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Hashimotos Types

In this first post of this series we will examine different Hashimoto’s types and explore the possibility of different types or subtypes of the disease in women.

Autoimmune thyroid disease is the most common autoimmune disease in the US and it affects an estimated 2% of the female population and an estimated 0.2% of the male population.

That’s roughly 3.08 million women in the US. Yet, for some reason all of these cases are treated the same way in the conventional medical model.

If it is determined that they are hypothyroid (their TSH is high and their total T4 is low), then they are prescribed synthetic T4 (Synthroid or a generic equivalent).  From there, their TSH and total T4 is monitored and managed and kept within a certain range (which many doctors don’t agree on). That’s the full extent of care.

The Conventional Approach Ignores Hashimoto’s Types

Actually there are many problems with this approach, but the biggest one is that it ignores two fundamental truths.

Firstly, not all of these people are at the the same stage of progression of the disease. Hashimoto’s is a progressive disease, if untreated or poorly managed it can progress and advance and cause widespread damage in the body. (More on this in a moment.)

Secondly, not everyone who has Hashimoto’s is at the same place in their lives. Women, in particular go through major changes in their lives in adolescence, pregnancy, peri-menopause and in their later years of menopause.

It is common knowledge that the endocrine system, the immune system and the central nervous are all impacted by these changes of life.

Why, then, wouldn’t Hashimoto’s be effected, also?

Hashimoto’s Can Be Different at Different Stages

Well, the truth is, that Hashimoto’s is impacted by different stages in life and these changes can provide important clues on how to better manage the disease and how to prioritize and focus care.

Let’s examine this theory and review the different stages of autoimmune disease and Hashimoto’s.

3 Stages of Hashimoto’s:

In the medical literature several different researchers have identified 3 stages of Hashimoto’s disease.

Dr. Datis Kharrazian has proposed 3 stages of autoimmunity and researchers Arvin Parvathaneni, Daniel Fischman and Pramil Cheriyath has identified 3 stages of Hashimoto’s, as well.

Both theories overlap and this matters because the further the disease progresses the more it impacts other systems of the body.

Here’s an excerpt from my book, Roadmap to Remission which details this progression:

Stage 1: Silent Autoimmunity

In this stage, the body has lost tolerance to its own tissue, but there are no symptoms yet and it doesn’t really affect the way that the system functions. This stage can, however, be identified by lab tests that show elevated antibodies. People can stay in this stage for years.

This is the best place to begin some sort of treatment aimed at prevention, because your odds of getting good results are highest.
Physiologically, in this stage thyroid specific antigens are presented to antigen presenting cells (APCs) by thyroid cells, often after some kind of insult or environmental stressor(s). (For example, infection(s), excessive iodine, pregnancy, toxins in cigarette smoke, etc.)

Stage 2: Autoimmune Reactivity

In this stage, the destruction of the target tissue has begun. Elevated antibodies and some symptoms appear. However, the destruction is not significant enough to actually be labeled autoimmune disease because 70–90 percent of the target tissue has not yet been destroyed. This stage is where a lot of Hashimoto’s patients are.

They may or may not have been placed on thyroid replacement hormone, and that may or may not have normalized their thyroid lab results. However, the destructive autoimmune process is active and is progressing.

This is a very important stage for treating the immune dysfunction, because you have a greater chance to slow or stop the destruction of that tissue and slow the progression to other autoimmune diseases.

Physiologically, this is the stage where APCs (Antigen Presenting Cells) differentiate into T cells and B cells and begin the process of destruction.

Stage 3: Autoimmune Disease

This stage is where Western medicine finally acknowledges the autoimmune disease. And it takes this long, because you need significant destruction of tissue in order to see the destruction with an MRI or ultrasound.

Other findings include elevated antibodies, serious and significant symptoms, lab results, and special studies that all confirm a loss of function. Unfortunately, this is really late in the game. With Hashimoto’s, this stage is where the thyroid is almost completely destroyed.

Luckily, most people don’t reach this stage before they have been given thyroid replacement hormone, because the symptoms have already become so serious that they will have sought out a doctor to help them before they got here.

Finally, this is the stage, physiologically, where positive feedback has led to massive destruction of the thyroid gland and major loss of function in other systems of the body. T cells have induced cytotoxicity, and B cells have produced antibodies that have led to apoptosis or programmed cell death of thyroid cells, and macrophages have infiltrated the thyroid and started producing the interleukin proteins we spoke about earlier.

You Can Be at Any Stage at Any Time in Your Life

The reality is that Hashimoto’s can begin at any time in a woman’s life and during the different changes that her body goes through there are different challenges and stressors that can exacerbate or complicate the disease.

In studying the medical literature and in examining my patient population (at the time of writing this blog post I have spoken with over 2,000 people with Hashimoto’s, 99% them have been women, and I have treated over 500 women).

Five Hashimoto’s “Types”

I have identified five different times of life for the onset and/or exacerbation of Hashimoto’s that could represent “types” or “subtypes” of Hashimoto’s patients.

1. Age 22 and under: “Hashi-Tweens”

The onset for this age group is most commonly mid-puberty. (Although we are seeing an increase in the prevalence of children diagnosed with the disease.)
Of course, puberty is a time of many hormonal changes, which can also impact the immune system and the nervous system and brain.

These young women have many of the common symptoms of Hashimoto’s and hypothyroidism and may also have developmental disorders if the disease has gone undiagnosed or it began earlier in childhood.

Common symptoms include:

  • Goiter
  • Poor linear growth (thyroid disorders usually effect height more than weight)
  • Delayed bone maturation
  • Puberty disorders
  • Irregular menstrual periods
  • Lethargy and/or impaired school performance
  • Fatigue
  • Bradycardia and decreased cardiac output
  • Constipation
  • Cold intolerance/Hypothermia
  • Fluid retention and weight gain (due to impaired renal free water clearance)
  • Puffiness of the face
  • Dry skin
  • Increased body hair
  • Delayed deep tendon reflexes

According to an Italian study,  the evaluation of these patients, according to their final outcome, revealed that subjects with deteriorating thyroid function had significantly higher anti-TG antibodies, TSH concentrations, and greater thyroid volume at presentation. And after 5 years, more than 50% of the patients remained or became euthyroid (meaning they had a normally functioning thyroid gland).

So this can resolve, and never be a problem again or it can resurface later in life. One of the life events that leads to it resurfacing and/or is a cause for onset all by itself is pregnancy.

2. After Pregnancy: “Hashi-Moms”

In pregnancy, a woman’s body goes through many hormonal changes and the immune system makes large adjustments in order to preserve the fetus and not reject it as a foreign invader.

During the third trimester a pregnant woman becomes TH-2 dominant, then TH-1 dominant after giving birth. This is thought to be due more to the body naturally suppressing TH-1, rather than boosting TH-2.

The Th-1 suppression ends after birth and this causes the immune system to surge. If it is already unstable, this can result in the onset of Hashimoto’s.

Postpartum Thyroiditis

This is inflammation in the thyroid that comes on after pregnancy in about 5 to 7 % of women, usually within two to four months after giving birth.
Interestingly, this is also a form of autoimmune disease. (In fact, these two disorders are very hard to distinguished from one another.)

This usually presents as a painless, small, firm enlargement of the thyroid or goiter. And it can cause either hyper or hypothyroid symptoms.

As noted, this can also lead to postpartum depression because of it’s impact on thyroid function.

Common Symptoms:

During postpartum thyroiditis, there are, potentially two phases. The inflammation and release of thyroid hormone may first cause signs and symptoms similar to those of a hyperthyroid condition, including:

  • Anxiety
  • Fatigue
  • Increased sensitivity to heat
  • Insomnia
  • Irritability
  • Rapid heartbeat or palpitations
  • Tremor
  • Unexplained weight loss

Hyperthyroid symptoms usually happen two to ten months after delivery—most commonly at three months—with recovery taking place over the next two to three months after it begins. It is important to figure out if it’s postpartum thyroiditis or Graves’ disease with proper lab testing.

Later, as thyroid cells are attacked,  signs and symptoms of a hypothyroid condition may develop, including:

  • Lack of energy
  • Increased sensitivity to cold
  • Constipation
  • Dry skin
  • Difficulty concentrating
  • Aches and pains
  • Depression

Hypothyroid symptoms usually happen two to twelve months after delivery—most commonly at six months. About eighty percent of women with postpartum thyroiditis return to normal thyroid function around the one-year mark, however, 30 to 50 percent develop permanent hypothyroidism within nine years.

So again, it can resolve and then resurface later after another pregnancy or another stressful time of life or other life change (see below).

Pregnancy and the Pituitary

Another thing that can cause hypothyroidism with pregnancy is the pituitary becoming depressed. Chronic stressors like food intolerances, blood sugar imbalances, gut infections and out of whack hormones can all depress the function of the pituitary.

And the pituitary is responsible for signaling the thyroid, so when it’s depressed it can fail to send enough TSH to the thyroid. Which means this isn’t a thyroid problem at all. It’s really a pituitary issue. For many women this can result in low thyroid function and depression.

And, of course, proper thyroid hormone levels are also essential for the healthy development of the fetus and infants. Some researchers believe that one factor in the development of autism is severe hypothyroidism in their mothers.

In addition, TPO andtibodies have been found to be a risk factor for complications during pregnancy and beyond.

4. Infertility: “Hashi-Heartbreak”

Another possible type are women who have difficulty conceiving and suffer one or more miscarraiges due to Hashimoto’s and hypothyroidism.

When women have hypothyroidism, a common problem is an increase of another hormone called prolactin. This causes less of a release of LH, and a loss of progesterone receptor site sensitivity, and a loss in sensitivity to FSH in the follicle. All of these losses lead to problems with ovulation, and they also may hamper communication to the pituitary gland.

Using birth control pills on top of this can further harm the communication and feedback loops in this system. Using herbs to stimulate the ovaries or the reproductive system will also not work unless the hypothyroid issues are corrected.

Studies have found that even mild hypothyroidism may cause ovarian problems. Testing thyroid function is very important with women who suffer from infertility, especially if they have elevated prolactin or they can’t ovulate.

Hypothyroidism may lead to low FSH levels, which may lead to immature follicles and infertility. Suppressed LH levels will often lead to problems with ovulation in timing or abnormal luteal phase progesterone levels. These changes may cause miscarriage, depression in the second half of your cycle, or migraines in the second half of your cycle.

To summarize, hypothyroidism can cause:

  •  A decrease in FSH release and FSH receptor sensitivity, this leads to problems with the development of the follicle and infertility
  • Suppressed LH which leads to problems with ovulation and abnormal progesterone levels, this leads to abnormal cycles and infertility
  • Progesterone receptor insensitivity which also leads to abnormal cycles and infertility
  • Increased Prolactin, which leads to problems with ovulation, abnormal menstrual cycles and infertility

There are a number of important issues to address when trying to conceive, here’s a post I wrote on this that goes into more depth on this.

3. Peri-Menopause: “Hashi – Hormone Hurricane”

The changes of life leading up to and during the transition to menopause are another time of life when Hashimoto’s can come on, resurface or progress.
As the ovaries retire and reproductive hormones decline, the adrenal glands step in and take over.

Essentially, what happens is this: FSH (Follicle Stimulating Hormone) receptors in the ovaries begin to lose sensitivity during perimenopause. This leads to changes in levels of FSH and estradiol.

The adrenals, in turn, step in and create more adrostenedione, a steroid hormone and this is converted to estrogen by adipose (fat) tissue.  It’s the body’s way of compensating for declines in estrogen.

Obviously, there is a potential problem here if the adrenals are already taxed or exhausted. A lot more demands are made on them in perimenopause.
So adrenal health is very important prior and during this transitional time.

Here are some of the common symptoms of peri-menopause and how they are connected to Hashimoto’s:

Common Symptoms and their Causes During Perimenopause

1. Systemic inflammation and pain: This is caused by surges in certain immune cells and proteins called cytokines. Cytokines like IL-6, IL-1 and TNF-alpha are all implicated in Hashimoto’s, as well.

2. Multiple food sensitivities, gastrointestinal symptoms: These are often caused by Intestinal permeability or “leaky gut”: This maybe caused by declines in estrogen, increases in cortisol production, hypothyroidism and dysfunction in the gut. Intestinal permeability is ground zero for autoimmunity, as well.

3. More stress, poor sleep, fatigue during the day: The adrenals have to do additional work when other female hormones, like estrogens decline. Adrenals issues are also very common with Hashimoto’s.

4. Poor circulation, cold hands and feet, poor nails beds, fungal overgrowth in nail beds: This is caused by problems with peripheral circulations, especially in the small vessels. And may be due to altered nitric oxide function. These symptoms are also very common with Hashimoto’s.

5. Brain fog, depression, memory loss and poor cognitive function: This is due to inflammation in the brain and deficiencies or declines in neurotransmitters. These are some of the most common symptoms of Hashimoto’s.

6. Hot flashes, night sweats: A hallmark of perimenopause caused by altered FSH (follicle stimulating hormone) and feedback from the ovaries. This is a less common symptom of Hashimoto’s but something many women experience.

7. Poor bone density: This is caused by problems in osteoclast or bone cell formation and other issues. It is also a very real concern for Hashimoto’s patients, as well because osteoporosis can be a side effect of thyroid medication . (One of the major causes of this breakdown in bone health is the cytokines that we spoke about above.)

Here’s a previous post I wrote on this subject that looks into all of these factors in more depth.

The important take away here is to see that all of these issues must be addressed. As I am fond of repeating, this is way more than a thyroid problem.

If these other areas are not addressed, the result is the perfect recipe for compounded problems and more aggressive symptoms and progression of the disease.

 Women 60 and over: “Hashi – Sage”

As women enter their later years the symptoms of long standing hypothyroidism and Hashimoto’s become harder to separate from other aging symptoms.

Analysis of patients with long term hypothyroidism due to Hashimoto’s thyroiditis suggested that metabolism of thyroxine (T4), including conversion (via deiodination) to triiodothyronine (T3), was reduced in the elderly. Consequently, low-T3 syndrome is also common in this population.

Another serious concern is that there are real risks of long term treatment with levothyroixine. Adults aged ≥70 years treated with it have a significantly increased risk of fractures, with a strong dose-response relationship, a Canadian research group has found.

Although autoimmune thyroiditis is the most common cause of hypothyroidism in elderly subjects, other things, such as medications can also cause complications. Unfortunately, many elderly women have been prescribed a number of medications and often doctors to not communicate with one another to determine if there are problems that may result from these different prescriptions.

Medications Can Complicate Hypothyroid Symptoms

A small subset of medications including dopamine agonists, glucocorticoids and somatostatin analogs affect thyroid function through suppression of TSH.
Other medications that may affect TSH levels are metformin, antiepileptic medications, lithium carbonate and iodine-containing medications.

In addition, other drugs can alter T4 absorption, T4 and T3 transport in serum and metabolism of T4 and T3, such as proton-pump inhibitors and antacids, estrogens, mitotane and fluorouracil, phenobarbital and rifampin. Amiodarone administration is also associated with hypothyroidism.

The Immune System Also Ages

As the body ages, many systems of the body also age. The immune system is no exception. Aging of the immune system, or immunosenescence, is characterized by a decline of both T and B cell function, and paradoxically the presence of low-grade chronic inflammation.

Chronic inflammation is at the root of Hashimoto’s and autoimmunity and many other disease such as cardiovascular disease and Alzheimer’s. So, this can have serious health impacts over time and be a factor in the progression of these other diseases.

Other Systems Also Decline

Other systems of the body also decline as the body ages, stomach acid levels tend may lessen, the intestinal lining can break down and commensal bacteria may decline and all of this this can impact thyroid hormone absorption and conversion.

In addition, there are numerous cardiovascular symptoms. These include:

  • Bradycardia
  • Diminished cardiac output
  • Diastolic hypertension
  • Increased LDL
  • Pericardial effusion

There are also a host of psychological issues that are related to the impact of hypothyroidism and autoimmunity on the brain. These include:

  • Lethargy
  • Fatigue
  • Sleep disturbances
  • Poor concentration
  • Cognitive impairment
  • Depression
  • Madness (confusion, paranoia) in severe disease

Finally there are also pulmonary issues. These include:

  • Shortness of breath
  • Sleep apnea
  • Increased susceptibility to lung infections

Bottom Line: There are Unique Circumstances at Different Times of Life

Here’s the important take away from this post. Women with Hashimoto’s at different stages of life are not all the same. And treating them all the same way does not make sense.

When you are diagnosed, the stage you have progressed to and where you are in your life are all important factors in determining the best course of treatment. It’s time we start acknowledging this and looking more deeply into the nuances of patient care.

In the next few posts of this series I will examine how the most common challenges for Hashimoto’s patients (weight gain, fatigue/exhaustion, brain fog and memory/cognitive issues and diet) may be different for these different “types” and how the treatment strategies and priorities might also be different.

We will begin by looking at how the brain is impacted in each of these Hashimoto’s “types”.

References:

http://www.thyroidmanager.org/chapter/hashimotos-thyroiditis/ Stages of disease

http://cdn.intechopen.com/pdfs-wm/28726.pdf 3 Stages of Disease referenced

20 and Under:

http://adc.bmj.com/content/83/3/207.short Prevalence and etiology of hypothyroidism in the young

http://www.hindawi.com/journals/jtr/2011/675703/#B2 Autoimmune Thyroid disease in children

P. Saravanan and C. M. Dayan, “Thyroid autoantibodies,” Endocrinology and Metabolism Clinics of North America, vol. 30, no. 2, pp. 315–337, 2001.

http://www.ncbi.nlm.nih.gov/pubmed/24756046 Natural course of Hashimoto’s in children

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4338651/ Thyroid function in pregnancy

http://www.ncbi.nlm.nih.gov/pubmed/17137901 Natural history of euthyroid in Hashimoto’s patients

http://www.ncbi.nlm.nih.gov/pubmed/11305796 Clinical course of Hashimoto’s in children and adolescents a 6 year follow up.

http://www.ncbi.nlm.nih.gov/pubmed/2189331 51 cases of children and adolescents with Hashimoto’s

Postpartum Thyroiditis:

http://www.thyroid.org/thyroid-disease-pregnancy/

http://www.mayoclinic.org/diseases-conditions/postpartum-thyroiditis/basics/symptoms/con-20035474

http://annals.org/article.aspx?articleid=691332 14 Cases of Transient Postpartum thyroiditis

https://drknews.com/why-pregnancy-can-trigger-hypothyroidism/

http://arbl.cvmbs.colostate.edu/hbooks/pathphys/endocrine/thyroid/thyroid_preg.html Changes in thyroid function during pregnancy

http://www.niddk.nih.gov/health-information/health-topics/endocrine/pregnancy-and-thyroid-disease/Pages/fact-sheet.aspx

http://www.thyroidmanager.org/chapter/thyroid-regulation-and-dysfunction-in-the-pregnant-patient/

http://www.indianjmedsci.org/article.asp?issn=0019-5359;year=2003;volume=57;issue=6;spage=252;epage=258;aulast=Kumar Thyroid function tests in pregnancy

http://www.ncbi.nlm.nih.gov/pubmed/9588218 Shifts in TH-1 and Th-2 during pregnancy

http://www.hindawi.com/journals/mi/2012/416739/ TH-1 suppression rather than TH-2 dominance

Stagnaro-Green A.  Clinical review 152: postpartum thyroiditis.  J Clin Endocrinol Metab.  2002;87:4024-7.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4518419/ TPO antibodies and risk for pregnancy complications

Infertility:

http://www.ncbi.nlm.nih.gov/pubmed/1427622 The role of thyroid hormone in ovulation

http://ttvps.com/saegre/revista/numeros/2010/n2/act_efectos_de_hormonas_tiorideas_n2.pdf Effects of thyroid hormone on ovarian function

Perimenopause and Hashimoto’s:

http://www.ncbi.nlm.nih.gov/pubmed/9356978 Perimenopause and thyroid issues (lipid and weight)

http://www.endocrine-abstracts.org/ea/0029/ea0029p1688.htm

https://www.hashimotoshealing.com/hashimotos-and-perimenopause/

Hashimoto’s in the Elderly:

http://www.ncbi.nlm.nih.gov/pubmed/9893482 Hashimoto’s and the elderly

http://www.ncbi.nlm.nih.gov/pubmed/1987440 Thyroid disease in the elderly

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2889224/ Aging and the immune system

Nature Reviews Endocrinology 7, 435 (August 2011) | doi:10.1038/nrendo.2011.99 Pharmacotherapy: Levothyroxine in the elderly—finding the breaking point by Linda Koch

 

Hashimoto’s and other autoimmune diseases have multiple causes. There is no single origin and, therefore, to date there is no single solution.

Instead, successful healing requires exploration into the multiple causes of the disease and healing the areas that need attention.

One such area that has recently been discovered to have a major impact on health and disease is the microbiota or the tiny living organisms that populate our bodies.

These various different species of bacteria, viruses and fungi make up the lion’s share of our DNA and are more a part of us than we realized.

In this post we explore the role of bacteria in the formation and healing of autoimmunity and Hashimoto’s.

We Are Bacteria

One of the fundamental things to understand regarding the world of microbes is that they are not separate from us. We are one. And I don’t mean this is a woo woo, philosophical sense.

I mean this is a very real, practical sense.

The Human Microbiome Project

Microbiome Global Map

The Human Microbiome Project (HMP) was a United States National Institute of Health (NIH) sponsored project whose goal was to identify and study the microorganisms (little critters) that are found in association with both healthy and diseased humans.

Launched in 2008, it was a five-year project, with a total budget of $115 million. The ultimate goal was to test how changes in the human microbiome are associated with human health or disease.

Here’s some of the things that they discovered:

•    No two people have the same microbiome, not even identical twins.

•    There are approximately 10 trillion bacteria in (and on) our bodies vs. only 1 trillion human cells.  You read that correctly.  We have 10x more bacterial cells than we do human cells.

•    Bacterial genes outnumber human genes 150:1.

•    Our cells have incorporated and use bacterial DNA.

•    There are over 1,000 species of bacteria found inside our GI tract alone.

•    There are over 1,000 different proteins made by bacteria in the gut which are essential to optimal body function.

•    Several diseases are directly associated with a disruption to the microbial ecosystem of the gut.  These include, but are not limited to: Asthma, Allergies, Crohn’s, IBS, Obesity and, in my humble opinion, Hashimoto’s.

•    Pathogenic bacteria/organisms like candida, h.pylori, etc. have evolved to be natural inhabitants of our gut, and under ideal conditions don’t always lead to illness or cause disease.  On the contrary, sometimes they provide vital functions and we’re worse off without them.

•    Destroying these pathogens completely has physiological consequences that we’re just beginning to understand. (Remember when the appendix didn’t matter? Oh yeah, we were wrong about that, too. It has been found to be a store house of good bacteria.)

The Truth About Antibiotic Therapy

One thing that looking at this research makes abundantly clear is how potentially destructive antibiotic therapy is, especially for children (for whom it is  often prescribed).

Of course, these drugs have saved countless lives, when they are used appropriately. But they have been abused and overused and we are now seeing the consequences in new bacteria resistant strains, as well as a wide variety of diseases like digestive disorders and autoimmune disease.

Giving a child or adult antibiotics every time they get an upper respiratory infection (most of which are caused by viruses not bacteria) is often doing little more than setting the table for future disease and a decline in natural immunity and actually makes them more susceptible to infections.

This also has physiological consequences in our guts and it makes us more vulnerable to pathogens because the beneficial bacteria that are killed play an important role in our immune system.

It’s time we stopped looking at medicine as, simply, a war between invading pathogens and our body. It’s more nuanced than that.

As I have written in the past, we are a collection of interacting ecosystems and researchers now know that these ecosystems are composed of a wide variety of friendly organisms.

Just like we need to learn to be good stewards of the earth and our external environment, we also need to view the insides of our bodies in this way and start caring for these internal ecosystems in the same way.

The lesson here is that we can’t just eradicate ourselves to good health. We see this time and time again with pesticides, herbicides and antibiotics.

Lots of patients and practitioners still have mind set that says, “All we need to do is kill ___________(choose your favorite pathogen), then you’ll be healthy.” And many of us have been trained to think and treat this way, whether it is with drugs or herbs and natural supplements.

Well, a lot of times this approach can result in a disruption of the ecosystem of the gut (and sometimes overgrowth of other pathogens). And this doesn’t just happen with drugs like antibiotics, it also happens with natural products like herbs that kill pathogens in our bodies.

It’s time we create a new way of doing things. Figuring tht out is beyond the scope of this post. So, first let’s try and figure out what a “healthy” microbial ecosystem is.

What Exactly Does A “Healthy” Microbiota Look Like?

Here’s the thing about your digestive tract, it’s not just one ecosystem. Really, there are several distinct ecosystems that overlap and interact with one another.

Let’s break it down:

There’s your mouth, your esophagus, your stomach, your upper and middle small intestine, your lower small intestine and your colon. The bacteria that populate each of these ecosystems is quite different.

And to complicate things, there’s the intestinal mucosa and lining which has distinctly different species than the space in side the intestine .

In addition, no two people have the same microbiota. Early research on this subject came up with the idea of “enterotypes” which are microbiota types like blood types, but they only looked at a small group of people.

After looking at a lot more people from different cultures researchers determined that it wasn’t so clear cut and there’s so much variation that it’s really hard to be definitive about this. (It’s more nuanced – I think that’s my new motto 🙂 ).

In the following diagram you can get a sense of the number and the diversity of bacteria that populate these various ecosystems.

Microbiome Species

from http://physrev.physiology.org/content/90/3/859

Frankly, this makes the claims and marketing of probiotics pretty ridiculous (more on that in a moment). No one or two strains of bacteria are going to properly populate your entire digestive tract. Nor does everyone need the same strains.

Furthermore, diversity is more important than overall population of certain strains.  A diverse microbiome is the very definition of good health. With diversity comes proper function, more resistant to pathogens, infections, and overgrowth from other species of bacterial, yeast, etc.

How Do These Bacteria Get Here?

Here’s what we have learned about this:

 •    During vaginal childbirth, we are exposed to our mother’s microbiome.  This occurs via the birth canal, and exposure to feces during the birth process.

 •    We receive between 400-600 different species via breast milk.  Also, breast milk contains a powerful prebiotics (which feed good bacteria). This helps these strains to proliferate and colonize inside our GI tract.

This means that births via C-Section and feeding babies formula (rather than breast milk) can have a very real impact on the diversity and overall population of a person’s microbiome.

•    An infant’s microbiome reflects the mother’s vaginal bacteria initially, and then it begins to resemble the mother’s mouth, skin, and gut after that.

•    After the very early stages of life, the microbiome is generally populated via environmental and food exposure.

•    Skin-to-skin contact with parents provides some of the strains comprising a healthy microbiome.

This means that anti-bacterial soap, hand sanitizers and overall germ-phobia can also have a very real ( and not so beneficial) impact on the development of healthy GI flora – especially related to diversity. You want your infants and kids exposed to dirt and grime ( this news will be liberating for some parents and horrifying for others).

Environment also really matters when it comes to a healthy microbiome.

•    Those who live in rural environments generally have much greater microbiome diversity than those who live in urban environments. (Working the earth is not just good for the soul, it turns out.)

How is this Connected to Autoimmunity and Hashimoto’s

There is a good deal of evidence to support the idea that the microbiome has a profound impact on the immune system and that it is involved with the prevention as well as initiation and progression of autoimmune disease.

But the idea that probiotics are always good for people with autoimmunity is not supported in the research, at all. On the contrary, there is some evidence that opposite is true and that certain strains of bacteria cause different types of immune responses and affect different autoimmune diseases differently.

And there are many complicating factors here including genetics, environment and type of disease. And mutations and changes in the microbiome can also result in different outcomes.

Like most things, the reality is that there is enormous individual variation and determining whether or not probiotic therapy is beneficial and which probiotics are appropriate is not an easy thing to do.

The reality is that we are only beginning to understand this complex interaction between our immune systems and the microbiome. However, there are two theories about how the microbiota can help protect against autoimmune disease.

Two Theories on How Microbes Protect Against Autoimmunity

The first is known as “specific lineage hypothesis” and it says that in genetically predisposed animals or humans, the microbiota could provide signals that calm our body’s immune responses.

As a result, the microbiota stays in a homeostatic (balanced) relationship with us.

Basically, the microbes are saving themselves and we have acquired these lineages from our mother and they have been passed down.

When a specific microbial lineage is expanded, it blocks the development of autoimmunity. It does so to improve its own odds of staying in this expanded state by suppressing our inflammatory and adaptive responses.

Autoimmunity is calmed as a side effect of this microbial self-preservation.

The second theory is called the “balanced signal hypothesis” this says that the host’s interactions with microbiota are independent of the precise microbiota composition and that the host’s genetics plays a critical role in the conversation with microbes.

So that your genetic profile is more important.

Whereas a balanced host response to good bacteria and this bacteria’s effort to reduce this response do not affect disease development, the inability of the host to control the microbiota properly results in stronger negative signaling provided by the microbiota and a reduction of autoimmunity.

Again, the microbes are looking out for themselves and sending out signals that result in calming autoimmunity.

(Both theories predict that the increase of tolerance would be lost in germ-free conditions without the microbes.)

There is also evidence that the microbiota behaves in different ways depending on the circumstances. It’s not static, it adapts to changing conditions.

Here’s the thing, the microbiota always faces 2 competing problems:

  1. Making sure our immune system doesn’t destroy the microbes (they have to induce us into creating tolerance).
  2. And our immune systems must also make sure they stay under control and they don’t breach the barrier systems and get into the rest of the body and  cause infections there.

So there’s this constant balancing act that we and our microbiome must do to keep each other healthy.

Bottom line is this, you need to be cautious when using probiotics with autoimmunity and don’t just assume that any variety is going to help.

They might, in fact, not help or make things worse. So, like everything else, you need to carefully assess your need for them and then experiment and keep track to see if they are, in fact, giving you the desired result.

Choosing the Right Probiotics

One question I frequently get is “which probiotic is a good one?” As with all things Hashimoto’s related you can see that this is not a simple question and there is so much individual variability that it really depends.

Probiotics are big business. Global probiotics market was valued at $32.06 billion dollars in 2013.

There are literally hundreds of brands and many make outrageous health claims. I’ve experimented with a number of different brands both personally and professionally. For some patients the results have been good, in others, there’s been little or no noticeable effect and for some they’ve actually had adverse reactions.

Some manufacturers and proponents might say these are “die off” reactions and they may be, but it could also be that in that particular individual with that particular genetic makeup and immune profile that they were inappropriate. ( I think that sometimes practitioners use “die off” to cover incompetence).

When deciding which type of probiotic to choose  there are a few things that are really important to determine.

Will the strain actually survive digestion to be of any help?

Are the strains actually found in nature?

Are they good quality?

Let’s take a look at these issues:

Will the Strain Survive Digestion?

In order to have any benefit, a probiotic must be able to reach the desired location within your GI tract alive (and the large intestine is by far the most populated bit of real estate in the GI tract).

Many strains of bacteria included in probiotic supplements today are very fragile, some requiring refrigeration.  The human gut, on the other hand, is not a hospitable environment. It has very low pH (extremely acidic) environments, it’s body temperature, and it has evolved to keep out invading critters.

A large study done on this subject was done by the Food Standards Agency (FSA), along with Reading University, in the UK.  They tested 35 popular commercial probiotic products, mostly comprised of lactobacillus and bifidobacterium strains.

Here’s what they found:

  • At pH 1 (optimal stomach acid) – none survived. That’s right, nobody made it out of the stomach alive.
  •   At pH 2-3 (weaker stomach acid production) – 18 of 35 showed 50% survival.  So half of the bacteria, in half of the products, survived.
  • Those 18 were then put through a test to mimic the environment in the small intestine, involving bile salt tolerance.  Of those 18, only 6 showed survivability – and a chance to actually make it to the large intestine.

Those 6 were put through survival tests to determine survivability in the large intestine, and only 4 survived the large intestines.

So, at the end of the day, only 4 of the 35 strains showed any chance of survival, and even that was at, or around 50%.

These are not very good odds of survival.

It’s safe to say that many of the probiotic products on the market don’t deliver on their claims because they don’t live long enough to do anything.

Are These Strains Found In The Natural World?

This is important and often overlooked. In our arrogance, man has made the false assumption that we can improve upon and do better than billions of years of evolution. Time and time again this has been proven wrong. Remember the Biosphere 2? That experiment didn’t go well.

Mother nature is infinitely more experienced and developed than we are. If we survive as a species, it will only be because we learn to leverage that truth.

(Bacteria are among the earliest forms of life that appeared on Earth billions of years ago. Many believe that more complex cells developed as once free-living bacteria took up residence in other cells, eventually becoming the organelles in modern complex cells. The mitochondria that make energy for our body’s cells is one example.)

Those strains found in nature have a very long track record of survival and adaptation. Those manufactured in laboratories do not. It’s important that the strains you take are found in the human microbiome.

In addition, this also highlights the importance of diversity. Having variety in the gut matters. Taking high doses of a few specific strains, and eating large amounts of the same fermented foods every day can result in self-induced bacterial overgrowth where a couple of species dominate.

This is the same principle that applies to any ecosystem. When you overload a particular species, things get out of balance and it compromises the entire system.

Are These Products Good Quality?

Because probiotics are such big business and are unregulated, this is an important concern. I looked at a study from Consumerlabs, which was a thorough review of many popular probiotic products and strains.

They found that two products did not have the amount of organisms that they claimed. Essential Formulas Dr. Ohira’s Probiotics and Jameison Probitoics were 2 brands that had significantly less number of organisms than advertised. Click here to read the full report.

Spore Bacteria: The Answer?

One type of probiotic I have been experimenting with is called spore form bacteria. These are organisms that survive the stomach and small intestines quite well. They have evolved to be very stable in the environment and also to colonize the GI tract very effectively.

These check all the boxes of the questions we just looked at. They survive digestion, are found in the natural world and they are of superior quality.

What do we know about spores?
•    They are found all over the environment (in soil, vegetation, aquatic environments, and the digestive systems of many living species like insects, marine life, mammals, etc.) what this means is that as a probiotic they have evolved to be very resilient.
•    Spores remain dormant until they get to the intestinal tract and then they colonize the bowel.  They pass through the stomach and upper GI and survive.
•    They are normal organisms of our digestive tract and are part of the human biome.
•    They have been used in industries where efficacy is closely monitored, for example the pharmaceutical and agriculture industries.
•    Human studies have proven spores to be safe and effective.

Why choose spore form bacteria over others?

What’s interesting about these bacteria is that they have been shown to be effective in several ways.

In a previous post I investigated oral tolerance and since then I’ve been looking for supplements to help improve it. These spore form bacteria have been shown to do this in a number of ways:

  1. They provide pre-biotic and healthy conditions for the proliferation of beneficial flora, increasing the population and diversity of beneficial GI microbes. So, they actually create an environment that helps other good bacteria. (They also produce powerful natural antibiotics to protect against unwanted pathogenic bacteria).
  2. They help increase Short Chain Fatty Acids (SCFA) production.  SCFA’s are known to increase colonic blood flow, improve fat metabolism, lower cholesterol and triglyceride levels, and reduce gut/systemic inflammation. SCFAs like butyrate are effective in increasing oral tolerance.
  3. They help to develop GALT (Gut-Associated Lymphatic Tissue), this is important for healing leaky gut and these bacteria are helpful in healing the intestinal lining and mucosa.
  4. They produce digestive enzymes, specifically protease, which aids in the digestion and absorption of dietary proteins – this is critical in calming reactions to dietary proteins, the source of many adverse food reactions.
  5. They help in the production beneficial B-Vitamins, Vitamin K2, Quinols, Carotenoids, Asaxanthin, Lycopene, and Lutein. In fact, this is a probiotic formulation that delivers powerful, highly-bioavailable carotenoids via in-vivo production. Bacillus indicus is a patented, carotenoid rich strain.
  6. They increase T & B Lymphocytes which are critical for optimal immune function. They may help shift from a state of Th2 dominance (allergies, asthma, inflammation) to more of a Th2/Th1 (adaptive immune response) balance. They may also improve pattern recognition, which can help with autoimmune conditions – by lowering the number of instances of your immune cells attacking your own tissues by mistake.

What brand has these?

The brand that I’ve been experimenting with with promising results thus far is called Megaspore Biotic. MegaSpore

This is not available in retail stores because it is pharmaceutical grade and really requires some understanding and clinical know how in order to administer it.

It contains five bacillus spore probiotics– the value of each strain is supported by numerous studies and scientific publications. All strains are produced in a GMP facility under drug manufacturing guidelines.

It’s a very powerful spore probiotic formulation, and it delivers more than four billion live probiotic cells daily – a dose that matches and exceeds many other products on the market.

Are there any downsides?

Nothing is perfect. There are some indications that some strains in this product may be histamine producing.

But this is not only true of these strains. There are a number of different bacterial species that produce histamine. For example, these common probitoic species are all histamine producers: E. coli, Klebsiella pneumoniae, Lactobacillus bulgaricus, Lactobacillus casei, Lactobacillus helveticus, Lactobacillus reuteri. And many of these are found in yogurt and other probiotic products.

So, be aware if you have histamine intolerance that you may have to be very careful about the probiotics you choose. These species have been found to degrade histamine: Bifidobacterium infantis, Bifidobacterium longum, Lactobacillus gasseri, Lactobacillus rhamnosus, Lactobacillus plantarum, Lactobacillus salivarius

Bottom Line?

Bottom line is this. A healthy microbiome is essential to good health. I can help increase oral tolerance, help you fight infections and overgrowth of destructive species, it can help you lose weight and can also help heal autoimmunity.

However, more is not always better and different species populate different parts of the ecosystem of the gut. So varying different products and different foods that feed those species is essential.

Furthermore, using spore based probiotics can be a beneficial part of your strategy.

Finally, it’s time we stop thinking of the gut as a battlefield of the enemy. Like a farm, it must be weeded, cultivated and nurtured.

Need Help?

If you’re not sure what to do, feel lost or are not getting the results from probiotics that you hoped for, I’m available for a consultation to discuss testing and treatment options.

Click here to book a consultation: Yes! I’d like to speak with Marc.

In the meantime, take good care of your microbiome.

References:

http://physrev.physiology.org/content/90/3/859 Gut microbiome in health and disease.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4528021/ Role of natural microbiota

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3145058/ Role of microbiota in health and disease

http://www.sciencedirect.com/science/article/pii/S1931312811002927 Microbiota and autoimmune disease

http://www.ncbi.nlm.nih.gov/pubmed/24763536 Diet, gut and autoimmunity

http://cshperspectives.cshlp.org/content/5/3/a007294.full.pdf+html Microbiota and autoimmunity

http://www.cell.com/cell-host-microbe/fulltext/S1931-3128%2811%2900292-7 Microbiota and autoimmune disease

http://www.nature.com/cmi/journal/v8/n2/full/cmi201067a.html Role of microbiota in cancer and autoimmune disease

http://bmcimmunol.biomedcentral.com/articles/10.1186/s12865-015-0083-2 Systemic effects of gut microbiota, relationship with disease and immunomodulation

http://www.discoverymedicine.com/Kouki-Mori/2012/11/27/does-the-gut-microbiota-trigger-hashimotos-thyroiditis/ Gut Microbiota and Hashimoto’s

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4036413/ Autoimmunity and the gut

http://gut.bmj.com/content/early/2014/11/28/gutjnl-2014-308514.short?g=w_gut_ahead_tab Does microbiome play a role in autoimmune disease?

http://www.naturalendocrinesolutions.com/articles/intestinal-dysbiosis-thyroid-health/ Self-explanatory

http://press.endocrine.org/doi/abs/10.1210/jc.2007-0606 Hypothyroidism and SIBO

http://www.bpgastro.com/article/S1521-6918%2813%2900057-7/abstract Fecal transplants for treating autoimmunity

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2904693/ Gut bacteria and TH-17

http://www.nature.com/articles/nmicrobiol201515 Assessment of Microbiome Research

http://www.newyorker.com/magazine/2012/10/22/germs-are-us Self Explanatory

https://hsbjournalclub.files.wordpress.com/2012/02/microbiota-article.pdf What are the consequences of the disappearing microbiota?

https://www.researchgate.net/publication/51577921_The_human_gut_microbiome_Are_we_our_enterotypes

http://www.nature.com/news/gut-microbial-enterotypes-become-less-clear-cut-1.10276

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3159383/ Has the microbiome played a critical role in the development of the adaptive immune system?

http://www.grandviewresearch.com/industry-analysis/probiotics-market Value of probiotics market

http://www.ncbi.nlm.nih.gov/pubmed/17241350 Adhesion of  31 actobaccilus strains

http://www.naturalevo.com/uncategorized/the-evolution-of-probiotics/

https://www.bulletproofexec.com/why-yogurt-and-probiotics-make-you-fat-and-foggy/

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3316997/ Probiotics that degrade histamine

 

 Marc Ryan, L.Ac. Founder of Hashimoto's Healing

Marc Ryan, L.Ac.
Founder of Hashimoto’s Healing

Every year, as we celebrate our anniversary I like to reflect back on what we’ve learned from working together over this last year. (Here’s a link to last year’s  if you’re feeling nostalgic.)

Going through this process a great opportunity to review, reflect and build on these lessons this coming year.

What an amazing year it has been! I wrote and published my book, Roadmap to Remission, a mere 436 pages of practical information. My daughter and I personally shipped over a 1,000 copies until we couldn’t stand it any more and had to hire a fulfillment house. Thanks to so many of you who showed remarkable patience through that process. That was a major learning experience!

(I’m currently working on the second edition which has some new material and a foreword by Dr. Datis Kharrazian).

A lot of people have shared with me via our Facebook group and via email how much the book has helped them. And I’ve had my share of haters tell me just how awful they think the book is and how terrible I am for writing and selling it (at cost for no profit on my website). That was something I wasn’t entirely prepared for. It stings when you’re really trying your best just to help people. But it was also a really valuable learning experience.

And I’ve done quite a bit of thinking about what else I learned and I’d like to share them with you, dear readers. Here are my top 5 Clinical Pearls for this year:

1. This is an inside job


2. It’s all about the proteins

3. Oral Tolerance


4. Diet matters times infinity


5. Hashimoto’s isn’t the end of your life, it’s the beginning of your journey

This is an Inside Job

The more I work with people, the more I have come to believe that the vast majority of healing happens between our ears (in both a literal and metaphorical sense). The brain is profoundly impacted by Hashimoto’s and our thoughts and beliefs are so often the the difference between success and failure.

There’s a quote attributed to Henry Ford:

“Whether you think you can or think you can’t, you’re right.”

And nowhere is that more true than the process of healing. You have to first, fundamentally, believe that it is possible.

I know for myself and for many of the people I’ve worked with that this belief is constantly being tested and some days you really need a powerful inner confidence and faith to keep going.

And there is also no question in my mind that this inner faith is something that for most of us needs to be cultivated and nurtured.

Resilience and the ability to bounce back and overcome difficulties are not always innate skills.

However, like any skills, these improve if you practice them.

For myself, it wasn’t until I started instituting a daily practice of writing my personal vision, writing the things I am grateful for and the also writing the “wins” that I had accumulated that I started to make significant strides in this direction.

Now I recommend this to everyone.

I can’t overemphasize the importance of this practice. It can yield remarkable results because it can shape your entire outlook on everything.

The Obstacle IS Your Way

Last year one of the books I read was The Obstacle is the Way by Ryan Holiday. (You have to read this book!) It’s all about using obstacles, disappointments and adversity to transform the world. And not just in a “glass half empty or half full” accentuate-the-positive sort of way.

This book takes it to a whole new level and it points out the incredible blessing of failure, illness, and disappointment. And, essentially, some of the greatest inventors, thinkers and doers of history weren’t defeated by hard times, pain and struggle they were made possible by it.

Instead of fighting it, they embraced it and used it to their advantage to do great things.

And transforming obstacles and adversity into positive action is a conscious choice. With our health it involves letting go of the victim mentality and becoming accountable.

I discussed this process of accountability in a recent video I made. At any time, you have a choice to be the victim or to make the obstacle your way.

So I encourage you to really spend some time cultivating this way of thinking and behaving and if you are feeling defeated and discouraged know that you are not alone is this and that the opportunity is there for you to accept it, embrace it and use it to create great things of your own.

Why It Isn’t Just About Your Thinking

The other part of what you really need to explore, in my opinion, is the physiological “why” of your signs and symptoms. Hashimoto’s and autoimmunity can be so complicated complicated and there are sometimes many different layers to our health challenges.

If we can find at least some of the “why”, then we can find important clues to getting you better, faster and more deeply. This brings me to my next clinical pearl:

It’s All About the Proteins

This last year I was invited to attend a powerful gathering of healers called the Thyroid Mastermind, hosted by Michael and Dr. Izabella Wentz. The keynote speaker of the event was Dr. Datis Kharrazian, who has been a longtime teacher and mentor of mine (and many others who attended).

Dr. K shared some of this research he has been doing over the last year or so with Dr. Vajdani, founder of Cyrex Labs. This was funded entirely on his dime (and we’re talking a serious chunk of change) because, while these issues that are very important to those of us with autoimmune diseases, they are not really seen as that important by the powers that be.

There are many layers to this research and it’s going to be released soon, and he’d have to kill me if I revealed the details because it could compromise the study, but here’s the big takeaway: It’s all about the proteins.

Autoimmune reactions are reactions by your immune system to various proteins. Or, really, protein fragments – the sequences of amino acids that make up those proteins.

They are what cause the immune reaction that destroys our tissue.

Proteins are the building block of life. So these proteins and the amino acid patterns that make them up are everywhere. In lots of different foods (and many you don’t think of as proteins like grains and vegetables) and in meat and in the tissues of our body.

And these proteins are the “on switch” for autoimmune destruction. They turn on the antibodies (which don’t destroy tissue) that signal other parts of the immune system to attack, kill and destroy.

And because these amino acid sequences repeat all over the place, all kinds of different tissue can get destroyed. Really important stuff. One example of this is the affinity of thyroid antibodies (like antibodies to TPO and T3) to tissues in our brain.

Proteins don’t just signal destruction of the thyroid, they can also signal other parts of our immune system to destroy our cerebellum and myelin, the sheath that protects our nerves. (Destruction of myelin is what causes Multiple Sclerosis (MS).

This is one of the reasons “why” some people with Hashimoto’s will develop encephalopathy. Their brain is being attacked and, in some cases, it’s being signaled by TPO. The most common symptoms of this process? Memory loss, fatigue and depression!

These proteins are a really big deal!!! Which leads me to my next clinical pearl:

Oral Tolerance Is an Important Part of This ProcessOralTolerance Clinical Pearl

Another important discovery for me was the importance of something called oral tolerance in autoimmunity and in sensitivity to dietary proteins.

Oral tolerance is defined as your immune system NOT REACTING locally and systemically to antigens such as food proteins.

In other words, oral tolerance is when you eat a certain protein and you become tolerant to that protein.

We can think about this in terms of our own evolution. If you are eating something (a protein) all the time, it would be a really good thing for you to develop a tolerance to it and not attack it.

If we’re only eating certain kinds of foods, we‘d be more likely to survive if we could build tolerance to them.

Proteins are the things we are most often exposed to. (They’re the building blocks of life, after all.)

And it turns out that tolerance to ingested proteins is also really important for the barrier function of the intestines i.e. to prevent leaky gut.

When this tolerance breaks down, chronic diseases follow; like celiac, Crohn’s, ulcerative colitis (these all occur locally in the intestines) and other systemic autoimmune disease like Multiple Sclerosis and even Hashimoto’s.

In other words, oral tolerance is a kind of dimmer switch, it turns down the attack. Both in the intestines and in the rest of the body.

When you have oral tolerance, your immune system doesn’t attack as aggressively.

Clinical Pearl: One thing I’ve observed is that some people actually lose some of this oral tolerance after being on an elimination diet for a prolonged period of time.

It has made re-think the reintroduction of foods after the elimination phase of Autoimmune Paleo diet and also to realize that this is an often missed opportunity to both reduce sensitivities and to restore immune system equilibrium.

To learn more about this and why it matters, check out my detailed post on this here.

Diet Matters Times Infinity

The single largest source of these proteins is the food we eat. This is why it makes me insane when doctors say things like “Diet doesn’t matter”.

That is a very dangerous and ignorant lie.

Not only does diet matter, ignoring the role of diet can literally ruin your health. Some of  these proteins can lead to inflammation and destruction of parts of your brain. No bueno.

Much of the research that Dr. Kharrazian and Dr. Vajdani have done involves testing the effects of these various proteins on the thyroid axis and the brain. And the results are going to be available to us soon and it’s going to radically transform how we can help you, but for right now here’s what we can tell you.

Dr. Izabella Wentz did a very interesting study of 2, 322 Hashimoto’s patients and she collected some really important data on just how important and effective dietary changes are.

Here are some of the results:

Izabella Food Survey

This illustration reveals just how effective diet is in improving symptoms and lowering antibody levels.

And here’s some more important information on some common foods that may cause problems:

Highly reactive foods per IgG test sampling:

100% – Cottage cheese, brewer’s yeast


90%- cola, safflower, whey, baker’s yeast


80%- casein, blue cheese, chicken, cow milk, goat milk, rosemary, yogurt


70%- corn, cheddar, Swiss, licorice, mushroom, sugar cane


60%-pineapple, pinto bean, ginger, oregano, oyster, white potato, sesame, walnut

For myself and my patient population I know that tomatoes can also be a problem. And as we know gluten, dairy and soy proteins can also wreak havoc.

Spinach can also be a problem. One thing I’ve observed with spinach is that it can actually reduce iron levels. I had a patient who was eating spinach salad 3 times a day and she was severely iron deficient.

I tried everything and nothing worked and finally I said stop eating spinach and that turned out to be the problem. Once she stopped, we were able to successfully restore her iron levels to the normal range.

One important thing to understand about these foods is that you may or may not react to them. As I said this is highly individualized. You can use the percentages to make an educated guess about what you might react to, but you are unique and you may not have these same reactions.

Here’s another pearl that’s really helpful: One important thing you can do to strengthen the T regulatory or the “good guy” part of your immune system is to feed them fiber: Here’s what Dr. Vajdani  drinks every morning (Pay attention to this, this is a guy who has devoted the better part of his life to researching  autoimmunity):

Psyllium powder


Hemp or chia seed powder


Flax seed powder


Almond milk (You can substitute coconut milk if you are sensitive to almonds.)

One important thing to understand about all of this is that there is tremendous variability and millions of possible permutations of this. So everyone doesn’t have sensitivities to all these foods. But, you really need to figure out which foods you have a problem with.

And here’s another clinical pearl: Since the problem is these amino acid sequences, the affinity that is formed is based on longer sequences. If you can break down those sequences into smaller pieces, then you can minimize their destructive potential.

Digestive enzymes that break down protein have the ability to do this in some measure. They break apart the amino acid connections and can render the protein harmless or at least less harmful.

Finally, remember this:

This Process Is A Journey Not A Destination

The last point I want to emphasize is that Hashimoto’s is not the end of your health (or life as you know it), it’s the beginning of your journey.

The good news is that we are all traveling this journey together and there are some really amazing people working on this.

But the reality is we are only in the infancy of understanding what is going on and what we need to do about it.

But there is reason for optimism because there are some great minds and some incredibly devoted people who are working day and night to help you.

So let me end on a positive note and say how grateful I am am to all the people who are working on solving these problems and to all of you that are committed to finding solutions outside the box.

The obstacle is our way and the journey is our path and together we will find hope, help and healing.

I can’t wait to see where this journey takes us and where this year will bring us.

Need help in getting there? Schedule an appointment with me and let’s talk!

This month we are celebrating our 3rd Anniversary of launching Hashimoto’s Healing. I can’t believe it’s been 3 years! I’ve had the privilege to work with speak with over 2,000 people with Hashimoto’s during that time and to work one on one with over 750. And as part of the celebration, I’ll be releasing a new updated version of my book, Roadmap to Remission. And I’m truly honored that Dr Datis Kharrazian (without whom this book and many of my clinical skills would not be) has written the foreword.

I’d like to share it here because it’s a wonderful summary of what I have tried to achieve with this book, the website and our Facebook community.

Dr K Boulder

With Dr. Kharrazian in Boulder Co., 2015 at the Thyroid Mastermind

Few Chinese medicine practitioners are willing or able to explain Chinese medicine concepts in Western terms. But Marc Ryan, LAc, who calls Traditional Chinese Medicine the “original functional medicine,” gamely builds us a bridge between the Eastern and Western arts of healing.

If you’ve read my books you’ll see familiar functional medicine concepts of Hashimoto’s hypothyroidism management. Not simply a problem of the thyroid, Hashimoto’s is an autoimmune disease in which the immune system attacks and destroys the thyroid gland.

Thus, Hashimoto’s is a problem of the immune system that involves a complex web of dysfunction and requires careful attention to the root causes of its debilitating symptoms.

What sets Marc’s book apart is how he takes us on functional medicine journey of Hashimoto’s hypothyroidism through the lens of Traditional Chinese medicine.

Where Western medicine concerns itself with science and studies, Chinese medicine tells us a story about the human body, weaving in natural phenomenon and earthly elements.

The Hashimoto’s patient will find herself surprised by the uncanny knowing of this ancient healing art. For instance, in Chinese medicine the thyroid is seen as the place where communications and dreams are generated. When this area becomes clogged due to an inflamed and under functioning thyroid, the patient may feel stuck in her situation and unable to express her needs.

Marc weaves many such examples in, along with Chinese concepts of yin and yang, the five elements, Chinese herbs, and Chinese healing exercises. For the Hashimoto’s patient, this book is a fascinating integration of sound functional medicine with an introduction to Chinese medicine’s view of thyroid and immune function.

What’s more, Marc presents the material in a conversational style that is fun to read. Hashimoto’s is a complex topic that can seem overwhelming at first. Many people with Hashimoto’s have difficulty with concentration, which makes it hard to read a complicated book about the topic.

In response, Marc has gone the extra mile to make his information easy to absorb with short paragraphs, clear descriptions, real-life examples, and helpful summaries. Throughout the book, his warm sense of humor, upbeat attitude, and genuine concern for helping people really shine through.

At the same time, staying true to Chinese medicine’s broad-sweep approach to healing, he continually reminds us of the bigger picture — the spiritual nature of our journey, the connection of our health to that of the planet, and how facilitating the flow of energy through the organs is reflected in our flow through life’s journey.   

I have taught thousands of practitioners over the years and I know Marc to be a passionate and dedicated practitioner with clear integrity and humility, one of the few who leaves a seminar and reads and rereads the manuals in order to master the material.

This, combined with his innate ability to incorporate larger life meanings of the Hashimoto’s journey, has moved him beyond the role of practitioner into that of healer.

This passion was born out of Marc’s personal experience as someone with Hashimoto’s and the parent to a child with the disease. Knowing he was sick long before he knew why, his experiences were like that of many Hashimoto’s patients:

Being told he’d have to wait until he was much worse before getting any treatment; being offered immunosuppressant therapy that would disable his body further; being dismissed by doctors; and most importantly, his doctors not getting to the root of the problem.

It was when he decided to step outside of outdated, traditional modes of treatment that he made progress.

He went on to become an experienced acupuncturist and herbalist whose entire medical practice is now devoted to Hashimoto’s.

He truly cares that patients have the opportunity to understand how their bodies work, what is out of balance, and what steps they must take to live in a state of vitality and wellness again.

With the disconnect between conventional hypothyroidism care and the realities of Hashimoto’s, the medical world clearly needs a renewed approach.

In Roadmap to Remission, Marc takes the best parts of both Western and Eastern functional medicine to create a methodical approach that touches all aspects of the Hashimoto’s journey with grace, humor, and firm encouragement.

In doing so, he has empowered patients to better understand their bodies so they can engage as active participants in their own healing.

Datis Kharrazian, DHSc, DC, MS
Author,
Why Do I Still Have Thyroid Symptoms When My Lab Tests Are Normal?
Why Isn’t My Brain Working?

As many of you know, for the last several years I have focused solely on treating people with Hashimoto’s.

This has given me a tremendous opportunity to explore this health issue in considerable depth. I have had the honor and the privilege to work with over 1,000 people with Hashimoto’s and I’ve been privy to some cutting edge research from colleagues like Dr. Datis Kharrazian and Dr. Izabella Wentz.

Dr. Kharrazian first introduced me to the concept of oral tolerance and I’ve spent a good deal of time combing through the medical literature learning about it’s significance with regard to Hashimoto’s and reactions to foods.

In doing so, I recently had an epiphany and it has changed my way of thinking about how we can use diet to heal this disease.

In this post, I’m going to go deep into what I have learned about oral tolerance and it’s relationship to Hashimoto’s, autoimmunity and the Autoimmune Paleo Diet.

You Can’t Get Better Without Addressing Diet

One thing I have learned is that diet is the foundation of success. And the reason this is true, in my opinion, is that the digestive tract is ground zero for autoimmunity.

An estimated 70% of the immune system is found there, and a breakdown of the gut and the intestinal lining leads to the systemic inflammation that is at the root of diseases like Hashimoto’s.

Ground Zero for Autoimmunity is the Intestines

According to Dr. Alessio Fasano, MD, an expert on the origins of autoimmunity, the cause of this disease in the intestines.

Zonulin-and-Gut-Integrity

In a paper published in the Clinical Review of Allergy Immunology February 2012 , he noted that,

“Together with the gut-associated lymphoid tissue and the neuroendocrine network, the intestinal epithelial barrier, with its intercellular tight junctions, controls the equilibrium between tolerance and immunity to non-self antigens.

Zonulin is the only physiologic modulator of intercellular tight junctions described so far that is involved in trafficking of macromolecules and, therefore, in tolerance/immune response balance. When the zonulin pathway is deregulated in genetically susceptible individuals, autoimmune disorders can occur.”

What that means in plain English is that the breakdown of the barrier of the intestines is the pathway to autoimmune disease.

Not The Whole Story

This is by no means the whole story. Yes, the breakdown of the intestinal lining is a causative factor for the development of autoimmune disease, however, it’s just the gateway.

This is kind of like getting a view of the door, but there is an entire landscape of immune reactions that go on beyond that door.

And what lies beyond the doorway is what we are going to explore here today.

Autoimmunity is the Loss of Self Tolerance

What’s happing with autoimmunity? Our immune system has lost the ability to differentiate between our own cells and foreign invaders, like bacteria, viruses and other pathogens.

And this confusion leads to our immune system attacking our body’s own proteins. This is caused by our immune systems losing the ability to have tolerance to our own tissue (made of these proteins).

The entire digestive tract is made up of multiple little ecosystems and these ecosystems are always battling with this problem of tolerance.

Because the gut is, essentially, one long open tube and lots of pathogens in the form of bacteria, viruses, fungi and parasites pass though there along with proteins that we need to ingest and get nourishment from.

An important part of this process of the ebb and flow of tolerance is something called “oral tolerance”.

Oral Tolerance: The Holy Grail of Autoimmunity?

Oral tolerance is defined as your immune system NOT REACTING locally and systemically to antigens such as food proteins.

In other words, oral tolerance is when you eat a certain protein and you become tolerant to that protein.

We can think about this in terms of our own evolution. If you are eating something (a protein) all the time, it would be a really good thing for you to develop a tolerance to it and not attack it.

If we’re only eating certain kinds of foods, we‘d be more likely to survive if we could build tolerance to them.

Proteins are the things we are most often exposed to. (They’re the building blocks of life, after all.)

And it turns out that tolerance to ingested proteins is also really important for the barrier function of the intestines i.e. to prevent leaky gut.

As we saw above, when this tolerance breaks down, chronic diseases follow; like celiac, Crohn’s, ulcerative colitis (these all occur locally in the intestines) and other systemic autoimmune disease like Multiple Sclerosis and even Hashimoto’s.

In other words, oral tolerance is a kind of dimmer switch, it turns down the attack. Both in the intestines and in the rest of the body.

When you have oral tolerance, your immune system doesn’t attack as aggressively.

When you lose oral tolerance you wind up with things like celiac disease (which is an autoimmune disease – not just a food intolerance).

How Does Oral Tolerance Work?

We don’t fully understand this, yet.

However, what we do know is that oral tolerance works by deactivating T and B cells that target our tissues – either by clearing them out and getting rid of them or by making them not respond to proteins anymore with something know as “anergy”.

Anergy is the lack of a normal immune response to a particular antigen or allergen.

Oral tolerance also works by Tregs directly suppressing these cells.

Tregs is another name for regulatory T cells (also called suppressor T cells). They are T cells which modulate the immune system, maintain tolerance to self-antigens, and discourage the development of autoimmune disease.

Can We Improve Oral Tolerance?

Of course, with autoimmune disease this may be a really important thing to achieve, if possible.

The question is this: If you can establish or re-establish or at the very least improve oral tolerance, can you remove or at least diminish the autoimmune attack?

Some researchers believe the answer is “yes”. There is some evidence that this may be an achievable goal.

If So, What Should We Improve Tolerance For?

That’s a very, very important question. Because this is potentially a dangerous game. By no means is this a easy, risk free process.

For example, should we attempt to establish oral tolerance to things like gluten and dairy? (Dietary proteins with tremendous destructive potential.)

In my opinion, the answer is a resounding NO!

They have been implicated in the destruction of brain tissue such as cerebellar tissue and myelin. (I’d like to keep my brain for as long as possible, wouldn’t you?)

So what does that leave us with?

A lot, actually. (More on this in Part 2 of this post).

But before we attempt to answer that, another thing the research has shown us is that simply establishing tolerance alone is not enough.

We must also do other things like reduce inflammation and strengthen the regulatory part of the immune system and work to calm and/or eliminate stress, restore integrity and balance to the ecosystem of the gut, etc. while we do this to achieve the best results.

So first, let’s look at the big picture.

What are the steps to first calming the immune system and then, secondly, trying to improve oral tolerance?

Steps for Influencing and Improving Oral Tolerance

First off, if you’re looking for a quick and easy solution, click away. This isn’t quick and it isn’t easy.

This is a long term project that may take several months and it may be riddled with unexpected outcomes (welcome to the immune system).

That being said, it can also yield profoundly positive long term results.

Step 1: The Elimination Diet Also Known as Autoimmune Paleo or Lectin Avoidance Diet.

If you are just starting out this is the place to begin.

The Autoimmune Paleo/Lectin Avoidance Diet removes the following foods:

Grains, nuts, seeds, legumes, nightshades, gluten, dairy, soy and eggs.

I’m not going to spend time on the how or the why of this diet in this post, but this is a very effective approach for reducing systemic inflammation and for calming the immune system.

In addition, in many cases with Hashimoto’s this will yield improvements in virtually all important thyroid markers including antibody levels, TSH, etc.

And it often results in a (sometimes dramatic) improvement in weight, brain fog, mood and energy.

With my patients, I also assess all the other systems of the body and when it is called for we work on healing the gut (almost always called for), detoxifying the liver, healing the adrenals and reducing inflammation in the brain while we are on this diet.

This is also beyond the scope of this particular post, but suffice it to say that this is a systemic, multi-organ problem and we need to heal every part of the body that is impacted if we hope to get this into remission.

Also, the fact is that being on this diet provides a tremendous opportunity to aggressively reduce inflammation and to clean up the liver, heal the gut and calm compounding factors.

Clinical Pearl: One thing I have observed with some people who tried the Autoimmune Paleo Diet (myself included) is that it can actually increase your sensitivity to foods that you are sensitive to.

A food that you had a reaction to in the past (like gluten) will often cause a much more severe reaction once you have eliminated it for a prolonged period of time.

And in some cases, the elimination can increase sensitivity to foods across the board. (And I have observed it seems to increase not decrease with time. Meaning the longer some people are on the strict elimination diet, the more sensitive they become.)

One theory is that what may be happening here is that the elimination of these antigens can lead to a decrease in oral tolerance.

This makes logical sense because oral tolerance requires exposure to the antigens ( in this case, dietary proteins).

Eliminating Foods Can Increase Food Reactions

And there is some evidence of this in the medical literature. Some researchers claim that the elimination diet is a potential cause of anaphylaxis or a severe and life threatening allergic reaction.

And many researchers and health professionals are now questioning the wisdom of NOT exposing children to things like peanuts in early childhood because the LACK of exposure can lead to a massive immune response when they do get exposed.

The question is, why?

If this is the case, what is the mechanism that could lead to the decline of oral tolerance?

I think the simple answer is that elimination of multiple immune stimulating antigens changes the entire landscape of your immune system. It has a major impact.

And while some of this is really good and, arguably, absolutely necessary, (especially in circumstances like autoimmunity) it may have some unintended consequences.

This is also a great illustration of the complexity of the immune system. It has multiple parts that move in multiple directions, all the time. And overly simplistic linear thinking doesn’t work when trying to understand and balance the immune system.

Increasing Food Sensitivity Is Very Stressful

Another important observation about this process is that having to worry about food all the time and having an increasingly smaller and more restricted diet is very stressful. It makes it difficult (if not impossible) to go out with friends and relatives. It can create anxiety over what to eat and it can make you feel further alienated and frustrated.

And stress is a really big deal for people suffering from autoimmune diseases like Hashimoto’s. The body is already under a great deal of physiological stress, to add further daily stresses regarding what to eat and where to find the right food can be really counter-productive to the process of healing.

So, if we can tweak this process to make it less stressful, than that is a very valuable innovation.

Step 2: Reintroduction Phase

Once you have done the elimination phase of the Autoimmune Paleo diet (usually for 30 to 60 days), the next phase involves reintroducing foods, one food at a time to see if you react to them.

In some cases, people react to an awful lot of stuff, precisely because they have been so good at eliminating these foods and have accomplished some really good things with regard to calming their immune systems.

My understanding of this phase of the Autoimmune Paleo approach is that this is essentially a test to see what you can and can not eat.

Proponents of the Autoimmune Paleo Approach rationalize this increase in sensitivity by saying, essentially, this is part of the healing process. And they assert that once you heal your gut you’ll have fewer sensitivities.

But this isn’t always true, there are people who have spent several years healing their guts and still find that they are sensitive to a number of foods.

Obviously, everyone is a little different and some people do better than others. And some people find they can re-introduce all sorts of things, while others can introduce just a few and still others find their diets becoming more and more restrictive.

If you’re one of these people, this process can be really demoralizing because here you have worked your butt off to be super compliant and follow the plan and the end result is that your diet consists of fewer and fewer foods.

It’s the living embodiment of the expression, “No good deed goes unpunished.”

 “Re-Establishment of Oral Tolerance” Phase

What I have come to see is that instead of just eliminating and seeing what happens during re-introduction, what we have is an amazing opportunity.

And that is to work to re-establish or improve oral tolerance and create a much more hospitable immune environment.

How do we do that?

Great question! (And one that needs a good deal more experimentation and exploration than this one post can provide).

I’m not going to pretend to have all the answers on this, but here is what the research suggests.

In autoimmune disease research, the goal with oral tolerance seems to be to suppress the Th1/Th17 response (for most autoimmune diseases).

There are two ways that researchers have tried to do this.

OralTolerance

The first is by giving a high dose of a protein once.  (This, obviously, is the heavy handed approach.) From an immune system standpoint, when it works this can result in a anergy or complete shutdown of both TH-1 and TH-2 responses.

Problem is that it doesn’t always work and obviously with autoimmunity the risk here is that you can cause a massive flare ups and discomfort.

The second approach is to take the protein at a lower dosage multiple times, which has been found to increase Tregs.

The multiple dose approach is gentler and from an immune standpoint, a lot better suited for autoimmune disease.

But You Can’t Just Re-Introduce Foods

Here’s the real difference in approach. You shouldn’t think of this phase as simply a testing phase.

It could be much more than that.

However, before you get all excited, understand that we are wading into uncharted waters and if we are going to challenge the immune system, there is bound to be some reactions.

And not all of them will be good.

In addition, maybe it’s time to view reactions differently. Maybe not every reaction is just simply “bad”.

And maybe total elimination of reactions isn’t totally “good”.

It may be a bit more nuanced than that.

That being said, there are two things to consider during this process:

1. What helps induce or improve oral tolerance? (This would include supplements, life style changes, etc.)

2. Which proteins do you want to create oral tolerance for? (This would include the approach to diet and reactions)

Both are important because we want to do everything we can to make this a successful experiment.

Actually, there is also a third thing to consider and that is, what can we do to minimize the discomfort and immune system flare ups during this process?

(I don’t know about you, but I prefer to suffer as little as possible.)

Mechanisms of Oral Tolerance

Before we look at what to do to improve oral tolerance, let’s take a look at some of the mechanisms for establishing and improving it.

IL-10 and Oral Tolerance: IL-10 is anti-inflammatory cytokine because it decreases various immune cells such as Th1 AND Th2 cells. It also inhibits NF kappa beta, which is important in destructive inflammation. It inhibits COX 2 and mast cells and it decreases insulin and leptin resistance. IL-10 is something we want to increase.

IL-12 and Oral Tolerance: IL-12 is part of the TH-1 family of cytokines and it can block oral tolerance in TH-1 conditions. It is responsible for helping cytotoxic lymphocytes, natural killer cells mature and it also supplies growth factor to help certain cells grow into the killers that they are.

IL-12 is also involved in turning on genes that result in attacks on specific organs and has been implicated as an important player in Hashimoto’s. IL-12 is something we want to reduce.

Tregs and Oral ToleranceTregs comprise ∼5%–10% of  T helper cells.

There are two types of Tregs: ‘induced’ (iTregs) and ‘natural’ (nTregs).  Both types are anti-inflammatory.   Induced means that they are created outside the thymus.  (There are 2 kinds of induced Tregs: (Th3 and Tr1). Natural means that they are part of the cells naturally produced in our thymus gland.

Tregs calm and suppress  Th1, Th2, Th17 cells and their cytokines, as well as many other immune cells and proteins such as, basophils, eosinophils, mast cells, and IgE and they also influence migration of inflammatory cells to tissues.

Tregs inhibit immune activation by direct cell to cell contact.  This means that they are directly anti-inflammatory.

Tregs need to be ‘activated’ in order to have their suppressor functions. Exposure to a dietary protein or an antigen is one of the ways that they get activated. Obviously, increasing Tregs  in a balanced way is a good idea with autoimmunity.

But, as with all things, if you do this too aggressively, there is the risk of becoming less able to defend against some infections. And unfortunately, one of those infections is a viral infection like herpes and Epstein Barr. (You can read more about the herpes/Hashimoto’s connection in this post.)

Mucous in the Intestines and Oral Toleranceresearchers have found that mucous plays an important role in maintaing the barrier of the gut and in modulating homeostasis (or balance) in the gut. Having a healthy amount of mucous in the gut is also a good idea.

Dendritic Cells and Oral ToleranceDendritic cells (DCs) are antigen-presenting cells(also known as accessory cells) of the immune system of mammals. Their main function is to process antigen material and present it on the cell surface to the T cells of the immune system. They act as messengers between the innate and the adaptive immune systems.

Dendritic cells are important for immune tolerance because they can adapt to proteins or enhance the attack on them. At low levels these proteins help dendritic cells to adapt, but if proteins become excessive and aren’t cleared this can result in dendritic cells attacking and consuming the protein (and in some cases our own tissue). With dendritic cells we want to encourage as much variety as we can and make sure that intestinal transit and protein clearance is functioning well.

cAMP and TolerancecAMP is a signaling molecule that relays messages to T cells to not respond and proliferate to a protein. This, essentially, trains the immune cells to not respond. Increasing cAMP may be beneficial.

Intestinal Health and ToleranceA healthy ecosystem in your gut, with good blood flow, motility and transit time and healthy amounts of enzymes, bile and stomach acid are all important for improving oral tolerance. A healthy gut ecosystem is extremely important.

Commensal Bacteria and ToleranceOral tolerance is dependent on good bacteria in the gut. The more we learn about intestinal bacteria, the more valuable they become and the more irresponsible excessive antibiotic treatment becomes. Gut bacteria should be treated like an endangered species and be tended to and watched over carefully.

High protein diets and Oral Tolerance: This was a very interesting finding in the research. Diets that are lower in protein reduced both TH-1 and Th-2 and were effective in helping promote oral tolerance. Reducing dietary protein may help to reduce sensitivity.

Things that Cause Declines in Oral Tolerance: There are a number of things that may lead to declines in oral tolerance. Obviously, these are things we want to avoid:

  • Alcohol : Sorry, booze fans. Alcohol has been shown to reduce intestinal mucosa and to disrupt immune regulation in the gut resulting in a decline in oral tolerance.
  • Appendectomy: Recent research has shown that the appendix is a repository for good bacteria. So, it comes as no surprise that removing it can negatively impact oral tolerance.
  • Citrus pectin :Pectin occurs naturally in the cell walls of most plants and especially concentrated in the peel and pulp of citrus fruits (lemons, limes, oranges, and grapefruits), plums, and apples.Recently, scientists have been able to modify and  break down pectin’s long, branched chains of polysaccharides into shorter, unbranched lengths of soluble fiber molecules that dissolve easily in water.The result, modified citrus pectin(MCP), is a substance that is rich in galactose residues, which are easily processed by the digestive system and absorbed into the bloodstream. It has shown promise in some cancer treatments. It has also been found to inhibit oral tolerance to certain types of proteins.Note: A potential dark side of increasing oral tolerance is that it may also make your immune system more tolerable to cancer cells. Obviously, another reason why balance is critically important.
  • H Pylori : Heliobactor pylori is a bacteria that can cause declines in stomach acid and can lead to ulcers and GERD.  It has also been linked to lower oral tolerance.
  •  Medium Chain Triglycerides: Made popular by the Bulletproof Coffee craze, these “healthy fats” were found to increase sensitization and lead to anaphlaxis by stimulating absorption into Peyer’s patches and by stimulating TH-2.( There are always physiological consequences to doing things.) This may be one of the reasons the Basic Bullet Proof Diet advocates lower levels of protein.
  • Retinoic acid: Used to treat acne, this metabolite of Vitamin A, was found in one research study to induce inflammation with IL-15. Interesting because Vitamin A has been found to increase oral tolerance.
  • Skin sensitization: This was also interesting. In mice models, using skin sensitization to try to create tolerance actually had the opposite affect on oral tolerance.

    Bottom Line:

    In summary, you can see that many factors contribute to the development and maintenance of oral tolerance. And that it is critically important for dampening immune reactions.

    And the loss of loss or decline of tolerance may be an important factor in autoimmunity and in sensitivity reactions to dietary proteins.

    But, as with everything, carefully balancing oral tolerance is critically important when dealing with autoimmune disease and reactions to dietary proteins.

    In part 2 of this series, we’ll take a look at specific herbs, supplements, dietary and lifestyle approaches for improving and maintaining healthy oral tolerance.

Let’s talk! Schedule an appointment with me to discuss these and other health issues.  Click Here

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References:

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3578149/ Mechanisms of oral tolerance

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3376463/ Boosting IL-10

http://science.sciencemag.org/content/342/6157/447.abstract Mucous and oral tolerance

http://www.hindawi.com/journals/jir/2013/972865/ Dendritic cells and oral tolerance

http://www.sciencedirect.com/science/article/pii/S0008874996902749 cAmp and Tolerance

http://www.news-medical.net/news/20110211/Blocking-interleukin-15-may-help-restore-oral-tolerance-to-gluten.aspx

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC27123/ Dendritic cells induce anergy in autoimmunity

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2857757/ Model of Oral Tolerance: Suppress TH1 and TH-17, but not TH-2

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3076704/ Keys to success

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC44268/pdf/pnas01136-0446.pdf Oral tolerance determined by dosage

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2270752/pdf/CDI-13-143.pdf Oral tolerance, therapeutic implications for autoimmune disease.

http://www.nature.com/mi/journal/v5/n3/full/mi20124a.html Oral tolerance to food protein

http://www.nature.com/mi/journal/v2/n1/full/mi200875a.html Celiac disease as an example of the destructive potential of loss of oral tolerance.

http://www.hindawi.com/journals/ad/2014/437231/ Link between environmental factors and auotimmunity

https://www.drmcdougall.com/misc/2009nl/jan/ms.htm MS and dietary protein

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3741914/ Celiac and cerebellar autoimmunity

http://circ.ahajournals.org/content/129/Suppl_1/AP354 Lectin Avoidance study

http://www.nature.com/nri/journal/v9/n5/full/nri2515.html Microbiata shapes intestinal immune responses

http://cshperspectives.cshlp.org/content/4/6/a006957.full T cell tolerance

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1628850/ Anaphlaxis during elimination diet

http://www.ncbi.nlm.nih.gov/pubmed/21333554 Intestinal tolerance requirements

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3376463/ Boosting Treg function (IL-10)

http://www.ncbi.nlm.nih.gov/pubmed/15681753 IL-10 Creates Tolerance

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3222333/ Having Lots of an Allergic Protein will create tolerance

http://www.ncbi.nlm.nih.gov/pubmed/12026189 Low Protein diet induces tolerance, boosts IL-4

http://www.ncbi.nlm.nih.gov/pubmed/12887157 Low protein reduces Th-1 cytokines.

http://naglerlab.bsd.uchicago.edu/documents/Caoetal2014.pdf Role of commensal bacteria in oral tolerance

http://www.ncbi.nlm.nih.gov/pubmed/22339388 Skin Sensitization and oral tolerance

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3563838/?report=classic Medium Chain Triglycerides and tolerance

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC187370/ H. Pylori’s impact on oral tolerance

http://www.ncbi.nlm.nih.gov/pubmed/17034584 Alcohol and oral tolerance

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3103798/ Apendectomy and oral tolerance

http://www.ncbi.nlm.nih.gov/pubmed/9921278 Palimate and oral tolerance

http://www.ncbi.nlm.nih.gov/pubmed/21307853 Retinoic acid and oral tolerance

Adapted from Chapter Seventeen of Roadmap to RemissionR2R3Dfixed

In this post, I will show you how to use  the A.P.A.R.T. System to heal the adrenals.

Not sure what that means? Click here to learn about the A.P.A.R.T. System.

1. A = Ask and Asses

Open your journal (keeping a food/behavior/reaction journal is an absolute necessity, in my opinion, if  you are serious about healing your Hashimoto’s) and try to figure out which symptoms of problems with the adrenals you have (see below for a list).

Note what they are, then create a plan for addressing them.

After that take inventory of what you did. Look at what worked and what didn’t. Both will provide valuable information.

Double down on what worked, change what didn’t. Keep at it.

But don’t wait to deal with stress and heal the adrenals. They are just too important to wait.

Signs and Symptoms of Adrenal Fatigue

Symptoms of Low Cortisol (Adrenal Exhaustion Phase)

Cannot stay asleep

Crave salt

Slow starter in the morning

Afternoon fatigue

Dizziness when standing up quickly

Afternoon headaches

Headaches with exertion or stress

Weak nails

Symptoms of High Cortisol (Adrenal Resistance /Alarm Stages)

Cannot fall asleep

Perspire easily

Under high amount of stress

Weight gain when under stress

Wake up tired even after 6 or more hours of sleep

Excessive perspiration or perspiration with little or no activity

Testing the Adrenals

In this section let’s take a look at some testing we can do for the adrenals and also to talk about the 3 stages of adrenal burnout.

Ok, so like virtually everything in our body, things don’t usually happen overnight. They develop over time and progress from ok, to sort of bad to really bad if you do’t do anything to stop that progression.

We saw this with the progression to type 2 diabetes. It goes from dysglycemia to insulin resistance to metabolic syndrome to full blown diabetes.

The same is true with autoimmune disease. It goes from silent autoimmunity to reactive autoimmunity to full blown autoimmune disease.

The adrenals are no exception. Adrenal problems also go through a progression as well.

It looks like this:

3 Stages of Adrenal Dysfunction

1. Alarm reaction: This happens in normal life. The adrenal glands become hyperactive to increase cortisol levels to adapt to the demands of stress.

2. The second stage is the Resistance stage: This occurs in response to prolonged stress as the body steals pregnenolone from cholesterol to make cortisol- also known as the pregnenolone steal.

When this happens, hormonal imbalances arise because there isn’t enough cholesterol to make them. It can cause PMS, infertility, male menopause, and polycystic ovarian syndrome (PCOS).

3. The third stage is the Exhaustion stage: At the point the adrenals are saying “Uncle” and they can no longer adapt to stress.

The cofactors needed to make cortisol become depleted and cortisol levels drop too low. Because the adrenals no longer produce sufficient cortisol, the pregnenolone steal cycle also stops.

How to Test your Adrenals at Home

Basically, let me give you a quick run down of what they are.

The first is to test your blood pressure in 2 different positions: sitting or lying down and standing.

Firstly, Take and compare two blood pressure readings—one while lying down or sitting and one while standing. Rest for five minutes in a relaxed position before taking the reading.

Stand up and immediately check your blood pressure again. If the blood pressure is lower after standing, then you may have reduced adrenal gland function, and more specifically, an aldosterone issue–(Aldosterone is an adrenal hormone and hypothyroidism can lead to low levels of aldosterone in the blood.)

(Normal adrenal function will elevate your BP on the standing reading in order to push blood to the brain.)

It’s also a good idea to do this test both in the morning and in the evening, because you can appear normal one time, and not another.

A Second Adrenal Test

The second test you can do is to check your pupils. This is called the Pupil Test and it also tests levels of aldosterone.

You need to be in a dark room with a mirror. From the side (not the front), shine a bright light like a flashlight or penlight towards your pupils and hold it for about a minute. Carefully observe what happens to your pupil.

With healthy adrenals (and specifically, healthy levels of aldosterone),your pupils will constrict, and will stay small the entire time you shine the light from the side.

The light causes them to constrict, it’s a natural response to having light shone in your eye.

In adrenal fatigue, the pupil will get small, but within 30 seconds, it will soon get larger again again or obviously start to flutter as it tries to stay small.

Why does this happen?

Because when you have adrenal insufficiency you can also have low aldosterone, which can cause an imbalance in sodium and potassium (too little sodium and too much potassium).

This imbalance is what causes the sphincter muscles of your eye to be weak and to dilate in response to light.

So the fluttering struggle to keep the pupil small may mean you have adrenal challenges.

Adrenal Lab Test

In terms of laboratory tests, by far the best one is ASI or Adrenal Salivary Index. This provides the most accurate, useful and comprehensive test for the adrenals.

One important thing to understand about this test; (and this is true of a number of different tests) The most important test is the second or even third test.

One test is useless, because we are establishing a baseline and then we are going to take action. And we need to know if what we are doing is helping.

The second and third tests give us that information. We must always reassess and readjust.

And the adrenals generally respond to treatment pretty well. If they don’t you need to look for something deeper. A parasite or heavy metal toxicity, a chronic viral infection or some food intolerance.

Some times you have to be a detective and examine, step by step, all of these things.

The ASI tells us how a person’s adrenals are working throughout the day. Its a 24 hour test. Cortisol is secreted in a specific pattern over a 24 hour day and by measuring saliva at different intervals throughout the day, we can chart the cortisol levels.

Being in a chronic state of alarm or prolonged stress will mess with this rhythm. One example of this is people who are night owls, or have trouble falling, staying asleep or they wake up really tired after getting enough sleep.

Their rhythm has been disrupted.

The ASI shows abnormalities in this circadian rhythm, charts key hormone levels and pinpoints where problems arise along the way. It can be a really valuable test.

If we want to heal out Hashimoto’s, we absolutely have to heal our adrenals.

And the reality is that this whole process of healing these multiple systems is, without question going to take longer than it takes you to read this book.

I am teaching you about what is going on. Correcting it takes time, patience, vigilance and devotion.

But it is so worth it, people.

Adrenal Testing Recap

Some of the tests that you can do for the adrenals are:

1. The blood pressure test. Take 2 measurements, one seated or lying downand one standing. Compare them. If there is a big difference, this may point to adrenal problems.

2. The pupil test. Point a light at your pupils. Watch it constrict, then watch it return to normal. If it gets small and quickly goes back to normal or flutters, then, “Houston, we’ve got a problem”.

3. Lastly, the best laboratory test is the ASI or Adrenal Salivary Index. This takes multiple saliva tests throughout the day and tracks your circadian rhythm. It can be very helpful, not only for identifying the problem but also for tracking your progress in fixing it.

2. P = Prioritize and Plan

Not everything has the same level importance. This is what 80/20 teaches us. Some things are having more of an impact than others. Figure out which they are (the positive feedback loops) and then make a plan to fix them.

What does that mean when it comes to the adrenals? Check kidney and adrenal function. Adrenal health is very important if you are taking􀀃 thyroid replacement hormone.

The warning label for Synthroid states:

“Patients with concomitant adrenal insufficiency should be treated with replacement glucocorticoids prior to initiation of treatment with levothyroxine sodium.

Failure to do so may precipitate an acute adrenal crisis when thyroid hormone therapy is initiated, due to increased metabolic clearance of glucocorticoids by thyroid hormone.”

What this means, in plain English, is that in cases of hypothyroidism, the adrenals need to be evaluated before putting patients on thyroid replacement hormone. And if they aren’t and you give them thyroid hormone anyway, this may cause an acute adrenal crisis. Not good.

How many people with Hashimoto’s and hypothyroidism do you think have adrenal insufficiency? A lot.

And how many were tested for adrenal insufficiency before they were put on thyroid hormone? Very few.

Clearly, evaluating and treating the adrenals, if necessary, is a major priority.

3. A = Act and Adapt

Once you have evaluated your adrenals, and you’ve established a plan, the you need to act on that plan. Here’s a some of the actions you can take.

Adaptogenic Herbs:

There are quite a few herbs that have adaptogenic properties, meaning that they help your body adapt to stress.

But as with everything, there is a risk/benefit analysis that must be done with them, especially when autoimmunity is involved. You must be cautious about stimulating the immune system when taking adaptogenic herbs.

Here’s a list of herbs that can be helpful, it may be best to introduce them one at a time rather than in a mixed formula. That way, if you have a reaction, you’ll know which herb was responsible:

Acanthopanax

American gensing

Ashwaghanda (this plant is a nightshade and may cause a reaction)

Cordyceps

Codonopsis

Eleuthrococcus

He shou wu (also excellent for helping promote hair growth)

Holy Basil

Jiaogulan (also excellent for reducing cholesterol)

Licorice

Maca

Panax gensing

Rhodiola

Schizandra

Herbs that influence ACTH:

ACTH is to the adrenals what TSH is to the thyroid. It regulates cortisol production. High ACTH may mean the adrenals aren’t producing enough cortisol. Low ACTH may mean the pituitary isn’t producing enough adrenal hormones.

ACTH Increasing:

Ginko

Panax ginseng

Tripterygium

ACTH Reducing:

Acanthopanax

Hypercium

Licorice

Suggestions for Different Stages of Adrenal Fatigue/Exhaustion

Earlier, we looked at symptoms for the different stages of adrenal issues. Figure out which stage you are in and try the supplements below.

1. Alarm Stage:

Balance blood sugar and support healthy response to insulin resistance: alpha lipoic acid, biotin, chromium, gynemma sylvestre, inositol, magnesium, zinc

Adaptogens: See above

Essential fatty acids: fish oil, evening primrose oil

2. Resistance Stage:

Balance blood sugar and support healthy response to insulin resistance: alpha lipoic acid, biotin, chromium, gynemma sylvestre, inositol, magnesium, zinc

Adaptogens: See above

Essential fatty acids: fish oil, evening primrose oil

Add licorice, and B vitamins (see food sources below)

3. Adrenal Exhaustion:

1. Chromium, adrenal, pancreas glands, choline bitartrate, co-enzyme Q 10, inositol, rubidium chelate, vanadium.

Adaptogens: See above

Essential fatty acids: fish oil, evening primrose oil

Add licorice, and B vitamins (see food sources below)

In cases of extreme exhaustion, consider consulting a physician or practitioner. You may benefit by adding pregnenolone and/or DHEA.

Here are some food sources of B Vitamins.

VITAMIN B1: rice bran, pinto bean, peas, millet, lentils, almonds, turnip greens, collard greens, kale, asparagus

VITAMIN B2: salmon, trout, cod, mackerel, perch, oysters, mushrooms, almonds, hijiki

VITAMIN B3: rice bran, red pepper, wild rice, kelp, sesame seed, peaches, brown rice, mushrooms, barley, almonds, apricot

VITAMIN B5 (PANTOTHENIC ACID): beef, chicken, salmon, mackerel, sardines, barley, rice, avocado, plums, raisins, almonds, dates

VITAMIN B6: banana, barley, brewer’s yeast, molasses, brown rice, liver, beef, cabbage, carrots, potato, yams

VITAMIN B12: beef liver, beef kidney, ham, sole, scallops, eggs, oats, pickles, amasake, algae, spirulina and chlorella, brewer’s yeast

FOLIC ACID: liver, asparagus, lima beans, spinach, swiss chard, kale, cabbage, sweet corn

4. R= Reassess and Readjust

Retest, Reassess and ask all over again. Figure out what worked and what didn’t. Double down on what worked and either eliminate or recreate a plan for what didn’t.

Try some things and reassess.

Retest your adrenals, Reorder the ASI (Adrenal Salivary Index) and see if what you did helped.

5. T = Try and Try Again

Keep doing it, keep refining, keep building on the positive results and keep looking for the remaining positive feedback loops that are causing vicious cycles.

The adrenals are a critically important part of the puzzle and given their importance for whether or not you can take thyroid hormone, it makes sense to make healing them your top priority.

Looking for help in assessing your adrenals? Do a consultation with Marc. Click here to learn more.

This post is an excerpt from my new book, Roadmap to Remission.

R2R3Dfixed

One of the things I sought to do in writing the book was to teach you how to evaluate and treat yourself so that you can get some successes and then build on them to create positive healing momentum.

That’s what the A.P.A.R.T. System is and I’ve broken it down for your here.

Remission is a journey.

It involves taking responsibility for your life and circumstances and doing whatever is necessary to change that life and those circumstances.

The road to your remission should be ever evolving and growing, and it should be a process that you continue to improve upon and refine.

So it is not a destination. Getting there is just half the battle.

Staying there is the other half. And the only way you can stay there is to be committed for the long haul.

Measurable goals should be:

  • normal thyroid lab tests,
  • antibodies within the normal range, and
  • a healthy range for a number of other key indicators (which we will explore in upcoming chapters of the book).

These goals are just that. They are meant to be targets. You may not reach them 100%.

And that’s ok, not reaching them 100% does not mean you will have failed or that you should give up and quit trying.

These are just numbers and numbers in isolation are never a complete measure of success or failure.

One important thing to remember about laboratory tests is that they are not meaningful outside the context of what you are experiencing in your own body.

So you must always be aware of what is happening in your body, of how you feel and also of what factors led up to that. Try to pay attention to both the good and the bad.

What you feel is clinically relevant and diagnostically important. And, really everything you do and try is just a test. What happens as a result is data that we can use; it provides us with clues and valuable information.

In addition, one should never keep forcing a solution when the evidence before you plainly shows you that it isn’t working.

You must change your plan when that happens.

This can be tricky, but it is possible to do it if you have a system.

Unfortunately, this is usually not part of the mainstream approach. With conventional medicine, medication is often the first treatment option, diet and lifestyle changes are ignored or dismissed and the experiences that you have within your body are not given the importance that they deserve.

To address this problem and offer an alternative way of approaching healing that does take important factors like diet, lifestyle, physical, emotional and spiritual experiences into account, I’ve created a simple system for you to use.

APART System B&W

 

The A.P.A.R.T. System

It’s called The A.P.A.R.T. System, because this approach stands apart and so will your results if you use it.

This is a simple, easy-to-remember acronym for getting better results that aren’t based on protocols, dogma, or preconceived ideas.

It goes like this:

Each letter has two ideas that are associated with it.

  1. A = Ask and Assess

Data has healing power, if you know what data to collect and analyze and you know what to do with that information. (Both are big “ifs.”)

You need to ask what the symptoms are and assess the different systems of the body to find out where these symptoms are coming from.

And every bodily system and lifestyle practice needs to be a suspect. Don’t exclude something because you’re attached to it, feel like you can’t dowithout it or have decided that it isn’t a problem.

Everything in your life should be evaluated with equal scrutiny and if it isn’t working to make you better, it may have to be eliminated.

This includes people, places, and things like your favorite foods and drinks.

  1. P = Prioritize and Plan

Not everything has the same level of importance. This is what 80/20 teaches us (20 per cent of your issues cause 80 per cent of your symptoms – I’ve described in more detail in the Introduction).

Some things are having more of an impact than others. Figure out which they are (the positive feedback loops – or the things that are repeated and reinforced in your body and mind) and focus on those first, then make a plan to fix them.

I have created a Cheat Sheet in the back of the book that contains what I think are the most common 20 percent issues that cause 80 percent of our problems.

  1. A = Act and Adapt

Act and put your plan into motion. Then observe what the results are. Double down on what works and change what doesn’t. And results should be apparent relatively quickly.

If they aren’t, you need to make changes.

The common practice of a doctor or practitioner prescribing something and then telling the patient to come back in three to six months is not the best approach, in my opinion. That’s way too long, especially if it isn’t working.

  1. R= Reassess and Readjust

Retest, reassess and ask all over again. Figure out what worked and what didn’t. Double down on what worked and either eliminate or recreate a plan for what didn’t.

It sounds obvious, but it is often overlooked or forgotten. Testing and reevaluating what you have done to see the result of your treatment is essential for good care.

Quick side note here: In my opinion, what I have learned over many years of practice is that you need to trust what the data is telling you. In most cases, when you make the right choice, you start feeling better.

Things like a “healing crisis,” a “die off,” or a “detox reaction” sometimes occur, but they can also be a cover for incompetence. The right decision should result in a positive result relatively quickly.

If you are doing something and you aren’t getting better or you continue to feel worse, or it causes more discomfort, pain, and adverse symptoms, then you need to question whether that is the best course of action.

Eliminate it, reduce variables, and find out which part of what you are doing is causing that reaction or set of symptoms.

And all of this should not be done on the basis of lab tests alone. With Hashimoto’s it must include a thorough examination of the signs and symptoms as well.

Remember, what you feel is diagnostically important and clinically relevant.

  1. T = Try and Try Again

Keep doing it, keep refining, keep building on the positive results and keep looking for the remaining positive feedback loops that are causing vicious cycles.

People sometimes give up before giving a certain approach a chance. Or they get some good results and then slide back to their old ways of doing things. When you find something that works, keep doing it. Don’t quit and don’t give up.

Lab work and symptoms should all confirm that this has taken place.

Again, lab tests must always be viewed in context to how you feel. It is the combination of these two factors that determine success or failure.

In addition, you must create realistic goals that are small enough to achieve and then build upon them. Acknowledge and celebrate your small victories.

You can’t go from sick to perfect in a couple of weeks.

As I said, remission is a journey. It is measured by how you feel, by your lab tests and by your quality of life.

In other words, this journey is all about creating a lifestyle that will sustain and foster ongoing success.

Would you like to read the whole book? It chock full of great information and is available for free (you just pay the shipping). Get a copy while they last, I don’t know how much longer I’ll be offering them.

Click here to order your copy of Roadmap to Remission.

Shannon Garrett Fall 2015 Headshot Cream Blouse_Final

My Personal Story
One of the responsibilities of a nurse is to educate patients about their medication(s) and to assess and monitor for symptoms of adverse reactions or side effects.

As a previous cardiac nurse, I’ve observed my share of medications that cause significant side effects, many of which were severe.

One of the reasons I became a holistic and integrative nurse in private practice was to help people discover how they could take care of their health, mind, body, spirit, and emotions through healthy lifestyle choices and eating real food.

My second reason is because after 8 long years of seeing several doctors, I was diagnosed with 3 autoimmune diseases: Hashimoto’s thyroiditis, pernicious anemia, and celiac disease.

My only knowledge with respect to medication for use in autoimmune disease at that point was of immune system suppressants such as Remicade, prednisone, Imuran and others.

As a nurse, I knew I didn’t want those because they carry significant health risks. So I set up business not only to help my clients, but also to help myself in the process.

I decided to follow many of the suggestions commonly recommended by functional medicine practitioners today. I was tested for food sensitivities, underlying co-infections such as H. pylori, Epstein-Barr virus, Lyme disease, Yersinia entercolitica and Candida overgrowth. I was also tested for adrenal fatigue, vitamin deficiencies, and had the Genova gut health test.

I had eliminated gluten and dairy within one week of receiving my diagnoses simply because I knew they wreaked havoc on the system and their potential for inflammation.

I was pleased when my kidney filtration rate increased by 20 points after 60 days simply by eliminating these two proteins from my diet!

Fortunately, I did not have any underlying co-infections to deal with. I did have an adrenal fatigue issue. However, after approximately 9 months of commitment to lifestyle changes, healthy eating and reducing stress, my thyroid antibodies hadn’t really moved much.

I was devoted to an anti-inflammatory diet based on my test results, healing my gut, reducing stress, optimizing vitamin & mineral deficiencies, and balancing my hormones.

Although I felt slightly better, I hadn’t really lost the weight I’d expected, and I knew with an immune system that was still “confused” about what was my tissue and what was foreign was the perfect storm for additional autoimmune illnesses.

In the past, I’ve cared for patients in the clinical setting who struggled with multiple autoimmune diseases (some 8 and 9) and their daily quality of life was null. I knew I wanted to prevent this for myself.

Within 6 months I was experiencing what I believed to be MS-type symptoms and this scared me. My doctor made arrangements for me to see a specialist.

One day I was sharing my issues with another nurse and she asked me if I’d ever heard of low-dose naltrexone (LDN) and as I listened to her explain how it basically cured her father’s autoimmune illness, I knew I had to learn more.

To make a long story short, I researched LDN, gathered the information and presented it to my physician in a way I thought he would be open to listening…very methodical and with research to back up what I was saying.

We consulted with LDN literate pharmacists and both agreed I didn’t have anything to lose; however I didn’t start it immediately. I continued to work on healing my body an additional 9 months.

LDN has changed my life and I’ve seen it change others for the better…however, it is not a stand-alone treatment, and for autoimmune thyroid disease, there is a specific protocol to follow.

Today I am an independent autoimmune/thyroid wellness nurse consultant, certified nurse-nutritionist, holistic lifestyle & wellness coach and nurse educator. I am also a LDN nurse educator and love to share my knowledge with physicians and pharmacists on its use in a variety of autoimmune diseases.

What is LDN?

LDN modulates the immune system and has been shown to help patients with autoimmune disease, cancer, and other neurodegenerative disorders. It is relatively inexpensive and is available by prescription only and dispensed by a compounding pharmacy. I recommend LDN only be compounded by a LDN approved compounder.

It has been recognized that in many diseases the body may be lacking endorphins. The discovery of LDN is somewhat of a miracle, e.g. it is derived from naltrexone which has been available in generic forms for many years; however in low doses, it has been shown to modulate the immune system by blocking opiate receptors during sleep resulting in an increase of endorphins.

The therapeutic effect is believed to be achieved by increasing the body’s production of bea-endorphin and metenkephalin which are important regulators of the immune system.

These endorphins can increase circulating natural killer cells and lymphocyte-activated CD-8 cells, both of which are important to immunity. They also help regulate T-helper 1 and T-helper 2 (Th-1/Th-2, respectively) balance in the immune system.

(For more in depth look at how LDN works read Marc’s previous post.)

Many physicians are not familiar with LDN, or what they do know about it is very limited. Big Pharma does not have a vested interested in marketing a drug unless they can hold a patent on it. The patent for naltrexone expired a long time ago so it’s not profitable for them.

This means that their best-dressed sales reps will never be knocking on the doors of physicians-at-large to educate them on the miracle of LDN. Sadly, it’s simply never going to happen!

What they might know about LDN is limited to generic naltrexone in 50 mg doses which is used for alcohol, opiate withdrawal and heroin addiction.

That’s not what we’re talking about here, at all. LDN used for autoimmune disease including Hashimoto’s is not prescribed higher than 4.5 mg – and we start at a much lower dose than that before landing on a maintenance dose.

LDN and Autoimmune Disease

As previously stated, LDN is not a stand-alone treatment; however it is an amazing adjunct with the potential to trick the body into healing itself. The people who experience the most success with LDN are those who have optimized thyroid hormone levels, corrected nutrient deficiencies (especially iron, ferritin, vitamins D & B12, selenium, magnesium, zinc, and folate, etc.), healed their adrenals, eliminated infections such as Candida (Candida will block LDN), or Lyme, and healed leaky gut and low stomach acid if that was an issue.

SIDENOTE: Candida must be healed to a level within normal limits prior to starting LDN or it will not work.

When LDN is prescribed for a patient with Hashimoto’s, we start very low with the dose and slowly titrate over two months prior to a 6 month period of what we refer to as the modulating dose.

When a physician refers a patient to me who has LDN in mind as their ultimate goal, not only do I work with them on lifestyle changes to get their body ready, I also teach them how to monitor their vitals at home when starting LDN and educate them on what to watch out for and what to report, etc.

Depending on a patients progress (believe it or not, going hyper is a sign that LDN is working) they will be taught how to titrate down their thyroid hormone. One of the biggest mistakes we see patients (and physicians) making when a patient reports hyper symptoms is that they will abruptly discontinue LDN.

This is the wrong course of action…what is necessary however, is to titrate down slowly on thyroid hormone (and of course lab tests are done to validate this action).

LDN and Medication Concerns

Since LDN blocks opiate receptors, it cannot be taken with any narcotic medication. Naltrexone is a pure opioid antagonist and will block the action of narcotics. In other words, pain medication won’t work if you’re taking LDN.

I recently temporarily had to discontinue my LDN due to surgery and I knew that pain medication was going to be prescribed for a few days after the procedure.

LDN will not work if you are taking medications that suppress the immune system like prednisone or others. LDN is an immune system modulator and steroids suppress – both will antagonize the other and neither will work.

Examples of narcotic-based medications include morphine, Percocet, duragesic patch and any medication that contains codeine.

LDN and Potential Side Effects

The main side effects I’ve observed and experience personally are mild and usually disappear within two weeks while the immune system is responding to the blocking of opiate receptors. Most common are:

  • Disturbed sleep
  • Vivid, colorful dreams
  • Tiredness or fatigue

Again, these typically go away within two weeks of starting LDN and given the potential LDN offers, are well worth the effort.

Tips if you are Interested in LDN

  • It is important to get your body in the best shape possible prior to going on LDN. I devoted 9 months to healing my body even further before going on LDN.
  • Be sure to work with a LDN-approved compounding pharmacy. I cannot tell you how important this is and we’ve found that not all compounding pharmacies follow the correct LDN protocol. For resources on approved pharmacists and new research you can check here: http://www.lowdosenaltrexone.org
  • Seek a physician who is either very open to LDN or is already LDN-literate for its use in autoimmune thyroid disease. The way LDN is dosed and monitored in autoimmune thyroid disease differs greatly than how it is prescribed for any other autoimmune disease. You can contact me HERE for resources, or check with the LDN Research Trust-England

This article focused on LDN for use in autoimmune thyroid disease. However, LDN is used successfully in a variety of autoimmune diseases as well as in cancer and Lyme disease. Given its potential, it’s very sad to me that drug companies aren’t interested.

LDN has changed my life! I now live a life full of vitality, and I have my body and my brain back. I’ve been in remission for 3 years as of this writing and I’m passionate about helping other women find this same level of healing…whether it be through natural lifestyle changes or LDN, my goal is to help them succeed.

To read more about my story, I invite you to read my eBook Hashimoto’s: Finding Joy in the Journey available on Amazon as a Kindle book and soon it will be available in paperback!

Hashi eBook Cover Web Image

I invite you to also check out my Facebook page (Holistic Thyroid Care) and website for resources to help you live your best thyroid life!

 

Shannon Garrett, BS, RN, CHLC, CNN

A_Vojdani_LDN

                                            Slide from presentation by Dr. A. Vojdani on LDN

Hashimoto’s is the most common autoimmune disease of the thyroid and if affects millions of people globally. The most common treatment for this condition is synthetic T4 (usually Synthroid or a generic equivalent).

For many this treatment is ineffective and for some it only makes their symptoms worse. There are many reasons for this, but one of the important ones is that synthetic T4 does not sufficiently address the autoimmunity that is at the root of this disease.

In addition, unfortunately, many doctors ignore autoimmunity and pretend that it isn’t there. This is an abdication of responsibility and it can result in poor outcomes and poor clinical results.

And, unfortunately, it is the patients who suffer most from this approach. In this post, which is part of a new series, we will explore alternatives to just giving synthetic T4. One that shows promise with very few side effects is Low Dose Naltrexone, also known as LDN.

What is Naltrexone?

Naltrexone is a drug that was originally approved in the 1980’s as a treatment for opiate and alcohol addiction. The drug is an opiate antagonist and it blocks opiate receptors on cells. So it blocks the effects of legal and illegal opiates like morphine, codeine, oxycontin and heroin and opium.

With alcohol, it acts to block endogenous opiates which are opiates our bodies naturally produce. These include endorphins, enkephalin and other hormones we produce naturally.

When these natural opiates are blocked, there are more of them in the system and it can result in less craving and consumption of alcohol by alcoholics.

It is also this effect of blocking our natural opiates that also may provide benefit by calming and modulating the immune system in autoimmunity.

A Little History: Dr Bernard Bihari

Naltrexone was approved in 1984 by the FDA in a 50 mg dose as a treatment for heroin addiction. When it was licensed, Dr. Bernard Bihari, then involved in running programs for treating addiction, tried it with more than 50 heroin addicts.

None of the patients stayed on the drug because of side effects experienced at the 50 mg dosage such as insomnia, depression, irritability and loss of feelings of pleasure, (all due to the effect of the drug at this dose in blocking endorphins which are involved in many of these activities and emotions).

Physicians treating heroin addicts with this approach got frustrated and many stopped prescribing naltrexone. Then, in the 1980s, a large number of heroin addicts began to get sick with AIDS (studies from that time have shown that about 50% of heroin addicts were HIV Positive).

AIDS Changed Everything

Dr. Bihari and his colleagues decided to shift their research focus to AIDS, in particular studying ways of strengthening the immune system. Since endorphins are involved in supporting and regulating the immune system, levels of endorphins were measured in the blood of AIDS patients. They were found to average only 25% of normal.

Naltrexone became the focus of Dr. Bihari’s research group because they observed that when given to mice and people at high doses, the body raises endorphin levels to compensate for the naltrexone blockade.

The group discovered that endorphins are almost all produced in the middle of the night, between 2 AM and 4 AM, and the studies focused on small doses (1.5-4.5 mg at bedtime) with the hope that a brief period of endorphin blockade before 2 AM might induce an increase in the body’s endorphin production.

In fact, it was discovered that the drug  was able to do this in this lower dosage range. It had no effect below 1.5 mg and too much endorphin blockade at doses over 5 mg. A placebo-controlled trial in AIDS patients showed a much better outcome in patients on the drug as compared with those on placebo.

Naltrexone Seemed to Work with MS

By coincidence, during the research trial, a close friend of Dr. Bihari’s daughter had three acute episodes of multiple sclerosis over a nine-month period with complete spontaneous recovery from each.

Because of his knowledge of MS as a neurologist and of recent evidence that naltexone might have impact on autoimmunity, Dr. Bihari decided to start his daughter’s friend on the drug at 3 mg every night at bedtime.

She took it for five years with no further attacks. At that point, when her supply ran out, she stopped it because she thought she no longer had MS.

About a month later, she developed an episode of weakness, numbness, stiffness and spasms in her left arm ( all common symptoms of MS) and resumed LDN, which she then stayed on for 12 years. During that time she reportedly had no further disease activity.

How Does LDN Work?

The exact mechanism of how naltrexone works with immune related diseases is not fully understood. But here’s what we do know.

LDN Works in Several Ways:

  1. It increases endogenous opiates
  2. It inhibits pro-inflammatory cytokines
  3. It promotes nuclear opioid growth factor
  4. It blocks opiate receptors in the GI tract
  5. It regulates T-reg cells like IL-10 and TGF

Increases Endogenous Opiates

A small dose of the drug taken nightly at bedtime increases endorphin levels in the body the following day.

Since endorphin levels are often low in people with autoimmunity, immune function is impaired and the normal immune regulatory function of CD4 cells is affected.

These cells include proteins in the TH-1, TH-2 and TH-17 families that can cause so much damage with autoimmune disease. These cells and proteins that are related to them are what create antibodies to our own tissue, signal attacks on that tissue and, ultimately lead to the destructive inflammatory process that destroys it.

If the T regulatory part of the immune system is weak, these other parts of the immune system can get out of control and cause more significant damage.

Inhibits Pro-Inflammatory Cytokines

The anti-inflammatory effect of LDN has been studied and using it resulted in suppressed TNF-alpha, IL-6, MCP-1, and other inflammatory agents in peripheral macrophages.

It also has strong effect on calming glial cells and given the wide variety of inflammatory factors produced by activated microglia (e.g., proinflammatory cytokines, substance P, nitric oxide, and excitatory amino acids) this is also a significant effect of the treatment.

Promotes Opioid Growth Factor

Opioid growth factor (OGF; [Met5]-enkephalin) is a natural peptide that has been shown to inhibit growth of certain cancer cells. LDN has shown promise in treating liver and pancreatic cancers.

LDN is an opioid receptor antagonist that acts at classical and non-classical opioid receptors including the opioid growth factor receptor (OGFr).

Animal models of type 1 and type 2 diabetes, as well as normal rodents, have shown that topical naltrexone enhances the healing rates of corneal epithelium and full-thickness cutaneous wounds. The mechanism of this general opioid antagonist on growth, and in particular the specific receptor pathway involved, is not understood.

Blocks Opiate Receptors in the GI Tract

Neuropeptides may play a role in irritable bowel syndrome and these molecules (e.g., enkephalins and endorphins) are present in the gastrointestinal tract and these modulate immune responses.

Upregulation of met-enkephelin (opioid growth factor-OGF) and opioid receptors can all be induced by low dose naltrexone.

LDN displaces endogenous endorphins bound to the OGF receptor. Affected cells become low in OGF which results in more receptors being made.

Receptor sensitivity is increased to capture more OGF and production of OGF is also increased to compensate for the perceived shortage of this molecule.

Higher levels of endogenous opioids and receptors inhibit cell proliferation which suppresses B and T lymphocyte responses. Naltrexone has been shown to reverse a mouse colitis model by decreasing the pro-inflammatory interleukins 6 and 12.

Down Regulates TH-17

LDN has been shown to stimulate certain parts of the immune system and suppress and down-regulate others. It has been shown to inhibit IL-17, a protein that is part of the TH-17 family. It can also down regulate IL-10 and TGF beta (Transforming Growth Factor beta).

What’s interesting to observe here is that not everyone has the same immune cell profiles and LDN may work better on those that have a profile that best fits the things that it enhances and suppresses.

(Note: If the part of your immune system that is causing problems is not suppressed but rather stimulated by LDN, then you might feel worse after taking it.

Once again, this is very complicated and not everyone with Hashimoto’s and autoimmunity has the same immune configuration. This may explain why some people do well with the drug and others seem not to.)

There is no real consensus on how this all works and considerable debate about how LDN does what it does.

Do Immune Cells Have Opiate Receptors?

One such question is whether or not immune cells have opiate receptors.

There is some debate in the scientific community about whether or not the effect of opioids on the immune system are due to the fact that immune cells have opiate receptors.

Researchers have not been able to find these receptors, yet there is no doubt that opiates have a powerful effect on immune cells. And there is ample evidence of the functional influence of opioids on these cells.

In fact, in many ways opiates behave like immune cells, themselves. They impact the production of immune cells by acting locally, and inside cells, they affect gene expression and these influences both depend on dosage and time.

Endogenous Opiates Are Not the Same as Drugs

One thing that’s also important to understand is that the endogenous opiates in our bodies do not behave the same as drugs like morphine, heroin and other exogenous opiates.

What’s also interesting is that immune cells themselves contain endogenous opiate proteins. They actually carry them to sites of inflammation.

Immune cells have been shown to contain numerous opioid peptides such as β-endorphin (END), met-enkephalin (ENK), and dynorphin-A (DYN), although the most common appears to be END.

These opioid-containing immune cells travel to inflamed tissues and once there, opioid peptide is released from the immune cells upon stimulation with corticotrophin-releasing factor (CRF), noradrenaline, and interleukin 1β (IL-1β), and then the immune cells return to the local lymph node depleted of this peptide.

Which means if you can increase the amount of these endogenous opiates (which LDN does) you have more of them available to be delivered.

It’s also interesting to note that research found that endogenous opiates can raise TSH.

The Standard Therapy for Autoimmune Disease May Make Things Worse

So if you can follow the logic of this, systemic immunosuppression (which is the standard approach used to treat autoimmune diseases) may affect the body’s ability to regulate immune cells that are important for the release of endogenous opioid peptides within inflamed tissue.

To further complicate matter it is know that exogenous opioids may impair immune cell function, something not shared by endogenous opioid peptides.

This means that giving pain relieving medication that are opiates may also impair immune system function.

So if you have autoimmune disease and you are using immunosuppresant therapy and opiates for pain relief, you are setting yourself up for failure and may be making the disease progression worse and more severe.

Glial Cells in the Brain and Central Nervous System Affect Opioids

Another really interesting thing that the research reveals is the role of glial cells in the brain and central nervous system on opioids.

This research has shown that these cells can become activated and they can make the opioids not work as well.

This happens via numerous mechanisms, including directly affecting receptors,  upregulation of excitatory amino acid receptor function, downregulation of GABA receptor function, etc.

The downstream effects of glial activation result in increased pain, suppressed acute opioid pain relief, increased tolerance, and the development of opioid dependence.

Conditions such as fibromyalgia may involve chronic glial cell activation and subsequent production of pro-inflammatory factors.

And Hashimoto’s and fibromyalgia have many symptoms that are identical. See this post I wrote on this.

In addition, it is widely known that T3 has important and dramatic effects on the microglia and hypothyroidism, “functional hypothyroidism” and “low T3 syndrome” can all result in glial cell activation, making all of this worse.

One theory is that LDN, itself, is a glial cell modulator. It may calm theses glial cells and prevent them from exerting the damage that they do.

What’s also really interesting is that CBD (Cannabanoid) has also been found to calm glial cells. I’ll be exploring this more in an upcoming post.

Is LDN Safe?

Naltrexone taken at low doses has virtually no side effects. According to lowdosenaltrexone.org, occasionally, during the first week’s use of LDN, patients may complain of some difficulty sleeping.

This rarely persists after the first week. Should it do so, dosage can be reduced from 4.5mg to 3mg nightly.

Caution: LDN May Cause Adverse Effects in These Circumstances

LDN Will Interfere With Narcotic Medication

Because LDN blocks opioid receptors throughout the body for three or four hours, people using narcotic medication — such as Ultram (tramadol), morphine, Percocet, Duragesic patch or codeine-containing medication — should not take LDN until such medicine is completely out of one’s system.

Patients who have become dependent on daily use of narcotic-containing pain medication may require 10 days to 2 weeks of slowly weaning off of such drugs entirely (while first substituting full doses of non-narcotic pain medications) before being able to begin LDN safely.

LDN May Impact Thyroid Hormone Dosage

Patients who are taking thyroid replacement hormone for Hashimoto’s with hypothyroidism ought to begin LDN at the lowest range (1.5mg for an adult).

Be aware that LDN may lead to a prompt decrease in the autoimmune disorder (and less inflammation within the thyroid and the rest of the body), which then may require a reduction in the dose of medication in order to avoid symptoms of hyperthyroidism.

LDN Should Not Be Taken With Immunosuppresant Medication

People who have received organ transplants and who therefore are taking immunosuppressive medication on a permanent basis are cautioned against the use of LDN because it may act to counter the effect of those medications.

The same is also true for people who have been prescribed immunosuppresant medications. As we learned above, the long term consequences of this medication may be increased severity and progression of the disease.

Bottom Line: LDN is Worth Trying

There are several important takeaways from this post:

1. LDN is safe and has few side effects

2. Dosage really matters, less is absolutely more!

3. There is ample evidence that it can be beneficial in calming the immune system in autoimmunity, though how it works is not yet fully understood.

There is evidence that it calms TH-1, TH-17 and other cytokines and that it can help calm glial cells in the brain and CNS (Central Nervous System).

3. It is not the magic bullet. If you don’t have an immune system profile that fits the way LDN works in your body, it may not work for you as effectively as it does for others. 

And you can’t take it and ignore all the other things we must do to heal Hashimotos such as:

Healing your brain, and calming glial cells, healing your adrenals, healing your gut and doing all of the other things we advocate.

But LDN may be a good option and could give you the upper hand in dealing with immune system dysfunction.

References and (A Boatload of) Research:

http://www.ldnresearchtrust.org

http://www.lowdosenaltrexone.org/ldn_and_ai.htm

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC95944/ Opiates receptors on immune cells

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3962576/   LDN and pain treatment

http://www.ncbi.nlm.nih.gov/pubmed/22850250 TLR4 Receptors

http://www.ncbi.nlm.nih.gov/pubmed/22826216 TLR4 Receptors promote autoimmunity

http://www.ncbi.nlm.nih.gov/pubmed/23188075 LDN for Crohn’s disease in children (safety)

http://www.ncbi.nlm.nih.gov/pubmed/17222320 LDN improves Crohn’s disease

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1857294/ Glial cells as “bad guys” opioids and glial cell modulation

Endogenous opioids and immune modulation

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1661636/ Endogenous opioid analgesia

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3912755/ Mu opiod receptor

http://www.scielo.br/scielo.php?pid=S0034-70942012000500010&script=sci_arttext&tlng=en Opioids and the Immune system

http://bja.oxfordjournals.org/content/111/1/80/T1.expansion.html Table of impact of endogenous opioids on the immune system. ENDOGENOUS OPIATES INCREASE TSH!

http://bja.oxfordjournals.org/content/111/1/80.full Opioids and immune modulation

http://www.nature.com/icb/journal/v78/n5/full/icb200077a.html Effect of neuropeptides on the immune system

http://www.ncbi.nlm.nih.gov/pubmed/9610674 Opioid cytokine connection

http://www.jimmunol.org/content/186/9/5078.full.pdf Relationship of T cells and pain relief

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4407783/ Endogenous opioids inhibit TH-1 and TH-2

http://link.springer.com/article/10.1007/s12026-008-8018-0 Microglial Cells and Parkinson’s

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1661636/ Endogenous opioid analgesia

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2096733/ Endogenous neurotransmitters function as retrograde inhibitory neurotransmitters

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4452882/ T3 and microglia

http://www.ldnscience.org/opioid-growth-factor-ogf/51-ogf/ogf-explanatory

http://www.gidoctor.net/client_files/file/LDN-for-IBS.pdf

Structure of herpes virus. A portion of the virus has been removed to reveal its inner structure. Vector scheme
                The herpes virus is an unstoppable biological machine

Like most health conditions, Hashimoto’s has no single cause.

It is the result of the perfect storm of factors that include a genetic predisposition, exposure to some pathogen (often a herpes virus), the breakdown of the gut and barrier systems (without or without the help of gluten), exposure to gluten, environmental toxins like radiation, mercury and other toxic chemicals and often, some particularly stressful event.

In this post we explore one of those causes, the herpes virus.

As many of you know, I have Hashimoto’s and have made it my life’s work to understand everything I can about the causes, treatment and management of this disease.

My Own Experience with Herpes

I also have herpes simplex 1 (along with 90% of the population). While this is not a life threatening disease it can be the cause of shame and embarrassment, especially when I get a more serious outbreak on my face or lips.

As a health care practitioner, there are times when having an outbreak of herpes has made me feel like I’m not very good at my job because it can look much worse than it is.

But the reality is that there are few other biological entities as resilient and unstoppable as the herpes virus. All the technology at our disposal is pretty useless when it comes to trying to eradicate this infection.

And I suppose one blessing of having it is that I can not venture too far from the things I know I need to do to stay healthy. The virus will rear it’s ugly head and remind me to get back in line.

In addition, one thing I have observed in my own life is that an outbreak of herpes can also affect my Hashimoto’s, resulting in a debilitating double whammy that can affect me emotionally, physically and psychologically.

So I thought I would explore this in more depth, and look at the relationship between herpes and Hashimoto’s. You may be surprised by the information and the impact that these various herpes diseases can have.

Herpes Viruses Are Everywhere

There are 8 different herpes viruses known to infect human beings. These include herpes simplex 1 & 2, varicella zoster (which causes chicken pox) also known as herpes 3, Epstein Barr virus (herpes 4), Cytomegalovirus (herpes 5), Human Herpes Virus 6 & 7 and Human Herpes Virus 8 found in people with complications due to HIV.

While the whole herpes family is believed to be linked to autoimmune disease, there is more research into the link between herpes simplex 1 & 2, Epstein Barr, and Cytomegalovirus and autoimmune thyroid disorders like Hashimoto’s.

The common factors that unite them is that all of them remain in the body forever, they can remain dormant for years and then get reawakened (often by stress or stressful events) and they all have the potential to do harm to the brain because the herpes virus has an affinity to nerve tissue.

Herpes Simplex 1 & 2

Herpes simplex virus (HSV) infections are very common worldwide. HSV-1 is the main cause of herpes infections on the mouth and lips, including cold sores and fever blisters. It is transmitted orally (through kissing or sharing drinking glasses and utensils). HSV-1 can also cause genital herpes, although HSV-2 is the main cause of genital herpes.

HSV-2 is spread through sexual contact. You may be infected with HSV-1 or HSV-2 but not show any symptoms. Often symptoms are triggered by exposure to the sun, fever, menstruation, emotional stress, a weakened immune system, or an illness (like Hashimoto’s).

While most herpes infections do not cause serious complications, infections in infants and in people with weakened immune systems, or herpes infections that affect the eyes, can be life threatening. In addition, herpes virus attack nerves so they can do damage to the brain by attacking the ganglia.

In fact, Herpes simplex encephalitis (HSE) is an acute or subacute illness that causes both general and focal signs of cerebral dysfunction. Brain infection is thought to occur by means of direct neuronal transmission of the virus from a peripheral site to the brain via the trigeminal or olfactory nerve. The exact pathway is unclear, and factors that precipitate HSE are unknown.

Epstein Barr Virus (EBV)

Epstein-Barr is the virus that causes mononucleosis and is part of the herpes family. Even if you didn’t come down with it in high school or college, you were very likely infected with it, an estimated 95% of US adults have been infected with this virus.

It can present without any symptoms and has been linked to both Hashimoto’s and Graves’ disease. In my own patient population about 80% of the people I have worked have been diagnosed with EBV.

I surveyed our Facebook group and asked how many also had the Epstein Barr virus. Of the 131 (and counting) people with Hashimoto’s who responded 85% were aware that they had been exposed to the Epstein Barr virus.

This is obviously not a rigorous study, but it does show you just how prevalent this infection is in this patient population.

It has also been linked to other autoimmune diseases, such as Multiple Sclerosis, Lupus, and Sjogren’s syndrome. In addition, both fibromyalgia and chronic fatigue syndrome are also linked to EBV.

Epstein Barr can also lead to inflammation of the brain (viral encephalitis). This is a serious concern with Hashimoto’s because it can also have a profound impact on the brain and this inflammation has the potential to lead to neurodegeneration and cognitive decline.

Cytomegalovirus (CMV)

Most people infected with CMV do not have any symptoms. Acute CMV infection can cause mono-like symptoms such as fever, enlarged lymph nodes, sore throat, muscle aches, loss of appetite and fatigue.

In people with compromised immune function, CMV infections can attack different organs and systems in the body and can lead to blurred vision and even blindness (CMV retinitis), lung infection, diarrhea, inflammation of the liver, inflammation of the brain (encephalitis). In more severe cases it can lead to behavioral changes, seizures and coma (again highlighting the impact of the virus on the brain).

How Do These Viruses Lead to and Impact Hashimoto’s?

It is not believed that the herpes viruses directly cause autoimmune disease. But they do play a part in it’s initial onset and progression and they can certainly make symptoms more intense and be a barrier to healing and feeling better.

There are many reasons for this and I will discuss them in a moment, but first let’s take a look at antigens and antibodies so that you can understand how these viruses cause problems in the body.

Antigens Trigger an Immune Response, Antibodies Bind to Antigens

An antigen is a substance that produces an immune response.  So for example, foreign substances such as chemicals, bacteria, or viruses are all considered antigens.  Foods can also be seen as antigens by the immune system.

However, an antigen can also be produced inside of the body, and even the tissue cells can be considered to be an antigen at times, which is what happens with autoimmune conditions such as Graves’ Disease and Hashimoto’s.

An antibody is a protein which is produced by the immune system, and this antibody binds to a specific antigen.  Once the antibody binds to the antigen other immune system cells (i.e. macrophages) attempt to engulf and destroy the antigen.

How These Antibody Reactions May Lead to Autoimmunity

There are number of theories about the different mechanisms that can lead viruses to trigger autoimmune disease. A couple examples are: direct bystander activation, and molecular mimicry.

 Direct bystander activation:  This describes an indirect or non-specific activation of autoimmune cells caused by the inflammatory environment present during infection.  Think of this as being in the wrong place at the wrong time,  just like being caught in a drive by shooting.

In this case, one part of the immune system becomes activated and this turns on other parts which can kill both viral-infected cells, and healthy cells as well.

So, for example, virus-specific T cells might migrate to the areas of a viral infection, and when these T cells encounter virus infected cells they sound the alarm and release immune proteins (called cytokines), which not only kill the infected cells, but also leads to “bystander killing” of other healthy cells nearby.

Molecular mimicry:  This is a process where a foreign antigen shares an amino acid sequence or has a similar structure to self-antigens. So for example, a certain virus can have an amino acid sequence that is very similar to the amino acid sequence of human cells.

This can result not only in the production of antibodies against the virus, but can also lead to auto-antibodies against the human cells due to the similarities in the proteins.

Something else that can occur is that viral fragments can attach to human tissue and result in a hybrid that is part virus and part human and this can also be attacked by the immune system.

Here Are The Possible Steps to Autoimmunity

The mechanisms mentioned above really the end of a series of potential steps that lead to autoimmunity. There are some interesting theories about how this happens. This matters because if we can figure out how it is happening, it can help us figure out what how to treat it.

And what’s also interesting is that this same process takes place with all herpes viruses, it’s not unique to the ones that we’re looking at as examples.

It Starts with CD8+ T-cells

CD8+ T-cells are a kind of cell which inhibits viruses. Basically, once activated they kill bad cells.

Scheme of virus replication cycle. Vector illustration

                 Cells infected with the virus are used to make more virus.

Cells which viruses have infected are one example. These cells will be used by the virus to make more virus, so they must be killed by the immune system.

Having a deficiency of them is a common characteristic of virtually every chronic autoimmune disease (including: multiple sclerosis, rheumatoid arthritis, systemic lupus erythematosus, Sjögren’s syndrome, systemic sclerosis, dermatomyositis, primary biliary cirrhosis, primary sclerosing cholangitis, ulcerative colitis, Crohn’s disease, psoriasis, vitiligo, bullous pemphigoid, alopecia areata, idiopathic dilated cardiomyopathy, type 1 diabetes mellitus, Graves’ disease, Hashimoto’s thyroiditis, myasthenia gravis, IgA nephropathy, membranous nephropathy, and pernicious anaemia).

Some scientists believe that this CD8+ T-cell deficiency may be partially responsible for the formation of these chronic autoimmune diseases, as well. And one reason is that they aren’t able to control the Epstein-Barr virus (EBV) or other herpes infection.

If EBV isn’t controlled, it can cause all kinds of problems in the body.   When EBV infects B cells it can make them “auto-reactive”, which means its products (antibodies) target our own tissues.

According to a paper called “CD8+ T-Cell Deficiency, Epstein-Barr Virus Infection, Vitamin D Deficiency, and Steps to Autoimmunity: A Unifying Hypothesis” by Michael P. Pender, one theory is that autoimmunity occurs in the following steps:

Steps to Autoimmunity

    1.    First you have CD8+ T-cell deficiency – this has a genetic component.

    2.    Then, EBV (or other herpes virus) infection and spread of EBV because of CD8+ T-cell deficiency (there aren’t enough of these cells to kill these virus infected cells).

    3.    Increased antibodies against EBV (kind of like a second line of defense), your body responds and tries to bring in more help.

   4.    EBV infects a specific organ – and, particularly, B Cells in that organ. This corrupts the B cells to attack our own tissue. (One theory is that since viruses and bacteria have proteins similar to our own proteins, we mistakenly attack our own proteins. This confusion by our immune system is the ‘molecular mimicry’ I described above.)

    5.    B Cells proliferate in the infected organ (your antibody numbers increase)

    6.    T cells are drawn into the organ and also attack our tissue. Antibodies signal the attackers.

    7.     Development of ‘structures’ in the target organ, which causes B cells to attack our tissues. (This is dependent on Th17 cells ) This process repeats and builds on itself.

What Factors Push Autoimmunity?

Some common factors that push autoimmunity are:

Low Vitamin D
High Estrogen
High Chronic Stress

Low Vitamin D

Vitamin D and sunlight are very important for CD8+ T cells production, which may explain why countries that get less sunlight have a higher occurrence of autoimmunity. People with Hashimoto’s commonly have low Vitamin D levels.

High Estrogen

Estrogen also decreases CD8+ T cells, which may explain the higher incidence of autoimmunity in females. Women with estrogen dominance and/or impairment of detoxification pathways in the liver may have too much circulating estrogen and this can cause problems with the immune system.

High Chronic Stress: High Cortisol/Low Pregnanolone

Chronic stress can cause reactivation of EBV, probably by downgrading the TH1 immune response. (TH1 are T helper cells that sound the alarm and also induce destruction. They are like the elite soldiers of the immune system.)

When you have chronic stress, your body keeps pumping out cortisol. Cortisol is made from cholesterol and a hormone that helps make cortisol is known as pregnenolone.

Pregnenolone is a neurosteroid and is important in the creation of other hormones like cortisol.

When your body is under constant stress (which is the state of living with an autoimmune disease like Hashimoto’s) and needs to keep producing more and more cortisol something called the “pregnenolone steal” can happen.

This is where cortisol is ‘stealing’ or diverting pregnenolone for cortisol production and depleting it.   When pregnenolone is depleted, there will, of course, be less of it to produce more cortisol in the future.

Viruses Hijack the Mevalonate Pathway

When a viral infection becomes active it takes control over what’s known as the “mevalonate pathway.”  Viruses use this pathway to make their protective outer coats.

In answer to this, your body makes interferon, which shuts down the mevalonate pathway, which in turn suppresses the virus.  However, inhibiting this pathway may also lead to a reduction in synthesis of pregnenolone and Co-enzyme Q10 (which also may be depleted in Hashimoto’s).

One of the most common viruses that causes this pathway to be inhibited is Epstein-Barr Virus (EBV).

There’s also another problem.

When you’re under high stress the body releases cortisol, which suppresses your immune system.

Specifically, the TH1 (or T Helper 1) part of the immune system is suppressed by chronic stress. This aspect of the immune system (Th1) protects us from viral reactivation. Cells and proteins in this family sound the alarm and kill viruses.

When this part of the immune system is suppressed, viral infections can then reactivate- including EBV, herpes and a host of other viruses.
What’s really interesting about this is that Hashimoto’s was originally thought to be a TH-1 dominant disease and some people with Hashimoto’s do have TH-1 dominance.

And here’s where it gets tricky. If you stimulate TH-1, then you may risk firing up the part of the immune system that is destroying your thyroid. So this requires some real skill in dealing with with both Hashimoto’s and EBV or other herpes viruses at the same time.

Other Things EBV Can Disrupt

There are some other things that EBV can cause problems with and these are really significant because they are also common problems with Hashimoto’s.

EBV can cause problems with serotonin, methylation, and can compromise the blood brain barrier and, as we have already seen, lead to neurodegeneration.

This is really interesting because with Hashimoto’s and hypothyroidism, serotonin can also become depleted. This one of the reasons why some people with Hashimoto’s experience depression and a lack of motivation and enjoyment in things. So the combination of Hashimoto’s and EBV can lead to some serious emotional issues.

Methylation issues are also quite common with Hashimoto’s and some people have MTHFR gene mutations which can exacerbate this problem. In addition, dominance of the TH1 part of the immune system can lead to methylation problems, as well.

And, finally leaky gut and intestinal permeability are the hallmark of virtually all autoimmune diseases and this is sometimes the sign of a larger systemic problem involving all the barrier systems of the body.

The gut and the brain are very closely related and the same proteins that protect the barrier of the intestines also line the blood brain barrier. When one area is compromised the other can be as well.

So, the combination of EBV and Hashimoto’s certainly has all the ingredients of a potent vicious cycle that can create a downward spiral of difficult to resolve physical and psychological health problems.

What To Do If You Have EBV and Hashimoto’s

Treating both EBV (and other herpes viruses) and Hashimoto’s at the same time can be tricky because herbs and supplements that are known to prevent reactivation of the virus can also stimulate parts of the immune system.

And if these parts of the immune system are causing tissue destruction and flare ups of your symptoms, then you are simply trading problems. And this approach may actually make matters worse.

So, let’s take a look at some obvious and less obvious treatment strategies that can keep EBV or other viruses at bay and not stoke the fires of autoimmunity.

Lifestyle Interventions

One of the most important treatments for EBV (and other herpes viruses) is having stress relieving hobbies. Many people are aware of the destructive power of stress, but it always amazes me how little they are willing to do about it.

If you have Hashimoto’s and EBV and you don’t do things to reduce stress daily, you are setting yourself up for failure. It’s like walking into oncoming traffic and expecting not to be hit by a car or truck. You are going to be in a world of hurt if you don’t have daily habits for reducing stress.

These include meditation, yoga, qi gong, music, art, relaxation, massage, acupuncture, spa days, mineral baths, etc. These are not luxuries, they are necessities for someone living with Hashimoto’s and EBV.

I’m giving you permission to indulge yourself. If you need a note from your doctor for this, email me and I’ll be happy to write one for you. 🙂

Foods to Avoid with EBV and Herpes Viruses

Another thing to be conscious of are foods and supplements that can feed and encourage the herpes virus. The most common are foods that are low in lysine and high in arginine.

These include:

•    chocolate
•    coconut (coconut oil is fine since it has no amino acids)
•    seeds and nuts
•    orange juice
•   wheat products and products containing gluten
•    oats
•    lentils
•    protein supplements: casein, the protein found in milk may also increase arginine levels.
•    gelatin

What’s interesting to note here is that some of these foods are foods we commonly avoid with Hashimoto’s while others are staples of the Paleo and Autoimmune Paleo diets. (This emphasizes the importance of being flexible and of the highly individualized nature of the problem.)

Highly acidic foods and those laden with chemicals can also exacerbate viral infections and lead to outbreaks.

•    alcohol
•    caffeine
•    all junk food
•    too much red meat
•    processed/white flour products
•    food additives
•    artificial sweeteners.

These are all also foods that can exacerbate your Hashimoto’s. So there’s no love lost here. Caffeine can potentiate or increase the utilization of arginine so that should be done in moderation.

Herbs for Treating EBV and Herpes

There are several different strategies for treating EBV and other herpes viruses. Novice herbalists will often throw lots of immune stimulating herbs at the problem like astragalus, ashwaganda and medicinal mushrooms like maitake and reishi.

These are great herbs, but can be a really bad idea for some people with autoimmune disease.

Instead a more targeted approach of attacking the virus and strengthening different parts of the immune system with a more nuanced approach is a much, much better idea. The Chinese Herbal Materia Medica is full of herbs that can accomplish these tasks beautifully.

Here are some herbs that specifically attack EBV and other herpes viruses:

Anti-EBV Herbs:

Angelica sinensis, chrysanthemum, citrus, lithosperum, milletia, paedria, picrorhiza

Anti-Cytomegalovirus:

Isatis root, baphicacanthes, cnidium, lithosperum, forsythia, gardenia, chrysanthemum, vitex, dandelion, epimedium, lonicera

Anti-Herpes Herbs:

Belamcanda, clove, crataegous, dandelion, epimedium, houttuynia, inula, lonicera, portulaca, prunella, rhubarb, salvia, scrophularia

It’s important to note that many of these herbs have multiple pharmacological properties and can therefore be used to accomplish more than one thing if combined properly.

Herbs for Safely Strengthening the Immune System

It’s important to strengthen the immune system to treat these herpes viruses, as well, but it must be done carefully.

As we saw before, Vitamin D is important for strengthening CD8+ T cells, as is glutathione and superoxide dismutase, EPA and DHA.

Turmeric is helpful because of it’s anti-inflammatory properties.

Also, there are couple of essential oils that I have found are very effective for first attacking the virus and, then healing the sores.

Ravensara is an excellent anti-viral oil that may applied topically directly on the lesions. Heliochrysum is an oil that helps regenerate flesh and can help to heal the sores more quickly.

My partner, Olesia Farberov makes a fantastic herbal salve with some of Chinese herbs mentioned above and both these essential oils called The Healer.

The_Healer_5ml_grande

The Healer, made with anti-herpes herbs and essential oils

This is an absolute must for your purse, pocket and medicine cabinet. I prescribe it to all of my patients with herpes and use it myself because it just plain works.

Vitamins, Minerals and Supplements:

Research has shown that a daily intake of at least 1250 mg of lysine supplements can help control herpes outbreaks.

Zinc, Vitamin C and B vitamins may also be helpful.

Other supplements that can help increase CB8+ cells include:

N-Acetyl-Cysteine (NAC), butyrate, andrographis, and gynostemma

Western Medication

One area where I actually advocate using Western pharmaceutical drugs is in the treatment of these viruses. Acyclovir is a potent anti-viral and for some people who have really stubborn hard to treat outbreaks, it can be an effective tool in your arsenal.

Another drug to consider is Low Dose Naltrexone (LDN). It has the ability to modulate immune function and calm physiological stress. It can also be effective in helping the body to deal with the herpes virus.

Bottom Line: If  You Can’t Beat ‘Em, Join ‘Em

At the end of the day, the reality is that these viruses are here to stay. They are remarkably adaptable and persistent and they have there own insidious intelligence.

We can not hope to defeat them, we have to accept them, live with them and adapt our lives to them. And the good news is, the most effective treatments for them like stress relieving hobbies and a healthy diet are also important ingredients in our long term health, happiness and well being.

References:

Notes from Studying with Dr. M.M. Van Benschoten, O.M.D.

http://www.ncbi.nlm.nih.gov/pubmed/24008857: herpes and Hashimoto’s 3 case studies

http://www.hindawi.com/journals/tswj/2013/867389/: Role of herpes 6 as a trigger for autoimmune thyroid disease

http://jidc.org/index.php/journal/article/viewFile/22169789/645: Role of viruses in Autoimmune disease

http://www.virologyj.com/content/6/1/5: Viruses and thyroiditis

http://www.dana.org/Media/GrantsDetails.aspx?id=38800: herpes and MS

https://umm.edu/health/medical/altmed/condition/herpes-simplex-virus:  good general info on herpes

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2654877/ : Viruses and thyroiditis

http://www.cellandbioscience.com/content/1/1/24 Affects of thyroid hormone on HSV-1 gene regulation

http://dx.doi.org/10.4236/health.2013.58162  Large cohort on TH levels and HSV 1 activation

EBV and Hashimoto’s

http://www.ncbi.nlm.nih.gov/pubmed/8750577: Elevated Epstein Barr titers in AIT

http://www.ncbi.nlm.nih.gov/pubmed/20404456: Immune responses to EBV in AITD patients

http://www.bioline.org.br/request?mb10037: EBV activation in AID patients

http://www.hindawi.com/journals/ad/2012/189096/: Hypothesis of how this all happens

http://www.ncbi.nlm.nih.gov/pubmed/16055563 Serotonin and EBV

http://www.ncbi.nlm.nih.gov/pubmed/21289059 EBV and methylation

http://www.ncbi.nlm.nih.gov/pubmed/20826008 EBV and the blood brain barrier

Infections and Autoimmune disease:

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2665673/ role of infections in AID

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1360274/ Molecular mimicry

http://www.direct-ms.org/sites/default/files/FujinamivirusMS.pdf

http://medicalxpress.com/news/2014-10-scientists-link-viral-infection-autoimmune.html

http://www.ncbi.nlm.nih.gov/pubmed/12699597 T3 autoantibodies can cause latent EBV activation!

Molecular mimicry

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3266166/

Neurological impact of herpes:

http://www.nature.com/nrneurol/journal/v3/n2/full/ncpneuro0401.html Neurological impact of herpes

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3437531/ Herpes infections in the CNS

http://www.herpes.org/whitepaper-the-psychological-effects-of-herpes/

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4175921/ Anxiety and depression and viral disease

http://medind.nic.in/daa/t12/i1/daat12i1p188.pdf   Viral infections and depression

http://www.naturalendocrinesolutions.com/articles/which-viruses-can-trigger-thyroid-autoimmunity/ Good descriptions and solutions

http://www.ncbi.nlm.nih.gov/pubmed/11572634 virus induced autoimmunity

http://www.ncbi.nlm.nih.gov/pubmed/22095454 molecular mimicry as autoimmune intitiation

http://www.ncbi.nlm.nih.gov/pubmed/25445494 B cell epitope spreading

http://www.ncbi.nlm.nih.gov/pubmed/11140461 Epitope spreading

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1360274/ Bystander activation

http://justherpes.com/facts/foods-to-avoid-with-herpes-diet/ Herpes food