Help For Hashimoto's Episode 29

So I believe I am in the beginning stages of hashimotos diagnosis, upon my research I came across your podcast. I have not seen my primary care physician yet for a follow up visit after blood work, but my TSH came back at 4.14, she did do a blood test for celiac which was negative, but my food allergy came back as borderline level for wheat and low level allergy for sesame. 

My mother has hypothyroidism (never told hashimotos) and my aunt has been diagnosed with hashimotos. I started discovering my symptoms after I got my BSN  and had my labs tested which were normal. Now I’m discovering that I can get the antibodies and it affect my thyroid before it even shows up on my labs. 

At this point I know that I need to clean up my diet. I am getting a little anxious about it, although I eat fairly healthy I just am so afraid that this diet modification is going to run my life. But all of these symptoms (including reoccurring yeast infections) are what I’ve been feeling for the past 6 months severely, and 6 years not as severely. So I am wondering if the celiac test did not come back positive because I am possibly in the early phases still? 

I am on the second podcast and I love it so thank you for all the advice!

Katie

Hi Katie, 

Thanks for your question!  I will start with the question about Celiac disease. I am not sure what blood test you had that tested for Celiac Disease. Here is what I know at the moment. Some labs test for alpha-gliadin in the blood and about half of people who have this test done that actually have celiac disease will have high antibodies against alpha-gliadin. Alpha-gliadin is a protein that the immune system would be on the lookout for and attacking. Half of those with celiac disease also do not test positive for these antibodies.  The tests that are looking for just alpha-gliadin are only getting that one portion of the proteins in gluten that your body is having trouble breaking down. Apparently there are around 60 plus different protein components to gluten that your immune system can launch an attack against. 

You should ask your doctor if their lab tests for more than just alpha-gliadin. Look for a test that will test for transglutaminase antibodies, intestinal transglutaminase as well as skin and brain tissue glutaminase antibodies. It will be a much more thorough test and give you a better picture of whether or not you may have celiac disease. 

What some research is showing is that most, if not all of us have some issue with digesting the proteins in wheat and other gluten containing grains (they actually all have gluten in them just in varying amounts). Just because we don’t feel bad when we eat a food containing gluten doesn’t mean we are not sensitive to it or have an intolerance.  If you regularly have headaches, brain fog, blood pressure, anxiety- things you don’t necessarily associate with your meal from the day before- these are things that could be caused by an intolerance to gluten or any food really. 

Symptoms to a food sensitivity or intolerance are not always digestive. This is something to really think about in your life. What symptoms are you having that have started to just seem “normal” or part of your daily life? Food sensitivity symptoms can show up anywhere in the body, not just in your digestive tract with bloating, diarrhea or constipation, gas, stomach upset etc. They can show up in your skin, joints, in your brain in the form of brain fog, inability to think well. 

Not so long ago the only way to find out if you had celiac disease was to do an endoscopy which is a procedure where a device is inserted into the GI tract to look for damage or inflammation. The damage to your gut would be classified as Marsh I, II or III with each one being progressively worse from inflammation in your intestines but the microvilli are still there in I to some damage in II and in III your microvilli are severely damaged.  You can have symptoms of gluten sensitivity and not have any damage to your microvilli. That doesn’t mean you shouldn’t remove it from your diet. 

If you have positive blood work but no damage to your microvilli, you should probably still avoid gluten. If you have or had things like anemia, chronic anxiety or depression, joint pain, gut issues, chronic fatigue, liver or gallbladder issues, loss of feeling in your hands and feet, skin rashes especially on the back of your upper arms you might want to ask your doctor to test you for celiac disease. 

It sounds like you have the genetic predisposition to thyroid issues with your family members also having it. This means that you have the genetic susceptibility to the problem and it will be your diet and lifestyle that determine whether or not you develop disease. 

I got this from Katie this morning: 

Good Morning! I just had labs drawn on 11/29- 

tsh 3rd gen was 4.14;

triglycerides slightly elevated 155; 

low level wheat allergy, 

low level sesame allergy detected on a food allergy panel. 

labs drawn again on 12/17 

tsh 3rd gen was 5.98, 

tpo 38.8, 

t4 free 0.95,

t3 total 0.99, 

tg <15.

Energy is poor, muscle aches, joint pain/stiffness, unable to lose weight despite healthy eating and exercise, poor recovery for exercise, hair is thin and brittle and I lose a lot but everyone tells me ‘it’s a normal amount’, haven’t really noticed a change in amount, but the outer third of my eyebrows are thin, my bowel movements used to be regular until about a year ago, now I might have one once every 2-3 days, sleep isn’t great and I feel like I need 10hours almost. I am cold regularly, but I also get very hot easily too.

The doctors office called and said it was "subclinical hyptothyroidism and that I don't need to be treated with medicine". I have been symptomatic severely for the last year, and intermittently for the last 7 years. In your opinion should I be on medicine? 

I plan to go gluten free in the new year, I hope that will help with my antibody levels, but will that help my tsh level go down? 

Here is the deal with labs. Often times the lab values that are established for a testing lab come from the population of people that are tested. This means you have healthy people, people who are like you, sub-clinically hypothyroid and people taking medication so you were at a TSH of 4.14 on November 29th and now at 5.98 and they are saying that is not “sick enough” to treat with medication. 

This is complete BS- clearly your TSH is getting higher which means you are feeling worse probably. When I quit taking my meds so I could get a good “baseline” number after being on the GTA Forte from Biotics Research, my digestion stopped completely about a month after not taking any meds. 

When you deal with a functional medicine practitioner they have a functional range anywhere between 1-3 TSH. Personally, I feel best at 1 or below which is where my free T3 is optimal. 

Hopefully the wheat issue will have been answered by the celiac info but you should definitely be gluten free, 100%- always. 

The functional range for free T4- the amount of active T4 in your blood, should be around 1-1.5 ng/dL- you are at .95 which is a little low for functional medicine. This means you don’t have enough Free T4 in your blood for your body to convert to free T3.

Your free or total T3 is .99. I don’t know what value of measurement that is in so check your labs against what I am saying here and again, you can see the transcript on my website to make it easier to see numbers and amounts. If that is in pg/mL then you are quite low. This means your cells are not getting enough free T3 which is why you feel the way you do. 

Free T3 is the best indicator of what is available for your cells to use. The functional range is around 300-400 pg/mL and if the measurements are not the same you can find a converter for pg/mL on google. 

You have antibodies which means if I were a medical professional I would diagnose you with hashimoto’s which is autoimmune in nature and means your immune system is the problem causing your hypothyroidism or subclinical hypothyroidism as they are calling it. I am not a medical professional though which means I do not diagnose or treat anyone for anything. I do however help people bring their body back in to balance so that it can operate properly and bring you back to a state of health.

It may be possible that you can handle this with diet and lifestyle changes if there has not been significant damage to your thyroid. This might be your first step in trying to feel better especially if your doctor won’t put you on medication.  You may want to try GTA from Biotics Research at www.getbiotics.com using code DFILC163- this is my account with them. I would take one capsule 1 time per day to start and see if it makes you feel better. GTA has porcine glandular or thyroid gland tissue from pigs in it with the T4 removed and selenium. Both nutrients that can be helpful to thyroid. I would not supplement with much more until you know your digestion is working well. No point in taking a bunch of supplements if your gut is not healed and you don’t really know what will work for you as we are all bio-individuals. If you take GTA you must have your thyroid tested regularly. 

Here is the thing with taking thyroid medication with hashimoto’s. You might feel better initially- like for a couple of weeks to a month. Your TSH might be brought in to the normal range but your symptoms will come back and you might even feel worse. This is what happened to me- I think I needed medication for sure because upon initial diagnosis my TSH was at 150- that is all that was ever tested on me until I worked with a naturopathic doctor. 

Hashimoto’s is an immune system issue first and is not a thyroid condition- it causes the thyroid condition. If the immune system is not addressed, you will certainly develop other autoimmune conditions as time goes on. 

The last episode- episode 28 discusses the immune system but we will go over some components right now. I’m going to use the analogy from Datis Kharrazian’s book Why Do I Still Have Thyroid Symptoms.  

You are a house. A house has walls to protect you from the outside- windows, doors and a roof. You too have things that protect you from the outside world. Your skin, your digestive tract, your lungs and brain. If our house has a leaky roof, the window are cracked so that wind and bugs and rain get through them and you have some holes in your walls where elements from the outside can get in quite easily. 

The same thing can happen when your body’s protective barriers have holes, cracks or leaks in them. Think of a cut on your skin- that is allowing the outside world direct access to your insides.  Your immune system reacts pretty quickly to a cut to work to keep invaders out of your body by clotting your blood and creating inflammation and then a scab which eventually heals and the cut is gone. 

When your gut or small intestine has cracks or holes it is leaky or permeable. Things called antigens come through the holes and your immune system is activated. Antigens are things like undigested food particles, bacteria, parasites, mold, toxins. You have immune cells called macrophages that are in your tissues waiting to eat up things that don’t belong. When a macrophage engulfs the antigen it sends a signal to the rest of the immune system to help it out. T-helper cells come first and organize the rest of the immune system in the attack on the antigen. Natural killer cells and cytotoxic T-cells arrive next and kill the invader. T-regulator cells make sure there are enough T-helper cells that help regulate the immune system and T-suppressor cells that stop the attack once the antigen has been destroyed. The B-cell antibodies are enlisted to remember all the information about that antigen so that when or if it invades the body again, it can remember to attack it. 

When you have autoimmune disease, somewhere along the line, something with these immune cells has gone awry. If you don’t make enough of the T- suppressor cells, the immune attack will continue and in the case of your thyroid, it can be mistaken for the antigen that was originally supposed to be attacked. 

This is just one scenario of many that can be the issue and is certainly part of why diet is so important. Removing inflammatory foods like gluten and dairy, managing blood sugar, ensuring your adrenals are optimal, managing sleep etc. It is multifaceted and about the whole body, not just one thing. 

So after the long answer, the short answer is yes, a gluten free diet can help your antibodies go down. They are not super high so that is good but you certainly don’t want them to get higher and it is clear with your TSH going up that you are needing to do something. Once you go gluten free I would go back in 30 days for labs that include all you had before and possibly even Reverse T3 which will tell you if stress is causing some of the issue of T4 and T3 being so low. 

Thanks so much for writing in Katie. I hope you start to feel better soon. 

Okay. I got a request for me to talk about what I eat. It seems that meals are a struggle for a lot of you, including me. Some days I don’t eat very well and some days are low on veggies so you know, no one is perfect with their diet and that is okay. I do notice I feel so much better with an extraordinary amount of vegetables in my diet and a smaller amount of meat. 

I have been watching The Paleo Way with Chef Pete Evans on Netflix. It is really good and so inspiring to me when it comes to getting vegetables in my diet. Check it out if you have Netflix- I am sure he worked pretty hard to get Netflix to take his show. 

What have I eaten in the last week?  I have been doing a green juice most mornings blended in my vitamix. I have had that blender for over 10 years- when the second George Bush was in office. It still runs like new. I have had to replace my canister and they have excellent customer service. This is not an ad. I really just love my blender. Anyway, I put chopped celery, about ⅓ of an English cucumber sliced, parsley which I buy and freeze and just pull a chunk out, a lemon- whole but peeled, a chunk of ginger (to your liking) and a handful of greens- lately I have been using Power Greens which is a bunch of baby dark leafy greens like spinach, chard, and kale. I blend that with some ice and water and drink it almost daily. It makes me feel light and energized. 

I tried just a couple pieces of celery all by themselves with some water and ice and it was horrible. I got a gag reflex from it but finished it and then felt nauseous for about an hour afterward. This might be a sign that my liver or gallbladder was getting some benefit and clearing out some toxins. 

So I have that- I do have breakfast which consists of leftovers. Things like hamburger patties on a bed of lettuce with onion dressing from Nom Nom Paleo’s Ready or Not cookbook. So good.  Or I will have leftover soup. 

I made roasted chicken for dinner last week and turned the leftovers in to soup with chopped carrot, celery and onion sautéed and then I added in the leftover chicken, pulled off the bone and shredded a bit with a zucchini chopped in to bite sized pieces and bone broth.  

I bought some pastured local mild Italian sausage and sautéed that in coconut oil with an onion and half a small butternut squash cut into bite sized pieces with some dried sage- about a Tablespoon. I had that for breakfast after my celery juice and then some green juice and a whole bunch of homemade chocolate bark- cocoa powder, coconut oil, some honey, sea salt with pumpkin seeds and goji berries. I can’t stop eating that stuff. I don’t make stuff like that often because I don’t have a lot of self control with sugar. 

We had burgers last night and I had mine on a salad. I will put almost any leftover meat on a salad and if you like fish you can do canned tuna, sardines or salmon on a salad. I am not a fan of fish at all so that is not for me. 

I did chicken breast sautéed with lots of garlic, broccoli and carrot “noodles” and coconut aminos for lunch yesterday and will eat that for lunch today too. 

I love the Thai Beef Stew from Against All Grain. You can find that on her website if you google it. I will make a big batch of that and eat it for lunch and breakfast. I was away from home most of the day last Saturday so I had lunch and dinner at the same place because they have some good gluten free meat options which I knew would fill me up. I had pulled pork- like a pound for lunch and dinner and it was a little too much meat with no veggies so I ate way more veggies on Sunday. I don’t feel great eating too much fat and meat so I have to work harder at eating more veggies. 

I like veggies roasted best- the rest of my family hates when I do that. So I usually make a sheet pan of roasted veg just for me. Broccoli, cauliflower, and cabbage are my favorites roasted with olive oil and sea salt or Redmond Real Salt. 

I will do a segment in my newsletter of meals I’ve eaten over the week if that would be helpful. Head over to my website and sign up for my newsletter. 

If you have questions about todays episode go over to my website under Epidsode 29 and leave a comment on the blog post for this episode. I will do my best to answer it as quickly as possible. Was this information helpful? Do you need something clarified? Let me no so I can help you out. 

If you have a question you want addressed on the podcast you can fill out the contact form on my website. I can’t wait to hear from you. 

You can find me at outofthewoodsnutriton.com or helpforhashimotos.com- they are the same website, on facebook at Out of The Woods Nutrition and join my private facebook group Help For Hashimoto’s to get support on your journey. You can also find me on Instagram as @stephanieewalsntp

I’m going to do some live group coaching in January- does that sound like something you would be interested in? I also have room for a couple of new clients working on diet changes, seeing where your body is out of balance and addressing those imbalances so you can feel better. Reach out to me on my contact page if this seems like something you might be interested in. We can chat to see if we are a good fit for working together. 

Thanks so much for listening. See you next week. 

Help For Hashimoto's Episode 28

Welcome to episode 28. I kind of feel like I left you in the dust last week by cutting things off at intestinal permeability. I’m still working on getting my TSH in normal range and my brain had had enough. It felt like too much work to dive deeper and so I ask you to have patience with me as my brain and body get back up to speed with all that I want to share with you. I had some kind of bug last week where my body ached which didn’t help me feel like doing much but lounging around. I did some research for a client and that was about it. I am fighting fatigue for a number of reasons, and am honoring my body’s need for rest. 

I want to say something about medication. It is not a bad thing to have to take thyroid hormones. Sometimes the damage done to the thyroid is so great that the gland just can’t make enough hormone for your cells. Some of us will need lifelong hormone replacement even after all the diet and lifestyle changes we have made and that is okay. It doesn’t mean you are a failure. It’s okay to need medication. All the diet and lifestyle stuff will help. It might even help you need less medication- just don’t feel bad if you still need to take it. 

Ok so lets dive more in to Hashimoto’s and the things that can affect it. You know you need to heal your gut if you listened last week. How do you do that? You have to lower inflammation. This starts with changing your diet and your lifestyle. An elimination diet or autoimmune protocol diet - AIP- can be very helpful. I’ll cover that more in detail in another podcast. 

Before I talk about the gut let’s talk a little bit about the immune system. When you have an autoimmune disease such as Hashimoto’s, your immune system is attacking self. It is attacking proteins in your body that are part of you. Our immune system is supposed to protect us from invaders like bacteria and viruses. In autoimmune disease it is attacking our tissues, like the thyroid. This means that autoantibodies have been created. Antibodies against our own tissue. 

Antibodies are important parts of our immune system where they recognize proteins in things like bacteria, viruses or parasites. The autoantibodies or antibodies hang on to the invader and signal the immune cells to launch an attack. In autoimmune disease, your body mistakenly makes antibodies to our own tissue as well as to the things that don’t belong like the virus or some bacteria.  

When your body creates antibodies against proteins in your own tissue this is called molecular mimicry or being cross reactive. This is the beginning of how you develop an autoimmune disease. 

Your genes will predict the probability of your immune system creating the autoantibodies and it will be your environment (diet and lifestyle) that cause the immune system to actually create them. How many genes you have that say you have susceptibility to autoimmunity will determine how quickly your autoimmune disease is triggered by your environment and how severe it will be. 

Your autoimmune disease likely happened or manifested because the autoantibodies formed and your body wasn’t able to determine the difference between the antibodies formed against your own tissue and the antibodies that formed against foreign invaders. Then your immune system launches the attack against both the foreign invader and your own tissues which eventually causes enough damage to your own tissue that will result in you having symptoms of disease. In the case of Hashimoto’s the symptoms result in what would look like hypothyroidism or a slow thyroid or it could trigger Graves disease which is a hyperthyroid state. 

You don’t have any control over your genes but you have a lot of control over your diet and lifestyle or what would be referred to as your environment. In order for you to understand why your body has essentially began an attack on you it might be a good idea to understand how your immune system works. 

We are all made up of various types of proteins. They are what are called the building blocks of the body. The bricks your house is made of so to speak. Proteins are broken down in to amino acids which form all kinds of things in the body. Some amino acids are essential, building everything we are made from. When some of these amino acids get strung together, they create proteins.  Our DNA is made from proteins and so is pretty much everything else in our body.

Antibodies created by our immune system are also a protein and they are called immunoglobulins. You may have been tested for IgA, IgE or IgG antibodies. What these immunoglobulins do is look for certain amino acids that are strung together a certain way in some proteins. They then attach themselves to these amino acids strung together and keep the protein from working properly. Once it binds to this protein and basically deactivates it, it lets the immune system know that this protein does not belong and should be attacked. 

Your immune system will then attack the whole thing, not just that little protein that was recognized. So if it is bacteria, the whole bacteria gets attacked. The same thing happens to our thyroid when there is a case of mistaken identity. The thyroid tissue gets attacked and the immune system remembers that the proteins in our thyroid are something that need to be attacked just like it would remember to attack the same bacteria if it invaded our system. So when you have an inflammation in your body, your immune system may be on constant high alert and attacking thyroid tissue because its protein structure is similar to something else being attacked. One common issue is foods that have similar protein structure like the protein in wheat or gluten- called gliadin. 

There is so much more to this- this is a vey simplified version of what is going on in our body. 70-80% or so of our immune system lies in our gut and the lining in our gut being in tact is crucial in the prevention of autoimmune disease. 

The small intestine also is where about 90% of absorption of nutrients happens through the microvilli. The microvilli are little fingerlike projections that line the small intestine also called the brush border. The microvilli  take up the nutrients from the food we eat and helps to transport those nutrients into the blood stream.  This is how your cells get the nutrients they need to work well. 

The adult small intestine is about 16 feet with a diameter of about 1 inch but the microvilli increase the surface area to be 500 times greater than that.

There is a mucosal layer- and that is just what it sounds like. A layer of mucous that lines the cell wall of the intestines keeping the outside contained to this area. What that means is, like I stated last week, our digestive tract is exposed to the outside and it protects the rest of our body (the inside) from harm. 

The wall of the intestines can become damaged in a number of ways- toxins, bacteria or pathogens and even from proteins found in grains, beans and even nightshades like tomatoes and potatoes. They can actually cause microscopic holes to be formed in the small intestines which allows undigested food particles, proteins and toxins to leak in to the blood stream causing inflammation and immune system reactions. 

The tight junctions formed in the wall of the intestine are one of the lines of defense that keep the inside protected from the outside. They are supposed to open up to our insides for certain nutrients to get absorbed properly.  Zonulin is a protein in our gut that acts like a gate keeper and will monitor the opening and closing of the tight junctions. 

One study describes the workings of zonulin quite well. The study done by Alessio Fasano in 2012 found that zonulin played a role in increased intestinal permeability (leaky gut) which “may be influenced by the composition of the gut microbiota” which contributes to autoimmune disease when antigens are present. Zonulin is a protein in our intestines that regulates the tight junctions in the small intestine which means it basically controls when or if there will be openings created/permeability in the small intestines where things from the outside can have access to our insides. 

The biggest triggers for zonulin to cause the small intestine to loosen the tight junctions (again, giving access to our insides) are exposure to bacteria and gluten. The bacteria discussed in the study were infections that trigger an immune response.  The protein gliadin which is in wheat was the other big trigger for zonulin to cause the tight junctions to open or create intestinal permeability/leaky gut. 

This may be partially why a gluten free diet is so helpful for people with autoimmune disease. There is some thought that all of us with autoimmune disease may have a gluten sensitivity.  Once the immune system recognizes a protein in a food, it can recognize similar proteins in other foods which can lead to multiple food intolerances. Gluten and proteins in dairy, oats, yeasts used in baking and in brewing as well as in many other grains are all similar enough that there can be a likelihood that you may be sensitive to one or more of these foods in addition to gluten. 

It doesn’t mean that you are but that there could be a likelihood of developing additional sensitivities to those foods. 

Hopefully I have established that the health and or integrity of the small intestine is important for your health when dealing with autoimmune disease. Diets like the autoimmune protocol are very helpful in determining which foods are giving you trouble and are cheaper than food sensitivity testing which isn’t always the most reliable.

Other things that can affect intestinal permeability are things like NSAIDS- ibuprofen or acetaminophen, hot peppers like cayenne, alcohol, the wrong types of bacteria in your gut, stress, exercising too hard, surgeries and food allergies. 

If it is not clear to you yet, you need to fix your gut in order to calm your immune system. It starts with digestion. You need to have good digestion, you need to have regular bowel movements that are about a 3 or 4 on the bristol stool chart. Your eliminations should be daily, 1-2 times a day. Your stool should be about the length of your forearm from your wrist to your elbow. It should come out with ease, and there should be little to nothing on the toilet paper when you are done. 

Eliminations should be about 16-24 hours after you eat- that means that what you ate should come out of you about 16-24 hours later. You also want to have a good balance of bacteria in your gut. You can feed the “good” guys by consuming lots of vegetables and fermented foods. 

We have more bacteria living in our digestive tract that we are made of cells. There are trillions of them and there are hundreds of different species of bacteria that make up those trillions. Usually though, you have a portion of bacteria that dominate your gut- these guys kind of run the show.

They help us digest sugars, starches and fiber in our food so we can absorb the nutrients from them. These bacteria provide us with certain chemicals that help us with energy production and help regulate our metabolism. They also make B vitamins and vitamin K and increase our ability to absorb our fat soluble vitamins A, D, E and K. 

A good or healthy gut bacteria help our immune system operate properly or keep it operating as it should. When we experience what is called gut dysbiosis or having the bacteria out of balance, we start to see dis-ease or symptoms of digestive upset. 

Feeding the bacteria the proper foods helps keep in balance the good and bad bacteria  which keeps your immune system operating properly. What you put in your mouth directly affects the amount and type of bacteria living in your gut. This is why diet changes are so important when you are looking to heal your gut or bring your body back in to balance. 

I will cover the diet changes needed in a future episode so please stay tuned for that. Do you have any questions about this episode? Go to helpforhashimotos.com and look up Episode 29 on the blog. You can read the transcript there and you can leave a comment or question under the blog post. 

Be sure to sign up for my newsletter there and get your free ebook 5 Things Your Doctor Won’t Tell You About Hypothyroidism. 

Join me on facebook in the Help For Hashimoto’s facebook group and on Instagram at @StephanieEwalsNTP. 

If you like what you are hearing I would appreciate it if you left a review on iTunes so more people can find the show and be helped. 

Look for information coming soon about a live group coaching program for those of you who don’t even know where to begin with the diet and lifestyle changes. The program will be live video calls and I will walk you through how to make the changes you need in order to feel your best. You will get nutrition and thyroid education as well as support from the group. Please let me know if this is something you would be interested in. 

Thanks so much for listening. See you next week. 

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