Autoimmune conditions are the third most common chronic health condition following heart disease.  There are over 80 different types of diagnosed autoimmune conditions, and dozens of other conditions are suspected as being an autoimmune condition.  But what causes autoimmunity, and why does someone develop a specific autoimmune condition and not another?  For example, why do some people develop Graves’ Disease but not Hashimoto’s Thyroiditis, and vice versa?  And why do some people have the antibodies for both of these autoimmune thyroid conditions?

Autoimmunity happens when the body doesn’t recognize its own cells and tissues as self, and this in turn leads to an immune response against these cells and tissues.  Hashimoto’s Thyroiditis is a condition characterized by autoantibodies against the cells and tissues of the thyroid gland.  Over time these autoantibodies frequently cause sufficient damage to the thyroid gland, which prevents it from producing adequate amounts of thyroid hormone.  On the other hand, Graves’ Disease involves autoantibodies against the TSH receptor antibodies, which in turn causes the thyroid gland to secrete an excessive amount of thyroid hormone.

On a short term basis it is usually far worse to have Graves’ Disease, as while the antibodies aren’t causing damage to the thyroid gland, the excessive production of thyroid hormone can result in extreme cardiac symptoms, and in some cases can even be life threatening.  In addition, some people have thyroid eye disease, where the TSH receptor antibodies will attack the tissues of the eyes.  Unlike some cases of Graves’ Disease, most cases of Hashimoto’s Thyroiditis aren’t considered to be emergency situations.  With that being said, many people with Hashimoto’s Thyroiditis have severe and sometimes debilitating symptoms.  And over the long term, if the autoimmune response isn’t addressed then there is a good chance the person with Hashimoto’s Thyroiditis will become hypothyroid, and thyroid hormone medication might be necessary to take.

Why Do People Develop Graves’ Disease and Hashimoto’s Thyroiditis?

As I mentioned earlier, there are many different autoimmune conditions.  But why does autoimmunity develop, and what factors determine whether someone will develop an autoimmune thyroid condition, or another autoimmune condition such as rheumatoid arthritis or multiple sclerosis?  Well, there are a combination of different factors which determine whether someone will develop an autoimmune condition.  First of all, in most cases a genetic marker is required.  I’m going to talk more specifically about this shortly.  Second, there needs to be some type of an environmental trigger, such as a food allergen, toxin, or infection.  Even stress can potentially be a trigger of autoimmunity.

In addition, some researchers speculate that a third factor is required to develop an autoimmune condition, which is hyperpermeability of the small intestines, also known as a leaky gut.  As of now this still remains controversial, and I have written about this controversy in past blog posts, specifically in a post entitled “Is A Leaky Gut Present In All Autoimmune Conditions?“.  In this post I discussed how many of my patients with Graves’ Disease and Hashimoto’s Thyroiditis have a leaky gut, but I also have had some patients with elevated autoantibodies test negative for a leaky gut using either the classic lactulose/mannitol test, or the Array #2 from Cyrex Labs.  Perhaps neither of these tests are 100% accurate in confirming the presence of a leaky gut, but it’s also possible that not everyone with an autoimmune condition has an increase in intestinal permeability.

The Role of Human Leukocyte Antigen (HLA) In Autoimmunity

I prefer to keep my articles and blog posts easy to understand, but the next few paragraphs might be a little bit advanced for some people.  Different autoimmune conditions will have different types of genetic markers, and something called human leukocyte antigen (HLA) is a type of genetic surface marker.  Keep in mind that there still is a lot to learn in the world of autoimmunity, as some of the autoimmune mechanisms discussed in journal articles are hypothetical, including what I mentioned earlier about intestinal permeability possibly being a factor in all autoimmune conditions.  But it is a fact that there are different genetic surface markers, and someone who has Graves’ Disease will have different genetic surface markers than those people who have Hashimoto’s Thyroiditis.  And there are some people who have the genetic surface markers for both Graves’ Disease and Hashimoto’s, which is why some people will have both types of autoantibodies.

What makes this complex is that an autoimmune condition can have more than one genetic surface marker which predisposes the person to developing multiple autoimmune conditions, and some autoimmune conditions share the same surface markers.  With regards to HLA, it’s also beneficial to understand that these genetic surface markers aren’t just a factor in autoimmune conditions, but in other chronic health conditions as well, such as cancer.  With regards to autoimmunity, people with certain HLA types are more likely to develop an autoimmune condition.  However, just having a specific HLA genetic surface marker doesn’t mean that the person will develop autoimmunity.

For example, many people are familiar with the HLA markers associated with Celiac disease, which are HLA-DQ2 and HLA-DQ8.  If someone has one or both of these markers it doesn’t necessarily mean that they will develop Celiac disease.  This is true even if they consume gluten, which is the environmental trigger associated with Celiac disease.  So what this tells us is that having a genetic marker and being exposed to an environmental trigger doesn’t always lead to autoimmunity.

Let’s look at another example.  Someone with Graves’ Disease might have the genetic surface marker HLA-DR3.  Unlike Celiac disease, there is no specific trigger that is associated with all cases of Graves’ Disease, as it appears that numerous factors can trigger the autoimmune response in this condition.  And the same is true with Hashimoto’s Thyroiditis and many other autoimmune conditions.  In any case, someone with the genetic surface marker HLA-DR3 who is exposed to a certain environmental trigger (i.e. chronic stress, H. Pylori), might develop Graves’ Disease, whereas another person with the same surface marker who is exposed to the same trigger might not develop Graves’ Disease.  What makes it even more challenging is that other autoimmune conditions can also have the genetic surface marker HLA-DR3, such as Sjogren’s syndrome and systemic lupus erythematosus.

The Importance of Regulatory T Cells In Preventing Autoimmunity

While this might be confusing to some people reading this, what hopefully is clear at this point is there are factors other than genetics and environmental triggers which will determine whether someone will develop an autoimmune thyroid condition, or any other autoimmune condition for that matter.  One of these factors is something called regulatory T cells, as these are immune cells which help to prevent autoimmunity from occurring.  I’m not going to discuss this in detail, as in the past I wrote a separate blog post on this topic entitled “Regulatory T Cells and Thyroid Autoimmunity“.  But essentially, if someone has a healthy immune system, they will have plenty of regulatory T cells, and this will help to prevent them from developing an autoimmune condition.  On the other hand, over a period of years, if someone eats a poor diet, is constantly stressed out, and/or doesn’t get quality sleep each night, then this will lead to a decrease in regulatory T cells, and will increase the likelihood of the person developing autoimmunity.

So a very likely scenario is that someone has the genetic surface marker for Graves’ Disease, Hashimoto’s Thyroiditis, or another autoimmune condition, and despite being exposed to numerous environmental triggers they don’t develop autoimmunity unless their body reaches a point where there isn’t enough regulatory T cells present to keep autoimmunity in check.  However, certain factors can potentially affect the number of regulatory T cells, such as a chronic infection, a leaky gut, mitochondrial dysfunction, and nutrient deficiencies such as low vitamin D levels.  Autoimmunity is very complex, and as I mentioned earlier, there is still a lot we don’t know about autoimmune conditions.

In the next blog post I’ll discuss the autoimmunity timeline, and will go over the different stages of autoimmunity.  Most people reading this know that it takes time for thyroid autoimmunity to develop, and these four stages should allow you to better understand why many people with these conditions don’t receive proper care until the later stages.  Plus, since there is a genetic component involved with most, if not all cases of Graves’ Disease and Hashimoto’s Thyroiditis, if you have either of these conditions then you probably will want to share this information with your siblings and children, as it can help to prevent someone from developing a full blown autoimmune condition.

Most of the diets for people with thyroid and autoimmune thyroid conditions are quite restrictive.  This is especially true with regards to autoimmune thyroid conditions, as most autoimmune diets will advise patients to not only avoid gluten, dairy, and grains, but will usually advise the patient to avoid eggs, nuts, seeds, legumes, as well as the nightshade vegetables.  And to top it all off, those with hypothyroidism and Hashimoto’s Thyroiditis are frequently told to avoid goitrogenic foods such as broccoli, kale, spinach, etc.  And unlike other autoimmune conditions, many with autoimmune thyroid conditions are also told to avoid seafood and sea vegetables due to the high iodine content.  So you might wonder what foods you CAN eat without having a negative effect on your health.

I’d like to begin by saying that there is no single diet that perfectly fits everyone.  For example, I commonly recommend an autoimmune Paleo diet to my patients with Graves’ Disease and Hashimoto’s Thyroiditis.  As I mentioned in the opening paragraph, one of the foods you’re supposed to avoid while following this diet is eggs.  And one reason for this is because a lot of people have a sensitivity to eggs.  Another reason is because egg whites have proteins  which can have a negative effect on gastrointestinal health.  Although I do have most of my patients avoid eggs initially, eggs are very nutrient dense, and not everyone with an autoimmune thyroid condition needs to avoid eggs for a prolonged period of time.  This is especially true with regards to egg yolks.  So while some people will need to avoid eggs, other people are able to incorporate them into their diet.  Others might be fine eating egg yolks but not egg whites.

On the other hand, fermented vegetables such as sauerkraut are allowed on most autoimmune diets, and are a big part of certain diets such as the GAPS diet.  However, if someone has a condition such as small intestinal bacterial overgrowth (SIBO), then they might not be able to eat fermented foods, along with some other foods.  So hopefully you understand that there are some foods that typically aren’t allowed on an autoimmune diet which some people can tolerate, as well as other foods which are allowed but might not be tolerated by some people.

What’s The Rationale Behind Excluding Certain Foods?

Before I list the foods which most people with thyroid and autoimmune thyroid conditions can eat, I figured it would be a good idea to briefly explain why certain foods are normally excluded.

Common Allergens. This includes gluten, dairy, corn, soy, and eggs.  The reason why these foods are excluded is because many people have food sensitivities/intolerances to them.  Of course with gluten it can be more serious than a food sensitivity or intolerance, as people with Graves’ Disease and Hashimoto’s Thyroiditis have an increased incidence of Celiac disease, which I discussed in my article “Celiac Disease and Thyroid Health“.  But even if someone doesn’t have Celiac disease, they still can be sensitive to gluten, as well as to these other foods.  And if someone eats foods they are sensitive to, this will cause inflammation, and in some cases can also cause an increase in intestinal permeability (a leaky gut).

You might wonder why you can’t simply test for food allergies and intolerances.  After all, people can have allergies and intolerances to foods other than the ones I mentioned in this post.  This without question is true, and although there are numerous labs which perform food intolerance testing, the accuracy of these tests remain controversial.  I usually just recommend an elimination diet, followed by the reintroduction of certain foods.  Although I realize that there are limitations to doing this, in my opinion it’s more accurate than food intolerance testing, and a lot less expensive.  Of course it’s also very time consuming to do this, and so it would be great if there was a lab which was accurate in testing for food intolerances.

Grains. Why should grains be avoided?  After all, certain grains such as rice, millet, and buckwheat don’t have gluten.  First of all, keep in mind that I’m not “anti-grain”.  Although we can live fine without eating any grains, many people can tolerate a small amount of gluten free grains.  But one problem is that many people don’t eat a small amount of these foods, which are high in carbohydrates.  And in most cases you want to minimize your carbohydrate intake.  Keep in mind that I’m not telling you to eat a low carbohydrate diet, but instead to avoid eating a high carbohydrate diet.  But a bigger problem than the high amount of carbohydrates is that these foods are also high in certain anti-nutrients, such as phytates.  These anti-nutrients not only affect the absorption of nutrients, but can also have a negative effect on the health of the gut.

Nuts, seeds, and legumes. Although these foods have some good health benefits, they also have anti-nutrients which can have a negative effect on the gut.  And since many people with autoimmune thyroid conditions have a leaky gut, it is best to avoid these foods while trying to repair the gut.  In fact, some researchers claim that everyone with an autoimmune condition has a leaky gut, although I’m not sure if this is the case, and I actually discussed this in a post entitled “Is A Leaky Gut Present In All Autoimmune Thyroid Conditions?“.

Nightshades. The nightshade vegetables include tomatoes, eggplant, white potatoes, and peppers.  Although these foods do have some healthy nutrients, they also have compounds which can cause inflammation in lot of people, and can potentially cause an increase in intestinal permeability.  Soon I’ll be releasing a separate article which goes into greater detail about these foods.

High glycemic index fruit. Although fruit is very healthy, it still is a source of sugar, and thus you want to be careful not to eat a large quantity of high glycemic index fruit on a frequent basis.  The higher the glycemic index, the faster it raises your blood sugar levels, and this includes fruits such as watermelon and cantaloupe.  This doesn’t mean that eating these foods once in awhile will cause problems, but in order to keep the blood sugar levels stable you want to eat fruit with a lower glycemic index such as blueberries, blackberries, raspberries, strawberries, and apples.  This is especially true in those who currently have blood sugar imbalances.

All refined foods and sugars, fast food, and artificial ingredients. I probably didn’t have to include this, but I figured I’d do so just to be on the safe side.  Just about everyone reading this knows they should avoid all of these foods, and stick with the whole, healthy foods.

Foods That MOST People With Thyroid and Autoimmune Conditions CAN Eat

Vegetables. Most people reading this know that vegetables are among the healthiest foods.  Even though this is true, the fact remains that most people don’t eat enough vegetables.  This applies to many people who eat healthy diets, as while every now and then I’ll consult with someone who before working with me was eating five or more servings of vegetables per day on a consistent basis, many people struggle to include a couple of servings of vegetables in their daily eating regime.  Not only do you want to eat plenty of vegetables, but you also want to try eating a wide variety of them.  I recommend a combination of raw and cooked vegetables.

Are there any vegetables that you shouldn’t eat?  Well, I mentioned the nightshade family of vegetables earlier.  I’m sure many people who have hypothyroidism and Hashimoto’s Thyroiditis are wondering about goitrogenic foods such as broccoli, kale, and cauliflower.  If someone with a hypothyroid condition has greatly depressed thyroid hormone levels and/or a severe iodine deficiency then it might be best to avoid these foods.  However, most people can eat small amounts of these foods on a daily basis.  And remember that cooking vegetables will help to reduce the goitrogenic activity.  I discussed goitrogens in my article entitled “An Update on Goitrogenic Foods and Their Impact on Thyroid Health“.

Fermented vegetables. Most people should eat plenty of fermented vegetables, such as sauerkraut and kimchi.  These foods are a great source of probiotics.  However, some people are unable to eat fermented foods, such as those who have problems with FODMAPs.  I spoke about this more in a blog post I wrote entitled “Should People With Thyroid Conditions Follow a Low FODMAP Diet?“.  When someone has problems eating fermented foods it usually is due to intestinal dysbiosis.  An example is the condition known as small intestinal bacterial overgrowth, also known as SIBO.

Low glycemic index fruit. Although those who don’t have blood sugar imbalances can eat some high glycemic index fruits every now and then, it still is best to stick with those foods that have a low glycemic index.  I mentioned some of these foods earlier, as this includes all types of berries, as well as apples, pears, and cherries.  Avocados are very nutrient dense and are an excellent source of healthy fats.

Meat and Poultry. This obviously doesn’t apply to vegetarians and vegans, but for those who eat meat, eating healthy forms of meat and poultry is fine.  For example, if you eat beef then you ideally want to eat organic, grass-fed beef.  If you eat poultry then you ideally want this to be organic as well.  Other types of meat such as lamb, deer, and porcupine are fine to eat, providing you remove  the quills before cooking it.  Okay, I’m just joking about eating porcupine, although I’m sure it’s a delicacy in some countries.  Organ meats are nutrient dense and also can be eaten.

Fish. Fish is the best source of omega 3 fatty acids, has other nutrients, and is a good source of protein.  Of course fish also has toxins, and while the larger fish and the farm-raised fish have the greatest number of toxins, there are still toxins present in smaller, wild fish.  With that being said, in most cases it is fine for people to have two or three servings of wild fish per week.  Some healthcare professionals feel that it’s fine to eat fish on a daily basis as long as the selenium content is greater than the amount of methylmercury, although I’m still cautious about people eating more than three servings of fish per week.

Coconut. Most people with thyroid and autoimmune thyroid conditions can also eat coconut products without a problem.  Of course there are some people who can’t tolerate coconut, including some people with SIBO.  But most people can have some coconut milk, coconut yogurt, and I highly recommend coconut oil for those who can tolerate it.  With that being said, you do need to be careful about some of the processed coconut products sold at health food stores, as some people will react to the other ingredients included.  This doesn’t mean that you can’t eat any of these products, but you want to read the labels carefully, and you might also want to consider making your own coconut milk and yogurt.

Other Foods. Many herbs and spices are allowed such as basil, cilantro, garlic, ginger, oregano, parsley, rosemary, and thyme.  Apple cider vinegar is allowed, as is olive oil.  Drinking green tea and many herbal teas are fine.

Additional Foods That SOME People With Thyroid and Autoimmune Conditions Can Eat

Eggs. Although eggs are a common allergen and therefore can’t be consumed by some people, not everyone with an autoimmune thyroid condition will need to avoid eggs.  And since eggs have many different nutrients and are a good source of protein, if someone doesn’t react to eggs I think they should eat them.  As I mentioned earlier, many people do fine eating egg yolks but should consider avoiding egg whites.

Soaked nuts and seeds. As I mentioned earlier, the main reason nuts and seeds should be avoided is because they can have a negative effect on the gut, and many people with autoimmune thyroid conditions have a leaky gut.  Lectins are a big culprit, and soaking nuts and seeds will help to reduce the lectin content.  I’ve had some people with a leaky gut eat soaked nuts and seeds and not have it affect their recovery.  On the other hand, I’ve also had some people with a leaky gut follow a strict autoimmune Paleo diet while eating soaked nuts and seeds, and on an intestinal permeability retest they showed little or no improvement.  Although there could have been other factors responsible for this, it very well might have been the nuts and seeds.  One of the benefits of nuts and seeds is that they make a great snack, as they are a good source of protein and fiber, and don’t raise the blood sugar levels.  But in some cases they can also prevent a leaky gut from fully healing.

Raw dairy. I realize that raw dairy isn’t available in all states, and for some people who wonder why I would specifically list raw dairy and not pasteurized dairy, I would read my blog post entitled “Should People With Graves’ Disease and Hashimoto’s Thyroiditis Avoid Dairy?“.  I also should let you know that I frequently don’t have people reintroduce any type of dairy while following a natural treatment protocol.  But I realize this diet is very restrictive, and while many people don’t do well with any type of dairy, some people can tolerate raw dairy.  And some people also seem to do fine with dairy from a goat or sheep.  Although I don’t encourage people to add dairy into their diet, if someone is struggling to follow this diet and they request to reintroduce dairy, I will usually allow them to do so and see how they respond.  However, it’s important to only reintroduce one dairy product at a time for three consecutive days, as it’s possible to react to one type of dairy, but not to react to a different type.

Other foods. Can people safely consume other types of foods?  For example, I’ll commonly get asked if someone can eat a small amount of gluten free grains, such as gluten free oats, rice, or a “pseudo grain” such as quinoa.  Earlier I gave the reason why grains are usually excluded.  And while eating rice, or gluten-free bread or pasta is better than eating whole wheat bread or whole wheat pasta, even gluten-free grains have antinutrients, spike up the blood sugar levels, etc.  With that being said, there are some people who are able to eat small amounts of gluten-free grains without a problem.  But if someone has a leaky gut and/or blood sugar imbalances then I would strongly consider going grain free.

I’ll also have some people wonder if they can reintroduce some of the nightshades.  Although some people can eat nightshades without a problem, other people can’t eat them without experiencing symptoms such as joint pain, headaches, and other symptoms caused by these foods.  Nightshades can also potentially cause a leaky gut, and so if someone has gut issues but isn’t experiencing any negative symptoms while consuming nightshades, then it still would be a good idea to avoid these foods.

“How Do I Know If I Can Eat These Additional Foods?”

At this point you might be wondering how would you know if you can eat eggs, soaked nuts and seeds, raw dairy, etc.  I usually will have my patients follow an elimination diet.  I’ll typically have them follow an autoimmune Paleo diet, and then after one month if they are struggling and feel the need to reintroduce certain foods I will usually have them start with eggs.  I would have them reintroduce eggs into their diet by having them eating one or two eggs daily for three or four consecutive days and to pay close attention to any symptoms they might experience.  Once again, it might be wise to only reintroduce egg yolks.  If they experience any symptoms (i.e. headaches, increase in fatigue, etc.), but are unsure whether or not it is related to the food they reintroduced, or if it’s just a coincidence, I will have them cut out the food again for a few weeks and then they can try reintroducing it back again.  Although this method isn’t perfect, if someone pays close attention to the changes in symptoms they usually can tell if they are having a negative reaction to a specific food.  As I just mentioned, eggs is one of these foods, and although I don’t frequently recommend for people to add raw dairy into their diet, if someone does this and has a sensitivity to the proteins in dairy then they will usually be able to tell if they are reacting upon reintroducing the dairy.

On the other hand, it can be a different story with soaked nuts and seeds.  With eggs and dairy, these foods are not part of an autoimmune Paleo diet because many people have allergies or intolerances to them (although as I mentioned earlier, egg whites can have a negative effect on the gut).  With nuts and seeds, as well as beans/legumes, while someone also can have an allergy or intolerance to these foods, the primary reason why they are excluded from this type of diet is due to the negative effects they can have on gastrointestinal health.  Eliminating these for one month and then reintroducing them might not result in any symptoms unless if you have a true allergy, or a problem breaking down fats due to another problem (i.e. bile/gallbladder problem).  So while some people with thyroid and autoimmune thyroid conditions eat soaked nuts and seeds and do fine, other people don’t do well until they eliminate the nuts and seeds from their diet.

Focus On Nutrient Density

Even though one might find the diet to be restrictive, just remember that the goal isn’t to limit your caloric intake.  I realize that it might seem challenging to eat enough calories with such a limited diet, but just keep in mind that there is a difference between foods that are high in calories and foods that are nutrient dense.  For example, a bowl of rice will be higher in calories than a bowl of kale, but the bowl of kale will have a much higher nutrient density.  To be fair, nuts and seeds are nutrient dense foods yet are excluded from an autoimmune Paleo diet, but most of the other foods listed are nutrient dense.

Also keep in mind that there is no single diet that will fit everyone.  Earlier I gave the rationale behind excluding certain foods, but not everyone will need to avoid eating these foods while trying to restore their health back to normal.  And what makes it even more frustrating is that with certain foods there is no surefire method to confirm that it is safe to eat this food, or if it should be avoided.  Some doctors like myself use an elimination diet, others might use food sensitivity/intolerance testing, while some doctors use applied kinesiology, which involves muscle testing to see if a certain food is allowed or should be avoided.  All of these methods have limitations, which is why many healthcare professionals recommend for everyone with an autoimmune condition to avoid all of the potentially problematic foods.

In summary, although most people who follow a natural treatment protocol will be put on a restrictive diet, it’s important to understand that there is no single diet which will be a perfect fit for everyone.  While myself and many other doctors will recommend for those who have Graves’ Disease and Hashimoto’s Thyroiditis to be put on an autoimmune Paleo diet, not everyone needs to avoid all of these foods.  On the other hand, at times some people might not be able to tolerate some of the “allowed” foods.  So while many people will benefit by avoiding the common allergens (gluten, dairy, corn, soy, and eggs), going grain-free, avoiding nuts, seeds, and legumes, along with the nightshades, and fruit which have a high glycemic index, not everyone who is trying to restore their health will need to avoid all of these foods.  Also remember that you don’t want to worry too much about consuming foods high in calories, but instead want to eat foods with a high nutrient density.

Many women with thyroid and autoimmune thyroid conditions have fertility problems.  And it’s also common for men to experience fertility problems as well.  It’s been awhile since I’ve written about this, and so I figured I’d put together a post discussing some of the most common reasons why many men and women have problems conceiving.  Although there isn’t always a natural solution to infertility, many women who at one time had problems getting pregnant and who didn’t want to consider fertility treatments such as IVF were able to conceive following some of the advice given below.  In addition, while the focus is on people with thyroid and autoimmune conditions, many people suffering from infertility who don’t have a thyroid condition can also benefit from this information.

Infertility is defined as the inability to conceive after one year of regular intercourse without contraception. The prevalence of infertility is estimated between 12% and 14% and has remained stable in recent years (1).  There are many different causes of infertility, but not surprisingly, many doctors overlook these causes, and as a result many couples resort to fertility drugs or IVF, which can cost thousands of dollars, and many times these methods aren’t successful.  As a result of this I have listed numerous factors which can potentially cause or contribute to infertility.

1. Thyroid hormone imbalance. There is no question that having a thyroid condition can cause infertility, as many studies have shown that thyroid dysfunction can affect the male and female gonads, interferes with human reproductive physiology, reduces the likelihood of pregnancy and adversely affects pregnancy outcome (2) (3) (4).  It also seems that both hypothyroid and hyperthyroid conditions can be factors.  As a result, anyone with depressed or elevated thyroid hormone levels will ideally want to get this problem addressed before trying to conceive.

2. The presence of autoantibodies. Most thyroid conditions are autoimmune, and besides the thyroid hormone imbalances commonly present in Graves’ Disease and Hashimoto’s Thyroiditis, the autoimmune component of the condition is also a factor that can affect fertility.  One recent study showed that there was a high prevalence of infertility among women with Graves’ Disease and Hashimoto’s Thyroiditis (5), as this specific study showed that the prevalence of infertility was 52.3% in Graves’ Disease and 47% in Hashimoto’s Thyroiditis.  Some studies show that in female infertility there is a significantly higher prevalence of positive TPO antibodies when compared to controls (6).  Another study showed that during the first trimester pregnant women with autoimmune thyroid conditions carry a significantly increased risk for a miscarriage compared to women without thyroid autoimmunity, even when euthyroidism (normal thyroid hormone levels) was present before pregnancy (7).  A few other studies have shown an increased risk of miscarriage with thyroid autoimmunity (8) (9).

3. Problems with the adrenals/HPA axis. Obviously low progesterone can be a factor with infertility and frequent miscarriages.  But many people don’t make the connection between chronic stress and hormone imbalances, even though numerous studies have shown a connection between stress and infertility.    One of these studies revealed that the hypothalamic-pituitary-adrenal axis (HPA) has been shown to be an important mediator of infertility, and that the HPA axis affects the hypothalamic-pituitary-gonadotrophic (HPG) axis (10).  The study shows that changes in cortisol secretion due to chronic stress will affect the HPG axis, and can play a role in infertility.  Another one of these studies shows how glucocorticoids affect gonadal function at multiple levels at the HPG axis (11).  What’s important to understand is that chronic stress can lead to infertility, and it’s not necessarily the stress itself which causes the problem, but instead one’s perception of the stressors.  And so if someone is having problems with infertility, then they probably will want to incorporate certain mind body medicine techniques to help with this.  In fact, a few studies have shown how yoga and meditation can potentially help with infertility by improving the stress response (12) (13).

4. Mitochondrial dysfunction. Most people don’t think about the mitochondria when it comes to their fertility.  However, having healthy mitochondria is important when it comes to fertility.  In fact, the authors of a journal article I came across discussed a “fertility diet” to help improve mitochondrial function, which in turn can help to improve fertility (14).  Keep in mind that the mitochondria is where cholesterol becomes pregnenolone, and pregnenolone is the precursor to the sex hormones (progesterone, estradiol, testosterone, etc.), as well as a precursor to other hormones, such as cortisol.  As a result, if someone has a progesterone deficiency, it very well might be due to mitochondrial dysfunction.  One of the best methods of determining mitochondrial dysfunction is through an organic acids test, which is a urine test that looks at certain markers of the mitochondria, as well as other markers.  I have put together a separate post on the mitochondria entitled “The Relationship Between Mitochondria and Thyroid Health“.

5. Nutrient deficiencies. To no surprise, having nutrient deficiencies can affect fertility, both directly and indirectly.  Nutrient deficiencies can lead to some of the health issues I’ve discussed in this article (i.e. mitochondrial dysfunction), which can in turn cause infertility.  But a deficiency of certain nutrients can also affect fertility.  For example, in men the deficiencies of zinc and/or selenium can have a negative effect on sperm quality and cause infertility (15) (16) (17).

I’ve spoken about the importance of vitamin D in the past, but not specifically with regards to its importance in fertility.  A couple of recent reviews of the literature has determined that vitamin D is involved in many functions of the reproductive system in both men and women, as it might influence steroidogenesis of estradiol and progesterone in women, and can play a role in semen quality in men and increase testosterone levels (18) (19).  So this is yet another reason why you want to have healthy vitamin D levels.

6. Chronic infection. Having certain types of infections can increase the risk of infertility.  In fact, as I have discussed in previous articles and blog posts, one of the infections associated with autoimmune thyroid conditions is H. Pylori.  This is more common in those with Graves’ Disease, but I’ve seen some patients with Hashimoto’s Thyroiditis test positive for H. Pylori as well.  And there is evidence that having an H. Pylori infection can be a factor in infertility (20) (21) (22).  So if infertility is suspected then it probably would be a good idea to get tested for H. Pylori, and other infections might be a factor as well.

7. Environmental toxins. Not surprisingly, exposure to certain toxins can also decrease fertility.  For example, higher blood mercury concentration is associated with both male and female infertility (23).  The same source mentioned that higher seafood consumption is associated with elevated blood mercury concentrations, although keep in mind that testing for chronic exposure to mercury is more accurate in the hair and urine.  Another interesting study looked at the effects of mercury vapor on fertility of female dental assistants (24).  The study showed that women with high occupational exposure to mercury were less fertile than unexposed controls.  However, the study also showed that women with low exposure were actually more fertile than unexposed controls.  Either way, those who are dealing with infertility might want to get their mercury levels tested, perhaps using multiple sources.  There is evidence that other heavy metals might play a role in infertility, including lead and cadmium exposure (25) (26) (27) (28).

I’ve spoken about xenoestrogens in the past, and since these disrupt the endocrine system it shouldn’t be surprising that there is evidence showing that these toxins can affect fertility (29) (30).  Unfortunately xenoestrogens are widespread, as they are found in household cleaners and cosmetics, pesticides and herbicides, and of course in bottled water.  Although it’s impossible to eliminate one’s exposure to all of these toxins, one of course can do things to help minimize their exposure to toxins, and those couples who are thinking about conceiving will want to consider doing things to help with the detoxification of these chemicals prior to conceiving.

8. Genetically modified foods. As far as I know there is no proof that eating genetically modified foods can cause infertility in humans.  However, there is evidence of animals fed genetically modified crops showing complications such as early deliveries, abortions, and infertility (31).   Of course even if infertility isn’t an issue I think it’s a good idea to try your best to avoid genetically modified foods, which is difficult if you eat any type of refined foods or eat out, although it’s not impossible if you become an expert in reading ingredients and also are cautious about where you go out to eat, as well as what you consume.  For more information on genetically modified foods I’ve written an article entitled “The Impact of GMOs On Thyroid Health“.

9. Moderate alcohol consumption. Numerous studies show that moderate to high alcohol consumption can decrease fertility (32) (33).  Some may wonder whether drinking alcohol on occasion will cause problems, such as a glass of red wine each week, or a few alcoholic beverages per month.  I don’t know of any studies investigating this, but if someone is having difficulty getting pregnant it’s probably best to play it safe and avoid all alcohol.

10. Vigorous exercise. Obviously I’m not discouraging people from exercising, as doing so on a regular basis is important for optimal health.  However, it seems that exercising at a high intensity for a long duration (greater than one hour per day) will affect fertility (34) (35).  So while you want to exercise regularly, you don’t want to overexert yourself, and you definitely don’t want to exercise to the point of exhaustion.

11. Obesity/insulin resistance. There is plenty of evidence which shows a relationship between obesity and infertility in both women and men (36) (37) (38).  Most people who are obese also have insulin resistance, which is factor in the development of PCOS, another common cause of infertility.  I talk about PCOS in a different article entitled “Polycystic Ovarian Syndrome and Thyroid Health“.

12. Gluten and dairy consumption. There aren’t many studies about how common allergens such as gluten and dairy can affect fertility.  There are a few studies which show how Celiac disease may decrease fertility, and going on a gluten-free diet can help with this (39) (40).  As a result, if you have problems conceiving then it might be a good idea to get tested for Celiac disease, or to just avoid gluten altogether.  With regards to dairy, I only came across one “prospective study” which showed that high intake of low-fat dairy foods may increase the risk of anovulatory infertility, while the consumption of high-fat dairy products may decrease the risk (41).  I didn’t find any studies which showed a negative correlation between casein consumption and infertility.

13. Stevia. There is a little bit of controversy as to whether stevia can affect fertility.  One study conducted on male rats showed that chronic administration of stevia decreased male fertility (42).  However, remember that this involved “chronic administration”, and an earlier study conducted on male and female hamsters showed that when given stevioside (which is extracted from stevia leaves) there were no abnormalities in growth and fertility in both sexes (43).  To this date there haven’t been any studies showing whether consuming stevia affects fertility in humans, and while my guess is that having a small amount of stevia won’t cause problems, I could be wrong, and therefore if someone is having problems conceiving then it might be wise for the both the male and female to avoid stevia.

So What Can You Do To Overcome Infertility Naturally?

Anyone dealing with infertility will of course want to go through this list and consider each one of these factors as possibly causing or contributing to their infertility problem.  Some of these factors can be easily addressed, such as avoiding alcohol and not exercising too hard.  And of course you want to try following the basics, such as eating mostly whole foods while trying to minimize your consumption of refined foods, as well as not consuming artificial ingredients and genetically modified foods.  Managing your stress is always important, as is reducing your exposure to environmental toxins.

However, other factors can be challenging to address.  For example, if someone has mitochondrial dysfunction then this can be corrected, but it can be challenging to determine if someone has this problem.  And then if it is detected it will take time to correct this.  While one can minimize their exposure to toxins by eating organic food and buying natural cleaners and cosmetics, if they have a mouthful of mercury amalgams then this can be more challenging, as it can be very expensive to get these removed and replaced, and then one still will probably want to do some things to remove toxins from the tissues.  Plus, there is really no way to confirm that this is what’s causing the infertility, and so there is a chance that someone might spend thousands of dollars getting the mercury amalgams removed and replaced, and their fertility won’t improve.  Of course one can argue that getting these removed would be a good idea regardless of whether or not someone is dealing with infertility issues.

It’s also important to keep in mind that BOTH men and women need to do things to improve their health in order to improve the chances of conception.  After all, if a male is stressed out all of the time, is eating poorly, and/or is being exposed to a lot of toxins then this can very well affect his fertility.  So both the male and female need to commit to eating well, doing things to improve their stress handling skills, minimize their exposure to toxins, and if there is a health issue such as mitochondrial dysfunction or H. Pylori then these need to be addressed.

And of course the thyroid or autoimmune thyroid condition needs to be addressed as well.  Since both depressed and elevated thyroid hormone levels can be a factor in infertility, any thyroid imbalance needs to be corrected.  This might mean taking medication on a temporary or long term basis, or you might choose not to take medication and try to overcome your condition naturally.  If you have Hashimoto’s Thyroiditis or Graves’ Disease then you should work with a natural healthcare professional to help you suppress the autoimmune component, as this can be a factor in infertility.

It’s also worth mentioning that acupuncture might be able to help with some cases of infertility.  I briefly spoke about this in a previous blog post I wrote entitled “Can Acupuncture Benefit People With Thyroid Conditions?“.  And so before taking fertility drugs or spending thousands of dollars on IVF it probably would be worth receiving a few acupuncture treatments.

In summary, many men and women with autoimmune thyroid conditions have problems with fertility.  Many resort to treatment procedures such as IVF, and while this is something to consider in some cases, one should also look at other factors which can be causing the infertility.  Some of these causes include the thyroid hormone imbalance, the presence of autoantibodies, problems with the adrenals/HPA axis, mitochondrial dysfunction, obesity, nutrient deficiencies, environmental toxins, and even a chronic infection such as H. Pylori.  And before resorting to fertility drugs or IVF, those people looking for a more natural method of overcoming infertility might want to consider these factors I discussed.

Those people with hypothyroidism and Hashimoto’s Thyroiditis who have been reading my articles and blog posts for a long time probably realize that I’m not a big fan of thyroid hormone medication.  Most cases of hypothyroidism are caused by Hashimoto’s, which of course is an autoimmune thyroid condition which affects the thyroid gland.  So my goal with these patients is to try to restore the health of the immune system, and if at all possible get the person to the point where they don’t need to rely on synthetic or natural thyroid hormone.  And even with non-autoimmune hypothyroid conditions one should try to detect and correct the cause of the problem.  Since in most cases the thyroid gland itself isn’t the cause of the condition, I commonly will have patients, and even non-patients ask me if they can stop taking thyroid hormone medication, and just focus on the imbalances which are responsible for the hypothyroid condition.

Before you stop taking your thyroid hormone medication, you do need to understand the importance of thyroid hormone.  Although taking Synthroid, Tirosint, Armour, Nature-Throid, or any other type of synthetic or natural thyroid hormone isn’t doing anything for the cause of your condition, you still might need to take thyroid hormone while trying to address the cause of the problem.  While I can understand someone not wanting to take any type of medication, if someone has low or depressed thyroid hormone levels, not taking thyroid hormone medication can lead to serious health issues over time.

Understanding The Importance Of Thyroid Hormone

In the past I wrote an article entitled “Why Is Thyroid Hormone So Important To Our Health?”  In this article I discussed some of the more important functions of thyroid hormone, as it’s important for the metabolism of proteins, fats, and carbohydrates, regulates the expression of genes, plays an important role in brain development and function, is important for reproductive health and bone health, and also plays a role in wound healing and peripheral nerve regeneration.  So hopefully you realize that having low levels of thyroid hormone isn’t a good thing, and while I’m all for trying to restore someone’s health so they won’t need to take thyroid hormone medication, until they reach this point it might be a good idea to take thyroid hormone.  And of course there are people who will need to take thyroid hormone medication on a permanent basis.

Recently I attended a nutritional conference which focused on epigenetics, and one of the presenters spoke about the role of thyroid hormone in the mitochondria. Thyroid hormones, especially T3, are critical for the function of the mitochondria.  The mitochondria are located in the cytoplasm of our cells, and they are responsible for cellular respiration, and have many other functions.  Also, keep in mind that biosynthesis of the steroid hormones begin in the mitochondria, and so if someone has low levels of T3, this in turn can affect the production of steroid hormones such as estrogen, progesterone, and cortisol.  With regards to the mitochondria I’ve written a separate post you might want to check out entitled “The Relationship Between Mitochondria and Thyroid Health“.

Subclinical Hypothyroidism and Thyroid Hormone

Is it important to take thyroid hormone if someone has subclinical hypothyroidism?  So for example, if someone has an elevated TSH, but if their thyroid hormone levels are well within the lab reference range, does this person need to take thyroid hormone medication?  It really does depend on the situation, as if someone has an elevated TSH and both free T3 and free T4 are well within the functional reference range, and if they aren’t experiencing any symptoms, then they very well might not need to take synthetic or natural thyroid hormone.  On the other hand, if they are symptomatic then sometimes taking a small dose of thyroid hormone can help.  Plus, one does need to realize that there is a difference between the lab reference range and a functional reference range.

For example, for free T3 many labs use a normal reference range of 2.3-4.3 pg/mL.  If someone has a free T3 of 2.7 pg/mL this is considered to be normal, but it’s still on the low side.  So if someone has an elevated TSH, elevated thyroid antibodies, has a free T3 of 2.7 with minimal thyroid symptoms, should they go ahead and take thyroid hormone medication?  Of course most medical doctors would focus more on the TSH, and if the TSH is elevated they will usually recommend giving thyroid hormone medication, regardless of what the thyroid hormone levels look like.

In addition, even if someone has subclinical hypothyroidism, is completely asymptomatic, and isn’t taking thyroid hormone, they of course will still want to figure out what’s causing the problem.  Hashimoto’s Thyroiditis is the most common cause of subclinical hypothyroidism, as what happens is that the person will first develop elevated thyroid antibodies, which in turn will damage the thyroid gland.  However, it can take months, or sometimes even years for the TSH and thyroid hormone levels to be affected.  Unfortunately most medical doctors don’t screen for the thyroid antibodies unless if someone already has an elevated TSH, even though the thyroid antibodies are present well before the TSH rises.

Anyway, if someone has an elevated TSH and the free T3 and free T4 are both within the functional reference range, then the person very well might not need to take thyroid hormone medication.  But if they don’t do anything to address the cause then eventually they might need to take synthetic or natural thyroid hormone.  If someone is pregnant and has subclinical hypothyroidism, this is where it gets more challenging.  Thyroid hormone is of course very important for the developing fetus, and if a pregnant woman has an elevated TSH and elevated thyroid antibodies, yet her free T3 and free T4 are within the functional reference range, it still might be a good idea to take a small amount of thyroid hormone.  And the reason for this is because the person might currently have normal thyroid hormone levels, but then a few weeks or a few months later the levels might drop significantly, which can affect the health of the fetus.  Obviously someone with a thyroid imbalance will want to obtain a thyroid panel on a regular basis during pregnancy, but in many cases it’s a good idea for a pregnant women with subclinical hypothyroidism to take thyroid hormone medication, even if it’s a small dosage, just to be on the safe side.

Is There A Natural Substitute For Thyroid Hormone Medication?

I’m sure some people reading this will wonder if there is something else they can take instead of synthetic or natural thyroid hormone.  I’ll probably write a separate post on this in the future, but I will say that if someone has a thyroid hormone deficiency then there is no nutritional supplement or herb you can take in place of thyroid hormone.  There are herbs which in some cases can help to stimulate the production of thyroid hormone, but these don’t always work, and they usually aren’t a long term solution to the problem.  Of course if someone is deficient in a nutrient important for the formation of thyroid hormone such as iodine or tyrosine then this can help with the production of thyroid hormone.  However, while many people with hypothyroid conditions have nutrient deficiencies, most cases of hypothyroidism aren’t directly caused by these deficiencies.

How about thyroid glandulars?  Well, some thyroid glandulars do have small amounts of thyroid hormone, along with some nutrients and/or herbs (i.e. zinc, selenium, ashwagandha, coleus, etc.), and many people can take these instead of synthetic or natural thyroid hormone and do fine.  On the other hand, glandulars without thyroid hormone might provide some support to the thyroid gland, but once again, if someone has low or depressed thyroid hormone levels then this probably won’t be sufficient.  I commonly recommend a supplement called Thytrophin PMG, which supports the thyroid gland, but doesn’t contain thyroid hormone.  Although there are some people who will take this instead of thyroid hormone medication, it’s important to understand that it’s not a replacement for thyroid hormone.

In summary, although I’m not a big fan of thyroid hormone medication, this doesn’t mean that I recommend for people with hypothyroid conditions to stop taking synthetic or natural thyroid hormone.  Having normal thyroid hormone levels is very important, and so if someone has low or depressed thyroid hormone levels then it probably is a good idea for them to take thyroid hormone, while at the same time addressing the cause of the problem.  If someone has subclinical hypothyroidism then they might not need to take thyroid hormone medication, but it does depend on the situation.  And while there are some herbs and nutrients which can increase thyroid hormone production, there really isn’t a natural alternative for taking synthetic or natural thyroid hormone, although some people with hypothyroid conditions do fine on glandulars which contain thyroid hormone.

Life can be very challenging when dealing with a thyroid or autoimmune thyroid condition.  Although it’s not always easy to focus on the positive things in your life, most of us do have things to be grateful for.  When I was first diagnosed with Graves’ Disease I admittedly didn’t take this advice frequently, as initially I focused more on the negative factors than the positive things in my life.  But after awhile I realized that I needed to be grateful for the positive factors.

For example, while having an autoimmune thyroid condition truly stinks, there are other conditions which are much worse than either Graves’ Disease or Hashimoto’s Thyroiditis.  And so while I had a negative attitude when I was diagnosed with Graves’ Disease, I eventually became grateful for not having a health condition that was even worse, and once I began seeing the results of following a natural treatment protocol I of course was very grateful for this.  I was also grateful for having a supportive wife, and I’m still very grateful for this.  I’m extremely grateful for having two lovely daughters.  Even though I’m not as brave as I used to be when going on roller coasters, I’m grateful that I have a “roller coaster buddy” in my older daughter.

I’m of course very grateful for my wonderful patients, as well as those who aren’t my patients but take the time to read my articles and blog posts, attend my webinars, etc.  Thank you so much for your support, as I truly am grateful for it, and I hope you and your family have a wonderful Thanksgiving holiday.  And please make sure that you take a few minutes to reflect on what you’re grateful for.