For those people with a thyroid or autoimmune thyroid condition, following a natural treatment protocol can be a big challenge.  Probably the greatest challenge during this time is sticking to the diet.  Although many people are disciplined and don’t cheat while trying to restore their health, others can’t resist certain temptations.  Obviously there are other temptations besides birthday cake, but every month it seems as if I get at least one or two emails from patients telling me that they “gave in” to birthday cake.  And since my birthday is in October I figured it was a good time to write a post on this topic.

On the surface it might seem silly to write a post which is focusing on birthday cake.  However, this post isn’t just about avoiding birthday cake, but it’s about trying to avoid all other temptations which can affect your recovery.  There are numerous situations which make it very difficult to stick with the diet while following a natural treatment protocol.  In addition to birthday parties, another big challenge is dealing with the holiday season, as during this time I also receive a lot of emails about sticking to the diet.  And of course it’s common to struggle with one’s diet while going on vacation.  So there are numerous scenarios which can make eating well even more challenging.

The Emotional and Physiological Aspects of Eating Well

Many people have strong cravings which makes it challenging to eat well.  And in these cases it’s not always just a matter of having the “willpower” to resist eating certain foods.  For example, if someone has blood sugar imbalances then they most likely will have a great challenge avoiding eating certain foods such as refined carbohydrates.  Similarly, if someone is addicted to caffeine then it can be a challenge to go “cold turkey”.  Sure, without question there is also an emotional component behind this, as I’ve known numerous patients who have successfully given up eating sweets and/or coffee immediately, and not slowly wean off of these.  But one can’t deny that there is also a physiological aspect when it comes to overcoming cravings.

The first thing someone needs to do is to make up their mind that they want to change their eating habits.  Once they have made this commitment the next step is to correct the physiological aspect of any cravings they have.  With regards to sugar cravings, in addition to avoiding the refined sugars, and minimizing the consumption of healthy sugars as those present in fruit, additional support might be required.  Some nutrients and herbs which can help to balance blood sugar levels and increase insulin sensitivity include chromium, alpha lipoic acid, and gymnema.  As for how to overcome caffeine cravings, for some people this can be more challenging, but one strategy is to switch from drinking coffee to another beverage which has some caffeine, but not as much, such as green tea.  Not only does green tea have a lower amount of caffeine than coffee, but it also has an ingredient called theanine, which counteracts the effects of caffeine.

The Key Is Setting Yourself Up For Success

Once you have decided to make the commitment to eat well, in addition to correcting any physiological aspects of cravings, you also want to do whatever you can to set yourself up for success.  Here are some tips to help accomplish this:

1. Try not to bring junk food into your home. It obviously is more challenging to resist certain temptations if you have easy access to them.  As a result, whenever you go grocery shopping you ideally want to avoid buying junk food, and only buy healthy, whole foods.

2. Get your friends and family on your side. It will be easier to eat well if your friends and family members are encouraging you to do so.  Many people might not understand why you are choosing to follow a natural treatment protocol, but even if this is the case, there shouldn’t be any arguments about wanting to live a healthy lifestyle.  One of the biggest challenges is trying to follow a strict diet when the spouse or significant other is freely eating whatever he or she wants.  This is especially true when the refrigerator and cabinets are filled with foods you are trying to avoid.  Although it might be difficult to convince your spouse and children to follow the same diet you’re following, at the very least I would try to incorporate healthier options.

3. Don’t put yourself in a position to cheat. This is especially important when first beginning a natural treatment protocol, but it can also be true months after starting one.  For example, if there is a birthday party you are invited to, then pass on going to it.  And if it’s a party of a close friend or family member and you feel you need to go, mention your strict diet to the person running the party ahead of time, and consider leaving right after they blow out the candles and before they have a chance to shove a piece of cake into your face.  In addition, don’t go to the party hungry, as if the party is around lunchtime, eat lunch before you go to the party.  And the same thing applies with a party that is being held around dinnertime.  Even though I’m focusing on birthday parties, this obviously applies to other types of parties as well.

4. Consider confronting your temptations. I realize that this contraindicates the previous tip about not putting yourself in a position to cheat, but sometimes implementing this strategy initially can help a great deal.  When I was close to graduating from chiropractic school I went on my very first detoxification.  While following the detox there was a seminar I wanted to attend in a different state (Orlando Florida), so a friend and I drove to Orlando, and his parents lived in Daytona Florida, which is about one hour away from Orlando.   We stayed at his parent’s house for one night, and the first night we were there everyone wanted to go out for pizza, including my friend, who wasn’t on a detox.

To make a long story short I went to the pizza place with my friend and his family, and I ordered a plain salad.  I’m pretty sure I was also avoiding meat at the time, so if I recall correctly I just ordered a plain salad…no chicken, no croutons, no salad dressing.  When they brought out the pizza I really thought about breaking the detox, or at least just indulging for the night and then getting back on track.  But I resisted the temptation, and when I was diagnosed with Graves’ Disease and followed the natural treatment protocol, I used the “pizza story” as my personal motivation to eat well without cheating.

This probably won’t work for everyone, but many people who follow a natural treatment protocol will indulge right before becoming strict with their diet.  In other words, they will eat a lot of junk food for a few days or weeks before starting the protocol.  You might want to consider putting yourself in a situation similar to my “pizza incident”, as within the first few days of beginning the natural treatment protocol you might want to consider “confronting your primary weakness” with regards to junk food, yet do everything you can to not give into the temptation.

Having Birthday Cake In The Future

As I’ve mentioned in previous articles and blog posts, once someone has restored their health back to normal they can usually indulge every now and then without having a serious setback.  Of course there are exceptions to this, as for example, if someone has Celiac disease then they really should avoid gluten permanently.  The good news is that there are plenty of gluten free options for dessert.  Which brings up another point, as when someone is following a natural treatment protocol which overlaps with their birthday, some will wonder why they can’t just have healthier type of cake, such as a gluten free cake without any artificial ingredients.  I get this question asked during the holidays as well, as every year a few people will ask me around Thanksgiving if they can have gluten free pecan or pumpkin pie.

Obviously I’d rather my patients have a gluten free piece of cake which doesn’t have any artificial ingredients when compared to a cake which has gluten and/or artificial ingredients.  But even if it’s gluten and dairy free, cake is still not considered to be healthy, and eating the “healthier” cake will still spike up your blood sugar levels.  I’m not suggesting that having a single piece of gluten free cake while following a natural treatment protocol will cause someone to relapse.  To be honest, some people following a natural treatment protocol would do fine eating a single piece of gluten free cake during Thanksgiving.  One problem is that many people won’t stop at one piece of gluten free cake.  In addition, everyone is different, and so for some people, having single piece of cake might be an issue, even if it is a “healthier” version.

When I followed a natural treatment protocol for my Graves’ Disease condition, I had to deal with eating well on my birthday, as well as during the holiday season.  It wasn’t easy, but I of course realized that indulging for a few minutes on my birthday or on Thanksgiving wasn’t worth the potential setback.  When I was following a natural treatment protocol, perhaps I could have had a gluten free piece of birthday cake without a problem, but I didn’t want to take the chance.

In summary,  many people find it very challenging to eat well when following a natural treatment protocol.  And even though most people feel better when making dietary changes, some people still have problems resisting certain temptations while trying to restore their health back to normal.  The first thing someone needs to do is to make the commitment to eating well.  They also need to do some things to set themselves up for success, such as not bringing junk food into their home, getting their family members and friends to understand the importance of them being strict with the diet, not putting themselves in a position to cheat, and to consider confronting their temptations.  Also keep in mind that while you want to be strict while following a natural treatment protocol, you probably will be able to eat birthday cake again in the future, after you have restored your health back to normal.

Over the years I’ve had numerous patients ask me about the potential benefits of maca, also known as Lepidium meyenii.  Of course there are many beneficial herbs that people can take, such as ashwagandha, eleuthero, rhodiola, etc.  However, this doesn’t mean that everyone with a thyroid or autoimmune thyroid condition should take all of these herbs.  And to be honest, while I’ll be discussing some of the benefits of maca root in this blog post, I can’t say that I commonly use this herb in my practice, although over this past year I have been recommending it more frequently to my patients.

Maca is an Andean plant that belongs to the brassica family. Some of the more common uses is to help improve sexual function and fertility (1) (2).  It seems that maca can be beneficial for both men and women.  For example, one small study showed that maca improved sperm production and sperm motility (3).  Another study showed that maca lowers measures of sexual dysfunction in postmenopausal women independent of estrogenic and androgenic activity (4).  These were both very small studies, and there are other small studies which show that maca can be effective in men and perimenopausal women.

More About Maca

There are actually a lot of studies on maca, although without question, larger trials need to be conducted.  But most of the studies I came across showed that maca has some great benefits.  Differences have been shown between the effects of the black, yellow and red maca varieties, as black maca shows the best results on spermatogenesis, memory and fatigue, while red maca is the variety that reverses benign prostatic hyperplasia and experimentally induced osteoporosis (5). In addition, maca reduces the glucose levels, and its consumption is related to the lowering of blood pressure and an improved health score (5). For those who are concerned about whether taking maca is safe on a long term basis, studies have demonstrated that short and long term consumption don’t show in vivo and in vitro toxicity.

Experimental scientific evidence showed that maca has nutritional, energizer, and fertility-enhancer properties, and it acts on sexual dysfunctions, osteoporosis, benign prostatic hyperplasia, memory and learning, and protects skin against ultraviolet radiation (6). A few different trials have shown that maca can help to reduce the symptoms of depression (7) (8), and can also improve diastolic blood pressure (8).  One study showed that maca can even affect the cytokines, as consumption of maca was associated with low serum IL-6 levels (9).

How Does Maca Work?

Initially it was thought that Maca root worked via phytoestrogens, but it looks like the mechanism of action is through numerous alkaloids, and not its plant hormones (10).  However, other components also can play a role such as sterols (campesterol, stigmasterol and beta-sitosterol), as well as polyunsaturated acids and their amides, called “macaenes” and “macamides”, as well as aromatic glucosinolates (10).  Although the exact mechanism of how maca root works still isn’t known, maca apparently affects the hypothalamus and pituitary gland (11).  And of course the hypothalamus and pituitary gland affect the output of the adrenal hormones, thyroid hormones, as well as hormones secreted by the ovaries and testes.

Can Maca Benefit People With Thyroid and Autoimmune Thyroid Conditions?

As I already mentioned in this post, maca seems to affect the hypothalamus and pituitary gland.  These of course both play a role in thyroid health, as the hypothalamus releases thyrotropin-releasing hormone (TRH), which in turn stimulates the pituitary gland to release TSH, which stimulates the thyroid gland to release thyroid hormone.  In this matter it is possible that taking maca root can affect thyroid health, and perhaps even help to increase the output of thyroid hormone in some people with hypothyroid conditions.  However, maca doesn’t seem to directly affect the thyroid gland, and so if someone with hyperthyroidism or Graves’ Disease were to take maca it shouldn’t increase the output of thyroid hormone.  With that being said, every now then I’ll receive an email from someone with hyperthyroidism who took an adaptogenic herb such as maca or eleuthero and claimed it increased the hyperthyroid symptoms.  Although this isn’t something my patients commonly experience when taking adaptogenic herbs, if this does happen to you then obviously I would discontinue taking the herb.

Maca does have a very small amount of iodine, and so those who are trying to completely avoid iodine might want to avoid taking maca.  With that being said, taking a few grams of maca doesn’t seem to cause problems in most people with autoimmune thyroid conditions such as Graves’ Disease and Hashimoto’s Thyroiditis.  But of course everyone is different, and so if you take maca and feel as if it’s worsening your condition then obviously I would advise you to stop taking it.  As I briefly mentioned earlier, maca is part of the brassica family, which also includes broccoli, kale, cauliflower, etc.  Many people with hypothyroid conditions avoid these foods due to their goitrogenic properties, although taking maca is unlikely to inhibit thyroid hormone production in most people.

Many people with thyroid and autoimmune thyroid conditions have problems with the adrenals and sex hormones (i.e. estrogen, progesterone, testosterone).  And since maca affects the hypothalamus and pituitary glands, it not only can affect thyroid health, but since the pituitary gland also secretes hormones such as FSH, LH, and ACTH, maca can also potentially affect the output of these hormones as well.

As for what dosage of maca to take, this will vary from person to person.  Most of the studies have used anywhere from 2 grams to 10 grams per day of maca.  If you decide to take maca it probably would be best to start with a smaller dose and then gradually increase it if necessary.  This is especially true if you’re taking maca to help with hot flashes, as if the dose is too high then it might actually increase the number of hot flashes in some women.  Plus, while some notice an improvement in their symptoms in as little as three or four days, in some people it can take a week or longer before noticing a positive change.

In summary, the use of maca root is growing in popularity, as some of its benefits include helping to improve sexual function and fertility, reducing glucose levels, lowering blood pressure, reducing hot flashes, and in decreasing depression.  Maca apparently affects the hypothalamus and pituitary gland, and thus can not only potentially affect thyroid health, but can also affect the output of adrenal hormones, as well as estrogen, progesterone, and testosterone.  Most people who take maca should begin with a small dosage and gradually increase it if necessary.

Bile is a fluid that is produced by the liver, and stored and concentrated in the gallbladder. It plays a role in digestion, specifically helping to break down fats into fatty acids. Many people have thick and sluggish bile, which commonly results in gallbladder surgery. But of course the surgery isn’t doing anything for the actual cause of the thick and sluggish bile. When you think about it, there is a lot in common with both gallbladder surgeries and thyroidectomies, as there are hundreds of thousands of these surgeries performed each year, and many of these could be avoided by addressing the actual cause of the condition.

There are approximately 500,000 gallbladder surgeries performed each year. But when someone has a problem such as gallstones, the problem usually isn’t with the gallbladder itself. If this is the case, then why is the gallbladder frequently removed when someone experiences recurrent cases of gallstones? Of course the main reason is because most medical doctors don’t know what else to do. To be fair, although many gallbladder problems can be prevented, sometimes the person reaches the point where gallbladder surgery might be necessary. While many times changing one’s diet or doing other things can help to prevent surgery, sometimes surgery is unavoidable.

Why Do Many People Have Gallbladder Problems?

Before I discuss some of the reasons why many people have gallbladder problems, I’d like to expand on the importance of bile. As you already know, bile helps to break down fats into fatty acids. Because of this, if someone has problems with bile, they will have problems breaking down fat soluble vitamins such as vitamins A, E, K, and D. They also might have problems digesting fish oil supplements, as well as other types of fats, such as the healthy fats present in avocados. Hopefully you are beginning to understand how problems with bile production can lead to nutrient deficiencies. And since removing the gallbladder won’t correct the bile problem, these people will still have problems breaking down fat soluble vitamins from the foods they eat.

In moderate to severe cases the person might experience certain symptoms when eating fatty foods, and thus might avoid not only greasy foods, but healthy fats such as nuts, seeds, and avocados. However, just because you’re not experiencing symptoms when eating these foods doesn’t mean that you aren’t having any problems with bile production. In fact, some people with mild to moderate bile production problems will have no symptoms. On the other hand, some of the common symptoms of gallbladder problems include bloating, gas, nausea, fatty stools, pain between the shoulder blades, and abdominal pain.

In addition to helping to break down fats, bile also plays an important role in the excretion of waste products. What happens is that the liver metabolizes toxins, and bile excretes them. This not only includes numerous environmental toxins, such as heavy metals, but also drug metabolites, and even the steroid hormones. This is how problems with bile relates to estrogen dominance, as if someone has estrogen dominance due to the buildup of bioidentical estradiol and/or xenoestrogens in the tissues, then this will lead to bile that is thick and sluggish. However, it’s not just estradiol which can change the properties of bile, as there is evidence that estriol, which is the main estrogen in pregnancy, produces profound changes in bile salt dependent flow and can lead to increased gallstone formation (1).

The Components of Bile

There are three main components of bile, and this includes 1) bilirubin, 2) bile acids and salts, and 3) cholesterol. Most people reading this are familiar with cholesterol, but you might not be familiar with the other two main components of bile. Bilirubin is the toxic catabolic product of heme metabolism, and the goal of bile is to help with the excretion of bilirubin. However, certain factors can cause a disturbance of bilirubin transport, which causes increased levels of bilirubin in the blood (hyperbilirubinemia), which in turn can lead to jaundice if the levels become high enough. Gallstones are a common reason for cholestasis, which is when there is a disruption of the flow of bile from the liver to the small intestine, although there can be other factors involved as well.

I’ve already mentioned some of the benefits of the bile acids/bile salts already, but they have numerous other functions as well. In fact, the bile salts play a big role in inhibiting the growth of bacteria in the small intestine (2). As a result, if someone has problems with the production of bile, then this can increase the risk of developing a condition such as small intestinal bacterial overgrowth (SIBO). Because of this it would make sense to give bile salts to those who currently have SIBO. This isn’t to suggest that the primary cause of SIBO has to do with low bile acids. Other factors can cause SIBO such as low or absent production of gastric acid, a deficiency of the pancreatic digestive enzymes, problems with the immune system, motility disorders, and other health issues. In addition to preventing the growth of bacteria in the small intestine, bile also might have antimicrobial properties against H. Pylori. Although bile acids are conjugated with taurine or glycine in the liver to form bile salts, there is some evidence that unconjugated dihydroxy bile acids has antibacterial activity against H. Pylori (3).

There is also evidence that bile acids play a role in preventing insulin resistance, as they appear to be signaling molecules that play important roles in glucose and lipid metabolism (4) (5). I of course mentioned earlier how bile is important for breaking down fats into fatty acids. It’s actually the bile receptors FXR and TGR5 which help to regulate lipid and carbohydrate metabolism, as well as inflammatory responses (6) (7). However, it’s the bile acids which activate these receptors. So having proper bile production can play a role in preventing insulin resistance and conditions such as non-alcoholic fatty liver disease.

Why Do Gallstones Form?

Because so many people develop gallstones, it probably is a good idea to discuss why gallstones form. Could it possibly be related to problems with bile production? It might be best to begin with a brief anatomy lesson, as I mentioned earlier that it’s the liver that produces bile, and the gallbladder stores and concentrates it. Your gallbladder will then release bile through a tube called the common bile duct. This duct connects your gallbladder and liver to the small intestine. Gallstones form when substances in bile harden, and this gallstone can block the flow of bile through the bile ducts, and this usually results in symptoms such as nausea, pain in the mid-back or abdomen, and sometimes vomiting.

There are two main types of gallstones. Gallstones made from cholesterol are the most common type, and are not related to cholesterol levels in the blood (8). One can also have gallstones made from bilirubin, which occur when red blood cells are destroyed and too much bilirubin is in the bile (8). Most medical doctors don’t think the formation of gallstones can be prevented, and while this might be the case in some situations, this isn’t true for the majority of gallbladder problems involving gallstones.

Diet of course is one of the main causes, as there is evidence that dietary factors can increase the risk of developing cholesterol gallstones. Dietary factors that may increase risk include cholesterol, saturated fat, trans fatty acids, refined sugar, and possibly legumes (9). Gallstones are also common in obesity (10) (11). Another study suggested that dietary constituents are important determinants for the formation of lithogenic bile (12). This doesn’t mean that eating a healthy diet will completely eliminate the risk of developing gallstones, but I think it’s safe to say that eating well will greatly reduce the likelihood of developing gallstones.

However, there are other factors to consider as well. For example, since estrogen dominance can make bile thick and sluggish and thus lead to the formation of gallstones, it shouldn’t be a surprise that there is evidence that those who take oral contraceptives are at an increased risk for gallbladder disease (13) (14). And while there are currently no studies which show a correlation between xenoestrogens and gallstones, there is no question that xenoestrogens can cause estrogen dominance, and since high levels of estrogen will affect bile production I think it’s just a matter of time before we see some clinical trials showing a correlation between the two.

What Are The Benefits and Risks of Gallbladder Surgery?

The obvious benefits of gallbladder surgery is that it will help to resolve the symptoms associated with the gallstones. However, as I mentioned earlier, surgically removing the gallbladder doesn’t do anything for the actual cause of the problem. And although most gallbladder surgeries are successful, there still are potential risks, such as injury to the common bile duct, injury to the small intestine, an infection, or internal bleeding. In addition, 5% to 40% of people who have the gallbladder removed may experience symptoms of postcholecystectomy syndrome which can include upset stomach, nausea, vomiting, gas, bloating, diarrhea, and persistent pain in the upper right abdomen (15).

But the main problem with gallbladder surgery isn’t the potential risks of the surgery, nor is it the symptoms associated with postcholecystectomy. The main issue is that removing the gallbladder won’t correct the bile problem. So if you have a condition such as estrogen dominance which caused problems with bile production and resulted in gallstones, removing the gallbladder obviously won’t correct the estrogen dominance problem. Similarly, if you are not efficiently breaking down fats into fatty acids, then getting gallbladder surgery isn’t going to help with this either.

What Role Does Bile Play In Thyroid Health?

So how does bile relate to thyroid health? First of all, thyroid hormones alter bile acid metabolism in humans (16) (17). In addition, a small study showed that bile acids play a role in human energy metabolism and in thyroid hormone control (18). However, larger studies are needed to confirm this. As for how hypothyroidism and hyperthyroidism affect bile, one smaller study showed that hypothyroidism may result in delayed emptying of the biliary tract (19). The same study suggested that this might be the cause for the increased prevalence of common bile duct stone formation in hypothyroidism. With regards to hyperthyroidism and Graves’ Disease, bile acid malabsorption can be associated with some people who have hyperthyroid conditions (20).

There are also indirect relationships between bile production and thyroid health. For example, earlier I discussed how problems with bile production can lead to deficiencies in the fat soluble vitamins. And both vitamin A and vitamin D play an indirect role in thyroid health. Not too long ago I wrote an article entitled “Can a Vitamin D deficiency Cause an Autoimmune Thyroid Condition?” I discussed how a vitamin D deficiency can make someone more susceptible to developing an autoimmune thyroid condition such as Graves’ Disease or Hashimoto’s Thyroiditis. Vitamin A is also important for the health of the immune system, but it’s also important for the health of the gut, as a deficiency of vitamin A might be a factor in the development of a leaky gut (21).

How To Have Healthy Bile Production

So what can someone do to improve the health of their bile? Obviously eating well is important, as you want to avoid refined foods and trans fats. Numerous studies also have shown that taking vitamin C supplements can help to prevent the formation of gallstones (22) (23) (24), and so this is also something to consider. Eating beets or taking supplements which contain beets can help, and choline can also be beneficial. Certain herbs which can help improve biliary function include dandelion root, fringe tree, and globe artichoke.

In the textbook “Nutritional Medicine” by Dr. Alan Gaby, he discusses the impact of food allergies on gallbladder health, and how the gallbladder can be a target organ for allergic reactions. He also mentioned an uncontrolled study where identification and avoidance of allergenic foods eliminated gallbladder symptoms in 100% of patients (69 in total) with gallstones or postcholecystectomy syndrome (25). So this is yet another reason to consider avoiding common allergens such as gluten, dairy, corn, etc.

Since estrogen dominance can make bile thick and sluggish, if you have this condition you will want to address it. For example, I mentioned how oral contraceptives can lead to the formation of gallstones. And many people reading this are already aware of the impact of xenoestrogens on our health, and so minimizing your exposure to these toxins can lead to healthy bile production and a decreased incidence of gallstones.

Doing a gallbladder flush may be beneficial. Although there is controversy over whether or not these truly will result in the passing of gallstones, numerous people have been helped by doing a gallbladder flush. However, while a gallbladder flush can be beneficial, there are potential risks involved. For example, if you have a large gallstone, it can possibly block the bile duct when trying to expel it with a gallbladder flush, which can result in a medical emergency. This is rare, although still is something to keep in mind.

What Should You Do If You Don’t Have a Gallbladder?

If you have had your gallbladder surgically removed, then you still will want to follow the advice given in this post. After all, remember that removing your gallbladder didn’t do anything for the bile problem, and so even after gallbladder surgery you want to do things to help improve biliary function.

So hopefully you now have a better understanding of how important normal bile production is not only to thyroid health, but having problems in this area can affect other areas of your health as well. There are way too many gallbladder surgeries performed, and while some of them are necessary, most of these “gallbladder problems” could be prevented by eating well, along with being aware of other factors which can affect bile production, such as taking oral contraceptives. As I discussed in this post, bile is important for breaking down fats into fatty acids, plays an important role in the excretion of waste products, and bile also has antimicrobial properties. If someone is trying to prevent the formation of gallstones, or even if they already have gallstones, one will want to eat a healthy diet, avoid common food allergens, consider supplementing with vitamin C, incorporate beets and/or choline into the diet, minimize their exposure to xenoestrogens, and there are times when they might want to consider doing a gallbladder flush.

For those people with Graves’ Disease and Hashimoto’s Thyroiditis who follow a natural treatment protocol, one of the primary goals should be to suppress the autoimmune response.  As you probably know, most endocrinologists don’t pay attention to the autoimmune component, as they just focus on getting the TSH and thyroid hormone levels within the normal lab reference range.  But remember that Graves’ Disease and Hashimoto’s Thyroiditis are not thyroid conditions, but instead they are autoimmune conditions which affect the thyroid gland.  Although not everyone with an autoimmune thyroid condition will test positive for thyroid antibodies, many people do have elevated levels.  And it’s not uncommon for these antibodies to remain high even after following a natural treatment protocol for a prolonged period of time.  Why is this the case?

Before I answer this question, let’s briefly discuss the different types of thyroid autoantibodies.  Hashimoto’s Thyroiditis is characterized by thyroid peroxidase antibodies and/or thyroglobulin antibodies.  Graves’ Disease is characterized by TSH receptor antibodies, also known as TSI antibodies.  There are a few other types of thyroid antibodies, but these are the most common ones associated with these conditions.  It’s also possible for people to have both types of antibodies, as I’ll frequently see people have both TSI antibodies and TPO antibodies, and every now and then I’ll see someone with all three of these antibodies.

What Causes Elevated Thyroid Antibodies?

In order to better understand why thyroid antibodies might remain elevated after following a natural treatment protocol, it is probably a good idea to discuss why these antibodies become elevated in the first place.  Once again, Graves’ Disease and Hashimoto’s Thyroiditis are autoimmune conditions.  There are many different types of autoimmune conditions, and the primary difference is that each one attacks different tissues of the body.  While Hashimoto’s Thyroiditis involves antibodies that attack and damage the thyroid gland, the TSH receptor antibodies of Graves’ Disease attack the TSH receptors.  Other autoimmune conditions will attack other parts of the body.  For example, with multiple sclerosis the immune system attacks the myelin, which covers the nerve cells of the brain and spinal cord.  Another example involves rheumatoid arthritis, which is a condition where the immune system attacks the synovial joints.

Although autoimmunity involves a genetic component in most cases, not everyone with a genetic marker develops an autoimmune condition.  It takes a combination of genetic, lifestyle, and environmental factors to trigger an autoimmune condition.  This isn’t just my opinion, as there are many journal articles which discuss this as well, and studies involving identical twins prove that genetics alone won’t lead to the development of an autoimmune condition.  So when someone develops an autoimmune condition, they most likely had a genetic predisposition, but something triggered the autoimmune response, and this causes the formation of thyroid antibodies.

Removing The Autoimmune Trigger Is The Key

If someone follows a natural treatment protocol and if their thyroid antibodies remain elevated, this usually indicates one of the following three problems:

1) The autoimmune trigger hasn’t been removed. This probably is the most common reason why elevated thyroid antibodies will remain high.  For example, one of the common autoimmune triggers is a leaky gut.  As a result, if I confirm that someone has a leaky gut and then help the person correct this problem by removing the leaky gut trigger and repair the gut, if this was the one and only trigger then it should  resolve the autoimmunity issue, and thus normalize the thyroid antibodies.  However, it is possible for someone to have multiple triggers.  In other words, it is possible for someone to have a leaky gut, but perhaps the main factor which triggered the autoimmune response was a certain toxin.  In this scenario, while it’s important to correct the leaky gut, the toxin issue would need to be addressed in order to normalize the thyroid antibodies.

This has happened to me numerous times while working with patients, as I’ve dealt with many people who have leaky gut syndrome, and while correcting this problem will frequently be the key in restoring the person’s health back to normal, this isn’t always the case.  Having multiple triggers admittedly is frustrating to both the doctor and patient.  And sometimes it can be a challenge to find all of the triggers.  This is especially true with a factor such as toxins, as there are so many toxins we’re exposed to, and it’s impossible to test for all of them.  Plus, even if it were possible to measure all of them, we need to keep in mind that not everyone reacts the same to toxins.  This is demonstrated by the Chemical Immune Reactivity Screen from Cyrex Labs, as this test measures the immune system response to certain toxins.  For example, one person might not have any problems when being exposed to large amounts of formaldehyde, whereas another person might have a negative reaction when exposed to smaller amounts of this toxin.  And the same concept applies with other toxins.

2) The autoimmune response hasn’t been suppressed. Many times just removing the trigger alone won’t “balance” the immune system.  So for example, if someone has a leaky gut due to eating gluten, if the person completely removes gluten from their diet and successfully goes through a gut repair protocol, the autoimmune component still might be active.  Another example involves exposure to a pathogen which triggered the autoimmune response, as while addressing the pathogenic infection is necessary, doing so might not suppress the autoimmune response.  In a previous blog post entitled “The Role Of Cytokines In Autoimmune Thyroid Conditions“, I spoke about something called nuclear factor kappa B (NFkappaB).  I discussed how this becomes chronically activated in autoimmunity, and while it is essential to remove the autoimmune trigger in order to restore the person’s health back to normal, NFkappaB might remain active even after removing this trigger.  When this scenario arises it becomes necessary to do things to help suppress the autoimmune component of the condition.  Certain nutrients which can help with this vitamin D, omega 3 fatty acids, curcumin, and resveratrol.

3) Other compromised areas of the body need to be healed. Getting back to the leaky gut example, if a pathogen such as H. Pylori or candida caused a leaky gut, then not only is it important to get rid of the pathogen, but it is also important to restore the health of the gut.  Some will assume that removing the trigger which caused the leaky gut is enough, but many times this isn’t the case.  Another example involves gluten, as if someone has a condition such as Celiac disease and consumes gluten, and this in turn caused a leaky gut over time, in addition to eliminating gluten from that person’s diet, certain measures usually need to be taken to repair the gut.  Another example involves stress.  Let’s look at the scenario where someone is dealing with chronic stress, which in turn causes HPA-axis dysregulation and weakened adrenal glands, thus making the person more susceptible to inflammation and resulting in autoimmunity.  While the person needs to improve their stress handling skills, doing this alone won’t always restore the health of the adrenals and the HPA-axis.

So in summary, in order to reverse autoimmunity and thus lower elevated antibodies one needs to 1) remove any autoimmune triggers, 2) suppress the autoimmune response, and 3) address other compromised areas of the body which might be contributing to the autoimmune component.  This can be very challenging, which is why I recommend for those looking to restore their health to work with a competent natural healthcare professional who has experience dealing with these conditions.  But even when working with someone it can be a challenge.  Although some people gradually improve with no setbacks, other cases are more challenging.  Obviously poor patient compliance can be a big issue, but some people don’t receive optimal results even when they are fully compliant.  And when this is the case one needs to look at these three factors I just mentioned.

Warning: The Thyroid Antibodies Can Fluctuate

While it’s great to see the thyroid antibodies gradually decrease as someone’s health improves, this doesn’t always happen.  In some people the thyroid antibodies will fluctuate, and so it’s not uncommon to see them decrease, and then to do another blood test one or two months later and see the antibodies increase.  This not only can become frustrating to the patient, but at times it can also become confusing, as their TSH and thyroid hormone levels might be improving, yet the thyroid antibodies will sometimes further increase.  Just remember that the thyroid antibodies don’t always gradually decrease, and they probably won’t normalize until the trigger has been removed and the autoimmune response has been suppressed.

Should The Autoantibodies Be Zero In A Healthy Person?

A question I get asked every now and then is whether or not the thyroid antibodies should be zero, or is just having them fall below the reference range sufficient?  First of all, if someone is negative for thyroid antibodies, many times the lab won’t give a specific value.  For example, for the thyroglobulin antibodies a common reference range used is between 0 to 40 IU/mL (keep in mind that the reference range may differ depending on the lab you use), and you might show up as being less than 20.  In this example you would be considered to be negative, although you wouldn’t know the exact number, and there is the possibility that the value wouldn’t be zero.   To me this is satisfactory.  However, if someone has TSI antibodies of 125%, and the normal reference range is <140%, one might not consider this to be satisfactory since they still have some TSH receptor antibodies present.  If someone has TSI antibodies of 400 and then this eventually gets them down to 125 and it remains there, then in my opinion this is considered to be excellent progress, although I of course would prefer to see them get even lower than this.

Just remember what I said earlier about the antibodies fluctuating.  Some people do experience a gradual decrease in their antibodies, and so for example, if someone had TPO antibodies that were 1,500, and then they gradually decreased over time until they were undetectable, then this would of course be a positive finding.  However, if they were 1,500 and then one month later they were undetectable, then I would be more suspicious of the levels fluctuating.  Either way I would want to retest the levels in a month or two, but if someone experienced a gradual decrease in the antibodies over a number of months until they eventually were undetectable I would be more confident about the autoimmune response being suppressed.

Another thing to keep in mind is that not everyone with an active autoimmune component will test positive for thyroid antibodies.  Although the majority of people with Graves’ Disease and Hashimoto’s will have positive thyroid antibodies, some people with autoimmunity don’t test positive for elevated autoantibodies.  When this is the case this obviously makes it more challenging to determine if the autoimmune response has been suppressed.  But even if someone has elevated thyroid antibodies you don’t just want to rely on this alone to monitor their progress.  This is why other types of testing is important, as if someone has tested positive for a leaky gut or compromised adrenals, then of course you want these conditions to be corrected.  And even though you don’t want to rely on signs and symptoms, this can be important.  For example, if someone has a depressed TSH and elevated thyroid hormone levels, negative TSI antibodies, but they have swelling and bulging of the eyes, then this is a pretty god indication that they have Graves’ Disease, even though the TSH receptor antibodies tested as negative.  In this scenario one would look for an improvement not only with the TSH and thyroid hormone levels, but with the eye symptoms as well.

In summary, for those with an autoimmune thyroid condition who are following a natural treatment protocol, one of the goals is to normalize the thyroid antibodies.  However, if the thyroid antibodies remain elevated after following a natural treatment protocol, this means that either the autoimmune trigger hasn’t been removed, the autoimmune response hasn’t been suppressed, and/or other compromised areas of the body need to be healed.  It’s also important to understand that not everyone with Graves’ Disease or Hashimoto’s Thyroiditis has elevated thyroid antibodies, and it also is important to understand that the thyroid antibodies can fluctuate.  Even though it can be challenging to reverse autoimmunity, this is possible to accomplish.