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Top 10 reasons Hashimoto’s patients don’t get better
There is not one easy fix to successfully managing Hashimoto’s hypothyroidism, an autoimmune thyroid disease. As many people have learned the hard way, using thyroid hormones to get TSH within lab ranges certainly doesn’t guarantee a fix for most people, although it can help. Hashimoto’s is a multifaceted autoimmune condition that involves many mechanisms. To truly manage your autoimmune Hashimoto’s hypothyroidism, it’s important to understand the factors that contribute to it.
10. Immune Reacting Fillers in Thyroid Hormone Replacement
Many thyroid supplements use corn starch or modified food starch that contains gluten. You need to make sure your thyroid hormones are gluten-free and free of corn starch if you react to corn. If your medication is in capsules make sure the capsules are gluten-free. Otherwise you could be taking hormones every day with dietary proteins that stimulate your autoimmunity.
9. Taking Immune Enhancing Supplements
Nutritional supplements can either help or flare up your autoimmunity based on an individual’s T-helper dominance (whether you have a TH-1 or TH-2 dominance). Supplements such as echinacea, green tea, acai, astragalus, licorice, and a variety others. can either help or aggravate autoimmunity depending on your dominance. If you are unaware of this you may be taking supplements that promote an autoimmune response. Please refer to Chapter Three of my thyroid book, Why Do I Still Have Thyroid Symptoms? for more information and lists of supplements and herbs to be aware of.
8. Fixating their focus on thyroid hormone replacement only
Many thyroid patients believe that if they could only figure out the perfect version of thyroid hormones (natural versus bio-identical or T3 versus T4) they can correct all of their symptoms. Unfortunately, Hashimoto’s hypothyroidism is a complex autoimmune disorder and thyroid hormone replacement is only one part of a large puzzle. However, if you need help learning more about thyroid hormone variations please refer to a previous newsletter article titled, Which thyroid hormone is right for you?
7. Increasing Stress
Emotional stress activates pathways involving the inflammatory immune messengers IL-6 and TH-17. This activity creates an autoimmune flare-up. Unhealthy relationships with your spouse, co-workers, or friends can promote autoimmune flare-ups, as can a bad work environment, or other significant and chronic lifestyle stressors. If you have Hashimoto’s you need to create a healthy emotional environment for yourself. Bad personal relationships or poor work environments can be detrimental to Hashimoto’s hypothyroidism patients.
6. Not Strictly Gluten-Free
You are either 100 percent gluten-free or you’re not gluten-free. Choosing to eat gluten-free only when it is convenient is not a gluten-free diet. If you are not strict about your food being 100 percent gluten-free when you eat out and you continue to consume condiments that have gluten, regular beer, and foods fried in fryers that use the same oil for breaded foods, then you are still being exposed to gluten. Gluten is a major trigger for most Hashimoto’s hypothyroidism patients and many cannot improve until they are 100 percent gluten-free.
5. Not avoiding gluten cross-reactive foods
Although a strict gluten-free diet is a great place to start, if you are still eating foods that cross-react with gluten you may not recover well. Cross-reactive foods have proteins similar in structure to gluten and can trigger the same immune response as if you were eating gluten. The most commonly ignored cross-reactive food is milk (casein), followed by rice, corn, sesame, and gluten-free oats. In fact, it is best to avoid all grains and adopt a diet such as a Paleo diet when you have Hashimoto’s.
4. Ignoring their brain health
The most common form of collateral damage in chronic Hashimoto’s patients is accelerated brain degeneration. Brain degeneration leads to identical symptoms of hypothyroidism, including fatigue and depression. I strongly suggest all thyroid patients become experts in identifying and supporting their brain health by referring to my second book, Why Isn’t My Brain Working?
3. Ignoring insulin sugar spikes
Surges of insulin that follow eating or drinking something sugary or starchy (sweet coffee drinks, desserts, bowls of pasta or rice, bread, etc.) trigger the inflammatory TH-17 activity, which promotes autoimmune flare-ups. Eating sweets throughout the day or overeating promotes insulin surges, which can be identified by symptoms of fatigue or sugar cravings immediately after eating. If you have those symptoms after eating it means you are not managing your insulin levels and your Hashimoto’s autoimmune response will be hard to tame.
2. Missing meals
When blood sugar gets too low it raises the inflammatory messenger IL-6 and promotes autoimmune flare-ups. Symptoms of low blood sugar are most noticeable between meals or if you skip meals and include shakiness, blurred vision, crankiness and irritability, and loss of function. If you feel a jump in your function and energy after eating it confirms your blood sugar was low—when your blood sugar is stable the only thing you should feel after eating is not hungry. Constantly skipping breakfast and missing meals will aggravate your autoimmune response and promote autoimmune flare-ups.
1. Passive attitude
The passive patient does not question or challenge her doctor. If you are a passive Hashimoto’s patient and you do not take your health into your own hands you may not fare as well as the person who educates herself. The conventional model is based only on lowering your TSH with whatever thyroid medication your insurance plan or doctor prefers. Once TSH is within lab ranges, this model has nothing more to offer except to check your TSH once a year. It takes time and effort, but the thyroid patient who wants to feel better needs to roll up her sleeves and master the various mechanisms of Hashimoto’s. The more you understand Hashimoto’s the more likely you are successfully manage your health.
Thyroid hormones are important for the health of hair follicles and many thyroid patients struggle with thinning hair and hair loss. Although many thyroid patients resolve their hair loss issues with thyroid hormone medication, many others don’t. It’s important to understand factors beyond thyroid medication that affect hair loss.
Inflammation can impair hair follicle cell function
First, the autoimmune response impairs how thyroid hormones act on cellular receptors, including the cells in hair follicles. When inflammation is high, inflammatory immune cells called cytokines can interfere with the action of thyroid hormones on these cellular receptors. This is one reason why, in addition to making sure your thyroid hormone levels are sufficient, it’s important you manage inflammation. Many times hair loss will not resolve until the patient learns how to manage their autoimmunity.
Elevated testosterone in women main cause of hair loss
However, the most common reason female Hashimoto’s patients suffer from hair loss is due to elevated testosterone. Symptoms of elevated testosterone include thinning hair, hair loss, an inability to lose weight, and in more extreme cases, excess facial hair. For most women, high insulin levels brought on by an unhealthy diet and lifestyle cause excess testosterone. This is because insulin stimulates an enzyme in the ovaries called 17,20 lyase, which promotes the synthesis of testosterone. This increased testosterone then leads to thinning hair and hair loss. Factors that promote insulin surges and hence elevated testosterone are a diet high in starches, refined carbohydrates, and sugars, and a sedentary lifestyle.
Poor blood flow to scalp causes hair loss
Another common cause of continued hair loss in Hashimoto’s patients is poor circulation. The hair follicles need a constant supply of nutrient-rich blood. If circulation to the scalp is compromised, hair loss is inevitable. Clinically, the signs that signify poor circulation include cold hands, cold feet, cold tip of your nose, and poor nail health (nails also require good circulation to be healthy). Thinning hair is not the only consequence—poor circulation can have devastating impacts on your brain health. I discuss this concept in detail and offer strategies in my new brain book, Why Isn’t My Brain Working?
A recently published case study showed that neurological symptoms can occur in Hashimoto’s patients. SPECT brain scan imaging showed reduced brain activity (hypoperfusion) both in patches and throughout the entire brain. The brain scan images completely changed after subjects were given corticosteroids to suppress the autoimmunity, showing improvements in many areas. However, patchy areas of impairment persisted despite autoimmune suppression.
This study illustrated two key concepts. First, Hashimoto’s impairs brain function and dampening autoimmunity can improve function. Second, areas of continued brain degeneration persist despite treatment that dampens autoimmunity.
I cannot stress enough how important it is to improve your brain health when you have Hashimoto’s. This is exactly why I wrote my second book on brain health—it is so critical for my Hashimoto’s readers. In in my practice I have found the most important second step Hashimoto’s patients must take after reducing their autoimmune expression is to optimize their brain function.
To read the study, click here.