My Bone Building Routine, Nightshades and Thyroid Autoimmunity, Bone Broth

Welcome to Healthy Gut Healthy Thyroid!

This is your weekly roundup of the BEST actionable steps for those people with thyroid and autoimmune thyroid conditions who want to restore their health…by healing their gut. Whether you have hyperthyroidism or Hashimoto’s you will benefit from the content in this newsletter.

In today's issue:

• Main Topic: The Thyroid-Gut-Osteoporosis Connection Part 2

• Podcast Review: Brain Injuries and Thyroid Health

• Understand Your Tests: Understanding Homocysteine

• Ask Dr. Eric:
  ✔️Why are nightshades excluded from many diets?
  ✔️Can I use bone broth powders instead of drinking bone broth?

QUICK QUESTION: What future topics would you like for me to cover in this newsletter? If reading this via email please reply and let me know!

The Thyroid-Gut-Osteoporosis Connection Part 2

In the previous edition of this newsletter, I shared my personal experience with low bone density. A few months ago, I had my first bone density scan—and the results were quite surprising. My bone density was significantly lower than average for a man in his 50s.

While the results were unexpected, I’m grateful I went ahead with the scan. As disappointing as it was to discover, it's better to find out at age 54 than at 64 or 74, when it would be more challenging (although not impossible) to reverse this process.

Why this matters to you: the good news is that my low bone density experience can definitely benefit those with hyperthyroidism and Hashimoto’s. After all, since there are no symptoms associated with low bone density, it’s safe to say that some readers of this newsletter have low bone density and don’t know it.

My Return to the Endocrinologist

When I was first diagnosed with Graves’ disease in 2008, I saw an endocrinologist once. At the time, I chose not to take methimazole and opted to monitor my bloodwork independently, which meant there was no need for ongoing follow-up.

After receiving my bone density results from a primary care doctor, it was recommended that I consult with an endocrinologist again. Although I was thinking about running blood tests on my own, I decided to schedule an appointment—mainly because I figured that my wife’s health insurance might cover some of the tests related to bone health.

This included markers such as CTX (a bone turnover marker), parathyroid hormone (PTH), and others the endocrinologist was willing to order. She honestly wasn't a big fan of CTX, but I asked her to order it anyway and she agreed. I plan on doing P1NP (procollagen type 1 N-terminal propeptide) on my own.

Why this matters to you: In the previous newsletter I mentioned the importance of getting a bone density scan, but even if you have low bone density it won’t reveal the cause, which is why further testing is necessary. I’ll include a list of recommended tests below.

My Current Bone-Building Routine

Now that I’m aware of my low bone density, here’s what I’m doing to support bone health:

𐂯 Eating an Anti-Inflammatory Diet. I’ve been eating an anti-inflammatory diet since my Graves’ disease diagnosis. While I’m not perfect and occasionally stray, the foundation of my diet is whole, nutrient-dense foods. For the most part I avoid common inflammatory triggers, including gluten.

𐂯 Supplementing with Calcium. Although I don’t completely avoid dairy, I don’t consume it regularly. I’ve relied mostly on plant-based sources of calcium, but it’s difficult to meet daily needs without including animal-based sources like dairy or small fish with edible bones.

I interviewed bone health expert Margie Bissinger on my podcast, and she recommends aiming for 1,000–1,200 mg of calcium per day. If this can’t be achieved through diet alone, supplementation is recommended. I personally use Advanced Bone Support by Thorne Research, which contains calcium malate and other synergistic minerals.

Food Sources of Calcium

I looked up some of the foods rich in calcium, and here is what I found:^1,2,3

1 cup raw collard greens: 84 mg

1 cup cooked collard greens: 266 mg

1 cup broccoli, cooked: 60 mg

1 cup Bok Choy, cooked: 160 mg

3 oz canned sardines with bones: 325 mg

3 oz canned salmon with bones: 180 mg

6 oz plain yogurt: 310 mg

1 cup fortified orange juice: 300 mg

1 cup mineral water: 50–75 mg

I must admit that while over the years I have minimized my consumption of dairy products, recently I started consuming goat milk kefir, which has 300 mg of calcium per cup. I'm drinking one cup three to four days per week.

𐂯 Prioritizing Resistance Training. As I mentioned in the previous newsletter, I’ve exercised consistently for over 30 years. Although I used to focus more on aerobic exercise, I now prioritize resistance training. I go to the gym three to four days per week, incorporating strength training and some cardio (usually biking or rowing). I initially increased my strength training to support muscle mass, but it's also critical for supporting bone density.

𐂯 Continuing to Support Gut Health. A healthy gut is essential for the digestion and absorption of nutrients—including calcium, magnesium, and vitamin D. I continue to focus on gut health by maintaining a whole-foods diet, managing stress, rotating high-quality probiotic supplements, and supporting overall digestive function.

Is There a Time and Place for Bone Medications?

As expected, the endocrinologist recommended a bone-building medication like Forteo, followed by a bisphosphonate. While I’ve spoken often about using natural approaches (and didn’t mention to the endocrinologist that I avoided methimazole during my Graves’ journey), I want to be clear: I’m not against medications when they are appropriate.

Just as antithyroid medication has its place in managing hyperthyroidism, and thyroid hormone replacement is sometimes essential for hypothyroidism, there are situations where bone medications are warranted—particularly in those at high risk for fractures.

That said, these medications can have side effects, and they are not meant to be taken indefinitely. Long-term use (5–10+ years) can pose risks. If someone does require medication such as Forteo, Tymlos, or Fosamax, it’s crucial that they also address nutrition, exercise, gut health, and other underlying factors during that time.

Recommended Tests for Evaluating Bone Health

This article is already longer than I planned for it to be, and so I'll wrap it up by listing some useful labs to consider if you're looking to assess your bone health more thoroughly:

🧪Comprehensive Metabolic Panel (CMP)

🧪25-OH Vitamin D

🧪CTX (C-terminal telopeptide)

🧪P1NP (Procollagen Type 1 N-Terminal Propeptide)

🧪Urinary Calcium (24 hour)

🧪Parathyroid Hormone (PTH)

🧪Estradiol

🧪Testosterone

🧪DUTCH Test (for hormones/adrenals)

🧪Celiac Panel

🧪Comprehensive Stool Panel (i.e. GI-MAP, GI Effects)

Keep in mind that not everyone needs to do all of these tests…especially functional medicine tests like the DUTCH and a comprehensive stool panel. On the other hand, sometimes these can be helpful when trying to identify the underlying causes of low bone density.

If you’d like to explore more about bone density, I’ve included links to relevant podcast episodes and resources in the “Additional Resources” section at the end of this newsletter.

 5 Steps To Reverse Hyperthyroidism and Avoid Radioactive Iodine and Thyroid Surgery

If you have hyperthyroidism (i.e. Graves’ disease, toxic multinodular goiter), visiting an endocrinologist is likely to result in one of the following three recommendations:

1. A prescription for antithyroid medication

2. Radioactive iodine

3. Thyroid surgery

While there is a time and place for conventional medical treatment, it’s crazy that most medical doctors don’t do anything to address the underlying cause of your condition.

The good news is that you can do things to reverse hyperthyroidism, which I discuss in my free webinar entitled “5 Steps To Reverse Hyperthyroidism and Avoid Radioactive Iodine and Thyroid Surgery”.

Click Here to register for the free webinar

Here are some of the things you’ll learn by attending this free webinar:

• How to avoid radioactive iodine and restore your thyroid and immune system health so you can feel great again and live a healthy life!

• The 4 main categories of Graves' disease triggers, and why you shouldn't overlook "hidden" hyperthyroid triggers

• How to break the "hyperthyroid cycle"

• How to address thyroid eye disease and toxic multinodular goiter

Click Here to register for the free webinar

Save My Thyroid Podcast Review

I have a podcast called "Save My Thyroid", where I discuss how people with hyperthyroidism and Hashimoto's can save their thyroid and regain their health. And during each edition of this newsletter I'll briefly discuss a recent podcast episode.

In a recent Q & A podcast episode I answered the question “Can Brain Injuries Affect Thyroid Health?” In this episode I discuss the link between brain trauma and thyroid dysfunction that most medical professionals overlook. Traumatic brain injuries (TBI) can compromise the brain's control center for thyroid function, leading to central hypothyroidism and impaired recovery. Beyond direct damage, brain injuries trigger inflammatory responses that potentially initiate autoimmune processes affecting thyroid health.

Why this matters to you: If you’ve ever suffered a concussion or head trauma, this might be a factor in your thyroid or autoimmune thyroid condition, and therefore is an episode that you can’t miss. Understanding the connection between brain injuries and thyroid health could be the answer to your healing journey.

Understand Your Tests

Understanding Homocysteine

I recommend that nearly all of my patients include homocysteine testing as part of a comprehensive blood panel. Homocysteine is a sulfur-containing amino acid, and its metabolism depends on adequate levels of folate, vitamin B6, and vitamin B12.⁴

A deficiency in any of these nutrients can result in elevated homocysteine levels. In the example above from one of my patients, you can see that her homocysteine was notably elevated.

What Are Optimal Homocysteine Levels?

Most functional medicine practitioners aim for homocysteine levels under 10 µmol/L. In the case of my patient, her homocysteine measured 18.3 µmol/L. While the lab’s reference range was 0–17.2, levels above 10 can indicate suboptimal methylation and increased cardiovascular risk…even if within the lab reference range.

When I was managing my own Graves’ disease, I didn’t initially test for homocysteine. However, a few years later, I did—and found that mine was elevated. I successfully lowered it using a supplement containing methylated B12, methylated folate, and vitamin B6.

Why Elevated Homocysteine Matters

✅Elevated homocysteine levels have been associated with numerous health risks, including:

✅Increased cardiovascular and all-cause mortality

✅Higher incidence of stroke

✅Elevated risk of dementia and Alzheimer’s disease

✅Increased likelihood of bone fractures

✅Greater prevalence of chronic heart failure

These associations underscore the importance of testing and addressing elevated homocysteine early—even in individuals without overt cardiovascular symptoms.

The Role of MTHFR and Methylation

The enzyme methylenetetrahydrofolate reductase (MTHFR) plays a critical role in the remethylation of homocysteine to methionine. Many people with genetic variations in the MTHFR gene have difficulty processing folate properly, which can lead to elevated homocysteine levels.

This describes my own experience as well—I carry an MTHFR gene variation. While I won’t go into detail about MTHFR here, I’ve written a separate article that dives deeper into the connection between homocysteine, methylation, and MTHFR. I also had the opportunity to discuss these topics further with Dr. Sam Shay on my podcast, where we explored genetics and methylation in the context of thyroid and overall health.

Key Takeaways:

➤ Homocysteine is a sulfur-containing amino acid that requires folate, vitamin B6, and vitamin B12 for proper metabolism. Deficiencies in any of these can lead to elevated levels.

➤ Optimal homocysteine levels should be below 10 µmol/L.

➤ Many individuals with MTHFR gene variations have higher homocysteine due to impaired methylation and may benefit from methylated forms of B12 and folate.

➤ Testing homocysteine is a valuable tool in assessing cardiovascular risk, cognitive health, and methylation status—and should be included in comprehensive bloodwork.

Ask Dr. Eric

During every issue I'll answer a few questions that I think can benefit most people with a thyroid or autoimmune thyroid condition. If you'd like for me to consider your question for a future edition of this newsletter email your question to [email protected].

QUESTION #1: WHY ARE NIGHTSHADES EXCLUDED FROM MANY DIETS?

Dr. Eric, Can you explain why the nightshades are excluded from many diets, including the AIP diet? Are they considered to be detrimental to gut health? I'm having a difficult time giving up tomatoes and would love to reintroduce them.

Nightshades belong to the Solanaceae family of plants, which includes tomatoes, white potatoes, eggplant, and most types of peppers (excluding black pepper). While these foods offer certain health benefits, individuals with autoimmune conditions such as Graves' disease and Hashimoto's may need to temporarily avoid them due to their potential impact on inflammation and gut health.

Why Avoid Nightshades?

Nightshade foods contain compounds that may contribute to inflammation and compromise gut integrity, including:

🔥Lectins

🔥Alkaloids

🔥Glycoalkaloids

While lectins have some health benefits, they may also damage the intestinal lining in susceptible individuals. This damage can contribute to increased intestinal permeability (leaky gut)—a common issue in autoimmune conditions. Avoiding high-lectin foods during the healing process may support gut restoration and reduce inflammatory responses.

The Effects of Alkaloids and Glycoalkaloids

Capsaicin and Inflammation. Capsaicin, an alkaloid found in spicy peppers, is responsible for the burning sensation associated with chili peppers and is also the active ingredient in pepper spray. Research indicates that capsaicin can trigger acute inflammation, bronchoconstriction, and irritation, particularly in sensitive individuals.⁵

Although not everyone will experience adverse effects from consuming spicy peppers, individuals with autoimmune conditions may be more susceptible to inflammation. As a precaution, temporary avoidance of all peppers—including mild varieties—may be advisable during the healing process.

Solanine and Neurological Effects. Solanine, a glycoalkaloid, is found in eggplant, potatoes, tomatoes, and peppers. This compound has natural fungicidal and pesticidal properties, protecting plants from pests by inhibiting acetylcholinesterase, an enzyme responsible for breaking down acetylcholine.

Since acetylcholine plays a crucial role in the nervous system, inhibitors like solanine may contribute to neurological and systemic issues, including:

⚡Low blood pressure (hypotension)

⚡Bronchoconstriction (airway restriction)

⚡Increased gastrointestinal motility (digestive disturbances)

While not everyone who consumes nightshades will experience these effects, some individuals react poorly to solanine, and eliminating these foods may provide significant symptom relief.

Should You Avoid Nightshades Completely?

Although nightshade foods contain essential nutrients and beneficial compounds, they may exacerbate symptoms in individuals with autoimmune conditions.

As a precaution, I recommend eliminating nightshades for the first few months of the healing process.

After this period, gradually reintroducing them while monitoring for reactions can help determine individual tolerance.

By taking a personalized approach, you can better assess whether nightshades contribute to your symptoms and make informed dietary choices that support long-term health.

QUESTION #2: CAN I USE BONE BROTH POWDERS INSTEAD OF DRINKING BONE BROTH?

Dr. Eric, Are bone broth powders just as effective as drinking bone broth for gut healing purposes?

Thanks for your question! While bone broth can be beneficial for gut healing, it’s important to understand that it is not essential for everyone. I often recommend bone broth to my patients—provided they are not vegan or vegetarian—but it’s not a mandatory component of a gut healing protocol. In other words, you can absolutely heal your gut without consuming bone broth.

Are Bone Broth Powders a Good Alternative?

It’s generally fine to use a clean bone broth powder or hydrolyzed beef protein powder as a way to increase protein intake. However, I don’t typically recommend these powders specifically for gut healing purposes.

While they may offer some of the same supportive amino acids found in traditional bone broth, if I want a patient to take a supplement that actively supports gut repair, I typically recommend a targeted gut-healing formula—one that includes nutrients like:

✔️L-glutamine

✔️DGL (deglycyrrhizinated) licorice

✔️Aloe vera, slippery elm, or marshmallow root

A good example is SMT-GI Restore, which combines multiple gut-repairing ingredients into one professional-grade supplement.

Don’t Forget the Full 5R Protocol

Many people focus solely on the "Repair" phase of the 5R protocol, but it’s crucial to also address the root causes of gut dysfunction.

Simply drinking bone broth or using a gut-healing supplement won’t be effective if the underlying triggers of intestinal permeability (i.e., leaky gut) remain unresolved.

To truly restore gut integrity, it's important to follow all five components of the 5R framework:

Remove – Eliminate inflammatory foods, infections, and toxins

Replace – Support digestion with enzymes and stomach acid if needed

Reinoculate – Rebuild the gut microbiome with probiotics and prebiotics

Repair – Use nutrients to heal the gut lining

Rebalance – Address lifestyle factors such as stress, sleep, and movement

In summary: Bone broth powders are a fine source of supplemental protein, but for targeted gut healing, I recommend specific nutrients tailored to repair the gut lining. And remember—the best results come from addressing the root cause, not just treating the symptoms.

Additional Thyroid-Related Resources

Click Here for How to Reverse Osteopenia and Osteoporosis (episode 124)

Click Here for an interview I did on another podcast related to Hyperthyroidism & Osteoporosis

Click Here for an article I wrote on methylation, MTHFR, and thyroid health

Click Here for How Genetics and Methylation Impacts Thyroid Health (episode 143)

Click Here to access hundreds of thyroid-related articles and blog posts

Click Here to join the Graves’ disease and Hashimoto’s community

Click Here to purchase one of Dr. Eric’s thyroid-related books

Click Here to work with Dr. Eric and his team

References:

(1) https://www.bonehealthandosteoporosis.org/patients/treatment/calciumvitamin-d/a-guide-to-calcium-rich-foods/

(2) https://www.ncbi.nlm.nih.gov/books/NBK279330/

(3) https://nutrivore.com/foods/

(4) https://pubmed.ncbi.nlm.nih.gov/18709886/

(5) https://pubmed.ncbi.nlm.nih.gov/9885922/

That’s a wrap