Recently I wrote an updated article on selenium.  In the article I mentioned how many people take selenium supplements, and if this describes you I’d like to know what your experience with selenium has been.  I realize that it’s not always easy to know if a specific supplement is helping, especially when most people are taking more than one supplement at the same time, which frequently is the case.  But if you noticed some positive changes when taking selenium I’d like to know.

So if you noticed an improvement in any of your symptoms while taking selenium please share it below in the comments section.  This can include an improvement in hypothyroid symptoms such as fatigue, brain fog, cold hands and feet, or other symptoms.  And of course if you have hyperthyroidism or Graves’ Disease and experienced an improvement when taking selenium please let me know!  If you didn’t experience an improvement in symptoms but noticed a decrease in your thyroid antibodies after adding selenium please let me know!  If you happened to experience any negative symptoms when taking a selenium supplement please let me know!  If you don’t take a selenium supplement but are instead relying on food sources of selenium you of course can also comment below if you’d like.  Thank you so much for sharing your experience with everyone.

Many people reading this are familiar with small intestinal bacterial overgrowth, which is also known as SIBO.  This involves an overgrowth of bacteria in the small intestine, and can lead to symptoms such as bloating, gas, and abdominal pain, along with diarrhea and/or constipation.  Although SIBO is more common in people with Hashimoto’s Thyroiditis, I have also seen it in patients with Graves’ Disease as well.  But can SIBO trigger an autoimmune thyroid condition?

Numerous pathogens have been associated with thyroid autoimmunity.  This includes H. Pylori, Yersinia enterocolitica, Lyme disease, Epstein barr, and parasites such as Blastocystis Hominis.  However, it’s important to understand that SIBO isn’t a pathogenic infection.  This condition involves having good bacteria in the wrong place, as most of the bacteria should be located in the large intestine, and only a small amount should be located in the small intestine.  But for numerous reasons that I’ll discuss in this blog post, there can be an overgrowth of bacteria in the small intestine.

As a result, small intestinal bacterial overgrowth itself doesn’t seem to be an autoimmune trigger.  However, there are a few things to keep in mind.  Some cases of SIBO are due to an autoimmune process, which I’ll describe below, and having one autoimmune condition can make someone more susceptible to having another autoimmune condition.  So perhaps having SIBO can lead to another autoimmune condition such as Graves’ Disease and Hashimoto’s Thyroiditis, but the correlation hasn’t been made yet.  But even if this isn’t the case, SIBO can cause an increase in intestinal permeability (a leaky gut), and this in turn can set the stage for the development of an autoimmune thyroid condition.

What Causes SIBO?

There are numerous factors which can cause someone to develop SIBO, and so let’s take a look at some of these:

1. Dysfunction of the migrating motor complex (MMC).  This is the main reason why people develop SIBO.  The MMC is a small wave that cleanses the small intestine of debris.  And so if the MMC isn’t working properly then bacteria and other debris are no longer swept through the lumen of the small intestine.  Food poisoning is the most common cause of a dysfunctional MMC, but other causes include hypothyroidism, diabetes, or an infection such as C. difficile, giardia, or Lyme disease.  Certain drugs such as opiates and antibiotics can also affect the MMC.

2. Altered anatomy.  This can interfere with the clearance of bacteria.  For example, adhesions due to surgery or endometriosis are potential causes of SIBO.  Other anatomical anomalies include a narrowing of the small intestine, fistulas, and diverticuli.

3. Hypochlorhydria (low stomach acid).  Millions of people take acid blockers, and this is a big problem.  Besides being necessary to break down nutrients, stomach acid also can help to eradicate harmful pathogens, and prevent the overgrowth of bacteria.  However, you don’t need to take acid blockers to have low stomach acid, as having a hypothyroid condition alone can result in the decreased production of stomach acid.  Stress can also decrease the production of stomach acid.

4. Absent or inefficient Ileocecal valve.  The ileocecal valve is the barrier that separates the small intestine from the large intestine.  It prevents backflow from the large intestine into the small intestine.  If this is absent or dysfunctional then it can cause the bacteria from the large intestine to migrate into the small intestine, thus leading to SIBO.

What Is The Relationship Between IBS and SIBO?

Infectious gastroenteritis, more commonly known as food poisoning, can result in the production of toxins by bacteria that can damage the nerves which play an important role in gut motility.  The specific name of the toxin is cytolethal distending toxin (CDT).  What happens is the immune system forms antibodies to this toxin (called anti-CDTb antibodies), but anti-vinculin antibodies are also produced.  Vinculin is a protein that helps connect the interstitial cells of Cajal (ICC) so that they can communicate properly to help the MMC .  When someone has the CDT-b toxins these harm the ICC, and in a case of mistaken identity the immune system attacks vinculin, which has a negative effect on gut motility.

So to summarize, food poisoning is the most common cause of irritable bowel syndrome with diarrhea (IBS-D).  This in turn has a negative effect on gut motility, and the problem with gut motility is what leads to small intestinal bacterial overgrowth.  There is a blood test called IBSchek by Commonwealth Laboratories that can determine if someone has IBS-D associated with anti-CDTb and anti-vinculin antibodies.

How Is SIBO Diagnosed?

Although one’s symptoms can provide a lot of valuable information, if SIBO is suspected then it is a good idea to test.  And the way it is detected is through a breath test.  With the breath test the patient fasts overnight, and then in the morning they will start with a baseline breath test, followed by the consumption of a substrate (i.e. lactulose or glucose).  After the baseline breath test they will measure a breath sample approximately every 20 minutes, and what the lab is looking for is bacterial fermentation, and it measures this fermentation by measuring the levels of hydrogen and methane. In other words, if someone has SIBO, there will be more fermentation, which will lead to higher levels of hydrogen, methane, or both gases. Let’s take a look at the two main breath tests used:

Lactulose breath test.  Lactulose can’t be absorbed by humans, but can be broken down by bacteria.  As bacteria consume lactulose they produce hydrogen and/or methane gases, which are measured with the breath test.  This is most commonly used because it can diagnose SIBO in the distal end of the small intestine.

Glucose breath test.  The glucose breath test seems to be more accurate, but the reason this test isn’t as commonly used is because glucose is absorbed in the beginning of the small intestine.  As a result, if someone has SIBO that is occurring in the distal small intestine then it is less likely to be detected.  However, some bacteria don’t ferment lactulose, and as a result, if SIBO is suspected yet the lactulose test comes back negative then you should consider doing a glucose breath test.  Another option is to do both the lactulose and glucose tests initially, although many labs don’t offer both types of testing.

Can A Stool Panel Detect SIBO?

Hydrogen and methane are produced by bacteria, and this is what’s being measured on the breath tests.  Methanobrevibacter smithii is a bacteria that accounts for most of the methane production in the body.  Some comprehensive stool panels test for this “methanogenic” bacteria, and if this is high then this might suggest that someone has SIBO.  However, this isn’t conclusive, and the breath test remains the gold standard for determining if someone has SIBO.

What Health Conditions Are Associated With SIBO?

Below I have listed some of the other health conditions associated with SIBO.  This doesn’t mean that SIBO is always responsible for the development of these conditions, but if you have any of the following conditions then SIBO is a possible cause.

• Acne Rosacea
• Chronic fatigue syndrome
• Fibromyalgia
• Inflammatory bowel disease (Crohn’s disease, ulcerative colitis)
• Interstitial Cystitis
• Restless legs syndrome
• Rheumatoid arthritis

What’s The Ideal Diet For Those With SIBO?

Although I like my patients with Graves’ Disease and Hashimoto’s to start on an autoimmune paleo diet, in the past I have written blog posts which discuss how there is no diet that fits everyone perfectly.  And the same concept applies with SIBO.  While all cases of SIBO involve the overgrowth of bacteria into the small intestine, the bacteria will differ from person to person.  As a result, one person with SIBO might be able to tolerate foods that someone else with SIBO can’t tolerate, and vice versa.  In addition, some people might be able to eat small quantities of a certain food, but if they eat larger quantities they experience bloating and gas.  With that being said, there are certain diets that people with SIBO should consider following, although there will be some modifications depending on the person.

Below I’m going to discuss the different diets that are recommended for patients with SIBO.  The primary goal of each of these diets is to feed the person while starving the bacteria.

Low FODMAP diet.  This probably is the most well known diet when it comes to SIBO, and because of this, many healthcare professionals will put their patients with SIBO on this type of diet.  FODMAP stands for fermentable oligosaccharides, disaccharides, monosaccharides and polyols.  Examples of high FODMAP foods include fermented foods (i.e. sauerkraut), starch (grains, beans, starchy vegetables), soluble fiber (grains, beans, fruits, vegetables), sugar (fruit, agave), and resistant starch (legumes, whole grains).

This doesn’t mean that everyone with SIBO needs to avoid all of these foods.  For example, some people with SIBO are able to tolerate sauerkraut, while others can’t eat any fermented foods without experiencing gas, bloating, and other symptoms.  Some people are able to eat small amounts of these foods, while others are unable to tolerate certain foods altogether.  And so you need to listen to your body.

Specific Carbohydrate Diet.  The Specific Carbohydrate Diet (SCD) is similar to a Paleo diet in that it allows meat, fish, eggs, nuts, seeds, vegetables, and fruit.  However, it differs in that it does allow some lactose-free dairy and certain beans.  The dairy products that are allowed include yogurt, aged cow and goat cheeses, butter, ghee, and cottage cheese.  The allowed beans include white beans, navy beans, lentils, split peas, lima beans, kidney beans and black beans.  In order to make the beans easier to digest you want to soak them overnight.  For more information I would read the book “Breaking The Vicious Cycle”, or you can visit the website www.scdlifestyle.com.

GAPS diet.  GAPS stands for Gut and Psychology Syndrome, and the diet was developed by Dr. Natasha Campbell-McBride.  The diet is very similar to the Specific Carbohydrate Diet, and involves minimal supplementation.  The only legumes allowed on the GAPS diet include lentils, split peas and white navy beans, and they need to be soaked first.  Dairy is initially eliminated, but then the person is allowed to slowly reintroduce ghee, followed by butter, yogurt, sour cream, kefir, hard cheese, and cream.  One of the main differences between the GAPS diet and the Specific Carbohydrate Diet is that the GAPS diet involves going through a 6-stage introduction diet before moving onto the “full” GAPS protocol, which is usually followed for one or two years.

SIBO Specific Diet.  This is a diet created by Dr. Allison Siebecker, and is a combination of the Specific Carbohydrate Diet and the low FODMAP diet.  While it’s a great diet for those who have SIBO, it’s important to understand that this a very restrictive diet, and as a result, Dr. Siebecker first recommends to try one or more of the other diets listed above first, and if you don’t do well with the other diets then you might want to consider giving this diet a try.   For more information I would visit www.siboinfo.com/diet.

Elemental diet.  The elemental diet can be the most effective diet when it comes to alleviating the symptoms of SIBO.  However, it is arguably the most challenging diet to follow.  It’s considered an antimicrobial approach because the goal is to starve the bacteria, but supply the person with sufficient nutrients in an easily absorbed form.  It essentially consists of protein, fat, carbohydrates, amino acids, vitamins, minerals, and either glucose or maltodextrin.  You can get a premade formula from a company such as Integrative Therapeutics, or if you visit www.siboinfo.com and visit the resources page you can get a recipe to make your own.  The elemental diet can help to lower both methane and hydrogen levels and typically you want to follow it for 2 or 3 weeks, and then do another breath test immediately upon completion of it.

Should Someone With Graves’ Disease or Hashimoto’s Also Follow An AIP Diet?

Many people with Graves’ Disease and Hashimoto’s Thyroiditis follow an AIP diet, and they might want to know if they should continue following an AIP diet when trying to address SIBO.  So for example, should they follow an AIP diet and a low FODMAP diet?  Doing this is extremely difficult, and what you usually want to do is prioritize the eradication of SIBO.  In other words, it’s usually okay to stray from the AIP diet while trying to address SIBO, and this falls into the “Remove” category of the 5-R protocol I mentioned in a previous blog post.  Then once the bacterial overgrowth has been “removed” you can focus more on gut healing by following the AIP diet, along with eating gut-healing foods (i.e. bone broth) and taking certain nutrients (i.e. L-glutamine).

Eradicating SIBO Through Drugs and Herbs

In order to eradicate SIBO there are two main methods used: prescription antibiotics and natural antimicrobials.  Let’s look at the pros and cons of each.

Prescription antibiotics.  Rifaximin is the antibiotic most commonly recommended for SIBO.  While I’m not a big fan of antibiotics, Rifaximin is different than most other antibiotics.  First of all, it stays in the small intestine, which means that it doesn’t harm the beneficial bacteria in the large intestine like most other antibiotics do.  In fact, there is evidence that Rifaximin can actually increase good bacteria (i.e. bifidobacteria) in the large intestine.  In addition, bacterial resistance isn’t too common when using Rifaximin.  With that being said, not everyone with SIBO will respond to Rifaximin.

Herbal antimicrobials.  I personally prefer to use herbal antimicrobials when dealing with SIBO.  Some of the natural agents which can help to eradicate SIBO include berberine, oregano oil, neem, and allicin.  Keep in mind that while garlic is a high FODMAP food, most people with SIBO can tolerate an allicin supplement, although not everyone.  Although I personally haven’t used pomegranate as of writing this blog post, Dr. Nirala Jacobi has a lot of experience with SIBO and has been experimenting with pomegranate as an antimicrobial.  As for whether the herbs are as effective as Rifaximin, there actually was a study that showed that herbal therapy is equivalent to Rifaximin for treating SIBO (1).  However, just as is the case with Rifaximin, not everyone with SIBO will respond to the herbal antimicrobials.

What To Do When Rifaximin or The Natural Antimicrobials Don’t Work

So what should be done if someone takes either Rifaximin or the natural agents and doesn’t improve?  Well, it is important to do another SIBO breath test after completing a round of treatment.  On the retest, if the gas levels have decreased a good amount but are still high then it makes sense to do another round of the Rifaximin or natural antimicrobials, regardless if the person’s symptoms have improved or not.  On the other hand, if the gas levels haven’t improved then it probably is wise to try a different treatment approach.  If the gas levels have normalized and the person is still symptomatic then this is usually an indication that there is something else going on besides SIBO, and additional testing might be indicated.

The Role of Prokinetics In Preventing a Relapse

Prokinetics help to stimulate the MMC, and since most cases of SIBO are caused by a dysfunctional MMC, taking prokinetics can be important to prevent a relapse after receiving treatment for SIBO.  It’s also important to understand that the MMC works in a fasting state, and so while I commonly recommend for patients to eat regularly throughout the day to help stabilize the blood sugar levels, those with SIBO probably shouldn’t snack in between meals, and should go at least 12 hours overnight without eating.

As for what prokinetics you should take, I used to recommend an herbal formulation called Iberogast, but it seems as this is being discontinued.  Ginger can be a good prokinetic, and 5-HTP also can be helpful.  Many reading this are familiar with low dose naltrexone, and this can also act as a prokinetic.  For those who aren’t familiar with LDN you can read the article I wrote entitled “Low Dose Naltrexone and Thyroid Autoimmunity“.  Erythromycin is commonly used as an antibiotic, but in very low doses it can also help to stimulate the MMC (2).

How long should someone take a prokinetic for after SIBO has been eradicated?  It depends on the person, as most will need to take it for at least 3 to 6 months.  And if someone has autoimmunity to vinculin then they might have to take prokinetics on a permanent basis.  I mentioned earlier how if someone has the CDT-b toxins these harm the ICC, and in a case of mistaken identity the immune system attacks vinculin.  And until we figure out how to stop the autoimmune process then the person will most likely have to continuously take prokinetics.

Can Someone With Graves’ Disease or Hashimoto’s Get Into Remission By Eradicating SIBO?

As I mentioned earlier in this post, SIBO doesn’t seem to be a direct trigger of thyroid autoimmunity.  However, SIBO can cause an increase in intestinal permeability, which is a factor in autoimmune conditions such as Graves’ Disease and Hashimoto’s Thyroiditis.  Because of this, one can argue that if someone has SIBO and a leaky gut, then in order to heal the gut it is necessary to eradicate SIBO, and if the trigger is also removed then this can put the person into remission.  And so while eradicating SIBO might be necessary for healing a leaky gut, in order to get someone with an autoimmune thyroid condition into remission it is still necessary to find and remove the trigger.

In summary, small intestinal bacterial overgrowth can be present in people with Hashimoto’s Thyroiditis and Graves’ Disease.  The most common cause of SIBO is dysfunction of the migrating motor complex.  SIBO is usually diagnosed with either the lactulose or glucose breath test, although false negatives are possible with either test.  Some of the common diets recommended for those with SIBO include the low FODMAP diet, the Specific Carbohydrate Diet, the GAPS diet, the SIBO Specific Diet, and the Elemental diet.  Although antibiotics such as Rifaximin are commonly given to people with SIBO, herbal antimicrobials can be equally effective in many people.  And taking prokinetics can be important to prevent a relapse from occurring after receiving treatment for SIBO.

Many reading this are familiar with Dr. Izabella Wentz, as she is the author of the bestselling book “Hashimoto’s Thyroiditis: Lifestyle Interventions for Finding and Treating the Root Cause”, and she also hosted the Thyroid Secret Documentary, which I was grateful to be a part of.  Dr. Wentz sent me an advanced copy of her new book “Hashimoto’s Protocol”, which I recently finished reading.  And so I decided to dedicate a blog post to review her book.

Note: For those who aren’t interested in reading this entire review, I do want to let you know upfront that Dr. Wentz is offering a free autoimmune paleo diet 2-week recipe plan, which you can get by clicking here.

First of all, I’d like to start off by saying that this is a lengthy book with plenty of great information!  The book consists of almost 400 pages, and while this includes sections you are unlikely to read (i.e. bibliography), even if we omit the bibliography, the acknowledgements, etc., you’re still left with approximately 350 pages of excellent content.  And so this is not a book that most people will knock out it a day or two.  She also offers an audio version of the book on Audible, which I probably would have purchased had I not been sent a free copy of the book.  While I love reading books, I must admit that I’m an Audible fanatic!

When I first learned about the title of the book, one of the first concerns I had was that this book was just going to focus on diet and supplements.  And don’t get me wrong, as she does talk a lot about diet, and there definitely are a lot of different nutritional supplements she talks about as well.  But this isn’t just a book on diet and supplements, as she talks about other lifestyle factors, some of the different methods of testing, and she even dedicates a chapter on how to optimize thyroid hormone levels.

This Book Actually Discusses Multiple Protocols

Another concern I had when I first learned about the title of the book is whether Dr. Izabella would just focus on a single protocol for Hashimoto’s.  After all, the title of the book is “Hashimoto’s Protocol”, which suggests that it discusses a single protocol.  Of course I should have known better, and if I counted correctly she actually discusses nine different protocols.  This might sound overwhelming, but keep in mind that not everyone with Hashimoto’s needs to follow all of these different protocols, and I’ll talk more about this shortly.

Dr. Izabella’s book is divided into three parts.  The first part is entitled “Getting To Know Hashimoto’s and the Root Cause Approach”.  In this section she starts off by talking about her Hashimoto’s success story, and then discusses the symptoms, diagnosis, and origins of Hashimoto’s.  The last chapter of this section then discusses how the root cause approach can help you to recover your health.

The second section of the book discusses the “Fundamental Protocols”.  This consists of three protocols that include the following:

1. The Liver Support Protocol.  This is a two-week protocol that focuses on reducing your exposure to toxic substances while simultaneously supporting the liver.  The goal is to 1) remove foods which can be potential triggers, 2) add supportive foods, 3) reduce toxic exposure, and 4) support detoxification pathways.

2. The Adrenal Recovery Protocol.  Dr. Izabella talks about a five-step adrenal recovery protocol, which according to her takes approximately 4 weeks to follow.

3. The Gut Balancing Protocol.  This is a six-week protocol, although Dr. Izabella does mention that you should reevaluate your gut function after this time, and so there is a chance it can take longer than this.

Dr. Izabella recommends for everyone to follow the fundamental protocols in order to help improve the health of the liver, adrenals, and gut.  According to Dr. Izabella, following these protocols should take approximately 90 days combined.  One thing I found interesting is that whereas most natural healthcare professionals focus on the health of the gut initially, Dr. Wentz first focuses on improving the health of the liver.  Of course this also involves certain dietary changes, and so essentially people are still doing things to improve the health of their gut through diet while also supporting the liver.

Root Cause Assessments

It’s also important to mention that each of these fundamental protocols comes with a separate assessment.  For example, before following the liver support protocol it is recommended to complete a liver assessment, which will help to establish your current level of toxicity.  The adrenal assessment helps to determine your risk for impaired adrenal function, and there is also an assessment for determining your gut health.

In the last chapter of the second section she talks about “Advanced Root Cause Assessments”.  These are additional assessments that can help you identify your personal triggers and prioritize the next steps of your protocol.  These include the thyroid hormone assessment, nutrition assessment, traumatic stress assessment, infections assessment, and toxins assessment.

Advanced Protocols for Hashimoto’s

The third section of her book talks about numerous advanced protocols.  I’m not going to discuss all of them, but here are two that I found to be pretty interesting:

Thyroid hormone optimizing protocols.  Here Dr. Izabella discusses five unique strategies that will assist with optimizing your thyroid hormone levels.  Not surprisingly one of these involves taking prescription thyroid hormones, but there are four other methods.  One of these includes low level laser therapy.  I was thrilled to see her discuss this, as I wrote a blog post on cold laser therapy and thyroid health in September of 2015, and then when I attended Dr. Izabella’s Thyroid Masterimind meeting one month later I learned even more great information about how this can benefit thyroid health in those with Hashimoto’s Thyroiditis.  Anyway, Dr. Izabella gives a specific protocol for cold laser therapy in this chapter.

Protocols for Overcoming Traumatic Stress.  Dr. Izabella explains how some people will continue to have adrenal dysfunction despite their best efforts to balance blood sugar and reduce present stressors, and she says that this is likely due to a long-standing history of traumatic stress.  She mentioned that 20% of her readers with Hashimoto’s reported that their symptoms started after the death of a loved one.  And while most people will benefit from certain mind body medicine techniques such as yoga and meditation, she talks about how some will need to go beyond these to resolve issues related to traumatic stress.  She gives a protocol for resetting your stress response, and an advanced adrenal support protocol.

Are Specific Supplements and Recommendations Given?

I’m sure some will wonder if Dr. Izabella gives specific recommendations in her book.  The answer is a resounding “YES”!  Not only does she give specific doses, but she also lists specific supplement companies.  In addition, when Dr. Izabella discusses some of the tests she recommends she also names some specific companies that offer the testing.

Does This Book Take The Place Of Working With A Natural Healthcare Professional?

Another question you might have is if you can reverse your Hashimoto’s Thyroiditis condition just by reading this book alone.  Although most people with Hashimoto’s can greatly improve their health by reading this book, even Dr. Izabella recommends working with a natural healthcare professional.  In fact, she recommends working with a team of experts that includes the following:

• An open-minded and supportive physician
• Functional medicine practitioner
• Compounding pharmacist
• Biological dentist
• Health coach
• Support network (family members, friends, a coach, a therapist, etc.)

The reason why she recommends working with a team of experts is because while there are specific recommendations given in this book, the truth is that everyone is different.  For example, while many people notice a dramatic improvement in their health by following an autoimmune paleo diet, this isn’t the case with everyone.  In fact, some people with autoimmune thyroid conditions feel worse when following this type of diet.  And the same concept applies with nutritional supplements and herbs.  There are a lot of different supplements and herbs listed in this book, but this doesn’t mean that everyone with Hashimoto’s Thyroiditis should take all of them.

Plus, while many people can benefit from following the fundamental protocols discussed in the book without doing any testing, in many cases testing will be necessary to detect the underlying cause.  For example, one of the reasons why I recommend adrenal saliva testing is because different people will have different adrenal patterns, and you can’t always rely on symptoms to tell which pattern someone has.  And while one of Dr. Izabella’s advanced protocols focuses on infections, doing certain testing (i.e. blood test, comprehensive stool panel) frequently is necessary in order to detect the presence of a specific pathogen.

Is There Anything About The Book I Didn’t Like?

While I can’t say that there were aspects of the book that I didn’t like, there were a few points I didn’t agree with.  I will say that overall I agree with most of the information in her book, and it’s important to keep in mind that different natural healthcare professionals will have different opinions. But for the most part Dr. Izabella and I take a similar approach with regards to Hashimoto’s patients. I greatly enjoyed reading her book, and I think it is a wonderful resource that everyone with Hashimoto’s Thyroiditis should have.

In summary, I thought The Hashimoto’s Protocol was an excellent book, and if you have Hashimoto’s Thyroiditis I would highly recommend that you check this out.  If anyone reading this review has also read Dr. Izabella’s Hashimoto’s Protocol book, please feel free to leave your comments below to let others know what you think.  And just as a reminder, you can get a free Autoimmune Paleo Diet 2-Week Recipe Plan by clicking the link below.

Click Here to Get Your Free Autoimmune Paleo Diet 2-Week Recipe Plan

There is a lot of controversy over vaccinations, and it’s not uncommon for a patient who has a thyroid or autoimmune thyroid condition to ask me what I think about vaccines.  I’m personally not a big fan of vaccines, and this is not a topic that I have written about in the past, other than a blog post I wrote on the flu shot a few years ago.  And it probably isn’t going to be a topic that I write a great deal about in the future.  However, for those who are interested in learning about the risks of vaccinations, I encourage you to register for the upcoming Truth About Vaccines documentary that is taking place from 4/12/17 to 4/18/17.  It’s from the same creators of the Truth About Cancer documentary series, and you can click here to register for this free event.

Will they be talking at all about autoimmune thyroid conditions such as Graves’ Disease and Hashimoto’s Thyroiditis?  I’m honestly not sure, but I have done some research in this area, and there aren’t too many studies which have looked into the relationship between vaccines and thyroid autoimmunity.  Apparently cases of Graves’ disease and Hashimoto’s thyroiditis following hepatitis B vaccine have been reported to the Vaccine Adverse Events Reporting System (VAERS), although one study I came across didn’t see an increased risk of Graves’ Disease or Hashimoto’s Thyroiditis following receipt of hepatitis B vaccine (1).  But the problem is that there are very few studies involving vaccines and thyroid autoimmunity, and as sad as it is to say, you can’t trust many of the studies out there dismissing vaccines as being harmful, and the reason for this is because many of them involve a conflict of interest.

For example, there has been a lot of controversy over whether vaccines can cause autism.  In June 2014, a meta-analysis of case-control and cohort studies showed that vaccines are not associated with autism, and that the components of vaccines at the time (i.e. thimerosol) or multiple vaccines are not associated with the development of autism (2).  But according to investigative reporter Sharyl Attkisson there was a conflict of interest, as the study was created from a firm that lists major vaccine makers among its clients.  I don’t know if vaccines cause autism, but it’s scary when you look at some of the ingredients included in vaccines.

According to the Centers for Disease Control and Prevention, the following are some of the common substances found in vaccines (3):

• Aluminum
• Antibiotics
• Egg protein
• Formaldehyde
• Monosodium glutamate (MSG)
• Thimerosal (a mercury-containing preservative)

Keep in mind that the CDC is in favor of vaccines, and they claim that the amount of these chemical additives found in vaccines are very small.  While this may be true, this doesn’t mean that they are safe.  For example, the amount of mercury used in mercury amalgams is very small as well, but there definitely is a correlation between thyroid autoimmunity and mercury (4) (5).  And while the current research doesn’t show a direct correlation between aluminum and autoimmune thyroid conditions, aluminum is a known environmental toxin that can stimulate the immune system, and has been linked to neurotoxicity (6) as well as Alzheimer’s disease (7).  Formaldehyde is also a harmful chemical, and many people reading this are aware of the problems associated with Monosodium glutamate (MSG).

If you are interested in learning more about vaccines, then I highly recommend for you to attend the Truth About Vaccines documentary.  Here are some of the questions that will be answered:

• Do vaccines confer immunity?
• Are there natural options to vaccination?
• What questions should you ask before you vaccinate?
• Were vaccines responsible for the declines in polio, pertussis, smallpox, etc?
• What about the flu shot and the HPV vaccine?
• Why do outbreaks occur in mostly vaccinated populations?
• Why are some states considering implementing forced vaccine legislation?
• What are possible adverse vaccine reactions?
• Are vaccines linked to cancer?
• Can vaccines cause permanent damage?
• What are all of your options?

Click Here to register for The Truth About Vaccines documentary.  Also, please feel free to share your thoughts about vaccines in the comments section below.

 

Most cases of hyperthyroidism are autoimmune in nature.  So when someone finds out that they have hyperthyroidism for the first time, there is a pretty good chance that they will be diagnosed with Graves’ Disease.  However, this isn’t always the case, as some people with hyperthyroidism have multinodular toxic goiter, which frequently doesn’t involve an autoimmune component.  And some people with hyperthyroidism have subacute thyroiditis.  And that will be the focus of this blog post, as I’ll be discussing the differences between Graves’ Disease and subacute thyroiditis.

With regards to the symptoms, both Graves’ Disease and subacute thyroiditis present with similar symptoms.  As a result, one usually can’t use the typical symptoms of hyperthyroidism to differentiate between the two conditions.  Here are some of the symptoms those with Graves’ Disease and subacute thyroiditis commonly experience:

• Elevated resting pulse rate
• Heart palpitations
• Tremors
• Weight loss
• Increased appetite
• Goiter
• More frequent bowel movements
• Sweating
• Hair loss

But are the symptoms of hyperthyroidism as severe in someone who has subacute thyroiditis when compared to someone who has Graves’ Disease?  The symptoms can be severe, as the resting heart rate can get very high, and on a blood test the thyroid hormone levels can be just as high as in someone who has Graves’ Disease.  In fact, over the years I’ve had a few Graves’ Disease patients who presented with what I would consider to be mild hyperthyroidism.  On a few occasions I have even worked with people who have subclinical Graves’ Disease.  In other words, they will have a depressed TSH with elevated thyroid stimulating immunoglobulins, but they will have normal thyroid hormone levels and/or won’t experience the hyperthyroid symptoms I listed above.

Two Main Types of Subacute Thyroiditis

1. Subacute granulomatous thyroiditis.  This is also known as De Quervain’s thyroiditis, and is very painful.  In fact, it is the most common cause of someone having a painful thyroid gland.

2. Subacute lymphocytic thyroiditis.  This typically doesn’t involve any pain, and is often mistaken for Graves’ Disease.

Both of these conditions seem to be caused by a viral infection of the thyroid gland.  This causes inflammation, which in turn damages the thyroid follicles, and this causes thyroid hormone to be released into the bloodstream, which in turn results in the symptoms of hyperthyroidism.  The hyperthyroidism usually lasts anywhere from a few weeks to a few months, and it is usually followed by a period of hypothyroidism that can last six months or longer, and in some cases can be permanent.

Three Ways To Differentiate Graves’ Disease From Subacute Thyroiditis

1. An elevation of TSH receptor antibodies.  Graves’ Disease is an autoimmune thyroid condition that is characterized by elevated TSH receptor antibodies.  Thyroid stimulating immunoglobulins are the most common type of TSH receptor antibody elevated in Graves’ Disease, and if someone with hyperthyroidism has these levels elevated then this confirms that they have Graves’ Disease, and not subacute thyroiditis.

2. The signs and symptoms of thyroid eye disease.  Some people with Graves’ Disease also have thyroid eye disease, which is when the immune system attacks the tissues of the eyes.  This can lead to symptoms such as eye pain, swelling, and/or bulging of the eyes, also known as exophthalmos.  And so if someone with hyperthyroidism has one or more of these signs/symptoms then in all likelihood they have Graves’ Disease.  Keep in mind that most people with thyroid eye disease have very high levels of thyroid stimulating immunoglobulins, and so if you have the signs and symptoms of thyroid eye disease I would definitely make sure to test the TSI levels.

3. An elevated radioactive iodine uptake test.  Many endocrinologists will recommend the radioactive iodine uptake test, which involves swallowing a very small dosage of radioactive iodine.  In most cases of Graves’ Disease the radioactive iodine uptake test will be elevated, while in subacute thyroiditis the uptake test will usually be low.

If someone has elevated thyroid stimulating immunoglobulins then there really is no good reason to do the RAI uptake test.  But how about if someone with hyperthyroidism tests negative for these antibodies, and doesn’t have the symptoms of thyroid eye disease?  Well, in this case one can make a better argument for getting this test, although I must admit that I’m still not a big fan of this test.

Treating Graves’ Disease vs. Subacute Thyroiditis

The conventional medical approach for treating Graves’ Disease usually consists of antithyroid medication, radioactive iodine, or thyroid surgery.  With subacute thyroiditis, since this usually leads to hypothyroidism, most medical doctors will manage the patient’s symptoms through antithyroid medication and/or beta blockers.  While Methimazole is a common choice for managing the hyperthyroid symptoms in Graves’ Disease, with subacute thyroiditis many medical doctors prefer to use beta blockers.  And the reason for this is because the person with subacute thyroiditis is likely to become hypothyroid within a short period of time, and if they are taking Methimazole then this will make them even more hypothyroid.  Of course taking the person off of the Methimazole will decrease the severity of the hypothyroidism, but many medical doctors still choose not to put these patients on antithyroid medication.

As for treating these two conditions naturally, the goal with Graves’ Disease is to detect and remove the autoimmune trigger.  This topic is too detailed to discuss here, but I have written numerous articles which discuss this, and I also regularly conduct webinars that focus on natural treatment methods for Graves’ Disease.  I will say that managing the symptoms is similar in both of these conditions, although as is the case with Graves’ Disease, antithyroid herbs such as bugleweed need to be used cautiously due to the person eventually becoming hypothyroid.  Motherwort might be a better option in those with subacute thyroiditis, although if this doesn’t help to lower an elevated heart rate then bugleweed can be used.  If this is the case then the person wants to make sure to carefully monitor their symptoms, and it probably would be a good idea to do a follow-up blood test within four weeks.

Since subacute thyroiditis is caused by a virus, it still makes sense to do things to improve the health of the immune system.  And the reason for this is because viruses usually can’t be eradicated, which means that a person can have subacute thyroiditis multiple times.  For more information on viruses I would refer to an article I wrote on viruses entitled “Which Viruses Can Trigger Thyroid Autoimmunity?”.

So hopefully you have a better understanding of the difference between Graves’ Disease and subacute thyroiditis.  Both of these conditions present with similar symptoms, including an elevated resting pulse rate, heart palpitations, weight loss, increased appetite, and frequent bowel movements.  Two main types of subacute thyroiditis include subacute granulomatous thyroiditis and subacute lymphocytic thyroiditis.  Three ways to differentiate Graves’ Disease from subacute thyroiditis include 1) an elevation of TSH receptor antibodies, 2) having the signs and symptoms of thyroid eye disease, and 3) having an elevated radioactive iodine uptake test.  With both Graves’ Disease and subacute thyroiditis, improving the health of the immune system is the key.