Not too long ago I attended a functional medicine conference, and the attendees were entitled to receive a free stool analysis.  Although I can’t say I enjoyed the collection process (especially since this required three different stool samples collected on different days), I was curious to see what the comprehensive stool panel results showed.  Fortunately I tested negative for pathogenic bacteria, yeast, and parasites.  And most of the other markers looked great, which of course made me very happy.  However, even though I hadn’t been experiencing any digestive symptoms, I had some positive markers for inflammation.  Fortunately the markers that are commonly high in inflammatory bowel disease looked good, although I was still surprised to see some of the other inflammatory markers on the high side.

You might wonder why I’m sharing this story with you.  Well, the main reason is to demonstrate that it is possible to have inflammation yet not experience any overt symptoms.  Another reason is to demonstrate that I’m not perfect, as while I eat a pretty good diet overall, I admittedly had been indulging more than usual prior to collecting the stool samples.  Not to make excuses, but I traveled a lot in 2015, and I probably gave in to too many temptations. And while it’s a little bit embarrassing to admit this, I thought it was a good idea to share this experience so that you realize that it’s not only a challenge to eat well when trying to restore one’s health when dealing with a thyroid or autoimmune thyroid condition, but it’s also a challenge to eat well when trying to maintain a state of wellness.

Is It Possible To Eat Too Many Healthy Foods?

When I was a teenager and young adult, there were certain foods I ate on a regular basis that I thought were healthy, but I eventually learned that this wasn’t the case.  A few examples include pasta, whole wheat bread, and soy chicken nuggets.  Of course now I have a pretty good idea of which foods are healthy and unhealthy, but one thing to be aware of is that you can eat too much of a healthy food.  For example, in the second half of 2015 there is no question that I ate too many nuts and too much dark chocolate.  Yes, I did eat some foods worse than these (i.e. pizza), and this probably was a factor as well.  But I don’t want you to overlook the fact that eating an excess of other foods that have some health benefits can also cause problems.

So was overindulging in nuts and dark chocolate a potential factor in my inflammation?  I’m honestly not sure, and I did mention earlier that I ate other foods far worse than nuts and dark chocolate.  For example, I attended my younger sister’s wedding in August of 2015, and Italian food was served.  And while we did put in a request for gluten free pasta, I ate a cannoli that definitely wasn’t gluten free.  Speaking of which, if anyone has a gluten free cannoli recipe please feel free to share it with me in the comment sections below!  I wish I can say that the cannoli was the only bad thing I ate, but the night before I also had some pizza at a Brooklyn pizzeria.  And while I ordered a gluten free pizza, I admittedly was naughty and also had some regular pizza.  Of course even gluten free pizza isn’t considered to be healthy, especially when you consider some of the ingredients used by many restaurants.  But eating pizza is even worse from a health perspective when it’s loaded with gluten (no matter how delicious it might be…and believe me, that Brooklyn pizza tasted amazing).

In last week’s blog post I spoke about gluten, and whether someone should avoid it even if they don’t feel bad upon eating it and/or don’t experience any improvement in their symptoms upon avoiding it.  I usually don’t feel bad when eating foods with gluten, but this doesn’t mean that it’s not having a negative effect on my health.  If you read last week’s blog post, you’ll recall that I mentioned that gluten apparently causes an increase in intestinal permeability (a leaky gut) in everyone, and not just those with Celiac disease or a non-autoimmune gluten sensitivity.

Do YOU Have Gut Inflammation?                                   

After reading this post, I’m sure there are some people who are wondering if they have gut inflammation.  The truth is that many people have gut inflammation and are unaware of it.  You of course can test for some general inflammatory markers through the blood such as high sensitive c-reactive protein (hs-CRP), or erythrocyte sedimentation rate (ESR).  Just keep in mind that negative findings don’t necessarily rule out inflammation.  While you can do a comprehensive stool analysis like I did, such testing can be expensive.  If you are eating gluten and/or dairy on a regular basis then this can be problematic.  But even if you are gluten and dairy free but are eating a lot of nuts, seeds, grains, and legumes, then these might cause inflammation when eaten in excess.  And so rather than spend a lot of money on additional testing, it might be best to just minimize your consumption of these foods for awhile and see if your health improves.

What’s the solution to get rid of gut inflammation?  Well, it of course depends on the cause of the inflammation.  If someone is sensitive to gluten and they eat even a small amount of it then this can result in inflammation.  On the other hand, not everyone with gut inflammation is sensitive to gluten.  In fact, some people who avoid gluten still have gut inflammation.  Other foods can cause inflammation, along with other factors such as an infection, and even chronic stress.  Taking certain nutrients and herbs can also help to reduce gut inflammation, such as fish oils, probiotics, and turmeric.  However, if the cause of the inflammation isn’t addressed then these natural anti-inflammatory agents aren’t going to be as effective.

In summary, many people have gut inflammation but are unaware of it.  And while some people with gut inflammation experience overt symptoms, this isn’t always the case.  Eating foods that contain gluten and dairy causes inflammation in a lot of people, but eating too many healthy foods such as nuts, seeds, grains, and legumes might also lead inflammation in some people.  While you can do some testing to confirm or rule out inflammation, regardless of the findings you of course want to eat a healthy diet, try not to overindulge in certain foods, and do a good job of managing your stress.

Many people with thyroid imbalances, and especially those with an autoimmune thyroid condition such as Graves’ Disease or Hashimoto’s Thyroiditis, can benefit from avoiding gluten.  It’s very common for my patients who go on a gluten free trial to tell me how much better they feel.  Sometimes the changes in their symptoms are dramatic, and some people even experience a dramatic reduction in their thyroid antibodies upon avoiding gluten.  However, not everyone feels better when avoiding gluten.  And so the goal of this blog post is to discuss what approach you should take if you don’t feel any improvement in your symptoms upon avoiding gluten.

Just as a side note, while growing up, gluten was part of my regular diet.  I would have cold cereal for breakfast (i.e. Fruit Loops, Apple Jacks, etc.).  I ate plenty of bread, cookies, and other foods loaded with gluten.  In addition, I  grew up in Queens New York, which has a bagel store on almost every corner, and there are also plenty of pizza places and bakeries.  And so I had plenty of gluten as a child and teenager, and I must admit that if gluten was as healthy as vegetables I would be eating gluten-based foods all of the time!  Sure, I feel great after having my green smoothie for breakfast, and I don’t mind eating steamed broccoli, but if bagels and pizza were just as healthy I’d be eating these foods every day.  And yes, I know there are gluten free versions of these, but they still aren’t as healthy as whole foods.

So now that you are aware of my secret obsession with bagels and pizza (more so pizza than bagels), let’s talk about what you should expect to happen when you avoid gluten.  If you are symptomatic should you experience an improvement in your symptoms within a few days or weeks of going gluten free?  Should you notice an improvement in your blood tests upon removing gluten from your diet?  It really does depend on the person, as if someone has a gluten sensitivity, or a condition such as Celiac disease, then they will usually feel better upon avoiding gluten.  However, not everyone experiences overt symptoms even when they are gluten sensitive, and some people even have silent Celiac disease (1) (2) (3).  Admittedly most of the cases of silent Celiac disease seem to be present in children and adolescents, but adults can have this as well.

How Can You Tell If You Have A Gluten Sensitivity?

There are basically two ways to tell if someone has a gluten sensitivity…by symptoms or through testing.  Of course if you experience symptoms when eating gluten then this is a clear sign to avoid it.  The problem is that not everyone experiences overt symptoms when consuming gluten, and so the lack of symptoms when consuming gluten doesn’t necessarily rule out a gluten sensitivity.  Also, keep in mind that foods that contain gluten are typically high in FODMAPs, and so if you have problems with gluten and other high FODMAP foods then there is a chance that gluten sensitivity isn’t the issue, but you might have small intestinal bacterial overgrowth instead.  If you aren’t familiar with FODMAPs then I would read the blog post I wrote entitled “Should People With Thyroid Conditions Follow a Low FODMAP Diet?”

As for testing, while this can help to detect a gluten sensitivity problem, a negative finding doesn’t rule out a sensitivity to gluten.  For example, if someone gets a Celiac panel which measures the antibodies to gliadin and transglutaminase and the test results are negative, this doesn’t mean you can’t be sensitive to other proteins of gluten which aren’t tested.  Cyrex Labs has the most comprehensive test for gluten that I know of, but while it tests for many of the markers of gluten, it doesn’t test for all of them. In addition, if someone has depressed immunoglobulins then this can result in a false negative result.

So hopefully you realize that it can be challenging at times to determine if someone has a gluten sensitivity, as while a positive test result usually confirms a gluten sensitivity, a negative result doesn’t necessarily rule out problems with gluten.  If one has overt symptoms when consuming gluten and/or tests positive for a gluten sensitivity then there is no question that they should avoid gluten.  But if they don’t experience negative symptoms, and if the testing reveals no gluten sensitivity, then it’s not clear if they should avoid gluten.  And this is one reason why many healthcare professionals will have all of their patients who have a chronic health condition avoid gluten.

“Can I Get Into Remission If I Continue To Eat Some Gluten?”            

At this point you might still be wondering if you can restore your health if you continue to eat gluten.  The answer is “maybe”.  In my experience it is possible for some people with Graves’ Disease and Hashimoto’s Thyroiditis to restore their health, even if they don’t completely avoid gluten.  While some natural healthcare professionals will disagree with this, and while I do encourage my patients to avoid gluten while following a natural treatment protocol, I have had some patients continue to eat gluten and still get into remission.  This doesn’t mean that they were eating large amounts of whole wheat bread and pasta on a daily basis, as they were still eating very healthy, but they didn’t completely avoid all sources of gluten.

With that being said, it does appear that gliadin, which is one of the proteins in gluten, causes an increase in intestinal permeability in everyone, even those who aren’t sensitive to gluten (4).  What this means is that gluten causes a leaky gut in everyone.  And while this study did show that those people with active Celiac disease and a non-autoimmune gluten sensitivity had a greater increase in intestinal permeability, those who didn’t have Celiac disease or a non-autoimmune gluten sensitivity still experienced negative effects on the intestinal barrier when consuming gluten.

However, some people are hesitant to avoid gluten if they don’t feel worse upon eating it, or if they don’t notice any positive changes in their symptoms upon eliminating it.  The problem is that you can’t always go by symptoms alone, and it is impossible to predict who will do fine when continuing to consume gluten.  And so there are basically two options for those who are looking to restore their health, yet don’t experience any negative symptoms when eating gluten (or don’t feel better upon eliminating it).  One option is to continue to eat gluten while following a natural treatment protocol and see how you progress.  If you choose this option I still would try to minimize your consumption of gluten, and if you are eating mostly whole foods then it’s easy to accomplish this.

A second option is to play it safe and completely avoid gluten.  This always leads to questions such as “is it okay to have a tiny amount of gluten?”, or “what if I’m 99% gluten free?”  This once again depends on the person.  Some people make an effort to go gluten free, but either intentionally or accidentally get exposed to small amounts of gluten.  And if they don’t have Celiac disease or a non-autoimmune gluten sensitivity then they probably will do fine.  On the other hand, if they have a gluten sensitivity they will continue to have gut inflammation even when consuming small amounts of gluten, and as a result they probably won’t improve.

What Should You Do If Avoiding Gluten For A Prolonged Period Of Time Doesn’t Help?

I’ve come across people who have gone gluten free for six months or longer without any improvement in their symptoms or thyroid blood tests/antibodies.  Isn’t this an obvious sign that they aren’t gluten sensitive?  Well, when this is the case there is a good chance that gluten isn’t the primary trigger.  However, keep in mind that there can be multiple triggers.  For example, someone can have a gluten sensitivity that is causing inflammation, but the main trigger is an underlying infection.  And so avoiding gluten might have helped with the inflammation, but since the main trigger (the infection) was still present, the person didn’t notice much of a difference with their symptoms when avoiding gluten.

It’s a no-win situation, and so you might as well just throw in the towel and munch on some donuts or muffins, right?  The truth is that I’m not against some people eating gluten on an occasional basis…after they have restored their health back to normal.  Although I try to eat a healthy diet most of the time, I’d be lying if I told you that I was completely gluten free 100% of the time.  Gluten should admittedly be avoided, just like alcohol, and while I don’t drink alcohol, I do occasionally indulge in foods that contain gluten.  I’m not suggesting that everyone is able to eat gluten after they restore their health, as there definitely are people who need to completely avoid it.  And next week I’ll be releasing a blog post which might suggest that I should completely avoid gluten altogether, even though I feel fine when I consume it.

In summary, while many people feel better upon avoiding gluten, not everyone who eliminates gluten from their diet notices an improvement in their symptoms and blood tests.  When this is the case, it is tempting to want to go ahead and eat gluten on a regular basis, but just remember that the lack of symptoms, and even a negative test result doesn’t rule out a gluten sensitivity.  While some people might be fine eating small amounts of gluten while trying to restore their health, others won’t do well.  As a result, I think it’s a good idea for everyone to go on a gluten free trial, although this doesn’t mean that everyone needs to completely avoid gluten on a permanent basis.

Thyroxine, also known as T4, is the primary thyroid hormone secreted by the thyroid gland.  This hormone is low or depressed in those people with hypothyroidism, and it is usually elevated in those with hyperthyroidism.  Although the focus of this post will be on T4, triiodothyronine (T3) is another thyroid hormone.  And because most T3 is produced via the conversion of T4 into T3, if someone has low T4 levels then they usually will have low T3 levels, although there are exceptions.

Before talking about some of the factors which can cause low T4 levels, I’d like to briefly discuss how thyroid hormone is manufactured.  Because if you understand how it is formed then you will also understand some of the things which can lead to lower thyroid hormone levels.  The thyroid follicles are cells in the thyroid gland, and this is where thyroid hormones are produced.  You get iodide from the diet, which travels through the bloodstream to the thyroid follicular cells, which in turn takes up the iodide with the help of something called a sodium-iodide-symporter.  Thyroid peroxidase is an enzyme which plays an important role in iodination, which involves the oxidation of iodide ions to form iodine atoms.

Thyroxine contains four iodine atoms, which is why it’s referred to as “T4”, and these iodine atoms attach to a tyrosine molecule.   And as you might have guessed, triiodothyronine contains three iodine atoms, which is why it’s referred to as “T3”.  There is also thyroglobulin, which is synthesized by the thyroid follicular cells, and this acts as a substrate for the synthesis of T3 and T4, and also stores inactive forms of thyroid hormone.  So what’s important to understand is that iodine and tyrosine are important for the formation of thyroid hormone, and thyroid peroxidase and thyroglobulin also play important roles.

Hopefully you have a better understanding of how thyroid hormone is formed.  Now I’d like to go ahead and look at seven reasons why you might have low T4 levels:

1. Hashimoto’s Thyroiditis.  This is an autoimmune condition which involves the immune system attacking the thyroid gland.  The immune system specifically attacks thyroglobulin and/or thyroid peroxidase, which in turn is what results in low or depressed thyroid hormone levels.  Although many people with Hashimoto’s don’t have low T4 levels, since most medical doctors don’t do anything to address the autoimmune component, the immune system will continue damaging these structures of the thyroid gland, and as a result, over a prolonged period of time most patients with Hashimoto’s will eventually have low T4 levels.

What’s The Solution To This Problem?  The goal is to address the autoimmune response.  The most important factor is to try to detect and then remove the autoimmune trigger.  While doing this you should do things to reduce inflammation and increase regulatory T cells, which I discussed in a separate blog post entitled “Regulatory T Cells and Thyroid Autoimmunity“.

2. Iodine Deficiency.  Since iodine is necessary for the formation of thyroid hormone, it should come as no surprise that an iodine deficiency can result in low T4 levels.  But how can you determine if you have an iodine deficiency?  The most accurate way of testing for iodine seems to be in the urine.

What’s The Solution To This Problem?  If someone has an iodine deficiency then the obvious goal should be to correct it.  However, not everyone does well when taking iodine, especially many people with Hashimoto’s Thyroiditis, and so if you test positive for an iodine deficiency and are thinking about supplementing with iodine, you do need to be cautious.  This is especially true if you are thinking about taking high doses of iodine, but it can also be a problem in some people even in small doses.  For those people with Hashimoto’s, many times it is best to restore the health of the immune system before taking iodine.

3. Dysregulation of the HPT Axis.  When talking about the formation of thyroid hormone earlier, I didn’t talk about the role of the hypothalamus and pituitary gland.  These both play an important role in the signaling of thyroid hormone.  Most people are familiar with thyroid stimulating hormone, which is also known as TSH.  TSH is released by the pituitary gland, which tells the thyroid gland to produce more thyroid hormone.  However, the hypothalamus communicates with the pituitary gland, and so if there are problems with either the hypothalamus or pituitary gland then this in turn can cause problems with the thyroid gland.

What’s The Solution To This Problem?  If someone has dysregulation of the hypothalamic-pituitary-thyroid (HPT) axis, then the goal should be to improve the health of the HPT axis.  Adaptogenic herbs can help to accomplish this, with ashwagandha perhaps the most well known herb which can have a positive effect on the HPT axis.  Taking glandulars to support the hypothalamus and pituitary gland can also help in some cases.  However, while taking adaptogenic herbs can help, stress causes dysregulation of the HPT axis, as well as the hypothalamic-pituitary-adrenal (HPA) axis, and so improving your stress handling skills is essential.

4. Tyrosine Deficiency.  You learned earlier that tyrosine plays an important role in thyroid hormone production, as the iodine atoms attach to a tyrosine molecule.  And while most cases of low T4 levels aren’t caused by a tyrosine deficiency, it’s still something to consider.  I spoke about this in greater detail in an article I wrote entitled “Tyrosine and Thyroid Health“.

What ‘s The Solution To This Problem?  If someone does have a tyrosine deficiency then they will want to increase their consumption of tyrosine-rich foods such as chicken, turkey, fish, eggs, avocados, and spinach.  Taking a tyrosine supplement might also be a good idea if one has a deficiency..

5. Iron deficiency.  As you have learned, the enzyme thyroid peroxidase plays an important role in thyroid hormone formation.  Thyroid peroxidase is a heme-containing enzyme, which means that it is dependent on iron.  And the research shows that an iron deficiency can reduce thyroid peroxidase activity, which in turn can affect thyroid metabolism (1) (2).

What’s The Solution To This Problem?  Many people are deficient in iron, and so before ruling out an iron deficiency you want to make sure to get  a complete iron panel consisting of serum iron, ferritin, iron saturation, and TIBC.  If you have an iron deficiency then supplementation probably is a good idea.  However, you also want to try addressing the cause of the problem, which I spoke about in an article entitled “Iron Deficiency Anemia and Thyroid Health“.

6. Environmental toxins.  Certain environmental toxins can potentially inhibit thyroid activity.  Numerous studies show that xenoestrogens such as BPA and flame retardants can inhibit thyroid hormone production (3) (4) (5).  Other studies also show that fluoride can interfere with thyroid gland function (6) (7).  Bromide might also have an inhibitory effect on thyroid hormone (8).  Perchlorate inhibits the uptake of iodine and can decrease thyroid hormone production (9).  Heavy metals such as mercury can also inhibit thyroid hormone production (10) (11).

What’s The Solution To This Problem?  Although it’s impossible to eliminate your exposure to environmental toxins, you of course can do things to minimize your exposure to them.  For example, you want to avoid drinking bottled water on a frequent basis, reduce your exposure to flame retardants, along with fluoride, and other environmental toxins.

7. Soy and other goitrogenic foods.  This one is controversial, as while there are studies which show that soy phytoestrogens can cause hypothyroidism (12), other studies show that this isn’t the case (13).  Other studies suggest that soy only has antithyroid effects in the presence of an iodine deficiency (14).  With regards to other goitrogenic foods (i.e. cruciferous vegetables, spinach, strawberries, etc.), there are no human studies I’m aware of which show that eating these foods inhibit thyroid activity.

What’s The Solution To This Problem?  Besides the possibility that soy has goitrogenic properties, soy is a common allergen, and most soy is also genetic modified.  And so it might be best to minimize your consumption of soy.  With that being said, some people are able to eat some organic fermented soy without a problem, although not everyone.  As for other goitrogenic foods, such as cruciferous vegetables, most people are able to eat these without a problem, although if someone has a moderate to severe iodine deficiency then it might be best to play it safe and limit your consumption of these foods.  However, keep in mind that cooking these foods will also reduce the goitrogenic activity.

In summary, there are numerous factors which can cause low T4 levels.  Hashimoto’s Thyroiditis is the primary cause of hypothyroidism.  Nutrient deficiencies can also play a role, including iodine, iron and tyrosine.  Other potential causes include dysregulation of the HPT axis, certain environmental toxins, and perhaps certain goitrogenic foods.

Adhesive capsulitis, also known as a frozen shoulder, is characterized by a painful, gradual loss of active and passive shoulder motion resulting from fibrosis and contracture of the joint capsule (1).  Although other shoulder conditions can result in similar symptoms, people with hyperthyroidism are more prone to developing a frozen shoulder.  As a result, if you have hyperthyroidism and are experiencing moderate to severe pain in one or both shoulders that isn’t due to a traumatic injury, then it’s possible that you have adhesive capsulitis as a result of your condition.

Adhesive capsulitis usually develops one of two ways.  The primary method is gradual, which usually is the case with those who have hyperthyroidism.  But it can also develop as a result of a trauma.  When it’s not caused by a trauma, it can take a few weeks or months until the pain is severe enough for the person to seek medical attention.  Sometimes they will only notice the shoulder pain initially, but over time they will realize that it’s also affecting their range of motion.

Adhesive Capsulitis Can Be Present In Other Conditions

Although hyperthyroidism is one of the more common conditions in which people develop a frozen shoulder, there can be other conditions that lead to this as well.  This includes hypothyroidism, as well as hypoadrenalism, Parkinson’s disease, cardiac disease, pulmonary disease, and stroke (2).

The Three Clinical Phases of Adhesive Capsulitis

The literature discusses three distinct phases of adhesive capsulitis (3):

1. The freezing or painful stage.  This is what I described above, as over time the pain will increase, and both the active and passive range of motion will decrease.  This phase typically lasts between 3 and 9 months and is characterized by an acute synovitis (inflammation of the synovial membranes) of the glenohumeral joint of the shoulder (3).

2. The frozen or transitional stage.  This stage can last from 4 to 12 months, and it’s usually when the pain is the most intense and the shoulder is the most restricted.

3. The thawing stage.  This is when the pain begins to decrease and the range of motion begins to improve.  This stage can last anywhere from 12 to 42 months (3).

How Is Adhesive Capsulitis Diagnosed?

As for how adhesive capsulitis is diagnosed, it can be challenging initially.  A physical examination will reveal both a loss of passive and active range of motion (4).  Many times it is diagnosed by ruling out other conditions, such as a rotator cuff tear, a bone contusion, or osteoarthritis.

What Are The Treatment Options For Adhesive Capsulitis?

The conventional treatment approach usually will begin with either drugs or physical therapy.  Nonsteroidal anti-inflammatory drugs (NSAIDs) can help to reduce the inflammation, which in turn might decrease the pain (5) (6).  Prednisone might also benefit some people with adhesive capsulitis, although the benefits seem to be more short term (7).  Cortisone injections are also commonly used and can lead to fast pain relief and an improved range of motion (8) (9), although of course there are potential side effects as well.  Sometimes arthroscopic surgery is used for adhesive capsulitis.  But in most cases surgery should be a last resort.

I’m more in favor of using natural anti-inflammatory agents, such as higher doses of curcumin, resveratrol, boswellia, and fish oils.  However, many times these won’t result in significant relief, and when this is the case, some type of physical therapy can be beneficial.  There is some evidence that a combination of bee venom acupuncture and physiotherapy can help with adhesive capsulitis (10) (11).  For those who aren’t familiar with bee venom acupuncture, this is a type of herbal acupuncture that uses bioactive compounds isolated from bee venom, combined with acupuncture.  But “standard” acupuncture can also be beneficial for a frozen shoulder.  Manipulation of the shoulder can be beneficial (12), and possibly even manipulation of the thoracic spine (13).  And so going to a chiropractor might help, especially if you see a chiropractor that has experience working on extremities.  Low-level laser therapy might also help with adhesive capsulitis (14).

In summary, people with hyperthyroidism are more prone to developing a frozen shoulder, which is also known as adhesive capsulitis.  Most of these cases develop gradually, although sometimes it can be due to a trauma.  Adhesive capsulitis is usually diagnosed by ruling out other conditions.  Conventional treatment usually involves NSAIDs, cortisone injections, physical therapy, and in some cases arthroscopic surgery.  Although natural anti-inflammatory agents probably won’t help much, acupuncture, manipulation, and low-level laser therapy might be beneficial.

Most people with thyroid and autoimmune thyroid conditions deal with chronic stress.  In fact, I think it’s safe to say that most people in general deal with chronic stress.  And while I have spoken about cortisol in past articles and blog posts, I haven’t talked as much about adrenaline.  And so what I plan on doing in this post is to discuss some of the factors which can cause high cortisol and adrenaline, some of the symptoms associated with elevated levels, and the consequences of having high levels of cortisol and adrenaline over a prolonged period of time.  And of course I’ll discuss what you can do to naturally lower cortisol and adrenaline.

Most people reading this are aware that adrenaline is involved in the “fight or flight” reaction.  When there is a stressful situation, there will be a rapid increase of adrenaline.  On the other hand, cortisol will also increase, but it’s a slower process.  During a chronic stress situation you can have chronically raised adrenaline and cortisol levels.

Adrenaline is known as epinephrine.  And there is also norepinephrine (noradrenaline).  Both of these are known as catecholamines.  As for how they are formed, the amino acid tyrosine gets converted into DOPA, which in turn gets converted into dopamine.  This neurotransmitter in turn gets converted into noradrenaline.  An enzyme called PNMT converts norepinephrine into epinephrine by catalyzing the transfer of a methyl group from SAMe to norepinephrine.  Both epinephrine and norepinephrine are broken down and inactivated by the enzymes catechol-oxymethyltransferase (COMT) and monoamine oxidase (MAO).  However, if someone has a genetic defect of the COMT gene or the MAOA gene then this can affect the breakdown of the catecholamines.  Fortunately there is genetic testing available to determine if someone has one or both of these genetic polymorphisms.

What Are The Causes/Symptoms Of Elevated Adrenaline?

Before talking about the symptoms of high adrenaline, it probably is a good idea to briefly mention some of the factors which can cause high adrenaline.  In addition to stress, other factors which can cause high adrenaline include not getting enough sleep, having hypoglycemia, pain, anger and fear, and being on certain medications.  If someone has high adrenaline then they can experience one or more of the following symptoms:

• Anxiety
• Elevated heart rate
• Elevated blood pressure
• Heart palpitations
• Low insulin and blood glucose
• Headaches
• Hot flashes

What Are The Causes/Symptoms Of Elevated Cortisol?

In addition to stress causing elevated cortisol levels, other factors include not getting enough sleep, inflammation, infection, blood sugar imbalances, and trauma (both emotional and physical).  Here are some of the symptoms one can experience with elevated cortisol levels:

• Memory and concentration problems
• Problems falling and/or staying asleep
• Depression
• Elevated blood glucose levels
• Low sex hormones due to the pregnenolone steal

What Are The Consequences Of Prolonged Elevations Of Adrenaline and Cortisol?

Although having elevated adrenaline and cortisol levels for short periods of time is normal under the presence of an acute stressor, if someone is dealing with prolonged chronic stress then this can not only cause the symptoms I mentioned earlier, such as anxiety, depression, hypertension, low sex hormones, and blood sugar imbalances, but it can also lead to osteoporosis, as well as cognitive impairment.

The hippocampus, which is important in learning and memory, is particularly sensitive to chronic stress and cortisol (1).  There is evidence that prolonged elevations of cortisol can compromise the hippocampus, and this can affect cognition (1) (2).

In addition, if someone has elevated cortisol levels for a prolonged period of time, this can lead to cortisol resistance.  You might be familiar with insulin resistance, which is when there is an excess of insulin, and the cells are no longer responsive to the effects of insulin.  It’s similar with cortisol, as large amounts of cortisol can result in a decreased negative feedback of the cortisol-ACTH feedback system resulting in increased ACTH secretion. This causes higher plasma cortisol and also increases the production of adrenal mineralocorticoids (3).  This not only can affect someone’s ability to handle stress, but it also can interfere with the regulation of the inflammatory process (4).

What Impact Does Elevated Cortisol and Adrenaline Have On Thyroid Health?

Cortisol seems to have a greater impact on thyroid health than adrenaline.  In past articles I have discussed how elevated cortisol levels can affect the conversion of T4 to T3.  This will result in low or depressed T3 levels, and an elevated reverse T3.  Studies show that stress can inhibit both type I iodothyronine 5′-deiodinase activity (5), as well as type II 5′-deiodinase activity (6) (7).

What Is Cushing’s Syndrome?                                  

Cushing’s syndrome is a condition which involves the body being exposed to excessive amounts of cortisol.  Although this can be caused directly by the adrenals releasing too much cortisol, it can also be caused by an excess of ACTH released by the pituitary gland, which in turn will lead to excess cortisol.  In fact, the latter problem is more common, as many people with Cushing’s syndrome have a pituitary adenoma that is responsible for the excess amount of ACTH, which is referred to as Cushing’s disease.  An adenoma is a benign tumor, and sometimes it can be difficult to diagnose.  Cushing’s syndrome can also be caused by taking an excess amount of prescription corticosteroids.

Although some of the symptoms of Cushing’s syndrome are similar to those with high cortisol, this is an extreme condition, and the symptoms are usually more severe.  Here are some of the symptoms associated with this condition (8):

• Weight gain
• Skin changes
• Menstrual irregularities
• Muscle loss and weakness
• Osteopenia or osteoporosis
• Elevated blood glucose levels
• High blood pressure
• Infections
• Dyslipidemia

As for how Cushing’s syndrome is diagnosed, in addition to having elevated cortisol levels in the blood, a urinary cortisol test might also be performed.  ACTH should also be tested, and if this hormone is elevated then a pituitary adenoma is the most likely cause of the excess cortisol release, although an ectopic source is also possible.  If cortisol is high but ACTH is normal then there might be an adrenal tumor.  Other tests commonly used include a high-dose dexamethasone suppression test, a corticotropin-releasing hormone test, and sometimes a CT scan or MRI will be conducted in order to detect the presence of a pituitary or adrenal adenoma.

If Cushing’s syndrome is due to a pituitary or adrenal adenoma, then surgery is commonly recommended.  If the pituitary adenoma can’t be identified, then partial surgery of the pituitary gland might be conducted.  If this procedure is performed then hormone replacement therapy is necessary. If someone has an adrenal gland tumor then the affected adrenal gland is usually removed. Sometimes radiation is used to shrink the adenoma.  Prescription drugs might also be used to control cortisol production.

How Can You Test For High Cortisol or Adrenaline?

Many reading this know that I prefer testing the cortisol levels through the saliva.  Although testing cortisol through the blood has some value, I prefer the saliva because it allows you to look at the circadian rhythm  of cortisol, whereas with serum testing you are relying on a single sample, which doesn’t always tell the entire story.  In addition, it’s common for false elevations of cortisol to occur when testing through the blood, and the main reason for this is because cortisol increases during stressful situations, and many people find it stressful to get blood drawn.  You can also test for the urinary cortisol metabolites, although this is something that I personally don’t do in my practice.

With regards to testing for adrenaline, although you can test adrenaline in the blood (along with norepinephrine), urine testing is more commonly used.  Usually a 24-hour urine collection is recommended.  Organic acids is another option, as this measures a metabolite called vanilmandelate, which usually increases when someone has elevated adrenaline levels.  You can also test for genetic polymorphisms of COMT and MAO-A, which help to break down adrenaline.  I’ll discuss these in a little more detail shortly.

How Can You Decrease Cortisol and Adrenaline?

1. Reduce your stress levels.  Since stress causes an increase in cortisol levels, it makes sense to do everything you can to try to reduce the stress levels in your life.  Although I realize that reducing the stress in your life isn’t always possible, what I recommend is to write down all of the major and minor stressors in your life, and  try to determine if you can eliminate some of these stressors.

2. Improve your stress handling skills.  Whether or not you can reduce your stress levels it is a good idea to do things to improve your stress handling skills.  After all, one’s perception of the stressor usually plays a greater role than the stressor itself.  In order to help accomplish this I recommend to incorporate one or more mind-body-medicine techniques such as yoga, meditation, biofeedback, or another technique.  Also consider utilizing acupuncture and massage, as these can also help with high cortisol and adrenaline levels.

3. Nutrients and herbs which lower cortisol.  Some of the nutrients and herbs which can lower cortisol include magnolia and Phellodendron bark (relora) (9) (10), phosphatidylserine (11) (12), and  ashwagandha (13) (14).

4. Nutrients and herbs which lower adrenaline.  GABA is an inhibitory neurotransmitter, and this can decrease adrenaline levels (15). GABA doesn’t seem to cross the blood brain barrier unless if it has a phenyl group attached, although you can also take nutrients and herbs which increase GABA production.  For example, both L-theanine (16) and valerian root can both increase GABA (17) (18).

5. Protect the hippocampus.  I mentioned earlier how prolonged elevations of cortisol can compromise the hippocampus.  Well, there is evidence that the herb Bacopa monniera can help to protect the hippocampus from damage (19) (20) (21).

6. Test for COMT and MAO-A polymorphisms.  Since the enzymes COMT and MAO-A help with the breakdown of adrenaline, if you continue to have chronically elevated adrenaline even after incorporating stress management and taking some of the nutrients I discussed, then you might want to do some testing to see if you have a COMT and/or MAO-A polymorphism.  While you can’t reverse these genetic polymorphisms, you can give nutritional support to help with these defects.

So hopefully you have a better understanding of the impact high cortisol and adrenaline can have on your health, and what you can do to try to lower these.  Some of the symptoms of high cortisol include anxiety, elevated heart rate and blood pressure, heart palpitations, low insulin and blood glucose, headaches, and hot flashes.  High cortisol frequently leads to memory and concentration problems, problems falling and/or staying asleep, depression, and low sex hormones.  Some of the things you can do to reduce cortisol and adrenaline include lowering your stress levels and improving your stress handling skills, and certain nutrients can also help such as relora, phosphatidylserine, ashwagandha, valerian root, and L-theanine.

There are numerous cells which play a role in modulating the immune system in autoimmune conditions such as Graves’ Disease and Hashimoto’s Thyroiditis.  In this blog post I’m going to focus on dendritic cells and toll-like receptors.  This admittedly will be a little more complex than many of the other articles and blog posts I’ve written, but every now and then I like to present some advanced information so that those people with autoimmune thyroid conditions can get a better understanding of what’s happening to their immune system.

Let’s start off by talking about what dendritic cells are.  Dendritic cells are one of the cells of your immune system, and they play a role in something called antigen presentation.  An antigen is a foreign molecule, and an example is pathogenic bacteria.  So for example, if someone has a bacterial infection, the dendritic cell will bind to the bacteria (antigen) and will then present it to the immune system.  And then of course the immune system will do everything it can to destroy the bacteria.

In addition to dendritic cells there are a few other antigen presenting cells.  These include macrophages and B lymphocytes.  Different antigen-presenting cells cause responses in different T cell populations (1).  In other words, while the goal of any antigen-presenting cell is to present an antigen to the immune system, dendritic cells will cause responses in different T cells than macrophages, which in turn will cause responses in different T cells than B lymphocytes.

What is A Major Histocompatibility Complex?

A major histocompatability complex (MCH) aids in allowing the immune system to recognize these antigens.  So for example, if there is pathogenic bacteria that invades the body, the MHC molecules are what actually bind to the proteins of these pathogens.  After doing this it displays them on the surface of the antigen presenting cell so that the appropriate T cells can recognize them, and of course these T cells then attempt to eradicate the bacteria.

You might wonder what specifically happens after the T cells recognize the antigens.  Of course we know that eventually the T cells will attempt to destroy the pathogen, but before this happens the T cell that binds to the MHC class II molecule is called a “naive” helper T cell.  If you have been reading my blog posts for awhile you might be familiar with Th1 and Th2 cells, and this naive helper T cell will become either a Th1 cell, a Th2 cell, a Th17 cell, or a regulatory T cell (2).  In a healthy immune system you want a balance of Th1 and Th2 cells, a large amount of regulatory T cells, and a low number of Th17 cells.  But with autoimmunity you commonly get an imbalance of the Th1 and Th2 pathways, along with an increase in Th17 cells and a decrease in regulatory T cells.

The Roll of Toll-Like Receptors                            

There are numerous studies which show that toll-like receptors play an essential role in the development of autoimmune conditions such as Graves’ Disease and Hashimoto’s Thyroiditis (3) (4).  Toll-like receptors are a type of pattern recognition receptor, and these in turn recognize a wide range of something called pathogen-associated molecular patterns, also known as PAMPS (5).  PAMPs are found in pathogens such as viruses and bacteria.  An example of a PAMP is a lipopolysaccharide, which  are large molecules found in gram-negative bacteria, and I discussed this in greater detail in a past blog post I wrote entitled “What Are Lipopolysaccharides and How Can They Affect Thyroid Health?“.  These PAMPs are not normally found in the body of humans, and so they are immediately identified as being a foreign substance by the immune system.  There is also something called DAMPs, which stands for “damage-associated molecular patterns”.  Unlike PAMPs, which are associated with infections, DAMPs are usually associated with trauma.  Both PAMPs and DAMPs are involved in the inflammatory response.

Are Dendritic Cells Beneficial or Harmful?

Although we know that proinflammatory cytokines increase inflammation, and regulatory T cells help to decrease the autoimmune response, it’s not certain whether dendritic cells are beneficial or harmful in those with autoimmune conditions.  Although dendritic cells might play a role in triggering autoimmunity (6), more recent observations have shown that dendritic cells are important to ensure “immunological peace” by modulating regulatory T cells (7), which help to suppress autoimmunity.  The truth is that while we refer to some immune system cells as “bad”, or proinflammatory, while others as being “good”, or anti-inflammatory, all of these immune cells serve a purpose.  And so when you think about it this way, hopefully you’ll realize that no immune cell is inherently good or bad.

How Can We Modulate These Dendritic Cells?

In past articles and blog posts I’ve discussed things you can do to decrease proinflammatory cytokines and increase regulatory T cells, and I still recommend to focus on incorporating these factors while removing the autoimmune trigger.  However, there are a few studies which show that certain nutrients can modulate dendritic cells in a positive manner.  This includes vitamin D, which also can help to decrease proinflammatory cytokines and increase regulatory T cells.  And there is also evidence that the 1,25(OH)₂D₃-Vitamin D₃ complex can affect the maturation and migration of many dendritic cell subsets and help to regulate the immune system (8).  There is also evidence that vitamin A can modulate dendritic cells (9).

There is also evidence that polyphenols, which are found in fruits and vegetables, can have a positive effect on dendritic cells and shift the immune response towards tolerance or immune activation (10).  Another article specifically mentioned the polyphenols quercetin and piperine as influencing the maturation of dendritic cells and modulating the inflammatory response (11).  In other words, the authors claim that polyphenols can drive the dendritic cells towards an anti-inflammatory profile (11).

In summary, dendritic cells and toll-like receptors both play a role in modulating the immune system.  Dendritic cells present antigens such as bacteria to the immune system, which in turn will attempt to destroy the pathogen.  Something called a major histocompatability complex (MCH) aids in allowing the immune system to recognize these antigens.  Toll-like receptors are a type of pattern recognition receptor, and they play an important role in recognizing pathogen-associated molecular patterns, which are found in pathogens such as viruses and bacteria.  Some nutrients which can modulate the dendritic cells include vitamin D, vitamin A, and polyphenols such as quercetin and piperine.

There are many spices that can benefit your health.  Eating these spices on a regular basis can help to decrease inflammation, eradicate pathogens, balance blood sugar levels, etc.  However, some spices have greater health benefits than others, and there are certain spices which should be avoided in those with autoimmune thyroid conditions such as Graves’ Disease and Hashimoto’s Thyroiditis.  And so I’ve decided to discuss the health benefits of seven spices that most people with thyroid and autoimmune thyroid conditions can safely consume (although there are a few exceptions).

Spice #1: Garlic.  I recommend for most of my patients to consume garlic.  Garlic has many different benefits, but one of the main reasons I recommend it to my patients is because it is a wonderful antimicrobial.  And many people with thyroid and autoimmune conditions have infections.  In fact, the research shows that garlic has antibacterial (1) (2), antiviral (3) (4), antifungal (5) (6), and even antiparasitic activities (7) (8).

In addition to being a great antimicrobial, garlic has other benefits, as it can help people with cardiovascular disease, including high blood pressure (9) (10).  Garlic can also reduce inflammation (11) (12).  And garlic also supports detoxification by increasing glutathione levels.  Some people who have small intestinal bacterial overgrowth (SIBO) are unable to consume garlic because they experience gas and bloating.

Spice #2: Turmeric.  Turmeric is yet another spice that most people can benefit from taking.  Inflammation is a big factor in autoimmune conditions such as Hashimoto’s Thyroiditis and Graves’ Disease.  And while there are numerous benefits of turmeric, perhaps the greatest one is that it is a wonderful anti-inflammatory agent.  With regards to autoimmune conditions it can help to reduce proinflammatory cytokines (13) (14) (15) and increase regulatory T cells (16).  Turmeric also can benefit cardiovascular health (17) (18), and it also has anticancer properties (19), as well as a neuroprotective effect (20).

Spice #3: Cinnamon.  This spice has many different benefits, but one of the primary benefits is helping to regulate blood glucose levels.  One meta-analysis showed that the consumption of cinnamon is associated with a statistically significant decrease in levels of fasting plasma glucose, total cholesterol, LDL-C, and triglyceride levels, and an increase in HDL-C levels (21).  However, there was no significant effect on the hemoglobin A1C (21).  Another meta-analysis showed that cinnamon improves fasting blood glucose in people with type 2 diabetes or prediabetes (22).  Another study showed that cinnamon proanthocyanidins had inhibitory effects on advanced glycation endproducts (AGEs), which are substances that contribute to increased oxidative stress and inflammation (23).

Cinnamon also seems to modulate the immune system, which can benefit people with autoimmune conditions.  Regulatory T cells help to suppress autoimmunity, and there is evidence that cinnamon can increase regulatory T cells (24).  Th17 cells are increased in autoimmunity, and cinnamon can potentially suppress these cells (24).  Another study looking at the effects of cinnamon in multiple sclerosis also discussed how cinnamon increases regulatory T cells while decreasing Th17 cells (25).  However, I must add that a recent study showed that cinnamon reduces serum T3 levels (26).  However, keep in mind that this was conducted on male rats, and it’s just a single study.

H. Pylori is a bacteria that can be a potential trigger of autoimmune thyroid conditions. And there is evidence that cinnamon has an inhibitory effect on H. Pylori (27). A recent study also showed that cinnamaldehyde, which is a major active constituent of cinnamon, has an anti-inflammatory effect on gastric inflammation caused by H. Pylori (28).

Spice #4: Thyme.  Thyme has numerous health benefits.  First of all, it has antimicrobial activity against yeast and bacteria (29).  I did come across an older in vitro study which showed that thyme had a significant inhibitory effect on H. Pylori (30).  There is also evidence that thyme can increase the activity of the phase 1 and phase 2 enzymes that are involved in detoxification (31) (32).  Thyme might also have anticancer effects as well (33).

Spice #5: Ginger.  Ginger belongs to the family Zingiberaceae, and it is very well known for its anti-inflammatory properties.  It helps to reduce inflammation by suppressing prostaglandin synthesis, specifically inhibiting cyclooxygenase-1 (COX-1) and cyclooxygenase-2 (COX-2), and also suppresses the formation of leukotrienes through the inhibition of 5-lipoxygenase (34) (35).  COX-1, COX-2, and 5-lipoxygenase are enzymes which play a role in the inflammatory process.  In addition, 6-gingerol, which is a major compound in ginger, has shown to inhibit both Th1 and Th2 cytokines (36), and an imbalance of the Th1 and Th2 pathways are a factor in autoimmune conditions.

Ginger also can be beneficial for certain types of cancers, including prostate cancer (37), pancreatic cancer (38), gastrointestinal cancer (39), and breast cancer (40).  Also, for those suffering from primary dysmenorrhea, a recent study also showed that ginger can be beneficial during the first 3 or 4 days of the menstrual cycle (41).  Those with insulin resistance or type 2 diabetes can also benefit from ginger, as a study showed that it improves fasting blood sugar, hemoglobin A1c, apolipoprotein B, apolipoprotein A-I, and apolipoprotein B/apolipoprotein A-I in patients with type 2 diabetes (42).

Spice #6: Sage.  Sage has been used for the relief of pain, protection against oxidative stress, free radical damage, angiogenesis, inflammation, along with bacterial and viral infections (43).  Many people with thyroid and autoimmune thyroid conditions have memory and concentration problems, and sage can potentially help to improve memory and cognition (44) (45).

Spice #7: Rosemary.  Rosemary (Rosmarinus officinalis L.) also has numerous health benefits.  First of all, it has antioxidant and anti-proliferative properties, and so it can help to reduce inflammation and inhibit the growth of cancer cells (46) (47) (48) (49).  It also has been shown to have antitumor activity against breast cancer cells, possibly by modulating estrogen (50).  There is also evidence that it can protect the liver (51).

Other Spices Can Be Beneficial As Well           

Of course there are numerous other spices that can also be beneficial to consume.  Examples include parsley, peppermint oil, cloves, cilantro, and oregano.  According to Sarah Ballantyne, author of the Paleo Approach, these spices are all autoimmune-friendly.  As a result, most people with Graves’ Disease and Hashimoto’s Thyroiditis should be able to consume these spices without a problem.

In summary, most people with thyroid and autoimmune thyroid conditions can benefit from consuming spices.  Numerous spices have anti-inflammatory effects (turmeric, ginger, rosemary), while other spices have powerful antimicrobial effects (garlic, thyme, sage).  Other spices help to balance the blood sugar levels (cinnamon, ginger), while some can help to support detoxification (thyme).  All of the spices I listed in this post should be fine for most people with autoimmune thyroid conditions such as Graves’ Disease and Hashimoto’s Thyroiditis.

X-rays represent a type of ionizing radiation, which in turn can cause damage to one’s cells and increase the risk of developing cancer.  While the focus of this blog post will be on dental x-rays, it’s important to understand that all x-rays emit ionizing radiation.  However, there are a few reasons why I’m specifically focusing on dental x-rays.  First of all, because of the proximity of the teeth to the neck, the thyroid gland has a greater chance of exposure when compared to other types of x-rays.  In addition, many people get annual dental x-rays, and so one of the main goals is to discuss the risks vs. benefits, and to try to determine if the benefits of getting annual dental x-rays outweigh the potential risks.

Let’s begin by trying to answer the following question…”why do many dentists recommend annual dental x-rays?”  There is no question that one’s oral health is important, and the main reason why many dentists recommend frequent x-rays is to detect the early formation of dental cavities.  This of course doesn’t happen overnight, as what usually will happen is that plaque will accumulate on the tooth, and bacteria will produce acid that will slowly demineralize the tooth.  This of course is why it’s important to brush your teeth on a regular basis, as this helps with the prevention of plaque buildup.  However, if someone doesn’t brush on a regular basis and/or they eat a lot of sugar, then this buildup of plaque can lead to a dental cavity, which can be spotted on a dental x-ray.

Obviously the goal should be to do what you can to prevent dental cavities from forming, but when they do form, what happens if you don’t get this addressed?  Well, if this isn’t treated then the cavity will usually become larger, and probably will affect the inner layers of the tooth, called the dentin and pulp.  Eventually the damage can be severe enough where the only solution is to get a root canal or a tooth extraction, and there are risks of both of these.

So in no way am I suggesting not to get dental cavities filled, although you of course want to make sure you don’t get any mercury amalgams.  However, is it necessary to get annual dental x-rays to detect the early formation of these cavities?  In my opinion most people don’t need to get dental x-rays every single year.  This is especially true for those people who practice good dental hygiene, as in most cases a cavity will take at least a few years to advance to the point where it causes severe damage to the dentin and the pulp of the tooth.  I’m sure there are exceptions to this, and of course if you are experiencing pain or a sensitivity in your teeth then it probably is a good idea to get a dental x-ray, even if the last one you had was recent.

How Often Should You Get Dental X-Rays?

Once again, keep in mind that it is only my opinion that most people don’t need to get annual dental x-rays.  And while many other natural healthcare professionals share the same opinion, of course most conventional dentists don’t feel this way.  You might be wondering how frequently I would recommend for people to get dental x-rays?  Should they wait until they experience pain or a sensitivity?  I probably wouldn’t take this approach, and I’d say getting dental x-rays every two or three years probably is fine for most people. ..assuming you are brushing your teeth at least twice per day and flossing at least once per day.  I’m sure there are some reading this who feel that every two or three years is too frequent.  Over the last few decades the longest I have gone between getting dental x-rays has been four years, and in this situation the x-rays revealed no cavities or other issues.  And I’m sure some reading this have gone even longer between having regular dental x-rays without having cavities or other oral problems.  If this is the case then please feel free to share your experience in the comments section below.

How Does Ionizing Radiation Cause Cancer?

Of course it’s not just dental x-rays that increases one’s risk of developing cancer, as all x-rays, as well as other types of procedures involving ionizing radiation, can increase your risk of developing cancer.  Just as a reminder, I’m focusing on dental x-rays because of the proximity of the teeth to the thyroid gland, and also because many people get annual dental x-rays without thinking twice.  As for how ionizing radiation causes cancer, what happens is that ionizing radiation causes oxidative stress and leads to the formation of free radicals (1) (2) (3).  Free radicals are molecules that are highly unstable, and they play a key role in the initiation and progression of tumor cells (4) (5).

But why do some people who are exposed to radiation develop cancer, while others don’t?  Well, there are a few factors that can play a role.  Genetics does seem to be one factor.  But epigenetics is usually a greater factor, and what this means is that one’s external environmental is what affects the genetics.  In other words, someone might have a genetic susceptibility to a certain type of cancer, but eating a poor diet and/or other factors will be primarily responsible for the development of cancer.  Sometimes it’s hard to make this connection, as a few years ago I worked with a patient who developed breast cancer, even though she lived a healthy vegetarian lifestyle, exercised regularly, etc.  On the other hand, many people eat plenty of junk food and don’t develop cancer.  Similarly, some people receive a lot of x-rays and don’t develop cancer, while others who develop cancer don’t have a history of frequent exposure to ionizing radiation.

Some Facts About Thyroid Cancer                                       

Thyroid cancer is the most common malignancy of the endocrine system, representing 3.8% of all new cancer cases in the United States and is the ninth most common cancer overall (6).  The American Cancer Society estimates that 62,450 people in the United States will be diagnosed with thyroid cancer in 2015, and 1,950 deaths will result from the disease (6).  95% of the cancers being of follicular cell origin-papillary, follicular, or anaplastic thyroid carcinomas (7).  Both papillary and follicular thyroid cancers have good survival rates, with the 5-year survival rate approaching 97%, although the median survival for a patient with anaplastic thyroid carcinoma is measured in months (7).  There is evidence of an increased risk of developing thyroid cancer in those with Hashimoto’s Thyroiditis and Graves’ Disease (8) (9) (10) (11).

But why do some people develop thyroid cancer?  Well, like most other cancers it seems to be due to a combination of genetic and environmental factors.  Of course the focus of this blog post is on the risks of dental x-rays, and below I’ll mention some of the research studies which show a correlation between the ionizing radiation in dental x-rays and the development of thyroid cancer.  But there can be other factors as well.  Thyroid cancer is more common in women, especially between puberty and menopause, and therefore estrogen seems to play a role in its development (12) (13) (14).  So doing things to improve one’s estrogen metabolism can also help to prevent thyroid cancer from developing.

What Does The Research Show Regarding Dental X-Rays and Thyroid Cancer?

So what does the research show?  First of all, an increased risk of thyroid cancer has been reported in dentists, dental assistants, and x-ray workers (15).  One case-control study provided some evidence that multiple exposure to dental x-rays may be associated with an increased risk of thyroid cancer (15).  Another study looked at different types of diagnostic x-rays, and found that overall there was no clear evidence of thyroid cancer risk associated with diagnostic x-rays except for dental x-rays (16).  And there are some other studies which show an increased risk of thyroid cancer with regular dental x-rays (17).

I’m sure many dentists will be angry upon reading this information, and keep in mind that I’m not suggesting that most people who receive dental x-rays on an annual basis will develop thyroid cancer.  And to be fair, there are other factors which also can increase someone’s susceptibility.  For example, since nutrients such as selenium might help to prevent thyroid cancer (18) (19), eating a poor diet can potentially increase one’s risk of developing this condition.  And there are many other minerals and phytonutrients which can help to prevent cancer.  Earlier I also mentioned how problems with estrogen metabolism can be a factor in the development of thyroid cancer.   In addition, wearing a thyroid shield while getting dental x-rays will decrease the risk of getting thyroid cancer (19), and so if you do get dental x-rays I would make sure to ask for a thyroid shield.

5 Takeaways From This Blog Post                                                                                   

Takeaway #1: Think twice about getting annual dental x-rays.  Once again, this is just my opinion, and I know some people reading this will disagree with me.  But while there are benefits of receiving dental x-rays, I don’t think most people need to receive them every single year.

Takeaway #2: When you get dental x-rays, make sure you wear a thyroid shield.  As ridiculous as this may sound, not all dental offices will provide their patients with a thyroid shield prior to having x-rays taken.  In fact, in the past I have had to ask the technician for a thyroid shield.

Takeaway #3: Maintain good oral health.  If you minimize your consumption of sugar, and brush and floss regularly, then this will greatly decrease your risk of having problems with your teeth and gums.  And of course this in turn will reduce your chances of getting dental cavities, which in turn will allow most people to get away with having less dental x-rays.  Keep in mind that I’m not suggesting that you don’t go to the dentist for regular cleanings, as I do think this is a good idea.

Takeaway #4: Eat a healthy diet.  While it’s important to minimize your consumption of sugar, you also want to eat plenty of whole healthy foods in order to make sure you get the necessary nutrients to help prevent cancer.  Eating plenty of vegetables, along with some fruits, can provide you with a lot of the nutrients and phytonutrients you need in order to help reduce one’s risk of developing cancer.

Takeaway #5: Do things to improve estrogen metabolism.  Since  increased estrogen levels can increase the risk of developing thyroid cancer (as well as some other types of cancers), it makes sense to do things to improve estrogen metabolism.  In the near future I will be releasing an article which focuses on improving estrogen metabolism.

In summary, x-rays are a type of ionizing radiation, which is one factor in the development of certain types of cancers.  As a result, it is a good idea to minimize one’s exposure to ionizing radiation.  Many dental offices recommend for their patients to get annual dental x-rays, and the research shows an increased risk of thyroid cancer with dental x-rays.  This doesn’t mean that people should never get dental x-rays, and I do think it’s a good idea to get regular cleanings.  But perhaps it’s time to question whether it’s a good idea to get annual dental x-rays.  Just like anything else, one needs to weigh the risks vs. benefits, and I’m not convinced that the benefits of annual dental x-rays outweigh the potential risks.

Please feel free to share your thoughts about getting annual dental x-rays in the comments section below.

When I was diagnosed with Graves’ Disease I chose not to take antithyroid medication to manage my hyperthyroid symptoms.  Many of my patients and email subscribers attempt to manage their symptoms without taking medication as well.  On the other hand, many others will choose to take antithyroid medication and/or beta blockers while trying to restore their health.  If you have hyperthyroidism and are deciding whether you should take the medication or manage your symptoms naturally I would make sure to read this entire post.

Keep in mind that my goal isn’t to scare anyone with this information, but just to make you realize that unmanaged hyperthyroidism comes with a great risk.  While getting a heart arrhythmia or suffering from a thyroid storm is rare, this can and does happen at times.  But if you do a good job of managing your symptoms the risk of developing these or other health conditions is less likely to happen.  So let’s go ahead and look at some of the things you need to do in order to safely manage your hyperthyroid symptoms.

1. Take action quickly.  When I was diagnosed with hyperthyroidism I knew that I was going to do something natural about it.  However, it took a few months before I took anything to manage my symptoms, which is a long time when you have an elevated heart rate.  This was foolish of me, and I’m lucky that nothing serious happened to me.  But some people aren’t as lucky when going a prolonged period of time without managing their hyperthyroid symptoms.  And so whether you choose to take prescription medication to manage the symptoms, or try taking herbs such as bugleweed and motherwort, it’s a good idea to take action quickly.

But what should you do if you can’t see a doctor quickly?  Sometimes it can be a few months before you can get in to see an endocrinologist, and if you plan on working with a natural healthcare professional it also can take some time.  Some people do choose to take herbs and supplements on their own to manage their symptoms, although it can be challenging to know what dosage to take.  If you prefer to take the medication, while it might take some time before you see an endocrinologist, you probably were referred to this endocrinologist by a primary care physician, and chances are he or she will give you something to manage the cardiac symptoms.  While they might not write a prescription for antithyroid medication, most will at least recommend a beta blocker to lower the heart rate.

2. Keep in mind that the herbs don’t work for everyone.  I was fortunate not to have to take any medication, as I used the herbs bugleweed and motherwort to manage my symptoms.  And over the years I have had many patients who also effectively managed their symptoms when taking the herbs.  However, the herbs don’t always do a good job of managing the symptoms in everyone, and there are some people who need to take the medication.  If the herbs do work then in most cases they should kick in within two to four weeks, and sometimes sooner than this.

3. You need to weigh the risks vs. benefits.  Everything comes down to risks vs. benefits.  I’ve worked with numerous patients who refused to take the medication, even if the herbs weren’t doing a good job of managing their symptoms.  And while there are certain circumstances when this is understandable, such as if the antithyroid medication causes elevated liver enzymes, or if someone has a negative reaction to the medication, if someone tolerates the medication well then it can be a good option.

Don’t get me wrong, as I’m not trying to convince anyone to take antithyroid medication or beta blockers.  However, I am suggesting that doing so is better than landing in the emergency room due to a thyroid storm.  For example, if someone has a resting heart rate of 150 beats per minute or higher, this isn’t something to play games with.  In fact, in this situation it might be best to take the medication immediately and not try the herbs, as you would want to lower the heart rate quickly.  Fortunately most of my patients don’t have a heart rate this high, but even a heart rate of 120 BPM isn’t something to take lightly.  My point is that sometimes it is necessary to take the medication, and don’t feel like you are giving in by doing so.  While overall drugs are overused and abused, and although there are potential side effects of taking antithyroid medication and beta blockers, sometimes taking prescription drugs is necessary, and there is no shame in taking medication for a very high heart rate.

4. Be aware of the signs and symptoms of a thyroid storm.  Although a thyroid storm is rare, it can happen, and when it does it’s an emergency situation.  It may be triggered by an acute event such as thyroid or nonthyroidal surgery, trauma, infection, or an acute iodine load (1). Some of the symptoms include change in alertness, confusion, increased temperature, very high pulse rate, diarrhea, shaking, and sweating (2).  If you suspect thyroid storm you should immediately go to the nearest emergency room.

5. You can restore your health regardless of how you manage your symptoms.  Bugleweed, motherwort, lemon balm, and L-carnitine are some of the herbs and supplements used to manage the hyperthyroid symptoms.  Just keep in mind that they aren’t doing anything to address the cause of the problem.  And so whether you take medication to manage the symptoms, or take a natural approach, you still need to do things to address the underlying cause of your condition.  And so for those people who take antithyroid medication such as Methimazole, PTU, or Carbimazole, or a beta blocker such as Propranolol, you can still can take a natural treatment approach.

Why Did I Decide To Write This Post?

If you’re wondering why I decided to write this post, there are a few reasons.  Of course the main reason is because I work with a lot of patients with hyperthyroidism, and from time to time I consult with someone who prefers not to take any medication, even if they are putting their health at risk.  In fact, as of writing this post I’m working with a teenager with Graves’ Disease whose symptoms aren’t being effectively managed by the herbs, and her mother doesn’t want for her to take Methimazole.  She was concerned about the Methimazole causing liver failure, which is unlikely, although I can certainly understand the concern of the mother.  But once again, everything comes down to risks vs. benefits, and the risk of this teenager having problems from not taking the medication is in my opinion much greater than her experiencing liver failure.

I had another situation recently when a patient of mine with Graves’ Disease sent an email to inform me that his heart rate was over 190 BPM while working.  Of course I advised him not to overexert himself and to take it easy, and it’s important to point out that while he was trying to manage his symptoms with the bugleweed, he also had a prescription for a beta blocker that he wasn’t taking.  He was concerned about the side effects of the beta blocker, but when someone has a pulse rate of 190+ BPM the main concern should be to get the heart rate down as quick as possible, and to not worry about having a negative reaction to the medication.

Should You Just Receive Radioactive Iodine?

I’m sure there will be a few people reading this and wonder if the “benefits” of receiving radioactive iodine are greater than the potential “risks” of treating your condition naturally.  Of course only you can make this decision, but I do want to say that if people with hyperthyroidism and Graves’ Disease do what is necessary to manage their symptoms and receive the proper guidance when taking a natural treatment approach, then the risks of something bad happening is low.  On the other hand, with regards to receiving radioactive iodine, there are risks of being exposed to  radiation, and there are also risks of not having a functioning thyroid gland, which is usually a consequence of receiving this treatment.

Truth to be told, there are people who receive radioactive iodine and are pleased with their decision.  On the other hand, there are many people who receive this treatment and never feel the same again, and they end up regretting their decision.  The problem is that you don’t know which category you will fall under.  And if someone receives radioactive iodine and doesn’t respond well, there is less of a chance that they will benefit from a natural treatment approach.

In summary, when following a natural treatment protocol it is important for anyone with hyperthyroidism or Graves’ Disease to manage their symptoms.  Some will choose to do this with medication, while others will attempt to manage their symptoms with herbs such as bugleweed and motherwort.  Either way, you want to make sure to take action quickly, and keep in mind that herbs such as bugleweed and motherwort don’t work for everyone, as some people do need to be on the medication.  Plus, if you choose to take the medication to manage your symptoms you still can restore your health, as you just want to make sure you’re safe while addressing the cause of your condition.

Many people with thyroid and autoimmune thyroid conditions work with an endocrinologist.  And it’s not uncommon for me to consult with someone who is intimidated by their endocrinologist.  In other words, they are afraid to say what’s on their mind and don’t want to upset their doctor.  This is especially true with those people who have Graves’ Disease, although I also see it at times with some people who have hypothyroidism and Hashimoto’s Thyroiditis.  You’ll probably be disappointed to learn that I’m not really going to teach you how to hypnotize your endocrinologist (although that would be cool), but I am going to give you a few tips that hopefully will help you feel more at ease when speaking with your doctor.

Most of what I discuss below is common sense, but the reason why I put this blog post together is because every week there are at least one or two patients who tell me they are intimated by speaking with their endocrinologist.  They are concerned because most endocrinologists aren’t open to a natural treatment approach, and so their doctor doesn’t want to hear anything about how diet and lifestyle can improve one’s health.  Don’t get me wrong, as every now and then I’ll work with a patient who has an open-minded endocrinologist, but this definitely isn’t the norm.  With that being said, let’s discuss some of the reasons why you shouldn’t be intimidated by your endocrinologist, or any other medical doctor for that matter.

1. Remember that your endocrinologist is a person just like you.  Even though some doctors have a superiority complex, I’m pretty sure they are made of flesh and blood just like you.  When you think about it, it’s silly to be afraid of your endocrinologist, or any other doctor.  Although I realize it might not be easy to find another endocrinologist to work with, there is no good reason to put up with an endocrinologist who isn’t willing to listen to you, and who just wants to tell you what to do without having you question them.

2. Keep in mind that we all have our biases.  Although I’m not opposed to conventional treatment methods, there is no question that I’m biased towards taking a natural treatment approach.  And the reason for this is not only due to my personal experience with natural treatment methods, but my training in chiropractic school as well.  It definitely didn’t have anything to do with how I was raised by my parents, as I wasn’t brought up with a natural mindset, and if in the past I chose to go to medical school instead of chiropractic school I can almost guarantee that I wouldn’t be writing this post, as I probably would be prescribing drugs or getting ready for a surgical procedure.

And it’s a similar situation with most endocrinologists, as they have gone through years of training to help people through conventional treatment methods.  While it would be great if there were more open-minded endocrinologists, and perhaps there will be in the future with the help of organizations such as the Institute for Functional Medicine, unfortunately most medical doctors have a closed mind and don’t want to hear about natural treatment methods.  Sure, there are a few exceptions, but it’s still rare to find an endocrinologist who has any type of experience or interest in taking a natural treatment approach for thyroid and autoimmune thyroid conditions.

3. You are in charge of your own health.  The reason why you probably work with any healthcare professional is to seek their advice and receive recommendations.  However, this doesn’t mean that you are required to follow their recommendations.  So for example, if someone with hypothyroidism needs to take thyroid hormone medication and prefers to take Armour or Nature-Throid, there is a good chance the endocrinologist they are working with will refuse to write a prescription for this.  If this is the case with you then of course you can choose to take synthetic thyroid hormone medication, or you can call around and try to find a different doctor who is willing to prescribe natural thyroid hormone medication.  Similarly, if someone with Graves’ Disease sees an endocrinologist for an initial consultation, and if the endocrinologist gives radioactive iodine treatment as the only option, then this person can choose to receive the treatment, but of course they also have the option of seeking a second opinion.  It’s the same concept when someone consults with me, as I will give them my recommendations, and then it’s up to the person to decide whether or not they want to follow my advice.

4. Do some research before you choose your doctor.  In most cases, before someone schedules a consultation with a natural healthcare professional they will do some research on the Internet to learn more about the doctor.  I know this is frequently the case with my patients, and I require people to first attend a free webinar so they can get a better idea of my approach, and make it easier for them to decide if they would like to work with me.  But this usually isn’t the case when someone schedules an appointment to see an endocrinologist.  Many people will choose an endocrinologist based on 1) whether they are a provider on their health insurance plan, and/or 2) the location of the practice.

While it’s fairly easy to learn about my approach by visiting my website and/or attending one of my webinars, I realize that this isn’t always the case with other doctors.  For example, if an endocrinologist is part of a group practice then they might only have a single page on the website dedicated to them, and it might not tell you much about the doctor.  If you have specific questions feel free to email the practice, or better yet, call the office and see what you can find out.  And if you can’t find the answers you’re looking for then try to contact a few other offices.

5. Be careful about how you approach your endocrinologist.  Although it’s true that you are in charge of your health, and while you want to be able to have a two-way conversation with your endocrinologist and not just listen to his or her recommendations, you do want to be a little cautious when trying to communicate with your doctor.  For example,  if you are also working with a natural healthcare professional, it probably wouldn’t be a good idea to tell the endocrinologist “Hey doc, I’m also working with a natural doctor and he recommends for me to do some blood and saliva tests, and so I’m hoping you will be able to order these.  Oh yeah, he also says that diet is a big factor with these conditions.  Plus, any drugs you prescribe need to be gluten and dairy free.”  Okay, perhaps you wouldn’t word it exactly like this, but my point is that most endocrinologists want to be the authority figure, and most don’t want to take orders from a natural healthcare professional.

Does this mean you shouldn’t tell them that you are working with a natural healthcare professional, assuming this is the case?  Is it wise not to say anything else about taking a natural treatment approach?  Before you tell your endocrinologist you are taking a natural treatment approach, I would simply ask him or her the following question: “What are your feelings about taking a natural treatment approach for my condition?”  Or you can ask “”What are your thoughts about me working with a natural healthcare professional to help improve my health while I work with you simultaneously?”  By doing this you aren’t openly admitting that you are currently following a natural treatment approach, but the question should elicit a response from the endocrinologist.  If the endocrinologist gives a negative response then it might be best not to further talk about natural treatment methods, unless if you’re looking for a good argument.  On the other hand, if the endocrinologist seems to be open to natural treatment methods, or even if they aren’t open but they don’t have a negative reaction, then you might want to tell the endocrinologist that you are thinking about taking a natural treatment approach, and you can also ask if he or she would be willing to work with you while you do this.

Keep in mind that you don’t have to tell the endocrinologist that you are considering working with another healthcare professional to try to address the cause of your condition.  After all, most of them don’t think that there is an underlying cause for thyroid and autoimmune thyroid conditions.  As a result, it might be best to tell them that you are working with a natural healthcare professional who is trying to improve your overall health by offering nutritional support and lifestyle advice, and not tell them that you are specifically looking to restore your health naturally.

While every now and then I’ll work with a patient who is seeing an open-minded endocrinologist, most endocrinologists are opposed to natural treatment methods.  In some cases they will refuse to work with you if you tell them you’re taking a natural treatment approach, and usually the best case scenario is that they won’t be thrilled about what you’re doing, but they will be still willing to write an order for labs and prescribe medication.  I do see this changing in the future, as more and more medical doctors are being exposed to functional medicine.  But unfortunately it still is challenging to find an endocrinologist who is open minded.

In summary, many people with thyroid and autoimmune thyroid conditions are easily intimidated by their endocrinologist.  And the reason for this is because most endocrinologists are close-minded when it comes to natural treatment methods.  Just remember that your endocrinologist is a human being just like you, and also remember that you are the one who hires your endocrinologist, as it’s not the other way around.  You are in charge of your own health, and while I realize it isn’t always easy to find another endocrinologist to work with, this doesn’t mean that any doctor has the right to talk down to you and insist that you need to follow their recommendations, even if you are uncomfortable with them.

Of course it is ultimately your decision how you want to approach your endocrinologist, and if you have something you want to add to this, or if you just want to share the experience you had with your endocrinologist please feel free to post a comment below.