Most people don’t consider problems with oral health to be related to health conditions in other bodily areas.  However, having poor oral health can increase the risk of developing certain chronic conditions, and might also play a role in the development of autoimmune thyroid conditions such as Graves’ Disease and Hashimoto’s Thyroiditis.  Of course I’m not suggesting that most cases of thyroid autoimmunity are caused by poor oral health, but this is a factor that is overlooked by most people, yet should be considered.  Fortunately more and more healthcare professionals are realizing that mercury amalgams can cause problems, and some also are aware of the potential risk factors of root canals.

It should make sense when you think about the connection between oral health and the rest of the body.  This is especially true with mercury amalgams, as many people reading this are aware of the risks of these, and it’s not uncommon for me to speak with a patient who has gotten all of their silver fillings replaced.  However, many people don’t make a similar connection with root canals and other health conditions.  Part of this has to do with the approach of most dentists, as while many dental clinics are avoiding the use of mercury amalgams, most still perform root canals on a frequent basis.  In addition, while there are tests which measure the amount of mercury in the tissues, which in turn can be linked to mercury amalgams, there isn’t a reliable test to see if a root canal is causing any health issues.

Is Mercury The Cause Of Your Autoimmune Thyroid Condition?

Before talking about root canals, let’s go ahead and briefly talk about the impact of mercury.  First of all, there is no doubt that having mercury amalgams results in the release of mercury vapors during the act of chewing.  What’s controversial is the effect that the mercury vapors have on our health, and whether this can serve as a trigger for thyroid autoimmunity, as well as other health conditions.  While some studies show that there is no relationship between dental amalgams and Hashimoto’s Thyroiditis (1), other studies have shown that the removal of dental amalgam decreases TPO and thyroglobulin antibodies in patients with autoimmune thyroiditis (2).  I’ll expand on this shortly.  Both the FDA and Centers for Disease Control (CDC) consider mercury amalgams to be safe in most cases.  On the other hand, the World Health Organization (WHO) considers mercury to be one of the top ten chemicals of major public health concern, and mentions how exposure to mercury, even in small amounts, may cause serious health problems (3).

I briefly spoke about the possible relationship between mercury and thyroid health earlier, and would like to expand on this, as there are numerous studies which demonstrate a negative effect of mercury on thyroid health.  Keep in mind that not all of these studies involve inorganic mercury, which is the mercury found in dental amalgams.  Methylmercury is found in fish, and both inorganic mercury and methylmercury can negatively impact the thyroid gland.  One study looked at the role of environmental factors in autoimmune thyroiditis, and showed that replacement of dental amalgams in mercury-allergic subjects resulted in improvement of health in about 70% of patients, and in some cases lead to a normalization of anti-thyroid autoantibodies (4).  Another study looked at the relationship between mercury and thyroid autoantibodies, and showed that there is an association between mercury and thyroglobulin antibodies, but not thyroid peroxidase antibodies (5).  Thyroglobulin antibodies are found in those with Hashimoto’s Thyroiditis.  However, mercury also might play a role in the development of Graves’ Disease, as this autoimmune thyroid condition usually involves the presence of Th2 cytokines.  And I did come across a study which showed that mercury can potentially trigger or worsen Th2 cytokine production in humans (6).  Although these studies focus on the effects of mercury and the immune system, numerous studies have shown that mercury can also have a direct effect on the thyroid hormones (7) (8).

So does this mean that everyone who has mercury amalgams should get them removed?  This remains controversial, as while there is no question that mercury shouldn’t have been used as fillings in the first place by most dentists, sometimes getting them removed can do more harm than good.  In some cases removing these amalgams can exacerbate the autoimmune response of someone who has Graves’ Disease or Hashimoto’s Thyroiditis.  Anyone who is looking to get their mercury amalgams removed should hire a dentist who takes the proper precautions when removing them, such as a biological dentist.  You can find one of these dentists by visiting the website of the International Academy of Oral Medicine and Toxicology or International Academy of Biological Dentistry & Medicine.  Their respective websites are www.iaomt.org and www.iabdm.org.

What Is The Risk Of Having One Or More Root Canals?

While many people reading this are aware of the risks of mercury amalgams, many aren’t aware of the potential risks of root canals.  Although the American Dental Association claims that root canals are safe simply because there is no scientific evidence which show them to be harmful, there also aren’t any scientific studies which show that root canals are completely safe.  Just to let you know, the ADA still considers mercury amalgams to be safe.  Without question this is a controversial topic, as while there are many people who have had their health improve upon removing their root canals, until there are numerous scientific studies which show this then most dentists will continue to recommend this procedure to their patients.

Before talking about the potential risks of root canals it probably would be a good idea to briefly explain what a root canal entails.  First of all, a root canal is usually recommended when the nerve of the tooth becomes infected or the pulp becomes damaged.  I’m not going to get into the details of the procedure, as you can find this information online, but essentially they will drill a hole into the tooth and remove the dental pulp, the decayed nerve tissue, and they will try their best to sterilize the area in order to kill the bacteria.  Once this has been accomplished the tooth will be sealed, and often times a crown will be placed over the tooth.

I left out a number of details, but the main controversy is whether all of the bacteria can successfully be eradicated.  In other words, can the canals be permanently sterilized?  Many reading this are familiar with Dr. Weston Price, who was a dentist who looked at the relationship between dental health and nutrition, and how it impacted our overall health.  Dr. Price took one thousand extracted teeth and sterilized the canals with forty different chemicals in order to see if permanent sterilization could be achieved.  After 48 hours he broke the teeth apart and cultured them, and found that all but one of the teeth had bacteria.  Other biological dentists have confirmed Dr. Price’s findings.

Although there aren’t any research studies I’m aware of which show a correlation between root canals and specific health conditions, there have been numerous people with different health conditions whose health improved dramatically upon removing their root canals.  In fact, in the article I just mentioned, Dr. Price stated that “the bacteria in root canals favor destruction of the nervous system and many other systems, resulting in the creation of autoimmune reactions”.  While a root canal isn’t the trigger for most autoimmune thyroid conditions, if someone who is following a natural treatment protocol has one or more root canals and doesn’t see an improvement in their health, then they might want to consider having these removed.

Should You Have Your Root Canals Removed?

If you have mercury amalgams and root canals and were to visit a biological dentist, there is an excellent chance they would advise you to replace your silver fillings.  There is also a pretty good chance they would recommend to remove any root canals you have as well.  This admittedly is a tough decision to make in some cases.  A few years ago I had a cavity in the back of my mouth that was between my teeth.  While I felt some discomfort at times, none of the dentists were able to spot it on the on the dental x-rays.  And by the time one of the dentists discovered the cavity it was too late.  Because it was towards the back of my mouth I decided I didn’t want a root canal, and I decided to get an extraction.

However, the decision isn’t as easy if someone needs to get a root canal in the front of their mouth.  If one needs a root canal in one of their front teeth and they choose to get an extraction, it probably is a good idea to get this replaced.  Truth to be told, it might also be a good idea to get it replaced if it’s towards the back of the mouth, but it’s arguably even more important to get some type of replacement for an extracted tooth in the front of the mouth.  The two options usually given are bridges and dental implants.  And there are pros and cons with each of these.

A dental bridge involves a non-removable prosthesis which is attached to the surrounding teeth.  The problem with these is that the healthy teeth surrounding the replacement tooth will usually need to be filed.  With regards to dental implants, many people receive these and seem to do fine.  However, there are a few drawbacks.  First, they are very expensive, and if someone doesn’t have dental insurance then they will be spending thousands of dollars on this.  Second, it’s an extensive procedure that will take months to complete.  And finally, most dental implants are made out of titanium, and while many people do fine with these implants, some people will react to titanium.

As a result, if someone currently has a root canal on a tooth that is towards the back of the mouth it might be best to get it extracted and not get a bridge or implant.  On the other hand, if someone has one or more root canals in the front or side teeth, then the decision to get the tooth removed can be more difficult.  Obviously the decision is ultimately up to the person, but regardless of where the root canal is, it probably would be a good idea to seek the opinion of a biological dentist to discuss the different options you have.  After all, while I have experience working with a biological dentist, and have read articles and watched videos conducted by biological dentists who spoke about root canals, I’m of course not a dentist.  And while this doesn’t prevent me from giving my opinion when someone asks about mercury amalgams or root canals, in many cases it is wise to speak with a biological dentist about this.

So hopefully you have a better understanding about the potential risks of dental amalgams and root canals.  A few different studies have shown that mercury can have a negative effect on thyroid health, as it can affect both the immune system, thus causing an increase in thyroid autoantibodies, and it can also have a direct effect on thyroid health.  As for root canals, although there aren’t any scientific studies which show that they are harmful, there also is no proof that they are safe.  And there have been many people with different health conditions who experienced a dramatic improvement in their health upon removing one or more root canals.  Does this mean that everyone with mercury amalgams and root canals should have them removed?  This remains controversial, and while there is no question that many people with thyroid and autoimmune thyroid conditions can benefit from getting these removed, it probably is best to consult with a biological dentist about this.

Many people who have an autoimmune condition follow an autoimmune paleo diet.  This is similar to a “standard” paleo diet, with a few additional restrictions.  While a standard paleo diet allows the consumption of eggs, nuts and seeds, along with the nightshade vegetables, an autoimmune paleo diet excludes these foods.  So essentially the person is allowed to eat meat, fish, vegetables, fruits, certain coconut products, and some spices.  But is this the ideal diet for everyone with Graves’ Disease and Hashimoto’s Thyroiditis?

Before answering this question I’d first like to talk in greater detail about the similarities and differences between a “standard” paleo diet and an autoimmune paleo diet.  Here are the main foods which are allowed on a standard paleo diet:

• Meat (beef, pork, chicken, lamb, etc.) and fish
• Eggs
• Fruits
• Vegetables (including the nightshades)
• Nuts and seeds

Foods which are excluded in a “standard” paleo diet include all grains, legumes, and dairy products.  And of course anything refined should also be avoided.  A standard paleo diet is restrictive with regards to what foods you can eat, although keep in mind that it is nutrient dense, and the goal isn’t to restrict calories.  As a result, while some people do struggle initially to follow a paleo diet, after awhile many of these people do perfectly fine and wish they had followed this sooner.  Many people do better upon avoiding the grains, legumes, and dairy products.  However, when someone also needs to avoid eating eggs, nuts and seeds, along with the nightshade vegetables, this makes it even more challenging.  And of course it’s even more challenging for a strict vegetarian or vegan to follow an autoimmune paleo diet, as they won’t be consuming any meat or fish.

Why Is An Autoimmune Paleo Diet So Restrictive?

Why are so many foods excluded from an autoimmune paleo diet?   Well, there are a few different reasons.  An autoimmune paleo diet excludes foods people with autoimmune conditions are commonly sensitive to such as gluten, dairy, eggs, and corn.  These foods can cause inflammation and/or exacerbate an existing inflammatory condition.  Gluten can directly cause an increase in intestinal permeability (a leaky gut), which is a factor in many, if not all autoimmune conditions.  Other foods such as all grains, legumes, and the nightshade vegetables are restricted because they contain antinutrients which not only affect the absorption of nutrients, but like gluten, can also have a negative effect on the gut.  So it’s not just gluten which potentially can cause a leaky gut, but other foods can potentially cause this as well.  Essentially those foods which are excluded from an autoimmune paleo diet are those foods which can cause gut inflammation and/or an increase in intestinal permeability.

I must admit that I do like the autoimmune paleo diet, and I commonly recommend this to my patients with Graves’ Disease and Hashimoto’s Thyroiditis.  However, there are a few “flaws” with this type of diet:

1) Some people do fine eating one or more of the restricted foods. A good example of this is eggs.  There are many people who are able to eat eggs without a problem, especially egg yolks.  And eggs are an excellent source of nutrients.  With regards to dairy, although I recommend for people to avoid dairy while trying to restore their health, some people with autoimmune thyroid conditions do okay when consuming dairy products.  This is especially true with raw dairy products.  I’ve also had some people with Graves’ Disease and Hashimoto’s Thyroiditis eat small amounts of gluten free grains and still receive good results.  I’ve also had a few patients eat soaked nuts while following the protocol and do well.  The problem is that it’s difficult to predict who will do fine eating some of the restricted foods, which is why many healthcare professionals recommend for all of their patients with autoimmune thyroid conditions to avoid all of these foods.

2) It is possible to be sensitive to the “allowed” foods. Someone can be strictly following an autoimmune paleo diet and then find out that they are sensitive to another food they are eating which is permitted.  For example, they might have a sensitivity to chicken or beef, or even a vegetable or fruit they are eating on a frequent basis.  And while sometimes a person will experience negative symptoms upon eating these foods, other times there won’t be any overt symptoms.  This admittedly can be frustrating, as a person might be following a strict autoimmune paleo diet and might be feeling better from a symptomatic perspective.  But upon doing some retesting they notice their numbers aren’t improving.  For example, someone’s thyroid panel might worsen even though they are feeling better, and  while this doesn’t mean this is due to a food allergen, it is possible.  Perhaps a better example is someone who initially tests positive for an increase in intestinal permeability, and upon getting this retested a few months later the results show that their leaky gut has gotten worse.  Once again, this might not necessarily be attributed to a food sensitivity, although it very well might be.

3) Some people find the diet to be too restrictive. I find this to especially be true with those patients who have Graves’ Disease, although sometimes this will also be the case with those who have Hashimoto’s Thyroiditis.  The problem with Graves’ Disease is that the increased metabolism usually leads to weight loss, which can be extreme in some cases.  While some people with an autoimmune hyperthyroid condition will lose a small amount of weight (i.e. 5 to 10 pounds), others will lose 20 pounds or greater.  As an example, when I was dealing with Graves’ Disease I lost over 40 pounds.  Many people find it difficult to gain weight when dealing with Graves’ Disease, and sometimes this is true with Hashimoto’s Thyroiditis patients as well.

Of course everyone is different, and many of my patients with Graves’ Disease do fine when following an autoimmune paleo diet.  On the other hand, others struggle with the restrictive diet.  Although I try to encourage my patients to stick with the diet, if someone is about to break the diet due to the fear of losing even more weight, I’d much rather them eat some “forbidden” yet healthy foods (i.e. eggs, nuts, seeds, tomatoes, etc.) than completely ruin their diet by eating junk food.  And so there are times when I’m fine with people reintroducing one or more of the excluded foods and see how they do.  When taking this approach I will always have them reintroduce one food at a time for three consecutive days.  For example, if someone wants to reintroduce nuts, I’d have them start with almonds, and preferably soak them overnight to help reduce the antinutrients.  Then I would have them eat some almonds for three consecutive days and to pay close attention to any symptoms they might experience.

Who Should Follow An Autoimmune Paleo Diet?

I currently recommend an autoimmune paleo diet to just about all of my patients with Graves’ Disease and Hashimoto’s Thyroiditis.  However, as I just mentioned, I will make modifications if necessary.  Plus, one needs to consider that autoimmune thyroid conditions are a little bit different than many other autoimmune conditions.  For example, there is the concern of goitrogenic foods, which in my opinion isn’t a huge concern in people with hypothyroid conditions.  But it’s still something to be aware of, and I have discussed this in other articles.  Eating foods rich in iodine such as seafood and sea vegetables is commonly recommended with other autoimmune conditions.  And while many people with autoimmune thyroid conditions do fine eating these foods, some people get worse when eating foods rich in iodine.  I’ll soon be releasing an article which talks about the impact of seafood and sea vegetables on thyroid health.

With regards to the restrictive diet, I’m open to patients reintroducing egg yolks after one month if they’re struggling on the diet.  And while I prefer for patients to avoid grains, if adding a few servings of gluten free grains each week will make someone more compliant with the other recommendations then I’m usually fine with them trying this.  The same thing applies with properly prepared nuts.  This doesn’t mean that everyone will do fine eating these foods, but if they are going to stray from the diet I’d rather them eat a small bowl of rice than a bowl of whole wheat pasta or a slice of pizza. Obviously there are certain foods I won’t allow under any circumstances, although just because I recommend avoiding a specific food doesn’t always mean the patient will follow my recommendations while trying to restore their health.  It’s not uncommon for me to receive an email from a patient who ate something they weren’t supposed to, and sometimes it can be challenging for them to  get back on track with the diet.  Just remember that while you want to continue eating well even after you have restored your health back to normal, you won’t necessarily have to follow a strict autoimmune paleo diet on a permanent basis.

In summary, an autoimmune paleo diet is recommended by many natural healthcare professionals to those people with Graves’ Disease and Hashimoto’s Thyroiditis, as well as those with other types of autoimmune conditions.  Although I commonly recommend this type of diet to my patients with autoimmune thyroid conditions, some people do fine eating some of the restricted foods, and it’s possible to be sensitive to foods which are permitted.  In addition, some people find this diet to be too restrictive and therefore have a difficult time sticking to it.  As a result, there are times when I will make modifications to this diet if necessary, although I do encourage people to try to stick as close to the diet as possible for optimal results.

In the last post I discussed some of the basics of autoimmunity, including why some people develop specific autoimmune conditions such as Graves’ Disease and Hashimoto’s.  I also discussed the role of human leukocyte antigen (HLA) in autoimmunity, as well as the importance of regulatory T cells in preventing autoimmunity.  In this post I will discuss the autoimmunity timeline, which will help you to better understand the different stages of thyroid autoimmunity.

If you read the last post then you probably understand that in order for autoimmunity to develop, a combination of genetic and environmental factors are necessary.  However, having a genetic surface marker and being exposed to an environmental trigger usually isn’t enough to lead to an autoimmune condition.  If this were true, then many more people would develop autoimmunity, as many people with these genetic markers are exposed to one or more environmental triggers, yet don’t develop an autoimmune condition.  And so other factors are necessary, such as a decrease in regulatory T cells, and perhaps an increase in intestinal permeability (a leaky gut).  Healthy mitochondria are also important, as several mitochondrial proteins have been implicated as regulators of apoptosis in the immune system that are required for prevention of autoimmunity (1).  I’m sure there are other factors as well which we’re unaware of at this time.

Understanding The Autoimmunity Timeline

But in addition to understanding what factors can lead to the development of an autoimmune thyroid condition such as Graves’ Disease or Hashimoto’s Thyroiditis, it is also beneficial to understand the autoimmunity timeline.  After all, most chronic health conditions take many years to develop.  And then when they do develop, it can take many more years for symptoms to manifest.  So let’s go ahead and look at different stages of autoimmunity:

Stage #1: Pre-autoimmunity. This is the most critical time to prevent an autoimmune condition from developing.  As I mentioned numerous times in the last post, having a genetic marker and being exposed to an environmental trigger usually won’t cause an autoimmune condition without other factors being present.  I mentioned a decrease in regulatory T cells as being a factor.  A leaky gut can also be a factor in some, if not all autoimmune conditions.  Mitochondrial dysfunction can also be a factor.  But it usually takes years for people to develop a significant decrease in regulatory T cells, a leaky gut, or mitochondrial dysfunction.

So the goal in most people should be to do whatever is necessary to have a healthy immune system, a healthy gut, and healthy mitochondria.  Obviously there is a lot of overlap, as someone can’t have a healthy immune system without having a healthy gut.  And one also needs healthy mitochondria to have a healthy immune system.  Of course there are many factors which can have a negative effect on the these areas, such eating a poor diet with a lot of refined foods and sugars, consuming common allergens such as gluten and dairy, being exposed to prolonged chronic stress, getting insufficient sleep for many months or years, toxic overload, an acute or chronic infection, etc.

As you can see, there are a lot of different factors which can  set the stage for autoimmunity.  Keep in mind that in most cases, if someone has a genetic marker for an autoimmune condition, a SINGLE exposure to an environmental trigger isn’t going to cause autoimmunity.  After all, most people deal with chronic stress these days, everyone is exposed to toxins, etc.  However, if someone is FREQUENTLY exposed to one of more of these factors, then over time this can cause a decrease in regulatory  T cells, lead to a leaky gut, and/or cause mitochondrial dysfunction, and set the stage for autoimmunity.  So perhaps the best way to think of it is that we’re all exposed to one or more of these triggers, but it’s the frequent exposure to these triggers over time which increases the likelihood of someone developing an autoimmune condition.

Stage #2: Silent autoimmunity. In this stage, autoimmunity has already been triggered.  However, there has been very little or no tissue damage, and therefore no symptoms are present, and the blood test results are negative at this point (i.e. normal TSH and thyroid hormone levels).  This is what happens with pretty much all autoimmune conditions.  However, the duration of this stage will vary greatly depending on the autoimmune condition.  For example, if someone has elevated thyroglobulin antibodies, which are associated with Hashimoto’s Thyroiditis, then there is a good chance that these will cause damage to the thyroid gland.  And if nothing is done to address the autoimmune component then the damage can be so extensive that the person might reach the point where they need to take thyroid hormone medication.

However, the person with Hashimoto’s Thyroiditis can be in the “silent” phase for many years.  With Graves’ Disease it may be a different story, as my guess is that the silent phase isn’t nearly as long.  And the reason for this is because when dealing with autoimmune conditions which involve tissue damage (i.e. Hashimoto’s, multiple sclerosis), the tissue damage can be minimal for many years, and so in some cases it can take a long time for the person to develop symptoms, which I’ll discuss next in phase #3.  Graves’ Disease is different from many other autoimmune conditions in that it doesn’t necessarily involve tissue damage.  The TSH receptor antibodies don’t seem to damage the TSH receptors, but apparently stimulate them, which results in the release of thyroid hormone.  And the symptoms of Graves’ Disease are usually more noticeable initially than those of many other autoimmune conditions.  Although in some cases it might take many years between the time someone develops Graves’ Disease autoantibodies and the time they develop hyperthyroid symptoms, in my opinion this is less likely to happen.

Stage #3.  Symptoms present with some tissue loss. Although stage #2 might involve some tissue damage, it’s very minimal, and it’s in stage #3 where this damage reaches the point where the person begins to experience symptoms.  Once again, it can take many years for this to happen.  So with the person who has Hashimoto’s Thyroiditis, what frequently will happen is that due to the tissue damage to the thyroid gland, the person will begin to experience some symptoms.  As a result, they might visit their medical doctor, who will run a thyroid panel, and at this point the TSH might be elevated, or it still might look fine.  Obviously one can’t rely on the TSH alone, but unfortunately this still is what frequently happens at many medical doctor’s offices.  And if the TSH is within the lab reference range, regardless of how the person feels, they might be told that everything is fine since the tests are within the normal reference range.  On the other hand, a smart doctor will run a more comprehensive panel which not only evaluates the thyroid hormone levels (which probably will also be normal), but they will also look at the thyroid antibodies, in this case thyroperoxidase antibodies and thyroglobulin antibodies.

Unlike Hashimoto’s Thyroiditis, when someone with Graves’ Disease is experiencing symptoms there usually is a correlation with the blood test results.  So for example, if someone has elevated TSH receptor antibodies and begins experiencing hyperthyroid symptoms (i.e. increased pulse rate, heart palpitations, tremors, etc.) then there is a good chance the TSH will be depressed and/or the thyroid hormone levels will be elevated, although this isn’t always the case.  As I’ve mentioned in other articles and posts, for some people with Hashimoto’s Thyroiditis and Graves’ Disease, the thyroid antibodies will show up as being negative when doing a blood test.

Stage #4.  Symptoms are present and there is greater tissue loss. This is the “final” stage of autoimmunity, as it’s when the person’s symptoms will usually worsen, there will be greater tissue loss, and the blood tests will be positive.  Although some people might be diagnosed with an autoimmune thyroid condition in stage #3, especially those with Graves’ Disease, many people with Hashimoto’s Thyroiditis won’t be diagnosed until they reach stage #4.  And the reason is because most of the symptoms of Hashimoto’s Thyroiditis can’t be measured.  In other words, if someone with Hashimoto’s Thyroiditis is in stage #3 and presents with negative blood tests, yet they are experiencing symptoms such as fatigue, brain fog, and hair loss, these symptoms can’t be measured.  On the other hand, if someone with Graves’ Disease is in stage #3 they very well might have an elevated heart rate, which will be detected almost immediately when the vital signs are being taken.  Getting back to Hashimoto’s Thyroiditis, if someone is in stage #3 and has negative blood tests, often times doing a good case history and conducting a thorough physical exam can determine if  someone has a thyroid condition.  But this isn’t always the case, and unfortunately, many medical doctors see such a high volume of patients that they won’t perform a thorough physical exam if all of the tests look good.

In summary, different autoimmune conditions are characterized by different types of autoantibodies.  There are a few factors which will determine whether autoimmunity will develop, as a genetic marker is usually present, and an environmental trigger is also necessary.  However, other factors are usually necessary to set the stage for autoimmunity, such as a decrease in regulatory T cells, a leaky gut, and/or mitochondrial dysfunction.  So in order to prevent autoimmunity, or restore the health of someone who already has an autoimmune condition it would appear to be necessary to have high numbers of regulatory T cells, a healthy gut, and healthy mitochondria.  I also discussed the four stages of autoimmunity, which should also help you to understand the progression of most autoimmune conditions.

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.