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May 25th marks World Thyroid Day! This day helps bring awareness to thyroid conditions, and acknowledges those who have thyroid disease, those who study it, and the treatments that surround it. At the end of May, I’m always looking at ways to increase thyroid awareness.

Did you know? Thyroid disease is prevalent throughout the world. In fact, an estimated 20 million Americans have some form of thyroid disease. Estimates are that between 90 and 97 percent of those diagnosed with hypothyroidism in the United States actually have Hashimoto’s, which has an autoimmune component to it.

My interest in Hashimoto’s was prompted by my own diagnosis, which came when I was just 27… almost a decade after visiting doctors who said my chronic cough, IBS, anxiety, leg cramps, muscle pain, carpal tunnel, hair loss, bloating, and new food sensitivities were just part of “getting older.”

After much crying to my family and doing what I could to “cover up” my symptoms (hello blonde hair to help cover my thinning hair), I sat down and thought about my clients. They were happy, despite their challenges, and I wanted to be like that too — so I decided to be the healthiest person possible with Hashimoto’s.

I decided to take on overcoming Hashimoto’s as a personal life mission. Fast forward to today, and here I am: The Thyroid Pharmacist. I want to share the knowledge that I now have about Hashimoto’s, with the world!

In this article, you are going to become knowledgeable in many facts about Hashimoto’s and the thyroid. We’ll also cover:

  • Lab tests that everyone who displays symptoms should get
  • Why Hashimoto’s is commonly misdiagnosed
  • Common nutrient deficiencies that those with Hashimoto’s may have
  • Common symptoms associated with Hashimoto’s
Top 10 Facts About Hashimoto’s

My readers are constantly astonished about new facts that they learn regarding Hashimoto’s, so I’ve compiled a list of the top 10 to share with you today. Many facts that you are going to read below are based on the insights shared by over 2,000 of my clients and readers, whom I surveyed back in 2015. (You can read about that survey here.)

1. If you take Synthroid/levothyroxine or have hypothyroidism, low thyroid levels, or sluggish thyroid, you likely have Hashimoto’s.

Hashimoto’s and hypothyroidism are NOT always the same. While Hashimoto’s is the leading cause of hypothyroidism, there is a difference between Hashimoto’s and hypothyroidism. A person can have one, and not the other.

Most cases of pure hypothyroidism can be remedied by taking thyroid hormones. However, as 97 percent of cases of hypothyroidism are due to advanced Hashimoto’s, the Hashimoto’s and the autoimmune attack will remain, even when proper levels of thyroid hormone are restored with medications (unless we find and treat the root cause).

The definition of hypothyroid is a thyroid that doesn’t produce enough thyroid hormone for the body, usually evident by a high TSH and/or low Free T4 and Free T3. Some doctor’s refer to that as a “sluggish” thyroid.

Hypothyroidism is a clinical state, associated with a lack of thyroid hormone, that can occur as a result of different factors, such as iodine deficiency, surgical removal of the thyroid, radioactive iodine treatment, not taking enough thyroid hormone, taking thyroid suppressing medications, or damage to the thyroid from an infection, an accident or a condition like Hashimoto’s.

Hashimoto’s is a progressive autoimmune condition that involves the body attacking its own thyroid gland, eventually leading to hypothyroidism. A person in the early stages of Hashimoto’s may not yet have hypothyroidism, just the attack on the thyroid gland. This autoimmune attack on the thyroid can cause symptoms, be triggered by various factors, and be responsive to lifestyle changes. I’ll discuss this further below.

The autoimmune attack on the thyroid develops decades before a person becomes hypothyroid, so catching the condition early allows us to prevent its progression. One may suffer from symptoms of Hashimoto’s for years before they are finally diagnosed with hypothyroidism and given thyroid medications.

Some common symptoms of Hashimoto’s include: anxiety, depression, weight gain, mood swings, fatigue, brain fog, cold hands and feet, and gastrointestinal issues.

Another common symptom is having multiple food sensitivities, especially to gluten, dairy and soy, which may not show up on a standard blood test, but can manifest as delayed symptoms after consuming these foods. (You can read more about food sensitivities and Hashimoto’s here.)

Hashimoto’s symptoms can be a spectrum: some people feel just fine, yet others may feel debilitated by their symptoms.

Some common symptoms of Hashimoto’s, based off of hypothyroidism, include:

  • Loss of eyebrow hair
  • Puffy face
  • Enlarged thyroid (goiter)
  • Slow heartbeat
  • Constipation
  • Weight gain
  • Brittle nails
  • Cold intolerance
  • Depression
  • Dry skin
  • Fatigue
  • Muscle aches

At the other end of the spectrum, when our body is in a hyperthyroid state, symptoms include:

  • Hair loss
  • Bulging eyes
  • Enlarged thyroid (goiter)
  • Sweating
  • Rapid heartbeat
  • Weight loss
  • Frequent bowel movements
  • Soft nails
  • Difficulty sleeping
  • Irritability
  • Heat intolerance
  • Nervousness

As you can see in the graphic below, one may experience symptoms of both hypo- and hyperthyroidism.

I personally experienced irritable bowel syndrome, anxiety, and advanced carpal tunnel in both hands, which required me to wear wrist braces. Despite my symptoms, however, I looked fine (except for some bloating). I had hair on my head (despite losing much of it) and I didn’t need crutches (although I experienced leg and muscle pain). When I came home from work, all I could do was eat, watch TV, and fall asleep on the couch. I was living proof that thyroid symptoms may affect someone, even though they may look fine on the outside!

2. Hashimoto’s can affect fertility and libido.

Women with Hashimoto’s may experience fertility struggles, such as having trouble conceiving and having miscarriages. Their children may also have birth defects.

Female hormones, such as estrogen, are thought to play a role in the development of autoimmune thyroid conditions. There are also three common periods of major hormonal change in a woman’s life, where the onset of the disease can occur – puberty, pregnancy, and perimenopause.

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.

Research has also shown that both women and men with thyroid disease experience a higher prevalence of low libido at some point in their lives – with some 64 percent of hypothyroid men suffering from diminished libido, along with other sexual function issues (such as erectile dysfunction, delayed ejaculation, and sperm abnormalities).

A low sex drive can also be caused by a number of co-occurring chronic health conditions, including other autoimmune diseases. For example, many women who have Polycystic Ovarian Syndrome (PCOS) have shared with me their own challenges with having a low sex drive. Read more about low libido and thyroid conditions here.

3. Misdiagnosing Hashimoto’s is more common than you think.

Many doctors don’t test for Hashimoto’s, despite having their patients present with symptoms of thyroid disease.

Many conventional doctors simply test one’s TSH (thyroid stimulating hormone) and T4 levels (the amount of thyroid hormone circulating in your blood), because these values are tested for a general diagnosis of “thyroid disease.” However, these tests don’t decipher between hypothyroidism and Hashimoto’s, and often don’t flag Hashimoto’s or hypothyroidism until a later stage.

For this reason, it’s important to have a full thyroid panel done, which includes not only TSH and T4, but also T3, TPO, and TG antibodies (whose presence can show how strong the autoimmune attack on the thyroid is).

Additionally, an ultrasound test can help to diagnose Hashimoto’s, as well as reveal what’s happening with your thyroid and see if there are any nodules present.

I’ll discuss more on how to get a proper diagnosis further on in this article.

4. Getting on the right thyroid medications can be a game-changer.

The conventional medical model treats autoimmune thyroid disorders in the same way as it would treat someone with a nutrient-deficiency-induced thyroid disorder, someone with a congenital defect of the thyroid gland, someone born without a thyroid, or someone who had their thyroid removed and treated with radioactive iodine. To treat these symptoms, synthetic thyroid hormones are often used.

The standard of care is to prescribe levothyroxine (known as T4), which can work wonders for some people’s symptoms. However, this same medication may be completely worthless for other people’s thyroid symptoms. This is because T4 is a pro-drug, and needs to be turned into the more active T3 in the body to exert most of its benefits. This conversion happens perfectly on paper and in a petri-dish, but as a pharmacist, I can tell you that it doesn’t always happen that way in the body. Some people may not convert T4 to T3 properly. This could be due to various reasons — including genetics, nutrients, co-occurring conditions, and sometimes even stress.

Of the readers I’ve surveyed, up to 59 percent have felt better taking a combination T4/T3 medication, while up to 43 percent have felt better on a synthetic T4 medication. While 69 percent saw an improvement in their thyroid lab results with the T4-only medication Synthroid® (69 percent), improvements to mood and overall energy were reported in 63 percent of people, after switching to a T3/T4 combination medication like Nature-Throid®.

Furthermore, those that switched to Tirosint® (a gluten and dairy free synthetic T4 hormone medication, free from harmful fillers) experienced a 68 percent improvement in labs. Fifty percent saw an improvement in mood, 62 percent saw an improvement in their energy levels, and 32 percent, an improvement in hair loss.

Natural Dessicated Thyroid (NDT), is another T4/T3 medication option. This is also sometimes called Desiccated Thyroid Extract (DTE). These medications are derived from the thyroid gland of pigs and are considered to be bio-identical hormones.

NDT medications also contain the thyroid hormones T1 and T2, which may have some physiological activity as well. Many patients who did not feel well on conventional treatments have reported feeling much better after switching to an NDT medication like Armour®, Nature-Throid® or WP Thyroid®. (Note: While Armour does not have any gluten-containing ingredients, it is not tested for gluten content, and as such, is not “certified gluten free.”)

When surveying my readers, I discovered that 59 percent did feel better after switching to Armour®, 57 percent felt better on Nature-Throid®, and 32 percent reported improvement with WP Thyroid®.

You can read more about thyroid medication options in this article.

5. Your doctor’s lab reference ranges may be outdated.

The TSH level considered “normal” has been skewed for years. Researchers have shown that, when scientists first determined the reference range for thyroid hormones, they looked at people within the “normal” reference range who were actually hypothyroid, or had naturally higher TSH levels due to being elderly. This caused the normal reference range to be inflated, where a TSH of up to 10 μIU/mL was considered normal. (As a side note, when my TSH was at 4.5 μIU/mL, I felt like a sloth.)

Functional medicine practitioners have further defined that normal reference ranges should be between 1 to 2 μIU/mL, for a healthy person not taking thyroid medications. Anecdotally, I’ve found that most patients feel best with a TSH between 0.5-2 μIU/mL.

Thus, the goal is to have your thyroid medications help your labs fall into the optimal reference ranges (as noted in the graphic below).

(Although there is an updated range, many conventional doctors have been slow to join in. This is why I encourage you to work with a functional medicine doctor who will treat you, and not just your labs.)

When your thyroid labs are optimal, you may see a reduction in your symptoms.

However, everyone is unique, so the most important thing is that you feel well. If your TSH range is slightly out of the optimal range, but you are feeling better than ever, then I wouldn’t focus so much on that number on your labs. What matters is the absence of symptoms.

6. Hashimoto’s can be reversed!

Once diagnosed with Hashimoto’s, most people are told that they will be fine as long as they take their synthetic thyroid hormone medication. However, patients don’t get an explanation as to why they have Hashimoto’s, what the autoimmune disease means for their future, and what actions they can do to support their thyroid and autoimmune disease… other than take medication. Most doctors dismiss autoimmune conditions as the result of certain genes and believe that once present, they cannot be reversed. However, leading researcher, Dr. Fasano, has proven otherwise. He has uncovered the three-legged stool of autoimmunity.

According to his research, there are three factors that need to be present for an autoimmune condition to develop:

  • A genetic predisposition.
  • An external trigger.
  • Intestinal permeability, also known as leaky gut (a condition that involves “holes” in the intestinal lining, which allows toxins and food particles to pass through and further damage our gut).

Dr. Fasano found that, upon removing the intestinal permeability and/or trigger, an autoimmune condition will go into remission. For this reason, I believe in addressing the root causes of Hashimoto’s symptoms to reverse the condition. (And yes, remission is possible with Hashimoto’s!)

7. Many people share common underlying root causes of thyroid disease.

Beyond optimizing thyroid hormones, those who have Hashimoto’s often share these similar root causes:

Food sensitivities – The most common food sensitivities found in people with Hashimoto’s are gluten, dairy, soy, grains (corn, in particular), nightshades (potatoes, tomatoes, and peppers), nuts, and seeds.

When someone is first setting out to change their diet, I always recommend removing 100 percent of gluten, dairy and soy.

In surveying my readers and clients, I’ve found that about 93 percent have felt better on a gluten free diet. Another 75 percent reported feeling better on a dairy free diet, 73 percent felt better grain free, and another 60 percent said they felt better soy free. Egg and nightshade free diets were helpful 40 percent and 35 percent of the time, respectively.

Nutrient depletions – Micronutrient deficiencies are common in people with Hashimoto’s. It could be due to lack of sufficient thyroid hormones, as it makes nutrient extraction from food more difficult and less efficient.

Nutrient deficiencies can also occur as a result of eating nutrient-poor foods, following a calorie-restricted diet, having inflammation from infections or food sensitivities, taking certain medications, or having an imbalance of gut bacteria.

These nutrient deficiencies contribute to the development of Hashimoto’s as well as many of its symptoms. Restoring one’s nutrient levels through nutrient-dense foods, supplementation, and optimizing digestion are some of the fastest ways to feel better with Hashimoto’s and begin to restore the body!

Impaired stress response – Stress affects so many different bodily functions, including metabolism, hormone production, immune system regulation, and emotional response.

Thyroid function is also decreased when in a stressful situation. The body wants to preserve energy to deal with whatever issue is at hand — whether you are being chased by a bear or stuck in traffic — the adrenal glands cannot decipher what is happening when in a “fight or flight” response, so it reacts the same way. “Fight or flight” mode can save us from danger and help us tackle the challenging situations in life. However, problems arise when this type of stress is ongoing and the body is constantly suppressing thyroid function to preserve its resources.

Additionally, high or low cortisol levels, caused by chronic stress to the adrenal glands, can cause hypoglycemia (low blood sugar) and hyperglycemia (high blood sugar). If left unmanaged, these blood sugar imbalances can lead to hypothyroid symptoms. An increase in cortisol will also disrupt the balance of the HPT (hypothalamic-pituitary-thyroid) axis, which the body relies on to keep thyroid levels steady.

Toxins – It is challenging to escape toxins from our environment because they are literally everywhere — cosmetics, skin products, pesticides, exhaust fumes — we can’t escape them! Whatever we inhale, ingest, and absorb into our skin eventually ends up circulating in our body. In fact, in 2006, the Centers for Disease Control reported that the average American has 116 out of 148 commonly used synthetic compounds in their body!

We are frequently exposed to xenoestrogens (found in BPA, soy, phthalates, parabens, etc.) which may increase TSH and perpetuate the autoimmune attack on the thyroid; and triclosan (found in antibacterial soap, toothpaste, deodorant, hair spray, etc.) which has a structure that resembles that of thyroid hormones and has recently been banned by the FDA due to thyroid toxicity.

Some other forms of toxins, are halogens (bromide, chloride, and fluoride), which can compete with receptor sites in the thyroid gland and build up in our thyroid tissue, leading to inflammation and thyroid cell death, as they are structurally similar to iodine.

Fluoride, in particular, can wreak havoc on the thyroid and is included in an array of products — bottled beverages, toothpaste, black and red tea, canned foods, certain medications, and even our drinking (tap) water! Fluoride was actually used to treat hyperthyroidism up until the 1950s, as it is an effective thyroid suppressor at daily doses of 0.9 to 4.2 mg. However, studies confirm that most adults in fluoridated communities ingest between 1.6 and 6.6 mg of fluoride a day, effectively suppressing their thyroid function.

Bacterial, fungal and parasitic Infections – Chronic infections (such as small intestinal overgrowth or SIBO, Blastocystis hominis, Candida overgrowth, and H.pylori) are the triggers of Hashimoto’s that get the least amount of attention, yet identifying and treating them can result in complete remission. There are protocols designed to eradicate them. In 2015, 80 percent of my clients who hit a plateau with nutrition and took the gut tests I recommended, tested positive for at least one gut infection. (Read more..

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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 Problem

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
  • Sore throat
  • Runny nose (or nosebleeds)
  • Cough
  • Headaches
  • Nausea
  • Dizziness
  • Skin irritation

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.

Safer Alternatives

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 medication and 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!

Hair Dye

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.

The Problem

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).

Safer Alternatives

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.

Breast Implants

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.

The Problem

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.

You can read my full article on how breast implants can be a trigger for Hashimoto’s, as well as one reader’s incredible story of healing after removing her implants.

Safer Alternatives Fat Grafting

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.

Breast Pumps

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.
Botox

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.

The Problem

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.

Safer Alternatives

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.

The Takeaway

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.

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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.

Through my research and work with people with Hashimoto’s, I have found that a combination of nutrient depletions, food sensitivities, an impaired stress response, an impaired ability to get rid of toxins, intestinal permeability, and infections can trigger Hashimoto’s.

What do all of these things have in common?

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:

  1. 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.
  2. 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.
  3. 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.
  4. Dig deeper: Some of us will need to dig a little bit deeper to identify and address our unique triggers. This may include optimizing thyroid hormones, addressing hidden infections, and removing other toxins, such as dental amalgams or fluoride in our water sources.

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..

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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.

Another great resource with information on products that are safe for your health is the Campaign for Safe Cosmetics website.

My Safe Beauty Recommendations

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:

Make-Up

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.

Hair Care

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!

My hair tends to be on the oily side, so I mostly use the Acure Organics Clarifying Shampoo along with the Acure Organics Conditioner or the Acure Lemongrass Leave-In Conditioner.

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.

Skin Care

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.
Fragrance

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.

While I haven’t tested this personally, some of my friends and colleagues like Carrie Vitt swear by using essential oils (like frankincense, clove, myrrh, marjoram, basil, and lemongrass) to support thyroid function naturally, along with dietary and lifestyle interventions.

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.

Beauty Luxuries

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..

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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?
  1. 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.)
  2. 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).
  3. 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:

  • Obesity
  • Genetic susceptibility (can dramatically increase risk, by nearly five times)
  • High homocysteine levels
  • Insulin resistance
  • 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.

Conventional Treatments

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!

If you are thinking of having gallbladder surgery (in a nonemergency situation), I highly recommend the book Save Your Gallbladder Naturally by Sandra Cabot, as well as consulting with a functional medicine practitioner, for guidance.

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..
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Over the years of working with people with Hashimoto’s, I have learned that most people will experience pain on some level. For some, it may manifest as a chronic condition, such as migraines or joint pain. In other cases, people may experience gastrointestinal pain that comes and goes. When I was first diagnosed with Hashimoto’s in 2010, I struggled with pain in the form of body aches and stiffness, as well as carpal tunnel in both arms. To deal with the pain and get through my workday, I took NSAIDs (painkillers) every day… before eventually getting to the root cause of my thyroid condition and making diet and lifestyle changes. These interventions alleviated my pain within weeks.

As a pharmacist, I certainly understand the value of pain medication and other conventional therapies in the right context. However, I also know that getting to the root cause of why we have pain, and treating the trigger itself — often through natural methods — can be more effective at providing a long-term resolution to pain.

Each pain disorder requires a unique, comprehensive treatment plan, as pain is a complicated and multifaceted issue, with many potential root causes — and therefore, many potential treatments. For example, a person may be in pain because of an injury, migraines, a structural abnormality, nerve damage, fibromyalgia, an autoimmune process, or because of an increased sensitivity to their environment.

In this article, I would like to:

  • Explore the conventional approach to pain management
  • Discuss the Root Cause approach to addressing pain
  • Provide some effective, natural strategies for reducing pain
The Conventional Approach to Pain Management

While pain may have various root causes, and some types of pain may require physical rehabilitation and other incredibly helpful conventional treatments, the most common conventional approach to treating pain is through the use of surgery and pharmaceutical pain medications. While this is not meant to be a complete review of the conventional approach, I’ll mention some of the more common options I’ve seen as a pharmacist.

Opiates

The use of opiate medications is a constant source of controversy. On one hand, they are overused, and often lead to addiction and health problems. On the other hand, for people who are terminally ill or seriously injured, opiates are often necessary and serve an important purpose in alleviating severe pain.

Opiates work by disconnecting the pain receptors in our brain from the pain signals themselves, making us “forget” that we’re in pain. While these medications are effective “band-aids” for pain relief, they can also be habit-forming for many people. The potential side effects of opiates include sedation, dizziness, nausea, vomiting, constipation, physical dependence, and respiratory depression. Over time, people can build up a tolerance to these drugs and require increasingly large dosages to counteract pain, leading to dependance, increased side effects and even death from overdosing.

Sadly, in 2017, over 47,000 people died in the United States from drug overdoses due to opiates. In some cases, people overdose on prescription drugs, while in other cases, they may turn to street drugs due to addiction and needing a stronger drug. A dear friend from high school became addicted to opiates after a sports injury while playing college football and lost his life to a fentanyl overdose, so this subject hits close to home for me.

Despite their habit-forming potential and potential for serious side effects and even death, a growing number of people are being prescribed opiates. Interestingly, Synthroid was the number one prescribed drug in 2013 and 2014 in the United States. In 2015, Synthroid dropped to number two and was displaced by Vicodin, an opiate painkiller. As a pharmacist, the irony is not lost on me that in many cases, addressing inflammation could prevent the use of both of these medications.

NSAIDs

NSAID medications (Non-Steroidal Anti-Inflammatory Drugs) are often a first line treatment for pain disorders. They help with reducing pain and inflammation by preventing an enzyme called cyclooxygenase (COX) from creating hormone-like chemicals called prostaglandins — one of the greatest contributors to inflammation in the body. Unfortunately, they are also associated with numerous side effects, most significantly gut dysfunction, which can lead to an increased likelihood of ulcers. For short-term use, such as the occasional headache or acute injury, NSAIDs can be very helpful. However, the longer we take them, the more likely we are to suffer adverse reactions.

Most medications have their time and place. As a pharmacist who is trained in both medication therapy management and functional medicine, I believe that instead of glorifying or demonizing medications, health professionals and patients need to be educated about appropriate medication use, along with complementary therapies that can eliminate or reduce the need for medications.

Surgery

Surgical intervention is sometimes necessary in addressing pain. However, it is more likely to be used in the case of acute pain (such as a broken bone) rather than chronic pain. Oftentimes with chronic pain, the source is difficult to identify. A surgeon can’t operate if they don’t know what to “fix.” However, there are some circumstances in which the source of pain is identifiable and surgery is an option, usually as a last resort when other solutions have failed.

An example of this would be a herniated (ruptured) spinal disk that presses on the sciatic nerve and causes chronic sciatica. Surgery to remove part of the offending disk (called a discectomy) may be performed to relieve the pressure and, thereby, the source of chronic pain.

Though surgery might be the best option in certain circumstances, the risks of surgical and invasive procedures are not minor. They include permanent injury to the body, psychological stress, and time, cost, and productivity losses.

Steroids

In some cases, steroids can be used to reduce pain. Most steroids are synthetic forms of cortisone (a hormone naturally made in your adrenal glands) and include prednisone, methylprednisolone, prednisolone, dexamethasone, and hydrocortisone. These come in many forms, including pills, topical creams, and injections.

Steroids decrease inflammation by reducing the production of inflammatory chemicals in order to minimize tissue damage. This might be particularly helpful in conditions such as rheumatoid arthritis, where chronic inflammation causes painful swelling in the tissue surrounding the joints.

However, as with all medications, steroids do come with negative side effects, and these side effects increase with dosage. In other words, most of the negative consequences that come from using steroids are a result of long-term use for managing chronic pain.

These side effects include adrenal insufficiency (altered response to physical stress), steroid withdrawal syndrome (fever, fatigue, and joint pain), infection (steroids depress the immune system), gastrointestinal ulcers and bleeding, osteoporosis, weight gain, depression, insomnia, elevated blood pressure, blood sugar imbalances, cataracts and glaucoma, elevated risk of heart disease, and even bone death (aseptic necrosis).

While there are some short-term circumstances in which steroids can be very helpful, they don’t address the root cause of pain itself, and may create more health consequences down the road.

What we know is that pain medications, surgery, and other conventional approaches don’t get to the root cause of the pain condition, and thus, we need to take a comprehensive approach to reducing pain in the body.

Addressing the Root Causes of Pain

Inflammation is always a factor with Hashimoto’s, as thyroid disease itself involves inflammation of the thyroid gland. When inflammation occurs, the body’s white blood cells release chemicals into the affected tissues to protect the body from what it sees as foreign substances. In autoimmune disease, the body views part of its own body as a foreign invader and stages an attack, resulting in inflammation. In most cases of Hashimoto’s, where the body attacks its own thyroid cells, the inflammation is not limited to the thyroid gland, but can manifest anywhere in the body.

When we experience pain with Hashimoto’s, inflammation will oftentimes be at the root, and reducing inflammation in our bodies will always help reduce pain and promote healing. While NSAIDs do reduce inflammation in the short term, they won’t get to the root cause, and the pain will return.

Instead, there are several natural approaches that have been shown to be effective without the unwanted side effects. Many of these solutions will target the reason that inflammation occurred in the first place, and may eliminate pain altogether.

Nutrition

Nutrient depletions may be at the root cause of pain in some cases, and supplementing with key nutrients can be very helpful for treating pain and reducing inflammation. Common nutrient deficiencies associated with pain include:

  • Magnesium – People with Hashimoto’s are at risk for being deficient in magnesium, which can lead to a long list of symptoms, including headaches, joint pain, leg and hand cramps, and menstrual pain. In my own case, I noticed a dramatic decrease in menstrual cramps when I began taking a magnesium supplement on a daily basis.
  • Omega-3 Fatty Acids – Omega-3s are a powerful ally against pain, intestinal permeability, and most conditions associated with inflammation. Additionally, omega-3 fatty acids can help manage oxidative stress, which often goes hand-in-hand with chronic inflammation associated with Hashimoto’s. Research has even shown that compared with the over-the-counter NSAID ibuprofen, omega-3 essential fatty acids could equally reduce arthritic pain, and be a much safer alternative for long-term pain reduction.
  • B Vitamins – Various B vitamins can help with different types of pain. B12 can help neuropathic pain, when taken in high doses of 40 mg/day. Vitamin B6 or the active form, P5P, taken at a dose of 100-200 mg/day, can relieve carpal tunnel syndrome, while B1 (thiamine), at high doses of 600–1800 mg/day, can help with pain from fibromyalgia.
Dietary Triggers

In addition to addressing nutrient depletions to reduce pain associated with Hashimoto’s, many symptoms can be helped by making dietary changes. In May of 2015, I conducted a survey of my readers to find the most helpful interventions for those with Hashitmoto’s. The results showed that many people experienced a reduction in pain by finding and eliminating foods that were causing excess inflammation and contributing to leaky gut.

  • Eliminating Nightshades: In my survey, 62 percent of people reported that removing nightshade vegetables from their diet helped to reduce their pain. Nightshades include: tomatoes, potatoes, bell peppers, eggplants, tomatillos, Goji berries, and the herb ashwagandha. (Note: Even if you’re not in pain, hot, capsaicin-containing peppers have the propensity to cause leaky gut, so they too could potentially contribute to autoimmunity.) I recommend trying a nightshade free diet for two weeks, to see if that makes a difference for you.
  • Low FODMAPs Diet: In my survey, 48 percent of readers saw an improvement in pain by following the low FODMAPs diet. This diet, typically used for irritable bowel syndrome (IBS), reduces the consumption of specific fermentable carbohydrates that can contribute to intestinal distress. For more information about the low FODMAP diet, you can visit the Monash University site, and stay tuned for a new article from me about FODMAPs in the very near future!
  • Autoimmune Paleo Diet: 50 percent of people reported a reduction in pain when following the Autoimmune Paleo (AIP) diet, which removes gluten, dairy, soy, grains, nightshades, legumes, nuts, seeds, and eggs — common food sensitivities for those with Hashimoto’s.
  • Low Oxalate Diet: Oxalates are substances that are found in some foods. They are also waste products made by our bodies, and excreted through our kidneys. Studies have shown that oxalates may contribute to Hashimoto’s. Symptoms of oxalate sensitivity include joint pain, pain in the body, and pain with urination, among others. A low-oxalate diet may provide relief from pain for those who have a sensitivity.

Additional diets that were reported to reduce pain, in my May 2015 survey, include the gluten free diet (47 percent), the grain free diet (43 percent), as well as an egg free diet (40 percent).

Hidden Infections

Another factor for many in overcoming pain can be addressed by treating infections, a common root cause of Hashimoto’s. In 2015, 80 percent of my clients who hit a plateau with nutrition and took the gut tests I recommended, tested positive for at least one gut infection.

The infection I have encountered the most in people with chronic pain and migraines is Helicobacter pylori. When combined with the use of NSAIDs, this infection (most commonly known for causing ulcers) creates a double whammy risk for ulcers. Treating this gut infection helped reduce pain for 50 percent of the people I surveyed. Please see my article on H. pylori for information on how to test for and treat this infection.

Small intestinal bacterial overgrowth (SIBO) is another infection that is common in Hashimoto’s. SIBO is an overgrowth of bacteria in the small intestine that leads to a variety of gastrointestinal symptoms and is often times associated with irritable bowel syndrome (IBS). Treating it helped 51 percent of people in my survey reduce their pain.

Additional infections that I often see in people with Hashimoto’s include Candida (yeast) overgrowth, Blastocystis hominis, and reactivated Epstein-Barr virus. Testing for and treating these infections, which are at the root cause of many cases of Hashimoto’s, may eliminate the pain symptoms that result from them.

Supplements for Pain

While these don’t get to the root cause per se, they may be options that are less likely to cause side effects. In my survey, I also asked my readers to identify some of the most helpful supplements specific to reducing their pain. These were the results:

  • Turmeric – Up to 65 percent of people reported a reduction in pain by taking a curcumin or turmeric supplement. Turmeric has a long history of reducing inflammation, and curcumin (its active component) has anti-inflammatory benefits that can be helpful in down-regulating autoimmune conditions. It has been found to reduce joint inflammation in rheumatoid arthritis, and has therapeutic anti-inflammatory effects for a variety of gastrointestinal conditions, including Crohn’s disease, ulcerative colitis, and irritable bowel syndrome. Adding this spice to your cooking, or adding a curcurmin supplement to your regimen, may help relieve a variety of pain symptoms associated with Hashimoto’s.
  • Betaine with pepsin – Another 40 percent of people with Hashimoto’s reported a reduction in pain by assisting their digestion with the use of betaine with pepsin. At first, this caught me a bit off guard, but the more I thought about the mechanism of action, it made perfect sense. Betaine (also known as trimethylglycine) and pepsin (naturally occurring components of gastric juice) break down protein bonds in food, thereby aiding digestion, reducing intestinal inflammation, and even leading to reduced systemic inflammation and less pain for many people. Trimethylglycine (betaine) can also be helpful for breaking down homocysteine, which has been associated with inflammation. Furthermore, it can increase the amount of SAMe, a naturally occurring substance with mood-boosting and pain-relieving properties, within the body.
  • Wobenzym – This systemic enzyme has been shown in studies to significantly decrease the levels of both anti-TPO and anti-TG antibodies in Hashimoto’s patients. Some people have found that this led to a reduction in pain associated with their thyroid symptoms.
  • Neurotransmitterlogical Support – Additional supplements that can be helpful for pain include supplements that support the production of neurotransmitters. Some examples include the supplement GABA, which supports the production of GABA (our “chill” neurotransmitter that helps with muscle relaxation) and 5HTP, which supports serotonin production. (Low serotonin has been a long known potential target for pain relief and pharmaceutical agents, including SSRIs like Paxil.)
Pain Relief Tools and Procedures

In recent years, a few new technologies have emerged that may offer relief from pain without many of the negative side effects associated with conventional therapies. Check with your care provider to see if any of these therapies might be of benefit to you.

  • Cold Laser Therapy: Also known as Low Level Laser Therapy (LLLT), cold laser therapy utilizes specific wavelengths of light to interact with tissue, in order to help accelerate the healing process. It can be used to alleviate a variety of acute and chronic conditions, which can help eliminate pain and inflammation. Cold lasers are handheld devices that are placed over the affected area of the body by a clinician. Non-thermal light that emits from the laser passes through the layers of skin and is absorbed by the body’s cells. When our cells absorb this energy, it is theorized that damaged or injured tissue can be normalized, resulting in reduced pain and an increased rate of healing in the damaged area.
  • Platelet-rich plasma injections (PRP): This therapy utilizes a process in which blood is taken from a patient. The platelets are then removed before being reinjected into the affected site of that same patient, to accelerate the healing of injured tendons, ligaments, muscles, and joints. PRP therapy has emerged in recent years as a promising treatment for chronic pain, and has even been used post-surgery to speed up the healing process. PRP may benefit those suffering from arthritis, sciatic pain, tendonitis, carpal tunnel, and musculoskeletal pain.
Using the Healing Arts to Manage Pain

Getting to the root cause of your pain may take some time and experimentation. There are a number of holistic approaches to pain that can help you manage it while you look for your own triggers. They also provide many therapeutic benefits that make them particularly helpful when you are pursuing whole-body health.

  • Massage Therapy: Of the readers I surveyed, 62 percent found that massage helped their pain. As a bonus, 80 percent found it beneficial for mood as well. In fact, one study asked patients in an acute care hospital setting to rate their pain levels on a scale of 1 to 10, before and after receiving massage therapy. The average rating before therapy was 5.81. After therapy, it dropped to 2.33, with patients also reporting improvements in emotional well-being, relaxation, and their ability to sleep. So if you’re in pain and struggling with depression, I urge you to treat yourself to a massage — pharmacist’s order! (I love in-home massages from Zeel on-demand. Massage therapists show up at your house with a massage table! You can use my personal Zeel invite code, 9qa2, and get $25 off your first Zeel Massage!)
  • Acupuncture: Similar to massage, 61 percent of people experienced pain relief with acupuncture treatments (a form of Chinese medicine in which thin needles are inserted at specific points in the body to remove “energy blockages”). I used to have a huge needle phobia — this is one reason why I went to pharmacy school and not medical or nursing school! However, the needles used in acupuncture are extremely tiny and are barely felt by the patient. In fact, most people report acupuncture to be a relaxing and therapeutic experience. The research supports the use of acupuncture for pain relief, and it is becoming more and more common in the West as an alternative to habit-forming opiates. Results from several studies suggest that acupuncture may help ease chronic pain, such as low-back pain, neck pain, and osteoarthritis pain. It has also been shown to reduce the frequency of tension headaches and prevent migraine headaches.
  • Chiropractic Care: Many people think of chiropractic treatment as “cracking the back” or realigning the spine. However, chiropractic care can take on several different forms, and involves looking at the whole body as an interconnected series of systems that all have an impact on each other. As such, finding alignment in one area of the body may release pain and stiffness in another part of the body. While opinions on the efficacy of chiropractic care vary amongst medical professionals, there is research supporting its use as an effective tool for pain relief. One study conducted at a hospital in the United Kingdom followed 30 patients with chronic low-back pain, for eight weeks. Twelve patients received treatment with medications at a hospital pain clinic, while 18 received chiropractic care. At the end of the eight week trial, the patients who received chiropractic care reported a greater reduction in pain compared to those who had received the..
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When I was diagnosed with Hashimoto’s in 2009, I was told I had low levels of thyroid hormones (because my TSH was elevated), and that I needed to take thyroid hormone meds to replenish my thyroid hormones. At the time, I wanted to understand why my levels were low in the first place. To me, I felt like the prescription-only approach was pouring my needed hormones into a “leaky bucket.” Wouldn’t it be better to figure out why the bucket was leaking and correct that?

If you have Hashimoto’s, there is an autoimmune component causing your thyroid to be actively destroyed by the immune system. So while your thyroid function will likely benefit from some type of thyroid hormone replacement medication, that medication won’t address the “root causes” of your autoimmune disease, nor the reason why your immune system is attacking your thyroid.

Everyone’s root causes of Hashimoto’s will be different, as we all have our own unique genetics, medical histories, and lifestyles. After years of trial and error, I eventually identified my own root causes… one by one… and corrected them. As a result, I’ve been able to put Hashimoto’s and my symptoms into remission — and I want the same for you!

So today, I want to talk to you about the importance of tackling chronic health problems, such as Hashimoto’s, using a Root Cause approach — instead of today’s more commonly used, conventional “standard of care” approach.

In this article, you will gain insight into:

  • The differences between the conventional and Root Cause approaches to thyroid disease
  • Why finding your root causes is particularly important in Hashimoto’s
  • How treating the gut treats the thyroid condition
  • How you can get started as a Root Cause detective
The Conventional Standard of Care Approach

The typical doctor visit today is not the doctor visit of decades ago.

Back then, most visits to the doctor were about acute issues. Acute issues are sudden and short-lasting (ear infection, viruses, a broken leg, accidents and the like), versus the lingering and worsening path of a chronic condition. Acute issues can be addressed pretty much the same way each time, regardless of the patient. Broken leg? You set it. Ear infection? Prescribe an antibiotic. You get the idea.

In contrast, chronic conditions encompass long-term diseases such as obesity, diabetes, heart disease, lung, thyroid, and dementia/Alzheimer’s disease, and have become the leading causes of illness in the US.

Most of us seem to understand where this increase in chronic disease is coming from. The aging population is growing as life expectancy rates increase. The rates of obesity for adults – and children – have more than doubled since the 1960s (2). Portion sizes are also increasing – one of my team members was recently telling me a story about her (35 year old) wedding china, and how she couldn’t really use them anymore, as the plates were too small for today’s typical meal!

Furthermore, many of us are under chronic stress, and we are surrounded by toxins in our environment and food. The world is a different place, and our bodies are physically reacting to all of the changes around us. (There is research that shows how the thyroid can sense danger in the environment and initiate the autoimmune response!)

Now, with over 133 million Americans suffering from a chronic disease, getting evaluated and adequately treated really requires more than the typical 15 minute (acute care-centric) office visit to cover more medical history, and generally, more testing (which is often not covered by insurance).

Unfortunately, the conventional standard of care model is based on inadequate testing and restrictive treatment.

To me, it is so unfortunate that a prescription alone is typically the conventional care model’s solution for most chronic diseases. We in the medical community refer to this as a “standard of care” approach: label the disease based on a few symptoms, and provide the approved boilerplate treatment for that disease. (This is also what insurance plans will cover.) Typically, more thorough lab testing is not deemed as necessary (or covered by insurance!) once the chronic disease is diagnosed and “labeled.”

The Conventional Approach to Hashimoto’s

The conventional approach focuses in on one particular organ or function (the thyroid), versus looking at the body as an integrated whole. Here are the typical recommendations made for those with Hashimoto’s:

1. The standard of care approach to Hashimoto’s is what I consider to be a lab number, T4-centric and reactive model, practiced by most conventional doctors and endocrinologists. If a patient presents with a series of known thyroid symptoms, the standard of care approach is focused on testing for low levels of TSH (thyroid-stimulating hormone).

The issue with this for someone having Hashimoto’s is that TSH often tests as abnormal only after a lot of damage to the thyroid has already been done. There are 5 stages of disease progression in developing Hashimoto’s, and TSH doesn’t usually test as abnormal until stage 4! It is not a “preventative” test, and a person with Hashimoto’s may appear to have normal TSH levels and be told they are fine… for years.

This happened to me. Even though I was suffering from many thyroid symptoms (debilitating fatigue, joint pain, low stomach acid, hair loss, and more), my TSH test was “normal.” My condition worsened over the next decade, until I learned that thyroid antibody testing was really the appropriate “preventative” testing that I should have done much earlier. Thyroid antibodies are typically seen much sooner than an abnormal TSH level, usually as early as stage 2, but this testing doesn’t fall under the “standard of care” that a physician would routinely order for thyroid symptoms. I also subsequently learned that the TSH ranges typically used by labs today are based on outdated reference ranges!

2. If thyroid levels are deemed “abnormal”, levothyroxine (T4) is the thyroid hormone of choice prescribed to most people with Hashimoto’s.

However, often, patients are not dosed on medication appropriately because outdated and cookie-cutter lab reference ranges are used. These measure the levels of thyroid hormone in the pituitary gland, but not in the rest of the body. (Furthermore, I’ve found that many clients respond better to non-T4-centric hormone medications. Some people’s bodies don’t adequately convert T4 to T3, so they may need a combination T4/T3 medication for optimal support. (As a pharmacist, I take appropriate medication use seriously.)

This recommended “one-size-fits-all” treatment is also given to those who have had their thyroid removed, those who have a congenital defect on their thyroid gland, and those with nutrient-deficiency-induced thyroid conditions.

3. Thyroid medications are expected to address a patient’s symptoms, and patients are often told that they should begin feeling better in a few weeks. Once on this prescription-only path, a patient will likely have limited follow-up that is focused primarily on the medication’s effectiveness at improving the TSH level. (Note: this is not the same thing as addressing their autoimmune condition or focusing on improving how the patient feels!) TSH levels may improve, but the patient’s condition can worsen, as Hashimoto’s is progressive and their immune system will likely continue to attack the thyroid.

Patients who continue to be symptomatic are often referred to other specialists for additional medications to target symptoms, such as dermatologists for hair loss, or psychiatrists for depression. These symptoms are not recognized as being related to the autoimmune thyroid condition or its root causes.

4. The conventional approach is about managing the “disease” rather than offering the support and tools needed to help them fully recover. There are usually no lifestyle recommendations or attempts to find triggers for the autoimmune response against the thyroid, and one’s thyroid antibodies are rarely even tracked.

5. The conventional approach limits its focus to the particular follow up appointment and labs, monitoring the medication’s effects at each visit, instead of having a practitioner truly partnering with the patient to figure out why their bucket is leaking in the first place (and what they can do about it).

There is never a focus on making the autoimmune issue better! Instead, the condition is seen as “irreversible”, but patients are told that medication will at least supply the body with the hormone (which the thyroid is no longer able to produce on its own) that it needs.

If this is the first time you are hearing about any proactive strategies (or any other strategy besides medication) that may help address your Hashimoto’s, you might feel overwhelmed, frustrated and even angry.

But, I encourage you to feel empowered instead, as there is another approach-the Root Cause approach-which goes beyond what conventional medicine can offer. It has helped myself and many other people to feel better, and even put their Hashimoto’s into remission!

The Root Cause Approach and the Functional Medicine Model

While some of you may not have previously heard the specific terminology of “root cause” used, you may be familiar with the concept of functional medicine.

Functional medicine tries to answer the question, “Why did this person develop a particular condition?” versus “What condition do they have?”. Functional medicine practitioners also want to know what an individual can do to prevent the progression of their condition, and even how to potentially reverse the condition.

My Root Cause approach is built on functional medicine’s core principles and is patient-centered.

So back to my leaking bucket… Functional medicine practitioners would ask the question that I had been asking myself back then: “Why is your body attacking your thyroid, and how can we intervene?”

While this approach takes a lot more time (certainly more than today’s 10-15 minute, acute care-centric visit) and requires a more rigorous review of medical histories, additional lab testing, and more ongoing support, it gets results.

Why the Root Cause Approach is Important for Resolving Hashimoto’s

Many people who are diagnosed with hypothyroidism will never be tested for or told they have Hashimoto’s. They will never know – or won’t know until a lot of damage has been done – that they have an autoimmune condition that can continue to worsen even if they are given thyroid hormone replacement medication.

On the flip side, with my Root Cause approach, we look early on at thyroid antibody levels. (Thyroid antibody tests may appear abnormal for up to 10 years before the standard TSH screening test for thyroid disease tests as problematic.)

We also utilize comprehensive thyroid tests and optimal/functional ranges of thyroid hormones, instead of outdated reference ranges, to determine diagnosis and the need for thyroid hormone therapy.

We optimize thyroid hormones utilizing the T3 and T4 hormones, when necessary (only T4 is present in levothyroxine, the most commonly prescribed thyroid drug, but many people report feeling better with the addition of a T3-containing medication). As mentioned above, labs are still utilized in medication monitoring, but the person’s symptoms are a primary tool in determining treatment.

The Root Cause approach also focuses on reversing the autoimmune attack on the thyroid.

Let’s talk more about how autoimmune diseases can be reversed with the Root Cause approach — but first, it is important to understand how autoimmunity develops.

The Root Cause Approach and the Three-legged Stool of Autoimmunity

The medical community used to believe that once an autoimmune process is activated, it no longer requires ongoing exposure to its particular environmental trigger, and becomes self-sustaining. In other words, Hashimoto’s would be irreversible no matter what you did about the initial trigger.

But this has been shown to not be the case. Autoimmune issues can be reversed. The particular environmental trigger does in fact need to be continuous in order to perpetuate the autoimmune process. This means that an autoimmune condition, such as Hashimoto’s, can be stopped and reversed when the triggers are eliminated.

One example of this is celiac disease, an autoimmune condition where gluten has been identified as an environmental trigger. In most cases of classical celiac disease, all symptoms resolve when gluten is removed from the diet.

That’s how the Root Cause approach works. You identify the triggers and remove them to get better.

There has been a lot of research done on autoimmune diseases and what causes them. Dr. Alessio Fasano, director of the Center for Celiac Research and Treatment at Massachusetts General Hospital, found that three things must be present for autoimmunity to develop:

  • A genetic predisposition
  • Intestinal permeability (also known as “leaky gut”, which occurs when the intestinal barrier of the gut is damaged and allows inflammatory pathogens to enter the bloodstream)
  • Triggers (infections, food sensitivities, etc.)

All three requirements of this “three-legged stool” must be present, or a person will not develop an autoimmune disease. Based on this, by removing one of the factors of autoimmunity, we can reverse Hashimoto’s. To me, this is very empowering!

How Autoimmune Thyroid Disease Develops

While we can’t change our genes, we can definitely remove triggers (once we identify them through our root cause detective work) and heal our gut (by identifying the root causes of our leaky gut).

In order to do so, we must first understand what makes up an autoimmune attack. If we understand the steps in the autoimmune cycle, we can interrupt the cycle and stop the breakdown of our thyroid tissue.

In autoimmune disease, a person’s body recognizes normally occurring physiological processes as foreign invaders, and attacks itself. In Hashimoto’s, the thyroid is the body part that is attacked. The problem is not with our thyroid function, but rather, the function of our immune system. Here’s what happens:

  1. Thyroid cells are damaged by triggers such as food sensitivities, infections, trauma or toxins.
  2. Damaged thyroid cells send out a stress signal.
  3. Immune cells rush to “save” the thyroid from invaders.
  4. Immune cells attack the thyroid instead, so additional thyroid cell damage occurs.
  5. The body cannot continue to regenerate thyroid cells.
  6. The thyroid is no longer able to produce adequate levels of thyroid hormone.

As previously mentioned, the conventional model focuses on adding more thyroid hormone (typically just T4) in response to the lack of thyroid hormone being produced. But that doesn’t stop the leaky bucket. The immune system will continue to attack.

However, if we can break the cycle of autoimmunity by removing the two legs of the “three-legged stool” that we can change, we can fix the leaky bucket. Then we will heal.

So, let’s talk about the other two legs of the stool: intestinal permeability and triggers. Again, conventional medicine won’t typically look at these causes, nor at how addressing them can heal Hashimoto’s.

How Treating the Gut Reverses Hashimoto’s

While there is a very long list of potential triggers that can cause intestinal permeability, the most common triggers that cause leaky gut are food sensitivities, nutrient deficiencies, a deficiency in digestive enzymes, an imbalance of gut bacteria, and intestinal infections.

When I was first putting on my own Root Cause detective cap, I had so many miserable symptoms that didn’t seem related to my thyroid issues, such as acid reflux, diarrhea, joint pain, and bloating. My thyroid hormone medication wasn’t helping with these symptoms, so I kept digging for their root cause. I read the research on gluten as a significant inflammatory food for celiacs (3); as well as research which found that gluten induces intestinal permeability in individuals whether or not they had celiac disease (4). I then tested positive for food sensitivities to gluten and dairy, so I decided to try going on both a gluten and dairy free diet.

I was quite surprised when my acid reflux, irritable bowel syndrome, and stomach pains completely went away within three days! I had been taking all kinds of antacid medications, including Tums, Pepcid, and proton pump inhibitors. After removing gluten and dairy, I was able to stop taking all of my acid-suppressing medications.

In my 2015 survey of 2,232 people with Hashimoto’s, 86 percent of respondents who had gone on a gluten free diet reported improvements across their digestive symptoms. For some people, getting off of gluten completely reversed their thyroid disease and even regenerated their thyroid tissue. You can read more about gluten’s effect on intestinal permeability here.

Gluten is not the only dietary intervention that helps improve gut health and symptoms. In the same survey, 79 percent said a dairy free diet made them better. Dairy was a huge food sensitivity for me, but many other dietary interventions helped me as well. You can read more about specific food sensitivities and dietary interventions here.

Functional medicine practitioners will tell you that “food is medicine” and that the foods you eat will determine whether you will be on a healthy path or not. They – and I as a root cause detective – believe that inflammatory foods can play a key role in developing chronic disease. Inflammatory foods affect our overall gut health. The gut has the all-important job of digesting and absorbing key nutrients that keep our body – including our thyroid – functioning properly.

If the gut is out-of-balance due to infections such as SIBO or Candida, or if there is a lack of digestive enzymes, nutrient absorption can be affected. (You can read about the most common nutrient deficiencies I see in my clients with Hashimoto’s here.)

Addressing these food sensitivities, nutrient and digestive enzyme deficiencies, and intestinal infections, can help to address the leaky gut and reverse the condition. This knowledge is very exciting!

The Unique You: Why Your Health History is so Vital to Finding Your Root Cause

Changing my diet, removing food sensitivities, and addressing nutrient deficiencies were important steps in my healing journey, but they were just the beginning.

In my clinical practice, I have also often found infections to be a primary root cause for Hashimoto’s. When people don’t feel better with dietary changes, I have found that many of them – up to 80 percent of my clients – eventually test positive for one, or more, infections!

There are a number of other possible environmental triggers, too. Dental procedures, periods of stress, medications you may take, surgeries, accidents, and environmental toxin exposures… all of these can be your unique causes for your autoimmune symptoms.

Stress is another common trigger. In fact, in my 2015 survey of 2,232 readers with Hashimoto’s, 69 percent said they had experienced a period of serious stress prior to experiencing their symptoms!

Remember, triggers are one of the legs of the three-legged stool for autoimmunity. So the good news is that if you remove them, you will feel better!

But how do you identify all of your possible triggers?

That’s where thoroughly reflecting on your health history comes in. This is different from the conventional first office visit medical history checklist. (Did you ever have these diseases? – yes/no). In my Root Cause approach, the client intake form is one of the most important tools I use to help people recall, What was happening in your life right before you started to feel unwell?

Here is a sample health timeline for you to use in creating one for yourself. You can also grab a health timeline template below:

Think back as far as you can remember. Maybe you can recall that you started feeling unwell after a particular illness or dental procedure. Perhaps you went on oral contraceptives and started experiencing symptoms.

Once you’ve completed your timeline, you can put on your detective’s hat and look into addressing them, following the protocols outlined in my book Hashimoto’s Protocol.

How to Get Started as a Root Cause Detective

So how can you get started with the Root Cause approach today?

  1. Don’t let yourself get overwhelmed. I know that reflecting on your medical history may seem daunting, but it’s a great place to start identifying your possible root causes. The good news? Tackle the root causes one by one and you’ll find that many (such as removing food sensitivities) are relatively easy to try and may have pretty immediate results. Addressing one root cause or symptom may even help with another. For example, you may
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Throughout my journey to heal from Hashimoto’s, I’ve been able to eliminate all of my symptoms and get my condition into remission, using a variety of interventions. The most profound of these strategies were those that were centered around food and nutrition.

I have come to believe so strongly in the healing power of nutrition, that I’ve focused a large part of my work around teaching people which foods are most beneficial for gut healing, which nutrients are required for proper thyroid function, and which foods are commonly problematic for those with Hashimoto’s. I’ve even written my own cookbook to share my favorite recipes and strategies for using food as medicine with my readers — that’s how passionate I am about the healing potential of food!

However, eating all the organic and nutrient-dense foods in the world won’t do us any good if our bodies aren’t able to extract the nutrition we need from them. The truth is that nutrient depletions are almost always a factor in Hashimoto’s thyroiditis. In fact, I would argue that due to our current farming practices and Western diet, most healthy people have nutrient depletions, too!

Eating conventionally grown foods, taking medications and having food sensitivities can affect nutrient extraction. Gut inflammation, poor digestion, malabsorption issues, gut infections, and even hypothyroidism itself, can also influence it. For many people with Hashimoto’s, a crucial step towards healing will be addressing digestive challenges that may be preventing them from absorbing the nutrients they need.

In this article, I will explore the role nutrients play in thyroid health, including:

  • The types of nutrients our bodies need
  • How nutrients are extracted from the food we eat
  • The many causes that affect the extraction of nutrients from food
  • The most common nutrient depletions in Hashimoto’s
  • How having nutrient deficiencies could be a sign of being in “survival mode”
What Are Nutrients?

Nutrients are molecules of food that the human body uses to create energy and grow, and can be broken down into two main categories: macro- and micronutrients. While macronutrients — fats, carbohydrates and proteins — are eaten in large quantities and provide the primary energy source for our bodies, micronutrients (vitamins and minerals) are eaten in relatively small quantities. However, they provide essential nourishment and keep all of our bodily systems (like our metabolism, blood pressure, and thyroid function) functioning as they should. When we talk about nutrient deficiencies, we are usually referring to a lack of these important micronutrients.

While all micronutrients serve a purpose within our bodily functions, the vitamins A, C, D, E, K, as well as the B vitamins thiamine (B1), riboflavin (B2), niacin (B3), pantothenic acid (B5), pyridoxine (B6), biotin (B7), folate (B9), and cobalamin (B12), are all considered essential. (This means that they are required for normal bodily functions, but the body cannot produce them in sufficient quantities to meet its needs.)

Our body’s essential minerals consist of phosphorus, potassium, sulfur, sodium, chloride, magnesium, iron, zinc, copper, manganese, iodine, and selenium, molybdenum, chromium, and fluoride.

How Does the Body Extract Nutrients?

When we eat food, our bodies break down the macro and micronutrients into smaller pieces until they can be absorbed by the body. This process is referred to as “nutrient extraction.” Depending on how well the process of breaking down food is working in your body, you could be extracting and absorbing less than 10 percent, or more than 90 percent, of the foods you consume!

The digestive process, responsible for nutrient extraction, begins in our mouths, with enzymes (amylase, lysozyme, and lipase) that are released via the salivary glands to break down the foods we chew. It continues in our stomachs, where hydrochloric acid (stomach acid) and gastric enzymes further break down the food particles before they move into the small intestine.

Here, the pancreas releases enzymes, and the liver produces bile, to break down the nutrients. This is done so that the villi (tiny finger-like bristles) on the intestinal lining can grab onto any usable nutrients and drop them into the bloodstream and lymphatic system, where they can be used by the rest of the body.

If any part of this chain is not functioning well, nutrient depletions can result.

What Causes Nutrient Depletions?

Breakdowns in digestive system function are just one of several factors that can affect nutrient extraction. The way in which our food is grown, the medications we take, the foods that we’ve developed intolerances to, stress, and even hypothyroidism itself, can all inhibit our bodies’ ability to extract and absorb the nutrients it needs to function properly. Let’s discuss a few factors that can significantly affect our ability to obtain nutrients from the foods we eat.

Farming Practices

Due to modern farming practices, the commercially-grown vegetables, fruits, and grains that we are eating today have significantly lower nutritional content than they had 100 years ago. For example, nutrient data from the U.S. Department of Agriculture (USDA) shows that the calcium content of broccoli averaged 12.9 milligrams per gram of dry weight in 1950, but only 4.4 mg/g of dry weight in 2003.

Though the reasons for this may be numerous, evidence points to two primary factors for the drop in nutrient content of most conventionally-farmed foods. The first is what is called the “dilution effect.” Today, the use of fertilization, irrigation and other means to produce greater yields in industrial farming, tends to decrease the concentration of vitamins and minerals in crops. Essentially, as tomatoes get bigger, they also get more watery and less nutritious.

The other factor is a genetic change in farmed foods, where nutrients are bred out of food at the genetic level, in favor of higher-yield varieties. Greater yields lead to greater profits. However, they also result in crops with higher levels of carbohydrates that tend to favor caloric density over nutritional quality.

To ensure you’re getting the most nutritious food possible, it’s important to opt for organically-grown, non genetically-modified fruits and veggies whenever possible. (You can read more about how to shop for produce in my Health Food on a Budget article.) Existing studies show that organic fertilization practices produce crops with higher levels of ascorbic acid (vitamin C), lower levels of nitrates, and improved protein quality compared with conventionally grown crops.

While eating organically farmed fruits and vegetables offers a higher nutrient content, it is also important to address digestive issues to ensure that those nutrients are properly broken down and absorbed, so that the body can optimally utilize them.

Diet

Eating a diet rich in a diversity of whole foods is the best way to ensure that we are taking in a healthy array of nutrients. However, many people with Hashimoto’s may be on a restrictive diet and find that they are not consuming all of the nutrients their body needs.

One example would be the gluten free and Paleo diets, which work wonders for most people with thyroid conditions, as they eliminate gluten, and other foods that tend to be problematic for most people. However, eliminating grains, as these diets do, can lead to a deficiency in thiamine, which is crucial for energy production and often deficient in those with Hashimoto’s. Selenium, zinc, and iron are also commonly deficient in those on grain free diets, and often need to be supplemented.

Vegan and vegetarian diets that eliminate animal foods will usually cause depletions in vitamin B12 as well as in calcium, chromium, copper, iodine, iron, magnesium, manganese, zinc, and Omega-3. Low-fat diets put us at risk for deficiencies in fat-soluble vitamins such as A, D, E, and K, as well as Omega-3 fatty acids. High protein diets can cause depletions of vitamin B6. Lactose free diets deplete vitamin B1, vitamin D, and calcium. Low carbohydrate diets cause depletions in vitamins B2, B6, B9, calcium, magnesium, potassium, and iron.

The Standard American Diet (SAD) itself causes depletions in fat-soluble vitamins, calcium, iodine, magnesium, potassium, zinc, and omega-3. Therefore, it’s important to take a look at your diet and supplement where necessary, so that you are not missing out on any of the important nutrients that your body needs to function properly.

Medications

Many medications, used for a variety of conditions, can deplete vital nutrients from the body. For example, birth control pills can deplete selenium, zinc and the amino acid tyrosine, which are all necessary for proper thyroid function.

While short-term use of medications generally won’t cause nutrient deficiencies, long-term use can. In some cases, drugs can even reduce your body’s ability to absorb nutrients from food sources themselves.

This is the case with proton-pump inhibitors (PPIs), used to reduce acid reflux and heartburn, which can interfere with the body’s ability to absorb vitamin B12, calcium, and magnesium (which are often depleted in those with Hashimoto’s). While these drugs are often prescribed to reduce acid, it is actually a lack of stomach acid that is the problem for most people, particularly those with Hashimoto’s. Many people will be misdiagnosed and put on these acid blocking medications long term, leading to a further reduction in stomach acid, and in turn, a depletion of important vitamins and minerals.

Low Stomach Acid

Studies have found that people with Hashimoto’s and hypothyroidism often have hypochlorhydria (low stomach acid) or achlorhydria (lack of stomach acid). Inadequate stomach acid levels can limit our absorption of amino acids, iron, zinc, and other nutrients.

Symptoms of low stomach acid include: acid reflux, low B12, ferritin or iron levels, fatigue despite thyroid medications, and constipation/diarrhea.

To counteract symptoms, several supplements can be used to help digest protein-rich meals. One such supplement that I routinely recommend is Betaine HCl and Pepsin. In fact, of the readers with Hashimoto’s who took my survey, over 59 percent said they felt better taking betaine with pepsin! Betaine and pepsin are naturally occurring components of gastric juice that make nutrients and amino acids from our protein-containing foods more bioavailable (by breaking down protein bonds). Thus, boosting stomach acid levels with betaine and pepsin may allow nutrients (including protein, calcium, B12, and iron) to be fully absorbed.

Leaky Gut

Our gut lining is the largest barrier between our bodies and the outside world. It fills the vital role of letting nutrients into the body while keeping bacteria, viruses, parasites, and toxins out. When the integrity of the gut barrier is impaired, these harmful organisms and substances can “leak” into the body through “holes” in the intestines, hence the term leaky gut. (This is also known as “intestinal permeability.”)

Low stomach acid, enzyme and nutritional deficiencies, bacterial imbalances, stress, certain medications, and infections can all lead to a leaky gut. Boosting stomach acid to help the body break down food for absorption (as mentioned above) will help prevent undigested food particles from damaging the gut lining.

Furthermore, drinking bone broth, which contains collagen, gelatin and amino acids to heal the gut lining, as well as following gut healing protocols such as the one in my book, Hashimoto’s Protocol, will also help to repair damages to the gut barrier and reverse leaky gut.

When the “holes” in the intestinal walls are repaired, the body will be better able to absorb nutrients from the foods it consumes!

Food Intolerances

Food sensitivities are known as type IV delayed hypersensitivity reactions, governed by the IgG branch of the immune system. As the name implies, they do not occur right away, unlike food allergies (think peanut allergies), which occur immediately. In fact, it can take up to four days for them to manifest, and this is one of the reasons why it’s so hard for most people to correlate food sensitivities with symptoms.

The most common food sensitivities found in people with Hashimoto’s are gluten, dairy, soy, grains, nightshades (potatoes, tomatoes, and peppers), nuts, and seeds. However, a person can become intolerant to any food!

In surveying my readers and clients, I’ve found that about 93 percent have felt better on a gluten free diet. Another 75 percent reported feeling better on a dairy free diet, 73 percent felt better grain free, and another 60 percent said they felt better soy free. Egg and nightshade free diets were helpful 40 percent and 35 percent of the time, respectively.

People with Hashimoto’s are also five times more likely to be diagnosed with celiac disease, wherein they experience an autoimmune attack on their intestines with every bite of gluten. This attack destroys the villi, which are delicate, hair-like projections that cover the intestines. The villi are important, as they help the body digest and absorb nutrients from food. Recently, gluten intolerance has been described as a spectrum, with only the most severe cases being diagnosed as celiac disease.

When people continue to eat the foods they are sensitive to, it can damage their intestines, and in turn, rob them of vital nutrients. Elimination diets and food sensitivity testing can help identify the food culprits. Eliminating them (for a time, or indefinitely) will allow the gut a chance to heal.

Lack of Digestive Enzymes

Many people with Hashimoto’s have a deficiency of digestive enzymes that prevents them from breaking down the foods they eat for proper absorption. This can contribute to food sensitivities and nutrient depletions when the body is unable to break down food into small enough pieces for nutrient extraction.

Around a third of people with Hashimoto’s may have deficiencies in bile and/or pancreatic enzymes, which can lead to issues with fat absorption. Additionally, up to 80 percent of people
with Hashimoto’s may have difficulty digesting plant fibers. The digestive process demands a lot of energy, so when it requires more metabolic work than normal, it can be taxing on the body.

Utilizing easy-to-digest foods and targeted digestive enzyme supplementation can restore proper digestion and eliminate symptoms like fatigue, virtually overnight. Many people are amazed by how much more energy they have after they start taking digestive enzymes, such as Rootcology Pancreatic Enzymes Plus, with their meals. You can read more about digestive enzymes here.

Gut Bacteria Imbalance

Our bodies depend on a vast army of microbes that perform a variety of crucial functions, including protecting us against germs, breaking down food to release energy, and producing vitamins.

People with autoimmunity have been found to have lower amounts of the probiotic bacteria Lactobacillus and Bifidus, as well as higher amounts of the opportunistic E. coli and Proteus bacteria. E. coli and Proteus bacterial species are often referred to as “opportunistic pathogens” because they only become pathogenic when the opportunity is just right. If they are outnumbered by good probiotic bacteria, they behave like good citizens of the gut and may add value to one’s gut health; but in times where they outnumber the probiotics, they may start to damage the gut wall, leading to intestinal permeability. This will, in turn, lead to food sensitivities and nutrient malabsorption.

The solution? Eating fermented foods and taking a high dose probiotic can populate the intestines with enough “good bacteria” to outnumber the opportunistic ones and help restore balance to the microbiome. Addressing underlying infections like Candida overgrowth and SIBO can also lead to a healthy balance of gut bacteria that will help heal a leaky gut and allow for nutrient absorption.

Reduced Liver Function

The liver is an important organ that is responsible for a multitude of processes: it filters the blood, stores glucose for energy, produces and secretes bile for fat digestion, and is necessary for converting T4 to the active T3 hormone. It’s also our primary detoxification organ.

An accumulation of toxic buildup in the liver (caused by toxins in our environment and the foods we eat) will reduce its ability to secrete bile and digest food, leading to nutrient deficiencies, along with bile and gallstone issues that tend to be more common in Hashimoto’s.

Additionally, a liver that is overburdened may cause extreme sensitivities to foods that it cannot process, which will lead to intestinal damage and a further depletion of nutrients.

Supporting the liver by removing toxins in our food and environment, eating foods that support liver health, and adding liver support supplements, such as the Rootcology Liver Support Kit, will help the liver produce adequate bile to boost digestion and increase nutrient extraction.

Thyroid Hormones

Hypothyroidism, in itself, will lead to poor extraction of minerals and vitamins from our food sources. It can be a bit of a “chicken or the egg” scenario — which came first, hypothyroidism or nutrient depletions? The answer is… either! A lack of essential nutrients can be a triggering event for Hashimoto’s, but having a thyroid disorder can, itself, also cause a depletion of nutrients.

Thyroid hormones determine our metabolism throughout the entire body, regulating everything from temperature, to hair growth and skin turnover. As such, the digestive tract is also impacted by thyroid hormones. A lack of sufficient thyroid hormones inhibits every aspect of digestion, from enzyme production to liver function, making nutrient extraction more difficult and less efficient.

One study conducted on rats observed that the rats who were hypothyroid showed an increase in intestinal transit time (diarrhea), while the rats who were hyperthyroid showed a decrease in bowel motility (constipation). A direct correlation was found between levels of T4 (thyroid hormone) and intestinal motility, highlighting one of the ways that thyroid hormones themselves affect gut health.

It’s important to note that a bowel that is impacted (as seen with constipation) may create a physical barrier in the small intestine, blocking the absorption of nutrients. This can also disrupt healthy gut flora and cause toxins to be reabsorbed into the body, instead of eliminated. On the other hand, food that moves too quickly (as seen with diarrhea) through the digestive tract may not be fully absorbed, resulting in a loss of macro and micronutrients.

Thus, optimizing thyroid hormones may promote healthier bowel functions, which in turn will help us better absorb nutrients.

Common Nutrient Depletions in Hashimoto’s

Now that we’ve covered the top eight causes of nutrient depletions, let’s talk about the seven nutrient depletions that are most likely to affect those with Hashimoto’s. Given that the thyroid relies on these highly-specific nutrients to perform optimally, and each nutrient has its own important role, addressing such depletions is vital to reversing Hashimoto’s! Some nutrients can be supplemented safely without specific testing, while others require testing to ensure proper dosage and use.

The four thyroid supplements that are safe and helpful for most, without lab testing, are:

  • Thiamine – Also known as B1, thiamine is responsible for converting carbohydrates into energy and also helps with the digestion of proteins and fats.
  • Selenium – Selenium is an important trace element and antioxidant required for healthy thyroid hormone synthesis and metabolism.
  • Magnesium – Magnesium is necessary for more than 300 biochemical reactions in the body: it supports the immune system, maintains normal nerve and muscle function, regulates the..
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I like to call myself diet “agnostic,” as I don’t think that there is one diet that’s perfect for everyone, and I don’t have a dietary plan that I feel dogmatic about. I often joke that my ideal diet (the Spring Break 2000 diet) would largely consist of croissants, mojitos, margaritas, rosé wine, and Tiramisu cake. Unfortunately, my body has other opinions on diet!

When I began my own healing journey and started experimenting with different diet protocols, I quickly realized that nutrition had a significant effect on my ability to heal from Hashimoto’s. I learned a great deal through trial and error, but also spent a lot of time researching (you know me!) to find the best ways to reduce my symptoms through the food I was eating.

These days, I am frequently asked, “What is the best diet to heal Hashimoto’s?” Though I don’t subscribe to the “one-diet-fits-all” mindset, I have learned that most people with Hashimoto’s feel better and see a reduction of symptoms when eating in a way that is similar to the one I have developed personally, for myself. I think I’ve figured out why…

I hear from a lot of different readers who are following different diets for various personal reasons. One such diet is the vegan diet. The following question often arises: “Are vegan diets beneficial for Hashimoto’s?” Again, I believe that there is not one diet that is perfect for every individual, but I have found, through clinical and personal experience, that there are some potential concerns associated with a vegan diet that need to be considered if you are dealing with Hashimoto’s.

In this article, I’d like to address:

  • Do vegan diets work with Hashimoto’s?
  • What nutrient deficiencies need to be addressed with vegan diets?
  • How should vegans use supplements?
  • Are there precautions for transitioning to a diet that includes meat?
  • How do you know if your diet is working for you?
What Does a Vegan Diet Look Like?

Vegan, or plant-based, diets have become more popular in recent years as more of us are becoming aware of the problems with factory farming and animal mistreatment, the negative effects of large-scale farming on the environment, and the proven health benefits of adding more whole fruits and vegetables to one’s diet.

Those following a strict vegan diet will eliminate any foods that come from animals, including meat, eggs, dairy, and even honey. Vegetarians, on the other hand, eliminate meat, but will often still consume dairy and other products that are derived from animals.

A few different approaches to the vegan diet include:

  • Raw: Plant foods that aren’t cooked beyond a certain temperature, usually 118 degrees F, are consumed on a raw vegan diet. Raw foodists typically rely on dehydrated and sprouted foods to bulk up their caloric intake.
  • Raw Till 4: Raw foods are eaten until 4 p.m., after which time, cooked vegan foods are incorporated.
  • HCLF: Short for “high carb/low fat,” carbs in the form of fruits, grains, and veggies are consumed in large quantities. Fat-containing foods, such as seeds, avocados, oils, and other high-fat plant foods, are consumed in smaller quantities.
  • 80/10/10: This version of a raw HCLF vegan diet sources 80 percent of calories from carbs (mostly fruit), 10 percent from protein, and 10 percent from fat.

More recently, the term “plant-based” is being commonly used, and denotes any diet that leans heavily on plant foods, but may allow the occasional animal product to be incorporated. This term doesn’t carry quite the same political connotation as “vegan” does for some people, and allows for a little more flexibility and intuitive eating for many people.

Reported health benefits of a vegan diet include weight loss, improved kidney function, possible protection against cancer, and a reduced risk of heart disease. It’s important to note, however, that the data surrounding the health benefits of vegan diets is inconclusive, and many of the benefits will be dependent on whether a person is eating a whole foods diet versus one that is full of processed foods.

Potential Problems with a Vegan Diet for Those with Hashimoto’s

While incorporating a large amount of plant food into a person’s diet will certainly provide a multitude of health benefits for the majority of people, including increased micronutrient and fiber intake, my experience has shown me that an exclusively vegan diet is usually not the most helpful for people who are trying to heal from Hashimoto’s.

Some of the reasons that vegan and vegetarian diets may be problematic in Hashimoto’s are that they can:

  • Exacerbate blood sugar issues: Those with Hashimoto’s often experience blood sugar issues, which can be exacerbated by carbohydrate-heavy vegan and vegetarian diets.
  • Prevent the gut from healing: Non-meat protein sources such as legumes (beans), dairy, grains, soy, nuts, and sometimes seeds, may prevent the healing of a leaky gut, as these foods are often found to be reactive in Hashimoto’s and can perpetuate intestinal permeability.
  • Contribute to nutrient deficiencies that may exacerbate Hashimoto’s: Vegan diets put us at risk for deficiency for many nutrients, including vitamin A, vitamin B3, vitamin B9, vitamin B12, vitamin D, calcium, chromium, copper, iodine, iron, magnesium, carnitine, manganese, zinc and omega-3’s.
Let’s Take a Look at the Evidence

To better understand how a vegan or vegetarian diet affects Hashimoto’s, I’ve examined the available research, conducted my own research, and observed the results from working with my own clients over the years. It has led me to a few conclusions.

An often cited study by Seventh Day Adventists suggested that a vegan diet may be protective of thyroid disorders, but there were some findings in the study that led me to believe that it wasn’t the lack of meat, per se, that was beneficial.

The study, which asked 97,000 church members about their dietary habits and health conditions, reported that people who followed a vegan diet were less likely to develop hypothyroidism, compared to those following the Standard American Diet. Interestingly, those who followed a lacto-ovo (dairy and egg) vegetarian diet were more likely to develop hypothyroidism, compared to those following the Standard American Diet. Based on this and my experience with most of my clients with Hashimoto’s, I believe that it’s possible that the reduction in hypothyroidism seen in the vegan diet was due to excluding dairy and eggs — two common reactive foods in people with Hashimoto’s.

While autoimmune thyroiditis is usually associated with excess iodine, hypothyroidism can be induced by a lack of iodine. In fact, it is the leading cause of non-autoimmune hypothyroidism in the world, with over 30 million people estimated to be iodine deficient. Since vegan diets tend to be low in iodine, due to the avoidance of seafood, dairy and eggs, vegans can be at a greater risk of developing iodine deficiency-induced hypothyroidism.

One study sought to determine the correlation between children following vegan diets and their risk for developing iodine deficiency and hypothyroidism. In this study, a young child who was on a vegan diet since being weaned from breastfeeding, was assessed and found to have hypothyroidism, due to iodine deficiency. This case highlights the risk for iodine deficiency in children on a vegan diet after the discontinuation of breast and formula feeding that could lead to acquired hypothyroidism. This, and similar studies, have highlighted the rise of hypothyroidism among children in parts of the world where vegan diets are on the rise.

Those following a vegan diet may also be deficient in other key nutrients that contribute to health and are often lacking in people with Hashimoto’s. Iron is one of those nutrients — it is essential for thyroid hormone production, as it is required to convert T4 to T3, and is often deficient in people on a vegan diet.

Beef or chicken liver and shellfish are all excellent sources of heme iron, a form of iron that is easily absorbed by the body. On the other hand, iron-rich plant foods, such as spinach, contain the non-heme form of iron, which is less readily absorbed and utilized by the body. Many vegans will find it hard to absorb the required amount of iron from plant foods alone, putting them at greater risk for thyroid disease.

A study conducted in Iran looked at the effect of low iron in young women by collecting urine and serum samples of iron deficient adolescent girls. Subjects with lower iron stores had a higher ratio of T3/T4, indicating an impairment in thyroid metabolism that can lead to hypothyroidism.

The study also found that those with low iron levels had a higher concentration of reverse T3, which binds to thyroid receptors but turns them off instead of activating them, resulting in a lack of active T3 hormone to be used. (A lack of active T3 can result in hypothyroidism symptoms — you can read more about that here). The results concluded that iron deficiency may affect thyroid metabolism in adolescent girls, which may put them at greater risk for thyroid issues.

Vitamin B12 is another nutrient that is essential to health, with symptoms of deficiency that include fatigue, memory loss, heart palpitations, constipation or diarrhea, muscle weakness, and vision loss. Because B12 is primarily found in animal foods, individuals following vegetarian or vegan diets are at a high risk for developing vitamin B12 deficiency.

One study reviewed the reported B12 serum levels among individuals adhering to vegetarian diets across 40 different research studies. The B12 deficiency prevalence among infants fed a vegetarian diet reached 45 percent. The deficiency among the studied children and adolescents reached 33.3 percent, while rates of deficiency among pregnant women ranged from 17 to 39 percent, dependent on the trimester. Furthermore, up to 86.5 percent of adults and elderly individuals had a B12 deficiency.

With few exceptions, the reviewed studies documented a relatively high prevalence of B12 deficiency among vegetarians, and even higher levels among vegans.

My experience tells me that, while some vegans do experience a reduction in symptoms and reduced thyroid antibodies, those results are often explained by the elimination of eggs and dairy, which can be highly reactive for people with Hashimoto’s.

My Experience with the Vegan Diet

In my own practice, I’ve sought out success stories to find Hashimoto’s remission stories.

While the Adventist study sounded promising, and while I was able to find a great amount of information about the vegan diet helping other autoimmune conditions and diabetes, I have only been able to find one report of a person recovering from Hashimoto’s by following a vegan diet, in comparison to encountering close to a hundred Hashimoto’s remission stories based on the gluten free, Paleo, and Autoimmune Paleo diets.

Many times, I’ve found cases of vegan Hashimoto’s remission stories, only to find that, upon deeper investigation, the person continues to struggle with symptoms such as low body temperatures, depression, brittle hair, irritable bowel syndrome, dry, pale skin, and numerous other symptoms associated with Hashimoto’s or inadequate nutrition.

While I realized that my own health significantly improved with the use of nutrition, and I had a hunch that I was not the only person that could see improvements in Hashimoto’s with diet, I wasn’t fully convinced that one particular diet was the answer for every single person with the condition. When I began working with clients with Hashimoto’s, however, I noticed that most clients got better with a dietary approach that was very similar to my own. Again, not wanting to jump the gun and before I made “official” recommendations, I decided to conduct a survey of Hashimoto’s patients in 2015.

I wanted to know how many people felt better with which dietary protocol, how many people felt worse, and how many people were able to reduce their thyroid antibodies with a dietary protocol.

While I am a big believer in the patient experience, and I always recommend trusting your own body as a guide as to what is working best for you, I decided to include antibodies as an objective measure. Objective measures, such as a reduction in thyroid antibodies, are the types of evidence scientists and doctors prefer to track to determine the severity of a condition, and whether the improvements seen by patients are measurable and “real.” Generally speaking, the higher the amount of thyroid antibodies, the more aggressive the attack on the thyroid gland, so seeing a reduction in thyroid antibodies is a potential indication that the condition is becoming less aggressive.

As far as the vegan diet, 30 percent of those on a vegan diet reported that they felt better, while 28 percent on a vegan diet felt worse.

In contrast, more than 80 percent of people reported feeling better following a grain free and Paleo diet, while less than 5 percent of people reported feeling worse with these types of dietary protocols.

Notably, the vegan diet did show a reduction in thyroid antibodies in my survey (23 percent saw a reduction in thyroid antibodies), and my hypothesis is that the antibody reduction resulted from the exclusion of dairy and eggs, two common reactive foods in Hashimoto’s (each food helped about 20 percent of people see a reduction in antibodies in my survey).

In contrast, 33 percent of people reported a reduction by removing gluten, 27 percent by following the Paleo diet, and 38 percent by following the Autoimmune Paleo diet.

As far as vegan protein sources, 44 percent of people who responded to my survey reported sensitivities to grains, 41 percent to soy, 15 percent to nuts, and 7 percent to seeds.

Additionally, many of my clients, who were former vegans, have reported improved symptoms of Hashimoto’s following a transition to a Paleo diet. Based on this, I believe that animal proteins must play an important role in building back the health of people with Hashimoto’s.

Some former vegans who were suffering from debilitating fatigue, because they weren’t eating a diet compatible with their needs, have been able to get their Hashimoto’s into remission by transitioning to a Paleo-like diet, and incorporating red meat into their lifestyle.

The Red Meat Controversy

A 2014 study reported that the majority of people with Hashimoto’s present with antibodies to Neu5Gc, a protein found in mammalian meat (this includes red meat, of course). However, the study did not attempt to demonstrate whether the exclusion of mammalian meat made any difference in Hashimoto’s outcomes. Most of my clinical experience points to people actually improving with the inclusion of red meat. (However, I am fully appreciative of every person being a unique individual, and more than happy to change my recommendations given new information.)

In surveying my own readers, out of 595 people who tried to avoid red meat, 40 percent reported that avoiding red meat made them feel better, while 14 percent reported that avoiding red meat made them feel worse.

So you may be wondering, what’s in red meat?

In addition to iron, which is commonly deficient in people with Hashimoto’s and harder to absorb from veggies, carnitine is an amino acid that has been found to be deficient in people with Hashimoto’s. The richest source of carnitine comes from red meat, and supplementing with carnitine has been reported to resolve Hashimoto’s fatigue. (Keep reading for specifics.)

Strive for Balance

That said, while meats and fats are important for healing, eating them exclusively will produce an acidic environment in the body, hindering healing. Therefore, one’s diet should be balanced with plenty of nutrient-rich vegetables (a suggested ratio may be 20 percent meat, 80 percent veggies).

Additionally, vegan and raw vegan diets can be extremely helpful for cleansing and detoxifying, especially for those with persistent protein digestion issues (very common in Hashimoto’s).

A vegan diet can be followed for a few days to a few weeks and may help the body detoxify. B12 and iron or ferritin supplements should be utilized at this time, to prevent deficiencies.

Another approach may be to follow a “semi-vegan” diet or the “Morning Vegan” approach, where one eats primarily vegan foods (nuts, seeds, veggies) for breakfast and lunch but consumes a meat-based meal for dinner.

Again, I believe that eliminating foods such as eggs and dairy will provide positive results for many people with Hashimoto’s on a vegan diet and could contribute to the improvement that they feel. Likewise, a move away from the inflammatory foods of the Standard American Diet will be beneficial to most everyone.

However, from my survey results, personal experience, and working with thousands of people with Hashimoto’s over the years, I have found a way of eating that seems most beneficial for the majority of people.

Why I Recommend a Paleo-type Diet

While going gluten, dairy and soy free is something I recommend for everyone with Hashimoto’s, a lot of people will find that they further benefit from a Paleo-style diet.

The Paleo diet is effective for so many people because it removes many of the foods that cause digestive problems, such as grains and processed foods, and replaces them with nutrient-dense foods like nuts and seeds, vegetables, fruit, and eggs. Meat is also allowed, as is fish and other meat products (like organ meats). The emphasis is put on nutrient density, controlling blood sugar, and reducing inflammation.

The theory behind this way of eating is that the digestive systems of humans have not adapted to today’s farming practices or to the ingredients and chemicals in modern processed foods. It blames the rise in chronic diseases, obesity, and allergies on the agricultural revolution, which added grains and processed foods into our diet.

Different people have their own take on the Paleo diet, and some will include foods such as dairy, eggs, and peas, while others eliminate them. I don’t recommend dairy, as it is a highly reactive food for most people. Other foods you will need to evaluate on an individual basis, depending on any food sensitivities that you may have.

I have developed my own version of the Paleo diet that I call the Root Cause Paleo Diet. It specifically eliminates the foods that tend to cause the most problems for those with Hashimoto’s, while adding in nutrients that help the body heal.

The Root Cause Paleo Diet eliminates:

  • Dairy
  • Grains
  • Legumes (except green beans and pea protein)
  • Sugar
  • Seaweed (due to immune-stimulating properties and iodine)
  • Caffeine
  • Capsaicin-containing peppers (chili pepper, red chili flakes, cayenne pepper)

Foods included on the diet include:

It’s important to reiterate that, while this type of diet has proved to be beneficial to many people with Hashimoto’s, each person needs to assess their individual dietary needs and find the diet that works best for them. For many people, that will involve some level of food sensitivity testing to get to the root cause foods that are reactive for them.

How to Know if Your Diet is Working for You

The flip side to using food as a method of healing is that we sometimes become so attached to a specific diet protocol, we lose the ability to determine whether or not a diet is beneficial to us, no matter the results.

Some people may get stuck on the idea that their diet will heal all, and that if they just take out more foods, they’ll be healed. But, this isn’t always the case. While the symptoms you are experiencing could mean that you are having a reaction to certain foods, they could also mean that you have deficiencies in nutrients or digestive enzymes, or that you have other root causes like intestinal infections, toxicities or an impaired ability to handle stress.

If you are following a vegan diet (or any diet, for that matter), it’s important that you continually check in with yourself. Are your symptoms getting better or worse? List them out. Get tested for food sensitivities. How are your thyroid antibody levels? Consider making changes to your diet to see what works for YOU.

What Vegans and Former Vegans Should Consider

First, if you are motivated to be one of the rare exceptions to overcome Hashimoto’s while following a vegan diet, more power to you! I hope that this post offers some support and guidance as far as nutrient deficiencies, and I would love to publish your success story — please be in touch when you take back your..

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