The primary reason why people choose to follow a natural treatment protocol is to avoid the risks associated with conventional medicine. Although there is a time and place for drugs, surgery, and other conventional treatment methods, these methods of course don’t do anything to address the cause of the problem. However, not everyone who follows a natural treatment protocol will receive optimal results. Many times this is due to the patient not being compliant, although some will do an excellent job of following the doctor’s recommendations and still won’t show much improvement.
When this happens it becomes frustrating to both the doctor and patient. Some doctors take pride in dealing with “tough cases”, and although I do work with a lot of tough cases, I think most doctors would prefer those cases when someone gradually improves without any setbacks. Don’t get me wrong, as I like dealing with challenges, and many cases of thyroid autoimmunity can be complex. However, I still get frustrated when someone is strictly following my recommendations but doesn’t receive optimal results. There can be numerous reasons why someone doesn’t receive optimal results despite following the recommendations of their doctor, but when this happens it usually comes down to one or more of the following five factors:
1. The patient is reacting to a food allergen or antinutrient. If someone’s health isn’t improving then one of the first things they need to do is reevaluate their diet, as there is a good chance one or more food allergens or antinutrients are responsible for the person not progressing. This can occur even if the person is eating a healthy diet. Many people reading this are aware that gluten and dairy are common allergens, and thus if someone has been consuming gluten and/or dairy while following a natural treatment protocol and aren’t receiving optimal results, then these allergens definitely need to be COMPLETELY avoided. This is true even if you haven’t noticed any negative symptoms upon consuming gluten and dairy. And yes, even if you have received testing which showed that you didn’t react to these foods you still want to cut them out.
There are times when I’m working with someone who isn’t progressing as expected, and they have been strict about avoiding gluten and dairy. Many times they have avoided these allergens for a few months or longer. If this is the case then they need to look at the possibility of other foods causing a negative reaction, such as corn, soy, eggs, and even gluten-free grains. For example, someone might have eliminated gluten, dairy, corn, and soy, but after doing an elimination diet find out they have a sensitivity to rice. And if they were consuming rice, even a few times per week, then this can cause gut inflammation and affect their recovery. Obviously this is just an example, but it of course is possible to have a negative reaction to rice, as well as other gluten free grains.
If someone has a leaky gut, then eating nuts, seeds, and legumes can slow down their progress. This usually isn’t due to a food intolerance, as these all have antinutrients which interfere with the absorption of minerals. In addition, antinutrients such as lectins can cause further damage to the gut. And so if someone has avoided all of the common allergens, but is still eating nuts, seeds, and/or legumes, then this can affect one’s recovery. Some people also react to the nightshade family of foods. These include tomatoes, eggplant, white potatoes, and most peppers. These also have substances which can cause a leaky gut.
How can someone tell if they have a food allergy or intolerance? It can be challenging to tell if someone has a food allergy or intolerance. As for a food allergy, this can be detected through IgE testing, and is usually conducted in an allergist’s office. Besides the fact that IgE testing isn’t always accurate (1) [1] (2) [2], delayed food intolerances are far more common. And while there are numerous food intolerance panels available, none of these are completely accurate either. This doesn’t mean that they don’t have some value, but false negatives are common, and if someone has a leaky gut this can also affect the results.
2. There is an underlying infection. If someone has ruled out food allergies and intolerances as a potential cause of their problem, and have eliminated the antinutrients I mentioned, then they will want to try to see if they have some type of infection. Some healthcare professionals will initially do testing for infections, as a lot of functional medicine doctors will run a comprehensive stool panel to see if there are any bacterial infections, yeast, or parasites. Although I do run a comprehensive stool panel every now and then, I don’t initially do this testing on all of my patients because 1) they are very expensive, and 2) they almost always come out negative for the presence of pathogenic bacteria, yeast, and parasites. Sure, the test might reveal gut inflammation, or a deficiency of short chain fatty acids, but I usually assume that most of my patients have gut inflammation, and while it’s also common to have an imbalance of the short chain fatty acids, in my opinion it’s not worth a few hundred dollars to test for this.
I’m not being critical of those doctors who do this type of testing on all of their patients. Quite frankly, it probably is a good idea to do such testing on someone who has obvious gastrointestinal symptoms. The problem is that the lack of gastrointestinal symptoms doesn’t mean that the person doesn’t have pathogens in the gut, which is why some healthcare professionals choose to have all of their patients obtain this test. On the other hand, a negative test for pathogens doesn’t necessarily mean the person doesn’t have an infection. For example, I’ve had patients with symptoms of a yeast infection test negative for such an infection on a stool panel, and then not too long after this have a test for yeast show up positive on a blood or urine test. Similarly, parasites aren’t always detected in the stool. In fact, this is the main reason why many labs will offer a 3 or 4-sample stool test. Collecting a stool sample on three or four different days will reduce the likelihood of a false negative, although false negatives still remain a possibility, even with testing multiple stool samples on different days.
Plus, most comprehensive stool panels won’t test for all of the pathogens which can be detected in the stool. For example, many labs offer both H. Pylori and C. difficile as “add-ons”, and other bacteria might need to be added as well. This of course means that it can cost a lot more money if you want to test for everything the lab offers. In addition, one also needs to keep in mind that not all chronic infections can be detected in the stool. Some examples include Lyme disease, Epstein Barr, and Cytomegalovirus. It would be great if there was a lab which offered a comprehensive panel for infections which included both blood and stool testing, and tested for most of the common pathogenic bacteria, viruses, fungi, and parasites.
So that brings up the question, “is there a surefire method for detecting a chronic infection?”. Unfortunately the answer to this question is “no”. And so there are a few options. One option is to do as much testing as possible, including blood tests and stool testing. The problem is that if you don’t have health insurance then doing all of this will be very expensive, and this still might not completely rule out an infection. What approach do I take? Well, I think it’s a good idea to start with the basics, such as a complete blood count with differential. This of course won’t determine if someone has a specific infection, but it sometimes can give an idea if someone is having an acute or chronic bacterial or viral infection, and sometimes even a parasitic infection if the eosinophils are elevated. If this test reveals a potential infection then I will consider further testing. If someone has overt gastrointestinal symptoms then I might do a stool panel, although I’m well aware of the limitations I mentioned above. If I think there’s a strong possibility someone has an infection I might just put them on a dysbiosis protocol and see how they respond. Or I might run an organic acids test, which looks at certain markers of dysbiosis.
3. Chronic stress is an issue. I probably should have listed this first, as stress is a common reason why many people don’t progress as expected. Although some healthcare professionals might frequently use chronic stress as an excuse for a person’s symptoms or lack of progress, the truth is that chronic stress does affect the biochemistry. In other words, the emotional component of stress can have a dramatic effect on someone’s health. And for someone who is dealing with a thyroid or autoimmune thyroid condition, the fact that they have a chronic health condition only increases their stress levels. It’s not so much the stress itself that is a problem, as everyone deals with acute and chronic stressors. What’s important is the person’s perception of the stressor, and it’s essential for people with thyroid and autoimmune thyroid conditions to truly become an expert in handling stress if they want to restore their health, and maintain their health thereafter.
In fact, I’ve had some patients get to the point where they were symptom free and all of the labs were negative, but then a very stressful situation came along, and they relapsed. This might sound discouraging to some people reading this, as you might be thinking to yourself “why would I want to follow a natural treatment protocol if there’s a chance that being exposed to a stressor will result in a relapse?” After all, everyone will eventually have to deal with an acute or chronic stressor such as financial problems, a divorce, a trauma, the loss of their job, a death of a family member or close friend, etc. While it’s just about impossible to prepare for all of the different stressors you will eventually have to deal with, if you become an expert in managing the stress then you will do a much better job of handling these future stressors.
It really is no different than eating well, as while some people are able to change their eating habits in one day, for others it takes time to accomplish this. Some people need to make gradual changes in their diet over a number of weeks or months before they are eating mostly whole foods, and minimizing their consumption of refined foods and sugars. The same concept applies when it comes to improving your stress handling skills, as it takes time to become an expert in managing stress. Truth to be told, I still don’t consider myself to be an “expert” when it comes to stress handling, although I’ve made some great strides over the years. If stress is an issue, you need to make stress management a priority if you want to receive good results. And the only way to truly become a master at handling stress is to block out some time every day to work on stress management. I discussed this in greater detail in my blog post entitled “Blocking Out Time To Manage Your Stress Is Essential [3]“.
4. Genetic polymorphisms. Although lifestyle and environmental factors seem to play a greater role than genetics in the development of most chronic health conditions, one still can’t dismiss the genetic component. And when someone isn’t responding as expected to a natural treatment protocol, there is a possibility that a genetic polymorphism is the reason behind this. A genetic polymorphism is a genetic defect that commonly affects a certain percentage of the population.
Having certain genetic polymorphisms can affect phase 1 and phase 2 detoxification, the immune system response, the metabolism of folate, vitamin and hormone receptors, and even DNA repair enzymes. So for example, a toxin such as mercury might have triggered an autoimmune response in a person with a polymorphism affecting the detoxification pathways. This person might have received months of chelation therapy, but still hasn’t noticed an improvement in their symptoms because their body isn’t doing a good job of eliminating the mercury due to the genetic polymorphism, which in turn is affecting the detoxification pathways.
I also mentioned how certain genetic polymorphisms can affect the immune system response. Proinflammatory cytokines are a factor in autoimmunity, and someone can have genetic polymorphisms of these cytokines. I’ve spoken about the Th1 and Th2 pathways in past articles and blog posts, and you can have polymorphisms of Th1 cytokines such as IL-2 and TGF-B1, and Th2 cytokines such as IL-6 and IL-10 (3) [4]. So if someone isn’t responding then it’s possible that they have one or more polymorphisms which are affecting their progress.
But how can someone tell if they have certain genetic polymorphisms? Testing is available for the more common polymorphisms. For example, many people reading this are familiar with the MTHFR polymorphism, and many labs offer testing for this. The company Genova/Metametrix offers testing for certain polymorphisms. For example, they have an “ImmunoGenomic Profile”, which will measure some of the Th1 and Th2 cytokines such as TNF-alpha, IL-4, IL-6, IL-10, etc. They also have a “DetoxiGenomic Profile”, which tests for a few dozen of the most common polymorphisms relating to detoxification. I can’t say I routinely do this type of testing on my patients, but it’s something to consider if someone isn’t responding as expected.
5. Toxic overload. Many of my patients initially will do things for detoxification. However, while this of course is beneficial, many times the person needs to be more aggressive in eliminating toxins from their body. First of all, we need to keep in mind that different people are exposed to a different amount of toxins. And while there are some tests available to measure the levels of certain toxins, it’s impossible to measure ALL of the different toxins. So for example, if someone obtains a hair analysis or a urine test to look at heavy metals, and if such testing reveals low levels of mercury, arsenic, and other toxic metals, this doesn’t necessary mean that they have low levels of other types of toxins.
A second factor to consider is that some people eliminate toxins better than others. As a result, if two people are exposed to the same level of toxins, one person might do a very good job of eliminating toxins, while the other person might not do a good job of eliminating toxins. There can be a few reasons for this. One reason could be that one person has higher levels of glutathione, which plays an important role in the detoxification pathways. Genetics can also be a factor. As I mentioned earlier, if someone has a certain genetic polymorphism then they might not be able to eliminate toxins as efficiently as another person, and this also can be related to glutathione production.
A third factor to consider is that people react differently to toxins. So for example, one person might have a severe reaction to a small amount of a specific toxin, while another person might not react to a large amount of the same toxin. In the past I’ve mentioned the Chemical Immune Reactivity Screen from Cyrex Labs. Although I admit this isn’t a test I commonly order, it’s a very interesting test, as it measures the immune system response to some of the more common toxins, such as mercury, arsenic, lead, formaldehyde, bisphenol A, parabens, and isocyanate.
In any case, if someone follows a natural treatment protocol recommended by their doctor and still isn’t receiving optimal results, toxins need to be considered. And it’s also important to keep in mind that some people have more than one health issue going on simultaneously. For example, it’s common for people with Graves’ Disease and Hashimoto’s Thyroiditis to have a leaky gut, along with intestinal dysbiosis. However, their bodily tissues might also be overloaded with toxins. And so when someone has a leaky gut I will focus on repairing the gut and correcting any dysbiosis. Once the gut has been healed and the dysbiosis has been corrected, if the person is still symptomatic and/or still has elevated thyroid antibodies, then toxins need to be considered. Although I might give some recommendations to help the person boost glutathione levels while repairing the gut, this might not be sufficient.
In some of my past articles and blog posts I’ve mentioned Dr. Walter Crinnion, as he is a naturopath who focuses on detoxification. He has been in practice for around 30 years, and while I was working towards my masters of science in nutrition degree he was the instructor for my biotransformation and detoxification course. He is a big proponent of both sauna therapy and colon hydrotherapy. In fact, he said if he had to choose one method of detoxification it would be colon hydrotherapy. Although colon hydrotherapy can be very effective in removing toxins, the problem is that you don’t want to receive colon hydrotherapy if you have a leaky gut. And so you first need to correct the leaky gut, and then if necessary receive colon hydrotherapy. While I personally don’t recommend colon hydrotherapy to most of my patients, it can be an excellent method of eliminating toxins.
Even if you get aggressive and utilize a combination of supplements (i.e. milk thistle, NAC, etc.), sauna therapy, and colon hydrotherapy to eliminate toxins, it can still take many months to notice results. In his book Clean, Green, and Lean Dr. Crinnion talks about how he commonly sees the autoantibodies of patients normalize after putting them on a comprehensive program to eliminate toxins. The downside is that this does take time, and even he admits that for some people it can take a couple of years before they receive optimal benefits from a detoxification program.
In summary, it can be frustrating when someone is strictly following the recommendations of their doctor, yet for some reason isn’t progressing as expected. There are numerous reasons why someone’s health doesn’t improve, but five common factors include 1) the person is reacting to a food allergen or antinutrient, 2) there is an underlying infection, 3) chronic stress is an issue, 4) they have one or more genetic polymorphisms, and 5) toxic overload. It can be challenging to find out which of these factors is responsible for the patient’s lack of progress, but doing so is of course necessary to help them restore their health.