Recovery is Possible - Assuming You Know What's Really Wrong... Part 4 - Symptoms vs Tests - The Immune System Piece of the Puzzle

[skyfall]

t's long

1. Autoimmune Thyroiditis and Related Conditions

2. What's Really Going on?

3. Can it be Stopped/Treated?

4. What Might Work?

5. My Results

OK so this is where my journey into thyroid distress started. When I was diagnosed with a thyroid problem (1st overactive, then underactive) I was screened for auto-antibodies. As is common with most hypothyroid sufferers I had high levels of anti-thyroid peroxidase antibodies (anti-TPO Abs) – Hashimoto’s.

A bit of background science detail here for anyone who’s new to this.

Thyroid peroxidase is an enzyme that means it helps change one biological molecule in the body into another. Its job is to free up iodine molecules in the thyroid gland so that they can be added to thyroglobulin to produce the thyroid hormones (T4, T3 etc.)

When the TPO auto-antibody attaches itself to the thyroid peroxidase enzyme it does two things (both bad).

1. It stops the enzyme doing its job (so there’s not enough T4 etc produced)

2. It attracts the other bits of the immune system to attack thyroid cells – hence the destruction of the gland.

Any more questions on the science happy to talk – antibodies were/are my thing.

So - we all know what the symptoms are.

But my question is what drives the immune system to turn on the body in the first place. And once it has can it be stopped?

Why does it happen

There’s lots of debate on this. All good and all with supporting evidence. Some believe it all starts in the gut when through infection, poor diet or some genetic disorder the gut starts letting foreign particles from our food straight into the bloodstream – so called ‘leaky gut’. This also results in gut inflammation. And whenever we have inflammation anywhere in the body we get an immune response to it (Hold that thought because it’s important if you’re thinking about doing something about it).

There’s a mountain of research on this. Having ploughed through some of it. My view is yes – this is right. My opinion’s not gospel. Your immune system’s geared up to recognise things that don’t belong (viruses, bacteria, toxins, foreign molecules) in your blood and to tackle inflammation.

Another explanation that in my view perhaps overlaps but is further 'upstream' is that some people are genetically susceptible to autoimmune disease.

That means with the right triggers – eg. pesticides in food, smoking, exposure to toxins (airborne, water-borne, food-borne) etc. – they produce auto-antibodies due to a malfunction in their genetics. Again I could bang on here but it’s pretty involved.

This is definitely true. That's one of the reasons thyroid probelms, diabetes often run in families. There’s a mountain of evidence of this since the human genome was sequenced (ie. we know how to read our genetics better than we ever have before).

There are 2 recognised groups of autoimmune diseases – the thyrogastric cluster (notice: thyroid + gut) and the lupus-associated autoimmune diseases (not covered here).

The thyrogastric cluster includes

1. autoimmune gastritis (stomach - anti-parietal cell Abs and anti intrinsic factor Abs). This can cause full-blown pernicious anemia if untreated and lead to poor B12 absorption

2. Hashimoto’s thyroiditis (thyroid - covered above)

3. Diabetes mellitus (type II) (pancreas – anti-islet of Langerhans Abs) lead to compromised insulin production

4. Addison’s Disease (adrenals – anti-adrenal cortex Abs) lead to compromised cortisol and DHEA production

Summary Hashimoto’s doesn’t necessarily travel alone. So if you’ve got it, it’s worth checking for other auto-antibodies because they may explain symptoms.

Note: one symptom of all of these is fatigue...

One more note here on gastritis and gut. If your gut's compromised – leaky/damaged – you may also lose the ability to absorb important things like iron, folate, and vitamin D from your diet. This leads to nutrient deficiencies with symptoms that also overlap with thyroid symptoms (funny that). More on this when I tackle gut and malabsorption.

Oestrogen

Here's another link in - genetic predisposition towards the thyrogastric cluster has also been linked to 'female' hormones - oestrogen etc. It’s also more common in women.

Pregnancy and childbirth clearly change our hormone balances significantly, as does menopause. This is one reason why there’s a specific group of women who get autoimmune disease post-natally (I’m one of them) and around menopause.

Then you can happily add stress into the mix…

There’s no doubt stress affects hormone balance as it causes the adrenals to produce adrenalin (short term) and cortisol (long term) and cortisol acts on every cell in your body along with T3 to manage energy production and metabolism.

So by my reckoning there are four building blocks that lead so many of us to feel rubbish day-to-day.

Our immune system linked to our gut (damaged/leaky?) – to our adrenals (stress) – linked to our thyroid (autoimmune?) – then add some out of balance sex hormones and bazinga!

There’s no clear order that this happens in. To be sure what happened to you you’d have had to catch the first problem before the others set in. Sadly by the time you’re autoimmune and you figure out your have a thyroid problem there’s already 2 systems involved. Because – no surprise - all the systems work together. They all rely on each other’s hormones to work properly. If one goes it will be a house of cards unless someone intervenes.

So what to do? How can you sort out an over-keen immune system?

For me number one has been reducing stress. It has to be because I know stress first suppresses my immune system, then allows it to 'bounce back'. This happens in pregnancy. It also happened with illness and as a result of the (sometimes enormous, crushing) stresses life dishes out.

Next I have to be honest – I tackled my ‘female’ hormones. They were out of whack and that’s just never good (for me or those around me ;-)) I’ll deal with this and specifically oestrogen dominance tomorrow. This one was relatively easy for me to sort and led to a drastic improvement.

Next I changed my diet and supported my gut (more on this tomorrow). I don’t eat anything containing wheat. Many of you do this already. It took me a while. I also (sniff!) have had to stop drinking. It makes me feel physically rubbish even if I feel mentally happier (I’m a happy drunk…)

Next I discovered the adrenal disaster. so I supported my adrenals, thyroid, gut with whatever was needed. I’ll cover supporting your systems and supplements later. Although I will deal with those that seem to be good for immune support below.

What to take...

This is by no means either prescriptive or complete or what I advise you to do. It’s just worked for me (so far…)

Some herbs that are thought to calm the immune system down but it’s best to see a qualified herbalist before you go here.

BE VERY CAREFUL because there are some things that are commonly thought to ‘help’ the immune system are actually going to stimulate it. People cpmmpnly think Echinacea is ‘good’ for the immune system. They take it when they get a cold to stimulate the immune system to help fight the cold. This is probably the opposite to what you want to do if you’re autoimmune. Just a thought ?. There’s evidence for this too. Echinacea (and spirulina) have been seen to stimulate autoimmune flares in some patients.

I guess spirulina could be a problem because of the iodine content. If you can’t use all the iodine up in your thyroid to make hormones because your anti-TPO Abs are blocking that process that iodine could build up. I know there’s a lot out there on iodine and everyone needs to be aware of what their own circumstances on this one.

So what’s safe (or is thought to be) in helping your immune system ‘calm down’

(I’m using these)

• Green tea – has been shown to reduce autoimmune response in rats and reduce inflammation. Full of antioxidants that combat chemical stressors ion the body. Loads of flavours available – why not.

• Quercertin has also been shown to be anti-infammatory.

• A-lipoic acid (found in dark green leafy vegetables) is crucial in the body in regulating glucose balance – has been tested with diabetes II patients with visible improvement. If you’re healthy and you can metabolise green veg you should be OK on this one. You can also get it as a supplement.

• Ashwagandha (a decent ref. webmd.com/vitamins-and-supp...

Vitamins (some good old favourites here…)

• Omega 3,6 fatty acids + vitamin E - reduce inflammation and therefore immune response to inflammation

• Vitamin D - suppresses autoimmune reactions

• Selenium – German study 70 women aged mean 47.5 years on selenium supplementation showed mean TPOAb concentration decreased significantly to 63.6% vs untreated women. That’s good enough for me.

For gastric-anti parietal cell Abs/gut related deficiencies (you can test for these deficiences via Myrios tests at home to keep a handle on things)

• I get a B12 shot every 3 months

• I take vitamin D and folate supplements and can confirm I am absorbing them OK

• I get an iron infusion every ~18 months as my ferritin stores get depleted. I have issues absorbing dietary iron

The ‘Medical Option’ – Immune Suppressants.

There’s also the well-publicised medical option involving drugs that suppress the immune (and therefore autoimmune) system.

Having worked in the drug industry I would hate to have to take these. There are medical conditions where it’s absolutely necessary eg. after transplants to avoid transplant rejection. I can’t even go there but there may be GOOD reasons if your doctor prescribes these. Just make sure you find out what those reasons are because it’s a very big deal and these drugs will do their job but do have risks and side-effects.

So Results-Time

My autoimmune antibodies have done something very interesting since I embarked upon the sorting-this-out-plan.

First off results for anti-TPO Abs (IU/ml) I only have 4 readings – sorry for the big gap in the middle…too busy being stressed!)

2002 – on initial diagnosis 725 (ref range. <35) USA

2010 – on 100mcg thyroxine 374 (ref range. <30) Australia

2011 – on 100mcg thyroxine 175 (ref range. <35) UK

2013 – on 0mcg thyroxine + nothing 137 (ref range. <35) UK

2013 – on 50mcg thyroxine +adrenal support etc. 85 (ref range. <35) UK

The final two measurements are interesting because they’re going down but the jury’s still out…

Uselessly the tests they use for gastric-parietal cell Abs are +/- tests so no idea what those are doing.

So that’s about it – another long one – sorry but it is complicated.

Tomorrow I’m going to go shorter and tackle oestrogen then onto Gut, Liver and Supplements/Diet…

Thanks for reading. Happy to field comments/questions.

[skyfall]

Skyfall's Log Supplemental...

The last couple of autoimmune panels I've done are from Medichecks and (with a Pracitioner) Genova. They also screen for anti-islet Abs (diabetes 2), anti-adrenal Abs (Addison's), anti-testicular Abs and anti-ovarian Abs (affect reproduction)

All negative.

[nightingale-56]

Thank you for all the hard work you are doing for all on this site nd family members. Janet.

[poing]

skyfall, do you understand this Th1, Th2 dominance in the immune system? depending on which one is dominant, then it will determine which supplements help and which hinder. I gather than Hashimoto's is usually Th1 dominant, and that's why echinacea is bad and green tea is good. If you have a Th2 domiinant problem, it would be the other way around.

[sarahstevenson in reply to poing]

ooh am lost here sorry can you explain Th1 and Th2 ?Thanks

[poing in reply to sarahstevenson]

Th stands for T helper cells, which are a kind of lymphocyte (white blood cell). There are two types of T helper cells, which have different roles in immune response. Auto-immune diseases tend to be Th1 dominant, while allergies tend to be Th2 dominant, but I gather there's no hard and fast rule about that. And that's about where my understanding runs out...

autoimmunepaleo.wordpress.c...

[skyfall in reply to poing]

My understanding is a bit different.

First off - for Sarah - what are Th1 and Th2? They're basically part of the immune system. T helper cells are white blood cells that are are part of a person's immune response that identifies and removes invading entities from the body. Th1 is a Type 1 helper cell, Th2 a Type 2.

I can go on here... Th1 cells work with macrophages to eat up and digest foreign particles (killer cells) Th2 works with B cells/lympocytes to make antibodies against invading material and develop long term immunity.

In the Th1 response state, killer cells are triggered to destroy abnormal cells or cells infected with microorganisms (bacteria, viruses, and fungi). In a Th2 state, antibody-producing cells are stimulated. The antibodies produced attack microorganisms outside the body’s cells - that's what most people understand the immune system to be.

In any disease state you get both a Th1 and Th2 response but the balance of Th1 to Th2 depends on the disease.

So in auto-immune conditions, both Th1 and Th2 cells are present. Th1 cells present proteins from the body cells to the Th2 cells and stimulate antibodies to be produced against the bodies cells.

Diseases tend to differ as to whether they're Th1 or Th2 dominant. Th1 dominant examples include RA, MS and diabetes 1. Th2 dominant includes ulcerative colitis, lupus. Note: the balance of Th1 and Th2 varies between people and all immune conditions have a degree of Th1/Th2 imbalance.

How to treat the immune system at this level depends on the nature of the individual, their response and then how to rebalance it to minimise antibody production and damage.

I have to admit I'm not dealing at that level. Hashimoto's is generally Th1 dominant.

Basically there's a good established link between faulty gut and autoimmune imbalance. Things to avoid are sugar, gluten, trans-fats and omega 6 (except for lineloic acid which is an Ok form of omega 6).

I'll deal with a full supplement panel later.

Hope this helps (a bit). This is a very complex area. The immune system is very intricate and finely balanced. When that balance is lost it's hard to get it back...no REALLY easy answers!

[poing in reply to skyfall]

I don't think my understanding is any different to yours - you just explained it in a lot more detail... nicely done.

[sarahstevenson]

Many thanks again skyfall will print out I think , as lots of interesting points - great!

[amusingsmiles]

Wow! This is very interesting to me and probably explains why my endo is talking about wanting to stop my ovaries from working ( I am resisting at the moment) I have had erythema nodosom 20 years ago but never totally recovered and followed by diagnosis' of fibromyalgia IBS vitiligo and now auto immune thyroitoxicosis. Currently the drs are assessing my liver, adrenals and nervous system. Any advice or further information would be much appreciated

[W3ndy2159]

Morning skyfall just to say I've been v,busy past couple of days. Briefly read pt3 and pt4 with interest. Looking forward to todays. Will read properly and no doubt comment over weekend. Thank you for all your hard work and sharing with us all. Have a good day wendy

[hotfeet]

wow! this is complicated stuff!

i was diagnosed with over active thyroid in feb 2012

my nan had a problematic thyroid so i guess genetic, i ve taken echinacea for years to avoid colds and support them so i guess that s a trigger and i m not good with wheat and for years avoided it but it became impossible when going out so re introduced it

i have a sweet tooth so i guess a lot of sugar in my diet and for ages was very oestrogen dominant which stopped but has this month returned

i ve taken supplements for years too so omega 3 multi vits probiotic magnesium vit c calcium and vit d

i m now wondering whether its time to omit sugar and wheat and stop the echinacea?

what do we think?

and what s the deal with dairy i have almond milk for breakfast and then skimmed milk in tea (2 cups daily)

thanks

hotfeet

[skyfall in reply to hotfeet]

I'd suggest trying no gluten, sugar and echinacea and see how you feel... I've also eliminated dairy as mush as possible (still have milk in the odd cup of tea) - just make sure it's organic.

[rustysmum]

Wow, very interesting - thanks for tking the time to post this. Looking forward to tomorrow's instalment.

[bossbird]

i have hashi just ordered Ashwagandha and will start taking Selenium again - i get B12 injections and usually take iron supplement - got so fed up of all the pills that i stopped supplements for a while, my last endo had me on -

Energy extra

Seriphos

Melatonin

none of the above did anything

[Xanthe]

A fantastic blog, skyfall - thanks for sharing it.

Just a couple of thoughts on the dietary side. I've gone completely gluten-free to avoid provoking my immune system and also completely dairy-free, for the same reason. So in the first case that means no oats, barley,rye, spelt or wheat. The rationale for going dairy-free is twofold - to avoid lactose and casein which are frequent allergens (i.e. provokers of the immune system), but also to avoid the hormonal growth-inducers which are part of the dairy industry. The other bugbear on the immune system side is contamination by toxic metals (eg mercury, lead etc) and by chemicals in the environment (e.g. cleaning products, toiletries etc). Some of these chemicals contribute to oestrogen dominance by mimicking oestrogen in the body - so-called "xeno-oestrogens", so reducing or altering the products used at home might be helpful.

[skyfall]

Thanks Xanthe - Agree with your comments - very useful additions. I also suggest - on the heavy metal and hormone side - anyone eating fish read this nrdc.org/health/effects/mer...

I've also (and forgotten to mention it) that I too, have dumped out dairy form my diet.

I can certainly tell when I have that or gluten products. No real loss except I miss my cheese!

[GSLSMK]

Hi wondering to all those who remove major food groups like: dairy, wheat etc what does your daily diet consist of, and do you take calcium supplements also?

[skyfall in reply to GSLSMK]

OK..I'm going to post on diet and supplements soon but here's a snapshot

- lots of fruit and veg (fresh and steamed)

- fish, chicken, turkey (I avoid red meat as my body hates it - it also can aggravate the immune system if you have digestive issues)

- gluten free bread, rice, quinoa (although I can rarely be bothered)

- loads of water

- nuts except walnuts and peanuts

- sushi (when I can get my hands on it)

I do take calcium but not the carbonate version that can't be absorbed - calcium citrate - always last thing at night.

I also avoid sugar and alcohol (except for the odd glass of red wine) as much as possible

[skyfall in reply to skyfall]

Prbably sounds brutal but it's quite easy and I feel loads better so I guess that's the point. I only drink green and herbal tea - no coffee or caffeinated tea.

I can now tell the difference when I eat wheat/dairy/sugary foods and drink - I feel less great...but you still have to live - right!

[GSLSMK]

Thanks skyfall, that is already helpful as it can be difficult to piece together a diet when restriction seems to be the only phrase on the block, it can be daunting and difficult and yep you certainly do have to live!