When I attended a recent functional medicine conference, one of the presenters asked the audience the following question: “how many people attending this conference are gluten free?”  The majority of the attendees raised their hands, which probably shouldn’t be too surprising considering that it was filled with functional medicine practitioners who commonly advise their patients to avoid gluten.  However, the presenter also mentioned that approximately 30% of the general public is gluten free, which did surprise me.  Although many people reading this post avoid gluten, I’m sure there are others reading this who eat gluten on a regular basis and want to know if they should follow a gluten free diet on a permanent basis.

Before I talk about this, you might be wondering whether or not I raised my hand when the question was asked about avoiding gluten.  To be honest, I was ready to raise my hand, but although I greatly minimize my consumption of gluten, I can’t honestly say that I’m 100% gluten free.  And I’m sure some of the practitioners who raised their hands at the conference fell into the same category, as they might try their best to avoid gluten most of the time, but they don’t necessarily avoid gluten 100% of the time, or even 95% of the time.  Once again, this obviously will vary depending on the person, as I know that some people reading this are 100% gluten free.  On the other hand, some people might think they are 100% gluten free, even though this isn’t the case, as I discussed a few years ago in a blog post I wrote entitled “Are You Really Gluten Free?”

Avoiding Gluten When Restoring One’s Health

Although I eat some foods which consist of gluten every now and then, I encourage my patients to follow a gluten free diet while trying to restore their health.  This might seem to be hypocritical of me, as why would I tell my patients to completely avoid gluten, even though I personally don’t avoid gluten all of the time?  Well, keep in mind that I’m not in the process of restoring my health, as I’m in a state of remission.  On the other hand, if someone with a thyroid or autoimmune thyroid condition is trying to restore their health it probably is best to go gluten free.  And the reason for this is because gluten is not only a common allergen, but it can also increase intestinal permeability (1), which is a fancy term for a leaky gut, and is a factor in most, and possibly all autoimmune thyroid conditions.  In other words, in some people, avoiding gluten is a necessary component to restore their health.  And in these people, consuming even a small amount of gluten can prevent them from fully recovering.

But how about those people who don’t have any type of gluten sensitivity or intolerance?  In other words, while you might understand why someone who has Celiac disease or a non-Celiac gluten sensitivity will need to avoid gluten, why should someone who doesn’t have a sensitivity avoid gluten?  The problem is that it can be challenging to determine who is sensitive to gluten.  Unfortunately one can’t always rely on symptoms, and while there is testing available, this isn’t completely accurate either.  And so there is a chance that someone can have problems with gluten, even if they don’t experience any negative symptoms when consuming it.  This can be the case even if they have a negative Celiac panel, as frequently a Celiac panel will come out negative for those in the early stages, and they might also be asymptomatic when consuming gluten, which is known as “silent Celiac disease” (2) (3).  There is a more comprehensive gluten sensitivity test offered by Cyrex Labs, but it’s very expensive, and even with this test it’s possible to have a false negative result.

Can Someone Restore Their Health While Consuming Gluten?

Based on what I have said so far, you might wonder if it is possible for someone with a thyroid or autoimmune thyroid condition to restore their health, even if they don’t completely avoid gluten.  The answer is “yes”, as it definitely is possible for some people to restore their health while continuing to eat gluten…if they don’t have a gluten sensitivity or intolerance.  After all, while many people do better when avoiding gluten, and although gluten can be the main factor with regards to the autoimmune response in some people with Hashimoto’s Thyroiditis and Graves’ Disease, in many people this isn’t the case.  However, as I mentioned previously, it can be challenging at times to determine if someone has issues with gluten.  And so a person with a thyroid or autoimmune thyroid condition who doesn’t experience any symptoms when eating foods with gluten can of course choose to continue eating these foods while taking a natural treatment approach, and if all goes well then that’s great.

On the other hand, if someone continues to eat gluten but isn’t showing much improvement then this makes the situation more challenging.  And the reason for this is because if someone continues to eat gluten but their health doesn’t improve, there is no guarantee that eating the gluten was responsible for their lack of progress.  Let’s put it another way…if someone is following a natural treatment protocol, is 100% gluten free, and after a few months their health isn’t improving, then we can almost definitely conclude that exposure to gluten isn’t the reason why they weren’t progressing, since they were gluten free.  On the other hand, if someone eats gluten while following a natural treatment protocol and doesn’t improve, while it is possible that the reason why they weren’t improving was due to the exposure to gluten, there is also the possibility that another factor was responsible for their lack of progress.

I know this might be a little bit confusing to some people reading this, but my point is that when trying to restore your health, initially you want to try to avoid as many factors as possible that can be responsible for triggering your condition, and this includes avoiding gluten.  While doing this will greatly improve your chances of restoring your health, if for any reason your health doesn’t improve, at the very least you won’t be able to blame your lack of progress on those potential triggers (i.e. gluten) you avoided.  And so this will allow you to focus on other factors which might be problematic.

I’d like to give another example.  Let’s look at a scenario where someone is dealing with Hashimoto’s Thyroiditis or Graves’ Disease, and this person completely avoids gluten, dairy, corn, refined sugars, drinks purified water, and uses natural household products in order to reduce their toxic exposure.  If this person’s health doesn’t improve after a few months of following a natural treatment protocol then we can conclude that their lack of progress wasn’t due to exposure to gluten, dairy, corn, refined foods, toxins in the water, or household products.  While it might be frustrating to the person that their health hasn’t improved despite making these changes, at least we would know to focus on other factors.  On the other hand, if the same person avoided dairy, corn, refined foods, drank purified water, used natural household products, but didn’t avoid gluten, then we might suspect that gluten was the culprit, even though there is the possibility that another factor was responsible for their lack of progress.

World-Renowned Expert On Gluten-Related Disorders Doesn’t Avoid Gluten?

Dr. Alessio Fasano is one of the world-renowned experts on gluten-related disorders, and in his book “Gluten Freedom” he states the following: “I am now convinced that our immune system mistakenly interprets gluten as a component of a dangerous bacterium or bacteria.  When this happens, it unleashes an immune response similar to that triggered by bacteria to rid the body of the attackers.  This response is elicited in everyone.  It is not exclusive to people affected by gluten-related disorders”.

In other words, according to Dr. Fasano, gluten has a negative impact on everyone, and not just people who have Celiac disease or a non-autoimmune gluten sensitivity.  And the study I brought up earlier mentions that increased intestinal permeability after gliadin exposure occurs in ALL individuals (1).  Based on this it would be fair to conclude that everyone should permanently avoid gluten, right?  And if this is the case, why would I choose to eat even a small amount of gluten on an occasional basis?  Well, it’s the same reason why some people choose to drink some alcohol every now and then, drink coffee, etc.

You might argue that unlike gluten, some alcoholic beverages such as red wine have certain health benefits.  However, like gluten, all alcohol can increase the permeability of the gut, including red wine (4).  I personally don’t drink alcohol, don’t drink coffee, and while I do eat a pretty healthy diet most of the time and eat very little gluten, I’m definitely not perfect.

And Dr. Fasano isn’t perfect either, as if you happened to listen to the “Autoimmune Summit” conducted by Dr. Amy Myers in Fall of 2014, Dr. Fasano was interviewed by Dr. Myers and admitted that he eats gluten sometimes.  Plus, he also mentioned the following in his book: “Although I have contributed to the discoveries of some of these inappropriate immune responses elicited by gluten in humans, I do not share the position of the proponents of a ‘gluten-free world’, who often cite my work to support their position.  We engage daily in a war with many dangerous bacteria but rarely do we lose this battle, which is an event that leads to infection.  We are also engaged in a daily confrontation with gluten, but only a minority of us will lose this battle.  These are the genetically susceptible individuals who will develop gluten-related disorders”.

So even though Dr. Alessio Fasano has done plenty of research on the adverse effects of gluten (he was one of the authors in the study I mentioned earlier), he does consume some gluten every now and then.  I’m pretty sure that I don’t have Celiac disease, and I don’t think I have a non-Celiac gluten sensitivity disorder.  And I assume gluten wasn’t a trigger when I was dealing with Graves’ Disease, or else I probably still wouldn’t be in remission.  Keep in mind that I don’t freely eat gluten, as I eat mostly whole foods, try to eat as many organic foods as possible, etc.  And if someone isn’t in remission and is in the process of trying to restore their health then without question I think it is best to play it safe and avoid gluten.

Is It Wise To Reintroduce Gluten After Getting Into Remission?

Although I seem to do fine consuming a small amount of gluten every now and then, this of course isn’t the case with everyone.  And so I admit that it is a risk for someone to reintroduce gluten after restoring their health.  While many people will do fine after reintroducing gluten, some people who reintroduce gluten won’t do fine, and at times the consequences can be severe.  As a result, there are some people who choose not to reintroduce gluten after restoring their health, even if they haven’t confirmed that they have Celiac disease or a non-autoimmune gluten sensitivity.

The truth is that we don’t need to eat gluten.  But gluten is just one of numerous toxins that many people voluntarily expose themselves to.  One can make a good argument that we should all be 100% alcohol free, not consume any caffeine, not put ourselves in a position to deal with high amounts of stress, always get at least eight hours sleep, avoid any type of household cleaner or cosmetic that isn’t certified organic, etc.  But it’s rare to come across someone who is 100% gluten free, alcohol free, and caffeine free AND has low stress levels, gets at least eight hours of sleep every night without exception, uses all natural products, etc.  Keep in mind that I’m not trying to convince anyone reading this that it’s okay to eat gluten on an occasional basis. I admit that there is no good reason to consume gluten, but one can make the argument that there is no good reason to drink any alcohol, coffee, stay up late, etc.  While it’s important to do everything you can to live a healthy lifestyle, nobody is going to be perfect in all aspects of their health.

In summary, not everyone with a thyroid or autoimmune thyroid condition has Celiac disease or a non-autoimmune gluten sensitivity.  However, since gluten is a common allergen and can increase intestinal permeability, and because it can be difficult to determine if someone has a gluten sensitivity, or even Celiac disease in some cases, I think it’s a good idea to avoid gluten while trying to restore one’s health.  As for whether it’s safe to reintroduce gluten after someone has restored their health, without question there are risks involved with doing this.  However, there are also risks involved with reintroducing other foods (i.e. dairy, corn), along with drinking alcohol, caffeine, staying up late on a frequent basis, etc.  Please feel free to share your thoughts on avoiding and reintroducing gluten in the comment section below, as I’m sure there are many people reading this who feel strongly about avoiding gluten, while others reading this might have a different opinion regarding gluten.

There are a lot of excellent books on thyroid health, and so I figured I’d not only share some of my favorite books, but I’ll also ask you to share at least one or two of your favorite books on thyroid health as well.  Although I’m sure some people will agree with my selections, others will disagree and will have their own favorite books.  And so in the comments section below please let me know what is your favorite book on thyroid health, whether it be one on hyperthyroidism/Graves’ Disease, or hypothyroidism/Hashimoto’s Thyroiditis.

Hashimoto’s Thyroiditis: Lifestyle Interventions for Finding and Treating the Root Cause by Dr. Izabella Wentz.  Everyone with Hashimoto’s Thyroiditis should read this book.  And this is one of those books where it probably would be a good idea to read more than once.  Dr. Wentz is a pharmacist, and she does an amazing job of discussing some of the root causes of Hashimoto’s Thyroiditis.  Like myself, she has her own personal success story, as she was diagnosed with Hashimoto’s in 2009 and took a natural treatment approach.   In her book, Dr. Izabella starts off by discussing some of the basics related to thyroid function and Hashimoto’s.  She also explains which thyroid hormone medication is best.  As the title of the book implies, she spends time discussing how to find the root cause of your condition.  Although the book focuses on Hashimoto’s, a lot of the information on finding the root cause can also help people with Graves’ Disease as well.  She dedicates an entire chapter on the “iodine controversy”, and also has separate chapters where she talks about the gut, adrenals, infections, and toxins.  Some of the last chapters in her book focuses on diet and supplementation, along with testing.

Graves’ Disease: A Practical Guide by Elaine Moore.  In my opinion, everyone with Graves’ Disease should read this book.  The book doesn’t focus on natural treatment methods, but it will help to provide a better understanding of your Graves’ Disease condition, as well the treatment options available.  Plus, even though the book doesn’t focus on natural treatment methods, Elaine was diagnosed with Graves’ Disease many years ago and received radioactive iodine, and she admits that she chose this treatment a little too quickly, and hasn’t felt the same since.  Her opening chapter discusses the pathology of Graves’ Disease, how some of the different systems of the body (digestive system, cardiovascular system, reproductive system, etc.) are affected.  She then talks about the autoimmune component of Graves’ Disease, discusses the role of iodine and the physiology of the thyroid gland.  One chapter talks about Graves’ ophthalmopathy and dermopathy (skin conditions).  She also talks about the diagnosis of Graves’ Disease, and does an excellent job of discussing the different types of thyroid autoantibodies.  She talks about both the conventional and alternative approach to treating Graves’ Disease.  Towards the end of the book she has a chapter where she talks about Graves’ Disease during pregnancy, childhood, and the teenage years.

Some of the information in the book might be somewhat advanced for some people, but you should be able to follow most of the important information without much of a problem.  She also has released a newer book entitled “Advances in Graves’ Disease and Other Hyperthyroid Disorders”, which I haven’t yet read, but it supposedly isn’t as technical as the “Practical Guide” book.  For those who have read her newer book I’d be interested in hearing what you thought about it.

Why Do I Still Have Thyroid Symptoms? When My Lab Tests Are Normal: a Revolutionary Breakthrough in Understanding Hashimoto’s Disease and Hypothyroidism by Dr. Datis Kharrazian.  This is another book that everyone with hypothyroidism and Hashimoto’s Thyroiditis should read.  This is one of the first books on Hashimoto’s that went deep into the immunology behind the condition, as Dr. Kharrazian talks about cytokines, Th1/Th2 imbalances, and he explains why most people with this condition feel lousy…and what to do about it.  Like Dr. Izabella Wentz does in her book, Dr. Kharrazian starts off talking about the basics of thyroid health and Hashimoto’s.  It isn’t too long before he begins talking about Th1 and Th2 dominance, along with regulatory T cells.  In one of his chapters he discusses six patterns of low thyroid function and how to find them on a blood test.  He spends a good amount of time talking about blood sugar issues, and of course talks about digestion and the adrenals as well.  He has a chapter dedicated to the brain as it relates to thyroid health, which shouldn’t be surprising, as he also has a “brain book” entitled “Why Isn’t My Brain Working?”.  Towards the end of his book he discusses 22 patterns of low thyroid function.

Natural Treatment Solutions For Hyperthyroidism and Graves’ Disease (2nd edition) by yours truly.  While there is no question that I am biased since this is my book, the truth is that there aren’t too many books which focus on treating hyperthyroidism and Graves’ Disease naturally.  The first edition of my book was very basic and was based more on my personal experience and the experience of my patients with hyperthyroidism and Graves’ Disease.  The revised second edition that was released in 2013 goes deeper into the science and is more research based.

Of course I have read other wonderful books on thyroid health, but these are some of my favorites.  While I could have put together a post on my top ten favorite thyroid health books, or something similar, I figured it would be more interesting to list a few of my favorites, and then see if others would be willing to share their favorite book, and perhaps briefly mention why you like the book so much.  Although most people usually won’t be able to get all of the information they need to restore their health by reading books, there still is a lot of great information you can obtain this way.

Biochemical individuality is a term which refers to the uniqueness of each individual.  It is based on a combination of genetics, lifestyle, and environmental factors.  It is the reason why no two people with a specific thyroid or autoimmune thyroid condition will respond the same when following a natural treatment protocol.

For example, let’s take two middle-aged women who developed Hashimoto’s Thyroiditis around the same age (although the example can apply to someone with Graves’ Disease as well).  Both women have an elevated TSH and thyroglobulin antibodies.  Woman #1 experiences severe fatigue, insomnia, and many other symptoms.  Woman #2 has some fatigue, although it’s not too bad.  She sleeps well, and overall isn’t too symptomatic.  Why does one woman feel so lousy, while the other woman doesn’t feel too bad?

Well, we know that both women probably had a genetic marker for Hashimoto’s Thyroiditis.  And we also know that some type of environmental trigger is what led to the development of their autoimmune thyroid condition.  However, while they have these similarities, there are many different factors which will not only affect how someone with this condition feels, but can also determine how the person progresses.  Here are just some of these factors:

Were they born via a natural birth or a C-section?  Although I realize that some C-sections are necessary, being born via a C-section can affect the gut microbiota, and increase the chances of developing intestinal dysbiosis.  And since having a healthy gut is necessary to have a healthy immune system, it is possible that being born via a C-section can potentially increase the risk of developing an autoimmune condition later in life (1) (2).

Were they breastfed?  Whether or not you were breastfed as a baby also affected your gut microbiota.  The duration of breastfeeding also is a factor.  Once again, I realize that not every woman is able to breastfeed her baby, but there are many women who are able to nurse their baby yet don’t.  I was exclusively bottle-fed as a baby, and while there is no way to know for certain if this played any role in the development of my Graves’ Disease condition a few decades later, one can’t completely rule this out as a contributing factor.  While there is no evidence that formula feeding can increase the risk of developing Graves’ Disease, a recent study showed that formula-feeding is associated with a shift towards Th1 cytokines, which can increase the risk of developing a Th1-dominant condition such as Hashimoto’s Thyroiditis (3).

Did they receive antibiotics as a child/teenager?  Receiving one or more rounds of antibiotics will also affect the gut flora, and can set the stage for intestinal dysbiosis.  There obviously is a time and place for antibiotics, but too many people take antibiotics unnecessarily.  When I was a child I took antibiotics numerous times, and this very well could have been a contributing factor to the development of my Graves’ Disease condition.  What we need to keep in mind is that there can be many different factors that can increase one’s susceptibility to developing an autoimmune condition.  And so while I’m sure some people reading this think it is ridiculous to suggest that being born via C-section, being bottle-fed, and/or taking antibiotics at a young age can be factors in the development of an autoimmune thyroid condition as an adult, the truth is that these factors can set the stage for chronic conditions.  So I’m not suggesting that someone develops an autoimmune thyroid condition solely because they weren’t breastfed and/or because they took a few rounds of antibiotics.  But I am suggesting that we can’t dismiss these as being contributing factors, even though these events might have taken place many decades ago.

In addition to having a genetic predisposition for an autoimmune thyroid condition, do they have a genetic predisposition to other conditions?  If someone with an autoimmune thyroid condition has many different symptoms, sometimes it’s assumed that these symptoms are related to the autoimmune thyroid condition.  But of course it is possible to have more than one health condition.  Someone with an autoimmune condition such as Hashimoto’s Thyroiditis or Graves’ Disease is more likely to develop another autoimmune condition.  But it’s also possible to develop other health conditions that aren’t autoimmune in nature.  Once again, just having a genetic predisposition alone doesn’t guarantee that you will develop a specific health condition, but the same environmental factor that caused an autoimmune thyroid condition can also cause another health condition.  Or a different environmental factor could be responsible.  For example, gluten is the trigger for Celiac disease.  And if someone with Celiac disease consumes gluten, this can cause a leaky gut, and if they have a genetic predisposition for Graves’ Disease or Hashimoto’s Thyroiditis then consuming the gluten can lead to the development of one of these conditions.  However, it is also possible that a person with Celiac disease can develop an autoimmune thyroid condition not due to gluten exposure, but due to another trigger, such as chronic stress or an infection.

Is there a family history of thyroid autoimmunity?  This of course relates to genetics, as if a close family member has an autoimmune thyroid condition, then there is a pretty good chance that you also have a genetic predisposition to the same condition.  Remember that even if this is the case this doesn’t mean that you will develop the same condition.  Although I’ve consulted with patients who had two or three immediate family members with the same autoimmune thyroid condition, I’ve also worked with many patients with either Graves’ Disease or Hashimoto’s Thyroiditis who had no known family history of the same condition.

What was their diet like growing up?  As a child and teenager I ate plenty of junk food, as my diet regularly consisted of refined foods and sugars, gluten, dairy, etc.  And this is the case with many people I consult with as well.  On the other hand, I also work with people who had naturally-oriented parents and therefore lived a healthier lifestyle as a child and teenager.  And of course one also has to consider that certain foods can affect people differently.  So for example, there are people who have been eating gluten and dairy for all of their life without a problem.  But some people develop a sensitivity to one or both of these foods (or other foods) later on in their life.  And there is always the possibility that their condition isn’t related at all to a food sensitivity.  This is one area where it can get complex, as you can have one person with Hashimoto’s Thyroiditis or Graves’ Disease follow a strict diet (i.e. an autoimmune paleo diet) and notice a significant improvement in their symptoms and blood tests, while another person with an autoimmune thyroid condition follows the same diet and still feels horrible.  This is yet another example of how biochemical individuality comes into play.  But in most cases, those people who have eaten poorly for many years will have more health problems when compared to those people who ate healthy for most of their life.

How big of an impact has stress been?  Stress of course can play a big role in one’s health.  One not only has to consider the impact of the actual stressor, but how well the person copes with the stressor.  For example, let’s look at two people with a genetic predisposition to Graves’ Disease.  Person #1 has always done a pretty good job of coping with the stress, while person #2 hasn’t done a good job of managing the stress.  It is likely that the poor stress handling skills of person #2 will lead to a greater risk of them developing Graves’ Disease than person #1.  But let’s say that person #1 developed Graves’ Disease due to an H. Pylori infection, whereas person #2 also tested positive for H. Pylori, but she hasn’t done a good job of managing high amounts of chronic stress for many years.  With person #1, getting rid of the H. Pylori infection alone very well might help to restore her health.  On the other hand, eradicating the H. Pylori infection might not be enough to get person #2 into a state of remission.

What type of toxic exposures have they had?  This is another big factor that is overlooked by most conventional healthcare professionals.  But exposure to environmental toxins can play a huge role in a person’s condition.  This is yet another complex area, as while many healthcare professionals test for levels of certain environmental toxins such as heavy metals, other toxins can of course play a role.  And it is impossible to measure all of the toxins in one’s body.  Plus, the levels of toxins in the blood or tissues don’t always tell the entire story.  For example, if someone gets a blood test for lead and it comes out positive, this usually indicates that there is some type of acute exposure to lead.  Similarly, if the person gets a urine or hair test for toxic metals then these tests can determine if there are toxic metals built up in the tissues.  However, there are  two things we need to consider.  First of all, everyone is going to have some toxins in their tissues.  Second, the amount of toxins measured on a test doesn’t necessarily determine how the person will react to the toxin.  This is yet another example of biochemical individuality.

For example, one person with an autoimmune thyroid condition can have low levels of a certain environmental toxin (i.e. mercury) that is causing a lot of problems, whereas a second person with the same autoimmune thyroid condition can have much higher levels of the same toxin and not have a negative reaction.  In other words, you can’t just rely on the tissue levels of environmental toxins, as some people will develop an immune response when exposed to a very small amount of a certain chemical, whereas others won’t develop an immune response when exposed to larger amounts of environmental toxins.

Does their body do a good job of eliminating toxins?  This relates to the previous question, as not only do different people have different sensitivities to toxins, but different people also have different abilities to excrete toxins from their body.  For example, not drinking enough water and/or not having regular bowel movements on a daily basis will affect the excretion of toxins, and can make someone more susceptible to the harmful effects of certain toxins.  This is why it is very important to have at least one or two bowel movements per day, and to drink plenty of water.  In addition, there are certain genetic polymorphisms which can affect one’s ability to eliminate toxins.  For example, certain genes play a role in phase one detoxification (i.e. CYP1B1 and CYP2C9), while other genes play an important role in phase two detoxification (i.e. COMT and GSTM1).  If someone has a genetic defect in one or more of these polymorphisms then this can affect the detoxification process.

Did they have any type of infection?  Not only can having a certain type of infection make it more likely for someone to develop a thyroid or autoimmune thyroid condition, but biochemical individuality can play a role in determining which person is more likely to develop such an infection in the first place.  For example, earlier I gave an example of two different people who had an H. Pylori infection.  But just being exposed to a certain strain of bacteria, virus, or yeast doesn’t mean that the person will develop an infection.  Someone who is in a better state of health will of course be less likely to develop an infection when compared to someone who isn’t in an ideal state of health.  In most cases a person who was born vaginally and breastfed as a baby, wasn’t given antibiotics, and ate a pretty healthy diet growing up will have a healthier gut and immune system than someone who was born via a C-section and was bottle-fed, given multiple rounds of antibiotics as a child, and ate a crappy diet.  Of course there are always exceptions, but my point is that the overall health of the person can play a big role in determining whether the person develops an infection in the first place.

In summary, biochemical individuality is based on a combination of genetics, along with lifestyle and environmental factors.  Biochemical individuality is the main reason why people with the same thyroid or autoimmune thyroid condition will respond differently when following a natural treatment protocol.  Some of the specific factors which can play a role in a person’s progress include if they were breastfed as a baby, if they received antibiotics when they were younger, if they ate a poor diet for most of their life, if they were exposed to stressors and environmental toxins, if they had an infection, and other factors.  If you have a genetic predisposition for a thyroid or autoimmune thyroid condition then there isn’t much you can do to change this, but by reading this post hopefully you have learned that lifestyle and environmental factors are what ultimately determine if you develop such a condition.  And for those who develop a condition such as Graves’ Disease or Hashimoto’s Thyroiditis, biochemical individuality will also play a big role in the recovery of that person.

Broccoli and other cruciferous vegetables are a rich source of glucosinolates, as well as isothiocyanates that help with phase 2 detoxification, increase antioxidant status, and can provide protection against different types of cancers.  However, these glucosinolates can form compounds that potentially have anti-thyroid activity by decreasing the uptake of iodine, which is why many natural healthcare professionals recommend for people with thyroid conditions to avoid cruciferous vegetables.  This is especially true with those who have hypothyroidism and Hashimoto’s Thyroiditis.  But does eating broccoli truly inhibit thyroid hormone production?

What I’d like to do is talk about the benefits of eating broccoli and other cruciferous vegetables, as well as any potential risks.  This way you can make an informed decision and decide what is best for you.  I must admit that overall I’m a big advocate of people eating broccoli, kale, and other cruciferous vegetables, as these are nutrient dense foods.  But at the same time I of course wouldn’t want to worsen the health of people who currently have a thyroid imbalance.

The Benefits of Eating Broccoli (and other cruciferous vegetables)

I listed some of the benefits of cruciferous vegetables in the opening paragraph, but I’d like to go ahead and expand on this.

Phase 2 detoxification.  How can eating broccoli help with detoxification?  Well, broccoli and other cruciferous vegetables have large amounts of glucosinolates, which in turn convert to isothiocyanates.  These include sulforaphane and 4-methylsulfinylbutyl isothiocyanate, which along with indoles (i.e. indole-3-carbinol) are very potent inducers of phase 2 enzymes responsible for detoxification (1) (2).  For a better understanding of the detoxification pathways I would read my blog post entitled “Understanding The Detoxification Pathways“:

High levels of antioxidants.  In addition to helping to support the detoxification pathways, brassica vegetables also contain micronutrients that may provide additional DNA protection from reactive oxygen species (R2).   Even though glucosinolates are converted into compounds which are considered to be goitrogenic, these compounds also have health promoting properties as well.  For example, glucoraphanin is a glucosinolate found in broccoli and other cruciferous vegetables, and when someone eats these foods they are converted into sulforaphane.  As I mentioned earlier, this can help to support phase two detoxification, but it has other health benefits as well, and can be protective against different types of cancers (3) (4) (5).  Isothiocyanates also have antioxidant properties (6) (7).

Improve gut health.  The compounds included in broccoli (such as glycosinolates) can be hydrolyzed by certain bacteria, and thus can alter the human gut microbiota (8).  Another study showed that broccoli (and blueberries) can alter the composition and metabolism of the microbiota of the large intestine (9).

Estrogen Metabolism.  The phytochemicals Indole-3-Carbinol (I3C) and 3,3′-diindolylmethane (DIM) are found in cruciferous vegetables, and there is plenty of research which shows that these can affect estrogen metabolism in a positive way.  One way they seem to work is by affecting the expression of the CYP19 gene that encodes the enzyme aromatase (10).  This is the primary enzyme responsible for the synthesis of estrogen.  In addition, I3C significantly increases the urinary excretion of 2-hydroxyestrone, which is known as the “good” estrogenic metabolite. (11) (12). The urinary concentrations of nearly all other estrogen metabolites, including levels of estradiol, estrone, estriol, and 16alpha-hydroxyestrone, were lower after I3C treatment, which lowers estrogenic stimulation (12).

The “Risks” of Eating Broccoli (and other cruciferous vegetables)

There is only a single “risk” I know of when it comes to eating broccoli and other cruciferous vegetables, which is that these foods include compounds which have goitrogenic properties.  This is especially true when eating large amounts of raw cruciferous vegetables.  But can cooking cruciferous vegetables reduce the goitrogenic properties?  I’ll talk about this more shortly, but I will say that in most people, eating one or two servings of raw cruciferous vegetables per day won’t cause any problems with thyroid health.

With regards to cooking broccoli, there have been a few studies about how different cooking methods affect the glucosinolates.  And as I mentioned earlier, these glucosinolates get converted into compounds (thiocyanates and isothiocyanates) that have antithyroid activity.  One study looked at broccoli cooked in three different ways: boiling with a cold water start, boiling with a hot water start, and steaming (13).  The study showed that steaming resulted in an increase in the amount of total glucosinolates, while boiling the broccoli with a cold or hot water start resulted in a significant decrease in the amount of total glucosinolates.  And so the authors concluded that steaming can actually improve the health aspects of broccoli.  Another study looked at the effects of microwave cooking on the nutrient composition of broccoli (14).  The results showed a decrease in the levels of glucosinolates, phenolic compounds, and vitamin C, although it didn’t reduce the minerals present.

Yet another study looked at the effects of five different types of cooking methods on  the nutrient composition of broccoli, including steaming, microwaving, boiling, stir-frying alone, and stir-frying followed by boiling (15).  The results showed that all cooking treatments, except for steaming, caused significant losses of chlorophyll and vitamin C and significant decreases of total soluble proteins and soluble sugars (15).  Total aliphatic and indole glucosinolates were significantly modified by all cooking treatments, with the exception of steaming.  It’s worth noting that in this study the broccoli was steamed for five minutes.

These studies would suggest that boiling, microwaving, or stir-frying broccoli and other cruciferous vegetables can make them less goitrogenic by causing a decrease in the glucosinolates.  It does this by degrading the enzyme myrosinase, which converts glucosinolates into those compounds which have antithyroid activity.  However, the evidence I came across shows that light steaming increases the glucosinolates, which might suggest that this would make these foods more goitrogenic.  On the other hand,  steaming cruciferous vegetables for seven minutes or longer seems to inactivate myrosinase activity (16).  And so if you are concerned about the impact of cruciferous vegetables on thyroid health, then you will want to avoid eating them raw, and will either want to boil, microwave, stir fry, or steam them for at least seven minutes.

What’s The Final Verdict On Broccoli and Thyroid Health?

I was only able to find one human study which looked at the impact of cruciferous vegetables on thyroid health.  This involved Brussels sprouts, which are a rich source of glucosinolates.  This was a very small study, as it involved only ten volunteer subjects, and they ate 150 grams of cooked Brussels sprouts per day for four weeks (17).  It was determined that there was no effect on thyroid hormone, which isn’t surprising since I discussed earlier how most cooking methods (except for light steaming) inactivate the enzyme myrosinase.

As I mentioned earlier in this post, I think it’s fine for most people with thyroid and autoimmune thyroid conditions to eat a few servings of broccoli and/or other cruciferous vegetables each day.  This is even true with regards to raw broccoli, although if you’re concerned you can always cook it.  Just remember that while boiling, microwaving, and stir-frying will greatly reduce the goitrogenic activity, light steaming for only a few minutes might actually increase the goitrogenic activity.

If you have Hashimoto’s Thyroiditis or Graves’ Disease and have considered taking low dose naltrexone (LDN), or even if you currently take LDN, then you’ll want to read the following guest blog post.  In the post, thyroid health expert Shannon Garrett discusses her experience with LDN, and how it greatly helped to improve her health.  Shannon is a big advocate of taking a natural treatment approach, but when she didn’t receive the benefits she was looking for she turned to LDN.  And it turned out to be one of the best decisions she ever made.

Written by Shannon Garrett

One of the responsibilities of a nurse is to educate patients about their medication(s) and to assess and monitor for symptoms of adverse reactions or side effects.  As a previous cardiac nurse, I’ve observed my share of medications that cause significant side effects, many of which were severe.

One of the reasons I became a holistic and integrative nurse in private practice was to help people discover how they could take care of their health, mind, body, spirit, and emotions through healthy lifestyle choices and eating real food.  My second reason is because after 8 long years of seeing several doctors, I was diagnosed with 3 autoimmune diseases:  Hashimoto’s thyroiditis, pernicious anemia, and celiac disease.  My only knowledge with respect to medication for use in autoimmune disease at that point was of immune system suppressants such as Remicade, prednisone, Imuran and others.  As a nurse, I knew I didn’t want those because they carry significant health risks. So I set up business not only to help my clients, but also to help myself in the process.

I decided to follow many of the suggestions commonly recommended by functional medicine practitioners today.  I was tested for food sensitivities, underlying coinfections such as H. pylori, Epstein-Barr virus, Lyme disease, Yersinia entercolitica and Candida overgrowth.  I was also tested for adrenal fatigue, vitamin deficiencies, and had the Genova gut health test.  I had eliminated gluten and dairy within one week of receiving my diagnoses simply because I knew they wreaked havoc on the system and their potential for inflammation.  I was pleased when my kidney filtration rate increased by 20 points after 60 days simply by eliminating these two proteins from my diet!

Fortunately, I did not have any underlying coinfections to deal with. I did have an adrenal fatigue issue.  However, after approximately nine months of commitment to lifestyle changes, healthy eating and reducing stress, my thyroid antibodies hadn’t really moved much.  I was devoted to an anti-inflammatory diet based on my test results, healing my gut, reducing stress, optimizing vitamin & mineral deficiencies, and balancing my hormones.  Although I felt slightly better, I hadn’t really lost the weight I’d expected, and I knew with an immune system that was still “confused” about what was my tissue and what was foreign was the perfect storm for additional autoimmune illnesses.  In the past, I’ve cared for patients in the clinical setting who struggled with multiple autoimmune diseases (some 8 and 9) and their daily quality of life was null.  I knew I wanted to prevent this for myself.

Within six months I was experiencing what I believed to be multiple sclerosis-type symptoms and this scared me.  My doctor made arrangements for me to see a specialist.  One day I was sharing my issues with another nurse and she asked me if I’d ever heard of low-dose naltrexone (LDN) and as I listened to her explain how it basically cured her father’s autoimmune illness, I knew I had to learn more.

To make a long story short, I researched LDN, gathered the information and presented it to my physician in a way I thought he would be open to listening…very methodical and with research to back up what I was saying.   We consulted with LDN literate pharmacists and both agreed I didn’t have anything to lose; however I didn’t start it immediately.  I continued to work on healing my body an additional 9 months.

LDN has changed my life and I’ve seen it change others for the better…however, it is not a stand-alone treatment, and for autoimmune thyroid disease, there is a specific protocol to follow.

Today I am an independent autoimmune/thyroid wellness nurse consultant, certified nurse-nutritionist, holistic lifestyle & wellness coach and nurse educator.  I am also a LDN nurse educator and I love to share my knowledge with physicians and pharmacists on its use in a variety of autoimmune diseases.

What is LDN?                                                                    

LDN modulates the immune system and has been shown to help patients with autoimmune disease, cancer, and other neurodegenerative disorders.  It is relatively inexpensive and is available by prescription only and dispensed by a compounding pharmacy.  I recommend LDN only be compounded by a LDN approved compounder.

It has been recognized that in many diseases the body may be lacking endorphins.  The discovery of LDN is somewhat of a miracle, e.g. it is derived from naltrexone which has been available in generic forms for many years; however in low doses, it has been shown to modulate the immune system by blocking opiate receptors during sleep resulting in an increase of endorphins.  The therapeutic effect is believed to be achieved by increasing the body’s production of beta-endorphin and metenkephalin which are important regulators of the immune system.  These endorphins can increase circulating natural killer cells and lymphocyte-activated CD-8 cells, both of which are important to immunity.  They also help regulate T-helper 1 and T-helper 2 (Th-1/Th-2, respectively) balance in the immune system.

Many physicians are not familiar with LDN, or what they do know about it is very limited.  Big Pharma does not have a vested interested in marketing a drug unless they can hold a patent on it. The patent for naltrexone expired a long time ago so it’s not profitable for them.  This means that their best-dressed sales reps will never be knocking on the doors of physicians-at-large to educate them on the miracle of LDN.  Sadly, it’s simply never going to happen!  What they might know about LDN is limited to generic naltrexone in 50 mg doses which is used for alcohol, opiate withdrawal and heroin addiction.  That’s not what we’re talking about here, at all.  LDN used for autoimmune disease including Hashimoto’s is not prescribed higher than 4.5 mg – and we start at a much lower dose than that before landing on a maintenance dose.

LDN and Autoimmune Disease

As previously stated, LDN is not a stand-alone treatment; however it is an amazing adjunct with the potential to trick the body into healing itself.  The people who experience the most success with LDN are those who have optimized thyroid hormone levels, corrected nutrient deficiencies (especially iron, ferritin, vitamins D & B12, selenium, magnesium, zinc, and folate, etc.), healed their adrenals, eliminated infections such as Candida (Candida will block LDN), or Lyme, and healed leaky gut and low stomach acid if that was an issue.  If you have Candida, this must be healed to within normal limits prior to starting LDN or it will not work.

When LDN is prescribed for a patient with Hashimoto’s, we start very low with the dose and slowly titrate over two months prior to a 6 month period of what we refer to as the modulating dose.   When a physician refers a patient to me who has LDN in mind as their ultimate goal, not only do I work with them on lifestyle changes to get their body ready, I also teach them how to monitor their vitals at home when starting LDN and educate them on what to watch out for and what to report, etc.  Depending on a patient’s progress (believe it or not, going hyper is a sign that LDN is working) they will be taught how to titrate down their thyroid hormone.  One of the biggest mistakes we see patients (and physicians) making when a patient reports hyper symptoms is that they will abruptly discontinue LDN.  This is the wrong course of action…what is necessary however, is to titrate down slowly on thyroid hormone (and of course lab tests are done to validate this action).

LDN and Medication Concerns

Since LDN blocks opiate receptors, it cannot be taken with any narcotic medication.  Naltrexone is a pure opioid antagonist and will block the action of narcotics.  In other words, pain medication won’t work if you’re taking LDN.  I recently had to discontinue my LDN temporarily due to surgery and I knew that pain medication was going to be prescribed for a few days after the procedure.

LDN will not work if you are taking medications that suppress the immune system like prednisone or others.  LDN is an immune system modulator and steroids suppress – both will antagonize the other and neither will work.

Examples of narcotic-based medications include morphine, Percocet, duragesic patch and any medication that contains codeine.

LDN and Potential Side Effects

The main side effects I’ve observed and experience personally are mild and usually disappear within two weeks while the immune system is responding to the blocking of opiate receptors.  Most common are:

• Disturbed sleep
• Vivid, colorful dreams
• Tiredness or fatigue

Again, these typically go away within two weeks of starting LDN and given the potential LDN offers, are well worth the effort.

Tips if you are Interested in LDN

• It is important to get your body in the best shape possible prior to going on LDN. I devoted nine months to healing my body even further before going on LDN.
• Be sure to work with a LDN-approved compounding pharmacy. I cannot tell you how important this is and we’ve found that not all compounding pharmacies follow the correct LDN protocol. For resources on approved pharmacists and new research you can check here: http://www.lowdosenaltrexone.org/
• Seek a physician who is either very open to LDN or is already LDN-literate for its use in autoimmune thyroid disease. The way LDN is dosed and monitored in autoimmune thyroid disease differs greatly than how it is prescribed for any other autoimmune disease.  You can contact me HERE for resources, or check with the LDN Research Trust-England

This article focused on LDN for use in autoimmune thyroid disease.  However, LDN is used successfully in a variety of autoimmune diseases as well as in cancer and Lyme disease.  Given its potential, it’s very sad to me that drug companies aren’t interested.

LDN has changed my life!  I now live a life full of vitality, and I have my body and my brain back.  I’ve been in remission for 3 years as of this writing and I’m passionate about helping other women find this same level of healing…whether it be through natural lifestyle changes or LDN, my goal is to help them succeed.  To read more about my story, I invite you to read my eBook Hashimoto’s: Finding Joy in the Journey available on Amazon as a Kindle book and soon it will be available in paperback!

I invite you to also check out my Facebook page (Holistic Thyroid Care) and website for resources to help you live your best thyroid life!

Shannon Garrett, BS, RN, CHLC, CNN