There is controversy over whether the cells of the thyroid gland can regenerate.  Some claim that any damage to the thyroid gland is permanent, although others like myself do think it is possible for the thyroid gland to heal if the trigger has been removed.  But it does seem to depend on the patient, as while some people who are taking thyroid hormone medication are eventually able to wean off of it once the autoimmune component has been suppressed, others will need to remain on thyroid hormone even after restoring their immune system health.

There is no question that different areas of the body will heal at a different rate.  For example, the liver has a remarkable regenerative capacity after a partial hepatectomy (1).  On the other hand, as I mentioned earlier, many don’t consider the thyroid gland as being a regenerative organ.  For example, whereas the liver usually returns to close its original weight after a partial hepatectomy, after a partial thyroidectomy the thyroid gland exhibits hypertrophy and hyperplasia (2), but it doesn’t return to its original weight as the liver does.  However, hyperplasia is an increase in cell production, and so this suggests that regeneration of this gland is possible, although admittedly it’s not a quick process when compared to other parts of the body.  And it also seems to depend on how much damage takes place to the thyroid gland, as I’m not suggesting that someone who has received a partial thyroidectomy can expect complete regeneration to occur.

Even if the thyroid gland can heal on its own, if there are methods that can speed up the healing process, or cause tissue regeneration to occur when it normally wouldn’t happen on its own, then it makes sense to consider such a treatment.  Many people are familiar with the benefits of cold laser therapy with regards to helping people with musculoskeletal conditions, pain, and wound healing.  However, most people aren’t aware that cold laser therapy can potentially benefit thyroid health by helping with the regeneration of thyroid tissue.  Before specifically talking about this, it probably would be a good idea to briefly talk about how cold laser therapy works.

How Does Cold Laser Therapy Work?

Lasers were actually discovered in the 1960s, and not too long after this it was found that laser therapy can help with wound healing, pain reduction, decreased inflammation, etc.  Studies were first conducted on mice, where it was demonstrated that lasers can help to speed up wound healing.  Eventually studies were conducted on humans and it was also found that laser stimulation helped with wound healing (3) (4).  Low level light therapy involves exposing cells or tissues to low levels of red and near infrared (NIR) light (5).  It is also known as “cold laser” therapy because the power densities used are lower than those needed to produce heating of tissue (5).

Although low level laser therapy (LLLT) has been proven to help with numerous conditions, there are controversies surrounding it.  First of all, the exact biological mechanism still isn’t completely known.  In addition, a large number of parameters such as the wavelength, fluence, power density, pulse structure, and timing of the applied light must be chosen for each treatment (5). A less than optimal choice of parameters can result in reduced effectiveness of the treatment, or even a negative therapeutic outcome (5).  This is important to understand, as some studies have demonstrated that LLLT wasn’t effective for certain conditions, but the reason might have been due to an inappropriate light source and dosage.

How Can Cold Laser Therapy Help People With Thyroid Conditions?

There are a few small studies which show that using cold laser therapy can help to improve vascularization and perhaps help to regenerate the thyroid cells in some people with hypothyroidism.  One of these studies involved 43 patients with autoimmune thyroiditis who were on levothyroxine, and the results suggested that LLLT can improve thyroid parenchyma vascularization (6).  The same study showed a significant difference in the average levothyroxine dose required between those who received the treatment, and those who received a placebo treatment (6).  They not only had an improvement in thyroid function, but the group treated by LLLT also had lower TPO antibodies, although there wasn’t a change in the thyroglobulin antibodies.  Another study involving fifteen patients who had hypothyroidism caused by autoimmune thyroiditis showed that LLLT promotes the improvement of thyroid function, as patients experienced a decreased need for levothyroxine, a reduction in the TPO antibodies, and an increase in parenchymal echogenicity (7).

Of course more studies need to be conducted to show further proof of the benefits of LLLT on thyroid health, but these results seem very promising.  One important thing to keep in mind is that even if LLLT can help to regenerate the tissue of the thyroid gland, it still won’t do anything to remove the underlying cause.  For example, if someone has Hashimoto’s Thyroiditis due to an infection, which in turn caused a leaky gut, these factors need to be addressed.  And while the studies demonstrated a decrease in TPO antibodies, they didn’t help at all with elevated thyroglobulin antibodies, which also demonstrates that the cause of the condition needs to be detected and removed.

If you have Graves’ Disease then you might wonder if  LLLT can be beneficial.  Although it’s common for people with Graves’ Disease to have elevated TPO antibodies, the primary autoantibody associated with this condition is the TSH receptor antibody…specifically thyroid stimulating immunoglobulins.  There is no evidence I’m aware of which shows that LLLT can lower these antibodies.  And the TSH receptor antibodies aren’t causing damage to the thyroid gland, as they are stimulating or binding to the TSH receptors, which in turn causes the excess production of thyroid hormone.  However, if someone with Graves’ Disease also has thyroid peroxidase (TPO) antibodies then they might benefit from receiving LLLT.

Other Chronic Conditions Which Can Benefit From Cold Laser Therapy

In addition to benefiting people with thyroid conditions, cold laser therapy can potentially help with other conditions as well.

Rheumatoid arthritis.  One study I came across showed that LLLT is able to help people with both early and late stages of rheumatoid arthritis by modulating the inflammatory response (8).

Trigeminal neuralgia.  This can be a very painful condition, and studies show that laser therapy was associated with significant reduction in the intensity and frequency of pain, and therefore LLLT can be considered for the treatment of trigeminal neuralgia without any side effects (9).

Discoid lupus erythematosus.  This condition is restricted to the skin, mostly the face.  And a small study involving 16 patients with this condition showed that laser therapy helped to improve the itching, erythema, scaling, scarring, and pain (10).

Hair loss.  A few studies have shown that LLLT can help with hair loss.  One study involved LLLT in the treatment of male and female pattern hair loss, and the authors concluded that LLLT may be an effective option to treat pattern hair loss in both men and women (11).  Another small study showed that LLLT may be a promising treatment option for patients to help with hair growth, although the technology appears to work better for some people than for others (12).

Acne Vulgaris.  This is a common skin condition, and in one study involving 28 patients, two different wavelenghts of LLLT (630 and 890 nm) were used (13).  Ten weeks after treatment the acne lesions were significantly decreased in those who were treated with 630 nm, but the decrease was not significant in those treated with 890 nm (13).

Bone repair.  A number of rat studies show that LLLT can help with bone fractures by augmenting bone tissue formation (14) (15) (16).  But of course it would be nice to see some human studies demonstrating this as well.

In summary, cold laser therapy can help with wound healing, pain reduction, decrease inflammation, and can therefore potentially benefit people with different conditions such as rheumatoid arthritis, acne, bone fractures, and other conditions.  There is also the possibility that cold laser therapy can help to regenerate thyroid tissue, which of course can benefit many people with Hashimoto’s Thyroiditis.  However, larger studies need to be conducted, and it’s important to keep in mind that even if cold laser therapy can help to regenerate thyroid tissue, it won’t do anything to address the underlying cause of the condition.

There are thousands of people with thyroid and autoimmune thyroid conditions who would like to follow a natural treatment protocol, yet don’t have a lot of money to spend. And let’s face it, when it comes to eating healthy foods, taking good quality supplements, ordering tests, and consulting with a natural healthcare professional, it can become quite expensive. Without question this is an investment in your health, but even though this is true, some people simply can’t afford this investment. Others can afford this type of treatment, but they have to make other financial sacrifices. So I decided to put together a post which discusses how to follow a natural treatment protocol on a budget.

1. Only take those supplements which are truly necessary. Although I take nutritional supplements and herbs on a wellness basis, and also recommend them to my patients who are taking a natural treatment approach, it’s easy to find yourself in a situation where you are taking too many supplements. There is so much information available, and so it’s common to read an article or watch a video or webinar which discusses a specific supplement, and then based on this information you can easily convince yourself that it would be a good idea to take that supplement. This happens to myself every now and then as well, as whenever I attend a nutritional conference it seems like I end up adding a few supplements to my daily regime. But if you’re not careful you can find yourself taking dozens of different supplements, many of which are unnecessary.

I’m sure most people reading this understand that while taking nutritional supplements and herbs can be beneficial, this doesn’t mean that you should take dozens of different supplements. Of course the challenge is finding out which supplements are absolutely necessary to take. And to be honest, this will vary from person to person, although there are a few supplements that most people can benefit from taking. Some examples include a probiotic and an omega-3 fatty acid supplement. Many people don’t get enough magnesium from their diet and therefore can benefit from taking a magnesium supplement. If someone has a confirmed nutrient deficiency such as vitamin D or vitamin B12 then they will usually need to supplement with these nutrients. Of course the quality of the supplement is important, as if you are taking magnesium you usually will want to avoid magnesium oxide due to the low quality, and if you take vitamin B12, in most cases taking methylcobalamin, adenosylcobalamin, or hydroxycobalamin will be the best option.

But how about other nutritional supplements and herbs? There are many others that can be beneficial to take, including L-glutamine, turmeric, zinc, selenium, digestive enzymes, CoQ10, garlic, rhodiola, etc. These are just a few of the common supplements and herbs people commonly take, and there are times when taking one or more of these can be beneficial. However, I’ll consult with at least a few new patients each month who seem to be taking all of these I listed, plus many other supplements and herbs. The supplements someone needs to take will depend on what imbalances they have. For example, if someone has weak adrenals then they might benefit from taking herbs such as licorice and rhodiola, vitamin C and pantothenic acid, etc. If they have a leaky gut then in addition to a probiotic they probably can benefit from taking L-glutamine and vitamin A. If they have other imbalances then other supplements might be necessary to take.

2. Utilize the dirty dozen and clean fifteen lists. Ideally you want to eat as many organic foods as you can. However, this of course can become very expensive, and not everyone can afford to eat a 100% organic diet. If you eat meat, eggs, and dairy products then I would try to eat organic whenever you can. But with regards to eating fruits and vegetables, if you are unable to afford to buy these organic then I would recommend to utilize the dirty dozen and clean fifteen lists from the Environmental Working Group (www.ewg.org). The dirty dozen list includes the top twelve fruits and vegetables with the greatest amount of pesticides, while the clean fifteen list includes the top fifteen fruits and vegetables with the least amount of pesticides. And so if you are unable to afford to purchase organic fruits and vegetables, make sure to avoid those foods that are on the dirty dozen list, and stick to those foods that are on the clean fifteen list.

3. Focus on healing the gut. With most chronic health conditions, especially autoimmune conditions such as Hashimoto’s Thyroiditis and Graves’ Disease, having a healthy gut will play a key role in restoring the health of the person. And while it sometimes can be challenging to know where to start, simply going on an elimination diet while at the same time doing things to heal the gut can help a great deal. For example, consider cutting out the common allergens for one month such as gluten, dairy, eggs, corn, and soy. If you want to take this one step further you can also avoid grains, legumes, nuts and seeds. I realize this can be very challenging, and I’m not suggesting that everyone has to do this in order to restore their health. But many people have benefited greatly from following such a diet, while at the same time eating foods such as bone broth and/or sauerkraut to heal the gut, along with supplements such as a probiotic, L-glutamine, and zinc.

Taking this approach won’t always work, as there are times when it’s challenging to identify the source of gut inflammation, or the factor which is responsible for increasing the intestinal permeability. But following an elimination diet and doing some things to heal the gut usually won’t hurt, and many times can make a big difference. Although there can be other imbalances people have (i.e. adrenals, sex hormones, toxic overload, etc.), it is essential to have a healthy gut in order to achieve an optimal state of health.

4. Don’t underestimate the importance of getting sufficient sleep and managing your stress. Getting quality sleep is important, and while some people have problems falling and/or staying asleep, others intentionally neglect their sleep. Most people should aim to get at least 7 to 8 hours of quality sleep each night. And while too much sleep isn’t a good thing for many people, some people with chronic health conditions can benefit from getting more than eight hours of sleep per night until their health improves.

As for managing one’s stress levels, this is something that is very cost effective, yet many people don’t do a good job of managing their stress. There are three main reasons why most people don’t block out time for stress. The first reason is because they don’t think that managing stress is important, even though there are many research studies which show a correlation between chronic stress and different health conditions. A second reason is because some people think they do a good job of managing the stress, even when this isn’t the case. Sometimes it can be challenging to know if stress is having a negative impact on your health, and so regardless of whether someone thinks they are doing a good job of managing their stress levels I recommend for people to block out time to manage stress.

A final reason why many people don’t block out time for stress management is because they can’t find the time to do so. Either they work very long hours, or perhaps they are a stay-at-home mom (or stay-at-home-dad) and have a few young children to tend to throughout the day and at night. The problem is that those people who can’t find the time to focus on stress management usually need this the most. The truth is that most people can block out at least 10 to 15 minutes per day to manage stress, but many don’t do so not because they don’t have the time, but because this isn’t a priority. For more information on this I would refer to the blog post I created entitled “Blocking Out Time To Manage Your Stress Is Essential“:

5. Price around before ordering tests. When it comes to ordering tests, it is a good idea to contact different labs. This is especially true if you pay out of pocket for blood tests, as there can be a big difference between the pricing of different labs. There are numerous online companies such as www.directlabs.com and www.privatemdlabs.com that offer blood tests at a discounted price. And what’s even better is that you don’t need a doctor’s order for these companies. The downside is that ordering blood tests online isn’t available in all states. If you are able to get an order from a doctor but pay out of pocket, then it might be a good idea to call some of the local labs, including any small hospitals, as you very well might find a lab that is willing to give you a nice discount on your blood tests.

As for other types of tests, such as a saliva test for the adrenals, you can of course shop around for these as well. However, keep in mind that different saliva panels include different tests, which will be a factor in the price. For example, you might choose an adrenal saliva test based on price alone, but then realize that it only tests for the cortisol levels, whereas another lab offers a more comprehensive adrenal panel which also includes tests for DHEA, 17-OH progesterone, and secretory IgA.

6. Eat as many whole foods as possible. You no doubt have heard of the phrase “food is medicine”, and while eating a healthy diet alone many times won’t be enough to restore one’s health, eating a diet consisting of whole foods while minimizing the refined foods and sugars will benefit your health. Earlier I mentioned how certain foods such as bone broth and sauerkraut can help to heal the gut. Similarly, certain foods such as broccoli, kale, and garlic can increase glutathione levels, which can help with the elimination toxins. Overall you want to eat foods that are nutrient dense, and try to eat a good variety of vegetables in order to get most of the phytonutrients which are essential for optimal health.

7. Do other things to improve your health. There are many other things you can do to improve your health which won’t cost a lot of money. For example, besides eating whole foods to help eliminate toxins, you of course want to try doing everything else you can do to minimize your exposure to toxins. This not only includes chemicals (i.e. pesticides, toxic metals, etc.), but electromagnetic fields (EMFs). Earthing can also be beneficial and is free, and I’ll discuss this in a future article. Take advantage of any free webinars on thyroid health, as many times these can provide some valuable information. If you have more time than money you also might benefit from visiting some thyroid health forums and/or facebook groups. And of course try to do your best to stay positive, as while it isn’t always easy to have a positive attitude when dealing with a thyroid or autoimmune thyroid condition, doing so can make a big difference.

In summary, if you are looking to follow a natural treatment protocol but are on a budget, there are still many things you can do to improve your health. Make sure you don’t take more supplements than you need, utilize the dirty dozen and clean fifteen lists, and focus on healing the gut. You also want to make sure to get sufficient sleep and block out time to manage your stress. Make sure you eat plenty of whole foods, and if you order tests and pay out of pocket for them consider contacting different labs in order to get the best price. You also want to minimize your exposure to toxins, consider doing earthing, and try your best to keep a positive attitude.

In the last blog post I spoke about how following an elimination diet can benefit a lot of people by determining which foods someone might be sensitive to.  After someone has gone on an elimination diet for three or four weeks the next step is to reintroduce foods.  While some people will want to continue following the elimination diet after three or four weeks, eventually just about everyone will want to reintroduce certain foods into their diet.

How should you go about reintroducing foods?  Well, you always want to reintroduce one new food at a time.  The obvious reason for this is because if you were to reintroduce more than one food on the same day and then experienced a negative reaction, you wouldn’t know which food was responsible.  It also is a good idea to eat the food you reintroduce a couple of times on the same day, and then wait an additional two days before reintroducing the next food.  The reason for this is because it is possible to have a delayed reaction to a food.  If all goes well when reintroducing a certain food then you can continue eating that food on a regular basis and can reintroduce the next food.

So for example, let’s say you followed the elimination diet for 28 days.  On day #29 you decide to reintroduce eggs, and have an egg for breakfast and another egg with lunch.  If by the end of day #31 you experience no negative symptoms, then on day #32 you can reintroduce a new food.  On the other hand, if you did experience a negative reaction to the eggs then you would wait until the symptoms subside before reintroducing the next food.

Which Foods Should You Reintroduce First?

It’s usually not necessary to reintroduce foods in a certain order, although some sources will recommend to first reintroduce the foods least likely to give a severe reaction, and to save foods such as gluten, dairy, and corn for last, if you choose to reintroduce these.  Many times I will recommend reintroducing eggs first if the person enjoys eating eggs, as they are very nutrient dense.  Of course you can choose to reintroduce a different food first if you prefer.  For obvious reasons you want to only reintroduce whole foods for now.  The reason is because if you reintroduce any type of processed food then you most likely will be reintroducing more than one ingredient.  For example, if you reintroduce pizza as one of the first few foods, and you had a negative reaction, you wouldn’t know if the negative reaction was due to the wheat (or other type of grains if it was gluten free), cheese, sauce, or other ingredients in the pizza.

This brings up another important point, as you don’t necessarily want to reintroduce ALL of the foods you originally eliminated.  So for example, certain foods are not eliminated because they are allergenic, but instead because they have compounds which can cause issues with the permeability of the gut.  Examples include nuts, seeds, legumes, grains, and the nightshade vegetables.  While sometimes eating these foods can produce symptoms (i.e. the nightshades commonly cause joint pain), the lack of symptoms doesn’t mean that it’s fine to continue eating these.

This doesn’t mean that everyone will need to completely avoid nuts, seeds, legumes, grains, and the nightshade vegetables.  If someone chooses to follow a strict autoimmune paleo diet then they will avoid these foods, along with dairy and eggs.  On the other hand, there are some people who are able to eat small amounts of these foods without a problem.  If someone has obvious gastrointestinal issues or has tested positive for a leaky gut then I do think these foods should be avoided until the gut has been healed.

When Can Dairy Be Reintroduced?

Dairy is one of the main foods that a lot of people commonly want to reintroduce first.  Although there are health benefits of dairy, I’m very cautious about people reintroducing it while trying to restore their health, mainly because many people are sensitive to the proteins of dairy, specifically casein.  And remember that is possible for someone to reintroduce a food they are reacting to and not experience any negative symptoms.  With that being said, some people do fine with raw dairy, and a good quality whey protein is an excellent source of glutathione.  And so if someone insists on adding dairy I would recommend starting with raw dairy (i.e. raw milk), and then perhaps they can add a good quality whey protein.  However, if someone is fine not reintroducing dairy I will usually encourage them to go as long as they can without consuming it, letting them know that they will eventually be able to reintroduce dairy products again, if they choose to do so.

What Are Some Symptoms You Might Experience When Reintroducing Foods?

If all goes well then you shouldn’t experience any negative reaction when reintroducing a specific food.  On the other hand, if you do have a negative reaction then you want to look out for symptoms such as bloating, gas, abdominal discomfort, headaches, fatigue, muscle or joint pain, insomnia, skin problems, sinus congestion, etc.  One question you might have is “if I experience a specific symptom how do I know for certain it’s related to the food I reintroduced?”  For example, if someone reintroduces a new food and experiences severe gas and bloating, then there is a good chance it’s related to the food.  On the other hand, if they were to experience a headache or a increase in fatigue then it might be related to the food, but there is a also a chance that these symptoms weren’t related.

If you’re not certain if a symptom is related to the food being reintroduced then I would recommend to stop eating the food for a few weeks and then reintroduce it again in the future.  So for example, if you reintroduce eggs and experience a headache on the same day, it is possible that you coincidentally had a headache that was unrelated to the food.  On the other hand, if you avoid eggs for a couple of weeks and then reintroduce them again, and experience headaches again, then chances are it’s the eggs which are responsible for the headaches.

Should Gluten Be Reintroduced At All?            

Gluten is a common allergen, and many healthcare professionals will recommend for their patients to permanently avoid gluten.  Others will recommend for them to first heal their gut and restore their health, and then later will give the patient the option to reintroduce gluten.  I’ve also taken this approach with my patients, but the problem is that if they are sensitive to gluten but aren’t aware of this, one can argue that it might be best to find out sooner than later.  In other words, sometimes it might be best to have the person reintroduce gluten after following an elimination diet, and then if they have a negative reaction this will confirm that they should continue avoiding gluten while trying to restore their health, and perhaps even after their gut has been healed.

However, a possible flaw with this approach is that a leaky gut can cause food sensitivities.  In other words, a person might develop a food sensitivity due to a leaky gut, and just because someone is sensitive to a certain food initially doesn’t mean that they will be sensitive to the same food after the gut is healed.  And so a person might develop a gluten sensitivity after developing a leaky gut, but it is possible for the gluten sensitivity to no longer be present after the gut has been healed.  I’ve spoken to the doctors at Cyrex Labs, as they offer comprehensive testing for gluten, and they recommend that if someone tests positive for gluten on one of their Arrays for them to avoid gluten permanently…even if after healing a leaky gut.  Another theory is that if you eat even a small amount of gluten you can have gut inflammation for up to six months, and so based on this you would want to be cautious about reintroducing gluten at all.  Plus, since you can’t always go by symptoms there is a chance that someone who has a gluten sensitivity will reintroduce it and feel fine, and because of the lack of symptoms will continue to consume it, thus causing inflammation.  So while many people choose to eventually reintroduce gluten, there are risks of doing this.

It can get confusing, and without question there are some people who are sensitive to gluten and will need to avoid it permanently, yet many of these people don’t know they have a gluten sensitivity issue.  And so it definitely is a dilemma, as we’re pretty much faced with two different scenarios.  Scenario #1 is to reintroduce gluten after eliminating it, and if you have a negative reaction just realize you might experience an increase in gut inflammation for a few months.  Scenario #2 is to reintroduce gluten after healing your gut, but then if you are sensitive you might undo some of the positive benefits you received from the gut healing program.

Food sensitivity testing is an option to consider, although there are a few drawbacks to this.  One drawback is that it can be very expensive to do this type of testing.  Another drawback is that false negatives are common, and so you can have a gluten sensitivity but it might not be picked up by the test.  A final drawback is that you need to be consuming gluten in order for this type of test to be accurate.  And so if you are on a gluten free diet and do a food sensitivity test for gluten then you are essentially wasting your money.

The Final Verdict on Gluten

I didn’t mean to spend so much time on gluten, but I realize that there is a lot of controversy around this common allergen.  My current approach is to have people initially avoid gluten, and ideally I will have them continue to avoid it while following the natural treatment protocol.  On the other hand, if someone insists on reintroducing gluten soon after the elimination diet then I will let them know that there is a chance that they can be sensitive to gluten, yet they might not experience any symptoms upon reintroducing it.  I will also let them know that if they do fine upon reintroducing gluten from a symptomatic perspective, and choose to continue to eat it, I would still recommend minimizing their consumption of gluten, and of course to try to eat mostly whole foods, which won’t contain any gluten.

In summary, after your elimination diet you want to reintroduce one food at a time.  If after three days you don’t experience a negative reaction you can continue eating this food, and can then reintroduce the next food.  If you react to a specific food then the symptoms can vary, as some people will experience digestive symptoms, while others might experience symptoms such as fatigue, headaches, brain fog, muscle and joint pain, skin problems, etc.  And sometimes the person won’t experience any symptoms.  Although food sensitivity testing is an option, this also isn’t completely reliable, and can be very expensive.  As for reintroducing gluten and dairy, I usually encourage my patients to continue avoiding gluten and dairy while trying to restore their health, although some of my patients choose to reintroduce one or both of these.

When taking a natural treatment approach it of course is important to eat a healthy diet.  Although most endocrinologists dismiss dietary factors as playing a role in thyroid or autoimmune thyroid conditions, the truth is that eating a lot of refined foods and fast food on a frequent basis can lead to many different health issues.  However, some people don’t improve even when eating a healthy diet, and while it’s possible that there can be other factors affecting their health (i.e. stress, lack of sleep, an infection, toxins, etc.), in order to achieve optimal health it is important to avoid eating any foods you might be reacting to.

An obvious question you might have is “what foods should I eliminate?”  Not surprisingly you will get different opinions from different healthcare professionals.  But most will agree that the most common allergens should be eliminated, along with a few other foods.  This includes gluten, dairy, corn, eggs, soy, shellfish, peanuts, and refined sugar.  And because most refined foods and fast food include one or more of these allergens it is best to stick with eating whole foods while on an elimination diet.  Some healthcare professionals will also recommend avoiding foods such as beef, pork, coffee, tea, citrus fruits, and chocolate during an elimination diet.

An Elimination Diet For Those With Autoimmune Thyroid Conditions

Many people reading this are familiar with the autoimmune paleo diet.  This recommends for people to avoid most of the common allergens I listed above (gluten, dairy, corn, eggs, soy, peanuts, refined sugar, coffee), but also recommends avoiding legumes, nuts and seeds, along with the nightshade vegetables.  This of course makes the diet even more challenging to follow, but because legumes, nuts, seeds, and the nightshades have compounds which can potentially increase the permeability of the gut it probably is a good idea for most people with Graves’ Disease and Hashimoto’s Thyroiditis to avoid these foods.

I do think following an autoimmune paleo diet as an elimination diet is a good idea for many people with Graves’ Disease and Hashimoto’s Thyroiditis.  And of course those who do well with this diet can choose to continue following it until their health has been restored back to normal.  However, there are a few issues with this diet.  One problem is that it’s a very restrictive diet, as it essentially allows the person to only eat vegetables, fruits, lean meats and fish, coconut products, and some healthy oils (i.e. coconut oil).  Even with these restrictions many people are able to follow such a diet, especially on a short term basis, although it can be very challenging.  This is true for most people, but it is especially true for vegans and vegetarians.  And regardless of whether someone eats meat or not, some people don’t do well on an autoimmune paleo diet, even when it’s followed for a short period of time.

The other dilemma is that it is possible for people to have an allergy or sensitivity to one of the “allowed” foods.  In other words, someone might be sensitive to chicken, avocados, or kale, which are all permitted on an autoimmune paleo diet.  While these sensitivities are much less common, it still is possible to be sensitive to these and other foods.  Of course one can do food allergy and/or sensitivity testing, but this can get expensive, and the accuracy of such tests is controversial.  Research shows that the ALCAT testing is controversial (1), and although I have done IgG testing in the past, it’s not something I do on everyone, mainly because they are very expensive tests and I still question whether such testing is completely accurate.  I do like the new Multiple Food Immune Reactivity Screen from Cyrex Labs, although this test is also very expensive and has some limitations.

What I personally do is have most of my patients follow a strict autoimmune paleo diet initially, and then after the first month if they are struggling I’m usually open to them reintroducing some foods that typically aren’t allowed.  For example, eggs aren’t typically allowed on an autoimmune paleo diet, and I discussed the reason behind this in my blog post entitled ” Can People With Graves’ Disease and Hashimoto’s Thyroiditis Safely Eat Eggs? “.  But many people do fine eating eggs, especially the egg yolks, and in most cases, those who don’t do well will experience some symptoms upon reintroducing eggs.  Although nuts, seeds, and grains (even gluten free) are also not part of an autoimmune paleo diet, there are some people who choose to reintroduce small amounts of these foods and have no problems.  On the other hand, there are also people who reintroduce these foods and don’t do well, and eventually need to eliminate them from their diet again.

Below I have listed some of the main foods I recommend to be avoided initially, and I also include which ones are allowed when following an elimination diet for those with thyroid and autoimmune thyroid conditions.  Once again, I realize this can be very challenging for many people, and in the next post I’ll discuss reintroducing foods.

FOODS WHICH SHOULD BE AVOIDED:                                           

Gluten

Dairy

Corn

Grains (even gluten free)

Eggs

Soy

Shellfish

Peanuts

Refined sugar

Coffee

Chocolate

Legumes

Nuts

Seeds

Nightshades

FOODS WHICH CAN BE EATEN:

Vegetables (excluding the nightshades)

Fruits (some elimination diets recommend to avoid citrus fruits)

Poultry (chicken, turkey, etc.)

Lamb

Other Meat

Wild fish low in mercury and other toxins

Some coconut products (i.e. unsweetened coconut milk and yogurt)

Healthy oils: olive oil, coconut oil

If you want a more complete list of the foods that are allowed and “forbidden” on an autoimmune paleo diet I would recommend reading the book “The Paleo Approach” by Sarah Ballantyne.  In this book she gives some comprehensive lists regarding the foods you can and can’t eat.  Although beef and pork are allowed on an autoimmune paleo diet, some elimination diets exclude these foods.  And while I didn’t discuss the quality of these foods, you of course want to try eating organic whenever possible, consider eating pasture-raised eggs and poultry, and if you eat beef then choose 100% grass fed.

Obviously if you have a known allergy or sensitivity to one of the “allowed” foods then I would avoid it.  Also, even though I listed coconut products here, keep in mind that many coconut products sold in health food stores have other added ingredients that might cause health issues (i.e. carrageenan).  As a result, if you are going to eat coconut products such as coconut milk and/or coconut yogurt during the elimination diet it is best to make your own.

How Long Should You Follow An Elimination Diet For?

You want to follow such a diet for at least three or four weeks.  The reason for this is because the antibodies take at least three weeks to significantly decrease.  So for example, if someone has a sensitivity to eggs and eliminates them for only one week, this won’t be a sufficient amount of time to reduce the antibodies, and thus the person who is sensitive to eggs probably won’t notice a difference upon reintroducing them.  On the other hand, after approximately three weeks of eliminating eggs the antibodies should greatly decrease, and so if the person with an egg sensitivity reintroduces eggs they most likely will experience some negative symptoms.  As a result, after three or four weeks most people can begin reintroducing some foods, which I will discuss in the next blog post.

Will You Experience Any Negative Symptoms While On The Diet?

Some people do experience negative symptoms when initially beginning an elimination diet.  These symptoms can include fatigue, headaches, lightheadedness, and gastrointestinal symptoms.  These symptoms usually only last for a few days, and not everyone experiences them.

Can I Expect Any Improvement In My Symptoms?

While some people experience a worsening of symptoms initially, many notice an improvement in their symptoms after a few days or a few weeks.  Some of the common symptomatic improvements reported by those following an elimination diet include an increase in energy, a decrease in brain fog, better sleep, a decrease in gastrointestinal symptoms, and a decrease in pain.  Keep in mind that just because you’re not noticing an improvement in certain symptoms doesn’t mean that you’re not benefiting from the elimination diet.  For example, you might have low energy levels and/or sleep issues due to weak adrenals and HPA axis dysregulation, and while eliminating certain foods might help to reduce inflammation, going on an elimination diet alone usually won’t restore the health of the adrenals.  Similarly, if someone has a leaky gut due to an infection such as H. Pylori, just following an elimination diet isn’t going to help with this.

Based on what I just said you might ask the question “why not just do some testing first to see if someone has problems with the adrenals, a leaky gut, an infection, etc?”  Although I do some testing initially, what you need to keep in mind is that it is common for someone to have more than one health issue.  And sometimes it can be challenging to know what is specifically triggering one’s condition.  For example, someone might have a leaky gut that was caused by chronic stress or an infection, but they might also have a food sensitivity such as dairy that is contributing to their gut inflammation.  And so the obvious goal would be to address all factors which can cause gut inflammation and thus is preventing the leaky gut from healing.

Is It Okay To Cheat Once Or Twice During The Elimination Diet?

While many people follow an elimination diet without a problem, for others it is a big challenge.  And it’s not uncommon for someone to ask me if they are able to cheat while following it.  Or sometimes they won’t ask me, but instead will send an email letting me know that they strayed from the diet.  For example, someone might be following an elimination diet and then have a piece of birthday cake to celebrate a family member’s birthday (or their own birthday).  Or they might have been invited to a wedding and ate some foods they weren’t supposed to eat.  Or perhaps they planned the elimination diet around the holiday season and they were invited to a party where it was almost impossible to strictly follow this diet.

Cheating even once can be an issue if you the food you consume has an ingredient you are sensitive to.  And one of the main reasons for following an elimination diet is to try to determine which foods you might react to.  As a result, you really do want to be 100% compliant during this time.  The best thing you can do is to plan ahead, as if there is a special occasion where you know you won’t be fully compliant and you can’t change your plans, then postpone the elimination diet if necessary.  For example, if you have a vacation planned in a couple of weeks, then it probably is best to hold off on following the elimination diet until after the vacation.  If there is a party or another special event coming up soon that you need to attend and you don’t think you will be fully compliant with the elimination diet, then wait until after the party is over with.

Do You Really Need To Stop Drinking Coffee?

Many of my patients find it difficult to give up drinking coffee.  It’s common for someone to say that they can strictly follow the elimination diet, but they can’t give up their coffee!  I know it isn’t easy for some people to stop drinking coffee, even if it’s only on a temporary basis.  And while some people do fine drinking coffee, not everyone does okay, which is why it’s a good idea to eliminate the coffee for at least three weeks, and preferably longer than this.  I realize that some people have problems going cold turkey, and so what you might need to do first is to gradually reduce the amount of coffee you drink until you have weaned off.  For example, if you drink three cups of coffee per day then perhaps you can reduce it to two cups per day for one or two weeks, and then cut it down to one cup/day for one or two weeks until you have weaned off of the coffee.  Another option is to drink half caffeinated and half decaffeinated coffee (organic preferred), and then after one or two weeks make it 3/4 decaffeinated and 1/4 caffeinated, and then once you are drinking decaffeinated coffee it should be much easier to wean off of it.

What are the potential consequences if you continue to drink coffee?  As I briefly mentioned earlier, some people do fine drinking coffee.  But the same can also be said for other foods that are eliminated.  Some people do fine with dairy, eggs, gluten free grains, etc.  The truth is that many people do much better when eliminating the coffee.  Obviously if you have a sensitivity to coffee then continuing to drink it can be a problem.  But even if you don’t have a sensitivity, if you have adrenal issues then drinking coffee usually isn’t a good idea.  And so if you choose to follow an elimination diet please try to do your best to eliminate the coffee, even if it means taking a few weeks to wean off of it before starting the elimination diet.

Remember That The Goal Isn’t To Restrict Calories

Some people think that the primary goal of an elimination diet is to lose weight, and they not only avoid the “forbidden” foods, but limit their consumption of the “allowed” foods.  Even if your main goal is to lose weight, restricting calories isn’t the best method of accomplishing this.  While it is common for people to lose weight while following the elimination diet, the main goal is to find out which foods you might be sensitive to.  And so you don’t need to restrict the amount of foods on the “allowed” list.

Should You Continue Taking Nutritional Supplements and Herbs?

In many cases I’ve had patients take certain nutritional supplements and herbs while following an elimination diet.  However, feel free to take a break from your supplements and herbs during this time, and if someone has a lot of known sensitivities it probably is best to avoid most supplements and herbs during an elimination diet.  After all, there is always the possibility that someone can be sensitive to one or more of the supplements they are taking.  Sometimes it’s not the actual nutrient or herb that they’re sensitive to, but one of the other ingredients (i.e. fillers, gums, etc.).  This of course can also be true with medication, as someone might be having gut inflammation due to the synthetic ingredients in the one or more of the prescription drugs they’re taking.  Obviously I’m not suggesting for people to stop taking their medication while doing an elimination diet, but this is something to keep in mind.

Should Everyone With Graves’ Disease and Hashimoto’s Thyroiditis Follow An Elimination Diet?

Although I think most people with an autoimmune thyroid condition can benefit from following an elimination diet, this doesn’t mean that everyone needs to do this in order to receive good results when following a natural treatment protocol.  Not all of my patients have followed an elimination diet, but those people who are experiencing symptoms such as gastrointestinal discomfort (bloating, gas, increased or decreased bowel movements, etc.), severe fatigue, headaches, muscle and/or joint pain, and other moderate to severe symptoms not related to their thyroid hormone imbalance should consider following an elimination diet.  Once again, this doesn’t mean that a food sensitivity is definitely the cause of these symptoms, but if a food sensitivity is the culprit then obviously this needs to be detected and then removed.

Other Important Tips

In order the get the most benefits from your elimination diet there are a few other things I would recommend.  First of all, I would try to eat as many organic foods as you can.  The main reason is because there are less toxins in organic food, and in some cases someone will have a negative reaction not because of the food itself, but because of a specific toxin.  For example, someone might feel lousy at times when eating non-organic apples, but at other times might be fine.  And while they might assume they have a sensitivity to apples, the problem could be due to the high amount of pesticides found on non-organic apples.

You also want to drink plenty of water each day.  Drink purified water, or a good quality spring water out of a glass bottle.  Try to get sufficient sleep each night.  Of course there are many people who have sleep issues and therefore have problems falling and/or staying asleep.  But there are also many people who fall asleep fine but intentionally stay up much later than they should.  This isn’t too big of a deal if done on an occasional basis, but you obviously want to get a good amount of sleep on a regular basis.  Some light exercise is usually fine, but you don’t want to exercise excessively, as this is common, and too much exercise can do more harm than good.

In summary, going on an elimination diet can help to determine which foods you have a negative reaction to.  Although taking this approach isn’t 100% reliable, the same is true with other methods such as food sensitivity testing, and of course an elimination diet is much more cost effective, although it does admittedly take time and discipline.  When I recommend an elimination diet to my patients with Graves’ Disease and Hashimoto’s Thyroiditis, I essentially have them follow an autoimmune paleo diet for three or four weeks before reintroducing certain foods.  I realize this makes the diet very restrictive, but doing so is essential in some cases, and after three or four weeks most people can start reintroducing some other foods.  Please remember that you don’t want to restrict calories while following an elimination diet, and you also should try eating as many organic foods as you can, drink plenty of water, get sufficient sleep, and not exercise excessively during this time.

Thyroid eye disease, which is also known as Graves’ ophthalmopathy, affects approximately 50% of those people with Graves’ Disease.  And while in most cases the condition isn’t severe, this isn’t always the case.  Common symptoms include eye swelling, eye bulging (exophthalmos), and sometimes even blurriness and double vision.  While steroids such as prednisone are commonly given to help with the inflammation, certain natural approaches can also benefit the patient, without them having the side effects of steroid medications.  Research shows that selenium can be very effective in helping with thyroid eye disease, which I’ll discuss in this post.

But why is selenium so effective in helping with thyroid eye disease?  In order to better understand why selenium can help it probably is a good idea to briefly talk about the pathophysiology of thyroid eye disease.  Research clearly shows that Graves’ ophthalmopathy isn’t due to the hyperthyroidism associated with Graves’ Disease, but instead is due to the autoimmune response (1).  The same autoimmune response involved in Graves’ Disease is also responsible for damaging the tissues of the eyes.  Some of the more common symptoms include a dry and gritty ocular sensation, sensitive to light, excessive tearing, double vision, and a pressure sensation behind the eyes (2). The most common clinical features of Graves’ ophthalmopathy are upper eyelid retraction, edema, and erythema of the periorbital tissues and conjunctivae, and bulging of the eyes (2).

Just to summarize, in Graves’ Disease it is the immune system which attacks the TSH receptors, which in turn leads to the excess production of thyroid hormone.  And in Graves’ ophthalmopathy the immune system also causes damage to the tissues of the eyes, which in turn cause the signs and symptoms associated with Graves’ Disease.  And so the obvious goal should be to modulate the immune system and decrease the TSH receptor antibodies.  Glucocorticoids are commonly prescribed by medical doctors to help reduce the inflammation associated with thyroid eye disease, as well as suppress the immune system, which in turn can lower the TSH receptor antibodies (3).  But there are negative health consequences of steroids, such as glucose intolerance, gastritis, hypertension, hepatitis, and depression (3).

How Can Selenium Specifically Help With Thyroid Eye Disease?

Although the focus of this post is on thyroid eye disease, selenium has been shown to be effective in the prevention and/or treatment of many other conditions including cardiovascular disease, osteoarthritis, rheumatoid arthritis, hypothyroidism, stroke, atherosclerosis, cancer susceptibility and treatment, HIV, AIDS, neuronal diseases such as Alzheimer’s disease and amyotrophic lateral sclerosis, pancreatitis, depression, and diabetes (4).  Selenium might even be able to decrease the progression of thyroid cancer (5) (6).  But how can one mineral have such a dramatic impact on these conditions?  Well, selenium has numerous functions, as it is a powerful antioxidant which in turn can help to reduce oxidative stress, it is involved in modulating the immune system, it is an enzymatic cofactor, and it is also involved in gene expression.  So it is very likely that a deficiency of this mineral will make someone more susceptible to developing other chronic health conditions.

As for how selenium can specifically help with thyroid eye disease, although the exact mechanism isn’t known, an increase in oxidative stress has been observed in both acute and chronic phases of thyroid disease with raised tissue concentrations of reactive oxygen species (7).  Selenium is important for the formation of selenoproteins.  These selenoproteins are powerful antioxidants and help to neutralize the effects of oxidative stress by reducing these free radicals (8).  Glutathione peroxidase and thioredoxin reductase are the two main seleno-enzyme systems which are responsible for the reduction of free radicals (7) (9).  These free radicals lead to an increase in proinflammatory cytokines, which as I have discussed in past articles and blog posts, are associated with autoimmune conditions (10).  So essentially what happens is that if someone has a selenium deficiency, this will result in a decrease in selenoproteins, and this in turn will result in the accumulation of hydrogen peroxide, which will cause tissue inflammation (11).  In addition, a deficiency of these selenoproteins can cause dysregulation of the immune system (12).  All of this can lead to tissue injury.

Remember that it’s the immune system attacking the TSH receptors which is responsible not only for the hyperthyroid symptoms of Graves’ Disease, but the immune system also attacks the fibroblasts of the orbit, which results in the symptoms associated with thyroid eye disease.  The TSH receptor antibodies are secreted by activated B cells due to immune system dysregulation.  But a sufficient amount of selenium can help to regulate the immune system, as it can help restore both innate and humoral immune functions (13) (14).

How Much Selenium Should You Take?

As for the dosage of selenium, it depends on the individual.  A typical dosage to help with these conditions is 200 mcg/day, as this frequently is sufficient enough to result in a therapeutic effect without causing a selenium toxicity.  Some people don’t respond unless if higher doses of selenium are taken (i.e. 400 mcg/day).  However, too much selenium can be toxic, and so you do want to be cautious.  Although you can try to get enough selenium through eating selenium-rich foods such as Brazil nuts, it might be best to take a selenium supplement.  The reason for this is because the dosage of selenium will vary in the food depend on the source.  For example, a Brazil nut that wasn’t grown in selenium-rich soil will of course have a lower amount of selenium than a Brazil nut that was grown in selenium-rich soil.

It also is a good idea to do other things to modulate the immune system, and not just rely on taking selenium.  Other nutrients which can decrease oxidative stress and suppress the autoimmune response include curcumin, resveratrol, fish oils, green tea, and vitamin D.  While taking supplements can help, in order to reverse thyroid eye disease one of course will need to remove the autoimmune trigger that is responsible for the elevated TSH receptor antibodies.

In summary, thyroid eye disease is common in Graves’ Disease, and this condition involves the immune system attacking the tissues of the eyes.  Selenium is a powerful antioxidant which reduces oxidative stress and can modulate the immune system, and it’s an important cofactor for glutathione production.  Essentially what selenium is doing is helping to regulate the immune system, which will decrease the damage caused to the tissues of the eyes.  Keep in mind that other nutrients can also help with this process, and it’s also essential to remove the autoimmune trigger.