Hashimoto’s changed my life. Drastically. But probably not in the way you are expecting. I’m fortunate to NOT have this condition. How then did it affect me? By changing the trajectory of the way I practice medicine.
It was about 8 years ago. I was practicing gynecology in a multi-specialty group. I was learning about metabolic conditions that affect weight, as many of my patients were struggling with weight and I wanted to be able to help them. I was already treating hypothyroidism, but am slightly embarrassed to say was not very familiar with Hashimoto’s. Until a few of my patients came to me knowing that they had the condition…
To gain some understanding I looked it up on UpToDate, a respected and well-used source of information to practicing physicians. What I saw startled me (I paraphrase here, as it was a long time ago, but here’s the essence): “Hashimoto’s thyroiditis is the number one cause of hypothyroidism in developed countries… We do not recommend testing antibodies for those with hypothyroidism…just treat the condition if thyroid hormone levels are low.” 1
EXCUSE ME? Your immune system is attacking your thyroid gland and that’s not a big deal? It’s a HUGE DEAL! God made your immune system to attack viruses, bacteria and cancer. If your immune system has gone rogue and is attacking your thyroid, don’t you think that you should care about it and try to intervene?
This was one of my “AHA!” moments that drove me to abandon my comfortable traditional-medicine practice and start my own Functional Medicine practice. I simply couldn’t ignore my conviction that the traditional-medicine-approach was missing something big here.
Why Immune Dysfunction Matters
The purpose of the immune system is to protect us from invaders and mutiny; Invaders are viruses, bacteria, and parasites. Mutiny is cancer—cells gone awry that divide uncontrollably. This is a full-time job.
Auto-immunity is where the immune system starts to attack proteins in the body—our own cells. This is where traditional medicine really misses the boat, in my opinion. The traditional medicine approach is to wait until there is SO MUCH end-organ damage that there is break-down of function. Then they name the disease based on the organ-system involved. Here are some examples:
- Hashimoto’s: Thyroid dysfunction
- Lupus: Blood vessel and connective tissue damage
- Crohn’s Disease: Diffuse intestinal damage
- Ulcerative Colitis: Large intestine (colon) damage
- Rheumatoid Arthritis: Joint damage
- Multiple Sclerosis: Nerve damage (destruction of the protective myelin layer of nerves)
The list is longer than this, but I think you get the picture. Other than Hashimoto’s, these are big, bad, ugly diseases for which there is no “simple pill” to “correct the hormone imbalances”. If your immune system is confused, and is attacking your thyroid gland today what is to keep it from moving on to another organ system tomorrow and causing one of the above major diseases?
I see Hashimoto’s as a great big red flag of immune system dysfunction. It’s time to take this seriously and figure out WHY the immune system is confused. Only then can we prevent system collapse and the worse illnesses.
Your Beautiful Immune System—Simplified
A well-functioning immune system is like a balanced teeter totter. On one end is cell-mediated immunity, and on the other is antibody-mediated immunity. They each have very important functions. Cell-mediated (Th-1) fights intracellular issues like viruses and cancer. Anti-body mediated (Th-2) thwarts bacterial infections (like strep throat).
Now, with a teeter totter when one side goes down the other goes up. That’s how it works. Stick with me here…
Certain viruses, like Epstein Bar (EBV) suppress cell-mediated immunity. This raises the anti-body (Th-2) side of the teeter totter. Mycotoxins are a big cell-mediated suppressor. This raises Th-2 more. All these weights pushing down the Th-1 side of the teeter totter eventually lead to a markedly elevated Th-2 and the off-shoot is auto-immunity.
This simple analogy explains why auto-immune diseases run in clusters, as well as the association of EBV and environmental toxins with auto-immunity. It also suggests a path to healing.
I dig deep with my patients to search for WHAT triggered the immune imbalance. Knowledge is power. If we can identify the trigger then we can work to remove it. I believe the body has an amazing capacity to heal if we take away the cogs in the wheel that impede it and provide it with the raw materials it needs for repair. My goal is to find the root cause, eliminate it, and do whatever possible to increase the rate of healing.
Why Nutrition Matters
70% of your immune-system cells are located around your gut. So if your immune system is malfunctioning, there’s a pretty good likelihood that your intestinal function is involved. Intestinal hyper-permeability (aka leaky gut) is the usual culprit. 2
The intestinal lining is an important single-cell barrier between the contents in the lumen (what we swallowed) and our blood stream. Working properly it is an impenetrable fortress, letting in only things that it determines will benefit us, and propelling the rest right out the exit without letting them in. Inflammation, however, damages the cells and leaves a gap between them. Now foreigners are allowed to sneak in through the gaps and enter the body. These invaders alarm the immune system and lead to even more inflammation. An alarmed immune system unbalances the teeter totter, leading to an increased risk of auto-immunity.
I’ll be honest. I don’t think poor diet is the sole CAUSE of auto-immunity. As I mentioned above, I think infections and environmental toxins play a big role. However, a healthy diet IS necessary to promote healing. We have to do whatever possible to lighten the burden of inflammation that is alarming the immune system. We have to do things to promote healing and quit eating things that inflame the gut. Here are a few suggestions:
- Avoid sugar—Sorry, but it just leads to inflammation
- Avoid grains—2 reasons: 1) Many are laden with mycotoxins 3; 2) They contain a protein called gluten which can inflame the gut
- Avoid chemicals in food (artificial sweeteners, preservatives, artificial coloring, artificial flavoring)—this should be self-explanatory—INFLAMMATION
- Avoid individual foods that cause inflammation in you—I help my patients determine this by using an elimination diet
Following this dietary advice WILL help you feel better. But I’ll be honest, I don’t think it will be enough to get you all the way back to health. There’s just been too much damage. Even with clean eating, if you have things weighing down your teeter totter, your immune system will still be imbalanced. That’s what I think is missing from these “self-help” programs and books. I think you need a more thorough approach that includes identifying the underlying root cause in YOUR case. These programs will HELP, but I don’t think they will be ENOUGH.
What about Thyroid Medication?
There is a growing movement of people that realize their thyroid condition is not optimized by a once-a-year blood test (TSH) and a prescription for Synthroid (aka Levothyroxine). They don’t feel well and they want more. I frequently get questions from potential patients about my approach to hypothyroidism. Let me answer the most common ones right here:
- Yes I use natural-dessicated thyroid medication (Nature-Throid, Armour, NP), when indicated.
- Yes I follow ALL thyroid labs and not just TSH.
- Yes I look for OPTIMAL thyroid function and not just “normal range”.
But don’t come to me if all you want is thyroid medication without looking to find the underlying root cause and heal the imbalance. I CANNOT MAKE YOU WHOLE BY MERELY MANIPULATING YOUR THYROID MEDICATION. I care too much about you to ignore the 800-pound gorilla of auto-immunity. If you are interested in whole-body health and healing, now THERE’S a starting point we can work with.