After being diagnosed with Hashimoto’s in 2009, I spent a lot of time, money, and resources on trying to figure out my root cause. I eventually did uncover and resolve multiple triggers, and was able to get into remission.
My first book, Hashimoto’s: The Root Cause, was based on my research and experience on how to get my own condition into remission.
Since that book was published in 2013, I have continued to study Hashimoto’s through working with clients, connecting with readers, analyzing research, sharing knowledge and best practices with colleagues, participating in functional medicine training, and reading everything I can find on triggers and solutions for autoimmune conditions.
I’ve done unofficial outcomes research with my clients and readers (such as surveys asking them what things made them feel better/worse), as well as collated numerous functional lab tests to look for emerging patterns.
And excitedly, I have come to see many patterns within my client and reader population, which allowed me to write my second book, Hashimoto’s Protocol, that contained protocols one could follow without spending a fortune on functional medicine testing.
One of the most notorious patterns I identified back in 2015 was that 29 percent of people with Hashimoto’s who utilized the BioHealth 401H stool test had the protozoan parasite Blastocystis hominis (Blasto). I personally had this protozoa as well, and I believe that eradicating it helped me get my own Hashimoto’s into remission. At the time, I had a history of IBS, multiple food sensitivities, and chronic urticaria (chronic hives), all tied to Blasto. I suspected this parasite could be relevant for others with Hashimoto’s, as research also tied chronic hives to early stages of Hashimoto’s/thyroid abnormalities.
I started speaking about the connection our stool testing showed between Blasto and Hashimoto’s in 2014, wrote a comprehensive blog about it in 2015, and shared my findings with my Thyroid Mastermind colleagues. I was then very excited to see a case study published in 2015 on this topic describing the case of a 49-year-old man with hives and Hashimoto’s who saw a reduction in TSH and thyroid antibodies after the eradication of Blasto. [1]
Additionally, in 2020, a study was published that also ties the eradication of Blasto to improvement in Hashimoto’s, including a reduction in TSH and TPO, as well as a decrease in a particular pro-inflammatory cytokine (IL-17) thought to have a role in Hashimoto’s pathogenesis. [2]
So what do these various findings and patterns tell us? It tells us that if you have Hashimoto’s, chronic hives, IBS, and/or multiple food sensitivities, you may have Blasto as an underlying root cause… and that if you can get rid of Blasto, you may be able to get Hashimoto’s into remission (especially in the early stages before damage to the thyroid occurs).
Unfortunately, the company that offered the stool test I had been recommending (BioHealth Lab) closed a few years back, and I had to transition to using other stool tests. In 2017, I began using the GI-MAP stool test for most clients and recommending it for participants in my Hashimoto’s Self-Management Program. Between 2017 and 2019, my team and I were able to collect and analyze the data from 298 GI-MAP tests. In the last few years, I’ve also poured through additional research as well as my peers’ own findings on gut health’s impact on the expression of various conditions.
Now I want to share some of the data with my community, with the hope of identifying some new patterns common in Hashimoto’s and offering some helpful protocols to address them.
In looking over the GI-MAP data, I was surprised by some new and emerging patterns. I was also surprised that some of the patterns that have been discussed for some time (by me and other functional medicine practitioners) were actually not found to be as common as I would have expected.
In full disclosure, I will say that the study of these labs has many limitations. In an ideal situation, I would like to run multiple labs on each client and follow them over a course of time, as these labs only represent a snapshot of time. But with that said, I hope you will find the results helpful in your own root cause journey.
In this article, you will learn:
- What the GI-MAP stool test can identify
- Previously identified patterns
- New patterns and other interesting findings
What the GI-MAP Stool Test Can Identify
The Gastrointestinal Microbial Assay Plus (GI-MAP®) is a test from Diagnostic Solutions Laboratory that I frequently recommend to clients. It is a comprehensive stool-based test that addresses a wide range of microbial targets (bacteria, opportunistic organisms, viruses, parasites, fungi, and normal flora), as well as immune and digestive markers.
The test uses DNA analysis, providing information on how much DNA is present for any given pathogen. This is important, as many microbes can be present in small (“normal”) amounts without causing problems. However, when pathogens are present at higher levels, and/or there are vulnerabilities in a particular person’s defenses (a weak immune system, poor diet, antibiotic exposures, etc.) they are more likely to become pathogenic.
I will talk more about ordering and taking the GI-MAP test, and provide helpful information about interpreting the GI-MAP test results, in the second part of this article (coming soon!).
For now, we’ll focus on the 298 sample tests I mentioned earlier, and talk about the common patterns seen in Hashimoto’s.
About the Samples
These 298 tests were collected from my clients and participants in the Hashimoto’s Self-Management Program between 2017 and 2019.
Research-Identified Patterns vs. What We Found in Our Data Analysis
1. H. pylori
Helicobacter pylori bacteria are widely recognized as a trigger for both Hashimoto’s and Graves’ disease in emerging medical research.
In one study involving 146 patients with Hashimoto’s, the rate of H. pylori detection was 70 percent (and 53 percent in the control group without thyroid disease). A smaller study in Iran showed antibodies to H. pylori were found in 46.5 percent of patients with Hashimoto’s, compared to just 11 percent in the general population. [3]
In a comprehensive 2015 survey I did with 2,232 people with Hashimoto’s, 7.31 percent of respondents reported that they had been diagnosed with an H. pylori infection. Treatment for H. pylori resulted in 41 percent of respondents feeling better. Some 50 percent saw improvement in pain, 34 percent improvement in labs, 40 percent improvement in mood, and 51 percent improvement in their energy.
H. pylori infection is common enough in my clinical practice that I have developed an excellent protocol to successfully eradicate it. I think of H. pylori as a kind of “jackpot” pathogen… I actually get a bit excited when clients test positive for this, because I know that getting rid of it will help them so much!
I’ve had numerous clients and readers report that their thyroid symptoms were greatly improved after eradicating their H. pylori Infection. Most had a reduction in thyroid antibodies; some were able to stop taking thyroid meds, and a few have even gone into Hashimoto’s remission following treatment.
H. pylori infection has been implicated in ulcer development, low stomach acid, and acid reflux, leading to poor digestion and food sensitivities. Researchers found the level of TPO antibodies (thyroid antibodies) was higher in patients with Hashimoto’s who also had H. pylori, compared to those without the infection. They tested 25 people with TPO > 700 kU/L and found 72 percent to have the H. pylori infection. [4]
If your TPO antibodies are this high and you’re experiencing these types of symptoms, I strongly recommend you get tested for H. pylori.
Testing for H. pylori
Testing for H. pylori can be done through stool, blood, or breath tests. However, blood and breath tests have some limitations.
Blood tests, which test for antibodies to the infection, do not differentiate between past and current infections; they may also provide a false negative if the test is done in an early phase of the infection, because at this point the antibody levels may be too low to measure. Some conventional doctors may recommend a breath test, but this will be positive only in advanced or severe cases. I recommend the stool antigen test because it can also uncover other low-grade infections.
The GI-MAP provides a good stool antigen test for the presence of H. pylori. In addition, it focuses on the presence of virulence factors — that is, how likely a given H. pylori strain would be to cause pathology towards certain diseases. Example: There is a virulence factor called CagA (Cytotoxin-associated protein A). If CagA shows up in your sample, you face a greater risk for having an H. pylori strain associated with gastric cancer and peptic ulcers. [5]
Prevalence of H. pylori in our Test Population
The 401H test showed the H. pylori pathogen to be positive in 21 percent of samples, while the results of the GI-MAP population showed H. pylori to be present in 16 percent of samples.
Note, however, that the GI-MAP test also provides info on detections that are considered “normal” (not “positive”). On the GI-MAP test, H. pylori can be detected yet classified as “normal” if the pathogen detection level is <1.0e3 – so tests coming back with “normal” detection levels are not flagged as positive for the infection.
As I began speaking to other clinicians about this test, I learned that some treat any detected levels, albeit with more natural, gentle protocols instead of antibiotics. When looking at people who had any level of H. pylori on the GI-MAP (not just what the lab showed to be positive or above normal), it ended up being 33 percent of people of our 298 tests that had the infection present.
Treatment of H. pylori and Its Impact on Hashimoto’s
In the earlier mentioned study of 146 people, a 14-day antibiotic therapy was used with successful eradication achieved for 86 percent of patients. A significant reduction in TPO antibodies was also observed (up to 62 percent) along with a reduction in tissue inflammation. [6]
In another study, researchers in Italy identified 10 patients having both Hashimoto’s and H. Pylori. They treated half of the patients to eradicate the infection and did not treat the other half. The people treated for H. pylori saw a 50 to 78 percent reduction in TPO antibodies, as well as a reduction in symptoms. [7]
I like to use more gentle treatments such as black seed oil, DGL, mastic gum, zinc carnosine, and S. boulardii, instead of antibiotic-based treatments if possible – but in recent years, the bugger has become resistant to many conventional and natural treatments!
I also love using Rootcology HP Restore for H. pylori, as it is designed to provide comprehensive gut support. This supplement is a combination product that uses therapeutic doses of mastic gum, methylmethionine sulfonium, DGL, zinc carnosine, and vitamin C, which support a healthy microbial balance and a healthy gut lining.* I recommend taking two capsules, twice per day, between meals (at least 90 minutes after eating and 45 minutes before eating). Remember to take them 30 to 60 minutes away from thyroid medications.
If you have H. pylori, I highly recommend that you take a look at this article about Hashimoto’s and Graves’ remission after H. pylori eradication. My Gut Recovery Program helps address gut infections like H. pylori and the other imbalances I will address in this article.
2. Blastocystis hominis (Blasto)
As I mentioned earlier, the gut protozoan Blastocystis hominis is another common pathogen I see in Hashimoto’s, especially when people have chronic hives (urticaria) or gastrointestinal symptoms such as irritable bowel syndrome (IBS).
A 2014 study found that almost 25 percent of people with chronic hives also had Hashimoto’s. Another found elevated anti-TPO (30 percent) and anti-Tg (22.85 percent) antibodies in patients with chronic urticaria (compared to 5-10 percent in the general population). Having both chronic hives and the presence of thyroid antibodies (indicating autoimmune thyroid disease) has a reported prevalence between 12 and 29 percent. [8]
Studies have also found associations between Blasto and IBS, with the prevalence rate of Blasto at 13 to 31 percent of people with IBS. Thyroid disease has also been associated with the progression of IBS. [9]
In a 2015 analysis of BioHealth 401H stool test results, 35 percent of respondents indicated they had tested positive for Blasto.
One other interesting note about Blasto is that it’s much more common in people who also have the Epstein-Barr Virus (EBV), another common trigger for Hashimoto’s (which I’ll talk more about in a minute). I always test for Blasto when people have had EBV.
Prevalence of Blasto in Our Test Population
In our 2015 test data using the BioHealth 401H stool test, 29 percent had the parasite Blasto.
In the GI-MAP test, however, only 16 percent showed detection of Blasto, while eight percent showed a positive or greater than “normal” measure (<2.00e3).
I believe that the GI-MAP test may under-report the presence of Blasto, as well as other parasites, because parasites by nature may not be shed in every stool sample. [10]
For that reason, most parasitology tests require at least three separate stool samples (testing for ova and parasites x3). The GI-MAP test, however, only collects one stool sample, while the 401H test tested four samples and thus had a higher likelihood of finding parasites. One way I’ve found to potentially hack this is to add samples into the collection tube for the GI-MAP test from three separate bowel movements.
You could also do another test for parasites that collects more than a single sample, such as the Comprehensive Stool Analysis + Parasitology 3-Day test by Doctor’s Data (a self-order option to Rupa is linked; you can also order via Direct Labs) or the Comprehensive Stool Analysis by Mosaic Diagnostics, or perhaps do another stool test like the Gut Zoomer that may use additional detection methods.
Treatment of Blasto and Its Impact on Hashimoto’s
There is some disagreement about whether Blasto is pathogenic, but recent studies suggest it can have a pathogenic role in causing intestinal inflammation and chronic hives. [11]
The good news is that research has found that eradicating Blasto often leads to the remission of both chronic hives and IBS. Many of my clients have also been able to reduce their TSH and TPO antibodies by eliminating Blasto. Some have seen a reduction in food sensitivities or even a remission of Hashimoto’s. Usually, within the first month of treating Blasto, I will see at least a 100-point reduction in thyroid antibodies. In my 2015 survey, 43 percent of people felt better after being treated for parasitic infections.
While I used to recommend the protozoal/antiparasitic/antiviral drugs like Nitazoxanide (Alinia) and more aggressive protocols to treat Blasto (as some strains are resistant to the usual drug of choice, metronidazole), these days I more often recommend S. boulardii as a starting point. [12] I generally find that 1 to 2 capsules of Rootcology S. Boulardii, twice per day, for 60 days, ensures we cover two life cycles of the parasite and eradicate the infection.
Because it’s gentler and I have seen it work really well in my clinical practice for not only Blasto but for other root causes such as H. pylori, SIBO, Candida, mold, and stress, among others. S. boulardii works by increasing secretory IgA, which supports our own body’s natural defense against infections and opportunistic gut bacteria. I’ll talk more about secretory IgA later on in this article, as low levels are also a pattern found in Hashimoto’s.
I recently posted info on the Blasto-Hashimoto’s connection on Instagram, and the commenters went wild. In particular, many readers expressed their own experiences and successes with my treatment protocol using S. boulardii.
Research has confirmed the effectiveness of S. boulardii in treating Blasto. [13] In a small study with children, 250 mg of S. boulardii was used twice a day for ten days, resulting in successful eradication of 94.4 percent after 30 days. [14]
In my experience since the initial connection of Hashimoto’s with Blasto, I found that it can also contribute to skin issues, IBS, and asthma, so I always say it’s better to treat the bugger!
For additional information, more research details, and treatment protocols, please check out my Blasto article.
3. Mycobacterium avium subspecies paratuberculosis (MAP)
A Mycobacterium aviumsubspecies paratuberculosis (MAP) infection causes a disease found in cattle (called Johne’s disease). The infection may also be spread from animal to humans by foodborne and water transmission routes. [15]
Researchers believe that infections such as MAP might be a common pathogenic trigger behind multiple autoimmune and other diseases (including Hashimoto’s, rheumatoid arthritis, Crohn’s disease, type 1 diabetes, and possibly psoriasis) in genetically susceptible individuals. [16]
The infection appears to evade people’s immune systems via molecular mimicry, which causes an inability of the body to recognize itself (such as one’s own thyroid). This can allow the body’s immune system to attack the thyroid (or elsewhere) versus the infection. [17]
One case study focused on three family members with Hashimoto’s who lived on a farm with cattle, and who drank cow’s milk and ate dairy products produced on their farm. The family members were all found to have a MAP infection, and researchers believed that the bacterial agent, along with other factors (genetic predisposition, leaky gut, etc.), could have been the immunological trigger for Hashimoto’s. [18]
Another study investigated the presence of MAP in people with thyroid disorders and found high infection rates – between 32.1 and 35.1 percent. [19]
In Sardinia, researchers tested the blood of 107 Hashimoto’s patients and 100 healthy controls, and found MAP antibodies were present in 20 to 26 percent of patients with Hashimoto’s, but only four to seven percent of controls. [20]
Much of the research relating to MAP has focused on Crohn’s disease. MAP has been detected in the blood and intestinal tissue of Crohn’s disease patients, and it has been cultured in the immune cells in 50 to 100 percent of Crohn’s patients. [21]
Presence of MAP in our Test Population
In our test population of 298 stool tests, there was only one MAP infection detected, but it was not considered positive or “outside of normal” per the lab (<5.00e3).
The GI-MAP test helps identify specific microbes like MAP that might be “confusing” the immune system as just described.
However, this pathogen is notorious for being difficult to detect in humans, so I’m not confident the GI-MAP test is the best test to uncover this pathogen (even though it is what we use today).
A new test is being developed for MAP detection in support of a vaccine for Crohn’s disease; it has been in clinical trials, and looks very promising. I’m awaiting publication of the trial results and will share more information when I find out.
Treatment of MAP and Its Impact on Hashimoto’s
Treatments include antimicrobial herbal formulas, high-dose probiotics, and a diet that is conducive to a healthy microbiome (generally low-carb, low-sugar). I have seen some physicians speaking on using anti-MAP antibiotics to get Crohn’s into remission; however, I’ve also seen far more gentle ways of getting ulcerative colitis and Crohn’s into remission (I have a section on this in my Gut Recovery Program).
4. Yersinia enterocolitica
Yersinia has long been implicated in both Hashimoto’s and Graves’ disease. [22]
This type of bacteria is transferred through contaminated food and water, but is normally kept at bay by a healthy gut immune system. In an individual with a weak immune system, leaky gut, and/or other gut infections, however, Yersinia can infiltrate the gut mucosal barrier and persist.
It has been shown to trigger Hashimoto’s via molecular mimicry, as its surface binds to TSH. A Yersinia infection can induce antibodies against sites that recognize and stimulate TSH receptors (such as thyroglobulin or thyroid peroxidase enzyme).
Studies have found that antibodies to Yersinia (indicating exposure) in people with Hashimoto’s were found more often than in people without Hashimoto’s. Another study found that if one has the genes that make a person more susceptible to Hashimoto’s, they may also be at a higher risk for a Yersinia infection. [23] In that study, otherwise healthy female relatives of patients with Hashimoto’s showed an increased prevalence of Yersinia antibodies (but not TPO antibodies).
Additional research found a higher prevalence of Yersinia antibodies in patients with a variety of thyroid disorders (75 percent) than in controls (less than eight percent). [24]
Prevalence of Yersinia in Our Test Population
While many practitioners would say off the top of their heads that Yersinia has been linked to thyroid disorders, in speaking to many of my colleagues, I have found that most have not seen it (or have only seen it infrequently) clinically!
In our 289 reported samples, using the GI-MAP test, only five people had detectable levels of Yersinia, and none tested “positive” or above normal according to the lab’s reference range (<1.00e5).
The GI-MAP test does test for Yersinia, but some of my colleagues have found that gut tests can produce false negatives here. Dr. Nikolas Hedberg, another specialist in autoimmune thyroiditis, has found that while stool testing is good for an acute infection, it can miss chronic infections. That’s why he recommends blood tests instead for IgG, IgA, and IgM antibodies.
A positive IgG test for Yersinia means you have antibodies to the infection, indicating that you’ve had an infection in the past, at some point. A positive IgM test means it is a recent infection. A positive IgG and IgA test means the infection has been ongoing for greater than three months (if a person tested positive for these antibodies, it could also point to evaluating them for thyroid disorders, if they hadn’t already been diagnosed).
Dr. Hedberg also suggests that if you are treated for Yersinia, you should retest, and if there is still an active infection, you may want to check for other viruses or Lyme disease.
Treatment of Yersinia and Its Impact on Hashimoto’s
When Yersenia did show up on lab tests, there were also other co-occurring infections found. Potential treatment options include doxycycline, berberine, black walnut, oil of oregano, grapefruit seed extract, caprylic acid, uva ursi, and silvercillin. Interestingly, I’ve used a combination of these for other infections, and they often do produce an improvement in Hashimoto’s symptoms/antibodies.
5. Candida albicans (Candida)
One common trigger for Hashimoto’s is the opportunistic yeast Candida albicans.
Candida is a normal part of the human microbiome, but can become problematic when there is too much of it.
We all have Candida in our mouths and intestines, and for women, in the vaginal tract. When it goes into overgrowth mode, it can break down the walls of the intestinal lining, causing leaky gut and nutrient malabsorption, and allowing toxins and partially undigested food molecules to cross into the bloodstream. [25] Food sensitivities and autoimmune disease progression can result.
(Did someone say you’re eating too many simple carbs? Candida thrives on that!)
In my 2015 survey, 25 percent of respondents said that they had been diagnosed with a yeast overgrowth condition. When I first set out to do my own initial gut testing, I found an overgrowth of yeast that was about three times higher than it should have been… that’s a lot!
Prevalence of Candida in Our Test Population
In our 298 GI-MAP test samples, 10 percent tested positive, although 19 percent showed some detection of Candida albicans that was not considered positive or above normal by the lab (<5.00e2).
Testing for Candida
I used to recommend the GI-MAP test for Candida, but after writing Hashimoto’s Protocol, I became more familiar with the Organic Acids Test (OAT) by Mosaic Diagnostics. I have found that this test is much more accurate and can find many more cases of Candida, as well as mold!
Treatment of Candida and Its Impact on Hashimoto’s
I’ve written an entire article on treating Candida infections, as it requires a multi-pronged approach involving killing off existing yeast, building up beneficial bacteria, and preventing further yeast from growing. Many times we find that there are other root causes involved that also have to be dealt with, but if we can get a handle on Candida, this can resolve multiple symptoms. My Gut Recovery Program is really helpful for those with yeast overgrowths and imbalances.
6. Low Lactobacillus
Low levels of commensal (friendly) bacteria such as Lactobacillus (as well as Bifidus) is a general sign of dysbiosis (gut microbiome imbalance) that is thought to be common in people with autoimmune disorders such as Hashimoto’s. People with Hashimoto’s are also more likely to have higher amounts of the opportunistic bacteria E. coli and Proteus. [26]
Lactobacillus bacteria produce enzymes, vitamins, short-chain fatty acids, and other metabolic products that keep the bowels and the body functioning well. Lactobacillus can be used therapeutically to promote regularity and good digestion, boost the immune system, and help control intestinal pH; it can also help prevent the overgrowth of Candida albicans, E. coli, and other pathogenic bacteria. [27]
Lactobacillus is involved in the retention and utilization of selenium, a nutrient we know is important to T4 to T3 thyroid hormone conversion and healthy thyroid function (and often found to be deficient in those with Hashimoto’s). [28]Lactobacillus is also important in the availability of Butyricimonas, another bacteria which has beneficial effects on the gastrointestinal tract. [29]
Lactobacillus bacteria also have a positive correlation with zinc levels, another important T4 to T3 conversion mineral that is often found lacking in Hashimoto’s. [30]
One study in China examined the stool composition of 74 participants; results found that patients with a thyroid disorder had lower levels of Lactobacillus than healthy controls. [31]
I’ve seen the pattern of low levels of probiotic bacteria such as Lactobacillus, with high levels of opportunistic bacteria (we’ll cover this later) on my clients’ lab tests, as well as my own, when doing stool testing. When I first took a stool test, I was shocked to see that I had zero growth of Lactobacillus bacteria even though I was eating probiotic yogurt on a daily basis. Back then, I didn’t realize that most commercial yogurts – and even probiotics – don’t have enough beneficial bacteria in them to truly make a difference.
I had to start eating fermented foods and using much higher doses of probiotics before getting my beneficial bacteria back in charge over the E. coli and Proteus species in my gut.
Testing
The GI-MAP test detects the presence of Lactobacillus using a “normal” range defined as between 8.6e5 – 6.20e8.
Prevalence of Low Lactobacillus in Our Test Population
In our test population of 298 stool samples, 12 percent had low Lactobacillus on the GI-MAP test.
Treatment of Low Lactobacillus and Its Impact on Hashimoto’s
In my 2015 survey, 74 percent of people trying probiotics said it made them feel better. Sixty-two percent said it improved their energy, 51 percent said it improved their mood, and 17 percent said they had improvements on their labs. As an interesting side note, 62 percent of people said they felt better with selenium supplementation (and we know low Lactobacillus impacts selenium availability).
Some research has suggested that probiotics such as Lactobacillus and Bifidobacteriaceae could constitute an adjuvant therapy for thyroid diseases such as Hashimoto’s, although most such studies have been focused on animal models. One study in particular discusses how beneficial probiotics were shown to act as LT4 therapy stabilizers (suggesting that they have a positive effect on accumulating thyroid-supportive trace elements such as zinc and selenium).[32]
I’ve written a lot about the best type of probiotics for Hashimoto’s, as I haven’t seen Lactobacillus probiotics help resolve Hashimoto’s symptoms unless taken in very high doses (and find that most people don’t do that). I also think that fermented food is a must (and you can make it in the comfort of your home as well). Learn more about my favorites in my book, Hashimoto’s Food Pharmacology, and be sure to check out my Gut Recovery Program which focuses on healing and balancing the gut. (Enrollment is open now through Nov 16th at 11:59pm PT, for a limited time only, and spots are limited!)
7. Epstein-Barr Virus
The Epstein-Barr Virus (EBV) is a common trigger for autoimmune thyroid disorders, and plays a role in other autoimmune diseases such as systemic lupus erythematosus and rheumatoid arthritis. [33]
In my 2015 survey, 11 percent of respondents reported that they had had mono prior to feeling unwell (I did too!). Mononucleosis (mono) is a viral infection caused by the Epstein-Barr virus, which can linger in the body for years after a person is exposed, hiding dormant in the thyroid gland or elsewhere. It can reactivate, causing inflammation and damage, producing symptoms in people with weakened immune systems.
EBV is more common in immunocompromised patients than in immunocompetent patients. One study found the virus in the thyroid cells of people with both Hashimoto’s (80 percent) and Graves’ (62.5 percent) at levels significantly beyond controls not having thyroid issues (who tested at 0 percent presence of EBV).
What I’ve seen in my clinical practice is that many people note that they’ve had mono or EBV when they fill out their health timeline. Then, they often say they started having irritable bowel problems after that. Some were also diagnosed with Blasto. All of these issues turned out to be triggers for their Hashimoto’s. The great thing is that as we resolve each of these infections, people will start feeling better (and in most cases, see a reduction in thyroid antibodies and symptoms as well).
Prevalence of EBV in Our Test Population
The GI-MAP showed less than one percent positives for the Epstein-Barr virus, although it was detected at “normal” levels (<1.00e7) in four percent of our 298 test samples.
While the GI-MAP test does test for EBV, I can’t speak to the validity of it for EBV purposes, and I usually recommend blood tests for EBV reactivation instead. For the most thorough evaluation relating to EBV, I suggest the EBV Panel Plus test (which can be done through your doctor or self-ordered online from Ulta Labs). This panel tests for both current and previous infections, and the presence or absence of specific antibodies is how the infection status is determined.
You can alternatively take the Epstein-Barr Virus Early Antigen test as a separate, stand-alone test, which will let you know if it is currently active.
Unfortunately, I don’t have exact data on how many clients test positive via blood tests, however… maybe this could be a project for when my son goes to college? 🙂
Treatment of EBV and Its Impact on Hashimoto’s
I have an entire protocol dedicated to addressing EBV in my book, Hashimoto’s Protocol. I’ve seen beneficial outcomes using cordyceps, olive leaf extract, monolaurin, oil of oregano, and lomatium, a broad-spectrum antiviral herb with potential therapeutic benefits for Epstein-Barr Virus (as well as for other herpes viruses, HPV, and even the flu).
8. Small Intestinal Bacterial Overgrowth (SIBO)
SIBO is a big topic in the gut microbiome world, so you may find conventional doctors (albeit progressive ones) willing to test for it. SIBO can lead to intestinal permeability (leaky gut) and contribute to a long list of digestive symptoms, including acid reflux, irritable bowel syndrome, bloating, and belching.
There are a number of studies showing connections between SIBO and hypothyroidism; the general theory is that the decreased gastric motility typically seen in hypothyroidism means your digestion moves so slowly that bacteria build up in the small intestine. I have found that SIBO often co-occurs with other Hashimoto’s triggers such as infections (including H. pylori), antibiotic usage, low stomach acid, and proton pump inhibitor (PPI) use, which people tend to take if they believe they have too much stomach acid. [34]
Clients who have a history of PPI use are often surprised to find that they actually have low stomach acid, which is common in Hashimoto’s. PPIs can mask the real trigger(s), which can be food sensitivities or an infection. (In my case, I took PPIs for a long time prior to identifying my issue with dairy.)
One study found that 54 percent of people with Hashimoto’s also had SIBO. The good news in this study was that 70.4 percent of those treated (with antibiotics) later tested negative for SIBO. I’ve found that treating SIBO can resolve gastrointestinal symptoms as well as reduce thyroid antibodies.
In my 2015 survey, 4.51 percent of respondents indicated they had been diagnosed with SIBO. I was actually somewhat surprised that this percentage wasn’t higher given the earlier research. It’s possible that, while many of the survey participants were dealing with various GI issues, few had been identified as SIBO because many conventional doctors weren’t looking for it.
My Gut Recovery Program has helped thousands of people with digestive problems and thyroid symptoms over the years. It includes a step-by-step approach to supporting gut health and resolving infections, including SIBO. Learn more about the program here.
Testing
My preferred testing for SIBO is via a breath (versus stool) test. The breath test allows us to measure the presence of gasses produced by bacteria (usually measurable levels of methane and hydrogen).
You can self-order the SIBO 3-hour test by Genova Diagnostics through Rupa, Direct Labs, or MyMedLab. The Trio Smart breath test is another option I’ve recently discovered that measures the three primary gasses that can indicate imbalances in the microbiome.
While I generally recommend a breath test, you can get some helpful data relating to SIBO via the GI-MAP as well (if you are already planning on doing this more comprehensive test). The GI-MAP test provides results of four particular opportunistic bacteria that can point to SIBO. Opportunistic bacteria are considered normal in stool, but sometimes excessive overgrowth can occur due to a weakened immune system, antibiotic use, poor diet, or a parasitic infection (or when there is leaky gut). High levels of Bacillus spp., Methanobacteriaceae, Morganella spp., and Streptococcus spp. can indicate SIBO. [35]
Prevalence of SIBO in Our Test Population
Unfortunately, I don’t have data to share with you on SIBO prevalence relating to breath tests (another future project?), but in the GI-MAP test, we measured the four opportunistic bacteria that may indicate SIBO, and found the following:
- Bacillus spp. – positive in 12 percent (normal <1.50e5)
- Morganella spp. – positive in 10 percent (normal <1.00e3)
- Streptococcus spp. – positive in 24.5 percent (normal <1.00e3)
Treatment of SIBO and Its Impact on Hashimoto’s
You can read my article on SIBO for additional information and treatment protocols. If you suspect SIBO, it is something you should work on with your practitioner or functional medical doctor to develop the best course of action for you. There are particular diets that have been found to help (like the low FODMAP diet), herbs (such as berberine and oil of oregano), antibiotics, and other treatments that can help.
In my survey, 25 percent of respondents said they felt better after being treated for SIBO. Sixty-four percent said treatment left them with more energy; 51 percent said treatment reduced their pain; 28 percent saw improvements with thyroid labs, and 48 percent had improvements in their mood. Treating SIBO may also help regenerate your sugar digestive enzymes (which can help you digest carbs and improve your overall digestive function moving forward).
9. Gluten Sensitivity
When we discuss gluten as a root cause for thyroid conditions, it may be helpful to think of a person’s reaction to gluten in terms of a spectrum.
Celiac disease (CD) is at one end of the spectrum, where gluten can cause serious damage to the intestines. But even if you have not tested positive for CD, you may have non-celiac gluten sensitivity (NCGS).
No matter where you fall on the spectrum, it is my opinion that removing gluten is one of the best things people with Hashimoto’s can do to feel better.
In my 2015 survey, 88 percent of respondents said that going on a gluten-free diet made them feel better (note that only 3.5 percent had been diagnosed with CD). Even better news, some 33 percent saw a reduction in thyroid antibodies on a gluten-free diet.
People also reported more energy (67 percent), better mood (60 percent), and less pain (46 percent).
Getting tested can help you determine where you are on the gluten spectrum.
Here’s some important information about gluten.
- Gluten is pervasive. Gluten is a protein found in barley, wheat, and rye (a staple in most homes serving up a Western diet with carbs and highly processed foods); it is also found hidden in foods like sauces, salad dressings, and even beauty products!
- An estimated one percent of people worldwide have CD. Having CD means a person will experience a highly toxic autoimmune attack (IgA branch of the immune system) on their intestines every time they eat any amount of gluten.
- Between 1.2 and 15 percent of people with Hashimoto’s also have CD. We know from one Italian study that when people with co-occurring subclinical hypothyroidism and CD were placed on a gluten-free diet for one year, 71 percent saw their thyroid function normalize. Another 19 percent were able to normalize their thyroid antibodies. [36]
- Hashimoto’s seems to be linked with Non-Celiac Gluten Sensitivity (NCGS). Many people – especially those with autoimmune diseases such as Hashimoto’s – have celiac-like reactions but won’t test for IgA celiac antibodies (or have the significant intestinal damage that CD causes); they will, however, test positive on IgG tests.
- Most people with Hashimoto’s will feel better on a gluten-free diet, whether they have tested positive for celiac disease or not.
While the only “perfect” way to confirm CD is a biopsy of the small intestine, I do feel that blood tests provide useful information (that can point to whether a biopsy needs to be done).
I generally recommend the Tissue Transglutaminase IgA antibody test, which tests for this CD marker and is 95 percent sensitive. I also measure total IgA antibodies to ensure my client has enough antibodies available to measure (2-3 percent of celiac disease patients are IgA-deficient).
There isn’t a true commercial blood test for NCGS (I’ll talk about the stool test for this in a moment), but you can test for gluten sensitivity using an IgG food sensitivity test. Years ago, prior to my saying “bye-bye” to gluten for good, I did IgG food sensitivity testing, which revealed that I had IgG (hypersensitivity) reactions to gluten, dairy, whey, and casein. Removing those foods from my diet was a true game-changer for me. I have since introduced dairy, but continue on a gluten-free diet.
IgG antibodies are thought to be the same type of antibodies that target the thyroid gland in autoimmune disease. Thus, removing IgG-reactive foods may also help reduce the IgG response to the thyroid gland.
The test that I have found to be highly accurate is the Alletess Lab food sensitivity test. I’ve used this test for hundreds of people with Hashimoto’s, and most do come up with an IgG gluten reaction.
There are other ways to “test” for gluten sensitivity — you can start with eliminating gluten from your diet to see if you feel better.
You can also learn more from stool testing by looking for the presence of anti-gliadin antibodies.
Stool Testing
The GI-MAP test measures anti-gliadin antibodies. Gliadin is a component of gluten. The presence of fecal anti-gliadin antibodies can indicate an immune response (in the gut) to gluten. Because there can be increased levels of fecal anti-gliadin antibodies even when serum (blood test) concentrations are undetectable, fecal antibodies can often be used as a marker for non-celiac gluten sensitivity. Anti-gliadin antibodies were the primary way doctors originally tested for celiac disease (for more than 20 years, prior to more sophisticated testing). One study I read focused on the use of anti-gliadin antibody measures relating to non-celiac gluten sensitivity patients, found that 93.2 percent of patients showed zero anti-gliadin antibodies (IgG class) after just six months on a gluten-free diet. [37]
Gliadin (as well as some gut bacteria) can activate zonulin, causing dysfunction of the barrier and immune dysfunction. Zonulin is a protein secreted by intestinal cells that regulates intestinal permeability; it opens or closes the tight junctions of the gut barrier as needed (so if there is a bacterial infection, high levels of zonulin can open up the barrier and flush out the toxin).
High levels of zonulin are associated with celiac disease among other conditions, including autoimmune diseases. [38] But how fecal zonulin correlates to serum zonulin is not yet understood. This could be an interesting test in the future for any number of “leaky gut” issues.
Along with the above markers, a good functional practitioner will also look at other markers on the GI-MAP test that can help identify when a person may have gluten sensitivities or celiac disease. The GI-MAP test also has an add-on test for zonulin. Some bacteria reported on (such as Lactobacilli and Firmicutes) are usually lower in those with celiac disease, for example, than healthy controls. [39]
So what did we find using our 298 test results?
Prevalence of Gluten Sensitivity in Our Test Population
While the GI-MAP certainly does not test for celiac disease, our test results found that 19 percent had elevated (“positive”) anti-gliadin antibodies. But there are some issues with the anti-gliadin antibody number that may impact its significance. First, the GI-MAP changed their reference ranges over the years of our data collection, in terms of what they viewed as a “positive” result.
The reference range through August 2017 was normal=0-100 U/L (for a positive result); then changed to normal=0-157 U/L the following year. We saw a decrease in positives from 45 percent in 2017, to only 11 percent in 2018, and then 25 percent in 2019. The sensitivity of the test changed over time (so should we cast doubt on the 2017 numbers because of this?). I’d love to see their reasoning for the change, and also their benchmarks on how the general population as well as those with CD tests for this marker.
We had no test results that were zero relating to anti-gliadin antibodies. This makes sense given that gluten is hidden in so many foods, so one could theorize that everyone will come back with some level of antibodies. So what really is the magic number that signifies a problem?
I think most people feel better when they avoid gluten, so in the end, I think looking at symptoms when eating – and eliminating – gluten makes more sense than some of these tests, unless a person is having severe symptoms such as ones seen with CD.
Treatment of Gluten Sensitivity and Its Impact on Hashimoto’s
I discuss how to go on an elimination diet in this previous article on gluten. You may find that simply eliminating gluten makes all the difference for you (like it did for me and thousands of my clients).
10. Mold as a Trigger
Mold is a type of fungi. There are literally millions of fungal species, but only a few hundred of them can make people sick. Molds, yeasts (like Candida), and mushrooms are all types of fungi.
Many people are sensitive to mold in the environment (from water damage and humid conditions), and even the tiny amount of mold that can be present in coffee, soft cheeses, and nuts. In my 2015 survey, 9.84 percent of respondents said they had been diagnosed with mold-related health issues.
Fungi are also a part of the normal microbiota of the human digestive tract. Sometimes, however, fungal overgrowth can occur in the body, which can cause symptoms in susceptible people (such as those with weak immune systems).
When I have clients complete their health timeline, they often indicate that they began feeling unwell after moving into a new home. In fact, in my 2015 survey, some 20 percent of respondents indicated their health began to decline after a move. This can often be due to mold (or other environmental toxins) in the new home.
Fungal growth such as with mold can cause adverse reactions, inflammation, and impacts on immune health – and in turn, it can act as a trigger for asthma and autoimmune conditions, including Hashimoto’s. Research has shown that exposure to harmful metabolites (called mycotoxins) produced by toxic fungi can lead to a deficiency in the active form of thyroid hormone, T3, among other things. [40]
There are many interventions to help you prevent or reduce mold in your home, including testing.
But what if the mold has taken up residence in your body?
Testing
I’ll talk about the GI-MAP stool test in a moment, but for detecting mold metabolites (mycotoxins), I usually recommend the Organic Acids Test (OAT) and/or the MycoTOX Profile test from Mosaic Diagnostics. The Organic Acids Test is the same test as earlier discussed relating to testing for the yeast Candida. The MycoTOX Profile test is a really great test that screens for 11 different mold mycotoxins, from 40 species of mold. The test is able to detect even low levels of fungal toxins, all in one urine sample.
There are additional mycotoxin panels such as the RealTime Laboratories urine test for mold metabolites, and the Vibrant Wellness Mycotoxins Test.
The GI-MAP stool test identifies fungi/yeast growing in your gut. Fungi capable of growing in and colonizing the gut are limited to a small number of species, mostly Candida yeasts and those in the yeast family Dipodascaceae (of which Geotrichum is a common one that is also associated with irritable bowel syndrome). [41]
The GI-MAP test measures the levels of several fungi, including Candida spp, Candida albicans, Microsporidia spp, Rhodotorula spp., and Geotrichum.
Prevalence of Fungi/Yeast in Our Test Population
In the GI-MAP test, we found Geotrichum was present in five percent of samples (normal <3.00e2). I wish we’d been able to have the urine test data as well.
Treatment of Fungi/Yeast and Its Impact on Hashimoto’s
Fungal overgrowth is usually controlled with a diet low in sugars and starches. Often, we need to implement a detoxification strategy to chelate the mycotoxins from the body. Recommended prescription antibiotics and antifungal medications, as well as natural treatments (including lifestyle changes and strategies to prevent and get rid of mold in your home) are also available, and outlined in this article on mold as a trigger for Hashimoto’s.
New Patterns
In addition to the above-mentioned triggers that were already commonly known and common in Hashimoto’s, we saw the following 10 patterns to be the most common in our stool testing results.
Alterations in SIgA (Immunoglobulin A)
Secretory IgA, or SIgA, is known as the respiratory and GI tract’s first line of defense. It can prevent the adhesion of parasites, bacteria, viruses, and other pathogens to our respiratory and gut linings. It plays a critical role in the immune function of the mucosal linings of the body, and helps to provide a protective barrier. [42]
The GI-MAP test measures levels of SIgA in the stool. It is considered an intestinal health marker for the body’s immune response.
When my clients do lab testing, I typically find low levels of SIgA, but both low and high levels are signs that something might be out of balance in our gut/immune system.
Low Secretory IgA Levels
When levels are low, pathogens and toxins can get into the gut lining and cause infections and inflammation, which can lead to leaky gut. As we know, leaky gut is a key part of autoimmune disease and Hashimoto’s, and is also associated with food sensitivities and inflammation throughout the body. [43]
Low SIgA levels are associated with impaired gut function, low immunity, getting sick often, and autoimmune disease. [44]
Aside from chronic infections like Candida, H. pylori, Blasto, and other parasitic infections, there are a few other things that may contribute to low levels of SIgA:
- Stress: Cortisol has been shown to decrease SIgA levels. [45] Mental and emotional stress can trigger the release of cortisol, and if this stress is chronic, it can lead to low SIgA levels and adrenal dysfunction.
- Diet: What we eat can have a big influence on levels of SIgA in the gut. A diet full of processed foods and low in nutrients isn’t supportive of gut health, and could influence levels of SIgA. I recommend eating a nutrient-dense, anti-inflammatory diet full of good quality proteins, healthy fats, vegetables, and fruit. Additionally, certain nutrients like vitamin D, vitamin A, zinc, and glutathione can help support healthy SIgA levels.
- Certain medications: Antibiotics and non-steroidal anti-inflammatory drugs (NSAIDs) have been shown to deplete SIgA levels. [46] Supporting the gut during and after antibiotic use can help ameliorate this effect, and finding ways to reduce NSAID use can be helpful in the long term.
- Mold exposure: One of the ways that mold affects the body is through the gut. It can disrupt the microbiome and lead to dysbiosis, and can increase intestinal permeability (leaky gut). [47] Mold’s ability to disrupt the gut environment can lead to lowered levels of SIgA and a suppressed immune system.
- Epstein-Barr Virus is a common virus that all of us have had, and most of us keep it dormant. However, the virus has the potential to reactivate when our immune system is not properly keeping it in check. Because low SIgA levels may indicate immune suppression, this can mean that EBV is not properly managed. Low SIgA may indicate that one should check for EBV reactivation.
High Secretory IgA Levels
High levels of IgA indicate an elevated immune response to antigens in the GI tract, and are often found in the presence of an acute infection, including a parasitic gut infection.
Testing
The GI-MAP test provides Secretory IgA (SIgA) levels with a normal range between 510 to 2010 ug/g.
Prevalence of Alterations in SIgA Levels in Our Test Population
In our data of 298 test samples, 53 percent of people had low secretory IgA levels, and 13 percent had high levels.
Treatment of Alterations in SIgA Levels and Its Impact on Hashimoto’s
I’ll be writing a deep dive on boosting secretory IgA at some point in the future, but for now, I wanted to share that S. boulardii is one great tool that can be used safely and effectively for many types of gastrointestinal infections or microbiome imbalances.
When my son and I tested for low levels of SIgA, this is what I used, and it worked very well. I felt comfortable using it, even with my young son (read my article on S. boulardii for more detailed info). I felt we both became more resilient to illness once our SIgA levels started to increase.
People with low SIgA levels may also want to address signs of chronic stress or adrenal dysfunction.
Other protocols include bumping up levels of Lactobacillus and Bifidobacteria probiotics, as well as essential fatty acids. I may also use glutamine and zinc to boost levels.
For high levels of SIgA, I would suggest looking at your GI-MAP test results for other GI infections, and treating any that you may find. If there are no infections on the GI-MAP, consider doing a different stool test.
I am working on an article on secretory IgA, and hope to publish it soon, so keep an eye out! 😉
Firmicutes
Firmicutes (and Bacteroidetes) are bacteria that dominate our entire digestive tract.
The Firmicutes/Bacteroidetes ratio (F/B) ratio has been found to be significantly higher in those with Hashimoto’s and other diseases such as IBS. Higher ratios are generally a sign of ill health, and are associated with microbial imbalance. A higher F/B ratio is also linked to obesity, and is even considered a hallmark of obesity in scientific literature. [48] After weight loss, this ratio improves.
In animal studies, mice with Graves’ ophthalmopathy were found to have increased levels of Firmicutes and decreased levels of Bacteroidetes in their intestines. [49]
Additionally, some cases of IBS show a high F/B ratio, which, as mentioned, appears to correlate with higher weight and also psychological symptoms, including depression and anxiety. [50] Other cases of IBS and IBD may have a low F/B ratio.
There is also research showing that a high F/B ratio was found more often in sick patients compared to healthy individuals. [51]
Now, I initially got excited when I saw that high levels showed up in 23 percent of our test samples, as that seemed to be a helpful pattern. However, then I saw that low levels came up even more frequently in our samples. So I’m not sure how relevant this marker relates to patterns in Hashimoto’s.
Testing
The GI-MAP provides levels of Firmicutes, Bacteroidetes, and the F/B ratio, along with a number of other bacteria.
Prevalence of High/Low Firmicutes in Our Test Population
High levels of Firmicutes showed up in 23 percent of stool samples (a normal range is defined as 5.70e10 – 3.04e11). Low levels showed up in 33 percent of samples.
Treatment of High/Low Firmicutes and Its Impact on Hashimoto’s
High Firmicutes or a high F/B ratio is often associated with poor diet, leaky gut, maldigestion, or hypochlorhydria (low stomach acid, which we know is very common in Hashimoto’s). Treatment protocols would focus on these areas.
The high-fat, high-carb, high-sugar (Western) diet, together with mainly sedentary activity, results in a predominance of Firmicutes, so dietary and exercise interventions can be helpful. [52]
S. Boulardii is a must as well as Bifidobacteria probiotics; both can reduce Firmicutes and help balance out the gut.
If you test with low levels, Lactobacillus spp. and Bacillus spp. (probiotics) can help elevate Firmicutes levels.
For more info on how to balance the gut microbiome, see my article on dysbiosis.
Overgrowth of Opportunistic Bacteria
Many bacteria measured on the GI-MAP test are considered opportunistic bacteria because they cause disease and illness in a subset of individuals, particularly those with compromised immune systems.
For these people, overgrowth (and resultant inflammation and GI problems) of opportunistic bacteria can occur due to infections, antibiotic use, poor diet, and/or leaky gut being present.
Testing
There are over a dozen opportunistic bacteria measured on the GI-MAP test, and elevated levels of any of them are considered “dysbiosis” (microbial imbalance in the gut).
Prevalence of High Levels of Opportunistic Bacteria in Our Test Population
Overgrowth of opportunistic bacteria was found in 59 percent of our test samples. In autoimmune conditions like Hashimoto’s, people already have gut imbalances due to leaky gut (it is one of the three requirements for having Hashimoto’s, the other two being a genetic predisposition and one or more triggers). [53]
So a person with Hashimoto’s is at increased risk of viral, bacterial, and opportunistic fungal infections. [54]
Treating High Levels of Opportunistic Bacteria
For most bacterial overgrowth conditions, I generally recommend taking an antimicrobial such as berberine, and addressing the possible root causes of a compromised gut.
There can be any number of causes, including low stomach acid, stress, unsanitary conditions, other infections, and so on.
I routinely recommend the GI-MAP test because it offers many other markers (other than opportunistic bacteria) that can help paint a comprehensive view of what all may be going on (and what may need to be addressed).
Here are highlights of the test results for a few of the top bacteria offenders reported on the GI-MAP test.
1. Pseudomonas
Found in 35 percent of our samples, Pseudomonas was one of the most common sources of overgrowth.
The Pseudomonas aeruginosa species can be found in damp areas and unsanitary water (hot tubs, pools, etc.). It’s also found in hospital-related infections, and is associated with wound and burn infections, pneumonia, and urinary tract infections, among others.
The bacteria are becoming resistant to certain antibiotics, which is a concern.
2. Enterococcus
Enterococcus overgrowth was found in 27 percent of our samples.
The GI-MAP tests for Enterococcus faecalis and Enterococcus faecium. High levels of these species have been associated with compromised digestive function, reduced stomach acid, PPI (proton pump inhibitor) use, and SIBO.
Other Enterococcus strains are associated with initiating the autoimmune response. In one study, genetically susceptible mice with E. gallinarum were found to have increased inflammation and autoantibodies. Researchers found they could suppress the autoimmune response if using a vaccine or antibiotic that specifically eradicates E. gallinarum. [55]
3. Streptococcus
58 percent of our samples had Streptococcus, although only 25 percent of these showed up in abnormal levels per lab standards.
Streptococcus spp. colonizes in the skin and mucous membranes throughout the body, and Streptococcus pyogenes is the bacteria that causes strep throat.
High levels of Strep in the intestine may be a sign of intestinal inflammatory activity, and can result from SIBO, low stomach acid, PPI use, stress, reduced digestive capacity, or constipation.
Streptococcus is of great interest to me, as it’s been implicated in anxiety and obsessive-compulsive disorder (OCD) – I experienced both in my younger days.
Immune system health and gut health are linked. Thus, commensal intestinal bacteria, if out of balance, may influence our neurological functioning and emotional behavior.
I have found that people with Hashimoto’s often present with anxiety, mood disorders, and OCD as initial symptoms. But where conventional doctors may prescribe antidepressants for anxiety and/or depression, I would recommend a thyroid panel first.
There is an entire field called immunoneuropsychiatry, which looks at how infection, chronic inflammation, autoimmunity, and psychosocial stress work together to impact neurological and psychiatric disorders.
One example of immunoneuropsychiatry in action is a condition called pediatric autoimmune neuropsychiatric disorder (or PANDAS). PANDAS has been associated with Streptococcal infections and subsequent OCD-type of behavior in children. [56] The OCD connection in Hashimoto’s is another example of a link between autoimmunity and neurological/behavioral changes (autoimmunity, leaky gut, nutrient deficiencies, out-of-balance gut, neurological impacts such as anxiety, depression, mood disorders, and OCD).
Other studies involving Streptococcal infections and behavior include one study of people with chronic fatigue syndrome (CFS), which is now known as myalgic encephalomyelitis (ME). ME is associated with intestinal microbiota dysbiosis, and patients with ME tend to have higher levels of both Enterococcus and Streptococcus spp. Eradicating Streptococcus infections (reducing pro-inflammatory cytokines and improving gut balance) has improved sleep and vigor in test subjects. [57]
Due to the research showing a connection between this bacteria and OCD, I usually have clients stay clear of probiotics containing Streptococcus probiotic strains if they are experiencing obsessive thoughts (although I haven’t seen worsening symptoms from anyone taking such a probiotic).
For those showing overgrowth, I have seen positive effects of a variety of interventions, including rebalancing the gut (berberine works well), reducing stress, removing reactive foods, and addressing nutrient deficiencies (in particular with selenium and myo-inositol). Studies have found that daily treatment with inositol resulted in improvements to OCD – for more information on this, please see my article on myo-inositol.
4. Staphylococcus
Almost 85 percent of our collected stool samples had some Staphylococcus present in their gut, with six percent positive on the lab test based on defined testing levels. The GI-MAP provides test measures on Staphylococcus spp. and Staphylococcus aureus.
I think that in my prior work, I have not appreciated Staphylococcus and Streptococcus as important triggers for Hashimoto’s – but I routinely see many connections between several common symptoms in my clients and overgrowth with these two opportunistic bacteria.
My experience with Staphylococcus overgrowth is that it has been more tied to food reactions and eczema. Each of these conditions occurs frequently in Hashimoto’s.
A 2013 research paper identified a toxin produced by Staphylococcus aureus on healthy skin that actually induced eczema. [58] The authors shared findings of another study showing that more than 90 percent of patients with atopic dermatitis are found to be colonized with Staphylococcus aureus, whereas most healthy individuals are not.
I’ve had recent personal experience with Staphylococcus relating to my son — he had been experiencing both food sensitivities and eczema. Fortunately, Dr. Sheila Kilbane (my go-to eczema expert and author of Healthy Kids, Happy Moms) introduced me to the work of Dr. Richard Aron, a dermatologist specializing in eczema. Dr. Aron has reported that food reactions and eczema start to resolve themselves when Staph is treated. His focus is on developing therapies for eczema, which focus on Staph causation, and minimize the use of antibiotics and immunosuppressive drugs.
The Aron Protocol focuses on eradicating Staph infections as the root cause of these conditions, and typically includes:
- Frequent and long-term use of a topical antibacterial agent with a low-potency steroid and moisturizing cream (The steroid addresses inflammation, and the antibacterial agent focuses on addressing the underlying Staph infection and balancing the gut. The moisturizer is meant to dilute the steroid.)
- Dietary restrictions
- Certain instructions relating to bathing, exercise, sports, sun protection, etc.
My son’s skin turned around with a topical Staph approach, and Dr. Kilbane also gave me some wonderful toddler-friendly protocols to support his gut microbiome. Interestingly, when his skin healed, his food sensitivities seemed to go away as well.
As a side note, I’m excited to share that courtesy of Dr. Kilbane, my son has been eczema-free since 2022. 🙂 You can see my Instagram post for details.
While research has shown that Staph skin colonization can lead to food allergies, I wonder if Staph in the gut can also lead to food sensitivities…
While the research on this is lacking, there are some related studies worth mentioning. Research focused on Hashimoto’s and Staphylococcus support that Staph, along with Streptococci, Yersinia, H. pylori, hepatitis C virus, Enterobacteriaceae, and the influenza virus, can all influence autoimmune thyroid disease pathology. [59]
Staphylococcus was shown to cause stimulation of thyroglobulin-primed cells, resulting in experimental autoimmune thyroiditis in mice. [60] Acute suppurative thyroiditis (AST) research found that the most common bacteria associated with the rare condition include Staphylococcus aureus and Streptococcus species. [61]Staphylococcus aureus has been shown to cause the release of pro-inflammatory cytokines that induce attacks of chronic hives as well. [62]
Other studies have highlighted similarities in the immunological mechanisms that play a role in the pathogenesis of both chronic hives and thyroid autoimmunity. [63]
I view eczema and other skin conditions as a sign of gut dysbiosis. My usual recommendation is for food sensitivity testing and/or trying an elimination diet.
If your GI-MAP test shows you as having Staph overgrowth, I would use a broad-spectrum antimicrobial such as berberine (article coming soon) to rebalance the gut. Studies have found that applying virgin coconut oil topically can reduce the number of Staph bacteria on the skin, which can reduce the chance of an infection. [64]
Imbalances/Dysbiosis in Normal Flora
Trillions of flora inhabit the human intestine. Commensal (friendly) bacteria extract nutrients and energy from the foods we eat, maintain healthy gut barrier function, produce vitamins (such as biotin and vitamin K), and protect our bodies against colonization by potential pathogens.
The GI-MAP test provides detection levels of a number of normal gut flora.
Treating Low Levels of Normal Flora
I generally recommend the daily use of a broad-spectrum probiotic formula containing 50-450 billion CFUs to rebalance the gut. (See my article on probiotics for more information on this.)
Prebiotics (beta-glucan, inulin, xylooligosaccharide, arabinogalactan) can also help. Fermented foods are also great, and are definitely one of my 12 favorite beneficial healing foods for the gut.
I also look at other imbalances reported on the GI-MAP and like to treat those as well.
Treating High Levels of Normal Flora
When we see an overgrowth of a previously-friendly bacteria (that is, it’s “friendly” when we have the right amount), we need to eradicate or reduce it. One thing I recommend for this is antimicrobial herbs.
Many bacteria are becoming drug-resistant to antibiotics, and that (as well as the side effects) is the reason I prefer not to use them if at all possible (when you keep the gut healthy, you are less likely to need antibiotics!). Removing sugar and refined carbohydrates from your diet is also important for reducing overgrowth. Then we look at other findings on the GI-MAP in order to see what else may need treatment.
Here are a few patterns we saw relating to normal flora.
Escherichia spp.
Escherichia coli (E. coli) is well-known as a pathogen, but most E. coli are actually nonpathogenic in nature, and routinely found in the gut. In our test samples, 34 percent were positive (out of the normal range 3.70e6 – 3.80e9), including both higher and lower levels than normal. High levels of Escherichia may be indicative of increased inflammatory activity in the intestines. Low levels may indicate a reduction in gut mucosal health and decreased protection against pathogenic E. coli infection.
Bacteroides fragilis
The normal microbiota of the human colon has the greatest population of bacteria in the body, and the largest part of these organisms are anaerobes (which don’t require oxygen to survive); of these, approximately 25 percent are of the species Bacteroides. [65]
It is thought to be an immune-modulating gut species responsible for gut barrier integrity, normal microbial balance, and neuro-immune health.
In our samples, we found 24 percent were positive (normal range 1.60e9 – 2.50e11), including both higher and lower levels than normal.
Overgrowth can occur due to inflammation or other disruption of the mucosal surface or microbial balance. Constipation can also cause overgrowth. Diets high in saturated fatty acids were found to have a stimulatory effect on the growth of Bacteroides fragilis. [66]
Low levels may result in reduced anti-inflammatory activity in the intestine.
Enterobacter
Enterobacter is a diverse bacterial family (which includes E. coli) that has been highly researched relating to its pathogenic activities. [67]
Enterobacter was found in 28 percent of our samples (normal range 1.00e6 – 5.00e7), including both higher and lower levels than normal.
People with inflammatory bowel disease (IBD) have been shown to have high levels of Enterobacter. [68]
High fat/sugar (Western) diets have been associated with IBD as well. In mice, a diet high in polyunsaturated fatty acids resulted in greater numbers of pro-inflammatory Enterobacteriaceae and Clostridia spp., as well as exacerbating symptoms of colitis. [69]
Low levels of Enterobacter may indicate reduced gut mucosal health.
Clostridium
Clostridium is a diverse group of bacteria found in the large intestine, which is important for having a healthy gut mucosal barrier and keeping pathogens at bay.
In our test sample, 17 percent of people tested outside of normal levels (normal 5.00e5 – 5.00e7), including both higher and lower levels than normal.
Clostridium difficile (C. diff) is one common bacterium where overgrowth has been found to lead to symptoms of colitis. It has also been associated with the thyroid. In one case study, a 24-year-old man was undergoing treatment for infection due to Clostridium difficile. During treatment, abnormal thyroid levels (hyperthyroidism) were found; these resolved after eradication of the C. difficile infection. [70]
Clostridium botulinum provides the botulinum toxin we know as Botox. You can read about Botox, along with other toxins that affect our thyroid gland, here. Know that one study found a possible pathogenic link between this bacteria toxin and autoimmune thyroid diseases. [71]
Low levels have been associated with inflammation and autoimmune conditions.
Lactobacillus spp.
We all have heard of these friendly bacteria as many different strains are used in probiotics.
In our test samples, 14 percent of people reported as outside the normal range (8.6e5 – 6.20e8).
I covered Lactobacillus earlier in this article, as low levels of the bacteria are a well-known pattern (12 percent of people had low Lactobacillus on the GI-MAP test). Please refer to that earlier information, or the above general treatment information in the section “Treating Low Levels of Normal Flora.”
If this resonates with you, my Gut Recovery Program works to help people balance their gut flora. (Enrollment is happening now through November 16th!)
High Calprotectin
This was surprisingly high in our sample! Some 31.5 percent of people had a huge elevation, and this is cause for great concern, as it is an intestinal inflammatory marker that could indicate a number of serious conditions.
Fecal calprotectin is a highly accurate biomarker for even the earliest stages of intestinal mucosal inflammation. Calprotectin levels are increased in inflammatory bowel disease; in fact, the level of calprotectin correlates very well with histologic (microscopic evaluation) and endoscopic measures relating to the severity of inflammatory bowel disease. [72] It is also increased in a number of cancer types, including those relating to the colon, breast, bladder, stomach, pancreas, and skin. [73]
Levels are also found to be increased in patients with papillary thyroid carcinoma, and in cases of infectious gastroenteritis and diverticular disease. [74]
Calprotectin will likely be high when a person has other infectious organisms (which will show up on the GI-MAP), as well as in cases of food allergies, food sensitivities, toxin exposures, and if they’ve been using certain medications such as anti-inflammatories.
I developed a protocol for elevated calprotectin with the help of a few colleagues (shoutout to Steve Wright from HealthyGut Company, Debbie Steinbock from Mindful Nutrition, and Dr. Jill Carnahan) for my hubby who was diagnosed with ulcerative colitis, and we were able to get him into remission within just a few weeks.
His levels of calprotectin are now at zero, and have stayed that way for years now! He has been in remission and free of flare-ups from ulcerative colitis. The protocol focused on soft mushy foods and following an elemental diet for part of the day. For supplements, he took aloe, high-dose turmeric, high-dose fish oil, Boswellia, S. Boulardii, and Serum-Based Immunoglobulin (it’s available via Fullscript – if you don’t have a Fullscript account, you can sign up with my credentials here). I just finished writing up the full protocol in my upcoming book on IBS, and it can also be found in my Gut Recovery Program.
Low Dose Naltrexone (LDN) is also a very helpful tool to balance the immune system.
(I will share more about this protocol when I have some more time to write — stay tuned!)
Possible Autoimmune Triggers
The GI-MAP measures a number of different bacteria that could potentially be autoimmune triggers for inflammatory conditions, such as autoimmune thyroiditis and rheumatoid arthritis, in susceptible individuals. Yersinia was mentioned in an earlier section, and has been associated with autoimmune thyroid disease and higher thyroid antibodies.
When the gut barrier becomes “leaky”, normally harmless opportunistic bacteria can pass through the barrier, resulting in inflammation and infection. Leaky gut has been documented in a number of autoimmune diseases (and we know it is considered a requirement in someone developing Hashimoto’s), including rheumatoid arthritis, inflammatory bowel disease, celiac disease, multiple sclerosis, ankylosing spondylitis, nonalcoholic steatohepatitis, and IgA nephropathy. [75]
In times of stress, these pathogens can be opportunistic and overgrow, which can cause a flare – so if possible, I recommend minimizing their presence. These bacteria can trigger or sustain an autoimmune condition.
Here are the top results we saw in this category:
Prevotella copri
Looking at the positive results for these types of bacteria (related to autoimmunity), Prevotella copri was the most common, with 21 percent of samples affected. It has been associated with rheumatoid arthritis. [76]
Klebsiella spp.
Klebsiella was found present on 40 percent of samples (but positive in around nine percent due to normal lab range). It has been associated with ulcerative colitis, Crohn’s disease, ankylosing spondylitis, and arthritis (associated with ulcerative colitis or with Crohn’s, reactive arthritis, and psoriatic arthritis). [77]
Citrobacter spp.
Citrobacter was present in 32 percent of samples (but positive in around five percent due to normal lab range). It has been associated with rheumatoid arthritis in particular, as it does have some cross reactive proteins similar to one of the types of collagen present in our cartilage. [78]
Parasites
The GI-MAP tests for common parasites and protozoa (both pathogenic and non-pathogenic).
Just like with other bacteria we’ve already discussed, some parasites exist without bothering their hosts, while others can cause significant harm, depleting the body of vital nutrients and damaging the gut lining.
Out of our 298 test samples, 93 people tested positive for parasites. Twenty-four of these, or eight percent of samples, included positive tests for Blastocystis hominis, which now has not just my clinical evidence, but also a case study and a small research study suggesting that it is a Hashimoto’s trigger. [79]
These are positive results (meaning those testing higher than normal, versus those testing with simply the presence of the parasite DNA).
One thing that I am a bit conflicted about is whether we should truly differentiate between positive versus presence when talking about a parasite. In my functional medicine training, you can’t just have a little bit of a parasite, you either have it or you don’t (you can’t just be a little bit pregnant, right?).
As you get both measures (positives and presence) with the GI-MAP test, which should we use as we study the data for patterns?
I’ve seen people who were symptomatic for Giardia, with just the presence of the parasite vs. a positive test. In speaking with other clinicians, some do consider any presence a positive. As such, I re-analyzed the data for the “presence” of parasite DNA labels, and the incidence was substantially higher… 274 total parasites were detected!
Now, some people had multiple parasites, so the percentage of people with any parasite present was actually 53 percent (157 people).
Based on these numbers and my own clinical experience, I think parasites are an important root cause to consider, especially since Blasto is a root cause.
Here are some of the individual results by parasite/protozoa. The numbers in parentheses indicate the total number of people with presence of the parasite/protozoa, and the percentage represents the percent of people with presence of the infection, of the total testing population:
- Blastocystis hominis (47) – 16%
- Cyclospora spp (51) – 17%
- Dientamoeba fragilis (50) – 17%
- Chilomastix mesnili (35) – 12%
- Giardia (28) – 9%
- Pentatrichomonas hominis (24) – 8%
- Endolimax nana (22) – 7%
- Entamoeba histolytica (3) – 1%
Worms (233 tests done, as they only added this later):
- Trichuris trichiura (6) – 2.5%
- Ancylostoma duodenale (5) – 2.1%
- Taenia spp. (2) – 0.8%
- Ascaris lumbricoides (1) – <0.5%
- No one had the Necator americanus worm
Some people may talk about parasite presence as possibly being a good thing that may even prevent autoimmunity – this can certainly be the case for some, but not all parasites. There have now been a number of studies (mainly animal studies, but some human) showing that low levels of parasitic infections appear to condition the immune system to prevent allergic reactions and autoimmune diseases such as asthma, rheumatoid arthritis, diabetes, and colitis. [80]
This concept is known as the “hygiene hypothesis.” The hygiene hypothesis addresses the following situation: in developed countries where sanitation has improved and there are reduced parasitic infections, there are increased incidences of allergic and autoimmune disorders. There is a connection between the two relating to immune system response. [81]
Parasitic helminths (worms such as tapeworms and roundworms) have been found, for example, to reduce the severity of rheumatoid arthritis in animal models. Hookworms appear to reduce allergies, asthma, and inflammatory bowel diseases due to the immuno-modulatory properties they present to the body, as well. [82]
Research with helminths has shown that they can cause an anti-inflammatory response called the T-helper cell 2 response (Th2 response), which decreases inflammation while directing the immune system to eradicate the parasite. Researchers feel this anti-inflammatory response can reduce the occurrence of autoimmune reactions.
There is strong evidence in mouse models that helminthic therapy (a type of immunotherapy) can treat and/or prevent inflammatory diseases such as rheumatoid arthritis, inflammatory bowel disease, type 1 diabetes, asthma, and multiple sclerosis. There has been some positive evidence of therapeutic effect in human trials in rheumatoid arthritis, celiac disease, multiple sclerosis, ulcerative colitis, and Crohn’s disease. [83]
But we have to remember that just like there are beneficial, opportunistic, and pathogenic bacteria, the same is likely true for parasites. Additionally, as with bacteria, some people can have levels of bacteria and be fine, while others (due to genetics or weak immune systems) will get sick. So the jury is still out, in my view, on using parasites as a general treatment for autoimmune conditions – and in my experience, most people feel better after treating the parasitic infections!
High Steatocrit
Steatocrit is a digestion marker and measures fecal fats. Fecal fats are normally emulsified by bile salts and absorbed in the small intestines. High levels found on the GI-MAP test may point to celiac disease, pancreatic insufficiency, or small intestinal absorption issues. Seventeen percent of our test samples had high steatocrit. For me, this often means they’re dealing with fat malabsorption. Here’s an article I wrote on how this can be treated.
Beta-Glucuronidase
Beta-glucuronidase (β-glucuronidase) is produced by bacteria such as Bacteroides fragilis, Escherichia coli, Staphylococcus, and Clostridium perfringens. High levels can indicate dysbiosis, unfavorable metabolic changes in the colon (increasing colon cancer risk), and problems with detoxing xenobiotics (estrogens) from the body.
Fourteen percent of our test samples had high β-glucuronidase.
I usually recommend prebiotics, probiotics, and fermented foods to address high levels. The GI-MAP may point to other issues that need to be addressed. If estrogen levels are a concern (if taking hormone replacement or at increased cancer risk), additional detox and liver support are recommended. See my article on estrogen dominance for more information.
Resistant starch can also help with high levels of β-glucuronidase. Resistant starch is the portion of dietary starch that “resists” digestion by the small intestine and reaches the colon; it is thought to have a protective role against colorectal cancer. Resistant starch can alter the composition of the microbiome. In one study, resistant starch was shown to lower the levels of β-glucuronidase activity, and thus play a protective role in the colon. [84]
Low Elastase
The GI-MAP test measures levels of fecal pancreatic elastase, an enzyme that helps the body digest and absorb fats.
Low levels of pancreatic elastase can indicate exocrine pancreatic insufficiency, and may point to a number of conditions (and Hashimoto’s triggers), including SIBO, celiac disease, low stomach acid (especially if you also find H. pylori), suppressed pancreatic function, gallstones, heavy metal toxicity, stress, or a vegetarian/vegan diet.
In my clinical experience, I have found that between 40 to 50 percent of people with Hashimoto’s have fat digestion issues. There are many reasons for this, including slowed digestion (which can, for instance, result in trapped food and resulting infection), reduced gallbladder functionality, and a slowed metabolism which affects pancreatic function.
Studies have found that decreased pancreatic function is more common in patients with hypothyroidism. [85]
In our test samples, 16 percent had low elastase at under 200 μg/g, which indicates a high level of pancreatic insufficiency.
While under 200 μg/g is considered “low,” an optimal level is above 500 μg/g, which means that levels between 200 and 500 are also indicative of low pancreatic efficiency, and people may be symptomatic.
Of the tested samples, an additional 57 percent had fecal elastase under 500 μg/g. This means that a total of 73 percent of people had suboptimal levels of elastase!
New Patterns: Some Honorable Mentions
These may or may not be related to thyroid health, but are important gut issues that could have serious consequences and implications. If you do a stool test and find one of these, it’s important to see your physician right away!
C. diff (Clostridium difficile) Toxins
C. diff is a common infection affecting almost 20 percent of hospitalized patients; it also can occur after antibiotic therapy. C. diff can cause inflammation, damage the gut lining, and cause leaky gut. (I mentioned one case study linking C. diff and subacute thyroiditis earlier.)
The test breaks the toxin DNA results into Toxin A and Toxin B. Total positives were six percent for Toxin A, and four percent for Toxin B.
I have found that S. boulardii can be helpful with this infection.
Shiga Toxins
This is an important potential trigger of ulcerative colitis, and one of the most potent bacterial toxins found. It is from the E. coli family, often called Shiga toxin-producing E. coli (STEC). One particular strain of STEC (0157:H7) is responsible for most gastrointestinal illness outbreaks in the U.S. (most often due to food poisoning). This type of infection can result in kidney failure if not successfully treated.
In our sample tests, two percent tested positive (eight percent were present at some level).
Salmonella
Salmonella is well-known in the food industry, as it is often the result of fecal contamination in the food supply chain (often with raw produce, eggs, and meat). Animals like reptiles and baby chicks can also spread salmonella.
In our sample tests, six percent tested positive (seven percent were detected).
There have been some rare cases of salmonella infection of the thyroid gland, a condition known as “salmonella thyroiditis”). [86]
Antimicrobial herbs can help, but depending on the infection spread, antibiotic support may be required.
E. coli
The GI-MAP test measures a number of strains of Escherichia coli known to cause gastrointestinal infections. Most strains are caused by contaminated food, water, or contact with infected animals or people; diarrhea is a common symptom of infection.
In our sample tests, two percent tested positive (six percent were detected). See the above section for more information on E. coli.
Cholera
The GI-MAP tests for the bacteria Vibrio cholerae, which results in an infection of the small intestine known as cholera. While you aren’t likely to come across Vibrio cholerae bacteria in developed countries, you can contract it if you are in an area with untreated water. (In the U.S., there have been a few cases of people contracting cholera after having eaten undercooked shellfish from the Gulf of Mexico.)
In our sample, we had less than one percent test positive (five percent were detected).
Limitations of Our GI-MAP Test Results
Before I wrap up with my final thoughts on our findings, let me point out a few additional thoughts about the GI-MAP test and my team’s data analysis efforts.
Some of the tests were not in the original data collection.
We started our data collection in 2015, but some pathogen-specific tests included in the GI-MAP test were added later.
Those added in December of 2017 were:
- Epstein-Barr Virus
- Cytomegalovirus
- Rhodotorula spp.
- Prevotella copri
- Staphylococcus aureus
- Bacteroidetes
- Enterococcus
- Firmicutes
- Citrobacter spp.
- Klebsiella spp
- Worms – Trichuris, Ancylostoma, E. histo, Taenia, Ascaris
Additionally, Mycobacterium tuberculosis (avium) was added in December of 2017, removed in August of 2018, and then replaced by M. avium subsp. paratuberculosis (MAP).
One additional marker, Enterobacter spp., was also added in January of 2018.
To account for the changes, we only included tests that actually checked for each of these imbalances and infections, in the totals for our results analysis. For example, in 2017, only two client tests actually checked for Klebsiella, so in determining percentages of positives and negatives for Klebsiella, we excluded all the tests in 2017 up until that point.
While my team and I have spent countless hours reviewing tests, making spreadsheets and “crunching the data” to ensure that our reporting is accurate and complete, we’re not professional statisticians or data scientists, just a group of health geeks passionate about root causes.
None of the content here has been peer-reviewed via traditional medical journal publication. I’ve tried and failed multiple times to find and hire professionals like contract statisticians and data scientists to publish my survey findings from 2015, as well as the findings discussed in this article, in a peer-reviewed scientific journal. I’ve spent thousands of dollars and countless hours designing strategies for data analysis and peer-reviewed journal publication with people who initially seemed experienced but didn’t follow through on the project. So in the interest of time, instead of spending the next five years sitting on this data, I thought I would get it out into the world.
Additionally, while I love the GI-MAP test, just like most tests on the market, it’s not a perfect test. Tests can often have false negatives, and I have heard of some DNA tests having false positives as well.
The Takeaway
The GI-MAP is a helpful tool and can be a key part of our investigation when we’re searching for our root causes of Hashimoto’s, including inflammation, infections, gut microbe imbalances, and leaky gut. This comprehensive testing approach provides many markers of intestinal health that can be helpful in interpreting the overall report.
Additionally, it has consistently given me helpful insights for my clients (and myself) on potential triggers to investigate such as low stomach acid, PPI or medication use, possible food sensitivity concerns, nutrient deficiencies, and exposure to environmental toxins.
While I am a fan of this method of testing, it’s important to remember that the results need to be investigated and interpreted alongside a person’s family history, health history, thyroid labs, other labs, and symptoms.
It’s also important to bear in mind potential shortfalls. The GI-MAP test may miss some of the following common root causes found in Hashimoto’s:
- Other stool tests besides the GI-MAP test that are helpful include the Comprehensive Stool Analysis + Parasitology 3-Day test by Doctor’s Data, the Comprehensive Stool Analysis by Mosaic Diagnostics, and the Gut Zoomer test.
- To detect SIBO, I recommend a SIBO breath test instead (available via Rupa, Direct Labs, MyMedLab, or the Trio Smart breath test).
- For Candida and mold, the Organic Acids Test (OAT) by Mosaic Diagnostics may be more accurate than the GI-MAP test.
- Yersinia is best detected via blood tests.
- For EBV, I recommend a blood test like the EBV Panel Plus test (most important in my experience is the Early Antigen Test).
- Some pathogens and parasites will not be detected on this test because parasites may not shed in every single bowel movement. One of the annoying (but helpful) things about the 401H test was that it required multiple collections. (Remember my workaround, which is to take samples from at least three different bowel movements; this can be used for the GI-MAP collection or other referenced stool tests.) Additionally, other tests on the market may have more impressive parasitology testing methodologies including the Gut Zoomer and ParaWellness Research Test.
I hope that providing this info is helpful to both readers and my fellow practitioners. I also hope some clinicians and patients write in to let me know if I’m on the right track and share some of their experiences.
My Gut Recovery Program has helped thousands of people address the root causes of leaky gut and symptoms like diarrhea, constipation, acid reflux/GERD, stomach pain, headaches, nausea, food sensitivities/intolerance, brain fog, mood swings, and more. It includes a step-by-step approach to supporting optimal gut health. Learn more about the program here. We are launching NOW, and limited enrollment is open through November 16th at 11:59pm PT. So if you’re looking for guidance on how to heal your gut, check it out! 🙂
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