Over the years, I have found that many people with Hashimoto’s have issues with digestion, although they often haven’t connected these symptoms to their thyroid condition. I frequently see people who have just accepted the daily struggle of their nagging digestive symptoms as simply being “the way their system is.” Some no longer even report these symptoms to their doctor; they have started to view them as normal.
But symptoms such as recurring diarrhea, stomach pain, having undigested food in your stool, and gas and bloating after eating, are not symptoms you need to live with! For many people, these issues can be resolved fairly rapidly by taking the right digestive enzymes. In fact, in a survey I did with 2,232 people having Hashimoto’s, 78 percent felt better after taking digestive enzymes.
There can be different types of digestive challenges, including the inability to adequately digest protein, starches and/or fat. I’ve written about protein digestion extensively in the past, and now, I’d love to turn to fat digestion issues, which affect about 40-50 percent of people with Hashimoto’s. Fat digestion challenges can leave people with stomach and bowel symptoms. They can also result in a depletion of important nutrients that are no longer being well absorbed, including fat soluble vitamins A,D, E and K, as well as essential fatty acids.
One key culprit that may cause fat digestion issues can be a deficiency in pancreatic enzymes, such as pancreatic elastase. While you likely have heard of the pancreas (where these key fat digestion enzymes are produced), you may not be aware of how important the pancreas is, and how supplementing with pancreatic enzymes can make all the difference in uncomfortable and embarrassing digestive symptoms.
In today’s article, you will learn about:
The role of the pancreas and pancreatic elastase
How Hashimoto’s affects pancreatic enzyme deficiency
Symptoms and testing for pancreatic enzyme deficiencies
The issue with conventional treatments
My Root Cause recommendations
The Role of the Pancreas and Pancreatic Elastase
The pancreas is an organ located in the upper abdomen. It consists of two tightly connected glands, each having a distinct function. One gland (referred to as the “exocrine” pancreas) focuses on producing enzymes to help with the digestion of food. These enzymes include trypsin and chymotrypsin to digest proteins; amylase for the digestion of carbohydrates; and lipase to break down fats. These pancreatic enzymes are released into the small intestine through a duct, along with another protein-digesting enzyme called pancreatic elastase.
The other gland, referred to as the “endocrine” pancreas, produces hormones such as insulin and glucagon. Unlike pancreatic enzymes, these hormones are released directly into the bloodstream. Pancreatic hormones help control how the body uses and stores sugar (glucose). Abnormal levels of thyroid hormone are associated with blood sugar abnormalities (and poor insulin control), and abnormal levels of pancreatic hormones have been linked to metabolic disorders, as well as diabetes.
While both of these roles are extremely important to our health, in this article I will be focusing solely on the exocrine pancreas and its role in supporting our digestive health. In particular, I’ll be explaining how exocrine pancreatic enzymes support fat digestion and the healthy absorption of nutrients, and why this often goes wrong in those with Hashimoto’s.
Fat Digestion and Nutrient Absorption
Our pancreas works along with our liver and gallbladder to digest and absorb fats. If we’ve eaten a fatty meal, concentrated bile (a substance produced by the liver and stored in the gallbladder) is released from the gallbladder into a duct leading to the small intestine. The bile’s job is to breakdown fats into tiny globules that can be more easily dissolved.
At the same time, the pancreas releases its own pancreatic enzymes and pancreatic juice, mixing with the bile and tiny globules of fat. The bile and pancreatic secretions work together to dissolve (emulsify) fats (lipids) in the watery small intestine. Pancreatic juices also help with digesting protein and carbohydrates, as well as neutralizing all of the digesting food (which is initially very acidic, in order to fend off bacteria). All of these actions allow nutrients to be more readily extracted and absorbed (plus, it ensures that we don’t experience nasty stomach and bowel symptoms).
Without adequate bile and pancreatic enzymes, many essential nutrients can be lost and excreted with other wastes in the stool, leading to nutrient deficiencies such as fatty-acid deficiency. Additionally, our foods will not be fully digested and may linger too long in the digestive tract. This can result in our developing food sensitivities, small intestinal bacterial overgrowth (SIBO), and other issues, which we’ll talk about. People who also have low stomach acid may also lose the ability to fend off harmful microorganisms in the gut, such as H. pylori — a very common infection seen in Hashimoto’s.
Pancreatic Elastase – A Key Biomarker
Pancreatic elastase is a protein-digesting enzyme produced exclusively by the pancreas. It is released into the small intestine, where it is activated by mixing with another protein enzyme, trypsin. Pancreatic elastase does not get degraded when it travels through the intestinal tract, and if there is any inflammation of the pancreas, this enzyme gets released into the bloodstream. Because it is an exclusive biomarker of pancreas functionality, testing for pancreatic elastase in either blood serum or stool can show when there is inflammation of the pancreas (known as pancreatitis) or a reduction in pancreas functionality (such as with the digestion and fat malabsorption symptoms seen in Hashimoto’s).
If left unchecked, pancreatic enzyme deficiencies can result in chronic pancreatitis; this can then lead to a more serious condition known as EPI (Exocrine Pancreatic Insufficiency). This is a significant deficiency in pancreatic enzymes, especially relating to fat malabsorption (actually due to abnormally low levels of lipase production). Some 20 percent of people with chronic pancreatitis will develop EPI over time.
We can test for low levels of pancreatic elastase in a simple stool test. I’ll talk about testing in a moment.
Low levels of pancreatic elastase can point to:
Suppressed pancreatic function
Hypochlorhydria (low stomach acid), especially if H. pylori is present
Heavy metal toxicity
Stress (adrenal fatigue)
A vegetarian/vegan diet
Interestingly, if you look at this list, there are several known triggers for Hashimoto’s, including low stomach acid, SIBO, H. pylori, heavy metal toxicity, Celiac disease (gluten sensitivity), and stress. Let’s look more closely at the Hashimoto’s connection to issues with the pancreas.
How Hashimoto’s Affects Pancreatic Enzyme Deficiency
Thyroid hormone levels can affect the metabolism or action of other hormones in our bodies, as well as other endocrine glands and organs.
As one example, gastric dysmotility (impairment) is significantly more frequent in hypothyroid patients. This condition slows down the normal muscular contractions of the small intestine, which slows down the movement of partially digested food and digestive juices. This can cause bloating and other digestive symptoms, as well as set the stage for bacterial growth in the small intestine due to the trapped food content just sitting there. Again, having low stomach acid further compounds this by providing an environment that is not well defended against bacteria.
The lack of thyroxine (free T4), as seen in Hashimoto’s, also decreases liver cholesterol metabolism. This has been found to negatively impact gallbladder function and change the thickness of the bile (produced by the liver), which can result in slowing the bile’s rate of flow and reducing its effectiveness in digesting fats.
Thyroid dysfunction can also impact our metabolism, which results in pancreatic dysfunction. We know that there are thyroid receptors in the pancreas, and studies have found that pancreatic function can be significantly reduced in patients with hypothyroidism.
One study tested the pancreatic function of 15 patients with hypothyroidism and 15 healthy patients by means of measuring their plasma amino acid uptake. The resting plasma amino acid concentrations of hypothyroid patients did not differ significantly from those of healthy subjects. However, while pancreatic stimulation caused a pronounced decrease in plasma amino acid concentration in healthy subjects (18.7 percent), a much smaller decrease was seen in the hypothyroid patients (6.8 percent). Treatment with thyroxine, however, restored pancreatic function to normal. The study concluded that the thyroid gland plays an essential role in maintaining the functional integrity of the pancreas.
Given that about a third of people with Hashimoto’s may have deficiencies in bile and/or pancreatic enzymes (leading to issues with fat absorption), and many also have low levels of stomach acid (leading to difficulties digesting and absorbing nutrients from the protein we eat), it is no wonder that nutrient depletions are so common in people with Hashimoto’s.
If you have pancreatic enzyme deficiency, you will not be properly digesting and absorbing fats. You may experience digestive symptoms as well as seemingly unrelated symptoms, such as low energy and increased cravings for carbs. This is due to fats being a slow-burning source of energy for our body. You may also experience symptoms related to both essential fatty-acid deficiency, as well as depletions in the fat-soluble vitamins (A, D, E, and K).
Fat Malabsorption Symptoms
Generally, if you are experiencing one of the symptoms below, you have an intermediate risk for fat malabsorption. If you are experiencing two or more of the symptoms below, you are at a high risk.
Indigestion/fullness 2-4 hours after meal
Bloating or flatulence 2-4 hours after meal
Undigested food in stool
Greasy/floating/light colored stools
Diarrhea, or oil/grease present during bowel movements
Gallbladder pain (right side, under ribs), gallstones, or gallbladder removal
Low vitamin levels (A, D, E, and K) – even after supplementing
Remember that these symptoms can point to gallbladder issues, pancreatic enzyme deficiency, or other root causes (SIBO, H. pylori, low stomach acid, etc.). The good news is that these root causes are often interrelated; addressing one will likely positively affect others as well.
Testing for Pancreatic Enzyme Deficiencies
Symptoms are the clearest initial clue that you may be experiencing fat digestion issues. And the timing of symptoms, such as when fullness, bloating and indigestion occur, can help shed light on whether you have pancreatic insufficiency or another issue, such as low stomach acid. Stomach acid issues will start while you’re still at the dinner table, when you feel the need to unbutton your pants just after eating! Pancreatic insufficiency, on the other hand, will more likely hit 2-4 hours later, or maybe even later in the evening, hours after a meal.
Another heads-up symptom is vitamin D deficiency. If you take a vitamin D lab test after supplementing with vitamin D, but still see results indicating a deficiency, that often means there is a fat malabsorption issue to address. It could point to gallbladder issues and/or pancreatic insufficiency.
Once you identify fat malabsorption symptoms, you may want to simply try taking some digestive enzymes to see if you gain relief. While there are six types of digestive enzymes available, I’d suggest starting with two that focus particularly on fat digestion: Pancreatic Enzymes Plus and Liver & Gallbladder Support. In many cases, I’ve seen issues relating to pancreatic insufficiency resolve in a few weeks to a few months, just in taking enzyme support. I’ll talk more about these later on in this article.
There is a simple lab test you can take that specifically reports on your level of pancreatic elastase. It is done using a stool sample, and is available through expanded stool tests (like my favorite, the GI-MAP). In general, I recommend running comprehensive stool tests, as there may be multiple imbalances we may need to address. I will be working on an article on how to interpret these tests in future posts.
The Gastrointestinal Microbial Assay Plus (GI-MAP™) provides an amazing report on your gastrointestinal microbiota DNA, detecting pathogens (bacterial, parasitic, and viral) that may be causing you symptoms, as well as detecting intestinal health biomarkers relating to underlying issues that could be disturbing your normal microbial balance. One such biomarker is testing for low levels of fecal pancreatic elastase. The GI-MAP test is also great at uncovering many other known triggers for Hashimoto’s, including H. pylori, Epstein-Barr, Yersinia and yeast overgrowth.
In the GI-MAP test, normal values are greater than 500 μ/g, with a measure between 200-500 μ/g indicating a decrease in pancreatic output. Anything less than 200 μ/g is considered insufficiency.
In my clinical practice, I’ve found that about 40 percent of people with Hashimoto’s taking the GI-MAP assay have a low level of fecal pancreatic elastase.
PRECAUTIONS: Low levels of pancreatic elastase may not be just a result of enzyme deficiencies and/or low stomach acid. This can result from damaged microvilli, gallstones, celiac disease, SIBO, heavy metal toxicity, inflammatory bowel disease, cystic fibrosis, diabetes, stress, or excessive alcohol use. Testing for some of these may need to be done to find all of the root causes of your pancreatic insufficiency and fat malabsorption issues.
The Issue with Conventional Treatments
Digestive enzyme deficiencies are often overlooked and not diagnosed by conventional practitioners.
Too often, doctors will simply prescribe proton pump inhibitors (PPIs) at the first sign of gastric distress, which in many cases is the opposite of what is needed (such as in instances of low stomach acid). This is what happened to me for years, and I often hear about it when interviewing new clients, many of whom have been prescribed PPIs for their symptoms.
Others may start down a road of being evaluated for irritable bowel issues, or other conditions.
Both pancreatic enzyme deficiencies and chronic pancreatitis are often hard to diagnose and may just progress over the years. Unless someone presents with the weight loss and severe diarrhea pattern seen with the more advanced condition of EPI, there may be no pancreas-specific diagnosis for some time (despite many invasive tests to the stomach, intestinal tract, and bowels). This is unfortunate, as EPI may not be diagnosed until the pancreas loses some 90 percent of its enzyme production! That’s a long time to feel miserable with a chronic disease that can also cause osteopenia, anemia and more.
In contrast to how conventional medicine looks at these symptoms, in functional medicine, we understand that there are proven linkages between Hashimoto’s, gallbladder disease, pancreatic insufficiency, fat malabsorption, and nutrient deficiencies. So why wouldn’t we start there?
My Root Cause Recommendations
As a Root Cause detective, I look at these types of important linkages early-on during my initial assessments with new clients. If someone is experiencing symptoms associated with fat malabsorption or fatty-acid deficiency, or tests as having low fecal pancreatic elastase, my Root Cause approach focuses our efforts on the following three goals:
Supporting liver and gallbladder health (bile from the liver and gallbladder supports our pancreatic enzymes in digesting and absorbing fats)
Addressing potential deficiencies in pancreatic enzymes and supporting pancreas health
Evaluating other common root causes for fat malabsorption that are also known triggers for Hashimoto’s, such as SIBO, low stomach acid, etc.
To address these goals, I focus on dietary and lifestyle interventions, as well as adding the support of key nutrients and supplements such as digestive enzymes.
Dietary and Lifestyle Recommendations
Remove food sensitivities: Food sensitivities such as gluten have been linked to gastric motility and gallbladder issues, and can be a trigger for Hashimoto’s. I always recommend removing common food sensitivities such as gluten and dairy as an initial step to feeling better. You may want to consider an elimination diet to help identify your specific trigger foods.
Be mindful of fats. While fats are essential to our survival and we never want to be on a “fat free” diet, we may need to be mindful of eating them in our initial healing stages. I suggest eating healthier fats to start, and as you improve upon your issues with fat malabsorption, you can reintroduce others. Note that gallstones have been associated with diets high in sugar, as well as with saturated fats — and this is especially true if we can’t digest them.
Add medium chain triglycerides (MCTs) to the diet: MCTs are a form of fat that are more easily digested and absorbed. Coconut oil is a great source of MCTs!
Avoid gallbladder-unfriendly foods: There are a number of foods that have been found to cause gallbladder/fat digestion issues, including: onions, milk, pork, poultry, coffee, nuts, corn, tomatoes, and oranges. You might want to avoid these, at least until your fat digestion improves.
Support your liver: No matter what your symptoms are, I always say to focus on supporting your liver to improve your thyroid condition, and overall health.
Reduce alcohol intake: Excessive alcohol intake is a risk factor for pancreatitis.
Stop smoking: Smoking increases the risk for pancreatitis and pancreatic cancer.
Improve digestive rituals:
Smaller, frequent meals may help with better absorption.
Chew food thoroughly and relax at meal time (this helps get digestive juices flowing and working early on through your saliva).
Ensure good hydration, but don’t drink with meals (it dilutes those important digestive juices).
Stop taking acid-blockers if you are taking them! Many people having Hashimoto’s have the opposite issue — low stomach acid.
Consider adding digestive herbs to the meal (note that curcumin..
If you’ve been trying to uncover all of the root causes behind your Hashimoto’s condition, you have likely already started looking at problems associated with your gut—either related to your diet and food sensitivities, gut infections, or nutrient deficiencies. But many people don’t realize that the gut extends all the way to the mouth. And in the mouth, there are a number of things that can occur that can be triggers for Hashimoto’s and other autoimmune diseases.
Gum disease (periodontitis), fluoride use, infections in the mouth, dental x-rays, and many dental procedures themselves can all be triggers responsible for your symptoms. This includes procedures like root canals, implants, crowns, and yes, even those typical and seemingly ordinary silver fillings (amalgams) many of us have.
In my survey of 2232 people with Hashimoto’s, 8.25 percent said they had extensive dental work done before they started feeling unwell. Perhaps not an overwhelming percentage, but those responses likely don’t include all of the people who may have just had a lot of fillings over the course of their lifetime. I have found that amalgam fillings can be triggers for many of my clients and readers. Having fillings and dental work during my younger days was also a trigger of my own symptoms.
Many people don’t realize that dental amalgams, often called “silver” fillings, actually contain 50 percent of mercury by weight. A small amount of ongoing mercury exposure comes from mercury vapor outgassing from such fillings. In fact, mercury is released every time a person chews. (I’ve linked a video of this mercury “outgassing” below!)
Mercury exposure can also occur when old fillings fail and need to be replaced. Many of my clients have reported an onset or increase in Hashimoto’s symptoms after improper amalgam removal. Careful protocols need to be followed by your dentist to ensure that you, as well as your dentist, do not have greater exposure to mercury than necessary. In this article, you will learn about:
The safety concerns with mercury and dental amalgams
Why some people can be more greatly affected by dental amalgams
The dental amalgam and Hashimoto’s connection
How to determine if you need your amalgams removed
The recommended protocol should you need to have your amalgams removed
Ongoing dental self-care
Mercury Exposure and Toxicity
Before I talk about dental amalgams, let’s talk about mercury toxicity in general.
According to the World Health Organization (WHO), human exposure to mercury can be caused by the outgassing of mercury from dental amalgams, the ingestion of contaminated fish, or occupational exposure (working with metals or waste products containing metals).
Mercury also used to be the main component of thimerosal, a controversial substance that had been widely used as a preservative in some vaccines. Today, all vaccines for children under the age of 6 are available without thimerosal (but you may need to request thimerosal-free versions), and many vaccines for adults are also available without thimerosal. While the FDA determined that the amount of mercury from vaccines was too low of a dose to cause toxicity (with the exception of perhaps low weight infants), they ultimately determined that vaccine manufacturers should minimize thimerosal in vaccines whenever possible, due to potential additive effects of mercury from other sources. (You can find out more about mercury in vaccines on the FDA website here.)
Symptoms of mercury accumulation may include digestive issues, joint pain, fatigue, brain fog/trouble concentrating, and hair loss. Many of the symptoms related to mercury exposure overlap with those seen in Hashimoto’s.
Safety Concerns with Mercury and Dental Amalgams
Animal studies have linked mercury toxicity to neurodegenerative diseases. There have also been a series of associations between mercury and neurodegenerative diseases in humans. In addition to the brain, metallic mercury has also been found deposited in the thyroid.
Most human mercury exposure comes from mercury vapor outgassing from dental amalgam fillings, at a rate of 2 to 28 micrograms per facet surface per day, of which about 80 percent is absorbed.
You can actually watch a video of mercury vapor being released from a human tooth here. Once you view this video, you will understand why gum-chewing isn’t recommended for people with dental amalgams due to the increased mercury vapor outgassing. (BTW — while you’re visiting YouTube, you may also want to subscribe to my channel… my one minute bone broth video is one of the most popular ones so far.)
In 2009, the Environmental Protection Agency (EPA) ruled dental amalgams as a class II (riskier) device and identified specific practices for managing their handling and disposal. That said, the FDA hasn’t yet recommended against the use of amalgams (you can read what the FDA says about dental amalgams here). Other organizations have made steps to actually stop their use and find alternatives.
The WHO has recommended that a phase down approach to dental amalgams should be pursued by promoting disease (and cavity) prevention, as well as alternatives to amalgams. The WHO also outlined the need for more research, higher education of dental professionals, and increased public awareness.
In 2013, the US ratified the Minamata Convention on Mercury, introducing a plan to dramatically reduce mercury in the environment. While this plan doesn’t completely ban the use of mercury in dental amalgams, it does require a “phase-down” approach of the toxic material.
While the American Dental Association (ADA) itself has a toxic substance “protocol” for safe handling of the amalgam mixture once it is prepared by a dentist or assistant, the safety of dental amalgams for patients has yet to be fully addressed.
In fact, there has been recent research that has shown, alarmingly, that some of the new amalgam “blends”, created to be superior in strength and corrosion resistance, actually emit about ten times more mercury vapor than ones used prior to 1970.
Given these obvious concerns about the need to reduce the use of dental amalgams, you might wonder what the research says relating to Hashimoto’s. Are dental amalgams making your Hashimoto’s symptoms worse? Should you remove them in order to improve your antibody levels and overall well-being?
To get to those answers, let’s talk about why some people with Hashimoto’s could be at an even greater risk of mercury toxicity from dental amalgams than others (and how to know if you have mercury sensitivity).
Why Some People Are More Greatly Affected by Dental Amalgams
We’re all biologically unique. Some of us have genetic predispositions that can affect us in regards to disease development. We know that all people with Hashimoto’s have a genetic predisposition for the autoimmune disease, and many have food sensitivities too. Some people with Hashimoto’s have greater sensitivities and reactivity to metals than others.
I have found that mercury sensitivity is a problem for many of my clients, making dental amalgams more of a concern. But not everyone with Hashimoto’s has this hypersensitivity.
So when clients and readers ask me if they should prioritize removing their dental amalgams, the first thing I always want to do is determine if they have mercury sensitivity or not. If they do, dealing with their dental amalgams as a priority can make a lot of sense. If they don’t have mercury sensitivity, removing their amalgams may not be the highest priority for them.
The MELISA test will tell you if your body has an immune reaction to mercury and your silver amalgam fillings. Again, if you have Hashimoto’s and mercury sensitivity, you may want to remove those silver fillings sooner than later.
There have been a few studies that have specifically looked into this. In one study with people who tested positive on the MELISA test and had their mercury amalgams removed, those individuals saw a decrease in thyroid peroxidase and thyroglobulin antibodies. In this same study, those with Hashimoto’s who did not test positive for mercury sensitivity on the MELISA test did not see an improvement when they removed their dental amalgams.
An earlier study focused on patients described as “mercury-allergic with autoimmunity” that had their amalgams removed and replaced with composite (non-mercury) fillings. Seventy-one percent of patients experienced health improvements, and the ones who improved were the ones with the highest lymphocyte reactivity before the amalgam removal.
A study in 2010 looked at the replacement of amalgam in mercury-allergic subjects (as defined with a positive MELISA test). The results? Several laboratory parameters (including thyroid antibodies) were normalized, and there were other reported health improvements in about 70 percent of patients. There were no changes seen in subjects that had been classified as non-allergic who underwent amalgam replacement. There were also no changes seen in mercury-allergic subjects who did not have their amalgams replaced.
Note that in a study done in 2014 looking at the effects of removing dental amalgams in people with Hashimoto’s, but where mercury sensitivity was NOT looked at as a specific test factor, the results showed there was no relation of amalgam with Hashimoto’s. I feel like this study missed the forest for the trees!
The MTHFR Gene Variation
When it comes to the dangers of having dental amalgams, mercury sensitivity is one factor to consider. Another is your body’s ability to clear accumulated toxins, including heavy metals.
Most people with Hashimoto’s already have issues with clearing toxins. But if you have certain genetic variations (called polymorphisms), you can be at an even greater risk. Your body may not be good at detoxifying mercury and may store it like a toxic waste dump in your body.
The MTHFR gene variation is one example of this, as it prevents people from properly methylating (a key detox process in the body). If your body can’t clear toxins such as mercury, you can start seeing symptoms associated with poor methylation, such as irritability, depression, anxiety, and brain fog.
I recommend focusing on your liver to detoxify the body and support the methylation pathways. In my Root Cause survey, 45 percent of people with Hashimoto’s said they felt better after adding methylation-supporting supplements to their regimen.
Note that I am not talking about chelating therapies here. Chelation can actually cause more issues, as the chelation process pulls out the mercury hiding deep in the body and may simply deposit them elsewhere if the liver or gut aren’t functioning optimally. To read more about safer ways to detoxify your body and support the methylation pathways, read my article on liver support.
The Glutathione Transferase (GST) Polymorphism
Another genetic variation that can decrease the body’s ability to clear heavy metals like mercury is a polymorphism of the gene that controls an important detoxifying enzyme that regulates the excretion of mercury. This enzyme is called glutathione-s-transferase (GSST), and the polymorphism is called the glutathione transferase (GST) polymorphism.
Once you test for mercury sensitivity and find out if you have one or more of the genetic variations that can diminish your body’s ability to detoxify itself from heavy metals, you can check how much mercury is currently stored in your body. Tests used to measure mercury levels typically involve samples of blood, urine or hair. The challenge with measuring mercury levels in your body, however, is that different types of measures are only optimal for specific types of mercury. Measurements are also sensitive to the timing of the exposures, so you can get variations in results.
Having said that, you can do a more complex test, called a provoked urine test, which involves taking a chelating agent like DMSA (dimercaptosuccinic acid) or DMPS (dimercaptopropane sulfonate). These chelating agents will bind to the mercury and help to pull it out of the storage cells, for a more accurate reading.
Blood tests can also be done to test for mercury, but unless there has been a high acute mercury exposure (one-time/sudden instead of chronic or ongoing), the results can vary widely.
The mercury concentration typically found in whole blood is usually lower than 10 μg/L, but can be as much as 20 μg/L and still be considered normal. With long-term exposure to mercury vapor, the blood’s mercury concentration can rise to 35 μg/L. But again, testing can often show wide fluctuations.
The Dental Amalgam and Hashimoto’s Connection
Along with the earlier studies mentioned that focused on people having documented mercury sensitivities, there have been more general findings showing a connection between dental amalgams (mercury toxicity) and autoimmune disorders, including Hashimoto’s.
First, I want to point out an interesting connection relating to mercury and Hashimoto’s—and that is relating to selenium deficiency.
Mercury can deplete the body of selenium, as well as the antioxidants that require selenium, that work to help us get rid of toxins such as mercury! Selenium is a vital nutrient required in the synthesis of thyroid hormone. Mercury binds to selenium-containing proteins and causes a functional selenium deficiency.
Research has shown that most people with Hashimoto’s will have a deficiency in selenium, and being deficient in this nutrient is a very common and widely recognized trigger of autoimmune thyroid conditions. (You can read more about selenium deficiency here.)
The good news is that supplementing with selenium has been found to reduce thyroid antibodies and thyroid symptoms. When I surveyed my Root Cause readers, 63 percent said that taking a selenium supplement helped them feel better.
Along with creating selenium deficiencies, mercury can act as an endocrine disruptor. Elevated levels of mercury in the body have been found to change the way T4 converts to T3, leading to potentially toxic levels of T4 and suppressed levels of T3. One of the problems is that your thyroid needs some iodine for healthy thyroid hormone synthesis. But because mercury is chemically similar to iodine, your thyroid will absorb and store it as well. When your body stores mercury instead of iodine, it can become deficient in iodine, leading to inadequate levels of T3. (That said, iodine deficiency in Hashimoto’s is uncommon, and you can read about that here.)
There have been studies that have looked further at the rates of mercury in the blood compared to the level of thyroid disease. Associations between positive thyroid antibodies and total blood mercury in women were evaluated in an NHANES study done between 2007 and 2008. They found that mercury exposure was associated with cellular autoimmunity and that mercury does accumulate in the thyroid gland. They also found specifically higher levels of thyroglobulin antibodies in people who had high levels of mercury.
A 2006 forensic study found that the more mercury fillings a person had, the higher amount of mercury was found in their thyroid gland. Mercury levels in the thyroid and in the renal cortex were respectively about 5 and 4 times higher in subjects with 12 occlusal amalgams or more compared with subjects with 3 occlusal amalgams.
Finally, a study found that babies of women with amalgam fillings may also have mercury deposits in their organs and experience an impact on thyroid function. The higher the maternal levels of mercury in the blood, the higher the TSH levels in the children.
How to Determine if You Need Your Amalgams Removed
So that’s a lot of information! Where should you go from here?
First, I suggest you consult with a biological dentist. Biological dentistry is a branch of dentistry that focuses on the connection between oral care and the health status of the rest of the body. It is very prevention-oriented, and biological dentists try to prevent health problems that may originate from exposure to certain procedures and materials used during dental care.
Should you have a question concerning existing amalgams, he or she will likely have you take the MELISA test to check for mercury sensitivity. You can then make an informed decision as to whether you should prioritize having any amalgams removed. The number of amalgams you have may be a decision factor. A biological dentist will work with you on future filling needs, as well as providing other preventative information and procedures.
There is another test your biological dentist may recommend called the Clifford Materials Reactivity Test. This test helps identify the body’s response to almost one hundred chemical groups that may be used in medical or dental treatments. It also provides info on the body’s response to corrosion byproducts of these materials, which is particularly important as materials break down in the mouth.
Should you decide to have amalgams removed, there is a recommended protocol that your dentist should use. There are slightly different variations available from different organizations, but I like the protocol that has been developed by The Institute for Functional Medicine (IFM), as it is very thorough and supportive. The protocol consists of a pre-procedure regimen (7 days), requirements for the actual day of treatment, and a post-procedure regimen (2 weeks). It also assumes you are working with a biological dentist who is taking other procedural precautions.
The Recommended Protocol, Should You Need to Have Your Amalgams Removed
Again, if you determine you should have your amalgam fillings removed, it’s important to do it safely. If done improperly, you may breathe in potentially large doses of mercury vapor or other toxic dental chemicals during the process. This can be particularly impactful if you have the MTHFR gene mutation and intestinal permeability, as the mercury overload can overburden your already weakened detox pathways.
Many of my clients have found that they have an onset or increase in Hashimoto’s symptoms after improper amalgam removal. Proper precautions for safe removal of dental amalgams (to prevent the absorption of mercury vapor into your body) include:
A Pre-Procedure Assessment: Lab tests done one week prior to the procedure to ensure fitness for the procedure include a complete blood count (CBC), a comprehensive metabolic panel (CMP) and a renal function-glomerular filtration rate (GFR) test.
Dental Procedure Day and Post-Procedure Regimen (2 weeks following the procedure): There will be a variety of preventative measures your dentist will want you to take, such as rinsing your mouth with activated charcoal several times before and after the procedure (to help bind any ingested mercury). They will also have you swish your mouth with chlorella to help bind and prevent any mercury absorption.
During the procedure, a biological dentist will likely include many of the IFM’s recommended protocols for safe amalgam removal, including: rubber dams that cover your mouth, oxygen masks and skin covers (for you), a saliva ejector under the dam, eye protection (for you), auxiliary suction devices that have mercury filters for escaping mercury vapor, and more. The dentist and dental assistant will also have special masks and gloves to reduce their exposure. There are recommended methods that the dentist will follow as well to minimize the amount of potential mercury exposure.
You will most likely be instructed to continue taking the glutathione (liposomal), NAC or other liver support supplements. Additionally, you may be told to continue with your other vitamins and supplements. Some dentists may want to give you an intravenous (IV) of either vitamin C or additional nutrients.
Fatigue was the most debilitating symptom I experienced with Hashimoto’s. It started eight years before I was finally diagnosed in 2009, after I contracted mono (the Epstein-Barr virus) in college. I needed to sleep for 12 hours each night to be able to function, and by “function” I mean after hitting the snooze button on my alarm clock for two hours (ask my poor husband), I would drag myself out of bed and then had to drink 4-6 cups of caffeine every day to keep myself awake. I often had Red Bull and Pepsi for breakfast and was the epitome of “wired but tired.”
I saw numerous doctors, and I was offered antidepressants and stimulant medications used for narcolepsy and ADHD, but no one thought to check my poor little thyroid. I then came across “chronic fatigue syndrome,” and was discouraged that there was “no cure.” I slept half of my early twenties away thinking that I had better just deal with it, since no one could help me anyway.
When I was finally diagnosed with Hashimoto’s, part of me was relieved. I thought that I would finally get more energy. But this was not the case. Sure, the thyroid medication helped; instead of sleeping for 12 hours, I only needed 11 hours of sleep. But I didn’t stop there. At the time of my diagnosis, I was working as a consultant pharmacist and had become accustomed to researching emerging healthcare information. Finding a way to get myself better became my mission.
It took me almost three years after my Hashimoto’s diagnosis to get my energy back, and I hope that some of the strategies that I used will help you get yours back too.
If you are dealing with Hashimoto’s fatigue, I’d like to share with you a few tips:
The optimal TSH number for fatigue resolution
The thyroid hormone that can block energy production
The three types of fatigue-inducing anemia your doctor may miss
Supplements that can reduce thyroid fatigue
Strategies to Address Fatigue
1. The Importance of “Normal” TSH
Conventional endocrinologists often refer to the TSH test as the “gold standard” test for diagnosing and treating thyroid conditions. One major symptom of hypothyroidism is low energy. So, it’s important to make sure that your TSH is within the range of a healthy person without thyroid disease (not within the range of an elderly person or someone with subclinical thyroid disease).
TSH stands for Thyroid Stimulating Hormone, which is produced in the pituitary gland in your brain. The pituitary gland tells your thyroid to make and release thyroid hormones into your blood. A TSH test measures how much of this hormone is in your blood. In advanced cases of Hashimoto’s and primary hypothyroidism, this lab test will be elevated. (Read my post about interpreting your TSH test for more information). In the case of Graves’ disease and hyperthyroidism, the TSH will be low. Keep in mind, however, that people with Hashimoto’s and central hypothyroidism may have a normal reading on this test.
The National Academy of Clinical Biochemists indicates that 95 percent of individuals without thyroid disease have TSH concentrations below 2.5 μIU/mL. However, as of 2017, the official reference range for the TSH test in most labs in the U.S. runs from approximately 0.5 to 4.5 or 5.0 (μIU/mL). A patient with TSH levels within this range is considered to have normal thyroid function.
However, many labs have not adjusted that range in the reports they provide to physicians and have kept ranges as lax as 0.2-8.0 μIU/mL. And, many physicians only look for values outside of the “normal” reference range provided by the labs. They may not be familiar with the new guidelines. This is one reason why patients should always ask their physicians for a copy of their lab results. Despite some lab tests stating that a TSH of 8 or 5 μIU/mL is “normal,” most people feel best with a TSH between 0.5-2 μIU/mL.
In 2001, the results of the Basel Thyroid Study conducted at the end of the 1990’s were published. Tiredness and fatigue remained as the cardinal impairment in hypothyroidism, in spite of thyroid hormone therapy. An editorial in Thyroid, written by Peter Andreas Kopp in 2014, found that patients remain symptomatic (that is, they may experience symptoms like fatigue) despite having “normal” thyroid hormone levels.
Similar to the opinion of Kopp, Mary H. Samuels, a professor of the Oregon Clinical and Translational Research Institute, stated: “It is a common clinical observation that some otherwise healthy patients with hypothyroidism continue to complain of fatigue, poor mood, inability to concentrate, and vague cognitive difficulties (often described as ‘brain fog’) despite normal TSH levels.”
You may also be interested to know that of the 2,000+ people who took part in a survey I conducted, thyroid patients reported that optimizing their TSH helped improve their energy. Seventy-seven percent of my readers with a TSH level under 1 μIU/mL saw improvement in energy from medication interventions, and 72 percent with a TSH between 1 and 2 μIU/mL saw improvement in their energy levels.
From a personal perspective, I felt like a sloth when my TSH was within the “normal” range at 4 μIU/mL.
2. The Impact of Low T3/High Reverse T3
Triiodothyronine, or T3, is a hormone produced by the thyroid gland that is essential for keeping our metabolism going. T3 is the main “energy” hormone produced by the thyroid. When our cells see T3, they produce more energy, so it’s very important to ensure that we have adequate levels of active T3, as T3 tells our body to grow hair, boost metabolism, and create more energy.
It’s also important to avoid having a high level of reverse T3, which is a molecule related to T3 that blocks thyroid receptors in cells instead of activating them. When cells see this molecule, they slow down energy production.
Synthroid® or levothyroxine (a synthetic version of T4) is the most commonly prescribed thyroid medication, but only contains T4, a precursor to T3, our main “energy” hormone. T4 is converted to T3 in the body, but this doesn’t always happen, due to numerous factors such as stress, nutrient deficiencies, and others… so we often continue to feel exhausted despite having normal T4 levels.
Ulta Labs is a great online esource for ordering a free T3, free T4, and TSH test, as well as for checking your reverse T3 levels, without needing to get a thyroid lab request from your doctor. The lab also bills insurance (please check with your own insurance to make sure you qualify), and I love using it to get a discount on lab tests with my high-deductible insurance plan.
If you continue to be fatigued while on medications, you can have your practitioner test your free T3 levels. (In some cases, testing reverse T3 may also be helpful, although it’s not always necessary.)
In the case that your T3 is low, or in the bottom part of the reference range, or if you’re still symptomatic with T4 medications alone, you may benefit from adding a T3-containing medication such as Cytomel (liothyronine) to your current medication regimen, or switching to a T4/T3 combination medication such as WP Thyroid, Armour*, Nature-Thyroid, or compounded T4/T3.
In my survey of over 2,000 readers, 76 percent reported improved energy while taking compounded T3/T4, 74 percent while taking Armour Thyroid*, 74 percent with Cytomel, and 72 percent with Nature-Thyroid. Only 52 percent saw improved energy levels with Synthroid, the most commonly prescribed thyroid medication.
The takeaway from the survey showed that getting on the right thyroid medication helps many people get their energy back. For further information, you can read my article about thyroid medications.
*Note: While Armour Thyroid does not have any gluten-containing ingredients, it is not tested for gluten content, and cannot be certified as gluten free. Armour does contain sodium starch glycolate, which can be derived from wheat or corn.
3. Is Anemia Stealing Your Energy?
Many people think of iron deficiency as the cause of anemia, but there are actually three types of nutrient deficiencies that can lead to anemia and are common in people with Hashimoto’s – iron, B12, and folate.
Testing for Anemia
Your practitioner will usually run a blood test to check for hemoglobin and hematocrit to look for anemia. While helpful for advanced cases of anemia, this test may miss some subtle cases of anemia that can leave us feeling exhausted.
In addition to testing hemoglobin and hematocrit, I recommend testing ferritin, B12 and folate. Always be sure to get a copy of your lab tests. As with the “normal” range for TSH, the “normal” lab values for B12 and ferritin are often not optimal.
Normal levels of vitamin B12 are between 200-900 pg/mL; however, levels under 350 pg/mL are known to be associated with neurological symptoms. In my experience, you can have symptoms if your levels are below 700 pg/mL, and you may still benefit from a supplement.
In a study regarding the prevalence of vitamin B12 deficiency among patients with thyroid dysfunction, it was found that autoimmune thyroid disease is also associated with the autoimmune disorder pernicious anemia, which may lead to malabsorption of vitamin B12. The study concluded that in order to ensure proper treatment, vitamin B12 screening is recommended upon initial diagnosis of autoimmune thyroid disease, and periodically thereafter.
As some people may have a difficult time absorbing B12 orally, it works best when taken as an injection or as a sublingual (under the tongue) drop.
Be sure to get the methylcobalamin or hydroxocobalamin version of B12 rather than a cyanocobalamin version, as they are better absorbed by most people.
Ferritin is the name given to your body’s iron reserve protein. “Normal” ferritin levels for women are between 12-150 ng/mL. However, the optimal ferritin level for thyroid function is between 90-110 ng/mL.
Ferritin is one of the most common deficiencies I see in people with Hashimoto’s, and in addition to fatigue, ferritin deficiency can also contribute to shortness of breath, restless leg syndrome, hair loss, insomnia, strange food cravings and mood swings.
While ferritin is likely to be deficient in up to 50 percent of women of childbearing age, as well as up to 80 percent of women who are pregnant or who are recently postpartum, I don’t recommend supplementing unless you’ve been tested to be deficient in ferritin. Too much iron/ferritin can also be a problem!
According to my survey, ferritin/iron supplementation improved energy levels for 82 percent of those who responded. While most iron supplements can cause digestive disturbances, two potential options may be better tolerated:
OptiFerin-C contains ferritin and has helped many of my clients boost their ferritin levels. Calcium ascorbate, a natural, water soluble version of Vitamin C, is added to increase intestinal absorption.
Thorne Iron Bisglycinate is an iron supplement that is more gentle on the stomach and less likely to cause constipation.
I recommend testing for ferritin before supplementing, and retesting your levels within 1-3 months, to ensure that you are supplementing enough (but not too much!).
Vitamin B9 is a necessary nutrient that naturally presents itself as folate, which plays a vital role in the formation of DNA and cell growth. In some cases, you may test normal or high for folate, but you could still be deficient in the right kind of folate for your body.
This is the case with the MTHFR gene variation, which can impact how well your body metabolizes folate. Both folate and folic acid are forms of vitamin B9, required for numerous critical bodily functions. However, folic acid is synthetic, while folate occurs naturally in foods, such as broccoli, lamb, beets, and quinoa. Some people, including some individuals with Hashimoto’s, have a MTHFR gene variation that prevents them from properly processing the folic acid that may be present in less expensive supplements and processed foods. Some professionals claim this type of folic acid may even cause a build-up in the body, leading to toxicity.
Likewise, the MTHFR gene produces an enzyme necessary to process vitamin B9 properly. This enzyme is also important for converting homocysteine to methionine, which the body needs for proper muscle growth and energy.
In addition to lifestyle changes, individuals with the MTHFR gene variation and high homocysteine levels may benefit from an activated or methylated version of folate, mainly because food alone does not provide sufficient levels. I have formulated MTHFR Pathways, which contains all of the above-mentioned ingredients and may be helpful with reducing homocysteine levels.
Fatigue can be experienced from ingesting a food you are sensitive to. Food sensitivities are very different than food allergies, and many people are sensitive to specific food groups which can result in fatigue. People with Hashimoto’s often present with gluten, dairy, soy, egg, corn, and nut sensitivities. In fact, two of the most common food sensitivities found in people with Hashimoto’s are gluten and dairy.
Gluten is the main reactive protein found in wheat, and casein is the main reactive protein found in dairy. Growing evidence has shown that food sensitivities can negatively impact our bodies and trigger a wide range of symptoms, such as asthma, arthritis, mood disorders, and autoimmune disorders. My own clinical and personal experience has shown that non-Celiac gluten sensitivity is one of the biggest triggers in Hashimoto’s.
Changing my diet helped with fatigue, and I regained my energy. It also helped me eliminate bloating, symptoms of irritable bowel syndrome, anxiety, congestion, and carpal tunnel!
In my outcomes survey of people with Hashimoto’s, 75 percent reported improvement in energy from the Autoimmune Paleo diet, and another 78 percent saw improvement in energy from the Paleo diet.
Food sensitivity testing may be helpful in some cases, but may not be affordable for many people. Not all tests are created equally, but I have found the food sensitivity testing through Alletess to be the most accurate. The company offers food sensitivity testing (96 and 184 food panels) for people to self-order. I started with the 96 food panel, which was enough to pinpoint most of my food triggers, and I now repeat the 184 food panel on an annual basis to be sure that I’m staying on top of potential triggers, as our food sensitivities and reactions to foods tend to change with time.
5. Balance Your Blood Sugar
Blood sugar imbalances can wreak havoc on our energy levels as well as cause anxiety. People with blood sugar imbalances will often have times of the day where they feel especially tired, weak and/or anxious, such as “morning fatigue” or the “afternoon slump”.
That’s why balancing blood sugar levels should be one of the priorities for anyone who is hoping to overcome fatigue. Balancing my blood sugar made a big difference for me, helping me feel more energetically balanced and less anxious throughout the day. As a side bonus, most people with Hashimoto’s will find that their thyroid antibody levels will drop thanks to balancing their blood sugar!
Before I balanced my blood sugar, I would get “hangry” (hungry + angry) multiple times per day. I found that the high carbohydrate foods I was eating were causing huge blood sugar swings, and I didn’t realize these swings were causing a spike in my thyroid antibodies and weakening my adrenals.
Practitioners, like myself, who focus on reversing Hashimoto’s, often describe blood sugar imbalances as adding fuel to the fire in autoimmune thyroid disease. I wasn’t aware that I had blood sugar issues when I was first diagnosed (despite being a self-admitted sugar addict).
Researchers in Poland found that up to 50 percent of patients with Hashimoto’s have an impaired tolerance to refined or simple carbohydrates like processed sugar or refined grains that have had the nutrients removed. This means that after consuming carbohydrate-rich foods, their blood sugar goes up too high, too quickly, which leads to a rapid, and often extreme release of insulin. These insulin surges can cause low blood sugar (reactive hypoglycemia), which in turn can cause troublesome symptoms like lightheadedness, nervousness, anxiety, and fatigue.
However, eating a low glycemic index diet can help you feel fuller longer. It can also improve cholesterol and blood sugar levels, enhance cognitive performance, improve energy, and reduce acne. The diet can also lower your risk of developing diabetes, heart disease, some cancers, and can promote weight loss as well.
Discovering that I had a deficiency of stomach acid was a huge “aha” moment for me! I couldn’t believe how energetic I became when I started taking Betaine with Pepsin with my protein containing meals.
My 10-year long debilitating fatigue was lifted practically overnight, and I went from sleeping for 11-12 hours per night to 8 hours — just because I started digesting my food better. I felt like Bradley Cooper in Limitless after I started taking Betaine with Pepsin. Finally having enough energy gave me the confidence that I could overcome Hashimoto’s and my long list of health struggles. It even helped with my brain fog, and I was able to come up with all kinds of clever words much quicker. My humor came back.
I started writing my book about overcoming Hashimoto’s the morning after I took a dose of Betaine with Pepsin. The restored energy gave me hope that I would be able to devote myself to research and find the root cause of my condition, then share that knowledge to help others.
Betaine with Pepsin promotes healthy digestion and supports nutrient absorption, such a protein, calcium, Vvitamin B12, and iron. I have found it very beneficial for anyone seeking enhanced digestive function.
Out of 627 of my readers who took Betaine HCI and Pepsin, 59 percent said it made them feel better and saw improved energy levels, 33 percent said it made them feel worse, while 7 percent saw no difference in their symptoms. These results lead me to estimate that 50-70 percent of people with Hashimoto’s are likely to have a deficiency in stomach acid, and the 33 percent of those who felt worse were likely not deficient in stomach acid. Those who did not see any improvement may not have been dosed adequately, as the dosage of Betaine with Pepsin should be individualized.
Ketogenic diets, which are high-fat/low-carb/moderate-protein diets, are a hot topic in the health and wellness community.
Some of my readers think that a ketogenic diet might be a little too high in fat and low in carbohydrates to be healthy, and wonder how it may impact those with Hashimoto’s.
Based on the growing popularity of this type of diet, and the interest people have expressed, I have carefully evaluated the pros and cons of doing a ketogenic diet to consider whether a high-fat, low-carbohydrate diet may be an option for those with Hashimoto’s thyroiditis and other autoimmune conditions.
In this article, I’ll cover:
What a ketogenic diet is and how it works
The potential benefits of a ketogenic diet
The potential drawbacks of a ketogenic diet
Strategies to optimize a ketogenic diet with Hashimoto’s
What is a Ketogenic Diet?
The ketogenic diet, which is a high fat and very low carb diet, has recently become a popular choice for people wanting to lose weight and a few inches. Historically, the diet has been used to help with the symptoms of pediatric epilepsy, until pharmaceutical companies took over with antiepileptic agents. The ketogenic diet puts our body in a state of ketosis — where it burns fat, either from food or within our own fat cells, for fuel. Fat becomes the main source for fuel, as opposed to glucose from carbohydrates and sugar.
Low-carbohydrate diets, such as the ketogenic diet, have been used as ways to reduce body fat. Part of this weight loss is due to caloric restriction, as a result of the removal of a significant amount of carbohydrates. Traditional ketogenic diets generally limit the intake of carbohydrates from fruit, grains, and starches to fewer than 15 grams per day; however, different people have different thresholds of how many carbohydrates they can consume without being “kicked out” of the state of ketosis.
Those following a ketogenic diet consume liberal amounts of fat, moderate protein, and non-starchy vegetables, and focus less on consuming foods that contain higher amounts of carbohydrates. This makes the diet very satiating, and for the most part, easier to follow than other diets due to the abundance of fats that help to satisfy us.
There are benefits of a ketogenic diet which I’ll dive into further as you read along, but in short, it can help to improve energy, blood sugar balance, pain, inflammation, migraines, and oxidative stress. It may also contribute to better brain function and mood regulation. Research has shown that ketogenic diets may be helpful in a variety of conditions, ranging from neurological issues, including multiple sclerosis and epilepsy, to reactive hypoglycemia. However, there are some precautions to consider.
How Does a Ketogenic Diet Work?
To understand how ketogenic diets work, we first need to take a look at how the body converts the food it takes in, to the fuel that powers our cells.
The body typically utilizes glucose as its primary fuel source. When it doesn’t receive glucose from dietary sources, the body looks to its energy storage units, called glycogen. Muscle cells contain glycogen, but most of the glycogen our body utilizes comes from the liver. However, the liver can only store about 100 grams (or 400 calories) of glycogen, which can quickly become depleted.
When we no longer have sufficient levels of glucose (either from food, or from glycogen, the body’s backup glucose), the body doesn’t just shut down. Instead, we have a backup fuel called ketone bodies, or ketones.
Ketones are water-soluble molecules, produced in the liver from fatty acids. There are three types of ketones – β-hydroxybutyrate (BHB), acetoacetate, and acetone. These ketones can become the brain and body’s main energy source when glucose is not available.
Restricting one’s carbohydrate intake can shift the body’s fuel source from glucose to ketones, as this limits circulating blood sugars. This shifts the body from utilizing glucose to utilizing fat, which gets repackaged as ketones. This metabolic state, in which some of the body’s energy supply comes from ketone bodies in the blood, is called ketosis. Fasting or starvation can put the body’s metabolism into a state of ketosis, as can a very low-carbohydrate, high-fat ketogenic diet.
While, in theory, one could remain in a state of ketosis indefinitely without harmful effects, experts are divided on if, and how long, a person should follow a ketogenic diet, with some touting it as a healthy lifestyle, and others using it as a short-term solution for weight loss.
What Does a Ketogenic Diet Look Like?
The classic ketogenic diet contains a 4:1 ratio by weight of fat to combined protein and carbohydrates. Ketosis typically occurs within two to four days of eating fewer than 20-50 grams of carbohydrates daily, although everyone has a different metabolism, and individual results will vary.
While this amount of fat is far more than what most people eat in their diet, it may not necessarily be unhealthy. Although dietary fat once got a bad reputation, today we see that fat quality is a more important factor, and that certain fats, like coconut milk and avocados, can even have health benefits. (You can read more about the benefits of good fats here.)
In the traditional ketogenic diet, high-fat foods, including various meats, eggs, cheese, fish, nuts and seeds, avocado, butter, and oils, form the foundation. A few other foods, such as non-starchy vegetables and small amounts of berries, lemons, and limes, are also allowed. Keep reading to see how to tailor a ketogenic diet to compliment a Hashimoto’s healing journey.
Ketogenic Diet and Hashimoto’s
It can be difficult to determine how to use a ketogenic diet for Hashimoto’s because most studies focus on how keto diets can affect appetite and weight loss, as well as specific conditions such as type 2 diabetes, rather than the impact on thyroid function.
One important thing to mention is that traditional ketogenic diets use copious amounts of dairy for the fat component, (especially cheeses!), and we know that dairy can be a trigger for Hashimoto’s. The use of MCT or coconut oil for a fat source, may be more of a thyroid friendly approach.
If followed mindfully, by removing common reactive foods, including gluten, dairy, soy, and grains, the ketogenic diet can be a very nourishing diet for Hashimoto’s. Removing these foods, in addition to sugar sources, contributes to the healing benefits of the ketogenic diet.
People with autoimmune thyroid conditions, however, oftentimes need additional support beyond a standard ketogenic diet, and may find that they need to eliminate other commonly reactive foods, including nuts, nightshades, and eggs. (You can learn more about this in my article on common food sensitivities in those with Hashimoto’s.)
Some studies that have looked at the impact of low-carbohydrate diets on T3 and T4 thyroid hormones, as well as thyroid antibodies, show mixed results.
For example, in a 2016 study that looked at the effects of low-carbohydrate diet therapy in people with autoimmune thyroid conditions, 180 people with Hashimoto’s were randomized, and a control group ate a low-calorie, low-carbohydrate diet with food restrictions and guidelines. Their diet contained 12-15 percent carbohydrates, 50-60 percent protein, and 25-30 percent fats. In addition to eating only lean parts of red and white meat, and fish with veggie-rich meals, those on the study diet also eliminated eggs, legumes, dairy products, bread, pasta, fruit, rice, and goitrogens.
After just 21 days, all the patients in the study group showed a significant decrease in their thyroid antibody levels. Based on the way this study was conducted, however, it’s difficult to tell whether the carb restriction, removal of highly reactive foods (gluten, dairy, soy, eggs), or all of the above, played a role in improving patient outcomes. (You can read more about my analysis of this study here.)
In another study, the effects of a ketogenic diet on the thyroid of 120 children with epilepsy were monitored for one year. Free T3, T4, and TSH levels were measured at 1, 3, 6, and 12 month intervals. The normal rate of hypothyroidism among preadolescent children is roughly 1 in 1250; however, as a part of this study, 1 in 6 of the children became hypothyroid and required thyroid replacement therapy. It was ultimately concluded that children undergoing a ketogenic diet to treat epilepsy should be closely monitored for thyroid dysfunction.
However, it is important to consider that this could be due to a connection between epilepsy and thyroid hormones. Studies have shown that thyroid hormone abnormalities may be more common in those with epilepsy, and that the use of antiepileptic drugs can impact thyroid function as well. One study found the following rates of subclinical hypothyroidism after 12 months of using various anti-seizure medications: “28% in valproate, 21.4% in oxcarbazepine, 18.2% in phenobarbital, 13.9% in carbamazepine, and 0% in levetiracetam groups.”
Another study, published in Diabetes, Obesity and Metabolism, found that a ketogenic diet resulted in lowered T3 levels and raised reverse T3 levels in healthy subjects. These were noted to be the same changes seen in cases of starvation, where the body kicks into survival mode and slows down its metabolic rate.
I have personally seen positive outcomes in my clients and myself, through eating a lower-carbohydrate, higher-fat diet, and have heard of others seeing improvements in their thyroid health while trying a keto diet. However, I’ve also seen negative outcomes for other people, who were not my personal clients, with the keto diet. It’s important to consider that diet is not a one-size-fits-all approach to healing, and that it should be individualized to our own needs.
There may be also other factors which need to be addressed, in order to get the best outcomes with this type of diet. I’ll cover some of those later in this article, but first, let’s look at some of the potential benefits of a ketogenic diet.
Oxidative Stress Reduction and Increased Energy
Normal cellular metabolism and environmental factors produce reactive oxygen species (ROS), highly reactive molecules that can damage cell structures. A healthy body is well-equipped to handle a certain amount of ROS, with the help of antioxidants.
However, autoimmune conditions, including Hashimoto’s, can shift that balance between ROS and the body’s antioxidant defense with what we call “oxidative stress.” Researchers have found that oxidative stress contributes to several inflammatory and immune-mediated disorders, including Hashimoto’s thyroiditis.
One study that looked at the pathogenesis and progression of Hashimoto’s found that oxidative stress could be a risk factor in the development of overt hypothyroidism in Hashimoto’s. Increased oxidative stress can also deplete levels of glutathione, an important antioxidant. (Read more about that here.)
Ketogenic diets can reduce the generation of these ROS by uncoupling proteins and increasing levels of antioxidants, including glutathione.
Interestingly, a study on traumatic brain injury in mice found that a ketogenic diet could decrease oxidative stress as well as boost energy levels, as the mice who were on a ketogenic diet were found to have greater cerebral function, despite their post-traumatic brain injury, than the mice who were on a standard diet. The results suggested that a ketogenic diet can improve the function of mitochondria, the little power plants within our cells that create energy.
Since hypothyroidism itself is a state of increased oxidative stress, reducing that stress with a ketogenic diet may help normalize thyroid function and increase one’s energy levels.
Chronic inflammation goes hand-in-hand with Hashimoto’s and can be caused by diet, injuries, unbalanced gut flora, and low-grade infections. A well-designed ketogenic diet that incorporates plenty of anti-inflammatory foods can, however, help reduce inflammation.
One study that focused on rheumatoid arthritis, an autoimmune condition often seen in those with Hashimoto’s, found that ketogenic diets could play an anti-inflammatory role because the ketone β-hydroxybutyrate (BHB) inhibits inflammasomes, which are responsible for the activation of inflammatory responses.
Thus, it’s possible that reducing inflammation with a ketogenic diet may help to improve symptoms related to autoimmune thyroid disease.
Improvements to Blood Sugar Levels
Researchers in Poland have found that up to 50 percent of patients with Hashimoto’s have an impaired intolerance to carbohydrates. This means that after consuming carbohydrate-rich foods, their blood sugar goes up too high, too quickly. This leads to a rapid, sometimes excessive release of insulin (the hormone that allows the body to use glucose from foods).
These insulin surges can cause low blood sugar, which can result in unpleasant symptoms such as nervousness, lightheadedness, anxiety, and fatigue. (You can read more about blood sugar issues and Hashimoto’s here.)
Since a well-designed ketogenic diet is naturally low in sugar and refined carbohydrates, it can help balance blood sugar levels.
The effect that ketogenic diets can have on blood sugar is highlighted in a recent study where 28 overweight individuals with type 2 diabetes were placed on a diet consisting of less than 20 grams of carbohydrates per day, for a period of 16 weeks. At the end of the study, the ketogenic diet had improved glycemic control in the patients to such a degree that diabetes medications were discontinued or reduced in most participants!
Given this, ketogenic diets have the potential to balance blood sugar levels in those with Hashimoto’s.
Improvements to Brain Fog and Other Mood-Related Symptoms
Blood sugar-balancing ketogenic diets may also have a positive effect on the brain. Many Hashimoto’s clients note that regularly consuming sugar results in brain-related symptoms such as headaches, dizziness, brain fog, anxiety, depression, fatigue, and insomnia.
Since ketogenic diets are very low in sugar, many people note that once the body adapts, they feel a mild euphoria that eliminates the brain fog, mood swings, and other symptoms associated with Hashimoto’s. That mental clarity likely comes from blood sugar balance and the brain utilizing ketones as fuel. (You can read more about how sugar impacts Hashimoto’s and blood sugar levels here.)
Another thing to note is that ketones can easily cross the blood-brain barrier. The brain utilizes ketones efficiently, converting them into an energy source called adenosine triphosphate molecules. In fact, research shows that the brain can source 75 percent of its energy from ketones. Thus, a keto diet may help improve mental symptoms in some individuals.
Precautions with a Ketogenic Diet and Hashimoto’s
While a ketogenic diet can potentially improve certain factors associated with Hashimoto’s, there are some important concerns to consider, before utilizing this type of diet with an autoimmune thyroid condition.
Reactive Foods on the Keto Diet
While a ketogenic diet restricts or eliminates some reactive foods such as gluten, the plan allows others such as soy and dairy. These foods are generally high in fat (and therefore keto-approved). However, they are two of the most problematic foods for the majority of those with Hashimoto’s.
While a thyroid-friendly, healthy ketogenic diet without dairy and soy is possible, it can be easy to turn to less than healthy foods on this type of diet. I sometimes see people eating inflammatory foods such as fast-food cheeseburgers (without the bun), nuts and seeds roasted in vegetable oils, and “keto-friendly” desserts that contain artificial sweeteners and other reactive ingredients.
While these would fall under the ketogenic umbrella, they are not healthy. (As with any diet, along with removing foods that can trigger thyroid flares, incorporating quality foods into your meals matters. Getting the right low-carb foods to help heal the body – like organic plant foods, grass-fed meats, seafood rich in omega-3 fatty acids, and healthy oils like extra-virgin olive oil, MCT oil and coconut oil – is crucial when following a ketogenic diet.)
Keto Diet and Candida Issues
Ketogenic diets might also exacerbate Candida overgrowth, which is a potential co-occurring infection and root cause seen in many with Hashimoto’s. While keto diets cut out simple carbohydrates to help starve the fungus, they also usually allow nuts, seeds, mushrooms, fruit, dairy, and some alcohol, which may continue to feed the Candida. Taking the beneficial probiotic S. Boulardii is one of my favorite ways to support the body in managing Candida.
Liver health is another concern with ketogenic diets. A congested liver is one of the many reasons why people’s bodies don’t utilize their thyroid medications effectively and don’t convert T4 to the active T3 hormone correctly. It can also lead to a greater buildup of toxins, an issue that might create new symptoms altogether or worsen those existing ones as a result of Hashimoto’s.
My experience has taught me that supporting the liver is an important part of re-establishing healthy thyroid function and eliminating the many symptoms associated with Hashimoto’s. (I discuss the role of liver support in Hashimoto’s here.)
There are a couple of potential problems with ketogenic diets and the liver. Since the mitochondria within the liver cells primarily produce ketone bodies, utilizing ketones as a predominant fuel source means extra demand for this already-hardworking and overburdened organ.
Toxins also congregate in fatty tissue. When someone eats conventional meat that was fed corn, grain, and other inflammatory foods, these substances may enter the body. Since ketogenic diets are very high in animal fat, increasing one’s intake of meat may result in the liver working harder to detoxify the body.
Optimizing the liver detoxification pathways is important for ketosis and thyroid health, so you may wish to focus on supporting your liver before considering a ketogenic diet.
Keto Diets and Their Effect on Thyroid Health
While ketogenic diets can benefit those with Hashimoto’s, some of my readers and clients have seen thyroid panel imbalances when following a ketogenic diet.
One potential cause of this could be that insufficient carbohydrates can trigger the release of reverse T3, leading to hypothyroid symptoms in light of “normal” lab values. (Perhaps reverse T3 induces a “hibernation” state that once helped us survive long winters as cavemen and cavewomen, by preserving our metabolic function when we couldn’t drive down to the market, and only had limited amounts of food available.)
These concerns should be taken on a case-by-case basis, paying attention to whether a person’s blood work and symptoms improve on a ketogenic diet. Some people feel great and see optimal lab results when eating a high-fat, low-carbohydrate diet. For others, thyroid levels and Hashimoto’s symptoms worsen when they reduce their intake of carbohydrates.
Oftentimes, this can be resolved by adding more nutrient-dense carbohydrates (like those found in fruits and vegetables) to one’s diet, until an ideal threshold is found.
Another potential root cause of a sudden onset of symptoms after starting a ketogenic diet is something called the “Keto Flu.” As the body shifts from glucose to ketones as its dominant fuel, some people experience symptoms such as nausea, headaches, aches, cramps, brain fog, difficulty sleeping, and sugar cravings.
Many of the symptoms of keto flu can overlap with those of Hashimoto’s, so there might be some confusion about their underlying cause. Keto flu symptoms usually subside once the body becomes accustomed to using ketones for energy; however, for some people, this process can feel agonizing and last days or even weeks!
Staying hydrated with sufficient amounts of filtered water and electrolytes can help with the keto flu, as very low-carbohydrate diets can deplete fluid levels. Electrolyte imbalances are common with ketogenic diets and can lead to cramping and other symptoms. (Many of my readers find taking an electrolyte supplement, like Electrolyte Synergy by Designs For Health, as well as sipping on bone broth, can help replenish those electrolytes.)
Most people report feeling energetic after starting a ketogenic diet, which may last from days to months, or even years for some. However, others — especially athletes and active individuals — may start to feel more fatigued.
This can be a sign that the body needs more carbohydrates, and may be resolved by gradually increasing one’s intake of whole, unprocessed vegetables, low-sugar fruits, nuts, and seeds, and seeing if they provide more energy. Many people do well “flirting” with ketosis by slightly lowering dietary fats and increasing healthy carbohydrates.
Consuming berries is a great way to do that. They are full of phytonutrients and antioxidants, and they are less likely to spike blood sugar compared to other fruits. Furthermore, blueberries are a rich source of myo-inositol, a nutrient that has been shown to improve thyroid function and blood sugar. If possible, try to buy organic fruit with limited exposure to pesticides.
Some people on ketogenic diets also use medium-chain triglycerides (MCTs), a fatty acid found in coconut oil, which can provide an important source of energy while also keeping the body in ketosis.
Digestive Enzyme Support
Another potential cause of low energy levels on a ketogenic diet is digestive enzyme deficiencies. Low energy levels could be due to low stomach acid, rather than the restriction of carbohydrates. Many people that don’t do well on a high-fat, moderate-protein diet, will find that they have deficiencies in digestive enzymes, specifically those that digest proteins and fats. As these macronutrients become the primary..
While pursuing thyroid health has been my mission for the past several years, I have always taken pride in my external appearance. Being a full-time mom and running a business has taken over much of the time. I still worry about my looks these days, but I’ve also gained more of an appreciation for how “necessary” certain beauty procedures can be, to keep us looking our best after long nights of very little sleep!
I applaud those who prefer to take a more natural approach to beauty and have learned to love the skin they were born into. But, I do know that many people find that they feel more comfortable when they can address the external issues that are stealing their confidence, such as hair that is slowly greying, or skin that is losing its youthful glow. However, just as I’ve swapped out all of my personal care products for ones that are safe for my health, I’m always looking for alternatives to many of the common beauty procedures that won’t compromise the health of the thyroid health, by exposing the body to harmful toxins.
My goal with this article is to shed some light on the health hazards of some of these common beauty procedures, while, at the same time, offering a few appealing alternatives that won’t compromise your health. It doesn’t have to be all or nothing!
In this article, we’ll explore:
Common beauty procedures, such as the Brazilian blowout, hair dyeing, breast augmentation, and Botox
How these procedures can negatively impact your health
Safer alternatives that still offer results
Resources for checking the safety of the products you use
The Brazilian Blowout
The Brazilian Blowout, and similar keratin treatments, became popular in Brazil in the mid 2000s, before becoming a hit in Hollywood and the rest of North America. Performed by a licensed stylist, these treatments use a combination of chemical straighteners and a flatiron to straighten and smooth the hair. Results last approximately 3 months, depending on the rate of an individual’s hair growth.
The primary concern with this procedure is that it uses formaldehyde in the treatment process. Even treatments that are advertised as “formaldehyde free” have been found to contain as much as 10 percent formaldehyde in the solution. During the heating process, the formaldehyde is released as a gas, which can then be inhaled by both the stylist and the client. For years, stylists have reported that the application of these hair treatments can cause difficulty breathing, eye irritation, and nosebleeds.
Formaldehyde is a colorless, water-soluble gas that has a pungent odor (but this may not always be detectable if levels are low). Short-term exposure to formaldehyde often causes symptoms that mimic signs of allergies, hay fever, upper respiratory infections, colds, or viruses. When formaldehyde is present in the air at levels exceeding 0.1 parts of formaldehyde per million parts of air, some people may experience:
Watery, itchy, or burning (irritated) eyes
Runny nose (or nosebleeds)
Long term exposure to formaldehyde has been linked to asthma, bronchitis, an increased risk for blood and lymphatic cancers, and impaired brain function. Formaldehyde has also been shown to reduce thyroid function, and can trigger an autoimmune response, leading to Hashimoto’s or Graves’ disease.
In 2011, the U.S. Department of Health and Human Services added formaldehyde as a known human carcinogen (agents, substances, mixtures, or exposures in our environment that pose a health hazard) to its Report on Carcinogens.
The Occupational Safety and Health Administration (OSHA) has issued a hazard alert for salon employees warning against the use of hair straighteners containing formaldehyde. Other countries (most notably, Canada, France, Ireland, and Australia) have recalled hair-smoothing products containing formaldehyde, based on their own testing results. However, these products are still on the market in the United States.
You can read more about the dangers of formaldehyde exposure in my full article on the topic, but I encourage you to do your research and avoid any salons that use keratin straightening treatments, to avoid exposure.
We all want smooth, shiny hair, right? I know all too well what it is like to deal with hair loss, as well as dry, lifeless hair, as a result of Hashimoto’s. Fortunately, there is a lot that you can do on a lifestyle and nutritional level to restore the lustre of your hair.
Adjust your thyroid medicationand optimize your thyroid hormone levels – When TSH levels are on the outskirts of the normal range, hair loss, as well as a lack of lustre and shine, can occur. If your hair tangles easily, this is a sign that you may not be producing and absorbing enough thyroid hormone.
Look for nutrient depletions – Nutrient depletions are often at the root cause of thyroid-related hair loss, and also cause hair to be dry and lack shine. Iron, biotin, zinc, biosil, and gelatin/collagen can all help boost hair growth and health.
Adjust your diet – Blood sugar swings, a lack of healthy fats, and too few green vegetables can all have a negative impact on hair health. To address these issues, stabilize your blood sugar levels by limiting carbohydrates, add plenty of coconut oil and grass-fed meat to your diet, and enjoy a daily green smoothie — you’ll be amazed at the impact these interventions can have on your hair!
Styling Tools and Products
Though the result will only last until the next time you wash your hair, heat styling tools, such as blow dryers and flatirons, can result in hair that is as smooth and straight as a keratin treatment, when used with the proper styling products. The key is to properly nourish your hair with moisturizing shampoos, conditioners and leave-in treatments that don’t contain toxic ingredients, which can cause hair to become dry and damaged over time.
My favorite hair products that give my hair shine and lustre are:
Before using your heat styling tools, be sure to use a protectant product that shields the hair shaft, in order to minimize heat damage and boost shine. While most commercial heat protectants are formulated with harmful silicons, natural oils act on the hair in much the same way by creating a protective barrier around the hair cuticle. Grapeseed oil, almond oil, and shea butter all work well for this purpose and have the added benefits of adding moisture and shine to your hair. All you need to do is smooth a few drops through your hair before using your heat styling tools. Bonus — you can find all of these oils at your local grocery or drug store!
Whether we’re trying to cover up a few grays, lighten our locks for summertime, or make a bold statement with a whole new look, most of us have experimented with hair dye at one point in our lives. In fact, a 2008 study conducted by Clairol found that 75 percent of American women dye their hair!
Hair dyeing is by no means a new beauty trend. In fact, women have been coloring their hair since the ancient Gauls used lye to lighten their strands, and the Egyptians used henna to brighten theirs. Even as late as the 1940s, hair dye was known to contain ingredients that were questionable to a person’s health, and safety fears kept large numbers of women from coloring their hair. However, with the advent of the first home hair dye kits in the 1950s, hair dye became suddenly accessible and, presumably, safe for the average woman. The number of women coloring their hair on a regular basis has since exploded.
Though we’ve moved past the days of using lye and raw bleach on our hair, there are still a number of potentially harmful ingredients that are found in many of the hair dyes on the market today. This is true of both at-home and in-salon dyes.
One of the most problematic ingredients is a chemical called resorcinol. Most commonly found in hair dyes, resorcinol can also be lurking in shampoos, facial peels, and products used to treat acne and other skin conditions.
Health concerns associated with resorcinol include skin and eye irritation, as well as organ system toxicity. It is also an endocrine-disrupting chemical (EDC), and has been shown to interfere with thyroid function by inhibiting the enzymes involved in thyroid hormone synthesis and the activation of thyroid hormone receptors.
Resorcinol is restricted in all cosmetics in Japan, and the EU limits concentrations and requires warning labels. The United States regulates the exposure to resorcinol for workers in certain manufacturing fields, as well as in coal processing (it is a byproduct of coal manufacturing), but not for salon workers.
To avoid this chemical, look for the following ingredients on your product labels: resorcinol, 1,3-benzenediol, resorcin, 1,3-dihydroxybenzene (m-hydroxybenze, m-dihydroxyphenol).
While many of the hair dyes on the market are filled with potentially harmful ingredients, there are a number of options that are both safe and effective.
Radico makes organic colors without harsh chemicals, and tests all of their dyes for heavy metals. They are made from natural ingredients without the use of any synthetic chemicals.
Hairprint restores grey hair to its natural color without the use of dyes. Rather, it deposits eumelanin into the hair shaft, which is a variation of the melanin pigment that is responsible for the color of your skin and eyes. All ingredients are non-toxic and food grade. Though this product only works on brown and black hair, it is perfect for those with chemical sensitivities.
The website Made Safe is a wonderful resource for finding products that are safe for your health. You can find out more about the ingredients to avoid, and search for products that have been certified by their strict vetting process.
Breasts can symbolize different things to different people — beauty, femininity, motherhood, sexual desirability — and, for at least as long as we have had a written history, women have sought to enhance their breasts for many reasons.
Early attempts at enhancing breasts experimented with everything from injecting liquid paraffin into breasts and implanting glass balls, to transferring fat from the buttocks. However, none of these methods resulted in success until the early 1960s, when two plastic surgeons developed the first silicone breast implants, and an industry was born.
Almost as soon as the new silicone breast implants came on the market, women started experiencing a host of complications, including infections, inflammation, and capsular contracture (when a foreign substance is inserted into the body and the body reacts by trying to wall it off by forming a capsule of scar tissue around it). Other complications reported included hair loss, fatigue, loss of sight and hearing, and weight loss.
Even saline implants, which came on the market in the 1990s as a safer alternative to silicone, produced the same initial complications that women experienced with silicone implants: infection, inflammation, rupture, and capsular contraction.
There is a heated debate in the medical community about whether or not breast implants can cause systemic illness, rather than just localized symptoms. However, the number of people who have reported illness reaches into the thousands.
Silicone Immune Disease occurs when silicone leaks outside the shell of the implant. Both the silicone itself, as well as any number of the many chemicals used in the manufacturing process, can make their way into the different systems of the body over a period of years. This can cause symptoms that include fatigue, muscle aches, and brain fog, along with diagnoses of arthritis, chronic fatigue syndrome and fibromyalgia. Since it is well known that exposure to toxic chemicals can result in autoimmune disease, it should be no surprise that when the chemicals present in breast implants leak into the body, an autoimmune disease can result.
Saline Implant Disease, which manifests in women with saline implants, is brought on by biotoxicity, rather than chemical toxicity. Mold and fungus have been found to be present in both the saline fluid, as well as on the valve of the implant itself. These biotoxins can breed in the breast tissue, causing severe muscle and nerve pain in the affected side of the body. But, it can also be released into the rest of the body and cause major disruptions to the endocrine, immune, and neurological systems.
Symptoms of biotoxicity include fatigue, weight gain, constipation, hair loss, dry skin, a deficiency in thyroid hormones, low body temperature, dizziness, weakness, lowered sex drive, menstrual irregularities, sleep disturbances, chronic pain, and leaky gut.
Both the chemical toxicity in silicone implants and the biotoxicity often present in saline implants can trigger an autoimmune reaction in the body that can result in illness, including Hashimoto’s thyroiditis. Those that have a genetic susceptibility to autoimmune diseases will be at particular risk for developing symptoms after being exposed to the toxins present in breast implants.
At this time, the most promising alternative to saline or silicone breast implants is fat grafting. This procedure uses liposuction to remove fat from one area of the body (often the buttocks) and inject it into the breast tissue. Though there are limits to the breast size that can be achieved with this method, the results are more natural looking than implants. There is also no risk of allergic reaction, as the procedure uses your own body tissue to fill the breasts.
Drawbacks to this type of breast enhancement include the risk of calcification (hardening of tissue) in the areas of fat injections, and lumps or nodules in the areas of fat removal. The procedure is also more expensive than traditional breast implants, and finding a skilled surgeon can be more challenging. However, with so much scrutiny around the safety of silicone and saline implant devices, fat grafts seem to be becoming a more and more popular alternative.
In the early days when my son was first born and I had to pump to stimulate my milk supply, I came across breast pumps for the purposes of breast enlargement. There are a few different devices on the market that are designed to use suction to naturally expand the breast tissue, without surgery or the implantation of foreign material into the body. While this sounds like a winning solution, there is not a lot of research around the effectiveness of these devices, and results vary greatly from person to person.
Breast enhancement pumps work as suction cups — the dome covers the breast, forming a seal. Then the air is sucked out of the space inside the dome, via the pump. This creates suction on the breast, which physically pulls the breast tissue towards the dome. Stretching a tissue stimulates the cells to increase their division rate, deposit more connective tissue between the cells, and expand in the direction in which they were stretched. This concept is called stretch-induced tissue expansion, and is used in a number of medical applications.
Though studies have shown that these types of devices can produce breast enlargement, there are a number of drawbacks to them. They can be time consuming and cumbersome to use. Though most of the manufacturers recommend using them for 15-30 minutes a day, one study found that participants had to use the device for 10 to 12 hours a day for at least 10 weeks to notice measurable results. For those that do achieve results, breast growth is modest: the average person only sees a maximum increase of one half to one cup size.
That said, this might be a safe and affordable alternative to surgery for those who are looking to boost their breast size. The most popular breast pump devices on the market are:
BRAVA – This electric breast pump is perhaps the most well-known. It was introduced in the late 1990s after a clinical evaluation of it showed promising results. However, at $2,000, the BRAVA is expensive and can be hard to find these days. If you are considering fat grafting, some surgeons do recommend the use of this device in the weeks preceding the procedure, to enhance results.
Noogleberry – This hand-pump is an affordable alternative that retails at around $60-80. The company claims that this device can produce results when used for only 15-30 minutes a day, over a period of six to nine months. While there haven’t been any studies to back up this claim, it may be a more accessible option for those looking for a safe and natural alternative to other breast enhancement procedures.
The anti-aging industry has exploded over the last few decades and, in 2018, was estimated to have a global net worth of 42.51 billion dollars (USD). There are no shortages of products marketed to make us want to hang onto our youth, and while some of these products are relatively harmless (I enjoy a luxurious face cream as much as the next person!), others can have negative consequences to our health.
One procedure that has become ubiquitous with anti-aging over the last few years is Botox. In this procedure, the Botox solution is injected into areas of the face, such as the forehead and eye region. Botox blocks the signals from the nerves to the muscles. With the muscle unable to contract, wrinkles will soften and relax. Results typically only last for three to six months, and the procedure does need to be repeated on a regular basis.
Botox is a brand name for the Botulinum toxin, which was approved by the FDA for cosmetic use in 2002. Since then, its injection has become one of the most common cosmetic procedures. However, there have been many concerns raised about potential side effects.
Botulinum toxins are among the most toxic poisons known to humans, with a lethal dose of approximately 1 ng per kilogram of body weight. There are seven serologically distinct types of botulinum toxins. Botulinum toxin A (used in cosmetics treatments) is the most potent serotype, with a toxicity one million-fold higher than cobra venom, and far higher than cyanide!
While there are benefits to using botulinum for specific medical purposes (for example, it can be used to address upper lid retraction issues associated with thyroid eye disease), I view botox as a toxic foreign body, and do not recommend using it for cosmetic purposes. People with Hashimoto’s need to be especially cautious about toxins, as they are usually triggers for symptoms. In fact, one study did find a possible pathogenic link between Botox and autoimmune thyroid disease.
Though the name is a little scary, the “vampire facial” is a new procedure designed to improve the appearance of the skin, without the risks associated with introducing a toxin into the body.
Also known as a PRP facial, this procedure involves microdermabrasion or microneedling (procedures involving deep exfoliation or needles, designed to generate new skin tissue), followed by an application of PRP (platelet rich plasma) to the facial skin. Essentially, a vial is taken of the patient’s own blood, and the platelets are removed from the serum portion of the blood. These platelets contain high levels of growth factors, which stimulate cell turnover when applied to the skin. This increases collagen and elastin in the skin, while also infusing the skin with antioxidants and hydration.
While it might sound a little gruesome, the procedure is actually quite safe. The only risk is a little bruising in the blood draw area. In fact, PRP is an exciting new procedure that is being used for everything from hair regrowth, to healing damaged bodily tissues. It allows the patient to avoid risky surgeries and harmful toxins. Instead of introducing foreign substances into the body, it is only the person’s own blood that is being used.
Though the procedure isn’t cheap (average costs are around $1,000), a vampire facial is a much safer alternative to Botox, and produces similar results: minimized fine lines, reduced sun damage, and an overall fresher appearance to the skin.
While there are a number of potentially harmful chemicals in many of the beauty products and procedures on the market today, it’s not necessary to forego all beauty treatments in the name of good health. As the risks of some of these procedures are becoming more widely understood, safer and effective alternatives are becoming more available.
Whether you are looking to rejuvenate your skin, brighten up your hair color, or enhance your bra size, I encourage you to put your health first, do your research, and find products and procedures that will allow you to enhance your natural beauty… while protecting your thyroid from harmful chemicals.
I often get questions from my readers about why women have higher rates of Hashimoto’s and autoimmune disease. After all, I teach that Hashimoto’s is triggered by our environment, and men and women live in the same world, right?
Most autoimmune conditions do have a higher incidence rate in women as compared to men. These conditions include systemic lupus erythematosus (SLE), Sjogren’s syndrome, primary biliary cirrhosis, rheumatoid arthritis, multiple sclerosis, and Hashimoto’s. In Hashimoto’s, between five and eight women are affected for every one man.
To compound matters, conservative estimates state that one in five women will be affected with Hashimoto’s or another thyroid disorder at some point in their lives!
In this article, I wanted to explore a very important element of women and autoimmune disease that most researchers have not figured out — I think I’ve cracked the code!
Let’s take a look at:
Theories about why women experience more thyroid disease
What triggers Hashimoto’s
How our immune system protects us
The Izabella Wentz Safety Theory
How to make our bodies feel “safe” again
Theories on Women and Autoimmunity
There are multiple theories as to why women are statistically more likely than men to develop autoimmune diseases in general, and Hashimoto’s in particular.
Theory #1: Hormones
Female hormones are thought to play a role in the development of autoimmune thyroid conditions. Pregnancy, puberty, and perimenopause (periods of major changes in female hormones) are three of the most common times in a woman’s life for the onset of thyroid disease to occur.
Sex hormones, especially estrogen and prolactin, have an important role in modulating the immune system and may impact autoimmune disease. Estrogen can also change the requirements for thyroid hormone, and this may result in an autoimmune condition, especially in the presence of nutrient deficiencies. Prolactin, released by breastfeeding women to promote milk production, may also become elevated in women with Hashimoto’s (even when they’re not breastfeeding), and has been tied to both increased thyroid antibodies and infertility.
Women have a higher risk of developing Hashimoto’s and Graves’ disease in the years following giving birth. One theory known as “fetal microchimerism” proposed that this is due to fetal cells that may remain in the mother’s thyroid gland, which can cause an immune system response. A study of women with Hashimoto’s once revealed that 50 percent of them had fetal cells in their thyroid glands. However, a 2015 study found that fetal cells in the thyroid gland postpartum were actually more common in women without autoimmune thyroid disease, and that they seemed to serve a protective role in preventing the development of Hashimoto’s and Graves’ disease. (Isn’t that sweet; it’s like our babies are trying to help mama out — even in utero!)
So, hormonal differences and pregnancy don’t fully explain the higher rates of thyroid conditions in women.
Theory #2: Personal Care Products
Another theory to explain the different rates of autoimmune disease between the sexes is the use of personal care products among women. Sadly, conventional personal care products are laced with toxins, and women use on average twelve personal care products, which amounts to 168 different chemical ingredients. Meanwhile, most men use just six products with 85 different ingredients.
The ingredients get absorbed into our skin, which is an excellent delivery system for chemicals. In fact, many topical patches and creams are used to administer pharmaceuticals and hormones directly into the bloodstream (think the Ortho Evra® birth control patch).
When products (food or drugs) are ingested, the liver usually works to make them less toxic before they enter the circulation. This is known as first pass-effect, and only a small percentage of the original product may wind up in the circulation system. By contrast, products applied to the skin bypass the liver and go directly into the circulation, potentially producing systemic effects, until they arrive at the liver and are eliminated.
Endocrine-disrupting chemicals (found in personal care products) that are applied directly to the skin can induce estrogen dominance, and thus, worsen or perpetuate autoimmunity. The same applies when using soy products that induce estrogenic activity. The use of lipstick, in particular, has been connected to the development of lupus, another autoimmune condition.
In my own case, I suffered a flare-up of Hashimoto’s from makeup I used in 2014. I have toxicity labs and a third party test to prove the source of my contamination. So, I do think the use of endocrine-disrupting chemicals plays a role in the development of autoimmunity.
But I don’t think personal care products fully explain the higher rates either.
Theory #3: Genetics
Genetics do help us understand why Hashimoto’s tends to run in families, as there is a genetic predisposition to developing the condition.
Hashimoto’s thyroiditis can occur in two varieties:
1) An organ wasting (atrophic) form associated with HLA-DR3 gene inheritance
2) An enlarged thyroid (goitrous form) through HLA-DR5 inheritance
However, in people with Hashimoto’s, only 50 percent of their identical twins presented with thyroid antibodies, meaning genes alone are not the single defining factor, and environmental triggers play a critical role. Intestinal permeability (leaky gut), as well as an environmental trigger, must also be present for the condition to present itself.
Well-established environmental triggers for developing Hashimoto’s in those who are genetically predisposed include excessive iodine intake, bacterial and viral infections, hormonal imbalances, therapy with certain types of medications, and exposure to chemicals and toxins.
The tragic Chernobyl incident is one example of a chemical-related environmental trigger. Interestingly, a 1997 study of children exposed to the nuclear fallout from the Chernobyl explosion found that 80 percent had thyroid antibodies, while only 17 percent of genetically similar children in a Ukrainian village that was at a further distance from Chernobyl, had the antibodies. These antibodies were found in boys and girls alike.
So, while genetics do play a role, clearly environmental factors are more impactful in determining who develops thyroid conditions.
So, What Triggers Hashimoto’s?
While I believe there is some merit to each of the theories above, they don’t give us the full picture of why Hashimoto’s develops in the first place.
All of these factors send a message to our body that the world we are living in is not a safe place, and that the body should go into an energy-conservation mode.
In 2014, I attended a lecture by Erica Peirson, ND, who specializes in thyroid disorders in children with Down Syndrome. She explained that more people in Ireland have Hashimoto’s because the lower metabolic rate helped them survive the potato famine of the mid-19th century.
Imagine that — thyroid disorders are advantageous in times of famine!
During a famine, it becomes crucial for us to conserve our resources.
What is the best way to conserve resources? Slow down the metabolism. That way, a person can still survive while eating fewer calories.
How do you slow down metabolism? Slow down thyroid function.
How do we slow down thyroid function? Send some inflammatory cells into the thyroid to attack it so that it doesn’t produce as much hormone.
In a way, hypothyroidism puts us in a quasi-hibernation mode so that we are more likely to retreat to our “caves,” survive on fewer calories, and conserve energy by sleeping a lot more. While I haven’t found any studies of thyroid antibodies in bears, thyroid hormone activity has been measured to be significantly lower in bears when they hibernate, as compared to when they are out and about catching fish and doing the other bear things that bears do during warm months. This mechanism helps them survive harsh winters when food and resources are scarce.
We humans have also made our own adaptations to survive difficult times.
How the Immune System Protects Us
To help our species survive, the immune system has an important job to perform: to sense our environment and to determine what is safe and what isn’t. The thyroid gland is also a part of this sensing pattern. In fact, a 2013 study found that the thyroid gland can sense danger and initiate the autoimmune response.
The innate immune response is known to be triggered when the thyroid gland becomes infected by a pathogen, like the Epstein-Barr virus, or when it is damaged by radiation or a toxin. The damage to the thyroid tissue releases molecules that call out to the immune system to help clear the pathogens and damaged cells, and begin cell repair.
These molecules are called danger (or damage)-associated molecular patterns (DAMPs). They can initiate and perpetuate an inflammatory response within a tissue or an organ, as the cells that are sent in may further damage thyroid cells. This theory explains why toxins like fluoride, or even excess iodine, which can initially damage the thyroid (especially in the presence of nutrient depletions), can contribute to an autoimmune response.
Many people know that I am a big evolution buff, and from an evolutionary perspective, it makes perfect sense to me that our immune system and thyroid gland are sending a message to our body in times that are not safe.
The Izabella Wentz Safety Theory
I developed my own theory on the development of autoimmune thyroid disease based on my work and observations with thousands of people with Hashimoto’s, a concept known as adaptive physiology, and some of the leading theories of autoimmune disease. These include the bystander effect, molecular mimicry, thyroid directed autoimmunity, and the three-legged stool of autoimmunity.
Adaptive physiology is a concept that suggests that our bodies develop chronic illness to adjust to our environment, and that the chronic illness serves a protective role.
Our bodies have evolved, or were brilliantly designed, to achieve two main goals:
1 – to help us survive
2 – to reproduce and perpetuate our species
In essence, our bodies are constantly adapting to our environment in a way that will ensure the best for us as individuals, as well as for the future of our species.
When it comes to women, we know that they carry the primary burden for bringing new life into our world. This means that women are particularly tuned into sensing the environment to make sure that the time is prime for reproduction. After all, pregnancy is a huge stress on the body and requires greater resources. In situations where resources are scarce, it’s generally easier to survive if you’re not pregnant. As infertility is often a side effect of thyroid disease, perhaps the immune system attack on the thyroid gland is an effort to help us survive.
Here’s the message our body is hearing from our immune system:
“You’re not safe here. This is not a good time to reproduce. I’m going to help you get through the tough winter by slowing down your metabolism. This will allow you to hold on to more weight to keep you fed when food is scarce. I’m also going to make you cold and tired so you don’t venture out of your cave… because that will keep you safe.”
Back when we were cave women, one of our main sources of stress was a lack of food. When we ate things that we were not adapted to digest, had deficiencies in nutrients, or didn’t eat at all due to a shortage of food available in our area, our actions sent a message to our bodies that we needed to conserve resources and reduce calorie burning.
In modern days, we can send the same signal to our body by eating things that are considered food today but would not be recognized as food by cavewomen (digestive difficulty), eating a processed diet lacking in essential nutrients (nutrient deficiencies), and being on a calorie-restricted diet (food is scarce).
For example, humans are not able to eat most grasses in their natural state due to not having the ability to ruminate (chew and digest food more than once). However, modern agriculture has found a way to process grasses (like wheat) to make them “edible” for humans. Of course, I use the word “edible” loosely; even with all of this processing, research is finding that there are still components of these foods that are highly indigestible to humans. Most notably is the protein gluten found in wheat.
Women’s Safety in Modern Society
In addition to food “shortages,” my Safety Theory also accounts for other situations where women are less safe than men, and therefore experience higher rates of thyroid conditions. One reason is that, simply, it is safer to be a man than it is to be a woman.
Women are more likely to be physically, emotionally, and sexually abused compared to men, and abuse sends a signal to our bodies that we are not safe. Multiple studies have confirmed that thyroid hormone alterations are present in people who have been abused:
In 2000, Stein and Barrett-Connor found that past sexual assault was associated with an increased risk of breast cancer, arthritis, and thyroid disease.
A 2005 study found that altered thyroid activity was found in women with post-traumatic stress disorder (PTSD) associated with childhood sexual abuse.
Two studies found alterations in thyroid hormone levels in women who were sexually abused and had co-occurring menstrual-related mood disorders.
Higher rates of Hashimoto’s were found in victims of child abuse, and researchers concluded that: “Severe childhood-trauma-related stress may promote lasting altered thyroid levels.”
Battered person syndrome (previously called “battered woman syndrome”) is experienced by people who are victims of physical, emotional, and sexual abuse. Health complaints like asthma (an autoimmune disorder) and fibromyalgia (often connected to Hashimoto’s and other thyroid antibodies) are very commonly reported symptoms of this syndrome.
Some PTSD studies have found that people who have undergone traumatic stress events may have alterations in their thyroid hormone release patterns. Some may show higher levels of T3/T4, while others may show lower levels of T4.
A 1999 study by Wang and Mason reported that former prisoners of war (POWs) with evidence of combat-related PTSD show decreased levels of free and total T3. These levels of thyroid hormone may be reflective of the ex-POWs’ reports of “shutting down” or “stonewalling” (refusing to communicate or cooperate), which were behaviors that were more life-preserving compared to a fight-or-flight response that may have put their lives in danger.
It may be easy for people to recognize physical abuse, but emotional abuse may also be a factor in feeling unsafe. Even “social defeat situations,” such as being picked on by “mean girls,” can cause a person to feel unsafe in their environment. In cavewoman times, if you were rejected by society, your chances of survival were reduced.
Can Hashimoto’s Help Us Survive?
While it may be hard to think of Hashimoto’s as a desirable condition, I do believe that it developed as a mechanism to help us survive as a species. Here are some of the ways it does this:
Hashimoto’s makes us want to sleep and withdraw, be less fertile, and carry more weight, which increases our chances of survival.
Hypothyroidism makes us less fertile, lowers our libido, and makes us potentially less attractive to potential partners and those who threaten us (i.e. our abusers). (This manifests as hair loss, weight gain, dull skin, and pheromone changes.)
The anxiety experienced due to thyroid cell breakdown may make a person more hyper-vigilant to potential dangers.
Mental health professionals who work with people who are overweight report that those who have been physically abused may inadvertently go on to form a protective barrier around themselves. A person who was abused or felt vulnerable may feel “protected” by the excess weight.
Being tired, depressed, apathetic, and withdrawn means that we are more likely to stay inside and sleep to conserve energy; and we are less likely to be out in the world where we could be attacked and/or exposed to toxins.
If our trigger is a stealth infection, thyroid disease makes us withdraw to help us focus on healing the infection. This also prevents the spread of the infection to others.
During postpartum, when prolactin is elevated (in addition to thyroid antibodies), our likelihood of becoming pregnant again is lowered. This ensures that we are conserving resources for ourselves and our newborn.
If you have thyroid disease, thank your body for having this genius design that has helped you survive.
How to Tell Your Body That You Are Safe
The good news is that there are many things you can do to make your body feel safe again so that you can emerge from your “cave” and feel better.
Wouldn’t it be great if we could just tell our immune system to stop attacking our thyroid gland and our body, and that we are actually relatively safe in this unsafe world? However, rather than repeating mantras and telling yourself that you are safe (though I always love those), the key is to communicate to your body in a language that it will understand.
In simple terms, you must eliminate the things that make your immune system believe that you need to conserve your body and resources.
In my work, I’ve found that there is often a combination of triggers that has fueled Hashimoto’s, and that a trigger can be anything that has the potential to stress the body or mind, upset the gut barrier, or clog up our detox pathways.
Though triggers will vary from person to person, there are a series of protocols that I have developed to get to the root cause of Hashimoto’s and allow the body to heal:
Support the liver: In this modern world, we are exposed to an unprecedented number of toxins every day. We inhale them through the air, absorb them through our skin when we use our personal care products, and ingest them through the foods we eat. We can begin the healing process by removing hidden toxins from our everyday lives, and helping our livers process out the toxins that are already in our bodies. To accomplish this, we can remove potentially triggering foods, add supportive foods to our diets, reduce our toxic exposure, and support our detox pathways. For more information, take a look at my article on the importance of supporting your liver.
Restore the adrenals: I’ve found that 90 percent of Hashimoto’s patients are dealing with at least some degree of adrenal dysfunction, which can manifest as insomnia, fatigue, dizziness, low blood sugar, anxiety, and stress, among other symptoms. We can support our stress hormones by embracing stress-reduction techniques that will help shift our bodies into a regenerative process so we can become stronger and more resilient. To do this, we need to learn how to rest, de-stress, reduce inflammation, balance blood sugar, and replenish nutrients. Visit my article on adrenal health for more information.
Balance the gut: Intestinal permeability is a factor in every case of autoimmune disease, including Hashimoto’s. By optimizing our gut health and restoring microbial balance in our intestines, we can start healing from within! To do this, we can remove reactive foods, supplement with enzymes, balance the gut flora, and nourish our gut. For more information, please see my article on the importance of gut health.
Be sure to check out my book Hashimoto’s Protocol to learn more about all the protocols I recommend to help you support safety and healing, uncover all the root causes of your symptoms, and start feeling better.
By the way, because nutrition is such a key factor in helping our bodies to heal and letting them know that we are safe in this world we are living in, I just released my own cookbook! It is full of information to help you uncover your own nutrient deficiencies, improve your digestion, and find the right diet that will allow you to thrive. The goal is to teach your body..
I’ll be honest — I’ve been a girly girl for most of my life. I started carrying around a purse when I was three, loved dressing up in fancy outfits for school dances, and used to drape myself in my mom’s and aunt’s “treasures and jewelry.” When I came to the United States at age nine, my proudest possession was my first real Barbie doll (they were hard to get in Poland), and I got my first “kid” make-up set at age ten — complete with pink lipstick and neon blue and purple eyeshadows!
My fascination with fashion trends continued throughout my teenage years. I loved reading beauty magazines and raiding the cosmetic aisles of the Walgreens where I worked as a pharmacy technician during high school, undergrad and pharmacy school.
By the time I was in my mid-twenties, I had caboodles of makeup, perfumes, lotions, hair styling products, and every other type of beauty “enhancing” potion. I had dyed my hair numerous different colors, trying to determine whether blondes, brunettes or redheads had the most fun.
After I finished pharmacy school, I dabbled in cosmetic chemistry and experimented with creating my own highly effective (read: highly chemical) antiperspirant. I developed the formulation and experimented with raw ingredients in my apartment kitchen. My fiancé, Michael, (now my husband), was in business school at the time, and even wrote up a business plan for my antiperspirant. We had a mini “Shark-Tank” moment, presenting our product in front of venture capitalists that came to the class
I never thought being a girly girl would be a detriment to my health… until I started doing research for the “Toxins” chapter of my first book, Hashimoto’s: The Root Cause. Learning about the hundreds of chemicals that we, as women, put on our bodies every day — in the name of beauty — was a huge eye-opener for me. I had many “aha!” moments when I began to realize how harmful many of those ingredients are… and what they were doing to my body.
In this article, I’d like to share a little bit more of my personal journey with beauty products, including:
How the ingredients in personal beauty products can affect our health
Common toxic ingredients to avoid
How to find safer alternatives to conventional hair, skin, and makeup products
My favorite non-toxic beauty products
The Danger Lurking in Beauty Products
We are bombarded by toxins in our environment from numerous sources every day… but often times, we overlook the toxins that we apply to our own bodies, in the name of beauty and cleanliness. This is especially important to those with Hashimoto’s, as they have an impaired ability to remove toxins from their bodies.
The Centers for Disease Control released a report in 2006 that stated that the average American has 116 out of the 148 environmental chemicals (found in water, food, soil, air, dust and consumer products) that were tested, in his or her body, at any given time. Most commercial personal products that we use every day are full of endocrine-disrupting chemicals that are toxic and wreak havoc on our hormones and health.
Women, on average, use 12 personal care and cosmetics products per day, which amounts to 168 different chemical ingredients! In contrast, men use an average of six personal care products, with an average of 85 different chemicals, on a daily basis. While it’s difficult to pinpoint the exact reasons as to why seven women develop Hashimoto’s for every one man with the condition, perhaps the use of endocrine-disrupting chemicals may play a role.
If you take a look at the average American woman’s bathroom, you will probably find close to 100 personal care products, including hairspray, nail polish, lotion, shampoo, cleansers, makeup, and perfume. Most of the chemicals in these products have not undergone safety studies to verify their nontoxicity to humans, because most cosmetic chemists only test the chemicals on themselves to see if the products make them more aesthetically appealing.
Conducting laboratory tests to assess blood levels and changes in organ or immune system function — or any other available medical tests, for that matter — are not a practice followed by the cosmetic industry. Sadly, there is very little regulation as to the safety of the products that we apply onto our bodies, and little regard for how much is absorbed through our skin and into our bodily systems.
The truth is that the skin is our largest organ, and its porous nature allows most of what it comes in contact with, to be absorbed. One study published in the American Journal of Public Health reported that 64 percent of chemicals found in drinking water were absorbed by the skin when it came into contact with the water. Some areas of the body, such as the underarms and genitalia, have been shown to have a 100 percent absorption rate, meaning that all of the chemicals that are placed on these areas are directly absorbed into the body!
Common Toxins in Beauty Products
While there are far too many chemicals present in beauty products to list them all, xenoestrogens are common components of commercial beauty products that most people use on a regular basis, and can be particularly damaging to thyroid health.
Xenoestrogens are endocrine-disrupting chemicals that mimic the effects of the sex hormone estrogen and include soy, BPA, phthalates, and parabens. The continued use and accumulation of these substances may lead to estrogen dominance and can have a profound impact on the immune system, adrenal health, and thyroid function. They can also cause birth defects, infertility, and cancers.
Here are three xenoestrogens commonly found in personal care products:
Phthalates are present in cosmetics, plastics, moisturizers, soaps, and perfumes. Implicated in cancers, endocrine disruption, diabetes, and obesity, phthalates may be listed on product packagings (e.g. as diethyl phthalate), or they may be disguised under the word “fragrance.” Check the ingredient list of your beauty products and refrain from using those that contain dibutyl phthalate (DBP). Avoid using personal care products, detergents, and cleansers that contain “fragrance” in the ingredient list, as this usually denotes phthalate ester (DEP).
Triclosan is commonly found in soaps, deodorants, hairsprays, toothpastes, and anything labeled “antibacterial.” The structure of triclosan resembles the structure of thyroid hormones and has been associated with altered levels of thyroid hormone in animals. Fortunately, triclosan has recently been banned for use in consumer products in the United States. However, this ban does not apply to hand sanitizers and wipes, and it may still be present in products manufactured in other countries, or found in older products you may still have sitting on your shelves.
Parabens are used as antimicrobial agents, and are found in body washes, shampoos, and lotions. They have been implicated in breast cancer and have been associated with causing skin reactions. Look for the ending “paraben” (as in methylparaben) in your personal care products, and choose products that do not list parabens in the ingredients.
Other ingredients to watch out for in your beauty and skincare products include triclocarban, retinyl palmitate, retinol, PEG, ceteareth, polyethylene, DMDM hydantoin, formaldehyde, formalin, toluene, dibutyl phthalate, and oxybenzone.
I know firsthand how scary some of the ingredients lurking in our beauty products can be. Back in 2014, I suffered a flare-up of Hashimoto’s from a lipgloss I had used. I have toxicity labs and a third party test to prove it. My symptoms started within 24 hours after beginning to use this particular product. It was a major turning point for me in recognizing the dangers of chemicals that were lurking in something as seemingly benign as lipgloss. To my surprise, the lipgloss had the power to bring my autoimmune condition into a full flare-up!
Now, I check every cosmetic product I use with the Environmental Working Group’s (EWG) Skin Deep® Cosmetics Database, and I encourage you to do the same. Their database features thousands of personal care products, each with its own safety rating based on dozens of toxicity and regulatory databases. You can search for various companies to see their overall rating, and also search for individual products. I try to use products with a 1 or 2 rating (lowest toxicity). The EWG even has a mobile app, so you can search while you shop.
I know that finding cosmetics that are both safe and effective can feel a little bit overwhelming, and many of you regularly send me emails and inquire on my Facebook page as to what specific low-toxin products I use. I have spent time trying a lot of different products through trial and error, so I’d like to share my favorites:
Looking at my headshots on my website or videos I’ve made, you may think that I wear makeup on a regular basis, but the truth is, I do not. Most days when I’m running around town, consulting, running my business, writing, or taking care of my family, I don’t apply anything to my face. I feel that this gives my face some breathing room, and makes applying makeup a fun treat instead of a daily chore.
That said, I recognize that I live in a world where women who wear makeup are perceived to be more professional, intelligent, and put together. I do wear makeup when I’m making public appearances, for photo shoots, and to attend formal events. When I do wear makeup, I have a lot of fun with it and like to use brands that are as clean as possible.
The entire line of make-up and skincare from Beautycounter is luxurious and highly effective!
I’ve always taken pride in my hair, but after restoring my hair loss (a symptom of Hashimoto’s), I have been particularly careful about using products that won’t be damaging to my hair or my thyroid health.
I wanted to find a shampoo that was gluten free and didn’t contain the harsh chemicals (such as sodium lauryl sulfate, polyethylene glycol, and triclosan) that are commonly found in shampoos. At the same time, I wanted to find products that smelled nice and made my hair soft and shiny like some of the commercial and high-end salon shampoos out there. I’ve tried numerous shampoos from the internet and health food stores that just didn’t quite make the cut. Some of them made my hair look like straw; others didn’t seem to wash out. I also had a brief trial with going “no poo” (using apple cider vinegar + baking soda instead of shampoo), but that experiment made my hair feel like a pile of hay on top of a grease ball.
I was really excited when I came across Acure at my local Whole Foods Market (you can also find them online through the links below). Their products are vegan and cruelty free, and are also free of gluten, parabens, sulfate, silica, sodium chloride, phthalates, and synthetic fragrances. Additionally, they are color safe, smell nice, and make my hair beautiful and shiny!
Many people with Hashimoto’s may have hair that’s naturally dry and dull (mine used to be before I stabilized my thyroid hormone levels), and for that, I love Acure Organics Moisturizing Shampoo and the Acure Organics Repair Conditioner. I use this combination when I want to give my hair an extra boost of shine, or when I want some deep conditioning. (As a bonus, it smells wonderful!)
For people with tangled hair (often a tell-tale sign of an underactive thyroid), I recommend Acure Lemongrass Leave In Conditioner and the Tangle Teezer brush. These two together did wonders for me when my hair was tangled, and I still like to keep my brush with me at all times, especially when I travel.
I have a number of favorites that I turn to for clean, hydrated skin, without the use of harsh chemicals. Here are the ones I use on a daily basis:
Body Wash: Dr. Bronner’s Shikakai Body Wash is organic, free trade, and made with natural ingredients. I love the scent and the lather. It also performs triple duty for me as a hand soap and shaving cream.
Lotions: I have always been partial to scented lotions. However, most are full of toxic synthetic fragrances. I love Acure Organics body lotions, which are free of toxins, are very moisturizing, and have a lovely smell.
Facial care: When I was first diagnosed with Hashimoto’s, I noticed that my skin became more dull and lackluster. My dermatologist recommended the Clarisonic device, which I love and use to this day. This is a little exfoliating brush that uses gentle vibrations to remove the dead surface cells on our skin. I noticed an improvement in my skin’s texture immediately.
Facial cleansers: I have liked MyChelle in the past, and also enjoy the SpaDr line. A while back, I also became obsessed with the entire Annmarie Skin Care line of moisturizers, creams, and cleansers. My favorite Annmarie products are:
Aloe Herb Facial Cleanser – This feels luxurious, and my face feels remarkably clean after I use it.
Coconut Honey Face Mask – This is a moisturizing mask that I like to use once or twice a week… partially because it makes my skin soft and dewy, partially because I like to lick it off my face. It’s made with edible ingredients like honey and coconut oil!
Herbal Facial Oil – This is a wonderful daily moisturizer, and it smells soft and lovely.
Neroli Toning Mist freshens up my face, and I sometimes use it as a light perfume.
Most perfumes have endocrine-disrupting chemicals in them, and often, we’re applying them to our neck. I like to use essential oils as a healthier alternative, blending a mix of aromas that appeal to my senses. I really enjoy the smell of frankincense, rose, and lavender, though everyone has their personal preferences.
Jodi Cohen, a Hashimoto’s patient and Nutritional Therapy Practitioner, has also created a line of essential oil blends. My favorite scent is Circadian Rhythm, and she has also created a thyroid-specific blend along with many other wonderful blends.
If you are not an oil connoisseur, you can purchase premade essential oil-based natural perfumes like the Aura Cacia Chakra Roll-ons. The “Expressive Throat” essential oil smells like my high-end department store perfumes without the added toxins! It was named after the throat chakra, which, according to Eastern medicine, is connected to the thyroid gland. The throat chakra is believed to govern our outspokenness. Wearing this reminds me to be bold about my lifestyle choices — including the choices I make to avoid “beauty” products that might be sabotaging my health!
Note: Essential oils may need to be avoided by those with chemical sensitivities, and some oils are contraindicated for women who are pregnant or nursing.
When I want to indulge in a little bit of self-care, I like to take baths with epsom salts (1-2 cups per full bath tub is all you need!) and add in some lavender essential oils or a natural bath bomb. The epsom salts are a natural source of magnesium, and aid with relaxation, detoxification, and pain relief. They also support the thyroid and adrenals. Please note, I only recommend plain epsom salts, as the ones infused with scents (and even essential oils) can cause disruptions in vaginal flora when used in large quantities.
The Rejuvelle bath bombs are a fun, fragrant treat to add to the tub. They were created by parents of a daughter with an autoimmune skin condition. They are made with..
There is a saying that I’m sure you’ve heard many times: “You are what you eat.”
And while that’s very true, I also like for people to remember: “You are what your body can digest, absorb and eliminate.” However, many people with Hashimoto’s may have issues related to these processes.
Specifically, many of my readers have diagnosed gallbladder issues, or have even had their gallbladder surgically removed, and find their ability to digest fats to be significantly impaired. These people suffer from a wide variety of symptoms, including diarrhea, nausea, belching, and stomach pain.
While you may think that the body’s inability to absorb fat sounds like a good thing weight-wise, it isn’t. We all need healthy fats in order to absorb vital fatty acids and other nutrients that our body needs. If our body isn’t able to absorb these nutrients, we should take that as a sign that there are other issues going on that are impacting us negatively as well.
I have found that difficulty with digesting fats (fat malabsorption) commonly affects 40 to 50 percent of people with Hashimoto’s. In fact, research has found links between thyroid disease, fat malabsorption and gallbladder issues.
So let’s talk about fat malabsorption, the role of the liver and gallbladder in digesting fats and eliminating toxins, and how Hashimoto’s increases your risk of having these issues.
In this article, you will learn:
How the liver and gallbladder affect one’s digestion of fats
The link between fat malabsorption, gallstone disease and Hashimoto’s
Symptoms of fat malabsorption and gallbladder issues
What to do if you don’t have a gallbladder
The Root Cause Approach to addressing fat malabsorption, and liver and gallbladder problems
The Liver and Gallbladder’s Role in Healthy Fat Digestion
First, let’s talk about how the liver and gallbladder work together (along with the pancreas) to break down fats for healthy digestion, absorption and elimination.
We know that whatever we eat eventually makes it down into the small intestine, but some people have trouble digesting the fats that we consume from the foods we eat. Such fats do not dissolve in water, and our small intestine is a very watery environment. So somehow, all of that fat needs to be broken down.
To do this, our liver produces a substance called bile. Bile from the liver is sent to the gallbladder via a passageway called the common bile duct, and then it is concentrated and stored there.
When we eat a fatty meal, the concentrated bile is released from the gallbladder through the common bile duct, then heads to the initial part of the small intestine (called the duodenum). There, the bile begins to breakdown the fats into tiny globules.
At the same time, the neighboring pancreas organ releases its own pancreatic juices (containing digestive enzymes such as lipase and bicarbonate ions), mixing with the bile and tiny globules of fat. The pancreatic juices neutralize the digesting food (which is very acidic) and also help with protein and carbohydrate digestion.
Both bile and pancreatic secretions emulsify the fats (or lipids) so that they can be digested in the watery small intestine.
Bile acts like dish soap and works to dissolve the globs of fat (picture fats that are sometimes left in a pan soaking in your sink). In the small intestine, this allows nutrients to be more readily absorbed. (In particular, bile helps us absorb fatty acids and fat soluble vitamins such as A, D, E, and K, as they cannot be absorbed without adequate bile.) Without adequate bile, these essential nutrients can be lost and excreted with other wastes in the stool – leading to nutrient deficiencies. This is one reason why nutrient depletions are so common in people with Hashimoto’s!
After working to break down fats in the small intestine, bile is then recycled from the intestines, back to the liver, for reuse. This offloads the workload of the liver by recycling about 95 percent of the body’s bile. (This way, the liver doesn’t have to continually produce new bile.)
If the gallbladder is dysfunctional, it is likely that the liver is also dysfunctional and producing unhealthy bile. The entire process – and your bile’s health – ultimately comes down to your liver’s health. (This is why I focus on liver support as an initial step with any new client I work with!)
You can see how bile’s role in breaking down fats, and emulsifying them, is vital to our ability to digest – and absorb key nutrients from – anything fatty. This includes healthy fats, too, like fish oil or avocados.
If you’ve had your gallbladder removed, or if your gallbladder is not functioning optimally, you are not going to have the concentration of bile that you need, nor will you get some of the additional benefits you would get from a healthy bile flow.
So What Are The Additional Benefits of Bile?
Bile is thought to be antimicrobial, although the exact mechanism as to how it provides this benefit isn’t certain. It appears to stimulate the immune system in the intestines. In fact, it has been known to help prevent the bacterial overgrowth that is seen in small intestine bacterial overgrowth (SIBO), a common root cause of Hashimoto’s. (Thus, I always recommend testing for SIBO if you have issues with fat malabsorption.)
Bile is key to supporting the liver in excreting hormones and excess toxins, including cholesterol, the body’s waste products, environmental toxins, heavy metals, and other harmful substances. Since it helps remove excess estrogen, bile plays a key role in female sex hormone balance (and I’ll discuss this more in a minute).
Bile may also have a role in blood sugar metabolism. Along with fat metabolism, bile may act as a signaling molecule relating to glucose (blood sugar) metabolism, and insulin levels have been correlated with bile cholesterol saturation. Thus, bile may play an important role in maintaining blood sugar balance. There have also been a lot of studies pointing to clear associations between insulin resistance and gallstones, which can form as a result of bile issues. (I found this particularly interesting, as blood sugar issues and type 2 diabetes often co-occur with Hashimoto’s, along with gallbladder issues!)
The Link Between Fat Malabsorption, Gallstone Disease and Hashimoto’s
People with Hashimoto’s and hypothyroidism often experience fat malabsorption issues and have an increased risk for gallbladder problems, as the thyroid can affect the composition of bile and its ability to flow.
The lack of thyroxine (free T4), as seen in hypothyroidism, decreases liver cholesterol metabolism. This results in changes to the bile composition itself, which then leads to what is called a state of bile cholesterol supersaturation. This thickens the bile and impairs it by slowing its rate of flow.
Decreased bile flow impacts an important process called peristalsis, which involves wave-like muscle contractions that push food and bile through the intestines. As peristalsis is reduced, many people experience constipation, with up to 15 percent of hypothyroid patients reporting to have fewer than three bowel movements weekly.
As digestion slows down, there can also be increased bacterial growth, which can then result in diarrhea.
Furthermore, the change in bile composition and delayed flow can cause the liver’s cholesterol to crystalize, forming gallbladder stones, or gallstones (solid particles that block the common bile duct, pancreatic duct, and cause inflammation of the gallbladder).
The lack of thyroxine associated with hypothyroidism can also affect the sphincter of Oddi (layers of muscle that regulate the flow of bile into the small intestine/duodenum, which close between meals, preventing bile from continuing to flow into the small intestine when it isn’t needed). The sphincter may experience increased tension, which can prevent normal bile flow. This has been thought to contribute to the formation of common bile duct stones, as well as gallstones.
Thus, it’s not surprising that there is an increased prevalence of hypothyroidism found in patients with common bile duct stones. In fact, patients with common bile duct stones and gallstones have, respectively, 7-fold and 3-fold increases in the frequency of hypothyroidism.
Experiments with hypothyroid rats have confirmed the thyroxine effect on bile composition, decreased bile flow and relaxation of the sphincter of Oddi. Research in rats has also shown that the administration of thyroid hormone improves bile flow – suggesting that there is a strong correlation between developing gallbladder issues and hypothyroidism.
There are also indirect effects relating to bile production in those with thyroid disease.
Remember that when you have issues with bile production, you can have deficiencies in essential fat soluble vitamins such as vitamins A, E, D, and K, as well as fatty acids. Vitamin D deficiency is commonly found in people with Hashimoto’s. Some 68 percent of my readers have reported having a diagnosed vitamin D deficiency. In fact, when I know someone has been supplementing with vitamin D, but still tests as deficient, I view that as an important clue that they may have fat malabsorption issues. The lack of key vitamins and fatty acid deficiencies can cause a whole host of additional symptoms, and can further impact thyroid hormone conversion (T4 to the active T3 hormone).
Furthermore, poor bile flow can lead to a recirculation of toxins such as heavy metals and excess hormones.
As you may know, nutrient depletions and impaired detoxification pathways are often the root causes of Hashimoto’s symptoms, so it’s important to address the gallbladder and bile issues that may be at the root of these issues.
Symptoms of Fat Malabsorption Issues and Gallbladder Problems
Since gallbladder and bile impairment can contribute to fat malabsorption issues and have been linked to hypothyroidism, it is no surprise that fat malabsorption issues are relatively common with Hashimoto’s. Unfortunately, they are often overlooked by practitioners or viewed as symptoms of other common conditions. Let’s review the common signs and symptoms of fat malabsorption and gallbladder issues:
Digestive symptoms include greasy, smelly, floating, or light-colored stools; gas or belching after eating, diarrhea, stomach pain, gallbladder pain (located on the right side, under the ribs), gallstones, nausea, and weight loss. If you are not properly digesting and absorbing fats from food, you may start to experience low energy levels and increased cravings for carbs, since fats are an incredible slow-burning source of energy. People attempting a ketogenic (high fat) diet may experience nausea or any of the above symptoms and find that they are unable to comply with the high fat dietary requirements.
Non-digestive symptoms include dry hair, eczema, depression, dry itchy/flaky skin or scalp, oily scalp, dandruff, and rashes. Hormonal imbalances (including estrogen dominance) and adrenal issues may also be seen.
Symptoms related to vitamin and fatty acid deficiencies: As I already mentioned, if you’ve had fat malabsorption occurring for a while, you may start to develop symptoms of fatty acid deficiency, as well as depletions in the fat-soluble vitamins A, D, E, and K. Fatty acid deficiency symptoms may present as pain, inflammation, dry skin, oily hair, acne, or eczema. Deficiencies in the fat-soluble nutrients can lead to numerous additional symptoms, including vision problems, immune system imbalance, fragile bones, poor wound healing, easy bruising, bleeding gums, nosebleeds, dull hair, depression, skin disorders, eczema, dry and itchy/flaky skin or scalp, dandruff, oily scalp, rashes, and many other seemingly unrelated symptoms.
How to Diagnose Gallbladder Issues
There are a number of simple diagnostic tools that I use with clients. The first is just evaluating your symptoms. Your stools can tell you a lot, too! Greasy, smelly, floating, or light-colored stools can be a sign of bile issues.
I have found that many people having fat malabsorption issues also often experience low stomach acid (another common issue associated with Hashimoto’s), which makes it more difficult to digest proteins. The proteins that are often most difficult are gluten, dairy and soy. Those who have symptoms of low stomach acid and see improvement after eliminating these proteins from their diet, may have a fat malabsorption issue.
Furthermore, if you have the MTHFR gene variation or difficulties with methylation, you may already have challenges with clearing toxins from your body and may suffer from symptoms related to impaired methylation (like brain fog, anxiety, irritability and chemical sensitivities). An impaired ability to detoxify may also contribute to gallbladder issues.
Your practitioner can run some labs, such as liver function tests and/or a complete blood count (CBC) test, to check for gallbladder issues. Markers for impaired gallbladder functioning may include high bilirubin, AST, ALT, LDH, GGT, ALP, and 5’-nucleotidase. However, I find that often times, gallbladder dysfunction can be missed.
As mentioned earlier, if a person has been supplementing with vitamin D but still shows a deficiency on their labs, I always suspect fat malabsorption, so testing one’s vitamin D levels can also help with diagnosis.
A low fecal elastase test result, such as on the GI-MAP test in functional-medicine stool testing, can also indicate fat malabsorption.
If you are experiencing pain, or if your practitioner suspects gallbladder issues such as gallstones or common bile duct stones, they may use ultrasound testing or an abdominal X-ray to look for stones or other problems.
Other Risk Factors That May Point the Way to Gallstone Issues
If you are experiencing some of the above symptoms, there are other risk factors that may point to the presence of gallstones. Known risk factors for gallstone formation include:
Genetic susceptibility (can dramatically increase risk, by nearly five times)
High homocysteine levels
Metabolic syndrome (three or more symptoms of: high blood pressure, high fasting glucose, abdominal obesity, reduced HDL levels, and increased triglyceride levels)
Advanced cirrhosis, chronic hepatitis C or nonalcoholic fatty liver disease
Furthermore, female sex hormone (estrogen) changes can lead to gallbladder issues. (This is the reason why women who have not yet reached menopause are three times more likely to be at risk of having gallstones.)
Interestingly, oral contraceptive use and estrogen hormone replacement therapy have both been tied to changes in bile composition, specifically increases in cholesterol levels, which thickens the bile. This composition change is thought to contribute to the formation of gallstones. (I’ve heard of increases in incidents of estrogen dominance seen after gallbladder removals, which would make sense given that the increased levels of estrogen would not be getting eliminated without sufficient amounts of bile.)
Some women also experience cholestasis, a reduction in bile flow, in late pregnancy. This is thought to be related to changes in estrogen and progesterone hormone levels. There can be a reduction in both the normal flow of bile (along with greater cholesterol saturation), as well as in the body’s ability to clear out hormones. This sometimes results in reduced gallbladder function, as well as the formation of gallstones, although gallstones may clear during the postpartum period.
Many people are not aware that they may have a fat malabsorption or gallbladder issue, as common symptoms may mirror other conditions. Gallstones themselves may often go completely undetected. It is estimated that about 15 percent of adults in the U.S. have gallstones, with only a very small percentage (1-3 percent) experiencing gallbladder-related symptoms.
It’s important, however, to be aware of severe gallbladder issues.
A gallbladder attack (acute cholecystitis), which happens when a gallstone passes into the small intestine or becomes stuck in a bile duct, can cause a good deal of continuous pain (in the upper right side of the abdomen) and is associated with nausea and vomiting, as well as fevers. Infections may also occur. This blockage is often what inspires someone to contact their physician or visit the ER. Gallstone issues are a leading cause for hospital admissions related to gastrointestinal problems.
The convention treatment for a gallbladder attack is often gallstone surgery.
In my opinion, (and many medical professionals agree), you should not have your gallbladder removed unless the symptoms warrant it. True, a cholecystectomy (the complete removal of the gallbladder) can sometimes be unavoidable – especially if someone has been dealing with gallbladder disease for a lengthy time. However, unfortunately, the surgery is overused today, and is often called for even when a patient is experiencing only minimal – and correctable – symptoms. It is one of the most common elective abdominal surgeries performed in the U.S. today!
After this surgery, bile flows directly from the liver to the small intestine via the common bile duct, but it does not get stored and concentrated, so you can experience all of the symptoms we’ve already talked about. Having the bile flow directly into the small intestine may also affect the gut microbiome and gut function. Additionally, this surgery doesn’t necessarily stop the patient from producing another gallstone in the bile duct or liver!
The Root Cause Approach to Supporting Liver, Gallbladder and Fat Digestion
If you are experiencing symptoms associated with fat malabsorption, if you know you have a gallbladder condition such as gallstones, or if you are at an increased risk for gallbladder disease, my Root Cause Approach recommends several goals to focus on:
Supporting your liver and gallbladder health
Stimulating bile flow (quantity and motility) to support fat digestion
Dissolving gallstones or common bile duct stones
Supporting your body’s overall detoxification system
There are a number of supplements that I recommend, as well as supportive foods that you can incorporate into your diet, to help you reach these goals:
1. Rootcology’s Liver and Gallbladder Support can help support liver and gallbladder health, while also supporting fat digestion, in three different ways: it can support the liver’s ability to process fat, it can give us extra bile, and it can support a healthy bile flow (with ingredients such as dandelion, artichoke, and beets). I routinely recommend taking one capsule of this supplement with each meal, as a key component of my Liver Support Protocol!
This supplement also contains some key ingredients that help with gallbladder health:
Taurine – This amino acid is a major constituent of bile. It protects the body from both toxicity and oxidative stress, and can naturally improve bile production. It has also been found to support thyroid function: research has shown taurine may help improve thyroid function in animals exposed to environmental toxins such as lead and insecticides.
Milk Thistle – This plant contains silymarin, a compound that is considered to have hepatoprotectant effects (which means it protects liver health, in particular relating to toxins), antioxidant effects, and potential anti-inflammatory effects. It has also been shown to improve pancreatic function after exposure to toxic agents. As a bonus, it has been found to support high blood sugar levels, which are commonly seen..