If you’re getting your TSH levels checked to monitor your thyroid health, it’s best to get that done in the morning. Otherwise, your results may come back normal even though you have hypothyroidism.
All the body’s hormones follow a daily rhythm, including thyroid hormone. This means there are times of the day when it naturally higher or lower. Researchers tested the blood of hypothyroid subjects both before 8 a.m. and again between 2 and 4 p.m.
In hypothyroid patients both untreated and on thyroid medication, TSH dropped was substantially lower during the afternoon test. This means an estimated 50 percent of people with hypothyroidism are not being diagnosed.
In the untreated group, TSH was 5.83 in the morning and 3.79 in the afternoon. In the treated group, TSH was 3.27 in the morning and 2.18 in the afternoon.
A 2004 study also showed late morning, non-fasting TSH was 26 percent lower compared to the early morning, fasting TSH. This means even a late morning blood draw could result in a failure to diagnose. Do you really want to know what is going on with your thyroid? Schedule a FREE 15-Minute Consultation with Dr. Celaya.
TSH blood test timing and functional medicine ranges
The timing of your blood draw plays an important role in reading a thyroid panel. However, there is more to it.
Even with an early morning blood draw, many doctors will still fail to diagnose hypothyroidism because they use lab ranges that are too wide and that do not reflect genuine thyroid health.
Many doctors still use a hypothyroidism TSH range of 0.5 to 5.0 even though the American Association of Clinical Endocrinologists recommends 0.3 to 3.0.
In functional medicine, we use an even narrower range of .25 to 1.25. We also know that only looking at TSH can miss hypothyroidism.
For example, TSH may be normal but other thyroid markers are off. That’s why it’s important to order a thyroid panel that includes total and free T4 and T3, reverse T3, free thyroxine index (FTI), T3 uptake, and thyroid binding globulins. Many conditions can cause poor thyroid function, including inflammation, hormonal imbalances, and chronic stress. Ordering these other thyroid markers provides more insight into such imbalances.
Always include a test for autoimmune Hashimoto’s hypothyroidism
In addition to these markers, anyone with symptoms of hypothyroidism should also test for Hashimoto’s, an autoimmune disease that attacks and destroys the thyroid gland.
Why? About 90 percent of hypothyroidism cases in the US are caused by Hashimoto’s. To screen for Hashimoto’s, order TPO and TGB antibodies.
Thyroid medications may be necessary to support thyroid function, but they do not address the autoimmunity attacking the thyroid gland. Failing to manage Hashimoto’s increases the risk of developing other autoimmune diseases such as pernicious anemia, rheumatoid arthritis, vitiligo, and Type I diabetes. It will also make it more difficult to manage your symptoms.
Want to see if Dr. Celaya is the right fit for you? Schedule a FREE 15-Minute Consultation with Dr. Celaya to talk about your thyroid.
A recent study found regular use of proton pump inhibitors (PPIs) for acid reflux raises the risk of stomach cancer. PPI users (Prilosec, Prevacid) in the study had twice the risk for stomach cancer compared to those who used H2-receptor acid reducing drugs (Tagamet, Pepcid).
About 20 percent of Americans suffer with acid reflux and heartburn. Most people attribute acid reflux to excess stomach acid. However, the problem is too little stomach acid. How does low stomach acid cause acid reflux? Want to know more? Schedule a FREE 15 minute consultation with Dr. Celaya.
The stomach is highly acidic by design so that it can quickly break down foods and kill bacteria, fungi, and other pathogens. Good stomach acidity also helps absorb minerals and signal the rest of the digestive tract to release the right hormones, enzymes, and emulsifiers. Sufficient stomach acid is an important first step in ensuring overall digestion runs smoothly and that you are less susceptible to heartburn, indigestion, belching, gas, food allergies, bacterial infection, and abdominal pain.
What causes low stomach acid?
Common factors that cause low stomach acid include stress, bacterial infection, poor diet, and nutritional deficiencies. However, an H. pylori infection, which is linked to stomach ulcers, is the most common cause of low stomach acid.
Other factors that play a role in low stomach acid include hypothyroidism, pernicious anemia, and deficiencies in zinc B12, magnesium, or chloride. People who have been vegetarians or vegans for a long time may be deficient in zinc and B12, which are abundant in meats.
How low stomach acid causes acid reflux
In order for the small intestine to receive food from the stomach, the contents must be acidic enough to trigger that passage. When this fails to happen, the food shoots back up into the esophagus.
Although the food is not acidic enough for the small intestine, it is too acidic for esophageal tissue. This is what causes the burning of acid reflux, or heartburn.
Why antacids worsen acid reflux in the long run
Antacids or acid blockers bring temporary relief but can cause bigger problems in the long run. Without stomach acid to trigger the release of enzymes, digestive hormones, and emulsifiers, nutrient absorption suffers and the digestive tract is more prone to infection, inflammation, and damage.
How to improve low stomach acid
The first thing to do with low stomach acid is address the root cause. As we age, stomach acid naturally decreases. You can boost stomach acid by taking a supplement that contains betaine hydrochloric acid (HCl). However, if you have stomach ulcers or stomach autoimmunity (when the immune system attacks and destroys tissue), supplementing with HCl could make you worse. In these situations you need to address the existing condition first.
If you would like to get to the root cause of your heartburn, you can schedule for a free consultation with Dr. Celaya.
A recent study showed a low-carbohydrate, whole foods diet low in inflammatory foods significantly decreases thyroid antibodies — the marker for autoimmune thyroid disease, or Hashimoto’s. Hashimoto’s occurs when the immune system attacks and destroys the thyroid gland; it is the cause of about 90 percent of hypothyroid cases. This study is further evidence you can profoundly influence autoimmune Hashimoto’s through diet and lifestyle interventions.
In the three-week study, almost 200 people with Hashimoto’s were divided into two groups. One group followed the low-carbohydrate study diet while the other followed a standard low-calorie diet.
The results were significant: Levels of several different thyroid antibodies that serve as markers for Hashimoto’s dropped between 40 and almost 60 percent! This group also lost a little weight.
Meanwhile, the group that followed a low-calorie diet saw antibody levels go up between 9 to 30 percent!
What the study group ate to tame Hashimoto’s
The study designers chose a curious route for their research in having their subjects follow both a low-carbohydrate, anti-inflammatory diet as well as a diet low in goitrogens. Goitrogens are compounds that lower thyroid function and are found in raw cruciferous vegetables (broccoli, cauliflower, cabbage, etc.), soy, and other foods.
Before people understood the mechanisms of autoimmune Hashimoto’s, it used to be the rule of thumb was to avoid goitrogenic foods.
However, through the evolution of functional medicine, we have learned most people with Hashimoto’s can safely eat normal amounts of cruciferous vegetables. In fact, they contain many beneficial nutrients as well as fiber. People with unresolved small intestinal bacterial overgrowth (SIBO) or genetic difficulty metabolizing sulfur may not do well with these vegetables. So we don’t know how subjects would have fared in this study had they included these vegetables.
Soy, on the other hand, has been shown to lower thyroid hormone levels in studies and is best avoided by those with Hashimoto’s.
The study diet that improved Hashimoto’s
Here is the diet the study subjects ate that lowered their thyroid antibodies:
- Low carbohydrate diet that was 12 to 15 percent carbohydrates, 50 to 60 percent protein, and 25 to 30 percent fats. (Most people eat a diet that is about 50 percent carbohydrates.)
- Lots of different vegetables. Research shows a diet high in veggies improves immune health through its impact on beneficial gut bacteria.
- Lean meats and fish.
- No goitrogens: cruciferous vegetables (which, if not eaten to excess, improve beneficial gut bacteria), canola, watercress, arugula, radish, horseradish, spinach, millet, tapioca, nitrates.
- Eggs, legumes, dairy products, bread, pasta, fruit, and rice. In functional medicine we know gluten and dairy exacerbate autoimmune Hashimoto’s for the most part. Eggs, legumes, and grains are inflammatory for many people as well. People with poor blood sugar stability may need to limit their fruit intake.
In functional medicine, we see the best results with a diet very similar to this one called the autoimmune paleo diet (AIP). In fact, a recent study showed the AIP diet significantly improved autoimmune gut disorders.
Ask my office for more advice on managing your Hashimoto’s hypothyroidism or other autoimmune disease.
Most thyroid issues are autoimmune by nature. Around 70-80% of the autoimmunity issues can be traced to gut infections. On the flip side, having gut infections can increase the likelihood of an autoimmune disease.
Autoimmune disease needs three things to occur.
The three risk factors include genetic predisposition, intestinal permeability, and environmental triggers like bacteria, virus, foods proteins, or inflammation. While we can’t do much about the genetics part, we can certainly do something to avoid the other two factors by first becoming aware of how they affect you. It’s all about lifestyle.
1 – Genetic predisposition is kind of obvious.
Parents’ traits may be passed down to children but is not always the case. Take, for example, genetics versus epigenetics. I like to look at this like a computer. Genetics can be considered the hardware and the epigenetics is the software. The hardware is not readily changeable but the software may vary. If you choose the wrong software, the hardware or genetics won’t operate correctly. You may have the propensity to get the disease, but it takes the two other triggers autoimmunity.
2 – Leaky gut or gastrointestinal permeability is one of the ways that autoimmune conditions start.
This is why it’s important to make sure that gluten and cross-contamination testing is part of every thyroid patient’s workup. Many patients don’t even know if they have an issue with gluten if they don’t have any abdominal pain.
The immune system acts in the mucosal area of the gut, a long tube lined with mucous tissue. This is where food is absorbed into your body. The immune system must be on high alert because this is where many things enter that could possibly be dangerous to the body. The gus is also lined with bacteria. Good and bad, our gut has to know the difference between the two.
The bad bacteria can release byproducts and toxins that can damage the intestinal wall. Intestines can also be damaged by processed foods, food preservatives, stress, alcohol, toxins, infections, inflammation, medication, and a lack of fiber. A protein called Zonulin is responsible for increasing the spaces between the intestinal cells so nutrients and other molecules can be absorbed into the body. However, when leaky gut is present, the spaces between the cells open too much. This eventually lets protein particles or amino acid sequences ease their way in your bloodstream. From there, an immunological reaction can take place.
The immune system has several different types of white blood cells. B lymphocytes, a certain kind of immune cell, makes antibodies. Antibodies are like a tag or marker that attaches to the foreign invader or pathogen. When immune cells see this tag, they know that a foreign invader needs to be destroyed. These antibodies continue to stay in the body. They wait in case the pathogen returns. Their job is to mark the foreign invader for destruction.
Certain amino acid sequences get absorbed into the body without digestion. These sequences tend to look a lot like body tissue amino acid sequences, causing the immune system to attack both. This is called molecular mimicry.
Take a look at the top of each drawing where you can see that the sequence of letters looks somewhat alike. This represents the amino acid sequence we may see common in these three things – thyroid tissue, gluten and casein.
The gluten or casein polypeptide chain looks a lot like the thyroid in some aspect. The antibodies can also tag thyroid cells for destruction if our leaky gut leaves in a peptide from gluten. This is in addition to tagging gluten or casein. This is called autoimmunity. Once you have the antibodies, your body can continue to make them if the pathogen still invades the body.
3 – Environmental triggers are important to eliminate.
The first pathogen is Yersenia Enterocolitica bacteria. This bacterium is prevalent in thyroid autoimmunity and resides in the gut. It has receptors to our thyroid stimulating hormone. TSH receptor antibodies are then made. This can trigger the immune response not only to the bacteria but also to the TSH receptor. We see higher antibodies for Yersenia in autoimmune thyroid patients.
Mycobacterium Avium Paratuberculosis, or MAP for short, is another bacterium in the gut. Molecular mimicry between this bacteria and human proteins is a likely cause of autoimmune disorders. Some autoimmune disorders this may cause include Crohn’s disease, Type I Diabetes, Hashimoto’s Thyroiditis, and Multiple Sclerosis. H-pylori and other bacteria can cause gastritis and cancer. This is also thought to play a part in Hashimoto’s and Grave’s disease. However, newer evidence shows that it can also be protective for chronic inflammatory diseases, autoimmunity and allergies. At this point, more research is definitely needed to further validate this claim.
Next, we have Lyme disease. Borrelia bacteria strain causes this condition. Research also shows that this can trigger Hashimoto’s disease as well. Epstein-Barr virus and Herpes virus have also been linked to leaky gut which, in turn, causes thyroid issues.
Under environmental factors, we also have medications, primarily antibiotics. They can destroy the beneficial bacteria in addition to the pathogenic bacteria. Aside from this, pathogenic or opportunistic bacteria can flourish, breaking down hormones which are secreted from the liver into the small intestines. If you lack the beneficial bacteria to break down estrogen and have a leaky gut, you may now reabsorb estrogens which can then affect thyroid function.
A second medication is non-steroidal anti-inflammatory medication. Inflammation-causing factors like food sensitivities, allergies, alcohol, and stress can cause inflammation. This can then cause an increase in intestinal permeability. Processed foods like sugar, grains, gluten, artificial sweeteners, processed meats, certain processed oils, corn, soy, cottonseed, omega-6 fats, and canola oil can also cause inflammation, which then can cause a leaky gut.
What about the flora in your mouth? Can your mouth be leaky? Oral health issues can be important to look at, not just bad odor, but also chronic gum or tooth infections that can lead to autoimmune diseases. There has also been research that showed that urinary bacterial overgrowth is strongly linked to different forms of autoimmune arthritis.
A lack of stomach acid (HCl), digestive enzymes, and bile can also cause a problem. If you don’t properly digest food, it can become inflammatory and cause damage to the intestinal walls. In addition, if proteins are not broken down into amino acids, they can pass through an already leaky gut, causing more immune responses and possible autoimmunity.
There are different ways to look for infection.
- The first is with a simple blood lab test.
A simple CBC or complete blood count looking at cell types can really catch large infections. I would also look at inflammatory markers like hsCRP, ESR, and plasma viscosity.
- The next test I would look at is stool testing.
Polymerase chain reaction technology or PCR looks at the DNA of microbes. This can help us get a good assessment of what normal bacteria is there. Most non-DNA stool tests take a sample and then culture the bacteria in a dish with a food medium. The problem is that 95% of your gut bacteria will die if they’re exposed to air, as they are anaerobic. They can’t survive in oxygen and they can’t be grown.
There are also other problems trying to grow the air-breathing bacteria. Some bacteria might flourish in certain types of medium, which is a food given to them so they can grow, while some may not flourish. Some may like different temperatures more than others. It’s hard to tell exactly what’s happening in a person’s gut without DNA. With functional medicine, we look at DNA since culture doesn’t give an accurate representation of the types and quantity of bacteria.
This is a great test and it’s one of my favorites. In this test, we also look for inflammation markers. Calprotectin is a marker of neutrophil-driven inflammation fecal secretory IgA. IgA is a marker of gut immunity and barrier function. It’s also important to follow up with testing for fecal Lactoferrin.
Pancreatic elastase is considered an exocrine pancreatic function indicator. We should also look at the products of protein breakdown. These are indicators of the presence of undigested protein. We also want to understand fecal fat and the markers of fat absorption and breakdown. We’ll also look at short chain fatty acids as indicators of gut microbe health. Another component is beta glucuronidase, which is an enzyme involved in the metabolism of complex carbohydrates.
We also want to look at the commensal bacteria or the friendly bacteria. This demonstrates the diversity, composition, and relative abundance of organisms in the gut. These things are directly linked to both your general health and your gastrointestinal system’s overall well being. Next, we get into parasitology and that involves microscopic examination of fecal specimens for OVA and parasites.
- The next test is a urine test where we look for oxidative stress markers which can be present as a result of chronic infections.
The first part of this urine test looks for lipid peroxidation. They’re reflective of oxidative damage to polyunsaturated fats which are components of cell membranes. We’ll next look at 8-OHdG (8-Oxo-2′-deoxyguanosine) which is reflective of oxidative damage to DNA.
Autoimmunity is very common in industrialized Western countries as opposed to the rest of the world.
What’s the difference? Well, we’ve scrubbed and cleaned our world with chemicals and cleansers and killed off beneficial bacteria. We have also limited our exposure to diverse strains of microorganisms. The cleaner we are, the more chronic diseases we have when certain parasites are present. They release chemicals that regulate the body’s immune response. It ensures that it doesn’t overreact. In other countries, inflammatory bowel disease–an autoimmune disease, is treated with Helminth interactions, which is a parasite. This type of treatment needs more research.
The following are some ways to help you avoid autoimmunities and thyroid disorders:
- Remove food sensitivities including gluten and other immune sensitive foods.
- Optimize vitamins, as they enhance our immune system.
- Reduce opportunistic and remove pathogenic bacteria and micro-organisms.
- Enforce diet changes to reduce inflammation.
- Further help reduce inflammation by taking resveratrol, turmeric and fish oils.
- Reduce stress, which also reduces cortisol.
- Heal the gut. I would feed the intestinal cells with different fibers, probiotics, glutamine, and acetyl glucosamine. Perhaps antifungals like oregano oil would help with infections.
- Make sure digestion is occurring well with proper digestive acid, enzymes, and proper bile production and delivery.
The protective barrier of the intestines plays an important role in human health. It encourages nutrient absorption from the food that we consume each day. It also provides some protection against invasion of bacteria, toxins, allergens, fungus and parasites.
Most doctors will only address the lack of thyroid hormone, but very few will consider autoimmunity. Again, remember if you have an autoimmune condition, you are 70-90% likely to get another autoimmune condition. To learn more about your condition, please contact me.