Adhesive capsulitis, also known as a frozen shoulder, is characterized by a painful, gradual loss of active and passive shoulder motion resulting from fibrosis and contracture of the joint capsule (1).  Although other shoulder conditions can result in similar symptoms, people with hyperthyroidism are more prone to developing a frozen shoulder.  As a result, if you have hyperthyroidism and are experiencing moderate to severe pain in one or both shoulders that isn’t due to a traumatic injury, then it’s possible that you have adhesive capsulitis as a result of your condition.

Adhesive capsulitis usually develops one of two ways.  The primary method is gradual, which usually is the case with those who have hyperthyroidism.  But it can also develop as a result of a trauma.  When it’s not caused by a trauma, it can take a few weeks or months until the pain is severe enough for the person to seek medical attention.  Sometimes they will only notice the shoulder pain initially, but over time they will realize that it’s also affecting their range of motion.

Adhesive Capsulitis Can Be Present In Other Conditions

Although hyperthyroidism is one of the more common conditions in which people develop a frozen shoulder, there can be other conditions that lead to this as well.  This includes hypothyroidism, as well as hypoadrenalism, Parkinson’s disease, cardiac disease, pulmonary disease, and stroke (2).

The Three Clinical Phases of Adhesive Capsulitis

The literature discusses three distinct phases of adhesive capsulitis (3):

1. The freezing or painful stage.  This is what I described above, as over time the pain will increase, and both the active and passive range of motion will decrease.  This phase typically lasts between 3 and 9 months and is characterized by an acute synovitis (inflammation of the synovial membranes) of the glenohumeral joint of the shoulder (3).

2. The frozen or transitional stage.  This stage can last from 4 to 12 months, and it’s usually when the pain is the most intense and the shoulder is the most restricted.

3. The thawing stage.  This is when the pain begins to decrease and the range of motion begins to improve.  This stage can last anywhere from 12 to 42 months (3).

How Is Adhesive Capsulitis Diagnosed?

As for how adhesive capsulitis is diagnosed, it can be challenging initially.  A physical examination will reveal both a loss of passive and active range of motion (4).  Many times it is diagnosed by ruling out other conditions, such as a rotator cuff tear, a bone contusion, or osteoarthritis.

What Are The Treatment Options For Adhesive Capsulitis?

The conventional treatment approach usually will begin with either drugs or physical therapy.  Nonsteroidal anti-inflammatory drugs (NSAIDs) can help to reduce the inflammation, which in turn might decrease the pain (5) (6).  Prednisone might also benefit some people with adhesive capsulitis, although the benefits seem to be more short term (7).  Cortisone injections are also commonly used and can lead to fast pain relief and an improved range of motion (8) (9), although of course there are potential side effects as well.  Sometimes arthroscopic surgery is used for adhesive capsulitis.  But in most cases surgery should be a last resort.

I’m more in favor of using natural anti-inflammatory agents, such as higher doses of curcumin, resveratrol, boswellia, and fish oils.  However, many times these won’t result in significant relief, and when this is the case, some type of physical therapy can be beneficial.  There is some evidence that a combination of bee venom acupuncture and physiotherapy can help with adhesive capsulitis (10) (11).  For those who aren’t familiar with bee venom acupuncture, this is a type of herbal acupuncture that uses bioactive compounds isolated from bee venom, combined with acupuncture.  But “standard” acupuncture can also be beneficial for a frozen shoulder.  Manipulation of the shoulder can be beneficial (12), and possibly even manipulation of the thoracic spine (13).  And so going to a chiropractor might help, especially if you see a chiropractor that has experience working on extremities.  Low-level laser therapy might also help with adhesive capsulitis (14).

In summary, people with hyperthyroidism are more prone to developing a frozen shoulder, which is also known as adhesive capsulitis.  Most of these cases develop gradually, although sometimes it can be due to a trauma.  Adhesive capsulitis is usually diagnosed by ruling out other conditions.  Conventional treatment usually involves NSAIDs, cortisone injections, physical therapy, and in some cases arthroscopic surgery.  Although natural anti-inflammatory agents probably won’t help much, acupuncture, manipulation, and low-level laser therapy might be beneficial.

Most people with thyroid and autoimmune thyroid conditions deal with chronic stress.  In fact, I think it’s safe to say that most people in general deal with chronic stress.  And while I have spoken about cortisol in past articles and blog posts, I haven’t talked as much about adrenaline.  And so what I plan on doing in this post is to discuss some of the factors which can cause high cortisol and adrenaline, some of the symptoms associated with elevated levels, and the consequences of having high levels of cortisol and adrenaline over a prolonged period of time.  And of course I’ll discuss what you can do to naturally lower cortisol and adrenaline.

Most people reading this are aware that adrenaline is involved in the “fight or flight” reaction.  When there is a stressful situation, there will be a rapid increase of adrenaline.  On the other hand, cortisol will also increase, but it’s a slower process.  During a chronic stress situation you can have chronically raised adrenaline and cortisol levels.

Adrenaline is known as epinephrine.  And there is also norepinephrine (noradrenaline).  Both of these are known as catecholamines.  As for how they are formed, the amino acid tyrosine gets converted into DOPA, which in turn gets converted into dopamine.  This neurotransmitter in turn gets converted into noradrenaline.  An enzyme called PNMT converts norepinephrine into epinephrine by catalyzing the transfer of a methyl group from SAMe to norepinephrine.  Both epinephrine and norepinephrine are broken down and inactivated by the enzymes catechol-oxymethyltransferase (COMT) and monoamine oxidase (MAO).  However, if someone has a genetic defect of the COMT gene or the MAOA gene then this can affect the breakdown of the catecholamines.  Fortunately there is genetic testing available to determine if someone has one or both of these genetic polymorphisms.

What Are The Causes/Symptoms Of Elevated Adrenaline?

Before talking about the symptoms of high adrenaline, it probably is a good idea to briefly mention some of the factors which can cause high adrenaline.  In addition to stress, other factors which can cause high adrenaline include not getting enough sleep, having hypoglycemia, pain, anger and fear, and being on certain medications.  If someone has high adrenaline then they can experience one or more of the following symptoms:

• Anxiety
• Elevated heart rate
• Elevated blood pressure
• Heart palpitations
• Low insulin and blood glucose
• Headaches
• Hot flashes

What Are The Causes/Symptoms Of Elevated Cortisol?

In addition to stress causing elevated cortisol levels, other factors include not getting enough sleep, inflammation, infection, blood sugar imbalances, and trauma (both emotional and physical).  Here are some of the symptoms one can experience with elevated cortisol levels:

• Memory and concentration problems
• Problems falling and/or staying asleep
• Depression
• Elevated blood glucose levels
• Low sex hormones due to the pregnenolone steal

What Are The Consequences Of Prolonged Elevations Of Adrenaline and Cortisol?

Although having elevated adrenaline and cortisol levels for short periods of time is normal under the presence of an acute stressor, if someone is dealing with prolonged chronic stress then this can not only cause the symptoms I mentioned earlier, such as anxiety, depression, hypertension, low sex hormones, and blood sugar imbalances, but it can also lead to osteoporosis, as well as cognitive impairment.

The hippocampus, which is important in learning and memory, is particularly sensitive to chronic stress and cortisol (1).  There is evidence that prolonged elevations of cortisol can compromise the hippocampus, and this can affect cognition (1) (2).

In addition, if someone has elevated cortisol levels for a prolonged period of time, this can lead to cortisol resistance.  You might be familiar with insulin resistance, which is when there is an excess of insulin, and the cells are no longer responsive to the effects of insulin.  It’s similar with cortisol, as large amounts of cortisol can result in a decreased negative feedback of the cortisol-ACTH feedback system resulting in increased ACTH secretion. This causes higher plasma cortisol and also increases the production of adrenal mineralocorticoids (3).  This not only can affect someone’s ability to handle stress, but it also can interfere with the regulation of the inflammatory process (4).

What Impact Does Elevated Cortisol and Adrenaline Have On Thyroid Health?

Cortisol seems to have a greater impact on thyroid health than adrenaline.  In past articles I have discussed how elevated cortisol levels can affect the conversion of T4 to T3.  This will result in low or depressed T3 levels, and an elevated reverse T3.  Studies show that stress can inhibit both type I iodothyronine 5′-deiodinase activity (5), as well as type II 5′-deiodinase activity (6) (7).

What Is Cushing’s Syndrome?                                  

Cushing’s syndrome is a condition which involves the body being exposed to excessive amounts of cortisol.  Although this can be caused directly by the adrenals releasing too much cortisol, it can also be caused by an excess of ACTH released by the pituitary gland, which in turn will lead to excess cortisol.  In fact, the latter problem is more common, as many people with Cushing’s syndrome have a pituitary adenoma that is responsible for the excess amount of ACTH, which is referred to as Cushing’s disease.  An adenoma is a benign tumor, and sometimes it can be difficult to diagnose.  Cushing’s syndrome can also be caused by taking an excess amount of prescription corticosteroids.

Although some of the symptoms of Cushing’s syndrome are similar to those with high cortisol, this is an extreme condition, and the symptoms are usually more severe.  Here are some of the symptoms associated with this condition (8):

• Weight gain
• Skin changes
• Menstrual irregularities
• Muscle loss and weakness
• Osteopenia or osteoporosis
• Elevated blood glucose levels
• High blood pressure
• Infections
• Dyslipidemia

As for how Cushing’s syndrome is diagnosed, in addition to having elevated cortisol levels in the blood, a urinary cortisol test might also be performed.  ACTH should also be tested, and if this hormone is elevated then a pituitary adenoma is the most likely cause of the excess cortisol release, although an ectopic source is also possible.  If cortisol is high but ACTH is normal then there might be an adrenal tumor.  Other tests commonly used include a high-dose dexamethasone suppression test, a corticotropin-releasing hormone test, and sometimes a CT scan or MRI will be conducted in order to detect the presence of a pituitary or adrenal adenoma.

If Cushing’s syndrome is due to a pituitary or adrenal adenoma, then surgery is commonly recommended.  If the pituitary adenoma can’t be identified, then partial surgery of the pituitary gland might be conducted.  If this procedure is performed then hormone replacement therapy is necessary. If someone has an adrenal gland tumor then the affected adrenal gland is usually removed. Sometimes radiation is used to shrink the adenoma.  Prescription drugs might also be used to control cortisol production.

How Can You Test For High Cortisol or Adrenaline?

Many reading this know that I prefer testing the cortisol levels through the saliva.  Although testing cortisol through the blood has some value, I prefer the saliva because it allows you to look at the circadian rhythm  of cortisol, whereas with serum testing you are relying on a single sample, which doesn’t always tell the entire story.  In addition, it’s common for false elevations of cortisol to occur when testing through the blood, and the main reason for this is because cortisol increases during stressful situations, and many people find it stressful to get blood drawn.  You can also test for the urinary cortisol metabolites, although this is something that I personally don’t do in my practice.

With regards to testing for adrenaline, although you can test adrenaline in the blood (along with norepinephrine), urine testing is more commonly used.  Usually a 24-hour urine collection is recommended.  Organic acids is another option, as this measures a metabolite called vanilmandelate, which usually increases when someone has elevated adrenaline levels.  You can also test for genetic polymorphisms of COMT and MAO-A, which help to break down adrenaline.  I’ll discuss these in a little more detail shortly.

How Can You Decrease Cortisol and Adrenaline?

1. Reduce your stress levels.  Since stress causes an increase in cortisol levels, it makes sense to do everything you can to try to reduce the stress levels in your life.  Although I realize that reducing the stress in your life isn’t always possible, what I recommend is to write down all of the major and minor stressors in your life, and  try to determine if you can eliminate some of these stressors.

2. Improve your stress handling skills.  Whether or not you can reduce your stress levels it is a good idea to do things to improve your stress handling skills.  After all, one’s perception of the stressor usually plays a greater role than the stressor itself.  In order to help accomplish this I recommend to incorporate one or more mind-body-medicine techniques such as yoga, meditation, biofeedback, or another technique.  Also consider utilizing acupuncture and massage, as these can also help with high cortisol and adrenaline levels.

3. Nutrients and herbs which lower cortisol.  Some of the nutrients and herbs which can lower cortisol include magnolia and Phellodendron bark (relora) (9) (10), phosphatidylserine (11) (12), and  ashwagandha (13) (14).

4. Nutrients and herbs which lower adrenaline.  GABA is an inhibitory neurotransmitter, and this can decrease adrenaline levels (15). GABA doesn’t seem to cross the blood brain barrier unless if it has a phenyl group attached, although you can also take nutrients and herbs which increase GABA production.  For example, both L-theanine (16) and valerian root can both increase GABA (17) (18).

5. Protect the hippocampus.  I mentioned earlier how prolonged elevations of cortisol can compromise the hippocampus.  Well, there is evidence that the herb Bacopa monniera can help to protect the hippocampus from damage (19) (20) (21).

6. Test for COMT and MAO-A polymorphisms.  Since the enzymes COMT and MAO-A help with the breakdown of adrenaline, if you continue to have chronically elevated adrenaline even after incorporating stress management and taking some of the nutrients I discussed, then you might want to do some testing to see if you have a COMT and/or MAO-A polymorphism.  While you can’t reverse these genetic polymorphisms, you can give nutritional support to help with these defects.

So hopefully you have a better understanding of the impact high cortisol and adrenaline can have on your health, and what you can do to try to lower these.  Some of the symptoms of high cortisol include anxiety, elevated heart rate and blood pressure, heart palpitations, low insulin and blood glucose, headaches, and hot flashes.  High cortisol frequently leads to memory and concentration problems, problems falling and/or staying asleep, depression, and low sex hormones.  Some of the things you can do to reduce cortisol and adrenaline include lowering your stress levels and improving your stress handling skills, and certain nutrients can also help such as relora, phosphatidylserine, ashwagandha, valerian root, and L-theanine.

There are numerous cells which play a role in modulating the immune system in autoimmune conditions such as Graves’ Disease and Hashimoto’s Thyroiditis.  In this blog post I’m going to focus on dendritic cells and toll-like receptors.  This admittedly will be a little more complex than many of the other articles and blog posts I’ve written, but every now and then I like to present some advanced information so that those people with autoimmune thyroid conditions can get a better understanding of what’s happening to their immune system.

Let’s start off by talking about what dendritic cells are.  Dendritic cells are one of the cells of your immune system, and they play a role in something called antigen presentation.  An antigen is a foreign molecule, and an example is pathogenic bacteria.  So for example, if someone has a bacterial infection, the dendritic cell will bind to the bacteria (antigen) and will then present it to the immune system.  And then of course the immune system will do everything it can to destroy the bacteria.

In addition to dendritic cells there are a few other antigen presenting cells.  These include macrophages and B lymphocytes.  Different antigen-presenting cells cause responses in different T cell populations (1).  In other words, while the goal of any antigen-presenting cell is to present an antigen to the immune system, dendritic cells will cause responses in different T cells than macrophages, which in turn will cause responses in different T cells than B lymphocytes.

What is A Major Histocompatibility Complex?

A major histocompatability complex (MCH) aids in allowing the immune system to recognize these antigens.  So for example, if there is pathogenic bacteria that invades the body, the MHC molecules are what actually bind to the proteins of these pathogens.  After doing this it displays them on the surface of the antigen presenting cell so that the appropriate T cells can recognize them, and of course these T cells then attempt to eradicate the bacteria.

You might wonder what specifically happens after the T cells recognize the antigens.  Of course we know that eventually the T cells will attempt to destroy the pathogen, but before this happens the T cell that binds to the MHC class II molecule is called a “naive” helper T cell.  If you have been reading my blog posts for awhile you might be familiar with Th1 and Th2 cells, and this naive helper T cell will become either a Th1 cell, a Th2 cell, a Th17 cell, or a regulatory T cell (2).  In a healthy immune system you want a balance of Th1 and Th2 cells, a large amount of regulatory T cells, and a low number of Th17 cells.  But with autoimmunity you commonly get an imbalance of the Th1 and Th2 pathways, along with an increase in Th17 cells and a decrease in regulatory T cells.

The Roll of Toll-Like Receptors                            

There are numerous studies which show that toll-like receptors play an essential role in the development of autoimmune conditions such as Graves’ Disease and Hashimoto’s Thyroiditis (3) (4).  Toll-like receptors are a type of pattern recognition receptor, and these in turn recognize a wide range of something called pathogen-associated molecular patterns, also known as PAMPS (5).  PAMPs are found in pathogens such as viruses and bacteria.  An example of a PAMP is a lipopolysaccharide, which  are large molecules found in gram-negative bacteria, and I discussed this in greater detail in a past blog post I wrote entitled “What Are Lipopolysaccharides and How Can They Affect Thyroid Health?“.  These PAMPs are not normally found in the body of humans, and so they are immediately identified as being a foreign substance by the immune system.  There is also something called DAMPs, which stands for “damage-associated molecular patterns”.  Unlike PAMPs, which are associated with infections, DAMPs are usually associated with trauma.  Both PAMPs and DAMPs are involved in the inflammatory response.

Are Dendritic Cells Beneficial or Harmful?

Although we know that proinflammatory cytokines increase inflammation, and regulatory T cells help to decrease the autoimmune response, it’s not certain whether dendritic cells are beneficial or harmful in those with autoimmune conditions.  Although dendritic cells might play a role in triggering autoimmunity (6), more recent observations have shown that dendritic cells are important to ensure “immunological peace” by modulating regulatory T cells (7), which help to suppress autoimmunity.  The truth is that while we refer to some immune system cells as “bad”, or proinflammatory, while others as being “good”, or anti-inflammatory, all of these immune cells serve a purpose.  And so when you think about it this way, hopefully you’ll realize that no immune cell is inherently good or bad.

How Can We Modulate These Dendritic Cells?

In past articles and blog posts I’ve discussed things you can do to decrease proinflammatory cytokines and increase regulatory T cells, and I still recommend to focus on incorporating these factors while removing the autoimmune trigger.  However, there are a few studies which show that certain nutrients can modulate dendritic cells in a positive manner.  This includes vitamin D, which also can help to decrease proinflammatory cytokines and increase regulatory T cells.  And there is also evidence that the 1,25(OH)₂D₃-Vitamin D₃ complex can affect the maturation and migration of many dendritic cell subsets and help to regulate the immune system (8).  There is also evidence that vitamin A can modulate dendritic cells (9).

There is also evidence that polyphenols, which are found in fruits and vegetables, can have a positive effect on dendritic cells and shift the immune response towards tolerance or immune activation (10).  Another article specifically mentioned the polyphenols quercetin and piperine as influencing the maturation of dendritic cells and modulating the inflammatory response (11).  In other words, the authors claim that polyphenols can drive the dendritic cells towards an anti-inflammatory profile (11).

In summary, dendritic cells and toll-like receptors both play a role in modulating the immune system.  Dendritic cells present antigens such as bacteria to the immune system, which in turn will attempt to destroy the pathogen.  Something called a major histocompatability complex (MCH) aids in allowing the immune system to recognize these antigens.  Toll-like receptors are a type of pattern recognition receptor, and they play an important role in recognizing pathogen-associated molecular patterns, which are found in pathogens such as viruses and bacteria.  Some nutrients which can modulate the dendritic cells include vitamin D, vitamin A, and polyphenols such as quercetin and piperine.

There are many spices that can benefit your health.  Eating these spices on a regular basis can help to decrease inflammation, eradicate pathogens, balance blood sugar levels, etc.  However, some spices have greater health benefits than others, and there are certain spices which should be avoided in those with autoimmune thyroid conditions such as Graves’ Disease and Hashimoto’s Thyroiditis.  And so I’ve decided to discuss the health benefits of seven spices that most people with thyroid and autoimmune thyroid conditions can safely consume (although there are a few exceptions).

Spice #1: Garlic.  I recommend for most of my patients to consume garlic.  Garlic has many different benefits, but one of the main reasons I recommend it to my patients is because it is a wonderful antimicrobial.  And many people with thyroid and autoimmune conditions have infections.  In fact, the research shows that garlic has antibacterial (1) (2), antiviral (3) (4), antifungal (5) (6), and even antiparasitic activities (7) (8).

In addition to being a great antimicrobial, garlic has other benefits, as it can help people with cardiovascular disease, including high blood pressure (9) (10).  Garlic can also reduce inflammation (11) (12).  And garlic also supports detoxification by increasing glutathione levels.  Some people who have small intestinal bacterial overgrowth (SIBO) are unable to consume garlic because they experience gas and bloating.

Spice #2: Turmeric.  Turmeric is yet another spice that most people can benefit from taking.  Inflammation is a big factor in autoimmune conditions such as Hashimoto’s Thyroiditis and Graves’ Disease.  And while there are numerous benefits of turmeric, perhaps the greatest one is that it is a wonderful anti-inflammatory agent.  With regards to autoimmune conditions it can help to reduce proinflammatory cytokines (13) (14) (15) and increase regulatory T cells (16).  Turmeric also can benefit cardiovascular health (17) (18), and it also has anticancer properties (19), as well as a neuroprotective effect (20).

Spice #3: Cinnamon.  This spice has many different benefits, but one of the primary benefits is helping to regulate blood glucose levels.  One meta-analysis showed that the consumption of cinnamon is associated with a statistically significant decrease in levels of fasting plasma glucose, total cholesterol, LDL-C, and triglyceride levels, and an increase in HDL-C levels (21).  However, there was no significant effect on the hemoglobin A1C (21).  Another meta-analysis showed that cinnamon improves fasting blood glucose in people with type 2 diabetes or prediabetes (22).  Another study showed that cinnamon proanthocyanidins had inhibitory effects on advanced glycation endproducts (AGEs), which are substances that contribute to increased oxidative stress and inflammation (23).

Cinnamon also seems to modulate the immune system, which can benefit people with autoimmune conditions.  Regulatory T cells help to suppress autoimmunity, and there is evidence that cinnamon can increase regulatory T cells (24).  Th17 cells are increased in autoimmunity, and cinnamon can potentially suppress these cells (24).  Another study looking at the effects of cinnamon in multiple sclerosis also discussed how cinnamon increases regulatory T cells while decreasing Th17 cells (25).  However, I must add that a recent study showed that cinnamon reduces serum T3 levels (26).  However, keep in mind that this was conducted on male rats, and it’s just a single study.

H. Pylori is a bacteria that can be a potential trigger of autoimmune thyroid conditions. And there is evidence that cinnamon has an inhibitory effect on H. Pylori (27). A recent study also showed that cinnamaldehyde, which is a major active constituent of cinnamon, has an anti-inflammatory effect on gastric inflammation caused by H. Pylori (28).

Spice #4: Thyme.  Thyme has numerous health benefits.  First of all, it has antimicrobial activity against yeast and bacteria (29).  I did come across an older in vitro study which showed that thyme had a significant inhibitory effect on H. Pylori (30).  There is also evidence that thyme can increase the activity of the phase 1 and phase 2 enzymes that are involved in detoxification (31) (32).  Thyme might also have anticancer effects as well (33).

Spice #5: Ginger.  Ginger belongs to the family Zingiberaceae, and it is very well known for its anti-inflammatory properties.  It helps to reduce inflammation by suppressing prostaglandin synthesis, specifically inhibiting cyclooxygenase-1 (COX-1) and cyclooxygenase-2 (COX-2), and also suppresses the formation of leukotrienes through the inhibition of 5-lipoxygenase (34) (35).  COX-1, COX-2, and 5-lipoxygenase are enzymes which play a role in the inflammatory process.  In addition, 6-gingerol, which is a major compound in ginger, has shown to inhibit both Th1 and Th2 cytokines (36), and an imbalance of the Th1 and Th2 pathways are a factor in autoimmune conditions.

Ginger also can be beneficial for certain types of cancers, including prostate cancer (37), pancreatic cancer (38), gastrointestinal cancer (39), and breast cancer (40).  Also, for those suffering from primary dysmenorrhea, a recent study also showed that ginger can be beneficial during the first 3 or 4 days of the menstrual cycle (41).  Those with insulin resistance or type 2 diabetes can also benefit from ginger, as a study showed that it improves fasting blood sugar, hemoglobin A1c, apolipoprotein B, apolipoprotein A-I, and apolipoprotein B/apolipoprotein A-I in patients with type 2 diabetes (42).

Spice #6: Sage.  Sage has been used for the relief of pain, protection against oxidative stress, free radical damage, angiogenesis, inflammation, along with bacterial and viral infections (43).  Many people with thyroid and autoimmune thyroid conditions have memory and concentration problems, and sage can potentially help to improve memory and cognition (44) (45).

Spice #7: Rosemary.  Rosemary (Rosmarinus officinalis L.) also has numerous health benefits.  First of all, it has antioxidant and anti-proliferative properties, and so it can help to reduce inflammation and inhibit the growth of cancer cells (46) (47) (48) (49).  It also has been shown to have antitumor activity against breast cancer cells, possibly by modulating estrogen (50).  There is also evidence that it can protect the liver (51).

Other Spices Can Be Beneficial As Well           

Of course there are numerous other spices that can also be beneficial to consume.  Examples include parsley, peppermint oil, cloves, cilantro, and oregano.  According to Sarah Ballantyne, author of the Paleo Approach, these spices are all autoimmune-friendly.  As a result, most people with Graves’ Disease and Hashimoto’s Thyroiditis should be able to consume these spices without a problem.

In summary, most people with thyroid and autoimmune thyroid conditions can benefit from consuming spices.  Numerous spices have anti-inflammatory effects (turmeric, ginger, rosemary), while other spices have powerful antimicrobial effects (garlic, thyme, sage).  Other spices help to balance the blood sugar levels (cinnamon, ginger), while some can help to support detoxification (thyme).  All of the spices I listed in this post should be fine for most people with autoimmune thyroid conditions such as Graves’ Disease and Hashimoto’s Thyroiditis.

X-rays represent a type of ionizing radiation, which in turn can cause damage to one’s cells and increase the risk of developing cancer.  While the focus of this blog post will be on dental x-rays, it’s important to understand that all x-rays emit ionizing radiation.  However, there are a few reasons why I’m specifically focusing on dental x-rays.  First of all, because of the proximity of the teeth to the neck, the thyroid gland has a greater chance of exposure when compared to other types of x-rays.  In addition, many people get annual dental x-rays, and so one of the main goals is to discuss the risks vs. benefits, and to try to determine if the benefits of getting annual dental x-rays outweigh the potential risks.

Let’s begin by trying to answer the following question…”why do many dentists recommend annual dental x-rays?”  There is no question that one’s oral health is important, and the main reason why many dentists recommend frequent x-rays is to detect the early formation of dental cavities.  This of course doesn’t happen overnight, as what usually will happen is that plaque will accumulate on the tooth, and bacteria will produce acid that will slowly demineralize the tooth.  This of course is why it’s important to brush your teeth on a regular basis, as this helps with the prevention of plaque buildup.  However, if someone doesn’t brush on a regular basis and/or they eat a lot of sugar, then this buildup of plaque can lead to a dental cavity, which can be spotted on a dental x-ray.

Obviously the goal should be to do what you can to prevent dental cavities from forming, but when they do form, what happens if you don’t get this addressed?  Well, if this isn’t treated then the cavity will usually become larger, and probably will affect the inner layers of the tooth, called the dentin and pulp.  Eventually the damage can be severe enough where the only solution is to get a root canal or a tooth extraction, and there are risks of both of these.

So in no way am I suggesting not to get dental cavities filled, although you of course want to make sure you don’t get any mercury amalgams.  However, is it necessary to get annual dental x-rays to detect the early formation of these cavities?  In my opinion most people don’t need to get dental x-rays every single year.  This is especially true for those people who practice good dental hygiene, as in most cases a cavity will take at least a few years to advance to the point where it causes severe damage to the dentin and the pulp of the tooth.  I’m sure there are exceptions to this, and of course if you are experiencing pain or a sensitivity in your teeth then it probably is a good idea to get a dental x-ray, even if the last one you had was recent.

How Often Should You Get Dental X-Rays?

Once again, keep in mind that it is only my opinion that most people don’t need to get annual dental x-rays.  And while many other natural healthcare professionals share the same opinion, of course most conventional dentists don’t feel this way.  You might be wondering how frequently I would recommend for people to get dental x-rays?  Should they wait until they experience pain or a sensitivity?  I probably wouldn’t take this approach, and I’d say getting dental x-rays every two or three years probably is fine for most people. ..assuming you are brushing your teeth at least twice per day and flossing at least once per day.  I’m sure there are some reading this who feel that every two or three years is too frequent.  Over the last few decades the longest I have gone between getting dental x-rays has been four years, and in this situation the x-rays revealed no cavities or other issues.  And I’m sure some reading this have gone even longer between having regular dental x-rays without having cavities or other oral problems.  If this is the case then please feel free to share your experience in the comments section below.

How Does Ionizing Radiation Cause Cancer?

Of course it’s not just dental x-rays that increases one’s risk of developing cancer, as all x-rays, as well as other types of procedures involving ionizing radiation, can increase your risk of developing cancer.  Just as a reminder, I’m focusing on dental x-rays because of the proximity of the teeth to the thyroid gland, and also because many people get annual dental x-rays without thinking twice.  As for how ionizing radiation causes cancer, what happens is that ionizing radiation causes oxidative stress and leads to the formation of free radicals (1) (2) (3).  Free radicals are molecules that are highly unstable, and they play a key role in the initiation and progression of tumor cells (4) (5).

But why do some people who are exposed to radiation develop cancer, while others don’t?  Well, there are a few factors that can play a role.  Genetics does seem to be one factor.  But epigenetics is usually a greater factor, and what this means is that one’s external environmental is what affects the genetics.  In other words, someone might have a genetic susceptibility to a certain type of cancer, but eating a poor diet and/or other factors will be primarily responsible for the development of cancer.  Sometimes it’s hard to make this connection, as a few years ago I worked with a patient who developed breast cancer, even though she lived a healthy vegetarian lifestyle, exercised regularly, etc.  On the other hand, many people eat plenty of junk food and don’t develop cancer.  Similarly, some people receive a lot of x-rays and don’t develop cancer, while others who develop cancer don’t have a history of frequent exposure to ionizing radiation.

Some Facts About Thyroid Cancer                                       

Thyroid cancer is the most common malignancy of the endocrine system, representing 3.8% of all new cancer cases in the United States and is the ninth most common cancer overall (6).  The American Cancer Society estimates that 62,450 people in the United States will be diagnosed with thyroid cancer in 2015, and 1,950 deaths will result from the disease (6).  95% of the cancers being of follicular cell origin-papillary, follicular, or anaplastic thyroid carcinomas (7).  Both papillary and follicular thyroid cancers have good survival rates, with the 5-year survival rate approaching 97%, although the median survival for a patient with anaplastic thyroid carcinoma is measured in months (7).  There is evidence of an increased risk of developing thyroid cancer in those with Hashimoto’s Thyroiditis and Graves’ Disease (8) (9) (10) (11).

But why do some people develop thyroid cancer?  Well, like most other cancers it seems to be due to a combination of genetic and environmental factors.  Of course the focus of this blog post is on the risks of dental x-rays, and below I’ll mention some of the research studies which show a correlation between the ionizing radiation in dental x-rays and the development of thyroid cancer.  But there can be other factors as well.  Thyroid cancer is more common in women, especially between puberty and menopause, and therefore estrogen seems to play a role in its development (12) (13) (14).  So doing things to improve one’s estrogen metabolism can also help to prevent thyroid cancer from developing.

What Does The Research Show Regarding Dental X-Rays and Thyroid Cancer?

So what does the research show?  First of all, an increased risk of thyroid cancer has been reported in dentists, dental assistants, and x-ray workers (15).  One case-control study provided some evidence that multiple exposure to dental x-rays may be associated with an increased risk of thyroid cancer (15).  Another study looked at different types of diagnostic x-rays, and found that overall there was no clear evidence of thyroid cancer risk associated with diagnostic x-rays except for dental x-rays (16).  And there are some other studies which show an increased risk of thyroid cancer with regular dental x-rays (17).

I’m sure many dentists will be angry upon reading this information, and keep in mind that I’m not suggesting that most people who receive dental x-rays on an annual basis will develop thyroid cancer.  And to be fair, there are other factors which also can increase someone’s susceptibility.  For example, since nutrients such as selenium might help to prevent thyroid cancer (18) (19), eating a poor diet can potentially increase one’s risk of developing this condition.  And there are many other minerals and phytonutrients which can help to prevent cancer.  Earlier I also mentioned how problems with estrogen metabolism can be a factor in the development of thyroid cancer.   In addition, wearing a thyroid shield while getting dental x-rays will decrease the risk of getting thyroid cancer (19), and so if you do get dental x-rays I would make sure to ask for a thyroid shield.

5 Takeaways From This Blog Post                                                                                   

Takeaway #1: Think twice about getting annual dental x-rays.  Once again, this is just my opinion, and I know some people reading this will disagree with me.  But while there are benefits of receiving dental x-rays, I don’t think most people need to receive them every single year.

Takeaway #2: When you get dental x-rays, make sure you wear a thyroid shield.  As ridiculous as this may sound, not all dental offices will provide their patients with a thyroid shield prior to having x-rays taken.  In fact, in the past I have had to ask the technician for a thyroid shield.

Takeaway #3: Maintain good oral health.  If you minimize your consumption of sugar, and brush and floss regularly, then this will greatly decrease your risk of having problems with your teeth and gums.  And of course this in turn will reduce your chances of getting dental cavities, which in turn will allow most people to get away with having less dental x-rays.  Keep in mind that I’m not suggesting that you don’t go to the dentist for regular cleanings, as I do think this is a good idea.

Takeaway #4: Eat a healthy diet.  While it’s important to minimize your consumption of sugar, you also want to eat plenty of whole healthy foods in order to make sure you get the necessary nutrients to help prevent cancer.  Eating plenty of vegetables, along with some fruits, can provide you with a lot of the nutrients and phytonutrients you need in order to help reduce one’s risk of developing cancer.

Takeaway #5: Do things to improve estrogen metabolism.  Since  increased estrogen levels can increase the risk of developing thyroid cancer (as well as some other types of cancers), it makes sense to do things to improve estrogen metabolism.  In the near future I will be releasing an article which focuses on improving estrogen metabolism.

In summary, x-rays are a type of ionizing radiation, which is one factor in the development of certain types of cancers.  As a result, it is a good idea to minimize one’s exposure to ionizing radiation.  Many dental offices recommend for their patients to get annual dental x-rays, and the research shows an increased risk of thyroid cancer with dental x-rays.  This doesn’t mean that people should never get dental x-rays, and I do think it’s a good idea to get regular cleanings.  But perhaps it’s time to question whether it’s a good idea to get annual dental x-rays.  Just like anything else, one needs to weigh the risks vs. benefits, and I’m not convinced that the benefits of annual dental x-rays outweigh the potential risks.

Please feel free to share your thoughts about getting annual dental x-rays in the comments section below.