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.

The primary reason why people choose to follow a natural treatment protocol is to avoid the risks associated with conventional medicine.  Although there is a time and place for drugs, surgery, and other conventional treatment methods, these methods of course don’t do anything to address the cause of the problem.  However, not everyone who follows a natural treatment protocol will receive optimal results.  Many times this is due to the patient not being compliant, although some will do an excellent job of following the doctor’s recommendations and still won’t show much improvement.

When this happens it becomes frustrating to both the doctor and patient.  Some doctors take pride in dealing with “tough cases”, and although I do work with a lot of tough cases, I think most doctors would prefer those cases when someone gradually improves without any setbacks.  Don’t get me wrong, as I like dealing with challenges, and many cases of thyroid autoimmunity can be complex.  However, I still get frustrated when someone is strictly following my recommendations but doesn’t receive optimal results.  There can be numerous reasons why someone doesn’t receive optimal results despite following the recommendations of their doctor, but when this happens it usually comes down to one or more of the following five factors:

1. The patient is reacting to a food allergen or antinutrient. If someone’s health isn’t improving then one of the first things they need to do is reevaluate their diet, as there is a good chance one or more food allergens or antinutrients are responsible for the person not progressing.  This can occur even if the person is eating a healthy diet.  Many people reading this are aware that gluten and dairy are common allergens, and thus if someone has been consuming gluten and/or dairy while following a natural treatment protocol and aren’t receiving optimal results, then these allergens definitely need to be COMPLETELY avoided.  This is true even if you haven’t noticed any negative symptoms upon consuming gluten and dairy.  And yes, even if you have received testing which showed that you didn’t react to these foods you still want to cut them out.

There are times when I’m working with someone who isn’t progressing as expected, and they have been strict about avoiding gluten and dairy.  Many times they have  avoided these allergens for a few months or longer.  If this is the case then they need to look at the possibility of other foods causing a negative reaction, such as corn, soy, eggs, and even gluten-free grains.  For example, someone might have eliminated gluten, dairy, corn, and soy, but after doing an elimination diet find out they have a sensitivity to rice.  And if they were consuming rice, even a few times per week, then this can cause gut inflammation and affect their recovery.  Obviously this is just an example, but it of course is possible to have a negative reaction to rice, as well as other gluten free grains.

If someone has a leaky gut, then eating nuts, seeds, and legumes can slow down their progress.  This usually isn’t due to a food intolerance, as these all have antinutrients which interfere with the absorption of minerals.  In addition, antinutrients such as lectins can cause further damage to the gut.  And so if someone has avoided all of the common allergens, but is still eating nuts, seeds, and/or legumes, then this can affect one’s recovery.  Some people also react to the nightshade family of foods.  These include tomatoes, eggplant, white potatoes, and most peppers.  These also have substances which can cause a leaky gut.

How can someone tell if they have a food allergy or intolerance?  It can be challenging to tell if someone has a food allergy or intolerance.  As for a food allergy, this can be detected through IgE testing, and is usually conducted in an allergist’s office.  Besides the fact that IgE testing isn’t always accurate (1) (2), delayed food intolerances are far more common.  And while there are numerous food intolerance panels available, none of these are completely accurate either.  This doesn’t mean that they don’t have some value, but false negatives are common, and if someone has a leaky gut this can also affect the results.

2. There is an underlying infection. If someone has ruled out food allergies and intolerances as a potential cause of their problem, and have eliminated the antinutrients I mentioned, then they will want to try to see if they have some type of infection.  Some healthcare professionals will initially do testing for infections, as a lot of functional medicine doctors will run a comprehensive stool panel to see if there are any bacterial infections, yeast, or parasites.  Although I do run a comprehensive stool panel every now and then, I don’t initially do this testing on all of my patients because 1) they are very expensive, and 2) they almost always come out negative for the presence of pathogenic bacteria, yeast, and parasites.  Sure, the test might reveal gut inflammation, or a deficiency of short chain fatty acids, but I usually assume that most of my patients have gut inflammation, and while it’s also common to have an imbalance of the short chain fatty acids, in my opinion it’s not worth a few hundred dollars to test for this.

I’m not being critical of those doctors who do this type of testing on all of their patients.  Quite frankly, it probably is a good idea to do such testing on someone who has obvious gastrointestinal symptoms.  The problem is that the lack of gastrointestinal symptoms doesn’t mean that the person doesn’t have pathogens in the gut, which is why some healthcare professionals choose to have all of their patients obtain this test.  On the other hand, a negative test for pathogens doesn’t necessarily mean the person doesn’t have an infection.  For example, I’ve had patients with symptoms of a yeast infection test negative for such an infection on a stool panel, and then not too long after this have a  test for yeast show up positive on a blood or urine test.  Similarly, parasites aren’t always detected in the stool.  In fact, this is the main reason why many labs will offer a 3 or 4-sample stool test.  Collecting a stool sample on three or four different days will reduce the likelihood of a false negative, although false negatives still remain a possibility, even with testing multiple stool samples on different days.

Plus, most comprehensive stool panels won’t test for all of the pathogens which can be detected in the stool.  For example, many labs offer both H. Pylori and C. difficile as “add-ons”, and other bacteria might need to be added as well.  This of course means that it can cost a lot more money if you want to test for everything the lab offers. In addition, one also needs to keep in mind that not all chronic infections can be detected in the stool.  Some examples include Lyme disease, Epstein Barr, and Cytomegalovirus.  It would be great if there was a lab which offered a comprehensive panel for infections which included both blood and stool testing, and tested for most of the common pathogenic bacteria, viruses, fungi, and parasites.

So that brings up the question, “is there a surefire method for detecting a chronic infection?”.  Unfortunately the answer to this question is “no”.  And so there are a few options.  One option is to do as much testing as possible, including blood tests and stool testing.  The problem is that if you don’t have health insurance then doing all of this will be very expensive, and this still might not completely rule out an infection.  What approach do I take?  Well, I think it’s a good idea to start with the basics, such as a complete blood count with differential.  This of course won’t determine if someone has a specific infection, but it sometimes can give an idea if someone is having an acute or chronic bacterial or viral infection, and sometimes even a parasitic infection if the eosinophils are elevated.  If this test reveals a potential infection then I will consider further testing.  If someone has overt gastrointestinal symptoms then I might do a stool panel, although I’m well aware of the limitations I mentioned above.  If I think there’s a strong possibility someone has an infection I might just put them on a dysbiosis protocol and see how they respond.  Or I might run an organic acids test, which looks at certain markers of dysbiosis.

3. Chronic stress is an issue. I probably should have listed this first, as stress is a common reason why many people don’t progress as expected.  Although some healthcare professionals might frequently use chronic stress as an excuse for a person’s symptoms or lack of progress, the truth is that chronic stress does affect the biochemistry.  In other words, the emotional component of stress can have a dramatic effect on someone’s health.  And for someone who is dealing with a thyroid or autoimmune thyroid condition, the fact that they have a chronic health condition only increases their stress levels.  It’s not so much the stress itself that is a problem, as everyone deals with acute and chronic stressors.  What’s important is the person’s perception of the stressor, and it’s essential for people with thyroid and autoimmune thyroid conditions to truly become an expert in handling stress if they want to restore their health, and maintain their health thereafter.

In fact, I’ve had some patients get to the point where they were symptom free and all of the labs were negative, but then a very stressful situation came along, and they relapsed.  This might sound discouraging to some people reading this, as you might be thinking to yourself “why would I want to follow a natural treatment protocol if there’s a chance that being exposed to a stressor will result in a relapse?”  After all, everyone will eventually have to deal with an acute or chronic stressor such as financial problems, a divorce, a trauma, the loss of their job, a death of a family member or close friend, etc.  While it’s just about impossible to prepare for all of the different stressors you will eventually have to deal with, if you become an expert in managing the stress then you will do a much better job of handling these future stressors.

It really is no different than eating well, as while some people are able to change their eating habits in one day, for others it takes time to accomplish this.  Some people need to make gradual changes in their diet over a number of weeks or months before they are eating mostly whole foods, and minimizing their consumption of refined foods and sugars.  The same concept applies when it comes to improving your stress handling skills, as it takes time to become an expert in managing stress.  Truth to be told, I still don’t consider myself to be an “expert” when it comes to stress handling, although I’ve made some great strides over the years.  If stress is an issue, you need to make stress management a priority if you want to receive good results. And the only way to truly become a master at handling stress is to block out some time every day to work on stress management.  I discussed this in greater detail in my blog post entitled “Blocking Out Time To Manage Your Stress Is Essential“.

4. Genetic polymorphisms. Although lifestyle and environmental factors seem to play a greater role than genetics in the development of most chronic health conditions, one still can’t dismiss the genetic component.  And when someone isn’t responding as expected to a natural treatment protocol, there is a possibility that a genetic polymorphism is the reason behind this.  A genetic polymorphism is a genetic defect that commonly affects a certain percentage of the population.

Having certain genetic polymorphisms can affect phase 1 and phase 2 detoxification, the immune system response, the metabolism of folate, vitamin and hormone receptors, and even DNA repair enzymes.  So for example, a toxin such as mercury might have triggered an autoimmune response in a person with a polymorphism affecting the detoxification pathways.  This person might have received months of chelation therapy, but still hasn’t noticed an improvement in their symptoms because their body isn’t doing a good job of eliminating the mercury due to the genetic polymorphism, which in turn is affecting the detoxification pathways.

I also mentioned how certain genetic polymorphisms can affect the immune system response.  Proinflammatory cytokines are a factor in autoimmunity, and someone can have genetic polymorphisms of these cytokines.  I’ve spoken about the Th1 and Th2 pathways in past articles and blog posts, and you can have polymorphisms of Th1 cytokines such as IL-2 and TGF-B1, and Th2 cytokines such as IL-6 and IL-10 (3).  So if someone isn’t responding then it’s possible that they have one or more polymorphisms which are affecting their progress.

But how can someone tell if they have certain genetic polymorphisms?  Testing is available for the more common polymorphisms.  For example, many people reading this are familiar with the MTHFR polymorphism, and many labs offer testing for this.  The company Genova/Metametrix offers testing for certain polymorphisms.  For example, they have an “ImmunoGenomic Profile”, which will measure some of the Th1 and Th2 cytokines such as TNF-alpha, IL-4, IL-6, IL-10, etc.  They also have a “DetoxiGenomic Profile”, which tests for a few dozen of the most common polymorphisms relating to detoxification.  I can’t say I routinely do this type of testing on my patients, but it’s something to consider if someone isn’t responding as expected.

5. Toxic overload. Many of my patients initially will do things for detoxification.  However, while this of course is beneficial, many times the person needs to be more aggressive in eliminating toxins from their body.  First of all, we need to keep in mind that different people are exposed to a different amount of toxins.  And while there are some tests available to measure the levels of certain toxins, it’s impossible to measure ALL of the different toxins.  So for example, if someone obtains a hair analysis or a urine test to look at heavy metals, and if such testing reveals low levels of mercury, arsenic, and other toxic metals, this doesn’t necessary mean that they have low levels of other types of toxins.

A second factor to consider is that some people eliminate toxins better than others.  As a result, if two people are exposed to the same level of toxins, one person might do a very good job of eliminating  toxins, while the other person might not do a good job of eliminating toxins.  There can be a few reasons for this.  One reason could be that one person has higher levels of glutathione, which plays an important role in the detoxification pathways.  Genetics can also be a factor.  As I mentioned earlier, if someone has a certain genetic polymorphism then they might not be able to eliminate toxins as efficiently as another person, and this also can be related to glutathione production.

A third factor to consider is that people react differently to toxins. So for example, one person might have a severe reaction to a small amount of a specific toxin, while another person might not react to a large amount of the same toxin.  In the past I’ve mentioned the Chemical Immune Reactivity Screen from Cyrex Labs.  Although I admit this isn’t a test I commonly order, it’s a very interesting test, as it measures the immune system response to some of the more common toxins, such as mercury, arsenic, lead, formaldehyde, bisphenol A, parabens, and isocyanate.

In any case, if someone follows a natural treatment protocol recommended by their doctor and still isn’t receiving optimal results, toxins need to be considered.  And it’s also important to keep in mind that some people have more than one health issue going on simultaneously.  For example, it’s common for people with Graves’ Disease and Hashimoto’s Thyroiditis to have a leaky gut, along with intestinal dysbiosis.  However, their bodily tissues might also be overloaded with toxins.  And so when someone has a leaky gut I will focus on repairing the gut and correcting any dysbiosis.  Once the gut has been healed and the dysbiosis has been corrected, if the person is still symptomatic and/or still has elevated thyroid antibodies, then toxins need to be considered.  Although I might give some recommendations to help the person boost glutathione levels while repairing the gut, this might not be sufficient.

In some of my past articles and blog posts I’ve mentioned Dr. Walter Crinnion, as he is a naturopath who focuses on detoxification.  He has been in practice for around 30 years, and while I was working towards my masters of science in nutrition degree he was the instructor for my biotransformation and detoxification course.  He is a big proponent of both sauna therapy and colon hydrotherapy.  In fact, he said if he had to choose one method of detoxification it would be colon hydrotherapy.  Although colon hydrotherapy can be very effective in removing toxins, the problem is that you don’t want to receive colon hydrotherapy if you have a leaky gut.  And so you first need to correct the leaky gut, and then if necessary receive colon hydrotherapy.  While I personally don’t recommend colon hydrotherapy to most of my patients, it can be an excellent method of eliminating toxins.

Even if you get aggressive and utilize a combination of supplements (i.e. milk thistle, NAC, etc.), sauna therapy, and colon hydrotherapy to eliminate toxins, it can still take many months to notice results.  In his book Clean, Green, and Lean Dr. Crinnion talks about how he commonly sees the autoantibodies of patients normalize after putting them on a comprehensive program to eliminate toxins.  The downside is that this does take time, and even he admits that for some people it can take a couple of years before they receive optimal benefits from a detoxification program.

In summary, it can be frustrating when someone is strictly following the recommendations of their doctor, yet for some reason isn’t progressing as expected.  There are numerous reasons why someone’s health doesn’t improve, but five common factors include 1) the person is reacting to a food allergen or antinutrient, 2) there is an underlying infection, 3) chronic stress is an issue, 4) they have one or more genetic polymorphisms, and 5) toxic overload.  It can be challenging to find out which of these factors is responsible for the patient’s lack of progress, but doing so is of course necessary to help them restore their health.

More and more people are working with natural healthcare professionals.  And it’s becoming more common for people to see more than one natural healthcare professional.  For example, someone might see a chiropractor to receive spinal adjustments, get deep tissue massages from a licensed massage therapist on a regular basis, see a biological dentist for their oral health, etc.  And of course there is acupuncture.  Over the years I have had many people with thyroid and autoimmune thyroid conditions ask me if acupuncture can benefit their health, which is why I decided to write this blog post.

Before talking about whether or not acupuncture can help with thyroid and autoimmune thyroid conditions, let’s first discuss some of the basics of acupuncture.   As most people reading this know, acupuncture involves using fine needles which are inserted at specific locations of the body, which are known as acupuncture points (1).  These points are linked together in a network of “meridians”, which run longitudinally along the surface of the body (1).  There are 20 meridians, and 12 of these are referred to as “primary meridians”, and these relate to specific organs (2).  There is also something called “Qi”, which is probably best described as an energy that flows through the meridians, and as described by Dr. Yin Lo in an article he wrote in Acupuncture Today, “Qi is what carries the effect of acupuncture from one acupoint to other parts of the body” (3).

Acupuncture affects all of the systems of the body, including the immune system, gastrointestinal tract, and the endocrine system.  It helps to promote blood flow (4), stimulates the release of neurotransmitters and endorphins which help to decrease pain (5), helps to reduce stress (6), and as I’ll mention later in this post, it can modulate the immune system.

What Are The Benefits of Receiving Acupuncture?

There are many different benefits of acupuncture.  And if you search through the literature you’ll see many studies which show that acupuncture can help people with a wide range of different health conditions.  Here are just a few conditions acupuncture might be able to help with:

Acute and chronic pain. There are many different studies which show that acupuncture can benefit people with chronic pain.  One systematic review compared the effectiveness of acupuncture with other treatment methods for alleviating pain due to osteoarthritis of the knee (7).  This review involved 114 trials and 9,709 patients, and they concluded that acupuncture can be considered to be one of the more effective physical treatments for alleviating osteoarthritis knee pain in the short term.  However, the authors did admit that a lot of the evidence is still of poor quality, and therefore more research is probably needed in this area.  There is also is evidence that acupuncture can be more effective than medication for pain relief for both acute and chronic low back pain (8) (9).  Randomized controlled trials have shown that acupuncture has short-term effectiveness in the treatment of neck pain (10).

Infertility and polycystic ovarian syndrome (PCOS). Acupuncture can help with some cases of female infertility (11) (12). With regards to PCOS, a literature review in 2010 showed that acupuncture may help people with PCOS by increasing blood flow to the ovaries, reducing ovarian volume and the number of ovarian cysts, increasing insulin sensitivity and reducing cortisol levels (13).  A recent randomized controlled trial involving 32 women with PCOS showed that repeated acupuncture treatments resulted in higher ovulation frequency, and that ovarian and adrenal sex steroid serum levels were reduced with no effect on LH secretion (14).

Asthma. One randomized controlled study showed that acupuncture performed in accordance with the principles of traditional Chinese Medicine showed significant immune-modulating effects and that asthma patients can benefit from acupuncture treatment (15).  However, there are other studies which don’t show benefits of acupuncture in the management of certain cases of asthma (16).

Cancer patients receiving chemotherapy. I came across one study involving 45 patients with cancer who had acupuncture administered one day prior to them receiving chemotherapy (17).  The study showed that acupuncture can have positive effects in cancer treatment patients who experience nausea, vomiting, pain, insomnia, and anxiety as a side effect of chemotherapy.  And so while I’m not a big fan of chemotherapy, those who do receive this might want to consider getting one or more acupuncture treatments beforehand.

Migraines. There have been numerous studies showing that acupuncture can benefit some people with migraines, although there also have been studies which have shown that acupuncture doesn’t have a greater effect than sham acupuncture.  A randomized controlled trial involving 175 patients with migraines showed that verum acupuncture is more effective than sham acupuncture in reducing the discomfort of an acute migraine, as well as in preventing migraine relapse or aggravation (18). Another randomized controlled trial involving 480 patients with migraines showed that acupuncture had a clinically minor effect on migraine relief compared with sham acupuncture (19).  A few other studies showed that acupuncture was no more effective than sham acupuncture in reducing migraine headaches (20) (21).

Acupuncture and Thyroid Health

There aren’t a lot of clinical trials involving acupuncture and thyroid health, although I did come across a few of them:

Acupuncture and Subclinical Hypothyroidism. One study looked at the influence of acupuncture on the quality of life in patients with subclinical hypothyroidism (22).  The study involved 27 female patients who were found to have elevated TSH levels, along with normal levels of thyroid hormones.  Twenty of the 27 patients who underwent the treatment showed a significant decrease in the severity of clinical symptoms, and the TSH levels fell down to the physiological values.  The study concluded that acupuncture may be regarded as an alternative to substitution therapy of subclinical hypothyroidism.  Of course this is just a single study involving only 27 people, and without question more research needs to be done on this.  With that being said, the results still were encouraging, and it might be worth for some people with subclinical hypothyroidism to see an acupuncturist.  Plus, remember that most people with subclinical hypothyroidism have Hashimoto’s Thyroiditis, and the improvement in these patients might suggest that receiving the acupuncture treatments modulated the immune system, which I’ll discuss shortly.

Acupuncture and Thyroid Eye Disease. One study compared the therapeutic effect and side effects on hyperthyroid exophthalmos with the combination of acupuncture and medication, and with medication only (23).  It involved fifty two cases, and it showed that the improvement of thyroid eye disease was better in the acupuncture and medication group than in the medication group alone. Hyperthyroid exophthalmos is typically due to the TSH receptor antibodies attacking the tissues of the eye, and so this also suggests that acupuncture might modulate the immune system, in this case benefiting people with Graves’ Disease.

Acupuncture and benign thyroid nodules. This study involved 46 patients with thyroid adenoma who were treated by electrochemical treatment during acupuncture anesthesia (24).  After three months to four years follow up the cure rate was 97.8%.  In addition to this being another small study, it was conducted in 1994, and so it would be nice to see larger, more current studies.

Acupuncture and autoimmunity. I did not come across any specific studies which showed that acupuncture can help with Graves’ disease or Hashimoto’s Thyroiditis.  However, acupuncture can modulate the immune system (25) (26), and thus it potentially can benefit people with immunological conditions such as those with allergies, infections, immunodeficiency syndromes, and autoimmune conditions.

Of course the lack of clinical trials related to thyroid health doesn’t mean that acupuncture can’t be beneficial for those with thyroid and autoimmune thyroid conditions.  I’ve had numerous patients see an acupuncturist and report back a positive improvement in their condition.  One thing to keep in mind is that while acupuncture might benefit people with autoimmune thyroid conditions such as Graves’ Disease and Hashimoto’s Thyroiditis by modulating the immune system, in most cases it won’t do anything to address the trigger.  For example, if someone has a leaky gut due to a gluten intolerance or an H. Pylori infection, receiving acupuncture probably isn’t going to heal the leaky gut, and most likely wouldn’t eradicate the H. Pylori infection (although by modulating the immune system it might improve the chances of eradicating H. Pylori when combined with other methods).  With that being said, acupuncture when used in combination with other natural treatment methods can potentially benefit those people with thyroid and autoimmune thyroid conditions.

In summary, acupuncture involves acupoints and meridians, which relate to specific organs.  Qi is an energy that flows through the meridians, and carries the effect of acupuncture from one acupoint to other parts of the body.  Acupuncture can help people with many different conditions, including those with acute and chronic pain, infertility, PCOS, asthma, patients receiving chemotherapy, migraines, and other conditions.  There are a few small studies which show that acupuncture can benefit thyroid health, probably by modulating the immune system in those people with Graves’ Disease and Hashimoto’s Thyroiditis.  And while acupuncture alone usually won’t restore someone’s health back to normal, many people with thyroid and autoimmune thyroid conditions can benefit from receiving acupuncture when combined with other natural treatment methods.