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. 

Looking for a way to exercise with chronic illness? Check out Autoimmune Strong

Help For Hashimoto's Episode 27

Welcome to Episode 27 of Help For Hashimoto’s. I’ve got some lab work to share with you today. In the past weeks I had been talking about how I went off my medication and had been feeling pretty good. That feeling lasted for only a couple of weeks. Last week I started to feel slow. I could feel my muscles having to work extra hard just to walk or write. I didn’t have a lot of energy. I pushed my lab appointment up by a week because I knew things were not okay. I started to feel like I could just lay in bed all day.

My digestion also had virtually stopped working. I felt bloated and was gassy and was not having eliminations at all. So then I didn’t feel like eating because I was so plugged up which affected my energy levels as well. I’m sure if you have dealt with or are dealing with hypothyroid symptoms, you can relate.

Some of you may be very sensitive to your medication or to a higher than normal and if you have a TSH that is 4, 5 or 7 or 9 and your doctor is telling you that you are fine but you are having symptoms like I just described then you are not fine. Maybe you can manage things with diet alone- that is possible.

Clearly for me, that was not possible. So either, I was dealing with way too much stress over the last nine weeks or there has been too much damage to my thyroid gland and I will always need medication. For now, I am back on medication and starting to feel a lot better. 

My TSH went from being suppressed at below 1 to being 119 in just eight weeks after being off all medication completely. I will have my actual lab results posted in the show notes for this episode on my website. Taking the Biotics Research GTA supplement had suppressed my TSH and so we could not get an accurate reading of where my body was at. I decided on my own to go off all medication to see if my body could do it on its own after all these years. 

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Clearly it cannot. I need the medication.  There was some talk with Aimee Raup in the episode on her book Body Belief about believing you can feel well. I want to be clear that you cannot think yourself in to remission but what you believe about your body’s ability to be well can affect how well you feel. I hope that makes sense. Even at a TSH of 119, feeling sluggish, and tired and like I didn’t want to get out of bed I remained positive about what this meant. I truly wanted to be able to tell you I didn’t need my medication any more. For now, that is just not the case. I need it and I am okay with that.

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 I don’t like feeling like I am walking through sludge with 100 pound pack on my back all day long. I don’t like only having enough energy to get dressed and then need to take a nap. So, if medication helps me feel at my best everyday along with a continued clean diet and good lifestyle management then this is how it is. I will make the best of it and live my best life because I am not going to let Hashimoto’s control my life. You don’t have to either. 

With that said, let’s dive in to the topic of Hashimoto’s and what that really means. I talked about hypothyroidism last week and how that is a symptoms of Hashimoto’s which is an immune system problem first. 

What exactly does this mean? 

When you have a diagnosis of Hashimoto’s this means that your immune system has launched an attack on your thyroid gland and is destroying it. It is the most common cause of hypothyroidism in the United States. Usually you have to fight for it to be tested mostly because the treatment of the disease is the same as it is for hypothyroidism. It is expected by your doctor that your thyroid will continue to be killed off with the immune attack so your medication will be adjusted over time as the thyroid is destroyed. 

Over the years as you continue to feel bad, you may be offered antidepressants as I was or you may be offered pharmaceutical solutions to your racing heart or treatment for your high cortisol output or lack of cortisol output. Maybe you will be offered the option of removing the thyroid altogether. 

These treatment options are frustrating for us, the patient, at best. You may be told there is nothing you can do. That a gluten free diet will leave you nutrient deprived or that it won’t help you. 

Here is the thing. Doctors receive about 40 hours or less of nutrition training in medical school. If they get extra training in nutrition they will be taught what the government and the USDA food pyramid teaches. They are not trained to look any further for answers to your problems when it comes to chronic health conditions. It isn’t their fault. It is frustrating, but it isn’t their fault. So your doctor is doing what he or she thinks is best for you. I want to be clear on that. I am not bashing them. I am frustrated with the way we are treated in our current health care system and things do need to change but that is for another episode. 

Okay. You may or may not have a Hashimoto’s diagnosis but you have gotten a hypothyroid diagnosis and they are not testing for thyroglobulin or thyroid peroxidase antibodies because the treatment for you is no different. 

Common treatment for other autoimmune diseases is to be put on an immune system suppressing drug like prednisone. Hashimoto’s isn’t aggressive enough of an autoimmune disease to warrant being on a drug like that- and frankly, you should not want to use that as your treatment. It is a bandaid. This disease and most other autoimmune diseases are very well managed through diet and lifestyle. 

If you are looking for a bandaid as a permanent fix for your autoimmune disease, this is not the place to get it. 

I don’t want to go through the rest of my life with a bandaid that doesn’t really make me feel good. Prednisone’s side effects are things like insomnia, mood changes, increased appetite, gradual weight gain, acne, dry skin, slow wound healing, headache, dizziness, nausea, stomach pain and the list goes on. 

Doesn’t sound fun- in fact is sounds like more crappy symptoms on top of all the crappy symptoms that come with a mismanaged thyroid condition. 

Even if you are put on thyroid medication, like me, with a combo of T4 and T3 and even the supplement with the porcine glandular in it- the immune system is not being addressed.

Hashimoto’s disease is named after the Japanese doctor, Hakuro Hashimoto who was the first to describe the disease in 1912. Our autoimmune disease was the first ever to be recognized as an autoimmune disease. 

About 50 million people suffer from some kind of autoimmune disease in the US and about 30 million of those people are women. Hashimoto’s and Graves disease are some of the most common autoimmune diseases with about 8% of the US population having a diagnosis. Most of the cases of hypothyroidism are due to Hashimoto’s. 

If you have hypothyroidism and are on medication but still feel symptoms or you continue to feel worse over time, then you are probably dealing with Hashimoto’s disease. You might be showing lab tests of normal TSH because you are on medication but your immune system may be on fire and so you present with symptoms. 

You also might be having symptoms of both hypothyroidism and hyperthyroidism which can fluctuate from week to week, day to day or month to month. This is a clue that your immune system is needing attention. Your TSH levels can be all over the place so if you happen to go in for your labs at a time when your TSH is in the normal range- you will not be given medication. In the case with Hashimoto’s medication in the form of thyroid hormone replacement is a band aid. You may need it for a time period until you get things under control but you may not need to be dependent on it for the rest of your life. There is even some evidence to show that it might be possible for your thyroid to regenerate once you get the immune system calmed down. 

In my case, I probably had Hashimoto’s when I was first diagnosed with hypothyroidism in 2002 but because I went for 8 years thinking all I needed was to take my levothyroxine there was probably enough damage to my thyroid that I will likely need medication for the rest of my life. Who knows. I’m still hopeful. I went through times of having hypo and hyper symptoms and could not figure out what was going on. One of those times was when I was pregnant in 2004 and lost my baby at 34 weeks. You can read more about that in Five Things Your Doctor Won’t Tell You About Hypothyroidism which you can get from my website when you sign up for my newsletter. 

What is happening in your body when you have those hypo/hyper symptoms? Essentially the immune system is attacking your thyroid, killing off some tissue. As that tissue dies, the thyroid hormone is released in the blood stream giving you symptoms of hyperthyroidism such as heart palpitations or racing heartbeat, you may have this feeling of inward trembling, you may feel nervous or moody/emotional, you can have insomnia and night sweats (I had night sweats for years), you may be losing weight for no reason at all. 

You can confirm you have Hashimoto’s by asking for a Thyroid Peroxidase Antibodies test (TPO Ab). This will verify that your immune system is attacking the enzyme that allows your body to produce T4 and T3. 

You can also ask for a Thyroglobulin Antibodies test (TGB Ab). Thyroglobulin is what your thyroid uses to make thyroid hormone. You can have a negative antibodies test. This is common because as with everything else in the body, your immune system can yo-yo. It may not be acting up at the time of your test. So you either have to go in and ask for the test when you know you're in a flare (having symptoms). 

What are the triggers for Hashimoto’s or autoimmune disease in general?

As has been said, “Your genes load the gun and your environment pulls the trigger”. 

You may be genetically predisposed to your disease- like me. My mom, her siblings and their mother all had or have some kind of thyroid condition. One of my Aunts and my Uncle have Grave’s disease. My Uncle also has an autoimmune kidney disease for which he is on an immune suppressant. My other Aunt has hyperthyroid symptoms and my mom has hypothyroidism. I’m pretty sure she has Hashimoto’s because she has spent her whole life not really feeling well. She has never been tested. 

So, genetics were there for me and I pulled the proverbial trigger of that genetic gun with my lifestyle and environmental factors. 

Things like gluten intolerance, estrogen dominance, blood sugar dysregulation, PCOS, being deficient in vitamin D and other nutrients, toxicity in the body from environment or heavy metals, chronic infections or inflammation, stress in any form. All of these or any one of these can lead to the breakdown of your body and the beginning of autoimmune disease. 

The good news is that you can definitely control your disease with diet and lifestyle. You maybe have figured that out already and that is why you are here. If not, you are in the right place to learn about how you can manage your disease and feel your best. 

If you are on medication, you need to start paying attention to how you feel on it. You may need to have it adjusted and hopefully you have a doctor who is willing to treat you by your symptoms and adjust or switch your medication as needed. The medication is kind of a Goldilocks type medication. It can take some time to find what is just right for you. Some people do fine on synthetic medications that are T4 only like Synthroid or Levothyroxine. Some people do better on Natural Desiccated Thyroid Hormone like Armour, Naturethroid, WP Thyroid or compounded thyroid powder.  If you don’t feel well on one type of medication ask to try a different one. 

One thing all autoimmune conditions have in common is intestinal permeability or what you may have heard of as leaky gut. Your intestinal wall is the only thing protecting your body from the outside world. It’s entrance is essentially your mouth and its exit is your anus. If it becomes permeable or leaky- having tiny microscopic openings in it- then the outside has access to your insides where your immune system is ready to protect you at all costs. 

We have a protein called zonulin which allows our intestinal wall to become permeable or causes the tight junctions in our intestinal wall to open which will allow proteins and bacterias to have access to our insides- our blood stream. This causes our immune system to go on high alert and launch an attack on these so called invaders. 

One of the bigger triggers for this in autoimmune disease can be gluten- the protein found in larger amounts in wheat, barley, rye and other grains. This is why you hear so many practitioners talking about being on a gluten free diet. It can help your immune system calm down. Next dietary change would be to take dairy out. It has proteins similar to gluten and can confuse your immune system and remember we are trying to calm the immune system. 

You also need to look at other factors like stress, sleep, nutrient deficiencies like vitamin D and healing the gut is a must. You can’t absorb nutrients if you are not first digesting your meals well and have a healthy gut. Gut means your small intestines. That is where about 80% of your immune system lies and that is where the majority of your nutrient absorption is. 

This is a lot of information and hopefully not too overwhelming. If you have questions or want something covered in more detail, please drop me a note at helpforhashimotos@gmail.com or go to my website and fill out the contact form. I’m here for you and want to help so send me your questions. 

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Thanks so much for listening. See you next week.