Why You May Want to Think Twice About Keto
People with metabolic insulin resistance or neurodegenerative conditions like Alzheimer’s and Parkinson’s can benefit enormously from a ketogenic diet. Others just want to have better focus, improve their game or stop eating processed foods.
Many of these people thrive with the shift but others don’t. So who doesn’t and why not?
Perhaps you have a friend who has tried a keto diet and done everything by the book but it hasn’t worked. This person may be feeling worse even after the initial adaptive phase.
When the HPA axis is stressed keto can make things worse. The body interprets this low carb diet as just another added stress to deal with. This’ll happen if cortisol, our primary stress hormone, is out of whack.
Symptoms of constant overwhelm, afternoon crashes, insomnia and poor waking energy indicate ‘adrenal fatigue’. The cause is chronic or acute stress that is more than the body can handle. Learning to regulate cortisol and recover from the stress has to come first. Otherwise switching to a ketogenic diet is unlikely to work. It may even make things worse.
It’s similar with thyroid health. Nearly every tissue in the body requires thyroid hormone. If you have a low body temperature, are losing hair and have thinning eyebrows you may want to have your thyroid checked. In fact, I screen all my patients for thyroid levels. This is because I see it so commonly missed and is essential to metabolism.
When it comes to keto or low carb diets caution make sense. Thyroid function requires consistent fuel. This fuel is most accessible through carbohydrate. Although the body can adapt it makes more sense to stabilize the thyroid first. The endocrine system as a whole has this check and balance system of negative feedback loops. The benefits of keto won’t roll out if thyroid health is not at a certain level of stability.
Often in clinic there is a dual presentation.This is why medicine is personal and individualized. As a practitioner I tease out what is possible. For example, a patient with a cortisol imbalance who has a family history of diabetes may benefit from keto if stress management is taken seriously. If this person’s life doesn’t allow space for meditation or good sleep hygiene then keto should be avoided.
Many people with adrenal or thyroid require specific nutrients. If symptoms flare on keto then electrolytes become even more important. Not enough electrolytes can cause cortisol to rise which interferes with the conversion of T4 to T3 which is the active form. Stay tuned because my next article is all about electrolytes.
Getting enough sleep, sunlight, movement and social contact optimizes our health in ways that diet doesn’t. Ignoring these aspects of health is common especially for anyone who likes to fixate. Experiment and keep a curious mind. For those with a history of disordered eating or addiction its important to notice if you are becoming neurotic about the details. After an initial phase switching to keto shouldn’t take too much thought.
Keep in mind that overeating is another stressor. It’s easier to eat less with keto because fat and protein is much more satiating than carbs are. You may have noticed feeling hungry if you have just a piece of fruit. If you add some nuts or cheese your snack last longer. This is a really simple example but it works. On keto cutting carbs down to less than 25% of your caloric intake means your body begins using fat as fuel. And we know healthy fats have benefits throughout the body from nourishing the joints, brain and gut.
As we enter a new era in Canada, it’s important to look at what’s happening in other places. Medical marijuana is legal in the majority of states in the USA. It is also legal in Australia although it is much more difficult to get. The supply is limited and there are no dispensaries. Medical marijuana in general doesn’t make it accessible to most people. Finding a doctor who will prescribe it isn’t always easy. Only a limited number of conditions are approved. What medical marijuana does is increase quality because the product is lab tested.
Recreational use is legal in Canada and in nine states of the US. This designation makes it much easier to obtain and quality can be determined by the consumer. In these states we find labs creating cleaner products that are free of fungus, pesticides, bacteria and chemicals. We can also get specific amounts of CBD:THC which allows is important for targeting specific symptoms. I’m looking forward to these kinds of labs emerging in Canada. At this time we can’t import across the border safely. It can be hit or miss what you get from a dispensary.
CBD For Pain
Medical marijuana is antispasmodic. Women who experience intractable pain during their cycle, CBD can help relax the muscles. It also dampens the communication from the pain receptors to the brain. What people report is still feeling the pain but it doesn’t bother them in the same way. This is important because the body can begin to heal when the pain response is lower.
Medical marijuana is anti-inflammatory. Therefore we see an improvement other symptoms as well. The side effects of other anti-inflammatories and pain medications can be severe. Not to mention that many of the stronger pain killers are habit forming and can result in overdose. I had a patient yesterday with a severe back spasm. The hospital denied him pain medication. NSAIDs don’t work for him because they are hard on the gut. He suffers from gastritis. He has no history of addiction to opiods. So why was he denied?
Another patient of mine had suffered with endometriosis for years. CBD was the only pain medication that helped her function. Once her pain was down she was able to make important decisions about her health, her career and her family.
Why does it work? How to take it?
The endocannabinoid system is part of our body. It’s a modulatory system that affects brain, endocrine, and immune tissues. Our body has endocannabinoid receptors. We produce chemicals naturally that are very similar to the chemical cascade of what occurs when we take CBD.
Smoking causes harm. Vaporization is a good alternative as are oils or tinctures. Suppositories can be excellent for severe abdominal and pelvic pain. Women who suffer from pain during intercourse are experiencing relief. But again we need to have standardized products. I have had two patients who experienced high anxiety and paranoia using products from a dispensary.
Endocannabinoids appears to play a very important regulatory role in the secretion of hormones related to reproductive functions and response to stress.
Women are using CBD for symptoms associated with PMS including painful periods, anxiety and insomnia. During perimenopause and menopause women are experiencing relief by using CBD particularly for insomnia and anxiety.
Pregnancy and Breastfeeding
There are only a few small studies on the subject of use in pregnancy. The results show a propensity towards pre-term labour and delivery. They also showed use over 20 days during pregnancy may result in lower birth weight. It is difficult to do clinical trials during pregnancy but this limited evidence shows that caution is warranted. Use during breastfeeding exposes the infant so the benefits need to be weighed carefully against the benefits.
One circumstance where more research could be valuable is when nausea/vomiting during pregnancy are extreme. Given that malnutrition of both mother and fetus is a concern, careful administration of CBD likely offers less risk than other medications that are used in this circumstance.
Dr. Rachna Patel is an expert in use of medical marijuana. Her website is an excellent resource.
Sleep is the cornerstone of health. Everything from immune function to mood & behaviour issues are all linked with poor sleep habits. Researchers are learning so much from experimenting with how sleep deprivation inhibits our ability to thrive.
Let’s get your sleep dialed so you can live well. Here are some of the facts that will help you do it.
Duration & Timing of Sleep
Duration is how long you sleep. Research shows that we need between 7-9 hours each night for optimal health. You’ll need to be in bed a little longer to achieve this because we all need transition time.
Timing is when you sleep. Sleeping during the day is very hard on the body. Natural light, temperature and seasonal changes all relate with timing.
The habits of three hunter-gatherer groups were recently studied. They went to bed, on average, 3.5 hours after sunset. Were they in front of screens during this time? Of course not. They were dancing, telling stories and singing. What’s very interesting is like us parents, they woke before sunrise. Why?
Temperature is a big deal when it comes to sleep
People wake up when temperature rises and this often happens prior to sunrise.
Having a hot bath before bed raises your temperature but when you get out you cool down rapidly. In fact your core temperature cools down and this can make you drowsy.
Alcohol raises your body temperature so you’ll often sleep worse after a drink. NSAIDs like tylenol drop temperature slightly but I don’t recommend using this as a sleep aid.
The Time You Spend in Bed
Allowing yourself a sleep period of 8 hours ensures that you’ll get the rest you need. How long we sleep varies but extending the time you have in bed means you’ll more likely get what you need. Keep in mind that recovery from a work out or an infection requires longer rest periods.
What is fascinating is that the tribes that were studied would be asleep for an average of 6 hours every night but in bed for 8 hours. So this brings us to why an extended sleep period is so effective for increasing sleep satisfaction.
This is the feeling of being rested, energetic and alert when you wake up. You may need even more sleep if you are using your brain a lot or want to optimize memory. This is why college students need almost as much as infants or toddlers.
The hunter-gatherer people who were studied were not affected by light exposure. Obviously this is because they have a consistent environment without artificial light. There is no jet lag and fewer changes in general.
Blue light at night, shifts in time zones and more stimulus at the wrong times all have an effect. Lack of daytime light exposure is a major contributor to circadian disruption. We all need at least 30 min of outdoor day light to set our clock. With people working indoors all day this is an important factor to address. In terms of productivity, cutting blue light during the day can be helpful. We are alerted constantly when exposed to blue light & don’t perform as well. Wearing orange tinted glasses is calming. It can help with focus. Take a walk outside at lunchtime will do the same thing.
Light is measured in lux. Although devices don’t have a high output most people hold their device too close. I’ve thought about how as a kid I never was allowed to sit that close to a television.
The intensity of light exposure is quadrupled if your device is a foot away versus two feet away. This is because of how directly the light penetrates into your eyes.
All Kindle type apps are now backlit. This can create a similar circadian disruption especially if you don’t get daytime light exposure & have your ebook lit up at bedtime.
Nature, distance & movement
Being in nature regularly is important too. Looking at a body of water, a field or the forest uses different parts of our eyes and brain. I was struck by how calming it is to look out at the mountains where I live.
Eye movement has a massive impact on learning and physicality. We know this from studying infants growth. I study this through a movement practice. I always sleep better after moving my body in different ways.
Chuck Czeisler’s has a Sleep Lab at Harvard University
Siobhan Banks is a researcher of sleep.
Dr. David Dinges is a psychiatrist who focuses on sleep and behaviour.
For glasses that block blue light check out: https://www.blublocker.com/
When your thyroid labs are ‘normal’
Every week I see women who are told their thyroid labs are normal. Often there is a general sense of feeling unwell. Symptoms like fatigue, weight gain, hair loss and feeling cold are common. Being told you are fine when you know you are not is confusing and painful.
What’s being missed and why?
The number one reason is that the root cause of most thyroid disease in the developed world is not iodine deficiency. Hypothyroidism that is autoimmune in nature is called Hashimoto’s. Many are undiagnosed because it is rarely tested in conventional medicine
Secondly, lab ranges used for TSH is based on the initial research that included participants who had Hashimioto’s but they didn’t know it. This became apparent in subsequent research but the conventional markers don’t reflect this evidence.
Breaking Down Thyroid Markers
TSH: Thyroid stimulating hormone from the pituitary causes the thyroid to release T4. The functional range of TSH is anything under 2.5 or even 2. The conventional range only flags it over 4 or 5.
T4 is normal when the thyroid is doing what it needs to do. It then gets converted into T3. This happens in the liver, gut and peripheral tissues which doesn’t always happen. T3 is the metabolically active form so if the conversion doesn’t happen then we see symptoms.
Then there is total and free T4/T3. Free means its unbound from its protein carrier and is a better way to assess function.
Hormones are fat soluble and need to be attached to a protein carrier to circulate around the body. Thyroid binding globulin is required for this.
Finally thyroid antibodies indicate if there is an autoimmune reaction going on. I always include this as part of basic work up for new patients because it is so common.
Just last week a patient told me they had started taking high doses of iodine because she suspected her thyroid was off. This is not a safe approach. In fact there is evidence that iodine restriction can be helpful in Hashimoto’s. Supplementing with thyroid nutrients is not a good starting place. Food is a much safer route to take.
Iodine is crucial for thyroid function. Deficiency is much less common today due to iodized salt. However many health conscious people switch to mineral or sea salt. If this is your plan make sure you eat sea vegetables. Cod is another excellent source of iodine.
Selenium is crucial for thyroid function. But it has a u-shaped curve meaning supplementation, even small amounts in a multi-vitamin, can be problematic after awhile. Eating brazil nuts is a much better choice.
Goitres are still a problem. In some patients it may be the only indication of Hashimoto’s. This isn’t completely understood but its linked to the next section.
Stress and inflammation
Thyroid hormone is required to metabolize cortisol. The testing I do shows both free and total cortisol. If these two markers are discordant it can indicate a thyroid issue. In some cases this will show up before thyroid markers go out of range. Keep in mind that stress is a trigger for autoimmune conditions. The common colds can also make symptoms worse and thyroid symptoms can flare with any type of stress.
Patterns to Rule Out
Often a patient comes to me convinced she has a thyroid issue but in fact something else going on. With a full panel we can see what’s actually happening. Here is a summary of the patterns that can happen:
- Pituitary dysfunction: TSH is low or normal but T4 and T3 are not.
- T4 not converted to T3: this is caused by inflammation, gut issues or nutrient deficiencies.
- Thyroid binding globulin: high estrogen is common and can inhibit this transport system.
- Low TRH (Thyrotropin-releasing hormone) from hypothalamus: this is caused by leptin/insulin resistence/inflammation.
- Cellular resistance to thyroid hormone. caused by stress, cortisol and/or inflammation.
Don’t Treat Yourself
Given how thyroid is being mismanaged by our system its not unusual to see patients who are attempting to treat themselves. Ordering pharmaceuticals from Europe or trying high doses of iodine is not recommended. Get proper testing and find someone you trust to work with.
You can begin by doing an autoimmune protocol. Its worth trying this elimination diet at least once and it is something you can safely do at home. I have a course that walks you through it. I lead a group each spring or fall so people have support and somewhere to ask questions. Send me a note if you are interested.
Another therapy to consider is low dose naltrexone. I’m seeing lots of excellent results with this in patients who have been diagnosed with an autoimmune condition.
Two additional nutrients to consider getting tested are vitamin D and glutathione. These both stimulate t-regulatory cells for immune health. It can be as dangerous to have too much vitamin d as it is to have too little. This is why I suggest testing especially if you are supplementing. Enough daylight exposure is the best source along with cod liver oil at 1 tsp/day. Glutathione an important antioxidant involved with cellular energy production and immune function. It can be tested with a urine organic acids lab. Finally curcumin, in a bioactive form, combats inflammation and stimulates the immune system’s t-regulatory cells.
Many people have high total cortisol when experiencing what has commonly been called adrenal fatigue.
The term HPA axis (hypothalamus, pituitary, adrenal) dysfunction or maladaptation is a more accurate description due to the complex interdependence of glands, cells and the brain. Furthermore research and statistics show it is usually not a case of low output by the adrenals at all.
Why is this so important?
Cortisol has an impact on inflammatory response, thyroid function, glucose levels and the list goes on. Studies show that early life events can set up a life long pattern that affects the HPA Axis and cortisol production. This maladaptation also can occur when there is decreased output by the pituitary gland. Receptor sensitivity is yet another way in which cortisol signalling can get disrupted. Lastly reduced bioavailability can happen at the tissue level by way of the binding globulin in the blood, conversion of cortisol to cortisone or cellular transcription. The point is that the HPA axis is much more nuanced than the concept of adrenal fatigue lets on.
Research and Testing
Much of the research on cortisol has been done based on saliva tests which only show free cortisol. Free cortisol levels can be very different, even opposite from total cortiso. Improper treatment can easily result. Looking more closely can lead to early detection of thyroid disease, diabetes, leptin resistance and even certain cancers.
Pregnenolone and DHEA
Chronic stress leads to lowered DHEA, an important steroid hormone. There is a common misconception that this is because cortisol is stealing from the precursor pregnenolone. Physiologically there is no evidence of this. Both pregnalone and DHEA are produced in mitochondria but in different tissues. Cortisol is actually regulated outside of the adrenals. Also the amount of cortisol produced is significantly more than DHEA. Location and function both debunk the myth that stress hormones ‘steal’ from sex hormones. This is news to me as and not commonly understood in the medical community. One way that this new theory can be proven is by looking at how supplementing pregnenolone will have no effect on DHEA.
Three ways of looking at Cortisol:
1. Is total cortisol low or high? Looking into other factors that are present and that will be influenced by this. Leptin and insulin resistance can be involved.
2. Is there a disrupted diurnal rhythm? It is important testing is done properly because the morning cortisol curve happens in the first hour of waking. Some tests are not specific enough by leaving a window of two hours. This creates misleading results.
3. Is there impaired cortisol metabolism? When there is more cortisone present this could indicate thyroid involvement.
Evolutionary medicine reminds us that being human means that we are really good at adapting to our environment. This includes learning to ride the wave of positive stressors that move us forward in our lives. Noticing when we dip into too much stress and backing off is a skill that requires constant refinement. I teach a course on the HPA axis so please take advantage of this information. Stress is by far the number one factor influencing health today. The HPA axis is what allows us to regulate stress appropriately. We all have times when stress becomes too much. Knowing which tools to engage and how to recover is key to resiliency.
Smart Ways to Work and Play
We all know that sitting a lot isn’t good. You may have heard the phrase ‘sitting is the new smoking’. Its true that blood sugar and cardiovascular risks go up significantly for people who find themselves in sedentary jobs. How can we mitigate these health complications when life requires a certain amount of work at a desk?
Continual activity throughout the day is more beneficial for improving glycemic control than a single bout of structured exercise. Just meeting recommended levels of physical activity isn’t enough. By spending the rest of the day sedentary, people are still at risk for insulin resistance leading to diabetes and a disrupted gut microbiome. Here are a few tips to keep in mind:
- Avoid sitting for extended periods.
- Engage in frequent light activity breaks throughout the day.
- Set up a standing desk and alternate with sitting.
- Treadmill desks can improve focus and productivity.
- Ensure that your leisure activities do not involve screen time.
Skipping Meals, Caffeine and Stress
I love my work. When I have a lot to do I often can forget to stop and eat. This in combination with sitting at a desk increases my stress. On the weekend I have no trouble with blood sugar but this isn’t true when I’m sitting which confirms what the research is saying.
Packing enough of a lunch and starting my day with some movement helps tremendously. I go for a walk, a swim or do some resistance training. On my research days I also have a yoga mat out in my office so I can take creative breaks or do some push-ups. Putting on dance music can also inspire me when needed.
I hear this from many of my patients about how caffeine is a contributor to stress. The connection between memory loss, blood sugar dysregulation and caffeine addiction is very real for many people working in tech. The rise in young people with memory loss is not separate from the rise in diabetes.
Life is better when you move
Activity breaks can include taking a walk outside over the lunch hour, or simply getting up to walk to the water dispenser every hour. Include some social time as this helps to regulate our nervous system. Having a fun activity to look forward to does as well. This may be the most important part of your work day.
Of course activity breaks can’t be considered a replacement for other physical activity. Recent research recommends that activity breaks be used daily in the context of an overall healthy lifestyle. Aiming for 150 minutes per week of moderate to vigorous intensity exercise is essential as a baseline.
“But I don’t feel stressed!” I hear this a lot from patients when their body is telling me otherwise either through lab work, radial pulse or other clinical factors. Explaining that there are many physiological causes of stress often is helpful. Financial or relationship stress is just part of the picture when it comes to cortisol.
1. Gut Health
For example, a gut infection is a major stressor to the body and when we resolve this a lot of energy is freed up. The next step is to rebalance the HPA Axis after a year of living with a parasite.
Dietary factors like consuming pro-inflammatory omega 6’s or restricting calories, nutrients and protein can raise cortisol. Increasing certain nutrients like magnesium does the opposite. Similarly, intake of the vitamin A in its bioavailable form regulates the HPA axis.
3. Lifestyle Factors
Commuting and posture are some of the factors that can raise your stress response. Running too much is another common one along with caffeine. Frequent marijuana use affects both cortisol and prolactin.
4. Sleep, Sleep, Sleep
- Reduced Sleep – A loss of sleep for just one night leads to higher cortisol levels the next evening.
- Poor quality sleep – Poor quality sleep activates the stress response.
- Staying up late – Cortisol goes up when we are awake during normal sleep times.
5. Other Hormones
- Thyroid: “The effect of thyroid hormones on the adrenal axis was not secondary to changes in the level of circulating corticosteroids.”
- Estrogen: Estradiol regulates the CRH (corticotropin releasing hormone) which is “best known for its role in activation of the mammalian stress response.”
- Leptin: This study looks at CRH in relation to adiposity and leptin. Furthermore, “the modulatory role of glucocorticoids could be altered in obesity.”
I was working with a patient the other day and a noise I didn’t notice outside was causing her to feel unsettled. It reminded me of how we all respond differently to stressors. Noise can be a significant one for many people.
7. Toxic exposure
This study looks specifically at heavy metals following an oil spill and the affect on the cortisol. This links back to how there can be physiological stressors that affect our endocrine system and stress response past its limit without us knowing.
I have a couple questionnaires I use to help assess both the stress we know about and the stress we don’t know about. Applying more than one method to figure out what is going on at the root is key to successful treatment.
Low Dose Naltrexone Works
With the astonishing rise of autoimmune diseases, we need effective treatment strategies. Studies on LDN are still limited however we can use this information along with what is being seen clinically. LDN is not going to be supported by the pharmaceuticals so this is part of why we aren’t seeing more research. Treatments that don’t make big pharma lots of money are unlikely to be given much attention by the conventional system.
The studies that do exist include treatment on cancer, multiple sclerosis, Crohn’s disease, fibromyalgia, and autism. For patients with Crohn’s the rate of remission was 70% with complete healing of the gastrointestinal mucosa without any side effects. If you know anyone with Crohn’s disease you’ll understand how debilitating the disease can be and conventional treatments are often ineffective so this is very encouraging.
In my clinic I have seen LDN work in a variety of autoimmune diseases like Hashimoto’s, rheumatoid arthritis and chronic fatigue syndrome. It is also used in neurodegenerative disorders like Parkinson’s and Alzheimer’s. In the United Kingdom, it is being used by one clinic to treat infertility with excellent success. The reason it is working is because it is regulating the immune system and reducing inflammation. In Functional Medicine, we know these two factors are at the root of most chronic disease.
I’ve had patients who don’t feel well but don’t know why. This can be a major factor in mental health especially when their doctor has told them their symptoms are in their head. Yes, this actually happens and in fact, two patients this week have reported this to me in clinic. I look for indications of specific autoimmune disorders in lab work. When a patient feels better on an autoimmune protocol this is sometimes enough to explore LDN as a treatment. With no side effects and positive results, there is little reason not to. One patient was able to stop strong painkillers after 20 years of use. These stories are what I live for.
To learn more about an autoimmune paleo and nutrient dense diet check out: www.amberwoodhealth.ca
The root is the gut. I’m going to tackle some of the most common autoimmune conditions by looking at the latest research. What is significant for all autoimmune disease is that conventional treatments fall short. New approaches are badly needed. Good results are being found with an anti-inflammatory diet like the autoimmune paleo reset along with prebiotic fibres that nourish beneficial bacteria. I also use herbs to soothe the intestinal lining and further reduce inflammation. Other therapies like low dose naltrexone have been very helpful for my patients.
Genetics and environment play an important role in autoimmunity. An ancestral diet with significantly more fibre and no processed foods has excellent outcomes. It is naturally lower in carbohydrate. Processed grains and grains in general were introduced recently in our evolution. Our biology does not tolerate these foods especially in the quantities they are being consumed. The high carb, low fat diet has led to many problems including overeating. Higher fat whole foods are more satiating and safe as long as they aren’t combined with refined sweeteners.
Blood Sugar Solutions
Diabetes is on the rise in both children and adults. In this disease the immune system attacks the pancreas preventing it from producing insulin by attacking it. A study done this year found an association between inflammation and microbial imbalances in those with type 1 diabetes (T1D). In biopsies of patients with T1D, two specific strains of bacteria associated with gut inflammation were out of balance. The study concluded that those with TID have a disrupted gut microbiome which plays a role in the disease 1.
Immunity and Lupus
Gut bacteria serve as immune protection against pathogens but in some cases they have taken over and contributed to transmission of a disease. This in unusual but is what happens in Lupus. Again it is an imbalance in specific strains of bacteria against others that contribute to the disease. By supplementing with the anti-inflammatory strains of lactobacillus and bifidobacterium symptoms of Lupus were reduced. In animal studies both lymphadenopathy and glomerulonephritis were affected by this simple intervention. Treatment with just bifido prevented the immune system from becoming over activated.2 A disrupted gut microbiota is associated with decreased DNA replication and repair. Impaired carbohydrate and amino acid metabolism have also been associated with gut dysbiosis. Therefore, we see dysbiosis epigenetically harming the body’s repair system and metabolism.
Rheumatoid Arthritis and Oral Microbiome Health
Increased levels of aggregatibacter actinomycetemcomitans (Aa) in oral cavities due to peridontitis may be connected to rheumatoid arthritis. Research suggests that the oral microbe Aa may trigger autoimmunity in rheumatoid arthritis. Therapies that treat Aa infection and improve the health of the oral microbiome may be valuable in the treatment of RA. Confirming the presence of Aa and then treating it would be the first step. Dietary interventions to reduce inflammation and probiotics specific to the oral microbiome would ideally be part of treatment.
Why are these 3 G’s so damn important right now? One out of every six people in North America suffer from an autoimmune condition. By 2050, it’s predicted that 600,000 kids will have type 1 diabetes given the current rate. This is alarming and I really think we can do better for our children.
Autoimmunity is complex and has many causes. In this article I discuss three diseases and the research connecting gut health to autoimmunity. Today I’ll focus on a specific genetic marker present in some autoimmune conditions and the strain of bacteria associated with it. We’ll also discuss how a lower carb, ancestral type diet is indicated.
Gluten increases inflammation even in those who are non reactive. It is also a filler food meaning its highly processed and modified. It lacks any nutrient value unless it is fortified which can actually cause more problems. For those who are reactive, gluten leads to several disease processes including neurological issues, joint problems, malabsorption and yes, autoimmune disease.
What about HLA?
HLA means human leukocyte antigen. Leukocytes are the white blood cells. They protect the body from infection and foreign substances. Antigen means the protein on the surface of immune cells. Genes determine which proteins are present on the surface of the immune cells. HLA is a highly polymorphic gene, meaning there are many different possible gene set variants, or haplotypes.
Humans have incredibly adaptive immune systems because of the number of haplotypes available. However, certain haplotypes predispose a person to specific immune system diseases. HLA-DQ haplotypes have also been associated with celiac disease (1), while HLA-DRB1 has been associated with rheumatoid arthritis (2). Mold illness may affect one person and not another due to the individual’s haplotype.
HLA-B27 in Autoimmunity
Crohn’s disease, ulcerative colitis, psoriasis, reactive arthritis, ankylosing spondylitis (AS) and uveitis are all associated with HLA-B27. Fusion of the spine in AS is the most common condition associated with this haplotype. An estimated 88 percent of people with AS are HLA-B27 positive. Some subtypes of this gene are protective against AS while others increase the risk of developing the disease. Keep in mind that you can have this haplotype and never develop an autoimmune condition.
Klebsiella and Ankylosing Spondylitis
A connection has been made between Klebsiella and HLA-B27 since 1980. Studies have found that this gut bacteria has two molecules that closely resemble HLA-B27 (3, 4). The immune system naturally produces antibodies against Klebsiella in an effort to remove it, but these antibodies can also bind to HLA-B27.
Studies have shown that Klebsiella does not grow on cellulose from plant starches but can grow on simple sugars (5). Simple sugars are absorbed in the small intestine whereas some starch makes it to the colon where bacteria live. Klebsiella can manufacture an enzyme called pullulanase, a starch-debranching which allows it to break down starch into simple sugars for energy and growth (6).
Human studies confirm that a high protein, low carbohydrate diet significantly reduces klebsiella in fecal samples (7). Another study found that a low-starch diet reduced the immune response in AS patients (8). The majority of these patients reported remission or at least a reduction in symptoms.
And Finally Back to Gluten
In four out of 5 randomized, double blind trials gluten showed to increase symptoms in patients. The patients who received the rice pill instead of the gluten pill continued to have symptoms improvement. This doesn’t mean that all people need to be strictly gluten free but it does mean that up to 80% of people who are struggling with chronic illness are reactive to gluten. I explain to patients who want to get better that removing gluten is an excellent starting place given the medical literature. Most testing available to the public only looks at alpha gliadin and wheat. More accurate testing is available. It covers 24 markers. I highly recommend this if you are questioning whether or not to remove gluten from your diet. Remember that diet and environment turn on genes that would otherwise be dormant. One step to preventing autoimmunity can be as simple as eating more vegetable and eliminating gluten for 2 weeks to see if you feel better.
Sleep is a big deal
Especially when two-thirds of adults don’t get the minimum required to meet basic physiological requirements. In fact, less than 7 hours per night can shorten lifespan significantly. Inflammation increases when we miss a night of good sleep. Other sleep research shows up to 29% lower sperm count in men who sleep poorly vs those who regularly get enough rest. Athletes performance drops 10-30%.
Why Parents are Crazy
As a parent of a young child I can vouch for how difficult it can be to get enough sleep. When your infant finally starts sleeping through the night your cortisol and melatonin production is so confused insomnia becomes a thing. Catching up is not actually possible especially as a single parent. Through trial and error I’ve discovered the ridiculous reality of living in a state of constant sleep deprivation. Caffeine stops working. You think everyone hates you and life is out to get you. This is the real reason parents are crazy a lot of the time! Anyone doing shift work or work late at night can be included in those who suffer the most.
Adults really do require 7-9 hours of sleep
- Newborns (0-3 months): 14-17 hrs
- Infants (4-11 months): 12-15 hrs
- Toddlers (1-2 years): 11-14 hr
- Preschoolers (3-5): 10-13 hours
- Elementary school age (6-13): 9-11 hrs
- Teens (14-17): 8-10 hrs
- Adults (18-64): 7-9 hrs
- Older adults (65+): 7-8 hrs
Sleep Hygiene: Focus on What to Do
1. Be consistent with your sleep schedule
Set a realistic bedtime. Train your brain to develop a regular circadian rhythm by going to bed at the same time most of the time.
2. Establish a bedtime routine
This can include a warm but not hot bath or shower. Journaling in a book, meditating, stretching gently or reading are all appropriate activities. Dim your lights and listen to relaxing music to unwind from your day.
3. Your bedroom needs to be quiet, cool and comfortable
Sleep is better when your room is cool rather than warm. You can keep a door or window cracked for circulation and to avoid stuffiness. Keep all lights off, including night lights, and lights from electronic devices. Sleep on a comfortable mattress. Turn off the extraneous noise. A white noise machine is fine. If your pets wake you up, keep them in another part of the house.
4. Turn off electronic devices in the evening
This allows for more connection, better digestion and a general parasympathetic or relaxed environment where you can reconnect and let go of the day. Electronic devices emit blue light which stimulates the brain. Cortisol and melatonin get confused and these hormones play a huge role in insomnia.
5. Exercise during the day
Exercise promotes continuous sleep. Its also great stress relief. Avoid intense exercise in the evening as this can interfere with deep sleep. Stress management is crucial to sleeping well.
6. Eat enough during the day
Blood sugar dysregulation causes spikes in cortisol and makes it more difficult to rest later on. In fact, having enough carbohydrates during your evening meal has been shown to support better sleep. Choose root veggies and unprocessed, gluten free options. Often times food reactions cause an internal stress response that we aren’t aware of.
7. Use caffeine with caution
We know that 50% of people don’t metabolize caffeine. This means it stays in the body for much longer and therefore amount matters. Cut down on caffeine and avoid it after noon entirely. This includes chocolate. Uncooked cacoa is easier on you. Matcha has a longer burn than coffee and many health benefits. Find alternatives like peppermint or dandelion tea. Golden tea is a delicious alternative as well. I know its not easy to change this habit especially when you are sleep deprived but it can be done. It may be the most important change you can make.
8. Get out of bed if you aren’t sleeping
Do a guided meditation or find another relaxing activity until you feel sleepy. This is part of training your body that bed is for sleep. Have a comfortable chair in your room and make a cup of sleepy tea. Simple rituals like this work.
9. Avoid large meals later at night
A small protein rich snack before bed can help with night hunger but large meals late at night create a burden for the liver. Finish meals a few hours before bedtime. The liver kicks into gear at 11pm so being asleep by then is ideal.
10. Reduce fluids before bedtime
I’m training my son to drink more during the day so he won’t need pull-ups at night. Just pretend you are 5 years old! My mom has sage advice for parents. Ask yourself if getting your kid up to pee in the night is more of a priority than your sleep.
11. Nap or no nap?
I teach meditation to my patients. I find if someone calms their nervous system for 5-20min during the afternoon it can support a deeper sleep later. People may or may not nap as part of the practice. I don’t see any problem with this however long naps may inhibit sleep later on.
12. Avoid these because we know they interfere with sleep
Alcohol raises our body temperature and requires that the liver clear it. Ever wake up between 1am and 3am after having a drink? Cigarettes and some medications also make sleep more elusive.
13. Black out your room, hide the clock and wake naturally if possible
This is basic but an incredibly important game-changer. Buy black-out curtains. Don’t use night-lights except in the bathroom. Turn your digital clock away from your bed while you sleep. Don’t wake to an alarm as much as possible.
14. Creat an extended sleep schedule
For anyone who has suffered from sleep problems an extended sleep schedule can support getting more sleep. Research shows that allowing a longer period of time in bed does increase the amount of sleep people get.
15. Only use your bedroom for sleep and sex
Train your body to expect only rest and pleasure in this space by creating this. Bedrooms ought to be a place of sanctuary from the world.
An Important Ally: Your Morning Awakening Response
Its best to get up when you first wake up. By exposing your eyes to bright full-spectrum light you are stimulating the cortisol awakening response (CAR). This accounts for half or more of our daily cortisol secretion. Remember the cortisol is anti-inflammatory and an important hormone that works synergistically with melatonin. Doing any kind of movement first thing supports morning cortisol. This could be carrying a child, going upstairs, walking your dog or going for a run. Daylight stimulates cortisol release, and darkness stimulates melatonin.
Blue light boxes improve sleep and depression simply by stimulating this early morning response during the winter for those who have to get up before dawn or who can’t go outside first thing in the morning. Beginning to notice this response and working with it can help repair your sleep-wake cycle if its been disrupted.
HPA-D is not Adrenal Fatigue
I’ve written extensively on this topic and the reason I bring it up is because you’ll see a bunch of recommended supplements for adrenal fatigue. Insomnia is a symptom of a much more complex disorder called HPA-D. (hypothalamus pituitary adrenal dysregulation). By testing cortisol thoroughly we can see that pattern of dysfunction and supplement accordingly. Giving adaptogens to everyone is not the answer. Nervine herbs on the other hand are safe and interestingly ashwaghandha is both an adaptogen and a nervine. Some of my other favourites include skullcap, passion flower and camomile. Anything that makes you feel groggy upon awakening is inhibiting the cortisol awakening response so avoid this. Be careful using licorice as this potent herb increases cortisol. L-theanine is an amino acid that is safe to use for anyone.
Certain patterns of HPA-D require increasing cortisol at certain times of day or decreasing it. Often there’s an issue with hormone clearance pointing to excess inflammation, inhibited liver function or thyroid issues. The testing I do looks at both free circulating cortisol and total metabolized cortisol. These are not always the same. In many cases only free cortisol is tested resulting in treatment that is not neccessarily exact.
CBD is both anti-inflammatory and promotes sleep. This is why standardized extracts need to made available. For those experiencing recalitrant pain CBD can bring down the pain where other pain medications won’t. A patient of mine with insomnia and endometreosis began using CBD. Once her pain came down she was able to sleep and could start making decisions about her health. She had been unable to work for many months. I’ve seen this with backpain as well.
Thorough blood work including iron, blood sugar, thyroid and inflammatory markers is required to see a full picture and get a sense of what is going on. A gut work-up is also important. Neurotransmitters play a role in HPA-D through the gut-brain axis. Healing the gut so its producing neurotransmitters again and absorbing nutrients is the key in some patients. Supplementing with precursors like 5HTP are helpful in these patterns during treatment. You may be noticing that it can take time to get to the root cause of insomnia. Often we are also addressing trauma during treatment. When we find out what works and are sleeping more, people report feeling that they got their life back.
Science no longer sees genetics a blueprint that is set in stone. In the last two decades we’ve learned that biological inheritance is much more complex and strongly influenced by environmental factors. How we live can actually create molecular changes that aren’t encoded in the DNA but do get passed down to our children and grandchildren.
New understanding means new language
The sum total of all the environmental factors in our lives is called the exposome. Included in this is any exposure to toxins and stress. Diet, activity level, social contact and sleep also play in. There’s a complex interaction between our exposome and our genes. The exposome regulates the activation, suppression and expression of genes. Its influence by what happend during our parent’s and even our grandparent’s lives. This is epigenetics.
Epigenetics and Methylation
What makes epigenetics so awesome? Factors we thought were set in stone aren’t. We have more power than we previously thought. I’ll explain how this happens on a cellular level.
In terms of methylation, a gene mutation like MTHFR predisposes a person to certain deficiencies. The activity of specific enzymes is affected which lowers energy production overall. However many people who have this defect will not express these deficiencies. Knowing the mutation is there is not a diagnosis. Its a clue. If symptoms arise then this can be a starting place. To avoid issues certain diet, supplement and lifestyle modifications can be made.
MTHFR is the most talked about mutation. It stands for methylenetetrahydrofolate reductase. Other important ones are: CBS, COMT, VDR, MTR, and MTRR. A genetic test like 23andme will show you if you have a mutation. Unless you’ve checked out how you are methylating this information is limited.
If you receive the same mutation from both parents you’ll be considered homozygous. If you’re heterozygous for a mutation it means you have a single normal, non-mutated copy of the gene and another copy that’s mutated. Homozygous mutations are often more serious because whatever enzymes this particular gene codes, are not going to be produced at all.
Another wild part of all this is symptoms don’t always show up even when enzyme activity is reduced significantly. So it really is individual. I’m treating an athlete right now with poor methylation. It’s unlikely that we’ll do genetic testing however we will look into the exposome because this accounts of 90% of what’s being expressed. A gut infection, chronic stress from undereating or overtraining, a cortisol or thyroid imbalance are all triggers.
Often people will have low levels of folate, B12 and glutathione. Checking these along with inflammatory markers and specific metabolites from the methylation cycle informs treatment.
Poor methylation increases susceptibility to toxins and infections. Impaired detox capacity and immune dysregulation can lead to infertility, mast cell activation syndrome, depression, anxiety, chronic fatigue and miscarriage.
An Important Difference
Genetic mutations like these are different than the mutations that are associated with specific diseases like cystic fibrosis and sickle-cell anemia. These gene mutations guarantee a person will develop the disease. With methylation there’s a lot more variation. It’s a predisposing factor meaning that it could lead to an issue or be a factor in health. This is really dependent on all the individual’s exposome as well as other factors that we don’t even fully understand yet.
There are two tests I commonly use that have methylation markers. One primarily looks at cortisol along with a number of other hormones and their metabolites. The other is a test that’s indicated when there are cognitive issues or at the beginning of treatment for a general health overview. All the functional labs are listed on my website under ‘Work With Me’.
Cortisol is our number one stress hormone. It has far-reaching effects on our physiology and health. The wisdom of what it does can be harnessed if we understand how it works.
The number one action of cortisol is that it is anti-inflammatory when its properly regulated. If its not regulated life quality of life plummets. Insomnia, pain and weight can all increase. Energy levels, cognitive function and libido decrease. Here’s why:
- Cortisol gives us a source of immediate energy by releasing glucagon from the liver. The down side is that it can lead to high blood sugar, pre-diabetes or insulin resistance if we are chronically drawing on it. Weight gain and estrogen dominance can also result.
- Cortisol also releases stored amino acids when in fight or flight mode to meet the heightened energy requirements. The negative result of this is similar to the first one. We want to be in the rest and digest mode most of the time so we absorb amino acids from our food.
- Cortisol increases the uptake of glucose to make fat tissue. This is hard-wired in us for times of famine. Body fat stored around the abdomen and trunk is due to running on cortisol.
- Cortisol breaks down bone to provide minerals to meet the energy needs. This weakens bones leading to osteopenia and osteoporosis. This is the same effect that taking steroid medications for too long has on bone health.
- Cortisol makes up happy. There’s a heightened neural excitability. This is the good side of stress. Perceptual and neural abilities are amplified.
- Cortisol mobilizes the immune system. More antibodies are produced when we are stressed. The body is ready to deal with injury. The negative side is that modern-day stressors are different from those of our ancestors. Sitting in traffic is stressful but we are not likely to get a sprained ankle the way we would running from a tiger.
- Cortisol increases our circulating neutrophils. Our immune systems are often in a state of hyper reactivity. Meditation trains us so we can come down.
- Our resources are diverted. T cells and lymphocyte production changes. This is why we get sick when we are stressed or when a period of high stress ends.
- Cortisol changes the thyroid function especially the conversion of T4-T3. When cortisol increases, thyroid hormone decreases. This is an attempt to maintain homeostasis.. Thyroid issues will develop when stress goes on for long enough. This is a major contributor to why we have the current epidemic of thyroid disease.
- Cortisol changes secretory IgA. Deactivates all the immune functions that aren’t needed for flight and fight mode. Mucosal tissues are weakened. Low grade infection can become chronic. Food reactions develop.
Ground breaking research highlights the role of social connection on long-term health. It’s fairly well accepted that smoking cigarettes is bad for health. However, sitting at computers for work, pleasure and social connection is widely accepted.
Getting up from your chair to interact with real people has a real impact. Structuring movement into your daily routine and quality time with those you love feels good. Leave your device at home or turn it off to mitigate the effects of constant distraction on your relationships.
Stress in Times of Change
The physiological impact of high stress on the body is significant. When life events like job loss, divorce or death compound and create a prolonged stress response, a cascade of health risks result. These include: insulin resistance, inflammation, memory and learning problems, poor metabolism, weight issues and lowered immunity.
Social isolation can happen during times of change, usually after the initial shock settles. Social networks shift while financial worries increase leaving fewer resources for recovery and connection.
The transition to motherhood is unlike any other. Ideally a new mother receives a lot of support. She needs sleep and enough nutrients to recover from birth and to breastfeed. Unfortunately this doesn’t always happen.
The demands of returning to work for one or both parents can make it difficult. The nuclear family lends itself to social isolation as the demands that previously were shared are put on two adults. A baby grows quickly. The needs of both mother and child also change quickly. It can be difficult to maintain relationships under these circumstances.
The transition to parenthood touches every aspect of life. It can take years to find a balance. New friendships emerge with other parents whose children have similar needs. Finding time for self-care or the social activities one used to enjoy can seem impossible at times.
Find stress management tools that can adjust with your lifestyle. Recently a friend and I have been working out with our kids. He uses them as weights which distracts them enough for me to do a few reps. This morning I practiced qi gong while my son played me guitar. Yesterday I swam lengths. My son put on some flippers and tried to keep up.
Motherhood is a wild endeavour. It’s an endless endurance feat that at times can be incredibly mundane and a lot of work. Other times it is wonderfully engaging and challenging. A lot depends on sleep and social support.
What is Enough?
New mothers are vulnerable for several reasons. It’s a time of life when social expectations change dramatically. At the same time societal judgements are stronger. The guilt of never being or doing enough is real. Hormones, emotions and the enormous responsibility of raising a child all play in. I remember walking with my newborn one day. We bumped into an old friend from my dance community. He remarked how I was doing the most important job around. This simple acknowledgement goes a long way.
A Kidless Culture
As parents our own early life trauma response can be triggered when we have our own children. This alone can be overwhelming. With significantly less time and resources it can be difficult to find the right support. Parents do the best that they can. Often parenthood brings on mortgages, career moves, marriage or separation. These are some of the biggest stressors in life. And they occur as we are learning a job that most of us were never taught to do.
One new mom told me she had never been around babies or children until she had her own as is common in the modern world. This is a far reach from how we evolved. That being said there is wisdom in our genetic memory or our bones so to speak.
Women, Mental Health and Thyroid
In one study of depression where medication didn’t help, fifty percent of patients improved once their thyroid was treated. The root cause of anxiety, panic, PMS, sexual dysfunction and chronic fatigue can involve impaired thyroid function.
In another study, 75% of women with clinically reported PMS tested positive for hypothyroid. When this was treated, 60% enjoyed a complete resolution of associated symptoms.
Two types of thyroid problems
The first is a supply problem. Thyroid hormone is not producing enough to meet the needs of the body. A marker called TSH or thyroid stimulating hormone will be high. The conventional range considers anything over 4.5 to be a concern. This is based on research that included both diagnosed and undiagnosed thyroid patients. More recent studies removed thyroid patients and a more accurate range has been established at 2.0 – 2.5.
The second problem is a conversion or uptake problem. TSH may be normal in this case. It will stimulate the release of T4 which is the inactive form of the hormone. T4 needs to be converted to T3 to be used in the body. Reverse T3 (rT3) is another marker. If there is significant inflammation or too much synthetic hormone replacement this marker can be high. The body can’t use rT3.
Stress and Inflammation
Women are more likely to develop thyroid issues. Pregnancy is the most common onset. Other major life events that increase stress and inflammation can also be triggers. Remember that the stress hormone cortisol helps reduce inflammation when its regulated well. In chronic illness, gut infection, heavy metal toxicity or food allergies cortisol may be dysregulated. One night of poor sleep can increase inflammation. Any inflammation can impair thyroid conversion. So can low testosterone.
Testing for thyroid antibodies is rarely done in conventional medicine. This is very unfortunate because over 80% of hypothyroid cases are autoimmune. Hyperthyroidism can also be caused by an autoimmune response. This is called Graves disease. Often one autoimmune disease will occur with another exacerbating symptoms. For this reason alone it is important to catch the autoimmune component. Preventing further disease processes from developing and paying attention to early warning signs saves both the patient and the system resources.
Specific nutrients are crucial for thyroid health include iodine and selenium. Its safest to get these from food sources. Iodine can be found in kelp and bladderwrack. It works synergistically with selenium and the daily intake should be 800 mcg. Selenium reduces TPO (the antibody production in Hashimoto’s). It is also needed for conversion. Two brazil nuts per day gives an adequate amount. Supplementing selenium should be done with caution and only as a short term measure at 200 mcg.
A synthetic form of T4 is what is commonly prescribed in cases of hypothyroid. This replacement therapy doesn’t always work. In some cases can make symptoms worse and in others the dose continues to be increased. You may not need T4 and it may be impacting thyroid hormone conversion negatively. Decreasing T4 & rT3 can be achieved by changing the medication to desiccated thyroid or by using T3 if this is what’s needed. What I like about desiccated thyroid is it has been around as a treatment for over a hundred years. It includes T4, T3, T2, T1 and calcitonin. Our Canadian brand ERFA is very good.
8 Steps You Can Take For Your Mental Health and Thyroid
1. Reduce immune response to food. Support detoxification pathways by switching from a standard diet to an anti-inflammatory one.
2. Optimize Vitamins B2, B12, C, A, D, Zinc, Magnesium and Iron. Testing is important.
3. Autoimmune diet: remove nightshades, eggs, nuts and seeds to see if reaction.
4. Reduce the negative effects of goitrogens and nitriles by cooking them.
5. Ensure a moderate carb diet. Nutraceutical vitamin and herbal support.
6. Manage stress, sleep and rest more.
7. Optimize blood sugar.
8. Increase the amount of movement, play and pleasure in your life.
Talk to your healthcare provider about these:
2. Commiphora mukul (Guggul): increases T3 levels & lowers when too high
3. Curcumin, boswellia, EPA/DHA, pro and prebiotics for inflammation and gut health
4. Coleus forskohlii: stimulates thyroid secretion
5. Iris versicolor (blue flag): stimulates glandular secretion & lymphatic waste removal
6. LDN for autoimmunity: start with 0.5 g and titrate up to 1-4.5 g.
Step one: Gluten is associated with autoimmune disorders because of a protein called zonulin. Molecules that shouldn’t to enter the bloodstream get through because of zonulin. This triggers an immune response that can never fully resolve. Remove gluten. I offer the most comprehensive lab test on gluten. It only just became available in Canada this year.
Step two: Cortisol is anti-inflammatory and therefore important in any immune response. If stress management is not central to treatment this hormone will have a negative impact on the thyroid especially if it is under an autoimmune attack. Cortisol spikes at night and may cause night hunger. A high protein snack before bed can help.
Step three: Having sufficient iodine in the diet is critical. Often 800 mcg of iodine is suggested for a period of time. Brazil nuts are high in selenium as is fish. Kelp and bladderwrack are good sources for iodine. Eating a variety of sea vegetables is good.
Step four: Add 300-500 mg magnesium glycinate at night is helpful for a variety of reasons including metabolic.
Step five: Dietary advice includes reducing nitriles and goitrogenic foods. Cooking these reduces the negative effects.
Step six: A moderate carbohydrate diet (around 30% of total calorie intake) is recommended as thyroid hormone conversion requires adequate amounts.
Step seven: Studies shows diabetics often have thyroid disorders. This is a bidirectional relationship, meaning thyroid disorders increase blood sugar problems and vice versa. Chronically high blood sugar leads to insulin resistance and inflammation. Repeated insulin surges increase the destruction of thyroid gland.
Step eight: Improving gut health is critical for all forms of thyroid disease. An autoimmune protocol is a starting place with individual variation that is found by experimenting. Thyroid hormones affect the tight junctions of small intestine and stomach. lipopolysaccharides, an endotoxin from the cell walls of pathogenic bacteria, can escape the gut and trigger an autoimmune reaction. This leads to inflammation and a decrease in thyroid hormone production. I recommend sweet potatoes, yams, plantains, taro, yuca, and winter squashes for adequate starches with fermented veggies as a condiment. A wide variety of other proteins, fats and plants can be eaten. Removing nightshades, eggs, nuts and seed is a standard autoimmune protocol as many react to these foods.
Step nine: Selenium deficiency is common and more so with those with gut issues and inflammation. Adequate selenium protects against the effects of iodine toxicity. Selenium is needed for the conversion of T4 to T3. Supplementation has been shown to reduce TPO antibodies and inflammatory activity Hashimoto’s.
Step ten: The cycle of low blood sugar leading to increased cortisol from the adrenal glands in order to promote glucose production. Cortisol is a glucocorticoids meaning that its role is to increase the amount of glucose available to the brain and muscles. Its will curb digestion, growth, and reproduction in order to do this. Continual release of cortisol can suppress the pituitary and therefore thyroid hormone output. Repeated cortisol release caused by episodes of low blood sugar can suppress pituitary function and reduce thyroid hormone output. Hypothyroidism will affect metabolic rate by reducing glucose sensitivity. Hypoglycemia can result and trigger more cortisol and this is a vicious cycle. Stress reduction is a very important part of treatment. Stress often induces and can exacerbate autoimmune disease, insulin-resistant hormone imbalance, and reduce total thyroid hormone output. It increases inflammation, decreases T4 to T3 conversion and weakens the immune barriers in the gut and brain. Stress reduces sensitivity to thyroid receptors leading to thyroid resistance. It also impairs estrogen clearance and increases thyroid-binding globulin levels. You can see why blood sugar and cortisol need to be understood in relation to one another especially when looking at thyroid hormone.
The key nutrients for thyroid health are iodine and selenium. It is best to get both of these nutrients from food sources. Many people have removed iodized salt from their diet and there are very few other sources that are part of the Standard North American Diet. Interestingly, dairy has iodine in it due to the cleaning agent used on the equipment that processes dairy. This has been shown to be a primary iodine source in today’s population. Cod is also particularly high. Seaweeds are by far the highest source of iodine however nori is not as high but consumed the most. Integrating kelp, kombu, arame, wakame and other sea vegetables is an excellent way to optimize iodine.
Selenium is found in most multi-vitamins and this is part of why I don’t recommend use of these. Supplementing selenium can be dangerous long-term due to toxicity. You can get your levels checked and maintain adequate selenium through eating 1-2 brazil nuts daily. Other sources are fish/shellfish, kidney, mushrooms, meat and poultry.
Adequate amounts of zinc, magnesium, vitamin A, C, D, B12 and B2 are also crucial for proper function. Magnesium glycinate is a good form and safe to supplement. Cod liver oil is a good way to get enough bioavailable vitamin A and D along with adequate sunlight exposure. omnivores will likely get enough B12 but it’s always good to check as health conditions related to low B12 can be debilitating. Ensuring iron ranges are optimal is also important as this is often too low but also can be too high. I check a number of markers beyond hemoglobin and ferritin in order to get an accurate iron profile. Clams are highest in iron and magnesium. Zinc can be found in oysters, liver, crab, beef and lobster. Vitamin C is highest in red pepper, kiwi and citrus fruits.
Avoiding goitrogens will optimize thyroid health and iodine levels. The best practice is to simply limit raw goitrogens to a couple servings per week. Cooking these foods reduces the harm for example cooking yucca reduces goitrogens by 90%. Cooking kale reduces them by 33%. Many of these foods have high nutrient densities so we don’t want to remove them completely. nitriles also have an effect on the thyroid. A great example of this is sauerkraut reduces nitriles but is cabbage which is a goitrogen. The benefits of raw sauerkraut outweighs the risk in this case and this is partially because nitriles are more of a concern than goitrogens.
As you can see there are grey areas but keeping it as simple is key. Except for sauerkraut keep steaming and cooking these foods. In another article I’ll talk more about the autoimmune diet, which in many cases is key to recovering vitality.
An anti-inflammatory diet is important for anyone concerned with thyroid health. This is because 85% thyroid disease is autoimmune. Inflammation plays a role in the destruction of the thyroid gland in cases of autoimmunity. In low T3 syndrome we know that chronic inflammation is a major contributor as well. I talk about this and other factors like poor gut health, high iron, nutrient deficiencies and low testosterone in another article.
Pregnancy is an excellent time to optimize diet and lifestyle for thyroid health because onset of thyroid disease post-partum is so common. Removing foods like vegetable oils, gluten, grains, sugar and processed foods is a good starting place. Adding more whole foods like meat, vegetables, fruit, nuts and seeds is excellent. Calories should not be restricted especially in pregnancy. This diet can be followed for thirty days to reset the body into knowing what it means to feel full and satisfied from eating nutrient dense foods. I walk patients through this all the time and have an online course called Baseline to support the process.
Keep in mind that a very low carbohydrate diet can inhibit thyroid conversion of T4 to T3. At least 30 percent of calories can come from starchy vegetables, fruits and gluten-free grains if these are tolerated. Keep in mind that gluten has a protein called zonulin. We know this increases intestinal permeability and leads to autoimmune disease like Hashimoto’s thyroiditis.
Keep in mind that for athletes and those with high levels of activity at work or in the home a higher carbohydrate diet is appropriate. Too much exercise can stress the thyroid as well. Incorporate times of rest and down time into your lifestyle. Conversely if you have a job where you sit a lot ensure enough activity as not enough movement, play and pleasure also impacts the thyroid negatively.
Patients with inflammation or those who are motivated to optimize their health are also asked to eat 4-5 servings of cold-water fatty fish per week. This works out to about a pound of salmon, sardines, trout, mackerel, snapper and cod. Canned, fresh or smoked are all good options. Variety is best in nearly all of our food choices. Please keep in mind that the research supports the safety of eating these fish due to the balance of selenium to mercury naturally occurring in them.
This brings us to specific nutrients to monitor in thyroid conditions. Selenium is one and is found in brazil nuts, fish/shellfish, kidneys, mushrooms and meat. Two brazil nuts per day is enough and much safer than supplementing especially long-term. Iodine is highest in seaweeds including kelp, kombu, hijiki, wakame and less so in nori. Fish, poultry, dairy, cranberries and potatoes are other sources.
Sufficient iodine minimizes the effect of goitrogens. These are foods that need to be limited in thyroid disease and cooked most of the time. I had a patient recently with Hashimoto’s who was having a green smoothie daily with kale. Kale is high in goitrogens and should be at least steamed. Collards, brussel sprouts, broccoli, cauliflower, bok choy, sweet potato, millet, soy and yucca all fall into this category.
Fermented foods like sauerkraut support the gut microbiome. This is very much linked to thyroid health. The live organisms and prebiotic fibers are effective at supporting long-term gut health as are a variety probiotic strains.
Last but not least is stress management. Meditation, journaling, yoga, breath work and other daily activities are known to reduce the negative effects of stress. The most pervasive and damaging factor in autoimmune and thyroid conditions may in fact be stress. Commit to making changes and get support. This factor alone can have an enormous impact on your health long-term.
Thyroid disease is very common and affects significantly more women than men. In conventional medicine, a diagnosis is made based on a high TSH (thyroid stimulating hormone). If the body isn’t producing enough thyroid hormone then the idea is TSH will be higher in an attempt to produce more. Unfortunately TSH will be considered normal in many people who are hypothyroid because the range is too wide. Preventative or functional ranges for TSH are lower. We look at anything above 2.0 or 2.5 in order to catch dysfunction before it becomes disease. Research also shows that conventional ranges are based on inaccurate data.
Signs and symptoms associated with hypothyroidism include: fatigue, depression/anxiety, insomnia, high cholesterol, cold hands and feet, slow wound healing, weight gain, oedema, hair loss, dry skin/hair,hives, headaches, asthma, bruising, constipation and PMS.
There are a number of other diagnostic tools including one called the THEA Score. The Thyroid Events Amsterdam (THEA) Score is based on the study “Prediction of progression to overt hypothyroidism or hyperthyroidism in female relatives of patients with autoimmune thyroid disease using the Thyroid Events Amsterdam (THEA) score” (Strieder, 2008). It is used to evaluate patient risk of progressing to hypothyroidism or hyperthyroidism within the next five years. http://www.ncbi.nlm.nih.gov/pubmed/18695079.
Two different antibodies to thyroid hormone show up on more extensive labs and may indicate a presence of autoimmune disease-causing hypothyroidism. This is also diagnosed using an ultrasound of the thyroid gland.
More extensive labs also show the amount of T4, which is the stored form of thyroid hormone. T4 is produced by the thyroid gland. TSH responds to the levels of T4 circulating in the blood, which is one reason hypothyroidism is under diagnosed.
The active form is called T3 and is what enters the cells and promotes DNA transcription. Then our body can enjoy the benefits of this important hormone. The conversion occurs in the organs and muscles using enzymes that require specific nutrients. I’ll talk about more about these nutrients in a different article but this is another reason thyroid disease is not diagnosed.
One more complicating factor is that T3 can be converted into reverse T3 or rT3. In this form there are no thyroid hormone benefits because rT3 is completely inert.
You can see why looking beyond TSH is important. If you are having any signs or symptoms and want to look deeper find a Functional Medicine practitioner who will do more comprehensive testing.
Lack or sleep is associated with several health concerns. Depression, memory problems and metabolic issues are just a few. Recent in-depth studies show that adults require between 7-9 hours of sleep per night. Younger people including college age people need more but unfortunately we are all getting significantly less. We see an increase in inflammation, obesity and emotional stability in those who are chronically sleep deprived. If there is one thing you can do to improve your health getting more rest and sleep may be the most important. Cardiovascular disease and cancers are also linked with insomnia.
Light exposure affects our circadian rhythm and our quality of sleep. Waking up feeling rested and energized indicates a proper amount of deep sleep has occurred. Black out blinds and a cool room are helpful. So is reducing light exposure after dark especially from screens. F.lux is a tool to reduce the blue light rays of screens if they must be used. Wearing orange coloured glasses is another option. Turning down lights in the evening and using this time for quiet activities and rest is important.
With electricity we work longer hours and have less time outdoors. Getting adequate daytime bright light anchors our circadian rhythm. Time zone travel and shift work are especially difficult for our bodies to adapt to. Alternating shift work is the worst. For travel you can take melatonin at the time you will go to bed in your new location. This helps you adjust to the new time zone and mitigates the discomforts of jet lag.
Melatonin also has an important regulatory effect on immunity. Those with adequate exposure to darkness are less likely to develop cancer than those with more artificial light. Anyone with chronic infection or autoimmune disease ought to focus on getting enough sleep as part of their treatment plan.
Allow more time to sleep than you need and wake up without an alarm whenever possible. Evening is not a time for stressful conversations but instead a time of unwinding from the day. The bedroom needs to be kept clear of electronics of all sorts.
Diet plays a role in insomnia. Studies show that not enough fat or carbohydrates contribute to poor sleep. Carbohydrates are needed to increase tryptophan in entering the pineal gland. Protein and fat are more satiating and this carries through the night. Often insomnia is a blood sugar issue. Sleep deprivation can lead to insulin resistance and weight gain.
Caffeine can contribute to sleep loss days after it is consumed. Fifty per cent of people don’t metabolize caffeine and for those with sleep problems reducing or removing caffeine completely is important. Not consuming any caffeine after noon is best.
Aerobic exercise can help with deeper sleep, depression and anxiety. It protects against the harmful consequences of stress if not overdone. Signs of too much exercise include insomnia, muscle fatigue, waking up not rested, poor recovery and a decline in cognitive function and performance.