Transcription
If food could be flaring my Hashimoto's, why don't I be overly avoidant just to be sure and safe? Understandable, but it's really the correct level of avoidance that leads to the highest level of improvement. Overly avoidance can make you feel worse, and there's two reasons why for this. One, you can develop nutrient deficiencies, and two, you may eat too low calorie or too low carb, both of which can cause a whole array of symptoms, most notably fatigue, insomnia, low mood, and falling or thinning hair.
Welcome to Dr. Rer Radio, providing practical science-based insights into health, exploring the importance of nutrition, lifestyle, and gut health through conversations with experts, research reviews, and personal stories. We break through the bias and the noise to bring you simple, trustworthy information that matters. Hey everyone, this is Dr. R's show. Let's discuss the three best and three worst treatments for Hashimoto's. The good news here, there's a lot you can do naturally to improve thyroid antibodies and therefore diminish the probability that your Hashimoto's will progress to hypothyroidism, and these are not the same thing. But also, sadly, there's some, I think, extreme advice circulating about Hashimoto's, and I've seen so many people who, when following this extreme, you know, message, actually make themselves feel worse. So let's detail the best things you should do and then also what things that you should avoid. And I take this very seriously, and this is why myself and our clinical team had published two papers on this in 2022. So I'm excited to share with you again what through many, many years of experimentation and also following the science on this, we have found to be the best, and then what things again to be careful about, because the these worst recommendations clearly seem to make people feel poorly, and we want to avoid those. So, okay, let's jump in.
To just clarify here, that Hashimoto's is when you produce antibodies against your thyroid gland. This can then lead to a different condition known as hypothyroidism, and these are not the same. Hashimoto is autoimmunity to the gland. Hypothyroidism is when the gland has been damaged and can't produce adequate hormone. Hashimoto does cause hypothyroidism, but we'll cover really promising data here in a moment that show you the majority of people with Hashimoto will actually not become hypothyroid. So it is important to distinguish between these two. Now, where does medication fit into all this? The antibodies and Hashimoto's do not require thyroid hormone. Thyroid hormone has been shown to lower antibodies, but it's really not, in my opinion, a good treatment because you're giving someone a hormone their body doesn't need just in attempts to lower antibodies, although that has been demonstrated. What does require hormone is when you become hypothyroid. So just wanted to clarify that as we go into our discussion here.
Okay, of the three best, the first being a food-first provider would be to improve your diet. And twofold recommendations here. One, cut out processed food. At this point, I don't even think that really is needed to mention, but just to make sure I state the obvious, cut out processed food. And then sort of building upon that would be an elimination and reintroduction diet. This is where you cut out foods that may potentially be triggers of inflammation or autoimmunity, but importantly, reintroduce to see if of those hypothetical foods, you notice any of them make you feel worse upon reintroduction. And I'll outline more in a moment why the reintroduction is so crucial. But firstly, what might you benefit from a elimination reintroduction diet using a framework of paleo? Not the only template, but I think it's a really, you know, justifiable starting point for a elimination diet. 2023 systematic review, I'll just paraphrase here. The paleo diet has been documented to improve thyroid antibodies and thyroid hormones in Hashimoto's thyroiditis. The paleo diet can provide a natural source of nutrients similar to supplemental nutrients that improve thyroid autoimmunity. So this is an easy one. Clean up your diet, undergo a elimination reintroduction. And the the long short of the paleo diet template is you cut out processed foods, gluten, dairy, and essentially focus on what you could hunt, fish, or forage. So proteins from animal sources, you know, beef, fish, chicken, pork, eggs, nuts, seeds, vegetables, fruits, and again, what you could hunt, what you could forage, a naturally occurring diet. Then followed by a reintroduction because that diet in perpetuity might be more strict than we need and can lead to some nutrient deficiencies. I hope you'll comment on this video in particular because I'm going to be sharing with you a few recommendations that are a bit sort of counter-functional or integrative medicine, and I would be curious to hear what you think. And also like and subscribe so you can hear more of our videos in the future.
Alrighty, let's come along to item two, which would be nutrients for autoimmunity: vitamin D, selenium, and myo-inositol. And these can be obtained through food or through supplements. Vitamin D, you've probably heard a fair amount of data here. In fact, there have been three separate meta-analyses, all finding that vitamin D supplementation can improve thyroid autoimmunity when supplemented at a dose between 1,000 and 8,000 IU per day. And food sources would be dairy, eggs, and liver, and not an exhaustive list. But the dairy is one of the reasons why I don't recommend a long-term elimination diet unless you notice dairy flares your symptoms. If you have bloating, gas, abdominal pain, loose bowels, let's say. Now, it's the selenium and myo-inositol that might be newer to you. And specifically, I would recommend using them together. The dosages here would be roughly, don't you don't have to be totally exact, but selenium at 83 micrograms per day and myo-inositol at 600 milligrams per day. The combination, here's why. This 2013 randomized control trial in the Journal of Thyroid Research found that when studying either selenium alone or selenium with myo-inositol, there was more benefit when using the combination. Now, both groups did see improvements in their antibodies, great. However, only the combination of selenium and myo-inositol saw improvements in their TSH, and the greatest improvement in ultrasound findings of the thyroid gland was seen in the combination group. This bit about the ultrasound findings is crucially important, as I'll show you later. The best assessment for if you have Hashimoto's, if you have gland damage, is the ultrasound assessment. So if the greatest reductions in patchy appearance on ultrasound of the thyroid occurred in selenium plus myo-inositol, I would encourage you to aim to optimize both in your diet or supplement with both for anywhere from six months to a year. Doesn't have to be forever, but at least a short-term sort of repletion. And regarding dietary sources, here are some dietary sources of selenium: yellowfin tuna, Brazil nuts, sardines, turkey, beef, liver, chicken, cottage cheese, brown rice, eggs, and of course, a supplement if you wanted to get this in a pill form. And depending on what version of the paleo diet you do, you may cut out dairy, including cottage cheese, grains, including brown rice, and eggs if you're on the autoimmune version of the paleo diet, which is why I recommend reintroducing so you don't make it harder to get in selenium. And similar to that, sources of inositol or myo-inositol would be cantaloupe, orange or oranges, grapefruits, lime, kiwi, nectarines, wheat, white beans, peas, and onions. And again, depending on the version and the restrictiveness of the paleo diet you do, you may avoid peas, white beans, and wheat if you have a clear aversion to them. If you introduce these foods back into your diet and you notice a problem, then yes, avoid them. But there does seem to be this trend that people think the more stuff I cut out of my diet that could be inflammatory, the better. And that's not the case because it ends up or it leads to some people who overly avoid food. And we'll we'll detail this more in a moment, but that can lead to undereating or too low carbohydrate consumption, both of which can lead to the very symptoms you may be trying to improve: fatigue, insomnia, brain fog, falling hair, just to name a few. So often in biology, we're trying to hit that Goldilocks zone. We want to clean up our diet, but not be overly restrictive. We want to hit that Goldilocks or that balance point of the diet.
So let's go to the third of the three, and this is probiotics. And this is because via improving gut health, you can improve autoimmunity, and therefore thyroid autoimmunity. Now, there's not much research looking at probiotics to lower antibodies. However, there is this really pivotal paper from this year published in Frontiers in Immunology, a meta-analysis finding that probiotics can reduce leaky gut, and leaky gut does correlate with autoimmunity. And I think more importantly, improving gut health may improve other symptoms that you think are being driven from your thyroid, but may actually be coming from your gut. And this is what we published on in the IMCJ last year, that people may have less brain fog, less fatigue, less low mood when they use a probiotic. The data that I derive my position on this from are two-fold randomized control trial or trials. The first one in 80 hypothyroid patients gave them a dose of 450 billion CFU, that's a high dose of a lactobacillus and bifidobacterium type probiotic. And here's what they found: in those taking the probiotic over the Interventional period, they had four dose decreases of their levothyroxine, whereas the control group that was getting placebo, they had six dose increases of their medication. And what this tells me is two things: one, they had improved absorption of the levothyroxine, therefore they required a lower dose, and two, they may have improved metabolism or conversion of the T4 into the active form of the T3. And this was sort of corroborated by a 2020 randomized control trial, similar setup, 60 patients taking levothyroxine for their hypothyroidism, given either probiotic or placebo. And again, they needed less levothyroxine, they had improved TSH, and they also had less fatigue. And this is, I think, the gut, leaky gut, inflammatin that we get with the use of probiotics. So even though there's not a, there's not really much in the way of direct research for probiotic lowering antibodies, because of the ability to reduce leaky gut, reduce inflammation, and reduce the required dose of thyroid hormone, all while improving fatigue, is why I recommend probiotics as a third of the three best treatments for Hashimoto's.
Okay, now so moving along to the worst treatments. The first is overly restrictive dieting. And I know the thinking here is, well, if food could be flaring my Hashimoto's, why don't I be overly avoidant just to be sure and safe? Understandable, but it's really the correct level of avoidance that leads to the highest level of improvement. Overly avoidance can make you feel worse, and there's two reasons why for this. One, you can develop nutrient deficiencies, and two, you may eat too low calorie or too low carb, both of which can cause a whole array of symptoms, most notably fatigue, insomnia, low mood, and falling or thinning hair. Gluten is the one that probably has the most, I would say, confusion surrounding it. Yes, gluten can be an issue, but the devil here is in the details. Let's go to probably the best data point we have by Volta and colleagues at University of Bologna. They examined over 12,000 patients very comprehensively who were at risk for non-celiac, so non-celiac gluten sensitivity, looking at both gastrointestinal symptoms, but also systemic symptoms like fatigue, anxiety, skin rash, and joint and muscle pain. So really a, a honest and earnest attempt to understand the prevalence here. They found a 3% prevalence of non-celiac gluten sensitivity. So this is something, and and this validates it, you know, it's not all in your head, you're not crazy if you think you have a problem with gluten, even though you're not celiac. Great. But it'd be a mistake to say it's 50% of the population or or it's everyone. Now, similar to this, they looked at the incidence of Hashimoto's. They found a 14% prevalence of Hashimoto's in this group with gluten reactivity. So again, validation for the connection, but not everyone with Hashimoto's should be avoiding gluten. That would be a mistake. And to quote the paper, we can extrapolate that the likely non-celiac gluten-sensitive prevalence in the general population should be slightly higher than 1%. Our present study highlights that there is a high prevalence of Hashimoto's thyroiditis in patients with suspected non-celiac gluten sensitivity. So there we have it, right? There is validation. But let's continue on this because it's the devil in the details. It's a prevalence that we need to understand. 2020 review paper from the journal Nutrients, it seems that gluten should only be eliminated by patients suffering from celiac disease or gluten sensitivity, which may coexist with Hashimoto's disease, as confirmed by various studies. Such patients constitute 5 to 19% of Hashimoto's patients. So again, validation for the concept, but we have to be clear and not sort of sloppy in our messaging on this, that it's only a subset and it's not the majority. And this was nicely, I think, firmly concluded by a meta-analysis published just this year, paraphrasing, not enough evidence to recommend a gluten-free diet to all patients with Hashimoto's thyroiditis. Well, what do you mean? Like, why not be more strict with my diet? Well, this study that I thought was fairly informative found that long-term strict paleo diet adherence led to iodine deficiency. And remember, you need iodine to be combined with tyrosine to make tetraiodothyronine or thyroid hormone. So iodine deficiency is something that we definitely want to avoid if we're trying to have optimum thyroid function. Now, too much iodine can also be a problem in flaring Hashimoto's, but we don't want to run into iodine deficiency. And on the note of Hashimoto's and and why not be as as strict with the diet as possible, enter a study by friend and colleague Dr. Robert Abbott. They took people on a baseline paleo-like diet that was gluten-free and had them go onto an autoimmune paleo diet protocol, more restrictive, cutting out eggs, nuts, and seeds, and nightshades. They found no improvement in TPO antibodies. So going more strict than not lead to them feeling any better, right? So it's important to keep this in mind that just because a diet is called autoimmune doesn't mean it's going to be the best for an autoimmune condition. And it also doesn't mean that everyone with Hashimoto's has to avoid gluten. And the reason I say this is because in working with people who have been told to do these really hard diets, you see them have their life suffer. Me, my husband aren't getting along, he's upset because I can't go out to eat, and I won't go out to eat because I heard even gluten in the sauce will flare my Hashimoto's for six months, and I'm getting kind of nervous about all this, and I'm I'm actually feeling worse than I was a year ago when I saw the Hashimoto's doctor who put the the fear of death into me about gluten. I'm losing some weight, I'm not sleeping well. This is what we see. And I'm hoping to provide you from, you know, falling into. And again, of course, if you eliminate gluten and then reintroduce it and notice a clear negative reaction, then continue to avoid it. But reactions should be consistent and repeatable, meaning usually within 24 hours, you will have a very reproducible and consistent negative symptom, whether it be bloating, abdominal pain, diarrhea, constipation, fatigue, brain fog, joint pain, and it won't be ethereal. Well, sometimes there's a problem and sometimes there's not. As someone who has nightshade reactivity, I can say 24 hours later, I will have joint pain, always. And that's what you're looking for. You're looking for a consistent and reproducible reaction. And not to avoid food, including gluten, based upon faith or fear or the compelling, you know, story that the gluten-avoiding educators are sharing with you. That's a valuable story for those who have to avoid gluten. It's a counterproductive story for those who don't need to. So this is the balance that we're trying to strike.
Point two is chasing numbers, treating numbers, not treating people. The summary on this is that the accurate numbers here are TPO antibodies and ultrasound. The inaccurate is the thyroglobulin or TG antibodies. And also important to keep in mind that antibodies don't cause symptoms. I know that sounds like blasphemy, but let's make the case. A 2013 study looked to correlate the ultrasound findings with antibodies. They found an agreement between TPO and what happened on the ultrasound. They found no agreement with thyroglobulin antibodies. And we did a whole video unpacking this in more detail if you want the deep dive. In brief, I just wanted to share with you these two histology slides, or these are ultrasound slides. The first slide is showing you a healthy ultrasound of the thyroid where there is what's called homogeneity or similarity in the density of the thyroid gland. That's what you want. That's healthy. The second slide here is showing patchy or heterogeneous where there's dense pockets from the inflammation that the autoimmunity can cause. So there's damage, and then the gland can produce less hormone, and you become hypothyroid. What you want is the healthy gland. What you don't want is the, the essentially scarred gland. And the TPO antibodies correlate with this, and the thyroglobulin antibodies do not. And this is why another paper, I'll just quote here, thyroglobulin antibodies are not significantly associated with thyroid disease. I used to think this, and as more research is being published, I've updated my opinion. So I would give your doctor maybe the benefit of the doubt if they haven't heard this yet. Some of this research is only a few years old, um, but important to bear that in mind that TPO and ultrasound, yes. Thyroglobulin, no. So don't treat the number of thyroglobulin as it pertains to Hashimoto's. That is. And then for the antibodies and the symptoms, thyroid antibodies are present in 10 to 20% of perfectly healthy individuals. And other data have shown that asymptomatic people, people with no symptoms, can have thyroid antibodies. So via multiple studies and multiple measures, we're seeing that antibodies don't necessarily correlate with symptoms. This is why a 2023 review paper quoted, TPO and TG antibodies, mere presence is not always a disease condition. And another paper quoting the presence of symptoms in Hashimoto's is linked to its evolution into hypothyroidism. Signs and symptoms of hypothyroidism are a consequence of thyroid hormone deficiency. So the Hashimoto's causes damage to the gland, less hormone production, therefore hypothyroid, and that's what causes the symptoms. But it's important to bear in mind that the antibodies in and of themselves are not going to be what drives your symptoms. And I say this from the perspective of seeing people who have spent, in some cases, years chasing their antibodies and overlooking the actual cause of their symptoms, like imbalances in the gut or female hormone imbalances or overly restrictive dieting. And then when they address those things, in a month or two, sometimes all their symptoms go away. So that's where I'm coming from. I'm not trying to tell anyone they're wrong, but what I'm trying to help people see is that if you're chasing the wrong number, you're going to make it harder to heal and improve how you're feeling. And this is partially evidenced by the six-patient case series that we published in the IMCJ, Integrative Medicine e-Clinician Journal, where we chronicled multiple cases who are chasing numbers and overlooking most, namely their gut, in driving their symptoms. And again, in some cases, people who had been suffering for years, within months, saw their symptoms resolve because they stopped chasing, let's say, their TPO or their thyroglobulin, and we figured out they weren't eating enough carbohydrate or they had an active issue in the gut that needed to be addressed.
So the third and final point here is fear and misunderstanding the risk that Hashimoto's poses. We know based upon very recent evidence that the prevalence of hypothyroidism in the US population is 5%, which perfectly matches to how often ultrasound finds evidence of Hashimoto's, 5%. However, 20% of the population has TPO antibodies. So if 20% has TPO antibodies and only 5% has hypothyroidism, that tells you that 75% of those with TPO antibodies will not become hypothyroid. That's great news. 25% will. So we've outlined a number of things that you can do to be in that 75% and not be in that 25%. But my concern in speaking with people on this is they're not being given accurate prevalence data and equating Hashimoto's with meaning you will have hypothyroid, and that's not the case. Now, there's one paper here that's pretty seminal. They looked at people with TPO and they tracked them over six years. And what they found was that when people had TPO antibodies below 500, there was no increased risk of hypothyroidism. If people had antibodies above 500, there was a 1.3 times increased risk. And I'll just paraphrase here, Hashimoto's patients with TPO antibodies below 500 had no increased risk for developing hypothyroidism. And again, why I mention this is not to diminish Hashimoto's, but to help you understand this is something that is a preventative finding, meaning if we find Hashimoto's, we can go through the steps I mentioned a moment ago to make sure you're in that 75%, not in that 25%. But it doesn't mean you're going to have a problem, right? I think the the the prognosis here is much more optimistic than it is bleak. And I don't see this very often with the people that come into the office and work with us. The fear and the misunderstanding of Hashimoto's leads to, as you would expect, overly avoiding food, right? Because your TPO antibodies are 200, Samantha, you got to go more strict in the diet, and you're gluten-free, but we should probably also cut out all dairy, even though you don't notice any problem with maybe either one of those. There's also social implications to this, right? Friends, family, eating out, dinner parties can be hindered. And like I mentioned earlier, undereating calories or carbs can lead to the very symptoms that you're trying to improve: fatigue, insomnia, low mood, thinning hair. Additionally, this can lead people to overuse supplements because they're trying to drive the numbers lower and lower with this unrealistic and unaccurate or inaccurate perspective on the risk Hashimoto's poses. And then all of this can lead to unnecessary worry and stress, which in and of itself is not good for your health or good for any autoimmune condition.
So then, in conclusion, the three best treatments are to improve your diet quality and undergo an elimination plus reintroduction diet. Vitamin D, selenium, myo-inositol, either dietarily or by supplements, and using probiotics. The three worst are overly restrictive dieting, chasing numbers like thyroglobulin or overly interpreting or or treating TPO, and also fear and misconceptions around the risks that Hashimoto's pose. And again, I say this from a place of love and compassion, wanting to help anyone with symptoms or with Hashimoto's feel their best, but also being so disheartened with all the people we see coming in who are are just going overboard with what they think Hashimoto's means, how it risks it it makes them for hypothyroidism, and if their symptoms are actually coming from their thyroid or potentially somewhere else. And this again, this is why we published two papers on this in 2022, trying to put good evidence out there for clinicians to learn from. I hope this has been helpful. I hope you'll comment, like, and subscribe, and let me know what you think. Okay, see you next time. [Music] Bye-bye.