Hashimoto’s Disease – not just an underactive thyroid
by Sue Kira, Naturopath & Clinical Nutritionist
Why doesn’t thyroid hormone treatment fix the thyroid?
Zonulin and removing gluten to heal the thyroid
Oxidative stress and inflammation
How do you reduce inflammation and oxidation?
Where do genetics fit into thyroid dysfunction?
Incompatible foods for auto-immune conditions
Case study 1: Hashimoto’s balanced by diet
Case study 2: Hashimoto’s cleared by gluten free diet
What is Hashimoto’s disease?
Hashimoto’s Disease – more than just an underactive thyroid
Hashimoto’s is an auto immune disease of the thyroid. It’s the second most severe thyroid condition apart from thyroid cancer. Those with Hashimoto’s disease have a dysfunctional underactive thyroid, as well as high levels of antibodies which destroy the thyroid. This makes it even harder for the thyroid to function.
Thyroid auto-immune disease is the third most common auto immune disease behind diabetes and celiac disease. It is postulated that around 90% of people with hypothyroidism also have the high levels of auto-antibodies antagonistic to the thyroid. Many people with an underactive thyroid do not even know they have an auto-immune disease and are simply prescribed thyroid hormone replacement to stimulate their low thyroid activity.
Why doesn’t thyroid hormone treatment fix the thyroid?
Many find the treatment for an underactive thyroid does not work. Although their thyroid-stimulating hormone levels (TSH) may have come back to normal, most, or even all, of their symptoms remain. Some even feel worse and this is probably because their autoimmunity hasn’t been addressed.
Thyroid hormones have little to do with your immune system attacking the thyroid.
Your doctor may prescribe hormone replacement therapy for your underactive thyroid, but this alone does not address the autoimmunity.
An additional approach that may be beneficial is to further investigate why your immune system is attacking your thyroid. Consider areas such as: parasitic infections; SIBO (small intestine bacterial overgrowth); Leaky Gut; sensitivity to gluten; chemicals in the environment, your house or personal care regime; or a combination of these factors…and the list can go on.
There are chemicals in our day to day environment that interfere with our thyroid hormone binding capacity, or even take up the same place in our receptor sites. For example, chlorine and fluoride can take up the same receptor site (parking space) of iodine – one of the most important minerals for a healthy thyroid.
Other mineral imbalances can also come into play, including a high copper to zinc ratio, particularly for women on the contraceptive pill. The pill increases copper levels in the body and at the same time depletes crucial nutrients such as zinc, vitamin C, magnesium, B vitamins (especially folate) and most other minerals, plus beneficial flora (good gut bacteria).
And while we’re at it, thyroid medications such as Thyroxine, Levothryoxine, Synthroid and Armour can deplete the body of iron and calcium. Note: Do not stop taking your prescribed medication, but do look at what else you can do to support your body.
A good book to read if you are interested in ‘what depletes what’ in the world of medications is ‘Drug Muggers’ by Suzy Cohen.
Zonulin and removing gluten to heal the thyroid
Gluten containing foods have long been regarded as a major contributor to thyroid conditions. There are many reasons and if interested, I also highly recommend reading Dr. Tom O’Bryan’s book, ‘The Autoimmune Fix’.
The biggest issue I found when discussing gluten free options with clients is that not everyone with an autoimmune disease has an allergy to gluten, such as with Celiac disease. Some clients felt it was inappropriate to remove a food that may not be causing any issues – or so they think.
The problem is that it can be difficult to accurately detect a gluten issue unless you have quite extensive testing done. But even if there is no allergy or intolerance to gluten, it still causes an increase in Zonulin. This is an inflammatory protein which increases intestinal permeability and is released due to the ingestion of gluten and gliadin.
Zonulin was discovered by Dr Fasano and others in 2000 when it was shown that Zonulin regulates the opening and closing of the junctions between cells that line our digestive tracts. Some suggest that this happens to help release fluid (mucus and water) to flush out the intestines, which is why we get diarrhoea in extreme cases as the body tries to eradicate the toxin/s.
Oxidative stress and inflammation
Other considerations for you and your practitioner to consider include your adrenal health, liver health, gut health, allergies, infections or indeed anything that can increase inflammation anywhere in the body.
One of the biggest contributors to auto-immune diseases, including Hashimoto’s, is oxidative stress, which is also known as free radical damage. It’s the number one contributor to inflammation in the body.
Basically, oxidative stress is the primary mechanism that produces cellular damage in our body which progresses to tissue and organ damage. The body in its infinite wisdom repairs these damaged tissues and organs, using antibodies to signal the breakdown of the damaged tissue and rebuild new tissue.
When the body repeatedly tears down damaged inflamed tissue and rebuilds new tissue over long periods of time, sometimes the immune system doesn’t always know when to stop. The result is what we call auto-immunity, because the body is constantly breaking itself down, thinking it’s doing the right job. Some say it’s because there is more damage to heal; others say that the immune system hasn’t been given the signal to stop.
So what causes oxidation and inflammation? There are many reasons such as chemicals, as mentioned previously, sugar, alcohol (also contains sugar), certain foods or food components such as gluten and gliadin, and even infections like parasitic or bacterial overgrowth.
What can be done to heal autoimmune diseases like Hashimoto’s? The first thing is to speak to your integrative doctor or health practitioner to look at possible triggers. Then reduce your oxidative stress and inflammation in the body.
How do you reduce inflammation and oxidation?
With dietary changes.
Enter the autoimmune diet, or as some call it – the autoimmune paleo diet. However, because we are looking at Hashimoto’s, this diet also needs to remove foods that the thyroid struggles with.
You do end up with a rather restrictive diet, but rest assured this is not a forever diet and many can get back to eating a healthy broad range of foods within a relatively short period of time. Speak to your practitioner about a time frame you can expect, which can vary depending on the complexities of your condition.
This diet removes antagonistic foods that promote inflammation and oxidation in the body in order to allow the body to reset and heal. It is also important to address any other toxic substances mentioned previously that you may be exposed to.
Where do genetics fit into thyroid dysfunction?
Genetic variances can certainly play a role in any disease process. It has been found that those with family members who have an autoimmune disease or thyroid dysfunction have a higher rate of incidence.
But the biggest contributor is what is now termed ‘epigenetics’. In other words, the way we live our life, our environment, what we choose to eat, how we handle stress and the choices we make can override or exacerbate genetic factors.
The WHO (World Health Organisation) suggest that up to 80% of all illness and disease is lifestyle related and therefore 80% can be addressed by making positive lifestyle changes. This is huge for our health, well-being and vitality.
Incompatible foods for auto-immune conditions
Potential problem foods that have been researched as incompatible with auto-immune conditions include:
- gluten
- processed foods
- sugar
- all dairy products
- grains
- legumes
- nuts and seeds
- soy products
- eggs
- spices of seed origin
- seaweeds
- the nightshade family of foods i.e. eggplants, tomatoes, potatoes, chilli, bell peppers (capsicum)
- goji berries
- the highest of histamine foods
These foods are considered to create inflammation or leaky gut.
You could call a diet for Hashimoto’s an auto-immune/anti-inflammatory paleo style diet with the addition of low histamine foods. Brassica family of vegetables that are considered to be ‘Goiterogens’ are also restricted during the initial healing phase of this diet. This includes broccoli, Brussels sprouts, cabbage, cauliflower and kale.
These same foods, if cooked, are less of a problem but it is best to keep them to a minimum at least for the first 6 weeks of your diet or as prescribed by your health professional.
Important: Before you commence this diet, see your medical or health care professional for qualified guidance. Your health care practitioner may also consider conditions such as leaky gut, SIBO, sleep quality, stress support etc.
It is also advised not to stop any medications or supplements prescribed to you during this diet unless otherwise advised by your doctor or practitioner. In fact, you may need extra supplementation while on this restrictive diet.
During the early stages of your new diet, you may experience symptoms such as fatigue, headaches or body aches, which may occur because your body is detoxifying. However, if you are unsure about a symptom at any time, check immediately with your medical or health care professional.
Case study 1: Hashimoto’s balanced by diet
Client name and identifying information changed
Every now and then as a practitioner, I would get what I called the real ‘doozies’ – those cases where I wasn’t sure where to start, or know if I could even help those clients because they had already been everywhere and seemingly covered every angle about their condition.
But in recent years, these clients became more the ‘norm’ than the odd one out, or perhaps I attracted them because of my repeated success rates.
My rule of thumb with difficult health situations is, if in doubt, treat the gut and sort out the diet and then go from there. This case was no different.
When Lydia first saw me she had a folder of information, test results, scans and a list of symptoms, supplements and things she had done over the previous two years with doctors, naturopaths and other ‘healers’.
Lydia’s thyroid problem started about 2.5 years previously after she gave birth to her second child and then put on an enormous amount of weight (25kgs/55lbs) onto her slightly framed body. She was very tired and foggy in the head, which was put down to childbirth, being a new mum and not getting enough sleep.
Eventually one doctor found that Lydia had an underactive thyroid and put her onto thyroid replacement hormone and she thought all her problems would be solved. She did in fact feel a little bit better with more energy for a few months, but then all came crashing down again.
Back to the doctors and her TSH (Thyroid Stimulating Hormone) level was through the roof and antibodies were very high, so her medication was doubled and again, she felt a little better for several months – but then back to square one.
This time the doctor sent her to a specialist where she had more tests and her medication was further increased. However, instead of feeling better with the higher dose, she felt worse – her heart rate was rapid, she had anxiety, couldn’t sleep, felt restless and generally unwell.
These were symptoms of an overactive thyroid, as if her thyroid levels had gone too much the other way. Yet tests revealed that her TSH was nearly normal (a bit low) but her antibodies were higher than ever. The doctor tried to lower her medication but then she became so tired and put on even more weight, to the point where she just didn’t know what to do for herself.
After more tests and specialist appointments, Lydia was getting nowhere, felt worse and fed-up. That’s when she saw me.
Folder in hand and exhausted, she wanted me to look at her situation differently and hopefully help her. She said, “You’re my last resort, I just don’t know what to do anymore”.
I have heard these words so often from clients, and I would answer, “Never, never give up or you will stay the same or get worse. If not me, then someone else will be able to help you.”
After an initial overview of Lydia’s situation I decided to investigate her gut health, as many diseases physically start in the gut. (I say physically, because most health conditions are emotionally based, but then physically manifest somewhere in the body, often in the gut, and then continue on a path of destruction to other organs.)
From some in-clinic tests, it looked like Lydia’s gut was unhealthy, so we organised some lab tests and sure enough, her digestive system was a mess.
She had loads of inflammation, high markers for gluten sensitivity, high markers for putrification in her gut and terrible levels of good and bad bacteria (too many bad, not enough good). Leaky gut (intestinal permeability) was also present and she had intolerances to many foods. Tests also confirmed low levels of vitamins and minerals, which indicated she was not absorbing nutrients efficiently.
Interestingly, Lydia was totally oblivious to her digestive system being such a mess, because she felt so bad in many other ways that it was all a blur of discomfort.
Because Lydia had been to many practitioners, doctors and specialists, her funds were low, so she didn’t want to take any supplementary products initially, but she had a strong feeling that diet changes might help.
She had experimented with diet by randomly choosing to eliminate certain foods like gluten or dairy but never the two together, or any other foods. Essentially, it was too exhausting for her, particularly because of how she felt and looking after a family. She needed guidance – that was my job.
Knowing Lydia’s case was quite serious because she was not responsive to medication and her immune system was attacking her body, I put her onto the full Auto-Immune diet protocol. There was no beating around the bush or going in gently, we dropped her in the deep, so to speak, with a radical change to her diet as we needed to reduce the inflammation pronto.
Normally I suggest to ease into these protocols by starting with a gluten, dairy and sugar free diet, but with so many intolerances and so much going on in Lydia’s body, we also included the second and third phase of the auto-immune protocol.
This involves avoiding all grains (not just the gluten ones), all nightshade family of fruits/vegetables, eggs, all fruits, nuts and all legumes. She was also placed on a low ‘FODMAPs’ diet combined with a low histamine diet. We also removed any foods that tested sensitive. All of this was combined.
This left Lydia with a very basic diet of proteins from meats, poultry and fish (all to be very fresh, thus low histamine) along with certain vegetables that are low FODMAPs and low histamine.
By taking away all potential inflammatory foods and aggravants to her body, within only three weeks Lydia felt much better. We still had a long way to go, but it was a good start. After another three weeks at this intensity. Lydia felt quite normal, but we needed to see her markers again.
Her thyroid (still on medication) was now within the normal reference level and her antibody levels had halved so we knew that even though she felt so much better, we still had work to do. Lydia was so pleased with how things were going that she was happy to continue with this restricted diet for another three months, after which we retested her antibodies and her gut.
Her antibodies were now within normal levels, so that meant no more auto-immunity for her thyroid and her TSH was dropping low enough for the doctor to drop her medication by half (he was very surprised).
She wanted to continue longer with this diet, but I felt it was time to re-introduce some of the foods that had been removed to see if any caused issues. It was time to ‘challenge’ her body.
I advised Lydia to gradually re-introduce only one food every three days and really feel if her body responded negatively to any foods. I suggested to commence with some of the foods she missed the most but leave out the foods on her reactive list till last.
Over the next three months Lydia managed to reintroduce many of the foods. She only reacted to three foods challenged and these were tomatoes, tinned tuna and chocolate. At this stage, we hadn’t challenged the more potentially dangerous foods like gluten, dairy, grains or eggs.
After 12 months on the less restrictive diet, we tested again and it looked like her thyroid condition had never existed and by this stage she was off medication. Her weight was normal, her energy good, she was sleeping well and she was so pleased that she found something to help her ‘get her life back’.
There were only three foods she hadn’t challenged which were grains, dairy and eggs. Before doing anything about these foods I asked her to get another food intolerance and allergy test done. Gluten, dairy (both casein and lactose) and egg whites all still came up reactive (yolks were ok).
I suggested to Lydia it would be best for her not to ever eat these reactive foods again. I would like to add that once we knew Lydia was fine with histamine foods, we also introduced gut healing foods like fermented probiotic rich foods and bone broths to help heal her gut and re-establish good bacteria.
It’s quite possible that the stress of her second childbirth, poor eating habits and potential intolerances, set off a leaky gut that cascaded into her initial auto-immune disease spiral of ill health.
However, along the way when Lydia came in for check-ups, we also discussed potential emotional triggers for her condition. We spoke about how thyroid conditions can be linked to holding back something we need to express and how we over-ride what we feel is best. Also, the intestines are generally about self-worth.
With these cues, she told me that when she gave birth to her second child, a feeling of dread came over her when she was to go home, because she knew she wasn’t going to get any support from her husband. It was bad enough with the first child but worse now there were two children. She didn’t respect herself enough to voice her concerns and she bottled it all up inside, only to be expressed through her body going into self-destruct mode.
She was right about not getting the help needed, but the worst part was that she didn’t even ask for help. Many women tend to ‘martyr’ themselves, thinking that their loved ones should just know to offer help. Meantime, their partner thinks all is well and each has their different roles in the house. I’ve made the same mistake myself in the past, so I could share how I managed to change this situation.
Lydia’s situation could have ended in divorce, so she needed to resolve it or risk creating another disease. Thankfully her husband was very open to do more in the home; he actually thought that Lydia was happy to do everything. He did need a nudge every now and then, but they were both much happier with improved communication.
Does this mean that all Hashimoto’s disease cases can be reversed by diet and talking to your partner (or whoever)? Not necessarily…but surely it’s worth a try.
Case study 2: Hashimoto’s cleared by gluten free diet
Client name and identifying information changed
At Amelia’s first consultation, she told me she had Hashimoto’s disease for which she was taking medication and her blood studies such as her TSH, free T3 and free T4 were fine. However, her highly elevated thyroid antibodies were just not coming down.
Amelia previously had various tests to find out why she couldn’t stop her body from destroying her thyroid gland, and because her doctor was threatening to remove it, she wanted to see if anything else could be done.
I ran tests to assess the condition of her digestive system, heavy metal and mineral balance, and for vitamins that are important for a healthy thyroid such as iron, iodine, vitamin D, selenium, tyrosine, B6 and B12.
I suggested that while waiting for the results, to go on a gluten and dairy free diet to see if it helped. Amelia disagreed as previous tests showed she had no sensitivity to gluten, dairy products or anything else.
The test results showed many nutrient imbalances as well as inflammation and leaky gut. Because Amelia refused to change her diet, we focused on supplemental nutrients and products to help heal her gut and reduce inflammation.
Amelia did this for a few months and then we re-tested everything. This time all her nutrients were in good balance, her gut still showed a little inflammation but her antibodies hadn’t significantly changed.
So once again the topic of gluten and dairy free foods came up and Amelia folded her arms, convinced it wouldn’t make any difference. I said she really didn’t have anything to lose, and possibly much to gain, so it was worth giving it a good try. She agreed.
I knew we had to do as much as possible with her diet in the shortest time possible, because I might not have her trust for long. So I put her right into the deep end by removing all foods that may be cross-reactive with gluten, as well as the top 10 allergenic foods, high FODMAP foods, high histamine foods, nightshade family foods, sugar, caffeine, alcohol and of course foods that contained gluten and dairy. In short, an Auto-Immune Paleo Diet.
We called it a detox to help Amelia ‘get her head’ around what we were doing and really that’s what it was, a detox from any inflammation producing food or substances that might be driving her condition.
I asked Amelia for a commitment of 12 weeks and during this time we used minimal supplements (just probiotics) now that her levels of nutrients were good. I made sure her meals were fresh and varied as possible, and to use organic produce for optimal nutrition without added chemicals.
I asked her to see me in three months when we would retest again and to contact me if any questions.
Amelia was totally committed during her three-month detox, and when she returned, she couldn’t wait to go and eat the foods she missed from her previous diet.
We tested everything and discovered all her markers were excellent and her antibodies were now within the reference range for her thyroid (which she and her doctor were very surprised to see). She also admitted she felt much better than before.
Next it was time to re-introduce foods back into her diet, while observing any symptoms or changes to her body and energy. I instructed Amelia to leave the gluten and dairy products till last. We arranged for testing to be done at two-month intervals to ensure her antibodies weren’t sneaking up again.
The first foods re-introduced were the nightshade family foods, which seemed to be ok, then the histamine foods and FODMAP foods. Amelia noticed a few foods gave her gas and bloating and made her tired, so she left these out as she didn’t miss them too much, so it was no big deal.
Then she tried dairy products which seemed ok, but did give her mucus in the mornings, and for about an hour after eating them she also had mucus and a mild headache across her sinus areas. At this point we retested her anti-bodies and they were still good.
Amelia then had to go back to her core clean diet for two weeks to clear the dairy from her system before trialling the gluten foods. With each of the foods that contained gluten, including wheat pasta, bread and soy sauce, she felt sick, aching and had a headache – even though these weren’t her normal symptoms previously.
She admitted that even though she spent the whole 12 weeks thinking about her next pasta meal or slice of bread, after eating them again she lost that desire as they didn’t feel at all right in her body.
Even though it was only two weeks since her previous antibody test, we re-tested after the gluten trial. Her thyroid antibodies were very high again as if we had not achieved anything with her dietary changes. We then definitely knew that gluten harmed her body, even though her previous intolerance tests ‘showed otherwise’.
Amelia knew she only needed to remove the gluten for her thyroid’s sake, but because the trial proved to her what foods and substances did not serve her general health and wellbeing, she decided to live a gluten and dairy free lifestyle that was also low in sugar – which she removed because sugar made her feel lethargic an hour after the initial energy spike.
There were no more folded arms of resistance from Amelia, her experience and self-observations convinced her what was best for her body.