by Brendan O’Brien NT, MSc. mNTOI
It is fair to say that many Nutritional Therapists approach healthcare from a different mindset than mainstream medicine doctors. The purpose of nutritional advice is not to treat any medical condition per say but rather to help the person support their overall health using sound scientific principles.
It is the experience of many Nutritional Therapists (NT’s) as well as many Medical Doctors (MD’s), that there is a tendency for GP’s to ignore test results indicating elevated thyroid auto-antibodies. The reasons for this are varied, but within the medical profession there exists a sense that thyroid function can be accurately reflected in the standard Thyroid work up…ie by evaluating just TSH and T4 values.
The result of this is of course that many people do get accurately treated and can enjoy a good return to health and daily function. However there is also a swell of opinion being voiced by others, who are being medicated for hypothyroidism but experience no symptomatic improvement, that these two hormone readings appear to be wholly inadequate, and thus deeper investigation is required. In answer to this, many doctors and growing numbers of Nutritional Therapists are recommending a more comprehensive work up for people whose symptoms do not improve with thyroxin replacement.
It has been brought to public awareness in the last few years, by for example prolific researchers such as Dr Datis Kharrazzian DHSc, that on closer analysis a majority of people suffering from low thyroid function in fact also suffer with thyroid autoimmunity and that it is thus now warranted to screen for this autoimmunity with any and all hypothyroid patients.
This, being relatively new information, is of course not yet officially acknowledged and thus is not part of medical protocols. But, from a much safer nutritional intervention point of view, one can still take action to support their health using sound nutritional principles when conversely the medical profession must wait for more certain pronouncements of evidence given the fact that drug interventions carry enormous potential for risk.
In other words testing out the veracity of new evidence using food changes is inherently safe, whereas doing this with drugs is not.
From a medical point of view once auto antibodies are detected the speciality switches from endocrinology to immunology, and within the immunologists toolkit there are only immune suppressants and ultimately radio ablation or surgery available for diseased thyroid glands.
The frustrating thing about this is that many Nutritional Therapists (whose toolkit is after all diet change) are finding very satisfying results in clients who present with autoimmunity, and yet the mainstream profession, and indeed mainstream dieticians, seem to oppose this method of support mainly because they don’t accept the new evidence or don’t understand it, or they apply a pharmaceutical rational to a nutritional intervention…when this is not appropriate.
Why might it be that diet change could positively affect such a thing as autoimmunity?
Several theories exist trying to explain the origin of autoimmunity, (I think there are 20 theories in the literature).
Nutritional Therapists, as well as many doctors who practice Functional Medicine, tend to go with the theory that autoimmunity is the result of a perfect storm of:
•a consequent disregulated immune response at the gut wall with a loss of what’s called ‘oral tolerance’.
This storm gives rise to an aberrant polarisation of T Helper cells within the Gut Associated Lymphoid Tissue (GALT) which in turn lends itself to the eventual production of auto antibodies that go on to ‘attack’ some gland or other.
The main body of research which backs this up is summarised in the paper by Fasano et al. 2011 (Zonulin and its regulation of intestinal barrier function: the biological door to inflammation, autoimmunity, and cancer) D.O.I. 10. 1152/ physrev. 00003. 2008.
Essentially what this is saying is that:
A disregulated / porus / hyperpermeable gut membrane (what NT’s call a leaky gut!) allows immune triggering food proteins (antigens) to enter the circulation in an undigested state and cause an inflammatory reaction. (In short undigested food slips through the gut wall and sets the immune system on fire!)
If the inflammatory reaction persists as a chronic state it lays the groundwork for disease including autoimmunity.
Many substances cause the gut wall to breakdown in this way, but key among these agents is gluten.
Dr Fasano proved that gluten caused the release of a hormone called Zonulin which then caused the destruction of the junctions between the cells of the gut wall, and ultimately caused the wall to become leaky. (In other words if we think of our gut as being made of cells that are stuck together like bricks in a wall, then gluten causes the mortar between the bricks to dissolve!) So what he was saying is that gluten is a prime suspect in the initiation of autoimmunity.
Nutritional Therapists often get good results by advising temporary avoidance of gluten in order to give the guts of people with autoimmunity a chance to heal. And, Functional Medicine doctors and Nutritional Therapists who practice using Functional Medicine principles see a reduction of autoimmune markers (such as Thyroperoxidase and Thyroglobulin) and a consequent improvement in the wellbeing of the client quite often as well.
Does this prove our theory is correct? No! But it sure is better for a person with thyroid issues than doing nothing. It could help, it often does…so why not try it and see?
About 1 in 5 women show elevated thyroid auto antibodies according to Kohno Y, et al. Anti-thyroid peroxidase antibodies in sera from healthy subjects and from patients with chronic thyroiditis: differences in the ability to inhibit thyroid peroxidase activities. Clin Exp Immunol. 1991 Sep;85(3):459-63. http://tinyurl.com/orxqc35
It is true that chronically elevated auto antibodies eventually cause destruction of the gland which will ultimately lead to irreversible hypothyroidism, but along the way can also give rise to hyper thyroid symptoms as a result of the leakage of T4 into the circulation. In short you can’t tell if someone is hyper or hypo thyroid just by looking at antibody titers, in fact many people with elevated auto antibodies can present with normal TSH and T4 levels.
Also whilst Thyroxin replacement can (sometimes) help ones symptoms it does nothing to prevent gland destruction due to auto antibodies…for this a different therapy is needed as the problem per say does not lie with the thyroid gland but rather with the immune system, and 80% of the immune system is in the gut, where the immune system takes much of its cues from.
Finally there’s Fluoride issue. Personally I have no specific evidence to offer (it’s not my area) on avoiding fluoridated water, but suffice it to say from a mechanistic point of view it makes prudent sense to reduce exposure to iodine displacing halogens (like fluoride) if one wants to support their struggling thyroid gland.