I’d like to wish you a happy Thanksgiving!  I want you to know that I sincerely appreciate you!  Thank you so much for reading my articles and blog posts.  I’d also like to thank all of the other healthcare professionals who educate their patients, email subscribers, etc.  Even though we still have one more month to go in 2016, I’m already preparing to share more great content with you in 2017!

Best of health,

Dr. Eric

Last month I wrote a blog post entitled “What’s Your Experience With Gluten?”  Not surprisingly, many of the comments received were from people who felt better upon eliminating gluten from their diet.  While not everyone who gives up gluten notices an improvement in their symptoms or labs, many people do.  And the same is true with dairy, although I will say that in general people seem to be more resistant to give up dairy.  And while having pasteurized and homogenized milk might not be healthy for you, other forms of dairy do have health benefits.

For example, many people do well when consuming raw dairy.  Others do fine eating fermented forms of dairy, such as kefir.  And many people do well when eating grass fed butter and ghee.  But if someone is following a strict autoimmune paleo diet, or even a standard paleo diet, then all forms of dairy should be excluded.

Anyway, I’d like for you to share your experience with dairy.  You can talk about milk, cheese, butter, ghee, etc.  You can talk about pasteurized dairy, raw dairy, and fermented dairy.  If you have been dairy free for awhile and feel like it has benefited your health please let me know!  And if you consume dairy regularly and are doing well please let me know!  Thank you in advance for participating!

Today’s blog post includes an interview of Jen Wittman, who reversed her Hashimoto’s condition through diet and lifestyle.  Jen is a holistic health care expert and a thyroid/autoimmune coach who has degrees in culinary arts, psychology, transformational coaching, nutrition, and Italian.  She spent a year honing her cooking skills in Italy and is passionate about physical rejuvenation, family, laughter and helping people craft the life of their dreams.

Dr. Eric: When reading your book it looked like you had a similar diet to myself growing up!  Chips Ahoy, Spaghetti O’s, Hostess cupcakes, Pepsi, etc.  How hard did you find it to make the transition from eating junk food to eating a clean diet?

Jen: At first, I found it terribly challenging to transition from eating junk food to eating a clean diet not because the changes were difficult but because I had a lot of emotional ties to certain foods and my general mindset around changing my diet. I wanted to see if I could reverse Hashimoto’s without altering my diet at all…and I tried…but it didn’t work. I tried every other healing modality I could find just so I could avoid making any dietary changes, but over time, it became clear that if I didn’t change my diet, my health wouldn’t improve either. In fact, I realize now that I stayed sick an extra year and a half because I was unwilling to change my diet. Once I changed my mindset and looked at changing my diet as a gift I was giving myself, my health improved immediately. Each nourishing dietary change I made gave me more energy and helped me to get my thyroid and antibody levels back to optimal.

Dr. Eric: How challenging was it to give up gluten?

Jen: As a trained chef, foodie and Italy lover, it was especially challenging at first for me to give up gluten. I didn’t want to give up any of my favorite foods like biscuits and gravy, fried mozzarella sticks, pastas and pastries. I just didn’t want to do it. But one day, I felt so awful that I decided I’d had enough. Was eating a donut more important than having the energy to play with my son? Was having a croissandwich more important than feeling fit in my body and having my hair back? Was it worth it to feel crummy everyday just so I could eat foods with gluten? No! In the end, I decided my health, my energy, my mood and my body were more important than gluten. Once I put the emphasis on feeling my best by eliminating gluten, it was easy to make the switch.

Dr. Eric: When you moved from Los Angeles to Italy you spoke about the “Italian lifestyle” and compared it to the “United States lifestyle”.  Can you please elaborate on this?

Jen: Yes! The Italian lifestyle was so eye opening for me. I was used to the Type-A go-go-go lifestyle of the U.S. – fast food, lots of doing, lots of multi-tasking and an overwhelming schedule. When I got to Italy, I was so surprised at how different it was from the U.S. First, food is really valued there. The ingredients are high quality, unprocessed, simple, and fresh. People really honor their meals by sitting down and taking time to eat together (not alone, in the car or standing up!). One eats at home usually for all meals and eats “slow” food. In general, everything is done at a slower pace in Italy. “Being” with friends and family is more of a priority than “doing” a million things. It really helped me understand the importance of balancing work and life in healthier way.

Dr. Eric: You developed Hashimoto’s Thyroiditis during your pregnancy.  Can you explain why it’s common for women to develop Hashimoto’s when pregnant?

Jen: So many major shifts happen during pregnancy – changes in hormone levels and immune function can play a role. Sometimes, pituitary function changes as well. And many women are now going into their pregnancies already stressed by demanding work/life schedules, or physical challenges like food sensitivities, autoimmune conditions, gut infections or blood sugar imbalances. These challenges coupled with the enormous hormonal changes during and post-pregnancy make women’s bodies the perfect storm for Hashimoto’s (and post-partum depression) to occur.

Dr. Eric: In your book you mentioned that “love” is what allowed you to heal and reverse the symptoms of your condition?  Can you please talk about this?

Jen: Yes, I was really awakened (by one of my doctors) to the fact that as women, we tend to nourish, care for and serve everyone else in our world but we don’t often apply that same love to ourselves.

As I learned more about thyroid and autoimmune conditions, it became clear that my needs weren’t being met…and I wasn’t allowing them to be. I often didn’t speak up when I needed help and I rarely reached out for support. I wasn’t showing myself the same love I was giving to others. And when you think of what an autoimmune condition is, it really is the body attacking itself. And with Hashimoto’s, the body is attacking your thyroid, the seat of communication. So, if you’re not speaking your mind and your truth, and you’re holding on to a lot of stress, anger, shame, guilt and you’re not asking for help, your body is manifesting symptoms in your thyroid to get your attention. For Hashimoto’s, I see it time and time again with my clients, the message your body is screaming at you is that you need to love yourself, care for yourself and speak your mind. You have to nourish yourself first before you can take care of everyone else.

Dr. Eric: In your book you discussed how you started a self-love practice every single day.  How did this benefit you?  Also, I assume this is something you recommend for others to do?

Jen: Yes, I’d absolutely recommend this practice to do. It has benefited me enormously by allowing me to put myself first at some point every day. It has helped me to reduce my stress levels and have more energy throughout the day as well.

Dr. Eric: You spoke about how your thyroid levels were always within the “normal” range, but not within the optimal range when you were dealing with Hashimoto’s.  Can you talk about this, and why people can’t rely on the lab reference ranges?

Jen: Yes. This is the single most prominent reason thyroid conditions go undiagnosed and misdiagnosed so often. The lab reference ranges for normal thyroid levels are way too large and aren’t even based on people with thyroid conditions. So, a person can have all the symptoms of a thyroid condition but their thyroid levels look normal because the range is so large. Instead, the key is to focus on the optimal functional levels for your thyroid. For most people, being just outside the optimal ranges in one direction or the other indicates that the thyroid isn’t functioning optimally and this is why you’re having so many symptoms. When we look at symptomatic clients/patients, we can see that those with symptoms often fall outside of the optimal ranges but within the “normal” ranges. And, the medical community/insurance companies need to start diagnosing thyroid conditions when they fall outside of the optimal range so that more people can catch the condition in its early phase; making it easier to reverse.

Dr. Eric: Can you please talk about the three transformative phases of healing?

Jen: Sure! When it came to healing thyroid and autoimmune conditions in my practice, three stages began to emerge consistently. I called them The Caterpillar, The Cocoon and The Butterfly.

The Caterpillar is the phase of nourishment – nourishing your body and mind with healing foods and self-care. In this phase, you are putting the most focus on your healing.

The Cocoon is the phase of restoration. It is a time of rest so your body can repair itself. It’s also the optimal time to go within and address stresses, obstacles and getting the support you need from others. During this phase, your body is rebuilding and rebalancing itself.

The Butterfly is the phase of freedom. This is when you emerge from the cocoon whole again and ready to fly. You can put less focus on healing because your symptoms are gone and the thyroid or autoimmune condition has been reversed.

To discover which phase you’re in, there’s a free assessment on my site. Click here.

Dr. Eric: Can you explain why having a healthy thyroid is necessary to have a healthy gut, and vice versa?

Jen: Poor gut health is intricately connected to low thyroid function and additionally, can trigger Hashimoto’s disease.  When your thyroid isn’t functioning optimally, it causes inflammation and immune dysregulation which in turn causes a leaky gut. The leaky gut then causes more inflammation and immune dysregulation which then further harms the thyroid. Press repeat. The cycle of destruction is endless if it is not addressed.

Dr. Eric: You mentioned how limiting sugar is one of the fastest ways to see results when you’re trying to heal from Hashimoto’s.  Why is this?

Jen: Sugar is so incredibly inflammatory to the body. When there’s a lot of sugar in your diet, your body spends a lot of time and energy dealing with the inflammation and not repairing itself. Also, oftentimes, women with thyroid conditions also have issues with candida and sugar feeds candida. It also promotes weight gain and blood sugar, insulin and leptin imbalances.

Dr. Eric: I’m always encouraging my patients to eat more veggies, and in your book you also said that you believe in “veggie heavy Paleo eating”.  How many servings of vegetables per day do you recommend?

Jen: I’m lazy about counting calories (which I never recommend) or servings…instead, I like to make things quick and simple and encourage folks to look at their plates. At each meal, make sure 75% of your plate is filled with veggies. I recommend 50% cooked veggies and 25% raw (like a salad) and then 25% a high quality protein. That’s just a simple way to eyeball it. I also encourage fruit smoothies with greens and fresh green juices as a way to get more veggies in your diet. I am personally not a veggie lover. I wasn’t raised to be…so this is my simple way to make sure I’m getting enough veggies in my diet.

Dr. Eric: What are some of your favorite techniques for managing stress?

Jen: For me, it’s singing. Singing massages the thyroid, it helps regulate breathing and it immediately puts me in a less stressed mood. Other techniques I love for managing stress are EFT (Emotional Freedom Technique), acupuncture, massage, epsom salt baths and journaling. Really though, anything that brings you joy and helps you refocus your energy on giving time and care to yourself, is a great tool for managing stress.

Dr. Eric: Thank you for this interview Jen.  Please tell my readers where they can find out more about you.

Jen: You can find me at Thyroid Loving Care www.ThyroidLovingCare.com and right now, I’m able to give away free digital copies of my book, Healing Hashimoto’s Naturally. And, if you’re a food lover like me, follow my adventures at The Gluten-Free Food Crawl, where I go all over the globe in search of the best gluten-free meals out there.

I have been recommending adrenal saliva panels to most of my patients for approximately seven years.  There are numerous reasons for this, which I will explain in this blog post.  On the other hand, some natural healthcare professionals don’t do any adrenal testing.  They instead assume that most of their patients have adrenal problems and simply recommend general adrenal support to all of their patients.  So is it best to test the adrenals, or since most people have adrenal issues is it best to just treat the adrenals, and not do any testing?

When I was diagnosed with Graves’ Disease I obtained an adrenal saliva panel.  The results showed depressed cortisol and DHEA levels, along with a depressed secretory IgA.  Even though I didn’t think that stress was a factor, after seeing the results of my adrenal saliva panel it made me realize that stress probably was one of the biggest factors, and perhaps the main factor in the development of my Graves’ Disease condition.  But this of course was just my experience, and so this doesn’t necessarily mean that everyone should get their adrenals tested, right?  Well, what I’d like to do is discuss why I choose to test the adrenals in my patients, and then for arguments sake I’ll also list some reasons why you might not want to have the adrenals tested.

Why Do I Choose To Test The Adrenals In Most Of My Patients?

Here are the main reasons why I recommend for most of my patients to obtain adrenal saliva testing:

1. Most people have adrenal problems.  Of course everyone deals with stress, but the main problem isn’t the actual stressor, but one’s perception of the stressor.  Unfortunately most people don’t do a good job of handling stress.  As a result, most of the patients I work with have adrenal issues.

2. Not all adrenal imbalances are treated the same.  While some natural healthcare professionals offer general support for the adrenals, the problem is that not all adrenal problems are the same.  Sure, everyone should manage their stress levels, and regardless of the state of your adrenals it usually won’t hurt to take adaptogenic herbs and some nutrients such as vitamin C.  But this doesn’t mean that everyone with adrenal problems can or should be treated the same way.  As an example, when I was dealing with Graves’ Disease, I took herbs and nutrients which helped to increase cortisol production, which made sense since I had depressed cortisol levels.  However, many people have elevated cortisol levels, and when this is the case they of course want to do things to decrease cortisol production.  And the only way to know for certain if someone has elevated or depressed cortisol levels is through testing.

3. Blood testing doesn’t look at the circadian rhythm of cortisol.  Some doctors will test the morning cortisol levels through the blood.  And while this has some value, blood testing doesn’t look at the circadian rhythm of cortisol.  This is important because even if the morning serum cortisol looks good, this doesn’t mean that the person has a normal circadian rhythm, as it’s possible for cortisol to be depressed or elevated at other times during the day.  Plus, remember that cortisol increases during stressful situations, and many people get stressed out when getting blood drawn, which can lead to a false high or normal reading of cortisol.

4. Seeing is believing.  What I mean by this is that some people need to see that they have compromised adrenals before they will start to make the necessary lifestyle changes.  This definitely described me, as before I received the results of my first adrenal saliva test I didn’t expect the results to show depressed cortisol and DHEA levels.  Prior to doing the saliva test I always thought I did a good job of handling stress, but the results of the saliva test proved me wrong.  And without seeing the results I probably wouldn’t have worked on improving my stress handling skills, which is not only a big factor when it comes to restoring one’s adrenal health, but is also important when it comes to maintaining healthy adrenals.

5. The saliva panel I recommend doesn’t just evaluate cortisol and DHEA.  In addition to looking at cortisol throughout the day, along with DHEA, the company I use looks at a few other useful markers.  One of these is 17-OH progesterone, which is a precursor of cortisol.  This can provide some value, as depressed 17-OH progesterone levels are common with weakened adrenals.  Secretory IgA is also evaluated, and I spoke about the importance of this marker in an article entitled “How Does Secretory IgA Relate To Thyroid Health?”

Why Shouldn’t You Test The Adrenals?

Let’s look at a few of the reasons why you might not want to do an adrenal saliva test.

1. Most people have adrenal problems.  Of course I used this same argument as a reason why most people SHOULD get adrenal testing, but as I mentioned earlier on, some healthcare professionals use this as a reason NOT to get the adrenals tested.  They just recommend for all of their patients to do things to improve their stress handling skills, give their patients general adrenal support, etc.  And while some people will do fine with taking some general support, others need more specific support based on their individual adrenal state.

2. Adrenal saliva testing can be expensive.  The truth is that most testing is expensive, and you therefore want to prioritize the testing that you obtain.  I’m pretty conservative when it comes to testing, but at the same time I will recommend those tests I feel are necessary.

In summary, different natural healthcare professionals will take different approaches with regards to testing the adrenals.  Some natural healthcare professionals won’t do any adrenal testing, but instead will recommend general adrenal support.  On the other hand, I have most of my patients obtain an adrenal saliva panel, and I gave a few reasons for this in this blog post.  While it is true that many people have adrenal issues, different adrenal imbalances shouldn’t be treated the same say, and seeing compromised adrenals on a saliva panel can serve as further motivation to do what is necessary to improve the health of the adrenals.

A few years ago I wrote a blog post on the 4-R protocol.  Since then it’s been updated to the “5-R Protocol by the Institute for Functional Medicine”, and I figured it would be a good idea to update and expand on the original post I wrote on this topic.  If you’re not familiar with this protocol then you’ll quickly realize that it relates to the healing of the gut, and a leaky gut is a factor with most, if not all autoimmune conditions, including Graves’ Disease and Hashimoto’s Thyroiditis.  And while the information in this post will focus greatly on thyroid autoimmunity, even if you don’t have an autoimmune thyroid condition, I feel that a lot of people can benefit from this information.

So let’s dive right into the protocol and discuss each of the five components

1. Remove.  Although genetics is a factor with most, if not all autoimmune conditions, in order for someone to develop autoimmunity they must be exposed to an environmental trigger.  And in order to reverse the autoimmune component and restore the person’s health it is necessary to find and remove the trigger.  The same is true with regards to healing a leaky gut.  While many people with a leaky gut will take supplements such as L-glutamine, and eat gut-healing foods such as bone broth, you won’t be able to heal your gut if you don’t detect and remove the leaky gut trigger.

This of course is easier said than done at times, as it’s not always easy to find out what the trigger is.  However, these are some of the common factors which can cause a leaky gut:

Food allergens.  Although many food allergens can potentially cause an increase in intestinal permeability, in the research I was able to find evidence for gluten (1), corn oil (2), and red wine (3) being factors which can cause a leaky gut.

Gut infections.  In the literature there are numerous infections which can cause an increase in intestinal permeability.  This includes candida (4) (5), H. Pylori (6), Blastocystis hominis (7) (8), and giardia (9).  There is also evidence that small intestinal bacterial overgrowth can cause an increase in intestinal permeability (10) (11).

Drugs.  Both NSAIDs and antibiotics can cause an increase in intestinal permeability (12) (13).

Stress.  There is evidence that both acute and chronic psychological stress can cause an increase in intestinal permeability (14) (15).

Systemic Inflammation.  I also came across a study which showed that systemic inflammation can cause an increase in intestinal permeability (16).

Finding the trigger is arguably the most difficult component of the 5-R protocol.  But once this has been accomplished you can move onto the next four components, which I’m about to discuss.

2. Replace.  The next component is to replace certain factors which play a role in digestion.  Many people reading this have taken digestive enzymes.  These include enzymes to break down protein (proteases), carbohydrates (amylase), and fat (lipase).  Many people with low gastric acid (stomach acid) can benefit from taking betaine HCL with meals.  Gastric acid consists mostly of hydrochloric acid, which is released from the parietal cells of the stomach.  It plays a role in activating pepsinogen into the active enzyme pepsin, which in turn breaks down proteins.

Some people can also benefit from supplementing with bile salts.  This is especially true for those people who have had their gallbladder removed, as getting gallbladder surgery doesn’t address the bile metabolism issues commonly associated with these conditions.  But some other people can also benefit from taking bile salts, such as those who have problems emulsifying fats.

Although dietary fiber doesn’t fall under the same category as digestive enzymes, betaine HCL, and bile salts, many people don’t consume enough dietary fiber, which is important for numerous reasons.  First of all, fiber helps to feed the good bacteria of the microbiota.  In addition, having sufficient dietary fiber is important for having regular bowel movements.

3. Reinoculate.  Many people take probiotic supplements, which is one method of reinoculating, or repopulating the gut flora.  And of course there are ways to accomplish this through diet as well.  But why do people have to reinoculate in the first place?  Well, there are many different factors which have a negative effect on the microbiota, including the foods we eat, taking antibiotics, being exposed to other environmental toxins, and even chronic stress can have a negative impact on our gut flora.

So what is the best way to reinoculate?  To be honest, we’re still in the beginning stages of dealing with probiotics, and so the approach we take now very likely won’t be the approach we take five to ten years from now.  I commonly recommend a probiotic supplement to my patients, but even this comes with some controversy, as not all probiotic supplements are created equally.  And some healthcare professionals like myself will recommend formulations with specific, well-researched probiotic strains, while other doctors won’t pay as much attention to the strains included, but instead will focus more on the diversity.  In other words, some will recommend a probiotic which has many different species, without worrying about the specific strains.

While it can be beneficial to take a probiotic supplement, it also is a good idea to take some prebiotics, and eat food sources of probiotics.  With regards to prebiotics, one can take a prebiotic supplement such as inulin or larch arabinogalactan, or you can eat prebiotic foods such as Jerusalam artichokes, asparagus, onions, chicory, bananas and other fruit, and even green tea is considered to be a source of prebiotics (17) (18).  The reason why prebiotic foods are important is because they feed the good bacteria such as bifidobacteria and lactobacilli, and these foods also are good sources of short chain fatty acids.

Probiotic Supplements vs. Food Sources

But why take a probiotic supplement when there are some excellent food sources of probiotics?  After all, foods such as sauerkraut, kimchi, kombucha, kefir, and a good quality source of yogurt can all be good sources of probiotics.  Well, I recommend getting probiotics from both supplements and food sources, and the reason for this is because the supplements you take will have different strains than the food sources.  Plus, many people simply don’t eat enough food sources of probiotics.

What About Soil-Based Probiotics and Fecal Transplants?

Over the past year I’ve had a lot of people ask me about soil-based probiotics, and I only recently started using these in my practice, and so I can’t say I have much experience with these.  Some examples of soil-based probiotics include bacillus subtilis and bacillus coagulans.  These are also known as spore-based probiotics.  These not only are more resistant to the gastric acid of the stomach than some other probiotic strains, but some sources claim that they colonize the gut more effectively.  If anyone reading this has had a positive experience while taking spore-based probiotics please feel free to share your experience in the comments section below.

I don’t get asked as much about fecal microbiota transplants, but I figured it was worth mentioning this here because this can potentially help with many different conditions.  This essentially involves transplanting healthy bacteria from one individual to another individual.  It seems to be very effective in helping people with Clostridium difficile, and while it hasn’t been approved for other conditions in the United States, this probably will change in the future.

4. Repair.  Many people reading this are familiar with a “leaky gut”, which I briefly spoke about earlier.  This is when the intestinal barrier is compromised, which allows larger proteins to pass into the bloodstream, where they normally shouldn’t be.  As a result, the immune system sees them as being foreign and mounts an immune system response.  Some claim that in order for autoimmunity to develop you need 1) a genetic predisposition, 2) an environmental trigger, and 3) a leaky gut.  I briefly spoke about this earlier when I discussed the “remove” component of the 5R protocol.  And of course this component is focusing on repairing the gut.

But before talking about how to repair the gut, it probably is a good idea to explain how one can determine if they have a leaky gut in the first place.  There is testing available, as there is a test called the Lactulose/Mannitol test that can determine if someone has an increase in intestinal permeability (a leaky gut), and there is also a test from the company Cyrex Labs called the Intestinal Antigenic Permeability Screen.  I have used both of these tests in the past, but these days I usually just assume that my patients have a leaky gut, especially those with Graves’ Disease and Hashimoto’s Thyroiditis.

As for how to repair the gut, this can be accomplished through a combination of supplementation and diet.  One of the most common nutrients recommended by healthcare professionals is L-glutamine, which is an amino acid that serves as fuel for the cells of the small intestine.  Vitamin A and zinc can also play important roles in gut healing, and herbs such as slippery elm, licorice, and marshmallow root can also help to support the gut.  Foods which can help heal the gut include bone broth, cabbage juice, and fermented foods such as sauerkraut.

5. Rebalance.  This used to be called the “4R protocol”, but not too long ago the Institute for Functional Medicine added a fifth component, which is to rebalance your body through sleep, stress management, etc.  I’m not going to discuss this in detail here, but this of course doesn’t mean that this component isn’t important.  I’m always talking about the importance of stress handling, as doing a poor job of managing your stress can have a profound effect on your health.  And most people are aware of the importance of getting sufficient sleep, although in some cases it is necessary to improve other aspects of one’s health in order to help them sleep better.

Can You Address More Than One Of These Components Simultaneously?

Some people might wonder if they can address more than one component at the same time.  In other words, if someone has a gut infection, can someone take digestive enzymes and probiotics at the same time that the infection is being eradicated?  Without question the answer to this is “yes”, as most healthcare professionals address different components simultaneously, including myself.  And so it isn’t necessary to focus on one of these components at a time.

In summary, the 5-R protocol relates to the healing of the gut, and a leaky gut is a factor with most, and possibly all autoimmune conditions such as Graves’ Disease and Hashimoto’s Thyroiditis.  The first, and perhaps most important component is removal of the trigger, which can include a food allergen, an infection, environmental toxin, and even stress.  The remaining four components of the 5-R protocol are replace, reinoculate, repair, and rebalance.