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.

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.