When you think about it, the job that the immune system does in protecting us is simply incredible.  We are constantly being exposed to different pathogens, toxins, and food allergens, and our immune system does an amazing job of making sure these factors don’t cause us any harm, while at the same time differentiating self from non-self.  There are numerous regulatory mechanisms which help to maintain immune homeostasis and prevent the development of autoimmune thyroid conditions such as Graves’ Disease and Hashimoto’s Thyroiditis.  And one of the main components of the immune system which helps to prevent autoimmunity is the regulatory T cells.

Maintaining self-tolerance while at the same time mounting immune responses against pathogens is a complex process.  Regulatory T cells (Tregs) are widely regarded as the primary mediators of peripheral tolerance (1).  Tregs originate in the thymus, although they also can derive from peripheral CD4+ T cells (2).  A healthy immune system will have an abundance of these Tregs.  On the other hand, autoimmunity involves an imbalance of the Th1 and Th2 pathways, and also involves Th17 cells (3).  As a result, when dealing with someone who has an autoimmune thyroid condition, the goal should be to increase the number and activity of the Tregs, while at the same time doing things to help suppress the Th17 cytokines.  Later in this post I’ll discuss some of the nutrients which can increase the number of Tregs and suppress the Th17 cells.

What is FoxP3?

FoxP3 is a transcription factor that is required for the development, maintenance, and function of Tregs (4).  Deficiency or mutation in Foxp3 in humans and mice leads to a decrease in Tregs, which in turn leads to an early onset, highly aggressive and fatal autoimmune disease affecting various tissues (5).  What’s important to understand is that Foxp3 plays an important role in the development and function of regulatory T cells, and both Foxp3 and Tregs are important in preventing the development of autoimmunity.

How To Increase The Number/Activity of Regulatory T Cells

Dr. Alex Vasquez is a chiropractor, naturopath, and osteopath who focuses on autoimmunity.  He is a contributing author of the Institute of Functional Medicine textbook, and he has written numerous journal articles.  In his book “Functional Immunology and Nutritional Immunomodulation” he discusses the nutritional induction of regulatory T cells by using certain nutrients.  What I’m going to do is list these nutrients, but I also have done my own research to see how these influence the Tregs, and of course will share these studies with you.

Vitamin A. Retinoic acid is a metabolite of vitamin A.  A few different studies show that retinoic acid induces Tregs in the presence of transforming growth factor Beta (6) (7).  The same studies reveal that retinoic acid can also inhibit the differentiation of Th17 cells, which as I mentioned earlier, play a big role in autoimmunity.  Some people with Graves’ Disease and Hashimoto’s Thyroiditis can benefit from taking 10,000 IU to 25,000 IU/day of vitamin A.  However, one does need to be cautious, as taking too high of a dosage of vitamin A for an extended period of time can lead to a toxicity.  And women who are pregnant, or are trying to become pregnant need to be especially cautious about taking high doses of vitamin A.  In the past I have written an article entitled “Vitamin A and Thyroid Health“.

Vitamin D. I’ve written numerous articles and blog posts about the benefits of vitamin D.  25-OH vitamin D is what most doctors test for to determine whether someone has a vitamin D deficiency.  Although the lower end of most lab reference ranges for 25-OH vitamin D is 30 ng/mL, for optimal immune system health you want the levels to be at least 50 ng/mL.  Numerous studies show that vitamin D supplementation can help to increase the number of Tregs and therefore might help to prevent the development of autoimmune conditions (8) (9) (10).

Probiotics. Many people take probiotics due to the benefits they have on the health of the gut.  Although this is true, let’s not forget that approximately 70% of the immune system is located in the gut.  As a result, taking probiotics can have a huge impact on the health of the immune system.  And certain strains of probiotics can increase regulatory T cells and help balance the Th1 and Th2 cytokines (11) (12).  If you read the second study you’ll notice that not all species have this effect, as both Lactobacillus reuteri and Lactobacillus casei induced the development of Treg cells, but not Lactobacillus plantarum.

Green Tea. Not too many people think of drinking green tea as a way to prevent autoimmunity.  Well, numerous studies show that the main ingredient of green tea, which is epigallocatechin-3-gallate (EGCG), interfered with the differentiation of Th1 and Th17 cells, and prevented IL-6 induced inhibition of Treg development (13) (14).  And so drinking green tea can increase the number of regulatory T cells and inhibit pro-inflammatory cytokines.  Even though the focus of this post is on autoimmunity, one very small clinical trial suggested that green tea can modulate circulating Tregs in the early stages of chronic lymphocytic leukemia and can potentially prevent the progression of the disease (15).

Omega 3 Fatty Acids. I recommend for just about all of my patients to take omega 3 fatty acids, usually in the form of fish oils.  Omega 3 fatty acids can do a great job of controlling the inflammation, and there is also evidence that they can lead to an increased number of Tregs (16) (17) (18).  However, this admittedly is controversial, as it also has been observed that DHA inhibited the suppressive effect of Tregs.

Lipoic Acid. Alpha lipoic acid can also help to increase the number of Treg cells while inhibiting Th1 and Th17 cells (19).  Although I like alpha lipoic acid and do recommend it to some of my patients, in most cases I focus on giving some of the other nutrients listed here, and only have someone supplement with alpha lipoic acid if I feel it’s necessary.  However, one thing to keep in mind is that alpha lipoic acid can also increase glutathione levels (20) (21).  As I’ve discussed in other articles and blog posts, glutathione is a powerful antioxidant that has numerous functions, especially with regards to detoxification.

Turmeric and Resveratrol. I’ve spoken about both turmeric and resveratrol in past articles and blog posts.  These nutrients have numerous benefits, and there is also evidence that they can help to increase Tregs (22) (23).

While giving these nutrients can help to increase the number of Tregs, other factors most likely need to be addressed as well.  For example, if someone has a leaky gut due to consuming gluten, or exposure to a pathogen, then just giving nutrients to increase the number of Tregs won’t help much.  In other words, before one focuses on increasing the number of Tregs, it’s important to remove the factor which triggered the autoimmune response in the first place.  Once this has been accomplished then the person can take some of these nutrients to help suppress the autoimmune component and keep the immune system in balance.

Low Dose Naltrexone and Regulatory T Cells

For those who are familiar with Low Dose Naltrexone (LDN), this affects the opiate receptors in the brain, and this apparently results in an increase of regulatory T cells.  So this essentially is how LDN can help to modulate the immune system.  However, LDN does nothing to address the autoimmune trigger, which means that people will need to take LDN on a continuous basis.  And this is assuming that it works, as while LDN has helped many people, it isn’t always effective in suppressing the autoimmune component.

In summary, regulatory T cells help to keep the immune system in balance and prevent an autoimmune condition from developing.  People with Graves’ Disease and Hashimoto’s Thyroiditis typically have a lower number of Tregs, and so increasing these cells is important in order to suppress the autoimmune component of the condition.  Certain nutrients can help to accomplish this such as vitamin A, vitamin D, probiotics, and green tea.  However, as I have mentioned in previous blog posts and articles, one also needs to address the cause of these conditions in order to restore the person’s health back to normal.

When someone with a thyroid or autoimmune thyroid condition is trying to restore their health back to normal, it of course is important to eat well, do a good job of managing their stress, get proper sleep, etc.  However, nutritional supplementation is almost always required.  There are a few reasons for this, but perhaps the main one is because even if someone eats mostly organic food it still is difficult to correct nutritional imbalances through diet alone.  One problem is that many people rely too much on supplements and herbs, and although adverse reactions are rare, they do occur at times.

Of course adverse reactions are pretty common with both over-the-counter and prescription drugs.  In fact, according to the CDC, every day in the United States, 105 people die due to a drug overdose, and another 6,748 are treated in emergency departments for the misuse or abuse of drugs (1).  To be fair, not all of these are due to medication, but about 60% are due to pharmaceuticals, which is still a very high number.  As a society we have become so used to people having adverse reactions from taking prescription drugs that we don’t tend to think much of it when this happens.  On the other hand, whenever there are any reports about nutritional supplements or herbs which resulted in a negative reaction it usually gets a lot of attention.

The Similarities Between Peanuts and Herbs

There is no question that side effects and adverse reactions are much less common with nutritional supplements and herbs when compared to medication.  However, this doesn’t mean that adverse reactions don’t occur.  Just as some people can be allergic to certain foods, some people can be allergic to the ingredients in certain supplements, as well as herbs.  I’m not just talking about a food intolerance, but a true allergy.  For example, if someone has a peanut allergy and eats peanuts, the consequences can be severe, and can even be life-threatening at times.  The same can also be true with certain herbs.  One example involves echinacea, which is a well known herb found in most health food stores, as well as in many pharmacies and retail stores.  I realize there is controversy over taking echinacea when one has an autoimmune condition, but I’m not going to discuss this right now.  What I do want to discuss is how if someone has an allergy to plants in the daisy family then they might experience an allergic reaction to echinacea.  Anaphylaxis is also possible in some cases if someone has an allergy to echinacea.  Once again, most people who take echinacea do fine, and I’m not trying to single out echinacea, as people can have an allergic reaction to other supplements as well.

This actually happened to one of my patients recently.  I have been recommending the herb bugleweed to patients with hyperthyroidism and Graves’ Disease for years without a problem.  However, recently one of my patients experienced what appeared to be an allergic reaction to this herb.  Fortunately nothing serious happened, and she simply stopped taking the bugleweed.  I’m not bringing this up to scare anyone, but just to make you aware that there are risks to taking certain supplements and herbs.  With regards to herbs, even though adverse reactions are possible, I still recommend them to my patients.  Everything of course comes down to risks vs. benefits, and whenever taking any supplement or herb you need to consider this.

While it is possible to have an allergic reaction to a specific nutrient or herb in a supplement, having a sensitivity is more common.  So for example, someone might not have an IgE-mediated allergy when consuming a certain supplement, but they instead might have a delayed reaction to one or more of the ingredients.  Sometimes it’s not the actual nutrients or herbs that they’re reacting to, but the fillers in the supplements.  This can happen with medication as well, as someone might not feel well when taking thyroid medication, and in some cases it’s not the medication itself that is causing the problem, but the fillers in the medication.

Are There Heavy Metals In Your Supplements?

In addition to experiencing a severe allergy to taking supplements or herbs, certain toxicities are also possible.  For example, in the past I wrote an article entitled “Peripheral Neuropathy and Thyroid Health“, and I brought up a case of peripheral neuropathy related to arsenic toxicity, which might have been caused by excessive intake of dietary supplements (2).  This involved a 74-year old woman who was taking large amounts of fish oils and glucosamine sulfate supplements, which were identified as possible sources of arsenic.  Upon stopping the supplements the urine arsenic levels had reduced, and there was an improvement in the patient’s symptoms. Another case study revealed that kelp supplements taken by a 54-year old woman had high arsenic levels (3).  Within weeks of discontinuing the supplements her symptoms resolved and her arsenic blood and urine levels were undetectable.

Does this mean we should stop taking nutritional supplements?  Of course not, as one can argue that there are also toxins in the food we eat, the air we breathe, etc.  We’re obviously not going to completely eliminate our exposure to toxins no matter how hard we try.  However, you do need to be cautious when purchasing supplements, as the quality does matter.  In addition, if someone is taking a specific supplement and has a negative reaction, one needs to consider that they might not be sensitive to the actual nutrient or herb they’re taking, but instead might be reacting to toxins in that supplement.  For example, if someone is taking a fish oil supplement high in arsenic, and they begin to develop symptoms they didn’t have prior to taking this supplement, they might conclude that they shouldn’t take fish oils, when the problem wasn’t with the fish oils, but instead was with the toxins in the specific fish oil supplement they were taking.

High Doses of Synthetic Supplements Can Be Toxic

Besides the fact that some supplements have toxins such as heavy metals, taking large doses of certain nutrients alone can cause adverse reactions.  Some examples of vitamins and minerals which can cause a toxicity when taken in higher doses include vitamin A, selenium, and iron.  And of course everyone is different, so there is really no way to tell who will experience a negative reaction to a higher dosage.  For example, someone might do fine when taking 800 mcg of selenium, while another person might experience toxicity reactions when taking 400 mcg of selenium.  And the same is true with other nutrients.

One also needs to be aware that sometimes the supplement manufacturers can make mistakes which can lead to serious problems.  For example, in 2008 there was a case were 201 individuals had adverse reactions to nutritional supplements which contained an excess amount of selenium and chromium (4).  When the supplements were tested it was found that they had almost 200 times the reported amount of selenium.  Some of the selenium toxicity symptoms people experienced included alopecia, fingernail changes, gastrointestinal symptoms, and memory difficulties (4).  Fortunately none of the patients required hospitalization.  Obviously this is a rare situation, but it’s another reason to purchase supplements from reputable companies.  Of course this doesn’t mean that it can’t happen with a good company, but this is less likely to happen with a company that has good quality control standards.

How Can You Avoid An Adverse Reaction From Taking Supplements?

If you are taking supplements as part of a natural treatment protocol, or just on a wellness basis, then you might be wondering what you can do to avoid having an adverse reaction from any supplements you ingest.  There really is no way to completely avoid having an adverse reaction, but here are some things you can do to minimize the chances of this happening:

1. Purchase supplements and herbs from reputable companies. I would definitely recommend to only purchase supplements from companies with a good reputation.  Of course this doesn’t guarantee that there won’t be any toxins in the products, as there have been a few instances of well known companies where testing revealed high amounts of toxins in some of their products.  But going with a company who has good quality control measures will greatly reduce the risk of taking supplements with toxins.

2. Be cautious about taking larger doses of nutrients and herbs unless under the supervision of a healthcare professional. There is a lot of information on the internet and in books, and it’s not uncommon for some people to recommend taking higher doses of supplements and herbs.  For example, if you get a 25-OH vitamin D test and if it’s determined you have a vitamin D deficiency, then you might do some searching online and find some information which recommends for you to take 10,000 IU to 15,000 IU/day of vitamin D3 for a short period of time to increase the vitamin D levels.  However, if someone has a condition such as hypercalcemia then you don’t want to take high doses of vitamin D3.  And even if someone doesn’t have hypercalcemia they would want to be cautious about taking high doses of this vitamin without any supervision.  Another example involves iron, as someone might get an iron panel and see they are low in iron, and based on this decide to take iron supplements.  However, too much iron can cause oxidative damage.  So you definitely need to be cautious.

3. Consider starting with smaller doses of supplements and herbs. The advantage of starting with lower doses is that it can minimize your chances of having an adverse reaction if you are either allergic to an ingredient in the supplement, or if the supplement has toxins.  Earlier I gave an example of one person who was fine taking 800 mcg of selenium, whereas another person had an adverse reaction when taking 400 mcg of selenium.  If you haven’t taken selenium before then you might not know if you can handle higher doses, and so if you decide to take a selenium supplement it might be wise to start with 200 mcg, or even 100 mcg.  Then if all goes well you can slowly increase the dosage.

4. If you need to take multiple supplements, consider taking one at a time. I commonly recommend for my patients to take multiple supplements simultaneously.  And while most people do fine taking multiple supplements at the same time, other people don’t do well.  If you are following a natural treatment protocol then the disadvantage of starting with one supplement at a time is that it might take longer for you to experience positive changes in your condition.  The advantage of starting with one supplement is that if you happen to experience an adverse reaction to one of the supplements you’re taking then it will be easier to screen out.  For example, if you take eight supplements all at once and then experience some headaches or digestive problems, then assuming one of the supplements was responsible for this you really have no way of knowing which of the supplements caused these symptoms.  On the other hand, if you begin with one supplement and then reintroduce another one every few days there is a much greater chance of figuring out which supplement you are reacting to.

In summary, while nutritional supplements and herbs are usually safer to take than most prescription drugs, adverse reactions are still possible.  Some people can have an allergic reaction to certain herbs.  And one needs to be aware of the possibility of toxins in the products they use, which is why you want to choose a supplement company with good quality control measures.  Also be aware that taking high doses of certain vitamins and minerals can lead to a toxicity.  In order to minimize an adverse reaction you want to purchase supplements and herbs from companies with a good reputation, be cautious about taking larger doses of supplements, and consider taking one supplement at a time when beginning a natural treatment protocol.

Part of the challenges of being a healthcare professional is determining which tests a patient actually needs.  When someone is suspected of having a thyroid or autoimmune thyroid condition, then certain tests obviously should be performed, such as a thyroid panel.  Other serum tests can also be valuable, such as a CBC with differential, a complete metabolic profile, a lipid panel, and a test for 25-OH vitamin D.  Most healthcare professionals would agree that these tests are valuable, but from this point on there is a dramatic difference in opinions with regards to which tests are necessary.

For example, many medical doctors will only recommend the blood tests I listed above, and won’t order additional tests.  In fact, some medical doctors will only order a thyroid panel, and won’t order other serum tests.  In my opinion EVERYONE should obtain the tests I listed above.  And of course if someone already has a chronic health condition such as Graves’ Disease or Hashimoto’s Thyroiditis, then they probably will need some of these tests measured on a frequent basis.

Is There An Overreliance of Tests By Natural Healthcare Professionals?

While some will argue that many medical doctors don’t do enough testing, others feel that some healthcare professionals do too much testing.  Other than the serum blood tests recommended by most other doctors, I usually recommend a few other tests, most commonly saliva testing and the “controversial” hair mineral analysis test.  There are times when I will recommend other types of testing, but these are the most common ones I recommend to my patients.  Some natural healthcare professionals will recommend much more testing than this, and sometimes it can run the patient thousands of dollars for the tests.

The goal of this post isn’t to criticize other healthcare professionals for recommending too many tests.  After all, I’m sure some might accuse myself of doing too much testing, although I personally don’t feel this is the case.  I’ve had a few people tell me that a competent healthcare professional shouldn’t rely on using tests, but instead should rely more on their diagnostic skills.  I agree that it’s important to have good diagnostic skills, as one needs to not only be able to take a good case history, but they also need to do a good job of interpreting the information, as well as evaluating the patient’s signs and symptoms.  However, when trying to find out the cause of a person’s thyroid or autoimmune thyroid condition, many times more information is required.  So in my opinion, a combination of good diagnostic skills and the appropriate testing is required to find out what the cause of the condition is.

This of course is easier said than done, as different healthcare professionals will have different opinions with regards to which tests are “appropriate”.  As I mentioned earlier, I usually recommend saliva testing and a hair mineral analysis test to my patients.  Some healthcare professionals laugh at the thought of using a hair mineral analysis, yet use other “controversial” methods of testing, such as food intolerance testing or micronutrient testing, both of which are also controversial, and are also very expensive.  Obviously each natural healthcare professional will have their own personal biases with regards to testing, and the most important factor is the results one receives with their patients.  I know numerous healthcare professionals who utilizing testing which is controversial, yet they receive excellent results with their patients.  For example, even though I don’t routinely do food intolerance testing, I know some healthcare professionals who routinely recommend this type of testing with their patients and receive excellent results.  And of course I wouldn’t recommend hair mineral analysis testing if I didn’t think it had some value in helping my patients restore their health.

What Are The Limitations Of The Different Tests?

What I’d like to do is take a look at some of the different types of tests and discuss some of their limitations.

Salivary cortisol testing. I recommend for just about all of my patients to do saliva testing to measure the cortisol levels throughout the day.  I also commonly test for other things through the saliva, but the focus here will be on the cortisol levels.  I find the cortisol testing to be accurate, meaning that when I test someone initially and find the cortisol levels to be elevated or depressed, frequently on a follow-up test I see the cortisol levels improve.  Of course this isn’t the case with everyone, and when someone isn’t showing improvement then we want to find out the reason why.

One of the most important factors to consider when measuring saliva cortisol levels is that cortisol responds to stress.  When someone has chronic stress, cortisol will become elevated for quite some time, sometimes for many years.  As the adrenals weaken over time the cortisol levels will become depressed, along with the DHEA levels.  However, “abnormal” stress can have a negative effect on such testing.  For example, if someone is collecting the saliva samples and gets into an argument with someone on the day of collecting the samples, there is a good chance this will result in a false elevation of cortisol levels, and will therefore lead to an inaccurate result.  Similarly, if someone is collecting the samples and has a migraine, this will also lead to a false elevation of cortisol.

As a result, it’s important to collect the saliva samples on a “normal” day.  Now when I say “normal”, keep in mind I’m not suggesting that you have to wait for a stress free day.  If this were the case then most of my patients would never be able to collect the samples.  If someone’s day is normally very stressful, then it’s fine to collect the saliva samples on this day.  On the other hand, if there is an unusual amount of stress then it’s best to not collect the saliva samples, and if you have already started to collect the samples on this abnormally stressful day then it’s best to start over.

By the way, even though I’m focusing on “salivary” cortisol testing, this also applies to serum cortisol.  For example, some people will get a one-sample serum cortisol test done at the doctor’s office, and because they get stressed out when they visit the doctor this will falsely elevate their cortisol levels.  Some will even get stressed out when receiving the injection to get the blood drawn, which once again can elevate the cortisol levels, thus leading to false results.

Obviously taking cortisol will affect the results of the testing.  And even certain nutrients can affect the results, which is why when collecting a saliva sample you always want to carefully read the instructions which come with the collection kit.  Saliva testing can provide some wonderful information, although hopefully you now understand some of the potential drawbacks of such testing as well.

Hair mineral analysis. This is another test I commonly recommend to my patients.  And I admit that it is a very controversial test, and if you are relying on a hair mineral analysis test to tell you about all of the minerals and whether you are sufficient or deficient in them, you will be disappointed.  The truth is that the hair mineral analysis can be a wonderful, low cost method of looking at certain mineral imbalances, as well as heavy metal toxicities.  However, there definitely are some limitations as well.

For example, most hair analysis companies will test for the mineral iron.  The problem is that you can’t rely on the hair mineral analysis when it comes to evaluating the iron levels.  Many times I find the iron to be low on a hair mineral analysis test, yet on an iron panel consisting of serum iron, ferritin, and iron saturation, everything is well within the normal limits.  In other words, these values are well with the “functional” reference range on a serum iron panel, yet iron might look completely depleted on a hair mineral analysis.  And iron is one of those minerals that you don’t want to take if you don’t need it.  Copper is another mineral which might appear as low on a hair mineral analysis test, but the person might not be deficient, and in some cases they might actually have a copper toxicity.  As a result, when interpreting copper in the hair  you want to look at some of the other values, such as zinc and calcium.  Just keep in mind that some of the minerals on a hair mineral analysis can appear to be low, but they might be biounavailable.

Another drawback of a hair mineral analysis is that certain external factors can cause a false elevation of the minerals.  For example, if someone has a water softener, then this can spike up the sodium levels on a hair mineral analysis.  As a result, if someone has a water softener then they will want to wash their hair in an alternative source (i.e. distilled water) for at least a few days before collecting the hair sample.  If someone is using a shampoo for dandruff, which commonly is high in selenium sulfide, this will mostly likely elevate the selenium levels.  Using pubic hair can elevate the phosphorus levels.

You might wonder why you can’t just do serum testing to look at the minerals.  Well, the problem is that serum testing isn’t completely accurate for most minerals.  And one reason for this is that with some of the minerals, the body will do everything it can to keep the minerals at a normal level.  For example, serum calcium will almost always be normal, even if someone has a calcium deficiency.  And the same is true with magnesium, along with some of the other minerals.  In any case, the hair mineral analysis isn’t perfect, but if someone takes the proper precautions (i.e. doesn’t wash their hair with a water softener or use dandruff shampoos), AND if the healthcare professional knows how to interpret it correctly, then it could be a very valuable tool.

Heavy Metal Testing. In addition to looking at the minerals, I also use the hair mineral analysis test to look at the toxic metals, such as aluminum, mercury, cadmium, arsenic, and lead.  One can also use urine and serum testing to look at toxic metals.  Serum tests are usually good for detecting acute heavy metal exposure, whereas both hair and urine are used for testing heavy metals that are stored in the tissues.  Although I think both urine testing and hair testing has value, the limitations of these tests is that they won’t reveal everything, as there will be always toxic metals stored in the tissues on the body which don’t show up on these tests.  Plus, when it comes to testing for mercury, the hair does a better job of testing for organic mercury, also known as methylmercury.  This type of mercury is more commonly found in fish.  On the other hand, urine testing for toxic metals is more accurate for determining levels of inorganic mercury, which is the type found in dental amalgams.  Thiomersal, which is still used in some vaccines, is a form of organic mercury.  Keep in mind that inorganic mercury is converted to organic mercury, and is considered to be more toxic than organic mercury.

Food intolerance testing. I know many healthcare professionals who require all of their patients to order a food intolerance panel.  In fact, when I was still in chiropractic school I had one of these done for the first time, and if I recall correctly I think I spent about $600 for this test.  There are different variations of these panels, as the most commonly recommended food intolerance panels utilize IgG testing.  Another common test is called the ALCAT”, which utilizes a different technology that involves something called the “Coulter” method, which involves “measuring white blood cells using the electronic principle of particle counting and sizing”.

Keep in mind that I have nothing against food intolerance testing.  In fact, if I knew for certain that such testing would be accurate I would recommend this type of testing to all of my patients.  After all, if there was a way to detect all of the food allergies and intolerances in a person that would be wonderful.  However, false results are very common with these tests.  This is especially true if someone has an increase in intestinal permeability (a leaky gut).  But even for those who don’t have a leaky gut, I can’t justify having my patients spend hundreds of dollars on a test which is likely to provide false results.

Once again, I’m not suggesting that these tests are completely inaccurate.  I’ve known some people who have obtained such testing and agreed with the positive findings.  In other words, upon eliminating the foods which came out positive on the food intolerance test they noticed an improvement in their symptoms.  However, false negatives are common, and so there is a decent chance of the person testing positive for certain foods, which might be accurate, yet they might have some false negatives.  And so what of course will happen in this scenario is that the person will avoid the foods they test positive for, but they will continue eating some foods which they might be sensitive to, yet didn’t show up as being positive on the test.

And as I mentioned earlier, having a leaky gut can completely throw off the results of the test.  Dr. Natasha Campbell McBride, who developed the GAPS diet, discusses this.  Here is what she has to say about leaky gut and food intolerances: “The reason for allergies and food intolerances is so-called ‘leaky gut’ when the gut lining is damaged by abnormal micro flora. Foods do not get the chance to be digested properly before they get absorbed through this damaged wall and cause the immune system to react to them. Many people try to identify, which foods they react to. However, with a damaged gut wall they are likely to absorb most of their foods partially digested, which may cause an immediate reaction or a delayed reaction (a day, a few days or even a couple of weeks later). As these reactions overlap with each other, you can never be sure what exactly you are reacting to on any given day. Testing for food allergies is notoriously unreliable: if one had enough resources to test twice a day for two weeks, they would find that they are “allergic” to everything they eat. As long as the gut wall is damaged and stays damaged, you can be juggling your diet forever removing different foods and never get anywhere.”

Stool testing for pathogens.  There are times when I will use stool testing for pathogens.  And when someone has a positive finding for certain pathogens, such as yeast, parasites, or other pathogens, there is an excellent chance that this is a true finding.  However, false results aren’t uncommon.  In other words, someone might test negative for yeast, even though they have a Candida infection.  As I mentioned in my article on Candida entitled “Candida and Thyroid Autoimmunity“, stool testing isn’t the best method of detecting a Candida infection.  One can also have parasites and test negative for these on a stool panel.  This seems to be true even with the newer technology some of the labs are using.  So does this mean such testing shouldn’t be utilized?  Well, I think there is value in doing such testing at times, but these are also expensive tests, costing hundreds of dollars.  And so it’s not one I would routinely run on all of my patients.  On the other hand, I know some natural healthcare professionals who do recommend stool panels to all of their patients.

Micronutrient testing.  I mentioned some of the flaws with the hair mineral analysis test, but what about micronutrient testing?  This type of testing looks for intracellular deficiencies.  In other words, it measures how certain nutrients are functioning within the white blood cells.  This type of testing evaluates all of the vitamins, minerals, amino acids, and numerous antioxidants.  I was very excited when I found out about this method of testing.  The problem is that the research is still lacking.  If there was a test which could accurately detect all of the nutrient deficiencies of my patients I would recommend this type of testing to everyone.  And although I find micronutrient testing to be interesting, I once again have a hard time recommending such expensive testing to everyone if I’m not certain that the results are accurate.  Keep in mind that I’m not saying that this type of testing isn’t accurate, but simply that there is no research I’m aware of which proves that this type of testing is accurate.

Organic acids testing. The company Metametrix is one of the companies which offers testing for organic acids, and gives the following definition of such testing: “Organic acids are metabolic intermediates produced in pathways of central energy production, detoxification, neurotransmitter breakdown, and intestinal microbial activity. Accumulation of specific organic acids in urine often signals a metabolic inhibition or block. This abnormality may be due to a nutrient deficiency, an inherited enzyme deficit, toxic build-up, or drug effect. Testing for organic acids helps reveal activity and changes at the metabolic level, helping practitioners discover hidden issues and pinpoint where therapeutic focus is needed.”  There are other labs which offer this type of testing, such as Great Plain Laboratories.

The organic acids test does have some value.  However, it is another expensive test, and false results are possible as well.  Plus, there is also controversy over the different types of methodologies used, which is GC/MS (Gas Chromatography/Mass Spectrometry) or LC/MS/MS (Liquid Chromatography/Tandem Mass Spectrometry). LC/MS/MS is the newer type of technology, but this doesn’t necessarily mean it’s the more accurate one.  One of the labs which utilizes the GC/MS technology wrote a paper why this technology is superior to the LC/MS/MS.  The paper is convincing, but of course has a biased view.

Applied kinesiology.  This isn’t the same as the other types of testing listed here.  As described by the website www.appliedkinesiology.com, “Applied kinesiology (AK) is a form of diagnosis using muscle testing as a primary feedback mechanism to examine how a person’s body is functioning.”  The reason I brought this up is because I know of numerous healthcare professionals who won’t do any of the testing I mentioned above, but will only utilize applied kinesiology on their patients.  In fact, some won’t even recommend blood testing, and so if someone has a suspected thyroid or autoimmune thyroid condition, they will just do applied kinesiology on the patient, and nothing else.  And the reason why they don’t do any additional testing is because it won’t change their recommendations.  This doesn’t describe everyone who uses applied kinesiology, as I know healthcare professionals who use this, but also require blood testing on all of their patients.

I have a good friend who practices applied kinesiology in his practice.  And I’ve worked with numerous patients who have seen one of these practitioners and received very good results with them.  The problem is that this type of “testing” solely relies on the skill of the practitioner.  While this might be fine for someone who is competent and has been using this technique for many years, in my opinion it probably shouldn’t be relied on with someone who doesn’t have as much experience.  Once again, I didn’t list this technique here because I disapprove of it.  After all, let’s not forget I also listed the saliva testing and hair mineral analysis as having limitations, even though I recommend these tests to my patients.  I decided to mention this in this post because even though those doctors who utilize this technique have the utmost confidence that it will provide them with the information they need to restore the person’s health back to normal, it still has limitations as well.

There are other tests I haven’t listed here which have limitations, but these are some of the most well known ones.  And this doesn’t mean that these tests don’t have value.  Obviously I wouldn’t continue recommending the saliva testing and hair mineral analysis to my patients if I didn’t think they provided information which helped to restore their health back to normal.  Similarly, other healthcare professionals utilize other types of testing which have limitations, but provide them with valuable information.  My goal wasn’t to try to criticize any specific testing method or technique, but was just to make you aware of some of the limitations and controversies involved.

When it comes to avoiding specific foods, I truly believe that if you do enough research you can find a reason to not eat anything.  If you follow a strict Paleo diet then you will be avoiding dairy and grains.  If you’re a vegan then you of course don’t eat meat, fish, dairy, or eggs.  In addition to this, if you have gut problems and are trying to avoid lectins, phytic acid, and other antinutrients, then besides avoiding grains you will want to cut out nuts, seeds, and legumes.  Let’s not forget sugar, and so we might as well cut out the fruit.  And it probably would be a good idea to stop eating nightshade vegetables since they can be inflammatory.  And if you’re hypothyroid then you might want to cut out the goitrogenic foods too.

The focus of this blog post is on spinach, which of course is a very healthy food.  While it might not give you a boost in strength like it does with Popeye, eating spinach is high in nutrients such as vitamin A, magnesium, folate, and vitamin K.  In fact, I frequently add spinach to my smoothies.  Sometimes I will also eat spinach in a salad, along with other greens.  And when I have the forbidden pizza, I enjoy adding spinach and garlic to it.  Even my vegetable-hating children “tolerate” spinach.

If spinach is so wonderful, why did I decide to write a blog post which questions whether people with thyroid conditions should avoid spinach?  Well, there are definitely worse foods you can eat other than spinach.  And as I mentioned before, if you do enough research you can make a case for avoiding just about any food.  But as much as I like spinach, there are risks of eating it with both hypothyroid and hyperthyroid conditions.

Spinach and Hypothyroidism. Spinach supposedly has goitrogenic properties.  However, it’s not as goitrogenic as other foods, such as the cruciferous vegetables.  For more information on goitrogens I would check out my articles entitled “Goitrogens: Thyroid Inhibiting Foods You Should Avoid” and “An Update on Goitrogenic Foods and Their Impact On Thyroid Health“.  If you read these articles you’ll realize that a number of years ago I was opposed to people with hypothyroid conditions eating any goitrogens, but based on the lack of human research studies involving goitrogenic foods I have eased up a bit on this.  Although I’m still cautious about people with hypothyroid conditions eating a lot of goitrogenic foods, in most people, eating a normal amount of these foods shouldn’t cause any problems.

So let’s ask the question “should people with hypothyroid conditions avoid eating spinach?”  As I just mentioned, if someone has a hypothyroid condition then I think it’s fine for them to have one or two servings per day of goitrogenic foods.  However, this also assumes they don’t have an iodine deficiency, as goitrogens interfere with iodine metabolism.  Assuming someone with hypothyroidism or Hashimoto’s Thyroiditis is iodine sufficient then I think it’s fine for them to eat spinach, along with other goitrogenic foods such as broccoli, kale, and cauliflower.

Spinach and Hyperthyroidism. Since spinach is goitrogenic and can therefore inhibit thyroid hormone production if eaten in large quantities, then it might make sense for people with hyperthyroidism and Graves’ Disease to load up on spinach!  From a goitrogenic standpoint I’m not at all concerned about people with hyperthyroidism eating spinach.  So why would there be any problem with people who have hyperthyroid conditions eating this green leafy vegetable?

Well, one of the main concerns with hyperthyroidism is that over a period of time it can lead to a decrease in bone density.  This yet another reason why unmanaged hyperthyroidism can cause problems.  In my articles and blog posts I tend to focus a great deal on the cardiac symptoms, but a decrease in bone density can also be a big concern.  This is even true after the thyroid hormone levels are back within the normal range.  So for example, if someone has elevated thyroid hormone levels for six months which causes a decrease in bone density, then just normalizing the thyroid hormone levels won’t necessarily correct the bone density problem.  So someone can still be more susceptible to suffering from a fracture.

At this point you might be thinking to yourself “what does this have to do with spinach consumption?”  Well, one of the nutrients which is important for strong bones is calcium.  And while other nutrients are also important for proper bone health, such as magnesium, phosphorus, and vitamin D, if someone has a calcium deficiency then this without question can affect bone density.  The good news is that spinach is high in calcium.  The bad news is that it also is high in something called oxalate, which binds to calcium, and therefore reduces its absorption.  As a result, eating a lot of spinach can actually cause a calcium deficiency, and therefore affect bone density.

Spinach Isn’t The Only High-Oxalate Food

Spinach isn’t the only food which has high amounts of oxalates.  Many other foods are high in oxalates, including blueberries, blackberries, raspberries, beets, okra, almonds, cashews, and other whole foods are high in oxalates.  The topic of oxalates probably deserves a separate article or blog post, but just understand that most people are fine eating foods with oxalates.  Although some people have conditions which require a low oxalate diet (no more than 50 milligrams per day), this isn’t a concern for most people.

However, there are risks with eating high amounts of oxalates.  I mentioned how they can potentially affect the absorption of certain nutrients such as calcium.  However, there is also evidence that consuming high levels of oxalates can lead to kidney stones (1) (2).  Once again, this doesn’t mean that eating normal amounts of blueberries, raspberries, spinach, and other high oxalate foods will lead to kidney stones.  One problem is that we’re in a “smoothie era”, and many people load up their smoothies with these foods.  I’m guilty of this myself, as I love smoothies, and in the past I would add 1/2 cup of berries, along with a full cup of spinach on a frequent basis.  I still include the berries, and while I do add some raw spinach every now and then to my smoothies, I don’t do this on a daily basis, as I rotate the vegetables that I add to them.

So let’s ask the question “should people with hyperthyroid conditions avoid eating spinach?”  Well, one thing I should add is that although cooking does seem to reduce the goitrogenic activity of spinach and other goitrogenic foods, cooking doesn’t seem to reduce the oxalate content.  And so from this standpoint it really doesn’t matter if you eat raw or cooked spinach.  I think it’s fine for most people with hyperthyroid conditions to eat spinach, but it probably would be a good idea to not load up on this food.  There are so many different vegetables out there, and while some vegetables other than spinach have a high oxalate content, there are many vegetables with a low oxalate content such as cucumbers, arugula, asparagus, broccoli, cabbage, cauliflower, romaine lettuce, and squash.

In summary, spinach is considered by most people to be a healthy food.  The purpose behind this blog post wasn’t to discourage anyone from eating spinach.  I still eat spinach, and think it’s fine for most people to continue to do so, regardless of whether they have a hypothyroid or hyperthyroid condition.  The main reason I decided to write this post is to demonstrate that there can be risks with eating large amounts of healthy foods.  This doesn’t necessarily mean that eating high amounts of spinach on a frequent basis will inhibit thyroid activity or eventually lead to osteoporosis or kidney stones, but in some people eating a lot of spinach will cause problems.   This is one reason why it’s best to try to eat a wide variety of foods whenever possible, and try your best to avoid eating large amounts of a single food on an everyday basis.

Most people with overt hypothyroid conditions have high TSH levels, and low or depressed thyroid hormone levels.  Then there are people with subclinical hypothyroidism, characterized by an elevated TSH and normal thyroid hormone levels.  Many people with Hashimoto’s Thyroiditis are considered to have subclinical hypothyroidism, as while the damage the immune system is causing to the thyroid gland usually results in high TSH levels, it usually takes many years before the thyroid hormone levels become depressed.  However, a small percentage of people have the condition known as thyroid resistance.

Thyroid hormone resistance is characterized by elevated thyroid hormone levels (free T3 and/or free T4), and normal or elevated levels of TSH (1).  It’s not uncommon for people with this condition to have a goiter, but the hypothyroid symptoms usually are very mild, and sometimes the person doesn’t experience any hypothyroid symptoms at all.  In the past I’ve spoken numerous times about insulin resistance, where the cells don’t respond to the actions of this hormone.  In other words, the body produces normal amounts of insulin, but the body becomes resistant to the effects of this hormone and is unable to utilize it efficiently.  It’s a similar situation with thyroid resistance, as there might be sufficient levels of free T3 and free T4, but the cells don’t respond to the actions of thyroid hormone.

What Causes Thyroid Resistance?

Although genetics can play a role in insulin resistance, this condition is commonly caused by lifestyle factors, such as eating too many refined foods and sugars.  With thyroid hormone resistance, there can be numerous causes.  Some of the potential causes include genetic mutations, drugs, chemicals, metabolites, and autoimmune antibodies that may impair thyroid hormone action in the cell (2).  In addition, certain conditions such as chronic fatigue syndrome and chronic renal failure can be accompanied by acquired thyroid hormone resistance caused by inhibition of thyroid hormone metabolism, cell uptake, and thyroid hormone receptor binding and transcription (2).  As I’ll discuss later in this post, certain nutrient deficiencies can also play a role in thyroid hormone resistance.

Sometimes it can be challenging enough to find out if someone has thyroid hormone resistance, but even if this has been determined, how can one find out the cause of this condition?  This also can be a challenge, as I’m not aware of any specific testing which is available to patients or healthcare professionals which will determine if someone has a genetic mutation which is causing this.  Certain environmental toxins such as PCBs and dioxins might cause thyroid resistance, although such chemicals might play a greater role in congenital hypothyroidism (3). Other toxins might also inhibit the binding of thyroid hormone to the receptor (4).  While it is possible to test for some of these environmental toxins, doing so can be quite expensive, and so it’s probably more cost effective to just do things to detoxify your body.  Other substances that might affect the thyroid receptors including iodocontrast agents (5), amiarodone (6), and phloretin (7).  A few different drugs can also bind to specific thyroid receptors (8), and so if someone started taking a certain medication and soon thereafter developed a thyroid condition, one has to consider the possibility that taking this drug was responsible for this.

Can Natural Treatment Methods Help With Thyroid Resistance?

If someone has a genetic polymorphism which is causing thyroid hormone resistance then there isn’t a way to reverse this problem.  However, this is rare, and many cases of thyroid resistance can be helped through natural methods.  As I mentioned earlier, certain environmental chemicals can bind to the thyroid receptors and cause thyroid resistance, and so doing things to detoxify your body would be a good place for many people to start.  I discussed this in a blog post I previously wrote entitled “3 Ways People with Thyroid and Autoimmune Thyroid Conditions Can Detoxify Their Body“.  Detoxification can also help someone who developed thyroid resistance due to a certain medication they’re taking, although if someone suspects that a prescription drug is responsible for their thyroid condition then it would be a good idea to run this by their medical doctor so they can take the person off of the drug, or perhaps switch them to a different drug which hopefully won’t have the same side effect.

Certain nutrients can affect the thyroid receptors and can alter the effect of T3 at the gene transcription level (9).  Since the binding of T3 to the receptor is retinoic acid-dependent (10), taking vitamin A might benefit people with thyroid hormone resistance.  Of course you want to be careful about taking high doses of vitamin A, as this can be toxic.  The T3 receptor is thought to require zinc to adopt its biologically active conformation (11), and so a zinc deficiency can play a role in thyroid resistance. There is also evidence that taking fish oils can support the thyroid receptors as well (12).

This isn’t to suggest that everyone with thyroid hormone resistance should “load up” on vitamin A, zinc, and fish oils.  The first thing one should do is make sure they’re eating a diet consisting of whole foods, while minimizing the refined foods and sugars.  If someone is deficient in these and other nutrients it’s usually due to a poor diet, although it can also be due to absorption problems.  If this is the case then the absorption issue needs to be addressed in order to obtain maximum benefits from the food you eat, and any supplements you might take.

In summary, thyroid resistance is a condition characterized by elevated thyroid hormone levels, and normal or elevated TSH levels. Numerous factors can cause thyroid resistance, such as mutations, drugs, environmental toxins, and nutrient deficiencies.  Many cases of thyroid resistance can be helped naturally.  Since toxins are a common cause of this condition, doing things to detoxify your body and increase glutathione levels would be a good idea for most people.  If a medication is responsible for this condition then of course this needs to be addressed.  Certain nutrients affect the thyroid receptors, such as vitamin A, zinc, and fatty acids, and so making sure you’re getting these nutrients in your diet is also very important.