Please see last week’s blog article here on the root causes of Hashimoto’s. This week we discuss solutions to Hashi’s using Functional Medicine.
** Please note: If you want the short summary version of this article with a video, then please click here **
How to test for Hashimoto’s?
It is fairly simple to test for Hashimoto’s. A blood test showing TPO Antibodies and Thyroglobulin Antibodies will indicate Hashi’s. Unfortunately, the vast majority of conventional doctors only look at TSH when assessing thyroid health. They pick up hypothyroidism through TSH and prescribe a medication. They don’t look at the thyroid antibodies so they don’t catch Hashi’s or the AI component of the condition. This is a great shame because AI, in the form of Hashi’s, needs to be treated differently than just prescribing Levothyroxine. Solutions need to focus on gut health, resolving leaky gut and if possible, identifying the environmental trigger.
Some Hashimoto’s patients do not have measurable antibodies. Between 5-10% of Hashimoto’s patients do not have increased levels of thyroid antibodies (The National Academy of Hypothyroidism, 2018). In this case, the condition can get overlooked if antibodies are the only marker used for diagnosis (The National Academy of Hypothyroidism, 2018). A skilled practitioner will always look at symptoms in addition to lab tests and treat based on symptoms.
An ultrasound can sometimes visually identify damage to the thyroid gland from an autoimmune attack, without the presence of any antibodies. This, however, is not routine screening. Unfortunately, thyroid dysfunction which has a root in autoimmunity may never be properly diagnosed or treated.
SOLUTIONS: The solution to Hashi’s lies in healing the gut, finding the environmental trigger(s) and addressing ALL causes of inflammation to calm the immune system and prevent the auto-attack.
Read on for key elements of a treatment plan.
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Here are the key elements of a treatment plan:
There are a few diets that could work for Hashi’s. Essentially, the diet should be high in whole, unprocessed foods, including lots of vegetables and fruit with healthy fats and proteins. It can be quite individual and people with Hashimoto's often end up experimenting with different diets until they find one that makes them feel best.
The Auto Immune Paleo diet or AIP diet is a good option. One study trialed this diet on a group of Hashi’s patients (Abbott RD, 2019). After 10 weeks symptoms decreased significantly and inflammation, as measured by the blood marker hs-CRP, significantly declined by 29% (Abbott RD, 2019). Thyroid markers, TSH and thyroid antibodies, did not go down at the 10-week point. However, the decline in hs-CRP suggests a modulation of the overall immune and inflammatory response underlying autoimmune thyroiditis. The authors of the study think that it is possible that eventually, there would have been a decrease in thyroid antibodies and a decreased need for thyroid hormone medication as well as even more changes and improvements in immune and inflammatory markers in the participants if they followed the AIP diet for a longer period of six to 12 months (Abbott RD, 2019).
Another very small study was performed with one participant, a 34-year-old woman with Hashi’s (Dolan K, 2018). She did not take thyroid hormone replacement medication and was able to manage her Hashi’s with diet and supplementation (Dolan K, 2018). She followed a diet rich in phytonutrients (brightly colored fruits and vegetables, like berries, tomatoes, carrots, peppers, aubergines, purple grapes, squash, sweet potatoes, peaches, dark green leafy vegetables, etc.). She avoided gluten and soy as they are harmful to thyroid health. Her diet included good quality fats, fermented foods and clean filtered water. She included supplements: vitamin B complex, D, alpha lipoic acid, coenzyme Q10, magnesium, omega 3 oil (DHA/EPA) and probiotics (Dolan K, 2018).
We recommend a few possible diets for Hashi’s:
- Auto Immune Paleo diet
- Paleo diet
- Gluten-free Mediterranean diet
There are a few specific diet recommendations that can help:
Eliminate gluten: We have discussed in previous articles on the thyroid how gluten cross-reacts with thyroid tissue and causes an attack on the thyroid. Gluten also increases zonulin which causes leaky gut (read more here and here). A 6 month gluten-free diet slightly increased thyroid function in women with Hashimoto’s and led to a reduction in both types of thyroid antibodies, TPO Ab and Tg Ab (Krysiak R, 2019).
Eliminate soy: Some studies show that soy isoflavones reduce thyroid function (Nakamura Y, 2017). In fact, genistein in soy inhibits the TPO enzyme needed to make thyroid hormones, thus reducing the amount of thyroid hormones (Nakamura Y, 2017).
Eat a fully organic diet: This will help to reduce pesticides, endocrine (hormone) disruptors and chemicals toxins found in the conventional food supply.
Consider eliminating lectins: Lectins are a protein found in most plants. The highest levels are found in nuts, seeds and beans. Lectins create certain antibodies which have molecular mimicry with thyroid tissue so they will inhibit thyroid function. It is not always necessary to avoid lectins with Hashi’s. But If your Hashimoto’s is severe you might want to avoid lectins. If you want to feel better quickly, try avoiding lectins.
Cook goitrogens and eat them in moderate amounts: Certain foods contain goitrogens. Goitrogens can interfere with iodine uptake in the thyroid gland. Goitrogens are cruciferous vegetables such as bok choy, broccoli, brussels sprouts, cabbage, cauliflower, Chinese cabbage, collard greens, horseradish, kale, kohlrabi, mizuna, mustard greens, radishes, rapeseed, rutabaga and turnips. We discussed goitrogens at length in this article here. The bottom line is that we recommend cooking these goitrogen foods and not eating them raw. Avoid juicing or making green smoothies with large amounts of raw crucifers like kale if you have a low thyroid condition. Adequate intake of iodine can offset the negative effect of goitrogens. For those with low thyroid hormone, it may be helpful to make sure that iodine is sufficient when consuming goitrogenic foods. But don’t take in too much iodine as excess iodine is a problem for Hashi’s.
Avoid the ketogenic or very low carbohydrate diets: Going very low carb can be harmful to thyroid function. Insulin, which is triggered by eating carbohydrates, is necessary to convert T4 to T3. Removing or drastically reducing carbs from the diet can lead to issues with T4 => T3 conversion. Insufficient conversion could lead to hypothyroidism. If you are hypothyroid, then we recommend eating a moderate carb diet. Aim for about 100 grams per day, or about 30 - 35% of total daily calories.
Starvation downregulates the thyroid: Chronic starvation, as seen in anorexia nervosa, can lead to changes in thyroid hormone levels (Douyon L, 2002). There is a decrease in T4 and T3 and an increase in Reverse T3 (which binds up T3) (Douyon L, 2002). It is important to eat adequate calories in cases of low thyroid function like Hashimoto’s.
Be sure to eat enough of the essential minerals and vitamins for thyroid function: Iodine, selenium, zinc, iron and vitamin D are all very important for thyroid health. A certain amount is needed but it is also important not to have excessive amounts, especially with iodine. It might be best to work with an experienced FM practitioner to help get the balances right of these vitally important nutrients.
Identify food intolerances and remove those foods: Food allergies and intolerances are an indicator of gut issues, inflammation and an overactive immune response. It is important to identify the food triggers you may have, eliminate these foods at least in the short term to reduce inflammation, then treat the gut. Later you can experiment with reintroduction and see how you react to these foods once the gut is healed. See our article here for more info on Food Allergies/Intolerances.
There are a number of supplements for Hashimoto’s:
Thyroid glandulars or Natural desiccated thyroid (NDT): Thyroid glandulars are made of bovine or porcine thyroid gland extract. This used to be considered standard treatment for low thyroid conditions. Brands of NDT are Armour Thyroid, Nature-Throid and NP Thyroid. They can be beneficial and can prevent the need to take a pharmaceutical drug. Some pharmaceutical drugs are glandulars but the vast majority contain synthetic thyroid hormone. These brands of prescription NDT provide a bioidentical form of T4 and T3. The pharmaceutical medication Levothyroxine (and others like it) contain a synthetic version of T4 only. Some people do better with the bioidentical form and others do better with the pharmaceutical form. One study comparing NDT and Levothyroxine (synthetic T4) found that 49% of patients preferred NDT, 19% preferred Levothyroxine and 33% had no preference (Hoang TD, 2013). A case study of one patient found that treatment with a glandular thyroid supplement significantly decreased symptoms of severe hypothyroidism and autoimmune thyroiditis (Wellwood C, 2014). Which medication works best for which person is very individual. Work with an experienced FM practitioner to find the best approach for you. We do not recommend that anyone take a thyroid glandular without being under the guidance of a skilled medical professional as too much thyroid hormone is a problem and some autoimmune thyroid issues can be triggered or worsened by some glandular products. Regular lab testing for thyroid function during glandular administration, even non-prescription glandulars, is strongly encouraged.
Aloe vera juice: In one study on women with Hashimoto’s, aloe vera juice was found to decrease thyroid antibodies (Metro D, 2018). Women in the study drank 50 ml of aloe vera juice for 9 months (Metro D, 2018). The result was a decrease in thyroid autoimmune inflammation and both TSH and TPO antibodies declined significantly by the end of 9 months (Metro D, 2018).
Iodine, zinc, iron, vitamin D and selenium are all nutrients that support thyroid health. You may be low in one or more of these. Work with a FM practitioner to test your levels properly to see if you need to supplement these nutrients.
Be careful with iodine supplements! Iodine can worsen Hashimoto’s and hyperthyroidism. Do not self-diagnose and take iodine yourself, without testing for iodine levels and having a full thyroid panel properly interpreted. The most accurate way to test iodine is through urine, not serum blood testing. Anyone with hyperthyroidism should not use iodine except under the guidance of a skilled practitioner, because it could over-activate the thyroid and worsen the condition if not used properly.
Probiotics and Prebiotics all promote good gut health and feed the good bacteria in the gut.
Guggul and Ashwagandha help to optimize T4 to T3 conversion and work to increase T4 and T3. See our article on Hypothyroidism for further details.
Low Dose Naltrexone (LDN) is a generic drug originally designed for withdrawal from opioids. It is now also used off-label for other conditions, often autoimmune in nature (Toljan K, 2018). LDN re-balances the immune system and reduces the inflammatory response by modulating immune system cells (Toljan K, 2018). At a dose of 2-3mg per day, it can be helpful in many cases of Hashimoto's or Grave's.
Other ways to support the thyroid and address Hashimoto’s are:
Heal the Gut: Work with a FM practitioner to improve gut health. Identify any infections, overgrowths or other issues and resolve them. It is critical in autoimmunity to resolve leaky gut. This can be done with diet and supplements. Once the gut is healed, nourish the good gut bacteria with a healthy diet, lifestyle habits and pro and prebiotics.
Boost Immunity: By healing the gut you will automatically be boosting immunity as 70-80% of the immune system is located in the gut. You can further boost your immune strength by testing vitamin D levels. The ideal level is around 50-60 ng/ml.
Address Infections: It is critical to address any underlying chronic infections like Epstein Barr Virus, or other viral or bacterial infections.
Stress Management: We can never eliminate all stress. But we do need to learn to manage it through mindfulness practices like meditation, yoga, tai chi, deep breathing exercises, other types of movement, listening to music and other ways to get into the parasympathetic state of the nervous system.
HPA (hypothalamus-pituitary-adrenal) Axis Support: With your FM practitioner, you can assess for HPA axis dysregulation. The HPA axis may contribute to the existence of low thyroid symptoms (Wellwood C, 2014). It is important to treat the adrenals and thyroid in combination. When the adrenals have been weakened, it can interrupt signaling and hormone levels (Wellwood C, 2014). Over time, this can reduce TSH and T4 =>T3 conversion and increase conversion to Reverse T3 (Wellwood C, 2014). This causes even more fatigue and exhaustion. If you are very stressed, the HPA axis will likely be dysregulated and will require some support.
Reduce Toxin Exposure: Decrease the amount of toxins that come into your body. Don’t smoke, drink minimal alcohol, eat an organic diet and reduce exposures to chemicals and pesticides. Clean up your personal care and cosmetic products & household products; use the EWG skin deep website to check products at https://www.ewg.org/skindeep. Use clean cookware and not Teflon. Avoid the chemical fluoride in tap water and toothpaste. Drink filtered water and get a shower filter. Add houseplants to absorb chemicals in the environment. Reduce EMF’s exposure where possible. Reduce exposure to bromide, which is especially high in supermarket breads. Reduce exposure to chlorine with a shower filter and minimal exposure to swimming pools.
Support the Liver & Detoxification: This is an important step to help detoxify toxins and chemicals. You can work with an experienced FM practitioner to take steps to detoxify. If there is a case of mercury excess or other toxic exposure, this will be a key step to healing Hashi’s. There are supplements that can help like glutathione and others. Diet changes can help to reduce toxic load. Other practices like sweating, using a sauna or far infrared light exposure (see our article here and here), drinking plenty of water and exercising regularly are important. You can test your liver function by looking at liver enzyme (AST, ALT, GGT) levels.
Remember the basics: Be sure to work on important lifestyle factors and ensure that you sleep well, exercise and meditate to manage stress!
** Please check our blog next week to read our next article in the Thyroid Series on **
Grave’s disease & Solutions using Functional Medicine
As always, please get in touch with us. If you or someone you know is struggling with thyroid issues, contact our clinic today. Book a free 15-min discovery call to see how we can help you with your symptoms. We can answer your questions and help you book an initial consult with one of the functional medicine doctors in our clinic.