Hashimoto’s can be exacerbated by or caused by a variety of triggers (or root causes, as I like to call them). The root causes for each person will vary, but in general, they can be grouped into food sensitivities, nutrient depletions, chronic infections, an impaired ability to handle stress, gut issues, and toxins.
While I’ve found that nutritional interventions are helpful for many people, in some cases, we need to dig deeper.
One of the things I really love about my work as a practitioner and thyroid advocate is the power of community. I learn just as much from my readers and clients as you learn from me!
A while back, after I had shared that nuts can sometimes be a trigger for acne, one of my readers wrote in about her experience with nickel hypersensitivity and Hashimoto’s.
I have celiac and Hashimoto’s, and had skin breakouts with nuts and some other foods. It turned up to be Systemic Nickel Allergy Syndrome – SNAS. It’s everywhere and particularly in nuts (and other seeds) and chocolate etc. ~Reli”
While I’ve had clients presenting with various types of toxicities, I hadn’t specifically worked with anyone with a nickel allergy. Nonetheless, I wanted to do a bit more research about the connection and offer some guidance and solutions in the case that nickel was a potential root cause for you. While various toxins are found in different places and may present with different symptoms, the general approach to addressing them will be very similar and focused on avoiding exposure to the toxin; and in the case of buildup in the body, removing it from the body. Additionally, in some cases, desensitizing ourselves from the toxin may be possible.
Since that time, one of my team members, who also has Hashimoto’s, recently discovered she has a nickel allergy after previously wearing costume jewelry and dental braces without any issues for many years. As she has been managing it with lifestyle and dietary interventions, she has successfully been eliminating one of her Hashimoto’s symptoms. She never realized, however, that her nickel allergy could also be a root cause of her Hashimoto’s!
Nickel allergy is a common condition, and it has been estimated that about 8.6 percent of people may have it worldwide. It is especially prevalent among young females, as about 17 percent of them have this condition. It’s also quite common in those with Hashimoto’s and may even play a role in the development of thyroid nodules and autoimmune diseases.
Are you unable to wear cheap costume jewelry? Many people informally discover their nickel allergy after reacting to inexpensive jewelry and cope with this realization by simply avoiding nickel-containing accessories. However, many do not know that their chronic contact dermatitis and skin issues could be an allergic reaction to nickel exposure from other sources, including everyday metal items and ingesting certain foods. Are you one of them? I have good news: these symptoms can be reduced with functional medicine interventions!
In this article, we’ll discuss:
- What is nickel and where can it be found?
- What are the symptoms of nickel allergy?
- How to test for a nickel allergy
- The connection between Hashimoto’s and nickel allergy
- Items and foods to avoid… and nickel free solutions!
What is Nickel and Where Can It Be Found?
Nickel is a silver-colored metal that can be found in rocks and soils, and it can form numerous alloys with other metals. Nickel is commonly alloyed with iron to create tough and corrosion-resistant stainless steel.
Unfortunately, it can leach into our bodies from cookware and cooking utensils, especially when the utensils are heated up or when cooking with acidic foods. For this reason, while stainless steel pans have been considered a healthier alternative to toxic Teflon-coated pans, nickel from the stainless steel pans can be problematic for some.
Aside from cookware, there are many other places where nickel can be found. Here’s a list of the most common sources of nickel:
- Food sources: Chocolate, nuts, canned foods, black tea, shellfish, processed meats with fillings or casings, beans, lentils, soy, peas, wheat, oatmeal, buckwheat, seeds, bean sprouts, Brussels sprouts, asparagus, broccoli, cauliflower, spinach, canned vegetables, and hydrogenated oils. (Please note, the nickel content in these foods may vary depending on differences in mineral content in different soils and regions.)
- Everyday Products: Electronic devices including iPhones, jewelry, electrical equipment and household appliances, batteries (Ni-Cd), metal and coins containing nickel, pens, eyewear, credit cards, clothing hardware (bra hooks/straps, zippers, buttons, belts), and lotions (containing shea butter, oats or cocoa butter).
- Medical devices: IUD devices, orthodontic appliances, and dental crowns and bridges.
- Other sources: Vitamins with nickel, tap water, tobacco, and public transit railings.
What is a Nickel Allergy?
As nickel can be found in a countless number of everyday items, it’s not surprising that it is one of the most common causes of metal sensitivities in people.
Nickel allergy, also known as nickel hypersensitivity or Systemic Nickel Allergy Syndrome (SNAS), results from an adverse immune response to nickel exposure. This can result after the skin comes in direct contact with nickel for a prolonged period of time and enough nickel is absorbed into the body. Hypersensitivity to nickel can develop after brief contact with the metal, or after several years of repeated exposures. Once the immune system identifies nickel as an “intruder”, it may trigger a reaction that may manifest as various symptoms.
Nickel allergies are characterized by contact dermatitis (skin flare ups) after touching nickel and systemic reactions after ingesting nickel-rich foods. These reactions can be delayed rather than immediate and manifest within 24 to 48 hours after contact.
Many women develop this allergy due to ear piercings or wearing a piece of jewelry that contains nickel. The prevalence may also be high in some occupational groups that frequently work with metal. (For example, one study showed that nickel allergies can be found in as many as 27 to 38 percent of hairdressers!)
Researchers believe that once sensitized, the sensitization tends to persist life-long.
Both Hashimoto’s and nickel allergy are considered Type IV hypersensitivity reactions, as a reaction in both conditions can take several days to develop. Interestingly, I’ve discovered that the common reactive foods in Hashimoto’s are also Type IV hypersensitivity reactions. In my experience with foods, Type IV hypersensitivity reactions tend to fuel one another, so I will often see reactive foods flare up Hashimoto’s antibodies and symptoms.
Symptoms of Nickel Allergy
Nickel reactions and symptoms may include increased inflammation as well as contact dermatitis (skin irritation), which can cause severe itching, warm and tender skin, fluid-filled blisters, and dry, discolored, scaly, raw and/or thickened skin.
Symptoms of a nickel allergy can also manifest on the skin as hives or eczema; or internally as headaches, fatigue, and celiac-like gut symptoms. Flares of eczema on the hands after exposure to the metal are not uncommon.
The skin reaction can occur at the site of contact, or sometimes spread beyond to the rest of the body.
In other cases, one may experience a generalized rash around the buttock, anus, genital area, and eyelids, also known as “baboon syndrome”. Not fun!
Perhaps one of the most overlooked symptoms of a nickel allergy is reacting to costume jewelry. Common reactions include experiencing red, itchy or irritated skin on the area that was in contact with nickel, as well as rashes, watery blisters, and hot, burning sensations. In extreme cases, jewelry such as wedding rings may leave the skin beneath it looking “raw” and inflamed.
In rare cases, respiratory problems like runny nose, nasal inflammation, asthma and sneezing may also occur.
How to Test for a Nickel Allergy
When it comes to getting a diagnosis, a patch test is generally the gold standard among conventional doctors. However, this method sometimes results in false positives or fails to detect hypersensitivities.
In 2010, Hybenova and colleagues found that patients with autoimmune thyroiditis and other autoimmune diseases like multiple sclerosis, psoriasis, systemic lupus erythematosus and atopic eczema, show increased lymphocyte reactivity (where white blood cells increase in size in the presence of an antigen, which could indicate the presence of an infection or an autoimmune condition) in vitro to inorganic nickel (as well as other metals) compared to healthy controls.
As such, delayed reactions and hypersensitivity to nickel can be measured with the commercially available lymphocyte transformation test, LTT-MELISA, which is a whole blood test that measures one’s lymphocyte reactivity upon exposure to metal. According to the current scientific literature, this test can detect hypersensitivity to metals, including nickel.
The Link Between Nickel Allergy and Hashimoto’s
Recently, scientists have suggested that there may be a link between Hashimoto’s and nickel allergy. In 2010, researchers proposed that the treatment of Hashimoto’s and other autoimmune diseases might be improved if exposure to metals like nickel are eliminated and any future exposure is restricted.
Meanwhile, a 2017 study found that thyroid nodules were more likely to be found in those with both autoimmune thyroid disease and a nickel allergy. Further research is needed, but this points us to the idea that addressing nickel toxicity may help those with thyroid disease and thyroid nodules.
As you know, I always recommend removing gluten from your diet as a starting point when starting your journey towards thyroid disease remission. Removing gluten, which is found in wheat, rye and barley, is especially important because there have been correlations found between nickel allergy and non-celiac wheat sensitivity. In one study, patients reporting contact dermatitis related to nickel-containing objects underwent a nickel patch test. The study found that contact dermatitis and nickel allergies were more frequent in non-celiac wheat sensitivity patients than in subjects with functional gastrointestinal disorders, and these patients had a higher chance of experiencing skin-related symptoms after ingesting wheat. The study concluded that nickel allergy should be evaluated in patients who have non-celiac wheat sensitivity and who experience skin manifestations after wheat ingestion.
Other researchers have found potential links between trauma and infections in the cartilage (a common area for nickel-plated jewelry) and autoimmunity.
A 2012 study published in the journal Autoimmune Diseases hypothesized that traumas like punctures in the cartilage, with or without the presence of foreign materials that are often associated with infections, could trigger an autoimmune disorder by having unusual cartilage matrix protein antigens stimulate the immune system. The results of the study also found that patients with previous local trauma experienced a greater systemic autoimmune response shown by the development of antinuclear antibodies and antineutrophil cytoplasmic antibodies, as well as the following conditions: autoimmune thyroiditis, rheumatoid arthritis, and vasculitis. In other words, ear piercings can trigger immune processes and may contribute to the onset of autoimmune thyroid disease!
My team member with nickel allergy recalls reacting to an inexpensive (but cute) pair of fashion earrings she bought at the mall a few years ago. The earrings, which most likely contained nickel, triggered an infection, and from then on, she was no longer able to wear costume jewelry without her skin turning red or itchy upon contact. She also started experiencing hand eczema after ingesting nickel-rich foods. Interestingly, this started to happen right around the same time her Hashimoto’s symptoms began to appear!
The Conventional Approach to Nickel Allergy
The conventional solution to nickel allergy is simply avoidance of any contact with nickel, for life. This means purging your house of any metals that may contain nickel, like kitchen tools. After all, it’s seen as a condition that is unlikely to improve and persists life-long. Topical corticosteroids are sometimes prescribed to help with acute eczema.
However, I’ve never been one to just accept my fate — I like looking for “unconventional” interventions that address the underlying root cause(s) of a condition with more natural solutions. So, I’d like to share some dietary and lifestyle interventions that can help reduce your reactions and hypersensitivity to nickel. You may even be able to completely eliminate your skin flares!
The Low Nickel Diet
Avoiding foods high in nickel helps prevent flares. Dermatologists recommend the Low Nickel Diet, which eliminates foods that are generally high in nickel content, regardless of regional soil differences in mineral content.
If you’re currently following a Paleo or Autoimmune Paleo Diet, you’ll be happy to know that transitioning to the Low Nickel Diet may be easy, as many nickel-rich foods are already eliminated on these diets! (I’ve bolded the most common Hashimoto’s food sensitivities in the list below.)
The Low Nickel Diet eliminates or limits the following:
- Whole wheat, whole grain, rye
- Soy products
- Cocoa and chocolate
- Baking powder
- Legumes (peas, lentils, peanut, red kidney beans, soya beans and chickpeas)
- Dried fruits
- Canned foods
- Strong licorice
- Alcoholic beverages (beer and red wine)
- Certain fish species: salmon, mackerel, tuna, herring
- Certain seeds/nuts: sunflower seeds, linseeds, hazelnuts, marzipan, walnuts
- Onion, garlic
- Raw carrot
- Processed foods
Limiting your intake of these foods may help reduce the daily total amount of ingested nickel, which in turn may reduce or eliminate nickel-related symptoms and flares.
This diet may also help those struggling with weight loss. Interestingly, a study in 2015 reported that having a nickel allergy is more prevalent in overweight women, especially those with metabolic syndrome and fatty liver disease, and that women in the study were able to lose weight on a low nickel diet, without restricting calories. Over the course of 24 months, on average, the participants lost about 4 inches off their waist and reduced their Body Mass Index (BMI) by 4.2 ± 0.5. (For women, a BMI of 18.5-25 is considered normal weight, a BMI above 25 is considered overweight, and a BMI above 30 is considered obese, so a 4.2 ± 0.5 difference is quite significant. In fact, this BMI difference is almost equivalent to jumping from being obese to being overweight!) Thus, the low nickel diet can help reduce one’s BMI as well as improve nickel allergy symptoms.
Additional Lifestyle Changes
In addition to dietary changes, I would also like to share some lifestyle tips that can help you cope with your nickel allergy.
Replacing Nickel-containing Items with Safer Alternatives
There are some common and unexpected sources of nickel that can be replaced with nickel free alternatives or other solutions.
- Steel pots, pans and dinner utensils: This is a common source of nickel that everyone will have at home. It’s important to note that many experts say that most people with nickel allergy can tolerate stainless steel. Nonetheless, some sensitive folks can still sense trace amounts of nickel in stainless steel. Furthermore, cooking acidic foods with stainless steel can increase the amount of nickel that leaches out. Opting for bamboo or wooden utensils may be a safer option for those with nickel allergy. Nickel free stainless steel utensils also exist. When shopping for cookware and flatware, avoid buying stainless steel that is graded as 18/8 or 18/10. (These grades may be called 304 and 316 in some countries.) These numbers mean that the steel products contain 18 percent chromium, and 8 or 10 percent nickel. Instead, look for grades that say 18/0 (or 440), as they will contain 0 percent nickel. The same rule can be applied to pots and pans. However, I recommend looking for ceramic-coated cookware, as they are safer options compared to those coated with toxic Teflon. Make sure your ceramic cookware is “safe”, as some can leach lead and cadmium when cooked at high temperatures. The safest cookware I’ve found is 100 percent ceramic cookware from Xtrema, which is made of all-natural materials. Multiple labs around the world have shown that they do not leach any metals, including lead and cadmium — and they publish their test results on their website.
- Faucet taps: Faucets may contain nickel, so your tap water may too. Running the tap for a minute in the morning may help prevent you from ingesting nickel that may have leached into the water overnight. However, getting a water filter is a more environmentally friendly solution and may be your best bet. I highly recommend getting a reverse osmosis system or one that filters out fluoride as well, such as the countertop AquaTru filter. Since fluoride and harmful toxins in your water supply can affect the thyroid, removing both thyroid-disrupting chemicals as well as nickel from your drinking water would be a tremendous investment in your health.
- Costume jewelry: Invest in high quality jewelry. 🙂 Replacing jewelry that is likely to contain nickel with more expensive, high quality pieces made of sterling silver and gold may seem easy, but even genuine silver and white gold pieces may contain nickel! It’s important to do your research by asking your local jeweler if they use nickel in their fine jewelry. If in doubt, popular nickel free ring and necklace materials include titanium, copper, brass, aluminum, niobium, cobalt, and Tungsten.
- Orthodontic appliances can contain nickel. In fact, studies have shown that due to saliva-induced corrosion, nickel ions can be released into the mouth from dental appliances. In extreme cases of nickel allergy, nickel free appliances should be used, so you may want to ask your dentist for possible options.
- IUD devices: If you have an IUD, be sure to check with your doctor, as recent reports have found that some IUDs may contain nickel and cause severe symptoms in those with a nickel allergy. For a safer birth control method, you may wish to consider tracking your basal temperature with the Lady Comp, as well as checking out the Fertility Awareness Method, as described in the book Taking Charge Of Your Fertility.
- Supplements: Some supplements, including multivitamins, may contain nickel, so be sure to check the labels of your supplements.
Other lifestyle strategies include wearing gloves when touching metals that may potentially contain nickel, as well as avoiding touching stainless steel with wet hands, as that can increase the absorption of nickel through the skin.
2. Displacing Nickel
In some cases, reactions to toxins are dose dependent or due to buildup in the body. Symptoms of nickel toxicity include hives, eczema, and itchy skin, as well as headaches, fatigue, allergies, increased inflammation, and celiac-like gut symptoms. In these situations, strategies to reduce absorption or displace the substance may help.
Taking vitamin C, iron and zinc supplements can help decrease the amount of nickel that your body absorbs, as they compete for the same receptors and can displace nickel. Vitamin C has also been found to reduce the rise in plasma nickel concentration when ingested alongside nickel.
For zinc, I recommend the zinc picolinate supplement from Pure Encapsulations, at no more than 30 mcg per day, unless you are monitored by a healthcare professional. (Click here to read more about zinc deficiency, which is common in those with Hashimoto’s.)
As for iron, Optiferin-C by Pure Encapsulations may work for you, as it contains both iron and vitamin C in one supplement! However, please consult with your doctor and check your iron and ferritin levels before supplementing with this, as high iron levels can lead to an iron overdose.
Eating a diet rich in iron and trying to eat foods rich in vitamin C when eating nickel-containing foods may also be beneficial.
Toxins can accumulate in your body due to nutrient deficiencies, especially deficiencies in minerals, which compete for binding sites. A gentle way to remove toxins from your body consists of limiting exposure and utilizing targeted nutrients to prevent the absorption and retention of the toxins.
3. Detoxing Strategies
- Sweating: Studies have found that certain heavy metals like nickel are going to be more concentrated in the sweat than in the urine when they are excreted from the body. So, doing activities that make us sweat, like hot yoga, can help us sweat out nickel. I also love using saunas (like the at-home Sunlighten sauna) for detoxification, as they offer a more gentle alternative to forceful detoxification methods like chelation. They also tend to carry additional health benefits not found in other therapies that make us sweat, like yoga and exercise. (You can read more about how infrared saunas can benefit those with Hashimoto’s and detoxification.)
- Liver Support Protocol: Liver supporting nutrients and herbs can aid with the liver’s natural ability to remove toxins from our body, as well as prevent the damage incurred by the toxin. For example, N-Acetyl Cysteine (NAC) has been found to inhibit nickel-induced cell death and DNA damage, as well as significantly prevent nickel-induced loss of MMP (enzymes related to tissue healing and cancer cell metastasis), in the lungs and kidneys. Meanwhile, a study done on rats found that quercetin can reduce nickel-induced inflammation and damage in the liver. NAC and quercetin are two of the ingredients I utilize as part of my broad spectrum liver support protocol. You can read more about this in my Liver Support article.
- Chelation: While I don’t generally recommend chelation as a starting point for most people with Hashimoto’s (it can make things worse if the gut and liver are not properly supported first), the chelating agents EDTA, DMSA and DMPS can help remove nickel buildup from the body, as well as the buildup of other metals.
4. Desensitization Strategies
A 2015 study proposed that chronic exposure to sensitizing allergens can reprogram the “danger” signal that the body sends in the presence of the allergen, (possibly via T cell class switching), resulting in an increased tolerance of the allergen.
Desensitization strategies have been reported to help some individuals with reducing their reactions to nickel. Here are some strategies you may consider in addition to the lifestyle changes mentioned above:
1. Oral Tolerance Therapies – Since the late 1980s, clinical trials have studied the effectiveness of oral hyposensitization therapy, which aims to turn off the production of antigens that are produced as a response to a harmless allergen, by exposing the body to small amounts of the allergen. It has been proposed as an effective method to reduce nickel allergies.
In 2009, 67 patients were administered low doses of nickel. All patients reported a reduction or absence of skin itching after the first 4 weeks of treatment. After 10 weeks, 67 percent of patients who completed the trial reported a complete remission of their symptoms, suggesting that oral tolerance of nickel can be induced with immunotherapies.
There are various forms of immunotherapy. Low dose immunotherapy is a form of immunotherapy that uses a tiny dose of the enzyme beta glucuronidase, with very minute doses of various allergens, to stimulate the production of T-suppressor cells (T regulator or T reg cells).
In one study, low-dose immunotherapy was used to treat nickel allergy. The results concluded that low-dose immunotherapy may affect baseline levels of intracellular calcium in lymphocytes (by reducing the lymphocytic intracellular calcium ion concentration). In other words, it suggested that this therapy can indeed help to promote more normal immune cell signaling in those with allergies.
In 2013, another study confirmed that oral immunotherapy can be helpful to increase nickel tolerance by reducing IL-2 and IL-10, molecules that play a role in oral tolerance and signal cytokines (proteins) in the immune system.
Sublingual (under the tongue) immunotherapy is another form of oral hyposensitization therapy. It involves creating a dilution of an allergen that one is sensitive to, and administering dosages under the tongue to promote tolerance to the substance in question. The treatment is considered safe and effective. In 1998, a clinical trial found that 85 percent of nickel-allergic patients experienced a subjective improvement in their skin reactions after undergoing sublingual immunotherapy.
2. NAET – NAET (Nambudripad’s Allergy Elimination Techniques) is a non-invasive technique that reverses allergies by using acupressure (gentle pressure on acupuncture points) in conjunction with exposure to one’s allergen.
After undergoing Neuromuscular Sensitivity Testing (NST or NST-NAET), which diagnoses allergies by comparing the strength of a muscle in the presence and absence of a suspected allergen, a patient holds a glass vial containing one allergen at a time, while the NAET practitioner applies pressure on acupuncture points. This is believed to clear the “energy blockages” in those areas, which in turns sends a message to the brain to become desensitized to the allergen.
At the end of the session, the allergen is checked again using NST. If the allergen is no longer active, the patient must avoid exposure to the allergen for about 25 hours.
While most evidence on the effectiveness of NAET is anecdotal, some practitioners that I know and trust have found this to be a helpful method for desensitization in their clients, and it seems to be a very low-risk option.
You can find out more about this technique, as well as local practitioners in your area who may offer NAET treatments for nickel and other chemical sensitivities, on the founder of NAET’s website.
3. Homeopathy – This form of alternative medicine, developed by Samuel Hahnemann in 1796, is based on the idea that any substance that can cause illness can also be a cure. In other words, if a substance causes a symptom in healthy individuals, giving someone a tiny amount of the same substance may cure his or her condition. Homeopathic preparations are made by repeatedly diluting substances in distilled water or alcohol, to the point where no molecules of the original substances remain. However, it is believed that the trace amounts left behind are active and are sufficient enough to desensitize the body to the original substance(s) in the remedy. Although this therapy has been considered highly controversial by conventional doctors, it is widely used around the world as an effective and gentle treatment for curing many conditions as well as allergies. I recommend consulting a homeopathic practitioner in your area to inquire about formulas available for nickel allergies.
In summary, being diagnosed with a nickel allergy doesn’t mean you’ll have to suffer from nickel reaction symptoms and avoid all things metal forever. You can take charge of your own health, reduce your symptoms, and find nickel free items! In doing so, you may even decrease your hypersensitivity to nickel.
To help you remember all the lifestyle and dietary strategies to reduce your exposure to nickel, I’ve created a graphic you can print at home:
I hope this helps you on your healing journey!
To learn more about other helpful interventions for thyroid disease, please consider picking up a copy of Hashimoto’s Protocol: A 90-Day Plan for Reversing Thyroid Symptoms and Getting Your Life Back and Hashimoto’s Thyroiditis: Lifestyle Interventions for Finding and Treating the Root Cause.
Has nickel sensitivity been a part of your journey? What have you found that has helped?
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