Since I started working as a Health Coach and Nutritionist here in Baja I have come across an increasing number of people, who either have been diagnosed with hypothyroidism or suspect that they are dealing with this issue. This prompted me to dive deep in to research on the subject and ultimately write this article. I apologize, if this text is a little bit too “sciency” in part, however I would like readers to understand the basic functions and connections between gut, gallbladder, liver and thyroid so you can perhaps make an informed decision for yourself or at least know where to continue with your own research.

There is a surprisingly large subset of people, who do not have hypothyroidism, but have been told that they have, because they have a few symptoms. This often happens because the appropriate cross referencing with lab work has not been done.

These symptoms are commonly attributed to Hypothyroid Issues:

1. Tiredness, Fatigue

2. Dry Skin

3. Brain fog

4. Weight gain

5. Constipation

It is important to consider:

Gastrointestinal (GI) problems such as irritable bowel syndrome (IBS, IBD, SIBO) are 45 times more common then hypothyroidism.

Many of the non-specific symptoms attributed to poor thyroid function can be caused by gastrointestinal disturbances (e.g., fatigue, depression, constipation).

There is a growing body of evidence substantiating that corresponding GI treatments can resolve these symptoms. This helps us appreciate that your gut health is more likely dysfunctional then your thyroid. However in both traditional and natural medicine there is still a strong focus on Thyroid and not enough on gut health.

A recent Meta Analysis has shown that 37% of patients on thyroid replacement hormones were actually able stop their treatment and they were fine even after a 5 year follow up. Similar data published suggests that up to 61% of those with hypothyroid diagnosis can successfully discontinue medication. This suggests that a notable portion of those diagnosed as hypothyroid may have been prematurely placed on thyroid replacement based on an incorrect diagnosis. The reason aside from symptoms may be that elevations of TSH (thyroid stimulating hormone) can be transitory in nature and do not necessarily reflect a long-term state of hypothyroidism.

Another reason behind this could be fluctuations in the conversion from T4 to T3 hormone. T4 is not the active form of thyroid hormone. It has to be converted to T3. The thyroid gland only partially does this job, however 80% of the T4 gets converted to T3 by the liver and kidneys. If the liver is overwhelmed by filtering out junk (from bad nutrition, reduced or thickened bile or gall bladder stones, alcohol, etc.) the rate of conversion may be reduced. The thyroid gland is then not getting the raw material it needs in order to release sufficient thyroid hormone when stimulated to do so by TSH.

You may want to check TSH and both T4 and T3 levels with your doctor regularly in case Hypothyroid is suspected or has been diagnosed. More so, if you are being treated for hypothyroid, but your symptoms have not improved much.

Instead of going down the hypothyroid lane right away, it may be prudent to first address any digestive issues and see if symptoms resolve.

And if you are already taking thyroid hormone medication better gut health may help with absorption of said medication so you may be able to reduce the medication on the long run.

Several studies have shown that after treating digestive tract issues like SIBO, IBS or H-Pylory infections (a bacterium that specifically infects the stomach) TSH levels have decreased alongside other symptoms like fatigue and depression. For others improving bile flow and addressing liver health have normalized hormone production.

Helpful dietary and lifestyle interventions for repairing your gut health can be elimination diets (low FODMAP, Autoimmune PALEO), probiotics, digestive enzymes and herbal supplements. Those interventions will take a few months; however is that not preferable to lifelong medication?

One of the main issues why you might fail over and over again, when it comes to diets and weight loss are those unsupportable cravings. You may crave sugary foods, or maybe you want something salty all the time. Cravings always get the better of you in the evening, at night or perhaps throughout the day.

It is important to understand that it is NOT because you lack discipline, because you cannot control los cravings. In other words, cravings are not your fault and you are not weak! In many cases the real reason for cravings is that your body is not getting the nutrients it needs.

Here are some factors that may contribute to this situation:

• Scientists are trying to create processed food that taste as if they are packed with nutrients - even though they are not. So when indulging in these "Frankenfoods" your taste buds signal to the brain that nutrients are coming...but once they arrive in your digestive system there is actually nothing there other then sugar and bad fats. 

• You may have impared digestion, which means your body cannot digest protein and/or fat very well.  This means your body wont get all the minerals and vitamins out of the food either.

• You may be electrolyte deficient (to check, if that is the case, please see my courses on bio-individuality and digestion). This means that the balance of minerals between your blood stream and cells is not as it should be. Maybe you aren't getting enough mierals because your digestion does not work well, or perhaps you are peeing out all the minerals.

• Your body might be too effective at burning those carbs and not effective at using proteins and fats. This leaves you feeling hungry very quickly even after meals.

The stomach - our first defense

We are constantly exposed to our external environment: From the food we ingest, the microbes that we touch with our hands, from our skin that is covered with billions of bacteria, the bacteria and viruses we inhale, the ones that come from our pets....many microbes go in and out - but others stay to live with us.

In order for any bacteria to stay with us, they first have to survive the acid in our stomach. This is the first defense of our digestive system and it insures that not too many bacteria enter our small intestine. This is why it is so important to keep our stomach acid enough, which means a PH between 1 & 2. 

What causes Reflux

One of the reasons for having acid reflux is, that the sphinster which connects the esophagus to the stomach relaxes. It actually needs the stomach acid to be low enough so it can close correctly. If the stomach PH increases (becomes less acid), the sphinster relaxes, the valve stays half open and you get reflux.

If there is not enough stomach acid a series of conditions happen that cause more pressure inside the abdomen and that in turn pushes up and opens the valve at the entrance of the stomach. If on top of that a little stomach acid touches the esophagus it starts to hurt and burn as this part of our digestive system does not have any protection against HCL (stomach acid). This is why you feel relief, if you then take an antacid (like Omeprazole) medication. But this will not solve the problem...what is worse, if you take antacids too frequently it can worsen the situation.

Unfortunately most of the time acid reflux is interpreted as having too much stomach acid, which is why some of the most sold and used over the counter medications are proton pump inhibitors (like Omeprazole) that block acid production of the stomach. The symptom, like burning and pain will go away with this for a short while, but the underlying cause remains untreated. In reality these kind of medications are meant to treat too hyperacidity of the stomach, but most commonly reflux is caused by too little stomach acid. So taking acid inhibitors for a longer period of time will result in problems. This is why you should first seek the help of a doctor or nutritionist to find out if your stomach is actually too acid or if lack of acid is causing your reflux. 

Here are the signs, that your stomach is not acid enough:

• Constipation

• burping after eating

• slow digestion

• feeling very full after eating

• nausea

• gases, inflammation, burning in the stomach that gets worse throughout the day

• feeling better between meals when no food was ingested

Here are the consequences if your stomach does not produce sufficient acid:

• Reflux

• Bacterial overgrowth in the small intestine (SIBO), fungal infections or parasites

• intestinal permeability

• growth of Helicobacter Pylori which thrives in a lower acid environment

• Reduction of the intrinsic factor which helps us absorb Vitamin B12 (causing a deficit of Vitamin B12) 

• Bad absorption of some supplements and medications that need high acid to be dissolved.

• chronic fatigue

• headaches

• IBS

• skin issues (acne)

• decreased immune system function

• decrease neurotransmitter synthesis

• hair loss

• inflammation in the joints

The Ketogenic Diet is everywhere and I am sure you have already heard about it. Many people are achieving great success on the Keto Diet especially when it comes to weight loss. First of all I want to make clear, that pretty much any diet has the potential to cause imbalances and problems in your body in the long run. A high carb diet has the potential to cause insulin resistance, but not for everyone. So there are also people out there, for whom the Ketogenic Diet can cause a whole lot of trouble!

We can group those people, who should stay away from the Keto Diet into three main groups:

1. Persons with any kind of digestive symptoms/problems.

If you suffer from burping, bloating, constipation, reflux, diarrhea, skin or acne issues, you will probably not do good with the Keto Diet until you fix those issues first. The reason is the following: if your digestion does not work properly,  you may not have enough stomach acid to break down protein or you do not produce enough bile and enzymes to break down fats, or maybe both....guess what the Keto Diet mostly consists of...yes, proteins and fats! So fi you digestion cannot break down proteins and fats correctly not only can it not use those for fuel and nutrition, they may also become a problem once they move on half digested through the intestine.

2. Persons with low mineral levels

The Keto Diet allows insulin levels in the body to go real low, this is why it works so great for people with pre-diabetes and metabolic syndrome. But the very low insulin level also causes people to pee out more minerals. This can create some real issues of imbalance in the body and can lead to depression, anxiety, insomnia, cravings.

So for people with low ineral levels it would first be necessary to lift those minerals in the body, mostly through improving digestion.

3. Persons with an overly Alkaline blood stream

When your bloodstream is too alkaline, something called the bore effect kicks in. This means, when the blood is to alkaline, oxigen cannot leave the blood and go into the tissues where it m=needs to be for energy production. Here is where the problem comes in with the Ketogenic diet. The burning of carbs, which is much easier then burning fat and protein for fuel, helps the body to produce CO2. CO2 is acidic, so helps to acidify the bloodstream. So in people who lean towards being more alkaline, the carbs actually help them balance out their bloodstream. So, if you reduce the carbohydrates dramatically, the bloodstream will become even more alkaline and the result will be really low energy. First this imbalance should be corrected, before thinking about going on a Keto Diet.