There is no question that engaging in regular exercise is important.  Exercise has many benefits, as it can decrease the risk of developing cardiovascular disease, improve insulin sensitivity, increase bone density, etc.  However, while many people don’t exercise enough, there are some people who exercise excessively, which also isn’t a good thing.  As I’ll discuss in this post, too much strenuous exercise can have a negative effect on the immune system and might potentially be a factor in the development of an autoimmune thyroid condition such as Graves’ Disease or Hashimoto’s Thyroiditis.

Although the focus of this post will be on the risks of overtraining in those with autoimmune thyroid conditions, moderate exercise seems to offer a protective effect on the immune system (1).  For example, while strenuous exercise can theoretically make someone more susceptible to an upper respiratory tract infection by temporarily suppressing the immune system defenses, moderate exercise can actually protect against upper respiratory infections (2).  Exercise has effects on both the humoral and the cellular immune system (2).

What Are The Potential Consequences Of Excessive Exercise?

Although there are no studies confirming that excessive exercise causes thyroid autoimmunity, there is no question that overtraining does affect the cytokines of the immune system.  And as I have discussed in other articles, these cytokines play a role in different autoimmune conditions, including Graves’ Disease and Hashimoto’s Thyroiditis.  In a properly functioning immune system you ideally want to have a healthy balance between T-helper 1 (Th1) and T-helper 2 (Th2) activity.  But certain factors can affect these pathways, and make someone Th1 or Th2 dominant.  This in turn can increase the chances of the person developing either Graves’ Disease or Hashimoto’s Thyroiditis.

Most cases of Hashimoto’s Thyroiditis are Th1 dominant conditions, whereas most cases of Graves’ Disease are Th2 dominant conditions.  However, this isn’t always the case, and the only way to know for certain is to test the cytokines.  A few years ago such testing was more common, as some natural healthcare professionals would test the cytokines through the blood to determine if someone was Th1 or Th2 dominant and then they would recommend specific nutrients or herbs to balance these pathways.  Although some healthcare professionals continue to do such testing on their patients, this remains controversial, and isn’t as commonly practiced these days.

So how does exercise specifically affect the cytokines and the Th1/Th2 balance?  Well, exercise of moderate intensity seems to cause a slight shift towards a Th1 profile, thus reducing inflammation and reducing the risk of infections (3).  However, it appears that acute exercise, as well as chronic moderate exercise, shifts the immune response towards a Th2 profile (3) (4).  Prolonged intense exercise may shift the balance towards Th2 to an even greater extent (3) (4).

What this is saying is that short bouts of intense exercise and chronic moderate exercise slightly shifts the immune response towards a Th2 profile, and excessive exercise seems to shift the immune system balance too much towards Th2.  Since most cases of Graves’ Disease are Th2 dominant conditions, this would suggest that excessive exercise can potentially trigger Graves’ Disease in those people who have a genetic predisposition for this condition.  However, the Th1 immune response offers protection against pathogens (i.e. viruses), and so this shift towards Th2 can make the person more susceptible to an infection, which can be a factor with either Graves’ Disease or Hashimoto’s Thyroiditis.  So excessive exercise might trigger Graves’ Disease by shifting the person to a Th2 dominant state, but it also might indirectly lead to Hashimoto’s Thyroiditis by making the person more susceptible to viruses and other infections.  For example, if someone with a genetic predisposition to Hashimoto’s exercises excessively this can weaken their immune system defenses, making them more susceptible to an infection, which in turn can lead to the development of Hashimoto’s Thyroiditis.

More About Excessive Exercise and Infections

Since infections can play a role in the development of autoimmune thyroid conditions I’d like to further discuss how excessive exercise can make someone more susceptible to developing an infection.  Secretory IgA plays an important role in providing protection by binding to pathogens, including viruses (5).  In other words, it is a first line of defense against pathogens.  However, prolonged strenuous exercise can cause a decrease in secretory IgA (6), which in turn can increase the chances of the person developing an infection.

So there are two mechanisms in which overtraining can increase the risk of developing an infection, which in turn can trigger autoimmunity.  The Th1 pathway is important to help prevent someone from getting an infection, but excessive exercise can shift the immune system towards a Th2 dominant state, which will make someone more susceptible to developing an infection.  In addition, excessive exercise can also lead to a decrease in secretory IgA, which plays a big role in providing protection against pathogens, including viruses.

The Impact Of Excessive Exercise On The Cardiovascular System

Although the focus of this post is on the risks that excessive exercise can have on the immune system, and how it can potentially trigger an autoimmune thyroid condition, there are other risks of overtraining as well.  Although there is no question that moderate cardiovascular exercise has some great health benefits, and that high intensity interval training can also be beneficial, too much exercise can cause harm to the cardiovascular system.  Excessive exercise can cause oxidative stress and increase the risk of atrial fibrillation, coronary artery disease, and malignant ventricular arrhythmias (7) (8).  So while it’s important to exercise regularly, you don’t want to overdo it.

Overtraining and Adrenal Insufficiency

The chronic stress that results from overtraining can also cause problems with the adrenal glands, and can even lead to adrenal insufficiency in some cases (9).  However, it appears that excessive exercise alone isn’t the only factor, as in order for adrenal insufficiency to develop it takes a combination of chronic overtraining along with a triggering stressful event (9).  But of course many people deal with a great amount of stress in their lives, and sometimes they use excessive exercise as a way of managing their stress.  In other words, someone who is dealing with a great amount of stress might initially feel better when overtraining, not realizing that they are actually worsening their health.

How Much Exercise Is Too Much?

The question you might have at this point is “how much exercise is considered to be too much?”  Well, further research is still needed in this area, but if you are engaging in moderate aerobic activity then you should be able to hold a conversation while exercising.  However, you might not be able to hold a conversation while engaging in high intensity interval training, although you shouldn’t be working out at a very high intensity for longer than a few minutes consecutively.  Just as a reminder, high intensity interval training involves short bouts (i.e. 30 seconds to a few minutes) of high-intensity exercise separated by one to five minutes of recovery (which involves either no or low intensity exercise).  Although doing this is fine in most healthy individuals, if someone participates in continuous high intensity exercise for prolonged periods of time (i.e. five minutes or greater) then this will increase the risk of causing problems with the immune system, cardiovascular system, and possibly other areas as well.

In addition, if you have a condition such as Graves’ Disease or Hashimoto’s Thyroiditis then you probably need to be extra cautious about overtraining, and in some cases even engaging in moderate exercise can cause problems.  For example, if someone has Graves’ Disease and has an elevated heart rate, then they need to be very cautious when doing any type of cardiovascular exercise.  This might seem obvious to many people, but I have worked with patients who had an elevated heart rate who asked if it was okay to engage in high intensity aerobic exercise a few days per week.  On the other hand, while someone with Hashimoto’s Thyroiditis might not need to worry about an elevated heart rate, if they have compromised adrenals then they will want to be cautious about engaging in vigorous exercise, even if they aren’t overtraining.  I mentioned earlier how someone who engages in excessive exercise and deals with a high amount of stress has a greater risk of developing adrenal insufficiency, and so it shouldn’t be surprising that someone who already has compromised adrenals will be doing more harm than good by overtraining.

In summary, while exercising on a regular basis is important and can provide many health benefits, exercising too much can do more harm than good.  With regards to the immune system, excessive exercise can cause an imbalance of the cytokines and decrease secretory IgA, which can increase the risk of developing either Graves’ Disease or Hashimoto’s Thyroiditis.  In addition, overtraining can have a negative impact on cardiovascular health, as well as the adrenals.  And so you need to be very cautious about exercising too much, and this is especially true if you have an autoimmune thyroid condition.

Note: This is the transcript from an interview I conducted with Dr. Izabella Wentz.  Dr. Wentz is the author of the book Hashimoto’s Thyroiditis: Lifestyle Interventions for Finding and Treating the Root Cause.

Dr. Eric: Hello everyone. I’d like to introduce you to our special guest, Dr. Izabella Wentz. She is a pharmacist who has dedicated herself to addressing root causes of autoimmune thyroid disease after being diagnosed with Hashimoto’s in 2009. She’s the author of the New York Times bestseller patient guide, Hashimoto’s Thyroiditis: Lifestyle Interventions for Finding and Treating the Root Cause. And she is an ardent champion of incorporating lifestyle change and functional medicine into the treatment of autoimmune disease.

How are you doing today Dr. Izabella?

Dr. Izabella: I’m doing great Dr. Eric and thank you so much for having me.

Dr. Eric: You’re welcome, and it’s great to have you. I really do look forward to interviewing you, and before asking you some specific questions I’d like to start by having you take a few minutes and explain your thyroid story and what motivated you to write your bestselling book.

Dr. Izabella: It’s kind of a funny story because people will ask me if I always had this big interest in the thyroid and I didn’t. When I was going through pharmacy school we learned about the thyroid gland and thyroid medications but it was just something that we learned in one day.

It was basically if you have a thyroid condition you take thyroid medications and that was it. I think there was some mention about it being autoimmune but nothing else besides that. And I was commonly dispensing thyroid medications when I worked in the community pharmacy and never realized the amount of suffering and pain people went through when they actually had thyroid disorders.

So I was diagnosed myself in 2009 and at that point I was fatigued, losing my hair, having joint pains, I had irritable bowel syndrome and all of these really strange symptoms that made me feel like my life was slowly falling apart. I went from being a relatively healthy person to where slowly my health was deteriorating and I was still in my 20’s. I went to my doctor who basically told me that I was getting older and losing my memory and hair, and gaining weight, and all these other things were part of getting older. Of course, I was only 26 at the time.

I eventually kept pushing and asking questions and going to different doctors, doctor shopping and trying to get some answers for all the symptoms I was experiencing. Then I was diagnosed with Hashimoto’s. At first I was relieved because I thought “okay, I have an answer to my problem and I can start on medication and I won’t be so tired anymore, and maybe I won’t be losing my hair”. But at the same time, the medication only helped a little bit and I was also interested in figuring out what I had done to develop this condition at such a young age because I thought I was leading a really healthy life. I was eating whole grains, low fat dairy, I was exercising and not smoking or drinking and I was just shocked. I wanted to know if there were any lifestyle factors that brought this condition on and if I could do anything to reverse or slow its progression.

And that’s how I got on this journey, I wanted to figure out if there was anything I could do on my own and I started digging for some answers and some lifestyle changes. One of the first things I discovered was the gluten free diet, which can make a drastic change in people in how they feel and look, and some people can actually put their condition into remission with a gluten free diet.

We went from there and my mom saw some improvements in my health. She’s a medical doctor trained in Poland and she told me that I needed to start writing things down so we can get this information over to my cousins and family members in Poland who had also been diagnosed. That’s kind of how the Hashimoto’s Patient Guide came to be. I was writing down things, I was researching and working on this to get myself better and I’m just really glad it’s been able to help other people as well along the way.

Dr. Eric: That’s a great story, and so from what I understand you were writing the book not necessarily to write a book, but to just write your own experience to benefit others and then turned it into a book?

Dr. Izabella: That’s kind of what was happening. When I was first diagnosed I had this brain fog like a lot of people do and I would research things on the internet, I’d go to the medical journals and get all of this great information and then I would forget it the next day. So it was really important for me to keep all of these things in a central place.

So the guide was kind of my own healing guide as well, and now it’s turned into that for other people.

Dr. Eric: Fantastic! Let’s get rolling with some questions. One of the questions I wanted to ask you is if you think it’s possible for the thyroid gland to regenerate if someone is able to suppress the autoimmune component of the condition?

Dr. Izabella: Absolutely, and I’ve seen it over and over again. So in some cases when people remove the triggers and they remove the root causes, or whatever is causing their immune system to attack their thyroid gland, thyroid tissue can regenerate. The challenging thing is that in different people it happens at a different rate. So one person may go gluten free and within 3 months they may need to start reducing their thyroid medications and get completely off their thyroid medications.

I collect a lot of remission stories from people on my website and we have a few people like that who basically changed their lifestyle and were able to get off thyroid medications because their thyroid function returned. Then we have other people who will do all of the right things and will see a reduction or even a remission in their thyroid antibodies but still may require the use of thyroid medications.

I wish there was a magic formula, and I used to think that it was younger people who had the condition for a shorter amount of time that were more likely to regenerate their thyroid tissue, but I’ve also had some people in their 50’s who have had the condition for 20 years who treated an infection they had and were able to get off thyroid medication. I don’t think there are any hard and fast rules, but definitely eliminating your triggers and supporting your body will help.

Dr. Eric: I agree. You first have to find and remove the trigger. And like you mentioned, I also haven’t noticed a set pattern. It can be someone who had the condition for a couple of years and someone else who had it for 20 years. Like you said, the person on thyroid medication for 20 years might able to get off the medication, whereas the person taking it for only a couple of years might be unable to.

And the challenge too, as you know, is if even if someone thinks they only had their condition for two years, chances are they’ve had it for quite some time. It takes time for the autoantibodies to be present and most of the time, as you know, they don’t test for the autoantibodies and usually they just do a thyroid panel. And so the autoantibodies might have been present five years prior to the TSH being affected and the person went through that time unaware of the condition.

Dr. Izabella: Yes absolutely! Some things that I found to be helpful is making sure you have your ferritin levels optimized, and have your adrenals optimized so that you’re not in a fight or flight mode, and you’re in a rest and digest mode, and just making sure you’re nourishing yourself properly.

Those are the things that are going to be helpful no matter if they help you get off thyroid medication or not. But like you said, it’s hard to prove, and some people will have thyroid antibodies for 10 or maybe 20 years before they actually start seeing a change in the TSH.

Dr. Eric: Exactly. Since you’re a pharmacist I want to ask you a few pharmaceutical questions. First, do you have a preference when it comes to patients with Hashimoto’s taking Armour vs. a compounded T4 or T3 product?

Dr. Izabella: I found that most people do very well with a combination of T4 and T3, and with Armour in a very, very small percentage of people. Some people might see an increase in thyroid antibodies with Armour, and so in that case I’d recommend doing the T4 and T3 compounded medication. Then we also might have potential problems with some of the fillers used in Armour. Some of the Armour products used to be corn-based, and some people who are very corn sensitive weren’t able to tolerate it. So in that case doing a compounded T4 and T3 medication may be beneficial.

The problem with compounded T4 and T3 medications is that they have to be made by specially trained compounded pharmacists. And you want to make sure the compounding pharmacist uses something called PCCA as a starter because thyroid medications are dosed in micrograms and so that’s like 1/1000th of a milligram. Most pills out there if you take Ibuprofen or Advil that’s 200 milligrams. So thyroid medications are dosed in 1/1000th of that and so it’s really easy to get the dosage wrong if you’re not using these specific starters that have the starting material very, very diluted. So that makes it very difficult to make the dose inaccurate.

If you go to your chain drugstore, even if they offer compounding medications they may not be doing them as accurately. So I’d always recommend working with a pharmacy that uses PCCA starters. Then making sure you ask for the medication to be prepared filler-free. A lot of times they can do that for you and make it gluten, dairy and soy free. There’s also 2 different types of fillers that can be used, Avicel and Methocel. And so the Methocel is extended release and some people with gut issues, which is mostly everyone with Hashimoto’s, may have trouble absorbing that medication.

I have seen people who were put on a compounded that was a suspend or release medication and they were not absorbing any of it. I would want to make sure you talk to your pharmacist about not including any kind of fillers that might impair the absorption of the medication.

Dr. Eric: What is the best way, in your opinion, to find a doctor who is willing to prescribe either Armour or compounded T4 and T3? Because most of them will just write a prescription for synthetic thyroid hormone medication such as Synthroid. What advice can you give with regards to finding a doctor who is more open minded to prescribe either natural thyroid hormone or the compounded thyroid hormone?

Dr. Izabella: Synthroid is the direct choice when you look at all the guidelines that most endocrinologists and physicians get. They’ll say that most people will do well on Synthroid and it’s the first drug you need to prescribe. There are some concerns, and back in the day Armour wasn’t standardized correctly. This hasn’t been an issue for many years now and the Armour and all of these other medications are going to be just as safe and potentially more effective for most people with Hashimoto’s.

I actually have a kind of pharmacist trick for this. In order to find a doctor in your area who prescribes this kind of medication then I suggest people work backwards and call their local compounding pharmacy, or call their local pharmacy, and I usually recommend working with independent pharmacies because the staff and people there actually want to take the time to get to know their customers, clients and patients vs. people who work in a community pharmacy, as they’re usually much more short staffed. If you’re working with the big chain boxes like CVS and Walgreens unfortunately people there don’t have enough time to interact with their patients.

So you call and ask them for a list of doctors in the area that prescribe these kinds of medications that you’re interested in getting. That will shorten your homework and research because when you just go through your insurance you’ll get a list of doctors and then you’d have to call each one and ask them if this doctor is open to prescribing these kinds of medications. Whereas, if you go through your pharmacy you’ll get a list of doctors that the pharmacists will know are good with exploring alternative thyroid medications and not just Synthroid.

For most doctors, if they haven’t prescribed something before then they’re not going to feel very comfortable with it because it’s a liability for them. And you probably don’t want to be the first patient they try on something either. So it’s good to go to a doctor who has a lot of experience with those kinds of medications.

Dr. Eric: You make an excellent point, because most people choose a doctor based on their insurance plan, and even if they don’t have health insurance they’ll just go to a doctor who is convenient. But starting with the pharmacist is probably a good idea. Even if you called some of the offices of the doctors, the doctor won’t actually speak with you. The receptionist will probably know what the doctor prescribes, but sometimes they won’t know.

So you might have to actually make an appointment to find out that the doctor’s only going to recommend Synthroid or another type of synthetic thyroid hormone. But that’s a good point to actually contact the pharmacist first and ask them for their list of doctors who will be willing to send you back to the pharmacist, and so that’s great advice.

Dr. Izabella: Just a little trick, right?

Dr. Eric: Yes, and thanks for that. I know you mentioned Armour with the fillers, but how about comparing Armour with Nature-Throid. Isn’t Nature-Throid a little more hypoallergenic than Armor?

Dr. Izabella: Yes, and so Nature-Throid is going to be a little bit cleaner and have fewer fillers compared to Armour. Then WP Thyroid which is made by the same company as Nature-Throid is going to be even cleaner and so that will have even fewer fillers.

So some people may react poorly to one of these medications, and I always want to make sure they’re reacting to the medication and not the fillers. So if they don‘t do well on Armour then they may want to consider doing something like Nature-Throid or the WP Thyroid medication, and that may absorb better for them. But if you’re someone who has a reaction to a filler in a medication, that may prevent you from properly absorbing the medication.

Dr. Eric: Okay that makes sense. WP Thyroid…is that the same as Westhroid?

Dr. Izabella: Yes, they kind of did this weird thing where they rebranded and what not, but yes, it’s through RLC Lab and that’s the new name they’ve had for the last 2 years or so. One thing about pharmacists is we always like our old names and so it’s taken awhile for me to call it that. But that’s a medication you can get that has fewer fillers and they call it WP Thyroid. They used to call it Westhroid Pure but there was some confusion with the other Westhroid and so it’s just WP Thyroid now.

Dr. Eric: Okay. For some reason I thought the ingredients were pretty much identical with Nature-Throid and Westhroid or WP Thyroid but it’s a little cleaner according to what you’re saying. So the WP Thyroid is cleaner than the Nature-Throid?

Dr. Izabella: Yes, and so it’s got even fewer fillers, and the fewer the better is my opinion on medications.

Dr. Eric: Great, and thanks for that as well. I commonly recommend the product Thytrophin PMG to my patients with Hashimoto’s and have done so for many years. I found it interesting that you mention it in your book. I wondered if this is also something you commonly use in your practice to help neutralize the effects of the thyroid antibodies?

Dr. Izabella: Yes, I found it very helpful. I’ve seen people reduce their thyroid antibodies by taking that supplement. It’s interesting because the science behind it is kind of weird. You try to look at the description from the company and basically what it says is that it neutralizes the antibodies and it helps to regenerate thyroid tissue and then it gives basically a blueprint for what a healthy thyroid gland is supposed to look like.

I kind of thought it was a very interesting mechanism of action but that’s all I was able to find on it. I tried it myself and have had clients who have tried it and most people have reported very positive results from reducing thyroid antibodies and feeling better. What has been your experience with it?

Dr. Eric: As I said, I’ve used it for a number of years and it does a pretty good job of neutralizing the effects of the antibodies. Of course it’s not removing the trigger, which is important to mention too. And just taking the Thytrophin PMG, if that’s all you do then it might minimize the effects of the immune system attacking the thyroid gland, but you still need to change your lifestyle and diet and try to find the trigger and remove it. But I’m still using it in my practice and recommend it to many of my patients.

Dr. Izabella: Good. I like to think of it as a decoy, right?

Dr. Eric: Yes.

Dr. Izabella: To distract the immune system from your actual thyroid gland while you work on all these other things. But it’s not something, like you said, that should be used on its own. Unfortunately, if there was a magic pill that’s not necessarily it.

Dr. Eric: I agree, and it’s good that you describe it as a decoy because from what I understand that’s what it does. The immune system actually attacks the Thytrophin PMG and so it’s just taking a lot of burden off the actual thyroid gland, thus allowing the thyroid tissue to regenerate as you were talking about. Once again, we do need to focus on removing the trigger, and so thanks for mentioning that as far as a decoy goes.

Obviously Hashimoto’s thyroiditis is an immune system condition even though some people perceive it as being a thyroid condition. In your experience, on average, and I know it varies from person to person, but how long on average does it usually take to rebalance the immune system once the cause of the condition has been addressed?

Dr. Izabella: It depends on the root cause. So for example, if someone had Celiac disease and that was their root cause, sometimes they get off gluten and dairy and within 3 months they don’t have any thyroid antibodies anymore and they start feeling amazing within a few days. I think that’s one of the best case scenarios where we identify the trigger and remove it right away.

With other things it can be progressive, and so let’s say if you have an H. Pylori infection that you treat. You might see a trend in reducing thyroid antibodies over the course of a few months but might not see the full effects for a year. But I’d say for every intervention, and I even recommend people to test their thyroid antibodies on a monthly basis when they’re actively doing different interventions trying to reduce them, you should see a trend of them going down in that first month.

Dr. Eric: I agree and ideally you want to see them consistently go down. Now sometimes I do see them fluctuate, but ultimately the goal is to get them where they’re going down and, of course, are eventually normal. Every now and then there will be someone who tests negative for antibodies the first time and then when you test them again they’re positive…so that’s another thing to bring up which you’ve probably have seen as well.

My point is that you can’t just go by one single antibody test if someone has an elevated TSH they get the thyroglobulin and thyroid peroxidase antibodies and both are negative. I’m sure you’ve seen where these might present as negative but then later on are positive. Have you seen that with some patients?

Dr. Izabella: Yes, absolutely and the thought is basically the autoimmune destruction of the thyroid may still be happening without any thyroid antibodies, and so that’s kind of one part of it. Then if your immune cells are out of balance and let’s say you don’t have enough white blood cells on board because overall your immune system is suppressed then you won’t be showing as many thyroid antibodies. As you get healthier and get a healthier level of white blood cells you might actually see a higher level of the thyroid antibodies as well, which some people might think is a negative but at the same time…you want to look at the whole picture.

How is the person feeling? If a person comes to me and they don’t have any thyroid antibodies and are feeling horrible, then of course we want to look at getting them to feel better and so we’re not going to say “well, your numbers look fine so I can’t do anything else for you”. And the reverse is also true, as if they’re feeling amazing and even if we see an increase in thyroid antibodies, of course we want to monitor that but we want to make sure that overall the first goal is to get the person to feel good, to get rid of their symptoms and then working on correcting all of the imbalances.

Dr. Eric: That’s an excellent point, as you have to look at the whole picture and not just the antibodies. As you said, if someone has antibodies that are decreasing but they’re still not feeling good, or for any reason they’re feeling worse, then obviously you want to address that. You’re not just treating the blood test results but you’re helping the person, and so that’s an excellent point there.

Let’s talk a little bit about selenium now. Can you talk about selenium and how it can potentially decrease thyroid autoantibodies in some cases? Perhaps you can discuss whether the average person can get enough selenium through food, or whether they need to take selenium supplements.

Dr. Izabella: Selenium is one of those things that I recommend for just about everybody with thyroid disorders. There are multiple studies that have shown that selenium can reduce thyroid antibodies in people with Hashimoto’s, and studies have also shown a positive effect on Grave’s Disease. Additionally, selenium has shown a positive effect on pregnancy and in preventing post-partum thyroiditis after pregnancy.

The different studies seem to show there’s a magic dose of it and so that’s going to be around 200 micrograms per day. A dose of 100 micrograms doesn’t work as well, and selenium is also one of those Goldilocks supplements that if you get too much of it, it can be toxic. So I will generally recommend anywhere between 200 and 400 micrograms per day of the selenium as a selenomethionine supplement.

The studies have shown that you’ll see a reduction of thyroid antibodies by about half at the 3 month mark. So if someone had 1,000 TPO antibodies, by taking the selenium they should see the antibodies drop to about 500. Selenium deficiency has been deemed as an environmental trigger for Hashimoto’s. What’s interesting is people with Celiac disease, people with Crohn’s Disease, people with any kind of irritable bowel issues are going to have a harder time absorbing selenium from their foods. As we know, the gut and thyroid are very much connected and this is a big thing that I always recommend for just about everybody in making sure they take a selenium supplement if they develop a thyroid condition.

Most multi-vitamins are not going to contain enough selenium in them and different things can impair its absorption. I can probably talk about multi-vitamins another time, but basically you put everything in one pill and all these different nutrients interact with each other for absorption and then you don’t end up absorbing anything when you take a multi-vitamin in a lot of cases. Some things do get absorbed but selenium absorption may not happen appropriately from the multi-vitamin.

I usually recommend taking the selenium supplement on an empty stomach in the morning. You do want to space your thyroid medications by about 30 minutes if you take those. What I’ve seen with clients is a lot of times they’ll say they feel a lot less anxious and their mood is going to be improved once they start taking a selenium supplement. If they’re monitoring their thyroid antibodies they’re going to see a reduction in their thyroid antibodies with that.

Another interesting thing to note that I just learned a couple of years ago is that gluten free diets, which are of course another big recommendation for people with Hashimoto’s, may make a person deficient in selenium as well. Some of the richest sources of selenium may include grains, as well as Brazil nuts. I know a lot of people have said they’ll take Brazil nuts to get their daily selenium dosage, but the only issue with that is that the content of the selenium in the Brazil nut is going to depend on where the Brazil nut was grown. If it was grown in a selenium rich soil it’s going to have more selenium, and if it’s grown in a soil that doesn’t have enough selenium then it’s not going to have an adequate dose of selenium. So people can actually under or over dose themselves with Brazil nuts given that we really don’t know how much selenium is in them.

A lot of times I’ll say to try to get most of your nutrients from food, but with selenium, because it’s such an important nutrient for thyroid function and because it has a neuro therapeutic index I’ll say skip the Brazil nuts and take a selenium supplement.

Dr. Eric: To summarize you said the average dosage would be between 200 and 400 micrograms. Is that correct? And then selenomethionine is typically what you recommend?

Dr. Izabella: Yes, that’s usually going to be my recommendation. Most people will do very well with that and the only exception is if someone is both iodine and selenium deficient, which is not very common, but selenium deficiency might exacerbate an iodine deficiency and so that would be the only thing.

So if you’re someone who reacted poorly to a selenium supplement and probably out of 1,000 people I’ve seen maybe one person like that, then there is a potential you may be iodine deficient.

Dr. Eric: I also found it interesting that you recommend taking it on an empty stomach because usually I recommend taking it with food. So I need to test it on an empty stomach with my patients and see if there’s a difference with the effectiveness. So you said to take it in the morning without food, such as a half hour after thyroid medication if they’re taking thyroid medication?

Dr. Izabella: Yes. I used to recommend it with thyroid medication and I had a couple of people, and I don’t know if their selenium had some calcium in it, the supplement they were taking had calcium and then that person reported that their TSH numbers got a little off balance. Now I recommend spacing it out about 30 minutes from the thyroid medications just to be sure. Thyroid medications are very finicky with absorption.

Dr. Eric: I agree with spacing it out and not taking with the thyroid medication. I haven’t given it to my patients on an empty stomach and so it’s something I’m going to test and see.

Dr. Izabella: Okay.

Dr. Eric: So just to clarify, if someone is on thyroid hormone medication you have them wait a half hour, they take selenium and then do you have them wait another half hour until they have breakfast?

Dr. Izabella: Basically, first thing when you wake up you’d take your thyroid medication and then you’d wait about 30 minutes to take your selenium and then wait another 30 minutes. I used to also recommend just waiting 30 minutes for thyroid medication but I found that not most people, but a lot of people actually need that hour before starting to eat because, like we said, thyroid medication can be finicky with their absorption.

Dr. Eric: Let’s talk about goitrogenic foods. Do you believe that people with Hashimoto’s should completely avoid goitrogens such as soy, and other goitrogens such as cruciferous vegetables?

Dr. Izabella: That’s such a great question and it’s one of those myths I like to bust. The word goitrogen is an old kind of word and it’s used to describe basically things that can enlarge the thyroid gland, but it can be done by a lot of different mechanisms.

Unfortunately, they’ve put these wonderful Brassica vegetables into this category like broccoli and cauliflower. A lot of people with thyroid disease think they can absolutely not have any broccoli which isn’t true. Basically, there’s a compound in these vegetables that could potentially interfere with iodine absorption into the thyroid gland. Well, if people are already taking thyroid medications or they have Hashimoto’s, iodine deficiency is sometimes the root cause, but in most cases it’s not. So usually eating these vegetables is not going to be an issue for most people.

I’ve just done a survey of about 2000 people with the kinds of foods they react to and what kind of reactions they were having with their foods. There was a huge percentage of people who reacted to gluten and dairy and soy and those kinds of foods, but as far as broccoli and cauliflower and foods like that, very few people reported that they actually reacted to those foods.

What I would suggest is that if someone isn’t on thyroid medication and is subclinical hypothyroid and maybe has an iodine deficiency, they may find that these vegetables slow things down for them a little bit more. So in that case you would just have to see them to break down the goitrogenic compound. But other than that, most people with Hashimoto’s can eat plenty of veggies. And so eat plenty of broccoli and cauliflower, raw or steamed or whatnot, it will be helpful with detoxification.

The only exception, of course, is soy. Soy works as a goitrogen because of a different mechanism, and so it interacts with thyroid peroxidase. They did studies in children who were fed a soy formula instead of breast milk and found these children were more likely to develop thyroid antibodies later on in life. So soy has been connected to Hashimoto’s and potentially inducing Hashimoto’s. So that’s one thing I definitely recommend avoiding.

In contrast, things like dairy or gluten, where people will often feel it in their stomach or gut when they eat this food. You may not have that kind of reaction to soy, but a day or two later after you eat it you might feel a little edgy or feel really tired. That’s because of its way of acting on the thyroid gland. So for most people with Hashimoto’s I recommend staying away from soy.

Dr. Eric: Yes, I agree. A few years ago I actually wrote some articles talking about goitrogens and I was telling people to minimize their consumption of goitrogenic foods. But that was not due to any research I did, but was based on information I learned from nutritional conferences I attended, and people who I perceived as being experts in thyroid health telling their patients not to eat goitrogens.

But then the more research I did and have done over the years I just realized that pretty much all of the studies have been on animals with regards to cruciferous vegetables, and usually involve large doses. Every now and then you’ll get a person who says when eating broccoli their thyroid swells. And like you said, if someone notices a difference they might want to ease up, but these are very healthy foods. So to deprive people of broccoli, kale and cauliflower… I think most people can definitely eat these foods without a problem.

And with soy, besides the goitrogenic properties, most soy is genetically modified. But even if you’re consuming non GMO fermented soy you still have to deal with the goitrogenic properties, and it also has some anti nutrients which also is a factor. So I agree with you about trying to not eat, or to limit the consumption of soy. Thanks for sharing that.

You’ve mentioned iodine a few times briefly so I want to talk a little more about iodine as far as some of the risks and potential benefits of iodine intake, and whether you think people with Hashimoto’s should completely avoid iodine, or if taking a small amount of iodine is okay.

Dr. Izabella: Wow we’re covering all the myths and controversies today. With iodine I know there are a lot of advocates out there who will say that high dose iodine can be very, very helpful for every thyroid disorder. I’m not going to disagree with that. I think everybody has to do what’s right for them, and iodine can help people with thyroid disorders.

The issue with Hashimoto’s, however, is that your thyroid gland, which is supposed to process iodine, is actually impaired. So when you give a person with Hashimoto’s who has an inflamed thyroid gland more work to do by giving it more iodine that can cause further inflammation.

In surveying my clients and readers about this…I’ll give you an example. About 80% of people said that going gluten free made them feel better and nobody said it made them feel worse. With high dose iodine I had about 25% of people saying it made them feel better and then 25% of people said it made them feel worse. So it’s kind of dangerous, I think, to be recommending it when you don’t really know and are just playing a guessing game, because for some people it may help them feel better and it may help especially if they’re iodine deficient and so you give them a high dose and it may actually make them feel better.

But then you have the other half of the people, which happen to be a lot of clients I’ve seen and I always try to recommend something safe first and safety is always my big thing. Let’s make sure everything is safe. And I’ve had clients who on their own or working with other practitioners they took very high doses of iodine and some had their thyroid antibodies skyrocket, going from a 200 or 300 range to the multiple thousand range. One woman’s TSH jumped to 98 and her T4 was at like zero, believe it or not, and she was bedridden because of the high dose of iodine.

I get super nervous about it, about these high doses of iodine, and studies have shown that it can accelerate thyroid tissue damage. On the other hand, the dosages you would get in a multi-vitamin is something like 150 micrograms. These dosages will actually be safe for most people with Hashimoto’s and will be helpful and they haven‘t shown any increase in thyroid antibodies when you just take a very tiny low dose of 150 micrograms per day, which is the recommended daily allowance.

Other studies have shown that people who actually go on an iodine restriction with Hashimoto’s may be able to improve their thyroid function as well. Where I am with that is for most people I’ll recommend working on these. I usually try to work on the things I know are very safe and very effective like the gluten free diet. Then if we’re still working with some of these issues then we may recommend a multi-vitamin. If someone has been on this super high dose iodine then I may recommend that person to just try to repair the damage and get off iodine for a short term period.

I wish I had a straightforward answer to say this is what we do every single time, but it’s not always so easy, and as you’re well aware there are a lot of different nutrients that act in synergy with one another. I always want to make sure everyone has their selenium on board, they’ve got their B vitamins and vitamin C on board and all these other things before we move on to the iodine. And iodine wouldn’t be a first level recommendation, it would be something like…okay we’re still struggling and we did this gluten free diet and we tried to address any infections and we’re still struggling…what else can we do?

But that is my stance in a nutshell for Hashimoto’s.

Dr. Eric: That’s great. I’m probably more pro iodine than you, but I’m also cautious with iodine, and I agree with you that some healthcare professionals will recommend high doses of iodine to all of their patients, or some people will take on their own a 50 milligram tablet of Iodoral daily without any testing. Some people will do fine, but some people don’t do well, and there’s really no way to predict who will do well and who won’t, and so I am cautious. And when I do recommend iodine I recommend testing, and even if someone is deficient I’ll recommend smaller doses and not have someone start out with very high doses. I usually don’t ever have people reach that high of a dose as I just mentioned such as 50 milligrams. So thanks for sharing that with us.

Alright, the last question I wanted to ask has to do with some of the common infections you see with your patients.

Dr. Izabella: For me, when I think about Hashimoto’s in general it’s in two parts, and one part is that your body is in a weakened state because maybe you’re nutrient deficient and/or maybe you’re eating foods you’re reacting to. Or maybe you’re under a lot of stress, or maybe you’ve been exposed to toxins, and that’s one thing that a lot of the lifestyle factors can address by getting you the right nutrients, getting you on the right diet, by taking supplements or doing some detoxifying.

The other part is the chronic infections. There’s a theory of autoimmunity called Molecular Mimicry where basically what is happening in very simple terms is that the immune system begins to recognize our thyroid glands as a foreign invader because there’s something else in our body that has invaded our body that looks similar to the thyroid gland. So different bacteria, viruses, potentially parasites might have protein structures that are similar to the thyroid gland, and so as the immune system… I like to think of it as walking around with a little IPhone and it takes a little picture of the protein sequence and then when it sees a similar protein sequence it will start attacking.

So there are a few different infections that have been identified as having a similar sequence to Hashimoto’s. H. Pylori and Yersinia are similar to the thyroid gland and have been identified. The most common infections that I’ll see are going to be H. Pylori, Epstein Barr Virus, and then parasitic infections in the gut. And so blastocystis hominis is a very common one too.

What we’ll find a lot of times is when you identify and treat that infection the person will feel better and in some cases they will see a reduction in thyroid antibodies and in some cases you’ll see the person going into remission. Those are the most common infections and I recommend doing stool testing. There is a company called BioHealth Labs that does the H. Pylori test and they also test for blastocystis hominis and you can have your doctor run a Epstein Barr virus panel. Most people have had Epstein Barr virus infections but they can become reactivated in people with Hashimoto’s and sometimes can keep the autoimmune response happening when they’re infected with that.

But research has connected so many different infections, and many are looking for that one infection, but it’s not always that one infection. I think it’s a combination of genes and maybe not having the right kind of natural flora, and the infection will determine what kind of disease you get.

Dr. Eric: With the stool testing, especially for parasites, do you typically have patients collect a stool sample on multiple days, such as collecting 3 or 4 different stool samples to increase the accuracy?

Dr. Izabella: Yes, that’s a really important question because a lot of times people will say I had a stool test and it was negative and they may have just had one stool test. The important thing to note is that the parasites may not shed in every stool or in every bowel movement, so the more stool samples you do the better your chances are at catching the parasites. So I actually recommend doing at least 4 stool samples on 4 consecutive days. You can also half that by doing it over 8 days where you put a little bit of a stool sample into each vial where you put 2 days worth of stool into one vial and that way you have a higher likelihood of potentially picking up the gut parasite.

I know this sounds nasty and gross and I didn’t want to believe it myself because we think we live in the Western world and we don’t have these kinds of things but it’s very common in people to have gut parasites and gut infections. They can then lead to all kinds of problems such as irritable bowel syndrome and having multiple food sensitivities, which then increases the antigenic load in Hashimoto’s.

Dr. Eric: Okay. One last question relating to the infections: do you take more of a natural approach, or do you prefer antibiotics, or does it depend on what type of infection?

Dr. Izabella: I’d say it depends on the person and it depends on the infection too. So whenever I write about it or I talk to clients about it I always want them to work with their own physicians and healthcare practitioners and I’ll give them a list of recommended therapies. So you may take a medication and then follow it with herbs, or you may take just the medication or just the herbs. I just give people some information on what some of the more effective ones that I know of and let them take this information to their doctor and make the decision on their own, because some people feel much more comfortable with antibiotics and others don’t feel comfortable with them at all. And there are certain infections that may not be susceptible to herbs, or it may take a really long time to eradicate them the herbal way of 2 to 3 months vs. 2 to 3 days on a medication.

So it’s different drugs for different bugs as I like to think of it.

Dr. Eric: I like that. Different drugs for different bugs. Thanks Dr. Izabella for answering these questions and I’m sure everyone found this information to be useful.

What I’d like you to do now is take a few minutes and talk about your excellent book, Root Cause. I’m sure many people reading this blog post have already read it, but I’m sure there are some who haven’t read it. So if you can talk a little bit about your book.

Dr. Izabella: Sure, and I think it has the longest title ever. It’s called Hashimoto’s Thyroiditis: Lifestyle Interventions for Finding and Treating the Root Cause. It’s available on Amazon. If you look for Hashimoto’s Root Cause or Izabella Wentz you’ll find it.

Basically it’s a patient guide to help people find out what the root causes and triggers may be and it gives people information on lifestyle changes they can start implementing on their own. So supplements they can take and different nutritional things they can do on their own, as well as more information so they can take it to working with doctors like yourself.

I think it’s really important for people to be empowered and be their own health advocates and be on board with what’s happening within their own bodies. And working with a physician is excellent but you don’t want the change to come from you because you can tell a person what to do and you have all this wonderful knowledge and experience with patients over so many years, but it’s really up to the patient to do it right in many cases.

Dr. Eric: Yes.

Dr. Izabella: To change their diets, to take that supplement and take that test. So the Patient Guide is all about how to figure out what’s going on with your body and the things you can do on your own to get yourself better.

I have a website too and its www.ThyroidPharmacist.com and I have lots of great information on there. I try to write a new blog post every week. I’m a big research nerd and so I’m always researching different types of infections and different root causes. As we both know, it’s not always the same thing for every person that triggers their Hashimoto’s but at the same time there are a lot of universal things that we can recommend that will help most people feel much better.

Dr. Eric: Great, and for anyone listening who hasn’t read her book I would definitely get it. I’m not saying that just because I’m interviewing you, but it is one of the best books I’ve ever read on Hashimoto’s. It’s one of those must reads for anyone with this condition.

Dr. Izabella: Thank you so much for that. I forgot to mention I also have a free book chapter if people go to www.ThyroidPharmacist.com/gift they can get the Nutrient Depletions and Digestions chapter and get a gluten free quick start diet as well as some recipes. When I first tried to go gluten free I did it all wrong. I was eating all this junk food and setting my blood sugar on fire.

Thank you so much for having me and I hope everybody found this information helpful.

Dr. Eric: Great and thank you again Dr. Izabella for sharing this information. Again, visit ThyroidPharmacist.com/gift for the free chapter in her book and ThyroidPharmacist.com for the weekly blog post. Then go to Amazon if you want to read the book which I highly recommend.

Again, thanks again for doing this interview. I thought it was great and I’m sure everyone has benefited from this information.

Dr. Izabella: Thanks so much Dr. Eric.

Dr. Eric: Thank you.

When someone gets a dental implant, it is commonly made out of titanium.  And titanium is also used in other procedures, as some hip replacements use titanium alloys.  While many people with these implants seem to do fine, some people have asked whether titanium can be a trigger for Graves’ Disease, Hashimoto’s Thyroiditis, or another autoimmune condition.

Before I answer this, you might wonder why titanium is commonly used in the first place.  One reason why it is commonly used is due to its high resistance to corrosion (1), which obviously is very important.  Another reason is because most people seem to have a low sensitivity to titanium when compared to other metals.  In fact, one study showed that all casting alloys seem to have a potential for eliciting adverse reactions in individual hypersensitive patients, although it listed titanium as being a possible exception (2).  However, as I’m about to discuss, some people do in fact react to titanium, and of course this can be a big problem for someone who has a dental implant, or titanium as part of a hip or knee replacement.

Why Is Titanium Problematic In Some People?

Although most people don’t have a problem with titanium implants, a small percentage of people are sensitive.  A clinical study involving 1,500 people who received dental implants showed that nine of these patients demonstrated a titanium allergy (3).  The good news is that only 0.6% of these patients experienced problems with the dental implants.  On the other hand, if titanium can lead to certain chronic health conditions, then even a small percentage o f negative reactions might be too high.  Another study involved fifty-six patients who developed clinical symptoms after receiving titanium-based implants, and 21 of these tested positive for a titanium allergy, with another 16 showing ambiguous results (4).  Sometimes someone will experience symptoms caused by these implants but they won’t make the connection, and many times their doctors also won’t be able to figure this out..

For example, a few years ago it was revealed that the actor Dick Van Dyke had experienced severe headaches which affected his sleep and caused chronic fatigue.  Over a seven year period he saw numerous healthcare professionals, received a CAT scan, MRI, and a spinal tap, along with other tests, but everything came back negative.  It wasn’t until his dental implants were removed that he finally received relief from his symptoms.

Once again, most people do fine with titanium implants.  But these patient experiences I mentioned show that in some cases, titanium can lead to severe symptoms.  In some cases the symptoms can be debilitating.  And many times people live with these symptoms for years before it is figured out that the problem is due to titanium.

Can Titanium Trigger Autoimmunity?

There is no concrete evidence that having titanium implants can trigger an autoimmune response.  However, this doesn’t mean that it’s not possible, as other metals such as mercury and nickel have been associated with thyroid autoimmunity (5) (6).  As a result,  if someone with Graves’ Disease or Hashimoto’s Thyroiditis was diagnosed with their condition after getting an implant which consisted of titanium, then this is a factor that should be considered.  Of course it can be difficult to make such a connection, as someone can be in the “silent” autoimmune stage for years, which means they might have elevated antibodies for many years, yet no positive tests or symptoms.  As a result, even if someone with an autoimmune thyroid condition began presenting with symptoms shortly after getting a titanium implant, this doesn’t necessarily mean the implant was responsible for the development of their condition.  With that being said, if you have a titanium implant and then developed an autoimmune thyroid condition, then it might be worth doing some testing to see if you have a sensitivity to titanium.

What Other Options Are There?

Before someone gets a dental implant, or a hip or knee replacement which involves titanium, it probably would be a good idea to get a metal allergy assessment along with some allergy testing.  Skin testing is an option, as the sensitivity of patch tests has been shown to be about 75% for a type IV metal allergy, although so far no study related to dental implant allergies has used this method (7).  A lymphocyte transformation test is another option, although false-positive results are possible (7).  There is also a Memory lymphocyte immuno-stimulation assay (MELISA) test (8), which can determine if someone has an allergy to a metal such as titanium.  In my opinion it should be routine to get such testing before getting a metal implant.

Another option is to use something else other than titanium.  Zirconia is a ceramic and is an option to consider.  It has been used to replace hip joints, and can also be an option to consider with dental implants.  However, even though one is less likely to be sensitive to zirconia, a sensitivity is still possible.  But if I were getting a dental implant I probably would choose a zirconia implant over a titanium implant.

In summary, although many people do fine with titanium implants, there are some people who have a titanium allergy.  And in some cases titanium can cause severe symptoms.  Although there is no research which shows that titanium can trigger an autoimmune thyroid condition such as Graves’ Disease or Hashimoto’s Thyroiditis, if someone received a titanium implant and then developed an autoimmune thyroid condition, it might be a good idea to do some testing to see if they have a sensitivity to titanium.  For those who are sensitive, zirconia can be an alternative option to consider.

Millions of people have thyroid and autoimmune thyroid conditions, and while most of these people won’t consider natural treatment methods, more and more people are choosing a natural treatment approach.  But sometimes it can be confusing to know what type of healthcare professional you should see for your condition.  And so the goal of this post is to discuss the different types of healthcare professionals so that you can be better informed when choosing one to help restore your health.

Before I discuss the different types of natural healthcare professionals I want to mention a few things.  First of all, you ideally want to work with someone who has a lot of experience with thyroid and autoimmune thyroid conditions.  This is especially true if you have hyperthyroidism or Graves’ Disease, but it’s also a good idea for those with hypothyroidism and Hashimoto’s Thyroiditis.  Although some “general” practitioners can help people with these conditions, autoimmune thyroid conditions can be very complex at times.  It can even be challenging for someone like myself who focuses on these conditions, let alone a healthcare professional who sees someone with an autoimmune thyroid condition every now and then.

How Can You Find A Natural Healthcare Practitioner Who Focuses On Thyroid Health?

But how can you know for certain if someone is an expert in thyroid and autoimmune thyroid conditions?  Well, there are a few different ways to find out.  One way is to simply call the office and ask the staff person to name the top three conditions the doctor focuses on.  If one of these conditions isn’t thyroid or autoimmune thyroid conditions then I would call another office.  Another option is to do a Google search for the doctor’s name and check out his or her website to see if they really do focus on thyroid conditions.  Keep in mind that just because they have a website which focuses on thyroid health doesn’t mean their entire practice focuses on this condition, as some healthcare professionals will have multiple websites, each focusing on a different condition.

So for example, if you visit Google and type in “Eric Osansky” or “Dr. Eric Osansky”, pretty much everything will relate to thyroid health, as on the top of the page the website www.naturalendocrinesolutions.com will be listed, my book on hyperthyroidism and Graves’ Disease should be there, etc.  And if you call my office and ask either of my assistants Cindy or Kate which condition I focus on they will say thyroid conditions.

Also, if you have hyperthyroidism or Graves’ disease it will be more challenging to find a natural healthcare professional who has a lot of experience working with hyperthyroid conditions.  It is far more common to find someone who has experience working with hypothyroidism and Hashimoto’s Thyroiditis.  And the reason for this is because many natural healthcare professionals are uncomfortable working with people who have hyperthyroid conditions due to the high pulse rate and heart palpitations most people with hyperthyroidism experience.

With that being said I’d like to go ahead and discuss some of the more common natural healthcare professionals to choose from:

Medical doctor who practices functional medicine.  The main advantage of working with a medical doctor who practices functional medicine is that they are able to prescribe medication.  So for example, if someone with hypothyroidism prefers to take natural thyroid hormone medication and their endocrinologist is unwilling to prescribe this, many medical doctors who practice functional medicine are willing to write a prescription for Armour or Nature-Throid.  With regards to hyperthyroidism and Graves’ Disease, even though a medical doctor who practices functional medicine can prescribe antithyroid medication and/or beta blockers if necessary, many will feel uncomfortable working with hyperthyroid cases and will insist on the person working with an endocrinologist.

Another advantage of working with a medical doctor who practices functional medicine is that they are usually more open to doing things to address the cause of the condition.  Whereas most medical doctors won’t even want to talk about nutrition, a medical doctor who practices functional medicine will usually encourage you to eat well, will give dietary suggestions and supplement recommendations, and will give other lifestyle recommendations to help improve your health.  Yet if they feel that medication is necessary they have the ability to prescribe what you need.  For example, if someone has a severe Candida infection they can prescribe an antifungal medication such as Nystatin, and at the same time give dietary recommendations and other advice to help address the cause of the problem.

However, there are a few potential downsides of working with a medical doctor who practices functional medicine.  First of all, just because they claim to practice functional medicine doesn’t mean they truly do so.  For example, a doctor might have attended a few functional medicine conferences and as a result labels themselves as a functional medicine practitioner, even though they don’t have much experience practicing functional medicine.  Finding a medical doctor who has gone through a functional medicine certification program will make it more likely that he or she is truly a “functional medicine practitioner”.  However, even this doesn’t guarantee that the doctor will be competent in functional medicine, as while passing a certification exam is great, the real knowledge is gained by applying what they learned in their practice.  In fact, while I’m proud of the degrees and certificates I have obtained, the only way someone is going to become truly competent is not by obtaining degrees and certifications, but by applying what they learn in practice.

Another potential downside is that some medical doctors who practice functional medicine rely too much on prescription medication.  Remember that many of these medical doctors were practicing conventional medicine for many years before they decided to learn about functional medicine.  While it’s fine to prescribe thyroid medication and other types of drugs when necessary, some medical doctors will recommend prescription drugs more frequently than they should.  Although one of the main benefits of working with a holistic medical doctor is that they can prescribe medication if needed, you of course want to make sure they try to address the cause of the problem, and not just recommend a different drug for each symptom that you have while making a few natural recommendations.

Naturopath.  Out of all of the different types of natural healthcare professionals, naturopaths who have attended an accredited naturopathic college are the most prepared to help people naturally upon graduating from school.  Most medical doctors don’t learn about nutrition and functional medicine while in medical school, as they need to learn this information after graduating.  Chiropractors do learn some nutrition while in chiropractic school, but in most cases it’s not comparable to the training received by naturopaths.  This isn’t meant to be a knock on chiropractors, as most people reading this know that I’m a doctor of chiropractic, and I’ll be talking more about chiropractors next.

But getting back to naturopaths, if you can find one who has a good amount of experience working with thyroid and autoimmune thyroid conditions then this can be a very good option.  And for those with hypothyroid conditions, in some states naturopaths are able to prescribe thyroid hormone medication.  This of course is great for those who need to take thyroid hormone medication, as if they are able to see a naturopath who can prescribe thyroid hormone medication then they don’t need to see two separate doctors.  In fact, if given the choice between seeing a medical doctor who practices functional medicine and a naturopath, both who have been in practice for an equal amount of years, in most cases I would go with the naturopath.

However, this doesn’t mean that all naturopaths are competent with regards to thyroid and autoimmune thyroid conditions, or other types of conditions.  For example, a few years before I began focusing on thyroid and autoimmune thyroid conditions I had hired a recent graduate of an accredited naturopathic college (Bastyr University) to help me with the nutritional aspect of my practice.  At the time she was more competent than me with regards to nutrition, but her lack of experience showed.  Obviously everyone has to start somewhere, as the only way to get experience is to actually work with patients.  And so I’m not suggesting that someone who recently graduated from naturopathic school can’t help a person with a thyroid or autoimmune thyroid condition.  All I’m saying is that many times experience does matter.

Chiropractor.  As I mentioned earlier, while chiropractors take some nutrition classes in chiropractic school, they don’t graduate with the same amount of knowledge in nutrition and herbal medicine as naturopaths.  This isn’t surprising, as a chiropractor’s main focus is to balance the nervous system by correcting vertebral subluxations.  However, a lot of chiropractors improve their knowledge of nutrition and functional medicine upon graduating.  And so while in most cases they don’t have the same amount of knowledge as a naturopath upon graduating from chiropractic school, they do have more knowledge in nutrition than most medical doctors.

However, many practicing chiropractors will attend nutritional seminars, and they might sell supplements in their practice, but some don’t really have a good understanding of nutrition and functional medicine.  Don’t get me wrong, as there are some chiropractors who have a great deal of knowledge and experience in nutrition and functional medicine.  But many will learn the information without applying it in practice.  In fact, some chiropractors will attend nutritional seminars mainly to fulfill their continuing education requirements, even though they don’t utilize much nutrition in their practice.

In addition, while some chiropractors like myself do have a lot of experience working with thyroid and autoimmune thyroid conditions, other chiropractors have “thyroid websites”, but don’t have much experience working with people who have thyroid conditions.  In other words, some chiropractors have a main practice website, but then have a separate “thyroid health website” which gives the impression that their practice focuses on thyroid conditions.  But if you were to call the phone number listed on their main website and ask the receptionist to list the top three conditions the chiropractor focuses on, there is a very good chance that “thyroid conditions” won’t be one of them.  And so you need to be careful, as some people have paid a lot of money for “thyroid programs” by chiropractors who didn’t have much experience working with thyroid conditions.

Once again, there are chiropractors who truly do have a lot of experience working with thyroid conditions.  And so I’m not suggesting that every chiropractor with a “thyroid health website” isn’t truly a “thyroid expert”.  All I’m saying is that you need to do your research, and while someone who is very knowledgeable about thyroid health might be able to do a good job of screening natural healthcare professionals to determine who truly has experience working with thyroid conditions, many people aren’t able to figure out the difference between an expert and an amateur.

Different type of natural healthcare professional (i.e. acupuncturist, etc.).  Other types of natural healthcare professionals can also be competent with regards to thyroid health.  For example, some acupuncturists are more knowledgeable than holistic medical doctors and chiropractors with regards to nutrition and functional medicine.  And so just because someone isn’t a doctor doesn’t mean they don’t have the knowledge and experience to help you.  The challenge is finding out whether the person is truly competent.

Credentials Are Important, But Experience Is Even More Important

When I first began helping people with thyroid and autoimmune thyroid conditions, the only credentials I had was being a doctor of chiropractic.  And as I mentioned earlier, just being a chiropractor doesn’t mean that someone is competent in nutrition and functional medicine.  At that point most of my knowledge was obtained through my own personal experience with an autoimmune thyroid condition, along with attending nutrition seminars and conferences, but over the years I felt it was important to obtain additional degrees and certificates related to nutrition and functional medicine.

But even though having numerous degrees and certifications looks impressive to some people, it really is the experience that matters the most.  While I have learned a great amount of information getting my degrees, certifications, and attending seminars and conferences in nutrition and functional medicine, applying this information over the years is what has made me competent.  In other words, while it’s great to learn new information, the information is much more valuable if you apply it in practice.

For example, every now and then a patient will ask me about essential oils, and I admit that this is an area where I’m not competent in.  I did attend an essential oils summit recently, but even if I went through an “essential oils” certification program this still wouldn’t make me “competent”, although it probably would greatly increase my knowledge on the topic.  But in order to truly become competent I would need to start taking essential oils and recommending them to my patients, and then over a period of months and years I would become more and more competent in this area.

And the same concept is true with regards to nutrition, Chinese herbs, functional medicine, etc.  While there are plenty of books, seminars, and even certification programs on these topics, one doesn’t actually become competent until they have applied in practice what they have learned over a period of months and years.  So when choosing a natural healthcare professional for your thyroid or autoimmune thyroid condition, while it’s understandable to choose someone based on their credentials, you ideally want to make sure to choose someone who has a decent amount of experience helping people with these conditions.

Eggs are very nutrient dense.  As a result, if someone likes to eat eggs and can eat eggs without a problem then it makes sense for them to eat eggs.  However, eggs are not part of an autoimmune paleo diet, which would suggest that those people with autoimmune thyroid conditions such as Graves’ Disease and Hashimoto’s Thyroiditis should avoid eating eggs.  But why is this the case, and does this mean that people with these conditions need to avoid eggs while trying to restore their health back to normal?

Before answering this question, let’s look at the reasons why eating eggs might cause problems in some people with an autoimmune thyroid condition, as well as those people with other autoimmune conditions.  First of all, regardless of whether someone has an autoimmune condition or not, eggs are a common allergen.  However, most egg allergies are in infants and young children (1) (2), although overall most infants and children don’t have egg allergies.  Keep in mind that there is a difference between a true egg allergy and an egg sensitivity.  An egg allergy is usually IgE-mediated, but it’s usually not as serious as other IgE-mediated allergies such as peanuts.

Whereas IgE-mediated allergies are immediate, IgG egg sensitivities involve a delayed reaction.  What this means is that if someone has an IgE-mediated egg allergy and eats an egg, they will experience a reaction almost immediately.  On the other hand, someone with an IgG-mediated egg sensitivity can take a few hours or even a few days before having a negative reaction.  And just because someone experiences a “negative reaction” doesn’t mean they will present with overt symptoms.

Why Eating Egg Yolks Might Be Better Than Eating Egg Whites

In addition to someone having a possible egg allergy or egg sensitivity, there are compounds in egg whites which can have a negative effect on gut health, specifically a protease called lysozyme.  Sarah Ballantyne, author of the excellent book “The Paleo Approach”, has an article on eggs which discusses the problems with lysozyme.  Lysozyme is a proteolytic enzyme with 129 amino acid residues, and it’s also produced in mucosal secretions such as saliva and tears (3).  In her article, Sarah explains how “lysozyme has the ability to form strong complexes with other proteins”, and how it is “resistant to digestion by our digestive enzymes”.  She also explains how when lysozyme passes through the intestinal barrier, other proteins can bind to it and pass through into the blood stream, where they shouldn’t be, and therefore can trigger an immune system response.  So essentially the problem isn’t with lysozyme itself, but the protein complexes it forms, which in turn pass through the cells of the small intestine.  Another disadvantage of egg whites is that it has a glycoprotein called avidin, which binds to biotin and can prevent its absorption (4) (5).  However, this is only an issue when eating raw egg whites.

Although eating egg whites can be problematic due to the reasons just given, some people with autoimmune conditions such Graves’ Disease and Hashimoto’s Thyroiditis are able to eat egg yolks without a problem.  The reason is because while some people still might have a sensitivity to egg yolks, the yolks don’t have compounds which will have a negative effect on gut health.  As a result, if someone doesn’t have an egg allergy or sensitivity then they might be fine eating egg yolks, although they might not do well eating egg whites.  I usually recommend for my patients with autoimmune thyroid conditions to completely avoid eggs while trying to restore their health, but if someone is struggling with the diet after one or two months I’m usually fine with them reintroducing eggs.  As long as their health continues to improve then of course I have no problem with them continuing to eat eggs.  And based on the information I presented in this post it might be best to start with egg yolks, although I’ve had patients eat the egg whites as well and still do fine.

Can One Test For An Egg Allergy or Sensitivity?

Some people reading this might wonder if they can simply do a test to see if they have an egg allergy or sensitivity.  Without question this is possible, and if someone tests positive for an egg allergy or sensitivity then it probably is a good idea for them to avoid eggs.  However, just keep in mind that even if someone tests negative for a food allergy or sensitivity, besides the fact that false negatives are always possible, one also needs to keep in mind that the compounds from egg whites can still have a negative effect on their gut health.

To try to make this easier to understand I’m going to briefly talk about almonds, which is another whole food that is excluded from an autoimmune paleo diet.  Almonds (along with other nuts) can cause problems in those with an autoimmune condition because they have compounds (lectins and phytic acid) which can have a negative effect on gut health.  As a result, it doesn’t matter if someone with Graves’ Disease or Hashimoto’s Thyroiditis has an allergy or sensitivity to almonds, as if they are trying to follow a strict autoimmune paleo diet then they should avoid eating almonds, along with other nuts and seeds.  Yes, I realize that soaking and sprouting nuts and seeds will help to reduce the negative impact these foods will have on the gut, but my point is that with both eggs and almonds, while it is possible to do IgE and IgG food allergy/sensitivity testing, a negative result doesn’t mean that the person with an autoimmune thyroid condition can safely eat these foods.

What’s The Final Verdict On Eggs and Thyroid Autoimmunity?

Just in case you’re still confused over whether or not you should eat eggs, I’ll give a brief summary of what I have stated so far.  Even though eggs are nutrient dense, they are a common allergen, and the egg whites have compounds which can have a negative effect on gut health by increasing intestinal permeability.  Because of this, eggs are not part of an autoimmune paleo diet.  As I’ve discussed in past articles and blog posts, some researchers speculate that everyone with an autoimmune condition has a leaky gut, and while this is controversial, if someone with Graves’ Disease or Hashimoto’s Thyroiditis is looking to restore their health then it might be best to avoid eggs until their health improves due to the reasons I mentioned earlier.

However, I also spoke about how some people with autoimmune thyroid conditions might be fine eating egg yolks while avoiding egg whites.  And the reason for this is because while egg whites have compounds which can have a negative effect on gut health, this isn’t the case with egg yolks.  As a result, if someone is following an autoimmune paleo diet and decides to reintroduce eggs, it might be best to start by reintroducing egg yolks.  As I briefly mentioned earlier, I have had patients who reintroduced the entire egg (both egg yolk and egg white) into their diet and their health still improved, which proves that everyone is different, and also demonstrates that there isn’t a specific diet that is a perfect fit for everyone.

So hopefully you have a better understanding as to why eggs aren’t part of an autoimmune paleo diet.  Although eggs are a healthy food, if someone has an egg allergy then this will result in inflammation, which in turn will have a negative effect on their progress.  But even if someone doesn’t have an egg allergy or sensitivity, compounds in egg whites can affect the health of the gut.  And since a leaky gut is a common finding in autoimmune conditions, and might be a factor in every autoimmune condition (even though I haven’t found this to be the case), those with Graves’ Disease and Hashimoto’s Thyroiditis who choose to reintroduce eggs might want to start with egg yolks, and be cautious about eating egg whites.