Most people with thyroid and autoimmune thyroid conditions don’t have a good understanding when it comes to the different types of serum tests used to evaluate thyroid health. Although it is true that blood tests don’t tell the entire story, I do think it’s important for people who choose to follow a natural treatment protocol to at least have a basic knowledge of the different types of blood tests. As a result, I’ve decided to put together a post which discusses the most important “thyroid” blood tests.

Thyroid stimulating hormone (TSH). Although many medical doctors primarily pay attention to the TSH, it’s important to understand that the TSH is actually a pituitary hormone. The role of the TSH is to stimulate the thyroid gland to produce the thyroid hormones (T3 and T4). It is synthesized and released by the anterior pituitary gland. So when someone has a hypothyroid condition, which is characterized by low or depressed thyroid hormone levels, the pituitary gland will secrete more TSH. This explains why the TSH is high in hypothyroid conditions. Due to the decrease in thyroid hormone, greater amounts of TSH will be released. On the other hand, if someone has a hyperthyroid condition, this of course is characterized by an excess of thyroid hormone. As a result, the pituitary gland will stop secreting TSH because it doesn’t want to stimulate the thyroid gland to produce more thyroid hormone. Because of this the TSH will be depressed.

Why do most medical doctors focus on the TSH when someone with hypothyroidism or Hashimoto’s Thyroiditis is taking synthetic thyroid hormone (i.e. levothyroxine)? The reason is because taking synthetic thyroid hormone will usually help to lower the TSH, but it won’t have an effect on the actual thyroid hormone levels. So when someone has Hashimoto’s Thyroiditis and is given synthetic thyroid hormone, most medical doctors will ignore the autoimmune response, as their primarily goal is to get the TSH within the normal reference range.

There of course are a few problems with this. The first problem is that taking thyroid hormone isn’t doing anything to address the autoimmune response. Another issue is that the upper end of the lab reference ranges tend to be too high with regards to TSH. For example, a common lab reference range is between .8 and 4.5 mlU/L. However, the functional reference range is between 1.0 and 3.0, and some claim that it should be between 1.0 and 2.0. But even if you get someone’s TSH between the functional reference range, many people still don’t feel well because the underlying cause of their condition hasn’t been addressed.

Free T3 and Total T3. Triiodothyronine, also known as T3, is a type of thyroid hormone. This is the active form of thyroid hormone which is important in regulating the body’s metabolism. The free T3 represents the free form of triiodothyronine in the blood. On the other hand the total T3 represents both the free and bound form of triiodothyronine. Over 90% of T3 is bound to proteins, and while I do think there is value in testing the total T3, because the free T3 is the active form of the hormone then it makes sense to test this as well. Although some T3 is produced directly from the thyroid gland, most of the T3 is produced through the conversion of T4. In hyperthyroid conditions the free T3 and total T3 are usually high, while in hypothyroid conditions the free T3 and total T3 are usually on the low side.

Which of these two values should be tested? Well, ideally it would be great for both of them to be tested. However, if someone has to choose between the two then it really depends on what one is looking for. As an example, if someone wants to monitor the thyroid hormone levels to see if someone has high or low thyroid hormone levels, it is usually preferable to test for the Free T3 since it is the unbound form of the hormone and thus is what produces a biological response. For example, if someone has hyperthyroidism, ultimately it’s the high levels of Free T3 which lead to the hyperthyroid symptoms. On the other hand, if someone wants to determine whether T4 is being properly converted into T3, then either the total T3 or the free T3 will be fine to measure. Or they might want to look at the reverse T3, which I will discuss shortly.

T3 Uptake. Thyroid-binding globulin (TBG) is what binds thyroid hormone, and helps to carry both T3 and T4 in the bloodstream. The T3 uptake test tells us how much TBG is bound by T4. For example, when TBG concentration is decreased, less TBG is available to bind labeled triiodothyronine (T3), and more labeled T3 reagent binds to the solid-phase material (increased T3 uptake) (1). T3 uptake is typically increased with hyperthyroid conditions, and decreased with hypothyroid conditions. Keep in mind that other factors can cause an increase in T3 uptake (i.e. anabolic steroids such as testosterone), while some other factors can cause a decrease in T3 uptake, such as xenoestrogens.

Free T4 and Total T4. Thyroxine, also known as T4, is a type of thyroid hormone. Just as is the case with T3, the free T4 represents the free form of thyroxine in the blood, whereas the total T4 represents both the free and bound form of thyroxine. As I mentioned before, T4 is converted into T3. In hyperthyroid conditions the free T4 and total T4 are elevated, while in hypothyroid conditions the free T4 and total T4 are on the low side.

It’s also important to understand that synthetic thyroid hormone consists of T4. Even though it is synthetic, the body can still convert it to triiodothyronine (T3). However, some people have problems with the conversion process and are given synthetic T3 (i.e. Cytomel). Natural thyroid hormone consists of both T4 and T3, as well as T1 and T2, which I won’t be discussing in this blog post.

Which of these two values should be tested? Free T4 or total T4? As I mentioned with triiodothyronine, it would be wonderful if both the total T4 and free T4 can be tested. But if choosing only one of these tests then one wants to look at the free form of the hormone. Fortunately most endocrinologists realize this and will test for free T4. However, there are some who will only test for total T4 and not free T4.

Thyroid-Binding Globulin (TBG). I briefly mentioned this test earlier, as this is a protein that moves the thyroid hormones throughout your body. One will typically see increased TBG levels in hypothyroidism, and decreased TBG levels in hyperthyroidism. However, other factors can cause this to increase or decrease. For example, certain drugs can increase TBG levels such as oral contraceptives. Liver disease can also increase these levels, and TBG levels are normally increased during pregnancy. On the other hand, certain drugs such as prednisone, dilantin, and high doses of salicylates can decrease TBG levels.

Free Thyroxine Index (FTI). The free thyroxine index was used more commonly before the free T3 and free T4 tests were made available. It is obtained by multiplying the total T4 with the T3 uptake, and might be useful to measure thyroid function when there are abnormalities in plasma protein binding. The free thyroxine index is typically high in hyperthyroidism, and usually low in hypothyroidism.

Reverse T3 (RT3). As I mentioned earlier, T4 is converted to T3. However, some T4 is also converted to reverse T3. I won’t get into much detail about reverse T3 here, as for more information you can read a separate article I wrote entitled “Reverse T3: What You Need To Know About It“. What I will say here is that some reverse T3 is normal, but you don’t want to have too much, as this usually indicates a conversion problem between T4 and T3. And as I mentioned in the article, chronic stress frequently leads to high RT3 levels. The reason for this is because elevated cortisol levels can inhibit the conversion of T4 to T3. Since the liver is also responsible for the conversion of T4 to T3, having a liver that isn’t functioning optimally can also lead to higher levels of RT3.

Thyroid peroxidase (TPO) antibodies. Thyroid peroxidase, also known as thyroperoxidase, is an enzyme produced by the thyroid gland which helps with the production of thyroid hormone. In fact, when someone takes antithyroid medication (i.e. methimazole or PTU), this essentially is inhibiting this enzyme. Thyroid peroxidase antibodies inhibit thyroid peroxidase, and so the thyroid gland is unable to produce sufficient amounts of thyroid hormone. This typically results in elevated TSH levels. And while taking synthetic or natural thyroid hormone can help to lower the TSH, it won’t do anything to address the autoimmune response, and thus lower these antibodies. TPO antibodies are frequently high in Hashimoto’s Thyroiditis, although it’s not uncommon for those with Graves’ Disease to have elevated levels of these antibodies as well.

Thyroglobulin antibodies. Thyroglobulin (Tg) is a glycoprotein homodimer produced predominantly by the thyroid gland (2). It acts as a substrate for the synthesis of thyroxine and triiodothyronine as well as the storage of the inactive forms of thyroid hormone and iodine (2). In other words, thyroglobulin is a protein produced by the thyroid gland, and it is important for the synthesis of T3 and T4. Thyroglobulin antibodies attack and damage this protein, which leads to the decreased production of thyroid hormone. Elevated thyroglobulin antibodies are common in people with Hashimoto’s Thyroiditis, although some people with Graves’ Disease can have these antibodies as well.

TSH receptor antibodies (TRAbs). There are two types of TSH receptor antibodies. Thyroid stimulating antibodies (TSAb), also known as thyroid stimulating immunoglobulins (TSI), are the main antibodies associated with Graves’ Disease. They stimulate or bind to the TSH receptors, which in turn cause the thyroid gland to produce excessive amounts of thyroid hormone. These antibodies can also attack the tissues of the eye, and can therefore cause thyroid eye disease, also known as Graves’ opthalmopathy. There are also TSH-stimulation blocking antibodies( TSBAb), which causes hypothyroidism. TSBAb-positive patients with hypothyroidism and Graves’ patients with hyperthyroidism may have both TSBAb and TSAb (3).

One important thing to keep in mind is that the absence of thyroid antibodies doesn’t necessarily rule out autoimmune thyroid disease. While testing positive for these antibodies will confirm the presence of an autoimmune thyroid condition, these antibodies can fluctuate, which is why you never want to rely on a single reading. As a result, if an autoimmune thyroid condition is suspected, yet the person tests negative for thyroid autoantibodies, it would be a good idea to test these again in a few months.

So hopefully you have a better understanding of the different types of thyroid blood tests available. While some medical doctors only test for the TSH and thyroid hormone levels, the other tests do have some value. However, also keep in mind that while these tests can provide valuable information, one can’t rely on blood tests alone. For example, just because someone has their TSH and thyroid hormone levels within the normal reference range doesn’t mean they don’t have a problem with the thyroid gland. Remember that the thyroid antibodies will develop before the TSH and thyroid hormone levels become out of range. In fact, with a condition such as Hashimoto’s Thyroiditis, the thyroid antibodies might be elevated for many years before they cause significant damage to raise the TSH and eventually decrease the thyroid hormone levels.

In last week’s blog post I discussed some of the most common causes of gut problems.  This included a poor diet, antibiotic use, chronic stress, pathogens, and toxins.  I also discussed how having a compromised gut can lead to an autoimmune condition such as Graves’ Disease and Hashimoto’s Thyroiditis.  As a result, for many people with an autoimmune thyroid condition, restoring the health of their gut can in turn restore their thyroid health.  In this post I’m going to discuss some of the things you can do to have a healthy gut.

Strategy #1: It all starts with eating well. One of the most common reasons why so many people have gastrointestinal problems is due to eating poorly.  Obviously you need to eat a diet consisting of whole foods, while avoiding the refined foods and sugars.  Common allergens such as gluten and dairy should also be avoided while trying to restore your health.  Having an intolerance to other foods is also possible, and many times it can be a challenge to find out which foods people are sensitive to.  Although food intolerance testing is available, these panels are expensive and aren’t complete accurate.  Many times an elimination diet is the best option, although it of course takes time going this route, and one can’t always rely on symptoms to determine if there are food intolerances.  In addition to avoiding common food allergens and being cautious about other food sensitivities, some people need to avoid other foods.  For example, if someone has small intestinal bacterial overgrowth or a different condition then they might need to be on a low FODMAPS diet. Some people have problems with oxalates and/or salicylates and therefore need to eat foods which are low in these.

Some people can benefit from following a protocol similar to the GAPS diet, which can be an effective diet, although it is very strict.  I usually have my patients follow a Paleo type diet.  If someone has a lot of food intolerances then this is when I will commonly recommend the GAPS diet.

While I’m sure many people reading this information have already made some wonderful changes to their eating habits, one thing to keep in mind is that if someone has been eating poorly for many years, then sometimes changing their diet alone won’t be sufficient to restore their gut health back to normal.  For example, growing up my diet was horrible, as I ate refined foods and sugars on a daily basis, drank plenty of cow’s milk, soda, and fruit punch, and frequently ate fast food.  I did this for about two decades of my life, and while I don’t recall having a lot of bloating or gas, I did have chronic constipation.  And when I eventually changed my eating habits it took many months to experience positive changes in my bowel movements.  But they still were far from normal, and it wasn’t until years later (after I was diagnosed with Graves’ Disease) when I began making further changes to my daily eating habits that I was able to have daily bowel movements.

Strategy #2: Do everything you can to avoid taking antibiotics and NSAIDS. Although there are other prescription drugs which can have a negative impact on your gut heath, probably the two worse drugs to take with regards to gut health are antibiotics and NSAIDS.  I realize that sometimes taking antibiotics are necessary, but many people take antibiotics when they don’t truly need to.  If someone absolutely needs to take antibiotics then they want to take a good quality probiotic supplement during this time.  It also is a good idea to eat plenty of fermented foods.  Then once they are done taking the antibiotic they will want to continue taking the probiotic supplement at least for a few months, and of course continue to eat fermented foods.  For more information on probiotics I recommend reading my article entitled “Can Taking Probiotics Improve Thyroid Health?“.

And of course NSAIDS should be avoided whenever possible.  Once again, I realize that there might be times when someone needs to take this medication.  But they should be taken on a short term basis due to the severe side effects associated with this prescription drug.  If at all possible someone should try to substitute antibiotics and NSAIDS with natural antimicrobials and natural anti-inflammatory foods and supplements.  I’ll talk more about natural antimicrobials shortly when I discuss pathogens.  As for natural anti-inflammatory foods and supplements, eating plenty of fresh vegetables, drinking green tea, and consuming omega-3 fatty acids, turmeric, ginger, and resveratrol can help greatly with the inflammation.  Vitamin D can also play a very important role in inflammation, and many people are deficient in vitamin D.

Strategy #3: Become an expert in managing stress. In last week’s blog post I discussed how chronic stress can affect the gastrointestinal tract.  I talked about how stress can cause problems with gastrointestinal motility, have a negative effect on the regenerative capacity of the GI mucosa, and can lead to a leaky gut.  So even if you are eating an almost perfect diet, if you are stressed out all of the time then this can affect the health of the gut.

In this day and age it’s a challenge to effectively manage stress.  But doing so is necessary for anyone who is looking to restore their health by following a natural treatment protocol.  Part of the problem is that many people don’t block out any time for stress handling.  It’s a catch-22 situation, as many people are so busy with their job and/or taking care of their family that it’s a challenge to find the time to work on improving their stress handling skills.  But doing so is necessary in order to achieve optimal health.

I’m in such a situation, as between consulting with patients, responding to emails, writing articles and blog posts, and trying to spend time with my family I don’t have much time to work on my stress handling skills.  But I block out at least 10 to 15 minutes each day to do this, and most people can do this too.  Even if you start out with five minutes per day this is better than nothing.  And then once you’re in the routine of managing your stress on a daily basis you can gradually increase the amount of time dedicated to this.

As for what you can specifically do to manage your stress, I’ll refer you to an article I previously wrote entitled “7 Stress Management Tips To Help Restore Your Thyroid Health“.  Although three of the tips involve 1) being aware of the impact stress has on your health, 2) eating a healthy diet, and 3) exercising regularly, in addition to doing these, just about everyone should incorporate at least one additional stress management technique into their daily routine.  I personally do biofeedback, but others might do some deep breathing and meditation on their own, while other people might prefer to do yoga, tai chi, or something else on a daily basis to manage their stress.  But it is important to do this every day, even if it is only 10 to 15 minutes per day.  Obviously it would be better to block out 15 to 30 minutes a couple of times per day, but even spending 10 minutes per day on stress management will be beneficial.

Strategy #4: Cautiously eradicate pathogens. Since pathogens can potentially trigger an autoimmune response, then it would make sense to eradicate any pathogens which are present, right?  Well, if someone with an autoimmune thyroid condition has a pathogen such as H. Pylori present then I agree it needs to be eradicated.  However, there are a few things you need to keep in mind.  First of all, antibiotics are frequently used to eradicate pathogens.  And as I mentioned earlier, one should try to avoid taking antibiotics whenever possible.  In most cases antibiotics should be reserved for acute infections (although not everyone who has an acute infection needs to take an antibiotic).

However, if someone has a chronic gastrointestinal infection, while antibiotics might help, they will also disrupt the gut flora.  And so whenever possible I will first try to use natural antimicrobials such as garlic, turmeric, oregano oil, and/or berberine.  Be aware that some natural antimicrobials can cause problems with the good bacteria of the gut.  For example, taking high doses of citrus seed extract can affect both good bacteria and bad bacteria.  I mentioned garlic and turmeric before, which are relatively safe.  But I also mentioned oregano oil and berberine, and while I commonly use these as antimicrobials, taking high doses of these for a prolonged period of time might have a negative effect on the gut flora.  In addition, certain herbs can be toxic if taken for too long, including wormwood, which is commonly recommended by natural healthcare professionals (including myself) to help with parasites.

While taking natural antimicrobials can be beneficial, probably the most important thing you can do is to improve the overall health of your immune system.  And while one can take immune modulating supplements and herbs on a short term basis to help with this, the best way to improve the health of your immune system is by following all of the other advice I have given in this post.  In other words, eating well, managing your stress, and minimizing your exposure to toxins will do wonders in keeping your immune system healthy and strong.  Getting sufficient sleep is also very important.

Strategy #5.  Detoxify your body on a frequent basis. There are so many different toxins we’re exposed to on a daily  basis, and while you can do things to help minimize your exposure to toxins, you also need to do things to help detoxify toxins from your body.  Eating mostly organic food, using natural household products, and doing other things to minimize your exposure to toxins can help.  Just keep in mind that organic food isn’t completely toxin free, and of course many homes are toxic as well.  And even if you take measures to minimize the toxins in your home, simply stepping outside of your house and breathing the “fresh” air will expose you to numerous toxins.  As a result, you always need to work on eliminating toxins from your body.

I have written a separate blog post entitled “3 Ways People With Thyroid and Autoimmune Thyroid Conditions Can Detoxify Their Body“.  In this post I spoke about how you can detoxify your liver through eating certain foods such as cruciferous vegetables, garlic, and cilantro.  You can also take certain supplements and herbs if necessary such as chlorella, milk thistle, and N-acetylcysteine.  I also discussed colon cleansing and sauna therapy.

However, if someone has a condition such as leaky gut syndrome then they want to be cautious when detoxifying their body.  While doing things to increase glutathione levels and eliminate toxins is usually fine, I would refrain from using more aggressive detoxification methods such as colon hydrotherapy.  Keep in mind that I’m not opposed to colonics, as they can be a very effective method of eliminating toxins.  But if someone has an increase in intestinal permeability then this should be addressed first.

Strategy #6.  Implement gut repair strategies (if necessary). If someone has a condition such as leaky gut syndrome then eating well can help, but it also might be necessary do certain things to assist with the gut repair.  L-glutamine is one of the most commonly used nutrients to help repair the gut, as it serves as fuel for the enterocytes.  Certain probiotics can also help with gut repair, such as Saccharomyces Boulardii.  You can also heal the gut by eating certain foods such as bone broth.

Strategy #7: Don’t forget about the gallbladder. The gallbladder plays a big role in digestive health, as it stores bile, which is important with regards to the digestion of fats.  Even though bile is stored in the gallbladder, it is actually produced by the liver.  Some classic gallbladder symptoms include pain between the shoulder blades, although the person might also experience some discomfort on the upper right side of the belly.  Sometimes the pain can become quite severe.  Frequently there are digestive problems upon eating greasy foods, and sometimes even healthy fats.  Hundreds of thousands of people have their gallbladder removed each year, and most of these could have been prevented if the person were to clean up their diet and receive support for the liver and gallbladder.

In summary, having gut problems can lead to many chronic health conditions, including autoimmune thyroid disorders such as Graves’ Disease and Hashimoto’s Thyroiditis.  As a result, you want to do what is necessary to restore the health of the gut, such as eat well, manage your stress, try to avoid taking antibiotics and NSAIDS, be cautious when eradicating pathogens, detoxify your body on a frequent basis, implement gut repair strategies when necessary, and to optimize the health of your gallbladder.  All of these factors can be important when it comes to restoring the health of your gut.  Of course there are other factors I didn’t discuss in this post which can have an impact on gut health, and I will cover many of these factors in future articles and blog posts.

Millions of people have problems with their gastrointestinal tract. Some of these people have overt symptoms such as bloating, gas, abdominal pain, constipation and/or diarrhea. On the other hand, not everyone with gut problems experiences digestive symptoms, as they might present with other types of symptoms such as fatigue, brain fog, muscle and joint pain, neurological problems, or numerous other symptoms. The goal of this blog post is to discuss why so many people have “gut problems”. Then in the next post I will discuss what you can do to overcome these gut problems, which in many cases is the most important factor in restoring one’s immune system health.

But before I do this, I’d like to briefly discuss the importance of having a healthy gut in people with thyroid conditions. Most thyroid conditions are autoimmune in nature. In other words, the autoimmune component of Graves’ Disease or Hashimoto’s Thyroiditis is what’s responsible for the thyroid hormone imbalance. So what is looked at as being “thyroid conditions” are really “immune system conditions”. Approximately 70% of the immune system is in the gut. And if someone has a compromised gut, this needs to be addressed in order to have a healthy immune system.

So let’s go ahead and look at five of the main reasons why many people have problems with the gut:

1) Poor diet. It of course all starts with one’s eating habits. While I’m sure many people reading this information have made some wonderful changes to their diet, the truth is that most people don’t eat well. It’s not uncommon for me to speak with someone who is eating a whole foods diet that is mostly organic, gluten free, etc. Yet many of these people still have digestive issues. And the reason for this is because most chronic health conditions take years to develop, yet most of these people made these changes after the development of their health issues. This described myself as well, as while I ate better than most people before being diagnosed with Graves’ Disease, I still was eating a decent amount of processed foods. It wasn’t until after I was diagnosed with an autoimmune thyroid condition that I made such dramatic changes.

Of course there are some people who were eating well for many years before they were diagnosed with a chronic health condition, yet still currently have gut problems. And I’ll talk about some of the other reasons why this could happen. In fact, I’d like to talk about one of these reasons now, which has to do with food intolerances. The truth is that it is possible to have an intolerance to any type of food. And if someone has a condition such as leaky gut syndrome then it’s not uncommon to have multiple food intolerances, and it can be a challenge to determine which foods someone is reacting to.

However, even if someone doesn’t have a leaky gut they can be sensitive to certain foods, which of course eventually can lead to a leaky gut. For example, although someone can be sensitive to any food, some of the most common food allergens include gluten, dairy, eggs, corn, and soy. Obviously people can have sensitivities to other foods, but these are the most common allergens, and many people who are eating a healthy diet are eating some of these foods. So for example, someone might be eating an organic diet and be 100% gluten free, yet they might be eating some dairy products. And while one can argue that some dairy products are healthier than others (i.e. raw dairy), if someone is sensitive to casein, then this can cause gut issues in some people regardless of the type of dairy they’re consuming. Similarly, if someone is both gluten free and dairy free but is eating foods with corn, and if they happen to have an intolerance to corn, then this can lead to gut issues.

The focus so far has been on people who have been eating somewhat healthy diets yet still might have gut issues, but of course the majority of people who have gut issues don’t eat well. Most people eat too many refined foods and sugars, too much fast food, and they don’t eat enough fruits and vegetables. I didn’t want to focus on this here because most people reading this know that they should avoid the processed foods, and eat mostly whole foods. But they might not be aware that in some cases eating a healthy diet can still cause health issues if the person has an intolerance to one or more of the foods they commonly eat.

2) Antibiotic use. The bacterial flora are very important when it comes to maintaining the health of the gastrointestinal tract. While I’m thankful that we have antibiotics, as there are times when they are necessary, taking antibiotics will disrupt the gut flora, thus resulting in overgrowth by pathogens, invasion and translocation of toxins, and in some cases life-threatening infections (1). And it’s not just the gut that is being affected, as a study which involved 70 females with urinary tract infections treated with antibiotics showed that after antibiotic therapy, the lactobacillus population had not been restored in the majority of patients, and uropathogenic bacteria were found to dominate the urethra and introitus (2). The same study suggested that artificial supplementation of indigenous bacteria (probiotics) is necessary to restore the flora back to normality.

The problem is that most people who take antibiotics don’t end up taking probiotics to help restore the normal gut flora. And as I discussed in my article entitled “Can Taking Probiotics Improve Thyroid Health?“, not all probiotics are the same, and some people who take probiotics aren’t getting sufficient amounts due to either low potency, low viability, or a combination of both factors. And the truth is that antibiotics are overprescribed. For example, if someone has a cold with some of the classic symptoms (i.e. fever, runny nose, sore throat, etc.) and they visit their primary care physician, there is a good chance that they will be prescribed antibiotics. However, if the pathogen which caused the illness was viral then taking the antibiotic won’t help. And even if the pathogen is a bacteria, most of the time medication isn’t necessary to take, as the body’s immune system will frequently be able to eradicate the pathogen. Once again, I’m not suggesting that antibiotics aren’t necessary, as if someone has a bad infection then they might need to take antibiotics. But most people who take antibiotics don’t think of the consequences this will have on their gut health.

I came across an article which discussed whether the rise in asthma and allergies can be at least partially related to antibiotic use (3). The article mentioned how epidemiologic studies have found strong connections between receiving treatment with antibiotics and the development of asthma and allergies. In this article the following question was asked: “How do changes in gut flora influence respiratory allergies?”. And the response was something called “oral tolerance”, which involves the immune system responding upon the ingestion of certain allergens, and this immune system response allows the rest of the body to be tolerant of allergens so that allergic reactions don’t occur. So in other words, if the gut flora is compromised, then this will have a negative effect on oral tolerance, and thus will make someone more susceptible to developing a food sensitivity.

Another study looked into how early antibiotic administration affects oral tolerance (4). The results of the study suggest that taking antibiotics early in life has a negative effect on tolerance to a specific antigen when this antigen is introduced while the person is taking antibiotics. The study hypothesized that “antibiotic treatment early in life might facilitate allergic sensitization to novel food antigens”. The authors of the study suggested that if an infant needs to take antibiotics then it might be a good idea to avoid the introduction of new food ingredients in order to minimize the risk of them developing a food allergy.

3) Chronic stress. Although stress seems to be blamed for the cause of many different conditions, there is plenty of evidence which shows that stress can cause problems with the gastrointestinal tract. The enteric nervous system is the intrinsic nerve supply of the gastrointestinal tract, and the enteric nervous system is connected to the brain by parasympathetic and sympathetic pathways forming the brain-gut axis (5). Corticotropin releasing factor (CRF) is a hormone which helps to regulate the central stress response, and it has been demonstrated that stress can cause an increase in intestinal permeability and can lead to an increased susceptibility to colonic inflammation (5). Physical and psychological stresses are widely accepted as potential triggers of certain gastrointestinal conditions such as peptic ulcer, irritable bowel syndrome, or inflammatory bowel disease (6).

I just mentioned how stress can potentially cause a leaky gut to occur. As for the mechanism behind this, it is thought that stress leads to the altered release or response to neuroendocrine factors (such as corticotrophin-releasing hormone) in the intestinal mucosa, and this either directly or indirectly acts on the cells of the small intestine, which causes intestinal barrier dysfunction and the uptake of proinflammatory material from the gut lumen (7).

Another journal article I came across stated that the major effects of stress on gut physiology include: 1) alterations in gastrointestinal motility; 2) increase in visceral perception; 3) changes in gastrointestinal secretion; 4) increase in intestinal permeability; 5) negative effects on regenerative capacity of gastrointestinal mucosa and mucosal blood flow; and 6) negative effects on intestinal microbiota (8). The same article discusses how melatonin can have protective effects against stress-induced lesions in the gastrointestinal tract, and how taking probiotics might affect the brain-gut interactions and attenuate the development of stress-induced disorders in both the upper and lower gastrointestinal tract. With regards to melatonin, many people use this hormone to help with sleep-related issues, but there is plenty of research which shows that melatonin can also benefit the health of the gastrointestinal tract (9) (10) (11).

4) Pathogens . Of course certain pathogens can have a negative effect on gastrointestinal health. For example, viruses such as norovirus and rotavirus can affect the gastrointestinal tract. Some bacteria which can have a negative effect on the GI tract include shigella, campylobacteria, and C. difficile. Giardia and cryptosporidium are parasites which can affect the gut. Although we can’t completely avoid all of these pathogens, some of the things we can do to minimize our exposure to these and other pathogens include practicing proper hygiene and avoiding uncooked or undercooked meat. With regards to hygiene, a lot of people rely on hand sanitizers, but they aren’t a substitute for soap and water.

While being exposed to certain pathogens can affect the health of the gut, having a compromised gastrointestinal tract will make one more susceptible to an infection by a pathogen. For example, if someone eats a poor diet and/or deals with chronic stress on a daily basis, this can affect the gut and immune system, making them more susceptible to an infection by a virus, bacteria, or parasite. Of course I realize that in some cases people will get an infection even with a healthy gut and immune system, but having a healthy body will of course reduce the likelihood of getting such infections.

5) Toxins. There is still a lot that isn’t known about the impact of toxins on gastrointestinal health. With regards to the routes of entry, environmental toxins taken orally may be modified in the GI tract by gastric pH, digestive enzymes, or even bacteria that live in the intestines (12). Environmental toxins that are internalized by skin absorption or by inhalation may be secreted into the lumen through the biliary system and lead to toxicity (12). Also, toxins suspended in air make their way into the intestinal tract by drainage from the sinuses into the pharynx and esophagus (12).

When talking about toxins, one can’t overlook the effect that certain medications have on the gastrointestinal tract. Pharmaceutical agents of several types interact with the small bowel mucosa causing impairment of transport processes for fluid and electrolytes, amino acid, lipid and sugars as well as vitamins (13). It is well known that NSAIDs have a negative effect on the gastrointestinal tract (14) (15) (16). But other prescription drugs can cause problems with the gut, and even over the counter drugs such as aspirin can cause gastrointestinal injury in some cases (17).

So hopefully you have a better idea as to why problems with the gastrointestinal tract are so common. In the next blog post I will discuss what you can do to have an optimally functioning gastrointestinal tract. While there can be numerous factors which can lead to the development of an autoimmune thyroid condition such as Graves’ Disease or Hashimoto’s Thyroiditis, the truth is that many people will be able to restore their immune system health just with the information included in this blog post, along with the second part I will be releasing.

For those people with Graves’ Disease and Hashimoto’s Thyroiditis who choose to follow a natural treatment protocol, the ultimate goal is to get these people to the point where the immune system is balanced.  In other words, the goal is to suppress the autoimmune component of the condition while addressing compromised areas of the body (i.e. adrenals, gut, etc.).  At this point the person’s symptoms have disappeared, their thyroid hormone levels will be normal and the thyroid antibodies will be negative.  Some might refer to this as a cure, but since there is a genetic component which can potentially be triggered again then it’s probably best to refer to this as a state of remission.  And of course once remission is achieved, the goal is to help the person maintain their health so that a relapse doesn’t occur.

But how can one maintain their health after remission is achieved?  After all, if there is a genetic predisposition then isn’t there the possibility that eating poorly, experiencing a stressful event or some other lifestyle or environmental factor can cause a relapse?  Without question this is possible, but once someone has restored their health back to normal there are numerous things they can do to help reduce the likelihood of having a relapse occur.  So let’s go ahead and discuss some of the more important factors to help maintain your health.

1. Make sure that your condition is stable. Some people think they are in remission even though this is not the case.  First of all, just because someone is symptom free and has a normal TSH and thyroid hormone levels doesn’t mean they are in remission.  You of course want the thyroid antibodies to be negative too, although since these can fluctuate you can’t always rely on a single test result.  If saliva testing was done then ideally you want these results to be normal too.  So for example, if someone presented with elevated cortisol levels, a depressed DHEA, and a depressed secretory IgA then the obvious goal is to get these to within normal limits.  If someone has a leaky gut then this should be healed before someone declares that they’re in remission.

Of course everyone wants to restore their health quickly.  And while it’s my goal to help people achieve optimal results as fast as possible, the truth is that it takes time for this to happen. Let’s not forget that with autoimmune thyroid conditions it frequently take years to develop, and so it will take time for someone’s symptoms to improve, and for the blood and saliva tests to normalize.  And if someone has a condition such as leaky gut syndrome, or toxic overload, then these conditions also take time to address.

2. You want to eat well most of the time. When following a natural treatment protocol you need to be very strict with your eating habits.  Once someone has restored their health it still is important to eat well, although in most cases it is fine to indulge every now and then.  When someone restores their health back to normal what I commonly see is the person eat well for a few months, but then frequently they will slowly incorporate more and more junk food into their diet.  It’s easy to get into bad habits, and I’d be lying if I told you I don’t give into the temptations every now and then.

While most natural healthcare professionals would like to give you the impression they eat well 100% of the time, the truth is that just about everyone indulges every now and then.  I frequently attend nutritional seminars and conferences, and it’s very common to see natural healthcare professionals drinking Starbucks lattes, eating unhealthy food for lunch, etc.  Once again, I’m not trying to criticize natural healthcare professionals who do this, as while I don’t care for Starbucks, and although I usually bring some of my own healthy snacks at these seminars and conferences, I’d be lying if I told you that I never eat some unhealthy foods when attending these conferences.

The point I’m trying to make is that most people who have already restored their health back to normal can get away with eating unhealthy foods on an occasional basis without having to worry about relapsing.  So while you should eat mostly healthy foods and try to avoid the refined foods and sugars, indulging every now and then should be fine after remission is achieved.  I’m sure some people reading this will want to know if this includes common allergens, such as gluten and dairy.  In other words, if someone avoided gluten and/or dairy while following a natural treatment protocol, after they restore their health is it okay to have some gluten based foods every now and then?

This is controversial, and it really depends on the person.  Of course if someone has a condition such as Celiac Disease then they really do need to avoid gluten on a permanent basis.  If someone has a non-autoimmune gluten sensitivity then this is where it gets more controversial.  Dr. Tom O’Bryan is an expert when it comes to gluten, and he feels that anyone with any type of gluten sensitivity should permanently avoid gluten. However, I’m still not sure of this.  For example, if someone developed a gluten sensitivity due to a leaky gut, but corrected this problem, then it might be fine for this person to have some gluten every now and then.  But perhaps this is just due to my own personal bias since every now and then I’m guilty of having a slice of non gluten-free pizza or a non-gluten free dessert.

I think many would agree that the problem with most people isn’t that they eat poorly once in a while.  The primary reason why there is a high prevalence of these chronic health conditions is because most people make it a daily habit of eating refined foods and sugars, fast food, common allergens such as gluten and dairy, etc.  So for those who ate poorly before being diagnosed with Graves’ Disease or Hashimoto’s Thyroiditis, if you changed your diet as part of a natural treatment protocol and then restored your health back to normal, you need to understand that while perfection isn’t necessary, you will need to eat well on a regular basis for the rest of your life if you want to maintain your health.

3. Become a master at handling stress. Managing one’s stress is just as important, if not more important than eating well.  It’s very common for people with these autoimmune thyroid conditions to link the onset of their condition to a stressful event.  There is no question that stress has an effect on the immune system.  While acute stress will lead to elevated cortisol levels and thus immunosuppression, chronic, prolonged stress has been associated with an increase in proinflammatory cytokines, which is also a component of autoimmunity.

I’ve spoken about the impact of stress in other articles and posts.  Stress is a factor in just about everyone’s life, and in many cases it’s not possible to reduce the stress levels.  And so what we need to do is change how we handle the stress.  Unfortunately most people don’t do a good job of handling the stress in their life.  And many people who think they are doing a good job of managing their stress really aren’t doing a sufficient job in this area.

So how about if you currently have low stress levels and feel that you are doing a good job of managing your stress?  As I just mentioned, just because you think you are currently doing a good job of managing your stress doesn’t mean that this actually is the case.  But even if this is true, you never know what the future will bring.  For example, I once had a patient who was doing great on the natural treatment protocol.  Her symptoms improved quickly, and her blood tests normalized after only three months on the protocol, which is great.  But then she was dealing with a close relative who had health problems and eventually passed away, and she relapsed.  It obviously is difficult to prepare for a situation like this, and chances are her condition wasn’t yet stable at this point.  But I brought this example up to demonstrate how important it is to be proactive in managing your stress.

Although eating well, exercising regular, and being aware of the impact stress can have on your health is important, you need to incorporate other stress management techniques into your daily routine.  At the very least you need to block out 10 to 15 minutes once or twice each day to work on managing your stress.  If you can block out 30 minutes each time this would be even better.  I spoke about this in detail in a blog post entitled “Blocking Out Time To Manage Your Stress Is Essential“.

4. Detoxify your body on a regular basis. We are constantly being exposed to toxins, and as a result, we need to do things to 1) minimize our exposure to toxins, and 2) do things to eliminate toxins from our body.  I have also spoken about this in a separate post entitled “3 Ways People With Thyroid and Autoimmune Thyroid Conditions Can Detoxify Their Body“.

5.   Take advantage of natural antimicrobials. Pathogens are also a potential trigger for an autoimmune condition.  We’re all going to be exposed to pathogens, and the in order to minimize the risk of getting an infection you should 1) practice proper hygiene, 2) improve the health of your immune system, and 3) take natural antimicrobials.  I’m not going to talk about hygiene here.  With regards to immune system health, those who are in a true state of remission should have a healthy immune system, and you can maintain its health by following the advice I have given so far in this post.  If you eat well and manage your stress you will maintain the health of your gut and adrenals, which will help greatly in maintaining the health of your immune system.  And of course minimizing your exposure to toxins and eliminating them from your body will also help with immunity.

With regards to natural antimicrobials, there are three that I’m going to mention here.  One of them is garlic, as this is one of the best natural antimicrobials available.  I would try to eat one clove of raw garlic per day, or if you don’t want to do this then take a garlic supplement.  I have written an article entitled “Can Garlic Benefit Thyroid Health?“.  Turmeric is another wonderful herb that has antimicrobial properties.  And so I would also consume some turmeric each day.  I’ve written an article entitled “Turmeric and Thyroid Health“.

The final antimicrobial I’d like to discuss is the controversial mineral iodine.  I’m not suggesting that everyone should take iodine on a wellness basis.  I’m sure some people reading this post were in agreement with most of what I said until I mentioned iodine!  In previous articles and blog posts I’ve mentioned that iodine isn’t for everyone.  Iodine is a potent antimicrobial, and is also effective in penetrating the biofilm of certain pathogens.  But of course there is also evidence of iodine triggering an autoimmune response in some people, and so while I’m pro-iodine, some people should avoid supplementing with this mineral.  In any case, when it comes to fending off pathogens, I would definitely make garlic and turmeric a part of your daily routine, and some people might also want to consider a small amount of iodine.

There are of course other factors which are important to maintaining one’s health.  It’s important to obtain quality sleep each night, as I would try to get at least seven to eight hours of sleep per night.  It is also important to exercise on a regular basis, although I realize that some people won’t be able to do this until they have restored their health back to normal.  However, you want to be careful not to overexert yourself, as this can put stress on the immune system as well.

In summary, without question it is a challenge for people with autoimmune thyroid conditions to restore their health back to normal.  Doing this takes a good amount of time, and requires extreme changes in lifestyle factors.  Maintaining one’s health also can be a challenge, although it doesn’t require being as strict as when one is following a natural treatment protocol.  With that being said, once someone has restored their health back to normal they want to continue to eat well, work on their stress handling skills, continue to minimize their exposure to toxins and do things to help eliminate toxins, take advantage of natural antimicrobials, get ample sleep, and exercise on a regular basis.  Once again, doing all of these things can be a challenge, but doing so is necessary to maintain your health and prevent a relapse from occurring.

While many people have problems losing weight, most people with hyperthyroidism and Graves’ Disease have the opposite problem. Due to the increased metabolism caused by the hyperthyroid condition, most people with hyperthyroidism lose a good amount of weight, and many of these people find it challenging to stop the weight loss. When I was dealing with Graves’ Disease I lost 40 pounds, and it took awhile before I began gaining weight. I work with many people with hyperthyroid conditions who have the same problem. And so the goal of this blog post is to discuss what people with hyperthyroidism and Graves’ Disease can do to gain weight.

When someone is initially diagnosed with hyperthyroidism or Graves’ Disease, they might actually like the idea of losing weight. In fact, some people don’t want to undergo any treatment until they drop a certain number of pounds. On the other hand, some people with hyperthyroid conditions begin to gain weight when taking antithyroid medication. But some people struggle to gain weight even while on the medication, and so let’s go ahead and discuss some of the things people with hyperthyroid conditions can do to gain weight.

WEIGHT GAIN STRATEGY #1: Normalize the thyroid hormone levels. Since the high thyroid hormone levels are usually responsible for the weight loss in hyperthyroid conditions you of course want to do what is necessary to normalize these levels. Most people with hyperthyroidism have Graves’ Disease, which is an autoimmune thyroid condition where TSH receptor antibodies stimulate or bind to the TSH receptors, thus causing the thyroid gland to secrete an excessive amount of thyroid hormone. Ultimately the goal should be to suppress the autoimmune component, but until this is accomplished it is important to manage the hyperthyroid symptoms.

Many people choose to take antithyroid medication such as Methimazole. This frequently will help to normalize the thyroid hormone levels, which in turn can prevent weight loss from occurring. However, it’s not uncommon for the antithyroid medication to make someone hypothyroid, and thus make it challenging to lose weight. Bugleweed and L-carnitine are natural options, as they both can inhibit thyroid hormone production, and thus stop the weight loss from occurring. Sometimes people will continue to lose weight even after the thyroid hormone levels are normal, and when this is the case they will need to look into the other “weight gain strategies” I listed here.

WEIGHT GAIN STRATEGY #2: Eat nutrient dense foods. Most people with hyperthyroid conditions try to address their weight loss issues by eating as many calories as they can. Frequently what they’ll do is try to load up on carbohydrates. Ideally what you want to do is eat nutrient dense foods. In his excellent book “You’re Personal Paleo Code”, Chris Kresser lists certain foods according to their nutrient-density scores. According to Chris, the food with the highest nutrient-density score was organ meats. Other meats are also nutrient dense, although not as high as organ meats. If you happen to be vegetarian then you’ll be happy to know that nuts and seeds are high up on the list. Some examples of nutrient dense fruits and vegetables include avocados, collard greens, kale, spinach, arugula, radishes, and carrots. Eggs are also nutrient dense. If someone has gut issues then they will either want to cut out, or completely avoid eating nuts and seeds (as well as beans and legumes). The reason for this is because these foods have lectins and phytic acid, which make them difficult to digest. Soaking these foods can help to reduce these antinutrients, although this won’t completely eliminate them.

WEIGHT GAIN STRATEGY #3: Consume one or two smoothies on a daily basis with some added protein. In addition to eating nutrient dense foods, you can also have one or two smoothies per day. In the smoothie you can of course add some nutrient dense foods, such as kale, avocados, coconut oil, etc. But in addition to this you can also add some additional protein in the form of whey protein (which is also a great source of glutathione), or if you’re trying to avoid dairy then you can use a rice- or pea-based protein powder.

WEIGHT GAIN STRATEGY #4: Correct any malabsorption problems. Malabsorption is common with hyperthyroidism (1) (2), as the increase in metabolism itself can affect the absorption of nutrients, although there can be other factors which cause problems with absorption. For example, many people with Graves’ Disease have an increase in intestinal permeability (a leaky gut), and this can cause problems with nutrient absorption. Certain pathogens can also cause problems with absorption, and in some cases it is wise to obtain a stool panel which detects the presence of pathogens. Gallbladder problems are another factor to consider. Sometimes a person will be taking medication other than antithyroid drugs and beta blockers which are interfering with nutrient absorption. For example, oral contraceptives interfere with the absorption of numerous vitamins and minerals.

WEIGHT GAIN STRATEGY #5: Do some LIGHT weightlifting at least 3 days per week . Since hyperthyroidism decreases the muscle mass (3) and affects the bone density (4), it would also be a good idea to do some light weightlifting at least a few days per week. When losing weight most people simply try to eat more calories, but doing some light weightlifting can help greatly in gaining weight. A small trial involving sixteen patients with hyperthyroidism showed that resistance training accelerates the recovery of skeletal muscle function and promotes weight gain based on muscle mass improvement (5). Of course if you don’t have experience lifting weights it probably would be a good idea to work with a personal trainer.

In summary, when dealing with a hyperthyroid condition it can be a challenge to gain weight. When this is the case, normalizing the thyroid hormone levels will be one of the keys to halting the weight loss. However, eating nutrient dense foods and doing some light weightlifting can also help people to gain weight. And if someone has another condition which is interfering with the absorption of nutrients (leaky gut syndrome, intestinal dysbiosis, gallbladder problems) then of course this needs to be addressed.