The Dr. Hedberg Show

Is There a Connection Between Vitamin D and Hashimoto's Disease?  Does Vitamin D Supplementation Help Heal Hashimoto's Disease?

Vitamin D has long been established in literature as a highly essential nutrient with benefit to the musculoskeletal system and bone density. It also functions in the body as an immunomodulator, facilitating normal immune system function and improving resistance against certain diseases.

Given this background, one has to wonder if a deficiency in vitamin D would be prevalent among individuals with Hashimoto’s thyroiditis and if so, would supplementation with vitamin D help patients manage the disease or perhaps even prevent it?

PART ONE – Vitamin D Deficiency and Hashimoto’s Disease

Research goes back to 2009 on the first question:  is there a connection between vitamin D deficiency and Hashimoto’s disease?  The earlier studies either indicated that indeed there was a connection while other studies concluded that there was none at all.  How is one to draw a final answer when the outcomes are 180 degrees apart?

Kmiec and Sworczak (2015) reviewed twelve studies published between 2009 and 2014 whereby seven of those studies concluded that there was a connection between lower vitamin D levels and Hashimoto’s thyroiditis while two other studies showed no association and three others were inconclusive.

Among the studies that established a connection included the ones by Bozkurt et al. (2013), Camurdan et al. (2012) and Mansournia et al. (2014).

Goswami et al. (2009)  showed no association between vitamin D levels and thyroid peroxidase antibody (TPO-Ab) positivity.

What was the takeaway message from the Kmiec and Sworczak article?

The authors concluded that no final word on a correlation could be made.  It was neither an absolute ‘yes’ nor a definitive ‘no’. They reported:

“…in many points accumulated data are inconclusive, many unresolved questions remain, therefore, it remains necessary to perform further studies that would affect clinical approaches to thyroid disease.”

They went on to state that the idea of vitamin D supplementation being able to influence the levels of antibodies in Hashimoto’s was also inconclusive:

“Moreover, vitamin D supplementation has not affected disease occurrence in intervention studies, as summarized in 2 recent reviews. The associations between vitamin D deficiency and disease may indicate that 25(OH)D is only a marker of ill health ([Theodoratou et al. 2014]; [Autier et al. 2014]).”

Fast forward a few years, and what does the research reveal on whether there is a connection between vitamin D and Hashimoto’s thyroiditis?

Anaraki, et al. (2017) found no association between vitamin D levels and Hashimoto's thyroiditis.

Boyuk et al. (2016) also reached the same conclusion of no correlation between vitamin D and Hashimoto's thyroiditis.

In 2018, Botelho, et al. reviewed several studies conducted around the world between 2012 and 2016 that basically led to the findings that an association between vitamin D and Hashimoto’s Thyroiditis “…remain unresolved in literature”.

Some of these included:

D' Aurizzio, et al. (2015) No differences in vitamin D deficiency in Hashimoto's thyroiditis patients and healthy controls

Yasmeh et al. (2016) No association of vitamin D deficiency and Hashimoto’s relative to controls

On the contrary,

Sun et al. (2017) revealed Vitamin D levels were inversely correlated with positive TPO-ab and higher D levels were linked to lower TSH in males.

Ma et al. (2015) found that there were lower levels of D in Hashimoto's thyroiditis patients relative to controls.

Wang et al's.  (2015) meta-analysis of twenty studies and the Mazokopakis et al. review (2014) also corroborated with Ma’s conclusion that there is an association.

Bozkurt et al.  (2013) found a direct relationship between vitamin D and Hashimoto's thyroiditis.  He and his colleagues looked at 180 Hashimoto's thyroiditis patients and 180 controls and found that vitamin D levels were significantly lower in the Hashimoto's thyroiditis patients compared to the controls.  He and his team concluded that the severity of vitamin D deficiency correlated positively with disease time (duration of Hashimoto's thyroiditis) and higher concentrations of anti-thyroid antibodies, suggesting a potential role of vitamin D in the development of Hashimoto's thyroiditis and/or its progression to hypothyroidism.

Botelho and colleagues then conducted their own study that included 159 participants whereby there were 88 patients with Hashimoto's thyroiditis, of which 82 were female (93%). In the control group, there were 71 subjects, 61 of which female (85.9%). Mean‐time of diagnosis of Hashimoto's thyroiditis was ten years (range 1– 47 years).

Vitamin D levels below 30 ng/dL were found in 59.1% (n= 39) of the control group and in 71.8% (n= 61) of Hashimoto's thyroiditis group (p= 0.1024).

Botelho and his team concluded that there was no relationship with a clarification:

Lower levels of vitamin D have not been associated with Hashimoto's thyroiditis, however  thyroxine levels were  determined as a risk factor for vitamin D insufficiency.  Additional studies are warranted to clarify the precise role of vitamin D in autoimmune thyroid disease (autoimmune thyroiditis).

Like Botelho and team’s conclusions, Yasmeh et al. (2016) also found that there was no connection between vitamin D and Hashimoto’s.  Yasmeh and his colleagues separated his research groups by gender.  The levels of vitamin D for the Hashimoto's thyroiditis and control groups among the females were significantly different (51.7% vs. 31.1%); however, there was no significant difference in D levels among the male group.  Furthermore, the researchers stated that none of the females were actually deficient in vitamin D in the first place! It’s just that the levels were different between the two female groups (Hashimoto's thyroiditis vs. healthy).

Do we then place emphasis on these two recent studies by Botelho and Yasmeh that show no connection between vitamin D and Hashimoto’s?  What did other more recent studies and meta-analyses reveal?

Bakr and Meawed (2017) did find an association between vitamin D and Hashimoto’s thyroiditis.  There is not only a positive correlation between the vitamin and autoimmune thyroiditis but also an inverse correlation with thyroid antibodies (anti-TGB and anti-TPO).

Kim (2017) reviewed twenty studies through 2016 and concluded that most studies have shown an association between low vitamin D status in the pathogenesis of autoimmune thyroid diseases, especially Hashimoto’s.  He did note, however, “there are only few preliminary interventional studies for Hashimoto's thyroiditis. Further randomized controlled trials are needed to determine whether there is a causal relationship, and investigate the potential application of vitamin D in the treatment of autoimmune thyroiditis.”

Some of the studies he reviewed included the following four:

Evliyaoglu et al. (2015) The prevalence of vitamin D deficiency in Hashimoto's thyroiditis patients was significantly higher than that in the control group. Blood levels of vitamin D in the Hashimoto's thyroiditis group was significantly lower compared to the control group.  Hashimoto's thyroiditis was observed 2.28 times more frequently in individuals with vitamin D levels <20 ng/mL.

Kim (2016) concluded that vitamin D insufficiency was significantly more prevalent in 369 patients with autoimmune thyroiditis than in the 407 without autoimmune thyroiditis and higher among the 221 patients with Hashimoto's thyroiditis than in those with Graves' Disease or non-autoimmune thyroiditis.

Among Hashimoto's thyroiditis cases, patients with overt hypothyroidism had a significantly higher prevalence of vitamin D insufficiency and lower vitamin D levels compared with those with euthyroidism and subclinical hypothyroidism or those without autoimmune thyroiditis.  Blood levels of vitamin D were significantly negatively correlated with thyroid-stimulating hormone (TSH) levels after adjustment for age, sex, body mass index, and sampling season. This study had an excellent sample size.

Mansournia et al. (2013)  found a significant inverse association between vitamin D levels and Hashimoto's thyroiditis such that each 12.5 nmol/L increase in vitamin D level resulted in a 19% decrease in the odds of Hashimoto's thyroiditis.

Unal et al. (2014) demonstrated that 254 newly diagnosed Hashimoto's thyroiditis patients had lower vitamin D levels than 124 healthy controls and vitamin D levels were inversely correlated with anti-thyroglobulin (Tg) and anti-thyroid peroxidase (TPO) antibodies.

Delving further into the research conducted in recent years, and looking beyond those studies that were included in Kim’s meta-analysis, here were other study conclusions drawn that point to a positive correlation between vitamin D levels and Hashimoto’s thyroiditis:

Maciejewski et al. (2015) revealed that serum vitamin D is significantly lower in Hashimoto's thyroiditis patients vs. controls.  He and his colleagues suggested that vitamin D deficiency is one of the risk factors for Hashimoto’s thyroiditis development.

Lionitris and Mazokopakis (2017) concluded that there is an association between vitamin D deficiency and the pathogenesis of Hashimoto’s thyroiditis but also thyroid hypofunction and autoimmunity in general. In summary, the research team’s data demonstrate the association of vitamin D deficiency with Hashimoto's thyroiditis pathogenesis, thyroid hypofunction and autoimmunity overall.

Sonmegoz et al. (2016) studied a group of 136 Turkish children and determined that the prevalence of a vitamin D deficiency was higher in subjects with Hashimoto’s disease (76%) compared to controls (35%).

Hu and Rayman (2017) concluded that lower vitamin D status was found in Hashimoto's thyroiditis pat

We have never had any good studies looking at how food allergies, or more specifically food intolerances, affect Hashimoto’s disease. A recent paper, however, did show that people following a gluten-free diet can help heal Hashimoto’s disease.  In this article, Dr. Hedberg answers the question if food intolerances affect Hashimoto's disease?

I was excited to find a new paper just published last month that looked specifically at food intolerances and Hashimoto’s disease. The paper was published in the Journal of the American College of Nutrition and it was entitled, “Evaluation of Correlations Between Food-Specific Antibodies and Clinical Aspects of Hashimoto’s Thyroiditis.”

Let’s break down the study and see what food intolerances may be connected to Hashimoto’s disease.

The authors do point out a previous study that showed TSH levels improved in people with Hashimoto’s disease who were lactose intolerant when they avoided consuming lactose.

The aim of this study was to evaluate whether testing IgG antibodies for specific foods show differences in people with Hashimoto’s disease compared to those without Hashimoto’s disease. The authors wanted to find out if there were any specific foods connected to Hashimoto’s disease so that those individuals would know what to avoid to help their condition.

How was the study done?

74 patients, 91.9% being female, with Hashimoto’s disease had blood testing done for 125 IgG food antibodies. Some of them were taking thyroid medication and some were not (28.17%). They also performed a thyroid ultrasound and tested them for thyroid-stimulating hormone (TSH), thyroxine (T4), free thyroxine (fT4), triiodothyronine (T3), thyroid peroxidase antibodies (TPOAb), and anti-thyroglobulin antibodies (TgAb). Additional markers included body mass index (BMI), height, weight, blood pressure, and asked them how many symptoms they had.

I was pleased to see a control group of 245 subject of which 54.7% were women. The control group was also tested for the same 125 IgG food antigens.

To test the food antibodies they used enzyme-linked immunosorbent assay or ELISA which is a very popular technique for testing food intolerances. They broke the food intolerances down into these categories:

Milk products

Eggs

Grains

Legumes

Nuts

Fruits

Vegetables

Fish

Seafood

Meat

Coffee and Tea

They also took into account all the differences of the above blood markers, biomarkers, medication, and symptoms to see if they could find any correlations. They even looked at how frequently the subjects were eating specific food groups.

What were the results?

They found increased IgG antibody responses in 12 foods that were significant but these were elevated in both groups. Of the 12, only plum was significantly elevated in the Hashimoto’s group with egg white and barley showing borderline significance. Interestingly, almond was actually significantly less reactive in the group with Hashimoto’s disease compared to controls.

Looking at the proportion of positive results however, only plum and barley were higher in those with Hashimoto’s disease but no significant difference with egg whites.

Anti-gliadin IgG antibodies which are specific for gluten were tested but they did not find any differences between the two groups.

The authors did not find any correlation with IgG food antibodies and symptoms of Hashimoto’s disease and hypothyroidism.

The magnitude of reactivity from strongest to lowest in both groups was:

Milk products and eggs > Grains > Nuts > Legumes > Fruits > Vegetables > Fish > Seafood > Meat > Coffee and Tea.

Author Discussion

The authors conclude that only plum was significant between the two groups with barley and egg white to a lesser extent. They did however find significant connections with thyroid volume and almond-specific IgG levels as well as for nuts, meat, and fish in those taking thyroid medication. So in those taking thyroid medication with higher levels of IgG reactivity to almonds, nuts, meat, and fish, this correlated with larger thyroid volume. The older the subjects were the less reactive they were to dairy products and egg whites. The also found that higher reactivity to coffee and tea correlated with fewer symptoms.

The authors point out that the greatest reactivity in both groups was to cows milk, egg white, yeast, wheat, corn, barley, pistachio, pea, sheep milk, goat milk, plum, and almond and that these are already known to induce food intolerance and food allergies.

They also make a very important point that elevated IgG food antibody levels may simply be due to increased frequency of consumption which makes it difficult to ascertain true intolerance. They even make a strong statement that perhaps the threshold for measuring food intolerance is too low and should be revised.

Regardless of frequency, the authors state that meat, vegetables, coffee, and tea induce a low IgG response compared to nuts and legumes which induce a high IgG response even when they aren’t consumed very often.

The strong reactivity to plum is kind of a mystery but they point out that a previous study did show a connection between plum and irritable bowel syndrome. They are clear that these results do not definitely say that those with Hashimoto’s disease should avoid plums.

There was an increase in anti-gliadin IgG antibodies in 24.32% of those with Hashimoto’s disease but there was no significant difference here with controls. There was also an increase in wheat reactivity in those with Hashimoto’s disease but again it wasn’t significant compared to controls.

71.62% of Hashimoto’s patients had increased reactivity to cow’s milk but this was comparable to controls as well.

The authors aren’t sure what to make of the low reactivity to almonds in those with Hashimoto’s disease but they postulate that it could just be another symptom of the disease. Almond allergy is the third most common tree nut allergy in the US. But the higher the IgG reactivity to almond the greater the thyroid volume which can indicate inflammation of the thyroid gland.

Finally, the authors do their diligence and point out the problem with ELISA IgG food antibody testing. One major issue is that foods can “cross-react” with each other which means that one food can drive an immune response to another food and show up reactive on these tests.

Author Conclusions

1. IgG levels to plum are significantly increased whereas IgG levels to almond are significantly decreased in those with Hashimoto’s disease compared to controls.

2. Cow milk and gluten-specific IgG levels did not differ between the groups.

3. There is no connection between increased IgG antibodies and all the blood and biomarkers that were tested in both groups. So TSH, T4, T3, thyroid antibody levels etc. were insignificant between the groups.

4. Increased IgG antibodies are not associated with the symptoms of Hashimoto’s disease.

5. Increased reactivity to coffee and tea seem to decrease symptoms in Hashimoto’s disease.

6. IgG antibody levels can be elevated even without frequent consumption of certain foods.

7. IgG antibody testing needs to be improved to eliminate cross-reactions.

“Taking these finding together, our study suggests that food intolerance is comparable between Hashimoto’s thyroiditis patients and controls, with the exception of plum and almond. In addition, there is no evidence that increased IgG antibodies are associated with clinical aspect of Hashimoto’s Thyroiditis, especially with thyroid hormone/antibodies or Hashimoto’s Thyroiditis symptoms, pointing out that the test of food intolerances does not bring greater advantage, to Hashimoto’s Thyroiditis cases in comparison to the general population.”

Dr. Hedberg’s Comments on Food Intolerances and Hashimoto’s Disease

I used to do IgG food antibody testing in my practice and sometimes it was extremely useful and sometimes it wasn’t. After running many tests, about 98% of patients would come back reactive to dairy, eggs, and gluten-containing grains. I would see what was found in this study that dairy, grains, legumes, eggs, and nuts were the most common reactions with meat, fish, seafood, fruits, and vegetables rarely if ever coming back reactive. Over time I just didn’t need to do this kind of testing any more as the majority of the patients I see have some type of autoimmune disease or gut disorder which requires removal of these foods any way.

This is an excellent study and I was pleased to see a large control group so we could see what “normal” people reacted to as well.

It is interesting that coffee and tea seem to help the symptoms of Hashimoto’s disease because coffee and tea are not on the autoimmune Paleo diet which is a popular diet for Hashimoto’s disease. I may allow some patients to continue with their coffee and tea based on this research.

Does this mean that patients with Hashimoto’s can now eat what they want? That is definitely not the conclusion we take from this study. Remember that there were a number of food reactions such as dairy and wheat, just not unique to those with Hashimoto’s disease.

One of the main goals in healing Hashimoto’s disease is to heal the gut and this requires reducing the amount of inflammation in the gut. Removing the most reactive foods from the diet helps to achieve this goal and this is why I’ll use a Paleo diet, autoimmune Paleo diet, Paleo low-FODMAP diet, low-FODMAP diet, ketogenic diet, or simple carbohydrate diet with Hashimoto’s patients but this depends on their unique presentation. These diets are mainly based on meat, fish, seafood, fruits, and vegetables which as shown in this study are least reactive for everyone. These diets are void of dairy, eggs, gluten, grains, legumes, and nuts which are the most reactive.

With autoimmune disease, we want to take as much stress off of the immune sy

A gluten-free diet is one of the first things most practitioners recommend to help heal Hashimoto’s disease but we’ve never had any research papers to support this recommendation. Thousands of patients report significant improvement in their Hashimoto’s symptoms on a gluten-free diet but these are just anecdotal reports. Now we finally have research looking into the effects of a gluten-free diet on Hashimoto’s disease.

I’m excited to report on a recent paper that looks at the effects of a gluten-free diet on Hashimoto’s disease. The paper is entitled, “The Effect of Gluten-Free Diet on Thyroid Autoimmunity in Drug-Naive Women with Hashimoto’s Thyroiditis: A Pilot Study.” For those who don’t know, “drug-naive” means that the participants in the study weren’t taking any thyroid medication.

The authors begin by discussing previous studies that show an association between celiac disease and Hashimoto's disease noting that Hashimoto’s disease is the most common autoimmune disease connected to celiac disease. They even state that everyone with Hashimoto’s disease should also be screened for celiac disease due to the high prevalence of both disorders found together.

They also discuss some possible explanations for why Hashimoto’s disease and celiac disease are so common together. The first is that celiac disease causes gut malabsorption which leads to low selenium and vitamin D levels and we know that deficiencies of those two nutrients can be a cause of Hashimoto’s disease. The second connection is that tissue transglutaminase-2 IgA antibodies can cross-react with thyroid tissue. Tissue transglutaminase-2 is the enzyme that the immune system attacks in celiac disease so the immune system attacks this enzyme in the gut as well as thyroid tissue.

How was the study done?

34 young women between the ages of 20 and 45 years with a recent diagnosis of Hashimoto’s disease but previously untreated for this condition were selected. The following criteria were required:

1. Thyroid peroxidase (TPOAb) antibody levels had to be greater than 100.

2. A thyroid ultrasound had to show changes in thyroid tissue.

3. TSH levels had to be between .4 and 4.5. (They considered this range normal)

4. Free T4 (free thyroxine) between 10 and 21.

5. Free T3 (free triiodothyronine) between 2.6 and 6.5.

6. Incidentally found positive anti-tissue transglutaminase antibodies without clinical symptoms of celiac disease.

They excluded women who had the following:

1. Symptomatic celiac disease.

2. Positive antibodies against the thyrotrophin receptor (This would indicate Graves’ disease).

3. Diabetes or other endocrine disorder.

4. Impaired liver and kidney function.

5. Any acute and chronic inflammatory condition.

6. Pregnancy or lactation.

7. Women receiving any form of chronic treatment.

Group A (16 women) consumed a gluten-free diet for 6 months and Group B (18 women) did not have any dietary restrictions. They followed-up with all participants every two months to be sure they were in compliance with the gluten-free diet. Those who followed the gluten-free diet had to actually provide the packaging for all the gluten-free products they ate.

What lab testing did they do?

Lab tests were done at baseline and at 6 months which was the end of the treatment period. They tested the following:

1. TSH (thyrotropin)

2. Free T4 (free thyroxine)

3. Free T3 (free triiodothyronine)

4. Thyroid peroxidase antibodies (TPOAb)

5. Thyroglobulin antibodies (TgAb)

6. Vitamin D (25-hydroxyvitamin D)

7. Immunoglobulin A antibodies against tissue transglutaminase antigen (te...

In this episode of The Dr. Hedberg Show I interview therapist Patti Elledge in a deep discussion about healing adverse childhood experiences (ACE's), trauma, epigenetics, attachment theory, somatic experiencing, evolutionary biology, and much more.

Patti Elledge has specialized in therapeutic application of neuroscience for more than 40 years. She has a broad clinical background in developmental and attachment based traumas and worked directly with babies, children and families for more than 25 years prior to her SE training in the late 90s. She specializes in interpersonal neurobiology and how that affects social/emotional, language/cognition and sensory processing development. Her blending of somatic and body-mind techniques helps resolve over-coupled elements of the fight-flight-freeze that seemingly becomes intractable with the essence of loving/bonding and "belonging." By accessing these parts of the nervous system we can return to healthy regulation and functioning, greater flow and creativity. Patti studied directly with Drs. Peter Levine, Raja Selvam and Diane Poole Heller and holds Trauma Informed Touch Certification from Kathy Kain.  She serves as Faculty for Diane's seminal trainings for healing adult attachment wounds, called DARe.  Patti has an active private practice in Asheville, NC where she provides therapy as well as mentoring to other somatic practitioners learning SE and DARe.

To contact Patti call (828) 273-0323 or email at [email protected]

Here is a transcript of the interview:

Dr. Hedberg: Well, welcome, everyone to "The Dr. Hedberg Show." This is Dr. Hedberg and I'm excited today to have Pattie Elledge on the show. We're gonna be talking a lot about adverse childhood experiences and trauma and we're gonna get into the things that she does in her practice. And as you know, I've been talking a lot, writing a lot recently about ACEs and what those mean. We're gonna get into that in some detail here. So, Pattie, welcome to the show.

Pattie: Oh, thank you so much, Dr. Hedberg. I'm really glad to be visiting with you today on this topic.

Dr. Hedberg: Yeah, thanks for joining us. So why don't we start by you just telling us a little bit about what you specialize in and your background and the types of people you've worked with over your career?

Pattie: Well, thank you. I've been a therapist for 40 years. Ad I started out, I always like to say, I started out really working with babies and children, moms and dads many, many years ago in a whole different field. But I learned so much working with those kids, you know, day after day, hour after hour, I worked with a lot of indigenous kids and indigent families, families that needed social services and I got to see a wide spectrum, that was when I was working in Albuquerque, New Mexico, but I got to work with a wide spectrum of population. And then I worked a lot with families later on that were, you know, had a lot of affluence and a lot of wealth. And so I got to see kind of what happens in the good, the bad, and the ugly early on in families and the perspective of really helping families understand the child that they had.

And then later in my career, I was introduced to Peter Levine's work and I just really turned in that direction. Peter's known, has been a very influential individual in the field of trauma healing. And Peter introduced the concept that trauma is stored in the nervous system and not in the story. So that in other words, talk therapy really wasn't touching it for healing for many people. And so Peter began publishing and writing and created a format called "Somatic Experiencing." That's a therapy strategy which I'm certified in and have assisted, oh, probably 40 or 50 trainings nationally and internationally for these wonderful three-year-long trainings.

And so I really consider myself a trauma healing ...

If you’re reading this then you’ve probably taken the ACE Survey. If you even just scored a 1 on the ACE Survey then this article is definitely for you. The higher your ACE score the more likely you are to have health problems as an adult due to what you went through as a child. Additionally, if you feel like you’ve been doing everything right with your diet, exercise, sleep, managing stress levels etc. but you just can’t get well, then you probably haven’t addressed your ACE’s.  This article will give you the tools you need and cover how to heal adverse childhood experiences.

In a previous article I discussed the connection between ACE’s and autoimmune disease, more specifically Hashimoto’s disease where I cover some of the best research on ACE’s. This article will focus on all the things you can do to overcome your ACE’s and start feeling the best you’ve ever felt. Let’s jump right in and cover all the different therapies you can do.

A large portion of the recommendations and quotes below come from the book, “Childhood Disrupted: How Your Biography Becomes Your Biology, and How You Can Heal” by Donna Jackson Nakazawa. I highly recommend you read this book if you have an ACE score of 1 or more.

Somatic Experiencing

Somatic Experiencing was started by Dr. Peter Levine to help people overcome trauma. According to Dr. Levine, humans have difficulty recovering from trauma compared to animals because our traumas are stored in the brain and nervous system. Animals can easily shake off their trauma but humans get stuck in a trauma loop and dissociated for their bodies.

Somatic Experiencing helps you slowly reintegrate with your body without having to relive your trauma. Specific exercises are recommended by skilled therapists to get in touch with your body again which eventually lets the trauma go.

I have personally done Somatic Experiencing for my own trauma and it has been extremely useful in my healing journey. I’m more in touch now with my feelings and my body and things that used to bother me don’t get to me anymore. Somatic Experiencing is one of the most common therapies I recommend to my patients who are trying to get well.

You can find a practitioner on Dr. Levine’s website the Somatic Experiencing Trauma Institute at https://traumahealing.org/.

EMDR

EMDR, or Eye Movement Desensitization and Reprocessing helps you overcome trauma by thinking about negative memories while rapidly moving your eyes back and forth similar to REM sleep. This is done staring at a device with lights that rapidly move back and forth while holding a device in each hand that vibrates.

Research has found that doing this will result in the dissipation of emotions and stress reactions that are associated with these memories. I have done EMDR before and I found it very useful and helpful for overcoming trauma. As with any therapy, the key is finding a skilled therapist in EMDR.

Just like meditation, EMDR has been shown to decrease the firing of the amygdala and increase the size of the hippocampus. EMDR is one of my top choices for healing childhood trauma.

Psychotherapy

Traditional psychotherapy is always a great place to start when you’re trying to heal. There is nothing better than a third-party objective view of your life and your feelings. Many people make the mistake of using a priest, friend or family member as the person they talk to. There is no substitute for a mental health professional trained in psychotherapy who can give you the best treatment.

Unfortunately, our society still views seeing a therapist as a weakness and it certainly isn’t given the funding or attention it deserves. I hope that in the future, everyone works with a mental health professional even when they are feeling well. Your mental health is the bedrock of everything about you and how you feel so it must be the number one priority for everyone.

Sometimes you need to have a few sessions with various therapists to find the right fit for you. Once you find the right fit, you’ll have a solid person to give you lots of support and guidance in your life. I have more respect for mental health professionals than any other branch of healthcare because I know the service they provide is more important and more beneficial than any other form of treatment.

Neurofeedback

Neurofeedback, or Electroencephalographic (EEG) Neurofeedback has been shown to improve brain function. Ruth Lanius, MD, PhD, is the director of the post-traumatic stress disorder research unit at the University of Western Ontario in Canada and she states, “Neurofeedback can help to bring some of the brain networks that are interrupted by trauma back online.”

The simplest way to think about neurofeedback is to view the brain as a symphony orchestra and when someone is traumatized, one or more sections of the orchestra are no longer playing or playing out of sync with the rest of the instruments. Neurofeedback brings the abnormal instruments back into harmony with the rest of the orchestra.

Neurofeedback is readily available but make sure the practitioner has experience in dealing with trauma and PTSD.

Mindfulness Meditation

Did you know that brain scans of individuals who experienced Adverse Childhood Experiences have smaller areas of the brain that process inflammation, loving relationships, and how we deal with stress? That means more inflammation, more difficult relationships, and greater difficulty handling stress.

This means that we really struggle in relationships which further drives inflammation, stress, and health problems, especially if your are a woman. The good news is that mindfulness meditation, or mindfulness-based stress reduction (MBSR) can change our brains back to normal.

Mindfulness meditation has been shown to change the brain which reduces inflammation and improves how we respond to stress. In fact, those who meditate recover from stress much more quickly than those who don’t. This means that when you get a spike in cortisol when you’re under stress, you’re cortisol levels will come down much more quickly than those who don’t meditate.

Research has also shown meditation to be helpful for the following:

Anxiety

Depression

Pain

Mental focus

Cardiovascular health

Improving empathy and concern towards others

Severe speech and physical impairments

Improve well-being

Research has even shown that meditation increases the density of gray matter in the hippocampus which is important for memory, stress regulation, and emotion processing.

Meditation also helps reduce fearfulness while improving empathy, self-reflection, and self-awareness. I have written an article previously on meditation which has all of my recommended apps for meditation. You can use an app or go to a class to learn how to meditate.

If you really have difficulty with meditation, you may do better with Guided Imagery. Guided Imagery has been known as the “lazy person’s meditation” because a practitioner or audio track guides you through the process. This involves picturing something in particular and picturing everything that is happening in your imagination through a story or process. The practitioner will give you something to picture in your mind followed by instructions on what to see and what to think about. You simply sit or lie with your eyes closed deep in your imagination. I highly recommend it if meditation just doesn’t feel right for you.

Loving-kindness Meditation

Loving-kindness meditation or “metta” is a powerful way to heal past and present relationships that are troubling you. This meditation is done by giving compassion to yourself and then to others. Forgiveness can be extremely difficult for those who have hurt you but forgiving yourself may be even more difficult.

Personally, I’ve always been extremely hard on myself. Much harder than I would ever be on someone else. Some of us would never treat another person with the same harsh self-talk that we give to ourselves. This is where loving-kindness meditation can help.

Begin in a place and position like you would normally be in to meditate and focus on your breath for a few minutes. Bring forth an image of yourself and say the following out loud:

May I be filled with love and kindness.

May I be safe and protected.

May I love and be loved.

May I be happy and contented.

May I be healthy and strong.

May my life unfold with ease.

Make sure you really mean each phrase as you say it to yourself. Next, think about someone who is close to you and say these phrases:

May you be filled with love and kindness.

May you be safe and protected.

May you love and be loved.

May you be happy and contented.

May you be healthy and strong.

May your life unfold with ease.

Now think about someone you don’t know so well such as a co-worker, hairdresser, mailman etc. and speak the phrases above to them.

Next, think of someone who has caused you some pain in your relationship with them. Not someone who has traumatized you however as this would be too much. This could be a close friend, family member, or loved one and go through the phrases again as noted above.

Finally, speak the following phrases to all human beings and animals if you’re an animal lover like me:

May all beings be filled with love and kindness.

May all beings be safe and protected.

May all beings love and be loved.

May all beings be happy and contented.

May all beings be healthy and strong.

May all being's lives unfold with ease.

Take a few moments when you’re done with some deep breathing and appreciate the new sense of calm you have before opening your eyes.

Forgiveness

Forgiveness ties in with loving-kindness meditation but you can do something even more specific for individuals who have hurt you. Forgiveness is extremely difficult but you don’t have to completely let go of what happened to you....

Recently I have been researching the fascinating field of childhood trauma and uncovered an interesting link between adverse childhood experiences and Hashimoto’s disease.

One of the studies I discovered came out of a large, important public health study, The ACE Study, but it focused specifically on cumulative childhood stress and autoimmune disease in adults.

What are adverse childhood experiences?

Adverse childhood experiences, or ACEs, are experiences that expose individuals under the age of 18 to childhood traumatic stress. These experiences include physical, emotional or sexual abuse; witnessing domestic violence; growing up with household substance abuse, mental illness, parental divorce, and/or the incarceration of a household member.

Who was studied?

A group of 15,357 adult Kaiser Permanente health maintenance organization members available for follow-up through 2005 was involved in this study. They were selected from the ACE Study, which was performed from 1995 to 1997.

These individuals are interesting because while many studies have looked at inner-city poor people of color, this study’s participants were mostly white, middle and upper-middle class college-educated San Diegans with good jobs and great health care.

This highly educated population was made up of 40 percent college graduates. Of the remaining individuals, 36% had some college education, 17% were high school graduates (i.e., they had 12 years of education). Only 7% had not completed high school.

What did they measure?

The study authors looked at the data from the ACE Study and created an ACE Score that included eight types of interrelated and co-occurring exposure to childhood adversity to measure cumulative childhood traumatic stress. So, the greater the number of adverse experiences, the higher the score.

The ACE Study Questionnaire is very simple and includes the following 10 questions.

 

“While you were growing up, during your first 18 years of life:

 

1) Did a parent or other adult in the household often …

 

Swear at you, insult you, put you down, or humiliate you?

or

Act in a way that made you afraid that you might be physically hurt?

 

2) Did a parent or other adult in the household often …

 

Push, grab, slap, or throw something at you?

or

Ever hit you so hard that you had marks or were injured?

 

3) Did an adult or person at least 5 years older than you ever…

 

Touch or fondle you or have you touch their body in a sexual way?

or

Try to or actually have oral, anal, or vaginal sex with you?

 

4) Did you often feel that …

 

No one in your family loved you or thought you were important or special? or

Your family didn’t look out for each other, feel close to each other, or support each other?

 

5) Did you often feel that …

 

You didn’t have enough to eat, had to wear dirty clothes, and had no one to protect you?

or

Your parents were too drunk or high to take care of you or take you to the doctor if you needed it?

 

6) Were your parents ever separated or divorced?

 

7) Was your mother or stepmother:

 

Often pushed, grabbed, slapped, or had something thrown at her?

or

Sometimes or often kicked, bitten, hit with a fist, or hit with something hard?

or

Ever repeatedly hit over at least a few minutes or threatened with a gun or knife?

 

8) Did you live with anyone who was a problem drinker or alcoholic or who used street drugs?

 

9) Was a household member depressed or mentally ill or did a household member attempt suicide?

 

10) Did a household member go to prison?”

 

If the answer was yes to any of these questions, the respondents were allocated one point.

Next, the authors looked at those scores and compared them with the risk of 21 different autoimmune diseases that resulted in hospitalization. These illnesses included Graves’ disease, diabetes, irritable bowel syndrome, multiple sclerosis, Addison’s disease, and Hashimoto’s thyroiditis.

What did the study results show?

The study revealed that eight of the study participants had Hashimoto’s thyroiditis, and all of them were women.

In the study, women were 50% more likely than men to be hospitalized with an autoimmune disease. In fact, they were 50% more likely to suffer from any autoimmune disease within the same Th2-type grouping that Hashimoto’s belongs to.

Compared to the individuals with no ACEs, those with more than two ACEs were 80% more likely to be hospitalized because of a Th2-type autoimmune disease.

And with every extra ACE added to their score, participants were 20% more at risk of suffering from a Th2-type autoimmune disease.

Interestingly, the study also showed that the relationship between the ACE Score and autoimmune disease hospitalization was stronger among younger adults. In fact, those between the ages of 19 and 64 were twice as likely to be hospitalized as individuals over 65 years old.

What causes this relationship?

The reasons behind these findings is an interesting point of discussion. Around the same time the ACE Study was being done, parallel research was being performed on children’s brains and how they are affected by toxic stress.

Pediatric and neuroscientist researchers from Harvard, Rockefeller, and the Child Trauma Academy found that when children are overloaded with stress hormones, they have difficulties learning at school, trusting adults and developing healthy relationships with their peers.

To relieve their anxiety, depression, guilt, shame and other emotions, they easily turn to biochemical solutions, such as nicotine, alcohol, and drugs. They may find other ways to escape their problems, too, like engaging in high-risk sports, sex with various partners, over-achievement/work or overeating.

Research from that time also shows that childhood abuse changes the brain and brain waves. The brains of severely sexually abused women and maltreated children are actually smaller in certain areas.

The relationship between stress and autoimmune disease is still being researched, and larger studies are needed in this field. However, we do know that there is a connection between immune disorders, emotional disorders, and mental disorders. What we don’t understand yet, is why these connections occur, though some have further speculated that 80% of autoimmune disease patients are women because female individuals respond to stress differently than males because they produce more estrogen.

Dr. Hedberg’s Comments

During the research that compared autoimmune diseases and ACE Scores, only patients who were hospitalized were studied. This leads to the question: what about the individuals that didn't go to the hospital due to Hashimoto's or another autoimmune disease during that time?

From my experience, most patients visit their doctor at a clinic and aren't hospitalized by Hashimoto's, though some cases naturally result in hospitalization.

This was recognized by the authors of the study, who said of autoimmune diseases: "Autoimmune diseases were identified through hospitalizations and not outpatient data. Future studies may be strengthened through the use of clinical data because most autoimmune diseases are diagnosed through outpatient visits."

Next, we must consider those in the general population who never receive Hashimoto’s diagnosis. The American Association of Clinical Endocrinologists (AACE) estimated that in the United States approximately 13 million people, or 4.78% of the population, have undiagnosed thyroid dysfunction. If true, this would represent approximately half of those with the disease.

The study also omitted patients over the age of 65.

However, this study is very useful and the findings that relate to ACE Scores appear to be very accurate. The estimated prevalence of childhood exposures to adverse experiences that the study revealed were almost identical to those reported in surveys of the general population.

They found that 16% of the men and 25% of the women met the case definition for contact sexual abuse. A national telephone survey of adults in 1990 conducted by a group of researchers using similar criteria, estimated that 16% of men and 27% of women had been sexually abused.

When it comes to physical abuse, 28% of the men in our study had experienced this abuse as boys. This closely parallels the 31% of men who had lived through the same type of experience and were examined in a population-based study of Ontario men.

In conclusion, this study is a great start and uncovers some very interesting connections between Hashimoto’s and cumulative adverse childhood experiences. The next step, of course, is to look at how to heal from ACEs in order to lower the risk of experiencing autoimmune diseases like Hashimoto’s, as well as potentially prevent the worsening of their symptoms.

In this episode of The Dr. Hedberg Show, I interviewed Dr. Shannon South to discuss healing trauma and finding joy in our lives.   Dr. Shannon D. South, aka the “Joy Doctor”, is an award-winning therapist, an Amazon best-selling author, and a professional speaker. As an expert in the field of spirituality and healing trauma for over 20 years, she knows how to assist people in finding wholeness and joy naturally. In 1994, during graduate school, Shannon had a spiritual experience during meditation that healed her debilitating anxiety and depression permanently. Since this transformative experience, she has helped thousands of clients connect to their most loving and joy-filled selves. Shannon also leads workshops and retreats for counselors, chaplains and coaches on how to integrate Spirit and Soul into their practice. Her most upcoming book, Ignite! Turn off the Chaos and Turn on the Joy is a roadmap to this unique, healing process. Shannon loves dancing, being in nature, teaching spiritual psychology and enjoying the beautiful mountains of NC where she resides with her family and friends. She can be found at www.whatsyourjoyiq.com or www.drshannonsouth.com

We answered the following questions in the transcript below:

1) Why did you start working with trauma and studying integrative approaches to counseling? (i can share a blip of my personal story in healing from anxiety, depression, and PTSD)

2) What are some of the best approaches you see/use in healing trauma?

3)Why is it important to heal unresolved trauma for health? (mind-body healing, connection to how we relate to something vs. what the something is, etc.)

4) How do clients learn to get out of stress reactivity and into the relaxation response?

5) How does unresolved trauma impact health?

6) Tell us more about Mindfulness-Based Stress Reduction and the research on it for healing.

7) You also use spiritual psychology in your work with clients. How is this different than traditional therapy?

8) Does healing old trauma patterns create more creativity, joy, and peace?

9 Does unresolved trauma hurt relationships? If so, how?

10) Thoughts on anxiety, depression, compulsive behavior and PTSD and healing from these…. Ex. what is the mind really meant to be used for? (instead of obsession and over thinking)

11) What are some attitudes that are important in healing from trauma from a mindfulness perspective?

Podcast Transcript:

Dr. Hedberg: Well, welcome everyone to the Dr. Hedberg Show. This is Dr. Hedberg. And I'm excited today to have Dr. Shannon South on the show. We've known each other for quite a while now here in Asheville. And Dr. South, she's also known as the Joy Doctor and has a tremendous amount of information and expertise on trauma, healing trauma, and really overcoming things like anxiety and depression, and things like that. So, I want to really dig in today, and you should learn a lot from her. And we'll talk about things that if you're a patient of mine, you know, we talk a lot about. But, of course, these are things that are outside of my area of expertise and that's why I want to have around today so that we could really dig into that. So, Dr. South, welcome to the show.

Dr. South: Thank you. I'm honored to be here. I've been following your work for some time and watching your amazing healing and supporting of other people, so I'm thrilled to be a part of that.

Dr. Hedberg: Great. Before we jump in, why don't you just tell us a little bit about yourself and what you're focusing on these days?

Dr. South: Absolutely. I am a licensed professional counselor and an author, and I do trainings for therapists on bringing more soul and spirit into their practice. But I also have been working with trauma and spiritual psychology for over 20 years. And I, of course as you know, we get into the field sometimes because of our own personal journeys. And when I was in my 20s, I was diagnosed with an anxiety disorder, and depression, and post-traumatic stress disorder which is a big word, but it happens. And so, I got into some healing practices. I think actually my therapist told me, "Go meditate. Learn some meditation." And I was like, "Well, that sounds better than medication."

So, I thought I would give it a try because I had tried medication, you know, and it worked to a point. But I really didn't like the side effects, so I was pretty determined to get off the medication. And so, I got into meditation and had an amazing healing experience around my anxiety disorder, and I never had a panic attack again. So, that kind of informed my whole journey really, and I went back and got my doctorate in what they call transpersonal psychology which is a field of study that's more holistic and really integrates the mind, body, and the spirit for helping people heal through trauma and into more joy. So, that's a bit about me.

Dr. Hedberg: So, do you think that was the reason why you started working with trauma or were there other reasons as well?

Dr. South: Well, sure. I mean I definitely had a childhood with some trauma in it. And I believe that that, you know, kind of fed my heart. I thought, "Gosh, I really wanna help these people and I really wanna understand what's happening to my family members that are going through addiction, or depression, or anxiety. And then also, understand my own issues of healing through my own trauma. And so, I think between those two things, that really fuel the fire for me to have a deep, deep desire to share what really works with people. And really getting to the crux of healing because, you know, there are so many avenues and so many ways to look at healing. But I really landed on an integrative approach that is very effective and I'm very happy about that.

Dr. Hedberg: Mm-hmm. And you have a personal story in how you overcame anxiety, depression, and PTSD. Did you wanna share some of that?

Dr. South: Well, yeah. I shared a little bit about the meditation practice I began but I was actually sitting in my apartment. I'll never forget this day of sitting in my apartment, in front of my window meditating. And I was, you know, I was a reluctant meditator. I was really not, I was like, "This is so stupid, but I'll do it anyway." And I really was sitting one day, and I started to feel my panic symptoms reoccur. They were coming up, my chest was heavy, I was getting this heat flash, and I was feeling scared again. And all of a sudden, you know, I just cried out like, you know, something, "Help me, please. I'm doing all I know to do. You know, please help me."

And this kind of wave of joy, and peace, and love just overcame my being. It kinda filled up the cells of my body it felt like, and at that moment, I think shifted. You know, in the transpersonal psychology world we talk about consciousness. And I believe something shifted in my consciousness. Whatever I was attached to, the trauma, the story, the energy, the emotion, the whole experience of the trauma I've had before, something just removed and left for good. And so, when I got to study in transpersonal psychology, they call that a peak experience, and it's available to all of us, you know? We all have the potential for these peak experiences and our healing lining up in a way that we can have permanent release from suffering in certain patterns that we've had a long time even. So, it's a pretty neat thing to know that that's possible.

Dr. Hedberg: Great. And that's one of the real bedrocks of a lot of the patients I see. Trauma is really usually underlying a lot of their health issues. And I think a lot of people think of trauma as a single event, but it could also be just ongoing stress. So, some of the common things I'll see are, if I'll see women and they had a father who was just completely emotionally detached in their entire childhood, or a mother who was overly critical, you know, nothing was ever good enough. And there's, you know, many examples. But I think we could consider that trauma even though it's not a single event. So, let's get into that a little bit as far as what you think are some of the best approaches for healing trauma? What do you like to use?

Dr. South: Well, I think you're absolutely right. Carl Young called those repetitive patterns. He said they turn into complexes, you know, the psychiatrist, Carl Young. And we get complexes, trauma complexes because of certain repetitive patterns that happen to us. And so, we want to overcome and heal those. Because we grow and change, and we want our stories, and our emotions, and our attitudes, and our stress reactivity, we want that to heal and change depending on what's going on with us now. We don't want the past running the future. And it will unless we begin to be more conscious and really look at that. So, that's where I became passionate about mindfulness-based stress reduction, that's one of the approaches I use for trauma.

Because we define trauma as too much, too soon, too fast. It's like it either happened all too, you know like a whole buffet tray got thrown on your head at once and it takes time to unwind all of that or stuff like this chronic long-term thing as you mentioned, and it's just becomes too much of the same thing over and over. So, as we unwind trauma, mindfulness-based stress reduction is one of the approaches that I find to be extremely helpful. And then I use also several spiritual psychology techniques. And I'll also use an approach called EMDR which many people may have heard of which is known for trauma release in the system by bilateral stimulation. So, there are lots of ways but those are three very effective ways to approach trauma from a healing perspective.

Dr. Hedberg: Right, right. And that's something that, you know, to any of my patients who are listening, you know, we talk a lot about this and the connections to their current health issues.

A fair number of the patients I see are already eating a healthy diet but they’re still not feeling well. Once we delve deep into their history and their lives, it becomes very clear that stress is at the bedrock of their illness. It’s extremely frustrating to be eating well all the time but still experiencing symptoms.

We know that stress shuts down digestion including suppression of stomach acid, bile flow, and pancreatic function. All of these are necessary for healthy digestion but if we’re stressed while we are eating, that healthy food we’re putting into our bodies won’t get digested properly and it may have some more interesting effects on the body.

Stress also immediately changes the behavior of your gut bacteria which also influences how your food is digested and absorbed.

I decided to look deeper into this connection and I found a very interesting paper entitled, “Depression, Daily Stressors, and Inflammatory Responses to High-Fat Meals: When Stress Overrides Healthier Food Choices.” The paper was published in the journal Molecular Psychiatry in March of 2017.

Let’s dig in and break down what the researchers found. 58 healthy women with a mean age of 53 received either a high saturated fat meal or a high oleic sunflower oil meal. An inventory of stressful events was assessed prior to consuming the meal.

The researchers found as expected that women without any prior day stressors showed increased signs of inflammation after the high saturated fat meal but no increase in inflammation after the sunflower oil meal.

This is expected because too much saturated fat increases inflammation and monounsaturated oils that are high in oleic acid such as sunflower oil or olive oil do not increase inflammation when eaten in excess. In fact, olive oil has been shown in studies not to increase inflammation when eaten in excess and also it has been shown to decrease inflammation.

However, any of the women who had prior day stressors showed an increase in inflammation after eating the high saturated fat meal as well as the high sunflower oil meal. The results looked identical after eating both types of fat. This clearly showed that if you have been under stress, eating fats that don’t increase inflammation such as sunflower or olive oil will still increase inflammation.

They also found that the more daily stressors the subjects had leading up to the meals, the greater the levels of inflammation after the sunflower oil meal but not the saturated fat meal. So saturated fat had a cut-off effect when more stressors were accumulated.

Additionally, any of the women who had a history of major depressive disorder showed an abnormal increase in blood pressure after the high-fat meal of both types. The authors go on to discuss how this increase in inflammation promotes plaquing of the arteries and can lead to diabetes by increasing insulin resistance.

The authors also discuss the connection between a history of depression and how people respond to stressors. Those with any history of depression or PTSD show an amplified response to stressors compared to those without such history.

Previous studies have also shown that marital stress can lead to higher insulin and triglyceride levels post-meal.

What did they eat?

The subjects at eggs, turkey sausage, biscuits, and gravy which contained 60 grams of fat, 59 grams of carbohydrates, and 36 grams of protein. The authors point out that these types of numbers are similar to that of a Burger King Double Whopper with cheese or a Big Mac cheeseburger and medium French fries.

How was inflammation measured?

Blood testing included CRP(c-reactive protein), serum amyloid A, sICAM-1, and sVCAM-1. SICAM-1 and sVCAM-1 are specific indicators of increased damage to arteries thus potentially leading to atherosclerosis.

Dr. Hedberg’s Comments

It is interesting that more daily stressors did not increased inflammation above a certain point in those who ate the high saturated fat meal but inflammation did increase in those who ate the high sunflower oil meal. Saturated fat appears to have a limiting effect on inflammation to a certain point.

The first weakness of this study and the authors point this out, is that these meals contained refined flour without much fiber. Perhaps a healthier meal with added vegetables, more protein, and whole grains or fruit combined with the high fat would yield different results.

Additionally, 38 out of the 58 subjects were healthy breast cancer survivors. Cancer is an extremely traumatic diagnosis which can lead to significant stress while going through treatment. A healthier population may have been a better choice for study participants.

Despite the weaknesses, this study does do an excellent job of showing the negative effects of stress on what we eat. What I would take away from this is that we need to put all of our efforts into reducing stress, even more so than with food. Diet can become stressful and confusing by itself but when we add daily stressors to the mix our bodies won’t respond the way we would like.

One could also take away from this that we shouldn’t feel too guilty if we binge on junk food when we’re really stressed, because inflammation will still increase even if we are eating healthier foods. If you’re going to cheat, and we all do sometimes, you might as well eat what you want and not try to do “healthy cheating.”

I hope this is a reminder to focus on stress reduction techniques as much as possible so all your efforts to eat healthily don’t go to waste.

In this episode of The Dr. Hedberg Show, I interview Dr. Michael Ruscio and we discuss non-celiac gluten sensitivity, prebiotics, probiotics, the microbiome, SIBO, FODMAPs and much more.  You can read the transcript below.

Michael Ruscio is a doctor, clinical researcher and best-selling author whose practical ideas on healing chronic illness have made him an influential voice in functional and alternative medicine. His work has been published in peer-reviewed medical journals and he speaks at integrative medical conferences across the globe. Dr. Ruscio also runs an influential website and podcast at DrRuscio.com, in addition to his clinical practice located in northern California.

Dr. Hedberg: Okay. Well, welcome, everyone, to "The Dr. Hedberg Show." This is Dr. Hedberg. And I'm excited today to have a good friend and colleague on Dr. Michael Ruscio. We've known each other for quite a long time I think since I launched "The Infection Connection" back in around 2012, and Dr. Ruscio has a lot of expertise in the gut and the thyroid and autoimmune disease, so we'll be talking about some of that today. So, Dr. Ruscio, welcome to the show.

Dr. Ruscio: Hey, thanks, for having me on.

Dr. Hedberg: Great. Well, you and I have a lot in common in that most of what we do is driven by the literature and so why don't we jump in and talk about some of the latest work on non-celiac gluten sensitivity. Because gluten is really one of those... it's a big topic right now. A lot of people are avoiding gluten maybe unnecessarily. But why don't you talk a little bit about the latest research on non-celiac gluten sensitivity?

Dr. Ruscio: Sure. And you're actually right. It's an important issue because I'm sure that if... whether you're a clinician listening to this or a patient or just a healthcare consumer you've likely heard of gluten-free dieting. You've probably known someone who's gone gluten-free and reported that they felt better eating gluten-free. It's certainly something that can help people. I think where we have to be careful is when we try to tell everyone that they have to eat like they have celiac disease. And it's kind of this mistake of falling into extreme ways of thinking or dichotomous ways of thinking where it's either all or none, 100% avoidance or total, you know, unrestricted gluten in the diet. And for some people, that's absolutely true, for some people they have to be very diligent with gluten avoidance.

But, and I guess one could ask the question, "Well, if it's a potential problem, if gluten in the diet is a potential inflammatory or detrimental food then why not just avoid it?" Well, because that poses some psychological and psychosocial stressors on people. It can be difficult and I certainly see patients who come in afraid of food and it's causing an impairment of their social life because of it. And so these are serious things that do have documented influences on your health. Fear, stress and social connectivity or lack thereof have been documented to have truly profound impacts on various measures of health. So this is important to have a nuanced idea of what we should be recommending for gluten avoidance.

And there was a multicenter study performed in Italy, and a group of different physicians and gastroenterologists, essentially comprised a 60-point assessment for identifying and tracking those who had non-celiac gluten sensitivity and also correlating what other symptoms and conditions non-celiac gluten sensitivity was associated with. And just for the audience, you have celiac and then if you're not diagnosable as celiac but you still seem to have a negative reaction to gluten then you can be labeled non-celiac gluten sensitivity. And what they found was very interesting. They found that 0.3% of the population that was studied and rigorously evaluated trying to identify non-celiac gluten sensitivity, looking at symptoms, physical exam, lab testing. They found that 3% of the over 12,000 patients who are assessed, those were a large sample size, were reported to have non-celiac gluten sensitivity.

Now, people may say, "Well, in Italy, or in Europe, I've heard that there's less glycophosphate use and there's less actual gluten in some of the grains after processing. Doesn't this differ in the United States?" Well, on the same paper, they cite research showing that in the United States, the estimates of non-celiac gluten sensitivity have ranged from point six to zero point six. So I'm sorry from 0.6% to 6%. So even in the U.S, it's not something that seems to impact close to the majority but definitely some people. And so this is important because I'm not saying that non-celiac gluten sensitivity is some sort of fad. It's clearly an issue and something that people should do some self-experimentation to see what their relationship with gluten should be. Some of the other researchers now are using the term gluten-reduced diet and I think this may be a better aim for people who notice they have some reaction to gluten but they're not decimated by gluten.

Some people may notice they don't feel right for days after eating gluten. Other people may notice little to nothing in the way of symptoms. And so perhaps for those with mild symptoms they can practice a gluten-reduced diet. And one just final point here to piggyback on this, some people make the argument that gluten fuels this silent inflammatory process in the body with no symptomatic reaction potentially for weeks or years. And what was very interesting about this study, they found that over 90% of people who were found to have non-celiac gluten sensitivity had a discernible symptomatic reaction within 24 hours.

So that's actually very good news for us because it tells us that again the vast majority of people will have some type of symptomatic reaction after gluten reintroduction within 24 hours. Now, that reaction might be brain fog, it might be fatigue, it might be skin breakouts, it might be bloating. The types of symptoms can vary but any negative symptom that you see within 24 hours after gluten ingestion can tell you that you may have a problem with gluten. And if you don't experience that symptomatic reaction, the likelihood that you're doing damage to your body is fairly minimal.

Dr. Hedberg: You know, I'm really glad you brought that up about Europe. It's kind of an interesting thing that I've seen actually not just in practice but personally. A lot of patients will report that, you know, they go on vacation to Europe, and they eat gluten and they actually feel great the whole time. And I'm kinda the same way but it's hard to differentiate the fact that you're just so much more... you're so much better at digestion and just everything across the board is working better when you're on vacation.

Dr. Ruscio: Exactly.

Dr. Hedberg: You know, parasympathetic nervous system is just gonna be running along just fine.

Dr. Ruscio: Sure.

Dr. Hedberg: So I just have to wonder is it... is there a real difference in the gluten content or the type of wheat and... or is it just the fact that you're on vacation or is it a combination of both? What do you think on that?

Dr. Ruscio: I'm really glad you said because I've wondered that same question. And what I can say is this, is that there's a fair number of patients that come into my clinical practice, and when we have this discussion and they go and they reintroduce this gluten, there's a fair number of people, I would say the majority of people, notice that they can have some gluten and there's no sizable repercussion. Yes, there are...there is a small minority who had to be very careful, absolutely, but I think that it absolutely could be a byproduct of being on vacation and being less stressed. And I also think there's a degree of placebo here.

If people are expecting to have a negative reaction in the United States, and not in Europe, we know that for example in randomized control trials where we're trying to isolate out the effect of the placebo influence, trials and IBS show on average a 45% placebo effect even when we're trying to isolate out for it. So imagine if you're knowingly operating under some kind of external placebo effect, we can infer that the influence of the placebo might be as high as perhaps 80%. So yeah, I think all these things likely play a role but definitely being less stressed, being on vacation, and then maybe having that positive expectation of being able to eat gluten in Europe probably all congeal together to allow people to eat more grains, you know.

Dr. Hedberg: Right, because in the psychoneuroimmunology research it's just so clear that our beliefs can change how our immune system responds. And we can actually create and use an affiliate response to certain foods even though we don't have an actual clinical allergy to it, just if we believe it is strong enough.

Dr. Ruscio: Right.

Dr. Hedberg: You know.

Dr. Ruscio: And that's why I think it's so important that as clinicians and nutritionists and health care providers that we use caution in the surrounding language because I think up until now the narrative on gluten has been way overzealous and to integrate it with fear. And I think it's actually, you know, we've gotten to the point where we've made people aware of gluten as an issue but I think we have overshot the landing now and we're making people unnecessarily afraid of gluten. And I think we need to pull back a little bit and give people some more balanced recommendations here.

Dr. Hedberg: Right. And I hate to say this about my own profession but, you know, alternative medicine, functional medicine, it's really done a lot of harm to a lot of people by creating just unnecessary fear and anxiety about not just food but a lot of other things. And then you combine that with the internet and people are just bombarded not only from their practitioners but from the internet with, like you said,...

I was pleasantly surprised to learn about some recent research on the positive effects of black cumin seed oil and Hashimoto’s disease. I’m always searching for compounds that can help my patients with Hashimoto’s disease and black cumin seed oil looks like a real winner.  In this article I break down two promising studies on black cumin seed oil and how it can help autoimmune thyroiditis.

What is Black Cumin Seed?

Black cumin seed is also known as Nigella sativa which is a medicinal plant and the seeds have been used in traditional and folk medicine in the Middle East for centuries. Black cumin seeds are used mainly in Iranian, Pakistani and Northern Indian cuisines. Black cumin seeds contain compounds that have the following properties:

Anti-inflammatoryAntioxidantImmune balancingEnhanced blood sugar metabolism thus improving insulin resistanceAnti-cancerKidney protectiveDecreases pain (Analgesic)Liver protectiveBronchodilatorAntihistamineAntimicrobial against bacteria, viruses, parasites, and fungiBreaks down biofilms and prevents biofilm formationGastroprotectiveCholesterol-loweringCardioprotectiveHypoglycemicHypotensiveImproves memorySupports a healthy microbiomeReduces lung inflammation

Specific chronic diseases that black cumin seed has been shown to improve include:

Hashimoto’s thyroiditisType 1 and Type 2 DiabetesHigh cholesterolCoronary artery diseaseHigh blood pressureGastritisObesityPolycystic ovarian syndromeUrinary tract disordersAsthmaEncephalomyelitisNeurodegenerative disordersHair loss (alopecia)EczemaBronchitisRheumatismRheumatoid arthritisIndigestionLoss of appetiteDiarrheaMale infertilityPainConvulsionsDepressionAllergies

What did the latest research show on Hashimoto’s disease?

40 patients were split into two groups of 20 receiving black cumin seed and 20 receiving a placebo. 2 grams a day of black cumin seed powder was taken for 8 weeks.

What improved at the end of the 8 week study period in those who took black cumin seed?

Body Mass Index (BMI) improvedWaist circumference improvedHip circumference improvedTSH decreased indicating improved thyroid functionT3 increased which is the most active form of thyroid hormoneThyroid Peroxidase Antibodies (TPO) decreased

None of the above measurements improved in the placebo group who just took a starch pill. This clearly indicates the black cumin seed had a profound effect on weight loss, metabolism, thyroid function and improvement in the Hashimoto’s antibody thyroid peroxidase (TPO).

What is it that resulted in such excellent improvements?

Black cumin seeds contain a compound called thymoquinone that has all of these beneficial properties. Thymoquinone has been heavily studied and one of its mechanisms is suppression of the COX-2 enzyme resulting in reduced inflammation. COX-2 inhibitors like Celebrex are popular drugs for inflammatory conditions but black cumin seed has similar benefits without the side effects.

Thymoquinone also has also been shown in previous research to improve thyroid function. Not only has it been shown to increase T3 but it actually can repair thyroid tissue that has been damaged by your immune system.

Black cumin seeds also contain thymohydroquinone and thymol which also have many of the same benefits.

Is there more research on black cumin seed oil and Hashimoto's disease?

Another exciting paper was just published which looked specifically at black cumin seeds and their effect on lipids, glucose metabolism, and anthropometric variables including body weight and body mass index (BMI).

The authors start by discussing the connection between hypothyroidism and lipids such as cholesterol, triglycerides, and LDL. High cholesterol levels are a hallmark sign of hypothyroidism which is interesting because some patients are prescribed cholesterol-lowering medication without a proper thyroid evaluation. One of the signs of successfully managing hypothyroidism is observing the drop in cholesterol levels as thyroid function improves. Hypothyroidism also increases the risk of heart attack and stroke.

The authors also state that Hashimoto’s thyroiditis is a risk factor for developing type 2 diabetes and diabetes is a common condition associated with heart disease. In fact, up to 38% of patient with type 2 diabetes also have Hashimoto’s thyroiditis.

Interestingly, the authors also discuss some of the potential negative consequences of taking the thyroid medication levothyroxine sodium which includes bone loss, cardiac dysfunction, and left ventricular hypertrophy.

They then discuss all of the known benefits of black cumin seed oil.

How was the study done?

40 patients aged 20-50 with Hashimoto’s thyroiditis confirmed with elevated anti-thyroid peroxidase (TPOAb) antibodies and TSH, T4, and T3 were also measured. None of them had taken any supplements or followed any diets 3 months prior to the trial.

Patients in the intervention group took 2 grams of Nigella sativa powder per day and those in the placebo group took 2 grams of starches per day for 8 weeks. The black cumin seeds were milled in a grinder to make the powder. Both groups were instructed to take 1 gram with lunch and 1 gram with dinner each day.

What did they measure?

Bodyweight, BMI, waist circumference, and 3-days of food logged.

Physical activity was measured based on intensity to an average weekday.

Fasting blood tests were obtained at the beginning and end of the 8 weeks which included:

Total cholesterol

Fasting glucose

Triglycerides

HDL cholesterol

LDL cholesterol

Insulin

Nesfatin-1

Insulin resistance was measured using the homeostasis model assessment of insulin resistance (HOMA-IR) which is a calculation of glucose x insulin / 405.

What were the study results?

The weight and the BMI of those taking black cumin seed significantly reduced after 8 weeks compared to the placebo group which had no changes.

LDL and triglycerides significantly reduced in the study group.

HDL levels increased in the study group.

The atherogenic index improved in the study group which is a marker of heart disease risk.

TSH and anti-TPO concentrations decreased.

T3 levels increased slightly.

In the discussion, the authors provide information about the potential reasons for these positive outcomes. The effects on weight could be explained by the mechanism that black cumin seeds increase the feeling of fullness and satiety. Black cumin seeds also decrease the absorption of lipids which can lower cholesterol and triglyceride levels. Black cumin seeds have also been shown to decrease fat storage and the spread of fat cells as well as increasing the breakdown of fat.

We know from the first paper I cover in this article on black cumin seeds and Hashimoto’s thyroiditis that it is a powerful anti-inflammatory agent which explains the reduction in TPOAb levels and a reduction in inflammation can also help with weight loss and insulin sensitivity.

What did the authors conclude?

Black cumin seed oil improves lipids and reduces body weight in patients with Hashimoto’s thyroiditis. They recommend this supplement as an adjunct to thyroid medication for Hashimoto’s thyroiditis.

Do I have to supplement?

There are a variety of ways to add black cumin seeds to your diet. You can make tea by pouring hot water over 1 tablespoon of black cumin seeds and steep for 10 minutes. You can also add the seeds to salads, salad dressings, stir-fries, baked goods, casseroles etc. If you drink protein shakes simply add 1 tablespoon of black cumin seeds to your shake. If you just want to optimize your health, then you are probably fine just adding the seeds to your diet.

What is the best way to take black cumin seed?

You could grind up your own seeds every day to consume the equivalent of 2 grams a day in the above study but this can be inconvenient. Or you could take a highly concentrated cold-pressed organic black cumin seed oil in softgel form. I like the organic black cumin seed oil softgels from Moss Nutrition. Black cumin seed oil is better absorbed and most of the health benefits are due to the compound thymoquinone which is much more concentrated in the oil.

I wouldn’t recommend buying the oil in glass jars that are available because you don’t really know how much light exposure they have had which results in oxidation of the oil.

In addition to some extraordinary benefits for Hashimoto’s disease, it is clear that black cumin seeds have many additional health benefits that everyone can enjoy. My patients have reported rapid improvement in their symptoms when adding the black cumin seed oil softgels to their regimens. I look forward to reviewing more before and after blood tests for Hashimoto’s disease so we can view the improvements in real time.

This is one supplement you don’t want to overlook if you have Hashimoto’s disease!