In the last post I spoke about some of the main causes of insulin resistance.  In this post I am going to focus more on hypoglycemia.  I will then discuss seven factors which can help to balance blood sugar levels.  These will be important regardless of whether you have insulin resistance or hypoglycemia.

Hypoglycemia refers to low blood sugar levels, typically less than 70 mg/dL.  What happens is that either the body’s glucose is used up too quickly, is released into the bloodstream too slowly, or too much insulin is released into the bloodstream (1).  Some of the causes of hypoglycemia include alcohol consumption, an infection, hypothyroidism or hypoadrenalism, and severe heart, kidney, or liver failure (1).  I’ll talk more about these causes shortly.  Some of the common symptoms associated with low blood sugar levels include weakness, fatigue, sweating, disorientation, and shakiness (2).

Reactive hypoglycemia is an exaggerated fall in the blood glucose levels, and is due to excessive insulin secretion in response to a meal.  Dr. Alan Gaby has dedicated a chapter to reactive hypoglycemia in his excellent book “Nutritional Medicine”, and he discusses how if the blood glucose levels fall too rapidly then the body compensates by releasing adrenaline, as well as other compounds which raise the blood glucose levels.  This in turn results in “fight or flight” symptoms such as anxiety, panic attacks, hunger, palpitations, tachycardia, tremors, sweating, and even abdominal pain.  Dr. Gaby also talks about the symptoms presented when the blood glucose levels fall slowly over a period of hours, as this can lead to symptoms such as headaches, fatigue, blurred vision, mental confusion, impaired memory, and even seizures.  These symptoms usually are worse before meals, and frequently are relieved by eating.

Keep in mind that not everyone who has hypoglycemic symptoms will have low blood glucose levels or an abnormal glucose tolerance test.  And so this can be a challenging condition to diagnose.  I briefly mentioned some of the causes of hypoglycemia earlier, but there are other factors which might play a role in this condition, such as food allergies or sensitivities.

The following are some of the potential causes of hypoglycemia:

1) Eating refined foods and sugars.  Most people reading this know that eating a lot of refined foods and sugars will affect the blood sugar levels.  Eating a lot of refined sugars over a period of time will usually lead to hyperglycemia/insulin resistance, and eventually can set the stage for a condition such as type 2 diabetes.  However, in some people it can also lead to hypoglycemia.  Skipping meals frequently also can have a negative effect on the blood sugar levels and lead to hypoglycemic episodes.

2) Alcohol consumption.  Alcohol has a hypoglycemic effect, which is probably caused by the inhibition of gluconeogenesis in the liver (3) (4).  Gluconeogenesis involves the production of sugars (primarily glucose).  While having an occasional alcoholic beverage usually won’t lead to hypoglycemia, frequent consumption of alcoholic beverages can cause blood sugar imbalances.  And if anyone currently has blood sugar imbalances it probably would be a good idea to completely eliminate any alcohol consumption.

3) Thyroid hormone imbalance.  There is evidence that hypothyroidism can be a factor in hypoglycemia (5).  However, it is also possible that having hypoglycemia can inhibit the pituitary-thyroid axis (6).  And while hyperthyroidism isn’t usually associated with hypoglycemia, hyperthyroidism with congestive heart failure or liver dysfunction can induce hypoglycemia, although this is very rare (7).

4) Adrenal Insufficiency.  Hypoglycemia is one of the clinical manifestations of chronic primary adrenal insufficiency (8) (9).  Most cases of primary adrenal insufficiency are considered to be Addison’s disease, which is an autoimmune condition involving the adrenals.  However, secondary causes of adrenal insufficiency can also cause hypoglycemia (10) (11).  And so if someone has low cortisol levels, a low serum ACTH, and/or low DHEA levels, then this can be responsible for the hypoglycemic symptoms.

5) Acute infections.  Most cases of hypoglycemia aren’t caused by infections.  However, in some cases hypoglycemia can occur in bacterial sepsis (12) (13), or in bacteremic pneumococcal infections (14).

6) Food allergies or sensitivities.  Earlier I mentioned the book “Nutritional Medicine” by Dr. Alan Gaby.  In this book he mentions that “the ingestion of allergenic foods can trigger a hypoglycemic response in some people”.  Sometimes this can be challenging to determine, and in people with Hashimoto’s Thyroiditis and Graves’ Disease food sensitivities are common, although many times they are the result of a leaky gut, and don’t cause hypoglycemia.  However, if someone notices hypoglycemic symptoms upon eating a certain food, and if this pattern occurs every time after eating this food then one obviously should suspect that this food is responsible for the hypoglycemic effect.

How Can Blood Sugar Imbalances Be Corrected?

Diet.  Regardless of whether someone has hyperglycemia/insulin resistance, or hypoglycemia, eating well is very important.  Obviously you want to eat whole foods, and minimize the refined foods and sugars.  You also want to minimize your overall carbohydrate intake, and this is especially true if you’re suffering from insulin resistance, as when this is the case you will usually want to consume less than 150 grams of carbohydrates per day, and eating less than 100 grams of carbohydrates per day is sometimes necessary.  Keep in mind that I’m not suggesting that everyone should eat a low carbohydrate diet, but a big problem is that many people eat too many carbohydrates, which is one of the main reasons for the high incidence of insulin resistance and type 2 diabetes.

Although I love eating fruit, eating a lot of servings of fruit per day can cause problems in some people, and this is especially true in those with blood sugar issues.  If you are dealing with blood sugar imbalances it probably is a good idea to limit your consumption of fruit to one or two servings per day.  Even though fruit is high in phytonutrients and consists of natural sugars, you can still overdo it by eating too much fruit.

You also want to eat regularly throughout the day.  This is especially important for those who have hypoglycemia, although I think it’s important for most people to eat breakfast within one hour of waking up, and then every two to three hours after this.  Some people reading this might bring up the benefits of caloric restriction and intermittent fasting, which I wrote about in an article entitled “Intermittent Fasting and Thyroid Health“.  I agree that intermittent fasting can be beneficial, although it probably isn’t a good idea in someone who has hypoglycemia.

Address food sensitivities.  This seems to be more of a trigger with regards to hypoglycemic conditions, but of course even if someone doesn’t have any blood sugar imbalances they want to try to avoid any foods they are reacting to.  It can be very difficult to determine which foods you are sensitive to.  There is testing available such as IgE testing for food allergies, an IgG panel for delayed food sensitivities, and other types of testing such as the ALCAT.  These all can be valuable, but they also all have limitations.  And testing for food sensitivities can be very expensive, yet still provide false results.  I usually recommend an elimination diet for 3 to 4 weeks, followed by reintroducing the “suspicious” foods one at a time over a three day period.  This also has certain limitations, and of course takes more time than conducting a test for food sensitivities.

Improve insulin sensitivity.  It is also important to do things to improve insulin sensitivity.  This is especially important with insulin resistance, although it also can benefit those who have hypoglycemia as well.  Some of the best nutrients which can help to increase insulin sensitivity include chromium (15) (16) (17), magnesium (18) (19), and alpha lipoic acid (20) (21).  Vanadium (22) (23) and bitter melon (24) can also increase insulin sensitivity.  Berberine can benefit those with insulin resistance and type 2 diabetes by lowering blood glucose levels, and it might do this by modulating the microbiota (25).  The herb gymnema sylvestre can help to balance the blood sugar levels (26) (27).  You can also improve insulin sensitivity through exercise, which I’ll discuss next.

Exercise.  We all know that regular exercise is beneficial.  Although there are many nutrients which can increase insulin sensitivity, there is plenty of evidence which shows that exercise can also help to increase insulin sensitivity (28) (29) (30).  A big problem is that many people who exercise regularly also spend a good part of their day sitting.  So for example, someone might have a job that involves sitting behind a desk for most of the day, and then they expect three or four sessions of exercise each week to offset all of this inactivity.  Unfortunately this isn’t the way this works, as regular movement is very important.

Decrease inflammation.  Earlier I discussed how inflammation is a big factor in insulin resistance, and so one needs to do things to reduce the inflammatory process.  Obviously eating a healthy diet can help to reduce inflammation.  But it frequently is necessary to take nutrients to help break the inflammatory process.  I spoke about this in my blog post entitled “The Role of Cytokines In Autoimmune Thyroid Conditions“, as there is a transcription factor called Nuclear Factor Kappa B (NF-kB), and this needs to be downregulated.  Certain nutrients which can help with this include vitamin D, fish oils, turmeric, resveratrol, gamma-linolenic acid, ginger, and green tea.

Reduce oxidative stress. I also discussed how oxidative stress and mitochondrial dysfunction can play a role in insulin resistance.  And so doing things to reduce oxidative stress and improve the health of the mitochondria can be beneficial.  Some nutrients which can help with this include vitamin C, lipoic acid, acetyl-l-carnitine, CoQ10, resveratrol, and omega 3 fatty acids.

Correct dysbiosis.  Since intestinal dysbiosis can play a role in inflammation and insulin resistance, it is necessary to address this problem.  As I mentioned earlier, I have written a separate article on this topic, and so I would refer to this when you get the chance.

So hopefully you have a better understanding of the different factors which can cause insulin resistance and hypoglycemia, as well as some of the things you can do to address these health conditions.  Insulin resistance is when the body no longer is responsive to the effects of insulin, and some of the factors which play a role in the development of insulin resistance include inflammation, mitochondrial dysfunction, lipotoxicity, gut dysbiosis, circadian disruption, and genetics.  Hypoglycemia involves low blood sugar levels, and some of the potential causes of this condition include alcohol consumption, an infection, hypothyroidism, hypoadrenalism, as well as food allergies or intolerances.  Eating well and exercising regularly are both important factors when trying to regulate blood sugar imbalances, but some of these other factors I discussed in this post also need to be considered.

Many people with thyroid and autoimmune thyroid conditions have blood sugar imbalances.  However, there are different types of these imbalances.  Two of the most common health issues involving blood sugar imbalances are hypoglycemia and insulin resistance.  In the past I’ve spoken about these in separate articles, but since so many people suffer from blood sugar problems I figured it would be a good idea to talk about the similarities and differences between these two conditions.  In this post I will focus on insulin resistance, and then in the next post I will talk about hypoglycemia, and I will also discuss what you can do to correct blood sugar imbalances.

Glycemia refers to the presence of glucose in the blood.  As the name implies, hypoglycemia is a condition characterized by low blood sugar levels, whereas insulin resistance is more characteristic of hyperglycemia, which of course involves high blood sugar levels.  And the solution might seem simple, as if someone has high blood sugar levels  then they obviously want to reduce their sugar intake, and if someone has low blood sugar levels they will want to eat more regularly, right?  For the most part this is true, but while dietary factors are obviously important with both hypoglycemia and insulin resistance, these conditions are frequently complex and require more than simple dietary changes.

Before talking about insulin resistance I’d like to briefly talk about insulin.  Insulin is a hormone that is produced by the beta cells of the pancreas.  Insulin has numerous roles, but one of the primary roles is the regulation of blood glucose levels.  So when someone eats a meal, this will cause their blood sugar levels to rise, and the beta cells will secrete insulin to help the body utilize or store the glucose.

As for how insulin reduces blood glucose, it does so by inducing glucose uptake into insulin-sensitive tissues such as skeletal muscle, fat, and heart (1).  Insulin also inhibits glucose production in the liver, kidney, and small intestine in the control of blood glucose (1).  Insulin has other functions, as it stimulates the synthesis of fatty acids and glycogen (2), and it also plays a role in mitochondrial function.  What happens with insulin resistance is that the body is no longer responsive to the effects of insulin.  This in turn can lead to other conditions such as type 2 diabetes, accelerated atherosclerosis, hypertension or polycystic ovarian syndrome (3).

What Causes Insulin Resistance?                                                    

But in order to understand how to correct insulin resistance, it’s important to understand how insulin resistance develops.  Although eating a poor diet and a lack of exercise are definitely factors in many people, the development of insulin resistance is usually more complex.  Here are some of the factors which are thought to cause or contribute to insulin resistance:

1) Inflammation.  Inflammation is one of the biggest factors associated with insulin resistance, and this is one of the primary reasons why weight loss is so challenging in those with autoimmune thyroid conditions.  The following information is going to be somewhat advanced, but then I’m going to do my best to clarify it so that you better understand it.  Activation of immune cells is closely associated with insulin sensitivity, and research shows that classically activated (M1) macrophages sustain insulin sensitivity, whereas alternatively activated (M2) macrophages induce insulin resistance through the secretion of proinflammatory cytokines (4).  Apparently in a lean state Th2 cells, regulatory T cells, natural killer cells, or eosinophils contribute to the M2 activation of macrophages, whereas obesity causes alteration of the constituent immune cells, in which Th1 cells, B cells, neutrophils, or mast cells induce M1 activation of macrophages (4).

So what exactly does this mean?  Essentially the activation of certain immune system cells will cause insulin resistance, while the activation of others will decrease insulin resistance.  One of the main takeaways is that Th1 dominant conditions are more commonly associated with insulin resistance, whereas Th2 dominant conditions involve an increase in insulin sensitivity.  Since most people with Hashimoto’s Thyroiditis are Th1 dominant, this can be another mechanism which makes it difficult for people with this condition to lose weight.  If this is the case, the main factor which will help with losing weight is to suppress the autoimmune component and decrease the inflammation, which can be very challenging, and has been discussed in other blog posts and articles.  Graves’ Disease is in most cases a Th2 dominant condition, although this doesn’t mean that people with this condition can’t develop insulin resistance.

2) Mitochondrial dysfunction.  Mitochondria are located in the cytoplasm of our cells, and they are where cellular respiration occurs.  I’ve written a separate article on Mitochondria entitled “The Relationship Between Mitochondria and Thyroid Health“, and so if you’re not familiar with mitochondria I would read this article when you get the chance.  There is evidence that dysfunction of the mitochondria can play a role in insulin resistance (5) (6) (7).  But how can damage to the mitochondria cause insulin resistance?  Well, adipocytes (fat cells) play an important role in regulating energy metabolism and glucose homeostasis, and it appears that free radicals which are caused by mitochondrial dysfunction causes impairment of the function of adipocytes in maintaining glucose homeostasis (7).  So what this is essentially saying is that the mitochondria helps to regulate glucose homeostasis in fat cells, but when there is mitochondrial dysfunction, this causes free radicals, which in turn impairs the fat cells.

As a result, if someone has insulin resistance then it probably would be a good idea to do some things to help improve the health of the mitochondria.  But how can one tell if they have mitochondrial dysfunction?  Well, this can be challenging, and one of the methods of determining problems with the mitochondria is through an organic acids test, although other testing methods which can be useful include an amino acid analysis and a carnitine analysis (8).

3) Lipotoxicity.  Lipotoxicity refers to an excess of free fatty acids in certain tissues, which can include skeletal and cardiac muscle cells, hepatocytes (liver cells), and pancreatic beta cells (9) (10).  This can be a factor in insulin resistance and metabolic syndrome, and it will typically show up as elevated triglycerides on a lipid panel.  A good example of a condition associated with lipotoxicity is nonalcoholic fatty liver disease (NAFLD), which not surprisingly is usually associated with insulin resistance.  I’ve written a separate article on NAFLD entitled “Nonalcoholic Fatty Liver Disease and Thyroid Health“.  But just as a reminder, these fatty acids can accumulate in other cells as well, and not just the liver cells.

4) Gut dysbiosis.  Accumulating evidence indicates that the gut microbiota play a significant role in the development of obesity, obesity-associated inflammation, and insulin resistance (11).  Many people with thyroid and autoimmune thyroid conditions have gut dysbiosis, which I discussed in an article I wrote entitled “Intestinal Dysbiosis and Thyroid Health“.  I’ve also spoken about PCOS in the past, which is characterized by insulin resistance.  And there is evidence that gut dysbiosis can cause activation of the immune system, thus interfering with insulin receptor function, driving up serum insulin levels (12).

5) Circadian disruption.  I’ve spoken about the circadian rhythm in the past when discussing the adrenals and cortisol.  Circadian rhythms follow a 24-hour cycle.  So for example, cortisol is normally at the highest levels when a person first wakes up, and should be at the lowest levels right before going to bed.  The opposite is true with melatonin, as this hormone should be at the lowest levels upon waking up, and at the highest levels upon going to bed.  Many hormones that modulate insulin secretion and glucose homeostasis are regulated by the circadian system, and in addition to cortisol and melatonin, this includes hormones such as leptin, glucagon, growth hormone, and the catecholamines (13).  Disruptions in the circadian rhythm can lead to an increase in body weight, elevated leptin levels, and increased insulin secretion (14) (15).  As a result, if you are having problems with sleep, you most likely have problems with the circadian rhythm, which can be a cause of insulin resistance.

6) Genetics.  Yes, genetics is also a factor in insulin resistance.  However, just as is the case with most other chronic health conditions, lifestyle and environmental factors usually trigger the genetics.  Although some people are more susceptible to developing insulin resistance due to genetic factors, the good news is that it is possible to change the expression of our genes by modifying our lifestyle and environment.

So hopefully you have a better understanding with regards to the different factors that can cause insulin resistance.  In the next post I’m going to talk about hypoglycemia.  And then at the end of the post I will discuss seven factors which can help to balance the blood sugar levels.

For those people who have normal T4 levels, but low or depressed T3 levels, a thyroid hormone conversion problem needs to be suspected.  The thyroid gland mostly produces thyroxine, which is also known as T4.  The thyroid gland also produces a small amount of triiodothyronine, which is T3.  Most of the T3 is produced by the conversion of T4 to T3.  But there are numerous factors which can affect the conversion of T4 to T3, which I’ll be discussing in this post.

Before I discuss some of the factors which can affect the conversion of T4 to T3, I’d like to briefly talk about this process.  The enzyme 5′ -deiodinase is responsible for this conversion process.  There are three forms of this enzyme, which include deodinase type I, deodinase type II, and deodinase type III.  The type 1 and type II deiodinases are primarily responsible for the conversion of T4 to T3, whereas the type III deiodinase is mainly involved in the inactivation of T4 and T3 (1) (2).  Most of this conversion takes place in the liver, although some of the conversion also takes place in the gastrointestinal tract.  As a result, if someone has liver problems and/or gut dysbiosis then this can potentially affect the conversion of T4 to T3.  A certain percentage of T4 is also converted into reverse T3, which I have spoken about in a different post entitled “Reverse T3: What You Need To Know About It“.

So why is it a concern if someone has problems converting T4 into T3?  Well, T3 is the active form of thyroid hormone.  Unfortunately not all endocrinologists test for T3, but when they do they will either test for total T3, where most of T3 is bound to a protein, or free T3, which isn’t bound to a protein.  Free T3 is what actually binds to the thyroid receptor.  If someone has normal T4 levels but low T3 levels then this is considered to be a hypothyroid condition.  Many medical doctors will only test the TSH and T4 levels, and the reason for this is because if the T3 is low then the TSH will typically be elevated, although this isn’t always the case.  I always recommend testing both the free T3 and free T4, along with the TSH.  If doing an initial thyroid panel it’s also a good idea to test the reverse T3, along with the thyroid antibodies.

Why Do Most Medical Doctors Give Synthetic T4?

When someone presents with hypothyroidism, most medical doctors will recommend a form of levothyroxine, which is synthetic T4.  A common brand is Synthroid, although there are other forms as well.  But if T3 is what actually binds to the receptor, wouldn’t it make sense to give the person T3 instead?  Well, some medical doctors will recommend synthetic T3 in the form of Cytomel.  However, many doctors are understandably cautious about doing this, as too high of a dosage can put the person into a hyperthyroid state.  Synthetic T4 will convert into T3, but of course if someone has a conversion problem then this won’t be the case.  Plus, even if someone doesn’t have a conversion problem they might do better taking a natural form of thyroid hormone such as Armour or Nature-Throid, which consists of both T4 and T3, along with T1, T2, and calcitonin.

Now that you have a better understanding of the importance of T3, I’d like to discuss the five factors which can have a negative effect on the conversion of T4 to T3.

Factor #1: Problems with the liver.  Since most of the conversion of T4 to T3 takes place in the liver, it would make sense that some health conditions affecting the liver can decrease the conversion of T4 to T3.  However, this isn’t always the case, as one study which investigated the relationships between thyroid function in obese adolescents with non-alcoholic fatty liver showed that they had a  higher conversion of T4 to T3 due to increased deiodinase activity as a compensatory mechanism for fat accumulation (3).  With that being said, if someone has problems converting T4 to T3 it usually is a good idea to give some liver support, such as milk thistle and N-acetylcysteine.

Factor # 2: Gut dysbiosis. As I mentioned earlier, the good bacteria in the gut helps to convert T4 into T3 through the help of an enzyme called intestinal sulfatase.  There isn’t much evidence in the literature showing that gut dysbiosis negatively affects the conversion of T4 to T3, but obviously if someone has dysbiosis then this should be addressed even if they aren’t having a conversion issue.  I did come across one study which showed that Crohn’s disease can affect the conversion of T4 to T3 (4).

Factor # 3: Selenium deficiency.  The iodothyronine deiodinases all contain selenium in the form of selenocysteine, and they play crucial roles in determining the circulating and intracellular levels of T3 (5).  Numerous studies show that a selenium deficiency can affect the conversion of T4 to T3 (6) (7) (8).  However, this might only be the case with a severe selenium deficiency, as one study showed that only when selenium levels were decreased by more than 80% was deiodinase activity markedly decreased (5).

Factor # 4: Stress.  Elevated cortisol levels can affect the conversion of T4 to T3.  Studies show that stress can inhibit both type I iodothyronine 5′-deiodinase activity (9), as well as type II 5′-deiodinase activity (10) (11).  This is yet another reason why it’s important to improve your stress handling skills.

Factor # 5: Certain medications.  Amiodarone is an anti-arrhythmic compound, and due to the structural similarity between this and thyroid hormone it apparently inhibits the activity of 5′-deiodinase (12).  Beta blockers are commonly taken in hyperthyroid conditions, and certain ones such as propranolol, alprenolol, atenolol, and metroprolol can affect the conversion of T4 to T3 (13).

Factor # 6: Pro-inflammatory cytokines.  There is also evidence that certain pro-inflammatory cytokines such as tumor necrosis factor alpha (TNF-alpha) and interleukin-6 (IL-6) can inhibit type 2 5′-deiodinase (5’D-I) enzyme activity (14) (15) (16).  These cytokines are commonly present in autoimmune conditions, including Hashimoto’s Thyroiditis and Graves’ Disease.

In summary, normal T4 levels along with low T3 levels frequently indicate a conversion problem.  This involves the enzyme 5′-deiodinase, and is one reason why when obtaining a thyroid panel you want to not only look at the TSH and free T4 levels, but also the free T3.  And it usually is a good idea to look at the reverse T3 as well.  Six common factors which affect the conversion of T4 to T3 include problems with the liver, gut dysbiosis, a selenium deficiency, high cortisol levels, certain medications, and pro-inflammatory cytokines.

When someone with hyperthyroidism or Graves’ Disease is following a natural treatment protocol, the goal should be to address the underlying cause of the condition.  However, while this is being accomplished it is important to manage the hyperthyroid symptoms.  While many people choose to do this with antithyroid medication such as Methimazole or PTU, or beta blockers such as Propanolol, others choose to manage their symptoms naturally.  In this post I’ll discuss some of the most common herbs used to manage the hyperthyroid symptoms.

Bugleweed. This herb has antithyroid activity, as it reduces the thyroid hormone levels, which in turn causes a decrease in the cardiac symptoms associated with hyperthyroid conditions.  Lycopus virginicus and Lycopus europaeus are the two main species.  Most of the research studies involving bugleweed which I have come across have involved lycopus europaeus (1) (2) (3).  These studies show that bugleweed is effective in mild forms of hyperthyroidism, although in my clinical experience I’ve had patients with moderate to severe forms respond to a 1:2 extract ratio.  On the other hand, for some people this isn’t potent enough, and in these cases taking antithyroid medication may be necessary to lower the thyroid hormone levels while addressing the cause of the problem.

Dosage: According to master herbalist Kerry bone, 2 to 6 mL of a 1:2 liquid extract should be used, although I have used higher doses than this on some patients.  6 to 18 mL/day of a 1:5 tincture is recommended by Kerry Bone.

Pregnancy and Lactation: According to Kerry Bone, bugleweed is associated with a substantial risk of causing harmful effects on the fetus or neonate, and he suggests that it shouldn’t be taken during pregnancy.  He also says this herb is contraindicated during breastfeeding due to the possibility of both prolactin reduction in the mother and antithyroid constituents passing into the breast milk.

Motherwort. This herb can greatly help with the cardiac symptoms of hyperthyroid conditions.  It can help to reduce the heart palpitations, decrease the heart rate, and also has antiarrhythmic activity.  While bugleweed is specifically used for hyperthyroid conditions, motherwort can be beneficial for other conditions, such as digestive disorders, bronchial asthma, amenorrhea, and even externally in wounds and skin inflammation (4).  So in addition to its effects on the heart and circulatory system, pharmacological studies have confirmed its antibacterial, antioxidant, anti-inflammatory, and analgesic activity (4) (5).  The results of one study showed that motherwort can weaken the generation of free radicals in mitochondria (5), which is one of the ways that it offers cardioprotection.  Another small study looked at the effect of motherwort in patients with arterial hypertension accompanied by anxiety and sleep disorders, and concluded that this herb may help with arterial hypertension and concurrent psycho-neurological disorders, with minimal side effects (6).

Dosage: According to Kerry Bone, 2 to 4 mL of a 1:2 liquid extract should be used, although I have used higher doses of this in some patients.  If using a 1:5 tincture then 6 to 12 mL should be used by most people.

Pregnancy and Lactation. There has been no increase in frequency of malformation or other harmful effects on the fetus from limited use in women.  However according to Kerry Bone there is evidence of increased fetal damage in animal studies, and as a result I don’t recommend motherwort during pregnancy.  Kerry Bone does mention that it is compatible with breastfeeding, and I have had some breastfeeding women take motherwort.

Lemon Balm. In past articles and blog posts I have briefly mentioned the benefits of lemon balm for people with hyperthyroidism and Graves’ disease.  However, I’m admittedly biased towards bugleweed and motherwort since I took those two herbs when I was diagnosed with Graves’ Disease, although I didn’t take lemon balm.  However, lemon balm can benefit many people with hyperthyroid conditions.  It has antithyroid activity, as it may block the binding of TSH to its receptor by acting both on the hormone and receptor itself, and might also inhibit the TSH receptor antibodies binding to the TSH receptors (7).  Lemon balm also has been used as a mild sedative, spasmolytic, and antibacterial agent, and might even have antitumoral activities (8).  I also came across a few studies which showed that lemon balm has inhibitory activity on the herpes simplex virus (9) (10).  Another study showed that lemon balm can decrease elevated liver enzymes due to its strong antioxidant properties and phenolic compounds (11).  Another study conducted on mice showed that lemon balm has anti-diabetic effects, which is probably due to enhanced glucose uptake and metabolism in the liver and adipose tissue, and the inhibition of gluconeogenesis in the liver (12).

Dosage:  Kerry Bone hasn’t listed doses for lemon balm, and so if I recommend this herb I usually will start someone on the recommended dosage provided by the manufacturer.

Pregnancy and Lactation: Even though lemon balm has some antithyroid activity, some consider lemon balm to be safe during pregnancy, while others recommend to avoid it.  It does seem to be compatible with breastfeeding, although it might produce a mild sedative effect in the baby.

Hawthorn. Although I usually recommend motherwort to help manage the cardiac symptoms associated with hyperthyroidism (elevated pulse rate and palpitations), I also will recommend hawthorn at times.  This can also be helpful in those people with cardiac arrhythmias.  Hawthorn also has anti-inflammatory, gastroprotective, free radical-scavenging, and antimicrobial activity (13).  With regards to its antimicrobial activity, hawthorn seems to be most effective against gram-positive bacteria, with no effect on Candida albicans.

Dosage: According to Kerry Bone 3 to 7 mL of a 1:2 liquid extract should be used.  If someone is taking a 1:5 ratio then 9 to 20 mL should be used.

Pregnancy and Lactation: According to Kerry Bone, hawthorn has shown no increase in the frequency of malformation or other harmful effects on the fetus from limited use in women.  Just as is the case with motherwort, I typically don’t recommend hawthorn during pregnancy.  According to Kerry Bone, hawthorn is compatible with breastfeeding.

Reminder: The Quality Of The Herb Does Make A Difference

When someone is taking one or more of these herbs and they aren’t helping to manage the symptoms, one needs to consider a few factors.  First of all, the potency of the herb is important.  For example, some people will prepare herbal teas using one or more of these herbs, which can offer some benefit, but many times won’t be potent enough to manage the hyperthyroid symptoms.  If you purchase a liquid herb then the extract ratio is important.  For example, a 1:2 ratio is more potent than a 1:5 ratio.  There aren’t a lot of companies which sell bugleweed, but most that do offer it as a 1:5 ratio.  If you are taking bugleweed as a 1:5 ratio and it’s not helping then you might need to increase the dosage, or switch to a 1:2 extract.

Speaking of dosage, I always get emails from non patients asking what specific dosage of bugleweed or motherwort they should take.  Obviously this depends on the person, as if someone has thyroid hormone levels well outside of the reference range, along with a very high pulse rate, and they’re not taking antithyroid medication, then they most likely will require higher doses of these herbs.  On the other hand, if someone has slightly elevated thyroid hormone levels and a pulse rate which isn’t too high then they most likely will require a lower dosage.

Finally, the quality of the herb does make a difference.  So for example, if you go online and purchase some motherwort to help with the elevated heart rate and palpitations, and it doesn’t seem to be helping, while there’s a chance the dosage isn’t high enough, there’s also the chance that the quality of the herb is poor.  So before coming to the conclusion that motherwort isn’t effective you might want to try a different brand.  If you have been following me for awhile you know that I recommend working with a natural healthcare professional who has experience working with hyperthyroidism and Graves’ disease, as they will have experience dealing with the proper dosing, and they should be able to recommend some good quality brands.

Where Does L-Carnitine Fit In?

L-Carnitine isn’t an herb, but I figured I’d briefly mention it here since it can help to lower thyroid hormone levels when taken in higher doses.  This also isn’t something I personally took when I was diagnosed with Graves’ Disease, but over the years many of my patients have taken this.  For more information on L-carnitine I’d recommend reading my article entitled “How Does L-carnitine Help With Hyperthyroidism and Graves’ Disease?”

In summary, while the goal of a natural treatment protocol should be to restore the health of the person with hyperthyroidism and Graves’ Disease, managing the cardiac symptoms is important.  In many people this can be accomplished with herbs, and four herbs which can play a role in managing the hyperthyroid symptoms include bugleweed, motherwort, lemon balm, and hawthorn.  Both bugleweed and lemon balm have antithyroid activity, while motherwort and hawthorn help with the cardiac symptoms.  Motherwort, lemon balm, and hawthorn also have other benefits as well.  And L-carnitine taken in higher doses also can lower thyroid hormone levels.

In my articles and blog posts I frequently talk about detoxification. It’s quite common for my patients to have followed one or more liver detoxification programs prior to speaking with me for the first time. In fact, I’m sure many people reading this have gone through at least one liver detoxification program over the last few years. And some people have gone through multiple liver detoxifications over the last year alone. However, most people who follow a liver detoxification don’t have a good understanding of the detoxification pathways. As a result, in this post I would like to share some of the basics so that you better understand the different phases of detoxification.

There are two primary phases of detoxification. In the phase one detoxification system, which is known as “biotransformation”, certain toxins are converted into intermediate metabolites which can actually be more harmful than the original compound. In the phase two detoxification system, also known as the conjugation process, these intermediate metabolites are combined with certain molecules and become less toxic and water soluble. And then of course these metabolites are excreted, which is considered as being phase three detoxification. I mentioned how in phase one these toxins can be more harmful, as these intermediate metabolites can cause damage to the proteins, DNA, and RNA if they don’t go through phase two detoxification. As a result, this can be problematic if someone has compromised phase two activity.

What Role Do Cytochromes Play In Detoxification?

Cytochrome P450 enzymes are produced by the liver, and are also found in the kidney, small intestine, lung, adrenals, and most other tissues. They are utilized in phase one. There are 58 different cytochromes, and different cytochromes will play different roles in the metabolism of toxins, which include medications. The cytochrome P450 can be inhibited or induced by certain drugs, as well as by certain nutrients (1). An inducing agent can increase the rate of another drug’s metabolism, whereas an inhibiting agent can inhibit the drug’s metabolism.

These cytochrome P450 enzymes not only play a role in detoxification, as they are also essential in the metabolism of certain nutrients. For example, the cytochrome P450 enzymes are necessary for the metabolism of vitamin D (2), as well as vitamin E (3). These cytochromes are also necessary for the metabolism of hormones such as estrogen, as the first step in the metabolism of estrogens is the hydroxylation catalyzed by cytochrome P450 (4).

Genetic Polymorphisms Can Affect Detoxification

Polymorphisms are common genetic defects, and these can occur in the Cytochrome P450 (CYP) family, which in turn can affect the detoxification process. This is especially true with regards to the phase one metabolism of drugs, since almost 80% of drugs are metabolized by these enzymes (5). For example, if someone has a polymorphism of CYP2D6 then the individual would be considered to be a “poor metabolizer” (5). And polymorphisms of other CYP genes are also common, such as CYP1A1, 2A6, A13, 2C8, 3A4, and 3A5.

But what’s the significance of these genetic polymorphisms? Simply put, having certain polymorphisms of the CYP enzymes can reduce the person’s ability to detoxify. And some of these polymorphisms have been linked to chronic health conditions. For example, many people with hyperthyroidism and Graves’ Disease will commonly be advised by their endocrinologist to take Propranolol, which is a beta blocker. The cytochrome CYP2D6 is primarily responsible for the metabolism of Propranol (6), along with some other beta blockers, such as metoprolol (7). As a result, if someone were to have a genetic polymorphism of this cytochrome then this can affect the clearance of Propranol. Why is this important? Well, someone who has a polymorphism of CYP2D6 might require a different dosage of these beta blockers when compared to someone who doesn’t have such a polymorphism. Of course most people aren’t tested for these polymorphisms, and so the medical doctor will just recommend what he or she thinks is the appropriate dosage. In the future more and more people are going to be tested for these genetic polymorphisms, which in turn will impact the drug recommendations given by medical doctors.

But even though the focus of this post is on the detoxification pathways, these polymorphisms can cause other health issues. As I mentioned earlier, people who have a polymorphism of CYP2D6 are considered to be “poor metabolizers”. Well, a few studies have linked this polymorphism with Parkinson’s disease (8) (9). This doesn’t mean that everyone with this specific polymorphism will develop Parkinson’s, although it very well might make that person more susceptible to developing this condition. There is also evidence that some of these polymorphisms can increase one’s susceptibility to cancer (10).

Although I’ve been focusing on CYP2D6, there are many other types of polymorphisms of the cytochromes one can have, as I briefly listed some of them earlier. In addition to having polymorphisms of the cytochromes, there are other polymorphisms which can affect detoxification. For example, polymorphisms of glutathione S-transferase M1 (GSTM1) can have a negative effect on detoxification. N-Acetyltransferases (NAT) are key enzymes in the conjugation of certain drugs and other xenobiotics with an arylamine structure (11), and these polymorphisms can also affect detoxification.

How Can Nutrient Deficiencies Affect Detoxification?

Having certain nutrient deficiencies can have a negative effect on detoxification. And the reason for this is because nutrients are necessary for the proper functioning of the detoxification pathways. Some of the more important nutrients required for phase one detoxification include vitamins B2, B3, B6, B12, and folate. Many reading this are familiar with glutathione, which is an important antioxidant that also plays an important role in both phase one and phase two detoxification. The amino acids glycine, taurine, glutamine, cysteine, and methionine are all important for phase two detoxification.

However, when looking back at phase one detoxification, remember that intermediary metabolites are produced, and these can lead to the formation of free radicals. As a result, it is important to have sufficient antioxidants to help neutralize these free radical reactions. This not only includes glutathione, but others such as selenium and vitamin C.

The Complexity of The Phase Two Detoxification System

As I briefly mentioned earlier, phase two involves the conjugation of the intermediate metabolite with another molecule to make it less toxic and water soluble. While this might sound easy enough, it actually can be quite complex, as there are numerous pathways required in this phase. This includes acetylation, acylation, sulfur conjugation, methylation, and glucuronic acid conjugation. I’m not going to discuss these here, but just remember that having problems with any one of these pathways can affect phase two detoxification.

But what would cause these systems to malfunction? Well, there can be numerous factors which cause this. Having a genetic defect such as an MTHFR polymorphism can cause problems. Or having a certain nutrient deficiency can also lead to big issues. For example, if someone has a vitamin B5 (pantothenic acid) deficiency then this can affect acetylation. If they have a deficiency in glycine or taurine then this can affect acylation. If they have a deficiency of vitamin A or niacin then this can affect sulfation, etc. So for example, glutathione synthesis is magnesium-dependent. There are other important nutrients and amino acids required, but if someone has a severe magnesium deficiency, yet they take something such as N-acetyl cysteine to help increase glutathione levels, they won’t be able to accomplish this if the magnesium deficiency isn’t addressed.

Thyroid Health and Detoxification

Thyroid hormones play an important role in detoxification. Either a hypothyroid or hyperthyroid state can have a negative effect on the cytochrome P450 enzymes, which you now know play an important role in phase one detoxification. For example, one study in mice showed that hypothyroidism can affect the metabolism of xenobiotics by suppressing the CYP3A enzyme, while inducing the CYP2B enzyme (12). Numerous studies also show that a thyroid imbalance can affect the cytochrome enzymes (13) (14) (15).

So what does this mean? Well, it means that having hypothyroidism or hyperthyroidism can have a negative effect on detoxification. And so while it’s beneficial for people with these conditions to do things to detoxify their body, if they have a thyroid hormone imbalance then this can reduce the ability of body to metabolize toxins. And so it is important to correct any thyroid hormone imbalance in order to achieve optimal detoxification.

So hopefully you have a better understanding of the importance of the detoxification pathways. When someone undergoes a liver detoxification, the foods and supplements they are taking should support these pathways. If someone is deficient in one of these nutrients then this will have a negative effect on detoxification. However, having certain genetic polymorphisms can also have a negative effect on the detoxification pathways. In addition, having healthy thyroid hormone levels are also important for proper functioning of the detoxification pathways.

It’s common for people who have thyroid and autoimmune thyroid conditions to have blood sugar imbalances.  Eating a large amount of carbohydrates and refined sugars is the primary factor responsible for this.  However, many people wonder about natural sugars and sweeteners, and so I decided to put together a post which discusses this, including which ones are okay to consume, which ones should be avoided, and which ones are controversial.

One thing to keep in mind as you read this information is that while some natural sweeteners are better than others, regardless of the type of sugar or sweetener, you do want to minimize your overall consumption of these.  Although there are some health benefits of certain sweeteners such as honey and maple syrup, eating large amounts can have a negative effect on one’s health.  This is true not only with the sweeteners I mention here, but even with whole foods which contain larger amounts of sugar, such as fruits.  For most people, eating a few servings of fruit per day is fine, but eating large amounts of fruit on a daily basis can cause health issues in some people.  This is especially true with those who have blood sugar imbalances and/or a yeast or bacterial overgrowth.

I’m not going to talk in detail about fructose in this post, but I wanted to briefly mention it, as when it comes to the different types of “natural” sweeteners, the high levels of fructose in some of these can be an issue.  Of course fruit has fructose, but eating a small amount of fructose won’t cause problems for most people.  On the other hand, consuming large amounts of fructose on a regular basis can impair insulin sensitivity and cause metabolic dyslipidemia (1) (2) (3).  While many people realize that high fructose corn syrup can be detrimental to their health, they might not realize that certain natural sweeteners such as agave syrup also has large amounts of fructose.  Once again, this doesn’t mean you need to completely avoid consuming fructose, but you do want to minimize your consumption of it.

With that being said, let’s go ahead and discuss some of the different forms of natural sugars and sweeteners:

Honey. There are many different health benefits of honey.   Honey consists of mainly fructose and glucose, along with 25 different oligosaccharides, and it has a glycemic index anywhere from 32 to 85 (4).   It also contains small amounts of proteins, enzymes, amino acids, minerals, trace elements, vitamins, aroma compounds and polyphenols (4).  Many studies have shown that honey is more tolerable than most common sugars or sweeteners in healthy subjects, as well as in patients with impaired glucose tolerance or diabetes mellitus (5).  Another study showed that honey caused greater elevation of insulin than sucrose, although it reduces blood lipids, homocysteine, and CRP in normal and hyperlipidemic subjects, and when compared with dextrose and sucrose caused lower elevation of the plasma glucose level in diabetics (6).  However, another study showed that while consuming honey can provide beneficial effects on body weight and blood lipids of diabetic patients, it also raises hemoglobin A1C (7).  Even though honey is high in fructose, most people with thyroid and autoimmune thyroid conditions can have a small amount of raw honey every now and then.

Maple syrup. Maple syrup, along with honey and brown sugar has shown intermediate antioxidant capacity (8).  It has many different phytochemicals, which might lead to numerous health benefits (9).  One study compared the enhancement of plasma glucose levels in type 2 diabetes by oral administration of sucrose or maple syrup, and concluded that maple syrup may have a lower glycemic index than sucrose, which may help in the prevention of type 2 diabetes (10).  Just as is the case with raw honey, many people with thyroid and autoimmune thyroid conditions do fine consuming small amounts of maple syrup every now and then.

Molasses. Molasses can also be used as a natural sweetener, as it the main byproduct of sugar production, and it is high in antioxidants (11).  In fact, one study looked at the total antioxidant content of some of the different alternatives to refined sugar, including raw cane sugar, maple syrup, agave, honey, etc., and found that dark and blackstrap molasses had the highest total antioxidant content (12).  Blackstrap molasses is also a good source of calcium (13).  Small amounts of molasses is fine for many people with thyroid and autoimmune thyroid conditions.

Agave syrup. A lot of people consider agave to be a healthier type of sweetener.  The good news is that agave syrup has a low glycemic index and might contain beneficial antioxidant nutrients, trace elements, or phytochemicals (14).  The bad news is that it is very high in fructose, and depending on the source and how it’s processed, it might actually have higher levels of fructose than high fructose corn syrup.  Consuming agave syrup can potentially lead to elevated serum triglycerides and VLDL (14).  Dr. Joseph Mercola has put together a very interesting and eye-opening article on agave syrup, and explains why you should avoid it.

Stevia. Stevia is a small perennial shrub that has been used for centuries as a bio-sweetener and for other medicinal uses such as to lower blood sugar (15).  It has no calories and is over 100-300 times sweeter than table sugar (15).  Steviol glycosides are the secondary metabolites responsible for the sweetness of stevia (16). One study on diabetic rats showed that stevia consumption not only resulted in a reduction of blood glucose, but also might ameliorate liver and kidney damage (17).  Based on another study on male rats which decreased their fertility, there is a small concern that stevia can have a negative effect on fertility (18).  However, this is yet another controversial subject, and there is no evidence that taking stevia can decrease fertility in humans.  With that being said, if someone is trying to conceive and/or is having a difficult time conceiving then it probably would be a good idea to play it safe and avoid stevia.  In addition, a recent study showed that the stevia glycosides can inhibit the growth of lactobacillus reuteri (19).  This has caused some healthcare professionals to claim that stevia is harmful to the gut flora, although more studies are definitely needed in this area before we can come to such a conclusion.  I’ve had patients with thyroid and autoimmune thyroid conditions consume small amounts of stevia while following a natural treatment protocol without it having a negative effect on their recovery.

Coconut sugar. I have had many patients ask about coconut sugar, also known as coconut palm sugar.  This is lower in fructose than some of the other sugars and sweeteners I’ve listed here.  However, the fructose content is somewhat controversial, as some sources claim that it has less than 10% fructose, while other sources claim it’s closer to 40%.  Coconut sugar does seem to be a good source of certain minerals and inulin.  While inulin can be beneficial to the gut flora, as it can help to stimulate the growth of the Bifidobacteria species (20) (21), some claim that it might cause problems with gut healing.  With that being said, I came across a study which showed that inulin-enriched pasta actually preserves intestinal mucosa barrier functioning and might be used in the prevention of gastrointestinal diseases and metabolic disorders (22).

Luo han. This comes from a Chinese plant, and is minimally processed.  One study conducted on rabbits showed that it not only improves the lipid profile by lowering total cholesterol and triglyceride levels while increasing HDL-C, but it also lowers plasma glucose levels (23).  Another study showed that Luo han can provide a positive health impact on stimulating insulin secretion (24).  Another study showed that Luo han might be beneficial as an antibacterial agent (25).  Small amounts of Luo han are probably fine to consume.

Xylitol and other sugar alcohols. Xylitol is a naturally occurring alcohol found in plants, and is a common sugar substitute.  Xylitol does seem to have some health benefits, as there is evidence it can help with otitis media (26), and also might help to prevent dental cavities by inhibiting the growth of several strains of mutans streptococci (27) (28).  Erythritol is another type of alcohol and also was found to prevent dental caries.

However, some people experience gastrointestinal discomfort and sometimes even diarrhea when consuming sugar alcohols such as xylitol.  A few studies have shown accelerated intestinal transit after xylitol ingestion (29) (30).  Since sugar alcohols are fermented by gut bacteria,  someone with a condition such as small intestinal bacterial overgrowth (SIBO) will want to avoid all sugar alcohols.  There is some concern that some sugar alcohols might cause an increase in intestinal permeability (a leaky gut), although I wasn’t able to find any studies showing this to be the case.  For those who have dogs you will want to make sure that they don’t ingest any foods which contain xylitol, as there is evidence that acute liver failure can occur when they consume xylitol (31).

Which Natural Sugars/Sweeteners Can You Safely Consume?

Now that I have discussed some of the more common natural sweeteners, I’d like to summarize which natural sugars/sweeteners most people with thyroid and autoimmune thyroid conditions can safely consume, and which ones should be avoided.  As I mentioned in this post, sweeteners such as honey, maple syrup, and molasses seem to be fine in very small amounts.  There is some controversy over stevia, although I personally think that it’s fine for most people to have small amounts of this as well.  However, if someone has problems conceiving then it might be best to avoid stevia.  I recommended to avoid sweeteners high in fructose such as agave since it has high levels of fructose.  Luo han seems to be a safe option.  Although coconut sugar is a better option when compared to certain sweeteners such as agave, it probably is best to first choose honey, maple syrup, or molasses.  Small amounts of sugar alcohols are fine for some people, but they can be problematic for someone with SIBO, and there is some concern that they can cause a leaky gut, although more research needs to be done in this area.

Keep in mind that there are some people who have problems tolerating honey and maple syrup, and if this is the case then of course it’s best to avoid these.  With regards to stevia, if you do take this I would recommend pure organic stevia, and avoid processed types.  But every now and then there will be someone who doesn’t seem to do well even with organic stevia, and thus should avoid it.

In summary, many people with thyroid and autoimmune thyroid conditions have questions about which natural sugars and sweeteners they can safely consume.  Many people with these conditions are able to consume small amounts of honey, maple syrup, and molasses.  In my opinion stevia is also okay to consume by most people, as long as it’s not processed.  Luo han is probably safe to consume in small amounts.  There is controversy over coconut sugar and the sugar alcohols.  And sweeteners high in fructose such as agave should be avoided.

In the last blog post I spoke about 5 power foods for hyperthyroidism and Graves’ Disease, and so it’s only fair that I put together a blog post where I discuss 5 power foods for hypothyroidism and Hashimoto’s Thyroiditis.  Remember that this list isn’t all-inclusive, as there are other foods which are nutrient dense that can benefit people with hypothyroid conditions.  Also, keep in mind that while I intentionally left off cruciferous vegetables because of the stigma they receive by many people with hypothyroidism due to their goitrogenic properties, many people with hypothyroid conditions can eat normal amounts of cruciferous vegetables.

Keep in mind that not everyone with hypothyroidism and Hashimoto’s Thyroiditis will be able to eat all of these “power foods”.  For example, the first power food I listed is coconut oil, and while most people do fine when eating this, if someone has a condition such as small intestinal bacterial overgrowth then they might not be able to consume coconut oil, along with other coconut products.  Obviously everyone is different, and while most people with hypothyroid conditions can eat the foods I’ve listed, there are always exceptions.  So with that being said, let’s go ahead and talk about these power foods.

Power Food #1: Coconut Oil. Because coconut oil is a saturated fat, many people still try to avoid this oil out of fear that saturated fats can cause heart disease.  Of course this isn’t proven in the latest research, and the evidence actually shows that coconut oil can lower lipid levels in serum and tissues and LDL oxidation by physiological oxidants (1).  Another study demonstrated that coconut oil has anti-inflammatory, analgesic, and antipyretic (can reduce fever) properties (2).  The anti-inflammatory properties can be especially beneficial for those with autoimmune thyroid conditions.  Coconut oil is also one of the fats you can safely cook with.

Lauric acid is the main ingredient of coconut oil that offers some wonderful benefits.  In addition to the benefits I already listed above, coconut oil also has antimicrobial properties due to lauric acid, which converts into monolaurin (3) (4) (5).  Lauric acid also has insulinotropic properties (6), which means it helps stimulate the production of insulin.  Another study showed that lauric acid present in coconut oil might protect against diabetes-induced dyslipidemia (7).

There are some sources which demonstrate that coconut oil can speed up the metabolism, and thus benefit people with hypothyroidism.  In fact, a few sources claim that coconut oil can cure hypothyroidism.  Although coconut oil might have a positive benefit on the metabolism, keep in mind that most cases of hypothyroidism have an autoimmune component, and just taking coconut oil isn’t going to address this.  But with that being said, due to some of the other health benefits I mentioned earlier, coconut oil should be consumed by most people with thyroid and autoimmune thyroid conditions.  I recommend for most people with thyroid and autoimmune thyroid conditions to consume at least one tablespoon of coconut oil per day.

Power Food #2: Avocados. Avocados are one of most nutrient dense foods, and so eating an avocado per day can help to provide many nutrients, and comes with other health benefits as well.  Current research has shown that avocado seeds may improve hypercholesterolemia, and can be useful in the treatment of hypertension, inflammatory conditions and diabetes (8). Seeds have also been found to possess insecticidal, fungicidal, and anti-microbial activities (8).  Avocado oil consists of 71% monounsaturated fatty acids (MUFA), 13% polyunsaturated fatty acids (PUFA), and 16% saturated fatty acids (SFA), which helps to promote healthy blood lipid profiles and enhance the bioavailability of fat soluble vitamins and phytochemicals from the avocado or other fruits and vegetables, naturally low in fat, which are consumed with avocados (9).  A recent study showed that avocado consumption is associated with improved overall diet quality, nutrient intake, and reduced risk of metabolic syndrome (10).  If you are unable to purchase organic avocados, the good news is that avocados are currently on the “Clean Fifteen” list of the Environmental Working Group, which means that non-organic avocados are lower in pesticides when compared to other fruits and vegetables.

Power Food #3: Bone Broth. Bone broth involves boiling the bones of animals, and it is very nutrient dense.  In addition, bone broth includes amino acids which can help to reduce inflammation and heal the gut.  This can be essential for someone who has Hashimoto’s Thyroiditis, as many people with this condition have a leaky gut.  And some researchers feel that everyone with any type of autoimmune condition has a leaky gut.  I’m not sure if this is true, but regardless of whether or not someone has a leaky gut, drinking bone broth can be beneficial.  And if someone does in fact have a leaky gut, then drinking a few cups of bone broth can help with the healing process, assuming the trigger which caused the leaky gut in the first place has been removed.

How much bone broth should someone drink on a daily basis?  If someone has received a positive test for a leaky gut then drinking at least 2 or 3 cups of bone broth daily would be a good idea.  If someone has an autoimmune condition and doesn’t know if they have a leaky gut, I would recommend drinking at least one or two cups per day, although more than this would be fine.  Of course the quality of the bone broth is important.  For example, if you are drinking beef bone broth then I would make sure the bones are from cows which were 100% grass fed.

Power Food #4: Asparagus: Asparagus possesses a variety of biological properties, as they are rich in antioxidants, plus they are anti-inflammatory, antihepatotoxic, antibacterial,  and antioxytocic (11).  Asparagus can also protect the liver cells against toxins and might even help to alleviate alcoholic hangovers (12).  This plant also contains vitamins A, B1, B2, C, E, magnesium, phosphorus, calcium, iron, and folic acid (11). Other primary chemical constituents of Asparagus are essential oils, asparagine, arginine, tyrosine, flavonoids (kaempferol, quercetin, and rutin), resin, and tannin (11).  Just as is the case with avocados, asparagus is also currently on the “Clean Fifteen” list from the Environmental Working Group.

Power Food #5: Garlic. Garlic has many different health benefits, and while some people are unable to tolerate garlic, for those who are able to eat garlic I recommend doing so on a frequent basis.  With regards to autoimmune conditions such as Hashimoto’s Thyroiditis (as well as Graves’ Disease), garlic can help to decrease proinflammatory cytokines and suppress nuclear factor kappa B (13) (14), which are both factors in autoimmune conditions.  In addition, many people are aware of the antimicrobial properties of garlic, as garlic can help to eradicate bacteria such as H. Pylori, and in some cases can even be effective against strains which are antibiotic resistant (15).  Garlic also has antifungal and antiparasitic activities (16) (17), and of course pathogens can play a role in thyroid autoimmunity.

How much garlic should you eat on a daily basis?  Well, it really does depend on the person, as if someone has a known infection then they should be eating more garlic than someone without an infection, and probably should also consider taking a garlic supplement on a daily basis.  Eating one or two cloves of garlic when having an infection would also be wise, and eating a clove of garlic per day would benefit those without an infection, as garlic can help to prevent infections as well.

So if you have a hypothyroid condition then I would consider incorporating most, if not all of these power foods.  Avocados and coconut oil are healthy types of fats, and both have anti-inflammatory properties.  Bone broth can benefit those who have a leaky gut, which is a component in many people with Hashimoto’s Thyroiditis.  And some sources claim that everyone with an autoimmune condition has a leaky gut, which would make bone broth even more important.  Asparagus has numerous properties which can be beneficial, and garlic is one of the most beneficial foods.

One of the most common questions I get asked from people with thyroid and autoimmune thyroid conditions is “what foods should I eat?”  A general answer I commonly give is to eat whole foods, minimize the refined foods and sugars, and to avoid common allergens such as gluten, dairy, corn, etc.  When it comes to choosing specific foods for thyroid and autoimmune thyroid conditions, one of the challenges is that some healthy foods can cause problems.  For example, if someone tries to avoid all foods with antinutrients such as lectins, phytic acid, saponins, and oxalates, this will greatly minimize the amount of foods they can eat.  On top of this you might decide to avoid eating eggs and the nightshades.  After doing this you will be left with a very small category of foods.

So when putting together this list, I realize that there are some foods which fall within the categories I listed above.  And I’m not suggesting that everyone should eat these foods.  For example, one of the power foods I listed below is eggs.  Eggs have a lot of good nutrients and are a pretty good source of protein.  The problem is that it’s not uncommon for people to be sensitive to eggs.  Of course it’s possible to have an allergy or sensitivity to any food, although some food allergies and sensitivities are more common than others.  The point I’m trying to make is that the “power foods” I listed below represent an excellent source of nutrients and can benefit many people with hyperthyroidism and Graves’ Disease.  However, this doesn’t mean that everyone with these conditions can eat these foods.  And of course there are other nutrient dense foods which I didn’t include on this list.  While this blog post focuses on power foods for hyperthyroidism and Graves’ Disease, for those with hypothyroidism and Hashimoto’s Thyroiditis, in the next blog post I’ll discuss some of the power foods for hypothyroid conditions.

With that being said, let’s go ahead and list five power foods that can benefit those people with hyperthyroid conditions:

Power Food #1: Kale. Kale has some wonderful health benefits.  First of all, it is very nutrient dense.  Second, it has antiproliferative effects (1), and so it can help with the prevention of cancer.  There is also evidence that it can favorably influence serum lipid profiles and thus reduce the risk of coronary heart disease (2).  As for whether you should eat kale raw, or if you should cook it, one study showed that the cooking process of kale resulted in lowering of the activity of its antioxidants (3).  However, you still will get many of the benefits of kale if you lightly steam it.  As for how kale can specifically benefit people with hyperthyroidism, kale is considered to be goitrogenic, which means that when consumed in larger amounts it can potentially inhibit thyroid function.  Cooking might reduce the goitrogenic activity, and if you have hyperthyroidism or Graves’ Disease feel free to eat a few servings of raw kale per day.  Bone density is an issue with hyperthyroidism, and kale is one of the best sources of calcium, and unlike spinach it exhibits excellent absorbability for its calcium (4).

Power Food #2: Organ Meats. Although I still can’t get over the “mental barrier” which has prevented me from eating organ meats, this category of food is very nutrient dense.  And while eating nutrient dense foods is important for everyone, one can argue that it is even more important for someone who is dealing with hyperthyroidism.  One of the biggest problems many people with hyperthyroid conditions have is losing a large amount of weight.  This of course is due to the increased metabolic rate caused by the elevated thyroid hormone levels.  And while it is important to normalize the thyroid hormone levels, while one is trying to accomplish this it is important to eat nutrient dense foods.

In addition, Coenzyme Q10 (CoQ10) is high in organs with high rates of metabolism such as the heart, kidney, and liver (5).  And numerous studies show that CoQ10 is low in people with hyperthyroid conditions (6) (7).  Although one can of course supplement with CoQ10, since organ meats have high amounts of this then this presents another option.

Power Food #3: Eggs. As I mentioned earlier, eggs are a common allergen.  As a result, not everyone is able to eat eggs.  However, even if someone doesn’t have an egg allergy, the egg whites have certain compounds which can cause problems in those people with autoimmune thyroid conditions, as well as those with other types of autoimmune conditions.  On the other hand, although I do have most of my patients initially avoid eggs, I’m not opposed to some people reintroducing eggs.  And this is especially true with those people who have hyperthyroid conditions, as many people with hyperthyroidism have a voracious appetite and are struggling to gain weight.  I know this described myself when I was diagnosed with Graves’ Disease.  Eggs are another nutrient dense food, and if someone doesn’t have an egg allergy it might be fine for them to eat egg yolks without much of a problem.

Some people are concerned that eating eggs will increase their cholesterol levels, even though research clearly shows that this isn’t the case (8) (9) (10).  In fact, one study showed that people who reported eating four or more eggs per week actually had a lower serum cholesterol concentration when compared with those who ate one egg or less per week (8).  In those with metabolic syndrome, eating eggs (including the yolks) improves lipoprotein profiles and insulin sensitivity (11).  Ideally you want to eat organic, pasture-raised eggs.

Power Food #4: Almonds. Almonds are rich in monounsaturated fat, fiber, α-tocopherol, minerals such as magnesium and copper, and phytonutrients (12).  Other cardioprotective nutrients unique to almonds include arginine, manganese, calcium, and potassium (13).  One study showed that incorporation of almonds into a healthy diet could ameliorate inflammation and oxidative stress in patients with type 2 diabetes mellitus (14).  There is also evidence that almond and almond skin ingestion may lead to an improvement in the intestinal microbiota profile and a modification of the intestinal bacterial activities (15).  One potential problem with almonds, as well as other nuts and seeds, is that it has antinutrients such as lectins and phytic acid.  As a result, you don’t want to eat large amounts of almonds, and if someone has a leaky gut then it probably would be best to avoid eating almonds while repairing the gut.  Because some researchers speculate that everyone with an autoimmune condition has a leaky gut, almonds are excluded from most autoimmune paleo diets, which means that those people with Graves’ Disease who are following this diet would want to avoid eating almonds.

Power Food #5: Berries. Consuming different types of berries can be beneficial to one’s health.  This includes blueberries, raspberries, blackberries, strawberries, and cranberries.  All berries have different phytonutrients, and the phenolic compounds are responsible for their antioxidant properties (16) (17).  In addition, numerous studies have shown berries of different kinds to have anti-inflammatory properties, and can potentially modulate inflammatory cytokines which are found in different types of autoimmune conditions (18) (19) (20) (21) (22).  Berries are typically high in oxalates, and so you want to be cautious about eating too many of these.  Growing up I never was much of a berry eater, as I frequently ate a lot of apples, grapes, and bananas.  But I currently have a smoothie on a daily basis, and I’ll always include some organic berries, as I usually rotate between blueberries, blackberries, raspberries, and strawberries.

So these are some of the “power foods” which can benefit people with hyperthyroidism and Graves’ Disease.  Of course there are other foods I didn’t include on this list which are also nutrient dense.  For example, while kale is without question a “power food”, so are other cruciferous vegetables such as broccoli and cabbage.  And although organ meats are very nutrient dense, other types of meat are nutrient dense.  For those people with hypothyroidism and Hashimoto’s Thyroiditis, in the next blog post I’ll discuss power foods which can be beneficial for people with these conditions.

Many people with hypothyroidism and Hashimoto’s Thyroiditis take thyroid hormone medication, and every now and then I’ll get asked if there is a natural substitute for thyroid hormone.  I deal with both hyperthyroid and hypothyroid conditions, and with hyperthyroid conditions there are some pretty good natural alternatives for the medication.  For example, bugleweed is an herb which has antithyroid activity, and many people choose to take this instead of antithyroid medication.  And motherwort can be used instead of beta blockers in some people with hyperthyroidism.  But are there nutritional supplements or herbs which can effectively manage the hypothyroid symptoms while someone is trying to restore their health back to normal?

Most people with hypothyroid conditions are aware that there are natural alternatives to synthetic thyroid hormone, such as Armour and Nature-Throid.  But while many people do better on natural thyroid hormone, this is still a form of hormone replacement therapy.  In other words, natural thyroid hormone isn’t doing anything for the actual cause of the condition.  Then again, neither is the bugleweed or motherwort many people with hyperthyroid conditions take, as I recommend these to manage the hyperthyroid symptoms while trying to address the cause of the condition.  Even so, some people prefer to take supplements and herbs, and would like to avoid taking hormones whenever possible.

Are There Supplements And Herbs To Take Instead of Thyroid Hormone Medication?

If someone has depressed thyroid hormone levels then unfortunately there are no nutritional supplements or herbs which will replace thyroid hormone.  And this is the case with any hormone deficiency.  However, there are nutrients and herbs which can help to increase the output of thyroid hormone, and in some cases these can be taken while the cause of the condition is being addressed.  So what I’d like to do is talk about some of these nutrients and herbs which might be beneficial in some cases of hypothyroidism.

Iodine. Yes, I’m starting with the controversial iodine.  I’m definitely not suggesting that iodine can be taken instead of thyroid hormone medication, and  I realize that many people with Hashimoto’s Thyroiditis don’t do well when taking iodine.  However, iodine is necessary for the formation of thyroid hormone, as thyroxine (T4) consists of four iodine atoms, while triiodothyronine (T3) consists of three iodine atoms.  Although an iodine deficiency can cause hypothyroidism, most cases of hypothyroidism are caused by Hashimoto’s Thyroiditis.  With that being said, if someone has a non-autoimmune hypothyroid condition and tests positive for a moderate to severe iodine deficiency, then it probably would be a good idea to correct this deficiency.  If someone with Hashimoto’s tests positive for an iodine deficiency then eventually this should be corrected, although other factors may need to be addressed first in order to make sure the person doesn’t have a negative reaction to iodine.

Tyrosine. This is an amino acid, and like iodine, this is also necessary for the formation of thyroid hormone.  As a result, many thyroid support formulas will include tyrosine.  However, very rarely is a tyrosine deficiency the primary cause of hypothyroidism.  And so while supplementing with tyrosine usually won’t cause any problems, it also is unlikely to make much of a difference with regards to thyroid hormone output.

Selenium. This mineral is important for the conversion of T4 to T3.  As a result, if someone has normal levels of T4 but low levels of T3, they very well might have a selenium deficiency.  However, there are other factors which can also interfere with the conversion of T4 to T3, such as high cortisol levels.  Some studies have shown that selenium can help to reduce thyroid antibodies, and while this isn’t always the case, when it does help to lower these antibodies this will minimize the amount of thyroid gland damage, which in turn can help with the output of thyroid hormone.

Iron. Iron is another mineral which is essential for normal thyroid hormone metabolism, and a deficiency of this mineral impairs thyroid hormone synthesis by reducing the activity of heme-dependent thyroid peroxidase (1).  Iron deficiency anemia is very common, and while this might not be the cause of most cases of hypothyroidism, if someone has an iron deficiency I think it’s safe to say that it’s not helping with the thyroid condition.  And so I recommend for most of my patients to not only get a complete blood count, but also an iron panel which includes serum iron, ferritin, iron saturation, and TIBC.

Zinc. Studies show a significant correlation between serum zinc levels and thyroid volume, along with thyroid antibodies and free T3 levels (2) (3).  Once again, taking zinc alone probably won’t make much of a difference in someone with hypothyroidism, although if someone is deficient in zinc it could be a contributing factor.

Ashwagandha. There are a few studies which show that ashwagandha can stimulate thyroid hormone production (4) (5).  In fact, one of these was a case study which showed that taking ashwagandha caused thyrotoxicosis in a 32-year old woman.  However, I’ve given ashwagandha to numerous patients with hyperthyroid conditions without a problem, as it doesn’t seem to directly affect the thyroid gland, but instead affects the hypothalamic-pituitary-thyroid (HPT) axis.  It also affects the hypothalamic-pituitary-adrenal (HPA) axis, which can in turn modulate cortisol levels.  Ashwagandha is commonly given to lower elevated levels of cortisol, but in most cases it can also be safely taken with those who have depressed cortisol levels.  Anyway, some people with low or depressed thyroid hormone levels might benefit from taking ashwagandha.

Coleus. Coleus (Coleus forskohlii) is a member of the Lamiaceae or Mint family.  While it can help with numerous conditions such as cardiovascular disorders, abdominal pain, and constipation, it also is commonly used for hypothyroidism, as it can potentially stimulate thyroid hormone production.

Thytrophin PMG. Some think of this as a glandular, although it’s actually referred to as a protomorphogen.  I have been using this in my practice for many years.  This product doesn’t contain any thyroid hormone.  In fact, many people with Graves’ Disease are able to take this, as its main purpose is to help neutralize the effects of the thyroid antibodies.  Thytrophin PMG isn’t meant to be a replacement for thyroid hormone medication, although every now and then I’ll receive an email from someone who is taking this instead of synthetic or natural thyroid hormone.

Thyroid glandulars. There are numerous types of thyroid glandulars, some of which don’t have thyroid hormone, and other products which do include thyroid hormone.  Obviously if someone is looking to completely avoid taking any type of thyroid hormone then they probably will also want to avoid taking thyroid glandulars which have thyroid hormone.  On the other hand, since these usually have a smaller amount of thyroid hormone, along with some of the nutrients and herbs I listed above, many are willing to take a thyroid glandular instead of levothyroxine, Armour, or Nature-Throid.

So these are some of the supplements and herbs which might benefit people who are looking to avoid taking thyroid hormone medication.  Unfortunately there is no natural substitute that can be taken in place of thyroid hormone, and having sufficient levels of thyroid hormone is very important.  While some people might do fine taking some of the nutrients and/or herbs I discussed in place of thyroid hormone, most people with overt hypothyroidism will need to be on some type of thyroid hormone medication, although they might be fine taking a thyroid glandular which has a small amount of thyroid hormone, along with other nutrients and herbs to support the thyroid gland.

I think it’s safe to say that we’re in a “smoothie era”, as millions of people consume smoothies on a daily basis.  There are a number of positive benefits of consuming green smoothies.  I personally have a green smoothie every morning for breakfast, and many of my patients do the same.  But while there are some great health benefits of drinking green smoothies on a daily basis, there are also some potential downsides of drinking these.

Before I discuss some of the potential “risks” of drinking green smoothies on a daily basis, I’d like to briefly mention a few of the primary benefits of green smoothies:

Benefit #1: Green smoothies can make it easier to start the day with a few servings of vegetables.  I look at the food diaries of patients all of the time, and to no surprise, most people don’t eat enough vegetables on a daily basis.  And most people who eat a few servings of vegetables per day don’t eat any during breakfast, but instead eat them during lunch and/or dinner.  Obviously this doesn’t apply to everyone, but it does apply to most people. It definitely applied to me growing up, as for the first few decades of my life I usually had a bowl of sugary cereal with cow’s milk for breakfast.

Benefit #2: Smoothies offer “instant hydration”, as they allow you to start the day off with a couple of cups of water.   To be fair, many people don’t add water to their smoothies, but instead add something else such as cow’s milk, almond milk, coconut milk, etc.  But many people don’t drink enough water, and so I would encourage you to at least add one cup of water to your smoothie.  For example, if you currently add two cups of coconut milk to your smoothies, try adding only one cup of coconut milk and one cup of purified water.  On most days I personally add 1/4 cup of organic almond milk to my smoothies, and 1 3/4 cups of purified water.

Benefit #3: You of course can include other healthy ingredients to your smoothies.  In addition to green leafy vegetables you can add carrots, avocados, and berries.  Many people can also add raw egg yolks and/or coconut oil to their smoothies.  Some people add a type of protein powder to their smoothie, which usually is fine, but just remember that these powders shouldn’t take the place of whole healthy foods.  I know some people have smoothies which consist of almond or coconut milk, strawberries and bananas, some type of protein powder, and nothing else.  While this is healthier than the bowl of sugary cereal I mentioned earlier, you should also add some vegetables and a healthy type of fat such as an avocado or coconut oil.  I can understand not wanting to add a raw egg yolk, although when combined with the other ingredients I mentioned, most people won’t even taste the raw eggs.  But besides the fact that some people find adding a raw egg to be disgusting, if someone is following a strict autoimmune paleo diet then they probably won’t be adding eggs to their smoothies.

So these are some of the health benefits of drinking smoothies.  But there are also some potential risks of drinking smoothies:

Risk #1: Green smoothies are typically goitrogenic. This of course depends on which green vegetables are added to the smoothie, but two of the most common green leafy vegetables added to smoothies are kale and spinach.  And while both of these have healthy nutrients, eating large amounts of raw kale and spinach can potentially inhibit thyroid activity.  Although there might be some risks with those people who have a hypothyroid condition with regards to eating large amounts of raw goitrogenic vegetables, adding 1/2 cup to one cup of these vegetables to a daily smoothie usually won’t cause a problem with most people, even those with hypothyroidism and Hashimoto’s Thyroiditis.  On the other hand, adding a few cups of raw goitrogenic vegetables to your smoothies and having one or two of these on a daily basis might cause problems in some people with hypothyroid conditions.  I spoke about goitrogens in greater detail in an article I wrote entitled “An Update On Goitrogenic Foods and Their Impact on Thyroid Health“.

Risk #2: Green smoothies can be high in oxalates. Oxalates are substances which bind to calcium, and this interferes with its absorption.  Eating foods high in oxalates can therefore lead to a decrease in bone density.  Another risk is that large amounts of oxalates can cause kidney stone formation.  I actually spoke about this in a post entitled “Should Spinach Be Avoided In Those With Thyroid Conditions?“, as I discussed the risk of loading smoothies with foods high in oxalates, such as spinach and swiss chard.  But it’s not just green leafy vegetables which are high in oxalates, as blackberries, blueberries, and raspberries are also high in oxalates, and of course many people add berries to their smoothies.  Once again, I’m not suggesting that people shouldn’t add berries to their smoothies, or other foods high in oxalates.  But it might be a good idea to minimize the amount of these foods you add to your smoothies.

Risk #3: Smoothies prepared the wrong way can spike up your blood sugar levels. Although I do think it’s fine to add some fruit to your smoothies, some people add too much fruit.  Bananas are one of the most commonly added fruits to smoothies, and while many people do fine adding a small banana to their smoothie, some people will add a few bananas, along with a few servings of other fruits to their smoothies.  This can especially be problematic for someone who has blood sugar imbalances, or an underlying yeast infection.  It’s not uncommon for people to prefer fruit over vegetables, and this definitely describes me.  When I first began making smoothies I probably added too much fruit, but I currently add 1/4 cup of organic berries to my smoothies and in my opinion it tastes fine.  Adding a healthy source of protein or fat will minimize the impact that the fructose will have on your blood sugar levels.  I would recommend adding an avocado, one tablespoon of coconut oil, and/or one or two raw egg yolks.

Risk #4: Some people include unhealthy ingredients in their smoothies. Although I’m fine with most people adding some type of “healthier” protein powder to their smoothie, doing so isn’t required.  And even if you do add a small amount of protein powder, you want your smoothie to consist primarily of whole foods.  Add a small amount of fruit, a few servings of vegetables, a healthy type of fat, etc.  But if you do add a protein powder you want to make sure it’s of good quality, and you also want to carefully read the ingredients and make sure it doesn’t include any artificial colorings or flavorings, as well as other unhealthy ingredients.

So What’s The Final Verdict?

I think most people with thyroid and autoimmune thyroid conditions can have green smoothies without a problem.  Just like anything else, the key is having a “balanced” smoothie.  Some people add too much fruit, while others add excessive amounts of green leafy vegetables.  But most people will do fine adding a small amount of fruit, while adding a few servings of vegetables, making sure to add a variety of different vegetables (i.e. 1/2 cup of arugula, 1/2 cup carrots, 1/2 cup broccoli, etc.).

Some healthcare professionals are opposed to smoothies because they feel it’s better to eat your food rather than drink your food.  In other words, rather than consume some or all of these ingredients in the form of a smoothie, they would recommend to simply have one or two eggs for breakfast, a few servings of vegetables, a serving of berries, a healthy type of fat, some meat, etc.  I can’t argue with this, as I admit that it’s better to sit down and eat a meal rather than drink a smoothie.  However, we live in an “era of convenience”, and whereas most people aren’t going to take the time to individually prepare all of these foods, many people are willing to add them to a smoothie.  Of course it can also be time consuming to make a smoothie, as I know it takes me awhile to make my morning smoothie.  In any case, for those people who are preparing a healthy breakfast I’m not suggesting to replace it with a smoothie.  On the other hand, for those people who aren’t eating a healthy breakfast and/or aren’t consuming a sufficient amount of vegetables each day, then having a daily green smoothie might be a good idea.

Something else to keep in mind is that even if you have a morning smoothie, you obviously still want to eat vegetables throughout the day.  I recommend eating a combination of raw and cooked vegetables.  Some healthcare professionals don’t recommend any raw veggies, but I think having a few servings of these are fine, along with having a few servings of cooked vegetables.  But there are some people who will overdo it with the raw vegetables, as they might have a green smoothie for breakfast, a big salad for lunch, another smoothie as an afternoon snack, and another salad for dinner.  I’m not opposed to people having salads, but they also should try adding in a few servings of steamed veggies each day.

In summary, millions of people consume green smoothies on a daily basis, and there are both benefits and risks of drinking these.  Some of the primary benefits of green smoothies are that they allow you to add some extra vegetables, along with some purified water, and other healthy ingredients, such as healthy fats and protein.  However, green smoothies are usually goitrogenic, can be high in oxalates, and might spike up the blood sugar levels.  You of course want to make sure not to add unhealthy ingredients, which can easily be avoided by sticking with whole foods, and organic foods whenever possible.  Overall I think green smoothies are fine for most people with thyroid and autoimmune thyroid conditions to drink on a daily basis, but you want to make sure not to load it up with too much of a single ingredient, such as green leafy vegetables, fruit, protein powder, etc.