I have been recommending adrenal saliva panels to most of my patients for approximately seven years. There are numerous reasons for this, which I will explain in this blog post. On the other hand, some natural healthcare professionals don’t do any adrenal testing. They instead assume that most of their patients have adrenal problems and simply recommend general adrenal support to all of their patients. So is it best to test the adrenals, or since most people have adrenal issues is it best to just treat the adrenals, and not do any testing?
When I was diagnosed with Graves’ Disease I obtained an adrenal saliva panel. The results showed depressed cortisol and DHEA levels, along with a depressed secretory IgA. Even though I didn’t think that stress was a factor, after seeing the results of my adrenal saliva panel it made me realize that stress probably was one of the biggest factors, and perhaps the main factor in the development of my Graves’ Disease condition. But this of course was just my experience, and so this doesn’t necessarily mean that everyone should get their adrenals tested, right? Well, what I’d like to do is discuss why I choose to test the adrenals in my patients, and then for arguments sake I’ll also list some reasons why you might not want to have the adrenals tested.
Why Do I Choose To Test The Adrenals In Most Of My Patients?
Here are the main reasons why I recommend for most of my patients to obtain adrenal saliva testing:
1. Most people have adrenal problems. Of course everyone deals with stress, but the main problem isn’t the actual stressor, but one’s perception of the stressor. Unfortunately most people don’t do a good job of handling stress. As a result, most of the patients I work with have adrenal issues.
2. Not all adrenal imbalances are treated the same. While some natural healthcare professionals offer general support for the adrenals, the problem is that not all adrenal problems are the same. Sure, everyone should manage their stress levels, and regardless of the state of your adrenals it usually won’t hurt to take adaptogenic herbs and some nutrients such as vitamin C. But this doesn’t mean that everyone with adrenal problems can or should be treated the same way. As an example, when I was dealing with Graves’ Disease, I took herbs and nutrients which helped to increase cortisol production, which made sense since I had depressed cortisol levels. However, many people have elevated cortisol levels, and when this is the case they of course want to do things to decrease cortisol production. And the only way to know for certain if someone has elevated or depressed cortisol levels is through testing.
3. Blood testing doesn’t look at the circadian rhythm of cortisol. Some doctors will test the morning cortisol levels through the blood. And while this has some value, blood testing doesn’t look at the circadian rhythm of cortisol. This is important because even if the morning serum cortisol looks good, this doesn’t mean that the person has a normal circadian rhythm, as it’s possible for cortisol to be depressed or elevated at other times during the day. Plus, remember that cortisol increases during stressful situations, and many people get stressed out when getting blood drawn, which can lead to a false high or normal reading of cortisol.
4. Seeing is believing. What I mean by this is that some people need to see that they have compromised adrenals before they will start to make the necessary lifestyle changes. This definitely described me, as before I received the results of my first adrenal saliva test I didn’t expect the results to show depressed cortisol and DHEA levels. Prior to doing the saliva test I always thought I did a good job of handling stress, but the results of the saliva test proved me wrong. And without seeing the results I probably wouldn’t have worked on improving my stress handling skills, which is not only a big factor when it comes to restoring one’s adrenal health, but is also important when it comes to maintaining healthy adrenals.
5. The saliva panel I recommend doesn’t just evaluate cortisol and DHEA. In addition to looking at cortisol throughout the day, along with DHEA, the company I use looks at a few other useful markers. One of these is 17-OH progesterone, which is a precursor of cortisol. This can provide some value, as depressed 17-OH progesterone levels are common with weakened adrenals. Secretory IgA is also evaluated, and I spoke about the importance of this marker in an article entitled “How Does Secretory IgA Relate To Thyroid Health?”
Why Shouldn’t You Test The Adrenals?
Let’s look at a few of the reasons why you might not want to do an adrenal saliva test.
1. Most people have adrenal problems. Of course I used this same argument as a reason why most people SHOULD get adrenal testing, but as I mentioned earlier on, some healthcare professionals use this as a reason NOT to get the adrenals tested. They just recommend for all of their patients to do things to improve their stress handling skills, give their patients general adrenal support, etc. And while some people will do fine with taking some general support, others need more specific support based on their individual adrenal state.
2. Adrenal saliva testing can be expensive. The truth is that most testing is expensive, and you therefore want to prioritize the testing that you obtain. I’m pretty conservative when it comes to testing, but at the same time I will recommend those tests I feel are necessary.
In summary, different natural healthcare professionals will take different approaches with regards to testing the adrenals. Some natural healthcare professionals won’t do any adrenal testing, but instead will recommend general adrenal support. On the other hand, I have most of my patients obtain an adrenal saliva panel, and I gave a few reasons for this in this blog post. While it is true that many people have adrenal issues, different adrenal imbalances shouldn’t be treated the same say, and seeing compromised adrenals on a saliva panel can serve as further motivation to do what is necessary to improve the health of the adrenals.
A few years ago I wrote a blog post on the 4-R protocol. Since then it’s been updated to the “5-R Protocol by the Institute for Functional Medicine”, and I figured it would be a good idea to update and expand on the original post I wrote on this topic. If you’re not familiar with this protocol then you’ll quickly realize that it relates to the healing of the gut, and a leaky gut is a factor with most, if not all autoimmune conditions, including Graves’ Disease and Hashimoto’s Thyroiditis. And while the information in this post will focus greatly on thyroid autoimmunity, even if you don’t have an autoimmune thyroid condition, I feel that a lot of people can benefit from this information.
So let’s dive right into the protocol and discuss each of the five components
1. Remove. Although genetics is a factor with most, if not all autoimmune conditions, in order for someone to develop autoimmunity they must be exposed to an environmental trigger. And in order to reverse the autoimmune component and restore the person’s health it is necessary to find and remove the trigger. The same is true with regards to healing a leaky gut. While many people with a leaky gut will take supplements such as L-glutamine, and eat gut-healing foods such as bone broth, you won’t be able to heal your gut if you don’t detect and remove the leaky gut trigger.
This of course is easier said than done at times, as it’s not always easy to find out what the trigger is. However, these are some of the common factors which can cause a leaky gut:
Food allergens. Although many food allergens can potentially cause an increase in intestinal permeability, in the research I was able to find evidence for gluten (1), corn oil (2), and red wine (3) being factors which can cause a leaky gut.
Gut infections. In the literature there are numerous infections which can cause an increase in intestinal permeability. This includes candida (4) (5), H. Pylori (6), Blastocystis hominis (7) (8), and giardia (9). There is also evidence that small intestinal bacterial overgrowth can cause an increase in intestinal permeability (10) (11).
Systemic Inflammation. I also came across a study which showed that systemic inflammation can cause an increase in intestinal permeability (16).
Finding the trigger is arguably the most difficult component of the 5-R protocol. But once this has been accomplished you can move onto the next four components, which I’m about to discuss.
2. Replace. The next component is to replace certain factors which play a role in digestion. Many people reading this have taken digestive enzymes. These include enzymes to break down protein (proteases), carbohydrates (amylase), and fat (lipase). Many people with low gastric acid (stomach acid) can benefit from taking betaine HCL with meals. Gastric acid consists mostly of hydrochloric acid, which is released from the parietal cells of the stomach. It plays a role in activating pepsinogen into the active enzyme pepsin, which in turn breaks down proteins.
Some people can also benefit from supplementing with bile salts. This is especially true for those people who have had their gallbladder removed, as getting gallbladder surgery doesn’t address the bile metabolism issues commonly associated with these conditions. But some other people can also benefit from taking bile salts, such as those who have problems emulsifying fats.
Although dietary fiber doesn’t fall under the same category as digestive enzymes, betaine HCL, and bile salts, many people don’t consume enough dietary fiber, which is important for numerous reasons. First of all, fiber helps to feed the good bacteria of the microbiota. In addition, having sufficient dietary fiber is important for having regular bowel movements.
3. Reinoculate. Many people take probiotic supplements, which is one method of reinoculating, or repopulating the gut flora. And of course there are ways to accomplish this through diet as well. But why do people have to reinoculate in the first place? Well, there are many different factors which have a negative effect on the microbiota, including the foods we eat, taking antibiotics, being exposed to other environmental toxins, and even chronic stress can have a negative impact on our gut flora.
So what is the best way to reinoculate? To be honest, we’re still in the beginning stages of dealing with probiotics, and so the approach we take now very likely won’t be the approach we take five to ten years from now. I commonly recommend a probiotic supplement to my patients, but even this comes with some controversy, as not all probiotic supplements are created equally. And some healthcare professionals like myself will recommend formulations with specific, well-researched probiotic strains, while other doctors won’t pay as much attention to the strains included, but instead will focus more on the diversity. In other words, some will recommend a probiotic which has many different species, without worrying about the specific strains.
While it can be beneficial to take a probiotic supplement, it also is a good idea to take some prebiotics, and eat food sources of probiotics. With regards to prebiotics, one can take a prebiotic supplement such as inulin or larch arabinogalactan, or you can eat prebiotic foods such as Jerusalam artichokes, asparagus, onions, chicory, bananas and other fruit, and even green tea is considered to be a source of prebiotics (17) (18). The reason why prebiotic foods are important is because they feed the good bacteria such as bifidobacteria and lactobacilli, and these foods also are good sources of short chain fatty acids.
Probiotic Supplements vs. Food Sources
But why take a probiotic supplement when there are some excellent food sources of probiotics? After all, foods such as sauerkraut, kimchi, kombucha, kefir, and a good quality source of yogurt can all be good sources of probiotics. Well, I recommend getting probiotics from both supplements and food sources, and the reason for this is because the supplements you take will have different strains than the food sources. Plus, many people simply don’t eat enough food sources of probiotics.
What About Soil-Based Probiotics and Fecal Transplants?
Over the past year I’ve had a lot of people ask me about soil-based probiotics, and I only recently started using these in my practice, and so I can’t say I have much experience with these. Some examples of soil-based probiotics include bacillus subtilis and bacillus coagulans. These are also known as spore-based probiotics. These not only are more resistant to the gastric acid of the stomach than some other probiotic strains, but some sources claim that they colonize the gut more effectively. If anyone reading this has had a positive experience while taking spore-based probiotics please feel free to share your experience in the comments section below.
I don’t get asked as much about fecal microbiota transplants, but I figured it was worth mentioning this here because this can potentially help with many different conditions. This essentially involves transplanting healthy bacteria from one individual to another individual. It seems to be very effective in helping people with Clostridium difficile, and while it hasn’t been approved for other conditions in the United States, this probably will change in the future.
4. Repair. Many people reading this are familiar with a “leaky gut”, which I briefly spoke about earlier. This is when the intestinal barrier is compromised, which allows larger proteins to pass into the bloodstream, where they normally shouldn’t be. As a result, the immune system sees them as being foreign and mounts an immune system response. Some claim that in order for autoimmunity to develop you need 1) a genetic predisposition, 2) an environmental trigger, and 3) a leaky gut. I briefly spoke about this earlier when I discussed the “remove” component of the 5R protocol. And of course this component is focusing on repairing the gut.
But before talking about how to repair the gut, it probably is a good idea to explain how one can determine if they have a leaky gut in the first place. There is testing available, as there is a test called the Lactulose/Mannitol test that can determine if someone has an increase in intestinal permeability (a leaky gut), and there is also a test from the company Cyrex Labs called the Intestinal Antigenic Permeability Screen. I have used both of these tests in the past, but these days I usually just assume that my patients have a leaky gut, especially those with Graves’ Disease and Hashimoto’s Thyroiditis.
As for how to repair the gut, this can be accomplished through a combination of supplementation and diet. One of the most common nutrients recommended by healthcare professionals is L-glutamine, which is an amino acid that serves as fuel for the cells of the small intestine. Vitamin A and zinc can also play important roles in gut healing, and herbs such as slippery elm, licorice, and marshmallow root can also help to support the gut. Foods which can help heal the gut include bone broth, cabbage juice, and fermented foods such as sauerkraut.
5. Rebalance. This used to be called the “4R protocol”, but not too long ago the Institute for Functional Medicine added a fifth component, which is to rebalance your body through sleep, stress management, etc. I’m not going to discuss this in detail here, but this of course doesn’t mean that this component isn’t important. I’m always talking about the importance of stress handling, as doing a poor job of managing your stress can have a profound effect on your health. And most people are aware of the importance of getting sufficient sleep, although in some cases it is necessary to improve other aspects of one’s health in order to help them sleep better.
Can You Address More Than One Of These Components Simultaneously?
Some people might wonder if they can address more than one component at the same time. In other words, if someone has a gut infection, can someone take digestive enzymes and probiotics at the same time that the infection is being eradicated? Without question the answer to this is “yes”, as most healthcare professionals address different components simultaneously, including myself. And so it isn’t necessary to focus on one of these components at a time.
In summary, the 5-R protocol relates to the healing of the gut, and a leaky gut is a factor with most, and possibly all autoimmune conditions such as Graves’ Disease and Hashimoto’s Thyroiditis. The first, and perhaps most important component is removal of the trigger, which can include a food allergen, an infection, environmental toxin, and even stress. The remaining four components of the 5-R protocol are replace, reinoculate, repair, and rebalance.
Last month I wrote a blog post entitled “What’s Your Experience With Iodine?”, which was very popular and received a good number of comments. And so I figured I’d run a similar blog post, but this time focus on gluten. Unlike iodine, most people who go on a gluten free trial don’t experience negative results, and many people feel significantly better upon avoiding gluten. However, there are also people who avoid gluten for a prolonged period of time and see no improvement in their symptoms, blood tests, etc.
So what I’d like for you to do is please share your experience with gluten. If you avoided gluten and it helped improve your symptoms or blood tests please let me know! And if you avoided gluten and you didn’t notice any improvement in your symptoms or tests please let me know! And if you are one of those rare people who went on a gluten free trial and had a worsening of your symptoms please let me know!
Also, please feel free to be as specific as possible. So for example, if you experienced gas and bloating, brain fog, daily headaches, skin problems, or any other sign or symptom that improved upon eliminating gluten please share this with everyone. Or if you noticed a significant improvement in your thyroid hormone levels, thyroid antibodies, or any other test markers please share this with us as well. Thank you in advance for participating!
Although many people with thyroid and autoimmune thyroid conditions are trying to lose weight, some people with these conditions are actually trying to gain weight, or at the very least, don’t want to lose any additional weight. This is especially true for those with hyperthyroidism and Graves’ Disease, but it’s also true for a small percentage of people with hypothyroidism and Hashimoto’s Thyroiditis. And following an autoimmune paleo diet can make this even more of a challenge, as while the goal of following this diet isn’t to reduce calories, it still is a very restrictive diet.
So if you are following an autoimmune paleo diet and are looking to gain weight and/or maintain a healthy weight, then here are a few things you can do:
1. Decrease the thyroid hormone levels. This mainly applies to those people with hyperthyroidism and Graves’ Disease, although if someone with hypothyroidism is taking too high of a dose of thyroid hormone medication then it also can apply to them as well. Either way, having high thyroid hormone levels will usually make it very difficult to gain weight. It’s not uncommon for one of my patients with hyperthyroidism to tell me how concerned they are about their weight loss, and while some of the other advice given in this blog post might help to prevent them from losing additional weight, in many cases they will need to address the thyroid hormone levels before the weight loss subsides.
This described my situation when I was dealing with Graves’ Disease, as I lost over 40 pounds. And I didn’t gain any weight until my thyroid hormone levels started to decrease. Of course some people who take antithyroid medication have the opposite problem, as the medication will make them hypothyroid and cause them to gain weight. This weight gain usually can be minimized by not taking too high of a dosage of antithyroid medication. Sometimes taking too high of a dosage of bugleweed can also cause weight gain, although it’s not as common as taking higher doses of antithyroid medication.
2. Eat nutrient dense foods. Although the autoimmune paleo diet is restrictive, it is also very nutrient dense. And while I understand the concern about not getting enough calories, it is better to consume less calories consisting of nutrient dense foods rather than eating a lot of high calorie, low nutrient dense foods. With that being said, eating a good amount of protein, along with a lot of healthy fats when following an autoimmune paleo diet can help you maintain a healthy weight, and might even cause you to gain weight.
Most people who follow such a diet focus more on the protein, as for example, they might eat meat with every meal. But don’t underestimate the benefits of eating a lot of healthy fats and oils. Avocados and coconut oil are two main sources of healthy fats to consider consuming, but other healthy fats and oils include olive oil, tallow, and coconut milk.
3. Heal the gut. Problems with digestion or absorption can cause someone to have problems gaining weight. So for example, while most people with a high TSH and low thyroid hormone levels will have problems losing weight, if you have a high TSH and low or depressed thyroid hormone levels and are losing weight, then I would suspect absorption issues. For example, if someone has inflammatory bowel disease then this can cause weight loss. Celiac disease can also result in malabsorption of nutrients, and cause weight loss.
4. Eradicate infections. Having certain infections can cause some people to lose weight. So for example, having a condition such as small intestinal bacterial overgrowth, or a parasitic infection can cause someone to have problems losing weight. In some cases H. Pylori can cause weight loss. Certain viruses can also result in gastroenteritis and make gaining weight difficult. And so you want to make sure to eradicate any infections.
5. Do things to increase muscle mass. Another way to gain some weight is to do things to increase muscle mass. While eating a healthy diet consisting of a good amount of protein and healthy fats is important, physical activity is also important, and this includes weight bearing exercises. For example, engaging in some light weight lifting three times per week is a good way to increase muscle mass. This doesn’t necessarily mean joining a fitness club, as you can get some light weights and exercise from the comfort of your own home.
So if you are having problems gaining weight when following an autoimmune paleo diet, then hopefully some of the strategies given in this post will help you to overcome this. If you have hyperthyroidism or Graves’ Disease, then in many cases you will need to decrease the thyroid hormone levels before you can gain weight. But other things that can help you to gain weight include eating nutrient dense foods, doing things to heal the gut, eradicate any infections, and increase muscle mass.
Every now and then I’ll have someone ask me if I followed an autoimmune paleo (AIP) diet when I was dealing with Graves’ Disease. The reason I get asked this question at times is because I commonly recommend for my patients with Graves’ Disease and Hashimoto’s Thyroiditis to initially follow an AIP diet. And so they want to know if I followed a similar diet when I was taking a natural treatment approach.
I’m assuming most people reading this know what an autoimmune paleo diet includes. But just to play it safe I’ll briefly distinguish between a “standard” paleo diet and an “autoimmune” paleo diet. A standard paleo diet allows the following foods to be consumed:
Meat (i.e. beef, pork, poultry)
Nuts and seeds
Green tea and herbal teas
So a “standard” paleo diet excludes foods such as dairy, grains, and legumes. And of course it also restricts refined sugars and oils, fast food, etc. Without question it’s a restrictive diet, and while some people struggle following a standard paleo diet, for many people it’s not difficult at all. As for an autoimmune paleo diet, this is even more restrictive than a standard paleo diet, as an autoimmune paleo diet also excludes eggs, nuts and seeds, and the nightshade family of vegetables, which includes tomatoes, eggplant, white potatoes, and peppers.
But why are these foods excluded? Well, the reason why eggs, nightshades, and nuts and seeds are excluded from an autoimmune paleo diet is because they include compounds which can potentially increase the permeability of the gut. And some theorize that a leaky gut is a factor in all autoimmune conditions. I spoke about this in greater detail in a past blog post I wrote entitled “Is a Leaky Gut Present In All Autoimmune Thyroid Conditions?”
Do I Have All Of My Graves’ Disease and Hashimoto’s Patients Follow an AIP Diet?
Initially I recommend for all of my patients with Graves’ Disease and Hashimoto’s Thyroiditis to follow an autoimmune paleo diet for at least the first 30 days. This isn’t to suggest that some people won’t need to follow this diet for a longer period of time. But I don’t think that there is a “one size fits all” diet, and I spoke about this in a past blog post entitled “Should Everyone With Graves’ Disease and Hashimoto’s Thyroiditis Follow an Autoimmune Paleo Diet?”. Although I do think the AIP diet is a good starting point for those with autoimmune thyroid conditions, not everyone needs to follow this diet for a prolonged period time, and not everyone with an autoimmune condition does well on this type of diet.
What Diet Did I Follow When I Was Diagnosed With Graves’ Disease?
So let’s go back to the original question, which asked if I followed an AIP diet when I was diagnosed with Graves’ Disease. First of all, when I was diagnosed with Graves’ Disease I’m pretty sure there wasn’t an official “autoimmune paleo diet”. Back then it was referred to as a “gut repair diet”. Just as a reminder, when I was treating my Graves’ Disease condition naturally I was working with a natural healthcare professional who had experience working with endocrine conditions. And initially she recommended for me to follow a standard paleo diet, and not an AIP/gut repair diet.
As a result I didn’t eliminate the eggs, nightshades, nuts and seeds from my diet. While I was progressing well, on my first saliva test my secretory IgA was depressed, and this marker didn’t improve when doing a retest (although my cortisol and DHEA levels did show some great changes). As a result, the natural healthcare professional I was working with suggested for me to follow a strict gut repair diet, which I did. I don’t remember if this involved giving up eggs. Truth to be told, I’ve never been a big consumer of eggs, as I usually add a couple of raw egg yolks to my smoothies a few times per week, but I usually don’t eat eggs for breakfast on a regular basis like many people do. On the other hand, giving up nuts and seeds was a big challenge for me, as I’ve always loved eating all types of nuts and seeds.
A few months after following the gut repair diet I had another saliva retest, and my secretory IgA had greatly improved. Was following the AIP/gut repair diet responsible for this improvement? I’d like to think so, although I will admit that I’ve had some patients with a depressed secretory IgA not give up nuts and seeds and a few months later this value improved. The truth is that everyone is different, and what works for one person doesn’t always work for the another person with the same condition. In addition, those following a natural treatment protocol are almost always doing multiple things to help improve their health, and so sometimes it can be challenging to know if a specific factor was responsible for the person’s improvement.
Should YOU Follow An Autoimmune Paleo Diet?
If you have Graves’ Disease or Hashimoto’s Thyroiditis (or any other type of autoimmune condition), then you might be wondering if you should follow an AIP diet. As I mentioned earlier, I currently recommend for all of my patients with autoimmune thyroid conditions to at least follow an AIP diet initially. Then after 30 days if they are struggling with the diet I’m open to them reintroducing other foods. Of course some people don’t follow an AIP diet at all, even for the initial 30 days. And some of these people still end up receiving good results, while others don’t progress well.
Even though one can make the argument that not everyone with an autoimmune condition needs to follow a strict AIP diet, it is impossible to know who will progress well without following such a diet. And so if you have Graves’ Disease or Hashimoto’s Thyroiditis you have a few different options, but I’m going to focus on two options here. The first option, which as you now know is the one I recommend, is to play it safe and strictly follow the AIP diet. A second option is not to follow an AIP diet, but to still eat whole healthy foods, avoid refined foods, and see how you progress.
If you choose not to follow a strict AIP diet I would at least encourage you to follow a standard paleo diet for awhile. If you don’t follow an AIP diet and your symptoms, blood tests, and other tests continue to improve then you probably are fine following the current diet. On the other hand, if your health doesn’t improve when following a standard paleo diet then it probably is best to try following a strict AIP/gut repair diet for at least a month or two. Sure, perhaps there are other factors responsible for the lack of progress, but since one’s diet can definitely play a role I think eating well is essential to receive optimal results, even if there are other factors to consider.
In summary, I usually recommend for my patients with Graves’ Disease and Hashimoto’s Thyroiditis to follow an autoimmune paleo diet initially. However, when I was dealing with Graves’ Disease I initially followed more of a standard paleo diet, although I eventually made the transition to an AIP/gut repair diet due to the secretory IgA remaining depressed. While some people with autoimmune thyroid conditions don’t need to follow a strict AIP diet, it’s impossible to know who will do well and who won’t do well when not following such a diet. As a result, I think it’s a good idea to try to be as strict as possible initially, and then as your health improves you should eventually be able to reintroduce other foods.
A few days ago I released an article entitled “An Update On Iodine and Thyroid Health”. In this article I discussed my personal experience with iodine, along with my patient’s experience. I also mentioned some of the benefits and risks of supplementing with iodine, and I spoke about the different forms of iodine supplementation.
But I decided to put together this blog post because I’m hoping that at least a few people will share their experience with iodine supplementation. So if you have Graves’ Disease, Hashimoto’s Thyroiditis, multinodular goiter, etc., and if you have supplemented with iodine in the past (or are currently supplementing with iodine), please feel free to share your experience in the comments section below. If you took iodine and had a negative reaction please let me know! And if you took iodine and had a positive experience please let me know! And even if you didn’t notice anything positive or negative please let me know!
Also, please feel free to be as specific as you can with regards to what type of iodine you took (i.e. Iodoral, Nascent, kelp, etc.), how much you took, etc. If you had a negative experience, what symptoms or lab values got worse? If you had a positive experience what symptoms or lab values improved? Thank you in advance for sharing your experience with iodine.
I’ve spoken about cytokines in past articles and blog posts, as these are proteins that play a role in regulating the inflammatory process. Although pro-inflammatory cytokines play a role in autoimmune conditions such as Graves’ Disease and Hashimoto’s Thyroiditis, there are also anti-inflammatory cytokines as well. Some healthcare professionals will test the cytokines of their patients, and in this blog post I’ll discuss if this is something everyone with an autoimmune thyroid condition should do.
Rather than beat around the bush, let’s jump right into the main subject and talk about testing for cytokines. So why do some healthcare professionals choose to test the cytokines of their patients? After all, assuming this isn’t covered by your health insurance, testing for cytokines can be expensive, and so what purpose is served by testing these? Well, the main reason why healthcare professionals choose to do this type of testing is in order to modulate the Th1 and Th2 pathways. I’ve spoken about this in previous articles and blog posts, but I’ll briefly talk about this below.
What You Should Know About Th1 and Th2
T helper cells are one of the most important cells related to immune system health…specifically something called adaptive immunity. They help to activate B cells, which in turn secrete antibodies, and they also activate other T cells to help kill infected cells. However, these T helper cells first need to be activated, and once activated they will differentiate into Th1 or Th2 cells. These cells have different functions, and they will secrete different cytokines. There are other types of T helper cells, but I’m going to mainly focus on the Th1 and Th2 cells here.
Autoimmunity involves an imbalance of these Th1 and Th2 cells. Conditions such as Hashimoto’s Thyroiditis are typically considered to be “Th1 dominant”, which means that there is an excessive amount of Th1 cells. On the other hand, most cases of Graves’ Disease are considered to be “Th2 dominant”, where there is an excessive amount of Th2 cells. However, this isn’t set in stone, and the only way to know for certain whether someone is Th1 dominant or Th2 dominant is to test the cytokines.
But what does someone do with the information they receive after testing for cytokines? Well, there are some studies which show that certain nutrients and herbs can help to stimulate Th1 cells, while other nutrients and herbs can stimulate Th2 cells. And so for example, if a doctor is working with someone who has Hashimoto’s and does cytokine testing, and this shows that the person is Th1 dominant (has an excess of Th1 cells), then this doctor might recommend nutrients and herbs that stimulate the opposite pathway (Th2), while at the same time tell the patient to avoid nutrients and herbs that stimulate Th1 cells.
What Is Nuclear Factor Kappa B?
Inflammation involves numerous signaling pathways which involve the regulation of both pro- and anti-inflammatory cytokines. Nuclear Factor Kappa B (NFkB) is a transcription factor that plays an important role in helping to regulate inflammation. The activation of NFkB is a normal process, but with autoimmune conditions what happens is that NFkB becomes chronically activated, which makes it more challenging to control the inflammation. And when dealing with autoimmune thyroid conditions such as Graves’ Disease and Hashimoto’s Thyroiditis, one of the primary goals should be to downregulate NFkB, which can be accomplished through the use of certain nutrients and herbs.
The Flaws With Trying To Balance The Th1 and Th2 Pathways
Using nutrients and herbs to balance the Th1 and Th2 pathways might sound like a good idea, but there are flaws to taking this approach. For example, some sources label turmeric and resveratrol as stimulating the Th2 pathway, which should suggest that they should be avoided in people with Th2 dominant conditions, including Graves’ Disease. However, other sources show that these can inhibit both Th1 and Th2 cytokines (1), and both turmeric and resveratrol also help to increase regulatory T cells and decrease Th17 cells, which can suppress autoimmunity. Over the years I’ve had many of my patients with Graves’ Disease take turmeric and/or resveratrol without having a negative effect on their recovery.
Another example involves the herb Echinacea, which can stimulate the Th1 pathway, and thus might be problematic for those with Th1 dominant conditions, including Hashimoto’s Thyroiditis. I will admit that I don’t give Echinacea often to my Hashimoto’s patients, although it’s not necessarily because I’m fearful of this herb worsening their condition. There are a few well known and competent healthcare professionals who willingly give Echinacea to their patients with Hashimoto’s Thyroiditis, and they claim that this usually doesn’t cause any negative effects on their health. Master herbalist Kerry Bone, who is the author of a few textbooks on herbal medicine, doesn’t seem to be concerned about Echinacea worsening a condition such as Hashimoto’s. Not too long ago I attended a seminar conducted by Ronda Nelson, who has many years of experience working with Hashimoto’s Thyroiditis and other endocrine conditions, and she recommends Echinacea to many of her patients with Hashimoto’s Thyroiditis.
I’m not suggesting that there isn’t any validity to the Th1/Th2 balancing theory, as I have come across patients with both Graves’ Disease and Hashimoto’s Thyroiditis who didn’t do well when taking certain nutrients and herbs. This doesn’t mean that it was due to the agent stimulating the Th1 or Th2 pathway, although perhaps this was the case. Without question this remains a controversial topic.
How Do You Test For Cytokines?
There are a few labs that offer cytokine panels. True Health Labs and Life Extension are two companies I know of that offer testing for cytokines. If anybody reading this is familiar with other companies which offer cytokine testing please feel free to post the name of the company/lab in the comments section below.
Th1 vs. Th2 Cytokines
What I’d like to do here is present a list of some of the more well known cytokines associated with the Th1 and Th2 pathways:
Tumor necrosis factor (TNF) alpha
Interferon gamma (IFN-y)
How Do You Inhibit These Cytokines?
From a conventional medical standpoint, selective cytokine inhibitory drugs are one option. There are also TNF-alpha inhibitors, which specifically bind to and inhibit the cytokine TNF-alpha. However, non-steroidal anti-inflammatory drugs (NSAIDs) can also inhibit cytokines. Of course these drugs come with potential side effects, and one reason is because you don’t want to completely inhibit these pathways. The real goal is to address the cause of the problem while trying to do things to reduce, or downregulate pro-inflammatory cytokines.
Fortunately, there are nutrients and herbs which can help to accomplish this, and these are some of the more well-researched ones:
Turmeric. There is plenty of evidence which shows that turmeric can help to inhibit NFkB and reduce proinflammatory cytokines (2) (3) (4), and it also can help to increase regulatory T cells while decreasing Th17 cells (5).
Vitamin D3. There is evidence that a vitamin D deficiency is associated with increased levels of pro-inflammatory cytokines (14), and reduced levels of anti-inflammatory cytokines (15). In addition, vitamin D might help to increase regulatory T cells (16) (17), and reduce Th17 cells (18) (19).
Alpha lipoic acid. Numerous studies show that alpha lipoic acid can reduce pro-inflammatory cytokines such as TNF-alpha, while downregulating NFkB (20) (21) (22). There is also evidence that alpha lipoic acid can suppress the number of Th17 cells, while increasing the number of regulatory T cells (23).
Probiotics. Certain strains of probiotics can help to reduce inflammation by reducing pro-inflammatory cytokines and modulating NFkB (24). Some probiotics, including Lactobacillus reuteri and Lactobacillus casei, have been shown to increase regulatory T cells (25).
Green Tea. Studies show that the green tea polyphenols can help to downregulate NFkB and increase regulatory T cells (26) (27) (28). In fact, the studies show that even decaffeinated green tea, which has reduced catechin content, doesn’t necessarily reduce its ability to inhibit NFkB (28).
Gamma-linolenic acid. Although most omega-6 fatty acids are considered to be pro-inflammatory, this isn’t the case with gamma-linolenic acid (GLA). Studies show that GLA can decrease proinflammatory cytokines (29) (30). Some excellent sources of GLA include borage oil, evening primrose oil, and black currant seed oil.
You might have noticed that in addition to reducing pro-inflammatory cytokines, many of the nutrients/herbs I mentioned in this post increase regulatory T cells and decrease Th17 cells. I’ve spoken about these in past articles and blog posts, as regulatory T cells help to suppress the autoimmune response, while Th17 cells promote autoimmunity. The good news is that some of the same nutrients and herbs which reduce proinflammatory cytokines will also increase regulatory T cells and decrease Th17 cells:
In summary, while some healthcare professionals recommend for their patients to get tested for cytokines to determine if they are Th1 or Th2 dominant, this has certain limitations. Although autoimmunity involves an imbalance of the Th1 and Th2 pathways, it is difficult to balance these pathways by using specific nutrients and herbs. And in my opinion, this is the only reason to test for cytokines in the first place. I personally don’t have my patients test for cytokines. With regards to reducing pro-inflammatory cytokines (and increasing Tregs and decreasing Th17 cells), natural agents which seem to benefit many people with both Graves’ Disease and Hashimoto’s Thyroiditis include turmeric, resveratrol, vitamin D3, alpha lipoic acid, probiotics, and green tea.
Hypothyroidism is characterized by elevated thyroid stimulating hormone (TSH) levels. When someone has an “overt” case of hypothyroidism, in addition to the TSH being high, the thyroid hormone levels will be low. Many people have subclinical hypothyroidism, and this is when the TSH is elevated, but the thyroid hormone levels are fine. Regardless of what type of thyroid condition someone has, the goal is to do more than just to lower the TSH. In fact, one can argue that in most cases, the TSH is one of the least important markers to look at, although many medical doctors still rely on this alone. But with that being said, when someone follows a natural treatment protocol we do want the TSH to eventually normalize.
Before talking about some of the reasons why your TSH levels might remain high, even after receiving conventional or medical treatment, it’s important to understand that you can’t rely on the lab reference range. In other words, many times the TSH is within the lab reference range, but is outside of the functional reference range. For example, Labcorp currently uses a reference range of 0.40 to 4.50 mIU/L. However, many consider anything over 3.0 to be too high, and most natural healthcare professionals prefer the TSH to be between 1.0 and 2.0.
So with that being said, let’s go ahead and discuss seven reasons why your TSH might still be high:
Reason #1: Your thyroid antibodies are still high. Most people with hypothyroidism have Hashimoto’s Thyroiditis, which is an autoimmune condition that involves the immune system attacking the thyroid gland. This damage is what leads to the decreased production of thyroid hormone, and this in turn causes the TSH to increase. As I mentioned in the opening paragraph, sometimes the thyroid hormone levels will be within the lab reference range, even when the TSH is high. In fact, most people with Hashimoto’s don’t even know they have this condition initially, as what frequently happens is that their TSH levels will be tested and are on the high side, and then the thyroid peroxidase (TPO) and/or thyroglobulin antibodies are eventually tested, and when the TSH is elevated and one or both of these autoantibodies are elevated this is what leads to the diagnosis of Hashimoto’s Thyroiditis.
There is thought to be a 3-legged stool of autoimmunity, which includes 1) a genetic component, 2) an environmental trigger, and 3) a leaky gut. When someone has Hashimoto’s Thyroiditis, or any other autoimmune condition, there of course is nothing they can do to change their genes. However, this doesn’t mean that you can’t reverse the autoimmune component by detecting and removing the trigger, along with healing the gut. This admittedly can be challenging to do, but it is possible for those who are willing to take responsibility for their health. And when the elevated TSH is caused by the autoimmune component of Hashimoto’s Thyroiditis, the only way to lower the TSH is by reversing the autoimmune component, or by taking thyroid hormone medication.
Reason #2: Problems converting T4 into T3. On a thyroid panel this might present as a high TSH, normal T4, and low T3. And the reverse T3 is commonly on the high side, although not always. As for why someone might have a conversion problem, there can be numerous reasons. Some of the different factors which can affect the conversion of T4 into T3 include a selenium deficiency, liver problems, gut dysbiosis, stress, certain medications, and even inflammation. I discussed these factors in greater detail in a blog post I wrote entitled “6 Factors Which Can Affect The Conversion Of T4 To T3”.
Reason #3: One or more nutrients important for the production of thyroid hormone are deficient. These include iodine, tyrosine, and iron. As a result, if someone has one of these nutrient deficiencies then this can lead to decreased production of thyroid hormone, which in turn will cause an elevated TSH.
Reason #4: Environmental Toxins. There are tens of thousands of chemicals in our environment, and unfortunately we don’t know the short and long term impact of all of these on our health. But we do know that certain environmental toxins act as endocrine disruptors, including bisphenol A (BPA) and flame retardants. Other toxins which can inhibit thyroid hormone production and thus lead to an elevated TSH include bromide, fluoride, perchlorate, and even heavy metals such as mercury. And while you can’t completely avoid these and other chemicals, you can do things to minimize your exposure to them.
This is especially true in your own home, as you can try to purchase mostly organic food, and use natural products. You can also invest in a water purification system which also helps to minimize your exposure to these toxins. And in addition to reducing your exposure to these chemicals, you can also support your detoxification pathways by eating an abundance of green vegetables, eating garlic, drinking plenty of water, along with some green tea, and perhaps even taking some supplements on an occasional basis to help with the elimination of toxins, such as N-acetylcysteine.
Reason #5: Thyroid hormone resistance. When someone has thyroid hormone resistance the TSH will usually be normal or elevated, and the thyroid hormone levels are also frequently elevated. This isn’t too common, and sometimes it will confuse medical doctors, as when the TSH is elevated it is typical to see the thyroid hormone levels on the low side. This is similar to insulin resistance, which is when the cells are no longer responsive to insulin. With thyroid hormone resistance, the thyroid cell receptors aren’t as responsive to thyroid hormone. As a result, the thyroid hormone levels build up in the circulation, but because the body isn’t utilizing thyroid hormone the pituitary gland looks at this as if it were a thyroid hormone deficiency, and thus will continue to secrete TSH, which in turn signals the thyroid gland to secrete more thyroid hormone. For more information on this condition I would check out my blog post entitled “Thyroid Resistance and Natural Treatment Solutions”.
Reason #6: Dysregulation of the Hypothalamic-Pituitary-Thyroid (HPT) Axis. Remember that thyroid stimulating hormone is secreted by the pituitary gland, and not the thyroid gland. Under normal circumstances the hypothalamus communicates with the pituitary gland through thyrotropin releasing hormone (TRH), and the pituitary gland will secrete TSH, which will signal the thyroid gland to produce thyroid hormone. However, if there is miscommunication between the hypothalamus and pituitary gland then this can lead to an elevation of the TSH levels, even if the thyroid gland is perfectly healthy. Unfortunately this isn’t something that is easily measured, and so it can be challenging to know if someone has HPT axis dysregulation.
Reason #7: Pituitary Tumor. Fortunately this is rare, but some people have a TSH-secreting adenoma, also known as a thyrotropinoma. This is usually benign, and like thyroid hormone resistance, the patient usually presents with an elevated TSH, along with elevated thyroid hormone levels. The TSH secretion by thyrotropinomas shares many characteristics of other pituitary hormone-secreting adenomas, such as abnormalities in growth hormone and/or prolactin (1).
In summary, there are numerous factors which can cause elevated TSH levels. Seven common reasons include 1) the immune system attacking the thyroid gland, 2) problems converting T4 into T3, 3) having a deficiency of iodine, tyrosine, or iron, 4) exposure to certain environmental toxins, 5) thyroid hormone resistance, 6) HPT axis dysregulation, and 7) having a TSH-secreting adenoma. So the obvious goal should be to find out what’s causing the elevated TSH, and then to try to address the cause. However, while it of course is desirable to have a normal TSH, it’s also important to understand that other markers can be even more important to look at, and therefore one should never just test the TSH alone.
Most people reading this are aware of the risks of bisphenol A, also known as BPA. This chemical is commonly found in plastic bottles, but it’s also found in other materials as well, including thermal paper receipts. While many people minimize their exposure to BPA by using BPA-free products, some don’t realize that “BPA-free” doesn’t equal “xenoestrogen-free”. In fact, bisphenol S and bisphenol F are found in BPA-free products, and might be even worse than BPA, which I’ll discuss in this blog post.
But I’d like to start off by talking about bisphenol A. Bisphenol A (BPA) is a chemical commonly found in plastic water bottles, but there are many other sources as well, including food packaging, dental materials, healthcare equipment, thermal paper (i.e. receipts), as well as toys and articles for children and infants (1). Due to its phenolic structure BPA has been shown to interact with estrogen receptors, and thus can play a role in the pathogenesis of numerous endocrine conditions, including male and female infertility, hormone dependent tumors (i.e. breast and prostate cancer), polycystic ovarian syndrome (PCOS), and other metabolic conditions (1). This is why it is labeled as being an “endocrine-disrupting chemical”.
In addition to interacting with estrogen receptors, numerous studies show that BPA can also have a negative effect on thyroid health. One study showed that BPA may alter thyroid function, leading to thyroid abnormalities, including subclinical hypothyroidism and perhaps even thyroid nodules (2). Another study showed evidence that BPA exerts a direct effect on the thyroid follicular cell (3). Yet another study showed that BPA might penetrate the placental barrier and therefore affect the endocrine system of the fetus (4).
Structural Analogs To BPA
A structural analog is a compound that has a similar structure to another compound, with a slight difference. However, it’s important to understand that even though structural analogs might be chemically similar, they can have different physical and biochemical properties. There are numerous structural analogs to BPA, including bisphenol B (BPB), bisphenol E (BPE), bisphenol F (BPF), and bisphenol S (BPS) (5).
The reason why I’m bringing this up is because many people realize that there are risks associated with BPA, and as a result they use BPA-free products. For example, many people drink out of BPA-free plastic bottles, thinking that this is a safer option than drinking out of “regular” plastic bottles. However, studies show that these structural analogs (BPB, BPE, BPF, etc.) have the same effects on the estrogen receptor and androgen receptor as BPA, and most of the alternatives are just as potent as BPA (5).
Admittedly there isn’t as much research on these structural analogs as there is on BPA, and I wasn’t able to find any studies showing a direct negative effect on thyroid health. But the evidence that is available shows that these other compounds are endocrine disruptors like BPA, and I’m sure in the future there will be many more studies which show that it’s best to avoid products that include these chemicals.
What Can You Do To Minimize Your Exposure To These Chemicals?
So what can you do in order to avoid exposure not only to BPA, but to the structural analogs? Well, in this day and age complete avoidance is very difficult, but here are a few suggestions to minimize your exposure:
1. Try not to drink out of plastic water bottles on a regular basis. Obviously it would be best not to drink out of plastic bottles at all, but I realize that sometimes it might be difficult to avoid doing this. For example, if you visit a different country with a questionable water supply, then I’d rather be exposed to the BPA in water bottles than to risk getting sick from drinking the water.
2. Minimize the use of other plastics. For example, plastic wrap usually contains BPA, and perhaps some of the structural analogs. Plastic food storage containers are usually another source, and you even want to minimize the use of plastic utensils. Once again, I realize that completely avoiding all sources of plastic is probably not going to happen, but you want to do everything you can to minimize your exposure to these.
3. Don’t ask for a receipt every time you make a purchase. Numerous studies show that thermal paper receipts (i.e. cash register receipts) can contain high levels of BPA (6) (7) (8). Other sources may use thermal paper with BPA as well, including movie tickets.
4. Be aware of other “hidden” sources of BPA. Other sources of BPA you might not be aware of include some canned foods, dental sealants (9), soda cans, and toilet paper.
In summary, bisphenol A (BPA) is a chemical commonly found in plastic bottles, as well as other materials, including thermal receipts. BPA is labeled as an “endocrine-disrupting chemical”, and some studies show that it can also have a negative effect on thyroid health. Although many people use BPA-free products, most of these people aren’t aware that these products might have chemicals that are similar in structure to BPA, such as bisphenol B, bisphenol E, bisphenol F, and bisphenol S. So you want to try your best to minimize your exposure to BPA by not drinking out of plastic water bottles, minimizing the use of other plastics, not asking for a thermal paper receipt, and by being aware of other hidden sources of BPA.
Before I was officially diagnosed with Graves’ Disease I knew I was going to take a natural treatment approach. Initially I found out I had hyperthyroidism from my primary care physician, and a couple of months later I saw an endocrinologist, who officially gave me the diagnosis of Graves’ Disease. But even though I had planned on doing things naturally for my condition, at the time I was still skeptical as to whether or not following a natural treatment protocol would help. After all, back then I didn’t know anyone with Graves’ Disease who had successfully restored their health through natural treatment methods.
Fortunately things worked out very well for me, as I was able to get into remission without taking any medication, and years later I have still managed to maintain a state of wellness. And many of my patients have had success in restoring their health back to normal as well. Not everyone is able to avoid taking medication such as Methimazole or Propranolol, but even when someone needs to take medication it is of course still possible to restore one’s health back to normal. The problem is that most people who take the medication don’t do anything to address the underlying cause of the condition, as they simply hope and pray that they will get into remission while taking antithyroid medication. And while some people do get into remission when taking the medication alone, this state of remission is usually temporary.
Unfortunately many people with Graves’ Disease choose radioactive iodine as a first option. And in most cases it’s because the endocrinologist they were working with convinced them that this was the very best option. When I saw an endocrinologist for my Graves’ Disease condition I was fortunate that she didn’t try to pressure me to receive radioactive iodine treatment. Of course even if she did recommend RAI I would have refused it, and I didn’t take the Methimazole she prescribed to me. But many other endocrinologists recommend radioactive iodine to every single one of their patients with Graves’ Disease, which makes me very sad knowing that most of these people could have preserved the health of their thyroid gland if they had just given natural treatment methods a try.
The Problem With Receiving Radioactive Iodine As A “First Resort”
But why shouldn’t radioactive iodine be the first treatment option? After all, hyperthyroidism can be a very scary condition to deal with. After I found out I had hyperthyroidism I not only was in a state of disbelief, but I also was terrified. And this was without an endocrinologist telling me that if I don’t get my thyroid gland “nuked” there is a chance I would experience a thyroid storm, or perhaps even a heart attack. The obvious “benefit” of radioactive iodine is that it usually will eliminate hyperthyroidism, and thus will remove the risk of having a thyroid storm, along with other conditions associated with an increased heart rate.
Of course the downside is that radioactive iodine doesn’t do anything to address the autoimmune component of Graves’ Disease. After all, it’s easy to forget that Graves’ Disease isn’t a thyroid condition, but instead is an immune system condition that affects the thyroid gland. And while it’s important to manage the hyperthyroid symptoms, receiving radioactive iodine won’t do anything to improve the health of the immune system. The research clearly shows that someone with one autoimmune condition is more likely to develop another autoimmune condition in the future. And so it is very important to try to reverse the autoimmune component of Graves’ Disease, and not just focus on managing the symptoms.
How Do You Find The Underlying Cause?
It admittedly can be a challenge to determine the underlying cause of your Graves’ Disease condition. The primary key is to try to detect the trigger or triggers which are responsible for the development of the autoimmune response. Some common examples of triggers include stress, infections, food allergens, and environmental toxins.
There are many things you can do on your own to improve your health, such as clean up your diet, do a better job of managing your stress, and minimizing your exposure to environmental toxins. However, it can be difficult to restore your health on your own. This is why I think it’s wise to consult with a competent natural healthcare professional who has experience working with Graves’ Disease patients, as this will give you the guidance that you need.
On that note, in the near future I will be releasing an online group coaching program for those who have Graves’ Disease. This new program for Graves’ Disease will be an affordable self-management/group coaching program. Although I do think it’s a good idea for those with Graves’ Disease to work one-on-one with a competent natural healthcare professional, I realize that not everyone will choose to do this. And even if you are currently working with a natural healthcare professional I’m sure the information provided in this program will only further help to optimize your health.
If this is something that sounds good to you I would recommend getting on my Reversing Graves’ Disease VIP priority notification list.
Click Here To Join The Reversing Graves’ Disease program VIP Priority Notification List