DR. IZABELLA WENTZ, PHARM D

Thyroid Pharmacist

The Importance of Gut Health

The Importance of Gut Health

Medically reviewed and written by Izabella Wentz, PharmD, FASCP on June 21, 2018

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What if I told you that the persistent bloating and stomach pain you’re experiencing could be your greatest ally on your road to recovery?

I’ve personally come a long way on my journey with Hashimoto’s over the years and hope to never return to the days when I was experiencing a long list of symptoms, including digestive problems, exhaustion, hair loss, brain fog, and anxiety. For years, I had no idea what was going on in my body, and even after my Hashimoto’s diagnosis, the long journey ahead of me toward recovery seemed daunting. Once I began to discover the connection between the gut and my Hashimoto’s diagnosis, however, I realized that I had an important key in my hands to unlocking my own remission.

While I was suffering from constant bloating, stomach pain, irritable bowel syndrome (IBS) and acid reflux, it was hard to imagine that any of those symptoms were doing me any good. But as I dove deeper into trying to uncover the mystery of these symptoms and a host of others that included exhaustion, hair loss, brain fog, and carpal tunnel, I learned to view them as a very important clue.

In my research, I came across the work of Dr. Alessio Fasano, a physician and researcher whose work has uncovered the idea that all autoimmune conditions, Hashimoto’s included, involve some degree of intestinal permeability, also referred to as “leaky gut”. His research led him to discover the three-legged stool of autoimmunity that has revolutionized the way we understand autoimmune disease.

The three legs consist of:

  1. Genetic predisposition
  2. A triggering event
  3. Intestinal permeability

I think we can all agree that we have no control over our genes, and identifying triggering event(s) that initiated your thyroid condition might take quite a bit of time and effort. But addressing leaky gut gives us an actionable pathway to begin healing and puts the power back in our hands, so we can begin the journey toward remission.

The Thyroid-Gut Connection

In the areas of natural and functional medicine, there is a widely held understanding that all disease (and thereby all healing) begins in the gut. And for good reason!

The gut performs the all-important role of digesting and absorbing the nutrients we take in, but it is also responsible for helping the immune system recognize foreign invaders from self-antigens, thereby facilitating the control of pathogens and preventing autoimmune reactions.

Interestingly, the fetal origin of the thyroid gland is the same as the stomach, digestive tract, and tongue. Because of this shared cellular origin, it would seem to make sense that improving digestive function often leads to a significant improvement in thyroid symptoms. This is encouraging news for those experiencing gut and thyroid issues!

While not everyone dealing with Hashimoto’s or leaky gut will experience bloating, stomach pains, irritable bowel syndrome and acid reflux like I did, most people with Hashimoto’s do have some degree of intestinal permeability. Even those who have no apparent gut symptoms may be experiencing intestinal permeability, and for anyone living with an autoimmune condition, addressing gut function might be the best place to start to bring healing to the body.

If we can reverse leaky gut, we can prevent or reverse autoimmunity.

What is Leaky Gut?

When functioning as they are designed to function, our healthy human intestines serve the role as both a barrier and a filter. A layer of cells form a mucus barrier, consisting of intercellular tight junctions similar to thread fibers that come together to form a piece of cloth. The intestines open and close their tight little junctions to allow nutrients to be absorbed from the food that passes through our gut and blocks the absorption of toxins like partially digested food, pollen, feces, dead cells, and bacteria that we certainly don’t want circulating around our bodies.

But what happens when those intestinal tight junctions become damaged and loose?

Those toxic substances become absorbed into the bloodstream, causing the body to recognize them as foreign invaders. This causes inflammation in the body as it begins to attack the intruders, and eventually leads to autoimmunity.

There are numerous factors that can cause intestinal permeability, and discovering which trigger (or triggers) is damaging your gut is key to restoring its function. These factors include:

How Do We Reverse Leaky Gut?

This long list of potential triggers can seem daunting, but the most common triggers that cause leaky gut are stress, food sensitivities, nutrient deficiencies, a deficiency in digestive enzymes, an imbalance of gut bacteria, and intestinal infections (including SIBO).

By addressing and managing stress and then tackling potential gut irritants, we can oftentimes reverse leaky gut and stop autoimmunity in its tracks!

There are four steps to removing some of the triggers and putting an end to leaky gut and its symptoms.

Step 1: Remove Reactive Foods

In some conditions, a single food can act as a trigger and induce intestinal permeability. This is the case with gluten (a protein found in wheat, barley and rye) and Celiac disease. Dr. Fasano estimates that for up to 20 percent of people with autoimmune conditions, the trigger may be gluten, and removing gluten will reverse the autoimmunity.

Even in a person without Celiac disease or any apparent gluten sensitivity, gluten can lead to a leaky gut because it is a protein that is difficult to digest for humans. While some people with Hashimoto’s go into remission just by removing gluten from their diet, others will need to search for additional “root causes”. These additional food sensitivities are likely to include dairy, soy, and grains, but might also include nuts, seeds, eggs or nightshades (potatoes, tomatoes, bell peppers and eggplant). The Autoimmune Paleo diet can be helpful with this.

I suggest that to discover the food triggers that are causing your leaky gut, begin by eliminating gluten, dairy, soy and grains for a period of 4 weeks. If you begin to feel a relief of gut symptoms after that trial period, you can slowly add each food group back into your diet, one at a time, allowing a few days between foods to see if you get a reaction.

If after eliminating each of these food groups you are still experiencing gut symptoms, it might be time to eliminate a wider group of possible food irritants.

This elimination diet would exclude:

  • Caffeine
  • Dairy
  • Eggs
  • Grains
  • Legumes
  • Nightshades
  • Nuts
  • Seaweed
  • Seeds
  • Sugar

It might seem extreme at first glance, but there are still many different delicious and healing foods you can eat while eliminating those that are causing your body harm.

Step 2: Supplement with Enzymes

Several studies have found that people with Hashimoto’s and hypothyroidism often have a deficiency in hydrochloric acid, resulting in low levels or even a complete absence of stomach acid.

Digestion is one of the biggest energy-requiring processes of our bodies. When extra effort is required to break down the proteins we eat, it takes a huge toll on our bodies and can often lead to extreme fatigue – a common symptom for those dealing with thyroid and other autoimmune conditions.

A digestive system that is weakened by difficulty with digesting proteins can set off a chain reaction of greater digestive trouble as it struggles to digest the more complex protein molecules found in gluten, dairy and soy. When proteins are poorly digested, we are more likely to become sensitive to them, leading many people with Hashimoto’s to become sensitive to gluten, dairy and soy, among other foods.

It’s a vicious cycle, but one that can be slowed by supplementing with hydrochloric acid and digestive enzymes, which can assist the body in breaking down these difficult to digest proteins and improving overall intestinal function and vitality. My research and personal experience have led me to recommend a few supplements to help restore proper gut function.

1. Betaine HCL with Pepsin – When I first took Betaine HCL after struggling for a decade with debilitating fatigue, I was amazed at how my energy returned almost overnight! I no longer needed to sleep for 12 hours, and my bloating was significantly reduced. All because I was finally able to digest my food.

Betaine HCl and Pepsin are naturally occurring components of the gastric juices that break down protein bonds in our food to make nutrients and amino acids more bioavailable. They are especially important for proper absorption of protein, calcium, B12, and iron. Taking Betaine HCL with Pepsin after every protein-containing meal can assist with digestion and greatly improve energy levels. I recommend the Betaine with Pepsin supplement by Rootcology, the brand I have personally formulated. I have also used Pure Encapsulations’ Betaine with Pepsin.

2. Proteolytic Enzymes – Also known as systemic enzymes, proteolytic enzymes can help bring our immune system back into balance by breaking down pathogens and reducing inflammation that can lead to autoimmunity. In Europe, these systemic enzymes have been studied extensively and have become a popular alternative to pain medications for many inflammatory conditions.

To help restore a leaky gut, I recommend a dose of five capsules taken three times a day on an empty stomach. Systemic Enzyme Complex by Pure Encapsulations is an excellent proteolytic supplement.

3. Fat Digestive Enzymes – Fat malabsorption is easily overlooked by patients and practitioners alike, but is a common occurrence, affecting 40 to 50 percent of people with Hashimoto’s. Some signs and symptoms of fat malabsorption include greasy, smelly, floating, light-colored stools, gas or belching after eating, diarrhea, dry skin, stomach pain, gallbladder pain (which is on the right side, under the ribs), gallstones, gallbladder removal, nausea, weight loss, hormonal imbalances, and adrenal issues. A low fecal elastase test on functional medicine stool testing can also indicate fat malabsorption.

Potential reasons why a person may have difficulty with fat malabsorption include bile deficiency, pancreatic enzymes deficiency, liver backlog, and small intestinal bacterial overgrowth (SIBO).

The Rootcology Liver & Gallbladder Support supplement can help fat digestion in three different ways: it can support the liver’s ability to process fat with milk thistle, give us extra bile via ox bile, and support our bile flow with dandelion, artichoke, and beets. If you have issues with fat malabsorption, this is life-changing support.

4. Vegetable Digestive Enzymes – Many people with Hashimoto’s may also have an impaired ability to digest vegetables due to fiber and starch content. In some cases of hypothyroidism, an indigestible ball of plant fiber material known as a phytobezoar has been found to cause bowel obstruction. In the case of poor fiber absorption, undigested vegetables fibers may be found in the stools, and high-fiber meals may cause bloating. A vegetable digestive enzyme that contains fiber-digesting enzymes like cellulase, and/or starch digesting enzymes like amylases, may help with digesting vegetables. I formulated the Rootcology Veggie Enzymes with a specific combination of enzymes, including cellulase and amylase, to help support this digestive process.

5. Broad Spectrum Digestive Enzymes – A broad spectrum digestive enzyme may also be helpful with decreasing symptoms of nutrient deficiencies and increasing energy. Broad spectrum enzymes, like Digestive Enzymes Ultra from Pure Encapsulations, promote optimal digestion of proteins, fats, and carbohydrates. Digestive Enzymes Ultra is comprised of a mixture of vegetarian enzymes, to support enhanced digestion for optimal nutrient bioavailability and absorption.

6. Aloe vera can help address gut health is by improving one’s digestion. Aloe vera is full of enzymes (alliinase, alkaline phosphatase, amylase, bradykinase, carboxypeptidase, catalase, cellulase, lipase, and peroxidase). Since many people with Hashimoto’s are deficient in digestive enzymes, aloe vera’s high enzyme content can actually support digestion by breaking down carbohydrates and fats from foods.

Aloe vera also can help with acid reflux, as it contains natural alkaline properties which can help balance the pH in the colon. Though many people with Hashimoto’s have a lack of stomach acid that will cause symptoms of acid reflux, those who have an overabundance of stomach acid and are at risk for ulcers may benefit from the alkalizing properties of aloe. Studies have shown aloe vera to be well tolerated and as effective in reducing symptoms of gastroesophageal reflux disease as common reflux medications such as omeprazole or ranitidine.

I recommend one capsule per day of Aloe by Rootcology, which is highly concentrated. In fact, it takes 200 pounds of aloe vera gel to make one pound of this nourishing aloe extract!

Step 3: Balance the Gut Flora

The gut is home to trillions of bacteria, and studies have shown that autoimmune disorders can be brought on by an overabundance of the wrong type of bacteria, and can be reversed by an increase in beneficial bacteria. So, you can see how important it is to make sure our gut flora is well balanced.

Gut flora balance is achieved in large part through eating a wide variety of healthy foods, but for those on restrictive diets to help get to the root cause of their autoimmunity, this might be difficult. For that reason, it is often necessary to supplement with fermented foods and probiotics.

Fermented foods – Sauerkraut and similar fermented vegetables are a wonderful source of beneficial bacteria and can help to restore proper gut flora when consumed regularly. Similarly, kefir and yogurt offer an abundance of good bacteria, but should be avoided by those who have been determined to have a sensitivity to dairy. Coconut yogurt and fermented coconut water are great alternatives.

Probiotics – Widely used to rebalance gut bacteria, probiotics can be a powerful tool for those dealing with leaky gut, as they can help restore healthy gut flora by displacing the pathogenic bacteria.

It is important to note that not all probiotics are created equally, and it’s crucial to start slowly and build up from there. As the “good” bacteria begins to take up residence in your intestines and displace the “bad” bacteria, the die-off can sometimes create what’s called a Herxheimer reaction. This can include lethargy, difficulty concentrating, cravings for sweets, diarrhea, rashes, irritability, gas, bloating, headache, nausea, vomiting, congestion, and increased autoimmune symptoms. This type of reaction usually clears within three to five days and leaves the person feeling much better in the end.

There are several different types of probiotics that can be beneficial for those dealing with Hashimoto’s. Lactic acid-based probiotic recommendations include Ther-Biotic Complete by Klaire Labs, and Probiotic 50B by Pure Encapsulations. Yeast-based probiotics are a safer option for those combating SIBO (small intestine bacterial overgrowth), in which case I recommend S. boulardii by Rootcology.

Finally, spore-based probiotics have recently been shown to reduce allergies and asthma, in addition to helping recovery from autoimmune disease and reducing SIBO. I recommend MegaSporeBiotic.

Step 4: Nourish the Gut

Providing nourishing food and supplements is an important last step to give your gut long term support. By adding a few critical nutrients, we can both heal and help prevent leaky gut.

One of the easiest ways to soothe and heal the lining of the gut is to have a delicious cup of bone broth. Bone broth is a traditional food that we hear a lot about these days because it really is one of the most nourishing foods we can feed our bodies.

The reported benefits of bone broth include boosting immunity, relieving joint pain, increasing energy, improving digestion, and giving you a more youthful appearance. Most importantly, for those suffering from leaky gut, the gelatin in bone broth actually helps to seal the junctions in the intestines so they are no longer permeable; and so that toxic substances can no longer pass through the intestinal wall.

Best of all, bone broth is cheap and easy to make and makes a delicious beverage or soup to sip any time of day.

Here’s an easy bone broth recipe that can be thrown together in a slow cooker before bed and enjoyed the next day:

Easy Bone Broth

5 chicken legs
2 cups mixed chopped carrots, onions, and celery
1 tablespoon apple cider vinegar
Sea salt to taste
Purified water

Add all ingredients to a slow cooker and cook overnight, or for 8-24 hours. You’ll wake up to a delicious smell!

Watch my Video on How to Make Bone Broth

In addition to bone broth, supplemental L-glutamine (5 g, 3 times per day), zinc (no more than 30 mg per day), NAC (1800 mg per day), omega-3 fatty acids (1-4 g per day), and Vitamin D (5000 IU per day) have nourishing properties that can assist in healing the gut lining and restoring optimal gut function.

Could an Infection Be at the Root?

In some cases, even after removing problematic foods and adding supplements, a person will still have symptoms of a leaky gut. In this case, we’ve got to look even deeper to get to the root cause, which can oftentimes be found in an underlying gut infection.

Since gut infections can lead to intestinal permeability, removing the infections can be the missing link in gut repair. It can be tricky to identify which type of infection is the culprit, but a few common ones I see in my Hashimoto’s clients include: Blastocystis hominis, H. pylori, SIBO or yeast overgrowth.

If you’ve hit a plateau with your healing and are losing more foods, instead of gaining foods back after a “leaky gut protocol”, I recommend pursuing gut testing. However, all gut tests are not created equally! I personally had numerous gut tests show that I was “negative” for a gut infection before I tested positive for Blastocystis hominis, a potential Hashimoto’s trigger. My current favorite test for gut infections is the GI-MAP stool test.

I also recommend testing for SIBO. SIBO testing is done via breath testing, like the Small Intestinal Bacterial Overgrowth 3-Hr Lactulose -Genova Kit. Unfortunately, current stool tests do not test for SIBO, and SIBO breath tests will not reveal infections in the stool.

For more information about identifying and treating these infections, you may wish to read the “Advanced Protocols” chapter in my book Hashimoto’s Protocol: A 90-Day Plan for Reversing Thyroid Symptoms and Getting Your Life Back.

If you discover that you do have an intestinal infection, the good news is that you now know one of the root causes of your autoimmune condition and have targeted tools to help you heal. You may need a combination of treatments that might include various types of herbs, as well as antibiotic, antifungal, antiviral or antiprotozoal agents, to eradicate these infections. Each infection will require a different approach, but please believe that with the right support, healing your gut can lead to an elimination of your gut-related symptoms—and recovery is possible!

You can find more information about the gut and thyroid connection, along with my complete healing protocol, in my book Hashimoto’s Protocol.

Also, be sure to sign up to my weekly newsletter to get a free book chapter, recipes, Thyroid Diet start guide and notifications about upcoming events and my latest research.

References

  1. Fasano A. Leaky gut and autoimmune diseases. Clin Rev Allergy Immunol. 2012;42(1):71-78. doi:10.1007/s12016-011-8291-x.
  2. Kvantchakhadze R. Wobenzym in the complex treatment of autoimmune thyroiditis. Int J Immunorehab. 2002;4(1):114.
  3. Liponis M, Geyer C, Hubkova T. Successful Eradication of Helicobacter pylori With Over-the-counter Products. . 2015;7(5).
  4. Mariani M, Palpacelli A, Mussoni A, Rossodivita A. Hashimoto’s thyroiditis: an accidental discovery of a lingual thyroid in a 7-year-old child. Case Reports. 2013;2013:bcr2013200247-bcr2013200247. doi:10.1136/bcr-2013-200247.
  5. Mehrdad M, Mansour-Ghanaei F, Mohammadi F, Joukar F, Dodangeh S, Mansour-Ghanaei R. Frequency of Celiac Disease in Patients with Hypothyroidism. Journal of Thyroid Research. 2012;2012:1-6. doi:10.1155/2012/201538.
  6. Mori K, Nakagawa Y, Ozaki H. Does the Gut Microbiota Trigger Hashimoto’s Thyroiditis?. Discovery Medicine. 2012;14(78):321-326.
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  1. Hello,
    I was diagnosed with Hashimoto’s when I was 15 years old (I’m 23 now), and my symptoms until now haven’t been incredibly severe. I have had brain fog, anxiety, depression, some constipation, fatigue, headaches, joint pains, etc. for years but felt a lot better after starting the Hashimoto’s protocol. However, recently I got back after spending a semester outside Puerto Rico (my home) and am experiencing symptoms I believe to be a flare up. It started with some very low level abdominal pain, which then turned into leg pain (the left leg), and that went away with exercise. I also have experienced some tingling sensations in arms, hands, legs, feet. And then later I developed some back and chest tightness, and very recently some mild palpitations. What’s worrying me the most, though, is that my abdominal pain came back after my period had passed (and it was an exceptionally difficult period- horrible pains that left me weak with nausea and almost unable to move). Although my only symptom as of now is that low abdominal pain that also hurts my lower back and some occasional tenderness, I’m afraid this could also be a result of Crohn’s disease and not a flare up. What do you think?

    Reply

    • Gabriela – thank you for reaching out and sharing your journey. <3 Please, understand that due to liability issues, I am unable to answer specific medical questions, but I highly recommend that you work with a functional medicine clinician to be a part of your own health care team. It’s an entire medical specialty dedicated to finding and treating underlying root causes and prevent serious chronic disease rather than treating individual disease symptoms.

      FUNCTIONAL MEDICINE APPROACH TO THE THYROID
      https://thyroidpharmacist.com/articles/functional-medicine-approach-to-the-thyroid

      CLINICIAN DATABASE
      https://www.thyroidpharmacistconsulting.com/clinician-database.html

      FIND A FUNCTIONAL MEDICINE CLINICIAN
      https://ifm.org/find-a-practitioner/

      Reply

      • Thank you for your wonderful information! My condition is difficult to diagnose because I don’t know if my symptoms are my hormones or my hashimotos. My tpo antibodies are above 700. My symptoms are foggy brain, problem sleeping, fatique, low temperature which makes it hard to lose weight, and I have no energy to work out. I’ve really lost my zest for life, and all the doctors will tell me to take is reactive selemium. I also take iodine, D. but I will get a probiotic and start taking zinc. I feel is important to work on leaky gut,I don’t know if I have any food allergies and I’m never sick, other a
        than hashimotos. Please help me I’m fading fast, thank you, Shelley Thompson

        Reply

        • Shelley – thank you for reaching out and sharing your journey. I am so sorry you are struggling with all of this. Hang in there! <3 Having Hashimoto’s can feel very stressful. Having out of range thyroid hormones, adrenal fatigue, negative food sensitivities and low nutrient levels can lead to feelings of anxiety, hopelessness, and stress. Treating these issues one at a time is the best plan of action. You can recover and regain your health! My new book Hashimoto’s Protocol is a step by step guide to the interventions that helped 80% of the people 80% of the time. I hope you check it out.

          Hashimoto’s Protocol
          http://amzn.to/2B5J1mq

          You may find this article helpful as well:

          WHICH SUPPLEMENTS ACTUALLY HELP HASHIMOTO’S
          https://thyroidpharmacist.com/articles/which-supplements-actually-help-hashimotos/

          Reply

    • I was looking for the same thing as I have read about all the potential gut issues and healing ways. After following through for many many months I still struggle with understanding when my gut is healed. My SIBO was treated and H pylori treated and negative post testing but knowing if leaky gut is healed is challenging.

      Reply

    • Mary – thank you for reaching out! I appreciate you pointing this out! I am sorry for the confusion, many people see a reduction and/or complete elimination of their GI and gut-related symptoms when their gut is healed. 😉 I hope that helps.

      Reply

      • Hi Izabella,
        Thank you for all your help, reading your work and following your advise has been miraculous to me.
        I have noticed a reduced amount of bloating and symptoms to my gut health, and I feel much, much better from most of my symptoms of Hashimoto’s.
        My tests show that my antibodies have reduced significantly but still show the presence of Hashimoto’s. Will this always be the case or can I continue to work towards full recovery? My medical doctor in Australia says that I will always show a presence of Hashimoto’s although he is astonishing of my recovery so far.
        Kind Regards,
        Marisa

        Reply

  3. You suggested in one of your articles an amino acid supplement for muscle wasting.
    Can you let me know what it is? I have your Hoshimotos Book, but if I read it there I can’t find it.
    I have really enjoyed your book. Thank you.

    Reply

  4. My doc says I don’t have an autoimmune disease after checking for one thyroid antibody two years ago. However she says I do have hypothyroidism (high RT3, low T3, low TSH ). Today, I’m still losing hair (scalp feels like it’s on fire whenever I touch it), my stools float, high ferritin (150) and inflammation now moving to my one finger. Food intolerance test suggests I remove certain things and I have with a slip up here and there. I take betain w/ dinner, and eat a low carb diet since developing increasing glucose numbers. My A1C has dropped to 5.4. However, if things can improve I want to get even better. Any suggestions?

    Reply

  5. With all these recommendations for supplements, surely they could all be acting against each other?

    Reply

    • Sue – thank you for reaching out. I believe that most nutrients should come from the diet. This is why I always list food sources in the book and on the blog, for most of the nutrients, vitamins, minerals. and probiotics that are depleted in Hashimoto’s. However, some may require or prefer supplements. I recommend getting tested for deficiencies to determine your need for a supplement as instructed in the book and blog. I also don’t recommend starting multiple supplements all at once. I recommend starting one at a time and then adding another a week or so later once it has been confirmed that the first supplement is not causing any harm.
      I do have a full supplements chapter in my books. Have you checked them out? Not everyone should be taking every supplement and any of these books will help uncover your root cause. This will help you figure out your supplementation. Here are the links

      Hashimoto’s Root Cause:
      http://amzn.to/2DoeC80

      Hashimoto’s Protocol (this is my latest book):
      http://amzn.to/2B5J1mq

      Reply

  6. Dr Izabella, I have hypothyroid and have had left side of thyroid removed because of nodules in 2015. Since then I have experienced all that you have written about and more. It’s like my body is attacking itself but I can’t find any answers or solutions. I literally feel like I am dying. I have been to 4 Drs since March 1 of this year. I passed parasites the end of February and started a treatment which started the die off process. Now I am passing the lining of my stomach. All tests come back negative for parasites but I see them in my stool. I’ve taken samples and pictures to the Drs but none of them have an answer. They send me from one Dr to the next. I have referenced Lesky Gut and several conditions you mention in your book. None of them give any credence to what I mention. Please, I need help. I live in Plano, TX. Who can I go to for some help? Can you please give me a Drs name? I have lost 30 pounds since February and I am waisting away. I am so tired.
    Thank you.

    Reply

    • Mary – thank you so much for sharing our journey with me. <3 I am so sorry you are struggling with these issues. I believe that everyone needs to find a practitioner that will let him/her be a part of the healthcare team. You want someone that can guide you, that will also listen to you and your concerns. You want someone that’s open to thinking outside of the box and who understands that you may not fit in with the standard of care. It's a good idea to ask some standard questions when contacting a new doctor for the first time. Something else to consider is you can work with a functional doctor remotely, via Skype. You could also contact your local pharmacist or compounding pharmacy, who may be able to point you to a local doctor who has a natural functional approach. But I encourage you to keep looking for the right one for you! Here are some resources you might find helpful.

      CLINICIAN DATABASE
      http://www.thyroidpharmacistconsulting.com/clinician-database.html

      FIND A FUNCTIONAL MEDICINE CLINICIAN
      https://ifm.org/find-a-practitioner/

      COMPOUNDING PHARMACIES
      http://www.thyroidpharmacistconsulting.com/recommended-compounding-pharmacies.html

      Reply

  7. Hi, the skin on the palms of my hands, and fingers keep peeling, is this symptomatic with a low thyroid.. What happens when your body’s own antibodies attack your thyroid?

    Reply

    • Patricia – thank you for reaching out. I am sorry to hear you are suffering with this skin condition. Our skin is a window to our internal health. It is the body’s largest elimination organ, and also a canvas where toxicities, nutrient deficiencies, food sensitivities and hormonal imbalances can show up. Women with Hashimoto’s and autoimmune conditions are more likely to have dry, dull skin, rashes, hives, pre-menstrual acne and facial swelling, especially if their thyroid levels are not optimized and they are not absorbing vitamins and nutrients correctly.

      THE THYROID AND SKIN
      https://thyroidpharmacist.com/articles/the-thyroid-and-skin

      Reply

  8. Ron Hoggan, a person who has been an activist in the fight against gluten-triggered illness, told me that recent studies (not exhaustive or double-blind) imply that non-celiac gluten intolerance affects about 12% of the population. Which is what I had for most of my life. Izabella, have you heard anything like this?

    Reply

  9. Hi,
    as usually your article is very interesting.
    I have no idea, if I have any problem with my thyroid, but many symptoms shows that I do, although standard tests are OK. I changed a lot in my diet, and see improvement.
    I am a big fan of a bone broth. I am (like You yourself) from eastern Europe, where bone broth, in my language named ROSOL, was often eaten with handmade pasta on Sunday or holidays. I cook it a few times a month and each time I think it is food from heaven. It’s perfect to drink, perfect to eat as soup with gluten free pasta, or as a base for many other soups. So I’d like to share my way of cooking it.
    Usually I use whole chicken ( but just bones are great) + I add carrot, parsley: root and the green top ( or parsnip), leek, celery (root and, or stalks), onion, few (3 to 6-7) cloves of garlic, bay leaves (2-3), salt and up to 20 pepper corns and cook it very, very slowly for a long time. It’s easy and delicious.
    Bon appetite!
    Anna

    Reply

  10. Dr. Wentz,
    How do I go about fixing my “Leaky gut”? Do I do the first step and then the subsequent steps or all at the same time?

    Reply

  11. Been following your work for awhile, but never commented. Thanks for all the good info, and congrats on the pregnancy! Do you have good articles or references of yours or of others, about why lactic based probiotics are tricky with SIBO? I’m not positive if I have it, and have read often that the breath test is iffy, but my practitioner wants me to begin taking mega doses of VSL3, and I’m not sure about that. Did start the MegaSporBiotic and Saccarodes. Trying to determine also where Elixa probiotic falls into these categories as well? Thanks!

    Reply

  12. Some years ago I was diagnosd with Graves’ disease. My symptoms at the time were 140 beats per minute heart rate, heat sensations, rapid speech, anxiety. I went to the hospital and the doctor there wanted to ablate (burn out, remove) my thyroid. I refused. On the suggestion of a nurse, I took Lugol’s Solution of iodine. My symptoms faded in a few days and became hypothyroid! Symptoms: slowed speech, slurred pronunciation, cold, depression, low energy. This time my blood test showed hypothyroid and, I believe, it was Hashimoto’s. My nurse acquaintance said to stop iodine supplementation and my thyroid would normalize. In about 10 days it did! At that time I had an appointment with a thyroid specialist. He turned out to be the doctor in the hospital who wanted to destroy my thyroid. I told him what happened. I asked the question: If my thyroid function moved from hyper- to hypo- with the inroduction and removal of iodine, aren’t these two supposedly separate diseases (Graves’ and Hashimoto’s) really simply the same condition taking place in high and later low activity? The same gland at high activity and at low activity? Having two names (Graves’ and Hashimoto’s) make the phenomenon appear to be two separate conditions when in reality they are one. He did not answer me. What is your opinion? And, what about this dual effect of iodine? Thanks.

    Reply

    • David – thank you for reaching out and sharing your journey. Graves and Hashimoto’s are both autoimmune conditions that affect the thyroid. They are thought to be closely related. Sometimes one turns into the other. The difference is the site of the antibody attack. In Hashimoto’s, the antibodies are found to thyroglobulin (in 80%) and thyroid peroxidase (TPO) enzyme (in 95% of people) Hashimoto’s results in hypothyroidism and is usually treated with Synthroid and replacement hormone. The same antibodies may be present in a smaller percentage of people who have Graves, but the main antibody is to the TSH Receptor (TSHR-Ab). Usually, people with Graves have hyperthyroidism, and they are treated conventionally with thyroid suppressing drugs (methimazole) or radioactive iodine to destroy the thyroid. At that point, the thyroid will no longer produce hormones on its own, and these people end up on Synthroid as well. Most thyroid conditions result from the immune system attacking the thyroid because the immune system is out of balance. Even when the thyroid is taken out surgically or treated with radioactive iodine the autoimmunity still persists in most cases. Many people will have their thyroids removed, and will develop new autoimmune disorders such as Lupus, Rheumatoid arthritis, etc. The immune system just finds a different target.
      We need to rebalance the immune system to prevent this. Sometimes the autoimmunity can be reversed as well! The gut determines your immune system.

      I am very hesitant in recommending iodine in Hashimoto’s. Although iodine serves as fuel for our thyroid and is very important in iodine deficiency hypothyroidism, Hashimoto’s is a different mechanism. It’s like pouring gas into an engine that’s on fire… that’s essentially what’s happening in Hashi’s, thyroid inflammation. Adding iodine to the mix before putting out the fire and fixing the engine may result in further damage to the thyroid. In those with a predisposition to autoimmunity, this has been documented time and time again, in animal and human studies.

      I have spent 4 years researching, and have seen too many people suffering the consequences of adding iodine too soon. My approach is, let’s fix the engine first (usually a gut issue), and then add the fuel once we know that the engine is no longer on fire. Hope that you will check out my books. I do have a chapter on the iodine controversy that references numerous studies as well as the work of Abraham and Brownstein. Here are the links to my books :

      Hashimoto’s Protocol
      http://amzn.to/2B5J1mq

      Hashimoto’s Root Cause
      http://amzn.to/2DoeC80

      Reply

  13. How long should I take Betaine HCL with Pepsin before my meals? Will a Hashimoto’s compatible diet restore my stomach acid or will I always need something to help my stomach function properly?

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  14. Thank You Dr. Isabella Wentz, Pharm D for all your help and your books and suggestions with everything to do with thyroid and Hashimotos!! You have helped me over and over!! It is such a joy to know I can turn to you for help and support and just knowing I am not alone is such a blessing and the hope that you give me that one day I can be free of all my issues and live a happier healthier life!! You amaze me how you have done so much to make this better for you and so many others!! I know I would be lost without You!! I hope to be closer to feeling and living a better and healthier life!! I just wanted to say Thank You From the Bottom of my heart!! ❤️

    Reply

  15. Hi Izabella,
    I am so thankful for you and all you’ve done for Hashimoto sufferers! Recently, someone asked me about einkorn flour. I figured that it still being wheat, it would be
    still be a no no for Hashimoto patients, let alone for Celiac patients. I couldn’t find anything in your articles about it and wondered what your thoughts were?
    Thank you.

    Reply

    • Claudia – thank you for reaching out. <3 I don’t currently have information to share on this but, I will add it to my list of possible future articles to research. I hope your thyroid healing journey is going well.

      Reply

  16. After a lot of time spent on the Autoimmune Diet with mixed results, I found that the foods causing the most issues were FODMAPs, and I suggest mentioning FODMAPs in your section on Reactive Foods.

    Reply

  17. I really appreciate this article, it seems to have all the fragments that concern thyroid issues, all in one place!

    I have a question. Suppose I don’t do a complete elimination diet, by keeping in legumes, seeds and eggs, would that be okay? Because I eat these on a regular basis and don’t feel bad in any way after consumption, unlike the way I feel when I eat gluten.

    Reply

    • Tanya – thank you so much for reaching out. <3 Until you eliminate the foods from your diet, it will be nearly impossible to correlate your symptoms with a food. This is because food sensitivities can take up to 4 days to manifest. You will only notice that you are reacting to the food if you withdraw it for a time-period of at least 3-4 days. The most common food sensitivities found in people with Hashimoto’s are gluten, dairy, soy, grains, nightshades (potatoes, tomatoes, and peppers), legumes, nuts, and seeds. Did you know that reactive foods trigger an inflammatory response in the GI tract, leading to malabsorption of nutrients (gluten sensitivity, in particular, has been implicated in causing a Selenium deficiency, a well-known risk factor for Hashimoto's), and can also produce intestinal permeability whenever they are eaten? Most people will see a dramatic reduction in gut symptoms, brain symptoms, skin breakouts, and pain by eliminating the foods they are sensitive to. Some will also see a significant reduction in thyroid antibodies! An additional subset of people will actually be able to get their Hashimoto's into complete remission just by getting off the foods they react to, normalizing their thyroid antibodies, and some even normalizing their thyroid function! Here are a couple of articles you may find helpful.

      FOOD SENSITIVITIES AND HASHIMOTO'S
      https://thyroidpharmacist.com/articles/food-sensitivities-and-hashimotos

      AUTOIMMUNE PALEO DIET
      https://thyroidpharmacist.com/articles/autoimmune-paleo-diet

      Reply

  18. I was diagnosed with hypothyroidism in 1995/6 and have been reading your posts for the last year with great interest as they cover the wide range of sometimes minor, odd and seemingly unrelated symptoms I live with.

    I am curious about probiotics, as I have suffered most of my life with constipation, and am mildly lactose intolerant. I was only tested for anti-bodies twice, first in 2005 which showed mild ratings. I cut out gluten soon after, and as of June, 2020 am not showing antibodies. However, the constipation remained.

    I have found that eating cultured (coconut) yogurt daily helps considerably.

    S. boulardi is frequently mentioned by you, sometimes in relation to IBS and sometimes not. Do you think it would be of assistance for those of us who suffer from constipation, likely in relation to Hashimoto disease, but not IBS or diarhea?

    I look forward to your comments.

    Anne

    Reply

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