other hand, there are people who have gone 100% gluten free for many months without getting into remission, which suggests that gluten isn’t an environmental trigger in everyone.  However, I did mention earlier that the research shows that gluten can cause a leaky gut in everyone.  So it can be argued that gluten is a leaky gut trigger in everyone, but not necessarily an environmental trigger in everyone.

Addressing The Triad To Achieve A State of Remission

In order for anyone with Graves’ Disease and Hashimoto’s Thyroiditis to achieve a state of remission it is necessary to identify and remove the environmental trigger, and to do things to heal the leaky gut.  The good news is that achieving this is very possible, but the bad news is that a relapse is also possible in those that don’t continue to live a healthy lifestyle.  For example, if stress was a big factor in the development of your autoimmune thyroid condition, while you can’t completely eliminate the stress from your life, you can do things to improve your stress handling skills.

Similarly, if the environmental trigger was an infection such as H. Pylori or Blastocystis Hominis, while getting rid of this infection is important, doing things to improve the health of the immune system is also necessary to prevent these and other infections from reoccurring in the future.  Improving the health of the immune system is perhaps even more important if the trigger was a viral infection such as Epstein Barr, which can’t be eradicated, but can be kept in a dormant state.  Of course since most people have been infected with Epstein Barr it can be argued that it is critical for everyone to do everything they can to have an optimally-functioning immune system.

And of course in order to have a healthy immune system you need to have a healthy gut, and so healing the leaky gut is not only essential to get into remission, but it’s also a necessary component of a healthy immune system.  As for how to heal a leaky gut, in addition to removing the “leaky gut trigger” you also want to heal the gut, which can be accomplished through both food and supplementation.  I’m not going to get into detail about this here, as I have discussed this in other articles and blog posts.

In summary, the triad of autoimmunity theorizes that three factors are necessary to develop any autoimmune condition.  These include a genetic predisposition, an environmental trigger, and a leaky gut.  Although not being able to modify the genetic component is the reason why we can’t cure conditions such as Graves’ Disease and Hashimoto’s Thyroiditis, the expression of our genes can change, and we of course can address the other two components, which can put the person into a state of remission.  And it is also is very possible to maintain a state of wellness by having a healthy gut and minimizing your exposure to environmental triggers.