Recently I wrote an article entitled “Low Dose Naltrexone and Thyroid Autoimmunity”.  In the article I discussed how more and more medical doctors are prescribing low dose naltrexone (LDN) for autoimmune conditions such as Graves’ Disease and Hashimoto’s Thyroiditis.  I also discussed some of the risks associated with this medication.

While in most cases the benefits of LDN outweigh the risks, it’s still not something I usually recommend initially to my patients.  And the main reason for this is because it’s not addressing the cause of the problem, and quite frankly, most people don’t need to take it.  However, there are some cases when I will recommend LDN to my patients.  One of these situations is when someone has severe symptoms that aren’t being managed through conventional or natural treatment methods.  Let’s look at a few situations when LDN might be a good option:

Scenario #1: Someone with hyperthyroidism or Graves’ Disease who isn’t able to effectively manage their symptoms with herbs such as bugleweed and motherwort, and isn’t able to take antithyroid medication due to side effects they experience.

Scenario #2: Someone with hypothyroidism or Hashimoto’s Thyroiditis who is still very symptomatic despite taking thyroid hormone medication and following a natural treatment approach.

Of course there are other situations when LDN might be worth giving a try, but these are two common scenarios.  In any case, besides not doing anything to address the cause of the problem, another downside of LDN is that it doesn’t work in everyone who takes it.  I personally have seen mixed results for those patients with Graves’ Disease and Hashimoto’s Thyroiditis who have taken LDN.  I’ve seen some autoimmune thyroid patients significantly lower their thyroid antibodies when taking LDN, but there are also people who took LDN and didn’t show any improvement.

When LDN doesn’t work there can be a few different reasons why this is the case.  One reason is due to low or depressed vitamin D levels.  Another reason can be due to having a Candida overgrowth.  Both of these are common problems, and ideally should be addressed before someone takes LDN.  However, there are some people who have taken LDN and didn’t receive good results, even with healthy vitamin D levels, and without an overgrowth of Candida.

The main purpose of this blog post is get the feedback of others with Graves’ Disease and Hashimoto’s Thyroiditis who took LDN.  If you took LDN and if it benefited you please let me know!  If you took LDN and didn’t notice any positive changes please let me know!  And if you took LDN and had any negative side effects please let me know!  Thank you so much for sharing your experience with others.

Many people with  Graves’ Disease have thyroid eye disease, which is also known as Graves’ ophthalmopathy or Graves’ orbitopathy.   While dealing with Graves’ Disease alone can be scary, it can be even more stressful to experience eye symptoms associated with this condition, including eye swelling, pain, bulging, and double vision. I have written a few other blog posts and articles in the past on thyroid eye disease, but I figured I’d put some of the more important information in this “5 Things To Know” blog post.

1. Like Graves’ Disease, thyroid eye disease is an immune system condition.  Thyroid eye disease involves the immune system attacking the tissues of the eyes.  Most people with moderate to severe eye symptoms will have very high thyroid stimulating immunoglobulins.  Since the immune system is the main factor with thyroid eye disease, the primary goal should be to detect and remove the autoimmune trigger.  Below I’ll talk about some conventional and natural anti-inflammatory agents that can help reduce the inflammation associated with thyroid eye disease, but in order to reverse thyroid eye disease you need to detect and remove the autoimmune trigger.

So how do you find and remove the autoimmune trigger?  Well, I’ve discussed this in greater detail in other articles.  But two of the main methods healthcare professionals use are a comprehensive health history, along with the proper testing.

2. Radioactive iodine can worsen thyroid eye disease. Numerous studies show that radioactive iodine is associated with an increased risk of thyroid eye disease (1) (2) (3).  It’s important to understand that not only can radioactive iodine treatment exacerbate an existing case of thyroid eye disease, but since many cases of thyroid eye disease are subclinical, receiving radioactive iodine can lead to the development of overt eye symptoms in someone who was previously asymptomatic.  One of these studies showed that taking oral glucocorticoids did not prevent the activation of thyroid eye disease after radioactive iodine (3).  However, intravenous glucocorticoids were effective, although keep in mind that the study was small, involving only nine patients (3).

This doesn’t mean that everyone with thyroid eye disease will experience a worsening of their eye symptoms upon receiving radioactive iodine treatment.  Some people with this condition have received radioactive iodine and didn’t experience any problems.  But since it’s impossible to predict who will do fine, and who will have an exacerbation of their eye symptoms, this isn’t a decision you want to take lightly.

3. Moderate to severe thyroid eye disease isn’t always reversible.  The good news is that most cases of thyroid eye disease are mild or subclinical.  However, some people do experience problems such as exophthalmos, conjunctival edema, or ophthalmoplegia, and a very small percentage experience optic nerve compression.  Can these problems be reversed through natural treatment methods?  It really does depend on the person.  For example, if some has moderate to severe exophthalmos then this might not be completely reversible.  Similarly, surgical decompression is necessary in some people who experience optic nerve compression.

4. High dose natural anti-inflammatory agents can help with the symptoms.  Since inflammation is a big factor in thyroid eye disease, it makes sense to do things that will help to reduce the inflammation associated with this condition.  From a conventional medical standpoint, prednisone is commonly recommended for those with thyroid eye disease.  Although taking a corticosteroid such as prednisone might be required in severe cases of thyroid eye disease that involve optic nerve compression, most people don’t need to take this drug.

Can natural anti-inflammatory agents help to reduce the symptoms associated with thyroid eye disease?  When a patient of mine is dealing with thyroid eye disease I do commonly recommend natural anti-inflammatory agents.  In fact, I commonly recommend natural anti-inflammatory agents to just about all of my patients with Graves’ Disease.  But if someone has moderate to severe eye symptoms then I will get more aggressive.  In other words, I will usually give higher doses of certain supplements and herbs to patients with moderate to severe thyroid eye disease.  I spoke about this in greater detail in a different blog post entitled “What Supplements Can Help With Thyroid Eye Disease?”, but below I’ll also list some of the supplements that can be beneficial in higher doses:

• Fish oils
• Gamma linolenic acid
• Turmeric
• Resveratrol
• Vitamin D

This doesn’t mean you need to take all of these that I listed here.  I recommend for most of my patients to take a fish oil supplement, and I commonly recommend gamma linolenic acid as well, which you can find in borage oil, black currant seed oil, and evening primrose oil.  Getting back to the fish oils, some people question why I don’t recommend another type of omega-3 fatty acid such as cod liver oil or krill oil.  And the reason is because these typically won’t have high enough levels of EPA and DHA to combat the inflammation.  I usually recommend a minimum of 2,000 mg of EPA and 1,000 mg of DHA per day.

There is a lot of research with both turmeric and resveratrol as anti-inflammatory agents.  But once again, larger doses are usually required to help with the symptoms of thyroid eye disease.  For example, someone might need to take 2,000 mg or more of turmeric in the form of a curcumin supplement.  You also want to make sure you have healthy levels of vitamin D.  I recommend for lab values to be at least 50 ng/mL (125 nmol/L), and between 60 and 80 ng/mL might be even more beneficial.

Keep in mind that taking high doses of these anti-inflammatory agents alone frequently isn’t sufficient to completely eliminate the symptoms of thyroid eye disease.  As I mentioned earlier, you also must detect and then remove the autoimmune trigger.  This is also the case with corticosteroids such as prednisone, as these drugs don’t do anything to address the cause of the problem.

5. There is a good amount of research involving selenium and thyroid eye disease.  I’m not going to discuss this in detail, as I have written a separate article on this entitled “Can Taking Selenium Help To Reverse Thyroid Eye Disease?”  But the way selenium seems to help is by reducing oxidative stress that is associated with thyroid eye disease.  And the way it accomplishes this is by forming selenoproteins, which are powerful antioxidants.  Many reading this are familiar with glutathione, which is an antioxidant that is dependent on these selenoproteins.  So if you have a selenium deficiency, this will result in low levels of selenoproteins, along with low glutathione levels, which can be very problematic in someone who has a lot of oxidative stress.

You might wonder if you can help to reduce oxidative stress by taking a glutathione supplement.  The answer is “yes”, as taking an acetylated or liposomal form of glutathione can help to reduce the oxidative stress associated with thyroid eye disease.  However, since healthy selenium levels are required for healthy glutathione levels, it’s important to make sure you have sufficient selenium levels as well.  But since selenium toxicity is a concern you don’t want to take too high of a dosage of selenium, which I discuss in greater detail in the separate article I wrote on selenium and thyroid eye disease.

Should You Choose A Natural Treatment Approach?

After reading this blog post you might not be sure if taking a natural treatment approach is the best option for your thyroid eye disease condition.  After all, I mentioned how taking natural anti-inflammatory agents and selenium can help, but I also explained the importance of detecting and removing the autoimmune trigger.  And so it can be challenging to overcome thyroid eye disease naturally.

However, I do think that most people with thyroid eye disease should consider taking a natural treatment approach.  And the reason for this is because the conventional medical treatment methods don’t do anything to address the underlying cause of the condition.  So for example, if you choose to receive radioactive iodine or a thyroidectomy, not only is there a chance that your thyroid eye disease symptoms can worsen (especially with RAI), but neither of these procedures will do anything to improve the health of your immune system.  And as I have mentioned in previous blog posts and articles, the research clearly shows that someone with one autoimmune condition is more likely to develop other autoimmune conditions in the future.

So hopefully you have a better understanding of thyroid eye disease.  Just remember that this is an immune system condition, and so while it’s understandable to do things to help manage the eye symptoms, it’s also necessary to address the autoimmune component.  And while conventional medical treatment methods sometimes are necessary, hopefully you’ll consider trying some of the natural treatment options I discussed in this blog post.  But in addition to using natural anti-inflammatory agents and selenium to help manage the symptoms, you also want to do everything you can to detect and remove the autoimmune trigger.

When someone with Graves’ Disease or Hashimoto’s Thyroiditis takes a natural treatment approach, the ultimate goal is to achieve a state of remission.  But one of the questions I commonly get asked is “how can someone tell if they are in remission?”  In this blog post I am going to discuss what someone should expect when they reach this state.  I’ll also discuss what you can do to maintain a state of wellness once remission has been achieved.

Before I talk about this, I’ll admit that I don’t like the word remission.  I like the word “cure” much better, as it of course sounds better to say “my autoimmune thyroid condition has been cured”, rather than say that “my autoimmune thyroid condition is in remission”.  While I have been guilty of using the word “cure” in the past, since genetics plays a role in the development of autoimmune thyroid conditions, the word remission is more appropriate.  However, I like to aim for a “permanent” remission, which is the next best thing to a cure.

The Difference Between Cancer And Thyroid Autoimmunity

If you visit www.cancer.gov they explain the difference between cure and remission with regards to cancer.  They mention that a “cure” means that there are no traces of cancer after treatment and the cancer will never come back.  On the other hand, they label “partial” remission as meaning the signs and symptoms of cancer have been reduced, whereas in complete remission the signs and symptoms of cancer have completely disappeared.  And when it has been completely gone for at least five years this is frequently labeled as being a cure.

But then they go on to say that even after five years there is a chance that the cancer can come back.  And when cancer returns after five years then a so-called cure was essentially a prolonged remission.  And I’d say that there are similarities between cancer and thyroid autoimmunity, as someone like myself who has been in remission for over five years is less likely to relapse than someone who has been in remission for less than five years.  But I’ve also worked with people who have been in remission for over five years and relapsed, which is why I can’t honestly say there is a permanent “cure” for thyroid autoimmunity.  On the other hand, there is a chance to achieve remission and stay there without relapsing, which is why I prefer to use the term permanent remission.

3 Signs That You Have Achieved A State Of Remission

So how do you know when you have achieved a state of remission?

1. Your symptoms have completely resolved.  One of the main goals is to get complete resolution of your symptoms.  For example, when I was dealing with Graves’ Disease I had an elevated resting heart rate, palpitations, tremors, weight loss, an increased appetite, and a few other symptoms.  All of these symptoms eventually resolved upon taking a natural treatment approach, and the same thing occurs with most of my Graves’ Disease patients.  And of course the same goal applies to my patients with hypothyroidism and Hashimoto’s Thyroiditis.

While most people who take responsibility for their health receive great results, unfortunately not everyone who follows a natural treatment protocol will get complete resolution of their symptoms.  Why is this the case?  When someone doesn’t get into remission, in most cases it’s because the underlying cause of their condition hasn’t been addressed.  Thyroid autoimmunity can be challenging, and finding the autoimmune trigger isn’t always easy.

But symptom resolution doesn’t always come down to finding and removing triggers, as sometimes certain imbalances can’t be completely resolved.  For example, if someone with Graves’ Disease or Hashimoto’s Thyroiditis has small intestinal bacterial overgrowth (SIBO) due to damage to the migrating motor complex, which in turn is caused by an autoimmune process, not everyone will have complete resolution of their symptoms.  This doesn’t mean that tremendous improvement isn’t possible, but a person in this situation might still have some mild symptoms after treating SIBO, and in order to prevent SIBO from coming back they might need to take prokinetics on a continuous basis after treatment.

2. Your thyroid panel and other blood tests are normal.  Of course we want the thyroid panel to normalize, and this includes the thyroid antibodies.  But other markers that were out of range initially should normalize as well.  For example, if someone had low or depressed vitamin D levels upon starting the natural treatment protocol, then upon restoring their health this should be within a healthy reference range.  If someone has elevated liver enzymes, which is common with hyperthyroidism, then these should normalize upon remission.

It’s important to understand that certain markers on a blood test might be important to normalize, but at the same time don’t directly relate to your condition.  And if this is the case, then these markers might remain out of range, even if someone is in a state of remission.  For example, some people will have an elevated homocysteine, but this doesn’t always directly relate to one’s thyroid or autoimmune thyroid condition.  This doesn’t mean that we don’t want to do things to lower the person’s homocysteine, but my point is that it’s possible to be in remission even with elevated homocysteine levels.  However, one wouldn’t be in an optimal state of health in this situation.

By the way, I’m not suggesting that having a high homocysteine level isn’t significant, but only that it might not be directly related to one’s thyroid or autoimmune thyroid condition.  However, an elevated homocysteine level indicates problems with methylation, which can be a factor.  I spoke about homocysteine and methylation in an article entitled “Methylation, MTHFR, and Thyroid Health”.

3. Other tests have normalized.  When I was dealing with Graves’ Disease I obtained an adrenal saliva panel, and the initial test results revealed depressed cortisol levels, a depressed DHEA, and a depressed secretory IgA.  All of these markers eventually normalized, and I expect the same with my patients who have compromised adrenals.  If someone tests positive for a gut infection in the blood or stool, such as H. Pylori or Blastocystis Hominis, then of course you want them to test negative for this in the future.

Does this mean all tests need to be perfect before someone achieves a state of remission?  Just as is the case with the high homocysteine example I gave above, some markers are more significant than others.  Let’s look at a different example that relates to testing the sex hormones.  If someone has low levels of progesterone and testosterone, even though these low levels are causes of concern, it still is possible to get into a state of remission.  However, a person with low or depressed hormone levels isn’t in an optimal state of health, and if chronic stress is the cause of the low sex hormones then this can prevent the person from maintaining a state of wellness.

How Can You Maintain A State of Remission?

So once you have achieved a state of remission, how can you maintain your health?  I admit that maintaining a state of wellness can be a challenge, especially initially.  But even after being in remission for many years there still is always a chance of a relapse.  However, doing the following will greatly increase the chances of maintaining a state of wellness:

1. Continue to eat well most of the time.  What do I mean by “most of the time”?  In other words, does the 80/20 rule apply here where someone can eat healthy 80% of the time, and indulge 20% of the time?  The truth is that it depends on the person, as some people are able to get away with eating “bad foods” more than others, while others need to eat more strictly in order to maintain a state of wellness.  But since you won’t know what you can get away with when you’re in remission I wouldn’t indulge too much…at least not initially.  I definitely don’t eat a perfect diet, but I do try to eat healthy most of the time.

In addition, over the last couple of years I’ve been following a 21-day liver detoxification program three or four times per year.  And while eliminating toxins is important, during the 21 days I also follow a very strict diet.  And so essentially I’m following a gut repair diet for 21 days.  As a result, even if I get into a bad eating spell, which I admit does happen every now and then, I can count on giving my body a 21-day break every three or four months.  Once again, this doesn’t mean I eat poorly for 3 or 4 months and then go on a 21-day liver detoxification, as I do try to eat well most of the time in between.

2. Always work on stress handling.  Stress was a big factor in the development of my Graves’ Disease condition, and it’s a factor with many of the people I work with.  In fact, when someone relapses it frequently is due to chronic stress.  This might be a concern to some people reading this, mainly because stress is a factor with just about everyone.  This is true, and this is why managing your stress is important.

However, just as is the case with diet, this doesn’t mean that you need to be perfect in the stress department.  And while completely getting rid of your stressors isn’t feasible, improving your stress handling skills is something you can do.  I’m not suggesting that it’s easy to do, but just like anything else you need to block out the time to do it and get into a routine.  If necessary I’d start by blocking out five minutes per day, and make sure you choose some type of mind body medicine that you enjoy doing.  Then once you’re in the routine of blocking out five minutes per day for stress management you can work on increasing the duration.

3. Minimize your exposure to other autoimmune triggers.  Sometimes this is easier said than done.  For example, in addition to food allergens and stress, two other potential autoimmune triggers include environmental toxins and infections.  While avoiding certain foods and improving your stress handling skills can be challenging, it’s impossible to avoid all of the environmental toxins you’re regularly exposed to.  And it’s not always possible to prevent an infection such as H. Pylori, Blastocystis hominis, Lyme disease, etc.  In the case of environmental toxins you obviously won’t be able to avoid exposure to every chemical out there, but you can do a lot of things to change your home environment, which can help a great deal.  And you can also do regular detoxifications like I do.

Just keep in mind that your body is always detoxifying, and so while every three or four months I personally follow a 21-day program to further support my detoxification pathways, you don’t necessarily have to take this approach.  Eating healthy foods on a daily basis, especially plenty of vegetables, will help to support your detoxification pathways.  If you have access to an infrared sauna then this can also help with the elimination of toxins.  And so in no way am I suggesting that most people need to follow three or four 21-day liver detoxifications per year.

With regards to preventing infections, the best way to do this is to improve the health of your immune system.  And of course this is the main goal for anyone who has Graves’ Disease or Hashimoto’s Thyroiditis, although even if you have a thyroid condition that doesn’t have an autoimmune component you still want to have a healthy immune system.  As for how to achieve a healthy immune system, I talk about this in other articles and blog posts, but I will say that following some of the advice given in this post will greatly help.

4. Get sufficient sleep.  Once you achieve a state of remission, in order to maintain a state of wellness you also want to get sufficient sleep on a consistent basis.  This doesn’t mean that staying up late once in awhile will cause you to relapse, but most people need to get at least a minimum of six or seven hours sleep each night, and many people do better getting seven or eight hours of sleep each night.  And “catching up” on sleep doesn’t work.  For example, if you only get four hours sleep Monday through Friday, and then sleep 10 to 12 hours on Saturday and Sunday, the extra sleep on the weekend isn’t going to compensate for the sleep deprivation during the week.

In summary, the primary goal of following a natural treatment protocol should be to achieve a state of permanent remission.  Three signs that you have achieved remission include 1) complete resolution of your symptoms, 2) normalization of your thyroid panel and other blood tests, and 3) normalization of other tests.  As for how to maintain a state of remission, you of course want to eat well most of the time, you should always work on improving your stress handling skills, minimize your exposure to other autoimmune triggers, and you also need to get sufficient sleep on a regular basis.

Recently I attended an autoimmune conference via livestream, and one of the presenters was talking about the different herbs that can be beneficial in people with autoimmune conditions.  One of the herbs he spoke about highly was ashwagandha, which is an herb I absolutely love.  However, ashwagandha is also a member of the nightshade family, and those with autoimmune conditions are supposed to avoid nightshades.  And so the question I plan on answering in this blog post is whether or not those with autoimmune thyroid conditions should avoid taking ashwagandha.

But before I answer this question, I first want to answer this question: why would someone with an autoimmune thyroid condition want to take ashwagandha in the first place?  Ashwagandha, which is also known as Withania somnifera, is an adaptogenic herb.  It helps to support both the hypothalamic-pituitary-adrenal (HPA) and hypothalamic-pituitary-thyroid (HPT) axes.  As a result, it can help people who have HPA axis dysregulation as a result of chronic stress, and by supporting the HPT axis it can also help to support thyroid function.

However, we need to remember that Graves’ Disease and Hashimoto’s Thyroiditis aren’t thyroid conditions, but are autoimmune conditions.  And so we also need to consider the effects of ashwagandha on the gut and immune system.  In the opening paragraph I mentioned how ashwagandha is part of the nightshade (Solanaceae) family, and how nightshades are excluded from an autoimmune Paleo diet.  But while it might make sense to avoid nightshade vegetables since they have compounds which can cause inflammation, does it make sense to avoid an herb like ashwagandha that has anti-inflammatory properties?  I’ll answer this question later on in this post.

What Are Some of The Health Benefits Of Ashwagandha?

If you’re wondering why ashwagandha is commonly recommended by healthcare professionals, it’s because this herb has many different health benefits.  Here are just a few of the benefits of ashwagandha:

Helps With Stress and Anxiety.  This is probably the main reason why many natural healthcare professionals recommend ashwagandha.  Without question this is one of the primary reasons why I sometimes recommend ashwagandha to my patients, as besides seeing some wonderful benefits of ashwagandha in some of my patients, the research shows that ashwagandha can help people to better adapt to stress and anxiety (1) (2).  Of course taking ashwagandha isn’t meant to be a replacement for eating well and incorporating mind body medicine techniques, but it can help to provide additional support in those who are dealing with high levels of stress and anxiety.

Modulates the Immune System and Reduces Inflammation.  This is one of the main arguments for using ashwagandha in those with autoimmune conditions.  Even though this herb is part of the nightshade family, and while nightshades can cause inflammation in some people, there is a lot of research which shows that ashwagandha has anti-inflammatory properties (3) (4) (5).  And some of these studies even involve autoimmune conditions, such as rheumatoid arthritis (6) (7).  One of these studies showed how ashwagandha significantly suppressed lipopolysaccharide (LPS) induced production of proinflammatory cytokines TNF-alpha, IL-1beta, and IL-12p40 in both normal individuals and patients with rheumatoid arthritis (7).  Another study showed that ashwagandha can help with chronic renal dysfunction by reducing inflammation (8).

Helps With Insomnia.  Ashwagandha also can help some people who are dealing with insomnia.  One way it does this is by lowering cortisol levels, although one study showed that this herb might help with insomnia by increasing levels of the neurotransmitter GABA (9).  However, a recent study from 2017 shows that triethylene glycol, which is an active component of ashwagandha, might be a sleep-inducing component of this herb (10).  However, the study mentioned that this component is in the leaves of ashwagandha, and usually the root is used in most ashwagandha supplements.

Improves Sexual Function and Fertility.  One study I came across showed that ashwagandha can help to improve sexual function in women (11).  I’m sure some of this is due to the effect of ashwagandha on the HPA axis, as in order to have healthy sex hormones you need to have healthy adrenals, and for more information on this I would read a blog post I wrote entitled “The Negative Impact of The Pregnenolone Steal“.  There is also evidence that ashwagandha can help males with a low sperm count (12).

Cognition.  A few studies show that ashwagandha can help to improve cognition and might even be helpful with certain neurodegenerative diseases, including Alzheimer’s disease (13) (14) (15).

Muscle strength and recovery.  One study I came across showed that taking an ashwagandha supplement is associated with significant increases in muscle mass and strength (16).

A Few Things To Know Before Purchasing An Ashwagandha Supplement

There are a few things you should know before you purchase an ashwagandha supplement.  First of all, you want to make sure you are purchasing a supplement that uses ashwagandha root.  Although most manufacturers of ashwagandha supplements do use the root, there are some that solely use ashwagandha leaves.  And while I did mention the study earlier that spoke about how triethylene glycol is found in the leaves, most of the studies demonstrating the beneficial effects of ashwagandha have used the root.  Of course if you can find a formulation that has both the leaves and the root then this is an option to consider, although using a product that just has the root should be fine in most cases.  In addition, typically the higher the concentration of withanolides the better, and this should be listed on the product label.

Why Are Nightshades Excluded From An Autoimmune Paleo Diet?

For more detailed information on nightshades you can read an article I wrote entitled “Nightshades and Thyroid Health”.  The main problem with nightshades is that they have compounds which can cause problems  in those with autoimmune conditions.  These compounds include lectins, alkaloids, and glycoalkaloids.  And the reason why these are problematic is because they can cause inflammation, and in some cases can even lead to an increase in intestinal permeability.  In other words, consuming nightshades might cause or contribute to a leaky gut, which is theorized to be a factor in all autoimmune conditions.

Based on this information it makes sense to look at some of the compounds found in ashwagandha.  According to the research, the roots of ashwagandha contain several alkaloids, withanolides, a few flavanoids and reducing sugars (17) (18) (19).  The active compounds reported in ashwagandha include the following (19):

• Sitoindosides VII–X
• 5-dehydroxywithanolide-R
• Withasomniferin-A, 1-oxo-5β
• 6β-epoxy-witha-2-ene-27-ethoxy-olide
• 4-(1-hydroxy-2,2-dimethylcyclpropanone)-2,3-dihydrowithaferin A
• 2,3-dihydrowithaferin A
• 24,25-dihydro-27-desoxywithaferin A
• Physagulin D (1→6)-β-d-glucopyranosyl-(1→4)-β-d-glucopyranoside
• 27-O-β-d-glucopyranosylphysagulin D
• Physagulin D, withanoside I–VII
• 27-O-β-d-glucopyranosylviscosalactone B
• 4,16-dihydroxy-5β
• 6β-epoxyphysagulin D
• Viscosalactone B
• Diacetylwithaferin A

Although I did do some research on these compounds, I admit that I need to do more.  I didn’t realize how many active compounds are in ashwagandha.  From the research I have done so far, most of these compounds should be beneficial in people with Graves’ Disease and Hashimoto’s Thyroiditis.  After all, the compounds in ashwagandha can help those dealing with stress and anxiety, which describes many people with these conditions.  And of course ashwagandha can have a positive effect on immune system health by decreasing inflammation, which is also a factor in thyroid autoimmunity, as well as other autoimmune conditions.

However, even though these compounds have beneficial effects, this doesn’t mean that everyone with an autoimmune thyroid condition can safely take ashwagandha.  If you do some searching on your own you’ll no doubt find some people with autoimmune conditions who had negative symptoms when taking ashwagandha.  On the other hand, you’ll also come across people with Graves’ Disease and Hashimoto’s Thyroiditis who have benefited from taking ashwagandha.  And this pretty much describes most of my patients, as while I don’t give ashwagandha to everyone, most of my patients who have taken ashwagandha haven’t had any negative side effects.  On the other hand, over the years I’ve had a few patients who didn’t do well when taking ashwagandha.

What’s interesting is that some people who don’t do well when eating nightshades such as tomatoes, eggplant, and peppers have no problems taking an ashwagandha supplement.  Is it possible that ashwagandha is causing inflammation in these people, but just not causing any overt symptoms?  Of course this is a possibility to consider, but I will add that it seems that most people who don’t do well when eating the nightshades experience overt symptoms, and I find this to be the case with those who don’t do well when taking ashwagandha supplements as well.

Should YOU Avoid Ashwagandha?

Sarah Ballantyne, author of the Paleo Approach, does a lot of research with regards to the autoimmune Paleo diet, and she excludes ashwagandha from the AIP diet.  However, in one of her posts she did mention (under the comments section) that many people who can’t tolerate nightshades seem to do okay with ashwagandha, and I also find this to be the case with many of my patients.  Over the years I have had many patients with autoimmune thyroid conditions do fine with ashwagandha.

Does this mean that taking ashwagandha is completely safe for those with Graves’ Disease and Hashimoto’s Thyroiditis?  I wouldn’t necessarily say this, as while many people with autoimmune thyroid conditions do fine with this herb, there are some people who do have a negative reaction.  As a result, when following a strict AIP diet it probably is a good idea to avoid ashwagandha during this time.  But of course everything comes down to risks vs. benefits, and there are times when I’ll recommend ashwagandha to a patient with thyroid autoimmunity.  Most of the time this won’t cause any problems, but of course if the person does experience a negative reaction, or if they don’t seem to be progressing when taking ashwagandha, then they obviously should stop taking it.

In summary, although those with autoimmune conditions such as Graves’ Disease and Hashimoto’s Thyroiditis are supposed to avoid nightshades, many people do fine when taking ashwagandha.  This herb has numerous health benefits, such as helping people to better adapt to stress and anxiety, reduces inflammation, helps with insomnia, cognition, muscle strength and recovery, and can even improve sexual function and fertility.  However, there are some people that don’t do well when supplementing with ashwagandha, and if this describes you then of course it is best to avoid it.

When it comes to trying to find out the cause of one’s thyroid or autoimmune thyroid condition, testing can play a very important role.  This is why I recommend testing to just about all of my patients with Graves’ Disease and Hashimoto’s Thyroiditis.  However, one shouldn’t underestimate the importance of a comprehensive health history.  While many times doing a thorough health history alone won’t identify the autoimmune trigger, it can still provide some important clues.

What I plan on doing in this blog post is to discuss some of the more important components of a health history.  While I hope that most people reading this are working with a natural healthcare professional who will conduct a thorough health history, if this isn’t the case I would go through each of these components on your own.  In fact, regardless of whether or not you are working with an expert I think it’s a good idea to read through this information, as doing so might help to identify certain triggers.  Another benefit of a thorough health history is that it can help determine which tests are required to find certain imbalances which are either directly or indirectly responsible for your condition.

It’s also important to understand that completing a thorough health history might require you to fill out multiple forms.   It depends on the healthcare professional you’re working with, as some doctors will have all of the information on a single form, while others will require multiple forms to be completed.  Some offices will allow you to fill out all of the patient information electronically, while this won’t be the case for others.

Components of A Comprehensive Health History                   

Lifestyle factors.  This is one of the main reasons that more and more people are developing autoimmune thyroid conditions.  Some of the more common lifestyle factors which can either directly trigger autoimmunity, or make someone more susceptible to autoimmunity, include the following:

• High stress levels
• Low stress handling skills
• Drinking alcohol on a regular basis
• Consuming a lot of sugar
• Overtraining
• Excess caffeine consumption
• Insufficient sleep

Medications and supplements.  Certain medications such as antibiotics, NSAIDs, and acid-blockers can make someone more susceptible to developing an autoimmune condition by having a negative effect on the health of the gut.  While most nutritional supplements and herbs won’t trigger or exacerbate an autoimmune thyroid condition such as Graves’ Disease or Hashimoto’s Thyroiditis, there are possible exceptions.  For example, some natural healthcare professionals recommend for people with Hashimoto’s to avoid Echinacea and chlorella out of fear that these will further enhance the immune system response, thus exacerbating, or possibly even causing an autoimmune condition.  However, this is controversial, and I spoke about this more in past blog post entitled “Echinacea: Harmful for Hashimoto’s, Beneficial For Graves’ Disease?”

Past procedures and surgeries.  While most medical procedures and surgeries won’t trigger thyroid autoimmunity, certain procedures may make someone more susceptible to developing autoimmunity.  For example, while there is a concern over estrogen dominance, estrogen also has a protective effect with regards to immune system health.  And while I didn’t find any evidence of a correlation between getting a hysterectomy and developing Graves’ Disease or Hashimoto’s Thyroiditis, there is evidence that a hysterectomy can be a factor in other autoimmune conditions, such as systemic lupus erythematosus (1).  Other surgical procedures might also increase the risk of autoimmunity, such as bariatric surgery (2).  Keep in mind that I’m not suggesting that women should never get a hysterectomy, as there definitely is a time and place for these and other surgical procedures.  And I think it’s safe to say that most of the time these and other medical procedures won’t trigger thyroid autoimmunity, but it’s still a factor we need to consider when gathering information.

Infections (current and past).  Certain infections can play a role in the development of autoimmune thyroid conditions.  As a result, it’s good to know if someone with Graves’ Disease or Hashimoto’s Thyroiditis had a previous infection.  Of course just because someone had a previous infection prior to developing an autoimmune thyroid condition doesn’t mean that the infection was the trigger.  But it still can be beneficial to know if someone had an infection.

For example, there is a correlation between H. Pylori and thyroid autoimmunity, especially with regards to Graves’ Disease.  As a result, if someone with Graves’ Disease tested positive for H. Pylori a few months or years prior to being diagnosed with Graves’ Disease, this doesn’t confirm that this was the trigger.  However, it is possible that this infection was a trigger, and even if the person had received treatment to eradicate this infection, it probably would be a good idea to do an updated test for H. Pylori.

Family history.  Although genetics isn’t the most important factor in the development of an autoimmune thyroid condition, it is a factor.  And while you can’t change your genes, I still think it is beneficial to find out if there is a family history of a thyroid or autoimmune thyroid condition in someone who has Graves’ Disease or Hashimoto’s Thyroiditis.  Although the natural treatment approach might not differ much for someone who does have a strong family history of thyroid autoimmunity, if a person with Graves’ Disease or Hashimoto’s Thyroiditis has multiple family members with an autoimmune thyroid condition then they might want to be a little more strict with the diet and other lifestyle factors not only while restoring their health, but while trying to maintain a state of wellness.

Symptoms.  While you usually can’t rely on symptoms for detecting the autoimmune trigger, this doesn’t mean that one’s symptoms should be ignored.  For example, many people with Hashimoto’s Thyroiditis are overweight, but some people with Hashimoto’s Thyroiditis have the opposite problem.  In other words, some people with Hashimoto’s have difficulty gaining weight.  And if this is the case then one possible cause is a malabsorption problem, which in turn can be due to a pathogenic infection, or a condition such as small intestinal bacterial overgrowth.  Speaking of infections, if someone has extreme fatigue, along with migrating muscle and joint pain, then Lyme disease might be the culprit.

Of course certain symptoms can have multiple causes.  For example, if someone with Hashimoto’s Thyroiditis has extreme fatigue, then this can be due to low thyroid hormone levels, adrenal fatigue, one or more nutrient deficiencies, a pathogenic infection, or even blood sugar imbalances.  And while testing might be necessary to determine the cause of the fatigue, asking the right questions can also help.  Below are some of the signs and symptoms people with Hashimoto’s Thyroiditis commonly have:

• Trouble concentrating/memory difficulties/brain fog
• Fatigue
• Cold hands and feet
• Weight gain
• Bloating/belching/gas
• Constipation
• Hair loss
• Lowered libido
• Hot flashes and/or night sweats

And these are some of the signs and symptoms people with hyperthyroidism and Graves’ Disease commonly have:

• Increased resting heart rate
• Heart palpitations
• Weight loss
• Increased appetite
• Tremors
• Loose stools or diarrhea
• Hair loss

These are other signs and symptoms some people with both hypothyroid and hyperthyroid conditions can experience:

• Sweet cravings
• Caffeine cravings
• Headaches/migraines
• Muscle pain/joint aches
• Bloating/belching/gas
• Stomach burning
• Dry eyes and/or dry skin
• Increased frequency to food reactions
• Intolerance to smells
• Multiple smell and chemical sensitivities
• Indigestion and fullness last 2-4 hours after eating
• Sense of fullness during and after meals
• Coated tongue
• Dizziness when standing up quickly

Exposure to Environmental Toxins.  We live in a toxic world, and most people are exposed to hundreds, if not thousands of different chemicals on a regular basis.  Because of this, if an environmental toxin is the trigger, then many times it can be challenging to find out what the triggering chemical is.  While you can spend money to test for certain environmental toxins, including heavy metals, as well as other chemicals, you can’t test for all of the chemicals you’re exposed to.  And so rather than spend a lot of money testing for environmental toxins, sometimes the best approach is to 1) minimize your exposure to environmental toxins, and 2) do things to eliminate chemicals from your body.

With that being said, sometimes you can find out some valuable information about environmental toxins during a thorough health history.  For example, mercury is a potential trigger of thyroid autoimmunity.  As a result, a natural healthcare professional who conducts a health history should find out if their patients with autoimmune thyroid conditions has mercury amalgams.  The presence of these amalgams doesn’t mean that this is the autoimmune trigger, although there of course is a possibility that this is the case.

Recently I had a patient who had very high cadmium levels on a hair mineral analysis.  Upon further investigation the patient told me that his work environment involves exposure to certain chemicals, and cadmium was one of them.  And while there isn’t a correlation in the literature between cadmium and thyroid autoimmunity, this doesn’t mean that high cadmium levels can’t be a factor.  For example, even if a certain environmental toxin isn’t a direct trigger of thyroid autoimmunity, this doesn’t mean that it can’t indirectly cause autoimmunity by compromising the immune system.

The truth is that we don’t know everything about environmental toxins and autoimmunity.  As a result, when conducting a health history, it’s foolish to just focus on the environmental toxins that have been proven to trigger autoimmune thyroid conditions.  Keep in mind that being exposed to one or more environmental toxins can result in a loss of self tolerance, which in turn can make someone more susceptible to developing an autoimmune thyroid condition.  I spoke about this in an article I wrote entitled “Thyroid Autoimmunity and Loss of Self Tolerance”.

When conducting a health history I recommend asking the patient (or you can ask yourself if you are conducting your own health history) the following questions with regards to environmental toxins:

• Do you consume conventionally grown fruits and vegetables on a regular basis?
• Do you consume conventionally raised animal products on a regular basis?
• Do you consume fish or seafood on a frequent basis?
• Do you consume foods with artificial colors, flavors, and/or preservatives on a regular basis?
• Do you frequently use conventional cleaning chemicals, hand sanitizers, air fresheners, and other scented products?
• Do you smoke or are you often exposed to second-hand smoke?
• Do you have mercury amalgams, root canals, crowns, dental implants, etc.?
• Do you have a history of heavy alcohol use?
• Do you have a history of heavy use of recreational or prescription drugs?
• Have you been exposed to new construction materials or furniture?
• Are you frequently exposed to adhesives, paints, solvents, and other air-borne chemicals?
• Do you live near a cell phone tower or high-voltage power lines?
• Have you been frequently exposed to herbicides, pesticides, and/or fungicides?
• Do you jog or ride your bike along busy streets?

Sex hormones/Reproductive health history.  Sex hormone imbalances can be a factor in thyroid and autoimmune thyroid conditions, and here is some of the information I ask for on my health history forms:

• Do you currently take, or have you taken oral contraceptives or bioidentical hormones?
• Do you currently take, or have you had an intrauterine device (IUD)?  If yes, was it a copper or hormonal IUD?
• How many live births have you had?
• Were they natural births or Cesarean sections?
• Is there a history of ovarian cysts?
• Is there a history of uterine fibroids?
• Is there a history of endometriosis?
• Is there a history of fibrocystic breasts?

Estrogen dominance can be an autoimmune trigger, and estrogen dominance is also a common factor with ovarian cysts, uterine fibroids, endometriosis, and fibrocystic breasts.  As a result, if someone checks off one of these then I will suspect problems with estrogen metabolism.  This is also one way to determine if testing of the sex hormones is necessary.  For example, if a cycling woman has irregular menstrual cycles, moderate to severe cramping, and a history of ovarian cysts, uterine fibroids, and/or endometriosis, then one can argue that testing the sex hormones might be necessary in this situation.

Completing A Food Diary Can Be Very Valuable

In addition to completing a health history, I find that having the patient put together a food diary can be valuable.  After all, certain foods can act as triggers, or can make someone more susceptible to autoimmunity by increasing the permeability of the gut.  I would recommend putting together at least a one-week food diary.  And the reason for this is because a person’s eating habits can vary depending on the day of the week.

So hopefully you understand the importance of conducting a thorough health history.  While doing tests can help to detect the underlying cause of your condition, doing a comprehensive health history can provide a lot of value as well.  First of all, a good health history can help to determine what tests are necessary to obtain, as well as what diet the person should follow, supplements they should take, etc.  And there are times when a thorough health history can help to detect the thyroid or autoimmune thyroid trigger.  If you choose not to work with a healthcare professional I would recommend to conduct your own health history.