Address Hashimoto’s and other autoimmune disorders with supplementation

When a patient has an autoimmune disease, it means the immune system isn’t functioning perfectly. What it decides to attack, we’re never quite sure we understand in medicine. Like why the thyroid? Why the joints? 

Regardless of the target, we have cytotoxic T cells and antibody-producing B cells, and they’re designed to fight invaders. Then we have regulatory T cells that create balance. When the first two cell types get out of whack and the third doesn’t create that balance, now we have what we call an autoimmune response.

The way I describe it to patients is if we’re on a playground, the kids playing there are protective of their playground. When a kid comes in to cause trouble, the immune system, or the kids already on the playground, fight and kick out the bad guy. That’s how it’s regulated. 

To expand this metaphor, let’s say there is no bad guy for the kids to unite against, so they get bored and pick out someone already on the playground to bully. That’s how the human immune system acts toward our organ systems in cases of autoimmune disease. 

Fight symptoms or the disease?

A lot of times in allopathic medicine, we either do nothing, or we don’t treat the right thing. To go back to our metaphor, sometimes we’re dealing with the kid getting bullied, but it’s not their fault; we should be addressing the immune system, the bully. We’re either not getting to the root cause, or we address the immune system in such a way that we become immunosuppressed. Now we have no kids to protect the playground. 

So when we look at autoimmune disease from a holistic, natural perspective, we look at why the immune system is not behaving properly. We know there is an enormous connection between the gut and the immune system as well as stress and the immune system. So take a multi-pronged approach: 

Start with the gut

When you look at all the supplements that could potentially be used to help support the immune system, it could easily be a long laundry list of things to throw at a patient. What if we really dove into what the gut is actually doing, instead of pulling that probiotic the rep sold us off the shelf without really looking to see what particular strains are in it? If we’re actually testing patients’ stool first, we can pick appropriate, condition-specific probiotics. As you choose, consider:

Do you need to eliminate anything in the gut? Like bad bacteria, yeast and other fungus, parasites and viruses? 

Is there inflammation? At least seven inflammatory markers could be elevated within the gut and should be tested, including faecal calprotectin (FC), one of the most reliable markers. When any of the seven are elevated, that inflammation has to come down too, because most illnesses are at least partially the result of a poor immune system and chronic inflammation. 

Balance the gut. I rely on curcumin, resveratrol, quercetin and N-Acetyl- glucosamine for this. Use them together or pick your favorites. 

Think about absorption. How well is the patient able to absorb and digest food? If they can’t break down fats, proteins or carbohydrates, they’re going to have trouble absorbing these macronutrients in food and the additional nutrients in supplements.  This may create a need to take them as a liquid or sublingually for easier absorption , or with digestive enzymes to help break them down. 

Get patient feedback on supplements. The immune system contains two different types of T cells, TH1 and TH2 helper cells, and about 80% of us are TH1 dominant. The other 20% are TH2 dominant, and there are certain supplements TH2-dominant people just don’t feel well on; they almost exacerbate symptoms. So if a patient takes something you prescribe and tells you they feel worse, trust that feeling, pull them off it and try something else.

Check for leaky gut. When the tiny milia supporting the normally tight border of the intestines start to break down, we get leakage of what I call toxic material, waste from food we didn’t need, into the bloodstream, causing chronic inflammation and a variety of symptoms like headaches, brain fog, joint pain and fatigue, which are also common with autoimmune disease. (Are you wondering if those symptoms are from the actual autoimmune disease or from the intestinal permeability?) 

Glutamine is wonderful for leaky gut. As an amino acid, it helps heal the intestinal lining. A combination of licorice, ginger, chamomile, aloe and slippery elm also supports healing and soothing.

Look for food sensitivities, such as those to gluten and gliadin. There’s an enormous correlation between food sensitivities and that flaring immune response. Gluten and gliadin are common culprits, but it could be other foods causing a sensitivity, which is very different from an allergy. An allergy is when you get a response from a food on an IgE pathway and the reaction is from right away to within about four hours. A sensitivity is when a food can react within up to 72 hours on an IgG, IgM, IgA or cell-mediated pathway. While not always as dramatic as allergies, sensitivities can cause inflammation throughout the digestive system, and any inflammatory process leads us down that path of autoimmune flaring, or at least not healing. 

Top 3 supplements for autoimmunity

No matter what autoimmune disease the patient has, my hands-down top three supplements are the same: 

Vitamin D, which we see very low in most patients. The optimal level is somewhere between 60 and 80 ng/mL; I like to see closer to 80. 

Glutathione, one of the best antioxidants. Glutathione helps support mitochondrial function, which in turn boosts immunity. Cysteine, glycine and glutamate are precursors for glutathione. Because it’s often hard to absorb glutathione, we can utilize those precursors. N-acetyl-cysteine is a precursor for conversion to glutathione and the acetyl component helps increase absorbability.

Bovine colostrum. The first few days a baby is nursed transfers that colostrum factor into our kids, which helps support the immunity we start life with. Even as adults, we benefit from supplementing that. 

The stress effect

We should measure patients’ cortisol, too. Cortisol should increase about 50% within 30 to 45 minutes of waking; it is your internal alarm clock. People who get up at the same time every day bounce out of bed, ready to go. That’s adequate cortisol response. But a lot of us are dragging when we awaken, hitting the snooze button 100 times and then when we do get up, we’re not feeling so well for a few hours. That’s a sign of burnout. 

A cortisol level under 50% is really low, but I’ve seen patients whose cortisol dips into the negative when they wake up, or it’s off-the-charts high. That’s the immune system waving a white flag before you even start your day.  

Cortisol should be high in the morning and drop drastically around noon, then continue to drop toward bedtime. If you experience major stress during the day, it results in a cortisol spike that quickly drops. This response happens the same way whether stress is good or bad. The body doesn’t differentiate, so when we’re under prolonged, excessive stress or we’re not eating well, sleeping enough, etc., then cortisol goes up, stays up ― and impairs immune function. 

To keep the cortisol-producing adrenal glands under control, we need protein at every meal, appropriate levels of exercise, and a reduction or elimination of caffeine and alcohol. Adaptogenic supplements like ashwagandha, Holy Basil, Rashi mushrooms and skull cap can have a real balancing effect. 

When our stress response is appropriate, the gut is healthy, there’s no inflammation and we’re eating the right foods, we don’t get that flare-up of autoimmune response. 

Help for Hashimoto’s

Hashimoto’s disease is commonly missed. A lot of patients go in and see their MD, their endocrinologist or other specialist and they run a thyroid-stimulating hormone (TSH) test and maybe thyroxine (T4) test, but they’re not working up the entire thyroid. Important tests include T3 free, T3 total, T4 free, T4 total, T3 uptake, reverse T3, TPO antibodies and thyroglobulin antibodies in addition to the TSH. 

When we see an elevation of the thyroglobulin antibody or the thyroid peroxidase (TPO) antibody, we know the immune system is attacking the thyroid gland. In our world of supplementation, if we can get that antibody response to calm down, and we can, a lot of these patients’ thyroid symptoms go away because that’s the underlying driver. Treating just the thyroid with medication usually leads to a fluctuation of hormone levels, resulting in dosage adjustments and the patient still feeling badly since it isn’t addressing that underlying driver. So blame the immune system and not the organ. 

Final thoughts

Autoimmune diseases like Hashimoto’s can be frustrating to treat, but addressing the immune system itself, rather than the body system under attack, has yielded real relief for many of my patients. By starting with the gut, you can methodically correct imbalances that contribute to immune dysfunction and offer patients much more control over their autoimmune condition. 

CINDY M. HOWARD, DC, DABCI, DACBN, FIAMA, FICC, is a board certified chiropractic internist and nutritionist specializing in finding the root cause to symptoms and disease. She earned her doctorate in chiropractic from National University of Health Sciences and is in private practice in Orland Park, Ill., where she focuses on individualized care. For more information, visit innovativehwc.com.