While I have a lot of stories of people who recovered their health through removing reactive foods, and through taking probiotics and supplements, I personally did not get my Hashimoto’s into remission by following those steps.
Sure, I felt much better, and my thyroid antibodies significantly dropped with the help of nutrition, but then my health problems began creeping back in. All of a sudden I became sensitive to nuts, bananas and eggs, and all of these “nutrient dense” Paleo foods that I began eating once I found out I was gluten and dairy sensitive.
This is because I was unknowingly walking around with 4 different gut infections, including Helicobacter pylori, which is connected to both Hashimoto’s and Graves’ disease and can cause new onset food sensitivities!
I was shocked and in complete disbelief that I had all of those issues (this was after 2 years of eating a gluten-free/dairy-free diet!). After that, I treated my gut infections one by one, seeing improvement with each treatment in how I felt and seeing a further reduction in thyroid antibodies.
At first, I was really embarrassed speaking publicly about having “gut infections,” it sort of grossed me out. But when I began working with people with Hashimoto’s, I realized I wasn’t the only one and realized that it was important for me to get past the ick factor to spread awareness.
In 2015, 80% of my clients who hit a plateau with nutrition and took the gut tests I recommended, tested positive for at least one gut infection.
We know that the three-legged stool of autoimmunity consists of the right genetic predisposition, the triggers, and the leaky gut. All three are required to be present for the autoimmune condition to manifest. Eliminating the triggers and addressing the leaky gut is key to getting autoimmune thyroid disease in remission.
While conventional medicine ignores the gut in relation to thyroid health, natural medicine also misses the point in gut health, by solely focusing on supportive and maintenance care of the gut, such as taking gut support supplements, probiotics, bone broth, and removing reactive foods.
Of course, all of those steps are essential in restoring gut health when someone is nutrient depleted or has a strong reaction to a particular food (like celiac disease), but they do not get to the underlying root cause of most cases of intestinal permeability… Gut infections!!
Thus, I recommend a three-pronged approach to healing the gut:
- Kill off any infections that may be irritating the gut wall and causing you to have leaky gut.
- Remove foods that are difficult to digest and that have big particle size for 30 to 90 days, such as gluten, dairy, soy, grains, nightshades, nuts, seeds.
- Add supplements that accelerate gut healing.
As I try not to adhere to a dogma of “there’s only one right way to healing” my infection protocols will include supportive foods, herbs, and medications, and sometimes a combination of all of the above to properly get rid of an infection.
Hashimoto’s and Infections
Chronic infections are the Hashimoto’s triggers that get the least amount of attention, yet identifying and treating them can result in a complete remission of Hashimoto’s. Additionally, some of the infections can be progressive, leading to more and more symptoms, if not identified and treated accordingly. Thus I want to make you all aware of them whenever I can.
Molecular mimicry is one of the leading theories of autoimmune disease. In very simple terms, this theory means that our immune system begins to attack our own thyroid gland because we are infected with a pathogenic organism (like a bacteria, parasite or virus), that looks similar to components of the thyroid gland. The immune system remembers isolated protein sequences on the pathogen (rather than the entire DNA sequence of the pathogen) and then looks for similar looking proteins as targets for an attack. If the proteins on the thyroid match the proteins the immune system remembered, then the thyroid will be targeted for attack as well. Therefore, the immune system attacks your thyroid glands due to a case of mistaken identity, when it is actually trying to attack an infection!
Another popular autoimmune theory that explains how infections can trigger autoimmunity is known as the bystander effect theory. This theory proposes that an infection inside the actual target organ leads the immune system to attack the “home’ of the infection. In the case of Hashimoto’s, the infection is inside thyroid cells, and thus the immune system attacks the thyroid gland.
Scientists have noted that in people with the right genetic sequence, an infectious agent that resembles the thyroid gland can trigger Hashimoto’s.
Where Do Infections Live?
Infections can live in your gums, your sinuses, your thyroid gland, your stomach, your intestines, and anywhere in your body. These infections can contribute to the development of autoimmunity through various mechanisms, depending on where they “live” (i.e. molecular mimicry outside of the thyroid gland, and the bystander effect inside of the thyroid gland). The infections that live in the gut, gums or sinuses can also contribute to intestinal permeability directly.
Why Isn’t There More Focus on Infectious Origins of Autoimmune Disease?
Scientists have found a great deal of evidence which suggests that Hashimoto’s is caused by an infectious cause. Hashimoto’s patients have positive blood tests indicating a past or current exposure to an infection and studies have shown that certain birth months have more common cases of Hashimoto’s (both of these factors are factors associated with infection-induced conditions).
However, scientists have yet to say that Hashimoto’s is caused by an infection because they’re looking for “ONE” single infection in every person with Hashimoto’s. But it’s not a black and white thing. The view that for an infection to be at the root cause means that every person with the disease should have the infection and that every person without the disease will be free of this infection is too simplistic.
Numerous infectious pathogens can have similar protein sequences to the thyroid gland, numerous infections have the ability to infect the thyroid gland, and many types of infections can cause leaky gut.
Some new research even suggests that our friendly bacteria (Lactobacillus species) has a similar protein sequence to the thyroid gland, so in the case of leaky gut, the good bacteria can get into our bloodstream and cause an immune response which can potentially cross-react with thyroid tissue.
All of those scenarios are potential mechanisms for how various infections could lead to developing autoimmune disease.
Studies fall short because they assume one infection = one condition.
In my observation, the equation is more akin to advanced calculus rather than simple (algebra) math! It looks more like: genes combined with infection A, and perhaps infection B, C, and even D, in the absence of nutrients and beneficial bacteria leads to the development of an autoimmune condition.
I’ve also had numerous readers and clients with Hashimoto’s report that their symptoms were greatly improved following treating the H. pylori Infection. Most of them showed a reduction in thyroid antibodies following the eradication of H. pylori; a few have gone into Hashimoto’s remission!
Here are Some Messages from Readers and Clients from my Archives:
- “I have been reading your book and decided to tackle any infections in my body…through this investigation I found I had H. pylori and 2 tooth infections. I have taken care of these infections to the best of my knowledge…a few weeks later my hair-loss is at an all time low!! Yessss…and with the addition of T3 my hair texture feels better too. I wouldn’t have known to look into this so thank you! On I go to the next step of healing my gut now!”
- “Dr. Izabella, I think you are on the right track…I have had Hashimoto’s for 20 years…. recently found out I had H. pylori. I have done the antibiotic treatment and my TPO just came back 17! I think the antagonist has been killed off!!! Haven’t felt this good in 20 years!”
- “I have an exciting update! I finished the H. pylori protocol you recommended last weeks and am now migraine free for almost two months! My joint pain is gone too! I just tested my antibodies, and they’ve gone from 953 to 366!”
- “After 20 years of having Hashimoto’s, I was treated for H. pylori. I feel better than ever; my TPO antibodies are in the normal range, and my doctor just reduced my medication!”
Root Cause Research Report
A 2013 Chinese study found a rate of H. pylori infection in 66% of people with Graves’ disease and 37.7% of people with Hashimoto’s. As the rates of H. pylori in controls was 32%, the researchers concluded that H. pylori was not likely a causative factor for Hashimoto’s, but of course, they did not perform genetic tests on the controls to determine if the controls had the correct genetic predisposition! After all, it’s a combination of genes vs. triggers.
Helicobacter pylori (H. pylori) is a Gram-negative spirochete shaped bacteria that burrows into our stomach lining and secretes urease, which neutralizes stomach acid.
The byproduct of the urease and stomach acid is toxic to epithelial cells as are the other chemicals produced by this bacterium, leading to damage to cells, a disruption of tight junctions and inflammation.
This bacterium can trigger an immune response and has been implicated in numerous autoimmune conditions, including Hashimoto’s.
While H. pylori is thought to be common in asymptomatic individuals – it can affect as many as 50% of people worldwide – I believe that similar to all autoimmune triggers, H. pylori is part of the perfect storm in a genetically susceptible and vulnerable individual.
H. pylori has been implicated in ulcers and can contribute to low stomach acid, leading people to improperly digest their foods. In turn, the poorly digested foods are not broken down properly, and thus the person ends up with multiple food sensitivities as a result of this infection.
Only a small percent, perhaps 5-10% of those infected will develop an ulcer with H. pylori. Others may have acid reflux, while as many as 50% may be asymptomatic!!
H. pylori is transmitted orally, from person to person, as well as potentially between people and their pets (who can resist doggie kisses, right?).
Thyroid Antibodies and H. Pylori
Antibodies produced in response to H. pylori can cross-react with many normal tissue antigens, such as gastric cells and even thyroid tissue!!
Antibodies to H. pylori were found in 46.5% of patients with Hashimoto’s in a small study in Iran, compared to just 11% in the general population.
The level of TPO antibodies was higher in people with Hashimoto’s with H. pylori, compared to those without H. pylori… The TG antibodies, however, did not seem to correlate.
Researchers tested 25 patients with TPO >700 kU/L were selected and tested for H. pylori. 72% tested positive via urea breath test.
So if those antibodies of yours are >700 kU/L, get checked for H. pylori STAT!!
Researchers in Italy identified 10 patients with Hashimoto’s and H. pylori. They treated half of the patients with medications to eradicate the infection and did not treat the other half. The results were astonishing – the people who were treated for H. pylori saw a 50-78% reduction in TPO antibodies, as well as a significant reduction in symptoms!
One patient who started with TPO=4745 kU/L, TG=1783 kU/L was able to see a reduction in thyroid antibodies, from 4745 to 45 over the course of 21 months, and TG from 1783 kU/L to 94 kU/L. The person was tested a total of 6 times, at the start, 3, months in, then 9, 14, 16 and 21 months after eradication.A pattern of reduction was seen within 3 months, and between month 16 and 21, TPO dropped from 100 kU/L to 45 kU/L, while TG dropped from 283 kU/L to 94 kU/L.
A pattern of reduction was seen within 3 months, and between month 16 and 21, TPO dropped from 100 kU/L to 45 kU/L, while TG dropped from 283 kU/L to 94 kU/L.
The other patients in the treatment group also showed patterns of reduction in TPO and TG antibodies. Reduction in TPO antibodies ranged from 50%-99%, while reduction of TG antibodies ranged from 31-95% over the course of 17-22 months.
Study Group –Received Treatment for H. Pylori
|TPOAb % Reduction||Initial
|TGAb % Reduction||Months Lapsed|
|1||4745 kU/L||45 kU/L||99%||1783 kU/L||94 kU/L||95%||21|
|2||1521 kU/L||434 kU/L||71%||74 kU/L||40 kU/L||46%||19|
|3||996 kU/L||312 kU/L||69%||73 kU/L||32 kU/L||56%||24|
|4||2157 kU/L||520 kU/L||76%||35 kU/L||24 kU/L||31%||17|
|5||1456 kU/L||724 kU/L||50%||0||0||n/a||22|
The five patients with Hashimoto’s and untreated H. pylori continued to have high TPO and TG levels… One person’s TPO antibodies stayed the same, another person’s decreased, while the three others decreased from 5-26%. Three people saw an increase in TG antibodies from baseline, and the other two saw a decrease of 6% and 16% over the course of 9-28 months.
Control Group – Did Not Receive Treatment for H. Pylori
|Patient||Initial TPOAb||Final TPOAb||TPOAb % Reduction||Initial TGAb||Final TGAb||TGAb % Reduction||Months Lapsed|
|1||1410 kU/L||1231 kU/L||13%||1341 kU/L||1483 kU/L||Increased||20|
|2||3440 kU/L||3440 kU/L||0%||311 kU/L||461 kU/L||Increased||28|
|3||4924 kU/L||4667 kU/L||5%||212 kU/L||200 kU/L||6%||17|
|4||1618 kU/L||1644 kU/L||Slight increase||70 kU/L||77 kU/L||Increased||9|
|5||9715 kU/L||7212 kU/L||26%||32 kU/L||27 kU/L||16%||17|
The treatment used in this study was triple therapy:
- Amoxicillin 1000 mg twice per day for 7 days
- Clarithromycin 500mg twice per day for 7 days
- Esomeprazole 20 mg twice per day for 7 days
(If you’re wondering why the researchers did not treat everyone, it turns out that the 5 controls all refused H. pylori treatment! 4 did not have symptoms, and one was allergic to antibiotics! )
Autoimmune Gastritis, Hashimoto’s, and H. Pylori
Autoimmune gastritis is a condition that often results in B12 and iron deficiency as well as cancerous gastric lesions. Parietal cell antibodies (PCA) are the self-antibodies that are produced in this autoimmune gastritis.
This condition was previously reported to affect 10-40% of people with Hashimoto’s. A 2014 study looked at the co-occurring rates of autoimmune gastritis in people with Hashimoto’s; this study was undertaken as autoimmune gastritis may contribute to the malabsorption of thyroid medication.
55 people with Hashimoto’s had their B12, Ferritin and PCA measured. 12.9% of people were found to have PCA, and all of them had an H. pylori infection! Furthermore, six months after these patients were treated for H. pylori, their PCA antibodies reversed, and they no longer met the diagnostic criteria for autoimmune gastritis.
The researchers thought it was peculiar that all of the PCA antibodies were due to “H. pylori infection and probably not due to a “per se” autoimmune gastric damage,” I think they missed the forest for the trees! Because H. pylori has been implicated as a trigger for autoimmune thyroid disease!
Three other studies have found that Hashimoto’s can be triggered by H. pylori, and there’s a strong connection to Graves as well.
While the researchers did not look at the rates of thyroid antibodies, other studies have found dramatic reductions in thyroid antibodies after treating Hashimoto’s.
Another study found autoimmune gastritis (AIG) to be present in 33.3% of people with autoimmune thyroid disease. AIG can cause low stomach acid. Anti-parietal cell antibodies were correlated with TPO antibodies, and parietal cell antigens in the stomach are very similar to the thyroid peroxidase enzyme.
This can result in low stomach acid and may require a person to need a higher dose of thyroid medications. In this study, around 40% of the patients presenting with gastritis had an H. pylori infection.
Marshall and Warren, the Original Root Cause Rebels
The story behind the discovery of H. pylori being the root cause of ulcers is one of my favorite stories and inspires me to keep doing what I’m doing despite a lack of acceptance of a root cause approach to Hashimoto’s in conventional medicine.
As early as 1899, Professor Walery Jaworski of the Jagiellonian University in Krakow found spiral bacteria in gastric washings of humans and was the first to suggest that these bacteria may cause gut issues.
This work was pretty much disregarded until almost 100 years after the initial connection, in the 1980’s two young scientists from Australia, Marshall and Warren were convinced that H. pylori caused ulcers!
However, their colleagues ridiculed them, as the conventional thought in those days was that no bacteria could survive the acidic environment of the stomach. Furthermore, ulcers were “obviously” caused by stress and spicy food, as time and time again, a stressed out person was more likely to come down with an ulcer. Of course, we know what happens when we are stressed out. Our bodies become more susceptible to infections, and also the microbes that we have living inside of us receive signals from our stress responses showing them that we are weak and giving them an opportunity to take over.
Most “serious” ulcer researchers were focusing on optimizing ulcer repair surgeries, not looking for bugs in a place bugs couldn’t grow!
But Marshall and Warren kept going. Though they had trouble growing the bacteria in Petri dishes, until one of them accidentally left the dishes in the incubator over the Easter weekend. Marshall was so convinced of his work that he actually drank a beaker of cultured H. pylori and became ill with nausea and vomiting several days later. He was found to have gastritis and H. pylori. He then showed that taking antibiotics to treat the H. pylori could reverse gastritis.
Finally, in In 1994, the National Institutes of Health stated that most ulcers were in fact caused by H. pylori and recommended the use of antibiotics for the treatment of ulcers.
This connection was big news and newly emerging research in 2002 when I started pharmacy school, 20 years after their initial discovery.
Eventually, the rest of the world caught up! Drs. Marshall and Warren were awarded the 2005 Nobel Prize in Medicine (23 years later). Slowly, physicians began to test for H. pylori in people with ulcers.
This is why I spend countless hours scouring the latest research for ways to reverse autoimmune disease. I not only look at what the recommendations are in conventional circles but also look for natural remedies, case reports and small studies from foreign countries, as well as the Journal of Medical Hypotheses.
I know that personally, I was not willing to wait 20 years for my endocrinologist to catch up, and you likely don’t have that time either, so that’s why I am passionate about bringing innovative treatment options to you!
Testing for H. Pylori
- Breath test
- Blood test
- Stool antigen test: self-order GI-MAP
Notes about testing: blood tests are also available for antibodies to H. pylori, but they may always differentiate between past and current infections. Conventional doctors may recommend an H. pylori breath test, but this will be positive only in severe cases. I prefer the stool antigen test which can uncover many low-grade infections as well.
The stool antigen tests I recommend above are advanced functional medicine tests that require the ordering practitioner to have an account set-up with. You can order them through a functional medicine practitioner, or go to Direct Labs for self-order options. (Note: self-order options are not insurance reimbursable).
H. Pylori Protocols
Pharmacologic Treatments for H. Pylori
- Triple therapy Option 1: omeprazole, amoxicillin, and clarithromycin (OAC) for 10 days; as directed by your doctor and pharmacist
- Triple therapy Option 2: bismuth subsalicylate, metronidazole, and tetracycline (BMT) for 14 days; as directed by your doctor and pharmacist
- Triple Therapy Option 3: lansoprazole, amoxicillin, and clarithromycin (LAC), which has been approved for either 10 days or 14 days of treatment; as directed by your doctor and pharmacist
- Quadruple therapy: Proton pump inhibitor, bismuth, tetracycline, and metronidazole as directed by your doctor and pharmacist
Please note: Most doctors will prescribe triple therapy or quadruple therapy to address this pathogen in the presence of a positive breath test and symptoms.
The above-mentioned treatments can take a toll on your gut health, leading to further dysbiosis. Adding an S. boulardii supplement to this treatment can increase the rates of eradication, and reduce the rates of dysbiosis from the use of antibiotics. Natural alternative protocols take longer but are also effective for suppressing H. pylori and also more gentle on your gut flora. Of course, the choice is between you and your doctor as to which path to take.
60 Day Natural H. Pylori Protocol
Some physicians may not recommend antibiotic treatments when H. pylori is found through a stool antigen test, and the person is asymptomatic, but you may benefit from the use herbal protocols to address it.
- Mastic Gum 500mg: Take two capsules three times per day (breakfast, lunch, dinner)
- DGL Plus: One three times per day (breakfast, lunch dinner)
- S. boulardii: 2 three times per day
While it’s ultimately up to you and your practitioner as to the right protocol to choose, I generally advise my clients to think about their symptoms, past reactions to antibiotics and timeline when choosing a treatment approach. For example, if someone had a prior negative reaction to antibiotics, they may want to consider the alternative route, and if someone felt an urgent need to address the infection due to severe symptoms, taking antibiotics may be a faster and more appropriate approach.
Cabbage juice, rich in glutamine can help support gut healing and suppress the H. pylori bacteria, promoting healing.
Instructions: Place cabbage in a masticating juicer and drink 4 ounces of cabbage juice daily to suppress H. pylori.
Have you been tested for H. pylori?
1. Aghili R, Jafarzadeh F, Bhorbani R, et al. The association of Helicobacter pylori infection with Hashimoto’s thyroiditis. Acta Med Iran. 2013;51(5):293-6.
2. Arslan M, Ekiz F, Deveci M et al. The relationship between cytotoxin-associated gene A positive Helicobacter pylori infection and autoimmune thyroid disease. Endocrine Research. 2015;40(4):211-214. doi:10.3109/07435800.2015.1015727.
3. Bassi V, Marino G, Iengo A, Fattoruso O, Santinelli, C. Autoimmune thyroid diseases and Helicobacter pylori : The correlation is present only in Graves’s disease. World Journal of Gastroenterology. 2012;18(10):1093-7. doi:10.3748/wjg.v18.i10.1093.
4. Bassi V, Santinelli C, Iengo A, Romano C. Identification of a correlation between Helicobacter pylori infection and Graves’ disease. Helicobacter. 2010;15(6):558-62. doi:10.1111/j.1523-5378.2010.00802.x.
5. de Luis D, Varela C, de La Calle H, et al. Helicobacter pylori infection is markedly increased in patients with autoimmune atrophic thyroiditis. Journal of Clinical Gastroenterology. 1998;26(4):259-63. doi:10.1097/00004836-199806000-00008.
6. Franceschi F, Satta M, Mentella M et al. Helicobacter pylori infection in patients with Hashimoto’s thyroiditis. Helicobacter. 2004;9(4):369-369. doi:10.1111/j.1083-4389.2004.00241.x.
7. Shi W, Liu W, Zhou X, Ye F, Zhang G. Associations of Helicobacter pylori infection and cytotoxin-associated gene A status with autoimmune thyroid diseases: A meta-analysis. Thyroid. 2013;23(10):1294-300. doi:10.1089/thy.2012.0630.