Note: Originally published in May 2015, this article has been revised and updated for accuracy and thoroughness.
The Role of the Gut
When I was first searching for a healing plan for Hashimoto’s, I learned about the role of the gut in autoimmune disorders.
According to research from Dr. Fasano and colleagues, every person with an autoimmune disorder has something called intestinal permeability, also known as a “leaky gut.” This made a lot of sense to me because I had many of the symptoms of intestinal permeability including bloating, stomach pains, irritable bowel syndrome (IBS) and acid reflux, as do many people with Hashimoto’s.
However, not everyone with intestinal permeability will have these symptoms. Some may have no apparent gut symptoms at all. As awful as it was to deal with IBS for almost a decade and acid reflux for three years, I’m grateful that I had them as these symptoms were signals from my body as to what part of the system was broken.
Autoimmunity has been determined to be a three-legged stool, needing a combination of the right genes, the right triggers, and intestinal permeability to manifest itself. This was exciting to me because I knew that I couldn’t change my genes and wasn’t sure if I would be able to identify the exact trigger that set off the autoimmune cascade in my body, but I was hopeful that I could fix my intestinal permeability.
I found that there are various reasons why a person may have intestinal permeability. Gluten, the protein found in wheat products, has become a well-known producer of intestinal permeability, and many individuals with autoimmune conditions have been able to find relief in symptoms by following a gluten-free diet, the Paleo diet, or another elimination diet such as the Autoimmune Paleo diet (AIP). Some people have even seen a complete remission in their autoimmune condition after removing gluten from their diet.
Another reason why a gut may be more permeable is due to an imbalance of probiotic (good) vs. opportunistic (bad) gut bacteria, also known as dysbiosis.
People with autoimmunity have been found to have lower amounts of the probiotic bacteria Lactobacillus and Bifidus, and higher amounts of the opportunistic E. coli and Proteus bacteria. E. coli and Proteus bacterial species are often referred to as “opportunistic pathogens” because they only become pathogenic when the opportunity is just right. If they are outnumbered by probiotic bacteria, they behave like good citizens of the gut and may add value, but in times where they outnumber the probiotics, they may start to damage the gut wall, leading to intestinal permeability.
I’ve seen this pattern of low levels of probiotic bacteria with high levels of opportunistic bacteria on my lab tests as well as the tests of many clients with Hashimoto’s that have had the GI Effects Gastrointestinal Function Comprehensive Profile – METAMETRIX KIT test that quantifies the microbial flora. (You can have your functional medicine doctor order this test for you, or you can self-order the METAMETRIX KIT or GI-MAP.)
When I first took this test, I was shocked to see that I had zero growth of Lactobacillus bacteria, even though I was eating yogurt on a daily basis. I didn’t realize at the time that the problem with most commercial probiotics and yogurts is that they don’t have enough beneficial bacteria to make a difference.
I started to eat fermented foods and added high doses of probiotics and started to feel better and better (I had already been gluten and dairy free and had hit a “healing” wall).
I retested myself with the GI Effects Gastrointestinal Function Comprehensive Profile – METAMETRIX KIT (we have also been using GI-MAP with great success as well) when all of my Hashimoto’s symptoms were gone and found that my probiotic bacteria were in the optimal range and the E. coli and Proteus species were no longer predominating my gut flora.
Thus, one of the very first recommendations I make for EVERYONE with Hashimoto’s is to be sure to get enough probiotics on board.
You can do that by eating fermented foods (like my friend and mentor Donna Gates recommends), as well as through taking probiotic supplements.
Probiotic Rich Foods
- Fermented coconut yogurt: CoYo Coconut Milk Yogurt and So Delicious Dairy Free are two potential options sold in the United States
- Fermented coconut water: The Body Ecology one from Donna Gates.
- Fermented cabbage (make sure you get the kind that is refrigerated, the probiotic bacteria only survive for a couple of weeks at room temperature). Check your organic grocery, otherwise Thirty Acre Farm ships in the US.
Probiotics have been widely researched for a variety of conditions including irritable bowel syndrome, constipation, anxiety, depression, and even skin disorders. Probiotics can help with improving digestion and nutrient extraction from the foods we eat and can also balance the immune system.
Probiotics can help with all types of gut symptoms, some can help with treating small intestinal bacterial overgrowth (SIBO) present in >50% of people with Hashimoto’s and responsible for leaky gut, and have helped me with symptoms of anxiety and helped me with digesting my food. (Please note, some probiotics can exacerbate SIBO.)
Types of Probiotics That I Have Used Successfully
Beneficial Yeast Probiotics
Saccharomyces boulardii (S. boulardii) is a beneficial yeast that helps to clear out pathogenic bacteria, candida, some parasites (including Blastocystis hominis), and H. pylori, an infection that has been implicated in ulcers and has been linked to Hashimoto’s.
S. boulardii does not colonize the gut wall, but instead, it causes an increase of secretory IgA, which supports our own body’s natural defense against infections and opportunistic gut bacteria.
While the label of the product recommends taking 2 capsules twice per day, I used higher doses, building up to 4 capsules three times per day.
This probiotic is generally safe for SIBO and should be used whenever you are taking a course of antibiotics (or after their use) to help rebalance the gut flora.
Lactobacillus-Based High-Dose Multi-Strain Probiotics
Most grocery stores and health food stores sell Lactobacillus-based probiotics that contain 10 billion colony forming units (CFU’s) of one probiotic strain. While this seems like a really big number, in reality, we have one trillion bacteria in our gut, and that small amount is not likely to make a difference. In fact, most probiotic supplements only contain enough probiotics to maintain an already healthy gut, not to restore gut microbe balance. I personally haven’t seen major benefits from using Lactobacillus probiotics until we get them into really high doses.
Furthermore, as research is showing that probiotic diversity is associated with greater health and improved gut function, I prefer probiotic blends containing Lactobacillus strains in addition to other probiotics, instead of single strain probiotics that only contain one type of Lactobacillus. Probiotic blends generally contain various strains of Lactobacillus, Bifidobacteria, and in some cases, beneficial Streptococcus bacteria. Thus, I recommend taking higher doses of multi-strain probiotics. If you’ve never taken probiotics, you will want to start with the 10 billion CFU probiotic but then work your way up to a higher dose over time.
Rather than taking multiple pills, numerous companies have created high dose probiotic blends.
Probiotic 50B by Pure Encapsulations, which contains 50 billion colony forming units, is a great high dose probiotic one can start with as you work your way up.
Another high dose Lactobacillus-based probiotic that I have used with great success and that has the most research behind it is known as VSL #3 and contains 450 billion CFU’s per dose. This particular probiotic has been clinically studied for ulcerative colitis and irritable bowel syndrome. The probiotic has been so successful in inducing remission, it has been labeled as a “medical food.” Please note, this is a very expensive probiotic, but you can get it covered by your insurance if you have the right diagnosis.
I have learned about a less expensive equally effective brand of high dose multi-strain probiotics from my brilliant nutritionist friend, Tom Malterre, called Klaire Ther-Biotic.
High-dose, multi-strain probiotics can be very helpful for people with Hashimoto’s in general, and especially for those who often show low levels of them on gut lab tests. However, they may be problematic for people with SIBO, which can be caused by an overgrowth of various bacteria, including Lactobacillus and Streptococcus bacteria, which are often found in probiotics. It’s important to note that up to 50 percent of people with Hashimoto’s may have SIBO, and the overgrowth, in up to 75 percent, may be comprised of Lactobacillus or Streptococcus bacteria.
Soil-based probiotics came on my radar after some colleagues reported having excellent results using them with their clients. Soil-based probiotics are naturally occurring, spore-based, and have a unique mechanism of action, which allows them to directly modulate the gut microbiome. Spore-based probiotics have shown promise in various autoimmune diseases and in reducing allergies and asthma. Spore-based probiotics also have an ability to boost Lactobacillus colonies, so they can be used concurrently with Lactobacillus probiotics as well as in place of them. Unlike the Lactobacillus probiotics, spore-based probiotics can reduce SIBO and increase gut diversity by boosting the growth of other beneficial flora.
Clients and colleagues with Hashimoto’s have reported the following after using for thirty to ninety days: a reduction in thyroid antibodies, an improved mood, less pain, better bowel movements, more energy, and a reduction or complete elimination of food sensitivities.
I have had clients use MegaSporeBiotic with great success. The starting dose for MegaSporeBiotic probiotics is one capsule every other day, and the therapeutic dose is two capsules per day. Once the desired effect has been seen (generally three to six months in people with Hashimoto’s), I recommend dropping down to a maintenance dose of one capsule per day.
Tips for Using Probiotics…
If you’ve never taken probiotics, you will want to start low and go slow, as you may have increased symptoms if your gut flora changes too rapidly. If you’ve found that you can tolerate that dose, but have not reached your gut health goals, you can work your way up to higher doses.
Tips for Healing the Gut
Gut healing is a journey; you may need various interventions like removing reactive foods and infections, taking enzymes and probiotics, and balancing nutrients. In some cases, such as after a bout of food poisoning, antibiotic treatment, or a stressful life period, you may need to start from scratch once more. Remember, be kind to yourself and learn to listen to your body so that you can support and feed it properly! You are worth it!
Wishing you all the best on your journey!
P.S. To learn more about other helpful interventions, 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.