It’s hard to believe that another Thanksgiving is upon us.  In addition to wishing everyone a happy Thanksgiving, I would also like to thank you for taking the time to read my articles and blog posts.

And if you live in a different country where Thanksgiving isn’t celebrated, I’d still like to express my gratitude.

Best of health,

Dr. Eric

A biofilm is a group of microorganisms (i.e. bacteria, yeast, etc.) which form a protective layer.  Bacterial biofilms are resistant to antibiotics, disinfectant chemicals and to phagocytosis and other components of the innate and adaptive inflammatory defense system of the body (1).  Candida albicans can also form biofilms, which can make them resistant to certain antifungal medications such as fluconazole (2).  And since many people with thyroid and autoimmune thyroid conditions have these types of infections, it can be beneficial to understand how to disrupt these biofilms.

Although bacteria and yeast infections are common, how can you tell if these pathogens have biofilm?  Unfortunately most labs that test for bacterial and yeast infections don’t do testing to determine if there are biofilms, and so when treating these infections you are faced with a couple of different options.  One option is to give the necessary treatment without any biofilm disruptors, and hope that biofilms aren’t present.  The second option is to take biofilm disruptors when treating an infection.  Authors of a recent study on antibiofilm peptides claimed that biofilm-related infections account for at least 65% of all human infections (3).  If this is the case then it probably would be a good idea to play it safe and take some type of biofilm disruptor when combating any type of infection.

Which Microorganisms Are Known To Have Biofilms?

Many different microorganisms have biofilms.  I’m not going to list all of them here, but I’ll list some of the more common ones, including some common pathogens associated with thyroid and autoimmune thyroid conditions.

Helicobacter Pylori.  This bacteria is a potential trigger of thyroid and autoimmune thyroid conditions.  Antibiotics are commonly used to eradicate H. Pylori, although it seems that they have become more resistant even when triple or quadruple therapy is used.  And a big reason for this is because  H. pylori forms biofilm on the gastric mucosa epithelium (4) (5) (6).  As a result, whenever giving treatment for H. Pylori it would be wise to give the person substances which can help to dissolve the biofilm matrix.

Borrelia Burgdorferi.  This is the bacteria associated with Lyme disease, and if the infection isn’t detected early then this can lead to chronic Lyme disease, which is usually very difficult to treat.  There is evidence that Borrelia burgdorferi can form biofilm (7), which may be a big reason why it is difficult to eradicate.

Yersinia Enterocolitica.  This bacteria has been associated with both Graves’ Disease and Hashimoto’s Thyroiditis.  One study looked to detect the production of biofilms by 60 strains of Yersinia enterocolitica, and found that all 60 strains produced biofilms (8).  In addition, they also discovered that the majority of the biofilms were resistant to all of the antimicrobials used.

Escherichia coli.  While E. coli isn’t commonly associated with the development of thyroid and autoimmune thyroid conditions, it probably is the most well known pathogen.  Most strains of E. coli are actually harmless, although some strains can cause respiratory infections, urinary tract infections, and other illnesses.  Both commensal and pathogenic E. coli can produce biofilm (9) (10).

Klebsiella Pneumoniae.  This is another gram-negative bacteria that can cause numerous infections, such as pneumonia, urinary tract infections, etc.  And these can also produce biofilm (11).

Mycoplasma.  There are many different species of mycoplasma, some of which are pathogenic, and many of these are also capable of forming biofilms (12) (13) (14).

Candida Albicans.  Unlike the other microorganisms listed so far, Candida is a fungus.  And there is plenty of evidence which shows that candida albicans can form biofilms (15) (16) (17) (18), which as I briefly mentioned earlier can make it resistant to antifungal medication.

Which Natural Agents Can Disrupt Biofilm?

There are actually a number of different natural agents which have been shown to dissolve the biofilm matrix:

N-acetylcysteine (NAC).  Although I commonly give NAC to my patients to increase glutathione production, numerous studies also show that it can be used to reduce and prevent biofilm formation (19) (20) (21) (22).  It seems that NAC works by degrading the extracellular polysaccharide matrix of the biofilm (22).  I spoke about H. Pylori earlier, and one study showed that N-acetylcysteine treatment prior to starting antibiotic therapy led to the disappearance of gastric biofilm in all patients who had H. Pylori (23).  And there also is a study which shows that NAC can be used to inhibit biofilm formation by Candida albicans (24).  So if someone has either bacterial or yeast overgrowth it probably would be beneficial to take an NAC supplement.

Proteolytic Enzymes.  Proteins, polysaccharides, and DNA constitute a major component of the biofilm matrix (25).  As a result, it would make sense for proteolytic enzymes (enzymes that break down proteins) to help degrade biofilm.  And numerous studies show that certain proteolytic enzymes can break down biofilm (25) (26) (27).  One of the most popular products used by many healthcare professionals to disrupt biofilm is Interfase by Klaire Labs, which consists of numerous proteolytic enzymes.

Colloidal silver.  Although I’m very familiar with colloidal silver, this admittedly isn’t something I have frequently given to my patients.  But after doing some research I very well might be recommending it more often for those with infections.  With regards to biofilm, there are numerous studies which show that colloidal silver can be effective against the biofilm of Candida albicans (28) (29) (30).  There also are a few studies that show that colloidal silver has antibiofilm activity in Staphylococcus aureus (31) (32).

Lactoferrin.  Lactoferrin is an iron-binding glycoprotein present in milk, and also has antimicrobial activities by withholding iron from iron-requiring bacteria.  Colostrum is rich in lactoferrin, and this is one of the main reasons why taking colostrum can enhance immune system function (33).  Numerous studies show that lactoferrin can inhibit biofilm formation (34) (35) (36).

In summary, both bacteria and yeast can form biofilms, which can be resistant to antibiotics and antifungal medications.  Some of the microorganisms which produce biofilms include H. Pylori, Borrelia Burgdorferi, Yersinia Enterocolitca, Escherichia coli, Mycoplasma, and Candida albicans.  Whenever someone has a bacterial or yeast infection it probably would be a good idea to have them take one or more natural agents which has been proven to dissolve biofilm.  These include NAC, proteolytic enzymes, colloidal silver, and lactoferrin.

When I was diagnosed with Graves’ Disease I chose not to take antithyroid medication or beta blockers.  Was this the right decision on my part?  Well, everything turned out okay, and it’s not as if I didn’t do anything to manage the hyperthyroid symptoms, as I took the herbs bugleweed and motherwort.  These herbs were effective in managing my symptoms while I addressed the cause of my condition.  However, recently I was consulting with a patient who has Hashimoto’s Thyroiditis, and she asked me if I would have taken thyroid hormone medication if I was diagnosed with Hashimoto’s.

Obviously it’s difficult to give a specific answer since I wasn’t diagnosed with Hashimoto’s Thyroiditis, but the truth is, if I needed to take thyroid hormone medication then without question I would take it…while addressing the cause of the condition.  The person who asked me this was under the impression that I don’t recommend for people with hypothyroid conditions to take thyroid hormone medication.  In past articles and blog posts I have mentioned that some people with hypothyroid conditions do need to take thyroid hormone medication, and some people will need to take it on a permanent basis.  However, while it’s fine to take thyroid hormone medication when necessary, the main reason many people with Hashimoto’s take thyroid hormone continuously is because nothing is ever done to address the autoimmune component.  I’m not suggesting that everyone with Hashimoto’s who is taking thyroid hormone medication can successfully wean off of it, but doing so definitely is possible if the cause of the condition is addressed.

The Pros and Cons of Thyroid Hormone Medication

During most of my webinars on hypothyroidism and Hashimoto’s Thyroiditis I talk about the pros and cons of taking thyroid hormone medication, and I’ll expand on this here.  First of all, there is no question that healthy levels of thyroid hormone is important for optimal health.  As a result, if someone has low or depressed thyroid hormone levels then it probably is a good idea to take either synthetic or natural thyroid hormone medication.

However, the obvious disadvantage of taking thyroid hormone medication ALONE is that it does absolutely nothing for the underlying cause of the condition.  Of course there are times when nothing can be done for the cause.  For example, if someone has received a complete thyroidectomy then they will need to take thyroid hormone medication for the rest of their life, as there is no natural substitute for thyroid hormone medication.  If someone has received a partial thyroidectomy or radioactive iodine treatment there is a good chance they will need to take thyroid hormone medication, although this isn’t always the case.  In fact, my staff person Kate received a partial thyroidectomy years before she began working for me, and she hasn’t taken thyroid hormone medication since.

In any case, while addressing the cause of the problem doesn’t always mean the person will be able to avoid taking thyroid hormone medication, many times this is the case.  The problem is that most endocrinologists don’t do anything to address the autoimmune component, and so over time the thyroid antibodies continue to damage the thyroid gland, and as a result the person will usually need to take thyroid hormone medication.  But if the autoimmune component is addressed then the person might be able to eventually wean off of their thyroid hormone medication, or if they aren’t currently taking thyroid hormone they might be able to avoid taking it altogether.  It depends on how much damage has occurred to the thyroid gland.

Once On Thyroid Hormone Always On Thyroid Hormone?

I’ve received emails from people taking thyroid hormone medication stating that they were told by their medical doctor that once someone starts taking thyroid hormone medication they will need to remain on thyroid hormone medication.  In other words, if someone gets diagnosed with hypothyroidism or Hashimoto’s Thyroiditis and takes synthetic or natural thyroid hormone, they will need to continue taking this for the rest of their life.  If the cause of the condition isn’t addressed then this most likely will be true.  And as I’ve mentioned numerous times already, most medical doctors don’t do anything for the cause of the condition, and so the person not only will usually need to remain on thyroid hormone, but as further damage of the thyroid gland takes place they most likely will need to take higher doses of thyroid hormone medication in the future.

On the other hand, if someone is taking thyroid hormone medication while the cause of the condition is being addressed, then many times they will be able to eventually wean off of the medication.  This is especially true when the hypothyroid condition is directly caused by nutrient deficiencies or toxins, as correcting the deficiency or removing the toxin will usually allow the person to stop taking thyroid hormone medication.  But it’s also true for many people with Hashimoto’s Thyroiditis, although as mentioned earlier, this does depend on how much damage has been done to the thyroid gland.  So there is no guarantee that someone with Hashimoto’s Thyroiditis will be able to wean off of thyroid hormone medication if the cause of the problem is addressed, but at the same time, not everyone with Hashimoto’s Thyroiditis who is taking synthetic or natural thyroid hormone will need to take the medication on a permanent basis.

What Would I Do If I Had Hypothyroidism/Hashimoto’s Thyroiditis?

Getting back to the question that I was asked, if it was determined that I was hypothyroid I would of course try to detect and address the cause of the problem.  However, if my thyroid hormone levels were depressed I am pretty sure I would take thyroid hormone medication while the cause of the condition was being addressed.  If they were low but not depressed I still might take thyroid hormone medication, or perhaps I would choose to take a thyroid glandular while addressing the cause of the problem.

In summary, thyroid hormone is very important, and if I had depressed thyroid hormone levels in all likelihood I would take thyroid hormone medication, or at the very least take a glandular with thyroid hormone.  I would of course try to address the cause of the problem while doing this.  Some people with hypothyroidism and Hashimoto’s Thyroiditis are hesitant to take thyroid hormone medication, as they fear that once they begin taking it they won’t be able to wean off of it.  While some people do need to take thyroid hormone on a permanent basis, not everyone who takes it will need to take it on a continuous basis.

Recently I attended a “thyroid mastermind meeting”, which was put together by Dr. Izabella Wentz, who is the author of the amazing book “Root Cause”.  In addition to Dr. Wentz there were other very knowledgeable practitioners present such as Dr. Datis Kharrazian, Dr. Alan Christianson, and numerous others.  It was a great experience, and so I figured I’d share some of the highlights.  In the future I hope to have separate blog post interviews with most of these presenters, along with many of the other attendees, and so be on the lookout for this.

Dr. Izabella Wentz.  Dr. Izabella Wentz started off the presentation, and one of the topics she spoke about was Blastocystis hominis, and how she finds that this parasite is common in her Hashimoto’s patients.  She also discussed a survey she conducted on 2,232 of her email subscribers with Hashimoto’s, as she asked them how they felt when eating certain foods.  Some of the statistics weren’t surprising, as she mentioned how most people felt better on a gluten free diet (88%), and less than 1% felt worse.  79% felt better when avoiding dairy, while only 1.5% felt worse.  81% felt better when following a Paleo diet, while only 3.2% felt worse. However, some of her findings were more surprising.  For example, for those who followed a vegan diet, 30% said they felt better, but 28% of them had felt worse.

Stacey Robbins.  Stacey Robbins was the next speaker.  Like Dr. Wentz, she was also diagnosed with Hashimoto’s, and is author of the book “You’re Not Crazy and You’re Not Alone”.  During her talk she spoke about gratitude, and how having Hashimoto’s isn’t the end of your health, but can be the beginning of your healing.  She finished with a wonderful yoga/meditation exercise…thank you for that Stacey!

Shannon Garrett.  Next up was Shannon Garrett, who is an integrative registered nurse, holistic lifestyle & wellness coach, and a certified nurse-nutritionist.  Not only was Shannon diagnosed with Hashimoto’s, but she also was diagnosed with Celiac Disease, pernicious anemia, and interstitial cystitis.  Shannon tried taking a functional medicine approach for her condition, but she didn’t respond well after two years of integrative therapies, as she didn’t feel better, her antibodies didn’t decrease, etc.  But after going on low dose naltrexone (LDN) she felt much better, and eventually her antibodies weren’t detectible.  Even though LDN worked well for her, she did mention that it shouldn’t be used as a standalone treatment.  One important thing she mentioned that I didn’t realize is that candida will block LDN from working, and so if anyone reading this took LDN while dealing with a candida infection but didn’t receive good results, then this very well might have been the reason for this.

Michael Roesslein.  Michael Roesslein was the next speaker, and his focus was on spore-based probiotics.  He discussed how they have 100% survivability, and they produce powerful antimicrobials.  He discussed some of its functions, and he said that spore-based probiotics seem to be especially effective for Th2 dominant conditions, which means that they might be more beneficial for those who have Graves’ Disease.  He mentioned how spores can benefit people with a leaky gut by helping with the tight junctions and increasing microvilli height.  He mentioned Dr. Tom Bayne, and how Dr. Bayne has seen up to a 66% reduction in TPO antibodies for those who take spores, although I wasn’t able to find this information.  He also said that people with histamine issues have received great results when using spores.  This past summer I attended a nutrition conference and one of the presenters there also spoke about spore-based probiotics, and so I’ll definitely need to look into this.  And of course if anybody reading this has received some good benefits from taking spore-based probiotics please feel free to share your experience in the comments section.

Dr. Kirk Gair.  The next presenter was Dr. Kirk Gair, who uses cold laser therapy in his practice, including on the thyroid gland of some of his patients.  I recently discussed this in a blog post entitled “Can Cold Laser Therapy Regenerate Thyroid Tissue?“.  One of the main studies is the Hofling study, which involved 43 patients, and it showed that cold laser therapy helped reduce the TPO antibodies and improved thyroid function. (1). It’s important to note that while the thyroid peroxidase antibodies were reduced, there was no improvement in the thyroglobulin antibodies. Dr. Gair also mentioned how people with Graves’ Disease can also benefit from cold laser therapy, although there doesn’t seem to be any research on this.  Just as is the case with LDN, Dr. Gair also mentioned how you need to incorporate other aspects of functional medicine.

Dr. Jolene Brighton.  Dr. Jolene Brighton is a naturopathic physician who was diagnosed with Hashimoto’s, and her presentation focused on postpartum thyroiditis.  She started off by telling everyone that 300,000 to 400,000 births will result in postpartum thyroiditis this year alone.  While many of these cases will be temporary, 30 to 40% of these women will develop permanent thyroiditis.  In addition, of those who go into a state of remission, they are at risk of developing postpartum thyroiditis again if they become pregnant in the future.

Dr. Alan Christianson.  I’m sure many reading this are familiar with Dr. Alan Christianson, who is also a naturopathic physician, and is author of the excellent book the Adrenal Reset Diet.  Dr. Christianson discussed some “curious case studies”, and he mentioned that 10 to 40% of people with Hashimoto’s will test negative for thyroid antibodies.  This of course can make it very challenging at times to tell if someone has Hashimoto’s.  He also spoke about how TSH isn’t linear.  For example, if someone has a TSH of 94, while another person has a TSH of 12, this doesn’t mean the person with the TSH of 94 needs to take more thyroid hormone medication than the person who has a TSH of 12.

Dr. Datis Kharazian.  The next presenter was Dr. Datis Kharazian, who has a very well known book on Hashimoto’s entitled “Why Do I Still Have Thyroid Symptoms When My Lab Tests Are Normal? “.  He spoke about the autoimmune paleo diet, and mentioned how some of the “allowed” foods might cause problems.  I spoke about this as well in other blog posts, as while I like the autoimmune paleo diet and commonly recommend it to my patients, it’s not a perfect fit for everyone with Hashimoto’s and Graves’ Disease.  He also spoke about cerebellum antibodies being the most common autoantibody associated with Hashimoto’s, with the exception of the autoantibodies associated with Celiac Disease.  Most people reading this are familiar with the health risks of bisphenol A (BPA), but Dr. Kharrazian warned everyone attending that bisphenol S (BPS) is frequently used as a substitute, and is just as bad as BPA, and perhaps even worse.  Sure enough I did some research on this, and the literature does show that bisphenol S also has endocrine-disrupting effects, as does bisphenol-F (2) (3) (4).

Andrea Nakayama.  The final presenter of the day was Andrea Nakayama, who is a functional nutritionist, and she essentially spoke about how we need to educate our patients better, and make them realize that they are on a “heroes” journey.  Although most people are looking for a quick and “smooth” recovery, she said what everyone attending the thyroid mastermind knows, which is that in many cases one’s recovery isn’t going to be a quick and easy fix.

Hashimoto’s Awareness.  Pearl Thomas-Flanagan and Fabienne Heymans are part of Hashimoto’s Awareness, which is a non-profit organization which helps to raise awareness of this autoimmune condition.  And although they didn’t have a presentation during the thyroid mastermind, I would like to encourage everyone to visit their website (www.hashimotosawarness.org) and consider helping them either by giving a donation, volunteering, or simply sharing your Hashimoto’s story with others.

Although I was honored to be invited to the thyroid mastermind meeting, initially I considered backing out due to my hectic schedule.  But I’m glad that I had the opportunity to attend and meet everyone there, and I’m very thankful to Dr. Izabella for putting this together.  As I mentioned in the opening paragraph, I’m hoping to eventually interview most of those who attended, and so you can look forward to learning even more about some of the topics mentioned in this post.

I’ve never been a big coffee drinker, but since many people with thyroid and autoimmune thyroid conditions consume caffeine in the form of coffee, tea, and other caffeinated beverages, I figured it would be a good idea to write an updated post on this topic.  Plus, since my wife drinks coffee on a daily basis I’m sure she’ll appreciate this blog post as well!  I usually recommend for my patients to initially avoid caffeine (especially coffee) while trying to restore their health, and not surprisingly, many people find this to be very challenging.  While there are certain risks of consuming caffeine, numerous studies show that caffeine does have some health benefits.

Caffeine is the most widely consumed psychostimulant substance (1).  As I mentioned in the opening paragraph, I have never been a coffee drinker, although my wife loves coffee, our dog Lexi loves coffee (just kidding), and many of my patients also enjoy drinking coffee on a daily basis.  I do consume caffeine in other ways, such as by drinking green tea and eating some dark chocolate.  Perhaps the main reason why I have most of my patients avoid caffeine initially is because it causes an elevation of ACTH and cortisol, along with the catecholamines.  And since most of my patients have adrenal problems I think it’s a good idea for many of them to refrain from consuming caffeine while trying to improve their health.

Here are some of the common beverages and foods with the approximate caffeine content (2) (3) (4):

Coffee (brewed): one 8-ounce cup has approximately 107 to 150 mg of caffeine

Black tea: one 8-ounce cup has approximately 28 to 46mg of caffeine

Green tea: one 8-ounce cup has approximately 25mg of caffeine

Starbucks Grande Cafe Mocha: one 16-ounce cup has approximately 175mg of caffeine

Coca-Cola Classic: one 12-ounce bottle has approximately 34 mg

Pepsi Cola: one 12-ounce bottle has approximately 40mg of caffeine

Dark Chocolate: one ounce has approximately 12mg of caffeine.

What Does The Research Show?

What I’d like to do now is discuss some of the research studies associated with the consumption of caffeine.

Caffeine and cardiovascular health.  One study involving 52 healthy adults aged 18-29 years of age examined the stress reactivity following caffeine consumption (5).  The study showed that both men and women had an increase in systolic blood pressure and cortisol levels after consuming caffeine, although the CRP levels weren’t affected.  Just as a reminder, CRP is a marker of inflammation.  Another study examined whether a single ingestion of caffeine improves microvascular function in healthy subjects (6).  The results showed that caffeine contained in a cup of coffee enhances microvascular function in healthy individuals.  A couple of meta-analyses showed an inverse relationship between coffee consumption and cardiovascular disease (7) (8).  One of these studies showed that the lowest cardiovascular risk occurred with the consumption of 3 to 5 cups of coffee per day, and concluded that heavy coffee consumption was not associated with an elevated risk of cardiovascular disease (8).

Caffeine and Glucose Metabolism.  How does caffeine affect glucose metabolism?  Well, one study evaluated the effect of consuming 200mg of caffeine taken twice per day for seven days on glucose metabolism, as well as on serum cortisol, DHEA, androstenedione, and nighttime salivary melatonin (9).  The study involved 16 healthy adults aged 18 to 22 with a history of caffeine consumption.  The results of the study showed that the insulin levels were significantly higher, while insulin sensitivity was reduced.  There were no differences in glucose, DHEA, androstenedione, and melatonin.  Based on this study you would think that people with insulin resistance or type 2 diabetes should avoid drinking coffee, but a few studies have shown that coffee has a protective effect on the risk of type 2 diabetes, probably by affecting postprandial glucose homeostasis (10) (11).

Caffeine and Cortisol.  One study measured the cortisol levels at eight times on days when healthy men and women consumed 250mg of caffeine 3x/day and underwent either mental stress or dynamic exercise protocols, followed by a midday meal (12).  The study showed that caffeine in combination with the mental stress further increased cortisol levels, whereas exercise alone didn’t increase cortisol, but caffeine taken before exercise elevated cortisol in both men and women.  Another study looked to show whether tolerance develops with the daily intake of caffeine (13).  It involved 48 men and 48 women, and after five days of avoiding caffeine, challenges with caffeine caused a robust increase in cortisol across the test day.  However, 5 days of consuming caffeine (300mg and 600 mg/day) abolished the morning cortisol response, although the cortisol levels were elevated later in the day.  So the study showed that cortisol responses to caffeine are reduced, although not entirely eliminated, in healthy young men and women who consume caffeine on a daily basis.

Caffeine and the immune system.  A number of in vitro and in vivo studies have demonstrated that caffeine modulates both the innate and adaptive immune responses (14).  Caffeine has been reported to decrease the production of both Th1 and Th2 cytokines (15).  Since these cytokines play a role in autoimmune conditions such as Graves’ Disease and Hashimoto’s Thyroiditis, it is possible that caffeine consumption can benefit many people with these conditions by decreasing pro-inflammatory cytokines.  Another study showed that chronic caffeine treatment attenuates experimental autoimmune encephalomyelitis (15).  It might accomplish this by causing a shift in the Th1/Th2 pathways.

Caffeine and Sleep.  One study evaluated the effects of 200mg and 400mg of caffeine on sleep in young and middle-aged adults (16).  The results of the study showed that compared to young adults, middle-aged adults are generally more sensitive to the effects of a high dose of caffeine on sleep quantity and quality (16).  However, another study found that low to moderate amounts of caffeine consumed in the home environment, mostly during morning hours, had little effect on sleep (17).  The ages of the participants ranged from 20 to 50 years.

Caffeine and Cancer.  One study looked at the incidence of breast cancer in relation to caffeine consumption in Sweden (18).  The findings suggested that coffee consumption and caffeine intake is negatively associated with the risk of breast cancer, whereas tea consumption is positively associated with the risk of breast cancer (18).   Another study evaluated the association of caffeine and coffee consumption with regards to melanoma risk (19).  After adjustment for other risk factors, higher total caffeine intake was associated with a lower risk of melanoma (19).

Caffeine and Alzheimer’s Disease.  Numerous studies show that caffeine can have a protective effect against dementia and Alzheimer’s disease (20) (21) (22).  These studies were based specifically on the consumption of coffee, and one of the studies mentioned that 500mg of caffeine daily (equal to 4 or 5 cups of coffee per day) can protect against or treat Alzheimer’s disease (22).  Another one of these studies mentioned that the protective effects against cognitive decline/dementia are less evident in tea drinkers (21).

Caffeine and Thyroid Health.  There aren’t many studies which show a direct correlation between caffeine and thyroid health.  I did come across a study which showed that coffee consumption may play a protective role against the development of benign or malignant thyroid neoplasms, possibly by the stimulatory effect of caffeine on the intracellular cyclic AMP production (23).  However, there is some evidence that coffee can interfere with the intestinal absorption of thyroid hormone medication (24).  This was based on a small study consisting of eight women, but it probably would be wise not to take thyroid hormone medication with coffee.

Genetic Polymorphisms and Caffeine Metabolism

Caffeine is metabolized by the cytochrome P450 1A2 (CYP1A2) enzyme.  Many people have  a genetic polymorphism for this enzyme, and those with certain genetic polymorphisms of the CYP1A2 enzyme are “rapid” caffeine metabolizers, whereas those with other genetic polymorphisms of the CYP1A2 enzyme are “slow” caffeine metabolizers (25).  So what does this mean?  Well those people who are “rapid” caffeine metabolizers break down and excrete caffeine quickly, whereas those who are “slow” caffeine metabolizers break down and excrete caffeine slowly.  Studies show that those who are slow metabolizers of caffeine have an increased risk of myocardial infarction (26) and impaired fasting glucose (27).  So being a slow metabolizer of caffeine is associated with certain health risks, and while many people can tell this by the way they feel after consuming caffeine, some labs offer genetic testing available to confirm this.

How is this interpreted on an genetic lab report?  Well, if you’re reading the interpretation from a 23andme test you should see CYP1A2 with an rsID listed as rs762551.  You’ll also see a column that says “alleles”, which is what you want to pay attention to.  If someone has the AA allele then they are considered to be a fast metabolizer (28).  If someone has the AC or CC allele then they are considered to be a slow metabolizer (28).

Who Should Avoid Caffeine?                      

As I mentioned earlier, initially I recommend for just about all of my patients to avoid caffeine, especially in the form of coffee.  Obviously not everyone takes my advice, although many people do.  However, not everyone needs to avoid caffeine on a long-term basis.  Those people who have adrenal problems will probably want to stay away from caffeine, at least until the health of their adrenals have been restored.  And if someone is a slow metabolizer of caffeine then it also is a good idea to avoid consuming large amounts of caffeine.

When Can Caffeine Be Reintroduced?

Many people who eliminate caffeine from their diet eventually would like to reintroduce it.  But when is the ideal time for someone to do this?  Well, it does depend on the person.  As I mentioned before, if someone has adrenal problems then it would be ideal for them to wait until the health of their adrenals have been restored before reintroducing caffeine.  This is especially true with coffee since it is high in caffeine, but it probably is a good idea to limit one’s consumption of caffeine altogether until their adrenal health has significantly improved.  If someone is a slow metabolizer of caffeine then it really is a good idea to minimize their consumption of caffeine on a permanent basis.  This doesn’t mean that slow metabolizers can never drink coffee again, but it probably would be wise to limit your consumption if this is the case.

In summary, many people consume caffeine on a regular basis, and this of course includes people with thyroid and autoimmune thyroid conditions.  Caffeine can have a negative effect on adrenal health, and thus probably should be avoided with those who have adrenal problems.  On the other hand, caffeine modulates the immune system and might actually benefit some people with Graves’ Disease and Hashimoto’s Thyroiditis by decreasing pro-inflammatory cytokines.  Coffee consumption might also decrease the risk of developing certain types of cancers.  Since coffee can interfere with the intestinal absorption of thyroid hormone, if you are taking thyroid hormone medication it would be best not to consume coffee when taking this.  Some people have a genetic polymorphism involving the CYP1A2 enzyme, and as a result can either be a “fast” metabolizer of caffeine, or a “slow” metabolizer of it.  Those who are a “fast” metabolizer will be able to tolerate larger amounts of caffeine, whereas those who are “slow” metabolizers will have problems breaking down and excreting caffeine, and thus should minimize their consumption of it.