Hashimoto’s is an autoimmune disease; the body is attacking the thyroid which causes low thyroid symptoms such as fatigue and weight gain. The most common cause of the autoimmunity is gluten and other foods and additives that our gut does not process properly.
What is Hashimoto’s disease?
Dr. Greg Olsen: Hashimoto’s is an autoimmune disorder associated with the thyroid. What that means is, through various mechanisms, the body has decided to start attacking the thyroid. The thyroid can be attacked in a couple of different areas. One is through what’s called a thyroid peroxidase enzyme, and the other area in the thyroid that it attacks is the thyroglobulin. And so, what we typically see with Hashimoto’s, somebody typically doesn’t go, “Woo!,” and wake up and then say, “I have Hashimoto’s.”
Hashimoto’s has been found through research and laboratory evaluation to be the cause of roughly 90% of people who are experiencing low thyroid. Some people have heard of it, but most people don’t know the association with this. They often times just get found to have low thyroid, and then get told, “You have hypothyroid,”. They are not looking at the cause, just give some thyroid hormone and say, “Here, start taking these.” Rather than saying, “Okay, well, here’s the problem. You’ve got some low thyroid,” and asking, “What’s the root cause of that? Is there a reason why this is happening?”
So, from a functional medicine standpoint when we begin looking at that, we begin, rather than doing a laboratory evaluation just looking at TSH or thyroid stimulating hormone, we look at the thyroid antibodies and say, “Hey, there’s an immune system problem here. We need to address the immune system problem.” Hashimoto’s then is an autoimmune problem needing to be addressed that way.
What symptoms do people experience if they have Hashimoto’s and what methods are used to diagnose it?
Dr. Greg Olsen: So, people who experience Hashimoto’s, as I was beginning to go into earlier, typically have low thyroid symptoms, and that can be typically, definitely fatigue. They get a good night’s sleep, they might get excessive sleep, they still wake up every day saying, “I never have enough energy, I never feel energized no matter how much sleep I get.” Their digestion can be slow. They can have weight gain. A patient the other day was reporting that while she was very active, but through family pictures was being able to identify as just steadily gaining weight, steadily gaining weight, steadily gaining weight which didn’t make any sense being very active and young, so was eventually diagnosed with a thyroid disorder and then ultimately determined to be Hashimoto’s.
Methods used to diagnose it: So most commonly when people are looking at thyroid type symptoms, will be having a blood test done and they may have something called TSH tested for thyroid stimulating hormone, or they may just test for T3 or T4. Typically, in the body, it works on a feedback loop. If the thyroid is putting out low thyroid hormone or low T3 or T4, it’s going to go feedback-wise up to the brain. The brain is going to interpret that and say “Hey, it’s low thyroid hormone,” and then interpret that for increased need and it will result in an increased TSH for the diagnosis of low thyroid.
So, to diagnose Hashimoto’s, you need to go a step further with that and look at the thyroid antibodies. Those thyroid antibodies are thyroid peroxidase or TPO antibodies or thyroglobulin antibodies. Those are the two most common ones to identify if there is an autoimmune reaction going on.
The challenge with diagnosing Hashimoto’s is when you have a blood test, that blood test is only telling us what those levels are at that time at that day. We do know there are times when people can have various stages in this autoimmune response where we could have anywhere from a normal response to an elevated response to a decreased response.
So, if we have somebody experiencing low thyroid and we have other indicators that there might be autoimmunity going on, sometime we have to pursue that and look on several occasions, different days, different times to correctly reach that diagnosis.
Do researchers know what causes Hashimoto’s and is it possible to prevent getting it?
Dr. Greg Olsen: Wow, that’s a great question: knowing what causes Hashimoto’s. Hashimoto’s, being an autoimmune disorder, one of the most common mechanisms looked at these days is because the autoimmunity reaction, the body’s immune system just doesn’t say, “Hey, that thyroid tissue, that thyroid peroxidase enzyme or thyroglobulin looks tasty, let’s go attack it.”
Basically, the immune system works by targeting protein sequences in the body called amino acid sequences. And so those two areas happen to have protein sequences that were targeted by the body saying, “Hey, this isn’t something that should be going on in here and this is similar to this other area I’ve been attacking,” and starts attacking the thyroid tissue.
So, where that step comes from before then when we’re looking for the cause of these areas, most of the time we take that back to how the gut is working. And so, if the gut is working properly, it’s a selective membrane, it only lets certain things through. When that membrane is compromised, we can begin to see substances passing through the gut that are getting into the system. Your body then says, “Hey, that’s foreign. It’s not supposed to be there,” and they start attacking it.
One of the most common causes of those is gluten or gliadin type issues. So, in the autoimmunity arena, looking at thyroid, looking at the causes of Hashimoto’s, those are really some of the beginning mechanisms with it. So if there is a concern, if there’s a family history, one of the best things to do, to work out, in terms of preventing it, is understanding how the gut works, understanding that gluten in an overall picture is not good for the intestines, and being on a low gluten/no gluten diet or at least making sure that you’re not eating genetically modified grains and really having an understanding of your family history so that you can know what your likelihood of experiencing this is.
The other side of that is also that women unfortunately experience this the majority of the time, so that’s also, we’ll say, a risk factor so very important in terms of understanding those things and the possibility of preventing it.
How is Hashimoto’s commonly treated? Are there any natural therapies or ways to help improve the condition?
Dr. Greg Olsen: When we look at how to treat Hashimoto’s, Hashimoto’s resulting in a hypothyroid diagnosis, most commonly, even if it is diagnosed, isn’t treated any differently in the medical model. From a medical standpoint, you’re diagnosed with Hashimoto’s, you have low thyroid, you’ll be given one of a number of different thyroid hormones and say, “Here take this,” I have yet to see in that model where somebody, a provider, has stepped back and said, “Hey, what’s the cause of this?” And instead just treats it with thyroid hormone. Typically, in those situations, the autoimmune reaction continues on, the person gets unstable, and they typically don’t get results. They’ll feel a little better on the thyroid hormone but typically they’re not getting full resolution. They’re still not waking up and feeling like, “I’ve got an abundance of energy.” Typically, their weight doesn’t stabilize, and really still just continue to suffer. But typically, in that situation, they’re just going, “Okay, your hormone levels look good so you should be fine, just deal with it. Figure it out or just deal with it.”
So, in terms of natural therapies or ways to help improve the condition, that is one of the areas that I specialize in. From a natural therapy standpoint, I don’t per se treat Hashimoto’s. What I look at is thyroid hormone metabolism and also the immune component. So, from a natural treatment standpoint, we begin to look at what’s causing the immune system to respond and that’s where we can go into looking at, as I was mentioning before, the gut function. Do we have a compromised intestinal lining, also known as leaky gut? Do we have gluten or gliadin issues?
There’s also now, through new testing, an understanding that there can be foods that cross react or are very similar in that protein sequence to those gluten proteins. There’s a big category of foods that also need to be evaluated and determined there. If we can identify and dampen or remove that immune response and we can look at the areas where that thyroid hormone metabolism may be compromised and that can be by looking at liver function, by looking at gut function, we typically get great results in improving those thyroid symptoms and the thyroid hormone function.
What are the risks to the body if Hashimoto’s goes untreated?
Dr. Greg Olsen: Well, that’s a big one because in the medical model, Hashimoto’s, most of the time, goes untreated or is just not being recognized or treated as an autoimmune condition, just being treated as low thyroid. So, what happens is if you don’t treat the autoimmune condition, the autoimmunity continues to go on.
In the environment we’re currently in with the exposure to many different foods, food additives, cross reactive foods, high levels of stress, compromising gut function, compromising our diet, this really gets complicated in terms of how that autoimmunity continues and progresses along.
Commonly, if this goes untreated, we’ll begin to see other areas in the body, if not already, begin to get attacked so we can get multiple areas of autoimmunity. The thyroid never gets stabilized, continue to have poor energy, continue to have weight gain or unable to lose weight and usually ties in with just generally not being happy. Just knowing that, “I can feel better, I can do better, there’s something holding me back, there’s something not right.”
And so, for me the biggest risk is that autoimmunity. The thyroid can begin to get attacked. Other areas that it can be affecting are the pancreatic tissue, the spinal cord tissue or myelin sheath, brain tissue. Those to me are what I see as the biggest risk, that autoimmunity continuing to progress and deteriorate the body.
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