Candida, Reverse T3, and Dairy Concerns

Welcome to Healthy Gut Healthy Thyroid!

This is your weekly roundup of the BEST actionable steps for those 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:

• The Impact of Candida on the Gut and Thyroid

• Understand Your Tests: Reverse T3

• Dairy Concerns and Alternative Sources of Calcium

• Sleep and the Gut Microbiome

The Impact of Candida on the Gut and Thyroid

Many reading this are familiar with the gut microbiome, but did you know that there is also a "mycobiome"? The human mycobiome inhabits the oral cavity, gastrointestinal tract, respiratory tract, urogenital tract and skin (1).

Yes, our bodies are heavily populated with fungi. Just as is the case with the commensal bacteria in our body, the goal is to live in harmony with yeast and other types of fungi.

In fact, the fungi living in and on the human body play vital roles in human health. They contribute to energy acquisition, metabolic homeostasis, and immunity via complex interactions with other microbes (2).

When Yeast and Mold Become Problematic

Both yeast and mold are fungi, and without question there are times when these can be problematic. For example, if someone takes a course of antibiotics, they can develop a yeast overgrowth, which at times can be difficult to address.

And while taking antifungal medication is an option to consider, just as is the case with antibiotics, antifungals eradicate the "beneficial" yeast as well. And so while there is a time and place for antifungal medications such as Nystatin and Diflucan, they aren't completely harmless.

As for mold, I did talk about mold and mycotoxins in a previous edition, and I'm sure I'll discuss this topic more in future editions. Although mycotoxins can have a negative effect on the permeability of the gut, not everyone has a problem with mold.

Some of it is related to genetics, as many people do a good job of clearing out mycotoxins from their body. On the other hand, those who aren't efficient at doing this are more likely to present with symptoms associated with mold exposure.

What is Candida?

Candida species are the most common causes of fungal infection (3). Approximately 90% of yeast infections are caused by five species: Candida albicans, Candida glabrata, Candida tropicalis, Candida parapsilosis, and Candida krusei (3).

However, as I already mentioned, most yeast aren't pathogenic. In other words, yeast such as Candida aren't inherently harmful, but certain factors can cause them to be pathogenic.

More About Candida Albicans

Candida albicans is probably the most well known yeast. It's a commensal yeast fungus of the human oral, gastrointestinal, and genital mucosal surfaces, and skin (4). So most of us live in harmony with Candida albicans.

I'll talk more about testing for yeast in a future edition, but I will say here that I find organic acids testing to be the most accurate test to determine if someone has a yeast overgrowth. Candida antibodies in the blood can provide some value, and so can a comprehensive stool test, although it's very common to have false negative findings in the stool.

Signs and Symptoms of a Yeast Overgrowth

While you can test to see if you have a yeast overgrowth, here are a few common signs and symptoms:

• Sugar cravings

• Fatigue

• Brain fog

• Digestive symptoms (i.e. bloating, gas)

• Thick white coated tongue

Can Candida Trigger Graves' and Hashimoto's?

In a past article I wrote entitled “Candida and Thyroid Autoimmunity” I discussed how there is evidence that Candida can result in an increase in proinflammatory cytokines, which are increased in autoimmunity. But I think the most likely role that Candida plays in autoimmunity is by increasing intestinal permeability, which is part of the triad of autoimmunity I discussed in the second edition of this newsletter.

And so having a candida overgrowth probably won't directly trigger thyroid autoimmunity, but it can prevent the gut from healing.

Yeast Overgrowth and Sugar Cravings

Many people are aware that a yeast overgrowth can cause sugar cravings. And eating sugar in turn can "feed" yeast, thus exacerbating the yeast overgrowth.

For this reason many "yeast protocols" involve the person eating a diet low in sugars. There is controversy over whether this should include natural sugars, including honey, pure maple syrup, and the sugar in fruit.

I find that it depends on the person, as while many people with a yeast overgrowth are able to consume small amounts of natural sugars, this isn't the case with everyone. If someone has a severe yeast overgrowth then they probably will want to be stricter with the diet, even when it comes to eating natural sugars.

How To Address a Candida Overgrowth

Because yeast thrive on sugars and simple carbohydrates it makes sense to do everything you can to minimize your consumption of these. Some suggest cutting out fermented foods as well, but not every practitioner agrees with this, and I do think that in many cases it's unnecessary to cut out fermented foods.

Having healthy bacteria, yeast, and stomach acid can also help to keep Candida in check. Taking a probiotic supplement with lactobacillus and bifidobacterium strains can be beneficial, as can taking saccharomyces boulardii, which is a friendly yeast.

While there is a time and place for prescription antifungals, I usually recommend natural antifungals initially. These include garlic, olive leaf, caprylic acid, monolaurin, and oregano oil. Just keep in mind that oregano oil is very potent and can also eradicate some of the beneficial yeast and bacteria.

In summary, many people have a yeast overgrowth. And while I use the terms "yeast overgrowth" and "candida overgrowth" interchangeably, there are different types of yeast that can negatively affect our health. That being said, the ultimate solution isn't to just treat the yeast, but to optimize the health of your body so that you can live in harmony with Candida and other microbes.

Find Your Hashimoto’s Triggers

If you have Hashimoto’s thyroiditis, visiting an endocrinologist is likely to result in a prescription for thyroid hormone replacement. And while there is a time and place for thyroid hormone replacement, the problem is that it doesn’t do anything for the autoimmune component of Hashimoto’s.

And so what happens is that many people will take thyroid hormone without doing anything to improve the health of their immune system, which means that over time further damage to their thyroid gland will take place.

The good news is that you can do things to reverse the autoimmune component of Hashimoto’s. And the best way to accomplish this is by finding and removing your triggers.

My book “Hashimoto’s Triggers” will show you how to do this. By reading this book you will discover the following:

• More than one dozen triggers of Hashimoto’s thyroiditis

• The different diet options, and how to detect your specific food triggers

• Everything you need to know to heal your gut

• How to reduce fatigue, brain fog, hair loss, lose weight, and address other common symptoms

• Strategies to lower thyroid antibodies when nothing else has worked

• Nutritional supplements and herbs for Hashimoto’s

• A comprehensive list of the blood tests you should get, along with other specific tests that can help detect your triggers

• What you need to do to achieve optimal adrenal health

• Natural treatment options for viruses, pathogenic bacteria, parasites, Candida, and SIBO

Click Here to order my book “Hashimoto’s Triggers”

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. I also have a few thyroid-related books. And during each edition of this newsletter I'll either review a recent podcast episode, or I'll give some insights from one of my books.

In a recent Q & A podcast episode I answered the question “Can Hyperthyroidism Cause Liver Dysfunction?” Liver biochemical abnormalities are seen in many patients with untreated hyperthyroidism – that is, those not taking antithyroid medication.

The good news is that, in most cases, liver enzymes can return to normal without causing permanent damage to the liver.

In this episode I discuss what the research shows about liver dysfunction in those with hyperthyroidism. I'll discuss the relationship between untreated hyperthyroidism and liver enzyme abnormalities, potential causes, and the importance of monitoring liver function in hyperthyroid patients.

If you have hyperthyroidism (Graves’ disease, toxic multinodular goiter, etc.) I highly recommend for you to check this episode out.

Understand Your Tests

Should You Test For Reverse T3?

Many medical doctors are guilty of doing very basic testing when it comes to the thyroid. Some only test the TSH, others will test the TSH and T4. At the very least I recommend testing the following:

• TSH

• Free T4

• Free T3

• Thyroid antibodies

The goal here isn't to talk about comprehensive thyroid testing, although if there is interest I can definitely discuss this in a future newsletter edition under this section. But in this edition I wanted to focus on a specific marker: reverse T3

What is Reverse T3?

T3 is the active form of thyroid hormone and is what binds to the thyroid receptors. On the other hand, reverse T3 is the inactive form of thyroxine.

As for the role of reverse T3, some suggest that it binds to the thyroid hormone receptors and prevents T3 from binding. Others say that it prevents the conversion of T4 to T3. Some say that it can play a role in both of these.

High Reverse T3 in Hyperthyroidism/Graves' Disease

I no longer test the reverse T3 in those with hyperthyroidism, and the reason for this is because it's almost always high. Assuming the goal of reverse T3 is to prevent T3 from binding to the thyroid receptor this would make sense in this situation, as if you have too much thyroid hormone then the body will try to do what it can to prevent this from happening, or at least prevent T3 from binding to the receptor.

High Reverse T3 in Hashimoto's

For those with Hashimoto's, reverse T3 is worth testing. If it is high then it might be related to inflammation, high cortisol (which can affect the conversion of T4 to T3), or even taking too much thyroid hormone replacement.

Another Perspective of Reverse T3

I've had Dr. Eric Balcavage on my podcast, and he doesn't think that the role of reverse T3 is to block T3 from binding to the receptor. He feels that reverse T3 becomes upregulated due to some type of cell stress or inflammatory response.

This also would make sense in hyperthyroidism, as without question elevated thyroid hormones will cause cell stress. Either way you don't want to see reverse T3 too high.

What's the Optimal Range?

Just like most other blood tests, the lab range for reverse T3 will be different depending on the lab. For example, in the image above the reference range is between 8 and 25 ng/dL.

As of result, if someone has a reverse T3 of 22 this would be considered "normal" according to this lab. I don't like to see reverse T3 too high, but I usually don't get too concerned if it's somewhere in the 12 to 16 range, as long as the free T3 is looking good.

On the other hand, some practitioners prefer to see the reverse T3 below 12. Either way we of course need to look at the whole picture, and not just reverse T3.

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: DAIRY CONCERNS AND ALTERNATIVE SOURCES OF CALCIUM

Dr. Eric, dairy is excluded from many diets (i.e. AIP and Paleo), but since it's a great source of calcium would it be okay to eat raw dairy, or perhaps you can recommend alternative sources of calcium?

I get a lot of questions related to dairy, as many want to know if they can consume raw dairy, or dairy from a sheep or goat. While these other sources of dairy have some great health benefits and are a rich source of calcium, I recommend to avoid ALL types of dairy while healing.

The main reason for this is because dairy is a common allergen. And although some people tolerate these other forms of dairy, this isn't the case with everyone.

That being said, whether or not you choose to avoid dairy while healing is ultimately up to you. Some people will choose to consume dairy, and as long as they're healing will continue to do so, but if they hit a roadblock in their recovery will remove it from their diet.

Alternative Sources of Calcium

Here are some good non-dairy sources of calcium:

• Collard greens

• Bok choy

• Kale

• Sardines and other fish with the bones

• Broccoli

• Butternut squash

How Much Calcium Do You Need?

On my podcast I have interviewed a few bone health experts, with one being Margie Bissinger. During the interview Margie discussed how we need between 1,000 to 1,200 mg of calcium per day.

While you should try to get as much calcium as you can through the food you eat, if you fall short then you can supplement with calcium. You just don’t want to supplement with calcium carbonate, and want to make sure you take vitamin K2, as this helps to guide calcium into the bone.

So for example, if you only get 700 mg of calcium from your food each day then you would want to consider supplementing with 300 to 500 mg of calcium per day.

QUESTION #2: SLEEP AND THE GUT MICROBIOME

Dr. Eric, is there any relationship between sleep and the gut microbiome?

There are a lot of different factors that can affect the gut microbiome, and there are a few studies that have looked at the relationship between sleep and the gut microbiome. However, the studies are conflicting, as some studies show that sleep deprivation leads to changes in gut microbiome composition, while other studies show that sleep deprivation does not lead to changes in the gut microbiome.

A 2019 journal article showed a relationship between gut microbiome composition, sleep physiology, the immune system and cognition (5). The authors suggest that this may lead to mechanisms to improve sleep by modifying the gut microbiome.

Since most of the neurotransmitters are located in the gut microbiome, it shouldn't be surprising that having a healthy gut microbiome can play a role in getting quality sleep. In addition, an unhealthy gut can cause problems with digestion and absorption, thereby affecting some of the nutrients that can help with sleep, including magnesium.

Of course there are a lot of other factors that can cause problems falling and/or staying asleep, but here I wanted to focus on the potential relationship between the gut and sleep. Although there does seem to be a relationship, more research definitely needs to be conducted in this area.

Additional Thyroid-Related Resources

Click Here for my article on Candida and Thyroid Autoimmunity

Click Here to access the Save My Thyroid Podcast

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://pmc.ncbi.nlm.nih.gov/articles/PMC9605233/

(2) https://pmc.ncbi.nlm.nih.gov/articles/PMC4448585/

(3) https://pmc.ncbi.nlm.nih.gov/articles/PMC4143104/

(4) https://pmc.ncbi.nlm.nih.gov/articles/PMC9728475/

(5) https://pmc.ncbi.nlm.nih.gov/articles/PMC6779243/

That’s a wrap