Hashimoto’s Food Pharmacology
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CATHARINE: Gluten free, brain fog gone for good in three days after having it for fourteen years.
CAROLINE: I had a huge moment that I would like to share. I was a bestselling author here in the UK and suddenly got sick with Hashimoto’s. (Looking back it wasn’t sudden—it had been creeping up for years.)
I found myself unable to focus, unable to write even though my thyroid numbers were within range, and I was on Armour. I removed gluten seven months ago, along with adding a few more tweaks here and there as suggested by Izabella Wentz. Along came my “Aha!” moment. My brain is sharper—my ability to write has come back. A few months ago the mere thought of going into a meeting would have terrified me, yet last week I sat in front of a publishing house and landed a book-trilogy deal.
Thank you, Izabella.
WHICH HEALING DIET SHOULD YOU IMPLEMENT NEXT?
You can use the step-up or step-down approach to determine where you want to start with the diets. The chart below can also provide some dietary direction, depending on where you are today.
NOURISHMENT KNOWLEDGE THAT CAN HELP YOU HEAL
“Bad digestion is at the root of all evil,” said Hippocrates, the ancient Greek physician who is considered to be the father of medicine. Although he was born in 460 BC, I think he was onto something! Another way to put this is, “You are what you absorb.” People with Hashimoto’s usually have a combination of nutrient deficiencies, food sensitivities, impaired ability to handle stress, digestive issues, infections, and an impaired ability to get rid of toxins. Many of these are related to a compromised ability to absorb from our diet the nutrients that the body’s systems require for optimal function.
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WHERE SHOULD I START?
IF . . .
THEN . . .
You are just starting and don’t know which one to do
Do the diet that will be the easiest for you to implement. Just take action!
You’re losing foods
Consider functional-medicine gut testing ASAP and working with your functional-medicine practitioner to clear infections.
If you’re already gluten free but hit a plateau in healing
Move to the Intro Diet (gluten free, dairy free, soy free).
If you’re already on the Intro Diet (gluten free, dairy free, soy free) but hit a plateau in healing
Move to Root Cause Paleo Diet.
If you’re on the Root Cause Paleo but hit a plateau in healing
Move to Root Cause Autoimmune Diet.
If you’re on the Root Cause Autoimmune but hit a plateau in healing
Consider gut testing, food-sensitivity testing, Hashimoto’s Protocol, the Hashimoto’s Self-Management Program, and/or the Root Cause Rotation Diet.*
If you have puzzling symptoms but have not had food-sensitivity testing
Test for food sensitivities.
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In my personal experience and in my work with clients, I’ve found that supportive enzymes can help improve digestion and thus may increase nutrient absorption from foods. An enzyme deficiency can, directly and indirectly, contribute to thyroid symptoms and autoimmunity. Using enzymes can help with overcoming symptoms of Hashimoto’s including fatigue, hair loss, nutrient deficiencies, infections, and food sensitivities as well as reducing thyroid antibodies.
There are five types of enzymes that may be beneficial on various parts of your healing journey with Hashimoto’s:
Protein digestive enzymes
Systemic enzymes
Fat digestive enzymes
Vegetable digestive enzymes
Gluten/dairy digestive enzymes
Protein Digestive Enzymes
Studies have found that most people with Hashimoto’s and hypothyroidism have either low stomach acid or no stomach acid, which contributes to food sensitivities, increased risk of gut infections like H. pylori, SIBO, and parasites (potential root causes for Hashimoto’s) as well as difficulties in protein digestion. Poor digestion of proteins results in fatigue, because we often become deficient in nutrients derived from protein, such as B12, iron, and amino acids, and because the digestive process requires a lot of energy! One of the reasons nutrient supplements, green smoothies, and green juices can boost our energy is that we get a shot of partially or fully digested nutrients without doing the energy-consuming work of digestion.
Betaine hydrochloride (betaine HCL) and pepsin are both naturally occurring components of gastric juice that can help raise levels of stomach acid, making nutrients and amino acids from our protein-containing foods more bioavailable. Betaine and pepsin are often found together in digestive supplements; most brands have around 500 to 750 mg of betaine and around 20 to 50 mg of porcine-derived pepsin per capsule.
Discovering the connection between my deficiency of stomach acid and Hashimoto’s was an “Aha” moment for me. After beginning to take betaine with pepsin with my protein-containing meals, my ten-year-long debilitating fatigue was lifted practically overnight! I went from sleeping for eleven or twelve hours per night to eight hours—just because I started digesting my foods better! Finally having enough energy gave me the confidence that I could overcome Hashimoto’s and my long list of health struggles. I started writing Hashimoto’s: The Root Cause the morning after I took the right dose of betaine with pepsin. The restored energy gave me hope that I would be able to devote myself to research and find the root cause of my condition and that I might one day be able to share my knowledge to help others.
Clients and readers have reported similar results as well as a reduction in pain, better mood, and even a more balanced weight. My survey has shown that 59 percent of people found that betaine with pepsin made them feel better; 33 percent said that it made them feel worse; and 7 percent saw no difference in symptoms. Many people have been able to improve their levels of ferritin and B12 by improving their stomach-acid levels; 50 to 70 percent of people with Hashimoto’s are likely deficient in stomach acid, and deficiency can be determined by a trial of betaine with pepsin.
Here’s how to do a trial of betaine with pepsin:
1. Start by taking just one capsule right after you’ve eaten a protein-containing meal.
2. Monitor for any reactions, such as a slight burning in your throat. If you do feel a burning in your throat, this means that you got too much acid. This is because either you do not need the supplement or the dose of the supplement was too high for your protein intake; that is, you didn’t need the supplement for the amount of protein in that meal.
3. If you didn’t feel anything, increase your dose to two capsules at the end of your next protein-containing meal and monitor again for any discomfort.
4. Keep increasing the dose by one capsule per meal until you feel a slight burning or discomfort. Once you’ve reached the burning/discomfort stage, you will know that you’ve had one dose too many and your target dose will be one less than the “too many” amount. You can drink a cup of water with a teaspoon of baking soda to relieve any continued burning sensation.
Here’s a dosing example:
Meal No. 1: Took one capsule, didn’t feel symptoms
Meal No. 2: Took two capsules, didn’t feel symptoms
Meal No. 3: Took three capsules, didn’t feel symptoms
Meal No. 4: Took four capsules, felt symptoms
Target dose: three capsules
Most people will require anywhere from 1 to 7 capsules (depending on the brand and their needs) and will often find that they are able to wean off the supplement as time goes on and their digestion improves. Once you find your target dose, you may need to vary your dose based on how much and what type of protein you have. Some people find that they don’t need as much with protein powders and vegetarian proteins, but need to increase their dose for a nice big juicy steak.
Please note, this enzyme is not for everyone:
If you have a history of ulcers or current ulcers or take NSAID medications, aspirin, or steroid medications, do not take betaine with pepsin.
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Acid-suppressing medications can negate the effect of betaine with pepsin, so I don’t recommend taking them together.
If you do have a history of ulcers or use acid-suppressing medications, I recommend testing for gut infections, especially H. pylori and SIBO, which could be triggers for gut symptoms and Hashimoto’s.
Systemic Enzymes
People with autoimmune disease often have a buildup of circulating immune complexes (CICs). CICs are molecular objects that are produced when an antibody and a reactive antigen, the toxin or foreign substance the antibody is attacking, bind together. CICs can be formed by antibodies mobilized against the thyroid gland as well as antibodies produced by the thyroid and can spell trouble, as they can contribute to liver congestion, autoimmune disease, and many associated symptoms, such as pain, inflammation, and even heart attacks!
Systemic enzymes, also known as proteolytic enzymes, can help bring our immune system into balance by breaking down these immune complexes. Proteolytic enzymes can also break down pathogens such as bacteria and parasites, but it is their role in breaking down the CICs that may reduce the antibodies to foods and to the thyroid.
The body does make some internal systemic enzymes, and we can also boost the break down of CICs by taking systemic enzymes externally. Systemic enzymes have been studied extensively in Europe and have become a popular alternative to pain medications for arthritic disease and many inflammatory conditions.
In one study, forty people with Hashimoto’s who were taking levothyroxine were given systemic enzymes for three to six months. The patients reported a reduction of thyroid symptoms, a normalization of thyroid tissue was seen via ultrasound, the number of inflammatory cells in the thyroid was reduced, and significant decreases in thyroid antibodies were seen as well. Many of the study patients were able to reduce their dose of levothyroxine, and some were able to discontinue their medications completely. Patients who had high cholesterol levels before starting the enzymes also presented with improved cholesterol profiles.
In my work with Hashimoto’s patients, systemic-enzyme supplementation for one to three months has shown to help significantly reduce both thyroid antibodies and food sensitivities. Clients also report less pain and improved wound healing. I also like to recommend them because they act on the whole immune system, and using them is thought to protect against developing future autoimmune conditions.
Systemic enzymes are a blend of plant- and animal-derived enzymes and may contain a mix of some of the following ingredients:
Bromelain (from pineapple)
Chymotrypsin (porcine)
Pancreatin (porcine)
Papain (from papaya)
Rutin or rutoside trihydrate (bioflavonoid)
Trypsin (porcine)
Systemic enzymes must be taken on an empty stomach at least 45 minutes before a meal or 90 minutes after a meal to work on the immune system. If you take them with food or too soon after you’ve eaten, they will get used up in the process of digestion instead of making their way to the bloodstream, where they can act on CICs.
The daily maintenance dose of systemic enzymes is typically considered to be 6 capsules. However, it should be noted that the dose of enzymes used in the study mentioned above was two and a half times higher, 5 capsules three times per day (on an empty stomach). This is the dose I recommend to my clients, and it’s the one other experienced clinicians use. Each dose of 5 capsules should be taken with a full glass of water (at least 8 ounces). In some cases, even 10 capsules three times per day may be used in the acute phase to modulate the immune system effectively.
Fat Digestive Enzymes
Fat malabsorption is easily overlooked by patients and practitioners alike, but commonly affects 40 to 50 percent of people with Hashimoto’s. Some signs and symptoms of fat malabsorption include greasy, smelly, floating, light-colored stools; gas or belching after eating; diarrhea; dry skin; stomach pain; gallbladder pain (which is on the right side, under the ribs), gallstones, or gallbladder removal; nausea; weight loss; hormonal imbalances; and adrenal issues. A low fecal elastase test in functional-medicine stool testing can also indicate fat malabsorption.
If you are not properly digesting and absorbing fats from food, you may start to experience low energy and increased cravings for carbs, since fats are an incredible slow-burning source of energy. If you’ve had fat malabsorption for some time, you may also find that you will start to develop symptoms of fatty-acid deficiency as well as depletions in the fat-soluble vitamins A, D, E, and K. Deficiencies in these nutrients can lead to numerous symptoms including vision problems, immune-system imbalance, fragile bones, poor wound healing, easy bruising, bleeding gums, nosebleeds, dull hair, depression, skin disorders, eczema, dry itchy/flaky skin or scalp, dandruff, oily scalp, rashes, and many other symptoms.
Another clue to fat malabsorption is when a person has been supplementing with vitamin D, but is still showing a deficiency on labs. Potential reasons why a person may have difficulty with fat absorption include bile deficiency, pancreatic enzyme deficiency, liver backlog, and SIBO.
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EXOCRINE PANCREATIC INSUFFICIENCY
Some people with fat malabsorption may also have exocrine pancreatic insufficiency, or a deficiency in pancreatic enzymes. In this case, I’ve found supplementing with pancreatic enzymes to be very helpful. These enzymes are taken with every fat-containing meal. In about 50 percent of cases, I’ve seen pancreatic insufficiency resolve simply by using pancreatic enzymes for a few weeks to a few months; in other cases, people may need to take the enzymes long-term and do more detective work to identify why they are deficient in pancreatic enzymes. Pancreatic insufficiency may result from damaged microvilli, celiac disease, SIBO, toxicity, stress, or alcohol use.
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The Rootcology supplement Liver and Gallbladder Support can help fat digestion in three different ways: it can support the liver’s ability to process fat with milk thistle; give us extra bile through ox bile; and support our bile flow with dandelion, artichoke, and beet. If you have issues with fat malabsorption, this is life-changing support.
Chronic fat malabsorption may result in a deficiency of essential fatty acids. If you have signs of fatty acid deficiency such as pain, inflammation, dry skin, oily hair, acne, or eczema, you may benefit from 1 to 4 grams of fish oil per day.
Vegetable Digestive Enzymes
Many people with Hashimoto’s may also have an impaired ability to digest vegetables due to their fiber and starch content. In some cases of hypothyroidism, an indigestible ball of plant fiber material known as a phytobezoar has been found to cause bowel obstruction! In the case of poor fiber absorption, undigested vegetable fibers may be found in the stools, and a high-fiber meal may cause bloating.
When fibrous foods aren’t properly digested, we miss out on the valuable micronutrients that don’t get extracted fully. One way to compensate for this somewhat is to juice vegetables and fruits, so that the nutrients are better absorbed.
A vegetable digestive enzyme that contains fiber-digesting enzymes like cellulase and/or starch-digesting enzymes like amylases might also help reduce symptoms of nutrient deficiencies and create increased energy.
Gluten/Dairy Digestive Enzymes
Gluten and dairy are two of the most common reactive foods for those with Hashimoto’s. When the large protein molecules found in these foods are not fully broken down in the body, they may trigger an immune response from the IgG branch of the immune system. Because this is the same branch of the immune system that makes antibodies to the thyroid, every time one of these reactive foods is consumed, there is a greater production of IgG antibodies—including of the antibodies to the thyroid.
Unfortunately, for some people even small amounts of gluten and dairy can produce significant symptoms and delay progress in healing. This makes many individuals scared to go out to restaurants or visit relatives. Even if the meal they get is made without any gluten or dairy ingredients, there may be potential
for cross-contamination if the food is prepared in the same kitchen where gluten/dairy-containing meals are prepared.
The enzyme dipeptidyl peptidase IV (DPP-4) can be helpful in splitting gluten into smaller fragments, so that it is easier to digest. It can be found in combination enzyme products that also contain enzymes that break down casein, beta-lactoglobulin (whey), and sometimes lactose (milk-sugar molecules found in dairy). Although enzymes may not be enough to allow a person with celiac disease to eat a whole bowl of pasta, the enzymes can be very helpful for those with a gluten and dairy sensitivity.
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RAW VEGETABLES
Raw fruits and vegetables can be difficult to digest if you have leaky gut, which is why in the early stages of intestinal healing you may need to focus on eating well-cooked foods. Cooking and/or pureeing softens fibrous content, making fruits and vegetables easier to digest. Once these are tolerated, you can try to work your way back to raw vegetables with a peel. Start by adding in some raw, peeled pureed vegetables, then progress to raw peeled fruits and vegetables, and eventually try the unpeeled variety. As you begin reintroducing raw fruits and veggies, you may benefit from vegetable-digesting enzymes, which can assist in the breakdown of fibers.
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I utilize enzymes that aid with the breakdown of gluten and dairy whenever I go out to eat and am concerned about cross-contamination issues. I’ve used them after accidental consumption of small amounts of gluten or dairy and have found that the enzymes effectively minimize my reaction. I still have a reaction, but instead of suffering for two or three days, I have problems for only a couple of hours. Many of my clients and readers carry a bottle of gluten/dairy digestive enzymes in their purses and travel bags for dining at restaurants and accidental exposures.