Gut testing, thyroid nodules, and SIBO

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 thyroid 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 Thyroid-Gut Connection

• Podcast review: Selenium, Brazil Nuts, and Thyroid Health

• Understand Your Tests: Small intestinal bacterial overgrowth

• Ask Dr. Eric: Is it possible to shrink thyroid nodules naturally?

The Thyroid-Gut Connection

How Digestive Health Affects Thyroid Function

Most thyroid conditions are autoimmune in origin. Specifically, most cases of hypothyroidism are due to Hashimoto's thyroiditis, while most instances of hyperthyroidism are linked to Graves' disease. Approximately 70 to 80% of immune cells reside in the gastrointestinal tract, meaning that a healthy gut is essential for a robust immune system.

It’s not surprising that conventional doctors rarely focus on gut health in patients with autoimmune disorders. If you're diagnosed with Hashimoto's thyroiditis, the typical recommendation is thyroid hormone replacement. On the other hand, for Graves' disease (and other forms of hyperthyroidism), doctors often suggest one of three standard treatments: 1) antithyroid medication, 2) radioactive iodine, or 3) thyroid surgery. While there’s a place for these conventional approaches, they don’t address the health of the gut or the immune system.

The Autoimmune Triad

Autoimmunity follows a triad of factors, often referred to as the "three-legged stool of autoimmunity." The three key elements are: 1) a genetic predisposition, 2) exposure to environmental triggers, and 3) increased intestinal permeability, commonly known as leaky gut. Since a leaky gut plays a role in the development of autoimmune conditions, it stands to reason that healing the gut is crucial to reversing the autoimmune process.

Additionally, about 20% of the conversion of T4 to T3 happens in the gut (with 60% occurring in the liver). If you have gut dysbiosis (an imbalance in gut flora), this conversion may be impaired, leading to lower T3 levels. This isn’t just a concern for those with Hashimoto's, as once your health is restored, you’ll want optimal thyroid hormone conversion regardless of whether you’ve had Hashimoto’s or Graves'.

A Healthy Gut is Key to Nutrient Absorption

Several minerals are vital for thyroid hormone production, including iodine, iron, selenium, and zinc. The amino acid tyrosine is also essential, which is why many thyroid support supplements contain tyrosine along with the minerals mentioned. A healthy gut is necessary to digest and absorb these nutrients, providing yet another reason to prioritize gut health.

The 5R Protocol for Gut Healing

The goal of this newsletter is to offer guidance on improving your gut and thyroid health, so I encourage you to stay tuned for future editions. A recurring theme you'll notice is the 5R protocol, which can significantly aid in healing most gut issues. The 5R protocol consists of the following steps:

Remove – Eliminate factors causing gut dysbiosis and leaky gut. This can include certain foods, gut infections, and even environmental toxins and toxicants.

Replace – Reintroduce essential elements that are lacking and necessary for proper digestion and absorption. Examples include digestive enzymes, stomach acid, and bile salts.

Reinoculate – Rebuild the gut microbiome by adding prebiotics and probiotics. You want to get these mostly through the food you eat, although I do commonly recommend supplementation as well.

Repair – Take steps to heal and restore the gut lining. Many people drink bone broth to support gut healing, while common supplements used to support the gut include L-glutamine, zinc carnosine, and aloe vera.

Rebalance – Support the parasympathetic nervous system to promote overall balance. You can accomplish this by incorporating mind body medicine techniques, as well as vagus nerve exercises, including vigorous gargling and cold showers.

Each of these components will be discussed in detail in future newsletters. For instance, in a future edition, I’ll focus on “removing” disruptive factors from the gut, as well as discussions on “replacing” what’s missing, and so on.

The "remove" step is arguably the most important because if you don’t eliminate the root cause of the gut imbalance, full healing may not be achievable. So while a lot of people use my Gut Healing Bundle to support the gut, keep in mind that it doesn’t address the “remove” component of the 5R Protocol.

What About Non-Autoimmune Thyroid Conditions?

Although this newsletter is geared primarily toward those with autoimmune thyroid disorders, gut health is vital for managing any chronic condition. For example, subacute thyroiditis is often triggered by viral infections, and maintaining a healthy gut and immune system helps to control viral activity. Similarly, in cases of multinodular goiter, impaired estrogen metabolism is frequently a factor, and a well-functioning gut is necessary for proper estrogen detoxification.

So, while this newsletter will be especially relevant for those with Graves' disease and Hashimoto's, much of the information will also benefit individuals with non-autoimmune thyroid conditions. Whether you’re managing thyroid autoimmunity or another thyroid disorder, I highly recommend keeping up with future editions of the "Healthy Gut, Healthy Thyroid Newsletter."

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 I get enough selenium from eating Brazil nuts?” There is no question that Brazil nuts are an excellent source of selenium, and I admit that I enjoy eating a couple of Brazil nuts per day (I buy organic Brazil nuts from Costco!).

On a wellness basis I do think it’s possible to get enough selenium from the food you eat. But since selenium can be so beneficial for those with Graves’ disease and Hashimoto’s, I usually recommend supplementation while someone is trying to restore their health.

And the reason for this is because there is no way to know for certain how much selenium someone is getting from the food they eat. When specifically talking about Brazil nuts, you can get anywhere from 20 mcg to 80 mcg of selenium from a single Brazil nut.

There is more that I discuss during this episode, and so if you are interested in learning more about selenium and thyroid health I recommend checking it out.

Understand Your Tests

What is SIBO?

In the above image you can see a couple of screenshots related to the small intestinal bacterial overgrowth (SIBO) test, which is from the company Genova Diagnostics.

SIBO is a condition when you have an excess of bacteria in the small intestine. Most of the bacteria should be in the large intestine, but there are some situations when you can get the buildup of bacteria in the small intestine.

This in turn can lead to symptoms such as gas, bloating, stomach pain, and changes in bowel movements (i.e. constipation or diarrhea). SIBO can also increase the permeability of the gut, and as I discussed earlier, this leaky gut is one of the components of the triad of autoimmunity.

As a result, having SIBO can be a factor in the development of a condition such as Graves’ disease or Hashimoto’s thyroiditis. Because of this, if someone has an autoimmune thyroid condition and they’re also dealing with SIBO, then it is necessary to address this in order to heal the gut, which in turn is necessary to restore one’s health.

Understanding The SIBO Breath Test

In order to test for SIBO you need to do a breath test that measures the gases produced by bacteria in the small intestine. If you look at the first screenshot above, you’ll see that the black line relates to methane (CH4), while the blue line relates to hydrogen (H2).

Many people who test positive for SIBO will have either methane or hydrogen elevated, but in this situation both of these are out of range. You can clearly see this by looking at the second screenshot. It’s also worth mentioning that some labs will test for hydrogen sulfide as well.

What These Findings Mean

Having either of these gases elevated can cause one or more of the symptoms I mentioned earlier (gas, bloating, etc.). And in most cases, elevated hydrogen levels will result in looser stools or diarrhea, while methane-dominant SIBO will commonly cause constipation.

In this situation not only do we see both gases elevated, but they are well above the reference range, and this represents a more extreme version of SIBO. This person might experience loose stools/diarrhea, constipation, or a combination of both.

Treatment Options For SIBO

As for how to treat SIBO, there are essentially three options:

1) Antibiotics. Rifaximin (brand name Xifaxan) is the antibiotic most commonly recommended for SIBO. Unlike most other antibiotics, Rifaximin stays in the small intestine, which means that it doesn’t harm the beneficial bacteria in the large intestine like most other antibiotics do.

2) Herbal antimicrobials. Some of the natural agents which can help to eradicate SIBO include berberine, oregano oil, neem, and allicin. Keep in mind that while garlic is a high FODMAP food, most people with SIBO can tolerate an allicin supplement, although not everyone.

As for whether the herbs are as effective as Rifaximin, there actually was a study that showed that herbal therapy is equivalent to Rifaximin for treating SIBO. However, just as is the case with Rifaximin, not everyone with SIBO will respond to the herbal antimicrobials.

3) Elemental diet. While some people follow a low FODMAP diet for symptomatic relief, an elemental diet can be a very effective diet when it comes to eradicating SIBO. Unlike the low FODMAP diet, the elemental diet is considered to be an antimicrobial approach because the goal is to starve the bacteria, but at the same time supply the person with sufficient nutrients in an easily absorbed form. The elemental diet can help to lower both methane and hydrogen levels and typically you want to follow it for 2 or 3 weeks and then do another breath test immediately upon completion of it.

There is so much more I can discuss about SIBO, and I can easily dedicate an entire newsletter on this topic. And while I’m sure I’ll discuss this more in future editions, for now I’ll lead you to an article I wrote on SIBO, as well as an interview I did on my podcast with SIBO expert Dr. Nirala Jacobi.

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: WHICH GUT TEST SHOULD I CHOOSE?

Dr. Eric, if someone is experiencing gastrointestinal symptoms such as bloating and gas, how would we know whether to do a comprehensive stool test, SIBO breath test, or a different type of gut-related test?

Thanks for your question, as I admit that sometimes it can be challenging to know which functional medicine tests someone should do. The problem is that you can’t always go by symptoms, and even if someone is experiencing digestive symptoms it doesn’t always mean that they should do testing.

For example, someone might be experiencing digestive symptoms because they are reacting to certain foods, and in this situation it of course would make sense to clean up their diet. While it’s always possible that one’s digestive symptoms are related to gut microbes such as parasites or SIBO, if one’s digestive symptoms resolve upon eliminating certain foods (i.e. gluten, dairy, unhealthy oils) then perhaps they wouldn’t need to do any gut-related testing.

When To Consider Gut-Related Testing

On the other hand, when cleaning up your diet doesn’t help resolve digestive symptoms then this is when you might want to consider doing some gut-related testing. Or perhaps you notice bloating and gas when eating higher FODMAP foods, which might hint that you have SIBO, and thus doing a SIBO breath test in this scenario would probably be a good idea.

If someone is experiencing heartburn and acid reflux, then it probably would be a good idea to test for H. pylori. Loose stools and diarrhea might indicate parasites, although it can also be related to hydrogen-dominant SIBO, or there can be another cause.

This is why it’s wise to work with a functional medicine practitioner, as they will conduct a comprehensive health history to try their best to determine what testing, if any, might be needed. Of course you can always clean up your diet on your own, but if this doesn’t help with gut-related symptoms then you might want to consider consulting with an expert.

QUESTION #2: SHRINKING THYROID NODULES NATURALLY

I had a thyroid ultrasound and they detected two larger thyroid nodules on the right lobe, and I was wondering if there is a way to shrink them naturally.

Thanks for your question, as I get a lot of questions related to shrinking thyroid nodules, and while it is possible to shrink nodules by addressing the cause of the problem, the challenge is that the only way to know for certain whether or not they’re shrinking is by doing a follow-up thyroid ultrasound.

I’m also assuming that in this scenario the thyroid nodules are benign, as I don’t have experience working with thyroid cancer. I will say that during a recent conversation I had with integrative endocrinologist Dr. Angela Mazza I learned that some malignant thyroid nodules can be addressed using radiofrequency ablation (RFA), which targets the specific thyroid nodule.

What Causes Thyroid Nodules?

So what causes the formation of thyroid nodules? There can be different causes, but some of the most common causes include insulin resistance, problems with estrogen metabolism, an iodine deficiency, and even inflammation in general.

You can determine if someone has insulin resistance through testing blood markers such as fasting insulin and hemoglobin A1C. As for testing to see if you have problems metabolizing estrogen, you can do a dried urine test, such as the DUTCH.

There’s not a perfect test for determining if someone has an iodine deficiency, although urinary testing is probably the best. And while there are some blood test markers that relate to inflammation, such as CRP and ESR, many people have inflammation present even when these markers are negative.

To summarize, in many cases it is possible to shrink thyroid nodules naturally, but you need to address the underlying cause. Not surprisingly, if you have one or more thyroid nodules and are looking to address the cause, I recommend working with a natural healthcare practitioner.

Additional Thyroid-Related Resources

Click Here to listen to the episode on selenium, Brazil nuts, and thyroid health.

Click Here to listen to an episode related to thyroid nodules

Click Here to listen to other episodes on 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 check out my Gut Healing Bundle

Click Here to work with Dr. Eric and his team

That’s a wrap