Nuts and seeds are my favorite snack. I love eating cashews, almonds, walnuts, pistachios, sunflower seeds, pumpkin seeds, as well as other nuts and seeds. However, nuts and seeds are excluded from an autoimmune Paleo (AIP) diet. But why is this the case? In this blog post I’ll discuss why nuts and seeds are excluded from an AIP diet, and when you can safely reintroduce them back into your diet.
In a blog post I wrote in 2014 entitled “Can Eating Nuts and Seeds Be Detrimental To Thyroid Health?“, I discussed the health benefits of many of the different nuts and seeds. As a result, I don’t plan on discussing this here, as if you’re interested in learning about the health benefits of the different nuts and seeds you can simply refer to this past article. In this current article I want to focus more on why nuts and seeds are excluded from an autoimmune Paleo diet, and whether they SHOULD be excluded.
The Problem With Eating TOO MANY Nuts And Seeds
There is no question that nuts and seeds have some good health benefits, which is why they are part of a standard Paleo diet. However, you do want to be cautious about eating too many nuts and seeds due to the following five reasons:
1. Nuts and seeds are high in omega 6 fatty acids. Although omega 6 fatty acids get a bad rap, it’s normal to have a higher ratio of omega 6 to omega 3 fatty acids. The problem is that in most people the ratio is way too high. In most cases this isn’t due to eating too many nuts and seeds, but instead is due to eating too many processed foods, including fast food, unhealthy oils, etc. However, eating a lot of nuts and seeds can increase this ratio. On the other hand, if someone is eating a relatively healthy diet and has an omega 3 index greater than 8%, then eating a few ounces of nuts per day shouldn’t cause a problem in this area.
So based on what I just said, if you haven’t recently tested your omega-3 index then you might want to consider doing so. Or you might even want to take this a step further and get a complete fatty acid profile. This not only will look at the omega 3 index, but it will evaluate other markers such as the ratio of arachidonic acid to eicosapentaenoic acid (EPA), the total omega-3 fatty acids, and the total omega-6 fatty acids.
2. Nuts and seeds are higher in lectins when compared to many other foods. This supposedly is one of the main reasons why nuts and seeds are excluded from an autoimmune Paleo diet. Lectins are compounds that are present in a variety of plants and seeds, and they serve as a defense mechanism. They are considered to be a type of anti-nutrient, and besides most lectins being resistant to heat and digestive enzymes, they can bind to different cells and potentially cause damage to numerous organs (1). There is also a concern about lectins causing an increase in intestinal permeability (a leaky gut).
However, lectins are found in many foods, and so their presence alone doesn’t mean that you should avoid a certain food. Not all foods have an equal amount of lectins, which is one reason why foods with higher amounts of lectins are excluded from a standard Paleo diet (i.e. legumes), while others such as nuts are allowed. Finally, there is no evidence I’m aware of which shows that eating nuts and seeds will cause an increase an intestinal permeability.
If this is the case, then why are nuts and seeds excluded from an autoimmune Paleo diet? To be honest I’m not 100% certain why, but one potential reason why nuts and seeds are allowed on a standard Paleo diet, but are excluded from an autoimmune Paleo diet, is that they can interfere with gut healing. In other words, while there is no evidence I’m aware of that eating nuts and seeds can cause a leaky gut, eating nuts and seeds might prevent an existing leaky gut from healing. And according to the triad of autoimmunity, everyone with Graves’ Disease and Hashimoto’s has a leaky gut.
But this might also depend on 1) the quantity of nuts and seeds eaten, and 2) how they are prepared. If someone with a leaky gut eats a large amount of raw nuts and seeds on a frequent basis then this will make it more difficult for their gut to heal when compared to someone who eats a small amount of nuts and seeds per day and also soaks and sprouts them. The problem is that many people eat too many nuts and seeds, and most people who eat them don’t properly prepare them. One can make the same argument with other foods, such as legumes.
3. Nuts and seeds are high in phytic acid. Phytic acid is the major storage form of phosphorous in cereals, legumes, seeds and nuts (2). One of the main concerns with phytic acid is that it can inhibit the absorption of certain minerals such as iron, zinc, and calcium. And there is also a concern that large amounts of phytic acid can be a factor in a leaky gut. However, if someone eats a small amount of nuts and seeds, while minimizing or avoiding other higher sources of phytic acid, such as grains, then they still might be able to heal the gut. Of course the key word is “might”, as everyone is different, and some people are able to get away with eating small amounts of nuts and seeds, while others will need to completely eliminate them.
It’s also important to note that soaking and sprouting nuts and seeds will dramatically reduce the levels of phytate (3). So once again, properly preparing nuts and seeds can make them much easier to digest, and reduce both the lectins and phytates, along with other compounds. One more thing I should mention is that phytic acid does seem to have some health benefits, as some studies show that it can have immunoregulatory effects and decrease proinflammatory cytokines (4).
4. Tree nuts are common allergens. Although many people are aware that peanuts are a common allergen, many people also have tree nut allergies. I came across a study which showed that walnuts and cashews are the most allergenic tree nuts in the United States, whereas hazelnut is the most common nut allergy in Europe, and Brazil nuts, almonds and walnuts are the most common tree nut allergies in the United Kingdom (5). Speaking of peanuts, they are considered to be a legume, which is why they are excluded from both an AIP and standard Paleo diet. This is also the reason why when a patient of mine asks if they can reintroduce peanut butter back into their diet I try to direct them towards other types of nut butters, such as almond butter.
5. Nuts and seeds are high in oxalates. Oxalates are small molecules that have the ability to form crystals, which in turn can deposit in different areas of the body, including the thyroid gland. One of the main concerns is that having high levels of oxalates can lead to the development of kidney stones. While having problems with oxalate metabolism and/or having a yeast overgrowth can lead to high oxalates, certain foods can also cause high oxalate levels. And unfortunately this includes nuts such as almonds, cashews, and walnuts. This is yet another reason to be cautious about eating large amounts of nuts on a daily basis. As for seeds, their oxalate content is high when compared to many other foods, although lower than nuts. This not only includes common seeds such as sunflower seeds, but chia seeds as well.
I think it’s also worth mentioning that there have been a couple of case reports showing a correlation between oxalate nephropathy and nuts (6) (7). One of these involved cashews, and the other peanuts, which as I mentioned earlier, is actually a legume and not a nut. An oxalate nephropathy is characterized by extensive calcium oxalate deposition in the renal tubules, resulting in kidney injury (8). Fortunately this condition is rare, and so I’m not suggesting that eating a lot of nuts is likely to result in kidney problems, but if someone does have kidney issues and eats a lot of high oxalate foods then this can be a potential cause to consider.
What’s The Deal With Nut Milks and Nut Butters?
When someone first realizes that nuts and seeds are excluded from an autoimmune Paleo diet, it’s quite common for them to ask me if they can eat nut and seed butters (i.e. almond butter, sunflower seed butter, etc.), as well as nut milks (i.e. almond milk, cashew milk, etc.). If you are trying to follow a strict autoimmune Paleo diet, then in addition to not eating nuts and seeds, you will also want to avoid all nut milks and nut butters. After all, nut milks and butters that you purchase at a local store or online will usually consist of raw nuts, and thus will be high in phytic acid and lectins. On the other hand, if you make your own nut milks and nut butters then of course you have the option of soaking and sprouting the nuts first. Another advantage of making your own nut milks and nut butters is that you don’t have to worry about some ingredients that are commonly included in these products sold in stores.
Can You Eat Soaked and Sprouted Nuts and Seeds?
For those who aren’t familiar with the process of soaking and sprouting nuts and seeds you can check out this article. But one question you still might have is whether you can eat soaked and sprouted nuts and seeds when following an autoimmune Paleo diet. After all, I mentioned earlier how soaking and sprouting nuts and seeds will greatly help to reduce the lectins and phytates. Although this is true, I still recommend following a strict autoimmune Paleo diet for at least 30 days, which means eliminating the nuts and seeds during this time. If you are struggling with the diet after this time then I think it’s fine to reintroduce some of the foods you eliminated, include nuts and seeds.
A Brief Explanation of Soaking and Sprouting
Although I realize that some people reading this are already familiar with soaking and sprouting, I’m sure there are others that aren’t familiar with this, and so I’ll give a brief explanation of these below. I’ll admit that I’m not an expert in this area, and so if you want to learn more about soaking and sprouting there are books and free videos on YouTube where you can learn to do this. But just as is the case with anything else, the key to becoming an expert is to actually start doing it!
Soaking. This is quite simple, as you can put your nuts and seeds in a glass jar with water, and add a small amount of sea salt. When first starting out you might want to begin with a small amount of nuts (i.e. one cup), but once you get into the routine of doing this you’ll probably want to make larger batches at a time. As for how long you should soak the nuts and seeds, the times vary depending on what you’re soaking. I’d refer to the article I mentioned above, which lists the different soaking times for different nuts and seeds.
Note: If you want to make the nuts and seeds crunchy after soaking you can put them in a dehydrator for 12 to 24 hours. If you don’t have a dehydrator you can use your oven, but make sure the temperature doesn’t exceed 115 degrees.
Sprouting. This takes more time, although this essentially just involves soaking the nuts and seeds for longer periods of time, and then rinsing them with water every few hours, or at the very least two or three times per day. Then within a few days they will germinate and sprout, which further enhances their digestibility and makes them more nutrient dense. One concern is that mold can form on the nuts and seeds during this process, and to reduce the chances of this happening you want to keep the nuts and seeds refrigerated after sprouting, and dehydrating them will also help to prevent this. It’s also important to know that not all nuts and seeds can be sprouted. For example, some of the nuts which can be soaked but not sprouted include walnuts, pecans, Brazil nuts, and macadamian nuts. Pumpkin seeds and sunflower seeds can be soaked and sprouted.
When Can You Reintroduce Nuts and Seeds?
If you choose to follow a strict autoimmune Paleo diet and therefore eliminate nuts and seeds from your diet, when are you able to reintroduce them? As I mentioned earlier, for those with Graves’ Disease and Hashimoto’s Thyroiditis, I would recommend to eliminate nuts and seeds from your diet for at least 30 days. After this point if you are doing well on the diet then it makes sense to continue for a little longer. On the other hand, if you are struggling with the diet then you can try to reintroduce certain foods.
But you might still wonder when you can specifically reintroduce nuts and seeds back into your diet? This really does depend on the person. Sarah Ballantyne is an expert when it comes to the autoimmune Paleo diet, and she has a 4-stage approach to reintroducing foods, which depends on the how most people react to certain foods, and which foods are the most nutrient dense. In other words, those foods that people are more likely to have a negative reaction to will be reintroduced towards the end, but she also considers the nutrient density of these foods. Although she does allow seed and nut oils (i.e. macadamia oil) to be reintroduced in stage #1, she doesn’t recommend for whole nuts and seeds to be reintroduced until stage #2. And certain nuts such as cashews and pistachios shouldn’t be reintroduced until stage #3 according to her reintroduction plan. I can’t say that I agree 100% with these recommendations, but it’s definitely worth checking out. Click here to gain access her to free reintroduction quick start guide.
Should You Consider Food Sensitivity Testing For Nuts and Seeds?
Every now and then someone will ask if they should do food sensitivity testing for nuts and seeds instead of eliminating them. This way they can see if they are reacting to the nuts and seeds, and if this is the case then they can simply eliminate them from their diet. And if the test shows they aren’t sensitive to them then they can continue eating them. Although I’m not opposed to food sensitivity testing, there are limitations to this approach. First of all, food sensitivity testing isn’t perfect, as false negatives are common. So it’s possible for you to test negative for certain nuts and seeds, yet still be positive.
But let’s assume that you do such testing and everything comes out negative, and it’s a “true” negative. Just because you don’t have an allergy or sensitivity to nuts and seeds doesn’t mean that they can’t interfere with gut healing. This is also a limitation of an elimination diet, as someone might feel fine when reintroducing a certain food, but just because they don’t have a negative reaction doesn’t mean that it isn’t interfering with gut healing.
The Final Verdict On Nuts, Seeds, and A Leaky Gut
Many people with Graves’ Disease and Hashimoto’s Thyroiditis are able to successfully reintroduce nuts and seeds back into their diet prior to getting into remission. However, this doesn’t describe everyone, and when you do choose to reintroduce nuts and seeds I would make sure to do so one at a time. For example, you can start by reintroducing sunflower seeds, and then wait three days before adding another seed or nut. If you have any type of negative reaction then stop eating the specific nut or seed, and then wait until your symptoms subside before reintroducing the next one.
Also, while I can’t honestly tell you that I always soak and sprout nuts and seeds before eating them, this can make a big difference in some people. In fact, when I was dealing with Graves’ Disease initially I didn’t eliminate nuts and seeds from my diet, and while overall I was progressing nicely, I eventually hit a roadblock and ended up eliminating nuts and seeds. However, I was eating raw nuts and seeds at the time, and so perhaps I wouldn’t have had any problems if I prepared them properly. Once again, I do recommend for those with autoimmune thyroid conditions to avoid eating nuts and seeds for at least the first month, but when reintroducing them I would strongly suggest soaking and sprouting them.
But how about if you reintroduce raw nuts and seeds and don’t experience any negative symptoms? Does this mean it’s fine to continue to eat them? This is where it can get tricky, as I described my situation where I was eating raw nuts and seeds initially when dealing with Graves’ Disease. I personally didn’t experience any adverse symptoms, but the secretory IgA that was initially depressed remained depressed upon retesting, and didn’t decrease until I stopped eating nuts and seeds. The point I’m trying to make here is that eating raw nuts and seeds might interfere with gut healing in some people, although you might not experience any negative symptoms when you eat these foods. Instead you might hit a roadblock like I did.
And if you’re questioning whether my lack of progress was truly caused by eating nuts and seeds, I agree that there is a chance that there could have been another factor which resulted in the secretory IgA not increasing. However, I’ll add that in the past I did a good amount of leaky gut testing on my patients using the Array #2 from Cyrex Labs, and there were some patients whose gut didn’t heal until they eliminated nuts and seeds. On the other hand, there were also people whose leaky gut healed even though they continued to eat nuts and seeds. And while it admittedly can be challenging to make a correlation between someone eating nuts and their gut not healing, it’s still something to keep in mind.
While the focus here is on nuts and seeds, this can also apply to other excluded foods, including eggs, nightshades, and even grains and legumes. In other words, even if you don’t experience negative symptoms when eating these foods, there is always the possibility that they are interfering with gut healing. And so if you are following more of a standard Paleo diet and your test results aren’t improving, there is the chance that it’s due to one or more foods that you are eating. Sure, there can be other factors as well, but before spending a lot of money on additional testing, it makes sense to experiment with eliminating certain foods that can potentially interfere with gut healing.
Should YOU Eat Nuts and Seeds?
If you have Graves’ Disease or Hashimoto’s Thyroiditis, or any other autoimmune condition, then I recommend for you to strictly avoid nuts and seeds for at least 30 days. If you have a non-autoimmune thyroid condition but have obvious gut issues (i.e. gas, bloating, and/or stomach pain) then I would also eliminate the nuts and seeds for at least 30 days. But I would also recommend to avoid other foods that can affect gut healing for this 30-day period.
While the autoimmune Paleo diet isn’t meant to be a long term diet, earlier I mentioned that if after 30 days of following this diet you’re thriving then by all means feel free to continue for an extra couple of months. On the other hand, if you are struggling with the AIP diet, which is common, then feel free to reintroduce some foods. I usually start my patients with egg yolks (for those who like eating eggs), and I just want to remind you that when you decide to reintroduce nuts and seeds you should reintroduce a different nut or seed at a time, as not all nuts and seeds are created equally, and some people do fine when eating certain nuts and seeds, but they don’t do well when eating other nuts and seeds.
I also mentioned earlier that you should consider eating soaked and sprouted nuts and seeds, at least until your gut has fully healed. If you don’t want to do this on your own there are some companies that will do this for you, although they are significantly more expensive than buying regular raw nuts and seeds. But Nate’s Raw Harvest is one company that sells organic nuts and seeds that are soaked and sprouted. Wilderness Family Naturals also has organic nuts and seeds that are soaked and dried, although they aren’t sprouted. It’s also worth mentioning that even if you soak the nuts and seeds and don’t sprout them this will still reduce some of the compounds I’ve discussed in this post and will make them easier to digest.
In summary, while nuts and seeds have some good health benefits, they are excluded from an autoimmune Paleo diet mainly because they are common allergens and they have compounds that can potentially interfere with gut healing. The same is true with nut milks and nut butters. However, many people with Graves’ Disease and Hashimoto’s are able to successfully reintroduce nuts and seeds before getting into a state of remission, although not everyone. In addition, soaking and sprouting them will make them much easier to digest, and so this is something to consider doing.
In this blog post I interviewed Bridgit Danner, who is a licensed acupuncturist and functional health coach, and she has a lot of experience working with women’s hormones. She is also the host of Women’s Wellness Radio, which is a weekly podcast, and I would check this out when you get the chance. Recently I read an article by Bridgit where she discussed perimenopause, and it made me realize that I haven’t had a recent article or blog post on this topic. As a result, I asked Bridgit if she would be willing to do a brief “blog post interview” on this topic, and I’m so grateful that she agreed to do this.
Dr. Eric: Can you please explain what perimenopause is?
Bridgit: Perimenopause is characterized by menstrual irregularity, as there are changes in the length of the menstrual cycle, and there can also be changes in the level of discomfort associated with menses. This is essentially the opposite of puberty. In puberty the ovaries are “waking up” in order to start your reproductive years, and during this time your brain and ovaries learn to work together to coordinate a monthly cycle. But with perimenopause, this brain-ovary relationship starts to shut down.
Dr. Eric: When does perimenopause usually begin?
Bridgit: Perimenopause begins several years before menopause, and it usually starts in a woman’s early 40s, although in some women it will begin in their late 30s. During this time the ovaries will begin to make less estrogen, and it will last until the ovaries stop releasing eggs.
Dr. Eric: How long does perimenopause usually last for?
Bridgit: Perimenopause is a long gradual process that occurs over many years. You may notice symptoms for many years, or just for a few years before menopause, or you may not have many symptoms at all, besides your period becoming less frequent. Perimenopause ends when the woman has gone 12 months without having her period.
Dr. Eric: What are some of the common symptoms associated with perimenopause?
Bridgit: With perimenopause you may notice that your PMS worsens, and you may have spotting in between periods. Eventually women will experience irregular and missed periods, and these irregular cycles can result in heavy menstrual bleeding. Sometimes these symptoms will disrupt sleep, and other common symptoms can include hot flashes, brain fog, headaches, heart palpitations, mood swings, and anxiety.
Dr. Eric: How can perimenopause affect thyroid health?
Bridgit: While both estrogen and progesterone decline in perimenopause, the decline of progesterone is more dramatic, which leads to a condition known as estrogen dominance. This estrogen dominant state can affect thyroid transport and conversion.
With regards to autoimmune thyroid conditions, estrogen seems to inhibit Th1 cytokines while stimulating the production of Th2 cytokines. Hashimoto’s Thyroiditis is considered to be a Th1-dominant condition, whereas Graves’ Disease is a Th2-dominant condition. As a result, estrogen dominance will typically exacerbate Graves’ Disease. And while estrogen dominance might actually benefit the immune system in those with Hashimoto’s, ideally you still would want to have a healthy balance of estrogen and progesterone.
Dr. Eric: Can you give some natural treatment tips to women who are in perimenopause?
Bridgit: Many of your readers probably know that having a healthy gut is important for a healthy immune system, and since some of the conversion of T4 to T3 takes place in the gut then this is another reason why improving the health of your gut is essential. But many don’t realize that having optimal gut health is essential for healthy estrogen metabolism, which can help in cases of excess estrogen.
How can you improve the health of your gut? Eating well is important, including fermented foods like sauerkraut and kimchi, eating a good amount of fiber from vegetables, berries, spices, etc. Sugar can feed both yeast and bacteria, and so reducing your sugar intake is essential. Glyphosate, which is in genetically modified foods and non-organic foods, can kill off your friendly bacteria, and so you should try to avoid these foods.
While estrogen dominance can involve high estrogen levels, a woman can have an estrogen dominant state by having low progesterone levels, and so doing things to boost progesterone can also be beneficial. Maca root is an adaptogenic herb that can help to boost progesterone levels, and I’ve been very impressed with how taking 1 -2 tablespoons of hemp oil a day helps with my own perimenopausal hormones. Borage oil has gamma linoleic acid, and this can also help with hormone production.
I also mentioned how estrogen dominance can cause an imbalance of the Th1 and Th2 pathways, and while fixing the estrogen dominance condition is necessary, doing other things to balance the immune system can be helpful. For example, taking fish oil supplements (make sure you find a good brand) will help to balance the immune system and decrease inflammation. Since vitamin D is commonly deficient in those with autoimmune thyroid disease it’s important to get your levels tested, and ideally get the levels to around 60 to 80 ng/dL through both sunshine and vitamin D3 supplementation.
Dr. Eric: Thank you so much for sharing this information on perimenopause. Please tell others how they can learn more about you, including how they can sign up for your podcast.
Bridgit: My website is www.bridgitdanner.com, and they can also subscribe to my “Women’s Wellness Radio” podcast on iTunes, or you can listen and watch interviews at my blog, http://www.bridgitdanner.com/blog.
Nightshades are members of a family of plants called Solanacea. Some of the most common nightshades include tomatoes, eggplant, peppers, white potatoes, and the herb ashwagandha. These foods are excluded from an autoimmune Paleo diet. However, while some people with Graves’ Disease and Hashimoto’s Thyroiditis have negative reactions to one or more of the nightshades, many people with these conditions don’t seem to have a problem with them.
If you want to learn more about why nightshades are excluded from an autoimmune Paleo diet you can read my article entitled nightshades and thyroid health. But the primary goal of this blog post is to find out what your experience has been with nightshades. While I realize that you can’t always go by symptoms, many people who have problems with the nightshades become symptomatic when consuming them. Other people are able to get into remission while continuing to eat nightshades, or upon reintroducing them back after initially eliminating them.
If you have problems with some or all of the different nightshades please let me know! If this is the case, please feel free to be specific and let me know what nightshades you have a negative reaction to. If you feel fine when consuming nightshades, please feel free to share this as well. Thank you so much for sharing your experience with everyone.
There are numerous factors that can trigger an autoimmune response, and lead to the development of a condition such as Graves’ Disease and Hashimoto’s Thyroidits. Infections are one of these factors, and in this blog post I am going to discuss four specific gut infections that can lead to the development of an autoimmune thyroid condition. While there are other infections that can trigger thyroid autoimmunity, the ones I will be discussing are some of the more common ones.
If you’re wondering how infections can cause an autoimmune thyroid condition, I spoke about this in greater detail in a past article I wrote on viruses and thyroid autoimmunity. In this article I discussed three different mechanisms in which an infection can ultimately lead to a condition such as Graves’ Disease or Hashimoto’s Thyroiditis. I realize that most people reading this won’t be interested in learning these mechanisms, but for those who are interested I’d check out this article.
Speaking of viruses, for those wondering why I don’t talk about certain viruses in this blog post such as Epstein Barr, the reason is because I’m focusing specifically on gut infections. However, I should mention that certain viruses can affect the health of the gastrointestinal tract as well. In fact, although Epstein Barr isn’t considered to be a “gut infection”, this virus can affect the gastrointestinal tract. In addition, cytomegalovirus and herpes simplex virus can potentially cause ulcerative disease of the gastrointestinal tract (1).
With that being said, let’s go ahead and discuss these four gut infections:
1. Yersinia enterocolitica. Yersinia enterocolitica is a gram negative bacteria that is a common cause of human gastroenteritis (2). Some of the common symptoms include diarrhea, abdominal pain, fever, and sometimes vomiting (3). Complications are rare and can include a skin rash, joint pain, or the spreading of bacteria to the bloodstream (4). As for how this bacteria is transmitted, the most common method is by eating contaminated food, such as raw or undercooked pork, although sometimes drinking contaminated milk or water can be a cause. A few studies show a correlation between this pathogenic bacteria and thyroid autoimmunity (5) (6) (7).
How Is Yersinia Enterocolitica Detected?
An infection of this pathogen is usually diagnosed through the stool, although the antibodies can be tested through the blood.
Treatment For Yersinia Enterocolitica
The conventional medical approach usually involves prescription antibiotics. These are usually effective, although the obvious downside is that these antibiotics also eradicate beneficial bacteria as well. Natural agents which can be effective against Yersinia include oregano oil, berberine, and garlic.
2. Helicobacter Pylori. Helicobacter pylori is a gram-negative bacteria that infects the stomachs of humans, and it is associated with peptic ulcer disease, gastric carcinoma, and gastric lymphoma (8). Keep in mind that while some people will experience symptoms such as heartburn, indigestion, and nausea, the absence of symptoms doesn’t rule out H. Pylori. As for how it is transmitted, the most common method is the oral-oral route (i.e. kissing), and the fecal-oral route (i.e. contaminated water) (9). A few studies show a correlation between H. Pylori and thyroid autoimmunity (10) (11).
How Is An H. Pylori Infection Diagnosed?
H. Pylori can be tested for through the blood, saliva, stool, and through a urea breath test. Blood and saliva testing measure the H. Pylori antibodies, while stool testing and the urea breath test can detect the actual presence of this bacteria. If someone has recently tested positive for H. Pylori then the antibodies can remain detectable for months after eradication, and as a result they should test for H. Pylori through the stool or the breath test.
Treatment for H. Pylori
Conventional treatment usually involves triple therapy consisting of two antibiotics and a proton-pump inhibitor (12). Sometimes quadruple therapy is used, as this also involves bismuth, a heavy metal that has antimicrobial activity against H. Pylori (12). With regards to natural treatment methods, a few studies show that mastic gum can eradicate H. Pylori (13) (14), and this is something I have used in my practice. Other natural agents I have used include berberine, black cumin seed, garlic, and matula tea. H. Pylori can form biofilms, and N-acetylcysteine (NAC) can be an effective biofilm disruptor in those with an H. Pylori infection (15) (16).
3. Blastocystis hominis. Blastocystis hominis is an enteric parasite, and some of the symptoms commonly associated with Blastocystis hominis include abdominal pain, pruritus, flatulence, malaise, anorexia and diarrhea (17). How Blastocystis is transmitted is not known for certain, although a fecal-oral route through contaminated food or water is the most likely cause (18).
In the past there has been some controversy over whether this is a harmful parasite, or if it is commensal. But more recently it has been recognized that this is indeed a pathogenic parasite, and in addition to increasing proinflammatory cytokines, Blastocystis hominis can also cause a leaky gut, which is a factor in autoimmune conditions such as Graves’ Disease and Hashimoto’s Thyroiditis. With regards to thyroid autoimmunity, there is one case report that shows that someone with Hashimoto’s went into remission upon eradicating Blastocystis hominis (19). Of course this is only a single case report, but over the years I have worked with a few autoimmune thyroid patients who tested positive for this parasite and went into remission upon eradicating it.
How Is A Blastocystis Hominis Infection Diagnosed?
Blastocystis Hominis is typically tested for through the stool.
Treatment for Blastocystis Hominis
From a conventional treatment standpoint, Metronidazole is usually the first drug given, although other prescription drugs that may be given include trimethoprim-sulfamethoxazole, paromomycin, and furazolidone (20). Some of the natural agents which can be effective in treating Blastocystis hominis include oregano oil, wormwood, clove, garlic, black walnut, and saccharomyces boulardii. With regards to S. boulardii, one study involving symptomatic children with Blastocystis hominis showed that this was more effective than Metronidazole (21).
4. Candida. Although Candida is listed here, it’s important to understand that Candida albicans are normal inhabitants of the skin, mucous membranes, gastrointestinal tract, and genitourinary tract. But if something disrupts the gut flora then this can lead to a Candida overgrowth. Many people are aware that taking antibiotics can increase the risk of developing a Candida overgrowth, but there can be other factors as well, including chronic stress, glucocorticoids, and even cigarette smoking.
In fact, anything that either suppresses the immune system or disrupts the good bacteria of the gut can lead to a Candida overgrowth. Some of the symptoms associated with a Candida overgrowth include fatigue, brain fog, gastrointestinal symptoms, allergies, and joint pain. Those with a moderate to severe Candida overgrowth will also commonly have a thick white coating on their tongue. On the other hand, a thin white coating on the tongue is not an indication of a yeast infection.
There is controversy over whether Candida is a direct trigger of thyroid autoimmunity. There is evidence in the research of Candida causing an increase in autoantibodies, although not specific to Graves’ Disease or Hashimoto’s Thyroiditis. A Candida overgrowth can also cause an increase in proinflammatory cytokines, which is associated with autoimmunity. However, an overgrowth of Candida can lead to an increase in intestinal permeability, which can make someone more susceptible to developing Graves’ Disease or Hashimoto’s Thyroiditis.
How Is A Candida Overgrowth Diagnosed?
I have found that the best way to test for a Candida overgrowth is through organic acids testing, which is a urine test that measures different metabolites related to yeast, with arabinose more specific to Candida albicans. Blood and stool testing are also options, although false negatives are common with these methods.
Treatment for a Candida Overgrowth
Conventional treatment methods consist of prescription antifungals such as Nystatin or Diflucan. Natural treatment usually involves a strict “Candida diet”. Like most diets, this involves eating whole foods while avoiding the processed foods, although it also eliminates most sources of sugar, and in some cases all sources, including fruits. It also is advised to minimize or eliminate starchy vegetables such as white potatoes, sweet potatoes, and winter squash. Natural antifungals can also be beneficial, including oregano oil, caprylic acid, olive leaf, garlic, and uva ursi.
Conventional vs. Natural Treatments: Which Should You Choose?
If you test positive for one or more of these pathogens, you might have a difficult time deciding if you should take the conventional medical treatment approach, which usually involves taking prescription drugs, or if you should take a natural treatment approach. Not surprisingly, in most cases I prefer a natural approach, although one has to consider the benefits and advantages of both.
For example, the advantage of taking prescription antibiotics or antifungals is that they usually work much faster than natural agents. Another advantage is that in many cases it is less expensive to take a prescription drug when compared to purchasing nutritional supplements and herbs. This is especially true for those who have health insurance coverage.
Of course one of the big downsides of prescription drugs is the potential side effects. This is especially true with antibiotics, as while there is no question that they are sometimes necessary, they are overused. This is why more and more bacteria are becoming resistant to antibiotics, and it also explains why multiple antibiotics are sometimes needed, which as mentioned earlier is the case with H. Pylori.
The reason why I prefer natural antimicrobials is because they are almost always less harsh on the body when compared to prescription drugs. However, the fact that natural agents usually take longer to eradicate infections can’t be overlooked.
Although I prefer a natural treatment approach, my patients are the ones who ultimately make the decision. For example, while I have recommended a natural treatment approach to many patients with different types of infections, recently I had a patient get diagnosed with H. Pylori, and not surprisingly her medical doctor recommended for her to take prescription antibiotics. I explained the pros and cons, and since she wanted to eradicate H. Pylori quickly she chose to take the antibiotics, even though she realized that this would be harsher on her gut flora. Keep in mind that some natural agents can also have a negative effect on the good bacteria, although they usually aren’t as harmful as prescription drugs.
In summary, infections can be an autoimmune trigger, and in this blog post I discussed four common gut infections in those with Hashimoto’s Thyroiditis. These include Yersinia enterocolitica, H. Pylori, Blastocystis hominis, and a Candida overgrowth. The last one isn’t considered an infectious process, but since it’s so common in people with Graves’ Disease and Hashimoto’s I decided to include it here. When choosing between a conventional and natural treatment approach you need to consider the pros and cons of each, which I discussed in this blog post.
An ultrasound uses sound waves to develop images, and it is the most sensitive imaging modality available for examining the thyroid gland. A thyroid ultrasound also has the benefit of being non-invasive, it doesn’t use ionizing radiation, and it is less expensive than other imaging techniques such as an MRI and CT scan. But does this mean that everyone with a suspected or confirmed thyroid or autoimmune thyroid condition should consider getting a thyroid ultrasound? I’ll of course answer this and other questions you may have in this blog post.
When I was diagnosed with Graves’ Disease, the endocrinologist I saw didn’t want to do a thyroid ultrasound. After palpating my thyroid gland she didn’t detect any thyroid nodules, and while I appreciated her trying not to recommend any unnecessary tests, I talked her into doing a thyroid ultrasound. Other than some thyroid swelling it came back clean, as I had no thyroid nodules.
Since I requested a thyroid ultrasound even though my endocrinologist didn’t think it was necessary, does this mean that I recommend for everyone with a thyroid or autoimmune thyroid condition to get an ultrasound? I can’t say that I recommend for all of my patients to order a thyroid ultrasound.
The reason I chose to get a thyroid ultrasound is because I don’t think that palpating the thyroid gland is always sufficient to detect thyroid nodules. But even if I had one or more thyroid nodules show up on an ultrasound, would I have done anything differently while taking a natural treatment approach? The honest answer is probably not. And even if I had one or more thyroid nodules, I probably would not have had them biopsied, although this would depend on the characteristics, which I’ll talk about shortly.
When Is A Thyroid Ultrasound Indicated?
According to the American Association of Clinical Endocrinologists (AACE), a thyroid ultrasound is indicated in the following situations (1):
1. To confirm the presence of a thyroid nodule when the physical examination is equivocal. So if the physical exam is inconclusive for thyroid nodules then a thyroid ultrasound would be indicated.
2. To characterize a thyroid nodule. In other words, to measure the dimensions accurately and to identify internal structure and vascularization.
3. To determine whether a thyroid nodule is benign or malignant. Although an ultrasound can’t always differentiate between a malignant and thyroid nodule, sometimes this can be determined based on the appearance of the nodule.
4. To differentiate between thyroid nodules and other cervical masses. While thyroid nodules are the main focus of a thyroid ultrasound, other masses that can show up include enlarged lymph nodes, a thyroglossal cyst, or a cystic hygroma.
5. To evaluate diffuse changes in the thyroid parenchyma. What is the thyroid parenchyma? The thyroid parenchyma is simply the tissues that comprise the thyroid gland.
6. To detect post-operative residual or recurrent thyroid tumor or metastases to the neck lymph nodes. For example, if someone has thyroid surgery to remove a malignant nodule, then a follow-up thyroid ultrasound would understandably be indicated.
7. To screen high risk patients for a thyroid malignancy. This includes people with a family history of thyroid cancer, or perhaps if someone had radiation exposure to their neck in childhood.
8. To guide diagnostic and therapeutic interventional procedures. For example, if someone needs to get a biopsy of a thyroid nodule then an ultrasound may be used to help guide the placement of the needle within a nodule.
Getting Back To My Situation…
If you read the eight indications above then you’ll notice that the first one mentions that a thyroid ultrasound is indicated “to confirm the presence of a thyroid nodule when the physical examination is equivocal”. When I received my thyroid examination the endocrinologist seemed pretty confident that I didn’t have any thyroid nodules, yet I overruled her and asked for a thyroid ultrasound anyway. And even though I paid out of pocket for the ultrasound, I didn’t have any regrets, as I didn’t want to rely on the palpation skills of the endocrinologist, and I had peace of mind knowing that I didn’t have thyroid nodules.
But what approach would I have taken if the ultrasound revealed thyroid nodules? Earlier I mentioned that if the thyroid ultrasound I received revealed one or more thyroid nodules I probably wouldn’t have done anything different with regards to the natural treatment protocol I followed. I also mentioned how I probably wouldn’t have had a biopsy done. However, one benefit is that I could have done a follow-up ultrasound in the future to monitor the thyroid nodules and make sure that they weren’t getting larger.
Ultimately the decision to request a thyroid ultrasound is up to you. If the endocrinologist you are working with recommends an ultrasound due to one of the indications I listed above, then it probably is a good idea to get one. On the other hand, if after palpating your thyroid gland they are confident that you don’t need a thyroid ultrasound, then it’s fine not to get one. If you’re skeptical like I was and want to get one anyway then of course there is nothing wrong with politely asking the doctor.
You might think that the endocrinologist I was working with was willing to order the thyroid ultrasound because I’m a chiropractor, but I actually didn’t tell her my profession, and I didn’t put it down on the health history form. The reason I didn’t let her know my profession is because I wanted to see how she treated someone who wasn’t a healthcare professional. And I must admit that she was very pleasant to work with, although I only saw her for that single visit. Probably the main reason she was willing to order a thyroid ultrasound is because not only did I ask her politely for it, as I told her that it would give me peace of mind, but she also knew that I was paying out of pocket for it. As a result, from a health insurance perspective there was no concern as to whether the ultrasound was medically necessary.
Hashimoto’s, Graves’ Disease, and Thyroid Ultrasounds
What I’d like to do next is specifically talk about both Hashimoto’s Thyroiditis and Graves’ Disease, and when a thyroid ultrasound should be considered. But wait, shouldn’t the indications I listed above apply to these two autoimmune thyroid conditions? Well yes, these indications do apply, but there are other circumstances when getting a thyroid ultrasound might be a good idea, especially with Hashimoto’s Thyroiditis.
Hashimoto’s Thyroiditis. Although the diagnosis of Hashimoto’s is usually confirmed by an elevated TSH combined with the presence of thyroid peroxidase and/or thyroglobulin antibodies, these antibodies are not always positive in those with Hashimoto’s. When this is the case, getting a thyroid ultrasound can be beneficial, as many times this can confirm the presence of Hashimoto’s Thyroiditis.
Graves’ Disease. Just as is the case with Hashimoto’s, most cases of Graves’ Disease are characterized by elevated thyroid antibodies…specifically TSH receptor antibodies, with the most common type being thyroid stimulating immunoglobulins. While I can’t say that everyone with Graves’ Disease needs to get a thyroid ultrasound, I did want to mention that many doctors recommend for people with hyperthyroidism to get a radioactive iodine uptake test. This involves taking a small dose of radioactive iodine, and the justification for this test is that a high uptake reading can confirm Graves’ Disease, and this test can also reveal if someone has thyroid nodules, and give an idea as to whether they are benign or malignant.
The reason why I’m not a big fan of this test is because 1) Graves’ Disease can usually be diagnosed by the presence of elevated thyroid stimulating immunoglobulins, and 2) a thyroid ultrasound can detect the presence of thyroid nodules, and can also give a good idea as to whether the nodules are benign or malignant. And of course the thyroid ultrasound is less invasive than the radioactive iodine uptake test, which is why I’m more in favor of getting an ultrasound.
Understanding Ultrasound Terminology
Remember that ultrasound involves waves, which are formed in the head of the instrument the doctor or radiologist applies to the body, which is also known as a transducer. Echogenicity of the tissue refers to the ability to reflect or transmit ultrasound waves in the context of surrounding tissues (2). Based on echogenicity, a structure can be characterized as hyperechoic (white on the screen), hypoechoic (gray on the screen) and anechoic (black on the screen) (2). Cartilage appears hypoechoic, including thyroid cartilage, and on an ultrasound Hashimoto’s Thyroiditis usually presents as diffuse enlargement of the thyroid gland, along with heterogeneous and hypoechoic parenchymal echo pattern. Graves’ Disease actually presents with a similar pattern. Thyroid blood vessels appear black or anechoic.
The thyroid gland is highly vascular, and certain types of ultrasound devices (i.e. Doppler ultrasound) can measure the vascularization of the thyroid gland, and so you might also see this on an ultrasound report. Hypervascularization means that there is an increased blood flow to the area, while hypovascularization refers to a decreased blood flow. Graves’ Disease is usually characterized by very high vascularity on an ultrasound. While you might expect Hashimoto’s and hypothyroidism to be of low vascularity, most cases of hypothyroidism are also characterized by high vascularity. If the ultrasound shows a small atrophied gland then this usually indicates that the person has had extensive damage to the thyroid gland, and this is sometimes referred to as “end stage” Hashimoto’s Thyroiditis.
What’s The Thyroid Ultrasound Pattern for Multinodular Goiter?
Although most of my patients have either Graves’ Disease or Hashimoto’s Thyroiditis, multinodular goiter is the most common cause of diffuse asymmetric enlargement of the thyroid gland (1). Not surprisingly, in people with multinodular goiter a thyroid ultrasound will reveal a diffusely enlarged thyroid gland, along with multiple nodules. I spoke about the vascularity of Graves’ Disease and Hashimoto’s, and the vascularity can help to differentiate multinodular goiter from a carcinoma, as someone who has thyroid nodules with an increased blood flow has a higher risk of malignancy (3).
More About Thyroid Nodules…
Although I have written separate articles on thyroid nodules and I don’t want to focus too much on this here, I do want to add that it is very common to have thyroid nodules. So while I requested a thyroid ultrasound from my endocrinologist because I was concerned about having thyroid nodules, what I didn’t realize at the time was that more than 50% of people will have thyroid nodules on an ultrasound (4). The good news is that most of these thyroid nodules are benign. And so please don’t get stressed out if you have one or more thyroid nodules show up on an ultrasound.
While a thyroid biopsy is used to confirm whether a suspicious thyroid nodule is benign or malignant, one of the indications I listed earlier mentioned how a thyroid ultrasound can give an idea as to whether a thyroid nodule is benign or malignant. And the way it does this is by looking at the following characteristics:
- The size of the nodule
- The presence of microcalcifications
- Irregular margins
- Solid composition
- Marked hypoechogenicity
So while a biopsy might be indicated to confirm whether a “suspicious” thyroid nodule is benign or malignant, most people who have one or more thyroid nodules don’t need to get a biopsy. Plus, keep in mind that biopsies aren’t perfect, as they don’t always confirm or rule out a malignancy. One more thing I want to add is that the presence of multiple nodules doesn’t increase the likelihood of a malignancy. In other words, if someone has five thyroid nodules, each nodule will have an equal risk of being benign or malignant when compared to someone who has one or two nodules.
In summary, an ultrasound is the most sensitive imaging modality used to examine the thyroid gland. Some of the indications for a thyroid ultrasound include to confirm the presence of a thyroid nodule when the physical exam is inconclusive, to characterize a thyroid nodule, and to differentiate between thyroid nodules and other cervical masses. Many people with Graves’ Disease are told to get a radioactive iodine uptake scan when many times a thyroid ultrasound (along with testing the thyroid stimulating immunoglobulins) would be sufficient. And sometimes an ultrasound can be used to diagnose Hashimoto’s Thyroiditis when the person has negative thyroid antibodies.
In past articles and blog posts I have briefly mentioned the triad of autoimmunity. This is also known as the “three-legged stool” of autoimmunity, and it consists of a genetic component, an environmental trigger, and an increase in intestinal permeability (a leaky gut). The theory is that all three of these are factors in the development of an autoimmune condition such as Graves’ Disease or Hashimoto’s Thyroiditis. And if this is the case, then these factors need to be addressed when trying to restore someone’s health.
What I plan on doing in this blog post is to discuss the individual components of this triad, and hopefully give you a better understanding of what you can do to address the individual components.
Component #1: Genetics. With regards to the three components of the triad of autoimmunity, genetics of course is the one component that can’t be modified. This is the reason why I try not to use the word “cure” when I talk about treating these conditions naturally. So when I talk about restoring one’s health back to normal, or reversing the autoimmune component, the goal is to get the person into a state of remission, and after this has been accomplished the next goal is to help them maintain a state of wellness.
But since the genetic component can’t be modified, you might wonder how it’s possible to get someone into a state of remission AND to help them maintain their health. Perhaps this can best be explained by looking at a different autoimmune condition, Celiac disease. With Celiac disease, the autoimmune trigger is gluten. Of course I’ll talk in greater detail about environmental triggers shortly, but I’m bringing this up here because if someone with Celiac disease completely avoids gluten, then they will remain in remission from this autoimmune condition on a permanent basis. This is true even though nothing can be done to change the genetics associated with Celiac disease.
Sticking with the example of Celiac disease, another thing to keep in mind is that just because someone has a genetic predisposition for Celiac disease doesn’t mean they will develop this condition. In fact, even if someone with the genetic markers for Celiac disease eats gluten, this doesn’t guarantee that they will develop Celiac disease. It’s a similar situation with those people who have Graves’ Disease and Hashimoto’s Thyroiditis. Those with a genetic marker for these conditions, as well as other autoimmune conditions, won’t necessarily develop the specific condition unless they are exposed to an environmental trigger and they also have a leaky gut.
Component #2: Environmental trigger. As I just discussed, while having a genetic predisposition seems to be necessary for the development of thyroid autoimmunity, other factors are also necessary, which of course is the basis behind the “triad of autoimmunity”. So in addition to having a genetic predisposition, an environmental trigger is also necessary to cause the development of Graves’ Disease or Hashimoto’s Thyroiditis. Earlier I spoke about Celiac disease, and unlike most other autoimmune conditions, with Celiac disease we know that the environmental trigger is gluten. And while it’s not easy for many people to completely avoid gluten, it still is a huge advantage knowing what the specific autoimmune trigger is.
This is what makes it challenging to help people with other types of autoimmune conditions, including Graves’ Disease and Hashimoto’s Thyroiditis. With these conditions the environmental trigger can differ from person to person. The following are just a few examples of environmental triggers of thyroid autoimmunity:
- Foods (i.e. gluten)
- Bacterial Infections (i.e. H. Pylori)
- Viral infections (i.e. Epstein Barr)
- Parasites (i.e. Blastocystic Hominis)
- Environmental toxins (i.e. mercury)
So how do you find the environmental trigger? As I mentioned earlier, this can be challenging, but it’s usually accomplished through a combination of a good health history and the appropriate testing. For example, when I was diagnosed with Graves’ Disease, stress was a big factor in the development of my condition. And this was verified through an adrenal saliva test I ordered, which showed that I had depressed cortisol levels, a depressed DHEA, and a depressed secretory IgA. And while stress is a big factor with many others with autoimmune thyroid conditions, some people have other triggers.
Sometimes the person will test positive for multiple triggers. For example, someone might choose to get an adrenal saliva test along with a comprehensive stool panel, and the results of the two tests reveal compromised adrenals and multiple infections. Of course it is possible that only one of these factors was the “true” environmental trigger, but it’s challenging to know which is the primary trigger, and of course either way the goal should be to address all of these imbalances. In other words, if someone has both adrenal problems and an infection, while it’s possible that dealing with a lot of stress weakened the person’s immune system and led to an infection, which in turn was the autoimmune trigger, the goal should be not only to eradicate the infection, but to help the person improve the health of their adrenals.
Component #3: Leaky gut. Dr. Alessio Fasano is the researcher who came up with the theory that having an increase in intestinal permeability is a necessary factor in autoimmunity. A few years ago I admittedly questioned this theory in a blog post I wrote entitled “Is a Leaky Gut Present In All Autoimmune Thyroid Conditions?” A number of years ago I did more frequent testing for a leaky gut on my patients, and in this post I discussed how some people with elevated autoantibodies tested negative for a leaky gut, which either meant that the testing wasn’t completely accurate, or that Dr. Fasano’s theory was incorrect.
This blog post was written almost three years ago, and while Dr. Fasano’s theory still hasn’t been proven, it is widely accepted by many well known healthcare professionals. And I agree that the mechanisms behind it make sense, which is why these days I don’t frequently test my patients for a leaky gut, and instead assume that this is a factor in those with Graves’ Disease and Hashimoto’s Thyroiditis. After all, everything comes down to risks vs. benefits, and in my opinion it’s a greater risk to not give gut support to someone who has a leaky gut than to put someone who might not have a leaky gut on a gut repair protocol. In other words, it isn’t harmful to treat someone for a leaky gut, even if they don’t have a leaky gut.
Removing The Leaky Gut Trigger
It’s important to understand that in order to heal the gut, it’s also necessary to find out the factor which caused the leaky gut in the first place. This is where it can get confusing at times, as the “leaky gut trigger” can be the same as the environmental trigger I mentioned above, although this isn’t always the case. For example, earlier I spoke about Celiac disease, and in this case gluten not only is the environmental trigger, but gluten also has been proven to cause an increase in intestinal permeability in everyone, regardless of whether or not they have a sensitivity to gluten. In any case, with Celiac disease, gluten is both the “environmental” trigger and the “leaky gut” trigger.
However, there are situations where the leaky gut trigger might differ from the environmental trigger. For example, someone with a genetic predisposition to Graves’ Disease or Hashimoto’s Thyroiditis might have a history of taking antibiotics, which can cause a leaky gut. So this person has a genetic predisposition and a leaky gut, but the autoimmune process hasn’t started yet since they haven’t been exposed to an environmental trigger. Then one day this person gets infected with Yersinia enterocolitica, which in this case is the environmental trigger, and they develop thyroid autoantibodies. So in this example the antibiotics were the “leaky gut trigger”, but not the environmental trigger.
Differentiating Between The Environmental and Leaky Gut Trigger
The truth is that it can be challenging to differentiate between the environmental and leaky gut trigger. In the example given above, while the excessive use of antibiotics might have caused the leaky gut, it’s also possible that the infection (Yersinia enterocolitica) caused the leaky gut. So while gluten is both the environmental trigger and the leaky gut trigger in Celiac disease, it’s probably safe to say that in many cases of Graves’ Disease and Hashimoto’s Thyroiditis, the environmental trigger and the leaky gut trigger are also the same, although this isn’t always the case. Hopefully you don’t find this to be too confusing, but the overall point is that the ultimate goal should be to remove anything that can be either an environmental trigger or a leaky gut trigger.
What Is Still Unclear About Environmental Triggers
While over the last decade we have learned a lot more about the different environmental triggers associated with autoimmunity, there is still a lot we don’t know. For example, the research shows that Yersina Enterocolitica is a potential trigger of both Graves’ Disease and Hashimoto’s Thyroiditis (1) (2). However, does this mean that everyone who has a genetic predisposition for thyroid autoimmunity and also has a leaky gut will develop Graves’ Disease or Hashimoto’s when exposed to this specific bacteria?
It would seem that this isn’t the case. For example, not everyone who has a genetic predisposition to Hashimoto’s or Graves’ Disease has a negative reaction to iodine. So this is one example of an environmental trigger which doesn’t trigger thyroid autoimmunity in everyone with a genetic predisposition (and a leaky gut).
Another example involves gluten, as this seems to be an environmental trigger in some people with autoimmune thyroid conditions, but not others. In fact, you might have read posts in Facebook groups or in forums from people with Graves’ Disease or Hashimoto’s Thyroiditis who got into remission upon eliminating gluten alone. On the other hand, there are people who have gone 100% gluten free for many months without getting into remission, which suggests that gluten isn’t an environmental trigger in everyone. However, I did mention earlier that the research shows that gluten can cause a leaky gut in everyone. So it can be argued that gluten is a leaky gut trigger in everyone, but not necessarily an environmental trigger in everyone.
Addressing The Triad To Achieve A State of Remission
In order for anyone with Graves’ Disease and Hashimoto’s Thyroiditis to achieve a state of remission it is necessary to identify and remove the environmental trigger, and to do things to heal the leaky gut. The good news is that achieving this is very possible, but the bad news is that a relapse is also possible in those that don’t continue to live a healthy lifestyle. For example, if stress was a big factor in the development of your autoimmune thyroid condition, while you can’t completely eliminate the stress from your life, you can do things to improve your stress handling skills.
Similarly, if the environmental trigger was an infection such as H. Pylori or Blastocystis Hominis, while getting rid of this infection is important, doing things to improve the health of the immune system is also necessary to prevent these and other infections from reoccurring in the future. Improving the health of the immune system is perhaps even more important if the trigger was a viral infection such as Epstein Barr, which can’t be eradicated, but can be kept in a dormant state. Of course since most people have been infected with Epstein Barr it can be argued that it is critical for everyone to do everything they can to have an optimally-functioning immune system.
And of course in order to have a healthy immune system you need to have a healthy gut, and so healing the leaky gut is not only essential to get into remission, but it’s also a necessary component of a healthy immune system. As for how to heal a leaky gut, in addition to removing the “leaky gut trigger” you also want to heal the gut, which can be accomplished through both food and supplementation. I’m not going to get into detail about this here, as I have discussed this in other articles and blog posts.
In summary, the triad of autoimmunity theorizes that three factors are necessary to develop any autoimmune condition. These include a genetic predisposition, an environmental trigger, and a leaky gut. Although not being able to modify the genetic component is the reason why we can’t cure conditions such as Graves’ Disease and Hashimoto’s Thyroiditis, the expression of our genes can change, and we of course can address the other two components, which can put the person into a state of remission. And it is also is very possible to maintain a state of wellness by having a healthy gut and minimizing your exposure to environmental triggers.
It’s been awhile since I’ve written an article on goitrogens, and so I figured I’d put together a blog post discussing 5 different things you should know with regards to goitrogenic foods. For those reading this who are unfamiliar with goitrogenic foods, there are certain foods that can potentially suppress the function of the thyroid gland, and it accomplishes this by interfering with the uptake of iodine. This in turn can result in the formation of a goiter, which is an enlargement of the thyroid gland. There are also “environmental goitrogens”, which are certain substances or chemicals that can inhibit the production of thyroid hormone, although the focus of this blog post will be on foods. According to the literature, the following foods have been identified as being goitrogenic (1):
- Brussels sprouts
- Mustard greens
- Sweet potatoes
- Green tea
So now that you are aware of some of the more common goitrogenic foods, let’s go ahead and discuss five things you need to know about them.
1. There are no human studies showing that cruciferous vegetables can cause a goiter. It’s very common for people with hypothyroidism or Hashimoto’s to express concern about eating cruciferous vegetables such as broccoli, kale, and cauliflower. However, these are very healthy foods, and while some people with hypothyroidism might have problems eating cruciferous vegetables, this isn’t common. Although there aren’t any human studies which demonstrate that eating cruciferous vegetables can inhibit thyroid hormone production, there are rat studies which show the goitrogenic effects of cruciferous vegetables.
One study showed that cabbage can significantly reduce plasma thyroxine (T4) levels within days, even when consuming a moderate amount of iodine (2). One thing I need to say is that cooking foods can decrease the goitrogenic properties, although you of course don’t want to cook cruciferous vegetables for too long in order to avoid the loss of nutrients.
2. Drinking high amounts of green tea might have a goitrogenic effect. A few studies have looked at the goitrogenic effect of green tea extract in rats, and found that catechin present in green tea extract might have antithyroid activity, and that drinking green tea at high doses can alter thyroid function adversely (3) (4). Keep in mind that the study specifically said that drinking “high doses” of green tea can have adverse effects on thyroid function, which perhaps explains why I haven’t seen a problem with my patients drinking green tea. And so I’m not suggesting for those with thyroid and autoimmune thyroid conditions to completely avoid drinking green tea. Plus, remember that just as is the case with cruciferous vegetables, these studies were conducted on rats, and not humans.
3. Not all goitrogenic foods are created equally. Some foods are considered to be more goitrogenic than others. For example, cruciferous vegetables are supposedly more goitrogenic than other foods such as spinach, strawberries, and peaches. Soy is perhaps the most goitrogenic food, but this isn’t the only reason why I recommend for my patients to avoid soy. As I discussed in a blog post entitled “4 Reasons Why Soy Should Be Avoided In Those With Thyroid Conditions“, soy is a common allergen, soy has phytates, which can lead to a decrease in iron and calcium absorption, and most soy is genetically modified. Although there are health benefits of eating organic fermented soy, the fermentation process apparently doesn’t reduce the goitrogenic properties.
4. A moderate to severe iodine deficiency can make goitrogenic foods more problematic. As I mentioned in the opening paragraph, the way that goitrogenic foods can potentially inhibit thyroid hormone production is by interfering with iodine uptake. So not surprisingly, those people who have a moderate or severe iodine deficiency are more likely to have problems when eating raw goitrogenic foods. While it might be a good idea to test for an iodine deficiency, keep in mind that not everyone with thyroid and autoimmune thyroid conditions do well when supplementing with iodine, and there is some evidence of this in the comments section of a blog post I released in 2016. This doesn’t mean that an iodine deficiency shouldn’t eventually be addressed, but in many cases it makes sense to improve the health of the immune system before addressing an iodine deficiency, which I discussed in an article I wrote entitled “An Update On Iodine and Thyroid Health”.
5. Turmeric can benefit those who eat a lot of goitrogenic foods. I absolutely love turmeric, as it has many health benefits. And one study involving 2335 residents of Pakistan showed that turmeric can help to reduce goiters (5). 669 of these subjects had a palpable goiter, and most were either hyperthyroid or euthyroid (had normal thyroid hormone levels). The authors recommended that those who eat high goitrogenic diets should be educated to consume turmeric to reduce the risk of goiter development. Keep in mind that turmeric isn’t well absorbed, which is why many turmeric supplements add piperine, liposomes, or other substances to help increase turmeric absorption.
So hopefully you learned a few things about goitrogenic foods. What I want you to take away from this blog post is that most people with thyroid and autoimmune thyroid conditions can eat a few servings of cruciferous vegetables per day, and most of the other foods listed above can also be safely eaten, with the possible exception of soy, peanuts, and millet. It’s also important to understand that since goitrogens interfere with iodine uptake, having a moderate to severe iodine deficiency can make someone more susceptible to the goitrogenic effects of certain foods. It’s also useful to know that turmeric can help to reduce goiter formation, and while fermentation doesn’t seem to reduce the goitrogenic properties of soy, cooking cruciferous vegetables can decrease the goitrogenic activity.
Last week I wrote a blog post entitled “The Elimination Diet vs. Food Sensitivity Testing“. In this post I spoke about both the pros and cons of an elimination diet and food sensitivity testing. I’m personally more in favor of an elimination diet, although there are times when I will recommend food sensitivity testing to my patients. For those reading this who have done food sensitivity testing, I’d like to get your feedback.
If you have had any type of food sensitivity testing done, whether it was an IgG food sensitivity test, an ALCAT, MRT, or another method, did you agree with the findings? Of course this is assuming you had some foods that you tested positive for. Although I realize that you can’t always go by symptoms, many times you can, and so I’m curious to know if you had a negative reaction to any foods you tested positive for. In other words, did the results of your food sensitivity testing make sense, or were they not what you expected?
And for those who have done food sensitivity testing AND have also followed an elimination diet, I’d love to hear what your thoughts are as well. Did you find an elimination diet or food sensitivity testing to be more helpful in identifying potential food triggers? Or did you find neither of these methods to be helpful? Please share your experience in the comments section below. Thank you!
Foods can be a trigger with autoimmune thyroid conditions such as Graves’ Disease and Hashimoto’s Thyroiditis. As a result, I have most of my patients follow an elimination diet initially. On the other hand, some healthcare professionals have all of their patients do food sensitivity testing to see what specific foods they are reacting to. While there are benefits to both of these methods, there are also limitations to both an elimination diet and food sensitivity testing, and in this post I’ll discuss the pros and cons of each of these so that you can better make an informed decision.
Before comparing the elimination diet with food sensitivity testing I’d like to discuss how food can cause autoimmunity in the first place. First of all, certain foods such as gluten can lead to autoimmunity by causing an increase in proinflammatory cytokines and a decrease in regulatory T cells (1) (2) (3). Molecular mimicry can also play a role, as what happens is that frequent exposure to certain food allergens can result in a decrease of oral tolerance. This in turn triggers an immune system response against various components of food proteins, and cross-reaction with B-cell molecules may trigger autoimmunity (3). In other words, eating certain foods will result in the immune system attacking the food proteins, and in the case of mistaken identity the immune system can also attack bodily tissues with a similar amino acid sequence.
In addition to causing an increase in proinflammatory cytokines or resulting in a molecular mimicry mechanism, certain food allergens can also cause an increase in intestinal permeability, which is also known as a leaky gut. According to the triad of autoimmunity, a leaky gut is one of three factors required for the development of an autoimmune condition. The other two components are a genetic predisposition and exposure to an environmental trigger. Keep in mind that not all foods will cause a leaky gut, and what can make it challenging is that a leaky gut can actually cause the development of food sensitivities through a loss of oral tolerance.
What Are The Most Common Allergens?
While it is possible to have a sensitivity to any food, the following are considered to be the most common allergens:
In addition, these foods are also commonly problematic in some people:
The Elimination Diet vs. The Autoimmune Paleo Diet
Most people reading this are familiar with the autoimmune Paleo diet. This is similar to a standard Paleo diet, but also has people avoid eggs, the nightshades, as well as nuts and seeds. The reason why these and other foods such as grains and legumes are excluded is because they can interfere with healing of the gut. However, the autoimmune Paleo diet also serves as an elimination diet, as you would essentially be eliminating the most common allergens, although some healthcare professionals do allow their patients to eat shellfish. The reason for this is because while shellfish is considered to be a common allergen, shellfish is AIP-friendly.
What Are The Benefits of An Elimination Diet?
There are a few reasons why I like to have my patients follow an elimination diet initially. First of all, I find that many patients can identify their food triggers if they do this type of diet carefully. Essentially you want to follow a strict AIP diet for a minimum of 30 days, and then after 30 days you would reintroduce certain foods one at a time, every three days, and pay close attention to symptoms. I have written a blog post on reintroducing foods that I would recommend checking out.
Another benefit of the elimination/reintroduction diet is that it is more cost effective than doing food sensitivity testing. Testing for food allergens can be expensive, which would be fine if the information provided was completely accurate, or close to it. But food sensitivity testing is far from perfect.
What Are The Flaws of An Elimination Diet?
Although I start most of my patients on an elimination diet, this admittedly does have certain limitations. First of all, while many people are able to identify foods they are sensitive to, this isn’t always the case. For example, someone who follows an elimination diet and reintroduces a certain food might experience some obvious symptoms, such as bloating and gas, headaches, an increase in fatigue, brain fog, or other symptoms. On the other hand, some people don’t experience any overt symptoms upon reintroducing foods, and the lack of symptoms doesn’t always rule out a food sensitivity.
I will add that most people will notice symptoms upon reintroducing foods they are sensitive to if they pay close attention. Many times people are only focusing on digestive symptoms, but as I discussed above, other symptoms can develop as well. But how do you know if a specific symptom is related to the food you introduced?
For example, if someone reintroduces eggs, and they experience headaches, how do they know if the headaches were caused by the eggs? Perhaps it was a coincidence and the person might have experienced the headache regardless. This admittedly can be challenging, but in a situation where you are unsure if the symptom experienced was a result of the food that was reintroduced, what you would want to do is take a break from that food for a few additional weeks, and then you can try reintroducing the food again. If you experience the same symptom then you can almost be certain that the food is responsible for that specific symptom.
Another limitation of an elimination/reintroduction diet is that it is possible for someone to be sensitive to one or more of the “allowed” foods. For example, someone can be sensitive to AIP-friendly foods such as broccoli, avocados, chicken, raspberries, and other foods that are not part of an elimination diet. This admittedly is a major limitation of this diet, although I find that most of my patients don’t react to AIP-friendly foods.
What Does Food Sensitivity Testing Involve?
In the past I wrote an article entitled “Food Allergies, Food Sensitivities, and Thyroid Health”. In this article I discussed the difference between a food allergy, a food sensitivity, and a food intolerance. As I mentioned in the article, a food allergy usually involves an immediate reaction to a food, and is considered to be IgE-mediated. This is the type of testing that most conventional allergists will conduct.
Food sensitivity testing usually involves a delayed reaction. As a result, it frequently will take a few hours, and sometimes a few days before someone will have a negative reaction to a food. While most food sensitivity panels involve Immunoglobulin G (IgG), there are other types of panels, including leukocyte activation testing (i.e. the ALCAT) and mediator release testing (MRT).
A food intolerance is usually the result of an enzymatic defect, and a good example of this is a lactose intolerance. Having a histamine intolerance can be due to a defect in the enzyme DAO, although there can be other causes of this type of intolerance as well.
What Are The Benefits of Food Sensitivity Testing?
One of the main benefits of food sensitivity testing is that it has the potential to identify specific foods that you are reacting to. And while I can’t say that I’m a big fan of such testing due to some of the limitations I’ll discuss shortly, I have had some patients successfully identify foods that were causing problems. And in some of these cases the foods were allowed on an elimination/AIP diet.
Another potential benefit is that it might prevent the person from having to eliminate certain foods, although this is controversial. For example, if someone is eating gluten or dairy on a regular basis and tests negative for both of these, does this mean it’s safe to eat these foods, even though they are excluded from an autoimmune Paleo diet, as well as many other diets? Well, we need to keep in mind that false negatives are possible with this type of testing. I personally recommend for my patients to avoid gluten and dairy while restoring their health, regardless of what a food sensitivity panel shows. And with regards to some of the other “excluded” foods, we need to keep in mind that some foods aren’t excluded because they are common allergens, but instead are excluded because they have compounds which can affect the healing of the gut.
So for example, nightshades are excluded from an autoimmune Paleo diet due to the compounds which can potentially cause inflammation and/or an increase in intestinal permeability. Solanine is one example, as it’s a glycoalkaloid found in the nightshade foods, especially eggplant and potatoes, although it’s also found in tomatoes and peppers. But if someone tests negative for eggplant, white potatoes, tomatoes, and peppers on a food sensitivity panel, this doesn’t mean that these foods won’t cause problems.
Getting back to the potential benefits of food sensitivity testing, one additional benefit that comes to mind is that if someone tests positive, and if it is a “true” positive, then this serves as a baseline. In other words, if someone tests positive for one or more foods, and if they decide to reintroduce the food in the future when their gut is healed, they can do another food sensitivity test after reintroducing the food to see if they are still reacting to that specific food.
What Are The Disadvantages of Food Sensitivity Testing?
While it might sound great to do food sensitivity testing to determine the specific foods you are reacting to, there are a few disadvantages to this type of testing. Here are some of the main ones:
- False results are possible
- You need to either be currently eating the foods, or have recently eaten the foods you’re testing for to get an accurate result
- Doing this type of testing can be expensive
- Most food sensitivity panels are incomplete, meaning that they don’t test for all of the foods a person eats
- There can be differences between cooked and raw foods, yet most food sensitivity panels don’t test for both of these
What Approach Do I Take In My Practice?
As I mentioned earlier, I have most of my patients with Graves’ Disease and Hashimoto’s Thyroiditis follow an elimination diet initially in the form of the autoimmune Paleo diet. I have them do this for the first month, and if they are doing well I’ll encourage them to follow this diet for a longer period of time. But eventually I’ll have them reintroduce some of the excluded foods, as the goal isn’t to keep them on this diet on a permanent basis. However, there are times when I will order an IgG food sensitivity panel. First of all, if someone insists on ordering this type of testing then I’m fine ordering it.
Another situation when I might order such testing is if the patient started out with an elimination diet, and followed my other recommendations, but a few months later they still aren’t progressing. Another scenario where I might order a food sensitivity panel is if the patient is progressing but then they hit a roadblock and don’t show further improvement. So there are times when I will order food sensitivity testing, but it’s not a test that I recommend to all of my patients.
How Should YOU Detect Food Allergens?
After reading this you still might not be sure what approach you should take. Of course ultimately the decision is up to you, and if you are working with a natural healthcare professional then you might leave the decision making up to them. Some healthcare professionals recommend food sensitivity testing to all of their patients. On the other hand, others never recommend food sensitivity testing to their patients. I also should mention that some healthcare professionals use something called applied kinesiology to detect food sensitivities, which is a type of manual muscle testing.
What I recommend is to do some of your own research, and then find a doctor who is compatible with what you’re looking for. For example, if you decide that you don’t want to do food sensitivity testing, then it’s probably not a good idea to work with a healthcare professional who recommends food sensitivity testing for every patient. And if you want to get a food sensitivity panel done, then it doesn’t make sense to work with someone who is unwilling to order one for you.
In summary, foods can be a trigger of Graves’ Disease and Hashimoto’s Thyroiditis. And while I commonly have my patients follow an elimination diet initially, many natural healthcare professionals will have all of their patients do food sensitivity testing. There are pros and cons with both an elimination diet and food sensitivity testing. With regards to the different tests for food allergens, IgE testing is specific for food allergies, while IgG testing is for delayed food sensitivities. Leukocyte activation and mediator release testing are two other options, although there isn’t a lot of research on these two methods.
Recently I attended a conference where one of the presenters mentioned that she thinks it’s malpractice for healthcare practitioners to have all of their patients go gluten free without first testing for Celiac disease. While I recommend for my patients to avoid gluten while restoring their health, I don’t require all of my patients to obtain a Celiac panel, and I’ll discuss some of these reasons in this blog post. However, the presenter did make some valid points, which I’ll also talk about. And so the goal of this blog post isn’t to convince you to order a Celiac panel (assuming you haven’t done so already), but only to provide you with information to help you make an informed decision.
What I’m going to do is first list some of the reasons why everyone with an autoimmune thyroid condition should consider doing a Celiac Panel. I will then list some reasons why it might not be a good idea for everyone with Graves’ Disease and Hashimoto’s to do a Celiac panel. This way you will see both perspectives. I’ll then talk about the different testing options for determining if you have Celiac disease or a non-Celiac gluten sensitivity. Finally, for those who choose to go through the testing, I’ll discuss the approaches you should take if you test positive or negative for a gluten sensitivity.
Reasons Why Everyone With Thyroid Autoimmunity Should Consider Doing a Celiac Panel
1. Celiac Disease is more common in those with thyroid autoimmunity. I discussed this in a separate article entitled “Celiac Disease and Thyroid Health”. In the article I discussed how studies show that both those people with Graves’ Disease and Hashimoto’s Thyroiditis have a greater chance of developing Celiac disease. In fact, some people develop Celiac disease first, and then years later they will develop an autoimmune thyroid condition. But assuming someone with either Graves’ Disease or Hashimoto’s hasn’t been diagnosed with Celiac disease and hasn’t had any testing done to confirm this, due to the higher prevalence it makes sense to get a Celiac panel. Those with other types of autoimmune conditions also have a greater chance of developing Celiac disease, and therefore they also might want to consider obtaining a Celiac panel.
2. If someone tests positive for Celiac disease they will need to avoid gluten on a permanent basis. Regardless of whether someone has overt symptoms when consuming gluten, if a person tests positive for Celiac disease then they will want to avoid gluten on a permanent basis. Not doing so can not only prevent their autoimmune thyroid condition from going into remission, but there are other risks of untreated Celiac disease, including the following (1):
- Iron deficiency anemia
- Early onset osteoporosis or osteopenia
- Infertility and miscarriage
- Vitamin and mineral deficiencies
- Central and peripheral nervous system disorders
- Pancreatic insufficiency
- Gallbladder issues
3. It’s best to find out if someone has Celiac disease sooner than later. Why is it best to find out if a person has Celiac disease sooner than later? Because if someone has Celiac disease then they need to completely avoid gluten, and so it does make sense to find out sooner than later to make sure you do everything you can to avoid gluten.
4. You can’t rely on symptoms alone. Although most people with Celiac disease will experience overt symptoms upon consuming gluten, this isn’t the case with everyone. In fact, some people have silent Celiac disease, which is when they don’t experience overt symptoms, yet test positive for the markers of Celiac disease. When this is the case the person should avoid gluten on a permanent basis, even if they feel fine when consuming gluten.
Reasons For NOT Testing Everyone For a Celiac Panel
1. If someone has been gluten free for awhile this test won’t be accurate. One of the downsides of testing for Celiac disease, or any other testing for gluten antibodies, is that you need to be eating gluten for the test to be positive. The reason for this is because for those who have Celiac disease, eating gluten will cause the immune system to produce certain antibodies, and these antibodies are measured during the testing. If the person hasn’t eaten gluten for a few weeks, or perhaps even a few months, then there still can be detectable antibodies on such a test. However, if the person has been completely gluten free for a prolonged period of time then such testing will come out negative, even if the person has Celiac disease.
2. Some people are fine giving up gluten forever even without a diagnosis. Another reason not to test everyone for Celiac disease is because some people have no problem avoiding gluten on a permanent basis, even if they haven’t confirmed that they have Celiac disease. This is especially true for those who feel better when avoiding gluten. However, I mentioned earlier how not everyone with Celiac disease experiences symptoms when consuming gluten. In my experience, patients are less likely to give up gluten on a permanent basis if they don’t experience any noticeable symptoms when eating gluten. However, if someone tests positive for Celiac disease or a non-Celiac gluten sensitivity, they are more likely to give up gluten on a permanent basis, even if they don’t experience any negative symptoms when consuming gluten.
3. A negative Celiac panel doesn’t always rule out Celiac disease. Although it would be great if such testing was 100% accurate, this isn’t always the case. Here are some of the factors which can lead to a false-negative test result (2):
- Age of less than 2 years
- Laboratory error
- Reduction or elimination of gluten from the diet
- Selective IgA deficiency
- Use of corticosteroids or immunomodulating drugs
So if an adult is eating gluten regularly, an IgA deficiency has been ruled out, and if they aren’t taking corticosteroids or immunomodulating drugs, then how can they tell if this is a false negative? Well, if Celiac disease is suspected in this situation even if someone has negative test results, one option is to have them get a biopsy of the small intestine. In addition, they can test for the genetic markers of Celiac disease, which are HLA-DQ2 and HLA-DQ8. If the Celiac panel is negative and both of these genetic markers are also negative then chances are the person doesn’t have Celiac disease.
4. A negative Celiac panel doesn’t rule out a non-Celiac gluten sensitivity. It’s possible to not have Celiac disease, yet have a sensitivity to gluten. I’m not going to get into detail about this here, as you can read my article on Celiac disease and Thyroid heath for more information. The good news is that there is more comprehensive testing available for gluten, which I’m about to discuss next.
What Are The Different Testing Options For Gluten?
There are numerous testing options to determine if someone has Celiac disease, or a non-Celiac gluten sensitivity. Here are some of the main options:
Gliadin antibodies. Gliadin is a protein of gluten, and while this is part of a Celiac panel, the reason why I listed this marker alone is because many healthcare professionals will only test this single marker. While elevated gliadin antibodies will confirm that you have a gluten sensitivity (not necessarily Celiac disease), a negative finding doesn’t rule out either Celiac disease or a non-Celiac gluten sensitivity. With that being said, patients with Celiac disease are more likely to have positive gliadin IgA antibodies, while those with non-Celiac gluten sensitivity are more likely to have positive gliadin IgG antibodies (3).
Celiac panel. Unfortunately there isn’t a single Celiac panel available. For example, if you visit the Labcorp website and do a search for “Celiac tests”, you’ll notice a few different options. All of the panels will test for the IgA and IgG deamidated gliadin antibodies, along with tissue-transglutaminase IgA and IgG. In addition, most panels will test for immunoglobulin A as well, which will help to rule out a false negative result. Some panels will also test for the endomysial antibodies, although many medical doctors will test for only the gliadin and transglutaminase antibodies. In my opinion, the more comprehensive the panel, the better.
Intestinal biopsy. An intestinal biopsy is still recommended by some gastroenterologists to diagnosis Celiac disease. However, it’s debated whether a biopsy is required to confirm the diagnosis of this condition. If the person is presenting with the signs and symptoms of Celiac disease and has a positive Celiac panel, then there’s a very good argument that a biopsy isn’t necessary. On the other hand, if the person presents with signs and symptoms indicative of Celiac disease, yet the Celiac panel comes back negative, then this might be a good time to conduct an intestinal biopsy.
Cyrex Labs Wheat/Gluten Proteome Reactivity And Autoimmunity (Array #3). This is the most comprehensive test available for determining if someone has a gluten sensitivity. This test measures the antibody production against multiple wheat proteins and peptides, transglutaminase-2, 3, and 6, and the gliadin-transglutaminase complex. Although Cyrex Labs claims that this test isn’t diagnostic of Celiac disease, many times it can give a pretty good indication if someone has this condition, or a non-Celiac gluten sensitivity.
Enterolabs gluten sensitivity stool test. This is also a pretty good test, although it’s not as comprehensive as the one from Cyrex Labs. The reason I listed this here is because it’s a popular test, and over the years I have had numerous patients order this test prior to working with me.
Genetic testing. When combined with a negative Celiac panel, genetic testing can help to exclude Celiac disease. The genetic markers associated with Celiac disease include HLA-DQ1 and HLA-DQ8. Approximately 0.4% of patients with Celiac are both HLA-DQ2 and HLA-DQ8 negative (4). But as mentioned earlier, if someone has been eating gluten and has a negative Celiac panel, and also has both genetic markers negative, then there is a very high probability that they don’t have Celiac disease. Genetic testing can also be considered if someone has been following a gluten free diet for a prolonged period of time, as one doesn’t have to be eating gluten for the results to be accurate.
What Approach Should You Take If You Test Positive For A Gluten Sensitivity?
If you choose to get one or more of the tests I listed above and it comes out positive, should you avoid gluten on a permanent basis? Or is eating a small amount of gluten every now and then okay? Well, some will argue that anyone with Graves’ Disease or Hashimoto’s Thyroiditis (or any other autoimmune condition) should avoid gluten on a permanent basis regardless of what the test results show. And one of the main reasons for this is because regardless of whether someone has a gluten sensitivity or not, the research shows that gluten causes a leaky gut in everyone. And for this reason alone, a good argument can be made that anyone with an autoimmune condition who tests positive for Celiac disease, or a non-Celiac gluten sensitivity, should ideally avoid gluten on a permanent basis.
In fact, someone with a confirmed case of Celiac disease should even be cautious about eating certain packaged gluten free foods. And there are a few reasons for this. First of all, gluten free foods aren’t always 100% gluten free, as they can include less than 20 ppm of gluten, yet some people react to as little as 5 ppm. In addition, some “so-called” gluten free foods have greater than 20 ppm of gluten, and so if you do choose to eat packaged gluten free foods, please make sure they are certified gluten free. For more information on this I would visit the websites for the Gluten-Free Certification Organization and Beyond Celiac.
In addition, if you test positive for a gluten sensitivity you also need to be cautious when eating out. And the reason for this is because if you suspect that a food is gluten free, or even if it’s labeled as being gluten free on the restaurant menu, cross contamination is common.
What Approach Should You Take If You Test Negative For A Gluten Sensitivity?
As I mentioned earlier, there is always the chance of a false negative result. I also mentioned that if you suspect Celiac disease but if the Celiac panel comes back negative then you can consider obtaining an intestinal biopsy. But perhaps a better, less non-invasive option is to order the genetic markers of gluten, HLA-DQ2 and HLA-DQ8.
Just keep in mind that a negative intestinal biopsy doesn’t rule out a non-Celiac gluten sensitivity, and the same is true if someone tests negative for the genetic markers associated with Celiac disease. But even if you’re 100% confident that you don’t have Celiac disease or a non-Celiac gluten sensitivity, it is a good idea to minimize your consumption of gluten. Not only is gluten unnecessary to consume, but as I mentioned earlier, even if you’re not sensitive to gluten, it can cause a leaky gut, which is theorized to be a factor in everyone with Graves’ Disease or Hashimoto’s Thyroiditis.
In summary, many people with autoimmune thyroid conditions such as Graves’ Disease and Hashimoto’s Thyroiditis should consider doing a Celiac panel. The reason for this is because Celiac disease is more common in thyroid autoimmunity, and if someone has Celiac disease they need to avoid gluten on a permanent basis. Also remember that you can’t rely on symptoms, as while most people with Celiac Disease will experience overt symptoms when consuming gluten, this isn’t always the case. Just keep in mind that you need to be eating gluten for a Celiac panel to be accurate. Also, a negative Celiac panel doesn’t always rule out Celiac disease, and it’s also possible to have a non-Celiac gluten sensitivity. An intestinal biopsy is also recommended by some gastroenterologists to diagnose Celiac disease, and Cyrex Labs has a comprehensive test that can help determine if someone has a gluten sensitivity.