Many people with thyroid and autoimmune thyroid conditions are familiar with the health benefits of probiotics. And I’m sure many people reading this are currently taking probiotics. But just as is the case with many other supplements, many people don’t have a good understanding when it comes to different probiotic supplements. Many just choose a brand with multiple strains, but otherwise don’t know if it is the right probiotic for them. So in this post I will discuss some of the different “features” of probiotic supplements, including some of the strains, the potency, and other factors.

Just so you have a better understanding of the classification of different probiotics, the genus is the first name of the bacterium. Two of the most well known genus are lactobacillus and bifidobacterium. The species is a bacterium’s second name, such as “acidophilus” or “bifidum”. So lactobacillus acidophilus is one example of a species, while bifidobacterium bifidum is another example. However, what many people don’t realize is that members of different species will typically have different strains. So for example, some probiotic supplements I have used included L. acidophilus LA-5, whereas others have included L. acidophilus LA-14.

This is where it can get confusing, as two different strains can have two completely different functions. So for example, one strain in a given species might be able to survive passage through the upper part of the gastrointestinal tract, whereas another strain won’t be able to survive. Similarly, some strains will be able to kill pathogenic bacteria, while other strains won’t do this.

Many healthcare professionals aren’t aware of this, and I also personally wasn’t aware of this in the past. And so what frequently happens is that someone will be told to purchase a specific probiotic supplement based on the species, but if it isn’t the correct strain then it might not have the therapeutic effect you’re looking for. And of course most people who buy probiotics on their own aren’t aware of this either, and so they also aren’t receiving optimal benefits from the probiotic they’re taking.

What Are Some Of The Benefits Of Taking Probiotics?

I’d like to discuss some of the benefits of taking a good quality probiotic. Probiotics can have many beneficial effects. Here are some of the different benefits that probiotics can provide:

• Helps to improve digestion and nutrient absorption
• Modulates the immune system
• Plays a role in the synthesis of vitamins
• Can inhibit certain pathogens
• Enhances motility of the gut
• Involved in the production of short-chain fatty acids
• Certain strains (i.e. Saccharomyces boulardii) can help improve intestinal permeability

Several animal and human studies have provided strong evidence that specific strains of probiotics are able to stimulate as well as regulate several aspects of natural and acquired immune response (1). There is also evidence that taking probiotics is effective in the prevention and/or management of acute gastroenteritis and rotavirus diarrhea, antibiotic-associated diarrhea and intestinal inflammatory disorders such as Crohn’s disease and pouchitis, and pediatric atopic disorders (1). Probiotics might also be beneficial in people with allergies, cancer, AIDS, and respiratory and urinary tract infections, and they might be able to reduce the risk of developing osteoporosis, obesity, and type 2 diabetes (2). Probiotics also can enhance the nutritional content and bioavailability of certain nutrients (3).

How Do Probiotics Work?

When going through my Masters in nutrition program, I took a course on “Gastrointestinal Imbalances”, which was taught by Dr. Jason Hawrelak. Dr. Hawrelak is a naturopathic doctor and western herbalist who focuses on both acute and chronic gastrointestinal conditions. Everything he taught was research-based, and the following were the mechanisms of action he discussed with regards to probiotics:

1) Competition from adhesion sites. For example, certain invading pathogens bind to receptors, but probiotics such as lactobacilli can bind to the same receptors. This will prevent the adhesion and subsequent invasion of the pathogen.

2) Modification of the microbial flora through the synthesis of antimicrobial compounds. Some strains of probiotics can synthesize substances which inactivate certain pathogens. One important thing to keep in mind is that not all strains of probiotics produce antimicrobial compounds.

3) Probiotics can stimulate the immune response and cause increased secretion of immunoglobulin A, elevated natural killer cells, or enhanced phagocytic activity of macrophages. While most people associate probiotics with gut health, many people don’t realize that approximately 70% of the immune system is in the gut. And taking probiotics can help to improve the health of the immune system.

4) Probiotics may compete for nutrients that would otherwise be utilized by pathogens. This is self explanatory, as if a specific pathogen needs certain nutrients to survive, and if certain strains of probiotics compete for the same nutrients, then having a healthy gut flora can lead to less nutrients available for the pathogens.

Which Strains of Probiotics Should You Take?

As I mentioned before, the strain you purchase makes a difference. For example, if someone is experiencing constipation then taking a probiotic supplement which has B. lactis Bb12 might be beneficial (4). If someone has gastrointestinal Candida then taking a probiotic with the strain L. rhamnosus GG would be beneficial (5). L. rhamnosus GG is also beneficial for intestinal dysbiosis. If someone has H. Pylori then taking a probiotic supplement with the strains L. acidophilus LA5 and B. lactis Bb12 can be beneficial (6). If someone has a urinary tract infection then the strains L. rhamnosus GR-1 and L. reuteri B-54 would be beneficial (7).

This is not how most people choose a probiotic. What usually happens is that they visit their local health food store and ask the person working there if they can recommend a good quality probiotic. Since most healthcare professionals don’t have a good understanding of probiotic strains, it’s no surprise that many people working in health food stores don’t have a great deal of knowledge in this area either. In most cases they recommend what they feel is a good quality brand, and they might recommend a specific potency depending on one’s condition. For example, if someone is taking antibiotics and is looking for a probiotic then they might recommend a high potency probiotic that has many different strains. However, if someone has a specific condition they usually won’t have a good deal of knowledge as to which strains are the most beneficial for this condition.

You want to make sure to take well-researched probiotic strains. This will greatly improve the chances of taking a supplement which will have therapeutic actions. I can’t say that I’m an expert when it comes to all of the different probiotic strains. However, I can say that when I recommend a probiotic supplement to my patients I do try to recommend probiotics which include well-researched strains.

How Do You Choose A Good Quality Probiotic?

Choosing a good quality probiotic supplement can be a challenge. Some people simply choose a product with many different strains and a high potency. If you’re sure that this probiotic supplement is from a good quality company then it might have therapeutic value. But once again, you need to realize that specific strains will have specific functions. As a result, the same probiotic supplement that works for “patient A” might not be effective for “patient B”.

When choosing a probiotic supplement, there are two main factors you need to consider. As I just mentioned, you want to be aware of the characteristics of the strain. The second factor you need to be aware of is the viability of the microorganisms. This is where the quality of the company comes into play, as the manufacturing procedures of the company is important, as is the packaging and storage. And of course most people don’t purchase probiotics directly from the company, but they either purchase them at a health food store, retail store, online, or from a healthcare professional. And so the companies which manufacture the probiotics ship the supplements to these companies, and so the transport mechanism also has to be considered.

Some strains need to be transported with an ice pack, while others are stable (unless if the temperature is extremely hot). Some probiotic supplements don’t need to be refrigerated, although even when this is the case it’s still a good idea to refrigerate them after being purchased. Although some sources will say that probiotics should be taken on an empty stomach, you ideally want to take a probiotic supplement with meals.

What Potency Is Ideal?

As for how potent your probiotic should be, it does depend on the situation. Not everyone needs to take a probiotic with 75 billion CFU. And some people don’t do well when taking high doses, as they experience gas and bloating. On the other hand, some probiotic supplements only have a few hundred million CFU, which frequently isn’t potent enough to produce a therapeutic effect.

Once again, the quality of the probiotic supplement is important. You can purchase a probiotic supplement that has 100 billion CFU, but if the strains aren’t viable then you might only be taking something equivalent to 5 billion CFU.

Can You Get Probiotics From Eating Fermented Foods?

Fermented foods can be a good source of probiotics. Some examples of fermented foods include yogurt, kefir, sauerkraut, and kimchi. Of course if someone is trying to avoid dairy (which I commonly recommend) then they won’t want to consume fermented dairy products, such as yogurt and kefir.

As for whether fermented foods have therapeutic effects, it of course depends on which food you’re eating. For example, many brands of yogurt don’t have a sufficient number of viable microorganisms, although many yogurt manufacturers routinely add certain species of probiotics. As I mentioned earlier, the strains will make a big difference. For example, both sauerkraut and kimchi have strains of L. plantarum, which have been proven to survive exposure to gastric acid and bile salts. Certain protocols such as the GAPS diet rely heavily on the use of fermented foods to help heal the gut.

Do You Need To Take A Separate Prebiotic Supplement?

Examples of prebiotics include fructooligosacharides (FOSs), galactooligosaccharides (GOSs), lactulose, and inulin, and their main purpose is to help to increase the number of beneficial bacteria, while at the same time reducing the number of pathogens. They can also enhance the immune system, improve the absorption of certain nutrients such as calcium and magnesium, help with constipation, and might help with other health issues. Some argue that taking prebiotics can serve as a substrate for candida and certain pathogens, although this is controversial.

As for whether it is necessary to take a separate prebiotic supplement, it really depends on the situation. You can get prebiotics by eating certain foods, such as asparagus, onions, garlic, artichokes, and chicory root. But if someone has an imbalanced gut flora then in some cases it might be a good idea to take a separate prebiotic supplement.

Understanding The Different Species and Strains

I’m not going to discuss all of the different species, but I did want to briefly mention the benefits of some of the strains I commonly recommend to my patients:

Lactobacillus acidophilus. This is probably the most well known species, and it is resistant to gastric acid and bile salts, along with pepsin and pancreatin. The strains Lactobacillus acidophilus LA-5 and LA-14 have been shown to inhibit certain pathogens (8) (9).

Bifidobacterium lactis. This species produces large amounts of antimicrobial substances. It also modulates the immune system response to help against pathogens. The species Bifidobacterium lactis BB-12 and HN019 are known for their antipathogenic and immune enhancement effects (10) (11) (12).

Lactobacillus casei. This probiotic also improves the health of the immune system, and can be effective against certain pathogens such as H. Pylori (13) and Candida albicans (14). There is evidence that the strains Lactobacillus casei CRL 431 and Lactobacillus rhamnosus CRL 1224 can be effective against Aspergillus flavus (15), which is a fungi.

Lactobacillus plantarum. A few strains of lactobacillus have proven to be beneficial. Lactobacillus plantarum 299v has been shown to provide effective symptom relief, particularly of abdominal pain and bloating, in patients with irritable bowel syndrome (16) (17). Lactobacillus plantarum Lp-115 also can benefit people with gastrointestinal disorders (18).

Saccharomyces boulardii. Saccharomyces bouldarii is another well-researched strain with many different benefits. It is well known for helping people with a candida infection (19) (20). It also can be useful in the maintenance treatment of Crohn’s disease (21). It can help to improve intestinal permeability (22), and also can help to reduce inflammation and dysfunction of the gastrointestinal tract in intestinal mucositis (23).

VSL#3. VSL#3 is a potent probiotic supplement consisting of multiple strains, and has numerous benefits. It can help people with ulcerative colitis (24), and also improves symptoms in children with irritable bowel syndrome (25).

Keep in mind that there are other beneficial strains besides the ones I listed. Two others worth mentioning are Bifidobacterium longum Bl-05 and lactobacillus reuteri mm53. And there are other beneficial strains as well.

Can Taking Probiotics Help People With Thyroid and Autoimmune Thyroid Conditions?

As far as I know there is no direct effect of probiotics on thyroid health. However, most people with “thyroid” conditions either have Graves’ Disease or Hashimoto’s Thyroiditis, which are autoimmune conditions that affect the thyroid gland. And since probiotics can help to improve the health of the immune system, then one can argue that many people with these conditions can benefit from taking a good quality probiotic supplement and/or making sure they eat plenty of fermented foods. But of course there are many other benefits besides modulation of the immune system, as I mentioned in this post how certain probiotic strains can inhibit pathogens, can help with intestinal dysbiosis, and even help to repair a leaky gut. All of these can be factors in people with thyroid and autoimmune thyroid conditions.

So hopefully you have a better understanding about the benefits of probiotics, including how they work, how to choose a good quality probiotic, and some of the benefits of the different species and strains. While I commonly recommend probiotic supplements to my patients, remember that fermented foods can be an excellent source of probiotics as well. Also remember that specific strains will have specific functions, and so you can’t assume that all strains within a certain species will have the same exact function, as this usually isn’t the case.

Autoimmune thyroid conditions such as Graves’ Disease and Hashimoto’s Thyroiditis are characterized by the presence of autoantibodies. And with both conditions, these antibodies appear before there are any changes in the TSH, thyroid hormone levels, or the person’s symptoms. This is the case with all autoimmune conditions, as the autoantibodies are the first thing to develop. And there is evidence that in some cases these autoantibodies can appear up to ten years before they result in changes in the labs and/or symptoms. Based on this information it might make sense to do preventative screening on everyone, including children, in order to determine if they have autoantibodies.

Most, if not all people who develop a condition such as Graves’ Disease or Hashimoto’s Thyroiditis have a genetic predisposition for this condition. However, just having a genetic marker for an autoimmune thyroid condition doesn’t mean a person will develop this condition, as something triggers the autoimmune response. Once this happens the person will develop autoantibodies, which eventually will lead to changes in the TSH and/or thyroid hormone levels. The person very well might develop symptoms before these values go outside of the lab reference range, or they might not become symptomatic until these are actually outside of the reference range.

Silent Autoimmunity Shouldn’t Be Overlooked

Recently I was reading an article entitled “New Predictors of Disease” by Aner Louis Notkins (1). In this article it was discussed how autoantibodies can be manufactured many years before enough tissue damage occurs to cause the development of symptoms. So let’s take a look at a condition such as type 1 diabetes, which involves destruction of the beta cells of the pancreas. When I was teenager I had a friend who developed type I diabetes. He was around 13 years old when he was diagnosed with this condition, but just like others with type 1 diabetes, his body began forming these antibodies many years earlier. It was only at the point where sufficient damage to his pancreas occurred that he became symptomatic.

The same concept applies to Hashimoto’s Thyroiditis. The primary autoantibodies associated with this condition are thyroid peroxidase antibodies and thyroglobulin antibodies. When someone begins developing symptoms associated with this condition, in most cases these thyroid antibodies have developed many years before the onset of symptoms. In fact, it usually takes years before sufficient damage to the thyroid gland occurs to cause an increase in the TSH, and it usually takes even more time than this before the thyroid hormone levels become depressed.

Graves’ Disease is somewhat different than many other autoimmune conditions. For example, most autoimmune conditions result in the destruction of tissue. As mentioned earlier, type 1 diabetes results in destruction of the beta cells of the pancreas. Hashimoto’s Thyroiditis results in destruction of the thyroid gland. The condition rheumatoid arthritis attacks and damages the synovial joints. Multiple sclerosis involves destruction of the myelin sheath of the brain. However, the TSH receptor antibodies associated with Graves’ Disease apparently don’t damage or destroy any bodily tissues. They either bind to or stimulate the TSH receptors. And when compared to other autoimmune conditions, chances are it doesn’t take nearly as long before someone with these antibodies experiences symptoms and/or changes in the TSH and thyroid hormone levels. However, it’s not uncommon for people with Graves’ Disease to also have thyroid peroxidase antibodies, and some will have thyroglobulin antibodies as well.

What Value Can Predictive Screening Provide?

I realize that many people reading this already have an autoimmune thyroid condition. However, there are a few factors to consider when thinking about whether you should consider predictive screening:

1) People with one autoimmune condition are more likely to develop another one. Research clearly shows that those people who have one autoimmune condition are more likely to develop additional autoimmune conditions. So for example, someone with Graves’ Disease or Hashimoto’s Thyroiditis has a greater likelihood of developing conditions such as Rheumatoid arthritis, Lupus, and other autoimmune conditions. In fact, if you currently have an autoimmune thyroid condition then there is the chance you have autoantibodies for another condition.

2) One of your family members might have a genetic predisposition for an autoimmune thyroid condition (or a different autoimmune condition). If you have any type of autoimmune condition and have children, then there is a greater chance of them having a genetic marker for the same condition. And just because they have a normal TSH and normal thyroid hormone levels and are asymptomatic doesn’t mean they don’t have any autoantibodies which are currently causing damage to their thyroid gland. Or they might have the autoantibodies for a different condition.

So does this mean that everyone should be routinely screened for the presence of autoantibodies? The problem is that such testing can be expensive. Just testing alone for the presence of thyroid antibodies can be very pricey. And if you want to do more than just test for thyroid autoantibodies then it can become extremely expensive. The company Cyrex Labs has a panel called the “Multiple Autoimmune Reactivity Screen”, which tests for about two dozen common autoantibodies, such as thyroid peroxidase antibodies, thyroglobulin antibodies, parietal cell antibodies, islet cell antibodies, myelin antibodies, and numerous other autoantibodies. But this test costs hundreds of dollars, and one might spend even more at a local lab to obtain all of these different autoantibodies. And even if you have good health insurance coverage, it is unlikely to cover all of these autoantibodies on a routine basis (i.e. annually or once every couple of years).

Can Genetic Testing Be Utilized?

Another option to consider is to do genetic testing to see if one has the genetic markers for certain autoimmune conditions. And then if they do test positive they can selectively obtain testing for autoantibodies. For example, if someone has the genetic markers for Celiac disease (HLA-DQ2 and/or HLA-DQ8), because they have an increased risk of developing Celiac disease they might choose to obtain a Celiac panel. Similarly, if they have one or more genetic markers for other autoimmune conditions then they can test for those specific conditions. Keep in mind that having a genetic marker for a specific condition doesn’t guarantee someone will have autoantibodies for that condition.

However, one important piece of information you need to understand is that an autoimmune condition can be triggered at anytime. For example, let’s talk about Celiac disease again. If someone has the genetic markers for this condition but the autoantibodies on the Celiac panel are negative, this doesn’t mean that some environmental factor won’t trigger an autoimmune response in the future, thus leading to the development of this condition. And this of course is true with any autoimmune condition.

Because of this fact, one ideally would want to do genetic testing to see which autoimmune conditions they’re susceptible to, and then if they have certain genetic markers they can routinely test for the presence of autoantibodies specific to these conditions. So for example, if they have the genetic markers for Celiac disease, multiple sclerosis, and Graves’ Disease, then it probably would be a good idea to get these autoantibodies tested at least every few years. While this won’t be as expensive as testing for all of the different autoantibodies, or even the most common autoantibodies, it still can be expensive. And getting the genetic testing can also cost a decent amount of money.

In addition, unlike Celiac Disease, there aren’t clear genetic markers for Graves’ Disease and Hashimoto’s Thyroiditis. In Graves’ Disease, the genetic marker HLA-DR3 was reported by several studies as the primary marker associated with this condition, while in Hashimoto’s Thyroiditis, no consistent associations were observed (2).

What’s The Purpose Of Doing Predictive Autoantibody Screening?

Another factor to consider is the approach one will take when someone does predictive screening and tests positive for autoantibodies. There really is no purpose to spend the money on genetic testing and/or autoantibody panels if you’re not going to do anything to address the autoimmune response. The primary reason to do such testing is to find out if one has elevated antibodies so that they can attempt to suppress the autoimmune component before sufficient tissue damage occurs, leading to symptoms and/or changes in other values.

In summary, with autoimmune conditions, the autoantibodies appear before the onset of symptoms and deviations in lab values. And in some cases, these autoantibodies can develop many years before noticeable changes take place. This is definitely the case with Hashimoto’s Thyroiditis, as some people have positive thyroperoxidase antibodies and/or thyroglobulin antibodies for many years before sufficient damage to the thyroid gland occurs which results in changes to the TSH, thyroid hormone levels, and/or the onset of symptoms. With Graves’ Disease this might not be the case, as while TSH receptor antibodies do develop before the TSH and thyroid hormone levels get out of range, these antibodies most likely aren’t high for many years before one notices these changes. But since autoimmunity is prevalent, doing predictive autoantibody screening or genetic testing for those conditions which result in tissue damage or destruction might be something to consider.

There is no question that nuts and seeds are my favorite type of whole food. I ate my share of junk food growing up, but nuts and seeds were one of the few “healthy” foods I consumed on a regular basis. Okay, I admit they weren’t too healthy, as I usually ate them out of a can, which of course included the unhealthy oils. In any case, eating nuts and seeds can be a healthy part of one’s diet. However, one needs to be cautious about eating too many nuts and seeds, and sometimes it is a good idea to completely avoid eating them.

Let’s begin by discussing some of the health benefits of nuts and seeds. First of all, nuts are an excellent source of protein. For example, one cup of almonds provides about 20 grams of protein. In fact, nuts and seeds can be a main source of protein for vegans and vegetarians. Nuts and seeds can also be a good source of certain minerals. Most nuts and seeds have a good amount of magnesium. And some nuts, such as almonds, are good sources of calcium. Nuts and seeds are also excellent sources of fiber. Yet another benefit is that nuts and seeds have a low glycemic index. So there are many great benefits of eating nuts and seeds.

Which Nuts and Seeds Are The Healthiest For You?

Almonds. Almonds are one of the healthiest nuts you can eat. They are high in many different nutrients. Some of the cardioprotective nutrients found in almonds include alpha-tocopherol, arginine, magnesium, copper, manganese, calcium, and potassium (1). They are an excellent source of protein, and are high in fiber. There have been numerous studies on the health benefits of almonds. One study showed that almond consumption may decrease total cholesterol and does not significantly affect LDL or HDL cholesterol, triglycerides, or the LDL:HDL ratio (2). Another study showed that almonds used as snacks in the diets people with high lipid levels significantly reduce coronary heart disease risk factors (3).

Walnuts. Compared to most other nuts, which contain higher amounts of monounsaturated fatty acids, walnuts are unique because they are rich in omega 3 and omega 6 polyunsaturated fatty acids (4). Walnuts contain multiple health-beneficial components, such as having high levels of arginine, folate, fiber, tannins, and polyphenols (4). One study showed that walnuts have a large antioxidant capacity (5). There is even evidence that eating walnuts might help to prevent breast cancer (6). Due to the high content of omega-3 fatty acids, eating walnuts might also help to improve learning and memory functions (7).

Cashews. Cashews are by far my favorite nut. Although I can’t say that they are the healthiest of all of the nuts, they still have numerous nutrients (i.e. manganese, tryptophan, magnesium), are high in protein and fiber, and taste great when covered with dark chocolate (of course just about every type of nut tastes better when covered with dark chocolate!). Unfortunately I couldn’t find too many studies regarding the health benefits of cashews, although there is some evidence that they might have anti-diabetic properties (8).

Brazil nuts. Brazil nuts are well known for having high levels of selenium. In fact, there are numerous studies which show that eating only one or two Brazil nuts per day can help to improve selenium status (9) (10) (11).

Macadamia nuts. These are also pretty yummy. The protein content of macadamia nuts isn’t as high as other nuts. Studies have demonstrated that eating macadamia nuts can help to lower both total and LDL cholesterol (12) (13). Another study showed that short-term macadamia nut consumption improves the biomarkers of oxidative stress, thrombosis and inflammation (14), which are risk factors for coronary artery disease.

Sunflower seeds. Sunflower seeds are also very healthy, as they have high levels of protein and dietary fiber. They are also high in vitamin E, thiamin, folate, manganese, copper, magnesium, selenium, and other nutrients. However, sunflower seeds (along with peanuts, flaxseed, and linseed) can also have high levels of cadmium (15).

Pumpkin seeds. Pumpkin seeds consist of high amounts of potassium, magnesium, manganese, selenium, copper, chromium, and molybdenum (16). In the past I’ve discussed how pumpkin seeds can act as a natural aromatase inhibitor, and it also can benefit men who have benign prostatic hyperplasia (17) (18). There is also evidence that pumpkin seed oil exhibits antihypertensive and cardioprotective effects (19).

Pistachios. I love pistachio nuts. Like most other nuts, pistachios have high amounts of protein and are a good source of dietary fiber. Among nuts, pistachios contain the highest levels of potassium, gamma-tocopherol, vitamin K, phytosterols, and xanthophyll carotenoids (20). One study showed that a diet consisting of 15% of calories as pistachio nuts (about 2-3 ounces per day) over a four week period can favorably improve some lipid profiles in subjects with moderate hypercholesterolemia and may reduce risk of coronary disease (21). This was confirmed by another study, which also showed that pistachios can increase serum antioxidants, such as lutein, gamma-tocopherol, and beta carotene (22).

Pecans.Let’s not forget about pecans. They are lower in protein when compared to other nuts, but they have a high amount of dietary fiber, and they are a good source of magnesium, zinc, manganese, and iron. Just like many other nuts, there is evidence that eating a pecan-enriched diet can help lower total and LDL cholesterol, and increase HDL cholesterol levels (23). Pecans can also help to increase plasma postprandial antioxidant capacity (24). So I guess there are some benefits to eating pecan pie!

One thing you’ll notice is that even though nuts are high in fat, there are numerous studies which demonstrate that eating nuts and seeds can potentially decrease the risk of cardiovascular disease.

What’s The Deal With Peanuts?

Peanuts aren’t considered to be a nut, as they are classified as a legume. There is a lot of controversy over whether peanuts are healthy to eat. One of the reasons for this is because peanuts contain aflatoxins, which are natural toxins produced by the fungi Aspergillus flavus and Aspergillus parasiticus. Aflatoxins are associated with an increase in liver cancer and impaired growth in young children (25). However, the levels of aflatoxins produced in peanuts differs with the genetic variety of the plant and with the species and strain of the fungus (26). In other words, not all peanuts have high amounts of aflatoxins. Of course it can be a challenge to know whether the peanuts you’re eating have high amounts of aflatoxns.

The FDA requires the aflatoxin levels to be 20 parts per billion or less in both organic and non-organic peanut butters sold by retail stores. Keep in mind that this doesn’t apply to grinding your own peanut butter at the health food store, and so you’re probably better off buying an organic, pre-packaged peanut butter. Whole Foods claims to test all of their batches of the “365” brand of peanut butter for aflatoxins, and says that they keep it between 0 to 10 parts per billion (27).

Even with the aflatoxins, there are some health benefits of eating peanuts. They are high in protein, and have high amounts of certain nutrients, such as manganese, tryptophan, vitamin E, and folate. They are a good source of fiber. They also have a small amount of resveratrol, which has many health benefits. Assuming someone doesn’t have a peanut allergy then I think in many cases it’s fine to eat organic peanuts (including organic peanut butter) on an occasional basis.

Getting back to the subject of aflatoxins, it’s important to understand that peanuts aren’t the only source of these toxins. Aflatoxins can be found in pecans, almonds, Brazil nuts, and other nuts, seeds, and legumes. They can also be found in other types of foods such as corn and wheat. Consuming small amounts of aflatoxins probably isn’t a big issue with most people, although you of course still want to be cautious, and this is yet another reason to consider buying organic food, as while it won’t completely eliminate the risk of aflatoxins, it will minimize the risk of exposure.

The Risks Of Eating Too Many Nuts And Seeds

I can easily eat a few cups of nuts and seeds per day. However, it usually isn’t wise to eat such a large amount on a daily basis. One of the biggest reasons is that nuts and seeds are high in omega 6 fatty acids. While it’s true that some nuts do have a decent amount of omega-3 fatty acids, pretty much all nuts and seeds have a higher amount of omega-6 fatty acids. These days most people have an imbalance of the ratio of omega-3 and omega-6 fatty acids, and so while it’s fine for most people to eat some nuts and seeds per day, you probably don’t want to exceed one cup per day, and it might be best to limit it to 1/2 cup on most days.

Nuts, Seeds, and Thyroid Health

I’ve spoken about goitrogens in the past, and certain nuts and seeds seem to have a small amount of goitrogenic activity. Some of the nuts and seeds which supposedly have goitrogenic activity include almonds, cashews, flax seeds, peanuts, pumpkin seeds, and walnuts. I couldn’t find much research on this, and most of the research I found showing that certain nuts and seeds are goitrogens were conducted many decades ago, and were performed on rats. This doesn’t mean that these studies weren’t valid, but it would be nice to have at least a few updated studies on this. Plus, roasting nuts and seeds apparently reduces the goitrogenic activity. With that being said, in my opinion, eating “normal” amounts of raw nuts and seeds shouldn’t inhibit thyroid function in most people.

However, there is another reason why some people with thyroid and autoimmune thyroid conditions need to be cautious about eating nuts and seeds. In past articles and blog posts I’ve spoken about how an increase in intestinal permeability (a leaky gut) is a potential cause of Graves’ Disease and Hashimoto’s Thyroiditis. Nuts and seeds contain lectins and phytic acid, which make them very difficult to digest. And there is evidence that lectins can cause an increase intestinal permeability. As a result, most people with gut problems will want to consider avoiding nuts and seeds until the health of their gut is restored back to normal. Soaking nuts and seeds can help to reduce the antinutrient content, and thus make them easier to digest. However, doing this won’t completely eliminate the lectins and phytic acid. In the past I put together a blog post entitled “Should People With Thyroid and Autoimmune Thyroid Conditions Avoid Foods With Lectins?”

In summary, nuts and seeds have numerous health benefits, as they are an excellent source of fats, protein, fiber, and have other beneficial nutrients. Although nuts and seeds have a high fat content, just about all of them offer cardioprotective benefits. Peanuts are actually classified as a legume, and although they also have numerous health benefits, some peanuts tend to have high levels of aflatoxins. One does need to be cautious about eating large amounts of nuts and seeds, as they are high in omega 6 fatty acids, are difficult to digest, and might also possess goitrogenic activity. On the other hand, for most people, eating a small amount of nuts and seeds on a daily basis can provide some great benefits to their health.

When it comes to achieving optimal health, most people with thyroid and autoimmune thyroid conditions don’t think much about the importance of their liver. And when we do think of the liver, we tend to focus on its role in detoxification. This of course is an extremely important function, and perhaps THE most important function. However, there are numerous other functions of the liver, and this organ has a role in thyroid health, which I’ll discuss in this post.

Understanding Some of The Many Functions Of The Liver:

Before I discuss the role of the liver in thyroid health, I think it’s important to understand some of the more important overall functions of the liver.

1. Removes or excretes drugs, hormones, and other substances. The liver is well known for its role in detoxification. There are many different toxins in our environment, and it’s the job of the liver to transform these toxins into less toxic compounds, and then assist in the excretion of these compounds. I’ll expand on this shortly when I talk about the different phases of detoxification and biotransformation.

2. Involved in carbohydrate metabolism. The liver plays an important role in maintaining glucose concentrations in a normal range (1). The liver stores glycogen, and this allows the liver to remove excess glucose from the blood and store it, and then when the blood glucose concentrations begin to fall it will release glucose back into the bloodstream.

3. Involved in fat metabolism. The liver plays a big role in lipid metabolism, as the formation of most lipoproteins (molecules made of both protein and fat) takes place in the liver. Cholesterol synthesis also takes place in the liver, and the conversion of carbohydrates and proteins into fat occurs in the liver.

4. Involved in protein metabolism. The deamination, or breakdown, of amino acids mostly takes place in the liver, as does the formation of urea. Deamination of the amino acids is required before they can be converted into carbohydrates or fats. Urea helps to remove ammonia from the body fluids. Formation of the plasma proteins also occurs in the liver.

5. Stores certain vitamins. Some of the vitamins stored by the liver include vitamin A, vitamin D, and vitamin B12.

6. Plays a role in vitamin D metabolism. I have spoken numerous times about the importance of vitamin D, and how this is deficient in many people. The liver produces 25-hydroxy vitamin D, which is the most abundant circulating form of vitamin D, and its measurement is used to assess vitamin D deficiency (2). As a result, if someone has problems with the liver, this can lead to low levels of 25-OH vitamin D. However, most cases of vitamin D deficiency aren’t caused by liver problems, as liver function needs to be severely compromised in order for the synthesis of 25-OH vitamin D to be impaired.

7. Involved in blood clotting. The liver is responsible for the formation of numerous substances which are important for the coagulation (clotting) of the blood. This includes fibrinogen, prothrombin, Factor VII, and other coagulation factors. As a result, acute and chronic liver conditions can lead to decreased synthesis of clotting and inhibitor factors, decreased clearance of activated factors, quantitative and qualitative platelet defects, hyperfibrinolysis, and accelerated intravascular coagulation (3). Simply put, problems with the liver can cause problems with blood clotting.

The Phases of Biotransformation and Detoxification

With regards to the toxins we’re exposed to, there are three phases involved in the biotransformation and detoxification of these compounds. In Phase 1, foreign compounds are converted into either more potent or less potent compounds in preparation for Phase 2. In Phase 2, the metabolites produced in phase 1 are combined with other substances which make them less toxic, and they also become more water soluble so they can be excreted through the bile and urine. Phase 3 involves the excretion of these compounds.

Something called Cytochrome P450 plays an important role in biotransformation, as the CYP1, 2, and 3 families are responsible for the biotransformation of most foreign substances including 70-80% of all drugs in clinical use (4). Expression of each CYP is influenced by a unique combination of mechanisms and factors including genetic polymorphisms, induction by xenobiotics, regulation by cytokines, hormones, during disease states, as well as sex, age, and other factors (4). Certain factors such as eating cruciferous vegetables can help to increase the levels of these cytochromes. On the other hand, other factors can lead to a decrease in these cytochromes, and therefore have a negative effect on biotransformation and detoxification.

What Role Does The Liver Play In Thyroid Health?

The two main types of thyroid hormone are thyroxine, also known as T4, and triiodothyronine, known as T3. Although the thyroid gland produces about ten times more T4 than T3, the active form is T3. While the thyroid gland does synthesize some T3, this hormone is also produced through the conversion of T4 to T3. And 30 to 40% of this occurs in the liver (5).

Many people reading this are already familiar with the role of the liver in converting T4 to T3, but the liver also plays a role in deactivating thyroid hormone. In addition, the liver also has specific functions with regards to thyroid hormone transport and metabolism. The liver synthesizes a number of plasma proteins that bind to the thyroid hormones and thereby provide a large, rapidly exchangeable pool of circulating hormone (5). Thus tissue thyroid status depends not only on thyroxine secretion but also on normal thyroid hormone metabolism, delivery of T3 to nuclear receptors, and on receptor distribution and function (5).

So what does all this mean? Essentially it means that if someone has a liver which is not functioning optimally, then this can affect thyroid health. While it is true that most thyroid imbalances are due to the autoimmune component of Hashimoto’s Thyroiditis or Graves’ Disease, it would also be prudent to consider the role of the liver when it comes to thyroid health. For example, if someone has a problem with the conversion of T4 to T3, rather than just give the person a drug such as Cytomel, it probably would be a good idea to look into the health of the liver to see if this is what’s responsible for the conversion problem. Plus, as I’m about to discuss, one also needs to consider the impact of hypothyroid and hyperthyroid conditions on the liver.

Hypothyroidism and Liver Health. There is evidence that hypothyroidism may directly affect the liver structure or function, as it has been associated in a few case reports with cholestatic jaundice attributed to reduced bilirubin and bile excretion (5). Hypothyroidism might also result in the elevation of the liver enzyme aspartate aminotransferase (AST) (6). However, most of the people I work with who have hypothyroidism and Hashimoto’s Thyroiditis have normal liver function tests.

Hyperthyroidism and Liver Health. It’s not uncommon for people with hyperthyroidism and Graves’ Disease to have abnormal liver function tests (7). This includes alkaline phosphatase, aspartate aminotransferase (AST), alanine aminotransferase (ALT), gamma -glutamyltransferase (GGT), and total bilirubin. However, when these values are out of range due to the hyperthyroid condition, they usually revert back to normal once the thyroid hormone levels are normalized. One thing to consider is that taking antithyroid medication such as Methimazole or PTU can cause liver damage, and thus raise the liver enzymes.

What Can You Do To Achieve Optimal Liver Health?

The problem is that with all of the toxins we’re exposed to, the liver has to work extremely hard in the process of biotransformation and detoxification. Because of this you want to try to do what you can to optimize the health of your liver, and here are 3 main things you can do to accomplish this:

1) Eat foods that can help optimize the health of the liver. There are many different foods which can help detoxify the liver. Some of these include the cruciferous vegetables, garlic, and drinking green tea. For more information I would recommend reading a blog post I previously wrote entitled “3 Ways People With Thyroid and Autoimmune Thyroid Conditions Can Detoxify Their Body“.

2) Do everything you can to minimize your exposure to toxins. Of course you want to try to eat as many organic foods as you can, as well as drink purified water. You also want to use natural cleaning products and cosmetics, as most name brand products are loaded with chemicals. If you frequently drink alcohol you should cut down on this, and of course want to avoid tobacco smoke. Regularly change your air filters, and consider investing in one or more air purification systems.

3) Do things to help eliminate toxins. Although minimizing your exposure to environmental toxins is important, you also want to do things to help eliminate toxins. One of the most important things you can do is to make sure you drink a sufficient amount of water each day. You also want to make sure you’re having regular bowel movements. These are the main two priorities when it comes to eliminating toxins, but there are other things you can do as well, such as taking nutrients or herbs to help with detoxification, or utilizing sauna therapy. Once again, you can refer to the blog post I wrote on detoxification for further information on detoxification.

So hopefully you have a better understanding as to why having a healthy liver is important for optimal thyroid health. With regards to thyroid health, having a healthy liver is important for both the activation and deactivation of thyroid hormone, as well as for thyroid transport. And of course most people realize the importance of the liver with regards to biotransformation and detoxification. But the liver also has other roles, such as the metabolism of carbohydrates, fats, and protein, and also is involved in vitamin storage, the synthesis of 25-hydroxy vitamin D, and in blood coagulation.

With autoimmune thyroid conditions such as Graves’ Disease and Hashimoto’s Thyroiditis, there is a lot of emphasis on avoiding gluten. And while I agree that people with these conditions should go on a gluten free trial, many natural healthcare professionals will also advise their patients to avoid dairy. This causes a great deal of confusion, as many people think of dairy as being healthy. Without question there are health benefits of certain types of dairy, but some forms of dairy can have a negative consequence on your health, which I will discuss in this post.

When I was growing up I drank plenty of cow’s milk. I also drank plenty of soda, fruit punch, and other unhealthy beverages as well. But of course the focus of this blog post is on dairy, and so let’s stick with this topic. Getting back to cow’s milk, many people perceive cow’s milk as being healthy. Although drinking cow’s milk is very healthy for baby cows, it’s not necessarily healthy for humans. Fortunately, more and more people are realizing this, and thus are substituting cow’s milk with almond milk or coconut milk. Unfortunately some people drink a lot of soy milk, which isn’t much better than cow’s milk, and is arguably even worse. But when it comes to cow’s milk, drinking this can cause a lot of health problems, and can potentially lead to conditions such as acne, obesity, type 2 diabetes, and even cancer. I will discuss the mechanism behind this shortly.

Why Is It Important To Avoid Drinking “Conventional” Cow’s Milk?

As I mentioned before, many people still think of cow’s milk as being healthy, and as a result they are drinking it on a regular basis. On the other hand, some people with thyroid and autoimmune thyroid conditions have been told to avoid dairy, and because of this they no longer drink any milk, and might avoid other forms of dairy such as yogurt, whey, and cheese. I’ll briefly talk about these other forms of dairy later on in this post, but let’s first answer the question “why is commercial cow’s milk bad for you?” There are a few different reasons for this:

Reason #1: The hormones. Most people realize that cow’s milk contains hormones. Cow’s milk contains estrogens and could stimulate the growth of hormone-sensitive tumors (1). I briefly mentioned soy milk earlier, and there is evidence that soy milk could increase the growth rate of breast cancer cells (1). Getting back to cow’s milk, many people are aware that growth hormones are given to dairy cows to increase the milk production. While it’s probably a good idea for everyone to avoid non-organic milk due to these hormones, it is especially important for children to avoid drinking cow’s milk. While drinking organic cow’s milk would be a healthier choice, it’s important to keep in mind that organic milk might not have growth hormones added, but this doesn’t mean it will be free of estrogens. Due to these and other factors I’m about to discuss, avoiding conventional cow’s milk altogether is probably best, whether or not it’s organic or non-organic.

Reason #2: The Pasteurization Process. The pasteurization process was developed by Louis Pasteur in 1864, and involves heating the milk to a specific temperature in order to kill harmful bacteria. When you think about pasteurization this might sound like a very good idea. The problem is that heating the milk decreases many of the nutrients, such as vitamin B1, B2, folate, B12, vitamin C, and vitamin E (2). In addition, the pasteurization process will modify the proteins of dairy, and can potentially lead to a greater increase in food allergies, although some argue that the opposite occurs, as by denaturing the proteins this might make someone less susceptible to a dairy allergy. Earlier I mentioned how organic milk will have estrogens from the cow. Some might wonder if the pasteurization process will inactivate these hormones, but organic and conventional dairy products do not have substantially different concentrations of estrogens (3).

Reason #3: The Homogenization Process. Why is commercial milk homogenized? The process of homogenization helps to give milk it’s white color and smooth texture, and also might help with the digestibility of milk (4). An excellent review article was written on homogenization and the potential link between cardiovascular disease, diabetes, and allergy (Click Here to read this article). Homogenization changes the physical structure of milk fat and because of this might alter the health properties of milk. If you read this review article you’ll see the evidence which shows the increased risk of cardiovascular disease and type 2 diabetes in those who drink homogenized milk. However, to be fair, most of these involve observational studies, and it’s difficult to use these to prove a direct correlation between milk consumption and these diseases.

For example, one of these studies show that the consumption of cheeses manufactured with non-homogenized milk is high in France where coronary mortality is low, whereas in Scandinavian countries homogenized milk consumption is high, and so is coronary mortality (5). But of course there might be other factors responsible for the difference in coronary mortality. In addition, as of writing this post there are no clinical studies which compare homogenized to non-homogenized dairy products. With regards to allergies to dairy, many people have claimed that they are unable to tolerate homogenized milk, but do fine when consuming non-homogenized milk.

Reason #4: The mTORC1 pathway. There is something called the mammalian TOR complex 1 (mTORC1) and it seems that this signaling pathway plays a big role in the development and progression of numerous conditions. This includes conditions such as acne (6) (7), as well as chronic conditions such as obesity (8) (9) (10), type 2 diabetes (10), and cancer (11) (12) (13).

But how can this signaling pathway lead to the development of these chronic conditions? Well, dairy proteins and meat stimulate insulin and insulin-like growth factor 1 signaling and provide high amounts of leucine, which causes mTORC1 activation (10). Something called kinase S6K1 is a downstream target of mTORC1, and this interaction leads to insulin resistance, which in turn increases the metabolic burden of B-cells (10). In addition, leucine-mediated mTORC1-S6K1-signaling plays an important role in adipogenesis, which in turn increases the risk of obesity-mediated insulin resistance (10). I realize that this is probably difficult to understand for many reading this, but the important point to understand is that activation of the mTORC1 pathway can lead to numerous health conditions, and leucine, which is an amino acid found in high amounts of dairy products, can activate the mTORC1 pathway.

Does this mean that drinking commercial milk will always lead to a condition such as obesity, type 2 diabetes, or cancer? Of course not. As I mentioned at the beginning of this blog post, I drank cow’s milk growing up on a daily basis, and I never developed insulin resistance. However, the same point can be made about other allergens as well. For example, some people do fine when eating gluten. On the other hand, many people don’t do well, and the health consequences of eating gluten could be severe when one is gluten sensitive. And of course gluten isn’t necessary to consume. The same can be said for pasteurized/homogenized cow’s milk. While some people do fine with this, others don’t do fine. And just as is the case with gluten, it’s unnecessary to drink cow’s milk.

Many people are aware of the glycemic index, and milk actually has a low glycemic index, which is a good thing. However, cow’s milk, along with other types of dairy, has a high insulin index, which means that it causes a high insulin response. I’m sure some people will wonder if it’s healthier to drink other types of milk. For example, how about drinking milk from a goat or sheep? There hasn’t been as much research on these types of milk, although it appears that the insulin index is similar to cow’s milk.

Another Problem With Cow’s Milk: Beta Casein A1

Cow’s milk consists of both casein and whey protein. Cow’s milk consists of approximately 80% casein. Although many people are lactose intolerant, some people are sensitive to casein. Although many people seem to have a “casein intolerance”, only a small percentage of people actually have a casein allergy, and will test positive for casein antibodies during IgE testing. However, in addition to milk, other dairy products include casein, such as yogurt and cheese.

There are different types of casein in dairy cows. The most common forms of beta-casein in dairy cattle breeds are A1 and A2. It is thought that beta-casein variant A1 yields the bioactive peptide beta-casomorphin-7 (BCM-7), which may play a role in the development of certain human diseases, such as diabetes mellitus and ischemic heart disease. There also might be a relationship of BCM-7 to sudden infant death syndrome (14). So just to clarify, BCM-7 can lead to the development of numerous chronic health conditions, and is found in beta-casein A1.

It’s also important to understand that some people react to beta-casein A1, but do perfectly fine when consuming beta-casein A2. The challenge is finding out where the dairy you purchase is coming from, and unfortunately most of the milk in the United States comes from “A1 cows”. I’ll talk about raw milk shortly, as this is definitely a better option than conventional milk. However, from what I understand, not all raw milk is made from “A2 cows”, which might explain why some people don’t do well when drinking raw milk. So what’s the best way to get milk which has beta-casein A2? You might need to go directly to the source, which means contacting some of the local farmers to find out whether they have “A1 cows” or “A2 cows”. I mentioned before how the milk from a goat or sheep probably has a high insulin index. However, they apparently don’t have BCM-7, which is probably why many people do better when drinking these types of milk.

Is It Okay To Drink Raw Milk?

There is no question that drinking raw milk is a healthier option when compared to commercialized milk. When it comes to drinking raw milk, one of the main concerns people have is the safety of it. Without question, there are risks with drinking raw milk. However, as I already mentioned in this blog post, there are also risks with drinking pasteurized milk. Chris Kresser does a great job of discussing the risks of drinking raw vs. pasteurized milk in an article entitled “Raw Milk Reality: Is Raw Milk Dangerous?“. For those not familiar with Chris, his articles are research-based, and if you’re concerned about drinking raw milk due to the possibility of becoming ill then you need to read his article.

Although there are health benefits of drinking raw milk, when I recommend for my patients to initially follow a natural treatment protocol I usually will advise them to avoid all dairy. In the future some people will be able to add dairy back into their diet, and when this is the case, raw dairy will be a great option for many of them. On the other hand, some people are better off avoiding all dairy on a permanent basis.

What About Other Types Of Dairy?

Most of this post focused on the risks associated with drinking cow’s milk. But is it okay to consume other types of dairy? As I just mentioned, initially I recommend for my patients to avoid all forms of dairy. This includes not only milk, but yogurt, cheese, kefir, and whey. The reason for this is because some people are sensitive to these other forms as well. However, I think that it’s fine for many people to eventually reintroduce other forms of dairy into their diet, as there definitely are health benefits to eating certain types of dairy, such as yogurt, kefir, and whey. But it does depend on the person, as some people might need to avoid certain forms of dairy for a prolonged period of time. Others might need to avoid dairy on a permanent basis. For example, if someone has a casein allergy then they will need to avoid not only milk on a continuous basis, but should also avoid yogurt, cheese, butter, and other dairy products which include casein.

Since butter is low in casein some will feel that it is fine to consume. This might be true, but if someone has a known casein allergy then I would still recommend for them to avoid it. Of course as I mentioned before, one also needs to consider the type of casein one is consuming, as some people will do fine consuming dairy from a goat or a sheep. It admittedly can be challenging at times to know exactly what a person should and shouldn’t eat, but when someone is trying to restore their health back to normal I would rather play it safe and have them avoid all type of dairy initially.

Some people are concerned about getting enough calcium if they are avoiding dairy. Although dairy is the primary source of calcium for many people, there are other foods which are high in calcium. Kale is high in calcium, and so you can eat steamed kale, and/or add it to a smoothie. Chinese cabbage is also an excellent source of calcium (15). Collard greens, broccoli, almonds, and blackstrap molasses can also provide a sufficient amount of calcium. So there are plenty of non-dairy sources of calcium.

In summary, there is a lot of controversy over whether dairy should be consumed in people with conditions such as Graves’ Disease and Hashimoto’s Thyroiditis. Since many people are sensitive to dairy I do recommend for all of my patients to initially avoid dairy. But this doesn’t mean that everyone should avoid dairy on a permanent basis. Raw dairy is definitely preferable to commercial dairy. However, there are different types of casein, and many people react to beta-casein A1, yet do fine when consuming dairy which has beta-casein A2. So if someone avoids dairy for a prolonged period of time and then reintroduces it back into their diet, they might want to consider raw dairy, and also do some research so they consume dairy which consists of beta-casein A2.