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Hashimoto’s and Gluten

Gluten. It seems like everyone is talking about it. Books are lining shelves declaring the evils of this grain-based protein most of us have been eating for years. The grocery stores are full of “gluten-free” labels and gluten free bakeries are popping up in cities all across the country.

Gluten Free LogoWhy are we suddenly so aware of this protein? And what does it mean for people who have Hashimoto’s? Let me take you through some of the basics.

What is Gluten?

Gluten is a protein found in several different grains – wheat, barley, rye, spelt, kamut and triticale. It is a combination of two different proteins, gliadin and glutenin. Not all grains contain gluten and a gluten-free diet can still provide the essential nutrients found in these grains.

Autoimmunity

Hashimoto’s thyroiditis is an autoimmune condition where the immune system attacks and destroys the thyroid gland. It is, in essence, an immune condition with the thyroid being the unfortunate victim.

Autoimmune conditions are thought to develop when there are a combination of different factors. The three most commonly suggested factors are:

  • Genetic predisposition
  • A triggering event – this can be a nutrient deficiency, acute illness, chronic infection, dysbiosis, excess stress, food sensitivities or impaired detoxification
  • Increased intestinal hyperpermeability or “leaky gut”

The increased intestinal hyperpermeability, or “leaky gut” is where gluten becomes a major issue.

Leaky Gut

Keep outThe cells that line our digestive tract are joined at tight junctions – these close connections allow only the smallest particles of digested food to present to our immune system. Certain foods, like gluten, are more difficult for our enzymes to completely digest. These partially digested proteins, called peptides, can cause inflammation at the lining of the digestive tract, leading to damage of the tight junctions. When these tight junctions are compromised they become more permeable, or leaky, allowing larger molecules (peptides) to present to our immune system.

Once the immune system has been exposed to these large peptide molecules it may begin to produce antibodies against the peptides – an attempt to protect us from this foreign molecule.

The issue of autoimmunity, especially Hashimoto’s thyroiditis, occurs when the immune antibodies begin to circulate through our body, searching for the sequence of amino acids that make up the gluten peptide. The surface of the thyroid gland is made up of fats and proteins – and unfortunately the amino acid sequence of proteins on the surface of the thyroid is the same as the gliadin peptide in gluten. This results in the immune system destroying the thyroid gland, mistaking it for the component of gluten that triggered the response in the digestive tract.

Gluten and Food Sensitivities

wheat is a common food allergenIn my practice I recommend that all people diagnosed with Hashimoto’s thyroiditis eliminate gluten from their diet. However, leaky gut can be caused by, or lead to many other food sensitivities which can also have the same devastating effect on the thyroid gland, and other tissues in the body.

Every person with an autoimmune condition, including Hashimoto’s should seriously consider having an IgG based food sensitivity panel done to identify their own sensitivities. Understanding the action of your immune system in your body is imperative to decreasing the overactivity of the immune system and preventing further damage to your body.

For more information on Naturopathic Medicine and Hashimoto’s Thyroiditis, please read the other articles on this website written by Dr. Lisa Watson, ND: Understanding Hashimoto’s, Hashimoto’s and Fertility, Naturopathic Treatments for Hashimoto’s. If you are ready to start on your path to healing your Hashimoto’s you can book an appointment with Dr. Lisa by following the links here.

Disclaimer

The advice provided in this article is for informational purposes only. It is meant to augment and not replace consultation with a licensed health care provider. Consultation with a Naturopathic Doctor or other primary care provider is recommended for anyone suffering from a health problem.

Select references

Carrocio A, D’Alcam A, Cavataio F, et al. Gastroenterology. High Proportions of People With Nonceliac Wheat Sensitivity Have Autoimmune Disease or Antinuclear Antibodies.2015 Sep;149(3):596-603.e1.

Fasano A, Shea-Donohue T. Mechanisms of Disease: the role of intestinal barrier function in the pathogenesis of gastrointestinal autoimmune diseases. Nature Clinical Practices. 2005 Sep:2(9):416-422.

 

Food Sensitivity Testing

Food sensitivity testing is one of the tools Naturopathic Doctors use to assess health in our patients.  In Naturopathic Medicine our goal is to find the cause of symptoms of illness and disease.  In a previous article, Understanding Food Sensitivities, I discussed what food sensitivities are and the importance of testing. In this article we will look at the options for food sensitivity testing.

Testing for Food Sensitivities

There are several methods of testing for food sensitivities.

  1. Elimination Diet

wheat is a common food allergenMost people attempt a food elimination diet as an initial way of self-diagnosing food sensitivities.  A hypoallergenic, anti-inflammatory diet is consumed for a set period of time (usually 6-12 weeks).  All the most common allergenic foods are eliminated and the patient self-monitors for improvements in symptoms.  Foods are re-introduced one at a time after the initial period of restriction.  If symptoms arise on reintroducing the food then a food sensitivity is suspected.

Advantages: Promotes a general sense of well-being, high level of patient involvement in their health.

Disadvantages: Does not eliminate all potential sources of sensitizing foods.  Requires compliance with a restricted diet for a period of time.  Can be expensive (the cost of egg-free, gluten-free, dairy-free, organic food adds up quickly).

  1.    Electrodermal Food Allergy Testing

A machine is held by the patient and the electrical frequencies of food are tested against the body’s reaction to those foods (the brain interprets the electrical signal and elicits a skin resistance response which is read by the machine).

Advantages: Painless.  Children can be tested easily.   A clear outline of food sensitivities and the severity of sensitivities is given.  Foods do not have to have been consumed recently for valid results (although accuracy is increased if they have been consumed recently or are consumed frequently).

Disadvantages: Moderately expensive.  Some practitioners do not accept the validity of the testing method.  Test accuracy relies on technician proficiency.

  1. IgG Food Sensitivity Testing

A blood test is analyzed by a specialized laboratory to assess for IgG (immunoglobulin G – one of two antibodies produced during an sensitivity response). IgG antibodies are produced for several hours or days after exposure to an allergen (which is one of the reasons why some symptoms of food sensitivity don’t occur immediately after eating a food).

Advantages: Gives a clear outline of food sensitivities and the severity of the sensitivity.  Tests for a wide variety of commonly consumed foods (from 120 to 300 foods).  Only a small amount of blood is required for the test and it can be done in office or at home.  Antihistamine use is permitted during the test.

Disadvantages: Can be expensive.  Food must be consumed within 3 weeks prior to the test for an accurate reading.  Immunosuppressant drugs (prednisone, chloroquine and azothioprine) must not be used during the testing.

In my Toronto clinic I most commonly use the IgG food sensitivity blood test to assess for food sensitivities.  Clinically I have found this test to accurately identify sensitivities and result a corresponding improvement in patient symptoms. I support my patient’s ability to choose whatever testing they find to be ideal and can support that decision making process and help to develop a treatment plan, whatever the testing method selected.

Why is this testing different than that provided by my MD or allergist?

milk is a common food allergyMost severe, immediate allergy symptoms are a result of IgE (immunoglobulin E) – responsible for Type I hypersensitivity reactions in which a food antigen attaches to an IgE antibody and results in an immediate, and potentially life-threatening, hypersensitivity reaction.  Because of this many MDs have limited their testing to this class of immunoglobulins.

There is considerable evidence for IgE testing, but there is also abundant evidence that IgG(immunoglobulin G) is an important marker for food sensitivity testing.  IgG and IgG-complexes are involved in 80% of all food allergy or sensitivity reactions.  IgG is involved in delayed immune responses which are more common in food intolerance.

How can I learn more about food allergy testing?

At my Toronto clinics, I offer Rocky Mountain Analytical’s IgG Food Allergy test.  They offer more information here.  You can also book a complimentary 15 minute consult with me to discuss whether or not food sensitivity testing can help you achieve your goals for a vibrant, healthy life.

Disclaimer

The advice provided in this article is for informational purposes only.  It is meant to augment and not replace consultation with a licensed health care provider.  Consultation with a Naturopathic Doctor or other primary care provider is recommended for anyone suffering from a health problem.

 

Naturopathic Treatment of Eosinophilic Esophagitis

What is Eosinophilic Esophagitis?

Eosinophilic esophagitis (EOE) is inflammation of the esophagus that results in difficulty swallowing food.  The inflammation occurs when eosinophils, a type of white blood cell, increase in numbers in the esophagus.  This influx of eosinophils stiffens the esophagus making it difficult to swallow foods.  Eosinophilic esophagitis can happen in children and adults.

What causes Eosinophilic Esophagitis?

Eosinophilic esophagitis is caused by an allergy, typically to a food (or possibly an inhaled allergen).  When an allergenic food is consumed the immune system produces high numbers of eosinophils which accumulate in the tissue just beneath the lining of the esophagus.

Symptoms of Eosinophilic Esophagitis

The main symptom is difficulty swallowing food.  People with EOE describe a sensation of food becoming stuck in the esophagus.  Some people also experience heartburn and chest pain.  Children can also experience nausea, vomiting, coughing and abdominal pain.

The difficulty swallowing occurs when the high number of eosinophils stiffen the esophagus and prevent it from stretching appropriately to allow food to pass.  Certain foods are more likely to cause difficult swallowing, especially meats and breads.

Diagnosis of Eosinophilic EsophagitisEosinophilic esophagitis

If you have difficulty swallowing your doctor will refer you for an endoscopy in order to take a look at your esophagus.  During the endoscopy a biopsy will be taken to confirm the presence of eosinophils in the tissue of the esophagus.

The incidence of EOE is increasing in North America.  This may be due to a general increase in allergic conditions, or increased awareness and diagnosis of EOE.

Mainstream Treatment of Eosinophilic Esophagitis

The mainstream treatments of eosinophil esophagitis include esophageal dilation (using a tube to gently stretch the esophagus to allow the passage of food), inhaled corticosteroids (i.e. Flovent) and proton pump inhibitors.  None of these treatments are without potential side effects and possible negative impacts on overall health.  This is why many people are exploring Naturopathic Medicine for the management of EOE.

Naturopathic Treatment of Eosinophilic Esophagitis

Treatment with Naturopathic Medicine is individualized for each patient.  However, there are some common treatment goals which are applied in most cases of eosinophilic esophagitis.

Eosinophilic esophagitis

1.  Identify food allergies and sensitivities

Only by identifying and eliminating the cause of disease can we expect to overcome the symptoms of disease.  The cause of eosinophilic esophagitis is allergy – in most cases to an ingested food.  In addition to skin prick allergy testing done with an allergist, Naturopathic Doctors will also perform a food sensitivity test which looks for a different type of immunoglobulin (IgG) that can also result in accumulation of eosinophils in the esophagus.

 While IgG based food sensitivities are not “allergies” per se, they still result in activation of the immune system that can lead to the symptoms of EOE.  The food sensitivity panel allows you to identify the most likely food sensitivities that can be contributing to your symptoms and eliminate them from your diet.  For more information read the article on Identifying Food Sensitivities.

2. Normalize function of the immune system

Allergies result from an over-activation of the immune system.  By modulating your immune system – decreasing over-production of eosinophils without compromising your body’s ability to fight off viruses, bacteria and other pathogens, you can decrease symptoms of eosinophilic esophagitis without the negative side effects seen with pharmaceutical treatments.

The approach to normalizing the function of the immune system is different for every individual.  Your Naturopathic Doctor will take a complete history and look at all the different systems of your body to determine the best treatment options for you.

3.    Decrease inflammation in the esophagus

The inflammation of the esophagus due to the presence of eosinophils results in the difficulty swallowing seen in EOE.  While you are identifying the underlying allergies and normalizing function of your immune system, your Naturopathic Doctor can help to decrease inflammation in the esophagus and improve symptoms.  Natural supplements like omega-3 rich fish oil, slippery elm powder, marshmallow root and curcumin (turmeric) are all well-tolerated anti-inflammatories which may be used short term (or long term) to support the esophagus and allow you to be symptom free sooner.

Naturopathic Medicine can help you overcome your eosinophilic esophagitis.  Book an appointment now with a Naturopathic Doctor experienced in the treatment of EOE and start the journey towards optimal health.

Disclaimer

The advice provided in this article is for informational purposes only.  It is meant to augment and not replace consultation with a licensed health care provider.  Consultation with a Naturopathic Doctor or other primary care provider is recommended for anyone suffering from a health problem.

Gallstones: Diet and Supplements

I’ve said it before, and I’ll say it again – every pregnancy is different.  And so too is the post-natal period, or months following the delivery of your baby.  My son was born at the end of September and in the weeks since then I’ve developed a troubling new symptom – biliary colic or “gallstone attacks”.

What is the gallbladder?

The gallbladder is a small pear-shaped organ that sits next to the liver.  It’s main function is to store and concentrate the bile that is produced in the liver.  When fat is consumed in the diet the gallbladder contracts to release bile back into the digestive tract for fat digestion.

What are gallstones?

Gallstones are accumulations of crystals that join together to form stones.  The stones can be composed of cholesterol (the most common), calcium salts, bilirubin or other bile pigments.  They can vary in size from very small (grains of sand or gravel) to as large as a golf ball.  A person can have gallstones and never know they are there.  Other people develop symptoms known as biliary colic or cholecystitis (inflammation of the gallbladder).

Gallstones are more common in women, people who are overweight, over 40 years of age, during pregnancy, after sudden weight loss or in people who consume a high-fat, high-sugar, low-fiber diet.

What are the symptoms of biliary colic or cholecystitis?

The symptoms of gallstone attacks vary but typically include some or all of the following:

  • Abdominal pain (often right sided)
  • Back pain or shoulder pain (often right sided)
  • Nausea and vomiting
  • Pain that begins after consuming a fatty meal
  • Pain that gets steadily worse
  • Pain lasting from 30 minutes to several hours
  • No symptoms between attacks
  • Fever (can indicate serious blockage – see a doctor immediately)

The best way to determine if you do have gallstones is with an abdominal ultrasound.

What is the recommended diet for people with gallstones?

Certain foods are better tolerated by people with gallstones.  In general a low-fat, high vegetable and fruit diet is the best for managing symptoms of gallstones.  A vegetarian diet is associated with a low incidence of gallstones.

Foods that are recommended for people with gallstones:

  • Beets (very good for supporting the liver and gallbladder)
  • Cucumber
  • Green beans
  • Sweet potatoes
  • Avocado
  • Artichoke
  • Tomatoes and tomato sauce
  • Okra
  • Cold water fish (salmon, trout, herring, mackerel) and fish oils
  • Grapes and organic grape juice
  • Apples and organic apple juice
  • Apricots
  • Blue and blackberries
  • Currants
  • Figs
  • Guava
  • Lemons
  • Pears
  • Papaya
  • Prunes
  • Coconut
  • Flax seed oil
  • Vinegar
  • Vegetable juices
  • Garlic
  • Ginger
  • Turmeric
  • Onions (may aggravate sensitive individuals)
  • WATER – incredibly important.  Drink 2 liters per day.
  • Peppermint tea
  • Herbal teas

Foods that should be avoided:

  • Deep fried foods
  • Eggs (cause symptoms in up to 95% of patients)
  • Pork
  • Turkey
  • Chicken
  • Beef
  • Nuts
  • Legumes
  • Dairy (milk, butter, cheese, cream, ice cream)
  • Gluten grains (wheat, barley, spelt, rye, kamut)
  • Corn
  • Coffee (can decrease the risk of developing gallstones, but can aggravate existing gallstones)
  • Black tea
  • Oranges, grapefruit
  • Margarine
  • Chocolate
  • Alcohol
  • Cabbage
  • Cauliflower
  • Carbonated beverages
  • Food allergens

In addition to avoiding these foods you should also avoid large meals, especially late in the evening.  Eat several smaller meals throughout the day and focus on consuming greater amounts of fruit and vegetables.  Once you are symptom free and ready to re-introduce dairy and meat products, select low fat options.

While weight loss is often desirable for people with gallstones it is important not to lose weight too quickly – this can lead to a gallbladder crisis.  Instead focus on slow, steady weight loss and regular aerobic exercise (which also supports gallbladder health).

Are there naturopathic treatments for gallstones?

Yes.  In addition to a healthy diet there are several supplements that can support the function of the gallbladder and decrease symptoms of gallstones.

Omega 3 fish oils – Fish oils reduce the formation of gallstones by enhancing bile flow and blocking cholesterol formation in the bile.  A combined EPA-DHA fish oil supplement should be taken by anyone with gallstones, or risk factors for the development of gallstones.

Increase dietary fiber – Diets high in water-soluble fiber (from fruits, vegetables, oat bran and guar gum) decrease cholesterol levels – a primary goal of gallstone treatment.  A good source of fiber is to mix 1 tablespoon of ground flaxseed into one serving (8oz or ½ cup) of organic applesauce and consume daily.

Vitamin C – Low levels are associated with the development of gallstones.

Lecithin – a phospholipid that reduces the saturation of cholesterol in bile that leads to stone formation.  Oral supplementation results in higher concentrations of lecithin in the bile.  This results in improved bile flow.

Enteric-coated peppermint oil – peppermint has been shown to have ‘anti-lithic’ activities.  It may be able to breakup small stones, but is unlikely to dissolve large stones.  Peppermint also has anti-spasmodic effects and can help manage the pain of gallstone attacks.  Non-enteric-coated forms can cause heartburn and should be avoided.

Other botanicals with liver and gallbladder specific actions can be used in some individuals.  These include dandelion root, milk thistle, artichoke, curcumin, celandine, wild yam, blackroot, boldo, and others.

Another popular natural remedy for gallstones is the “Olive Oil Flush”.  Stories abound of individuals passing large gallstones after following this protocol.  Studies examining these ‘stones’ have demonstrated them to be saponified olive oil and not gallstones.  Olive oil flushes are NOT recommended for individuals with gallstones as they can lead to a complete blockage of the bile ducts and result in the need for surgery.

As with any serious health concern, it is recommended that you contact a qualified Naturopathic Doctor who can individualize your plan to meet your specific needs.

Disclaimer

The advice provided in this article is for informational purposes only.  It is meant to augment and not replace consultation with a licensed health care provider.  Consultation with a Naturopathic Doctor or other primary care provider is recommended for anyone suffering from a health problem.

Ten Tips to Treat Allergies

Spring has sprung!  And with it comes… allergies.  The sniffling, sneezing, burning and redness can put a damper on this beautiful time of year.  But there is hope.  Here are ten tips to try this allergy season.

1. An Apple a Day…

The oldest medical cliché in the book – but it’s true.  A study of 1500 people found that eating apples lowers the incidence of allergy and asthma symptoms.

2. Eat Citrus Fruits Daily

Eating citrus regularly can decrease the symptoms of allergies and asthma.  This is likely due to the vitamin C and bioflavonoids that are abundant in citrus fruit.  Eat at least one citrus fruit daily – organic lemons, limes, oranges, tangerines, clementines, kumquats and grapefruits are good choices.

3. Eat Lots of Berries

Berries truly are a ‘superfruit.’  They are rich in vitamin C, bioflavonoids, anthocyandins and antioxidants.  A high intake of antioxidants has been shown to have a positive impact on allergy symptoms.  Eat one handful of blueberries, blackberries or raspberries daily to get the benefit from these sweet superfoods.

4. Determine Food Allergies and Avoid Them

Food allergies and sensitivities can cause a lot more than just digestive symptoms.  Consider having a food allergy test to determine your individual food reactions.  Or try the elimination diet with your Naturopathic Doctor to see how food allergies and sensitivities are impacting your allergies.

5. Eliminate Margarine From Your Diet

Margarine is high in poly-unsaturated omega-6 fatty acids which can result in inflammation in the body (the symptoms of allergy – runny nose, itchy red eyes – are due to inflammation of mucous membranes).

Adults and children with allergies should remove all margarine from their diet.  A 2003 study found that eating margarine led to more symptoms of wheezing and runny nose (allergic rhinitis) in children with allergies.

6. Try the Anti-Inflammatory Diet

There are foods that we eat that can decrease inflammation and there are other foods that can promote inflammation in our bodies.  The Anti-Inflammatory diet can teach you how to boost anti-inflammatory foods (like flax seed oil, citrus fruits and various vegetables) and decrease pro-inflammatory foods (like margarine, dairy products and red meat).

7. Increase Essential Fatty Acids

Essential fatty acids are the heavy-hitters of the natural anti-inflammatory world.  Omega 3 fatty acids found in flaxseed and cold water fish are the most effective in the treatment of allergy symptoms.  Increasing omega 3 fatty acids in your diet (or through use of supplements) results in decreased production of inflammatory chemicals and fewer allergy symptoms.

8. Quercetin

Quercetin is a bioflavonoid that is found in a wide variety of foods (including apples, citrus fruits, onions and buckwheat).  It is nature’s anti-histamine, reducing the release of histamine from mast cells.  It should be taken preventatively – year-round for chronic allergies and seasonally for seasonal allergies.

9. Stinging Nettles (Urtica dioica)

This local medicinal plant has a long history of use in the treatment of allergies.  It has been rigorously studied and has been shown to be as effective, or more effective, than popular allergy medications.  It is available as a tea or in freeze-dried extracts.  It should be taken daily throughout allergy season.

10. Acupuncture

Acupuncture can be a useful addition to the management of chronic or seasonal allergies.  Between 6-10 sessions are needed to tonify the detoxification systems of the body and balance the organ systems (skin, liver, kidneys, and adrenals) that are commonly involved in allergy symptoms.

Book an appointment with your Naturopathic Doctor now to customize your comprehensive plan for the upcoming allergy season.  It may turn out to be your best season yet!

Disclaimer

The advice provided in this article is for informational purposes only.  It is meant to augment and not replace consultation with a licensed health care provider.  Consultation with a Naturopathic Doctor or other primary care provider is recommended for anyone suffering from a health problem.