When you have hypothyroidism it’s easy to get caught up in thyroid lab values and which thyroid meds and supplements work the best. While these are significant factors in improving thyroid health, it’s important to remember gut health is foundational to thyroid health. As long as you struggle with a leaky gut, gut inflammation, gut infections or parasites, heartburn, poor digestion, or chronic constipation or diarrhea—conditions that are so popular they fuel a multi-billion-dollar industry of drugstore remedies—you’ll never experience optimum thyroid health.
As I mention in the introduction to my book, poor thyroid function is like the engine light in your car turning on—it’s an indication to open the hood, investigate the engine, and repair what’s wrong. You don’t want to just take a drug or a supplement that will make the engine light go off.
The gut-thyroid connection can be a vicious circle as hypothyroidism causes poor digestive health, and poor digestive health may cause hypothyroidism. This is why it’s so important to appropriately manage Hashimoto’s and hypothyroidism, which involves more than finding the right thyroid medication. For the most part however, America’s addiction to processed foods, sweets, and stressed-out lifestyles leaves most people in need of some serious gut repair.
How poor gut health impacts the thyroid
For 90 percent of Americans, hypothyroidism is caused by Hashimoto’s, an autoimmune thyroid disease. Since most of the immune system is situated in the gastrointestinal (GI) tract, poor gut health is a significant factor in triggering and exacerbating autoimmune diseases such as Hashimoto’s. An important step in taming Hashimoto’s is to repair gut health.
Conversely, appropriately managing Hashimoto’s and restoring thyroid function can help improve digestive function. Studies show both T4 and T3 protect the intestinal lining from ulcers. Studies also show hypothyroidism can cause intestinal permeability, or “leaky gut,” which allows undigested food into the bloodstream and instigates an immune attack. These are examples of the thyroid-gut vicious cycle and how you may need to go after both fronts at once.
Gut flora and T3
Our digestive tracts host an array of bacteria that contribute to our health in a number of ways. One way is in the production of active thyroid hormones. A whopping 20 percent of thyroid function depends on a sufficient supply of healthy gut bacteria to convert T4 to T3. When diets are poor and digestion falters, dysbiosis, an overabundance of bad bacteria, crowds out the beneficial bacteria, thus hampering the production of active thyroid hormone. Studies have also shown that bacterial gut infections reduce thyroid hormone levels, dull thyroid hormone receptor sites, increase the amount of inactive T3, decrease TSH, and promote autoimmune thyroid disorders. Additionally, some studies have found connections between Yersinia enterocolitica and Hashimoto’s disease—antibodies to this bacteria are 14 times higher in people with Hashimoto’s. Maintaining healthy gut flora and addressing bacterial overgrowth is an important component of good thyroid function.
Low stomach acid
Hypothyroidism contributes to hypochlorhydria, a condition in which stomach acid is too low. For someone with acid reflux this may sound like a good thing, but in fact low stomach acid often causes heartburn. When hydrochloric acid is low the stomach cannot digest food thoroughly. The food in the stomach begins to rot and putrify. The small intestine attempts to reject this rotting mess, so the putrified food shoots back up into the esophagus. Though the food is not acidic enough for the small intestine, it is too acidic for the delicate tissue of the esophagus and causes painful heartburn. When this poorly digested food eventually does make its way into the digestive tract, it contributes to intestinal inflammation, infection, and leaky gut.
Although hypothyroidism can contribute to low stomach acid, low stomach acid can also contribute to hypothyroidism. It’s estimated more than 90 percent of the population suffers from hypochlorhydria, due to nutrition-poor diets of processed foods. The digestive dysfunctions stemming from low stomach acid likewise set the stage for autoimmune disease, chronic stress, and poor absorption of nutrients, all of which can lead to hypothyroidism.
Poor gallbladder function
Many people don’t realize how important the gallbladder is for proper digestion. It secretes bile to emulsify fats, which in turns aids in mineral absorption and prevents irritation of the GI tract. Hypothyroidism can cause the gallbladder to become sluggish and congested. A sluggish gallbladder increases the risk of gallstones; studies show more gallstones and bile duct stones among those with hypothyroidism.
A sluggish gallbladder also hinders the liver’s ability to detoxify. Poor liver detoxification not only hinders the conversion of T4 to T3, but also prevents the elimination of excess estrogen. As a consequence excess estrogen leads to an over abundance of the thyroid-binding proteins that transport thyroid hormones through the bloodstream. Too many thyroid-binding thyroid hormones prevent thyroid hormones from getting into the cells and hypothyroid symptoms ensue.
Repairing the gut begins at the plate
The topic of repairing digestive health is discussed in my book, and is worthy of a book in itself. However a few key points are worth mentioning again:
The Elimination/Provocation Diet requires you eliminate gluten, dairy, eggs, soy, corn, and yeast for two to three weeks, and then reintroduce each food every 72 hours to monitor reactions. It’s imperative to eliminate problem foods to support gut health. And of course if you have Hashimoto’s you should be on a strict gluten-free diet anyway, as the book explains.
The 4-R program
In the book I go over the basics of restoring gut integrity, which is known as the 4-R program. The remove phase removes harmful foods from your diet and eradicates bacterial and/or parasitic infections. The reinoculate phase restores healthy gut flora, necessary for T3 conversions, with probiotics. The replace phase includes support for hydrochloric acid, digestive enzymes, and gallbladder function until your GI tract is up and running on its own again. Lastly, the repair phase includes the use of specific herbs and nutrients to reduce gastric inflammation and regenerate the intestinal walls.
Manage stress and blood sugar swings
Chronic stressors lead to either too much or too little of the stress hormone cortisol. Studies show both extremes weaken the integrity of the GI tract. Blood sugar imbalances from diabetes, insulin resistance, or hypoglycemia are the most common chronic stressors today, and contribute to poor GI and thyroid health.
Address small intestinal bacterial overgrowth
Although dysbiosis in the large intestine has been the target of attention for some time, newer research is showing the importance of addressing dysbiosis in the small intestine. I find a monosaccharide diet to be quite effective in managing this issue. As I mentioned in last month’s article, this is a diet akin to the GAPS diet that eliminates all grains, starchy vegetables (such as potatoes), and sweeteners except for honey. It also includes daily consumption of homemade bone broths, which are soothing to the gastric lining. For people who find a gluten-free diet isn’t delivering the expected benefits, a monosaccharide diet may be the next step.
Don’t remove the engine light
The topic of restoring digestive health is vast and formidable, and this overview in no way constitutes a comprehensive approach. Instead it is an introduction to some fundamentals of thyroid health that go beyond thyroid meds and supplements. As I mention in the introduction to my book, poor thyroid function is like the engine light in your car turning on—it’s an indication to open the hood, investigate the engine, and repair what’s wrong. You don’t want to just take a drug or a supplement that will make the engine light go off.
Given the deleterious combination of poor diets, blood sugar imbalances, and the chronically stressful lives so prevalent today, the gut is usually the first to complain. Don’t ignore what it has to say with the use of over-the-counter medicines. When it goes down other systems in the body quickly follow suit, including the thyroid (the brain is also severely impacted, which will be the topic of my next book). When you set about recovering your thyroid health, it’s imperative you address digestive health as well.
Once again, thank you for this easy to understand review on the importance of Gut health. Amazing. Oh, and I can’t wait until your next book. When will it be ready?
I was screened for problems with gluten and all the tests came back normal. I haven’t had my Hasimoto’s antibodies checked in a long time (5+ years) I’m feeling pretty good most days. Could I be in remission?
Screened for gluten, what does that mean exactly? You had a blood test or…?
I’d run a thyroid peroxidase and antithyroglobulin ASAP along with an enterolab.com Celiac test cost $375. no doctor required. Blood work you can get at http://www.lef.org their doctors write the script. Costs less than other avenues of testing.
Feeling good means nothing and having no intestinal symptoms means nothing.
Like low doses of radiation you can’t always see or feel an autoimmune attack.
The consensus is all Hashimoto’s patients have Celiac. You may look like you are in remission but eating gluten will set it off. DR K can get patients into a “remission” unless they cheat, then the antibodies flare right back up.
The autoimmune disease is not really gone, just the autoimmune attack is halted.
I need an answer to a critical question: after reading the thyroid book twice, I cannot find anything that addresses my situation — I’ve had a total removal of my thyroid. I’ve had lupus (SLE) for 16 years, but was diagnosed with RA in 2009. What autoimmune disorder comes next? I’m terrified. I went gluten free two weeks ago, at my OD dr.’s suggestion, but I don’t feel better. I have chronic anemia, but my PCP refuses to re-test for this, as my most recent bloodwork showed my iron levels “normal.” I’m so terribly depressed that I hardly function these days. I have a PhD and enjoy my work, but my health is forcing me to consider retiring at age 57. I will do whatever it takes to restore my health.
Kelli, a gluten free diet may not be enough. autoimmune issues appear to be above all else, leaky gut issues. The thyroid book mentions briefly in chapter 6, that a “caveman diet” works best to support gut repair. Try the Paleo diet, which is basically, pastured, grass fed livestock, (vs. grain fed feed lot livestock purchased at your local grocer), organic vegetables and fruit, completely grain free, and no processed foods.
I’ve been mostly grain and starch free for years, and 1 1/2 yrs ago stopped taking RA meds after about 10 yrs on methotrexate and enbrel. My goal was to stay off these meds.
After RA symptoms began returning earlier this year in addition to my “well-controlled” hashimoto’s flaring up, I began searching for a natural remedy. I found also that I was allergic to soy, which I thought I had removed from my diet, but after reading labels, found it listed in the ingredients of many of the processed foods I was eating.
I’ve been eating pastured, grass fed animals (beef, pork, chicken, lamb, buffalo) and wild caught seafood (salmon, shrimp, scallops) plus organic or local produce. check your local farmer’s market and/or eatwild.org to locate where to buy the grass fed meat in your area.
in four months of eating this way, I have experienced numerous significant health benefits, including my RA symptoms subsided, my lipid panels improved and hba1c (diabetes) improved. my thyroid can still a problem, but usually only when I’ve allowed something in my diet that shouldn’t be there.
Dear Dr. Kharrazian,
Your written word is excellent. Please know how much your work is appriciated. My sister, has suffered one year with many of the listed sym ptoms. After sixteen visits to the Mayo Clinic, no physician has offered her assistance. She lives in the W.Palm Beach, Florida area. Please help us find a health care professional able to use your methods of treatment.
2004 hurricaine season left her working in mold and living in mold. She retired after 44 years of teaching and has been unable to enjoy her life because of sickness.
Thanks for this nice article it had been just what i was craving for today! I even have my very blog on hypothyroidism furthermore and if you have the possibility please take the time to check it out as I have some very interesting information on these topic’s.
I haven’t received a newsletter on email yet.
just learning about all of this stuff and am wondering what else gluten is called so i can look for it in the food I have.
Traci: Check out the unsafe food list at the celiac.com website
Thank you Dr. Kharrazian for your work! In your podcast interview with Underground Wellness, you talked about people with Hashimoto’s being susceptible to autoimmunity in the gut. One caller asked about candida and being very sensitive to perfumes. You mentioned something about an acid aldehyde imbalance, something sounding like aceto-aldehyde and that one could use maldemum cofactor to help correct it. I tried googling these terms and clearly I don’t have the spelling correctly or might not even have the proper terminology. Would you please write it out so I can understand and research it and hopefully have my doctor address it.
Many thanks, Pam
Thank you for doc sharing this informative post on thyroid and leaky gut. I have suffered from this condition and it was tough. But, folks like you sharing information freely on Internet has helped a lot. Without this I would be lost.
Dr. Kharrazian, I am very interested in the work that you do.
I was diagnosed with Hypothyroidism within month of giving birth to my second and last child 13yrs ago. I have been on meds since, 33yrs old and feel like i’m 90..heck my 85yr old grandmother has more energy than me. I am tired of being tired and without any energy all the time, if I forget to take my meds first thing in the morning..by afternoon I am on my butt and out of commission for at least two days..I don’t want to take meds anymore, I need help. What do you suggest? I have been told to take GTA Forte II-Biotics Corp as a replacement to help “fix” my thyroid, and hear many mixed stories. I have a confirmed leaky gut, did have yeast in my blood which has now been treated… I am what they call a “hot” mess.
Any suggestions would be greatly appreciated!
A year ago I took myself off of Cymbalta, after having horrific side effects. I tried weaning off for 2 weeks, but was continuously sick. Going off must have been so hard on my system. Was sick for 2 months. Developed dysarthria, which I still have. Damaged my CNS, so my right hand became extremely week and uncoordinated. Had an MRI done, which was negative for stroke and brain tumor. All the Neurologist suggested was speech therapy. I knew there was more going on, so I didn’t do it. Last December I became so tired and weak. Also have dizziness & balance issues, and have fallen over 6x in the last few months. Well, I went to a Naturopath. She determined I have Hashimoto’s and some Rheumatoid arthritis. I’ve been off gluten and coffee now. After taken probiotics and homeopathic things, I’m starting to feel better. Joint pain stays away if I avoid these, and processed dairy. Family is insisting I consult with an MD. Western medicine has never gotten anything right for me. My question is, will they run appropriate tests if I ask, or just TSH? Since they only go by a bell curve, it may be a waste of time. By the way, my insurance is with Mayo Clinic. Does an Endocrinologist here know how to treat Hashimoto’s? . . .
Try natural liquids with lactic acid. I had serious thyroid and poor bone health for years. Cleaned my gut. Taking probiotics, natural liquid with whey and lactic acid. I no longer take thyroid meds. I knew all along that the immune system lies in the gut but did nothing. Anyway, better late than never.
90% of all American Hypothyroid cases male and female are Hashimoto’s? I’m gonna need some references and citations on that.