Last month I wrote a blog post entitled “What’s Your Experience With Iodine?”, which was very popular and received a good number of comments.  And so I figured I’d run a similar blog post, but this time focus on gluten.  Unlike iodine, most people who go on a gluten free trial don’t experience negative results, and many people feel significantly better upon avoiding gluten.  However, there are also people who avoid gluten for a prolonged period of time and see no improvement in their symptoms, blood tests, etc.

So what I’d like for you to do is please share your experience with gluten.  If you avoided gluten and it helped improve your symptoms or blood tests please let me know!  And if you avoided gluten and you didn’t notice any improvement in your symptoms or tests please let me know!  And if you are one of those rare people who went on a gluten free trial and had a worsening of your symptoms please let me know!

Also, please feel free to be as specific as possible.  So for example, if you experienced gas and bloating, brain fog, daily headaches, skin problems, or any other sign or symptom that improved upon eliminating gluten please share this with everyone.  Or if you noticed a significant improvement in your thyroid hormone levels, thyroid antibodies, or any other test markers please share this with us as well.  Thank you in advance for participating!

Although many people with thyroid and autoimmune thyroid conditions are trying to lose weight, some people with these conditions are actually trying to gain weight, or at the very least, don’t want to lose any additional weight.  This is especially true for those with hyperthyroidism and Graves’ Disease, but it’s also true for a small percentage of people with hypothyroidism and Hashimoto’s Thyroiditis.  And following an autoimmune paleo diet can make this even more of a challenge, as while the goal of following this diet isn’t to reduce calories, it still is a very restrictive diet.

So if you are following an autoimmune paleo diet and are looking to gain weight and/or maintain a healthy weight, then here are a few things you can do:

1. Decrease the thyroid hormone levels.  This mainly applies to those people with hyperthyroidism and Graves’ Disease, although if someone with hypothyroidism is taking too high of a dose of thyroid hormone medication then it also can apply to them as well.  Either way, having high thyroid hormone levels will usually make it very difficult to gain weight.  It’s not uncommon for one of my patients with hyperthyroidism to tell me how concerned they are about their weight loss, and while some of the other advice given in this blog post might help to prevent them from losing additional weight, in many cases they will need to address the thyroid hormone levels before the weight loss subsides.

This described my situation when I was dealing with Graves’ Disease, as I lost over 40 pounds.  And I didn’t gain any weight until my thyroid hormone levels started to decrease.  Of course some people who take antithyroid medication have the opposite problem, as the medication will make them hypothyroid and cause them to gain weight.  This weight gain usually can be minimized by not taking too high of a dosage of antithyroid medication.  Sometimes taking too high of a dosage of bugleweed can also cause weight gain, although it’s not as common as taking higher doses of antithyroid medication.

2. Eat nutrient dense foods.  Although the autoimmune paleo diet is restrictive, it is also very nutrient dense.  And while I understand the concern about not getting enough calories, it is better to consume less calories consisting of nutrient dense foods rather than eating a lot of high calorie, low nutrient dense foods.  With that being said, eating a good amount of protein, along with a lot of healthy fats when following an autoimmune paleo diet can help you maintain a healthy weight, and might even cause you to gain weight.

Most people who follow such a diet focus more on the protein, as for example, they might eat meat with every meal.  But don’t underestimate the benefits of eating a lot of healthy fats and oils.  Avocados and coconut oil are two main sources of healthy fats to consider consuming, but other healthy fats and oils include olive oil, tallow, and coconut milk.

3. Heal the gut.  Problems with digestion or absorption can cause someone to have problems gaining weight.  So for example, while most people with a high TSH and low thyroid hormone levels will have problems losing weight, if you have a high TSH and low or depressed thyroid hormone levels and are losing weight, then I would suspect absorption issues.  For example, if someone has inflammatory bowel disease then this can cause weight loss.  Celiac disease can also result in malabsorption of nutrients, and cause weight loss.

4. Eradicate infections.  Having certain infections can cause some people to lose weight.  So for example, having a condition such as small intestinal bacterial overgrowth, or a parasitic infection can cause someone to have problems losing weight.  In some cases H. Pylori can cause weight loss.  Certain viruses can also result in gastroenteritis and make gaining weight difficult.  And so you want to make sure to eradicate any infections.

5. Do things to increase muscle mass.  Another way to gain some weight is to do things to increase muscle mass.  While eating a healthy diet consisting of a good amount of protein and healthy fats is important, physical activity is also important, and this includes weight bearing exercises.  For example, engaging in some light weight lifting three times per week is a good way to increase muscle mass.  This doesn’t necessarily mean joining a fitness club, as you can get some light weights and exercise from the comfort of your own home.

So if you are having problems gaining weight when following an autoimmune paleo diet, then hopefully some of the strategies given in this post will help you to overcome this.  If you have hyperthyroidism or Graves’ Disease, then in many cases you will need to decrease the thyroid hormone levels before you can gain weight.  But other things that can help you to gain weight include eating nutrient dense foods, doing things to heal the gut, eradicate any infections, and increase muscle mass.

Every now and then I’ll have someone ask me if I followed an autoimmune paleo (AIP) diet when I was dealing with Graves’ Disease.  The reason I get asked this question at times is because I commonly recommend for my patients with Graves’ Disease and Hashimoto’s Thyroiditis to initially follow an AIP diet.  And so they want to know if I followed a similar diet when I was taking a natural treatment approach.

I’m assuming most people reading this know what an autoimmune paleo diet includes.  But just to play it safe I’ll briefly distinguish between a “standard” paleo diet and an “autoimmune” paleo diet.  A standard paleo diet allows the following foods to be consumed:

Meat (i.e. beef, pork, poultry)

Fish

Vegetables

Fruits

Eggs

Nuts and seeds

Healthy oils

Green tea and herbal teas

So a “standard” paleo diet excludes foods such as dairy, grains, and legumes.  And of course it also restricts refined sugars and oils, fast food, etc.  Without question it’s a restrictive diet, and while some people struggle following a standard paleo diet, for many people it’s not difficult at all.  As for an autoimmune paleo diet, this is even more restrictive than a standard paleo diet, as an autoimmune paleo diet also excludes eggs, nuts and seeds, and the nightshade family of vegetables, which includes tomatoes, eggplant, white potatoes, and peppers.

But why are these foods excluded?  Well, the reason why eggs, nightshades, and nuts and seeds are excluded from an autoimmune paleo diet is because they include compounds which can potentially increase the permeability of the gut.  And some theorize that a leaky gut is a factor in all autoimmune conditions.  I spoke about this in greater detail in a past blog post I wrote entitled “Is a Leaky Gut Present In All Autoimmune Thyroid Conditions?”

Do I Have All Of My Graves’ Disease and Hashimoto’s Patients Follow an AIP Diet?

Initially I recommend for all of my patients with Graves’ Disease and Hashimoto’s Thyroiditis to follow an autoimmune paleo diet for at least the first 30 days.  This isn’t to suggest that some people won’t need to follow this diet for a longer period of time.  But I don’t think that there is a “one size fits all” diet, and I spoke about this in a past blog post entitled “Should Everyone With Graves’ Disease and Hashimoto’s Thyroiditis Follow an Autoimmune Paleo Diet?”.  Although I do think the AIP diet is a good starting point for those with autoimmune thyroid conditions, not everyone needs to follow this diet for a prolonged period time, and not everyone with an autoimmune condition does well on this type of diet.

What Diet Did I Follow When I Was Diagnosed With Graves’ Disease?

So let’s go back to the original question, which asked if I followed an AIP diet when I was diagnosed with Graves’ Disease.  First of all, when I was diagnosed with Graves’ Disease I’m pretty sure there wasn’t an official “autoimmune paleo diet”.  Back then it was referred to as a “gut repair diet”.  Just as a reminder, when I was treating my Graves’ Disease condition naturally I was working with a natural healthcare professional who had experience working with endocrine conditions.  And initially she recommended for me to follow a standard paleo diet, and not an AIP/gut repair diet.

As a result I didn’t eliminate the eggs, nightshades, nuts and seeds from my diet.  While I was progressing well, on my first saliva test my secretory IgA was depressed, and this marker didn’t improve when doing a retest (although my cortisol and DHEA levels did show some great changes).  As a result, the natural healthcare professional I was working with suggested for me to follow a strict gut repair diet, which I did.  I don’t remember if this involved giving up eggs.  Truth to be told, I’ve never been a big consumer of eggs, as I usually add a couple of raw egg yolks to my smoothies a few times per week, but I usually don’t eat eggs for breakfast on a regular basis like many people do.  On the other hand, giving up nuts and seeds was a big challenge for me, as I’ve always loved eating all types of nuts and seeds.

A few months after following the gut repair diet I had another saliva retest, and my secretory IgA had greatly improved.  Was following the AIP/gut repair diet responsible for this improvement?  I’d like to think so, although I will admit that I’ve had some patients with a depressed secretory IgA not give up nuts and seeds and a few months later this value improved.  The truth is that everyone is different, and what works for one person doesn’t always work for the another person with the same condition.  In addition, those following a natural treatment protocol are almost always doing multiple things to help improve their health, and so sometimes it can be challenging to know if a specific factor was responsible for the person’s improvement.

Should YOU Follow An Autoimmune Paleo Diet?

If you have Graves’ Disease or Hashimoto’s Thyroiditis (or any other type of autoimmune condition), then you might be wondering if you should follow an AIP diet.  As I mentioned earlier, I currently recommend for all of my patients with autoimmune thyroid conditions to at least follow an AIP diet initially.  Then after 30 days if they are struggling with the diet I’m open to them reintroducing other foods.  Of course some people don’t follow an AIP diet at all, even for the initial 30 days.  And some of these people still end up receiving good results, while others don’t progress well.

Even though one can make the argument that not everyone with an autoimmune condition needs to follow a strict AIP diet, it is impossible to know who will progress well without following such a diet.  And so if you have Graves’ Disease or Hashimoto’s Thyroiditis you have a few different options, but I’m going to focus on two options here.  The first option, which as you now know is the one I recommend, is to play it safe and strictly follow the AIP diet.  A second option is not to follow an AIP diet, but to still eat whole healthy foods, avoid refined foods, and see how you progress.

If you choose not to follow a strict AIP diet I would at least encourage you to follow a standard paleo diet for awhile.  If you don’t follow an AIP diet and your symptoms, blood tests, and other tests continue to improve then you probably are fine following the current diet.  On the other hand, if your health doesn’t improve when following a standard paleo diet then it probably is best to try following a strict AIP/gut repair diet for at least a month or two.  Sure, perhaps there are other factors responsible for the lack of progress, but since one’s diet can definitely play a role I think eating well is essential to receive optimal results, even if there are other factors to consider.

In summary, I usually recommend for my patients with Graves’ Disease and Hashimoto’s Thyroiditis to follow an autoimmune paleo diet initially.  However, when I was dealing with Graves’ Disease I initially followed more of a standard paleo diet, although I eventually made the transition to an AIP/gut repair diet due to the secretory IgA remaining depressed.  While some people with autoimmune thyroid conditions don’t need to follow a strict AIP diet, it’s impossible to know who will do well and who won’t do well when not following such a diet.  As a result, I think it’s a good idea to try to be as strict as possible initially, and then as your health improves you should eventually be able to reintroduce other foods.

A few days ago I released an article entitled “An Update On Iodine and Thyroid Health”.  In this article I discussed my personal experience with iodine, along with my patient’s experience.  I also mentioned some of the benefits and risks of supplementing with iodine, and I spoke about the different forms of iodine supplementation.

But I decided to put together this blog post because I’m hoping that at least a few people will share their experience with iodine supplementation.  So if you have Graves’ Disease, Hashimoto’s Thyroiditis, multinodular goiter, etc., and if you have supplemented with iodine in the past (or are currently supplementing with iodine), please feel free to share your experience in the comments section below.  If you took iodine and had a negative reaction please let me know!  And if you took iodine and had a positive experience please let me know!  And even if you didn’t notice anything positive or negative please let me know!

Also, please feel free to be as specific as you can with regards to what type of iodine you took (i.e. Iodoral, Nascent, kelp, etc.), how much you took, etc.  If you had a negative experience, what symptoms or lab values got worse?  If you had a positive experience what symptoms or lab values improved?  Thank you in advance for sharing your experience with iodine.

I’ve spoken about cytokines in past articles and blog posts, as these are proteins that play a role in regulating the inflammatory process.  Although pro-inflammatory cytokines play a role in autoimmune conditions such as Graves’ Disease and Hashimoto’s Thyroiditis, there are also anti-inflammatory cytokines as well.  Some healthcare professionals will test the cytokines of their patients, and in this blog post I’ll discuss if this is something everyone with an autoimmune thyroid condition should do.

Rather than beat around the bush, let’s jump right into the main subject and talk about testing for cytokines.  So why do some healthcare professionals choose to test the cytokines of their patients?  After all, assuming this isn’t covered by your health insurance, testing for cytokines can be expensive, and so what purpose is served by testing these?  Well, the main reason why healthcare professionals choose to do this type of testing is in order to modulate the Th1 and Th2 pathways.  I’ve spoken about this in previous articles and blog posts, but I’ll briefly talk about this below.

What You Should Know About Th1 and Th2

T helper cells are one of the most important cells related to immune system health…specifically something called adaptive immunity.  They help to activate B cells, which in turn secrete antibodies, and they also activate other T cells to help kill infected cells.  However, these T helper cells first need to be activated, and once activated they will differentiate into Th1 or Th2 cells. These cells have different functions, and they will secrete different cytokines.  There are other types of T helper cells, but I’m going to mainly focus on the Th1 and Th2 cells here.

Autoimmunity involves an imbalance of these Th1 and Th2 cells.  Conditions such as Hashimoto’s Thyroiditis are typically considered to be “Th1 dominant”, which means that there is an excessive amount of Th1 cells.  On the other hand, most cases of Graves’ Disease are considered to be “Th2 dominant”, where there is an excessive amount of Th2 cells.  However, this isn’t set in stone, and the only way to know for certain whether someone is Th1 dominant or Th2 dominant is to test the cytokines.

But what does someone do with the information they receive after testing for cytokines?  Well, there are some studies which show that certain nutrients and herbs can help to stimulate Th1 cells, while other nutrients and herbs can stimulate Th2 cells.  And so for example, if a doctor is working with someone who has Hashimoto’s and does cytokine testing, and this shows that the person is Th1 dominant (has an excess of Th1 cells), then this doctor might recommend nutrients and herbs that stimulate the opposite pathway (Th2), while at the same time tell the patient to avoid nutrients and herbs that stimulate Th1 cells.

What Is Nuclear Factor Kappa B?

Inflammation involves numerous signaling pathways which involve the regulation of both pro- and anti-inflammatory cytokines.  Nuclear Factor Kappa B (NFkB) is a transcription factor that plays an important role in helping to regulate inflammation.  The activation of NFkB is a normal process, but with autoimmune conditions what happens is that NFkB becomes chronically activated, which makes it more challenging to control the inflammation.  And when dealing with autoimmune thyroid conditions such as Graves’ Disease and Hashimoto’s Thyroiditis, one of the primary goals should be to downregulate NFkB, which can be accomplished through the use of certain nutrients and herbs.

The Flaws With Trying To Balance The Th1 and Th2 Pathways

Using nutrients and herbs to balance the Th1 and Th2 pathways might sound like a good idea, but there are flaws to taking this approach.  For example, some sources label turmeric and resveratrol as stimulating the Th2 pathway, which should suggest that they should be avoided in people with Th2 dominant conditions, including Graves’ Disease.  However, other sources show that these can inhibit both Th1 and Th2 cytokines (1), and both turmeric and resveratrol also help to increase regulatory T cells and decrease Th17 cells, which can suppress autoimmunity.  Over the years I’ve had many of my patients with Graves’ Disease take turmeric and/or resveratrol without having a negative effect on their recovery.

Another example involves the herb Echinacea, which can stimulate the Th1 pathway, and thus might be problematic for those with Th1 dominant conditions, including Hashimoto’s Thyroiditis.  I will admit that I don’t give Echinacea often to my Hashimoto’s patients, although it’s not necessarily because I’m fearful of this herb worsening their condition.  There are a few well known and competent healthcare professionals who willingly give Echinacea to their patients with Hashimoto’s Thyroiditis, and they claim that this usually doesn’t cause any negative effects on their health.  Master herbalist Kerry Bone, who is the author of a few textbooks on herbal medicine, doesn’t seem to be concerned about Echinacea worsening a condition such as Hashimoto’s.  Not too long ago I attended a seminar conducted by Ronda Nelson, who has many years of experience working with Hashimoto’s Thyroiditis and other endocrine conditions, and she recommends Echinacea to many of her patients with Hashimoto’s Thyroiditis.

I’m not suggesting that there isn’t any validity to the Th1/Th2 balancing theory, as I have come across patients with both Graves’ Disease and Hashimoto’s Thyroiditis who didn’t do well when taking certain nutrients and herbs.  This doesn’t mean that it was due to the agent stimulating the Th1 or Th2 pathway, although perhaps this was the case.  Without question this remains a controversial topic.

How Do You Test For Cytokines?

There are a few labs that offer cytokine panels.  True Health Labs and Life Extension are two companies I know of that offer testing for cytokines.  If anybody reading this is familiar with other companies which offer cytokine testing please feel free to post the name of the company/lab in the comments section below.

Th1 vs. Th2 Cytokines

What I’d like to do here is present a list of some of the more well known cytokines associated with the Th1 and Th2 pathways:

Th1 Cytokines:

Tumor necrosis factor (TNF) alpha

Interferon gamma (IFN-y)

Interleukin (IL)-2

IL-12

IL-18

Th2 Cytokines:

IL-4

IL-5

IL-6

IL-9

IL-10

IL-13

How Do You Inhibit These Cytokines?

From a conventional medical standpoint, selective cytokine inhibitory drugs are one option.  There are also TNF-alpha inhibitors, which specifically bind to and inhibit the cytokine TNF-alpha.  However, non-steroidal anti-inflammatory drugs (NSAIDs) can also inhibit cytokines.  Of course these drugs come with potential side effects, and one reason is because you don’t want to completely inhibit these pathways.  The real goal is to address the cause of the problem while trying to do things to reduce, or downregulate pro-inflammatory cytokines.

Fortunately, there are nutrients and herbs which can help to accomplish this, and these are some of the more well-researched ones:

Turmeric.  There is plenty of evidence which shows that turmeric can help to inhibit NFkB and reduce proinflammatory cytokines (2) (3) (4), and it also can help to increase regulatory T cells while decreasing Th17 cells (5).

Resveratrol.  Like turmeric, resveratrol can also inhibit NFkB and result in a decrease in proinflammatory cytokines (6) (7) (8).  In addition, it can help to regulate the Treg/Th17 balance (9) (10).

Omega 3 fatty acids. Numerous studies show that omega 3 fatty acids in the form of fish oils can decrease pro-inflammatory cytokines, while increasing anti-inflammatory cytokines (11) (12) (13).

Vitamin D3.  There is evidence that a vitamin D deficiency is associated with increased levels of pro-inflammatory cytokines (14), and reduced levels of anti-inflammatory cytokines (15).  In addition, vitamin D might help to increase regulatory T cells (16) (17), and reduce Th17 cells (18) (19).

Alpha lipoic acid.  Numerous studies show that alpha lipoic acid can reduce pro-inflammatory cytokines such as TNF-alpha, while downregulating NFkB (20) (21) (22).  There is also evidence that alpha lipoic acid can suppress the number of Th17 cells, while increasing the number of regulatory T cells (23).

Probiotics.  Certain strains of probiotics can help to reduce inflammation by reducing pro-inflammatory cytokines and modulating NFkB (24).  Some probiotics, including Lactobacillus reuteri and Lactobacillus casei, have been shown to increase regulatory T cells (25).

Green Tea.  Studies show that the green tea polyphenols can help to downregulate NFkB and increase regulatory T cells (26) (27) (28).  In fact, the studies show that even decaffeinated green tea, which has reduced catechin content, doesn’t necessarily reduce its ability to inhibit NFkB (28).

Gamma-linolenic acid.  Although most omega-6 fatty acids are considered to be pro-inflammatory, this isn’t the case with gamma-linolenic acid (GLA).  Studies show that GLA can decrease proinflammatory cytokines (29) (30).  Some excellent sources of GLA include borage oil, evening primrose oil, and black currant seed oil.

You might have noticed that in addition to reducing pro-inflammatory cytokines, many of the nutrients/herbs I mentioned in this post increase regulatory T cells and decrease Th17 cells.  I’ve spoken about these in past articles and blog posts, as regulatory T cells help to suppress the autoimmune response, while Th17 cells promote autoimmunity.  The good news is that some of the same nutrients and herbs which reduce proinflammatory cytokines will also increase regulatory T cells and decrease Th17 cells:

In summary, while some healthcare professionals recommend for their patients to get tested for cytokines to determine if they are Th1 or Th2 dominant, this has certain limitations.  Although autoimmunity involves an imbalance of the Th1 and Th2 pathways, it is difficult to balance these pathways by using specific nutrients and herbs.  And in my opinion, this is the only reason to test for cytokines in the first place.  I personally don’t have my patients test for cytokines.  With regards to reducing pro-inflammatory cytokines (and increasing Tregs and decreasing Th17 cells), natural agents which seem to benefit many people with both Graves’ Disease and Hashimoto’s Thyroiditis include turmeric, resveratrol, vitamin D3, alpha lipoic acid, probiotics, and green tea.