Lipopolysaccharides (LPS) are referred to as endotoxins, and they are large molecules found in gram-negative bacteria.  Although most people with thyroid and autoimmune thyroid conditions have never heard of lipopolysaccharides, these can have a profound effect on one’s health.  This is especially true for those people with Graves’ Disease and Hashimoto’s Thyroiditis, although they can also affect those with non-autoimmune thyroid conditions.

LPS are the major components of the cell wall of gram-negative bacteria (1).  Under normal circumstances they protect the cell membrane.  However, when a gram-negative bacteria dies, the LPS of this bacteria is released.  LPS can cause numerous biological effects, such as fever, leukocytosis (high number of white blood cells), iron deficiency, platelet aggregation, thrombocytopenia, and blood clotting disorders (2).  LPS from gram-negative bacteria is one of the most potent innate immune-activating stimuli known.  An alteration in the LPS response may play a role in the pathogenesis of a number of inflammatory diseases (3).

The Role of LPS In Autoimmunity and Leaky Gut Syndrome

Lipopolysaccharides can lead to an increase in intestinal permeability, also known as a leaky gut (4) (5).  I’ve spoken about the relationship between leaky gut syndrome and thyroid autoimmunity in other articles and blog posts.  There are numerous factors which can cause a leaky gut, and lipopolysaccharides are one of these factors.  So having high levels of LPS can increase one’s chances of developing a leaky gut, and this in turn can increase one’s chances of developing Graves’ Disease or Hashimoto’s Thyroiditis.

The company Cyrex Labs has an intestinal permeability test that measures the antibodies against LPS.  When this shows positive findings for LPS it usually means that there has been infiltration through the intestinal barrier into the systemic circulation.  In other words, there will be the presence of lipopolysaccharides in the bloodstream, and the person will usually have an increase in intestinal permeability (a leaky gut).  However, I’ve had some patients test positive for LPS antibodies on a Cyrex Labs test, but not show any signs of hyperpermeability.

For those who aren’t familiar with Cyrex Labs, their Intestinal Antigenic Permeability Screen tests for the presence of three types of antibodies that are associated with an increase in intestinal permeability.  These include the Actomyosin antibodies, the Occludin/Zonulin antibodies, and the Lipopolysaccharides (LPS).  Both the Actomyosin and Occludin/Zonulin antibodies directly relate to the presence of a leaky gut.  So in other words, if either of these two antibodies are outside of the normal range then this indicates that someone has a leaky gut.

However, the presence of LPS alone doesn’t necessarily indicate that someone has a leaky gut.  The presence of LPS does indicate intestinal dysbiosis (an imbalance of the gut flora), and dysbiosis is commonly associated with a leaky gut.  As a result, if someone does the Cyrex Labs test and has a positive test for LPS, but both the Actomyosin and Occludin/Zonulin antibodies are negative, then this means the person has intestinal dysbiosis in the absence of a leaky gut.  Of course this is assuming the person doesn’t have suppressed immunoglobulins, which can result in a false negative on the Cyrex Labs test and is something to be aware of.

What Are The Causes Of Elevated LPS?

Remember that lipopolysaccharides are endotoxins which are found in gram-negative bacteria, and that LPS is released when a gram-negative bacteria dies.  When someone has high levels of LPS this is associated with intestinal dysbiosis.  And there are numerous causes of intestinal dysbiosis, and some of the more common causes include antibiotics, chronic stress, and food allergens (6).

LPS and Thyroid Health

LPS can affect thyroid health in numerous ways.  As I have already mentioned, LPS can lead to the development of a leaky gut, which can in turn trigger an autoimmune thyroid condition.  However, there is also evidence that LPS can suppress the hypothalamic-pituitary-thyroid axis (7).  Remember that the hypothalamus produces thyrotropin-releasing hormone (TRH), which stimulates the pituitary gland to secrete TSH, which in turn signals the thyroid gland to secrete thyroid hormone.  A more recent study shows that LPS can downregulate pituitary and thyroid function (8).  In addition to decreasing TSH secretion, it also affects secretion in follicular cells directly (8).  In other words, LPS can decrease thyroid function not only by affecting the pituitary gland, but also by directly affecting the cells of the thyroid gland.  However, while it seems to result in a decrease in thyroxine (T4), it doesn’t seem to decrease the conversion of T4 to T3.

In summary, lipopolysaccharides are large molecules found in gram-negative bacteria, and they are elevated in intestinal dysbiosis.  LPS activate the innate immune system, and can lead to the development of inflammatory conditions, as well as a leaky gut.  This can in turn trigger an autoimmune response, leading to a condition such as Graves’ Disease or Hashimoto’s Thyroiditis.  There is also evidence that LPS can suppress the hypothalamic-pituitary-thyroid axis.

I’ve discussed leaky gut syndrome in the past, as this is commonly associated with conditions such as Graves’ Disease and Hashimoto’s Thyroiditis.  In fact, some researchers believe that ALL autoimmune conditions are associated with an increase in intestinal permeability (a leaky gut).  I’m not sure if I agree with this, as while I don’t test every single one of my patients for a leaky gut, of those people I have tested for this who have elevated autoantibodies, a few of them have come back with negative results.   In any case, if it is determined that someone has a leaky gut then you want to consider implementing the 4R protocol.

But what is the 4R protocol?  Before talking about this I would briefly like to remind everyone reading this what happens when someone has a leaky gut.  In a normal, healthy gut, the cells of the intestines (enterocytes) should be held close together by tight junctions.  Tight junctions regulate the permeability of ions, macro molecules, and cells via the paracellular pathway (1).  In other words, these tight junctions prevent larger molecules and other substances from passing between the cells of the intestine.

However, certain factors can break down these tight junctions, and thus lead to what’s referred to as an “increase in intestinal permeability”.  An “increase in intestinal permeability” is synonymous with a “leaky gut”.  So disruption of these tight junctions leads to an inadequate epithelial barrier, and this in turn results in an incontrollable water and electrolyte loss, and is implicated in the pathogenesis of numerous autoimmune and inflammatory diseases (1).

In the past I’ve discussed the intestinal permeability test from Cyrex Labs, which can measure the antibodies against these tight junction proteins.  Occludin and zonulin are two tight junction proteins.  Occludin is part of the main component of proteins which hold together the tight junctions, while zonulin is a protein which regulates the permeability of the intestine (2).  When someone has a leaky gut, there will be elevated antibodies to both occludin and zonulin, and this is what the test from Cyrex Labs measures.  This test also detects antibodies against actomyosin, which helps to regulate intestinal barrier function.

Hopefully you now have a better understanding of what a leaky gut entails.  Now let’s take a look at what the 4R protocol involves:

1. Remove.  First of all, you want to remove the factor or factors which caused the increase in intestinal permeability.  So for example, gluten is a common factor which can lead to an increase in intestinal permeability.  However, there can be other factors which can cause a leaky gut to occur.  In addition to gluten, other food allergens can be a factor.  Certain pathogens can also compromise the tight junctions, thus causing an increase in intestinal permeability.  Unfortunately stress can also be a factor, as high cortisol levels can lead to a decreased secretory IgA, making someone more susceptible to developing a leaky gut.  Certain medications such as NSAIDs can also cause a leaky gut.

Sometimes it admittedly can be a challenge to determine what is causing the increase in intestinal permeability.  Although it’s easy enough to avoid gluten and dairy, what if another food is responsible for the leaky gut?  There are many different types of pathogens, and so how can one determine if a specific pathogen is the culprit?  Everyone deals with stress, and so how do you know if this is the trigger?  Some detective work is usually required, which is one reason why it’s not recommended to self treat your condition.  Although finding the trigger under the guidance of a natural healthcare professional can still be challenging, in my opinion it still is best to work with someone who has the knowledge and experience dealing with these conditions.

After removing the factor or factors which caused the leaky gut, you want to focus on the next 3 components of the 4R protocol:

2. Replace. You want to replace those factors which are necessary for proper digestion.  Some examples include digestive enzymes, betaine HCL, and dietary fiber.  I frequently give digestive enzymes to my patients and recommend for them to consume enough dietary fiber.  As for betaine HCL, whether someone should take this or not depends on the patient.  The goal isn’t for the person to take digestive enzymes and/or betaine HCL on a permanent basis, but many times it is a good idea for patients to take these while following a natural treatment protocol to make sure they’re digesting the food they’re eating and the nutrients from the supplements they’re taking.

3. Reinoculate. This is where prebiotics and probiotics come into play.  Remember that the probiotic strain does make a big difference.  For example, bifidobacterium lactis HN019 is great for intestinal dysbiosis, while Saccharomyces boulardii can help with a yeast infection and play a role in gut repair.  Prebiotics such as inulin can help to enhance the growth of the beneficial bacteria.  For more information on probiotics I recommend checking out my article entitled “Can Taking Probiotics Improve Thyroid Health?“.

4. Repair. It of course is important to repair the gut.  L-glutamine is an amino acid, and this is one of the best nutrients used for gut repair.  When I’m working with someone who has a leaky gut I’ll commonly recommend at least 5,000 mg of L-glutamine per day, and with some people I’ll recommend higher doses.  I mentioned before that Saccharomyces boulardii can help with gut repair.  Certain herbs can help with the mucosal lining such as slippery elm, marshmallow root, and aloe vera.  Zinc can also be beneficial.  However, certain foods can help with the healing of the gut as well, including bone broth, cabbage juice, and fermented foods such as sauerkraut and kimchi.

In the opening paragraph of this post I discussed how some researchers hypothesize that in addition to genetic and environmental factors, loss of intestinal barrier function (a leaky gut) is necessary to develop autoimmunity (3).  However, these same researchers also feel that once the autoimmune process is activated, it is not auto-perpetuating, but rather can be modulated or even reversed by preventing the continuous interplay between genes and environment (3).  In other words, not only can a leaky gut be cured, but the autoimmune process can be modulated and in many cases even reversed.

I’ve been mentioning this for many years due to my personal experience with Graves’ Disease, along with the experiences of many of my patients with autoimmune thyroid conditions.  But even though the research shows that the autoimmune process can be modulated, most medical doctors don’t do anything to address the autoimmune component of Graves’ Disease and Hashimoto’s Thyroiditis, as they just focus on managing the thyroid symptoms.  This doesn’t mean that addressing autoimmunity is an easy process, as it can be a challenge finding out what the trigger is.  And if someone has a condition such as leaky gut syndrome it can take a good amount of time to correct the problem.  But in most cases it is worth the “hassle”, especially when compared to receiving radioactive iodine and/or having to take thyroid hormone medication for the rest of your life.

In summary, leaky gut syndrome is common in autoimmune conditions such as Graves’ Disease and Hashimoto’s Thyroiditis.  And when dealing with a leaky gut, one wants to implement the 4R protocol.  Doing so not only can help to correct the leaky gut, but if this is what’s responsible for one’s autoimmune condition then it can be the key factor in restoring their overall health back to normal.

Many people with thyroid and autoimmune thyroid conditions have problems with their adrenal glands.  Although eating well, doing a good job of managing one’s stress, and getting sufficient sleep are probably the three most important factors when it comes to having healthy adrenals, sometimes supplementation can help to restore the health of compromised adrenals when combined with these other factors.  In this post I’m going to discuss six supplements and herbs which can benefit people with adrenal problems.

1. Vitamin C.  The adrenal glands have one of the highest concentrations of vitamin C in the body (1).  Ascorbic acid is a cofactor required both in catecholamine biosynthesis and in adrenal steroidogenesis (1).  As a result, anyone who deals with a good amount of stress needs to make sure they eat foods rich in vitamin C.  However, in my opinion it usually is a good idea to also have the person take a vitamin C supplement.  Most vitamin C is sold as ascorbic acid, but I usually recommend a whole food vitamin C supplement for two reasons.  The first reason is because ascorbic acid is just one component of vitamin C, and you want to consume the required cofactors as well.  The second reason is because ascorbic acid supplements are made from corn syrup, and most corn in the United States is genetically modified.

2. Vitamin B.  The B vitamins are also beneficial for those who are constantly “stressed out”.  Like vitamin C, in most cases there is little risk in taking a B complex supplement since the B vitamins are water soluble.  However, taking high doses of some of the individual B vitamins can cause problems.  Like vitamin C, some of the B vitamins also play a role in the synthesis of hormones important to adrenal health.  For example, vitamin B3 is involved in the synthesis of adrenal hormones.  Vitamin B5 is also important for adrenal health, and can aid in the secretion of the steroid hormones.  Vitamin B6 is involved in the synthesis of norepinephrine.  When someone is stressed out these vitamins will become depleted, and so if someone is dealing with chronic stress then it usually is a good idea to supplement with a vitamin B complex.

3. Ashwagandha.  Ashwagandha (Withania somnifera) is one of the most beneficial herbs for the adrenals.  Although this herb can potentially stimulate thyroid hormone production in hypothyroid conditions, in most cases it doesn’t seem to exacerbate one’s hyperthyroid condition.  As a result, Ashwagandha can usually be used for adrenal support in both people with hypothyroidism and Hashimoto’s Thyroiditis, or hyperthyroidism and Graves’ Disease.  If someone has elevated cortisol then giving Ashwagandha and Rehmannia can help to lower the cortisol levels.  However, Ashwagandha can also benefit people with depressed cortisol levels.  In addition to benefiting people with adrenal problems, Ashwagandha has many other benefits, as I have written about in my article “Ashwagandha and Thyroid Health“:

4. Licorice.  Licorice is an herb I frequently recommend for those people who have depressed cortisol levels.  Glycyrrhizin is the main compound in licorice root, and is what helps to lower cortisol levels by inhibiting the enzyme responsible for the conversion of cortisol to cortisone.  However, licorice also can cause an elevation of blood pressure, and so it typically is contraindicated in those with hypertension.  Licorice also can help to decrease inflammation of the gastrointestinal tract as well.  For more information on Licorice you can read my article entitled “Licorice and Thyroid Health“:

5. Eleuthero.  Eleuthero (Siberian Ginseng) is a great herb for those who deal with chronic stress on a daily basis.  Of course this describes just about everyone, but this doesn’t mean that everyone should take Eleuthero.  I usually recommend this herb to those patients who deal with a lot of stress AND do a poor job of handling it.  Of course the goal is to work on improving one’s stress handling skills so they don’t have to rely on taking Eleuthero.  There is some concern that taking Eleuthero might increase the production of thyroid hormone, but most people with hyperthyroid conditions do fine when taking it.  In fact, when I was following a natural treatment protocol for my Graves’ Disease condition I personally took Eleuthero for a number of months without any problem.  But of course everyone is different, and so if someone who has a hyperthyroid condition takes this herb and feels that it’s exacerbating their condition then of course I would advise them to stop taking it. For more information on Eleuthero check out my article entitled “How Eleuthero Can Help People With Thyroid and Autoimmune Thyroid Conditions“.

6. Phosphatidylserine.  Phosphatidylserine is produced naturally by the body, although you can also get this from foods.  It can also be taken as a supplement.  It is important in maintaining cellular function.  I frequently will recommend this for those who have high cortisol levels.  Clinical studies show that phosphatidylserine can weaken the cortisol response (2) (3).  And although these studies involved giving phosphatidylserine to those who had high cortisol levels due to exercise-induced stress, in my experience it doesn’t matter what type of stress resulted in the elevated cortisol levels.

Which Of These Supplements/Herbs Should You Take?

As I suggested in the beginning of this blog post, while taking certain supplements and herbs can help with the recovery process, taking supplements isn’t a substitute for eating well, getting sufficient sleep, or managing stress.  These factors are without question more important than taking supplements.  In fact, in some cases just eating well and improving one’s stress handling skills can do wonders for the adrenals.  With that being said, sometimes it is can be beneficial to take one or more of the supplements I discussed.

If someone is dealing with chronic stress on a daily basis and is having a difficult time handling the stress, then in addition to working on their stress handling skills they might benefit from taking a vitamin B and vitamin C supplement.  Taking either Ashwagandha or Eleuthero can also be beneficial in helping someone to better deal with stress.  If someone has depressed cortisol levels (and they don’t have hypertension) then taking an herb such as licorice can be beneficial.  On the other hand, if high cortisol levels are an issue then they might want to consider taking Phosphatidylserine, or if they prefer an herbal approach then taking the herbs Ashwagandha and Rehmannia can also help to lower elevated cortisol levels.

As usual, I do think it’s a good idea to work with a competent natural healthcare professional, as they will evaluate your adrenals, and if you have compromised adrenals they will determine which of these supplements and herbs are best for you.  Of course I realize that many people aren’t going to take my advice and will self treat their condition, and if this describes you then just make sure you start with very small doses, especially when taking any of the herbs I mentioned.  Although most people do fine taking the herbs, everyone is different, and every now and then someone will experience a negative reaction.  For the most part vitamin B and vitamin C are safe to take, although I still would be cautious about taking very high doses of these on your own.

Plus, keep in mind that there are other supplements and herbs which can help with adrenal health.  For example, the herb rhodiola is an excellent herb which can benefit people with compromised adrenals.  Biotin can also be beneficial for adrenal problems.  Some people can also benefit from taking an adrenal glandular, although you usually don’t want to take these for a prolonged period of time.

In summary, there are numerous supplements and herbs which can benefit people with compromised adrenals.  Although eating well, getting sufficient sleep, and doing a good job of managing stress are all important factors, taking supplements and/or herbs can frequently help to speed up the recovery process.  While taking a vitamin B and C supplement usually won’t cause problems, I would recommend working with a competent natural healthcare professional before taking the herbs I discussed.  Even though most people do fine when taking the herbs I discussed, every now and then someone will have a negative reaction.

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.